Diabetes Checklist

Every 3 months

• Hemoglobin A1c
• Weight check
• Blood Pressure
• Discuss emotional concerns you have about your diabetes with your provider

Each year              

• Fasting blood work to check the following (can all be checked in the same visit):
  • Kidney health
  • Liver health
  • Cholesterol levels
• Urine testing
  • Kidney health
• Diabetes Eye Exam
• Diabetes Foot Exam
• Diabetes Education to review the following, as needed:
  • Eating plan
  • Exercise plan
  • Blood sugar monitoring plan
  • Review all medications

What to do at home

• Check blood sugars and take medications as recommended
• Create a healthy eating plan to fit your lifestyle
• Incorporate physical activity into your daily routine
• Manage stress, and others for support when you need it

Reasons to contact your healthcare team sooner

• Blood sugars are reading over 200 every day for 1 week or more
• If you need to stop or change a medication due to side effects
• Unable to obtain medication refills or testing supplies for any reason
• Loss of health insurance or onset of financial difficulty which might prevent you from receiving diabetes care
• Onset of depression, lack of motivation, feelings of hopelessness, or suicidal ideation
• A skin tear or wound that is not healing properly
• Changes in vision
• If you get “off track” and want to work with a diabetes educator or attend a diabetes class to help you make a plan to improve control over your diabetes

 

Source: Diabetes Education Curriculum 2nd Edition, American Association of Diabetes Educators

I Have Diabetes: What Comes Next?

Finding out you have diabetes is life changing. It is normal to experience a wide range of emotions including shock, fear, anger, guilt, apathy, or denial.  Remember that it’s okay to feel any, all, or none of these things. Allow yourself to experience these emotions as you need to. Take steps to manage your stress and absorb the new information the best that you can.

Unfortunately, when you are at your doctor’s office following a diabetes diagnosis – there will be a lot of new information to learn. It can be overwhelming.  Here is some information to help you navigate the first few steps you will take on your diabetes journey, and to help you know what to expect along the way.

How is Diabetes Diagnosed?

Note: blood glucose and blood sugar mean the same thing

Test Name	Description	Meaning	Normal	Pre-Diabetes	Diabetes
Fasting Plasma Glucose Test	Fast (don’t eat) overnight, then test blood right away the morning	Tells us how well your body regulates your blood sugar during the night	Below 100	Between 100-125	Above 125
Oral Glucose Tolerance Test	Fast (don’t eat) overnight, then drink a special sugar solution at the doctor’s office and test blood	Tells us how well your body digests the sugar solution today	Below 140	Between 140-199	Above 200
A1c	Test blood at any time, even if you have eaten	Tells us the average of your blood sugar reading over the past 3 months	Below 5.7	Between 5.7-6.4	Above 6.5

 

When should I get my blood checked again?

Get rechecked every 3 months, unless your doctor instructs you differently.

What causes diabetes?

We don’t know exactly what causes diabetes. There are many different things that can increase your risk such as family history of diabetes, history of gestational diabetes (diabetes when you are pregnant), decreased physical activity, and increased body weight. Certain race/ethnic groups also have higher risk for getting diabetes: African American, Asian American, Hispanic/Latino, American Indian, and Native Hawaiian/Pacific Islander.

Does diabetes ever go away?

If you have normal blood sugar levels or if you have been diagnosed with pre-diabetes, it is possible to reduce your chances of getting diabetes.  Talk with your healthcare team about what you can do to prevent diabetes.

If you already have diabetes, this means that you have had pre-diabetes for quite some time even though you may not have known about it.  If your blood test result is high, this means diabetes is already developed. Diabetes can be controlled, but it does not completely reverse once it is developed. In general the sooner you receive treatment in the course of your diabetes, the more responsive your body will be to the treatment.

Is there hope?

Yes. Even though we don’t have a cure for diabetes, there is a lot that you can do to keep yourself healthy despite having a chronic condition.  You can take important steps to improve your health, which will slow the progression of diabetes and prevent serious problems from developing in the future.  1 in 3 Americans live with diabetes, and many are able to still have normal lives.

What can I do?

People with diabetes who keep their blood sugar numbers at the target levels recommended by their doctor have the best outcomes and quality of life.  It takes some time to learn how to do this, and to figure out what kind of treatment is going to work best for you.

The first step will be to learn basic survival skills. Be patient with yourself, not all of the changes you need to make are going to happen all at once.  You will need some time to absorb the fact that you have diabetes and to cope with many of the common emotions that people experience when they find out they have diabetes.

What happens if I wait to treat diabetes?

Diabetes that goes untreated affects your body, even if you don’t feel it right away.  In the short term, high blood sugar can cause extreme thirst, tiredness, frequent urination, and stomach pain.  If your blood sugar gets too high, it can cause you to go into a coma and die.  Long term, some of the most common and serious problems caused by high blood sugar are damage to your blood vessels and your heart.  It can also cause kidney failure and loss of vision.  These problems are usually preventable when diabetes is treated successfully.

What if I can’t afford to treat my diabetes?

Unfortunately, medications and doctor appointments can be expensive.  However, the long-term problems that diabetes can cause if left untreated are even more costly.  If you have concerns about how you are going to pay for your medications, please talk to your doctor about what the most affordable options for care might be.

What if I feel too much stress and anxiety about my diabetes?

Many people dealing with a chronic disease experience stress, anxiety, fear or depression about the future and about day to day living. If you are experiencing any of these feelings and you think it may hold you back from taking care of your diabetes, you may find it helpful to meet with a professional counselor.  Ask your doctor about getting an appointment set up.

What comes next?

• Come to your next follow up with your doctor
• Ask your doctor if you can talk with a diabetes educator, who can help you get started learning basic survival skills
• Talk with your doctor about any concerns or questions you have about starting your diabetes treatment
• Ask for support from a close friend or family member, or seek professional counseling

 

 

American Association of Diabetes Educators. (2015). Diabetes Education Curriculum: A Guide to Successful Self-Management (2nd ed.). Chicago, IL: American Association of Diabetes Educators.

April Newsletter

Spring is here (or at least getting close…)! This month’s newsletter has tips about getting out to enjoy the warm weather and cooking tips to help freshen up your routine.

Diabetes Newsletter Apr 16

Diabetes Services Flyer

Here is a full description of the extra diabetes services we are currently offering at our clinic. Some are open to the public and others are limited to clients who see a provider at our clinic. Please contact us (402-371-8000) with any questions!

Click here: Diabetes Services Flyer

 

 

Medical Alert Cards

Having a medical alert card is an important way to keep you safe in the event of a diabetic crisis. If your blood sugar becomes either too low or too high, you will become unconscious.  You will not be able to tell anyone that you have diabetes, and this could cause a delay in appropriate life-saving treatment.

Here is a free printable version provided by the American Diabetes Association. It has all the information you need to communicate in the event you are unable to do so for yourself.

Medical Alert Card

Print and complete copies to keep in your wallet, purse, desk at work, or in your car. There are other versions available elsewhere on the web, and some people prefer to purchase a medical alert bracelet or necklace that they can wear. The important thing is to keep it with you wherever you go. It is also a good idea to make sure that close family and friends know you have diabetes, and know what to do or when to get help.

If you are unable to print this at home, just ask us at the clinic and we will be happy to provide you with one. We also have a Spanish version available. You may also ask at your local library or community center.

 

Part 3: Getting Exercise on Your Terms

Here is an area of health that is often underrated. Let me just start by rattling off some benefits: helps us maintain a healthy body weight, boosts and stabilizes our moods, improves sexual health, builds muscle mass which supports our skeletal system (bones!) which helps prevent injury and some types of chronic pain, creates strong social bonds when we do it together, gives us a sense of accomplishment, and can even – wait for it…be FUN!

In fact, I can’t really emphasize the fun part enough – because when we find activities which we enjoy and allow us to spend quality time with friends and family – we are much more likely to make such an activity an ongoing part of our lives. On the flipside, when we view exercise as an obligation or a punishment – the fun gets lost and it becomes challenging or impossible to stick with it.

Sometimes we think we have to go BIG or go home. Not so with exercise. In fact, the American Heart Association says –just walk! Walk more often and walk farther, walk with your dog and walk with your best friend (I think I’m starting to sound like Dr. Seuss) – just keep moving!  However, there are real barriers even to do something so simple. For those of us who live in crowded cities or in areas of the world which are partially frozen over half the year – it can be trickier to find a safe place to exercise.  People who suffer from chronic pain or chronic depression may experience extreme difficulty with exercise (although as I mentioned above, exercise may one of the most promising remedies for reducing symptoms for both chronic pain and chronic depression).  Busy workers, parents, and caregivers are loaded with stress and responsibilities, making it hard to find the time and motivation to exercise.

I would encourage you to examine your life and identify your own barriers to being active.  You may have to get creative – but I assure you it is possible to find some kind of solution to being sedentary (not moving enough).  Stretches or strength moves that can be done from sitting or lying-down positions can help those who need low-impact exercises due to joint problems or other injuries.  Going to physical therapy may help with a severe pain issue and regaining strength.  Getting a membership to a gym or hiring a trainer can help you learn how to exercise safely and more effectively.  If this is not something you can afford – try asking a friend who likes to exercise to teach you what they do. Chances are – this is something they care about and would be happy to do with you.  Find activities you can do with your children or grandchildren (exercise is important for them to!), or that involves doing something other than just “exercise” – think hunting, fishing, hiking, gardening, or fixing that broken step.

It sure sounds like it is hard to go wrong with exercise.  As a wise consumer, what might be important to consider when choosing an exercise program?

• Safety
• Personal Preferences, Motivators and Goals
• Cost
• Sustainability

In the last post we talked about the importance of making gradual and sustainable changes to your lifestyle. This also applies to exercise. If you have not typically done much exercise in the past, it is a good idea to talk to your healthcare team about how to start.  If you have a medical condition like diabetes, it is important to know that an increase in exercise can cause episodes of low blood sugar which can make you pass out. You need to know how to properly check your blood sugar and make sure you eat enough carbs during your work out.

You also want to make sure you don’t go from 0 to 60 too quickly.  You might burn out and think exercise wasn’t such a great idea after all.  You might pull a muscle or injure your back.  It’s important to realize that even if you start with a very small amount of exercise – you will gradually be able to build your way up to a higher level of intensity if you do it consistently.  A program that will help you stick with exercise may be the most important factor to consider.

If you are exercising specifically to lose weight, you may need a more intense exercise program to help you burn extra calories. It is also important to learn how much weight is safe to lose over a certain amount of time.  (For most people, the recommendation is no more than 2 pounds week).  However, you might find it more encouraging to focus on the exercise itself, rather than thinking only about your weight loss.

Investment in a gym membership or home exercise program may motivate you to stick with your program. However, it is good to know that there are many ways you can do exercise without spending extra money.  Using the buddy system and a free workout video on YouTube might be an alternative way to meet your exercise goals.

Whether you have years of experience doing exercise or you are just getting started, the best advice I can give is to listen to your body. There are all kinds of specialty workouts and gyms out there – if you are concerns something is hurting your body, stop.  If you have trouble telling the difference between sore muscles and an injury, it might be time to talk to your doctor or physical therapist about exercise safety and appropriate injury treatment to prevent long term complications and pain.

Thanks for sticking with me on this series about becoming wise consumers! I hope you found it helpful and that you feel more confident next time you are making a decision about how to best manage your personal health.

Part 2: Learning About Eating and Diet Plans

While we are learning new things each year about vitamins, minerals, nutrients, micronutrients, and phytochemicals (hmm – that sounds exciting, right?) – there is also quite a lot that we DO already know about food. Food habits in society are prone to changing over time. As we have more technology and methods to grow and produce food – preferences, tastes, and trends change – or we experience periods or food shortage or plenty – we can expect there to be some changes in our diets as well. HOWEVER – basic food information really has not changed much in recent times (think My Pyramid which you may have learned about in elementary school, it has since evolved to My Plate – but the core principles have remained the same, see www.choosemyplate.gov ).

Also check out the most recent (for 2015-2020) updates to the guidelines summarized nicely here:

http://health.gov/news/dietary-guidelines-digital-press-kit/2016/01/top-10-things-you-need-to-know/

 

So let’s say you are either trying to lose weight or eat more healthfully and your friend suggests a new diet plan that worked for him or her.  How do you know if it’s legit? While food principles have remained largely unchanged – the ways in which we think about food are constantly changing – just like people.  This isn’t a bad thing. We might find new recipes which are more exciting and appealing – we could find a meal plan we can really stick with and make progress towards our health goals.

The key to judging a diet plan is whether it sticks to the core principles of nutrition science – or simply put, the basic food rules that are well known and widely accepted. A diet plan that suggests major changes – for example cutting out an entire food group or essential nutrient – is unlikely to be a truly healthy or sustainable plan.  A core value of basic nutrition is that nearly all kinds of foods can be incorporated into a healthful eating plan, as long as the foods are eaten in the right amounts and in the correct ratio to each other –or as my mother-in-law loves to say, “All things in moderation”. In this way, a well-balanced diet can meet the needs of people all around the world – without having to give up special traditions and preferences.

Consumer tip number three: In everyday language, the word “diet” can sometimes refer to a plan specifically intended to cause weight loss. But, it can also just mean a general eating plan. It can refer to an eating plan that incorporates special preferences or practices – for example you may have heard of the Mediterranean Diet which reflects food choices popular in a certain area of the world.

Another issue to consider is the cost of the product or plan.  Is the price going to put an unnecessary burden on your food budget? Is this specialized food plan something you will be able to afford for a long time – or something that will cause you to “fall off the wagon” once it becomes too expensive or once the initial appeal wears off?  If a product or plan is based in sound food principles AND you can afford it – then it might be an awesome tool for you to use to reach your goals. Sometimes having a little money invested (for example, paying for an online cooking class) is more motivation to actually DO it.

One important thing to know – is that you don’t NEED a special plan or product to reach your goals. (Although having A PLAN doesn’t hurt!) By reading about appropriate healthy diet changes and exercise habits, you can do everything you need to do from the comfort of your own home without spending significant amounts of extra money.  The special programs and plans should be thought of as tools or helpers – a kick in the pants, if you will – to really get you motivated and moving towards your goals in a way that is more interesting, exciting and provides you with accountability and support. However, I can’t emphasize enough that the most effective plans should help you make gradual and sustainable lifestyle changes. We are all human, and it’s important to allow for that in our self-expectations!

It is also very important that basic health information be widely available – on the internet, at the library, in schools and medical clinics – presented in a way that people from all different backgrounds can access, understand and afford. Efforts to do this will help to bring down some of the barriers that people face to living healthfully.

One more point worth touching on is specialized diets. You may have heard of things like low-carb diets, gluten-free diets, or low-sodium diets.  There are specialized diets which are recommended to certain people based on specific medical conditions. For example, when a person has abnormally high blood pressure – it is necessary to reduce sodium intake in order to maintain health (there is also a recommended sodium intake for people with normal blood pressure – 2,300mg or less per day).  For people with diabetes, it is important to measure carbohydrate intake. For people who have gluten intolerance or allergies – it is necessary to cut certain foods out altogether.  However, usually these kinds of diets are not appropriate for people who do not have the specific medical condition for which the diet applies.  Once again, a good practice is to talk to your healthcare provider if you are considering a new diet or meal plan.

What about vegetarians and vegans? This is perhaps more mainstream knowledge – but it’s worth noting that it is possible to maintain complete nutrition using these dietary practices (by getting protein from plant sources). However, you have to know what you are doing. If you don’t get enough of the right foods, you could become severely deficient in nutrients your body needs to survive. This can be a concern with other dietary preference based diets as well – including the popular Paleo diet (calcium and Vitamin D deficiencies have been observed).

Our human bodies are readily adaptable to many different kinds of foods – and the general scientific consensus is that we thrive on a wide variety of nutrients.  Another area of agreement is that foods which are generally less processed contain more valuable nutrition and less extra sugar and salt – not to mention better flavor!  This is why there is good scientific basis in the push for eating more fresh foods and using healthy food-growing practices.  But, it’s also important to realize that people started preserving certain foods for a sound reason too – to prevent waste and increase food supply. While fresh foods are an important piece of a healthy diet – appropriately preserved foods can also serve to make healthy foods more widely available and affordable for everyone.

You’ve almost made it! We have one more section to go in our discussion about being wise consumers. Getting Exercise on Your Terms will be the final topic!

Part 1: Things to Know About Nutritional Supplements

As I mentioned in the introduction post to this series, we (people in general who study medicine and nutrition) are still in the process of learning about how different amounts of different chemicals in our food affect our bodies and our health. Yes, I just said chemicals. As in – the naturally occurring substances that make up the world around us (think back to that high school science class) – any of which can be helpful or harmful depending on the dose.

Consumer tip number two: don’t be afraid of the word chemicals. Rather, learn about which products contain healthful chemicals in healthful quantities and which products do not. Learn what chemical-free, all-natural, or organic claims actually mean for each product – in some instances a claim may truly be beneficial while in other cases it might just be a gimmicky advertisement for an ineffective or overpriced product.

The thing to know about nutritional supplements is that they are not officially regulated by the FDA (Food and Drug Administration) for safety and quality as other kinds of medications are (prescription and over the counter drugs which are not considered supplements).  This also means that the claims which companies make who sell these products – are only loosely regulated. They can say most anything they please with the caveat of printing “These statements have not been approved by the FDA” in the small print.

We do know – based on long-term study – that there are benefits to taking certain nutritional supplements. Some of the best examples include folic acid for pregnant women. Lack of this essential nutrient is linked to a severe birth defect called Spina Bifida (part of the baby’s spinal cord is on the outside of the body).  We know that taking calcium supplements can help reduce the risk of osteoporosis – especially in at risk women who do not get or absorb enough calcium from the food they eat. Iron supplements can help with the problem of anemia (too little iron in the blood).

For other kinds of supplements, there is far less evidence to support whether or not the product does in fact improve your health – or even if it is safe to take on a daily basis.  There is also a considerable amount of evidence to suggest that getting nutrition from your food – rather than in a pill form – is most beneficial for your health.  Yet all of this is not to say that there are not some useful and safe supplements on the market.

Additionally, there are long-standing traditions in many cultures of using certain plant-based supplements or herbal remedies that many people find to be helpful.  In fact, some of these traditions have become prescription medications throughout history.  Did you know that aspirin is made from the bark of a willow tree? Meanwhile others have been found to be dangerous and their use has become less common – take tobacco as a prime example of a plant that turned out to be not so healthy.

The most important thing I can say about these supplements is to talk with your health care provider about whether a certain supplement is right for you.  While supplements are not technically “drugs”- they do contain chemicals (even if they are natural) that could interact with other prescription or over the counter medications you are taking in a dangerous way. They could also be a problem if you have a certain health condition.  Or, maybe they are just a waste of your money if you are eating plenty of nutritious foods already and “peeing out” the excess nutrition. (For example, your body can only hold a certain amount of certain kinds of vitamins at a time –so extra may not be used or stored by your body. Other vitamins are stored in your fat – and taking very high amounts of them could be unhealthy!). Weight loss supplements can be high in caffeine or other compounds which can cause dangerous amounts of weight loss or an increased heart rate. It is also possible to have an allergic reaction to a supplement. Because there are so many different kinds of supplements out there, good practice is to talk it over with an expert to help you make a decision.

Supplements contain varying amounts of each ingredient. Therefore, it is possible that if you are taking multiple supplements with multiple ingredients – you could be getting double or triple doses past the recommended safe amount (safe amounts or daily values are set by the people who study nutrition science – think about those % numbers you see on a nutrition label). What if your multi-vitamin, calcium supplement, and mood-boosting mix supplement each contain a high amount of Vitamin D? Supplements also vary in quality – as I said before, the regulations for making the products are less strict. This means a bottle could claim to have high amounts of a certain Vitamin – but be of such poor quality that your body can’t even absorb it. Not only would this be a waste of your money, but you might not be getting the nutrition you need. To help prevent this, your doctor or pharmacist may be able to recommend the most reputable and trusted brands available.

A final note – when a company or salesperson makes a claim which sounds “too good to be true” – it likely is.  Unfortunately, most real health improvements are not so easily attained.  A pill or supplement that claims easy weight loss – may come at the cost of causing harm to your body. A claim to cure you or prevent all diseases plays on our desire for “quick fixes” or security that we won’t become sick in the future. The truth is, based on the past 100 years plus of intense medical practice and research – we don’t have any miracle cures just yet. Anyone who claims to have one is likely lying to you – or worse, taking advantage of your good intentions to make a profit.  But again, I would like to emphasize that we are constantly learning new things about nutrition and the benefits of healthy foods in preventing diseases –nutrition is really important – we just can’t claim to know more than we really do about the subject.

Sometimes it is tempting to base our decisions off “hearsay” or what other people have said works for them.  It is important to consider that your unique health needs may be different from someone else, and also that just because one person says it works – or thought it worked doesn’t necessarily mean it is true.  It is better to get information when many people have tried something and it has been shown to work time and time again (for example, a drug proven through research to lower blood sugar) – this is a kind of information that can be more readily relied upon to get good, predictable results.  Or at the very least – sets realistic expectations for what kinds of benefits and limitations will result.

Up next, Part Two: Learning About Eating and Diet Plans

The “Skinny” on Health-Fad Business: Tips to Being a Wise Consumer

Introduction:

Take a quick look around on the internet and you will notice that advertisements for weight loss programs and health foods abound – from exercise videos to meal plans, food lifestyles and dietary supplements. There’s no question the health arena is a hot area in business. Seeing all of this different information might cause you to ask questions like – how do I know if it will work, if it is safe, and if it will actually help me reach my personal health goals?

My goal in this three part series is to help you make sense of what you see, and to learn how to judge for yourself whether a program or idea that promises health and wellness is worth your money, time and energy.  I want to be very clear that I am not encouraging or discouraging any specific brands, programs or ideologies – just providing information to help you understand the choices you have in managing your health.  Health is deeply personal, and it is important that we show respect towards each other’s varying values and beliefs.  Keeping this in mind makes it easier to have meaningful conversations and to exchange valuable information with one another.

After this introductory post, we will also cover these topics:

• Things to Know About Nutritional Supplements
• Learning About Eating and Diet Plans
• Getting Exercise on Your Terms

You will find that the ideas I share will follow mainstream medicine and health science –as I personally believe to be my responsibility as a trained healthcare professional.  I will talk about evidence – which means that information I share is not just based on my opinion, but is the same general conclusion reached by many different people who have studied a certain topic for a long time. This does not mean that I simply repeat everything I hear from expert scientists – I think about it and decide whether I think it makes sense. I encourage you to do the same.

Consumer tip number one: Notice how I’m using words like “usually, in general, typically” and avoiding phrases such as “never, always, or the only possible right way to do something”?  This is a GOOD thing. Whenever someone claims to know everything there is about anything – they probably don’t – especially if the main argument they present is based primarily on their own opinion or experience, and they can’t give you much information to help you understand it for yourself.

On the flip side – if someone presents a reasonable argument that is based on the best information available (meaning information which you can look at and evaluate for yourself) – it may be well worth your time to listen. It may also help to consider the advice of experts (someone who has spent a considerable amount of time learning about the subject) – not because they are an expert, but because they have taken the time to learn about a complicated issue and can help you understand it for yourself.

Let’s take a minute more to talk about evidence. Sometimes when I am talking to patients, family or friends about health – a common response is “the doctors are always changing their minds about what is healthy and what isn’t – do they even know what they are talking about?” For example, 10-20 years ago the recommendation was not to eat eggs because they were too high in cholesterol.  Now, the medical community has backed off a bit to say that eggs are in fact healthy to eat despite their cholesterol content, just don’t eat too many of them at once. It often seems there are all kinds of trendy new fads for health, exercise, or eating.   When your healthcare team gives you advice you might wonder, “Will eating less saturated fat really make a difference in my cholesterol level? Will lowering my cholesterol really prevent a heart attack?”

It can be frustrating when we hear that a health recommendation which we thought we could trust has changed.  But really, we should be very glad that it does. For example – early surgeons used to perform “blood-letting”- a practice in which they drained blood from a patient to “get the disease out”. Not surprisingly – people used to die from this.  They also never used to realize how important it was to wash hands or sterilize surgical instruments. Of course – we now understand very well how important these practices are in preventing serious infection.  For better or worse, this is all part of our natural human process for learning new things and improving upon what we already know.

Same goes for recommendations about diet and exercise, and how they affect people who have certain diseases– only, there is a still a lot we have to learn. The most important thing is to know if the information you are being told is current, up to date and actually based on careful and honest study – not just the whim of a company or magazine trying to make a profit. If you would like to learn more about how to find trusted websites, I encourage you to read my upcoming blog post: How Do I Find Trustworthy Health Information?

Otherwise, check out the next post, Part One: Things to Know About Nutritional Supplements.

March Newsletter

This month we are focusing on carbohydrates (or carbs, for short): what they are, how to know how many you should eat, and how to keep track.  We will talk about how you can do this in a practical way.  Learning about carbs and carb-counting will help you gain better control over your blood sugar readings!

Click on the link below to view A Guide to Managing Your Diabetes for the month of March:

Diabetes Newsletter Mar 16