eating habits so that their blood sugar records improve.
I have seen several teenagers whose falsified blood sugar data were discovered by this test.
Itherefore suggest that HgbAlc be measured at regular visits every two to three months.
This test costs about $65.
IdeaUy, the other blood and urine tests should beperformed before attempting to normalize blood sugar and annuaUy thereafter.
If anab normal value is found, your physician maywish to repeat thattestand related tests more often.
The exception isthe fasting C-peptide test, as there islittle value in repeating it except to see if pancreatic function is deteriorating or improving.
I certainly like to repeat the thrombotic risk and Upid profiles about four months and theneight monthsafter blood sugars have been normalized.
The improvement that I fre quently see tends to encourage patients to continue their efforts at blood sugar normalization.
The R-R interval test should be performed every eighteen months.
I consider it the second most important test I perform on my patients after the HgbAlc
A final note: Dietaryvitamin C isimportant to good health.In doses above 500 mg/day, however, vitamin C supplements can destroy the enzymeson blood sugar test strips andcan also raise blood sugars. Fi- naUy, in levels higherthan about 400 mg/day, vitamin C becomes an oxidantrather than an antioxidant andcan cause neuropathies. If you are already taking supplemental vitamin C, I urgeyou to taperit offor lower your dose to no more than 250 mg daily. Only use the timed- release form.
Your Diabetic Tool Kit SUPPLIES YOU WILL NEED AND WHERE TO GET THEM
I n order to monitor and control your blood sugarlevels,you're go ing to need certain tools.
This chapter lists and describes them; you'U learn more about them in later chapters.
Also included are suppUes for foot care and for treating dehydrating illnesses.
For most items, approximate costs are Usted.
Some expenses wiU be onetime outlays, such as for your blood glucose meter outfit.
Others wiU con tinue on an ongoing basis.
The tools that all diabetics wiU need are Usted first.
Tools that only insuUn users wiU need are Usted separately.
Some are necessary, and some are optional.
You can show your physician the list and he or she can decide which items are appropriate for your needs.
FoUowing the tables of supplies is a brief description of each,what it's for, where you can purchase it, whether you'U need a prescription, and where in this book you'U find a complete description of its use.
If you can't locate some of these suppUes in your area, aU pres cription items and most nonprescription items can be ordered via telephone and credit card,check, or money order from Rosedale Phar macy, (888) 796-3348.
Your Diabetic Tool Kit 67
SUPPLIES FOR ALL DIABETICS
For measuring and recording Approximate cost blood sugar Blood sugar meteroutfit (including $40-$75* lancingdeviceand lancets) Blood sugartest strips (at least 1boxof 50) $37/box Glucograf III data sheets $12.95/pad of 26 double-sided sheets(covers one year),at Rosedale Pharmacy
For removing blood from clothing Hydrogenperoxide $1
For dehydration Morton's LiteSalt, Featherweight Salt $2.50 Substitute, Diamel Salt-It, Adolf's Salt Substitute, Nu-Salt Salt Substitute, etc.
For diarrhea Lomotil (diphenoxylate HCl with $25/60ml dropper bottle; $4/100 atropine sulfite) tablets (generic prices)
For severe vomiting Tigansuppositories (trimethobenzamide HCl) $45/box of 10,generic, 100mg (children), 200 mg (adults)
For low blood sugars (required if taking medication that lowers blood sugar) Dextrotabs: 1-3 bottles of 100 tablets. $ 13/bottle of Dextrotabs Also,in an emergency,B-D glucose tablets, Dextro Energy,Dextro-Energen, Dex 4, Sweetarts, or Winkies (kosher) MedicAlert identificationbracelet $35-$700 (gold)
For urine testing during Illness Ketostix (foil-wrapped), 1 package $9.50
Seeyour pharmacist for current mail-in rebate or trade-in deals. f This is an important product. The bracelet and accompanying contact infor mation (see page 71) can provide paramedics or other medical professionals with considerable information in case of loss of consciousness.
68 Before You Start
For testing food for sugar Clinistix or Diastix, 1 package $12
For foot care Olive oil, vitamin E cream, coconut oil, $5-$12 mink oil, emu oil, etc. Bath thermometer $20
For menu planning The Complete Book ofFood Counts, 7th ed., $7.99 (paperback) Corinne T. Netzer (Dell, 2005) Bowes & Church's Food Values ofPortions $59.95 (plastic comb bound) Commonly Used, 17thed.,JeanA.T.Penning ton, ed. (Lippincott Williams &Wilkins, 2004) The NutriBase Complete Book ofFood Counts $14.95 (paperback) (Avery, 2001) Artificial sweeteners Stevia extract $18.95/2ounces liquid; $18/ 1 ounce powder Saccharin tablets $4.80/1,000 tablets (1/2 grain) Equal tablets $2.95/100 tablets
SUPPLIES FOR INSULIN-USING DIABETICS ONLY
Insulins and insulin supplies* Humalog (Lilly) or Novolog(Novo),2 vials $84/vial Humulin R (Lilly) or Novolin R (Novo), 2 vials $39/vial Lantus insulin, 2 vials $90/vial Levemir (Novo), 2 vials $90/vial Frio (to store insulin while travelingin $29 hot climates) 30-unit short-needle insulin syringeswith $29/box of 100 Vi-unitmarkings, such as B-D Ultrafine II (get at least 200 to start) 30-unit standard-needle insulin syringessuch $29/boxofl00 as B-D Ultrafine (for correcting elevated blood sugarswith optional intramuscular injections, get 100to start)
The particular insulins to be used willvary from one person to another, as in dicated in Chapters 17-19.
YourDiabetic Tool Kit 69
For low blood sugar emergencies Glutose 15 (Paddock Laboratories) $15/3 tubes Glutolliquid glucose* (PaddockLaboratories) $6/bottle GlucagonEmergencyKit $104 Metoclopramidesyrup $20/4-ouncebottle
RECOMMENDED DIABETIC TOOLS , THE DETAILS
For All Diabetics
Blood sugar meter outfit.
A blood sugar meter outfit should con tain a blood sugarmeter, a finger-stick device, and a smallstartup sup ply of disposable lancets and test strips.
The meter does the samejob as the one I bought decades ago, although my old one weighed three pounds and some of the new models have footprints smaller than a credit card.
They work quite simply: with one drop of blood from a finger stick, the instrument gives you a reading of your blood sugar. (See Chapter 4, "How and When to Measure Blood Sugar.") For small children and for people who develop calluseson their fin gertips from frequent blood sugar testing, try Vaculance (Bayer), which can secure a drop of blood from arms, buttocks, or abdomen.
I use it myself occasionally.
Blood sugar meters are available at most pharmacies and chain drugstores.
Some are more accurate and reliable than others.
Because of the rapid advances in technology, it would be counterproductive to recommend a particular meter in this book.* If you want our current recommendation, please call our Diabetes Center at (914) 698-7525, Monday through Thursday, 9:30a.m. to 3:00 p.m.
Eastern (U.S.) time.
Disposable 30-gauge lancets. Theseare used with or without your finger-stick device to puncture your skin for glucose testing. I reuse mine until they become dull. The small supply packed with the vari ous meter outfits should easilylast a year.
For people with severegastroparesis(see Chapter 22). +The most accuratepersonalmeter as of this writingis the HemoCue. It is much larger and more difficult to use than other meters and requires much more blood. It is great for calibrating more portable meters.
70 BeforeYou Start
Blood sugar test strips. When youstick yourfinger, you'll put the drop of blood on or into oneof these. They work with your meter to give yourblood sugar readings. Glucograf HI data sheets. SeeChapter 5,"Recording Blood Sugar Data."These are essential to record your blood sugars and other im portant data properly. They are available from Rosedale Pharmacy and www.rx4betterhealth.com. These are the only data sheets that I recommend.
Hydrogen peroxide. Now and then, whenyou're sticking your fin gers or injecting through your shirt, asI do, you may get a little blood on yourclothing. Hydrogen peroxide isaneffective way to eradicate it. You can get small bottles for home, office, car, or travel. Available at anydrugstore and at many groceries. (See Chapter 16, page 261.)
For dehydration. Dehydrating illnesses, such as vomiting,diarrhea, or fever, are potentially fatal for diabetics. If you become dehydrated, these products can help you replace lost electrolytes. Look for potas sium chloride on the list of ingredients. These should be available at the supermarket or grocery store. Their use is covered in Chapter21, "How to Copewith Dehydration, Dehydrating Illness, and Infection." Theyshouldbe used asdirected by a physician.
For diarrhea. Diarrheacan causedehydration.The one product that appears always to workis Lomotil (diphenoxylate HCl with atropine sulfate). This is a prescription drug. Generic versions are available at lower cost.
For vomiting. Vomiting can also cause dehydration, which,as noted above, can be life-threatening for diabetics. Tigan suppositories (tri methobenzamide HCl) frequently relieve vomiting and should be used for no more than 1-2 days at a time,unless directedotherwiseby your physician. They are available in 100 mg (children and elderly) and 200 mg (adults) dosages. Use rectally as directed in Chapter 21. This product requires a prescription. Generic versions are available.
For low blood sugars. If you experience low blood sugars, Dex trotabs are a good, controlledway of bringing them up by precisein crements, while minimizing the risk of overshoot that you might experience with, say, a glass of fruit juiceor a soft drink. Each tablet
YourDiabetic Tool Kit 71
will raise the blood sugar of a 140-pound person byabout8 mg/dl.
If you run out of Dextrotabs and need an emergency supply of glucose tablets, you can use one of the following: B-D glucose tablets, which will bring up blood sugars approximately 25 mg/dl in most adults; Dextro Energy, approximately 15 mg/dl; Dextro-Energen, 20 mg/dl; Dex 4,20 mg/dl; Sweetarts, 10 mg/dl;* andWinkies, 2 mg/dl.
Most of these are available through most drugstores; Winkies are only avail able at kosher food stores andat Rosedale Pharmacy. (See Chapters 14, "Using Exercise to Enhance Insulin Sensitivity," and 20,"How to Pre vent and Correct Low Blood Sugars") Glucose tablets will not work rapidly enough for people withsevere gastroparesis (see Chapter 22).
A liquid glucose product, Glutol, made by Paddock Laboratories, raises blood sugars almost instantly.
As with most other products listed here, contactRosedale Pharmacy ifyoucannotobtainGlutol lo cally.
Dextrotabs arenot available at otherpharmacies but canbepur chased from Rosedale or from www.rx4betterhealth.com.