Study the sections below to watch education content about diabetes

Understanding Diabetes

Transcript: Understanding Diabetes: an Overview

This animation focuses on how the body normally breaks down and uses food, and explores how the body maintains a healthy level of glucose, the simple sugar used for energy.

There are several types of nutrients, we will focus on how the body digests one type, called carbohydrates, as this most directly affects glucose levels.  Carbohydrates are made up of long chains of sugars.

After you swallow food, it travels into the throat and down the esophagus and into the stomach.

Carbohydrates in the food are broken down into smaller chains of sugars and eventually into glucose, the main energy source used by the body.  Enzymes are biological molecules, or proteins, that help complex reactions occur everywhere in life.  Enzymes like alpha glucosidase are responsible for the breakdown of carbohydrates into smaller chains of sugars.  These sugars travel to the intestines where they are absorbed into the blood.  Hormones, such as GLP-1 and amylin, are released by the intestines and help to slow food leaving the stomach.  These hormones also act on the brain, causing it to slow food leaving the stomach and all-around creating a feeling of fullness.

In the pancreas, there are groups of cells called islets. Beta cells, which produce insulin, are a type of cell within the islets. Glucose from digested food and the gut hormone GLP-1 both stimulate beta cells to release more insulin into the blood stream when food is eaten.

Most cells in the body, including muscle and fat cells, need insulin to bind to cells before glucose can enter the cell and be used for energy.

Glucose entry allows these cells to function and also lowers glucose levels in the blood stream.

Since most cells in the body need glucose for energy, it’s important for the body to maintain steady glucose levels in the blood.  The liver helps maintain blood glucose levels by storing glucose when insulin is present.  When you are fasting (or not eating food for long periods of time), less insulin is present and the liver releases stored glucose into the blood.

The kidneys help filter toxins from the blood and excrete them into the urine.

The kidneys also filter out some glucose, but the body is able to re-absorb that glucose through protein transport channels on the surface lining of the kidney so that glucose is not lost in the urine.

Transcript: Type 2 Diabetes

Type 2 diabetes is the more common form of diabetes

In type 2 diabetes, cells in the body become more resistant to the effects of insulin, so less glucose is taken up by the cells.  This raises blood glucose.

Beta cells in the pancreas try to produce and release more insulin to overcome this resistance.  However, over time the pancreas cannot produce enough insulin and blood glucose levels remain high, resulting in diabetes.

The liver also becomes more resistant to insulin, which normally stops it from releasing stored glucose.  As a result, the liver releases too much glucose into the blood.

The higher levels of glucose in the blood causes damage to the blood vessels in organs throughout the body in both these forms of diabetes.


Transcript: Type 1 Diabetes

There are several forms of diabetes.  All forms of diabetes involve having too much glucose in the blood, which can have harmful effects on the body over time.

Type 1 diabetes, formerly known as “Juvenile diabetes”, is an autoimmune condition.  This means that the immune system, which usually fights viruses and bacteria, produces antibodies that fight and destroy the insulin-producing beta cells in the pancreas.

Since insulin is needed for cells to take up glucose, a lack of insulin will raise blood glucose levels and result in diabetes.  Because beta cells are destroyed, people with type 1 diabetes always require insulin therapy.


TRANSCRIPT: Nutrition for People with Diabetes - Part 1: An Overview of Nutrition

Hello.  Thank you for listening to my presentation “Nutrition for People with Diabetes.”  I’m Christine McKinney, a Registered Dietitian Nutritionist and Certified Diabetes Educator with Johns Hopkins Medicine.

My talk is divided into four parts so you can listen to the entire talk or just the parts you choose.  This is Part 1:  An Overview of Nutrition

To start, I want to talk about the general relationship between food and blood glucose.  It’s important to eat at the right time to keep blood glucose steady and to prevent glucose from dropping too low.  Eating the right amount is also important.  Eating too much food can raise blood glucose and too little food can lower blood glucose.  Eat healthy foods from all the food groups and eat Whole Foods.  Whole Foods are as close to their natural form as possible.  For example, a baked potato is considered a whole food, but french fries are not.

A good starting place for when to eat is to think about consistent timing with meals and snacks.  When possible, eat about the same time each day.  Eat at least three times during the day.  Plan meals no more than 4 to 5 hours apart.  Avoid skipping meals, which can cause you to become more hungry and overeat at the next meal or cause a low blood glucose if you take certain diabetes medications.  Some diabetes medications are recommended to be taken with food so consider balancing the time you take your medication with the times you eat.

To help control glucose, try eating about the same amount at each meal.  Snacking between meals should depend on your personal preferences, individual eating plan, meal timing, and hunger.  Think about the timing of your meals.  If lunch is at 12 noon and dinner is at 7 pm, that’s 7 hours and you need to plan a snack between those meals.  In general, if your meal timing is more than 4 hours apart you may need a snack.  When it comes to snacking, avoid snacking out of boredom, or habit, especially nighttime snacking.

An important part of eating the right amount of food is learning to listen to our body’s signs of satisfaction and fullness.  Satisfaction means I’m no longer hungry.  Think about asking yourself before, during, and after you eat if you are satisfied and that will help you to eat the right amount of food.

This concludes Part 1 of the Presentation.

In Summary: Eat three meals each day and snack if you are hungry or if there was a long time between meals.  Eat about the same amount at each meal to help control glucose.  Listen to your body and stop eating when you are satisfied.





Transcript: Nutrition for People with Diabetes – Part 3: Nutrition Labels

Welcome to Nutrition for People with Diabetes – Part 3: Nutrition Labels.  I’m Christine McKinney, a Registered Dietitian Nutritionist and Certified Diabetes Educator with Johns Hopkins Medicine.

The Nutrition Facts label gives us helpful information about the food we eat.  At this time we have two food labels.  Larger companies are required to update the labels by January 2020, and smaller companies by January 2021.  There were several changes, including:

  • Removing calories from fat, because research shows that the type of fat is more important than the amount.
  • Enlarging the type size for “servings per container”, “servings size”, and “calories” to focus on serving size and calories.
  • Including added sugars under total sugars. On the old label, sugars included natural sugar from milk and/or fruit and added sugars.  On the new food label, added sugar is listed under total sugars.  With the new label, it’s easy to tell how many carbohydrates come from added sugar.  As a reference four grams of sugar is equal to one teaspoon.

When reading a food label, start at the top with a serving size.  The nutrient information on the label is for one serving of the size listed.  The percent daily values (%DV) are a guide based on a 2,000 calorie diet for adults.  So, if the label says 10% DV total fat, that means it’s providing 10% of fat for your day.  You can use the percent daily value as a quick reference for nutrients.  5% or less is low for a nutrient and 20% or more is high for a nutrient.  6 to 19% is in the middle range.  Total carbohydrates include starches, natural and added sugars, sugar alcohols, and fiber.  If you are counting carbs look for total carbohydrates in grams.  If you are using carb choices divide the total carbohydrates by 15 because one carb choice has 15 grams of carb.

Let’s practice label reading.  How many grams of carbs are in two tablespoons of this peanut butter?  If you answered eight grams, that’s correct.

Which nutrients are high in this product?  The answer is total fat and niacin, because those contain more than 20% of the daily value.

Which nutrients are low in this product?  If you answered cholesterol, sodium, calcium, iron, and potassium, that’s correct, because the percent daily value is 5% or less

Let’s read another food label.  How many grams of carbs are there in three cups of riced cauliflower?  Remember to check the serving size first.  If you answered 12 grams of carbs that’s correct because one cup equals 4 grams of carb.

How many calories are in the entire package?  There were 4 servings in the container so the entire package is equal to 80 calories.

How much fiber is in 2 cups?  If you answered 4 grams of fiber, that’s correct, because each cup contains 2 grams of fiber.

This concludes Part 3 of the presentation.

In Summary: Read the Nutrition Facts label to compare products and make healthy choices.  Use the percent daily value as a guide for nutrients.  Remember 5% is low and 20% is high for any nutrients on the label.  If counting carbohydrates, count total carbohydrates on the label.


Transcript: Basic Nutrition - Maureen Seel

When we as dieticians talk about nutrition, you’ll hear us talk about three main kinds of nutrients:

We’ll be talking about carbohydrate more in a later video.

 Protein comes from many different foods.  It helps us build and rebuild tissue, and it functions as part of our immune system that helps us fight disease.

 Protein comes from animal sources such as meat, eggs, cheese, and other dairy, like milk.  It also comes from vegetable sources such as soy products like tofu, beans, lentils and other legumes, nuts, and seeds.

 When eaten by itself, protein doesn’t have much of an effect on your blood sugar.  But when you combine it with foods that contain carbohydrate, it can improve your blood sugars response to the carbohydrate.

 Fat, though many think it’s not very good for you, is a very important part of our diets.  It helps insulate us from the cold, and it cushions your organs from injury.

 It can be found in healthy sources such as mono and polyunsaturated fats.  Most of these types of fats are either found in fatty fish like salmon, or in vegetable sources such as olives and olive oil, and nuts, seeds, and avocados.

 Unhealthy fats – trans – which are man-made fats, and saturated fats, which come from animal products, are found in things like full-fat dairy, butter, cheese, and the white fat that you might see on meat, which is called marbling, and also from things like full-fat dairy.

Transcript: Carbohydrate Basics - Maureen Seel

The word carbohydrate has been used several times in the previous videos. 

You might be wondering what exactly is carbohydrateCarbohydrate is really just a word for different kinds of food that, when you eat them, most of what is in that food will turn into sugar.  That being said, there’s nothing wrong with carbohydrate foods.  Our bodies use sugar the same way that a car uses gasoline.  The problem is diabetes is not a problem with the food, but our body’s ability to handle the food.  When there’s an imbalance of the hormone insulin and sugar from these carbohydrate foods, that’s when your blood sugar start to get out of control.

Carbohydrates come from many different foods, and they fall into one of two categories:

Both sugar and starch are carbohydrate, just like a Dachshund and a Dalmatian are both dogs.  Both will wind up as sugar, or glucose, which is a simple sugar, eventually.  But some may raise your blood sugar faster than others. 

Two main sources of starch in our diet are grains, such as oats, rice, and bread products such as of course bread, pasta, and crackers, as well starchy vegetables such as potatoes, sweet potatoes, peas corns, beans, and legumes.

Sugar comes from added sources such as sweets like cake, candy, and cookies, as well as natural sources such as fruit, fruit juice, milk, and yogurt.

All of the foods pictured here, including the sweets, can fit into a healthy diet.  Moderation is the key.

You might be wondering how many carbohydrates do I need.  For more specific information to yourself, you may want to see a dietitian for specific advice.

A general rule of thumb is for men, if your blood sugars are not in good control or if your doctor has told you to lose weight, you should aim for 45 to 60 grams of carbohydrate for each meal.  If you’re looking to maintain your weight and your blood sugars are well-controlled, you may have more than 60 grams or up to 75 grams per meal.

For women, same thing.  If you are looking to lose weight or if your blood sugars are not in good control, you would shoot for 30 to 45 grams of carbohydrate for each meal, or if you’re in good control and your weight is at a healthy level, you may have 60 grams of carbohydrate for each meal.


Transcript: Nutrition for People with Diabetes – Part 2: Essentials

I’m Christine McKinney, a Registered Dietitian Nutritionist and Certified Diabetes Educator with Johns Hopkins Medicine.

Let’s talk about essential nutrients.  Our bodies can’t make all of the substances it needs to function.  We need a diverse supply of nutrients.  Food and water deliver those essential nutrients.

Food is made up of macronutrients micronutrients and water.  When we eat, we often eat a combination of these nutrients.  During our time today, we are focusing on macronutrients, which are carbohydrates, protein, and fat.  Micronutrients are vitamins and minerals that have unique roles in different body processes.  Water makes up 45 to 75% of your body weight.  Water works in the body to flush out toxins, remove waste, keep joints lubricated, control body temperature, and carry nutrients to the places they’re needed.  We need all of these nutrients daily.

Next, I want to talk in detail about the food groups, and which foods raise glucose.  Carbohydrates are our body’s main source of energy.  Carbohydrates include sugars, starches, and fiber.  Carbohydrates turn into glucose, cause blood glucose to rise quickly; and even more quickly when consumed in a liquid form.  Think about the difference between drinking apple juice or eating an apple.  Apple juice will cause glucose to rise more quickly than eating an apple.  It’s important to know that you can and should still eat carbohydrates.  Divide them between your meals and snacks to help control glucose, because eating a lot of carbohydrates at one time will cause glucose to spike.  Carbohydrates are found in all grains, beans, vegetables, fruits, and milk and yogurt.  The amount of carbohydrates within these groups varies.

Because the amount of food you eat matters I want to talk about general portions of carbohydrates starting with starches.  People measure carbohydrates in different ways.  One way to do this is with a plate or measuring cups.  Because the serving size is small for starches, think about limiting these foods to 1/4 of your plate, or less than one cup at a meal.  Starches include food such as cereal, bread, grains, including rice and pasta; starchy vegetables, such as potatoes, corn, and green peas; and legumes, which includes beans, lentils, and peas.  Use measuring cups to control portions.  If you are estimating the portion size, 1/2 of a cup is about the size of your hand when cupped.

Choose whole grains more often.  Whole grains contain more nutrients and fiber than processed grains.  Eating more whole grains may help to reduce the risk of heart disease, weight management, and improve blood glucose levels.  Look for 100% whole grains on the nutrition label, or look for the whole grain stamp.

There are some small changes you can make to include more whole grains.  Try switching to 100% whole grain bread, crackers, or pasta.  Try a whole grain cereal or oatmeal.  Try brown rice or 100% whole grain pasta.  Add quinoa, wild rice, or barley to soup, salads, and other mixed dishes.

Some people want to measure carbohydrates in more specific ways, and this includes either carb choices or counting grams of total carbs.  Carb choices describes the amount of food within a group of similar foods.  One carb choice is considered one serving of carb and is equal to 15 grams of carb.  So for the starch group, one carb choice or 15 grams of carbs is one slice of bread; 1/2 of an English muffin; six saltine-type crackers; 3/4 cup unsweetened dry cereal; 1/2 cup cooked cereal such as oatmeal or grits; 1/3 cup rice or pasta; 1/2 cup beans, lentils, peas, corn, or mashed potatoes; or one small potato.

These carb choices are small serving sizes and your meal doesn’t have to be limited to one carb choice or 15 grams of carb.  This is a guide to help you understand how many carbs you are having.  Let’s look at pasta as an example.  If 1/3 cup of pasta is one carb choice or 15 grams of carb, then one cup of pasta is three carb choices or 45 grams of carb.  Think about a portion of three cups of pasta.  That equals nine carb choices or 135 grams of carb.  Carb choices are a way to estimate carb intake according to serving size and grams of carb.   I will also cover more precise carb counting by reading labels in Part 3 of this talk

All fruit contains carbohydrates.  Fruit is a healthy choice and should still be included in your daily eating plan.  Think about eating one to two cups of fruit or one to two small pieces of fruit each day.  As a reference for size, one cup is about the size of your fist or a tennis ball.  Enjoy fruit as a healthy snack or as the side to a meal.  Limit juice intake to four ounces or less each day.  Juice contains almost no fiber, and, remember, liquid raises blood glucose more quickly.  Choose whole fruit instead of fruit juice.  When grocery shopping choose fresh fruits in the produce section.  Purchase small whole fruits instead of large pieces of fruit.  If buying frozen fruit, read the label and make sure it doesn’t have any added sugar.  If you are buying canned fruit look on the label for 100% juice or no added sugar instead of syrup.

Just like we did for the starch list you can use carb choices or count grams of carbs for fruit.  One carb choice or 15 grams of carbs is one small piece of fresh fruit, 1/2 cup unsweetened canned fruit, two tablespoons dried fruit, one cup melon or berries, 17 small grapes, or 1/2 cup fruit juice.  Some fruit on the list is measured by weight.  The weight includes the skin, core, or seeds.  If you are counting grams of carb, use a food scale and weigh fresh fruit.

Milk and yogurt contain carbohydrates.  Milk has natural sugar lactose, so milk and yogurt raise blood glucose levels.  These are both still important to include in your daily eating plan.  Milk is a good source of protein, calcium, and vitamin D.  Low fat milk, skim or 1%, is usually a good choice, but the percent fat milk you choose depends on how much you drink, and the fat in your overall diet.  Non-dairy milks include almond, coconut, flax, soy, pea, cashew, oat, rice, and sunflower.  There are a lot of varieties and it’s best to choose the unsweetened versions.

Yogurt is a good source of protein, calcium, vitamin D, and probiotics.  We have good and bad bacteria in our gut.  Probiotics are the good guys, the beneficial bacteria and yeast found in your digestive system.  The benefits of probiotics include improved immune system function, decreased inflammation, decreased cholesterol, increased nutrient absorption, reduced symptoms of lactose intolerance, and treatment for diarrhea.  Having a healthy gut and eating probiotic-containing foods may help with glucose control.  Greek yogurt contains more protein and fewer carbs than other types of yogurt.  Yogurt often has added sugar and usually fruit on the bottom is an indicator of added sugar.  Yogurt can be purchased in individual portions, which is great for portion control and easy snacks.  Again just like the starch list, and the fruit list you can count one cup of milk or six ounces yogurt as one carb choice.  One cup of milk is technically 12 grams of carb, not 15.  The amount of carbohydrates doesn’t change with the percent fat of milk.  The calories, fat, and cholesterol are lower in low-fat or fat-free milk.  There is a large variety of yogurts on the market and carb content varies.  Read food labels for total carbohydrates in yogurt.

Sweets and desserts contain sugar, which means they are considered carbohydrates.  People who have diabetes can still eat some sweets in small portions, but sweets shouldn’t be an everyday food.  These foods are high in sugar and lacking other healthy nutrients like fiber, protein, vitamins, and minerals.  Desserts or sweets usually raise glucose quickly.  In general, for desserts or sweets, one carb choice or 15 grams of carbs is 1/2 cup of ice cream or frozen yogurt; two small cookies; one tablespoon syrup, jam, jelly or table sugar or honey; a small piece of unfrosted cake or brownie; or 1/2 cup sugar free pudding.

Vegetables without starch, or non-starchy vegetables, include all vegetables but corn, peas, potatoes, and winter squash, which are all the starchy vegetables.  Vegetables contain phytonutrients you can only get from plants that have important roles in our body.  Some phytonutrients can help with blood glucose control and lower cholesterol and blood pressure.  Vegetables are the food group you can always have more of.  Vegetables do contain a small amount of carbs.  In general, they have five grams of carbs per 1/2 cup cooked or one cup raw, so one cup of cooked broccoli is 10 grams of carbs, or three cups of [leafy] salad is 5 grams of carb.  If you aren’t carb counting think of vegetables without starch as a free food.  Aim for at least three cups non-starchy vegetables each day.  Non-starchy vegetables should take up 1/2 of your plate at most meals.  When grocery shopping look for vegetables in the produce section.  Choose different colored vegetables to increase nutrient intake.  If you are buying frozen vegetables, look for vegetables without added sauces or gravies.  If you are buying canned vegetables, read food labels for low sodium or no salt added options.

Because vegetables are such an important part of our diet, I want to talk about practical ways to increase your intake of this nutrient rich, lower carb food group.  Wash and slice raw vegetables at the beginning of each week so they are ready to eat for meals and snacks.  Keep salad greens on hand for a quick side to a meal.  Batch cook a large amount of vegetables to last several meals.

Try cooking vegetables in new ways, including riced cauliflower, riced beets, and spiralized zucchini or carrots.  Add more vegetables to any recipe or meal you make such as soups, casseroles, omelets, pasta, pizza, or sandwiches.

We have talked a lot about carbohydrates, so now we’re going to talk about proteinProtein helps to build and repair muscles, skin, and every cell in our body.  Protein helps to stabilize blood glucose.  While some glucose is produced during digestion, protein does not raise glucoseProtein helps you to stay feeling full and balances glucose when spread throughout the day.  Think about including protein with meals and snacks.  Protein is found in meats, poultry, eggs, fish, cheese, and beans and legumes.  Remember, beans and legumes also contain carbs.  The American Heart Association recommends eating fish, particularly fatty fish, at least two times per week to lower the risk of heart disease.  Fatty fish like salmon, mackerel, herring, trout, sardines, and tuna are high in omega-3 fats.  Omega-3 fats benefit the heart by reducing the risk of cardiovascular disease, reduce triglycerides levels, slow growth rate of plaque in the arteries, and lower blood pressure.  A serving of meat, poultry, or fish is about three ounces cooked, or think about the size that would fit in the palm of your hands or the size of a deck of cards.

In the past, there has been dietary advice to limit fat because it was unhealthy.  We now know that it is more important to balance the type of fat rather than to eat everything low-fatFat is an essential nutrient that supplies energy, part of every cell in our body including your brain, which is about 60% fat.

It’s part of hormones that regulate body functions like blood pressure, immunity, clotting, and muscle contraction.  Fat helps to transport and absorb nutrients; specifically fat-soluble vitamins.  Fat takes longer to digest, so it leaves the stomach slowly and provides a feeling of fullness.  Fat slows down how fast carbohydrate is converted into glucoseFat does not raise glucoseUnsaturated fats have been found to lower LDL (or bad cholesterol), triglycerides, and risk of heart disease.  There are two kinds of unsaturated fats: monounsaturated and polyunsaturated fats.

Monounsaturated fats include avocado, nuts, and oil such as olive, avocado, canola, and peanut oil.  Polyunsaturated fats include margarine, salad dressing, seeds, mayonnaise, and oil such as corn, soybean, safflower, and flaxseed oils.  Saturated fat and trans fat can raise LDL cholesterol and risk of heart disease.  Saturated fat should be limited.  These fats are solid at room temperature and include butter, lard, bacon, cream, canned coconut milk, sour cream, and solid shortening.  Trans fats should be avoided.  Most trans fats are made by adding hydrogen to a vegetable oil to turn it into a solid fat.  Trans fat may be found in shortening, baked goods, stick margarine, and fried foods.  The FDA has banned artificial trans fat from new food products.

What we drink during the day is really important.  Avoid drinking sweetened beverages such as juice, soda, lemonade, sweet tea, and sweetened coffee.  These beverages usually contain added sugar and raise glucose quickly.  A diet high in added sugar is directly associated with weight gain, inflammation, type 2 diabetes, and heart disease.  Research shows that sugar can decrease beneficial bacteria in our gut.  Work on drinking more water.  Try fruit-infused water or sparkling water for other healthy options.  Limit diet drinks.  Diet drinks contain non-nutritive sweeteners or sugar substitutes and fewer than 10 calories per serving.  Some research suggests an association with non-nutritive sweeteners and weight gain, and a decrease of beneficial gut bacteria.  Think of these as an occasional drink or short-term replacement if weaning off sweetened beverages.

This concludes Part 2 of the presentation.

In Summary: Carbohydrates raise blood glucose.  Carbohydrates are starches, fruits, vegetables, milk, and yogurt.  Use your plate or measuring cups to help control portions of carbohydrates.  Include non-starchy vegetables, protein, and healthy fats with each meal.  Think about the foods you eat most often and what food groups they fall into.

Hopefully you now know the impact foods you commonly eat have on your blood glucose.


Transcript: Nutrition for People with Diabetes - Part 4: The ADA Diet & Other Healthy Hints

Welcome to Nutrition for People with Diabetes Part 4:  The ADA Diet and Other Healthy Hints.  I’m Christine McKinney, a Registered Dietitian Nutritionist, and Certified Diabetes Educator with Johns Hopkins Medicine.

The American Diabetes Association acknowledges that not one diet works for everyone.  People have different needs and respond differently to food and diet.  There is no ideal percentage of carbohydrates, protein, or fat for everyone.  ADA does recommend:

  • Healthful eating patterns containing nutrient dense foods with less focus on specific nutrients.
  • An individualized eating plan that includes an assessment of current eating patterns, preferences, and metabolic goals. This can be done by seeing a Registered Dietitian Nutritionist.

ADA also recommends the Diabetes Plate Method.  The Diabetes Plate Method is an easy way to plan meals.  When you think about your plate, plan for 1/2 plate non-starchy vegetables, 1/4 plate lean protein, 1/4 plate carbohydrates.  The carbohydrates can be grains, starchy vegetables, fruit, or yogurt.  1/4 of the plate doesn’t mean you can only have one serving of carbs.  People need different amounts of carbs at meals so the amount of carbs will vary.  Healthy fats can also be added to meals.  Some examples of healthy fats are olive oil, nuts, nut butters, seeds, avocado, and olives.  This is a great tool to use to control portions, carb intake, and include all food groups, increase fiber and vitamins and minerals.

This is also very helpful for meal planning.  Take some time each week to plan meals.  Start with planning dinner meals.  Instead of thinking seven meals, think about cooking three to four meals and planning for some leftovers.  Once you have dinners planed, think about some ideas for breakfast and lunch.  Make a grocery list and stick to your list when shopping.  When you are grocery shopping, look at your cart.  What’s in your cart should be similar to what you see on your plate.  Think about filling your cart with produce, like vegetables and fruit, which should be at least half of your plate.

Snacks can be part of a healthy eating plan.  Think about snacking if you are hungry, if your next meal is later than usual or more than four hours between meals, or if snacks are part of your eating plan.  For snack options, think about whole foods, and pairing carbohydrates with protein and/or healthy fats to help balance glucose and increase satietySome healthy snack choices around 15 grams of carb, or one carb choice, are apple with almond butter, one cup of fruit and cashews, avocado slices on one slice wheat toast, six ounces Greek yogurt, carrots and peppers dipped in four tablespoons of hummus.

People with diabetes should eat breakfast.  Studies have found that people who eat breakfast daily are more likely to be at a healthy weight, less likely to have type 2 diabetes, high cholesterol and high blood pressure then people who skip breakfast.  People with diabetes should eat a well-balanced breakfast.  Breakfast can include fruit, whole grains, nuts, eggs, dairy, and vegetables.  Avoid low fiber items or foods with added sugars and processed meats.  Some breakfast ideas are Greek yogurt with sliced almonds; vegetable omelet and an orange; egg and spinach in a whole wheat wrap; oatmeal and flaxseed with cinnamon; cottage cheese and blueberries; peanut butter on whole wheat toast; egg, tomato, cheese, and Greek yogurt.

This concludes Part 4 of the presentation.

In Summary: Use the Diabetes Plate Method as a guide to include a variety of foods in a portion-controlled way.  For snacks, consider pairing carbohydrates with protein and/or healthy fats.  Eat a healthy breakfast daily.

Transcript: Carb Counting - Maureen Seel

Now that we know which foods contain carbohydrate we can use the nutrition facts label to help us count the grams of carbohydrate.

First of all, you will not need to know every bit of information on this label.  It’s a lot to look at, and it’s not all necessary for counting the carbohydrate.

The first thing we should always look at when counting carbs is the serving size.  This may not be the amount that you are planning to eat, but all of the information on the label is only for what the manufacturer says the serving size is.

 The second thing to look at is the total carbohydrate.  The reason that we look at this and not at sugar is because of sugar and fiber and anything else listed under total carbohydrate is already included in the total grams of carbohydrate.

 From here you may choose to look at the sugar or fiber to help you make better choices between two similar items.

 Now let’s use the nutrition facts label to count carbohydrates for the example breakfast that we discussed earlier.

 Let’s say that you allowed to have 45 to 60 grams of carbohydrate for this meal.  The bread says that one slice of bread is equal to 13 grams of carbohydrate.

 Let’s say that you want to eat a cup and a half of the cereal that was shown.  One cup of the cereal is equal to 20 grams of carbohydrate.  From here you need to figure out how many carbs are in a half a cup so you would take those 20 grams and divide it by 2.  This would give you the amount and a half a cup, which is 10; then you add that to the amount that’s in one cup for a total of 30.

 The milk contains 13 grams of carbohydrate for an 8-ounce glass, and the melon for an entire medium melon contains 49 grams of carbohydrate, which is clearly too much.

 Let’s say you’re going to eat a quarter of that melon.  You would take 49 and divide it by 4.  This would give you about 12 grams of carbohydrate.  From there you need to add 13 grams to the 30 grams to the 13, and then to the amount that you needed for the melon, which was 12, for a total of 68 grams of carbohydrate.

 Ways that you could save yourself some carbohydrate at this meal is to have a smaller portion of cereal, or to switch out the cow’s milk for a non-dairy milk such as almond milk.

 If it’s unsweetened, it has less than a gram of carbohydrate for a full 8-ounce glass.

Viviendo con Diabetes

Parte 1: Transcripción (Español)

Muy buenos días mi nombre es el Dr.Stanley Chen Cárdenas del departamento de endocrinología de la Universidad de Johns Hopkins y en el día de hoy queremos hacer un video para nuestros pacientes, ayudarlos un poco con la educación en diabetes. Esta charla la hemos dividido en dos partes: una que es la parte básica sobre qué es la diabetes y cuáles son sus complicaciones y la segunda parte habla un poco de manejo en general.

Entonces en la primera parte es transmitirle por qué es importante conocer sobre diabetes? Según los datos de la Asociación Americana de Diabetes en el 2018 alrededor de 34 millones de personas tenían diabetes o 10.5% de la población en los Estados Unidos y dentro de ese grupo 12.5% o aproximadamente uno de cada 10 hispanos tenía diabetes. Es también la séptima a causa de mortalidad los Estados Unidos y esta enfermedad tiene complicaciones como enfermedades del corazón, enfermedades de los riñones, enfermedades de la circulación, además de ceguera amputaciones de miembros inferiores que desde luego impactan la calidad de vida de los pacientes.

Cómo prevenimos estas complicaciones? con mucha educación. Es importante que el paciente con diabetes se eduque y continuar aprendiendo a lo largo de la enfermedad.  El que se diagnostique a un paciente con diabetes no significa necesariamente que va a desarrollar estas complicaciones. Si se controla la diabetes pueden prevenirse (o retrasarse) entonces para iniciar quisiera darles un breve una breve introducción que es la insulina y cómo es su funcionamiento normal en el cuerpo. La insulina es una hormona que muchos de ustedes quizás han escuchado y es producida en un órgano que se llama el páncreas y usted lo aprecia en la diapositiva de color amarillo o dorado y dentro de ese órgano existe un grupo de células que se llaman las células Beta, está células Beta producen la hormona que se llama insulina y su papel principal entre muchos que tiene en el metabolismo es regular o disminuir los niveles de azúcar en la sangre.

Cómo actúa la insulina? como dijimos en la diapositiva anterior esta es producida en esa célula que se encuentran en el abdomen y una vez es liberada en la sangre ella va a unirse a un receptor en el tejido blando blanco como el tejido muscular, el tejido adiposo o grasa y como ven en la diapositiva a la insulina, se representa por unos triángulos morados (circulo verde). Cuando esta hormona se une a su célula que está representada por los círculos amarillos (chocolate-higado-liver), abre unas compuertas donde permite el paso de la glucosa o azúcar que son las esferas rojas y permiten que pase de la sangre hacia dentro de la célula y de esa forma la insulina disminuye los niveles del azúcar o la glucosa en sangre. Ustedes se podrán imaginar que si alguien tiene alguna condición que se llama resistencia a la insulina, la hormona está presente, pero no puede actuar y no puede retirar la glucosa de la sangre para que entre al tejido y esto mantiene el nivel de azúcar elevado. Esto es como para darle una introducción de como es el funcionamiento normal. Si tienen una pregunta sobre esto no duden en pregúntale a su medico.

La insulina normalmente es producida de dos maneras una producción continua que es a lo largo de todo el día aunque uno no coma y hay otra producción qué es en respuesta los alimentos o los nutrientes principalmente la glucosa y que ustedes ven en esta gráfica representada por ese incremento en el área en naranja en el desayuno y el almuerzo y la cena. Por eso es que ustedes van a ver que muchos pacientes con diabetes utilizan dos tipos de insulina que le llaman lenta, que es la parte basal y la insulina de las comidas que la parte que representa los los picos de elevación en esta gráfica.

Pasando del funcionamiento básico a qué es la diabetes mellitus? la diabetes mellitus en general se define como una condición caracterizada por el aumento de la glucosa en la sangre, existen dos tipos principales: la tipo 1 que se da cuando el cuerpo no produce insulina y esto en la gran mayoría de los casos es por una respuesta inmune anormal donde el propio cuerpo destruye estas células Beta que mencioné previamente y finalmente no se produce la insulina. La tipo 2 es la más común y es donde el cuerpo es resistente a la acción de la insulina y fue la que les trataba de explicar en la diapositiva previa que a pesar de que haya insulina inicialmente el cuerpo no responde a la hormona y luego lo que pasa es que el cuerpo trata de producir más insulina para compensarla, pero llega un punto donde ya no hay suficiente hormona para compensar la resistencia a la insulina y se desarrolla entonces finalmente la diabetes.

Que causa la diabetes tipo 2? existen múltiples factores, genéticos y factores que son modificables en el estilo de vida, como la obesidad o el sobrepeso, la dieta alta en azúcares o en grasas y más adelante les hablaré un poquito más de estos que son factores importantes en la predisposición a desarrollar diabetes tipo 2 .

Cómo se dan cuenta que ustedes pueden tener la azúcar elevado o cuáles son esos síntomas? Muchos pacientes experimentan cuando su azúcar está alta excesiva orina o va mucho al baño, excesiva sed, exceso de apetito y a pesar de eso hay pérdida de peso principalmente por cierto grado de deshidratación, fatiga o cansancio.  De la glicemia elevada o el azúcar elevado sostenido pueden surgir lo que le llamamos complicaciones de la diabetes mellitus y se han clasificado de dos tipos dependiendo del tamaño de los vasos sanguíneos que afecten y pueden afectar órganos como los ojos y una de las complicaciones de la pérdida de la vision, los nervios donde se manifiesta con dolor en las extremidades, con pérdida de la sensibilidad que predispone a úlceras o heridas, afectación en los riñones predisponiendo enfermedad renal y muchos pacientes lamentablemente llegar a necesitar diálisis o trasplante renal para aliviar su su función de los riñones. Dentro del grupo de las enfermedades macrovasculares (vasos sanguineos grandes) están los infartos al corazón, enfermedad cerebrovascular o derrame también conocido (stroke) otro que está también es la insuficiencia o la falta de circulación en las piernas que también predispone a infección y amputaciones.

Pero todas estas complicaciones son potencialmente prevenibles, como les decía al principio de la charla, con educación y control de la diabetes apropiado no necesariamente estas complicaciones van a ocurrir.

Si por ejemplo está experimentando síntomas, cómo se diagnostica la diabetes? Hay múltiples formas de diagnosticarla. Una de ellas es medir la glucosa en ayuno, si su glucosa en ayuno luego de 8 horas de ayuno en más o igual a 126 mg/dl es diagnóstico de diabetes,  si tiene una hemoglobina glicosilada mayor de 6.5% también es criterio de diagnóstico de diabetes o luego de una prueba de tolerancia, que es donde se le da una cantidad medida de glucosa al paciente, si la glucosa es más 200 mg (luego de 2 horas) es considerado diagnóstico de diabetes y si la glucosa es más de 200 a cualquier momento del día al azar y tiene síntomas que mencionamos previamente también se considera que tiene el diagnóstico de diabetes.

Muchos de ustedes ya han escuchado el nombre de hemoglobina glicosilada y saben que su médico le mide esto y que su meta está cerca de 7, que quiere decir esta hemoglobina glicosilada?  nos da un estimado un promedio de cómo fueron los valores de glucosa a lo largo de los últimos tres meses aproximadamente y por ejemplo si su hemoglobina glicosilada está en 8%, su glucosa ha estado a lo largo de los meses como un promedio de 183 mg/dl y ahí existe una tabla donde entre más alta como ustedes ven correlaciona con el nivel de glucosa. La hemoglobina glicosilada es importante porque los estudios han asociado a su valor con el riesgo de complicaciones, entre más alta la hemoglobina glicosilada mayor es el riesgo y este riesgo aumenta por encima de la hemoglobina glicosilada mayor de 7  tanto de microvasculares (pequenos vasos sanguineos) como retinopatía, nefropatía y neuropatía diabética se asocian a esto, o sea que si su hemoglobina glicosilada está muy alta, está en alto riesgo de presenter estas complicaciones, por eso es importante monitorear su hemoglobina glicosilada cada tres meses, si su diabetes está bien controlada se pueden espaciar un poco los controles pero tres meses en la recomendación general.

La meta en la mayoría de los adultos y mujeres no embarazadas es menos de 7%, pero en aquellos pacientes que tienen alto riesgo de hipoglicemia o azúcar baja se puede ser más flexible y menos de 8% es adecuado.  

De esta presentación cuales son los puntos importantes que me gustaría que ustedes recordaran y es uno que la diabetes es una enfermedad muy común y que se caracteriza por el azúcar elevado en la sangre, este azúcar elevado puede tener complicaciones si no se controla, el segundo punto que me gustaría que recuerden es que la obesidad, el sedentarismo y la alimentación inapropiadas son los factores de riesgo modificables más importantes para la diabetes tipo 2 y de esto es lo que me voy a concentrar en la siguiente de parte de esta presentación gracias 

Part 1: Transcript (English)

Good morning, my name is Dr. Stanley Chen Cárdenas, from the Department of Endocrinology at Johns Hopkins University and today we wanted to make a video for our patients to help them with diabetes education and we have divided this talk into two parts, one that is the basic part explaining what diabetes is and what its complications are and the second part talks about management of diabetes in general.

The goal of the first part is to convey to you why it is important to know about diabetes. According to the data of the American association of diabetes in 2018 around 34,000,000 people had diabetes or 10.5% of the population in the United States and within that group 12.5%, ​​approximately one in 10 Hispanics had diabetes. It is also the seventh cause of mortality in the United States and this disease has complications such as heart disease, kidney disease, circulation diseases as well as blindness, limb amputations, and of course they impact the quality of life of patients.

How we prevent these complications? with a lot of education. It is important that the patient with diabetes educate himself and continue learning throughout the disease. The fact that a patient is diagnosed with diabetes does not necessarily mean that will develop these complications. If diabetes is controlled they (the complications) can be delayed or prevented. To start, I would like to give you a brief introduction about what is insulin and how it normally functioning in the body.  Insulin is a hormone that many of you may have heard and it is produced in an organ called the pancreas and you can see it on the slide it is golden/yellow and inside that organ there is a group of cells called Beta cells. These Beta cells produce a hormone called insulin and its main role among many it has in metabolism is to regulate or lower blood sugar levels.

How insulin works? as we said in the previous slide, it is produced in that cell found in the abdomen (pancreas) and once it is released into the bloodstream, it will bind a target tissue such as muscle or adipose tissue also known as fat. As you can see, insulin in the slide is represented by purple triangles (green circles).  When that hormone binds to its cell which is represented by the yellow circles (brown) it opens some gates where it allows the passage of glucose or sugar, which are the red spheres, and allow the transport from the blood into the cell, in this way insulin lowers blood sugar or glucose levels. You can imagine that if someone has a condition called insulin resistance, meaning that the hormone is present, but it can’t act and it cannot remove the glucose from the blood so that it enters the tissue that will result in high blood sugar levels, this is to give you an introduction of how it works, do not hesitate to ask your doctor if you have further questions.

Insulin is normally produced in two ways: a continuous production throughout the day even though one does not eat and there is another way of production in response to food or nutrients, mainly glucose that you see in this graph represented by an increase in the area in orange at breakfast, lunch and dinner. That is the reason why you are going to see that many patients with diabetes use two types of insulin that are called the basal insulin, and the meal time or short acting insulin the latter represents the elevation peaks in this graph.

Moving to discuss what is diabetes mellitus? It is in general defined as a condition characterized by increased glucose in the blood. There are two main types, type 1 that occurs when the body does not produce insulin, in the vast majority of cases due to an abnormal immune response where the body itself destroys the beta cells that I mentioned previously and finally insulin is not produced.  type 2 is the most common and occurs when the body is resistant to the action of insulin and was the one that I was trying to explain in the previous slide where insulin is present initially, but the body does not respond to the hormone and then what happens is that the pancreas tries to produce more insulin to compensate it, but there comes a point where there is no longer enough hormone to compensate for insulin resistance and finally type 2 diabetes appear.  

What causes diabetes? There are multiple factors including genetic factors, modifiable factors in lifestyle such as weight, diet high in sugar or fat that later I will discuss in more detail. These factirs are important as they predispose to the development of type 2 diabetes

When you should suspect that you may have high blood sugar? What are those symptoms? when their blood sugar is high many patients experience excessive urination, excessive thirst, excessive appetite, and despite that there is weight loss, mainly due to a certain degree of dehydration. There is fatigue or tiredness, and from sustained high blood sugar complications of diabetes mellitus may arise. These have been classified into two types depending on the size of the blood vessels that affect and can affect organs. Small vessels (microvascular) such as the eyes resulting in vision loss, in the nerves where it manifests with pain in the extremities, with loss of sensation that predisposes to ulcers or wounds affectation, the kidneys can be affected predisposing to kidney disease and many patients unfortunately end up needing dialysis or a kidney transplantation to alleviate their kidney function.  Within the group of macrovascular diseases are heart attacks, cerebrovascular disease or stroke, insufficiency or lack of proper circulation in the legs that also predisposes to infection and amputations. 

All these complications are potentially preventable as I said at the beginning of the talk, with education and appropriate diabetes control these complications may be prevented or delayed. 

If for example you are experiencing symptoms, How diabetes is diagnosed? there are multiple ways to diagnose it, one of them is to measure your fasting glucose, if your fasting glucose after 8 hours of fasting is more than equal to 126 mg/dl means you have diabetes. If you have a glycosylated hemoglobin (HbA1c) greater than 6.5% is also a diagnostic criteria for diabetes or after a glucose tolerance test. Which is a test where a measured amount of glucose is given. If the glucose is higher than 200 mg/dl is considered diagnosis of diabetes, and if glucose levels are over 200mg/dl at any random time of day and you have symptoms of high blood sugar as mentioned previously it is also considered that you have the diagnosis of diabetes.

Many of you have already heard the name of glycosylated hemoglobin (HbA1c), you know that your doctor will look at this test to evaluate your control and that your goal is usually close to 7%, and what does it means? Glycosylated hemoglobin (HbA1c) gives us an average estimate of how the glucose values ​​were throughout the last three months approximately and for example if your glycosylated hemoglobin is 8% your glucose has been throughout the months as an average of 183 mg/dl. There is a table where you can appreciate that the higher the HbA1c represents a higher level of glucose for that period. It is important because studies have associated its value with the risk of complications, the higher the glycosylated hemoglobin, the greater the risk and this risk increases above the glycosylated hemoglobin > 7%. Microvascular (small blood vessels) diseases such as nephropathy, retinopathy, and diabetic neuropathy are associated with higher HbA1c, therefore if your glycosylated hemoglobin is very high, you are at high risk to develop of all these complications, this is why it is important to monitor your glycosylated hemoglobin every three months, if your diabetes is well controlled, the checks can be spaced a little, but three months in the general recommendation. The goal in most adults and non-pregnant women <7% is appropriate, but in those patients who are at high risk of complication, frequent hypoglycemia or low blood sugar can be more flexible and < 8% is adequate.

From this presentation, which are the important points that I would like you to remember? First, that diabetes is a very common disease and is characterized by high blood sugar this high sugar which can have complications.  the second point I would like you to remember is that obesity, a sedentary lifestyle, are the most important modifiable risk factors for type 2 diabetes and these what I am going to focus on in the next part of this presentation thanks

Part 2: Transcripción (Español)

Muy buenos días Soy el doctor Stanley Chen Cárdenas del departamento de endocrinología de la universidad John Hopkins en Baltimore, Maryland y hemos querido poner estas presentaciones para nuestros pacientes y que tengan una base de información para que se puedan educar en diabetes tipo 2 y en esta segunda parte les quiero hablar sobre cómo se trata la diabetes tipo 2. La primera parte o la primera intervención que se debe hacer en un paciente con diabetes tipo 2 son cambio en el estilo de vida y esto con el objetivo final de lograr perder peso o un índice de masa corporal normal. y cómo logramos este objetivo?  bueno través de cambios en la dieta y en el ejercicio, si esto no funciona se maneja en conjunto con medicamentos como en la gran mayoría  de los pacientes. Los cambios en el estilo de vida siempre debe mantenerse, entonces si un paciente no logra la meta con esto nosotros avanzamos a medicamento y existen diferentes tipos de medicamentos, hay medicamentos orales como la metformina o la glipizida , existen inyecciones como por ejemplo la liraglutida y la insulina en pacientes que necesitan medicamento más potentes. Sobre esto es lo que les hablaré en esta presentación en más detalle.

La dieta en general se basa en evitar lo malo comer más de lo bueno y cómo ven en esta dispositiva muchos vegetales y dicen que evitar los malos carbohidratos. Las recomendaciones generales de la Asociación Americana de Diabetes primero que cada individuo debe tener una dieta individualizada de acuerdo a su circunstancia a su gusto y debe ser guiada por un nutricionista o un médico capacitado en esto dietas como la dieta mediterránea, dieta baja en azúcar, dieta vegetariana. Todas se consideran saludables pero la dieta que se elija debe ser aquella que el individuo sea capaz de mantener y sostener a travez del tiempo.  En general nosotros y la Asociacion Americana de Diabetes recomienda consumir vegetales, frutas, granos completos, reducir al mínimo azúcares refinados y evitar comida procesada, con estas intervenciones iniciales es un punto de partida para que con su nutriciónista y su médico continúen trabajando en las cambios en la dieta.

Adicionalmente, mencionamos el ejercicio y las recomendaciones son de al menos 150 minutos semanales de actividad física aeróbica intensa dividida en al menos tres días a la semana por no más 2 días seguidos y recuerda si usted tiene alguna limitación en su articulación o dolores o siente que su peso es una limitación, existen maneras de adaptar y que hacer que su ejercicio se acorde a sus capacidades no se sienta desmotivado para nada si no puede iniciar o si al principio es difícil poco a poco y  con la guía de su médico la ayuda de la persona indicada puede lograr la meta, además de esto también se recomiendan dos a tres sesiones semanales de ejercicio de resistencia o estiramiento, todo esto ayuda al metabolismo y a incrementar la sensibilidad a la insulina y al final pérdida de peso que precisamente es la meta en pacientes con obesidad o sobrepeso que es reducir al menos 5% del peso.

Si por ejemplo usted tiene un peso de 150 libras la meta es reducir alrededor de 7.5 libras o 5% inicialmente y luego poco a poco entonces continuamos hasta que llegamos a la meta de índice de masa corporal normal.  Al final nosotros queremos iniciar diciéndole hay que evitar la inactividad física o el sedentarismo en diabetes tipo 2 y en general cosas tan simples que se pueden hacer es usar las escaleras en vez del elevador o no estacionarse tan cerca del almacén el cual va para que dé unos pasos más o si estás hablando por teléfono con algún ser querido caminar mientras lo hace en vez de estar sentado, son pequeñas cosas de la vida diaria que ayuda a evitar la inactividad.

Pasando a los medicamentos como mencioné anteriormente existen diferentes medicamentos orales por ejemplo la metformina, es importante tomarlos consistentemente, no debemos a hacer esa práctica de solo la tomo si mi glucosa está alta y eso aplica para condiciones como la presión alta, asi como la diabetes. Es importante tomarlos consistentemente y debido que si deja que la glucosa está alta y luego la trata ya ha tenido el cuerpo un periodo de exposicion a hiperglicemia dónde puede generar ciertos daños a los tejidos con el tiempo.  Si usted esperimenta efectos adversos, molestia abdominal intolerancia o alergia por favor consulte a su médico sobre los efectos adversos y notifiquele para que no pase un tiempo o dónde detenga el tratamiento o deje de tomar su medicamento, de nuevo si no se controla la glicemia puede finalmente llevar a complicaciones.

Con respecto a las inyectables o la insulina les quiero dar algunos consejos, uno cuidado con confundir la insulina lenta y la insulina de las comidas tienen propiedades diferentes y así que si por ejemplo usted se inyecta la insulina de las comidas en vez de la lenta va a tener un período muy corto de cobertura y va a terminar teniendo la glucosa alta y si hace lo contrario (se inyecta la lenta con las comidas) se pone a riesgo de que la glucosa se le baje. Entonces es importante que lea bien el rótulo de su de su envase o que coloque alguna manera de diferenciarlas.  También cuidado donde se almacena la insulina, no es bueno llevarla en el carro o dejarla altas temperaturas o que esté expuesto al sol porque se puede degradar y al final la insulina que se inyecta no va actuar. Por todo esto es muy importante que se monitore la glucosa frequentement para para ver si está alta, así que no dejen de medirse la glicemia de la manera que su médico se la recomienda.

Entonces es importante también reconocer los síntomas del azúcar bajo e hipoglicemia algunos de ellos pueden ser tan sutiles como un dolor de cabeza, pero pueden ser también más como cambios en el estado mental o cambio de comportamiento, irritabilidad, algo que puede ocurrir también en muchos pacientes es la visión borrosa, náuseas, debilidad o somnolencia son signos de que deben medirse la glucose y si esta baja tratarla apropiadamente.  Qué hacer si se baja la azúcar? si su azúcar esta baja, llamese menos de 70 mg/dl, muchas personas tienen un diferente nivel donde empiezan a sentir síntomas, pues lo que recomendamos es 15 gramos de carbohidratos o equivalente a 4 tabletas de glucosa o cuatro onzas de bebida azucarada, luego de esto le recomendamos que espere unos 15 minutos y se vuelva medir el azúcar en la sangre , si se encuentra debajo de 70 repita este procedimiento en general le decimos a los pacientes que utilizan insulina que siempre deben tener tableta de glucosa por si se presenta alguna emergencia o sino tener algun snack que contenga azúcar

Es importante también que los pacientes conozcan que ciertas condiciones que le van a crear variabilidad es su nivel de azúcar por ejemplo cuando presenta una enfermedad como neumonía o alguna respuesta inflamatoria del cuerpo va hacer cambios en el metabolismo de la glucosa y es posible que experimente azúcar mas elevada de lo normal, contacté a su médico si esto ocurre.  Ciertos medicamentos por ejemplo los corticoides o los esteroides como por ejemplo la Prednisona también van hacer un efecto en el metabolismo de glucosa principalmente luego  de las comidas, si esto ocurre también es importante que contacté a su medico. El estrés también puede crear variabilidad o aumento de la glucose. Tener mucho cuidado con el alcohol,  muchas personas no comen apropiadamente mientras toman alcohol. El uso del alcohol debe ser muy moderado en los pacientes con diabetes.

Síntomas de glucosa elevada les repito, mucha sed y orina mucho se siente cansado, fatigado y hay pérdida de peso son síntomas de alarma que el azúcar puede estar muy elevada . En resumen y con esta presentación les he querido compartir que, uno para ustedes como pacientes la educación y aprendizaje continuo sobre la diabetes es muy importante para lograr las metas. Dos que es importante que trabajemos juntos nosotros como médicos y pacientes para llegar a esta meta y evitar las complicaciones de la diabetes. Recuerden que una vez tenga el diagnóstico de diabetes no significa que automáticamente va a desarrollar complicaciones, estas son prevenibles y podemos trabajar juntos para evitar (o retrasarlas). Muchas gracias

Part 2: Transcript (English)

Good morning. I am Dr. Stanley Chen Cárdenas from the Department of Endocrinology at the John Hopkins University in Baltimore, Maryland and we wanted to put these presentations for our patients providing an information base so that they can educate themselves on type 2 diabetes and on this second part I want to talk about how type 2 diabetes is treated.

The first intervention that should be done in a patient with type 2 diabetes are changes in lifestyle and this with the ultimate goal of achieving weight loss or normal body max index. How do we achieve this? Through changes in diet and exercise, if this does not achieve the goal. Then lifestyle changes in conjunction with medications will be the next step, and this is how the vast majority of patients are managed. Lifestyle changes should always be maintained, then if a patient does not achieve the goal with this we advance to medication and there are different types of medications. There are oral medications such as metformin or glipizide, there are in injections, for example liraglutide and insulin in patients who need more potent medications and this is what I will discuss about in this presentation in more detail.

The general recommendation in diet is to avoid the bad, and eat more of the good. As you can see in this slide eating lots of vegetables and avoid bad carbohydrates.

The general recommendations of the American Diabetes Association is that each individual should have an individualized diet according to their circumstance, to their liking and should be guided by a nutritionist or a trained doctor.  In these diets such as the Mediterranean diet, low-sugar/carb diet, vegetarian diet, they are all considered healthy, but the diet that is chosen must be the one the individual will be able to maintain and sustain over time. In general we recommend and the American Association of diabetes recommends consuming vegetables, fruits, whole grains, minimize refined sugars and to avoid processed food, with these initial interventions is a starting point so that with your nutritionist and your doctor continue working on the changes in the diet.

We mentioned exercise and the recommendations of at least 150 minutes per week of intense aerobic physical activity divided into at least three days a week for no more than 2 days in a row. Remember if you have any limitation in your joints or pain or believe that your weight is a limitation there are ways to adapt and make your exercise according to your capabilities, do not feel demotivated at all.  If you cannot start or if at first it is difficult little by little and with it again with the guidance of your doctor you have the right professional you can achieve this goal. In addition to this, two to three weekly sessions of resistance exercise or stretching are also recommended that all this helps the metabolism and increases the sensitivity of the body to insulin and in the end weight loss and precisely this is the goal in obese or overweight patients is to reduce to at least 5% of the weight.  If for example you have a weight of 150 pounds the goal is to reduce about 7.5 pounds or 5% initially and then slowly, but sustained we continue until we reach the goal of normal body mass index.  At the end of all this we want to start by telling you to avoid physical inactivity or sedentary lifestyle in type 2 diabetes. In general there are simple things that you can do on a daily basis to become more active such as using the stairs instead of the elevator or not parking so close to the Warehouse or store when shopping, which is going to take a few more steps or if you are talking on the phone, walking while doing it instead of sitting are small things of daily life that helps to avoid inactivity.

Switching to medications, as I mentioned previously, there are different kind of medications, oral medications such as metformin as an example. It is important to take them consistently, we should not do that practice in which you only take it when the blood sugar is high and that applies to conditions such as high blood pressure. it is important to take them consistently, because if you let the glucose be high and then treat it, the body has already had a period of hyperglycemia where it can generate certain damage to tissues over time.

If you experience adverse effects such as abdominal or gastrointestinal discomfort with metformin or tolerance or allergy with any of your medications, please consult your doctor about the adverse effects and notify the doctor to avoid a period without treatment and exposure to hyperglycemia.

Regarding injectable medications or insulin I want to give you some advice, one should be aware of not confusing short acting insulin (the mealtime insulin) with the long acting or basal insulin that have different properties and so that if, for example, you inject insulin from meals instead of the basal insulin, you will have a very short period of coverage, and you will end up having high glucose and if you do the opposite (use the basal instead as a mealtime insulin), then you put yourself at risk of lowering your blood sugar.

So it is important that you read the label on the container well or that you have some way of differentiate it. Also, be careful where insulin is stored, it is not a good idea to leave the insulin in the car or at high temperatures or allow it to be exposed to the sun light because it can degrade insulin molecule and in the end the insulin that is injected will not work.  In general it is very important to keep checking your glucose levels the way that your doctor recommends it.

Also, its important to recognize the symptoms of low blood sugar or hypoglycemia. Some of them can be as subtle as a headache, but they can also present as changes in mental status or behavior change, irritability, blurry vision, nausea, weakness or drowsiness are signs of that the glucose should be measured.

What to do if your blood sugar is low? if your blood sugar is less than 70 mg/dl it is called hypoglycemia, it’s important to consider that many people have a different glucose levels where they start to experience symptoms.  To treat it we recommend 15 grams of carbohydrates or equivalent to 4 glucose tablets or 4 ounces of sugary drink. After this we recommend that you wait about 15 minutes and re-check your blood sugar, if it is below 70, repeat this procedure. In general, we tell patients who use Insulin that they should always have glucose tablets in case of an emergency or if they have one drink/snack that contains sugar.

It is also important that patients know that certain conditions that will create variability in their blood sugar levels, for example when they have a pneumonia or an activated inflammatory response of the body will induce changes in glucose metabolism and it is possible that the patient experience higher or sometimes lower blood sugars.  Certain medications such as corticosteroids or steroids such as prednisone, they will also have an effect on glucose metabolism, mainly after meals, so if this happens, it is important that you contact your doctor. Stress can also create variability increasing glucose and be very careful with alcohol, many people do not eat properly while drinking and alcohol use should be very moderate in patients with diabetes.

High blood glucose symptoms as I previously explained include excessive thirst and urination, you feel tired, fatigued and there is weight loss. These are alarm symptoms that the  blood sugar may be very high

In summary with this presentation we wanted to share that patient education and continuous learning about diabetes is very important to achieve the goals. It is important that we doctors and patients work together as a team to reach the goal of diabetes control and avoid complications of diabetes. Remember that once you have the diagnosis of diabetes it does not necessarily mean that you will develop complications. These are preventable and we can work together to avoid or delay them. Thank you very much


Medidores: Resumen (Español)

Muy buenos días mi nombre es Sananda Moctezuma Vega del departamento de endocrinología de la Universidad de Johns Hopkins y en el día de hoy queremos hacer un video para nuestros pacientes, ayudarlos un poco con la educación en diabetes.

Tal vez haya escuchado el término MCG, pero no está seguro de qué se trata. Analicemos lo que debe saber. Un sistema de monitoreo continuo de glucosa (MCG) es un dispositivo que le permite monitorear de manera continua los niveles de glucosa en la sangre. El MCG le ofrece a una persona con diabetes (o a una persona que cuida a alguien con diabetes) un modo fácil y rápido de acceder a los niveles de glucosa en la sangre las 24 horas del día. Como la mayoría de las personas con diabetes sabe, controlar la glucosa en la sangre es fundamental para el control de la diabetes. Se ha demostrado que con los sistemas de MCG se ayuda a las personas a mantener los niveles de glucosa estables, a reducir los episodios tanto de glucosa baja en la sangre (hipoglucemia) como de glucosa alta en la sangre (hiperglucemia) y a disminuir los riesgos de complicaciones por la diabetes. A diferencia de los medidores de glucosa tradicionales que dan información de la glucosa en la sangre en tiempo real, con el MCG usted puede saber dónde están sus niveles de glucosa actuales, dónde estaban y hacia qué dirección están yendo.

Las mediciones del CGM pueden ayudarle a decidir qué comer y cómo ejercitarse. Y también pueden ayudarle a saber cuánto medicamento tomar. Puede observar en el receptor cuando hace estas cosas. De esa manera, usted puede ver cómo afectan estas actividades su nivel de azúcar en la sangre durante el día y la noche. Toda esta información detallada les da a usted y a su médico una mejor idea de cuáles son sus necesidades de tratamiento. 

Un medidor continuo de glucosa (CGM, por sus siglas en inglés) tiene varias partes.

Usted usa una parte, el sensor, contra la piel. Tiene una aguja diminuta que permanece debajo de la piel y mide el nivel de azúcar en la sangre de manera constante. Envía esta información a un receptor inalámbrico. El receptor puede indicarle si su nivel de azúcar en la sangre sube o baja y con qué rapidez cambia el nivel de azúcar en la sangre. Y puede visualizar los datos almacenados para ayudarle a identificar tendencias en sus niveles de azúcar en la sangre.

Algunas bombas de insulina incluyen un CGM. En este caso, la bomba de insulina también es el receptor.

La tecnología de los medidores continuos de glucosa cambia y mejora constantemente. Estas son algunas cosas que debe saber sobre la mayoría de los CGM. Es posible que no se apliquen a todos los sistemas.

Es necesario cambiar los sensores. Según el sistema, es posible que tenga que cambiar el sensor cada pocos días. Algunos sistemas tienen sensores que duran 10 días.

Algunos CGM requieren que se pinche el dedo para confirmar la precisión del CGM.

Los elementos del sistema de MCG trabajan a la perfección para brindarle la información que necesita. Los sistemas de MCG incluyen un sensor, un transmisor y un receptor que trabajan en conjunto para registrar la información sobre la glucosa. Otros sistemas de MCG requieren un lector que usted utiliza para escanear el sensor al menos cada ocho horas para que no se pierda la información. También, se puede utilizar una aplicación móvil para escanear el sensor y evitar tener que llevar un dispositivo adicional.

EL SENSOR: Es un dispositivo pequeño resistente al agua que mide los niveles de glucosa en el fluido intersticial de manera casi continua y se aloja de forma parcial debajo de la piel. Algunos sensores tienen el tamaño de una pestaña y se implantan por completo debajo de la piel bajo la supervisión de un médico. El sensor dura un tiempo (esto varía según el sistema) antes de que sea necesario reemplazarlo. EL TRANSMISOR: Este es un transmisor resistente al agua recargable o recambiable que envía información de manera inalámbrica desde el sensor hacia el receptor o hacia un dispositivo inteligente compatible. El dispositivo transmite de manera automática o solo cuando se escanea el sensor. La información sobre la glucosa se transmite sin dolor y puede enviarse a través de la ropa. El transmisor puede ir por separado o estar incorporado al sensor. EL ESCÁNER O

LECTOR: Es un dispositivo independiente recargable del tamaño de un teléfono celular o más chico, o se puede utilizar una aplicación en su teléfono inteligente. La información se muestra en forma de gráfico y se actualiza de manera constante con datos nuevos sobre la glucosa. La información en la pantalla también incluye las flechas de tendencia con las que se muestra en qué dirección se mueven los niveles de glucosa y se proporcionan datos previos y actuales. Toda esta información puede ayudarlo a usted y a su proveedor de atención médica a tomar decisiones sobre el tratamiento

Sistema de monitorización flash. La principal característica de este sistema es que no tiene transmisor. El sensor, que realiza una monitorización continua, almacena los datos hasta 8 horas y es necesario “escanear” el sensor con el lector para que éste le transfiera la información. Es el sistema FreeStyle Libre®.   

El  FreeStyle Libre utiliza este tipo de sistema, y en sus primeras generaciones carecia de avisos en tiempo real para hipo e hiperglucemias, esto cambio con las mas recientes versiones que incluyen alarmas para estas situaciones.

Sistemas de monitorización continua. Estos incorporan el transmisor, por lo que los datos son enviados al receptor de manera constante. La principal ventaja de estos sistemas es que se pueden programar alarmas y cuando los niveles de glucosa se desvían de un valor preestablecido, el receptor avisa para la toma de medidas oportunas. Actualmente, hay dos sistemas; Guardian y Dexcom.

Medir el éxito: A1c y el tiempo en rango Conocer los datos sobre su glucosa es una de las claves para mejorar el control de la diabetes. La mayoría de las personas con diabetes se realiza una prueba de sangre llamada hemoglobina A1c (o simplemente A1c) una vez cada tres a seis meses. Los resultados muestran el promedio de glucosa en la sangre durante los últimos dos a tres meses y ofrecen un panorama general sobre qué tan bien se está controlando la glucosa en la sangre. Sin embargo, la prueba de A1c no registra el tiempo en que la glucosa en la sangre se encuentra por debajo o por encima del rango objetivo. El MCG ofrece una nueva manera de medir qué tan bien está alcanzado sus objetivos. Su tiempo en rango (TIR, por su sigla en inglés) hace referencia al porcentaje de tiempo que la glucosa en la sangre está dentro de un rango objetivo específico. Este rango objetivo puede variar, pero en la mayoría de las personas se encuentra dentro de los 70 y los 180 mg/dL. Tener información sobre qué porcentaje de sus lecturas están por debajo, dentro y por encima del rango objetivo permite que su proveedor lo ayude a decidir cualquier cambio en los medicamentos o en el estilo de vida necesario para poder alcanzar sus objetivos. Por lo general, un TIR ideal es >70 %. Estos detalles pueden ser útiles para establecer o modificar su plan de tratamiento.

El MCG brinda más información. El medidor de glucosa en sangre le ofrece un panorama en tiempo real, informándole con exactitud cuál es el nivel de glucosa en la sangre en ese momento. No establece relaciones entre los niveles de glucosa pasados y futuros. El MCG puede darle más información sobre la historia, mostrando las tendencias actuales, las tendencias predictivas y las tendencias a lo largo del tiempo. 

Así como el furgón de cola se arrastra detrás de la locomotora, las lecturas del MCG van apenas más atrás de las mediciones de la glucosa en la sangre. Los resultados de los sensores de glucosa pueden ir un poco más atrás que las mediciones de la glucosa en la sangre, es decir, con las lecturas del sensor de glucosa se le informa cómo estaba su glucosa unos minutos antes.

Cuando el nivel de glucosa en sangre se encuentra estable durante un tiempo, los niveles de la glucosa en ambos líquidos se equilibran y coinciden. Pero como la composición del líquido intersticial depende de los intercambios entre las células en el tejido y la sangre, cuando hay fluctuaciones de glucosa en sangre, existe un retardo de la intersticial respecto a la capilar de unos 5-10 minutos.

Normalmente, esto no debería afectar la capacidad de usar el sensor de glucosa para tomar decisiones sobre el tratamiento. Sin embargo, es bueno saberlo en situaciones donde la glucosa puede alterarse con rapidez, como, por ejemplo, durante el ejercicio físico o luego de haber tomado una dosis de insulina para corregir una lectura alta de glucosa.

Es posible que aún necesite punciones digitales. Algunos sistemas de MCG deben calibrarse para mostrar resultados correctos. Para esto, se necesitan lecturas de punción digital. Tal vez le aconsejen que se haga punciones digitales en determinadas ocasiones, como, por ejemplo, cuando su sensor se está iniciando (a menudo durante las dos horas posteriores a la inserción), cuando las lecturas del sensor son bajas o altas, si tiene síntomas de glucosa baja o alta en la sangre o si sospecha que las lecturas son incorrectas por alguna razón. Puede haber diferencias y no necesariamente tiene el mismo valor.

¡Muchas Gracias!


Fármacos: Resumen (Español)

Muy buenos días mi nombre es Sananda Moctezuma Vega del departamento de endocrinología de la Universidad de Johns Hopkins y en el día de hoy queremos hacer un video para nuestros pacientes, ayudarlos un poco con la educación en diabetes. 

Generalmente, los medicamentos para la diabetes en la clase de los agonistas del péptido similar al glucagón tipo 1 se reciben mediante una inyección que se administra a diario o semanalmente y que incluye lo siguiente: 

Dulaglutida (Trulicity), Exenatida (Bydureon,Byetta), Semaglutida (Ozempic), Liraglutida (Victoza, Saxenda), Lixisenatida (Adlyxin), Semaglutida (Rybelsus- vía oral).

 Estos medicamentos imitan la acción de una hormona llamada péptido similar al glucagón tipo 1. Cuando los niveles de glucosa en la sangre empiezan a subir después de comer, estos medicamentos estimulan al cuerpo a producir más insulina. La insulina adicional ayuda a reducir los niveles de glucosa en la sangre. 

Los niveles más bajos de glucosa en la sangre son útiles para controlar la diabetes tipo 2, pero no se sabe exactamente cómo los medicamentos de péptido similar al glucagón tipo 1 conducen a la pérdida de peso. Los médicos saben que los péptidos similares al glucagón tipo 1 parecen ayudar a controlar el hambre. Estos medicamentos también disminuyen el movimiento de los alimentos desde el estómago hacia el intestino delgado. En consecuencia, es posible que se sienta satisfecho más rápido y durante más tiempo, por lo que termine comiendo menos. 

Además de ayudar a controlar la glucosa en la sangre y aumentar la pérdida de peso, los inhibidores de los péptidos similares al glucagón tipo 1 y el cotrasportador de sodio-glucosa tipo 2 parecen tener otros beneficios significativos. Las investigaciones han descubierto que algunos medicamentos en estos grupos pueden reducir el riesgo de enfermedades cardíacas, como insuficiencia cardíaca, accidentes cerebrovasculares y enfermedades renales. Las personas que reciben estos medicamentos han visto mejoras en su presión arterial y en sus niveles de colesterol, pero no se sabe con certeza si estos beneficios se deben al medicamento o a la pérdida de peso.

La desventaja de los medicamentos de péptido similar al glucagón tipo 1 es que todos, menos uno, deben administrarse mediante inyección. Y, como cualquier medicamento, hay un riesgo de efectos secundarios e incluso algunos de ellos pueden ser graves. Los efectos secundarios más comunes suelen mejorar con el tiempo y a medida que sigue recibiendo el medicamento. Algunos de los efectos secundarios más comunes incluyen : nausea, vomitos y diarrea. 

 La clase de medicamentos de péptido similar al glucagón tipo 1 no se recomienda si tienes antecedentes personales o familiares de cáncer medular de tiroides o neoplasia endocrina múltiple. Los estudios de laboratorio han relacionado estos medicamentos con tumores de la tiroides en ratas, pero no se conocerá el riesgo en humanos hasta que se realicen más estudios a largo plazo. 

Estos medicamentos no se recomiendan si has tenido pancreatitis

Una segunda clase de medicamentos que pueden ayudar a bajar de peso y mejorar el control de la glucosa en la sangre son los inhibidores del cotrasportador de sodio-glucosa tipo 2. Entre estos, se encuentran la canagliflozina (Invokana), la ertugliflozina (Steglatro), la dapagliflozina (Farxiga) y la empagliflozina (Jardiance). 

¡Muchas Gracias!




Living with Diabetes

Transcript: Injecting Insulin Using a Pen

Injecting Insulin Using a Pen

If you have diabetes and have been prescribed insulin to take via an insulin pen, there are a few things that you should know.  There are many kinds of insulin, and your doctor will decide what insulin type, amount, and injection times are best for you.  It’s understandable if you’re feeling a little nervous or anxious about taking insulin injections.  But with a little practice you will see that it takes only a few seconds to do, and can be rather easy.

To ease any anxiety you might have about taking insulin injections, we will demonstrate how to take an insulin injection using an insulin pen.  Now let’s begin.

First, start by washing your hands with some soap and water

Preparing the Insulin Supplies

Prepare the insulin supplies, and make sure you have the following items:

Preparing the Insulin Pen

Prepare the Insulin Pen.

  • Always remember to check the label and the color of the insulin pen.
  • Remove the cover of the pen
  • Take your alcohol swab and wipe the tip of the pen where the needle will attach.
  • Some insulin pens like NPH or mixed 70/30, or 50/50 insulin, will need to be gently mixed before use. These types of insulin look cloudy or milky white and need to be gently mixed by rolling the pen between your palms. If you are using a different type of insulin that looks clear like this one, you do not need to mix it. Only the cloudy insulin needs to be rolled.
  • Take a new pen needle and remove the protective tab.
  • Insert the needle into your pen and screw it on until it is secured.
  • Now you want to prime the pen which means removing air from any of the needles. We do that by dialing the pen 2 units. Then, remove the needle cover.
  • Point the needle up into the air. Tap on the side of the pen and then press down on the knob. By doing this you have primed the pen and made sure insulin is going through the needle.

Set the pen to your dose. Turn the knob until you see the correct dosage.

Choosing an Injection Site

Now it’s time to choose an injection site.  Insulin can be injected into any of the following sites:

  • The stomach. This is the preferred injection site.  Stay at least two inches away from the bellybutton or any scars that you might have.
  • You can inject insulin into the fatty tissue at the back of the arm or the top and outer area of the thigh or the upper and outer part of the buttocks. Remember, the insulin needle goes under the skin only, not into the muscle like the flu shot, for example.  Insulin injections in general are easier then intramuscular injections.
  • Avoid injecting cold insulin, since this can cause discomfort. When using the insulin pen or vial for the first time, take it out of the fridge at least 30 minutes before injecting so it has time to warm up.
  • Rotate the injection sites to use a slightly different spot with each injection and avoid injecting insulin into scar tissues or hard lumps that you may have. Insulin might not be absorbed as well if injected into these areas.  Injecting into the same spot too often can cause hard lumps under the skin and can impair insulin absorption.
  • You can rotate the injection sites in a pattern that works for you. Examples of rotation patterns are shown here.

Once you’ve chosen your injection site, wipe it down with alcohol to make sure that it’s clean.

Injecting the Insulin

Now you are ready to inject the insulin.

  • Gently pinch the skin with your free hand and quickly insert the needle at a 90 degree angle.
  • Release the pinch, push down on the plunger at a steady motion for about 10 seconds until the pen goes back to zero.
  • Pull the needle straight out of the skin.

Now that you have taken your injection you need to safely dispose of the pen needle or syringe.  FDA-cleared sharps disposal containers are generally available through pharmacies, medical supply companies, health care providers, and on-line.

If an FDA-cleared container is not available, some organizations and community guidelines recommend using a heavy-duty plastic household container as an alternative.  The container should be leak-resistant, remain upright during use, and have a tight-fitting, puncture-resistant lid, such as a plastic laundry detergent container.

All sharps disposal containers should be labelled to warn of any hazardous waste inside of them.  Follow your community guidelines for proper disposal methods.

  • You should always store unused insulin pens in the refrigerator at a temperature of about 40°F or 4.4°C.
  • Insulin pens can be used (if refrigerated) until the expiration date that’s listed on them.
  • It’s likely that you bought more than one insulin pen at a time. You should store all extra insulin pens in the refrigerator except for the one that you are currently using.
  • Remember, do NOT freeze insulin or keep the insulin near ice.
  • Do NOT keep insulin in a hot place (warmer than 86°F or 30°C) or in direct sunlight.
  • Do NOT use the insulin after the expiration date printed on the pen.
  • You can keep the insulin pen that you’re currently using at room temperature (below 86°F or 30°C) for up to eight (8) weeks. The number of days or weeks depends on which pen that you use.

Congratulations!  You’ve just learned how to inject and store insulin.  Taking insulin injections can be a very simple process, and the more you do it, the easier it becomes.  If you would like to learn how to take an injection using a syringe and vial, please watch the next video.

Transcript: Injecting Insulin using a Syringe

Injecting Insulin Using a Syringe

If you have diabetes and have been prescribed insulin to take with a syringe and vial there are a few things that you should know. There are many different kinds of insulin, and your doctor will decide what type, amount, and injection times are best for you.

It’s understandable if you are feeling a little nervous or anxious about taking injection sites.  But with a little practice, you’ll discover it only takes a few seconds to do, and is rather easy.  To help ease any anxiety you might have about taking insulin injections, we will demonstrate how to take an injection with a syringe and vial.  Now let’s begin.

First, start by washing your hands with some soap and water.

Preparing the Insulin Supplies

Prepare the insulin supplies and make sure you have the following items:

  • the insulin vial
  • alcohol swab, or cotton ball moistened with alcohol
  • and a new insulin syringe

Preparing the Insulin Vial:

  • Always remember to check the vial to be sure it’s the type of insulin you intend to inject. Also, check the expiration date.
  • If you are using NPH or mixed insulin 70/30 or 50/50 insulin that looks cloudy or milky white, gently mix the insulin by rolling the bottle between your palms for 15 seconds. Fast acting or long acting insulin does not need to be mixed.

Drawing the Insulin into the Syringe:

  • Pull back the plunger on the syringe to draw in an amount of air that is equal to your insulin dose, matching the tip of the black plunger with the correct marking on the syringe and remove the needle cover.
  • Wipe the top of the vial with alcohol and allow it to dry
  • Hold the needle like a pencil and insert it through the rubber stopper on the top of the vial.
  • Push the needle down to push the air into the vial. This will make it easier to withdraw the insulin.
  • Leaving the needle in place, turn the bottle upside down. The needle tip should be fully submerged in the insulin. Pull the plunger down to fill the syringe to the desired amount of insulin, again, using the tip of the black plunger to match the markings on the syringe.
  • Pull the needle out of the vial. Gently tap on the side of the syringe to move any air bubbles up. Slowly push the plunger so the air exits the syringe.

Choosing an Injection Site

Now it’s time to choose an injection site.  Insulin can be injected into any of the following sites:

  • The stomach. This is the preferred injection site.  Stay at least two inches away from the bellybutton or any scars that you might have.
  • You can inject insulin into the fatty tissue at the back of the arm or the top and outer area of the thigh or the upper and outer part of the buttocks. Remember, the insulin needle goes under the skin only, not into the muscle like the flu shot, for example.  Insulin injections in general are easier then intramuscular injections.
  • Avoid injecting cold insulin, since this can cause discomfort. When using the insulin pen or vial for the first time, take it out of the fridge at least 30 minutes before injecting so it has time to warm up.
  • Rotate the injection sites to use a slightly different spot with each injection and avoid injecting insulin into scar tissues or hard lumps that you may have. Insulin might not be absorbed as well if injected into these areas.  Injecting into the same spot too often can cause hard lumps under the skin and can impair insulin absorption.
  • You can rotate the injection sites in a pattern that works for you. Examples of rotation patterns are shown here.

Once you’ve chosen your injection site, wipe it down with alcohol to make sure that it’s clean.

Injecting the Insulin

Now you are ready to inject the insulin.

  • Gently pinch the skin with your free hand and quickly insert the needle straight in.
  • Release the pinch and push down on the plunger on a steady motion until the syringe is empty.
  • Pull the needle straight out of the skin and place it in a sharps container.

Now that you have taken your injection you need to safely dispose of the pen needle or syringe.  FDA-cleared sharps disposal containers are generally available through pharmacies, medical supply companies, health care providers, and on-line.

If an FDA-cleared container is not available, some organizations and community guidelines recommend using a heavy-duty plastic household container as an alternative.  The container should be leak-resistant, remain upright during use, and have a tight-fitting, puncture-resistant lid, such as a plastic laundry detergent container.

All sharps disposal containers should be labelled to warn of any hazardous waste inside of them.  Follow your community guidelines for proper disposal methods.

  • You should always store unused insulin vials in the refrigerator at a temperature of about 40°F or 4.4°C.
  • Insulin vials can be used (if refrigerated) until the expiration date listed on them.
  • It is likely that you bought more than one insulin vial at a time. You should store all extra insulin vials in the refrigerator except for the one you are currently using.
  • Remember: Do NOT freeze insulin or keep the insulin near ice.
  • Do NOT keep insulin in a hot place (warmer than 86°F or 30°C) or in direct sunlight.
  • Do NOT use the insulin after the expiration date printed on the pen.
  • The insulin vial does not need to be refrigerated after the first use.
  • You can keep the insulin vial that you’re currently using at room temperature (below- 86°F or less than 30°C) for up to 6 weeks. The number of days or weeks will depend on what kind of insulin you use.

Congratulations!  You’ve just learned how to inject and store insulin.  Injecting insulin can be a very simple process, and the more you do it, the easier it becomes.  If you would like to see how to take an injection using an insulin pen, please see our other video.



Checking Blood Glucose

Transcript: Using a Blood Glucose Meter

Blood Glucose Monitoring

One of the most important parts of diabetes management is home blood sugar monitoring. Most people with diabetes have a home blood sugar meter that they use to read the level of glucose (or sugar) in their blood. This information is very important to help you and your health care provider make decisions about your treatment including medications, diet, exercise. In this video you will learn what a blood sugar meter or glucometer is, how it works, the best way to get a blood sugar reading at home, safe storage and disposal of the lancet needles and used test strips. Now let us begin. 

Setting up your blood sugar meter:

There are several parts and steps involved in checking your blood sugar. To check your blood sugar, you will need the following:

  • The blood sugar meter
  • Your lancing device and needles
  • Your test strips
  • A cotton or tissue
  • A log book or another way to track blood sugar information
  • A sharps container
  • Optional: alcohol swab

How to check your blood sugar level:

First, start by washing your hands with some soap and water. If you are not in a place where this is possible or convenient, you can use an alcohol swab to clean your finger.

Next, insert a lancet or needle into the lancing device. First remove the cap from the lancing device. Then take a new needle and insert it. Then twist the protective cap covering the needle until it comes loose-remember, don’t pull on it until it is loose. Then replace the cap on the lancing device. On most lancet devices, you can decide how deep the needle will poke the finger by adjusting the number on the dial. Higher numbers are deeper, lower numbers are shallower. Take into account your skin thickness. A level 1 may not work on most adults. If you have very tough skin or any calluses, you will likely need a deeper setting. To start, most patients use a level 2.5 or 3.

Next, insert the test strip into the glucose meter. Remember that each meter has its own test strips that must be used. When the strip is inserted correctly the meter will turn on.

Now we need to get a drop of blood. To make this easier and more comfortable, there are a few tips to live by: Only use the sides of the fingers-avoid the tip of the finger and the pad of the finger. Rotate where you poke your finger-don’t always use the same finger twice or you can develop scar tissue. Use different fingers and different sides of the fingers.

Next we need to prepare the lancet to poke the finger. Slide back on the lever if you have one. Then put the end of the lancet to your finger. To make sure you don’t pull your hand away it might help to have your hand flat on a sturdy surface like a table. Now go ahead and poke the finger. Once you have a drop of blood, wipe it away with the Kleenex or the cotton swab. Then, use the second drop to check your blood sugar. Apply it to the strip-there will be a small line on the end of the strip where you will place the blood. When you touch it to the drop of blood, the test strip will “suck” the blood into the strip.

Dispose of the used lancet into a sharps container. Many needles  come with a cap that you can apply to the end that you had removed earlier. This will keep anyone from poking their finger accidentally.

As you can see the blood sugar meter (or glucometer) displays your blood sugar numbers. Most meters automatically store glucose readings as well, sometimes for up to three months. Ot you can record your blood sugar level in a log book or an app if you use one on your phone. 

Store test strips in a cool dry place. They do not need to be stored in the refrigerator and you should avoid storing them in a moist or very hot place. Make sure to check the expiration date on your strips before using them.

When to check your blood sugar:

There are several times during the day that you can check your blood sugar and different times may give you different information. Your healthcare provider will discuss with you the appropriate times and frequency to check your readings based on your treatment regimen. Most people using insulin will need to check about 3-4 times per day, often before meals and at bedtime. People with diabetes who are on oral medications alone may only need to check once per day.

However, it is important to check your blood sugar before you drive, and sometimes before bed especially if you are more prone to having hypoglycemic episodes or low blood sugar levels.

Most people that check only one time per day will check their blood sugar first thing in the morning before they eat or take medications (also called your fasting number).

Here are some points to remember:

  1. There are many different types of glucose meters with different features and sizes. Check with your health care provider to find out which meter is best for you.
  2. You cannot reuse test strips or the needle in your lancet. Please dispose after each use.
  3. Do not use expired test strips-they may not give you accurate readings.
  4. Do not throw lancets in the trash-use a sharps container.
  5. Make sure the time and date in your meter are correct-don’t forget to change at daylight saving’s time.
  6. Bring your meter with you to each visit with your doctor, nurse or dietitian.


You have now learned how to use a blood glucose meter to monitor your blood glucose at home. When used routinely and properly, it can be a vital tool for you and your provider to manage your blood sugars. Talk to your provider about what your blood sugar targets are, how frequently you should check your blood sugar and what times you should check during the day. Bring your blood glucose meter to every visit, as your providers can learn more about how your diabetes is being managed and make recommendations to improve your control. Remember, the numbers are knowledge and knowledge is power to managing diabetes.


Transcript: Using a continuous Glucose Meter

Continuous Glucose Monitoring Intro

Continuous Glucose monitoring is a way of monitoring your blood glucose (or blood sugar) continuously or more frequently with fewer or sometimes no finger-sticks. In this video, we will explain what a continuous glucose monitor or CGM is, how it works and how it is different from a glucose meter as well as some of the benefits and disadvantages of using continuous glucose monitoring.

Parts of the CGM:

There are three main parts to a continuous glucose monitoring system:

  • The sensor itself. This is a small threadlike device that will be inserted under your skin with a needle. This is the part that goes into your body. Don’t worry-the needle is used just to insert the sensor under your skin-it doesn’t stay there.
  • The receiver: This part of the system will receive the information from your sensor and display it on the screen. Some sensors allow the information to be sent to your phone as well or instead of using the receiver.
  • The transmitter: Think about this part of the system as being the translator between the sensor and the receiver or your phone. It will take the information from your sensor and send it to your phone or to the receiver.

There are expiration dates on the sensors. Most people do not have sensors expire if you are using them routinely. You have to be careful about not storing your sensors in very hot or very cold areas. The CGM (Continuous Glucose Monitor) does let you know when it is time to change your sensor and it is important to follow the instructions provided along with the system with regards to changing your sensor.

Benefits: Some of the benefits to continuous glucose monitoring are:

  • You can monitor your blood sugar throughout the night without having to poke your finger.
  • You receive updates about every 5 minutes and you can monitor your trends in your blood sugar-where it has been earlier in the day and where it is trending now-up or down.
  • You can add customized ranges for your blood sugar and the CGM will alert you with an alarm when you are outside of those ranges.
  • A CGM is helpful for a person that does not feel when their blood sugar is low or when they have low blood sugar during the night time.
  • If you have wide ranges in your blood sugar-very high highs and very low lows-the CGM can improve your blood sugar range and help you get closer to goal-because the CGM will alert you when your sugar is high or low or when it is going high or low.

Disadvantages: Some of the disadvantages to using a continuous glucose meter

  • The number on the CGM is not as always exactly the same as your blood sugar. It reads a different level of sugar in your body called “Interstitial Fluid” or the fluid in between the cells just under your skin. Because of this, there can be a lag time between what you see on the CGM and what you see on your blood glucose meter. Most sensors also require that you confirm the sensor with a finger-stick blood sugar before correcting a blood sugar with insulin.
  • A CGM is a device with a sensor that is inserted under your skin and will be worn for up to 2 weeks depending on what CGM you use. It is usually placed on your abdomen but may also be placed on the upper buttocks or upper arm. This means you will have a device on you and you will need to keep the CGM receiver or your phone in range in order to receive any information.
  • Because the CGM is designed to alert you when your blood sugar is out of range, if you normally have big changes in your blood sugar or you tend to have a lot of highs and lows, the CGM will be alarming at you a lot. 

    Types of CGM’s

    There are three types of continuous glucose monitoring systems:

    – A flash “CGM” allows the person to “scan” the sensor and receive data when they want to. However, this type of sensor does not give alarms to warn about highs and lows.

    – A real-time CGM will give continuous information during the day and updates about every 5 minutes with new blood sugar information. Because it is reading continuously, it will provide alarms when the user is out of range of their blood sugar targets and may even alarm when their blood sugar rises or falls quickly. This type of sensor can be used as part of what is now called the “artificial pancreas system”.

    – There is also a sensor that can be implanted under the skin and worn for 90 days. These two options will not be discussed in this video.


    You have just learned about what a continuous glucose monitoring system is, how it works, the benefits and disadvantages of CGM technology and important points about CGM use. CGM’s are not needed for everybody, but can be a very beneficial part of diabetes blood sugar management for many people with diabetes.

    Treating Hypoglycemia

    Transcript: Injecting Glucagon


    If you or someone you know has diabetes and is on either insulin or other medications that can cause severe low blood sugar, your doctor may have prescribed a medication called glucagonGlucagon is an injection that is given to a person who has severe low blood sugar.  If the person is unconscious and unable to take either food or beverage by mouth, you may have to administer this injection.

    Remember:  Glucagon is for emergencies only, so it can be helpful to be familiar with the process before the emergency happens.  To help you become more familiar and comfortable with the process, follow along and I will demonstrate how to administer glucagon.

    • Open up the glucagon kit.
    • There are instructions inside of the kit if you need them later.
    • Inside the kit is also syringe full of liquid and a vial full of powder.
    • You will need to inject the fluid into the vial to mix up the medication.
    • To do this, set the vial on a hard surface and inject the fluid into the vial.
    • Remove the syringe and gently mix the powder into the liquid.

    Once it’s thoroughly mixed together like this, insert the syringe again and turn both the syringe and vial upside down so that the vial is on top, like this.  Draw up the mixture into the syringe.  Once the syringe is full, remove the vial and make sure you remove any bubbles from the syringe.  Now the injection is ready.

    Unlike an insulin injection, the glucagon injection is an intramuscular injection, much like epinephrine.  This means that you have to use some force when giving the injection.  The person receiving this shot will most likely be unaware or unconscious when this shot is given, so don’t be afraid to use more force.  This shot can be given through the clothes and anywhere in the body that there’s muscle but most people give it to the person in the arm or leg or buttocks.

    Giving glucagon can be a scary process and is usually an emergency situation.  But now that you’ve seen this video you can refer back to it as needed or look at the instructions in the glucagon kit.


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