People with diabetes are at a high risk for cardiovascular disorders such as coronary heart disease, stroke, and peripherial vascular disease. Education is crucial to understand the proper way to live well with diabetes.

WHAT IS DIABETES?
Diabetes is a progressive disease that makes it hard for your body to use sugar. Either your body doesn't make enough insulin or doesn't respond properly to insulin. This causes your blood glucose ("blood sugar") levels to rise too high.

TWO TYPES OF DIABETES
*Type 1 diabetes
*Usually occurs in children and young adults
*The body makes very little or no insulin
*Requires daily injections of insulin

*Type 2 diabetes
*Most common form of diabetes
*Occurs most often in middle-aged adults
*The body doesn't make enough insulin and doesn't efficiently
use the insulin it does make (insulin resistance).
*Can be controlled with diet, exercise and medication.

HOW DANGEROUS IS DIABETES?
If left untreated diabetes can lead to a lot of serious medical problems. These include blindness, kidney disease, nerve disease, limb amputations and cardiovascular disease. If you have diabetes it is very important to know the warning signs of heart attack and stroke and how to respond to them if they occur.

HEART ATTACK WARNING SIGNS]
A heart attack is an urgent message from your heart that its starvec for oxygen. When a clot blocks a heart vessel, oxygen-rich blood can't reach your heart. Then heart muscle begins to die and symptoms of a heart attack begin. The sooner you get tothe hospital, the sooner treatment can start to help save your life and your heart muscle.

KNOW THE SIGNS
PAIHN OR DISCOMFORT
*Pain, pressure, fullness, a squeezing feeling, or other dis-
comfort in your chest, under your sternum, or in your mid-back
*Pain may radiate from chest to shoulders, neck, jaw, arms, or
back.
*The pain or pressure may come and go, especially in women.

OTHER SYMPTOMS
A profuse cold, clammy sweat on the upper body.
Shortness of breath that feels like a tight rope around the chest.
Heartburn, nausea, or vomiting--especially when it doesn't seem related to anything you ate
A lightheaded or weak feeling, especially when you stand up.
This feeling is often accompanied by one or more of the symptoms listed above.
Anxiety or a feeling of doom.
Changes in skin color to pale or gray.

STROKE WARNING SIGNS
* Sudden numbness or weakness of the face, arm or leg,
especially on one side of the body
*Sudden confusion, trouble speaking or understanding.
*Sudden trouble seeing in one or both eyes.
*Sudden trouble walking, dizziness, loss of balance or
coordination
*Sudden severe headache with no known cause.

LOW BLOOD SUGAR (HYPOGLYCEMIA)
When your blood sugar level drops too low symptoms occur within minutes. It is important for you and your family to be aware of these symptoms so action can be taken quickly.
SYPMTOMS ARE:
*Sudden hunger
*Weakness, fatique
*Headache, dizziness
*Sweating
*Rapid or pounding heart beat
*Confusion, irritability
*Slurred spech, seizures
*Fainting or unconsciousness
Causes are:
*Too much insulin or deabetes medication
*Not enough food, missed meal or snack
*Too much exercise or unplanned activity
Treatments are:
*Consuming a fast-acting sugar source such as 1/2 cup fruit juice, 2 tsp sugar, 1/2 cup soda, Sweet Tarts, Life Savers or 3-4 glucose tablets

You should start to feel better and your blood sugar level should improve within 15 minutes of taking action. If not, treat again with a sugar source. If fainting or unconsciousness occurs, call 911 immediately.

HIGH BLOOD SUGAR (HYPERGLYCEMIA)
When your blood sugar level rises too high symptoms may occur within hours or develop over several days. Again it is very important for you and your family to recognize these symptoms for early intervention.
Symptoms are:
*Extreme thirst
*Frequent need to urinate
*Dry skin and mouth
*Blurry vision, drowsiness
*Ketones are in urine or blood
*Abdominal pain
*Upset stomach, vomiting
*Deep, rapid breathing
*Fruity smelling breath
Causes are:
*Not enough insulin or diabetic medication
*Too much food, the wrong foods
*Illness, infection
*Not enough exercise
Treatments are:
*Test blood sugar and ketones
*Call your doctor
*Take insulin or medication as prescribed
*Drink plenty of sugar-free fluids
Having a high blood sugar level can leat to serious consequences in a short period of time. It's vital to monitor yourself closely and seek medical attention promptly when necessary/

COMPLICATIONS OF DIABETES
Untreated and poorly managed diabetes can cause long-term destruction to your body. High blood sugar levesl can damage your blood vessels and nerves, which can lead to:
* Heart and blood vesel problems, putting you at risk for heart
attack and stroke.
* Eye disease, leading to blindness
* kidney disease, leading to failure and the need for dialysis
or transplant.
* Nerve disease, leading to numbness and increased risk for
injury.
* Delayed healing, leading to skin infections that sometimes
result in amputation

TIPS TO AVOID COMPLICATIONS
* Check your blood sugar levels as often as necessary.
* Control your blood sugar livels as much as possible
* Take your diabetes medications as prescribed
* Don't smoke
* Exercise regularly
* Control your blood pressure
* Eat a healthy diet low in salt, saturated fat and cholesterol
* Lose excess weight
* Monitor your skin closely, especially your feet
*avoid excessive alcohol
* Undergo physical exams, blood tests, and eye exams as reco-
Mmended by your doctor

SICK-DAY RULES
Being ill requires you to pay special attention to your diabetes because your blood sugar levels can rise higher than normal during this time. Talk with your doctor about the sick-day rules that are best for you
General rules to follow are:
* Never stop taking your insulin or diabetes medication without
consulting your doctor first
* Drink plenty of water or sugar-free fluids to prevent de-
hydration
* If your're unable to keep solid foods down, try some broth every hour
* Check your blood sugar at least every four hours
Contact your doctor immediately if you:
* Cant't eat regularly for more than 24 hours
* Can't keep fluids down
* Have an unbreakable fever
* Can't control your blood sugar level
* Have elevated ketone levels in your urine
* Feel your're getting worse
* Can't take care of your diabetes

TIPS FOR GOOD FOOT CARE
People with diabetes are more likely to have problems with their feet due to poor circulation, nerve damage, or infection. These things can cause the loss of a toe, foot or leg. So god foot care is very important.
Do the following to care for your feet:
* Keep them clean and dry
* Don't take hot baths or showers
* Use lotion to prevent dryness, but not between your toes
* Never go barefoot
* Wear socks and shoes that fit well
* Inspect skin daily for cuts, bruises or swelling. Use a
moror to see the bottom of your feet.
* File your toenails straight across
Call your doctor if have any of these warning signs of foot problems:
* Pain, nimbness or swelling
* Sores that won't heal
* Changes in skin color
* A cut, bruise, or any other foot injury

BLOOD SUGAR SCALE
The scale below lists the blood sugar goals recommende for people with diabetes. These goals may change over time depending on how well you are managing your diabetes. Ask your doctor what is best for you and keep him informed of your g=blood glucose readings.
* Before meals