In type 1 diabetes, which used to be called juvenile-onset or insulin-dependent diabetes, the body completely stops producing insulin. People with type 1 diabetes must take daily insulin injections to survive. This form of diabetes usually develops in children or young adults but can occur at any age. (In type 2 diabetes, which used to be called adult-onset or non-insulin-dependent diabetes, the body produces insulin but either does not produce enough to properly convert food into energy or is not able to use the insulin it does make. This form of diabetes usually occurs in overweight people who are over 40 with a family history of diabetes.)

In type 1 diabetes, the body stops--or almost stops--producing insulin because the immune system misfires and attacks the beta cells of the pancreas, which manufactures the hormone. The causes of this autoimmune disorder aren't known, although factors relating to genetics, environment, and trauma or infection all may be involved.

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Temporal clusters of type 1 diabetes cases (those that occur around the same time--whether within families, a school, or a geographical region) have also prompted people to suspect an environmental agent. However, given that the development of diabetes takes many years in most cases, as the body's immune system malfunctions and begins destroying the body's insulin-producing cells, a clustering in time seems more likely due to chance than a common cause.

• If one child in a family has type 1 diabetes, siblings have about a 1 in 10 risk of developing it by age 50.
• The risk for a child of a parent with type 1 diabetes is lower if it is the mother who has diabetes than if it is the father. If the mother is 25 or younger when the child is born, the child's risk is 1 in 25, compared with about 1 in 17 when the father has diabetes. When the mother is over age 25, the risk drops to 1 in 100 -- virtually the same as for the average American. The risks are somewhat higher when a parent developed diabetes before age 11.
• About 1 in 7 people with type 1 diabetes has a condition known as type 2 polyglandular autoimmune syndrome. These people have thyroid disease, malfunctioning adrenal glands, and sometimes other immune disorders. When a parent has this syndrome, the child's risk of developing it--including type 1 diabetes--is 1 in 2, according to the American Diabetes Association.

Caucasians have a higher risk of type 1 diabetes than any other race. Whether this is due to differences in environment or genes is unclear. Even among whites, most people who are susceptible do not develop diabetes, so scientists are studying what environmental factors may be at work. Genes influencing the function of the immune system are the most closely linked to susceptibility, regardless of race. One of those genes is HLA-DR. Most Caucasians with diabetes carry gene variants (alleles) 3 or 4 (or both) of the HLA-DR gene, known as HLA-DR3 or HLA-DR4. The HLA-DR7 allele plays a role in diabetes in blacks, while HLA-DR9 allele is significant in diabetes among Japanese.

It is also theorized that a link exists between coxsackie virus, which causes meningitis, and type 1 diabetes, though the connection is unclear. Scientists do have some significant evidence that mumps does not trigger diabetes, however. A Maryland study showed that despite a great decline in mumps cases after the mumps vaccine was introduced 30 years ago, the incidence of type 1 diabetes did not change.

Some scientists believe early diet may play a role, since children who have developed type 1 diabetes are less apt to have been breastfed for a prolonged period. While some studies have pointed to exposure to cow's milk as a factor, much remains to be learned about its importance. To be prudent, mothers of infants at heightened risk of developing diabetes may want to breastfeed as long as possible and use cow's milk in moderation after the baby is weaned.

The OGTT requires a fast of eight to 12 hours, after which a person's blood glucose is measured before drinking a glucose-containing solution and then again two hours later. In normal glucose tolerance, blood glucose rises no higher than 140 mg/dl two hours after the drink. In people with prediabetes or impaired glucose tolerance (IGT), the two-hour blood glucose is between 140 and 199 mg/dl. If the two-hour blood glucose rises to 200 mg/dl or above, the diagnosis is diabetes.

In the fasting plasma glucose test, a person's blood glucose is measured once after a fast of eight to 12 hours. A person with normal blood glucose has a blood glucose level below 100. A person with impaired fasting glucose has a blood glucose level between 100 and 125 mg/dl. If the fasting blood glucose level rises to 126 mg/dl or above, the person has diabetes.

The OGTT includes measures of blood glucose levels after a fast and after a glucose challenge. In 1997, an American Diabetes Association expert panel recommended that doctors use the fasting plasma glucose test to screen their patients for diabetes because the test is easier and less costly than the OGTT. On the other hand, the OGTT is more sensitive in identifying people with problems that may first appear only after high glucose intake.

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Your doctor or diabetes team will help you decide what type of meter to buy. Most new meters today read the glucose level as if the blood sample were plasma rather than whole blood, since that's the way results are reported by your doctor's office or lab. By having the meter record results as "plasma glucose," you and your healthcare team can more easily compare your lab tests with your home tests. Plasma numbers run 10 to 12 percent higher than those for whole blood; if your premeal plasma glucose target is 90 to 130 mg/dl, the target would be 80 to 120 mg/dl if your meter reads whole blood.

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In order to understand what the readings mean for you, you will need to know:

• Your target blood glucose range. A range of 90 to 130 mg/dl before meals is suggested for most people with diabetes. Ask your doctor what your target range should be.
• When to check your blood glucose. Some people check two times a day every day; others check four times a day. Ask your healthcare provider for guidance.
• It's a good idea to write down your blood glucose numbers in a diary or logbook and look for patterns over time. For example, are your blood glucose readings before breakfast higher or lower than your target? Once you see patterns, you can look for causes--and avoid them.

A terrific result does not necessarily mean that your blood glucose has been continuously under control; people with highs and lows that balance each other out could also get a great reading. This is why daily blood glucose readings are so important. A reading that falls between 7 and 8 for more than six months, or a reading over 8, suggests that the treatment plan needs to be changed.

You can test to see if your body is making ketones by doing a simple urine test. There are several products available for ketone testing that can be purchased without a prescription. Common product names include Ketostix, Chemstrip K, and Acetest. The test result can be negative or show small, moderate, or large quantities of ketones.

You should test for ketones:

But in the early stages, shortly after diagnosis, many patients experience a "honeymoon period" during which insulin needs are minimal; some people can actually maintain normal or near-normal blood glucose taking little or no insulin. This occurs because at this point in the disease's progression, a small percentage of the body's insulin-producing cells are still in operation. The disease may even appear to go away, since symptoms may emerge when the patient has an illness, then subside along with the illness as insulin needs decrease.

But the process that has destroyed most of the insulin-producing cells will ultimately destroy the remaining cells.

When you eat is also important. Your meals and medication work together so that your body can use the sugar from the food for energy or store it for a later time. A dietitian can help you formulate a meal plan.

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The balance between the amount of carbohydrate you eat and the available insulin determines how much your blood glucose level goes up after meals or snacks. To help control your blood glucose, you need to know which foods contain carbohydrate, the size of a "serving" of different foods, and how many carbohydrate servings to eat each day. There's no magic number of daily servings that's right for everyone; instead, it is important to work with a dietitian to determine what will work for you. By checking your blood glucose, you can see whether changes are needed. If your levels are too high, for example, you may need to eat fewer carbohydrate servings, be more physically active, or work with your diabetes team to adjust your insulin.

Foods that contain carbohydrate include grains, pasta, and rice; breads, crackers, and cereals; starchy vegetables such as potatoes, corn, peas, and winter squash; legumes such as beans, peas, and lentils; fruits and fruit juices; milk and yogurt; and sweets and desserts. Nonstarchy vegetables such as broccoli, salad greens, and green beans are very low in carbohydrate.

Carbohydrate counting can ensure that the right amount of carbohydrate is eaten at each meal and snack. Likewise, insulin may be adjusted based on what the person wants to eat. For example, if you want to eat a much larger meal, this approach can help you determine how much extra insulin to take.

The only way you can tell if you are eating the right amount is to measure your foods carefully:

• Practice, practice, practice. Don't rely on measuring once and then just "guesstimating." Pull out the scales at least once a week to check yourself.
• Use a glass that you know holds only 4 or 8 ounces. You can also place a piece of tape on the outside of a glass to mark off a serving.
• A bread serving is based on a 1-ounce slice of bread. Many single bread servings may weigh more than 1 ounce and therefore have more impact on blood glucose. Check labels of such items as light breads, bagels, or rolls.
• Know the weight of fruit servings for portion control.
• Check your cereal portion using measuring cups.

Some alcoholic beverages are higher in sugar and carbohydrates: sweet wines, sweet vermouth, and wine coolers, for example. Use these sparingly.

When making the decision about whether to use alcohol, you should understand what the potential effects of alcohol are on your health. Although alcohol has little effect on blood glucose control, it may worsen other medical problems. Make sure you discuss the use of alcohol with your doctor. Here are some general guidelines:

• With your doctor's approval, alcohol should be limited to two drinks a day. A "drink" is defined as a 12-ounce beer (preferably light beer); a 4-ounce glass of wine; a 2-ounce glass of dry sherry; or 1.5 ounces of a distilled beverage, such as whiskey, rye, vodka, or gin.
• Even though your doctor may approve the use of alcohol, you may want to avoid the extra calories if you are trying to lose weight.
• Alcoholic beverages can make your blood glucose drop. Avoid the risk of low blood glucose by having your drink at mealtime, or having a snack along with the drink.
• Avoid drinks that contain large amounts of sugar.
• Drink with caution, and carry identification that says you have diabetes. Signs of low blood glucose are similar to those of intoxication. Make sure your companions know how to treat an insulin reaction.

• Rapid-acting insulins include insulin aspart (Novolog) and insulin glulisine (Apidra). They begin to act in 10 to 30 minutes and reach their peak in 30 minutes to three hours, and their effects last between three and five hours.
• Short-acting insulin is regular insulin. It begins to work in 30 to 60 minutes, peaks in one to five hours, and lasts as long as eight hours.
• Intermediate-acting insulins such as NPH begin working in between one and four hours. They peak at between four and 12 to 15 hours, and last up to 26 hours.
• Long-acting, peakless insulins include insulin glargine (Lantus), which begins working in between one and two hours, does not peak but has consistent effects, and lasts as long as 24 hours.

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Effective, safe use of the pump requires a commitment to checking blood glucose at least four times a day, counting carbohydrates, and adjusting your insulin doses based on blood glucose levels, carbohydrate intake, and physical activity.

The main advantages of pump therapy are increased flexibility of lifestyle; predictable and precise insulin delivery; the ability to accurately deliver one tenth of a unit of insulin; tighter blood glucose control, while reducing the risk of low blood glucose; reducing episodes of severe hypoglycemia; reducing wide fluctuations in blood glucose, and helping manage the "dawn phenomenon" (the early-morning rise in blood glucose).

The main disadvantages of pump therapy are risk of skin infections at the catheter site; risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems; the cost; and the need to check blood glucose at least four times per day.

• Store unopened bottles in the refrigerator and do not use after the expiration date. Don't freeze them.
• Store bottles you are using at room temperature (59 to 86 degrees Fahrenheit) for 28 to 30 days. The strength of the insulin may be altered after that.
• Avoid exposing the bottles to temperature extremes (less than 36 degrees Fahrenheit or more than 86 degrees Fahrenheit).
• Don't use regular insulin if it becomes cloudy in appearance.
• Don't use NPH if it becomes clumped or crystallized or if the bottle becomes frosted.
• Make sure that you recheck your dosage whenever you change insulin.
• Get guidance from your healthcare team before mixing insulins or prefilling syringes.

• People who have poorly controlled diabetes sometimes experience weight loss because their bodies are unable to properly convert food into energy. Taking insulin helps reverse that process and can result in a weight gain.
• When blood glucose runs high, you can become dehydrated as your body works to clear itself of all that excess glucose. Getting your blood glucose under better control may cause you to retain fluid.
• Once you start taking insulin injections, glucose in your blood can get into the body's cells and be used rather than remaining in your bloodstream and being excreted in your urine.
• High blood glucose may cause people to feel hungry and eat more, because not all the food taken in can be properly processed to nourish the cells. Frequently, eating patterns continue after insulin has been started and is allowing more-efficient use of nutrients.

Some people cut back on their insulin once they discover they can lose a few pounds quickly by doing so. But when they go back to using the right amount of insulin, they discover that they gain the weight back--and perhaps more--in equally rapid fashion. Manipulating insulin to lose weight is an unhealthy habit to get into. Letting your blood glucose run high can lead to long-term complications. Better to make careful adjustments in how much you eat.

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How to get back on track?

• Remember that success depends upon having realistic, practical, and achievable goals. Define one action you could take to start to improve your situation--preferably a fairly easy action that makes success likely.
• If a specific obstacle keeps getting in your way, try to concretely define it. When, where, and why does the problem occur? Consider changing your behavior or your environment, either to make handling the issue easier or to avoid it.
• Consider: Are there other people who could help you? Moral support at home, at work, and in social situations can make a big difference. Decide what kind of support you need and then ask.
• Understand that strong negative feelings about diabetes are normal. Talking with family, friends, health professionals, and other people with diabetes about your feelings can help you to better tolerate them and react in constructive, rather than self-destructive, ways.
• Keep your eye on the rewards of good care, not the consequences of failure. Fears about complications may motivate you for a short time, but in the long run most people either dismiss their fears or become paralyzed by them. Rather, focus on how great you've felt when you've managed the disease well.

"Sick day" guidelines

When people with diabetes are sick with a cold or the flu, or are vomiting, or recovering from surgery, their blood glucose will often be higher than usual--even if they are eating less food. This is because insulin is often less effective during an illness or after an injury. Talk to your healthcare provider about how to manage your disease when you're not feeling well. In general, the following "sick day" steps should be taken to keep blood glucose under control:

• Take your usual insulin even if you can't eat normally, unless your healthcare provider instructs you differently. In some cases, additional insulin is required.
• Check your blood glucose every three to four hours, including during the night. Have someone do it for you if you are too sick to do it yourself.
• Check for ketones if your plasma blood glucose is 250 mg/dl or higher, unless otherwise instructed by your healthcare team.
• Write the results of your blood glucose and ketone checks down and have them ready if you need to call your healthcare provider.
• Drink plenty of fluids--about 6 to 8 ounces every hour you are awake. If you are able to eat your meals, drink fluids that are sugar free and caffeine free. If you are unable to eat, alternate sugar-free fluids one hour with fluids containing sugar the next. Include liquids with salt, too, such as bouillon or clear soup.
• Rest. Stay warm.

Call your healthcare provider if:

• you are vomiting or have diarrhea for more than two hours,
• you have a fever,
• your blood glucose values remain above 250 mg/dl for at least two checks or do not decrease with extra insulin (whether or not you have ketones),
• you have stomach pains that won't go away.

When the damaged nerves influence how well your stomach and intestines clear food through your system, a condition called gastroparesis develops; symptoms can include abdominal discomfort, nausea, vomiting, and bloating. Nerve damage in other areas of the body might mean incomplete emptying of the bladder, incontinence, or sexual dysfunction. Damage to nerves that regulate blood flow and blood pressure can cause significant drops in blood pressure--and lightheadedness or fainting--when you sit or stand.

If you begin to show signs of neuropathy, the most important first thing you can do is to try to prevent further damage by making sure your blood glucose is under control. Sometimes, improving blood glucose control can lessen symptoms of neuropathy over time, even as it's helping to prevent further damage. Nerves do not grow back, however. Once pain is replaced with numbness--a sign the nerves are dead--the numbness will not go away.

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One of the most commonly used and effective medications is gabapentin (Neurontin), which has relatively few side effects. A topical cream (capsaicin) may help relieve the pain of neuropathy by blocking nerve signals. An analgesic ointment such as Bengay may also help.

Surprisingly, clinicians have found that certain antidepressants seem to be effective at helping patients tune out their pain. Antidepressants can take several weeks to work, so patients should wait a month before deciding whether a drug is helpful or not.

Some patients have experienced success with other forms of pain management--biofeedback, meditation, hypnosis, and acupuncture, for example.

Other factors can cause or exacerbate sexual dysfunction, including self-consciousness and fear of failure. If you are experiencing impotence or sexual dysfunction, it's important to see your doctor for an accurate diagnosis of your condition. People who experience sexual difficulties can lead more enjoyable, fulfilling sex lives by learning about causes, treatment options, and how to discuss their feelings and needs with a doctor and partner.

There's no certain way to avoid heart disease and circulation problems. But there are things to do to cut your risk:

• If you smoke, stop.
• Lose weight if you are overweight.
• Keep your blood pressure in the proper range.
• Be physically active.
• Keep your blood fats and cholesterol levels in a healthy range.
• Keep your blood glucose under control.

You can lower your chances of developing foot problems by treating your feet gently:

• Wash your feet in warm, soapy water every day. To avoid drying out your skin and getting cracks, don't soak your feet or use hot water, and choose mild soap. Towel off carefully, including between the toes.
• Apply lotion, but not between the toes. Put talcum powder on your feet if they sweat.
• Check every day for dry skin, cracks, or cuts, and inform your doctor if you find cuts that are not healing. If you cannot easily inspect your feet, use a mirror or ask for help.
• File your toenails with an emery board, rounding the edges. Do not use scissors. Get assistance if you do not see clearly.
• See a doctor to determine the best treatment for corns and calluses. Never cut them.
• See a foot doctor regularly if you have poor circulation, nerve damage, or thick toenails.

An exercise program should be individually tailored and designed to complement your lifestyle. Many factors--such as the time of day you exercise or the type and duration of your exercise--will determine whether adjustments should be made in your insulin dose or your meal plan. Discuss your exercise program with your exercise physiologist to determine the type of adjustments you need to make.

Some tips on exercise:

• If you are over 35, you may need a stress test before beginning to exercise regularly.
• Test your blood glucose before and after exercise.
• Do not exercise if blood glucose is over 250 mg/dl and there are ketones in your urine. If no ketones are present, do not exercise if blood glucose is 300 mg/dl or more.
• Plan exercise to prevent low blood glucose reactions. That means you want to exercise one to 1½ hours after eating, check blood glucose before and after exercise, always carry a carbohydrate snack with you (glucose tablets, juice, etc.), and drink plenty of fluids.

High blood glucose after physical activity

When you exercise, your muscles need added glucose as a source of energy. In response to the demand from your exercising muscles, your liver pours an extra supply into your bloodstream. Remember, however, that the glucose can't be used by your muscles without the help of insulin to "unlock the door" to muscle cells; if insulin available isn't sufficient, your blood glucose levels can actually increase right after exercise.

To avoid problems:

• Check your blood glucose before exercising. Do not exercise if the reading is over 250 mg/dl and you have ketones.
• If the reading is 300 or more but no ketones are present, retest within five or 10 minutes of beginning your exercise program. It's OK to carry on if the blood glucose is dropping. If not, stop exercising.

Low blood glucose after physical activity

A common cause of low blood glucose is too much physical activity without compensating for it. In fact, moderate-to-intense exercise may cause your blood glucose to drop for the next 24 hours. This post-exercise hypoglycemia is often referred to as the "lag effect" of exercise.

When you exercise, the body uses two sources of fuel to generate energy: glucose and free fatty acids--or fat. The glucose, stored in the body in a form called glycogen, comes from the blood, the liver, and the muscles. During the first 15 minutes of exercise, most of the glycogen is drawn from the bloodstream or the muscles. After 15 minutes of exercise, the body is fueled more by glycogen stored in the liver; and, after 30 minutes of exercise, by the free fatty acids.

The body will replace its depleted glycogen stores, but this process may take four to six hours, or even 12 to 24 hours when the physical activity has been intense. During this period, a person with diabetes is at higher risk for hypoglycemia--though there are precautions that can prevent it:

• Check your blood glucose before exercising to make sure your blood glucose is sufficient. If necessary, eat an appropriate snack.
• Avoid exercise at the peak of your insulin action.
• Avoid late-evening exercise. Exercise should be completed two hours before bedtime.
• Avoid alcohol before or immediately after exercise.
• Avoid hot tubs, saunas, and steam rooms directly after exercise. Otherwise, your heart rate will remain elevated longer, and your blood glucose may continue to drop.
• Check with your doctor about the length, intensity and duration of your planned exercise program.
• Check your blood glucose immediately after exercise to prevent low blood glucose from occurring hours after exercise. It may also be necessary to check your blood glucose more often for two to four hours after exercise. Intense exercise may cause your blood glucose to drop for the next 24 hours.

What should you do if you find your blood lucose is less than 100 mg/dl immediately after exercise?

• Follow post-exercise snack guidelines. If you are not scheduled for a snack or a meal for 30 to 60 minutes after exercise, 15 grams of carbohydrateshould be sufficient to prevent a low blood glucose. If no meal or snack is scheduled for more than one hour, take 15 grams of carbohydrateand 7 to 8 grams of protein.
• Increase carbohydrate intake before exercise.
• Decrease the dose of active insulin for the next exercise session.
• Consider decreasing the insulin dosage following exercise.
• If your blood glucose at bedtime is still less than 100 mg/dl, double your bedtime snack, or if possible, decrease your bedtime insulin dose.

Unplanned exercise

Sometimes exercise or physical exertion occurs spontaneously, so that preparation isn't possible. You may need extra carbohydrate (or an insulin adjustment, or both) at these times to make sure you have the sufficient energy. A number of factors will determine what you need:

• Snacks may be necessary for exercise beginning two hours or more after your last meal.
• You may need a snack if you exercise for an hour or more.
• Long-duration or all-day activities may require both a snack adjustment and an insulin adjustment.
• If you are attempting to lose weight, plan your exercise so you can limit the amount of extra food needed to keep your blood glucose from dropping too low.

You'll want to prevent an unplanned pregnancy; your goal is to conceive after your blood glucose levels have been well controlled for several months. During the earliest weeks of fetal growth, the risk of birth defects is heightened if blood glucose levels are not in control.

During pregnancy, your dietary and insulin needs are bound to change as your body does. It'll be even more vital than usual to get good medical care and nutritional guidance.

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In general, high blood glucose, also called hyperglycemia, is reached when the level is 160 mg/dl, or when it is above your individual target. If your blood glucose is high for long periods of time, you run an increased risk of complications over the long term: eye disease, kidney disease, heart attacks, and strokes, to name a few. High blood glucose can pose health problems in the short term as well. Your treatment plan may need adjustment if your blood glucose stays over 180 mg/dl for three days in a row.

Symptoms of high blood glucose include increased thirst, increased urination, dry mouth or skin, tiredness or fatigue, blurred vision, more frequent infections, slow-healing cuts and sores, and unexplained weight loss.

High blood glucose can be caused by too much food; too little exercise or physical activity; poorly calibrated treatment; or illness, infection, injury, or surgery.

What should you do if you have hyperglycemia?

• Be sure to drink plenty of water.
• If your blood glucose is 250 mg/dl or greater, check your urine for ketones. If they are present, call your healthcare team, as you may need additional insulin.
• Ask yourself what may have caused the high blood glucose, and take action to correct it. Ask your healthcare team if you are not sure what to do.
• Check your blood glucose before meals three days in a row. If it's higher than your target level for three days, a change in your treatment plan may be needed.

Hypoglycemia is usually unpleasant, with the most common symptoms being shakiness and sweatiness and having one's heart pound. The most common reasons for hypoglycemia are too much insulin, too little food, or too much activity. Another cause is drinking alcoholic beverages. Most hypoglycemia, if quickly and appropriately treated, it is more of an inconvenience than a cause for alarm.

However, severe hypoglycemia can cause mental confusion, antagonistic behaviors, unconsciousness, and seizures. The biggest danger is not the condition itself but what may happen as a result: a motor vehicle accident caused by passing out at the wheel or swerving into oncoming traffic, or a tumble down the stairs, for example. In rare cases, seizures can result in brain damage.

To avoid problems with hypoglycemia:

• Recognize the symptoms, which are specific to each individual and may change over time. If you have symptoms, test immediately if possible to see if your blood glucose is low.
• Understand the interaction between food intake, treatment, and physical activity so you can anticipate when hypoglycemia is a risk.
• Always carry carbohydrates for treatment. Don't overdo it: The most common error is to overtreat low blood glucose.
• Check blood glucose levels again in 15 minutes, and repeat treatment if symptoms persist or blood glucose levels have not risen above your target level.
• Check blood glucose levels before driving if you think you may be low--and stop the car immediately if you're already underway. Treat immediately with the appropriate amount of fast-acting carbohydrate. Check blood glucose levels again in 15 minutes and do not start driving again until you're no longer hypoglycemic.

Call the doctor if your blood glucose is 250 mg/dl or higher for more than two readings and you:

• Are urinating more frequently than usual
• Are excessively thirsty
• Feel ill
• Have a fever
• Feel sick to your stomach or are throwing up
• Experience confusion or vision impairment

• Ask your doctor for a green light.
• Get a letter from your doctor that says you have diabetes. You may need it if you are ever challenged for having syringes and medications with you.
• Get prescriptions for syringes and medicines. You will need them if you lose your supply.
• If you will be traveling across time zones, check with your medical team to find out what that will mean for your insulin intake and eating schedules.
• Ask your doctor for names of other physicians along your route.
• Get any necessary shots a month before you travel. When you pack, carry medical necessities (plus extras) and snacks in a small travel bag--and then, when you travel, keep it with you at all times.
• Take along all the syringes that will be needed during your trip. Pack alcohol to wipe off the tops of insulin bottles. Take a glucagon kit and your monitor and strips to check your blood for glucose. Bring foot-care supplies.
• Store insulin so that it is neither too cold (below 35 degrees) nor too hot (above 90 degrees).

• Carry a card that says you have diabetes. It should include your name, address, and phone number; your doctor's name and phone number; and the kind and dosages of all medications you take. Wear a bracelet or necklace with the same information on it.
• Do not skip meals or snacks. Keep food with you to treat an insulin reaction. Pull off the road if you have a reaction while driving.
• Check your blood glucose more often. Match the amount of food you eat and your medication dose with your activity. You will need more food for walking, swimming, or skiing than for sitting in movies. Follow your meal plan and exercise program when traveling.