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Creating a Circle of Support

No one can go it alone. Whether you have diabetes or you’re a caregiver, it’s important to have a few options for emotional support. Knowing who to turn to with specific questions will make life easier. Find other people with diabetes Few things are more comforting than talking with someone who understands you when you have diabetes, or if you are facing a type 1 or type 2 diagnosis. If you don’t already have a friend or family member with diabetes who can fill this role, seek out a diabetes support group near you. What have you got to lose? If you don’t like one group, look for another until something clicks. Another great way to find others who support people with diabetes is to volunteer or join fundraising events for diabetes non-profit groups. Some helpful groups may be: Diabetes South Africa (www.diabetessa.org.za) Youth with Diabetes (www.youthwithdiabetes.com) Join the DOC The DOC is the Diabetes Online Community, a deep well of inspiration and support, all online. There are dozens of options: message boards, private groups, social media, blogs… people with diabetes are online everywhere. Some examples of helpful Facebook pages you can join are: https://www.facebook.com/AccuChekSubSahara/ https://www.facebook.com/CDE-Your-Partner-in-Diabetes-1427714494189015/ https://www.facebook.com/YouthWithDiabetes/ https://www.facebook.com/groups/Kidspoweredbyinsulin/ Know your healthcare team You’ve worked with your healthcare providers to lay out a plan for controlling your diabetes, so don’t let all that hard work go to waste. Make (and keep) regular appointments with your primary physician, and find someone like a nurse or diabetes educator you can contact whenever you have questions about your health. Enlist your child’s school If your child has diabetes, build a team of caretakers for your own peace of mind. Ask the school principal or head teacher to arrange a meeting between you and anyone who needs to understand your child’s diabetes needs, such as office workers, the school nurse, all teachers, coaches, and even transportation or field trip chaperones. The Kids and Diabetes in Schools (KiDS) project is a valuable resource for creating a supportive environment at school. Download the information pack , which is divided into sections for teachers, parents of children with diabetes, children with diabetes, and parents in general. It’s free, and can be used with any educational session you arrange with your school. Additionally, get a clear understanding from your doctor about how the school day should work properly, and then make sure that the school understands your child’s daily treatment needs. The school nurse is your best friend. They’ll be your biggest asset when it comes to teaching other staff at the school about how to care for your child. Above all, don’t get discouraged. Learning curves are steep for the first few weeks, and that’s okay. Educate your family and friends One of the tasks that comes with living with diabetes is educating the people around you who aren’t living with it. You may feel like it’s not working, but keep educating others, always speak up, and be clear about what really helps you (and what doesn’t). In time, everyone will be on the same page. And if there’s ever an emergency, they’ll know what to do.

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Ways to Increase Activity

Exercise is good for everyone, but for people with diabetes, it can make a big difference in keeping your blood sugar levels under control. Not only that, but staying active allows your cells to process insulin more efficiently, improving your overall A1C levels. The many benefits of staying active Exercise is one of the cornerstones of managing your diabetes, and the list of its benefits for people with diabetes is long. Exercise can:1 Improve insulin sensitivity for people with type 12 Decrease the glucose in your blood for people with type 23 Improve glucose utilisation Decrease circulating insulin levels during activity Decrease glucose production by the liver Lower your cholesterol, blood pressure, and reduce stress Improve cardiovascular health, and quality of sleep Reduce obesity, joint pain, and coronary artery disease Prevent osteoporosis and delay the onset of dementia Decrease fatigue and the number of sick days you take from work Increase energy, quality of life, and self-esteem Talk to your doctor or diabetes educator about what type of exercise is right for you, and get moving once a day for 30 minutes at least. Stay safe while you exercise People with diabetes need to add a few extra steps to their workout routine. Here are a few safety considerations. You can do the same things as people without diabetes, but you should still talk to your doctor or diabetes educator to make sure that you have no limitations. For example, someone with diabetic retinopathy may want to skip a strenuous activity like weightlifting.4 Check your blood sugar levels before, during, and after you exercise. Have some carbs or fast-acting sugar on hand – like a banana, juice or glucose tablets – that you can take if you start to feel your blood sugar dropping. And the next time you talk to your doctor or diabetes educator, let them know your test results so they can offer advice on your regimen. Drink a lot of water while you exercise. If you get dehydrated, your blood sugar levels could drop. Be ready for an emergency. Wear a medical ID tag that provides information about your medical situation, and make sure you have a way to call someone for help. If you can, it’s always a good idea to have a workout buddy or let someone else know where you are. Pay special attention to your feet. Make sure your shoes fit well and offer good support. Ideally, wear socks that wick sweat away from your skin. After your workout, check your feet for any signs of blisters, irritation or cuts. If you have any that aren’t healing, have them checked out by a doctor. It’s important to get a good workout, but don’t overdo it. If you’re in a lot of pain, out of breath or can’t talk, dial down the intensity to a level you’re comfortable with. It may sound obvious, but don’t forget to breathe. Holding your breath, which we tend to do if we’re in pain or distress, will only deprive your muscles of the oxygen you need to function at your best. Exercising at home If you don’t live near a hiking trail, or if you don’t have access to a gym, don’t worry. You can still increase your physical activity at home, and it’s completely free! As you continue to see improved blood sugar test results, you’ll be encouraged to stick to an exercise routine, lengthen it, and even add to it. Here are some moves you can do in the comfort of your own home: Stretching is a good way to get your body ready for exercise. Simple yoga moves increase flexibility and build strength. Make small and large circles with your arms while they are straight out at your sides. Calf raises are an easy strength-building and toning exercise for everything from the waist down. Jog in place for 10 minutes, at your own pace.

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Living in Range

When you find your mind wandering – thinking about the future – what do you see? Whether you dream about taking photos somewhere amazing or starting a family, or you'd simply like to have more energy or sleep through the night, keeping your blood glucose in line can help you achieve it. Sometimes it can seem like diabetes is all about the numbers. But your efforts to stay within your target ranges for blood glucose before and after meals, as well as meeting your HbA1c goal, are really about feeling your best today and for years to come. Self-checks vs. HbA1c and why you need both To track your self-care progress, your healthcare provider will probably want to review your self-monitoring and HbA1c (commonly called A1C) test results side by side. Why? A self-check shows your blood glucose level at a single point in time. You can plot individual results on a graph to see patterns and look for ways to improve your control. The HbA1c test, however, samples haemoglobin cells that have been in your system for an average of about 3 months; the A1C test gives you a broader view.1 Still, because it's an average, the A1C result can't be viewed on its own. Think about it: A person whose blood sugar runs from 2.8 to 14.4 mmol/L , could have an average blood glucose of 8.6/mmol/L, and an A1C right around 7%.1 On its own, that might look very healthy, but blood sugar running from 2.8 to 14.4 isn't so safe. 2.8 mmol/L is dangerously low, and rollercoastering up to 14.4 mmol/L is going to make for a day of exhaustion, thirst and generally not feeling well.1 Better today and better tomorrow You know that controlling blood glucose means lowering your risk of illnesses and health problems years from now, but you don't have to wait for your efforts to pay off. Managing your blood glucose means you may have more energy, sleep better and even be in a better mood every day.2 That can help a lot in achieving whatever is on your bucket list – whether it's learning to play golf, starting your own business or going dancing this Saturday night.

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Choosing 1 Thing to Improve

There are probably many things that each of us would like to change about our life, but thinking about them all at once can be overwhelming. Instead, choose just 1 thing to improve for now. Changing any 1 of the things below could have a big impact on your life with diabetes – both your physical health, and your emotional wellbeing. Make testing matter For people with diabetes, testing more often is the key to staying in control of your health. Frequent testing provides the data you need to make informed decisions about your medication, diet, and exercise regimens. Your test results show you the effects of your diet and activity on your blood glucose. Your test results also inform the conversation you’ll have with your healthcare provider about setting target range goals for yourself, and they show how well you’re achieving them. It also helps you understand how to adjust your own oral medications or insulin dosage if your doctor has taught you how to do this yourself. Over time, as you stay close to your target range, you’ll feel better each day, and you’ll lower your risk for future diabetes complications.1 Learn to count carbs The amount of carbohydrates (starches and simple sugars) you eat has a significant impact on your blood sugar level. Counting them at every meal lets you match the carbs you eat or drink with the insulin you need to process it. Even if you’re not on insulin, it’s a powerful skill for controlling your blood sugar on an ongoing basis. Some of the benefits of counting carbs include:4 It singles out the food that makes the biggest impact on your health. It allows you to enjoy any food you like with the proper amount of insulin. It puts you in control of your insulin doses. Overall, your health and your quality of life improve when you eat the right amount of carbs for your body. Move more Staying active is one of the cornerstones of managing your diabetes. Physical activity can:5 Improve insulin sensitivity and glucose utilisation. Decrease circulating insulin levels, during activity. Decrease glucose production from the liver. Lower your cholesterol, blood pressure, and reduce stress. Improve cardiovascular health, and quality of sleep. Reduce obesity, joint pain, and coronary artery disease. Prevent osteoporosis and delay the onset of dementia. Increase energy, quality of life, and self-esteem. Talk to your doctor or diabetes educator about what type of activity is right for you, and get moving at least once a day. Be patient with yourself Not every day is going to be perfect. In fact, you can eat and exercise exactly the same for 2 days in a row, and have very different blood sugar test results over those 2 days. Be patient with yourself, adapt any changes in your routine into your life, and keep moving forward if you hit any bumps in the road while managing your diabetes. It’s also important that you don’t compare your diabetes to other people’s diabetes. Everyone has a unique diagnosis story. People respond differently to exercise. Other issues like gluten sensitivity or a heart condition affect one’s self-management plan. Simply put, it’s illogical to look at someone else’s life with diabetes and compare it to your own. Seek out what works for you and continue to learn.

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Turning a Down Day Around

Everyone with diabetes has good and bad days, days with in-range blood sugar levels and days when things just don’t work out right. When the bad day seems to be taking over, here’s how to turn it around. Perspective is everything Change your mind, change your life. When you look at your diabetes as something you can effect, as an opportunity to learn about your own health, you’ve already taken the most important step to a better day and a healthier life. Don’t forget to laugh! Humour helps you see everyday things from a new perspective. That’s why it’s such a great stress-reliever; it pulls you out of your current frame of mind, even if it’s only for a little while. Keep moving forward Nobody is perfect, and there are many bumps in the road that everyone – honestly, everyone – with diabetes encounters eventually. Whether it’s over compensating for a low blood sugar, under or over estimating carb counts, or forgetting to ask a question at a doctor’s appointment, you’re not alone. The point is, keep moving forward and make the rest of the day a good one. When you’re feeling stressed If you’re already having a bad day, stress can raise your blood sugar level.1 Since we can’t eliminate stress entirely, we can try to manage it. Pay attention to how stress makes you feel physically and emotionally. Begin to relax by removing yourself from the activity that is causing you stress, even if it’s just for 5 minutes. Resolve to make a few small changes to your life that will ease the stress you’re dealing with today. When you’re feeling emotional When your blood sugar level is off, it affects your mood. Start by treating your highs or lows. Other ways to feel calmer include taking a short walk, taking a shower or bath, calling a friend and sharing your troubles, doing something you love like listening to music, or making a list of the things you’re thankful for – even the lessons you’ve learned from having diabetes. A word about depression Everyone has down times, but depression is different. Sadness, grief, anxiety – these are normal human emotions that we experience for brief moments in time, and eventually we recover. Depression, however, is an illness that causes intense feelings of sadness, grief, or anxiety that won’t seem to go away. Your doctor or diabetes educator may not be able to recognise whether you are depressed. If you think you are, ask for help. It may be a difficult first step to take, but it’s the only way to start understanding the feelings you’re having, how they’re affecting your health, and how you’re going to treat it moving forward.2 Move more Staying active is one of the cornerstones of managing your diabetes. If you’re feeling upset or anxious, even a short walk around your neighborhood will make you feel better. It distracts you from dwelling on problems, it releases endorphins, lowers your blood sugar level, and you might find that it helps you get a better night’s sleep, too. Find a local support group Surround yourself with people who can help you, emotionally or physically, over the long run. Friends and family love you, but there is something very special about meeting other people with the same experiences and concerns. Be your own best friend Sometimes you need to stand up for yourself and demand that your needs are being addressed and met – at work, at home, or even among friends. Don’t let people assume things about your life with diabetes. Have prepared answers to common questions (example: Can you ever eat sugar again?) so you can keep everyone around you informed about what diabetes is and is not. Long-term happiness Cultivating a lifetime of happiness when you have diabetes is completely possible, despite the many ups and downs along the way. You’ll learn a lot of trial-and-error lessons over the years, but every new piece of information about how to better manage your diabetes brings comfort and security. Work with your doctor to be as healthy as you can be. It adds up. Over time, you’ll realise that “I can’t” has been replaced with “I can” in every aspect of your life, on any day

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How to Travel with Diabetes

Having diabetes adds complexity to planning a well-deserved holiday. Changing your schedule, time zones, increased activity, eating on the go or new foods can affect your health. You’ll want to be ready for anything. But don’t stress! We’re here to make it easy, with a review of everything you’ll need for hitting the roads, skies, seas or rails. Make a doctor’s appointment If your trip is going to last longer than a day or two, make an appointment with your doctor or pharmacist a few weeks before you leave. Let them know about your travel plans, and ask if they have any concerns or recommendations. Get any necessary immunisations or extra prescriptions. Ask for a letter explaining that you have diabetes and what your treatment includes. It could come in handy at security checkpoints, pharmacies, or with other healthcare providers you may need while you’re away. Ask for what you need Call your airline or cruise ship ahead of time and ask them if they have special meals for people with diabetes or can refrigerate insulin. They probably can meet your needs. Travelling internationally? It’s a good idea to learn (or at least write down) helpful phrases such as “I have diabetes” or “Where is the clinic or hospital?” in the local language. Do some research, and find the address of at least one clinic or hospital that speaks your language. If you’re flying, know your airport’s guidelines for passengers with diabetes before you even start to pack. Most airports let you bring the things you need – like your medication, insulin, syringes, insulin pumps and supplies, lancing devices, blood glucose meters and supplies, and even food for treating low blood sugar – but they still have to go through security. Your airport may not require you to bring a prescription, but if you have one it may help clear up any questions at screening. Contact your airport to see if there are any other specific, local restrictions you need to follow.1 Don’t cut corners when packing Bring extra equipment and medication. How long will you be away? Now, add supplies for another 2 weeks to the pile, and you’ll be comfortably prepared for anything. If you’re flying or taking a train, you will need a carry-on. All (and we mean all) of your medicine, syringes, meters, test strips, pump supplies – anything you need – should stay with you. Not only is it convenient, it’s safer since cargo holds are usually not climate-controlled. Lists are important: your doctor’s contact information, all the medications you take, and instructions for what you need in case there is an emergency. You’re probably already used to carrying around snacks, juice or glucose tablets. Just remember to pack extra. To make life easier at security checkpoints, as much as it’s possible, leave your diabetes testing supplies, equipment and medicine in its original container with prescription labels clearly visible. You’ll probably be walking a lot more than usual, so pack extra shoes and socks for your tired feet. Changing time zones When travelling west, your travel day gets longer. When travelling east, your travel day gets shorter. If you’re on insulin or oral medications, you will most likely need to adjust your treatment schedule – including snacks and meals – while you’re en route to your destination. Generally, a longer day could mean that you need more food and more medication, and a shorter day could mean that you need less of both.2 For this reason, you might want to check your blood sugar level more often to help you stay close to your target range. Before you travel, work with your healthcare provider to create a plan for treating your diabetes while travelling. While you’re on the go While en route, don’t sit for long periods of time. If you can, stand up and stretch or walk around for a few minutes every hour. Check your glucose levels more often than you normally would. You’re probably walking more and trying new foods and these changes to your routine could affect your blood sugar. Speaking of getting more exercise, pay special attention to your feet. Change your shoes often to avoid blisters, and check for blisters often. And if you have diabetes-related issues with your feet, you might want to wear protective shoes at the beach or pool. If you’re not sure what’s on your plate or in your glass, just ask. It’s important to know how many carbohydrates you’re eating. Don’t forget: always wear a medical ID that lets others know what type of diabetes you have. Most importantly, have a great vacation!

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Preparing for Pregnancy

Let's think into the future. Imagine sitting in a rocking chair playing with 10 brand-new, tiny toes. That's the image you can remember every time you check your blood glucose, visit your doctor or say no to a glass of wine. And it's absolutely worth it. Not ready for parenthood yet? Here's what you can do now There are several things you can do to prepare for pregnancy well before you're ready to conceive. Read about it – just not too much. When you understand the risks, you can take steps to reduce them, but it can be overwhelming if you dwell on them. Stay confident knowing that many women with diabetes have happy, healthy pregnancies. Find a great doctor. Seek out an obstetrician/specialist who has cared for other women with diabetes. You will get pretty close to them throughout your pregnancy, so make sure it's someone you feel good about. Ask about your targets. Your doctor may want you to aim for a tighter blood sugar range when you're trying to get pregnant and throughout your pregnancy.1 Fine-tune your blood sugar. Keeping your numbers in range is incredibly important for a healthy pregnancy – even before you conceive.1 Why start early? You never know Once you start trying to conceive, it could happen any time. High blood sugar can affect your baby in those first few weeks, before you even know you're pregnant, so make it a habit to stay in range. You may find that more frequent blood glucose checks help you improve control by guiding insulin doses, helping you identify patterns in your numbers, and helping you quickly respond to high or low blood glucose. Once you're pregnant, you'll have more advice than you can handle – from your doctor as well as family, friends and strangers on the street. Try to stick to the more reliable information sources and keep smiling. After all, there's a baby on the way.

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How and Why to Get a Good Night’s Sleep

When you get enough sleep, you may find that you have an easier time controlling your blood sugar. You’ll be more alert during the day, have more energy, less stress, and an overall better mindset for monitoring and managing your diabetes. Consider what happens when you don’t get enough sleep. In addition to other things that may interfere with your sleep, like schedule changes or stress, people with diabetes can have potential complications with sleep. Both high and low blood sugar levels can interrupt your sleep. People with type 2 diabetes who don’t get a good night’s sleep may be more insulin resistant and have a harder time controlling blood sugar levels.1 Sleep apnoea is also common in people with type 2 diabetes, and neuropathy can cause leg pain that keeps you awake. The good news: it’s entirely possible to control these things and get a long, healthy night of rest. With that in mind, here are some tips for sleeping well. 8 helpful tips for getting a good night’s sleep Relax before bedtime. Exercise, chores, errands… have everything all finished at least an hour before you go to bed. Go to bed at the same time every day, even on the weekends, if you can. Try not to take a nap late in the day. Don’t eat a heavy meal right before bedtime, and don’t drink alcohol or caffeine late at night. In fact, limit all fluids at least an hour before bedtime to avoid waking up in the middle of the night to go to the bathroom. Use the bathroom right before you go to bed, too. If you’re stressed out, try relaxation techniques like meditating, deep breathing, gentle yoga, reading a favourite book, listening to calm music, or writing in a journal. Make your room comfortable: not too cold or hot, quiet, and dark. If you currently use your bedroom as an office or another TV room, rethink this arrangement. Make your bedroom a place to rest, not to get distracted. Put all electronics away before bedtime, especially mobile devices like your smartphone or tablet. We know you love your pets, but they can interrupt your sleep so try to keep them off the bed or out of your room altogether if you have allergies (diabetes alert dogs excluded, of course). Checking your blood sugar level at night It is important to check your blood sugar level an hour before bedtime. To avoid going low overnight, experiment with bedtime snacks that will keep your blood sugar normal overnight, like hummus or guacamole with vegetables. Some healthcare providers recommend a 3:00 a.m. blood sugar test to ensure that your overnight blood glucose is stable. If you’re on an insulin pump, fine-tune your basal levels if your blood sugar level tends to drop overnight. When to talk to your doctor or diabetes educator If you are having trouble sleeping, we hope these tips will help. However, if you’re still struggling to get a good night’s rest, or if someone tells you that you have a snoring problem, consider talking to your doctor or diabetes educator. Snoring is an indicator of apnoea, which is associated with high blood pressure, heart disease, acid reflux, and fatigue.

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