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WALKING – THE KING OF EXERCISES
Take a two-mile walk every morning before breakfast. [Harry Truman -advice on how
to live to be 8O, on his 8Oth birthday]
Improved standard of living has come with a big “side effect”. The accessibility and
availability of vehicles, television, and deskwork have taken their toll! By their 5O’s
more than 4O per cent of males and 8O per cent of females are sedentary - they spend too
much time sitting. A sedentary lifestyle is now considered so bad for you that The
American Heart Association lists it as a major 'risk factor' on a par with high blood
cholesterol, high blood pressure and cigarette smoking for your heart.
In addition to improving cardiovascular health, walking helps with back pain, arthritis,
osteoporosis, varicose veins, reducing cholesterol, and other medical problems where
inactivity is a factor. Walking also improves the mood and helps bowel movement and
sleep.
Walking is one of the easiest and most profitable forms of exercise. All you need is a
good pair of shoes, comfortable clothing, and desire.
HOW TO START
It is easy! Just walk out the door. For most people this means head out the door, walk for
10 minutes, and walk back. Do this every day for a week. If this was easy for you, add
five minutes to your walks next week (total walking time 25 minutes). Keep adding 5
minutes
until
you
are
walking
as
long
as
desired.
WATCH your posture. Walk tall. Hold your head up and eyes forward. Your shoulders
should be down, back and relaxed. Walk with a natural stride.
Be sure to drink plenty of water before, during, and after walking.
Start your walk at a slow warm up pace, stop and do a few warm up stretches. Then walk
for the desired length of time. End your walk with the slower cool down pace and stretch
well. Stretching will make you feel great and assist in injury prevention.
HOW
MUCH
TO
WALK?
If you are walking for the general health benefits try to walk 30 minutes a day, most days
of the week, at a "talking" pace. (Talking pace means you have elevated breathing, but
you
can
still
carry
a
conversation.)
To improve cardiovascular fitness you should walk 3 to 4 days a week, 20 to 30 minutes
at a very fast pace. At this pace you are breathing hard but not gasping for air.
If you are walking for weight loss you should walk a minimum of five days a week, 45 to
60
minutes
at
a
brisk
pace.
Zero to Sixty in Twelve Weeks - An easy to follow schedule to get you walking 60
minutes in 12 weeks.
WHAT WALKING GEARS DO YOU NEED?
One of the easiest fitness activities is walking and a big reason it is so easy ... you don't
really
need
any
gear.
Below
are
a
few
items
to
consider.
Shoes - The most important item you need is a good pair of walking shoes. Shoes should
fit comfortably, have a flexible sole and plenty of toe room.
Socks - As important as what shoes to wear is your choice of socks. Be sure to wear the
socks you will walk in when trying on shoes. Cotton socks are preferable to synthetic
ones.
Clothing - Wear what is comfortable for you. On cold weather days, layer your clothing
so
items
can
be
removed
as
you
warm
up.
Water - Please be sure to drink plenty of water. If walking around the block drink some
water before you head out and more when you return. If walking for longer than 30
minutes take your water along. Be sure to drink every 20 minutes. There are many
convenient water carriers - from waist packs to shoulder carriers. Choose what works best
for
you.
Pedometer - A pedometer is a device that counts your steps and/or mileage. They must
be accurately adjusted to your stride length to get a good reading. They come with a
variety of features. Some will even calculate calorie expenditure. The most sophisticated
versions are the new GPS systems. These actually calculate speed and distance based on
satellite
readings!
Personal Stereo - A personal stereo / CD player can be a great walking companion.
Music can motivate you and energize your workout while helping to pass the time by
creating a distraction. Be sure to keep the volume at a low enough level so you can hear
what
is
going
on
around
you.
A Training Diary - A diary or fitness log is a great tool. Use it to write down your goals,
and keep track of your fitness program.
TREADMILL WALKING
Treadmill is an optional device for walking. Owning a treadmill makes sticking with
your walking routine easier. If time, personal safety, allergies, or weather conditions,
limit your outdoor walking a treadmill can be a great asset.
Now-a-days more and more people are investing in a treadmill. They come in different
varieties. Before buying one, take your time and compare different models. But most
important aspect is using it! An unused treadmill is a waste of money.
Come let us make a resolution on this day about our health – “START WALKING”
Diabetes Sick Day Guidelines
डाय्बेटीस (मधुमेह) – िबमार िदन के िनयम
Minor illness can alter your blood sugar and require some changes in your daily diabetes
routine. Your diabetes can become uncontrolled quickly when you are ill. By following a
few simple guidelines, you can minimize the effects of an illness on your diabetes.
छोटे – छोटे िबमारी आपके खून के शुगर के माप को बगल सकते हैं । इसीिलए आपको अपनी
खाने – पीने और रहन – सहन में थोड़ी बदली करनी है । थोडे उपायों से इस िबमारी के असार से बच
सकते हैं ।
Need for Insulin
During an illness, blood sugar levels tend to rise. As a result of this increase, your body
may require more insulin. Illness causes a greater than normal demand for insulin due to
the release of stress hormones. These hormones are triggered by such things as fever, loss
of body fluid (dehydration), and infection.
िबमारी के समय सुगर बढ जाता है िजस वजय से ज्यादा इन्सुिलन जरूरत पढता है । बुखार,
इन्फ़ेक्शन, आिद िबमािरयों के समय बदन में हारमोन उत्पन्न होते हैं जो शुगर को बढा दे ते हैं
Monitoring Your Blood Glucose during Illness
Frequent blood glucose monitoring is especially important during an illness. Blood
glucose should be monitored (preferably with a meter) every four hours. If your blood
sugar level exceeds 240mg/ml, it is important to test the urine for ketones. Testing for
ketones should also be done every twelve hours.
ऐसे समय शुगर का टे ःट बार-बार करना हैं – हर चार घंटे, मीटर सबसे अच्छा। आगर यह 240
mg/ml से ज्यादा हो तो पेशाप मे ‘कीटोन्स’ िदखना हैं । यह टे ःट हर 12 घन्टे करनी है ।
Eating Meals
Loss of appetite is common during illness. Nausea and vomiting may prevent you from
eating your usual meals. However, you need food and fluids to help you get better. Sip or
eat slowly, especially if you feel nauseous and if you are vomiting, do not eat for two
hours.
भूक नही लगता है , मतली या उल्टी की वजय से कुछ खाया नहीं जाता। लेिकन आपत्ती से बचने
के िलये कुछ खाना आवँयक है । थोडा-थोडा पीिजये व खाइये। अगर उल्टी होती है तो 2 घन्टे कुछ
न खाइये।
Fluids
Fluids are also important during an illness, especially if you are experiencing nausea and
vomiting. Repeated vomited can lead to dehydration (loss of body fluid) and loss of
important electrolytes such as sodium and potassium.
पानीय चीज पीना आवँयक है , खास तौर से तब जब आप को मतली या उल्टी हो रही हो। बार –
बार उल्टी होने से बदन सूख सा जाता है , और सोिडयम व पोटे िशयम नमक धल जाता है ।
Try to consume four to eight ounces of fluid every one to two hours. Fluids such as broth,
teas, Gatorade, water, cola or soda, orange juice, and soup will not only help with fluid
replacement, but also with sodium and potassium losses. You should not eat for two
hours after vomiting.
कम से कम ¼ लीटर पानीय पदाथर् हर एक या दो घन्टे भर मे पीना चािहये। सूप, शोरबे, चाय,
कोला, सोडा, नारन्जी रस, आिद आप के बदन से खोए नमक व पानी की कमी को भर दे ता है ।
उल्टी के बाद दो घंटों तक कुछ नही खाना चािहए।
If you take your routine dose of insulin and you are not eating or taking fluids, there is a
danger of hypoglycemia (low blood sugar).
अगर आप इन्सुिलन ले कर कुछ खा-पीयेन्गे नही तो शुगर बहुत कम हो जाने का खतरा है
(hypoglycemia)।
Sick Day Rules:
िबमार िदन िनयम:
1. Always take your usual daily dose of insulin or diabetes medication. िनयमानुसार
इन्सुिलन अथवा गोली जरूर लीिजये। Never omit your medicines, even if you are unable to
eat. कभी भी दवाइयाँ बन्द मत करना। Illness may even be a time when you need additional
insulin or to change to a different schedule. िबमारी पढने और ज्यादा या समय बम को
बदलना पडे गा।
2. Test your blood sugar every four hours or as directed by your physician. शुगर हर चार
घन्टे या डाक्टर के सलहानुसार मािपये। If your blood sugar is 240mg/ml or greater, you
should also check your urine for ketones and notify your physician if ketones are present
in your urine. अगर 240 से ज्यादा हो तो पेशाप मे कीटोन चेक किरये। Keep a record of your
results to report to your physician. इन नम्बर को आपके डायरी मे िलख कीिजये।
3. Weigh yourself frequently during an illness. This can help your physician estimate any
fluid loss you may be experiencing. आपका वजन बार – बार मािपये, इससे आपके बदन से
खोये पानी का अन्दाजा लगाया जा सकता है ।
4. Drink four to eight ounces of fluid (e.g., beverages containing sugar, water, broth, teas)
every two hours. Keep a record of total fluid intake that you can report to your physician.
½ पाव से पाव भर पानीय – शबर्त, पानी, शोरबा, चाय जैसे, (िजस मे शक्कर हो), पीिजये। िकतना
पीते हैं उसको िलखकर रखें तािक पूछने पर अपने डकटर को बता सकेगें।
5. If you are unable to eat regular meals, try to consume liquid or soft foods that equal 15
grams of carbohydrate every hour or 50 grams every three to four hours. अगर आप खा न
पय तो कम से कम हर घंटे कुछ पी जरूर लें िजसमे 15 माम काबोर्हैसेट हो या िफ़र 50 माम 3 या
चार घंटे में जरूर लें।
6. Rest and stay warm. Do not exercise. Have someone available to help you take care of
yourself. आराम कीिजये। ज्यादा पिरौम न करें । अपनी दे खबाल के िलये िकसी िक मदद या
सहायता लीिजये।
7. If you should be alone during an illness, contact a neighbor, friend, or relative who will
check on you several times a day. अगर आप आकेले रहते हैं तो िबमारी होने पर आस – पास
अडोस – पडोस, या कोई दोःत या िरष्टेद
् ार से पूछे िक वह आप पर नजर रखे और आ कर िदन मे
बीच – बीच में हालत दे ख जाये।।
8. Check with your doctor to determine at what blood sugar level he/she wants to be
notified. Usually a blood sugar greater than 320 or 2+ ketones. आप के डाक्टर से पहले ही
पता कर लें शुगर के िकस हद पर उनको बताएं। (आम तौर से 320 या कीटोन 2+ से ज्यादा)।
KEEP NAME AND TELEPHONE NUMBER OF PHYSICIAN HANDY.
9. In any illness preventing you from eating anything at all (Nausea/Vomiting) for more
than six hours, you should check your blood sugar every four to six hours and adjust with
sliding scale of regular insulin and cut down long-acting insulin to half the daily insulin
dose, per physician recommendation.
10. Call your doctor if:
a) Fever persists
b) Vomiting and/or diarrhea is severe
c) Illness persists beyond one to two days
11. Once the illness has passed, gradually return to your regular diabetic meal plan.
Sick Day Foods and Drinks
If you are unable to eat regular meals, try to consume liquid or soft foods that equal 15
grams of carbohydrate every hour or 50 grams every three to four hours. The following is
a list of sample foods suitable for a sick day.
Fluids containing 10-27 grams of carbohydrate:
1 cup soup (1 cup Chunky Chicken Noodle ready-to-serve has 27 grams CHO
OR 1 cup Tomato with milk=22 grams CHO
OR 1 cup Tomato with water=17 grams CHO
OR 1 cup Potato with water=17 grams CHO
OR 1 cup Chicken Rice with water=7 grams CHO
1 cup Gatorade
1 cup Milk
half cup Fruit Juice
half cup Soft Drink (not sugar free)
Foods containing 10-15 grams of carbohydrate:
half cup Gelatin (not sugar free
5 to 7 Saltine Crackers
10 to 11 Wheat Thins or 5 Ritz Crackers
half cup Cooked Cereal (Oatmeal) or half Single-Serve Packet of Instant Oatmeal
3 Graham Crackers
6 Vanilla Wafers
half cup Custard
1 Popsicle
quarter cup Sherbet
half cup Applesauce
half cup Ice Cream
half cup Sugar-Free Pudding
half cup Mashed Potatoes
HYPOGLYCEMIA: Urgent Treatment
Oral treatment with glucose tablets or glucose-containing fluids, candy, or food is
appropriate if the patient is able and willing to take these. A reasonable initial dose is 20
g of glucose. If the patient is unable or unwilling, because of neuroglycopenia, to take
carbohydrates orally, parenteral therapy is necessary. Intravenous glucose (25 g) should
be given and followed by a glucose infusion guided by serial plasma glucose
measurements. If intravenous therapy is not practical, subcutaneous or intramuscular
glucagon (1.0 mg in adults) can be used, particularly in patients with T1DM. Because it
acts by stimulating glycogenolysis, glucagon is ineffective in glycogen-depleted
individuals (e.g., those with alcohol-induced hypoglycemia). It also stimulates insulin
secretion and is therefore less useful in T2DM. These treatments raise plasma glucose
concentrations only transiently, and patients should therefore be urged to eat as soon as is
practical to replete glycogen stores.
ABOUT DIABETES
Type 1 (insulin-dependent or juvenile diabetes) can occur at any age, but most commonly
is diagnosed from infancy to the late 30s. In this type of diabetes, a person's pancreas
produces little or no insulin. Although the causes are not entirely known, scientists
believe the body's own defense system (the immune system) attacks and destroys the
insulin-producing cells in the pancreas. People with type 1 diabetes must inject insulin
several times every day.
Type 2 (non-insulin-dependent or adult-onset usually develops after age 40, but can
appear earlier, and has more recently begun to appear with more frequency in children.
In this form of diabetes the pancreas still produces insulin, but the body does not produce
enough or is not able to use it effectively. Treatment includes diet control, exercise, selfmonitoring of blood glucose and, in some cases, oral drugs or insulin.
Type 1 and 2 diabetes are polygenic diseases, meaning the risk of developing these forms
of diabetes is related to multiple genes. But some rare forms of diabetes result from
mutations in a single gene and are called monogenic; they are sometimes mistaken for
type 1.
Gestational Diabetes
About 2 to 5 percent of pregnant women develop high blood sugar during pregnancy.
Although this type of diabetes usually disappears after the birth of the baby, women who
have had gestational diabetes are at high risk of developing type 2 diabetes later in life.
Dr G Maruthi Ramana
Sr CMO (SAG), CGHS
Bangalore
SYMPTOMS OF DIABETES
The symptoms may occur suddenly, and include one or more of the following:
Extreme thirst
Frequent urination
Drowsiness, lethargy
Sugar in urine
Sudden vision changes
Increased appetite
Sudden weight loss
Fruity, sweet, or wine-like odor on breath
Heavy, labored breathing
Stupor, unconsciousness
If you think you have diabetes, call a doctor immediately, and drink fluids
WITHOUT SUGAR to prevent dehydration.
In a person who has type 1 diabetes, the insulin-producing beta cells in the pancreas are
destroyed by immune cells. However, right after the time of diagnosis, some patients go
through a "honeymoon phase" in which their existing beta cells still function. A number
of research projects are currently taking place which hope to preserve the function of
these existing beta cells after the honeymoon phase in people with type 1 diabetes.
Ninety percent of children who develop type 1 diabetes actually have no relative with the
disease. Thanks to studies of families, researchers now can identify at birth when a baby
carries some of the genes that indicate risk factors for type 1 diabetes. Certain genes
called HLA markers are associated with diabetes risk. If a child is born with such
markers, his or her risk of developing type 1 diabetes is about the same as if he or she had
a sibling with type 1 diabetes, even though no other family member may have the
disease. There are other genes that also create risk for juvenile diabetes that have not yet
been identified.
Although the causes of type 1 diabetes are not entirely known scientists believe the
body's own immune system attacks and destroys insulin-producing cells in the pancreas.
It is not caused by obesity or by eating excessive sugar, which are two common
myths about type 1. Both genetics and environmental "triggers" are being studied as
potential causes of type 1 diabetes.
At most, only 15 percent of people with type 1 diabetes have an affected first-degree
relative - a sibling, parent, or offspring. Research suggests that genes account for less
than half the risk of developing type 1 diabetes. These findings suggest that there are
other factors besides genes that influence the development of diabetes.
At this point, type 1 diabetes is a chronic disease, meaning you never outgrow it.
Life expectancy is very difficult to predict -- just as each child is unique so will be their
experiences with type 1 diabetes. On average, the current life expectancy of a child with
type 1 diabetes is shortened by 7-10 years, but this number has been trending down in
Dr G Maruthi Ramana
Sr CMO (SAG), CGHS
Bangalore
recent years with advances in technology and treatment options. The best thing you can
do is listen and learn from the experiences of others while also responding to your child's
individual needs -- avoid blaming yourself or your child when things don't go smoothly.
The reality is that type 1 diabetes is a difficult disease to manage, but we have come a
long way and the technology is getting better all the time. Take advantage of the people,
products, and other resources available to you.
DAILY LIFE AND MANAGEMENT
The optimal blood sugar range:
You should check with your doctor to determine the range of blood sugar levels best for
you. In general, optimal blood sugar goals are:
Before Meals: 70-110 mg/dl
At Bedtime: 100-140 mg/dl
If your before-meals blood sugar is consistently lower than 70 mg/dl or higher than 140
mg/dl, or your bedtime blood sugar is consistently lower than 100 mg/dl or higher than
160 mg/dl, you probably need a change in your treatment plan and should consult your
doctor. Blood sugar goals may be modified for children and others who are at greater risk
for hypoglycemia.
Foods should a person with type 1 diabetes eat/avoid
You'll be pleased to learn how many different foods can be included in the diet of a
person with type 1 diabetes. Once you get into the habit of eating less fat and smaller
portions of a variety of nutritious foods, you and your entire family will benefit. Fat
restriction is very important for those with type 1 diabetes because high cholesterol and
diabetes are two of the four risk factors for developing heart disease.
Some tips:
o Don't fry foods - bake, broil, poach, or sauté in non-stick pans.
o Steam or microwave vegetables.
o Make ice cream, butter, and whole milk cheese an occasional treat.
o Eat less high-fat red meat and more low-fat turkey, fish, and chicken with the
skin removed before cooking.
o Avoid refined sugar, or at least limit its use. (Several kinds of artificial
sweeteners are available, but all are a very costly alternatives.
o Restrict salt (sodium), which can raise blood pressure. This is particularly
important for people with type 1 diabetes - as is anything that threatens the
circulatory system.
o Replace diets high in animal protein with meals high in complex
carbohydrates, which are starches found in breads, cereals, starchy vegetables,
legumes, rice, and pastas.
o Choose whole-grain cereals, breads, and other products such as brown rice,
kasha, bulgur, and barley.
Dr G Maruthi Ramana
Sr CMO (SAG), CGHS
Bangalore
o Eat fresh vegetables and fruits, unpeeled. Avoid overcooking vegetables.
Type 1 diabetes in school presents a host of challenging issues for children with juvenile
diabetes, and it's important to know how to manage your diabetes. If you need financial
assistance for type 1 diabetes supplies and/or healthcare. There are pharmaceutical
assistance programs offered directly by some drug companies for people with type 1
diabetes who have little or no insurance to help offset the cost of supplies or prescription
medications.
Sick-Day Guidelines for People With Diabetes
What happens when you are sick:
o When you are sick, your body reacts by releasing hormones to fight
infection. But these hormones raise blood sugar levels and at the same
time make it more difficult for insulin to lower blood sugar.
o When you have diabetes, even a minor illness can lead to dangerously
high blood sugar.
o This may cause life-threatening complications, such as diabetic
ketoacidosis or a hyperosmolar state.
Steps to take during an illness:
1.
Continue taking your insulin (or pills for diabetes - if you have type 2 diabetes),
even if you are vomiting and having trouble eating or drinking. Your blood sugar may
continue to rise because of your illness. If you cannot take your medicines, call your
doctor and discuss whether you need to adjust your insulin dose or other medicine.
Try to eat your normal types and amounts of food and to drink extra fluids, such as water,
broth, carbonated drinks, and fruit juice. Encourage your child to drink extra liquids to
prevent dehydration.
2.
If your blood sugar level is higher than 240 milligrams per deciliter (mg/dL),
drink extra liquids that do not contain sugar, such as water or sugar-free cola.
3.
If you cannot eat the foods in your regular diet, drink extra liquids that contain
sugar and salt, such as soup, sports drinks, or milk. You may also try eating foods that are
gentle on the stomach, such as rusks or biscuits (without cream).
4.
Try to eat or drink 50 grams (g) of carbohydrate every 3 to 4 hours.
For example, 6 saltine crackers, 1 cup of milk, and ½ cup of orange juice each contain
approximately 15 g of carbohydrate.
5.
Check your blood sugar at least every 3 to 4 hours, or more often if it is rising
quickly, even through the night.
• If your blood sugar level rises above 240 mg/dL and your doctor has told
you to take an extra insulin dose for high blood sugar levels, take the
appropriate amount.
• If you take insulin and your doctor has not told you to take a specific
amount of additional insulin, call him or her for advice.
6.
If you take insulin, do a urine test for ketones every 6 to 12 hours,
especially if your blood sugar is higher than 300 mg/dL. Call your doctor
Dr G Maruthi Ramana
Sr CMO (SAG), CGHS
Bangalore
if you have more than 2+ or moderate ketones in your urine. Check your
child's urine for ketones at least every 6 hours, even through the night.
• Weigh yourself and check your temperature, breathing rate, and pulse
frequently if your blood sugar is higher than 300 mg/dL. If you are losing
weight and your temperature, breathing rate, and pulse are increasing,
contact a doctor. You may be getting worse.
Don't take any medicines without talking with your doctor. Many nonprescription
medicines affect your blood sugar level.
When to call your doctor
Minor illnesses in people with diabetes—especially children with type 1 diabetes—can
lead to very high blood sugar levels and possible emergencies. When children are sick,
watch them closely for signs that they need immediate medical attention. Call 108 or
other emergency services if you or your child has:
•
•
•
Symptoms of diabetic ketoacidosis (DKA), such as abdominal pain, vomiting,
rapid breathing, fruity-smelling breath, or severe drowsiness.
Symptoms of dehydration, such as a dry mouth and very yellow or dark urine.
Dehydration is particularly dangerous in children and may be caused by vomiting
and diarrhea.
A low blood sugar level that continues.
It may not be necessary to call your doctor every time you or your child with diabetes has
a mild illness, such as a cold. But it is a good idea to call for advice when you are sick
and:
•
•
•
•
•
•
Your blood sugar level is higher than 240 mg/dL after taking the adjusted amount
of insulin in your sick-day plan.
You take oral diabetes medicine and your blood sugar level is higher than 240
mg/dL before meals and stays high for more than 24 hours.
You have more than 2+ or moderate ketones in your urine.
You still have a fever and are not feeling better after a few days.
You are vomiting or having diarrhea for more than 6 hours.
When you are sick, write down the medicine(s) you have been taking and whether
you have changed the dosage of your diabetes medicines based on your sick-day
plan. Also note changes in your body temperature, weight, blood sugar, and urine
ketone levels. Have this information handy when you talk to your doctor.
JDRF (Juvenile Diabetes Research Foundation) guidelines,
Olin Medical Center, Texas guidelines
Joslin Medical center guidelines
Dr G Maruthi Ramana
Sr CMO (SAG), CGHS
Bangalore
These general guidelines will most likely need to be adjusted depending on the child and
the nature and severity of the illness.
•
•
Monitor blood sugar levels more frequently
When you are under stress from illness or injury, your body releases hormones,
which can cause blood sugar levels to skyrocket. Loss of appetite, nausea, and
vomiting, on the other hand, may result in extremely low blood sugar levels.
Since you can't be sure how an illness will affect your child's blood sugars, it is
important to check them often. How often target depends on the child and the
seriousness of the illness, but a general is at least every 2-3 hours.
•
•
Don't stop taking insulin
People with type 1 diabetes should never completely stop taking their insulin,
even when they're not eating anything. Insulin is necessary to maintain normal
metabolism, and without it, the body starts to burn fat, which can lead to diabetic
ketoacidosis (DKA). Therefore, even if your child is vomiting or unable to eat, he
will still need to take insulin. To determine the proper dosage, use blood sugar
numbers to guide you, or call your doctor for help.
•
Check urine for ketones
o This is very important for people with juvenile diabetes.
o The presence of ketones in the urine, regardless of blood sugar level,
shows that the body is in serious need of insulin.
o This could become a life-threatening situation if not corrected.
o If you find ketones in the urine, give your child additional insulin and lots
of fluids.
o If the ketones don't clear up in a few hours, call your doctor.
Be careful with over-the-counter medicines. Over-the-counter remedies for colds,
allergies, upset stomachs, etc., may contain ingredients that raise or lower blood sugars,
or that imitate the symptoms of high or low blood sugar.
Have a plan and don't hesitate to ask for help
• Ideally, you and your doctor should come up with a strategy for managing sick
days before your child ever gets sick. Put it in writing, and then make
adjustments as you gain experience with sick days.
• Discuss the possibility of using smaller, more frequent doses of short-acting
insulin to better avoid high blood sugars. For low blood sugars brought on by
vomiting or loss of appetite, you'll need to replace carbohydrates, perhaps with
liquids or soft foods.
•
Call your doctor if: your child has a fever or illness that lasts longer than two
days, or vomiting or diarrhea that lasts more than eight hours;
Dr G Maruthi Ramana
Sr CMO (SAG), CGHS
Bangalore
•
your child's blood sugar is higher than about 250-300 mg/dl and you can't bring it
down; you find ketones in the urine and they don't go away within a few hours;
•
your child can't keep any food or liquid down; or any time that you just feel
uncomfortable or confused about what to do.
•
be sure to keep accurate records of blood glucose readings, ketones, medication,
fever, and all symptoms.
Remember that the care of diabetes is a group effort involving you, your doctor, and
other members of your diabetes care team. These tips should not replace or supersede
this team effort.
Guidelines for Sick Days
"Sick" refers to anytime that you have a cold, the flu, an infection, feel nauseous, are
vomiting, having surgery, or an injury. When a person with diabetes gets sick, the blood
glucose will often be higher than usual, even if you are eating less food. This is because
insulin is often less effective during illness. Also, keep in mind that during illness the
liver is still releasing glucose even when one cannot eat, so insulin is still needed. The
following steps should be taken to keep blood glucose under control and prevent more
serious problems. Be sure to ask your healthcare provider about these guidelines and any
special recommendations they have for you.
1. Take your diabetes medication. Always take your usual diabetes medication, unless
your healthcare provider instructs you differently. Even if you cannot eat your usual
meals, you need to take your medication. In some cases, additional medication is
required. Check with your healthcare provider or diabetes educator.
2. Check blood glucose and ketones.
Check your blood glucose every 3 to 4 hours all day and all night. Have someone do it
for you if you are too sick to do it yourself.
If you take insulin, check for ketones if your blood glucose is 250 or higher, unless
otherwise instructed by your healthcare team.
Write the results of your blood glucose and ketone checks down and have them ready if
you need to call your healthcare provider.
3. Drink plenty of fluids — about 6 to 8 ounces every hour you are awake.
If you are able to eat your meals, drink fluids that are sugar-free and caffeine-free, such
as: water, decaffeinated tea, broth, etc.
If you are unable to eat, alternate sugar-free fluids one hour with fluids containing sugar
the next hour. Examples of fluids containing sugar include: 7-Up or Sprite (6 ounces),
apple juice (4 ounces), Gatorade (4 ounces), regular gelatin (1/2 cup). Liquids with salt in
them, such as bouillon or clear soup, are also important to include.
4. Rest. Stay warm. Ask someone to help take care of you.
Dr G Maruthi Ramana
Sr CMO (SAG), CGHS
Bangalore
5. Call your healthcare provider for any of the following reasons:
Vomiting or diarrhea for more than 2 hours.
If you have a fever.
Blood glucose values that remain above 250 for at least two blood glucose checks or that
do not decrease with extra insulin. Do this whether you have ketones or not.
If you have moderate or large ketones.
If you have stomach pains that won't go away.
If you have questions or concerns.
There are many misconceptions that people with diabetes must follow a strict diet, when
in reality they can eat anything a person without diabetes eats. Some common food
myths for people with diabetes.
1. People with diabetes have to eat different foods from the rest of the family.
• People with diabetes can eat the same foods as the rest of their family.
• Current nutrition guidelines for diabetes are very flexible and offer many
choices, allowing people with diabetes to fit in favorite or special-occasion
foods.
• Everyone, whether they have diabetes or not, should eat a healthful diet that
consists of fruits, vegetables, whole grains, lean protein foods, and hearthealthy fats.
• So, if you have diabetes, there's no need to cook separately from your
family.
2. People with diabetes should never give in to food cravings.
• Almost everyone has food cravings at some point, and people with diabetes
are no exception.
• It's not uncommon for people with diabetes to cut out all sweets or even cut
way back on food portions in order to lose weight.
• In turn, your body often responds to these drastic changes by creating
cravings.
• Nine times out of ten, your food choices in these situations tend to be high in
fat and/or sugar, too.
• The best way to deal with food cravings is to try to prevent them by following
a healthy eating plan that lets you occasionally fit sweets into your diabetes
meal plan.
• If a craving does occur, let yourself have a small taste of whatever it is you
want. By doing so, you can enjoy the flavor and avoid overeating later on.
3. People with diabetes shouldn't eat too many starchy foods, even if they contain
fiber, because starch raises your blood glucose and makes you gain weight.
• Starchy foods, such as bread, pasta, rice and cereal, provide carbohydrate, the
body's energy source.
Dr G Maruthi Ramana
Sr CMO (SAG), CGHS
Bangalore
•
•
•
•
Fruit, milk, yogurt and desserts contain carbohydrate as well. Everyone needs
some carbohydrate in their diet, even people with diabetes.
Weight gain occurs when you take in more calories than you burn off. So, if you
eat too much of any food, you'll end up gaining weight.
The key is knowing how much of all the good food groups to eat to help keep
blood glucose levels in a safe range and keep you at a healthy weight.
Choose starchy foods that are whole grain and high in fiber for overall good
nutrition.
4. People with diabetes do not have to worry about eating fat because it doesn't
have much of an effect on blood glucose.
• Fat, found in margarine, oils and salad dressings, has little immediate effect on
blood glucose levels.
• However, eating a fatty meal can slow down digestion and make it harder for your
insulin to work, causing a possible high blood glucose level hours after your meal.
• Some fats can raise blood cholesterol, increasing your risk for heart attack or
stroke. These fats are called saturated fat and trans fat and should be limited as
much as possible.
• Sources of saturated fat include: butter, shortening, red meat, cheese and whole
milk. Trans fat is found in some margarines, snack foods and fast foods.
• Also, fat is very high in calories and should be limited if you're trying to lose
weight.
5. People with diabetes should always follow a low-sodium diet.
• Having diabetes doesn't mean you have to cut salt and sodium from your diet.
• However, people with diabetes should cut back on their sodium intake since they
are more likely to have high blood pressure, a leading cause of heart disease, than
people without diabetes.
• Some examples of high sodium foods include
o canned soup
o canned vegetables
o cold cuts
o salad dressings
o some cereals
• Even if you don't have high blood pressure, it's not a bad idea to watch your
sodium intake, since some people are "salt sensitive" and may experience an
increase in blood pressure after eating salty foods.
(Joslin Diabetes Center)
Servings
per Day
Food Group
Contains
Examples
Breads, grains, other
starches
(15 g carb)*
carbs (starch, sugar, fiber), B bread, pasta, cereal,
vitamins, minerals
beans, peas, corn
5-8
Dr G Maruthi Ramana
Sr CMO (SAG), CGHS
Bangalore
Vegetables
(1/2 cooked or 1 cup raw
servings)
Fruits
(3-4 oz portions; 15 g
carbs per serving)
Milk
(8 oz servings)
Meat, meat substitutes,
other protein
(1 oz serving)
Fats, oils, sweets
(5 g fat per serving)
vitamins and minerals,
minimal amount of carbs
broccoli, spinach,
tomatoes, salad greens
carbs (sugar, fiber, starch),
vitamins and minerals
apples, oranges, peaches,
2-4
pears, melons
carbs (milk sugar), calcium,
minerals, vitamin D, protein
protein, Iron, vitamins,
minerals
milk, soy milk, yogurt, ice
2-3
cream
beef, poultry, pork, fish,
8 - 12
cheese, tofu
ounces
saturated fat, unsaturated fat
butter, vegetable oils, sour use
cream, cream cheese
sparingly
3-5
*should be spread evenly throughout the day at 30-75 g per meal
Festivals and social gatherings can be challenging for people with diabetes who are trying
to manage blood glucose levels and weight. Many traditional Festivals and social
gathering foods are high in fat as well as carbohydrates, but with careful planning, you
can make healthy choices that fit into your diabetes meal plan and enjoy this wonderful
celebration with friends and family, (Joslin Diabetes Center).
The Festivals and Social gatherings’ Food Choices:
o Start the day off with a good breakfast so you won’t be tempted to overeat.
o Nibble on raw vegetables with low-fat dips before dinner rather than salted nuts
or cheese and crackers.
o Choose white rather than dark turkey meat, without the skin.
o Make mashed potatoes with low-fat milk and margarine instead of butter, and
take it easy with the gravy. Skim the fat off the top of the gravy before serving.
o Steam vegetables like peas and green beans rather serving them in a casserole
with creamed sauces.
o Have dessert with everyone else, but choose a dessert you’ve made with an
artificial sweetener. Top it with low-fat whipped cream.
Family Support: - It is unquestionably hard to stick to your diabetes meal plan on
Festivals and social gatherings, when you see all of the food and everyone else is
overindulging. It's also difficult if you have “food police” in your family who try to tell
you what you can or can’t eat, or have someone who wants to load more food on your
plate, saying “it’s only once a year.”
Dr G Maruthi Ramana
Sr CMO (SAG), CGHS
Bangalore
Let your family members know they can support you by walking around the block with
you after dinner, Make your day about togetherness and family fun, and not just about the
food.
http://www.joslin.org/managing_your_diabetes_653.asp
Dr G Maruthi Ramana
Sr CMO (SAG), CGHS
Bangalore