Diabetes may be what I live with, but I remain me, the person I was before, with the same skills, strengths and frailties. So let’s go on and look at other aspects a newly diagnosed person would want to know about.
Since I can remember, we have heard about the three-pronged approach to treating diabetes, which includes diet, medication and exercise. For that reason, we include an article each month on exercise. We try to motivate you to begin a program or continue one.
We spell out the reasons that you as a diabetic should be exercising, so please go to the articles in this area, and pick and choose rereading the ones that are of interest. Don’t forget to read the articles on various sports and activities. We enjoy writing those because we really do practice what we preach.
So what do you have to do before you start an exercise program? Talk to your physician or health care team about exercise guidelines for people with diabetes. These will answer the questions of “how hard,” “how often,” and “when.”
If you’ve read the exercise articles and the medical abstracts that we post with the positive results of exercise for people with diabetes, you may know the generic answers to these questions, but make sure if those are right for you too. Next, get to know how to snack when you exercise. Your care team will inform you about food and exercise and when to eat.
Finally, it is very important that you know how to prevent high and low blood glucose levels when you exercise. When I first became diabetic, I remember that I was put off about having to carry provisions and a monitor, but then it just stopped being of any importance, because I love to hike, sail, ski, run, or just plain go to a dance class. As with many other aspects of having diabetes, it all becomes routine.
Sick Day Management:
I can still remember the first time I got a viral infection after my diagnosis, lying in bed wondering if there was something special I needed to do, but being too tired to do anything I was supposed to be doing. Well, I soon found out and I never went through dehydration again.
Meet with your physician or care team and get the guidelines for people with your personal medical complications. Know the basics, and always have the proper foods available in your pantry. My first thought was, do I have my husband make sugar-free or regular Jell-o? Silly, huh? But no one had told me.
My first cold arrived and we didn’t have sugar-free cough medicine in the house and it was difficult to find in those days. Today, we stock our medicine cabinet and pantry. I know when to call for help. Fevers or dehydration, ketones in urine, high blood glucose levels-all point to a need to make that call.
Make sure you have all of this information readily available for those who are helping you. It’s too easy to get into a life-threatening situation, so my husband and I have spoken about when to call my endocrinologist or any of the others I see.
The problem is that when you are ill, you are under stress and your body makes hormones to protect you, but these hormones can make it difficult to control your blood glucose levels, and these may rise quickly. If you are a type 1 diabetic, you may go into a ketoacidosis and then a coma, and if you are type 2 diabetic, you may go into a non-ketoacidosis coma.
Knowledge of how to take care of yourself will keep your flu just flu, and not a reason for an ambulance ride to the hospital. As I said before, we keep food in the pantry that is easy to prepare for sick days. These are not gourmet, but they will give me the calories that I will need. I also know how to give my insulin, and you should know what to do about your oral medications. With a pump, I get hourly insulin as programmed, so I also know when to change those rates as needed and how often to take my blood glucose levels. Just because you sleep a lot of the day, does not mean that you can forget about diabetes care. You may need to have your levels taken more often if you are really sick.
Finally, make a list of all of these. Post doctors’ phone numbers and emergency numbers. Keep your medications together and make sure your family knows how and when you take it. During flu season, have extra medication available in case you’re unable to get to the pharmacy for a week. There are good surprises in this life, and the others. Keep those others away when you are down with a bug.
Knowledge of high and low blood sugars: High and low blood glucose levels are a fact of life when you have diabetes. Knowledge about these conditions can save you from long- and short-term complications of diabetes. First you need to know just what causes these two conditions, that is, why does my blood glucose level fall after I exercise, or why does it go up when I skip exercise? How does stress at work make mine go up, or playing with the dog make it retreat? Next, you and your family need to be aware of the symptoms of high and low blood glucose levels.
If you have not discussed this with your physician, please do, because we all know how important it is to keep our blood glucose levels as normal as possible. Forestalling long term complications like kidney, heart, vascular, retinal, neurological and all others complications of high blood glucose levels as well ketoacidosis and coma is of great importance, while avoiding diabetic coma and seizures from very low blood sugars.
The symptoms of hypoglycemia, or low blood glucose levels include:
- Sudden mood changes
- Clumsy or jerky movements
- Difficulty paying attention or confusion
- Tingling around the mouth
You may have some of these, or as you have diabetes, you may develop Hypoglycemia Unawareness. I certainly share some of these symptoms, but also at least one other that goes along with a herniated disc that I must have decompressed at some time in the future. My daughter can tell when I am sliding into hypoglycemia on the phone. She tells me that I slur my words. My husband knows when my thinking becomes confused and simple things that I do routinely become impossible.
The answer of when to treat hypoglycemia is easy. When in doubt treat it. If you are awake, you can take glucose tables (usually three) and wait. The trouble is that it takes a few minutes for them to work and the people around you may want you to eat more so that in an hour your blood glucose levels may be high and so you will yoyo for a while. Have a plan, please. My husband and I do. I take the sugar pills and he waits.
Being a physician did not make him an expert on hypoglycemia but we have it pretty down pat now. If your blood glucose level falls so low that you are not awake or you go into seizures, eating is not appropriate. You need to have a glucagon injection, and to that end, you need to have at least one of these prepackaged sets at home. They’re easy to use and will bring you around. A bit of protein when you awaken will keep your blood glucose from falling again.
The Symptoms of Hyperglycemia are simple, so it’s easy to know when to treat.
- You will have high blood sugar levels in your urine and of course when you take your blood glucose levels it will be high.
- Frequent urination
- Excessive thirst
- Ketoacidosis (coma)
The symptoms are:
- Shortness of breath
- Fruity breath
- Nausea and vomiting
- A blood glucose level of 240 or higher
- The presence of ketones in your urine
One question that we frequently receive here at Diabetic-Lifestyle is, how are ketones formed? Well the short answer is that when you have high blood glucose levels, the body breaks down fat for energy. The by-product of this process is a waste product called ketones, some of which is expelled in your urine, however it also builds up in your body and can lead to coma and death.
For more information about ketones and hyper- and hypoglycemia, please read our What’s Hot articles and, by all means, talk to your physician about how he/she wants you to treat these conditions. Get guidelines on when to call the office or when to go to an ER, and make sure that someone in your family knows how to treat them if you are unable to do so. Also, when you are away from home, trust at least one person with some information. If you have read this site, you know that my friends with whom I travel to spas all carry fruit or glucose tablets. It makes for better sleep and happier days.
Mostly this has to do with examining our feet to make sure there are no sores that are not healing properly or any wounds. We make sure that our nails are cut properly and if necessary, we go to a podiatrist to care for corns and calluses. All of this takes a few seconds, but not knowing that we have a problem because of neuropathy might lead to an amputation, so it is well worth our whiles.
We also have medications and equipment to treat emergency cuts, sores and abrasions. Ask your doctor what you need. Finally, we try to wear the proper footwear, which does not include stiletto heels nor pointy toe shoes. We also select our socks to wick moisture away from our feet, and change our shoes and socks to keep our feet healthy. Ask your doctor about pantyhose and your medical condition.
Urine testing for ketones:
We’ve mentioned ketones many times during this article. Talk to your physician or health care team so you know when and how to test for ketones. Make sure you get a prescription for the testing supplies so your insurance will cover it. If you are still not sure what ketones are and why they are important to your health, please read more and talk to your doctor. Know when to call your physician. You should know when you need help and have a plan to get to the office or wherever you are told to go.
Finally, let’s talk about a very common question we hear. “Will my diabetes go away?” The short answer for type 1 diabetes is “No.” When those beta cells are 90% gone you have diabetes and although you may go into a honeymoon period, ultimately the remaining 10% will also be destroyed and this person will be completely dependent on insulin to stay alive.
People with type 2 diabetes who loose weight and begin regular exercise after diagnoses may find that their blood glucose levels go back to normal, but their diabetes has not disappeared. The development of type 2 diabetes is a gradual process. A person gradually goes from “impaired glucose tolerance,” which is the state of decreased but still adequate ability to convert food into energy, to having “diabetes.”
If this person would regain the lost weight and scale back on exercise, the high blood sugars probably would continue to go higher than someone without diabetes. Also the decreased insulin production and/or increased insulin resistance that led to the initial diabetes diagnosis will gradually intensify over the years and during times of stress. In time, the person who could control diabetes with diet and exercise may need oral medications or insulin injections to maintain healthy blood glucose levels.
The good news is that people with either type 1 and type 2 diabetes which is controlled with medication, exercise, and weight loss, will also have a good chance to control long term complications of diabetes. This means aiming for a hemoglobin A1c level of 7.0 or lower. It also means that your blood glucose levels should not be above 140 mg/dl before eating or above 180 mg/dl two hours after eating. Above these levels is considered high.
Talk this over with your physician. The numbers we came up with are lower for me and my well-being. I feel better and more comfortable. This is one to talk over. Too high is bad and, as you learned, too low is too.
Our last section here is a listing of tests, information updates, and exams you need to have at least once a year depending on your health.
- Glyco-hemoglobin (2-4 times per year)
- Kidney function
- Cholesterol, LDL, HDL, and triglycerides
- Foot exam
- Eye exam
- Blood pressure
- General physical exam
Update management checklist:
- Meal plan
- Medications and how and when to take
- Glucose monitoring, techniques, how, when, why
- Treatment of high and low blood glucose levels
- Sick day management
- Risk factors for health problems
When we began these two articles, we asked you to read on and then feel free to ask questions. Talk to your health care team and physician. Make sure you’re comfortable with and understand what you hear. No matter what, continue to read and ask questions. You have diabetes, not them, and you want to be here, playing tennis or taking vacations for years.