Contents:

• What alternative devices for taking insulin are available?
• What are the prospects for an artificial pancreas?
• Points to Remember
• Hope through Research
• For More Information
• Acknowledgments

Many people with diabetes must take insulin to manage their disease.

Most people who take insulin use a needle and syringe to inject insulin just under the skin. Several other devices for taking insulin are available and new approaches are under development. No matter which approach a person uses for taking insulin, consistent monitoring of blood glucose levels is important. Good blood glucose control can prevent complications of diabetes.

What alternative devices for taking insulin are available?

Insulin pens provide a convenient, easy-to-use way of injecting insulin and may be less painful than a standard needle and syringe. An insulin pen looks like a pen with a cartridge. Some of these devices use replaceable cartridges of insulin. Other pens are prefilled with insulin and are totally disposable after the insulin is injected. Insulin pen users screw a short, fine, disposable needle on the tip of the pen before an injection. Then users turn a dial to select the desired dose of insulin, inject the needle, and press a plunger on the end to deliver the insulin just under the skin. Insulin pens are less widely used in the United States than in many other countries.

Insulin pens are a convenient alternative to a needle and syringe for insulin injections.

External insulin pumps are typically about the size of a deck of cards or cell phone, weigh about 3 ounces, and can be worn on a belt or carried in a pocket. Most pumps use a disposable plastic cartridge as an insulin reservoir. A needle and plunger are temporarily attached to the cartridge to allow the user to fill the cartridge with insulin from a vial. The user then removes the needle and plunger and loads the filled cartridge into the pump.

Insulin pumps contain enough insulin for several days. An infusion set carries insulin from the pump to the body through flexible plastic tubing and a soft tube or needle inserted under the skin.

Disposable infusion sets are used with insulin pumps to deliver insulin to an infusion site on the body, such as the abdomen. Infusion sets include a cannula—a needle or a small, soft tube—that the user inserts into the tissue beneath the skin. Devices are available to help insert the cannula. Narrow, flexible plastic tubing carries insulin from the pump to the infusion site. On the skin's surface, an adhesive patch or dressing holds the infusion set in place until the user replaces it after a few days.

Users set the pumps to give a steady trickle or "basal" amount of insulin continuously throughout the day. Pumps can also give "bolus" doses—one-time larger doses—of insulin at meals and at times when blood glucose is too high based on the programming set by the user. Frequent blood glucose monitoring is essential to determine insulin dosages and to ensure that insulin is delivered.

Injection ports provide an alternative to daily injections. Injection ports look like infusion sets without the long tubing. Like infusion sets, injection ports have a cannula that is inserted into the tissue beneath the skin. On the skin's surface, an adhesive patch or dressing holds the port in place. The user injects insulin through the port with a needle and syringe or an insulin pen. The port remains in place for several days and is then replaced. Use of an injection port allows a person to reduce the number of skin punctures to one every few days to apply a new port.

Using an injection port reduces the number of skin punctures to one every few days to apply a new port. The user injects insulin through the port.

Injection aids are devices that help users give injections with needles and syringes through the use of spring-loaded syringe holders or stabilizing guides. Many injection aids have a button the user pushes to inject the insulin.

Insulin jet injectors send a fine spray of insulin into the skin at high pressure instead of using a needle to deliver the insulin.

 

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What are the prospects for an artificial pancreas?

To overcome the limitations of current insulin therapy, researchers have long sought to link glucose monitoring and insulin delivery by developing an artificial pancreas. An artificial pancreas is a system that will mimic, as closely as possible, the way a healthy pancreas detects changes in blood glucose levels and responds automatically to secrete appropriate amounts of insulin. Although not a cure, an artificial pancreas has the potential to significantly improve diabetes care and management and to reduce the burden of monitoring and managing blood glucose.

An artificial pancreas based on mechanical devices requires at least three components:

• a continuous glucose monitoring (CGM) system
• an insulin delivery system
• a computer program that adjusts insulin delivery based on changes in glucose levels

CGM systems approved by the U.S. Food and Drug Administration (FDA) include those made by Abbott, DexCom, and Medtronic. A CGM system paired with an insulin pump is available from Medtronic. This integrated system, called the MiniMed Paradigm REAL-Time System, is not an artificial pancreas, but it does represent the first step in joining glucose monitoring and insulin delivery systems using the most advanced technology available.

For more information about CGM systems, see the National Diabetes Information Clearinghouse's fact sheet Continuous Glucose Monitoring or call 1-800-860-8747 to request a copy.

Points to Remember

• Many people with diabetes who need insulin use a needle and syringe to inject insulin under the skin.
• The most common alternative ways to deliver insulin are insulin pens and insulin pumps. Injection ports, injection aids, and insulin jet injectors are also available.
• Researchers are developing an artificial pancreas, a system of mechanical devices that will automatically adjust insulin delivery based on changes in glucose levels.
• People who take insulin should monitor their blood glucose levels regularly.
• Good glucose control can prevent complications of diabetes.

Hope Through Research

Research supported by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health is contributing to the development of new technologies for continuous glucose monitoring, insulin delivery, and an artificial pancreas.

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.

For More Information

For more information about insulin and devices for taking insulin, see

• the publication What I need to know about Diabetes Medicines, available by calling 1-800-860-8747
• the FDA's information about insulin and insulin delivery devices at www.fda.gov/diabetes/insulin.html
• the American Diabetes Association's annual Resource Guide at www.diabetes.org/diabetes-forecast/resource-guide.jsp

Acknowledgments

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was reviewed by William V. Tamborlane, M.D., Yale University.

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your doctor for more information.

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National Diabetes Education Program

1 Diabetes Way
Bethesda, MD 20814-9692
Internet: www.ndep.nih.gov

The National Diabetes Education Program is a federally funded program sponsored by the U.S. Department of Health and Human Services' National Institutes of Health and the Centers for Disease Control and Prevention and includes over 200 partners at the federal, state, and local levels, working together to reduce the morbidity and mortality associated with diabetes.

National Diabetes Information Clearinghouse

1 Information Way
Bethesda, MD 20892-3560
Internet: www.diabetes.niddk.nih.gov

The National Diabetes Information Clearinghouse (NDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1978, the Clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public. The NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes.

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NIH Publication No. 09-4643
May 2009

Statistics providing insight into how serious diabetes is and the complications of diabetes.

• Adults with diabetes have heart disease death rates 2-4x times higher than adults without ("Diabetes Complications: Heart Disease and Stroke"). Because of this, many people with diabetes need to monitor their blood pressure and cholesterol diligently.

• The chance of stroke is 2-4x higher in those with diabetes.

• Diabetes in pregnancy (gestational diabetes) can greatly and gravely complicate a pregnancy.

• Diabetes is the leading cause of blindness and kidney failure.

• 60-70% of people with diabetes have nervous system damage that can lead to the loss of a limb (diabetic necrosis).

• If diabetes is not managed correctly, it can lead to a diabetic coma.

• Minorities are more at risk of diabetes, especially those in the Hispanic, African American, Native American and Polynesian communities ("Who Gets Diabetes?").

• Diabetes is on the rise due to an aging population, as well as the obesity and sedentary lifestyle common with many in the US.

• 80% of people with diabetes are overweight.

• The risk of death for people with diabetes is twice that of the general public when comparing similar ages.

You are probably quite shocked by these statistics, but there is some good news. Unlike many illnesses, diabetes can be managed and completely prevented in many cases.

Learn more about the risks in diabetes at "Diabetes Complications".

Questions to Ask about Diabetes Medicines

Ask your doctor these questions when you get a prescription for a diabetes medication. Make copies of this insert and use one sheet for each of your diabetes medicines.

1. What are the names of my medicine?

   Brand name: ________________ Generic name: ________________

2. What does my medicine do?
3. When should I start this medicine?
4. This medicine is prescribed by:
5. How long will it take this medicine to work?
6. What is the strength (for example, how many milligrams, written as mg)?
7. How much should I take for each dose?
8. How many times a day should I take my medicine?
9. At what times should I take my medicine?
10. Should I take it before, with, or after a meal?
11. Should I avoid any foods or medicines when I take it?
12. Should I avoid alcoholic beverages when I take it?
13. Are there any times when I should change the amount of medicine I take?
14. What should I do if I forget to take it?
15. If I'm sick and can't keep food down, should I still take my medicine?
16. Can my diabetes medicine cause low blood glucose?
17. What should I do if my blood glucose is too low?
18. What side effects can this medicine cause?
19. What should I do if I have side effects?
20. How should I store this medicine?

Physical activity, exercise, is a key tool for managing diabetes. Learn how a diabetes exercise plan can help you. 

Exercise for Diabetics

On this page:

• How can I take care of my diabetes?
• What can a physically active lifestyle do for me?
• What kinds of exercise can help me?
• Can I exercise any time I want?
• Are there any types of physical activity I shouldn't do?
• Can physical activity cause low blood glucose?
• What should I do before I start a physical activity program?
• What can I do to make sure I stay active?
• For More Information

Taking Care of Your Diabetes

Diabetes means your blood glucose, also called blood sugar, is too high. Your body uses glucose for energy. But having too much glucose in your blood can hurt you.

When you take care of your diabetes, you'll feel better. You'll reduce your risk for diabetes complications with your kidneys, eyes, nerves, feet and legs, and teeth. You'll also lower your risk for a heart attack or a stroke. You can take care of your diabetes by

• being physically active
• following a healthy meal plan
• taking medicines, if prescribed by your doctor

What can a physically active lifestyle do for my diabetes?

Research has shown that exercise and other physical activity can

• lower your blood glucose and your blood pressure
• lower your bad cholesterol and raise your good cholesterol
• improve your body's ability to use insulin
• lower your risk for heart disease and stroke
• keep your heart and bones strong
• keep your joints flexible
• lower your risk of falling
• help you lose weight
• reduce your body fat
• give you more energy
• reduce your stress levels

Physical activity also plays an important part in preventing type 2 diabetes. A major Government study, the Diabetes Prevention Program (DPP), showed that modest weight loss of 5 to 7 percent—for example, 10 to 15 pounds for a 200-pound person—can delay and possibly prevent type 2 diabetes. People in the study used diet and exercise to lose weight.

For more information about the study, read: Diabetes Prevention Program . Or call the National Diabetes Information Clearinghouse at 1-800-860-8747 to request a printed copy.

What kinds of diabetes exercise plan can help me?

Four kinds of activity can help. You can

• be extra active every day
• do aerobic exercise
• do strength training
• stretch

Be Extra Active Every Day

Being extra active can increase the number of calories you burn. Try these ways to be extra active, or think of other things you can do.

• Walk around while you talk on the phone.
• Play with the kids.
• Take the dog for a walk.
• Get up to change the TV channel instead of using the remote control.
• Work in the garden or rake leaves.
• Clean the house.
• Wash the car.
• Stretch out your chores. For example, make two trips to take the laundry downstairs instead of one.
• Park at the far end of the shopping center parking lot and walk to the store.
• At the grocery store, walk down every aisle.
• At work, walk over to see a co-worker instead of calling or emailing.
• Take the stairs instead of the elevator.
• Stretch or walk around instead of taking a coffee break and eating.
• During your lunch break, walk to the post office or do other errands.
• Other things I can do:

Do Aerobic Exercise

Aerobic exercise is an activity that requires the use of large muscles and makes your heart beat faster. You will also breathe harder during aerobic exercise. Doing aerobic exercise for 30 minutes a day at least 5 days a week provides many benefits. You can even split up those 30 minutes into several parts. For example, you can take three brisk 10-minute walks, one after each meal.

If you haven't exercised lately, see your doctor first to make sure it's OK for you to increase your level of physical activity. Talk with your doctor about how to warm up and stretch before you exercise and how to cool down after you exercise. Then start slowly with 5 to 10 minutes a day. Add a little more time each week, aiming for at least 150 minutes per week. Try

• walking briskly
• hiking
• climbing stairs
• swimming or taking a water aerobics class
• dancing
• riding a bicycle outdoors or a stationary bicycle indoors
• taking an aerobics class
• playing basketball, volleyball, or other sports
• in-line skating, ice skating, or skateboarding
• playing tennis
• cross-country skiing
• other things I can do: _________________________

The National Institute on Aging offers a free booklet, Exercise: A Guide From the National Institute on Aging. To read it online, go to https://order.nia.nih.gov/

Do Strength Training

Doing exercises with hand weights, elastic bands, or weight machines three times a week builds muscle. When you have more muscle and less fat, you'll burn more calories because muscle burns more calories than fat, even between exercise sessions. Strength training can help make daily chores easier, improving your balance and coordination, as well as your bones' health. You can do strength training at home, at a fitness center, or in a class. Your health care team can tell you more about strength training and what kind is best for you.

Stretch

Stretching increases your flexibility, lowers stress, and helps prevent muscle soreness after other types of exercise. Your health care team can tell you what kind of stretching is best for you.

The Weight-control Information Network, a service of the National Institute of Diabetes and Digestive and Kidney Diseases, has information about exercise. Call 1-877-946-4627, toll-free, to request free copies of the following publications:

• Active at Any Size
• Walking: A Step in the Right Direction
• Physical Activity and Weight Control

Can I exercise any time I want?

Your health care team can help you decide the best time of day for you to exercise. Together, you and your team will consider your daily schedule, your meal plan, and your diabetes medicines.

If you have type 1 diabetes, avoid strenuous exercise when you have ketones in your blood or urine. Ketones are chemicals your body might make when your blood glucose level is too high and your insulin level is too low. Too many ketones can make you sick. If you exercise when you have ketones in your blood or urine, your blood glucose level may go even higher.

If you have type 2 diabetes and your blood glucose is high but you don't have ketones, light or moderate exercise will probably lower your blood glucose. Ask your health care team whether you should exercise when your blood glucose is high.

Are there any types of physical activity a diabetic shouldn't do?

If you have diabetes complications, some kinds of exercise can make your problems worse. For example, activities that increase the pressure in the blood vessels of your eyes, such as lifting heavy weights, can make diabetic eye problems worse. If nerve damage from diabetes has made your feet numb, your doctor may suggest that you try swimming instead of walking for aerobic exercise.

When you have numb feet, you might not feel pain in your feet. Sores or blisters might get worse because you don't notice them. Without proper care, minor foot problems can turn into serious conditions, sometimes leading to amputation. Make sure you exercise in cotton socks and comfortable, well-fitting shoes designed for the activity you are doing. After you exercise, check your feet for cuts, sores, bumps, or redness. Call your doctor if any foot problems develop.

Can physical activity cause low blood glucose?

Physical activity can cause low blood glucose, also called hypoglycemia, in people who take insulin or certain types of diabetes medicines. Ask your health care team whether your diabetes medicines can cause low blood glucose.

Low blood glucose can happen while you exercise, right afterward, or even up to a day later. It can make you feel shaky, weak, confused, grumpy, hungry, or tired. You may sweat a lot or get a headache. If your blood glucose drops too low, you could pass out or have a seizure.

However, you should still be physically active. These steps can help you be prepared for low blood glucose:

Before Exercise

• Ask your health care team whether you should check your blood glucose level before exercising.
• If you take diabetes medicines that can cause low blood glucose, ask your health care team whether you should
  • change the amount you take before you exercise
  • have a snack if your blood glucose level is below 100

During Exercise

• Wear your medical identification (ID) bracelet or necklace or carry your ID in your pocket.
• Always carry food or glucose tablets so you'll be ready to treat low blood glucose.
• If you'll be exercising for more than an hour, check your blood glucose at regular intervals. You may need snacks before you finish.

After Exercise

• Check to see how exercise affected your blood glucose level.

Treating Low Blood Glucose

If your blood glucose is below 80, have one of the following right away:

• 3 or 4 glucose tablets
• 1 serving of glucose gel—the amount equal to 15 grams of carbohydrate
• 1/2 cup (4 ounces) of any fruit juice
• 1/2 cup (4 ounces) of a regular—not diet—soft drink
• 1 cup (8 ounces) of milk
• 5 or 6 pieces of hard candy
• 1 tablespoon of sugar or honey

After 15 minutes, check your blood glucose again. If it's still too low, have another serving. Repeat until your blood glucose is 80 or higher. If it will be an hour or more before your next meal, have a snack as well.

What should I do before I start a physical activity program?

Check with your doctor. Always talk with your doctor before you start a new physical activity program. Ask about your medicines—prescription and over-the-counter— and whether you should change the amount you take before you exercise. If you have heart disease, kidney disease, eye problems, or foot problems, ask which types of physical activity are safe for you.

Decide exactly what you'll do and set some goals.

Choose

• the type of physical activity you want to do
• the clothes and items you'll need to get ready
• the days and times you'll add activity
• the length of each session
• your plan for warming up, stretching, and cooling down for each session
• a backup plan, such as where you'll walk if the weather is bad
• your measures of progress

Find an exercise buddy. Many people find they are more likely to do something active if a friend joins them. If you and a friend plan to walk together, for example, you may be more likely to do it.

Keep track of your physical activity. Write down when you exercise and for how long in your blood glucose record book. You'll be able to track your progress and see how physical activity affects your blood glucose.

Decide how you'll reward yourself. Do something nice for yourself when you reach your activity goals. For example, treat yourself to a movie or buy a new plant for the garden.

What can I do to make sure I stay active?

One of the keys to staying on track is finding some activities you like to do. If you keep finding excuses not to exercise, think about why. Are your goals realistic? Do you need a change in activity? Would another time be more convenient? Keep trying until you find a routine that works for you. Once you make physical activity a habit, you'll wonder how you lived without it.

For More Information

To find diabetes teachers—nurses, dietitians, and other health professionals—near you, call the American Association of Diabetes Educators toll-free at 1-800-TEAMUP4 (832-6874). Or look on the Internet at www.diabeteseducator.org.

For additional information about diabetes, contact

American Diabetes Association
National Service Center
1701 North Beauregard Street
Alexandria, VA 22311
Internet: www.diabetes.org

Juvenile Diabetes Research Foundation International
120 Wall Street
New York, NY 10005-4001
Internet: www.jdrf.org

This publication may contain information about medications used to treat a health condition. When this publication was prepared, the NIDDK included the most current information available. Occasionally, new information about medication is released. For updates or for questions about any medications, please contact the U.S. Food and Drug Administration at 1-888-INFO-FDA (463-6332), a toll-free call, or visit their website at www.fda.gov. Consult your doctor for more information.

National Diabetes Information Clearinghouse

1 Information Way
Bethesda, MD 20892-3560
Internet: www.diabetes.niddk.nih.gov

Source: NIH Publication No. 08-5180, March 2008

Sticking to a diet for diabetes keeps blood glucose levels on target. Learn about eating and diabetes, diet and diabetes.

Healthy Eating and Diabetes:

• Eating and Diabetes
• Blood Glucose Levels
• Your Diabetes Medicines
• Your Physical Activity Plan
• The Diabetes Food Pyramid
• Starches
• Vegetables
• Fruits
• Milk
• Meat and Meat Substitutes
• Fats and Sweets
• Alcoholic Drinks
• Your Meal Plan
• Measuring Your Food
• When You're Sick
• Where can I get more information?

Eating and Diabetes

You can take good care of yourself and your diabetes by learning

• what to eat
• how much to eat
• when to eat

Making wise food choices can help you

• feel good every day
• lose weight if you need to
• lower your risk for heart disease, stroke, and other problems caused by diabetes

Healthful eating helps keep your blood glucose, also called blood sugar, in your target range. Physical activity and, if needed, diabetes medicines also help. The diabetes target range is the blood glucose level suggested by diabetes experts for good health. You can help prevent health problems by keeping your blood glucose levels on target.

Blood Glucose Levels

What should my blood glucose levels be?

Target Blood Glucose Levels for People with Diabetes

Before meals	80 to 130 mg/dL
1 to 2 hours after the start of a meal	less than 180 mg/dL

Talk with your healthcare provider about your blood glucose target levels.

Ask your doctor how often you should check your blood glucose on your own. Also ask your doctor for an A1C test at least twice a year. Your A1C number gives your average blood glucose for the past 3 months. The results from your blood glucose checks and your A1C test will tell you whether your diabetes care plan is working.

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How can I keep my blood glucose levels on target?

You can keep your blood glucose levels on target by: 

• making wise food choices
• being physically active
• taking medicines if needed

For people taking certain diabetes medicines, following a schedule for meals, snacks, and physical activity is best. However, some diabetes medicines allow for more flexibility. You'll work with your health care team to create a diabetes plan that's best for you.

 

Your Diabetes Medicines

What you eat and when you eat affect how your diabetes medicines work. Talk with your doctor or diabetes teacher about when to take your diabetes medicines. 

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Your Physical Activity Plan to Help Manage Diabetes

What you eat and when also depend on how much you exercise. Physical activity is an important part of staying healthy and controlling your blood glucose. Keep these points in mind:

• Talk with your doctor about what types of exercise are safe for you.
• Make sure your shoes fit well and your socks stay clean and dry. Check your feet for redness or sores after exercising. Call your doctor if you have sores that do not heal.
• Warm up and stretch for 5 to 10 minutes before you exercise. Then cool down for several minutes after you exercise. For example, walk slowly at first, stretch, and then walk faster. Finish up by walking slowly again.
• Ask your doctor whether you should exercise if your blood glucose level is high.
• Ask your doctor whether you should have a snack before you exercise.
• Know the signs of low blood glucose, also called hypoglycemia. Always carry food or glucose tablets to treat low blood glucose.
• Always wear your medical identification or other ID.
• Find an exercise buddy. Many people find they are more likely to do something active if a friend joins them.

Low Blood Glucose (Hypoglycemia)

Low blood glucose can make you feel shaky, weak, confused, irritable, hungry, or tired. You may sweat a lot or get a headache. If you have these symptoms, check your blood glucose. If it is below 80, have one of the following right away:

• 3 or 4 glucose tablets
• 1 serving of glucose gel—the amount equal to 15 grams of carbohydrate
• 1/2 cup (4 ounces) of any fruit juice
• 1/2 cup (4 ounces) of a regular (not diet) soft drink
• 1 cup (8 ounces) of milk
• 5 or 6 pieces of hard candy
• 1 tablespoon of sugar or honey

After 15 minutes, check your blood glucose again. If it's still too low, have another serving. Repeat these steps until your blood glucose level is 80 or higher. If it will be an hour or more before your next meal, have a snack as well.

The Diabetes Food Pyramid (Diet and Diabetes)

The diabetes food pyramid can help you make wise food choices. It divides foods into groups, based on what they contain. Eat more from the groups at the bottom of the pyramid, and less from the groups at the top. Foods from the starches, fruits, vegetables, and milk groups are highest in carbohydrate. They affect your blood glucose levels the most.

The diabetes food pyramid can help you make wise food choices. It divides foods into groups, based on what they contain. Eat more from the groups at the bottom of the pyramid, and less from the groups at the top. Foods from the starches, fruits, vegetables, and milk groups are highest in carbohydrate. They affect your blood glucose levels the most. See "How much should I eat each day" below to find out how much to eat from each food group.

How much should I eat each day?

Have about 1,200 to 1,600 calories a day if you are a

• small woman who exercises
• small or medium-sized woman who wants to lose weight
• medium-sized woman who does not exercise much

Choose this many servings from these food groups to have 1,200 to 1,600 calories a day:
6 starches	2 milks
3 vegetables	4 to 6 ounces meat and meat substitutes
2 fruits	up to 3 fats

Talk with your diabetes teacher about how to make a meal plan that fits the way you usually eat, your daily routine, and your diabetes medicines. Then make your own plan.

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Have about 1,600 to 2,000 calories a day if you are a

• large woman who wants to lose weight
• small man at a healthy weight
• medium-sized man who does not exercise much
• medium-sized or large man who wants to lose weight

Choose this many servings from these food groups to have 1,600 to 2,000 calories a day:
8 starches	2 milks
4 vegetables	4 to 6 ounces meat and meat substitutes
3 fruits	up to 4 fats

Talk with your diabetes teacher about how to make a meal plan that fits the way you usually eat, your daily routine, and your diabetes medicines. Then make your own plan.

Have about 2,000 to 2,400 calories a day if you are a

• medium-sized or large man who exercises a lot or has a physically active job
• large man at a healthy weight
• medium-sized or large woman who exercises a lot or has a physically active job

Choose this many servings from these food groups to have 2,000 to 2,400 calories a day:
10 starches	2 milks
4 vegetables	5 to 7 ounces meat and meat substitutes
4 fruits	up to 5 fats

Talk with your diabetes teacher about how to make a meal plan that fits the way you usually eat, your daily routine, and your diabetes medicines. Then make your own plan.

Starches

Starches are bread, grains, cereal, pasta, and starchy vegetables like corn and potatoes. They provide carbohydrate, vitamins, minerals, and fiber. Whole grain starches are healthier because they have more vitamins, minerals, and fiber.

Eat some starches at each meal. Eating starches is healthy for everyone, including people with diabetes.

Examples of starches are 

• bread
• pasta
• corn
• pretzels
• potatoes
• rice
• crackers
• cereal
• tortillas
• beans
• yams
• lentils

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How much is a serving of starch?

Examples of 1 serving:

Examples of 2 servings:

Examples of 3 servings:

If your plan includes more than one serving at a meal, you can choose different starches or have several servings of one starch. A diabetes teacher can help you with your meal plan.

What are healthy ways to eat starches?

• Buy whole grain bread and cereal.
• Eat fewer fried and high-fat starches such as regular tortilla chips and potato chips, french fries, pastries, or biscuits. Try pretzels, fat-free popcorn, baked tortilla chips or potato chips, baked potatoes, or low-fat muffins.
• Use low-fat or fat-free plain yogurt or fat-free sour cream instead of regular sour cream on a baked potato.
• Use mustard instead of mayonnaise on a sandwich.
• Use low-fat or fat-free substitutes such as low-fat mayonnaise or light margarine on bread, rolls, or toast.
• Eat cereal with fat-free (skim) or low-fat (1%) milk.

Vegetables

Vegetables provide vitamins, minerals, and fiber. They are low in carbohydrate.

Examples of vegetables are

lettuce broccoli vegetable juice spinach peppers carrots

green beans tomatoes celery chilies greens cabbage

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How much is a serving of vegetables?

Examples of 1 serving:

Examples of 2 servings:

Examples of 3 servings:

If your plan includes more than one serving at a meal, you can choose several types of vegetables or have two or three servings of one vegetable. A diabetes teacher can help you with your meal plan.

What are healthy ways to eat vegetables?

• Eat raw and cooked vegetables with little or no fat, sauces, or dressings.
• Try low-fat or fat-free salad dressing on raw vegetables or salads.
• Steam vegetables using water or low-fat broth.
• Mix in some chopped onion or garlic.
• Use a little vinegar or some lemon or lime juice.
• Add a small piece of lean ham or smoked turkey instead of fat to vegetables when cooking.
• Sprinkle with herbs and spices.
• If you do use a small amount of fat, use canola oil, olive oil, or soft margarine (liquid or tub types) instead of fat from meat, butter, or shortening.

Fruits

Fruits provide carbohydrate, vitamins, minerals, and fiber.

 

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Examples of fruits include

• apples
• fruit juice
• strawberries
• dried fruit
• grapefruit
• bananas
• raisins
• oranges
• watermelon
• peaches
• mango
• guava
• papaya
• berries
• canned fruit

How much is a serving of fruit?

Examples of 1 serving:

Examples of 2 servings:

If your plan includes more than one serving at a meal, you can choose different types of fruit or have several servings of one fruit. A diabetes teacher can help you with your meal plan.

What are healthy ways to eat fruits?

• Eat fruits raw or cooked, like juice with no sugar added, canned in their own juice, or dried.
• Buy smaller pieces of fruit.
• Choose pieces of fruit more often than fruit juice. Whole fruit is more filling and has more fiber.
• Save high-sugar and high-fat fruit desserts such as peach cobbler or cherry pie for special occasions.

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Milk

Milk provides carbohydrate, protein, calcium, vitamins, and minerals.

How much is a serving of milk?

Examples of 1 serving:

Note: If you are pregnant or breastfeeding, have four to five servings of milk each day.

What are healthy ways to have milk?

• Drink fat-free (skim) or low-fat (1%) milk.
• Eat low-fat or fat-free fruit yogurt sweetened with a low-calorie sweetener.
• Use low-fat plain yogurt as a substitute for sour cream.

Meat and Meat Substitutes

The meat and meat substitutes group includes meat, poultry, eggs, cheese, fish, and tofu. Eat small amounts of some of these foods each day.

Meat and meat substitutes provide protein, vitamins, and minerals.

 

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Examples of meat and meat substitutes include

• chicken
• beef
• fish
• canned tuna or other fish
• eggs
• peanut butter
• tofu
• cottage cheese
• cheese
• pork
• lamb
• turkey

How much is a serving of meat and meat substitutes?

Meat and meat substitutes are measured in ounces. Here are examples.

Examples of 1-ounce serving:

Examples of 2-ounce serving:

Examples of 3-ounce serving:

*Three ounces of meat (after cooking) is about the size of a deck of cards.

What are healthy ways to eat meat and meat substitutes?

• Buy cuts of beef, pork, ham, and lamb that have only a little fat on them. Trim off the extra fat.
• Eat chicken or turkey without the skin.
• Cook meat and meat substitutes in low-fat ways:
  • broil
  • grill
  • stir-fry
  • roast
  • steam
  • microwave
• To add more flavor, use vinegars, lemon juice, soy sauce, salsa, ketchup, barbecue sauce, herbs, and spices.
• Cook eggs using cooking spray or a non-stick pan.
• Limit the amount of nuts, peanut butter, and fried foods you eat. They are high in fat.
• Check food labels. Choose low-fat or fat-free cheese.

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Fats and Sweets

Limit the amount of fats and sweets you eat. Fats and sweets are not as nutritious as other foods. Fats have a lot of calories. Sweets can be high in carbohydrate and fat. Some contain saturated fats, trans fats, and cholesterol that increase your risk of heart disease. Limiting these foods will help you lose weight and keep your blood glucose and blood fats under control.

Examples of fats include

• salad dressing 
• oil
• cream cheese
• butter
• margarine
• mayonnaise
• avocado
• olives
• bacon

Examples of sweets include

• cake
• ice cream
• pie
• syrup
• cookies
• doughnuts

How much is a serving of sweets?

Examples of 1 serving:

 

How much is a serving of fat?

Examples of 1 serving:

Examples of 2 servings:

How can I satisfy my sweet tooth?

Try having sugar-free popsicles, diet soda, fat-free ice cream or frozen yogurt, or sugar-free hot cocoa mix.

Other tips:

• Share desserts in restaurants.
• Order small or child-size servings of ice cream or frozen yogurt.
• Divide homemade desserts into small servings and wrap each individually. Freeze extra servings.

Remember, fat-free and low-sugar foods still have calories. Talk with your diabetes teacher about how to fit sweets into your meal plan.

Alcoholic Drinks

Alcoholic drinks have calories but no nutrients. If you have alcoholic drinks on an empty stomach, they can make your blood glucose level go too low. Alcoholic drinks also can raise your blood fats. If you want to have alcoholic drinks, talk with your doctor or diabetes teacher about how much to have.

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Your Meal Plan

Plan your meals and snacks for one day. Work with your diabetes teacher if you need help.

Breakfast
Food Group	Food	How Much
Snack
Food Group	Food	How Much
Lunch
Food Group	Food	How Much
Snack
Food Group	Food	How Much
Dinner
Food Group	Food	How Much
Snack
Food Group	Food	How Much

 

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Measuring Your Food

To make sure your food servings are the right size, you can use

• measuring cups
• measuring spoons
• a food scale

Or you can use the guide below. Also, the Nutrition Facts label on food packages tells you how much of that food is in one serving.

Guide to Sensible Serving Sizes

This much	is the same as
	3 ounces 1 serving of meat, chicken, turkey, or fish
	1 cup 1 serving of cooked vegetables salads casseroles or stews, such as chili with beans milk
	½ cup 1 serving of fruit or fruit juice starchy vegetables, such as potatoes or corn pinto beans and other dried beans rice or noodles cereal
	1 ounce 1 serving of snack food cheese (1 slice)
	1 tablespoon 1 serving of salad dressing cream cheese
	1 teaspoon 1 serving of margarine or butter oil mayonnaise

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When You're Sick

Take care of yourself when you're sick. Being sick can make your blood glucose go too high. Tips on what to do include the following:

• Check your blood glucose level every 4 hours. Write down the results.
• Keep taking your diabetes medicines. You need them even if you can't keep food down.
• Drink at least one cup (8 ounces) of water or other calorie-free, caffeine-free liquid every hour while you're awake.
• If you can't eat your usual food, try drinking juice or eating crackers, popsicles, or soup.
• If you can't eat at all, drink clear liquids such as ginger ale. Eat or drink something with sugar in it if you have trouble keeping food down because you still need calories. If you can't eat enough, you increase your risk of low blood glucose, also called hypoglycemia.
• In people with type 1 diabetes, when blood glucose is high, the body produces ketones. Ketones can make you sick. Test your urine or blood for ketones if
  • your blood glucose is above 240
  • you can't keep food or liquids down
• Call your healthcare provider right away if
  • your blood glucose has been above 240 for longer than a day
  • you have ketones
  • you feel sleepier than usual
  • you have trouble breathing
  • you can't think clearly
  • you throw up more than once
  • you've had diarrhea for more than 6 hours

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Where can I get more information?

Diabetes Teachers (nurses, dietitians, pharmacists, and other health professionals)

To find a diabetes teacher near you, call the American Association of Diabetes Educators toll-free at 1-800-TEAMUP4 (832-6874) or see www.diabeteseducator.org and click on "Find an Educator."

Recognized Diabetes Education Programs (teaching programs approved by the American Diabetes Association)

To find a program near you, call the American Diabetes Association toll-free at 1-800-DIABETES (342-2383) or see professional.diabetes.org/ERP_List.aspx on the Internet.

Dietitians

To find a dietitian near you, call the American Dietetic Association's National Center for Nutrition and Dietetics toll-free at 1-800-877-1600 or see www.eatright.org and click on "Find a Nutrition Professional."NIH Publication No. 08-5043
October 2007

What's going on at HealthyPlace this week?

• Listen to Yourself: You Are Your Best Mental Health Resource
• From the HealthyPlace Mental Health Blogs
• Have My Schizoaffective Voices Gone Away for Good?
• Most Popular HealthyPlace Articles Shared by Facebook Fans
• Quote on Hurtful, Negative Thoughts

Do you ever feel overwhelmed by all the noise around you telling you how you “should” feel and what you “should” do in your own life? This can be difficult and draining, contributing to or worsening anxiety, depression, and the stress and symptoms of any mental health challenge.

You know yourself better than anyone else ever can. To nurture your own mental health and wellbeing, begin to turn inward, away from the attitudes of others and toward your own sense of who you are.

It can be difficult to listen to ourselves, though, especially when mental health challenges erode our self-confidence. Think of it as an ongoing adventure in self-discovery in which you gradually build the skills you need to listen to and honor yourself as your best mental health resource. Here are some tips for listening to and trusting yourself.

• Pay attention to your body’s signals. Your body communicates to you through aches and pains, sensations of hot and cold, hunger and thirst, nausea and butterflies, and more. Tune in to your body’s messages when making decisions that affect your mental health.
• Notice your thoughts and feelings. Pause to hear what your mind is telling you rather than letting thoughts and feelings run amok, unchecked (How Negative Thinking Destroys Your Mental Health). Notice them, accept that they’re there, and then decide for yourself whether they’re completely true or if you want to adjust them.
• Embrace your decisions. Always look forward, never back, and be confident that you are steering yourself in a positive direction.

Recommended Video

You need to practice self-care daily, although it may feel strange. Here's how to incorporate daily self-care into your life and why you should do it. Watch now.

 

Articles Related to Listening to Yourself

• Taking Care of Myself by Asking for What I Want and Need
• Listen to Your Body: Pay Attention so You Can Hear
• Shift Self-Talk: Don’t Listen to What Anxiety Says About You
• Other People’s Opinions and Your Self-Esteem
• Empathy for Yourself and Others in Eating Disorder Recovery
• Self-Love
• Self-Compassion and Self-Esteem Both Help Our Wellbeing

Today's Question: When has listening to yourself helped you and your mental health? We invite you to participate by sharing your thoughts, experiences, and knowledge on the HealthyPlace Facebook page.

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From the HealthyPlace Mental Health Blogs

On all our blogs, your comments and observations are welcomed.

• The Holidays Made Me Mad
• How to Set Eating Disorder Recovery Resolutions for 2022
• Escaping a Cycle of Self-Harm and Self-Hatred
• What Do Thoughts of Hurting Yourself Mean?
• When Anxiety Is a Barrier to Your Goals in the New Year
• Introduction to Juliet Jack, Author of ‘Surviving Mental Health Stigma Blog’
• Introduction to Liana M. Scott, Author of 'Anxiety-Schmanxiety Blog'

Feel free to share your thoughts and comments at the bottom of any blog post. And visit the mental health blogs homepage for the latest posts.

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From the HealthyPlace YouTube Channel

Elizabeth is very happy that she no longer suffers from the schizoaffective disorder symptom of hearing voices. Find out what it's like for her to be free of auditory hallucinations right here. Take a look.

Subscribe to the HealthyPlace YouTube channel

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Most Popular HealthyPlace Articles Shared by Facebook Fans

Here are the top 3 mental health articles HealthyPlace Facebook fans are recommending you read:

1. Grounding Techniques for PTSD
2. How Anxiety Ruins Relationships
3. My Depressed Partner Blames Me for Everything. Should I Put Up with It?

If you haven't already, I hope you'll like us on Facebook too. There are a lot of wonderful, supportive people there.

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Quote on Harmful, Negative Thoughts

“Nothing in this world can torment you as much as your own thoughts.”

Read more quotes about mental health and mental illness.

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That's it for now. If you know of anyone who can benefit from this newsletter or the HealthyPlace.com site, I hope you'll pass this onto them. Please share the newsletter on any social network you belong to. For updates throughout the week, follow us on Twitter, like us on Facebook, subscribe to our YouTube channel, or follow us on Instagram.

Thank you,
Deborah

Community Partner Team
HealthyPlace.com - America's Mental Health Channel
"When you're at HealthyPlace.com, you're never alone."
http://www.healthyplace.com

Bulimia statistics can be frightening at first glance and underscore the seriousness of bulimia nervosa and other eating disorders.

Bulimia Statistics: How Prevalent is Bulimia?

Bulimia nervosa is statistically more common than anorexia nervosa, but anorexia can lead to bulimia and in rare cases bulimia can lead to anorexia. Bulimia statistics include:

• The lifetime prevalence of bulimia nervosa among women is 1%-3%
• Lifetime prevalence among men is 0.1%

Concerned that you might have bulimia? Take our bulimia test.

Bulimia Facts: Who Becomes Bulimic?

Bulimia facts are hard to pinpoint as eating disorders have only recently started receiving serious study. Adoelscent women in industrialized countries who suffer from low self-esteem appear to have the highest risk for developing bulimia. Bulimia statistics suggest that cultural norms surrounding beauty and thinness can affect the development of bulimia, but race itself is not a factor. Facts about bulimia include:

• Bulimics are often normal to slightly overweight
• Bulimics overestimate their body's size
• One third of patients who present for treatment of bulimia nervosa have past histories of anorexia nervosa
• Median age of bulimia onset is 18 years

What Happens During Bulimia?

Many changes in the human body result from long-term bulimia. Because typically bulimics do not get as dangerously thin as anorexics, the physical damage may not be as severe, but does include damage to most body organs as well as severe tooth decay. Other bulimia facts include:

• Bulimics commonly have other mental illnesses such as depression or substance abuse
• Bulimics commonly have irregular menstrual periods and may become infertile
• 0-3% of women with bulimia eventually die from complications of the disease, although these numbers may be underestimated

Information on the effects of bulimia.

Facts and Statistics on Bulimia Recovery

Bulimia statistics on recovery are some of the most sobering facts about bulimia. While most bulimics who receive treatment do go into remission, the incidence of relapse is extremely high and often some symptoms of bulimia still remain. Recovery statistics include:

• Cognitive behavioral therapy reduces binge-eating, vomiting and laxative misuse by about 90% and as much as 2/3 stop binge-eating entirely²
• CBT shows improvement of symptoms within 6 months of initiation
• A specific form of cognitive behavioral therapy has been developed for the treatment of bulimia known as CBT-BN.
• Fluoxetine (Prozac) is the only antidepressant with clinical evidence to support its use in the treatment of bulimia, but other selective serotonin reuptake inhibitors (SSRIs) are being studied
• 5-10 years following presentation, approximately 50% of all women with bulimia nervosa fully recover while 20% still have full bulimia nervosa
• Bulimics who receive ongoing treatment achieve greater remission rates than those who don't

(Bulimia facts and statistics provided by eMedicine¹ unless otherwise noted.)

article references