E-newsletter for Patients - April 2008

Diabetes Questions & Answers

Susan Jones, M.S., CRNP, CDE shares frequently asked questions and answers

This edition of the newsletter features frequently asked questions of Susan Jones, M.S., CRNP, CDE from the Penn State Milton S. Hershey Medical Center's Endocrinology Department. Sue specializes in Intensive Glucose Management.

Q: "Glucose meter advertisements say that you no longer have to stick your fingers. How can that be?"

A: Recently, glucose meters are available that give you the choice of using body sites other than your fingers (alternate site testing). This is usually less painful than the fingers because other areas have fewer nerve endings. The forearm is the most common alternate site to use, but the fleshy part of the hand, upper arm, thigh, or calf may be used. Not all sites are FDA approved for all meters. It is important to check the meter guidelines for use.

Alternate site testing should not be used if your glucose is changing rapidly (after eating, for example) or if you have no symptoms of hypoglycemia. Because blood flow to the fingers is faster, changes in glucose are detected there first. A low blood glucose will be detected on finger blood before forearm blood. So, a forearm glucose might be 90, while a finger glucose done at the same time might be 70 and might make the difference between treating and not treating. Be sure to discuss with your health care provider whether alternate site testing is right for you.

Q: "What's the point of testing? I don't know what to do with the number."

A: Monitoring blood glucoses is the only way we have to make day to day decisions, problem solve, and make changes with your treatment plan. When you are wondering if it is OK to eat a specific food, the best answer comes from monitoring your blood glucose approximately 2 hours after eating that food. If your glucose increases more after eating that than other foods, it may be an item you should eat smaller portions or only for special occasions. Knowing your glucose levels allows your provider to adjust or change your diabetes medications. The numbers aren't "good" or "bad"... they are just numbers. The more numbers you have, the more information is available to make the correct decisions to have your glucoses in the target range more of the time. Working with a diabetes educator can help you learn what to do with those numbers, whether it is adjusting your insulin, making different food choices, changing activity, etc.

Q: "I'm still confused by Type 1 and Type 2 diabetes. It was easier when it was juvenile and adult."

A: Years ago, type 2 diabetes was termed adult-onset diabetes and type 1 diabetes was juvenile. Because the age at which these diseases are occurring is changing, the name needed to be changed to be more accurate. Type 1 diabetes, in which the pancreas is no longer producing insulin, can occur at any time in life. Type 2 diabetes is increasing due to decreased fitness and obesity and is becoming more frequent in children. Type 2 diabetes occurs when your body has trouble using the insulin it makes or when your body cannot make enough insulin. People with type 2 diabetes often control their diabetes with diet, exercise, pills or insulin. About 90% of Americans with diabetes have type 2.

Q: "Does taking insulin mean my diabetes is worse?"

A: No, it doesn't. Type 2 diabetes changes and progresses over time. It just means that other treatments have been unable to bring the glucoses to an acceptable range and now insulin is needed. With glucoses better controlled, you should feel better and decrease your risk of complications or slow the progression of complications. People starting insulin often wonder why they resisted for so long. "It's not such a bad thing!"

**For future editions of the newsletter, we welcome you to submit your questions for consideration in this column. Please direct any questions to diabetes@psu.edu