Diabetes Management

Diabetes can lead to serious difficulties with your overall health, impacting or causing many conditions such as heart disease, stroke, kidney disease, blindness, nerve disease or even amputation, but by learning to manage your diabetes you can have a better quality of life.

There are four main types of diabetes: Type 1, Type 2, gestational diabetes and pre-diabetes.

Type 1 Diabetes

Type 1 diabetes is often called insulin dependent or juvenile diabetes. Most cases of type 1 diabetes are diagnosed in people under the age of 30. Type 1 diabetic patients have very little or no insulin, which makes them dependent on insulin injections to live.

The cause of type 1 diabetes is unknown, but a family history of diabetes, viruses that injure the pancreas and the autoimmune processes may be a factor.p

Type 2 Diabetes

Type 2 diabetes is called non-insulin-dependent diabetes or adult onset diabetes. These patients’ bodies continue to make insulin but not in adequate amounts or their body has become unresponsive to its effects. When diagnosed, people with type 2 diabetes often have both high glucose levels and high insulin levels, but they may not have any symptoms. Type 2 diabetes normally occurs later in life, and may affect people who are overweight and sedentary.

Risk factors include:

  • Obesity
  • Lack of exercise
  • Family history of diabetes
  • Pre-diabetes
  • Ethnicity: African-American, Hispanic-American, Native American, Asian-American, Pacific Islander
  • Gestational diabetes during pregnancy or baby weighing more than 9 pounds
  • High blood pressure
  • High triglycerides, high cholesterol, low HDL


Pre-diabetes is described as a person having glucose levels that are higher than normal, but not high enough to be diagnosed with diabetes. Usually people who have pre-diabetes do not exhibit symptoms but, if they do not lower their glucose levels, they are at risk of developing diabetes. It is a good idea to be tested for pre-diabetes if you have any of the risk factors for type 2 diabetes.

Gestational Diabetes
Gestational diabetes is a form of hyperglycemia that can occur in the late stages of pregnancy. Often women are screened for gestational diabetes between their 24th and 28th week of pregnancy. When gestational diabetes is not taken care of babies tend to be larger than normal, can have low glucose levels, or be born prematurely. Gestational diabetes most often is temporary and goes away after the baby’s birth, but both the mother and children have an increased risk of developing type 2 diabetes later in life. Women who have gestational diabetes with one pregnancy can also experience it with later pregnancies.

Tips for testing and managing your diabetes:

  • It is a good idea to record all your results in log book.
  • Don’t worry if you have some readings out of range. Your treatment plan is working if at least half of your readings are in range.
  • Always bring your log sheets or log book with you when you visit your physician.

To perform your blood glucose test:

  1. Wash hands with soap and warm water to clean and increase circulation in hands.
  2. Dry hands before testing.
  3. Shake hands down to get more blood in hands.
  4. Place lancet firmly against the side of your finger, being careful to not using the pad or fingertip.
  5. Massage or “milk” finger toward tip after you stick your finger for larger drop of blood.
  6. Alternate fingers and sides of fingers, using all ten including thumbs.
  7. Keep your test strips dry, covered, and in packing until you are ready to perform a test.
  8. Store equipment at room temperature, avoiding extreme temperatures and moist areas.
  9. Check supplies for the expiration date and do not use if they are expired.
  10. Dispose of lancets properly (ask your pharmacist).
  11. Do a control test on your monitor every time you open a new container of strips, drop the monitor, or if you get a strange reading that does not seem right to you.
  12. Check expiration of control solution. Control solution is generally only good for three months after you open it.
  13. Clean your monitor with a damp cloth and do not use alcohol.

When should I test my blood glucose?
This testing schedule is most appropriate for anyone with type 2 diabetes on oral medication. Also, it is very important to regularly chart your blood glucose levels. Click here to get a sample diabetes log.

  • First thing in the morning before you have anything to eat or drink. (This is called fasting, or abstaining from eating or in some cases drinking overnight for a person with diabetes.)
  • Before your largest meal of the day
  • Two hours after the first bite of the largest meal of the day

What is the target range for my blood glucose?

  • Your blood glucose should be within the 70 – 130 mg/dl range after fasting and before meals.
  • Your blood glucose should be less than 180 mg/dl two hours after the start of meals.

When should I notify my physician?

  • Call your doctor if your blood glucose is greater than 250 for two days in row.
  • Call your doctor if you notice that more than half of your blood glucose readings are out of the target ranges.
  • If glucose is greater than 250 for two days or less than 70 two times in a week.

What should I do if my blood glucose is suddenly out of range?

  • Think about changes in your diet or normal schedule that would cause your blood glucose to be out of range and make note of it on your log sheet or log book.

Pay special attention to your blood glucose around that same time for the next few days to see if there is a pattern.

Lab Values Used to Diagnose Diabetes

A glucose test measures the amount of sugar (glucose) in the blood. These tests can be used to diagnose or screen for diabetes or to monitor patients who have diabetes.

Glucose is a major source of energy for most cells of the body, and the major hormone regulating glucose concentration in the body is insulin.

People with type 1 diabetes require daily injections of insulin to control their disease. Injecting too much or too little insulin in your body can be dangerous because of the limited range of blood sugar levels that allow the brain to function normally.

These are the ranges that are used to diagnose diabetes:

Diagnosis Fasting Blood Glucose Casual Blood Glucose
No Diabetes Less than 100 mg/dl Less than 140 mg/dl
Pre-Diabetes 100-125 mg/dl 140-199 mg/dl
Diabetes 126 mg/dl or higher on two occasions 200 mg/dl or higher and symptoms

To receive diabetes education, your physician must fill out a referral form. When you have been accepted, we will notify you of the class schedule. We offer both day and evening classes.

The Classes
We offer classes for people who are not insulin dependent, and those who are taking insulin.

Our primary goal is to teach people with diabetes, and their family members, the importance of lifelong diabetes care. Our program stresses prevention of complications, and to show that diabetes is a manageable disease.

The class format is based on the International Diabetes Center requirements and is recognized by the American Diabetes Association. Please call 304-598-4391 and press #1 for Connie Kyle to find out most current class schedule.

General Topics covered:

  • The role of glucose and insulin in the body
  • The diagnosis of diabetes
  • Risk factors of type 2 diabetes
  • Possible complications of poor glucose control
  • Possible treatment options
  • Self-blood-glucose testing and current targets
  • Help with selection of glucometer
  • Effect of carbohydrate on blood glucose
  • Reading food labels
  • Benefits of physical activity
  • Relationship between glucose self-tests and A1C levels
  • Foot care
  • Targets for blood pressure
  • Targets for cholesterol levels
  • Strategies for sticking to meal plan while dining out
  • Guidelines for alcohol in the diet
  • Goal of blood glucose (low blood sugar) self tests
  • Hypoglycemia and treatment
  • Stress management
  • Foods that contribute to heart health
  • Portions sizes
  • Problem solving for out of target glucose readings
  • Discuss relationship between diabetes and depression
  • Healthy weight loss plans
  • Community resources for ongoing education
  • Sexual dysfunction

Some Additional Topics Covered for People Taking Insulin

  • Concerns about taking insulin
  • Types of insulin
  • How to inject, measure and store insulin
  • Insulin pump education
  • Insulin pump training

Referring a Patient

How do I make a referral?
For outpatient classes or one-on-one education, please complete the referral form and fax the completed form to 304-598-4941. Please include all information requested so that we can meet Medicare and Medicaid requirements. We will notify your patient about the class schedule, and you will be updated on your patient’s progress after each session.

Click here for the referral form

Health Screening and Maintenance Schedule

See your doctor and be sure to have the following as recommended:

Hemoglobin A1C Every three months Less than 7.0% at WVUH labs
Blood Pressure Every three months Less than 130/80
Triglycerides Every year Less than 150
LDL Cholesterol Every year Less than 100 {with heart disease, less than 70}
HDL Cholesterol Every year Females greater than 50
Males greater than 40
Urine albumin/creatinine ratio Every year Less than 30 mg/g Cr
Retinal eye exam Every year Normal
Comprehensive foot exam with microfilament Every year Normal or no loss of sensation
Visual foot exam Daily No changes
Dental exam Every six months Normal
Flu Vaccine Every fall
Pneumonia Vaccine At age 65, then every 5-6 yrs.
A one-time revaccination is recommended for individuals older than 64 years of age.
A booster shot is necessary if you were previously immunized when you were younger than 65 years of age and if the vaccine was administered more than 5 years before you turned 64.
Formal Diabetes Education Every year
Treatment plan review Every 3 months
Continual self-glucose testing Varies depending on treatment plan. Typically, at minimum, three times a week testing three times a day – fasting, before main meal and two hours after start of main meal Fasting and before main meal, 70-130mg/dL.
Two hours after the start of main meal, less than 180mg/dL.

Free Support Group
Typically every second Thursday of the month.
WVU Medicine University Town Centre
Conference Room 1A, 1B or 4 – call for specific location
6:30 pm – 7:30 pm

For confirmation of topic and date please contact us:
Phone: 304-598-4391 x 1

Free Diabetes Prevention Classes
Learn more, click to take the CDC pre-diabetes risk quiz.
Call us for any additional information or to register for the next class.

#T1 Mountaineers
A Support Group for people 18 years and older dealing with the challenges of managing Type 1 Diabetes.
For more information contact:
Emily Smaniotto, RN, BSN
Phone: 304-598-4391 x 5

Useful Websites for People with Diabetes

Adnan Haider, MD

FAD-SearchResult -

J.W. Ruby Memorial Hospital
View Profile1-855-WVU-CARE

Timothy Jackson, MD

FAD-SearchResult -

Section Chief; Professor, J.W. Ruby Memorial Hospital
View Profile1-855-WVU-CARE

Jessica Perini, MD

FAD-SearchResult -

Assistant Professor, J.W. Ruby Memorial Hospital
View Profile1-855-WVU-CARE

Melissa Phillips, NP, NP-C

FAD-SearchResult -

Rn-Per Diem Res Pool R1, J.W. Ruby Memorial Hospital
View Profile1-855-WVU-CARE

Renee Schwertfeger, NP, FNP-BC

FAD-SearchResult -

APRN, Advanced Practice Professionals; Nurse Practitioner, J.W. Ruby Memorial Hospital
View Profile1-855-WVU-CARE

Rohma Shamsi, MD

FAD-SearchResult -

Assistant Professor, J.W. Ruby Memorial Hospital
View Profile1-855-WVU-CARE