A: The CDE credential means that the educator possesses specialized diabetes knowledge. CDEs help people with diabetes:

• develop a diabetes plan
• understand their medicines
• learn how to monitor blood sugar
• balance eating and physical activity
• identify barriers to self-management and adjust emotionally to diabetes
• learn how to help prevent or delay complications like heart disease, blindness, kidney failure, and nerve damage

CDEs include registered nurses, registered dietitians, pharmacists, and doctors, among others. To be certified, they must have at least 1,000 hours of diabetes self-management education experience.

—Donna Rice, RN, certified diabetes educator and president of the American Association of Diabetes Educators

A: Losing weight can improve diabetes control by helping your body use insulin better. Insulin is a hormone that moves sugar from the bloodstream into the cells for energy. If you have excess fat, the insulin your body makes doesn’t work as well as it should and may not move sugar into your cells effectively. This condition is called insulin resistance. When this happens, your body may make too much insulin to try to lower blood sugar levels. At the same time, your liver releases too much sugar into your bloodstream because your body’s cells need fuel. The end result? High blood sugar.

Losing just 5% to 10% of your weight can make a big difference in how well you are doing in controlling your diabetes. Making gradual changes in your eating and activity habits is the best way to lose weight and keep it off. A registered dietitian or certified diabetes educator can help you create a meal plan to reach your goal weight and help control your diabetes at the same time.

—Amy Campbell, RD, certified diabetes educator and education program manager at the Joslin Diabetes Center in Boston

A:  There isn’t enough research to recommend taking extra of any particular vitamin or mineral for diabetes, unless you are deficient. Like everyone else, people with diabetes need to eat a balanced and healthful diet. Some people choose to take a multivitamin, especially if their diet is lacking in some key nutrients. Vegans, for example, may choose to take a multivitamin to make up for nutrients found primarily in animal products.

If you read an article about a vitamin, mineral, or herb that sounds promising for diabetes, bring it up with your doctor, who may know about the latest research. And always check with your doctor or certified diabetes educator before starting any new supplements.

—Nora Saul, RD, certified diabetes educator and nutrition manager for nutrition services at Joslin Diabetes Clinic in Boston

A: Look beyond sugar—check the label for total carbohydrates and fats. If a food is labeled sugar-free but is high in carbs, it can still affect blood sugar. The carb count may drop dramatically in a sugar-free version of a beverage or ice pop, because sugar was the main source of carbs to start with. But the carb count may be high in sugar-free cookies, because they still contain carbs in the form of flour. All kinds of carbs are broken down in the body as sugar. Also, keep in mind that removing the sugar in a product doesn’t always make it low calorie.

In addition, sugar-free products often have the same amount of fat as the original version. To make smart choices, consider all the information on the nutrition label.

—Amy Campbell, RD, certified diabetes educator and education program manager at the Joslin Diabetes Center in Boston

A: The physical activities you do as you go about your day count just as much as planned exercise in controlling blood sugar and weight. On a 60-minute brisk walk, the average person might burn around 250 calories, but that leaves 23 hours that you can be moving. If you use 3 of those hours to do chores, you could burn more calories than you did during your planned activity.

Household chores and yard work often use major muscle groups, which build strength and endurance. To get cardiovascular benefits, try adding 10- to 15-second intervals in which you’re working faster. These chores burn the number of calories listed in just 15 minutes for a 150-pound person.

• Washing dishes: 39
• Sweeping floors: 56
• Vacuuming: 60
• Scrubbing the bathroom: 65
• Raking leaves: 73
• Operating a snow blower: 77
• Shoveling snow: 102
• Carrying groceries upstairs: 128

—Sheri Colberg, PhD, an exercise physiologist at Old Dominion University in Norfolk, VA, and author of The 7 Step Diabetes Fitness Plan

A: Artificial sweeteners are chemicals that offer the sweetness of sugar with much fewer calories. There are 5 types of low-calorie sweeteners approved by the Food and Drug Administration for use in the United States:

• Aspartame (Equal®, NutraSweet®)
• Saccharin (Sweet’N Low®, SugarTwin®)
• Acesulfame K (Sweet One®, Sunett®)
• Sucralose (Splenda®)
• Neotame

They can be found in many foods, from sodas to puddings. But are they safe? Studies have confirmed that artificial sweeteners are safe when used in moderation. You can use artificial sweeteners to make food sweet without raising the carb count. They can also help you control calories and portions. Whereas each gram of sugar contains 4 calories, many sugar substitutes have 0 calories per gram.

And because sugar substitutes are much sweeter than sugar, you can use less. Just be sure to consider the nutritional profile of the food or beverage that the sweetener is added to. To make smart choices, you still have to keep an eye on total carbs, calories, and fat.

—Jolene Sloat, RD, a diabetes educator with the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York City

A: The eyes do indeed provide a window into the human body. Although an eye exam is not a conclusive test of your heart or kidney health, damage to the small blood vessels in your eyes indicates that problems may be developing in the small blood vessels throughout your body. That's one reason why it's so important to have a comprehensive eye exam with an eye doctor at least once a year. If you are diagnosed with retinopathy (damage to the blood vessels in the retina), it is very important to consult with your primary care doctor to make sure your blood sugar, blood pressure, and blood cholesterol are under control. In addition to following your eye doctor's instructions, follow a healthy diet, exercise, and take your medicine as prescribed.

—John I. Loewenstein, MD, associate professor of ophthalmology at Harvard Medical School in Boston

A: You made a smart move when you decided to quit smoking. Smoking is one of the most important modifiable risk factors for heart disease. In people who already have a high risk of heart disease—such as people with type 2 diabetes—smoking is particularly dangerous. The good news: People who quit smoking have only half the risk of those who continue to smoke, regardless of how long they smoked before quitting. The benefits of quitting smoking begin immediately and increase with time. Even if you don't smoke, secondhand smoke still appears to increase the risk of heart disease. Because you have diabetes, you already have a higher risk of a heart attack, so it's wise to take every precaution to reduce that risk. If you can convince your spouse to quit, you'll probably improve his health and yours. As a compromise, you might convince him to smoke outside the home.

—Thomas K. Houston, MD, assistant professor of medicine at the University of Alabama at Birmingham

A: Beginning at age 50, men and women at average risk should be screened for colon cancer, the third leading cause of cancer death. In fact, after considering personal risk factors, some health-care professionals may recommend screening at an even earlier age. For example, research shows that having diabetes may increase your risk of colon cancer. You can help reduce that risk by following a healthy diet, exercising regularly, and taking prescribed medicines to control your blood sugar. Also, avoid drinking excessive amounts of alcohol and smoking. And make an appointment today to have a colonoscopy. In many cases, thanks to colon cancer screenings, polyps can be found and removed before they turn into cancer.

—Donald A. Garrow, MD, clinical instructor in the division of general internal medicine at the Medical University of South Carolina in Charleston

A: Many studies show that people with diabetes are more likely to develop gum (periodontal) disease than people without diabetes. This higher risk may stem from the increased risk of infections common in people with poorly controlled diabetes. Preliminary research indicates that the connection also works in reverse, with gum disease raising blood sugar levels. We don't know why, but we suspect that gum disease triggers inflammation in the body, which raises blood sugar levels. For these reasons, you should visit your dentist regularly, floss daily, and brush after meals.

—Robin Goland, MD, endocrinologist and codirector of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York City

A: Even with normal cholesterol levels, someone with diabetes has a risk of dying of a heart attack that's as high as someone without diabetes who has already had a heart attack. High blood sugar levels over time can lead to increased deposits of fat and other materials along the artery walls. These deposits may affect blood flow, increasing the risk that the artery will become clogged. Increased risk of inflammation in people with diabetes may also contribute. For these reasons, doctors often prescribe medicines to reduce levels of LDL (bad) cholesterol. More recently, we have learned that some drugs also reduce levels of inflammation, protecting you from a heart attack even if your LDL cholesterol is normal.

—Gary Enzmann, MD, endocrinologist and medical director of the Joslin Diabetes Center Affiliate at Swedish Medical Center in Seattle

A: Over-the-counter liquid antihistamines and decongestants could affect blood sugar levels because of a key ingredient: sugar. Check labels on liquids to make sure sugar isn't one of the top 3 ingredients. Solid formulas—tablets and capsules—generally don't contain enough sugar to have an effect. You could also ask your pharmacist to recommend a sugar-free product. Be sure to monitor your blood sugar, and consult your doctor if you see a change in levels.

—Peggyann Zaenger, PharmD, pharmacist and advisor for the American Pharmacists Association

A: The Partnership for Prescription Assistance (PPA) connects you to more than 475 patient assistance programs through a toll-free number (1-888-477-2669) and a user-friendly Web site (pparx.org). In turn, these assistance programs link you to more than 2,500 brand-name and generic prescription medicines at little or no cost. All you need to do is tell PPA the medicine(s) you're taking and answer a few questions. In minutes, you'll receive a list of programs for which you might qualify. If you're applying online, you can print out the applications; if you're applying by phone, PPA will mail the applications. Each patient assistance program has its own timeline, but many patients receive medicines in 2 to 3 weeks. PPA is sponsored by Pharmaceutical Research and Manufacturers of America (PhRMA).

—Ed Belkin, vice president of communications and public affairs for PhRMA

A: The tops of the fingers have the highest concentration of nerve endings, so try taking a blood sample from the sides of your fingertips using a very thin finger-pricking device. Before pricking your finger, shake your hands down by your sides and "milk" your fingers by pushing the blood down to the ends of the fingertips. This way, you'll most likely get a good drop and won't need to prick multiple times. Keep rotating the fingers and locations that you use to keep any one finger from getting pricked too often. If you still have trouble, consider a meter that allows for samples from the forearm, thigh, base of the thumb, and upper arm. Check with your doctor first, though, because samples from these sites typically do not capture rapidly changing blood sugar levels as well as samples from a traditional finger prick.

—Melinda D. Maryniuk, RD, CDE, associate director of affiliated programs at Joslin Diabetes Center in Boston

A: Dehydration is a big concern, so be sure to drink plenty of water. It's also a good idea to avoid strenuous outdoor activity in hot conditions. If you need to be outdoors, stay in the shade as much as possible and check your blood sugar levels more often than usual. Don't forget to carry identification with you, in case of emergency. If you carry insulin, use a cooler to keep it at the recommended 59° to 89°F. Ask your diabetes educator for more hot-weather solutions specific for you.

—Donna Rice, RN, certified diabetes educator, and president of the American Association of Diabetes Educators

A: If your friend mentions frequent urination, intense hunger or thirst, unexpected weight loss, tingling in the hands and feet, or vision changes, she may have diabetes. Sometimes there are no symptoms at all, but she could be at higher risk if she's overweight or has a family history of diabetes. Undiagnosed diabetes can lead to health complications that include heart, vision, and kidney problems. It's important to let her know that you're concerned for her health. Try saying, "It may be nothing, but please get checked out by a doctor." Let her know that diabetes is controllable. If she is scared, offer to go with her to the doctor's office.

—Janis Roszler, RD, LD/N, certified diabetes educator

A: As long as you're feeling healthy, you can donate blood. Healthy means that you feel well and can perform normal activities. It also means that you are being treated and have your diabetes under control—with lifestyle modifications, oral medicines, or insulin. There's only one automatic decline for a person with diabetes: having received an injection after 1980 of bovine (beef) insulin made from cattle from the United Kingdom because of concerns about mad cow disease.

—Stephanie Millian, director of biomedical communications for the American Red Cross

A: Every woman's body is different, so menstruation may or may not affect blood sugar. But for many women, levels increase around the 3rd week of their cycle and may remain elevated for up to 5 days. The natural release of hormones that occurs around the time of menses can cause a woman's body to be resistant to insulin, resulting in higher blood sugar levels. Some women may note lower levels the first couple days after their period. If you suspect that changes in your levels could be related to your menstrual cycle, share your blood sugar readings and menstruation dates with your doctor. Only your doctor can determine if treatment adjustments are needed.

—Arlene Loeschen, MSN, and certified diabetes educator at Diabetes Centers of America in Katy, Texas