Advice for patients living with Diabetes

1. Your small blood vessels are at risk if your sugar levels are not at target!

High sugar levels affecting the small vessels include damage to the retinal vessels, the small vessels of the kidney and the distal vessels of the nerves.

Uncontrolled diabetes, whatever type it is, may results in diabetic retinopathy and blindness, kidney disease leading to dialysis, and nerve injury which predisposes to amputations.

For this reason, I advise you of the following:

  1. Visit your endocrinologist once or twice a year, more so if your sugar levels are not at target (too high or too low)
  2. Have a yearly eye checkup at the ophthalmologist, including a pupil dilatation and retinal exam
  3. Have a yearly urine microalbuminuria test
  4. Have a yearly foot exam, done during your visit to the endocrinologist.

Tip: Don’t ignore your diabetes. If you treat it right, it will treat your right!

2. Your medium and large blood vessels are at risk if your sugar levels are not at target!

High sugar levels affecting the medium and vessels include damage to the coronaries, to the carotids, the aorta and the vessels of the limbs.

Uncontrolled diabetes, whatever type it is, may result in heart attacks, emboli to the brain, and emboli to the lower limbs.

What are the tests required to prevent these complications?

At the diagnosis of type 2 diabetes, it is preferable to check for the presence of medium to large vessel complications, since they could be present without symptoms. This includes:

  1. An electrocardiogram
  2. A cardiac ultrasound
  3. A stress test if needed
  4. An ultrasound exam of the vessels of the neck and lower limbs.

A repeating schedule is decided with the physician according to the findings.

Tip: Don’t ignore your diabetes. If you treat it right, it will treat your right!

3. Do not ignore hypoglycemia!

It is the result of when the sugar level drops, characterized by 3 elements:

  1. Symptoms of hypoglycemia
  2. Sugar level < 55mg/dL
  3. Resolution of the symptoms after the sugar level is increased.

It is called Whipple’s Triad, and can occur at different sugar levels, depending on the patient.

For most patients, a drop in sugar causes symptoms, including:

  1. Palpitations
  2. Sweating
  3. Hunger
  4. Shaking
  5. Inability to concentrate
  6. Anxiety
  7. Nausea.

Hypoglycemia is not dangerous by itself. It is important to remain calm and seated when symptoms happen, measure sugar levels in the finger, and resolve the issue with a controlled amount of sugar. Patients should keep checking their sugar levels every 15 minutes until resolution.

Tip: patients with diabetes are at risk of hypoglycemia, especially if taking specific kinds of diabetes medication. Contact your physician in case you get it!

4. What do to in case of hypoglycemia? 

Hypoglycemia is not dangerous by itself. It is important to remain calm and seated when symptoms happen, and follow the 15:15 rule: consume 15 g of sugar and wait for 15 min.

15 g of sugar are equivalent to:

  1. 3 small cubes of sugar
  2. Half a glass of juice
  3. A small can of regular soda
  4. 6 or 7 regular hard candy.

Avoid chocolate, fruits, bread and other sources of sugar as they need more time for absorption.

If the sugar level does not rise within 15 minutes, consume another 15 g of sugar. Keep monitoring and repeating every 15 minutes until resolution, and don’t forget to ask yourself what could be the cause:

  1. Did you take your medication and forgot or took a longer time to eat?
  2. Did you omit carbohydrates at the meal?
  3. Did you take an extra dose of medication?
  4. Did you engage in strenuous activity?
  5. In case you are on insulin, have you overestimated your meal?

Tip: Don’t forget the 15:15 rule, and inform your doctor of your hypoglycemia. She/he may adjust the medication dose, or even remove it.

5. How to care for your feet?

Diabetes is associated with small blood vessel disease, affecting the retina, the kidney, and the small nerves. For this reason, diabetes may lead to foot disease, even reaching amputation, if we are not very careful.

Here are some tips to prevent diabetic foot disease:

  1. Inspect your feet daily. Make sure no new lesions or discoloration are seen. If you are unable to see your sole, you can use a mirror.
  2. Wash your feet in lukewarm water, not in hot water, as hot water may burn the skin if the pain sensation is decreased
  3. Be gentle when washing your feet, to avoid skin tearing. Make sure you wash in between the toes.
  4. Dry your feet well after the bath. If you would like to use a hair dryer, make sure the temperature is not set at hot
  5. Moisturize your feet but not between your toes: this would increase the humidity there and increase your risk for fungal infections.
  6. Cut your toe nails carefully, avoiding to injure the skin or cut the nail too sharp. It is better to schedule an appointment with a medical team of doctors, podiatrists and nurses certified in foot care for patients with diabetes.
  7. Never try to remove excess skin or corns yourself!
  8. Never walk barefoot! Instead, make sure your socks are made of cotton
  9. Never wear shoes that are very tight, you might injure yourself
  10. Shake out your shoes before wearing them; you can even pass your hand inside to make sure no sharp objects or pebbles are stuck in.
  11. Take care of your diabetes: keep your sugar levels stable, follow up with your physician, and ask for help to quit smoking.

Tip: if you take care of them, your feet will take you a long way

6. Avoid gaining weight, especially during quarantine!

Being in quarantine has a lot of impact on weight, as many have noticed. Increased stress, no gyms, and confinement have all contributed to many complaining of weight gain!

Here are some tips to avoid the quarantine fifteen:

  1. Create a routine: set a breakfast / lunch / dinner mealtime
  2. Set a snack schedule, 1 to 3, with healthy snacks available
  3. Eat mindfully, avoid doing so in front of your laptop or tv
  4. Make healthy shopping choices: avoid shopping on a healthy stomach, and remember that boosting your immunity starts in the kitchen!
  5. Get a lot of sleep: set an alarm in the morning and a bedtime schedule
  6. Make sure you drink enough water, as thirst sometimes is perceived as hunger
  7. Set a time for exercise, whether at home or in nature
  8. Enroll in an online physical activity class, or benefit from the free live sessions on social media
  9. Keep contact with your friends: schedule live online meetings and phone calls, you will benefit from their support
  10. Pick up old hobbies, or even try new ones!

Tip: Maintaining a healthy lifestyle does not only maintain your weight, but boosts your immunity status to protect you against viruses, especially during the pandemic

7. Advice on starting Intermittent Fasting

Intermittent fasting is NOT a diet, but a timed approach to eating. Unlike diets, it does not specify what foods to eat and what to avoid.

It may have some health benefits, seen in studies, such as weight loss, decreased inflammation, better well-being, but it may not be beneficial for everyone: people on chronic medication need to be followed closely by their physician to avoid complications.

Here are 5 tips to help you start your intermittent fasting:

  1. Identify personal goals for IF
  2. Pick the method: 16:8 or 5:2: eating 500 to 600 calories on alternate days
  3. Figure out caloric needs
  4. Figure out a meal plan
  5. Focus on the nutritional values and calories of the foods to eat

Tip: IF is a great approach to eating, but be sure to follow with your doctor and your nutritionist!

8. Advice for women who are approaching menopause

Menopause is the natural stopping of a woman’s menstruation. The timing is dependent on many factors, including age, family history, and medication, among others.

Menopause does not have to be very bothersome, if managed in the right way. Here are some tips for the ladies approaching menopause or are already in it:

  1. Learn to cope without food: focus on “me-time”, try deep breathing or meditation, try being more outdoors
  2. Eat less: people in their 50s need around 200 Cal less than their 40s, and need more muscle mass to increase their metabolism. Focus on nutritious food such as vegetables, fibers, fruits and wholegrain
  3. Stay hydrated as skin tends to lose its elasticity, and is at risk for dehydration
  4. Get moving! Engage in more physical activity, whether it is parking a bit further and walking, joining aerobic classes or going on hikes
  5. Make sure to contact your physician for further information and management options and advice.
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