Diane Zych, RD, CDE, our resident certified diabetes educator, invites your questions about diabetes management.

About the Certified Diabetes Educator

Diane's focus is to educate and assist people with diabetes or those who are at risk for diabetes.

Diane is a registered dietitian and a certified diabetes educator in BJC Community Health Services, which provides a variety of preventive and early detection services for employers and community members. Diane also has worked in the Diabetes Center at Missouri Baptist Medical Center and as an outpatient dietitian in Nutrition Counseling at Christian Hospital. Diane has been with BJC HealthCare since 1991.

Get the Ask the Diabetes Educator flyer to display in your workplace.

The BJC Help for Your Health website is intended as a reference and information source only. If you suspect you have a health problem, you should seek immediate care with the appropriate health care professionals. The information in this website is not a substitute for professional care, and must not be used for self-diagnosis or treatment. Do not start, stop or change medications; or any health, nutritional or exercise program without first consulting your personal physician. BJC HealthCare assumes no liability for the information contained in this website or for its use.

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Blood Sugar Questions and Answers

I ate breakfast at 9 a.m. and at 11.30 a.m. my blood sugar was 178 mg/dl. Do I have diabetes?
A random blood glucose of 200 or more can indicate diabetes. A postprandial (after meals) blood glucose of 178 is out of range for someone without diabetes. Ideally, blood glucose should stay under 140 mg/dl, even after eating. Make an appointment with your doctor for an A1c test.

My mother is 83 and has type 2 diabetes. What are acceptable parameters for her fasting and A1c?
Ideally, your mother would discuss those goals with her doctor or CDE that her doctor works with. They know your mother and her health issues better than anyone. But, a typical fasting goal would be between 90 and 130 mg/dl. Under 140 mg/dl might also be considered low enough. An A1c should be 7.0 percent or lower for a senior, in most cases. Our blood glucose levels do make a difference, even at her age. She will generally feel better and more energetic when her sugar is in proper range. Also, high sugars can damage all our blood vessels over time, which increases the risk for heart attacks, strokes, and poor circulation in our legs. Those are just a few complications. There are many more, such as kidney disease and loss of vision.

My last HgbA1c was 6.4. About twice a week my after-dinner glucose is 200. The other five times, two hours after dinner, it is 150-160. Will this raise my HgbA1c past 7?
When you have an HgbA1c under 7.3 percent, postprandial numbers have approximately 30 percent weight and fasting 70 percent weight. Blood glucose results from the last few weeks prior to the test are also more heavily weighted. A 6.4 percent reflects an eAG (estimated average glucose) of 137 mg/dl., which is a desired result when you have diabetes.  A 7 percent HgbA1c represents an eAG of 154 mg/dl. So, I think your next HgbA1c reading would be similar, unless fasting glucose levels have significantly increased or something else in your self care has changed.

I have bursitis of the hip, and it is inflamed. Can this cause my blood sugar to rise? My last A1c was 6.9. I am 77. Should I be concerned?
Sickness and pain can cause blood glucose level to rise. Ideally, an A1c level would be under 6.5% , but staying under a 7% is still quite good. As your condition improves, a repeat A1c in 3-4 months will indicate if the bursitis influenced the number. You may need a medication change or change in diet or activity, if the number has increased.

I took a random blood glucose test this morning before breakfast. The result was 116 mg/dl. Do I have diabetes?
You need two blood glucose tests done on two separate days to be diagnosed with diabetes. A fasting glucose level of 116mg/dl indicates pre-diabetes -- a condition where the glucose level is not normal, but not elevated enough to be considered diabetes. Only your physician can diagnose diabetes. It would be good to make an appointment.

I just bought an Accu-Chek for my friend who is diabetic type 2.  I tested my blood and it showed 116 (it was 4 p.m. and I had breakfast, lunch, fruit and ice cream). Does it mean that I am diabetic? 
Please stop worrying. After eating, a blood glucose value of 116 mg/dL is normal. Ideally, random glucose values should be less than 140 mg/dL. A random glucose value is the amount of glucose in the blood regardless of the time of day taken or food eaten.

I am on 1000mg of metformin twice daily for PCOS and pre-diabetes. Lately my fasting glucose levels are 118-130 and my 2hr pp reading are around 140. Some days they range from 140 to 200. All doctors say that there is no need to worry because I am not diabetic yet. Is this not causing damage to my body? Should I not be concerned, I have a family history of diabetes and want to be proactive rather than just sit back and wait.
Your doctor is correct -- your blood glucose is in a good range. Fasting blood glucose goals for most individuals is <130 mg/dL.  Two hour post prandial glucose goals are typically <180 mg/dL. Keep a record of your numbers, and notify your doctor if you have several readings out of range. Moderate exercise after the largest meal of the day is helpful in bringing down glucose. Eating habits play a role also.

Four months ago my blood glucose level was 116. I cut back on carbs, sugar, and chose whole grain wheat and oats. I exercise 4-5 days weekly. I'm a very fit person. My fasting glucose is now 117. What did I do wrong? Recently I took a three-week course of amoxicillin for an infection in my gums.
You didn't do anything wrong. Your blood glucose is testing in the pre-diabetic range (100-125 mg/dl). Yes, an illness or infection can cause higher blood glucose readings temporarily. Continue with eating nutritiously and exercise to help maintain an ideal weight, since that benefits blood glucose levels. Diabetes is a progressive disease and tends to run in families.

Ideally, blood glucose levels should not fall below 70 mg/dl. Too much diabetes medication or not enough food earlier in the day is the likely cause. Extra physical exertion can contribute. Show your physician your detailed blood glucose monitoring records, and consider reviewing your diet with a dietitian.

Probably not. Metformin works by decreasing hepatic glucose production, decreasing intestinal absorption of glucose, and improving insulin sensitivity by increasing peripheral glucose uptake and utilization. Metformin should be taken with food, and at the same time(s) each day. If you are just beginning to take metformin, there is normally a 24- to 48-hour timeframe to reach the idea blood level. Following oral administration, approximately 90 percent of the absorbed drug is eliminated via the renal route (kidneys) within the first 24 hours. If you take this consistently, you should not notice an appreciable change in your blood sugar unless there is another reason for your blood sugars to be off. Follow your diet, avoid alcohol and be careful about infections. Take your other diabetic medications as prescribed and when prescribed. If you have fluctuations in your blood sugars and you are closely following your diabetic plan, contact your physician. Doses may need to be adjusted due to changes in weight, diet or activity level. It is important to regularly check blood sugars, even for stable, long-time diabetics.

Test your blood glucose two hours after the start of your meal. Ideally, the blood glucose should be less than 140 mg/dl. If you seldom meet this goal, have a discussion with your doctor about a change in the treatment plan. You may need to exercise more or work with a registered dietitian to modify the carbohydrate content of your meals.

There are general guidelines for blood glucose management published by the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE). However, each person needs to discuss with their physician or other professional staff -- such as a certified diabetes educator -- what their blood glucose goals should be. Differences in age and overall health status can influence recommended blood glucose targets.


Community Programs Questions and Answers

What is the "Dining with Diabetes" program? Is it like the typical diabetes education classes?
Dining with Diabetes is offered at select Dierbergs stores as a part of its School of Cooking  in the Healthy Bites section.


Diabetes Educator Questions and Answers

I need to set up an appointment with a diabetes educator at Missouri Baptist Medical Center. How do I do this?
Call the scheduling number, 314.996.5170, and request an appointment. She is also a registered dietitian.

General Questions and Answers

I am giving a speech to my classmates on diabetes. Is there anything that you would suggest I say to them?
Here are a few points to include. Many more of us have diabetes today. The rise in diagnosis is connected to being overweight or obese. Our environment is killing us. Lack of activity and fast food everywhere. Genetics do play a role. So diabetes (type 1) cannot be avoided, based on the research we have today. Type 2 diabetes risk can significantly be lowered if we live a healthier lifestyle. It is better to take good care of ourselves when we are young instead of waiting until we have health problems to then try to fix it. Last comment; have an A1c test done as a young adult if you are overweight or have diabetes in family. A 5 percent is ideal . If A1c reaches 5.7 aggressive improvements in diet, exercise and weight management are needed to avoid diabetes.

My friend has type 2 diabetes and had to go to the Emergency Department due to a poisonous spider bite. His blood glucose was 600. The doctor sent him to the waiting room. Shouldn't they have treated him right away?
Yes, that is a dangerously high level and any health problem might occur at that point. The sooner anyone receives treatment, the outcome is usually better. The Emergency Department often has many constraints and likely did the best they could in prioritizing patients.

What can I take for a headache?
Whatever works best for you. There are no exclusions with aspirin, acetaminophen (Tylenol) or NSAIDS (nonsteroidal anti-inflammatory drug like Aleve or Motrin) and most diabetes medicines. Only if you have other health issues in addition, may there be concerns.

Would you know of a sharps container drop-off site in St. Louis?
I do not.  You may try the ADA (American Diabetes Association) at 800.342.2383 (1 800 Diabetes).  It is better to not buy sharps containers due to this problem. The trash companies will not take them  It is better to use an empty plastic laundry detergent container. When full, put the lid back on and take black tape or black marker and draw an big "X" on it so it is not recycled.

If I don't have any insulin and my blood glucose level is 198, what can I take or eat to bring it down?
There is nothing you can eat to bring it down. Drinking extra water may help the sugar get through your system faster to be excreted. Exercising can also lower blood glucose levels, but do not do it when glucose is 250 mg/dl or higher. Let your doctor know as soon as you can when you are out of insulin. Some diabetics on insulin also take pills to lower blood glucose values.

Should diabetes recipes give the exchanges, so I know what I'm eating?
Diabetic recipes might still give the exchanges, but for the last 10 years or so total carbohydrate is the focus. That's because carbohydrates affect blood glucose the most. One carbohydrate serving is 15 grams. The carbohydrate could be from starch, fruit or milk; or from sugar, honey or molasses used in a recipe for sweetness. To estimate the ounces of poultry or meat per serving: deduct 25% of the raw weight and divide by the number of servings. Guessing the amount of added fat can be trickier. One tablespoon of oil, butter, cream generally adds 11-15 grams of fat. One fat serving or exchange is equal to 5 grams of fat.

What are some good diabetic breakfast cereals?
There are no specific "diabetic cereals." There are cereals with fewer carbohydrates per serving, more fiber and less added sugar than others. Look for the "whole grain" label, also for the added nutritional benefits. "Good" cereals include shredded wheat, Cheerios, Wheaties, bran flakes, and kashi. One carbohydrate portion is equal to 15 grams of carbohydrate. You may subtract half of the fiber grams from the total carbohydrate if the portion has at least 5 gram of fiber.

With Mucinex D (guaifenesin w/pseudoephedrine) and most every product that contain an oral decongestant, there can be issues. Pseudoephedrine (Sudafed) can interfere with the actions of antidiabetic agents (insulin and other drugs used to treat diabetes), and may lead to a change in your blood sugar. Check your blood sugar regularly while taking these medicines together. Additionally if you also have high blood pressure or heart disease, please speak to your physician before taking any oral decongestant.

Can taking Claritin raise blood sugar levels?
From Ask the Pharmacist
The only way that I can see that Claritin (loratadine) would be able to raise blood sugar levels is if someone would be taking the Claritin Childrens Syrup in large doses. (several bottles per week). There are no contraindications or precautions for diabetes and Claritin.

Can people with type 1 diabetes take loratadine?
From Ask the Pharmacist
Yes. Take the loratadine as needed for allergy symptoms. Be careful if you must be alert, particularly if you take other products that may cause drowsiness.

I took doxycycline and my sugar level dropped to 59. I am tired and sleepy. Why?
From Ask the Pharmacist
Doxycycline (Vibramycin) is an antibiotic. Generally speaking, infections can cause an increase in blood sugar. Taking antibiotics would kill the infection and lower the blood sugar to normal. Infections can also reduce a persons energy level. You should always have dextrose or some form of emergency sugar product to take.

My youngest has Down's Syndrome and type 1 diabetes. Can he take Mucinex Multi-Symptom Cold and Fever? Can he take amoxicillin?
Your son's conditions, neither the Down's Syndrome nor the diabetes, should keep him from using the Mucinex Multi-Symptom product or amoxicillin antibiotic. Give the Mucinex product with plenty of water and only when needed. Give the amoxicillin until all is taken.

Can I take naproxen for torn rotator cuff pain?
The issue that individuals with diabetes could have with steroids and NSAIDs (nonsteroidal anti-inflammatory drugs), like naproxen (Naprosyn), has to do with kidney function problems that may cause fluid retention. If you have diabetes with good kidney function and take the anti-inflammatory NSAID for a temporary condition, there should be no problems. If you would have to take the naproxen for a longer time, please speak with the doctor treating your diabetes.

Can you mix Aleve with ibuprofen?
Aleve (naproxen) and ibuprofen (Motrin or Advil) are both NSAIDs. You should not take these at the same time as you will be duplicating
drug therapy, increasing your risk of side effects and most likely wasting money. Take one or the other but not both together.
Take both of these medications with food or milk to prevent stomach upset.

I have diabetes and a herniated disc. What type of pain medication can I take?
The type of pain reliever is up to the physician to decide. Always inform your health care providers with your chronic conditions and current medication list. The doctor will have to decide with you, the risk vs. benefit of any form of therapy.

I am a type 2 diabetic and taking Amaryl 1mg per day. I currently have 24-7 pain due to a pulled groin muscle, and my readings have gone from the 100s to 195-250 range for the last month or so. Is it OK to take Amaryl 2 times a day instead of once a day?
From Ask the Pharmacist
Do not adjust the dosing of the Amaryl (glimepiride) without the direction of the prescribing physician. Blood sugars can run higher if there are infections or your body is under stress. The muscle pull could do this. You should contact your diabetes health care provider to let them know your condition and what your readings are.

If I take metformin and glyburide. Is it OK to take Aleve?
There is an interaction possibility between Aleve (naproxen) and glyburide (Micronase). Anytime you mix NSAIDs (like Aleve) and sulfonylureas (like glyburide) there is an increased risk of hypoglycemia. If you are looking to relieve pain or fever, Tylenol (acetaminophen) would be a better option. If you must take Aleve, do regular blood sugar tests and keep rescue dextrose with you. All your health care providers should have a complete list of the medications you take, even those just occasionally.

Can I take Aleve or Motrin if I am a diabetic?
The only contraindications for NSAIDS, including ibuprofen (Motrin) and naproxen (Aleve) are asthma, aspirin allergy, CABG (coronary artery bypass graft) and NSAID allergy. Unless you are taking other products that irritate the GI tract, there is no reason for you to avoid these drugs.

Would taking Benadryl raise your blood sugar if you have diabetes?
I cannot find any references that indicate any cause/relationship between diabetes and Benadryl (diphenhydramine) or any short-acting antihistamine. Unless you take bottles of the Benadryl Children's syrup (which contains some alcohol), there should be no problem taking Benadryl. Any diabetic should keep in mind that the better control you have over the blood sugar and A1C levels, the better your outcomes will be. Please check your blood sugar regularly.

Lantus is a long-acting insulin that stays active in the body for 24 hours and has no pronounced peak. Generally, Lantus is prescribed as a once daily injection and may be used in combination with oral agents.

Discuss this with your doctor or pharmacist. Each product contains different ingredients that may or may not work with your other medications or conditions.

Do not take any expired medication. Contact your doctor or pharmacist for a refill, or ask for samples if the cost of the medication is an issue. Expired medications may be ineffective.

Fasting blood glucose levels should be less than 100 in those without diabetes. Within four hours of eating, blood glucose levels should return to pre-meal levels. In non-diabetics, blood glucose should always stay under 140 mg/dl. Fasting levels for diabetics should be between 90 and 130. Goals after eating vary for diabetics; ideally, blood glucose should never rise above 180 mg/dl. Within four hours of eating, blood glucose should return to pre-meal levels. Pre-meal goals are often less than 130 mg/dl. How quickly insulin works depends upon what type of insulin it is. There is rapid-acting insulin and longer-acting insulin. Ask your pharmacist or doctor about the type prescribed for you.

There are no contraindications between diabetes and Mucinex (guaifenesin). Drink plenty of water with the Mucinex, and take it only as needed.

Take a sugar-free, fiber-based laxative. Metamucil and most off-brands make sugar-free products. Follow the instructions on the package. Drink more water, and eat fruits and vegetables as much as possible.

Naproxen (Naprosyn, Anaprox, Aleve) is not contraindicated for diabetes, however, some medications used to treat diabetes may interact with naproxen (any NSAID -- nonsteroidal anti-inflammatory drug). Patients with a history of GI ulceration, bleeding or perforation; liver dysfunction; or renal disease should avoid any NSAID. Make sure all your health care providers have a current list of your medications and medical conditions. Before I could say if it is safe for you to take naproxen, I would need to know your other medications.

There are three general reasons to avoid loratadine (Claritin): impaired liver function, impaired renal function or pregnancy. There is no contraindication or problem with loratadine and diabetes or any diabetes medications. Avoid the syrup and oral disintegrating forms of loratadine if you have diabetes. They may contain some sugars. Even though this is a nonsedating antihistamine, the most common side effect is drowsiness. Take as needed, and drink plenty of water.

Yes, unless you would need to take the liquid version. The liquid suspensions may have sugars with the flavorings that could cause someone with type 1 diabetes some issues. Be sure to take the antibiotic until complete and remember that infections may cause your blood sugar readings to increase. Let your endocrinologist or the doctor who prescribes your diabetes medications, know that you have an infection and keep close track of your blood sugar readings.

I cannot find any studies or papers that indicate hydrocodone should be avoided with diabetes. If you are diabetic and your physician has prescribed hydrocodone for pain, you should not have to worry about the diabetes being affected.

Vicodin (hydrocodone with acetaminophen) is not contraindicated with diabetes or with any diabetic medications. I do not believe that this will cause the blood sugar to increase on its own. Have you changed your diet or reduced your activity? Talk to your diabetes doctor about your concerns.

Tylenol (acetaminophen) would be the safest pain/fever reducer to take for any diabetic. Be sure to limit the amount of the Tylenol (acetaminophen) to no more than 4000mg per 24 hours.

There are no direct drug interactions between metformin (Glucophage) and Excedrin Back & Body (acetaminophen with aspirin). Take the metformin as instructed, usually around meal times. Limit the Excedrin to keep the daily intake of acetaminophen to 4000mg or less. The aspirin may irritate the stomach, so take this with food or milk. People with diabetes sometimes have issues with circulation, generally to the extremities or peripheral areas. If your circulation is good, you may try the Therma Patch but watch for local irritation and skin problems. Only use on intact skin.

Acetaminophen (Tylenol) does not affect blood pressure. Contact your physician. If you have a home blood pressure kit, check your pressure at the same time each day. You should not take more than 4000mg of Tylenol per day.

Sudafed PE should not cause an increase in blood sugar. It can affect blood pressure and some eye conditions. Inform all your physicians and pharmacists that you may occasionally take this medication.

Amoxicillin does not affect blood sugar, unless it was the oral suspension, which is flavored for children. Typically, when there is an infection, blood sugar does increase. I would suggest the high blood sugar is due in part to the infection. Contact your endocrinologist to see if your diabetes medication should be adjusted.

If honey is used as a cough suppressant, you have to count 1 tablespoon (3/4 oz.) as 1 carbohydrate serving. A teaspoon once or twice a day (with several hours in between) could be used and not counted. 

Diabetes can cause neuropathy, which may be a reason for pain in the extremities. However, you need to make an appointment right away with your doctor to be evaluated.

My uncle has type 2 diabetes and has managed it well with diet and exercise. However, the neuropathy in his legs has gotten worse. His falls are more frequent and also more frightening. Suggestions?
Your uncle should see his doctor for a thorough evaluation. He might need to see a neurologist. You mention that he has managed his diabetes well with diet and exercise. Diabetes is a progressive disease, and most people eventually need medications to keep the glucose down. The HgbA1C needs to be less than 6.5 percent for most people with diabetes, especially to lessen the chances of developing problems such as neuropathy.

If you haven't had a physical in the past year, it would be a good place to start.  Listen to your doctor and/or nurse or diabetes educator. Cut back on food portions. Reduce the amount of snack foods or sweets in your diet. Set up an appointment with a registered dietitian to help with meal planning. With permission from your doctor, begin taking walks or doing some other moderate activity. Check back with your doctor every 3-4 months for an HgbA1c test, and follow-up with a CDE (certified diabetes educator).

Are there any websites that give a type 2 diabetic on Metformin a good routine? I am struggling with a routine.
There are many helpful websites, but you should get basic information from your doctor about timing of medication, testing, exercise etc. Metformin should always be taken with meals. Talk to your pharmacist if you have medication questions. Test your blood glucose first thing in the morning. For most people, a range of 90-130 mg/dL is recommended. It is important that you achieve this goal before you begin testing after meals. If you meet morning goals, most people test 2 hours after a meal and less than 180 mg/dL is often advised. Discuss your blood glucose goals with your doctor. It is always beneficial to exercise, however, one hour after your largest meal often benefits us the most. Here are a few of my favorite websites:

• The EatingWell Media Group website -- Type in diabetes meal plan for 1,200-, 1,500-, and 1,800-calorie patterns that include some recipes
• This website offers information to registered dietitians  -- Go to Visit the Diabetes Center then select For Your Patients to get basic meal patterns, exercise information and more
• The Food Network website -- Select Healthy Eating in the top menu or type in 30 day meal plan for people with diabetes

Weight Questions and Answers

I have diabetes and have trouble losing weight. What can I do?
Losing weight is a challenge. We all need to work towards a healthy weight, whether we have diabetes or not. Remember weight loss does take time -- we didn't put on the 20 or 30 pounds in a few months. Research shows we can lose weight by reducing our caloric intake only, however, most people gain all of the weight back (and more) without exercise.

Get a thorough physical and talk with your doctor about starting a lower calorie diet-and-exercise program. BJC HealthCare employees with BJC health insurance can work with a registered dietitian (RD) at one of our hospitals free of charge. Others should check their medical insurance; it often covers nutrition counseling for those with diabetes. Learn more about nutrition counseling at:
Alton Memorial Hospital
Barnes-Jewish Hospital
Christian Hospital
Missouri Baptist Medical Center
Parkland Health Center
Schedule a visit with the outpatient dietitian, who can help you eat properly for diabetes with a caloric level that encourages weight reduction.