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Rochester, Minnesota: My overnight fasting glucose never seems to go under 130 and is more often 150-175. All other times it is 90-120, with a four hour fast. Is there a way to bring the eight hour fasting level down?
Linda and Sarah: Your fasting levels depend on what medicaitons you take along with the food and exericse regimen that you have. A good way to keep track of this is to keep a food and exercise diary, so everytime that you eat or do exercise write it down along with the times. After doing that for about a week or two, you may be able to determine why your fasting readings are fluctuating. Another thought could be because of hormones that are released in the early part of sleep (called the Dawn Phenomenon). Typically, the blood glucose level rises between 4 AM and 8 AM. Check your blood glucose level in the middle of the night (around 3 AM). If your blood sugar is high, you may be experiencing the dawn phenomenon. If it is low, it may be a rebound hyperglycemia (high blood glucose) causing your high blood glucose levels in the morning. This occurs if you have low blood glucose levels at night and your body is releasing hormones as a defense mechanism against low blood sugar. It would be best to consult your physician for proper diagnosis and treatment.
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suffolk va: What is a normal range of blood sugar
Linda and Sarah: 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). 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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ADA Moderator : Welcome to ADA Live!
Today our guests are Linda Higgins, R.Ph. a drug information specialist at the Rite Aid Drug Information Center and Sarah Parnapy, Pharm.D. an Assistant Professor of Pharmacy Practice at Shenandoah University who is also affiliated with Rite Aid Pharmacy.
It's a pleasure to have you here today Linda and Sarah.
Linda and Sarah: Thanks! We're already getting lots of great questions today.
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san antonio Tx: a diabetic should i aviod sugar?
Linda and Sarah: For almost every person with diabetes, the answer is yes! Eating a piece of cake made with sugar will raise your blood glucose level. So will eating corn on the cob, a tomato sandwich, or lima beans. The truth is that sugar has gotten a bad reputation. People with diabetes can and do eat sugar. In your body, it becomes glucose, but so do the other foods mentioned above. With sugary foods, the rule is moderation. Eat too much, and 1) you'll send your blood glucose level up higher than you expected; 2) you'll fill up but without the nutrients that come with vegetables and grains; and 3) you'll gain weight. So, don't pass up a slice of birthday cake. Instead, eat a little less bread or potato, and replace it with the cake. Taking a brisk walk to burn some calories is also always helpful. Make sure you discuss your dietary choices and caloric intake ultimately with your dietician or nutritionist.
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DeLand, FL: Can Diabetes be reversed? I read that Diabetes is the only known disease that can be reversed.
Linda and Sarah: Unfortunately, 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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Ft. Gibson, Oklahoma: My paternal Grandfather had diabetes since childhood and had to have insulin shots. I have heard that diabetes often will skip a generation before it shows up in a family member. I have other serious illness and could this contibute to high risk for development of diabetes. I do have quite a few of the symptons.
Linda and Sarah: There has been some information stating that diabetes is herditary, but we are still unsure how people get it. The exact cause of diabetes is unknown; however, genetics and environmental factors have been shown to affect the onset of diabetes. Environmental factors include obesity and a sedentary lifestyle. In order to diagnose diabetes the doctor must complete a blood test, either a fasting plasma glucose test or an oral glucose tolerance test. The results will determine if you have pre-diabetes, diabetes, or are normal. The fasting plasma glucose test measures the blood glucose level first thing in the morning after a person does not eat (fasts) overnight. The fasting plasma glucose test defines pre-diabetes as blood glucose levels between 100 and 125 mg/dl and diabetes as blood glucose levels at 126mg/dl or above. The normal fasting blood glucose level would be less than 100 mg/dl. The oral glucose tolerance test measures blood glucose levels first thing in the morning after a person fasts and then again 2 hours after the person ingests a drink that contains glucose. With this test, pre-diabetes is defined as the 2-hour blood glucose level between 140 and 199 mg/dl and diabetes as the 2-hour blood glucose level at 200mg/dl or above. The normal 2 hour blood glucose level would be less than 140 mg/dl. Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. If you are concerned about developing diabetes, that you have diabetes, or are having any of the symptoms of diabetes, we recommend that you speak with your doctor for an examination and appropriate testing. Additionally, you may want to take the American Diabetes Association Diabetes Risk Test available online at http://www.diabetes.org/risk-test.jsp. For additional information on diabetes, please visit the Rite Aid Diabetes website at www.riteaiddiabetes.com or the American Diabetes Association's website at www.diabetes.org.
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arlington, va: How can I find a doctor, I'm a permanent resident and I'm new in the USA. Thanks for all information.
Linda and Sarah:
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logan, utah: I am dating a man who is in his 50's and he just told me he was diagnosed with type 2 diabetes several years ago. I like him , but he does not seem like he is interested in intimacy. I am wondering if it may be because his sexual health has been affected by his diabetes? How common would this be, or about what percentage of men suffer this complication?
Linda and Sarah: 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. Men who have diabetes are three times more likely to have erectile dysfunction as men who do not have diabetes. The prevalence of erectile dysfunction range from 20-80% in men. Your friend should consult his physician for treatment options.
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NAPERVILLE, ILLINOIS: ARE THERE RISKS ASSOCIATED WITH THE NEW OVER THE COUNTER DIET DRUG ALLI? ANY NOTED DIABETIC DRUG INTERACTIONS WITH ALLI?
Linda and Sarah: Some of the side effects of alli include gas with oily spotting, loose stools, and more frequent stools that may be hard to control. There are no interactions noted at this time with Alli and medications for diabetes. It is noted that changes in dietary intake and weight loss may improve blood glucose control in people with diabetes. Prior to starting this medication, we recommend speaking with your physician to see if Alli is an appropriate treatment option for you and how it could affect your medications prescribed to control diabetes. Alli can also reduce the absorption of some vitamins. Ask your physician if this is of a concern for you. Although, the key thing with Alli is that it prevents the absorption of fats, it is important to eat a reduced-calorie and low fat meal with this product to avoid the side effects noted above.
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Edmonton Alberta Canada: Can a person with type 2 diabetes have alcohol?
Linda and Sarah: Please see the following section on the ADA website about alcohol use. It is a great resource. http://www.diabetes.org/type-1-diabetes/alcohol.jsp . Alcohol is a carbohydrate and depending on how much is consumed; your blood sugar could at first be elevated. This occurs because carbohydrates are quickly absorbed in your blood and then cause elevated blood sugar, this elevation can vary depending on how much you drink. Additionally, alcohol can cause low blood sugar levels especially if you use insulin injections or take oral medications. Therefore, you should never drink alcohol on an empty stomach, be sure to eat your meals and snacks and drink in moderation. The ADA suggests that women have no more than 1 drink a day and men no more than 2 drinks per day. Additionally, some people with diabetes should not drink at all. Alcohol can aggravate some diabetes complications such as nerve damage and eye conditions. Please speak with your physician for more information and to discuss the specifics of your alcohol use.
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corpus christi, tx: (type2)What can I do when my glucose levels drop between 45-65. I have taken about 3 chewable glucose tablets, and that raises my level only about 15 points. This seems to happen more often thru the night, but fluctuates throughtout day, also.
Linda and Sarah: Hypoglycemia can cause shakiness, weakness, nervousness, headache, hunger, mental confusion, and blurred vision. If blood glucose levels get very low, a patient can have convulsions or become unconscious. A quick source of sugar equal to 15 grams of carbohydrates will help raise your blood glucose. Possible sugar sources would include 3-4 glucose tablets, 5 chewed lifesavers, 6 jelly beans, 1 box or 2 tablespoons of raisins, 1 cup of low-fat milk, 1/2 cup of regular non-diet soda, 1 & 1/2 tubes of glucose paste, 3 packets or 1 tablespoon of sugar, or 1/2 cup of orange or apple juice. Check your blood glucose level 15 minutes after eating a quick source of sugar. If your level is still less than 70 mg/dL you should have another serving of sugar. If your next meal is not within 2 hours, eat a snack such as 1/2 sandwich or crackers with peanut butter or cheese. If your blood glucose levels are low, consult your physician for an evaluation.
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belleville: is there a meter for visually impaired persons?
Linda and Sarah: Yes, Accucheck makes a meter called Voicemate which is recommended for blind or visually impaired patients. Check with your insurance company to see if they will pay for the meter, it is expensive. If you get the machine, ask your local pharmacist to show you how to use it.
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Brooklyn New York: What are the symptoms of diabetes?
Linda and Sarah: Some of the symptoms of diabetes include: excessive thirst, extreme hunger, frequent urination, blurred vision,irritability,and tiredness. If you are experiencing any of these symptoms, we recommend contacting your physician. She/he can do blood work to determine if you have diabetes.
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Martinsville,VA: My husband had his yearly check up and blood work last Monday. After visiting the lab, he was to see his doctor again in two days. Aafter the two days we returned to our doctor with the alarming results that his blood sugar was in the range of 1000. Our doctor sent him back to the lab for more testing, saying to him he had diabetes, our return back to the doctor, they said to just keep a watch on his sugar intake.
She gave him, Tricor 145mg. Is he diabetic or not?
Linda and Sarah: Tricor is a medication prescribed to help lower triglycerides and cholesterol. A physician will be the one to diagnose your husband with diabetes. Double check with the physician's office to make sure that the reading of 1000 was for his blood glucose level. The following ADA general blood glucose level guidelines for nonpregnant patients with diabetes are: Before meals - 90 - 130 mg/dl (5.0-7.2 mmol/l), Peak after a meal (1-2 hours after the start of a meal) - Less than 180 mg/dl (less than 10 mmol/l). If the reading of 1000 is a correct reading, it is extremely high and your husband should be treated accordingly (by the physician) with prescription medications along with diet modifications and an exercise regimen.
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Turlock, California: I have just been diagnoised with diabetes. My blood sugar is in the 140 range about 2 hours after I eat a balanced dinner. I do not eat anything after dinner which is usually around 6:00 to 6:30 at night. In the moringn my blood sugar is sometmes in the 200 range. Why does it go up at night when I am sleeping and not eating anything???? sincerely, confused!!
Linda and Sarah: Some patients do have high before-breakfast blood glucose levels because of hormones that are released in the early part of sleep (called the Dawn Phenomenon). Typically, the blood glucose level rises between 4 AM and 8 AM. Check your blood glucose level in the middle of the night (around 3 AM). If your blood sugar is high, you may be experiencing the dawn phenomenon. If it is low, it may be a rebound hyperglycemia (high blood glucose) causing your high blood glucose levels in the morning. This occurs if you have low blood glucose levels at night and your body is releasing hormones as a defense mechanism against low blood sugar. It would be best to consult your physician for proper diagnosis and treatment.
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Dublin, Ireland: Can having type 2 Diabetes affect me getting pregnant?
Linda and Sarah: There are 2 hormones that women produce that play an important role in pregnancy. They are estrogen and progesterone. These hormones are produced by the ovaries and regulate a women's reproductive cycle. When a woman has diabetes and her blood sugars run higher, her menstrual cycle may become irregular. Irregular periods can make it more difficult for a woman to conceive. Therefore, having blood sugar in tight control will help prevent menstrual irregularities and the delay of becoming pregnant. The most important thing to do first is to speak with your physician before trying to get pregnant. Some women are referred to a specialist that handles these types of pregnancies. Good blood glucose control is key before you get pregnant. It is best to plan a pregnancy and work to get your diabetes under control for at least 3- 6 months before trying to get pregnant. The baby's organs develop within the first 6 weeks of pregnancy so it is important to have your blood glucose levels under control during this very critical point in a baby's development to decrease the risk of birth defects. When women have maintained strict blood glucose control prior to conceiving and during the first trimester, the incidence of malformations is much lower. Also, hyperglycemia (high blood glucose) can increase the risk of a miscarriage. You may also want to consult a registered dietician to help develop a meal plan that will help you before you get pregnant and also for after you get pregnant. You will also need to monitor your glucose levels more frequently. If your glucose levels are too high, the baby gets too much sugar which can make the baby too big or too fat.
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LUCK,WI.: CAN HIGH BLOOD GLUCOSE LEVELS CAUSE IRIATIBILTY AND FATIGUE? I ALSO HAVE HEP C AND CIRROSSIS OF THE LIVER.
Linda and Sarah: Yes, common symptoms of high blood glucose levels (also known as hyperglycemia) include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurred vision. Fatigue is also noted as a symptom of Hepatitis C. Consult your physician regarding your symptoms.
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housten, tx: i know that diabetes can cause loss of feeling ofthe foot. i experience numbness of my left thigh, often when walking ,could this be a warning sign for diabetes or something else?
Linda and Sarah: You are correct, a common complication of diabetes is numbness or 'loss of feeling' sensation. Numbness in your thigh could be caused by a variety of things. You should go to your doctor so he/she can make a proper diagnosis for you.
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CARSON,CA.: WHEN IS THE BEST TIME TO MONITOR BLOOD GLUCOSE, HOW LONG AFTER EATING?
Linda and Sarah: You should monitor your blood glucose first thing when you wake up, to get a fasting level, then various times throughout the day, for a total of 2-3 readings per day. It is recommended to take a reading two hours after eating. If you start a new medication regimen, you may want to monitor 3-4 times during the day. Also, if you are sick, it is recommended to monitor more frequently. It is important to keep a log of your readings along with the time of day and take this information to your doctor visits.
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Horsham, PA: Why do my BS run higher in the morning before breakfast then any other time of the day? What can I do to lower it?
Linda and Sarah: We have found that some patients do have high before-breakfast blood glucose levels because of hormones that are released in the early part of sleep (called the Dawn Phenomenon). Typically, the blood glucose level rises between 4 AM and 8 AM. Check your blood glucose level in the middle of the night (around 3 AM). If your blood sugar is high, you may be experiencing the dawn phenomenon. If it is low, it may be a rebound hyperglycemia (high blood glucose) causing your high blood glucose levels in the morning. This occurs if you have low blood glucose levels at night and your body is releasing hormones as a defense mechanism against low blood sugar. It would be best to consult your physician for proper treatment as your medication regimen may need to be adjusted.
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Anand, Gujarat: What is oral glucose tolerance test? How it will help in diagnosis of diabetes?
Linda and Sarah: 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. The results will determine if your daughter has pre-diabetes, diabetes, or are normal blood glucose levels.
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Benton.KY: I Have a Question My Grandad on My Bological side had diabetes and I was wondering if I could get Diabetes?
Linda and Sarah: Family history is certainly a strong risk factor for diabetes. Other risk factors include age, having a baby weighing greater than 9 pounds at birth (or had gestational diabetes), pre diabetes (fasting blood sugar 100-125mg/dl), high cholesterol or blood pressure, obesity, inactive lifestyle (exercise fewer than 3 times per week)and certain ethnic backrounds (African American, Asian American, American Indian, Latin American, Pacific Islander, Alaska Native). Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. If you are concerned about developing diabetes, that you have diabetes, or are having any of the symptoms of diabetes, we recommend that you speak with your doctor for an examination and appropriate testing. Additionally, you may want to take the American Diabetes Association Diabetes Risk Test available online at http://www.diabetes.org/risk-test.jsp. For additional information on diabetes, please visit the Rite Aid Diabetes website at www.riteaiddiabetes.com or the American Diabetes Association's website at www.diabetes.org.
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Midlothian,IL: What cause high blood sugars in the morning
Linda and Sarah: We have found that some patients do have high before-breakfast blood glucose levels because of hormones that are released in the early part of sleep (called the Dawn Phenomenon). Typically, the blood glucose level rises between 4 AM and 8 AM. Check your blood glucose level in the middle of the night (around 3 AM). If your blood sugar is high, you may be experiencing the dawn phenomenon. If it is low, it may be a rebound hyperglycemia (high blood glucose) causing your high blood glucose levels in the morning. This occurs if you have low blood glucose levels at night and your body is releasing hormones as a defense mechanism against low blood sugar. It would be best to consult your physician for proper diagnosis and treatment.
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St. Paul, Minnesota: I have various other elments, many of which my mother died of at the age of 39 in 1962. I am now 56 although I do have many medical problems I am getting confused about. I have high bp usually 140/85 or something in the same range. I have high cholestral 180/40 or close. I am on cholestral medication and high blood pressure medication. Now I have diabetes, alnong with sever degenerative arthritis, acid reflux and I take medication for both. I cannot get my new diets together, I am one of those people if you say I can have a cup of corn per day then I will mesure out my cup and I will know that is all I can have for that day. With all the calculating and grams, and mgs. I have no idea what the heck I am doing. I have just been diagnosed with the diabetes part of all my problems, but the rest I have know about for quiet some time. I have a very bad knee and ankle that I rarely do much walking or anything else if I don't have to and haven't for years
Linda and Sarah: We understand that you are concerned. Staying in touch with your health care providers (including doctor, eye doctor, pharmacist, dietician, foot doctor), will help you stay healthy. The American Diabetes Association (ADA) website also has a wealth of information for you. Since you were recently diagnosed, it is important to monitor your blood glucose readings daily, along with a food and exercise diary. In regard to calculating grams of nutrients per day, a dietician would be a great person for you to get in contact with. You may want to check out your local hospital to see if they list any diabetes education programs that involve a dietician. A dietician can help devise a meal plan specifically for you and your needs. Also, your community may have local ADA chapter meetings in which you can attend; the local paper would have that information for you.
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Wichita, Ks: My husband has a 59 yr old cousin. She was recently found to have Type II. She lives in Miami, OK and has no health insurance until Oct. Her blood sugar was 471 when tested on June 19th. She stated she only test once a week because of the cost of the testing supplies. She has not seen a spec or dietican because of the lack of insurance. Are there any programs to help her obtain the help she needs?
Linda and Sarah:
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ft lauderdale, florida: Hi, My grandmother is 81 and one of her diabeties medications is Avandia 4mg 2x a day. She has been seeing advertisements on tv that there is some controversy with this medicine it can lead to heart attack or stroke? She has stopped taking it on her own; is what she just told me. Her sugar was 190 this morning? What is your input about this medicine is it safe for my granny? I don't think she should just stop a medicine without Dr's advice.Is that why her sugar has been high recently? She's very stressed at this time as well.She's a worry wort. Worries about everything. Can her Dr. give her something for that? I love her and am very concerned about her health. Please advise. Thank you in advance for your time and attention in this matter Carey Green of Ft. Lauderdale, Florida
Linda and Sarah: We understand your concern in light of the recent media attention that Avandia has received. However, we recommend that you consult her physician to determine if Avandia continues to be the best medication regimen for her or if a change in her medication is warranted based on her medical condition. It is very important to stress to your grandmother that she should not stop taking the Avandia without first consulting with her physician. Stopping the medication is leading to her high blood glucose readings. Short term (days to weeks) hyperglycemia can lead to increased urination, increased thirst, weight loss, blurred vision, fatigue, nausea, and can also lead to many fungal and bacterial infections. More serious complications include diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHNKS). 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.
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san bernardino: what is water diabetes?
Linda and Sarah: Water diabetes is also 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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St. Louis MO: I have six generations of women before me, including my mother, who have all had diabetes. I am 54 years old. I have been checking my blood sugars before and after meals. I am not a diabetic. After I eat, I am getting readings from 145 to 180. I have had several other recent health issues inlcuding an increase in BP, along with a lot of GI problems leaving my cholesterol level at 245, TG 114, HDL 48, and LDL 163. I have just started taking Pravachol. Shouldn't my doctor be checking me for diabetes. I am 163 pounds. My mother got DM at age 40.
Linda and Sarah: The following ADA general blood glucose level guidelines for nonpregnant patients with diabetes are: A1C - Less than 7%, Before meals - 90 - 130 mg/dl (5.0-7.2 mmol/l), Peak after a meal (1-2 hours after the start of a meal) - Less than 180 mg/dl (less than 10 mmol/l). To be on the safe side, it wouldn't hurt for your physician to check you for diabetes. Especailly, if you have any of the symptoms (increase thirst, increase urination - are the common ones)let your physician know. We still aren't sure what causes diabetes, but it seems that family history is a factor. It is better to catch the diagnosis early for proper treatment. Good job at being proactive with your health.
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Raleigh, NC: What can you do to help bring surgar levels down if you are away from home and you feel like yyour levels are high?
Linda and Sarah: Exercise itself can actually lower out blood glucose readings. I would suggest talking with his doctor about an appropriate exercise regimen. Going for a walk would be a great way to exercise, which you can do anywhere. Increasing water consumption will also help with lowering blood glucose levels. (Please note: If your blood sugar is higher than 240mg/dL, check your urine for ketones before exercising. If there are ketones in the urine, do not exercise, this could make the blood sugar even higher. Contact a doctor if this occurs.)
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cary il: Hi,what is the normal glucose clinical range in the blood/the test was taken trough the vein/,and what does mean if the glucose is negative in the urine with the performed test.
Linda and Sarah: General blood glucose level guidelines according to the American Diabetes Association (ADA) are: Before meals - 90 - 130 mg/dl (5.0-7.2 mmol/l), 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: 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. In regard to negative glusose in the urine, that is good. When your blood sugar levels are too high, glucose will start to spill into your urine. If the results would have been positive then that would not be good as your blood glucose is running high and glucose is spilling into your urine. A negative result is good.
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springfield illinois: How is diabetes detected. My symptoms are as follows. Blurred vision, yet the physician says my vision is ok). Contant headche in frontal lobe, nausea, dizziness, cloudy thought process, numbness in fingers and toes that lasts several days at a time, and fatigue. I weigh apporx. 150lbs and my height is 5'1.
Linda and Sarah: In order to diagnose diabetes the doctor must complete a blood test, either a fasting plasma glucose test or an oral glucose tolerance test. The results will determine if you have pre-diabetes, diabetes, or are normal. The fasting plasma glucose test measures the blood glucose level first thing in the morning after a person does not eat (fasts) overnight. The fasting plasma glucose test defines pre-diabetes as blood glucose levels between 100 and 125 mg/dl and diabetes as blood glucose levels at 126mg/dl or above. The normal fasting blood glucose level would be less than 100 mg/dl. The oral glucose tolerance test measures blood glucose levels first thing in the morning after a person fasts and then again 2 hours after the person ingests a drink that contains glucose. With this test, pre-diabetes is defined as the 2-hour blood glucose level between 140 and 199 mg/dl and diabetes as the 2-hour blood glucose level at 200mg/dl or above. The normal 2 hour blood glucose level would be less than 140 mg/dl. Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. If you are concerned about developing diabetes, that you have diabetes, or are having any of the symptoms of diabetes, we recommend that you speak with your doctor for an examination and appropriate testing. Additionally, you may want to take the American Diabetes Association Diabetes Risk Test available online at http://www.diabetes.org/risk-test.jsp. For additional information on diabetes, please visit the Rite Aid Diabetes website at www.riteaiddiabetes.com or the American Diabetes Association's website at www.diabetes.org.
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Beresford South Dakota: I am not sure if this is the correct place to pose this question but I am going to do it anyway. I recently visited my Endocrinoligist. During my appointment we discussed my options to get my A1C back to 7 or below. I am a Pump wearer and also am quite a bit overweight. In my discussion with the CNP she realized that since I have started my insulin treatment I have gained a considerable amount of weight and suggest we change my insulit from Humolog to Apedra. I was given a sample to try to see how my Blood sugars did. Well I also am following a strict diet and while I was using the new insulin my blood sugars were great my diet was going great and I lost over 10 pounds. I went to get my perscription for my new insulin filled to find out that my insurance company would not pay 1 penny of it. At a cost of $245.00+ per month I cannot afford it. So I was forced to go back to Humolog. I have continued my strict diet but my blood sugars are back to being not so good and I haven't lost an ounce. In fact I have gained some I have lost. Is there anything available or that I can do to plea to my insurance co that I need Apedra. I was told that Humolog was the same medicine and worked the same and they would not pay. ??? Well, in my case that is not true. I need to lose weight and get sugars in control Apedra was helping me do this. Any suggestions on what I can do to fight my insurance co on this?
Linda and Sarah:
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rajkot,gujrat: how the metformin causes anorexia? please explain the pathway.
Linda and Sarah: It is not known why anorexia or loss of appetite occurs with metformin. Gastrointestinal side effects including anorexia occur in about 30% of patients when metformin therapy is intiated. These effects usually subside the longer the medication is taken.
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Phoenix Arizona: i was told i had diabetes and i have not took any medication, because i have no insurance or health benifits i wk 40hr a wk and have no time to go to the doctor,, i reasently checked my blood and i had 529 of sugar levels,, i feal heavyness on my head and verry thisty and sleepy,, im a single mother of two girls,, is there any heal for me?
Linda and Sarah:
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napa ca: I have just been diagnosed with Type 2 and I'm a 47 year old female. How many carbs a day can I have?
Linda and Sarah: Your body needs carbohydrates, in general, the ADA does not recommend restricting carbohydrates to less than 130 grams per day. Balanced nutrition is extremely important in managing blood glucose levels. Eating three meals a day plus small snacks in between and at bedtime can prevent extreme fluctuations in blood glucose. Fifteen grams of carbohydrate equals one serving. General guidelines for carbohydrate intake are 3-5 servings of carbohydrate (45-75 grams) per meal and 1-2 (15-30 grams) servings of carbohydrate per snack. A registered dietician can help devise a meal plan that is right for you. Ask your physician if he/she can recommend a dietician that you can talk to. You may also call your local hospital who may have a dietician on staff who can meet with you and help you determine how many carbohydrates you should consume in a day and how to determine what is considered a carbohydrate.
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richmond, va: What are the protocols for diabetic sick day?
Linda and Sarah: The American Diabetes Association has good information on their website regarding sick days, you can go to http://diabetes.org/gestational-diabetes/sick.jsp to access this information.
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Tampa, Florida: I have been getting dizzy,and even fainting on occasion, since I was a child. It happens almost daily and has gotten worse as I've gotten older. I am only 22. If I don't eat every few hours I can expect to end up on the floor, my I start seeing black spots until I can't see anything, sometimes my vision doesn't return at all until I get a piece of candy or something in me. A couple of days ago it happened and I could barely get the candy in my mouth because I was shaking so bad. Its really embarrasing. My doctor is not concerned, but I know that there is something wrong. Could I have diabetes?
Linda and Sarah: You will want to speak to your physician about this as this could be serious. Anyone can develop hypoglycemia, low blood glucose. Hypoglycemia occurs because the brain is not receiving enough glucose because you may not have eaten enough or skipped a meal. It occurs more often in people with diabetes because the medications used to treat diabetes are intended to lower blood glucose. Common symptoms of hypoglycemia are hunger, dizziness, shaky, nervousness, sweating, fast heartbeat, headache, weakness, or nausea. Possible sugar sources would include 3-4 glucose tablets, 5 chewed lifesavers, 6 jelly beans, 1 box or 2 tablespoons of raisins, 1 cup of low-fat milk, 1/2 cup of regular non-diet soda, 1 & 1/2 tubes of glucose paste, 3 packets or 1 tablespoon of sugar, or 1/2 cup of orange or apple juice. If you start feeling like these symptoms are coming on as your are driving, make sure to pull over and get some type of sugar product in your system. Also, make sure that everyone at home and that you work with is aware of this as well, and let them know what types of sugar products they should give you.
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Denver, CO: 1. I was just diagnosed with early diabetes on June 19, 2007, and my doctor started me on Glucophage. Can you tell me more about this drug? 2. To be honest, I am very anxious and frightened about my diabetes diagnosis. My Mother got diabetes at age 42 and died 20 years later from its complications. What can I do to avoid complications and have a good quality of life? jazzcat317@juno.com
Linda and Sarah: I can understand your worries. With proper medications, diet and exericse you will be able to live a regular lifestyle like anyone else. Glucophage is also known as metformin. It may be used in patients with type 1 or type 2 diabetes or even in those with prediabetes. Some physicians will use glucophage in patients with prediabetes to keep their blood sugars from rising to "diabetic range," thus helping to prevent diabetes. Glucophage, from the biguanide group, works by decreasing the amount of sugar your liver makes and that your stomach/intestines absorb. It is particularly known for causing weight loss as a side effect primarily because it causes loss of appetite. To decrease the GI upset that glucophage may cause, it is important to take it with food. It is also important to take it at the same time each day. If you are taking an extended release product (which you can ask your pharmacist), make sure to swallow whole, do not crush or break. To avoid complications it is important to stay up to date with all of your physicians, including eye doctor and foot doctor. Again, with proper exercise, diet, medications, and keeping your blood glucose as close to normal as possible, your complications can be minimized. It is also important to monitor your blood glucose on a regular basis. By following the advice of your health care team, you could live a long and happy life.
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New York, NY: My mother swelled up on the bottom half of her body, what should she do?
Linda and Sarah: We recommend taking your mother to the physician as soon as possible. There could be a variety of reasons why this is happening to her, so it is important to have a doctor check her.
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Willow River, MN: What problem can occur when I have diabetes and drink alcohol. Even 1 or 2 beers a day?
Linda and Sarah: Please see the following section on the ADA website about alcohol use. It is a great resource. http://www.diabetes.org/type-1-diabetes/alcohol.jsp. Alcohol is a carbohydrate and depending on how much is consumed; your blood sugar could at first be elevated. This occurs because carbohydrates are quickly absorbed in your blood and then cause elevated blood sugar. This elevation can vary depending on how much you drink. Additionally, alcohol can cause low blood sugar levels especially if you use insulin injections or take oral medications. Therefore, you should never drink alcohol on an empty stomach, be sure to eat your meals and snacks and drink in moderation. The ADA suggests that women have no more than 1 drink a day and men no more than 2 drinks per day. Additionally, some people with diabetes should not drink at all. Alcohol can aggravate some diabetes complications such as nerve damage and eye conditions. Please speak with your physician for more information and to discuss the specifics of alcohol use.
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GALLATIN,TN.: WHAT SHOULD MY TEST LEVEL BE 2 HRS AFTER A MEAL?
Linda and Sarah: Your blood glucose level 2 hours after a meal should be less than 180.
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Harlingen, TX: I had a home test done to check my sugar level, both times in the morning. The first one was done before I ate and registered 84. The second day it was after breakfast and registered 92. There was concern that I might have hypoglycemia. Was is the normal reading? Thanks...
Linda and Sarah: General blood glucose level guidelines according to the American Diabetes Association (ADA) are: Before meals: 90 - 130 mg/dl (plasma/serum blood glucose reading) Peak after a meal (1-2 hours after the start of a meal) - Less than 180 mg/dl (less than 10 mmol/l) plasma/serum blood glucose reading). Having a blood glucose reading of 92 after you ate is a good sign that your pancreas is secreting enough insulin for the amount of food that you just ate. If you start to feel shaky, fast heartbeat, sweaty, dizzy, anxious, hungry, weak, headaches, and being irritable you may want to consume something with sugar in it, such as juice or regular soda. If you do have these symptoms and are concerned, speak to your physician.
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Manassas, VA: I have been suffering with shoulder pain, undergone a steroid shot and physical therapy but the pain keeps getting worse, and I am getting the results of an MRI this week. I had been taking extra-strength tylenol, but the pain has been more than the pain reliever can handle. The Dr. prescribed Vicodin and since I have been taking it 3 times a day, my blood Glucose is about 30 points higher in the morning than usual, as well as about 20 points higher before meals. Could this be attributed to the pain reliever?
Linda and Sarah: Sorry to hear about your shoulder. When your body is in pain, it is under physical stress. When you are stressed your body produces hormones that can increase your blood glucose level. We were unable to locate information that Vicodin would increase your blood glucose levels. We recommend consulting your physician regarding your glucose levels and the physical pain that you are experiencing.
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Williamsport, Pa: My husband has a blood blister on the top of his toe just below his nail by the joint. Can I use a bandage made especially for blisters on it ?, should I break it?, how do I care for it? He has had diabetis for over 34 years and it is not as controlled as we would like it to be. He has lost 3 toes on this foot and the circulation is not the best. Should I bandage it with a dry non ashesive bandage?
Linda and Sarah: We recommend your husband consult with his physician or a podiatrist(foot specialist) and not treat the blood blister on his own. Since simple problems can worsen and lead to serious complications, it is important to see his physician or podiatrist when there are any changes to his feet, no matter how minor they may seem. Also, it is important for patients with diabetes to have their feet checked regulary by a podiatrist(foot specialist).
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Parker, CO: Could you tell me why after working out (treadmill for 30 min.) my blood sugar is higher than when I started? Thanks
Linda and Sarah: There are a couple of reasons why this happens. If a low amount of insulin is in the blood, the blood sugar will rise. Adding exercise to the mix, especially anaerobic activities (such as weight lifting, sprinting, or any sport requiring short intense spurts) can cause a further increase in blood sugar. The low insulin levels along with the secretion of hormones (i.e., epinephrine, cortisol, growth hormone, and glucagon) cause the liver to release glucose into the blood sending the blood sugar even higher. These hormones are called "stress" hormones and have the same affect on the body whether it is a physical stress or a mental stress. Consult your physician regarding your concerns. Your medication regimen may need to be adjusted.
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Parker, CO: Hi, I was wondering what is a good substitute for the drug Avandia? It did such a good job keeping my blood sugar down. My Dr. has me taking Januvia, but it hasn't been as effective. Thank you.
Linda and Sarah: Avandia is in the class of medications called thiazolidinediones. Actos is also in this class, which may be an option for you to try. The physician will be the one to make this change in your therapy. Continue with the Januvia until you talk to him about the options that are available to you. If you recently started Januvia (or other diabetes medications) it is important to monitor your blood glucose 3-4 times a day to see the effect of the medication.
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Altoona, PA: Do you always have to have a close relative (mother, father, brother, sister) to be at risk for Diabetes?
Linda and Sarah: Family history is a risk factor for developing diabetes, but other risk factors include: overweight, physical inactivity, race, previously identified impaired glucose tolerance, high blood pressure, high cholesterol, history of gestational diabetes, delivering a baby weighing more than 9 pounds, and history of vascular disease. Those are all risk factors for the development of type 2 diabetes. Typically type 1 diabetes is caused by an autoimmune disorder. Common symptoms of diabetes include excessive thirst, extreme hunger, frequent urination, irritability, increased fatigue, unusual weight loss, or blurry vision. If you are concerned about developing diabetes, that you have diabetes, or are having any of the symptoms of diabetes, we recommend that you speak with your doctor for an examination and appropriate testing.
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Miami, Florida:
Linda and Sarah: The Mayo clinic and national digestive disease information clearinghouse has some good information on this, the websites are: http://www.mayoclinic.com/health/gastroparesis/HQ00743
and
http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/index.htm
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Massachusetts: Do you know of any safe herbal supplements known to lower blood sugar levels?
Linda and Sarah: Herbal supplements or "natural" products are not required to undergo the FDA (Food and Drug Administration) approval process to demonstrate their safety and effectiveness. The FDA only regulates the package labeling, prohibiting a product from making claims that it is intended to diagnose, treat, cure, or prevent a disease. Side effects, drug interactions effectiveness and appropriate dosage information of herbal products are not always complete and not always known. We do not recommend taking any herbal supplements without first consulting with your physician.
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Marshall, Texas: Is it true when people have diabetes and overweight will they be a diabetic still if they lose over 300 pounds.
Linda and Sarah: Unfortunately, there is no cure for diabetes and once you are diagnosed with diabetes you will always have it. Your body may not be making enough insulin or your body may prevent the insulin from working properly. Their are many benefits of weight loss, especially 300 pounds. Loosing weight lowers blood glucose levels, blood pressure, and cholesterol. It could even make it easier for you to breath and to have more energy. Losing weight may also help you cut down on the medications you take along with the amount you take. Even if your blood sugars are controlled through diet, exercise and/or medication, the diabetes actually is being controlled - it is not truly gone. Always consult with your physician regarding weight loss and how it could affect your condition and your medications.
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ADA Moderator : My mother has diabetes mellitus and also has cirrhosis of the liver, which is advancing to mid-stage now. She has just been diagnosed with diabetic gastroparesis and I, as her daughter and caregiver, am in need of more information on this stage of her illness. Please provide any websites I can research, or if you have any information that you can forward - I would greatly appreciate any help you can give me. My e-mail is elizabeth@baptisthealth.net, and my cell phone number is 786-879-5070. Thank you so much. It is important for you to get to a physician for proper treatment to prevent any complications. Since you do not have insurance, you could speak with your local pharmacist or health department for advice regarding local doctors or clinics that do not require insurance. Also, we would suggest that you inquire into Medicare coverage, or any county or state funded programs that you might qualify for. We also have found that many pharmaceutical companies offer prescription assistance for patients without insurance coverage. The Partnership for Prescription Assistance (PPA) is a program created to help qualifying patients without prescription coverage obtain medications at a reduced price or free of charge through public or private programs. Their mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. You may contact the PPA by phone at 1-888-4PPA-NOW (1-888-477-2669) or though the internet at www.pparx.org. Additionally, there is a card called Together RX which allows qualifying patients to save on certain prescription medications. This card is made possible through a coalition of pharmaceutical companies. To enroll, you may call 1-800-865-7211 or enroll online at www.Together-Rx.com. Finally, you may also contact the manufacturers of your medications directly in order to obtain information about available patient assistance programs. The following ADA general blood glucose level guidelines for nonpregnant patients with diabetes are: A1C - Less than 7%, Before meals - 90 - 130 mg/dl (5.0-7.2 mmol/l), Peak after a meal (1-2 hours after the start of a meal) - Less than 180 mg/dl (less than 10 mmol/l). We have found that hyperglycemia(high blood glucose levels) should be treated as soon as you detect it. Untreated hyperglycemia may lead to serious problems. Short term (days to weeks) hyperglycemia can lead to increased urination, increased thirst, weight loss, blurred vision, fatigue, nausea, and can also lead to many fungal and bacterial infections. More serious complications include diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHNKS). 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. We recommend seeing a physician as soon as possible. Apidra is expensive and I understand your frustrations. Check with your prescription insurance company to see if there is an appeal process. Sometimes if a physician writes a letter to the prescription insurance company and explains the necessity of the medication, the insurance company may make a determination to help with the cost. Also, the manufacturer of Apidra, Sanofi-Aventis U.S, may have a prescription assistance programs that you could qualify for. Their phone number is 800-633-1610. Since she does not have insurance, she could speak with her local pharmacist or health department for advice regarding local doctors or clinics that do not require insurance. Also, we would suggest that she inquire into Medicare coverage, or any county or state funded programs that she might qualify for. We also have found that many pharmaceutical companies offer prescription assistance for patients without insurance coverage. The Partnership for Prescription Assistance (PPA) is a program created to help qualifying patients without prescription coverage obtain medications at a reduced price or free of charge through public or private programs. Their mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. You may contact the PPA by phone at 1-888-4PPA-NOW (1-888-477-2669) or though the internet at www.pparx.org. Additionally, there is a card called Together RX which allows qualifying patients to save on certain prescription medications. This card is made possible through a coalition of pharmaceutical companies. To enroll, she may call 1-800-865-7211 or enroll online at www.Together-Rx.com. Finally, she may also contact the manufacturers of her medications/testing supplies directly in order to obtain information about available patient assistance programs. An endocrinologist is a specialized physician who treats people with endocrine gland problems such as diabetes. This kind of physician would be the specialist to look for if you are a seeking a specialist. One option is to check with your local pharmacist or hospital. They may be able to direct you to a physician in your area. Also, there is a program sponsored by the NCQA (National Committee for Quality Assurance) and cosponsored by the American Diabetes Association. The program is called the Diabetes Physician Recognition Program which assesses physicians on their performance on measure of care. Recognized physicians and groups are publicized through health plan provider directories and on NCQA's Web site (www.ncqa.org/dprp). You may also find information on the ADA website at www.diabetes.org and finally the 1-800-DIABETES National Call Center will aid in those seeking referrals to a physician in your area.
That's it for today. The hour has just flown by. Thanks so much for taking the time to be here Linda and Sarah.
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, August 2, 2007. See you then.
Linda and Sarah: It was a pleasure to be here. Thanks to all of you who tuned in today.
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