Each week, after our newsletter is published, I receive multiple questions from our customer base. I generally respond to those specific customers directly but have decided that these questions may benefit everyone in our ADW family. I often share questions and concerns from the patients from my diabetes practice but now you can all join in. Always feel free to write in to our customer service department if you have a question or concern. I will be delighted to respond and share the information with you.
- I get the shakes, sweats, confused and agitated when I do too much exercise or delay a meal. Sometimes it even wakes me up while I am sleeping. I also get extremely hungry. I know these are symptoms of hypoglycemia so I grab a candy bar. It is my excuse for a treat. Is that OK?
Answer – A chocolate candy bar is really the worst choice when experiencing low blood sugar. Chocolate is mainly fat, takes a long time to metabolize and enter the blood stream. The longer you take to treat the low episode the longer the uncomfortable feeling hangs around. Many of you know that hypoglycemia is a very unpleasant sensation. The gold standard to treat hypoglycemia (blood glucose levels under 70mg/dl and/or with symptoms) is the “Rule of 15”, using glucose tablets. This means chewing 3-4 glucose tablets (15 grams of a simple carbohydrate), waiting 15 minutes and then retesting. You should then monitor your blood glucose levels, and if the glucose does not raise, then retreat (if you are unable to chew, then use a gel formula or cake decorating gel). The reasons are easy – tablets offer you a fixed amount of glucose without sending levels too high. They have a specific amount of calories. They are cheap, portable, easy to purchase and most important: fast-acting. They taste fine (not like chalk from years ago) and come in multiple flavors from, sweet to sour. They last in the plastic tube for about a year without spoiling. They can be stored in the heat or cold without a problem. If you are with someone who becomes disoriented during a low do not try to force feed tablets since that may cause them to choke. If you have type 1 or 2 diabetes and suffer frequently from severely low blood sugars which cause you to pass out, consider getting a prescription for a glucagon kit; this must be injected by another person. You always need to be prepared to call 911 even after the glucagon shot. Certain diabetes medications – including insulin – increase your risk of hypoglycemia as well as not eating on a schedule. A recent study in Diabetes Care (August, 2013) notes that severe hypoglycemia in type 1 or 2 diabetes can lead to heart arrhythmias which may be lethal. Being prepared with simple glucose tablets can prevent a serious problem. Keep several tubes of tablets on hand.
- My health care provider is always recommending exercise and suggested that I purchase a pedometer. Why should I exercise and what is the purpose of the pedometer?
Answer – For years since the DCCT Trials we have known that lifestyle changes including exercise are a perfect way to help prevent type 2 diabetes, delay type 2 diabetes, increase insulin sensitivity when you have type 2 diabetes, and helps those with type 1 control their diabetes. A recent study documented that only 1 in 5 people actually get the recommended 150 minutes of weekly exercise. More and more research shows us that exercise is like a medicine and can be dose related. According to Dr. Barry Braun, Ph.D, at The University of Massachusetts, “You take it in a dose and over time it wears off. Then you have to take it again.” This means that the benefits of exercise are temporary and must be repeated often. If you have type 2 diabetes you are insulin resistant or unable to get the glucose out of your blood stream. Blood sugar is an irritant which causes inflammation and creates damage to the small blood vessels including the eyes, kidneys and feet. Blood sugar can also irritate the endothelial lining of the big blood vessels. Exercise can lessen insulin resistance and improve insulin action from 2-72 hours after doing 30 minutes. Without a proper and consistent program the benefits are quickly lost. Fitness levels do not matter. Being faithful matters. Simple walking can create many positive benefits. The pedometer is used as a tool or incentive. Studies show that wearing a pedometer causes you to keep track of your steps and walk more. People tend to get into friendly competition with themselves, friends, spouses or coworkers. A pedometer is low priced, light weight, easy to wear, easy to operate and motivates you to take 10,000 steps as an eventual goal. It makes walking distances more fun when you can track your progress and helps you become more “distance aware.” Always remember when starting an exercise program to get medical clearance from your health care provider. If you have limited time to exercise do not schedule it on consecutive days-skip a day to keep benefits thru out the week. Even if you are unable to do your structured exercise like going to a class or the gym try to do something. Remember to move. Try to be inefficient and force yourself to make multiple trips carrying groceries. Do not count on exercise for weight loss but understand it will help you maintain the weight you lose and increase insulin sensitivity.
I hope these questions and answers have opened your eyes to some important information. Always keep asking!
NOTE: Consult your doctor first to make sure my recommendations fit your special health needs.
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.