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Texas: WHAT IS THE PROPER RANGE READING FOR TYPE 1. iS IT 80 TO 115 THANK YOU

Melissa and Michelle: Blood glucose goals for most people with diabetes, type 1 and type 2, are to obtain levels as close as possible to that of someone without diabetes. Goals are different, regarding the time of the day, and relationship to meals. Values also depend on the meter you use. Most meters measure plasma, but if you have an old meter, it may measure whole blood (goals for whole blood are 10 points lower than goals for plasma). For meters that measure plasma, the American Diabetes Association recommends the following: Fasting (after 8 hours without food) 90-130mg/dl and 2 hours after a meal - less than 180mg/dl.

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Hinckley, Ohio: I'm concerned about an episode I had this afternoon. I woke up with a blood sugar of 123 this morning. I ate yogurt and whole wheat toast for breakfast, hardboiled eggs for lunch, potato salad for a snack about 3 p.m. I went out shopping and by about 5:30 I was feeling dizzy, weak, faint and sick to my stomach. My daughter and I went out to eat right away and I had a coke right away and then an appetizer of fried green beans and a dinner of chicken and brocolli. I very gradually began to feel better and in about a half hour or so began to feel better. I took my blood sugar when I got home (about an hour to an hour and a half after dinner) and it was 118. I then ate an apple and in another half hour it was 102. Although I didn't have my meeter with me when I was out shopping, I presumed my blood sugar had fallen too low. I thought it best to skip my evening dose of 500 mg. Metformin. (I take one a day at dinner). I hope I did the right thing but I was worried that my blood sugar would fall just too low. Any thoughts?

Melissa and Michelle: The best thing to do when you feel dizzy, weak or just not right is to test your blood sugar. As in your case, this isn't always possible. If you don't know if your sugar is high or low, treat it as if you are low. Being too low, hypoglycemic, is an immediate danger whereas being too high coorrelates with long-term dangers. The best way to treat a low blood sugar reaction is the rule of 15. Eat 15 grams of carbs, wait 15 minutes, and test (if possible). If you don't have your meter and you still feel bad, eat 15 more grams of carb. Patients have a tendency to overindulge when they are having a low blood glucose reaction. Remember, we dont want to fix 1 problem (low blood sugar) by creating another problem (high blood sugar). Some examples of 15 grams of carb includes: 3-4 glucose tablets, 1/2 can of regular soda, 4 ounces of fruit juice, and 3 to 5 hard candies chewed up quickly. Metformin (Glucophage)is a drug that works by decreasing the amount of glucose that your liver makes. It also helps make cells more sensitive to insulin. Unlike many of the other oral medications used for diabetes, metformin, by itself does not cause low blood glucose (hypoglycemia). If taken with other drugs that do cause hypoglycemia, such as glyburide, glipizide, or insulin, a patient may experience hypoglycemia. If this happens again, take your metformin as your doctor has prescribed, test your blood as soon as you can, and treat accordingly. Its not always possible to carry your meter with you but try to make it a habit, especially if you continue to have episodes where you feel low. Testing is the only way to know for sure if your symptoms are from being too high or too low. If youre feeling low frequently after exercise, try eating a healthy snack (15-20 grams of carb) such as fruit, or a protein bar before exercising. And always carry a source of sugar with you for emergency situations.

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Heidelberg, Germany: I am a type 2 diabetic who is trying everything under the sun to loose weight. I exercise 2 separate hours per day. I eat very healthy food and in very modest amounts. If my caloric intake were any lower, I might as well stop eating altogether. If I don't loose weight, I will be separated from the military with nothing to show for 17 years of service. I would be exempt from the weight control program if there were some underlying medical issue that caused weight gain but I am being told that diabetes causes all people to loose weight meaning that I have to loose weight and fast. Help!

Melissa and Michelle: Diabetes does not cause all people to lose weight. Often times people will present initially with weight loss along with increased thirst, hunger, and urination. Diabetes is not a one-size-fits-all disease, so every patient is different. It sounds like there is an underlying metabolic disorder that may be affecting your inability to lose weight. I would recommend making an appointment with an endocrinologist which may be able to determine the cause of your problem with a simple blood test. One possibility is dysfunction of the thyroid gland, but a physician would need to determine that. As far as diet and exercise, it sounds like you are doing all the right things. Good luck!

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mumbai India: I have been prescribed Pioglitazone , I think i read it is not good for the heart, Please confirm

Melissa and Michelle: There has been alot of media attention lately regarding a study of rosiglitazone (Avandia) and its effect on cardiovascular disease. There is much debate on the strength of this study and the outcomes that the authors concluded in the study. At this time, the FDA has decided to keep Avandia on the market. Pioglitazone (Actos), is in the same class of drugs as Avandia (class of drugs is called thiazolidinediones-TZDs). These drugs work by increasing the cells sensitivity to insulin. Possible side effects are mild-moderate swelling and weight gain. These drugs should not be used in patients with Class 3 or 4 congestive heart failure and patients with liver dysfunction. If you are taking either Actos or Avandia and experience rapid weight gain, shortness of breath, chest pain, swelling, or fluid retention, contact your doctor right away. Pioglitazone has actually been shown to have beneficial effects on lipids (cholesterol). Pioglitazone (Actos) can lower triglycerides by 9-12% and both Avandia and Actos have been shown to increase good cholesterol (HDL) up to 19%. These drugs are effective at lowering A1c levels (3 month average of blood glucose levels) by 1-1.5%). Goal for A1c is less than 7% in a patient with diabetes. There is definately a subset of patients that these drugs should never be used in, but for the most part, as long as a patient has proper monitoring and follow-up with their physicians, Actos is safe and effective in the management of diabetes.

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Forest Park, Georgia : Yes, I would like to have some information about a product I can use/carry to eat every 2 hours. I used some I found in walmart is like orange pills that melted in your mouth, but this effect do not last for 2 hours in my system.

Melissa and Michelle: I'm not sure if the orange pills you are talking about were glucose tablets or not. If so, these are intended to treat low-blood sugar reactions, not as small meals. I'm also not sure what your diet is but if you are eating small snacks every 2 hours you may want to try a nutrition bar. They make many brands, and many flavors of these that are very well balanced for people with diabetes who need a snack. Check out the food label, choose something that has around 15-20 grams of carb, a few grams of protein, and a few (3-5)grams of fiber.

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Monroeville, NJ: My name is Kim and have a son Eric who has had diabetes for almost 4yrs now. Diagnosis at 2 1/2 yrs old. He is attending school which has a wonderful nurse who is very good with him and taking care of his diabetes. He will be in first grade this year and I have started a new Diabetes MedicaL Management Plan and 504 Plan. Last year I had done this, his first year of school, but no one from the school had ever signed it, even though my doctor and nurse educator and myself had signed it. Should I still worry about getting this signed this year, since things have been going smooth so far. The nurse will have 4 students this year in school with Type 1 diabetes. They were training substitute nurses last year and everything went good. Please give me your advice on this. Should I get a signed copy from them even though things are good.? I should know the answer to this since I am still in the process of taking a daycare to Civil Rights for Discrimination. Still on the table at this time. Found probable cause but she is not settling with Civil Rights.

Melissa and Michelle: I had never heard of a 504 plan, but based on what I read, this would be my advice. Even though your child has an excellent nurse at school, I would still probably have the school sign a 504 plan just in case an issue were to arise. You could explain to the nurse or school administration that you do not want to offend them, or do not mistrust them, it is just a precaution you take to protect your son. Good luck to you and your son. When he gets a little older, find out if your area offers a diabetes summer camp for children with type 1 diabetes. I attended one this summer and it is such a great experience for the campers.

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Hillsboro, OR: Some labels suggest that sugar alcohol does not count against carbohydrate intake. Fact?

Melissa and Michelle: Sugar alcohols (also known as polyols) include sorbitol, xylitol and mannitol, and have fewer calories than sugars and starches and do not raise the blood glucose as much as the same amount of other carbohydrates. Keep in mind that the use of sugar alcohols in a product does not necessarily mean the product is low in carbohydrate. Always remember to check the label for the grams of total carbohydrate, as this is what affects blood sugar. When counting carbohydrates, subtract half of the sugar alcohol grams from the grams of total carbohydrates. The remaining number is the grams of carbohydrates you should count. The ADA website has an example at http://www.diabetes.org/nutrition-and-recipes/nutrition/overview.jsp

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Iver, Buckinghamshire, UK: I have a fasting glucose level of 100.8 and a glucose intolerance of 165.6. I am overwight and have blood pressure and high cholesterol. I regularly exercise at a local jym. My practice nurse will not put me on any medication. I just rely on diet and excercise is this right?

Melissa and Michelle: With glucose levels like yours, it is appropriate to manage diabetes with diet and exercise, and this is probably the most common treatment for someone like you. However, it would not be inappropriate if you were to be started on a medication for your diabetes. If your glucose levels start increasing, talk to your doctor or nurse practioner about other treatment options.

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HENDERSONVILLE NC: I WAS RECENTLY PUT ON INSULIN FOR TYPE 2 THE DOC PUT ME ON LANTUS 10 UNITS IN THE EVENING BUT MY BLOOD SUGAR IS STILL ABOVE 200 EVEN IN THE MORNING AND I TAKE MY SHOT IN THE EVENING I ALSO TAKE 2 GLUCOTROL PILLS BUT THEY DONT BRING IT DOWN EITHER THE OFFICE IS CLOSED TILL TUESDAY AND IM NOT SURE IF I SHOULD UP THE UNITS TO 15 OR NOT

Melissa and Michelle: I recommend waiting until you speak with your doctor on Tuesday. Most people will start with 10 units of insulin and increase by a couple units every 2-3 days until they are meeting their blood glucose goals. Since I don't know what kind of schedule your doctor gave you, it won't hurt to wait another day to determine what he wants you to do.

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los angeles ca: is it harder for diabetes women to get pregnant?

Melissa and Michelle: I cannot find any information that suggests that woman with diabetes have a harder time getting pregnant. Although woman with diabetes are at higher risk for complications, for themselves, and the baby, if they are pregnant. For this reason, good blood glucose control before you get pregnant is very important. Most women do not know they are pregnant until the baby has been growing for two to four weeks. During the first six weeks of pregnancy, the baby's organs are forming. Your blood glucose levels during these early weeks affect the baby's growing organs. High blood glucose levels can lead to birth defects. Because these early weeks are so important to your baby, you need to plan your pregnancy. If your blood glucose levels are not in good control, work to bring your diabetes under control before getting pregnant. It is a good idea to be in good blood glucose control three to six months before you plan to get pregnant. You'll want to keep excellent blood glucose control during pregnancy, and after as well. With your blood glucose in the target range and good medical care, your chances of a trouble-free pregnancy and a healthy baby are almost as good as they are for a woman without diabetes.

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WINTHROP, MA: MY A1C HAS NEVER BEEN HIGHER THAN 6 WITHOUT MEDS. I'M QUESTIONING WHETHER OR NOT I EVEN HAVE DIABETES? MY ENDO SAYS I DO, MY PCP SAYS I DON'T. I'M CONFUSED!!

Melissa and Michelle: An A1c is not a test used to diagnose someone with diabetes. You would have either had to be diagnosed with a fasting blood glucose test, a random blood glucose test, or an oral glucose tolerance test. Find out which test was used to diagnose you. You may have met the qualifications for a diagnosis of diabetes, but fortunately they caught it early. If you do have diabetes, and your A1c is less than 6, that is wonderful. The closer we can get it to normal (4-6) the better. But once you have been diagnosed with the proper test, diabetes can't be reversed. Find out if the appropriate test was used to diagnose you, then you can know for sure. Eventhough your A1c is very good, if you do have diabetes, you still need to continue to make healthy lifestyle choices to keep your blood glucose levels as close to normal as possible.

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MEXICO CITY: Hi. I am a Physician and I want to know if you have records about level of glucose in blood (with out treatment) and its correlation with years of life, for example: 900 mg/dl: Years expected to live: < 5 years 300 mg/dl: 10 years in average. This information will be useful to in my clinical practice. Thank you

Melissa and Michelle: Dr. Rodriquez, I cannot find, nor have I ever seen, any information directly relating specific blood glucose levels to years of life. Here is some information that may be useful to you. http://aje.oxfordjournals.org/cgi/content/abstract/116/4/678 The following graph represents average years of life lost due to major causes of death. A person with diabetes on average, lives 14.3 years less than their non-diabetic conterpart. http://seer.cancer.gov/csr/1975_2004/results_figure/sect_01_zfig.20.pdf

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Bloomington, IL: Is there diabetic measuring tools without piercing the finger? What are the brands available in market? Is there any specification for these meters?

Melissa and Michelle: There is no way to measure your diabetes control without testing your blood. Many meters now offer alternate site testing which allows you to test blood using alternative sites, such as the upper arm, forearm, base of the thumb, and thigh so you don't have to always prick a finger. The limitation to alternate site testing is that results may not be accurate when blood sugar is changing rapidly (e.g. after a meal, taking insulin, or during or after exercise). In this case, you would still need to test you blood using a finger prick. Most Accu-check, Ascensia, and One-Touch meters offer this feature.

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rose hill: I recently had my A1C done it is .53 I usually control my diabetes by diet but lately My sugar has been running 164 fasting what should I do please help

Melissa and Michelle: Do you mean an A1c of 5.3? 5.3 is a very good A1c which is close to that of a person without diabetes. However, a fasting blood sugar of 164mg/dl is high, as the American Diabetes Association recommends fasting blood glucose levels between 90-130mg/dl. It is difficult to recommend anything without knowing what kind of dietary and exercise changes you have made. If you feel that you are eating healthy and exercising enough, and your sugar is still too high, it may be time to start thinking about starting a medication. We know that diabetes is a progressive disease. While many people are able to control their diabetes with diet and exercise at first, most people will eventually need oral medication and/or insulin. There is no way to tell at what point diet and exercise are no longer able to control the disease, as everyone is different. It is necessary to realize that people don't fail diet and exercise, but rather diabetes just progresses. Talk to you doctor to see what he recommends. Again, it is hard for me to determine what the best course of action is for you without knowing your history. If your doctor determines that it is time to start a medication, it's okay. The most important thing for you to do is to try to keep your blood sugars as close to normal as possible to prevent or delay complications of diabetes. Often times medication is necessary to do this, but the benefit of taking medication outweighs the risk of having high blood sugar which can lead to chronic complication.

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Buffalo, NY: I am having difficulty affording my testing supplies and medications, is there any help available?

Melissa and Michelle:

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WPB, Florida: I am 51 years old and recently diagnosed with Type-2. I seem to get severe headaches in the early morning(3-5AM). I have been eating properly however I am not on any meds. I cannot see DRs until next month. Any ideas?

Melissa and Michelle: The headaches you are experiencing in the middle of the night may be due to either high sugar, low sugar, or may be unrelated to your diabetes. The best way to determine this is to test your sugar between 3am and 4am. If you are low at this time, you may want to have a snack before bedtime. If you are high at this time, you may try not eating before bedtime, eating less at dinner, or exercising. It is really hard to determine anything without actually knowing what your sugar is doing in the middle of the night. If the headaches are so severe that they are waking you every night, I really recommend trying to get into the doctor sooner.

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South Brunswick, NJ: I was diagnosed as being pre-diabetic. My mother and both my grandmothers are/were diabetics. My aunt who is diabetic has one blue eye and one brown eye. Which has just happened prior to she had brown eyes. Am I prone to having my eye color change?

Melissa and Michelle: I can not find any information that leads me to believe that the change in your aunt's eye color is caused from diabetes. It is most likely unrelated, but a optometrist, or ophthalmologist may be able to better answer why her eye changed colors. People with diabetes do need to worry about their eyes for other reasons. People with diabetes have a higher risk of blindness, glaucoma, and cataracts. Keeping your sugar under control and seeing an eye doctor regularly are the best ways to prevent or delay eye damage. Here is a link to the American Diabetes Association website with information on eye care and diabetes. http://www.diabetes.org/type-2-diabetes/eye-complications.jsp

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Hyderabad India: Hello, I am from India. I work in nights and I drink quite a lot of water in nights due to which (I assume) I urinate more in nights. I am also having a pain at the lower and thigh part of my leg. Are these can be constituted as symptoms of diabetes?

Melissa and Michelle: While increased thirst and urination are hallmark signs of diabetes, a diagnosis of diabetes can not be made based on symptoms alone. I recommend you seeing your doctor. He will be able to do blood tests that will give you more answers. While pain in the leg is not a common issue seen diabetes, numbness, burning, and tingling of the arms, legs, hands, and feet can be seen in someone with diabetes. Your doctor will need to examine your leg to determine where the pain is coming from.

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Orlando, florida: Is there any connection between diabetes and oxygen therapy? This might sound strange, but, I had not experienced readings in the 140's until after going on oxygen 24 hrs. a day.

Melissa and Michelle: Hi Pat, I cannot find any studies or evidence that oxygen therapy has any effect on blood glucose. The connection does sound a little strange. I recommend notifying your doctor of the change in blood sugars after starting your continuous oxygen therapy.

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Lehigh Acres, Florida: Is it true that the American Diabetes Association considers the new diet drug Alli good for people with diabetes?"

Melissa and Michelle: I cannot find any information that the ADA endorses the use of Alli (orlistat) as a weight loss drug in people with diabetes. What the ADA does endorse is a healthy weight loss which incorporates a well balanced diet and increased physical activity. For more information on what the American Diabetes Association recommends for weight loss you can visit the website: http://www.diabetes.org/weightloss-and-exercise/weightloss-healthy-weight-loss.jsp

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Sunnyside, Wa.: Hi, Can you tell me if the ADA recommends that newly diagnosed type two diabetics be started on metformin right at diagnosis, regardless of fasting or A1C levels? Perhaps more specifically, should someone who was diagnosed type two diabetic be on meds even though their fasting levels are in the 90's and their most recent A1C was 6.08%? This person was diagosed via the O.G.T.T. & was not pregnant at the time.

Melissa and Michelle: The Standards of Medical Care in Diabetes 2007- endorsed by the American Diabetes Association does, for the first time, recommend Metformin, along with lifestyle intervention at diagnosis. This recommendation was based on the recognition that for most individuals with type 2 diabetes, lifestyle interventions fail to achieve or maintain metabolic goals, either because of failure to lose weight, weight regain, the natural progression of the disease, or a combination of factors. Metformin is recommended as the initial pharmacologic therapy, in the absence of specific contraindications, for its effect on blood glucose, absence of weight gain or hypoglycemia, low level of side effects, high level of acceptance, and relatively low cost. The algorithm published in the 2007 standards of care is an attempt to simplify the management of hyperglycemia in patients with type 2 diabetes. There is much dispute over this new stepwise approach to care. The chart tends to focus on using the A1c as a measure of diabetes control when many other factors play into how well diabetes is controlled and the risk for complications, such as fasting blood glucose, and post-prandial blood glucose (after meals). The goal of all health care providers would be to obtain blood glucose levels as close to normal as possible. We do know that an A1c of less than 7% significantly decreases long term complications. Diet and Exercise will be a recommended treatment for all patients with diabetes. Metformin is certainly a reasonable option as an initial therapy at diagnosis, but it is not a one-size fits all protocol. It is a decision to be made by the physician and the patient weighing the risks and benefits of starting a medication.

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ADA Moderator : If you are age 65 or older, I suggest that you inquire into Medicare coverage. Additionally check to see if there are county or state funded programs that you might qualify for. 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. You could also talk to your doctor or pharmacist to see if there are any cheaper medications that you may be able to use. A pharmacist could also help you pick out a meter with cheaper testing supplies. You can nearly always get a meter for free.

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

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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, October 4, 2007. See you then.