Frequently Asked Question

Of all the things you should do to prevent problems from diabetes, which is more important, Diet or Exercise?
Exercise on a regular basis, because it reduces the blood sugar levels both immediately and over several days by reducing insulin  resistance (But Diet, or avoidance of high carbohydrates and sugars that are rapidly absorbed is almost as important.

Is testing my blood sugar every day important?
People who test at least once a day, though at varying times, have been found to be able to control blood sugar better than those who don’t. As a result, they avoid the complications more than others.

Does  using pills for control of blood sugar work as well as insulin?
It has been shown that pills work just as well as long as you get to the goal level of an A1c of 7 or less. It is the effectiveness, not the type of therapy that is important.

Which are the best pills?
There is no one “best” Each works in a different way, and can vary in effectiveness. You should learn what your pills do, and you can do this by going to the Live Well with Diabetes Guide and learn about each type.

Why do I need to take pills for blood pressure and cholesterol, as well  as pills for blood sugar?
We have learned that we can prevent loss of eyesight, loss of nerve sensation, and loss of kidney function by controlling blood sugar and getting your A1c  to less than 7%, but we can not necessarily control heart disease, which actually kills more people with diabetes than anything else. So we have to treat blood  pressure and cholesterol as well

Is insulin only given by injection, or can I take it by pill or by other means?
Insulin is destroyed in the stomach, so we can not take it by mouth. New forms of insulin that can be taken other ways are being tested. For example, taking it by an inhaler. This is not as yet available in Canada .

What should my blood sugar be before eating, and should it be the same before breakfast as before any other meal?
Your blood sugar before breakfast as well as before any meal should be between 4 and 7 mmols/L.

What should my blood sugar be two hours after a meal?
Two hours after a meal, the result should be below 10, but if you are well controlled, it should be below 7 after two hours. By three hours it should be below 7.

What is my goal A1c level, and what does it mean?
Your A1c is the most important test in your diabetes control. The test indicates the average blood sugar all day long for the past three months and the goal level is to be below 7%.

Does stress cause my blood sugar to go up?
Stress certainly can raise your blood sugar, both for the short term and over a long  period of time if your life is not in order. That can not be an excuse to give up on control, however.        

Is there a cure?
At this point in time there is no cure for diabetes. What we can do is manage diabetes effectively and there has never been better tools available for this purpose than there is today. There is excellent guidance for diet and physical activity as well a wide range of medications, when needed, that help to manage the risk factors that must be treated with diabetes; high blood sugars, high blood pressure and high blood fats.

What have I done to cause diabetes?
You might ask yourself why do I have diabetes.  Have I done something wrong? Well almost always the answer is no.  We know that the vast majority of the tendency to diabetes is genetically transmitted.  If you are obese, your chances of developing diabetes are much higher than if you are not obese.  But by the same token we know that obesity has many genetic causes as well. So, rather than blame yourself for where you are at, I think it is better to think of what can do about it, to control your diabetes and to make your health better.

Why do I have to test my blood sugars?
Testing blood sugars provides you with valuable information that lets you know whether the diet, exercise and possibly medical therapy are working for you. Ask your diabetes doctor what your blood sugar targets are and do your best to achieve those targets. If changes in diet and physical activity for a period of 8 to 12 weeks doesn’t help then it may be time to start some form of medical therapy. Good blood sugar control is essential to good diabetes management and therefore you need to test your blood sugars and take medications as prescribed by your doctor.

I feel okay so why should I bother with medications and making changes in my diet and exercise?
Diabetes is a very deceptive disease because most people diagnosed with diabetes have probably had it for a number of years but didn’t know it. The symptoms are not always obvious. The average blood sugar tends to rise gradually and as it rises there is damage occurring throughout the body; to the heart, the eyes, the kidneys, the nerves. This can occur even though you feel okay. That is why it is so important to take action as soon as you are diagnosed with diabetes. Make the changes suggested by your doctor and see a dietician immediately.  Take the medications if needed and focus on taking care of yourself. Managing your diabetes is like managing a long-term investment. You must be thinking years ahead and the quality of your future life depends on decisions and actions in the present.

Once I start taking these medications will I have to take them for the rest of my life?
It is very possible that you may be taking many of these medications for the rest of your life but this should not be your focus. These medications are helping you to manage your diabetes and the associated risk factors. Think of these medications as a way to help you manage your wellness and avoid the long-term complications associated with diabetes. What really matters is the quality of life and these medications are often essential to helping you manage your blood sugars, blood pressure and blood fats, the risk factors associated with diabetes.

Once I start insulin am I going to gain weight like friends say?
When diabetes is poorly controlled there is a large amount of glucose being excreted in the urine. When insulin is started and blood sugar control improves much of the blood sugar (calories) that was previously being excreted in the urine is now being effectively absorbed into the body tissues and as a result some people may gain weight. This only happens when excess calories are consumed so when taking insulin you should pay very close attention to your food intake, carbohydrates in particular, as well physical activity.

I’m getting plenty of physical activity but I can’t seem lose any weight and don’t know what to do?
Weight loss can be very difficult and is a complex issue. Sometimes the best efforts at balancing energy output with caloric intake result in little or no success with respect to weight loss. Please keep these two important messages in mind.  First of all increased muscle tone and mass can mask a reduction in fat tissue and the focus should be on how you feel with respect to energy levels. Always remember that the physical activity is helping you to lower your insulin resistance and improve blood sugar management. Secondly, there are numerous research studies that indicate ‘fat and fit’ represents a far lower risk for heart disease and stroke than someone who is thinner but is less fit.  Although some weight loss is desirable and beneficial the primary emphasis of a physical activity program should be on improved fitness and a sense of well-being.

My vision is fine so I don’t understand why I need to keep going to an eye doctor?
The problems that occur with the eyes associated with diabetes don’t always appear as an immediate impairment of vision. With diabetes the small blood vessels in the back of the eye can become damaged, especially when blood sugars and blood pressure are poorly controlled. This can occur before you notice any change in vision. Therefore it is important to have regular eye check-ups. If there is evidence of eye damage, laser therapy can be used to halt the progression of the damage and preserve your vision.

My cholesterol lab results are in the normal range so I don’t understand why I should take a cholesterol lowering medication?
There is strong evidence that lowering the bad cholesterol, the LDL cholesterol, to levels well below the normal range can reduce heart attacks and strokes in people who have a high risk for these events, and that includes people with diabetes.  In other words the LDL target is lower for people with diabetes. The family of medications that is used to lower cholesterol most effectively is the statins, and along with a heart-healthy diet and exercise, you should take your cholesterol-lowering medication if your doctor prescribes it.

My blood pressure is the same as my wife’s but she isn’t being told to take blood pressure medication?
One of the reasons for this would be that blood pressure needs to be managed more aggressively in people with diabetes. There is clear evidence that lowering blood pressure below normal targets helps to reduce damage to the eyes and the kidneys, two major long-term complications associated with diabetes. Lower blood pressure can also reduce heart attacks and strokes in people with diabetes so blood pressure lowering medications are often essential as part of the treatment of diabetes. Typically these will be prescribed in small doses so you may end up taking a small amount of several different medications rather than a large dose of just one medication.