There are many pearls, tricks, statements and facts sprinkled in reliable diabetes journals, sites and magazines that may be helpful to you. I often share this information with my patients during diabetes management sessions since I am constantly reading. I hope some of these tidbits can increase your knowledge of diabetes as well as getting your blood sugars under control.

The Genetic Factor

There are definite genetic factors that are linked to developing diabetes. For example, you are 10-20 times more at risk for developing type 1 diabetes than the general population if you have a parent with type 1 diabetes. If you have one parent with type 2 diabetes your risk goes up to 40% and if you have two parents with type 2 diabetes your risk for type 2 goes up to 70%. Obviously, you can’t change your genes but you can do a lot to lower your chances of developing diabetes. Work on your lifestyle and get your blood pressure, weight, LDL’s, triglycerides and blood sugars down. Pre-diabetes is fasting blood sugar of 100-125 mg/dl. With proper changes, that number can return to normal which is 60-99mg/dl. When diabetes develops it is controlled, not reversed, except in cases of gastric bypass. Long term studies show when the weight returns after the gastric procedure that the diabetes returns.

Winter is Coming – So is Dry and Itchy Skin

Winter is coming and dry, itchy skin is a common complaint of people with diabetes. The best recommended ingredient in over–the–counter creams and lotions is urea. Urea is a natural compound already found in the skin’s outer layer. After being reviewed in a group of studies, “it works by smoothing and soothing since it helps cells bind to water”. Try to use it after a bath or shower when the skin is still damp or moist. Putting socks on your feet at night after using the lotion with urea offers even more benefits.

Calluses and Foot Care

People with diabetes frequently have thick, rough calluses on their feet due to super dry skin. This can lead to painful walking and even problems with balance. Using files and blades on your own feet is never considered safe since it could lead to severe infections. Podiatrists or foot doctors should always be consulted for this condition. Podiatrists can now treat calluses with a lactic acid peel. “These chemical peels can remove the toughest calluses without creating open areas”, according to Dr. Oliver Zong, a New York City podiatrist. You should refer to a podiatrist for ingrown toe nails as well. Anything that requires cutting should be shown to a foot doctor and not self-treated.

Supplements – Good or Bad?

Facts About Vitamins & SupplementsAccording to a study in the New England Journal of Medicine “adverse effects of supplements were responsible for an average of 23,000 emergency department visits per year”. Since people with diabetes are already on multiple prescription medications for blood pressure, cholesterol and diabetes, it is best to eliminate supplements and herbs unless specifically recommended by your physician. Unlike the FDA, there is not a federal agency that formally regulates these products. Yes, you can still add cinnamon to your coffee or oatmeal. Spices are a good way to boost nutrition.

Less Stress = Less Blood Sugars

Stress reduction techniques can actually have an impact on your blood sugar readings. Start simply by including 10 minutes of deep breathing or meditation in the morning. Plan your quiet time as a daily treat. Consider a monthly massage or a walk in the woods or garden for stress relief. Reducing stress can lower blood pressure, cortisol levels, improve your mood and get your blood sugars down. Alert your physician that you are using stress reducing techniques as they may need to reduce your diabetes medications.

Diabetes Smart Phone Apps

There are a multitude of health, fitness, food and diabetes Smartphone apps that can help keep you and your diabetes on track. Some of the more current and popular ones are: My Glucose Buddy which works on insulin doses, activities and consumed carbohydrates. Diabetic Connect connects you with other people who have diabetes for support and information through social media. GSK-Diabetes Health Mate tracks blood glucose readings in relation to your mood, activity, diet and medications. MediSafe assists patients to remember to take their medications by setting reminders. These are just a few apps that can introduce you to different avenues of assistance and support to achieve better glucose numbers.

Keep Hydrated

Dehydration, although more common in warmer months, is possible anytime of the year and is especially critical if you have diabetes. People with diabetes are usually on water pills or blood pressure pills which increase dehydration. Being on a very low carbohydrate diet can also lead to dehydration since carbohydrates are stored with fluids. Even living in high altitudes can promote fluid loss since elevation causes you to breathe harder and exhale more vapor. Being dehydrated makes your blood more concentrated which could lead to higher blood sugars. Drink adequate amounts of water or sugar-free liquids throughout the day. Remember that coffee and tea are allowed but can cause dehydration due to caffeine content. Include foods which add fluid such as cucumbers, lettuce, watermelon, strawberries, cantaloupe, zucchini squash and peppers.

Liver Disease and Diabetes

A new concern with pre-diabetes and type 2 diabetes is the effect it has on the liver. NAFLD (Non-Alcoholic Fatty Liver Disease) is more prevalent due to the growing number of diabetes cases. Because of insulin resistance (a precursor to pre-diabetes and diabetes) the liver develops fatty deposits inside which leads to scarring. “Roughly 2 out of 3 people who have type 2 diabetes or are obese have too much fat in their livers which increases inflammation and NASH-nonalcoholic steatohepatitis”, according to Dr. Kenneth Cusi, chief of Endocrinology at the University of Florida. This excess fat, scarring and inflammation in the liver can lead to cirrhosis and liver cancer. The best way to avoid these conditions and liver damage is to lower insulin resistance by exercising, lowering blood sugars and losing weight all of which are the gold standard for diabetes control.

Be Wary of Hypoglycemia

Glucose TabletsHypoglycemia or low blood sugar can happen to anyone with pre-diabetes, people with type 1 diabetes, people with type 2 diabetes and especially to those taking diabetes medications called sulfonylureas, meglitinides or insulin. Skipping or delaying meals can lead to hypoglycemia as well as over-exercising without proper carbohydrate intake. Symptoms can include: sweating, shaking, being jittery, being dizzy or weak, having a headache, feeling an increase in your heartbeat or being irritable. Many people who experience these symptoms are unaware of what they actually mean and they do not treat the symptoms correctly. Many patients drink water or take a nap instead of getting glucose into their system. Others chew a dozen peppermints or eat a chocolate bar. Hypoglycemia should be treated with “specifically designed glucose products” like glucose gels, tablets or liquids to raise blood sugars quickly without over-treating. These products are simple glucose found in cheap and portable form and containing a fixed amount of sugar and calories that are effective quickly. These products do not over-treat the condition with too many calories and huge swings in blood sugar. Chocolate bars contain mostly fat and take too long to raise blood sugars along with being highly caloric. Treat with 15-20 grams of glucose tablets (usually 3-4 tablets) when blood sugars are 70mg/dl or below or you are experiencing symptoms. Wait 15 minutes and retest. If it is still under 70mg/dl then retreat and follow with a small serving of cheese (protein) and cracker. Choose gels and liquids if you have dentures or difficulty chewing. All these products come in various flavors. When severe hypoglycemia occurs especially in type 1 diabetes, patients may become unconscious. If unconscious, a glucagon kit injection may need to be available immediately and given by another family member. Call 911 after treating with glucagon for further treatment.

Cleanlyness Leads to Better Readings

When testing blood sugar with a glucose meter, you should wash your hands with soap and before each test. Alcohol swabs are not necessary since they dry out the skin. Hand washing is recommended to remove contaminants which when present may alter blood sugar results. Hand lotions or creams as well as residue from vitamins, medicines or food can change blood sugar results. Remember to use a new lancet each time for a clean, sharp stick which will help you preserve test strips.

Sharing information with you on how to improve your diabetes control is what we do at ADW diabetes. We hope you keep learning which is sure to give you better results!

Have a question or comment? Post below or email me at RKleinman@adwdiabetes.com if you would like to share them with ADW diabetes.


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

Roberta Kleinman

Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia.

She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.

She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.
Roberta Kleinman