FAQ

EATING OUT

My wife and I entertain a great deal and we often go out for meals I a restaurant. I have recently been commenced on insulin for my Type 2 diabetes. How am I going to cope with eating out?

Nowadays people with Type 2 diabetes usually eat similar food to anyone who is following a healthy lifestyle. Although you should normally try to avoid foods that are obviously high in sugar and fat, this may be difficult when you are visiting friends.

Restaurants or takeaways should pose less of a problem as you can choose suitable dishes from the menu. Many people using a basal bolus regimen choose to take additional short-acting insulin to cover the extra food they are eating. Estimating the amount of carbohydrate in the food and deciding how much insulin you need is a skill which develops with experience. If you are uncertain about the size of the portion you will be given in a restaurant, you should wait until you see what is on your plate before deciding on the dose of insulin.

Sometimes people worry about how they are going to give their injections when they are away from home. With an insulin pen there should be no difficulty and most people are able to give the insulin discretely at the table when the food arrives. Do not take your evening dose of insulin before leaving home in case the meal is delayed.

FASTING AND DIABETES

As a Muslim I wish to fast during Ramadan. Is this possible?

People with diabetes who fast during Ramadan may experience large swings in blood sugar levels, as a result of the long gaps between meals and the consumption of large quantities of carbohydrate-rich foods during the non-fasting hours. Therefore, if you have diabetes, you may be exempt from fasting.

However, many people with diabetes do not want to be exempted from a religious observance they feel strongly about. If you have Type 2 diabetes and are treated by diet alone there should be no problems with fasting during Ramadan. However, there will be major changes in the pattern of eating during this month, which may affect your diabetes. If you are treated with insulin injections, sulphonylurea tablets, or a combination of the two, you should discuss how fasting may affect your blood sugar control with your diabetes team, before Ramadan commences.

If you are on sulphonylurea tablets and are fasting during Ramadan, you can take the tablet at the end of the fast, within 30 minutes of starting your evening meal. You must not miss the sehti, the meal before sunrise, if you are to avoid hypoglycemia later in the day. Rapaglinide can be particularly useful, as it need only be taken with a meal, thus requiring no change of treatment during Ramadan.

LONG TERM COMPLICATIONS: EYES

I have been diagnosed with retinopathy. Can you explain more about this?

Retinopathy is a condition affecting the back of the eye… the retina. It may occur in people with long-standing diabetes, particularly those in whom control has not been very good. There is a gradual change in the blood vessels – arteries and veins – at the back of the eye which can lead to a deterioration in vision. This may be due either to deposits in a vital area at the back of the eye or to bleeding into the eye from abnormal blood vessels.

Retinopathy may be diagnosed by examination of the eye with an ophthalmoscope or by retinal photography. It can usually be detected before it leads to any disturbance in vision. Laser treatment at this stage usually stops further deterioration.

My father has diabetes and was recently told he had cataracts. Is this connected with his diabetes?

Cataracts occur in older people whether or not they have diabetes. However, they tend to occur at an earlier age in people with diabetes. The ageing process affects the substance that makes up the lens of the eye causing it to wrinkle and become less transparent than normal. Eventually it becomes so opaque that it becomes difficult to see properly through it.

Your father’s doctor should arrange for him to see an eye specialist.

MONITORING AND CONTROL

In the past 12 months I have had to increase my insulin dosage several times … I still have been unable to get blood test results that are near to normal. I have had Type 2 diabetes for over 25 years and until last year I have usually been well controlled. What do you think is the problem?

Here are a few reasons why your blood sugar levels may have gradually crept up and why you have needed more insulin after so many years of great control:

  • Less exercise, which means more insulin is needed. Exercise acts like insulin
  • An increase in the amount of food you are eating
  • An increase in emotional upsets or stress
  • A lingering illness
  • An increase in your weight and maybe the middle-age spread
  • Treatment with new medications, especially if these include steroids
  • Problems with your injection site… are there any lumps from repeated doses of insulin being given in the same site? 

These are identified reasons… but some people do find the dose of insulin they need may vary by large amounts with no obvious explanation.

Should I keep my blood glucose monitoring strips in the fridge with my insulin?

No. It is important to keep them dry as any moisture will affect their activity. The container of strips should be kept in a cool, dry place, and not be exposed to extremely high temperatures.

You must put the lid back on the container immediately after removing a strip, unless of course the strips are individually foil wrapped. Many of the strips contain enzymes, which are biological substances that do not last long. The strips should never be used beyond their expiry date.

If you have any reason to suspect the result of a blood test, it is best to repeat the test using a new bottle of strips.

What is the normal range of blood sugar in a person who does not have diabetes?

Before meals the range is from 3.5 to 5.5 mmol/L (63 to 99 mg/dL). After meals it may rise as high as 10 mmol/L (99 mg/dL) depending on the carbohydrate content of the meal.

However long a person without diabetes goes without food, the blood sugar concentration never drops below 3 mmol/L (54 mg/dL) and however much they eat, it never goes above 10 mmol/L (99 mg/dL).