Meet the Pharmacist Archive, Thursday, June 3, 2008

 

 

Anthony Valenza, R.Ph., graduated from Northeastern University in Boston, MA with a BS in Biology and a degree in Pharmacy. He is currently a pharmacy manager at Rite Aid in Saugus, MA. Anthony became a Certified Diabetes Manager in 2004 and is a participant in Rite Aid's Medication Therapy Management and Immunization programs.

Chiung-Huei Lui, R.Ph., is a Rite Aid pharmacist in Union City, CA. Chiung-Huei received specialized training in diabetes care through the National Institute for Pharmacist Care Outcomes (NIPCO) Diabetes Care Certificate Program and is one of Rite Aid's Diabetes Care Specialists.

Natalie Teaff, R.Ph., is a drug information specialist at the Rite Aid Drug Information Center. She received specialized training in diabetes care through the National Institute for Pharmacist Care Outcomes (NIPCO) Diabetes Care Certificate Program.

The "Ask the Pharmacist " series is brought to you by an unrestricted educational grant from Rite Aid Pharmacy.

 

ADA_Moderator: Welcome to ADA Live. Today our guests are Anthony Valenza, R.Ph., Chiung-Huei Lui, R.Ph., and Natalie Teaff, R.Ph. It's a pleasure to have all of you here today. We have a lot of questions so we're going to go ahead and get started

Guest_Pharmacists: Thank you, we're very happy to be here
Suzie: I was wondering if you had any statistics on african americans and access to diabetic products
Chiung: African-Americans have twice the incidence of Caucasians. And diabetic products are readily available in any pharmacy. Ask your doctor to write you prescriptions for the meter, test strips, lancets as insurances do pay for them. If you do not have private insurance, they are usually covered under Medicare and Medicaid. If your private insurance does not pay for the meter, most of the times, pharmacies have glucose meters on sale, costing you nothing or very little. Otherwise, look out for free clinics in your area. They might have programs for people with diabetes.
dave: how does albuterol, and my advair and spiriva effect my glucose level?
Chiung: I am not aware of Albuterol, Advair and Spiriva affecting glucose levels. However, bronchitis, pneumonia, etc. can cause fluctuations in your blood glucose requiring more self-monitoring.
meelak: Iwas diagnosed with Type-2 diabetes four years ago. and was on medication. I was forced recently to supplement the same with low-dose long-acting Lantus. This resulted in bringing my numbers within limits. In fact I have indications of hypoglycemia, on the average twice a day. Should I reduce the dosage of medication or insulin? I have lost 45 lbs. in the last three years and am currently 138 lbs. My height is 68 inches
Chiung: Given that I do not have any other data besides your current weight, I cannot answer your question accurately. You must discuss with your doctor about reducing the dosage on the medication or insulin because your numbers are within limits and you are experiencing hypoglycemia that often. Make sure you check your blood glucose levels whenever you 'have indications of hypoglycemia'.
Obama_Girl_3313: How do you know when your spilling urine?
Anthony_V: Normally, any glucose that is filtered by the kidneyss is reabsorbed. When the kidney's capacity to reabsorb glucose is exceeded, the excess "spills over" into the urineand is excreted. The appearence of glucose in the urine (glycosuria)is abnormal. There should not normally be glucose excreted into the urine. I would let the doctor know. A simple urine test would show this. A urine ketone test may also be suggested.
lala: what is the best meds for neuropathy and does the pain ever go away
Anthony_Valenza: Although there are many medication for controlling the pain due to neuropathy from diabetes. One of the most common ones is gabapentin (neurontin). It may cauese drowsiness, but there are many stregnths available to help toleratre the side effects and to titrate upwards, if needed. The newer medication is Lyrica. It is simular to gabapentin and would be considered the next course of action by many. To answer the second part of the question. NO, it usually does not go away. Howevere the pain should be controlled with medication and controlling the diabetes will help stop it from worsening.
rose: can a man have a yeast infection? he is a diabetic ..he is not taking his diabetic pills for 2 months
Anthony_Valenza: Yes, although not as common as in men,it is possible. A Doctor could prescribe medication to help treat this. Diflucan taken orally for the yeast infection and if burning is occuring, Pyriudium may be prescribed as well.
SQ: Is there any coralation between diabetes and Psoriasis? My husbands b/s has been very high for several months and his Psoriasis has gone crazy--palm size patches as well as pin point cover most of his body--he has been giving new meds for the b/s which are under control now but i am wondering if the two go hand in hand? thanks for your help!
Chiung: While we can not determine if your husband's high blood sugars caused his psoriasis flareup, high blood sugars may be associated with an array of physical ailments. We recommend that you consult with your husband's physician to discuss your concerns.
dc: My husband has diabetes and he claims that a cactus named peyote would help his diabetes is this true?
Chiung: Peyote is an illegal substance in the United States according to the Food and Drug Administration. We do not recommend it's use for any ailment, including diabetes.
msmel: is it true that with diet and exercise that someone with type 1 or type 2 diabetes may some day be able to be taken off medications?
Chiung: For type 2 diabetes, by the decade, these beta cells are non-functioning already, therefore, medications and/or insulin are necessary.
Chiung: In type 1 diabetes, the body's own immune system mounts a fight against oneself, in this case, it destroys its own beta cells in the pancreas, where insulin is produced. Currently, there is no other treatment available besides insulin for type 1.
Chiung: However, I believe that in early stages of pre-diabetes, with strict control of diet and exercise program, one can manage it and delay the progression into diabetes.
Dixie: I have a colleague at work that has diabetes. Sometimes he'll come to work slightly slurring his words and smelling funny. Is this a side effect of diabetes? Should I be concerned? I have brought it to his attention before but he doesn't seem to notice that anything is wrong.
Chiung: We suggest contacting the physician for evaluation of your blood sugar levels and symptoms.
Chiung: 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.
Lana: Why do people with diabetes sometimes have to get their limbs cut off?
Chiung: Poorly controlled blood sugar for long time will cause damage to the nerves and blood vessels. Blood vessels serve as channels of oxygen and nutrients to each single cell of the body and organs. Let's say a blood vessel that supplies nutrients and oxygen to the feet is damaged. That area of the feet won't have any sensation, whether to hot, cold, cuts, etc as the cells and tissues are dead. So people with diabetes can step into a nail and not realize it, causing the area to be infected. If not treated promptly and properly, it can turn into a gangrene, which at times cannot be saved and thus part of the limb must be removed.
sally: i take 500 mg metformin and my sugar levels still run between 170-190.is this acceptable?
Chiung: The ADA guidelines for sugar levels are 90-130 before meals and less than 180 two hours after meals. However, the AACE (American Association of Clinical Endocrinologists) recommends less than 110 for fasting sugar and less than 140 for 2 hours after meals. Studies have shown that a tighter control of blood sugar can delay the progression of the long-term complications seen in diabetes. We recommend that you consult with your physician to determine where your blood glucose levels should be and steps you can take to achieve those goals.
Nurse: I currently take Glucophage, Glucotrol and Byetta for type 2 D.M. and work an overnight 9 hour shift and my sugars in the AM are in the 160-180 range. Before taking the Byetta I was taking Avandia with my other meds and my AM levels were 125-140 is there any correlation to the way these meds were / are effecting my sugars that indicate which of these drugs are better for me??
Chiung: Has anything changed recently in your life/lifestyle? Stress, illness, dietary changes, etc. If the answer is negative, then talk to your doctor about the results with Byetta. Unless the doctor has a specific reason s/he does not want you to stay on Avandia, tell her/him you would like go back to it.
ANNA: Well my question is what is Bitter Melon? I been reading that it would help for Diabetes.
Chiung: There is insufficient, reliable evidence that bitter melon is of benefit for someone who has diabetes. It has been shown that bitter melon may have additive effects when used with diabetes medication(s) and this may increase the risk of low blood sugars in some patients. Unlike pharmaceuticals, "natural" products are not required to undergo the FDA (Food and Drug Administration) approval process to demonstrate their safety and effectiveness. The FDA only regulates the package labeling, prohibiting a product from making claims that it is intended to diagnose, treat, cure, or prevent a disease. We recommend that you consult with your physician before adding any herbal product, like bitter melon, to your daily regimen.
Susie: when do you begin the timing of a 2 hour postprandial blood glucose level, 2 hours AFTER you START eating, or 2 hours AFTER you FINISH eating? This could make a 30-45 minute difference depending on how fast or slow you eat.
Anthony_V_: This is actually a very good question. The ADA recommends less than 180mg/dl two hours after starting a meal. If for any reason one forgets when they started their meal I would recommend taking a post-prandial blood glucose reading 1 & 1/2 hours after one finishes eating.
Susie: How successful is Starlix?
Anthony_V: There is also a 10% increase in risk of upper respiratory tract infections.
Anthony_V: If meals can be controlled, it may be worth trying.
Anthony_V: As with all medication. The question is "Is strarlix successful for you (the individual).
Anthony_V: Starlix (Nateglinide),classed as a meglitinide, can be effective. It does not need dosage adjustment for patients with hepatic nor renal impairment.Used for type 2 diabetic adults and elderly. Dosage is 60mg to 120mg orally three times a day prefferably 30 minutes before a meal. If a meal is skipped, do not administer. Hypoglycemia is the primary caution with this medication. An example may be at a restuarant, where a meal may be delayed after taking the medication. The hypoglycemic effect will not wait for the food to arrive (or to be ingested).
tyurek: I'm just wondering how i can tell what is good carbs and bad carbs
Anthony_V_: To my knowledge there are no true: bad vs. good carbohydtrates.Pretty much starches and sugars of different types. They either get used by the body to make "energy", or they get stored for future use as fat. However, it has to be controlled more by a diabetic. The amount should be controlled and individualized to each person.The emphasis should be on unrefined foods with high fiber content whole grains, fruits and vegetables. Carbohydrates may be replaced by monounsaturated fats in some people to improve glucose and lipid levels. I know the ADA offers meal plans on the website that one may follow.
Anthony_V_: I hope I've been helpful.
Anthony_V_: Calorie counting is the most accurate diet. However, I recommend the Idaho Plate Method because of its simplicity, to the average person. It is like splitting a plate into "pie slices". Breakfast: no more than half for the "starch group"; one quarter "milk and or fruit group"; and the other quarter (optional)"protein group" . lunch/ dinner: half "vegetables group"; a quarter "protien group"; and a quarter "starch/carbs group".
Dave: I have a sweet smell in my nose from time to time. I have heard this can be related to a diebetic complication. Is that true.
Anthony_V_: The only smell or or breath odor that I have heard of, directly related to diabetes, is an sweet or acetone-like odor. This may be a sign of ketoacidosis. When there is an absolute lack of insulin, the production of ketones exceeds the capacity of the kidneys and muscle cells to eliminate them. The accumulation of ketones in the blood leads to a metabolic acidosis referred to as diabetic ketoacidosis (DKA). We recommend that your friend consult with their physician for a proper diagnosis.
dzip: How can I get help paying for my Medication?
Anthony_V: Getting help paying for your medication depends on many things. First of all; what medication are you on. Is there a generic alternative, or a generic comprable medication that your doctor may switch you to. Alot doctors have samples they maybe able to give you. A lot of manufactures have there own coupons or finacial support programs. If you don't have a "800" telephone number for the manufacturer, call your pharmacy for it. Also there are government funded insurances. Either low cost, medicare D for seniors, welfare, or local senior support (depending on your age), religious support, etc.
Jim: how much should my BG rise 20 mins after eating
Anthony_V: Blood Glucose readings usually peak 1 to 2 hours after start of meal. ADA giudelines recommend blood glucose levels of 90 to 130 mg/dl before meals and at peak after meal less than 180 mg/dl. The American College of Endocrinology (ACE) have stricter guidelines and recommend fasting BG levels less than 110 mg/dl and two hours after eating a meal less than 140 mg/dl. Non-diabetics are able to maintain this range while those with diabetes can not. Sudden flucuations in blood glucose levels may cause symptoms. For example: if ones blood glucose is running high 180 mg/dl, a sudden drop to 130 mg/dl (50 point drop) may cause one to get shaky, not feel well, sweat, or even feel like passing out; but ones blood sugar would still be considered high if fasting. Another factor would be how much and what types of food one would eat to increase it. You may decide to be aggressive in BG readings and time graphs in controlling your diabetes. However, a tight control, although effective, may result in side effects as with severe lows. I would descuss a testing routine and set of individual blood glucose goals with your clinician as it is not possible to determine how much your blood glucose levels may rise 20 minutes after eating.
Chung: I took the the Avanida for Type 2 for 6 years and 10 months and I switched to Actos since Oct. 31, 2007. I had a side effect of swelling in face, hand, feet and chest pain and shortness of breath, and weight gain. I am going to quit the Actos today, and I am not going to take any drug from now on. What do I expect to or what is a risk? My blood sugar test is with fasting (93 - 100 with Actos) and 2 hours later after meal test was 114. I am a Korean woman and my weight was 116 pounds for 30 years but today's weight is 122.40. Can I take care of diabetes without taking drugs? Maybe with diet and exercise? Please answer me. Thank you.
Chiung: Though I will love to tell you that you can take care of diabetes without taking drugs, studies have shown that after 5 years of diagnosis, most of the beta cells in the pancreas (these are the cells that produce insulin in our bodies) are not working properly any more. I strongly encourage you to find a practioner who is willing to work with you using alternative methods, such as diet, exercise, botanicals, homeopathic, supplements, in addition or in conjunction with medications. Whenever you try 'natural pills' under a provider's supervision, you must also monitor your blood sugar levels more frequently.
beng7: well see i was hanging out with a friend and he started to notice that im always thirsty and have dark lines under my eyes all the time and im always tired he has type 1 diabetes and said i might have a form of it and to go to a doctor
Anthony_V: In order to diagnose diabetes the doctor must complete a blood test, either a fasting plasma glucose test or an oral glucose tolerance test. The results will determine if you have pre-diabetes, diabetes, or are normal. The fasting plasma glucose test measures the blood glucose level first thing in the morning after a person does not eat (fasts) overnight. The fasting plasma glucose test defines pre-diabetes as blood glucose levels between 100 and 125 mg/dl and diabetes as blood glucose levels at 126mg/dl or above. The normal fasting blood glucose level would be less than 100 mg/dl. The oral glucose tolerance test measures blood glucose levels first thing in the morning after a person fasts and then again 2 hours after the person ingests a drink that contains glucose. With this test, pre-diabetes is defined as the 2-hour blood glucose level between 140 and 199 mg/dl and diabetes as the 2-hour blood glucose level at 200mg/dl or above. The normal 2 hour blood glucose level would be less than 140 mg/dl. Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. If you are concerned about developing diabetes, that you have diabetes, or are having any of the symptoms of diabetes, we recommend that you speak with your doctor for an examination and appropriate testing. Additionally, you may want to take the American Diabetes Association Diabetes Risk Test available online at http://www.diabetes.org/risk-test.jsp. For additional information on diabetes, please visit the Rite Aid Diabetes website at www.riteaiddiabetes.com or the American Diabetes Association's website at www.diabetes.org.
frustrated_wife: My husband is on his fourth week of having a cold. He's like a guinea pig. They just keep giving him different antibiotics, he takes them for a week and it doesn't work, then they give him another one, and that one doesn't work, etc. He finally went to a lung doctor who couldn't help him either and said to come back in three weeks when he's better so he can take tests. Well, he might be dead by then. He's now on his third antibiotic. He gets colds every year. How can diabetics treat their colds effectively when they do get colds? He's also tired of the chicken soup, vaporizing his room, drinking 8 glasses of fluid, etc. He's so tired. Please, please help. Thank you.
Chiung: Sick-day management is part of diabetes self-managment. During these times of illness, stress, the normal body response is to make more glucose. So, it is very important that he continues his medications to accommodate anticipated blood sugar increases. In addition, he needs to increase the frequency of glucose monitoring. We have found many available over-the-counter (OTC) medications for the relief of cough and cold symptoms. However, some of these medications may interfere with diabetes. Decongestants containing pseudoephedrine or phenylephrine can worsen diabetes control and should not be used unless directed to do so by a physician. As an alternative, saline nasal spray may be used to help break up and clear nasal congestion. Antihistamines may help in drying and relieving congestion. These products are available OTC and include diphenhydramine, chlorpheniramine, brompheniramine, loratadine, and cetirizine. None of the OTC antihistamines should cause a problem with diabetes. Guaifenesin is an expectorant available OTC for facilitating the thinning and removal of bronchial secretions. Guaifenesin is not known to affect diabetes and is useful for productive coughs (a cough in which you bring up phlegm). Dextromethorphan is a cough suppressant available OTC for the relief of a dry, hacking cough. This product should not be given for a productive cough, unless the cough is disrupting sleep at night. This product is not expected to interfere with diabetes. Analgesics may provide relief from aches, pains, and fever associated with the common cold. Acetaminophen is the preferred OTC analgesic in patients with diabetes. Ibuprofen, naproxen, and aspirin may cause hypoglycemia (low blood glucose levels) in patients with diabetes. Additionally, naproxen and aspirin have caused hyperglycemia (high blood glucose levels) in some people. It is important to also check the inactive ingredients of cough and cold medications. Many formulations contain some form of sugar which can increase blood glucose levels. Additionally, many contain alcohol which can cause either increases or decreases in blood glucose levels. It is best to look for a sugar-free and an alcohol-free preparation to minimize the impact on the blood glucose level. Please consult with your husband's physician before adding any medication to his current drug therapy.
dianne: My last 2 A1c readings were 5.9 and 6.1. However, my fasting reading in the mornings is around 125-135 and after a meal it is on occasion 220. Since the a1c are pretty good are the spikes in blood glucose levels putting me at risk for complications from diabetes?
Chiung: Though your A1c levels are great, I believe we should look at the body and therefore treat it as a whole system rather than just a part of it. Thus, I am a proponent of keeping blood glucose levels as close as possible to that of a normal person's. So, go by the target goals your physician and you have set up for fasting and after meal readings. Minimizing spikes will be good.
Bebes: Who can "get" type two diabetes?
Anthony_V_: Genetics has a primary role in type 2 diabetes.Also Obesity is a strong factor. There is a linear relationship when the degree of obesity increases above ideal body weight of 30%. Also fat accumutation in the trunk of the body confers a greater risk factor. Obesity in people with type 2 diabetes is related to the development of both insulin resistance and hyperinsulinemia. More compications may also arise from obesity as well. Also age it self is a factor (as with many things) in that with increased age there is some decrease in insulin secretion.
Uc: Please im from Nigeria.my mum is diabetic though not a member and for some years she has been taking a drug called Glucophage.She fainted few days ago as a result of weakness and diziness.pls kindly advise me comprehensively on what to do.im very worried.is there any other drug you can recommend apart from Glucophage?thanks
Chiung: Weakness and dizziness are signs of hypoglycemia or low blood sugar levels. Usually, Glucophage does not have these type of side effects. But hypoglycemia can be seen in elderly, debilitated or malnourished patients, in persons consuming insufficient calories daily, exerting too much physically or taking some other medications or alcohol. Have her examined by a physician.
tess: Is it true that the onset of this disease can be caused by a trauma? Especially if it's followed by and extended period of an inactive lifestyle, due to the trauma?
Chiung: There are a few hypotheses as the cause of diabetes is not certainly known yet. There are environmental factors that may play a role in the development of type 1 diabetes such as cow's milk, some viruses, cold weather, trauma to the immune system that predisposes one to the destruction of beta cells of the pancreas. In regards to inactive lifestyle followed by trauma, I am not familiar its association with diabetes.
peggy: my husband finger blood test is always around 115 to140 he gets very upset he wants it to be 100 or lower. he has been told that as long as it stays below 180 not to worry. his PCP tells him 105 or lower. another person told him 110. we want to know the range that is safe?? he takes ACTOS now, no insulin.
Chiung: The ADA guidelines for sugar levels are 90-130 before meals and less than 180 two hours after meals. However, the AACE (American Association of Clinical Endocrinologists) recommends less than 110 for fasting sugar and less than 140 for 2 hours after meals. Studies have shown that a tighter control of blood sugar can delay the progression of the long-term complications seen in diabetes.
venkatesh: in fasting my blood sugar level is 114.5 after taking food it is 126.5 my age 39 weight 42.5 whether I am an diabetic patient ?
Chiung: Go to www.diabetes.org and take the Diabetes Risk Test. If you do everything right and you still have diabetes, then, in your case, is genetics. Your fasting is higher than the normal person's. I am not sure about your ethnicity but in my area, I see a lot of Indian descent people in their 30's with diabetes. And I was informed that genetic testing could be perfomed.
Deb: I've read from a few sources that many people can have normal fasting levels for "many years" whlie they have abnormal post-prandial levels. How many years are they typically talking about?Thanks, Deb.
Anthony_V: I believe you are referring to "beta-cell bunout". In the subset of patients who do progress to impaired glucose metabolism, the greater demand placed on the pancreatic beta-cells by insulin resistance results in a progressive loss of function of beta-cells. This beta-cell failure is sometimes referred to as "beta-cell burnout". When the beta-cells are no longer able to meet the increased demands of insulin resistance, impaired glucose tolerance (IGT) occurs. It is hard to determine on an how long this may occur for as each person's case has different factors involved.
Deb: Am I diabetic, pre-diabetic, or normal? I was dxed with Type 2 Diabetes 7 years ago via an O.G.T.T. (I was not pregnant). But I am still experiencing normal fasting levels after all this time(in the 90's). More specifically, I had a fasting level of 113, at a routine physical (I've not seen anything that high since). The O.G.T.T. results were: fasting 97, 1/2 hour 220, 1 hour 218, 2 hours 219, 3 hours 115. I do have abnormal post-prandials from time to time (some as high as 220; the highest I've seen was 255 an hour after lunch when I had a bout with the flu bug a year ago . My latest A1C was 5.2% in Dec. 2007 (the highest it got was 6.08% in Dec. 2006. I'd like your opinion on where I'm at with this disease. Thank You, Deb.)
Anthony_V: OGTT results with a 100-g glucose load should be: fasting 95 mg/dl , 1 hour 180 mg/dl , and at 3 hours 140mg/dl . It seems that you are testing your blood glucose levels. You may want to test a fasting am and before going to bed (as late as possible) and post-prandials one to one and half hours after eating (peak time). It may be a good idea to log these figures along with what food and how much of each food (including caffine) for at least a week. This may make it easier to see if there is any correlation with your peaks and your diet. Unfortunately, we can not determine what your diabetes status is however, we recommend that you keep a detailed log of when and what you eat and your blood glucose levels in relationship to that and discuss the results with your physician.
bobbi: I am taking glyburide for my Type 2 Diabetes but I am gaining weight since I started taking it. I asked by Dr. about metformin because I've read that it doesn't cause weight gain but he said that there are too many side effects with it. Is that true? I am trying to watch what I eat and I do the treadmill for 30 minutes a day on top of having an active livestyle. I work part time (25 hrs. a week) and have 5 children (3 home and 2 in college). I have a lot of stress (lost my husband 2 years ago) and I heard stress can complicate matters. Please let me know about the two medications because I don't want to gain weight.
Chiung: Weight gain is a common side effect of glyburide. Metformin does not produce weight gain but has gastrointestinal(GI) side effects such as nausea, diarrhea, abdominal cramps, and a metallic taste. These GI effects can be minimized by slowing introducing the metformin into your daily regimen, which would need to be determined by your physician. About 6% of patients in a study discontinue the medication due to diarrhea.
bob: how do you know if you have diabetes?
Anthony_V_: In order to diagnose diabetes the doctor must complete a blood test, either a fasting plasma glucose test or an oral glucose tolerance test. The results will determine if you have pre-diabetes, diabetes, or are normal. The fasting plasma glucose test measures the blood glucose level first thing in the morning after a person does not eat (fasts) overnight. The fasting plasma glucose test defines pre-diabetes as blood glucose levels between 100 and 125 mg/dl and diabetes as blood glucose levels at 126mg/dl or above. The normal fasting blood glucose level would be less than 100 mg/dl. The oral glucose tolerance test measures blood glucose levels first thing in the morning after a person fasts and then again 2 hours after the person ingests a drink that contains glucose. With this test, pre-diabetes is defined as the 2-hour blood glucose level between 140 and 199 mg/dl and diabetes as the 2-hour blood glucose level at 200mg/dl or above. The normal 2 hour blood glucose level would be less than 140 mg/dl. Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision.
bob: how is the disease diagnosed?
Anthony_V_: Fasting plasma glucose (FPG) levels is the most specific test for diabetes. A value less than 100 mg/dl is favored. And a level greater than 126 mg/dl is a reason to test for diabetes to further diagnose. Post plasma glucose (PPG) can range from 140 to 180 mg/dl. Any reading over 200 mg/dl would again be a reason to test for futher diagnosing. An oral glucose tolerance test (OGTT) is usually doned. After fasting overnight adults are given 75 grams og glucose to drink(children 1.75 grams/kg max 75gm) then two blood samples are drawn one less than 2 hours and one at 2 hours after ingestion. (There is also an 100gm load glucose test with a third drawing) then the results are compared to the fasting levels. Two or more of the venous plasma concentrations must be met or exceeded for a positive diagnosis. Then a true diagnosis can be made.
Nan: I think that I have Diabetic Sores on the bottom of my feet. Where do I look on the Internet for pictures of Diabetic Sores and how can I treat them?
Anthony_V: You may find some pictures and a video on www.webmd. This web site may also give some tips on diabetic foot care. Always wear shoes (or protective foot covering, never bare feet)and look for sores or cuts everyday. You should really see a foot specialist at least once a year, if not twice.
Chad: I have diabetes 2, and have noticed that my lips are turning blueish and I have low back and feet pain. is my diabetes getting worse?
Anthony_V_: Although these symptoms may be related to the diabetes. It is upto a doctor to diagnose and monitor this progression. They may also be signs of circulatory and or nerve problems that may or may not be related to the diabetes. We highly recommend that you consult with your physician for a proper diagnosis and treatment options available.
mobydick: What can cause low blood in diabeties patients?
Chiung: Taking medications or insulin and not eating afterwards; excessive exercise or exercising when not appropiate; stress; illness.
Rascal: What brand glucose meter is the most accurate?
Chiung: I think they are all very accurate. The newest in the market has, of course, the latest technology, meaning it has more memory, additional feature to add comments, smaller blood sample size, possibly, more ergonomic.
ms__Lee: how many carbs should I eat per meal and snack, I'm 5'3, 152lbs, mild exercise? Thank You!
Chiung: As a general rule, 45-60 grams of carbohydrate per meal and 15-30 grams per snack are the recommendations.
insonia: I just want to know if a type 2 diabetic allowed to go to a spa? i'm referring to those full body massage etc
Anthony_V: A diabetic may be able to go to a spa and may receive a massage. However, they should consult with a doctor first. I would also let the spa and/or massage therapist know that you have diabetes. I would also make them aware of any limitations you may have. For example: loss of feeling in any area, or open sores, or pain, skin integrity, or vascular problems, etc. You may be careful of deep tissue massages and of the hot rock massages.
carebear4: I'm a 26 year old female who's a type 1 diabetic experiencing gastroparesis. Is there something over counter that would help? I've been eating smaller meals thru out the day which has helped a little.
Chiung: There are not over-the-counter medications you could take, they all must be prescribed. Avoiding high-fat and high-fiber foods can also help.
Rascal: I recently acquired a glucose meter that consistently registers 14 points lower than my old meter. How concerned should I be about this?
Chiung: Consistenly registering 14 points lower could mean something wrong with either the blood glucose meter that you received or your old meter. We recommend taking your blood glucose meters with you to your physician's office and when they do a blood glucose test perform a blood glucose test at the same time on your meter(s) for comparison. The meter(s) may also be checked by performing tests with control solutions specific for your blood glucose meter(s). Check with your local pharmacy to purchase the correct solutions for your meter(s).
sldr64: I had previously submitted a question concerning interaction between neurontin and zantac. I take neurontin, 600mg @ 8am, 600mg @ 5pm and 1200mg @ 10pm. I am prescribed zantac 150 mg twice a day. Due to drug interaction, what time of day do you recommend taking the zantac?
Chiung: Neurontin interacts with Maalox, an antacid. Zantac, an 'antacid', belongs to a class of medications called H-2 blockers, which works differently than Maalox. Thus, you can take Zantac twice a day with or without food.
Sandy: What can you do to avoid weight gain with insulin usage? I watch my carbs and exercise regularly but can't seem to lose 10-15 pounds I want to lose.
Chiung: Half a pound to one pound weekly is a healthy amount of weight to loose. Watching your carbohydrate intake and exercising are good, but you also have to look at your total caloric intake. Therefore, in your meals, could it be possible that there are extra protein and fat? In order to lose the above mentioned 1/2-1 lb per week, you need to decrease your daily caloric intake by 500.
sldr64_2: What are the recommendations concerning the use of novolog and lantus insulin
Chiung: Novolog is a rapid-acting insulin given at meal times. You can eat after 5-10 minutes of injection. Lantus is basal insulin and is usually given once a day. As the disease progresses in type 2 cases, about 40-50% patients will need to use insulin.
twig: once diagnosed with type 2 diabetes can you ever get it
Chiung: Once a person is diagnosed with type 2 diabetes, that person has diabetes. The best thing one can do to prevent the long term complications of diabetes is to maintain a healthy weight by eating sensibly (opt for fresh vegetables and fruits and less processed foods) and doing some type of physical exercise (such as walking around one's neighborhood) daily for 45-60 minutes and at least 5 times per week; taking the prescribed medications, and monitoring blood glucose levels.
sldr64: What causes neuropathy and how does neurontin affect it?
Chiung: Constant high glucose level causes blood vessel changes and in due time, damages nerve. How well blood sugar is controlled predicts the severity of neuropathy. The higher glucose levels one has regularly, the worser the neuropathy. As to how Neurontin relieves neuropathy, it is not known exactly.
twig: I am a commercial driver can I still drive
Anthony_V: Most people with diabetes lead full lives with no restrictions, however, only your physician can determine if you are able to perform your job as a commercial driver. We recommend that you consult with your physician to discuss your concerns.
slick: can a injury such as a knee and ankle injury, where you can not exercise the way you used to cause you to develop diabetes?
Anthony_V_: No, the knee or ankle injury itself can not cause diabetes. Diabetes can be inherited, caused by pregnancy (gestational), trauma or diseases to organs (like the pancrease), endocrinopathies, drug-or chemically-induced, infections (like congenital rubella), or related to obesity.
ADA_Moderator: That is all we have time for today. Thanks so much for taking the time to be here. Thanks to all of you who joined us by asking great questions or by just tuning in. If you wish to continue any of today's discussions please feel free to visit the ADA Message Boards.
ADA_Moderator: Keep up to date with all the ADA Live events and reference the archives here. We hope you found this interesting and informative and that you'll join us again next time here at ADA Live. Our guest will be Rite Aid Pharmacists and diabetes experts, will discuss and answer your questions on all aspects of diabetes at 1:00 p.m. EDT Thursday, June 12, 2008. See you then.