Are you Prepared?

April 14, 2015

Emergency Preparedness

by Susan Klick, MSN, RN, CNL

Spring time in St. Louis reminds us that Emergency preparedness is important for everyone.   When you have diabetes, it requires that much more planning and gathering of supplies. However, it being human nature to procrastinate, many people (maybe even you?) are not fully – or even partially – prepared to deal with having to leave home in a hurry or to survive at home for several days with no power, no running water, a limited ability to communicate with others, and no way to buy groceries or get to a pharmacy.

When you think about being prepared for a natural disaster, keep the following in mind:

  • Do you have enough medication and supplies? For example: blood glucose monitoring supplies; insulin syringes, or an extra battery for your pump and monitor.
  • Who can you reach out to in case of emergency? Do you have family nearby who will be able to get to you?
  • Do you have enough water and non-perishable food items that could last you for up to 2 weeks?

Do you have non-perishable foods to treat hypoglycemia?

Basic Emergency Preparedness steps include:

  1. Have a plan that includes proper diabetes care.
  2. Emergency Supplies – store three days’ worth of supplies in an easy-to-identify container, and store it in a location that is easy to get to in an emergency.
  3. Emergency contacts: Keep a list of emergency contact phone numbers in your supply kit.

Other Helpful Hints:

  • Identify yourself to relief workers as having diabetes and wear diabetes identification.
  • Prevent dehydration. Make sure you are taking in enough fluid to meet your body’s needs. This must be done safely so make sure you are drinking clean water or non-carbohydrate fluids.
  • A word about hypoglycemia: Keep something with you to treat low blood sugar at all times. Due to the serious concerns of low blood sugar and the unusual circumstances faced in the aftermath of an emergency such as a natural disaster, particularly if you are unable to monitor your blood glucose, it may not be best to strive to keep your blood glucose levels to as close to possible as normal, but allow the level to be somewhat higher. Remember too that certain medications require certain diet requirements that may be altered, and activity levels may be different. Excessive work (activity) to repair damage to your home, neighborhood, etc. may cause a drop in blood glucose as well as erratic meal times.
  • Prevent Infection – People with diabetes are naturally at higher risk to develop infections, particularly in their feet. Be aware! In catastrophic events, there may be debris that presents additional danger. Wear protective clothing and shoes.
  • Medications: If you are insulin dependent and insulin is NOT available, carbohydrate intake will most likely need to be cut. The most important priority is to stay hydrated. When medications are available they should be started cautiously as diet and activity levels may be different, or weight loss may have occurred.
  • Pharmacies in affected areas may allow you to get your medications without a prescription if you have the pill bottles.
  • High blood sugar – Look for elevation in blood sugar as a result of stress, erratic meal times, lack of medication(s).
  •  Check your kit every time the seasons change and watch expiration dates.

Food Supplies Suggestions for your Emergency Kits:

Unopened crackers (saltines)                                                         checklist-cartoon

Peanut Butter

Powdered Milk

Bottled Water

Cheese Crackers

Dry/Unsweetened Cereal

6 cans regular soda

6 cans diet soda

6 cans light/water packed fruit

6 cans juice


Disposable Cup

Glucose Tablets or hard candies

Canned tuna/Chicken/Nuts

Mechanical Can Opener







Diabetes Self-Management

American Diabetes Association



An Easter “Sweet”

March 27, 2015

Sweet ‘n’ Salty Raspberry Bars                                            

by Alison Brinker, RD, LD

April showers bring May flowers…… also brings Easter candy……candy tempting us from every basket. Try this low carbohydrate dessert when gathering with friends and family. It’s refreshing and as bright and colorful as a Spring day. The sweetness of the raspberry gelatin is a great compliment to the salty pretzel crust. Enjoy!

What you will need:

1 ½ cup finely crushed pretzels

¼ cup plus 1 ½ tablespoons Splenda Sugar Blend, divided

½ cup light tub margarine, trans-fat free, melted

1 package (4 serving size) sugar-free raspberry flavored gelatin

1 cup boiling water

1 (12 ounce) package frozen raspberries, slightly thawed (see Note*)

1 (8 ounce) package fat-free cream cheese, softened

1 (8 ounce) frozen fat-free whipped topping, thawed

What to do:

  1. Preheat oven to 400 degrees. Coat an 8-inch square baking dish with cooking spray.
  2. In a medium bowl, combine crushed pretzels, 1-1/2 tablespoons Splenda, and margarine. Press mixture into bottom of prepared baking dish.
  3. Bake 8 minutes; let cool
  4. In a large bowl, dissolve gelatin in boiling water. Add raspberries and chill until slightly thickened. In another large bowl, using an electric mixer on medium speed, combine cream cheese and remaining Splenda until smooth and creamy. Fold in whipped topping and spread evenly over pretzel crust.
  5. With an electric mixer on low speed, beat gelatin and raspberries until berries are broken up. Spread over cream cheese layer. Cover and chill at least 4 hours, or until firm.

*Note: Although the raspberries need to be thawed slightly so they are not frozen solid, the colder they are, the faster the gelatin will thicken.

Cut pan into 16 servings. Each serving is 107 calories, 18 grams of carbohydrate, 3 grams of fat


51 Ways to Prevent Type 2 Diabetes

March 18, 2015

by Susan Klick, MSN, RN, CNL

Put less on your plate, Nate.

  1. Drink a large glass of water 10 minutes before your meal so you feel less hungry.
  2. Keep meat, chicken, turkey, and fish portions to about 3 ounces.
  3. Share one dessert.

Eat a small meal, Lucille.

  1. Use teaspoons, salad forks, or child-size forks, spoons, and knives to help you take smaller bites and eat less.
  2. Make less food look like more by serving your meal on a salad or breakfast plate.
  3. Eat slowly. It takes 20 minutes for your stomach to send a signal to your brain that you are full.
  4. Listen to music while you eat instead of watching TV (people tend to eat more watching TV).

Dance it away, Faye.

  1. Show your kids the dances you used to do when you were their age.
  2. Turn up the music and jam while doing household chores.
  3. Work out with a video that shows you how to get active.

Let’s go, Flo.

  1. Deliver a message in person to a co-worker instead of sending an e-mail.
  2. Take the stairs to your office
  3. Catch up with friends during a walk instead of by phone.
  4. March in place while you watch TV.
  5. Choose a place to walk that is safe, such as your local mall.
  6. Get off of the bus one stop early and walk the rest of the way home or to work during the week if it is safe.

Snack on a veggie, Reggie.

  1. Buy a mix of vegetables when you go food shopping.
  2. Choose veggie toppings like spinach, broccoli, and peppers for your pizza.
  3. Try eating foods from other countries. Many of these dishes have more vegetables, whole grains, and beans.
  4. Buy frozen and low-salt (sodium) canned vegetables if you are on a budget.
  5. Serve your favorite vegetable and a salad with low-fat macaroni and cheese.

Cook with care, Claire.

  1. Stir fry, broil, or bake with non-stick spray or low-salt broth. Cook with less oil and butter.
  2. Try not to snack while cooking or cleaning the kitchen.
  3. Cook with smaller amounts of cured meats (smoked turkey and turkey bacon). They are high in salt.

Cook in style, Kyle.

  1. Cook with a mix of spices instead of salt.
  2. Try different recipes for baking or broiling meat, chicken, and fish.
  3. Choose foods with little or no added sugar to reduce calories.
  4. Choose brown rice instead of white rice.

Eat healthy on the go, Jo.

  1. Have a big vegetable salad with low-calorie salad dressing when eating out. Share your main dish with a friend or have the other half wrapped to go.
  2. Make healthy choices at fast food restaurants. Try grilled chicken (with skin removed) instead of a  cheeseburger.
  3. Skip the fries and chips and choose a salad.
  4. Order a fruit salad instead of ice cream or cake.

Rethink your drink, Linc.

  1. Find a water bottle you really like (from a church or club event, favorite sports team, etc.) and drink water  from it every day.
  2. Peel and eat an orange instead of drinking orange juice.
  3. If you drink whole milk, try changing to 2% milk. It has less fat than whole milk. Once you get used to 2% milk, try 1% or fat-free (skim) milk. This will help you reduce the amount of fat and calories you take in  each day.
  4. Drink water instead of juice and regular soda.

Eat smart, Bart.

  1. Eat foods made from whole grains every day, (whole wheat bread, brown rice, oats, and whole grain corn.)
  2. Use whole grain bread for toast and sandwiches.
  3. Keep a healthy snack with you, such as fresh fruit, a handful of nuts, and whole grain crackers.
  4. Slow down at snack time. Eating a bag of low-fat popcorn takes longer than eating a candy bar.
  5. Share a bowl of fruit with family and friends.
  6. Eat a healthy snack or meal before shopping for food. Do not shop on an empty stomach.
  7. Shop at your local farmers market for fresh, local food.

Keep track, Jack.

  1. Make a list of food you need to buy before you go to the store.
  2. Keep a written record of what you eat for a week. It can help you see when you tend to overeat or eat foods  high in fat or calories.

Read the label, Mabel.

  1. Compare food labels on packages.
  2. Choose foods lower in saturated fats, trans fats, cholesterol, calories, salt, and added sugars.

You can exhale, Gail.

  1. Take time to change the way you eat and get active. Try one new food or activity a week.
  2. Find ways to relax. Try deep breathing, taking a walk, or listening to your favorite music.
  3. Pamper yourself. Read a book, take a long bath, or meditate.
  4. Think before you eat. Try not to eat when you are bored, upset, or unhappy.


St. Anthony’s Medical Center is presenting a FREE class on Preventing Type 2 Diabetes. Please join us on Saturday, April 11, 2015 from 9:00 – 11:00 a.m. in the Hyland Education Center Great Room. Registration is required. Call 314-ANTHONY (268-4669). For more information visit


Source: National Diabetes Education Program

Adding to your Physical Activity

March 2, 2015

By:  Susan Klick, MSN, RN, CNL Diabetes Educator

Aerobic exercises such as walking, cycling, swimming, and cycling are part of the focus in managing blood sugar for all diabetics.  However, there is also much to gain from other forms of exercise such as resistance, balance, flexibility and strength training.   These muscular fitness activities can slow the age-related loss of muscle mass and improve mobility, endurance and function.  Resistance training exercises include weight machines, resistance bands, or the use of one’s own body weight as seen with pushups and squats.  Because some of the main tissues in the body that are sensitive to insulin are the skeletal muscles; by increasing the amount and sensitivity of skeletal muscles with resistance exercise, many diabetics can better manage their blood glucose levels and weight by adding resistance training.

Performing resistance training two to three times per week and incorporating it with aerobics is most beneficial for type 2 diabetics.  The combination of the two improves blood glucose control and reduces cardiovascular risk factors more than either type of exercise alone.

Those diabetics with balance issues have a higher risk of falling due to slower reaction times, and an unsteady gait.  Diabetic related complications such as neuropathy, vision problems, and side effects from certain medications (lightheadedness for example) may contribute to the risk of falling.  Many people who are at risk of falling develop a fear of falling, which further limits their activity level!   These individuals can benefit from balance training, which can improve their gait and reduce their risk of falling.  Tai Chi and Yoga exercise programs involve varies combinations of flexibility, balance, and resistance training.   Lower-body and core strengthening exercises will also improve balance.

Flexibility is the ability to move our joints through a complete range of motion.  Certain activities of daily living will require more flexibility than other ones.  People with diabetes are more prone to develop changes in their joints that can limit movement.  Stretching exercises help to increase flexibility, and it may be included as part of a physical activity program.  It should not be used as a substitute for other training as its beneficial impact on blood sugar is unclear.  Flexibility training combined with resistance training increases joint range of motion, and when combined with balance training can reduce the risk of falls.  Remember though – time spent on flexibility does not count toward meeting the aerobic activity time guidelines of 30 minutes/day or 150 minutes/week.

Exercise is a vital component in managing diabetes.  Ultimately, diabetics should aim for at least 150 minutes of moderate to vigorous aerobic activity per week, together with activities that build muscular strength two to three times per week.  It is important to find activities that you enjoy and that you are able to perform safely.  If you are unsure, check with your physician.  St. Anthony’s Medical Center offers a variety of fitness classes Monday through Saturday at the Body, Mind, and Spirit Center in the Medical Plaza building.  For more information on these classes visit



Diabetes Spectrum

St. Anthony’s Get Fit



Managing Low Blood Sugar

February 3, 2015

by:  Susan Klick, MSN, RN, CNL

Do You Know How to Manage a Low Blood Sugar?

A recent online survey of both Type I and Type 2 diabetes revealed that many are uncertain of how to prevent and manage hypoglycemia (low blood sugar). Avoiding alcohol as a way to prevent hypoglycemia was reported by 30% of the participants and 49% were unaware that glucose tablets could be used to treat an episode. Forty-two percent of participants who had never experienced hypoglycemia were unable to correctly define what it is. Let’s take a look at the What – When – Why – and How of low blood sugar.

WHAT IT IS: Hypoglycemia or low blood sugar occurs when the blood glucose drops below the normal level. For most people, a blood glucose reading below 70 mg/dl is considered below normal.

WHEN IT OCCURS: Hypoglycemia happens when there is not enough glucose in your blood to provide the energy your body needs. You may experience symptoms when the level of blood sugar in your body falls below its normal range. This may happen if you do not eat enough food at a meal or a snack, or if you skip a meal. It may happen if you take more insulin or diabetes medicine than needed for the food that you eat. It may also occur if you exercise or are more active than usual. Drink alcohol without eating food can also cause hypoglycemia.

WHY IT IS DANGEROUS: This condition is dangerous because your brain is not getting enough glucose (sugar) to work properly. If there is not enough glucose for your brain to function, you may pass out or even have convulsions.

HOW TO RECOGNIZE HYPOGLYCEMIA: A low blood glucose reaction brings on uncomfortable feelings.  Mild symptoms occur in the early stage and include sudden hunger, headache, shaking, fast heartbeat, sweating, feeling tired or drowsy, feeling dizzy, having blurry vision, nervousness, and/or numbness or tingling around the mouth and lips. If not treated, you may experience symptoms of moderate hypoglycemia which can include personality change, irritability, confusion, poor coordination, difficulty concentration, and slurred or slow speech. If the reaction is still not treated, and your blood glucose continues to fall, you may pass out or develop convulsions. This is severe hypoglycemia and will require emergency treatment.

Some people have what is called “Hypoglycemia Unawareness,” a condition in which you lose the ability to feel the symptoms of low blood glucose until the blood glucose is very low. The first symptom may be confusion or passing out. This can occurs in diabetics who keep their blood glucose very close to normal or who have had diabetes for many years. It may be the result of having many episodes of low blood glucose.

HOW TO TREAT HYPOGLYCEMIA:   Check your blood sugar if you think it may be low or if you are experiencing symptoms. If your symptoms make you very uncomfortable and you feel that you do not have the time to check your blood glucose, eat first and then immediately check your blood sugar. If your blood glucose is less than 70 mg/dl:

  1. Treat with 15 grams of carbohydrates (4 oz. juice, 3 glucose tablets, ½ can soda, 8 Lifesavers)
  2. Wait 15 minutes and retest. It takes about 15 minutes for the sugar to raise your blood glucose level.
  3. If your blood glucose is less than 60 mg/dl, treat with another 15 grams of carbohydrates.
  4. If your next meal is more than an hour away, eat a snack of 15 more grams of carbohydrate and one ounce of protein (i.e. five crackers and one ounce of low fat cheese, half of a ham or turkey sandwich)

There may be times when your blood sugar is not low, but has dropped rapidly from a very high level to a lower level. Your body is reacting to the quick drop, not the actual level. You do not want to treat a normal blood glucose and cause it to rise above normal. However, continue to pay attention to your symptoms and your blood sugar. If the symptoms become worse or your blood sugar continues to drop, eat a snack with carbohydrates and protein such as crackers and peanut butter, crackers with cheese, half of a ham or turkey sandwich, or a cup of milk with cereal.

Note: Candy bars, ice cream and chocolate are not good choices for treating hypoglycemia.   Foods with fat or protein will not raise your blood glucose fast enough.

HOW TO PREVENT HYPOGLYCEMIA: The best ways to prevent hypoglycemia are to:

  1. Eat on time
  2. Make sure you eat enough food for the medication you are taking
  3. Do not drink alcohol without eating food
  4. Take your medication on time
  5. Be prepared. Always carry some form of carbohydrate (glucose tablets, juice, hard candy) in the event that a meal is delayed or you are more active than usual.


Healio Endocrine Today:   Survey: People with diabetes uncertain about management of hypoglycemia January 20, 2015.

BD Getting Started: Hypoglycemia and Diabetes

The Latest in GLP-1 Therapy

January 22, 2015

By Kristen Rider, BSN, RN, CDE

GLP-1 agonist medications are a common treatment for the management of Type 2 Diabetes. They work like the hormone GLP-1 (Glucagon-like peptide 1) that the body normally produces to help regulate blood glucose levels. People with Type 2 Diabetes may be deficient in GLP-1, which is why these medications are being used. GLP-1 agonists work to control blood glucose levels by decreasing the amount of glucose that the liver produces, delaying gastric emptying time, and helping the pancreas to produce more insulin when blood glucose levels are high. The first to hit the market was Byetta in 2005. Since then, several others have been launched, some within the past few months. All of the GLP-1 agonist medications are injectable, but each has a different device or mechanism for injection. Dosing varies from twice daily, daily, to once weekly. Some of these medications are FDA approved for use in conjunction with basal insulin, while others were not studied as such. See the comparison chart below for more information on GLP-1 agonists.

Drug Dose Mixing


Pre-injection waiting time


Approved for use with basal insulin


Twice daily



5mcg, 10mcg


Bydureon Kit


Once weekly Yes No

2 mg

Bydureon Pen
Once weekly Yes No 2 mg



Once weekly


Yes 15 min

30mg       50mg




Once weekly



0.75 mg




Once daily

No No 0.6mg


1.8 mg


Package Insert (PI) list

Byetta (exenatide) AZ – Bydureon Pen and Kit (exenatide extended release) AZ – Tanzeum (albiglutide) GSK – Trulicity (dulaglutide) LILLY – Victoza (liraglutide NOVO –

This information is not meant to replace your healthcare Provider’s advice. It is not an endorsement of these products or of the pharmaceutical companies. The Outpatient Diabetes and Nutrition Services Department at St. Anthony’s Medical Center can assist you with questions you may have regarding this change or other questions you have regarding your diabetes self-management. Call us at 314-525-4523 for more information.


Happy New Year – Happy Feet

January 5, 2015

You may have heard that diabetes can lead to foot problems. It can be tempting to ignore your feet, but diabetes can be hard on the feet over time because high blood glucose levels may lead to neuropathy, or nerve damage. Nerve damage can make your feet numb. So you may not feel a small cut or a tight-fitting shoe that can lead to calluses, blisters, or other wounds. Such wounds can get infected and be slow to heal, especially if you have high blood sugar levels and poor blood flow in your feet and legs.

Most people can prevent any serious foot problems and keep feet feeling their best by following these simple steps:

  1. Check your feet every day.

Look for calluses, blisters, scaling (dry skin), cracks in the skin (especially between toes and on your heels), redness, and swelling. If you can’t turn your leg to see the bottom of your foot, try placing a magnifying mirror on the floor and hold your foot above it to check the bottom for trouble spots, or ask someone for help.

Neuropathy can result in both pain and loss of sensation in your feet. When you can’t feel pain, you won’t feel a wound forming (that’s why daily checks are so important!).

  1.  Wash your feet every day and moisturize. Cut nails carefully.

After washing your feet in lukewarm water (not hot!), dry them carefully, especially between the toes. You can avoid dry skin and cracking by using a thick moisturizer on your feet. Rub it in well, but don’t put it between your toes—those dark, moist areas are great hosts for infection.

Cut nails straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toe nails. Have a foot doctor trim your toenails if you cannot see or feel your feet, if you cannot reach your feet, if your toenails are thick or yellowed, or if your nails curve and grow into the skin.

  1. Wear shoes that fit your feet and don’t go barefoot. Don’t forget socks!

Wear comfortable shoes that fit well and protect your feet. Wearing shoes that rub or pinch makes it more likely for a blister or wound to form. Look for a snug but not tight shoe fit, with room to wiggle your toes. For hard-to-fit feet or if you already have foot problems, you may need therapeutic shoes. Ask your doctor about Medicare and other insurance coverage for special shoes. Walking/athletic shoes are good for daily wear. They support your feet and allow them to “breath”. Avoid vinyl or plastic shoes because they do not stretch or breath. Avoid shoes with pointed toes or high heels as they put too much pressure on your toes. And buy shoes at the end of the day when your feet are the largest so that you can find the best fit.

Check inside your shoes before wearing them. Make sure the lining is smooth and there are no objects inside. If you keep your shoes in the garage or outside, look to make sure no spiders or other critters have taken refuge in the warmth of your shoes!

Wear clean, dry socks and change them daily. Avoid tight elastic bands (they reduce circulation). Don’t wear thick or bulky socks as they can fit poorly and irritate the skin.

  1. Protect your feet from hot and cold and don’t go barefoot!

Never walk barefoot! Wear shoes at the beach or on hot pavement. Don’t put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it. If your feet get cold at night, wear socks. Be sure to wear proper foot wear in the winter months to prevent frost bite and don’t let your feet get wet in snow or rain.

  1. Show your feet to your health care provider at every office visit.

Ask your doctor to look at your feet at every visit. Take your shoes and socks off once you are in the exam room. Your health care provider should perform a complete foot exam at least annually – more often if you have foot problems. This exam should include checking the sense of feeling and pulses. Call your doctor right away if a cut, blister, or bruise on your foot does not begin to heal after a few days.

  1.  Keep the blood flowing to your feet.

Poor circulation means you won’t get enough blood flow to heal wounds, so it will take longer to get well. Some signs of poor circulation include weak pulses in your feet or legs, shiny and hairless skin, and discolored skin.

Put your feet up when you are sitting. Wiggle your toes for 5 minutes, 2 or 3 times a day. Move your ankles up and down and in and out to help blood flow in your feet and legs. Don’t cross your legs for long periods of time.

Don’t smoke. Smoking restricts blood flow in your feet.

  1. Try to hit your blood glucose targets

High blood glucose levels can lead to slow-healing foot wounds and slow the body’s ability to fight infection. High sugar in the blood acts like a food source for the bacteria in infections, making them become more powerful and spread more quickly!

  1. Get help for open wounds

Don’t risk your health! Get treatment for foot wounds as soon as possible. Visit your physician or a podiatrist, a doctor specializing in foot care, if you have an open cut, blister, or sore on your foot that isn’t healing. Do not try to treat yourself with over-the-counter antibiotic ointments.


If you take care of your feet every day, you can lower your chances of losing a toe, foot or leg. Begin taking care of your feet today!






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