Support and Ongoing Care
Diabetes Support Services
The Norton Diabetes Center and the Endocrinology Service at Kosair Children's Hospital offer education and support services, including:
- Diabetes clinician available for in-patient education
- Home health program for diabetes education
- Hot Shot's diabetes support group
Norton Diabetes Center
For more information on the Norton Diabetes Center, call (502) 629-2604.
Kosair Children's Hospital
For more information on the Endocrinology Service at Kosair Children's Hospital, call (502) 629-2094.
Self-Care for Diabetes
Basic diabetes management skills will help prevent the need for emergency care. These skills include:
- How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
- What to eat and when
- How to take insulin or oral medication
- How to test and record blood glucose
- How to test urine for ketones (type 1 diabetes only)
- How to adjust insulin or food intake when changing exercise and eating habits
- How to handle sick days
- Where to buy diabetes supplies and how to store them
After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. People with diabetes need to review and update their knowledge, because new research and improved ways to treat diabetes are constantly being developed.
Self-Testing for Diabetes
If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes and can help your doctor prevent complications.
The American Diabetes Association recommends that premeal blood sugar levels fall in the range of 80 to 120 mg/dL and bedtime blood levels fall in the range of 100 to 140 mg/dL. Your doctor may adjust this depending on your circumstances.
Eating with Diabetes
You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can be very helpful in planning dietary needs.
Type 1 Diabetes
People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugars from becoming extremely high or low.
Type 2 Diabetes
Persons with type 2 diabetes should follow a well-balanced and low-fat diet.
Taking Medication for Diabetes
Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.
Type 1 Diabetes
Persons with type 1 diabetes cannot make their own insulin, so daily insulin injections are needed. Insulin does not come in pill form. Injections are generally needed one to four times per day. Some people use an insulin pump, which is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use a new type of inhaled insulin.
Insulin preparations differ in how quickly they start to work and how long they remain active. Sometimes different types of insulin are mixed together in a single injection. The types of insulin to use, the doses needed, and the number of daily injections are chosen by a health care professional trained to provide diabetes care.
People who need insulin are taught to give themselves injections by their health care providers or diabetes educators.
Type 2 Diabetes
Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes. They fall into one of three groups:
- Medications called oral sulfonylureas that increase insulin production by the pancreas.
- Medications called thiazolidinediones that help increase the cell's sensitivity (responsiveness) to insulin.
- Medications that delay absorption of glucose from the gut. These include acarbose and miglitol.
There are some injectable medicines used to lower blood sugar. They include exenatide and pramlintide.
Most persons with type 2 diabetes will need more than one medication for good blood sugar control within 3 years of starting their first medication. Different groups of medications may be combined or used with insulin.
Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity, because when their ideal weight is reached, their own insulin and a careful diet can control their blood glucose levels.
It is unknown if hypoglycemic medicines taken by mouth are safe for use in pregnancy. Women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy and while breastfeeding.
Gestational diabetes is treated with insulin and changes in diet.
Exercise for Diabetes
Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than diabetics who do not exercise regularly. You should be evaluated by your physician before starting an exercise program.
Here are some exercise considerations:
- Choose an enjoyable physical activity that is appropriate for your current fitness level.
- Exercise every day, and at the same time of day, if possible.
- Monitor blood glucose levels before and after exercise.
- Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
- Carry a diabetes identification card and a mobile phone or change for a payphone in case of emergency.
- Drink extra fluids that do not contain sugar before, during, and after exercise.
Changes in exercise intensity or duration may need changes in diet or medication dose to keep blood sugar levels from going too high or low.
Foot Care for Diabetes
People with diabetes are prone to foot problems because of the likelihood of damage to blood vessels and nerves and a decreased ability to fight infection. Problems with blood flow and damage to nerves may cause an injury to the foot to go unnoticed until infection develops. Death of skin and other tissue can occur.
If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.
To prevent injury to the feet, people with diabetes should adopt a daily routine of checking and caring for the feet as follows:
- Check your feet every day, and report sores or changes and signs of infection.
- Wash your feet every day with lukewarm water and mild soap, and dry them thoroughly.
- Soften dry skin with lotion or petroleum jelly.
- Protect feet with comfortable, well-fitting shoes.
- Exercise daily to promote good circulation.
- See a podiatrist for foot problems or to have corns or calluses removed.
- Remove shoes and socks during a visit to your health care provider and remind him or her to examine your feet.
- Stop smoking, which hinders blood flow to the feet.
For more information, to schedule an appointment for a diabetes class or to see a dietitian, call (502) 629-2604.