Take Control: Testing Your Blood Sugar

July 1, 2015

By Susan Klick, MSN, RN, CNLDiabetes

Last week we listed the Top Ten Reasons why people avoid testing their blood sugar. You may have identified with one or more of those reasons, or maybe you discovered a few new reasons why not to test your sugar.

BUT WAIT!!!! While never decide that regular monitoring is great fun, it does have its benefits. Research results are overwhelming:   Checking your blood glucose regularly can help you manage your diabetes more effectively.   Taking control will help you to feel physically better. It gives you a wider range of options regarding food, medication, and activity. It leads to a greater sense of freedom. Take steps get that meter out of the drawer and start testing on a regular basis:

  1. Have a serious talk with your meter. Readings are not good or bad. They are high or low. When you have a reading that is out of range focus on problem-solving.
  2. Be reasonable about blood glucose expectations. Ask your healthcare team what your range is.
  3. Learn to make good use of blood glucose information. Know when to change your food intake or your activity level. If it isn’t working, it may be time for a new plan!
  4. Make your environment work for you. Sometimes the biggest barriers to regular monitoring are the little things. Be creative and think about ways to modify your life to make regular monitoring easier.
  5. Get yourself the right equipment. If your finger pricks are painful, you may need a new or different lancing device.
  6. Become a smart shopper. To lower your out-of-pocket expenses, shop around to find the lowest prices on supplies.
  7. Make sure everyone knows that you are in charge. The diabetes police are well-intentioned; they are just trying to be helpful. Tell them about your diabetes care plan, let them know you appreciate their concern, and offer suggestions as to what sort of support you would prefer.
  8. Make peace with your blood glucose meter. Identify the reasons that keep you from monitoring regularly. The good news is that these barriers can be successfully overcome!


Diabetes Self Management


Blood Glucose Monitoring has a Top Ten List

June 22, 2015

by Susan Klick, MSN, RN, CNL

This is Part One of a two part blog on monitoring blood glucose.  This week we will look at the Top Ten Reasons something so easy….becomes such a big deal. In Part Two, we will look at overcoming these common barriers.   So here we go… The Top Ten Reasons to Avoid Testing Your Blood Glucose:

Reason #1: Your meter makes you feel bad about yourself – Do you judge yourself based on your results? Do you think of blood glucose monitoring as a “test”, and the resulting number a grade? You begin to think of high numbers as a failing grade.   Naturally, the meter ends up in a drawer.

Reason #2: Monitoring seems pointless – Do you ever think to yourself, “why bother testing, how is testing going to change the fact that I have diabetes?” It is frustrating to work hard to manage your blood glucose, and continue to get results that don’t make any sense. And so the meter ends up in a drawer.

Reason #3: Monitoring reminds you that you have diabetes – Who needs to be reminded that they have diabetes?   Testing can be seen as an irritating, annoying reminder that you have a disease that isn’t going away, that you will have to deal with the rest of your life. Back in the drawer with the meter.

Reason #4: Your meter seems to control your life – If you constantly feel you are being pushed around by your meter, and view your meter as a bully; naturally you are going to stop monitoring.   High readings might be telling you not to eat so much, low readings might be telling you to wait before you drive or exercise. The monitor starts to control your life and limit your freedom. Who needs a puny machine telling you what to do – so you put it in a drawer upside down.

Reason #5: Monitoring gives friends and family an opportunity to bother you – “What was your sugar?” “You wouldn’t be that high if you hadn’t eaten that pasta for lunch” “My friend at work who has diabetes never eats….”   Suddenly everyone is an authority on diabetes, and this time the meter goes in the drawer and the drawer is slammed shut.

Reason #6: Your healthcare team is indifferent to the results – You spend hours making a beautiful spreadsheet, with circles and arrows, and a paragraph describing what you ate and how you felt, and what your blood glucose test results were. It’s in color. You make multiple copies. And your doctor gives it a superficial glance and says “let’s just keep observing your sugars over the next few months and see what happens”. You feel like your time was wasted. “Why bother” you say to yourself? Now the glucometer is in the back of the drawer and the pretty spreadsheet is deleted.

Reason #7: It hurts for goodness sakes! Sticking yourself should be relatively painless, but let’s be honest – you are sticking yourself and sometimes you may hit a tender spot. Your fingers get irritated, sore, and sometimes bruised. So you decide to “take a break” from monitoring, and the meter is covered with papers and other stuff in the back of the drawer.

Reason #8: Monitoring can be inconvenient – You are going out to dinner….don’t forget your meter. You are going on a trip….don’t forget your meter. You are going hiking, biking, swimming, fishing…..don’t forget your meter. It takes time, and it interrupts what you are doing. So the meter gets left behind (in a drawer covered with stuff) while you go out and about.

Reason #9 Monitoring can be expensive – If you don’t have good insurance, or if you are uninsured, you know that test strips can be costly, especially if you are testing several times a day. Once again, the meter is tossed aside.

Reason #10 Life is too busy and demanding to take the time for regular monitoring – At first, we start out with good intentions. Testing regularly isn’t a big deal. Until you are running late for work, or having to get dinner on the table before running the kids to practices and getting the grocery shopping done, and don’t forget to get your 30 minutes of exercise in. Testing gets pushed to the bottom of the list and doesn’t get done as frequently as it should, or doesn’t get done at all because life gets in the way.   Before you know it, the meter is completely forgotten in the back of the drawer, covered with stuff. You don’t even remember what drawer it is in!


Stay Calm

Tune in next time for Part Two….Overcoming Avoiding Testing Your Blood Sugar!



Diabetes Self Management

Summer Safety Tip: Diabetes and Dehydration

June 8, 2015

By Susan Klick, MSN, RN, CNL

We may not want to admit it, but we all know that those hot, humid St. Louis summer days are right around the corner! Summer is a great time to be with friends and family for outside entertainment, but don’t let the heat and humidity cause you to become dehydrated. Diabetics are at a higher risk for becoming dehydrated, so know what it is, what causes it, how to avoid it, and how to treat it.

Man drinking bottle of water after workout uid 1520095


What is Dehydration: When the amount of liquid in your blood is low in relation to the amount of nutrients and waste products in your blood, the body is dehydrated.

When Does Dehydration Occur: Dehydration occurs when your body does not have enough fluid to carry out its normal functions. Dehydration can be mild, or it can be severe and life threatening, resulting in coma and death. In addition to heat and humidity, low fluid intake, illness, exercise, excessive sweating, consuming alcoholic beverages and too much sun exposure can all cause dehydration.

Blood glucose levels increase causing fatigue, headache, blurred vision, increased thirst and an increased need to urinate. Since diabetes is characterized by increased thirst and urination anyway, if you are diabetic, dehydration can rapidly become a serious problem. Severe dehydration adds irritability, dry mouth, sunken eyes, low blood pressure, rapid heartbeat and fever. Delirium, unconsciousness and death can follow.

Avoiding Dehydration: Exercising in high heat and humid conditions requires a greater fluid intake, as does spending the day at the beach – but avoid beverages containing high sugar or alcohol. When the humidity is high, your sweat cannot evaporate as well. Wear clothing that allows sweat to evaporate easily. Pay attention to your body’s thirst signals.   When you are outside in the heat, test your blood glucose more frequently. Have a plan to prevent or minimize dehydration caused by fever, vomiting or diarrhea.

Taking Action: If you suspect you are mildly dehydrated, check your blood sugar. If it is high, take immediate steps to lower it. Drink water or a beverage with electrolytes and follow your doctor’s instructions about taking insulin or other medications. Do not drink coffee, tea or other liquids which act as diuretics. Focus on rehydrating (providing enough fluid for your body to function properly). While keeping your glucose levels under control is important, you cannot maintain normal glucose levels without reversing the dehydration.

If you have any symptoms of severe dehydration–if you cannot keep fluids down, are disoriented, develop severe diarrhea or vomiting, have blue lips, cold hands or feet, or if you are extremely thirsty and do not urinate for seven to eight hours–seek medical attention immediately. Severe dehydration constitutes a life-threatening emergency.

Remember: Both hot weather and high blood sugar can cause dehydration. This makes it doubly important to drink plenty of fluid. From your friends at the St. Anthony’s Outpatient Diabetes and Nutrition office – have a safe and fun-filled summer.



Mayo Clinic

5 Tips for Travel with Diabetes

May 25, 2015

By: Kristen Rider, BSN, RN, CDE

travel diabetes

As the warmer months approach, many people have trips and vacations planned. Don’t let diabetes ruin your travel plans. Plan ahead and be prepared for any “bumps in the road”.

First, always make a checklist for packing. Whether you will be gone for a day or a month, you need to be sure and pack the necessities.   The excitement of getting ready for a trip can sometimes be distracting, causing you to forget to pack certain things. The focus may be on remembering things like the camera, the hiking boots, the bathing suit, etc. Items that you use every day, like your glucometer or medications may be overlooked.

Second, be prepared for anything! Things do not always go according to plan. Have a back-up plan in case of delayed arrival times, altered meal times and medication times. Always carry snacks, whether traveling by car, plane or boat! Make sure your snacks include fast-acting carbohydrates in case of hypoglycemia. Bring a written prescription along to use for a back-up should you need to fill a prescription while you are out of town. Your glucometer, medications and snacks should be kept nearby when traveling (e.g. in your carry on, not in your checked luggage). Wear or carry a medical ID.

Third, take care of your feet. Wear comfortable shoes that fit well, especially if you will be doing a lot of walking. Don’t forget socks! Do not go barefoot. Wear shoes on the beach or on hot pavement.   If you have a long drive or flight, keep your feet moving to promote good circulation. Point and flex your toes and get up and move around when you can. Inspect your feet frequently for problem areas or abnormalities such as blisters, sores, redness, discoloration.

Fourth, test your blood glucose often. When travelling, blood glucose levels may vary more than they normally do. You may have to test more often than you would at home. Various factors such as altitude, time change, and temperature may affect blood glucose levels.   Try to keep blood glucose levels on target. Bring extra testing supplies if possible.

Finally, enjoy yourself! If you are planning on a relaxing vacation, don’t let diabetes get in the way. Try new foods, just keep in mind moderation. Keep your personal targets in mind at meals, but remember nobody is perfect all the time. Increase your physical activity where possible…take the stairs instead of the elevator. Walk the golf course instead of riding in a golf cart. This can help keep blood glucose on target. With proper planning, people with diabetes can travel safely and confidently.


Granola – Quick and Healthy or Just Quick?

May 12, 2015

Granola Bars

by Alison Brinker, RD, LD

Granola bars can be tricky. Some are good and others not so good. The bars can be a very convenient, on-the-go snack, but following a few guidelines will ensure that it isn’t just convenient, but healthy too.

Look for the first ingredient to be whole grain oats or some other whole grain (wheat, barley, brown rice, quinoa). This will indicate the bar is a good source of fiber and other nutrients. When a product is made with the whole grain it contains more vitamins, minerals, and antioxidants too.

Also watch for too much sugar. When sugar is listed as one of the first few ingredients the bar will be higher in calories and may be lower in nutrients.

Limit the bars with coatings. You are pretty much guaranteed a higher calorie content if the bar is coated with chocolate or yogurt. A bar with an icing drizzle won’t be quite as high in calories, but a bar with no drizzle is best.

Chocolate chunks are a tempting ingredient, but consider bars that are flavored with nutrient-rich dried fruit, nuts and seeds as an alternative to chocolate.

Some numbers to look for per serving:

Total carbohydrate: 15-20 grams, less than 10 grams of sugar

Fiber: 3 grams or more

Protein: 3 grams or more

Total fat: 3 grams or less—this may be a little higher if the bar is made with nuts and seeds which are a healthy source of fat so it will still be a good choice.

Saturated fat: 2 grams or less

Avoid any bars with hydrogenated oil or palm oil listed in the ingredient list

Enjoy your quick AND healthy snack!


Diabetes and Dental Health – A Two Way Street

April 27, 2015

by:  Susan Klick, MSN, RN, CNL

Did you know that the risk of oral health problems for diabetics can be up to three times that of patients without diabetes

Having diabetes increases the rate at which the condition progresses. But the problems run both ways – poor oral health increases the risk of poor blood glucose control and the development of diabetes complications. Oral health diseases include:

  • Periodontal disease (gum disease).
  • Xerostomia (dry mouth).Tooth-1024x987
  • Tooth Loss.
  • Dental caries (cavities) and abscesses.
  • Oral candidiasis (thrush).
  • Oral lichen planus (an inflammatory condition causing painful lesions)
  •  Burning mouth syndrome.

Warning signs of periodontal disease may include: bad breath, or a bad taste in your mouth that won’t go away; red or swollen gums; tender or bleeding gums; painful chewing; loose or sensitive teeth; gums that have pulled away from the teeth; any change in the way teeth fit together when biting down or any change in the fit of partial dentures.

Tobacco use promotes periodontal disease and delays healing. Poor nutrition, such as diets rich in carbohydrates and with high sugar content has a negative effect on oral health. Other risk factors include poor general hygiene in general, stress, heredity, crooked teeth, an immune deficiency, defective fillings, medications that cause dry mouth, ill-fitting bridges, hormonal changes, and bulimia.

Good blood glucose control is key to controlling and preventing mouth problems. People with poor blood glucose control experience gum disease more often and more severely than people whose diabetes is well controlled. Daily brushing and flossing, regular dental checkups every six months and good blood glucose control are the best defense against the oral complications of diabetes.

Keep your mouth and teeth healthy and keep smiling!




Today’s Dietitian March 2015


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




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