Diabetes information is available almost everywhere. It can be overwhelming and difficult to decide what's relative to you and what doesn't apply. Whether you want to know the recommended blood sugar numbers or need advice on how to stay motivated, I have taken on the most commonly asked diabetes questions so you have the answers you need to successfully manage your diabetes.
Q: What is diabetes?
A: Diabetes is a disease of the pancreas, an organ located behind your stomach. Normally, the pancreas releases a substance called insulin into the blood. Insulin helps the body to use sugars and fats that are broken down from the foods we eat.
When a person has diabetes, the pancreas:
• Does not make insulin
• Makes only a little insulin or,
• Makes insulin, but the insulin does not work as it should.
Diabetes is a lifelong disease. People with diabetes must manage their disease to stay healthy.
Q: My father has diabetes. Does that raise my risk?
A: Yes. Having a family member with diabetes raises your risk of developing type 1 by about 5 percent and type 2 diabetes by more than 30 percent.
Q: I've read that stomach fat is a diabetes risk factor. Should I worry about being over weight?
A: Yes. Excess fat around your stomach is linked to a higher risk of type 2 diabetes. In particular, the visceral fat wrapped around your internal organs can pose a problem, and it increases insulin resistance (the problem in type 2 diabetes) more so than fat in other parts of your body.
Being obese or overweight in general can hike your risk of type 2 diabetes by more than 90 times. Why? Overweight bodies may just be too big for their pancreases to keep up.
Q: Can diet or exercise really prevent diabetes?
A: Yes, exercising and eating a healthy diet helps you keep off excess weight, which can prevent or at least delay diabetes. If you already have diabetes, doing aerobic exercise and resistance training helps by encouraging the muscles to take up more blood sugar.
Over the short term, it may even reduce the amount of blood-sugar-lowering medication you need to take. Long term, exercise helps lower the risk of complications like blindness and nerve and kidney damage by helping you better manage blood-sugar levels. On the diet front, a recent study found that type 2 diabetics who ate a Mediterranean diet, which is rich in fish, fruits, nuts, and olive oil, lost more weight and went longer without blood-sugar-lowering medication than those on a low-fat diet.
Q: What causes diabetes?
A: The following factors may increase your chance of getting diabetes:
• Family history of diabetes
• Being overweight
• Age (Chances increase with age)
Q: What are the types of diabetes?
A: There are two types of diabetes: type 1 and type 2.
• Type 1 diabetes — The pancreas makes little or no insulin. A person with type 1 diabetes must take insulin to survive. This type occurs most often in people who are under 25 years old.
• Type 2 diabetes — Insulin is made but it doesn't work as it should. Nine out of 10 people with diabetes have type 2 diabetes. This type occurs most often in people who are over 30 years old and overweight.
Q: How is diabetes managed?
A: Diabetes is managed through proper diet, exercise and, if needed, medication. People with diabetes must use home and office tests to monitor the levels of sugar, cholesterol, and triglycerides (a type of fat) in their blood. Steps are then taken to keep the levels of these substances as normal as possible.
Type 1 diabetes is controlled with:
• Insulin shots
• Meal planning
Type 2 diabetes is controlled with:
• Diet and exercise
• Medicine taken by the mouth
• Insulin shots (less common)
Q: What are the symptoms of diabetes?
A: The symptoms of type 2 diabetes often go unnoticed. These symptoms build up over time and include:
• Blurred vision
• Slow healing sores or cuts
• Itchy skin (usually in the vaginal or groin area)
• Yeast infections
• Increased thirst
• Dry mouth
• A need to urinate often
Q: Could eating lot of sugar lead to diabetes?
A: One of the oldest myths about diabetes is that sugar causes the disease. A lot of people still think you get diabetes from eating too much sugar.
Not true. Nor is it necessary for diabetics to avoid all sugar. Eating a well-balanced diet rich in whole grains, protein, veggies, and fruit -- and low in fat, cholesterol, and simple sugars (which cause blood sugar to spike) -- is a healthy plan for everybody.
Q: I'm skinny, so I can't get diabetes, right?
A: Being overweight is a major risk factor for type 2 diabetes, but 20 percent of people who get it are slim. The number of type 2 diabetics is growing, especially in thin populations.
Q: If I had gestational diabetes (diabetes during pregnancy) that went away, should I worry?
A: Unfortunately, your risk of developing type 2 diabetes after gestational diabetes increases substantially -- between 20 percent and 50 percent. (Gestational diabetes occurs when hormones that help a baby's placenta develop interfere with the mother's insulin, resulting in higher blood sugars.) Your personal odds depend upon other factors like ethnicity, genetics, and weight. Losing weight after you've had a baby can help limit your risk.
Q: How can I know if I have diabetes?
A: Your Doctor can perform blood and urine tests to see if you have diabetes. The standard diagnosis of diabetes is made when two blood tests show that your fasting blood sugar level (blood sugar before you have eaten anything) is 126 mg/dl or greater or post meal blood sugar level is 200 mg/dl or greater.
Q: Can I continue to eat at my favourite restaurants?
A: If you like fast-food restaurants, most can give you nutritional information about the items on their menus. This will help you know how much carbohydrate, fat, and protein you're eating.
Generally, whenever you eat out, you're safest sticking to selections that are broiled, baked, or grilled. Avoid fried foods because they are higher in fat. Ask your server to bring your salad with the dressing on the side. Hold the mayonnaise on your favorite sandwich.
If you have room left in your meal plan, have a bowl of fresh fruit or small scoop of low-fat frozen yogurt for dessert.
Q: Do I need to stop eating out at restaurant? Can I have ice cream? Can I take artificial sweetener?
A: Certainly not, as long as you are not planning to eat out everyday! You need to know what the right food is and correct amount.
Occasionally yes, but do not make a habit of eating ice cream regularly. There are certain ice cream available now with no added sugar, but do not forget they have calories.
Certainly yes, artificial sweeteners are safe. Do not put them in cooking, they break down when heated. So they will not be sweet any more.
Q: Can I control Diabetes with Diet only?
A: Diet is a very important aspect in the treatment of Diabetes particularly the timing of it. At the beginning you may be successful in controlling Diabetes with diet only, but unfortunately a time will come when only diet won’t be enough, you will require medicine. This time is different for different people, for somebody this can be a few months while for others it may be a few years. It is very important to try with diet first; this will help you to understand the principles of diet and will convince you the need for treatment to control Diabetes.
Q: Once started, do I need to take tablet for life?
A: This all depends on your Diabetes. If your Diabetes is very well controlled with a small dose of tablet, you may try only with diet. If that is fine, why not to control your Diabetes only with diet and life-style measures. But if you see, your control is not good with diet alone, you must accept that your body needs medicine and you should start again.
Q: Can diabetes be cured?
A: No. A cure for diabetes has not yet been found. However, diabetes can be treated and controlled. Most people with diabetes manage their disease and lead normal lives. Without proper care, diabetes can lead to:
• Heart disease
• Kidney disease
• High blood pressure
• Low blood pressure
• Eye damage and blindness
• Gum disease
• Serious infections in feet, sometimes requiring amputation
• Damage to nerves, resulting in pain or loss of sensation
Q: What are the symptoms of low blood sugar?
A: Most people have symptoms of low blood sugar (hypoglycemia) when their blood sugar is less than 60 mg/dl.
When your blood sugar is low, your body gives out signs that you need food. Different people have different symptoms. You will learn to know your symptoms.
Common low blood sugar symptoms include the following:
• Feel weak
• Feel dizzy
• Feel hungry
• Feel shaky
• Have a pounding heart
• Have pale skin
• Feel frightened or anxious
• Feel confused
• Have a headache
• Feel cranky
• Have poor coordination
• Have bad dreams or nightmares
• Be unable keep your mind on one subject
• Feel a numbness in your mouth and tongue
• Pass out
Q: Can I take both tablets and insulin to control my blood sugar?
A: Yes. The combination of insulin and an oral medication, when taken as directed by your doctor, is very safe and effective in controlling blood sugar. A typical combination therapy consists of taking an oral medication during the day and insulin at night. Once you begin taking insulin, you will need to monitor your blood sugar more often to reduce the risk of low blood sugar reactions.
Combination therapies are often helpful for people who have type 2 diabetes (adult onset diabetes). If you have been taking an oral medication, your doctor may change your treatment plan to include insulin injections. This change is often made to help people with type 2 diabetes gain better control of their blood sugar.
Q: What are insulin pumps?
A: Insulin pumps are small, computerized devices, about the size of a beeper, that you wear on your belt or put in your pocket. They have a small flexible tube with a fine needle on the end. The needle is inserted under the skin of your abdomen and taped in place. A carefully measured, steady flow of insulin is released into the tissue. Insulin pumps can cost Rs. 2 - 4 lakhs for the pump. There are additional costs for necessary supplies to use the pump.
Using a pump requires you to monitor your blood sugar level at least four times a day. You program doses and make adjustments to your insulin, depending on your food intake and exercise program. Some Doctors prefer the insulin pump over injections because its slow release of insulin mimics a working pancreas.
Q: How can I monitor the development and progression of diabetic complications?
A: Eye disease (retinopathy)
All patients with diabetes should see an ophthalmologist yearly for a dilated eye examination -- beginning at diagnosis in people with type 2 diabetes, and after 5 years in people with type 1 diabetes after puberty. Patients with known eye disease, symptoms of blurred vision in one eye, or blind spots may need to see their ophthalmologist more frequently.
Kidney disease (nephropathy)
Urine testing should be performed yearly. Regular blood pressure checks are important, since control of hypertension (high blood pressure) is essential in slowing kidney disease. Persistent leg or foot swelling may be a symptom of kidney disease and should be reported to your doctor.
Nerve disease (neuropathy)
Numbness or tingling in your feet should be reported to your doctor at your regular visits. You should check your feet daily for redness, calluses, cracks, or skin breakdown. If you notice these symptoms before your scheduled visit, notify your doctor immediately.
Q: What should my blood sugar be when I wake up (fasting) and before meals? What about after?
A: For most people with diabetes, the American Diabetes Association recommends a fasting or before-meals blood glucose (or blood sugar) goal of 70–130 mg/dl. One to two hours after eating, a postprandial blood sugar reading at or under 180 mg/dl is recommended.
Q: Does a diagnosis of type 2 diabetes mean I will have to go on insulin?
A: No. People with type 2 diabetes may or may not ever need to take insulin injections, depending on several factors, including the timing of diagnosis. Research indicates that if type 2 diabetes is treated early and blood sugar is controlled initially and over the years, the pancreas is more likely to produce enough insulin longer. But a person who lives with type 2 upward of 15 years is unlikely to continue to make sufficient insulin and will need to take it via syringe, pen, or pump.
Q: Who with Diabetes needs Insulin?
A: In type 1 Diabetes Insulin is a must for living. In type 2 Diabetes we advice Insulin in certain situations like pregnancy, during and after surgery, severe infection and for some reason or other when you are not able to eat. Obviously, when tablets do not work, you need Insulin for Diabetes control.
Q: Can I get rid of type 2 diabetes if I stop eating carbs and/or lose a lot of weight?
A: No, but you can control it. If you have prediabetes or were just diagnosed with type 2, losing a lot of weight can put the condition into remission. Weight regain, aging, and the natural progression of type 2 diabetes can bring it back. Not eating carbohydrate or severely restricting it is nearly impossible for any length of time. It’s also not healthy, because you won’t get essential nutrients.
Q: Why is it OK to eat fruit when it’s full of carbohydrate? Are some fruits better to eat than others?
A: The calories in all fruits (fresh, frozen, dried, and canned without added sugar) are mainly carbohydrate with a bit of protein. People with diabetes need to eat a certain amount of carbs every day for energy and essential nutrients. Healthy sources of carbs include fruits, as well as vegetables, whole grains, legumes (beans), and low-fat dairy foods.
Q: Why do my legs hurt when I start walking and stop hurting when I sit down?
A: You have signs of peripheral arterial disease, or PAD. It develops when too much plaque in your arteries limits blood flow to the legs. The pain may occur while you walk because muscles need increased blood flow. The pain may stop when you sit because your muscles then require less blood flow. PAD increases the risk of heart attacks, strokes, and foot ulcers. I suggest lowering your risks for PAD with the same advice you follow to stay healthy with diabetes.
Q: How can I learn to accept my diabetes?
A: Accepting that you have diabetes is largely an act of cognition—a realignment of what you view as real and vital to your existence and how it can impact your life. Diabetes becomes an integral part of a person’s life. While we all wish it would simply go away, this isn’t possible—yet. My advice: Accept that diabetes will, for the rest of your life, be there. And it’s a very treatable disease, which places few restrictions on you if you follow treatment recommendations.
Q: My husband has type 2 diabetes and is a truck driver. What foods can he take on the road?
A: Preplanning and having healthy snacks at the ready are keys to helping you eat healthy on the road. I suggest fresh fruit, small containers or cans of fruit (no syrup), fat-free yogurt, part-skim cheese (sticks, slices, and cubes), sugar-free pudding cups, nuts (any type), whole wheat crackers or pretzels, peanut butter, baby carrots, and 100-calorie snack packs (buy them or create your own). Also, drink plenty of water and no-calorie drinks.
Q: Will insulin make me gain weight?
A: The reason we need insulin—as a hormone made in our bodies or as a medication—is to push glucose into cells for energy. Insulin’s job is to process calories. For this reason, it can—but doesn’t have to—cause weight gain. To prevent weight gain: Practice portion control. Burn extra calories with exercise. If your blood sugar has been high for a while prior to starting insulin, you’ve likely been excreting calories in your urine instead of fueling your body. This won’t happen once your blood sugar is under control. If you experience hypoglycemia (low blood sugar), treat it with just 15 grams of carb.
Q: Why is weight loss so important? What’s the best way for a person with type 2 to lose weight?
A: Weight loss is vital, particularly just after a diagnosis of type 2 or prediabetes. Weight loss increases insulin sensitivity, allowing cells to more effectively use the insulin the body continues to make. Losing just 5 - 10 kgs can accomplish a boatload of benefits. Among them are improved blood sugar, blood pressure, and cholesterol levels and possibly taking fewer medications or lower doses. To lose weight slowly and steadily, change your lifestyle. The kilograms you keep off over time are the most important to living a long life.
Q: Can I drink alcohol?
A: Yes, adults with diabetes can drink alcohol and should follow the same guidelines as the general public—an average of up to one drink per day for women and up to two drinks per day for men, with no more than three or four drinks in any single day for women and men, respectively. Research shows moderate alcohol consumption has minimal short- or long-term effects on glucose levels in people with type 1 or 2 diabetes.
Although alcoholic drinks are made from grains or fruits (starches or sugars) through the processes of fermentation and distillation, alcohol cannot be changed into glucose. Also, alcohol is the only nutrient that doesn’t require insulin to be broken down for energy; carbohydrate, protein, and fat do. However, drinking more than three drinks per day over time has been shown to make glucose control a challenge.
For people who take insulin or another blood glucose-lowering medication that can cause hypoglycemia, eat some food when drinking alcohol. A cautionary note to people with type 1 diabetes: Significant alcohol intake can cause hypoglycemia a number of hours later, so regularly check blood sugar levels when you drink.
Q: Can your menstrual cycle and/or going through menopause affect glucose levels?
A: Yes and yes! It’s common for women to have hormone fluctuations the week before their period, and those can affect glucose control. After ovulating, estrogen and progesterone rise. Estrogen can make women more sensitive to insulin and cause hypoglycemia. Progesterone can do the converse. Glucose levels often return to their usual patterns after the first few days of the menstrual cycle. Check your glucose levels and analyze your monthly fluctuations to know your patterns. Then devise a management plan for these days. Menopause also can affect blood sugar. During perimenopause, estrogen and progesterone can fluctuate and lead to glucose swings. An early sign of perimenopause for women who take insulin is hypoglycemia due to dropping progesterone.
Q: What are the best foods to eat before and after exercising?
A: Foods that contain carbohydrate are quick and easy to digest for energy. Eat foods like bread, crackers, pretzels, dry cereal, 100 percent fruit juice, or sports drink with calories. But if weight loss is a goal and you aren’t at risk of hypoglycemia, just drink water—ditto for after exercise. Unless your workout was particularly exhausting or lasted several hours, you don’t need food. People who take insulin and are physically active should consult their Diabetologist about how to adjust insulin dosages.
Q: Why can’t my wife and I use the same lancet if we clean it?
A: The CDC strongly recommends that blood-testing devices, including lancets, should never be used by more than one person to prevent any chance of infection. And alcohol may not sufficiently disinfect a lancet.
Q: Why are women with diabetes pre-disposed to developing recurrent vaginal yeast infections?
A: The glucose (sugar) in your body is the perfect trigger to encourage and grow yeast within your body.
Q: What are the complications of using birth control tabletes while having diabetes?
A: Birth control tabletes may raise your blood sugar levels. Using them for longer than a year or 2 may also increase your risk of complications. For instance, if you develop high blood pressure while on the pill, you increase the chance that eye or kidney disease will worsen.
Q: Will menopause affect my diabetes?
A: Yes. The changes in hormonal levels and balance, may lead to BG levels that are out of control. Women with diabetes are also at risk of developing premature menopause and consequent increased risks of cardiovascular disease.
Q: Can I get rid of diabetes? Will it ever go away?
A: Once you are diagnosed with type 1 or type 2 diabetes, you have it for the rest of your life. To stay healthy, keep your blood sugar, blood pressure, and cholesterol under good control. To do so, eat healthy, be physically active, and take your prescribed medications. Also get the tests and checks you need to detect complications early and treat them aggressively.
Q: How often should I replace my glucose meter?
A: The only reason to replace your meter is if you determine it is not working correctly with its strips. To check, use the control solution that comes with your meter. It’s an essential monitoring supply that many people don’t know about or use.
To use control solution, put a drop (similar to the amount of blood you need) on a strip and do a test. Your vial of strips gives you a glucose range in which the result should fall. If it's in the range, your meter and strips are working correctly. If not, contact the manufacturer, which will offer advice and possibly a free replacement meter. Use control solution each time you open a new box of strips or any time you suspect your meter or strips aren’t working together.
I suggest cleaning and disinfecting your meter at least once a week, when blood is on the meter, and before allowing anyone else to use it. Consider upgrading your meter ever five or so years because there is so much innovation.
Q: Should I always carry glucose tablets?
A: Your risk for hypoglycemia depends on the category of blood glucose-lowering medication(s) you take, not your type of diabetes. Some medications can cause hypoglycemia, including insulin; those in the sulfonylurea category, such as glibenclamide, glipizide, and glimepiride; and those in the glinide category, such as repaglinide and nateglinide . If you take one of these medications, always carry treatment. Most of the commonly used blood glucose-lowering medications for type 2 diabetes don’t cause hypoglycemia.
Q: Is it true that complications of diabetes can be delayed and even prevented?
A: Yes! Research shows that the earlier your diabetes is diagnosed and the sooner you start to aggressively get your blood sugar, blood pressure, and cholesterol into target ranges, the healthier you can be over the years. To stay healthy and detect any complications early, make sure your health care provider orders all the tests and checks you need. Let your provider know if you have any signs or symptoms of a potential problem. Today, diabetes complications don’t need to happen.
Q: Will I need to be on insulin the rest of my life? Why can’t I take pills instead?
A: If you have type 2 diabetes and were put on insulin, it’s likely you need it to bring your blood sugar down farther than pills could. In this case, you’ll likely need to take insulin injections the rest of your life. If, however, you started taking insulin when you had an infection, needed surgery, or were hospitalized for a medical reason, your need for insulin may be temporary. These situations raise stress, and stress can raise blood sugar levels. When the stress abates, you may be able to taper or stop taking insulin and get back to your previous medication regimen.
The big ‘if’ is whether your pancreas still makes enough insulin to get your glucose down. The glucose-lowering medications, other than insulin, available today (mainly pills and a few injectables) use various routes to lower glucose levels. They don’t lower glucose as much as insulin, in part because with insulin you can keep increasing the dose as needed.
Q: How can I get motivated to take care of myself?
A: Taking care of diabetes and getting through your daily to-do list along with your other responsibilities is demanding. It’s easy to understand why motivation waxes and wanes. With diabetes being so common, it's not hard to find other people with diabetes. Look for opportunities to connect with other Diabetic's who successfully manage their diabetes, live a similar lifestyle to yours, and are willing to share. Ask to chat, go for a walk, or meet for coffee. Gather information about how they deal with situations you struggle with every day, or even only once in a while. Get practical tips for your daily diabetes to-do list, such as taking medications, checking glucose levels, and more. Help someone else who is struggling. Form one or more supportive partnerships. There is strength in numbers!
Diabetes is a 24/7/365 disease that requires continual treatment adjustments over the years. While you need to stay in the driver's seat for your day-to-day management, you'll want a Diabetologist who will work side by side with you as a partner in your efforts. Your Diabetologist should constantly strive to help you fine-tune your treatment to achieve your blood sugar, cholesterol, and blood-pressure goals. Search out a knowledgeable and up-to-date Diabetologist, one who knows and uses new medications, technologies, and behavior-change strategies. Make sure your Diabetologist knows the American Diabetes Association Standards of Care and orders the tests and checks you need to prevent or detect diabetes complications.
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