Kim,

My advice is to enjoy a piece of your favorite cake on your birthday. Diabetes does not mean that you have to give up all sweets and goodies, especially once a year when you are celebrating your birthday. All foods, even cake, can be enjoyed when you have diabetes but the key is moderation. Your daughter does not have to bake anything "special". I believe your daughter should still bake your favorite cake. Just be prepared with a plan so you can enjoy a piece of birthday cake.

For example, remember to eat normally on the day you will be celebrating your birthday. Do not skip meals to "save up". Since you know that you will be having cake with your meal, make smart choices regarding the other foods you eat at that meal. Choose a lean meat and non-starchy vegetables and let the cake be your carbohydrate. If you are concerned about your blood glucose level being too high after eating the cake, go for a walk with your family and friends or better yet go dancing to celebrate.

Finally, send the leftover cake home with your guest so it won't be a temptation the next day. The bottom line is: Happy Birthday! Enjoy that piece of cake.

Lyssa

Kenneth,

Glucose tablets and glucose liquid are used to treat a low blood glucose reaction otherwise known as hypoglycemia. A blood glucose level less than 70 is considered too low. When a person’s blood glucose level drops below 70, they usually experience one or more of the following symptoms: lightheadedness or dizziness, headache, hunger, shaking, sweating or clammy feeling, fast heartbeat, anxiousness, irritability and weakness. If left untreated, you can pass out and lose consciousness. The most common reasons a person’s blood glucose level drops too low are listed below:

1) Skipping meals or going too long between meals

2) Not eating enough carbohydrate at each meal

3) Taking too much diabetes medicine, either oral medications or insulin

4) Unplanned or more exercise than normal or exercising on an empty stomach

5) Drinking alcoholic beverages without food

To treat a low blood glucose reaction, a person should eat 15 grams of carbohydrate and some examples are:

1) 3 – 4 glucose tablets or one bottle of glucose liquid

2) 3 pieces of hard candy (peppermints)

3) 4 ounces juice

4) 8 ounces milk

5) 4 ounces, 1/3 can, of regular soda pop

After eating or drinking one of the food items listed above, it will take about 10 - 15 minutes to start feeling better. You should then eat either a meal if it is time for one and if not time for a meal, eat a snack to keep your blood sugar level from dropping too low again. A good snack choice would be a half a sandwich or 3 peanut butter crackers. To prevent hypoglycemia, make sure that you are eating about every 4 to 5 hours during the day (3 meals and 2-3 snacks), exercise 45 to 60 minutes after a meal, take your medications correctly, and if you consume an alcoholic beverage, do so with a meal and not on an empty stomach.

Ensure, Boost, Glucerna or Equate drinks are considered meal replacements and should not be consumed to treat a low blood glucose reaction but consumed as a meal. I hope this explains how these different products are to be used. Thanks for asking such a great question and good luck with managing your diabetes,

Lyssa

John,

The first question most people ask when diagnosed with diabetes is what can I eat? I am glad that you have seen a dietitian and have been given some direction re: what to eat. I think the best place to get the answer to your questions would be from the dietitian you are working with currently. I will, however, give you some general guidelines. Please remember these are general guidelines and may not be specific for your needs.

1) Protein: Most people need about 7 ounces of protein per day. An ounce of protein is equal to 7 gm of protein so this would be about 50 gm of protein per day.
2) Fat: Again, the general guideline is 25% - 35% of your total calories should come from fat and only 7% of this should be from saturated fat. Most people can allow for 2 fat servings per meal. An example of a fat serving is a teaspoon of butter, oil, or mayonnaise. Nuts contain fat and protein and 6 – 10 nuts is a serving of fat but ¼ cup of nuts is a serving of protein, depends on how you are counting the nuts in your diet. One fat serving is equal to 5 gm of fat and this would translate to about 30 gm of fat per day. Some people may be allowed more, depending on caloric needs.

Thanks for your question. Both the American Diabetes Association, www.diabetes.org and American Dietetic Association, www.eatright.org, have great information regarding nutrition. Take a look at their websites for more suggestions and continue to work with the dietitian in your area that has started to help you develop a meal plan right for your specific needs.

Lyssa

Dear James, 

The symptoms you have described in your email certainly sound like you are experiencing hypoglycemia or a low blood glucose reaction. Since I do not know your medical history or what medications you are taking, I cannot say for sure what is causing your blood glucose to drop so low. A blood glucose level less than 70 is considered too low and is called hypoglycemia. When a person’s blood glucose level drops below 70, they can experience the following symptoms: lightheadedness or dizziness, headache, hunger, shaking, sweating or a cold, clammy feeling, fast heartbeat, anxiousness, irritability and weakness. If left untreated, a person can pass out from having too little glucose in their bloodstream. The most common reasons a person’s blood glucose level drops too low are as follows:

1) Skipping meals or going to long between meals
2) Not eating enough carbohydrate at each meal
3) Taking too much medicine to lower your blood glucose level
4) Unplanned or more exercise than normal or exercising on an empty stomach
5) Drinking alcoholic beverages without eating any food

If you are experiencing the above symptoms, check your blood glucose to see if it is close to 70 or below. If it is, you need to treat it by eating 15 grams of a simple carbohydrate.  Some examples are:

1) 3 – 4 glucose tablets
2) 3 pieces of hard candy (peppermints)
3) 4 ounces of juice
4) 8 ounces of milk
5) 4 ounces, 1/3 can, of regular soda pop like Coke or Sprite

Once you have eaten or drank a quick-acting sugar source like the examples listed above, it will take about 15 minutes for you to start feeling better and then you should eat a meal or a snack if a meal is more than 30 minutes away. A good snack choice would be a half a sandwich or 3 peanut butter crackers to make sure the blood glucose level stays up and doesn’t drop again.

To prevent hypoglycemia, try to do the following:

• Make sure that you are eating about every 5 hours during the day while awake, either a meal or small snack
• Exercise 30 to 45 minutes after a eating a meal or snack, and don’t exercise on an empty stomach
• Take your medications correctly
• If you consume an alcoholic beverage, do so with a meal or at least a snack.

If you continue to have frequent drops in your blood glucose levels as you have described, it may mean that the medication you have been prescribed needs to be adjusted to a lower dose by your doctor. Low blood glucose can be a serious complication and should be addressed, so please discuss this with your doctor. The more you know about diabetes and how to manage it, the better your control will be. Good luck and thanks for asking such a good question.

Lyssa

Dear Cindy,

The important thing when taking Metformin is to take it with food. This helps to reduce or minimize any possible upset stomach side effects like gas, bloating, nausea, vomiting or diarrhea. It is also important to try and take your medication at about the same time every day to keep your blood levels as consistent as possible. When testing your blood sugar, just remember to either test right before a meal or 2 hours after a meal regardless of whether you take your Metformin at the start of your meal or end.

As a reminder, remember the American Diabetes Association guidelines for blood glucose target ranges are as follows:

1) Before meals, your blood glucose level should be between 90 – 130mg/dl
2) 2 hours after meals, your blood glucose should be less than 180mg/dl
3) At bedtime, your blood glucose should be between 100 – 150mg/dl

There are other organizations that have set slightly different recommended target levels, so I always encourage my clients to discuss with their health care provider what target blood glucose levels are appropriate for you. The more you know about diabetes and how to manage it, the better your control will be.

How often should you test? I usually recommend a person test at least two times a day when making changes or their blood glucose is not within the above recommended target ranges. Considering your financial concerns, it would be an efficient use of your supplies to test only once a day but making sure that you vary the time of the day that you test. Sometimes test before a meal and sometimes test 2 hours after a meal.  Keep a logbook of all your results so that over a few weeks you will have numbers before and after each mealtime and you can compare your results to the above target ranges to help you decide if you are in good control or not. If your readings are above the recommended target ranges most of the time, then your blood glucose level is not in good control. If your results are within the above ranges, then your diabetes is in good control. If you have been newly diagnosed with diabetes, I would also strongly suggest you make an appointment with diabetes educator or dietitian in your area to get more information about how to self-manage the disease of diabetes. You can go to the American Diabetes Association webpage, www.diabetes.org and search for a recognized program in your area that offers diabetes education classes or individual counseling sessions if preferred. The Diabetes Education program may require a referral from your physician but they will assist you with this process. The more you know about diabetes and how to manage it, the better your control will be. Good luck and thanks for asking such a good question. Hope that's helpful--

Good luck and thanks for asking such a good question.

Lyssa

Dear Anita,

The Food Exchange System was designed by the American Diabetes Association and the American Dietetic Association to teach people with diabetes how to eat well-balanced meals and control blood glucose levels.

An exchange is the same thing as a portion of food. All foods are divided into different groups; Breads and Starches, Fruits, Milks, Proteins, and Fats. Each food item within the same group is then assigned a specific portion thus making sure all food items within the same group had the same number of calories, fat, protein and/or carbohydrate so it could be equally "exchanged" when making choices.

Today, we focus on the total amount of carbohydrate consumed at meals and snacks when suggesting a healthy meal plan for persons with diabetes. One carbohydrate serving is equal to 15 grams of total carbohydrate and therefore, 1 Starch, 1 Milk, or 1 Fruit exchange is equal to one carbohydrate choice or serving. So, for example, if a food package lists that there are 2 Starches and 1 Milk exchanges that would be equal to 3 carbohydrate servings or 45 grams of total carbohydrate. For most people, a general guideline is to eat 45 – 60 grams of total carbohydrate at each meal, based on eating three meals per day. You can find more information about the Food Exchange System at www.diabetes.org or www.eatright.org.

I hope this helps you understand what an exchange is a little better. If you have not done so, I highly recommend that you work with a registered dietitian or certified diabetes educator to obtain counseling regarding a specific meal plan for you and the required education you need to follow it whether that is carbohydrate counting, the exchange system, the glycemic index, label reading or the plate method. All of these systems are valid ways to plan healthy meals.

Lyssa

Angie,

The first question most people ask when diagnosed with diabetes is what can I eat? I certainly understand your frustration and fear. I want to give you some basic advice that can help you provide nutritious meals for your husband but I want him to find a certified diabetes educator or registered dietitian in your area to meet with to get specific recommendations regarding his nutritional needs and education to learn how to self-manage his diabetes. Trust me when I say, this will be the most valuable thing your husband can do to know what to eat and how to manage diabetes. I realize your husband is uninsured but you can often find nonprofit clinics that offer these services based on your ability to pay. Even your local hospital will sometimes offer these services to the uninsured and will be paying out of pocket on a discounted basis. Please make this a financial priority because learning about what foods to eat and how they affect your husband's blood glucose levels is a key component of good diabetes management for life.

Now to address your question, when making healthy food choices as a person with diabetes, you want to concentrate on the total carbohydrate content of the foods you eat. Below is a list of simple things he can do to start eating healthier and improving his blood glucose levels.

1) Eat 45 – 60 grams of total carbohydrate at each meal. This is a general guideline and specific recommendations for your husband should be obtained from a certified diabetes educator or registered dietician.

2) Another quick and easy thing for your husband to do initially to change his diet is to cut out empty calories. For example, if he drinks liquids that contain sugar like juices, sodas, coffee or tea, switch to sugar-free beverages and use sugar substitutes to sweeten his beverages instead of sugar or honey. Initially cut out cookies, cakes, pies and candy. This does not mean that he will never be able to eat sweets again… it is just a fast solution for the time being to help lower his blood glucose levels quickly.

3) Make sure he eats regularly, do not skip meals and be sure to balance your meals by eating whole grains, fruits, vegetables and lean meats or protein at each meal and snacks.

4) Do not go too long between meals without eating. Go no longer than 4 - 5 hours during your waking hours without eating either a meal or small snack to help to keep your blood sugar level. Most people need 3 meals and 1 -2 small snacks each day.

5) Eat more foods high in fiber like whole grain pastas, brown rice, sweet potatoes, fresh vegetables and fruit. Substitute processed foods like cookies, chips and pastries with these high fiber foods that will fill him up and keep his blood glucose level more stable for longer periods of time than the processed foods.

If you go to the American Diabetes Association website, www.diabetes.org and look at the Food and Fitness section, you will find reliable information about planning meals and eating healthy with diabetes. Also, on the US Government's Nutrition website there is a wonderful education brochure you can download called "Recipes & Tips for Healthy, Thrifty Meals: http://www.cnpp.usda.gov/Publications/FoodPlans/MiscPubs/FoodPlansRecipeBook.pdf. Finally, the American Dietetic Association, www.eatright.org, has great information regarding nutrition. Take a look at these websites for suggestions for healthy eating.

Lyssa

Dear Lisa,

It can be confusing to know what all the numbers mean when it comes to being diagnosed with diabetes and what is good control when checking your blood glucose at home. The American Diabetes Association defines the diagnostic criteria for diabetes as follows:

If you have been told by your doctor that you have Pre-Diabetes then it is recommended that when you test your blood glucose at home you keep your blood glucose levels in the target ranges listed below:

1) Fasting blood glucose level should be less than 100
2) 2 hour after meal blood glucose should be less than 140

When you test at home and have been diagnosed with diabetes, the American Diabetes Association recommends the following target ranges below for persons with diabetes to say their diabetes is in good control:

1) Before meal blood glucose level between 90- 130
2) 2 hour after blood glucose level less than 180

I suggest you follow-up with your doctor to have blood work done to confirm or rule out a diagnosis of Pre-diabetes or Diabetes. The key to preventing the onset of diabetes is eating healthy, being active and moderate weight loss which is defined as a weight loss of 5 – 10% of your current body weight. You are on your way, having already lost 7 lbs. Hope this helps to clear up some of your questions. Meeting with a registered dietitian or certified diabetes educator would be very helpful in assisting you with your weight loss goals and the prevention of diabetes.

Lyssa

Dear Lupe,

Fast acting glucose tablets will raise your blood glucose level. They are meant to be taken when your blood glucose level is too low. A blood glucose level less than 70 is considered too low and this is called hypoglycemia. When a person's blood glucose level drops below 70, they can experience the following symptoms: lightheaded or dizzy, headache, hunger, shaking, sweating or clammy feeling, fast heartbeat, anxiousness, irritability and weakness. If left untreated, you can pass out and lose consciousness. The most common reasons a person's blood glucose level drops too low are as follows:

1) Skipping meals or going to long between meals
2) Not eating enough carbohydrate at each meal
3) Taking too much medicine, if have diabetes and take medication to lower your blood sugar level
4) Unplanned or more exercise than normal or exercising on an empty stomach
5) Drinking alcoholic beverages without food

To treat a low blood glucose reaction, a person should eat 15 grams of carbohydrate and some examples are:

1) 3 – 4 glucose tablets
2) 3 pieces of hard candy (peppermints)
3) 4 ounces juice
4) 8 ounces milk
5) 4 ounces, 1/3 can, of regular soda pop

After consuming one of the food items listed above, it will take about 10 - 15 minutes to start feeling better and then you should eat either a meal if it is time for one and if not, you should at least eat a snack to keep the blood sugar level from dropping too low again. Good luck,

Lyssa

Dear Matthew,

I will try and give you a few suggestions to pass onto your friend for making good choices at breakfast. I would like to suggest that your friend consider meeting with a registered dietitian, preferably one that is also a certified diabetes educator, because a dietitian with experience in diabetes would be able to make specific meal planning recommendations based on your friend’s complete medical history and needs.  

Having said that, making healthy choices at breakfast is often the most difficult for people with diabetes to accomplish because carbohydrates are the main food group consumed at this meal and it is easy to eat more than we need causing the post meal blood glucose level to rise above the recommended target level.  It is easier to make good choices when you have what you need on hand in your kitchen. Keep whole-wheat English muffins and breads, whole grain cereals, fresh fruit, peanut butter, low-fat cheeses, milk, and yogurt on hand. Most people need about 45 – 60 grams of carbohydrate per meal. Some examples might include: 

1) ¾ cup of plain cheerios, 1 cup skim milk, and ½ banana (45 grams of carbohydrate)

2) 1 energy, sport or breakfast bar, 1 orange, and 1 cup skim milk (45-60 grams carbohydrate depending on bar)

3) 1 cup cooked oatmeal made with 1 cup skim milk, 2 tbsp. raisins, sprinkled with cinnamon and topped with walnuts (60 grams of carbohydrate)

4) 3 pancakes - each 4 inches round, 2 tbsps. sugar free syrup, 1 cup strawberries (60 grams of carbohydrate)

5)2 slices whole grain cinnamon toast, ½ grapefruit, 1 cup skim milk, 1 tsp. margarine (60 grams of carbohydrate)

6) 1 flour tortilla – 6 inches across, thinly spread with peanut butter, add 1 banana to middle and roll up (45 grams carbohydrate)

7) 1 smoothie made with 8 oz. low-fat or light yogurt or 1 cup 1% or skim milk, 1 cup frozen strawberries, and 1 banana (45 – 60 grams of carbohydrates depending on specific yogurt)

Thanks for your question. Both the American Diabetes Association and American Dietetic Association have great information regarding nutrition. Take a look at their websites for more suggestions.

Hope that's helpful--

Thanks,
Lyssa

Dear Paul,

I am so glad that you are considering ReliOn products and have taken the time to ask questions while researching your choices.

Let me begin by answering the first part of your question. ReliOn insulin products are only available in multi-dose vials at this time and are for use with insulin syringes only. So unfortunately, pens are not available in this product line.

Next, I would like to answer the second part of your question. The ReliOn insulin products that are available are not an equal substitution to the two insulins that you are currently taking. Therefore, you would have to discuss with your physician what would be involved in switching from your current insulin dosage regimen to one that would use the available ReliOn insulins.

Each insulin has a specific 1) onset of action, time it starts working in your body, 2) duration of action, how long it continues to work in your body, and 3) peak action, when it is working the hardest in your body. I encourage you to become familiar with these actions for the insulin that you take. It is the difference in these actions that would have to be taken into consideration if you were to switch from Novolog and Levemir insulin (what you are on at present) to Regular and NPH (what is available in the ReliOn product line).

Thanks for asking such a great question. Please discuss this further with your physician if you are still interested in making a change in your diabetes medication regimen.

Best Regards,
Lyssa

Dear Pam,

I am so sorry you have had this experience that is all too common when people are diagnosed with diabetes. I want you to find a Diabetes Education program in your area and get signed up right away for a class. You can go to the American Diabetes Association webpage, www.diabetes.org and search for a recognized program in your area. Trust me, this will be the most valuable thing you can do to understand diabetes and the skills you need to learn to be able to better manage the disease of diabetes. If you take the time to attend a class about diabetes self management, you will learn from a registered nurse and/ or a registered dietitian about diabetes the disease, healthy eating, monitoring, being active, medications, possible complications, and stress management just to name a few topics. Most insurance companies cover the cost of classes like these, especially when you have been newly diagnosed but be sure and confirm that your insurance will help cover the cost of attending. The Diabetes Education program may require a referral from your physician but they will assist you with this process.

Now to address your question, when making healthy food choices as a person with diabetes, you want to concentrate on the total carbohydrate content of the foods you eat, not the grams of sugar and that is why you are having a hard time finding information about grams of sugar and diabetes. Google carbohydrates and diabetes and you will find a lot of information. Everyone has different nutritional needs and that is why I want you to go to a class so you can get information specific to your needs. A general guideline however, is 45 - 60 grams of total carbohydrate is what is recommended for most people to eat at each meal, based on eating three meals per day. When you are looking at food labels or nutrition information about the individual foods you want to consume, pay attention to the total carbohydrate content per serving of the food item(s) and eat about 45 - 60 grams of carbohydrates per meal. I hope this will help until you get to a diabetes class or meet with a registered dietitian.

Hope that helps--

Thanks,
Lyssa

Dear David

The three different pre-mixed insulins you listed each contain two different “insulins” premixed together in different concentrations. Each insulin has a specific 1) onset of action, time it starts working in your body, 2) duration of action, how long it continues to work in your body, and 3) peak action, when it is working the hardest in your body. 

The pre-mixed insulin combinations you have asked about each contain an insulin that works very rapidly once it enters your body. It starts working within 15 minutes after you inject it, is working at its peak in about 30 -90 minutes and is essentially finished doing its work in about 4 hours. The pre-mixed insulin also includes another type of insulin that is a long acting insulin that is much slower to start working but works for almost 10 – 16 hours after you inject it into your body.

Humalog or Novolog 70/30 is a mixture of 70% long acting insulin and 30% rapid acting insulin. This means each unit you draw up contains this mixture, more long acting and less fast acting.  This would then mean that Humalog 75/25 would be in a concentration that includes 75% long acting insulin and 25% rapid acting insulin and Humalog 50/50 would be made up of a half and half concentration.

The most important thing for you to know about these pre-mixed insulins are that they deliver different amounts of the rapid acting and long acting insulin when in injected and cannot be substituted for one another without making an adjustment in your insulin dose regimen. I encourage you to become familiar with these actions for the insulin that you take and address any further questions or any possible changes in your diabetes medication regimen with your physician.  

Hope that helps--

Thanks,
Lyssa

Dear Beverly,

Thanks for asking such a great question. Diabetes is a disease that can affect just about every part of the body, including the skin. About 33% of all people with diabetes will develop a skin disorder at some point in their lives. Having uncontrolled diabetes, or high blood sugar levels above the recommended target ranges, is what increases a person's risk of developing skin complications. So first and foremost, the most important thing a person with diabetes can do to prevent these complications is make sure your blood sugars are well controlled. This promotes healing, improves blood flow to your lower extremities and prevents future skin problems.

Now to specifically address your question regarding the blisters and rash you are experiencing on your feet. The blisters and rash you described could be a rare but possible skin complication related to having uncontrolled diabetes. They could also be caused but medical conditions other than diabetes. This is why it is very important that you have these breakouts or "irritations" as you called them evaluated by your physician. If the condition is found to be related to diabetes, the treatment in most cases, is blood sugar control, properly fitted footwear consisting of a wide, rounded toe box and enclosed heel and toe, and proper daily foot care. Proper daily foot care, also referred to as a daily self foot exam, includes the following:

1) Daily exam of your feet, especially paying close attention to the bottom of your feet. Look for cuts, bruises, splinters, blisters or other breaks in the skin, noting any signs of infection such as swelling, drainage, redness or heat. Observe for sudden changes in overall color or temperature of your feet. Report any abnormal findings, such as infection, immediately to your physician for further evaluation.

2) Keep your feet clean, dry, and moisturized. Use mild soap and warm water to clean your feet. Do not use HOT water. Wash your feet daily, dry well and apply moisturizer to the tops and bottoms of your feet but not between your toes.

3) Wear shoes and socks at all times, never go barefoot so you provide maximum protection to your feet at all times. Avoid friction to the skin which can cause blisters to form. Friction is most often caused by poorly fitting shoes, either too tight or too loose.

4) Keep blood flowing to your feet by not crossing your legs at the knees, not wearing binding or tight fitting socks or hose, no knee highs, and not smoking. Staying active and getting regular exercise promotes blood flow to your feet.

5) Report any concerns or abnormal findings to your physician immediately, including reoccurring blisters and rashes. Little infections can get out of control quickly in people with diabetes causing serious complications.

6) Make sure your primary care physician or Podiatrist performs a complete foot exam yearly.

If you go to the following American Diabetes Association links listed below, you will find good information regarding skin complications in persons with diabetes and proper foot care. Thank you for your question.
http://www.diabetes.org/living-with-diabetes/complications/foot-care.html
http://www.diabetes.org/living-with-diabetes/complications/skin-complications.html

Hope that answer is helpful--

Best regards,
Lyssa

Dear Louise,

Let me begin by saying, let’s not panic. My recommendation would be that you follow up with your physician and get blood work done in a laboratory to see if you have diabetes. A fasting blood glucose test is the test of choice to diagnose a person with diabetes. By fasting, I mean that you should not have anything to eat or drink at least 8 hours prior to the blood test being drawn and this test should be a blood draw in a laboratory, not a finger stick, to be most accurate. A fasting blood glucose test greater than or equal to 126 is diagnostic of diabetes. Most physicians like to get a second confirmation fasting blood glucose test on a different day to say for sure whether you have diabetes or not. 

So Louise, let’s start there and see what the result shows. A normal fasting blood glucose level is less than 100, so some people fall in that gray area of not normal but not at the level to say you have diabetes. This is called pre-diabetes. If that is what the test shows, then you want to go ahead a start making some healthy lifestyle changes to prevent yourself from developing diabetes. These lifestyle changes would include eating a healthy diet, getting regular exercise and maintaining a healthy body weight. I would strongly suggest you make an appointment with diabetes educator or dietitian to get more information. You can go to the American Diabetes Association webpage, www.diabetes.org and search for a recognized program in your area that offers pre-diabetes counseling or education. The Diabetes Education program may require a referral from your physician but they will assist you with this process.

Dear John,

Diabetes most certainly can affect both men and women’s sexual desires and function. This happens most often when diabetes is not well controlled, leading to the blood vessels and nerves in a person’s sexual organs becoming damaged. For men this can cause many different symptoms like difficulty having or maintaining an erection or complete erectile dysfunction known as impotence. Men who have type 2 diabetes are also twice as likely to suffer from a condition known as low testosterone levels. 

The symptoms associated with low testosterone can include loss in sexual interest, erectile dysfunction, weight loss, depressed mood and lack of energy. There are other reasons men can have a decrease in sexual interest that are not related to diabetes so you definitely need to discuss your symptoms with your health care provider so the root cause can be found and treated. But that is the good news, this can be treated.

Remember that good diabetes control, maintaining a healthy weight, and regular exercise can also go a long way to improve your symptoms or prevent sexual complications related to diabetes. This is a topic that is often difficult for people to discuss with their health care provider and I am so glad you are starting to get more information so you can find the problem and in turn, improve your quality of life. There is some great information on the American Diabetes Association website regarding this topic. Go to www.diabetes.org and look under “Living with Diabetes”, “Complications-Men’s Health Issues”. Best of luck and be sure and follow-up with your doctor regarding your symptoms.

Dear Bob,

If possible, I still would like for you to have at least one meeting with a registered dietitian, preferably one that is also a CDE (certified diabetes educator). If you pay out of pocket, it would cost somewhere between $30 - 50 per hour for this type of visit. But in the meantime, here are some websites that are reliable and will hopefully give you some good information.

American Diabetes Association – www.diabetes.org

American Dietetic Association – www.eatright.org

USA Food website – www.mypyramid.gov

Calorie King – www.calorieking.com

Recipe website – www.diabetic-recipes.com

National Institute of Health - http://www.nlm.nih.gov/medlineplus/tutorials/diabetesmealplanning/htm/index.htm

Be sure to use your local library for checking out books on diabetes, meal planning, and cookbooks with recipes for people with diabetes.  Continue to keep your eyes and ears open for free diabetes education seminars offered in your area. Your doctor’s office should know of some educational programs available to you, be sure and ask. Here is my last piece of advice, call your doctor’s office and let them know you are very frustrated with being told you have diabetes without being given any education and ask them to help you find affordable education resources in your area.

Dear Lorraine,

Unfortunately, diabetes is a progressive disease and over time, the pancreas becomes less able to make enough insulin to keep up with the demands of your body to regulate your blood sugars effectively. The oral medications that a person can take for diabetes control work by either asking the pancreas to make more insulin, use the insulin your body is making more effectively or inhibits the liver from producing too much glucose. So you can see that if the pancreas is not producing enough insulin, the oral medications will not be able to effectively control your blood glucose levels adequately. Without knowing your specific medical history, it seems you are at a point where your body may need the help from taking supplementary insulin by injection. Even though you may be resistant to taking injections, the important thing to remember is good blood sugar control is the goal to prevent the complications associated with diabetes.

I am so glad that you are considering ReliOn products and have taken the time to ask questions while researching your choices. ReliOn offers three different types of insulin products; ReliOn/Novolin R, ReliOn/Novolin NPH, and ReliOn/Novolin 70/30.  Each insulin has a specific 1) onset of action, time it starts working in your body, 2) duration of action, how long it continues to work in your body, and 3) peak action, when it is working the hardest in your body.

ReliOn/Novolin R is a short acting insulin and is often taken before meals to keep the after meal blood glucose level from rising to high.  

ReliOn/Novolin NPH is an intermediate acting insulin that helps keep the before meal blood glucose levels from rising too high. NPH insulin is usually prescribed twice a day, before breakfast and before dinner.

ReliOn/Novolin 70/30 is a combination of these two different insulins: 70% is NPH and 30% is R.

These insulins are certainly a reasonable choice but there are other insulins available that should be considered as well. This is a decision that should be made with your physician’s guidance. If cost is an issue then you certainly should let your doctor know that it a factor in your decision because some of the other insulins that are available can be very expensive. So, I cannot say definitively that ReliOn would work better than other types of insulin, but it certainly is an option that can be considered. Remember, the important goal is good blood sugar control and if your current treatment is not working, you need to try something different so you prevent the long term complications associated with uncontrolled diabetes. Please discuss this further with your physician.

Lyssa 

Dear Curtis,

The American Diabetes Association guidelines for blood glucose target ranges are as follows:

1) before meals your blood glucose level should be 90 – 130

2) 2 hours after meals your blood glucose should be less than 180

3) at bedtime your blood glucose should be 100 – 150

There are other organizations that have set slightly different recommended target levels so I always encourage my clients to discuss with their health care provider what target blood glucose levels he or she is trying to reach for you. If you are newly diagnosed with diabetes, I would also strongly suggest you make an appointment with diabetes educator or dietitian in your area to get more information about how to self-manage the disease of diabetes. You can go to the American Diabetes Association webpage, www.diabetes.org and search for a recognized program in your area that offers diabetes education classes or individual counseling sessions if preferred. The Diabetes Education program may require a referral from your physician but they will assist you with this process. The more you know about diabetes and how to manage it, the better your control will be. Good luck and thanks for asking such a good question.

Lyssa

ReliOn offers three different types of insulin products; ReliOn/Novolin R, ReliOn/Novolin NPH, and ReliOn/Novolin 70/30.  Each insulin has a specific 1) onset of action, time it starts working in your body, 2) duration of action, how long it continues to work in your body, and 3) peak action, when it is working the hardest in your body.

ReliOn/Novolin R is a short acting insulin and is often taken before meals to keep the after meal blood glucose level from rising to high. 

ReliOn/Novolin NPH is an intermediate acting insulin that helps keep the before meal blood glucose levels from rising too high. NPH insulin is usually prescribed twice a day, before breakfast and before dinner because it has a duration of action that is 12 to 16 hours and then it is gone from your body.

ReliOn/Novolin 70/30 is a combination of these two different insulins: 70% is NPH and 30% is R.

Unfortunately ReliOn does not offer a long acting insulin at the present time that has a duration of action of 20 – 26 hours that can be taken once a day. If you are currently taking a long acting insulin, there is not an equal substitution in the ReliOn product line. Therefore, you would have to discuss with your physician what would be involved in switching from your current insulin dosage regimen to one that would use the available ReliOn insulins.  Thanks for asking such a great question.

Lyssa