Questions

I get lumps and bumps where I inject insulin. Is there something wrong?

The lumps you describe are fat deposits that may occur when insulin is injected into the same general area on a repeated basis.

These lumps can delay the absorption of insulin and cause unwanted glucose fluctuations that trigger low blood sugar, or hypoglycemia.

You should point these areas out to your doctor. In the meantime, you should avoid those areas for injecting to allow time for them to heal.

You should change injection sites to other areas.

Always keep 2 to 5 cm distance between old and new injection site. Something that could be helpful are “injection site templates”.

One easy way to remember to rotate injection sites is to inject on the right side (of the arm, leg, or belly) for any morning and lunch insulin, and on the left side (of the arm, leg, or belly) for the dinner and bedtime insulin.

Since I have been taking insulin, I have the feeling that I am gaining weight. Is that possible?

Weight gain is a common side effect for people who take insulin — a hormone that regulates the absorption of sugar (glucose) by cells. However, controlling your weight is not only possible but also an important part of your overall diabetes management plan.

When you take insulin, glucose is able to enter your cells, and glucose levels in your blood drop. This is the desired therapeutic goal. However, if the number of calories you take in and your activity level result in more calories than you need to maintain a healthy weight, your cells will get more glucose than they need. Glucose that your cells don’t use accumulates as fat.

Weight gain may also be related to other complex functions of insulin in the body related to how cells use fats and proteins.

Eating healthy foods and staying physically active every day can help you prevent unwanted weight gain. The following tips can help you keep the pounds off:

  • Count calories. Eating and drinking fewer calories helps you prevent weight gain. Stock the refrigerator and pantry with fruits, vegetables and whole grains. Plan for every meal to have the right mix of starches, fruits and vegetables, proteins, and fats. Trim your portion sizes, skip second helpings and drink water instead of high-calorie drinks. Talk to your doctor, nurse or a dietitian about meal-planning strategies and resources.
  • Don’t skip meals. Don’t try to cut calories by skipping meals. When you skip a meal, your body is less efficient at using energy, and you’re more likely to make poor diet choices at the next mealtime because you’re too hungry. Skipping meals also causes large fluctuations in blood sugar levels. Three modest meals a day with healthy snacks in between can result in better control of weight and blood glucose levels.
  • Be physically active. Physical activity burns calories. A reasonable goal for most adults is a minimum of 150 minutes per week of moderately intense aerobic activity — such as walking, bicycling, water aerobics, dancing or gardening — plus muscle-strengthening exercises at least two times per week. Talk with your doctor about activities and exercises that are appropriate for you.
  • Ask your doctor about other diabetes medications. Some diabetes medications that help regulate blood glucose levels — including metformin (Fortamet, Glucophage, others), exenatide (Byetta), liraglutide (Victoza) and pramlintide (Symlin) — may promote weight loss and enable you to reduce your insulin dosage. Ask your doctor if these or other medications would be an appropriate part of your diabetes treatment plan.
  • Take your insulin only as directed. Don’t skip or reduce your insulin dosages to ward off weight gain. Although you might shed pounds if you take less insulin than prescribed, the risks are serious. Without enough insulin, your blood sugar level will rise — and so will your risk of diabetes complications.

I found a blister on my foot, what should I do?

Diabetes complications include nerve damage and poor blood circulation. These problems make the feet vulnerable to skin sores (ulcers) that can worsen quickly and are difficult to treat. Proper diabetes management and careful foot care can help prevent foot ulcers.

When foot ulcers do develop, it’s important to get prompt care. An ulcer that won’t heal causes severe damage to tissues and bone and may require surgical removal (amputation) of a toe, foot or part of a leg.

Here’s what you need to know to keep your feet healthy, and what happens if amputation is necessary. (Hyperlink)

How to correctly manage medication intake

Medication non-compliance is the failure to take drugs on time in the dosages prescribed. It’s a common problem. According to an April 2011 Mayo Clinic Proceedings article, only about half of those who are prescribed medication take it exactly as prescribed.

There are many reasons you might not take your medication as prescribed. They include not understanding medical terms, not being involved in the medical decision making, poor communication on the part of your health care provider, your doctor having an incomplete medical history, limited finances or access to health care, complex medication regimens, cultural barriers, memory issues, health beliefs or misconceptions and many others. It’s a complex issue with no single solution.

So then what can be done? What can you do?

First, ask questions. You have the right to understand your own medical program. Consider inviting a family member or friend to your appointments in order to assist with understanding instructions.

A lot people tend to forget to take their medication. Taking medication is a behavior, and all behaviors can be changed, although change isn’t always easy. Consider tools designed to help — such as medication organizers, dispensers, pill box timers, alarms and written schedules or calendars.

Preparing for your next Doctor appointment

Prepare for your next Appointment

Here’s some information to help you get ready for your next appointment.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there’s anything you need to do in advance. This will likely include restricting your diet, if you need to complete a fasting blood sugar test.
  • Write down any symptoms you’re experiencing, including any that may seem unrelated.
  • Write down key personal information, including major stresses or recent life changes. If you’re monitoring your glucose levels at home, bring a record of the glucose results, detailing the dates and times of testing.
  • Take a family member or friend, if possible. Someone who accompanies you can help you remember information you need.
  • Write down questions to ask your doctor. Ask about aspects of your diabetes management you’re unclear about.
  • Be aware if you need any prescription refills. Your doctor can renew your prescriptions while you’re there.

Preparing a list of questions can help you make the most of your time with your doctor. For diabetes, some questions to ask include:

  • Are the symptoms I’m having related to my diabetes or another condition?
  • What else can I do to protect my health?
  • What are other options to manage my diabetes?
  • I have other health conditions. How can I best manage these conditions together?
  • Should I see another specialist, such as a dietitian or diabetes educator?
  • Is there a generic alternative to the medicine you’re prescribing?
  • Are there brochures or other printed material I can take with me? What websites do you recommend?

Don’t hesitate to ask any other questions you have.