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Readers Forum

We have had a  so many wonderful questions and comments from our  E-Lerts™ Newsletter. Please send any questions to Lisa Rasolt,or Andrew P. Mandell.
 
Here are just a few of the latest questions:
 
Q: Are Epsomsalts bad to use when you are a diabetic? One person told me yes and another said no. It's very confusing. - Ebonee
A: Soaking the feet is not recommended for people with diabetes unless a special therapeutic soak is used for a specific problem. Soaks can cause the skin to get very dry and crack, which becomes an easy entry point for infection. It is recommended that you pat your feet dry with a towel after bathing and apply lotion on the top and bottom of your feet, but not between your toes. Make sure that you inspect your feet daily after bathing and report any redness, paleness, swelling or sores to a podiatrist. I don't know why you were soaking in epsom salts, but if it is because you are having some discomfort in your feet, perhaps you should see a podiatrist now. children with diabetes
 
 Q: I'm interested in the new inhaled insulin, but I'm afraid that I won't always get the correct dose, especially if I have a cold. Has this yet been tested? - Michelle
A: Exubera, the new inhaled insulin, has past the tests with flying colors. We just posted an article, Exubera Works Even with Cold or Flu-Study, that shows a new form of insulin which is inhaled rather than injected works even if patients have a respiratory infections or are exposed to passive cigarette smoke.
 
Q: I just found out I have diabetes. I am also home sick with a cold today. I had the flu about 4 weeks ago which led me to discover my diabetes. I have diabetes because it runs in my family. My uncle and aunt on my mother's side and my dad has it. I am not overweight, but need to eat healthier and exercise more. Why do I keep getting sick???? How do I manage simple colds and why do I keep getting them? - Elizabeth -
Mr. Diabetes® Answer: Take heart!!  Now that you know you have diabetes, life should improve for you. Diabetes, unchecked will do a number on your immune system. So, by properly taking care of your diabetes you will be able to strengthen your immune system.  Now, how do you do this?
First you must be seeing the right physician.  My very STRONG recommendation is for you to be under the care of an endocrinologist.  This physician is a specialist in the field of diabetes.  Think about it, if you had a heart problem you'd see a cardiologist; if you had a skin problem you'd see a dermatologist.  Well, you have a diabetes problem, so you should see an endocrinologist. This doctor will coordinate all aspects necessary for your complete program.  That will include getting you proper advice for a comprehensive nutrition program and advising you on the best physical fitness program for you. All three of these actions are a MUST to properly treat your diabetes!!
 
Once you are on track w/ properly treating your diabetes, your other health problems will improve dramatically.
 
Please continue to visit  www.DefeatDiabetes.org where you will find over 2700 pages of diabetes information presented in a very user-friendly format. And, don't forget to sign up for our E-Lerts™ newsletter - it's monthly, comes to you over the internet, has valuable information every issue and it's FREE!!!  Scroll down the Home Page to subscribe. Further, our Products & Services Page offers a number of fantastic benefits for diabetics.
 
Q: I have a 17 year old son who has had Type I for three years. Do you know of anybody that has had success that is open to the public who has been able to reverse the disease through Stem Cell or whatever.  We have been going to Mexico to obtain a vaccine there that is mixed with his own blood and he gives himself shots of this vaccine that supposedly kills of the antibodies. I am a little leery of the doctor although he has scores of successes with other conditions , he doesn't return emails with my questions and I haven't been able to get results of blood work I did there either. It's very frustrating needless to say but I have heard of successes with Stem Cell in Korea.  Anything you know of that is working. Thanks very much. - Chris -
Mr. Diabetes® Answer: My advice to you,as strongly as I can suggest it, is NOT to vary from the conventional medical treatment available here in the United States!!!!   You MUST continue to work with a qualified medical health team that specializes in diabetes!!!  Continue to work with your endocrinologist (diabetes specialist), registered dietician and maintain a regular physical fitness program - ALL under the guidance of your endocrinologist!!!
 
DO NOT, I repeat DO NOT go off on your own to experiment with unknown therapies!!!

Q - I have type 2 diabetes and I'm also suffering from depression. I have cravings for sweets and carbohydrates that are out of control and I'm gaining lots of weight. Do you know of anything that might curb these cravings? - Shana -
A - There is a popular nutritional supplement may reduce serious carb cravings in people with depression. The supplement is chromium picolinate.

Another known effect of chromium picolinate is the supplement's ability to increase the body's sensitivity to insulin, helping it work better to control blood sugars.  Read More

Q - I am pre diabetic. I purchased 500MG cinnamon pills from a well known vitamin store. This is a easy way to take cinnamon. However, on the label it states "not for long term use". Do you know why this would be true? The dosage is 2 pills/day or 1000MG. - Robert -
A - In my research, I could not find anything that would limit the long term use of cinnamon. I did find out that cinnamon contains some substances that can be toxic in high amounts, so people should be sure not to get too much of a good thing. "Certainly, a gram (less than ¼ teaspoon) per day is not a high amount," said Dr. Richard A. Anderson of the Beltsville Human Nutrition Research Center in Maryland.

Q - Is is okay to keep Metformin in the refrigerator? - Gary -
A - Re Storage of Metformin:
a. Keep out of the reach of children.
b. Store away from heat and direct light.
c. Keep the medicine from freezing. Do not refrigerate.
d. Do not keep outdated medicine or medicine no longer needed. Be sure
that any discarded medicine is out of the reach of children. MedlinePlus - U.S. National Library of Medicine and the National Institutes of Health

Q - How can I find out about clinical trials and if I qualify?  - Lisa -
A - The U.S. National Institutes of Health have a web page. Their introductory paragraph is as follows:

ClinicalTrials.gov provides regularly updated information about federally and privately supported clinical research in human volunteers. ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and phone numbers for more details. The information provided on ClinicalTrials.gov should be used in conjunction with advice from health care professionals. Before searching, you may want to learn more about clinical trials.

The url is: http://www.clinicaltrials.gov/ct/gui/c/r.

Q - I have type 1 diabetes and recently my hands and ankles became very swollen. Everything is okay now and it hasn't happened again, but I'm nervous. Is this a sign of vascular problems related to diabetes? - Beau -
A - This could be related to diabetes, but it may not be. The swelling can be a direct sign of dehydration, as the body tries to conserve fluid. It could also be a sign of kidney and/or vascular problems, both of which are complications of diabetes. I suggest that you go see a physician as soon as possible.

Q - Does my fasting blood glucose depend on the food (carbohydrates) I had the previous day? How do I treat my morning high blood glucose? - Ralph -
A - Morning hyperglycemia could be due to what you ate the night before or the dawn phenomenon, the early morning (4 AM to 8 AM) rise in blood glucose. A Certified Diabetes Educator (CDE) would be a good person to go to for a meal plan and total diabetes regimen.

Q - What is diabetes? I hear so much about it, but can you please give me a simple definition or explanation of what is diabetes? - Henry -
A - The following is from the Florida Agency for Health Care Administration: "Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life."

Q - What causes type 1 diabetes? - Jean -
A - The causes of type 1 diabetes appear to be much different than those for type 2 diabetes, though the exact mechanisms for developing both diseases are unknown. The appearance of type 1 diabetes is suspected to follow exposure to an "environmental trigger," such as an unidentified virus, stimulating an immune attack against the beta cells of the pancreas (that produce insulin) in some genetically predisposed people. CDC

Q - Half of everything I read says to take a BG (blood glucose) reading 1 hour after meals, to see how high it goes. The other half says to take it 2 hours after meals, to make sure it returns to normal. I know that both pieces of information are important, but I also know that few, if any, people with diabetes take a BG reading both 1 and 2 hours after meals. So which is more important? - George -
A - I did some research and was as confused as you as to when to test after meals. So, I consulted with one of our Certified Diabetes Educators (2004-2005 National Diabetes Educator of the Year), Theresa Garnero, APRN, BC-ADM, MSN, CDE, and this is what is her opinion:

"Testing after a meal? For gestational, it's 1 hour after starting a meal. For everyone else, it's 1½ hour after your last bite, or 2 hours after you start eating."

Q - My cat has just been diagnosed with diabetes. What is the expected life span for a diabetic pet? - Marilyn -
A - Veterinarian research doesn't have a lot of data on well regulated pets with diabetes. It is only recently that animals were treated aggressively for diabetes.  It was not that many years ago that these animals would have automatically been euthanized. The lifespan often quoted in textbooks (2-5 years) include all diabetic pets, including those whose owners do not aggressively manage their diabetic control. Also keep in mind that many are diagnosed later in life so a 2-5 year life expectancy may not be that different from their average lifespan anyway. The newer data coming out suggests that, if an animal is kept well-regulated and does not have any other health problems, they should be able to have a normal life expectancy.

Q - We know the body is a biochemical factory. Food is chemically broken down and absorbed. The body recognizes only chemicals, not the source of the chemicals. So why do I hear stuff from so-called experts about how we should never eat chocolate or sweet snacks every day, but only on rare special occasions? If our A1c is in line, our cholesterol numbers are okay, and we are not overweight, isn't it okay to eat such things, as long as they are included in our daily carb count? If one eats a bowl of rice containing 60g of carbs, the body doesn't know if it was rice or apples or chocolate that was eaten. All it knows is that 60g of carbs must be processed. So, why do the experts continue to scare us into nearly never eating certain foods, always neglecting to mention that if all our statistics are okay and we eat healthy food at almost every meal, it shouldn't make a difference? - George -
A - There is no longer a single diabetes diet that will suit everyone. The overall approach is based on the US Dietary Guidelines for healthy eating for all Americans, and includes the following:

 Limit fats. Avoid saturated fats (found in animal products) and trans-fatty acids (hard margarines, commercial products, fast foods). In selecting fats or oils, prefer monounsaturated fats (virgin olive oil, canola oil), although also include polyunsaturated oils as well (sunflower, rapeseed). Of note, a 2001 report suggested that trans-fatty acids were a risk factor for diabetes type 2 while polyunsaturated were protective. 
 Limit dietary cholesterol. 
 Consume plenty of fiber-rich foods in the form of whole grains and fresh fruits and vegetables. Includes a daily choice of nuts, seeds, or legumes. 
 When choosing foods with sugar, choose fresh fruits, but do so in moderation. 
 Limit protein. In selecting proteins, eat in moderation and prefer fish or soy protein to poultry or meat. (Avoid, in any case, high-fat meats.) 
 Reduce salt.

Patients ideally should meet with a professional dietitian to plan an individualized diet within the general guidelines that takes into consideration their own health needs. There is no single diet that meets all the needs of everyone with diabetes.

A simple heart-healthy diet with weight control may be sufficient for people with type 2 diabetes. One study of people with type 2 diabetes compared several diet plans: a high-carbohydrate/high-fiber diet, a low-fat diet, and a weight management diet. After 18 months all groups experienced similar and improved glycolated hemoglobin and cholesterol levels. The researchers concluded that the positive benefits of the diets were derived not from the specific regimens, but because the people in the study were attentive and focused. In other words, any healthy diet works if patients work at it.

Intricate dietary methods are available for control of blood sugar in type 1 and more severe type 2 diabetes. The most common method for controlling blood sugar is the use of The Diabetic Exchange Lists. More sophisticated methods include counting carbohydrate grams and using the so-called glycemic index to determine the impact of carbohydrates on blood sugar. 

If one of these approaches works in controlling glucose levels, there is no reason to choose another. Each of them can be effective, but because regulating diabetes is an individual situation, everyone with this condition should get help from a dietary professional in selecting the best method. Well-Connected

Q - My mother in law has told me about Topomax. I was wondering, well I have n problems with the reasons why people take them, she said it has helped her lose weight, and I am at a stand still with weight loss. I need to lose about 20-30 more lbs. and I was just wondering could I take this to lose Weight? I have read the side effects, but I need something to help lose these last pounds. - Doris -

A - Topomax is actually a drug used in the treatment of seizure disorders, namely epilepsy. At one stage there was some research done into its suspected benefits to those wanting to lose weight. 
 
The phase 3 weight loss trials had to be discontinued because of significant, unfavorable side effects. Topomax is not approved for weight loss. Weight Loss International
Two-thirds of people with Type 2 diabetes are not in control of their blood glucose: This is what a report from the American Association of Clinical Endocrinologists (AACE) reveals. This finding is worrisome, because high blood glucose levels can damage blood vessels and nerves, and cause serious complications. These complications can include heart disease, vision problems and blindness, kidney disease, circulatory problems, and even amputations. In fact, diabetes is the 6th leading cause of death in the US.

Q - What is the best way to measure control? - Ramona -
A - The A1C test is the preferred standard for measuring glycemic control. The A1C test measures your average blood glucose level over the past 2-to-3 months. It's the best tool you and your healthcare provider have to assess your overall control — and your risk of developing serious complications.

AACE recommends an A1C target goal of 6.5% or less, and also suggests having an A1C test at least 4 times per year.
• You and your physician should determine how often you should test.
• In fact, AACE recommends talking to your physican about your A1C during every visit.
• A1C testing is not a substitute for regular blood glucose monitoring. Lifescan

Q - If I'm measuring my A1C, is blood glucose self-monitoring also necessary? - Freddy -
A - The A1C test and blood glucose monitoring work together. The A1C test shows your average blood glucose over the past 2-to-3 months — while testing with a glucose monitor shows your glucose level at a specific point in time.

• If you're not in good control, self-monitoring your A1C and blood glucose can help you better understand your diabetes and how to manage it.
• Talk to your physician about self-monitoring — and if a specific monitoring plan may make sense for you. Lifescan

Q - I read, with interest, the short article written on the Diabetic Insole developed at the University of Michigan by  Ammanath Peethambara. I would like more information on the product. - Barry -
A - This information was published in the March 2005 issue of Applied Neurology. Hope that this helps:

ORTHOTIC INSOLE FOR DIABETIC FOOT

The immediate goal of treatment for patients with diabetic foot ulcers is offloading pressure from the wound to allow healing. At the testing stage is an insole designed to be a shear-reducing orthosis. The insole, developed by Ammanath Peethambaran, CO, of the University of Michigan Orthotics and Prosthetics Center, is intended to help prevent ulcers and promote faster healing.

"Traditional orthoses address only the vertical force," Peethambaran said, "but not the horizontal force, or shear friction, that happens underneath the foot." The insole is designed to be a friction-reducing and shear-reducing interface between the foot and the orthosis and to provide a rolling and sliding motion in the front section of the device, according to Peethambaran. "The foot remains in one place but the orthosis moves, reducing the friction and shear," he said.

Peethambaran says his insole, which can fit into any shoe, is made of Poron (PPT) and Plastazote. "I didn't utilize any different material," he said. "I just changed the configuration. So it's more of an engineering innovation."

Although Peethambaran has engaged in only small, preliminary, unpublished studies, he's looking for funding, and perhaps manufacturer input, to establish larger trials. "The pilot study [unpublished] indicates there is at least a 50% reduction in the time that it takes ulcers to heal and that calluses are reduced tremendously compared to standard insoles," Peethambaran said. He's looking to study use of the insole in about 300 patients, because a larger pool of subjects will give him more reliable results.

Q - What is your opinion of the product DIABETICINE? - Fernando -
A - I did some research on the web regarding Diabeticine and here is what I found:
The ingredients, by themselves, do not appear harmful; I did not read of any side effects;
The only research is anecdotal, without any hard facts; the product is very expensive;
The claim to drop blood sugar by 50 points doesn't impress me - I'd like to hear about what the A1c levels are after 3 months and I can't find that anywhere; It is not approved by FDA, so you cannot be absolutely sure that each capsule or tablet has the same amount.

Never take a supplement instead of a prescribed medication without first consulting with your physician. ALWAYS consult with your doctor before taking any type of supplement that may interfere with your medication. If your physician does approve this supplement, make sure you keep very good records of your readings as it may affect your future prescribed medications.

I cannot endorse this product as I do not know anyone who has been on it and nothing I have read has been conclusive. If you do decide to take Diabeticine, I would be very interested in your experience with it; if it works and to what extent and if it doesn't.

Q - When is diabetes a disability under the Americans with Disabilities Act (ADA)? -Sharon -
A - Diabetes is a disability when it substantially limits one or more of a person's major life activities. Major life activities are basic activities that an average person can perform with little or no difficulty, such as eating or caring for oneself. Diabetes also is a disability when it causes side effects or complications that substantially limit a major life activity. Even if diabetes is not currently substantially limiting because it is controlled by diet, exercise, oral medication, and/or insulin, and there are no serious side effects, the condition may be a disability because it was substantially limiting in the past (i.e., before it was diagnosed and adequately treated). Finally, diabetes is a disability when it does not significantly affect a person's everyday activities, but the employer treats the individual as if it does. For example, an employer may assume that a person is totally unable to work because he has diabetes. Under the ADA, the determination of whether an individual has a disability is made on a case-by-case basis. The U.S. Equal Employment Opportunity Commission

Q - Why do doctors suggest that people with diabetes drink lots of water? - Jen -
A - Water is necessary so that we will continue to be hydrated and not get dehydrated. When blood glucose levels are running high, there is a tendency to become dehydrated. Plus, drinking water helps with our kidney function. It is healthy practice to drink 6-8 glasses of water per day. diabetesdigest.com

Q - In 1996, I discovered that I was having some problems with sugar regulation.  I wasn't feeling right and went to the doctor and the sugar level was dangerously low - 32.  So my doctor ordered a glucose tolerance test.  According to the test, the results revealed that I was mildly diabetic.  I was instructed to purchase a meter to check my fasting sugar every morning.  Since I am a serious runner, my doctor referred me to an endocrinologist. When I met the endocrinologist, he blew me off, and treated me like one of the overreacting idiots.  He didn't even check me and told me that I was crazy for even thinking that I was possibly diabetic.  I left his office embarrassed and never returned.  This was in 1996.  Time went on and there has been times when I have checked my sugar level, it would be over 150.  Last month, I got very sick with bronchitis and was on medication.  Due this illness, I was unable to eat adequate meals.  I got better but still struggled with appetite.  I went back into running because I was training for a marathon.  While I was running, I felt really terrible.  I thought my sugar was low due to not eating well from my illness.  After running 6 miles, I checked my sugar and it was 211.  Tell me, is this a warning sign.  Should I try to go back to the doctor?  I don't to be embarrassed again.  - Sandra -

A - Go see an endocrinologist! But I would go to a different one from the one you went to before. Depending on your health insurance, I would either ask friends for a recommendation, ask your doctor for a different referral or call the insurance company for a recommendations.
 
By the way, the "mild" diabetes is a diagnosed condition called pre-diabetes. Over 41 million people have this condition and most will eventually get type 2 diabetes unless they change their diet and exercise and lose weight. Some will get the disease in spite of lifestyle changes, but anyone with pre-diabetes should be medically monitored.
 
Don't be embarrassed. You have legitimate health concerns that need to be addressed.

Q - Can surgery affect my diabetes? - Anne -
A - In one word - YES! I wrote an article last year which is very important for all people with diabetes who are going into the hospital Helpful Hints For Your Hospital Stay.

Q - How does diabetes affect metabolism of food? - Stephanie
A - Diabetes is a chronic disease in which the body's glucose (sugar) levels are abnormally high. Diabetes occurs when your pancreas stops making enough insulin, which is necessary for the proper metabolism of digested foods. Diabetes doesn't interfere with digestion, but it does prevent the body from using an important product of digestion: glucose for energy.

When we eat, foods containing proteins, fats, and carbohydrates are broken down into simpler, easily absorbed chemicals. One of these is a form of simple sugar called glucose. Glucose circulates in the blood stream where it is available for body cells to use as "fuel". In a non-diabetic person, the blood carries the glucose or sugar throughout the body, causing blood glucose levels to rise. In response, a large gland called the pancreas (found just behind the stomach) makes insulin and releases it into the bloodstream. Insulin signals the body tissues to metabolize or burn the glucose for fuel, causing blood glucose levels to return to normal. Sansum Medical Research Institute

Q - What is the expected life span for a diabetic pet? - Jon -
A - Veterinarian research doesn't have a lot of data on well regulated pets with diabetes. It is only recently that animals were treated aggressively for diabetes.  It was not that many years ago that these animals would have automatically been euthanized. The lifespan often quoted in textbooks (2-5 years) include all diabetic pets, including those whose owners do not aggressively manage their diabetic control. Also keep in mind that many are diagnosed later in life so a 2-5 year life expectancy may not be that different from their average lifespan anyway. The newer data coming out suggests that, if an animal is kept well-regulated and does not have any other health problems, they should be able to have a normal life expectancy.

Q - Recently the principal at my school said I had an "alcoholic" odor to my breath.  I have heard that people with diabetes often exhale a sweet/sour odor.  I had not been drinking, (although high school students these days surely makes one wonder), and had just recently finished a meal with students of chili and hot dogs with hash brown casserole.  Is it possible that my breath could be caused by the onset of diabetes? - Sabrina -

A - This"alcohol smell" can be a sign of ketosis. We more commonly refer to this as "fruity breath." This can happen when there is an insufficient supply of insulin on board to handle the sugar in the bloodstream. To avoid starvation, the body begins to break down fat at a rapid rate, for "food," releasing these toxic byproducts called "ketones." High protein diets can also produce this effect.
 
This is a RED FLAG TO CHECK BLOOD SUGARS AND MAKE THE NECESSARY INSULIN ADJUSTMENTS BEFORE SOMETHING MORE SERIOUS DEVELOPS, SUCH AS A DIABETIC COMA. If this continues, go to your practitioner for necessary adjustments or diagnosis.
 
Q - Is it safe for diabetic patients to use echinacea tablets? -Mercy -
A - Evidence is mixed over whether or not echinacea is a good idea for people with type 1 diabetes. Because type 1 is an autoimmune disorder, and echinacea stimulates the immune system, some medical professionals believe it should be avoided in these individuals.
 
The only other research information I found is that echinacea should never be used in the injectable form for any diabetic.

Q - I know that diabetes and depression are often linked, but can diabetes affect the brain in other ways as well? - Fred -
A - Diabetes affects the blood stream (or circulation) which in turn affects the brain. People with diabetes are twice as likely to become depressed. Depression can be short-term (situational) or long-term (clinical) and affects the brain hormone levels of serotonin in the brain. Research also indicates that people with diabetes may also be at a higher risk of developing Alzheimer’s disease or may affect the brain systems that control memory for words and events, the speed of processing information, and the ability to recognize spatial patterns. (May 2004, Vol 61(5) Archives of Neurology)

Q - How do I, as a woman, reduce my risk for heart disease and stroke, the biggest killers of people with diabetes? - Christine -
A - Data from the National Health and Nutrition Examination Survey shows that women with diabetes are at particular risk for heart disease and stroke. Deaths from heart disease for women with diabetes increased 23 percent in the past 30 years, compared to a 27 percent decrease in women without diabetes. But women with diabetes who keep their blood glucose, blood pressure and cholesterol levels in the recommended range can lower their risk of cardiovascular disease.

Q - I've been having trouble coping with my diabetes. I'm depressed and moody all the time and I feel like it's too much to deal with. Is that unusual and what do you suggest? - Sarah -
A - Everybody tends to feel down at one point or another in their lives, but what happens when that feeling lasts for
weeks at a time? This could be a major sign of  clinical depression.

Depression can affect your mood, thoughts, behavior, and body and can lead to problems at school, work, or home.   Depression affects the way you communicate with others, and the way you think and feel about life in general.  Depression may also lead to alcohol or drug abuse as well as other addictions. 

Many  risk factors can contribute to clinical depression.  Some of these factors include one's biology (body's function), medications, family history (genetics), situation (i.e. death of a loved one, divorce, etc.) and other co-occurring illnesses such as stroke, heart disease, cancer, or diabetes. 

Researchers have found that major depression is significantly more common in patients with diabetes than in the general population.  In fact, studies indicate that people with diabetes (Type 1 or Type 2) are twice as likely to become depressed as compared with non-diabetes groups, and women with diabetes suffer more from depression than men with diabetes. Approximately 15% - 20% of adults with diabetes, both type 1 and 2, suffer from depression (Lustman PJ, et al. Depression in Adults with Diabetes. Semin Clin Neuropsychiatry 1997).  Increased health care use and costs for people with diabetes who have depression is 4.5 times higher than for individuals without depression ($247 million versus $55 million). (Deyi Zheng, E, & Simpson, K. Diabetes Care 2002; 25(3), pp. 464-470)

Depression can become a serious paralyzing factor in caring for one's diabetes. It can cause people to just want to "give up" or "not care anymore" about things like taking their blood sugar levels. It can also cause unhealthy eating patterns, not taking one's medications, lack of motivation to exercise or good self-care for diabetes. Ask your physician, psychologist, social worker or other mental health professional for help.
What are the symptoms of clinical depression*?

Source: Rhode Island Department of Health: Diabetes Prevention and Control Program.

- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
- Decreased energy, fatigue, being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Changes in appetite (loss or increase of appetite)
- Weight fluctuations (extreme weight gain or weight loss)
- Thoughts of death or suicide; suicide attempts
- Restlessness, irritability
- Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
- Use of alcohol or drugs to feel "better"


*It is natural to briefly experience some of these symptoms from time to time.  However, if you have been encountering a number of these symptoms for two weeks or more and they are having a detrimental effect on your personal or professional life, you may be experiencing a more serious form of depression. 

If you are experiencing any of these symptoms talk with your doctor, nurse, counselor or other health/mental health professional. 

Editor's Note: The holidays can cause additional stress.

Q - Does FDA (Food and Drug Administration) develop or test new medicines or other treatments for diabetes? How are new drugs approved by FDA? - Ernie -
A -  FDA does not develop or test new medicines or other treatments. Instead, FDA evaluates the information from manufacturers who have tested their medicines. FDA does give substantial advice to the companies who are developing the drugs or other products.

Since 1938, every new drug has been the subject of an approved New Drug Approval (NDA) application before it is sold in the U.S. The NDA application is the vehicle through which drug sponsors formally propose that the FDA approve a new pharmaceutical for sale and marketing in the U.S. The data gathered during the animal studies and human clinical trials of an Investigational New Drug (IND) become part of the NDA.

The goals of the NDA are to provide enough information to permit FDA reviewers to reach the following key decisions:

 whether the drug is safe and effective in its proposed use or uses.
 
 whether the benefits of the drug outweigh the risks.
 
 whether the drug's proposed labeling (package insert) is appropriate and what it should contain.
 
 whether the methods used in manufacturing the drug and the controls used to maintain the drug's quality are adequate to preserve the drug's indentity, strength, quality, and purity. Source: FDA

Phases of Clinical Trials
After a drug is shown to have promise in terms of effectiveness and an adequate measure of safety for humans during animal studies, it moves into clinical trials to test for effects in humans. Clinical trials are categorized into the following phases:

Phase I - Small studies, usually involving 20 to 80 patients, for the purpose of determining safety.

Phase II - Larger studies, involving up to several hundred subjects, to further explore safety and to determine effective dosage for a specific indication.

Phase III - Still larger studies, involving up to several thousand subjects, for the purpose of gathering additional information about safety, efficacy, and dosage that is needed to determine the overall benefit-risk relationship of the drug and to characterize the drug for its intended use.

Q - I'm looking for a disposal system for my son's diabetic syringes (from home). Is a mail back disposal system available yet? - Lisa -
A - BD ( Becton, Dickinson) does have a Disposal by Mail Program. This is it:

More than a billion syringes, needles, and lancets are used for diabetes care in the United States each year. If they're not disposed of safely, these items, known as "sharps," can injure other people.

BD now offers the best option for Safe Needle Disposal, the BD™ Sharps Disposal by Mail system. It encompasses containment, storage, transportation, treatment, disposal and tracking of sharps, all in one package.

Here's how the system works:

The BD Sharps Disposal by Mail can be purchased in your local drugstore, the container holds up to 300 pen needles or lancets, or up to 100 insulin syringes.

After use put your syringe, pen needle or lancet into the container BD™ Sharps Disposal by Mail.

When full, the sharps container is sealed and placed inside a red bag, which is then placed inside the outer postage prepaid mailing box. 

The user fills out the tracking form and keeps a copy for their records.

Give the closed postage paid box to your mail carrier or bring it to the post office.

When the mailing box reaches the treatment facility, the tracking form is scanned and a certificate of destruction is mailed back to you confirming the destruction of your sharps.

If you don't have access to a BD™ Sharps Disposal by Mail, follow these guidelines:

Never throw loose sharps into the trash, whether at home or away from home.

Never flush sharps down the toilet.

Remove needles from syringes and pen needle units using a BD  Safe-Clip™ clipper device and put the rest of the syringe or pen needle in your

BD™ Home Sharps Container. Don't try to recap or clip a needle that has been used by another person. This can lead to accidental needle sticks, which may cause serious infections. Don't attempt to remove the needle without the BD Safe-Clip™ clipper device because the needles could fall, fly off, or get lost and injure someone.

Put your used syringes, pen needles, and lancets in a sharps container.

When your BD™ Home Sharps Container is full, seal it and check with your community how to dispose of it properly. Only as a last resort, put it in a trash receptacle - not a recycling bin - because syringes, pen needles, and lancets aren't recyclable.

Keep this container away from children.

Never handle someone else's syringe unless a healthcare professional trains you in proper injection technique and disposal.

If you have any questions about throwing away syringes or lancets, call BD toll free: 1.888.BD CARES (232.2737).

The rules and regulations regarding sharps disposal are different in towns and counties around the country, so check with your local sanitation or health department. For additional information on the availability of safe disposal programs in your area or for information on setting up a community disposal program, contact the Coalition for Safe Community Needle Disposal at 1-800-643-1643.

To read more about the program go to http://www.bddiabetes.com/us/yourinsulin/disposal_mail.asp.

Q - Hello, I hope that you can answer a question for me. My daughter has a dark discoloration around her neck, someone told me this could be an early sign of diabetes. Is there any truth to this? Thank You very much. - Alexander -
A - The short answer is yes. The following is an explanation from the National Institute of Health (NIH) about a condition called acanthosis nigricans (AN) which is what it sounds like your daughter has.

Acanthosis nigricans is a skin disorder characterized by dark, thick, velvety skin in body folds and creases. Acanthosis nigricans can affect otherwise healthy people, or it can be associated with medical problems. Some cases are genetically inherited. It is most common among people of African descent. Obesity can lead to acanthosis nigricans, as can many endocrine disorders. It is frequently found in people with diabetes. Some drugs, particularly hormones such as human growth hormone or oral contraceptives ("the pill"), can also cause acanthosis nigricans. People with cancers of the gastrointestinal or genitourinary tracts or with lymphoma can also develop severe cases of this acanthosis nigricans.

Acanthosis nigricans usually appears slowly and doesn't cause any symptoms other than skin changes. Eventually, dark, velvety skin with very visible markings and creases appears in the armpits, groin, and neck. Sometimes, the lips, palms, soles of feet, or other areas may be affected.

Your physician can usually diagnosis acanthosis nigricans by looking at the appearance of your skin. A skin biopsy may be needed in unusual cases. If no clear cause of acanthosis nigricans is obvious, it may be necessary to search for one. Your physician may order blood tests, endoscopy, or X-ray studies to eliminate the possibility of underlying diabetes or cancer.

Because acanthosis nigricans itself usually only causes changes to the appearance of the skin, no particular treatment is needed. It is important, however, to attempt to treat any underlying medical problem that may be causing these skin changes. Acanthosis nigricans often fades if the cause can be found and treated. Call your physician if you develop areas of thick, dark, velvety skin. NIH

Q - Does diabetes cause any problems in the liver? - Casey -  
A - Diabetes doubles risk of liver disease and liver cancer is the title of an article published by the American Gastroenterological Association in February 2004. A link between diabetes and liver disease was previously known; it was unknown whether diabetes caused liver disease or vice versa. Liver disease associated with diabetes is usually insidious, asymptomatic and goes undetected until a severe condition, such as liver cancer, occurs.
 
'For patients with diabetes who receive oral medications, there has been a concern about toxicity in the liver � more reason to test liver enzymes early on and then periodically thereafter.' The risk for developing liver disease and liver cancer is highest among patients with long-standing (10+ years since diagnosis) diabetes. The increased risk is independent of alcoholic liver disease, viral hepatitis and demographic features.

Q - I have noticed that when I cut way back on carbohydrates my glucometer readings are good. My question: At what point will I not be getting enough carbohydrates? - Mel - 
A - Carbohydrates are in most of the foods we eat including dairy, fruits and vegetables, so it is very hard to get too few. For all people, especially diabetics, there are good carbohydrates and bad carbohydrates.
 
For diabetics and pre-diabetics (which is 1 of 3 in today's society) a lower carbohydrate diet is more satisfying and reacts better with the blood sugars and cholesterol. I am enclosing a link about low glycemic diets which ranks foods on how they affect our blood sugar levels: http://www.defeatdiabetes.org/Articles/diet030807.htm. To find out more about the Glycemic Index you may go t www.mendosa.com.

Q - I was diagnosed 4 months ago with Type II diabetes after a Glucose Tolerance Test.  I have improved my diet and increased exercise and am not taking any medications.  I had a A1c result of 5.5 last month.  I regularly take my BG levels and am staying within target goals provided to me.  The one area that I have not been able to improve in is morning fasting levels, usually 100 - 110 (immediately after waking up) and 110 - 120 (before breakfast 2 hours after wakeup).  It appears that I have a natural increase of BG as the morning goes on, food or no food.  I've tested a few times in the middle of the night and run around 90 - 95.  Do you have any suggestions on how I can improve my morning BGs? - Brian -
A -
What you are describing sounds like the Dawn Phenomenon. The Dawn Phenomenon occurs when there is an apparently unexplained morning rise in the fasting blood sugar (blood glucose) levels. That is when the fasting (pre-breakfast) level in the morning is higher than the pre bed-time level.
Increased morning blood sugar levels can have two causes -
1.The Liver dumps its reserve of glycogen (a form of glucose) when blood sugar levels get too low.
2.Insufficient Insulin in the blood together with increased Insulin Resistance due to hormones released in the early morning.

The hormonal changes are basically preparing the body for the expected exertions of the morning and occur in everyone, both diabetic and non-diabetic. In diabetic's though they can raise blood sugar levels to high and cause further difficulties at breakfast time.
The two causes have two different solutions and you need to find out which is occurring first.

Check blood sugar (glucose) levels at 2-3am, if they are regularly very low followed by a higher bounce in the morning fasting level, it's likely to be a liver dump. Liver dumps cause a sudden release of glucose in the blood leading to a quick increase in blood sugar levels. They may happen after a blood sugar low or hypo that may wake you in the early morning.  A small snack last thing at night can help; a mix of carbohydrate, fiber, protein & fat to slow the release of blood sugar. Something like Cheese on Toast, Peanut Butter on Ryvita and so on.

Otherwise if the blood sugar levels are more or less the same as it bed-time followed by a rise in the morning fasting level it's likely to be insufficient insulin that may be combined with early morning insulin resistance. For diabetics injecting insulin a common cause of high fasting blood sugar levels in the morning, can be if the insulin runs low during the night. That combined with a lessened effect of any remaining insulin due to hormonal changes that occur in the early morning. The remaining insulin is insufficient to cover the background needs of the body even at sleep. So after about 4am, blood sugar levels gradually rise. For Type 2s on drugs this is likely to be a lesser effect because their pancreas still has some remaining insulin production.

Insulin Resistance may remain high for many hours including before and after breakfast. Carbohydrates eaten in the morning may cause a greater increase in blood sugar levels than carbohydrates eaten at mid-day or evening.
Source: Bristol Diabetes, Great Britain.

Brian, yours is most likely the liver dump. When doing my research most of the sources said it was rare for Type 2s to experience the liver dump. While I am not a medical professional, anecdotally I disagree. I know many Type 2s (including me) who have had morning highs so you are not alone.

You should tell make sure you tell your doctor about these readings.

Q - I have Type 2 diabetes and am on Zocor for high cholesterol. My doctor took me off Vitamin E based on the latest research that it was bad for you. What is your opinion? I just want to get more information. - Dave -
A - Some research suggests that the so-called antioxidant vitamins, intended to offset the harmful effects of oxygen, may help keep arteries healthy, while other reports have disputed this idea. Extra doses of vitamins such as C and E may blunt some benefits of widely prescribed cholesterol-lowering drugs, a new study concludes (2001).
 
But Dr. Kenny Jialal of the University of Texas Southwestern Medical Center at Dallas criticized the study's small size and disagreed with the conclusion that patients should be warned off antioxidants. Jialal, a member of the antioxidant panel of the Institute of Medicine, noted that vitamin E has been shown in other studies to reduce the risk of heart disease.
 
High vitamin E intake can significantly reduce the risk of developing type 2 diabetes, according to a recent study. Diabetes Care. 2004 Feb;27(2):362-6. For diabetics, the letters C and E may spell hope...boosting insulin with vitamins C and E may improve the drug's effectiveness and prevent liver damage and other serious complications of the disease. University Of California at Irvine
 
There are differing points of view regarding using Zocor and vitamin E together, but vitamin E has been shown to be beneficial for diabetics.

Q - I have had diabetes since 1994. Recently lost job and insurance so was off meds for about 9 months. During that time my body was hit with major nerve and muscle damage. I have several places where organs have moved and formed bulges. What kind of exercise program can I due to recondition these muscles? Doctors At VA are not helpful with this matter. - John-
A -  From our Executive Director, Andrew P. Mandell, Mr. Diabetes®:Hi John: Your description brings back terrible memories for me, as you describe some things I personally experienced:  no insurance, bulges, nerve and muscle damage.  Pay attention to what I tell you here, John, or you will be in a lot more trouble than you're in right now. 
  * Number 1:  You MUST be under the care of an endocrinologist/internal medicine    specialist. These doctors are diabetes specialists.  They will conduct complete medical exams designed to recognize existing complications as well as symptoms of potential problems long before they appear.  Those potential problems include diabetic retinopathy (a leading cause of adult blindness), circulation problems (which can lead to heart attack, stroke, amputation and more), kidney and other organ problems, and more. And they will    coordinate all treatment areas which will include nutrition and fitness programs.  You need all three (Medical, Nutrition, Fitness) for treatment to be complete and effective. NO OTHER DOCTOR IS QUALIFIED TO ADDRESS THE NEEDS OF DIABETICS!!!!!!!  If you had a heart problem you'd see a cardiologist.  For a skin problem you'd see a dermatologist.  Well, for a diabetes problem you MUST see an endocrinologist.  PERIOD!!!!!
  *Number 2:  A sound nutrition program is essential.  You should visit w/ a registered dietician/nutritionist.  These specialists are trained to address individual needs.  This is so important because the food you consume is the fuel your body needs to function properly.  Never underestimate the importance of proper nutrition.  Again, your endocrinologist will have qualified specialists he/she works w/ already and will work closely w/ you/them in this area.
 *Number 3:  The fitness (exercise) program you initially asked about. Again, you MUST coordinate this activity w/ your endocrinologist.  He/she will assess your fitness level and then make recommendations accordingly.  That said, however, a moderate walking program is a good place to start.  It is cost effective as it only requires special "walking shoes" for equipment.  Do not underestimate the importance of appropriate footwear!!  BUT, "moderate" for you may be very different than "moderate" for someone else.  Also, available through the Defeat Diabetes Foundation is "THE MR. DIABETES* HOME FITNESS PROGRAM". BUT, GET EVALUATED BEFORE YOU BEGIN AN EXERCISE PROGRAM.

Q - Does Reflexology help people with diabetes? How? - Sorela -
A - Diabetics are very vulnerable to all sorts of foot problems. Reflexology, from my limited understanding of it, stimulates the blood flow not only to the feet, but to all parts of the body. That, along with good diet, exercise and proper medication can certainly stave off complications.

I found a website, http://www.pacificreflexology.com/diabetes.htm, where there are 5 abstracts of small studies done in China that have proved the benefit of Reflexology for diabetics. I have not found any studies in "western" cultures, but would not be surprised if some would be done soon.

Q - I've been hearing a lot about pre-diabetes lately. I took your Defeat Diabetes® Screening Test and didn't show any of the symptoms except having a family history of diabetes. What is the difference between diabetes and pre-diabetes? - Ida -
A - About 40 percent of U.S. adults ages 40 to 74 -- or 41 million people -- currently have pre-diabetes, which is marked by blood glucose levels that are higher than normal but not yet diabetic. Many people with pre-diabetes go on to develop type 2 diabetes within 10 years.

Treatment is not difficult. Watch your diet - staying away from fast foods and eating whole grains, fruits, vegetables, etc. Lose 5 - 10% of total body weight and exercise as little as 20 minutes a day can help keep pre-diabetes from developing into diabetes.
Since you have a family history of diabetes, you should mention your concerns to your doctor at your next visit. That way the proper tests can be performed and even if you do not have pre-diabetes, you will be establishing a good baseline that will be good for comparison in the future.

Q - Is there a cure for diabetes? - Arthur -
A - Several approaches to "cure" diabetes are being pursued by the US Federal government, through the National Institutes of Health (NIH) and other research facilities:

Pancreas transplantation 
Islet cell transplantation (islet cells produce insulin) 
Artificial pancreas development 
Genetic manipulation (fat or muscle cells that don’t normally make insulin have a human insulin gene inserted — then these "pseudo" islet cells are transplanted into people with type 1 diabetes). 

Each of these approaches still has a lot of challenges, such as preventing immune rejection; finding an adequate number of insulin cells; keeping cells alive; and others. But progress is being made in all areas, but as of this time, there is no cure.

Q - Please provide for me the symptoms of diabetes. I cannot afford to see a doctor. Is there a test available that is not a million dollars to get done? - Deborah -

A - There are many warning signs and symptoms of diabetes. On our website, www.DefeatDiabetes.org we have devoted specific pages to warning signs: http://www.defeatdiabetes.org/warningsigns.htm. If you haven't already, you should take the Defeat Diabetes® Screening Test:  http://www.defeatdiabetes.org/screeningtest.htm and if your score says you should seek a medical opinion, I suggest you do so.
 
If you can't afford to see a doctor, check with you local or county Health Department, or the local hospitals in your area. They will be able to steer you to the right place to see a doctor at a low or no cost.
 
If you do have diabetes, and if you qualify, you may receive your medications at a very low cost by going to http://www.everyonesrx.com/. It is an advocacy program for low income people who cannot afford to pay for their medications.
Q - I spoke to my mother in law yesterday and she told me she was supposed to start Dialysis. She has been an insulin dependent diabetic for some years. I don't know too much about her medical history but she said the Dr. told her that her kidney's were functioning at 15%. I don't know what that means but I know it can't be good.

My concern is that she says she isn't going to do the dialysis. She is quite religious and plans to leave it in "God's Hands". She says she has too much to lose if she starts dialysis.

Do you have information on this subject or know where I might find some advice? I am really worried about this but don't know how to get her to understand how important this is. Thank You in advance for any information you can provide. - Kathleen -

A - Dialysis is a treatment that does some of the things done by healthy kidneys. It is needed when your own kidneys can no longer take care of your body's needs. You need dialysis when you develop end stage kidney failure --usually by the time you lose about 85 to 90 percent of your kidney function.
 
Like healthy kidneys, dialysis keeps your body in balance. Dialysis does the following:
 removes waste, salt and extra water to prevent them from building up in the body 
 keeps a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate 
 helps to control blood pressure 

Some kinds of acute kidney failure get better after treatment. In some cases of acute kidney failure, dialysis may only be needed for a short time until the kidneys get better.

In chronic or end stage kidney failure, your kidneys do not get better and you will need dialysis for the rest of your life. If your doctor says you are a candidate, you may choose to be placed on a waiting list for a new kidney.

You can find out more information about dialysis by going to www.kidney.org.
 
A - You've taken the first step by taking our Defeat Diabetes(r) Screening Test and know your must seek a medical evaluation. I would contact your city or county Health Department and ask them if there is a low income assistance program.
 
Once you have seen a physician and have received a diagnosis there is a way to get low cost medications, if you qualify. It is an advocacy program for low income people who can not afford medications. Go to http://www.everyonesrx.com/.
Q - What is a good blood sugar range for a person with diabetes? How do I check my blood sugar? When should I check my blood sugar? What is my A1c Test? What do the results of the A1c test mean? - Mary -

A - What is a good blood sugar range for a person with diabetes?
 A good fasting blood sugar (before breakfast) is < 110 mg/dl.* 
 A good blood sugar before bedtime is < 140 mg/dl.*
Remember that everyone is different and their readings will vary. Check with your doctor to find out your target blood sugar range.
 

How do I check my blood sugar?

 Wash your hands with soap and water. Use warm water to allow more blood to circulate to the fingers. Dry your hands well before you pierce your finger. 
 Pierce the side of your finger. The tip of the finger contains more nerve endings and will hurt more than the side of your finger when pierced. 
 Change which finger you pierce each time you test your blood sugar. Using the same finger will cause the skin to become tough and more difficult to stick.
If you have questions about how to use your monitor call the toll-free telephone number listed on the monitor.
 

When should I check my blood sugar?

You and your doctor can learn something about your control each time you test and record your blood sugar. The best times to check your blood sugar are:
 
 In the morning, before breakfast. 
 2 hours after a meal. 
 Before you go to bed at night. 
 Before and after you exercise. 

If you are sick, have a fever or diarrhea, or have had changes in your medications, check your blood sugar more often.

Keep a log of your blood sugar levels, including the date and time of measurement. Bring this record with you each time you see your doctor. This will give you and your doctor a chance to check your blood sugar control and make changes in your treatment plan.
 

What is my A1c Test?

Self blood sugar testing reveals your blood sugar level at a particular moment. A1c is a blood test that reveals your average blood sugar level over the past 2 to 3 months. The result of this test gives you and your doctor a bigger picture of how well your diabetes is being controlled over time.


 

What do the results of the A1c test mean?

The results of the A1c test are given percentages:

 6% = an average blood sugar of 120 mg/dl. 
 7% = an average blood sugar of 150 mg/dl. 
 8% = an average blood sugar of 180 mg/dl. 
 9% = an average blood sugar of 210 mg/dl. 
At least once a year show your doctor or diabetes nurse educator your blood glucose monitor and talk about any questions you may have.

* Reflects the new Diabetes Screening and Management Guidelines set by the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE), 2001.

 

Q - Hello, My name is Sarah and I am almost 13 years old. My family has a long history of diabetes and recently I have been excessively thirsty, I am overweight, and I have been going to the bathroom a lot. I took your Defeat Diabetes ® Screening Test and I got a 75. I don't want to talk to my parents about it because if I am wrong, it will make me look stupid, and they have so much going on, I don't want to worry them. What should I do? How do I know if I may have diabetes? - Sarah

A - First off, just because you scored 75 on the Defeat Diabetes ® Screening Test does not mean you definitely have diabetes. But it does mean that you should see a doctor for a medical evaluation. You may have prediabetes which may lead to diabetes. However, in most cases, prediabetes can be controlled by diet and exercise. Now is a good time to learn good lifestyle habits.
  
Please don't be afraid to talk with parents. You do need to see a physician. If it would make you feel more comfortable you may show the screening test and this response to a teacher, your school nurse, a guidance counselor or even a friend's parent and maybe one of them could help you approach your parents.
  
Good luck Sarah, and please let me know how you are doing.


Q - Can too much niacin be toxic for a diabetic? - Allen -
A -
If you have diabetes you should know that niacin can interfere with your blood glucose control. This is a cruel combination, because high levels of cholesterol and triglycerides often go hand-in-hand with diabetes and niacin has been shown to be helpful in controlling cholesterol and triglycerides. It's worth trying the vitamin, but if a regimen of niacin sends your blood sugar levels up you'll have to switch to another therapy to reduce your blood lipids.

Q - What are the normal ranges for the hemoglobin A1c? Mine is now 11.7!! - Melissa -
A - Remember, the hemoglobin A1c result must be compared to the normal range for each particular lab. Eventually that normal range will be standardized to a range of 4-6% but some labs still have ranges that are quite different.

To convert the A1c to average blood glucose, consider the high end of the normal range (e.g. if normal is 4-6%, then 6%) is equal to 120 mg/dl. For each change in 1% of A1c, there is a corresponding increase or decrease of approximately 30 mg/dl average plasma glucose.

A reading of 11.7 is very high. Please see your doctor.

Q - I've been under a lot of stress lately and my blood sugar (which previously had been well controlled) has gone all out of whack. Could my blood sugar readings be relating to my stress? - Joseph -
A - Yes, stress can have a direct effect on your blood sugar level. Physical and psychological stress can cause your body to produce hormones that prevent insulin from working properly. That, in turn, increases your blood sugar levels. This is more common in people with type 2 diabetes.
Mayo Clinic

Also, it's important to stick to your regular routine. Make sure your exercise, eat healthy foods and test your blood sugar regularly. It will help you control your diabetes and your stress.

Q - I am 14 years old and have diabetes. I've noticed that when my blood sugar is low I cry very easily. Also when my blood sugar is high I am very nervous and my parents and friends say I snap at them. Is there a correlation between moodiness and blood sugar? - Erica -
A - Yes, often times there is a correlation between blood sugar levels and mood changes. Usually this happens at very high (300 mg/dL) or very low (60 mg/dL) levels. Monitor your blood sugar especially when the mood swings occur and make a note of them and show it to your doctor at your next appointment. You may need adjustments to your medication.

But other factors may also contribute to mood disorders in all people with diabetes. It can take time for people and their families to emotionally adjust to having diabetes. And the teen years puts on added pressure. Talk to your parents and your doctor. You may also benefit from talking with a mental health professional to see if there are other factors.

Q - Has anyone done any studies on the relationship of Beta Blocking meds and diabetes type 2 ? I did not have diabetes type 2 until I had been on a Beta Blocker for 6 mos. to a year. Any thoughts? It seems odd that the increase in the use of Beta Blockers and the increase in type 2 diabetes, might be related? Possible? - Connie -

A - A study by researchers at Johns Hopkins School of Medicine in New England Journal of Medicine suggests that the use of beta-blockers, a commonly prescribed medication for high blood pressure (hypertension), can increase patients' risk of type 2 diabetes.
Experts at Joslin Diabetes Center say that while the study results need to be confirmed with further research, the study could lead physicians to ask patients whether they have a history of type 2 diabetes in their family or are members of certain ethnic groups that are at high risk for diabetes. Physicians might one day make judgments about which blood pressuring lowering medication they prescribe based on the answers to those questions. To read more http://www.defeatdiabetes.org/Articles/drug031227.htm.

Q - Thank you for your newsletter.  The information is quite helpful….I have been diabetic for 26 years.  I take many small injections a day.  I am interested in natural supplements, specifically cinnamon.  How much should be taken a day?  Is there a capsule or tincture which makes it easier to get the full amount daily? Blessings to you, and great appreciation - Darlyne -
A - In a study, diabetics who incorporated one gram -- equivalent to less than one-quarter teaspoon -- of cinnamon per day for 40 days into their normal diets experienced a decrease in levels of blood sugar, cholesterol and blood fats. To read more in an article that was just posted http://www.defeatdiabetes.org/Articles/cinnamon031230.htm .
 

Q - I have a 43 year old male friend that I am very concerned about his Diabetes.....he is at the point where he has to take insulin shots 6-12 times a day! I have been reading articles and just recently came across your site and subscribed to your newsletter. My question is this......when the pancreas quits..... If there was a donor , Why can not their be a transplant?........would this not take care of the problem? I am really curious as to why this would not work?.....has it even been tried? -Judy -
A - Pancreas transplants are performed and in 1999, 1303 pancreas transplants were performed in the United States. There have been over 20,000 pancreas transplants performed worldwide to date. It is often performed at the same time as a kidney transplant and is definitely for people who have diabetes. Lately there has been some news that pancreas transplants alone may not be as beneficial.
 
Many university hospitals have pancreas transplant programs, especially in large metropolitan areas. The Mayo Clinic in Rochester, Minnesota also has a clinic and a web site for you to read more http://www.mayoclinic.org/pancreastransplant-rst/ .

Q - Where do you get your information that you mention on your website? - Aisling and Elizabeth
A - We get our statistics from the CDC (Centers for Disease Control and Prevention), NIH (National Institutes of Health), WHO (World Health Organization) and many reputable medical journals such as Diabetes Care and Journal of the American Medical Association. Each of the articles in our Latest News section show the source from which the article was obtained.

Q - I'm 15 years old and I think that I have diabetes. Me and my mom are going to the doctor in a few weeks so that I can get a check up and see. I have been noticing new dark spots around my neck and underarms. At first I thought it was a lack of cleanliness but from TRUE FACTS, I am quite positive that that is not what it is! I am about the cleanest person that you could meet. I am writing to you to tell you that I'd like to know if you all have brochures of early awareness of diabetes or anything that might help me out.
As I previously mentioned my mom is going to take me to the doctor to get a check up but sad to say, my mom isn't the most responsible person that I know. She does understand that this is a very serious issue but work has always came first in this house. I'd like to know as soon as possible if I have diabetes or if there is anything signs that I should be watching out for or if there is important things that I should know.
Thank you very much for taking time to read this letter, I greatly appreciate it. - Roxann -
A - You are exhibiting one of the warning signs of diabetes: Acanthosis Nigricans (AN), a skin condition characterized by darkened, velvety and/or thickened skin patches, usually around the neck area. To see if you have any other indications of diabetes of "pre-diabetes" (blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as diabetes) take the Defeat Diabetes
® Screening Test: www.DefeatDiabetes.org/screeningtest.htm .

Don't be frightened. You are going to see your doctor. Express your concerns. If you are diabetic, you are catching it early and can control it to prevent complications. If you are pre-diabetic, you need not ever become diabetic if you learn how to take control of your lifestyle: eat a balanced diet; exercise; and consult with a physician who is knowledgeable about diabetes. Here is an article that gives a good explanation about pre-diabetes: www.DefeatDiabetes.org/Articles/prediabetes021106.htm .

Q - In the Defeat Diabetes ® Screening Test, www.DefeatDiabetes.org/screeningtest.htm, I believe your response omitted a very possible cause of the itching, that is a yeast infection.  Diabetics are more prone to yeast problems than the general population.  Yeast loves a high-glucose environment.  Consequently, yeast infections frequently plague diabetics. In my opinion, yeast should be mentioned when the subject of itching is raised, especially by a diabetic.  - Alice -
A - Diabetics are more prone to yeast infections than the general population, but itching may also occur when the body's nerves become irritated. Itchy skin may also be a symptom of kidney problems, which can occur with diabetes.

Diabetes can cause dry skin and increased skin infections. If your blood sugar is not well controlled, the body will produce extra urine, which can cause the skin to become dry. Itchy spots on knees, elbows and the buttocks may also occur.

The best way to avoid these types of problems is to care for your diabetes. Keep your blood sugar levels in your target range, follow a healthy diet, exercise regularly and take your medication as directed.

Q - I was writing to ask if a person has sleep apnea can it cause a person's blood sugar to rise.

I've been testing my sugar levels myself and this pattern is emerging. I
wake up and when I take the test my blood sugar is about 150 and I have a
bad headache unless I have a strong pain pill, I have to wait over an hour
for it to go away). I wait until before lunch and check again with the
results being closer to 90-100. I am also about 50 lbs overweight. Also my
a1c, was at 5.7%. Could my episodes of apnea lead to high sugar results
during the night? -Will -

A - Scientists have found a link between obstructive sleep apnea and early signs of diabetes.  People with this common breathing disorder which strikes while they are asleep could be at increased risk of getting diabetes later in life. Here is a link to an article we posted on our website in July 2003 regarding diabetes and sleep apnea:  http://www.defeatdiabetes.org/Articles/sleepapnea030707.htm.
  
Please go see you doctor and be checked out.

Q - What should I do  if two of my toes on each foot are  swollen and I am in a lot of pain? I have type 2 diabetes. - Mary -

A - "Diabetes in the United States is responsible for approximately 50% of all leg and foot amputations from non-traumatic causes and the number one cause of lower limb amputations in the United States!"
That is the first line from our September 2003 E-Lerts(tm) newsletter. The main theme is diabetes and foot complications. Few people realize that diabetes can cause major problems with your lower limbs. The link to that issue is http://www.defeatdiabetes.org/E-Lerts/elerts0309.htm. Please see your doctor and have your situation evaluated.

Q - I am a 12 year veteran of diabetes. What started as a mild case controlled by diet and exercise has progressed to oral medication and now to insulin injections. I have developed a chronic itch that has all of my doctors baffled. It's so bad it keeps me up at night. Could this be another symptom of diabetes and how can it be treated? - Patricia -
A - Many conditions can cause itching. When it relates to diabetes, it is often a result of severe neuropathy. (Yes, itching is a sign of diabetes.) If you have no visible manifestations with the symptoms, it sounds like something systemic that may require a blood test. Has that been done? Conditions like shingles, where you do have rashes, etc. on skin, will drive you wild! If your blood sugars have remained in good control throughout, it does not sound like an infection.

Q - I just delivered a baby 3 months ago and at that time I had no signs of diabetes, but for the past two weeks I have been showing signs of it. Is it possible that I could have gotten it since my 6 week check-up? by the way I took the test that you have and I scored an 80. should I really worry? - Jami -
A - When you go through a pregnancy your body goes through a lot of changes. You can develop diabetes during pregnancy or after. It CAN be temporary, but you must be tested and treated. The most important thing to do is to contact your physician and tell him/her of your symptoms. I would suggest contacting both your obstetrician and your primary care physician so they can work together for you.

Q - Do you have a diet that someone who struggles with high blood pressure can go on to keep from becoming diabetic, help lose weight, lower blood pressure and keep from having heart trouble: I have all the above in my family and I have tried every diet there is and nothing has worked. A friend of mine has just been diagnosed with diabetes and she is on a diet and has lost 30 pounds in 3 months. I am just really struggling ! Thanks for your help. - Debbie

A - There is a lot of controversy about the right "diet" for diabetics and pre-diabetics with very qualified nutritionists, medical doctors and research doctors going every which way. They all agree that in order to lose weight you must eat fewer calories than you currently eat and EXERCISE!!!
For diabetics and pre-diabetics (which is 1 of 3 in today's society) a lower carbohydrate diet seems to react better with blood sugars and cholesterol. Not all carbohydrates are created equal. The Glycemic Index ranks foods on how they affect our blood sugar levels. Here is a link to an article about low glycemic diets http://www.defeatdiabetes.org/Articles/diet030807.htm. To find out more about the Glycemic Index you may go to www.mendosa.com.

Q - I am a type 2 diabetic on oral medication. Sometimes I have such a craving for chocolate, it drives me bonkers. I don't like taking artificial sweeteners. Do you have any suggestions? - Janice -
A - Try eating real semi-sweet dark chocolate chips. The problem is stopping at just a few. They are low in carbohydrates. If you are sluggish or really hungry you can mix them with peanut butter, like a peanut butter cup.
Another hint, after you eat your semi-sweet chocolate chips, go for a walk to walk off the calories. It will make you feel better in many ways.
 

Q - My son was recently in our doctor's office for a physical for football. Our doctor told us something we find quite strange. We we're told Steven our boy had a ring around his neck and that it was an early sign of diabetes.? We have never heard of this. Can you bring some light to this question? Is this possible ? please any information will be greatly appreciated. - Sesario -
A -
Sesario, It sounds as if Steven has AN, Acanthosis nigricans. Acanthosis nigricans is a skin disorder characterized by dark, thick, velvety skin in body folds and creases. Acanthosis nigricans can affect otherwise healthy people, or it can be associated with medical problems. Some cases are genetically inherited. Obesity can lead to acanthosis nigricans, as can many endocrine disorders. It is frequently found in people with Diabetes.
I suggest that Steven be tested by an Endocrinologist for Diabetes. If he does not have Diabetes, he may have Pre-Diabetes. (See answer to question by Mary further down for an explanation of Pre-Diabetes.)
If Steven is Pre-Diabetic his doctor will put him on a program to eat healthy, lose weight, and exercise (something we all should do!) If Steven lives this kind of healthy lifestyle, even if he is Pre-Diabetic now, this is a 90% chance he will NEVER get Diabetes.

Q - I am bi-polar and am borderline diabetic. I started taking topamax and lost 58 lbs., but now I am gaining. I want to know why! My doctor isn't telling me enough information. - Cheryl -
A - Cheryl, there are so many aspects to weight loss and weight loss medications that it is very difficult to be definitive about any one answer about why one medication works for one person and not another. And why it works for a period of time and then stops.
I suggest you express your concerns to your doctor again and you always have the option of seeking a second opinion.

Q - I'm afraid I might have diabetes. My grandmother had diabetes when she died. My brother and I both are overweight. Our hands and arms feel like they are asleep while we are using them. It's a burning, tingling feeling and no matter how much you shake them, that feeling doesn't go away for awhile. I have to go to the bathroom a lot and I have sores that don't heal well at all. I can't afford to go to the doctor. I'm only 23 and my brother is 21 and I'm really scared. - Serena -
A - Serena, you and your brother definitely seem to exhibit symptoms of diabetes. We have an on-line test HERE that I suggest you and your brother take. It will also help you to pinpoint other symptoms you may have.

If you do not have health insurance and are considered low income there is help out there. Contact your local city or county health department to find out what you need to do to get low cost medical treatment. After you have seen a doctor and have received a definitive diagnosis, there is a program to get low cost diabetes medication. Go to www.diabetesmeds.org.
Please do not wait! Good luck!

Q - I was told several months ago that I was border line diabetic when I was in the hospital. My family doctor had me take every test he could think of and could not find the actual diabetes. But when I took your screening test at www.DefeatDiabetes.org/screeningtest.htm, I found that I have all the symptoms of both "Type 1 and Type 2", with the exception of about two.

I don't want to be a diabetic, but I feel that I should start treating myself as if I was, in order to save my life in the future. I need to learn how to eat and whatever it is that a diabetic does in order to sustain a longer, healthier life.

Please help me. You could not even imagine how horrible I have been feeling these last several months. - Mary -

A - Mary, from what you wrote, it sounds like you may have Pre-Diabetes Syndrome, which could lead to diabetes. As many as ⅓ of Americans have Pre-Diabetes Syndrome.

I suggest you see an Endocrinologist, who is a doctor who specializes in internal medicine. S/he would be able to diagnose this condition. Treatment is not difficult. Watch you diet - staying away from fast foods and eating whole grains, fruits, vegetables, etc. Lose 5 - 10% of total body weight and exercise as little as 20 minutes a day. Here is a good article link that explains further Pre-Diabetes Syndrome: www.defeatdiabetes.org/Articles/prediabetes021106.htm.

Q - My husband has chronic neuropathy in his hands and feet. We have heard a lot about Alpha Lipoic Acid (ALA) in the treatment for his condition. His exercise is limited because of his condition, walking bothers him. The only relief he gets is to put an ice pack on his feet. - Nancy
A - A collaborative study between Mayo Clinic and a medical center in Russia found that alpha lipoic acid (ALA) significantly and rapidly reduces the frequency and severity of symptoms of the most common kind of diabetic neuropathy. Symptoms decreased include burning and sharply cutting pain, prickling sensations and numbness. It is very promising for the future, but at this time it is not Food and Drug Administration-approved for this purpose.

A large, multi-center trial of oral ALA is under way. "We should see what the further data show before we give this widely to patients with diabetic neuropathy," says Dr. Dyck. Click to read the entire article .

Q - My dad who is diabetic recently had bypass surgery. We are interested in finding literature on this matter. My dad is worried. - Ray
A - Diabetics can dramatically reduce their risk of dying from a subsequent heart attack by undergoing bypass surgery, according to a study in New England Journal of Medicine.

Among the diabetics, the differences in survival were dramatic. Only 17 per cent of those who had undergone bypass surgery died after a heart attack. For those who received angioplasty, the rate was 80 per cent.

But the study suggests the heart recuperates from a heart attack just as quickly in diabetics treated with bypass surgery as in non-diabetics. Bypass surgery, according to the research, is more effective long-term than angioplasty at keeping a healthy blood flow to the heart.  Click to read the entire article.

Q - Is a burning sensation under the bottom of the feet a symptom of diabetes? - Kathy
A -
Peripheral neuropathy is a common neurological disorder resulting from damage to the peripheral nerves. It may be caused by diseases of the nerves or as the result of systemic illnesses. Diabetes is one of the most common causes of peripheral neuropathy. Symptoms of neuropathy include weakness, numbness, paresthesia (abnormal sensations such as burning, tickling, pricking or tingling) and pain in the arms, hands, legs and/or feet.
Therapy for peripheral neuropathy caused by diabetes involves control of the diabetes. Recovery from peripheral neuropathy is usually slow. Depending on the type of peripheral neuropathy, the patient may fully recover without residual effects or may partially recover and have sensory, motor, and vasomotor (blood vessel) deficits. If severely affected, the patient may develop chronic muscular atrophy.
Information gathered from NINDS (National Institute of Neurological Disorders and Stroke)

Q - I'm a Type 2 diabetic and my vision is fine, but my doctor insists that I get my eyes checked annually. Is this really necessary? - Peter
A -
If you have diabetes, you should have your eyes examined at least once a year. Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of this disease. All can cause severe vision loss or even blindness. Diabetic retinopathy is a leading cause of blindness in American adults.
Often there are no symptoms in the early stages of the disease. Vision may not change until the disease becomes severe. Nor is there any pain. Blurred vision may occur when the macula--the part of the retina that provides sharp, central vision--swells from the leaking fluid. This condition is called macular edema. If new vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision. But, even in more advanced cases, the disease may progress a long way without symptoms. If caught early, it can be treated. That is why regular eye examinations for people with diabetes are so important.
Information gathered from the National Eye Institute

Q I can't afford medical care and I have all the signs of diabetes. What can I do? Is there a test I can do at home to find out if I have diabetes? - Sharon
A - Diabetes is a serious disease and should not be self-medicated or self-managed without first seeing a physician. Contact your local (county, city, etc.) health department and ask them where you should go for low cost care.
If you are diagnosed with diabetes contact www.diabetesmeds.org. If you qualify under their low income program, you may receive medications for a very low cost.

QFor the past two months I've noticed a drastic change in my eating/drinking habits. I used to hate water and now can't go through a school day without drinking at least two bottles. Also, I've started eating too much and am constantly on a hunt for sweets. My mom and friend said this could be due to a high sugar level. The thing is, I haven't been losing weight (like the warning signs suggest) but instead have been gaining it. My cuts take a long time to heal, but that has been for as long as I can remember. Should I get this checked out or what? Or am I just paranoid? - Tonya
A - The first thing you should do is take the Defeat Diabetes
® Screening Test at www.DefeatDiabetes.org/screeningtest.htm.  If you score above 20 make an appointment with your doctor. Many diabetics GAIN weight rather than lose weight. Plus you seem to have a number of other symptoms.
Do not be afraid. As Mr. Diabetes ® says," What's worse than knowing you have diabetes? Not knowing!"
If you have diabetes, you can learn how to take care of yourself and prevent complications. If you don't have diabetes, you can learn how to avoid getting it in the future.

Q - My husband is a diabetic. And I was wanting to know is there any food that he could munch on, because he is always craving something to munch on. Do you know a low calorie, sugar free, and carbohydrate free food I could give him? - Patti
A -
Cravings are very difficult to get under control, especially for diabetics. Two suggestions when a craving comes:  either get out of the house and take a walk and/or drink a large glass of water and wait for at least 10 minutes for the craving to subside.

Another way of dealing with cravings is to be aware of them by keeping a food diary of all foods eaten and when and what might trigger the craving.
  
Crunchy vegetables and fruits like celery, carrots and apples take longer to eat and are lower in calories and carbohydrates. But any foods in moderation are okay as long as the diabetes medication is monitored and are part of a regimen of medication, diet and exercise.

Q - I have a son who is almost 13 years old. On his father's side there is a long history of diabetes. His father, grandfather, grandmother and uncle all have or have had it on his father's side. No pediatrician has been able to tell me if there is anything I can do now (while he is still young) or what, if any, precautions can be taken so he doesn't get diabetes. He is very active and has zero body fat, but as most adolescents, he takes in a lot of sugar.

If you can tell me what if anything I can do to detect or prevent him from acquiring this awful disease, I would be most grateful. - Linda
A - What you are doing for your son right now is just what our motto means "Awareness + Action = Prevention"
™.
Having your son keep very active and lean is a great start. If you could ease him into drinking water instead of soda (not diet drinks!), and try to incorporate complex carbohydrates (fruits, vegetables and whole grains) into his diet would help. If this is to succeed, especially with a teenager, do it gradually, or it won't take.
Also with his family history, keep monitoring him with his doctor when he has his annual physical, or he exhibits any diabetic symptoms ( www.DefeatDiabetes.org/screeningtest.htm .)

Q - What kind of eye surgery did Mr. Diabetes have to correct his retinopathy? - Jeanette
A - After years of careful monitoring by an opthamologist(s) I underwent laser surgery on both eyes. Each eye was operated on separately a few weeks apart. It was an outpatient procedure and quite painless. The only discomfort was the bright light of the procedure itself and a period of "sunspots" which eventually subsided and is barely noticeable now (1 1/2 years later). -
Andrew P. Mandell, MR. DIABETES ®
 

Q - I have heard that Avocado tea is used as a Sugar Lowering Drink. What do you know about this as a “treatment”? - Alan
A -
Be very careful with alternative treatments! Diabetes is a severe medical problem with established treatments and therapies that work. That's not to say it isn't helpful, but any alternative treatment should be regarded with suspicion. Before beginning to use such a treatment you should review it/them with your doctor and dietician. ALWAYS FOLLOW THEIR ADVICE.

Q - My boyfriend has Diabetes, or at least we're pretty sure of it, but can't find out until his test results come back. The problem is that he will not let his doctor know about certain habits he has. My question is this: He takes two testosterone pills that help you obtain a "buff" body. I was curious as to how harmful it could be for him to take them. Does anybody know the answer? I know that he has taken the screening test on this website and scored an 80. (www.defeatdiabetes.org/screeningtest.htm) So, I am concerned for his safety because he does seem so far into the disease. - Marie
A - Why don't you go with your boyfriend on his next appointment - and YOU tell his doctor. Anyone who scores 80 on the Defeat Diabetes Screening Test should definitely take a "Glucose Tolerance Test." His doctor will set it up.

Important Notice: The opinions and statements expressed in the Defeat Diabetes® E-Lerts ä Newsletter are directed at a general audience. Its intent is solely for informational, educational, and entertainment purposes and is not to be construed as medical advice or instruction. Please consult a health professional on any matters regarding your health and well-being, or if you are interested in anything mentioned in the Defeat Diabetes® E-Lerts ä Newsletter. The information presented here is believed to be accurate, based on the best judgment of the Program Director, but the reader is responsible for consulting with his/her own health professional on any matters raised within.

 

 
 
 
 
 
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