• Skin care
• Foot care
• Eye care
• Dental care
• Travel
• Eating out
• How About a Drink?
• Make the Best of Sick Days
• Care of Elderly Diabetics
• Special Concerns of Male Diabetics
• Emotional Factors and Diabetes
• Hugs Help

Travel

Diabetes is a disease in which your personal role in your treatment has an important effect on the quality of your life. Your health care team will give you guidelines to follow for personal routines that can help you enjoy a more normal live.
As a diabetic you will want to devote a little more attention to some of your personal care than you may have done before. Your health care team will provide you with specific hints concerning care of your skin, feet, and teeth. Maintaining good skin-cleaning habits can help your skin remain healthy and protect your body effectively. Promptly treating minor injuries such as burns, cuts, and bruises helps your skin heal properly and avoids problems. Your health care team will explain that, because decreased circulation in many diabetics is often noticed first in the legs and feet, attention to foot care can help you maintain good function. Avoiding poor diabetic control can help you avoid other problems such as vascular system difficulties, kidney disease, and dye difficulties.
Your health care team will also instruct you about general hygiene, what to do when you are ill, what to do when traveling and eating out, what to do about social drinking (if you are permitted to do so at all by your physician), as well as addressing sexual concerns. If you are elderly, your health care team will tell you about special arrangements for your home health care.
Your family's emotional adjustment to your diabetes will also be an important concern which your health care team will discuss with you and members of your family. Your family's health education should begin right away. Family members will quickly learn that diabetes isn't contagious and isn't transmitted by any kind of physical contact. As you and your family learn to live with diabetes, you will all become familiar with common acute and chronic complications and their possible prevention, how to recognize circumstances warranting a call to your health care team, skills such as blood and/or urine testing, and, if necessary, injection techniques. Your health care team will assist you in living comfortably with your disease by providing continuing education during each visit.

• Skin Care

Because diabetes can cause changes in the tiny blood vessels that supply your skin with nutrients, proper skin care is especially important in preventing bacterial and fungal infections, impaired nerve sensations, dry, itchy skin, and other skin disorders. Your health care team will suggest daily guidelines for your personal hygiene. These may include the following.
• After bathing, keep your skin dry, particularly in the skin folds in the armpits, the groin, and under the breasts. Use talcum powder to help yourself stay dry.
• When bathing, avoid excessively hot water and use a super fatted soap to lubricate your skin. Try to avoid harsh and highly perfumed soaps.
• Use a humidifier at home to moisten the air during the cold winter months. Use a lubricating skin oil to moisturize your skin when the humidity is low.
• Take care of any injuries to hands or feet right away. People with impaired nerve sensations tend to be more susceptible to infections, particularly in the legs and feet. Seek professional assistance for changes such as pressure injuries from shoes or changes in color of your skin and proper management of open wounds, should they occur. Check your feet frequently, since you may not feel an injury to your feet as readily with diabetic nerve changes that create decreased sensation.
5. Avoid excessive exposure to the sun, as these burns can be serious to a diabetic because of infection, dehydration, and altered diabetic control.

• Foot Care

You feel as good as your feet feel. To keep your feet feeling good, your health care team will recommend many of the following routines for you.
• After daily bathing, dry your feet well. Excessive moisture can set the scene for fungus infections, blisters, and other irritations.
• When choosing shoes and socks, be sure they fit well and do not cause pressure effects such as corns and calluses or constriction by elastic.
• Keep your toenails trimmed straight across and not too short. Avoid cutting into the corners, which could injure the soft tissue and permit infection to develop. To prevent ingrown toenails you might want to round the corners gently.
• If you do develop corns and calluses, careful use of pressure relieving pads may help. If you want to reduce corns and calluses, discuss this with your health care team. They may recommend use of a pumice stone. If corns and calluses cause persistent pain, redness, or swelling, you will want to seek professional advice from competent specialists recommended by your medical advisors.
• If excessive dryness or cracking of the skin on your feet is a problem for you, moisturizing bath oil or skin lubricants may be helpful.
• In cold climates, wear adequate protective outer footwear. Boots should be warm, waterproof, and fitted carefully to prevent constriction, excessive rubbing, and frostbite.
• Use caution when going barefoot at swimming pools, on the beach, and in locker rooms. Wear clogs or waterproof sandals whenever possible in public places. Wearing slippers or shoes at all times can help prevent foot injuries at home. Wear socks or stockings to absorb moisture as bare feet in moist shoes may result in blisters.
• Apply cleansing or antiseptic solutions to any openings in the skin. Call your health care team for advice if you have an injury.

• Eye Care

Blood vessels in the eyes may show effects of diabetes. Your physician will probably examine your eyes during most routine visits to check for subtle changes. Additionally, to preserve your vision there are several things you can remember to do:
• Have your eyes and vision checked periodically by an ophthalmologist. If you wear glasses, be sure your prescription is up to date.
• If you notice that your vision is blurred or changed markedly, consult your physician, as diabetes control changes as well as other conditions can be treated early.
• When you have your eyes checked regularly by an ophthalmologist, be sure to make known the fact that you have diabetes. If there are signs of diabetic changes, your ophthalmologist or retinal specialist may advise a test known as an angiogram. With this test a dye is injected into your arm, and pictures are taken of your eyes to indicate blood vessel changes. Early treatment of these vascular changes with laser or other techniques has been extremely important in prevention progressive eye changes that occur in longtime diabetics.
• Wear protective eyewear while manipulating machinery that may cause flying particles. Wear sunglasses while outdoors in bright sunlight.
• Don't rub your eyes unnecessarily. If you have to touch your face to shave, apply makeup, or remove foreign objects from your eye, be sure your hands are clean.
• Avoid straining your eyes. Try to maintain adequate lighting when reading, writing, or working. Get enough sleep.

• Dental Care

Oral hygiene is an important aspect of overall diabetic care. Your teeth and mouth tissues must be in good health to prevent dental problems that could have serious complications, such as gingivitis. To keep your mouth in top condition your health care team will recommend that you follow a few suggestions:
• See your dentist at least twice a year. Have a checkup and have your teeth cleaned (prophylaxis) at least twice a year. Follow your5 dentist's recommendations for mouth x-rays, which will permit changes in bony structures to be seen.
• Brush your teeth regularly, at least twice a day, following instructions from your dentist or oral hygienist. If possible, keep a toothbrush in your purse or pocket so that you can brush during your workday or while away from home after meals. Floss your teeth daily according to your dentist's recommendations.
• If any scratches, sores, or other injuries appear in your mouth, seek professional advice. Avoid using too-hard toothbrushes that might irritate delicate oral tissue.
• Be sure to tell your dentist that you have diabetes. Your dental office may wish to contact your health care team before any dental procedures are done.

• Travel

Travel is part of the spice of life. A little change of scene is as good for diabetics as for nondiabetics. Along with a change of scene, however, comes a change in personal care routines. As a diabetic you should plan for changes in your routine ahead of time by consulting your health care team. Plan as far ahead as possible. Learn the locations of local American Diabetes Association affiliates in the areas in which you will travel. Other suggestions your health care team may make include the following.
• Carry enough supplies with you so that, if you stay away longer than you originally plan, you won't have to look for supplies (especially important in foreign countries).
• In a separate case, carry your urine and/or blood testing equipment as well as insulin, syringes, and swabs. Don't pack these items in luggage that you check on a plane, train, or bus.
• Carry identification indicating that you have diabetes and information about you medication and dosages. Carry a prescription from your doctor for your insulin and syringes. Carry ant nausea medication as well as medication to relieve possible vomiting and diarrhea.
• Plan to alter your meal plan according to your travel plans. For example, when traveling by car, plan on having extra food supplies with you to avoid an insulin reaction. You can keep hard candy, raisins, graham crackers, or fruit handy.
• Store your insulin in a cool place such as inside the car with  you rather than in a trunk or glove compartment, where it might be extremely warm or exposed to heat or sun.
• If you are flying, be prepared to change your insulin injection procedure if you need to have an insulin injection while in the air. Plan on putting about half the usual amount of air into your insulin bottle to balance for pressure in the cabin in a high altitude flight.
• Be aware of changing time zones and administer your insulin injections and have your meals on your home time rather than according to the time zone you are in. Your health care team will assist you in planning ahead for time zone changes of two hours or more.
• Because traveling causes special stresses, it will be important to continue testing your glucose levels frequently to be sure that your diabetes is under control. If you notice high sugar readings, try to exercise more and reduce your intake of carbohydrates. Your health care team will give you instructions to follow regarding changes in insulin doses if your glucose level can't be controlled with exercise and carbohydrates.
• Be careful about getting blisters from more walking than usual. Try to break in new shoes before going on a trip. If you do get a blister on your foot, try to keep the blister from breaking by covering it with a simple dressing. Don't use tapes that injure the skin further. Use paper of special tape. Your health care team will advise you about various first aid procedures for such injuries.
• Learn to say (or carry a card with your reading) "I have diabetes" in the languages spoken in the area in which you might travel.
• Tell your traveling companion's) that you are diabetic and how they can assist you in case you need help. If you are on a tour, be sure that the tour guide or operator known about your special needs, particularly about having meals at proper intervals and about what to do if a medical emergency occurs.

• Eating Out

Eating out can be fun for you as well as your companions. The difference is that you, as a diabetic, will want to remember to fit your eating out into your overall meal plan and allotted exchanges for each day. You will want to be careful to keep high sugar foods to a minimum and avoid highly salted foods. Watch portion sizes so that you do not unknowingly consume too many calories during one meal.
When preparing your meal plan your health care team will ask questions about your eating out habits and make some general recommendations for you to use as guidelines when you eat out.
Following are some tips.
• Become familiar with your meal plan. Know it well. If you can't remember it all, carry a copy with you. Become familiar with foods and portion sizes on your exchange lists.
• Ask questions about how food is prepared before you order it. Try to advise your hosts or the restaurants you patronize that you have diabetes to avoid meal delays and inappropriate meals.
• When you know that there will be a wait for a table in a restaurant or at a group meal, such as a banquet, carry a snack to eat while waiting but then plan to eliminate part of the meal to account for the snack in your total daily caloric intake.
• Ask local restaurant owners to provide more menu variety, more salad bars, and better beverage choices. Be a strong consumer and make your desires and needs known.
• Ask for substitutions in restaurants. If inappropriate foods are part of the meal, ask for another food in their place or simply skip some foods but maintain the calories and balance of your meal.
• Choose foods that are not prepared with sauces or gravies. Try to avoid breaded or creamed dishes; they are likely to be higher in calories than plainer foods.

• How About a Drink?

If you are accustomed to having an occasional alcoholic drink, you may want to ask your physician about the timing of such beverages and the types you can drink safely. Many physicians say it is not harmful for most people with diabetes whose disease is under control to have a drink once in a while. However, remember that alcohol consumed before or during a meal may produce changes in your blood sugar. Alcohol drunk before a meal may cause a drop in your blood sugar. Since alcohol consumed must be calculated into your daily caloric intake, be aware of the caloric content of your favorite drinks. In younger persons with diabetes parental supervision will

Whiskey, Wine and Beer Caloric and Exchange Details*

Alcoholic Beverages Containing No Carbohydrate*

Alcoholic Beverages Containing No Carbohydrate (cont.)

Play a role in consumption of alcoholic beverages. Parents may wish to make their own family habits regarding this matter known to the child's physician. In some cases alcohol use by per sons with diabetes or abuse of alcohol can have serious consequences. If you have been a heavy drinker, you might want to discuss your habits with your health care team, which will assist you in trying to alter your habit to fit the requirements of your dietary therapy for your diabetes.
Also, if you have non-insulin-dependent diabetes and take one of the oral hypoglycemic, alcohol may cause extreme flushing, and you may notice a very warm sensation and some redness or the skin.
If your diabetes is out of control, consumption of alcoholic beverages should be avoided.
Your health care team will give you some general guidelines, from which you can draw the aspects that are most applicable to you. These may include the following.
• If you have certain forms of heart or kidney disease, gastritis (inflammation of the stomach) or pancreatitis (inflammation of the pancreas), you will probably be advised to avoid drinking. Also, if you have high triglyceride levels (certain fats in the blood), you will probably be advised to avoid drinking. Chronic consumption of alcohol can aggravate the condition, which in turn may be a major cause of atherosclerosis.
• If you are not eating regularly, drinking can produce hypoglycemia because alcohol taken while fasting enhances the blood sugar action of insulin and interferes with your body's ability to produce glucose.
• If you are taking oral glucose lowering medications, alcohol can cause a lowering of your blood sugar.
• If you are dieting to lose weight, remember that alcohol provides calories but has little nutritional value. Alcohol should contribute no more than 6 percent of your total calories each day.
• Alcoholic drinks are usually calculated as fat exchanges. Check your meal plan and omit appropriate fat exchanges for the day if you have had a drink. If you cook with alcohol, you do not have to calculate the amounts you use in your meal plan because the alcohol evaporates as it cooks. Few calories remain, making alcohol a good low-calorie flavoring.
• It may be helpful to know that dry wines usually contain moderate amounts of alcohol (12 percent) and have little or no sugar. Very sweet dessert wines and liqueurs have up to 50 percent sugar and should be avoided.
• Keep in mind the dangers of mixing alcohol and medications. You may want to talk to your physician or pharmacist about the advisability of drinking while taking certain prescriptions or over the counter medications.
• Remember that alcohol dependency is generally unhealthy for diabetics and nondiabetics. Alcohol can damage all the vital organs in the body.

• Make the Best of Sick Days

Most people have days when they feel a little under par. Diabetics and nondiabetics alike get colds, flu, upset stomachs, and other common ailments. When this happens, rest, relax, and make the best of the day. However, keep in mind that, as a diabetic, these minor ailments can be more serious for you than for others because illnesses of any kind can temporarily interrupt your control of your disease.
Illness of any type promotes stress, and stress in turn can raise your blood sugar level and cause a loss of control. If you are unable to eat or drink because of illness, you will learn to make certain adjustments in your insulin therapy. At some times you will be able to make these adjustments yourself without calling your physician. At other times you will want to seek professional advice. Self monitoring of your glucose level will be important at such times, and when you call your physician you may be asked about the results of your at home tests. Some specifics to remember regarding sick days are:
• Keep your physician's phone number handy. Know how to reach other members of the health care team. Be sure others in your family also have these phone numbers.
• Ask your physician and health care team to prepare a sick day menu plan for you during one of your routine visits. They will give you several variations of your regular menu plan to follow when you do not feel well.
• Carefully record results of your home urine and /or blood tests. Do not omit your home tests, especially if you do not feel well. Also record your fluid and food intake so that you can report these to your doctor when you call on a sick day.
• Take your usual dose of insulin. If your self tests are high for sugar, test for ketones; if ketones are present, call your doctor right away. You may need extra insulin.
• Report vomiting episodes to your doctor right away. Keep available an antiemetic prescribed for you to control nausea and vomiting and use it according to your physician's directions.
• If you are ill, your doctor's advice may be to stay in bed for a few days, drink plenty of liquids, and take medication as advised. Your health care team will make individual recommendations to help you keep your diabetes under control. You should notify them when you are ill so that adjustments in your routine can be made.
• If you have a bacterial infection and your physician prescribes an antibiotic medication for you, be sure to take it according to directions. Antibiotics will not interfere with your diabetic control.
• If you have to be hospitalized, you will have some special nutritional needs. For example, if you require surgery, you might be advised to consume more calories than usual for a while to build up your strength. At this time your physician may adjust your insulin dosage to accommodate for the extra food. Your diabetes health care team will work closely with your general or specialized surgeon to adjust techniques such as anesthesia and medications to meet your specific needs at this time.

• Care of Elderly Diabetics

Some older persons with diabetes find the routines of their diabetic care stressful and sometimes fail to comply with recommendations for control of their disease. If you have an older relative in your household who requires special attention to diabetic control, you can be supportive by reinforcing the physician's instructions, emphasizing the need for constant control of the disease, and assisting the person in personal care routines. Careful bathing and care of the feet and teeth may prevent damaging infections.
Many elderly diabetics have chronic ill health and find some assistance by social service and home health care groups helpful. Some who are unable to continue living in their homes, caring for themselves, consider moving into sheltered care facilities. Elderly persons living in retirement hotels, sheltered car homes, or nursing homes should make their diabetic needs known to staff nurses and others in charge so that meals and lifestyle will be conducive to control the disease.

• Special Concerns of male Diabetics

Impotence, generally defined as a man's inability to achieve and maintain an erection of the penis during sexual intercourse, is common in nondiabetic as well as diabetic men. Impotence has many causes, including emotional ones such as anxiety and fear. It can result from an organic problem, such as systemic or vascular disease or a hormone deficiency. It can happen because of neurological reasons, including brain disease or damaged nerves. Abuse of alcohol and other drugs contributes to impotency. Sometimes side effects of certain medications cause temporary impotency.
While physicians say that there is a higher frequency of impotence in male s with diabetes, only some diabetic men notice impotency or become impotent as a result of their diabetes. When nerve endings are affected by the disease, however, reduced ability to achieve erection will occur. Vascular problems such as hardening of the arteries also contribute to the inability to achieve and maintain an erection, because an adequate supply of blood must flow to the penis.
Your health care team will meet with you and your partner to talk about your adjustments, both psychological and physical, to any changes in your physiological and physical, to any changes in your physiological function. Some of the aspects they will probably mention arte as follows:
• See your physician right away if you are experiencing impotence. It is possible that the condition is occurring as a response to some other factor and not your diabetes.
• Reduce or eliminate use of alcohol. This may alleviate the impotence.
• Sometimes impotence results as a side effect of medications. What medications are you taking? Perhaps they can be substituted for others with fewer side effects.
• What emotional factors are involved in your current situation? How was your sexual relationship before you had diabetes?
• If decreased pelvic blood flow is responsible for preventing blood flow to your penis, vascular surgery might be recommended, and for some a prosthesis might be recommended after thorough evaluation and family counseling.
• More attention paid to diet, wall balanced meals, and weight control may assist in a return of potency. Ask your physician and health care team to reevaluate your meal plan and other lifestyle factors that may affect your potency. Many men have found the condition reversible, and if you have it, you may find it reversible, too.

• Emotional Factors and Diabetes

Coping with diabetes will be an ongoing challenge for you as well as for members of your family. Many feelings will enter into acceptance of the diagnosis. There may be some anger, guilt, or anxieties, both expressed and unexpressed. It is important for you, the diabetic, to discuss these feelings with those who love you. If it is your child who is diabetic, it is important to encourage discussion of these factors so that the child understands that having such feelings is part of the coping procedure.
Stable mental health is important for proper control of diabetes. Emotional stresses affect secretions of hormones that may counteract or interfere with the helpful effects of insulin. How ever, stresses cannot always be avoided easily. It is part of the human condition to react in different ways to different situations. More stress results at some times than at others. Situations that you meet calmly at one time may plunge you into turmoil at another. Your health care team will discuss dealing with the emotional component of your treatment plan. Your emotional needs and problems will be considered along with your menu plan, exercise plan, and therapy by insulin and other medications. Health professionals have had experience in helping diabetic patients cope with emotional responses to their illnesses, and their backgrounds can help you deal with your current concerns and those of your family.
Problems such as consistently mishandling the food plan, refusing to take insulin injections, consciously overeating, and suffering from depression occur in some diabetics. Health care professionals know that these situations can be handled well with the support of parents, spouses. or significant others. As you become acquainted with your health care team and how they can help you, you will begin to feel freer to discuss details about your diabetes of the disease of someone you love. Your team will help you find ways to approach everyday problems so that solutions you find ways to approach everyday problems so that solutions can be found quickly and a plan of compliance with physicians' instructions can be followed more easily. When the person with diabetes appreciates the short and long range goals of therapy compliance seems easier and becomes a part of everyday life.
Your health care team will have many constructive ideas for you and your family. For example, they may encourage participation in a family therapy session to learn about family coping mechanisms along with other families with diabetes. Such groups foster exchanges of helpful ideas concerning the practical aspects of diabetes. They may suggest that you use the "buddy system," working with another diabetic to reinforce support and provide a model for adjustment to life with diabetes. Finally, your health care team will identify existing support systems. They will probably tell you about groups run by your local American Diabetes Association or Juvenile Diabetes affiliate, hospital, or community health department and the availability of social workers trained in diabetes counseling. Being aware of existing services is the first step toward obtaining assistance.

• Hugs Help

Your needs for love and emotional support are the same as those of nondiabetics. Your health care team will help you balance these needs with the special features of you diabetic life style. A combination of acceptance, understanding, and teamwork will help you and those you care about live a happy life.