Diabetes Alert Day (cont.)

To answer the second part of the question, can antidepressants help control sugars in a person who's depressed -- certainly antidepressants work to improve the quality of life in someone who suffers from depression. Antidepressant medications, in combination with psychotherapy, can benefit anyone suffering from this condition. Whether this can improve sugars is hard to say. If the stress is the cause of the elevated sugars, I would have no doubt that antidepressants would help. But ultimately we're not treating high sugars with antidepressants -- we're treating depression with antidepressants.

Remember, when a diabetic patient is placed on an antidepressant, medications need to be chosen cautiously. A few of these medications can alter blood sugars and cholesterol levels, so it's always a good idea to discuss these with your health care provider. If you suffer from depression, it is an illness like any other and not a sign of weakness. Get treatment.

MEMBER QUESTION:
What is the maximum amount of times a person should test their sugars in a day?

NAZARIO:
Every case is different. The recommendations are two to three times a day, although people on insulin, people on insulin pumps or people with brittle diabetes are often advised to check their sugars more frequently. Blood sugars fluctuate throughout the day, and although the strips are quite costly, checking sugars once a day or once every few days gains very, very little information.

Ultimately, we know having your blood sugar under control reduces your risk of complications. The only way to know whether your sugars are under control on a day-to-day basis is to check your blood sugars. The more frequently you check the more accurate that information is in reflecting your blood sugar over a 24-hour period.

MEMBER QUESTION:
I'm a 59-year-old male. I was recently "blood screened" and found to have a fasting blood sugar count of 114. My 87-year-old mother is taking pills for diabetes. I'm about 5'11" and weigh 200 pounds. I've since become more dedicated to my workout program. I weight train three times a week, and do bicycle cardio three times a week. I'm a truck driver and spend most of my time sitting still, looking out the window, but it's interspersed with pretty heavy work. I eat a lot of chicken, fish, and some beef. I eat lots of veggies and fruits, and occasional nuts. I drink red wine with dinner (about a glass to a glass and a half). I don't smoke. I'm going in for a follow-up blood test in about a week. Do I sound like I'm on the right track with my diet and exercise program?

"As you may be aware, one of the biggest complications affecting people with type 2 diabetes is heart disease or premature heart disease."

NAZARIO:
You sound like the ideal patient. At 5'11' and 200 pounds, your BMI (body-mass index) is 28; so you're about 20 percent overweight. But it sounds like you're doing all the right things.

Your fasting sugar at 114 puts you at high risk of developing type 1 diabetes. You're overweight, you have a family history and you have a sedentary type of job; you have a lot of risk factors that would push you towards developing type 2 diabetes. Having prediabetes does not necessarily commit you to having diabetes. I believe the estimates are about 30% of people go on to develop type 2 diabetes, but you have numerous risk factors that push you to a high likelihood of being one of those 30%.

It sounds like you're working on what we call modifiable risk factors -- your weight, your sedentary lifestyle and your diet. You can't change your family history, but the things you can change you are working at. The moderate amount of alcohol is what is recommended by the American Heart Association. At 5'11", ideally your weight should be under 178 to be normal. Dieting and exercise are both the way to get there. Dieting will help you lose weight, which will help improve the resistance to insulin that you have, the exercise will help that as well, but the exercise has the added benefit of being heart protective. As you may be aware, one of the biggest complications affecting people with type 2 diabetes is heart disease or premature heart disease. People who have prediabetes also have an increased risk of heart disease above the normal population, so it sounds like you're on the right track.

MEMBER QUESTION:
Does vitamin C help lower the blood sugar or just mask it?

NAZARIO:
Although vitamin C is an antioxidant, I'm not aware of any good, quality studies that show that vitamin C lowers your blood sugar. Having said that, I do know that vitamin C does interfere with the reading of blood sugars; specifically it interferes with the blood glucose strips.

So, if you're seeing an improvement in your sugars and you are taking vitamin C, make sure this is not a false improvement based on some interaction of vitamin C with the blood glucose strip. Verify it with the three-month hemoglobin A1c reading as well. It may not be the vitamin C; it may be an overall improvement in your lifestyle. I generally see people who take antioxidants who also seem to participate in other healthy lifestyle habits, and that may be what you're seeing in the improvement in blood sugars.

MEMBER QUESTION:
I'm a newly-diagnosed type 2 49-year-old female. At this point I am controlling my sugar with diet and exercise. In the last month my sugars have been a bit high at bedtime: 140 and 155. I go back to see my doctor in April. At what point would my doctor put me on medication?