Diabetes information is available almost everywhere. It can be overwhelming and difficult to decide what's relative to you and what doesn't apply. We asked our diabetes experts to answer 20 of your most-asked queries. Here's what they told us.
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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: I was recently diagnosed with type 2 diabetes. Do I need to see an endocrinologist?
A: “While diabetes is an endocrine disease and falls under the specialty of an endocrinologist, there are only 3,000 of us in the U.S. who treat diabetes,” says Nicholas Argento, M.D., an endocrinologist with Maryland Endocrine near Baltimore who has type 1 diabetes. Do the math: 25 million people have diabetes; there are not nearly enough endocrinologists. “Most people with type 2 diabetes, especially in the early years, can partner with a primary care provider who takes an active interest in their diabetes,” Argento says. Make sure your doctor keeps up-to-date and provides you with care in sync with current guidelines. Be active in your care and ask questions.
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," says JoJo Dantone, RD, CDE, a diabetes program coordinator in New Orleans.
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,” says Marjorie Cypress, Ph.D., CNP, CDE, a nurse practitioner in Albuquerque and president of Health Care and Education for the American Diabetes Association. PAD increases the risk of heart attacks, strokes, and foot ulcers. Cypress suggests 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,” says David Marrero, Ph.D., who has diabetes and is the director of the Diabetes Translational Research Center at the Indiana University School of Medicine. Marrero’s 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,” says Lisa Brown, RD, CDE, of BrownFox Solutions in Minneapolis and chair of the Academy of Nutrition and Dietetics Diabetes Care and Education practice group. Brown suggests 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 10–20 pounds 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 pounds 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,” says Marion Franz, RD, CDE, owner of Nutrition Concepts by Franz in Minneapolis.
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, she says. 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,” says Natalie Strand, M.D., of the University of Southern California. Strand was the first person with diabetes to win The Amazing Race TV show. 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,” she says. 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,” Strand says. 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,” says Gary Scheiner, CDE, an exercise physiologist and owner of Integrated Diabetes Services near Philadelphia. 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 health care provider 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,” says Connie Crawley, RD, nutrition and health specialist at the University of Georgia Extension Service in Athens. “And alcohol may not sufficiently disinfect a lancet.”
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,” says Janine Freeman, RDN, CDE, a member of the American Association of Diabetes Educators Board of Directors.
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,” says Freeman, who also suggests 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, Freeman says.
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 glyburide (Diabeta, Glynase, Micronase), glipizide (Glucotrol), and glimepiride (Amaryl); and those in the glinide category, such as repaglinide (Prandin) and nateglinide (Starlix). 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,” says Dan Kent, Pharm.D., CDE, a specialty clinical pharmacist with Group Health in Seattle and member of the American Association of Diabetes Educators Board of Directors. “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,” Kent says.
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. BJ Fogg, director of the Persuasive Technology Lab at Stanford University and a leading expert on human behavior change, offers some tips to help get started: