FAQ’s

How do you get high blood glucose?
Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all the cells in your body. Insulin is a chemical, also called a hormone, made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body doesn’t make enough insulin, or if the insulin doesn’t work the way it should, glucose can’t get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing prediabetes or diabetes.

What is prediabetes?
Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. People with prediabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is, if you have prediabetes, you can reduce your risk of getting diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes and even return to normal glucose levels.

What are the signs of diabetes?
The signs of diabetes are
• Being very thirsty
• Urinating often
• Feeling very hungry or tired
• Losing weight without trying
• Having sores that heal slowly
• Having dry, itchy skin
• Losing the feeling in your feet or having tingling in your feet
• Having blurry eyesight
You may have had one or more of these signs before you found out you had diabetes. Or you may have had no signs at all. A blood test to check your glucose levels will show if you have prediabetes or diabetes.

What kind of diabetes do you have?
People can get diabetes at any age. Type 1, type 2, and gestational diabetes are the three main kinds. Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. With this form of diabetes, the beta cells of the pancreas no longer make insulin because the body’s immune system has attacked and destroyed them. Treatment for type 1 diabetes includes taking insulin and possibly another injectable medicine, making wise food choices, being physically active, taking aspirin daily—for some—and controlling blood pressure and cholesterol.
Type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age-even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes. Treatment includes using diabetes medicines, making wise food choices, being physically active, taking aspirin daily-for some-and controlling blood pressure and cholesterol.
Some women develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin

Traveling With Diabetes
If you have diabetes, traveling requires extra planning. Changes in meal patterns, activity levels, and time zones can affect your blood sugar levels with diabetes. That’s why it’s important to have some key reminders to make traveling with diabetes much easier..

Before You Travel With Diabetes
• Make an appointment with your health care provider to discuss your travel plans.
• Provide advance notice to your airline. You may request special meals in advance.
• Get twice as many supplies needed to travel and bring extra prescriptions and a letter from your doctor explaining that you have diabetes.
• If you need immunization shots, plan to get them three to four weeks before your vacation. Some of these shots can upset your blood sugar levels.
• Be prepared. Know what facilities are available within the region that you will be traveling.

What Should I Bring When Traveling With Diabetes?
• Bring your doctor’s name and phone number and keep it with you at all times.
• Bring a list of current medicines and keep it with you at all times.
• Always carry and wear medical identification that states that you have diabetes.
• Keep medicines, syringes, blood glucose testing supplies, and all oral medications in your carry-on luggage. Do not check these supplies with your luggage in case it is lost. Also, the cargo hold is not heated or insulated well, so medicine and supplies can be damaged.
• Take enough medicines and medical supplies to last an extra week in case you get stranded or stay longer than you planned.
• Have a traveling companion carry some of your medical supplies, if possible.
• Always carry some type of sugar source in case you develop hypoglycemia.
• Inform the airlines, cruise ships, and tour guides in advance that you have diabetes. Most airlines and cruise ships will provide special meals.
• Test your blood sugar more often than usual.

Traveling With Diabetes: At the Airport
Steps you can take to make your trip through airport security with diabetes supplies hassle-free include:
• Make sure you tell security that you are diabetic and that you are carrying medical supplies. Your supplies can be taken through security check points, but they must have a prescription label on them
• All of your supplies should have a proper manufacturer’s label.
• Syringes will be allowed through security if you have insulin as well.
• If you are wearing an insulin pump, you must notify security. They will visually inspect the meter. You must request that the meter not be removed.
• Be sure to check the latest information on the Transportation Security Administration web site on what you can take on board with you if you are flying and have diabetes.

Insulin Injections When Traveling With Diabetes
• If you are traveling on an airplane and you need an insulin injection during your flight, follow your normal procedure – with one difference: put only half as much air into your insulin bottle as you normally would. The air pressure is different in airplanes than on the ground. The air pressure in the cabin when in flight may cause the plunger of the needle to resist your efforts to inject air into the insulin bottle.
• Keep the temperature of your insulin between 33 and 80 F. Do not freeze your insulin or keep it in direct sun.
• If you are crossing time zones, you’ll need to adjust your insulin dosage. Some experts recommend taking regular insulin every four hours until your body has had enough time to adjust to the change. Once this happens, switch back to your usual insulin regimen. Talk with your doctor first, as you may need to adjust your insulin dose upwards if you travel west (longer days) or decrease your dose if you travel east (shorter days).
• As an extra precaution to avoiding low blood sugar, do not take your insulin until you know that food is available, and always carry extra snacks with you.

Foot Care When Traveling With Diabetes
• Pack at least two pairs of shoes so you can change shoes often if you have diabetes. Changing shoes helps prevent blisters and sore pressure points.
• Pack comfortable shoes, socks, and a first-aid kit to treat minor foot injuries.
• Do not go barefoot. Instead, wear shoes that are specially made for ocean or beach walking. Protect your feet at all times when you are walking by the pool, in the park, on the beach, or swimming in the ocean.
• Do not wear open-toe shoes, including sandals, flip-flops, or others (you increase your risk for injury and infection when your toes are exposed).
• Follow your daily foot-care regimen.

Coping With an Emergency When Traveling With Diabetes
If you are overseas and a diabetic emergency occurs and you do not know where to go, try to reach the American consulate, the Red Cross, or a local medical school. Learn certain phrases in the local language such as “I need help” or “I have diabetes, where is the hospital?” or “I need sugar.”

What happens when you are sick
When you are sick, your body reacts by releasing hormones to fight infection. But these hormones raise blood sugar levels and at the same time make it more difficult for insulin to lower blood sugar. When you have diabetes, even a minor illness can lead to dangerously high blood sugar. This may cause life-threatening complications, such as diabetic ketoacidosis or a hyperosmolar state.

Recommended Related to Diabetes

Does Prediabetes Lead to Diabetes?
In every issue of WebMD the Magazine, we ask our experts to answer readers’ questions about a wide range of topics. In our January-February 2011 issue, we asked WebMD’s diabetes expert, Michael Dansinger, MD, to answer a question about the link between prediabetes and diabetes. Q: At my last checkup, my doctor told me I have prediabetes. Does that mean I’ll ultimately develop diabetes? A: Almost everyone who develops type 2 diabetes develops prediabetes first. But not everyone who has prediabetes…

Plan ahead
Work with your doctor to make a sick-day plan for you or your child with diabetes. Discuss your target blood sugar goal during an illness, how you should adjust your insulin dose and timing (if you take insulin), and when you need to contact your doctor for help. Also, make sure you know how often to check blood sugar and urine ketone levels. Keep your plan in a convenient place, and include contact information in case you need to reach your doctor at night or on the weekends.

Steps to take during an illness
Here are some general sick-day guidelines:
• Continue taking your pills for diabetes (if you have type 2 diabetes) or insulin, even if you are vomiting and having trouble eating or drinking. Your blood sugar may continue to rise because of your illness. If you cannot take your medicines, call your doctor and discuss whether you need to adjust your insulin dose or other medicine.
• Try to eat your normal types and amounts of food and to drink extra fluids, such as water, broth, carbonated drinks, and fruit juice. Encourage your child to drink extra liquids to prevent dehydration.
o If your blood sugar level is higher than 240 milligrams per deciliter (mg/dL), drink extra liquids that do not contain  sugar, such as    water or sugar-free cola.
o If you cannot eat the foods in your regular diet, drink extra liquids that contain sugar and salt, such as soup, sports drinks, or milk. You may also try eating foods that are gentle on the stomach, such as crackers, gelatin, or applesauce.Try to eat or drink 50 grams (g) of carbohydrate every 3 to 4 hours. For example, 6 saltine crackers, 1 cup (8 fl oz) of milk, and 1/2cup (4 fl oz) of orange juice each contain approximately 15 g of carbohydrate.
• Check your blood sugar at least every 3 to 4 hours, or more often if it is rising quickly, even through the night. If your blood sugar level rises above 240 mg/dL and your doctor has told you to take an extra insulin dose for high blood sugar levels, take the appropriate amount. If you take insulin and your doctor has not told you to take a specific amount of additional insulin, call him or her for advice.
• If you take insulin, do a urine test for ketones every 4 to 6 hours, especially if your blood sugar is higher than 300 mg/dL. Call your doctor if you have more than 2+ or moderate ketones in your urine. Check your child’s urine for ketones at least every 6 hours, even through the night.
• Weigh yourself and check your temperature, breathing rate, and pulse frequently if your blood sugar is higher than 300 mg/dL. If you are losing weight and your temperature, breathing rate, and pulse are increasing, contact a doctor. You may be getting worse.
• Don’t take any nonprescription medicines without talking with your doctor. Many nonprescription medicines affect your blood sugar level

When to call your doctor
Minor illnesses in people with diabetes-especially children with type 1 diabetes-can lead to very high blood sugar levels and possible emergencies. When children are sick, watch them closely for signs that they need immediate medical attention. Call 911 or other emergency services if you or your child has:
• Symptoms of diabetic ketoacidosis (DKA), such as abdominal pain, vomiting, rapid breathing, fruity-smelling breath, or severe drowsiness.
• Symptoms of dehydration, such as a dry mouth and very yellow or dark urine. Dehydration is particularly dangerous in children and may be caused by vomiting and diarrhea.
• A low blood sugar level that continues.
It may not be necessary to call your doctor every time you or your child with diabetes has a mild illness, such as a cold. But it is a good idea to call for advice when you are sick and:
• Your blood sugar level is higher than 240 mg/dL after taking the adjusted amount of insulin in your sick-day plan.
• You take oral diabetes medicine and your blood sugar level is higher than 240 mg/dL before meals and stays high for more than 24 hours.
• You have more than 2+ or moderate ketones in your urine.
• You still have a fever and are not feeling better after a few days.
• You are vomiting or having diarrhea for more than 6 hours.
When you are sick, write down the medicine(s) you have been taking and whether you have changed the dosage of your diabetes medicines based on your sick-day plan. Also note changes in your body temperature, weight, blood sugar, and urine ketone levels. Have this information with you when you talk to your doctor.

Genetics of Diabetes

Genetics of Diabetes
You’ve probably wondered how you got diabetes. You may worry that your children will get it too. You may also be interested in our book, . Unlike some traits, diabetes does not seem to be inherited in a simple pattern. Yet clearly, some people are born more likely to get diabetes than others.

What Leads to Diabetes?
Type 1 and type 2 diabetes have different causes. Yet two factors are important in both. You inherit a predisposition to the disease then something in your environment triggers it.
Genes alone are not enough. One proof of this is identical twins. Identical twins have identical genes. Yet when one twin has type 1 diabetes, the other gets the disease at most only half the time. When one twin has type 2 diabetes, the other’s risk is at most 3 in 4.

Type 1 Diabetes
In most cases of type 1 diabetes, people need to inherit risk factors from both parents. We think these factors must be more common in whites because whites have the highest rate of type 1 diabetes. Because most people who are at risk do not get diabetes, researchers want to find out what the environmental triggers are.
One trigger might be related to cold weather. Type 1 diabetes develops more often in winter than summer and is more common in places with cold climates. Another trigger might be viruses. Perhaps a virus that has only mild effects on most people triggers type 1 diabetes in others.
Early diet may also play a role. Type 1 diabetes is less common in people who were breastfed and in those who first ate solid foods at later ages.
In many people, the development of type 1 diabetes seems to take many years. In experiments that followed relatives of people with type 1 diabetes, researchers found that most of those who later got diabetes had certain autoantibodies in their blood for years before.
(Antibodies are proteins that destroy bacteria or viruses. Autoantibodies are antibodies ‘gone bad,’ which attack the body’s own tissues.)

Type 2 Diabetes
Type 2 diabetes has a stronger link to family history and lineage than type 1, although it too depends on environmental factors. Studies of twins have shown that genetics play a very strong role in the development of type 2 diabetes. Lifestyle also influences the development of type 2 diabetes. Obesity tends to run in families, and families tend to have similar eating and exercise habits.
If you have a family history of type 2 diabetes, it may be difficult to figure out whether your diabetes is due to lifestyle factors or genetic susceptibility. Most likely it is due to both. However, don’t lose heart. Studies show that it is possible to delay or prevent type 2 diabetes by exercising and losing weight.

Have you recently been diagnosed with type 2 diabetes?

Type 1 Diabetes: Your Child’s Risk
In general, if you are a man with type 1 diabetes, the odds of your child getting diabetes are 1 in 17. If you are a woman with type 1 diabetes and your child was born before you were 25, your child’s risk is 1 in 25; if your child was born after you turned 25, your child’s risk is 1 in 100.
Your child’s risk is doubled if you developed diabetes before age 11. If both you and your partner have type 1 diabetes, the risk is between 1 in 10 and 1 in 4.
There is an exception to these numbers. About 1 in every 7 people with type 1 diabetes has a condition called type 2 polyglandular autoimmune syndrome.
In addition to having diabetes, these people also have thyroid disease and a poorly working adrenal gland. Some also have other immune system disorders. If you have this syndrome, your child’s risk of getting the syndrome including type 1 diabetes is 1 in 2.
Researchers are learning how to predict a person’s odds of getting diabetes. For example, most whites with type 1 diabetes have genes called HLA-DR3 or HLA-DR4.
If you and your child are white and share these genes, your child’s risk is higher. (Suspect genes in other ethnic groups are less well studied. The HLA-DR7 gene may put African Americans at risk, and the HLA-DR9 gene may put Japanese at risk.)
Other tests can also make your child’s risk clearer. A special test that tells how the body responds to glucose can tell which school-aged children are most at risk.
Another more expensive test can be done for children who have siblings with type 1 diabetes. This test measures antibodies to insulin, to islet cells in the pancreas, or to an enzyme called glutamic acid decarboxylase. High levels can indicate that a child has a higher risk of developing type 1 diabetes.

Type 2 Diabetes: Your Child’s Risk
Type 2 diabetes runs in families. In part, this tendency is due to children learning bad habits eating a poor diet, not exercising–from their parents. But there is also a genetic basis.
In general, if you have type 2 diabetes, the risk of your child getting diabetes is 1 in 7 if you were diagnosed before age 50 and 1 in 13 if you were diagnosed after age 50.
Some scientists believe that a child’s risk is greater when the parent with type 2 diabetes is the mother. If both you and your partner have type 2 diabetes, your child’s risk is about 1 in 2.
People with certain rare types of type 2 diabetes have different risks. If you have the rare form called maturity-onset diabetes of the young (MODY), your child has almost a 1-in-2 chance of getting it, too.

Kidney Disease (Nephropathy)
• High blood sugar can overwork the kidneys, causing them to stop working properly.
• When diagnosed early, kidney disease can be slowed with treatment.
• When diagnosed later, kidney failure usually results.
• Once kidneys fail, replacement therapy via dialysis or transplant is necessary.
Kidneys are remarkable organs. Inside them are millions of tiny blood vessels that act as filters. Their job is to remove waste products from the blood.
Sometimes this filtering system breaks down. Diabetes can damage the kidneys and cause them to fail. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease.

How does diabetes cause kidney disease?
When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood. Diabetes can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.
When kidney disease is diagnosed early, (during microalbuminuria), several treatments may keep kidney disease from getting worse. Having larger amounts of protein in the urine is called macroalbuminuria. When kidney disease is caught later (during macroalbuminuria), end-stage renal disease, or ESRD, usually follows.
In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, ESRD, is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).

Who gets kidney disease?
Not everyone with diabetes develops kidney disease. Factors that can influence kidney disease development include genetics, blood sugar control, and blood pressure. The better a person keeps diabetes and blood pressure under control, the lower the chance of getting kidney disease.

What are the symptoms?
The kidneys work hard to make up for the failing capillaries so kidney disease produces no symptoms until almost all function is gone. Also, the symptoms of kidney disease are not specific. The first symptom of kidney disease is often fluid buildup. Other symptoms of kidney disease include loss of sleep, poor appetite, upset stomach, weakness, and difficulty concentrating.
It is vital to see a doctor regularly. The doctor can check blood pressure, urine (for protein), blood (for waste products), and organs for other complications of diabetes.

How can I prevent it?
Diabetic kidney disease can be prevented by keeping blood sugar in your target range. Research has shown that tight blood sugar control reduces the risk of microalbuminuria by one third. In people who already had microalbuminuria, the risk of progressing to macroalbuminuria was cut in half. Other studies have suggested that tight control can reverse microalbuminuria.

Treatments for kidney disease

Self-care
Important treatments for kidney disease are tight control of blood glucose and blood pressure. Blood pressure has a dramatic effect on the rate at which the disease progresses. Even a mild rise in blood pressure can quickly make kidney disease worsen. Four ways to lower your blood pressure are losing weight, eating less salt, avoiding alcohol and tobacco, and getting regular exercise.

Drugs
When these methods fail, certain medicines may be able to lower blood pressure. There are several kinds of blood pressure drugs, however, not all are equally good for people with diabetes. Some raise blood sugar levels or mask some of the symptoms of low blood sugar. Doctors usually prefer people with diabetes to take blood pressure drugs called ACE inhibitors.
ACE inhibitors are recommended for most people with diabetes, high blood pressure, and kidney disease. Recent studies suggest that ACE inhibitors, which include captopril and enalapril, slow kidney disease in addition to lowering blood pressure. In fact, these drugs are helpful even in people who do not have high blood pressure.

Diet
Another treatment some doctors use with macroalbuminuria is a low-protein diet. Protein seems to increase how hard the kidneys must work. A low-protein diet can decrease protein loss in the urine and increase protein levels in the blood. Never start a low-protein diet without talking to your health care team.

Kidney Failure
Once kidneys fail, dialysis is necessary. The person must choose whether to continue with dialysis or to get a kidney transplant. This choice should be made as a team effort. The team should include the doctor and diabetes educator, a nephrologist (kidney doctor), a kidney transplant surgeon, a social worker, and a psychologist.

Ketones
Ketones in the urine is a sign that your body is using fat for energy instead of using glucose because not enough insulin is available to use glucose for energy. Ketones in the urine is more common in type 1 diabetes.

When should I test?
Ask your doctor or nurse when to check for ketones. You may be advised to check for ketones under the following conditions:
• Your blood glucose is more than 300 mg/dl
• You feel nauseated, are vomiting, or have abdominal pain
• You are sick (for example, with a cold or flu)
• You feel tired all the time
• You are thirsty or have a very dry mouth
• Your skin is flushed
• You have a hard time breathing Your breath smells “fruity”
• You feel confused or “in a fog”
These can be signs of high ketone levels that need your doctor’s help.

How do I test?
Urine tests are simple, but to get good results, you have to follow directions carefully. Check to be sure that the strip is not outdated. Read the insert that comes with your strips. Go over the correct way to check with your doctor or nurse.
Here’s how most urine tests go:
• Get a sample of your urine in a clean container.
• Place the strip in the sample (you can also pass the strip through the urine stream).
• Gently shake excess urine off the strip.
• Wait for the strip pad to change color. The directions will tell you how long to wait.
• Compare the strip pad to the color chart on the strip bottle. This gives you a range of the amount of ketones in your urine.
• Record your results.

What do my results mean?
Small or trace amounts of ketones may mean that ketone buildup is starting. You should test again in a few hours. Moderate or large amounts are a danger sign. They upset the chemical balance of your blood and can poison the body. Never exercise when your urine checks show moderate or large amounts of ketones and your blood glucose is high. These are signs that your diabetes is out of control. Talk to your doctor at once if your urine results show moderate or large amounts of ketones.
Keeping track of your results and related events is important. Your log gives you the data you and your doctor and diabetes educator need to adjust your diabetes care plan.

Causes of Hypoglycemia in Diabetes
In people with diabetes, hypoglycemia (low blood sugar) develops when there is not enough sugar (glucose) in your body to be used as fuel for cells. A number of different factors can cause hypoglycemia, including certain medications and diet. Certain medical conditions can also make hypoglycemia more common in people with diabetes.

Symptoms of Hypoglycemia
Most people feel symptoms of hypoglycemia when their blood sugar is 70 mg/dL or lower.
Each person with diabetes may have different symptoms of hypoglycemia. You will learn to recognize yours.
Early symptoms of hypoglycemia may include:
• Confusion
• Dizziness
• Feeling shaky
• Hunger
• Headaches
• Irritability
• Pounding heart; racing pulse
• Pale skin
• Sweating
• Trembling
• Weakness
• Anxiety
Without treatment, more severe hypoglycemia symptoms may develop, including:
• Headache
• Feeling irritable
• Poor coordination
• Poor concentration
• Numbness in mouth and tongue
• Passing out
• Nightmares or bad dreams
• Coma

Diabetes Drugs Linked to Hypoglycemia
Certain types of oral diabetes drugs can cause low blood sugar. These include the sulfonylureas and meglitinides. Alpha-glucosidase inhibitors, biguanides, and thiazolidinediones alone should not cause hypoglycemia but can when used with other diabetes medicines.
The older oral diabetic medications tend to cause low sugar more frequently than newer drugs used to treat type 2 diabetes. Examples of these first generation drugs include:
• Orinase (tolbutamide)
• Tolinase (tolazamide)
• Diabinese (chlorpropamide)
Other diabetes medications that can cause low blood sugars include: glimepiride (Amaryl), Nateglinide (Starlix), Prandin (replaglinide), and sitagliptin (Januvia). Taking these pills alone or in combination can cause low blood sugars to occur.
Other drugs that can cause low blood sugars include the use of alcohol, aspirin, Benemid, Coumadin (warfarin), Zyloprim (allopurinol), or Probalan (probenecid) with diabetic medications.
Hypoglycemia can also occur if you take too much insulin for the amount of carbohydrates consumed.
Ask your health care provider if your medication can cause hypoglycemia.

Diet and Hypoglycemia in Diabetes
Hypoglycemia can occur in someone with diabetes following a meal that contains a lot of simple sugars. This condition is called reactive hypoglycemia. It may also develop if a person with diabetes misses a snack, doesn’t eat the whole meal, eats later than usual, doesn’t eat when ill, or drinks alcohol without eating any food. Therefore, it’s particularly important for people with diabetes to not skip meals, particularly when they’re taking diabetes medications. Intense exercise may also trigger a hypoglycemic reaction.

Hypoglycemia Treatment in Diabetes
If you suspect you have hypoglycemia and have diabetes, check your blood sugar level.
If you have blood sugar levels that frequently drop after meals that have a high content of simple sugars, a way to diminish these episodes of reactive hypoglycemia is through a more balance diet. Avoid simple sugars and eat frequent small meals during the day.
If you experience low blood sugar when you haven’t eaten (fasting hypoglycemia) have a snack before bedtime, such as a protein or a more complex carbohydrate.
Your doctor may determine that you are taking too much insulin that peaks toward the evening to morning hours. In that case, he or she may decrease your insulin dose or change the time when your last dose of insulin is given.
Other things that you can do to help yourself get through the low blood sugar episode start by consuming 15 grams of a fast-acting carbohydrate such as :
• Take two or three glucose tablets (available at pharmacy).
• Take one tube of glucose gel (available at pharmacy).
• Chew four to six pieces of hard candy (not sugar-free).
• Drink 1/2 cup fruit juice.
• Drink 1 cup skim milk.
• Drink 1/2 cup soft drink (not sugar-free).
• Eat 1 tablespoon honey (placed under your tongue for rapid absorption into the bloodstream).
• Eat 1 tablespoon table sugar.
• Eat 1 tablespoon corn syrup.
Fifteen minutes after you have eaten a sugar-containing food, check your blood sugar again. If you do not feel better and your blood sugar is still less than 70 mg/dL (milligrams per deciliter), eat another serving of one of the foods listed above.
Eat a carbohydrate and protein snack such as peanut butter crackers or cheese and crackers, or a half of a sandwich.
Keep a record of the date and time of day your reaction occurred and what you did. This can help your doctor look for a pattern and help you adjust your medications.
Call your health care provider if you have more than one unexplained hypoglycemic reaction in a week.
Hypoglycemia may cause you to pass out. If so, you will need someone to give you a glucagon injection. Glucagon is a prescription medicine that raises blood sugar and may be needed with severe hypoglycemia. It is important that your family members and/or friends know how to give the injection in case you have a low blood sugar reaction. Talk with your health care provider about the use of glucagon.
If you witness a loved one suffering from a severe hypoglycemic reaction, call 911 or take them to the nearest hospital for treatment. Do not try to give an unconscious person food as they may choke.
Note: It is very dangerous to drive during a low blood sugar reaction. If you are driving and you experience symptoms of hypoglycemia, safely pull off the road and eat a glucose-containing (sugary) food. Wait at least 15 minutes and repeat if necessary. Eat a protein and carbohydrate source (such as peanut butter crackers or cheese and crackers) before continuing to your destination. It is important to keep a sugar source, a protein and carbohydrate source in your car at all times for emergencies.

Hypoglycemia Prevention for Those With Diabetes
If you have diabetes, ways you can prevent hypoglycemia include:
• Follow your meal plan.
• Eat at least three evenly spaced meals each day with between-meal snacks as prescribed.
• Plan your meals no more than four to five hours apart.
• Exercise 1/2 to one hour after meals.
• Double-check your insulin and dose of diabetes medicine before taking it.
• Know when your medicine is at its peak level.
• Carry a sugar source with you at all times. It is important to keep a sugar and protein and carbohydrate source in your car for emergencies.
• Test your blood sugar as often as directed by your health care provider.
• Ensure a family member or friend knows how to administer a glucagon injection in severe cases of hypoglycemia when
you may be unconscious.
Prolonged or frequent episodes of low blood sugar present a risk to your health. It is very important to recognize the warning signs of low blood sugar and treat it promptly.
Talk with your health care provider if you have more than one unexplained low blood sugar reaction in the same week.
Wear a medical identification tag (for example, MedicAlert) and/or carry an identification card that states that you have diabetes.

Eye Problems and Diabetes
If you have diabetes, regular visits to your eye doctor for regular exams are important to avoid eye problems. High blood sugar (glucose) increases the risk of eye problems from diabetes. In fact, diabetes is the leading cause of blindness in adults age 20 to 74.
If you have eye problems and diabetes, don’t buy a new pair of glasses as soon as you notice you have blurred vision. It could just be a temporary eye problem that develops rapidly with diabetes and is caused by high blood sugar levels.
High blood sugar in diabetes causes the lens of the eye to swell, which changes your ability to see. To correct this kind of eye problem, you need to get your blood sugar back into the target range (90-130 milligrams per deciliter or mg/dL before meals, and less than 180 mg/dL one to two hours after a meal). It may take as long as three months after your blood sugar is well controlled for your vision to fully get back to normal.
Blurred vision can also be a symptom of more serious eye problem with diabetes. The three major eye problems that people with diabetes may develop and should be aware of are cataracts, glaucoma, and retinopathy.

Cataracts and Diabetes
A cataract is a clouding or fogging of the normally clear lens of the eye. The lens is what allows us to see and focus on an image just like a camera. Although anyone can get cataracts, people with diabetes get these eye problems at an earlier age than most and the condition progresses more rapidly than in people without diabetes.
If you have a cataract, there is a cloudy area in the lens of your eye that results in the inability to focus light, and your vision is impaired. Symptoms of this eye problem in diabetes include blurred or glared vision.
During cataract surgery, the cloudy lens is removed or cleaned out and replaced by a clear man-made lens.

Glaucoma and Diabetes
When fluid inside the eye does not drain properly, it can lead to excess pressure inside the eye. This results in another eye problem with diabetes called glaucoma. The increase in pressure can damage nerves and the blood vessels in the eye, causing changes in vision.
Treatment of open-angle glaucoma — the most common form of glaucoma — requires lowering the eye’s pressure by increasing the drainage of aqueous humor or decreasing the production of the fluid. Medications can accomplish both of these goals.
With open-angle glaucoma, there may be no symptoms of this eye problem at all until the disease is very advanced and there is significant vision loss. In the less common form of this eye problem, symptoms can include headaches, eye aches or pain, blurred vision, watering eyes, halos around lights, and loss of vision.
Treatment of this eye problem in diabetes can include special eye drops, laser procedures, medicine, or surgery. Surgery and laser treatments are directed at improving the eye’s aqueous drainage. You can prevent serious eye problems in diabetes problems by getting an annual glaucoma screening from your eye doctor.
People with diabetes are also more likely to get an uncommon type of glaucoma, called neovascular glaucoma. In this form of glaucoma new blood vessels grow on the iris, the colored part of the eye. These blood vessels block the normal flow of fluid out of the eye, raising the eye pressure. It is difficult to treat. One option is laser surgery to reduce the vessels. Doctors are also studying the use of implants to help drain the fluid.

Diabetic Retinopathy
The retina is a group of specialized cells that convert light as it enters though the lens into images. The eye nerve or optic nerve transmits visual information to the brain.
Diabetic retinopathy is one of the vascular (blood-vessel related) complications related to diabetes. This diabetes eye problem is due to damage of small vessels and is called a “microvascular complication.” Kidney disease and nerve damage due to diabetes are also microvascular complications. Large blood vessel damage (also called macrovascular complications) includes complications like heart disease and stroke.
The microvascular complications have, in numerous studies, been shown to be related to high blood sugar levels. You can reduce your risk of these eye problems in diabetes complications by improving your blood sugar control.
Diabetic retinopathy is the leading cause of irreversible blindness in industrialized nations. The duration of diabetes is the single most important risk for developing retinopathy. So the longer you have diabetes, the greater the risk of this very serious eye problem. If retinopathy is not found early or is not treated, it can lead to blindness.
People with type 1 diabetes rarely develop retinopathy before puberty. In adults with type 1 diabetes, it is also rare to see retinopathy before five years’ duration of diabetes. The risks of retinal damage increase with progressive duration of diabetes. Intensive control of blood sugar levels will reduce your risks of developing retinopathy. The DCCT, a large study of people with type 1 diabetes showed that people with diabetes who achieved tight control of their blood sugars with either an insulin pump or multiple daily injections of insulin were 50%-75% less likely to develop retinopathy, nephropathy (kidney disease), or nerve damage (all microvascular complications).
People with type 2 diabetes usually have signs of eye problems when diabetes is diagnosed. In this case, control of blood sugar, blood pressure, and blood cholesterol with diabetes have an important role in slowing the progression of retinopathy and other eye problems.

Types of Retinopathy in Diabetes:
• Background retinopathy. Sometimes the blood vessel damage exists, but there is no vision problem. This is called background retinopathy. It’s important to carefully manage your diabetes at this stage to prevent background retinopathy from progressing to more serious eye disease.
• Maculopathy. In maculopathy, the person has developed damage in a critical area called the macula. Because this occurs in an area that is critical to vision, this type of eye problem can significantly reduce vision.
• Proliferative retinopathy. New blood vessels start to grow in the back of the eye. Because retinopathy is a microvascular complication of diabetes, a disease of small vessels, this type of retinopathy develops because of an increasing lack of oxygen to the eye from vascular disease. Vessels in the eye are thinned and occluded and they start to remodel.
Here, it is important to address the risks factors that can worsen the occluded vessels. Smoking cessation, high blood pressure control, cholesterol management, and blood sugar control must take place in order to stop the progression of new vessels from forming into the orbit of the eye. These are fragile vessels that can bleed and eventually cause a clot to form in the orbit, which scars and causes detachment of the retina. This eventually leads to irreversible vision loss.
Treatment of diabetic retinopathy may involve laser procedures or surgery. In a study of people with diabetes with early retinopathy, laser therapy to burn the fragile vessel resulted in a 50% reduction of blindness.
To prevent retinopathy with diabetes, have your eye doctor screen your eyes annually. Women with diabetes who later become pregnant should have a comprehensive eye exam during the first trimester and close follow-up with an eye doctor during the rest of their pregnancy to avoid serious eye problems with diabetes. (This recommendation does not apply to women who develop gestational diabetes, since they are not at risk for retinopathy.)

Preventing Eye Problems With Diabetes
Everyone should have regular eye exams, but annual eye exams are particularly important if you have diabetes. A thorough eye exam can help identify a problem early on when it is more easily treated. This can also help prevent further vision loss.
If you are considering pregnancy and have a history of diabetes, you should have an eye exam prior to and possibly during pregnancy. Ask your eye doctor what is right for you. Also, controlling your blood sugar and blood pressure will help prevent eye problems if you have diabetes.

When to Contact Your Doctor About Eye Problems in Diabetes
If you have diabetes, contact your doctor about any eye problems in if any of the following occur:
• Black spots in your vision.
• Flashes of light.
• “Holes” in your vision.
• Blurred vision

Erectile Dysfunction and Diabetes
It is been estimated that about 35%-75% of men with diabetes will experience at least some degree of erectile dysfunction — also called ED or impotence — during their lifetime. .
Men with diabetes tend to develop erectile dysfunction 10 to 15 years earlier than men without diabetes. As men with diabetes age, erectile dysfunction becomes even more common. Above the age of 50, the likelihood of having difficulties with an erection occurs in approximately 50%-60% of men with diabetes. Above age 70, there is about a 95% likelihood of having some difficulty with erectile function.

Why Do Men With Diabetes Have Erectile Dysfunction?
The causes of erectile dysfunction in men with diabetes are complex and involve impairments in nerve, blood vessel, and muscle function.
To get an erection, men need healthy blood vessels, nerves, male hormones, and a desire to be sexually stimulated. Diabetes can damage the blood vessels and nerves that control erection. Therefore, even if you have normal amounts of male hormones and you have the desire to have sex, you still may not be able to achieve a firm erection.

What Treatments Are Available for Men With Diabetes and Erectile Dysfunction?
Men with diabetes having trouble with achieving and/or maintaining an erection can take oral medications like Viagra, Cialis, Stendra, or Levitra.
However, because people with diabetes also tend to have problems with their heart, these medications may not be appropriate and cause dangerous interactions with your heart medicine. Talk to your doctor to determine what treatment is best.
Additional treatments men with diabetes might want to consider include intracavernous injection therapy, vacuum constriction devices, intraurethral therapy, and sex therapy.
So what treatment is best? It depends on many factors including a man’s health and their ability to tolerate the treatment. Have your doctor refer you to a specialist (a urologist) to work with you and determine the best treatment for your situation.

Table Tips
Not everyone with diabetes has the same meal plan or the same nutrition goals. For some, cutting calories is most important. Others may need to limit fat and salt, and eat more foods high in fiber.
Work with your health care team to identify your own goals. Ask about eating out. If you’re planning a special occasion, ask about adding some special food items.
If you eat out a lot, find ways to follow your meal plan as much as possible. Pick a restaurant with a variety of choices to increase your chances of finding the foods you want.

Ordering
When you eat out, order only what you need and want. Know how to make changes in your meal plan in case the restaurant doesn’t have just what you want. Here’s how to order.
• If you don’t know what’s in a dish or don’t know the serving size, ask.
• Try to eat the same portion as you would at home. If the serving size is larger, share some with your dining partner, or put the extra food in a container to go.
• Eat slowly.
• Ask for fish or meat broiled with no extra butter.
• Order your baked potato plain, then top it with a teaspoon of margarine or low-calorie sour cream, and/or vegetables from the salad bar.
• If you are on a low-salt meal plan, ask that no salt be added to your food.
• Ask for sauces, gravy and salad dressings “on the side.” Try dipping your fork tines in the salad dressing, then spear a piece of lettuce. Or add a teaspoon of dressing at a time to your salad. You’ll use less this way.
• Order foods that are not breaded or fried because they add fat. If the food comes breaded, peel off the outer coating.
• Read the menu creatively. Order a fruit cup for an appetizer or the breakfast melon for dessert. Instead of a dinner entree, combine a salad with a low-fat appetizer.
• Ask for substitutions. Instead of French fries, request a double order of a vegetable. If you can’t get a substitute, just ask that the high-fat food be left off your plate.
• Ask for low-calorie items, such as salad dressings, even if they’re not on the menu. Vinegar and a dash of oil or a squeeze of lemon are a better choice than high-fat dressings.
• Limit alcohol, which adds calories but no nutrition to your meal.
Some restaurants will better meet your special needs if you phone ahead. When you make the reservation, ask if your food can be prepared with vegetable oil, low-fat margarine, little salt, no extra sauce or butter, and broiled instead of fried. Or ask to see a copy of the menu in advance so that you know which items would work well with your meal plan.
If you like the healthy choices on a restaurant’s menu, let the manager know. If you want more low-calorie, low-cholesterol choices, say so. Restaurants, like any business, offer what their customers want. They only know what you want if you tell them.

Dining on Time
If you take diabetes pills or insulin shots, it pays to think about when you’ll eat as well as what you’ll eat. You can avoid problems by planning ahead.
• If you’re eating out with others, ask them to eat at your usual time.
• Make your plans so you won’t be kept waiting for a table when you need to be eating.
• Have your reservations and be on time. Avoid the times when the restaurant is busiest so you won’t have to wait.
• Ask whether “special” dishes will take extra time.
• If your lunch or dinner is going to be later than usual, eat a fruit or starch serving from that meal at your usual mealtime.
• If the dinner will be very late, you can eat your bedtime snack at your usual dinner time. Then, eat your full dinner at the later hour. You may need to adjust your insulin to do this.

The Fast Food Challenge
Believe it or not, you can make healthy fast-food choices. How? Know exactly what you are ordering and plan ahead.
Keep the ground rules of good nutrition in mind. Eat a variety of foods in moderate amounts, limit the amount of fat you eat, and watch the amount of salt in food. Follow the guidelines you’ve worked out with your dietitian or doctor.
What you order is the key. It’s easy to eat an entire day’s worth of fat, salt, and calories in just one fast-food meal. But it’s also possible to make wise choices and eat a fairly healthy meal.
Here are some tips to help you choose well.
• Know that an average fast-food meal can run as high as 1000 calories or more, and raise your blood sugar above your target range.
• Know the nutritional value of the foods you order. Although there are some good choices, most fast-food items are high in fat and calories.
• If you’re having fast-food for one meal, let your other meals that day contain healthier foods, like fruits and vegetables.
• Think about how your food will be cooked. Chicken and fish can be good choices – but not if they are breaded and deep fried.
If breakfast is your fast-food meal, choose a plain bagel, toast, or English muffin. Other muffins may be loaded with sugar and fat. Add fruit juice or low-fat or fat-free milk. Order cold cereal with fat-free milk, pancakes without butter, or plain scrambled eggs. Limit bacon and sausage because they are high in fat.

Your order, please?
The fast food we eat may stick around a lot longer than we’d like. It may linger in our bodies as excess blood fats and extra pounds.
• Watch out for words like jumbo, giant, deluxe, biggie-sized or super-sized. Larger portions mean more calories. They also mean more fat, cholesterol and salt. Order a regular or junior-sized sandwich instead.
• Choose grilled or broiled sandwiches with meats such as lean roast beef, turkey or chicken breast, or lean ham. Order items plain, without toppings, rich sauces, or mayonnaise. Add flavor with mustard, and crunch with lettuce, tomato, and onion.
• Skip the croissant or biscuit. Eat your sandwich on a bun, bread or English muffin and save calories and fat.
• Stay away from double burgers or “super” hot dogs with cheese, chili, or sauces. Cheese carries an extra 100 calories per ounce, as well as added fat and sodium.
• Go for the salad bar, but watch out for high-fat toppings like dressings, bacon bits, cheeses, and croutons. Even too much low-calorie dressing can add up. Check the calories on the packet. Also limit salad bar items that are dressed with a lot of mayo, such as potato or macaroni salad. Fill your salad with things like carrots, peppers, onion, celery, broccoli, cauliflower, spinach, and etc.
• Order bean burritos, soft tacos, fajitas, and other non-fried items when eating Mexican fast foods. Choose chicken over beef. Limit refried beans. Or ask if they have beans that aren’t refried. Pile on extra lettuce, tomatoes, and salsa. Go easy on cheese, sour cream, and guacamole. Watch out for deep-fried taco salad shells – a taco salad can have more than 1,000 calories!
• Pizza can be a good fast food choice. Go for thin crust pizza with vegetable toppings. Limit to 1-2 slices. Meat and extra cheese add calories, fat and sodium.
• End your meal with sugar-free, fat-free frozen yogurt or a small cone of fat-free yogurt. Better still, bring a piece of fresh fruit from home. Ices, sorbets, and sherbets have less fat and fewer calories than ice cream. But they are chock full of sugar. They can send your blood sugar too high if you don’t work the extra carbohydrate into your meal plan.
• Be alert for traps. Fat-free muffins for breakfast may have plenty of sugar. Skinless fried chicken can have almost as much fat as the regular kind. Chinese food may seem like a healthy choice, but many dishes are deep fried or high in fat and sodium, especially in the sauces.
Eating out can be one of life’s great pleasures. Make the right choices, ask for what you need, and balance your meals out with healthy meals at home. You can enjoy yourself and take good care of your diabetes at the same time.

The Skinny on Diabetes and Fat
Eating out healthfully is no easy task. From the oversized portions of food to the use of large quantities of fats, oils, sugar and salt for added taste, fast food restaurants can spell trouble, especially for people who struggle with excess weight, diabetes or heart disease.
Fats can make most food taste good and stay moist. So it’s no surprise that restaurants love fat-laden foods that can tempt the taste buds and keep you coming back for more. But there’s no reason you can’t find (or request) healthier options by mastering the craft of being a fat sleuth, according to Hope S. Warshaw, MMSc, RD, CDE, author of the 2nd edition of the American Diabetes Association’s ADA Guide to Healthy Fast-Food Restaurant Eating.

Fat Recommendations for People with Diabetes:
• Keep total fat to 20-35% of your total calorie intake
• Keep saturated fat to less than 7% of total calories
• Keep trans fat consumption as low as possible
• Keep cholesterol intake to less than 200 mg
• Eat two or more servings of fish each week, staying away from fried options As always, ask your doctor or a registered dietitian for help understanding these numbers and tailoring goals that are right for you.
•Read more about fat and diabetes

Here are some things to keep in mind:
• Not all fats are created equal — Whether you’re at your favorite fast food restaurant or cooking at home, you need to know how much and what types of fats are in the foods you eat. Foods have a combination of different fats and cholesterol, including unsaturated fat, saturated fat and trans fats.
A general rule is to limit or avoid the so-called “bad” fats, which include saturated and trans fats, that are known to carry health risks. Over time, these fats can partially or totally block blood vessels to your heart. This is especially concerning for people with diabetes who have a higher-than-average risk of having a heart attack or stroke.
Trans fats, which use artificial ingredients and have long been used as a substitute for saturated fats in baked goods and snacks, fried foods, salad dressings, margarine and other foods, have received a lot of attention lately. New York City became the first large U.S. city to strictly limit trans fats in restaurants, and other states and towns are quickly following
suit.
Bottom line: Although your body needs fat to survive, not all fats are created equal. When you can, stick with “good” fats — the unsaturated fats and omega-3 fatty acids — that offer a great source of energizing fuel.
• Know where fat hides in fast food restaurants.
Remember, harmful fats lurk in:
o high-fat ingredients like butter, sour cream, cream and lard
o high-fat foods such as cheese, bacon or potato chip
o high-fat cooking methods, such as deep-fat frying and breading and frying It’s also found on the table in the form of
Chinese noodles, tortilla chips and butter or oils for breads.
• Make healthy requests that cut the fat.
When you order food, don’t be shy about asking them to hold the potato chips, put the salad dressing on the side, substitute mustard for mayonnaise or swap the usual croissant for whole grain bread instead. Opt for healthier side options like fruits and vegetables. The good news is that some fast food restaurants are now using hearts or other notations to indicate which menu items offer healthier selections.
• Know when your eyes are bigger than your stomach.
Fast food portions are often enough to feed two adults. Try to order less, go for the side dish and learn to leave your ”clean-plate club” membership behind.
Just because you have diabetes doesn’t mean you can’t venture into your favorite fast food spot, but you need to plan ahead and know how to choose healthfully. The Association’s ADA Guide to Healthy Fast-Food Restaurant Eating. provides everything you need to know for food on the go. Along with nutrition information, this compact, easy-to-use guide gives the skills and strategies you need to find healthy meals in the most popular fast-food restaurants in America.

Diabetes Myths
There are many myths about diabetes that make it difficult for people to believe some of the hard facts – such as diabetes is a serious and potentially deadly disease. These myths can create a picture of diabetes that is not accurate and full of stereotypes and stigma. You may also be interested in our book, Diabetes A-Z, 6th Ed.
Recently the American Diabetes Association tested Americans knowledge of common diabetes myths and facts. See how they scored.

Get the facts about diabetes and learn how you can stop diabetes myths and misconceptions.

Myth: Diabetes is not that serious of a disease.
Fact: Diabetes causes more deaths a year than breast cancer and AIDS combined. Two out of three people with diabetes die from heart disease or stroke.

Myth: If you are overweight or obese, you will eventually develop type 2 diabetes.
Fact: Being overweight is a risk factor for developing this disease, but other risk factors such as family history, ethnicity and age also play a role. Unfortunately, too many people disregard the other risk factors for diabetes and think that weight is the only risk factor for type 2 diabetes. Most overweight people never develop type 2 diabetes, and many people with type 2 diabetes are at a normal weight or only moderately overweight.

Myth: Eating too much sugar causes diabetes. .
Fact: The answer is not so simple. Type 1 diabetes is caused by genetics and unknown factors that trigger the onset of the disease; type 2 diabetes is caused by genetics and lifestyle factors.
Being overweight does increase your risk for developing type 2 diabetes, and a diet high in calories from any source contributes to weight gain. Research has shown that drinking sugary drinks is linked to type 2 diabetes.
The American Diabetes Association recommends that people should limit their intake of sugar-sweetened beverages to help prevent diabetes. Sugar-sweetened beverages include beverages like:
• regular soda
• fruit punch
• fruit drinks
• energy drinks
• sports drinks
• sweet tea
• other sugary drinks.
These will raise blood glucose and can provide several hundred calories in just one serving!
See for yourself:
• Just one 12-ounce can of regular soda has about 150 calories and 40 grams of carbohydrate. This is the same amount of carbohydrate in 10 teaspoons of sugar!
• One cup of fruit punch and other sugary fruit drinks have about 100 calories (or more) and 30 grams of carbohydrate.

Myth: People with diabetes should eat special diabetic foods. .
Fact: A healthy meal plan for people with diabetes is generally the same as a healthy diet for anyone – low in fat (especially saturated and trans fat), moderate in salt and sugar, with meals based on whole grain foods, vegetables and fruit. Diabetic and “dietetic” foods generally offer no special benefit. Most of them still raise blood glucose levels, are usually more expensive and can also have a laxative effect if they contain sugar alcohols.

Myth: If you have diabetes, you should only eat small amounts of starchy foods, such as bread, potatoes and pasta. .
Fact: Starchy foods are part of a healthy meal plan. What is important is the portion size. Whole grain breads, cereals, pasta, rice and starchy vegetables like potatoes, yams, peas and corn can be included in your meals and snacks. The key is portions. For most people with diabetes, having 3-4 servings of carbohydrate-containing foods per meal is about right. Whole grain starchy foods are also a good source of fiber, which helps keep your gut healthy.

Myth: People with diabetes can’t eat sweets or chocolate. .
Fact: If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten by people with diabetes. They are no more “off limits” to people with diabetes than they are to people without diabetes. The key to sweets is to have a very small portion and save them for special occasions so you focus your meal on more healthful foods.

Myth: You can catch diabetes from someone else. .
Fact: No. Although we don’t know exactly why some people develop diabetes, we know diabetes is not contagious. It can’t be caught like a cold or flu. There seems to be some genetic link in diabetes, particularly type 2 diabetes. Lifestyle factors also play a part.

Myth: People with diabetes are more likely to get colds and other illnesses. .
Fact: You are no more likely to get a cold or another illness if you have diabetes. However, people with diabetes are advised to get flu shots. This is because any illness can make diabetes more difficult to control, and people with diabetes who do get the flu are more likely than others to go on to develop serious complications.

Myth: If you have type 2 diabetes and your doctor says you need to start using insulin, it means you’re failing to take care of your diabetes properly. .
Fact: For most people, type 2 diabetes is a progressive disease. When first diagnosed, many people with type 2 diabetes can keep their blood glucose at a healthy level with oral medications. But over time, the body gradually produces less and less of its own insulin, and eventually oral medications may not be enough to keep blood glucose levels normal. Using insulin to get blood glucose levels to a healthy level is a good thing, not a bad one.

Myth: Fruit is a healthy food. Therefore, it is ok to eat as much of it as you wish. .
Fact: Fruit is a healthy food. It contains fiber and lots of vitamins and minerals. Because fruits contain carbohydrates, they need to be included in your meal plan. Talk to your dietitian about the amount, frequency and types of fruits you should eat.

DIABETES AND NERVES
Nerve damage from diabetes is called diabetic neuropathy (new-ROP-uh-thee). About half of all people with diabetes have some form of nerve damage. It is more common in those who have had the disease for a number of years and can lead to many kinds of problems.
Over time excess blood glucose can injure the walls of tiny blood vessels that nourish your nerves, especially in the legs. Nerves send messages to and from your brain about pain, temperature and touch. They tell your muscles when and how to move. They also control body systems that digest food and pass urine.
If you keep your blood glucose levels on target, you may help prevent or delay nerve damage. If you already have nerve damage, this will help prevent or delay further damage. There are also other treatments that can help

PERPHERAL NEUROPATHY

Symptoms
Look at the list below and make a note about any symptoms you have. Bring this list to your next office visit.

Tingling
• My feet tingle.
• I feel “pins and needles” in my feet.

Pain or increased sensitivity
• I have burning, stabbing or shooting pains in my feet.
• My feet are very sensitive to touch. For example, sometimes it hurts to have the bed covers touch my feet.
• Sometimes I feel like I have socks or gloves on when I don’t.
• My feet hurt at night.
• My feet and hands get very cold or very hot.

Numbness or weakness
• My feet are numb and feel dead.
• I don’t feel pain in my feet, even when I have blisters or injuries.
• I can’t feel my feet when I’m walking.
• The muscles in my feet and legs are weak.
• I’m unsteady when I stand or walk.
• I have trouble feeling heat or cold in my feet or hands

Other
• It seems like the muscles and bones in my feet have changed shape.
• I have open sores (also called ulcers) on my feet and legs. These sores heal very slowly.

Diagnosis
Foot exams.Your health care provider should look at your feet at each office visit to check for injuries, sores, blisters or other problems. As a reminder, take off your shoes and socks when you’re in the exam room.
Have a complete foot exam once a year. If you already have foot problems, have your feet checked more often. A complete foot exam includes a check of the skin on your feet, your foot muscles and bones, and your blood flow. Your provider will also check for numbness in your feet by touching your foot with a monofilament. It looks like a stiff piece of nylon fishing line or a bristle in a hairbrush.
Other ways to check your nerves include using a tuning fork. It may be touched to your foot to see if you can feel it moving.
Nerve conduction studies and electromyography (EMG).
If the doctor thinks you might have nerve damage, you may have tests that look at how well the nerves in your arms and legs are working. Nerve conduction studies check the speed with which nerves send messages. An EMG checks how your nerves and muscles work together.

Treatment
To treat nerve damage, you will need to keep your blood glucose levels in your target range, manage your pain and protect your feet. Many people get depressed when they have nerve damage and may need medication for depression as well as counseling.
Medications.

Medications to relieve pain and reduce burning, numbness and tingling are available. Some of these are known for their use in other conditions but they still seem to help those with nerve damage. Choices include medications also used for:
• seizure prevention
• depression
• pain
Speak with your doctor to find out what treatments are best for you

AUTONOMIC NEUROPATHY

Autonomic neuropathy affects the autonomic nerves, which control the bladder, intestinal tract, and genitals, among other organs.
Paralysis of the bladder is a common symptom of this type of neuropathy. When this happens, the nerves of the bladder no longer respond normally to pressure as the bladder fills with urine. As a result, urine stays in the bladder, leading to urinary tract infections.
Autonomic neuropathy can also cause erectile dysfunction (ED) when it affects the nerves that control erection with sexual arousal. However, sexual desire does not usually decrease.
Diarrhea can occur when the nerves that control the small intestine are damaged. The diarrhea occurs most often at night. Constipation is another common result of damage to nerves in the intestines.
Sometimes, the stomach is affected. It loses the ability to move food through the digestive system, causing vomiting and bloating. This condition, called gastroparesis, can change how fast the body absorbs food. It can make it hard to match insulin doses to food portions.
Scientists do not know the precise cause of autonomic neuropathy and are looking for better treatments for his type of neuropathy.

Symptoms
This type of nerve damage affects the nerves in your body that control your body systems. It affects your digestive system, urinary tract, sex organs, heart and blood vessels, sweat glands, and eyes. Look at the list below and make a note about any symptoms you have. Bring this list to your next office visit.

About my digestive system
• I get indigestion or heartburn.
• I get nauseous and I vomit undigested food.
• It seems like food sits in my stomach instead of being digested.
• I feel bloated after I eat.
• My stomach feels full, even after I eat only a small amount.
• I have diarrhea.
• I have lost control of my bowels.
• I get constipated.
•My blood glucose levels are hard to predict. I never know if I’ll have high or low blood glucose after eating.

About my urinary tract
• I have had bladder control problems, such as urinating very often or not often enough, feeling like I need to urinate when I don’t, or leaking urine.
• I don’t feel the need to urinate, even when my bladder is full.
• I have lost control of my bladder.
• I have frequent bladder infections.

About my sex organs
• (For men) When I have sex, I have trouble getting or keeping an erection.
• (For women) When I have sex, I have problems with orgasms, feeling aroused, or I have vaginal dryness.

About my heart and blood vessels
• I get dizzy if I stand up too quickly.
• I have fainted after getting up or changing my position.
• I have fainted suddenly for no reason.
• At rest, my heart beats too fast.
• I had a heart attack but I didn’t have the typical warning signs such as chest pain.

About my body’s warning system for low blood glucose levels (hypoglycemia)
• I used to get nervous and shaky when my blood glucose was getting too low, but I no longer have those warning signals.

About my sweat glands
• I sweat a lot, especially at night or while I’m eating.
• I no longer sweat, even when I’m too hot.
• The skin on my feet is very dry.

About my eyes
• It’s hard for my eyes to adjust when I go from a dark place into a bright place or when driving at night.

Diagnosis
To diagnose this kind of nerve damage, you will need a physical exam and special tests as well. For example, an ultrasound test uses sound waves to check on your bladder. Stomach problems can be found using x-rays and other tests. Reporting your symptoms plays a big part in making a diagnosis.

Treatment
There are a number of treatments for damage to nerves that control body systems. For example, a dietitian can help you plan meals if you have nausea or feel full after eating a small amount. Some medications can speed digestion and reduce diarrhea. Problems with erections can be treated with medications or devices.

Additional Types of Neuropathy

Charcot’s Joint
Charcot’s Joint, also called neuropathic arthropathy, occurs when a joint breaks down because of a problem with the nerves. This type of neuropathy most often occurs in the foot.
In a typical case of Charcot’s Joint, the foot has lost most sensation. The person no longer can feel pain in the foot and loses the ability to sense the position of the joint. Also, the muscles lose their ability to support the joint properly. The foot then becomes unstable, and walking just makes it worse. An injury, such as a twisted ankle, may make things even worse. Joints grind on bone. The result is inflammation, which leads to further instability and then dislocation. Finally, the bone structure of the foot collapses. Eventually, the foot heals on its own, but because of the breakdown of the bone, it heals into a deformed foot.
People at risk for Charcot’s Joint are those who already have neuropathy. They should be aware of symptoms such as swelling, redness, heat, strong pulse, and insensitivity of the foot. Early treatment can stop bone destruction and aid healing.

Cranial Neuropathy
Cranial neuropathy affects the 12 pairs of nerves that are connected with the brain and control sight, eye movement, hearing, and taste.
Most often, cranial neuropathy affects the nerves that control the eye muscles. The neuropathy begins with pain on one side of the face near the affected eye. Later, the eye muscle becomes paralyzed. Double vision results. Symptoms of this type of neuropathy usually get better or go away within 2 or 3 months

Compression Mononeuropathy
Compression mononeuropathy occurs when a single nerve is damaged. It is a fairly common type of neuropathy. There seem to be two kinds of damage. In the first, nerves are squashed at places where they must pass through a tight tunnel or over a lump of bone. Nerves of people with diabetes are more prone to compression injury. The second kind of damage arises when blood vessel disease caused by diabetes restricts blood flow to a part of the nerve.
Carpal tunnel syndrome is probably the most common compression mononeuropathy. It occurs when the median nerve of the forearm is compressed at the wrist. Symptoms of this type of neuropathy include numbness, swelling, or prickling in the fingers with or without pain when driving a car, knitting, or resting at night. Simply hanging your arm by your side usually stops the pain within a few minutes. If the symptoms are severe, an operation can give complete relief from pain.

Femoral Neuropathy
Femoral neuropathy occurs most often in people with type 2 diabetes. A pain may develop in the front of one thigh. Muscle weakness follows, and the affected muscles waste away. A different kind of neuropathy that also affects the legs is called diabetic amyotrophy. In this case, weakness occurs on both sides of the body, but there is no pain. Doctors do not understand why it occurs, but blood vessel disease may be the cause.

Focal Neuropathy
Focal Neuropathy affects a nerve or group of nerves causing sudden weakness or pain. It can lead to double vision, a paralysis on one side of the face called Bell’s palsy, or a pain in the front of the thigh or other parts of the body.

Thoracic/Lumbar Radiculopathy
Thoracic or lumbar radiculopath is another common mononeuropathy. It is like femoral neuropathy, except that it occurs in the torso. It affects a band of the chest or abdominal wall on one or both sides. It seems to occur more often in people with type 2 diabetes. Again, people with this neuropathy get better with time.

Unilateral Foot Drop
Unilateral foot drop is when the foot can’t be picked up. It occurs from damage to the peroneal nerve of the leg by compression or vessel disease. Foot drop can improve.

Steps to Prevent or Delay Nerve Damage
There’s a lot you can do to prevent or delay nerve damage. And, if you already have diabetic neuropathy (nerve damage), these steps can prevent or delay further damage and may lessen your symptoms.

Keep your blood glucose levels in your target range.
Meal planning, physical activity and medications, if needed, all can help you reach your target range. There are two ways to keep track of your blood glucose levels:
• Use a blood glucose meter to help you make decisions about day-to-day care.
• Get an A1C test (a lab test) at least twice a year to find out your average blood glucose for the past 2 to 3 months.
Checking your blood glucose levels will tell you whether your diabetes care plan is working or whether changes are needed.
• Report symptoms of diabetic neuropathy.
• If you have problems, get treatment right away. Early treatment can help prevent more problems later on. For example, if you take care of a foot infection early, it can help prevent amputation.
• Take good care of your feet. Check your feet every day. If you no longer can feel pain in your feet, you might not notice a foot injury. Instead, use your eyes to look for problems. Use a mirror to see the bottoms of your feet. Use your hands to feel for hot or cold spots, bumps or dry skin. Look for sores, cuts or breaks in the skin. Also check for corns, calluses, blisters, red areas, swelling, ingrown toenails and toenail infections. If it’s hard for you to see or reach your feet, get help from a family member or foot doctor.
• Protect your feet. If your feet are dry, use a lotion on your skin but not between your toes. Wear shoes and socks that fit well and wear them all the time. Use warm water to wash your feet, and dry them carefully afterward.
• Get special shoes if needed. If you have foot problems, Medicare may pay for shoes. Ask your health care team about it.
• Be careful with exercising. Some physical activities are not safe for people with neuropathy. Talk with a diabetes clinical exercise expert who can guide you.

Diabetes and Heart Disease
For people with diabetes, heart disease is a common and serious health condition. If you have diabetes, it’s important to understand your heart disease risk and what you can do to lower it.

Diabetes and Heart Disease Statistics
Over the years, high blood sugar slowly causes damage to blood vessels throughout the body. This is especially true in the heart and brain. As a result, heart disease and stroke are two of the most important health risks for people with diabetes.
If you or someone you love has diabetes, here are some of the statistics you need to know about heart disease and diabetes:
• Heart disease strikes people with diabetes almost twice as often as people who don’t have diabetes.
• People with diabetes tend to develop heart disease at a younger age than people without diabetes.
• Two out of three people with diabetes die from either heart disease or stroke.
Compared to people without diabetes, people with diabetes are at about two to four times the risk for stroke. Stroke is a serious health risk for people with diabetes. But it affects fewer people overall than heart disease.

Types of Heart Disease in People With Diabetes
People with diabetes are at risk for two main types of heart disease:
Coronary artery disease (CAD). This refers to the slow narrowing of the arteries in the heart by fatty deposits, called plaques. If a cholesterol plaque suddenly ruptures, the resulting blockage in one of the heart’s arteries causes a heart attack.
Congestive heart failure. This is a chronic condition in which the heart loses the ability to pump blood effectively. Shortness of breath with exertion and leg swelling are the main symptoms of heart failure. :
These heart conditions are often related. For instance, CAD is a major cause of congestive heart failure. High blood pressure, common in people with diabetes, can also contribute to CAD and heart failure.

Risk Factors for Heart Disease and Diabetes
Certain risk factors elevate the risk of heart disease, especially in people with diabetes.
Many people with diabetes have a group of risk factors for heart disease known as metabolic syndrome. And having diabetes as part of metabolic syndrome increases the risk of heart disease even more than diabetes alone. Metabolic syndrome adds several risk factors to the risk of high blood sugar, including:
• Abdominal obesity — a waistline greater than 35 inches in women or 40 inches in men.
• Abnormal cholesterol levels — a low HDL “good” cholesterol, a high LDL “bad” cholesterol, or a high triglyceride level.
• Elevated blood pressure.
All these risk factors are related, and they tend to occur together. For example, obesity makes diabetes more likely, and most people with diabetes also have high blood pressure. In addition, other factors can increase the risk of heart disease for people with diabetes even more. They include:
• Smoking
• Having a family member with heart disease
• A diet high in saturated fat and cholesterol
If you have diabetes, talking with your doctor can help identify your personal risk for heart disease.

Preventing Heart Disease by Managing Your Diabetes
To make sure your diabetes treatment is working, experts recommend following the “ABCs”:
• A1c: This is a blood test that provides a rough assessment of blood sugar control for the previous three months. An A1c level less than 7 is ideal for most people with diabetes.
• Blood pressure: Most people with diabetes should maintain a blood pressure below 130 over 80.
• Cholesterol: An LDL less than 100 and an HDL greater than 40 are the goals for most people with diabetes.
If you smoke and have diabetes, it’s time to quit. Set a quit date and talk to your doctor. And don’t be discouraged if you’ve tried to quit before but didn’t succeed. New treatments can increase your chances of quitting for good.
Nearly everyone with diabetes can benefit from increasing physical activity. Going for a daily walk is one of the easiest and most effective ways to reduce your risk for heart disease. Exercise also helps keep blood sugar under better control.
Some people with diabetes should take a daily aspirin to protect against heart disease. Your doctor can tell you if daily aspirin is right for you.

Diabetes and Foot Problems
For people with diabetes, having too much glucose (sugar) in their blood for a long time can cause some serious complications, including foot problems.

How Can Diabetes Affect My Feet?
Diabetes can cause two problems that can affect your feet:
• Diabetic neuropathy. Uncontrolled diabetes can damage your nerves. If you have damaged nerves in your legs and feet, you might not feel heat, cold, or pain. This lack of feeling is called “sensory diabetic neuropathy.” If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected. The muscles of the foot may not function properly, because the nerves that make the muscles work are damaged. This could cause the foot to not align properly and create too much pressure in one area of the foot. It is estimated that up to 10% of people with diabetes will develop foot ulcers. Foot ulcers occur because of nerve damage and peripheral vascular disease.
• Peripheral vascular disease. Diabetes also affects the flow of blood. Without good blood flow, it takes longer for a sore or cut to heal. Poor blood flow in the arms and legs is called “peripheral vascular disease.” Peripheral vascular disease is a circulation disorder that affects blood vessels away from the heart. If you have an infection that will not heal because of poor blood flow, you are at risk for developing ulcers or gangrene (the death of tissue due to a lack of blood).

What Are Some Common Foot Problems With Diabetes?
Anyone can get the foot problems listed below. For people with diabetes, however, these common foot problems can possibly lead to infection and serious complications, such as amputation.
• Athlete’s foot . Athlete’s foot is a fungus that causes itching, redness, and cracking. Germs can enter through the cracks in your skin and cause an infection. Medicines that kill the fungus are used to treat athlete’s foot. These medicines may be pills and/or creams applied directly to the problem area. Ask your doctor to recommend a medication for athlete’s foot.
• Fungal infection of nails. Nails that are infected with a fungus may become discolored (yellowish-brown or opaque), thick and brittle, and may separate from the rest of the nail. In some cases, the nail may crumble. The dark, moist, and warm environment of shoes can promote fungal growth. In addition, an injury to the nail can put you at risk for a fungal infection. Fungal nail infections are difficult to treat. Medications applied directly to the nail are available, but they only help a small number of fungal nail problems. Oral medications (pills) may need to be prescribed by your doctor. Treatment also may include periodic removal of the damaged nail tissue.
• Calluses. A callus is a build-up of hard skin, usually on the underside of the foot. Calluses are caused by an uneven distribution of weight, generally on the bottom of the forefoot or heel. Calluses also can be caused by improperly fitting shoes or by a skin abnormality. Keep in mind that some degree of callus formation on the sole of the foot is normal. Proper care is necessary if you have a callus. After your bath or shower, use a pumice stone to gently remove the build-up of tissue. Use cushioned pads and insoles in your shoes. Medications also may be prescribed to soften calluses. DO NOT try to cut the callus or remove it with a sharp object.
• Corns. A corn is a build-up of hard skin near a bony area of a toe or between toes. Corns may be the result of pressure from shoes that rub against the toes or cause friction between the toes. Proper care is necessary if you have a corn. After your bath or shower, use a pumice stone to gently remove the build-up of tissue. Do not use over-the-counter remedies to dissolve corns. DO NOT try to cut the corn or remove it with a sharp object.
• Blisters. Blisters can form when your shoes rub the same spot on your foot. Wearing shoes that do not fit properly or wearing shoes without socks can cause blisters, which can become infected. When treating blisters, it’s important not to “pop” them. The skin covering the blister helps protect it from infection. Use an antibacterial cream and clean, soft bandages to help protect the skin and prevent infection.
• Bunions. A bunion forms when your big toe angles in toward the second toe. Often, the spot where your big toe joins the rest of the foot becomes red and callused. This area also may begin to stick out and become hard. Bunions can form on one or both feet. They may run in the family, but most often are caused by wearing high-heeled shoes with narrow toes. These shoes put pressure on the big toe, pushing it toward the second toe. The use of felt or foam padding on the foot may help protect the bunion from irritation. A device also may be used to separate the big and second toes. If the bunion causes severe pain and/or deformity, surgery to realign the toes may be necessary.
• Dry skin. Dry skin can crack, which can allow germs to enter. Use moisturizing soaps and lotions to help keep your skin moist and soft.
• Foot ulcers. A foot ulcer is a break in the skin or a deep sore, which can become infected. Foot ulcers can result from minor scrapes, cuts that heal slowly or from the rubbing of shoes that do not fit well. Early intervention is important in treatment. Ask your doctor for advice on how to best care for your wound.
• Hammertoes. A hammertoe is a toe that is bent because of a weakened muscle. The weakened muscle makes the tendons (tissues that connect muscles to bone) shorter, causing the toes to curl under the feet. Hammertoes can run in families. They can also be cause by shoes that are too short. Hammertoes can cause problems with walking and can lead to other foot problems, such as blisters, calluses, and sores. Splinting and corrective footwear can help in treating them. In severe cases, surgery to straighten the toe may be necessary.
• Ingrown toenails. Ingrown toenails occur when the edges of the nail grow into the skin. They cause pressure and pain along the nail edges. The edge of the nail may cut into the skin, causing redness, swelling, pain, drainage, and infection. The most common cause of ingrown toenails is pressure from shoes. Other causes include improperly trimmed nails, crowding of the toes and repeated trauma to the feet from activities such as running, walking, or doing aerobics. Keeping your toenails properly trimmed is the best way to prevent ingrown toenails. If you have a persistent problem or if you have a nail infection, you may need a doctor’s care. Severe problems with ingrown nails may be corrected with surgery to remove part of the toenail and growth plate.
• Plantar warts . Plantar warts look like calluses on the ball of the foot or on the heel. They may appear to have small pinholes or tiny black spots in the center. The warts are usually painful and may develop singly or in clusters. Plantar warts are caused by a virus that infects the outer layer of skin on the soles of the feet. DO NOT use over-the-counter medications to dissolve the wart. If you are not sure if you have a plantar wart or a callus, let your doctor decide

Can These Foot Problems Be Prevented?
Proper foot care can help prevent these common foot problems and/or treat them before they cause serious complications. Here are some tips for good foot care:
1.  Take care of yourself and your diabetes. Follow your health care provider’s advice regarding nutrition, exercise, and medication. Keep your blood sugar level within the range recommended by your doctor.
2.  Wash your feet in warm water every day, using a mild soap. Test the temperature of the water with your elbow, because nerve damage can affect sensation in your hands, too. Do not soak your feet. Dry your feet well, especially between the toes.
3.  Check your feet every day for sores, blisters, redness, calluses, or any of the other problems listed above. If you have poor blood flow, it is especially important to do a daily foot check.
4.  If the skin on your feet is dry, keep it moist by applying lotion after you wash and dry your feet. Do not put lotion between your toes. Your doctor can tell you which type of lotion is best to use.
5.  Gently smooth corns and calluses with an emery board or pumice stone. Do this after your bath or shower, when your skin is soft. Move the emery board in only one direction.
6.  Check your toenails once a week. Trim your toenails with a nail clipper straight across. Do not round off the corners of toenails or cut down on the sides of the nails. After clipping, smooth the toenails with a nail file.
7.  Always wear closed-toed shoes or slippers. Do not wear sandals and do not walk barefoot, even around the house.
8.  Always wear socks or stockings. Wear socks or stockings that fit your feet well and have soft elastic.
9.  Wear shoes that fit well. Buy shoes made of canvas or leather and break them in slowly. Extra wide shoes are also available in specialty stores that will allow for more room for the foot for people with foot deformities.
10.  Always check the inside of shoes to make sure that no objects are left inside by mistake.
11.  Protect your feet from heat and cold. Wear shoes at the beach or on hot pavement. Wear socks at night if your feet get cold.
12.  Keep the blood flowing to your feet. Put your feet up when sitting, wiggle your toes and move your ankles several times a day, and don’t cross your legs for long periods of time.
13.  If you smoke, stop. Smoking can make blood flow problems worse.                                                                                                                                           14.  If you have a foot problem that gets worse or won’t heal, contact your doctor for advice and treatment.
15.  Make sure your diabetes doctor examines your feet during each check-up. An annual foot exam should be performed that includes an inspection of the skin, a check of the temperature of your feet, and an assessment of the sensation to the foot.
See your podiatrist (foot doctor) every two to three months for check-ups, even if you don’t have any foot problems.

When Should I Contact My Doctor if I Have Diabetes?
If you have diabetes, contact your doctor if you experience any of the following problems:
•  Changes in skin color
•  Changes in skin temperature
•  Swelling in the foot or ankle
•  Pain in the legs
•  Open sores on the feet that are slow to heal or are draining
•  Ingrown toenails or toenails infected with fungus
•  Corns or calluses
•  Dry cracks in the skin, especially around the heel
•  Unusual and/or persistent foot odor

Diabetes and Exercise
Exercise is very important in managing type 2 diabetes. Combining diet, exercise, and medicine (when prescribed) can help control your weight and blood sugar level.
Exercise helps control type 2 diabetes by:
• Improving your body’s use of insulin
• Burning excess body fat, helping to decrease and control weight (decreased body fat results in improved insulin sensitivity)
• Improving muscle strength
• Increasing bone density and strength
• Lowering blood pressure
• Helping to protect against heart and blood vessel disease by lowering ‘bad’ LDL cholesterol
• Improving blood circulation and reducing your risk of heart disease
• Increasing energy level and enhancing work capacity
• Reducing stress, promoting relaxation, and releasing tension and anxiety

How Does Exercise Affect Blood Sugar Levels?
Normally, insulin is released from the pancreas when the amount of sugar (glucose) in the blood increases, such as after eating. Insulin stimulates the liver and muscles to take in excess glucose. This results in a lowering of the blood sugar level.
When exercising, the body needs extra energy or fuel (in the form of glucose) for the exercising muscles. For short bursts of exercise, such as a quick sprint to catch the bus, the muscles and the liver can release stores of glucose for fuel. With continued moderate exercising, however, your muscles take up glucose at almost 20 times the normal rate. This helps lowers blood sugar levels. AT the same time insulin levels may drop in anyone not taking insulin so the risks of hypoglycemia or low blood sugar is minimized.
But intense exercise can have the opposite effect and actually temporarily increase your blood glucose levels right after you stop exercising. This is especially true for many people with diabetes. The body recognizes intense exercise as a stress and releases stress hormones that tell your body to increase available blood sugar to fuel your muscles. If you have diabetes you may need to check your sugar after exercise to see if this happens to you.

Is Blood Sugar Ever Too High to Exercise?
Yes. In some cases, you should hold off on exercising if your blood sugar is very high. Ask your doctor about if and when you should hold off on exercise.

What Types of Exercise Are Best for Diabetes?

While most any exercise is healthy for people with diabetes, let’s look at some specific types of exercise and their benefits:

Strength Training and Type 2 Diabetes
The latest findings show that exercise such as strength training has a profound impact on helping people manage their diabetes. In a recent study of Hispanic men and women, 16 weeks of strength training produced dramatic improvements in sugar control that are comparable to taking diabetes medication. Additionally, the study volunteers were stronger, gained muscle, lost body fat, had less depression, and felt much more self-confident.
For more detail, see WebMD’s article Strength Training and Diabetes.

Aerobic Fitness and Type 2 Diabetes
Any activity that raises your heart rate and keeps it up for an extended period of time will improve your aerobic fitness. Aerobic exercise helps decrease the risk of type 2 diabetes and helps those with diabetes to better manage their blood sugar levels. Besides the health benefits, exercise is fun and boosts your mood. It’s hard to feel stressed when you’re walking on a treadmill or swimming laps in a pool.

Type 2 Diabetes and Exercise Tips
• To reduce the risk of hypoglycemia if you have diabetes, follow a regular routine of exercising, eating your meals, and taking your medicines at the same time each day.
• Prolonged or strenuous exercise can cause your body to produce adrenaline and other hormones that can counteract the effects of insulin and cause your blood sugar to rise. If you are participating in strenuous exercise (exercising at your maximum capacity) or prolonged exercise (lasting for several hours or more), your insulin and/or oral diabetic medicine or your calories may need to be changed. Talk to your health care provider about how to adjust your medicine.
• Be careful exercising when your medicine is reaching its peak effect.
• Depending on the time of exercise, reducing your dose of either long-acting insulin or short-acting insulin may be necessary. Your doctor can recommend how to make this adjustment.
• Exercise with someone who knows you have diabetes and knows what to do if you have a low blood-sugar reaction.
• Wear a medical identification tag (for example, MedicAlert) or carry an identification card that states you have diabetes.
• Check your sugars before, during and after exercise and always carry a small carbohydrate snack such as a fruit or fruit drink since low blood sugars can occur.

More Diabetes-Specific Exercise Tips
The American Diabetes Association offers these basic exercise guidelines for those with diabetes:
• Discuss with your doctor what types of exercise might be appropriate for you. Complications of diabetes such as severe eye disease and nerve damage may make some forms of exercise dangerous for you. Your doctor may also schedule a test to see how your heart responds to exercise.
• Do not exercise if you have type 1 diabetes and your blood sugar is greater than 250 mg/dL (milligrams per deciliter) and your ketones are positive. This is an indication that you already may have a lack of insulin and exercise will only cause a greater rise in your blood sugar. Hydrate yourself and adjust your insulin as necessary, contact your health care provider.
• Use caution when exercising if your blood sugar is greater than 300 mg/dL without evidence of ketones. Exercise may help decrease your sugars, but it’s possible they will increase instead. Hydrate well prior to and after exercise and keep track of your sugars and ketones.
• Learn the effects of various types of exercise on your blood sugar.
• Have carbohydrate-based foods available for exercise and for the period following exercise. Add some carbohydrates to your meals if you plan on doing exercise, adjust your insulin dose appropriately in anticipation of exercise.

General Exercise Guidelines and Precautions
• If you have diabetes, check with your health care provider before you begin an exercise program. Tell your doctor what kind of exercise you want to do so adjustments can be made to your medicine schedule or meal plan, if necessary.
• Start slowly and gradually increase your endurance.
• Choose an activity that you enjoy. You’ll be more likely to stick with a program if you enjoy the activity. Make exercise a lifetime commitment.
• Consider a water exercise program. Some other exercise options include walking, riding a stationary bicycle, or swimming.
• Exercise at least three to four times per week for about 30 minutes each session. Ideally, you should exercise every day. A good exercise program should include a 5- to 10-minute warm-up and at least 15 to 30 minutes of continuous aerobic exercise (such as walking or biking) followed by a 5-minute cool down.
• Add muscle strengthening or resistance exercises to your routine 2 or 3 times a week.
• Wear good shoes and practice proper foot care.
• Drink water before, during, and after exercise to prevent dehydration.
Do not ignore pain — discontinue any exercise that causes unexpected pain. If you continue to perform the activity while you are in pain, you may cause unnecessary stress or damage to your joints.

Should I Stop Exercising When I Reach My Ideal Weight?
Exercise is a lifetime commitment. Regardless of your weight, you should exercise at least 150 minutes a week spread out over at least three days. Ideally, you should not go more than two days without exercising.

THE BASICS

1. Create a supply checklist.
Write down everything you’ll need to stay healthy to ensure that you don’t forget important items, especially when you’re in a rush to get out the door.

2. Keep a small travel bag with you at all times.
The American Diabetes Association (ADA) recommends that you keep a bag stocked with these items:
• Insulin and as many syringes as you’ll need for the trip (and a disposal container for storing used syringes and test strips)
• Blood and urine testing supplies (with extra batteries and strips for your glucose meter)
• Oral medications with the prescription labels attached (extras are a good idea)
• Other medications, such as antibiotic ointment, anti-nausea drugs, etc.
• Your ID and diabetes identity card, as well as your doctor’s emergency number
• A well-wrapped snack pack containing crackers, cheese, peanut butter, fruit, raisins, a juice box, and some form of sugar (such as candy or glucose tablets) to treat low blood sugar levels
• A portable meal (that doesn’t require refrigeration) in case of unexpected delays

3. Pack workout clothing.
That way you’ll be ready to exercise, wherever you are. Most hotels have facilities for guests but require proper clothing. Ask the hotel staff or locals about safe places to walk and other active pursuits in the area.

4. Wear comfortable shoes.
They’ll help you walk briskly – and ache-free – through airports, train stations or cruise ships. Plus, once you reach your destination, use them for sightseeing on foot.

5. Don’t neglect your blood-sugar monitoring.
No matter how long you’ll be traveling, test your blood glucose as frequently as your doctor recommends. Regular monitoring can help you catch potential problems early, thus preventing highs and avoiding lows.

AT THE AIRPORT

Traveling by air can be stressful, especially if you have diabetes-related items to keep in tow.
Fortunately, the Transportation Security Administration (TSA) allows people with diabetes to carry testing supplies and medications in their hand luggage.

6. Keep anything vital in your carry-on.
More than two million bags were reported lost or mishandled by the airlines last year. If your checked luggage ends up lost, you don’t want to be without important medications, syringes and blood-testing supplies.

7. Tell the security screener you have diabetes and are carrying supplies.
The TSA allows people with diabetes to carry these items on the plane:
• Insulin and insulin-loaded dispensing products (vials or a box of individual vials, jet injectors, biojectors, epipens, infusers, and preloaded syringes)
• Unlimited number of unused syringes when accompanied by insulin or other injectable medication
• Lancets, blood glucose meters, blood glucose meter test strips, alcohol swabs, meter-testing solutions
• Insulin pump and insulin pump supplies (cleaning agents, batteries, plastic tubing, infusion kit, catheter, and needle); insulin pumps and supplies must be accompanied by insulin
• Glucagon emergency kit
• Urine ketone test strips
• Unlimited number of used syringes when transported in Sharps disposal container or other similar hard-surface container
For more diabetes travel regulations, see the TSA website. The agency also has information about taking liquids through airport security and how best to present them.
Each airline may enforce security measures differently, so check with yours before you leave.

8. Identify your insulin and syringes with the proper manufacturer’s label.
You may need to prove that what you’re carrying is insulin. The Federal Aviation Administration (FAA) says you should bring the box that your insulin came in (or the plastic bag your boxes came in, if your insulin is from a mail-order pharmacy).
These packages should have a “professional, pharmaceutical preprinted label which clearly identifies the medication.”

9. Make special arrangements before your flight.
Ask for an aisle seat if you plan to use the restroom for insulin injections. If the flight has meal service and you’re on a special diet, notify the airline at least 24 hours ahead.
If no food is offered on the flight, bring your own healthy meal on board.

10. Tell the flight attendant that you have diabetes, especially if you’re traveling alone.
You may need help if your blood glucose levels go too low.

11. Drink plenty of water.
Dehydration is common because cabin air has a much lower humidity level than a typical indoor environment. It can cause mild discomfort, scratchy eyes, fatigue and breathing problems for people with respiratory conditions, such as asthma. Drink water to stay hydrated, but avoid alcoholic and caffeinated beverages throughout the flight.

WHEN TRAVELING ABROAD

Because prescriptions can differ from country to country, take precautions if you’re traveling internationally and bringing diabetes medication.

12. Consult your doctor before you leave on your trip.
Ask your doctor for prescriptions and a letter that explains your diabetes medications, supplies and allergies, the ADA advises. This way, pharmacists or physicians in other countries can provide them for you in an emergency.
Some drugs may not be available in the country you’re traveling to. And even if they are, they may have different names or come in other strengths.

13. Get extra supplies from your pharmacist.
Keep a two-week supply of medications with you at all times, along with supplies you can store in a separate bag in case your luggage is lost or stolen.

14. Store all medications in an air-tight, insulated case.
This will protect them from exposure to extreme temperatures or humidity.

15. Wear an ID bracelet.
Also, stash an ID card in your wallet that identifies you as someone with diabetes. The identification should be written in the languages of the places you are visiting.

16. Plan for time-zone changes.
Make sure you’ll always know when to take your diabetes medicine, no matter where you are. If you wear a watch with two time displays, keep one set to your home time. Eastward travel means a shorter day, so you may need less insulin, according to the National Diabetes Education Program. Heading westward, you could need more.

WHEN DINING OUT

When you’re on a strict diabetes diet, navigating an unfamiliar restaurant menu can be difficult. The key is to be prepared and feel comfortable asking for what you need.

17. Be vocal.
Ask about the ingredients of menu items to avoid post-meal highs or lows that can ruin your day. Also, find out how food has been prepared, and request sauces and salad dressing on the side so you can control the amount on your food.
Some chefs are annoyed by special requests, so make sure the server understands the requests are for medical reasons.

18. Choose the right restaurant.
Read the menu – it’s often posted outside by the entrance – and decide if you have enough healthy, lower-fat choices before you sit down.
You also can call the restaurant, have a menu faxed to you, look it up on the Internet or ask your concierge if the hotel has a menu collection.
Many chain restaurants post calories and other nutritional information, either at the restaurant or online.
In fact, a new federal law requires that all U.S. restaurants with 20 or more locations post calorie counts for all items on menus, drive-through boards and even on vending machines or glass displays. Additional information, including carbohydrate and sodium levels, must also be available on request.

19. Balance your restaurant meal with food choices the rest of the day.
Save most of your calories and fat choices for when you’re dining out.

20. Look for low-fat words.
Fish that is broiled or baked usually has less than 5 grams of fat per ounce. Also good for you: “grilled,” “baked,” “braised,” “broiled,” “poached,” “roasted” or “steamed.”
Avoid foods described with the words “fried,” “breaded,” “buttered,” “creamed,” “sautéed,” “scalloped,” or served “with gravy” or a “thick sauce.”