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Figure 7.7. Food curve common, such as when pre-breakfast short-acting insulin peaks mid-morning after the BG-raising effects of breakfast have ended, and no snack has been eaten.

The last external cue chapter focuses on physical activity. The term 'physical activity' is used instead of 'exercise' to emphasize the fact that any significant change in metabolic demand can alter BG. This includes unanticipated increases in activity during routine tasks (e.g. housework, gardening, child care, running errands, shovelling snow), as well as scheduled physical exercise. These unanticipated, and often unnoticed, increases in routine activity are a common cause of hypoglycaemic episodes. Unnoticed decreases in activity can also be problematic, leading to hyperglycaemia if food intake remains the same. To increase awareness of physical activity, patients monitor the intensity of their daily activity levels, categorizing them as low, moderate or high in intensity. Patients learn to plot physical activity curves that graphically summarize changes in intensity throughout the day (see Figure 7.8). Curves are plotted for several days during the week to

High 6-10 METs

Medium 4-5 METs

Figure 7.8. Physical activity curve determine the extent to which activity varies from day to day, and for weekdays and weekends when schedules and activity levels often change. To complete external cue training, patients compare their insulin, food and physical activity curves to identify mismatches in these three basic aspects of diabetes management. Throughout external cue training, patients engage in an ongoing evaluation of how self-care behaviours contribute to mismatches in insulin, food and activity, and how they can change their behaviour to produce better matches and thereby avoid predictable BG extremes.

The purpose of the final chapter of BGAT is to provide patients with an opportunity to review what they have learned over the past weeks, receive positive reinforcement for completing training, and prepare to continue improving BG awareness on their own without the structure and support of the manual and weekly meetings. The chapter summarizes the most important didactic material from each chapter, and includes exercises requiring patients to reflect on what they have learned about themselves. Patients also review their Summary Sheet information from the past 7 weeks and evaluate their own symptoms, beliefs, accuracy and behavioural changes.

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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