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Diabetes For Canadians For Dummies®, 2nd Edition

Table of Contents

Diabetes For Canadians For Dummies,® 2nd Edition

by Ian Blumer, MD, FRCPC and Alan L. Rubin, MD

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About the Authors

Ian Blumer, MD, FRCPC, is a diabetes specialist in the Greater Toronto Area of Ontario. He has a teaching appointment with the University of Toronto, is the medical advisor to the adult program of the Charles H. Best Diabetes Centre in Whitby, Ontario, and is actively involved in diabetes research. An enthusiastic lecturer, he has spoken about diabetes to numerous professional and lay audiences and has appeared regularly in the Canadian media.

Dr. Blumer is a member of the Clinical and Scientific Section of the Canadian Diabetes Association (CDA), where he currently serves as Chair of the Dissemination and Implementation Committee for the 2008 CDA Clinical Practice Guidelines. He is also a member of the American Diabetes Association, and the European Association for the Study of Diabetes.

Dr. Blumer is the author of What Your Doctor Really Thinks (Dundurn, 1999), and co-author of Understanding Prescription Drugs For Canadians For Dummies (co-written with Dr. Heather McDonald-Blumer). His Web site () offers practical advice on how to manage diabetes. Ian welcomes your comments about this book at .

Alan L. Rubin, MD, is one of America’s foremost experts on diabetes. He is a professional member of the American Diabetes Association and the Endocrine Society and has been in private practice specializing in diabetes and thyroid disease for more than 30 years. Dr. Rubin was Assistant Clinical Professor of Medicine at University of California Medical Center in San Francisco for 20 years. He has spoken about diabetes to professional medical audiences and non-medical audiences around the world. He has been a consultant to many pharmaceutical companies and companies that make diabetes products.

Dr. Rubin was one of the first specialists in his field to recognize the significance of patient self-testing of blood glucose, the major advance in diabetes care since the advent of insulin. As a result, he has been on numerous radio and television programs, talking about the cause, the prevention, and the treatment of diabetes and its complications.

Since publishing Diabetes For Dummies, Dr. Rubin has had four other bestselling For Dummies books — Diabetes Cookbook For Dummies, Thyroid For Dummies, High Blood Pressure For Dummies, and Type 1 Diabetes For Dummies — all published by Wiley Publishing. His five books cover the medical problems of 100 million Americans.

Dedication

Ian: This 2nd edition of Diabetes For Canadians For Dummies is dedicated to diabetes educators from coast to coast to coast. Not a day passes when Ian doesn’t thank his lucky stars that he and his fellow physicians have such a dedicated group of caring individuals working together as part of a team striving to keep people living with diabetes healthy.

Alan: This book is dedicated to Alan’s wife Enid and their children, Renee and Larry. Their patience, enthusiasm, and encouragement helped to make the writing a real pleasure. This book is also dedicated to the thousands of people with diabetes who have written to thank Alan for helping them to understand what they are dealing with and for telling him where he needs to provide more information and emphasis to make this an even better book.

Authors' Acknowledgments

Ian: I cannot imagine there exists a nicer, more mentoring, and more thoughtful editor than Robert Hickey. Robert; thank you (again!). I would also like to thank Lisa Berland whose skilled review of my manuscript has saved me from committing egregious (and embarrassing) grammatical errors and has kept a potentially disparate several hundred pages from being, well, disparate. Thanks also to Lindsay Humphreys who has so ably overseen this project.

I would like to thank Bin Chin, who has once again educated me on the nuances of nutrition and to Marian Barltrop, who helped research the first edition of this book and who continues to be such a wonderful partner in both clinical work and scientific research. It will never be possible for me to express my degree of respect and admiration for Marlene Grass, the epitome of selfless dedication and a pioneer in childhood and young adult diabetes education. Marlene has improved the lives of thousands of people with diabetes. It was Marlene who brought me into the diabetes fold; how very lucky I am that she did so!

Thanks to those who have provided helpful tips for this book including Keith Bowering, Jeannette Goguen, Henry Halapy, Robin Ingle, Claire Lightfoot, Jill Milliken, Paul Oh, Ron Sigal, and Karyn Thompson. And a special thanks to Maureen Clement, a physician of immense knowledge and caring who has contributed enormously to the improvement of diabetes care in Canada and who, on a personal level, has been kind enough to review this manuscript.

Thanks to those readers of the first edition of this book who sent me such kind emails. I cannot tell you how much these have meant to me. And to my patients I extend my profound appreciation for giving me the honour of assisting you with your health care and my great thanks for the lessons I learn from you.

Last, but heavens, not least, I would like to thank my wonderful wife Heather whose love, companionship, partnership, encouragement, and support have brought me nothing but joy for almost twenty-five years now. Everyone — including our kids! — tells me I’m the most fortunate husband alive. They’re right.

Alan: For this edition, acquisitions editor Michael Lewis deserves major thanks. I have had the pleasure of working with him for several years. He is supportive, encouraging, and fun and I look forward to a long association with him. I am also blessed with another great project editor, Jennifer Connolly, who not only made sure that everything was readable and understandable, but offered excellent suggestions to improve the information. My thanks also to Dr. Seymour Levin for reviewing the book for scientific accuracy.

Ronnie and Michael Goldfield should definitely be considered the godparents of this book.

My friends in the Dawn Patrol, a group of guys with whom I play squash and solve the problems of the world thereafter, kept me laughing throughout the production of this book. Their willingness to follow me convinced me that others would be willing to read what I wrote.

My teachers are too numerous to mention, but one group deserves special attention. They are my patients over the last 35 years, the people whose trials and tribulations caused me to seek the knowledge that you will find in this book.

This book is written on the shoulders of thousands of men and women who made the discoveries and held the committee meetings. Their accomplishments cannot possibly be given adequate acclaim. We owe them big-time.

Publisher’s Acknowledgments

We’re proud of this book; please send us your comments through our online registration form located at . For other comments, please contact our Customer Care Department within the U.S. at 877-762-2974, outside the U.S. at 317-572-3993, or fax 317-572-4002.

Some of the people who helped bring this book to market include the following:

Acquisitions, Editorial, and Media Development

Editor: Robert Hickey

Editor, previous edition: Michelle Marchetti

Project Manager: Elizabeth McCurdy

Project Editor: Lindsay Humphreys

Copy Editor: Lisa Berland

Cover Photos: Mauritius Images/PhotoLibrary

Cartoons: Rich Tennant ()

Composition Services

Project Coordinator: Lynsey Stanford

Layout and Graphics: Samantha K. Allen, Reuben W. Davis

Proofreaders: Laura Albert, Laura L. Bowman, Dwight Ramsey

Indexer: Potomac Indexing, LLC

Publishing and Editorial for Consumer Dummies

Diane Graves Steele, Vice President and Publisher, Consumer Dummies

Kristin Ferguson-Wagstaffe, Product Development Director, Consumer Dummies

Ensley Eikenburg, Associate Publisher, Travel

Kelly Regan, Editorial Director, Travel

Publishing for Technology Dummies

Andy Cummings, Vice President and Publisher, Dummies Technology/General User

Composition Services

Debbie Stailey, Director of Composition Services

Introduction

A second edition: Wow, is it really necessary? You bet it is. So much has happened since the last edition. As the 2008 Canadian Diabetes Association Clinical Practice Guidelines (upon which this book is based) reveal, doctors now know much more about diabetes. (And after reading this book, you’ll know it too.) Best of all, the guidelines include increasingly effective ways of keeping people with diabetes healthy. We have new and better ways of using nutrition therapy; we have, thanks to Canadian researchers, more effective ways of using exercise; and we also have entirely new types of medicines available.

In 1985 there were 30 million people with diabetes in the world. By 2000 that number had risen to 150 million. By the year 2025 it’s estimated that 380 million people will have diabetes. If you’re like us, these numbers sound alarming but are so large they’re hard to relate to. So, looking closer to home, a recent study found that from 1995 to 2005 the number of people in Ontario living with diabetes doubled, reaching 9 percent of the population, or 827,000 individuals. (It is quite likely that similar figures are present elsewhere in Canada, too.) Nine percent! Next time you’re at a hockey game, look around the stands and just imagine that nearly one in ten people in the arena have diabetes. As we mention in Chapter 1, you surely are not alone in having diabetes.

Diabetes has become so prevalent and so important in its worldwide health (and, therefore, financial) implications that the United Nations has recently declared November 14 (the birthday of the co-discoverer of insulin, Frederick Banting) to be World Diabetes Day.

In a sense, a diagnosis of diabetes is both good news and bad news. It’s bad news to be told you have a health problem you could do without, thank you very much. But it can be good news if you see it as an opportunity to have a look at your lifestyle and make those changes that may have been due anyhow. It’s never too late to start leading a healthier life!

As for humour, at times you will feel like doing anything but laughing about your diabetes. But scientific studies are clear about the benefits of a positive attitude on a person’s diabetes. In very few words: He who laughs, lasts. Also, people find out and remember more when humour is part of the process. Our goal isn’t to trivialize human suffering by being comic about it, but to lighten the burden of a chronic disease by showing that it’s not all doom and gloom.

About This Book

We’ve designed Diabetes For Canadians For Dummies so you don’t have to read it cover to cover, but if you know nothing about diabetes, doing so may be a good approach. (Indeed, many readers of our first edition have told us this is exactly what they did!) We want this book to serve as a source for information about diabetes, what causes it, how it affects you, and, most importantly, how to effectively deal with diabetes so that you can achieve and maintain good health.

Canada has a long and proud history of being in the forefront of diabetes research and therapy. Diabetes For Canadians For Dummies looks at the special issues that Canadians with diabetes have to face (like Ian’s patient who returned to his car one February morning after his son’s hockey practice, only to find his insulin frozen solid!) and uses the most recent Canadian Diabetes Association recommendations (2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada). These guidelines are of such high quality that they’re referred to and used around the world. (You can find the guidelines online at ).

In addition to discussing the latest facts about diabetes, this book tells you about the best sources you can access to discover any information that comes out after the publication of this edition. You’ll find frequent references to Web sites that offer excellent information. If you don’t have Internet access yourself, you can still get online at your neighbourhood library. As Internet addresses change frequently, if you find a recommended link to be non-functional, try going to the home page of the site and check their site map to find the new page.

Conventions Used in This Book

Diabetes, as you know, is associated with sugar problems. But sugars come in many types, so doctors avoid using the words sugar and glucose interchangeably. In this book, we use the word glucose rather than sugar (unless we’re talking about things such as table sugar or sweets you have in your diet). As well, because it gets to be redundant to keep adding mmol/L (which is short for millimoles per litre) after every blood glucose value to which we refer, you can safely assume that when we say, for example, that a fasting blood glucose of 7 (or higher) is indicative of diabetes, we mean 7.0 mmol/L.

What You Don’t Have to Read

We hope you’ll enjoy reading everything in this book; however, throughout the book, you’ll find shaded areas, which are called sidebars, that contain material that’s interesting but not essential. We hereby give you permission to skip them if the material they cover is of no particular interest to you. You’ll still understand everything else.

In addition, we’ve noted some paragraphs that have a more technical nature with the Technical Stuff icon (see the section “Icons Used in This Book,” later in this Introduction for more information on icons). Although these paragraphs deepen your knowledge of diabetes, you can still understand the text without reading them. Our feelings won’t get hurt if you don’t read these paragraphs, but these technical tidbits may come in handy during a high-stakes trivia game, or at the very least can make you sound pretty smart in front of your doctor.

Foolish Assumptions

This book assumes that you know nothing about diabetes. You won’t suddenly have to face a term you’ve never heard before that isn’t explained. However, if you already know a lot about diabetes, you’ll find more in-depth explanations. You can pick and choose how much you want to know about a subject. The key points are clearly marked.

How This Book Is Organized

This book is divided into six parts to help you find out all you can about the topic of diabetes.

Part I: Dealing with the Diagnosis of Diabetes

To slay the dragon, you have to be able to identify it. This part sorts out the different types of diabetes and looks at how you get diabetes and how you can help protect your family from developing it.

In this part, you’ll also find out how to deal with the emotional and psychological consequences of the diagnosis and what all those intimidating-looking polysyllabic words mean.

Part II: How Diabetes Can Affect Your Body

Diabetes may be associated with sugar, but to say that it’s the same as sugar is like saying that a car is the same as a spark plug. Diabetes is far more than that and can affect every part of you. If you understand diabetes, you’ll understand how your body works both when it’s healthy and when it’s not.

In this part, you find out what you need to know about both the acute and long-term problems that diabetes can cause. You also find out about sexual problems related to diabetes and about how diabetes can affect pregnancy.

Part III: Rule Your Diabetes: Don’t Let It Rule You

In this part, you discover all the tools available to treat diabetes. You find out about the health care team that is there to assist you and about the ways that you can make effective use of good nutrition and exercise to keep yourself healthy. You also discover the medications that may assist you with controlling your blood glucose.

We also take a look at alternative and complementary therapies, including natural products that people with diabetes often take.

Part IV: Particular Patients and Special Circumstances

Diabetes affects people differently depending on their age group. In this part, you hear about those differences and how to manage them. You also find out about diabetes in Aboriginal peoples.

We look at employment and insurance difficulties that people with diabetes can face and how to address them. This part also discusses diabetes and driving and offers suggestions to help you maintain a driver’s licence and to obtain a commercial licence. We also look at the implications of having diabetes on the ability to pilot an aircraft.

And so that you are always prepared, we discuss precautions you can take so that you can look after your diabetes in the event that a disaster strikes.

Part V: The Part of Tens

This part presents a concise summary of the most crucial stuff you needto know. Find out not only Ten Ways to Stay Healthy and Prevent Complications, but also Ten Frequently Asked Questions and Ten Ways to Get the Best Possible Health Care.

Part VI: Appendixes

This is where you’ll find information on the Food Group System used in diabetes meal planning. We also look at some terrific diabetes-oriented Internet sites and, last, we present a glossary. (We define words as we go along, but in case you forget what a term means, you can quickly flip to the back of the book.)

Icons Used in This Book

The icons tell you what you must know, what you should know, and what you might find interesting but can live without.

anecdote.eps This icon indicates a story about one of our patients. (The names and other identifiers have been changed to maintain confidentiality.)

TechnicalStuff.eps This icon gives you technical information or terminology that may be helpful, but not necessary, to your understanding of the topic.

Warning(bomb).eps When you see this icon, it means the information is critical and is not to be missed.

HealthCareTeam.eps This icon points out when you should contact your health care team (for example, if your blood glucose control is in need of improving or if you need a particular test done). Your health care team includes your family doctor, your diabetes specialist, your diabetes nurse educator, your dietitian, your eye doctor (optometrist or ophthalmologist), your pharmacist, and, when necessary, other specialists (such as a podiatrist, dentist, cardiologist, kidney specialist, neurologist, emergency room physician, and so forth). We’ll let you know which member of your team you should contact. (Incidentally, the most important member of your health care team is you.)

Tip.eps This icon is used when we share a practical, timesaving piece of advice, sometimes providing some additional detail on an important point.

Part I

Dealing with the Diagnosis of Diabetes

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In this part . . .

You have found out that you or a loved one has diabetes. What do you do now? This part looks at the cause of your diabetes and how it can make you feel — both mentally and physically.

Chapter 1

Membership in a Club You Didn’t Ask to Join

In This Chapter

Understanding what diabetes is

Meeting others with diabetes

Coping with diabetes

As a person with diabetes, you already know that diabetes isn’t “just a sugar problem.” In fact, the moment you were told you had diabetes, many different thoughts may have run through your mind. You have feelings, and you have your own personal story. You’re not the same person as your next-door neighbour or your sister or your friend, and your diabetes and the way that you respond to its challenges are unique to you.

And unless you live alone on a desert island, your diabetes doesn’t affect just you. Your family, friends, and co-workers are influenced by your diabetes and by their desire to help you.

In this chapter we consider how you might feel after you first find out you have diabetes, and we also look at some coping strategies to help you deal with this unwelcome news.

Figuring Out What Diabetes Is

Because we spend so much time discussing diabetes in this book, we want to start by defining the condition. Diabetes is a metabolic disorder (a problem with the body’s internal chemistry) characterized by the presence of high blood glucose because the pancreas is unable to make enough insulin hormone or because the insulin the pancreas makes is not working properly, or both. (We take a closer look at glucose in Chapter 2.)

That may be the technically correct definition of diabetes, but to leave it at that would be akin to defining Paris as “a city with a metal tower located in France.” France does indeed have a metal tower — and diabetes does indeed have high blood glucose — but to limit your perspective to such simple definitions would be to miss out on so, so much. Diabetes isn’t just a sugar problem; it’s a whole body problem. To make this point, Ian made up his own definition of diabetes: “A disease that involves high blood glucose levels and an increased risk of damage to the body, much of which is preventable.”

TechnicalStuff.eps Diabetes is actually the short form for diabetes mellitus. The Romans noticed that the urine of certain people was mellitus, the Latin word for “sweet.” The Greeks noticed that when people with sweet urine drank, fluids came out in the urine almost as fast as they went in the mouth, like a siphon. They called this by the Greek word for “siphon” — diabetes. Hence diabetes mellitus, but we think this is much better captured by the 17th-century definition of diabetes: “the pissing evil.” Talk about calling it the way you see it!

You may have done some searching in books or on the Internet and come across another form of diabetes called diabetes insipidus. This term refers to an entirely different condition than diabetes mellitus. The only thing they have in common is a tendency to pass lots of urine. And now that we’ve clarified that, you won’t see diabetes insipidus mentioned again in this book (unless you count the index at the back!).

You’re Not Alone

Hardly a day goes by when a person with diabetes isn’t in the news. Years ago, such appearances were often of heartbreak or loss. Nowadays it’s more likely to celebrate an achievement. On May 25, 2008, Sebastien Sasseville () became the first Canadian with type 1 diabetes to reach the summit of Mount Everest. In 2007, Chris Jarvis (), a resident of Victoria, B.C., won a rowing gold medal at the Commonwealth Games. And in that same year Scott Verplank, insulin pump and all, won the EDS Byron Nelson Championship (and the US$1,134,000 that went with it!).

Away from the sports arena, Ernest Hemingway, Thomas Edison, Jack Benny, Elizabeth Taylor, and — Ian’s all-time favourite piece of diabetes lore — Elvis Presley all lived with diabetes.

You may not have spoken to Stephen Steele, but it is quite possible he has spoken to you. Stephen is a commercial pilot with a major Canadian airline. (You get to know Stephen better in Chapter 18.) And in the event that you had the bad luck to be in dire straits on some sinking vessel off the Atlantic coast, it is quite possible that the hero that plucked you from the ocean was none other than Major Chuck Grenkow, a Medal of Bravery–winning Canadian Forces pilot and aircraft commander performing search and rescue operations with the Canadian military. Oh, by the way, they both have diabetes.

Diabetes is a common disease, so it’s bound to occur in some very uncommon people. But you don’t have to be famous to be considered exceptional. Indeed, every day of the week in our practices we see special people, people who have diabetes yet look after families, work in automotive plants or office buildings, write exams, go to movies, and do their best to live life to the fullest — people, perhaps, just like you.

The point is, diabetes shouldn’t define your life. You’re the same person the day after you found out you had diabetes as you were the day before. It just happens that you’ve been given an additional issue to deal with. Diabetes shouldn’t stop you from doing what you want to do with your life. Certainly, it does complicate things in some ways, but if you follow the principles of good diabetes care that we discuss in this book, you may actually be healthier than people without diabetes who smoke, overeat, underexercise, or engage in other unhealthy activities.

Handling the News

Do you remember what you were doing when you found out that you or a loved one had diabetes? Unless you were too young to understand, the news was likely quite a shock. Suddenly you had a condition from which people get sick and can die. The following sections describe the normal stages of reacting to a diagnosis of a major medical condition such as diabetes.

Experiencing denial

You may have begun by denying that you had diabetes, despite all the evidence to the contrary. You probably looked for any evidence that the whole thing was a mistake, and you may not have followed the advice you were given. But ultimately, you had to accept the diagnosis and begin to gather the information needed to start to help yourself.

Hopefully, you not only came to accept the diabetes diagnosis yourself, but also shared the news with your family and other people close to you. Having diabetes isn’t something to be ashamed of, and it isn’t something that you should have to hide from anyone.

Your diabetes isn’t your fault. You didn’t want to have diabetes. You didn’t try to get diabetes. And no one can catch it from you. There are over 2 million Canadians living with diabetes. You have joined a very, very large club!

anecdote.eps When you and others are accepting and open about having diabetes, you’ll find that you’re far from alone in your situation. (If you don’t believe us, read the section “You’re Not Alone” earlier in this chapter.) And you will likely find it comforting to know there are others you can relate to and draw support from. For example, a number of years ago, one of Ian’s patients, newly diagnosed with diabetes, was buying her diabetes supplies at the pharmacy and mentioned to the person beside her in line how worried she was about her health. Turns out this other person also had diabetes and was able to provide lots of reassurance. Well, more than just reassurance as it turns out — they got married a year later!

Feeling anger

When you’ve passed the stage of denying that you have diabetes, you may become angry that you’re saddled with this “terrible” diagnosis. But you’ll quickly find that diabetes isn’t so terrible and that you can’t rid yourself of the disease. Anger only worsens your situation, and being angry about your diagnosis is detrimental in the following ways:

If your anger becomes targeted at a person, he or she is hurt.

You may feel guilty that your anger is harming you and those close to you.

Anger can prevent you from successfully managing your diabetes.

Tip.eps As long as you’re angry, you’re not in a problem-solving mode. Diabetes requires your focus and attention. Use your energy positively to find creative ways to manage your diabetes. (For ways to manage your diabetes, see Part III.)

Bargaining for more time

The stage of anger often transitions into a stage when you become increasingly aware of your mortality and bargain for more time. Even though you probably realize that you have plenty of life ahead of you, you may feel overwhelmed by the talk of complications, blood tests, and pills or insulin. You may even experience depression, which makes good diabetes care all the more difficult.

Studies have shown that people with diabetes suffer from depression at a rate that is two to four times higher than the rate for the general population. Those with diabetes also experience anxiety at a rate three to five times higher than people without diabetes.

If you suffer from depression, you may feel that your diabetes situation creates problems for you that justify your being depressed. You may rationalize your depression by saying that it’s caused by the following: You

Don’t have the freedom to eat whatever you want whenever you want.

Have to adjust your leisure activities.

May feel that you’re too tired to overcome difficulties.

May dread the future and possible diabetic complications.

May feel that diabetes hinders you as you try to form new relationships.

May feel annoyed over all the minor inconveniences of dealing with diabetes.

All of the preceding concerns are legitimate, but they also are all surmountable. How do you handle your many concerns and fend off depression? The following are a few important methods:

Try to achieve excellent blood glucose control (see Chapter 9).

Begin a regular exercise program (see Chapter 11).

Tell a friend or relative how you are feeling; get it off your chest.

Recognize that not every abnormal blip in your blood glucose is your fault (see Chapter 9).

Sometimes, in order to surmount these challenges, professional help is required. We look at this in the sidebar “When you’re having trouble coping.”

Moving on

If you can’t overcome the depression brought on by your diabetes concerns, you may need to consider therapy. But you probably won’t reach that point. You may experience the various stages of reacting to your diabetes in a different order than we describe in the previous sections. Some stages may be more prominent, and others may be hardly noticeable.

Almost everyone with diabetes goes through periods when they pay less attention to their health, do less blood glucose testing, fall off their lifestyle treatment program, and even start missing some of their medicines. That’s a fact of diabetes life and you needn’t feel guilty. By the time you recognize that this is happening to you, you will probably also discover that you are ready to get back on track. The trick is not to dwell on perceived “failure,” but to refocus on future success. It’s just like when driving: gazing too long in the rearview mirror distracts you from focusing on where you’re heading.

Tip.eps Don’t feel that any anger, denial, or sadness is wrong. These are natural coping mechanisms that serve a psychological purpose for a brief time. Allow yourself to have these feelings, but then drop them. Move on and learn to live normally with your diabetes. You’ll be surprised how much more easily you can control your diabetes when your spirits improve.

Here are some key steps you can take to manage the emotional side of diabetes:

Focus on your successes. Some things may go wrong as you find out all about managing your diabetes, but most things will go right. As you concentrate on your successes, you will realize that you can cope with diabetes and not let it overwhelm you.

Involve the whole family in your diabetes. A diabetic diet is a healthy diet for everyone. And the exercise you do is good for the whole family too. By doing things together, you strengthen the family ties while everyone benefits from a healthier lifestyle. Also, should you need your family to help you, for instance, if your blood glucose level is severely low, their being aware of how to help you will both reassure them and benefit you. (We discuss low blood glucose and how to treat it in Chapter 5.)

Develop a positive attitude. A positive attitude gives you a can-do mindset, whereas a negative attitude leads to low motivation, preventing you from doing all that is necessary to manage your diabetes.

Find a great team. Don’t try to be your own doctor, nurse, or dietitian. Rather, assemble a great team of supporting players like the family physician, the diabetes nurse educator, the dietitian, the eye doctor, and so forth; and work together with them. They can help you set realistic, doable goals and, more importantly, assist you to achieve them. (We discuss the members of the diabetes team in Chapter 8.)

Don’t expect perfection. Although you may feel that you’re doing everything right, you may find that, at times, your blood glucose levels are off. This situation happens to every person with diabetes and isn’t always readily explained. Simply put, it’s likely not your fault. So don’t beat yourself up over it. If this happens to you, contact your health care team (see Chapter 8) and they can work with you to improve things.