Your FAQs About Diabetes Answered

Kim Richardson, BSN, RN, a diabetes care and education specialist with the Phelps Health Diabetes Self-Management Education and Support (DSMES) program, answers frequently asked questions about diabetes.

What is the difference between type 1 and type 2 diabetes?

“[Diabetes] is a chronic condition that people can have, where they're not using the sugar in their blood well to make energy to do all the normal functions that we do on a daily basis.

“With type 1 [diabetes], people don't have enough of the hormone insulin that helps get the sugar from our blood stream into our cells to give us energy, and usually that is [due to] an autoimmune [issue]. Typically, you'll see type 1 [diabetes] patients as children or young adults because it will happen early, but there are also adults that can develop type 1 diabetes.

“Type 2 diabetes is typically what we know of as adult-onset diabetes, and that's where you may not have enough insulin, but it's also that our body can't use it well because [we] have become resistant to the insulin.

“Insulin acts as a key…to open the doors on the cells to let the sugar in. If our bodies don't have enough, then not enough doors get opened to let all the sugar in. If we are resistant, or those locks on the doors are rusty, then the insulin we have doesn't work. Either way, you end up having too much sugar in your blood, but not enough in the cells where we need it.”

What are the symptoms of type 1 and type 2 diabetes?

“The symptoms are similar because we have high blood sugar [in both type 1 and type 2 diabetes]. They can be fairly subtle symptoms at first because [you] tend to be really thirsty and you can't quench that thirst. Then, [you’re] having a lot of urination because of all that water and your body is trying to get rid of the sugar. You can have hunger because your body is starving for energy since it's not able to use the energy that you are taking in. Fatigue can be [a symptom], too.

“Many of those symptoms can be written off as just life or, ‘Oh, I just need to drink more water,’ so people can ignore those symptoms for a long time. It may not be until something severe happens where they're really dehydrated and their blood sugar is astronomically high and they end up in the hospital before they're diagnosed.”

What are the ABCs of diabetes?

“The ABCs of diabetes are a way to manage certain parts of your health that will also help manage your blood sugar.

“A is…A1C, and that is a blood test that…gives a measurement of the average blood sugar for the last three months. That [A1C] includes all your high blood sugars and low blood sugars and everything in between. You don't have to be fasting for [A1C]; it can be drawn at any time.

“B is blood pressure. That's something that should be checked any time you go see a [healthcare] provider…because that gives us a lot of information about the pressure inside our arteries. They [healthcare providers] can see how healthy our blood vessels are to try to address and control risks for heart disease and stroke…as well as how well we're doing on our blood sugar.

“C is cholesterol, which works with the body to help carry different nutrients around. The fat in the cholesterol can help with building cell walls…so it's important to have some, but we just don't want it really high. Part of the good cholesterol, your HDL, actually helps to protect and clean up the bad fats in your blood.

“For people who have…really high blood sugars, your triglycerides – which is another part of your cholesterol lipid panel measurement – can actually be high because triglycerides are made of sugar and fat together. Sometimes just high triglycerides can help direct providers down the road to figure out that you're diabetic.

“All of those together [A1C, blood pressure and cholesterol], if we can keep all those numbers in those target ranges, that's really going to help our whole body work better by helping our heart not have to work too hard and keeping our blood vessels nice and healthy.”

What is the target range for our A1C levels?

“For someone without diabetes…your A1C [should] be 5.7 or less because what that means is that when you eat something and you have sugar that goes into your blood, your body is able to respond to that sugar appropriately and get it into the cells and into the muscle so that it can be used as energy.

“Because we know that people with diabetes have a harder time utilizing the sugar in [their] blood and getting it used up as energy, the expectation is for [their A1C levels] to be in 7 or lower, and that would be considered well-controlled diabetes.

“The targets are the same for men, women and [different] age groups. The only difference would be if someone was diabetic while pregnant, then the target levels are a little tighter because we know that too much blood sugar can affect how quickly the baby grows and how large the baby grows, which could put pressure on the mom and cause delivery issues.”

What happens to a person’s insulin levels if they have diabetes?

“Typically…a person with type 1 diabetes [has] either no insulin or very little insulin. Since insulin is that key that opens the doors on the cells to let the blood sugar in, there's not enough keys. You have all these doors that are locked, and there's no way to open them. That's why someone with type 1 diabetes has to take insulin because it replaces what their body can't make.

“[For] people with type 2 diabetes...their cells don't respond appropriately to the insulin to let the sugar in. You have plenty of doors and you may have plenty of keys, but the locks are rusty and the keys aren't working very well. It can actually decrease the amount of doors that work on cells by 20% to 25%.

What is the target range for a person’s normal blood sugar level?

“Typically for a…person without diabetes, their fasting blood sugar -- meaning [they had] nothing to eat or drink for eight hours, or first thing in the morning -- would be 80 to 95 or 100.

“But those targets change, just like the A1C does, [for] people with diabetes, because we know that the inefficient use of insulin and sugar is going to be a little higher. [For diabetes] to be considered well-managed, we would want fasting [blood sugar levels to be] between 80 and 130, and then two hours after the first bite of your meal would be 80 to 180.”

Why does a person with diabetes need to measure and monitor their blood sugar?

“There are so many things that are affected by your body if your blood sugar is not good. It can be challenging to get people to understand that managing your blood sugar is so important. There [are] lots of long-term complications, like kidney disease; problems with your nerves, your feet and your hands; blood vessel issues that can lead to hardening of your arteries, heart problems and stroke; even sexual problems and depression are higher [for] people with diabetes.

“You're going to just feel better if you manage your blood sugar. Typically, if your blood sugar is running really high, you're going to be really tired. It makes it just hard to go through life. If your blood sugar is really low, you can be shaky…where you just are irritable and angry.”

What are the warning signs if someone's blood sugar is too high? What can someone do if their blood sugar is too high?

“Some of the symptoms can be similar for both high and low [blood sugar]. Typically for high blood sugar, you've got that insatiable thirst and you've got frequent urination. You may be hungry even though you just ate, and fatigue [is another sign].

“The best thing you would want to do at that point [high blood sugar] is to drink water, because drinking water is going to help your kidneys flush out the extra sugar. Another thing that can really help your body use the sugar is easy, light exercise, like going for a walk.”

Should a person with diabetes keep a journal?

“Yes, definitely, because everybody will react a little differently to different foods or stress. Writing it down in a log book with a note about what you ate or if you had a really high-stress day, [writing those notes] can really help put those pieces together to give you that ability to manage your blood sugar well. There's lots of apps on your phone that you can use to track things too, so it's easy and handy.”

Should people with diabetes take their medicine everyday or just when they’re not feeling well?

“It's really important to be consistent…not only with how you're eating, but with taking your medication, because some medications take a while to build up [in your body]. They [medications] need to be taken consistently, so they can work the best.

“If you are only taking your medications once in a while – when you don’t feel good – you're not going to get the best results. You'll end up being on a roller coaster, where your blood sugar is high and you take your medicine, then it goes low. It's really going to help you feel better to just be consistent.”

What are some of the most important things to check or measure at doctor's appointments?

“Blood pressure…should be checked at every doctor's appointment because…not only is knowing if you're high at this very second important, but [also] seeing the trends if…your blood pressure is starting to run high more often, [it] can be an indication to get on medication or talk about other lifestyle changes you can do to help with your blood pressure.

“Your provider – if you do have diabetes – would want to see either the [blood] sugars on your meter or your log book to see what your trends have been for that, too.

“One of the things we worry about with people with diabetes is that because of the inflammation that's going on already with the blood sugar, then you can run into problems with your skin and having wounds that don't heal well.

“Typically, [our] feet can be a big area that is missed when we're taking care of ourselves at home, because we just take our feet for granted. Taking your socks and shoes off and having your provider check your feet – just to make sure everything looks healthy [and] make sure your sensation is good – is important. If we can catch those complications early, then there's a lot better chance that we can minimize the impact on your life.”

Should a person who has diabetes stop smoking?

“Smoking is not your friend. You may enjoy it, but smoking contributes to a lot of complications, not only with your heart and with your circulation, but if you think about your arteries and your blood vessels as hoses that run throughout your body…all the energy, all the nutrition circulate throughout your muscles and organs.

“If we smoke, they [blood vessels] get smaller…so there's less space for all the nutrients and everything to go through. That is why people who smoke tend to have higher blood pressure, because there's still the same amount of fluid; it's just in a smaller tube.

“If you add in high blood sugar, that just increases that pressure and it actually makes our blood thicker…and that is not healthy for us at all. That increases your risk for circulatory complications, kidney problems and eye problems. It also puts more pressure on our heart, so it can increase our risk of heart issues, clogged arteries, heart attack [and] stroke.

“It's super important to stop [smoking] to help minimize those problems.”

Can people with diabetes reverse their diagnosis if they stop eating carbs or lose weight?

“Everybody needs carbs. Our brains prefer carbohydrates because carbohydrates as foods get broken down into sugar, and sugar is the preferred fuel source for our body, especially our brain. So, even if you are a person with diabetes, you still need carbohydrates throughout the day to help keep your energy levels up.

“There's no cure for diabetes, but you can have your diabetes be in remission. What that means is that your numbers – your A1C, your blood sugars – are all well within the targets of a non-diabetic. You are probably not on any medication, except maybe Metformin, so you can be considered in remission.

“Even people who've had weight loss surgery or who lost a ton of weight…it [diabetes] is still kind of there in the background.”

Can someone with diabetes eat fruit?

“There [are] no off-limit foods when you're diabetic. The key is portion size as well as combination, because if we are having a balanced diet – where we have consistent carbohydrates throughout our day – paired with proteins and fat, then it really helps keep our blood sugars be more stable. Fruit, cake, pumpkin pie – all those things can be integrated into your diet appropriately and be successful with your management of your diabetes.

“My goal is to try and find ways to help integrate the foods that you love…and still meet those goals and those benchmarks to keep yourself healthy.”

Should someone with diabetes avoid fat?

“Fat is important because…we use it in building our cell walls and…other things in our bodies. It [fat] helps carry certain vitamins and nutrients, so you do need fat. You still want to have fat in moderation, so trying to [eat] healthy fats and minimizing saturated fats from junk food and fast [is important].

“Being present [when] you're eating and savoring it is going to help you enjoy what you have in a smaller portion. Paying attention to when you're full…is important too. If we're paying attention to what we're eating, then that can help [us] meet those goals a lot easier.”

What are some good travel foods for people with diabetes?

“Trail mix is a good one because you've got your protein and your fats with your nuts and there may be some dried fruit in there, or maybe even a little chocolate, so that'll give you a good balance of carbohydrates and proteins. Things like cheese sticks and meat sticks [are other options].

“You can get a lot of different protein bars…that will give you some sugar or carbohydrates, along with your protein to help keep you full. Veggies tend to travel well, so carrots, celery and broccoli [are good travel foods].”

What resources are available to help someone manage their diabetes?

“The great thing about this area is the fact that we have this diabetes education program [at Phelps Health]. I think…talking to your physician, your nurse practitioner or your PA (physician assistant) – whoever it is you see on a regular basis – they’re a great starting point. They can put in a referral [for you] to see diabetes education [specialists] to help get more information.

“Most insurances do cover diabetes education. There's also free classes that we've started offering once a month to give survival skills for people who are prediabetic or they're nearly diabetic, but they have a really high deductible or are underinsured.

“The American Diabetes Association…website has great information about parents helping their children with diabetes or women who are pregnant with diabetes or adults who have new diagnoses.  The Mayo Clinic…the CDC (Centers for Disease Control and Prevention), National Institute of Health – those also can direct you to good information that you can use that can actually be helpful for your life.”

How can I learn more about Phelps Health diabetes education?

“Our standard [diabetes] education program is actually 10 hours of instruction. We cover everything from what is diabetes to meal planning to healthy eating and more.”

Services provided through the Phelps Health diabetes education program require a referral from your primary care provider. To learn more, call Kim Richardson, BSN, RN, a diabetes care and education specialist, at (573) 458-7697.