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Your questions on diabetes:
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Dr. Tony Morrison

Welcome to Times Talkback. Dr. Tony Morrison, co-director of the Diabetes Center at the University of South Florida, took readers' questions on diabetes. His responses are posted below.


Questions and answers:
Question: Do you have any information on the use of Dioscarea to lower elevated blood sugar levels?
Dr. Morrison: I know nothing about this compound. I would have to see the active ingredients.

Question: What is the proper way to be tested for Diabetes? Does one still need to go through the old method of fasting and then doing the glucose tolerance testing?
Dr. Morrison: Diabetes can be diagnosed one of three ways:
a. A fasting plasma glucose greater than 126 mg/dl on two occasions or;
b. A 2-hour plasma glucose after a 75 gram glucose challenge greater than 200 mg/dl or;
c. A random (not necessarily fasting) plasma glucose greater than 200 with symptoms of a high glucose (eg excessive thirst, increased frequency of urination, etc).

Question: With regards to a Type 1 diabetic why would sugar levels go up when one does not eat? Why would you get a severe headache every time you take insulin? If you follow the endocrinologists regime of food, insulin and monitoring blood sugars, and your 3 month average is within the normal range, would you feel progressively sicker after 2 years of treatment instead of better?
Dr. Morrison: a. Insulin prevents the liver from making too much sugar (glucose). If there is no insulin, then the liver proceeds unchecked in releasing glucose into the blood.
b. Unless the blood sugar were going too low, the injection should not cause a headache. Remember insulin is a replacement for what the body would normally produce.
c. One should be feeling one’s usual self recognizing that one is two years older.

Question: Is there is an organization that helps people with Diabetes? I have a friend who is 43 years old and who lost his right foot due to diabetes. He cannot work at the present time and he does not have the funds to buy medications such as Insulin or the strips for the testing machine.
Dr. Morrison: I would suggest contacting the local office of the American Diabetes Association. They are a great resource for many different needs.

Question: Is there a test I could do at home for diabetes?
Dr. Morrison: We strongly encourage people with diabetes to do home blood glucose testing. However these meters are usually not used to diagnose diabetes, but rather one uses a laboratory facility.

Question: Does having heart problems cause Diabetes?
Dr. Morrison: Heart problems can sometimes unmask diabetes and an individual with diabetes is at increased risk for heart problems. However heart problems should not cause diabetes unless there is an inherited predisposition.

Question: I try to follow the guidelines of the food that I should eat, but I find that I am often hungry. If I eat till I am full then my blood sugar is high. I miss the breads, potatoes that seem to fill you up. What am I doing wrong? Also I walk 18 minutes each evening. Would other kinds of exercise (weights, etc) make a difference in my blood sugar?
Dr. Morrison: a. You should not feel guilty. You are probably asking your body to change many years of how you have been eating and it is difficult, especially initially to do this for any length of time. If the sugars do go high, then consult with your doctor about possibly changing or adding to your treatment plan.
b. Both aerobic and strength exercises can help improve insulin resistance.

Question: Why is that most thin people don't have diabetes?
Dr. Morrison: Many people with type 1 diabetes are thin. However, the majority of people with type 2 diabetes are on the heavy side. Being overweight frequently leads to insulin resistance (an inefficient use of insulin by the body’s tissues) which can increase the likelihood for high blood sugars especially if the is an inherited tendency for this type of diabetes.

Question: How do doctors test for diabetes? When I get a standard blood test, is this one of the things they look for?
Dr. Morrison: A glucose determination is a component of a Basic Metabolic Panel (BMP) and also the Complete Metabolic Panel (CMP). These are panels frequently requested by practitioners.

Question: I had gestational diabetes while pregnant with my daughter in 1988. I took insulin shots and was on a diabetic diet. Do I have a great potential for the diabetes to return and if so, when in my life, how, etc?
Dr. Morrison: Gestational diabetes is a frequent forerunner of Type 2 diabetes. Some 40 – 50 % will develop diabetes within 10 years after the pregnancy. Thus, you have done very well and the best way to try to prevent the progression to diabetes is by "lifestyle" (i.e. watching one’s weight, frequent exercise, etc). It is probably a good idea to have a blood glucose test on an annual basis as well.

Question: Does black coffee or caffeine affect your sugar levels? Do sugar substitutes affect your sugar levels?
Dr. Morrison: There have been many studies examining caffeine and no definite conclusion has been drawn after many years. Thus, if there is an effect, it must be a very weak one.

Question: My nails are splitting and peeling on my fingers and toes, what could cause this and how can I get them back to normal? I have my blood glucose under tight control, my A1C is 5.6. Why am I so tired all the time?
Dr. Morrison: For answers to these questions, I would look at other possibilities than diabetes. You might want to talk to you doctor.

Question: Does it make a difference when you take your medication? Should you take it all at the same time, every day or just before you eat? How long should you stay on the same pills before changing to something else, when they appear not to be working anymore?
Dr. Morrison: It is very important at what time one takes some medicines (eg. Insulin and some others). Others allow more variability. One can take a medication for as long as it is effective assuming there are no contradictions for doing do. If a medicine becomes ineffective, then it is reasonable to either add a new one or to replace it with another. See your doctor.

Question: Why is diabetes prevalent in the South and the East? Why does the epidemic seem to skip most of New England? Also is there one cookbook, or meal-planning guide, that is recommended as being accurate.
Dr. Morrison: a. Unfortunately, diabetes is being more prevalent across the entire country (and the World as well). New England has not escaped (take a look at a color map of the US as published by the Centers for Disease Control) to see then changed that have occurred in each state over the years.
b. Both the American Diabetes Association and the American Dietetic Association can recommend a number of excellent food guide references. A "Diabetic Diet" is, in essence, a sensible diet.

Question: Why shouldn’t diabetics wear tight socks?
Dr. Morrison: Tight socks can sometimes pinch either nerves or blood vessels and thus increase the symptoms of neuropathy, edema or circulation that may occur with diabetes.

Question: Is there a free clinic in the Tampa Bay area to get tested for diabetes?
Dr. Morrison: There are frequent health fairs held around the Bay area throughout the year and glucose testing is frequently included. November is "Diabetes Month" and testing sites are especially common at that time. The local American Diabetes Association office can often help with specific information.

Question: My grandfather and paternal father have chronic diabetes. I am a 56 year old male about 45 pounds overweight. I am currently taking anti-cholesterol medicine and have my blood checked regularly because of a risk of liver failure. If I had diabetes would it have been picked up during the blood tests?
Dr. Morrison: If the blood tests ordered are a Basic Metabolic Panel (BMP) or a Complete Metabolic Panel (CMP), then a glucose will be included.

Question: I know doctors are uncomfortable recommending other doctors. But I am determined to control my diabetes with exercise and weight loss. I would like to find a doctor who strongly supports that. Who would you recommend?
Dr. Morrison: I would suggest checking with the local office of the American Diabetes Association. They do have a list of individuals with a particular interest in diabetes.

Question: I just had my glucose tested and it was 42, which seems really low. My cholesterol was 265. My mother and grandmother both had diabetes once they entered their 60's. I've always had low cholesterol and was last tested 2 years ago when I had a hysterectomy. My glucose level at that time was around 90. Can you give me an idea of what might be going on with my body to change so radically? I am 46 and fairly active, although I have gained 15 pounds since the surgery.
Dr. Morrison: If there have been marked changes in test results, you might want to consider repeating the test especially if there has not been a marked change in diet, exercise or any medications. Unlike what was thought in the past, a low blood sugar is not felt to be a precursor of diabetes.

Question: What is a good sugar count?
Dr. Morrison: A "normal" fasting glucose is between 65 and 99 mg/dl and a "normal" two hour after meal glucose is less than 140 mg/dl.

Question: What are important aspects of foot care for diabetics? Should they walk barefoot at all? My husband has mild Type 2 diabetes and recently had a heart attack. Can you explain what happens in diabetes to make heart attacks so prevalent? What should his blood pressure be to prevent further attacks?
Dr. Morrison: a. Good foot care is basically common sense which includes wearing appropriate foot ware especially outside. First of all find out if you have impaired sensation or circulation in the feet. Diabetes education classes are a wonderful means of obtaining detailed explanations and information.
b. Many people with type 2 diabetes have the Insulin Resistance Syndrome (or Metabolic Syndrome) in which there is an increased likelihood for early blood vessel problems. The exact cellular cause of the Syndrome has yet to be fully elucidated.
c. If possible, I like to see the systolic (higher number) blood pressure to be less than 130 mm Hg. Admittedly this is sometimes difficult to achieve especially in an elderly individual.

Question: What is the name of the syndrome that causes diabetics the inability to digest food?
Dr. Morrison: You may be referring to "gastroparesis diabeticorum" which is somewhat unusual but cause the food to be retained in the stomach (and thus not able to be absorbed for longer than usual).

Question: My sister & I are diabetic. Hers is newly diagnosed. She got a rash from the diabetic medicine. Her doctor has tried 4 different pills so far. The rash is worse following the vericose veins on her legs. Can someone be allergic to all diabetic medicine? She is not allergic to anything else that she is aware of. Any suggestions for a type a diabetic medicine to try?
Dr. Morrison: It would be inappropriate for me to answer this question off the "top of my head". I should think she might discuss this with her practitioner.

Question: Just what are carbs besides pototoes and pasta?
Dr. Morrison: "Carbs" refers to all carbohydrates from simple sugars such as sugar to more complex ones such as pasta potatoes, rice, etc.

Question: Once diagnosed and put on oral medication, can a compliant patient (having lost weight, modified diet and exercise) ever be taken off medication altogether if levels normalize?
Dr. Morrison: If one is able to decrease insulin resistance sufficiently by "lifestyle" changes (eg diet, exercise, etc), then medication may not be necessary. It depends upon overall glucose control.

Question: On rare occasion, maybe 2 to 3 times per month, I have light tingling in my hands or feet. It may last for a few seconds to a minute, and go away and the re occur at times within a 24 to 48 hour period. Less frequently, this tingling will occur in other parts of my body, including my back and/or face. At this point, I would describe any tingling as a minor happening is usually remedied by moving the area. Can these be early signs of diabetes? I have no family history of diabetes and exercise regularly. I am 46 years old, 5’10" and weigh 235.
Dr. Morrison: This does not sound like diabetic neuropathy and I would seek some other explanation.

Question: I have type 2 diabetes and have 1 whole banana with my cereal daily. Is that not good? My blood sugars are taken daily and I read under 6.0.
Dr. Morrison: Sounds good to me. Bananas are a good source of potassium. I am assuming that you mean that your Hemoblobin A1c level is less than 6.0.

Question: I often fall asleep very easily when I sit and read, feel tired, and have cold and "tingling'' feet. I tend to fall faster asleep after having a can of regular Coke, a piece of chocolate, or just a regular meal. I am tall and skinny and, although I do not get much exercise, I would say I am a very active person. Do you think I might have some form of diabetes?
Dr. Morrison: From this distance, it does not sound like diabetes. You can always check by having a blood sugar test when you are having these symptoms.

Question: I have become light headed in the afternoon, if I don't eat and walk in the mall, or other such activity. So, I grab a candy bar, and I feel OK. I am not overweight, according to standards for a 64-year-old man, and do my hourly exercises at the gym three times a week. Is this diabetes?
Dr. Morrison: From this distance, it does not sound like diabetes. You can always check by having a blood sugar test when you are having these symptoms.

Question: What can I do to stop my feet from swelling up so much?
Dr. Morrison: It depends upon what is the cause and you should check with your practitioner as there are many causes of feet swelling.

Question: If I am borderline diabetic, are fruits wrong?
Dr. Morrison: Fruits, in moderation, are an excellent food choice. You might want to discuss diet with a registered dietician. There is usually one associated with a diabetes education program.

Question: I had a fasting glucose test in 2000 and 2002. The results are as follows for 2000 - fasting was 93, 1 hour was 200, and 2 hour was 179 and three hour was 125. In 2002 the fasting was 102 and the " hour was 180 and 1 hour was 239 and 2 hour was 181 and the 3 hour was 86. My Triglycerides are 287 and Cholesterol is 241 (HDL 43 and LD 140). My question is do I have Type 2 Diabetes and what diet should I be following? Can you have Type 2 and not have the high fasting levels?
Dr. Morrison: a. You would appear to have what is now termed "prediabetes." You are at increased risk for developing diabetes in the future and the usual recommendations would be to encourage a diet to maintain "ideal body weight" and an exercise program. These, in combination have been proven to be helpful in preventing the progression to diabetes.
b. Some people can have normal fasting blood glucoses and elevated after meal or after glucose challenge values.

Question: Are the low carb diets really that great as a whole for diabetics?
Dr. Morrison: Opinions vary strongly and widely about this. My own feeling (which is not necessarily correct) is that the "Adkins Diet" may not be the best one but that the "South Beach Diet" is more reasonable. In any event diets are best individualized and can be discussed with a registered dietician.

Question: My job is literally sitting at a desk on the computer for most of the day. I try to go for walks on my breaks, because I can feel the tingling in my right hand, and occasionally my feet. Is there anything I can do to help this? Also, I notice when my numbers are too high, I get blurred vision. Usually it goes away. How do I know if this is caused from diabetes, or if my eyesight is changing?
Dr. Morrison: I am assuming that you do have diabetes. It is impossible to say at this point if your symptoms are positional (which I would suspect) or more related to neuropathy. It would be good to do foot and hand exercises while you are staring at your CRT as they suggest you do during long airplane rises. As for your vision, you would need a dilated eye exam by an experienced professional to tell if there are any diabetes-related changes.

Question: Are there any natural supplements that can help with diabetes?
Dr. Morrison: Many have been suggested over the years from ginseng to chromium picolinate, to evening primrose oil, etc. etc. Unfortunately there is no strongly positive controlled studies for these. There have been many reports over the years about benefits from one or another but they have not stood the test of time. Some "natural" products may contain amounts of glucose-lowering chemicals and clearly need further evaluation. Also the psychological effect of various compounds also needs to be taken into consideration.

Question: If I am diagnosed with Type II diabetes is it possible to forego medication if I am successful at controlling blood glucose and lowering "bad" cholesterol levels by diet weight loss and exercise?
Dr. Morrison: Yes. It depends upon have successful the "lifestyle" modifications have been in controlling blood sugar and hemoglobin A1c levels.

Question: If you have some of the symptoms of diabetes but your blood test comes back normal should you still have a glucose tolerance test?
Dr. Morrison: A glucose "challenge" (i.e. a blood glucose level 2 hours after a standardized glucose drink) if frequently more sensitive than a fasting glucose in determining glucose status.

Question: How many carbs should you have a day to keep your sugar level down?
Dr. Morrison: There is no one correct answer. Many nutritionists recommend that somewhere between 30-50% of total calories be in the form of carbohydrate. However these numbers vary greatly and need to be individualized with the help of a registered dietician.

Question: Is Miller Lite beer that bad for sugar?
Dr. Morrison: A lite beer has approximately 100 calories and need to be taken into account as part of the entire dietary picture.


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