Diabetes

Diabetes

Diabetes mellitus (MEL-ih-tus), often referred to as diabetes, is characterized by high blood glucose (sugar) levels that result from the body’s inability to produce enough insulin and/or effectively utilize the insulin. Diabetes is a serious, life-long condition and the sixth leading cause of death in the United States. Diabetes is a disorder of metabolism (the body's way of digesting food and converting it into energy). There are three forms of diabetes. Type 1 diabetes is an autoimmune disease that accounts for five- to 10-percent of all diagnosed cases of diabetes. Type 2 diabetes may account for 90- to 95-percent of all diagnosed cases. The third type of diabetes occurs in pregnancy and is referred to as gestational diabetes. Left untreated, gestational diabetes can cause health issues for pregnant women and their babies. People with diabetes can take preventive steps to control this disease and decrease the risk of further complications.

Recently Answered

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    AWilliam Lee Dubois, Endocrinology, Diabetes & Metabolism, answered
    An A1C test is run quarterly, twice a year, or once a year, depending on how good or bad your control is; how good or bad your insurance is; and your provider’s approach to diabetes care.

    Even in healthy, well-controlled patients, I like to run the test every quarter. If something is starting to change I want to jump on it right away. Remember: all diabetes is chronic and progressive and the body eventually adapts to all meds; they will lose their effectiveness.
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    AStacy Wiegman, PharmD, Pharmacy, answered
    A good score on the A1C test depends on whether you’ve been diagnosed with diabetes. For those who do not have diabetes, a score of less than 5.7% is considered normal, while 5.7% to 6.4% indicates prediabetes and 6.5% or higher means you have diabetes. If you already have diabetes, a score of 7% or lower is desired. You and your doctor can decide what score is best for you. The A1C diabetes test is a way to get an average of how well your blood sugar has been controlled for the past three months.
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    AJacob Teitelbaum, Integrative Medicine, answered
    Research shows that the antioxidants we get from food, such as vitamin C, can lower the risk of diabetes. In a study published in the Archives of Internal Medicine in 2008, participants who ate the most fruit and vegetables were found to have a 22 percent lower risk of developing diabetes.

    You can also up your antioxidant quotient by taking a good vitamin powder that contains vitamin C and other key nutrients. Supplementing with vitamins and minerals is very important for diabetics because as excess sugar washes out into the urine, it can drag along many other nutrients and wash them out of the body, too. This can lead to widespread nutritional deficiencies. One of the most common deficiencies is magnesium.
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    AStacy Wiegman, PharmD, Pharmacy, answered
    Most people who have diabetes, whether it's type 1 or type 2, test their blood glucose (blood sugar) level by pricking a finger for a tiny drop of blood, which they put on a test strip that's entered into a glucose monitoring machine. A continuous glucose monitor works differently. A tiny sensor is inserted under your skin. It contains a transmitter that sends information about your blood sugar levels to a wireless monitor, similar to a pager. The sensor is left under your skin for a few days to a week before being replaced.

    These devices are more expensive than standard glucose monitors and are not as accurate. But because they provide almost minute-by-minute monitoring of your blood sugar, they may allow for more effective blood sugar control. Talk to your doctor to see if a continuous glucose monitor is a good idea for you.
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    AWilliam Lee Dubois, Endocrinology, Diabetes & Metabolism, answered
    It is important to calibrate your blood sugar meter. That's because there are manufacturing variances in test strips that can make the results quite different from batch to batch. Rather than make the manufacturing process more precise and reliable, meter companies have devised a cheap work-around. Every batch of test strips is given a code. The code tells the meter how bad the batch of strips is, and by how much to change the reading to get the results in the same general neighborhood as correct.

    I’m sure it will ruin your day to learn that for the FDA to consider a test strip accurate it must be within 20% of correct. That means if your blood sugar is really 100, any test strip that reads from 80 to 120 is considered accurate and can be approved.

    How far off will your meter be if calibrated wrong? Depends on the meter. I’ve seen cases of 100 or 150 points off. If I find a patient’s meter mis-calibrated I don’t even look at the numbers or the log. They are too likely to be wrong.
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    AWilliam Lee Dubois, Endocrinology, Diabetes & Metabolism, answered
    It is very important to set the date and time for your blood sugar meter. Make sure the date is right and the hour, if not right, is close. The meter has a memory because the meter companies know you don’t bother to keep an actual paper logbook of your blood sugar readings. If the time is set wrong, your computerized logbook in the meter will be wrong, and all the data will be worthless.
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    AWilliam Lee Dubois, Endocrinology, Diabetes & Metabolism, answered
    Your test strips are expired. The meter knows this and won’t work for even one hour past the expiration date. We can trick it by setting the meter to last year, and just so long as the strips aren’t more than 3 months old we’re OK.
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    There are six types of diabetes pills. These pills work in different ways on different parts of the body to lower blood glucose levels.
    • DPP-4 Inhibitors lower amount of glucose released and increase insulin production.
    • Biguanides lower the amount of stored glucose that’s released from your liver into your body.
    • Sulfonylureas help your body make more insulin.
    • Meglitinides help your body release a quick burst of insulin when you eat a meal or snack.
    • Alpha-glucosidase inhibitors slow the digestion of some carbohydrates. After-meal blood glucose  peaks aren’t as high.
    • Thiazolidinediones (TZDs or glitazones) lower your insulin.
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    AWilliam Lee Dubois, Endocrinology, Diabetes & Metabolism, answered
    Where should your blood sugar numbers be? Like everything else in diabetes, there is not a 100% agreement on that issue amongst experts in the field. Most of the experts agree that under 115 mg/dl is where your blood sugar ought to be in the morning when you wake up: your fasting glucose. Some clinicians want it closer to 100. Depending on your meds, we really don’t want you too much below 90. After you’ve had something to eat we look toward the period of time two hours after you chow down. If you only test before you eat you are missing out on the important part of the game: how your meds help you to deal with sugar. The whole point of testing before the meal is to have a baseline for how much you go up after eating, which is what’s really important.

    By the same token, if you only checked after meals it would be worthless. If you are 225 two hours after eating, should we be horrified? Well, yeah, if you started out at 118. But if you started out at 205, the meal itself went pretty well, but there is a baseline medication problem that needs to be addressed.

    It is this after-meal number that is most hotly contested by various diabetes experts, with opinions ranging from 140 on the low side to 200 on the high side. I tell our patients to shoot for 150 but not to worry if some meals clock in at 180. I think if you are routinely above 180 two hours after a meal, you need to look at changing what you eat, or what medications you take, or both.
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    AStacy Wiegman, PharmD, Pharmacy, answered
    There are several things you can do with your test strips to make sure you get the most accurate reading possible with your glucose meter, according to the Food and Drug Administration. First, make sure your test strips are compatible with your meter. Small differences in test strips can affect results. Check the test strips' expiration date. If you use an expired strip, you may get an inaccurate result. Read the instructions carefully to make sure you put enough blood on the test strip to get an accurate reading. Insert the test strips completely into the meter guides. Finally, run quality control tests as directed by the manufacturer, even if the strips haven't yet reached their expiration date. As often as possible, check the results from your meter against laboratory test results.
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