www.withyoualltheway.info

How do I stay

healthy?Diet and exercise info

At Novo Nordisk, we are changing diabetes. In our approach to developing treatments, in our commitment to operate profitably and ethically and in our search for a cure.

This information is not designed to replace the advice of a healthcare professional. Please consult your doctor or nurse if you have any questions or concerns about managing your diabetes.

With you all the way is a patient support programme created by Novo Nordisk, providing practical information on diabetes and its management for children and young adults with diabetes.

This material has been reviewed by a panel of experts:

� Lead Diabetes Specialist Nurse – Nicola Lewis, UK

� Paediatric Endocrinologists – Prof Thomas Danne, Germany and Dr Nandu Thalange, UK

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Staying healthyDiet and exercise are important, whether you have diabetes or not.

The key to managing diabetes is getting the right balance between your food intake, insulin dose and physical activity.1

When you learn how your body reacts to different types of food and exercise, it will get easier to manage your diabetes.

This leaflet provides information on diet and exercise. If you have any questions or concerns speak to your doctor, nurse or dietitian for advice.

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Physical activity is an important part of diabetes management. Activity helps to lower your blood glucose levels and has other health benefits.

Benefits of regular exercise:2

� Makes you feel better

� Helps you stay at a healthy weight

� Improves physical fitness

� Improves cardiovascular health

How often should I exercise?You should try and be active for 30 to 60 minutes each day.2 Even if you are not sporty, there are lots of other enjoyable ways to stay active, such as walking or dancing, or getting a part-time job.

You could try taking the stairs instead of using a lift or escalator, or getting off the bus a stop earlier so you have a longer walk than usual.

Staying active

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Testing your bloodBefore exercise – you should always test your blood before exercise. If your blood glucose is too low, you may need an extra carbohydrate snack before exercise. If your blood glucose is very high, particularly if you have elevated ketones, you should avoid exercise, otherwise you may develop diabetic ketoacidosis.2,3

After exercise – sometimes blood glucose levels decrease after activity, so it is a good idea to test afterwards too.4

During exercise – you may need to test during activity, especially if you are exercising for a long time. You may need a snack during exercise if your blood glucose levels are low.2

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Nearly all activities lasting 30 minutes or more (such as a sports lesson at school or a football match) will require an adjustment of your food intake and/or insulin dose.4

Your doctor or nurse will advise what to eat and teach you how to adjust your dose for the activity you are going to be doing. If you have an insulin pump, you may choose to disconnect this for a short time (maximum of 2 hours).4

Depending on how active you are going to be, you can do some or all of the following:

� Have a carbohydrate-containing snack just before exercise

� Reduce your insulin dose for the meal before exercise

� Include long-acting carbohydrate in the meal after exercise (to reduce your risk of hypoglycaemia afterwards)

� Reduce your long-acting insulin the evening after exercise, particularly after strenuous ‘endurance’ type exercise

Make sure you have a fast-acting carbohydrate snack with you when you exercise to treat hypoglycaemia should it occur.

Preparing for exercise

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Examples of fast-acting carbohydrate snacks:3,4

� Sports drinks

� Fruit juice

� Glucose tablets or sweets

If you feel like you have low blood glucose (hypoglycaemia) while you are exercising, you will need to stop to have a fast-acting carbohydrate snack or drink before you resume.4

Examples of long-acting carbohydrates:3,4

� Fruit, such as a banana

� Cereal or fruit bar

� Biscuits

� Bread

� Milk

If you are planning longer activities you may need an additional long-acting carbohydrate snack.

AySE NAz BAykAl, Turkey Ayse has type 1 diabetes

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Healthy eating

A balanced dietIt is important to try and maintain a healthy balanced diet, along with regular exercise and taking insulin.1

You should have three balanced main meals with snacks in between, depending on your insulin regimen.1

Different types of food No single food group provides you with all the energy and nutrients you need. You should aim to have a healthy balance of different food groups.5

Carbohydrates Foods that contain carbohydrates provide your body with energy. When carbohydrates are digested they are broken down into sugars, increasing your blood glucose levels if they are not used up as energy. Some carbohydrates act slowly, some quickly.67

Sugar (simple carbohydrates)

Starch (complex carbohydrates)

Fibre (complex carbohydrates)

Fruits and juices Potatoes Fruits and vegetables

Cakes Bread Whole grain bread

Cookies Pasta Whole grain/oat cereals

Some cereals Rice Lentils and beans

Peas Nuts

Corn

Lentils and beans

What foods contain carbohydrates?Common foods that contain carbohydrates:

Different types of carbohydratesThere are three main types of carbohydrates:5

� Sugar (simple carbohydrates)

� Starch (complex carbohydrates)

� Fibre (complex carbohydrates)

Complex carbohydrates

Complex carbohydrates are long-acting carbohydrates which take longer to digest (you may hear people call these low GI carbohydrates). They increase your blood glucose levels slowly over time.

Ideally, the majority of carbohydrates should come from complex carbohydrates. These types of carbohydrates can help to prevent hypoglycaemia.6

Simple carbohydrates

Simple carbohydrates are short-acting carbohydrates that will increase your blood glucose levels quickly.6

These are used when you have a hypoglycaemic episode. These are sometimes called high glycaemic index (GI) carbohydrates.

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Carbohydrate countingThere are two main ways to count carbohydrates:Changing insulin dose to match carbohydrate intake (“carb counting”)

With this method, you can eat different amounts of carbohydrate and will need to change the insulin dose to match.7 This may make it easier when you are eating out or eating at someone else’s house.

Your doctor, nurse or dietitian will advise you how to work out how much carbohydrate you need to match your insulin dose.

You will have your own insulin-to-carbohydrate ratio to help you calculate how much insulin you need.7 This will depend on your age and weight and will change as you get older and may also vary at different times of the day. Some people, especially during puberty, will need a higher carb ratio (more insulin) at certain times of the day – particularly at breakfast time.

If you are not very good at working out your insulin dose in your head, talk to your doctor or nurse about tools, such as apps for your mobile phone, that can help.

Planning carbohydrate intake to match insulin dose

With this method, you need to try and eat the same amount of carbohydrate at each meal to match your insulin dose.7

Your doctor, nurse or dietitian will advise how much carbohydrate you need each day and what insulin dose you should take.

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ServeS 2 – half pizza provideS

of your guideline daily amount

calS495

25%

Sugar9.0g

10%

fat18.3g

26%

Sat fat9.2g

46%

Salt2.0g

33%

How do I know how much carbohydrate is in food?

Lots of foods show how much carbohydrate they contain on the label. Food labels often show how much carbohydrate is in each serving and per 100g (this may be different in some countries).

Your doctor, nurse or dietitian will advise you how to work out how much carbohydrate different foods contain.

Check the serving size:8 CrackersIs that how much you are going to eat?

This number (28g) is the weight of the crackers, not the amount of carbohydrate in the serving.

Nutrition FactsServing Size 8 Crackers (28g)

Amount per serving

Calories 120 Fat Calories 30

% Daily Value

Total Fat 3.5g 5%

Saturated Fat 1g 5%

Trans Fat 0g

Polyunsaturated Fat 1.5g

Monounsaturated Fat 0.5g

Cholesterol 0mg 0%

Sodium 140mg 6%

Total Carbohydrate 22g 7%

Dietary Fiber less than 1g 3%

Sugars 7g

Protein 2g

Vitamin A 0% Vitamin C 0%

Calcium 10% Iron 4%

Reading food labels:

Count total carbohydrate.

You do not need to count sugars separately because they are already counted as part of the total carbohydrate.

Some foods also have a traffic light system on their labels which shows foods with low, moderate or high sugar.

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Timing of mealsYour doctor or nurse will help you to plan when is best to eat and when to take your insulin. Depending on your insulin regimen, they may recommend that you try and eat each meal at around the same time every day.

However, if you are out and about, at after school activities or at a friend’s house, it isn’t always possible to plan your mealtimes.

If you are going to eat much later than usual, you should test your blood and have a snack if your blood glucose levels are low. If you eat much earlier than usual, you may need to increase your insulin dose or take an extra dose.

If you are unsure how to do this, speak to your doctor or nurse.

Eating outIt is not always easy to eat healthily, time meals and count carbohydrates when you go out for dinner. It’s OK to treat yourself occasionally, as long as you adjust your insulin dose to balance your blood glucose levels.

If you would like to check the carbohydrate content of foods, many restaurants will provide nutritional information if you ask them. Some restaurants also show this information on their website so you can look before you go.

Sometimes it can be hard to time your insulin dose if you are unsure of when your meal will arrive. On these occasions, it is better to wait until your meal arrives before injecting your insulin.

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Weight and insulinIt is normal for a teenager’s weight to increase over time due to growth. However, you may notice that you put on weight once you start taking insulin.8 This may be some of the weight you may have lost before you were diagnosed.

It is important that you continue your insulin regimen and eat healthy meals as advised by your doctor or nurse. Skipping insulin or meals or going on ‘crash diets’ is not good for you. Poor glucose control can lead to long-term complications.9 Prolonged high blood glucose levels have been shown to increase the risk of problems with your feet, eyes, kidneys, nervous system or heart.10

The best approach to maintain a healthy weight is to keep up a healthy lifestyle, with a balanced diet and regular exercise.

If you are concerned about weight gain:

It is important that you speak to your doctor or nurse if you are concerned about your weight. They may be able to suggest ways to help maintain a healthy weight, including altering your insulin regimen, dietary intake or activity level.

Sometimes using an insulin pump will help you to manage your weight better, as usually you won’t need as much insulin when you are using a pump.

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SUDE IĞDIR, Turkey Sude has type 1 diabetes

References1. Smart C et al. ISPAD Clinical Practice

Consensus Guidelines 2009 Compendium: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2009; 10(Suppl. 12): 100–117.

2. Silverstein J et al. Care of children and adolescents with type 1 diabetes. Diabetes Care 2005; 28(1): 186–212.

3. Sydney Children’s Hospital. Physical activity and diabetes. Available at: www.sch.edu.au/health/factsheets/joint/?physical_activity_and_diabetes.htm Accessed October 2012.

4. Robertson K et al. ISPAD Clinical Practice Consensus Guidelines 2009 Compendium: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2009; 10(Suppl. 12): 154–168.

5. American Diabetes Association. Food and Fitness: Planning meals. Available at: www.diabetes.org/food-and-fitness/food/planningmeals/ Accessed October 2012.

6. NIH Medline Plus Library. Diabetes diet – type 1. Available at: www.nlm.nih.gov/medlineplus/ency/article/002440.htm Accessed October 2012.

7. International Diabetes Foundation. A parent/caregiver guide: Carbohydrate counting for children with diabetes. Available at: www.idf.org/sites/default/files/attachments/HI62553-Carbohydrate-Counting-for-Children.pdf Accessed October 2012.

8. American Diabetes Association News. Deborah Young-Hyman, PhD: Evaluating the risk of eating disorders in teenagers with type 1 diabetes. Available at: www.diabetes.org/news-research/research/research-discoveries/in-the-news/evaluating-the-risk-of-eating.html Accessed October 2012 Accessed October 2012.

9. Rewers MP et al. ISPAD Clinical Practice Consensus Guidelines 2009 Compendium: Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes 2009; 10(Suppl. 12): 71–81.

10. NIH Medline Plus Library. Type 1 diabetes. Available at: www.nlm.nih.gov/medlineplus/ency/article/000305.htm Accessed October 2012.

11. Novo Nordisk website. Available at: www.novonordisk.com Accessed October 2012.

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www.withyoualltheway.info

APROM ID#4601; approval date: December 2012.

Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S. Novo Nordisk A/S Novo Alle 2880 Bagsværd Denmark

About Novo Nordisk

This information was developed by Novo Nordisk, a global healthcare company specialising in the care of people with diabetes.

Novo Nordisk was started up almost 90 years ago by a Danish couple with a passion for changing diabetes. August Krogh was a professor at the University of Copenhagen and Nobel Prize winner and his wife Marie, a doctor and researcher into metabolic diseases, suffered from type 2 diabetes. They learned of insulin being developed in Canada and were determined to ensure access to insulin for everyone with diabetes, hence in 1923 Novo Nordisk was born.

Since then Novo Nordisk has grown to become a world leader in the provision of diabetes products and support for patients of all ages.11

We fully understand the challenges that children with diabetes face and are working together with parents, schools and healthcare professionals to improve the care of children with diabetes, as they grow up and develop.

For more information about Novo Nordisk, please visit: www.novonordisk.com

This information is not designed to replace the advice of a healthcare professional. Please consult your doctor or nurse if you have any questions or concerns about managing your diabetes.