Meet the Pharmacist Archive, Thursday, May 1, 2008
The American Diabetes Association is pleased to present ADA Live! - a series of live Q&A sessions on topics related to diabetes and healthy living.
Erica Russell Whyte received her Doctor of Pharmacy from the University of Pittsburgh in 2003 and began working as a Diabetes Care Specialist with Rite Aid Pharmacy. She is currently a site coordinator for Rite Aid’s accredited ADA diabetes education program in Waynesburg. Each week she spends time educating patients about Diabetes, helping them learn about glucose testing, proper medication use, and diet.
The "Ask the Pharmacist " series is brought to you by an unrestricted educational grant from Rite Aid Pharmacy
Forum_Moderator: Welcome to ADA Live. Today our guests are Bill Breen, R.Ph., and Lorena Brandl, R.Ph., Pharm D.. Welcome!
Bill_and_Lorena: Thanks, its great to be here.
kishia: other than a syringe, what other method can i used to administer my insulin?
Bill: There was an inhaled insulin, but has been taken off the market. Now syringe is the only way.
Sam: One question. I am extremely overweight and my sugars have been 135 fasting and 186 after meals. My doctor says under new guidlines this is onset type 2 diabetes. Can this be reversed by getting back to a guideline weight?
Bill: Your levels are not way off at this point. There is a very good chance losing weight would make a difference.
lady_dreamer: is it safe to still have kids if one has diabetes?
Bill: According to American Diabetes Association, the key to a healthy pregnancy is keeping blood glucose in the target range -- both before a woman is pregnant and during her pregnancy. New research shows how diabetic women and their babies can stay healthy.
Joey: My husband has had Type 1 diabetes for 50 years. He has been experiencing problems with short term memory loss. Is this a common side effect of Type 1?
Bill: We suggest contacting the physician regarding your husband's symptoms of memory loss. He or she may evaluate any other underlying conditions which may or may not be present. There may be some evidence supporting an increased risk of developing memory impairment disorders with diabetes.
munga: What is the risks and benefits of taking a lower dosage of metformin?
Bill: As with any medication you should always take the lowest dose you can, and still get the best control of your blood glucose levels. Typically, side effects are less with lower doses.
dj: if my dad has diabetes, then what are the chances of me getting it too?
Bill: The exact cause of diabetes is unknown; however, genetics and environmental factors including lack of exercise and obesity have been shown to affect the onset of diabetes. Therefore, maintaining a healthy weight and exercising may help prevent or at least delay the onset of diabetes.
The exact cause of diabetes is unknown; however, genetics and environmental factors including lack of exercise and obesity have been shown to affect the onset of diabetes. Therefore, maintaining a healthy weight and exercising may help prevent or at least delay the onset of diabetes. There are various factors that determine one's genetic risk of developing diabetes. Without knowing your family history, it is difficult to determine. You may want to take the American Diabetes Association Diabetes Risk Test available online at http://www.diabetes.org/risk-test.jsp. You may want to speak to your physician regarding the results and your concerns.
There are various factors that determine one's genetic risk of developing diabetes. Without knowing your family history, it is difficult to determine.
You may want to take the American Diabetes Association Diabetes Risk Test available online at http://www.diabetes.org/risk-test.jsp. You may want to speak to your physician regarding the results and your concerns.
maria: my mom is over sixty and my grandma died from diabetes I'm worried that now my mom is taking insulin how bad is it?
Bill: There have been many great advancements in the treatment of diabetes just in the past 10 years. It is not a bad thing to be on Insulin. I see people every day live very normal lives on Insulin.
maria: how can I help her out is there any alternative or something optional to help her instead of insulin?
Bill: Not knowing her exact situation I am not sure if she has any alternatives. It is very important that she eats right and gets some exercise. Make sure she has a good new meter, and checks her level as often as her M.D. recommends.
Still_bill: When is the fasting period? or what time is the fasting period before testing?
Bill: Fasting is a period of no caloric intake (i.e. at night while sleeping) for at least 8 hours.
Norm: How can your sugar go before you should take insulin?? My sugar level is 220.
Bill: Your physician must determine when insulin is necessary for your particular blood sugar levels.
Sweetie: can I drink wine?
Bill: According to the American Diabetes Association, a person should ask themselves these 3 basic questions before consuming alcohol. 1. Is my diabetes under control?
2. Does my health care provider agree that I am free from health problems that alcohol can make worse-for example, diabetic nerve damage or high blood pressure?
If you said "yes" to all three, it's OK to have an occasional drink. But what does occasional mean? The American Diabetes Association suggests that you have no more than two drinks a day if you are a man and no more than one drink a day if you are a woman. This recommendation is the same for people without diabetes.
It is best not to drink alcohol on an empty stomach.
3. Do I know how alcohol can affect me and my diabetes?
Obama_Girl_3313: Is it better to be treated by an Endocrinologist or a primary care doctor when you are diagnosed with type 2 diabetes?
Bill: Your primary care physician is trained for care of diabetes patients. An endocrinologist is specialized in his or her training for diseases that affect the endocrine system such as diabetes. The primary care doctor can determine if a patient needs referred to an endocrinologist when he or she feels that their patient could benefit from a specialist.
dippy: I have been taking 5mg of glipizide twice daily for about 7 year when I was told I had diabetes. It is no longer controlling my diabetes. Is insulin my only solution?
Bill: Glipizide is one of the older sulfonylureas on the market. There are many other oral anti diabetic agents that are available. Your doctor will evaluate your blood glucose levels and determine a proper treatment plan appropriate for you. We suggest contacting the physician for an evaluation.
virgogal55: My blood sugar level has been running below 150 every afternoon now for two or three weeks. When I took it a half hour ago it was 171. What could be the reason(s) for this? I haven't been eating anything "bad" or different from what I normally eat. P.S. I was diagnosed with Type 2 diabetes almost two months ago.
Bill: It could be as simple as eating lunch at a different time. Talk with your physician regarding the change in your blood glucose levels for an evaluation of your condition.
paris: How many grams of sugar can an diabetic have?
Bill: There is no set amount. It is best to talk with your physician or dietitian to determine a proper meal plan which includes specific amounts of carbohydrates (including sugars), proteins and fats which is appropriate for you.
treas_: What should the normal bloodglucose level be?
Bill: General blood glucose level guidelines according to the American Diabetes Association (ADA) are:
Before meals – 90 - 130 mg/dl (5.0-7.2 mmol/l) (plasma/serum blood glucose reading)
A1C – Less than 7% (The A1C goal for an individual patient is an A1C as close to normal (<6%) as possible without significant hypoglycemia)
Peak after a meal (1-2 hours after the start of a meal) - Less than 180 mg/dl (less than 10 mmol/l)(plasma/serum blood glucose reading)
General blood glucose level guidelines according to the American Diabetes Association (ADA) are: A1C – Less than 7% (The A1C goal for an individual patient is an A1C as close to normal (<6%) as possible without significant hypoglycemia) Before meals – 90 - 130 mg/dl (5.0-7.2 mmol/l) (plasma/serum blood glucose reading) Peak after a meal (1-2 hours after the start of a meal) - Less than 180 mg/dl (less than 10 mmol/l)(plasma/serum blood glucose reading) The new general blood glucose level guidelines according to the American College of Endocrinology (ACE) are stricter than the ADA guidelines and include: A1C – Less than or equal to 6.5% Before breakfast in the morning – Less than 110 mg/dl (less than 6.1 mmol/l)--(plasma/serum blood glucose reading) Two hours after eating a meal - Less than 140 mg/dl (less than 7.8 mmol/l)--(plasma/serum blood glucose reading) Consult your physician to determine what specific goals are appropriate for you.
Two hours after eating a meal - Less than 140 mg/dl (less than 7.8 mmol/l)--(plasma/serum blood glucose reading)
The new general blood glucose level guidelines according to the American College of Endocrinology (ACE) are stricter than the ADA guidelines and include:
A1C – Less than or equal to 6.5%
Before breakfast in the morning – Less than 110 mg/dl (less than 6.1 mmol/l)--(plasma/serum blood glucose reading)
Consult your physician to determine what specific goals are appropriate for you.
AT: If my sugar is elevated, I get a slight headache and feel sluggish. I know if my sugar drops to drink OJ or eat peanut butter to raise it quickly. Is there a 'quick fix' to lower the sugar level quickly, other than medication?
Bill: When the blood glucose level is too high this condition is called hyperglycemia. Hyperglycemia may be caused by eating too much, lack of physical activity, illness, stress, the body not having enough insulin, the body not being able to use the insulin present, skipping medicine, or exercising less than usual. Symptoms of hyperglycemia include confusion, drowsiness, rapid breathing, fruity breath odor, increased urination, unusual thirst, low blood pressure, high levels of sugar in the urine, blurred vision, fatigue, headache, nausea, difficulty concentrating, or changes in mental status.
Other measures that may be taken to help decrease your blood sugar include changing your diet and increasing water consumption. If altering your diet and exercise do not work, you may need to have the doctor adjust your medication or insulin. If your blood sugar is higher than normal, you should not give yourself additional medication or insulin other than what was prescribed by your physician unless otherwise directed to do so.
Hyperglycemia may be controlled with oral diabetic medications and/or insulin therapy. Exercise is also a common treatment for hyperglycemia. (Please note: If your blood sugar is higher than 240mg/dL, check your urine for ketones before exercising. If there are ketones in the urine, do not exercise, this could make the blood sugar even higher. Contact a doctor if this occurs.)
chinni: what is the reason for frequent fluctuations(with in 2hours from 409 to 36) in sugar levels?
Bill: We are unable to determine the cause of these frequent fluctuations and would suggest contacting the physician for an evaluation of your blood glucose levels.
sweetpuppy: I have a sweet smell the last week or so. My bs has been running 250 and over. Is this why I'm getting this odor?
Bill: Symptoms of hyperglycemia include confusion, drowsiness, rapid breathing, fruity breath odor, increased urination, unusual thirst, low blood pressure, high levels of sugar in the urine, blurred vision, fatigue, headache, nausea, difficulty concentrating, or changes in mental status.
However, if your symptoms include dry mouth, nausea, vomiting, fever, abdominal pain, low blood pressure, shortness of breath, dehydration or increased heart rate, you may need to see a physician for an evaluation of your condition. In some instances when blood glucose levels go above 250 mg/dl with the symptoms described above, DKA (diabetic ketoacidosis) may occur. If this happens, medical assistance is needed from hospital staff. Treatment includes insulin infusions, fluid replacement, and potassium replacement.
We suggest contacting the physician for evaluation of your blood sugar levels and symptoms.
J: I would like to know why diabetes happens. Does it just happen?
Bill: You know by taking your blood glucose level. There are many reasons that it happens, some are disease states, overweight, pregnancy. It also happen for no reason at all.
Joshua: How does diabetes occur? Does it "just happen"?
Bill: Diabetes is a condition in which the body does not properly use or does not produce insulin. Insulin is necessary for the body to process starches, sugars, and other foods into energy to be used throughout the day. The exact cause of diabetes is unknown; however, genetics and environmental factors including lack of exercise and obesity have been shown to affect the onset of diabetes. Therefore, maintaining a healthy weight and exercising may help prevent or at least delay the onset of diabetes.
Wendy: I was diagnosed with type 2 diabetes 2 years ago and have done remarkably well and my doctor says I'm not the norm by getting and keeping my levels in the normal range, and I do not take medication I have lost 85 lbs. and exercise 5 days a week and eat healthy living and green foods no processed stuff and make my own whole grain bread, but recently I have in the last couple of days felt lousy and have low energy and feel fatigued. I checked my blood sugar before bedtime and it was a low 78
Bill: You may be experiencing some symptoms of hypoglycemia which can include shakiness, dizziness, inability to concentrate, headache, sweating, hunger, fast or pounding heart, fatigue, paleness, weakness, fainting, sudden moodiness or behavior changes, tingling sensations around the mouth, clumsy or jerky movements, and poor or blurred vision.
To help prevent hypoglycemia, eat meals and snacks on a regular schedule and test your blood glucose levels frequently. Ask your doctor how often you should check your glucose levels. It is important to know the symptoms of hypoglycemia and treatment options in order to prevent worsening hypoglycemia. Contact the physician to discuss your concerns.
Wendy: Could this be what is causing me to fell weak and Blah having a low blood sugar of 78?
Bill: When blood glucose levels drop below 70 mg/dL this condition is called hypoglycemia. Hypoglycemia may be caused by exercising, skipping meals, too much medication or insulin, drinking alcohol on an empty stomach, or changes in your schedule. Symptoms of hypoglycemia include shakiness, dizziness, inability to concentrate, headache, sweating, hunger, fast or pounding heart, fatigue, paleness, weakness, fainting, sudden moodiness or behavior changes, tingling sensations around the mouth, clumsy or jerky movements, and poor or blurred vision. These symptoms may still occur at your blood sugar level of 78 mg/dl. To help prevent hypoglycemia, eat meals and snacks on a regular schedule and test your blood glucose levels frequently. Ask your doctor how often you should check your glucose levels. It is important to know the symptoms of hypoglycemia and treatment options in order to prevent worsening hypoglycemia.
lady_dreamer: how do i know what type of diabetes i have?
Bill: Your physician can give you a proper description of your exact diabetes diagnosis.
Type 1 diabetes (also known as insulin-dependent diabetes) in which the body produces little or no insulin (hormone needed to convert sugar into energy.) Type 2 diabetes is the type of diabetes in which the body produces some but not enough insulin to maintain a normal blood sugar level or the body becomes resistant to the effects of insulin.
lady_dreamer: is it cureable?
Bill: There is no cure, but there are very good treatments so you can live a very long and normal life if you take care of yourself.
lady_dreamer: if i lose weight will i still have to be on meds?
Bill: I have seen many overweight type 2 diabetics reduce the amount of medications they are on by loosing weight. Some were able to stop taking all their menications.
red: my husband gets very shaky, weak and starts to sweat. What does this mean?
Bill: These could be the signs of many things. If it is related to his glucose level then I would say it is hypoglycemia (low blood sugar). When he gets like this, take his glucose level and see what it is.
chrisett: My eighty year old grandpa has ype 2 diabetes. He just checked his blood sugar and 333. is that too high?
Bill: Yes, that is very high. He should be in the lower 100's. He should check with his doctor about his medications.
Susie: What are the side effects of Starlix?
Bill: The most common are mild flu-like symptoms, back pain, dizziness and joint ache.
mishi: hi i want to know that is this possible to have diabetes from open wounds of patient if touched by the healthy person have a open wound
Bill: No it is not.
bunni: I accidentally was diagnosed with type 2 diabetes a year ago. however i have noticed my thought process changing to an extreme. sometimes i feel i am in another world and am a total different person with no I Q is this normal and what can i do about it
Bill: If your glucose level is not under control, it can cause some of the symptoms you have described. Check your level to make sure you are under control, if not talk to your doctor about adjusting your medication.
shy: how is diabetes transmitted?
Bill: It is not really transmitted. There is an increased risk of getting it if someone in your family has it. It is a disease that develops, but is not transmitted.
ADA_Moderator: That's it for today. Thanks so much for taking the time to be here Lorena and bill..
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