Patient Information
By Phyllis Woodson, MS, RD, CDE

1. Check blood glucose/sugar before meals and at bedtime at least two days weekly unless on insulin (then daily). Try to check your BS also two hours after eating several days each week. Write down BS so you can find a pattern (why) of highs/lows.
   BS Goals: 80-120 mg/dL before meals, 100-140 mg/dL at bedtime and two hours after eating. If BS continues to be elevated, more oral agents and insulin may be needed. It has been estimated that over 50% of patients with Type 2 diabetes may eventually require insulin, some sooner than later. Make good lifestyle changes early.
2. Take your medications according to your physician’s recommendations; check the prescription or ask your pharmacist if you have questions. Metformin/Glucophage or any combination drug containing it is best taken with a meal. Short-acting insulins such as regular and premixed 70/30 or 50/50 are normally administered about 30 minutes prior to eating. Rapid-acting insulins such as Humalog, Novolog, Apidra, and premixed 75/25, 70/30, or 50/50 are administered at the meal or no earlier than 15 minutes prior to the meal. Basal or long acting insulins such as Lantus and Levemir and intermediate-acting NPH need to be taken as prescribed. There are many classes of diabetes medications and new ones are constantly being made available. For example, injectables such as Byetta and Symlin and other new oral medications provide multiple interventions for controlling BS. Diabetes medications may need to be taken at specific times, check with your physician.
3. If you are going to be late for a meal, eat something to prevent a low BS, e.g., peanut butter and crackers or low fat cheese and crackers. If you already have a low BS (<70 and/or clammy skin, dizziness), try 1/2 c orange juice or regular soda or three glucose tablets or five Lifesavers. Wait 15 minutes, then recheck your BS — it should be up. If not, repeat above. If BS is < 60, recommendations include doubling the amount of the above food treatment, e.g., six glucose tablets. Prevention is best.
4. Avoid weight gain; this can make BS harder to control.
5. Limit carbohydrate foods at meals to about 1/2 to 1 cup starch, 1/2 cup fruit, and 1 cup low fat milk per meal. Remember that potatoes, rice, pasta, corn, peas/dried beans and bread are starch foods. Limit/avoid sweets. Fruit juice may need to be limited/avoided — note your BS.
6. Limit fatty foods; even though they don’t affect your BS as much as carbohydrate foods, large portions of fat and protein foods will interfere with insulin and its function of reducing your BS after eating. Excess fat can also damage blood vessels and cause weight gain.
7. Eat plenty of vegetables — tomatoes, broccoli, cauliflower, cabbage, etc. These foods are rich in fiber, vitamins and minerals and may help improve your BS. These low calorie/low carbohydrate vegetables can also help “fill you up but not out,” decrease constipation, improve blood pressure and reduce your risk for cancer and blood vessel disease. The above food choices are also high in vitamin C.
8. Eating a “mixed meal” — a protein, starch, and vegetable —can help improve BS. Examples include baked chicken with no skin, potato with skin, and salad; sandwich with whole wheat bread and raw vegetables; and salad with cottage cheese and crackers.
9. Exercise — even 10-15 minutes a day of brisk walking, especially after meals can help reduce/improve BS. Park the car farther away and take the stairs.
10. Keep your doctor appointments — have your weight, blood pressure and feet checked at every medical appointment; check urine/kidney function and cholesterol at least yearly; and check eyes yearly or as your physician recommends. It is also recommended that all persons with diabetes check their feet daily and always wear shoes even around the house. Don’t forget to see your dentist every six months. Know your A1C — below 7% is desirable and is associated with fewer health complications; this blood test is usually performed every six months. Please remember to always bring your medications and BS records with you to each medical appointment so your health care providers can accurately assess your health condition and make the correct medication changes.

For more information, please consult with your certified diabetes educator.