16 17 控制糖尿病的方法 : 糖尿病飲食計劃 Management of Diabetes: Diabetic Meal Planning 6. 多選用低鈉質的調味品及配料如芹菜辣椒蒜頭薑洋蔥青椒香菜芫茜胡椒咖喱粉五香粉花椒八角醋和檸檬汁等 7. 可以選擇無糖飲品或食

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1 14 15 控制糖尿病的方法 : 糖尿病飲食計劃 Management of Diabetes: Diabetic Meal Planning VII. 控制糖尿病的方法: A. 糖尿病飲食計劃如果你腎臟功能有問題, 你需要遵從特別的飲食計劃, 限制鉀, 鈉, 磷和蛋白質的攝入量你可以向你的醫生或註冊營養師咨詢有關合乎你病情的適當膳食計劃糖尿病飲食規則 1. 定時飲食及保持良好的飲食習慣每日應包括三小餐及一至兩次的小吃並選擇合適的食物種類及適當的份量最好每隔四至五小時吃一小餐 2. 多選擇含纖維素高的食物如糙米 brown rice 乾豆類黃豆眉豆黑豆等全麥麵包 (100% whole wheat) 麥片 (oatmeal) 鮮果和蔬菜等 3. 選擇低脂肪蛋白質類食品如瘦的肉類魚類海鮮雞胸肉豆腐和蛋白等肉類應切除脂肪和皮適量進食果仁種子瓜子和花生醬等每日可進食大約六安士肉類和一安士果仁 4. 多選用蒸灼煲和烤的烹飪方法 5. 烹飪時可用少量的植物油如菜籽油 canola oil 或橄欖油 olive oil 等每日可進食六茶匙油. VII. Management of Diabetes A. Diabetic Meal Planning If you are already having problems with your kidneys, you will need to follow a more specialized diet which limits your intake of potassium, sodium, phosphorous and protein. Consult with your doctor or a registered dietitian regarding an appropriate meal plan for your condition. Principles of Diabetic Meal Plan 1. Eat at regular times and maintain healthy eating habits. Consume 3 small meals and 1-2 snacks daily. Include appropriate servings from each food group at each meal. Ideally, you should eat every 4-5 hrs. 2. Include foods high in fiber such as brown rice, dried beans, whole grain breads and cereals, fresh fruits, and vegetables. 3. Choose protein foods low in fat such as lean meats, seafood, chicken breast, tofu, and egg white. Remove all visible fat and skin from meat. Nuts, seeds, and peanut butter may be eaten in moderation. About 6 ounces of meat and 1 ounce of nuts may be eaten daily. 4. Prepare foods by steaming, braising, boiling, or baking. 5. Use a small amount of vegetable oil in cooking. Choose canola oil or olive oil. About 6 teaspoons of oil may be used daily.

2 16 17 控制糖尿病的方法 : 糖尿病飲食計劃 Management of Diabetes: Diabetic Meal Planning 6. 多選用低鈉質的調味品及配料如芹菜辣椒蒜頭薑洋蔥青椒香菜芫茜胡椒咖喱粉五香粉花椒八角醋和檸檬汁等 7. 可以選擇無糖飲品或食品 Diet or sugar free) 清湯咖啡和茶等 8. 減少用糖類如砂糖黃糖冰糖和蜜糖等若要加糖可用假糖代替如 Sweet & Low, Equal, Splenda 等 9. 減少進食含糖的食品飲品或調味品如甜豆奶波霸奶茶汽水煉奶甜飽果醬蜜棗無花果糖果及各類甜品甜酸食物燒烤醬海鮮醬甜麵醬酸梅醬和蠔油等 10. 減少吃白飯粥糯米及米類製品如腸粉米粉河粉粽湯丸年糕 11. 減少吃高澱粉質的水果如香蕉及榴 12. 以下的食物含高澱粉質及糖份碳水化合物需酌量食用 6. Use these low sodium seasonings: celery, chili pepper, garlic, ginger, green pepper, onion, parsley, black pepper, red pepper, curry powder, five spice powder, anise, vinegar, and lemon juice. 7. Sugar-free products, diet soda, broth, coffee, and tea may be consumed. 8. Reduce sugar (white sugar, brown sugar, corn syrup, honey) in foods or beverages. Sugar substitutes such as Sweet & Low, Equal, or Splenda can be used to provide sweetness. 9. Reduce sugar-containing beverages, foods, and condiments such as sweetened soy drinks, bubble tea, soda, condensed milk, sweet buns, jams, dates, figs, candies, desserts, sweet and sour foods, BBQ sauce, ketchup, hoisin sauce, sweet bean paste, plum sauce, and oyster sauce. 10. Limit white rice, rice porridge, glutinous (sticky) rice and rice products such as rice noodles ( cheong-fun, mei-fun, ho-fun), rice dumplings, rice balls, and rice cakes. 11. Eat less of starchy fruits such as bananas and durian. 飯麵粥粉麵包麥片餅乾番薯薯仔芋頭淮山薏米葛粟米青豌豆和乾豆類等水果牛奶脫脂 Fat Free 或 1% 低脂 Low fat) 或加鈣純豆奶每餐大約一碗飯 / 麵 / 麥片或二片麵包 ( 一碗 = 八安士 ) 每日二至三個小型水果每日大約二杯一杯 = 八安士

3 18 19 控制糖尿病的方法 : 糖尿病飲食計劃 Management of Diabetes: Diabetic Meal Planning 13. 有時可飲用半杯四安士純果汁以代替一個水果 14. 減少吃含有高膽固醇的食品如內臟肝腎腰腦蛋黃蝦墨魚和魷魚等 15. 減少吃動物脂肪豬油雞油牛油煎炸食物點心人造牛油和沙律醬等減少用椰汁作配料 16. 減少吃鹹高鈉質的食物和調味品如鹹蛋鹹魚火腿臘味罐頭食品鹽豉油魚露蠔油味精豆豉辣椒醬豆瓣醬蝦醬和腐乳等 17. 避免空腹喝酒以免引起低血糖反應 12. The following foods contain mostly starches and sugars (carbohydrates) and should be consumed in moderate amounts: Rice, rice porridge, rice noodles, bread, cereal, crackers, potato, yam, taro, corn, barley, gourd, green peas, dried beans Fruits Milk (fat free or 1% low fat) or unsweetened soymilk with calcium Approx. 1 cup cooked rice/noodle/cereal or 2 slices bread per meal 1 cup = 8 oz. 2-3 small fruits per day Approx. 2 cups per day 1 cup = 8 oz oz. (1/2 cup) of 100% unsweetened fruit juice may be substituted for 1 serving of fruit occasionally. Use the MyPlate icon as a guide to plan your meal ½ = vegetables On a 9 plate: ¼ = grains ¼ = protein May include a small fruit and a cup (8 oz) of milk or soymilk 使用 MyPlate 營養建議指引來計劃你的餐膳以一個 9 英大小的碟來計算 : ½ = 應該是蔬菜類 ¼ = 應該是穀類 ¼ = 應該是蛋白質類另外可以加一個小型水果及一杯 (8 安士 ) 牛奶或豆奶 14. Eat less of high cholesterol foods such as organ meats (liver, gizzard, kidney, brain, tongue), egg yolk, shrimp, cuttlefish, and squid. 15. Reduce animal fats (lard, chicken fat, butter), fried foods, dim sum, margarine, mayonnaise, and salad dressing. Limit coconut milk. 16. Limit salty (high sodium) foods and condiments such as salted egg, salted fish, ham, sausage, preserved meats, canned foods, salt, soy sauce, fish sauce, oyster sauce, MSG, fermented black beans, chili sauce, bean paste, shrimp paste, and fermented bean curd. 17. Avoid drinking alcohol on an empty stomach as it may cause low blood sugar.

4 20 21 控制糖尿病的方法 : 如何計算碳水化合物的份量 Management of Diabetes: Carbohydrate Counting 如何計算碳水化合物 (Carbohydrate) 的份量碳水化合物是食物升高血糖的主要成分患有糖尿病的人不單要注意所進食的甜品及糖類也應該注意碳水化合物的攝入量碳水化合物主要來源於澱粉類的食物如米飯麵薯仔穀類麵包乾豆類水果牛奶和某些蔬菜如玉米青豌豆胡蘿蔔當你讀食物營養標簽時應了解每一份量的碳水化合物總含量而不要只單純考慮糖份的含量要牢記四克 gram 的碳水化合物相當於一茶匙的糖最好將含碳水化合物的食物分成小餐吃並在每次進餐或小吃時均衡份量並留意碳水化合物的攝入量根據你每日所進食的熱量每餐攝取碳水化合物 45 至 70 克小吃則 20 至 40 克均較為合宜在進食後二小時測量一下你的血糖值以便了解那一種食物會影響你的血糖度數以及攝取多少碳水化合物較合適你參考碳水化合物含量的圖表來協助你計劃你的餐膳並向註冊營養師咨詢有關合適你個人的飲食餐單 Carbohydrate Counting Carbohydrate is the primary nutrient in foods that raises blood glucose. People with diabetes need to watch their total carbohydrate intake, and not only sweets and sugars. Carbohydrates come from starchy foods (e.g. rice, noodles, potato, cereal, breads, dried beans), fruits, milk and certain vegetables (e.g. corn, peas, carrots). When reading a food label, consider the total carbohydrate per serving rather than the amount of sugar in a product. Keep in mind that 4 grams of carbohydrate is equivalent to about a teaspoon of sugar. It is a good idea to spread your carbohydrate foods into small frequent meals and keep the amount of carbohydrates consistent at each meal and snack. Depending on how many calories you consume in a day, limit carbohydrates to between 45 to 70 grams per meal and between 20 to 40 grams per snack. By checking your blood sugar 2 hours after eating, you can see how a particular food affects your blood glucose reading and whether the amount of carbohydrates eaten is appropriate for you. Use the carbohydrate content list to assist you in meal planning and consult a registered dietitian if you need help in designing a personalized diet.

5 22 23 控制糖尿病的方法 : 糖尿病飲食餐單樣本 Management of Diabetes: Diabetic Meal Plan 糖尿病飲食餐單樣本 (1200 卡路里 / 熱量 ) 碳水化合物克早餐半碗麥片 13 一片全麥麵包 15 半杯脫脂牛奶 6 小吃一個小型水果 15 午餐半碗麵 20 二安士瘦的肉類 0 一碗蔬菜 5 一茶匙油 0 小吃一個小型水果 15 晚餐半碗糙米飯 23 二安士魚 0 四安士豆腐 4 一碗蔬菜 5 一茶匙油 0 小吃五片全麥餅乾 10 一杯加鈣純豆漿 5 Sample Diabetic Meal Plan (1200 calories) Carbohydrates (gm) BREAKFAST ½ c. Oatmeal 13 1 sl. Whole wheat toast 15 ½ c. Fat free milk 6 SNACK 1 Small fruit 15 LUNCH ½ c. Noodle 20 2 oz. Lean meat 0 1 c. Cooked vegetable 5 1 tsp. Oil 0 SNACK 1 Small fruit 15 DINNER ½ c. Brown rice 23 2 oz. Fish 0 4 oz. Bean curd (tofu) 4 1 c. Cooked vegetable 5 1 tsp. Oil 0 SNACK 5 Whole wheat crackers 10 1 c. Unsweetened enriched soymilk 5

6 24 25 控制糖尿病的方法 : 糖尿病飲食餐單樣本 Management of Diabetes: Diabetic Meal Plan 糖尿病飲食餐單樣本 (1500 卡路里 / 熱量 ) 碳水化合物克早餐一平碗麥片 25 一片全麥麵包塗 15 一茶匙軟裝人造牛油 0 一隻蛋白 0 半杯脫脂奶 6 小吃一個小型水果 15 午餐一平碗麵 40 二安士瘦的肉類 0 一碗蔬菜 5 一茶匙油 0 小吃一個小型水果 15 晚餐一平碗糙米飯 45 三安士魚 0 四安士豆腐 4 一碗蔬菜 5 一茶匙油 0 Sample Diabetic Meal Plan (1500 calories) Carbohydrates (gm) BREAKFAST 1 c. Oatmeal 25 1 sl. Whole wheat bread 15 1 tsp. Soft margarine 0 1 Egg white 0 ½ c. Fat free milk 6 SNACK 1 Small fruit 15 LUNCH 1 c. Noodle 40 2 oz. Lean meat 0 1 c. Cooked vegetable 5 1 tsp. Oil 0 SNACK 1 Small fruit 15 DINNER 1 c. Brown rice 45 3 oz. Fish 0 4 oz. Bean curd (tofu) 4 1 c. Cooked vegetable 5 1 tsp. Oil 0 SNACK 5 Whole wheat crackers 10 1 c. Unsweetened enriched soymilk 5 小吃五片全麥餅乾 10 一杯加鈣純豆漿 5

7 26 27 控制糖尿病的方法 : 一般食品碳水化合物成份 Management of Diabetes: Carbohydrate Content 有關份量的縮略語 : Abbreviations: gm. = 克 Gram oz. = 安士 Ounce c. = 杯 ( 八安士 ) Cup (8 oz) sl. = 片 Slice tsp. = 茶匙 Teaspoon med. = 中型 Medium 一般食品碳水化合物 ( 澱粉質及糖 ) 成份 Carbohydrate (Starch & Sugar) Content of Common Foods 澱粉質類煮熟份量碳水化合物克熱量 STARCHES, COOKED AMT CARBOHYDRATE (gm) CALORIES 白飯 White rice 1c 糙米飯 Brown rice 1c 糯米飯 Sweet rice 1c 餃子 Dumplings 河粉 Ho-fun 1c 米粉 Mei-fun 1c 瀨粉 Lai-fun 1c 粉絲 Bean thread (Fun-see) 1c 麵 Noodles 1c 意大利粉 Spaghetti 1c 通心粉 Macaroni 1c 麥皮 Oatmeal 1c 薏米 Barley 1c 白麵包 White bread 1sl 麥麵包 Wheat bread 1sl 餅乾 Crackers 黃豆 Soy beans 1c 蠶豆 Lima beans 1c 黑豆 Black beans 1c 眉豆 Black-eyed peas 1c

8 28 29 控制糖尿病的方法 : 一般食品碳水化合物成份 Management of Diabetes: Carbohydrate Content 鮮果類份量碳水化合物克熱量 FRUITS, FRESH AMT CARBOHYDRATE (gm) CALORIES 蘋果 Apple 1 med 杏 Apricots 雪梨 Asian pear 1 med 香蕉 Banana 1 med 香瓜 Cantaloupe 1c 車厘子 Cherries 榴 Durian 3 oz 葡萄 Grapes 西柚 Grapefruit ½ med 蜜瓜 Honeydew 1c 奇異果 Kiwi 1 med 龍眼 Longan 枇杷果 Loquats 荔枝 Lychee 芒果 Mango ½ med 桃李 Nectarine 1 med 橙 Orange 1 med 桃 Peach 1 med 啤梨 Pear 1 med 柿子 Persimmon 1 med 黑李 Plum 1 med 木瓜 Papaya ½ med 菠籮 Pineapple 1c 沙田柚 Pummelo 1c 士多啤李 Strawberries 1c 柑 Tangerine 1 med 西瓜 Watermelon 1c 乾果類份量碳水化合物克熱量 FRUITS, DRIED AMT CARBOHYDRATE (gm) CALORIES 杏脯 Apricots 蜜棗 Dates 無花果 Figs 西梅 Prunes 葡萄乾 Raisins 1/3 c 蔬菜類煮熟 VEGETABLES, COOKED 蘆筍 Asparagus 1c 竹筍 Bamboo shoots 1c 豆芽 Bean sprouts 1c 西蘭花 Broccoli 1c 白菜 Bok choy 1c 紅籮蔔 Carrots 1c 玉米 * Corn * 1c 芹菜 Celery 1c 椰菜 Cabbage 1c 椰菜花 Cauliflower 1c 青瓜生 Cucumber, raw 1c 茄子 Eggplant 1c 葛 * Gourd * 1c 豆角 Green beans 1c 生菜生 Lettuce, raw 1c 蓮藕 Lotus root 10 sl 芥菜 Mustard green 1c 紹菜 Napa cabbage 1c. 8 36

9 30 31 控制糖尿病的方法 : 一般食品碳水化合物成份 Management of Diabetes: Carbohydrate Content 蔬菜類煮熟份量碳水化合物克熱量 VEGETABLES, COOKED AMT CARBOHYDRATE (gm) CALORIES 洋蔥 Onions 1c 南瓜 Pumpkin 1c 青碗豆 * Peas * 1c 馬鈴薯 * Potato * 1 med 蕃薯 * Sweet potato * 1 med 菠菜 Spinach 1c 節瓜 Squash 1c 草菇 Straw mushroom 1c 冬菇 Dried mushroom 芋頭 * Taro * 4 oz 籮蔔 Turnip 1c 蕃茄生 Tomato, raw 1 med 西洋菜 Watercress 1c 馬蹄 Water chestnut 1c * = Starchy Vegetables 高澱粉質瓜菜飲料 DRINKS 汽水 Soda, regular 1 can (12 oz.) 葡萄酒 Wine 4 oz. <2 70 啤酒 Beer 12 oz 烈酒 Liquor 1 oz 茶 Tea 1c. 0 0 咖啡 Coffee 1c. 0 0 果汁 Fruit juice 1c 蔬菜汁 Vegetable juice 1c 牛奶 Milk 1c 淡豆漿 Soymilk (unsweetened) 1c 糖份量碳水化合物克熱量 SUGARS AMT CARBOHYDRATE (gm) CALORIES 沙糖 White sugar 1 tsp 黃糖 Brown sugar 1 tsp 蜜糖 Honey 1 tsp 果醬 Jam 1 tsp 糖漿 Syrup 1 tsp 其他 OTHERS 蛋 Egg 肉類 Meat 3 oz 魚類 Fish 3 oz 果仁 Nuts 1 oz 栗子 Chestnuts 1 oz 白果 Ginko nuts 1 oz 蓮子 Lotus seeds 1 oz 花生醬 Peanut butter 1 tsp 油 Oil 1 tsp 豆腐 Tofu (bean curd) 4 oz

10 32 33 控制糖尿病的方法 : 體力活動與糖尿病 Management of Diabetes: Physical Activity B. 體力活動與糖尿病運動的益處 - 可減低血糖的度數 - 可減低三酯甘油的度數 - 增加高密度膽固醇好膽固醇的度數 - 改善胰島素的作用 - 增強你的肌肉骨質和其他身體的重要器官 - 使你精力充沛 - 幫助你減輕體重或保持健康的體重 - 緩舒焦慮及憂鬱 - 減低患上心臟病中風高血壓以及某些癌症的機會保持運動並注意飲食可減低你身體對胰島素或降血糖藥物的需求及依賴運動前後以及運動中要注意的事項在開始任何運動計劃之前先請你的醫生為你做詳細的身體檢查以免使併發症更加惡化運動前. 檢查血糖如果你的血糖低於 100mg/dl 在運動之前要進食額外的澱粉質類食物如麵包或米飯等. 檢查你的足部是否有毛病切記穿著適合你運動類型的鞋子. 做 5-10 分鐘熱身運動開始時先做輕度的健身運動如步行然後伸展肌肉等 B. Physical Activity and Diabetes Benefits of Exercise Lowers blood glucose levels Lowers triglyceride levels Increases HDL (good) cholesterol Helps cells respond better to insulin Strengthens your muscles, bones, and other vital organs in the body Increases your energy level Helps you lose weight, or maintain a healthy weight Reduces anxiety and depression Reduces your risk of heart disease, stroke, high blood pressure, and some types of cancers Combined with a healthy diet, regular physical activities may lower your need for insulin or diabetes medications. Precautions Before, During, and After Exercise Before starting any exercise program, it is important that your health care providers check your health condition thoroughly to avoid risk of worsening complications. Before exercise: Check your blood glucose level. If your blood sugar is lower than 100 mg/dl, eat additional starchy foods such as bread or rice before beginning to exercise. Inspect your feet for foot problems. Make sure you wear proper footwear for the type of exercise you choose. Warm-up for 5-10 minutes. Start with low-intensity aerobic activity, such as walking, followed by stretching of your muscles.

11 34 35 控制糖尿病的方法 : 體力活動與糖尿病 Management of Diabetes: Physical Activity 運動中要做到運動中也可以毫無困難地與人談話為免身體缺水應帶備飲用水尤其在天氣炎熱時身體缺水可使血糖升高影響心臟功能應隨身帶備碳水化合物補充食品如葡萄糖片果汁或餅乾等以預防低血糖或在低血糖時服用特別在進行長時間的運動時在太炎熱或太寒冷的日子最好不要運動如覺得眩暈胸悶呼吸困難或噁心應馬上停止運動最好隨身帶上糖尿病人的確認手環 I.D. Band 以防發生緊急意外時可辨別你患有糖尿病運動後做放鬆運動使心臟回復運動前的狀態放鬆運動與熱身運動很相似記得運動後也要測量血糖的度數運動時間的長短每個人的運動時間或頻密程度要視乎各人的年齡性別健康情況以及平日的運動習慣等因素來確定專家建議通常每天運動 30 分鐘較合適如果你剛剛開始進行有規律的運動則應從做 5-10 分鐘的運動開始然後慢慢增加至 30 分鐘如果你需要減輕體重應盡量每日做到 60 至 90 分鐘的運動 During exercise: You should be able to carry a conversation without difficulty while working out. Carry a water bottle with you to keep hydrated, especially when it is hot. Dehydration can increase blood sugar levels and affect heart function. Carry a source of carbohydrate, such as glucose tablets, fruit juice, or crackers, to treat or prevent low blood sugar, especially during prolonged activities. Do not exercise in extreme hot or cold weather. Stop exercising if you experience lightheadedness, chest tightness, severe shortness of breath, or nausea. Wear a diabetes identification band in case of emergency. After exercise: Do cool-down exercises to allow your heart rate to gradually return to pre-exercise level. Cool-down exercises are similar to warm-up exercises. Remember to check your blood glucose after exercising. Length of Exercises How long and how often you should exercise depend on your age, sex, health condition, and level of fitness. Generally, 30 minutes of physical activity on most days of the weeks is recommended. If regular physical activity is something new to you, start with 5-10 minutes of exercise, and gradually increase to 30 minutes a day. If you need to lose weight, aim for minutes of exercise daily.

12 36 37 控制糖尿病的方法 : 體力活動與糖尿病 Management of Diabetes: Physical Activity 運動的類型糖尿病患者特別是那些因糖尿病而有眼部或足部問題的人仕在選擇運動類型時更要注意以免因選擇不當而加深對眼睛或足部的損害建議的運動步行騎單車輕量健身操原地踩單車輕量重游泳鍛煉手臂太極拳六通拳園藝不建議的運動重量的舉重激烈的運動強度健身操 Types of Exercises Diabetics, especially those with eye or foot problem, should choose the appropriate type of exercise to avoid further damage to the eyes and feet. Exercises recommended: Walking Bicycling Low impact aerobics Stationary cycling Light weight training Swimming Arm exercises Tai Chi Loo Tung Chuan Gardening Exercises not recommended: Heavy weight lifting Heavy competitive sports High impact aerobics

13 38 39 控制糖尿病的方法 : 糖尿病藥物 Management of Diabetes: Medications C. 糖尿病藥物如果控制飲食和運動仍然不能將血糖維持到正常的水平的話就需要服食藥物通常有口服藥丸注射胰島素或兩者結合的治療方法口服藥丸 ( 糖尿丸 ) 糖尿丸並不是胰島素因為胰島素不可能是丸狀若是丸狀則會經過胃部而會被胃酸破壞糖尿丸通過以下的方法將血糖降低刺激胰臟釋放更多胰島素減低肝部產生葡萄糖改善細胞對葡萄糖的吸收應用緩慢澱粉質類食物及糖份的消化及吸收阻止腎臟重吸收葡萄糖和增加尿液中葡萄糖的排泄服食糖尿丸的副作用有氣脹腹瀉尿道感染和低血糖記得詢問你的醫生或劑師甚麽時間服藥較為適宜以便減少副作用並學習如何處理低血糖 ( 請參閱低血糖症章節 ) 非胰島素注射性糖尿藥非胰島素注射性糖尿藥通過以下的方法將血糖降低 : 刺激胰臟胰島素分泌減慢胃的排空減低肝臟產生葡萄糖增加飽肚感覺這藥物需要在餐前皮下注射每天 1 至 4 次副作用包括有作悶嘔吐體重下降低血糖 ( 若同時採用胰島素 ) C. Diabetes Medications When diet and exercise are not enough to lower blood glucose to the desired levels, diabetes medications may be necessary. Oral diabetes pills, insulin injections, or a combination of both are used to control blood glucose. Oral Medications (diabetes pills) Diabetes pills are not insulin. Insulin does not come in pill form, because stomach acids can easily destroy insulin. They work to reduce blood glucose by: Stimulating the pancreas to release more insulin Reducing the amount of glucose produced by the liver Improving the use of glucose by the cells Slowing down the digestion and absorption of starches and sugar Blocking reabsorption of glucose by the kidneys and increasing elimination of glucose in the urine Side effects may include gas, diarrhea, urinary tract infection, and low blood sugar. Ask your doctor or pharmacist for the best time to take your medication in order to minimize side effects and learn how to treat low blood sugar (refer to section on treatment of low blood sugar). Non-insulin Injectable Diabetes Medications They work to reduce blood glucose by: Stimulating insulin secretion Slowing stomach emptying Reducing production of glucose by the liver Increasing feeling of fullness Injections are given under the skin before meals, between 1-4 times a day. Side effects may include nausea, vomiting, weight loss and low blood sugar (when given along with insulin).

14 40 41 控制糖尿病的方法 : 糖尿病藥物 Management of Diabetes: Medications 注射胰島素如果你的胰臟不能再產生足夠的胰島素又或者它在你的身體中起不到作用時你則需要注射胰島素根據每個人身體情況的不同需求胰島素可一天注射一次或數次注射部位最佳是腹部其次是上臂或大腿胰島素主要的副作用是低血糖懂得如何預防及處理低血糖是非常重要 ( 請參閱低血糖症章節 ) 如果你手部嘴唇面部舌頭有麻感言語不清或昏昏欲睡應立刻與醫生聯絡目前有不同類型的胰島素快效短效中效長效以及混合的幾種各種不同的胰島素合劑是根據其在身體上停留的時間長短以及生效的快慢而用來控制血糖何時吃東西吃甚麽東西以及注射胰島素的時間等對控制血糖均很重要因這些因素都可以幫助你身體維持正常的血糖度數以及防止低血糖的產生緊記遵從醫生指示在何時及如何注射胰島素, 以達到最佳效果胰島素吸入劑是一種在進餐前吸入的快效胰島素, 現時已批准使用請與你的醫生商討這選擇是否適合你 Insulin You will need to take insulin injection when your pancreas does not produce enough insulin to keep your blood glucose levels in a healthy range. Insulin shots are given one or more times a day depending on the person s need. The preferred injection site is the abdomen, followed by the upper arm or thigh. The major side effect of insulin is low blood sugar. It is important to know how to prevent and treat low blood sugar (refer to section on low blood sugar), Contact your doctor immediately if you begin to experience tingling in your hands, lips, face or tongue, slurred speech, or become extremely drowsy. There are different types of insulin: fast-acting, shortacting (regular), intermediate-acting, long-acting and premixed. Depending on how fast the insulin begins to work and how long it remains in your body, a combination of the different types of insulin is used to control blood glucose. When and what you eat as well as the timing of your insulin shots are important as they help to maintain a normal range of blood glucose and prevent low blood sugar. For best results, follow your doctor s instructions on when and how to give insulin injection. Inhaled insulin, a fast-acting insulin that you breathe in before meals, is currently available. Ask your doctor if this option is right for you.

15 42 Management of Diabetes: 43 控制糖尿病的方法 : 自我血糖測試 Blood Glucose Monitoring D. 自我血糖測試為甚麼我要測試血糖? 定時測試血糖可幫助你更好地護理你的糖尿病並可減低糖尿病併發症你可以在家中使用血糖測試機自我測試多久或何時測試血糖? 需要注射胰島素的一型糖尿病以及孕期糖尿病患者 - 每天至少測試三次二型糖尿病者 - 如果服用糖尿丸每天至少測試一次 - 如果注射胰島素在每次注射前測試測試時間空腹進餐之前或進餐之後兩小時其他測試時間 : - 運動之前運動之中或運動之後 - 當你感覺到血糖低症狀的時候 - 當你生病時你也可以在一天中更頻密地或在不同的時間内測試血糖以便了解你血糖上升或下降的情況 D. Blood Glucose (Sugar) Monitoring Why should I check my blood glucose? Checking your blood sugar regularly helps you to better manage your diabetes and reduce long-term complications from the disease. You can check it yourself with a blood glucose monitor (meter). How often and when should I check my own blood glucose? For type 1 diabetics and pregnant women on insulin: - at least 3 times a day For type 2 diabetics: - at least once a day if on oral medications - every time before insulin injection if on insulin Time to test - fasting, before meal, and/or 2 hours after meal Other times to test: - before, during, and/or after exercise - when you experience low blood sugar symptoms - when you are sick You may wish to check your blood glucose more often and at different times of the day to determine a pattern of your blood glucose readings.

16 44 Management of Diabetes: 45 控制糖尿病的方法 : 血糖, 血壓及血脂肪目標 Blood Glucose, Blood Pressure and Blood Lipid Goals 血糖目標空肚及進食之前 mg/dl 開始進餐之後两小時低於 180 mg/dl ( 最理想是 140 mg/dl 以下 ) 血糖血红素 (A1C) * 低於 7 % * 血糖血紅素檢驗是一種特別血液檢驗可測量過去三個月以來一個人的平均血糖度數這測驗是用來測量一段長時間内血糖的控制情況 A1C (%) 估計平均血糖 (mg/dl) 血壓目標正常目標低於 120/80 mmhg ** 低於 140/90 mmhg ** 有些資料顯示正常血壓應低於 115/75mmHg 血脂肪目標血脂肪目標 (mg/dl) 總膽固醇 (Total Cholesterol) 低於 200 壞膽固醇 (LDL) 低於 100 *** 好膽固醇 (HDL) 高於 40 男性高於 50 女性三脂甘油 (Triglyceride) 低於 150 *** 對患心血管疾病有高風險的病人其壞膽固醇之目標應低於 70mg/dl. 資料來源 : 美國糖尿病協會 (2015) Blood Glucose Goal Before Breakfast & Meals mg/dl 2 Hours after the start of a meal Less than 180 mg/dl (ideally less than 140 mg/dl) A1C Test* Less than 7 % * A1C test is a special blood test which reflects a person s average blood glucose over the past 3 months. It is a measure of long-term blood glucose control. A1C (%) Estimated average glucose (mg/dl) Blood Pressure Goal Normal Goal Less than 120/80 mmhg ** Less than 140/90 mmhg ** Some data suggests normal BP should be less than 115/75 mmhg Blood Lipid Goal Blood Lipid Goal (mg/dl) Total Cholesterol Less than 200 LDL (Bad Cholesterol) Less than 100 *** HDL (Good Cholesterol) More than 40 (Men) More than 50 (Women) Triglyceride Less than 150 *** For people with very high-risk cardiovascular disease, LDL goal is less than 70mg/dl Reference: American Diabetes Association (2015)

17 46 Management of Diabetes: 47 控制糖尿病的方法 : 血糖, 血壓及血脂肪目標 Blood Glucose, Blood Pressure and Blood Lipid Goals 綠色區域 : 控制良好血糖血紅素 (A1C) 低於 7 意味著您的平均血糖值低於 150 空腹血糖值介於之間進食兩小時之後的血糖值低於 180 採取行動 : 請繼續遵從醫生指示服用您的藥物請繼續定時測量您的血糖請遵循健康的飲食習慣請按時見您的醫生黃色區域 : 提醒 / 警示血糖血紅素 A1C 介於 7-9 之間意味著您的平均血糖值處於之間空腹血糖值低於 200 進食兩小時之後的血糖值高於 200 採取行動 : 適當地增加您的運動量請與您的家庭醫生密切跟進並和他 / 她討論是否有需要調整您的糖尿病治療法請咨詢註冊營養師或糖尿病教育師來幫助您更好地調理飲食和生活習慣紅色區域 : 停下來並思考血糖血紅素 A1C 超過 9 意味著您的平均血糖值高於 210 空腹血糖值連續兩天高於 200 進食兩小時之後的血糖值高於 250 空肚或隨機血糖值同一天內連續兩次測量都高於 300 採取行動 : 請立刻聯繫或致電您的家庭醫生!!! Green Zone: Great Control A1C under 7, which means average blood sugars under 150 Fasting blood sugars between 80 to130 2-hour blood sugars after meal under 180 Green Zone Actions: Continue taking your medications as prescribed Continue regular blood sugar monitoring Follow healthy eating habits Keep all doctor appointments Yellow Zone: Caution A1C between 7 and 9, which means average blood sugars between Fasting blood sugars under hour blood sugars after meal over 200 Yellow Zone Actions: Increase your activity level, as tolerated Follow up closely with your primary care provider to discuss any need to adjust your diabetes treatment Consult a registered dietitian and/or diabetes educator to work on diet and life style changes Red Zone: Stop and Think A1C greater than 9, which means average blood sugars over 210 Fasting blood sugars over 200 two days in a row 2-hour blood sugars after meal over 250 Fasting and/or random blood sugar is over 300 two times on the same day Red Zone Actions: CALL YOUR PRIMARY CARE PROVIDER IMMEDIATELY!!!

一般食品碳水化合物 ( 澱粉質及糖 ) 成份 Carbohydrate (Starch & Sugar) Content of Common Foods 糖尿病患者之碳水化合物建議進食份量 : For Diabetics Recommended Intake of Carbohydrate: 每餐

一般食品碳水化合物 ( 澱粉質及糖 ) 成份 Carbohydrate (Starch & Sugar) Content of Common Foods 糖尿病患者之碳水化合物建議進食份量 : For Diabetics Recommended Intake of Carbohydrate: 每餐 45 70 克 Per Meal 45 70 gm 小吃 20 40 克 Per Snack 20 40

16 17 控制糖尿病的方法 : 糖尿病飲食計劃 Management of Diabetes: Diabetic Meal Planning 6. 多選用低鈉質的調味品及配料 如芹菜 辣椒 蒜頭 薑 洋蔥 青椒 香菜 芫茜 胡椒 咖喱粉 五香粉 花椒 八角 醋和檸檬汁等 7. 可以選擇無糖飲品或食

16 17 控制糖尿病的方法 : 糖尿病飲食計劃 Management of Diabetes: Diabetic Meal Planning 6. 多選用低鈉質的調味品及配料如芹菜辣椒蒜頭薑洋蔥青椒香菜芫茜胡椒咖喱粉五香粉花椒八角醋和檸檬汁等 7. 可以選擇無糖飲品或食