Theresa Garnero

Caring.com Expert

About

Theresa Garnero is clinical nurse manager of Diabetes Services at California Pacific Medical Center in San Francisco. A certified diabetes educator, she's the author of DIABETease: A Lighter Look at the Serious Subject of Diabetes. She also wrote a daily guide to living with diabetes for the American Diabetes Association, scheduled for publication in fall 2008. She was named Diabetes Educator of the Year by the American Association of Diabetes Educators for 2004-2005.

Recently Published on Caring.com

  1. Thursday September 03, 2009

    1. What constitues high blood sugar?

      Answer - The goal for glucose levels are: 70-130 mg/dl before a meal, and two hours after a meal less than 180 mg/dl. A person with diabetes will exceed these levels due to the body's inability to make enough insulin, meal choices, stress, lack of exercise, not enough or the right type of medicine, or infection...

  2. Saturday August 01, 2009

    1. What do I do when blood sugar high?

      Answer - If your glucose is too high, and you cannot lean on the exercise department to help lower it, then the next step is to discuss medication options with your healthcare provider. The pain associated with surgery could be the cause for your higher glucose levels. Once you are back on your feet, your medications would be adjusted again...

  3. Friday July 31, 2009

    1. Can I make insulin substitutions to control my blood sugar?

      Answer - With your doctor's authorization you should be able to switch from 75/25 to 70/30. You may need an adjustment in the amount of units taken as the action profile is different (when your new insulin peaks - or is working at its strongest). This is important to know as your risk for lows with the 70/30...

  4. Sunday May 24, 2009

    1. Will lumps under my injection site go away?

      Answer - Technically called lipodystrophy, the lump or small dent in the skin from repeated injections, may resolve if you give those areas a rest and inject elsewhere. If you continue to inject into those "lumps" on your stomach, the insulin absorption may vary significantly.

    2. I've just been diagnosed with Diabetes? How can I learn to take care of myself?

      Answer - Diabetes education will help you navigate the best way to care for yourself, so you are off to a good start in looking for classes. A nationally recognized program will help you learn fact from myth and understand what will work best for you.

  5. Friday May 15, 2009

    1. Can an extreme low blood sugar episode cause damage?

      Answer - If your glucose has dropped to an extremely low level (hypoglycemia is less than 70 mg/dL) ,yes, you need to call your doctor to problem solve why it occurred so you can reduce the risk of it happening again. Your doctor would consider adjusting medication. Neurological damage is possible with repeated or a single prolonged episode of hypogycemia...

  6. Wednesday May 06, 2009

    1. How long is a bottle of NovoLog insulin good for?

      Answer - An unopened vial of NovoLog insulin is good until the expiration date (it is best stored in the refrigerator).

  7. Monday April 20, 2009

    1. How common is Type 1.5 diabetes?

      Answer - Type 1.5 is not an official classification of diabetes, although it is referred to in diabetes circles in the way you have described. The majority of people with type 2 diabetes will need insulin at some point in their lifetime. Many people think that if you need insulin, it automatically equates type 1 diabetes...

  8. Tuesday March 24, 2009

    1. Can a type 1 diabetic take an insulin-resistence drug in addition to insulin to better control blood glucose?

      Answer - No. That would be considered off label. Type 1 diabetes is an insulin deficiency issue. Although some type 1s may be overweight and at risk for insulin resistance, it may seem logical to consider medications to reduce that resistance thereby improving glucose control while continuing to take insulin injections...

  9. Tuesday March 10, 2009

    1. Has anyone heard of brain fog or confusion after taking Metformin for diabetes?

      Answer - No patients I have worked with have reported experiencing "brain fog" or confusion as a result of taking Metformin. Usually, the main side effect is gas, bloating and diarrhea when first starting the medication.

  10. Tuesday October 21, 2008

    1. How can I encourage my wife, who has diabetes, to exercise more?

      Answer - Motivation to change is personal. Your wife has to want to exercise -- you can't do it for her. What you can do is set up an environment that gives her opportunities to be more active. But resist the temptation to transform from husband to athletic director. Such behavior will likely just backfire...

  11. Friday April 25, 2008

    1. My dad eats lots of sweets and doesn't like to drink water--could he have diabetes?

      Question - Find out if a sweet tooth or a lack of thirst are symptoms for type 2 diabetes.

    2. My dad eats lots of sweets and doesn't like to drink water--could he have diabetes?

      Answer - Find out if a desire to eat sweets and an aversion to drinking water are signs of type 2 diabetes.

  12. Tuesday April 22, 2008

    1. What can I cook for my diabetic husband?

      Answer - Cook a variety of fresh foods, mostly plants, and serve them in moderation. One easy way to think about how such a diet might look is to imagine a plate (9 inches round). On half of the plate pile veggies, on a quarter of the plate serve protein, and on the other quarter put carbohydrates or starches...

  13. Saturday March 22, 2008

    1. How can I convince my stubborn father to see a doctor about his diabetes?

      Answer - Have a heart-to-heart discussion with your dad about your concerns. Get support from other family or friends who can join you in having a serious, yet supportive conversation with him about your observations of his changing health status. Ask how your father feels. Tell him you are worried and you'd feel better if he saw the doctor for a check up...

    2. Is diabetes affecting my mom's brain?

      Answer - Given your mother's change in ability to do something as basic as write a check, and the fact her sister already has Alzheimer's, I suggest you make an appointment with her primary care doctor and, if you can, go with her to her share your observations. Ask to have your mom professionally evaluated for this brain disorder...

  14. Tuesday March 18, 2008

    1. What is insulin resistance?

      Answer - What "insulin resistance" means, how it affects people with type 2 diabetes, and what you can do to treat the condition.

    2. How serious is type 2 diabetes? Is it more serious than type 1 diabetes?

      Answer - No, definitely not. In fact, in some ways type 2 diabetes is a more serious disorder because your mom may have had it for years before she was diagnosed. So she may well have developed some of the long-term, debilitating complications linked to the condition without knowing it...

  15. Monday February 25, 2008

    1. Should my dad, who's scheduled to have an operation unrelated to his diabetes, keep up his normal diabetes routine?

      Answer - Your dad should frequently monitor his blood glucose immediately prior to the surgery. Stress can play havoc on his blood sugar and having an operation is a stressful event. He also needs to ask his anesthesiologist which medications he should continue on the day of surgery...

    2. Should I be concerned that my mom has lumps where she injects insulin?

      Answer - Yes. The lumps you describe are fat deposits that may occur when insulin is injected into the same general area on a repeated basis. The technical term for this condition is lipohypertrophy. These lumps can delay the absorption of insulin and cause unwanted glucose fluctuations that trigger low blood sugar, or hypoglycemia...

    3. How can we prevent my mom, who has type 2 diabetes, from constantly getting yeast infections and cystitis?

      Answer - First try helping her get her blood sugar levels in her target range. Uncontrolled diabetes is a notorious contributing factor to frequent vaginal and bladder infections. How is your mom's A1C (the lab test that shows a three-month blood sugar average)? An A1C of less than 7 percent means she has good control...

  16. Wednesday February 20, 2008

    1. How should we handle a diabetic's fluctuating metaglip levels?

      Answer - How to handle highs and lows when your parent with type 2 diabetes takes the oral diabetes drug glipizide.

  17. Tuesday February 05, 2008

    1. Is it OK if my mom with type 2 diabetes drinks alcohol?

      Answer - With clearance from her physician and some caution and common sense, your mom may still partake in the pleasure of a glass of merlot if her diabetes is well controlled. Her doctor, though, may advise against drinking alcohol because of related complications such as nerve damage or high blood pressure...

    2. How can I help my mom deal with high cholesterol, diabetes and hypertension?

      Answer - First, it might help to know you're far from alone. While your mother is dealing with a triple-whammy diagnosis, her situation is not uncommon. Many people with type 2 diabetes must also contend with hypertension and high fat levels (such as cholesterol or triglycerides) in the blood, known as hyperlipidemia...

    3. Should I let my dad, who has diabetes, drive?

      Answer - Yes, he can still drive, though he must get a medical clearance to do so from his main diabetes doctor. She will want to uncover why he's having repeated hypoglycemia episodes and figure out a way to deal with these situations. The doctor will also want to discuss safety measures your father needs to...

    4. My mom has type 2 diabetes, so does that mean I'll get it?

      Answer - Family history is a risk factor for diabetes. If one of your parents has type 2 diabetes, you're at slightly increased risk of developing the disease. If both your parents have the disease, your risk is much greater.

  18. Sunday February 03, 2008

    1. What precautions should my dad, who has type 2 diabetes, take when traveling?

      Answer - When your father takes a trip, his diabetes travels with him; he can't take a vacation from his disease. So he should bring his glucose-monitoring equipment and any medications he's taking in his carry-on bag, not his checked luggage. (It's smart to check with the airline beforehand about its policy...

    2. What extra precautions should my dad with diabetes take when he has the flu?

      Answer - If your dad becomes ill, he should test his blood sugar levels more often than usual, as sickness -- even something seemingly minor like a cold or the flu -- can make his sugar levels soar. That's because the body produces more glucose as a natural response to illness...

  19. Friday February 01, 2008

    1. Because of her diabetes, my mom has nerve damage to her feet -- what kind of footwear does she need to avoid problems?

      Answer - Think extra foot support and protection at all times for a parent with neuropathy. In practical terms that means shoes that are sturdy enough so that you can't fold them into a pretzel shape or wring them out like a towel. Your mom needs the extra support because people with neuropathy often can't feel their feet at all because of the nerve damage...

    2. What can I do to get my mom to take her diabetes pills, which she doesn't think are keeping her blood sugar in check?

      Answer - First, try to find out why your mother has stopped taking her diabetes drugs. Maybe she's recently been diagnosed and is still in denial about her condition or doesn't like the inconvenience of routine pill taking. Or perhaps she experiences uncomfortable side effects, such as severe low blood sugar, from her prescription pills...

  20. Monday January 21, 2008

    1. What's an A1c test and why is it important for my dad to take it?

      Answer - A diabetes expert gives you the scoop on A1c tests and why your parent with diabetes might need one.

    2. What's carbohydrate counting and should my dad do it?

      Answer - Explains what carbohydrate counting is, why your parent might want to do it, and what's involved.

    3. What should diabetics cut out of eating and should they avoid carbohydrates?

      Answer - Expert commentary on whether cutting carbs completely is okay when your parent with type 2 diabetes is trying to lower his blood sugar quickly.

    4. How can I help my mom, who seems really down about her diabetes diagnosis?

      Answer - How you can help your parent with depression following a diabetes diagnosis.

  21. Saturday December 15, 2007

    1. How can I help my father deal with the "dawn phenomenon," or high blood sugar on awakening?

      Answer - Dawn phenomenon is when a person wakes up with high glucose levels Here are some ways to deal with dawn phenomenon.

  22. Saturday November 17, 2007

    1. Should my active parent check his blood sugar during exercise?

      Answer - Your father should check his blood glucose if he notices symptoms such as shakiness, nervousness, vision changes, hunger, dizziness, headache, confusion, or sweating. These are all potential signs of low blood sugar, which can be brought on by physical activity.

    2. How long does insulin last once it's been opened?

      Answer - As a general rule, most bottles of insulin are good for 28 days once they're opened. Of course, how quickly a person goes through a vial is highly individual. Some may go through a bottle in a week or two. Others, on a lower dosage, may not use all the insulin within four weeks. But the drug's stability and potency is only guaranteed for 28 days...

    3. Is there a relationship between stress and blood sugar levels?

      Answer - Yes, absolutely. Physical and mental stress can cause blood sugar levels to skyrocket. Some people with type 2 diabetes see their numbers soar 100, 200 points or more under stress. And it's not just "bad" stress like illness, injury, or bankruptcy that can trigger such a response...

  23. Friday November 16, 2007

    1. How can I get my father with diabetes to eat appropriately?

      Answer - What you describe is very common in people with type 2 diabetes who don't want to face the disease. In this situation it's best to help your father take small steps toward change, lead by example, and offer your support. Start by asking him what he is willing to do to make his diet healthier. Maybe he'll agree to add one serving of vegetables to his dinner...

    2. How can I help my parent figure out when her blood sugar is too high?

      Answer - Unfortunately, older people with diabetes often don't experience any signs of high blood sugar. Or, confusingly, the symptoms can mimic low blood sugar, such as feeling tired, hungry, or shaky. So the only way you or your parent can accurately assess the situation is by testing her blood sugar.

    3. How can I help my mother handle low blood sugar incidents?

      Answer - When your mother is having a low blood sugar episode, it's quite possible she may not have enough fuel in her brain to make rational decisions such as, "I need to eat something -- right now." Also, there's a tendency for warning signs -- which include irritability, shaking, sweating, headaches, confusion...

    4. How do I handle my dad's denial about his diabetes?

      Answer - Denial has its place: It helps protect people from difficult information. But, as you're finding with your father, it can also get in the way of doing what needs to be done to keep healthy. Still, tread lightly in your efforts to turn this situation around. If you push too hard, you run the risk of alienating your dad, which you don't want to do...