How to Live with Your ___Type 2 Diabetes__

Answers to Frequently Asked Questions

Copyright Notice: 2009 Beverleigh H Piepers RN. All rights reserved. No portion of these materials may be reproduced in any manner whatsoever, without the express written consent of the publisher. Limit of Liability

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It is always your choice to seek a second opinion if you are uncomfortable or have any

unanswered questions about the treatment recommended by your Health Care Provider.

You should not use any information on DrugFreeType2Diabetes.com for treating a health problem or disease or prescribing any medication or other treatment. You should always speak with your Health Care Provider before taking any medication or supplement or adopting any treatment for a health problem.

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com About the Author

Hi Im Beverleigh Piepers and have been a Registered Nurse for 25 years. I am registered in both Australia and the United States. I have worked in several areas of Health including Pediatrics, Geriatrics, Medical, and Chemical Dependency.

From the early days of my training I had the deepest respect for the administration of the drug Insulin. I have seen many diabetic patients admitted to hospital due to accidental misuse of this drug. The common cause I believe, is lack of understanding of information on food choices, exercise and when, or if, insulin is required. I do not think its the patients fault, often the condition and treatment is not explained, or is inadequately explained.

And now the most common form of diabetes is Type 2, affecting 85-90% of all people diagnosed with diabetes.

Imagine my surprise when following a regular blood test which included fasting blood

sugar levels, I was told my blood sugar levels were elevated and I would require a glucose tolerance test. These results came back within normal levels. So that meant, due to the original elevated levels, I was told: I would possibly become Type 2 Diabetic in the future. In other words I was pre-diabetic.

I was not overweight; I had been having yearly fasting blood sugars done along with cholesterol levels. I had been telling the Health Care Provider for almost eight years that I didnt feel right, I was ever so tired. It seems my climbing blood sugar levels had been overlooked.

I was given no satisfactory information on Type 2 Diabetes, just follow a low-GI diet! That is how my journey began.

My search for information on Type 2 Diabetes took me everywhere and then I really started to realize why so much people do not understand. The information sounds complicated and is in a foreign language.

So I would really like to translate for you and help you take back your power, as you are in charge of your body and your Type 2 Diabetes.

This guide is in response to some of the many questions put to me, I hope they help you on your journey to living Beverleigh Piepers RN

Beverleigh H Piepers RN 2009 http//:drugfreetype2diabetes.com

Those of us diagnosed with pre-diabetes or Type 2 Diabetes usually have several years in which to avoid long term complications. So the good news is you get the chance to make those changes to your lifestyle that will not only prevent complications, but help you to live longer with a good quality of life.

You already know Type 2 Diabetes:

is the more common form of diabetes and affects 85-90% of diagnosed cases

is brought about by lifestyle choice until recently it was found to occur mainly in adults and was known as

Adult Onset Diabetes is also known as non-Insulin Dependant Diabetes Mellitus

( NIDDM )

People with Type 2 usually have ample insulin but their bodies resist its normal healthy action. This is where the term insulin-resistance comes from. It is now known this also relates to:

high blood pressure elevated tri-glyceride levels high cholesterol levels heart disease

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com How would I know I have Type 2 Diabetes?

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Usually you would have a few of the following symptoms:

extreme fatigue frequent urination and unusual thirst blurred vision cuts that are slow to heal urinary tract infections genital itching heart disease tingling and/or numbness in hands or feet abdominal obesity

See your health care provider so he can organize:

fasting blood glucose test glucose-tolerance test fasting insulin levels

Why would I need to have fasting insulin levels checked?

Because elevations in insulin precede the increase in blood sugar by as much as fifteen years. High insulin levels actually do more damage. It leads to an increase in belly fat, blood pressure and blood fats.

Beverleigh Piepers RN 2009 http://drugfreetype2diabetes.com Can I undo the damage done by high blood sugars?

If you have had high blood sugars for a while this will have increased the strength of your insulin resistance. If your liver has become insulin-resistant also, this may be dumping glucose into your bloodstream also.

The good new is, yes. By lowering your carbohydrate intake you can reduce your insulin resistance. By getting your levels as near as possible to normal, after a few days your insulin resistance will start to decrease. Then, whatever insulin you are making will work more effectively and you will get a lower rise in your blood sugars.

What are the signs of hypoglycemia?

If you are not injecting insulin or taking any sulfonylurea drugs (Amaryl,

Glucotrol, Glucotrol XL, Micronase) you will not have a hypo.

whiteness or skin pallor sweating palpitations anxiety hunger sensation

The above signs and symptoms show when your blood sugar falls quickly.

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com You have the following symptoms when hypoglycemia takes longer to occur:

headache loss of concentration maybe double vision confusion fatigue

Hypoglycemia means any reading below 75 mg/dl (4.2 mmol/l)

Why am I putting on weight, I am watching what I eat? I take Glucotrol before meals.

Glucotrol is in the family of drugs known as sulfonylureas and helps your pancreas produce more insulin. More insulin more weight gain. The weight gain may also be from intense hunger that is often experienced when taking these drugs. Hunger may be due to the intense variations in blood sugars that they cause.

Many people do not like taking these drugs because of the hunger and weight gain.

Does Metformin cause Low Blood Sugar

Metformin is not supposed to cause dangerous hypos, though some people have found themselves feeling uncomfortable due to a fall in their blood sugar level.

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com Why do some people get Type 2 diabetes?

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Insulin-resistance is one cause. But most people have a genetic predisposition based on family history or ethnicity. Add to that age, weight gain, and a sedentary lifestyle.

What is a HbA1c test and why do I need it?

This test is abbreviated as HbA1c and looks at how blood sugar has damaged proteins in your blood. The test provides a picture of your average glucose levels over the last six weeks and reveals what a single fasting glucose test does not. Research has found the risk of developing health problems increases when HbA1c levels are above 5%, and the risk of a heart attack increases by approximately 20% for each 1% rise in HbA1c levels. In other words a person with an HbA1c level of 7% had a 40% more chance of having a heart attack than a person with an HbA1c of 5%.

And how do I interpret the HbA1c result?

Normal HbA1c 4.5 to 5.7% Pre-diabetic 5.7 to 6.9% Diabetic 7% or higher

Sometimes eating sugary foods the day before a fasting blood sugar test will throw your levels out. The HbA1c provides an average over the past six weeks.

Beverleigh H Piepers RN http://drugfreetype2diabetes.com I am 65, I have been diagnosed with Type 2 Diabetes but due to arthritis I have trouble exercising. Can I still lose weight?

Yes, arthritis does make it difficult to exercise but lack of mobility will not stop you from losing weight or getting control of your blood sugar levels. Exercise is beneficial but nowhere near as much as losing weight. So be really careful about sticking with your diet. Just do what you can, walk when you are able. Dont forget everyday things such as climbing stairs, going shopping, gardening and housework all count as activity.

What has caused neuropathy in my legs? I have Type 2 Diabetes?

In addition to continuously high blood sugar levels, neuropathy is made worse

in the following:

the age of the diabetic is higher than 40 drinking even small amounts of alcohol can make the pain worse

Damaged nerves cant send messages, send them at the wrong time or send them too slowly. Researchers arent sure how high glucose levels damage nerves, but it is believed that the damage is due to a cut-off in the blood supply to the nerve in some cases. Often when the blood sugar level is brought down to normal the signs and symptoms improve.

If you dont improve your control, the neuropathy will continue until you feel no pain at all and that is not a good sign. If the pain is unbearable, see your Health Care Provider so he can help you with pain relief.

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com My blood sugar level is really high in the morning, should I have breakfast?

Yes, you should have breakfast. Many diabetics have high glucose in the

morning. As morning approaches levels of other hormones, such as cortisol and growth hormone, begin to increase. Some of these make insulin less effective, so the result is a temporary morning insulin resistance. This is known as the dawn phenomenon or the dawn effect.

Check your blood sugar level when you wake in the morning, if it is often above 126 mg/dl (7 mmol/l); try to lower this by doing some form of physical

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activity the previous evening. If you are taking insulin, your Health Care Provider may need to adjust the timing or amount of your evening insulin dose.

How often should I check my blood sugar levels?

The main reason for testing is to find out what you need to do to keep your blood sugars in the recommended range. So it will depend on what information you need. If you are ill or have changed your medications you made need to test 5 to 8 times/day. Your Health Care Provider can help you work out how often you should test.

When is it really important for me to test my blood sugar level?

If you use insulin or insulin-stimulating pills, and you start to feel hypoglycemic, check your level so you can take action straight away. Test before you drive so you can take preventative action and not have a hypo while driving. And test when you feel ill.

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com My Doctor has suggested I try Byetta because I overeat, how does this work?

When your stomach does not empty you feel full. Byetta works by closing off the stomach valve through which food passes into your intestines. Sometimes this lasts for hours and makes it impossible for you to overeat.

So when you stop eating so many calories or kilojoules at your meals, your weight will drop. If overeating is the reason for your weight gain and high blood sugar levels, this drug will reduce both.

Over time though the effect does wear off as does Byettas effect on weight loss.

If you test your blood sugar levels normally two hours after eating, you will need to check them much later as stomach emptying is delayed.

Another thing Byetta does in some people is stimulate the pancreas to release more insulin when the food you have just eaten starts to raise your blood sugar. This is different to what the sulfonylurea drugs do, because Byetta only stimulates while the blood sugars have risen and stops when they drop. This means you would not get a hypo.

Byetta does not work for everyone; it may not work for you. Many have become nauseated; others vomit a lot. This is due to the way it closes off the lower stomach valve.

If you try Byetta for a month and your blood sugars get worse, ask your Doctor to help find a medication that will work better for you.

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com Why should I always have to check my blood sugar level?

Regular testing is extremely important and that will mean you should check them more than once a day. You should also change the times you test regularly. The best times to check is a half an hour before breakfast, then two hours after breakfast, a half hour before lunch and then two hours after lunch. And also at bed time.

You should write those numbers down, or some glucose meters actually record them, and take them to your Doctor. This is the only way your Doctor will know whether you need to change your medications and/or diet.

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Without regular testing it could be months before you realize that your overall blood sugar levels are too high and this is when diabetic complications accelerate. Complications include strokes, heart attacks or blindness. And you dont want that to happen.

When you become fairly stable (in the area of 72-126 mg/dl or 4-7 mmol/l) and by the HbA1c result, (best is less than 5%, though ADA suggests under 6%), maybe your Doctor will suggest testing less each day.

What do you think of Medi Alert necklaces?

I think it is important to wear an identification of some kind to alert people to your diabetes, especially if you are taking medications. A bracelet is more likely to be noticed if you happened to become unconscious, eg. following a motor vehicle accident. Health care professionals would then know you are diabetic and take the appropriate action. Personally, I think a bracelet is the best option and should be worn at all times.

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com How often should I have my eyes tested?

You should have a yearly examination by an Ophthalmologist so you can preserve your vision. For this examination, the Doctor will instill drops into your eyes and then use different instruments to check the pressure, the appearance of your lens and most importantly, the retina.

All kinds of procedures can be done if any abnormalities are found. If you havent been doing so, you need to get an examination at the time of your diagnosis and every year after that.

You mention low-GI foods a lot, what is a low-GI value?

A high-GI value is ... ... 70 or more

A medium-GI value is 56-69 inclusive A low-GI value is 55 or less

Most rice types have a high-GI value, which one would you recommend?

Basmati, Moolgiri or Doongara have lower GI values. Rice vermicelli ( a rice noodle) is also low-GI.

Beverleigh H Piepers RN 2009 http://drugfreetype2doabetes.com Potatoes have a high-GI, do I have to stop eating them?

You dont have to stop eating everything that has a high-GI, just enjoy them in moderation. And mix them with low-GI foods, then that will put the overall count in the medium-GI range. The GI is also affected by how theyre cooked. Pre-cooking and reheating potatoes, or eating cold potatoes, eg. in potato salad, reduces the glycemic response. Freshly cooked and mashed potatoes have a high GI. And were not even dealing with fried potatoes!

If I change to low-GI foods do I need to lower my insulin dose?

In theory yes, in practice no. Most studies have shown no need for this, as the insulin dose is dictated not just by the carbohydrates in the diet but by the protein and fat also.

I have recently been diagnosed with diabetes. I enjoy a drink with my meal, is that a problem?

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A small amount of alcohol with food will have little effect on your blood glucose levels. Recent research has shown that a glass or two of wine with, or before a meal, may reduce glucose levels by 25%. For others, the opposite can happen blood sugars seem to rise later that night. Sweeter wines seem to bring on higher blood sugars, so many diabetics drink red wines and drier wines. If you do have a glass of wine, check your blood sugar level before bed and if you are awake at 2 or 3am, check it then also.

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com How does alcohol affect my blood sugar levels?

Sometimes alcohol reduces your levels a lot. If you are using insulin, alcohol can make your levels go too low. Alcohol can paralyze the mechanism that brings your blood sugars back up. This can be avoided by not drinking on an empty stomach and having snacks alongside your drink.

A maximum of one standard drink per day for females and two standard drinks for males are acceptable recommendations for people with diabetes.

A standard drink is:

1 beer 9.5oz/280mls 1 beer reduced alcohol ... 12.5oz/375mls 1 glass dry wine 4oz/120mls 1 glass port or sherry 2 oz/60mls 1 nip spirits 1 oz/30ml

I am a Vietnam-era veteran with post-traumatic stress disorder. I also take blood-pressure medication. I have type 2 diabetes and I am tired or hearing it is a lifestyle disease, especially when its an established fact that taking antidepressants and blood-pressure medications predisposes one to type 2 diabetes.

Although lifestyle issues such as obesity, are a common cause of type 2, there are many other aspects to consider. Family history, ethnic background and, as you quite rightly point out, life experiences, that affect our long-term health and well being. I am sorry and understand you feel criticized by this unfair association.

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com I was diagnosed with diabetes when I returned from duty in Vietnam. I think I drink too much but what is really bothering me is I have loose teeth. Is this connected with my diabetes?

If your blood sugar levels are not really well controlled this can lead to periodontal (gum) disease. Periodontal diseases are infections of the gums and bone that hold your teeth in place.

So high blood sugars in your saliva encourage the growth of bacteria and this helps cause gum disease.

Do you smoke? This can be another factor. Smoking is harmful to oral health even for people without diabetes.

Why not make an appointment to see your local Dentist. He may suggest:

removal of plaque removal of infected tissue if in the early stages of gum disease

medication

Thrush is another mouth infection common in people with diabetes, again due to high sugar levels in the saliva.

How much is too much drinking? Suggested alcohol for a male with diabetes is two standard drinks/day. Do you have a friend you can talk to? Why not give your local Alcoholic Anonymous group a call?

Beverleigh H Piepers RN http:// drugfreetype2diabetes.com When I wake up in the morning my feet tingle, and feel cold. Do I have neuropathy?

Virtually all diabetics who have had higher than normal blood sugars for more than five years can suffer some loss of sensitivity in their feet to pain, pressure and temperature. Long-term elevated blood sugar may also cause impairment of circulation in the major arteries of the legs, as well as veins and capillaries.

Talk to your Doctor and have your fasting blood sugar levels and HbA1c checked as well.

I am 54 years old and have Type 2 Diabetes. Is this why I can no longer have an erection?

I would say 50% of males with diabetes have this difficulty. But before blaming diabetes, are you taking medications for high blood pressure or depression? Eliminate all other possibilities first.

How long have you had diabetes and how well controlled are your blood sugar levels? Check with your Doctor and take along your blood sugar readings to help him with your diagnosis. Fortunately, nowadays there are many approaches to treatment of erectile dysfunction and the success rate is high.

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com No-Nos in a Nutshell List by Richard K Bernstein, MD

Here is a concise list of foods to avoid:

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Sweets and Sweeteners

powdered sweeteners (other than stevia) candies especially so-called sugar-free types honey and fructose most diet and sugar free foods (except sugar-free Jell-O gelatin when

the label doesnt mention maltodextrin and diet sodas that do not

contain fruit juices or list other carbohydrates on the label) desserts (except Jell-O gelatin without maltodextrin no more than !

cup per serving) and pastries: cakes, cookies, pies, tarts, etc. foods containing as a significant ingredient, products who end in ol or

ose (dextrose, glucose, lactose, mannitol, mannose, sorbitol, sucrose, xylitol, xylose, etc), except cellulose; also corn syrup, molasses, maltodextrin, etc.

Sweet or Starchy Vegetables

beans: chili beans, chickpeas, lima beans, lentils, sweet peas, etc. (string beans, snow peas and bell and chili peppers, which are mostly cellulose, are okay, as are very limited amounts of many soybean products)

beets carrots corn onions, except in small amounts packaged cream spinach containing flour

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com parsnips potatoes cooked tomatoes, tomato paste, tomato sauce and raw tomatoes

except in small amounts winter squash

Fruit and Juices

all fruits (except avocados) all juices (including tomato and vegetable juices except for some

people, in a small Bloody Mary)

Certain Dairy Products

milk sweetened, flavored and low-fat yogurts cottage cheese (except in very small amounts) powered milk substitutes and coffee lighteners canned milk concentrate

Grains and Grain Products

wheat, rye, barley, corn, and lesser known alternative grains such as kasha, quinoa and sorghum

white, brown, wild rice or rice cakes pasta breakfast cereal pancakes and waffles bread, crackers, and other flour products including whole grain

breads

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com Prepared Foods

most commercially prepared soups most packaged health foods snack foods (virtually anything that comes wrapped in cellophane

including nuts) balsamic vinegar (compared to wine vinegar, white vinegar, or cider

vinegar, balsamic contains considerable sugar)

Vegetables

Most vegetables, other than those listed in the No-No section are acceptable. Dr Bernstein mentions cooked vegetables tend to raise blood sugar more rapidly than raw vegetables because the heat makes them

more digestible and converts some of the cellulose to sugar.

Beets. Like most other sweet-tasting vegetables, beets are loaded with sugar. Sugar beets are a source of table sugar.

Carrots. After cooking, carrots taste sweeter and appear to raise blood sugar much more rapidly than when raw. Even raw carrot should be avoided.

Corn. Not a vegetable at all but a grain. Nearly all of the corn grown in the US is used for two main purposes. One is the production of sweeteners. Most of the sugar in Pepsi-Cola comes from corn. The other main purpose is animal feed, eg. fattening up hogs, cattle and chickens. Diabetics should avoid eating corn, whether popped, cooked, or in chips.

Potatoes. For most diabetics, cooked potatoes raise blood sugar almost as fast as pure glucose, even though they do not taste as sweet.

Beverleigh H Piepers RN 2009 http://drugfreetype2diabetes.com Tomatoes, tomato paste and tomato sauce. As you know tomatoes

are actually a fruit not a vegetable, and as with citrus fruits, their tang can conceal just how sweet they are. The prolonged cooking necessary for the preparation of tomato sauces releases a lot of glucose.

Commercially prepared soups. Many commercial soups can be loaded with added sugar, as much as in a soft drink. Even if there wasnt, the prolonged cooking of vegetables can break the special glucose bonds in the cellulose of the slow-acting carbohydrates, turning them into glucose. Add to that the common inclusion of potatoes, barley, corn, rice and other unacceptable foods and you have a product you should avoid.

Health foods. Dr Bernstein says that of the hundreds of packaged food products that you see on the shelves of the average health food store, perhaps 1% is low in carbohydrate. Many are sweetened with honey or other so-called natural sugars.

I included this last section as maybe an alternative to your present eating plan. If you are having difficulty with your blood sugar levels, eliminating some of the foods on this No-No List may be worth considering.

Thats it for now.

The End

Beverleigh H Piepers RN 2009