6 Frequently Asked Diabetes Question

  • Medical Author:
    Ruchi Mathur, MD, FRCP(C)

    Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.

  • Medical Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

Better Blood Sugar Balance

What kind of cold medicine can diabetics take?

My mother just found out she has diabetes. What can she take for a cough or cold, since most of the medicines have a lot of sugar?

Doctor's response

There are a few things I'd like to mention before I get straight to your answer. If your mother's cough is accompanied by other symptoms, such as fever, chills, sore throat, or other systemic symptoms, she should be assessed by a physician. Likewise, is she is coughing up phlegm (sputum) that is thick, green, otherwise has color, or is excessive in amount, she should be seen by a doctor. In addition, if she identifies triggers, such as dander, or pollen, this may be more than a simple cough, and should be investigated. Finally, it is common sense that she and anyone with diabetes (or without diabetes, for that matter) should not smoke.

There are over-the-counter remedies available without sugar, and if in doubt, your pharmacist should be able to point you in the right direction. In particular, Benylin Adult is sugar and alcohol free, and provides some relief from a non-productive (dry) cough. This should not be used in conjunction with MAOIs, in pregnancy or in nursing mothers. The active ingredient in this formula is Dextromethorphan, and it is PPA (phenylpropanolamine) free. Another possibility is Robitussin CF. This preparation has been re-formulated to be PPA free, and now contains pseudoephedrine instead. The other active ingredient is dextromethorphan, and together, this preparation helps to suppress cough and also helps to expectorate (which means it makes the bringing up of phlegm easier). Robitussin CF is sugar free and alcohol free. It should be used with caution in patients with high blood pressure or heart disease, and should be avoided in patients on MAOIs. This medication is not recommended for pregnant or nursing mothers.

There are other stronger medications available, but these should be taken on the advice of a physician after a full assessment. It there is no improvement in symptoms within 5 days, your mother should be seen by her primary doctor for further evaluation.

Quick GuideType 2 Diabetes Diagnosis, Treatment, Medication

Type 2 Diabetes Diagnosis, Treatment, Medication

What Kind of Candy Can a Diabetic Eat?

I am a diabetic. If I want to eat a candy bar, for example, is there a way to calculate how much insulin I could take to knock out the sugar in the candy bar?

Doctor's response

Well, the correct answer is that a person with diabetes really is not restricted to eating certain foods, so while a candy bar may not be the best choice nutritionally, an occasional indulgence is understandable. A candy bar usually has about 220-250 calories and somewhere between 25-30 grams of carbohydrates. On average, most patients with diabetes require one unit of insulin for every 10-15 grams of carbohydrates they eat. So you could try two units of a short acting insulin and see how you do. However, it is really important that you meet with a diabetes educator/nutritionist to see what your insulin ratios are, and what your sensitivity is. You should not consider insulin an option to "knock out" the sugar in the candy bar. It is more complicated than that. The type of carbohydrate, what it is combined with, and what your glucose level is before you start eating are all factors to be considered. I would strongly suggest you meet with a diabetes educator/nutritionist or your physician before you move ahead and adjust any insulin doses by yourself.

Is Weight Loss Caused by Diabetes Dangerous?

I have a friend that is 35 and has diabetes. For the past eight years, his weight has always been in check and if anything he may have been a little overweight. Just recently, he has lost a lot of weight and he told me that he weighs less than he did in high school. I think he looks too thin and I am concerned about his health with him being a diabetic. Should there be a concern and what kind of advice can you give me to pass on to him.

Doctor's response

We often assume weight loss is good and healthy. A slow steady intentional weight loss using nutritional change and exercise is associated with beneficial effects on the heart, blood pressure, and cholesterol levels. In addition, weight loss can reduce "insulin resistance" and make muscles and fat tissues more sensitive to circulating insulin levels in the blood.

A reduction in insulin resistance is problematic because insulin is needed to help glucose enter these tissues to be metabolized. If these tissues are resistant to insulin, higher than normal levels are needed for this process to occur. This is often the case in Type 2 diabetes. As a result, a vicious cycle occurs, the higher the insulin levels are, the harder it is to lose weight (insulin is anabolic, and is a hormone that likes to store fat). On the other hand, the heavier a person is, the more likely they are to have higher insulin levels. As you can see, the cycle is often hard to break.

While intentional weight loss in people with diabetes is usually a good thing, unintentional weight loss is not. If blood sugars are very high, patients with diabetes tend to urinate a lot, and this results in dehydration as a possible cause of weight loss. Also, muscle breakdown can occur if sugars are too high, causing an unhealthy weight loss. Actually, many patients with diabetes present for the first time to their doctor's office because of unexplained loss of weight. In addition to diabetes, there are other concerning causes of unexpected weight loss which should be explored such as thyroid disease and cancers.

In summary, a supervised attempt to lose weight in people who can exercise without risk is usually of benefit. However in certain cases such as if blood sugars are too high or too low or if heart disease is present, it can be dangerous. This is why all exercise and weight loss programs should be started only after discussion with a physician. Any unexplained weight loss, in patients with or without known diabetes may be a sign of high blood sugars or another serious illness. It is absolutely necessary to see a physician and undergo a complete evaluation in these cases.

Can a Diabetic Get a Deep Tissue Massage?

Can a person with diabetes have a deep tissue massage?

Doctor's Response

A patient with well controlled diabetes has no limitations on what they can do provided they have suffered no damage from their diabetes, and other commonly occurring conditions (such as hypertension) are well controlled.

If you are interested in a deep tissue massage, there is no contraindication, but you should observe certain precautions. Stay well hydrated before during and after your treatment, notify your therapist of any particular areas that are bothering you, and make certain your blood sugars are controlled before the treatment. If you plan on delaying a meal because of scheduling, make certain you eat something before going into your treatment so you do not become hypoglycemic during your massage.

If you have wide blood sugar swings, or if your diabetes is poorly controlled, you should see your primary physician before considering any activity such as massage therapy.

Can Diabetes Cause Muscle Pain?

How does diabetes mellitus affect the muscle?

Doctor's response

Diabetes mellitus can affect the muscle in several ways.

Patients with diabetes mellitus can develop contracture of digits and limbs as a result of soft tissue thickening in these areas. This can lead to wasting of the muscle from disuse. This is referred to as atrophy.

Diabetes mellitus promotes atherosclerosis which impairs the circulation to many tissues of the body. When the muscles of the limbs are affected, the decreased blood flow can lead to cramping and to painful walking (peripheral vascular disease resulting in claudication). In the worse case scenario - this can lead to death (infarction) of the localized areas of muscle. This is characterized by local pain in the involved area. Blood testing can demonstrate elevated muscle enzymes (CPK, aldolase). When the heart muscle is affected by such atherosclerosis, it can lead to heart attack.

Diabetes mellitus can also damage the nerves that supply the hands and feet. This can lead to inadequate nerve supply and further muscle wasting. Persons with longstanding diabetes mellitus can develop pain, and muscle twitching, in addition to muscle wasting of the muscles around the shoulders and hips (limb girdle wasting). This condition is referred to as diabetic amyotrophy.

In the majority of people with diabetes, muscle strength is preserved well enough to allow for modest physical activity under a doctor's supervision, This is not an excuse for someone with diabetes to refrain from physical activity!

Quick GuideType 2 Diabetes Diagnosis, Treatment, Medication

Type 2 Diabetes Diagnosis, Treatment, Medication

What Is a Safe Hemorrhoid Treatment for Diabetics?

I have diabetes, and also have hemorrhoids. I cannot use Preparation H, what other options do I have, Tucks Pads?

Doctor's response

Some simple treatments for hemorrhoids in patients with diabetes are as follows:

  • Eat plenty of high-fiber foods including bran, fresh fruits and vegetables. Psyllium-containing products also may be used to add fiber to the diet.
  • Avoid straining during defecation or sitting on the toilet for a prolonged period of time. In general, do not sit for prolonged periods of time. Ice compresses may ease the swelling.
  • Sitting in warm water for approximately 15 minutes at a time may ease the symptoms. Adding Epsom salt to the water helps relieve the inflammation. Sitz baths taken several times a day will also provide a soothing effect.
  • Avoid any foods or drinks that seem to make the discomfort from hemorrhoids worse.
  • If you have diabetes, do not use over-the-counter products that contain a vasoconstrictor (for example, ephedrine, epinephrine, phenylephrine HCI). This includes Preparation H. Although it does not contain phenylephrine, Preparation H hydrocortisone 1% itch contains hydrocortisone-a steroid that can cause the blood sugar to rise if absorbed in large amounts.

Other options for patients with diabetes include astringents, protectants, and topical anesthetics .

Astringents cause the tissues overlying the hemorrhoids to dry and provide relief from burning and itching but not from pain. Witch hazel is recommended for external use, providing temporary relief of itching, discomfort, irritation and burning. Zinc oxide and calamine also act as astringents.

Protectants form a physical barrier over the skin and mucous membranes, thereby decreasing inflammation and preventing water loss. Recommended protectants include aluminum hydroxide gel, cocoa butter, glycerin in aqueous solution, lanolin, mineral oil, zinc oxide, calamine, and topical starch.

Anesthetics relieve the sensation of pain and burning by blocking sensation in areas where they are placed for a short period. Anesthetics should be used externally on the perianal area because this is where the nerve endings are most concentrated. Active ingredients often found in local anesthetics include benzocaine, dibucaine, lidocaine, pramoxine and tetracaine.

REFERENCE:

"Overview of medical care in adults with diabetes mellitus"
UpToDate.com

"Clinical manifestations and causes of central diabetes insipidus"
UpToDate.com


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Reviewed on 6/16/2017

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