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ADA Moderator : Welcome to ADA Live!

Today our guests are Marvin Bouchon, R.Ph. and Terry Towers, Michele Seifert, R.Ph., Pharm D. Drug Information Specialists with Rite Aid Drug.

Thanks for being here today Marvin and Michelle.

Marvin and Michelle: Thanks. Great to be here.

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kansas city, mo.: I am a 29 year old white female, I had gestational diabetes when I was pregnant, but, I don't have it anymore, my question is this: My paternal grandfather had Diabetes and so did my maternal grandmother and my father had high blood sugar. does this put me at a greater risk for diabetes? I have achilles tendonitis, but, i have pain in my toes also, and I also want to now is it true that Diabetes skips generations? I am really concerned, because if it does, then it will fall directly on me!!!can you please give me dome advice!?

Marvin and Michelle: No, diabetes DOES NOT skip generations. If you have a familial hisory of diabetes then you have a significantly higher risk of developing diabetes. In addition having had gestational diabetes increases a female's risk of developing diabetes later in life. I highly recommend that you start safeguarding yourself. Start by having a through physical check-up. The key ingredients to preventing or delaying the onset of diabetes are weight control, diet, and exercise.

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lynn haven FL: When should you seek emergency care if you blood sugar level is high. Mine stay high like 240 day and by night it in the 400 or higher. I'm really having a hard time with the diabetes and I should go to the hospital to get it to normal but I don't have insurance so I try to work with it myself. I also have ran out of medication.Even with it being so high i still get sick if i get to hungry so even if it goes down a bit when i eat it shoots up by bed time. sometimes i wonder if i going to wake-up in the morning. Please help, Monica

Marvin and Michelle: Short term (days to weeks) hyperglycemia can lead to increased urination, increased thirst, weight loss, blurred vision, fatigue, nausea, and can also lead to many fungal and bacterial infections. More serious complications include diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHNKS). 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. Hyperosmolar hyperglycemic non-ketotic syndrome (HHNKS) can be life-threatening and is associated with blood glucose levels greater than 600mg/dL. Symptoms of HHNKS include dehydration, excessive thirst, low blood pressure, glucose in the urine but no ketones, hallucinations, sensory deficits, rapid eye movements, paralysis on one side of the body, loss of vision in half of the visual field, seizures, and a partial or total loss of the ability to comprehend spoken or written language and express ideas. Medical assistance is needed from hospital staff. Treatment also includes fluid replacement, potassium replacement, and insulin infusions. Long term (years) hyperglycemia can lead to 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. Extremely high blood glucose readings are a medical emergency and require medical assistance. If your blood glucose levels are high, consult your physician for evaluation. If you are experiencing extremely high blood glucose levels and have any of the symptoms listed above, go to the nearest hospital for medical assistance. Hyperglycemia may be caused by eating too much, lack of physical activity, illness, stress, the body not having enough insulin, the body not being able to use the insulin present, skipping medicine, or exercising less than usual. Symptoms of hyperglycemia include confusion, drowsiness, rapid breathing, fruity breath odor, increased urination, unusual thirst, low blood pressure, high levels of sugar in the urine, blurred vision, fatigue, headache, nausea, difficulty concentrating, or changes in mental status. Hyperglycemia may be controlled with oral diabetic medications and/or insulin therapy. Exercise is also a common treatment for hyperglycemia. (Please note: If your blood sugar is higher than 240mg/dL, check your urine for ketones before exercising. If there are ketones in the urine, do not exercise, this could make the blood sugar even higher. Contact a doctor if this occurs.) Other measures that may be taken to help decrease your blood sugar include changing your diet and increasing water consumption. If altering your diet and exercise do not work, you may need to have the doctor adjust your medication or insulin. If your blood sugar is higher than normal, you should not give yourself additional medication or insulin other than what was prescribed by your physician unless otherwise directed to do so.

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HUNTINGTON MA.: HAVING BEEN RECENTLY DIAGNOSED WITH TYPE 2 DIABETES, AND DO NOT NEED MEDS OF ANY KIND AT THIS POINT, WILL I AT SOME POINT NEED EITHER PILLSOR INSULIN INJECTION EVEN IF I WATCH MY DIET CAREFULLY?

Marvin and Michelle: Diabetes is a chronic, progressive disease. While we are unable to predict for certain if you will need some sort of medication therapy (whether oral medication or insulin therapy), the nature of the disease makes it likely that you will need some type of medication therapy in the future. Maintaining a healthy weight, eating a healthy diet, and exercising may help slow the progression of the disease. Additionally, if medication is required, by following these lifestyle changes you will likely minimize the dosage required.

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Kerrville,TX: Is taking Pepto-bismol bad for a person with diabetes?

Marvin and Michelle: Pepto-Bismol contains bismuth subsalicylate as the active ingredient. Large doses of bismuth subsalicylate or prolonged use has been shown to increase the blood glucose lowering effects of insulin or oral diabetes medications. Therefore, it is recommend that patients with diabetes use Pepto-Bismol with caution and carefully monitor blood glucose levels for changes.

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San Diego, Ca.: My friend has diabetes and doesnt have to take insulin. My question is during work she has to urinate frequently. She doesnt drink that much fluid to warrant having to use the restroom that often. Any ideas to whats causing this? thank you

Marvin and Michelle: Frequent urination is one of the symptoms of diabetes. If your friend does not regularly check her blood glucose levels, we recommend that she begins checking to determine if her levels are within the recommended ranges. If her levels are elevated, she should speak with her physician. It may be necessary to adjust the dosage of her medications. Other potential causes of frequent urination include urinary tract infections (UTI), certain medications, bladder dysfunction, drinking caffeinated beverages, inflammation of the bladder, enlarged prostate (men only), pregnancy, etc. We recommend that you friend speaks with her physician regarding her symptoms for a proper diagnosis and treatment plan.

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monterrey: How many persons die per year in the whole world by diabetes?

Marvin and Michelle: Death is not a direct cause of diabetes. It is the complications of uncontrolled diabetes that can lead to premature death. Patients with uncontrolled diabetes are at a very high risk for complications such as heart disease, stroke, high blood pressure, and kidney disease. These complications can lead to an early death in individuals who do not control their diabetes. People with diabetes, in conjunction with their health care providers, can work together to reduce the occurrence of these complications by controlling their blood glucose levels, blood pressure, and cholesterol. Preventative practices in a timely manner can lower your risk of serious medical problems.

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suisun, ca: does alcohol cause diabetes

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. 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. Although alcohol use does not necessarily cause diabetes, it can effect your blood glucose levels. Alcohol has carbohydrates in it and depending on how much is consumed your blood sugar could at first be elevated. This occurs because carbohydrates are quickly absorbed in your blood and then cause elevated blood sugar, this elevation can vary depending on how much you drink. Additionally, alcohol can cause low blood sugar levels especially if you use insulin injections or take oral medications. Therefore, you should never drink alcohol on an empty stomach, be sure to eat your meals and snacks and drink in moderation. The ADA suggests that women have no more than 1 drink a day and men no more than 2 drinks per day. Additionally, some people with diabetes should not drink at all. Alcohol can aggravate some diabetes complications such as nerve damage and eye conditions. Consult with your physician or dietitian about adding alcohol in your meal plan. For more information on alcohol use, simply type "alcohol" into the search field on the ADA website.

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fort worth: does ada have a dka protocol?

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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Parma, Ohio: Would the herb Glucosamine have any effect on my pre-diabetes? I recently started taking it in place of Vytorin.

Marvin and Michelle: Glucosamine has been reported to cause hyperglycemia (elevated blood glucose levels) in some patients. However, other studies have shown no significant effect on hemoglobin A1C or blood glucose levels when used for up to 3 years. You stated that you replaced Vytorin with Glucosamine. Vytorin is used to treat high cholesterol levels. Glucosamine is typically used to treat osteoarthritis. Additionally, there is some concern that Glucosamine may increase cholesterol and triglyceride levels. Glucosamine would NOT be an appropriate substitute for Vytorin. We recommend that you speak with your doctor to further discuss your medication usage.

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Canton, Ohio: I have been looking into the supplement Mangosteen, Mangosteen Juice, which contains a number of helpful anti-oxidants etc.., and I have read that there are some helpful benefits to a diabetic. Such as a lowering of blood sugar levels. I'm not suggesting that this would take the place of my current medication [which is insulin(novolog & Lantus)], but assist in the treatment. Do you have any insight or information on this? thx, john

Marvin and Michelle: 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. Additionally, "natural" products do not have to conduct side effect or drug interaction studies and therefore this information is not always known. We reviewed our resources for information on the use of Mangosteen for the treatment of diabetes. Currently, there is no reliable scientific evidence to support its effectiveness or safety for any use including diabetes. Therefore, we do not recommend that you take this supplement without your physician's approval.

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Florida : Is is Possible to acess the drug Januvia from out side the United States of America ...Lets say for some one in the Caribbean region who might be interested in purchasing the drug instead of taking the insullin injections.

Marvin and Michelle: Januvia is the most recently approved drug for the treatment of type 2 diabetes. It can be used either alone or in combination with other oral medications including metformin or thiazolidinediones (Actos or Avandia). It is not a substitute for insulin and therefore can not be used by people with type 1 diabetes. We do not have access to availability information outside of the United States.

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Pensacola FL: What can a loss of consciousness with type 2 diabetes mean?

Marvin and Michelle: It could mean that the individuals blood sugar has dropped too low. 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 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 the individual may develop slurred speech, confusion, seizures, combativeness, or pass out.

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Ashville,Ohio: I have medicare and medicaid,I also have type 2 diabites and heart disease.my question is why I can not get Byetta covered by my insurance since this is the only medication I have found that will help.thank you Malissa Howell malissa49@hotmail.com

Marvin and Michelle: Insurance companies usually have a formulary, or a preferred list of medications that they cover. Items not on the list are considered non-formulary. However, most insurance companies have procedures in place to allow overrides for certain medications if they are truly medically necessary. Physicians usually must submit letters and supporting documentation to prove that a particular medication is necessary for a patient and that formulary alternatives will not work. Many times newer and more expensive medications are not initially on insurance formularies unless there is a clear benefit over older options. We recommend that you speak with your insurance carrier to determine the procedure for applying for an override (called a prior authorization). Once you know the procedure, you can speak with your physician.

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Portland, Oregon: What is a good level for glucose? is 198 too high

Marvin and Michelle: 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 mol/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: 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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raleigh, nc : If someone has diabetes, can they go 3 weeks without taking their medication, not checking their blood level and not eating properly?

Marvin and Michelle: In order to maintain blood glucose control, it is very important to eat regular healthy meals, take prescribed diabetes medications, and test blood glucose levels regularly as directed. If these guidelines are not followed, the blood glucose levels will rise (hyperglycemia). Untreated hyperglycemia may lead to serious problems. Short term (days to weeks) hyperglycemia can lead to increased urination, increased thirst, weight loss, blurred vision, fatigue, nausea, and can also lead to many fungal and bacterial infections. More serious complications include diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHNKS). 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. Hyperosmolar hyperglycemic non-ketotic syndrome (HHNKS) can be life-threatening and is associated with blood glucose levels greater than 600mg/dL. Symptoms of HHNKS include dehydration, excessive thirst, low blood pressure, glucose in the urine but no ketones, hallucinations, sensory deficits, rapid eye movements, paralysis on one side of the body, loss of vision in half of the visual field, seizures, and a partial or total loss of the ability to comprehend spoken or written language and express ideas. Medical assistance is needed from hospital staff. Treatment also includes fluid replacement, potassium replacement, and insulin infusions. Long term (years) hyperglycemia can lead to 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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chickasha, oklahoma: yes. i read information from the ada site and most of the time it only talks about type 2 diabetes. When it says there is a new drug out, it is always for type 2. They need to focus on us underpriviledged type 1. make medicine so we don't have to have it anymore. all the money ada gets has to be all about type 2. it doesn't make since. i've been a diabetic for 23 yrs now and i have not heard anything good about type 1. its always about type 2. if that is the case. i hope you will take me off of this e-mail stuff. don't got time for type 2 news. so anyway i am so sorry you can't say hey type 1 has a medicine now . so we don't have to take shots anymore. etc., etc., tired of hearing about type 2...

Marvin and Michelle: In order to address your question, it is first necessary to explain the differences between type 1 and type 2 diabetes. Type 1 diabetes occurs in 10% of people with diabetes. They have no insulin production and rely solely on supplemental insulin (usually injections) for survival. Typical age of onset is before 25 years of age and people are generally of normal weight. Type 2 diabetes occurs in 90% of people with diabetes. These people do have some insulin production, however they may not produce enough or it may not work the way it is supposed to in the body. People with type 2 diabetes are often overweight and usually over 45 years of age. These people are usually treated with oral medications; however, some may also have to rely on insulin to keep their diabetes under control. As stated above, patients with type 1 diabetes produce NO insulin and therefore the only treatment option as of now is to supplement with insulin. This significantly limits the treatment options whereas with type 2 diabetes there are different mechanisms that can be utilized to aid the body in increasing insulin production or in utilizing the insulin that is present. Contrary to your beliefs, there is constant research going on in the field of type 1 diabetes. Just this year Exubera, the inhaled insulin, was approved for type 1 diabetes patients as well as type 2 diabetes patients. Although Exubera must be used in combination with either an intermediate or long-acting injected insulin in type 1 patients, it still can significantly decrease the number of injections required each day. Additionally, whole pancreas transplants and islet cell transplants (the cells that produce insulin in the pancreas) are also being studied and conducted in the United States and other parts of the world. These procedures are still considered experimental and have various risks and benefits; but, they are researched in hopes of finding another solution in the fight against type 1 diabetes. If you wish to read information on these procedures, simply type in "pancreas transplant" or "islet cell transplant" in the search field on the ADA's website and numerous articles will be displayed discussing the procedures as well as the pros and cons. Additionally, research is also being conducted in other alternative insulin delivery systems such as oral tablets, topical patches, and mouth sprays. The problem with these systems is that insulin is not absorbed well by the lungs, gastrointestinal tract, or mucous membranes. This leads to large amounts of insulin waste and a much higher cost. Additionally, it will likely be necessary for these alternative delivery systems to be used in combination with insulin injections to achieve adequate blood glucose control. But scientists are still working on possibly perfecting these systems for potential use someday. You may access information on these options by typing "alternative insulin delivery" into the ADA's search field. Don't give up hope, the scientists are working very hard, it just takes time.

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fort worth- texas: Are there any cures for diabetes mellito and where about in the states? Thank-you.

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. 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. Currently, there is no cure for diabetes. Therefore, it is recommended to maintain a healthy weight and exercise to help prevent or at least delay the onset of diabetes.

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Forrest City, Arkansas: Is it normal for your stomach to be sore once your glucose level has risen from the norm? I have not had any trouble out of my diabetes for 2 and a half years. I was taken off of avandia because I controlled it through diet. I guess I figured I was cured. All of a sudden I got really sick and did not think about the diabetes. I ended up going to the emergency room and found out my blood sugar was at 447. It wasn't that high when I first got sick with it 4 years ago. They gave me a shot of insulin at the hospital and told me to go see my physician of Monday. I dont have a problem with being a diabetic, I know it is at my on hands that it has came back on me by not being responsible about taking care of myself. What I dont understand is why does it make your stomach so sore is that normal?

Marvin and Michelle: There are numerous medical conditions than can cause stomach symptoms. However, diabetes can cause nerve damage. Nerves are linked all over you body including your stomach. Damage to the stomach nerves can cause food to either pass too quickly or too slowly through your digestive system. Damage to the vagus nerve causes the stomach and intestine muscles to not work properly and food movement is slowed or stopped. This is called gastroparesis. Damage to the vagus nerve occurs when the blood glucose levels are consistently high over a long period of time causing chemical changes in the nerves and blood vessel damage altering the ability to carry oxygen and nutrients to the nerves. Symptoms of gastroparesis vary with each person from mild to severe. Symptoms include nausea, vomiting, weight loss, heartburn, early feeling of fullness when eating, abdominal bloating, lack of appetite, spasms of the stomach wall, erratic blood glucose levels, and gastroesophageal reflux. We can not say for certain the exact cause of your symptoms. We recommend that you speak with your doctor to determine the cause of your stomach symptoms.

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Powhatan VA: If a person has been a diabetic for 38 years and now has some nerve damage to private places, can nerve damage be repaired?

Marvin and Michelle: Nerve damage can cause erectile dysfunction. Currently, there is no cure for nerve damage. Treatment consists of treating specific symptoms with either oral or topical medications. Effectively controlling blood glucose levels may also help prevent or at least slow further damage. We recommend that you speak with your physician regarding your symptoms for an appropriate treatment plan.

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Tuscaloosa, Alabama: Hello: My dad is an 83-year-old type 2 diabetic, has had 2 bypass surgeries, and this summer had his teeth removed and dentures made which, despite many fittings, still no not fit properly and he is able to eat very little, if any meat at all. My mother keeps him on a very strict diet, but he is so incredibly thin and losing so much weight he looks as if he is about to blow away and seems to be becoming more and more depressed, just sitting in a chair, which is very unusual for him. Is there any way we can get some weight on him and not cause his blood sugar to go sky high and/or hurt his heart? Thanks so much - if you do answer by e-mail mine is transcription35401@hotmail.com. Otherwise I will hope for an answer here, and I appreciate your help. Sincerely, Kathy Wilson

Marvin and Michelle: Due to your father's various health conditions we can not make a specific recommendation on how to treat his weight loss. There are medications available to stimulate the appetite if that seems to be the problem. Additionally, the doctor may wish to alter the number of calories he is currently eating or add supplements to his meal plan. We recommend that you speak with the doctor to discuss your father's treatment options.

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whitesburg, KY: My boyfriend who is 25 yrs old was diagnosed with Type II diabetes three years ago. He takes actos once a day and glucophage twice a day. In Feb. he was injured by a cement block that hit his leg below the knee cap at approx. 45 mph. He was diagnosed Monday, 10-23-06 with neuropathy. Do you think his diabetes contributed to his nerve damage? His doctor has put him on an anti-depressant, neurontin, for the nerve damage. (It is only painful when touched in the area where the block hit, he has no pain walking, no tingling) He took the neurontin for two days and it made him sick. He operates heavy equipment for a living and was unable to work because of the dizzyness and blurred vision. Now he needs another med to help him heal. What do you recommend he take? Is it okay to combine anti depressant medication with diabetes meds?

Marvin and Michelle: Gabapentin (brand name Neurontin) is commonly used to treat neuropathy symptoms; however, it is an anticonvulsant medication (seizure medication) not an antidepressant. Dizziness and vision changes are listed as possible side effects to gabapentin use. Neuropathy treatment is targeted at treating the symptoms. Each person is treated on an individual basis, depending on their specific symptoms. Currently, many doctors recommend that people with neuropathy closely manage blood sugar levels, exercise regularly, and maintain an ideal weight. Various medications are used to treat the symptoms of neuropathy such as pain medications (narcotics and some seizure medications), topical creams (for pain), and antidepressants (for depression, insomnia, and anxiety). Additionally, physical therapy, massage, and acupuncture have been used to help treat diabetic neuropathy. We are unable to determine if your boyfriend's diabetes contributed to the neuropathy diagnosis if the injury was the sole cause. We recommend that your boyfriend speaks with his doctor to determine the best treatment for his specific symptoms. Once a medication is selected, it can be checked for drug interactions with his other medications by the pharmacist.

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highland park IL: is it bad if i smoke Tobacco like newprots

Marvin and Michelle: Smoking is very dangerous for people with diabetes. Smoking raises blood glucose levels, increases blood pressure, and increases total cholesterol while reducing HDL (good cholesterol). It also increases the risk for heart attack, stroke, and blood vessel disease. Individuals with diabetes who smoke are three times as likely to die of heart disease as are other people with diabetes. Smoking also narrows blood vessels affecting circulation. This can worsen foot ulcers and prevent skin infections from healing. Smoking also increases the risk for stillbirths and miscarriages, colds and respiratory infections, and the risk for impotence. Smoking is related to the earlier development of typically long-term complications such as kidney disease or nerve damage. We strongly encourage you to stop smoking completely. If you need assistance, speak with your doctor or pharmacist to discuss smoking cessation products that are available either by prescription or over-the-counter. A wide variety of products are available including tablets, gum, patches, a lozenge, a nasal spray, and an inhaler.

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Chicago, IL: Can taking the supplement glucosamine and chondrotin raise your blood sugar levels??

Marvin and Michelle: Glucosamine has been reported to cause hyperglycemia (elevated blood glucose levels) in some patients. However, other studies have shown no significant effect on hemoglobin A1C or blood glucose levels when used for up to 3 years. We recommend that you receive approval from your physician before taking glucosamin and chondroitin.

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Reserve Mines, Nova Scotia, CANADA: I have a great deal of problems with my feet. I had a toe removed (4th) on my right foot July 31 this year and still not walking normal. My feet have burning and pins and needles feeling on both feet. Have had this for years, I am 62 and would like what should I use for this? Have tried various creams and am now wearing diabetes socks but not working.. I am now trying lanacane on left foot only don't what to touch right foot as it is still being looking after by the VON homecare. Thank you Brian

Marvin and Michelle: The symptoms you are describing may be due to diabetic neuropathy. Neuropathy is one of the most common complications for people with diabetes. Neuropathy is damage to the nerves that run throughout the body, connecting the spinal cord to muscles, skin, blood vessels, and other organs. The cause of neuropathy is unknown and currently there is no cure. There are different types of neuropathy which are classified based on if they affect one or both sides of the body, the type of nerve(s) affected, the number of nerves affected, and the parts of the body affected. Treatment is targeted at treating the symptoms associated with neuropathy. Each person is treated on an individual basis, depending on their specific symptoms. Currently, many doctors recommend that people with neuropathy closely manage blood sugar levels, exercise regularly, and maintain an ideal weight. Various medications are used to treat the symptoms of neuropathy such as pain medications (narcotics and some seizure medications), topical creams (for pain), and antidepressants (for depression, insomnia, and anxiety). Additionally, physical therapy, massage, and acupuncture have been used to help treat diabetic neuropathy. We recommend that you speak with your doctor to determine the best treatment for your specific symptoms. For additional information, you may wish to visit the American Diabetes Association website at http://www.diabetes.org/type-1-diabetes/nerve-damage.jsp or www.riteaiddiabetes.com.

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muir, mi: for diabetes, how does your body fix high blood pressure?

Marvin and Michelle: your body does not "fix" high blood pressure. However, blood pressure can be controlled. Methods of controlling high blood presuure may include, weight reduction, reducing dietary salt or sodium, proper exercise, and or medication.

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Richmondville NY: I just lost my medicaid insurance fo to they think I make too much money and can not afford my insulance where can I get it and how

Marvin and Michelle:

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Pune, India: Hi, can you please suggest what all is best to eat for a diabetic and what all to avoid completely. please note that it is the start of diabetes for the patient with levels of 180-195. thanks

Marvin and Michelle:

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ridgway ,pa: can you please tell me about med med called glimepiride . it is my diabetes med . can you please tell me the side affets if this emd. thank you, shannon fuller

Marvin and Michelle: The most common side effect to glimepiride is nausea or upset stomach. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Remember that your doctor has prescribed this medication because the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: yellowing eyes or skin, stomach/abdominal pain, dark urine, unusual tiredness or weakness, easy bleeding or bruising, signs of infection (e.g., fever, persistent sore throat), mental/mood changes, unusual or sudden weight gain, or seizures. This medication can cause low blood sugar (hypoglycemia). This effect may occur if you do not consume enough calories (from food, juices, fruit, etc.). The symptoms include chills, cold sweat, blurred vision, dizziness, drowsiness, shaking, rapid heart rate, weakness, headache, fainting, tingling of the hands or feet, or hunger. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you are in a situation where you don't have these reliable forms of glucose, eat a quick source of sugar such as table sugar, honey, or candy, or drink a glass of orange juice or non-diet soda to quickly raise your blood sugar level. Tell your doctor immediately about the reaction. To help prevent hypoglycemia, eat meals on a regular schedule and do not skip meals. Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, or fruity breath odor. If these symptoms occur, tell your doctor immediately. Your medication dosage may need to be increased. A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

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Mt. Carmel, IL.: We have a diabetes support group here and a question that no one had the answer for was this: What kind of immediate treatment does someone get who's blood sugar is way too high? For ex. someone goes to a free screening and is made to go straight to the hospital because their blood sugar is 600. What does the hospital do for them? Or someone who takes a certain amt. of medication and/or insulin checks and sees that their level is way too high. What can they do at home..take more of their medicine or insulin?

Marvin and Michelle: In general, hyperglycemia may be controlled with oral diabetic medications and/or insulin therapy. Exercise is also a common treatment for hyperglycemia. (Please note: If the blood sugar is higher than 240mg/dL, check the 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.) Other measures that may be taken to help decrease the blood sugar include changing the diet and increasing water consumption. If altering the diet and exercise do not work, you may need to have the doctor adjust your medication or insulin. If your blood sugar is higher than normal, you should not give yourself additional medication or insulin other than what was prescribed by your physician unless otherwise directed to do so. Extremely high blood glucose levels can be life threatening and are considered medical emergencies and require immediate assistance from hospital staff. Treatment includes fluid replacement, potassium replacement, and insulin infusions. This type of treatment can not be given at home.

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Schoharie, New York: Just being diagnosed borderline diabetic, my doctor suggested limiting carbohydrates, sugars, starches, etc. I would like to know what the normal carbohydrate # is for daily meals. In other words how many carbohydrates should I try to limit my diet to each day.

Marvin and Michelle: The amount carbohydrates an individual can consume each day varies according to factors such as age, weight, and physical activity. We recommend that you visit the following American Diabetes Association website where you will find a wealth of information regarding food, shopping, preparation: http://vgs.diabetes.org/planningmeals/food_labels.jsp

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prevessin-moens,01280 france: I am interested with a device for blood glucose testing without lancet.I tried to obtain information on home use Lasette without success.Could plse let me know if a similar device ie non intrusive such as watch or any other other product based on this concept is available and where shall contact them.Thanks and regards,Madjd Madani

Marvin and Michelle: The watch you are referring to is the Glucowatch which uses electric current to measure the blood glucose levels. This product can only be obtained with a prescription directly from the manufacturer; it is not carried in pharmacies. However, this product does NOT replace regular fingerstick blood glucose monitoring. The product is designed to be used with your regular monitor. For more information on the glucowatch, you may visit the company's website at www.glucowatch.com. Lasette Plus is designed for home use and uses lasers instead of a traditional lancet to obtain the blood sample. It can be used in combination with any blood glucose monitor. It has limited availability. You may obtain more information on Lasette Plus on the company's website at http://www.cellrobotics.com/lasette/home.html.

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Phila. PA: My glucose level was 114. I am very concerned about diabetes prevention, it runs in my family. What do my numbers mean?

Marvin and Michelle: You do not state when the glucose value you are reporting occured. It is important to know if this glucose reading occured first thing in the morning before eating, immediately after a meal or several hours later. 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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Caliente,Ca.: Once your desired weight has been reached and blood sugar testing is under control, is it still necessary to limit your food portions to the same small amounts?

Marvin and Michelle: In order to maintain your weight and keep blood glucose levels under control, it is important to continue following a healthy meal plan. The meal plan should be individualized based on your lifestyle and likes/dislikes. We recommend that you speak with a dietician to determine an appropriate meal plan for you. The dietician can help you determine the proper number of calories you should be eating as well as the amount of carbohydrates and sugars. Moderation and appropriate portion control are key components in healthy meal plans.

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conyers, Ga: what is the heathly blood sugar for a child

Marvin and Michelle: For children under age 6: before meals 100-180 mg/dl and bedtime/overnight 110-200 mg/dl. For children age 6 to 12: before meals 90-180 mg/dl and bedtime/overnight 100-180 mg/dl. For young adults ages 13 to 19: before meals 90 -130 mg/dl and bedtime/overnight 90-150 mg/dl. Check with your physician to determine if these values are appropriate for your child.

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Bath UK: I have type 2 for four years and now are having trouble to achieve good control. My doctor thinks that I may have to go on to insulin. If this is the case can I come off it if my control gets better....eg by taking more exercise ?

Marvin and Michelle: Treatment of type 2 diabetes with insulin injections need not be permanent. If a patient takes the initiative to control their weight, eat a proper diet, and exercise, insulin may no longer be necessary to control blood glucose. However, if the patient's body has lost total ability to manufacture insulin, then it would be necessary to continue with insulin treatment.

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Edison,New Jersy: Hello, I am 27 yr old. Now my 30'th week of pregnency is running. I have gestational diabetes. My glucose levels are under control by diet and excercise. I have no family history of diabetes and I am not overweight. I want to know my chances of getting type2 diabetes later in life.

Marvin and Michelle: Gestational diabetes occurs in about 4% of pregnant women and usually goes away after pregnancy. In future pregnancies, the chance of developing gestational diabetes is 2 in 3. In some cases, pregnancy may actually uncover type 1 or type 2 diabetes and therefore treatment would need to continue after pregnancy. Both gestational and type 2 diabetes involve insulin resistance and there seems to be a link between the two. Many women develop type 2 diabetes years after having gestational diabetes; however, the actual numbers vary anywhere from 20-63% of women. Losing weight, exercising, and making healthy food choices may help prevent diabetes from developing after having gestational diabetes.

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Orland Park, Illinois: I was recently diagonised with type 2. Every morning I wake up and am extremely hot. I sweat from every pore in my body. What can be causing this?

Marvin and Michelle: Sweating could be a symptom of hypoglycemia (low blood glucose levels). Other symptoms of hypoglycemia include shakiness, dizziness, inability to concentrate, headache, 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. Hypoglycemia occurs when blood glucose levels drop below 70 mg/dL. We recommend that you test your blood glucose levels in the morning when you are experiencing this symptom to determine if your levels are low. We recommend that you speak with your doctor regarding your symptom(s) and provide him/her with your blood glucose levels so that a proper diagnosis and treatment plan can be determined.

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Kingston, NY: I am not sure if this can be answered or not. I have pre-diabetes as my am blood sugars are well above the norm of 100mgdl. I lost 20 pounds and am eating sensibly. Low - medium carbs and high protein. Yet, my sugars continue to creep up. Why ??

Marvin and Michelle: First, we want to congratulate you on starting to make lifestyle changes that can help your condition. It is very important to manage your blood glucose levels when you have pre-diabetes in order to help delay or prevent the progression to type 2 diabetes. With pre-diabetes, long-term damage may already be occurring to your heart and circulatory system. Pre-diabetes is usually treated with moderate weight loss by altering the diet and starting moderate exercise. In some cases, if caught early, weight loss and exercise can actually cause blood glucose levels to return to the normal range. Additionally, the doctor may start you on medication to help prevent the development of type 2 diabetes. While we can not tell you exactly why your blood glucose levels continue to rise, we recommend that you continue your diet and weight loss regimen. You may wish to speak with a dietician to go over your meal plan to see if there are additional changes that you could make. Additionally, adding moderate exercise can also help. It may also be necessary for you to start medication therapy if diet and exercise alone do not work. We recommend that you speak to your doctor regarding your continued elevations in your glucose levels for further evaluation.

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winder ga: can such drugs as lipitor, depression drugs or antidepression drugs cause promblems with your diabetes?

Marvin and Michelle: Some medications can affect your diabetes by causing fluctuations in blood glucose. Lipitor does not seem to this effect. Some antidepressants may also cause fluctuations in blood glucose. We will be glad to check this for you when given the specific medication.

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Austin, TX: I have diabetes. Yesterday, I was feeling dizzy and started shaking a little. I checked my blood sugar level and it had dropped to 86. My average is 137. How did that happen?

Marvin and Michelle: When blood glucose levels drop below 70 mg/dL this condition is called hypoglycemia. Hypoglycemia may be caused by exercising, skipping meals, too much medication or insulin, drinking alcohol on an empty stomach, or changes in your schedule. Symptoms of hypoglycemia include shakiness, dizziness, inability to concentrate, headache, sweating, hunger, fast or pounding heart, fatigue, paleness, weakness, fainting, sudden moodiness or behavior changes, tingling sensations around the mouth, clumsy or jerky movements, and poor or blurred vision. 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. It is important to know the symptoms of hypoglycemia and treatment options in order to prevent worsening hypoglycemia. We recommend that you speak with your doctor to discuss your sudden drop in blood glucose levels.

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Cabot , Ar. : Why does my blood sugar go high even when I've not eaten anything?

Marvin and Michelle: Hyperglycemia (high blood glucose levels) may be caused by eating too much, lack of physical activity, illness, stress, the body not having enough insulin, the body not being able to use the insulin present, skipping diabetes medicine, exercising less than usual, or other medications that you take. Additionally, if your blood glucose level drops low (which could occur if you are not eating regularly), your body could be releasing hormones as a defense mechanism against the low blood glucose level causing a rebound hyperglycemia (high blood glucose level). Please consult with your physician to determine the exact cause of your elevated blood glucose levels.

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Dallas: What is normal blood sugar range for a diabetic person. Fasting and non fasting?

Marvin and Michelle: 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) include 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); and 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 American College of Endocrinology (ACE) recently announced new general blood glucose level guidelines that 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); and Two hours after eating a meal - Less than 140 mg/dl (less than 7.8 mmol/l)--(plasma/serum blood glucose reading). Please consult with your physician to determine what specific goals are appropriate for you.

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montebello: normal diabetes reads what what is high surger what is low

Marvin and Michelle: Hypoglycemia (low blood glucose levels) occurs when blood glucose levels drop below 70 mg/dL. Hyperglycemia (high blood glucose levels) occurs when blood glucose levels are above your recommended blood glucose goal. Only your physician can determine what specific blood glucose goals are appropriate for you. However, we have included some general blood glucose level recommendations for your information. 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) include 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); and 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 American College of Endocrinology (ACE) recently announced new general blood glucose level guidelines that 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); and Two hours after eating a meal - Less than 140 mg/dl (less than 7.8 mmol/l)--(plasma/serum blood glucose reading). Please consult with your physician to determine what specific goals are appropriate for you.

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longview WA: I have been having problems breathing and then my hand and feet will start to get a burrnig sensation and swell up and the only thing that helps make it go away is to run them under cold water.Then there is a iritating rash that is on my inner thigh that is very dry and itichy. if I dont eat in the mornining I will get very light headed and shaky until I get some fruit or juice aor chocolate in to my system. If you can help me with this I would be very gratefull.

Marvin and Michelle: Burning and swelling of the hands/feet and a rash could be the result of numerous health conditions. The lightheadedness and shakiness could be due to hypoglycemia (low blood glucose levels) since you said you are not eating. We recommend that you test your blood glucose levels in the morning when you are experiencing these symptoms to determine if your levels are low. Hypoglycemia occurs when blood glucose levels drop below 70 mg/dL. If your blood glucose levels are low, 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. To prevent hypoglycemia, eat meals and snacks on a regular schedule and test your blood glucose levels frequently. Additionally, we recommend that you speak with your doctor regarding all of your symptoms to determine potential causes and appropriate treatments for each symptom.

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Louisa, VA.: I am taking the drug Risperdal and was told by one of my doctors that it can affect my blood sugar levels, which can then affect my heart? I already have CHF and I'm wondering if this is true? They are planning to take me off Risperdal because of this and put me on another drug! Is this really necessary? I don't really want to rock the boat here. Thank you!

Marvin and Michelle: Risperdal belongs in the class of medications called atypical antipsychotics. Hyperglycemia (elevated blood glucose levels) in some cases associated with diabetic ketoacidosis, hyperosmolar coma, or death has been reported in patients treated with atypical antipsychotics. Additionally, an increased risk of new onset diabetes and worsening pre-existing diabetes has occurred. Blood glucose levels should be monitored closely when taking this type of medication. Patients with cardiac disease such as a history of a heart attack, ischemia, heart failure, etc should use caution when using Risperdal due to its ability to cause orthostatic hypotension (a sudden drop in blood pressure upon rising) associated with dizziness, fainting, and increased heart rate. We recommend that you speak with your physician(s) to discuss your concerns regarding stopping the medication versus the potential side effects of staying on the medication.

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honea path SC: What can cause your sugar to rise after a long period of not eating and many hours of sleep? It continued to rise after being up for 4 hours and working.

Marvin and Michelle: Some patients do have 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. Check your bood glucose level in the middle of the night (around 3 AM). If your blood sugar is high, you may be experiencing the dawn phenomenon. If it is low, it may be a rebound hyperglycemia (high blood glucose) causing your high blood glucose levels in the morning. This occurs if you have low blood glucose levels at night and your body is releasing hormones as a defense mechanism against low blood sugar. It would be best to consult your physician for proper diagnosis and treatment.

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West Bend, Wisconsin: I've read some of the symptoms of diabetes no matter what "type". One that stands out is the itching. Would a person itch over their entire body and can this itching come and go. One day it's stronger than the next and some days it doesn't even occur. The itching developed almost over night without warning. There is no fatigue, no excessive thirst however there is tingling in the hands at times but I thought it wasw due to over excessive use of my laptop :) On a serious note, would this itching happen overnight and does it come and go? Thanking you in advice.

Marvin and Michelle: Diabetes can affect various parts of your body including your skin. Itching may be caused by a yeast infection, dry skin, or poor circulation which could be caused by diabetes. However, many other conditions can also cause itching and dry skin. Additionally, each person exhibits symptoms differently; therefore, we are unable to determine how suddenly the itching would start or if it would come and go. We recommend that you speak with your doctor to determine the cause of your itching and an appropriate treatment plan.

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São Paulo, Brazil : Hi, My name is Sidney ( male) I´m 35 yo and I´m a lot overweight. (135 KL) . My recent blood test for glucosis ( fasting 12 hs) showed a level of 103 mg/dl. Is this diabetes? I have no history of diabetes in my family. Thanks

Marvin and Michelle: 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.

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poulsbo wash.: We have recently lost a family member and would like to have friends and family members make donations to you rather than flowers. Could you help me to set up an easy way for people to visit your site and do this in his name?

Marvin and Michelle: What a great way to honor your loved one and help other people with diabetes. You may select the link "Support the Cause" on the main ADA website (lower left-hand side). Then choose "Make a Donation". This will then give various options such as memorial gift, honor gift, general gift, etc. The ADA's phone number is also listed if you prefer to speak to someone personally for assistance.

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dublin virginia: Lately I have been very tired.And my suger was only 54 when my mom tested me this morning.After i ate some peanut butter it went to 105 after an hour. My mother is diabetic.What is this a sign of? Should I tell my physican? Thank YOu Valerie

Marvin and Michelle: Hypoglycemia (low blood glucose levels) occurs when blood glucose levels drop below 70 mg/dL. Symptoms of hypoglycemia include shakiness, dizziness, inability to concentrate, headache, hunger, sweating, 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. We recommend that you speak with your doctor as soon as possible to discuss your symptoms for a proper diagnosis and treatment options.

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Owego, New York: I take Amaryl (Glimepride) as my Diabetes Medicine. I have heard that certain diabetes medicines keeps one from losing weight. Is this true and if so is my medicine one of the medicines that preventsweight lose? Also explain how these medicinezs keeps one from losing wiehgt. Thank you for answering my question.

Marvin and Michelle: Amaryl does not list weight loss or gain as a side effect. We would not expect it to have any effect on your weight. Metformin, a common diabetes medication, is particularly known for causing weight loss as a side effect primarily because it causes loss of appetite. The thiazolidinedione class of medications (which includes Avandia and Actos) can cause weight gain due to their ability to cause fluid retention. Insulin therapy can also cause weight gain because it improves the body's ability to use and store glucose. Eating a healthy diet, reducing the number of calories you are eating, and increasing exercise can help manage your weight.

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new port richey,fl: what are the sings of diabetes in childern?

Marvin and Michelle: Diabetes symptoms are the same for children and adults including excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision.

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philadelphia pa: i would like to know what foods you can eat or is there a web site that can tell me that

Marvin and Michelle: We highly recommend that patients with diabetes take a look at the American Diabetes Associations Virtual Grocery Store website at vgs.diabetes.org. A wealth of information is available at this website including a grocery store tour, how to read and interpret food nutritional labels, planning meals, recipies and preparing a shopping list. I also recommend this site for individuals who are caretakers of patients with diabetes. Everyone can learn something about eating a healthier diet, even those do not have diabetes.

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Canton, MI: During a recent diabetes education class we were told that if we are taking insuin injections we should wear an id. Should that id say 'diabetes' or 'insulin' ?

Marvin and Michelle: If you are only given a one word choice between "diabetes" or insulin" to describe your medical condition to health care providers in a medical emergency, we would choose the word "insulin". Insulin indicates that you are a patient with diabetes and at the same time describes the medication you are using for treatment. Choosing the word "diabetes" describes your condition but says nothing about your treatment.

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Galt, CA: What can diabetics do when they are sick with a cold or flu? Can we take 'Airborne Formula' to prevent getting sick?

Marvin and Michelle: You are wise to plan ahead and be prepared for what medications to take should you catch a cold or become strickened with the flu. All patients with diabetes should have a "sick day" plan. This means preparing a list of medications, preferably approved by your physician, for use when you are ill. We personally do not like to see patients take products such as Airborne which contain natural or herbal ingredients. 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. At your next physician visit, ask for some recommendations for cold/flu products that you can purchase. Patients with diabetes should avoid products containing decongestants unless approved by their physician.

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Warren, Michigan: Many products contain no sugar, but contain sugar alcohol. How does sugar alcohol affect the blood sugar of a diabetic?

Marvin and Michelle: Sugar alcohols are a sugar substitute used as a sweetening agent in many foods and candies. Sugar alcohols contain about 1/3 to 1/2 the calories of sugar and are converted to glucose more slowly requiring little no insulin for breakdown in the body. As a result they do not cause sudden increases in blood sugar. Some common sugar alcohols are sorbitol, mannitol, isomalt, xylitol, and lactilol. The American Diabetes Associations claims that moderate amounts of sugar alcohols are acceptable but should not be eaten in excess. If eaten in uncontrolled amounts some patients with diabetes have experienced blood sugar rises, and possible side effects can occur such as bloating and diarrhea. We recommend that when eating foods containing sugar alcohols that patients look for the carbohydrates contained in each serving and to be sure to include them as a part of their meal plan.

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west sayville, ny: Can METFORMIN cause iron deficiency anemia? It seems I read something about it, but now can't locate the information. If that is the case, and I have iron deficiency anemia, what drug can I use in place of METFORMIN, that acts the same way and I won't gain weight?

Marvin and Michelle: There have been 5 cases of megaloblastic anemia (vitamin B12 deficiency) reported with metformin; however, none of these cases were in the United States. The cases seem to be rapidly reversible with discontinuation of metformin and vitamin B12 supplementation. It is recommended to check blood work yearly for this rare side effect in patients on prolonged metformin therapy. People who are predisposed to developing subnormal B12 levels include those with inadequate B12 or calcium intake or absorption. Iron deficiency anemia is not listed as a side effect of metformin use.

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WEST POINT UTAH: MY HUSBAND HAS TYPE 2 DIABETES. WHILE ON VACATION HIS FEET AND ANKLES SWELLED REALLY BAD AND HIS CALVES GOT TIGHT. SHOULD HE CONSULT HIS PHYSICIAN IMMEDIATELY OR CAN IT WAIT A FEW DAYS

Marvin and Michelle: Swelling is a symptom that should never be ignored. I recommend that your husband contact his physician immediately to be evaluated.

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Tel-Aviv,Israel: Can CINNAMON play any part in reducing blood sugar?

Marvin and Michelle: 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. Additionally, "natural" products do not have to conduct side effect or drug interaction studies and therefore this information is not always known. Although there is some talk about cinnamon being tried to treat diabetes, there have not been any controlled clinical studies to prove that this will be beneficial or more importantly to show that it is not detrimental. Currently there is insufficient reliable information to rate the effectiveness of cassia cinnamon (a particular form of cinnamon) for the treatment of type 2 diabetes. Studies conducted to date have shown conflicting results, some showing benefit while others show none. Potential reasons for contradictory results include patient differences and different product formulations. Therefore, it is not recommended to use cassia cinnamon in the treatment of diabetes without the consent of a physician.

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erie, michigan: My brother's sugar rose to over one thousand and he began having chest pain. He does not have any heart trouble or blockage or breathing difficulty. The doctor gave him morphine for the chest pain. I thought I read somewhere that a diabetic patient should not receive morphine, it that true?

Marvin and Michelle: Morphine does NOT list a contraindication or warning for people with diabetes. Additionally, it does NOT list hyperglycemia or hypoglycemia (high or low blood glucose levels) as side effects. Therefore, we would not expect a person with diabetes to experience a problem if he/she were to take morphine as prescribed by their physician. However, drug interactions should be checked by the pharmacist when the prescription is filled. There have been reports in animal studies that hyperglycemia can reduce the response to morphine. To date, this has not been seen as being a problem in humans. If your brother experiences alterations in his blood glucose levels or inadequate pain control, we recommend that he speaks with his physician for further assistance.

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Silvis, Illinois: I have recently lost my job and my husband is not work. My husband is a diabetic and now with no health insurance I have no way of paying for his medicine. I have searched the web is there any place that can help us afford his medicines.

Marvin and Michelle:

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Hermitage, PA: My 10 yr. old daughter fainted at school. She had a glucose level of 228 30-40 mns. after she had Chef Boyardee mini shells for lunch. She had approximately 1 egg scrambled with one vienna sausage with about 2 oz. of milk that morning. She was extremely pale, disoriented and sweatie before she fainted. (Nurse in school tested blood sugar level.) Could she be having diabetes? Thanks. Yolanda

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 your daughter has pre-diabetes, diabetes, or are normal. Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. We recommend that you speak with your daughter's doctor to discuss her symptoms and complete appropriate testing.

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Stockton, CA: I need help managing my diabetes. Do you know where I can go for diabetes education? It would have to be after working hours. Thank you.

Marvin and Michelle: Unfortunately, we do not have access to diabetes education programs across the country. We recommend that you speak with your physician, local pharmacist, or local hospital for assistance determining if there are classes available in your area. Additionally, the ADA has a Diabetes Expo that travels around the country. You may obtain more information on the Diabetes Expo and determine if it is coming to a city near you on the ADA's website at http://www.diabetes.org/communityprograms-and-localevents/diabetesexpo.jsp.

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ADA Moderator : 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 his medications directly in order to obtain information about available patient assistance programs. In order to provide you with the name and phone number of the manufacturers, please submit your question to our "Ask the Pharmacist" service with a list of your husband's medications including the manufacturer if it is a generic product (this information is located on the prescription bottle) and we would be happy to assist you. The ADA recommends that people with diabetes follow an individualized meal plan based on their likes/dislikes and lifestyle to manage diabetes and weight. The key to maintaining a healthy weight and blood glucose levels is moderation. Watching the amount of sugar and carbohydrates will help achieve these goals. However, you do not have to cut these out of your diet entirely. As long as you eat moderate amounts and compensate accordingly (for example with added exercise or decreasing sugar and carbohydrates at an earlier meal in the day), you can have that piece of cake at a birthday party. If you have not already, we recommend that you speak with a registered dietician to help develop a meal plan that is appropriate for you. Your physician should have an idea of local dietitians in your area (in the U.S. a person may call 1-800-366-1655 which is the American Dietetic Association nutrition information line for more information). The ADA's website has a great list of frequently asked questions regarding nutrition. You may access this at http://www.diabetes.org/nutrition-and-recipes/nutrition/faqs.jsp. 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 your medications directly in order to obtain information about available patient assistance programs. Please resubmit your question to our Ask the Pharmacist link at www.riteaid.com with the names of the medications that you are on and we can provide you with the telephone numbers of the manufacturers so that you can contact them about their assistance programs.

That's it for today. Thanks so much for taking the time to be 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. Our guest will be Robert Reames one of the nation's most recognized personal trainers who brings over 20 years of experience to the Gold's Gym Fitness Institute at 1:00 p.m. ET Tuesday, November 14, 2006. See you then.