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

Q.   The winter killed my skin!  It is red, chapped and itchy.  What do you suggest?

A.   Here are several suggestions that may help:

• Use plenty of moisturizing lotion or cream to relieve the itch that often comes with dry skin.  It can help heal the irritation and cracking, and also prevent future damage from occurring.
• Drink plenty of water to stay hydrated.
• Keep your blood glucose level in a healthy range.  A high level can cause the skin to become dehydrated and slow healing. 
• Wear gloves while the weather is cold.
• If the irritation continues, see your doctor or dermatologist for additional guidance.

When you have diabetes, it is important to protect your skin from injury as cuts can invite the development of an unwanted infection.  Hang in there.  The weather should be improving soon!

Q.   I keep chocolates in my home in case my blood sugar drops.  A friend told me that people with diabetes shouldn’t eat chocolates. Why not?

A.   People with diabetes can enjoy most foods, including a small amount of chocolate, if it fits into their daily meal plan.  But chocolate is not the best food choice when managing hypoglycemia (low blood sugar). The fat in the chocolate slows down its absorption, so it won’t raise your glucose level as quickly as other foods will.  If that’s all you have handy you can use it, but it isn’t ideal.  When treating a low blood glucose level, use the 15/15 Rule:

1.  Eat 15 grams of a fast acting carbohydrate, such as those listed below.

2.  Wait 15 minutes

3.  Test again

4.  Repeat if needed

The following items contain approximately 15 grams of carbohydrate:

½ cup (4 oz) of fruit juice

Half a can of regular (not diet) soda

2-5 Glucose tablets (check label)

Two tablespoons of raisins

5-7 hard candies

Your blood sugar level will begin to rise before the unpleasant feelings disappear, so don’t keep eating or drinking until the feelings go away.  That will cause your glucose level to climb too high and may cause you to gain weight.

Q.   I was just diagnosed with type 2 diabetes.  I’m so ashamed. Do I have to tell people I have it? 

A.   First, let’s tackle your feelings of shame.  You did NOT cause your diabetes.  Diabetes is a complex condition that can be triggered by certain lifestyle behaviors, such as weight gain and inactivity, but you must inherit the potential to get it.  You are also not alone.  23.6 million Americans have diabetes and 57 million have pre-diabetes, which means they are on their way to developing it. The good news is that you can now take steps to become healthier.  Attend a diabetes class and learn how to make better food choices, achieve a healthy weight, and feel better than you have felt in a long time.

As for telling people, your medical health is a personal issue.  Share your diabetes information with those who can support you and help you in an emergency. If you believe someone will make fun of you or make it more difficult for you to care for your health, don’t say a word. 

*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.   A friend of mine suggested that I use agave nectar as a sweetener instead of artificial sugar substitutes. Isn't agave the stuff they use to make tequila?  Is it possible to take a liquor ingredient and turn it into a diabetes sweetener?

A.   Like sugar cane, the agave plant has many uses. Rum is made from sugar and tequila is made from agave, yet sugar and agave are not alcoholic items. Agave syrup won't cause you to dance on tables. It is a nice, safe sweetener.

Q.   Why do I feel hungrier when my blood sugars are high?
A.   When your blood sugar level is above your target range, your main source of energy is stuck in your bloodstream and can’t enter your cells at a healthy rate. Your cells need energy to do their jobs. When they can't get it, they signal to the brain that you have no food for them, sends out a hunger signal and your brain starts to scream...."WHERE'S THE FOOD?!" 

Q.   I was diagnosed with type 1 diabetes a few months ago and just discovered that I am pregnant. My diabetes control is good right now, but I’m so worried about my baby.  Is it possible that he or she will develop diabetes?

A.   Here is a list of the probably risk of developing diabetes:

If no members have diabetes: the child has an 11% chance of type 2 diabetes by age 70 and a
1% chance of type 1 by age 50

One parent with type 1:
Father: 6% chance of type 1
Mother who was younger than 25 when child was born: 4% chance of type 1
Mother with diabetes who was older than 25 when child was born: 1% chance of type 1

(The risk doubles if the parent was diagnosed by the age of 11)

One parent with type 2 who was diagnosed before the age of 50: 14% chance of type 2

Both parents with type 2: 45% chance of type 2 by the age of 65

Take care of your diabetes and work closely with your health care team and all will hopefully go well.

Q. How can I tell if I’m eating enough carbohydrates?

A.   Many people cut way back on their carbohydrate intake and find that they don’t have enough energy to make it through the day. Here are a few ways to tell if your carbohydrate intake is right for you:

• Evaluate how you feel.  Is your energy level low?  Carbohydrate provides the form of energy that the body prefers to use. You may need to eat additional carbohydrate servings.  A registered dietitian can help you determine if you are eating the right amount.
• Check your A1C level, which represents your average blood sugar level for the past three months.  If it is 6.5% or higher, you may be eating too many carbohydrates. Most experts believe that your body needs at least 130 grams of carbohydrates to function properly, so don’t cut back too drastically.
• Check your blood sugar level at 2-hours after the first bite of a meal.  If you are within your target range, your carbohydrate intake was probably fine.  If you don’t know your target goal, aim for less than 180 mg/dl for good control, less than 160 mg/dl for better control, and less than 140 mg/dl for tight control.
• Monitor your weight.  If you are gaining, you may be over-eating all different types of food, including carbohydrates.

* 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 

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

Q.   Can you suggest a few holiday gifts for someone who has diabetes?

A.   Sure! Here are several diabetes-friendly gift ideas:

• Exercise videos or a health club membership. 
• A massage.
• A bicycle or other piece of exercise equipment.
• A romantic date that includes dinner plus a night of dancing or tickets to a show.
• Assorted low carbohydrate snacks and a diabetes-friendly cookbook arranged in a new piece of cookware.
• A selection of relaxing music CD’s. 
• Slippers and a robe.  Choose slippers that have solid soles as people with diabetes must protect their feet from cuts and other injuries that invite infections. 
• A new diabetes book. 
• Make a donation in your friend’s honor to the International Diabetes Federation’s Life for a Child Program.  This program supports the care of close to 1100 children with diabetes in more than 18 countries worldwide.  Their website is www.lifeforachild.idf.org

Q.   I get a flu shot every fall.  A friend told me she got a pneumonia shot also.  Do I need that too?

A.   According to the American Diabetes Association, people with diabetes are three times more likely to die from pneumonia than those without diabetes.  You can take a pneumonia shot anytime during the year.  A single shot will protect most people for their entire lifetime.  Ask your doctor if a pneumonia shot is right for you.

Q.   Can I ski while wearing an insulin pump?  What if I fall?

A.   Your pump can definitely join you on the slopes.  Pump cases are made from a plastic similar to the type used for motorcycle helmets.  They tolerate bumps quite well, so you needn’t worry about taking a fall. You can also purchase a comfortable holder from your pump company, so your pump will stay on securely. 

Athletic activity requires an adjustment in insulin delivery rate as exercise usually lowers blood sugar levels.   Also, very cold or windy conditions may intensify the blood-glucose lowering effect, so monitor your blood sugar level often.

Some experts recommend the following:

• Reduce your mealtime boluses by 10-30% for all-day or intense skiing and snowboarding.
• Reduce your basal insulin rates by 25-50% for the entire day.
• If needed, eat 10-15 grams of additional carbohydrate per hour.

Q.   Who discovered insulin?

A.   The discovery of insulin is a great story.  The year was 1921.  In a poorly equipped, long-forgotten lab in Toronto, Canada, Dr. Frederick Banting and Charles H. Best began their research.   They were given about eight weeks to prove Banting’s belief that the pancreas contained a magical substance that could prevent diabetes.  Using the money from the sale of Banting’s car, the researchers started their work.  The first few weeks were terribly disappointing.  Finally, as the seventh week approached, a breakthrough happened.  Banting isolated the “anti-diabetic factor” and demonstrated its ability to lower blood sugar in diabetic dogs.

Banting was awarded a Nobel Prize for medicine with Dr. John J. MacLeod, who provided the research lab.  Upset that his associate, Charles Best, had been slighted, Banting shared his Nobel Prize with him.  Later, Banting was knighted by the Queen and became Sir Frederick Grant Banting.  In 1922, Banting and Best became associated with Eli Lilly and the commercial production of insulin for human use began.

*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