Diabetes Alert Day (cont.)

NAZARIO:
Every patient is different; every doctor is also different. I tend to be fairly aggressive in treating diabetes -- I don't put everyone on insulin. What I mean is that I tend to sit and spend time with patients and really teach them about diabetes and let them know they can truly get a handle on their diabetes if they participate.

If your blood sugar by monitor is 140 to 155, there's a bit of bad news to that. Blood sugar readings on the monitors tend to be lower than what we will get in the lab. The reason for that is that the monitors check whole blood, or the red stuff you see. Blood sugars are actually in the serum and that's what the lab checks. So the blood test will probably come up 5% to 10% higher. To be certain, the doctor will probably order a hemoglobin A1c.

If you're seeing your highest blood sugars are at bedtime, you may want to play around with the calories you take at night. Typically most of us consume most of our calories at dinner, or at least in this country. You may want to switch that to having a larger lunch or an afternoon snack and smaller dinner. You also may want to adjust your exercise program, if you're exercising in the morning but your sugars are high in the evening, switch your exercise program to the evening hours.

As far as when your doctor will start you on medications, I can't answer that.

"Weight loss, especially reduction in fat around the person's belly, helps improve sugars. But weight loss in any form will help diabetes and blood sugar control."

MEMBER QUESTION:
Does increased blood sugar cause weight gain?

NAZARIO:
It's usually the other way around. Increased weight gain causes insulin to work less efficiently, meaning insulin is less capable of lowering blood sugars. This is commonly called insulin resistance. As a result of continued weight gain and insulin not working as efficiently as it can, eventually blood sugars increase first into a range of prediabetes and then to higher ranges where a person gets diagnosed with diabetes.

Weight loss has the opposite effect. Weight loss, especially reduction in fat around the person's belly, helps improve sugars. But weight loss in any form will help diabetes and blood sugar control. One of the easiest ways to do that is to reduce your calorie intake by 500 calories a day, so you don't have to calculate how many calories you take every day, just eliminate 500 from your diet. That should lead to a 1 to 2 pound weight loss per week. Losing weight will improve your blood sugars.

MEMBER QUESTION:
There is no history of diabetes in my family, but I am overweight. I experience some numbness in my fingers, get frequent yeast infections, and have declining vision. I am trying to work on the weight problem. I could explain away the fingers (I type for a living), and everyone in my family wears glasses (besides once you reach the 50s a lot of us experience vision problems), but my diabetic girlfriend tells me that frequent yeast infections are a problem for women with diabetes and said I may have diabetes. I know you can't tell me if I have diabetes, but is it true that women with diabetes get a lot of yeast infections? Should I get my blood sugar tested?

NAZARIO:
Yes, women with recurrent yeast infections should be screened for diabetes, although being overweight puts you at risk for recurrent yeast infections. A simple fasting blood sugar is all you need.

MEMBER QUESTION:
I'm 35-year-old male, diagnosed with type 1 about 11 months ago. I am on Humalog and Lantus insulins. Up until about three months ago I required very little insulin at breakfast (1u:45g carbs). Recently I have had to increase my ratio at breakfast to 1u:15g, bringing it in line with lunch and dinner ratios. I had a C-peptide at six months after diagnosis. I'm still producing insulin, but just below the bottom of normal range. Would the change in insulin requirements be indicative of the end of the honeymoon period or that my islet cells have finally shut down completely (or are they the same thing)?

NAZARIO:
It looks like, from the information you gave me, the ratio of 1 to 45 now changed to 1 to 15 and you went from being sensitive to insulin to more resistant to insulin. That, to me, would not suggest that your honeymoon period is over. In other words, all you needed before was one unit for every 45 grams of carbohydrates, which is pretty good. That one unit can only take care of 15 grams of carbs, so you've become more resistant. If your honeymoon period were indeed over, I would have expected just the opposite. You are becoming more sensitive to insulin rather than more resistant to insulin.

As far as the C-peptide goes, I don't know under what circumstances the test was done. Time and time again I've seen the C-peptide test done wrong. If someone is trying to diagnose you with type 1 diabetes, a C-peptide test may help. But there's still a lot of overlap and the test may not give you any information. A GAD (glutamic acid decarboxylase) antibody, anti-insulin antibody or islet cell antibody is the profile you want to look at to determine whether someone really has type 1 diabetes.

Unfortunately, I'm still questioning the diagnosis of type 1 diabetes based on the small amount of information you gave me. It is unusual to be diagnosed with type 1 at such a late age, although it can happen. There are type 1s that are diagnosed later in life -- they are assumed to be type 2, but it's later discovered they're type 1. They don't really fit the profile of the classic type 1 diabetes and they are LADA (latent autoimmune diabetes in adults), or type 1.5 diabetes.



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