Considerations for Other Health Conditions
Heart Disease and Diabetes
Concern: I have heard that heart disease is a big risk for people with diabetes.
Solution: You can make positive choices to protect your heart:
- Being a non-smoker is the most important thing you can do to protect your heart. Non-smokers have more oxygen circulation for the exercise they want to do. Non-smokers' blood pressure stays lower and vessels stay free of cholesterol and clots better.
- Have your blood pressure checked every 3 months. Step up your treatment until it is controlled to an ideal level (diastolic of 80 or less is optimal)
- Have your cholesterol checked yearly and find out about heart healthy eating. A level of LDL cholesterol less than 100 is optimal.
- Aspirin therapy is often started around age 30 in people with diabetes, but should not be taken in pregnancy or with some conditions. Consult your physician
- Exercise! Find ways to build physical activity in to every day doing things you enjoy.
Pregnancy and Diabetes
Concern: I am worried about how I will be able to have kids with my diabetes.
Solution: Be sure that you have an effective method of contraception if you are having sex. Women with diabetes can usually take birth control pills safely. Women with diabetes can have healthy pregnancies. Tight blood sugar control prevents birth defects. The supplement of 800 mcg folic acid per day should also be started before pregnancy. You need to maintain a truly normal glycosylated hemoglobin of 6.0 or less for 3 months before getting pregnant. Discuss this with your doctor.
Complications of Diabetes
Concern: The idea of diabetes-related complications scares me.
Solution: It is scary to realize you are at risk. If you think you have a problem with your eyes, nerves, kidneys, or heart, seek medical help at once as many problems can be turned around if caught early. Near normal blood sugar control reduces your risk and delays complications. Screening of eyes, kidneys and nerves every year will help you catch problems at an early, treatable stage. Review Intensive Diabetes Management on the Maintenance Care section.
Illness and Diabetes
Concern: What if I get sick?
- Ask your diabetes team for a sick day plan.
- Stock a box with supplies. Your “Emergency Breakdown Kit” could have ketone strips, instant soup, gingerale, Jell-O, thermometer, water bottle and prescription medicine for nausea. What else would make you feel better?
- If you are ill, take your usual insulin, even if you have nausea. Take extra insulin for high blood sugar according to your physician’s instructions. Check blood sugar and urine ketones every 3-4 hours. Drink fluids including some salty liquids such as chicken soup. See your physician for any illness with moderate or large ketoses, high fever, and glucose above 240 or if you are unable to hold down liquids. Make a appointment to see if you need antibiotics, anti-nausea medicine or other treatment.
Alcohol Use and Diabetes
Concern: I do use alcohol. How does that affect my diabetes?
Solution: Alcohol in general lowers your blood sugar. Moderate drinking with a meal can be included in a diabetes plan. Moderate means 1 drink for women, 2 drinks for men. At other times, consuming alcohol means you need to eat carbohydrates and follow blood sugar closely to prevent hypoglycemia. Carry sugar with you. Call a cab, or walk if you have been drinking. Do not drive. If you are trying to lose weight, or have problems with unawareness of lows, alcohol is not a good choice. Wear ID that says you have diabetes and let other people know what to do if you have hypoglycemia so they won’t assume you are “just drunk”.
Low Blood Sugar and Diabetes
Concern: How can I prevent low blood sugar?
- Gather information: keep a logbook and make note of any symptoms before you test.
- When you have a low blood sugar (less than 70) write down any factors that caused it and any symptoms you missed. This will help raise your awareness of subtle symptoms.
- Treat immediately. Use glucose tablets, 15 grams to avoid over treating or taking in extra fat.
- Review the past week to see if there is a pattern. If it was a severe low or is happening repeatedly, adjust your insulin that is active at the time the low occurred. Discuss with your doctor any changes in insulin.
- Plan ahead: exercise, less food, longer wait before meals, and more insulin than usual can all lower your blood sugar.
- Learn about your insulin: when it starts, peaks and stops. Know which doses are acting at different times. Review your insulin program regularly with your physician and learn what adjustments you can make on your own.
- Consider an insulin pump if you have problems with overnight lows or need the flexibility to adjust quickly for exercise or unpredictable schedules.
Losing Weight with Diabetes
Concern: How can I lose weight healthily?
- Meet with a dietitian for individualized counseling to assess your current eating pattern and come up with ideas for healthy eating.
- Set realistic goals for yourself and consider your priorities. Fitness and healthy diabetes control will mean more to your long term happiness than just being thin.
- For people with type 1 diabetes, exercise is very helpful for weight management.
- Let your diabetes team know about your goals. Have several strategies for correcting high blood sugar such as exercise, lag time ( waiting after your insulin shot before eating) or modest reduction of carbohydrates.
- Prevent low blood sugar so you don’t have to eat more.
- Treat hypoglycemia with glucose tablets, not fatty candy.
- Adjust your insulin with your doctor’s help to just the right dose so you don’t have to eat just because your insulin is peaking at the wrong time.
*You may have heard of people skipping insulin to lose weight. This is extremely dangerous. The very high blood sugar rapidly brings on damage to small blood vessels while the starvation state of diabetic ketoacidosis causes loss of muscle and vital organ tissues, not just fat, with added poisoning of your body by dehydration, electrolyte and fluid loss. Some people call this “Diabulimia”. Anorexia and bulimia or diabulimia in someone with diabetes all speed up the development of complications. Disordered eating and skipping insulin are extremely dangerous for people with diabetes. If this is an issue for you, help is available to regain control of your diabetes and save your health. Please make an appointment with your medical doctor, dietitian, or counselor for an assessment.