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ADA MODERATOR : Welcome to ADA Live!
Today our guests are Marvin Bouchon, R.Ph and Michele Seifert, R.Ph., Pharm D.. Both are Drug Information Specialists at the Rite Aid Drug Information Centerand
Welcome Marvin and Michelle.
Marvin and Michelle: Thank you we are both happy to be back with you again.
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san diego, california : My husband has been told that he is borderline diabetic (7 points away from what would be considred diabetic). He also takes meds to control his blood pressure and his cholestrol is high but he cant take meds for that as he had severe muscle pain when he tried them. He has a family history of heart disease and both parents have diabetes and high cholestrol. He exercises frequently and has a very low resting heart rate. We are trying to figure out what he is suppose to eat that won't raise his cholestrol nor his blood sugar. Help!
Marvin and Michelle: It sounds like your husband has many different medical conditions that need to be considered when planning an appropriate meal program for him. We recommend that he seeks the assistance of a dietician who is specially trained to develop individualized meal plans similar to what he would require. Additionally, he should watch the food labels for cholesterol and carbohydrate content. His regular exercise should help his various conditions as well. I assume that your husband was taking a ?statin? medication for his cholesterol when he experienced the muscle pain side effect. This is a possible side effect with all statin medications; however, some people will experience this side effect with one statin but not with another. Currently, there are six statin medications on the market. The doctor may have a sample of a different statin that your husband could try. Additionally, there are other medications to help lower cholesterol that do not cause muscle pain. We recommend that you husband speaks with his doctor to discuss cholesterol medication options.
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Delray Beach, FL : lease what would you consider good numbers, testing your blood first thing in the morning?
Marvin and Michelle: That would be considered "before meals" and according to the American Diabetes Association your before meal blood glucose should between 90 and 130 mg/dl (5.0-7.2 mmol/l) (plasma/serum blood glucose reading). Consult with your physician to make sure this number is appropriate for you.
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Cocoa, Florida : I am A Type 2 Diabetic. I am 73 years old, and have been a Diabetic for 13 years. My oral meds are not keeping my BG under control as well as they use to. My Dr is reccomeding Byetta (exenatide)i.e.,Lizard Spit. What are your best thoughts??? Thanks,Eric
Marvin and Michelle:
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Portland, Oregon : The inhealers that you breath in for insulin can that hurt the lungs, could this be the end of the shot in the arm?
Marvin and Michelle: The new inhaled insulin is called Exubera. There is concern and evidence that alterations in lung function can occur with use of inhaled insulin. This data continues to be studied and analyzed. Currently, it is recommended that all patients have their lung function assessed prior to starting therapy, after the first 6 months of therapy, and yearly thereafter. Inhaled insulin is not recommended for use in patients with lung disease such as asthma or COPD (chronic obstructive pulmonary disease). This product may be a good alternative for some patients; however, it is not for everyone and therefore can not replace the insulin shots completely.
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Cleburne, TX: My doctor suggested that I see an endocrinologist because of my high sugar count. HOWEVER, I am unable to locate one who will take medicade. Can you help me?
Marvin and Michelle: Unfortunately we do not have a listing of physicians who are Medicaid providers. I recommend that you speak with your local county assistance office for advice. You may also want to check the yellow pages of your phonebook under "physician specialties" and "endocrinologist" and begin calling from the list to see if any of them are Medicaid providers. Finding a physician who accepts Medicaid can be difficult, but don't give up and lots of luck.
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Newport, Arkansas: Is there a product available that will relieve the "burning" sensation in my feet. My doctor has me on Neurotin at the present time, but that has not give me any relief. I hope you have some good news for me.
Marvin and Michelle: The burning sensation in your feet is most likely due to diabetic neuropathy (nerve damage due to diabetes). Lyrica is the latest medication that is beng used for the treatment of diabetic neuropathy. Although similar to your Neurontin, the differences may be sufficient enough to provide a beneficial effect. I recommend that you speak with your physician about it. I hope that was good news for you.
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KELLER TEXAS 76248: I AM A 64YR OLD MAN AND HAVE MANY PROBLEMS I HAVE HAD HEART BYPASS SURGEY TWICE 14YRS APART 1 WAS TRIPLE 2nd 5 BYPASS I ALSO HAVE INSULENT DEPENDT DIABETES 2SHOT A DAY I NOW HAVE DEVELPOED RENAL FAILURE ANDSO FAR I LOST 87LBS A FISTULA IMPLANTED IN UPPER LEFT ARM MY CREATON LEVEL IS NOW DOWN TO 2.2 I AM TRYING TO FOLLOW A DIET PLAN TO LOOSE WEIGHT I HAVE SO FAR LOST 87lbs BUT ITS HARD TO TRY AND EAT A PROPER DIET VERY CONFUSING ANY SUGESTIONS
Marvin and Michelle: First of all, I want to congratulate you one losing 87 lbs. That takes a lot of hard work and you should feel good that you have accomplished so much. It is very hard to stick to a particular diet. My recommendation is that you visit a dietician who can help you design a meal plan that is best for you based on your likes/dislikes, schedule, and lifestyle. Keep up the good work!
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victoria,texas: is diabetes reversible.is there a specific food that well reverse it. (like cinnamon,nepaules,etc.)
Marvin and Michelle: Diabetes is not reversible, however it can be controlled with proper diet and exercise. There are no specific foods or non-prescription remedies that can reverse the diabetes. I have found information about a special species of cinnamon called cinnamomum cassia which is reported to lower blood glucose. However, currently there is no conclusive evidence of this. Before it can be recommended, additional studies will be necessary to determine if it is effective. I am not familiar with anything called nepaules.
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Seminole,FL: I am trying to find a chart that outlines the sugar levels most frequently vary on an hourly basis or on a several hour basis for people with type 2 diabetes. A typical answer may be " low before breakfaast and up 30 - 50 points after lunch" or similar types of variences.
Marvin and Michelle: I am not familiar with a standardized chart discussing blood glucose variations. Blood glucose levels will vary differently in each person depending on various factors such as type and quantity of food consumed, skipping meals, physical activity level, medication therapy, skipping medication, stress, illness, the body's production of natural insulin, alcohol consumption, or changes in a person's schedule. All these factors must be considered when trying to control blood glucose levels.
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Sagamore Hills, Ohio: I always experience a large difference between my meter and the hospital blood test. I have used different meters, had them calibrated and tested by the manufacturing company. I have also compared my meter to friends meter readings and they are consistant. Here is an example of my concern. 6:30 am at home: 82 I start to get hypoglycemic in the 70's my meter from my finger. 7:30 am hospital: 150 hospital result from my arm. 7:30 am hospital my meter from my arm 135 7:30 am hospital my meter from my finger 117 All tests were fasting and within an hour of each other. 82 is too low 150 is too high Confused.
Marvin and Michelle: Blood glucose levels can be tested in plasma (a component of the blood) or in whole blood. Plasma readings are usually 10-15% HIGHER than whole blood readings and can be even greater after eating. Most home glucose monitors measure glucose in whole blood whereas most lab tests measure levels in plasma. Some meters will convert the whole blood result to "plasma equivalents" which would allow you to compare your reading to your lab test results. We recommend that you find out if your monitor reports results in whole blood or plasma equivalents. This information should be in the owner's manual or you can call the company directly or ask your doctor or pharmacist. Based on what you described, it sounds like your monitor is reporting in whole blood and that would explain the discrepancies. Additionally, the blood glucose levels are constantly changing so an hour can produce significant changes in levels.
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Sachse, Texas: My blood sugar sporadically will shoot (317 once) up, but then drop back to normal. I've had the blood work where you give blood, drink orange syrup and wait 2 hours and give blood again. These come up normal. Thyroid was normal too. Could there still be a possibility of diabetes? Laurie P
Marvin and Michelle: According to the American Diabetes Association (ADA) one of the criteria for a diabetes diagnosis is when a person displays symptoms of diabetes such as the classic symptoms of frequent urination, thirst, and weight loss along with a casual plasma glucose greater than or equal to 200. The ADA defines casual as "any time of day without regard to the time since the last meal". It is also recommended that when a diagnosis is not definite then repeat testing on a different day should be done. I recommend that you see your physician.
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Fort Worth,TX: I have been told that if you have diabetes that you should not soak your feet in water.Is this true?
Marvin and Michelle: Many patients with diabetes have poor circulation in the extremities, particularly the feet. When the skin on the foot is broken, poor circulation makes healing difficult and increases the risk of complications. For this reason it is recommended that patients with diabetes avoid doing anything that may potentially cause problems with their feet. Soaking the feet may oversoften the skin and allow it too tear easier. Many patients also have diabetic neuropathy (nerve damage) and should be cautioned that they may not be able to feel water that is too hot and could potentially burn themselves. If you are having foot problems, I recommend that you see your physician. Also, I do not recommend that you attempt to cut your own toenails. A mistake when cutting could lead to a break in the skin or an irritation. See your local podiatrist.
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Perry ,Ga: My Partner has Type 1 Diabetes. He doesn't have ED, but when he ejaculates nothing comes out. Can he ever father a child?
Marvin and Michelle: Anejaculation is the term used to describe the absence of an ejaculate flow. Although this condition may be affected by diabetes there could be another physical condition present. Your partner should discuss this with his physician.
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cleveland, ohio: what does it mean when you have a copper taste in your mouth?
Marvin and Michelle: Taste disturbances may be the result of numerous causes. Are you taking a multi-vitamin that contains minerals and in particular copper? Do you live in an area where industrial smoke may contain trace elements of copper? Often nasal and sinus disorders or upper respiratory infections can lead to alterations in taste. Although you may have the taste of copper in your mouth it may actually be something else that is now tasting like that to you. If this continues it is best to check with your physician. Determining a cause for this condition can be difficult.
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oakland, nj: I was diagnosed 2 months ago with type 1 diabetes. As my index improves can I become a type 2?
Marvin and Michelle: If you have been diagnosed with type I diabetes this means your body no longer has the ability to produce insulin. Patients with type II diabetes still have some insulin making capabilities. It is unlikely that your body will begin making sufficient insulin to be classified as a patient with type II diabetes.
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lloydminster,sk Canada: why is metformin perscribed, when sugar levels are high. what causes high sugar levels?
Marvin and Michelle: 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. When the sugars are not processed then they show up as high amounts in the blood and can also be found in the urine. Metformin is prescribed to lower the blood sugar as well as decrease the production of sugars in the liver. The overall result is a reduction in the blood sugar.
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Littlerock, CA: What is an A1C?
Marvin and Michelle: HbA1C, or A1C for short, stands for hemoglobin (HEE-mo-glo-bin) A1C or glycosylated (gly-KOH-sih-lay-ted) hemoglobin. It is a test for the measurement of an individuals average blood glucose levels for the previous 2 to 3 months. The result is expressed as a percentage value. The test is indicative of the amount of glucose that sticks to the red blood cells. More specifically it indicates the percentage of hemoglobin within red blood cells that have glucose attached. The record is kept current because red blood cells die about every 120 days and are replaced by new ones. So, we are always replacing red blood cells with fresh hemoglobin giving us a nice tidy picture of the last few months. Hemoglobin carries oxygen from the lungs to the rest of the body and is responsible for the red color of our blood cells. Glucose becomes attached to the red blood cells by a process known as glycation (hence the above term glycosylated). If our daily blood glucose is high then more glucose attaches itself to the red blood cells and our A1C value goes up. The higher the glucose level is, the higher the A1C number reported
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Wilmer, Texas: I come from diabetes generations on both sides of my family, not my husband's side. My question: Would a prescription of glucophage started now help my children, who are not now diagnosed with diabetes in "prevention of diabetes" and help with now obesity. The obesity is a concern, because of diabetes in my family. The inturnist my son goes to says no. I say yes. It would help control appetite and with diabetic education use the information on carbs to help prevent possible diabets, and with exercise they may never have this horrible diease. This question is VERY important to me, because there is a silence on what this drug could do for others in prevention. Many doctors won't prescribe this drug - I say they are unaware. Why withhold this drug for children of diabetics in light of the epidemic the world over!
Marvin and Michelle: There have been some studies using metformin to prevent or delay the progression from impaired glucose tolerance to type 2 diabetes. Reports indicate that it is somewhat successful but not as successful as proper diet, weight control and exercise. Your concerns are valid. High risk factors for diabetes include family history of diabetes, obesity, and physical inactivity. It has been shown repeatedly that proper diet, exercise, and weight control can delay or even prevent the onset of diabetes. With proven evidence such as this I feel it is a better choice than relying on medication to do the job. What if the medicine stops working? Incorporate the proven into your childrens lifestyle. Teach them to be healthy and you will be safegarding them against the early onset of diabetes.
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Chicago, IL: Good Afternoon Guys!! I am 8 months pregnant and I was just diagnosed with Gestational Diabetes and I am actually scared. My Dad had Diabetes and it's primarily on his side of our family. As of today, I have begun to monitor my glucose level(s) and such but I'm not on insulin. I don't know what to expect. I know there is a chance that I may only have this for the duration of my pregnancy, then again, I may have it afterwards (hopeuflly not). The two times I took my levels today, the levels were 128 post-lunch and 130 post-dinner. Is it that high due to my just beginning to monitor my levels or will it go down? Thank you. P.S. To all the Mothers: HAPPY MOTHER'S DAY!!!
Marvin and Michelle: Once diagnosed, treatment for gestational diabetes should be started as soon as possible. Special meal plans, exercise, and many times insulin injections will be utilized to help keep the mother's blood glucose levels within the normal range. Blood glucose levels should be monitored using a blood glucose machine. Below are general blood glucose guidelines. It is best to consult your physician to determine the levels that are appropriate for you. The following readings depend on whether your meter checks for whole blood glucose or serum plasma glucose: before meals - less than or equal to 95(for whole blood glucose)and 105 (for serum/plasma blood glucose). One hour after a meal - less than or equal to 140mg/dl (whole blood glucose) and 155mg/dl (serum/plasma glucose). Two hours afer a meal - less than 120 mg/dl (wholeblood glucose) and 130mg/dl (serum/plasma glucose). Between 2:00AM and 8:00 PM greater than 70mg/dl (both whole blood glucose and plasma/serum glucose).
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Woodridge,il: I had a brain mri recently showing "plaques" in areas of my brain. Can nerve damage caused by diabetes do damage to areas of the brain (myelin) spinal cord if it has gone undiagnosed for a long time? i am looking for other causes besides Multiple Sclerosis.
Marvin and Michelle: We were able to find some information stating that in cases of diabetes there were no increases in brain plaque formation. However, the data did state that when brain plaques were present, the extent corresponded to the duration of diabetes. Based on this information, diabetes does not appear to cause brain plaques. Most of the information available relates to patients with diabetes and Alzheimer's disease. Plaques are common in patients with Alzheimer's disease. We recommend that you continue to speak with your doctor to evaluate other potential causes of your symptoms.
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dawsonville georgia: I am a 25 year old diabetic that is having problems with my foot and need some assistance with my care who do I contact?
Marvin and Michelle: You do not state the type of problem you are having (corns, open wound, burning sensation?). Podiatrists are doctors who are trained to prevent and treat foot conditions. However, not knowing your condition I would recommend seeing your primary care or family physician first.
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lexington Ky: what is anormal blood sugar rate when you have a gloucose tolerance test?
Marvin and Michelle: 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.
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Petaluma, California: My wife has Type 2 diabetes. Blood sugar levels are very high. How can she nutritionally lower her high blood sugar levels? Drinking water? We are at a loss. Our doctor will not help her. It is to the point where he refuses to write a prescription for diabetes education.
Marvin and Michelle: Hyperglycemia (high blood glucose levels) may be controlled with oral diabetic medications and/or insulin therapy. Exercise is also a common treatment for hyperglycemia. However, if the blood glucose is higher than 240mg/dL, your wife should check her urine for ketones before exercising. If there are ketones in the urine, she should not exercise, this could make the blood glucose even higher. A doctor should be contacted if this occurs. Other measures that may be taken to help decrease the blood glucose include changing her diet and increasing water consumption. She may need to consult with a dietician to formulate an appropriate meal plan for her. If altering her diet and exercise do not work, she may need to have the doctor adjust her medication or insulin. If her blood gluocse is higher than normal, she should not give herself additional medication or insulin other than what was prescribed by her physician unless otherwise directed to do so. If your wife is experiencing difficulties with her physician, she may wish to seek a second opinion or visit a specialist (called an endocrinologist).
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Baltimore,Md: I have been diagnosed with type 2 diabetes since August 21st. 2005, and have been on a low starch(one slice of bread) diet. But now, I been thinking of becoming a vegetarian because it seems like no matter what diet I take, I still lose a little or gain a lot of weight. I use to take metformin (50mg) a day and now they switch me over to Glyburide (10mg). Will becoming a vegetarian make a difference in my diet or should I ask them to give me a stronger dosage?
Marvin and Michelle: Although possible, managing both your weight and glucose levels will probably not occur simply by becoming a vegetarian. Eating a properly balanced diet combined with exercise is the proven method to weight control as well as glucose management. The key to successful diabetes and weight control as a vegetarian is proper planning. It is essential that the diet be properly planned to insure sufficient nutrients, a good glycemic index (rating of how food breaks down in relationship to sugar levels), as well as fiber. The vegetarian diet must also satisfy your hunger as well as remain within caloric boundries that will allow weight loss. I believe that you should talk with your physician about you interest in becoming a vegetarian. I suspect he will steer you away from the idea. I suggest that you ask for the opportunity to consult with a dietician.
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hurst,texas: Why do my ankles and heels hurt so badly that I cannot walk? What exercises can I do to relieve the pain? should I wear tight or loose stockings? should I use a motorized chair at work (especially towards the end of my workday when my pain in my ankles and lower legs are throbbing with pain?) I have t2 diabetes.
Marvin and Michelle: We are unable to determine the exact cause of your ankle and heel pain. We recommend that you speak with your physician for an evaluation and to determine the potential cause as well as an appropriate treatment plan. Your physician can recommend appropriate exercises based on the exact problem. Additionally, physical therapy may be an option depending on the specific medical condition.
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Reynoldsburg Ohio: My wife's sugar count is 304 since she can't make it to the doctor until Monday what can we do until then to get it down?
Marvin and Michelle: I am assuming she does not have medication to treat her condition. Hyperglycemia can be serious. 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. If any of these symptoms develop we recommend that she immediately seek medical attention. Exercise is 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.) Exercise is dependant on the indivicual can could be walking or if previously inactive some increase in physical activity. Other measures that may be taken to help decrease blood sugar include changing the diet and increasing water consumption.
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conway sc: Why do i throw up when sugar level go up to 220 and then it drops to 80s?
Marvin and Michelle: Nausea and vomiting can be symptoms of both hyperglycemia (high blood glucose levels) and hypoglycemia (low blood glucose levels). We are unable to determine exactly why your blood glucose levels are spiking high and then dropping immediately. Vomiting will cause you to lose calories and possibly become dehydrated which can affect your glucose levels. We recommend that you speak with your physician regarding the recurring symptoms you are having for an evaluation and treatment plan.
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Charlotte, NC: Am newly diagnosed with type 2. Taking Avandia. What foods contain potassium? I have always used orange juice...but now see it contains lots of sugars and carbs. Need this because I must take a diurectic once a day, as I have heart trouble. Thank you for the answer. Nancy
Marvin and Michelle: There are many foods that are high in potassium such as dried fruit (prunes, dates, apricots, raisins), fresh vegetables (spinach, peas, mushrooms, tomatoes, beets, greens), dried vegetables (peas, beans), fresh fruit (cantaloupe, oranges, strawberries, watermelon, bananas), fresh juice (orange), canned juice (prune, grapefruit, apricot), and fresh meat (fish, turkey, beef). There are also potassium supplements available both over-the-counter and by prescription if you can not get enough potassium through dietary sources. We recommend that you speak with your doctor to discuss how much potassium you need through your diet and/or supplements.
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Hallsville, Texas: My husband found out 2 years ago that he has type 2 diabetes. We have tried so many types of medication to monitor his numbers and nothing seems to help. He is only 168 lbs and his weight keeps dropping. He has lost at least 40 lbs since we have found out. We just received his A1c and it was 11 and his average # was 269. He has cut out all the sugar in his diet so we do not know what is going on. Right now he is taking Byetta 10 mg bid and Actoplus Met bid. His #'s are always in the 200's. He is a smoker could that be the cause? Any suggestions?
Marvin and Michelle: Smoking can affect many aspects of diabetes. It can cause hyperglycemia (elevated blood glucose levels). Additionally, smoking can aggravate heart and blood vessel disease, increase the risk for development of nerve damage or kidney disease, or damage and constrict blood vessels worsening foot ulcers as well as leading to leg and foot infections. Smoking also increases the risk of cancer, raises the blood pressure and cholesterol levels, makes it easier to catch a cold or respiratory infection, and causes impotence. People with diabetes who smoke are three times more likely to die of cardiovascular disease than non-smoking diabetes patients. We recommend that your husband speaks with his doctor, diabetes educator, or pharmacist to discuss smoking cessation products. There are numerous products available to help him quit including pills, patches, gum, and inhalers (Some of these products require a prescription). I'm concerned about your husband's continued weight loss unless he has increased his physical activity and/or decreased his calorie intake intentionally. If he has not done either of these things, we recommend that he speaks with is physician and a dietician to devise an appropriate meal plan to make sure he is getting enough calories. The dietician can also evaluate his current meal choices to determine if he has indeed managed to cut out all the sugar that he can. Additionally, the doctor may need to re-evaluate his medication regimen and alter the dosage of his current medications and/or add additional medications to control his blood glucose levels.
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Ramsey, MN: We have an 8 yr. old daughter who was recently diagnosed with Type I diabetes. We are missionaries living in Japan, and we will be flying back to America next year for an 8 month visit. With the heightened anti-terrorism security procedures at airports, what kind of procedures are necessary for a diabetic person to carry their lancets, insulin pen, needles, etc. on board the plane with them?
Marvin and Michelle: When flying, you should always carry your diabetes medication and supplies with you in your carry-on luggage. Tell the security screener that you have diabetes and that you have your supplies and medication in your bag. All medications and devices/supplies should be clearly labeled and able to be identified. You may request a visual inspection of your medication instead of using the x-ray machine. It is also a good idea to have a letter from your doctor explaining what medications or devices you use for your treatment. For more information on traveling with diabetes, please visit the ADA's website at http://www.diabetes.org/advocacy-and-legalresources/discrimination/public_accommodation/travel.jspand http://www.diabetes.org/pre-diabetes/travel/when-you-travel.jsp.
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Corpus Christi, TX: Once Insulin shots are started, can the shots be stopped after a certain time or if the diabetes is controled more?
Marvin and Michelle: Insulin injections are usually started when the body is no longer producing insulin naturally. Therefore, supplemental insulin will continue to be needed and the injections can not be stopped. The insulin injections are the cause of the improved diabetes control, if they are stopped the control will be lost and blood glucose levels will increase again. You should not alter your insulin injection regimen without first consulting your physician.
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brooklyn, new york: What are the adverse effects of diabetes?
Marvin and Michelle: I'm assuming you mean long term (years) complications of hyperglycemia (high blood sugar). These complications include coronary artery disease, skin breakdown, infections, peripheral vascular disease which may lead to amputation of limbs, loss of vision, numbness and tingling in the extremities, feet problems, skin ulcers, joint problems, and kidney problems.
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san leandro, ca: What is the most reliable blood glucose monitor?
Marvin and Michelle: There are numerous blood glucose monitors available on the market. However, no one monitor is "the best". Monitors vary based on their features such as the amount of blood necessary to conduct a test, the speed of testing and results, size, location that the sample may be taken (finger versus forearm), the ability to store test results in a memory, compatibility with computer software to download results or make charts and graphs, cost of the meter, and cost of accessories such as test strips and lancets.
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orlando florida: What is the cost of a diabetes test without insurance? Where can I get it done?
Marvin and Michelle: Unfortunately, we do not have pricing information for diabetes tests. This could vary with each site as well as the test performed. We recommend that you speak with your physician for assistance. If you do not have a regular physician, you may wish to look for a health clinic in your area or local hospital for information. Additionally, your local pharmacy may have information on clinics in your area that may be able to assist you.
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VIRGINIA BEACH VIRGINIA: WHAT ARE TARGET NUMBERS (GLUCOSE LEVEL POST MEALS, RISING IN THE MORNING.
Marvin and Michelle: The general blood glucose level guideline for nonpregnant patients from the ADA is: 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 are: Two hours after eating a meal - Less than 140 mg/dl (less than 7.8 mmol/l)--(plasma/serum blood glucose reading). You should speak with you physician to determine what guideline is the most appropriate for you.
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Baltimore, MD: I would like to buy a glucometer for my mom because she has DM. Which model should I consider? thanks a lot.
Marvin and Michelle: When choosing a blood glucose monitor it is best to evaluate the features to determine the most appropriate monitor for the individual who is going to use it. Monitors vary based on their features such as the amount of blood necessary to conduct a test, the speed of testing and results, size, location that sample may be taken (finger versus forearm), the ability to store test results in a memory, compatibility with computer software to download results or make charts and graphs, cost of the meter, and cost of accessories such as test strips and lancets. If your mother is not going to download test results to the doctor and make charts and graphs of her results, then this feature would obviously not be a major selling point for you. No one blood glucose meter is "the best". I would first recommend that you speak with her insurance company to determine if they pay for a particular meter. Some companies may not pay for the monitor itself but will pay for or at least discount the price of the supplies. This can be very important because supplies can be costly and they are an ongoing expense.
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Hattiesburgh: How long does it take for diabetes complications like retinopathy,stroke, nephropathy to set in a diabetic?
Marvin and Michelle: Unfortunately, there is no way to predict how long it will take for complications to affect a specific person. The complications you are asking about are usually long term complications and general take years of uncontrolled hyperglycemia (high blood glucose levels) to occur. Other long term complications include coronary artery disease, skin breakdown, infections, peripheral vascular disease which may lead to amputation of limbs, loss of vision, numbness and tingling in the extremities, feet problems, skin ulcers, joint problems, and kidney problems. We recommend that you work with your physician and diabetes care team to keep your blood glucose levels under control to decrease your risk of long term complications.
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danville,illinois: I was wondering in an adult woman age 52 what is the range that is normal and what would be considered high sugar level?
Marvin and Michelle: 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) 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)
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Ballwin, MO: What should glucose reading be 2 hours after eating?
Marvin and Michelle: 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) 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)
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Owensville, MO: If a patient's blood sugar gets too high, such as 500, what is the typical behavior? Is it typical to be noncomplient, rude and disrespectful to others?
Marvin and Michelle: Symptoms of hyperglycemia (high blood glucose levels)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.
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red bank, new jersey: My husband has Type 2 Diabetes. He tests his blood sugar usually twice a day. We noted that his BS may be normal at bedtime, but by the time he wakes up in the morning it is usually high around 140-160. This high morning blood sugar occurs whether he has a bedtime snack or not. What can he do to keep it within normal?
Marvin and Michelle: Some patients experience high before-breakfast blood glucose levels because of hormones that are released in the early part of sleep (called the Dawn Phenomenon). Typically, the blood glucose level rises between 4 AM and 8 AM. It is best to check your husband's blood glucose level in the middle of the night (around 3 AM). If his blood sugar is high, he may be experiencing the dawn phenomenon. If it is low, it may be a rebound hyperglycemia (high blood glucose) causing his high blood glucose levels in the morning. This occurs if you have low blood glucose levels at night and the body is releasing hormones as a defense mechanism against low blood sugar. It would be best to consult with his physician for proper diagnosis and treatment.
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Torrance, California: Is there a recommended brand of multivitamin for diabetics?
Marvin and Michelle: There numerous multivitamins available that are specifically marketed for patients with diabetes. However, no one vitamin is "the best". It is best to speak with your doctor to determine if you even need a vitamin supplement. If the doctor feels that you do, he/she can give you guidance as to the specific vitamins or minerals that you are lacking and then you should compare the various brands to determine which best meets your specific nutritional needs. Your local pharmacist can help you compare the vitamin options once you know the ingredients that are most important for you (and amounts required if possible) from your doctor.
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cleveland,ohio: I have type 2 diabetes and I want to get a tattoo my question is can I get a tattoo even though I have diabetes?
Marvin and Michelle: There are many risks involved when getting a tatoo. Unsterile tattooing equipment, needles, and ink can transmit infectious disease such as hepatitis. Transmission of infection is the reason the American Association of Blood Banks requires a one-year wait between getting a tattoo and donating blood. Allergic reactions are possible and some people have had an allergic reaction to a tattoo that they have had for many years. Granulomas (formation of a nodule as a result of inflammation) and keloids (a raised, firm, thick scar that forms as a result of a defect in the natural healing process) can also occur after a tatto. There have also been reports of people with tatoos or permanent makeup who have experienced welling or burning in the affected areas when they underwent magnetic resonance imaging (MRI). Because individuals with diabetes have increased risk factors for skin infections I do not recommend geting a tattoo unless your physician permits you to do so.
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aberdeen, wa: I have frequent headaches, neasia, and vomitting constant thirst and fatique. Many members of my family have diabetes. Are these symptoms that could occur with diabetes?
Marvin and Michelle: Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. Based on the symptoms you described and your family history of diabetes, we recommend that you schedule an appointment with your doctor for proper testing.
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clay city, ky: My dad has diabetes and he has a lot of fluid in his legs,feet,stomach he looks like he could explode,its bad the family dr. has him on shots 2 kind, and fluid meds. but its no better, he dont have a diabetes dr. he sugar goes from 155 to 500 plus 8 - 10 shots a day what can he do to get this fluid off him, and could dibetes cause this he is 66 yrs. old.and has non hodskins lymphoma too. thanks pam
Marvin and Michelle: There are numerous factors that can cause fluid retention such as certain diabetes complications, medications, as well as the Non-Hodgkin's lymphoma itself. Unfortunately, we can not determine the exact cause of your father's fluid retention. We recommend that you continue to work with his physician to determine the cause and an appropriate treatment for him. Good Luck!
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Denham Springs, Louisiana: I have been diagoned as pre-diabetic. I would like to know what is a normal blood glucose reading before you eat a meal and what is high. What would be a good weight loss program to follow? Also what kind of foods can I have?
Marvin and Michelle: 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 mol/l) (plasma/serum blood glucose reading). The best way to lose weight is by following a healthy eating plan. You may want to start by reviewing the governments Food Guide Pyramid at www.mypyramid.gov. If additional help is needed consult the nutrition and meal planning sections of the American Diabetes Association at www.diabetes.org. If possible consult with a dietician who can answer all you nutritional questions as well as help you plan a safe and effective program to lose weight.
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hutchinson, kansas: How high should your blood sugar be before you go to the hospital?
Marvin and Michelle: Diabetic ketoacidosis (DKA), also known as diabetic coma, occurs when the body lacks insulin and breaks down fats for energy. When this occurs the body produces ketones which can be found in the urine. Ketoacidosis occurs when the body does not get rid of all the ketones in the urine and they build up in the blood. This is a life-threatening situation and needs immediate treatment. DKA is associated with blood glucose levels from 200-2,000mg/dL. Symptoms of DKA include unexplained blood glucose greater than 250mg/dL, fruity smelling breath, dry mouth, nausea, vomiting, fever, abdominal pain, low blood pressure, shortness of breath, dehydration, increased heart rate, shock, and coma. Medical assistance is needed from hospital staff. Treatment includes insulin infusions, fluid replacement, and potassium replacement.
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port st lucie fl: What are the numbers on your blood work that tell you that you have diabetes, 100, 200? etc
Marvin and Michelle: 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.
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san leandro, ca: What is known about a new drug called rimonabant (brand name: Acomplia). It is supposed to suppress appetite, lower the risk of heart disease and diabetes and help kick the tobacco addition.
Marvin and Michelle: The latest information I could find on Acomplia is that it is still under review by the Food and Drug Administration. (FDA). It is reported that the FDA has issued an approval letter for use in weight management but issued a non-approved letter for smoking cessation. Although reported as effective in both categories, I believe it is prudent to wait until additional information from use in the general public becomes available before evaluating it. I want to make sure that you understand Acomplia itself does not lower the risk of heart diasease or diabetes but rather assists in alleviating two major risk factors - obesity and smoking.
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new york: My brother is having problems with his vision due to his diabetes, he is blind. i was just wondering if there is a chance to restore his eye sight at all?
Marvin and Michelle: Diabetic retinopathy is one of the complications of diabetes as well as one of the leading causes of blindness. It is a progressive disease and occurs when diabetes causes damage to the small blood vessels that are inside the retina. Vision loss is not reversible. Depending on the degree of vision loss there are potential treatment options such as laser surgery or devices that help with low vision. There is currently no cure for diabetic retinopathy. Prevention is the most important factor by maintaining blood glucose levels and having regular eye exams. We recommend that your brother visits his eye doctor to determine if there are any procedures or devices available that may benefit him.
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Lubbock, Texas: My husband has had diabetes for 30 years now. He is very stubborn and in the 15 years we have been married , he has never seen a doctor. He regulates his own insulin, plus he does not eat right. He is not overweight,and in the last year he has lost about 20-30 pounds with his job. For the past year his blood sugar goes so low in his sleep he does not wake up. I wake when he starts jerking and breathing funny. Could someone please tell me why this is nowe happening? I am arming myself with all the information I can so I can have a serious heart to heart with him. Thank you very much! Shauna
Marvin and Michelle: You state he does not eat right and has lost 20 to 30 pounds and has a new job. Does this new job require that he be more physically active? Weight loss in an individual who is not overweight and not trying to lose weight usually indicates that sufficient food is not being consumed and/or physical activity has been increased. This can lead to low blood sugars or hypoglycemia. Hypoglycemia may be caused by exercising, skipping meals, too much medication or insulin, drinking alcohol on an empty stomach, or changes in a person's 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. If blood glucose drops very low an individual may develop slurred speech, confusion, seizures, combativeness, or pass out. Hypoglycemia can be a very serious condition. To find additional information, before talking to your husband, consult the American Diabetes Association website for additional information at www.diabetes.org.
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ADA MODERATOR: Diabetes is a progressive disease so it is not uncommon for medications to either need an increase in dosage or stop working all together. In some cases in patients with type 2 diabetes, the pancreas stops producing insulin all together which means that oral medications will no longer work and insulin injections are the only available treatment option. Byetta is a new injectible medication for the treatment of type 2 diabetes approved to be used with the oral diabetes medications metformin and/or a sulfonylurea (such as glyburide, glipizide, or glimepiride). Even though Byetta is an injection it is not insulin. Byetta works to increase insulin production in the pancreas to the amount needed for each meal and stops the production when blood glucose levels return to normal. Byetta also helps stop the liver from producing glucose when you don't need it as well as slowing the absorption of glucose into your bloodstream. Byetta is an exciting new option in diabetes treatment. If you would like more information on Byetta, you can visit the product website at www.byetta.com or call the Amylin Lilly Customer Support Center toll-free at 1-800-868-1190.
Those are all the questions we have time for today. Thanks so much for being here Marvin and Michelle.
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.
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. Rite Aid Pharmacists and Diabetes Care Specialists will be with us next at 1:00 p.m. EDT July 6, 2006. See you then.
Marvin and Michelle: Thanks, there were a lot of great questions today.
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