Exercise therapy for diabetes

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Regular aerobic exercise improves blood circulation and lowers blood glucose levels. Exercise
also strengthens the heart and helps maintain an ideal body weight. The chosen aerobic exercise
should use large muscle groups. Running, walking, biking, and swimming are excellent activities
for most people. The frequency, type, and duration of exercise depend on the individual's age,
treatment goals, and physical ability. An exercise program should be designed with the guidance
of a health care professional.

Exercise usually decreases the blood glucose levels. If blood glucose is low or normal, exercise
may cause hypoglycemia (low blood glucose) due to the utilization of glucose by the active
muscles. Therefore, food intake and insulin doses should be adjusted based on the intensity and
duration of the anticipated exercise.

Diet therapy for diabetes

How is diabetic treatment monitored at home?

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The goal of diabetic therapy is to control blood glucose levels and prevent diabetic
complications. Glucose levels are lowered into a normal range, if possible, but it is important not
to reduce the levels to abnormally low levels that can cause symptoms of hypoglycemia such as
sweating, increased heart rate, and even

Therefore, it is necessary not only to treat the diabetes, but also to monitor the effects of
treatment on blood glucose levels to avoid overtreatment or undertreatment of diabetes.

There are two types of tests for blood glucose monitoring in the home. The first type uses a
reagent strip, and the second type uses a reagent strip and a glucose meter.

Glucose and ketones also can be measured in the urine. Ketoacidosis is a serious but preventable
complication caused by inadequate treatment of diabetes. This condition can be identified by
testing urine for ketones.

Blood glucose reagent strips

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Reagent strips are saturated with glucose oxidase, an enzyme that interacts with glucose. When a
drop of blood is placed on the strip, the glucose oxidase chemically reacts with the blood
glucose. The resultant reaction changes the color of the strip. The higher the glucose level, the
greater the reaction, so the more dramatic the color change. The blood glucose level can be
determined by comparing the color of the strip with a color chart. For accurate results, test strips
should be stored at room temperature and away from moisture. To protect the strips from
moisture, bottles should be closed after use.

The disadvantage of reagent strips alone is that they do not give an exact glucose measurement.
They are accurate enough, however, to alert patients to seriously high or low levels of glucose.
Examples of reagent strips available overthecounter (OTC) are Chemstrip bG and
Glucostix. To determine a more accurate blood glucose level, the reagent strip must be
combined with a blood glucose meter. (See below.) Continue Reading

Blood glucose meters

Self-monitoring of blood glucose is the most important tool available to a patient for determining
their glycemic control. This test is simple to perform. It involves taking a small lancet to poke a
finger. Usually, this testing is performed just off to the side of the finger's tip, although some
meters do allow testing at other sites, such as the forearm. Then, a small quantity of blood is
placed on a testing strip that has been inserted into a meter that reports the glucose value.

The meter determines the blood glucose level by measuring the chemical reaction on the reagent
strip. Results obtained using a glucose meter are more accurate than those obtained without the
meter (that is, with reagent strips alone). However, the results using a home meter vary as much
as 20% from the more accurate measurements in a hospital or clinical laboratory. Fortunately,
portable meters are accurate enough for home monitoring and self-adjustment of insulin doses at
home.

It is important to know that reagent strips are calibrated for specific meters. Many meters need to
be

each time a new box of test strips is used. Inappropriate calibration will lead to errors in glucose
readings. Using incompatible strips and meters will give unreliable glucose readings.

Errors can also be caused when:

meters are improperly calibrated;

the meter is dirty;
the battery in the meter is dead;
reagent strips are stored improperly;
the reagent strips have expired;
not enough blood is applied to the reagent strip;
blood is not left on the reagent strip long enough, or is left too long, before reading;
the test is performed under the wrong conditions of temperature and humidity; or
patients are dehydrated.

The main advantage of self-monitoring blood glucose is its immediate feedback. The immediacy
of the result allows the individual to make decisions in terms of insulin, diet, and exercise that
immediately improve glucose control. This, in turn, gives people more control over their diabetes
and allows them to adapt their diabetes treatment plan to their lifestyle. Providing regular results
to a health care professional allows for more frequent and therapeutic adjustments of
medications. This improves symptoms and diabetic control, especially in the outpatient setting.

The main disadvantages of the self-monitoring of blood glucose are cost, discomfort, and
inconvenience (such as interrupting one's usual activities to do it). In addition, some patients
experience a feeling of frustration at seeing high blood glucose results when they expected lower
readings. One could say, "The thing about blood testing is that I know what my sugar is, and the
bad thing about glucose testing is that I know what my sugar is."

The information obtained from self-monitoring blood glucose is valuable to all people with
diabetes, even those controlled with diet and exercise, and those who require oral medication.
Many physicians routinely give all their patients with diabetes a glucose meter, along with an
individualized testing schedule. This schedule ranges from once daily up to six times each day,
depending on patient needs. Introducing the self-monitoring of blood glucose is effective, in
conjunction with diet education.

Many meters are available on the market and differ in attributes. They vary in the amount of
blood used, speed to display results, font size of the display, ability to store readings in memory,
and capability to download data. Some meters no longer require calibration. Newer meters
function as a portable digital assistant (PDA) for health, allowing patients to enter other
laboratory values, dates, and results of health visits. Newer meters may also store the strips right
in the meter, thereby allowing the patient to avoid handling the strips. They may also allow for a
patient to flag readings taken after eating vs. before a meal. Examples of glucose meters
available over-the-counter are Accu-Chek III, Glucometer Elite XL, and One Touch Ultra.

Software programs and mobile applications are also available that can help people with diabetes
manage their glycemic control. Depending upon the program, users can store and chart glucose
levels, lab values, doctor visits, or other health parameters. Continue Reading

Medically Reviewed by a Doctor on 3/22/2016

Urine glucose tests

The role for testing urinary glucose at home has faded with universal blood glucose monitoring
by fingerstick. Those few patients who choose to test urinary glucose must realize its limitations.
Urinary glucose only estimates blood glucose values roughly, and it provides no information at
all unless there is glucose in the urine. Glucose appears in the urine when the blood glucose level
is over 180 mg/dL, well above the target for most patients. Below that level, urinary glucose is
usually negative.

Urinary glucose levels should not be confused with checking urinary microalbumin and related
protein levels. Urinary glucose levels should not be confused with checking urinary
microalbumin and related protein levels. Performed in the doctor's office at least annually, these
tests provide necessary information about kidney function the basis for determining whether
certain medications should be added to the treatment plan to protect kidney function.

Urinary glucose tests also do not indicate the current blood glucose level, but rather the glucose
level during

period of time between the collection of the urine and the previous urination. In many patients,
the level of blood glucose must be very high in order for glucose to appear in the urine.
Therefore, the urine may be free of glucose, despite unacceptably high blood levels of glucose.
Thus, results from urine glucose tests should not be used to adjust insulin doses.

There are two types of urine glucose tests. Both types rely on a chemical reaction that produces a
color change. These tests use either tablets or strips. Generally, the test strip or tablet is placed in
urine. The resulting color change is matched against a color chart provided by the manufacturer,
which shows the different colors produced by different levels of glucose.

The first type, called the copper reduction test, uses cupric sulfate (for example, Clinitest). In
the presence of glucose, cupric sulfate (which is blue) changes to cuprous oxide (green to
orange). The reaction should be observed closely and the manufacturer's instructions closely
followed. The copper reduction tests can react with substances other than glucose in the urine,
leading to false positive results. This means the test erroneously shows glucose when it is not
present. Examples of these other substances include aspirin, penicillin, isoniazid (Nydrazid,
Laniazid), vitamin C, and cephalosporin-type antibiotics. Tablets and solutions utilizing copper
reduction may damage the skin and are poisonous if ingested. They should be handled carefully
and kept out of the reach of children.

The second type of urine glucose test, called the glucose oxidase test, uses the chemical
toluidine and the enzyme glucose oxidase (for example, Clinistix). Glucose oxidase converts the
glucose in urine to gluconic acid and hydrogen peroxide. The interaction of the hydrogen
peroxide with the toluidine causes a change in color. False negative results (meaning the test
shows no glucose when glucose really is present) may occur in patients taking vitamin C, aspirin,
iron supplements, levodopa (Sinemet), and tetracycline-type antibiotics. Glucose oxidase tests
are more convenient to use and less expensive than copper reduction tests. The strips should be
kept away from moisture. Continue Reading

Medically Reviewed by a Doctor on 3/22/2016

Tests for urinary ketones

Ketone testing is an important part of monitoring type 1 diabetes. It is a tool that is often also
used in pregnancies that are complicated by diabetes (called gestational diabetes).

Ketones form when one fasts (for example, while sleeping overnight) or when there is a
profound lack of insulin. When the body produces insufficient insulin, its cells cannot adequately
remove glucose from the blood, and the level of glucose in the blood rises. Responding to what
appears to be a lack of glucose, cells release hormones to stimulate the body to produce larger
amounts of glucose. Rising blood glucose level causes more urination and dehydration. Due to
low insulin action, the liver produces ketones, which are acids released into the blood. The
presence of ketones signals a condition in diabetic patients called diabetic ketoacidosis (or
DKA). Ketoacidosis always signifies that the cells are not receiving enough insulin.

Severe DKA is a medical emergency, since it can result in loss of consciousness and even death.
About 0.1% of those with DKA die as a result of it. There is a correlation between high blood
glucose levels, dehydration, and ketones. The higher the glucose level, the more likely that
ketones will be made. Therefore, diabetic patients with any blood glucose level over 240 mg/dL
should test promptly for urinary ketones. Patients with type 1 diabetes should also test for
ketones during any acute illness and during severe stress. Also, urinary ketones should be
checked if any symptoms of DKA occur (such as nausea, vomiting, abdominal pain, or increased
thirst).

Ketones can normally be found in the urine. For example, after an overnight fast, ketones can be
seen in up to 30% of people without diabetes. However, these levels of ketone production are
usually below the threshold of measurement by the ketone test strips. The strips can give falsely
positive results when patients are on drugs such as captopril (Capoten). Falsely negative readings
may be seen when test strips are old, exposed to air, or if the urine is very acidic (for example,
after drinking a lot of orange juice, which is also high in vitamin C).

These tests are based on the color change that occurs when ketones react with sodium
nitroprusside or similar compounds. The tests are performed in a manner similar to that of
urinary glucose testing. Different tests detect the three types of ketones (named acetoacetic acid,
acetone, and -hydroxybutyric acid). For example, Acetest only detects acetoacetic acid and
acetone, but not -hydroxybutyric acid. Ketostix detects only acetoacetic acid, which can
produce false-negative results if only acetone and -hydroxybutyric acid are present in the urine.
Ketone tests are supplied as strips or tablets.

The American Diabetes Association advises that ketone testing materials be available in the
office setting and that physicians should prefer using blood ketone measurements over urine
ketone measurements if possible. Home testing for blood ketones is also available, though not
often used due to higher cost of the test strips. Continue Reading

Medically Reviewed by a Doctor on 3/22/2016

Hemoglobin A1C (HbA1c) testing

The hemoglobin A1c test (HbA1c) is crucial to monitor blood glucose control in patients with
diabetes. In brief, hemoglobin A1c is the final product of several chemical reactions that occur in
the bloodstream as red blood cells are exposed to glucose. A red blood cell typically lives for
about three months, so the HbA1c reading provides a report card averaging blood sugar levels
over the prior three months. Many different methods are available to determine the HbA1c level.
Regardless, HbA1c level has been shown to predict the risk for developing complications of
diabetes, much in the same way that cholesterol levels are predictive of heart disease. The
HbA1c test should be performed routinely at three-month intervals in patients with established
diabetes. HbA1c can be tested when a new case of adult diabetes is suspected, although its use to
diagnose borderline pediatric diabetes is still controversial.

To measure HbA1c, blood obtained in the usual way (from a vein) can be sent to a laboratory.
Alternatively, many clinics specialized in diabetes care now have desktop HbA1c machines,
which will read a simpler fingerstick blood sample within minutes. Several conditions can affect
HbA1c measurements, and most relate to

disorders of the red blood cells. For example, results may be falsely low if too few red cells are
present (anemia). Falsely low readings can occur when red blood cells lose their proper shape
(due to conditions like thalassemias, sickle cell disease, or spherocytosis). HbA1c is invaluable
as a tool to individualize patient care plans so that glycemic goals can be achieved. Continue
Reading

Medically reviewed by John A. Seibel, MD; Board Certified Internal Medicine with a
subspecialty in Endocrinology & Metabolism

REFERENCE:

Medscape. Type 2 Diabetes Mellitus.

Medically Reviewed by a Doctor on 3/22/2016

http://www.medicinenet.com/diabetes_foot_problems_pictures_slideshow/article.
htm

How can diabetes affect my feet?

Chronically high blood sugar (glucose) levels can be associated with serious complications in
people who have diabetes. The feet are especially at risk. Two conditions called diabetic
neuropathy and peripheral vascular disease can damage the feet (and other areas of the body) in
people who have diabetes.
What is diabetic neuropathy?

Chronically high sugar levels associated with uncontrolled diabetes can cause nerve damage that
interferes with the ability to sense pain and temperature. This so-called "sensory diabetic
neuropathy" increases the risk a person with diabetes will not notice problems with his or her
feet. Nearly 10% of people with diabetes develop foot ulcers due to peripheral vascular disease
and nerve damage. People with diabetes may not notice sores or cuts on the feet, which in turn
can lead to an infection. Nerve damage can also affect the function of foot muscles, leading to
improper alignment and injury.

What is peripheral vascular disease?

Diabetes is associated with poor circulation (blood flow). Inadequate blood flow increases the
healing time for cuts and sores. Peripheral vascular disease refers to compromised blood flow in
the arms and legs. Poor blood flow increases the risk that infections will not heal. This, in turn,
increases the risk of ulcers and gangrene, which is tissue death that occurs in a localized area
when there is an inadequate blood supply.

What are common foot problems of people with diabetes?

The following images show common foot problems that anyone can get; however, those with
diabetes are at increased risk for serious complications associated with these conditions,
including infection and even amputation.

Athlete's foot

Fungal infection of the feet is called athlete's foot. Cracked skin, itching, and redness are
associated with the condition. Fungus enters cracks in the skin causing an infection that must be
treated with antifungal medications. Oral medications or topical creams may be used to treat
athlete's foot.
Fungal nail infection

Thick, brittle, yellow-brown, or opaque nails are common with fungal nail infections. The
infected area may crumble or seem to pull away from the rest of the nail. Fungus thrives in the
warm, moist, dark environment created by wearing closed-toed shoes. Nail injury also increases
the risk of fungal nail infection. These infections are difficult, but not impossible, to treat. Oral
medications work best to treat fungal nail infections. Topical treatments are only effective for a
few types of fungal nail infections. Sometimes, surgery is necessary to remove infected areas of
the nail.
Calluses

Calluses are hard areas of thickened skin that build up on the bottom of the feet. Uneven weight
distribution, a skin abnormality, or ill-fitting shoes may cause calluses. Use these tips to care for
calluses:

Rub the area with pumice stone after a shower or bath. Ask your doctor the best way to
do this.
Place cushioned insoles or pads in shoes.
Ask your doctor about prescription medication to soften calluses.
Corns

A corn is a thickened, button-like area of skin that builds up between the toes or near a bony area
of a toe. Pressure and friction cause corns. Use these tips to care for corns:

Rub the area with a pumice stone after a shower or bath. Consult your doctor before
doing this.
Avoid over-the-counter corn removal treatments.
Never try to cut the corn with a sharp object. Doing so can cause serious injury.
Blisters

Blisters are raised, fluid-filled areas of skin that form due to friction. Popping a blister is not a
good way to treat it since the skin covering the area helps guard against infection. To care for a
blister, keep the area clean, apply antibacterial cream or ointment, and cover it with a bandage to
reduce the risk of infection.

Bunions
A bunion is a sore, red, callused area that forms on the outside of the joint of the big toe. Bunions
make the big toe angle inward. They may appear on both feet and tend to run in families.
Wearing high-heeled shoes with inadequate toe room increases the risk of bunions by pushing
the big toes into an unnatural position. Covering the bunion with padding or a foam cushion
helps protect it. Special toe separators and other devices may be used to keep the toes in proper
alignment. If the bunion is very painful or unsightly, surgery may be used to alleviate the
symptoms.

Dry skin

Dry, cracked skin allows bacteria and other germs to enter your body, potentially causing an
infection. Moisturizing soaps, lotions, and other products can help keep the skin barrier soft,
intact, and healthy.
Foot ulcers

Foot ulcers are dangerous wounds that can affect people with diabetes. When a minor scrape,
skin break, or sore on the foot becomes infected, a sore can result. In people who have diabetes,
sores heal slowly or fail to heal. Early diagnosis and treatment are necessary to reduce the risk of
complications. Your doctor is the best source of information on how to properly care for a foot
sore.
Hammertoes

Weakened muscles in the toes contribute to the curled appearance known as "hammertoes." This
weakness shortens the tendons in the toes, causing them to contract. Hammertoes can be
hereditary. They can also be caused by wearing shoes that are too small and provide inadequate
toe room. Hammertoes can cause foot problems such as calluses, sores, blisters, and difficulty
walking. Corrective footwear and splints can help reposition and treat hammertoes. Sometimes
surgery may be needed to straighten the affected toes.

ingrown toenail

Ingrown toenails derive their name from growing into the skin along the edges of the nail. An
ingrown toenail may cause pain, pressure, and even cut into the skin leading to an infection.
Wearing tight or ill-fitting shoes increases the risk of ingrown toenails. High-impact activities
such as running and aerobics may contribute to the problem. Walking, toe crowding, and
inadequately trimmed toe nails may also cause ingrown toenails. The best way to prevent
ingrown toenails is to keep the nails trimmed. Professional medical treatment is necessary if an
ingrown toenail is severe or if there is an infection. Sometimes surgery is necessary to remove
the affected part of the nail and the growth plate from which the nail grows.
Can these foot problems be prevented?

Taking good care of your feet can prevent problems before they start! Use the following tips to
reduce your risk of common foot problems and serious complications associated with them.

Diabetes and Foot Problems

Prevention Tip #1

Living with diabetes requires you to pay special attention to your health and your condition.
Follow your doctor's instructions regarding diet, exercise and medication. Keeping your blood
sugar (glucose) levels within the recommended range is one of the best things you can do to
control your condition and protect your feet.

Diabetes and Foot Problems

Prevention Tip #2

Carefully inspect your feet daily for redness, blisters, sores, calluses, and other signs of irritation.
Daily foot checks are especially important if you have inadequate blood flow.
Diabetes and Foot Problems
Prevention Tip #3

Follow these foot care tips to properly care for your feet:

Wash your feet daily with non-irritating soap and warm water.
Avoid soaking your feet.
 Dry your feet completely after bathing, paying special attention to the areas between the
toes.
Avoid applying lotion to the areas between the toes.

Diabetes and Foot Problems

Prevention Tip #4

After bathing, use a pumice stone or emery board to smooth hardened areas of the feet that
contain corns and calluses. Working in one direction is most effective. Consult your doctor on
the proper way to use a pumice or emery board.
Diabetes and Foot Problems
Prevention Tip #5

Use the following toenail care tips to help prevent ingrown toenails.

Once a week, examine your toenails.

Trim toenails straight across using a nail clipper.
Avoid rounding or trimming down the sides of toenails.
Smooth rough nail edges with an emery board after clipping.

Consult your doctor for the proper way to care for your toenails.
Diabetes and Foot Problems
Prevention Tip #6

Proper footwear, socks, and stockings can go a long way to help protect your feet. Follow these
tips:

Choose well-fitting socks and stockings that contain soft elastic.

Wear socks to bed if your feet get chilly.
Avoid sandals and walking barefoot, even at home.
Wear properly-fitting shoes.
Choose shoes made of soft materials such as leather or canvas and take time to break
them in.
Protect your feet by always choosing slippers or closed-toed shoes.
If you need roomier shoes due to bunions or other deformities, extra wide shoes are
available online and in specialty stores.

Diabetes and Foot Problems

Prevention Tip #7

Follow these tips to keep blood flowing to your feet:

If you can, prop your feet up when sitting down

Wiggle your toes frequently.
Take frequent breaks to flex and point your toes and circle your feet in both directions.
Avoid crossing your legs, especially for long periods.
Diabetes and Foot Problems
Prevention Tip #8

Avoid smoking and if you do smoke, quit. Smoking aggravates blood flow problems.

Diabetes and Foot Problems

Prevention Tip #9

People who have diabetes should see a foot doctor (podiatrist) every 2 to 3 months, even when
not experiencing foot problems. At each check-up, ask the doctor to thoroughly examine your
feet. An annual foot exam should include:

An examination of the tops and bottoms of the feet and in between the toes
An assessment of skin warmth and redness
An assessment of pulses in the feet and temperature of the feet
An assessment of sensation using a monofilament tool

When should I contact my doctor?

Call your doctor if you notice any of the following with your feet:

Changes in skin color or temperature

Foot or ankle swelling
The appearance of corns, calluses, ingrown toenails, infected toenails, or dry, cracked
skin
Leg pain
Foul-smelling, persistent, or unusual foot odor

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Slow or Prevent Diabetes Nerve Damage

If you have nerve pain or peripheral neuropathy due to diabetes there is some evidence exercise
may either improve or worsen nerve damage. Consequently, people with diabetes should always
speak with their doctors to see which exercise program might be the best for them to participate
in. People with diabetes will need to make exercise a regular part of their ongoing treatment.

Look for Low-Impact Exercise

Lowimpact exercises seem to be useful and well-tolerated by many people with diabetes.
Exercises such as swimming, water aerobics, yoga, or tai chi are usually good choices. These
exercises may also help you improve balance and relaxation skills. High-impact exercises may
actually make symptoms such as peripheral neuropathy worse or cause damage that you are not
easily able to detect because of peripheral neuropathy.

Start Slow to Overcome Fear

For many people with diabetes and peripheral neuropathy, a regular exercise program is
something they haven't done in a while. You need to begin to exercise, but begin slowly and
gradually over days and weeks. You can slowly improve so you can exercise about 30 minutes a
day, five times a week. The key for beginning an exercise program is to go slowly and improve
by making small advances over long periods of time.

Working on Balance

With peripheral neuropathy, sometimes balancing yourself is difficult. Balancing can be

improved slowly by doing some simple exercises. For example, you can practice getting out of a
chair slowly by using your arms to help steady yourself. This exercise can be easily repeated
several times during the day and it can build confidence and show you have the ability to do
simple tasks without asking others for help. Improved balance may help you to take another step
forward in your exercise program.

Balance on One Leg

Increasing the difficulty of certain exercise tasks can result in very good benefits for those with
peripheral neuropathy caused by diabetes. One such task is attempting to balance on one leg.
Before trying this task, you should be next to a stable object in case balance falters. Attempting
to do balance on each leg for 30 seconds without holding on to a stationary object is a reasonable
goal. This can help your confidence, strength, and balance.

Walk a Tight Rope

Okay, maybe walking a tightrope is a bit ambitious! But balance is improved if you practice
walking heel-to-toe both forwards and backwards just like tightrope walkers do.
Tippy Toe

As people with diabetes with peripheral neuropathy progress, there are other exercises that can
further improve balance. For example, standing close to a stable stationary object (a desk or a
chair), you should slowly rise up on your toes and hold that position as long as you can without
using your arms to hold on to a stationary object. This can be done every day and repeated at
least three times, attempting to slowly increase the time you spend on your toes.

Get Checked Before You Start

In the beginning of the slideshow it was suggested your doctor should approve of your exercise
program. In addition, your doctor will probably check your heart, eyes, and feet to determine the
best type of exercise you can do depending upon any disabilities. Special care should be given to
the feet since peripheral neuropathy may interfere with you realizing you are developing blisters
or cuts on your feet.

Proper Footwear and Pack a Snack

As stated in the preceding slide, people with diabetes with peripheral neuropathy should pay
special attention to their feet. In terms of exercising, a good-fitting pair of athletic shoes is one of
the better ways to avoid foot problems such as cuts, abrasions, and/or blisters.

For those people with diabetes who are more advanced in their exercise program, it may be a
good idea to bring along a quick source of carbohydrates (for example, a small can of orange
juice or sports chews or gels) in case you have a drop in blood sugar due to exercise.
Blood Sugar and Exercise

For those people with diabetes with peripheral neuropathy or other problems, it's a good idea to
check blood glucose levels before and after exercise. If your average blood sugar is over 250
mg/dL, and you have type I diabetes, you might want to check for ketones in the urine. If the
ketones are moderate or high, exercise should be delayed until the ketone levels are low or
absent. Discuss with your doctor the glucose levels you should have before and after exercise
and what you should do if the glucose levels are not within those parameters.

Make Fitness Fun

Exercise shouldn't be a chore. It should be enjoyed. Do an exercise you enjoy such as swimming
or walking - whatever gets your body moving - will help your health, and can be fun so that you
want to keep doing it. As stated previously, people with diabetes don't need to do extreme or
high-impact exercises which may actually worsen their condition; low-impact exercises are
encouraged.

Get a Workout Buddy

Exercise for a person with diabetes, besides being fun, can also be a social event. You and a
friend (human or animal!) can have a good time and encourage each other to slowly advance.
Joining a low-impact exercise group can reinforce the idea of regular exercise and also be a way
to develop socially.

Try Something New

Once you have developed confidence and better balance, it may be time to take on a new
activity. What activity really depends on your individual desire, but some suggestions include
bowling, dancing, golf, or any other sport or activity that varies from your usual exercise routine.
Consequently, if you are person with diabetes with peripheral neuropathy and gradually increase
your exercise tolerance and balance, participating in social sports is not an unreasonable or
unattainable goal.

https://www.ncbi.nlm.nih.gov/books/NBK2631/pdf/Bookshelf_NBK2631.pdf

Chapter 13. Patient Safety and Quality in Home Health Care

http://www.ajmc.com/journals/issue/2015/2015-vol21-n6/improving-diabetic-patient-transition-to-
home-healthcare-leading-risk-factors-for-30-day-readmission/P-3

Improving Diabetic Patient

https://www.saintelizabeth.com/Services-and-Programs/Homecare-
And-Other-Services/Diabetes-Care.aspx

Diabetes Care (Canadian Diabetes Association, 2010)

What is diabetes care?

Most people who receive home and community care for diabetes are:

Newly diagnosed: Includes people who need health education and/or monitoring, those who
are adjusting to a newer technology like the insulin pump, and children attending school.
Self-managing but needing some help: Includes regular foot care , nutrition support,
medication management, and helping people who are aging (often with multiple health
conditions) and need more help managing their day-to-day diabetes care.
People who have developed long-term diabetes complications: Includes people with vision
loss, neuropathy (often causing pain and numbness in hands and feet), delayed surgical wound
healing, diabetic foot ulcers, stroke, or chronic kidney disease.

Receiving care in your home and community

Managing your own, or a loved one's, diabetes can feel overwhelming - especially in the
beginning or if you run into complications. Our diabetes care team includes:

Nurses who provide at-home care. During a visit to your home, a nurse will assess your needs as
they relate to diabetes and any other conditions you may have (such as high blood pressure),
provide general monitoring of blood glucose and the delivery of insulin in situations where
individuals need help to manage this critical part of their care. Nurses also provide education and
support on topics such as nutrition, exercise, and making healthy lifestyle choices.

Certified Diabetes Educators (CDE), who are health professionals with specialized knowledge
in diabetes care and education, and who have passed the Canadian Diabetes Educator's
Certification Board (CDECB) exam.

Diabetes resource nurses, nurses with additional knowledge and skill in diabetes care,
education, and management.

Personal support workers (or community health workers) who can provide personal care,
such as bathing, dressing, or assistance with meals.

Registered dietitians who can assess a person's diet, develop customized meal plans and menus,
and educate individuals and families on the implementation of these plans.

School health support teams, who help monitor, manage diabetes, and provide self-
management support for students with diabetes at school.
Social workers who support families in working through the emotions and life changes
associated with diabetes by providing coping and stress management strategies.

Wound care nurses who help care for diabetic foot ulcers, skin infections and other wounds.
Wound care specialists also help prevent complications from wounds and assist with neuropathy
(decreased blood flow, pain and/or numbness in their hands and feet).

http://www.hopkinsmedicine.org/homecare/services/HHS/

Johns Hopkins Health Services division

Home Health Services

Home Care for All Ages

Johns Hopkins Home Health Services knows that, in some cases, healing at home with loved
ones is the best option. Thats why we offer and educate you on a variety of home health services
that allow you to leave the hospital and continue necessary treatment where youre most
comfortable.
HomeCare Elite

The Johns Hopkins Home Care Group is recognized as a HomeCare Elite award winner, putting
us in the top 25 percent of Medicare-certified agencies in home health performance measures.

Measuring the Home Health Care Patient Experience

Quality home care is critical to ensuring patients continue to receive treatment after a hospital
stay for medical conditions that may require it. Effective communication and compassionate care
from home health providers ensures patients and families understand how to manage their health
condition, which can help to prevent a hospital readmission.

Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS)
survey is designed to measure how often key components of home health care happen.
Prospective home health care patients and families can use HHCAHPS survey results to
objectively compare other patient perspectives on communication quality, communication
frequency and overall experience.

Learn more about the home health care patient experience and HHCAHPS.

Home Health Compare is a resource that provides home health agency performance in a variety
of ways, including its own star rating measures, as well as data from HHCAHPS. Learn more on
the latest quality data from Home Health Compare.

Expectations of Home Care

You have the right to:

Receive high-quality care.

Be educated about your role and your familys role in managing pain when appropriate, as well
as potential limitations and side effects of pain treatments.
Be admitted only if we can provide the care you need. A qualified staff member will assess your
needs. If you require care or services that we do not have the resources to provide, we will
inform you and refer you to alternate services if available, or we will admit you, but only after
explaining our limitations and the lack of a suitable alternative.
Receive emergency instructions and be told what to do in case of an emergency.

https://www.diabetesaustralia.com.au/managing-gestational-diabetes

http://www.medicinenet.com/gestational_diabetes/article.htm
Gestational Diabetes

http://americanpregnancy.org/pregnancy-complications/gestational-diabetes/

All expectant mothers will be tested for gestational diabetes

https://www.diabetesaustralia.com.au/pregnancy

Pre-pregnancy care for people with diabetes

http://www.mayoclinic.org/diseases-conditions/gestational-diabetes/basics/definition/con-20014854

http://www.medbroadcast.com/channel/diabetes/diagnosis-and-treatment-of-diabetes/treatment-for-
gestational-diabetes

Treatment for gestational diabetes

http://www.bupa.co.uk/health-information/directory/d/diabetes-in-pregnancy

Gestational diabetes (diabetes in pregnancy)

https://intermountainhealthcare.org/ext/Dcmnt?ncid=51062504

Gestational diabetes

https://hartfordhealthcaremedicalgroup.org/resources/health-resources/health-
library/detail?id=hw197466&lang=en-us

Gestational Diabetes

http://healthcare.utah.edu/utahdiabetescenter/gestational.php

http://www.diabeteszone.org/gestational-diabetes
https://www.diabetes.co.uk/about-insulin.html

http://www.the-diabetic-voice.com/gestational-diabetic-diet.html

http://www.wikihow.com/Control-Diabetes