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Fairfax, VA: I was diagnosed with Type II over one year ago. I was put on medication, Avandia and Metformin. It seems that I am tired all the time. I want to know if there is a supplement that can bring back my energy without taking drinks supplements loaded with sugar.
Linda and Grace: Since lack of energy may be a symptom of a medical condition, or a side effect of a medication, we recommend that you consult with your physician about your lack of energy for a proper diagnosis and treatment.
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ADA Moderator : Welcome to ADA Live!
Today our guests are Grace Popeck and Linda Higgins drug information and Diabetes Care Specialists with Rite Aid.
Thanks for being with us today Grace and Linda. Lots of questions coming in so let's get started.
Linda and Grace: Thanks, it's good to be here.
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Blue Ridge, Tx.: I would like to know if taking Avandia keeps you from loosing weight? H.K.
Linda and Grace: Weight gain has been reported as a side effect of Avandia. Unusual rapid weight gain has also been reported, and it is recommended that this unusual gain be immediately evaluated by a physician.
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Pittsfield, IL: what is the range on a A1C blood test thats a 7.2
Linda and Grace: A1C 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 causing significant hypoglycemia.) The American College of Endocrinology (ACE) guidelines recommend an A1C -Less than or equal to 6.5%. An A1C of 6 relates to an average plasma glucose of 135 while a 7 relates to an average plasma glucose of 170.
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West Haven, Connecticut: Is numbness and tingling of the tongue a symptom of hypoglycemia?
Linda and Grace: Hypoglycemia occurs when blood glucose levels drop below 70 mg/dL. 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 your blood glucose drops very low you may develop slurred speech, confusion, seizures, combativeness, or pass out. 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. If you are experiencing numbness and tingling of the tongue, test your blood sugar levels. If your blood glucose levels are normal, consult your physician for a proper diagnosis as the numbness and tingling may be symptoms of other serious medical conditions.
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Cisco, TX: I have not been diagnosed with diabetes, but I have a glucose meter, anyway. I am wondering what is a 'normal' level is. Evry now and then I start to feel shaky and start sweating so I check my glucose level. This afternoon I checked it as I started getting shaky and the meter showed 77. Is that too low? If I wait another 30 minutes after the shakes start, I will so shaky that I am useless. Any suggestions?
Linda and Grace: 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. You may start to get symptoms of hypoglycemia as your blood glucose approaches 70 or below. 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 your blood glucose drops very low you may develop slurred speech, confusion, seizures, combativeness, or pass out. If you experience symptoms of hypoglycemia, eat a quick source of sugar equal to 15 grams of carbohydrates. Possible sugar sources would include 3-4 glucose tablets, 5 chewed lifesavers, 6 jelly beans, 1 box or 2 tablespoons of raisins, 1 cup of low-fat milk, 1/2 cup of regular non-diet soda, 1 & 1/2 tubes of glucose paste, 3 packets or 1 tablespoon of sugar, or 1/2 cup of orange or apple juice. Check your blood glucose level 15 minutes after eating a quick source of sugar. If your level is less than 70 mg/dL you should have another serving of sugar. If your next meal is not within 2 hours, eat a snack such as 1/2 sandwich or crackers with peanut butter or cheese. We recommend that you contact your physician about your glucose levels for a proper diagnosis and possible treatment.
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Raleigh, NC: I am using both Lantus and Humalog insulins. The Lantus information sheet states that other insulins should not be mixed with it or its function can be affected. If my injections are close together in time and location, can they mix under the skin and cause a problem?
Linda and Grace: You should not mix or dilute Lantus insulin with any other insulin or solution. This insulin will not work if it is mixed or diluted and you may lose blood sugar control, which could be serious. You should not use the same injection site as your last injection (Humalog).
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lansing, michigan: We recently had a close family friend's baby (14 months) diagnosed with type 1. She has been in the hospitial for 1 week and they can not get her stabilized. It seems she first showed symptoms after having routine infant vaccines. Is there any evidence that the vaccine can cause the onset of type 1? It is very difficult to find information on children this young -- any advice on good resources for the family?
Linda and Grace: Type 1 diabetes is an autoimmune disease in which the immune system destroys the insulin-producing beta cells of the pancreas which regulates the blood glucose. The cause of type 1 diabetes is unknown but the cause is believed to be a combination of genetic and environmental factors which puts people at an increased risk for type 1 diabetes.
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Edgerton, Wisconsin: My partner's daughter, age 8, is type 1 diabetic. She also has a growth hormone deficiency & takes hormone by injection daily. I would say 80% of the time we have her blood sugars under control. But a few days ago, I went to wake her up in the morning & she wasn't real responsive. I wake her up everyday @ the same time. That morning her blood sugars were 27. I know that is a bad number. She was disoriented, couldn't stand on her own, couldn't form a sentence.
Linda and Grace: Nighttime hypoglycemia is a danger. It can be hard to catch because your child may not wake up enough to feel the symptoms. Signs of nighttime hypoglycemia include: damp pajamas and sheets in the morning; nightmares or restless sleep; waking up with a headache or still feeling tired; an unusually high blood glucose reading in the morning. (The body can react to hypoglycemia by releasing hormones that raise blood sugar levels -- a rebound effect.) When you suspect that your child may have nighttime hypoglycemia, wake her at 2 or 3 a.m. for a few nights and check her blood glucose. If it's too low, treat for hypoglycemia before she goes back to sleep. If your child has nighttime hypoglycemia often, tell the doctor. The doctor may want to adjust her insulin or eating schedule. Since your appointments are every 3 months you may want to make appts. more often if having difficulty maintaining glucose levels in range.
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St. Louis MO: how does diabetes affect your sex life - particularly in males
Linda and Grace: Diabetes is a risk factor for erectile dysfunction. One study showed that erectile dysfunction was three times more prevalent in diabetic patients than in those without diabetes. The cause may be linked to accelerated atherosclerosis (clogging, narrowing, and hardening of the arteries) or neuropathy (disorder involving nerves). Consult your physician if you are experiencing symptoms related to erectile dysfunction.
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san antonio, tx: Will my insurance pay for the Accucheck monitor's test strips?
Linda and Grace: Sorry, but we do not have insurance information here. It would be best to contact your insurance company directly (the phone number should be on the back of your card) to determine which glucometers are covered by your insurance plan.
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Corpus Christi, Texas: What do you do when your blood sugar drops to example 54
Linda and Grace: When blood glucose levels drop below 70 mg/dL this condition is called hypoglycemia. We have found that it is important to treat hypoglycemia as soon as it is detected. If you are not sure but feel like you could be hypoglycemic it is best to treat before it gets worse. If you lose consciousness it will be necessary to have a glucagon injection or be taken to the emergency room for treatment if glucagon is not available. If you experience symptoms of hypoglycemia, eat a quick source of sugar equal to 15 grams of carbohydrates. Possible sugar sources would include 3-4 glucose tablets, 5 chewed lifesavers, 6 jelly beans, 1 box or 2 tablespoons of raisins, 1 cup of low-fat milk, 1/2 cup of regular non-diet soda, 1 & 1/2 tubes of glucose paste, 3 packets or 1 tablespoon of sugar, or 1/2 cup of orange or apple juice. If you are taking the diabetes medications miglitol (Glyset) or acarbose (Precose) only glucose tablets or milk will work to treat hypoglycemia, do not use candy, soda or sugar. Check your blood glucose level 15 minutes after eating a quick source of sugar. If your level is still less than 70 mg/dL you should have another serving of sugar. If your next meal is not within 2 hours, eat a snack such as 1/2 sandwich or crackers with peanut butter or cheese. Make sure that family, friends, and co-workers know how to treat hypoglycemia in case you would not be able to treat yourself. If you take insulin you should speak with your doctor about using a glucagon emergency kit. If your blood glucose levels are low, consult your physician for evaluation. For additional information on diabetes, you may visit the American Diabetes Association at www.diabetes.org or Rite Aid's diabetes webpage at www.riteaiddiabetes.com.
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Bartlett, Tennessee: I am look for a table for daily results to see if I am in the range for morning, afternoon and evenings -- where do I get a print out so I can see if I am in range?
Linda and Grace: We have found that blood glucose level recommendations for nonpregnant patients with diabetes vary depending on the source of the recommendation. 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.
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Greenville, NC: I have noticed that many sugarfree products contain sugar alcohol. Will this affect my blood sugar or are these products safe for diabetics?
Linda and Grace: Sugar alcohols are a reduced-calorie sweetener. They are neither sugars nor alcohols. Sugar alcohols are carbohydrates and they do not raise blood glucose as much as the same amount of other carbohydrates. Sugar alcohols are safe for people with diabetes to consume but you do need to take them into account when counting your carbohydrates. Consult your physician or a dietitian about incorporating sugar alcohols into your daily meal plans because they are not "free foods".
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Baton Rouge, Louisiana: One of the symtom for diabetes is frequent urination...for the past week, i feel like that but it's also burning...am i experiencing the 1 type diabetic?
Linda and Grace: Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. A burning sensation when urinating is usually not a symptom related to diabetes. What you are experiencing could be due to another condition. Consult your physician for a proper diagnosis and treatment options. 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. 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.
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Okemos, MI: This summer I have experienced head rushes every time I eat, the intensity depends on how long I have gone without eating. I have very recently been very dizzy and tired, I frequently feel like I am floating. My vision has also become very blurry and it is hard for me to concentrate. This summer I was also much more active than I normally am and was eating twice as much as I did before. I just stopped that activity and have not been eating as much. Should I be concerned about this?
Linda and Grace: Unfortunately we are unable to diagnose your condition, please consult with your physician about your symptoms for a proper evaluation and treatment.
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Wilson, NC: How does diabetes affect your eyesight. I work on a computer all day long and at the end of the day I have trouble focusing.
Linda and Grace: Diabetes is associated with various eye complications including blurry vision, double vision, glaucoma, cataracts, corneal disease, diabetic retinopathy, and blindness. The best way to avoid these eye complications is to keep your blood glucose levels under control, follow a healthy diet, and have good eye care. Consult your eye doctor regarding your symptoms. It is also very important to have regular eye exams and make your eye doctor aware that you have diabetes. The eye doctor will perform a special dilated eye exam to check for the various complications associated with diabetes.
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qatar: if u have a partner with diabetes & if u have sex with her does these disease gets tranfered.
Linda and Grace: 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. Diabetes is not a disease that can be transmitted through sexual intercourse.
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Irvine, CA: The topic of the talk in a T.V. program (in refernce to a report in a medical journal) was about a chemical called "BYATE" that is effective in dropping blood glucose to normal levels for days after each application. Byate is drived from the poison (venom)of a lizard like animal that had a diabetic victim. Is this a true story? Thank you
Linda and Grace: The drug you are asking about is Byetta (exenatide) which is extracted from the salivary gland venom of the lizard Heloderma suspectum (Gila monster). This is the first drug in a new class of agents called incretin mimetics. Exenatide is used in combination with medications such as metformin or a sulfonylurea (such as glyburide or glipizide), or with the combination of metformin and a sulfonylurea, when type 2 diabetes management has been inadequate with these agents alone. Byetta is administer within the 60-minute time period prior to the morning and evening meals, or administer before the two main meals of the day, approximately 6 hours or more apart. Do not administer Byetta after meals. There is a long-acting release formulation of exenatide currently being tested that would be administered once weekly. For additional information check out the following website: www.byetta.com.
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san diego california: what about taking chromium for diebetes
Linda and Grace: Chromium is considered a natural or herbal product and 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. Side effects, drug interactions effectiveness and appropriate dosage information of herbal products are not always complete and not always known. There is some evidence that chromium picolinate is possibly effective for diabetes. Chromium may decrease fasting blood glucose, insulin levels, and glycosylated hemoglobin (HbA1c) and increase insulin sensitivity in people with diabetes. We recommend consulting your physician to determine if chromium is an appropriate treatment option for you.
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fresno, california: why is thier problems when an expecting mother has diabetes?
Linda and Grace: It is very important to strictly control blood glucose levels during pregnancy especially during the first trimester. During this time, the baby is rapidly developing and growing and high blood glucose levels can cause birth defects or a miscarriage. When the mother's blood glucose levels are high, excess sugar is circulating in the mother's blood as well as the baby. This can make the baby too big or fat. The baby's body is making extra insulin to account for the extra sugar. After delivery, it is hard for the baby to stop producing the extra insulin. Because of this, babies usually need to be watched to make sure their blood glucose levels don't drop too much because of the extra insulin. This is why it is crucial when you become pregnant to reduce your blood glucose levels to as near normal as possible. Also, to help achieve a smooth pregnancy and a healthy baby, it is important to follow an appropriate meal plan, frequently self-monitor blood glucose (SMBG), administer insulin injections and know how to adjust the doses depending on results of SMBG, control/treat hypoglycemia, and add or maintain an appropriate level of physical activity.
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Venice, FL: I was just diagnosed with Type II and started using the Free Style testing kit. My first reading was 128 mg/dl. Is that good? Bill
Linda and Grace: We have found that blood glucose level recommendations for nonpregnant patients with diabetes vary depending on the source of the recommendation. 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.
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North Vernon, IN: Along with medication, what are some suggestions to help a person who is experiencing stinging in the feet due to circulation. One suggestion read in a magazine was to put Vick's on your feet. Any other suggestions to help with the circulation? Thank you for your time.
Linda and Grace: There are currently 2 products approved by the FDA for the treatment of pain associated with diabetic peripheral neuropathy, Cymbalta (duloxetine) and Lyrica (pregabalin). Other commom off-label treatments are targeted at alieviating the symptoms associated with neuropathy. These include pain medications(aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs), tri-cyclic antidepressants, anticonvulsants and topical creams. Topical capsaicin which is sold over-the-counter is a pain reliever derived from red hot chili peppers. Relief may be experienced from this cream within a few days but it may take several weeks before a patient feels maximum relief. Additionally, physical therapy, massage, and acupuncture have been used to help treat this condition. We recommend that you speak with your physician before using any over-the- counter product. He/She will determine the best treatment option for your specific symptoms.
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Carthage, Illinois: What is the best medication for diabetes?
Linda and Grace: The treatment of diabetes is highly individualized, depending on the type of diabetes, if you have other active medical problems, if you have complications of diabetes, your age, general health, and success of previous therapy. With type 1 diabetes your body stops producing insulin or produces too little insulin to regulate blood glucose levels. People with type 1 diabetes usually require at least daily insulin treatment to sustain life. Adjustments are made based on diet and exercise requirements. With type 2 diabetes the pancreas is able to secrete insulin, but the body can be partially or completely unable to use the insulin. This is referred to as insulin resistance. Diet and exercise is needed to decrease insulin resistance. If this doesn't control blood glucose levels then an oral medication may be needed. Sulfonylurea type medications (glyburide, glipizide) will stimulate your pancreas to produce more insulin. Biguanides (i.e. metformin) decrease the amount of glucose produced by your liver. Alpha-glucosidase inhibitor agents (i.e. acarbose and miglitol) slow absorption of the starches you eat and slows glucose production. Thiazolidinedione agents (i.e. pioglitazone, rosiglitazone) increase your sensitivity to insulin. Meglitinides agents (i.e. nateglinide, repaglinide) stimulate the pancreas to make more insulin. Amylin synthetic derivatives: Amylin is a naturally occurring hormone secreted by the pancreas along with insulin. An amylin derivative (i.e. pramlintide (Symlin), is used when blood sugar control is not achieved despite optimal insulin therapy. Incretin mimetics (i.e. exenatide (Byetta) promote insulin secretion by the pancreas and mimic other blood sugar level lowering actions that naturally occur in the body. It is indicated for diabetes mellitus type 2 along with metformin or a sulfonylurea when these agents have not attained blood sugar level control alone. There is also various insulins, Nph, regular, lispro (Humalog), aspart (Novolog), glulisine (Apidra), ultralente, lente, glargine (Lantus),detemir (Levemir), and the newest type insulin--inhaled insulin (Exubera).
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Mobile, ALABAMA: My grandmother thinks she might have diabetes. I checked her sugar and it was 574 and in the past four days it has not gotten under 250. She has an appointment in the morning, but my question is what are some of the signs of diabetes?
Linda and Grace: 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. We have also found that blood glucose level recommendations for nonpregnant patients with diabetes vary depending on the source of the recommendation. 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)
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veedersburg , indiana: i was wondering if a person has diabetes if an infection of some kind would cause your blood sugar to fluctutate be low one time and be high the next time especially if you hadn't eaten anything to cause it to go up?
Linda and Grace: We have found that blood glucose (sugar) levels will rise when you're sick or getting sick. This occurs because the body sends out hormones to fight the infection or virus. These hormones also make it difficult for the body to use insulin. It is very important for a person with diabetes to check blood glucose levels more often and also check for ketones in the urine when they are sick. Consult your physician regarding the fluctuations in your blood glucose readings.
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North Hills, California: My question is regarding my wife who has type 2 Diabetes which is controlled so far with medication and exersice. my biggest concern at this moment is that she got pregnant this month (August 2006) or so. we barely found out about it. we set up an appointment with her doctors for the next week. we specifically asked them to tell us if she should stop taking the medication ( Actoplus met, a combination of pioglitazone HCL 15mg + Metformin HCL 850mg) but they didnt reply to our Question. Please tell us if she should still take this medication or stop it cause its her first trimester. ill be really gratefull thanking you
Linda and Grace: We have found that while it may be best to avoid medications during pregnancy (other than vitamin supplements recommended by your physician), this is not always possible. When the benefit to the mother outweighs the risk to the fetus, medications are often administered during pregnancy. Medications are given pregnancy risk categories, which are assigned according to information regarding the drug's potential to cause fetal harm in animals and/or humans. These categories are A, B, C, D, and X, with A being the most safe and X being the least safe. The product you are asking about, Actoplus Met (Metformin; Pioglitazone), is considered to be a Category C. This means that either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus. There are no adequate and well-controlled studies in pregnant women with pioglitazone/metformin or its individual components. No animal studies have been conducted with the combined products in pioglitazone/metformin. Most experts recommend that insulin be used during pregnancy to maintain blood glucose levels as close to normal as possible. Of course, it would be up to your wife's physician to determine the best treatment option for her diabetes while pregnant. Do not stop taking Actoplus Met without first consulting her physician because abnormal blood glucose levels during pregnancy can also result in an increase in congenital problems. Again, the benefits of taking the medication must be weighed against the potential for risk to the fetus. We suggest you contact her physician to discuss your concerns regarding taking this medication while pregnant.
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westland, michigan: My urine smells really musty as well as I experience pain in the lower part of the shaft of my penis, where I feel the vein. sometimes the tip also. I'm getting pains in my stomach on the left side and by my belly button. Why is this and what can I do to help? Is it related to my type-2 diabetes? mike
Linda and Grace: We have found that urine that smells sweet may indicate uncontrolled diabetes. We are unaware of musty smelling urine being related to diabetes and are unable to diagnose your medical condition. Please consult with your physician regarding your symptoms for a proper diagnosis and treatment. Your symptoms may be related to your diabetes or another medical condition.
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san antonio,tx: What target range does the American Diabetes Association (ADA) recommend for a fasting blood glucose level? 2)How many times a day does the ADA recommend that patients with type 1 diabetes mellitus (T1DM) check their blood sugar?
Linda and Grace: We have found that blood glucose level recommendations for nonpregnant patients with diabetes vary depending on the source of the recommendation. 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. People that use insulin should usually test their blood glucose levels 3 to 4 times a day. If you are sick, your diabetes treatment has changed or your daily habits change, you should check your blood glucose levels more often. It is best to consult with your physician to determine how often to test your blood glucose levels.
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Philiphines: why there is slowed wound healing during diabetes?
Linda and Grace: It is believed that diabetes can affect how well the blood vessels function in response to an injury. Atherosclerosis (hardening of the arteries), which is characterized by a build-up of plaque, may lead to the blood vessels being obstructed. If the blood vessels are blocked or narrowed, the blood that is supplying oxygen and infection-fighting white cells can't get to the wound to help it heal. Also, if you have neuropathy (disorder involving the nerves), the nerves near the wound do not function properly which in turn hinders the healing process.
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Warren Texas: Would a bad yeast infection be a sign of diabetes
Linda and Grace: Diabetes can affect every part of the body, including the skin. Some of these problems include skin conditions that anyone can have, but people with diabetes may get them more easily. If you suspect that you may have diabetes or are getting yeast infections, please consult with your physician.
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Carrollton, Texas: Is there a database or information link of physicians that diabetes is their profession? My husband needs to change physician and get another one that is qualified in this field. Thanks, Shaima
Linda and Grace: An endocrinologist is a doctor who specializes in the endocrine system. The endocrine system includes the thyroid gland, the neuroendocrine glands of the pancreas, the parathyroid gland, the pituitary gland, ovaries, and the adrenal glands. Many endocrinologists specialize in the diagnosis and treatment of diabetes, and research into diabetes treatments and drugs. Many hospitals have a physician directory or referral system which may assist you in finding a diabetes specialist.
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Kingsville, Texas: Does the Dr. have to precribe the Injection Pen for insulin and can it be brought with all kinds of insulin?
Linda and Grace: It depends on the insulin that has been prescribed for you. Usually, there are specific pens designed for each type of insulin. Some pens can only be obtained from the physician's office, while others may be purchased at the pharmacy. Consult your physician, local pharmacist or send a detailed message, including the brand of insulin you are inquiring about, through our Ask the Pharmacist service (see link on ADA live page) where one of our Drug Information Specialists would be happy to help answer your question.
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Farmington, NM: Does cinnamon have a positive effect on Type 1 (insuline dependent diabetes)? There are a number of studies about cinnamon and Type 2 diabetes. However I cannot find information about the effects on Type 1.
Linda and Grace: There are two types of cinnamon--cinnamon bark and cassia cinnamon. Cinnamon bark does not have sufficient reliable information available about it's effectiveness in diabetes. Cassia Cinnamon taken orally possibly seems to improve type 2 diabetes. Some research suggests that taking cassia cinnamon 1 to 6 grams for 40 days can lower fasting serum glucose by 18-29%. We were not able to find any information on cinnamon use with type 1 diabetes. We recommend that you consult your physician before adding any herbal or natural product to your current drug regimen.
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florida: Can I use honey as sugar?
Linda and Grace: Honey has more carbohydrates and more calories than granulated sugar does. Honey provides some minerals also unlike sugar - but only in trace amounts. Honey is sweeter than sugar, so that you may substitute a smaller amount of honey for sugar in some recipes. The calories and carbohydrates you save however are minimal. You also need to be sure you count the carbohydrates in honey as part of your eating plan
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ludlow,ma: i was recently told by my md i had diabetes. my sugar level is 10.4%. is this very high? should i be montioring my level each day? and if so,how? i was given metformin hcl 500mg/3x times a day. i was told return in 3 months.
Linda and Grace: Blood glucose (blood sugar) monitoring is the main tool you have to check your diabetes control. This check tells you your blood glucose level at any given time. Monitoring helps you find out what happens to your blood glucose when you eat certain foods, when you exercise, or when you lose or gain weight. Additionally, it helps you see what happens to blood glucose when you take diabetes medication or insulin, are sick, or are emotionally upset. Keeping a log of your results is vital. Self monitoring of blood glucose levels is the best way to know if you are reaching your goals. The more you check, the more you learn how different foods, exercise, stress, and medication affect your levels. Self monitoring of blood glucose will help you and your health care team find a diabetes care plan that is best for you. Always write down your blood glucose readings, diet, and exercise and share them with your health care team. The decision on how often to check your blood glucose and what times of the day to test is up to your doctor. It is important to follow his/her recommendations. In general, a person with type 1 diabetes should test 3-4 times a day whereas a person with type 2 diabetes should test 1-2 times a day. We recommend that you speak to your doctor to determine how often you should be testing your blood glucose each day. In general, the recommended goal for a non-pregnant patient with diabetes is an A1C less than 7%. (The A1C goal for an individual patient may be an A1C as close to normal (<6%) as possible without significant hypoglycemia.) However, this goal may vary from person to person. We recommend that you speak with your physician or diabetes educator to determine exactly what your A1C goal should be.
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Wichita, Kansas: I am a female 67 yrs, 50 lbs over weight and a family history of diabetes. I have recently started feeling dizzy at times - could this be a symptom of diabetes? I also drink more fluids and urinate more than my co-workers. But I don't know what
Linda and Grace: 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. 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 unusual thirst, extreme hunger, increased urination, irritability, increased fatigue, unusual weight loss, confusion, drowsiness, rapid breathing, fruity breath odor, 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 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.
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Newtown, PA: Is substituting Splenda or Aspartame for sweeteners? The ADA recommends vegetables and fruit in their diet suggestions. Will fruits raise your glucose level?
Linda and Grace: Splenda Brand Sweetener is the only artificial, no-calorie sweetener made from sugar. It contains sucralose and has no effect on blood glucose levels, and does not require insulin for its metabolism. Splenda Granular, has a bulking agent which is the common food starch maltodextrin, and it will contribute 1/2 gram of carbohydrate or the equivalent of 2 calories per tsp. Up to 6 tsp of Splenda Granular is considered a free food in a sugar restricted diet. When used in larger amounts, as in cooking or baking, these calories should be accounted for in the daily allowances towards bread/starch exchange (i.e. 5/8 of a cup of Splenda Granular contributes 15 g of carbohydrates and is counted as one starch food choice. Also with Splenda Packets, sucralose is combined with maltodextrin and dextrose. These ingredients will contribute a total of 1 gram of carbohydrate or 4 calories per packet. Therefore, three Splenda Packets may be considered a free food, however, when used in greater quantities, the calories from Splenda Packets would be counted in the fruit exchange. Equal brand sweetener contains aspartame and will also not increase your glucose levels. Aspartame should not be used by people with a rare hereditary disorder called phenylketonuria. Splenda and Equal are both appropriate sweeteners for people with diabetes. Effects of fruit on glucose varies based on whether fruit is cooked or raw, portion size, whether you eat a piece of fruit after a high-fat meal or on an empty stomach, and what your blood glucose is prior to eating the fruit. Most important is that people have individual differences. Using your blood glucose monitor you can see how fruits affect your blood glucose.
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wyoming,michigan: will they monitor me before and after or let me moniter my blood sugar myself during labor. ashley, 27 weeks along
Linda and Grace: Control of blood sugar levels is important during pregnancy and even during labor, which can be a stressful time for both the baby and the mother. We recommend that you consult with your physician so that you may be well prepared with your planned care during pregnancy and labor.
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Austin Texas: What is the correct number glucose level should be at both prior to a meal and after a meal?
Linda and Grace: Blood glucose level recommendations for nonpregnant patients with diabetes vary depending on the source of the recommendation. 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). The new general blood glucose level guidelines according to the American College of Endocrinology are stricter than the ADA guidelines and include: 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.
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Tell City, Indiana: I have been hearing about an alternative drug known as diamaxol...I was wondering if you have done any research on this drug..
Linda and Grace: Diamaxol is a natural product, 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. Diamaxol is said to contain bananaba, cinnamon, bitter melon, zinc, chromium, biotin, huckleberry, and gymnema sylvestre. We recommend that you consult your physician before trying this product.
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Goodyear, AZ: Are there legal or regulatory compliance issues in the area of diabetes education? Do you know if gestational diabetes is in a DRG by itself? I am researching this topic for a Master's program directed toward starting a business for a gestational diabetes educator. Thanks for any help you can offer. Kerry Schaan
Linda and Grace: Information on diabetes educators may be found at http://www.aadenet.org/
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conway missouri: how high does your sugar have to be before hospitalization? How high before diabetic coma?
Linda and Grace: When you have diabetes, prolonged blood sugar extremes can cause you to lose consciousness. This is known as a diabetic coma. Both very high blood sugar (hyperglycemia) and very low blood sugar (hypoglycemia) can lead to a diabetic coma. Left untreated, a diabetic coma can be a life-threatening condition.
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Dover, Tennessee: My husband is type 2 diabetic with copd and Empyhsema and has recently lost vision in the lower area of both eyes, with outstanding blood pressure. Could the copd and emphysema had caused the vison lost or a stroke without high blood pressure
Linda and Grace: Unfortunately we are unable to diagnose the exact cause of your husband's medical condition. Please consult with your husband's physician regarding his vision loss to determine the cause and a treatment to prevent further loss of sight.
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Monroe, Washington: I am having a hard time finding diabetic diet plans with sample meals included. I need my whole family to be involved, so the caloric levels vary? I saw one in school, so I know they exsist, but just can't seem to find them???
Linda and Grace: Diabetes diet plans or guides may be found at: http://www.diabetes.org/nutrition-and-recipes/nutrition/overview.jsp and http://www.mayoclinic.com/health/diabetes-diet/DA00027
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Canton, PA : I have a friend who recently had his toes cut off because of diabetes. He needs medicine which he is suppose to take daily, but doesn't due to the cost. He also is supposed to use a wheelchair, but can't afford it. Is there any help? If this is not the right person or place to ask the question, please direct me to the right person. Andrea Sutton
Linda and Grace:
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Toledo, Ohio: is there a cure for diabetes?
Linda and Grace: Even though there is no cure for diabetes right now, advances in diabetes treatment are being made all the time. There is currently three approaches to diabetes being made by the US Department of Health and Human Services: prevent diabetes, cure diabetes, and improve the quality of care of people with diabetes to prevent complications. Current research for a possible cure includes: pancreas transplantation, islet cell transplantation (islet cells produce insulin), artificial pancreas development, and genetic manipulation (making "pseudo" islet cells out of fat or muscle cells by adding a human insulin gene.)
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Deming, NM: I am doing fairly well after being diagnosed with type II last year my last A1C was 5.77, but I still don't know much about the disease. I'm not insulin dependant, I take 500mg of Metformin twice a day and watch what I eat and avoid drinking alcohol. How do I answer my friends' question about what would a drink or two do to me?
Linda and Grace: Alcohol may cause low blood sugar especially if using insulin or oral medications. Drinking as little as 2oz. of alcohol (aprox. 2 drinks) on an empty stomach can cause very low blood glucose. Normally when your blood glucose drops your liver will kick in and cause stored carbohydrates to convert to glucose to keep your glucose within the normal range. When alcohol is involved the liver won't react to the low glucose until the alcohol is cleared from the blood, thus low levels of glucose (hypoglycemia) can occur very fast. Check with your physician before drinking alcohol, especially if you're using medication, or insulin. If your physician oks an occasional drink make sure you combine it with a meal. Some symptoms of hypoglycemia are similar to alcohol intoxication,(confusion, slurred speech) and the people with you may not be aware that you have hypoglycemia and that you need to raise your blood glucose quickly. Always make sure your companions are aware that you have diabetes and how to treat hypoglycemia if it occurs.
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means, kentucky: my husband has recantly been tested for diabetes on the three month blood level and was told that he had diabetes. How do they determan on a three month bases? his was 7.3.
Linda and Grace: Hemoglobin A1C level estimates your average blood glucose level over the past 2-3 months. When converting A1C values to a blood glucose level (mg/dl) an approximate conversion is completed. Hemoglobin is found inside red blood cells and functions to carry oxygen all over the body from the lungs. Hemoglobin will link up with sugars such as glucose if they are present in the blood. If diabetes is uncontrolled, you will have too much sugar in the blood. The extra glucose will link up (glycate) with the hemoglobin inside the red blood cells. The more glucose in the blood the more glycated the hemoglobin is and the higher the percentage of A1C in the blood. The A1C test is an average of your blood glucose control for the past few months. The red blood cells do not unlink from the glucose and only when the red blood cell dies, after about 120 days, does that "memory" of the high blood glucose go away. Therefore, as your blood glucose levels fluctuate and your red blood cells die and new ones are created by the body the A1C level varies and reports the average over the past few months. A person who does not have diabetes will have an A1C of around 5%. Hemoglobin A1C levels less than 7% are beneficial to people with diabetes because they have been associated with decreased rates of long term complications such as eye problems (retinopathy), kidney problems (nephropathy), and nerve problems (neuropathy). In general, the recommended goal for a non-pregnant patient with diabetes is an A1C less than 7%. (The A1C goal for an individual patient may be an A1C as close to normal (<6%) as possible without significant hypoglycemia.) However, this goal may vary from person to person. We recommend that you speak with your physician or diabetes educator to determine exactly what the A1C goal should be for your husband. You may find additional information on diabetes through Rite Aid's diabetes webpage at www.riteaiddiabetes.com or the American Diabetes Association (ADA) at www.diabetes.org.
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Augusta, Ga.: When mixing NPH or long acting insulin in the same syringe with Regular insulin, which do you drw up first?
Linda and Grace: When mixing insulin in the same syringe, you need to draw up the short acting (clear) insulin 1st and then the long acting insulin (cloudy). (Clear before cloudy). Be sure to check with your physician before mixing two different insulins in one syringe as some insulins are not to be mixed. (i.e. Lantus insulin is clear but is not to be mixed with any other insulin) You may also find more infomation on mixing insulin at http://www.diabetes.org/uedocuments/rg06_insulin.pdf
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West Bloomfield, Michigan: What are the long term effects of taking cinnamon? Can you recommend a brand of cinnamon tablets? Thanks, Jason
Linda and Grace: Checking our drug information resources we have found that cinnamon when used orally in excessive amounts, long-term, or when not consumed in amounts commonly found in foods, cinnamon may possibly not be safe. Reports have been found that indicated serious side effects like diarrhea, vomiting, dizziness, or unconsciousness with cinnamon oil ingestion. 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 using cinnamon in products other than when consumed in amounts commonly found in foods.
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ADA Moderator : We have found that many pharmaceutical companies offer prescription assistance for patients without insurance coverage. The Partnership for Prescription Assistance (PPA) is a new program created to help qualifying patients without prescription coverage obtain medications at a reduced price or free of charge through public or private programs. Their mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. You may contact the PPA by phone at 1-888-4PPA-NOW (1-888-477-2669) or though the internet at www.pparx.org. Additionally, there is a card called Together RX which allows qualifying patients to save on certain prescription medications. This card is made possible through a coalition of pharmaceutical companies. To enroll, you may call 1-800-865-7211 or enroll online at www.Together-Rx.com. Finally, you may also contact the manufacturers of the medications directly in order to obtain information about available patient assistance programs. Your friend may consult the local pharmacist to obtain the manufacturer's name of his medications.
That's it for today. Thanks so much for taking the time to be here Grace and Linda.
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. Our guest will be Crystal Jackson, ADA's Manager of Legal Advocacy with a focus on school discrimination issues and a parent of a child with diabetes will address questions related to diabetes and school advocacy issues at 1:00 p.m. ET September 14, 2006. See you then.
Linda and Grace: Thanks for having us. It was great with lots of interesting questions.
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