Consider Generic Medications When You Have Diabetes

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by Roberta Kleinman, RN, M.Ed., CDE


Worrying about a chronic illness and its future expenses can be overwhelming especially in this economy and the fact is that worry and stress do increase your blood sugar and blood pressure. Medications become a monthly recurring charge and other outside costs never seem to stop. Some are lucky enough to have insurance coverage with drug benefits which still may require co-pays. Others do not have these plans available at all.

Things to consider:

  • If you are lucky enough to live in an area that has Publix grocery stores then you should become familiar with their pharmacies. They offer certain free generic (immediate release metformin – an oral medication for type 2 diabetes that is prescribed by your physician) in any of these 3 doses – 500mg, 850mg and 1000mg tablets. You can receive a 30 day (90 tablet) supply for free. It has nothing to do with your insurance provider or the number of prescriptions you need. There is no limit to the number of refills you can receive. You do not have to fill out any forms or supply any paper work. Publix also offers a 30 day (60 tablet) supply of lisinopril – an ACE inhibitor used to treat hypertension and protect kidney function in people with type 2 diabetes; the brand name is Zestril or Prinivil. Extended release metformin is not free nor is a lisinopril in combination with HCTZ (a water pill). They offer multiple antibiotics for free as well. You can check on Publix.com to find out more of the details.
  • There are also hundreds of generic medications that are available at Target, Wal-Mart or Sam’s Club for a monthly cost of $4 for a 30 day supply or $10 for a 90 day supply. You should check with your health care provider when they are writing the prescription to see if a generic version is available.
  • What are generics? In the United States, approximately 8 out of 10 written prescriptions are now generic. They are simply copies of the original brand name medication. Generics have the same intended use, dosage, side effects, safety, risks and strengths. Generic names are not capitalized but brand names are; Glucophage is the brand name and metformin is the generic. The FDA requires that the exact same standards be utilized for brand names and generics. Many times the brand name producer also makes the generic drug. Generics are cheaper because they do not require the huge expense of development and marketing the medication. This reduces the cost of research and future promotion. Generic forms of medications can be produced when the original manufacturer loses its patent which is in place for 20 years (a patent is given to the company that created the original drug). The generic version will look different in shape, color, size and may even taste different from the inactive ingredients. The active medical ingredients must be prepared exactly the same and offer the same benefits.

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  • If these points do not help you and your medication needs, also check to see if you qualify for aid from Partnership for Prescription Assistance at www.pparx.org. It includes more than 2500 prescription medicines and 475 patient assistance programs.

Finding ways to take care of yourself and your diabetes without breaking the bank is exactly what you want to do in this time of dramatic change in medicine. That may help leave some left over funds for you to enjoy a relaxing experience!

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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

Blood Sugar Highs and Lows can Affect Brainpower

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by Roberta Kleinman, RN, M.Ed., CDE


Overall diabetes control is based on the A1C, which is an average of approximately 3 months worth of blood sugars that includes the extreme highs and lows. Let’s review what can happen to your body with highs and lows and how to treat them.

1. The organs which are mostly affected by elevated sugars are supplied by tiny vessels: the eyes (retinopathy), the kidneys (nephropathy) and the nerves (neuropathy). New research confirms that the brain can also be affected by elevated blood sugars. Fuzziness of the brain can be a symptom of poor blood sugar control. Columbia University Medical Center studies suggest that high sugars cause less blood flow in the brain which can reduce oxygen and nutrients to the brain cells. A published study in the Diabetes Care Journal (2009), reported on over 3000 participants with type 2 diabetes that the higher the A1C, the lower the cognitive function. A study in The Journal of Clinical Investigation (March, 2012) done by the University of Pennsylvania Medical School, showed a significant association between insulin resistance, elevated blood sugars and an increased amount of diagnosed Alzheimer’s disease. A lack of insulin and elevated sugars impact brain functions that include learning, remembering, judging and problem solving. People with uncontrolled diabetes can develop Alzheimer’s two times as often as those who are controlled.

What to do to help prevent the highs?

  • Take medications as prescribed. If you are not sure when or how to take them, check with your pharmacist or MD. Set a timer if you need to; place them in an obvious location so skipping your meds does not occur. Carry a pill box or a case for your insulin. Do not run short on medication – refill when you can.
  • Physical activity needs to become part of your daily life. Muscle mass helps your body utilize insulin and blood sugar. Anything helps including gentle walking, chair exercises or pool activity.
  • Watch portions sizes, space out meals, do not skip meals or snacks and load up later. Eat on a schedule. Think about healthful food choices including low glycemic foods.
  • Drink plenty of water and stay hydrated and incorporate stress reduction.

2. The other extreme is hypoglycemia or low blood sugar. Any number under 70 is considered hypoglycemia although you may feel symptoms at higher numbers especially if you have had uncontrolled diabetes for awhile. Low blood sugar also impacts brain function. The Journal of the American Medical Association found that increased hypoglycemia causes Alzheimer’s disease as well. The brain needs glucose to operate and depends on glucose for mental concentration. Brain cell energy requirements are two times more than any other cells. The brain does not produce its own sugar source and it depends on blood sugar; low blood sugar decreases cognitive function. Low blood sugar symptoms can include shaking, sweating, hunger, headaches, confusion or weakness; try to test when you experience these to get an idea of your actual value. Causes of low sugar can occur if you are skipping meals or snacks, exercising too much, drinking alcohol on an empty stomach, taking too much insulin or sulfonylurea’s, injecting insulin in an area you are using for exercise, injecting into a muscle instead of fat tissue, or taking a hot bath / shower following an insulin injection. If you are experiencing hypoglycemia more than one time a week you should contact your health care provider. Some people get hypoglycemic unawareness – no symptoms, which require even more diligence.

What to do to help prevent the lows?

  • Eat on time and never skip meals. Include small amounts of carbohydrates to feed the body and the brain.

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  • Learn the rule of 15 – 15 grams of a carbohydrate, wait 15 minutes for it to work, check blood sugar in 15 minutes and repeat up to 3 times. Follow the 15 grams with a protein and carbohydrate – like half of a sandwich. My favorite sources of 15 gram carbohydrates are glucose tablets and the best ones to take are Diachieve glucose tablets. The reasons are simple. When your sugar is low, the glucose tablets are portable and easy to store in your gym bag, car, night stand, purse or pocket; they are cheap enough to put all around for those unexpected lows. They have a fixed amount of carbohydrate with a fixed amount of calories. All other glucose tablets require 4 tablets to be chewed to equal 15 grams where as Diachieve requires only 3 tablets since they are 5 grams a piece. They taste fairly good as opposed to the dry, chalky kind. Usually when you are low you grab for anything and eat large portions just to relieve the symptoms, which results in extra calories and weight; the blood sugars swing from too low to sky high when you over treat. I had a patient that treated with hard candies, cracked a tooth and ended up with a crown. Chocolate candy has too much fat and takes too long to get into the system – as does fruit or regular food. Keep it easy and get fast results with Diachieve glucose tablets.

Keeping blood sugars in target range is good for all your organs including your brain! You will ultimately feel better too!

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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

Interview with Marlene Koch, RD

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American Diabetes Wholesale recently had the chance to speak with bestselling author, television personality, and diabetes expert Marlene Koch about her New York Times bestseller: Eat More of What You Love and how to healthfully enjoy all the foods you love. Marlene also shared her four tips for a healthy and tasty July 4th, along with a couple of her amazing recipes.

Here is our conversation:

With the fourth of July holiday right around the corner, let me share some ideas of how to lighten up a picnic or backyard barbeque. With just a few simple swaps it’s easy to trim the sugar, fat and calories from the not-so-healthy festive fare we all love. Here are four tips for a healthier Fourth of July:

1. For the biggest bang for your buck, ditch the sugary drinks. For a festive and refreshing drink, combine ¼ cup 100% cherry juice with ice, sparkling water, and a lemon wedge or make homemade lemon or limeade with your choice of sugar substitute. If it’s soda pop you crave, switch to diet and in the process save an entire days’ worth of added sugar with just one can.

2. Swap out some of the chips for crunchy veggies served with a flavorful dip. A recent study demonstrated that kids ate 80% more broccoli when it was served with a low-fat ranch-style dip. To make your own: In a small bowl mix ½ cup buttermilk with ¼ cup each light mayonnaise and Greek yogurt. Whisk in ½ teaspoon each of garlic and onion powder, ¼ teaspoon ground black pepper, and 1/8 teaspoon salt (optional: add ¾ teaspoon dried dill). Chill and serve with assorted raw or blanched veggies.

3. Grill it lean. Replace fattening hot dogs with flavorful turkey or chicken sausages on the barbie, ribs with tender pork tenderloin, and fatty rib-eye or porterhouse steaks with marinated top sirloin. For burgers opt for either lean ground beef or turkey (93% lean is my choice). Here’s an additional tip: to create a great-tasting turkey burger, add moisture and flavor to the meat. You’ll find these secrets, and more, in this better-than-beef Totally Terrific Turkey Burgers recipe.

4. Enjoy seasonal fresh fruit for dessert There’s no better time than summer for juicy watermelon, fresh peaches, apricots, and plums, along with naturally sweet cherries, strawberries, blueberries and raspberries–are all in season! Or, for an extra special dessert, beat the heat with my festive No-Bake Red, White and Blue Cheesecake Cups (P.S. There’s no need to tell anyone they’re healthy!)

Read the rest of the article here.

5 Tips to Spring Clean your Home if You have Diabetes

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by Roberta Kleinman, RN, M.Ed., CDE


American Diabetes Wholesale - Free Shipping on Orders Over $100 According to the F.D.A., two-thirds of Americans have expired medication in their cabinets at any given time. Only 42% of Americans clean, organize and restock their medical prescriptions and OTC supplies on a yearly basis. Another alarming statistic is that only 80% of Americans clean out expired foods from their refrigerators.

Now that we are in March, plan to look around your house and make it a safer home for everyone. Things to consider:

1. Start with the bathroom medicine cabinet.

If you do store blood glucose testing supplies or prescription medications in the bathroom, make an immediate change. The bathroom has the most heat, humidity and concentrated light source of any room in the house and has an effect on these products; they can decompose. Dispose of expired prescription medications (you can check with your pharmacist if you have questions about future potency) in the correct manner. Do not flush them in the toilet or sink; remember, that can enter our water supply. Check with your pharmacy or local health department for help. Store products in the original container so that there is no confusion in the house. Think about storing your medications, vitamins and supplements in a kitchen cabinet. Restock things like first aid supplies, band-aids, aspirin, and non-steroidal anti-inflammatories (Advil, Aleve, or Motrin). Include hot and cold packs for injuries. Add gauze, antibiotic ointment, cortisone cream and Benadryl for allergies. Be prepared for insect bites as well as sun burn. Keep new sunscreen available with SPF (change yearly) and insect repellant. Change toothbrush heads after 3 months, after a cold or flu or after a dentist visit. Check body and face creams for color and fragrance change.

2. Talk to your physician or pharmacist about changing to generic medications this spring.

This is the biggest year for medications to come “off patent”, which means other companies can produce them at a huge discount and pass the savings on to you. Some popular medications which now have generic formulations include: Actos (diabetes), Lipitor (cholesterol), Plavix (blood thinner), and Singulair (asthma). Most generics give you all the same benefits as their counterparts, but do check with your physician. During your appointment, mention that cost is a factor if they prescribe a new medication. Consider a local pharmacy (not good if you travel and need medication in another state). They may have more flexibility to lower prices compared to a chain store. Spring is a good time of year to update your medication list and make a copy for your wallet, the refrigerator door as well as the glove compartment of the car. Add your allergies, surgeries, medical conditions as well as emergency phone numbers.

3. Think about the basics of hand washing during spring cleaning.

Always consider the old standby – soap and warm water. A study published in Clinical Infectious Diseases compared 27 hand cleaning sanitizers with soap and water. The result was that there was no difference between these products as far as removing more bacteria or spreading disease compared to regular soap and water. Wash hands for a minimum of 20 seconds and remove all jewelry. Dry with a fresh towel for best results. In a pinch you can use alcohol based products that contain 60 – 70% alcohol and have a moisturizer (alcohol dries your skin) included. Make sure to use a quarter size amount, rub for 20 seconds – especially between fingers. Hand washing is the single best thing to prevent sharing an illness.

4. Spring clean in the kitchen.

Never thaw frozen meat at room temperature – keep it in the refrigerator. Do not put hot food directly in the refrigerator – keep it out until it cools down. Check expiration dates on condiments like ketchup, salad dressing, hot sauce, salsa, steak sauce and mayonnaise; we tend to forget about the staples. Check dried spices. They change color, lose freshness and flavor when stored for more than a year. Try to purchase small quantities so they will maintain freshness (buy large sizes if you use frequently, which will be cheaper). Wash fresh fruits and vegetables with a vegetable wash spray or plain soap and water to help remove pesticides. Change out sponges, the biggest germ carriers of all, or put them in the dish washer often.

5. Spring is the best time to open windows and get fresh air into the house.

Consider air filters to eliminate pollutants – either a centralized or portable system if you can’t let fresh air in. Things like dust, dust mites, bacteria, viruses, and animal dander can linger in the house and on hard surfaces.

Spring is a wonderful time of year to make some positive changes. Start today!

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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

5 Tips to Spring Clean Your Body

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by Roberta Kleinman, RN, M.Ed., CDE


I really hate to rub it in, although it has been a mild winter in many parts of the country, but as I sit here, it is 84 degrees and sunny in South Florida. We basically have had a non-existent winter, so I decided to get right down to the topic of spring cleaning for your body. In my next newsletter, I will address spring cleaning your home.

For you and your body – if you can start spring season by being proactive instead of reactive, your body will most likely reward you. What that means is taking steps to prevent problems instead of fixing them when they present themselves later on. Yes, it is the usual advice most health care professionals give you and since we just went thru New Year’s resolutions, maybe some of you have already started. If not, here goes:

1. Reduce mental stress – part of my interview when teaching patients with diabetes is, “Do you have stress?”. Most answer back with a resounding “YES!” The next question is, “How do you deal with it?” Most everyone says they over-eat to relieve their stress because it’s comforting and makes them feel good. Besides that, they are not eating celery and cucumbers for comfort. It usually is macaroni and cheese or meat loaf and mashed potatoes, and lots of it. This spring, if this is your dilemma, try to find a proactive stress solution such as yoga, deep breathing, meditation, or just going for a walk. Remember, mental stress makes your hormones elevate which raises your blood sugar. Adding extra food to the mix only makes the blood sugars worse. Physical movement and deep breathing actually lowers the sugar and uses the stress hormones.

American Diabetes Wholesale - Free Shipping on Orders Over $1002. Exercise smarter, not longer – come up with a plan to make your exercise most efficient. Most everyone complains that they have no time to exercise. If possible, try interval training instead of steady state exercise; that means you speed up and slow down your activity and speed up again. You could elevate the treadmill and then walk flat instead of just maintaining the same speed and elevation the whole time. The body gets used to steady state exercise and few benefits are achieved. Always check with your physician, but interval training increases your metabolic rate and your ability to burn calories. You may have to push a bit harder, but you will not have to exercise as long when you interval train. That equals more time for other things.

3. Start flossing – this is proven to help reduce and remove tartar and plaque formation, a main culprit in periodontal disease. You are already at risk when you have diabetes due to the extra sugar in your saliva and because your healing process is reduced – so be proactive. Using a tongue scraper and a mouth rinse without alcohol to follow is also a positive behavior. Remember, there is a strong correlation between heart disease, diabetes and gum disease.

4. No smoking – because it is the worst thing you can do with diabetes due to the fact that it increases blood pressure, increases heart rate and narrows the blood vessels.

Try to find happiness and meaning in all that you do – feeling self motivated and gaining self esteem and self respect is important; taking care of yourself first and making time for yourself makes you stronger for everyone around you. Feeling depressed and worthless can definitely have an impact on your physical being and health, leading to chronic fatigue as well as aches and pains. Learn to communicate better, feel more, work and play and remember to really feel!

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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

Diabetes and Sleep

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by Roberta Kleinman, RN, M.Ed., CDE


During this week of diabetes educational sessions I have been answering some pertinent questions coming from patients like you. You may have read a version of this information before but each patient seems to put a different spin on the question. I am confident that you will all learn something new with each question which can only be a benefit to your overall diabetes care.

I still do not understand! I stop all eating by 8 P.M. since I heard that it is bad to eat at night and I test before I go to bed. I usually get a decent number in my target range of 80-120 mg/dl and feel empowered that I can skip my bedtime snack. I would actually enjoy something to eat but I am afraid and I am trying so hard to get my blood sugars under better control. Then I wake up and my fasting numbers are between 130-170 mg/dl! I know you would like to see my fasting value between 80-110 mg/dl so what am I doing wrong?

Answer: The body actually requires glucose or sugars all day and night long. If your body is not getting the glucose source from food (as in sleep) your body turns to glucose that is stored in the liver. Your insulin production from the pancreas will be less over night in a fasting state and it cannot keep up or match the glucose being pushed out by the liver. This can result in those increased fasting blood sugars. An easy remedy can be a bedtime snack that can actually lower the fasting morning reading. The most effective snack would be one that combines protein, healthy mono-unsaturated fat and a slowly absorbed carbohydrate. A simple but complete snack could be a slice of dense whole grain or stone ground bread with 2 teaspoons of peanut butter. That covers all the desired foods that can help with the blood sugar. Remember to count the snack in your overall daily carbohydrates as well as calories. An oral medication called Metformin can also help reduce the sugar churned out from the liver especially during the night. Some people cannot tolerate this medication due to GI upset or pre-existing kidney disease. If after trying the bedtime snack your fasting blood sugars do not enter target range talk to your physician; you may eventually need a medication change including a once daily long acting basal insulin shot.

I take a baby aspirin 81mg, cholesterol medicine and a blood pressure pill all in the morning when I wake up so that I will not forget them later in the day. Now I read that I should take them before bed, why?

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Answer: Studies have showed us that the leading cause of death associated with diabetes is a heart attack or M.I. Diabetes is not just a sugar problem so your physician must keep track of all your cardiac values to decrease MI and stroke risk and treat them accordingly. The reason to take these medications prior to bedtime makes sense. The greatest amounts of heart attacks are seen between 4-6 A.M. The blood pressure starts to rise at this time to get us ready for the day. It takes about 50% increase in blood circulation to get the system from sleep state to being awake. This sudden and increased pressure could cause a tear in the vessel lining creating a blood clot and heart attack. Our major vessels are also stiffer upon awakening like our joints and stay rigid in those early morning hours. This too can cause more plaque build-up and an eventual rupture. Taking the blood pressure medication before bed can help maintain a better and consistent reading in the early morning hours. Taking the cholesterol medicine prior to bed is necessary because the liver churns out cholesterol especially during the night. Taking the baby aspirin before bed can help reduce platelet sticking that also increases during those early morning hours. The stickier the platelets, the thicker the blood, which can result in blood clots causing a stroke or heart attack. Also consider taking a magnesium supplement (always check with your physician before starting a new supplement) of 500-1000mg before bed. You can get magnesium from green vegetables, nuts, legumes and whole grains but you may run short if you are not eating the proper amounts. Magnesium may help keep the vessels open and more relaxed which aids in lowering the blood pressure. It may prevent blood clots by reducing platelet sticking, decrease insulin resistance and help muscle and nerve function. People with kidney disease should not take added magnesium because they do not have the ability to excrete the excess. Magnesium loss can be accentuated when blood sugars are elevated since the increased urination that comes with high sugars can pull out magnesium; people with diabetes are often low in magnesium. Studies have shown that a decreased amount of magnesium may also increase the risk of peripheral neuropathy (a big complication of diabetes). Magnesium supplements can have a laxative response, so think about taking it in combination with calcium which makes it better tolerated.

These great questions offer insight into what others with diabetes often experience. Hopefully the answers can make you care for your diabetes in a more effective way!

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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

Interview with Nutritionist and Diabetes Expert Samantha Heller

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American Diabetes Wholesale recently had the opportunity to speak with talk show host and registered dietician Samantha Heller, MS, RD, CDN. Heller is part of the team working on the ‘Blood Sugar Basics’ campaign that is designed to offer education and instruction on how a person with diabetes can take better care of themselves as it relates to diabetes testing, diet, exercise, and overall health.

With years of experience as a health and wellness expert, Heller has assisted people with chronic health conditions – including diabetes, heart disease, obesity and cancer – adopt healthier lifestyles. Additionally, as a senior clinical nutritionist, Heller developed and ran NYU Langone Medical Center’s Outpatient Cardiac Rehabilitation & Prevention Nutrition program for nearly a decade.

Here is our conversation:

1. Of all of the ‘Super Foods’ that we read and hear about, which one has the greatest benefit to a person with diabetes?

I don’t think that there is one ‘Super Food’ that is ideal for diabetes, but when used together, there are tremendous benefits. ‘Super Foods’ are whole foods. Vegetables, whole grains, legumes, nuts, seeds, fruit, lean proteins, soy, edamame – these are super foods because they are so packed with vitamins, minerals, and anti-oxidants. They help address so many of the issues associated with diabetes; from blood pressure to inflammation to blood sugar management. Work on combining as many of these super foods into your daily eating plan as you can.

2. Tell us a little about juicing. Are the nutritional benefits of juicing something that someone with diabetes should consider?

I don’t believe so. When you are juicing, you are leaving a lot of the important parts of fruits and vegetables out. Fiber is essential, and with juicing it is discarded. Juicing also becomes a very concentrated level of sugar and calories which is not beneficial for a person with diabetes. It is hard to drink a small amount of juice so the result is that we over-drink and ultimately take in more sugars. For example, instead of drinking 4-6 ounces of carrot juice, I would like someone to eat a few raw carrots and dip them in hummus. That would be better for their waist-line and blood sugar levels. It is also about combining food groups.

Read the rest of the Heller Interview here.

Diabetes Care and New Technology

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by Roberta Kleinman, RN, M.Ed., CDE


Some of us remember the evening TV doctor shows like Dr. Kildare with his awesome looks and great bed-side manner; he stayed by our side for at least 30 minutes and made us feel safe and secure. Others (me included) remember when the doctor made house calls including that very evening when your mom called and said you had a high fever and cough.

Next was the need for you to see all of the physician’s board certifications and diplomas on their walls. Does my doctor have special credentials for endocrinology, cardiology, orthopedics, etc.? The more they were specialized, the better they were. As the health care system evolves these luxuries seem far away and mostly non-existent.

Research tells us that another new and important quality of your physician and his practice is to be connected and well versed in technology. Technology can help them become a better practitioner in multiple ways.

What to look for:

1. Does the office use paper charts or electronic records? Are they at least trying to make changes to switch to electronic records?

In the Journal of General Internal Medicine, a research paper was published that states physicians who use electronic records report fewer errors in treatment, more accurate follow-up and improved overall patient care and contact. Electronic records make retrieving past information much more streamlined. For example, if you had a question about a previous test result so that you could compare them, it would be much easier for you and the provider to pull up that information. Medical histories and physicals, charted notes, blood work and test results are much more secure in an electronic record or digital file. The doctor can notify medication updates from recent studies to multiple patients in decreased time and with less effort than on paper charts. Up to one third (33%) of health care providers already utilize the electronic health record format and it will soon become mandatory.

2. Can the doctor be reached by e-mail?

Complicated questions and concerns should always be addressed by a phone call or even a visit but certain direct information could be obtained by e-mail. If blood results are all within normal limits and no discussion is needed than e-mail may be a great alternative. Setting up appointments by e-mail could save a lot of patient phone time. We have all sat on an automated phone prompt and waited through 6 prompts to finally get voice mail. Then we wait hours to get a return phone call just to get an answer or make an appointment. For simple recommendations or suggestions like OTC remedies, e-mail would be perfect. Also, sending blood glucose readings for the week could be sent by e-mail with a quick physician response if they were well controlled.

3. Does your doctor use “e-prescribe”?

We are all aware that for some reason many doctors have poor hand writing. The pharmacist may miss read the actual prescription and fill the wrong medication or the wrong dose and you may not realize it until you get home. Half (50%) of M.D.’s now use a program that lets them electronically transmit the scripts to the pharmacy. According to the study in The Journal of General Internal Medicine using e-prescribing encourages more consistent care and better patient results. It also helps patients with chronic conditions like diabetes stay up to date with their medication refills and prescription renewals.

Your relationship with your health care provider is extremely important to your overall care. Keeping your information safe, secure and accurate is a terrific benefit to you both!

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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

Insights from Diabetic Patients

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by Roberta Kleinman, RN, M.Ed., CDE


I am constantly reading and researching information to find interesting things to write about for you but I keep coming back to conversations that I have had with actual patients as a great resource. We can give you important advice as well as accurate protocols as health professionals but if you are living with diabetes, you may have concerns that we would never even think about.

I want to share some thoughts and questions that were addressed during my week in the diabetes management setting.

“I was in the hospital for knee surgery and I know that they documented on my chart that I have diabetes and a history of heart disease with multiple heart attacks. I am on 3 blood pressure pills, a blood thinner and on 2 diabetes pills at home. They continued to give me all the heart medications. They did tell me that I might be on insulin instead of diabetes pills during the hospital admission due to the fact that blood sugars can rise after stress from the surgery and I was fine with that. The first meal I had in the morning after my surgery was 3 pancakes with real butter and syrup, a large glass of orange juice, 2 strips of bacon and a side of fruit cocktail in gooey syrup. I demanded to see the dietitian who tried to explain that I never filled out a form for my menu and that was what made it up to my room. I just do not understand what they were thinking since my blood sugar was already elevated from the surgery. Then she started talking about exchanges and I did not understand. I know how to count carbohydrates not exchanges. I think there were 6-8 servings of carbohydrates and plenty of saturated fat on that tray. I know on a regular morning I have 3 servings of carbohydrates for breakfast. I finally got oatmeal, plain fruit and a boiled egg but I was starving by the time it came!”

I was so pleased with this patient’s response to what happened to him. He knew exactly what to do except wait “to be starving.” Unfortunately this scenario does occur frequently. Luckily he also knew not to accept the rapid acting insulin before he got the new tray (take within 15 minutes of the meal) and understood what that original meal could do to his blood sugars. He also realized that eating the saturated fat in the bacon was not the best choice for someone with heart disease. For the record, one exchange equals 15 grams which is a serving size of carbohydrate. The words are often used inter-changeably.

“I have been hearing that some weight training or resistance training is helpful to diabetes, is that true?”

A study in Diabetes Care showed that people who had type 2 diabetes who did weight training two times per week were able to have better control of their blood sugars. Increased strength means a better A1C. When adding a weight program to your routine you need to schedule days off with at least one day rest period of that body part to recover and restore your glycogen levels. Weight training can tear down muscle and the rest period gives it time to rebuild. Remember to always start under supervision so you do not get injuries and check with your physician before starting a weight program. Weight training can build muscle mass and increase your metabolic rate which will help you burn more calories. Consider keeping up your vitamin C levels from citrus, leafy greens or a supplement. Exercise can form free radicals which can account for part of the soreness after the session. Vitamin C decreases free radical damage and increases collagen formation. Collagen is a connective tissue that helps support bones and muscles. Get a partner to hold you accountable and then you can train together. Many insurance programs will now pay for gym memberships. Isolate the muscle group that you are working to prevent injury and get the most benefits.

“I know nuts can be a good snack but I know they are high in calories and fat? What should I choose if any?”

Research has shown that adding a handful of unsalted dry almonds may help lower the blood sugars especially for after meal values. A handful of almonds are reasonable and even the skin of the almond has positive anti-oxidants. The fat is mono-unsaturated fat which is the healthy kind. A study in metabolism (2011) showed that 1 ounce prior to a heavy carbohydrate meal lowered blood sugars up to 30%. The nuts were eaten 30 minutes prior to the meal. Regular daily almond intake was also studied and results did show a lower A1C and less body mass. Eat plain or add to salads, fruit salad or meat loaf. Remember a serving of nuts is usually 6 nuts (45 calories), so portion size does matter!

I hope these hints from patients may help you with your daily challenges!

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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

10 Techniques for Diabetic Management Goals

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by Roberta Kleinman, RN, M.Ed., CDE


Each person who attends a physician visit or educational session to learn about diabetes management comes in with a different set of learning skills, styles, as well as their ability to accept and make quick changes in behavior. Many times, we as health care professionals tend to forget this and forge ahead with tons of information quickly and in a matter of fact way.

The appointment may begin with the initial news about recent blood work numbers followed by the professional firing off of multiple lists. Lists of things to change along with lists of things to do, suddenly all added to your daily life. Remember, you already had a full life with little time to add anything else to your over-committed existing day. Included now may be: testing your blood sugar 2-4 times a day, taking 3 more pills to cover your blood pressure, monitoring your cholesterol and your blood sugar, testing your blood pressure, not eating any sugar, exercising & counting carbohydrates, etc. This is just the beginning of all the new demands placed upon you. At this point, all you can think about is how overwhelmed and annoyed you may be and miss much of the information during the initial interaction. Patients often say “I do not get it, there are people heavier than me and they do not have diabetes or I do not know how or why I got this.” They are not even coming to terms with the disease, yet all these demands are being blasted at them at once. What usually happens is nothing or no change occurs. The best way to benefit from all this acquired knowledge being thrown at you is to work out a long term plan – slowly and gradually – between you and the professional (I can hear you all laughing since you get about 15 minutes to a visit unless you go to a diabetes management program and you actually get more face time). Eventually you will be able to think about the following:

Pick 1-2 goals. Pick the ones that have the biggest impact in the shortest time. This will lead to more confidence for you and the provider.

The goals have to be important to you, the patient, since you are the one completing them. First pick the ones that matter to you the most.

Make them accurate, precise, personal and measurable. Make it self-directed.

Build a relationship between you and the professional so there is some trust involved.

Make sure the professional knows how you learn (verbal/visual). How much do you really understand? Sometimes professionals get too wordy and do not realize what information you are missing. Ask and ask again, if there is a question.

The end result of the changes should be to achieve a long, healthy life and feel as good as possible.

Give yourself a time frame and limit so you do not go on too long without any positive changes.

Conquer a target. If a target is not met, reevaluate why not – as a team. Do not go at it alone.

Keep checking, keep trying and focus on how change can make you feel better, stronger or healthier.

Remember, these are your goals and you are the one who has to achieve them, not the provider.

These questions and concerns may not apply to you directly but you should always be consulting with your physician and searching for reliable answers to any of your specific ones. Knowledge today may help you tomorrow!

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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.