Frequently Asked Questions

• Diabetes is a disease that affects the metabolism. People who have diabetes either do not produce enough insulin as they use to, or no longer produce any insulin at all.

• Insulin is a hormone that is produced by the pancreas (an organ that lies behind the stomach) to keep blood sugar regulated throughout the day. Insulin attaches to the outside of the body cells and allows glucose to leave the bloodstream and enter the cells. In diabetes there is not enough insulin action. Insulin injections may be needed to lower blood glucose. Insulin cannot be taken as a pill because it would be destroyed by digestive enzymes. A simple way of understanding how insulin works is to think of it as a key. The only way glucose (sugar) can be absorbed in our bodies is if insulin attaches to the cells in our bodies and opens the cell doors to let glucose enter. That way glucose can be used as energy right then or stored for later energy use.

• With Type 1 diabetes the body is no longer able to make any insulin on its own. Causes of Type 1 diabetes include: (1) family history, (2) a virus which injures the pancreas, reducing the pancreas’ ability to make insulin; the body's immune system in response to the virus mistakenly attacks the insulin producing cells and over time these cells are destroyed. Type 1 diabetes requires that the individual take insulin (via injections) everyday. Type 1 diabetes is usually seen in children and young adults, but it can develop in older adults as well.
   
• The most common form of diabetes is Type 2. People with Type 2 diabetes are still able to produce their own insulin, but the body may not recognize the insulin like it used to, and over time there is a decline in insulin production by the pancreas, leading to the possible necessity of insulin therapy.
   
• The causes of Type 2 diabetes include: (1) Family history, (2) Overweight/inactive, (3) Belonging to a high risk ethnic or racial group such as Native-American, African-American, Latino, Asian-American, or Pacific Islander. Women who have a history of gestational diabetes (diabetes during pregnancy) or deliver a baby weighing more than 9 pounds also have an increased chance of developing Type 2 diabetes later in life.

• The diagnosis of pre-diabetes does not mean that a person has diabetes. Pre-diabetes occurs when a person's blood sugar is higher than normal, but not high enough to be considered diabetic. Pre-diabetes is more of a warning or an alert that if lifestyle changes do not occur such as increasing exercise, decreasing food portion sizes, weight loss, etc., the person will eventually end up getting Type 2 diabetes. The Diabetes Society provides education services to those patients with pre-diabetes in order to assist them in adopting a healthier lifestyle. By changing habits and sticking to them, the person with pre-diabetes can usually prevent getting Type 2 diabetes or halt it’s progression for many years.

• A cure for diabetes has not yet been discovered.. However diabetes can be treated and controlled with diet, exercise, blood glucose monitoring and medication (oral medications and or insulin) as needed.

• Eating sugar in and of itself does not cause diabetes. But eating a lot of sugar can lead to obesity (which is a risk factor for diabetes) and tooth decay. Once a person has been diagnosed with diabetes, too much sugar consumed at one time can lead to elevated blood glucose levels which over time can lead to diabetes complications.
   
• The Diabetes Society has information available on carbohydrate (including sugar) content in popular foods.

• The Diabetes Society offers free meters and testing instructions to all patients. A glucose meter is a device used to test your blood sugar. It requires a small blood sample in order to be able to tell you what your blood sugar reading is at any given time. Glucose meters can be purchased at most drug stores or grocery stores. The meters are usually located in the pharmacy area. Testing with a glucose meter is the only tool that can currently test an individual's blood sugar quickly and accurately and is easy to attain. The reason you want to test is because this is the only tool that will let you know how different foods affect your blood sugar readings, and also how your medications are working.

• Fasting = 80 - 130 mg/dl (fasting means when you wake up in the morning before you eat or drink anything, you test your blood sugar; fasting typically means 8 hours without food or drink).
   
• Pre-meal = 80 -130 mg/dl (pre-meal means you are testing before a meal, such as lunch or dinner).
   
• 2 hours after a meal = less than 160 mg/dl (this test allows you to see how the food you ate affects your blood sugar, allowing you to determine what portion size works for you in achieving your glucose level goals. Remember that 2 hours after meal begins when you start your first bite of food. For example if you start eating dinner at 6 pm you will test at 8 pm).
   
• Bedtime = 110 - 140 mg/dl.
   
• You can receive free testing booklets used to record blood glucose numbers and/or have your meter numbers computer downloaded and receive comprehensive printed reports by visiting the Diabetes Society.
   
• Target blood sugar ranges may vary for people who are unable to detect low blood sugars, young children, elderly people, women who are pregnant, or people with serious medical conditions. Please consult your healthcare team to specifically determine what your glucose goals should be and how often you should be testing your blood sugar.

• Once you have been diagnosed with Type 2 diabetes, you have it for life - it does not go away. However, with diet, weight loss, and exercise your blood sugars will improve. Your diabetes will appear to be in a remission state - which is a great goal to achieve. But as soon as you go back to old lifestyle habits like inactivity, high carbohydrate/high caloric meals, not testing your glucose regularly, and so on your glucose levels will begin to rise. So you always want to stay vigilant in regards to your diabetes self management skills.

• Please contact us at (408) 287-3785 to enroll in our ADA recognized program. To locate educators outside the area, there are several options on how to locate a diabetes education program. You can find a diabetes program by going to the following links/websites:
  • www.diabetes.org/education/eduprogram.asp - this link takes you to a list of education programs that have been approved by the American Diabetes Association.
  • You can also go to the American Association of Diabetes Educators at www.aadenet.org. Click on General Public and then go to "Find a Diabetes Educator". This site has a list of diabetes educators that you can search for by city and zip code.
  • Contacting your local hospital or health care provider to recommend a nearby diabetes education program is an option as well. It is important to think of diabetes education as a life long learning experience. It is not a one time appointment.

• Medicare covers 80% of the costs of education (within limits) and you can call us for more information. . The Diabetes Society also has contracts with many insurance plans, IPA’s and HMO’s such as Santa Clara County Individual Practice Association (SCCIPA), Physicians Medical Group (PMG), Santa Clara Family Health Plan (SCFHP-managed care medi-cal), and Valley Health Plan (VHP). These plans generally cover our programs with a minimal (co-pay) cost to you. More and more health plans are seeing that covering the cost of diabetes education and/or nutrition counseling (known as medical nutrition therapy) is beneficial. The best advice is to call the 800 number on the back of your health plan card to determine what they pay for in regards to diabetes self- management training.

• Diabetes is diagnosed by having two blood glucose tests that are higher than normal. These should be taken on two different days. Fasting blood glucose must be higher than 126 mg/dl and Random (any time of day) must be higher than 200 mg/dl. Two high blood glucose levels are enough to diagnose diabetes. Keep in mind there is no such thing as "borderline diabetes" or a "touch of sugar"- either you have diabetes or you don't. Pre-diabetes is diagnosed by having a fasting blood glucose level between 100 mg/dl - 125 mg/dl and is what used to be referred to as “borderline diabetes.”

• Diabetes can be inherited. If your parent has been diagnosed with diabetes there is an increased chance of you developing the disease. However, it does not mean that you will definitely develop diabetes - it simply means you are at a higher risk of developing diabetes over someone else whose parent does not have a history of diabetes.

• If you do not have good control of your diabetes over time, the following complications can and most likely will occur:
  • Heart disease
  • High blood pressure
  • Eye damage and blindness
  • Kidney disease
  • Neuropathy (nerve damage)
  • Poor circulation
  • Stroke
  • Gum disease
  • Serious infections in feet (often requiring amputation)
• But, with proper care and attention you can lead a happy and healthy life - complication free.

• A carbohydrate is just a fancy word for different kinds of sugars. There are many foods that contain carbohydrates such as grains, fruits, starchy vegetables, milk, yogurt, and sugary sweets.

• Carbohydrates will raise the blood sugar within 1 to 2 hours of eating them, therefore it is important to monitor how much carbohydrate you are eating.

• No, carbohydrates are not bad for you. You actually need them to survive. Your brain cannot function at its best if you do not eat enough carbohydrates. Carbohydrates from grains, fruits, starchy vegetables, milk, and yogurt provide essential nutrients the body needs to stay healthy.

• That all depends on your individual needs and your blood sugar goals. Consult a registered dietitian at the Diabetes Society to help you figure out the right amount for you.

• Registered dietitians (RDs) have training and expertise in how the body uses food. An RD that specializes in diabetes can teach you how to maintain optimal control of your blood sugar with food, exercise, and diabetes medications. Your RD will work with you to create a healthy meal plan and also incorporate your favorite foods to help manage your blood sugar levels. The Diabetes Society has an RD that can help you with your meal planning.

• Yes, most persons with diabetes can eat sugary foods in moderation. Eating a piece of pie made with sugar will raise your blood sugar level. So will eating a bowl of beans, a sandwich, or a cup of yogurt. When you eat sugary foods, the key is moderation. If you eat too many sugary foods, your blood sugar will rise higher than you expect. You will not get all of the nutrients that you would get from grains, vegetables, fruits, and milk. You can also gain weight by eating too many sweets because you will be eating too many calories. So, keep sugary foods at moderate amounts.

• The key to healthy eating is moderation and eating a wide variety of foods. By controlling the portion sizes of food you eat, you can also include your favorite foods and still keep your blood sugar in a safe targeted range.

• Potato, sweet potato, yams, taro, corn, peas, all types of beans, lentils, winter squash (acorn, butternut, pumpkin), and plantains.

• No, with diabetes your risk of heart disease is a lot higher than someone who doesn't have diabetes; therefore you must manage your cholesterol levels as well as your blood pressure. By managing your cholesterol levels with a healthy diet, you should try to eat less saturated fat and trans-fat and substitute it with unsaturated fats. Reducing your sodium intake will help lower your blood pressure.

• Foods that contain saturated fats are animal based such as lard, bacon, butter, whole milk, cheese, sausages, beef, etc. Plant based fats and oils such as palm kernel oil, coconut oil, and coconut milk also contain saturated fats.

• Usually these are store-bought cookies, margarines, some animal products, processed foods, etc. Be sure to check the labels of the foods you eat for more information on trans-fats.

• The “best” fat for you is monounsaturated fat. That includes avocado, canola oil, olive oil, olives, nuts (almonds, cashews, peanuts, and pecans), natural peanut butter, sesame seeds, tahini or sesame paste. These types of fats can actually help lower cholesterol levels.

• Polyunsaturated fat is the next “healthiest fat”. These include nuts (walnuts), corn oil, safflower oil, soybean oil, seeds (pumpkin, sunflower), and mayonnaise. These types of fats may also help lower cholesterol levels.

• Processed foods, canned soups and canned vegetables, pickled foods, fast foods, chips, table salt, seasoned salt, etc.

• That all depends on your individual needs and your current goals. For a healthy diet generally you need 30% of calories coming from fat, with less than 10% of these from saturated fat. Consult an RD at the Diabetes Society if you need further assistance with your meal planning.

• Yes, you can use sugar substitutes, except for people with phenylketonuria, who should not use aspartame (Equal brand). Sugar substitutes are calorie-free sweeteners and they do not contain any carbohydrates and will not raise your blood sugar level. Examples of sugar substitutes are aspartame (Equal), saccharin (Sweet & Low), sucralose (Splenda), and acesulfame K (Sweet Ones).

• The best thing you can do for yourself is to exercise to utilize the sugar in your blood stream. Being physically active helps lower your blood sugar, cholesterol, and blood pressure. It also helps your insulin work more effectively.

There are a couple of prerequisites needed before a candidate can be approved to sit for the exam. The requirements include (the below information is taken directly from the following website source http://www.ncbde.org/eligibilityreq.html):

1. Discipline
   1. Clinical psychologist, registered nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician (M.D. or D.O.), or podiatrist (D.P.M.) holding a current, active, unrestricted license from the United States or its territories.

      OR

   2. Dietitian holding active registration as a dietitian with the Commission on Dietetic Registration or physician assistant holding active registration with the National Commission on Certification of Physician Assistants.

      OR

   3. Diabetes educator with a minimum of a master's degree in social work or exercise physiology from a United States college or university accredited by a nationally recognized regional accrediting body.

      OR

   4. Diabetes educator with a minimum of a master's degree in nutrition, health education, or specified areas of public health from a United States college or university accredited by a nationally recognized regional accrediting body.*
2. Professional Practice Experience

   All professional practice experience is defined as employment for compensation as a diabetes educator in the United States or its territories within the past five years.

   Employment for compensation means to hold a job in which one is actively engaged in diabetes self-management training and for which paid income is comparable to other diabetes educators in the same area or region of the country. Only experience occurring AFTER completing the Discipline requirement can be counted toward the Professional Practice Experience requirement.

   After meeting the Discipline requirement and before applying for the Examination, all (A through C) of the following requirements must be met:

   1. A minimum of two years (to the day) of professional practice experience in diabetes self-management training.

      AND

   2. A minimum of 1,000 hours of diabetes self-management training experience.

      AND

   3. Current employment in a defined role as a diabetes educator a minimum of four hours per week, or its equivalent, at the time of application.

*Eligibility on the basis of an advanced degree in nutrition, health education, or public health is no longer be available, except those qualifying degrees that were completed and conferred by the degree granting institution by the end of 2005, provide that the required professional practice experience requirements are also completed and an Application submitted within 5 years (no later than 12/31/2010).

Advanced degrees in public health must be in an area of concentration specific to health education, health promotion, health and social behavior, or health communication. A degree in any other track or concentration, including administration, health policy, epidemiology, biostatistics, or population studies, is not accepted. To verify the program of study specific to the acceptable areas of concentration, an official transcript that indicates that an advanced degree was awarded and the area of concentration must be submitted with the Application for the Examination.