Liver…..It’s Not Just for Dinner

May 19, 2017

By Susan Klick, MSN, RN, CNL Diabetes Educator

The Liver is one of the most important organs in our body. It weighs about three pounds in an average adult, making it the largest internal organ in the human body.  It has a central role in a number of processes, one of which is to help control glucose (sugar) balance in the blood.   Today we will take a look at the liver’s role in controlling blood sugar.

When blood sugar levels are high, the liver will absorb some of the sugar and pack it into bundles called glycogen. These glycogen bundles fill up liver cells, so the liver is like a warehouse for excess sugar.  The liver can then release the stored sugar (glycogen) when the body tells it to.   Here are some examples:

The liver responds to stress by releasing stored glycogen, (the stored form of sugar). In this situation, the release of stored sugar is part of the body’s “fight or flight” response, which prepares the body with energy to respond quickly to a threat.

When we exercise, our muscles take up sugar, and the liver responds by releasing glycogen to replace the sugar that is being taken up and used by our muscles.

Normally the liver slows down its release of sugar into the blood if blood sugar is high. But in people with Type 2 diabetes, the pancreas may be producing too much of a hormone called glucagon.  Glucagon’s job is to tell the liver to release sugar into the blood.  If too much glucagon is being produced, then the liver is releasing too much sugar, keeping blood sugar levels high after meals and overnight.

Insulin is a hormone made by the pancreas. Insulin’s job is to move sugar from the blood into the body’s cells. When you eat, a hormone in your gut tells your pancreas to start producing insulin.  When you don’t eat (i.e. skips meals) there is little insulin being produced and therefore the liver will start releasing its’ stored glucose!  The liver isn’t able to detect blood glucose levels; it only knows what insulin tells it.  If there is a shortage of insulin, the liver assumes the body needs more sugar (even if blood sugar levels are already high).  That is why some people with Type 2 diabetes will have high blood glucose levels even if they haven’t eaten, like first thing in the morning!

People with diabetes have reason to focus on liver health. Overweight people, particularly those who carry their weight around the middle, have the highest risk for liver problems.  Losing weight, eating well and exercising are recommended for helping you to control blood sugars, and what you do to help your blood sugars is good for your liver too.



Resource: The Diabetes Educator and Diabetes Forecast

Heat and Humidity – What about those Test Strips???

July 5, 2016

By Susan Klick, MSN, RN, CNL

Summer Storage of Test Strips: Heat, humidity, temperature and exposure to air can all affect strips. Store test strips at a temperature less than 86 degrees F.  DO NOT FREEZE and DO NOT expose test strips to direct sunlight.

Other Good Test Strips Tips:

Loose diabetes test strips. If you put individual diabetes test strips into your purse or wallet this can affect the accuracy (unless they are foil-wrapped from the manufacturer). Also, try not to move the few remaining strips of one vial into the new vial you are opening if the code numbers don’t match. And if you have one vial of diabetes test strips at home and one vial at work but just use the one meter – make sure the vials have the same coding. WAIT!!! Ahhh. . . and one more thing. Even if the strips have the same code, they may have different expiration dates! After transferring a few strips a couple of times, you could end up with some pretty outdated strips floating around in a vial!

Age of blood sugar monitor: Old blood sugar monitors may be inaccurate simply because of age. But old diabetic meters also tend to need cleaning or the dirt/dried blood could affect the accuracy of the reading. Be sure to follow cleaning instructions from the manual to ensure accurate results. If you have a diabetic meter older than 5 years please consider calling the meter company (often there is a 1-800 # on the back of the meter) and asking for a free updated model. They should want to keep you as a customer buying their strips.

Expired diabetes test strips? Check the expiration date when the pharmacy gives you the diabetes test strips. If you don’t feel you’ll be using them before that date, ask for another batch with a later date

Underfilled? Most newer meters have under-fill detection of some sort, and some beep after a few seconds even if the chamber isn’t full.   You may get a reading lower than anticipated.   Some meters tend to “err” and waste strips if you don’t hold your finger in place long enough. It’s a good practice to hold your finger to the strip for 1-2 seconds after the beep to avoid wasting diabetes test strips because of under fill.

Date vial opened? For some diabetes test strips, once you open the vial you should use the content of the vial within 3 months no matter what the expiration date (because of repeated exposure to air). Some products have a lid with a preservative in it so they are supposedly good up until the actual expiration date on the bottle. However, other vials of strips are good for a limited time once the lid is opened (regardless of the date). Check the information in your diabetes test strip box to be sure.

Storage of meter: Don’t leave blood sugar monitors in the car on hot or freezing days. They are just tiny little devices and you know how temperamental electronics are.

Have a safe and healthy summer!




Source: American Diabetes Association


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 and the American Diabetes Association

Breakfast Tips

October 5, 2015

By Susan Klick, MSN, RN, CNL

Last time we talked about the important reasons to EAT breakfast.  So here are some tips on what makes the perfect breakfast:

A perfect breakfast has three to four components:

  • One serving of a whole grain carbohydrate
  • One serving of a dairy or high-calcium food
  • One serving of fruit
  • One serving of protein (if desired)

Choose these toppings for your whole wheat bagel, English muffin or toast:

  • Two tablespoons nonfat cottage cheese sprinkled with flaxseed
  • One slice low-fat cheese melted over a slices of mango
  • Two tablespoons of peanut butter or nut butter with a sliced banana
  • One slice of baked ham and one slice of tomato
  • One slice of low-fat mozzarella cheese melted over a slice of tomato

Quick Breakfast Preps:

  • Make brown rice, barley or quinoa. Cook the grain the night before. In the morning put it in a bowl with 2 tablespoons of raisins, a cut up apple and a sprinkle of cinnamon and artificial sweetener.
  • Make a fruit smoothie. Put ½ cup of fruit (strawberries, banana, kiwi, berries), ½ cup unsweetened orange juice and 1 cup of plain yogurt in the blender. Add a scoop of protein powder and a cup of crushed ice and you’ve got a healthy, on-the-go breakfast.
  • Sprinkle a whole wheat burrito with 2 ounces of grated, low fat cheddar cheese and broil until the cheese is melted. While it is cooking eat a piece of fruit.
  • Breakfast burrito—scrambled egg, egg substitute or tofu, chopped tomatoes, onion, peppers and a little grated reduced fat cheese, wrapped in a whole wheat tortilla.
  • Trail Mix. Mix ½ cup Wheat Chex or Mini Wheats, dried fruit, mixed nuts in a snack size baggie and eat on the way to work with a thermos cup of skim or 1% milk.
  • Have lunch for breakfast. Have whole wheat toast topped with 2 tablespoons tuna made with low fat mayo, or canned or smoked salmon. Have a bowl of soup too.

The possibilities are endless!  Choose one item from each column below for a balanced breakfast:

Whole Grain Carb Low Fat Dairy Fruit Protein
½ cup cooked oatmeal 1 cup skim milk 1 piece of fresh fruit 2 egg whites or one whole egg (limit to 3 yolks per week)
¾ cup whole grain cereal 1 cup 1% milk ½ cup canned fruit packed in its own juice 1 tablespoon peanut butter
½ whole wheat English Muffin, bagel or pita 6oz. low fat yogurt ¾ cup berries 1 tablespoon almond, cashew or soy nut butter
1 slice whole wheat bread or a whole grain toaster waffle ¼ cup dried fruit ¼ cup low fat or fat free cottage cheese or 1 oz low fat cheese stick
Granola bar or muffin (less than 200 calories, less than 5g fat, less than 2 gm saturated fat ½ cup 100% fruit juice 1 oz low fat turkey sausage or bacon
1 whole grain tortilla 1 oz ham or turkey

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!


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

Higher Prevalence of Diabetes Among Our Veterans

May 22, 2013


Within the past twenty years, the prevalence of diabetes among U.S. adults has grown by 45 percent, with the greatest increase seen among seniors aged 65 and over, according to the U.S. Centers for Disease Control and Prevention (CDC). Currently diabetes affects one in ten U.S. adults, but government health officials say that with the aging population, the risk of this condition increasing is very high. Approximately 18.8 million Americans are living with diabetes today, and another seven million people are unaware that they have the disease. A new study by the CDC report predicts that the number of new cases of diabetes found in individuals will increase from 8 per 1,000 people to 15 per 1,000 people in the next forty years.

Why is diabetes in the American population increasing so rapidly? There are several reasons for this, but a primary cause is the overwhelming number of obese individuals in the United States. Approximately 70 percent of American adults are overweight or obese.


According to the International Diabetes Foundation (IDF), diabetes and obesity are the biggest public health challenges of the 21st century. Two-thirds of U.S. adults are overweight or obese. About 80 to 90 percent of patients with diabetes are also classified as obese. Although obesity is not the only factor in the development of diabetes, the two conditions are definitely linked to one another. Being obese increases the risk for diabetes and worsening control of blood sugar levels, blood pressure and cholesterol, which in turn makes cardiovascular disease more likely. Not only does being overweight interrupt your body’s ability to maintain proper glucose levels, it can also cause your body to become resistant to insulin. In this case the pancreas will continue to put out high levels of insulin until it eventually can no longer meet the body’s requirements. It is then that insulin levels begin to decrease and blood sugar levels increase, ultimately leading to diabetes.

New studies are finding that almost 25 percent of veteran patients have diabetes. Memorial Day, this coming Monday, May 27, is a day of remembering the men and women who served in the United States Armed Forces. Many people visit cemeteries and memorials on Memorial Day, but it is also seen as the traditional start of summer. With that being said, it is a perfect time to get out there, be active and start a new kind of work out plan for the summer months! Regular exercise helps control the amount of sugar in the blood, improve insulin sensitivity and increases levels of HDL (good) cholesterol. It also burns excess calories and fat to help you achieve optimal weight as well as giving you more energy during the day to do everyday tasks.

Summer is also the season of fresh fruits and vegetables. Pineapple, mango, watermelon, strawberries and blueberries are just a few of the numerous fruits that will be readily available to incorporate into your everyday diet, along with fresh vegetables such as broccoli, tomatoes, lettuce varieties and many more.

Whether you are a veteran or a civilian, you can reduce your risk of diabetes by maintaining a healthy weight through incorporating a variety of healthy foods (including fruits and vegetables) into your daily meal plan and increasing your physical activity. We wish you all a happy and safe Memorial Day and hope you get out there and enjoy the first day of summer!

Written by: Regina Zorich, Southeast Missouri State University


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