Tis the Season to be Jolly!
By: Jessica Cook MS RD LD CDE (Director of Education)
This season brings merry moments to life while enjoying loved ones, time off and traveling. No matter which holiday you celebrate remember to think of all of the gifts life has to offer at any age. Even with all the excitement or gifts, this can be a busy time of year with deadlines, increased expenses and lack of time, causing many people to let this joyous season become stressful. When people with diabetes become stressed or overwhelmed during the holiday season it can lead to elevated blood sugars.
Try to remember these simple steps to relieving holiday stress to keep this season merry & bright:
- Exercise. Exercise releases endorphins in our brain, naturally reducing stress. Many people also don’t realize exercise can lower blood sugar, blood pressure, cholesterol and help you sleep better!
- Laugh, Laugh, Laugh. Now is the time of year to celebrate with those you love the most and usually friends or family know how to really make you laugh. Try finding humor in even stressful situations to help you feel relieved and reduce the pressure of the situation.
- Listen to music or even better Dance to music! Rhythms, dancing, singing and listening to your favorite artists can make even a very stressful day, melt away. Try dancing or singing with a partner or go to a live concert to blow off some steam!
- Give. Nothing reminds us more about the holidays than giving back to those who are less fortunate. Even if you don’t have a lot of money to give, try donating your time to help local shelters, soup kitchens or donate old clothes or shoes you have not worn recently or that do not fit. Giving makes the heart feel warmer and there are many thanks that will be received.
Please enjoy this issue of our Healthy Living with Diabetes Newsletter to help celebrate this holiday season!
Medications that cause low blood sugars
By: Dr. William Kaye
There are many definitions for low blood sugar, but for the purpose of this article we are choosing “sugars under 70” to define hypoglycemia.
All diabetic medications lower sugar, but only certain ones can cause hypoglycemia.
To cause hypoglycemia medications must either be insulin or stimulate insulin.
Traditional medications that have the potential to cause hypoglycemia include:
Any type of insulin
- Humulin N
- Novolin N
- All mixed insulins such as 75/25 or 70/30/
Oral hypoglycemic pills
- Glypizide (glucotrol)
- Glimiperide (amaryl)
Medications that rarely if ever cause hypoglycemia include:
Reasons why the list of medications that “rarely cause hypoglycemia” rarely cause hypoglycemia.
Lets’ take these medications one by one or in groups to understand why they usually do not cause low blood sugar.
- Metformin does not cause low blood sugar because it works by stopping the liver from overproducing sugar. It does not stimulate insulin. It actually causes insulin levels to decrease when the sugar decreases.
- Januvia, Tradjenta, Onglyza: These all work the same way and are also called DPP-IV inhibitors. DPP-IV inhibitors block the breakdown of a hormone in our body called GLP-1 which has sugar lowering ability. These medications only work when the blood sugar is high and stop working when the blood sugar is low, so by themselves do not cause hypoglycemia and if so it is rare and mild.
- Invokana, Farxiga, Jardiance: These medications also work the same way and are called SGLT2 inhibitors. They work by making the kidney excrete excess blood sugar.
- Actos: Also called pioglitizone: This medication makes your body more sensitive to your insulin.
When drugs from the list “that do not cause hypoglycemia” are added to any of the drugs “that can cause hypoglycemia” then low blood sugar is possible. For example an individual who is either taking insulin or glyburide experiencing high blood sugars (with no hypoglycemia) may receive either metformin, actos, a DPP-IV inhibitor or SGLT2 inhibitor from their doctor. If hypoglycemia occurs the patient usually thinks it was the last medication added. In reality the last medication added may have simply made the other medications “more effective” and less necessary. The correction action for the doctor to make to avoid further hypoglycemia is NOT to discontinue the last medication, but to discontinue or reduce the medicines that are known to cause hypoglycemia.
The key to excellent diabetic control with a minimum of hypoglycemia is that both you and your doctors understand how each and every medication works. To learn more about this subject please attend our ADA recognized diabetic education program titled Living Well with Diabetes 1,2,3 program or visit www.learndiabetes.com. Or call (561) 513-5100 to make an appointment with a registered dietitian or certified diabetes educator today!
Self Monitoring Blood Sugar Levels
By: Ines Cobo RN, CDE, CPT
Self-monitoring blood sugars is an important component of diabetes management. Blood sugar monitoring is recommended for people with diabetes in order to achieve better blood sugar control and to prevent hypoglycemia (low blood sugars.) The goal of self glucose monitoring is to establish patterns of blood glucose levels at different times to aid in the adjustment in dietary intake, physical activity, oral medications, and insulin doses to improve glucose control on a day to day basis. Self monitoring of blood glucose can aid in diabetes control by improving recognition of hypoglycemia and severe hyperglycemia. Also, self monitoring enhances through patient empowerment regarding the effects of lifestyle or medication intervention on glucose control.
The frequency with which people with diabetes should monitor their glucose levels varies from person to person. Insulin treated patients should monitor blood sugars at least 4 times per day, most commonly fasting, before meals, and before bed. In addition, patients taking insulin can benefit from monitoring blood sugars 2 hours after meals to help adjust insulin regimens more accurately. For people with type 2 diabetes, not on insulin, monitoring blood sugars varies depending on the oral medication regimen and whether the person is getting medications adjusted or is at target. If a person is on a stable oral medication regimen with HbA1c within the target range of 6.5% or less, less frequent blood sugar monitoring is appropriate. In such cases people can use glucose monitoring data as feedback at times of high stress, changes in diet, physical activity or illness. If you are having difficulty testing blood sugar levels or are looking for the right self monitoring routine for you medication please make an appointment with one of our diabetes educators to help you reach your blood sugar goals at (561) 513-5100.
New Diabetes Support Group
Are you interested in learning new ways to manage diabetes while getting support from other people with diabetes in your local community?
Would you like to attend a group meeting with other people with diabetes, doctors and diabetes educators to discuss topics specific to those with diabetes?
Then come join us at the first quarterly diabetes support group held on Tuesday February 11th from 5:30-7:00pm at our West Palm Beach office on Flagler Drive. This group meeting is free of charge and will include presentations from The Palm Beacher’s Top Doctors of 34 Specialties Dr. William Kaye and licensed clinical social worker plus diabetes educator, Gail Starr to discuss benefits, research and practical applications of mindful eating.
To make your reservation for this exciting event, please call our scheduling department at (561) 513-5100.
At Healthy Living with Diabetes we want to ensure that you are satisfied with all services received. We also would like your input on educational workshops that you would like us to offer, information you would like to read about in Healthy Living with Diabetes Monthly or feedback on any workshop that you may have attended.
You can contact the director of education personally by email jcook@PBDES.COM or leave a message at (561) 513-5100. We would love to hear from you!