Ask an Expert FAQs — Your Miscellanious Diabetes Questions Answered

1. My doctor/diabetes professional isn't working out. How do I find another one? What criteria do I look for?
2. I have multiple health/other issues. How do I prioritize them?
3. I am healthy. Diabetes does not run in my family. How did I get it?
4. How do I become a CDE?
5. How do I take care of my diabetes when I get sick?
6. What are the effects of smoking on my diabetes?
7. What are the affects of alcohol on my diabetes?
8. What are the affects of drugs on my diabetes?
9. Should I take a baby aspirin daily?

Didn't find your question? Click here for more expert answers to questions from dLife members.

Q: My doctor/diabetes professional isn't working out. How do I find another one? What criteria do I look for?

A: Diabetes is a chronic disease for which there is no cure. Although we need doctors and other diabetes professionals, the person living with diabetes is the primary person responsible for their own diabetes management. Therefore, it is very important for the person with diabetes to have a good relationship with his or her health care team. As a person with diabetes you are an important part of that team! You need to feel respected and valued for your knowledge of your diabetes. You need the diabetes experts to provide you with their expertise and knowledge to help you implement behavior change plans with their support. Look for health care providers that believe in this patient centered model of care.

A good place to start looking for new diabetes health care providers is the American Diabetes Association (ADA) website. The following website lists all of the ADA recognized educational programs in the country. The program managers at these sites can provide you with the names of physicians and Certified Diabetes Educators (CDE's) for you to evaluate. When a program is an ADA recognized program, it means that they have met rigorous criteria established by the ADA to ensure a quality diabetes education program.

The following website has a list of all the diabetes education programs recognized by the American Diabetes Association:

http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/special-considerations/post-secondary-education.html

Other criteria to look for are programs that state they implement the Chronic Care model of patient care. These programs tend to be comprehensive and incorporate planned follow appointments into their diabetes care. Diabetes treatment should not be problem based, meaning you should not only see your health care provider when there is something wrong. You should see your health care provider for on-going evaluation and follow up to make plans to avoid complications and unnecessary treatments. Look for health care providers that treat many patients with diabetes to ensure that they have read the most recent literature and are using the most up to date medications and technology. Take charge of your care! Go to the Diabetes.org website and print out a copy of the current Standards of Care and bring them with you to your provider. Be prepared to ask questions when you think something is missing from your treatment plan. Remember you are the most important person involved in the management of your diabetes!

http://professional.diabetes.org/CPR_search.aspx
http://www.dlife.com/diabetes/information/resources/dlife_diabetes_locator/

Deborah Greenwood APRN,BC-ADM, MEd, CDE

Back to Top

Q: I have multiple health/other issues. How do I prioritize them?


A: The following link has tremendous amounts of information regarding the management of diabetes and related conditions:

http://care.diabetesjournals.org/cgi/reprint/30/suppl_1/S4

This question is very difficult to answer. Diabetes is often associated with multiple health issues and concerns so managing diabetes first may improve related issues. The triad of hyperglycemia, hypertension and hypercholesterolemia should be addressed at the same time. These three diagnoses all contribute to heart and blood vessel disease. It is very common for someone with diabetes to be taking multiple medications to manage blood sugar, multiple medications to manage hypertension and multiple agents to manage cholesterol. It is very hard to separate these three issues. Controlling all them with reduce your risk of complications significantly. The following guidelines have been recommended by the American Diabetes Association:

 

• A1C of less than 7

div style="margin-left: 40px;">• Blood Pressure of less than 130/80

• Total Cholesterol of less than 200
• LDL cholesterol of less than 100 (less than 70 for patients with cardiovascular disease)
• HDL greater than 40
• Triglycerides less than 150


By meeting these goals, you will be managing multiple health issues and lowering your risk of complications significantly.

Other health concerns need to be prioritized with help from your primary care provider. When you have multiple chronic medical problems look for clinics or primary care practices that use a Chronic Care Model of medical care. These programs tend to be comprehensive and incorporate planned follow appointments into their diabetes care. Diabetes and other related conditions are best treated within this framework. Ideally you should not only see your health care provider when there is something wrong. You should see your health care provider for on-going evaluation and follow up to make plans to avoid complications and unnecessary treatments. Look for health care providers that treat many patients with diabetes to ensure that they have read the most recent literature and are using the most up to date medications and technology. Take charge of your care! Go to the Diabetes.org website and print out a copy of the current Standards of Care and bring them with you to your provider. Be prepared to ask questions when you think something is missing from your treatment plan. Remember you are the most important person involved in the management of your diabetes! – Deborah Greenwood APRN,BC-ADM, MEd, CDE

Back to Top

Q: I am healthy. Diabetes does not run in my family. How did I get it?


A: Diabetes has a genetic component but the increased rates of type 2 diabetes are a direct result of lifestyle. Being overweight and physically inactive is a risk factor for diabetes.. Research has shown that individuals with increased abdominal fat are not able to utilize the insulin they make effectively. They have a condition known as insulin resistance. Individuals with insulin resistance need to produce a large amount of insulin to lower blood glucose, over time there pancreas can no longer keep up with the demand and blood glucose levels are elevated. Frequently weight loss of at least 5-7% and 30 minutes of physical activity per day may lower your blood sugar. - Kathleen Gold, RN, MSN, CDE

Back to Top

Q: How do I become a CDE?


A: The NCBDE (National Certification Board of Diabetes Educators) http://www.ncbde.org/ is responsible for certifying diabetes educators. Their website lists all of the criteria and requirements needed to complete an application. If you are thinking about becoming a CDE here are the essential requirements.

(Excerpted from the NCBDE website)

First you must be one of the following disciplines:

1. Clinical psychologist, registered nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician (M.D. or D.O.), or podiatrist holding a current, active, unrestricted license from the United States or its territories.

OR

2. Dietitian holding active registration with the Commission on Dietetic Registration, physician assistant holding active registration with the National Commission on Certification of Physician Assistants, or exercise physiologist holding active registration as a clinical registered exercise physiologist (minimum of a master's degree) with the American College of Sports Medicine.
 

Professional practice experience: (must be paid employment not volunteer hours)

1. A minimum of two years (to the day) of professional practice experience in diabetes self-management education.


AND

2. A minimum of 1,000 hours of diabetes self-management education experience.


AND

3. Current employment in a defined diabetes educator role performing diabetes self-management education a minimum of four hours per week, or its equivalent, at the time of application


Once these requirements are met, you must sit for a National exam offered twice a year at present. Upon passing the exam, you will then be required to obtain 75 hours of continuing education, every 5 years, in the field of diabetes and related issues.

If you are interested in becoming a CDE, and you meet the discipline requirements, begin documenting hours of diabetes education performed within your practice environment.

I would also encourage you to join the American Association of Diabetes Educators and expand your contacts within the field of diabetes education. http://www.diabeteseducator.org/

And finally, subscribe to diabetes related journals and educate yourself about this incredibly complex disease. – Deborah Greenwood APRN,BC-ADM, MEd, CDE

Back to Top

Q: How do I take care of my diabetes when I get sick?


A: - There are guidelines or sick day rules for patients with diabetes. The most important is that you continue to take your insulin or medications. Illness will cause blood glucose levels to rise even if you do not feel like eating and it is important that you take your medications. If you are not able to eat, be sure to take small amounts of fluids every hour. These should not be sugar free fluids so it is best if you have available in your pantry regular soda, regular jello, apple or orange juice to use for these occasions.

Also be cautious about taking over the counter medications when you are ill. Discuss with your pharmacists any over the counter medications effect on your blood sugar. Cold medicine especially may elevate your blood sugar.

For more information you may want to review this page: http://www.dlife.com/diabetes/information/daily_living/tips/057.Daily_Living.sickday.html - Kathleen Gold, RN, MSN, CDE

Back to Top

Q: What are the effects of smoking on my diabetes?

A: Studies show that smoking shortens life on an average by 5 to 10 years, however this could be even more in people with diabetes. The following information is taken from the American Diabetes Association website: http://www.diabetes.org/diabetes-basics/prevention/checkup-america/smoking.html

The best-known effect of smoking is that it causes cancer. Smoking can also aggravate many problems that people with diabetes already face, such as heart and blood vessel disease.

Smoking cuts the amount of oxygen reaching tissues. The decrease in oxygen can lead to a heart attack, stroke, miscarriage, or stillbirth.

• Smoking increases your cholesterol levels and the levels of some other fats in your blood, raising your risk of a heart attack.
 
• Smoking damages and constricts the blood vessels. This damage can worsen foot ulcers and lead to blood vessel disease and leg and foot infections.
 
• Smokers with diabetes are more likely to get nerve damage and kidney disease.
 
• Smokers get colds and respiratory infections easier.
 
• Smoking increases your risk for limited joint mobility.
 
• Smoking can cause cancer of the mouth, throat, lung, and bladder.
 
• People with diabetes who smoke are three times as likely to die of cardiovascular disease as are other people with diabetes.
• Smoking increases your blood pressure.
 
• Smoking raises your blood sugar level, making it harder to control your diabetes.
 
• Smoking can cause impotence.


In addition, smoking can make it harder to control your diabetes. Studies have shown that smokers with diabetes have higher average blood sugars than those with diabetes that do not smoke. Smoking has been shown to increase insulin resistance, which means it makes it more difficult for your body to use insulin when you smoke.
Smoking can also harm your family! Second hand smoke has been shown to increase insulin resistance and can increase the risk of developing type 2 diabetes for those at risk for diabetes.

If you have diabetes and you smoke, consider quitting. It takes on average of 7-10 attempts at quitting before a person succeeds. Each time you try to quit, you get closer to your goal. There is support to help you. Every state has a tobacco cessation hotline (1-800-quitnow) will forward you to smoking cessation help in your state. There are also prescription medications that can help you quit smoking. Although smoking cessation medications may be purchased over the counter, seek the advice of a qualified health care provider to ensure that you are using the medication correctly. Some prescription medications can actually reduce the desire to smoke by blocking the pleasure response in the brain caused by nicotine. Studies have shown that a combination of counseling and medication therapy work the best.

The following links can provide more information:
http://www.dlife.com/diabetes/information/smoking/smoking.html

http://patienteducation.upmc.com/Pdf/SmokingDiabetes.pdf

http://care.diabetesjournals.org/cgi/reprint/27/suppl_1/s74

Deborah Greenwood APRN,BC-ADM, MEd, CDE

Back to Top

Q: What are the affects of alcohol on my diabetes?


A: The American Diabetes Association recommendations suggest that it is safe to drink alcohol in moderation when you have diabetes. For men that means no more than two drinks per day and for women, no more than one drink per day. Alcohol should be consumed with food to prevent hypoglycemia. Alcohol is processed and removed from the body in the liver. The liver is also responsible for putting out glucose into the system to prevent hypoglycemia. However, while the liver is processing alcohol, it may not be able to regulate the blood sugar level, resulting in hypoglycemia, if you take medication for diabetes.

Drinking alcohol may result in your judgement being impaired. Your family and close friends should know that hypoglycemia may mimic the effects of alcohol. If you drink alcohol you should test your blood sugar more often. In addition, alcohol may cause you to put on weight and can affect your overall control. Heavy

Some considerations when you drink alcohol.

• Do not drink alcohol when your diabetes is poorly controlled - it is likely to make things worse
• Keep your alcohol intake down if you want to lose weight. Alcohol is high in calories. A pint of beer contains as much as 180 calories.
• Never drink on an empty stomach.
• Do not drink after heavy exercise
• Set an alarm and check your blood glucose during the night after drinking
• Don't skip meals or delay meals when you drink alcohol - you can have low blood sugar several hours after consuming alcohol. Remember to check your blood glucose levels before you go to sleep.
• Drink slowly. Try alternating alcohol with a non-alcoholic beverage or water. This gives you a chance to deal with the alcohol you have already had.
• Always carry glucose tablets or an alternative source of fast acting sugar
• If you have high triglyceride levels, you probably should not drink alcohol. Alcohol raises triglyceride levels.
• NEVER drink and drive.
• Make your own drink so that you know what it contains
• Avoid sweet drinks such as sherry, sweet wines and liqueurs
• Always wear your medical ID


Some studies have shown that small amounts of alcohol, especially red wine, may actually be beneficial and reduce your risk of heart disease. However the relationship between alcohol and health is a complex one. The protective effect of alcohol is thought to be evidenced by an increase in levels of HDL cholesterol.

According to the ADA website: A warning: glucagon shots don't help severe low blood glucose caused by drinking. Glucagon shots treat very severe low blood glucose reactions caused by too much insulin. Glucagon works by getting your liver to release more glucose into your blood. But alcohol stops this process. You need to be able to treat your reaction with a carbohydrate, such as oral glucose tablets or gels. So you need to avoid letting a low blood glucose level become severe. If you pass out, you will need glucose injected into your bloodstream by a health care professional.

For more information: http://www.diabetes.org/type-1-diabetes/alcohol.jsp

Deborah Greenwood APRN,BC-ADM, MEd, CDE

Back to Top

Q: What are the affects of drugs on my diabetes?


A: Since recreational drugs are illegal, here has been very little research on the effects of recreational drugs with individuals who have diabetes. Most experts agree that the effects on the brain caused be the drugs can adversely effect diabetes management. For example, marijuana stimulates appetite, thus may increase food intake and worsen diabetes control. Cocaine may suppress appetite and thus result in hypoglycemia.

The May 2002 issue of the American Journal of Cardiology, reported that frequent cocaine use "triggers a dangerous series of events linked to risk of heart attack and stroke." Cocaine constricts blood vessels and increases blood pressure-adding to the increased risk of heart attack and stroke that people with diabetes already face.

Effects of illegal drugs on diabetes control:

Marijuana

• (Its effect is highly related to dosage, but the strength of the main active chemical in marijuana, known as THC, delta-9-tetrahydrocannabinol, can vary widely.)
• Causes problems with memory, concentration, sensory and time perception, coordinated movement and problem solving, which may affect control.
• Increases appetite and can cause overeating and subsequent hyperglycemia.
• Impairs short-term memory during intoxication.
• Can cause profound impairment when mixed with alcohol.
• Can impair glucose tolerance and cause hyperglycemia when heavily used.


Amphetamines/Cocaine/ Psychedelics

• Can increase blood glucose and change eating habits.
• Can cause high blood glucose as a result of increased liver glycogen breakdown (highly variable among individuals).
• Alters perception, which can affect the ability to manage diabetes.


Opiates/Heroin

• Can change eating habits, which can affect blood glucose.
• Alters perception, which can affect the ability to manage diabetes.


Blood glucose should be checked frequently if consuming recreational drugs to monitor your reaction to the substance and your blood glucose response.
Of course, when you have diabetes, you are placing your health at unneccesary risk by consuming these drugs. As a diabetes educator, I can not support their use.

For more information: http://www.diabeteshealth.com/read/2003/11/01/3163.html
Deborah Greenwood APRN,BC-ADM, MEd, CDE

Back to Top

Q: Should I take a baby aspirin daily?


A: Studies have shown that taking one aspirin (ASA) per day can reduce the risk of heart attack by 30% and the risk of stroke by 20%. The American Diabetes Association recommends ASA as a method of preventing heart attack and stroke. The following link provides specific information. http://care.diabetesjournals.org/cgi/reprint/30/suppl_1/S4

If you have diabetes and have already had a cardiovascular incident, then ASA is suggested. Most clinical trials used doses between 75 and 325 mg daily, using the lowest dose possible to reduce side effects. There is no "suggested dose."

ASA is used to prevent cardiovascular incidents if you meet the following criteria:
Type 1 or type 2 diabetes-over age 40 and have a cardiovascular risk factor (hypertension, smoking, family history of cardiovascular disease, high cholesterol, or protein in your urine)

If you are between the ages of 30 and 40 and have risk factors for cardiovascular disease, you may also benefit from ASA therapy.

The following people should not use ASA therapy:
Person's less than 21 years of age due to the risk of Reye's syndrome.
Person's with ASA allergy, recent gastrointestinal bleeding, on anticoagulant therapy such as coumadin, or active hepatitis.
Please consult your doctor about your specific questions.
Deborah Greenwood APRN,BC-ADM, MEd, CDE

Back to Top

Click here for more Frequently Asked Questions

Last Modified Date: May 24, 2013

All content on dLife.com is created and reviewed in compliance with our editorial policy.

Sign up for FREE dLife Newsletters

dLife Membership is FREE! Get exclusive access, free recipes, newsletters, savings, and much more! FPO

Congratulations!
You are subscribed!
Congratulations!
You are subscribed!
Congratulations!
You are subscribed!
112 Views 0 comments
by Nicole Purcell
I have a friend, M, who has diabetes and never, ever tests her bloodsugar before she gets behind the wheel. This has always worried me about her. On Wednesday, she had a bad accident after passing out behind the wheel. She hit another car head on. I thank the universe that no one was killed, but she and the driver of the other vehicle were both badly injured. She's got a long healing road ahead of her, as does the woman she hit. I was talking about the...