VA/DoD Clinical Practice Guideline for Management of Diabetes Mellitus. Version 4, 2010.
Contact Information

Health Care Provider:

Name: 

Number: 

Other Health Care Team Members:

Name: 

Number: 

Name: 

Number: 

Pharmacy (Refill):

Name: 

Number: 

Depending on your facility, your diabetes team may also include for example: diabetes 

educator, dietitian, counselor, exercise therapist.

Knowing the members of your health care team and working with them will help you 

control your diabetes.

The content provided here is not intended to be a substitute for professional medical advice. Always seek the advice of 

your qualified healthcare provider with any questions you may have regarding your health care.
Contents

1

When You Have Diabetes . . . . . . . . . . . . . . 2

What is Diabetes? . . . . . . . . . . . . . . . . . . . 3

Eating Healthy . . . . . . . . . . . . . . . . . . . . 4

Know Your Nutrients. . . . . . . . . . . . . . . . . . . 6

What Does the Food Label Tell Me? . . . . . . . . . 7

Using the Plate Method. . . . . . . . . . . . . . . . . 8

Healthy Portion Sizes . . . . . . . . . . . . . . . . . 9

My Healthy Eating Plan. . . . . . . . . . . . . . . . . 10

Being Active. . . . . . . . . . . . . . . . . . . . . . 12

My Active Lifestyle Plan. . . . . . . . . . . . . . . . . 15

Monitoring . . . . . . . . . . . . . . . . . . . . . . 16

Hypoglycemia or “Low Blood Sugar”. . . . . . . . . . 18

Hyperglycemia or “High Blood Sugar”. . . . . . . . . 20

Medications. . . . . . . . . . . . . . . . . . . . . . 22

Diabetes Oral Medication (Pills) . . . . . . . . . . . 24

Insulin. . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Sick Day Management. . . . . . . . . . . . . . . . 32

Living Well With Diabetes . . . . . . . . . . . . . 38

Care for Your Heart. . . . . . . . . . . . . . . . . . . . 39

Care for Your Kidneys. . . . . . . . . . . . . . . . . . . 40

Care for Your Eyes. . . . . . . . . . . . . . . . . . . . . 40

Care for Your Feet. . . . . . . . . . . . . . . . . . . . . 41

Care for Your Emotional Health. . . . . . . . . . . . . 42

Enjoy Traveling. . . . . . . . . . . . . . . . . . . . . . 44

Contents
Self-Care Skills for the Person with Diabetes

2

Diabetes does not have to be managed alone . This workbook provides 

information to help you and your family manage your diabetes . Diabetes 

is a chronic (lifelong) condition that makes it diffi cult for your body to 

regulate the sugar (glucose) in your blood . Without treatment, it can result in high 

levels of glucose in your blood and serious health problems . Diabetes is the leading 

cause of blindness, kidney disease, and amputation . It is often associated with high 

blood pressure, obesity, high cholesterol, heart disease, and stroke . Anyone can 

develop diabetes . 

To help control your blood glucose you will need to learn how to:

	 •	 Make	healthier	food	choices

	 •	 Start	and	maintain	an	active	lifestyle	

	 •	 Monitor	your	blood	glucose	

	 •	 Take	your	medications	correctly	

	 •	 Manage	sick	days

	 •	 Take	charge	of	your	health	

When You 

Have Diabetes

Your health care team will advise you what your blood glucose target level should 

be and how to check your blood glucose level on your own . Your provider will also 

test your blood glucose level with a hemoglobin A1C test (also called A1C) . The A1C 

shows what your average blood glucose was for the past 3 months . The results from 

your blood glucose check and the A1C test will tell you whether your diabetes care 

plan is working . 
When You have Diabetes

3

What is Diabetes? 

Our bodies use glucose (sugar) for energy. Most of the glucose we need comes from 

the food we eat. Once the food is digested, insulin — a hormone made by the 

pancreas— is needed to move the glucose from the bloodstream into the body’s 

cells. When you have DIABETES, your body has trouble using the GLUCOSE because 

insulin is either absent or does not work well to move the glucose into the cells. As a 

result, the glucose level in your blood becomes too high.

Insulin helps sugar (glucose) 

move into cells, where it is used to 

produce energy

Without insulin, glucose cannot 

enter the cells

Cells quickly waste away from 

lack of glucose

There are different types of diabetes: 

Type 1 Diabetes. Your pancreas does not make insulin and cannot move glucose 

into the body’s cells. Insulin injections or an insulin pump are needed.

Type 2 Diabetes. This is the most common type of diabetes. It is usually triggered 

by poor diet, being overweight and lack of exercise. With this kind of diabetes, the 

pancreas is not producing enough insulin, or the cells are not responsive to the 

insulin. Management of type 2 diabetes may include oral medication, diet, and 

exercise. Sometimes a person with type 2 diabetes will also need insulin therapy.

Glucose

Insulin

Receptors

Cell
Self-Care Skills for the Person with Diabetes

4

You can make a 

difference in your blood 

glucose control through 

your food choices. You do 

not need special or diet 

foods. The food that is 

good for you is good for 

your whole family.

Eating Healthy
Eating Healthy

5

Food Changes You Can Make

	 •	 Eata widevarietyof foodseveryday,andtry new foods

•	 Trytodistributeyour carbohydrateintakeevenlythroughout theday

	 •	 Eat high-fiber foods, such asvegetables, fruits, wholegrains,andbeans

•	 Uselessaddedfat, sugar,andsalt

	 •	 Do not skip mealsorgolonger than 3 ‐ 5 hours withouteating

	 •	 Drinkplentyof wateror sugar-freebeverages,avoidsugareddrinksor juices

	 •	 Avoidfriedfoodsor foods with lotsof saturatedfatandcholesterol

	 •	 Usealcoholonly with theadviceofyour health careproviderand neverdrinkon

an empty stomach (can cause blood glucose to go too low)

	 •	 Ifyouareoverweight,decreasefat intakeanddecreaseportion sizes

	 •	 UsethePlate Methodtoguideyour foodchoicesandportions through theday

Your diabetes educator or dietitian will 

help you learn more about which foods 

contain carbohydrates and help you 

choose a meal plan that will help you 

keep your blood glucose in target range.

Eating a healthy diet and exercising 

work together to improve your blood 

glucose control and overall health.
Self-Care Skills for the Person with Diabetes

6

Carbohydrates

	 •	 The main foodsourceofenergytokeepyouandyourbody moving

•	 The main foodthat raisesbloodglucoselevels

	 •	 A foodyou want todistributeover thedayandbecareful not toovereat

Carbohydrates are found in: 

 ] Fruits

 ] Starchy vegetables (such as corn, 

potatoes, peas, and beans)

 ] Breads and cereals

 ] Pastas and rice

 ] Milk, yogurt, ice cream

 ] Sugary foods, sweetened drinks, 

juices, and many snack foods 

(such as chips and candy)

Proteins

	 •	 Keepingaproper levelofprotein in yourdietbuilds muscles, helpsyourbody

heal, and gives it energy

Proteins are found in: 

 ] Chicken ] Beef ]	 Fish andshellfish	

 ] Eggs ] Cheese ] Tofu

 ] Peanut butter ] Nuts

Fats

•	 Helps toprovideenergy

	 •	 Supports severalbodilyfunctions (absorption ofvitamins)

Fats are found in: 

 ] Canola or olive oil ] Avocado ] Nuts and seeds

 ] Bacon, butter or margarine (saturated fats that are not heart healthy)

Carbohydrates Proteins Fats 

Know Your Nutrients
Eating Healthy

7

Food labels can be found on most food packages. This picture shows 

an example of a food label and explains how this information can 

help you make healthy food choices.

NUTRITION FACTS

Serving Size 1⁄2 cup (114g)

Servings Per Container: 4

Amount Per Serving

Calories 90 Calories From Fat 30

 % Daily Value*

Total Fat 3g 5%

Saturated Fat 0g 0%

Trans Fat 0g **

Cholesterol 0 mg 0%

Sodium 300 mg 13%

Total Carbohydrate 23g 4%

Dietary Fiber 6g 12%

Sugars 3g

Sugar Alcohol 8g

Protein 3g

Vitamin A 80% Vitamin C 2%

Calcium 4% Iron 4%

* Percent Daily Values are based on a 2,000 

calorie diet. Your daily values may be higher or 

lower depending on your calorie needs.

Calories 2,000 2,500

Total Fat Less than 65g 80g

Sat Fat Less than 20g 25g

Cholesterol Less than 300mg 300mg

Sodium Less than 2400mg 2400 mg

Total Carbohydrate 300g 375g

Fiber 25g 30g

Calories per gram:

Fat 9 Carbohydrate 4 Protein 4

**Limit trans fat as low as possible.

What Does the Food Label Tell Me?

Serving Size 

The nutrition values 

listed on the label are 

based on one serving 

size. Always check for 

the serving size when 

reading a label.

Total 

Carbohydrate

Includes total grams 

of starch, sugar and 

anything that will 

become sugar when 

it is digested.

Sugar Alcohol 

Sugar alcohols are 

reduced-calorie 

sweeteners that have 

fewer carbohydrates. 

They still raise your 

glucose and may have 

undesired side-effects 

(bloating, diarrhea).

Servings per 

Container 

There are 4 servings in 

this example. Products 

often contain more than 

1 serving in a package.

Fat

Choose low-fat foods 

and limit saturated fats 

and trans fat. Low-fat 

foods have 3g of fat 

or less for every 100 

calories.

Fiber

Choose foods with 

3 grams or more of 

fiber. High fiber foods 

can help control blood 

glucose. Whole grains 

and vegetables 

contain fiber (aim for 

30 - 35 grams daily).
Self-Care Skills for the Person with Diabetes

8

Controlling portion sizes

Use the size of familiar objects to remind you of 

size portions:

	 •	 	Vegetable	or	salad	portion	similar	to	the	size	

of baseball or light bulb (1/2 cup ) 

	 •	 	Starchy	carbohydrates	portion	similar	to	the	

size of a computer mouse (1/2 cup )

	 •	 	Protein	(cooked	meat)	portion	similar	to	the	size	of	a	deck	of	cards	(2	-	3	ounces)

	 •	 	Fat	portion	similar	to	the	size	of	a	dice	(1	tsp)

Using	portions	will	help	you	feel	satisfi	ed,	help	control	your	blood	glucose	levels,	and	

maintain your weight .

Using the Plate Method

Use the picture of the Healthy Plate to remind yourself of how to eat a healthy, 

balanced meal .

Fill 1/2 of your plate

with vegetables such 

as broccoli, carrots, 

caulifl ower, and salad .

Fill 1/4 of your plate 

with a starchy choice 

such as 1/2 cup of 

mashed potatoes .

Fill 1/4 of your plate 

with lean meat, 

chicken	or	fi	sh;	

about 3 ounces .

as broccoli, carrots, 

caulifl ower, and salad .

such as 1/2 cup of 

mashed potatoes .

Vegetables

Salad

1/2 cup 

of fresh or 

canned fruit .

One cup of 

milk or yogurt

(low fat) .

Margarine or 

oil in cooking 

or at the table .
Eating Healthy

9

Healthy Portion Sizes

Fats & Oils Group 

•	 Oils likecanolaoroliveoil (1tsp)

•	 Margarineorbutter (1tsp)

•	 Mayonnaise(1tsp)

•	 Nutsandseeds (1 oz)

•	 Saladdressing(1Tbsp)

•	 Cream cheese, sour cream,butter,

shortening, lard, or meat fat (1 Tbsp) 

(not heart healthy)

Protein Group 

•	 2to3ouncesof cooked meat,

poultry,or fish

•	 1/2 to 3/4 cup tuna in water 

•	 1/2 to 3/4 cup cottage cheese

•	 2to3ounces cheese

(try to use low fat)

•	 2tablespoonsofpeanutbutter

count as 1 ounce of meat

Milk Group 

•	 8ounces milk(low fat) •	 6ouncesyogurt(lowfatunsweetened)

Non-starchy Vegetable Group 

•	 1cupraw vegetables

•	 1/2 cup cooked vegetables

•	 1/2 cup tomato or vegetable juice 

Fruit Group

•	 1/2 cup fruit juice

•	 1smallpieceof fresh fruit

•	 1/2 cup canned fruit

•	 1/4 cup dried fruit

Starch Group

•	 1slicebreador1small roll

•	 1/2 small bagel or English muffin 

•	 1/2 hamburger or hot dog bun

•	 1smallpieceof corn bread

•	 3/4 cup of dry cereal (unsweetened)

•	 1/2cupcookedcereal

•	 1small waffleor smallpancake

•	 1/3 cup cooked noodles or rice

•	 1/2 cup white or sweet potato or 

1/2 small baked potato

•	 1/2 cup corn or 1 small corn on the cob

•	 1/2 cup beans or peas (except for 

green beans)

•	 4to6crackers

•	 3graham cracker squares

•	 3cupspopcorn

Carbohydrates
Self-Care Skills for the Person with Diabetes

10

My Healthy Eating Plan

Ask yourself:What is my goal for eating healthier? What change(s) will help me 

reach my goal? Only you can spot the changes you are ready to make to your diet 

andlifestyle. Developing new habits takes time;bepatientandkeeptryinguntilyou

succeed. Start with a small goal and work your way up! You can do it!
Eating Healthy

11

Now write your plan by filling in the blanks

1. What I will do:

Example: I’ll use the plate method to plan my meals

2. When I will do it:

Example: I’ll start with my evening meals at home.

3. What I need to get ready:

Example: I’ll add more vegetable choices to my grocery list.

4. What might get in the way of my healthy eating:

Example: I don’t eat at home.

5. If that happens, I will do this instead:

 Example: I’ll try to choose something on the menu that resembles a healthy plate.

6. Here’s when I will start:

 Example: On the first of the next month.

.
Self-Care Skills for the Person with Diabetes

12

Engaging in regular 

physical activity 

improves blood glucose 

control by helping 

insulin work better.

Being Active

	 •	 Benefits include weight loss, loweringbloodpressure,

lowering cholesterol, and increasing strength

	 •	 Beingactive maydecrease how much diabetes medication you

will need

	 •	 Beingactivecan helppreventordelaytheonsetof theproblems

that can occur with poor glucose control (heart, kidney, and eye 

or nerve disease)
Being Active

13

Be safe! 

	 •	 Getapproval from yourprimarycareprovider

before starting any new activity

	 •	 Startandincreaseyour chosen activityslowly

	 •	 Weargoodshoes for thechosen activity

	 •	 Chooseasafearea

•	 Carryacellphone

	 •	 Carryafastactingcarb, (glucosetabletsor

candy) if you are on insulin or taking medicine 

that increases insulin production

	 •	 Drinkplentyof water,especiallyon hotdays

	 •	 Wearavisibleform of identification that lets

peopleknow you havediabetes (medical-alert

bracelet, or necklace), or carry a diabetes 

care-card

Make physical activity a regular 

part of your day

	 •	 Aim forat least150 minutesof moderate

activity per week with no more than two days 

off between activities

	 •	 Choosean activitythatyouenjoy:

 * Household activities like vacuuming, 

gardening, or washing the car

* Leisure activities like brisk walking, biking, 

swimming, dancing, walking the dog, playing 

ball,golfing,orbowling

* Structured activities like going to the gym, 

weight training, and aerobic exercise class

	 •	 Findatimethatworksforyou.10minutesbefore

work, at lunch time, or in the evening after 

dinner.Startexercise30 ‐ 60minutesafterameal

Remember, the benefits 

of regular activity will last 

a lifetime! 
Self-Care Skills for the Person with Diabetes

14

Hereisasample12-week walking

schedule from the National Heart, 

Lung and Blood Institute:

	 •	 Beforestartingthisoranyother

activity plan, get approval for 

the activity from your health 

care provider

	 •	 Tryto walkat least fivetimes

each week. Always start with a 

five-minute, slowerpaced walk

to warm up, and end with 

a five-minute, slower

paced walk to cool down

Week Warm-up Brisk Walking Cool-down Total minutes

1 5 minutes 5 minutes 5 minutes 15 minutes

2 5 minutes 7 minutes 5 minutes 17 minutes

3 5 minutes 9 minutes 5 minutes 19 minutes

4 5 minutes 11 minutes 5 minutes 21 minutes

5 5 minutes 13 minutes 5 minutes 23 minutes

6 5 minutes 15 minutes 5 minutes 25 minutes

7 5 minutes 18 minutes 5 minutes 28 minutes

8 5 minutes 20 minutes 5 minutes 30 minutes

9 5 minutes 23 minutes 5 minutes 33 minutes

10 5 minutes 26 minutes 5 minutes 36 minutes

11 5 minutes 28 minutes 5 minutes 38 minutes

12 5 minutes 30 minutes 5 minutes 40 minutes
Being Active

15

My Active Lifestyle Plan 

Getting Started 

Ask yourself: What is my goal? What change(s) will help me reach my goal? 

Make your chosen activity fun! It should be something you enjoy and is within your 

ability to do. Only YOU can spot the changes you are ready to make. In time, your 

chosen activity will become routine for you. Be patient and keep trying until you 

succeed. You can do it!

Now write your plan by filling in the blanks:

1. Here’s what I will do:

Example: I’ll take a brisk walk 5 days a week for 30 minutes.

2. Here’s when I will do it:

Example: I’ll walk after breakfast.

3. Here’s what I need to get ready:

Example: I’ll need comfortable shoes.

4. This might get in the way of my plan:

Example: If it’s raining, I won’t be able to walk outside.

5. If that happens, I will do this instead:

Example: I’ll go to the recreation center and walk around inside.

6. Here’s when I will start:

Example: I’ll start my walks on Monday.
Self-Care Skills for the Person with Diabetes

16

Blood glucose monitoring 

helps you to understand 

how foods, physical 

activity, and diabetes 

medicine aff ect your 

glucose levels. Monitoring 

also tells you when your 

glucose is too low or 

too high.

Monitoring
Monitoring

17

Glucose Testing Tips

	 •	 Wash hands with warm soapy water toclean surfaceandpromoteblood flow

•	 Toreducepain,prickthesidesof thetipsof the fingers,avoidthecenterpads

	 •	 Rotatetest sitesbetween all fingersoralternatesites

	 •	 Keepalogbookofyour readingsandbringit toeach providervisit. Bringyour

glucose meter with you. Your provider may be able to download the information 

directly from the device

	 •	 For meterproblems, call thephone numberon thebackof the meter

•	 Teach family members how tocheckyourglucose, ifyouareunabletodoso

Your health care team will let you know how often and when you need to check

	 •	 You maybeaskedtocheckbeforeorafter meals,activity,or medications

	 •	 You may needtocheck moreoften

if you are sick or on certain diabetes 

medications

	 •	 Your health careteam will helpyou

identify your blood glucose goals 

(target range)

My blood glucose target range is: to

Here’s what I will do: 

1. I will check my blood glucose times a day 

2. Here’s when I will do it: 

Example: Before meals and at bedtime.

3. Here’s what I need to get ready:

Example: I’ll need my meter and strips.

4. This is what I will do to remind myself: 

Example: Ask a friend or family member to remind me.
Self-Care Skills for the Person with Diabetes

18

“Low Blood Sugar” or Hypoglycemia

In general, hypoglycemia, or a “low blood sugar”, is any reading below 70 mg/dL . If 

you are taking insulin or other diabetes medications, you may experience symptoms 

of hypoglycemia .

What are the symptoms?

	 •	 Weakness	 	 •	 Irritability	or	Anxiety

	 •	 Headache	 	 •	 Fast	heart	beat

	 •	 Blurred	vision	 	 •	 Sweating

	 •	 Shakiness		 	 •	 Hunger	/	Light-headedness

What causes low blood sugar?

	 •	 Delayed	meals	 	 •	 Too	much	diabetes	medicine

	 •	 Not	eating	enough	 	 •	 Unplanned	strenuous	activity

	 •	 Drinking	alcohol	on	an	empty	stomach
Monitoring

19

What Do I Do When I Have a Low Blood Sugar?

If your blood sugar drops below 70, 

follow the 15-15 rule “Check - Treat - Repeat”:

Check your blood sugar

Treat if less than 70, eat or drink 15 gramsof fast-actingcarbohydrate

 Examples: tube of glucose gel, 3 ‐ 4 glucose tablets, half a cup of regular 

soda or orange juice, or a full cup of low fat milk.

Repeat checking your blood sugar after 15 minutes (Be patient, wait the 

 full 15 minutes).

 If still less than 70, eat another 15 grams fast acting carbohydrate 

Do your best to wait 15 minutes so you don’t over treat.

Repeat the above steps until your blood sugar rises above 70.

 When you start to feel better, take time to rest. Eat a small snack if your next 

REGULAR meal is morethan a half houraway.

 If you have type 1 diabetes, ask your provider about obtaining a glucagon kit.

You can prevent hypoglycemia!

	 •	 Eatevery3 ‐ 5 hours

•	 Don’texercise without checkingyourbloodsugar first

	 •	 Ifyourbloodsugar is less than 110,eatasnackbeforeexercising

	 •	 Takeyour medicationsasyourprovider has instructed

	 •	 Teach familyor friends how totreat low bloodsugar

•	 Do notdriveifyourbloodsugar is less than your target range

Tips

	 •	 Always carryasourceof sugar/carbohydrate(hardcandy,glucosetabletsorgel)

•	 Wearadiabetesalertbraceletandcarryacardin your walletorpurse

	 •	 For repeatedlow bloodsugars, contactyour health careteam

If you become unconscious or confused, 

have family or friends call 911
Self-Care Skills for the Person with Diabetes

20

“High Blood Sugar” or Hyperglycemia

Hyperglycemia or high blood sugar is any glucose reading above your goal range . 

Persistent hyperglycemia (above 250 mg/dL) will increase the risk of diabetes related 

complications, produce unwanted symptoms, and may result in serious illness such as 

ketoacidosis	or	life-threatening	dehydration.	

What are the symptoms of high blood sugar?

	 •	 Urinating	more	often,	especially	at	night	 	 •	 Blurred	vision

	 •	 Fatigue	or	low	energy	 	 •	 Increased	thirst

	 •	 Increased	hunger	 	 •	 Dry	skin

What can cause a high blood sugar?

	 •	 Eating	too	much	food	or	sugary	liquids	 	 •	 Illness/infection

	 •	 Not	taking	enough	diabetes	medication	 	 •	 Not	exercising

	 •	 Forgetting	to	take	diabetes	medicine	 	 •	 Stress

	 •	 Taking	medications	such	as	steroids

“High Blood Sugar” or Hyperglycemia
Monitoring

21

What to Do When I Have a High Blood Sugar?

	 •	 Drinkplentyof sugar-free/calorie-free fluids (water isbest)

•	 Takeyourdiabetes medicinesasprescribed

	 •	 Do not skip meals when yourbloodsugarsare high

	 •	 Determine, ifyoucan, what causedyour high bloodsugar

For Type 1

 ] If blood sugar less than 250, be active

 ]	 If blood sugar is greater than 250, check blood sugar before meals and at 

bedtime until less than 200

 ]	 Check for urine ketones. If moderate or high, call your provider. 

When blood glucose is high, the body produces ketones (learn more about 

ketones on page 36).

For Type 2

 ] If blood sugar less than 300, be active

 ] If blood sugar is greater than 300, check your blood sugar before meals and at 

bedtime until less than 200 

 If your blood sugar does not go down 

contact your health care team

Many of the symptoms of high blood sugar are the same as low blood sugar. 

It is important to check your blood sugar before treating.
Self-Care Skills for the Person with Diabetes

22

Along with physical 

activity and meal 

planning, your health 

care provider may 

prescribe pills, injections, 

or both to help control 

your blood glucose. Each 

medication works in a 

different way. 

Medications
Medications

23

Tips for Taking Medications Safely

	 •	 Youshouldtake medicationsasprescribed. Never stoptaking medication on

your own

	 •	 Ifyouexperienceanysideeffects, talktoyour health careteam.Youandyour

health care provider may need to change the dose or try a new one

	 •	 Keepalistofyour medications,dosages, when totakeandthereason you

take them

	 •	 Tellyour health careprovideraboutallprescription medications,over-thecounter medications, dietary supplements or vitamins that you take

	 •	 Talkaboutanyallergiesyou haveandtellyour health careprovider ifyouare

breastfeeding or pregnant
Self-Care Skills for the Person with Diabetes

24

Diabetes Oral Medication (Pills)

Class: Sulfonylureas

Main Site of Action: Pancreas

How it Controls Blood Glucose: 

Stimulates pancreas to release 

more insulin

Generic: Glyburide, Glipizide, 

Glimepiride

Brand Names: Amaryl, Dymelor, 

Glucotrol XL, Glynase, Micronase

Side Eff ects: Hypoglycemia

Class: Meglitinides

Main Site of Action: Pancreas

How it Controls Blood Glucose: 

Stimulates pancreas to release 

more insulin

Generic:	Repaglinide,	Nateglinide

Brand Names: Prandin, Starlix

Side Eff ects: Hypoglycemia

Class: Alpha-glucosidase 

inhibitors

Main Site of Action: Intestine

How it Controls Blood Glucose:

Slows the digestion of some 

carbohydrates.	After-meal	blood	

glucose peaks are not as high

Generic: Acarbose, Miglitol

Brand Name: Precose, Glyset

Side Eff ects: Gas, diarrhea

Class: Biguanides

Main Site of Action: Liver

How it Controls Blood Glucose: 

Keeps liver from releasing too 

much glucose

Generic: Metformin

Brand Names: Glucophage

Side Eff ects: Stomach cramps, 

diarrhea
Medications

25

Insulin

Insulin helps keep blood glucose levels on target by moving glucose from the blood 

into your body’s cells.

There are many different types of insulin and schedules for injections. Your health care 

team will help you decide the best choices for you.

Insulin isgiven asan injection usingasyringeorpen-likedevice,oran insulin pump.

A member of your health care team will teach you what insulin you will be taking, 

what device to use, what dose, when to give the injection, and when to monitor blood 

glucose. It is important to monitor your blood glucose according to your provider’s 

instructions. This will help establish if you are on the right dose and if not, make the 

necessary changes.

Where to inject the insulin

	 •	 Thefattytissue of the abdomen, outerarms, thighs, or buttocks.

	 •	 Rotateinjections within thesamesiteforat leasta week beforeanother

site is used. 

Upper 

outer arms

Abdomen 

(avoid the 

belly button area)

Buttocks

Upper 

outer thighs
Self-Care Skills for the Person with Diabetes

26

Inspect 

insulin — 

if cloudy, 

roll to mix

a

c

b

d

a b

Image 1:

Pull off pen cap, clean rubber end of the 

pen with alcohol pad

Check for discoloration/crystals — 

if found DO NOT USE and call your 

pharmacy

How to Use an Insulin Pen

Reminders: 

	 • Always use a new needle for each injection 

	 •	 Becarefulnot tobendordamageneedlebeforeuse

	 •	 Review theappropriatetechnique withyourhealthcareteam.

Image 2:

a.	Removeprotectivecapfrom new

disposable needle

b. Screw it onto your pen

c. Pull off outer needle cap and 

keep for later

d. Pull off inner needle cap and 

dispose of it

Image 3:

a. Hold pen in upright position

and turn the dose selector to select 

2 units

b. Hold pen with needle pointing 

upwards and then lightly tap side of 

pen to remove air bubbles, press the 

push button and watch for insulin 

drop to appear
Medications

27

acbd

Image 4:

Turn selector to select your dose 

of insulin

Your pen is now ready to use

Image 5:

Chose your injection site (abdomen, arm, 

or thigh) and keep each injection at least 

one finger’swidth fromthelast injection Clean area with soap and water or 

alcohol pad and let dry

Image 6: a. Hold insulin pen as shown b. LIGHTLY pinch up skin

c.	 Injectat45 ‐ 900 angle

d.	

Wait

6 ‐ 10seconds BEFOREremoving

the needle from your skin (this 

ensures absorption of the insulin)

After injecting, apply gentle pressure 

to the site — NO RUBBING

Image 7:

Put outer cap over needle, unscrew, 

and dispose

Recordthedate, time,dose,andlocation

of your injection in your log book, 

as a reminder of where, and when you 

gave your insulin
Self-Care Skills for the Person with Diabetes

28

How to Use an Insulin Syringe

Image 1:

Inspect insulin — if cloudy, roll to mix

Reminders:

	 •	 Alwaysuseanew syringeforeachinjection

	 •	 Becarefulnot tobendordamagetheneedlebeforeuse

	 •	 Review theappropriatetechnique withyourhealthcareteam.

Image 2:

Pulling back plunger, measure the same 

amount of air into the syringe as the 

dose of insulin needed

Image 3:

Clean top of insulin vial with alcohol 

pad, let dry, and then push needle 

through the rubber stopper and inject 

the air into the vial

Image 4:

While the syringe is attached to the vial, 

turn upside down as shown
Medications

29

a b

Image 5:

Pull the plunger down to measure out 

your dose of insulin, (have someone 

double check for you if possible to 

ensuregettingthe RIGHTdose)

Image 6:

Pull the needle out of the vial

Image 7:

Choose your injection site (abdomen, arm, or 

thigh) and keep each injection at least one 

finger’swidth fromthelast injection site

Clean with soap and water or an alcohol 

pad — let dry 

Image 8:

a. LIGHTLY pinch up skin

b. Inject at 900 angle

c. Push the plunger down to inject the insulin

d.	Wait6 ‐ 10seconds BEFOREremoving

the needle from your skin (this ensures 

absorption of the insulin)

After injecting apply gentle pressure to the 

site — NO RUBBING 

Discardthesyringein a hardplastic container. Recordthedate, time,dose,and

location of your injection in your log book, as a reminder of where and when you gave 

your insulin

c d
Self-Care Skills for the Person with Diabetes

30

How insulin works

0 hours 2 hours 4 hours 6 hours 8 hours 10 hours 12 hours 14 hours 16 hours 18 hours 20 hours 22 hours 24 hours

Plasma Insulin Levels

Aspart, Lispro, Glulisine

Regular NPH Detemir Glargine

Insulin Types

Type of Insulin 

& Brand Names 

Begins 

working in

Most 

effect in Lasts How it helps to manage blood glucose

Rapid-acting 

Aspart (Novolog®) 10 – 20 min 40 – 50 min 3 – 5 hours Rapid-actinginsulin coversinsulin needsfor

meals eaten at the same time as the injection Glulisine (Apidra®) 15 – 30 min 30 – 90 min 3 – 4 hours

Lispro (Humalog®) 15 – 30 min 30 – 90 min 3 – 5 hours

Short-acting (Prandial)

Regular

(Novolin R®,

Humulin R®)

30 – 60 min 2 – 5 hours 5 – 8 hours Short-actinginsulin covers insulin needs for

mealseaten within 30 ‐ 60 minutes

U-500isusedif morethan 200unitsof

insulin are needed daily. It is 5 times more 

potent than regular insulin. Regular U-500

(Humulin R U-500®) 30 – 45 min 2 – 4 hours 5 – 8 hours

Intermediate-acting (Basal)

NPH 

(Novolin N®, 

Humulin N®)

60 – 90 min 2 – 4 hours 20 – 24 hours

Intermediate-actinginsulin covers insulin

needs for about half the day or overnight. Can becombined with Rapid-or shortacting insulin

Long-acting (Basal)

Glargine (Lantus®) 60 min No Peak 20 – 24 hours Long-actinginsulin covers insulin needs for

about one full day. Can be combined, when 

Detemir (Levemir®) 60 – 120 min 6 – 8 hours 10 – 24 hours needed, with rapid-or short-actinginsulin

Premixed products (Meal time + Long acting)

NPH/Regular70/30

(Novolin 70/30®) 30 – 60 min 2 – 12 hours 10 – 24 hours

Generally used twice a day before mealtime.

Insulin protamine 

aspart/aspart 70/30 

(Novolog Mix®)

10 – 20 min 1 – 3 hours 10 – 16 hours

Insulin protamine 

lispro/lispro 75/25 or 

50/50 

(Humalog® mix 75/25 

or 

Humalog mix 50/50TM)

15 – 30 min 1 – 6 hours 10 – 16 hours

Themain sideeffectof insulin isalowbloodglucose. Reviewthe15-15 Ruleon page19andalwayscarryarapid-acting

carbohydrate such as glucose tablets or juice with you. Sometimes insulin can lead to a very severe low blood glucose that 

causes unconsciousness or seizures. Glucagon may be required to raise the blood glucose to a safe level when this happens.
Medications

31

Storing your Insulin

•	 Check storage guidelines for your insulin. This is usually in the product package 

insert or can be obtained from your pharmacy

•	 Once a vial or insulin pen is used, mark it with the date that it should be 

discarded. Some pens, insulin cartridges, and mixed insulin products may expire 

in less than 28 days. Check with your pharmacist

•	 Unopenedinsulin shouldbestoredin arefrigeratoratatemperatureof36 ‐ 46oF.

Do not freeze

•	 	 Openedinsulin maybestoredat room temperaturebelow 86oF

•	 Never use insulin beyond the expiration date stamped on the vial, pen, 

or cartridge

•	 Keep insulin out of direct sunlight and away from heat or extreme cold

My insulin is called: 

I take: units before breakfast

units before lunch

units before dinner

units at bedtime

I will use a: to give my insulin.

I need to check my blood glucose: 

(how often?)

I havereviewedthe15-15ruletotreat hypoglycemia.

I will carry with me at all times to treat a low blood glucose.
Self-Care Skills for the Person with Diabetes

32

Sick Day 

Management

When you have diabetes 

and get sick, your 

blood glucose levels 

may go up. They may 

also rise because of 

other conditions such 

as surgery, injury, and 

emotional stress. 
Sick Day Management

33

When you have a cold or flu or if you have a fever for a day or two your body needs 

glucosethat it can useforenergyto help fight theillness.

If you’re feeling too sick to eat, your body will get its energy by releasing glucose from 

stored supplies in the liver, making your blood glucose level rise.

That is why you need to keep taking your insulin or diabetes medication when you’re sick 

to control your blood glucose levels even though you may be eating less than normal.

Maintain Your Insulin Therapy Regimen

	 •	 Unlessyourprovider tellsyouotherwise, continuetakingthesame numberof

insulin units or other medication you normally would, even if you are sick to your 

stomach or not eating

Keep Eating

	 •	 Trytoeatyourusual mealsor

snacks, if possible. If you can’t 

stick to your usual diet, follow 

these guidelines for replacement 

foods: carbohydrates every 

4 ‐ 6 hours

	 •	 Ifyou’re havinga hardtime

swallowing, eat soft foods with 

the same amount of carbohydrates as your regular foods

	 •	 Ifyou’resicktoyour stomach orvomiting,drinkenough liquids toequal the

amount of carbohydrates that you would normally eat

If your blood glucose is 

over 250 while you are sick

If your blood glucose is 

under 70 while you are sick

Drink: water, tea with no sugar, 

instant broths, diet drinks

Drink: fruit juice, regular soda drinks 

(not diet)

Eat: Icechips, sugar-freeJELL-O®,

sugar-freePopsicle®

Eat: Glucose tablets, Popsicle® or 

JELL-O®(notsugar-free),

soups,

mashed potatoes
Self-Care Skills for the Person with Diabetes

34

What to Eat or Drink When You’re Sick

(Each item equals 15 grams of carbohydrate)

Food Item Amount

Apple or pineapple juice 1/2 cup (4 oz.)

Soda (regular, not diet) 1/2 cup (4 oz.)

Jell-O®(regular, not sugar-free) 1/2cup

Popsicle®(regular, not sugar-free) 1/2twin

Sherbet 1/4 cup

Saltine crackers 6 squares

Milk 1 cup (8 oz.)

Ice cream (vanilla) 1/2 cup

Pudding(sugar-free) 1/2cup

Pudding (regular) 1/4 cup

Thin soup (examples: vegetable, 1 cup 

chicken noodle)

Thick soup (examples: cream of 1/2 cup 

mushroom, tomato)

Macaroni, noodles, rice, 1/2 cup (cooked) 

mashed potatoes

*Useof trade names is for identification onlyanddoes not implyendorsementbythe VA/DoD
Sick Day Management

35

Short-term Illness Can Often Be Managed at 

Home by Following These Simple Guidelines:

Type 1 Diabetes

Checkbloodsugarevery2 ‐ 4 hours. Ifyourbloodsugar isabove250andurine

ketones are positive, or if your blood sugar is constantly very high, (above 300) after 

2 ‐ 3checks, callyour health careteam immediatelyorgotothe hospitalor clinic.

Type 2 Diabetes

Checkbloodsugarevery4 ‐ 6 hours. Ifbloodsugars remain elevated(above300)and

do not respond to medications, call your health care team for instructions.

Illness and Medications 

Stoptaking metformin (Glucophage) ifyou havea high fever (morethan 101oF),

vomiting, or diarrhea. Contact your provider for instructions.

Your health care provider may need to give you medication for infection, nausea, 

vomiting, diarrhea or replace fluid you have lost through dehydration. It is very 

important to drink fluids.

Avoid Dehydration

High blood sugar, fever, diarrhea, 

vomiting can lead to loss of too much 

body fluid. Dehydration may cause 

the following symptoms:

	 •	 Dry mouth

	 •	 Decreasedurination or

dark urine

	 •	 Thirst

	 •	 Dry, flushedskin

Try to drink fluids every hour while you are awake. It may be easier to keep down if 

youtakesmall sipsof fluidsevery5 ‐ 15 minutes.
Self-Care Skills for the Person with Diabetes

36

Test and Monitor for Ketones

Be alert for the following symptoms when you’re sick:

	 •	 Pains in thestomach

	 •	 Fruitybreath

	 •	 Diarrhea

	 •	 Fastbreathing

	 •	 Vomiting

These symptoms could mean that your blood sugar levels are dangerously high, which 

indicate that you could be progressing into a condition called diabetic ketoacidosis 

(DKA). DKA is the result of the buildup of harmful waste products called ketones in the 

blood. DKA occurs when not enough insulin is available to break down glucose and 

the body breaks down only fat instead. Ketones are formed as the fat breaks down, 

and they can reach dangerous levels in the blood.

•	 Tobesafe, checkyoururineforketoneseveryfour hours when youaresick,and

report their presence to your provider immediately

	 •	 Theprovider will needaccuraterecordsofyourketonereadings in order togive

you proper advice
Sick Day Management

37

When to Call Your Health Care Team

You don’t need to call every time you have a mild stomach 

bugor thesniffles,butdocall foradviceif:

	 •	 Your fever is100oFor more

	 •	 Youarevomitingand/or havediarrheafor morethan 6 hours

	 •	 Yourbloodsugar isover250for24 hours

	 •	 Yourbloodsugar isover300for twotests in arow (in a2to8-hourperiod)

	 •	 You findketones in yoururine

When to get care immediately:

	 •	 Youcannotkeepfoodand fluidsdown

•	 You havetroublebreathing

	 •	 You havesignsofdehydration, such as:

 ] Drowsiness or confusion

 ] Dry eyes or mouth

 ] Irregular or fast breathing, fast or pounding heartbeat, and 

low blood pressure

 ] Leg cramps

 ] Weakness or dizziness

If you have to go to the hospital or emergency room, immediately tell doctors and 

nursesyou havediabetes. Always wearyourdiabetes identification braceletor

necklace in case you’re not able to talk to the doctors or nurses.
Self-Care Skills for the Person with Diabetes

38

Living Well 

with Diabetes

Maintaining good health 

when living with diabetes 

means paying attention 

to your entire body and 

your mind. Preventing or 

delaying complications 

will help you to protect 

your health for years 

to come.
Living Well with Diabetes

39

Care of Your Heart

High blood glucose harms blood vessels, which can cause heart problems. Heart 

and blood flow problems are made worse by smoking, high blood pressure, and high 

cholesterol. Heart and blood vessel disease can lead to heart attacks and strokes. It 

also causes poor blood flow (circulation) in the legs and feet.

•	 Checkyourbloodpressure

	 •	 Ifyourbloodpressureis higher than 140/80,

talk to your health care team

	 •	 Eat foods thatarelow in saltandfat

•	 Exercisemostdaysof the weekandbeas

physically active as you can

	 •	 Don’t smoke! Ifyoudosmoke, this is thetime

to quit

	 •	 Lose weight ifyouare heavy:

 ] Dropping even a few pounds will help keep 

your heart from working too hard

 ] If you need help to start, ask your provider or 

dietitian for a plan to lose weight

 ] Consider joiningthe MOVE!Weight

Management Program 

	 •	 Relax – stayingcalmhelpskeepyourblood

pressure and blood sugar under control

	 •	 Takeyour medicine. Ifyouareon medication to

lower your blood pressure or cholesterol, take it 

every day

	 •	 Askyour health careteam about takingaspirin

for your heart
Self-Care Skills for the Person with Diabetes

40

Care of Your Kidneys

Diabetes can damage the small blood vessels in the kidneys. This prevents them from 

clearing the waste out of your blood and can lead to chronic kidney disease.

•	 Keepyourbloodglucoseunder control

•	 Keepyourbloodpressureunder control

•	 Talktoyour health careteam aboutaurinetest forprotein at leastonceayear

	 •	 Askyour health careteam about medicinesandfoodthat can affectyourkidneys

Care of Your Eyes

Diabetes can harm the blood vessels in your eyes. This can lead to eye disease and 

even blindness. Early treatment of eye problems can help save your sight.

•	 Keepyourbloodglucoseunder control

	 •	 Haveadilatedeyeexamination byan eyecareprofessionaleveryyearor two,

even if your vision is not bothering you

	 •	 Watch forproblems. Reportblurryvision, flashesof light in youreyes,blind

spots, “things” floating in your eyes, or changes in your vision to your health 

care provider

	 •	 Don’tusetobacco.Smokingcan cause high bloodpressure, which can makeeye

problems and kidney problems worse
Living Well with Diabetes

41

Care of Your Feet

Because diabetes affects nerves, it can make it hard to feel pain in your feet and legs.

You may not know if, or when, you have been hurt. Diabetes can also cause problems 

with circulation. This makes it hard for cuts and sores to heal and can cause infection.

•	 Callyourprovider ifyouseesignsof troublesuch aspain or swellingin your feet,

acutorburn thatbecomes redor sore, calluses, corns,andin-grown toenails can

all lead to bigger problems

	 •	 Exercise.Stayingactiveimprovesblood flow toyour legsandfeet

	 •	 Checkyour feeteveryday.Lookfor cuts, sores,andblisters.Put lotion on dry

spots to prevent cracks. Use a mirror to see the bottom of your feet or ask a family 

member or friend to help you

	 •	 Keepyour feet clean.Wash your feeteveryday with mildsoapand warm water.

Test the water first to makesureit is not too hot. Dryyour feet well,especially

between your toes

	 •	 Cutyour toenails straightacross. Useclippers, notpointedscissors,andbe

careful not to cut the skin. Never cut corns and calluses. If you have hard or thick 

toenails, ask your provider if a foot specialist should cut them for you

	 •	 Always wear socksandshoes (not sandals).Cotton socks helpkeepyour feetdry.

Comfortable shoes help your blood flow. Never go barefoot

	 •	 Weargoodshoes. Beforeyouputon your shoes, feelaroundinsideor shakethe

shoeto findanysmallobjects that couldcutyour feet
Self-Care Skills for the Person with Diabetes

42

Care of Your 

Emotional Health

Managing emotional health is just as 

important as managing your physical 

health. This is true for all people.

Everyone feels stressed at times. Stress 

can aggravate any medical condition and 

make control difficult.

Living with diabetes is a daily task. Every aspect of your day, what you eat, 

your lifestyle and activities, stressful situations — fear, anger, despair, and 

depression, will have an effect on your diabetes.

Stress increases blood glucose levels and in people with diabetes can lead to poor 

blood glucose control.

Learning ways to take care of your whole self will help your diabetes control. Think 

about what causes stressful feelings.Then, find ways tolimit,alter,oravoidstressful

situations.

To combat stress try: 

	 •	 Exercisingasa natural stress reliever (andit helps tolowerbloodglucose)

	 •	 Makingtimetodothingsyouenjoy—such as reading, walking,or spending

time with friends or family 

•	Makingtimetorelax—yoga, tai chi,

meditation, and prayer are all ways of 

relaxing the mind and body

•	Picturingarelaxingscenein your mind

•	Usingdeepbreathingtechniques to

release physical tension
Living Well with Diabetes

43

Strategies for coping with stress:

	 •	 Haveasupport networkof familyand/or friends

	 •	 Beassertiveandlearn tosay“no”when appropriate

	 •	 Becurious,askquestions,andaskfor help

	 •	 Learn what triggers the most stress foryou,andtrytoalter thosesituations

	 •	 Challengeyourself with small short term goalsand workyour wayup

Recognizing depression

Manypeoplefeel sadordown when they first hear that they havediabetes.Feelings

like these are normal. But frequent feelings of helplessness or hopelessness are a 

symptom of depression. Depression is a serious problem, but it can be treated. If you 

feel overwhelmed, or if you are having trouble sleeping or eating, talk to your health 

care provider, your minister, or a counselor. Don’t wait! 
Self-Care Skills for the Person with Diabetes

44

You Can Live a Full Life and 

Enjoy Traveling with Some Advance Planning

Safe Travel 

Preparedness

While traveling, diabetes 

can be more of a challenge 

but with a little bit of 

planning, you can manage 

diabetes anywhere! Using 

a small makeup or travel 

bag to pack your “Diabetes 

Tool Kit” can help you stay 

organized.

Here are some travel tips:

	 •	 Carryalistofyour medications,doses,allergies,and medicalproblems

in your wallet

	 •	 Remember toadjust medication for timezonechanges

	 •	 Weara medical-alertbraceletor necklaceandcarryyourdiabetes care-card

	 •	 If travelingbyairplane, check with theairlineabout carryingyour insulin syringe

•	 Requestan aisleseat ifyou needfrequent rest room breaks

•	 Pack medication in your carryon luggage. Keepthem with you,do not storein

overhead bin

What to Pack:

	 •	 Packtwicetheamountofdiabetes medication and

supplies than you usually need

•	 Easytocarrysnackssuch asstringcheese, nuts,or jerky

	 •	 Medical insurancecard

	 •	 Comfortableshoes—you will likelybe walking more

than usual, so be attentive to your feet

Your Toolkit suggestions
45

Keep Track of Your Diabetes Health

Ask your provider to help you set goals to stay healthy

MyLast Result My Goal My Target

A1c

Blood Pressure

Cholesterol

LDL

HDL

Weight

UrineTest (eGFR)

Date

Eye exam (dilated)

Foot exam

Dental exam

Pneumonia vaccine

Flu vaccine

Other ____________________

Thanks to the members of the VA/DoD Diabetes Guideline and Toolkit Working Groups, the patients, and others who 

contributed to the design of this book.

My Last Exam/Vaccine

Ask your provider about:
This edition of the “Self-Care Skills for the Person with Diabetes” 

is based on the VA/DoD Management of Diabetes Mellitus 

Clinical Practice Guideline, revised in 2010. The guideline 

includes evidence-based recommendations for screening and 

management of patients with diabetes.

The full text of the Guideline can be found at: 

https://www.qmo.amedd.army.mil or 

http://www.healthquality.va.gov

Published September 2011