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ADA Moderator : Welcome to ADA Live!
Today our guests are Michele Seifert, R.Ph., Pharm D. a Drug Information Specialist at the Rite Aid Drug Information Center and Michele McClung, PharmD, R.Ph. a diabetes care specialist at The Rite Aid Diabetes Connection in Parkersburg, WV.
It's a pleasure to have you here today Michele and Michele.
Michele and Michele: Thanks...we have lots of great questions already.
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Frasier Park, California: How do I find a Diabetic Educator in my area?
Michele and Michele: Go to aadenet.org (the website for the American Association of Diabetes Educators). In the bar on the left side of the screen, click on "diabetes education" then "find a diabetes educator". There you can enter your zip code and find the closest educators.
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WINTERHAVEN: MY AIC IS 5.9 IS THAT THE AVERAGE OR IS IT HIGH? WAS 1 1/2 YEARS AGO 8.6
Michele and Michele: An A1c of 5.9 is excellent. The usual goal for A1c is less than or equal to 6.5 according to the ACE (American College of Endocrinologists) and less than 7.0 according to the ADA (American Diabetes Association). Congratulations on getting your numbers under control! Keep in mind, however, that the A1c is an average. That means that if you are having a lot of low blood sugars, that number will make your diabetes control look better than it actually is.
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Arizona, USA: what is the name of the blood test that diabetics receive every 3 months?
Michele and Michele: The test is called the A1c and measures your average diabetes control over the past 3 months.
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Seattle, Washington: Has anyone ever heard about the mangosteen fruit in Thailand helping diabetics significantly?
Michele and Michele: Mangosteen juice has become very popular lately and you can find lots of testimonials about it on the Internet. To date, there is insufficient reliable information that proves that it is either safe or effective. The FDA sent a warning letter to a company that was promoting this juice for a whole list of uses because it has not been proven. That is not to say that it won't work, but it is better to stick with things that have been proven to be safe and effective.
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Erie Pennsylvania: I seem to itch whenever I have a high or too low blood sugar. Have been a diabetic for 30 years and my doctor seems to think it has nothibg to do with Diabetes.
Michele and Michele: Itching is commonly a sign of high blood sugar. As your body tries to pull water from anywhere it can to dilute the sugar in your blood, your skin can become dry and itch. It is not as common of a sign of low sugars, but some people have signs of lows that are unusual. If it happens most of the time that you have a low, it is probably related to your diabetes.
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Hammond Louisiana: my uncle has been diagnosed with diabetes and he really smokes alot but he is very active not overweight at all but could this smoking play a major role in his diagnosis
Michele and Michele: There are several risk factors that make it more likely for a person to get diabetes. Smoking is one of those risk factors. Smoking can increase blood sugar levels and decrease the body's ability to use insulin. Additionally, the chemicals in tobacco can lead to muscle, blood vessel, and organ damage which can also increase the risk of diabetes. Once diagnosed, smoking can affect many aspects of diabetes. It can aggravate heart and blood vessel disease, increase blood glucose levels, increase the risk for development of nerve damage or kidney disease, or damage and constrict blood vessels worsening foot ulcers as well as leading to leg and foot infections. Additionally, smoking increases the risk of cancer, raises the blood pressure and cholesterol levels, causes impotence, and makes it easier to catch a cold or respiratory infection. People with diabetes who smoke are three times more likely to die of cardiovascular disease than non-smoking diabetes patients. We recommend that your uncle speaks with his doctor, diabetes educator, or pharmacist to discuss smoking cessation products. There are numerous products available to help him quit including pills, patches, gum, and inhalers (Some of these products require a prescription).
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Denville, N.J.: I am a 62 yr. old female with fasting blood sugars of 112-116. I am presently on Triamterene HCTZ to control blood pressure. Knowing that I am at risk for developing diabetes, I have purposefully lost 23 pounds ( from 173 to 150 since May 06, but my FBS was 116 last week. My Primary care physician says my BS is okay. What do you advise?
Michele and Michele: According to the American Diabetes Association, fasting blood sugar between 100 and 125 is classified as pre-diabetes. This means that you do not have diabetes, but you are at a higher risk of getting it than someone with normal blood sugar readings (less than 100). The best treatment for pre-diabetes is weight loss, exercise and eating a healthy diet. It has been shown that these measures can prevent or delay the progression from pre-diabetes to diabetes.
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derry: do you see people with diabetes as being ill?
Michele and Michele: I don't like to label people as ill. We all have ailments, some of us more than others. Someone with diabetes is no more ill that someone with heart problems or chronic pain or allergies.
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hot springs,ar: Is it possible to take lantus at bedtime, novolog at mealtime and still need an oral medication. Would take be over medicating?
Michele and Michele: In most cases, that would not be overmedicating. There are two things that can be happening in diabetes: your body doesn't produce enough insulin or your body doesn't use the insulin it has properly. Sometimes, both problems are happening in the same person. Different types of insulin mimic what your body would do naturally if you didn't have diabetes. Normally, our bodies would release little bits of insulin all the time to prevent sugar from being high between meals (that's what your Lantus does). It would also give bursts of insulin when we eat a meal (that's what your Novolog does). Most diabetes medications help your body use insulin more effectively.
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topeka kansas: I have just been informed that I have gestational diabetes.. and the only thing my doctor has said/done is made me get a testing kit and test myself four times a day.. she has not but me on a diet and she has not giving me or told me I need Insulin. reading this page it says that the first thing she should of done is but me on a plan.. anybody is my doctor right or wrong ?? this page says she is wrong.
Michele and Michele: The first thing someone with gestational diabetes should do is meet with a dietician and educator to learn the basics about their condition and develop a diabetes care plan. This may include a meal plan, blood glucose testing, urine testing for ketones (a chemical your body produces when your sugar is very high), kick counts, increased monitoring of the baby, insulin injections, and other things that apply to your particular case. If you feel that you are not receiving optimal care from your doctor, you may want to consult with a high risk obstetrician who works only with pregnancies that have complications like diabetes.
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Chicago, Illinois: I was a type one diabetic for 23 years, before I received a pancreas/kidney transplant in March of 2004. My question is do I need to have follow up visits with an Endocrinologist. The transplant team draws my blood every month to check my amalyse level, and so far they have been wonderful. I just need to know if the transplant doctors are they only doctors I need to see right now, and I have not asked them if I needed to see Endocrine.
Michele and Michele: It is so wonderful to hear success stories like yours. You probably do not need to see an endocrinologist any longer unless you encounter a problem. However, you should ask the transplant team to be sure. They see people in your situation very frequently and know your particular case as well.
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chennai,India: i have diabetes for 7 years. my blood sugar levels of late are in control with hba1c level at 6.9( it was 8 three months back). does diabetes affect marital life in the sense sexual life? i have recently started having problems of no excitement in it.
Michele and Michele: Uncontrolled blood sugar can cause loss of libido (sexual desire) in both men and women. It can cause erectile dysfunction (the inibility to achieve or maintain an erection) in men and vaginal dryness in women. While your control has certainly improved, you may benefit from even lower numbers. Ask your doctor if trying to achieve a lower A1c is appropriate for you.
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Kent, Washington: I've been diagnosed pre-diabetes. When doing at-home test I'm getting numbers that don't make sense to me. 120s in the morning, which I would expect to be a fasting number and mid 90s in the afternoon, after a breakfast and lunch. What is the proper fasting period/method to give the at-home test any meaning? Thnks.
Michele and Michele: Often when people have pre-diabetes, their numbers are above normal either fasting or after meals and normal at the other time. High sugars only in the morning (after not eating for at least 8 hours) is called impaired fasting glucose or IFG. High sugars after meals (and we are referring to 2 hours after the start of your meal) is called impaired glucose tolerance or IGT.
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Denver, CO: I have type II diabetes. Recently, my big toes have turned black under the toe nail. Is this due to diabetes or some other problem?
Michele and Michele: Diabetes can damage nerves and blood vessels in the feet and cause lots of different foot problems. Any changes in your feet, especially any type of black spots, warrant a call to your doctor. Foot problems left untreated can quickly get worse and lead to very unpleasant things like loss of a toe.
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cedarburg, wisconsin: My son's teacher said he fell asleep in class last week. My mother is a diabetic and had a glucose monitor, so we tested him after school he was over 200 and continued to be over 250 every day @ the same time. I took him to my ped. He was 96, They said he was diapbetic. But he also had strep. We have continued to monitor him,he is ranging from 130-190, but in the am he has been 100 or so. He however, hasn't been over 200 since Friday. Could the strep have just caused the high levels? OR does he have diabetes?
Michele and Michele: Illness can cause blood sugar fluctuations, but usually only in someone who already has diabetes or pre-diabetes. He may benefit from taking an oral glucose tolerance test, where he drinks a sweet drink and they test his sugar 2 hours after to see how well his body can handle the sugar. This may give the doctor additional information. Also, there is a condition where blood sugars are higher than normal, but not high enough to be called diabetes. This is called pre-diabetes and correlates with a fasting blood sugar of 100-125 and a sugar 2 hours after meals of 140-200.
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Valparaiso, IN: My husbands family doctor said that Ingrown toe nails and bad teeth can affect his diabetes. I would like to know if this is true. I have told my husband what the doctor said but he does not believe me.
Michele and Michele: Any type of illness, even things that seem small like ingrown toenails and bad teeth can raise blood sugar. Any problem with the feet is especially worrisome for someone with diabetes because ulcers that progress to needing amputation can start as something very small.
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Lake City, Florida: I have yet another urinary infection. When my doctor checked my urine he also said I was dry and needed to drink more. I drink a lot of water, so I don't understand why I would be dehydrated. How much water should I be drinking? Is there a possible underlying reason that I would be dehydrated despite plenty of water consumption? Thank You for any helpful info you can provide.
Michele and Michele: Eight 8oz glasses of water a day is adequate for most people, but you may need more when the weather is hot or while you are exercising. Excessive thirst and frequent infections are both possible symptoms of diabetes. You may want to ask your doctor if he has run blood tests to rule out diabetes as a possible cause.
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Hampton, South Carolina: Can a pancreas transplant cure type 2 diabetes?
Michele and Michele: No. In type 2 diabetes, the main problem is not with the pancreas. It is the cells not responding properly to insulin that is made. That often makes the pancreas work overtime and wear out. Even if someone with type 2 takes insulin, the pancreas transplant would only help until the cells wear out the new pancreas. That is why doctors generally will not put a new pancreas in someone with type 2.
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Bluefield, West Virginia: I need to know how many of each exchange I should have each day.
Michele and Michele: We are not qualified to make that assessment because it differs depending on your weight, gender, activity level, and if you want to lose or maintain weight. Only a dietician is really able to make a recommendation specifically for you. I would recommend finding a dietician in your area and working with them to find a meal plan for you.
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mumbai,maharashtra: how much exogenous plain insulin is required to neutralise 25 grams of dextrose not taking into consideration of endogenous insulin
Michele and Michele: This will vary from person to person. People who inject insulin have a number called an insulin to carb ratio or insulin sensitivity. This tells them how many grams of carbohydrate 1 unit of insulin will take care of.
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Altha, Florida: I have Type 2 diabetes and am currently prescribed Glucovance 500mg/ twice per day. However, this current therapy dose not seem to be helping my fasting glucose readings which continue to be 130-215. Is there a specific medication that might help control the sugar dumping overnight
Michele and Michele: Glucovance is a combination drug and there are actually 2 medications in it, metformin and glyburide. The strength is given in two numbers, such as Glucovance 500/5. The medicine that will help the most with "sugar dumping" is the Meformin. You are taking a total of 1000mg per day and may benefit from increasing. Talk to your doctor about the best thing to do for you.
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raleigh: I have been diabetic for two years. in the last year I have gained fifty pounds. I went to the emergency room a few days because my sugar level was almost 400 fasting. It took them several hours to get it down to 260 then they let me go home. my tester is broken and reads all over the place. It could not be adjusted. It is called flash and i have strips for it. Is there any place I can get one for a very reduced price or free now i have no health insrance. I am very weak and un steady now I am sure the count is high. I have an appointment with a dr on 29.
Michele and Michele:
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Acushnet, Massachusettes: Hi my mom has type 2 diabetes. She complains that she can not eat anything with sugar at all. So she will not eat much. Is there a certain amount of sugar she can eat in a day? Is there certain foods that are good for her to eat? Is there somewhere I can find any of this info.. I told her to ask the doctor about this but I dont think she has... She also has high colesteral so see says there is nothing she can eat between both circumstances. Meal time is difficult here and I dont know what I can prepare for her and she is not giving much help... Thank you in advance for any help you may offer....
Michele and Michele: It sounds like your mom has received some misinformation about what is a healthy meal plan for diabetes. It is very important that she meets with a dietician who can help her make a meal plan specifically for her. Have her ask her doctor for a referral to a dietician in your area. In answer to your question, it is not "sugar" that we are concerned with in diabetes, but rather carbohydrates. All carbohydrates eventually break down into sugar and can affect blood sugar. Foods that contain carbs include sweets; starches like bread and pasta; fruits; starchy vegetables like corn, peas, and potatoes; and milk products like ice cream, milk, and yogurt. This is not to say that she needs to cut these foods out of her diet, but she needs to eat moderate and consistent amounts of them. The dietician will help her figure out exactly how much she can eat.
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west bend, WI: What is M.O.D.E.?
Michele and Michele: The only thing with that acronym that we could find that is diabetes related is the Michigan Organization of Diabetes Educators. Most states have an organization that allows diabetes educators to share ideas and attend classes to learn about new advances in diabetes. One other thought is that you are referring to MODY, which could sound the same as MODE. MODY stands for maturity-onset diabetes of the young which is genetically inherited and caused by a defect in a single gene. It is a rare type of Type 2 diabetes that only accounts for 1 to 5 percent of people with diabetes. MODY patients are typically in their teens or twenties and are thin. To diagnose MODY, the usual diabetes urine and blood test can be performed along with genetic tests. MODY can often be controlled by diet and/or diabetes medications in pill form. Patients with MODY are not resistant to insulin but have a defect in insulin secretion or glucose metabolism.
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vacherie: can adults get type one diabetes
Michele and Michele: Yes. While type 1 is more common in children and adults younger than 30, it can happen at any age.
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jacksonville, florida: Concerned that I may have diabetes. what were your systoms and what made you go to the doctor to be tested? what test were done & how soon did you find out? thank you
Michele and Michele: The most common symptoms of diabetes are excessive thirst, excessive urination, excessive hunger, and fatigue. There are two tests that can diagnose diabetes. One is the fasting blood sugar test where they test your blood after you don't eat anything for 8 hours. The second is an oral glucose tolerance test where they have you drink a very sweet drink and test your sugar two hours after. The results from these tests usually come in within a week.
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Rancho Cucamonga, CA: My husband and I are newdly weds and He has type 1 diabetes, I want to be able to help him control his diabetes, so i try to educate my self on the subject. 1st and foremost is what amount of carbs should he be consuming daily to keep his blood sugar normal?
Michele and Michele: Because this varies from person to person, we are unable to give you this information. When he was first diagnosed with diabetes and periodically thereafter, he should have met with a dietician, who is qualified to tell him how many carbs he needs.
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belle plaine mn: how many units of insulin do you need per gram or grams of carbs . one extra quetion if my suger is at 200 how much isulin should some take to bring it down to a better level ..
Michele and Michele: We are unable to give you the information you are requesting because this varies for each person. Your doctor will be able to give you this information, called an insulin to carb ratio and a sliding scale or correction bolus.
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St. Louis, Missouri: Can a veteran from Vietnam contract diabetes from exposure to Agent Orange? How does one determine if Agent Orange gave him diabetes (if it is possible) or if it is just inherited?
Michele and Michele:
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santa rosa, ca: my blood lab report: Glucose=112 abnormal, note ADA Guidelines for fasting glucose. What does this mean? Thank you.
Michele and Michele: If this was a fasting test (you hadn't eaten in 8 hours) this reading is above normal. Normal fasting blood sugar is less than 100. Diabetes is diagnosed when your level is 126 or above. You fall in between those numbers, which is called pre-diabetes. This means that you do not have diabetes, but you are at a higher risk of getting it. If you eat a healthy diet, lose weight if you're overweight, and exercise regularly, you may be able to delay or prevent the progression to diabetes.
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sparta, new jersey: i went to my doctor recently and my fasting sugar test result was 106. i tested my sugar myself in the morning the next 2 days and the results after fasting were 94 and 102. 2 hours after eating my sugar is always 90 to 95. should i have any concern?
Michele and Michele: Fasting blood glucose readings in the range you are decribing (any readings between 100 and 125) point to impaired fasting glucose or IFG. This is a form of pre-diabetes where readings two hours after meals are normal, but fasting readings are elevated. The readings are not high enough, however, to be classified as diabetes. People with pre-diabetes have a higher risk of getting diabetes later on, and would benefit from a healthy lifestyle. This would include eating a moderate amount of carbohydrates, engaging in regular physical activity, and losing weight if overweight. It has been shown that these measures may prevent or delay the progression from pre-diabetes to diabetes.
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Arlington Heights IL: I am type 2 and I noticed my cousin (he just turned 40 and very over weight) presented the typical symptoms. I checked his blood (it was 418 at 6:16 pm he had not eaten anything since lunch. I then took his sugar after dinner approx 1 hour and it was 479) Does this mean he is definitely a diabetic? My other problem is that he currently does not have health insurance but will be coved in 30 days. if he gets tested now will this be considered a pre-existing condition? If so can he let this wait?
Michele and Michele: Two random blood glucose readings above 200 accompanied by the typical symptoms of diabetes does point towards diabetes. However, only a doctor can truly diagnose this condition. It is dangerous for him to allow his blood sugar to remain that high and he should see a doctor as soon as possible. As far as his health insurance is concerned, different plans look at pre-existing conditions in different ways. The most important thing is that he is seen as soon as possible and gets his blood sugar under control. The longer he leaves it in this dangerous range, the more damage it does to his body.
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South Bend Indiana: what concerns do people face with diabets
Michele and Michele: This is an interesting question. Because everyone is different, everyone has different concerns about diabetes. Many people are concerned about the bad things that uncontrolled diabetes can do to the body, such as kidney disease, blindness, loss of a toe or leg, or heart disease. Most people are concerned that they will have to drastically change the way that they eat or other aspects of their daily life. Some people are concerned about low blood sugars and how to treat them. Others are concerned that they will have to take medication or insulin to treat their diabetes. Some are worried that people will treat them differently if others know about their condition. Whatever concerns a person has about their diabetes, it is important that they talk to their doctor or another member of their diabetes care team about these concerns. Many of the complications of diabetes can be minimized by regulating blood glucose.
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chicago, IL: What percentage of either type 1 and type 2 diabetics take diabetes pills? insulin?
Michele and Michele: According to the CDC (Centers for Disease Control and Prevention) in 2003, 49% of adults with diabetes were taking only diabetes pills, 19.4% were taking only insulin, and 12.3% were taking both.
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Howell, NJ : I am 50 years old and have Diabetes Type 1 and Celiac Disease as well. I am experiencing alot of hair thining and was wondering if my high blood pressure medicine (Fosopril) can be causing this? I recently had my thyroid and TSH levels checked and they were okay.
Michele and Michele: Fosinopril and other medications in its class called ACE inhibitors can cause hair thinning. You may ask your doctor to try switching you to a medication in a similar class called angiotensin receptor blockers (ARBs) that will have the same benefit on your blood pressure and kidneys but less of a chance to cause hair thinning.
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sioux city, ia: What is insulin?
Michele and Michele: Insulin is a hormone made by the body in the pancreas. The body is unable to properly use sugar without insulin. The insulin brings the sugar out of the blood and into your muscles where it can be used for energy.
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Bean Station, TN: How to count carbs. I get different answers . Is it safe to say that one carb equals fifteen grams?
Michele and Michele: Carb counting can be complex, so it is best to meet with a dietician to really understand it. We can only give the very basics here. There are two kinds of carb counting: for people generally trying to eat consistent amounts of carbohydrates at each meal and those who give themselves a dose of insulin based on the number of carbs they plan to eat. If your insulin dose depends on the number of carbs you eat, you need to count carbs exactly. If you do not take insulin or take fixed doses of insulin, it is safe to use the exchange system. In this system you round the carbohydrate content of a food to the nearest 15 grams, called an exchange. For example, a glass of milk that is 12 carbs and a serving of crackers that is 20 carbs would both count as one exchange.
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Oak Lawn, Illinois: My blood sugar level seems to be good at bedtime (100 - 115) but raises as much as 50 points overnight. Any ideas?
Michele and Michele: There are several things that happen in the body that can cause this. Sometimes the hormones that are at their highest levels in the early morning hours cause your blood sugar to rise at that time. If this is the problem, a change in insulin or medication dose may be necessary. The second problem may be blood sugar starting to drop during the night. In this situation, your body will compensate by releasing stored sugar and increasing blood sugar. Unfortunately, it usually overshoots and brings your sugar higher than it was before you went to bed. A way to prevent this is eating a snack containing both carbohydrate and protein before bed. The third thing that can happen is that the liver (where sugar is stored) can slowly leak out sugar overnight. A medication called metformin can often help with this issue.
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Chattanooga, TN: What is consider to be the normal range for blood sugar?
Michele and Michele: Normal blood sugar is a fasting reading of less than 100 or a reading two hours after a meal of less than 140.
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Saratoga, CA: My mother is having a difficult time regulating her sugar level. We were wondering, since there are short and long term residential programs for rehab and weight loss, are there any for diabetic people to learn the diets and exercise (appropriate for older people)? Thank you.
Michele and Michele: We are not aware of any residential programs specifically for diabetes, but there is something called diabetes self-management education. This is a program that takes about 8 hours, which can be done all in one day or spread over weeks or months. In this program you will learn all of the basics about diabetes, including defining diabetes, nutrition, exercise, short and long term complications, setting and achieving health related goals, monitoring diabetes, medications and insulin, adjusting to living with diabetes, and diabetes and pregnancy (if appropriate). Ask your doctor about a diabetes education program in your area.
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Buckhorn, Ontario: My husband was just told he has IFG, which is not surprising given fam. history. I am just wondering if it explains all the symptoms he originally went to the dr. for. Is there anywhere to get a list of possible symptoms of IFG?
Michele and Michele: Impaired fasting glucose or IFG is often a precursor to diabetes. Most people do not have any symptoms at all, but those who do have the same symptoms as someone who has uncontrolled diabetes. These symptoms are frequent thirst, frequent hunger, frequent urination, and fatigue.
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Semmes Alabama: My husband has recently been diagnosed with diabetes. His palms have begun to turn yellow in the last couple of days. Could that be a reaction to his medication or have anything to do with the diabetes?
Michele and Michele: The symptoms you describe could be the result of many health conditions. We are unable to determine the exact cause of your husband's symptoms. We recommend that he consults with his physician regarding the symptoms he is experiencing for a proper diagnosis and treatment.
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Hopkinsville, KY: My husband has been told that his blood sugar has been going up periodically. He was only told to cut back on his pop and sugars. We recently found out that his mother had diabetes before she died at 47. She hadn't been taking her meds. My husband has had numerous health problems, swollen lymph nodes, flu symptoms, headaches almost daily, continuous thirst, frequent urination, trouble sleeping. He has been checked for cancer, AIDS, TB, and anything else the Doctors could think of and the only thing they can come up with is it is an autoimmune disorder. He recently found out about the diabetes. Could that be the main cause? The doctor didn't tell him anything. What should we do now? Should we get him to a specialist that works with diabetes or should be find a family doctor that will be more aggressive in finding out what is happening? We have three young children and we don?t want me raising them on my own. He feels bad almost daily but he is still making himself get up and go to work EVERY day. Can you PLEASE help?
Michele and Michele: The most common symptoms of diabetes are frequent hunger, frequent thirst, frequent urination, and fatigue. Headaches can also be a symptom. Usually blood sugar is checked when labwork is done, but it wouldn't hurt for him to ask his doctor what his fasting blood sugar is. Anything over 100 is abnormal. There is also another test that can be used to diagnose diabetes called an oral glucose tolerance test. This is a test where you drink a very sweet drink and then they test your blood sugar after several hours to see how well your body handles the sugar. In that test, any reading over 140 is abnormal. If his numbers are higher than that and he feels that his family doctor isn't paying enough attention to his blood sugar, it would be a good idea to get a second opinion from an endocrinologist (a doctor who specializes in diabetes).
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Oakton,Virginia: I have a friend who is also diabetic, she takes Hummlus N and then if her reading is 150 or over she takes R in 5 cc/mgs/?? ex:150=5 R, 250 +10R and so on. Well her readings range from the low 20 to 300 and over all in the same week. It seems that the R at nite makes the moring reading very very low.What do u have that may work better. She is 73 years old. HELP
Michele and Michele: R and N insulins have been around for a long time and work very well for some people. If your friend is having very uncontrolled blood sugar, however, she may benefit from a newer insulin. There are new insulins that are similar to Humulin N called Lantus and Levemir that she would take once or twice a day. There are also new insulins similar to her Humulin R called Novolog, Humalog, and Apidra that she would take when her sugars are high (called a sliding scale or correction bolus). Have her ask her doctor if these insulins would be right for her or find an endocrinologist (a doctor who specializes in diabetes).
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KENNEWICK WA: I was recently diagnosed with Type 2 diabetes this past October. Is there a certain magic number for low blood sugar and prevention?
Michele and Michele: In general, anything below 70 is considered a low blood sugar and requires 15 grams of fast acting sugar. Just as important, there are things that you should do to prevent low blood sugars. Make sure you eat a consistent amount of carbohydrates at your meals and try not to go more than four hours without eating. Also, if you take insulin, make sure that you are eating enough for the amount of insulin you take and timing your insulin and meals properly. Lastly, check your sugar and have a snack if needed before physical activity because exercise lowers blood sugar.
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Middlesboro, KY: Is it true that there is a shot that can cure diabetes?
Michele and Michele: Currently, there is no cure for diabetes. There are some very good shots available that improve blood sugar levels, but they are not a cure.
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Daly City, Ca. 94015: I just want to know what type of diabetes i have i dont know i take metformin 1000mg lisinipril, and hydrochlorets. all pills
Michele and Michele: We are not able to make diagnoses based on the information we have. However, we can tell you how the different types of diabetes are commonly treated. Type 1 always requires insulin injections. Type 2 can require pills, insulin, both or neither.
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Melbourne, FL: I have seen so many suggestions for releiving neuropathy of the feet. Are there any real cures or relief to treat this condition. I've had Type 2 diabetes for 15 years and am unable to find relief For this very uncomfortable affect. Now I'm trying orthopedic shoes as a last result. This, if it works, will only providre relief for walking.
Michele and Michele: Diabetic neuropathy occurs when the nerves in the body are damaged. It is unknown exactly what causes neuropathy to occur. Currently, there is no cure for neuropathy. Treatment is targeted at treating the symptoms associated with neuropathy. Each person will have to be treated differently 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 associated with diabetic neuropathy.
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Urbana, IL: I have sudden hunger attacks, my hands even are shaking at times, furthermore my skin is easily bruised. Does it mean that I have diabetes?
Michele and Michele: Hunger and shakiness can be signs of diabetes, but they can also be signs of other conditions. If you believe that it may be diabetes, ask your doctor to run a fasting glucose test or an oral glucose tolerance test to be sure.
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Ethel, LA: In order to check my blood glucose level, I need a list to determine if my sugar is too high or too low. Thanks
Michele and Michele: We think you are referring to a recommended range for blood glucose values. According to the American Diabetes Association, fasting blood glucose should be less than 130 and two hours after eating blood sugar should be less than 180. According to the American College of Endocrinologists, fasting blood glucose should be less than 110 and blood glucose two hours after eating should be less than 140. It is best to check with your physician to determine which set of recommendations are appropriate for you to follow.
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Worcester, Mass 01610: How does Accutane affect juvenile diabetes? Are insulin requirements different? Does it affect blood sugar results when testing?
Michele and Michele: Isotretinoin (Accutane) lists hyperglycemia (elevated blood glucose levels) as a possible side effect. Additionally, there have been reports of new onset diabetes in patients using isotretinoin. However, the isotretinoin has not been confirmed as the cause of these new cases of diabetes. We recommend that you speak with your physician to discuss your use of isotretinoin and your concerns regarding diabetes.
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Chico, CA 95928: I recently had two operations. In both cases they perscribed antibiotics. I noticed in each case after taking the antibiotics, my blood sugar was considerably lower. That is the only drug I was taking that I can attribute to the drop in my blood sugar. I ate the same way, probably excercised less, yet my blooksugar dropped. Can you explain this????????
Michele and Michele: Antibiotics, like other medications, have potential side effects. Some antibiotics can cause decreased blood glucose levels while others will cause increased levels. Without the exact name of the antibiotics you were prescribed, we can not say for certain if decreased blood glucose levels is one of the side effects that would be possible with their use. You may resubmit your question to our "Ask The Pharmacist" service with the names of the antibiotics and we would be we happy to review our references to determine if either of them can cause this reaction.
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Lubbock Texas: What am I to take to counteract my blood sugar when it is higher than normal? I have a sinus infection at the time and taking antibiotics along with my usual heart medication.
Michele and Michele: Some doctors prescribe fast acting insulin to lower blood sugar during illness or ask you to increase your current insulin dose. Sometimes this is not necessary and it is sufficient to monitor your blood sugar more closely and make sure that it doesn't get too high and comes back to normal after you are well again. Ask your doctor what is best in your case.
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Chicago: What are your thoughts on Symlin. My doctor says it can be mixed with insulin even though the packaging says no. True or false?
Michele and Michele: "Mixing insulin" can be interpreted two different ways. Symlin should not be mixed in the same syringe as insulin. However, it is meant to be taken by people who take insulin and is taken with mealtime insulin. While it has sometimes intolerable side effects (nausea and vomiting), when prescribed properly it often lowers blood sugar and allows you to decrease your mealtime insulin dose.
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San Antonio,Tx: i am on Avandia pills but i have been taking Prednisone 5 mg but my sugar is 655 what can i do to bring it down fast. I have been useing to bathroom about 5 times in the middle of the night
Michele and Michele: A blood sugar reading as high as yours needs immediate attention. It can not be lowered quickly at home. Please call your doctor or go to the hospital emergency room for assistance.
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New York, NY: I wake up in the morning with fasting glucose levels over 500. What is wrong with me. Are there specialist in my area that can help me?
Michele and Michele: Readings consistently over 500 are a cause for concern. It sounds like a change in medicine and/or insulin is needed. While we are not familiar with the doctors in your area, there should be several endocrinologists (doctors specializing in diabetes) reasonably close. Ask your family doctor for a referral or go to www.aace.com (the website for the American Academy of Clinical Endocrinologists) and click on "find an endocrinologist" in the bar on the left hand side of the screen.
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Puyallup, Washington: More frequently after I eat about 30 mins after I become extremely thirsty sometimes to the point that I am shaking? I feel better after I down a bottle of water.
Michele and Michele: Try checking your blood sugar when you feel this way. More than likely, it is elevated. When your sugar is high, your body wants to dilute the sugar in your system. That is why you crave water and why you feel better after you drink a large amount of it. Speak with your doctor to discuss the reaction you are having and your blood glucose readings. The doctor may need to adjust your medication regimen accordingly.
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Villa Rica Georgia: I've been told that I am pre-diabetic. I'm 37, 5'4", and 109 lbs. with no family history. I was gestational and insulin dependent with 2 of my pregnancies. My fastings are fine, all other endocrinology test are fine except that I have IGT, My endo stated that I am right on the line of type 2 with my levels, and wants me to start glucophage. However, my last 2 A1c have been 5.6. I do not eat much or exercise. I am hesitant to start glucophage. I've read the pre-diabetic journal on this site. Understandable that it's based on over weight patients. The question is, if I start eating a low carb diabetic diet and exercise will I be able to avoid glucophage, or am I headed towards being type 2 no matter what? Thank you for any information that can guide me.
Michele and Michele: The studies have shown that diet and exercise are actually more effective than metformin (Glucophage) in delaying or preventing the progression from pre-diabetes to diabetes. Some people do end up with type 2 diabetes, regardless of the changes that they make or medication that they take. However, those healthy changes give you a better chance to avoid it. You mentioned a low carb diet. People with diabetes in general should get roughly half of their calories from carbohydrates. The important thing is to eat moderate amounts and space them throughout the day. You may benefit from meeting with a dietician and working out a meal plan that works for you. We recommend that you continue to speak with your doctor regarding your symptoms to determine if the doctor feels diet and exercise alone are a good treatment option for you or if the medication is necessary.
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Grand Rapids, Mi: My physician recently added me on byetta 5cc . I am currently taking amaryl 4mg qd. since I began the byetta I have been having severe hypoglycemic attacks, as low as 31. I then broke the dose of amaryl in half with the same results. For the past 2 days I did not take the amaryl and I have noit had any symptomatic hypoglycemia. There is a msg in with my doctor. How low is a too low bg? I am worried because I cant function when that happeds and it takes me a good hour to stabilize.
Michele and Michele: Byetta often makes Amaryl and other medications in its family work better than they should. Generally, any blood sugar less than 70 is considered too low. When you have a low, make sure that you are using fast acting sugar to treat it. This may be regular pop (not diet), fruit juice, candies that contain no chocolate or peanut butter such as jelly beans or life savers, glucose tablets or gel, or skim milk. Anything with fat (like chocolate) will slow down how fast the sugar gets into your system and may make it take longer for your sugar to stabilize. We recommend that you speak with your physician to determine how to alter your medication regimen or meal plan to better control your blood glucose levels.
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Okemos, Mi: I have a 14 year old, female student recently diagnosed with type 1/2 diabetes (I know rare, but thats what they've told me), her sugar levels were at 300 over xmas, so they started her on 4 doses of insulin every day, 8mg a shot. Since she returned to school I have called 911 three times. Obviously her level goes out of whack before we can even catch it. These are my questions: Can an eating disorder cause the onset of diabetes? Are there mood disorders or changes, such as stubborness associated with low blood sugars? (Her level was at 41 today, and I couldn't get her to eat or drink anything, she argued with me, just before she passed out.) Also, what is the effect of stress on insulin levels? Her parents are recently in the middle of a custody battle, as well as other issues, like the eating concerns! Any additional information would be helpful and appreciated. I'm trying to learn as much as I can, as fast as I can. Thank you, A concerned educator
Michele and Michele: The onset of diabetes is sometimes triggered by a physical or emotional stressor in someone already predisposed to diabetes. It could be possible that an eating disorder or custody battle could have played a role, but we can not say for certain. One of the most frustrating symptoms of a low blood sugar for people around the person with diabetes is changes in mood. It is very common for the person experiencing a low to be irritable, stubborn, and argumentative. Stress can have a profound impact on diabetes control, usually increasing sugar but occasionally causing lows. If you haven't already, you may want to look into having a diabetes educator come to school and give additional training to anyone who may be involved in this student's care. Even if someone came in the very beginning, it may help to have a follow-up session now that you have dealt with this situation and have questions.
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Hiawassee, Ga.: My husband has been running an average of 160/170 for almost two months. His A1C last week was 6.8 but shouldn't his daily blood sugars be controlled better than that? Our doctor was satisfied with the 6.8 and couldn't adequately explain why he wasn't worried about the high blood sugar levels but I am. Can you shed some light on this?
Michele and Michele: Both the A1c and the home blood sugar monitor have limitations and should be used together. The A1c is an average. If you have a high numbers and episodes of low blood sugar, your average may look perfect even though you know you are having lousy control. An A1c of 6.8 actually is equal to a blood sugar of 165, so it looks like your tests are agreeing. That said, there are some studies out there that show that keeping your numbers even lower (less than 6.5) will decrease your risk of diabetes doing damage to your body even further. Have him stress to his doctor that he would like to see his numbers lower and ask what is the best way to get those lower numbers in his case.
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Eureka, CA: I have had a fasting reading of 140 3 times and in the 120's several times.My level is above 100 most of the time. Should I be concerned. I went to a P.A. and when she tested my blood sugar level is was 96, she said that I do not have diabetes, that my husband's meter is wrong. My husband's Doc checks his meter every time he goes in , every 3 months. At that point I just said thank you and left and made an appt. with my Doc. Should I be concerned?
Michele and Michele: Blood sugar readings can fluctuate from day to day or even minute to minute. Even people with diabetes can occasionally have a reading below 100. If you do have diabetes, it is important to catch it as early as possible. It is best for you to keep your appointment with your doctor and have a regular fasting blood glucose test or oral glucose tolerance test performed to determine if you have diabetes. Self monitors are not intended to diagnose diabetes. They are simply to monitor the condition.
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Memphis Tn : Iam in high risk of getting diabetes and I have this condition call aconthosis nigricans. I am overweight and I wanted to know if I loose weight and get in a better health condition if this condition would go away? Is it curable?
Michele and Michele: Acanthosis nigricans itself is not harmful, but it can be frustrating. It is a sign of insulin resistance, which is very common in overweight people. Losing weight generally reduces your insulin resistance and may lessen or eliminate the acanthosis nigricans.
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Ontario Canada: I have type 2 diabetes. I have heard so many different things about its reversability. Is type 2 diabetes reversable? Can a person get to a stage where they not only do not need meds anymore, but also no longer have to monitor?
Michele and Michele: Anyone who has diabetes, even if well-controlled, should never stop monitoring completely. It is not "reversible"; however, in some people it can be controlled through major changes in lifestyle (diet and exercise) alone. Some people who have lost a substantial amount of weight have been able to stop using insulin and diabetes medications and have normal blood sugars. However, it is important that they continue to monitor to make sure that blood sugar levels do not start to worsen/progress again.
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Clearwater. Florida: Do you believe that Splenda is safe? I thought that I read something that indicated that it may not be, because of some unknown chemical component.
Michele and Michele: The FDA approved Splenda in 1998 after reviewing over 100 studies that took place over 20 years showing that it was safe. It is sweeter than sugar and does not affect blood sugar.
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Baton Rouge LA: I know you have to fast to get the correct number but what if you forgot to fast and the number came back with a 114. Can you actually determine from that?
Michele and Michele: If you ate anything in the past 8 hours it is not a valid fasting test. You can't determine anything from a non-fasting reading of 114. Tell your doctor that you forgot to fast and ask him to retest your blood sugar. Don't forget that fasting includes not drinking anything besides water.
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ADA Moderator : Diabetes has been linked to exposure to Agent Orange in Vietnam Veterans. If you have other risk factors for diabetes, it would be difficult to determine what was the exact cause. There is medical assistance available through the VA for qualifying veterans who have developed diabetes. For more information, please contact the Agent Orange Helpline at 1-800-749-8387 or visit the Department of Veterans Affairs website discussing Agent Orange at http://www.vba.va.gov/bln/21/benefits/herbicide/. Additionally, the ADA's website has information regarding Agent Orange and diabetes at http://www.diabetes.org/type-2-diabetes/agent-orange.jsp The companies that make blood glucose meters will often give their meters away, because if you have their meter it is more likely that you will buy their testing strips. At our pharmacy, we have free coupons for the flash meter. You may want to try you local pharmacy. Or you may want to call the company directly at 1-888-522-5226. They also provide testing strips for free if your income is low enough to qualify.
That's it for today. Thanks so much for taking the time to be here Michele and Michele.
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, March 1, 2007. See you then.
Michele and Michele: Thanks for having us. It's been a pleasure.
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