By: Dr. Syeda Arzinda Fatima

Tips

  • Question: How should I choose the best glucometer for myself?

Answer: There are lot of models available. You should ask your diabetes educator for assistance. It is better if you choose a glucometer that is:

  1. Accurate
  2. Takes less time to display rsults
  3. Strip is easily available and easy to handle.
  4. Large display screen
  5. Long battery life and warranty.
  • Question: Should I tell my co-workers that I have diabetes?

Answer: It is very important that your friends and co-workers know about your disease so they can detect symptoms of hypoglycemia and help you when needed. They should also know your special dietary needs and they can cover you on sick days.  

  • Question: Does my anti-depressant medicine interfere with blood sugar control?

Answer: No, anti-depressant medicines do not directly interfere with diabetes medicines or insulin. On the other hand if you are depressed, your blood sugar level will go up due to certain hormonal mechanisms. You will not eat properly or exercise routinely if you are depressed. Diabetes can cause depression sometime that can be managed by effective counseling and life style changes.  

  • Question: Can diabetic patient get pregnant?

Answer: yes! Diabetic women can conceive. They have to maintain very good control of blood glucose during pregnancy. Frequent visits to doctor to monitor baby’s growthare required. Follow proper diet and exercise pattern. Most diabetes medicines are not safe in pregnancy so diabetes is controlled with insulin during pregnancy. Also read article “ pregnancy and diabetes” on www.sugartoday.info  

  • Question: Can diabetic kidney disease worsen during pregnancy?

Answer: Diabetes can adversely affect the kidneys, more proteins will be excreted in urine. Kidney disease will reverse after delivery of the baby. There is risk of still birth, premature delivery and small size of baby if mother has diabetic kidney disease. You have to strictly monitor blood glucose and blood pressure during pregnancy to prevent serious complications.  

  • Question:Will steroids for asthma affects my blood glucose level?

Answer: Prednisolone or other steroids are sometimes used temporarily to control asthma or other respiratory problems. They tend to raise blood glucose by acting on the same principle as the stress hormone ‘cortisol’ by mobilizing more glucose from stores in the body. To deal with this situation your doctor will increase the dose of diabetes medicines or insulin for the time you are taking steroids. The blood glucose level will come back to normal 1-2 days after stopping steroids.

  • Question: How is blood sugar affected during any illness?

Answer: During any illness like fever, common cold, flu etc blood glucose level will increase despite the fact that you are eating less during illness. This is because stress hormones like cortisol are released during illness that tends to raise blood glucose level. So do not stop taking diabetes medicine or insulin during sick days, in fact you should check blood glucose and urine ketones every 4 hours when you are sick. If blood glucose is high you need to increase dose of insulin.

  • Question:Why is my HbA1c high when my fasting blood glucose is normal?

Answer: HbA1c gives you an average record of blood glucose over a period of 3 months. Whereas fasting blood glucose is the level at that point in time when you check blood glucose. Even when your fasting glucose is normal, there may be other times when your blood glucose is high for example 2 hours after a meal or during the night. You can check several times during the day or night to find out when your blood glucose is higher than normal and then work with your doctor to adjust meals or medicine dose to maintain proper steady control.

  • Question:Why do I sweat profusely while eating food even when it is not spicy?

Answer: After some years of uncontrolled diabetes, a complication called autonomic neuropathy develops. One of its symptoms is gustatory sweating in which patient starts to sweat while eating food. The cause is nerve damage due to long standing diabetes. There is no specific medicine to treat this condition. You should keep good control of blood glucose and avoid certain foods that cause more sweating

  • Question: Why do I get dizzy when I stand up?

Answer: After many years of uncontrolled diabetes, autonomic neuropathy develops, that is damage to nerves supplying various organs. As a result when you stand up suddenly your heart and blood vessels cannot regulate your blood pressure. Blood pools down in the legs due to gravity and blood pressure drops which makes you feel dizzy. This is also called postural hypotension. The best advice is to change postures slowly, when you stand up from sitting or lying position, do it slowly. There are also some medicines to control this but they can have harmful effect in heart patients.

  • Question:Why do I have leg pain when I walk?

Answer: The blood vessels supplying your legs tend to become narrow with time in diabetic patients. This leads to inadequate blood supply to leg muscles when you walk hence the pain. This pain is relieved when you take rest. This is called intermittent claudication. Your doctor will advise you to walk till you start having pain in legs then rest for few minutes and then start walking again, in this way you can increase your pain free walking distance gradually. Another reason can be sore muscles due to fatigue, such pain will improve with rest.  

  • Question: Why do my feet burn at night?  

Answer: The burning sensation in feet is caused by painful peripheral neuropathy. It is due to damage to nerves supplying your feet caused by persistent high blood glucose level. Some patients also experience pins and needle sensation or leg cramps. These symptoms are more pronounced at night because there is nothing else to distract you at that time. It can be prevented by maintaining good glucose control. Once developed, neuropathy can benefit from anti-depressant medicines, vitamins or capsaicin cream (made from chilies)

  • Question: Can I eat chocolate when I have hypoglycemia?

Answer: Many diabetics love chocolate so they save it as a treat to eat during hypoglycemia episode. It can be used but chocolate is rich in fats that digest slowly and raise the blood glucose level slowly and for longer time. whereas during hypoglycemia emergency, you need to raise blood glucose level urgently, so you need foods like juice, honey, sugar that have high glycemic index and raise blood glucose within minutes.  

  • Question: Why does my blood sugar soar too high after I treat hypoglycemia?

Answer: When you have low blood sugar, your body releases hormones that try to raise blood sugar by releasing stored glucose or fats in the body. Secondly, when you eat something sweet to treat hypoglycemia, it may be more than what is required. Both factors combined together can raise blood glucose more than required. It is advised to take only 15-20 gram carbohydrates like half a glass of juice or glucose tablets and recheck blood glucose level after 15-20 min to see if it is corrected.

  • Question: Why is it important to warm up before exercise and cool down after finishing exercise?

Answer: When you start exercise, you should warm up your muscles for 5 min by gentle stroll or stretching the joints, it increases blood flow to the joints, gradually increases your heart rate to 20% of your target level. Then start your routine exercise. Warm up will reduce the chance of injury to muscles or joints during exercise. After exercise, aerobics or brisk walk, you need a 5 min period of cool down and stretching of all joints of the body. It will prevent sore muscles after exercise and help the heart rate return to normal after exercise

  • Question: Can I prevent eye disease by keeping tight control of blood glucose?

Answer: When your blood glucose comes down to normal, you may feel temporary blurring of vision or worsening of eye disease but it will improve with time. In the long run good control of blood glucose will prevent progression and worsening of eye disease (retinopathy). It is proved from results of two large studies, DCCT (diabetes control and complication trial) and UKPDS (United Kingdom prospective diabetes study)  

  • Question: Can insulin and diabetes medicines cause weight gain?

Answer: When your blood glucose level is too high you are excreting glucose in urine, in that way number of calories is lost, and so you lose weight. But in the long term it damages the kidneys and other vital organs. When you start insulin or medicines o sulphonylurea group ( glibenclamide, gliclazide, glipizide) you may gain weight initially as urine glucose loss is stopped. Insulin is an anabolic hormone that builds up muscles by protein deposition so you may gain few pounds. But you can maintain your weight by reducing diet and increasing exercise

  • Question: Why has my doctor prescribed cholesterol lowering drugs even when my cholesterol level is not so high?

Answer: People with diabetes have a high risk of developing heart disease as compared to rest of population. High cholesterol level is another risk factor for heart disease, so it is highly recommended that all diabetics should be given lipid lowering drugs even if their cholesterol level is only border-line high.

  • Question: How often should a diabetic patient visit the doctor?

Answer: It depends on your duration of diabetes, presence of complications, and your ability to adjust your treatment dose according to your blood glucose level. Generally diabetic patients should visit their doctor every 3-6 months. On each visit they should repeat HbA1c test to access their control. Get your eye examination once a year. Test for renal functions and lipid profile should be repeated yearly. If there is a query or unexpected illness in between this period, you can contact your primary doctor or diabetes educator earlier.

  • Question: Why should I take special care of my feet if they don’t hurt?

Answer: Some diabetic patients have diabetic neuropathy that numbs the nerves of their feet. As a result they don’t feel pain. They can burn their feet by soaking in warm water or walking bare foot on hot floors. They can develop blisters due to tight fitting shoes without noticing. It is advised never to walk bare foot, wear comfortable shoes that don’t pinch, examine your feet daily for any sores, cracks or blisters. Clean your feet daily, apply moisturizer and don’t cut the nails too deep. Ask your doctor to examine your feet sensations at each visit. If you have in growing toe nail or calluses consult a podiatrist.  

  • Question: What should I do if my blood glucose is 220md/dl before I start my meal?

Answer: If your blood glucose is too high before a meal, it means your liver is releasing stored glucose. In that case you should take your insulin shot so that it signals the liver to stop releasing glucose into blood. Wait for 60-90 min after insulin (instead of regular 20-30 min wait) before you start your meal, so that insulin gets a head start and normalizes blood glucose level before you eat food.

  • Question: What changes should I make in the diet to lower blood pressure?

Answer: Blood pressure increases with high sodium intake that is present in salt. So reduce salt while cooking your meals, remove the salt shaker so that you don’t sprinkle extra salt before eating. Use black pepper, garlic or lemon juice as flavoring instead of too much salt. Read food labels and choose low sodium or no added salt foods. When you go to a restaurant, order low salt dishes. Raw vegetables and fruits are very good choices as snacks, as natural foods are low in sodium.

  • Question: What should I do if I don’t like to exercise?

Answer: If you don’t like exercise, start any physical activity for few minutes like 5 min a day and then build up gradually to 30 min daily. Choose a physical activity of your own interest like brisk walk, swimming, dancing, and aerobics. It can be daily activity like walking your dog, or playing with your grandchildren. You can pair exercise with another pleasurable activity like listening to music while jogging or taking on phone. Find a friend or family member to accompany you. You can increase your physical activity in your routine life by taking stairs instead of lift, walking to the nearby store for grocery instead of driving.  

  • Question: What should I eat when I’m sick?

Answer: You should keep taking your diabetes medicines when you are sick with fever, flu or stomach problem. During illness stress hormones will raise blood glucose level so do not stop diabetes medicines. You need calories and energy so take easy to eat snacks or meals on short intervals. Examples include soups, fruit juice, yoghurt, fruit, half cup ice cream, pudding, rice. Avoid dehydration by taking plenty of water, juice and soup.

  • Question: Why should I take low dose aspirin daily?

Answer: Low dose aspirin (72-100 mg) is prescribed as a prevention against heart attack. Diabetic patients are at increased risk of heart disease or stroke. Aspirin makes the blood thin and prevents clot formation.

  • Question: Should I stop exercise after laser therapy of my eyes?

Answer: You should stop exercise for 1 month after your laser therapy for retinopathy. As the blood vessels are fragile and too much pressure can cause rupture or bleeding. Brisk walk will do no harm. But try to avoid sports like weight lifting, under water diving or tennis that puts strain on the eyes.

  • Question: My wife has become ‘diabetic police’. She is telling me all the time what to do and what not to do. It gets irritating for me, how can I stop her?

Answer: Keep in mind that family members or spouses try to control what you eat and exercise only because they love you and don’t want you to get hurt by developing diabetes complications. Obviously their policing irritates you and when you don’t act upon their advice it frustrates them. A better option is to sit together and discuss what they want from you and kind of help you would appreciate to help you manage your diabetes in a friendly and stress free home environment.    

  • Question: Does diabetes cause problems in sexual life?

Answer: Yes, long standing or uncontrolled diabetes can cause problems in some patients like erection problems in males and pain due to vaginal dryness or reduced orgasm in females. You can discuss these problems with your diabetes doctor. They can be managed with effective control of blood glucose, stress management and certain medicines. Women can use estrogen creams or lubricants while men are prescribed drugs that increase blood flow to maintain erection.    

  • Question: My doctor has advised me to take insulin, but I have seen many people taking insulin have developed diabetes complications after it. Why should I take insulin?

Answer: It is a miss-conception that patients develop complications of diabetes after they start insulin. In fact they start insulin once they have developed some complication. Complications develop due to uncontrolled blood glucose for 5-10 years. The best way to prevent complications is to maintain tight control of blood glucose, which can be done with insulin. So it is better to start insulin earlier to prevent development of any complication.

  • Question At what temperature should I keep my insulin?

Answer: Once an insulin container is opened, use it within one month. Avoid freezing and avoid exposure to very high temperature because frozen or over heated insulin becomes ineffective. It is better to keep it in fridge in summers and at room temperature in winters. When travelling, keep insulin in a cooler so that it doesn’t get too hot in the car. When travelling by air or long distance, keep insulin in your hand bag, do not book in your luggage as it may get misplaced or you may need it before you reach the destination. In the luggage compartment, insulin may be exposed to extreme heat or cold.