Learning About Your Health

Adults Living With Type 2 Diabetes: Your Care in the Hospital and at Home

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What is Diabetes?

Diabetes is a Self-Managed, Life Long Condition:
There are two types of diabetes, type 1 and type 2. The outcome is the same with both types of diabetes – your blood glucose (sugar) is high. With type 1 diabetes, your pancreas no longer makes insulin and so you must give yourself insulin injections (shots) to live. With type 2 diabetes, your pancreas can make some insulin, however your body may not use it properly. And over time, your pancreas may make less and less insulin. The liver also assists in regulating blood glucose. There is no cure for diabetes. Management of diabetes requires that you take special care of yourself by keeping your blood glucose in a safe range. With the support of your family, and the Diabetes Management team, you will learn how to manage diabetes and prevent long-term complications.

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Your Diagnosis of Type 2 Diabetes

You and Your Doctor Will Discuss Your Diagnosis of Type 2 Diabetes:
Insulin is a hormone normally made in the pancreas that helps to keep your blood glucose in the normal range. Most foods turn into sugar (which is the main fuel of the body). Insulin is necessary to allow the sugar to get into the body's cells to be used as energy. As long as there is a lack of insulin, your blood glucose will remain high and you will not get energy from your food. Insulin is necessary for life. With type 2 diabetes, your pancreas does not make enough insulin for proper use. In addition, the muscle cells necessary for energy do not take in sugar. This is called insulin resistance. Over time, the pancreas may tire out and lose its ability to make enough insulin. This is called insulin deficiency.

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Your Hospital Stay

Diabetes may not be the main reason for your hospital admission. The length of your hospital stay may vary depending on the seriousness of your condition. Some conditions such as infection, stress, or surgery may make it difficult to manage your diabetes. However, it is important to keep your blood glucose levels under control to promote healing and recovery.

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Tests & Treatments

Testing your blood glucose levels is key to managing type 2 diabetes. There are 2 different tests to check your blood glucose control:

  • A1C: This blood test measures your blood glucose control over the last 2-3 months. This test is done by the laboratory.

  • A "finger stick" blood glucose test: This test measures your blood glucose at the time you test it. To obtain blood for this test, your finger is pricked with a small needle device.

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Understanding Your Medications

Intravenous Fluids:
The nurse may place an intravenous (IV) line in your arm to give you fluids and medications (including insulin if needed).

Oral Diabetes Medications (Pills):
Your doctor may order one or more medications in pill form to control your diabetes. These medications do not contain insulin. These medications are divided into 5 different groups. Each group of medications works in different ways. Please see Basic Skill #2 below for a complete listing of oral diabetes medications. Also, read the precautions on taking oral diabetes medications.

Insulin by Injection:
You may need insulin by injection during your hospital stay. You may also need this insulin when you go home, even if you are taking oral diabetes medications (pills). If you require insulin when you go home, the nurse will teach you how to give insulin subcutaneous injections (under the skin) using a syringe or insulin pen.

The nurse teaches you:

  • How your body uses insulin.
  • When to take oral diabetes medications (pills) and/or insulin in relation to meal times.
  • Types of oral diabetes medications (pills) you may be taking.
  • Type of insulin if necessary (rapid-acting, short-acting, intermediate-acting and long-acting).
  • Your oral diabetes medication and/or insulin schedule.

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Managing Your Diabetes – Know the 6 Basic Skills

In the hospital, you will learn basic skills to safely manage your diabetes.

  1. Testing Your Own Blood Glucose
  2. How to Take Your Oral Diabetes Medications
  3. If Needed – Drawing Up, Injecting, and Timing Your Insulin
  4. Your Individual Meal Plan
  5. Preventing, Recognizing and Treating a Low Blood Glucose (Hypoglycemia)
  6. When to Call Your Doctor

Basic Skill #1: Testing Your Own Blood Glucose

If you are going home on insulin, before you leave the hospital, you will learn how to use a blood glucose meter and you will be given a record book. This important record tells you and your doctor how much insulin you need to take on a daily basis to control your diabetes.

The target blood glucose range is 90 - 130 (before meals)
and under 180 (after meals).

The target blood glucose may also be individualized
by your physician or diabetes educator.



Basic Skill #2: How to Take Your Oral Diabetes Medications

These medications are divided into 5 different groups. Each group of medications works in different ways. See below for the precautions on taking oral diabetes medications.

Sulfonylureas
Help the pancreas make more insulin. (Take this medication before you eat.)
Glyburide (Micronase, Glynase, DiaBeta)
Glipizide (Glucotrol, Glucotrol XL)
Glimepiride (Amaryl)
Tolazamide (Tolinase)
Tobutamide (Orinase)
Meglitinides
Help the pancreas make more insulin. (Take this medication before you eat.)
Repaglinide (Prandin)
Nateglinide (Starlix)
Thiazolidinediones (TZDs)
Help your body use its own insulin better. This lessens insulin resistance. (Take this medication as directed.)
Pioglitazone (Actos)
Rosiglitazone (Avandia)
Biguanides
Reduce the production of sugar by the liver. The liver stores sugar as glycogen – to be converted to sugar and used as energy when needed. (Take this medication with meals to decrease the possibility of nausea and diarrhea. If symptoms persist, contact your doctor.)
Glucophage (Metformin)
Glucophage XR (Metformin Long-Acting)
Combination Drugs
Glyburide/Metformin (Glucovance)
Glipizide/Metformin (Metaglip)
Avandia/Metformin (Avandamet)
Alpha-Glucosidase Inhibitors
Reduce the absorption of sugar in the intestines. (Take this medication before meals.)
Acarbose (Precose)
Miglitol (Glyset)
Note: Precautions on Taking Oral Diabetes Medications

  1. Talk with your doctor and/or diabetes educator about the possible side effects of these medications.

  2. The Sulfonylureas and Meglitinides may cause low blood glucose. Review with your doctor and/or diabetes educator when to take these medications to prevent low blood glucose.

  3. If you have a history of heart disease or congestive heart failure, review with your doctor and/or diabetes educator about the safety of taking Actos or Avandia. These medications may promote fluid weight gain.

  4. If you drink alcohol or have kidney or liver disease, review with your doctor and/or diabetes educator about the safety of taking Metformin or combination drugs.

Basic Skill #3: If Needed – Drawing Up, Injecting, and Timing Your Insulin

  • If needed, you will learn the timing and action of your insulin in relation to your food intake. See Appendix A: Chart – The Action and Timing of Different Types of Insulin.

  • If needed, the nurse will give you a schedule of how much insulin to draw up for your injections and the number of times in a day that you will need to give yourself an injection. See Appendix B: Schedule for Taking Insulin at Home.

  • Needle Disposal: All used needles (including syringes, lancets, and insulin pen needles) need to be safely disposed of in a special container called a sharps or safe container. Check with your pharmacist or diabetes educator about how to obtain one as well as how to safely dispose of a filled sharps or safe container.

Basic Skill #4: Your Individual Meal Plan

  • Follow your meal plan provided by the dietitian to balance and maintain your blood glucose in a safe range.

  • It is important to check your blood glucose level often and to take your oral diabetes medication and/or insulin at the correct time.

  • Eat the right foods at the right times to keep your blood glucose in balance. (See Appendices C – Dietary Guidelines for Diabetes, D – Carbohydrate (CHO) Food Choices, and E – Sample Meal Plan.)

  • Maintaining an adequate body weight is critical to controlling diabetes.

Basic Skill #5: Preventing, Recognizing and Treating a Low Blood Glucose (Hypoglycemia)

It is important for you to prevent low blood glucose. A low blood glucose is a reading which is under 70 mg/dl. Your blood glucose is also low if it is 70-100 mg/dl with symptoms (See Warning Signs below). The nurses will teach you how to prevent, recognize and treat low blood glucose. Be sure to discuss the signs and symptoms of low blood glucose with your nurse and doctor before you go home.

Know the Warning Signs of Low Blood Glucose:
Early Warning Signs: Sweatiness, cold clammy skin, shakiness, crankiness, nervousness, hunger, weakness, rapid heartbeat, feeling dizzy or lightheaded, headache.

Late Warning Signs: Tingling around the mouth, mental dullness, personality change, seeing spots in front of your eyes, and changes in your vision.
Treat Low Blood Glucose Right Away: TEST your blood glucose immediately or if you are unable to test your blood glucose, eat one of the following emergency foods and check your blood glucose as soon as possible.

Emergency Foods (approx. 15 Gms CHO):
  • ½ (4 oz.) cup orange juice or ½ cup apple juice
  • 4 round or 3 square glucose tablets
  • 1 tablespoon of honey
  • 5 small sugar cubes or 1 tablespoon of sugar
  • 8 Lifesavers®
  • 2 tablespoons of raisins (1 small box)
  • 1 cup of skim milk
Wait 10-15 minutes, recheck blood glucose, if blood glucose remains below 70 or you are still symptomatic, repeat emergency food treatment.

Note:
If your blood glucose is less than 55:
→ Take 6 oz. of juice or 5 glucose tablets.

If your blood glucose is less than 40:
→ Take 8 oz. of juice or 6-8 glucose tablets.
Low Blood Glucose and Driving:

  • Check your blood glucose before driving.
  • Do not drive if your blood glucose is below 70 mg/dl or you have the symptoms of low blood glucose.
  • When driving or traveling, carry a blood glucose meter and glucose tablets.

Basic Skill #6: When to Call Your Doctor

When you are sick, the stress from the illness can make your blood glucose rise. However, if you are unable to eat or to keep food down, your blood glucose may become too low.

Call Your Doctor:
  • If you are unable to keep food down or if your blood glucose is below 70 or above 300.
  • Per your doctor's recommendations.

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Making Lifestyle Changes

This is your formula for successful diabetes management.

  • Monitoring Your Blood Glucose: Regular monitoring of your blood glucose is important to keep your blood glucose levels controlled for your overall health.

  • Taking Your Medication Correctly: It is important that you carefully follow the instructions given by your doctor and pharmacist regarding your medications.

  • Eating the Right Foods at the Right Times to Keep Your Blood Glucose in a Safe Range. Follow your meal plan provided by your dietitian.

  • Following a Regular Exercise Program: Talk to your doctor before you start an exercise program. Learn about the health benefits of regular exercise. Ask for guidance from your health care provider on what type of exercise program might be best for you.

  • Maintaining a Healthy Weight: It is important to maintain a healthy weight. Talk to your doctor and/or health care provider about ways to lose and/or maintain a healthy weight.

  • Calming the Stress in Your Life: Accepting the diagnosis of diabetes can be difficult. Talk to family members or close friends, or try joining a support group. Set aside time to enjoy stress relieving activities such as listening to music, walking with friends, or reading a good book.

  • Learning More About Your Diabetes: Knowledge about your diabetes can give you a sense of control in your daily life. Talk to your health care professionals about taking educational classes.

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Managing Your Diabetes Checklist

Uncontrolled high blood glucose can impact your overall health in many ways. It can affect your heart, nerves, and blood vessels. It is important to follow the American Diabetes Association Guidelines to Keep Healthy that are listed below. Keeping your blood glucose levels under control helps prevent serious long term medical conditions such as:

Eye DiseaseHeart Problems
Kidney DiseaseStroke
Nerve DamageHigh Blood Pressure
Frequent InfectionsBlood Vessel Disease
Gum Problems

Note: These serious long term medical conditions are preventable. Remember – if you control your blood glucose 85% of the time – that is considered good control.


American Diabetes Association Guidelines to Keep Healthy:

  • Have your blood pressure checked at every medical appointment. High blood pressure increases your risk for long-term health problems. Goal: blood pressure less than 130/80.

  • Cholesterol test every year - total (below 200). Lipid profile means:
    • HDL (good cholesterol) Men: above 45; Women: above 55.
    • LDL (bad cholesterol) below 100.
  • Triglycerides (below 150).

  • A1C every 3 to 6 months (goal <7%).

  • Stop Smoking - Call the California Smokers' Help Line at 1-800-NO BUTTS (1-800-662-8887) for support and a list of resources in your county to help you stop smoking.
Diabetic Feet
 
  • Complete foot exam every year by your doctor; self foot exam every day; and never go barefoot even at home.
  • Call your doctor for a sore on your foot that does not heal in 3 days or if the sore looks infected call immediately.
  • Dilated eye exam every year.
  • Microalbuminuria (small protein in the urine) test for kidney problems (goal below 30) every year.

  • Physical exam every year. During your exam, ask your doctor about the Flu shot that is offered every Fall, and the Pneumonia Vaccine.
Obtain Your MedicAlert® Bracelet or Necklace:

The application form is available in the Center for Diabetes Services or from your local pharmacy.

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More Ways to Learn About Your Health

Make an Appointment to Learn About Diabetes
Call the Center for Diabetes Services at (415) 600-0506 to make an appointment for an individualized diabetes education program.
The Center is located at 3801 Sacramento Street, 7th Floor.
Hours: Monday - Friday 8:00 a.m. until 5:00 p.m.
If you live out of town, the CDS staff will provide you with a local referral number. A family member, friend, or caregiver is encouraged to attend this educational program with you.

Watch the Patient Video Education Channel
Anyone can use the video library by following these instructions:

  • Tune to channel 60 on the television set, and follow the on-screen directions.
  • Pacific Campus patients dial extension 78888, California Campus patients dial extension 21000, and Davies Campus patients dial extension 33600.
  • Order videotape for viewing according to category or title by listening to information given over the telephone.
  • Please watch the following videos*:
    • Basic Skills for Controlling Diabetes
    • Understanding Insulin
    • Injecting Insulin
    • Diabetes Foot and Skin Care
    • Healthy Food Choices: Developing a Plan

      *All videos are available in Spanish
Visit These Web Sites
Interactive Tools

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Appendices


Produced by the Center for Patient and Community Education in association with The Center for Diabetes Services at California Pacific Medical Center. Last updated: 7/06.

References: American Diabetes Association (2005) Position Statement, Standards of Medical Care for Patients With Diabetes Mellitus. Retrieved October 2005 from http://care.diabetesjournals.org/cgi/content/full/25/suppl_1/s33.

© 2004-2008 California Pacific Medical Center

Funded by: A generous donation from the Mr. and Mrs. Arthur A. Ciocca Foundation.

Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).

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