How to live with type 2 diabetes frequently asked question

2. About the Author
Hi … I’m Beverleigh Piepers and have been a Registered Nurse for
25 years.
I am registered in both Australia and the United States. I have
worked in several
areas of Health including Pediatrics, Geriatrics, Medical, and
Chemical
Dependency.
From the early days of my training I had the deepest respect for
the administration of the drug Insulin. I have seen many diabetic
patients admitted
to hospital due to accidental misuse of this drug. The common
cause I believe,
is lack of understanding of information on food choices, exercise
and when, or if,
insulin is required. I do not think it’s the patient’s fault, often the
condition and
treatment is not explained, or is inadequately explained.
And now the most common form of diabetes is Type 2, affecting
85-90% of all
people diagnosed with diabetes.

3. Imagine my surprise when following a regular blood test which
included fasting blood sugar levels, I was told my blood sugar levels
were elevated and I would require a glucose tolerance test. These
results came back within normal levels.
So that meant, due to the original elevated levels, I was told: “I
would possibly
become Type 2 Diabetic in the future”. In other words I was pre-
diabetic.
I was not overweight; I had been having yearly fasting blood sugars
done along with cholesterol levels. I had been telling the Health
Care Provider for almost eight years that I didn’t feel right, I was
ever so tired. It seems my climbing blood sugar levels had been
overlooked. I was given no satisfactory information on Type 2
Diabetes, just follow a low-GI diet! That is how my journey began.
I was given no satisfactory information on Type 2 Diabetes, just
follow a low-GI
diet! That is how my journey began.
My search for information on Type 2 Diabetes took me
“everywhere” and then I really started to realize why so much
people do not understand. The information sounds complicated and
is in a “foreign language”.
So I would really like to translate for you and help you take back
your power, as you are in charge of your body and your Type 2
Diabetes.

4. This guide is in response to some of the many questions put to me, I hope
theyhelp you on your journey to living …
Beverleigh Piepers RN;

5. Those of us diagnosed with pre-diabetes or Type 2 Diabetes usually
have several years in which to avoid long term complications. So the
good news is you get the chance to make those changes to your
lifestyle that will not only prevent complications, but help you to live
longer with a good quality of life.
You already know Type 2 Diabetes:
 is the more common form of diabetes and affects 85-90% of
diagnosed cases.
 is brought about by lifestyle choice
 until recently it was found to occur mainly in adults and was
known as Adult Onset Diabetes
 is also known as non-Insulin Dependant Diabetes Mellitus
(NIDDM).
People with Type 2 usually have ample insulin but their bodies resist
it’s normal healthy action.
This is where the term insulin-resistance
comes from. It is now known this also relates to:
 high blood pressure
 elevated tri-glyceride levels
 high cholesterol levels
 heart disease

6. How would I know I have Type 2 Diabetes?
Usually you would have a few of the following symptoms:
 extreme fatigue
 frequent urination and unusual thirst
 blurred vision
 cuts that are slow to heal
 urinary tract infections
 genital itching
 heart disease
 tingling and/or numbness in hands or feet
 abdominal obesity See your health care provider so he can organize:
 fasting blood glucose test
 glucose-tolerance test
 fasting insulin levels
Why would I need to have fasting insulin levels checked?
Because elevations in insulin precede the increase in blood sugar by
as much as fifteen years. High insulin levels actually do more
damage. It leads to an increase in belly fat, blood pressure and
blood fats.

7. Can I undo the damage done by high blood sugars?
If you have had high blood sugars for a while this will have increased
the strength of your insulin resistance. If your liver has become
insulin-resistant also, this may be “dumping” glucose into your
bloodstream also.
The good new is, yes. By lowering your carbohydrate intake you can
reduce your insulin resistance. By getting your levels as near as
possible to normal, after a few days your insulin resistance will start
to decrease. Then, whatever insulin you are making will work more
effectively and you will get a lower rise in your blood sugars.
What are the signs of hypoglycemia?
If you are not injecting insulin or taking any sulfonylurea drugs
(Amaryl, Glucotrol, Glucotrol XL, Micronase) you will not have a
“hypo”.
 whiteness or skin pallor
 sweating
 palpitations
 anxiety
 hunger sensation
The above signs and symptoms show when your blood sugar falls
quickly.

8. You have the following symptoms when hypoglycemia takes longer
to occur:
 headache
 loss of concentration
 maybe double vision
 confusion
 fatigue
Hypoglycemia means any reading below 75 mg/dl (4.2 mmol/l)
Why am I putting on weight, I am watching what I eat?
I take Glucotrol before meals.
Glucotrol is in the family of drugs known as sulfonylureas and helps
your pancreas produce more insulin. More insulin more weight gain.
The weight gain may also be from intense hunger that is often
experienced when taking these drugs. Hunger may be due to the
intense variations in blood sugars that they cause.
Many people do not like taking these drugs because of the hunger
and weight gain.
Does Metformin cause Low Blood Sugar ?
Metformin is not supposed to cause dangerous hypos, though some
people have found themselves feeling uncomfortable due to a fall in
their blood sugar level.

9. Why do some people get Type 2 diabetes?
Insulin-resistance is one cause. But most people have a genetic
predisposition based on family history or ethnicity. Add to that age,
weight gain, and a sedentary lifestyle.
What is a HbA1c test and why do I need it?
This test is abbreviated as HbA1c and looks at how blood sugar has
damaged proteins in your blood. The test provides a picture of your
average glucose levels over the last six weeks and reveals what a single
fasting glucose test does not. Research has found the risk of
developing health problems increases when HbA1c levels are above
5%, and the risk of a heart attack increases by approximately 20% for
each 1% rise in HbA1c levels. In other words a person with an HbA1c
level of 7% had a 40% more chance of having a heart attack than a
person with an HbA1c of 5%.
And how do I interpret the HbA1c result?
Normal HbA1c … … 4.5 to 5.7%
Pre-diabetic … … 5.7 to 6.9%
Diabetic … … 7% or higher
Sometimes eating sugary foods the day before a fasting blood sugar
test will throw your levels out. The HbA1c provides an average over
the past six weeks.

10. I am 65, I have been diagnosed with Type 2 Diabetes but due
to arthritis I have trouble exercising. Can I still lose weight?
Yes, arthritis does make it difficult to exercise but lack of mobility will
not stop you from losing weight or getting control of your blood sugar
levels. Exercise is beneficial but nowhere near as much as losing
weight. So be really careful about sticking with your diet. Just do what
you can, walk when you are able. Don’t forget everyday things such as
climbing stairs, going shopping, gardening and housework all count as
activity.
What has caused neuropathy in my legs? I have Type 2
Diabetes?
In addition to continuously high blood sugar levels, neuropathy is made
worse in the following:
 the age of the diabetic is higher than 40
 drinking even small amounts of alcohol can make the pain worse
Damaged nerves can’t send messages, send them at the wrong time or
send them too slowly. Researchers aren’t sure how high glucose levels
damage nerves, but it is believed that the damage is due to a cut-off in
the blood supply to the nerve in some cases. Often when the blood
sugar level is brought down to normal the signs and symptoms improve.
If you don’t improve your control, the neuropathy will continue until you
feel no pain at all and that is not a good sign. If the pain is unbearable,
see your Health Care Provider so he can help you with pain relief.

11. blood sugar level is really high in the morning, should I
have breakfast?
Yes, you should have breakfast. Many diabetics have high glucose in
the morning. As morning approaches levels of other hormones, such as
cortisol and growth hormone, begin to increase. Some of these make
insulin less effective, so the result is a temporary morning insulin
resistance. This is known as the “dawn phenomenon” or the “dawn
effect”.
Check your blood sugar level when you wake in the morning, if it is
often above 126 mg/dl (7 mmol/l); try to lower this by doing some form
of physical activity the previous evening. If you are taking insulin, your
Health Care Provider may need to adjust the timing or amount of your
evening insulin dose.
How often should I check my blood sugar levels?
The main reason for testing is to find out what you need to do to keep
your blood sugars in the recommended range. So it will depend on
what information you need. If you are ill or have changed your
medications you made need to test 5 to 8 times/day. Your Health Care
Provider can help you work out how often you should test.
When is it really important for me to test my blood sugar
level?
If you use insulin or insulin-stimulating pills, and you start to feel
hypoglycemic, check your level so you can take action straight away.
Test before you drive so you can take preventative action and not have
a “hypo” while driving. And test when you feel ill.

12. My Doctor has suggested I try Byetta because I overeat, how
does this work?
When your stomach does not empty you feel full. Byetta works by
closing off the stomach valve through which food passes into your
intestines. Sometimes this lasts for hours and makes it impossible for
you to overeat.
So when you stop eating so many calories or kilojoules at your meals,
your weight will drop. If overeating is the reason for your weight gain
and high blood sugar levels, this drug will reduce both.
Over time though the effect does wear off as does Byetta’s effect on
weight loss.
If you test your blood sugar levels normally two hours after eating, you
will need to check them much later as stomach emptying is delayed.
Another thing Byetta does in some people is stimulate the pancreas to
release more insulin when the food you have just eaten starts to raise
your blood sugar. This is different to what the sulfonylurea drugs do,
because Byetta only stimulates while the blood sugars have risen and
stops when they drop. This means you would not get a “hypo”.
Byetta does not work for everyone; it may not work for you. Many have
become nauseated; others vomit a lot. This is due to the way it closes
off the lower stomach valve.
If you try Byetta for a month and your blood sugars get worse, ask your
Doctor to help find a medication that will work better for you.

13. Why should I always have to check my blood sugar level?
Regular testing is extremely important and that will mean you should
check them more than once a day. You should also change the times
you test regularly. The best times to check is a half an hour before
breakfast, then two hours after breakfast, a half hour before lunch
and then two hours after lunch. And also at bed time.
You should write those numbers down, or some glucose meters
actually record them, and take them to your Doctor. This is the only
way your Doctor will know whether you need to change your
medications and/or diet.
Without regular testing it could be months before you realize that
your overall blood sugar levels are too high and this is when diabetic
complications accelerate. Complications include strokes, heart
attacks or blindness. And you don’t want that to happen.
When you become fairly stable (in the area of 72-126 mg/dl or 4-7
mmol/l) and by the HbA1c result, (best is less than 5%, though ADA
suggests under 6%), maybe your Doctor will suggest testing less
each day.
What do you think of Medi Alert necklaces?
I think it is important to wear an identification of some kind to alert
people to your diabetes, especially if you are taking medications. A
bracelet is more likely to be noticed if you happened to become
unconscious, eg. following a motor vehicle accident. Health care
professionals would then know you are diabetic and take the
appropriate action. Personally, I think a bracelet is the best option
and should be worn at all times.

14. How often should I have my eyes tested?
You should have a yearly examination by an Ophthalmologist so you
can preserve your vision. For this examination, the Doctor will instill
drops into your eyes and then use different instruments to check the
pressure, the appearance of your lens and most importantly, the
retina.
All kinds of procedures can be done if any abnormalities are found.
If you haven’t been doing so, you need to get an examination at the
time of your diagnosis and every year after that.
You mention low-GI foods a lot, what is a low-GI value?
A high-GI value is ... ... … 70 or more
A medium-GI value is … 56-69 inclusive
A low-GI value is … … … 55 or less
Most rice types have a high-GI value, which one would you
recommend?
Basmati, Moolgiri or Doongara have lower GI values. Rice vermicelli
(a rice noodle) is also low-GI.

15. Potatoes have a high-GI, do I have to stop eating them?
You don’t have to stop eating everything that has a high-GI, just
enjoy them in moderation. And mix them with low-GI foods, then
that will put the overall count in the medium-GI range. The GI is
also affected by how they’re cooked. Pre-cooking and reheating
potatoes, or eating cold potatoes, eg. in potato salad, reduces the
glycemic response. Freshly cooked and mashed potatoes have a
high GI. And we’re not even dealing with fried potatoes!
If I change to low-GI foods do I need to lower my insulin
dose?
In theory yes, in practice no. Most studies have shown no need for
this, as the insulin dose is dictated not just by the carbohydrates in
the diet but by the protein and fat also.
I have recently been diagnosed with diabetes. I enjoy a
drink with my meal, is that a problem?
A small amount of alcohol with food will have little effect on your
blood glucose levels. Recent research has shown that a glass or two
of wine with, or before a meal, may reduce glucose levels by 25%.
For others, the opposite can happen … blood sugars seem to rise
later that night. Sweeter wines seem to bring on higher blood
sugars, so many diabetics drink red wines and drier wines. If you do
have a glass of wine, check your blood sugar level before bed and if
you are awake at 2 or 3am, check it then also.

16. How does alcohol affect my blood sugar levels?
Sometimes alcohol reduces your levels a lot. If you are using insulin,
alcohol can make your levels go too low. Alcohol can paralyze the
mechanism that brings your blood sugars back up. This can be
avoided by not drinking on an empty stomach and having snacks
alongside your drink.
A maximum of one standard drink per day for females and two
standard drinks for males are acceptable recommendations for
people with diabetes. A standard drink is:
 1 beer … … … … … 9.5oz/280mls
 1 beer reduced alcohol ... 12.5oz/375mls
 1 glass dry wine … … 4oz/120mls
 1 glass port or sherry … 2oz/60mls
 1 nip spirits … … … … 1oz/30ml
I am a Vietnam-era veteran with post-traumatic stress
disorder. I also take blood-pressure medication. I have type
2 diabetes and I am tired or hearing it is a lifestyle disease,
especially when it’s an established fact that taking
antidepressantsand blood-pressure medications predisposes
one to type 2 diabetes.
Although lifestyle issues such as obesity, are a common cause of type
2, there are many other aspects to consider. Family history, ethnic
background and, as you quite rightly point out, life experiences, that
affect our long-term health and well being. I am sorry and
understand you feel criticized by this unfair association.

17. I was diagnosed with diabetes when I returned from duty in
Vietnam. I think I drink too much but what is really
bothering me is I have loose teeth. Is this connected with
my diabetes?
If your blood sugar levels are not really well controlled this can lead
to periodontal (gum) disease. Periodontal diseases are infections of
the gums and bone that hold your teeth in place.
So high blood sugars in your saliva encourage the growth of bacteria
and this helps cause gum disease.
Do you smoke? This can be another factor. Smoking is harmful to
oral health even for people without diabetes.
Why not make an appointment to see your local Dentist. He may
suggest:
 removal of plaque
 removal of infected tissue if in the early stages of gum disease
 medication
Thrush is another mouth infection common in people with diabetes,
again due to high sugar levels in the saliva.
How much is too much drinking? Suggested alcohol for a male with
diabetes is two standard drinks/day. Do you have a friend you can
talk to? Why not give your local Alcoholic Anonymous group a call?

18. When I wake up in the morning my feet tingle, and feel cold.
Do I have neuropathy?
Virtually all diabetics who have had higher than normal blood sugars
for more than five years can suffer some loss of sensitivity in their
feet to pain, pressure and temperature. Long-term elevated blood
sugar may also cause impairment of circulation in the major arteries
of the legs, as well as veins and capillaries.
Talk to your Doctor and have your fasting blood sugar levels and
HbA1c checked as well.
I am 54 years old and have Type 2 Diabetes. Is this why I
can no longer have an erection?
I would say 50% of males with diabetes have this difficulty. But
before blaming diabetes, are you taking medications for high blood
pressure or depression? Eliminate all other possibilities first.
How long have you had diabetes and how well controlled are your
blood sugar levels? Check with your Doctor and take along your
blood sugar readings to help him with your diagnosis. Fortunately,
nowadays there are many approaches to treatment of erectile
dysfunction and the success rate is high.

19. No-No’s in a Nutshell List by Richard K Bernstein, MD
Here is a concise list of foods to avoid:
Sweets and Sweeteners
 powdered sweeteners (other than stevia)
 candies especially so-called sugar-free types
 honey and fructose
 most diet and sugar free foods (except sugar-free Jell-O gelatin
when the label doesn’t mention maltodextrin and diet sodas
that do not contain fruit juices or list other carbohydrates on
the label)
 desserts (except Jell-O gelatin without maltodextrin … no more
than ! cup per serving) and pastries: cakes, cookies, pies,
tarts, etc.
 foods containing as a significant ingredient, products who end
I n –ol or –ose (dextrose, glucose, lactose, mannitol, mannose,
sorbitol, sucrose, xylitol, xylose, etc), except cellulose; also corn
syrup, molasses, maltodextrin, etc.
Sweet or Starchy Vegetables
 beans: chili beans, chickpeas, lima beans, lentils, sweet peas,
etc. (string beans, snow peas and bell and chili peppers, which
are mostly cellulose, are okay, as are very limited amounts of
Many soybean products)
 beets
 carrots
 corn
 onions, except in small amounts
 packaged cream spinach containing flour

20.  parsnips
 potatoes
 cooked tomatoes, tomato paste, tomato sauce and raw
tomatoes except in small amounts
 winter squash
Fruit and Juices
 all fruits (except avocados)
 all juices (including tomato and vegetable juices … except for
some people, in a small Bloody Mary)
Certain Dairy Products
 milk
 sweetened, flavored and low-fat yogurts
 cottage cheese (except in very small amounts)
 powered milk substitutes and coffee lighteners
 canned milk concentrate
Grains and Grain Products
 wheat, rye, barley, corn, and lesser known “alternative” grains
such as kasha, quinoa and sorghum
 white, brown, wild rice or rice cakes
 pasta
 breakfast cereal
 pancakes and waffles
 bread, crackers, and other flour products including “whole
grain” breads

21. Prepared Foods
 most commercially prepared soups
most packaged “health foods”
 snack foods (virtually anything that comes wrapped in
cellophane including nuts)
 balsamic vinegar (compared to wine vinegar, white vinegar, or
cider vinegar, balsamic contains considerable sugar)
Vegetables
Most vegetables, other than those listed in the No-No section are
acceptable. Dr Bernstein mentions cooked vegetables tend to raise
blood sugar more rapidly than raw vegetables because the heat
makes them more digestible and converts some of the cellulose to
sugar.
 Beets. Like most other sweet-tasting vegetables, beets are
loaded with sugar. Sugar beets are a source of table sugar.
 Carrots. After cooking, carrots taste sweeter and appear to
raise blood sugar much more rapidly than when raw. Even raw
carrot should be avoided.
 Corn. Not a vegetable at all but a grain. Nearly all of the corn
grown in the US is used for two main purposes. One is the
production of sweeteners. Most of the sugar in Pepsi-Cola
comes from corn. The other main purpose is animal feed, eg.
fattening up hogs, cattle and chickens. Diabetics should avoid
eating corn, whether popped, cooked, or in chips.
 Potatoes. For most diabetics, cooked potatoes raise blood
sugar almost as fast as pure glucose, even though they do not
taste as sweet.

22.  Tomatoes, tomato paste and tomato sauce. As you know
tomatoes are actually a fruit not a vegetable, and as with
citrus
fruits, their tang can conceal just how sweet they are. The
prolonged cooking necessary for the preparation of
tomato
sauces releases a lot of glucose.
 Commercially prepared soups. Many commercial soups
can be Loaded with added sugar, as much as in a soft drink.
Even if there wasn’t, the prolonged cooking of vegetables
can break the special glucose bonds in the cellulose of the
slow-acting carbohydrates, turning them into glucose. Add
to that the common inclusion of potatoes, barley, corn, rice
and other unacceptable foods and you have a product you
should avoid.
 Health foods. Dr Bernstein says that of the hundreds of
packaged food products that you see on the shelves of the
average health food store, perhaps 1% is low in
carbohydrate.
Many are sweetened with honey or other so-called natural
sugars.
I included this last section as maybe an alternative to your
present
eating plan. If you are having difficulty with your blood sugar
levels,
eliminating some of the foods on this No-No List may be
worth
considering.

23. That’s it for now.
The End