Diabetes Topics

Diabetes Basics

Diabetes Information for You and Your Family

How does diabetes happen?

Diabetes happens when the body:

What is type 2 diabetes?

Type 2 diabetes is when the body does not use insulin well and does not make enough insulin. This is the most common type of diabetes.

The chances for type 2 diabetes are higher if you:

• Have a parent, brother, or sister with diabetes
• Have ever had diabetes during pregnancy
• Are overweight
• Are not physically active
• Have prediabetes

Prediabetes is having blood sugar levels higher than normal but not high enough for diabetes.

Symptoms of Diabetes

• Increased thirst
• Increased hunger
• Feeling very tired most of the time
• Increased urination
• Unexplained weight loss
• Blurred vision

These symptoms can be severe or mild. Some people may not have any symptoms.

How can you find out if you have diabetes?

A blood test will show if you have diabetes. Ask your health care provider about getting tested and where you can get more information.

Make healthy food choices.

Choose water instead of sugary drinks.

Stay active.

Check your blood sugar.

Take medicine.

Find healthy ways to cope with stress.

Everyone has a different experience with diabetes. Sometimes it can be tough. Having support from family, friends, and others with diabetes can be helpful. There may be a diabetes education program at your clinic or in your community.

Diabetes and Emergencies

When a crisis happens, medication, water, or diabetes supplies may be hard to get. By planning ahead you can act quickly. Have an emergency kit ready to go so you can better manage your diabetes away from home.

Build an Emergency Kit

Get a backpack or box that holds a week or more worth of supplies. Stock the kit with items that apply to you on the checklist. Place the kit where you can grab it and go. See more at Ready.gov Exit Disclaimer: You Are Leaving www.ihs.gov  on how to build your kit.

Diabetes Medical Supplies for 1-2 weeks

• Prescriptions and over-the-counter medications taken by mouth, inhaled, or injected
• Glucose meters, test strips, lancets, and batteries
• Continuous glucose monitoring supplies
• Insulin pens, needles, and syringes
• Insulin pump supplies
• Glucose tablets, juice boxes, or hard candy to treat low blood sugar
• Hand sanitizer and sanitizing wipes
• First aid kit

Personal Information and Items

• Current medication list, along with your pharmacy and provider’s contact information
• Copies of important records, identification, and health insurance cards
• Extra cell phone charger
• Extra pair of glasses or contact lenses, as needed

More Essentials for Your Kit

A 3-day supply of food, water, and other essentials to pack

• Non-perishable food such as peanut butter, crackers, protein bars and shakes, tuna, sardines, nuts, and canned fruit
• A can opener and eating utensils
• One gallon of water per day
• Radio, flashlight, and extra batteries
• A warm blanket and a change of clothing

Things to consider

• Discuss where to meet in case you are separated from your family. Include a back-up location.
• Plan how you will stay in touch if phones and internet are out.
• Decide what tasks need to be done by each household member.
• For more help with making your emergency plan, see the American Red Cross Disaster Preparedness Plan. Exit Disclaimer: You Are Leaving www.ihs.gov 

If you have disabilities or other medical needs:

• Decide what you might need during and after an emergency.
• Talk with your caregivers to help you prepare your emergency plan.
• For help making a plan for people with disabilities, see the American Red Cross, Disaster Safety for People with Disabilities. Exit Disclaimer: You Are Leaving www.ihs.gov 

Diabetes and Pregnancy

Having a Healthy Baby

You’re going to have a baby! In pregnancy, your body goes through many changes. These changes affect the way your body uses sugars and starches (carbohydrates) for energy. Sometimes, these changes cause extra sugar (glucose) to collect in the blood, resulting in high blood sugar, or diabetes.

People who are pregnant can have two types of diabetes:

Eat healthy foods.

Good nutrition is an important tool to help control blood sugar. A dietitian can work with you to create an individualized meal plan.

Eat 3 small meals a day.

Choose foods and drinks low in added sugar. Include vegetables, protein, and whole grains in each meal.

Eat breakfast every day.

Include a protein and a whole grain, such as an egg and a small bowl of oatmeal. Avoid having fruit with breakfast.

Eat 2 or 3 snacks a day.

Combine a fruit, yogurt, or whole grain with a protein or a healthy fat, such as nuts or avocado.

Drink water, milk, and unsweetened beverages.

Limit caffeine and artificial sweeteners. Avoid energy drinks, fruit juices, and sugary drinks.

Be active.

Activity helps to lower blood sugar levels. Light exercise is best, such as walking, dancing, and yoga. Even a 15-minute walk helps lower blood sugar. Ask your provider about exercise during pregnancy.

Test your blood sugars often.

Use a glucose meter to keep track of your blood sugar throughout the day. Your provider or team will help you learn how and when to do testing, and what your blood sugar targets should be.

Take your medications.

If you have gestational diabetes, you may need to use insulin or other medications to control blood sugar. If you have pregestational diabetes, changes to your medications will be needed during pregnancy.

Avoid alcohol, tobacco, street drugs, and medications that your provider hasn’t prescribed.

These substances can harm you and your baby. If you need help quitting, talk to your healthcare provider who can refer you to resources.

After Your Baby is Born

• Continue to eat healthy, be physically active, and keep your weight within a healthy range.
• Breastfeed your baby to reduce your risk of diabetes. If you have diabetes, breastfeeding will help with blood sugar control. Breastfed babies have a lower risk of developing obesity and diabetes later in life.
• Get tested for diabetes six weeks after your baby is born and then once a year if you had gestational diabetes.

Working With the Diabetes Health Care Team

Medical Care

Getting regular medical care is important to living well with diabetes. Below is a list and schedule of routine medical care recommended for managing diabetes.

Each Diabetes Medical Visit

• Blood Pressure
• Foot Check

Every 3 to 6 Months

• A1C Test

Usually Once a Year

• Exams
  • Eye
  • Dental
  • Foot
• Lab Tests
  • Kidney (urine and blood)
  • Cholesterol
• Flu Shot

• Healthy eating
• Managing blood sugar and blood pressure
• Taking care of feet, eyes, kidneys, and heart
• Becoming or staying active

• Taking medicine
• Feelings and emotions
• Coping with stress
• Tobacco use

Checking Your Blood Sugar

Living well with diabetes means knowing how food, activity, and diabetes medications affect your blood sugar. Checking your blood sugar regularly provides information you can use to adjust eating habits and activities to manage your diabetes.

What numbers are right for you?

Blood sugar goals vary from person to person. Talk to your health care team about your goals and what is best for you.

Getting started

Your health care team can help you decide if and when to check your blood sugar. They can provide a blood sugar meter and instructions on how to use it.

When to check

Work with your health care team to make a plan for testing your blood sugar. Common times to check are:

• When you first wake up and before you eat (fasting)
• Before meals
• 2 hours after the start of a meal
• At bedtime

Different ways to check your blood sugar

Blood sugar meters are small devices used to check blood sugar levels. The results show the amount of sugar in the blood at the time of the test.

Continuous Glucose Monitoring (CGM) uses a tiny sensor under the skin to check blood sugar levels every 1 to 5 minutes, 24-hours a day. CGM devices can be linked to a cell phone.

Hemoglobin A1C is a lab test that measures your average blood sugar level over the past 2 to 3 months.

What or when you eat and drink

Medications

Physical activity

Managing stress

Going UP

Things that may cause hyperglycemia

• Eating more than usual or a large meal
• Forgetting your diabetes medication
• Dealing with stressful situations
• Having an illness or infection

Going DOWN

Things that may cause hypoglycemia

• Eating less than usual or skipping meals
• Being more active than usual
• Taking more medication than prescribed by your provider

Low Blood Sugar

Know the Symptoms of Low Blood Sugar.

Low blood sugar can be a problem. You may feel one or more of the symptoms below when your blood sugar is getting low. Some people may not feel any symptoms.

Tips for Managing Blood Sugar

Did you know?

Living well with diabetes is possible!

There are things you can do to help you stay healthy.

Checking blood sugar

Taking medicines

Fats and Heart Health

Diabetes Information for You and Your Family

Fat provides energy for the body. Native people hunted and harvested food like buffalo, seal, fish, nuts, and seeds that provided "good" fats. As food choices changed over the years, so have the kinds of fats we eat.

Today, our food includes more of the fats that may cause heart disease. Heart disease is more common among people with diabetes.

Nutrition Facts Label

The Nutrition Facts label can help you learn about nutrients in foods and drinks.

More Ideas for Heart-Healthy Eating

• Eat plenty of fruits, vegetables, whole grains, low-fat dairy, poultry, fish, and nuts.
• Limit fatty red meat. Choose buffalo, moose, elk, deer, or caribou when you can.
• Eat fish twice a week. Salmon, sardines, and tuna contain “good” fats.
• Decrease how much salt you use. Check the Nutrition Facts label for the amount of sodium (salt) on packaged and fast foods. The recommended daily amount for sodium is 2300 mg.
• Limit sugary foods and drinks.
• Grill, stir fry, bake, boil, roast, or slow cook food

What about eggs?

Eggs are rich in protein and nutrients. They are low in saturated fat with 1 gram per egg. If you eat eggs, limit them to 7-12 eggs per week.

Keeping Your Heart Healthy

Diabetes Information for You and Your Family

Keeping your heart healthy and strong is important, especially if you have diabetes. By taking care of your heart, you can lower your chances of having heart disease.

Below are some things you can do to keep your heart healthy.

Understanding Your Cholesterol

What is Cholesterol?

Cholesterol is a fat-like substance that helps your body build cells, vitamins, and hormones. Too much cholesterol in the blood can be harmful. It can increase the risk of a heart attack and stroke, especially in people with diabetes.

Check Your Cholesterol Levels

This is done with a fasting blood test known as a lipid panel that measures cholesterol and triglyceride levels.

Knowing your cholesterol and triglyceride numbers helps you understand your risk for heart disease.

Recommendations

This table shows optimal cholesterol levels for most adults. However, levels are different for people with diabetes or those at increased risk of heart disease and stroke.

For people with diabetes and cardiovascular disease, the optimal LDL-cholesterol level is less than 70 mg/dL.

For more tips, view: Fats and Heart Health

Form Healthy Living Habits

Begin by making small, positive steps in your daily life.

Heart Healthy Living

• Get regular exercise: 150 minutes/week.
• Lose weight if you are overweight. A 5–10 pound loss may lower blood fats.
• Limit intake of alcohol, if you drink.
• Quit smoking and vaping.
• Cholesterol medication may be needed to reach cholesterol goals.

Heart Healthy Eating Choices

• Eat plenty of fruit and vegetables; choose a wide variety.
• Use healthier fats from plants: corn, canola, olive, soybean, peanut, sunflower and avocado oil.
• Choose healthy proteins: lean cuts of meat and poultry, buffalo, elk, wild-caught fish and game.
• Eat fish twice a week. Fish like salmon and sardines have heart-healthy omega-3 fatty acids.
• Eat less high fat dairy foods like whole milk, cream, and full-fat cheese.
• Eat less fatty meat like pork or beef ribs, sausage, and processed meat like bologna and hot dogs.
• Choose whole grains instead of refined grains like white bread and white rice.
• Avoid foods and drinks high in added sugar.

What Causes High Cholesterol?

• Genetics
• Diets high in saturated fats
• Not enough physical activity
• Having excess body fat
• Smoking
• Some medications

What Increases Triglycerides?

• Added sugar in foods/drinks
• Diets high in carbohydrates and low in fiber
• Alcohol intake in excess
• Being overweight or obese
• Diets high in fat
• Uncontrolled diabetes

Saturated fat comes from animal fat in dairy and meat and from tropical fats. Examples are solid fats like butter, lard and coconut oil.

For more tips, view: Cut Down on Saturated Fats Exit Disclaimer: You Are Leaving www.ihs.gov  [PDF]

Protecting Your Kidneys

When You Have Diabetes

In most cases, there are no symptoms of kidney problems. That is why it is important for people with diabetes to get their kidneys checked.

Take steps to protect your kidneys:

Get your kidneys checked every year.

Blood and urine tests are the only way to know how well your kidneys are working.

Take care of your blood pressure and blood sugar.

Did you know?

Frequent use of common over-the-counter medicines can harm your kidneys.

These include the following:

Ibuprofen (Examples: Advil, Motrin, Midol)

Naproxen (Examples: Aleve, Naprosyn)

Talk with your doctor about over-the-counter medicines you may be using.

Carbohydrates by Color

Carbohydrates are your body’s main source of energy

Carbohydrates (carbs) come from sugars, starches, and dietary fiber. They are part of a healthy diet. For most people, carbs are the body’s leading energy source and affect blood sugar.

How much and what carbs you eat affects how high and quickly your blood sugar rises.

To keep it simple, you can use colors—colorful, brown, and white—to identify carbs. Some carbs are healthier than others. Carbs with deeper or brighter colors are usually more nutritious than paler, more processed carbs, such as foods made with white flour and sugar.

Colorful Carbs

Starchy Vegetables

Starchy vegetables add color and texture to meals. They are healthy substitutes for highly processed grains, such as white flour and white rice. Native people traditionally ate a wide variety of corn, beans, squash, and root vegetables.

These vegetables are naturally high in fiber and nutrients. They raise blood sugar more slowly than the more processed carbohydrates.

Try to eat at least 5 cups of starchy vegetables every week.

Fruit

Fruit is a colorful carbohydrate which is low in fat and calories. The sweetness you taste when eating fruit is from the natural sugar in it. Although fruit has carbohydrates, it is low in fat and calories.

Fruits may be fresh, frozen, canned, or dried. Fruit is a good source of nutrients: potassium, folate, vitamin C, and fiber.

Try to eat 2 to 3 servings of fruit each day—such as a cup of berries and a small apple, or 2 tablespoons of raisins.

Brown Carbs

Whole Grains

Whole grains are usually brown. They come in many shapes and textures and are a major energy source. Whole grains include whole wheat flour, brown and wild rice, rolled oats, and corn meal. Some breads and pastas are made with whole grain.

Whole grain foods are full of fiber and raise sugar more slowly than processed grains. They are less likely to cause spikes in blood sugar.

Make half your grain choices whole grains.

White Carbs

Processed Grains and Sugars

Processed grains and sugar are usually white. Foods made from these tend to raise blood sugar quickly and could contribute to it going too high.

Food made with white flour includes crackers, white bread, flour tortillas, fry bread, and instant noodles.

Choose white carbs less often.

Dairy Foods

Dairy foods are rich in essential nutrients: calcium, phosphorus, vitamin D, and protein. Many dairy foods have carbs along with protein and fat. They can be part of a healthy diet.

Aim for 3 servings of dairy foods each day.

Low Carbs or No Carbs

Foods with low or no carbs have very limited or no effect on blood sugar levels. Some foods with few or no carbs include:

• Meats, fish, eggs, and cheese
• Non-starchy vegetables, such as tomatoes, onions, green beans, carrots, cabbage, celery, lettuce, and peppers

Find the Carbohydrates on My Native Plate

For use with Carbohydrates by Color Fact Sheet

Knowing which foods have carbohydrates (carbs) is one of the first steps to choosing healthy foods. Use the four plates shown to practice finding carbs.
(See answers below.)

1. Find the grains and starches using the color shades of white, brown, and colored foods on the plates.
2. Find the other brightly colored carbs. (Hint, they are naturally sweet.)
3. Find the foods that have low carbs or no carbs.

Helpful Tips

• Try choosing healthier carbs for meals and snacks. Balance the carbs you eat throughout the day.
• Eating the right kinds and amounts of carbs can help with blood sugar control.
• For more on understanding carbohydrates:
  • Visit a Dietitian or Diabetes Care Specialist for an eating plan specifically for you. They can help you learn how many carbs are right for you.
  • This worksheet is a companion material to the Carbohydrates by Color fact sheet.

Healthy Eating on a Budget

Diabetes Information for You and Your Family

Did you know?
Healthy eating is an important part of managing diabetes. Eating healthy doesn’t mean you need to buy costly foods. Many of the foods you already prepare for yourself and your family are healthy.

What are healthy foods?

Plan your meals

• Think about the foods that your family enjoys. Start planning with one meal, such as dinner.
• Start by writing your meal ideas down
• Consider using a Weekly Meal Plan. Exit Disclaimer: You Are Leaving www.ihs.gov 
• Plan easy-to-make meals for when you won’t have a lot of time.

Make a grocery list

• Keep an ongoing list of foods you need.
• Check to see which foods you have on hand.
• Limit adding costly processed foods such as chips, cookies, donuts, soda pop, and packaged meals.

Plan your shopping trip

• Take a freezer bag or cooler if you are far from home.
• Check the store ads for sales. Join the store’s loyalty program for offers and discounts.
• Eat before you shop. It helps you stick to your list.

Save money while you shop

• Look for in-store markdowns.
• Buy store brands. They taste similar to name brands, but cost less.
• Buy fruits and vegetables in season. See - Seasonal Produce Guide. Exit Disclaimer: You Are Leaving www.ihs.gov 

Cook at home

• Eat healthier and save money by cooking at home.
• Cook traditional foods with family to celebrate culture.

Helpful Tips

• Buy healthy foods in bulk. Divide into servings and store.
• Rinse canned vegetables to remove added salt.
• Frozen and canned vegetables are easy to add to meals.

Getting enough healthy foods

Sometimes it may be hard to get enough healthy food. Consider a family garden, joining a community garden, hunting, or gathering what you can from the land and water.

Learn about nutrition assistance programs. Your healthcare team may know about food support options such as:

• Food pantries and/or farmer’s markets.
• Federal Food Assistance Resources. Exit Disclaimer: You Are Leaving www.ihs.gov 
• USDA National Hunger Hotline:
  1-866-3-HUNGRY (1-866-348-6479)

Healthy Recipes

Get Fresh! Cooking Exit Disclaimer: You Are Leaving www.ihs.gov  – Recipes from the Chickasaw Nation and USDA.

MyPlate Kitchen Recipes Exit Disclaimer: You Are Leaving www.ihs.gov  – Videos, seasonal recipes, food safety and more. Diabetes Food Hub Diabetes– Friendly recipes from the American Diabetes Association.

Spend Smart-Eat Smart Exit Disclaimer: You Are Leaving www.ihs.gov  – Ways to cut food costs. Iowa State University Extension & USDA.

Sample Grocery List

• Vegetables
• Fruits
• Wild or brown rice
• Whole grain cereals and breads
• Eggs
• Beans
• Chicken or turkey
• Fish
• Beef or Pork – leaner cuts: round and loin

Limit Added Sugar

Sugar in food can occur naturally or can be added. Sugars (simple carbohydrates) are digested quickly and change to glucose as fuel for the body. Too much sugar is not good for you.

Natural Sugar

Natural sugar is in fruits and naturally sweetened fruit juices, milk, and some vegetables.

Added Sugar

Added sugars are syrups and sugars that are added to foods and drinks during preparation, processing, or at the table.

Too much added sugar may contribute to health problems such as,

weight gain, obesity, and diabetes.

Eating large amounts of added sugar may make it difficult to get all the daily nutrients your body needs and may cause you to consume too many calories.

Sugar Sweetened Drinks

Sodas & Soft Drinks
Teas & Coffees
Energy & Sport Drinks
Powdered Drink Mixes
Fruit Drinks

Desserts

Cupcakes & Muffins
Cakes & Pies
Ice Cream
Cookies & Donuts
Candy

Sweet Breakfasts

Sweet Cereals
Cereal Bars
Pastries
Pancakes with Syrup
Flavored Yogurt

Syrups and Sweets

Jams
Jellies
Chocolate Syrup
Honey
Molasses

SWAP THIS

• Sodas, sports and energy drinks
• Sweet desserts
• Candy bar
• Cookies
• Sweetened cereals

FOR THAT

• Fruit infused water or tea
• Fresh fruit or frozen fruit pops
• Smoked salmon or dried meat
• Peanut butter with celery
• Blue corn mush or cereals with less than 3 grams (g) sugar

Let the Nutrition Facts Label Be Your Guide

Check the label to see if foods are LOW or HIGH in added sugars.

• 5% Daily Value or less is LOW in added sugar
• 20% Daily Value or more is HIGH in added sugar

In this example, the added sugar is 23 grams, and the Daily Value is 46%. This food is high in added sugar.

The Daily Value for added sugars is 10% of total calories per day.

For example, if your daily food intake is about 2,000 calories, this would be 50 grams of added sugars.

Sodium and Your Health

Sodium is a mineral that our body needs in small amounts to keep our fluids balanced. Typically, we get it in the form of salt. Most people get more sodium than their bodies need. If you have kidney disease, high blood pressure, or heart disease, ask your health care provider what the right amount of sodium is for you.

Where is sodium in food?

Reducing sodium can help lower your blood pressure and reduce your risk for heart disease, stroke, and kidney disease.

What about salt substitutes?

Potassium chloride is a common salt substitute. Talk with your provider before using a salt substitute. People with kidney disease are at risk for having potassium levels either too high or too low.

Ways to Reduce Sodium

• Look for foods labeled “No Added Salt,” “Low Sodium,” “Reduced Sodium,” and/or “Lightly Salted.”
• Eat more fruits and vegetables.
  
• Prepare meals with low sodium ingredients.
  
• Rinse canned vegetables, meat/fish, and beans to remove some of the sodium.
  
• Prepare traditional foods with less or no salt.
  
• Eat a smaller portion of a high sodium food or have it less often.
  
• Use herbs, spices, and sodium-free seasonings in place of salt.
  
• Look for hidden sources of sodium in sports and energy drinks, vegetable juice, and cottage cheese.

Sodium impacts people with kidney disease

Kidney disease is when your kidneys are damaged and have difficulty removing sodium from the body. This may raise blood pressure and cause water retention. Talk with your provider about the right blood pressure goal for you.

A deli or bologna sandwich can be high in sodium. Choose a low sodium food like egg salad, or peanut butter and jelly

Read the Nutrition Facts label.

Compare and choose foods with the lowest Percent Daily Value for sodium: 5% is low and 20% is high.*

What is the daily sodium limit?

The recommended daily limit for most adults is 2,300 mg of sodium, which is about 1 teaspoon of salt from all foods and drinks. On average, people in the U.S. get 3400 mg per day, or 50% higher than the adult limit.

Try the DASH Eating Plan,

proven to help lower blood pressure. Learn more at,
DASH – Dietary Approach to Stop Hypertension Exit Disclaimer: You Are Leaving www.ihs.gov 

Looking for healthy recipes low in sodium?
See My Plate.gov Exit Disclaimer: You Are Leaving www.ihs.gov 

How To Get Started Walking

Diabetes Information for You and Your Family

Why walk?

Our bodies are meant to get up and walk—to the mailbox, down the road, around the neighborhood.

How To Walk Farther and Faster

Diabetes Information for You and Your Family

Why walk more?

You are already walking and that’s great! By walking more, you are taking steps to stay healthy and live longer so you can:

• Be there for your children, grandchildren, and other family members.
• Be an active and helpful member of your community.
• Serve as an Elder and share your wisdom.

Being Active is Traditional

For generations, Native people have lived active lives: growing crops, hunting, fishing, and gathering berries, herbs, and traditional medicines. Cultural ways are active, such as dancing, running, drumming, carving, and playing games. Being active improves mental and spiritual well-being—it is good medicine.

Movement helps muscles use sugar for energy, which may improve blood sugars. Any increase in movement is good for you.

How to get started

• Talk with your health care team about what is safe and best for you.
• Set a day and time for your activity, and write it on your calendar.
• Ask a friend to join you.
• Plan indoor and outdoor activities.

Fun ways to get moving

• Gardening, gathering berries and greens, and doing yardwork.
• Yoga and tai chi for balance and flexibility.
• Brisk walking, hiking, jogging, swimming and bike riding.
• Fitness classes and strength training.
• Chair exercises and arm movements.
• Do what you enjoy!

Move More – Sit Less

Sitting for more than 7-8 hours a day at home or in the office can decrease muscle strength and increase the risk of diabetes and blood clots over time. Reduced sitting time has benefits even for those who are physically active.

Interrupt sitting every 30 to 60 minutes