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A diabetic diet recommended by your doctor and exercise are other key components of a type 1 diabetes treatment program discount ultram 200mg mastercard. Type 2 diabetes is treated first with weight reduction generic ultram 50 mg without prescription, a diabetic diet 200mg ultram for sale, and exercise. When these measures fail to control the elevated blood sugars, oral medications for type 2 diabetes are used. If oral diabetes medications are still insufficient, treatment with insulin is considered. The American Diabetes Association (ADA) guidelines for a diabetic diet call for a balanced, nutritious diet that is low in fat, cholesterol, and a small amount of simple sugars. The total daily calories are evenly divided into three meals. The other important treatments for diabetes are weight reduction and exercise. Nearly 6 million people in the United States have type 2 diabetes and do not know it. Diabetes symptoms can also be so mild that you might not even notice them. Some people have symptoms but do not suspect diabetes. Diabetic symptoms include:increased urination, especially at nightMany people do not find out they have the disease until they have diabetes complications, such as blurry vision or heart trouble. If you find out early that you have diabetes, then you can get treatment to prevent damage to your body. Anyone 45 years old or older should consider getting tested for diabetes. If you are 45 or older and overweight ?see the BMI (body mass index) chart (pdf)* ? getting tested is strongly recommended. If you are younger than 45, overweight, and have one or more of the risk factors, you should consider getting tested. Ask your doctor for a fasting blood glucose test or an oral glucose tolerance test. Your doctor will tell you if you have normal blood glucose, pre-diabetes, or diabetes. Pre-diabetes means your blood glucose is higher than normal but lower than the diabetes range. In 2007, at least 57 million American adults had pre-diabetes. Having pre-diabetes also means you are at risk for getting type 2 diabetes and heart disease. However, you can reduce the risk of getting diabetes and even return to normal blood glucose levels with modest weight loss through healthy eating and moderate physical activity. If you are told you have pre-diabetes, have your blood glucose checked again in 1 to 2 years. Physical activity, exercise, is a key tool for managing diabetes. Diabetes means your blood glucose, also called blood sugar, is too high. But having too much glucose in your blood can hurt you. A major Government study, the Diabetes Prevention Program (DPP), showed that modest weight loss of 5 to 7 percent?for example, 10 to 15 pounds for a 200-pound person?can delay and possibly prevent type 2 diabetes. People in the study used diet and exercise to lose weight. For more information about the study, read: Diabetes Prevention Program. Or call the National Diabetes Information Clearinghouse at 1-800-860-8747 to request a printed copy. You canbe extra active every dayBeing extra active can increase the number of calories you burn. Try these ways to be extra active, or think of other things you can do. Get up to change the TV channel instead of using the remote control. For example, make two trips to take the laundry downstairs instead of one. Park at the far end of the shopping center parking lot and walk to the store. At work, walk over to see a co-worker instead of calling or emailing. Stretch or walk around instead of taking a coffee break and eating. During your lunch break, walk to the post office or do other errands. Aerobic exercise is activity that requires the use of large muscles and makes your heart beat faster.

The Bible teaches that sex outside of marriage is sin ultram 100mg low price. Wendell Cotton purchase 100mg ultram, 82 order ultram 50mg without prescription, and Lurline Cotton, 83, of Garland, TX, have gotten to know each other well after 61 years of marriage. The parents of two know firsthand and wholeheartedly agree that committed couples have better sex. The "honesty of the situation" makes committed couples have better sex than singles, believes Dr. You should innately know what the other desires and what is good for each other. Tiy-E says that committed and married couples will have better sex because you perform at your best if you are in your comfort zone. You give a woman a commitment and you have great sex for as long as the man does right by his beloved woman"Some may believe that single people have better sex, because there is no commitment and there can be variety. And loneliness is exactly what you get when your sex partner leaves you in the bed after a sexual session... Even if a man claims to be a big-time ladies man, he still goes to bed at the end of the night feeling lonely. Every man and woman wants someone whom they can trust, respect and please every day, not just for an occasional booty call. At that time, virtually nothing was known about the virus that causes the disease, and there was little that clinicians could do to slow its inevitable progression to AIDS, then death. A lot has changed since then, and though there is still no cure for HIV, the HIV virus can often be controlled now with medications. But adhering to an HIV drug regimen can pose tremendous challenges. Missing just two drug doses can result in increased levels of virus in the body, or resistance to the drug, derailing their effectiveness. Maintaining HIV control requires a near perfect score in drug adherence. But, some drug regimens for HIV are hard to stick to, to say the least. Some require upwards of 20 pills per day, pills that must be refrigerated or taken at particular times during the day or pills that must be taken with or without food. For patients looking for that "perfect score", the level of difficulty is high. Susan Ball, Associate Professor at the Weill Cornell College of Medicine, talks about the importance of drug compliance in HIV treatment, and some of the issues HIV patients struggle with on a daily basis. How do drug manufacturers determine the timing and dosing of HIV medications? Drug companies arrive at drug dosing by trying to inhibit the virus for the longest amount of time in the body, with the lowest drug levels in the blood. As a result, the drug needs to be given more frequently. They work to reduce the concentration of the drug needed so that they can minimize side effects. Often when a drug first comes to market, it will be in a form that is difficult to take: either multiple pills per day, or by injection only, or it will have side effects that make it unpleasant, if not intolerable. AZT, for instance, was one of the earlier HIV drugs, and had to be taken every four hours. Norvir, a protease inhibitor, used to be offered in doses that made most patients too nauseated to tolerate it. Manufacturers try to make the drugs more and more palatable in terms of reducing the number of pills, the side effect profile, and the number of times a day that you have to take a medication. The drugs are carefully dosed to maintain blood levels that will suppress the virus. But if a person does not take the prescribed dosage, the drug level can fall and there will not be enough concentration of the drug to inhibit the virus. The virus can "escape", which means that some virus can replicate, even though there is drug there. In patients who skip one dose, and take the dose several hours or a day late, the drug level will drop, but the situation may be manageable. You may be able to get your drug levels back up to where they should be, so the virus is inhibited again and the replication levels are below detection. Suddenly the viral load will be elevated and detectable in the blood, and virus that is resistant to the drug will be replicating. How carefully must one adhere to a drug regimen to avoid resistance? Approximately 95% of the drug doses need to be taken to prevent resistance. Patients have to be very strict about taking their medication. Are there any immediate physical signs related to a missed dose? So there is not that physical illness reminder that helps them remember their medicine. And many patients will say they just feel better without being on a medicine. There is a lot of talk about structured treatment interruption or patients taking "a drug holiday.

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Victimhood is often learned from the way parents treat their children and sometimes it happens later in life trusted ultram 50mg. David: What draws these individuals into abusive relationships? Often these folks feel fearful and insecure order 100mg ultram fast delivery, and find a mate who can give them answers or take charge safe ultram 200mg, not knowing the extent of the taking charge. In the cycle of abuse, one form of abuse is self-abuse. One form of self-abuse is being paired with a perpetrator. David: Just to clarify here, what is your definition of an abusive relationship? Psychologically, what does it take for an individual to break out of an abusive situation? They need to make some personal, internal changes, to increase self-esteem. Some people need professional help and support to make the change. Then they need to take action in the most expedient manner possible. Shelters offer protection and allow the abused person to hide from their abuser. In some situations, it presents a practical problem, in that someone with a career may need to drop out of their job and economic support when making this change. Sometimes it is best to call the police and have the abuser physically removed, then take out a restraining order. Bein: A typical pattern is for the abuser to "see the light" after perpetrating the abuse. Often they are just as trapped in the cycle of abuse, as is the abused (not that this excuses them). I think it is more difficult for the abuser to change, and would need more professional help than it is for the abused to change. One can receive counseling at a shelter, even if they are not ready to go there to live. Abusers are usually cowards when they come up against someone more powerful. The domestic abuse builds them up, just for a moment, then they feel even worse about themselves because of what they have done. David: One of our audience members, NYMom, is being abused by her son. She says he has punched her several times and given her a black eye. Bein: She should call in the authorities, and make them do their job. This has to stop as soon as possible, or it will get worse. The authorities can and must deal with the medical issues. I feel like he throws the line out and reels me in repeatedly. However, this niceness only lasts no more than three to four days. Once he thinks he has me back, he turns into the monster again. I want to get out of this, without having to hear the begging and crying from him that he is sorry and will never do it again. Bein: If you are really ready to assert your rights, then I suggest that you call the police when he hurts you, then get a restraining order. If you feel that you would be in danger, then go to a shelter. However, you have to stay tough, and not back down when he is nice, and goes through the "roses" phase. It may be wise to seek professional help for this one. Recently, I was assaulted by a stranger and I want to know how these people find me. I must first say, Lumpyso, that it is not your fault! This may be your body posture, closing yourself in front with your arms, the way you look at someone, or other non-intentional ways that you show you are powerless, however, this is correctable! David: By the way, Lumpyso, and everyone else here tonight, we had a great conference on just that subject -- why those who have been abused are open to re-abuse and what to do about it. The transcript is from our conference on " The Damage Caused by Sexual Abuse. I found out after my husband died, that he was a child sexual abuser.

Here is how the conversation went at the start of their first meeting discount 100mg ultram visa. Through tremendous hard work buy ultram 200 mg cheap, he pulled himself out of poverty and is now quite wealthy cheap ultram 100 mg overnight delivery. But all his life, he maintained the same work ethic that delivered him from poverty. He has a new car, a pocket full of credit cards and anything that he wants, he can buy. So the father, even on his days off, gets up early and is always doing something. Finally, he goes to his son and tries to get him out of bed. The father was trying to convey to his son a message. Some state laws cite mental illness as a condition that can lead to loss of custody or parental rights. Thus, parents with mental illness often avoid seeking mental health services for fear of losing custody of their children. Custody loss rates for parents with mental illness range as high as 70-80 percent, and a higher proportion of parents with serious mental illnesses lose custody of their children than parents without mental illness. Studies that have investigated this issue report that:Only one-third of children with a parent who has a serious mental illness are being raised by that parent. In New York, 16 percent of the families involved in the foster care system and 21 percent of those receiving family preservation services include a parent with a mental illness. Grandparents and other relatives are the most frequent caretakers if a parent is psychiatrically hospitalized, however other possible placements include voluntary or involuntary placement in foster care. A research study found that nearly 25 percent of caseworkers had filed reports of suspected child abuse or neglect concerning their clients. If mental illness prevents a parent from protecting their child from harmful situations, the likelihood of losing custody is drastically increased. All people have the right to bear and raise children without government interference. Governments may intervene in family life in order to protect children from abuse or neglect, imminent danger or perceived imminent danger. When parents are not able, either alone or with support, to provide the necessary care and protection for their child, the state may remove the child from the home and provide substitute care. The Federal Adoption and Safe Families Act, Public Law 105-89 (ASFA) was signed into law November 19, 1997. This legislation is the first substantive change in federal child welfare law since the Adoption Assistance and Child Welfare Act of 1980, Public Law 96-272. It requires that state child welfare agencies make "reasonable efforts" to prevent the unnecessary placement of children in foster care and to provide services necessary to reunify children in foster care with their families. While ASFA is designed to protect children, it also includes provisions pertaining to parental rights. For example, under ASFA, parents have the right to receive supports and services to help them retain custody and keep their families intact. The child welfare system must provide these services according to an individualized plan that has been developed and agreed upon by all parties to ensure parents with mental illnesses are not discriminated against due to their illness. A plan with parental input also helps ensure that, when appropriate, efforts are made by state welfare agencies to promote family permanency, including establishing whether children in foster care can be moved into a permanent living situation. Parental mental illness alone can cause strain on a family; parental mental illness combined with parental custody fears can cause even greater strain. Such strain, as well as the lack of specialized services for families in the child welfare system and the overall stigma associated with mental illness, makes it difficult for families to get the help they need. With the right services and supports though, many families can stay together and thrive. The following efforts by advocates can help families living with mental illness maintain custody and stay intact:Help parents become educated about their rights and obtain legal assistance and informationAdvocate for parents as services plans are developed, and assist adult consumers to develop their own self-care plans and advance directives to strengthen their parenting skills and manage their own illnessEnable parent-child visitation during psychiatric hospitalization to maintain the bond between parent and childTrain child protective services workers to better understand parental mental illnessEducate the legal system about advances in the treatment of serious mental illnessAdvocate for increased specialized services for parents with serious mental illnesses available through the court systemNetwork practical tools for changing environment. Making the Invisible Visible: Parents with Psychiatric Disabilities. National Technical Assistance Center for State Mental Health Planning. Special Issue Parents with Psychiatric Disabilities. Joanne Nicholson, Elaine Sweeny, and Jeffrey Geller. This fact sheet is made possible through an unrestricted educational grant from The E. He probably idolizes everything you do -- dressing up in your clothes, imitating the way you read the paper or the way you stand when you talk. He tries to do everything you do and works hard to make sure he has your attention and your approval. And if you are a dad whose son has gotten a bit older, you can stop for a moment and smile when you recollect those special days with your young son. As time goes by, though, your son gets older and your relationship changes.

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While this is still a viable (if frustratingly slow) tactic cheap ultram 200 mg with amex, psychiatrists are relying more and more on secondary generic ultram 50 mg mastercard, and even tertiary order ultram 100 mg, drugs to boost the primary player. One of those booster drugs is Cytomel, a thyroid stimulator. About 50 percent of the time, it helps the primary drug work more effectively. Other popular booster medications are lithium (Eskalith) and Ritalin (Methylphenidate). Scientists have spent years and years investigating chemicals like serotonin and their effects on mood, while neglecting to study brain chemicals still more common, and abundant, like estrogen and progesterone. He believes many women become depressed either because they have a measurable imbalance of estrogen and progesterone or because their brains are too sensitively tuned to normal fluctuations. For women with agitated depressions that make them nervous and jumpy, Herzog might prescribe progesterone to calm with a bit of estrogen to brighten, in the form of a cream the woman rubs into her skin. Hormone treatment for depression requires that you see a knowledgeable neuroendocrinologist and that you undergo a hormone profile, having your levels of progesterone and estrogen measured at the beginning and end of the month. The vagal nerve connects your brain stem with your upper body, specifically your lungs, heart and stomach. The nerve is a critical conduit for relaying information to and from your central nervous system, carrying electrochemical signals up its tubing and depositing them directly into your cortex. Some years ago, researchers began implanting a small pacemaker into the vagal nerves of epileptics to see if tiny pulses might help stop the seizures. The pacemakers did indeed reduce or eliminate seizures in some epileptics, but they did something else, as well, something surprising and critical. Some doctors hypothesize that vagal-nerve stimulation (VNS) instigates changes in norepinephrine and serotonin, two neurotransmitters closely associated with mood. They implanted the pacemakers into those people and, over a two-week period, gradually increased the amount of stimulation current to levels the patients could tolerate comfortably. Forty percent of these patients showed a substantial decrease in depression as measured by a verbal test asking them about their thoughts and feelings; 17 percent had a complete remission. After one year of VNS, more than 90 percent of the patients who benefited from the initial treatment continued to show a decrease in depression. Transcranial magnetic stimulation (TMS) may someday replace electroconvulsive therapy (ECT) altogether. In TMS, an electrical current passes through a handheld wire coil that a doctor then moves over your scalp. The electrical current makes a powerful magnetic pulse, which passes straight through your scalp and stimulates nerve cells in the brain. TMS is in part remarkable because of its specificity. Researchers now believe they can target brain structures that they know are involved in the creation and maintenance of depression and anxiety. Although TMS is still considered an experimental form of treatment, various hospitals and clinics offer it. Within five to ten years, TMS may become a common form of treatment for people with depression. The next few decades will bring as-yet-unheard-of kinds of cures, for us, for our children and so on down the line. Bernie Zilbergeld discussed the concept of "conditions," or requirements, for enjoyable sex. If you are troubled by what it takes to make you feel comfortable, discuss it with a close friend or a professional. Everyone has conditions under which they can enjoy sex, which I believe can be divided into three categories: those concerning ourselves, concerning our partner, and concerning the erotic environment. Get to know your conditions for functioning sexually, then ask yourself: Do your conditions fit your values? If you need a lot of time to feel connected and relax, and your partner is impulsive, it will be hard for both of you to feel comfortable at the same time. Similarly, if you enjoy lots of gentle words, but your partner likes to talk nasty, it may be hard to create an environment you both like. Many couples in such situations, unfortunately, argue about which of them is "unreasonable," "uptight" or "kinky. They may interpret their conditions in new ways: playing music or wearing a blindfold during sex, for example, can give a sense of privacy. Similarly, if feeling clean is an issue, have your partner stroke your genitals with a warm, damp towel, which will enhance the erotic climate, rather than detract from it. Remember, though, that the issue is not for you to have "normal" conditions, or the same conditions as your partner. Ultimately, you want to be able to have sex that celebrates who you are, whatever partnership you are in, and that enhances your life. He has written for national magazines and appeared on many TV shows, including Donahue, Sally Jessy Raphael and Jenny Jones. You can read more about his books, tapes and appearances on his Web site, SexEd. Imagine being in a situation where you are terrified you will die. That is the level of intensity experienced by people who have a panic attack. Unfortunately, that excessive worry may actually create a panic attack and the situation becomes a self-fulfilling prophecy. As you might guess, the list of places to avoid starts to get pretty long.

The blood glucose then rises gradually and by the 24hour has usually returned to pretest levels ultram 50mg otc. The magnitude of the reduction order 50 mg ultram amex, when expressed in terms of percent of the pretest blood glucose buy discount ultram 200mg line, tends to be similar to the response seen in the nondiabetic subject. Tolbutamide tablets are indicated as an adjunct to diet to lower the blood glucose in patients with non-insulin-dependent diabetes mellitus (type II) whose hyperglycemia cannot be controlled by diet alone. In initiating treatment for non-insulin-dependent diabetes, diet should be emphasized as the primary form of treatment. Caloric restriction and weight loss are essential in the obese diabetic patient. Proper dietary management alone may be effective in controlling the blood glucose and symptoms of hyperglycemia. The importance of regular physical activity should also be stressed, and cardiovascular risk factors should be identified and corrective measures taken where possible. If this treatment program fails to reduce symptoms and/or blood glucose, the use of an oral sulfonylurea or insulin should be considered. Use of Tolbutamide tablets must be viewed by both the physician and patient as a treatment in addition to diet, and not as a substitute for diet or as a convenient mechanism for avoiding dietary restraint. Furthermore, loss of blood glucose control on diet alone may be transient, thus requiring only short-term administration of Tolbutamide tablets. During maintenance programs, Tolbutamide tablets should be discontinued if satisfactory lowering of blood glucose is no longer achieved. Judgments should be based on regular clinical and laboratory evaluations. In considering the use of Tolbutamide tablets in asymptomatic patients, it should be recognized that controlling the blood glucose in non-insulin dependent diabetes has not been definitely established to be effective in preventing the long-term cardiovascular or neural complications of diabetes. Tolbutamide tablets are contraindicated in patients with:1. The administration of oral hypoglycemic drugs has been reported to be associated with increased cardiovascular mortality as compared to treatment with diet alone or diet plus insulin. This warning is based on the study conducted by the University Group Diabetes Program (UGDP), a long-term prospective clinical trial designed to evaluate the effectiveness of glucose-lowering drugs in preventing or delaying vascular complications in patients with non-insulin-dependent diabetes. The study involved 823 patients who were randomly assigned to one of four treatment groups (Diabetes, 19 (supp. UGDP reported that patients treated for 5 to 8 years with diet plus a fixed dose of Tolbutamide (1. A significant increase in total mortality was not observed, but the use of Tolbutamide was discontinued based on the increase in cardiovascular mortality, thus limiting the opportunity for the study to show an increase in overall mortality. Despite controversy regarding the interpretation of these results, the findings of the UGDP study provide an adequate basis for this warning. The patient should be informed of the potential risks and advantages of Tolbutamide and of alternative modes of therapy. Although only one drug in the sulfonylurea class (Tolbutamide) was included in this study, it is prudent from a safety standpoint to consider that this warning may also apply to other oral hypoglycemic drugs in this class, in view of their close similarities in mode of action and chemical structure. All sulfonylurea drugs are capable of producing severe hypoglycemia. Proper patient selection, dosage, and instructions are important to avoid hypoglycemic episodes. Renal or hepatic insufficiency may cause elevated blood levels of Tolbutamide and the latter may also diminish gluconeogenic capacity, both of which increase the risk of serious hypoglycemic reactions. Elderly, debilitated or malnourished patients, and those with adrenal or pituitary insufficiency are particularly susceptible to the hypoglycemic action of glucose-lowering drugs. Hypoglycemia may be difficult to recognize in the elderly, and in people who are taking beta-adrenergic blocking drugs. Hypoglycemia is more likely to occur when caloric intake is deficient, after severe or prolonged exercise, when alcohol is ingested, or when more than one glucose-lowering drug is used. When a patient stabilized on any diabetic regimen is exposed to stress such as fever, trauma, infection, or surgery, a loss of control may occur. At such times, it may be necessary to discontinue Tolbutamide and administer insulin. The effectiveness of any oral hypoglycemic drug, including Tolbutamide, in lowering blood glucose to a desired level decreases in many patients over a period of time, which may be due to progression of the severity of the diabetes or to diminished responsiveness to the drug. This phenomenon is known as a secondary failure, to distinguish it from primary failure in which the drug is ineffective in an individual patient when first given. Adequate adjustment of dose and adherence to diet should be assessed before classifying a patient as a secondary failure. Treatment of patients with glucose 6-phosphate dehydrogenase (G6PD) deficiency with sulfonylurea agents can lead to hemolytic anemia. Because Tolbutamide belongs to the class of sulfonylurea agents, caution should be used in patients with G6PD deficiency and a non-sulfonylurea alternative should be considered. In post-marketing reports, hemolytic anemia has also been reported in patients who did not have known G6PD deficiency. Patients should be informed of the potential risks and advantages of Tolbutamide and of alternative modes of therapy. They should also be informed about the importance of adherence to dietary instructions, of a regular exercise program, and of regular testing of urine and/or blood glucose. Blood and urine glucose should be monitored periodically. Measurement of glycosylated hemoglobin may be useful. A metabolite of Tolbutamide in urine may give a false positive reaction for albumin if measured by the acidification-after-boiling test, which causes the metabolite to precipitate. There is no interference with the sulfosalicylic acid test.

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Generic Name: pramlintide (PRAM-lin-tyd) acetate (ASS-ih-tayt)Symlin helps keep your blood glucose from going too high after you eat buy 200 mg ultram, a common problem in people with diabetes buy ultram 50 mg otc. It works by helping food move more slowly through your stomach discount ultram 100mg free shipping. Symlin helps keep your liver from putting stored glucose into your blood. It also may prevent hunger, helping you eat less and maybe lose weight. However, you should always use a separate syringe to inject Symlin. But taking Symlin may change the amount of insulin you take. There may be times when you should not take your usual dose of Symlin. But your risk of having low blood glucose is higher because Symlin is always taken along with insulin. You can take good care of yourself and your diabetes by learningMaking wise food choices can help youlose weight if you need tolower your risk for heart disease, stroke, and other problems caused by diabetesHealthful eating helps keep your blood glucose, also called blood sugar, in your target range. Physical activity and, if needed, diabetes medicines also help. The diabetes target range is the blood glucose level suggested by diabetes experts for good health. You can help prevent health problems by keeping your blood glucose levels on target. Target Blood Glucose Levels for People with DiabetesTalk with your health care provider about your blood glucose target levels and write them here:Ask your doctor how often you should check your blood glucose on your own. Also ask your doctor for an A1C test at least twice a year. Your A1C number gives your average blood glucose for the past 3 months. The results from your blood glucose checks and your A1C test will tell you whether your diabetes care plan is working. You can keep your blood glucose levels on target by:making wise food choicestaking medicines if neededFor people taking certain diabetes medicines, following a schedule for meals, snacks, and physical activity is best. However, some diabetes medicines allow for more flexibility. Talk with your doctor or diabetes teacher about how many meals and snacks to eat each day. Fill in the times for your meals and snacks on these clocks. What you eat and when you eat affect how your diabetes medicines work. Talk with your doctor or diabetes teacher about when to take your diabetes medicines. Fill in the names of your diabetes medicines, when to take them, and how much to take. Draw hands on the clocks to show when to take your medicines. What you eat and when also depend on how much you exercise. Physical activity is an important part of staying healthy and controlling your blood glucose. Keep these points in mind:Talk with your doctor about what types of exercise are safe for you. Make sure your shoes fit well and your socks stay clean and dry. Check your feet for redness or sores after exercising. Call your doctor if you have sores that do not heal. Warm up and stretch for 5 to 10 minutes before you exercise. Then cool down for several minutes after you exercise. For example, walk slowly at first, stretch, and then walk faster. Ask your doctor whether you should exercise if your blood glucose level is high. Ask your doctor whether you should have a snack before you exercise. Know the signs of low blood glucose, also called hypoglycemia. Always carry food or glucose tablets to treat low blood glucose. Always wear your medical identification or other ID. Many people find they are more likely to do something active if a friend joins them. Low blood glucose can make you feel shaky, weak, confused, irritable, hungry, or tired. If you have these symptoms, check your blood glucose.