Frequently Asked Questions
Diabetes occurs when the body fails to produce or correctly use insulin. Insulin is a hormone that changes sugar, starches and other food into energy. When controls break down in the regulation of insulin, the patient becomes diabetic. Related health problems can be severe, including blindness, kidney disease, nerve damage, amputation, heart disease and stroke.
There are two main types of diabetes:
Type 1 - Previously known as juvenile onset diabetes, this type occurs when the pancreas makes little or no insulin. The body‘s own immune system may attack and destroy the insulin-producing cells in the pancreas. Most often seen in children and young adults, Type 1 diabetes is treated with daily insulin injections and careful meal planning. Regular exercise is also important in controlling the disease.
Type 2 - Almost at the epidemic stage, type 2 accounts for more than 90% of all cases. In this adult disorder, the body becomes unable to make enough insulin or to use it properly. Treatment involves medications (insulin and other drugs), careful eating and exercise.
During pregnancy, some women experience gestational diabetes. Pregnancy hormones tend to make the body resist insulin. This type of diabetes usually goes away soon after the baby is born. Later in life, women who experience gestational diabetes may become diabetic.
While the exact cause of diabetes is not yet known, Americans' inactive lifestyle and regular diet of fats, salt and sugar account for a large portion of the worrisome rise in the number of diabetic patients. Persons at risk also include those over age 45, overweight individuals and certain ethnic groups (African American, Latino and Native American).
This is a blood test. A hemoglobin A1c percentage is important because it is the main way to know how well patients are controlling their diabetes over time. Based on blood tests taken over a period of two or three months, doctors can estimate patients' average blood sugar levels. The goal for most diabetics is an A1c of less than 7%. This is roughly equivalent to an average blood sugar level of about 150 mg/dl. An A1c of 9% indicates an average blood sugar level of about 210 mg/dl.
Here‘s how the test works. Glucose (blood sugar) circulates in the blood after food is absorbed in the intestine. A small amount normally combines with the hemoglobin molecule (A1c). Hemoglobin is the red-colored protein in red blood cells that carries oxygen to the rest of the body. The glucose remains with the hemoglobin molecule until the individual‘s red blood cells die - usually between two and three months. When the patient‘s blood is analyzed for hemoglobin A1c, the resulting value number provides an estimate of the level of glucose over that time period.
Take these steps to treat a low blood glucose:
Test your glucose
If it is under 70mg/dl, eat or drink 15 grams of a fast acting carbohydrate.
- 4 oz fruit juice
- ½ can regular soda
- 8 oz (1 cup) of nonfat milk
- 5-7 Lifesavers
- 3-4 glucose tablets
Rest 15 minutes
Retest your glucose level.
If glucose is less than 80mg/dl, treat with another 15g fast acting carbohydrate.
If your glucose level has increased above 80mg/dl, eat a meal or snack with a carbohydrate/protein (1/2 sandwich with turkey and 1 slice bread, 1 oz cheese and 6-8 crackers)
Chocolate should not be used to treat a low blood glucose because the fat in chocolate prevents your glucose from rising quickly.
Diabetes often causes poor circulation and damaged in the legs and feet. This is one reason people with diabetes must take special care of their feet. Diabetics are likely to have foot problems, such as fungus, ingrown toenails, infections, bunions and ulcers. Most foot amputations can be prevented with good foot care. Note any changes in your feet, such as cuts, scratches, red areas, corns, cracks, itching or other abnormalities. Any changes should be reported to the podiatrist. To smooth down calluses, use a pumice stone when bathing, and never cut calluses off. Trim or file toenails straight across to reduce the chance of ingrown nails. Make sure shoes fit properly. Pressure from ill-fitting shoes can cause sore areas and lead to ulcers and infections. Lotion can be used around feet but not in between the toes. Moisture can lead to infections. Keep your feet clean and dry; once a day, wash your feet with mild soap and water. See a podiatrist regularly.
Foods with higher amounts of simple "added" sugars should be avoided, such as fruit juice, regular soda, sport drinks, all other caloried liquids, and candies. With diabetes, it's important to save sweets and desserts for special occasions. But with a little planning, you can still enjoy a small portion of your favorite treat once in a while. Speak with a Registered Dietitian to see how you can incorporate these treats into your meal plan.
Check the Total Carbohydrates. Total carbohydrates include sugar, starches and dietary fiber. The total amount of carbohydrates is what affects blood glucose levels—not just sugar. 15 grams of carbohydrates = 1 serving. The more fiber the product has, the more satisfied you will feel and glucoses will not increase as high after meals. Add more vegetables and whole grain foods to your eating plan.
Patients who have diabetes, high blood pressure and take blood pressure medication should limit sodium intake to 1500mg a day. Most sodium in the American diet comes from processed or prepared foods, not from the kitchen table salt shaker. Foods that have 400 mg per serving are considered high sodium foods. It's no secret that most Americans are consuming too much sodium. The average American takes in about 3,400 mg of sodium per day. Yet the American Diabetes Association guidelines recommend that people with diabetes have 2,300 mg or less per day. One teaspoon of salt contains about 2,300 mg of sodium.
The recommended amount of fiber is 25 to 30 grams per day. Check for fiber on food labels to help reach this number. Some examples of high fiber foods are fruits, vegetables, legumes and whole grains. Fiber is not completely digested and absorbed in the intestinal system, and it is unavailable as blood sugar. Therefore, a high-fiber meal does not provide as much available carbohydrates as a similar-content low fiber meal. To avoid constipation, increase water intake as more fiber is added to the diet.
We recommend using new lancets and syringes for each injection. Patients run the risk of insulin contamination and infection if the needle is used more than once. Every syringe and lancet should be discarded after use.
The American Diabetes Association recommends the following for adults:
- Fasting blood glucose 70-130mg/dl
- 2 hour after start of meals <180 mg/dl
- Pre meal glucose: <140 mg/dl
However: Blood glucose goals are individualized based on the durations of diabetes, age/life expectancy, co-morbid conditions, known cardiovascular disease or advance microvascular complication, hypoglycemia unawareness, and individual patient considerations. More or less stringent glucose goals may be appropriate for individual patients.
Visit the ophthalmologist once a year. For patients with retinopathy, an ophthalmologist should be seen on a routine basis.
Signs include extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness and nausea.
Signs include shaking, fast heartbeat, sweating, anxiety, dizziness, hunger, impaired vision, weakness/fatigue, headache and irritability.