Diabetes

When you have diabetes, your body cannot properly use the energy from the food you eat. This problem is closely tied to how your body makes and uses insulin. Insulin is a hormone made in your pancreas that helps to keep your blood sugar in the normal range.

Type 1 diabetes is when your body makes little or no insulin. What was once known as “juvenile diabetes”, is now being diagnosed in individuals of all ages. It is an autoimmune disease.

Type 2 diabetes is when your body makes insulin, but your cells cannot use it well. This is called insulin resistance. Over time, your ability to make insulin gradually decreases. This is called insulin deficiency.

If you have any of the risk factors or have signs and symptoms of diabetes, you may want to talk to your doctor. 

The diagnostic criteria include:
• A fasting blood glucose of 126 mg/dL or higher on 2 separate occasions
• An A1c (blood test) of above or equal to 6.5%
• A random blood glucose of above 200mg/dL with symptoms

(Type 1) 

At this time, no one knows the exact cause of type 1 diabetes. But it is related to:
• A family history of type 1 diabetes
• A problem with the body’s defense (immune) system that causes it to destroy the insulin-making cells in the pancreas

(Type 2)

• Being overweight
• Age 40 or older
• Physical inactivity
• A family history of diabetes
• Having given birth to a baby weighing over 9 pounds
• Having stress, injury, or illness
• Being African American, Hispanic/Latino American, American Indian, Asian American, or Pacific Islander
• High blood pressure
• Low HDL cholesterol and/ or high triglycerides
• Agent Orange exposure is an associated risk factor, according to the Veteran’s Administration

• Increased thirst
• Excessive urination
• Feeling very tired
• Increased hunger
• Sudden weight loss
• Blurred vision
• Dry itchy skin
• Frequent infections
• Slow healing of cuts or sores
• Sexual problems
• Numbness or tingling in hands or feet

You are still able to eat all foods, however moderation and portion sizes are key. When it comes to diabetes, foods that contain carbohydrates (carbs) are what affect blood glucose. A common misconception is that you need to eliminate or stay away from carbs. The truth is our body runs off of carbs, and so it is important to know appropriate portion sizes and keep intake consistent throughout the day. Foods that contain carbs include: 

• grains (bread, cereals, pancakes, pasta, rice)
• starchy vegetables (beans, corn, peas, potatoes), 
• fruits (and/or fruit juice), 
• milk (cow’s milk and yogurt)
• sweets/snacks (cake, cookies, brownies, ice cream, chips, crackers, soda, sweet tea, etc.). 

To eat a well-balanced diet, it is also recommended to include vegetables, fruits, whole grains, low-fat dairy, lean proteins, and heart-healthy fats. 

For more specific guidelines, please consider meeting individually with one of our dietitians for Medical Nutrition Therapy.

Yes! There are eight artificial sweeteners, also known as low-calorie sweeteners or sugar substitutes that are either approved by the U.S. Food and Drug Administration (FDA) or on the Generally Recognized as Safe (GRAS) list. Many scientific studies have found these sweeteners to be safe to eat. For people with diabetes, they can be used to help satisfy your “sweet tooth” without having an impact on your blood glucose or adding additional calories. Choosing “diet” soda in place of regular soda or sweetening unsweetened tea with a pink, yellow, blue or green packet may help improve your blood glucose levels.

Checking your blood sugar is an important part of your diabetes self-management. 

Checking often will let you know:

• If your diabetes medications are working
• How physical activity affects your blood sugar
• How the food you eat affects your blood sugar
• How life, stress or illness affect your blood sugar

What affects my blood glucose?

• Activity—usually decreases 
• Food—increases
• Stress/illness—usually increases
• Medications—depends, diabetes medications should decrease but other medications may increase

It is suggested that blood glucose ranges be individualized based on your needs and diabetes control. Your doctor may consider certain variables when choosing your target range such as:

• How long you have had diabetes
• Your age, older individuals often have less stringent ranges
• Frequent episodes of low blood sugars, called hypoglycemia
• Your level of diabetes related health complications
• Personal lifestyle factors and goals

The American Diabetes Association provides people with diabetes suggested targets for blood glucose testing if your doctor has not suggested a different target. Check with your doctor to verify these targets are appropriate for your best blood sugars control and lower risk of diabetes related complications.

A low blood glucose number, usually less than 70 mg/dl, can make you feel bad. This reaction is called hypoglycemia, or low blood glucose. When you are becoming hypoglycemic, common symptoms include:

• Shakiness
• Dizziness
• Sweating, even when not overheated
• Headache
• Hunger
• Irritability or moodiness
• Confusion
• Tingling sensations around the mouth
• Seizures, if blood glucose level is extremely low

How do I treat a low blood sugar reaction or hypoglycemia? The fastest way to raise blood glucose levels is to eat sugar or another form of quickly absorbed carbohydrates. It is advised when you are diagnosed with diabetes to carry glucose tablets with you at all times. You never can predict when a low blood glucose level may occur. Glucose tablets can be purchased at drug stores or supermarkets that carry diabetes supplies.

A simple and easy rule to remember to treat a low blood sugar reaction is The Rule of 15 in 3 easy steps:
Step 1: If you are feeling symptoms of hypoglycemia, test your blood sugar level.

Step 2: If your blood sugar is below 70 mg/dl or you have multiple symptoms of hypoglycemia, eat about 15 grams of sugar or carbohydrates such as 3-4 glucose tablets, 4 ounces fruit juice, or regular soda, 4 teaspoons of sugar, 1 tablespoon of honey, or 3-5 hard candies. Stick with choices that are mostly sugar, avoiding foods with a high fat content like chocolate or cookies, which do not work as quickly to raise blood sugars to normal again.

Step 3: Wait 15 minutes, and retest your blood sugar level. If your blood sugars are still low, repeat step 2, and retest your blood sugar again in 15 additional minutes. Once levels have returned to a normal range, consider eating a small snack if no meal is planned in the next 1-2 hours.

If your hypoglycemia continues to get worse, you could become confused or pass out. Seek immediate medical attention for any worsening symptoms of hypoglycemia by calling 911 or be taken to the nearest emergency room. You may also use an injectable alternative called glucagon available by prescription from your doctor. Glucagon is an injectable hormone that works on the liver to raise blood glucose levels.

It is the medical term used when blood sugars levels go too high. Hyperglycemia can often happen when the pancreas does not make enough insulin or insulin does not work properly. Blood sugars levels may also rise too high in response to poor dietary choices, forgetting to take diabetes medications, or due to illness or excessive stress.

• Common signs of hyperglycemia include:
• Frequent urination
• Extreme thirst
• Increased hunger
• Dry, itchy skin
• Increased drowsiness or lethargy
• Slow to heal wounds
• Blurry vision
• High levels of sugar in the urine

If you are experiencing any of the symptoms and have not been diagnosed with diabetes, visit your doctor to determine if they are related to undiagnosed diabetes. If you are diabetic and having signs/symptoms of hyperglycemia, test your blood sugar level using a blood glucose meter. If your level is significantly outside of your normal range, call your doctor, and drink plenty of water.

.High blood sugar values may be related to a lifestyle factor that is within your control such as food choices and portions, missed diabetes medication, or lack of exercise. Cutting down of food volumes of high carbohydrate foods may help. Talk with a dietitian to make changes in your food choices. Work with your diabetes educator or support people around you to help to remember to take your medication as ordered by your doctor. Or consider exercise as another alternative to help lower blood sugars. 

It is advised by the American Diabetes Association to check your blood sugars before exercise. If your blood glucose level is above 240 mg/dl, check your urine for ketones using urine strips you can obtain by prescription from your doctor. If ketones are present in your urine, DO NOT EXERCISE. Exercise may make your blood glucose level go higher if ketones are present in your urine. Talk to your doctor about the safest way to lower your blood glucose level, potentially by changes to your medication or they may advise going to your nearest emergency room.

Ketones are chemicals made by the liver. They are produced when you don’t have enough insulin in your body to turn sugar into energy. If ketones are present in your urine, it can be a sign that the body is breaking down fat stores for energy instead of sugars/glucose due to the lack of insulin.

Get a sample of urine in a clean container. Put a ketone test strip (available by prescription from your doctor) in the urine sample. Follow the directions on the container of ketone strips, typically waiting for the strip pads to change color. Compare the strip to the color chart on the side of the strip container for the range of ketones in your urine.

Moderate to larger amounts of ketones present in the urine can be a danger sign in a person with diabetes. High levels of ketones can cause an imbalance in blood that alters body chemistry and affects how the body functions. Typically high levels of ketones in the urine is a sign that diabetes is out of control. Talk to your doctor as soon as possible about your results for guidance on managing your diabetes.

Any of these warning signs can be an indication or cause high ketone levels:

• When blood glucose is greater than 250-300 mg/dl
• You are sick with cold or flu, have uncontrolled nausea or vomiting
• You have difficulty breathing
• Your breath has a “fruity” odor
• Confusion or disorientation

Diet and exercise alone may not be enough to help keep your blood glucose level in your target range. Medication may be the next step to get better control over your diabetes to prevent long-term health problems related to poorly controlled diabetes. Diabetes medications can be a pill, injecting insulin or wearing an insulin pump. The best type of diabetes medication for you should be determined by a doctor who can evaluate blood sugar control and lifestyle factors.

Many people can control their diabetes with oral pill(s), without the use of injectable forms of insulin. People with type 1 diabetes typically have to depend on injectable insulin to control their diabetes. Diabetes pills often work well for individuals with type 2 diabetes, but may lose their effectiveness or stop working over years of having diabetes. You may need more than one type of oral diabetes medication or a combination of oral pills and insulin to best control blood sugars.

There are many different types of oral diabetic pills to choose from, so talk to your doctor about options that can work best for you. Talk to your pharmacist or doctor about when to take your medication, considering your meal plan, exercise patterns and lifestyle.

Insulin can be an effective way to get tight control of blood sugars and can be dosed based on food intake. Insulin is not a pill. It is delivered by injection using an insulin needle or pen device. Insulin is available in different types based on the length of time it takes to reach the bloodstream, when the strength peaks and how long it continues to work in minutes or hours.

Rapid-acting – begins to work about 5 minutes after it is injected, peaks at about 1 hour and full action is lost after about 2-4 hours.

Regular or short-acting – takes about 30 minutes to begin working, peaks at about 2-3 hours and last for about 3-6 hours

Intermediate-acting – reaches the bloodstream in about 2-4 hours, peaks 4-12 hours and last for 12-18 hours

Long-acting – takes 6-10 hours to reach bloodstream and lasts for 20-24 hours

Insulin types can be mixed to optimize peak and duration for better blood sugar control. Mixed insulins are available pre-mixed by the manufacturer. Talk to your doctor or pharmacist for more specific information how insulin can help better control your diabetes. If you are already on insulin, be sure to talk with your doctor or pharmacist about correct dosages, administration, and timing of insulin with meals to get the best control of blood sugars.

An insulin pump is a small external device that is linked to a catheter placed below the skin to deliver insulin to help eliminate the need for multiple daily injections using a syringe or insulin pen. An insulin pump allows you more freedom to adjust your insulin based on your lifestyle. Insulin can be delivered 24 hours a day, set at different rates throughout the day, based on time of meals, activity levels, sleep schedules and work schedules.

Advantages of using an insulin pump include eliminating daily insulin injections, increased flexibility in what you can eat, reduction in extremes in blood glucose, and often improved A1C or average blood glucose levels. There are a few disadvantages to using an insulin pump–they can be expensive if not covered by your insurance, there is a potential for weight gain, and there is a need for extended training on use and care of the pump. 

Talk with your doctor and/or diabetes educator to see if an insulin pump would work for you.

• Follow manufacturer guidelines for storage of your insulin.
• Do not store insulin in extreme heat such as sunlight or cold such as in the freezer.
• Always check the expiration date. DO NOT use if past the marked date.
• Visually check the bottle or pen contents to make sure it looks normal before use.
• Store unused bottles of insulin or insulin pens in the refrigerator.
• Many manufacturers recommend keeping the insulin bottle or pen currently in use at room temperature to help reduce pain during injection due to being cold. Most insulin will last approximately a month at room temperature, but check with your pharmacist because it can vary depending on the type of insulin.

• With an insulin syringe, if you can do it safely, clip the needles off with a needle clipping device to prevent anyone else from using the syringe. Do not use scissors.
• Or put the entire insulin syringe, pen needle that you have unscrewed from the top of the pen, or lancet into a medical grade waste container. A heavy duty plastic bottle with a screw cap may also be used if approved by your waste disposal company. Check with your local waste authority for your state, city, or town for the best methods that meet safe and accepted disposal of hazardous waste.

The A1C test is a blood test that provides information about your average levels of blood glucose, also called blood sugar, over the past 3 months. It is sometimes called the hemoglobin A1C, HbA1C, glycated hemoglobin, or glycohemoglobin test.

The American Diabetes Association (ADA) recommends a goal of A1C that is less than 7% for most diabetic adults.

• Take all medications (pills and/or insulin) as prescribed by your doctor.
• Monitor your blood sugars closely.
• Follow a sensible diet and don’t skip meals.
• Exercise regularly.
• See your doctor regularly to monitor for complications.

• There is no cure for type 2 diabetes but studies show it is possible for some people to reverse it through diet changes and weight loss. You may be able to reach normal blood sugar levels without medication. This doesn’t mean you are cured as type 2 diabetes is an ongoing disease.
• As of now, there is no cure for type 1 diabetes so it is important to take insulin as prescribed and monitor blood sugar to stay in target range.

Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not quite high enough to be diagnosed as type 2 diabetes. Approximately 84 million American adults—more than 1 out of 3—have prediabetes.

Some things you can do to try to prevent diabetes when diagnosed with prediabetes:

• Eat healthy foods including those low in fat and calories and high in fiber
• Be more active with 30 to 60 minutes of moderate physical activity most days of the week as a goal
• Lose excess weight
• Quit smoking
• Take medications as prescribed

There are three basic types of exercise – aerobic, strength, and flexibility exercises.

Aerobic exercise increases your heart rate, raising your breathing rate while working muscles of the body. A good goal to aim for is 30 minutes of aerobic exercise five days a week. The time can be broken into two or three separate 10-15 minute exercise times if you are unable to get 30 minutes all at once. If you are trying to lose weight, it is recommended to aim for more than 30 minutes of aerobic exercise every day.

Examples of aerobic exercise include:
• Walking
• Biking
• Swimming
• Tennis, golf or ice-skating
• Dancing
• Use of exercise equipment such as elliptical machines or rowing machines

Strength training exercise along with aerobic exercise helps keep you strong and helps maintain muscle mass that tends to be lost over the years as we grow older. Having more muscle makes everyday jobs like lifting and everyday chores easier. When you have more muscle on your body, you burn more calories than people who do not strength train which helps manage your weight. Lift weights at home, purchase exercise rubber bands or join a strength training class at your local gym.

Flexibility exercises or stretching keeps aging joints limber. Always do gentle stretching before any aerobic exercise to help your body warm and become flexible. Yoga or Pilates classes or videos can also be alternatives to improve flexibility and muscle tone.

Finding small ways to be more active in your daily routine can be easy if you look for opportunities to move. Even these small, short bursts of activity can make a long-term difference in your blood sugar and weight.

• Go for a short walk after getting the mail or newspaper
• Get off the bus one stop early
• Doing yard work like raking leaves or planting flowers
• Play basketball or go for a bike ride with your kids
• Park a distance away from stores or take a walk at the mall when shopping
• Get up from your desk at work to stretch and walk the hallways
• Take the stairs instead of the elevator when able
• Find a friend or support person to encourage you to be more active – it becomes easier if others provide encouragement and support!

Talk to your doctor about the best times of day for you to test your blood sugars. Typical times to test might be first thing in the morning, before meals, 1-2 hours after meals, or at bedtime. Likely, you do not need to test more than a few times a day—unless your blood sugars are variable and often outside of your target levels. Your doctor can guide the number of times of day to test and what times of day are best for you. Many insurance companies will provide only a certain amount of supplies per month to test your blood sugars, so be sure to communicate with your doctor about your testing schedule to make sure you won’t run out of lancets and testing strips.

It is suggested to keep a log book or list of all of your blood sugars that include date and time of the test. Your doctor and diabetes care team can use this information to make decisions about medication dosages and times, meal planning, and physical activity guidelines. Be sure to take your log book to all of your doctors and diabetes education appointments.