Diabetes Etiquette for Family and Friends

November 17, 2016

Last week our blog was about dealing with “Food Police”. This week we are focusing on diabetes etiquette for people who DON’T have diabetes –  well-meaning family members and friends of those with diabetes!

DON’T offer unsolicited advice about eating or other aspects of diabetes. You may mean well, but giving advice about someone’s personal habits, especially when it is not requested, isn’t very nice.  Besides, many of the popularly held beliefs about diabetes (“you should just stop eating sugar”) are out of date or just plain wrong.

DO realize and appreciate that diabetes is hard work. Diabetes management is a full-time job that wasn’t applied for, didn’t want, and can’t quit. It involves thinking about what, when, and how much is eaten, while factoring in exercise, medication, stress, blood sugar monitoring, and so much more – each and every day.

DON’T tell horror stories about your grandmother or other people with diabetes you have heard about. Diabetes is scary enough and stories like these are not reassuring! Besides, we now know that with good management, odds are good you can live a long, healthy, and happy life with diabetes.

DO offer to join your friend/loved on in making healthy lifestyle changes. Not having to be alone with efforts to change, like starting an exercise program, is one of the most powerful ways that you can be helpful. After all, healthy lifestyle changes can benefit everyone!

DON’T look so horrified when you see someone check their blood sugars or give themselves an injection. It is not fun for them. Checking blood sugar and taking medications are things they must do to manage diabetes well. If they have to hide while they do so, it makes it harder!

DO ask how you might be helpful. If you want to be supportive, there may be lots of little things that would be appreciated. However, what is needed most may be very different than what you think is needed, so please ask first.

DON’T offer thoughtless reassurances. When you first learn someone has diabetes, you may want to reassure them by saying things like, “Hey, it could be worse; you could have cancer!” This won’t make anyone feel better. And the implicit message seems to be that diabetes is no big deal. However, diabetes (like cancer) IS a big deal.

DO be supportive of self-care efforts. Help the person with diabetes set up an environment for success by supporting healthy food choices. Honor their decision to decline a particular food, even when you really want them to try it. You are most helpful when you are not being a source of unnecessary temptation.

DON’T peek or comment on glucose numbers without asking first! These numbers are private unless shared! It is normal to have numbers that are sometimes too low or too high. Your unsolicited comments about these numbers can add to the disappointment, frustration and anger being felt!

DO offer your love and encouragement. Sometimes just knowing that someone cares can be very helpful and motivating.




Resource: Behavioral Diabetes Institute

Handling the “Food Police”

November 10, 2016

Everyone manages their diabetes differently these days, including choices about food. Unfortunately, many well-intentioned people have outdated or incorrect information about how a person with diabetes is “supposed” to eat.  Hearing comments such as “should you be eating that?” can make people with diabetes feel frustrated, angry, isolated, and less likely to make diabetes-friendly choices.  Here are some tips for successfully navigating the challenges of the “food police”:

  1. Know when to speak up: Decide when it’s worth the hassle of responding to others who have commented on your eating or any other aspect of your diabetes management. Some factors to consider: your relationship with the person, how likely he or she is to change, and whether you want to spend your holiday time explaining your diabetes care.
  2. Choose your response: While you may want to tell the food police to mind their own business, choose a response that can help educate and keep the peace. An appropriate response will differ based on the person. For example, you might choose to educate your coworker about how modern diabetes management allows for occasional splurges. But you may decide to change the subject when faced with comments from your grandmother (while reminding yourself that she cares about you but has outdated knowledge and is unlikely to change).
  3. Be ready: Putting some forethought into what you would like to say can help things to smoother. What do you want people to know and what would you like them to do differently? For example, you might say, “I appreciate your concern for my health. You may not know that no foods are off limits for people with diabetes. I can have sweets for a special treat. I have planned ahead for this party, so you don’t need to worry!”

Holiday gatherings can cause the food police to come out in full force. Know when you would like to speak up and have a response ready.


Resource: Diabetes Forecast, Nov. 2016




Oh Those Aching Legs

September 27, 2016

by:  Susan Klick, MSN, RN, CNL

You are tired, you want to go to sleep, but your legs aren’t cooperating. You have an irresistible urge to move your legs, maybe even your thighs or your arms.  Or maybe you are at the movies, and your legs feel “jumpy”.  Long trips in the car, or a long-distance flight give you a throbbing, pulling, or creeping feeling in your legs.  This is Restless Leg Syndrome (RLS) and it can make bedtime or long car trips a nightmare.

Many times, RLS is confused or misdiagnosed as Peripheral Neuropathy. Diabetic neuropathy in particular is a nerve disorder caused by poor blood sugar control in people with diabetes.  The most common type of peripheral neuropathy results in problems with the feet.  Symptoms include numbness, pain, or tingling in the feet or lower legs and may be associated with difficulty in walking and weakness in foot muscles.

How do you know what you are dealing with? The most important questions to ask yourself are:  1) when does the pain occur and 2) does movement make the pain go away or feel better.  If the symptoms occur when you are lying down and trying to relax, in the evening, and movement makes the pain better, then you are most likely dealing with RLS.  RLS is sometimes seen in patients with kidney disease, Parkinson’s disease, people with low iron, pregnancy, and those taking antidepressants or antipsychotic drugs.  However, if you are experiencing numbness, tingling, and pricking sensations, sensitivity to touch, muscle weakness, burning pain that is not eased by walking (movement may even make the pain worse), and symptoms which do not change during particular times of the day –  you may be dealing with Peripheral Neuropathy.  What can make a diagnosis difficult is that the two can occur together.

By definition, RLS is a neurological disorder with symptoms occurring when lying down or trying to relax (primarily at night), and relief is found in moving the legs. Peripheral Neuropathy describes damage to the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body.  It can be either inherited or acquired (as is the case with Diabetic neuropathy).

The key to managing peripheral neuropathy is to recognize the symptoms and work with your doctor to find the right treatment and approach that works for you.

  1. Keep your blood glucose levels in check. This can prevent or delay nerve damage or prevent further damage.
  2. Mild symptoms can be relieved with over the counter, nonsteroidal anti-inflammatory medications.
  3. Medications to treat epilepsy, such as gabapentin and pregabalin, may help control more serious symptoms.
  4. Some physicians may recommend a tricyclic antidepressant, such as amitriptyline or doxepin, in a modest dose, to alleviate pain. Studies show that newer antidepressants may ease discomfort

If you have a distinct “creepy crawly” sensation, consult your doctor. Treatment for RLS may include having your blood checked for levels of vitamin D and iron.  Correcting deficiencies of each helps some people control symptoms.  Reducing the use of caffeine, alcohol, and tobacco can also make a difference.  The treatment of choice are drugs known as dopaminergics, which increase the body’s dopamine and have shown to alleviate moderate to severe RLS.





Source: Diabetes Living Fall 2015; Clinical Advisor March 2015; NIH.Gov

August Diabetes Support Group Meeting

August 4, 2016

The TalkDiabetes Support Program

and the Diabetes Education Program at St. Anthony’s present:


Diabetes “Trivia”

Join us for an evening of fun while you test your knowledge and learn a little too!  We will have three “rounds” each with five questions.   Helpful hints about party snacking will be presented too.


6:30 p.m. Thursday, August 18, 2016

Hyland Education Great Room

10020 Kennerly Road

St. Louis, MO 63128

Meetings are FREE to the public.

All are welcome!


To register, call 314-ANTHONY (268-4669)

or visit stanthonysmedcenter.com/diabetes.

The “No White Food Diet”

June 21, 2016

brought to you by:  Alison Brinker, RD, LD

Has anyone ever told you to avoid white food? Have you ever thought about all the good foods that are white?  I know as a dietitian I tell people to eat foods that are every color of the rainbow to get the best variety and nutrient content.  However, avoiding everything white is too general of a statement.  I know most of us can benefit from choosing brown rice instead of white rice, or whole wheat bread over white bread.  Salt and cream are white too, other examples of foods that are best eaten in smaller amounts.  But, as you will see from the list below, following the guideline of “no white food” will cause you to miss out on a lot of nutritious and delicious foods.

Bananas:  A small banana is 15 grams of carbohydrate and about 60 calories.  It is a good source of fiber, potassium and vitamin B6.  Potassium helps control blood pressure and is important for muscle movement.  Vitamin B6 is important for the nervous system to function properly.

Cauliflower:  One cup of raw cauliflower has only 25 calories and 5 grams of carbohydrate.  It is also a good source of vitamin C which is important for tissue and bone growth and repair.

Cheese:  One ounce of part-skim mozzarella cheese (such as a cheese stick) is only 70 calories.  It provides calcium for strong bones and is a great low fat protein source with very little carbohydrate.

Chicken:  Three ounces of white meat chicken (about the size of a deck of playing cards) without the skin has only about 135 calories.  It provides 21 grams of lean protein and no carbohydrate.  It is also a good source of niacin, vitamin B6, phosphorous and selenium.  Niacin is important for a healthy nervous system and healthy skin.  Phosphorus is needed for healthy bones and selenium is important for your metabolism.

Egg Whites:  Two egg whites have about 45 calories and the same amount of protein as one ounce of meat.  Egg whites have no fat, cholesterol or carbohydrate.

Fish:  A three ounce portion of cod has only 90 calories and 21 grams of protein.  It is also a good source of vitamin B6, B12, phosphorous, potassium and selenium.  Vitamin B12 helps to keep nerve cells and red blood cells healthy.

Milk:  One cup of skim milk has only 90 calories and 12 grams of carbohydrate.  It is a good source of protein, calcium for healthy bones, phosphorous, vitamin B12, and riboflavin.  Riboflavin is important in keeping red blood cells healthy.

Mushrooms:  One cup of sliced mushrooms has only 25 calories and 5 grams of carbohydrate.  Mushrooms also provide niacin.

Onions:  One cup of chopped onion is only 64 calories and 5 grams of carbohydrate.  Onions are a good source of vitamin C.

Turnips:  These are low in calories too just like all the non-starchy vegetables.  Turnips also provide a good source of vitamin C.

White Beans:  A half cup of beans is about 150 calories, 7 grams of protein and 6 grams of fiber.  Portion size is important because a half cup also has 15 grams of carbohydrate.  But when you consider that beans are also a source of folate, thiamin, and iron necessary for healthy red blood cells, calcium, magnesium, and phosphorus for healthy bones, zinc and copper for a healthy immune system and manganese which is important for metabolism of the foods we eat beans are a great high carb food choice.

White Potatoes:  Like beans, white potatoes have higher carbohydrate content than non-starchy vegetables.  One half cup of mashed or roasted potatoes has 15 grams of carbohydrate and, but white potatoes provide fiber, vitamin C, thiamin, niacin, vitamin B6, folate, iron and potassium.

Yogurt:  One cup of plain nonfat yogurt is 137 calories, 14 grams of protein and 17 grams of carbohydrate.  It provides calcium, potassium, vitamin B12 and riboflavin.  It is a great base for a fruit smoothie and depending on the fruit you decide to mix it with, it won’t be white anymore.

I hope this list will make you think twice about white food choices. All of us should be working towards eating less processed and refined foods, but to base our choices on color alone is not the best strategy.  Enjoy these white foods


Source: Nutrition411.com

Hyperosmolar Hyperglycemic State – Watch Out

May 24, 2016

by Susan Klick, MSN, RN, CNL Diabetes Educator

Hyperosmolar Hyperglycemic State (HHS) is a serious condition caused by extremely high blood sugar levels. The condition most commonly occurs in people with type 2 diabetes, but can occur in those with type 1 as well.   It’s often triggered by illness or infection. As a result, your body tries to rid itself of the excess blood sugar by passing it into your urine. Left untreated, this condition can lead to life-threatening dehydration. Prompt medical care is essential. Take a few minutes to learn about this very serious, life-threatening complication.

What is it?

HHS is the most serious acute hyperglycemic emergency associated with diabetes that involves extremely high blood sugar (glucose) levels and severe dehydration. The buildup of ketones in the body (ketoacidosis) may occur, however it is unusual and often mild.

Why does it happen?

HHS can occur for several reasons:

  • Infection (such as a urinary tract infection or pneumonia)
  • Illnesses such as heart attacks, congestive heart failure, strokes, kidney disease or recent surgery
  • Certain medications such as corticosteroids (prednisone), diuretics (hydrochlorothiazide, water pills); anti-seizure medication (Dilantin) and some anti-psychotics; any medication that can raise blood sugar levels
  • Missed or not enough insulin
  • Undiagnosed diabetes, or not monitoring your blood sugar


HHS can take days or weeks to develop. Possible signs and symptoms include:

  • Blood sugar level of 600 or higher
  • Dry mouth
  • Increased urination (particularly at the beginning)
  • Warm, dry skin
  • Fever
  • Weakness
  • Drowsiness, confusion
  • Hallucinations
  • Vision loss
  • Convulsions
  • Coma


This condition is a medical emergency. Go to the emergency room or call 911 if you develop symptoms of HHS. The best treatment plan is prevention by recognizing the early signs of dehydration and infection and monitoring blood sugars regularly.

The goal of treatment is to correct the dehydration, which will improve blood pressure, urine output, and circulation. Fluids and potassium will be given and high glucose levels are treated with intravenous insulin. Without proper treatment HHS can lead to shock, blood clot formation, brain swelling, increased blood acid levels and even death.



Sources: Mayo clinic.org. and the American Diabetes Association

A Wee Bit of Wisdom About Alcohol and your Blood Sugar

March 10, 2016

By Susan Klick, MSN, RN, CNL

 Happy St. Patrick’s Day! Have you ever really thought about why we celebrate St. Patrick’s Day? Or is it just a holiday when you decorate your front door with something green, cook corned beef and cabbage, paint a street green and maybe indulge in an Irish coffee or green beer? The truth is, it is a day to celebrate not just the Irish culture, but to celebrate the life of St. Patrick himself, the patron Saint of Ireland. But did you know that St. Patrick is also the patron saint of engineers???? That is because one of St. Patrick’s achievements was teaching the Irish to build arches of lime mortar instead of dry masonry. These beginnings of ceramic work developed into organized crafts, and that is how St. Patrick became a patron saint of engineers.

Should you decide to kick up your heels a wee bit on St. Patty’s day, here are some guidelines on Diabetes and Alcohol: If you have questions about whether alcohol is safe for you, talk to your doctor.

Alcohol and your body

Alcohol goes from your stomach straight into your blood. The alcohol in your blood stream is highest 30 to 90 minutes after drinking. Your liver slowly breaks down alcohol. If you weigh 150 pounds, it takes about 2 hours to break down one drink. Two drinks take twice as long, or 4 hours. If you drink faster than your body breaks it down, the alcohol stays in your blood and affects other body parts. When alcohol affects your brain, you feel or act drunk. Some signs of too much alcohol (slurred speech, confusion) are similar to low blood glucose. If you drink a lot of alcohol (3 or more drinks a day), you may develop liver disease and other health problems.

Alcohol and blood glucose

Alcohol can make blood glucose too high or too low. You need to know when and how to drink to keep your diabetes under control. When no alcohol is in the blood, your liver keeps blood glucose from going too low by releasing glucose into your blood. However, if the liver is busy breaking down alcohol, it cannot release glucose into your blood!

If you take insulin or diabetes pills, your blood glucose may go too low when you drink alcohol because the medicine causes your blood glucose to go low and the liver is not releasing any glucose.

The sugars in many drinks can cause blood glucose to go too high and alcohol can also cause high blood triglycerides (fats).

Alcohol and Diabetes

Many people with diabetes can have a moderate amount of alcohol if they want. Still, there are some people who should avoid alcohol. A moderate amount of alcohol is no more than:

1 drink for women per day                           2 drinks for men per day

One drink is equal to:

  • 1 ½ ounces of liquor
  • 12 ounces of beer
  • 5 ounces of wine

When to avoid drinking

  • You are pregnant
  • If you are under the age of 21
  • If your doctor has told you not to
  • If your diabetes is not in good control, wait to drink until it is in better control
  • If you have complications such as severe neuropathy
  • If you take medicines that say avoid alcohol on the medicine bottle
  • If you have high blood triglycerides
  • If you have eye disease
  • If you have had problems with alcohol abuse
  • After vigorous exercise

Be safe if you drink alcohol:

  • It is best to drink alcohol only when diabetes is under control.
  • Always eat if you drink alcohol. Munch on pretzels, popcorn, or crackers if you are drinking apart from a meal.
  • Check your blood glucose more often the day you drink and the next day to see how alcohol affects you.
  • Tell people with you that you have diabetes and teach them about signs of low blood glucose.
  • Check the size of your glasses. Most wine glasses hold much more than 5 ounces of wine. Large beer glasses are more than 12 ounces.
  • Sip slowly to make the drink last.
  • Try a wine spritzer (wine and diet club soda) or mix liquor with plenty of water or diet soda to make it last.
  • Limit yourself to 1 or 2 drinks a day
  • Wear medical identification. If you have a low blood glucose reaction, you want others to know that you have diabetes and are not drunk.
  • Alcohol can change your judgment. Be careful with medicine, food, and testing.
  • Do not drive after drinking alcohol.

Lower calorie options

  • Light beer instead of regular
  • Dry red or white wine
  • Drinks made with sugar free mixers like diet soda, light juice, or diet tonic water.
  • Skinny mixes 

Avoid high calorie drinks

  • Liqueurs – like Irish Crème
  • High calorie mixed drinks like margaritas, Pina coladas, Mudslides
  • Drinks mixed with cream
  • Full sugar soda and other sugary mixes



Sources: American Diabetes Association; Academy of Nutrition & Dietetics; Diabetes.org

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