Frequently Asked Questions

Most of the food we eat is turned into glucose (sugar) for our body to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose enter the cells of our bodies. When you have diabetes, your body either does not produce enough insulin, or cannot use the insulin it does produce as well as it should. This causes glucose to build up in your blood.

Left untreated, diabetes can cause serious complications including heart disease, blindness, kidney failure, loss of feeling to the hands and feet and lower extremity amputations. Diabetes is the seventh leading cause of death in the United States.Tips to control blood glucose

• Test your blood glucose. Ask your health care provider when and how often.
• Keep a record of your blood tests, medications and daily events. Review the record with your health care provider.
• Take your diabetes medication as prescribed. Your medication plan should make you feel better and fit your lifestyle.
• Eat foods that are low in fat, salt, and sugar and high in fiber to control your blood sugar. Eat about the same number of calories each day, choose a variety of foods, and never skip meals.
• Get physical activity. Check with your health care provider before you begin an exercise program.
• Check your feet for cuts, blisters, red spots and swelling that can result from diabetes-related nerve damage. Call your health care provider right away about any sores that won't heal. If you prevent problems such as foot ulcers, you can greatly reduce your risk of amputation.

All people with diabetes need to control their condition with proper diet and exercise. They also need to take glucose readings so they can keep their blood sugar level under control. You can read more about those activities in the section on Lifestyle Issues and Prevention.

Type 1 Diabetes:

People with Type 1 diabetes all take insulin, which is the hormone they are lacking. You will have to take injections (shots) every day or wear an insulin pump that controls the flow of insulin into your body.

If you take insulin for Type 1 diabetes, you should:

Take your insulin every day, as directed. Take your insulin, even if you don't feel well or are sick. If you have any questions, contact your doctor immediately.

Eat at the same time and eat the same amount of food every day, if possible.

Never skip meals, especially if you have taken an insulin injection, because your blood sugar may drop too low.

Monitor your blood glucose levels regularly, as your doctor recommends.

Remember that insulin must be balanced with a good diet and exercise.

Learn the good places on your body for injections, and ask your doctor or nurse to check your skin where you give your injection for any problems.

Always use your own needles and travel with your own needles and insulin.

Keep extra insulin in your refrigerator in case you break the bottle you are using. Keep your insulin out of bright light, out of the freezer, and out of very hot places.

Type 2 Diabetes:

Because your body does not make enough insulin for your needs, you may have to take insulin or other medication.

If you take insulin or other medication for diabetes, you should:

Know how often to take your medication and stick to the schedule.

Tell your doctor if these pills make you feel bad or if you have any other problems.

Remember that the pills don't lower blood sugar without your help. You still need to eat right and get exercise.

Know that sometimes you may need to have insulin injections, especially if you become sick, hospitalized, or pregnant. You may need to start insulin if your pills are not able to lower you blood sugar insufficiently.

Try to lose some weight, because losing even a small amount of weight can help to lower your blood sugar. You may even be able to stop taking medication if your body can gain control through weight loss.Eyes
Various types of eye damage found in diabetes, how each is detected, and some of the mechanisms involved.

Kidneys
How to tell what stage of kidney disease you may have, information on reversing damage, and ways to prevent kidney disease.

Nerves
Neuropathy represents the most common complication of diabetes.

Heart
Excellent links to Congestive Heart Failure and Ace Inhibitors information.

Feet
Various foot problems and what to do about them.

Skin
Necrobiosis, Dermopathy, Fungi and moreIf you are living with diabetes, your lifestyle becomes an important element of your care. It is extremely important that you eat a good balance of foods every day and exercise regularly to stay your healthiest. You will also have to learn to manage your disease by taking medicine (if necessary) and testing yourself each day for blood sugar levels.

Diet:

The good news is that diabetes does not require special foods. You should try to stick to certain foods, however:

• Low in fat and salt
• High in fiber - beans, other vegetables, and fruit
• Remember to eat foods from all food groups: milk and milk products; meat, chicken, turkey, fish, beans, cheese, and eggs; bread, cereal, rice, noodles, and potatoes; and fruits and vegetables.

If you are overweight, reducing the amount of food you eat will help you lose weight and make your diabetes easier to control. Your doctor can refer you to a dietitian who can help you plan meals that will include the right foods that taste great and are good for you.

Alcohol:

Your doctor may let you drink alcohol if your diabetes is under control and you don't have high blood pressure or nerve damage. You need to understand, however, what happens to you when you drink alcohol. You risk low blood sugar if you take insulin or diabetes pills. Your liver won't release glucose until it clears the alcohol, which your liver treats as a poison in your system. Thus, you could end up with very low glucose levels if you drink alcohol.

If you do drink, limit yourself to one drink a day if you're a woman and two drinks a day if you're a man. Remember, never drink alcohol on an empty stomach.

Smoking:

Smoking greatly increases the risk of heart and blood vessel disease, two of the major complications of diabetes. Stopping smoking is the single best thing you can do to decrease your chances of developing heart and blood vessel disease.

Exercise and activity:

Always see a doctor before you start an exercise program. Your doctor may have good ideas about types of exercise that would be best for you. Exercise is important for people with diabetes because it:

• Helps insulin work better to lower blood sugar
• Helps keep weight down, which also improves your condition
• Is good for your heart, blood vessels, and lungs
• Gives you more energy
• You won't have to do a special set of exercises because you have diabetes. You should be aware, however, of how exercise affects your body's need for sugar.

When you exercise, be sure to:

• Have a snack with you in case you get low blood sugar
• Wear a tag or carry a card that says you have diabetes
• Eat a snack, such as milk or an apple, if it has been more than an hour since you've eaten
• Avoid exercising if your blood sugar is over 240 mg/dL. Try to lower your blood sugar (see section on Treatment Options, "If your blood sugar is high")

Managing your condition:

If you have diabetes, you have the responsibility of managing your own case.

If you need to take medicine, be sure to take it as directed. Don't try to change your own dosage and try to take it on time every day. Be careful not to skip doses of insulin or other medications.

You will have to test your blood for sugar as directed by your doctor. Some people only test once a day. Those who take insulin or multiple medications might test four times a day.

To test your blood, you will need test strips and a lancets to pierce your finger for a blood drop.

You will simply prick your finger, get a drop of blood, and place it on the end of the strip. After a short time place the strip in your glucose meter and get an exact number for your blood sugar.

People with Type 1 diabetes may also want to buy a urine test strips for ketones, substances that your body forms when you don't have enough insulin and your blood glucose levels are high, usually when you are sick. You may need to test for ketones when you have a blood sugar reading of more than 240 mg/dL before you eat.

If you have ketones when you take a urine test, call your doctor immediately. This may indicate a developing condition called diabetic ketoacidosis that is a serious condition that can cause death if left untreated.

Finally, you should see your doctor for a special blood test every three-to-six months. This is the hemoglobin A1c test, which gives your doctor a picture of your blood sugar over time. It shows how much sugar is attached to the hemoglobin in your red blood cells. Ask your doctor if you have questions about your hemoglobin A1c test results. You should have a normal result if most of your blood sugar levels are near 100.

Managing your diabetes may take some planning. Ask your doctor how to best prepare for different situations, which may require extra insulin or even changes to your regular dose of medication:

• When you are sick
• If you are planning a pregnancy or become pregnant
• When you are traveling
• When you are at school or at work
• When you are exercising

How often, and under what conditions, should I test my blood glucose? What should I do with the results? What patterns should I try to achieve?

What is my A1c level? (HbA1c is the test that measures your average blood glucose level over the previous 2-3 months.)

How can I get my A1c into the normal range?

What effect has diabetes had on my eyes, heart, kidneys, and feet?

Do I have microalbuminuria (the detection of tiny amounts of albumin in urine indicating early kidney disease) as a result of my diabetes?

How should I take care of my feet?

When should I meet with a dietitian to review what I eat?

What exercises are best for me? What adjustments to my food or insulin should I make if I plan to exercise?

What should my family and friends do if my blood sugar drops so low that I need their help?

Are there any diabetes support groups I can attend in my area?In response to the growing health burden of diabetes, the diabetes community has three choices: prevent diabetes; cure diabetes; and take better care of people with diabetes to prevent devastating complications.

The U.S. Department of Health and Human Services is actively pursuing all three approaches.

Both the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) are involved in prevention activities. The NIH is involved in research to cure both type 1 and type 2 diabetes. CDC focuses most of its programs on ensuring that the proven science is put into daily practice for people with diabetes.

Several approaches to “cure” diabetes are being pursued:

• Pancreas transplantation
• Islet cell transplantation (islet cells produce insulin)
• Artificial pancreas development
• Genetic manipulation: fat or muscle cells that normally do not make insulin have a human insulin gene inserted. These “pseudo” islet cells are then transplanted into people with Type 1 diabetes.
• Each of these approaches still has many challenges, such as preventing immune rejection, finding an adequate number of insulin cells, and keeping cells alive. Progress is being made in all areas.

Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes may account for 5 to 10 percent of all diagnosed cases of diabetes. Auto-immune, genetic and environmental factors are involved in the development of this type of diabetes.

Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90 to 95 percent of all diagnosed cases of diabetes. Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes.Testing your blood glucose level will show you how food, physical activity and diabetes medications are affecting your blood glucose. The readings from these tests will help you manage your diabetes day by day, or even hour by hour! Keep a record of your test results to review with your health care provider. Keeping your blood glucose level as close to normal as possible may also help you prevent the onset, or lessen the severity of diabetes-related health complications.This is a simple blood test that will show how well you have controlled your blood glucose levels over the last 2 - 3 months. The A1c test shows if your average glucose level is too high, or even too low. Ask your health care provider for an A1c test at least twice a year, more often if your blood glucose level stays too high, or if your treatment plan changes.Poorly controlled blood glucose can cause nerve damage, circulation problems and infections that, in turn, cause serious foot problems for people with diabetes. There is a lot you can do to prevent the onset of these complications. Wash your feet daily and pat them dry, trim your toenails carefully, treat corns and calluses gently, and wear properly fitting shoes. Ask your health care provider to check your feet at least four times a year, and ask if you might benefit from wearing shoes made especially for people with diabetes.Diabetic retinopathy is a complication of diabetes that damages the eye’s retina. It affects half of all Americans with diabetes. With timely treatment, blindness can be prevented in a large percentage of those affected. It is very important to have an eye examination through dilated pupils at least once a year. If you notice any change in your vision, talk to your health care provider immediately..American Association of Clinical Endocrinologists (AACE)

701 Fisk Street, Suite 100
Jacksonville, Fl 32204
904 353-7878
904 353-8185 (FAX)

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American Association of Diabetes Educators (AADE)

444 N. Michigan Avenue, Suite 1240
Chicago, IL 60611
(312) 644-2233 or (800) 338-3633
(800) Teamup4 (Diabetes Educator Access Line)

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American Diabetes Association (ADA)

ADA National Service Center
1660 Duke Street
Alexandria, VA 22314
(703) 549-1500 or (800) 232-3472

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American Dietetic Association

216 West Jackson Boulevard, Suite 800
Chicago, IL 60606-6995
1 800 366-1655

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Centers for Disease Control-Diabetes Home Page

National Center for Chronic Disease Prevention and Health Promotion
TISB Mail Stop K-13
4770 Buford Highway, NE
Atlanta, GA 30341-3724
(770) 488-5080

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Diabetes Care and Education Practice Group (DCEPG)

701 Fisk Street, Suite 100
Jacksonville, Fl 32204
904 353-7878
904 353-8185 (FAX)

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Pathway to Prevention Study

TrialNet is an international network dedicated to the study, prevention, and early treatment of type 1 diabetes. TrialNet sites are located throughout the United States, Canada, Finland, United Kingdom, Italy, Germany, Sweden, Australia, and New Zealand. TrialNet is dedicated to testing new approaches to the prevention of and early intervention for type 1 diabetes.

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International Diabetes Center (IDC)

International Diabetes Center
3800 Park Nicollet Boulevard
Minneapolis, MN 55416
(888) 825-6315

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MedicAlert

Medic Alert is a non-profit organization that strives to protect and save lives by providing identification and information in emergencies.

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National Diabetes Education Program

The National Diabetes Education Program (NDEP) is a federally sponsored initiative to improve treatment and outcomes, to promote early diagnosis, and ultimately to prevent the onset of diabetes.

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National Diabetes Information Clearinghouse (NDIC)

1 Information Way
Bethesda, MD 20892-3560

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NIDDK Diabetes Home Page

National Institute of Diabetes and Digestive and Kidney Disease's home page for diabetes information.Medicare is a federal program that provides health care services for people aged 65 or older. People who are disabled, or who have become disabled, can also apply for Medicare. Coverage is available for people of all ages with kidney failure. To learn if you are eligible, call the Medicare Hotline listed below. Medicare covers glucose monitors, batteries, test strips, lancets, lancing devices, control solution, insulin pumps, and even insulin when it is used in a pump.

Medicaid is a state program that helps pay medical costs for people with low incomes and limited resources. Medicaid programs vary from state to state. Most of your health care costs may be covered if you qualify for both Medicare and Medicaid. States also have programs that pay some or all the recipient’s Medicare premiums, and may also pay Medicare deductibles and other co-insurance for those who have Medicare and whose income is below a certain amount.

Health Care Providers: Always be honest with your health care providers. Tell them if you are unable to pay for food, medicines or diabetes supplies. Ask them if they know of any local programs that can assist you. Your health care provider may be able to give you information about additional resources, or refer you to a social services program.How do I dispose of sharp items like lancets/syringes and unused/expired medications safely? Sharps are items including needles, syringes, lancets and any other devices capable of cutting or piercing the skin. Improper disposal of sharps and medications can be dangerous if not done correctly. Follow these links for sharps and unused or expired medications disposal:

Safe disposal of medications.

Safe disposal of syringes.