Alcohol and Diabetes

The American Diabetes Association (ADA) states that the guidelines for drinking alcohol are the same for the public AND people with diabetes. The ADA suggests no more than two drinks per day for men and one drink per day for women.* Some people who should avoid alcohol altogether, such as those with a history of alcohol abuse or anyone who is pregnant. People with diabetes who have medical problems, such as pancreatitis, high triglycerides or nerve damage should avoid alcohol. Some medicines may be unsafe when used with alcohol. Ask your pharmacist or doctor for guidance on your safe alcohol consumption. What are the safety measures? Drinking alcohol can affect blood sugar, so diabetics should be conscious of consuming alcohol at a minimum level. To play it safe, you should only drink alcohol if your diabetes is in good control. For those who take insulin or diabetes pills, low blood sugar can occur. Alcohol prevents the liver from making sugar. It remains in the body up to 8 - 12 hours. During this time, no sugar is released from the liver. The only sugar in the blood comes from food. Therefore, always eat food with alcohol to prevent low blood sugar. Plan to drink with a meal or snack. Mixing alcohol with exercise may cause even lower blood sugars. Are there other things diabetics need to consider? Too much alcohol can impair judgement. You could forget to check your blood sugar or take your medicines. Alcohol stimulates your appetite, which might result in you overeating. This could increase blood sugar levels and cause weight gain, as alcohol does contain calories. If your doctor has recommended that you lose weight, these calories need to be worked into your meal plan. How much alcohol can a diabetic drink? If you take insulin and do not need to lose weight, you can have one or two drinks in addition to your meal plan. Do not omit food as this may result in low blood sugar. If you use regular soda or any type of juice to mix with your liquor, note that the carbohydrates present in these drinks should be counted into your meal plan. If you mix alcohol with a non-caloric beverage such as diet soda, it does not need to be counted. In general, If you need to lose weight, alcohol must be counted into your meal plan. What Diabetics Need to Remember Before Drinking... Drink alcohol only if your diabetes is under good control. Only have one or two alcoholic drinks per day. Always drink alcohol with food. Never drink alcohol on an empty stomach, or when your blood glucose is low. Avoid caloric mixers such as regular soda or juice, and if used, count these carbs into your meal plan. Opt for calorie-free drink mixers like diet soda or club soda. Avoid exercise before, during or after drinking. Carry carbs with you at all times to treat low blood sugar levels. In case of an emergency, always carry your diabetes I.D. with you. Hypoglycemia may be mistaken for simply being drunk and can occur as a result of drinking alcohol for up to 24 hours after drinking. Check your blood glucose before and while you drink, before bed, over the course of the night, and more often within the 24 hour time period. How can your doctor help you? Make sure that you discuss using alcohol with your doctor. They will help you decide if it is safe to drink, to what capacity, and what precautions you should take depending on your diabetes and other health risks. *https://care.diabetesjournals.org/content/42/Supplement_1/S46 Accessed 06/28/19
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Being in Control of Alcohol Intake

When a person chooses to drink alcohol, they should learn some helpful tips to control their blood sugar levels and prevent alcohol abuse. Every person needs to pay special attention to how much they drink, when they drink and why they drink alcohol. Getting started By using these simple tips, you will learn how to be more in control of your drinking. You will also learn how to avoid any problems connected with drinking alcohol. Plan how much you will drink before you go out. Look for problems that could arise and try to avoid them. If you are pressured because you do not drink, do not be afraid to make your feelings known. Remember parties are for having fun, not for drinking alcohol. Do not use alcohol to avoid stress. Do not get into the habit of drinking every time you go out. Do not get into the habit of drinking at a certain time of the day. If you choose to drink, do not drink on an empty stomach. Eat some food with your drink. This will decrease the risk of low blood sugars. It is best to avoid drinks with sweet liqueurs, cordials and most frozen drinks. These drinks contain high amounts of sugar. Slow down! Limit your drinks to 1-2 per day. Sip your drink. Do not quench your thirst with alcoholic drinks. Try water, seltzer or sugar-free soda. Have 1 alcoholic drink. Then with your next drink, skip the alcohol. After that, have your second alcoholic drink. Remember to limit your alcoholic drinks to no more than 1-2 per day. If you are taking medicines of any kind, discuss whether you should be drinking alcohol with your doctor. Check with your dietitian to see how alcohol fits into your meal plan. Go to places where alcohol is not served. Never drink and drive. Never ride with a person who has been drinking too much. Avoid alcohol if you are pregnant. Always carry an I.D. about your diabetes in your purse or wallet. How can your doctor help you? If you think you have an alcohol problem, get help. Ask your doctor to refer you to an alcohol treatment program. You can look in your local phone book for support groups such as Alcoholics Anonymous. Do not wait until the problem is out of control. Remember, an entire family suffers when one member of the family has a drinking problem. The less you drink, the better you feel. Drink in moderation. It can be done. Talk with your doctor about finding a behavioral health specialist.
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What about Diabetes and Alcohol?

Having diabetes does not mean that you have to give up your favorite foods or beverages altogether. This includes alcohol. The key is moderation.
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Tips for Taking Insulin

Learning to give an insulin injection can be frightening. Over time it gets easier. Insulin is needed to help keep blood sugar under control. What are some of the latest thoughts about insulin? The following practices were tested and found to be safe. Please check with your doctor before including them in your daily routine. Alcohol for the Skin Research has shown the number of bacteria carried by an insulin needle is not enough to cause an infection. Most people clean the area where they are going to give insulin with alcohol. Let the alcohol dry. Then give your insulin. If the area is still wet, you may feel a burning sensation. Angle of Injection People with diabetes are taught to give injections at a 90 degree angle. This is to insure the insulin goes into the fat layer. The fat layer is just under the skin. You do not want to inject insulin into the muscle. Rotating Sites Research has found insulin is absorbed at different rates in different sites. The best site to inject insulin is the abdomen. Insulin is absorbed here more consistently then other sites. You can also use the arms, thighs and hips. The hip area is the slowest to absorb insulin. The current recommendation is that you rotate sites at one location, preferably the abdomen. Storing Insulin If insulin is not stored properly, it may not work right. The insulin bottle in use can be kept at room temperature (less than 86°F). Extra bottles should be stored in the refrigerator. Once opened, insulin in a vial remains stable at room temperature for 28-30 days. Insulin pens remain stable at room temperature for 10-28 days depending on the type of insulin being used. Give insulin at room temperature to prevent a burning sensation. Be sure to read the directions that come with your insulin vial or insulin pen. Important things to remember Learn all you can about syringes, needles and insulin pens. Choose the ones that work best for you. Syringes come in different sizes that hold from 25 to 100 units. Buy the syringes that work best with the number of units you will give with each injection. Generally, insulin syringes have a very short, thin needle. Thin needles may be less painful to use. The higher the gauge of the needle, the thinner it is. Learn all you can about injecting your insulin. Steps to Inject Insulin It is important to mix the insulin by gently rolling it in your hands. Do this about 20 times before drawing it into the syringe. First draw up your insulin. Choose where you will give your shot. Insulin is absorbed best in the abdomen. The stomach also has fewer nerves than other places. Pick a spot at least 1 inch from the place you gave your last shot. Avoid the area within 2 inches of the belly button. If you prefer, you can clean the injection site with alcohol and allow it to dry. Remove the cap from the needle. Hold the syringe in one hand as you would hold a pencil. With your other hand, pinch up a couple of inches of skin. Stick the needle straight into the pinched skin. Put the needle all the way in through the skin with one, smooth motion. Relax the pinch and slowly push the plunger all the way down. Be sure all the insulin is in, count slowly to 5 and then remove the needle. If the needle is short count up to 10. Lightly press down on the site. Don?t rub the spot. Don?t worry if a drop of blood appears where the needle was. Write down the insulin dose you just gave yourself in your diabetes log. When you are ready to discard your used needles and syringes, put them into a hard plastic or metal container with a screw-on lid. Label as "Medical Waste" and discard according to the rules in your city. How can your doctor help you? Your doctor can answer any questions concerning insulin shots. Discuss the above injection practices with your doctor and if you should use an insulin pen or syringe.
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Tips for Parents

Diabetes can bring many changes. There are changes in eating healthy foods, daily medicines, checking blood sugar and activity levels. These changes could upset family routines. It is important for the family to understand diabetes. It is also important to work through the issues that can occur for the person with diabetes and their family. How can you support your child's diabetes management? Remember that your child is a child first. This means your child may need to test limits, fit into his peer groups and assert independence. As a parent you must maintain enough guidance to insure a safe and healthy lifestyle. You also must assist your child in becoming more independent in diabetes self-care. Look at your attitude and acceptance of your child's diagnosis of diabetes. How you deal with and accept diabetes affects the way your child deals with and accepts diabetes. Encourage your child to work with their doctor to come up with a self-care plan. This plan should come closest to meeting your child's needs for activities and daily living. Encourage your child to talk about their life with diabetes and its treatment. It will bring a sense of control over diabetes. It also helps create skills to talk with people. These routines will aid in the future as life and treatment continue to change. Work with a dietitian for a meal plan that includes your child's and your family's food choices. Learn how to plan for exercise, gym and other activities. Check blood sugar more often. Increase or decrease food, adjust insulin as needed. Be sure your child carries a source of carbohydrate at all times. This way your child will be able to treat emergencies, like low blood sugar, if they occur. If you have a child that attends school or daycare, you need to help teachers understand diabetes and how to care for your child's needs. Watch how you say things. Say blood "check," not blood "test." A child needs to know that they do not pass or fail the "test." The check is simply a blood sugar value. Also, say "high" and "low," not "bad" and "good." Good and bad can reflect success or failure. What can you do about sibling rivalry? Sibling rivalry can become a problem in households affected by diabetes. A sibling may feel the child with diabetes gets all the attention. On the other hand, the child with diabetes may feel the parents do not let him do the same activities their brothers and sisters can do. Here are some hints to help reduce sibling rivalry: Talk with your whole family about the need for some extra attention to manage your child's diabetes and health. Let children discuss their feelings. Involve them in solving problems. Set aside special times with each child. Focus only on him or her. Let the child with diabetes take part in all activities with their siblings. Feed the same food to everyone in the family. Learn how to fit their favorite meals into the diabetes meal plan. What can you do when your child is sick at home? Children can pick up many illnesses from others at school and daycare. Here are a few reminders: Never skip an insulin dose, even if your child is sick or is not able to eat or keep food down. Illness may cause an increased need for insulin. Check your child?s blood sugar at least every 2-4 hours. Check the urine for ketones several times a day. If your child is feeling sick and cannot follow their meal plan, try small amounts of liquids, such as grape juice or regular cola. Important things to remember Be well-informed about diabetes. Be flexible about trying new eating and exercise routines. Whenever possible, help your child meet their goals. Set a good example with your own use of alcohol and avoidance of drugs. For your teen, make sure they understand the effects of alcohol on blood sugar. Alcohol can mask signs and symptoms of low blood sugar. Smoking and illegal use of drugs can also have negative health effects.
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Low Blood Sugar

Chances are better than ever that a woman with diabetes will have a healthy baby. The first step is to get good control of your diabetes before you conceive. To prevent problems for the mother and baby, the American Diabetes Association (ADA) suggests that blood sugars be kept at or near the normal range. This will help to prevent problems. If your blood sugar drops too low, you can have a low blood sugar reaction, called hypoglycemia. Hypoglycemia is a blood sugar of less than 70. What can it be caused by: Too much insulin Missing a meal Delaying a meal Exercising too much Drinking too much alcohol What does low blood sugar feel like? Shaky or dizzy Sweaty Hungry Headache Sudden mood change Confused Rapid heart beat What to do? If you are not sure if your sugar is low, test your blood sugar. Eat or drink something that turns to sugar such as: 1 cup of milk ½ cup of fruit juice ½ cup of soda (not diet soda) 5 Life Savers® 3-4 glucose tablets 1 small box of raisins 1 big spoonful of sugar or honey - Wait 15 or 20 minutes. Test your blood sugar. If it is still low, eat or drink something again. - If you take insulin and your blood sugar gets too low, you may get very confused. You may also pass out. You will need to get help right away. If you cannot eat or drink, you will need a shot of glucagon. Make sure you tell people around you when and how to give glucagon. - If glucagon is not available, call 911 or have someone take you to the nearest emergency room for help. How can I prevent low blood sugar? Eat your meals on time. Take your diabetes medication as prescribed. Test your blood sugar often. Ask your doctor about exercise and food. Ask your doctor about drinking alcohol.
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Glucagon

Glucagon is an emergency treatment given to people with type 1 diabetes. It is used to treat very low blood sugar. Glucagon is a hormone produced by the pancreas. It raises blood sugar levels by causing the release of glucose from the liver. Similar to insulin, glucagon must be injected. When given, it raises blood sugar levels fast. Glucagon kits are available by prescription. Talk to your doctor about getting one. When would you consider using glucagon? Glucagon is used when a very low blood sugar makes the person unable to function. At this time, the person may not be able to swallow or take food by mouth. Try to check the person's blood sugar to be sure it is low. Glucagon must be given by someone who has been trained. A family member or co-worker can be trained on how to give glucagon. If in doubt, glucagon should be given. If glucagon is not available when a very low blood sugar occurs, call 911 right away. What happens after you use glucagon? In most cases, glucagon works within 15 minutes. If the person is out cold, keep the person on their side. That way if they vomit it will prevent choking. Once awake, give them sips of juice, clear liquids or regular soda. If the person keeps the liquids down, offer solid food. Be sure the person eats a meal with starches to prevent the blood sugar from dropping again. If the person remains unaware or confused after 15 minutes, call 911 right away. If low blood sugar has been caused by alcohol, do not treat with glucagon. Call 911 right away. Some common causes of low blood sugar are lack of food, taking too much insulin, increase in exercise or alcohol use. When you have a low blood sugar always report this to your doctor. Important things to remember Discuss with your doctor the proper treatment and prevention of low blood sugar. Ask your doctor for a prescription for glucagon. Make sure friends recognize signs and symptoms of low blood sugar. Instruct friends where to find the glucagon and how to use it. Make sure the glucagon is not expired. Glucagon is good for about two years. Replace any expired glucagon right away. Take glucagon with you when you are away from home. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html Accessed 07/05/19.
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High Lipids

Hyperlipidemia means high lipids or high fats in the blood. The liver makes these fats on its own. These fats also come from the foods we eat. Lipids travel in the blood and form plaque. The plaque sticks to the inner walls of the arteries. This causes the arteries to clog. Heart disease results from this plaque build-up. To help lower the risk of heart disease, people with diabetes need to control blood sugar levels and lower blood fat levels. How often should you be tested and what are your goals? The American Diabetes Association (ADA) suggests adults have a lipid profile at least once a year. If the results show levels in the low risk group, the lipid profile can be done every two years.* The lipid profile consists of: Total cholesterol LDL cholesterol (LDL) Triglycerides HDL cholesterol (HDL) The ADA has not set a goal for total cholesterol. For people with diabetes, the LDL (also known as "bad" cholesterol), should be below 100 mg/dL. A high LDL level may increase the risk for heart disease. Triglycerides should be below 150 mg/dL. Triglycerides are the main form in which fat travels in the blood. The goal for HDL (also known as "good" cholesterol), should be greater than 50 mg/dL in women and greater than 40 mg/dL in men. HDL may help the body get rid of plaque.* How can you improve blood fat levels? A medicine called a "statin", plus diet and exercise are the first treatments to lower high blood fats in diabetes patients. Your body makes LDL ("bad" cholesterol) from two types of fats in the diet. Saturated fats include fatty meats, whole milk dairy products (whole milk, butter, cream, sour cream, cheese or ice cream) and coconut or palm oil. The other fat is trans fats. They are in many fried foods, baked goods (cookies and crackers) and stick margarine. To lower your LDL cut down on foods high in saturated and trans fats. Choose lean meats, fish and poultry. Try low fat or fat-free dairy products. Cook with monounsaturated fats. These include olive oil, canola oil and peanut oil. The first step to lower triglycerides is to control blood sugar levels. When blood sugar levels are high, the sugar goes to the liver. Then, the liver uses sugar to make triglycerides. If needed, lose weight, increase exercise, limit carbohydrate intake and lower your fat intake. These can help lower your triglycerides. Too much alcohol can raise triglycerides. It may help to avoid or limit alcohol intakeHDL ("good" cholesterol) levels may be harder to increase at first. If needed, lose weight, stop smoking and exercise more often. This can help. In many cases, though, medicines are needed. Important steps to take Speak to your doctor about having your lipid profile checked. Keep a record of your results. You can track your progress. Meet with a dietitian to learn how to lower your fat intake. Check with your doctor to see if you need a referral to a dietitia Speak with your doctor about starting an exercise program. If taking medicines to lower blood fats, take it as ordered. Let your doctor know if you are having any side effects. How can your doctor help? Your doctor can order a lipid profile as needed. Your doctor can refer you to a dietitian to help you make the needed changes in your meal plan. If needed, your doctor will order medicines. If your doctor decides to put you on medicines, your levels should be checked every 4-6 weeks until your goals are met. *American Diabetes Association: Diabetes Care Volume 37, Supplement 1, January 2014 S38
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Quitting Smoking

Mark Twain once said, "Quitting smoking is easy. I've done it a thousand times." Why is it so hard to quit smoking? Nicotine (the addictive drug in cigarettes) is the answer. There are many tips and resources that will assist in the goal of quitting smoking. Aids to help you quit Nicotine Replacement Therapy (NRT): NRT provides nicotine to the smoker without many other poisons found in the cigarette smoke. The NRT that is available include: the nicotine patch, gum and nasal spray. NRT should not be used as the only treatment to quit smoking. Studies show that smoking cessation programs combined with NRT will double the chances of success rates for the smoker. ¹ As always, speak with your healthcare team to see what is best to help you to kick the habit. Zyban or Chantix: These medicines are often used to help smokers kick the habit. Both are anti-depressants. They reduce the desire to smoke. Both can be used alone or with other NRTs. Both need a doctor's order. Speak with your doctor if you would like to try this method. Smoking Cessation Classes: Studies have shown that smoking cessation programs are helpful.¹ If you want to attend one, ask about the following: Length of class. It needs to be at least 20-30 minutes long; Number of Classes. Having at least 4-7 classes is best; Number of weeks. Attend for at least 2 weeks; Make sure your leader is certified to teach a smoking cessation class. Often, the American Cancer Society, American Heart Association, American Lung Association or your local health department will hold smoking cessation classes in your area. Nicotine Anonymous Group: This is similar to Alcoholics Anonymous. There is a 12-step approach. To find a local meeting place, look in the business section of the phone book for a listing or visit nicotine-anonymous.org for more information. Getting started Before you chose to quit, you must think about these factors: Make a decision to quit. This is the first and most important step. Review your past attempts to quit. What worked and what did not work? Make a plan. Set a "Quit Date." Pick a certain day to quit. Make it a special day (birthday or anniversary). Do not wait too long to pick your "quit day." This will give you more time to think of reasons you do not want to quit. Commit yourself to this day. Mark it on your calendar. Tell your friends and family. Stock up on sugarless gum, carrot sticks and snacks that fit within your meal plan. Keep on saying, "No thank you, I don't care for a cigarette!" This will give you a "sense of control." On the day you decide to quit, try to: Get rid of all ashtrays. Keep active and drink water all day long. Ask yourself if alcohol, coffee or any other drink tempts you to smoke. If so, try to avoid them. Call a friend for support. If you miss having a cigarette in your hand or mouth, play with a pencil or rubber band. Keep a toothpick in your mouth. Brush your teeth often. Deal with withdrawals. The American Cancer Society suggests for you to use the "4 A's" when tempted to "just have one puff " or "to have just one more cigarette." Distract yourself from smoking again. Avoid. Stay away from the places where you are tempted to smoke. Alter. Take a new way to work or take a quick walk. Alternatives. Eat a quick snack or chew some sugarless gum. Activities. Go exercise or start a new hobby. Keep your new healthy lifestyle. Staying off the cigarettes is what matters in the long run. How can your doctor help you? Your doctor can also refer you to a program that will help you quit for good. Quitting smoking is not an easy thing to do. Remember, to keep on trying, even if you relapse. Good luck! ¹ www.ncbi.nlm.nih.gov/pubmed/11828726 Accessed 02/26/2014 American Diabetes Association: Diabetes Care Volume 37, Supplment 1, January 2014 S41-42
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Avoiding Hospital Stays and Emergency Room Visits

Staying out of the hospital or ER has many benefits! It may help avoid unwanted breaks in your daily routine. It may help keep insurance costs down. You may save money by avoiding co-payments. You may cut down on unpaid days off from work. Below are the causes for hospital stays and ER visits: Problems from high blood sugar Low blood sugar Poorly controlled diabetes Long-term problems of diabetes that require a lot of treatment Getting started: Try to keep your blood sugar in range. Check your blood sugar often. Report highs and lows to your doctor. Talk with your health care team regularly. Keep scheduled follow-up visits with your health care team. Call your doctor or diabetes educator about any problems that occur between visits. When you go to the hospital or ER, let your doctor know. Work with your team to develop a plan you can manage. Every patient should work with a diabetes educator and dietitian. This will help you to learn about your medicine, diet, exercise and lifestyle changes. Preventing problems from high blood sugar: If you have type 1 diabetes, know how to check for Diabetic Ketoacidosis (DKA). If you are sick, follow sick day guidelines. For people with type 2 diabetes, learn about Hyperosmolar Hyperglycemic Non-Ketotic Syndrome (HHNKS). Repeated episodes of DKA indicate a serious problem. This problem must be corrected. Otherwise, you are at risk for long term problems. Preventing low blood sugar: Ask your doctor what causes low blood sugar. You also need to know how to avoid having low blood sugar. Changes may need to be made to your medicine, meal and exercise plan. You also need to know how alcohol affects your blood sugar. If you have type 1 diabetes, learn how exercise affects blood sugar. Discuss with your doctor how to adjust insulin and food for exercise. Check your blood sugar often Learn how to treat low blood sugar. If you have type 1 diabetes, have glucagon on hand. Teach family, friends and co-workers how and when to give glucagon. How can your doctor help you? These suggestions may help you control your diabetes. In doing so, you may avoid hospital visits. However, if you are very sick you should not wait to seek care. http://www.diabetes.org/living-with-diabetes/treatment-and-care/whos-on-your-health-care-team/when-youre-sick.html Accessed 6/28/19
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