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Depending on the meal plan you have discussed with your healthcare team, the table below gives you an estimate of the number ofgrams of carbohydrates, or carb servings, you can include each day.Basic Carb CountingAdvanced Carb Counting1000 Calories40% carbohydrates50% carbohydrates6 servings8 servings90 grams120 grams1200 Calories40% carbohydrates50% carbohydrates8 servings9 servings120 grams135 grams1500 Calories40% carbohydrates50% carbohydrates9 servings11 servings135 grams165 grams1800 Calories40% carbohydrates50% carbohydrates11 servings14 servings165 grams310 gramsOf course, these should bedivided into meals and snacksthroughout the day. This willgive nutritional energy to thecells in portions that shouldkeep blood sugar levels in thetarget range. How will youknow if the amount of carbohydrate was appropriate? Test yourblood sugar before the meal, andthen two hours after the meal.This will give you a good idea ofhow well you did. Keep a log ofthe information you are gatheringso you can refer to it in the future.Pretty soon you will have a clearunderstanding of what foods areokay for you, and which foods raiseyour blood sugar above your target.What will you do if you find that one or more of yourfavorite foods makes your blood sugar rise too high? Is itreasonable to say that you will never eat that food again?Of course not. You may choose to have a smallerportion of the food, or have it less often. Thesedecisions, based on information you are gathering,will really put you in charge of your diabetes. Also,remember that protein and fat are not includedin carbohydrate counting. But, if you are trying tolose weight, you will need to limit the portions ofprotein and fat that you eat. We have become so usedto “super-sizing” portions that you may be surprisedat the size of portions that are actually healthy. Usesmaller plates, plenty of colorful vegetables and foodswith fiber to fill you up and help you feel satisfied.9

Other tips for healthy eating include: Don’t skip meals. E at a variety of foods, especially fresh foodsthat are high in vitamins, minerals and fiber. A void all sugar-sweetened drinks, includingfruit juices. Eat whole fruit instead of havingfruit juice. One exception: Fruit juice isa good choice for treating low blood sugar. Eat slowly. Drink plenty of water, 6-8 glasses a day. I nstead of preparing fried foods, use cookingspray, water or broth instead of oil. Substituteolive oil or canola oil for butter or lard. A dding fiber to your diet will aid in digestion,help you feel more satisfied and can help lower cholesterol. High-fiber foods include mostfruits and vegetables, whole wheat breadsand pastas, bran cereals and legumes, suchas kidney beans, navy beans, black beans. 10A nimal fats, such as fatty meats, butter andsaturated fats add pounds and contribute tohigh cholesterol, LDL cholesterol and heartdisease. Choose lean meats like chicken,turkey and fish. Use low-fat foods and avoidprocessed foods when possible.S odium (salt) can increase your risk of highblood pressure. Canned, processed and frozenfoods, snack foods, such as potato chips andpretzels and seasonings, often contain largeamounts of salt. Be careful with your choices,read labels and add little or no salt at the table. Sugar-free foods, except for drinks, areoften loaded with carbohydrates, willraise blood sugar unexpectedly and aregenerally quite expensive. Choose regularfoods and limit your portions.Healthy eating is good for thewhole family. You do not need“special” foods or diets.

Special OccasionsEating out.Dining out can present a challenge. Restaurants oftenhave large portions and, of course, you don’t alwaysknow exactly how foods are prepared. Keep portioncontrol in mind. Ask for the bread and butter to betaken away so you’re not tempted to eat it. Ask to haveyour food broiled or grilled, rather than fried. Mostrestaurants are happy to honor your requests. Take halfof the meal home in a “doggy bag,”Parties and holidaysSpecial occasions may present difficult choices. Planahead and adjust your meal plan so you can enjoy someof the festivities without overeating.AlcoholAlcoholic beverages may be consumed in moderation.Women may drink no more than one drink a day andmen should consume no more than two drinks a day.Alcohol can quickly affect blood glucose, often lowering it unexpectedly. Don’t drink on an empty stomach.It is important to discuss using alcohol with your healthcare provider to be sure it does not interfere with othermedications that you may be taking.Goal SettingSetting specific, achievable goals can make iteasier to incorporate healthy changes into yourmeals. What one thing can you do to improveyour eating habits? Choose a goal that you feelconfident you can achieve in a defined amountof time. Some suggestions are: I won’t skip meals for two weeks I will not drink any sugar-sweetened drinksor juice, this week I will test my blood sugar before and twohours after I eat pizzaThese are specific goals that can be tried andcompleted in a short time. If you are not successful, try to identify the barrier. Can you overcomethat barrier? If not, try a different goal and comeback to the first one at a later date. Don’t setyourself up for failure — plan for success!11

BEING ACTIVEExercise plays an important role in managing yourdiabetes. Over time, uncontrolled diabetes can reduce your leanmuscle mass while adding fat to your body. This increases yourneed for medication and makes diabetes management moredifficult. By adding activity to your day, you can rebuild healthymuscle mass and improve your ability to burn sugar.Being physically active helps improve blood pressure and cholesterol as well ascontrol blood sugar. A walking program can be a great way to get started. Ask afriend to join you and use a pedometer to measure your progress (Always checkwith your doctor before starting any exercise program).If you are trying to lose weight, increasing activity to 60 minutes a day will help.A weight loss of even five to 10 pounds will improve blood glucose control. Thereis no one best exercise, but aerobic (or cardiovascular) exercise helps to: Lower blood sugarLower blood pressureStrengthen heart and lungsReduce stressGive you more pep and energyExamples of aerobic exercises are: Walking brisklyCyclingDancingSwimmingTalk to your health care provider about adding strengthening exercises, such aslifting light weights. This helps build muscle and increase endurance.12

Exercise Tips E xercise three to five days a week. If youexercise at about the same time every day,it is easier to manage your blood sugar. B egin slowly, even starting out by walkingfor just one or two minutes. Build up to20-30 minutes a day. W ear comfortable clothing and properly fittedsneakers or shoes and socks with no holes. W arm up before exercise and cool downafter with light stretching. I f you take insulin, on exercise days, inject itinto your abdomen, not your arms or legs, toprevent too rapid absorption of the insulin. I f you take insulin, you may be able to adjustyour dose before an activity. (Discuss thiswith your health care provider.) D on’t exercise if blood glucose is toohigh or too low. A LWAYS carry a quick-acting sugar, such asglucose tablets, with you. If you take diabetesmedications you can experience low bloodsugar during and after exercise, so be prepared. C heck your blood sugar before starting activityand keep track of blood sugar after the activity. K eep information in your journal about whichactivities have the greatest effect on blood sugarand plan accordingly. C arry personal identification, such as a driver’slicense. Wear a medical ID bracelet or medalthat says you have diabetes. D rink plenty of water before and during activity. Carry your cell phone. S top exercising if you feel pain, upset stomachor trouble breathing and report symptoms toyour health care provider. W ait until your blood glucose level iswithin your target range.Goal SettingIs there one goal that you would like to worktowards when it comes to being active? Remember, it should be something specific that youthink you can accomplish in one to two weeks.Examples may be: I will walk around the block four out ofseven days this week I will use a pedometer and increase my stepsby 100 steps every day this week I will carry my cell phone with me when I takethe dog for a walk each day this weekAs you accomplish each goal, congratulateyourself and work towards the next goal inyou management plan.13

MONITORING YOUR HEALTH STATUSBlood Glucose MonitoringManaging your diabetes every day may seem like a difficult job,but it can reduce your risk of health complications. Testing bloodsugar is an important part of being in charge of your diabetes.THINGS TO KNOW: I f you do not have a bloodglucose meter, your VNSNYnurse will order one for you.If this is a new skill for you,your VNSNY nurse will showyou how to get started. S teps on how to check yourblood sugar are included withevery new blood glucose meter.Your VNSNY nurse will alsoshow you how to use your meter, and how to keep a recordof your blood glucose results. All blood glucose metershave a toll-free customercare telephone number on theback. This is a great resourceso register your meter and usethe customer care number toget help if you need it. M ost meters have a memorywhich keeps the blood glucoseresults for 30 days or more. Youcan bring the meter when youvisit your doctor and reviewyour past results.14IMPORTANT: Be sure toask your doctor for yourindividual target.Keeping your blood sugar in a setrange, as suggested by your doctor,will help you feel better and maydecrease your risk for health problems later. Together you and yourdoctor will decide how often youshould check your blood glucose.Some people check their blood glucose once a day and others check itmore often. If you only check yourblood sugar once a day, don’t alwaysdo it at the same time. For example,if you only check every morningbefore breakfast, there are 23 hoursand 59 minutes in the day that youdon’t know your level. Use yourmeter like a detective. Check, againbefore you eat and two-hours aftera meal to track the effect from thatparticular meal. Check before yougo to bed and again when you getup a few times each month as well.This information can help yourdoctor prescribe the best possiblediabetes medication for you. If youare on insulin therapy, it is important to check more frequently. Askyour nurse or doctor.

The America Diabetes Association (ADA) recommendsthe following blood sugar goals for people with diabetes:Before MealsAfter Meals70-130 mg/dlLess than 180 mg/dlLOW BLOOD SUGAR 7 0mgdlWhether you have type 1 or type 2 diabetes, one ofyour main treatment goals is controlling your bloodsugar by keeping it as close to normal as possible.People without diabetes normally have blood sugarlevels that range from 70 to 110 mg/dl.My target range or blood glucose goals are:Before meals:After meals:Bed time:Alternate Site TestingMost blood glucose meters allow you to testwithout having to take blood from your fingertips. Meters can usually test blood taken fromother body sites, such as the arm, thigh and hand.The ability to choose other body sites is usefulfor people who find it painful or difficult to withdraw blood from their fingertips. If you decideto use other sites for testing, however, be awarethat there may be a real difference between thefingertip result and other site results when bloodglucose levels are changing rapidly in your body.It is best to speak with your doctor or VNSNYnurse if this is an idea you are considering.HIGH BLOOD SUGAR 180mgdl15

A1c / Estimated Average GlucoseThe A1c or Estimated Average Glucose(eAG) is a blood test. It measures howmuch sugar stuck to your red blood cellsover the past nine to 12 weeks. By tracking the results, you can get an overallpicture of how successful your diabetesmanagement has been in that time.You should always request a copy of your lab work andkeep it filed where you can access it. This is important foryou to make sure you are trending in the right directionwith your management skills, or if you need to improvein some areas. You will also want to take these recordswith you if you change health care providers.My current A1c/eAG is: My A1c/eAG target is:A1C% eAG 52261024010.52551126911.528312298Testing for Ketones (see glossary)Your doctor may want you to test your urine forketones, if you have high blood sugar, nausea, orvomiting. Having ketones in the urine is most common in people who have type 1 diabetes, but it canoccur in those with type 2 diabetes. You can test yoururine with a ketone dip stick. It’s a good idea to keepurine ketone sticks on hand, in case you are sick. Youcan buy urine testing sticks at your local drug storeand simply follow the directions on the package.16Also, here are some general steps for urine testing: Collect urine in a clean cup. Dip test strip into urine and remove. Wait for the time required in the directions. Compare the color of the pad on strip to thecolor chart on the test strip bottle. Call your doctor if you have moderate orlarge ketones in your urine.

Monitoring Cardiovascular HealthBlood pressure is a measure of how hard yourblood is pressing against your artery walls. Itis recorded as two numbers:SystoleBLOOD PRESSURE DiastoleThe top number is when the heartcontracts (systolic pressure)The bottom number is when theheart is at rest (diastolic pressure).WHAT’S NORMAL BLOOD PRESSURE?This chart reflects blood pressure categories as definedby the American Heart Association. Lipid abnormalitiescontribute to cardiovascular disease.Blood PressureCategorySystolicmm Hg(upper #)Normalless than 120andless than 80Prehypertension120 – 139or80 – 89High Blood Pressure(Hypertension)Stage 1140 – 159or90 – 99High Blood Pressure(Hypertension)Stage 2160 or higheror100 or higherHypertensive Crisis(Emergency care needed)Higher than 180orHigher than 110Diastolicmm Hg(lower #)NOTE: B lood pressureshould be measuredat every doctor’svisit and every timea VNSNY nurse or atherapist visits yourhome. T arget Blood Pressure for all peoplewith diabetes is lessthan 130/80 mm/Hg.17

SOME STEPS TO CUT DOWN ON SODIUM: D o not add salt when cooking. Try usingother flavorful spices. Remove the salt shaker from your table. R ead food labels for sodium content andavoid foods high in sodium. Avoid processed and fast foods.Managing your triglycerides and cholesterol, especially lowering LDLcholesterol, reduces your chance of developing cardiovascular disease.A person with diabetes who lowers his LDL cholesterol can reduce cardiovascular complications by up to 50 percent.TARGET FOR MOST ADULTS WITH DIABETES:Lipid GuidelinesGoalTriglycerides (TG) 150 mg/dlLow-Density Lipoprotein (LDL) 100 mg/dlHigh-Density Lipoprotein (HDL)Males/Females 40 mg/dl/ 50 mg/dlEating a Low-Fat DietTo protect your heart cut down on foods high in cholesterol andcertain other fats that clog your blood vessels. This will also helpdescrease your chance of having a heart attack or stroke.18Cutting down onsodium is a very important way to keepyour blood pressureunder control.

CHOOSE FATS WISELYYour body needs some fats to stay healthy. However, eating toomuch of some types of fat is bad for your heart. Try to choosethe healthier fats and avoid unhealthy fats (see chart below).CHOOSEType of FatWhere It Is FoundWhat You Should DoLIMITAVOID Unsaturated Fats(good fats) Saturated Fats(Bad Fats)Trans Fats Nuts, seeds Fish AvocadosAnimal products, forexample: B eef, pork, egg yolks,organ meatHigh-fat dairy, forexample: Ice cream, w hole milkcheese Snack foods Margarines Processed foods E at as little saturatedfat as you can. To cut down, chooselow-fat or fat-free milkproducts, and leanmeats, chicken or fish. Avoid foods withtrans fat. C heck label for andavoid “hydrogenatedoils” or “partiallyhydrogenated oils.” Olive and canola oils Soy Try to use unsaturatedfats when possible. For example, use oliveoil on your vegetablesinstead of butter.WHAT IS CHOLESTEROL?Cholesterol is a fatty, wax-like substance found in the bloodstream andyour body’s cells. Your body needssome cholesterol to stay healthy. Toomuch cholesterol can clog your bloodvessels and make heart failure worse.Cholesterol is absorbed into the bloodfrom foods. One way to lower yourcholesterol is to cut down on theamount of cholesterol you eat. In somecases, your doctor may also prescribemedications to lower your cholesterol.A CHOLESTEROL PROFILEINCLUDES: Fried foods B akery foods (cakes,cookies, donuts)HEALTHY VALUESCholesterolBelow 200 mg/dlLDL (bad) cholesterolBelow 100 mg/dlHDL (good) cholesterol35 to 55 mg/dl or more(the higher the better)Triglycerides21Below 150 mg/dlNOTE: Ask your healthcare provider about your cholesterol levels.19

HOW TO CUT DOWN ON FAT AND CHOLESTEROL IN MEALS:Just as you are learning to cook with less salt you can also learn to cook withless fat and cholesterol. Foods may taste different at first, but in time you willenjoy the new taste. Check any changes you are ready to make: B ake, steam, microwave, or broil foods;avoid frying. B efore cooking, trim fat and remove skinfrom chicken or other poultry. Choose lean cuts of meat. After cooking, chill soups and stews andskim off fat before reheating and serving. T ry using half as much cheese as the recipecalls for, or even less. Choose dairy productswith 0-1% fat. C ook with canola oil, olive oil, or trans-fat freemargarine instead of butter or regular margarine. R emember that cheeses and low-fat foods canbe high in sodium, so check the label and buylow-sodium foods.EATING A HEART-HEALTHY DIETA heart-healthy diet includes a balance of protein(meat/fish/poultry/beans), low-fat dairy products,fruits, vegetables, and grains. It is also low in sodiumand low in fat. Good food is like medicine — it canheal and repair your body to make you stronger!Monitoring WeightManaging weight is another way to control your diabetes.If you are overweight (see BMI table), a weightloss of as little as five to 10 percent can make adifference in bringing your blood glucose, bloodpressure, and cholesterol numbers to acceptable levels. Having a scale in your house canhelp you monitor your weight.MAINTAINING A HEALTHY WEIGHTOVERWEIGHTBeing overweight increases the work your heart does.It also raises your risks for many other health problems. Being overweight can make the symptoms ofheart failure worse. This results in an increase in shortness of breath and increased tiredness after activity.Cutting out some foods, like soft drinks, packagedcakes and cookies, alcohol, and salty snacks can help.20UNDERWEIGHTIf you are not active, your muscles, including yourheart muscle, get weaker. To rebuild muscles, youneed protein from low-fat dairy products, leanmeat, chicken, fish and vitamins and mineralsfrom fruits and grains. If you are overweightor underweight, work with your nutritionist ordoctor to set safe eating and weight-loss goals.

BMI (Body Mass Index) is a measure of body weightrelative to height. BMI can help determine if you areat a healthy weight, overweight or obese.BMI TABLEHeight (ft./in)Weight 19191818171716161515151414

Diabetes is a disorder that occurs when the body either does not produce insulin or cannot use insulin effectively to convert the foods you eat into energy for your cells. This leads to high amounts of sugar in the blood, since it is not able to get into the cells of the