Medication Questions
What is the name of the medication?
When should I take it?
Should I take it before, with, or after meals?
Are there any other special directions for taking this medication?
If I forget a dose, should I take it later, or skip it?
What side effects are common with this medication?
What side effects should I tell the doctor about?
Are there any blood tests or other checks I need to have while taking this medication?
Types Of Medication
There are several types of medication commonly used to treat type 2 diabetes:
Sulfonylureas Stimulate your pancreas to make more insulin.
Biguanides Decrease the amount of glucose made by your liver.
Alpha-glucosidase inhibitors Slow the absorption of the starches you eat.
Thiazolidinediones Make you more sensitive to insulin.
Meglitinides Stimulate your pancreas to make more insulin.
D-phenylalanine Help your pancreas make more insulin quickly.
Combination oral medicines. A combination of different types of pills.
How-To Information:
Remembering Your Pills
It's very important to take your diabetes pills regularly, even if you feel better.
Buy a pill organizer with a compartment for every day of the week. Load it up once a week. (Include any other pills you are taking regularly, such as pills to control cholesterol or blood pressure.)
Keep your pills where you can see them easily, for example, on your bedside table or near where you eat.
Ask a family member to remind you about your pills.
When traveling, put a note in your luggage reminding you to take the pills. Carry a spare prescription, in case you lose the pills. Be sure to locate a pharmacy near where you are staying in case you have a medication question or need to fill a prescription.
Fill prescriptions well before you run out of medicine, especially if you'll be going on vacation or around the holidays.
If you have side effects, talk to your doctor. But don't stop taking the pills without your doctor's permission.
Do You Need Insulin?
If you have type 1 diabetes, when the body no longer produces insulin, you probably need to take insulin shots every day. With type 2 diabetes, sometimes the pancreas can't make enough insulin, even with the help of pills. If that happens, you will need to take insulin as well.
Insulin has to be given as an injection. If you took it like a pill, it would be digested in your stomach and small intestines, just like food.
You can store insulin at room temperature for up to a month. It can also be kept in the refrigerator, but be sure to let it warm up before the shot. Insulin that's too cold may be uncomfortable to inject.
Insulin won't work if it goes below 36 degrees or above 86 degrees. It can also be damaged by sunlight.
Don't leave bottles in a car on a hot or cold day.
Keep them out of direct sunlight.
If you are traveling by plane, keep the bottles with you. Bags you check may get too hot or too cold.
Your doctor or nurse will show you how to draw up insulin into the syringe. Sometimes you may use a single type; sometimes you need to mix two types in the syringe, so they can be given together in one shot. Or you may use an insulin pen, which comes pre-loaded with insulin and ready to use.
Where to Give an Insulin Shot
Insulin is injected into the fat just beneath the skin. Ask your health care team about a good spot, because the injection site may affect how well the insulin is absorbed. The best places are:
The abdomen
The upper arms
The thighs
The hips (not the buttocks)
Choose an injection site about half an inch (one finger-width) from the place where the previous shot was given.
How to Take an Insulin Shot
Pull the skin tight.
Insert the needle as far as it will go. Push it straight in, at right angles to the skin.
Let go of the skin.
Push in the plunger, then quickly remove the needle.
If there is a drop of blood or fluid, apply pressure with a tissue.
Make a note in a logbook after each shot. Mark down the time, and the dose. This will be useful if you need to adjust dosage.
Care of Syringes
Syringes can be used more than once, but must never be shared. When the needle starts to get blunt after three or four shots, throw it out. Many states require you to use a special "sharps" container for the disposal of used needles. You can get one from your pharmacy.
How Is Blood Sugar Monitored?
Keeping track of your blood sugar levels makes your diabetes easier to manage and helps you keep an eye on your condition.
Blood sugar that is too high (hyperglycemia) can make you feel sick. You may urinate frequently, become thirsty, have blurring of vision and may get skin infections, eg, boils. And if it stays high for long, it can cause problems with your eyes, feet and kidneys.
Blood sugar that is too low (hypoglycemia) can make you feel sick too. You may sweat, feel very hungry, weak and anxious, feel your heart pounding in your chest. You may not be able to think clearly and even pass out.
If you are taking insulin A hormone made in the pancreas. It regulates the way sugar, fat, and protein are moved into the cells, and the way they are stored or used for energy.,you should test your blood at least twice a day, usually before a meal. Some people take only one injection of insulin a day before going to bed. In that case, testing your blood only once a day before breakfast is necessary.
When you are sick.
When you are starting a new medicine, and need to see how well it is working.
If you get symptoms of low blood sugar.
About Glucose Meters
You can buy inexpensive meters that tell you how much sugar is in your blood. With most, after you prick your finger with a special lancet A short pointed blade used to obtain a drop of blood; it has a guard above the blade that prevents a deep incision., you put a drop of blood on a test strip for the meter to read. Glucose Commonly referred to as sugar, it is the major source of energy used by the body's cells. It is taken from foods we eat and can be made from protein. meters also store the results of tests, with the date.
There are more than 25 different types of meters on the market. They differ in these ways:
Amount of blood needed for test
Testing speed
Overall size
Ability to store test results in memory
Cost
Newer types of meters are generally easier to use and have more features, such as the ability to store results or print them out. "Noninvasive" models are also available that don't require a finger stick The act of puncturing the tip of the finger to get a small sample of blood..
When using a lancet to prick your finger, try to get a good drop of blood from the side of your finger. The side has a good blood supply, but is less sensitive than the tip.
Even if you have a meter that stores numbers, note the time and the blood sugar number in a logbook. Then you won't lose your data if the meter goes wrong or its battery dies. Also,it will be easier for your doctor to analyze the results written in a log book than to have to scroll through the results that are stored in the meter. Be sure to have spare batteries on hand, just in case.
Glucose Meter A special device used to measure blood sugar levels. Use
Each meter has a different set of instructions. With some meters, get a good drop of blood, put it on a test strip, insert the test strip into the meter, and read off the result. With other meters, insert the strip into the meter before you place the drop of blood on the test strip. In both cases,you will get an exact figure.
"Normal" blood sugar is between 70 and 110 (before meals) up to 140 (soon after meals). Your diabetes team will tell you how close to those numbers your readings should be.
The Hemoglobin A1C Test
About once every three months, you will need a blood test that shows how well you have been controlling your blood sugar over the long term. The hemoglobin A1C test measures the amount of sugar that has stuck to the red blood cells. It reflects the average blood sugar over the past two to three months.
How Does Diet Affect Diabetes?
A healthy diet is a crucial part of managing diabetes. People who have diabetes should watch:
What time they eat (meals and snacks should be about the same time every day)
How much they eat (meals and snacks should be about the same size every day)
The balance of what they eat at each meal (not too much of one type of food).
In the beginning, you will probably work with a dietitian to plan meals and snacks. You may follow a plan called "carbohydrate counting." Carbohydrate counting is keeping track of starchy foods and sugar, which have the most effect on blood sugar.
The Balanced Diet
Meals and snacks should be based on the food pyramid. Your dietitian may tell you just how many servings you need of each food, and how large a serving should be.
The largest part of each meal should be the foods at the bottom of the pyramid, such as whole grain breads, pasta and rice, and starchy vegetables like potatoes, corn, peas and beans.
Every day, you should have several servings of vegetables and fruit.
Protein should come from lean meats, chicken, turkey, or fish, or meat substitutes like beans, eggs or low-fat cheese.
Dairy foods should be either non-fat or low-fat.
Eat fats and sugars only in small amounts.
There isn't one diet that is right for everyone. Your dietitian will help you design a meal plan that is right for you.
A meal plan is a guide that tells you what kinds of food you can choose at meals and snack time and how much to have. For most people with diabetes (and those without, too), a healthy diet consists of:
40% to 60% of calories from carbohydrates
20% from protein
30% or less from fat
The Food Pyramid
This pyramid shows approximately where food should come from, with much more from the wide parts than the narrow.
Fat and sugar: Use sparingly
Dairy foods (two to three servings): Choose non-fat or low-fat
Protein (two to three servings): Meat, poultry, fish, eggs, beans: Choose lean protein sources, such as skinless chicken and fish. Limit egg yolks to 3-4 per week, 1/2 cup of beans can be substituted for 1 serving of meat or fish
Vegetables (three to five servings): Eat all different types and colors
Fruit (two to four servings): Eat whole fruit rather than drinking fruit juice so you get enough fiber
Grains and starchy vegetables (six to 11 servings): Choose whole grain breads, and a wide variety of other starches
Salt
High blood pressure often goes along with diabetes. High sodium intake has been linked to high blood pressure.
Cut down gradually on salt used in cooking and at the table.
Avoid high-sodium foods such as chips, snack crackers, processed meats, and canned soups.
Sugar
There is no need to avoid all sugar. However, use sugar sparingly and try not to add additional sugar to foods.
Eat sugar as part of a meal (for example, in fruit pies, frozen yogurt, or pudding).
Avoid too much sugar between meals. Drink diet soft drinks, not regular.
Don't waste your money on "diabetic" foods. They are often high in fat to make up for lack of sugar.
Avoid processed foods, which are often high in sugar and fat and low in nutrients.
Fats
Fats may not cause blood sugar to fluctuate in people with diabetes, but they still should be reduced, especially if you are trying to lose weight.
People with diabetes have a much higher than average risk of heart disease. You can reduce that risk if you cut down on saturated fat, which is found in meat, dairy foods, and solid vegetable fats.
Choose lean meats; take the skin off chicken.
Instead of butter or hard margarine, eat "good" fats from oils such as canola or olive, or from nuts. Choose margarine that lists a liquid oil as the first ingredient.
Buy skim or low-fat milk, and non-fat or low-fat yogurt. Limit the amount of regular cheese: choose a low-fat type.
Avoid fried foods. Grill, broil, boil or bake instead.
Limit egg yolks to three to four per week.
Alcohol
Ask your diabetes team how much alcohol (if any) you can have with meals.
Don't drink alcohol on an empty stomach. Have it with a meal and sip it slowly.
Research shows that if your diabetes is under control, a moderate amount of alcohol has only a minimal effect on blood sugar. A moderate amount is defined as:
No more than two alcoholic drinks daily for men
One alcoholic drink daily for women
One drink equals:
One 12-ounce can of beer
One 5-ounce glass of wine
One 1-ounce shot glass of whiskey.
If your blood sugar is not under control or you have diabetes complications, avoid large amounts of alcohol. It can worsen some complications, including nerve damage, coronary artery disease and high blood pressure.
Also keep in mind that alcohol is high in calories. If you're trying to lose weight, alcohol can make that more difficult.
Snacks
Snacks can help keep blood sugar from dipping too low between meals. These should not be high in sugar and fat, like candy or chips, but foods such as:
Peanut butter and crackers
Cheese and crackers
Low-fat sugar-free yogurt
Fresh fruit
Bran muffins
Graham crackers
Always carry a source of carbohydrate, eg,,glucose Commonly referred to as sugar, it is the major source of energy used by the body's cells. It is taken from foods we eat and can be made from protein. tablets, in case yor blood sugar gets too low. This may occur if you are taking either insulin A hormone made in the pancreas. It regulates the way sugar, fat, and protein are moved into the cells, and the way they are stored or used for energy., or to a much less extent, a sulfonylurea agent. It is much more likely to occur if you skip meals, eat less than usual or exercise more than usual.
Eating Out
When you eat out, stick to the same plan you follow at home.
Eat servings about the same size as you have at home. If there is food left over, ask for a doggy bag.
Avoid food high in fat. Order foods that are broiled, boiled, steamed, grilled, or baked, not fried.
If you order salad, ask for the dressing on the side, and use only a little.
Have fruit for dessert or, as a treat, split one dessert with a friend or two.
If your doctor has asked you to limit salt, ask for low-sodium dishes.
About Fast Food
Eat fast food only as an occasional treat, and follow these tips:
Try to keep fat content as low as possible.
Don't add cheese to hamburgers.
Have vegetable toppings on pizza instead of meat.
Avoid fried chicken and chicken nuggets.
Opt for a side salad instead of fries or onion rings.
Many fast food chains provide leaflets that tell how much fat there is in each serving.
What Is Low Blood Sugar?
Hypoglycemia - low blood sugar - can be very unpleasant and sometimes dangerous. It can be caused by:
Taking certain diabetes pills (sulfonylureas) without enough food
Overexercising if taking insulin or a sulfonylurea
Alcohol on an empty stomach
Too much insulin
The Signs of Hypoglycemia
You may feel:
Shaky, sweaty, hungry, faint or weak
Palpitations, or a rapid heart beat
Irritable and impatient
If you don't raise your blood sugar, you may get blurred vision and headache. You may get drowsy and confused, and even pass out.
What To Do About Low Blood Sugar
You should immediately take about 15 grams of sugar. Good sources are:
Food item
Amount
Glucose Commonly referred to as sugar, it is the major source of energy used by the body's cells. It is taken from foods we eat and can be made from protein. tablets
Fruit juice
Soda pop (not diet)
Hard candy
Sugar or honey
Raisins
Sugar packets
2 to 3
1/2 cup (4 ounces)
1/2 can (6 ounces)
3 to 5 pieces
3 teaspoons
Handful
2 to 3
If possible, test your blood sugar 15 minutes after eating some sugar. If it is still low (below 70) or if you can't test but still feel weak and shaky, take more sugar.
As soon as you feel better, you should eat some solid food. If it's nearly mealtime, have your next meal early. If it's an hour or more before mealtime, have a snack, such as:
Half a ham or turkey sandwich
Peanut butter with crackers
Even if you can bring up your blood sugar quite easily, make a note in your log each time you have hypoglycemia, so you can tell your doctor what seemed to cause it. Write down:
The time
When you last ate
When you last had a pill or an insulin shot.
If you have hypoglycemia frequently, you may need changes in your medication, or in your mealtimes. If your blood sugar level dips low after exercise, plan to eat a snack or small meal before your exercise session.
Safety Tips
Make sure you always have a high-sugar snack with you.
If you are feeling at all weak or shaky, check blood sugar before driving a vehicle, using heavy equipment, or planning something energetic. Or have something to eat.
Tell family, friends and co-workers to call 911 if you pass out.
Wear a diabetes identification bracelet or necklace in case you pass out when you are alone.
How Does Illness Affect Diabetes?
Even "normal" illnesses like colds and flu can cause special problems when you have diabetes.
If you can't eat, or are vomiting, it may be hard to keep blood sugar up.
Some illnesses interfere with the way insulin works. If you are taking insulin, youo may need more while you are ill. If you are ill for a long period and the pills are not controlling your diabetes, your doctor may want you to start insulin.
Get an action plan from your diabetes team that tells you exactly what to do when you get sick. For example, you should know:
Whether you will need insulin (or extra insulin);
When to call the doctor;
What soft food and drink you should have on hand in case you can't eat normally;
What extra medicine you may need (for example, to settle your stomach).
Some General Rules For When You Are Ill
Call the doctor if your blood sugar is over 300.
Drink plenty of fluids. Drink at least one 8-ounce cup of water every hour (people with diabetes can get sick if they are dehydrated).
If your blood sugar is low and you can't eat, drink juice or regular (not diet) soda to keep your blood sugar up.
If you can't keep anything down, suck on ice chips, then sip clear soda, such as regular ginger ale.
Keep taking your medicine.
Have someone look in on you or call you every few hours.
Call the diabetes team if you have any questions, or if you start to feel worse.
How Do You Avoid Complications?
People with diabetes have a high risk of many serious health problems. That's because when you have more sugar than normal in your blood, it can damage blood vessels and nerves. This can lead to:
Problems with eyes
Problems with kidneys
Problems with nerves, especially in the feet
Problems with teeth and skin
People who control their blood sugar have fewer diabetes complications. The best thing you can do for your health is to:
Keep testing your blood regularly.
Keep eating healthy food, and eating regularly.
Keep exercising.
Keep taking your medication.
Make sure that your blood pressure and levels of fat in your blood are normal to avoid heard disease and strokes.
You can also catch any problems early, and treat them before they become too serious.
If You Smoke - Quit!
Smoking can make the problems of diabetes far, far worse. Smokers are likely to get complications much sooner than others.
If you smoke, quit! Ask your doctor about new methods of quitting. There are now pills that can help (bupropion), as well as nicotine replacement systems such as patches or gum.
Cut Your Risk For Heart Disease
You can keep your risk of heart disease low by taking care of your health:
Control your weight.
Exercise regularly.
Eat a low-fat diet, with plenty of vegetables.
If you have pills to control blood pressure, or cholesterol, take them every day, even if you feel fine.
Care For Your Kidneys
Your doctor will check your kidneys regularly. In addition, it's important to tell the doctor any time you get symptoms of a bladder infection-having to urinate more often than usual, and feeling pain or a burning sensation when you urinate. Then the infection can be treated before it causes damage.
Care For Your Eyes
See the eye doctor at least every year. Diabetes can cause damage to the retina in the back of the eye. You may not get any symptoms, but the doctor can see if damage is starting. Early care can prevent blindness.
Care For Your Mouth
You have a higher risk of gum disease than average, and may get mouth sores that don't heal.
See your dentist regularly (every three to six months).
Brush and floss your teeth regularly.