(3) The patient must remember that alcohol is high in calories and that any
alcoholic drink he consumes must be counted into his total caloric intake.
(4) The diabetic patient can usually have as much as he wants of these
foods: unsweetened gelatin, clear and fat-free broth, unsweetened pickles, cranberries,
rhubarb, coffee, tea, and certain salads.
(5) Before eating any dietetic foods, the diabetic patient should consult his
physician. Additionally, a diabetic patient should remember to count these foods in his
diet and to read the label of these foods. Sugar, fat, and protein contents should be
listed. "Low calorie" and "dietetic do not always mean "no sugar."
d. Medications. Oral hypoglycemic agents (Sulfonylureas) will stimulate the
pancreas to produce and release insulin. Sulfonylureas are not insulin. When there is
some pancreatic function and when diabetes is unable to be controlled by insulin alone,
oral hypoglycemic agents are usually given. Oral hypoglycemic agents are NOT usually
prescribed when there is no insulin production and when there is cardiac disease.
Some of the oral hypoglycemic agents are tolbutamide (OrinaseR), chlorpropamide
(diabinese), acetohexamide (DymelorR), and tolazamide (TolinaseR).
e. Insulin. Sources of insulin are animals, genetic engineering of E. Coli.
Injectable insulin is obtained from cattle, pigs, and E. Coli. Insulin promotes glucose
uptake by cells. There are two categories of insulin: the short-acting and the long-
acting types. The short-acting type of insulin has an onset of 30 to 60 minutes and
reaches its peak effectiveness at four to six hours. This type of insulin is effective for a
period of six to twelve hours. Short-acting insulin agents are Regular, Actrapid, and
Semilente. The longer acting type of insulin has an onset of one to two hours and
reaches its peak of effectiveness from eight to twelve hours. It has a duration of 24 to
48 hours. The agents of the longer acting insulin type are NPH, Lente, and Lentard.
Insulin is not given orally because gastric acids will destroy insulin. Insulin is
administered subcutaneously or intravenously in concentration of U-40 (40 units/1 cc) or
U-100 (100 units /1cc). Insulin must be stored at 75 degrees Fahrenheit. Freezing
temperatures may change the crystal size of insulin.
f. Exercise. Proper exercise is important in controlling diabetes mellitus.
Exercise improves circulation and helps the body metabolize carbohydrates, both of
which decrease the need for insulin. A patient who exercises very little during the week
but is more active on the weekends will find that the amount of glucose in his blood
varies greatly. If there is no way the patient can exercise more during the week, he
should discuss this situation with his physician. His food and insulin requirements may
need to be adjusted to fit his activities. A patient should be sure to have some easy to
eat carbohydrates with him during exercise in case he feels symptoms of hypoglycemia
(weak, sweaty, pale skin, etc.).