Q & A from Janis Roszler, MSFT, RD, CDE, LD/N

Q.   I really try to follow my diabetes diet, but just can’t do it.  Do you have any ideas that might help me?

A.   Your diabetes meal plan shouldn’t be a burden.  If it is, meet with a registered dietitian who can redesign your plan to better fit your preferences and lifestyle.  If you find that you still indulge once in a while, try to do the following:

• Learn to treat abnormal glucose levels that may result from eating foods in portions that aren’t recommended.
• Don’t punish yourself for veering off your redesigned meal plan!  We are all human.  If you make a poor food choice, forgive yourself and eat healthier at your next meal.
• Learn your A1C number.  Most experts recommend a starting A1C goal of less than 7 percent with an ultimate goal of less than 6.5 percent.  If your A1C level is good, an occasional high blood glucose meter reading should not be a problem.  If it is too high, meet with your healthcare team to adjust your treatment plan.

Q.   If I have to start insulin, will I ever be able to stop?

A.   If you have type 1 diabetes, the answer is no – you must take insulin from an outside source because your body can’t produce any of its own.  If you have type 2, it may be possible to reduce or even eliminate your need for insulin if you do the following:

1.  Follow a healthy meal plan.  A registered dietitian who specializes in diabetes can help design a meal plan that fits your lifestyle and improves your diabetes control.
2. Stay physically active.  The addition of even a small amount of movement can make a significant improvement in your blood sugar control.  Discuss exercise choices with your doctor before starting.
3. Lose weight, if needed.  You should be able to see an improvement in your diabetes control after a small amount of weight loss.

Q.   Is it true that pregnant women with diabetes make more amniotic fluid?  I had an awful lot of fluid appear when my water broke and the nurse blamed it on my diabetes.  Just curious.

A.   This is actually true. Women who are pregnant and have diabetes may make more amniotic fluid if their blood glucose level runs high during the pregnancy.  Those who control their glucose level well will probably produce the same amount as other women.

Q.   I used to feel my blood sugar level drop, but can’t anymore.  Can I ever get the sensation to return?  

A.   Unfortunately, it is very common to lose the ability to feel a drop in your blood glucose (sugar) level when it runs low.  This often happens to people who make a real effort to keep their blood sugar level in a very narrow range.  Some experts also believe that frequent low blood sugar episodes can cause this unawareness to develop.  It may be possible to get this sensation to return or to better anticipate when it may drop, by trying the following:

• Maintain blood sugar level within 80-180 mg/dl for 2-3 weeks.  Many people have regained their ability to feel blood sugar lows after doing this.
• Meet with your health care team to review your daily blood sugar test results for patterns.  You may be able to learn to predict when a low will occur and change your eating and/or medication schedule to help prevent it.

*This article originally appeared in 2010

** please consult with your healthcare provider before making any changes to your diabetes regimen.

- For more great articles by Janis Roszler, visit the e-version of our magazine at walgreensdiabetes.com 

Q & A from Janis Roszler, MSFT, RD, CDE, LD/N

Q.   Thanksgiving is almost here and my family is going to embarrass me again – they will lay out a delicious spread of homemade foods that I can’t eat, and set aside some store-bought microwaveable foods for me, their “little diabetic.”  Can you help me have a better holiday?

A.   Here are several things you can try to help everyone enjoy a better Thanksgiving:

Call the host of the dinner ahead of time and let him or her know that you appreciate their concern, but don’t require special foods.  Then use the Plate Method to take reasonable portions, so your blood glucose level stays within your target range:

• Take a standard 9-inch plate. 
• Fill one half of the plate with non-starchy vegetables.  These include lettuce, broccoli, tomatoes, peppers, celery, cauliflower, etc. 
• Limit your starch servings to ¼ of the plate.  These include potatoes, stuffing, corn, peas, etc.  Do not eat a larger portion.  These are carbohydrate-rich foods that will raise your blood glucose level.
• Fill the remaining ¼ of the plate with turkey or other protein item.
• Limit your dessert servings.  Take just a taste and move away from the buffet table.  If you can’t limit yourself, walk away before dessert is served and sit down with a cup of coffee or tea.  Or, offer to bring a diabetes-friendly dessert that all can enjoy.

I can’t stop your relatives from calling you their “little diabetic,” but I do have a suggestion that may help.  Go to www.behavioraldiabetes.org and print out copies of their Diabetes Etiquette booklet for people who DON’T have diabetes.  Pass these around to relatives who are interested in learning how to interact with people who have diabetes.  It is a great resource!

Here’s another hint that you may find helpful.  Most people respond to the tone that you set.  If you are comfortable with your diabetes, they will be comfortable too.  When your aunt calls you her “little diabetic” give her a hug and call her your “little auntie” and see what happens then change the subject. You’ll be turning it into a light-hearted joke and will, hopefully, take the sting out of the comment.  Family can be frustrating, but they do provide us with many things that we are thankful for.

Q. My boyfriend has type 1 diabetes.  His doctor said that he might not be able to have children. Is this true?

A.   Having diabetes shouldn’t affect a man's ability to have children. A very small study published in 2007 in the Journal of Human Reproduction showed that men with type 1 diabetes may have a slight change in sperm quality that could affect fertility.   All of my patients with type 1 who wanted to have children, now have beautiful families. Tell your boyfriend not to worry.

Q.   I forgot what to do when my blood sugar drops too low.  Can you print the tips again?

A.   Sure!  If your blood glucose level drops below 70 mg/dl (or below your target range), use the 15/15 Rule.  Here it is:

1. Eat 15 grams of a quick-acting carbohydrate food.  Examples include:

½ cup of fruit juice

 1 can of regular soda (not diet)

 2 teaspoons of sugar

Commercially sold glucose tablets (as directed on the label)

2. Wait 15 minutes
3. Test again. 
4. Repeat until you are within your target range or above 70 mg/dl.  Follow this treatment with a small protein/carbohydrate snack.

*This article originally appeared in 2008

**please consult with your healthcare provider before making any changes to your diabetes regimen.

- For more great articles by Janis Roszler, visit the e-version of our magazine at walgreensdiabetes.com