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Care New England Diabetes Resources

Care New England Diabetes Resources

At Care New England, we are continuously striving to bring better quality, service, and access to support our community. That is why we are expanding our enhanced programs and services to better serve our patient population living with diabetes.

With the condition continuing to grow and affect more than 106,000 individuals across all age levels here in Rhode Island, it’s an issue that warrants both attention and action to help us advance the pace of progress in the fight against diabetes. Nationally, every 21 seconds someone is diagnosed with diabetes, which puts them at greater risk for series complications including kidney failure, heart disease, stroke, blindness, and lower-limb amputations. If you’ve witnessed the effect it has, it’s easy to understand the struggle those who are affected go through daily.

We’re committed to helping you not only manage your fight, but provide you with the resources, information, and services to help you live your best life.

The Care New England Wellness Center Diabetes Self-Management Education Program has been Recognized by the American Diabetes Association for Quality Diabetes Self-Management Education* and Support.

Understanding Diabetes

 Diabetes is a condition that can affect anyone, from all walks of life, across all age levels. The condition causes higher than normal blood glucose levels, or blood sugar. Blood sugar is the main source of energy your body uses and is derived from the food you eat. It’s also your brain’s main source of fuel. While the underlying causes of diabetes vary by type, the issues lies with how your body makes – or doesn’t make – insulin to properly process your body’s glucose levels.
 
Over time, having too much glucose can lead to significant health problems, including heart disease, blindness, kidney failure, and lower-extremity amputations. While there is no cure, there steps to manage diabetes and lead a healthy, active lifestyle.

Type 1 diabetes

In type 1 diabetes, the body does not produce the insulin needed to get glucose (energy) into the bloodstream. Usually diagnosed in children and young adults, type 1 diabetes can appear at any age. With proper care and use of insulin therapy in conjunction with other treatments, those affected can learn to manage the condition and lead long, healthy lives.

Type 2 diabetes

Type 2 diabetes is the most common form of diabetes. With type 2, the body does not make or use insulin properly. While medication may be necessary for some to control their blood sugar levels, others are able to manage through healthy eating and exercise. With nutrition and fitness being a key component to proper management, Care New England’s Wellness Center is here to support you in your journey to improved health and management of type 2 diabetes.

Gestational diabetes

Gestational diabetes develops in some women during pregnancy, and it is similar to type 2 diabetes. During pregnancy, your body makes hormones that make your body resistant to insulin. Most pregnant women make more insulin to keep their blood sugar levels normal. But seven to 14 percent of pregnant women still cannot make enough insulin to keep their blood sugar levels normal during pregnancy, resulting in gestational diabetes.
Our team at Women & Infants’ Diabetes in Pregnancy Program, part of the Division of Maternal-Fetal Medicine, is here to provide a wide variety of services for women who are pregnant and have diabetes, whether living with the condition prior to pregnancy or developed during.

Managing the Condition 

Care New England offers a variety of comprehensive management programs through our Wellness Center. The staff at the Care New England Wellness Center includes nutritionists, exercise physiologists, an RN, and a pharmacist. All of our experts have specific information about diabetes to share with you to help you better manage your diabetes.

We offer a variety of patient-teaching diabetes management programs and dietitian consultations for people living with diabetes. Our program is recognized by the American Diabetes Association (ADA) and is a Certified Diabetes Outpatient Education (DOE) site.

Whether you have been recently injured or have suffered from back or neck pain for longer and have tried various options, we are ready to create a care plan that is just for you. Because of this approach, we can usually help people with even the most complicated situations find relief.

  • Risk Assessment
  • Management
  • FAQs

 Care New England, with support from the American Diabetes Association (ADA), want to be your partner in health. Understanding your personal risk factors for diabetes is a critical first step towards early detection and long-term complications.

Not sure where to start? The ADA has developed the below risk test to help start you on your journey. It takes less than one minute to complete and your results will then be emailed to you. You can then take them with you to your health care provider to help you start a conversation. 

For questions or support, our Wellness Center team is here to help. They offer a variety of patient-teaching diabetes management programs and dietitian consultations for people living with diabetes. Our program is recognized by the American Diabetes Association and is a certified Diabetes Outpatient Education (DOE) site.

 

Take the Assessment

At the Care New England Wellness Center, we understand that everyone has different needs. That is why our diabetes program uses a personalized approach to help you meet your individual goals and lifestyle. We offer a variety of patient teaching programs and dietitian consultations for people living with diabetes including gestational diabetes

Diabetes Outpatient Education classes are now being offered at the CNE Wellness Center. Pre-screening and a physician referral is required. Please call (401) 732-3066 for more information.

The Care New England Wellness Center Diabetes Self-Management Education Program has been Recognized by the American Diabetes Association for Quality Diabetes Self-Management Education* and Support.

 

Diabetes Outpatient Education

 

 The Care New England Wellness Center diabetes program has been awarded recognition by the American Diabetes Association in accordance with the National Standards for Diabetes Self-Management Education Programs and is a state-certified Diabetes Outpatient Education (DOE) site. Classes are taught by a registered dietitian, a registered nurse and a pharmacist.

The program meets for two hours once a week over a five-week period and includes an individual appointment with a nurse practitioner and registered dietitian. This program is ongoing with evening and morning sessions available. After completing the series, there is a three-month follow-up appointment.

The Program includes:

  • Nutrition assessment and individual goal setting
  • Understanding diabetes
  • Meal planning
  • Dining out and alcohol guidelines
  • High and low blood sugar
  • Monitoring blood sugar and ketones
  • Sick day rules
  • Insulin and other anti-diabetic drugs
  • Insulin injection
  • Risk factors and complications
  • Foot care and hygiene
  • Exercise
  • Taking control of diabetes through your lifestyle
  • Travelin
  • Stress and psychological factors in diabetes.
  • Support systems

A 1997 Rhode Island law mandates insurance coverage for diabetes education when ordered by physicians. Patients are encouraged to call their insurance company for information regarding co-pays. Private consultations are available with certified diabetes educators, including nurse practitioners registered dietitians.

 
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 Experts from the Care New England Wellness Center have answered a range of questions about diabetes and diabetes education as part of our "Ask the Experts" campaign. 

 

Is there a cookbook that you would recommend for someone recently diagnosed with diabetes?


The American Diabetes Association has several cookbooks that would be helpful. We carry an ADA cookbook for sale here at the Care New England Wellness Center titled Diabetic Meals In 30 Minutes--Or Less. The cost is $5.00. Stop in to pick up a copy.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

I have friends and relatives that have been diagnosed with diabetes, put on medication, then seem to be able to control it enough to no longer need medical intervention. How is this possible?


Diabetes is controllable. Sometimes individuals can come off diabetes medications if they are adhering to proper dietary guidelines and exercising regularly. These individuals are still, and will always be, diabetics so regular medical appointments are always important.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

Does diabetes affect your teeth health?


Poorly controlled diabetes can cause gum disease. Bacteria, especially those that thrive in the mouth, love sweets. When you have high glucose levels, your saliva makes your mouth a home for the bacteria that causes gum infections. It's harder for your body to fight off infections when you have diabetes. Schedule regular visits with your dentist and remember to inform him or her that you are diabetic.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

I worry about my blood sugar getting too low. How do I safely exercise as a diabetic?


Your blood glucose reacts to any exercise. Exercise can lower your levels right after, or for as long as 24 hours afterward. If you take oral medications or insulin, your blood glucose level can sometimes drop too low. Always check your blood glucose readings before you exercise. If your blood sugars are between 120 and 250, you can exercise. Always carry a snack, 15gms of carbohydrate with you in case your blood glucose goes too low. Best time to exercise is one to three hours after a meal.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

I just turned 52, and I have a long history of diabetic close relatives with high Cholesterol. I had gestational diabetes when I was pregnant with my 2nd child. I'm 5ft, 3 in. and my weight is 150 lb. My annual physical check up is OK. I eat healthy, exercise time to time. It makes me worried that diabetes is in the corner waiting for me. What can I do to prevent it from catching up with me?


You may be able to delay or prevent diabetes with continued physical activity and healthy, balanced eating. Your present BMI (height to weight ratio) is 26.5, a healthy BMI is 25. A 5 to 10 lb weight loss can be helpful. You had an annual physical, did your physician have you do blood work? If so, always ask them to review the results with you.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

Do sugar free soft drinks have a deleterious effect on diabetes?


Sugar-free soda does not have a harmful effect on diabetes. Artificial sweeteners have been subject to intense scrutiny for years but they are FDA regulated and approved. They are a good alternative to sugar for diabetics. Like anything we consume, moderation is the key.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

Are sugar free lollipops a free food for diabetic children? One regular size lollipop made with Sorbee?


Typically sugar-free hard candies/lollipops should be limited to 3 per day. These products are made with a sugar alcohol that gets into the blood stream slowly and shouldn't affect blood sugar levels. Sometimes sugar alcohol has a laxative affect and can cause some stomach cramping.

Why did my blood sugar increase after exercising and why is my urine and water from my eyes feel sticky? I never noticed it before being diagnosed with diabetes.


Exercise usually makes your blood glucose levels go down, however if your blood glucose level is high before you start, exercise can make it go even higher. Your blood sugars should be between 120 and 250 before you exercise.

Glucose is not usually found in urine. When the level of glucose in the blood is high, the kidneys will move excess glucose into the urine because it cannot properly absorb it all. This urine is characteristically sticky. It is important to inform your physician of this symptom as soon as possible.

Diabetes can cause changes in your eyes. Keeping your blood glucose levels in control lowers your risk of developing any eye diseases. You should see an eye specialist (ophthalmologist or optometrist) once a year for a complete exam.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

 

My husband is "pre-diabetic" but is there really such a thing? He was just given a referral slip for diabetes teaching, can he participate in the classes even though he is not on insulin?


Pre-diabetes is a condition that comes before diabetes. It means that blood sugar levels are higher than normal but aren't high enough to be called diabetes. If you have been diagnosed with pre-diabetes, you are at a higher risk of developing diabetes and should do something about it at this time. Studies show that you can prevent or delay type 2 diabetes by making changes in your lifestyle. Begin by making an appointment with a registered dietitian. What and how you eat is a key part of your care, the dietitian can help you figure out your food needs. The classes are for individuals who have already been diagnosed with diabetes whether or not they are on medication or insulin.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

 

A family member is a diabetic and seems to feel that for a snack she can eat cake and ice cream. She states that it is ok to do this as its all about the carbs... What should I say to her?


Individuals with diabetes can consume sugar, have desserts and almost any food that contains caloric sweeteners. After you eat, your blood sugar level is largely determined by the TOTAL amount of carbohydrate you have consumed, not the source. The source of carbohydrate does effect how fast it turns into glucose. However, it is important to remember that while foods with sugar can be incorporated into a diabetic meal plan most sweets and desserts are HIGH in carbohydrates, calories, fat and have little or no nutritional value. While these foods can be consumed, they should be considered TREATS and eaten less often in limited amounts. The American Diabetes Association suggests you limit these treats to special occasions.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

 

I have type 2 diabetes, one year ago my blood sugar was fine. I also have neuropathy- Isn't that kind of soon to get foot pain? Will it ever get better? I am on Metformin and watch my diet and exercise-lost 30 pounds.


First, allow me to congratulate you on being pro-active in your diabetes care by watching your diet, exercising and taking your prescribed medication. I hope your blood sugar levels are still in good control. Loss of sensation in the feet due to nerve damage is a problem for people with diabetes. Neuropathy is more likely to affect people who have had diabetes for a long time or whose glucose control is poor, however, this condition could also occur from other causes not related to diabetes. Continue to be pro-active and follow-up regularly with your physician.

Joan Perlmutter, RD, LDN, CDOE, CVDOE 

 

How does exercise affect my blood glucose?

Exercise is truly one very important part of the diabetes care plan. When you exercise, your muscles work harder and use up their glucose stores for fuel. When those sources run low, glucose from the blood is used, lowering your blood glucose levels. Exercise also makes muscles and other tissues more sensitive to insulin, so less insulin is needed to move glucose out of the blood and into the cells. The American Diabetes Association recommends at least 30 minutes 5 days a week. Always remember to check your blood glucose levels before exercise. It should always be between 120 and 250 before you exercise.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

My blood sugar is usually normal at bedtime around 90. But high when I wake up in the morning it is 200-300.What can I do?

There are many possibilities why your blood sugar levels are out of control in the morning. To begin with blood glucose levels at bedtime should be between 100 and 140. When you ate last and what you ate can play a large part. If and when you are taking oral medications or insulin affect this number. Your body stores sugar inside the liver during the day and sometimes releases sugar into your blood stream when you are not eating (such as during sleep). Hormones released overnight can also cause blood glucose levels to rise. For people who don't have diabetes, the increase in glucose is offset by an increase production of insulin. For people with diabetes, this can be a problem. If this scenario continues you should speak with your physician or diabetes educator.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

I read recently that epsom salts are very beneficial to aiding your body's ability to use insulin (magnesium I think it is). It stated the best way for absorption is a bath/thru your skin but warned about unstable blood sugar levels and or blood pressure. What would be considered a safe amount?

From my research into this topic I learned there has been little medical research done on the effectiveness of epsom salts on relieving symptoms of diabetes. Epsom salt is magnesium sulfate which is absorbed through the skin. People with high blood pressure, heart problems or diabetes should consult their personal physician prior to using. Epsom salts can cause a severe drying of the skin, making the skin more fragile and this is something diabetics want to avoid. When reading any health articles in magazines or online please make sure the sources are reliable.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

 

Can diabetes be cured?


Once you are diagnosed with diabetes, you will have it for the rest of your life. Although you can not cure diabetes, be assured that with the help of your health care team, you can treat your diabetes, take charge of it and control it. There are a number of ways to keep your diabetes in control, including following a meal plan, checking your blood glucose levels, staying or becoming active, getting regular check-ups and taking medications, if necessary.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

What if your blood sugar is 111?

If you have already been diagnosed with diabetes, a blood sugar level of 111 is within normal range whether the reading was taken fasting or two hours after a meal. If you have not been previously diagnosed, two fasting blood sugar levels greater than 100 and less than 126 classify you as pre-diabetic. Pre-diabetes means that your blood sugar levels are higher than normal but aren't high enough to be called diabetes. Even if you have pre-diabetes, you may be able to delay or prevent diabetes. If you have pre-diabetes you can and should do something about it. Talk with your physician or member of the health care team on the steps you should be taking.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

I have diabetes for four years and the morning readings have always been from 115 -120 until a few weeks ago. Now they are 136-149 every day. What should I do?

If you haven't recently changed your eating or exercise habits which could alter your numbers, then a call to your physician is suggested to appraise him or her of the situation.

Joan Perlmutter, RD, LDN, CDOE, CVDOE

How does lisinopril protect my kidneys?

Your kidneys are your body's filter units. They work 24 hours a day to rid your body of toxins that your body makes or takes in. Toxins enter the kidney by crossing the walls of the small blood vessels, called capillaries, along its borders. Diabetes can cause changes in the small blood vessels. They can become blocked or leaky. The most important thing you can do to prevent kidney disease is to keep your blood glucose levels under control. A special type of blood pressure medication, called ACE Inhibitors, lisinopril being one, is usually prescribed, even if your blood pressure is normal, to decrease the rate of progression. Your physician or pharmacist are excellent resources for more specifics.

Joan Perlmutter, RD, LDN, CDOE, CVDOE 

I was diagnosed with type 2 diabetes about a year ago and started taking Metformin. However my doctor recently put me on Lantas because my A1C level was 9.8. I had been following a rigid diet and lost 15 lbs in the past 3 months. If I'm doing all the right things why is my blood sugar still high?


Congratulations on your weight loss. Have you seen any changes in your blood sugar numbers since starting on the Lantus? Your previous medication, the metformin, doesn't make the body produce more insulin and your body was probably not producing enough on its own to get the sugar out of the blood stream into the cells. You stated you were following a rigid diet, not knowing what that actually consisted of makes it difficult to assess why your blood sugars are out of control. Consistency and appropriate portion sizes of carbohydrates at meals are important in getting your blood sugar levels in control. If you haven't met with a dietitian yet, I highly recommend you do. He or she can work with you and help you get your diabetes under control.


Joan Perlmutter, RD, LDN, CDOE, CVDOE

 

I have type 11 diabetes and have had it for about 15 years. I am currently experiencing numbness in all of my toes as well as the balls of my feet. Is this cause for concern?


Your risk for nerve damage is greater because you have diabetes. The small blood vessels that feed your nerves can become blocked and cause poor circulation. The feet and legs are commonly affected. Numbness is a common symptom as is pain and a tingling sensation. You should contact your physician whenever you experience changes in your physical being.

Joan Perlmutter, RD, LDN, CDOE, CVDOE 

 

I just got diagnosed. Never sure what to eat. Can I have any sugar? It is hard to find food without any sugar.


As a newly diagnosed diabetic it is always a good idea to meet with a registered dietitian. Learning how and what to eat is an essential part of managing your diabetes. The dietitian will provide you with an individualized meal plan, adjusted to fit your lifestyle, so you consume the right kinds and amounts of food. Foods are made up of carbohydrates, proteins and fats. Carbohydrates affect your blood sugar levels the most. Carbohydrates turn into sugar, but they are the main source of fuel for our bodies as well as provide essential vitamins and minerals and therefore necessary in a healthy diet. The amount of carbohydrate you need depends on your age, weight, activity and medications you may be taking. Sugar and sweets are OK to include once in a while but keep in mind they often contain lots of carbohydrates, calories, and fat with very little nutritional value.

Joan Perlmutter, RD, LDN, CDOE, CVDOE