Grunberger Diabetes Institute FAQs


Frequently Asked Questions

What is the rule of 15?

The “Rule of 15” is a guideline to follow when you have a blood sugar <70 mg/dL. When a blood sugar <70 mg/dL is confirmed with a glucose meter, eat 15 g of quick-acting carbs (1/4 C juice or sugar pop, 4 glucose tabs, 15 grapes, one slice of bread); wait 15 minutes and recheck your blood sugar with a meter.  If your blood sugar is <70 mg/dL, then repeat by eating another 15 g of carb, waiting 15 minutes, and retesting.  If the reading is >70 mg/dL, then do not eat more quick-acting carbs.  You may still have symptoms of low blood sugar which will take a while to resolve.

What are the signs of hypoglycemia?

 Hypoglycemia (low blood sugar) often is characterized by sweating, dizziness, weakness, altered thinking. When these symptoms occur, test blood sugar with a glucose meter to confirm because the symptoms may be related to something other than diabetes.  If hypoglycemia, or low blood sugar of <70 mg/dL is confirmed, then follow the “Rule of 15” for recovery.

What are the signs of hyperglycemia?

Hyperglycemia (high blood sugar) often is characterized by increased thirst and urination, hunger, irritability, drowsiness. When these symptoms occur, test blood sugar with a glucose meter to confirm.  Follow guidelines recommended by your prescriber.  The recommendations often include drinking plenty of water or non-sweetened beverages which helps the blood sugar to decrease by helping the kidneys to work better.  However, if you take rapid-acting insulin, you will be told how much insulin to take to bring down your blood sugar to a good range.

What are the effects of getting a steroid injection or prescribed steroid pills?

 Often getting a steroid injection or being prescribed a steroid pill raises the blood sugar. Depending on the dose of the steroid, the blood sugar can increase only slightly or by a significant amount. This is caused by insulin resistance from the steroid.  Depending on the type of diabetes medication you take, your prescriber can recommend a dose increase in the event of your needing a steroid.  The effect of higher blood sugar can last days to weeks depending on the dose and how long you take the steroid.

What is the best way to travel with diabetes medications?

Guidelines for traveling with diabetes medications include the following:

  1. Keep all diabetes medications in your carry-on luggage to avoid problems with lost luggage and because of the wide variation in temperature in a cargo hold.
  2. Oral medications should be kept in their original prescription bottles.
  3. Insulin – should be carried in a temperature-controlled container; carry extra insulin in case of a faulty insulin pen or broken vial. Remember to pack insulin pen needles or syringes.
  4. If you have an insulin pump, be sure to know your back-up plan (the insulin injection plan you go to in case of pump failure) and bring that insulin as well.

What does the HbA1C actually measure?

 The hemoglobin A1C number is the percent of red blood cells that have glucose (a sugar) attached – the higher the number, the higher the blood sugars have been. Since the average life of a red blood cell is 120 days, the typical wait for a new HbA1C is at least 60-90 days to see a new “picture” of diabetes management.

Do I really need to see a Podiatrist?

Having an established relationship with a Podiatrist is recommended. The Podiatrist can perform regular toe nail trims and inspect your feet.  Additionally, if you ever have a more serious problem with your feet, you already have an established relationship and may be seen sooner.

Where can I go for diabetes classes?

 Diabetes education is available through our office in several ways – 1) meeting with our Registered Dietician who is versed in diabetes management; 2) attending a group class in our office; or 3) asking for a referral to group classes at a hospital system.

store insulin in the refridgerator

Will my neuropathy ever get better?

 The short answer is, “it’s difficult to know.” Often times, if neuropathy is mild and has not been occurring for a long time, it can improve with improved blood sugar control.  Healing of the nerves that have not been receiving good blood flow because of high blood sugars takes time – sometimes months to over a year.

What is the best way to store insulin?

 Insulin that is unopened – insulin pens or vials – should be stored in the refrigerator and these will last until their expiration dates. Once opened, an insulin pen or vial will last for anywhere from 4-8 weeks, depending on the brand.  If you are traveling with insulin, be aware of the heat or cold in your car – use an appropriate cooler to maintain temperature.  If you are traveling by airplane, keep insulin in your carry-on bag to avoid extreme temperatures in the cargo hold and to avoid lost luggage and delayed insulin use.

Should I get an insulin pump?

Insulin pumps can benefit persons with Type1 diabetes or Type2 diabetes who inject insulin before all meals and long-acting insulin daily. Insulin pumps require training in our office and they require interaction on part of the patient – they do not take away diabetes management but they can allow more flexibility of one’s lifestyle.  They have the benefit of eliminating injections and being able to vary background insulin to match one’s insulin needs over the day.  During your office visit, you can request information on the insulin pumps available and schedule a meeting with a pump representative to learn more.

What are the benefits of a personal continuous glucose monitor?

 A continuous glucose monitor provides real-time glucose (sugar) information to its wearer. The device measures glucose in the fluid just under your skin which closely matches blood sugar levels.  By viewing a phone or a reader, or swiping a device over the sensor, a person can know their current glucose level.  All of the available systems now have the ability to provide its wearer with warnings of high or low glucose levels based on individual settings.  During your office visit, you can request information on the available continuous glucose monitors and schedule with an educator to learn more.

What should I do if I inject the wrong insulin?

If a rapid-acting or ultra-rapid-acting insulin – Novolog, Humalog, Apidra, Fiasp, or Lyumjev – is injected in place of long-acting insulin, you will need to eat carbohydrate. How much carbohydrate to eat depends on the amount of rapid insulin that was injected.  The easiest calculation is to compare the dose injected with your regular meal dose and adjust your intake.  You may need to monitor your glucose level with a continuous glucose monitor or additional finger stick testing for the next 2-5 hours because the effect of these insulins lasts for up to 5 hours.  This means that the blood sugar will drop for the next 3-4 hours without any carbohydrate consumption.

If long-acting basal insulin – Tresiba, Toujeo, Lantus, Basaglar, Levemir – is injected instead of rapid-acting insulin, the change in your blood glucose will depend on the dose injected and when you last injected your long-acting insulin. You can expect the long-acting insulin to last at least 24 hours.  Call your prescriber for advice on how to adjust your next dose of long-acting insulin.  Additional monitoring of your glucose level is advised and you may need to eat extra carbohydrates to compensate for the extra insulin.