What is jaundice? 

Jaundice is yellowing of your newborn's eyes and skin. It is caused by too much bilirubin in the blood. Bilirubin is a yellow substance found in red blood cells. It is released when the body breaks down old red blood cells. Bilirubin usually leaves the body through bowel movements. Jaundice happens because your newborn's body breaks down cells correctly, but it cannot remove the bilirubin. Jaundice is common in newborns. It usually happens during the first week of life.

What increases the risk for jaundice in newborns? 

•      Sepsis (blood infection) or a blood disorder, such as the mother and newborn having different blood types

•      Passing through a narrow birth canal and developing a large bruise on the head

•      Not enough breast milk

•      Premature birth that prevents the liver from developing correctly

•      Liver disease, biliary atresia (bile duct disorder), or an infection

How is jaundice diagnosed?

Your newborn's healthcare provider will check your newborn's skin and eyes. Tell the provider how long your newborn has had signs of jaundice. Tell him or her if you or your newborn have a blood disease, different blood types, or if any siblings also had jaundice. Tell the provider if your newborn was bruised during birth or has trouble breastfeeding. Your newborn may also need blood tests to check for bilirubin and to measure red blood cell levels. These tests will show if he or she has jaundice or is at risk for developing it.

How is jaundice treated in newborns? 

Jaundice often goes away on its own. If it continues or becomes severe, your newborn may need treatment. This may happen at home or in the hospital. You will be able to stay with him or her in the hospital so you can continue to breastfeed. Treatment for jaundice includes the following:

•      Phototherapy is a procedure that uses light to turn bilirubin into a form that your newborn's body can remove. One or more lights will be placed above your newborn. He or she will be placed on his or her back to absorb the most light. Your newborn may also lie on a flexible light pad, or his or her healthcare provider may wrap him or her in the light pad. Eye covers may be used to protect his or her eyes from the light. Do notput your newborn in direct sunlight. He or she may get a sunburn or become dehydrated. The only light therapy your newborn should have is phototherapy guided by a healthcare provider

•      Exchange transfusion is a procedure used to replace part of your newborn's blood with blood from a donor. This will be done in the hospital and may be used if your newborn has severe jaundice

How can I help decrease my newborn's risk for jaundice? 

Breastfeed your newborn as early and as often as possible. Talk to your newborn's healthcare provider about using formula along with breast milk if you do not produce enough breast milk alone. Look for signs of thirstin your newborn, such as lip smacking and restlessness. Try to breastfeed 8 to 12 times daily for the first few days to boost your milk supply. Ask your healthcare provider for help if you have trouble breastfeeding.

When should I seek immediate care? 

•      Your newborn has a fever

•      Your newborn is limp (too weak to move)

•      Your newborn moves his or her legs in a cycling motion

•      Your newborn changes his or her sleep patterns

•      Your newborn has trouble feeding, or he or she will not feed at all

•      Your newborn is cranky, hard to calm, arches his or her back, or has a high-pitched cry

•      Your newborn has a seizure, or you cannot wake him or her

When should I contact my newborn's pediatrician? 

•      Your newborn has new or worsened yellow skin or eyes

•      You think your newborn is not drinking enough breast milk, or he or she is losing weight

•      Your newborn has pale, chalky bowel movements

•      Your newborn has dark urine that stains his or her diaper

CARE AGREEMENT:

You have the right to help plan your baby's care. Learn about your baby's health condition and how it may be treated. Discuss treatment options with your baby's caregivers to decide what care you want for your baby. 

© 2017 Truven Health Analytics LLC All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

What is an insulin pen? 

An insulin pen is a device used to inject insulin. The pen contains a cartridge of insulin. The pen may be reusable or disposable. You may need a different pen for each type of insulin you use. 

How do I get the insulin ready to use? 

•      Check the label and color of the insulin. Check that you have the correct type and strength of insulin. Insulin pens are available as U100 and U500 strengths. Also check the expiration date on the label. Use a new cartridge or pen if the expiration date has passed. Short or rapid-acting insulin should be clear, colorless, and free of particles or clumps. Use a new cartridge or pen if the insulin does not look right. Follow the pen manufacturer's instructions for inserting a new cartridge into a reusable pen

•      Mix cloudy insulin. Gently roll the pen back and forth between the palms of your hands. Repeat this 10 times. Do not shake the pen. This can make the insulin clump together. Next, gently tip the pen up and down 10 times. Do not use the insulin if there are clumps in it after you mix it

How do I get the pen ready to use? 

•      Remove a new pen from the refrigerator 30 minutes before you use it. Insulin should be injected at room temperature

•      Wash your hands. Use soap and water or an alcohol-based hand rub. This will help decrease your risk for an infection

•      Remove the cap from the pen. Wipe the needle attachment area with an alcohol swab

•      Attach a needle to the pen. Remove the tab from the needle. Do not remove the outer cap on the needle. Push the needle straight onto the pen. Turn the needle clockwise until you cannot turn it more. Make sure the needle is straight

•      Remove the needle caps. Remove the outer cap and save. Remove the inner cap and throw it away

•      Remove air from the pen. Air may cause pain during injection. Turn the dial to 2 units. For most insulin pens, you will hear a click for each unit of insulin that you dial. Hold the pen and point the needle up. Gently tap the pen to move air bubbles to the top of the pen. Press the injection button. You should see a drop of insulin on the tip of the pen. If you do not see a drop, change the needle and repeat this step. If you do not see a drop after you repeat this step 3 times, use a new pen

•      Select the correct dose on the pen. Turn the dial to the number of units you need to inject. The pointer on the side of your pen should line up with your dose. The dial can be turned in either direction to choose the correct dose. You cannot choose a dose larger than the number of units left in the cartridge. Insert another cartridge or use another disposable pen if there is not enough insulin. Instead you can inject part of your dose with the insulin that is left. Next, you can use a new cartridge or pen to inject the rest of your dose

Where do I inject insulin? 

•      You can inject insulin into your abdomen, upper arm, buttocks, hip, and the front or side of the thigh. Insulin works fastest when it is injected into the abdomen

•      Do not inject insulin into areas where you have a wound or bruising. Insulin injected into wounds or bruises may not get into your body correctly

•      Use a different area within the site each time you inject insulin. For example, inject insulin into different areas in your abdomen. Insulin injected into the same area can cause lumps, swelling, or thickened skin

How do I inject insulin with a pen? 

•      Clean the skin where you will inject the insulin. You can use an alcohol pad or a cotton swab dipped in alcohol. Let the area dry before you inject. This will decrease pain

•      Grab a fold of your skin. Gently pinch the skin and fat between your thumb and first finger

•      Insert the needle straight into your skin. Do not hold the syringe at an angle. Make sure the needle is all the way into the skin. Let go of the pinched tissue

•      Push the injection button to inject the insulin. Continue to press on the injection button. Keep the needle in place for 10 seconds

•      Pull out the needle. Replace the needle cap. Press on your injection site for 5 to 10 seconds. Do not rub. This will keep insulin from leaking out 

•      Remove the needle from the pen.Twist the capped needle counter clockwise. Place the needle in a heavy-duty laundry detergent bottle or a metal coffee can. The container should have a cap or lid that fits securely

•      Replace the pen cap. Store the pen as directed

What should I do with my used needles? 

Ask your local waste authority if you need to follow certain rules for getting rid of your needles. Bring your used needles home with you when you travel. Pack them in a plastic or metal container with a secure lid. 

How do I store an insulin pen? 

Do not store your pen with a needle attached. Follow the storage directions on the label or package insert that came with the insulin. Unopened pens can be stored in the refrigerator until you are ready to use them. Most insulin pens can be opened and kept at room temperature. Store your pen in a cool, dry place. Do not keep your pen in direct sunlight or in your car. Throw away pens that have been frozen or exposed to temperatures above 85° F (30° C). If you travel, keep the pen in a cool pack. 

When should I contact my healthcare provider? 

•      You feel or see hard lumps in your skin where you inject your insulin

•      You think you gave yourself too much or not enough insulin

•      Your injections are very painful

•      You see blood or clear fluid on your injection site more than once after you inject insulin

•      You have questions about how to give the injection

•      You cannot afford to buy your diabetes supplies

•      You have questions or concerns about your condition or care

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

© 2017 Truven Health Analytics LLC All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

What is a fever?

A fever is an increase in your body temperature. Normal body temperature is 98.6°F (37°C). Fever is generally defined as greater than 100.4°F (38°C).

What are common causes of a fever? 

The cause of your fever may not be known. This is called fever of unknown origin. It occurs when you have a fever above 100.9˚F (38.3°C) for 3 weeks or more. The following are common causes of fever:

•  An infection caused by a virus or bacteria

•  An inflammatory disorder, such as arthritis

•  A brain infection or injury

•  Alcohol or illegal drug use, or withdrawal

What other signs and symptoms may I have?

•  Chills and shivers

•  Muscle stiffness

•  Weight loss

•  Night sweats

•  Fever that comes and goes

•  Fever that is higher in the morning

How is the cause of a fever diagnosed? 

Your healthcare provider will ask when your fever began and how high it was. He or she will ask about other symptoms and examine you for signs of infection. He or she will feel your neck for lumps and listen to your heart and lungs. Tell your provider if you recently had surgery or an infection. Tell him or her if you have any medical conditions, such as diabetes or arthritis. You may also need blood or urine tests to check for infection. Ask about other tests you may need if blood and urine tests do not explain the cause of your fever.

How is a fever treated? 

You may need any of the following, depending on the cause of your fever:

•  NSAIDs, such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask if NSAIDs are safe for you. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child's healthcare provider

•  Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly. Do not use more than 4 grams (4,000 milligrams) total of acetaminophen in one day

•  Antibiotics may be given if you have an infection caused by bacteria

What can I do to be more comfortable while I have a fever?

What is chronic diarrhea?

Diarrhea that lasts less than two weeks is called acute. Diarrhea that lasts between 2 and 4 weeks is called persistent. Diarrhea that lasts for one month or more is considered to be chronic.

What causes chronic diarrhea?

Chronic diarrhea has many different causes. Some common causes are:

•    Celiac disease

•    Irritable bowel syndrome (IBS)

•    Intestinal infections

•    Inflammatory bowel disease (like ulcerative colitis or Crohn’s disease)

•    Reactions to some medicines

What are the symptoms of chronic diarrhea?

People with chronic diarrhea have to go to the bathroom more often than they normally do. They produce more stools than they usually do and the stools are less solid than normal. Stools may be loose and watery, greasy or bloody. Some people find that they wake up at night because they have to go to the bathroom. Other associated symptoms may include decreased appetite, weight loss, fever or abdominal cramping.

How will the doctor find out what is causing my diarrhea?

There are many causes for chronic diarrhea. The doctor will look at the medicines you are taking to be sure that none of them are causing diarrhea. The doctor may order tests, based on your symptoms and history. Tests may include blood or stool tests. If these initial tests do not reveal the problem, other tests may be needed.

What is the treatment for chronic diarrhea?

•    The treatment of chronic diarrhea depends on its cause.

•    Diarrhea caused by an infection may be treated with antibiotics

•    Some other causes of chronic diarrhea may have specific treatments, like pancreatic enzymes

•    Changes in diet may be helpful for some people. Your doctor can give you more information on what foods are best in your case

•    A daily fiber supplement is helpful for many people

•    Drinking plenty of water helps avoid dehydration

•    Avoiding alcohol and beverages that contain caffeine. Alcohol and caffeine can lead to dehydration

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team’s medical advice and should not be relied upon for treatment for specific medical conditions.

©2017 The General Hospital Corporation.

Primary Care Office lnSite

developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine

Any bleeding during pregnancy needs to be reported promptly to your healthcare provider. However, bleeding is common during the first three months (12 weeks) of pregnancy and may or may not be a sign of a problem. It can range from slight brown spotting, to bright red bleeding, may last from a day to weeks and may be accompanied by mild cramping or low backache. Many times, the bleeding stops on its own and the pregnancy continues normally.

Note: mild, low abdominal cramping without bleeding is common in the early weeks of pregnancy.

Causes

Most women fear that bleeding means they are miscarrying. There are other reasons for bleeding in early pregnancy: the hormonal changes of pregnancy; implantation bleeding, when the fertilized egg attaches itself to the lining of the uterus; cervical bleeding. Sometimes, no cause for vaginal bleeding can be found.

About 15-20% of all pregnancies end in miscarriage. A miscarriage can be the body's response when, for some reason, the pregnancy is not developing normally. Most early miscarriages cannot be prevented. Remember, heavy lifting or intercourse will not affect a healthy pregnancy and will not bring on a miscarriage.

Treatment

Your healthcare provider will examine you to determine the cause of the pain and/or bleeding. The following examinations and tests may be ordered:

•   Pelvic exam

•   Blood pregnancy test

Hearing problems are not unusual. A report from World Health Organization in 2015 showed there are 600 million people suffered from hearing impairment, accounting for 5.3% of the global population. This report also showed there were 27.8 million people with hearing impairment in China. It is important to get a hearing test to find out whether a hearing aid can help. You can also take these steps to help yourself hear more clearly.

Take charge of speaking situations

•  Face the person who is speaking with you. Stand or sit within six to ten feet of the speaker to hear most clearly

•  If you are comfortable doing so, let the speaker know that you have a hearing impairment and that you will do much better if he or she looks at you and speaks clearly and distinctly

•  Ask friends and family members to speak to you only when they are in the same room. It's very difficult to hear if the speaker and listener are in different rooms

Listen between the lines

•  Do not expect to hear every word. No one hears everything all the time! Listen for key words

•  Do not dwell on what you missed

•  Use the words you do hear to get more information

•  Ask questions to make sure you understand. People with normal hearing frequently ask a speaker to repeat what he or she said

For instance,

   o  What did you say about_________?

   o  How did _________do_________?

   o  When did _________do_________?

Don't be afraid to ask for help

•  If you do not hear enough to get key words, and the person has repeated the message, ask him or her to say it again using different words

•  If proper names are used and you can't understand them evenwhen they are repeated, ask the speaker to spell them

•  When you do not understand what someone is saying, take it as an opportunity to find out why you are not hearing more clearly:

  o  Were you paying attention?

  o  Was the lighting poor?

  o  Was there a lot of background noise?

  o  Was the speaker talking too softly?

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

What is cirrhosis?

Cirrhosis is scarring of the liver that may happen as a complication of many diseases affecting the liver. The liver is a large organ located on the upper right side of the abdomen. When the liver is scarred, it stops functioning as well and may not do its jobs within the body.

What causes cirrhosis?

The liver helps cleanse the body of toxins and bacteria, and also produces certain proteins that the body needs. When the liver is irritated or inflamed because of toxins, infection, or other reasons, it tries to heal itself by forming scar tissue. With time, this leads to scarring of the liver called cirrhosis. Causes of liver damage include:

•   Heavy alcohol use - people who abuse alcohol are at the greatest risk for cirrhosis

•   Hepatitis B or C - These viruses are spread by sharing needles or having sex with people who are infected. They cause liver disease that can eventually lead to cirrhosis

•   Nonalcoholic steoatohepatitis (NASH) - NASH resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. Although the cause of NASH is unknown, many people who develop this disease are obese and have diabetes

What are the symptoms of cirrhosis?

Some people with cirrhosis have no symptoms. When symptoms do occur, they can include:

•    Weakness and fatigue

•    Swelling of the abdomen and/or legs due to extra fluid

•    Bruising or bleeding easily, especially from the stomach or esophagus

•    Trouble breathing

•    Yellowing of the skin or whites of the eyes, called jaundice

•    Spider like blood vessels on the skin

•    Itching

•    Loss of appetite

•    Confusion

How is cirrhosis diagnosed?

The diagnosis of cirrhosis is usually based on the presence of a risk factor for cirrhosis, such as alcohol use or obesity, and is confirmed by physical examination, blood tests and imaging tests such as abdominal ultrasound. In some cases, the doctor may order a liver biopsy.

How is cirrhosis treated?

Treatment usually depends on the cause of the disease, how severe it is and what symptoms you have. The goals of treatment are to slow the progression of scar tissue in the liver and prevent or treat the symptoms of the disease. The main treatments include:

•   Avoiding alcohol and medications that can damage the liver

•   Medicines called beta blockers may be used to reduce blood pressure in the liver and help reduce the chance of bleeding from the esophagus if abnormal blood vessels (varices) are present

•   Medicines called diuretics are sometimes used to decrease fluid build-up that causes bloating in the abdomen. Your doctor may also ask you to go on a special diet and to monitor your weight closely

Will I need a new liver?

People with cirrhosis need a new liver when their symptoms cannot be controlled by treatment. Ask your doctor whether this is an option for you and talk about the process before you get too sick. The number of people who need a liver transplant is much greater than the number of livers donated. People with the best chance of living for a long time are the most likely candidates for a liver transplant.

What can I do to help manage my cirrhosis? 

To help slow the development of cirrhosis:

•   Do not drink alcohol

•   Get the vaccine for hepatitis B and A, if you need it

•   Use condoms when you have sex

•   Do not share drug needles

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

Primary Care OfficelnSite

developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine

What is type 2 diabetes? 

Type 2 diabetes is a disease that affects how your child's body uses glucose (sugar). Normally, when the blood sugar level increases, the pancreas makes more insulin. Insulin helps move sugar out of the blood so it can be used for energy. Type 2 diabetes develops because either the body cannot make enough insulin, or it cannot use the insulin correctly. After many years, your child's pancreas may stop making insulin. 

What increases my child's risk for type 2 diabetes?

 Your child has a higher risk for type 2 diabetes if he or she is overweight, and at least 2 of the following are true: 

•     A member of your child's family has type 2 diabetes

•     Your child is Native American, African American, Latino, Asian American or Pacific Islander

•     Your child has high blood pressure, high cholesterol, or is female and has polycystic ovary syndrome

What are the signs and symptoms of type 2 diabetes? 

Your child may have high blood sugar levels for a long time before symptoms appear. Your child may have any of the following: 

•     More hunger or thirst than usual

•     Frequent urination

•     Weight loss without trying

How is type 2 diabetes diagnosed? 

Your child may need tests to check for type 2 diabetes by the time he or she is 10 years old: 

•     An A1c test shows the average amount of sugar in your child's blood over the past 2 to 3 months. Your child's healthcare provider will tell you the level that is right for your child. The goal is usually below 7.5%. Your provider can help you make changes if a check shows your child's A1c is too high

•     A fasting plasma glucose test is when your child's blood sugar level is tested after he or she has fasted for 8 hours. Fasted means your child has not eaten anything or had anything to drink except water

•     A random glucose test can be done any time of day, no matter how long ago your child ate

•     An oral glucose tolerance test starts with a fasting blood sugar level check. He or she is then given a glucose drink. His or her blood sugar level is checked again after 2 hours. Healthcare providers look at how much your child's blood sugar level increases from the first check

•     Genetic testing may be done to check for genes that may cause diabetes 

How is type 2 diabetes treated? 

Type 2 diabetes can be controlled. The goal is to help keep your child's blood sugar at a normal level. He or she must eat healthy foods, and exercise regularly. Your child may also need medicine by mouth or insulin if blood sugar levels cannot be controlled with nutrition and exercise. 

How do I check my child's blood sugar level?

You will be taught how to check a small drop of blood with a glucose monitor. You may need to check your child's blood sugar level at least 3 times each day. Ask your child's healthcare provider when and how often to check during the day or night. Before meals, your child's blood sugar should be between 90 and 130 mg/dL. At bedtime, it should be between 90 and 150 mg/dL. You may need to check for ketones in your child's urine or blood if the level is higher than directed. Write down the results and show them to your child's healthcare provider. Your provider may use the results to make changes to your child's medicine, food, or exercise schedules. 

What do I need to know about nutrition for my child? 

A dietitian will help you create a meal plan to keep your child's blood sugar level steady. Do not let your child skip meals. His or her blood sugar level may drop too low if he or she takes insulin and does not eat.

•     Keep track of carbohydrates (sugar and starchy foods). Your child's blood sugar level can get too high if he or she eats too many carbohydrates. Your child's dietitian will help you plan meals and snacks that have the right amount of carbohydrates

•     Give your child low-fat and low-sodium foods. Examples of low-fat foods are lean meat, fish, skinless chicken or turkey, and low-fat milk. Limit high-sodium foods, such as potato chips and soup. Do not add salt to food you cook. Limit your child's use of table salt

•     Give your child high-fiber foods. Foods that are a good source of fiber include vegetables, whole-grain breads, and beans

What else can I do to help my child manage type 2 diabetes? 

•     Go to all follow-up appointments. Your child may need to return to have his or her A1c checked at least twice a year. Your child may also need tests to check his or her blood pressure, cholesterol, eyes, and feet

•     Have your child exercise as directed. Exercise can help keep your child's blood sugar level steady. Encourage your child to exercise for at least 60 minutes on most days of the week. Help your child include activities 3 days each week that strengthen his or her muscles and bones. Work with your child's healthcare provider to create an exercise plan:

  ○   Check your child's blood sugar level before and after exercise. Healthcare providers may tell you to change the amount of insulin your child takes or food he or she eats. If the blood sugar level is high, check your child's blood or urine for ketones before you exercise. Do not let your child exercise if the blood sugar level is high and your child has ketones

  ○   If your child's blood sugar level is less than 100 mg/dL, have him or her eat a carbohydrate snack before exercise. Examples are 4 to 6 crackers, ½ banana, 8 ounces (1 cup) of milk, or 4 ounces (½ cup) of juice. Have your child drink water or liquids that do not contain sugar before, during, and after exercise. Ask your dietitian or healthcare provider which liquids your child should drink when he or she exercises

 •     Help your child maintain a healthy weight. Ask your child's healthcare provider how much your child should weigh. A healthy weight can help control your child's diabetes. Ask your child's healthcare provider to help you create a weight loss plan for your child if he or she is overweight. The provider can help your child set manageable weight loss goals

•     Check your child's feet each day for sores. Have your child's feet checked at least once each year for problems that may develop if his or her diabetes is not controlled. Make sure his or her shoes and socks fit correctly. Ask your child's healthcare provider for more details about foot care

What other care will my child need for type 2 diabetes? 

•     Make sure your child always wears medical alert jewelry or carries a card that says he or she has diabetes. Ask your child's healthcare provider where to get these items

•     Give instructions to your child's school. Make sure your child's teachers know he or she has diabetes. Provide written instructions about what to do if your child has symptoms of high or low blood sugar levels at school

•     Do not smoke around your child.Do not let others smoke around him or her. Do not let your older child smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung and heart damage. Cigarette smoke can worsen the problems that occur with diabetes. Ask your healthcare provider for information if you or child currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you or your child use these products

•     Ask about vaccines. Your child has a higher risk for serious illness if he or she gets the flu or pneumonia. Ask your child's healthcare provider if your child should get a flu or pneumonia vaccine, and when to get the vaccine

What are the risks of type 2 diabetes in children? 

Uncontrolled diabetes can damage your child's nerves and arteries. Long-term high blood sugar levels can damage his or her eyes and kidneys. Diabetes is life-threatening if it is not controlled. Control your child's blood glucose levels to prevent complications.

When should I seek immediate care? 

•     Your child has a low blood sugar level and it does not improve with treatment

•     Your child's blood sugar level is above 240 mg/dL and does not come down after a dose of insulin

•     Your child has ketones

•     Your child has a fever

•     Your child has nausea or is vomiting and cannot keep any food or liquid down

•     Your child has symptoms of a low blood sugar level, such as trouble thinking, sweating, or a pounding heartbeat

•     Your child has blurred or double vision

•     Your child's breath has a fruity, sweet smell, or his breathing is deep and labored

•     Your child's heartbeat is fast and weak

When should I contact my child's healthcare provider? 

•     Your child's blood sugar levels are higher than his or her target goals

•     Your child often has low blood sugar levels

•     Your child has abdominal pain, diarrhea, or is vomiting

•     Your child has numbness in his or her arms or legs

•     Your child has warm, red patches of skin or a wound that does not heal

•     Your child gets easily irritated

•     Your child is anxious or depressed

•     You have questions or concerns about your child's condition or care

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

© 2017 Truven Health Analytics LLC All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

What is type 2 diabetes?

Type 2 diabetes is a disease that affects how your body uses glucose (sugar). Normally, when the blood sugar level increases, the pancreas makes more insulin. Insulin helps move sugar out of the blood so it can be used for energy. Type 2 diabetes develops because either the body cannot make enough insulin, or it cannot use the insulin correctly. After many years, your pancreas may stop making insulin. 

What increases my risk for type 2 diabetes? 

•     Obesity

•     Physical inactivity

•     Older age

•     High blood pressure or high cholesterol

•     A history of heart disease, gestational diabetes, or polycystic ovary syndrome 

•     A family member with diabetes

•     Being African American, Latino,Native American, Asian American, or Pacific Islander

What are the signs and symptoms of type 2 diabetes? 

You may have high blood sugar levels for a long time before symptoms appear. You may have any of the following: 

•     More hunger or thirst than usual 

•     Frequent urination 

•     Weight loss without trying 

•     Blurred vision 

How is type 2 diabetes diagnosed? 

You may need tests to check for type 2 diabetes starting at age 45. You may need any of the following: 

•     An A1c test shows the average amount of sugar in your blood over the past 2 to 3 months. Your healthcare provider will tell you the A1c level that is right for you. The goal for your A1c is usually below 7%. Your provider can help you make changes if a check shows the A1c is too high

•     A fasting plasma glucose test is when your blood sugar level is tested after you have not eaten for 8 hours

•     A 2-hour plasma glucose test starts with a blood sugar level check after you have not eaten for 8 hours. You are then given a glucose drink. Your blood sugar level is checked after 2 hours 

•     A random glucose test may be done any time of day, no matter how long ago you ate

How is type 2 diabetes treated? 

Type 2 diabetes can be controlled to prevent damage to your heart, blood vessels, and other organs. The goal is to keep your blood sugar at a normal level. You must eat the right foods, and exercise regularly. You may need 1 or more hypoglycemic medicines or insulin if you cannot control your blood sugar level with nutrition and exercise. You may also need medicine to lower your risk for heart disease. An example includes medicine to lower or control your cholesterol. 

How do I check my blood sugar level? 

You will be taught how to check a small drop of blood in a glucose monitor. You will need to check your blood sugar level at least 3 times each day if you are on insulin. Ask your healthcare provider when and how often to check during the day. If you check your blood sugar level before a meal, it should be between 80 and 130 mg/dL. If you check your blood sugar level 1 to 2 hours after a meal, it should be less than 180 mg/dL. Ask your healthcare provider if these are good goals for you. Write down your results, and show them to your healthcare provider. Your provider may use the results to make changes to your medicine, food, and exercise schedules.

What should I do if my blood sugar level is too low? 

Your blood sugar level is too low if it goes below 70 mg/dL. If the level is too low, eat or drink 15 grams of fast-acting carbohydrate. These are found naturally in fruits. Fast-acting carbohydrates will raise your blood sugar level quickly. Examples of 15 grams of fast-acting carbohydrate are 4 ounces (½ cup) of fruit juice or 4 ounces of regular soda. Other examples are 2 tablespoons of raisins or 3 to 4 glucose tablets. Check your blood sugar level 15 minutes later. If the level is still low (less than 100 mg/dL), eat another 15 grams of carbohydrate. When the level returns to 100 mg/dL, eat a snack or meal that contains carbohydrates. This will help prevent another drop in blood sugar. Always carefully follow your healthcare provider's instructions on how to treat low blood sugar levels. 

Keep track of carbohydrates (sugar and starchy foods). 

Your blood sugar level can get too high if you eat too many carbohydrates. Eat fruits, legumes, vegetables, and whole grains. Your dietitian will help you plan meals and snacks that have the right amount of carbohydrates

What do I need to know about nutrition?

A dietitian will help you make a meal plan to keep your blood sugar level steady. Do not skip meals. Your blood sugar level may drop too low if you have taken diabetes medicine and do not eat. 

•     Eat low-fat foods, such as skinless chicken and low-fat milk

•     Eat less sodium (salt). Limit high-sodium foods, such as soy sauce, potato chips, and soup. Do not add salt to food you cook. Limit your use of table salt. You should have less than 2,300 mg of sodium per day

•     Eat high-fiber foods, such as vegetables, whole-grain breads, and beans

•     Limit alcohol. Alcohol affects your blood sugar level and can make it harder to manage your diabetes. Limit alcohol to 1 drink a day if you are a woman. Limit alcohol to 2 drinks a day if you are a man. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor 

How much exercise do I need? 

Exercise can help keep your blood sugar level steady, decrease your risk of heart disease, and help you lose weight. Stretch before and after you exercise. Exercise for at least 150 minutes every week. Spread this amount of exercise over at least 3 days a week. Do not skip exercise more than 2 days in a row. Include muscle strengthening activities 2 to 3 days each week. Older adults should include balance training 2 to 3 times each week. Activities that help increase balance include yoga and tai chi. Work with your healthcare provider to create an exercise plan.

•     Check your blood sugar level before and after exercise. Healthcare providers may tell you to change the amount of insulin you take or food you eat. If your blood sugar level is high, check your blood or urine for ketones before you exercise. Do not exercise if your blood sugar level is high and you have ketones

•     If your blood sugar level is less than 100 mg/dL, have a carbohydrate snack before you exercise. Examples are 4 to 6 crackers, ½ banana, 8 ounces (1 cup) of milk, or 4 ounces (½ cup) of juice. Drink water or liquids that do not contain sugar before, during, and after exercise. Ask your dietitian or healthcare provider which liquids you should drink when you exercise

•     Do not sit for longer than 30 minutes. If you cannot walk around, at least stand up. This will help you stay active and keep your blood circulating 

What else can I do to manage type 2 diabetes? 

•     Check your feet each day for sores. Wear shoes and socks that fit correctly. Do not trim your toenails. Ask your healthcare provider for more information about foot care 

•     Maintain a healthy weight. Ask your healthcare provider how much you should weigh. A healthy weight can help you control your diabetes and prevent heart disease. Ask your provider to help you create a weight loss plan if you are overweight. Together you can set manageable weight loss goals