Connie Crawley, MS, RD, LD
Public Service Associate & Extension Nutrition & Health Specialist,
Department of Food and Nutrition

Document Use:

A new type of insulin call lispro (brand name Humalog) was approved by the Food and Drug Administration in June 1996. This insulin works much faster than regular insulin. While regular insulin must be injected 30-40 minutes before meals, lispro can be injected 5 minutes before. This allows people to match their insulin dose to their food intake better.

Since lispro works faster than regular insulin, you may need to exercise at a different time to prevent low blood glucose reactions. Regular insulin doesn't really start working until 30 to 60 minutes after injection. It lasts for four to six hours. However lispro lowers the blood glucose the most about one hour after you inject it. It begins working within five minutes and is only effective for two to four hours.

If your doctor suggests switching to lispro, when should you exercise? The answer is probably three or four hours after you inject it. This is when its effect will be wearing off and there will be less chance for hypoglycemia (a low blood glucose reaction). In contrast, those on regular insulin should exercise soon after a meal. If a person on regular insulin exercises three to four hours later, their blood glucose level may drop too low.

Of course blood glucose monitoring before, during and after exercise is the only way to tell when exercise is best for you. Other factors like taking NPH insulin, the site of the injection and how much you ate will influence how exercise will affect your blood glucose level. Talking to your medical team and keeping good blood glucose records can make any change in your diabetes treatment safer and easier.

The Food and Drug Administration (FDA) has approved a new drug to help control Type II diabetes. It is called troglitazone (Brand name - Rezulin). This drug fights the insulin resistance that many people have and makes the cells use insulin better. It also controls the liver's production of glucose after meals. Unlike many other diabetes pills, it does not cause the pancreas to secrete more insulin.

This drug is for people who have poorly-controlled diabetes even on insulin shots. In fact it is only recommended for people with Type II diabetes who take over 30 units of insulin per day. Studies show that insulin doses can be lowered as much as 42 percent when troglitazone is given, along with insulin.

This drug cannot be taken by people with Type I diabetes. It should not be used by pregnant women or people with liver disease or serious heart disease. The FDA recommends that it not be taken with other diabetes pills. Of course, troglitazone does not replace good nutrition and regular exercise. But it is another option to help improve blood glucose control and reduce risk for complications.

Dr. Lois Jovanovic-Peterson, an expert in diabetes and pregnancy, promotes strict blood glucose control during pregnancy. High blood glucose levels put the baby and mom at risk during pregnancy and delivery and have long-term effects on the baby.

Babies born of moms with poorly-controlled diabetes are more likely to become overweight as they get older. They also may have higher blood glucose levels as adolescents and develop diabetes later in life. If the mom's diabetes control causes the baby to be premature or low birth weight, the baby is more likely to have problems later in school.

Having good blood glucose control is vital for a healthy baby. If you have diabetes, control your diabetes before you get pregnant. Then keep it under control throughout your pregnancy. If you get gestational diabetes after you are pregnant, strictly control your blood glucose until delivery. Every woman wants to have a healthy baby. Keeping your blood glucose in the normal range will give your baby the healthiest start possible.

With time some people with diabetes become less aware of their symptoms of hypoglycemia. This means their symptoms can be serious before they notice their blood glucose is getting low. If you have this problem, you can protect yourself.

Why hypoglycemia unawareness occurs is unclear. The body may lose its ability to release the stress hormone, adrenaline. Adrenaline causes some of the early symptoms of hypoglycemia. These early symptoms include shakiness, sweating, irritability, rapid heart beat, nervousness and anxiety. While these signs are unpleasant, they do help you know your blood glucose is dropping.

When hypoglycemia unawareness occurs, the symptoms are more serious before anyone notices. The more serious symtoms include confusion, sleepiness, stubbornness, clumsiness, nausea, headache, nightmares, personality changes, vision changes, tingling or numbness of the tongue or mouth and unconsciousness.

How can you control this? First, talk to your medical team about more realistic goals for your blood glucose control. They may help you find different warning signs so you can treat your hypoglycemia earlier. Second, test your blood glucose more often. Definitely test before driving or whenever you use dangerous equipment. Finally, tell everyone you spend time with regularly what hypoglycemia is and how it can be treated. Describe your symptoms and show what they can do to help.

The 1997 edition of the publication catalogue from the American Diabetes Association is now available. In it are some new and exciting publications that may interest you.

As usual, ADA has some great cookbooks for those needing new recipe ideas. The most exciting for our region is the new cookbook, Southern Style Diabetic Cooking by Marti Chitwood. But there are other unique cookbooks like World-Class Diabetic Cooking that features unusual recipes from around the world and even a cookbook called Brand-Name Diabetic Meals in Minutes that uses convenience foods to make cooking a snap.

Beside the ever-popular cookbooks, there are also some new diabetic "self-help" books. A very important one is the newly-revised Type II Diabetes: Your Healthy Living Guide that gives lots of helpful tips for people with Type II diabetes. For the parents of a child with Type I diabetes, there is the new publication, The Ten Keys to Helping Your Child Grow Up with Diabetes. A much-needed new book is Women and Diabetes that addresses the challenges that being female adds to diabetes management.

These new books and all the other popular publications in the catalogue will make you want to buy all of them. Of course, ADA members get discounts on their orders. If you order $35 worth of books, you receive free a book called 101 Tips for Improving Your Blood Sugar that gives you quick ideas for keeping your diabetes in control. To get your catalogue, call your local ADA affiliate at 1-800-DIABETES or call the ADA Order Fulfillment Office at 1-800-232-6733.

1. Blenderize strawberries and artificial sweetener.

2. Add yogurt and milk and blend until frothy.

3. Can garnish with a lemon slice or sliced strawberry.

4. Serve as snack or breakfast drink.

Serves 2.

Print copies of Diabetes Life Lines are available 6 times per year free to Georgia residents by calling the local county extension office.