Are you considering the use of an insulin pump? More and more people with type 1 diabetes and insulin-dependent type 2 diabetes are wearing insulin pumps. Insulin pumps deliver rapid-acting insulin 24 hours a day.

Insulin pumps deliver insulin in three ways:

Basal rate. The insulin pump delivers small hourly increments of rapid- or short-acting insulin over a 24-hour period. The basal rate replaces a long-acting insulin injection and accounts for approximately 50 percent of a person's total daily insulin requirement. Boluses. These insulin injections are required to cover carbohydrates eaten at meals.Correction. A correction is used to adjust the pre-meal insulin bolus for glucose values outside of the blood glucose target range.

Benefits of insulin pumps
Insulin pumps can:

Improve blood glucose control by delivering individualized basal ratesEliminate inconvenience of multiple daily injectionsIncrease lifestyle conveniences — you have more flexibility about when and what you eatOffer precise dosage delivery in basal rates as low as 0.025 units per hour and bolus rates of 0.1 unit dosesAllow temporary basal rates Deliver a special meal bolus to match the delays in the absorption of certain foodsUsually result in fewer large swings in your blood glucose levelsReduce frequency of hypoglycemia

Disadvantages of insulin pumps
On the flip side, an insulin pump:

Can malfunction, delivering too much or too little insulinIncreases risk of diabetes ketoacidosis — the pump uses only rapid-acting insulin, and if insulin delivery is disrupted for any reason, your blood glucose will rise rapidly putting you at risk of ketoacidosisMay be expensive — costing around $7000 for the pump itself, with supplies costing about $1500 a yearIs attached to you all day every dayWon't take care of all your blood glucose problems — you'll still need to test your blood sugar before meals and at bedtime, and the person using the insulin pump will continue to give a bolus before meals

Most insulin pump users would agree that the advantages far outweigh the disadvantages. My two sons with diabetes both use insulin pumps and wouldn't have it any other way. If you're considering an insulin pump, you must currently be on a multiple daily insulin dose program, be experienced in carbohydrate counting, and test your blood sugar at least four times a day. A good candidate for an insulin pump must also be able to understand and work with mechanical devices or computers. Please discuss with your diabetes care team if insulin pumps interest you.

Peggy

Summer has arrived for many of us, and summer makes me think of travel and camping trips. Traveling with diabetes requires a little advance planning. Preparation depends on where you're going and what you're doing. The American Diabetes Association (ADA) provides some good travel trips that I'd like to share:

See your doctor before leaving

Ensure good blood sugar control. If your blood sugars aren't well controlled, allow enough time before your trip to improve control before you leave. I'd also recommend seeing a certified diabetes educator, if possible, for help.Get a letter and prescription from your doctor. Ask for a letter and a prescription with a list of your medications for diabetes pills or insulin shots. The prescription will cover you if you run out or lose your insulin or medications while away. However, in the United States, prescription laws may vary from state to state. When my son forgot his insulin, we went to a pharmacy from the same chain that he usually gets his prescriptions from and he was able to get a vial of insulin. Prescription laws may be different if you're traveling abroad. The ADA recommends that you write for a list of International Diabetes Federation groups — see www.idf.org.

Prepare for an emergency abroad

Know how to find a doctor. You can get a list of English-speaking foreign doctors from the International Association for Medical Assistance to Travelers — see www.iamat.org, or call 716-754-4883. If you have an emergency while traveling and you don't have a list with you, you can contact the American Consulate, American Express, or local medical schools for a list of doctors.Wear a medical I.D. bracelet or necklace. It's important to wear identification that states that you have diabetes. It could also be helpful to know how to say "I have diabetes" and "Sugar or orange juice please" in the language of the country you'll be visiting.

Pack extras

Pack extra medication and insulin. Aim for at least twice as much as you think you'll need. Keep your medication and insulin with you in a carry-on bag, because checked luggage can be lost.Keep snacks available. Bring well-wrapped, air-tight snacks such as crackers, cheese, peanut butter, fruit, and some form of sugar, such as hard candy or glucose tablets, to treat low blood glucose.Protect supplies from heat. Insulin stored in very hot or very cold temperatures may lose strength. So, don't leave your insulin in the car. Meters and supplies are also sensitive to extreme temperatures. If you're camping or backpacking, consider storing insulin or meter supplies in a cooling pack made specifically for diabetes supplies.

Understand potential insulin issues

Try to use the same insulin. Stick with the exact brand and formulation of insulin as prescribed by your provider. But if you run out while you're on the road and you're unable to fill your prescription for some reason, you can buy NPH or regular insulin over the counter in the United States. Contact a physician for equivalent doses. You can discuss this with your physician before leaving for your trip.Be aware of differences abroad. In the United States, insulin is usually sold as U-100 (100 units of insulin per mL). Outside the United States, insulin may come as U-40 (40 units of insulin per mL) or U-80 (80 units of insulin per mL). If you need to use these types of insulin, you must buy new syringes to match the new insulin. When my son had emergency surgery for an appendectomy in Ukraine, he was allowed to use his own insulin. Adjust for time zone changes. If you're crossing several time zones, talk to your doctor or a certified diabetes educator to help you plan the timing of your injections. Bring along your flight schedule and information about the time zone changes. Note that if you need to inject insulin during a flight, be careful not to inject air into the insulin bottle. In the pressurized cabin, pressure differences can cause the plunger to "fight you."

Take care once you're there

Monitor your blood glucose more often. Jet lag may make it hard to tell if you have high or low blood sugar.Carry hypoglycemia treatment. If you're more active than usual, your glucose may go too low. Carry along snacks if there's a possibility that meals will be delayed or missed.Be careful about what you eat. Avoid tap water overseas, and ask for a list of ingredients in unfamiliar foods.Protect your feet. Wear comfortable shoes, and check your feet daily for blisters, cuts, redness, swelling and scratches. I talked to a man who'd hiked in the Arizona desert for several hours; when he got home, he saw blood on his socks. A cactus needle had pierced through his shoe and wedged a quarter-inch into his foot! Because he had peripheral neuropathy, he hadn't felt it.

Lastly, it can be helpful to prepare for airport security if you're flying to your destination. Check the ADA's webpage on air travel and diabetes for more information about how security measures may affect you — www.diabetes.org.

Happy travels!

Peggy

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Throughout my years as a diabetes educator, I've seen many people faced with the shock of a new diabetes diagnosis. There's the diabetes diagnosis itself, and then being thrown immediately into the required management of the disease. Everyone processes and reacts to this information differently. Unfortunately, the disease generally doesn't allow much time to ease into its management — scheduling and giving medications and injections, counting carbohydrates, storing insulin, understanding hypoglycemia and its treatment, using blood glucose meters, foot care, exercise and much more.

People's response to a new diabetes diagnosis varies. It's natural to respond with shock and stress. You might feel dazed or agitated, have poor concentration or a narrowing of attention, have difficulty comprehending information, anxiety, panic, a rapid heart beat, sweating, and shakiness and flushing. Some statements I've heard include:

Honestly? I wasn't expecting it, I don't eat sugar.No one in my family has diabetes.I ate a bunch of candy yesterday. That's why my sugar is high.Test my blood sugar again, I don't think it's right.I can never eat cake again.I'm not overweight. How did I get this?

People are frequently told they have diabetes, then rushed into a quick education session to learn how to test blood glucose, take the medications and insulin required, modify their diet and treat low blood sugar. These quick educations sessions aren't ideal. They may happen because of lack of time, at a patient's or physician's request, or because a person doesn't have insurance. I've looked at a person sitting there in shock and wondered how much of the information he or she really absorbed. This isn't my preferred method of education, but people amaze me sometimes at how well they adapt to it.

Studies show that after three days, adults only remember 10 percent of what they read, 20 percent of what they hear, and 30 percent of what they see. However, when adults are actively involved in learning new material, they'll remember up to 90 percent of what they say and do. So, the more active a role you can play in your diabetes education, the better.

What was your reaction to first being told "You have diabetes?"

Have a good week,

Nancy

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Hi fellow bloggers,

Last week I shared with you a patient story about "hypoglycemia unawareness" — a condition in which a person with diabetes doesn't experience the usual warning symptoms of hypoglycemia. This week I'd like to share some risk factors and possible treatment strategies for such hypoglycemia unawareness.

Long-standing type 1 diabetes. Reduced awareness of hypoglycemia is common among people who have long-standing insulin-dependent diabetes. Many of those who've had diagnosed diabetes for 15 to 20 years report having lost their ability to perceive low blood glucoses and to often failing to treat and prevent severe hypoglycemia.

Severe hypoglycemia is an episode in which the person with diabetes is unable to treat him or herself and needs the assistance of another person. This includes prompting by a relative or friend to drink juice or eat.

Being an older adult and having type 2 diabetes. There also have been an increasing number of hypoglycemia unawareness episodes in those with type 2 diabetes; adults older than 65 seem to be most at risk.

Strict avoidance of hypoglycemia. Strict avoidance of hypoglycemia for several weeks to months can restore at least partial awareness of warning symptoms. Strategies for avoiding hypoglycemia when you have hypoglycemia unawareness or don't experience the warning symptoms include:

Aim for a higher blood glucose targetTry to more accurately count carbohydratesAvoid overcorrection or stacking of insulin dosesTest your blood glucose and adjust your insulin dose more frequentlyConsider blood glucose awareness training education programs to help you learn to identify new symptoms and improve recognitionConsider a personal continuous glucose monitor (CGM) that sounds an alarm when your glucose gets too lowConsider a service dog that can recognize low blood glucose

Glucagon for emergencies. Glucagon is the treatment of choice if someone with diabetes is unconscious or unable to swallow. The length of time a person is unconscious, is more of a concern than how low the blood glucose number is.

Ask your health care provider for a prescription for Glucagon or GlucaGen and for instructions on how to use it. Instruct your family members or friends on how to use this in an emergency and on how to access the emergency response team, such as calling "911."

Have you lost any awareness of symptoms of low blood glucose? How have you coped?

Regards, and have a good week.

Nancy

According to the National Eating Disorders Association, eating disorders — such as anorexia, bulimia and binge eating disorder — include extreme emotions, attitudes and behaviors surrounding weight and food issues. Eating disorders are serious emotional and physical problems that can have life-threatening consequences for females and males.

The Juvenile Diabetes Research Foundation reports that a new type of eating disorder has surfaced. Unofficially coined "diabulimia," the condition occurs when those with type 1 diabetes skip or restrict insulin use to lose weight. Type 1 diabetes is a dangerous disease if untreated. Failing to take insulin raises your blood sugar and results in frequent urination — the body's attempt to rid itself of excess sugar in the bloodstream — resulting in rapid weight loss.

According to the American Diabetes Association (ADA), researchers estimate that 10 to 20 percent of females with diabetes in their mid-teens and 30 to 40 percent of those in their late teens or young adult years skip or alter insulin doses to control their weight. Uncontrolled blood sugar can lead to long-term complications, such as heart attacks, strokes, eye problems or blindness, nerve damage in the hands and feet, kidney damage, and gum disease.

The ADA suggests that early warning signs of an eating disorder such as diabulimia in someone with diabetes include:

Very high A1C test resultsFrequent hospitalizations for diabetes ketoacidosisFrequent severe low blood sugarAnxiety or avoidance of being weighedWidely fluctuating blood sugar levels without obvious reasonDelay in puberty or sexual maturation or irregular or no mensesBinging with food or alcohol at least twice a week for 3 monthsExercising more than is necessary to stay fitSevere family stress

If you think that you or a loved one might have diabulimia or another eating disorder, please talk to your healthcare provider. It is important that you seek evaluation and treatment. Your provider can recommend a health counselor who will help you or your loved one with this problem.

Peggy

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This week I'd like to deviate from the human nature of diabetes and chat, instead, about our animal friends (pets) with diabetes. For the first time in my life, I have the opportunity to have a dog in my life, so I started looking at local websites for adoptable dogs. I'm looking for a medium to large adult female dog that's trained, laid back and likes children. A particular dog caught my eye. Her name is Carlie, and she's a golden retriever and Labrador mix. Carlie has diabetes and is in a foster home that's taking great care of her. Carlie was extremely overweight and has gone from 118 pounds to 75 pounds. Her foster parents have her on a special diet and exercise regimen, and she's given insulin injections twice a day. I started asking my patients about their pets. The first patient I saw today told me her dog has diabetes.

I recently did some research on pets with diabetes and found that:

Diabetes is on the rise in United States cats and dogs as they, and we, become more overweight.Overweight cats are six times more likely to develop diabetes than are thinner cats.Symptoms of diabetes in pets include excessive urination, increased thirst and weight loss.Dogs often get type 1 diabetes, and type 2 diabetes is more common in cats.Like humans, dogs properly treated for diabetes typically live a long, full life.

Right now, I have a choice whether or not to take on the management of owning a pet with diabetes, unlike those of you who have diabetes and have no choice but to cope with the daily self-management of this chronic disease. As a first time dog owner, Carlie would be quite a commitment, and I don't know if I have the time or resources to manage her properly. I want to make the right decision for me and her. I'll keep you posted on my decision.

Please share stories about your pets with diabetes, including pros and cons.

Have a great week.

Regards,

Nancy

Friends or family members often ask us how they can help a loved one who has diabetes to make lifestyle changes. With a husband who has type 2 diabetes and two sons who have type 1 diabetes, I know that there's a lot to learn about living well with diabetes on a personal level. Diabetes is a hard disease to handle alone.

Here are some ways that you can support your friend or loved one.

Voice your support. Let the person with diabetes know that you love them and are willing to help.Learn about diabetes. Read books and reliable websites on diabetes. And go to doctor's appointments and diabetes classes with your loved one. Talk about your feelings. Let your loved one know that his or her diabetes affects you, too.Let go. It's not your responsibility to manage another person's diabetes. Just because I'm a certified diabetes educator doesn't give me nagging rights. My family members with diabetes feel more comfortable asking for help when I'm simply available to them.

I've also found that lifestyle changes that are good for a person who has diabetes are also beneficial to the rest of the family. For example:

Exercise together. Exercise for you and your loved one with diabetes. Invite your loved one to go to the gym or for a walk with you.Choose healthy foods. Healthy meals benefit the whole family. If you have a relative with diabetes, you're at risk. Making lifestyle changes now can postpone or prevent diabetes!Encourage. Applaud your loved one's efforts and successes and encourage him or her during struggles.Be considerate. When having a party, offer healthy, tasty treats such as fresh fruit.Seek outside help. If your loved one is sad or depressed, ask your health care provider about ways to get help. Ask about a diabetes support group in your area. You can also ask to meet with a certified diabetes educator.

Being the primary caregiver for a person who has diabetes can take an emotional toll. A diabetes caregiver may be the one taking ownership of his or her loved one's diabetes if the person with diabetes doesn't or can't. If you find it's too much for you, talk with your healthcare provider or diabetes educator. Together, you can determine at what point you may need outside assistance, such as from a nurse.

Peggy

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This blog is in response to a reader question about the symptoms of kidney disease that we received about our blog, "With diabetes, kidney care is crucial."

In some people with diabetes, over time, high blood glucose levels can damage the millions of tiny blood vessels that filter waste from the blood and dispose of it in the urine. Unfortunately, early kidney disease has no symptoms. Generally, not until the damage is extensive do symptoms emerge.

Symptoms of advanced kidney disease include:

Swelling of ankles, feet and handsShortness of breathHigh blood pressureConfusion or difficultyPoor appetiteNausea and vomitingDry, itchy skinFatigue

To identify kidney problems early, an important part of your yearly diabetes management checkup is getting what's called a urine microalbumin test. This test measures the amount of a protein, albumin, in your urine.

When kidneys are functioning normally, they filter out only waste in your blood, excreted in your urine. Protein and other helpful substances remain in your bloodstream. When your kidneys become damaged, waste products remain in your blood, and albumin leaks into your urine.

When your kidneys are in early distress, only small amounts of albumin escape into the bloodstream. You may lose 30 to 300 milligrams (mg) of albumin a day through the urine. This condition is called microalbuminuria. In advanced stages of kidney disease, you might lose more than 300 mg of albumin a day.

The most reliable test to screen for microscopic protein in the urine is to collect the urine in a container for 24 hours. Another available test, the random microalbuminuria test, requires only a one-time sample of urine.

If your health care provider is aware of early kidney disease through such testing, early treatment measures can help prevent or slow down the progression of diabetes-related kidney disease. Treatment measures include:

Keeping blood glucose levels in a healthy target range, as determined by your doctorMaintaining a healthy blood pressure level, as determined by your doctorStarting an ACE inhibitor blood pressure medication, which has protective benefits to the kidneysEating a low-protein diet

Your comments are appreciated.

Have a great week,
Nancy

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My husband and I recently went on a road trip to Arizona for our son's wedding, and our van broke down. Fortunately, there was a motel and repairman nearby. We settled in at the motel and went through the routine of getting ready for bed. My husband — who takes two types of insulin — suddenly said, "I feel like I'm going to pass out." I immediately went into "nurse mode" and checked his pulse.

Next, I glanced at the bedside table and saw a bottle of NovoLog insulin and a used syringe. I picked up the vial and asked if he'd just given himself that insulin, and he said he had. I realized he'd accidentally given himself NovoLog — his rapid-acting insulin — instead of Lantus — the slowly released insulin. We tested his blood sugar and it was 40 mg/dl (2.2 mmol/L). We spent the next 4 hours giving him simple carbohydrates and testing his blood sugar every 10 to 15 minutes.

For many people with diabetes, injecting two types of insulin is a daily requirement. As diabetes educators, we suspect that taking the wrong insulin happens more often than is reported. Giving yourself your injections can become so much a part of your routine that you can do it without thinking — which can lead to errors. My husband learned this lesson about insulin safety the hard way. He was distracted, thinking about the van repairs we needed to get back on the road.

To increase insulin safety and avoid taking the wrong insulin:

Pause, and double-check that you're taking the correct insulin. Use a syringe for your long-acting insulin and an insulin pen for your short-acting insulin. Label insulin vials or pens with different-colored tape, so that you can differentiate between them. For example, use red tape for short-acting insulin and yellow tape for long-acting insulin.

If you accidentally give yourself the wrong insulin:

Call 911 or your local emergency number.Test your blood sugar frequently until help arrives. Eat or drink a fast-acting carbohydrate to maintain a blood sugar within your goal range.

In preparation for such issues, it's a good idea to:

Always carry a simple sugar source with you, such as glucose tablets, juice, regular soda or hard candy.Wear a diabetes medical I.D. bracelet.Carry a glucagon kit.

We'd love to hear from readers who've had similar insulin safety experiences.

Peggy

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You've been told that high blood sugar causes complications, but have you ever wondered why? Diabetes often has no obvious symptoms. Occasionally, a patient tells us that maybe high blood sugar is normal for him or her. But there's no such thing as "a touch of diabetes" or having blood sugar that is "a little high."

Blood sugar actually coats red blood cells (hemoglobin), causing them to become stiff. These "sticky cells" interfere with blood circulation, causing cholesterol to build up on the inside of your blood vessels. It can take months to years for the damage to your body to appear. The fragile blood vessels in your eyes, kidneys and feet are most susceptible, so problems are usually noticed first in those areas.

Controlling high blood sugar may help prevent or decrease many long-term diabetes complications, such as:

Heart attackStrokeEye problems that can lead to trouble seeing or blindnessNerve damage in your hands and feet that can cause pain, tingling and numbnessKidney problems, including kidney failureGum disease and tooth loss

Some damage to the body may already start occurring during prediabetes — a condition in which your blood sugar is higher than normal but not high enough to be considered diabetes. Research has shown that if you have prediabetes, you can reduce your risk of developing type 2 diabetes by almost 60 percent through lifestyle changes. These changes include increasing your physical activity and modest weight loss — losing as little as 5 to 7 percent of your current weight. That's a huge risk reduction from small changes!

Ultimately, diabetes is a chronic health condition that can affect many aspects of your health. It's important that you take high blood sugar seriously. Regular follow-up care may help you better manage the disease and live an active, healthy life.

Peggy

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A diabetes lifestyle is a demanding one, in which the majority of management is self-care. The key to managing your diabetes involves testing your blood sugar; taking diabetes medications, insulin or both; eating a healthy, balanced diet; exercising; caring for your feet; stopping smoking; and keeping your diabetes appointments with your provider. If you don't do these things, you're at great risk of developing diabetes complications.

Research has proven that complications are less likely to occur if you keep your blood glucose as near to normal as possible, yet, as diabetes educators, we hear many reasons why our clients don't make simple changes to better their own health. Here are a few.

"I'm too young to have diabetes." This is a form of denial. According to the Centers for Disease Control and Prevention (CDC), more than 13,000 young people are diagnosed with type 1 diabetes in the United States each year. The number of children and adolescents diagnosed with type 2 diabetes is growing at an alarming rate. New diagnoses for type 2 diabetes in children accounts for up to half of all diabetes diagnoses in children and adolescents."I don't have enough time." Whether you work full-time or stay at home, it's important to take time to improve your way of life. Managing your blood sugar doesn't require you to make drastic changes. Break tasks down into smaller, doable actions. For example, take a 10-minute walk twice a day instead of walking for 20 minutes at one time. There are, however, things you must make time for. To stay healthy, you must test your blood sugar and take your diabetes medications."I feel fine. Maybe high blood sugar is normal for me." High blood sugar is never normal. Normal blood sugar for people who don't have diabetes is 70 to 100 mg/dL (3.9 to 5.6 mmol/L). Diabetes is an insidious disease, often called a silent killer. You may feel fine, but damage is being done to your entire body, from your hearing and vision, to sexual function, to mental health and sleep.

Other comments we hear include everything from "I don't like vegetables" to "Lifestyle changes won't work, so just give me diabetes pills."

But no change is too small to ward off type 2 diabetes or to delay further progression of diabetes! A large, national study conducted at 27 sites around the U.S. found that small lifestyle changes are far more successful at warding off diabetes or delaying further progression of the disease than are medications. The Diabetes Prevention Program (DPP) found that participants who lost a modest amount of weight through dietary changes and increased physical activity greatly reduced their chances of developing diabetes or developing further complications of diabetes.

Get started today and set a specific goal. Choose a lifestyle change that you're willing to work on. Don't change behaviors that will make your health care team happy — change for you. Ask yourself what you'd like to change and how you're going to do it, for how long, and how many days of the week. Start with one specific, attainable goal, for example, "I will walk 10 to 15 minutes three days a week for one month."

Lifestyle changes take patience, but, with persistence, you can make them happen.

Peggy

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Hello, bloggers. I've been looking at articles from a number of popular diabetes magazines and other resources about diabetes myths. Each one seems to have its own list of the top five or 10 diabetes myths.

I decided to develop my own list of the top 10 diabetes myths that I've heard as a diabetes educator at the Mayo Clinic in Rochester, Minn. I'll reveal five this week, five next week.

Here goes (drum roll).

I have borderline diabetes or just a touch of diabetes.

Either you have it or you don't. Two fasting blood sugar readings over 126 milligrams per deciliter (mg/dL) or 7 millimoles per liter (mmol/L); a random blood glucose over 200 mg/dL (11.1 mmol/L); or an A1C of 6.5 percent or higher are all considered diabetes.

I don't know why I got diabetes, I never eat sweets.

Just about everything you eat is converted into glucose — sugar — so for most people with type 2 diabetes, what you eat is not as important as how much you eat. When you overeat, you're adding extra calories your body doesn't need for energy, so your body will convert these extra calories into fat. Being overweight is a predisposing factor for developing diabetes. 

I can't eat carbohydrates; it makes my blood sugars go high.

Of course they do — even people who don't have diabetes will see an elevation in their blood glucose after eating. Carbohydrates should be approximately 50 percent of your daily food intake each day. Carbohydrates are your fuel, without them you will have little energy.

If I have to go on insulin; that must mean my diabetes is really bad.

You know, insulin has gotten a bad rap through the years. It's the blood glucose control that determines whether you go on insulin; if diet alone or diet along with oral or noninsulin-injectable diabetes medication(s) is not controlling the blood glucose, insulin is necessary.

Insulin causes complications of diabetes.

Again, insulin has gotten a bad rap. Insulin is a natural hormone and is probably one of the safest medications around. Insulin helps control the blood glucose, which in turn slows down or prevents diabetes complications.

Your thoughts? What are some of the diabetes myths you have come across?

Have a great week,

Nancy

A patient shared the following story:

She was in a grocery store and felt that something was wrong, so she walked over to the checkout lane and grabbed a couple candy bars off the shelf. She stood there in a daze, clutching the candy bars in her hands but not eating them. She must have looked like she needed help, because a woman walked over to her and asked if she had diabetes. The woman told her to open the candy bar wrapper and eat the candy right away. My patient was in such a confused state that she hadn't thought to do that herself. The woman stayed with her until she felt better and told her that she had a family member with diabetes, who she'd assisted before when he or she was in a similar confused state of low blood glucose (hypoglycemia). My patient was lucky to have received this assistance and avoided the need for an emergency medical response team (911) call for the seizures or unconsciousness that could have occurred with severe hypoglycemia.

Is this scenario familiar to you or a family member or friend with long-standing diabetes? This story is an example of "hypoglycemia unawareness" — a condition in which a person with diabetes doesn't experience the usual warning symptoms of hypoglycemia.

Usually, when a person's blood glucose drops, the body tries to raise it by releasing the hormones glucagon and epinephrine. Glucagon spurs the liver to release stored glucose from the liver into the bloodstream. Epinephrine signals the liver to produce more glucose and also causes the typical early warning signs of hypoglycemia — sweatiness, shakiness and weakness.

If you experience hypoglycemia unawareness, you skip these warning symptoms. Instead, without warning, you can lapse into severe hypoglycemia, becoming confused, disoriented or unconscious. This is because when you've had diabetes a long time, or experienced frequent, extreme swings of high to low blood glucose levels, you can lose the epinephrine response to low blood glucose.

In the next blog, I'll discuss more features of hypoglycemia unawareness, including the predisposing factors and possible treatment strategies for this condition.

Until next time, have a good week.

Nancy

Before people develop type 2 diabetes, they usually have prediabetes or impaired fasting blood glucose. If your blood sugar level is over 100 mg/dL (5.5 mmol) but less than 126 mg/dL (7 mmol), you're considered to have prediabetes.

Prediabetes/diabetes has become a worldwide epidemic. There are 57 million people in the United States alone who have prediabetes and most don't know it, according to the American Diabetes Association.

Unfortunately, many people who believe they're "borderline diabetic" or have "a touch of diabetes" think that they're safe. However, research has shown that some long-term damage is being done to the body, especially to the heart and circulatory system.

You're overweight or obese. This can keep your body from making and using insulin properly. Being overweight can also cause high blood pressure.You have a parent, brother or sister with diabetes. If you have a relative with type 2 diabetes, this more than doubles your risk of getting the disease.You're African-American, American Indian, Asian-American, Pacific Islander or of Hispanic/Latino heritage.You had gestational diabetes or gave birth to at least one baby who weighed more than 9 pounds (4.1 kilograms).You have high blood pressure.Your HDL or "good" cholesterol is below 35 mg/dL (0.9 mmol/L) or your triglyceride level is above 250 mg/dL (2.83 mmol/L).You exercise fewer than three times a week.

You can have prediabetes and not know it. Two tests are commonly used to diagnose prediabetes:

Fasting blood glucose. Measures blood glucose first thing in the morning before you eat. A normal fasting blood glucose is between 70 to100 mg/dL (3.8 to 5.5 mmol). You have prediabetes if your fasting blood sugar is 101 to 125 mg/dL (5.6 to 6.9 mmol).Oral glucose tolerance test. Measures blood glucose after fasting and again 2 hours after drinking a glucose-rich drink. Normal blood glucose is below 140 mg/dL (7.7 mmol) 2 hours after the drink. In prediabetes, the 2-hour blood glucose is 140 to 199 mg/dL (7.8 to 11.0 mmol/L). If the 2-hour blood glucose rises to 200 mg/dL (11.1 mmol) or above, you have diabetes.

If you have prediabetes, you should do something about it. Studies have shown that people with prediabetes can prevent or delay the development of type 2 diabetes by up to 58 percent through changes to their lifestyle, including modest weight loss (as little as 5 to 7 percent of your current weight) and increasing physical exercise. That is huge!

- Peggy

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Make a plan to help your child manage diabetes at school. Start by meeting with school staff and by making sure your child has the necessary supplies for routine care and blood sugar emergencies.

You may already have bought the basic school supplies for sending your child back to school. But if your child has diabetes, you need to make additional preparations.

A person with diabetes must manage this chronic illness all the time, including during the school day.  Staff such as nurses, teachers and coaches can work with you and your child on managing diabetes. This assistance may include helping your child take medications, check blood sugar levels, choose healthy foods in the cafeteria, and be physically active.

To help your child get ready for the first day of school and for the rest of the school year, here are a few key tips:

Meet with staff early in the school year to learn more about how the school helps students care for diabetes and handles any diabetes-related emergencies. Public schools and schools that receive federal funding are prohibited from discriminating against people with diabetes by the Americans with Disabilities Act and Section 504 of the Rehabilitation Act.  You can work with your child's doctor and school staff to create a Diabetes Medical Management Plan. Having a plan helps your child and school workers with managing diabetes in school and during extracurricular activities. Be sure to include information on services the school will provide and how to recognize high and low blood sugar levels. Your child may need assistance with giving insulin and checking blood sugar levels, and also may need to eat snacks in the classroom. For more information, visit Helping the Student with Diabetes Succeed: A Guide for School Personnel.

Your child must have access to supplies needed to manage diabetes and to treat any episodes of high or low blood sugar. You and your child can work together to create a care package to bring in his or her backpack. Supplies should include:

blood glucose meter, testing strips, lancets, and extra batteries for the meterketone testing suppliesinsulin and syringes/pensantiseptic wipesglucose tablets or other fast-acting glucose snackwaterfor children who wear an insulin pump, backup insulin and syringes/pens in case of pump failure

Also, be sure school workers have a glucagon emergency kit and know how to use it if your child experiences a low blood sugar emergency.

If your child is going to monitor his or her blood sugar, ensure that he or she feels comfortable doing so. If a trained school employee will do the monitoring, be sure your child knows where and when to go for testing. Also, make sure your child knows who to go to for help with high or low blood sugar episodes. The actions to be taken should be in the Diabetes Medical Management Plan.

Prepare a healthy breakfast, which will help your child stay focused and active. If you send a lunch with your child, pack a healthy meal that contains whole grains and fresh fruits and vegetables. Replace high-fat foods with low-fat options, such as low-fat turkey, reduced-fat cheese, and skim milk. Include healthy snacks, such as fruit, nuts or seeds, which your child can eat later in the day to help avoid the vending machine and keep blood sugar under control. If your child buys meals at school, look at the cafeteria menus together to help him or her make choices that fit into a healthy meal plan. Many schools post their menus online, or you can request this information from school workers.

Having diabetes does not mean that your child cannot be physically active or participate in physical education classes.  In fact, being active can help your child improve his or her blood sugar control. Also, limit screen time – TV, videogames and the internet – to one to two hours a day. Being active at an early age establishes good habits for a lifetime and is a lot of fun. Encourage your child by being active together, doing such things as walking the dog, riding bicycles or playing basketball, and you will get the health benefits too.

Check to be sure your child has had all recommended vaccinations, including the flu shot. If children with diabetes get sick, they can take a longer time to recover than children without diabetes. Talk to your child's doctor to see if your child needs any vaccinations before starting the school year. Also, encourage your child to wash his or hands regularly, such as before eating and after using the bathroom.

Diabetes does not have to get in the way of your child's good experience at school. Remember, parents and schools have the same goal: to ensure that students with diabetes are safe and that they are able to learn in a supportive environment. Make sure school staff have the information and resources they need for your child's safety and health. Help prepare your child to manage diabetes when he or she goes back to school.

CDC works 24/7 saving lives, protecting people from health threats, and saving money to have a more secure nation. A US federal agency, CDC helps make the healthy choice the easy choice by putting science and prevention into action. CDC works to help people live longer, healthier and more productive lives.