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ADA Moderator : Welcome to ADA Live!

Today our guests are Marvin Bouchon, R.Ph. is a drug information specialist at the Rite Aid Drug Information Center and Dani S. Dolin, RPh, PharmD.

Marvin and Dani: Thanks. Happy to be here. We have a lot of great questions already today. We'll get to as many as we can.

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Chicago, IL: I am working hard getting my type 2 diabetes under control. On the whole, my readings are going down, but I am still having a problem with higher readings after breakfast through early afternoon, even though I am controlling my eating. I take Metform 1000 mg twice a day, Glyburide 5 mg twice a day and Lantus 20 units in the am and 15 units in the pm. I also take Plendil and Uniretic in the am. Is there a way to switch around my meds so that my readings are consistent throughout the day? I sometimes experience some low readings (low 60's) in the evenings or during the night.

Marvin and Dani: It's hard to make a recommendation without seeing your glucose log and bloodwork, but if you are having "higher" readings after breakfast and lunch, perhaps it's time to start taking injections of a rapid acting insulin like Novolog before meals and get rid of the glyburide. There also needs to be some investigation into why you are having lows. I might recommend that you try to find a dietician or diabetes educator in your area. Sometimes inconsistent carbohydrate intake can cause sugars to go up and down. Some people find that they may not be eating enough carbs at some of their meals, although the meal may be plenty big. Testing at bedtime can be a way to help decrease nighttime lows. If the blood sugar is <110mg/dl, may educators will have their patients eat a small snack (such as a low fat yogurt, a couple fig newtons, etc). Again, it is hard for me to make a true recommendation without actually seeing your log. I think that you would really benefit from meeting with a dietician familiar with diabetes or a certified diabetes educator who can review your log, eating patterns, and activity and come up with a plan to help you normalize those sugars. In the meantime, keep a detailed glucose log where you mark what time of day you are testing (before breakfast, lunch, or dinner, 2 hours after breakfast, lunch, dinner, at bedtime, etc) and make notes about reasons why you think you might be high or low (skipped breakfast, had big Easter dinner, etc).

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Laguna Beach, Ca.: for diabetics, the recommendation is 1/3 cup of pasta for 1 carb exchange (15 grams). How does one measure 1/3 of a cup of pasta?

Marvin and Dani: The cooking yield of pasta depends on whether it is dry or fresh pasta and on the shape of the pasta. Since fresh pasta has higher moisture content and absorbs less water during cooking during cooking, a given amount of fresh pasta will serve fewer people than the same amount of dried pasta. The cooking yield of pasta is as follows: Small to medium pasta shapes such as shells, rotini, spirals, bow ties, penne and rigatoni: 8oz of uncooked equals 4 cups of cooked. Long pasta shapes such as angel hair, linguine, spaghetti, vermicelli and fettuccine: 8oz equal 4 cups of cooked. Egg noodles: 8oz uncooked equals 2&1/2 cups cooked. Fresh pasta: 3 oz uncooked makes one cup cooked. So to answer your question directly if you had fresh noodles and wanted your recommended serving of 1/3 of a cup you would measure out 1 oz of uncooked which would make 1/3 cup of cooked pasta. More generally, you could also just cook your pasta, put it into a measuring cup and see how much you have. Cooked pasta is soft and conforms well to the shape of a measuring cup.

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Long Branch, N.J.: If a diabetic client isexperiencing confusion what could that be indicative of?

Marvin and Dani: It is best to test the client's blood sugar if they appear confused. If <70mg/dl, they are likely having a low blood sugar reaction. Confusion, irritability, mood changes, shakiness, and dizziness are just a few of the many potential symptoms of a low blood sugar. If this happens, the client need to eat 15 grams of a fast-acting carbohydrate like 1/2 cup fruit juice, 1/2 can of pop, 1 cup of skim milk, 3-4 glucose tabs, 5 saltines, 1 tablespoon of honey. Wait 15 minutes and see if the blood sugar has come up. If not, repeat. Confusion can also be a sign of a high blood sugar, along with symptoms of blurred vision, fatigue, and frequent thirst and urination. If the client's blood sugar is >240mg/dl and/or they are nauseated, vomiting, confused, having muscle cramps, or showing signs of dehydration with other symptoms of high blood sugar they need to get to the doctor immediately. Confusion in a patient with diabetes may or may not be indicative of a problem with blood sugar. It is always be to test to rule out problems with the blood sugar. then other causes can be explored.

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Las Vegas, NV: My son was diagnosed with type one diabetes at the age of 18. He has been in and out of the emergency room frequently with acidosis and sugar levels over 1000. I have recently discovered that my son is also a habitual user of oxycontin (not prescribed). My question: does oxycontin have any know adverse effects on diabetics. Affect on insulin effectivness?

Marvin and Dani: Insulin's effectiveness should not be bothered by the Oxycontin, and many patients with diabetes are safely prescribed painkillers. Because your son is having a problem with prescription pain medications, I would suspect that he is not always taking his insulin as directed. When he is on the Oxycontin, he may not care to take his insulin. Persons with this type of addiction often do not prioritize self care, including taking medications, like insulin, as prescribed. For young people who have frequent ER visits for ketoacidosis, we often suspect drug use. Being "high" on oxycontin may make him dizzy/drowsy and less likely for him or his friends to recognize a low blood sugar. Oxycontin, when taken under the guidance of a doctor, can be a safe and effective medication. When individuals, having diabetes or not, take a drug without being supervised by a physician, they open themselves up to may dangers including side effects, drug interactions, addiction, incarceration, and death. Although I'm sure it will br difficult, I recommend that your son see a mental health professional and consider joining Narcotics Anonymous. Unprescribed use of pain medication and be dangerous and deadly for anyone, but especially for a young person with diabetes. Controlling diabetes requires a lot of hard work and focus. It requires that someone be in control of their life and devoted to testing, taking medication, making doctors appointments, and caring about their health. Please continue to love and support your son, and help him get the help he needs.

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Indianapolis: Is it true or false that a child who loves, eats lots of sweets, is more likely to get diabetes when they get older? This child is six years old, and is not overweight by any means. She just loves sweets. We do restrict at some level, but what isn't safe? (We know it's not good.)

Marvin and Dani: Eating certain foods, like sweets, will not increase a person's risk of diabetes UNLESS it causes the person to gain weight. Obesity is a risk factor for diabetes, but eating a lot of food, not matter what the food, does not increase risk. Diabetes is a disease where the body has a problem breaking down the foods we eat. As long as the body can metabolize the foods we eat, we;re in good shape. That being said, >18 million people in THIS country have diabetes and the number continues to rise. Excess amounts of sweets are not good for diabetes, cholesterol, blood pressure, or the waist line. It is easier to teach children healthy eating habits when they are young and let them grow up eating that way, then to have to make a total lifestyle transformation later in life should they get diagnosed with one such disease.

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Chicago, IL: Hi, There are two questions and one comment i want to address today with you. My first question regaurds tattoos. is it safe for a type 2 diabetic to get a tattoo? My second question: is when your doctor calls you pre-diabetic (insulin resistence) and you are currently on metformin called type 2 diabetes. My comment is, i thik you should put a notice of some sort on you website stating that the anti-depressent seroquel causes diabetes in people who are exposed to it if their family has it. thank you, gary

Marvin and Dani: The risks for a person with diabetes getting a tattoo are the same as that of the general population. So yes, you can live a normal life! Your blood sugars may run higher that day; it will be a stressful, exciting, and painful time! Should you get an infection from the tattoo or have a reaction to the ink, you could expect your sugars to go up. Make sure you choose a parlor that meet local safety regulations and always uses clean instruments. It may not be a bad idea to get your hepatitis B vaccine, which can be transmitted by needles. Second question: Prediabetes is when your fasting blood sugars are between 100-125mg/dl. If they ever are more than that first thing in the morning, you may want to see your doctor again about getting a diabetes diagnosis. Pre diabetes is not necessarily insulin resistance. The problem with type 2 diabetes is that either the body is not making enough insulin or the body is resistant to its insulin (it doesn't recognize the insulin). Metformin may be used in patients with type 1 or type 2 diabetes or even in those with prediabetes. Some physicians will used metformin in patients with prediabetes to keep their blood sugars from rising to "diabetic range," thus helping to prevent diabetes. Thank you for the note about Seroquel. The company who makes the drug has put a notification in their literature about the risk of diabetes associated with the drug.

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san diego california: What is A1C and what is the ADA's goal for a person's A1C?

Marvin and Dani: Hemoglobin A1c, commonly referred to as, A1C, is a component in the red blood cells that increases in proportion to the blood glucose level over the preceding 3 to 4 months. Because the red blood cell has a life span of 120 days, this test reflects the glucose concentration over that period of time. It is an accurate, objective measure of glycemic control. The ADA recommended A1C goal is < 7.0%. The lower the A1C, the better. A measurement of 7% reflects a glucose reading of approximately 170mg/dl, 8% is about 205mg/dl. The higher the A1C, the poorer the diabetes control. A patient with an A1C of 12% has a glucose level around 345mg/dl. Individuals without without diabetes have an A1C range of 4-6%.

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semnan,iran: what s the relationship between metformin and blood creatinine level?

Marvin and Dani: Metformin is mostly excreted by the kidneys. Blood creatinine levels are used to monitored or determine one's kidney function. That is why patients who are taking metformin typically have their creatinine levels checked because if their kidney function is starting to decline metformin may accumulate in the body and increase the risk of lactic acidosis. Lactic acidosis is when lactic acid builds up in the blood stream faster than it can be removed. Common symptoms to describe lactic acidosis is nausea and weakness.

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sa diego california: What is a normal postprandial blood sugar level?

Marvin and Dani: The ADA recommends that the goal for indiviudals with diabetes have a fasting blood glucose (before meals) below 110mg/dl, postprandial glucose (peak after a meal) below 140mg/dl, and A1c less than 6.5%.

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naples, fl: is diabetes infectious?

Marvin and Dani: No, if you could catch diabetes from someone else, I would certainly have it. It cannot be transmitted from one person to another, although family history is certainly a strong risk factor. Other risk factors include age, having a baby weighing >9lb at birth, pre diabetes (fasting blood sugar 100-125mg/dl), high cholesterol or blood pressure, obesity, and certain minorities (African American, Asian American, American Indian, Latin American).

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fort collins, CO: just saw a recipe for a cake mix with 1 can diet 7 Up, no other added ingredients. This recipe came from

Marvin and Dani: You'll have to look at the portion size on the nutrition information- how big a piece of cake can you eat? There really is not food that you have to avoid as a person with type 2 diabetes. You just have to watch how much and how often you eat things like cake. If you make the cake, how much will you have? Will you stop at one piece, or will you pick at it bit by bit until you've eaten the whole thing in a matter of days? It does have 25 grams of carbs, which is roughly equal to a sandwich, so go ahead and try it, as long as you include it in your meal plan, and can limit how much you eat of it.

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karachi: i want the 10 name of companies whish manufacures non-invastive meters..i want to know about prices and methods too

Marvin and Dani: Unfortunately, we do not have non invasive meters at this time. Medtronic Minimed has a "real time" device that reduces the need for multiple daily fingersticks. A catheter is inserted into the subcutaneous layer of fat (like an insulin injection) and can be worn up to 3 days before changing sets. It is the size of a pager and interacts with the insulin pump (also the size of a pager and runs around $6000). For more information, go to www.minimed.com Another noninvasive device is the GlucoWatch. It isi indicated to supplement, not replace regular glucose testing. It records the blood sugar every 10 minutes for up to 13 hours. It's readings have about a 15 minutes lag time from regular testing, which might pose a problem in the event of low blood sugars. The watch sells for about $600 and the sensors, which must be changed at least every 13 hours, run $7.50 each. A statement of medical necessity is required for insurance coverage. You can find more information at www.glucowatch.com Most modern glucometers offer alternate site testing. While still invasive, alternate site testing can give the fingers a break. Finger testing is still recommended by many educators for post meal testing, testing around exercise, and for treatment of hypoglycemia as alternate sites can have a lag time. Glucose testing from the fingers has the most up-to-date glucose information, but alternate site testing can be appropriate for before meal tests. Freestyle, Ascensia, Accu-chek, and One Touch are companies that offer alternate site testing meters. Prices are comparable between all meters, althogh sometimes insurances have a preferred meter for which they will provide better reimbursement. Usually pharmacists have this type of information. Also, pharmacists often have coupons for free meters; Rite Aid has a program where we can provide free Accu-chek meters with the purchase of test strips.

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owensboro ky: once you are diagnosed with diabetes, do you always have it or can weight loss and diet show your numbers to not be diabetic?

Marvin and Dani: Unforunately, once a diagnosis of diabetes has been confirmed, it can not be cured/reversed. However, with proper diet, exercise, and/or medication, diabetes can be kept "under control" and you may not even require any medications but you are still a diabetic. Learn as much as you can about diabetes and how to prevent complications. People with diabetes can live long, healthy, happy lives. The important thing is to take care of yourself and follow your physicians recommendations.

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Chicago, IL: I currently take 500mg metformin, yet my random blood glucose is, at times, above 400mg/dl. What should I do?

Marvin and Dani: Easy answer. Get in to see your doctor. Keep a detailed record of your sugars and what time you're testing (whether it's before meals, 2 hours after meals, or at bedtime) and this will help your doctor decide what to do about medication adjustment. Stick to the testing times I just mentioned (unless you are testing because you feel sick, low, or are exercising) because these are the times where we have recommendations for what yor sugar should be.

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Southgate, KY: My doctor says I have an A1c level of 6.5...does this mean I have diabetes?

Marvin and Dani: Use of the A1c for the diagnosis of diabetes is not recommended at this time. However, according to the American Diabetes Association, reference to a patient without diabetes is 4.0-6.0%. An A1c level of 6.5% represents a mean plasma glucose level of 152mg/dL. Speak with you physician about having a fasting plasma glucose (FPG) test done or and Oral glucose tolerance test performed. These are two of the most common test that meet the criteria for the diagnosis of diabetes.

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Smyrna, Tennessee: My husband has type 2 diabeties and is having a bad time keeping his sugar regulated, he is the general manager of a used vehicle, buy here pay here, sales lot. I am wanting some information on diabeties and stress. I said something about being under alot of stress will make his sugar levels go up. He ask me to show him something in writing that states stress is a factor in making sugar levels rise. Can you help me with something that he can read that relates to this . thanks, concerned wife

Marvin and Dani: You are right, stress can definately affect blood sugars. Good stress or bad stress, those sugars can go up. The ADA website has a good article on it your husband can read. http://www.diabetes.org/type-1-diabetes/stress.jsp

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Springdale Ar.: Why is my Blood sugar so much higher in the morning before I eat, and what # should I look for. I get home frome work about 11:45 Pm with a normal reading of 80 to 110 Am reading will be around 120

Marvin and Dani: 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. If you eat a snack before bed, you might want to try adding cheese to it, because it is a protein it takes longer for your body to breakdown. It would be best to consult your physician for proper treatment.

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downey ca: what happens when the blood test reads 37?

Marvin and Dani: Low blood glucose levels or hypoglycemia occurs when the blood glucose level falls below 70 mg/dL. Ideally, your blood glucose level should remain above the 70 mg/dL. Symptoms of hypoglycemia include shakiness, dizziness, inability to concentrate, headache, sweating, hunger, fast or pounding heart, fatigue, paleness, weakness, fainting, sudden moodiness or behavior changes, tingling sensations around the mouth, clumsy or jerky movements, and poor or blurred vision. If your blood glucose drops very low you may develop slurred speech, confusion, seizures, combativeness, or pass out. To help prevent hypoglycemia, eat meals and snacks on a regular schedule and test your blood glucose levels frequently. It is very important to treat hypoglycemia as soon as it is detected. If you are not sure but feel like you could be hypoglycemic it is best to treat before it gets worse. If you are having low blood glucose readings regularly, you should speak to your doctor for an evaluation of your condition and medication dosages. For more information on low blood sugar, please visit our Rite Aid diabetes website at www.riteaiddiabetes.com. If you do not have symptoms of hypoglycemia or think your glucometer may be in error when you have a reading like 37mg/dl, use your control solution to make sure the meter is working properly. Also, in the absence of symptons of lows, make sure that you are getting enough blood on the strip.

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Talpa, TX: I have very tough skin and am having trouble getting enough blood to the surface to use my monitor. I have to pinch and work at it to get enough blood to get an accurate reading. Often, I have to stick myself 4 or 5 times in different spots to finally get a little drop of blood and then it isn't enough for a reading on the monitor. Isn't there anything easier to use? I do not check it near often enough because of this problem and I don't have the extra time during the day to spend working at it to get enough blood to test. They gave me a longer finger pricker but it works no better, I put it to the highest level and just cannot get blood to the surface.

Marvin and Dani: A couple suggestions... 1. Prick the sides of your fingers which are usually less callused. 2. Run your hands under warm water to get the blood circulating in the fingers. 3. Hold your hands below heart level and let them dangle to get more blood flow to the hands. 4. Use a meter that requires less blood. Freestyle actually requires less blood than any other meter. 5. "Milk" your fingers . Don't just squeeze the tips, but massage the whole hand and finger to get the blood to the tip. Some folks use a technique where they use the thumb to apply pressure down the finger while bracing the pricked finger with the 4 fingers from the other hand. 6. Alternate site testing is another option. Most meters are approved to test places other than the fingers, like the forearm or palm of the hand. Your pharmacist or diabetes educator should be able to tell you if your meter is approved for this type of testing and show you how to do it, as the procedure is slightly different than finger testing. If you have your meter's instruction book, it should tell you as well. If all else fails, ask your doctor or hospital if there is a local diabetes support group, extension office, or diabetes educator who can help.

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birmingham uk: my mother has type 2, insulin dependent diabetes & suffers with her whole body skin being sore as though she has been burnt.this only occured when she went on insulin (glargine). however nobody in the proffession seems to have any answers for her, saying it is not related. can you please help us with this please as she is in constant pain.

Marvin and Dani: While injection site reactions sometimes occur with Lantus injections, these are usually limited to the area where the insulin was injected and are limited to pain, redness, stinging, etc. We are unaware of anything in the literature that links such a syndrome with Lantus, however, you can report it to "MedWatch." This is a form that the government uses to monitor and assess adverse drug events. The web address for the form is http://www.fda.gov/medwatch/

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Annandale, Va.: Thank you for this opportunity!! I have been recently diagnosed with Pre-diabetes, although my fasting number was 106, my A1C number is 6.5 - I am currently checking my numbers twice a day and doing EXACTLY what the dietician recommends - Do you think by doing this that I will be able to avoid Type II Diabetes? Thank you for your attention in this matter.

Marvin and Dani: According to the American Diabetes Association, before people develop type 2 diabetes, they almost always have "pre-diabetes" -- blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. Research has also shown that if you take action to manage your blood glucose when you have pre-diabetes, you can delay or prevent type 2 diabetes from ever developing. A Diabetes Prevention Program study conclusively showed that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range. This program also determined that diet and exercise worked better than medication. Just 30 minutes a day of moderate physical activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in diabetes

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Ipoh, Perak Malaysia: My husband is 31 years old and he is an insulin dependent. Does a diabetic will face difficulty in producing sperms?

Marvin and Dani: Diabetes can often cause sexual dysfunction in men- trouble getting or maintaining an erection. It is treatable with medication and maintaining near normal glucose levels, not smoking, limiting alcohol, and exercising helps as well. Men with poor glucose control or nerve damage can have what is called retrograde ejaculation where sperm is ejaculated into the bladder instead of the penis. Cloudy urine and small amounts of sperm ejaculated from the penis are symptoms. A urologist can usually offer treatment. There is a relationship between diabetes and infertility, but sperm count doesnot appear to be a significant factor.

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Cleveland county uk: can you suffer from severe headaches with diabetes

Marvin and Dani: That is a great question and the answer is yes. Headaches can indicate that blood glucose levels are too low. However, headaches can also be a sign of high blood glucose levels. It is very important that you tests your levels often, especially when experiencing any unusual symptoms. Doing so can help to determine the cause (high or low levels) these episodes. If your blood glucose levels are controlled we recommended consulting with your physician regarding these headaches. You can get additional information on how to treat high and low sugar levels through our website www.riteaiddiabetes.com

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peoria illinoix: i have been having a slightly nauseating feeling in my stomach, in january, not february, and now again. i am drinking alot because i feel thirsty, and have a sweet taste in my mouth. are these symptoms? paula

Marvin and Dani: The symptoms you are experiencing describe, diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHNKS). Diabetic ketoacidosis (DKA), also known as diabetic coma, occurs when the body lacks insulin and breaks down fats for energy. When this occurs the body produces ketones which can be found in the urine. Ketoacidosis occurs when the body does not get rid of all the ketones in the urine and they build up in the blood. This is a life-threatening situation and needs immediate treatment. DKA is associated with blood glucose levels from 200-2,000mg/dL.Long term (years) hyperglycemia can lead to coronary artery disease, skin breakdown, infections, peripheral vascular disease which may lead to amputation of limbs, loss of vision, numbness and tingling in the extremities, feet problems, skin ulcers, joint problems, and kidney problems. Extremely high blood glucose readings are a medical emergency and require medical assistance. Other common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. If you have any of the above listed symptoms and your blood glucose levels are high, consult your physician for evaluation. I understand this is scary for you but it is very important to start the appropriate treatment if you do have diabetes. If you are diagnosed with diabetes, seek a diabetes education program which can be found on the ADA website or through your physician.

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Ulysses, KS: What are acceptable blood sugar levels?

Marvin and Dani: According to the American Diabetes Association, 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%, Before meals - 90 - 130 mg/dl (5.0-7.2 mmol/l), and 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), and Two hours after eating a meal - Less than 140 mg/dl (less than 7.8 mmol/l). You should consult your physician to determine what specific goals are appropriate for you.

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barrie, ontario: Last year I went for my annual physical and I did not have diabetes. This year I went, and I do. Can I change my diet and lifestyle enough to make it go away completely or is it here to stay?

Marvin and Dani: Unfortunately, there is no cure for diabetes. That being said, beginning an exercise program, changing your diet, and making other lifestyle modifications can help you to control the diabetes and slow the progression. There is hope, and the cool thing about diabetes (if there is such a thing) is that there is a lot you can do to control it. Some patients can control thier diabetes for many years just by changing their lifestyle without even going on medications. Others may start on a medication, but after losing some weight or beginning an exercise regimen, are able to decrease or go off their meds. Stay motivated and make some positive changes. You can do it!

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Irwin Idaho: I have a sister in ID who needs immediate attention, has an open wound on her leg and very sick. She has no money and she has not been excepted by medicare yet. Where can she go and who can help her knowing that she doesn't have the money? She may loose her leg or worse her life

Marvin and Dani: Your sister needs to get into the Emergency Room as soon as possible. Getting her well has to be the first priority. Most hospitals have internal procedures about how to work with patients who cannot pay. I do not believe that they will deny a patient care who cannot pay.

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snellville ga: How common is it for someone in their late 40's to be diagonosed with type 1 diabetes? and what is the cause?

Marvin and Dani: Although the majority of type 1 diabetes occurs before age 30, it can develop at any age. With type 1 diabetes there is a progressive decline in the beta cell (cells that make insulin) function, usually caused by an autoimmune attack. Overt diabetes may be precipitated by an acute illness or increased stress. During this time, high blood glucose readings will continue until the illness or stress has ended and the patient may enter a compensated state where the beta cell mass production is sufficient to maintain normal glucose levels. This is the "honeymoon phase", where there is a period of non-insulin dependency and this phase may last from 3 to 12 months. There will be continued destruction of beta cells and ultimately the patient will have permanent type 1 diabetes and require insulin. If this is what is happening in your case, prevention of type 1 is probably not an option.

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rye nh: why is insulin a last resort in the treatment of type 2 diabetes?

Marvin and Dani: I'd love to know the answer to this question. Insulin is often the last resort and I hate that. It is a wonderful drug and if I ever get diagnosed with diabetes, I want to skip the pills and go straight to insulin. Many patients and some doctors are afraid of insulin. Some doctors are not confortable with how to dose it and adjust it, while some patients think that the needle is a foot long. Many patients "fight the needle, " fearing that bad things will happen when they begin insulin treatment. Actually, the longer patients let their blood glucose be out of control, that's when the bad things start to happen. Some patients are not willing to test more often, and others fear low blood sugars. Some think the shot will hurt. All of these factors can be worked out by communication between the doctor, patient, pharmacist, and diabetes educator. Insulin is not a bad thing!

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Chattanooga, TN: My husband was told he was borderline diabetic about 2 1/2 yrs ago and he never finished testing himself or followed up. He has been having spells where he is light headed, dizzy, and extremely tired. He is also frequently irritable. He started testing again. Today it was 160 when he woke up, but after he ate lunch today, about an hour it was 109 and he was dizzy and tired, then he tested again another hr later and it was 161. Is he now diabetic? We are going to keep testing before he goes to the doctor b/c of limited funds/no insurance. How many times a day should he test and when?

Marvin and Dani: Your husband definately should get in to see the doctor. The American Diabetes Association defines diabetes as a fasting (nothing to eat for 8 hours) glucose of 126mg/dl or greater or a random (anytime) glucose of 200mg/dl or greater. There is another test called a glucose tolerance test that may be done. Only the doctor can diagnose diabetes, and although money may be tight, the sooner your husband gets a diagnosis and treatment, the less expensive things will be in the long run. There are some glucometers out there that are designed for those with low incomes. Talk to your pharmacist or diabetes educator about which machine may be right for your husband. Resist the offer of doctors to give you a free meter unless if you have a way to pay for the strips; strips can be quite expensive. One way to see what your husband's sugars are running without using a lot of strips is to test once daily, but at a different time each day- alternating before breakfast, lunch, dinner, and bedtime, in addition to 2 hours after meals. Be sure to write down what time you are testing with regard to meals, so that we know what the numbers mean. For instance, before meal readings should range 90-130mg/dl, 2 hour post meal sugars should be less than 180mg/dl, and bedtime readings should be 110-150mg/dl. Some people find this too difficult and like to test twice a week, but test 3 times a day instead of once a day. The doctor can give him more specific instructions on testing.

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North Aurora, Illinois: Will airport screening devices, x-rays, etc. affect insulin vials and/or pens, meters and/or test drums/strips and what is the recommendation for air travel regarding diabetic supplies?

Marvin and Dani: It is recommended that when you fly, you carry your insulin, needles, and testing supplies in your carry on. Your insulin should be stable at room temperature. There are no specific recommedations for diabetes medications and supplies going through screening devices, so you should be safe. Do make sure that you have the presciption label for your medications and syringes that matches the name on your airline ticket. Let the airport screeners know that you have syringes, lancets, insulin, etc. Check out the ADA's website for more information: http://www.diabetes.org/type-1-diabetes/travel.jsp When planning your trip, keep in mind that your insulin doses may change if crossing times zones. You will also need to be prepared on the plane in the case of lows, so have some snacks in your carry on. Talk to your doctor about specific insulin dose changes.

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salinas,ca : what is the normal range for your glucose level?

Marvin and Dani: Normal blood glucose level values may vary slightly among different laboratories. However in general, normal blood glucose levels for a person who does not have diabetes before meals (fasting) would be less than 100 mg/dL (5.55 mmol/L). Blood glucose levels two hours after a meal would be less than 140 mg/dL (7.77 mmol/L). We were unable to find a specific guideline for 1 hour after a meal. For patients with diabetes, the American Diabetes Association recommends a glucose of 90-130mg/dl before meals, <180mg/dl 2 hours after a meal, and 110-150mg/dl at bedtime.

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Jersey City NJ: I have to go for a blood test for diabetes. Can I eat before the test?

Marvin and Dani: We would not recommend that you eat prior to your test. In order to diagnose diabetes the doctor must complete a blood test, either a fasting plasma glucose test or an oral glucose tolerance test. The results will determine if you have pre-diabetes, diabetes, or are normal. The fasting plasma glucose test measures the blood glucose level first thing in the morning after a person does not eat (fasts) overnight. The fasting plasma glucose test defines pre-diabetes as blood glucose levels between 100 and 125 mg/dl and diabetes as blood glucose levels at 126mg/dl or above. The normal fasting blood glucose level would be less than 100 mg/dl. The oral glucose tolerance test measures blood glucose levels first thing in the morning after a person fasts and then again 2 hours after the person ingests a drink that contains glucose. With this test, pre-diabetes is defined as the 2-hour blood glucose level between 140 and 199 mg/dl and diabetes as the 2-hour blood glucose level at 200mg/dl or above. The normal 2 hour blood glucose level would be less than 140 mg/dl.

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Troy, Michigan: My son is diabetic type 1 and plays hockey, he has trouble with early morning lows, could changing to a insulin pump help him and will he be able to use while playing hockey? he practices 3-5 days a week with 3-5 games a week. Thanks

Marvin and Dani: This is something to definately discuss with his endocrinologist. On days when he has practice and games, I'd assume that he tends to run low due to the increased activity. The pump would be nice because he could decrease his basal rates so that he's still getting some insulin , but it's a low amount. He may even be able to have a basal rates for days and times he's more active, and another rate for times when he's not as active. You would also be able to limit how much insulin he gets at night with the pump. Many kids who play sports use the pump, although some choose to disconnect it during the activity. For instance, some kids will disconnect the pump when they go jogging because the activity is sufficient to control their glucose. When they finish the activity, the hook the pump back up; it's a simple procedure. This would be something that could be worked out between you, your son, his doctor, and the pump trainer.

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Toronto, Ontaro, Canada: My friend with diabetes, has ankles and feet which are abnormally hard and sore. What should she do?

Marvin and Dani: Feet are something that we need to pay close attention to in a person with diabetes. She should be checking her feet everyday, looking for anything that wasn;t there the day before. She should be looking for sores, cuts, and signs of infection (redness, swelling, pain). Anything that doesn't heal within a couple of days or looks infected should be reported to the doctor. Sometimes exercises like walking or stretches can increase blood flow to the feet, but I think your friend should be checked out by her doctor to make sure that everything is okay and that it is safe for her to exercise.

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Uniontown, Pa.: I am concerned about my 15-month-old granddaughter. She appears very healthy and is a very happy, active toddler. However, tonight when I was baby sitting her I noticed a very fruity, acidic odor to her breath. She gulps water every time we give it her. She is losing what we thought was her

Marvin and Dani: You are a very good grandmother. There could be other explanations for your grandaughters symptoms other than diabetes but it would not hurt if you had her pediatrician or endocrinologist perform and FPG, fasting plasma glucos test on her because it is the preferred test to diagnose diabetes in children. She is presenting common symptoms of diabetic ketoacidosis (DKA). Diabetic ketoacidosis (DKA), also known as diabetic coma, occurs when the body lacks insulin and breaks down fats for energy. When this occurs the body produces ketones which can be found in the urine. Ketoacidosis occurs when the body does not get rid of all the ketones in the urine and they build up in the blood. This is a life-threatening situation and needs immediate treatment. DKA is associated with blood glucose levels from 200-2,000mg/dL. Symptoms of DKA include unexplained blood glucose greater than 250mg/dL, fruity smelling breath, dry mouth, nausea, vomiting, fever, abdominal pain, low blood pressure, shortness of breath, dehydration, increased heart rate, shock, and coma.

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greeneville tennessee: Is it the result of medicine needing to be changed or a symptom when a diabetics begins to becoome agitated easily with outburst and very short tempered? what do you need to do when they dont realize this is a medical problem?

Marvin and Dani: Mood changes can be a sign of low blood sugars. I recommend that you test the patient's blood sugar when he or she is having one of these episodes; if it is <70mg/dl, then you need to take action to get the blood sugar up. Use 15 grams of a fast-acting carbohydrate source (1/2 cup juice, 1 cups skim milk, 3-4 glucose tablets, 5 saltines, etc) and then retest. If the blood sugar has not risen to above 70mg/dl, repeat. See the following website for more information on how treat low blood sugars: http://www.accu-chek.com/us/rewrite/generalContent/en_US/article/ACCM_general_article_2387.htm Mood changes can be related to certain medications or may be a medical condition in and of itself. Test the patient's blood sugar to see if it is the culprit; if so, the patient may need a decrease in medication. If not, the patient may need further evaluation by a physician.

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Marshfield MA: Can physical trauma such as being involved in a severe car crash alter blood sugar?

Marvin and Dani: That is a great question and the answer is, yes physical trauma or stress can alter blood sugars. One of the most challenging issues with diabetes is that sometimes when it seems we are doing everything right we still see increased blood sugar levels. What we are eating, how we are exercising and when we take our medications do directly affect our blood glucose but sometimes there are other factors to consider. An increase in stress in our lives can set off metabolism processes that will elevate our blood glucose. Stress can occur from negative issues in our lives, such as a severe car crash, or stress can come from positive events like a daughter's wedding. Stress can also occur when we start to see those elevated readings. Stress can be managed by taking a few minutes and a few deep breaths everyday, reading a favorite book, or talking with a close friend, or just participating in whatever it is that you like to do. It is always a good idea to schedule a follow-up doctor visit when we start to see changes in our blood glucose readings. Take your logbook with you and your physician may be able to see a pattern in the elevations. The increased reading could stem from an underlying infection or simply the need for a medication adjustment. As time passes our bodies change and our diabetes changes, a medicine that worked for years may need to be increased or a new medicine added. Just remember, this isn't a failure just the natural progression of a disease.

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indianapolis[Submitted: 2007-03-28 05:32:00.000]: My sugar levels was 320 is this too high?

Marvin and Dani: Yes. The American Diabetes Association recommends that blood sugars run 90-130mg/dl before meals and <180mg/dl 2 hours after a meal. When your sugars are at those recommended levels, most people feel better and have less risk of diabetes complications. Consider making an appoiment with your doctor or diabetes educator to see how you can get your sugars down to the recommended range.

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Spokane, Wa.: Our care service has a client, male, in his 80's. Type 2 diabetic, Alz. and loves his wine, loves alot of wine! We have been un able to control the drinking, after all he's in his own home and we don't have that kind of control. I need some info. on this subject.

Marvin and Dani: Because of this patient's age and Alzheimer's disease, he would be at an increased risk of falls. Alcohol, like Alzheimers disease, can impair congition. Alcohol can increase the risk of low blood sugars, and intoxication can not only mimic the appearance of lows (confusion, weakness, slurred speech)but it can make it hard for the patient and others to differentiate between a low blood sugar and drunkenness. Alcohol can increase the risk of heart disease, stroke, high blood pressure, high triglycerides, eye disease, and nerve damage in a person with diabetes. The American Heart Association gives 2 drinks (2 glasses of wine in this case) as a limit for men. I would recommend a discussion with the patient, his doctor, and his family. Sometimes the doctor may be able to tell an individual what do something and they will listen. Sometimes, a family will have the ability to control a loved one's actions more than their health care team. It may also be appropriate to involve the patient in the decision making process. See how many drinks he's willing to sacrifice for the good of his health. Check out the ADA's website- www.diabetes.org/type-1-diabetes/alcohol.jsp

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Powell, Ohio: My daughter is a 25 yrs. old Type 1 and takes Lantus and Novolog. Most of her weight gain is in her upper abdomen. This gain has been a result of better diabetes control however has resulted in a 20# weight gain. She watches her food intake and eats small if no carbs and has been exercising daily the past month but no weight loss. Sheis getting very upset and I am afraid she will start to decrease her insulin to help her lose weight. Any advise or suggestios?

Marvin and Dani: Your daughter is definitely on the right track and she should be congratulated because it takes a lot of hard work to control ones diabetes. Unfortunatley weight gain is a side effect to Lantus and Novolog. Insulin is a fat-storing medication and large doses of insulin can cause weight gain. You may want to recommend her talk to her physician about Symlin. Symlin (Pramlintide) is with mealtime insulin and a proper diet and exercise program to control high blood sugar in people with type 1 and type 2 diabetes. It is used when patients who are already using insulin need better blood sugar control. Pramlintide acts like the natural blood-sugar lowering hormone called amylin. It works by slowing the movement of food through your stomach. It also decreases your appetite and the amount of sugar your liver makes. Pramlintide does not replace insulin, but it may lower the amount of insulin you need.

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Lexington, KY:: How often should one test for blood sugar levels if you are a type 2 diabetic.

Marvin and Dani: There is no set answer to how often a person with type 2 diabetes should test. It is very important, however, that you test. Testing is one way that you get direct feedback as to how your body is doing with diabetes. It is a way to catch any problems with your blood sugars (like high sugars every night before bed) and address them. While it may be recommended that one patient test once daily, another patient with type 2 diabetes may need to test 10 times a day. Blood sugar testing can tell you and your doctor lots of things like: are your sugars running high or low or perfect; what time of the day are they running high, low or perfect; is your medication working well all day, part of the day, none of the day; do certain foods or does exercise effect your blood sugar? There are lots of factors that can cause your sugar to go up and down; testing can help you to learn about them. Talk to your doctor or diabetes educator to find out exactly how often and when you should be testing.

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Deer Park, Texas: I have diabetes and I know it is not controlled. Recently I have noticed that my legs tingle all the time can this be another sympton from diabetes?

Marvin and Dani: This tingling could be a sign of diabetic neuropathy. It is not so much a symptom as it is a long-term complication caused from being an uncontrolled diabetic. Diabetic neuropathy is damage to the nerves that run throughout the body, connecting the spinal cord to muscles, skin, blood vessels, and other organs. The cause of neuropathy is unknown and currently there is not cure. There are different types of neuropathy which are classified based on if they affect one or both sides of the body, the type of nerve(s) affected, the number of nerves affected, and the parts of the body affected. There is a great link on the American Diabetes Association's website at http://www.diabetes.org/type-2-diabetes/diabetic-neuropathy.jsp which has wonderful information on neuropathies, their causes and treatment options.

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Devon England: My daughter has been diagnosed with type 1 diabetis. she is having a HYPO on a regular basis. what is the cause. What are the complications? She has difficulty in accepting her illness. She is self injecting 3 times a day & is leading her same busy life style She smokes and consumes alcohol

Marvin and Dani: Your daughter sounds like a very busy girl and the recent numerous lows can have a draining effect on an individual. Hypoglycemia may be caused by exercising, skipping meals, too much medication or insulin, drinking alcohol on an empty stomach, or changes in your schedule. Symptoms of hypoglycemia include shakiness, dizziness, inability to concentrate, headache, sweating, hunger, fast or pounding heart, fatigue, paleness, weakness, fainting, sudden moodiness or behavior changes, tingling sensations around the mouth, clumsy or jerky movements, and poor or blurred vision. If your blood glucose drops very low you may develop slurred speech, confusion, seizures, combativeness, or pass out. To help prevent hypoglycemia, eat meals and snacks on a regular schedule and test your blood glucose levels frequently. Ask your doctor how often you should check your glucose levels. It is important to know the symptoms of hypoglycemia and treatment options in order to prevent worsening hypoglycemia. If her blood glucose levels are low, consult her physician for evaluation. Remind your daughter that being a diabetic she is at risk for cardiovascular disease and smoking on top of that increases her chances of a stroke or heart attack even more.

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rapid city south dakota: I would like to know what the "honeymoon phase" is?

Marvin and Dani: The honeymoon phase is something that occurs in some patients with type 1 diabetes. The body goes into a temporary remission of diabetes, and the pancreas may resume production of insulin. Patients' insulin requirements can greatly decrease during this time. It is however a temporary stage, lasting weeks to a year depending on the individual.

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jackson, miss: over a couple of months my blood sugar was 133 which was a test that cover a three month period to average out my score. what is that

Marvin and Dani: The Hemoglobin A1c, often referred to as "A1c," is a test to measure the amount of blood glucose attached to the red blood cells. Results reflect average blood glucose level for past 2-3 months. the A1c is reported as a percent. The American Diabetes Association recommends a level <7%, which correlates to an AVERAGE blood sugar of 170mg/dl. Other guidlelines by the American College of Clinical Endocrinologists (diabetes doctors) recommend an A1c of 6.5% (~152mg/dl). the A1c is a nice way to give you and the doctor an idea of how your sugars are looking at times of the day when you are not testing. The A1c is to complement, not replace. daily blood sugar testing.

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Okemah, Oklahoma Submitted: 2007-03-19 22:02:00.000]: I am 71 yrs of age, I have been diagonosed with congestive heart, diabetes, enemia, allergy and asthma. I'm a mess literally. Recently i have been diagnosed with bronchial infection which is going around; and i am taking styroids with antibiotics. My questions is; does infections cause your sugar to go higher. I took my sugar test earlier and it was 440. Should I take some more diabetes medication or go to the ER?

Marvin and Dani: I'm sorry to hear that you've been under the weather. Different types of stress on the body, including infections, can cause the blood sugar to rise. Additionally, steroids, often prescribed for asthma flare ups, can cause the blood sugar to go up. When you are sick or prescribed a new medication, you may beed to test your blood sugar more often to see how it will be effected. Talk to your doctor about at which blood glucose level you should be concerned. Unless otherwise directed, drink lots of water when you are sick and report to the doctor if you feel nauseated, are vomiting, or cannot seem to get your sugars down. Do not take extra medication unless instructed by your doctor. Some doctors will put their patients on extra medication until an illness resolves to prevent high sugars.

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ANTHONY N,M: [Submitted: 2007-03-16 22:15:00.000]: CAN CINNAMON CAUSE CANCER TO DIABETEC PATINTES AND OTHER PEOPLE?

Marvin and Dani: Unlike pharmaceutical drugs, "natural" products like cinnamon are not required to undergo the FDA (Food and Drug Administration) approval process to demonstrate their safety and effectiveness. The FDA only regulates the package labeling, prohibiting a product from making claims that it is intended to diagnose, treat, cure, or prevent a disease. Additionally, "natural" products do not have to conduct side effect or drug interaction studies and therefore this information is not always known. There are two types of cinnamon--cinnamon bark and cassia cinnamon. Cinnamon bark does not have sufficient reliable information available about it's effectiveness in diabetes. Cassia Cinnamon taken orally possibly seems to improve type 2 diabetes. Some research suggests that taking cassia cinnamon 1 to 6 grams for 40 days can lower fasting serum glucose by 18-29%. Though there is some talk about cinnamon being tried to treat diabetes, there have not been any controlled clinical studies to prove that this will be beneficial or more importantly to show that it is not detrimental. Because the cinnamon has not been studied by the FDA, data about its link to cancer is limited. However, cinnamon for diabetes is related to the common cinnamon that we use in cooking. We recommend that you speak with your physician, diabetes educator, or endocrinologist before trying any "natural" products to treat your diabetes.

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Enterprise, AL[Submitted: 2007-03-19 14:44:00.000]: I'm an insulin dependent diabetic and I'm obese. I give my injection of insulin into my stomach. Would the insulin work better if I injected myself in another area of my body?

Marvin and Dani: The areas that are recommended for insulin injection are the stomach, back part of the upper arms, the outer part of the upper thigh, the upper part of the buttocks and hips. It is important to pinch a 1/2 inch of fat and inject your insulin into the fat so that you get the insulin into the "subcutaneous" layer of skin. Since you say that you are overweight, make sure that you are not getting "short" needles (it would say "short" on the box) which are designed for athletes or children are not able to pinch up that 1/2 inch of fat for an injection. Be sure that you rotate your injection sites. Giving your shot in the same spot every time can cause scar tissue to build up and the insulin may not absorb properly. If you inject in your belly, try to give it in a different spot in your belly each time. Sometimes when patients give their insulin in a different location that normal, it absorbs into the bloodstream at a different rate than usual, which may potentially cause low blood sugars. www.bddiabetes.com has a lot of good information about injecting insulin. Talk with your doctor or diabetes educator about which injection site or sites might be right for you.

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San Diego, Ca.: My son is very overweight and has a rash/sore on hus lower leg. Could that be a sign of diabetes? He does not have the other symptoms. He is 55 yrs old.

Marvin and Dani: Rashes and sores are not considered signs or symptoms of diabetes. That being said, the risk factors for diabetes include: age, family history, high blood pressure or cholesterol, pre diabetes (a fasting glucose 100-125mg/dl), obesity, having a baby born weighing >9 lb, and minorities such as African American, Latin American, American Indian, ans Asian American. Having a cut or sore that doesn't heal well can be a symptom of diabetes, along with increased thirst, hunger, or urination; unexplained weight loss, blurry vision, and fatigue. Sometimes people who are overweight can get rashes or sores in their skin folds. These rashes can often be treated with goldbond or over-the-counter antifungals. Sometimes, however, rashes and sores require prescription treatment and evaluation by a physician, especially if they are not improving or getting worse after a couple of days. If your son isn't under that care of a physician, I might recommend that he receive a routine physical including bloodwork.

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Indianapolis, Indina:[Submitted: 2007-03-16 07:31:00.000]: I'v have type two diabetes, on pills and insulin. I've been haearing about a new drug call something like atta or atte. Can you tell me something about it. Charlie Roush, 25yrs diabetic.

Marvin and Dani: Byetta was approved in 2005 for the treatment of type 2 diabtes. It is indicated for patients taking metformin, a sulfonylurea (glipizide, glyburide, glimiperide), or a thiazolidinedione (Actos, Avandia). It is given twice daily by a subcutaneous injection like insulin , but it is not a substitute for insulin. Its main side effect is nausea and can cause weight loss in some people.

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houston, tx: My daughter is 16 yrs old. She was diagnosed w/ Type 1 ,four and a half years ago. For the first two years her A1c was in control. Then it started going up. The doctors try different tricks, but there are too many irregularities in her blood gluocose. She is in total compliance as regards to testing, changing sites, bolus,exercise,& eating healthy. She was prescribed glucophage once a day, which was later increased to 2 tablets i.e. 1000mg a day. But her A1c is 8.6. The anti bodies are way out of range. Her other tests are normal. She is also on birth control due to slightly elevated testostrones. I don't know what else can be done. I have heard semolin shots help with the metabolism, But they are usually given to adults. I am not sure if I spelled semolin correctly. I wonder if it has any side effects.Just this week her doctor has discntinued glucophage as she feels it is really not doing any good. I wonder if there are any suggestion? sippy

Marvin and Dani: The drug your are referring to is called Symlin. It is an injectible drug that is given with insulin in a separate syringe or pen. It can actually decrease the amount of insulin a patient has to take, but does not replace insulin. It's main side effect is nausea, but it tends to decrease after the firts couple weeks. The drug can also help patients to lose weight. I might recommend that your daughter see and endocrinologist, if she is not doing so already. Teenage years, in part due to hormones, can often be a diffult time with glucose control. Has your doctor discussed the insulin pump? In some highly motivated patients, it can be a good option to help regain glucose control. Hang in there and good luck. For more information on Symlin, you can visit their website at www.symlin.com

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Boise, Idaho:[Submitted: 2007-03-15 14:55:00.000]: I heard about a new diabetes medication that is taken at night that helps keep your liver from releasing glucose at night. I think it was called jenuvia , i'm not sure of the spelling but it's said to been only out for about 2 months how can i get information onthis drug?

Marvin and Dani:

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Vicksburg, MS: [Submitted: 2007-03-15 07:58:00.000]: Can diabetics eat 1 tsp of honey a day or is honey forbidden for a diabetic?

Marvin and Dani: There is no "forbidden" food for a person with diabetes. 1 tablespoon of honey has about 15 grams of carbs, the same amount as a slice of bread or a small apple. If you ever wonder how a food will effect your sugar, you can test your blood sugar before you eat and then 2 hours later. If your sugar goes above the level recommended by your doctor (often 140, 160, or 180mg/dl) then it may not be the right food or amount for you. It is generally recommended that a person with diabetes eat a variety of foods and to eat in moderation with regard to meal size.

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SALEM, OH: [Submitted: 2007-03-14 11:07:00.000]: DELTA BURKE WAS ON THE VIEW TODAY. AND SHE SAID SHE IS ON A NEW MEDICATION FOR DIABETES. THAT HELPS YOU LOOSE WEIGHT. DIDN'T CATCH THE NAME DO YOU KNOW WHAT IT IS?

Marvin and Dani: The medication Ms. Burke referred to is called Byetta. I believe she also referred to the website: www.byettaletstalk.com. Byetta is a medication used to help contol type 2 diabetes and is given by injection. According to the manufacturer's website, Byetta has been shown in studies to cause weight loss in some patients, in addition to lowering blood sugars. While the exact mechanism for weight loss is unknown, Byetta can decrease appetite and slow the passage of food from the stomach to the intestines. Byetta is not approved as a weight loss drug and should only be used in patients with type 2 diabetes.

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Atlanta, Georgia:[Submitted: 2007-03-14 14:13:00.000]: Do people die from diabetes regularly?

Marvin and Dani: Patients do not typically die from diabetes. However, uncontrolled diabetes can lead to long term complications. Patients with diabetes have an increased prevalence of lipid abnormalities increases the risk of heart attack and stroke. In addition patients with diabetes can suffer from insufficient circulation and the resulting complications (damage to eyes, kidney, limbs) This is why it is important for patients with diabetes to achieve and maintain glycemic control by using drug therapy and lifestyle management. They should also monitor blood pressure, cholesterol levels and weight to prevent or resolve any acute and short term complications that could cause death.

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Bernie, Missouri:[Submitted: 2007-03-15 10:05:00.000]: I have Type 2 diabetes. I have been on 2500 mg. of Glucophage for almost 2 yrs. My sugar levels are avg. 125. I am starting to gain my weight back.I recently started seeing an Endocrinologist. He spoke to me about Byetta. It is an injection 2 x's day. Will it push me into being a type 1? I despratly want to lose weight. I am a food acholic. It is an addiction. Please help.

Marvin and Dani: If you have type 2 diabetes, you have type 2 for life. Barring misdiagnosis, you cannot switch your type of diabetes. In type 1, which is most often diagnosed in children and young adults, the body produces no insulin and the patient needs to take insulin injections to replace what the body does not make. Type 2 is the more common form of diabetes, making up 90-95% of the diabtes population. Type 2s either do not make enough insulin or their bodies do not recognize the insulin they make. Treatment of type 2 can include diet and exercise, pills, insulin, or any combination. Some patients with type 2 do progress to require insulin, but everyone is different. Those patients on insulin can lead healthy happy lives. Treatment does tend to change with time, and this is not the fault of the patient or doctor; diabetes is a progressive disease. Byetta will not push you into type 1 or insulin dependence. It may help you better control your diabetes and could potentially cause weight loss. According to it's website, Byetta may decrease appetite and the amount of food eaten. Although it is injectable, Byetta is not insulin. It does however help the body to produce and regulate its own insulin.

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troup,tx.: [Submitted: 2007-03-13 19:09:00.000]: what is the range for glucose levels?

Marvin and Dani: According to the American Diabetes Association, before meal sugars should be 90-130mg/dl. Blood glucose levels 2 hours after meals should be <180 mg/dl, and bedtime readings should range 110-150mg/dl. Based upon your individual circumstances, your doctor may choose different blood glucose goals.

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Layton, Utah:[Submitted: 2007-03-13 10:29:00.000]: My doctor has had me take a Fasting diabetes test. Recently I have been in the hospital with gastrointestinal complications. My blood work there came back with a glucose level of 137. I am a male of only 28 years old. I have not received the result of my fasting glucose tests yet. Do I need to worry?

Marvin and Dani: The American Diabetes Association defines a diagnosis of diabetes as a fasting (8 hour fast) of greater than or equal to 126mg/dl. This is ususally repeated to confirm on a different day. Diabetes can also be diagnosed with a casual plasma glucose of greater than or equal to 200mg/dl. "Casual" is defined as a reading any time of the day without regard to meals. Lastly, a glucose tolerance test of 200mg/dl or greater is a diagnosis of diabetes. For this test, the doctor would give you a sweet liquid to drink and measure your glucose levels to see how your body responds to the liquid. I would not worry until you get the results from your doctor's tests. Early diagnosis is important; getting the diabetes under control early on can help you to live a more healthy normal life. In the meantime, it's never a bad idea to begin watching the things you eat and begin an exercise program, with your doctor's approval.

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vass nc:[Submitted: 2007-03-12 17:00:00.000]: my Dr said my blood work showed my blood suagar at 148, I am 69 yrs and do not know what my blood sugar is suppose to be.

Marvin and Dani: The first question that I have is were you fasting 8 hours? According to the AMerican Diabetes Association, a fasting blood sugar of 126mg/dl or above is a diagnosis of diabetes. If the blood sugar is non fasting, >200mg/dl is a diagnosis of diabetes. Pre diabetes, a risk factor for diabetes, is diagnosed as a fasting sugar 100-125mg/dl. Doctors will often do blood work again to confirm the results. We recommend that you follow up with your doctor to discuss your results.

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springfield, oregon:[Submitted: 2007-03-13 13:50:00.000]: I was just diagnosed, no one told me when or how oten I am to change the needle on my ascensia monitor, please help. thank you

Marvin and Dani: The manufacturers of insulin needles and lancets (the needles for your blood glucose meter) recommend that each needle only be used once. Using a needle more than once can cause more pain, bleeding, and bruising, and possibly increase your risk of infection. Needles can bend, break, or become otherwise damaged when reused according to BD, a maker of such devices. For an image of what needles look like after multiple uses, check out http://www.bddiabetes.com/ca/english/managingdiabetes/dangers.asp

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Madison Heights, Michigan: [Submitted: 2007-03-12 10:33:00.000]: I was recently diagnosed with diabetes. I wanted to find out what a good fasting blood sugar level is? I have heard many different answers.

Marvin and Dani: The American Diabetes Association's guidelines recommend a fasting blood sugar of 90-130mg/dl. The American College of Clinical Endocrinologists (diabetes doctors) however recommend a fasting <110mg/dl. Talk with your doctor to see what is an appropriate fasting glucose goal for you. Some patients, especially when first diagnosed, may have different blood sugar goals as the doctor adjusts treatment.

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Essex junction, VT: [Submitted: 2007-03-11 09:20:00.000]: My father has type 2. I've been told that if his glucose level is less than 60 and does not go up after treating I should call 911. At what number on the high side should I (or he) call 911 and what can be done to bring the number down.

Marvin and Dani: This is a good question to ask your doctor or diabetes educator. Often doctors like to know when a patient's blood sugar is running over 160mg/dl for a week, they have symptoms of high blood sugars (fatigue, blurry vision, peeing a lot, thirsty, etc), there are 2 or more readings >300mg/dl, or the patient is vomiting, confused, or showing signs of dehydration. Again, talk to your dad's doctor about what specific plan he has for him.

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Orange, CA: [Submitted: 2007-03-09 12:37:00.000]: I need to find a really good Diabetes Nurse Educator that specializes in Type 1, insulin dependent, on a pump, in Orange County. Do you have any recommendations or suggestions on how I may find one. Thank you.

Marvin and Dani: You can go to the American Association of Diabetes Educators website at http://www.diabeteseducator.org/ Additionally, you can find an education program recognized by the American Diabetes Association at http://www.diabetes.org/education/edustate2.asp?loc=x . You could also contact your pump company as they often employ certified pump trainers who can answer your questions.

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charleston wv: [Submitted: 2007-03-09 08:11:00.000]: I am doing a college 101 project and i need visual material were can i get them?

Marvin and Dani: The Rite Aid on Maccorkle Avenue has a diabetes specialist that should have lots of visual material that you could use. The National Diabetes Education Education Program has a good website where you can order materials http://ndep.nih.gov/diabetes/diabetes.htm, as does the American Diabetes Association www.diabetes.org. You could also talk to any of the local physician's offices who may be able to put you in touch with a representative from the drug companies who make diabetes products as they often have visual material.

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Bethlehem , PA: [Submitted: 2007-03-06 20:07:00.000]: I have diabetes type 2 and have a very itching skin, lately all I do is scratch , do it have anything to do with my diabetes?

Marvin and Dani: It sure can. Dry and itchy skin can be a sign of high blood sugars. While there can be other causes of itchy skin, such as allergic reactions to a new detergent, medication, even the environment, we recommend you test your blood sugar regularly and report the results to your doctor. Once the cause has been determined an appropriate treatment can be prescribed.

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Springfield, Tennessee: [Submitted: 2007-03-06 15:30:00.000]: My doctor told me yesterday that my glucose level was 100. Do I need to be concerned with this?

Marvin and Dani: Pre-diabetes is determined from the results of a fasting plasma glucose test. The normal fasting blood glucose level would be less than 100 mg/dl. 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. We recommend that you speak to your doctor regarding your concerns to determine what course of action should be taken.

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Sacramento: I am a female, 5'5'',58 years old. I took a fall last summer and found out at a clinic that I went to for treatment that I had high blood pressure. So I changed to a healthy diet with lots of fruits and vegetables and whole grains. And I now walk briskly 50 minutes a day. As a result, I dropped 35 pounds (I now weigh 166 pounds) and my blood pressure is a healthy 90/76. But when I had my glucose tested at a supermarket clinic, it was 295! If diabetes can be treated with diet and exercise,what went wrong in my case??

Marvin and Dani: First off, I would recommend you see your doctor for further blood work and a diagnosis. The supermarket was likely doing a screening, so the results should be confirmed by your doctor. Secondly, CONGRATUALTIONS on your lifestyle changes. It sounds like you are doing an amazing job of taking care of yourself. Although "diet and exercise" are an important part of diabetes care, they are not the only treatments. Some patients can be controlled on diet and exercise, but diabetes is different in everyone, and thus the treatment is different in everyone. While some folks do not require medication, others may need oral medication, insulin, or a combination. Some individuals may be overweight, some may be a perfect weight. The good news for you is that you have started doing those things that make it easier to control diabetes. Your doctor will likely choose to put you on a medication, but don't be discouraged. The changes you've made matter! Some risk factors for diabetes can be changed- like losing weight. Others can't- family history/genetics, age, race (African American, American Indian, Asian American, Latin American).

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Denver, PA: How can you tell when you have high or low blood sugar?

Marvin and Dani: The best way to tell is by testing your blood sugar and by testing it regularly. The American Diabetes Association recommends blood sugars be between 90 and 130mg/dl before meals, <180mg/dl 2 hours after meals, and 110-150mg/dl at betime. Anything above that is considered high. Anything less than 70mg/dl is considered low. There are certain symptoms associated with high and low sugars, although not everyone feels them. The symptoms for high blood sugar include: excess thirst, hunger, and/or urination; blurry vision, cuts that won't heal, fatigue. Symptoms of low blood sugar include: dizziness, weakness, sweating, rapid heart beat, confusion, mood changes, and possibly even seizures or coma.

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Fife, WA: Regarding Diabetes 1, when the blood sugar gets so low (especially during sleep) and the sweating and jerking starts and then a full convulsion starts and like a coma state follows. What is this called and where can I find out more about this? Thank you, Debbie

Marvin and Dani: Hypoglycemia is the name for the condition when the blood sugar drops too low. Hypoglycemia can cause lots of symptoms including shakiness, weakness, mood changes, hunger, rapid heart beat, and sweating. When the blood sugar drops during sleep, patients often have vivid dreams/nightmares, extreme night sweats, or cold chills accompanied by hunger. In some cases, the patient may become unconscious, go into a coma, or have a seizure. These symptoms can happen to patients with type 1 or type 2 diabetes. To treat a low blood sugar, it is recommended to eat 15 grams of fast acting carbohydrate (1 cup skim milk, 1/2 cup OJ or soda pop, 3-4 glucose tabs, etc), wait 15 minutes, and test to see if the blood glucose has risen to above 70mg/dl. If not, repeat. If you cannot get the person to eat or drink, glucose gel is avalible that can be queezed into his/her mouth. When blood sugars drop to dangerously low levels, the patient may need a glucagon injection. Reserved for "severe low blood sugars" in patients using insulin, glucagon is often used when sugars drop so low that the patient is unconcious or having seizures. Friends and loved ones of the patient on insulin should know how to use the glucagon, which requires a prescription from the doctor. The injection is easy to give and may save the patient's life. For type 1 patients especially, it is a good idea to carry glucagon at all times in the case of an emergency. It will cause a rapid rise in the patient's glucose, along with the possible side effects of nausea and vomiting. For more information on the general treatment of low blod sugars, check out http://www.accu-chek.com/us/rewrite/generalContent/en_US/article/ACCM_general_article_2387.htm For more information on the glucagon injection, see http://www.glucagenhypokit.com/

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Wilkesboro, NC: What is insisplin diabetes?

Marvin and Dani: Not exactly sure what "insisplin diabetes" is, but there is a disease known as "diabetes insipidus." It is not the same as diabetes mellitus, which is the result of hyperglycemia either due to lack of insulin sensitivity or lack of insulin within the body. Diabetes insipidus is due to a lack of antidiuretic hormone or a lack of sensitivity to antidiuretic hormone. However, both diabetes mellitus and diabetes insipidus display similar symptoms, such as increased thirst, frequent urination and dehydration.

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kyle texas: are there any physical signs of diabetes? maybe a birthmark appearance on top of your ankle, knee and elbows or inside wrist?

Marvin and Dani: Some patients with diabetes will have cuts or sores that don't heal well. The other major physical symptom is something called acanthosis nigricans. It is a light brown to black velvety rash that appears on the skin of some patients with type 2 diabetes. It is associated with obesity and insulin resistance and usually occurs on the back of the neck, the groin area, in the arm pits, or on the elbows. Some schools are promoting screening of children for type 2 diabetes by looking at the back of their necks.

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Deer Lodge, Montana: Why would my BG be 88 before bedtime and 118 the first thing in the morning? Is this something to be concerned about? Also, I recently started hormone therapy (Cream-progesterone/estrogen) and a nightly pill form of Progeserterone. My BG has been somewhat elevated since I started this regiment. Would the medication affect the BG? Thank you for any help you can provide.

Marvin and Dani: The American Diabetes Association recommends a fasting glucose of 90-130mg/dl first thing in the morning, so your 118 is within range. The liver often produces glucose at night, so that numbers are higher in the morning. There are medications to help decrease the production of glucose by the liver; this is a decision to be made by you and your doctor. Assuming your A1c is <7 and the rest of your numbers look as good as the 2 numbers you gave me, you are in good shape. Creams do not usually affect the blood sugar as limited amounts get absorbed into the blood stream. Progesterone in general does not appear to increase blood glucose.

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Pose a Question | Refresh Januvia? (sitagliptan) was approved by the FDA, October 16, 2006 as a prescription medicine used along with diet and exercise to lower blood sugar in patients with type 2 diabetes mellitus (type 2 diabetes). Januvia is taken once a day and may be taken alone or along with certain other medicines to control blood sugar. Januvia lowers blood sugar when blood sugar is high, especially after and between meals. In addition, it decreases the amount of sugar made by the liver and is unlikely to cause your blood sugar to be lowered to a dangerous level (hypoglycemia) because it does not work when your blood sugar is low. To learn more about this drug you can ask your physician or local pharmacist, visit www.januvia.com or contact Merck at 1-800-727-5400.