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ADA Moderator : Welcome to ADA Live!

Today our guests are Grace Popeck, R.Ph., Pharm D. is a Drug Information Specialist at the Rite Aid Drug Information Center and Terry Towers, pharmacist and diabetes care specialist for Rite Aid.

It's a pleasure to have you here today Grace and Terry.

Grace and Terry: Thanks, nice to be here.

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N-D-I-P, Quebec: Is diabetes contageous? can it be spread somehow?

Grace and Terry: Diabetes is not a contagious disease and you can not catch it through contact with someone who has diabetes. The exact cause of diabetes is unknown; however, genetics and environmental factors including lack of exercise and obesity have been shown to affect the onset of diabetes.

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Fontana, CA: It seems that when I eat sweets my legs itch. Why is that?

Grace and Terry: One symptom of hyperglycemia (high blood glucose) is dry, itchy skin. It could be that after a large glucose load your bg levels are high enough to trigger that itchy response. We cannot positively state that this is the reason, you should discuss the problem with your health care provider.

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simi valley,ca: i about 6 years ago had gestational diabetes and recently started to feel very not tired but worn down alwys feel like eating even when im not hungry have had mild headaches on and off for the last two weeks and my joints are aching. are these sighns that point towards diabetes? and if so do you know where i can go to be tested for free as i am without medical insurance.

Grace and Terry: You can speak to your doctor's office to determine how much the test will cost. Additionally, you may want to speak to your local Rite Aid pharmacist or hospital to see if they know of any local free or low-income clinics in your area where you may be able to be tested. If you do have diabetes, it is very important to start treatment as soon as possible to avoid long term complications.

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Mclean,Virginia: It is necesary to fast for finding the blood sugar levels for diabetes?

Grace and Terry: The fasting blood glucose levels are used to determine certain areas of concern, while a post prandial (after eating) test would be used to measure other areas of concern. If your physician has ordered a fasting blood sugar, then you would need to fast.

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Cleveland, Ohio: Lipitor and Zetia have been very effective in reducing my high cholesterol, but routine bloodwork over the last year has shown a slow, steady rise in my blood sugar--reaching 103 a month ago. I'm 6'3 male and feel that I may have pre-diabetes.

Grace and Terry: 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. With your current eating and exercise regimine, it would appear that, while we can't predict just how your glucose numbers will manifest, you will be successful in maintaining control.

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houston,tx.: what are the syntoms of diabetes?

Grace and Terry: Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. If you are concerned about developing diabetes, that you have diabetes, or are having any of the symptoms of diabetes, we recommend that you speak with your doctor for an examination and appropriate testing. Additionally, you may want to take the American Diabetes Association Diabetes Risk Test available online at http://www.diabetes.org/risk-test.jsp. For additional information on diabetes, please visit the Rite Aid Diabetes website at www.riteaiddiabetes.com or the American Diabetes Association's website at www.diabetes.org.

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Powder Springs Ga: How many carbs a day should a diabetic person have? And what is a good carb and bad carb?

Grace and Terry: Your best source to determine a proper balance in your dietatary intake would be to consult wtih a dietician. Ask your physician if they can recommend one that you can talk to. You may also call your local hospital who may have a dietician on staff who can meet with you and help you determine how many carbohydrates you should consume in a day and how to determine what is considered a carbohydrate.

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Brant Rock, MA 02020: I was slightly hurt by Hurricane Katrine. After my house was sold, I saw my local g.p. and she said I had diabetes 2. She gave me glucophage, and I moved to Massachusetts. I found an internist who also said I had diabetes. He told me to take 2000 mgs. twice a day. He sent me to classes. On class 3, they were still working with how to use the meter. I DO NOT know how or what to eat. They gave me no information. I am nauceous ALL the time. Yesterday, I ate 2 small pieces of cheese and 3 crackers with peanut butter - 1 diet soda. Today my sugar is 161. Where would you turn for help? I just had knee surgery, and am barely moving. I know that's bad, but after being diagnosed in Sept., by now I should be knowing what to do and I don't. Any help appreciated.

Grace and Terry: We would suggest that you find a diabetes educator in your area and discuss your problems and concerns, education on diabetes and proper treatment and control are vital. if you cannot find an educator, visit the ADA website at diabetes.org and follow their links to answer all of your questions.

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Edison,New Jersy: Hi, I have gestational diabetes. Now my 38'th week is running. My glucose levels are under control by diet and excercise. After delivery can I eat sweet atleast one time?.

Grace and Terry: Is sugar ok to eat? For almost every person with diabetes, the answer is yes! Eating a piece of cake made with sugar will raise your blood glucose level. So will eating corn on the cob, a tomato sandwich, or lima beans. The truth is that sugar has gotten a bad reputation. People with diabetes can and do eat sugar. In your body, it becomes glucose, but so do the other foods mentioned above. With sugary foods, the rule is moderation. Eat too much, and 1) you'll send your blood glucose level up higher than you expected; 2) you'll fill up but without the nutrients that come with vegetables and grains; and 3) you'll gain weight. So, don't pass up a slice of birthday cake. Instead, eat a little less bread or potato, and replace it with the cake. Taking a brisk walk to burn some calories is also always helpful. Make sure you discuss your dietary choices and caloric intake ultimately with your dietician or nutritionist.

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Tucson, Arizona: Is walking the best exercise for a person with Diabetes. I want to improve upon upper body strength and to shape and tone upper torso. In addition I am interested in loosing my abdomin as this is where I have the most concern.

Grace and Terry: Walking is an excellent form of physical activity for people with diabetes. Toning upper body usually requires using weights or tension devices, but caution should be used by people with diabetes because this type of activity may cause problems with the eyes. We recommend that you consult your physician for an exercise program adjusted to your needed. It is also recommended to have at least a yearly eye exam.

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Valdosta, Ga.: I am supposed to be taking four 500mg. Glucophauge every night before bed. I have told the doctor repeatedly the Glucophauge don't stay down long enough to even remove the engraved lettering. My question is: Is there anything else I can try oraly instead of going on insulin?

Grace and Terry: Our suggestion is to take the Glucophage with dinner, and if nausea still persists, ask MD about using 2 tabs with breakfast and 2 with dinner. Please do not lose hope if insulin therapy is required. Talk to your MD, diabetes educator or pharmacist in regards to insulin use and injection technique, insulin use has a bad reputation, however,using insulin is not as bad as you might think.

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Helena, Arkansas: What if you don't have any medical coverage is there a way for you to get tested for diabetes?

Grace and Terry: You can speak to your doctor's office to determine how much the test will cost. Additionally, you may want to speak to your local Rite Aid pharmacist or hospital to see if they know of any local free or low-income clinics in your area where you may be able to be tested. If you do have diabetes, it is very important to start treatment as soon as possible to avoid long term complications.

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chicago illinois: what is the relationship between insulin and tpe II diabetes?

Grace and Terry: People with Type 2 diabetes have some insulin production, but may have either problems with the body utilizing it, or with the pancreas not releasing the insulin properly.

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Elk Garden wv: I was wondering what should a person do If they get real weak feeling.What should they eat.

Grace and Terry: We are assuming that you are referring to a person with diabetes. Whenever you have a feeling that is not normal(weak;lightheaded;nauseous;etc) you should do a blood test to determine what action should be taken. If you are below 70mg/dL (considered 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 the 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. If your glucose numbers are normal when you are having this feeling, you should consult your physician for an evaluation. 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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Conroe, TX: Does diabetes come from heredity or can you get it from inactivity?

Grace and Terry: 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 type 2 diabetes.

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Helena, Arkansas: What if your mother,uncle, and two aunts all died from diabetes related issues.(blindness,kidney failure, heart failure) Me and my sister have some signs but were never tested. What should we do?

Grace and Terry: We suggest that you and your sister consult with your physicians and get tested for diabetes.

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TOLEDO, OH: Why did my friends blood sugar go up when he slept? shouldn't it go down?

Grace and Terry: We have found that 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 blood 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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bronx, new york: MY FIANCE HAS DIABETES AND HE DOSEN'T INJECT HIMSELF YET WITH INSULIN, BUT FOR THE PAST TWO DAY'S HIS LEFT FOOT HAS BEEN SWOLLEN. IT STARTED OFF AS ITCHING AND DRY SKIN THAT NEVER HEALED. NOW HIS FOOT IS LOOKING RAW TO ME. HE' AFRAID TO GO TO THE DOCTOR BECAUSE OF FEAR OF AMPUTATION. MY QUESTION IS COULD YOU PLEASE EXPLAIN TO ME HOW SERIOUS THIS IS AND SHOULD WE WORRY ABOUT AMPUTATION.I THINK HE SHOULD GO TO THE DOCTOR AS SOON AS POSSIBLE. I JUST NEED SOME INFO ON THE SYMPTOMS DESCRIBED.

Grace and Terry: People with diabetes tend to heal slower than people without diabetes and this makes infection a bigger risk when a diabetic person develops cuts, or sores. With increased chance of infection, there is increased chance of gangrene, your fiance would be wise to go to his physician and have this condition evaluated.

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Tucson, Arizona: Is it typical of adults with type 11 diabetes to be hot even to sweat during the days and nights? Is this due to the disease?

Grace and Terry: Sweating and feeling hot may be symptoms of hypoglycemia (low blood sugar). We recommend that you check your blood sugar level when you are experiencing these symptoms to determine if your blood glucose level is low. Keep a log of your symptoms as well as your blood glucose results and consult with your physician for a proper diagnosis and treatment.

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wilmington nc: why does a person have to use insulin and medication? Is this necessary?

Grace and Terry: Insulin is a hormone produced by the pancreas and is necessary for survival. It is needed to convert sugar, starches and other food into energy needed for daily life. People with Type 1 do not have any insulin production, therefore must supply their bodies with insulin from an outside source. People with Type 2 diabetes have some insulin production, but either have problems with the body utilizing it or the pancreas may not be releasing the insulin properly. Usually lifestyle changes may be the first treatment plan that is recommended for a newly diagnosed person with Type 2 diabetes. If lifestyle changes are not effective then medication is prescribed by your physician, or a specialist in diabetes. Treatment with medication for Type 2 diabetes may help the body to increase insulin production, or it may help to increase your body's sensitivity to the insulin it produces. Sometimes additional insulin must also be used to increase insulin, and insulin utilization for the body's needs. We recommend that you consult with your physician to evaluate the recommended treatment for diabetes.

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Des Moines, IA: Could you explain in more simplier detail regarding insulin to carb ratio

Grace and Terry: Very simply put, the insulin to carb ratio indicates how many grams of carbohydrate will be processed by 1 unit of insulin. An average is usually 1 unit of insulin for every 15 grams of carb, or 1:15. The ratio varies from person to person, some may be 1:10; or 1:20, this is why we test after eating and keep a diary of our carb intake and our insulin dosage, so that we can determine our personal insulin to carb ratio.

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South Boston,Va.:

Grace and Terry: Our suggestion is to see your physician and get tested for diabetes, you have the risk factors and you have finger stick results that would appear to indicate diabetes, but a physician has to diagnose and recommend a treatment plan. In order to diagnose diabetes the doctor must complete a blood test, either a fasting plasma glucose test or an oral glucose tolerance test. The results will determine if you have pre-diabetes, diabetes, or are normal. The fasting plasma glucose test measures the blood glucose level first thing in the morning after a person does not eat (fasts) overnight. The fasting plasma glucose test defines pre-diabetes as blood glucose levels between 100 and 125 mg/dl and diabetes as blood glucose levels at 126mg/dl or above. The normal fasting blood glucose level would be less than 100 mg/dl. The oral glucose tolerance test measures blood glucose levels first thing in the morning after a person fasts and then again 2 hours after the person ingests a drink that contains glucose. With this test, pre-diabetes is defined as the 2-hour blood glucose level between 140 and 199 mg/dl and diabetes as the 2-hour blood glucose level at 200mg/dl or above. The normal 2 hour blood glucose level would be less than 140 mg/dl. Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. If you are concerned about developing diabetes, that you have diabetes, or are having any of the symptoms of diabetes, we recommend that you speak with your doctor for an examination and appropriate testing. Additionally, you may want to take the American Diabetes Association Diabetes Risk Test available online at http://www.diabetes.org/risk-test.jsp. For additional information on diabetes, please visit the Rite Aid Diabetes website at www.riteaiddiabetes.com or the American Diabetes Association's website at www.diabetes.org.

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Greenville North Carolina: Diabetes is no where in my family but I have a 7 year old son who has been seeing a urologist for frequent urination and bed wetting, in the last 6 months he has complained of headaches and blurred vision so we went to eye doctor and their test showed nothing that should bother him so we got him prescribed reading glasses which are doing no good. He has been on medication for urination for 6 months with no change. He is hyperactive and is always thirsty and hungry (although most 7 year old boys are) and his urologist suggested I have him tested for diabetes ensifidous (spelling) and I was wondering which type that is and what the possibilities are.

Grace and Terry: Diabetes Insipidus is where there is excessive urination and excessive thirst, it is a condition caused by decreased action of vasopressin, or ADH (anti diuretic hormone)and should not be confused with Diabetes Mellitus, which results from insulin deficiency or resistance. More info can be found on-line, search "diabetes insipidus"

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PANAMA CITY BEACH FLORIDA: My mother has diabetes im very concerned latley ,because all she is doing is sleeping over 12 hrs a day.She tells me shes alright but I know it has something to do with her blood sugar level.I just dont know anything about diabetes or what to do in this case or even where to begin learning about diabetes and how to help her even if I can?

Grace and Terry: Fatigue is listed as a symptom of both high and low blood glucose levels. Therefore, we recommend that you or she closely monitor blood glucose levels at various times throughout the day to determine if they are high or low at any point. Additionally, many other health conditions can cause fatigue. We recommend that you discuss her symptoms along with the blood glucose level results with her doctor to try to pinpoint the cause of the fatigue.

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Egypt,cairo: how could i know wether i m type 1 or type 2?does the medication differs?

Grace and Terry: Insulin is a hormone produced by the pancreas and is necessary for survival. People with Type 1 do not have any insulin production, therefore must supply their bodies with insulin from an outside source. People with Type 2 diabetes have some insulin production, but either have problems with the body utilizing it or with the pancreas not releasing the insulin properly. Medication is prescribed based on your body's needs. Medication for type 2 diabetes either helps to increase insulin in the body, or increases your body's sensitivity to the insulin it supplies, or both. Please consult with your physician regarding your medication, and what your needs are.

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WEST PALM BEACH,FLORIDA: LIKE 8 MONTHS AGO THE DOCTOR FOUND PROTEIN IN MY URINE,ALSO I HAVE TWO GRANDMAS WITH DIABETES AND RECENTLY I FOUND OUT MY BLOOD DOES NOT CLOT COULD THAT BE SIGNS?

Grace and Terry: The presence of protein in the urine is called proteinuria or sometimes albuminuria. As blood passes through the healthy kidneys, it filters out the waste products, and leaves in the things the body needs, like proteins. If the kidneys are damaged, then protein can pass into the urine. The level of protein and the type of proteinuria (whether the urinary proteins are albumin only or include other proteins) can determine the extent of damage and whether you are at risk for developing progressive kidney failure. Kidney damage can be caused by many different conditions including inflammation, high blood pressure, diabetes, and other kidney diseases. Proteinuria in someone with diabetes is the first sign that kidney function is decreasing, a common long term complication of diabetes. Proteinuria may cause an increase or decrease in blood clotting proteins. We recommend that you consult with your physician to determine the reason for the proteinuria, and to determine whether or not you also have diabetes.

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coral springs, Florida: 68 year old female, fasting glucose is 101. Is this considered high or risky

Grace and Terry: 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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Sun City hilton head south carolina: my wife is checking her blood suger twice a day, what are good numbers to look for her dr said to shoot for 140. Joe

Grace and Terry: 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). 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) We recommend that you consult your physician to determine what specific goals are appropriate for you.

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Port of Spain Trinidad & Tobago: What test is required to determined if someone has diabetes and how it is done?

Grace and Terry: In order to diagnose diabetes the doctor must complete a blood test, either a fasting plasma glucose test or an oral glucose tolerance test. The results will determine if you have pre-diabetes, diabetes, or are normal. The fasting plasma glucose test measures the blood glucose level first thing in the morning after a person does not eat (fasts) overnight. The fasting plasma glucose test defines pre-diabetes as blood glucose levels between 100 and 125 mg/dl and diabetes as blood glucose levels at 126mg/dl or above. The normal fasting blood glucose level would be less than 100 mg/dl. The oral glucose tolerance test measures blood glucose levels first thing in the morning after a person fasts and then again 2 hours after the person ingests a drink that contains glucose. With this test, pre-diabetes is defined as the 2-hour blood glucose level between 140 and 199 mg/dl and diabetes as the 2-hour blood glucose level at 200mg/dl or above. The normal 2 hour blood glucose level would be less than 140 mg/dl. Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. If you are concerned about developing diabetes, that you have diabetes, or are having any of the symptoms of diabetes, we recommend that you speak with your doctor for an examination and appropriate testing. Additionally, you may want to take the American Diabetes Association Diabetes Risk Test available online at http://www.diabetes.org/risk-test.jsp. For additional information on diabetes, please visit the Rite Aid Diabetes website at www.riteaiddiabetes.com or the American Diabetes Association's website at www.diabetes.org.

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greeley,colorado: is it true that diabetics should not use heating pads and if yes why?Thank you

Grace and Terry: Because people with diabetes may develop a complication of neuropathy (nerve damage)they are advised not to use heating pads because they may burn themselves and not know it. We do not recommend the use of a heating pad without the knowledge and consent of your physician.

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HONOLULU, HAWAII: WHAT ARE SOME SYMPTOMS OF HAVING DIABETES

Grace and Terry: Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. If you are concerned about developing diabetes, that you have diabetes, or are having any of the symptoms of diabetes, we recommend that you speak with your doctor for an examination and appropriate testing. Additionally, you may want to take the American Diabetes Association Diabetes Risk Test available online at http://www.diabetes.org/risk-test.jsp. For additional information on diabetes, please visit the Rite Aid Diabetes website at www.riteaiddiabetes.com or the American Diabetes Association's website at www.diabetes.org.

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Corinth Texas: Why don't you have anything as to some examples of setting up and planning breakfast lunch and dinner?

Grace and Terry: The ADA website has a multitude of resource material in regards to healthy eating and meal planning, please visit www.diabetes.org/nutrition-and-recipes/healthyfoodchoices.jsp

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Marlboro, New Jersey: can worry and stress over a 10 week old medical problem,caused by an accidental fall, cause my sugar to go from 97 to 109. I have lost 10 lbs. for no reason and are getting up at night twice for the bathroom. I am not thirsty or tired feeling. I am under the care of my internist and a wound care doctor for the cellulitis and swelling in my leg which has improved 60%. This also caused a leg ulcer to appear but all are improving.

Grace and Terry: Stress and infections will sometimes cause an increase in blood glucose levels. It would appear that the source of infection is being controlled and is subsiding, in regards to stress, you have to find ways that will help you reduce the amount of stress. You have identified the reason for the stress, which is always the first step, now you have to find the ways that will assist you in dealing with it. You should use the help of your health care team; physician, family, diabetes educator, physical therapist, pharmacist, ask the questions that you need answered. You should continue to keep an eye on your blood glucose levels, until these problems resolve.

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Longview, Texas: What is the best insulin pump?

Grace and Terry: The best insulin pump is the one that is best suited for your needs, discuss the different pumps, what they offer, and whether or not they are covered by your insurance, with your endocrinologist and together you can determine what is best.

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Minot, ND: If a person has Type II Diabetes and is obese, losses a significant amount of weight, thereby allowing to be taken off Diabetic medications (oral), and is told their diabetes is "in remission"...is it?

Grace and Terry: Diabetes is a progressive disease, but by maintaining a healthy weight and continuing a good physical activity program, it should help to delay the progression. Don't lose the control that you have gained by becoming complacent, you must continue to be diligent in those programs that resulted in the classification of "in remission"

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Georgetown, Ky.: How often can the same needle be utilized when checking blood sugar?

Grace and Terry: It is recommended that you use lancets only once, with each use the lancet becomes duller, and there is formation of burrs, which makes the finger stick more painful. There is also a possibility of residual blood left on the lancet which may alter the results.

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Burbank CA: how dangerous is it for a person to have a glucose level of 1400?

Grace and Terry: 1400 is a seriously high blood glucose level, and you should contact your physician, and if you cannot get the physician, seek immediate care by going to the ER.

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Pittsburgh, Pa: I have been diagnosed with type 2 about 9 months ago. I am on metformin 2 pills 2 times a day. my blood sugar is 121. My doctor says I do not need a meter as my diabetes is under control. This holiday was bad for me & i consumed a more sweet stuff then I wanted to when I have been so good for so long. I am going to get back on track & leave the sugar alone as I have since I was diagnosed. My ? is I feel downright awful-queasy stomach everyday, slight headache, very tired... any thing could be coming from my sugar???? thank you

Grace and Terry: It is our opinion that you should get a meter and test your blood glucose levels, at least twice a day; a fasting (first thing each morning) and 2 hours after a meal (do after a different meal each day). This will give you a better idea of how well you are controlling the levels. Also, it is not sugar that is the culprit, it is all carbs, so just cutting out sugar products won't work. You have to limit the amount of carbohydrates per day. Visit the ADA website at diabetes.org for healthy eating suggestions.

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from karachi pakistan: im aged 47 i hv got CABG since june2004 im the patient of diabetes mell since 8 years im on medication tab clopidogiril tab dispirin cv tab tenormin 25 mg tab simvastanin 20 mg and for dm i take tab daonil +glucophage now sir what is ur advise my bp is under control my dm is 160random my bp 120/70 mmh are these drugs safe for longer use?

Grace and Terry: The continuation of your medication therapy will be determined by your physician, following continued testing and monitoring of your blood glucose, blood pressure and cholesterol levels. One set of results is not an adequate indicator as to how well the medication is working, also the timing of your blood glucose results are of prime importance, are they fasting, before meals, 2 hours after meals? Each time period has defined goals. Discuss these goals with your physician, diabetes educator or pharmacist.

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chino ca.: Hi I have a 9 year old son that is a type 1 diabete but i can't seem to controller his sugar level we just found out August 2006. What can I do to control it? I changed his foods he's very active I don

Grace and Terry: Talk with your physician, diabetes educator and dietician. Continue to test blood levels often, diabetes control will improve. It takes some time and some work, but with increased knowledge of the disease and the support of your health care team, you can control the diabetes.

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Cincinnati, Ohio: What are the ranges in numbers for being considered a diabetic?

Grace and Terry: Fasting blood glucose ranges are: <100mg/dL is normal, 100 to 125mg/dL is considered pre-diabetes, and > 126mg/dL is considered diabetes. Random blood glucose: anything >200mg/dL (with symptoms) is considered diabetes. Oral Glucose Tolerance (OGTT): 2 hrs after = <140mg/dL is normal, between 140 and 199mg/dL is pre-diabetes, and >200mg/dL is diabetes

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Kaduna, Kaduna State: Pls prepare a food time table for me to control my diabetics

Grace and Terry: The ADA website has a multitude of resource material in regards to healthy eating and meal planning, please visit www.diabetes.org/nutrition-and-recipes/healthyfoodchoices.jsp You may also want to ask your physician for a consultation with a dietician to assist you with understanding nutrition and diabetes.

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Los angeles, CA: My mom has dieabetes type2, she does not have medical insurance or anytipe of healthcare, lately her symptoms are worsening, and well her doctor is not really doing much about it(he's not an expert on this)is there anyway that she could be helped by some organization or something without charging too much?

Grace and Terry:

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KENTUCKY: AFTER MY BLOODSUGARS GET SO HIGH WHAT IS THE BEST WAY TO GET THEM DOWN FAST?

Grace and Terry: You do not want to bring your glucose levels down too fast, when your numbers are high (over 300mg/dL) check for ketones, drink more fluids (gator-aid; water), test often, and call your physician if the numbers persist.

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denver colorado: I know someone who has diabetes and now has a purple toe. What does that mean?

Grace and Terry: Proper foot care is a very important factor in the treatment and control of diabetes. Whenever there appears to be a problem, from a small reddened area to a purple toe, it must be attended to. People with diabetes tend to heal slower than people who do not have diabetes, this increases the chance for infection. Any infection of the feet or lower legs which does not heal, or is not treated could ultimately lead to amputation. We recommend that this person consult with his/her physician or podiatrist for a proper diagnosis and treatment.

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Glenview, Illinois: I was diagnosed with type 2 diabetes about 5 years ago and was prescribed Glucotrol 5mg/daily, this kept my blood sugar levels below 80 for the most part. As a result of a layoff at work I was without a job (and medical insurance) for 3 years. During this period I also had to do without my medication. Now that I'm back to work and can afford medications I find glucotrol no longer affects my sugar levels. My Doctor has added three other medications and it's still uncontrollably high. Three weeks ago my Doctor sent me to my hospitals emergency ward because I complained of chest, neck, jaw and back pain. They admitted me and 3 days later they preformed an angioplasty with 6 stents. This releived my symptoms but they were concerned about my sugar levels (way over 300) I told them that my meds didn't seem to be working and they started me on several formulations of insulin. This did lower it some but it never got below 183. I am worried that I won't be around much longer if this goes on. Is there any hope for my condition. I'm only 57 years old and I'd like to think there is. Please respond. I'm going to see an Endocrinologist Jan. 3rd but I would like some answers now. My email address is: james.zaborsky@pdt.com Thank you, Jim Zaborsky

Grace and Terry: You are stepping in the right direction. The appointment with the endocrinologist will provide you with many of the answers that you seek. It would appear that the insulin therapy is working (your bg readings have gone from over 300 to around 183). You do not want to lower the levels too fast, your physicians will help modify the insulin therapy to provide you with best coverage. Remember, however, that you must take charge and do those things that you need to do: eat healthy, maintain a good physical activity program (approved by Md), test your glucose levels more often (until you have better control).

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Norman, Ok: type 2 very low sugar in the early am when first get up then raises to 150 and up. What can be done for the early am low count?

Grace and Terry: You did not indicate whether or not you are currently taking any medication for your diabetes, and you did not indicate your blood glucose results, or at what time in the early AM, 3AM?, 7AM? If the results are under 67mg/dL, they could be considered as hypoglycemic. Please resubmit your question to our "Ask the Pharmacist" section at our Rite Aid Website at www.riteaiddiabetes.com. and supply more information and we will try to give a more detailed answer.

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Gatesville, TX: My Mom is 69, in Nsg home, on low salt, low sugar diet. She gets Reg Insulin 4 x daily plus Nph daily..Can she have unsalted, unbuttered popcorn as a filler for when she is hungry at night? She is limited on what she can eat and drink.

Grace and Terry: You should discuss this with the dietician at the nursing home, your mother's diet is most likely being monitored, and nothing should be added without first talking to the dietician.

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kearny,n.j.: what causes problem with feet, they see like tehy are bruning some times

Grace and Terry: Burning and swelling of the hands/feet could be the result of numerous health conditions, 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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jacksonville florida: what are the effects of steriods on diabetics?

Grace and Terry: It has been shown that steroids will increase blood glucose levels, so it is important when taking steroids, that you test more often and possibly adjust your food intake and physical activity accordingly.

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Abilene.Tx: I am newly diagnosed with diabetes and am having trouble getting info about my carb intake. I am Hispanic,52 y. o. 5' 130# down from 150# and my daily readings are about 70 to 134. What should be my daily intake of carbohydrates?

Grace and Terry: Balanced nutrition is extremely important in managing blood glucose levels. Eating three meals a day plus small snacks in between and at bedtime can prevent extreme fluctuations in blood glucose. Fifteen grams of carbohydrate equals one serving. General guidelines for carbohydrate intake are 3-5 servings of carbohydrate (45-75 grams) per meal and 1-2 (15-30 grams) servings of carbohydrate per snack. The American Diabetes Association recommends that people with diabetes follow an individualized meal plan based on their lifestyle to manage diabetes and weight. 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. We also recommend that you view information from the National Diabetes Information Clearing House at the following website: http://diabetes.niddk.nih.gov/dm/pubs/eating_ez/index.htm or http://diabetes.niddk.nih.gov/treatments/index.htm You may also visit www.riteaiddiabetes.com for extensive information on meal planning and food choices.

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Los Angeles, CA: I take metformin(500mg)twice a day. My blood sugar reading after eating is around 148. How come my blood sugar is around 199 after dinner? I eat around 60 grams of carbohydates.

Grace and Terry: Unfortunately we do not have sufficient information to adequately answer your question. Is the 148 reading after breafast? How long after? How long after dinner is the 199? Do you eat 60 grams of carbohydrates after each meal? Are you taking any other medications? Please resubmit your question to our "Ask the Pharmacist" section at our Rite Aid Website at www.riteaiddiabetes.com.

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LA: Im a student from argentina.how to buy metformina in usa?

Grace and Terry: Metformin is available in the United States by prescription only. Therefore you would have to consult with a physician here, and that physician would determine if he/she should prescribe metformin for you.

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Edison,New Jersy: Hi, I have gestational diabetes during my first pregnancy. But not for my secong pregnancy. I want to know my chances of getting diabetes later in life. Thanks

Grace and Terry: 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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San Francisco, California (S.E.Lawrence): From Tom Blackwell, National Post in Toronto, Canada, Dr. Salter has injected into the pancreases a substance that corrects and cleared up Diabities. What is up on this?

Grace and Terry: We think that you are referring to a study done on mice, that identifies the role of pain nerves in the cells that produce insulin. It was found that abnormal nerve endings in the insulin producing cells of the pancreas initiated a chain of events that caused type 1 diabetes in mice, if the nerve cells were removed the mice did not develop the disorder.(1) As far as we know, no studies have been done in humans. (1)www.diabetesincontrol.com/modules.php?name+News&File=article&sid=4412 (the journal Cell, 12/14/2006)

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Davis CA: My husband has had type 2 diabetes for over 20 years. In the last 3 years has been taken to the hospital 6 times because he has been found unconcious and unresponsive with low glucose levels - less than 40. There are numerous (each month ~ 5 times) his numbers are so low that he raids the fridge for sugar laden foods to bring the numbers up. He believes he is controlling his disease well enough. He does not record his testing, nor how much insulin he takes. He forgets if he has taken his insulin and then re-takes it sometimes. His diet is very poor, high fat, infrequent meals, poor choices when he does eat - NO vegetables, high starch, NO exercsie ever, etc. How do I

Grace and Terry: Hypoglycemia can cause shakiness, weakness, nervousness, headache, hunger, mental confusion, and blurred vision. If blood glucose levels get very low, a patient can have convulsions or become unconscious. As your husband's partner you may notice such signs and symptoms, and may need to act fast by giving your husband 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. However, if your husband has become confused and is not thinking clearly, he may resist help. If he loses consciousness and can no longer safely swallow foods or liquids, you may need to inject glucagon, which makes the liver release stored glucose into the bloodstream. In some cases you may need to call emergency services. We recommend that you and your husband consult with your physician or endocrinologist for an evaluation of his diabetes and diabetes medication, and if he is suffering from diabetes complications from unconrolled diabetes. Your physician may also be able to suggest how you may assist your husband in keeping tract of his glucose readings, dietary needs, and medication regimen, and work as a team to keep your husband healthy.

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Finleyville, PA: What is a good glucose reading 2 hours after eating?

Grace and Terry: 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). 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) We recommend that you consult your physician to determine what specific goals are appropriate for you.

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Silver Spring, Maryland: Should a diabetic patient use vibrating bedroom slippers? I want to purchase for a Xmas gift.

Grace and Terry: If there is a chance that damage to the feet could be caused by using the vibrating slippers, then another gift might be more appropriate. People with diabetes sometimes develop a condition called peripheral neuropathy and the condition may result in decreased sensation in the feet. If this patient has peripheral neuropathy, they may burn or injure their foot and not be aware of it. This could lead to infection and possible amputation.

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KENTUCKY: WHY DO I FEEL SO TIRED AFTER MY BLOOD SUGAR HAS GOTTEN HIGHER THAN WHAT IT SHOULD BE?

Grace and Terry: One symptom of hyperglycemia (high blood sugar) is drowsiness or a tired feeling, this could be caused by less nutrients being able to get to the cells for energy.

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san rafael california: How does Bocca Burgers figure as part of a diabetic compliant eatting plan?

Grace and Terry: These are vegetarian burgers and the amount of carbohydrate, fat and protein contained in each pattie should be included in the total daily intake program that your dietician or nutritionist has suggested.

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Long Beach, CA: Is there a conflict in taking Tylenol and taking metformin & glyburide & avandia? jack112229@alumni.uci.edu

Grace and Terry: We did not find any drug:drug interactions with taking Tylenol (acetaminophen) with these medications that is known to cause harm. Please note however you should not be using more than 4000 mg of acetaminophen per day (maximum dose per 24 hour period).

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Harmony, New Jersey: My husband was just diagnosed with type 2 diabetes, where do i find out about healthy snacks and what he can eat? We have not had a chance yet to meet with a dietician.

Grace and Terry: One of the best resources for healthy eating that we have seen is the ADA website. www.diabetes.org . A link to the healthy food choices is: http://www.diabetes.org/nutrition-and-recipes/nutrition/healthyfoodchoices.jsp . The National Institute of health also provides information on diet and diabetes at: http://www.nlm.nih.gov/medlineplus/diabeticdiet.html

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New York, NY: My suger has hit a new high 385. At What number should I run to the emergency room? Thank you.

Grace and Terry: It's important to treat hyperglycemia as soon as you detect it. When your blood glucose levels are above 240, you should test for ketones. Call your physician if you find moderate amounts of ketones in the urine. If you have ketones, do NOT exercise. Often, your health care provider can tell you what to do over the phone. Call your health care provider at once if: your urine test shows a large amount of ketones, if your urine tests show large ketones and your blood glucose level is high, or if you have vomited more than twice in four hours and your urine tests show high ketones. You can drink water. Water helps remove the excess glucose from your urine and helps you to prevent dehydration. Test your bg every 4 hours. You may want to review what had happened before testing your blood glucose, to try to determine what caused the elevated results. If the numbers continue to remain elevated, you should call your health care provider. Call your doctor if your blood glucose is consistently greater than 180 mg/dL 1-2 hours after a meal or if you have two consecutive readings greater than 300 mg/dL.

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ADA Moderator : We would suggest that you inquire into Medicare coverage, or any county or state funded programs that your mom might qualify for. We also 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 her medications directly in order to obtain information about available patient assistance programs. Please check with your local Rite Aid pharmacist for assistance with the manufacturer's name for the prescriptions your Mom may use. My Father recently passed away. And I've been useing his Ascensia Breeze to monitor my glucose level. The first time we checked it the reading was 350 and my mother told me to get my butt to a Doctor.My father was ill aand passed away about a week later.I changed my diet right away and it droped to 130-124-117 then it has started going back up to 200.

That's it for today. Thanks so much for taking the time to be here Grace and Terry.

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 guests will be Rite Aid Pharmacists and Diabetes Care specialists at 1:00 p.m. ET Thursday, February 1, 2007. See you then.