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Diabetes: Taking Control of this Serious Disease

Dr. Pauline Shipley November 18, 2009 10:00 AM This chat has ended. Thank you for participating.
Moderator (Moderator) - 9:57 AM:
Welcome! Today’s chat: Diabetes: Taking Control of this Serious Disease, will begin shortly. Please start submitting your questions and Dr. Pauline Shipley will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Diabetes pages to obtain more information about Diabetes.

Dr. Pauline Shipley (NorthShore) - 9:57 AM:
Good morning! As the Director of Diabetes for the NorthShore University HealthSystem Endocrinology Division I want to welcome you to this online chat. I hope it will be informative regarding your questions about diabetes. Also, for additional resource information during and after this chat I encourage you to explore the NorthShore diabetes Website at www.northshore.org/diabetes .

M. Vernon (Skokie, IL) - 10:00 AM:
What is an acceptable blood sugar level for diabetic person? What signs/symptoms can you look for if a person's blood sugar level is low?

Dr. Pauline Shipley (NorthShore):
An acceptable blood sugar varies on the individual's personal situation. In general, we look for blood sugars between 80 and 140. Signs and symptoms of low blood sugar include feeling hungry, headache, sweating, nervous, agitation and nausea.

Steven Boone (Oroville, Ca) - 10:01 AM:
I inject insulin and was told not to inject in the same spot. Well, there's only so many spots one can inject before I have to go back to square one. What is the acceptable time period before one can start over at square one?

Dr. Pauline Shipley (NorthShore):
We try to each people to use mostly their abdomen and inject two inches between spots on a rotating basis. We suggest they should be getting back to the original injection spot no sooner than every four or five days.

Jose Florez (Chicago's North side) - 10:02 AM:
My recent blood fasting glucose test was 107. Those that have been in the medical field since the 1970's tell me that's nothing to worry about. But then I read that anything above 100 places me in the Pre-diabetes stage. My family has a history of diabetes and I'd like to know how to slow its progression; I know that I'll have it some day...

Dr. Pauline Shipley (NorthShore):
This would be called an impaired fasting glucose. In order to be sure there is no diabetes present, a two-hour post-meal glucose should also be looked at. That number should be below 200. The best way to prevent progression to diabetes is with diet, weight loss and exercise. A healthy lifestyle is the best way. Try to get more fruits and vegetables and more whole grains into your diet. Reducing refined carbohydrates (white bread, cake, cookies) is also helpful.

Nicky (Thousand Oaks, CA) - 10:06 AM:
I was just diagnosed on Wednesday and was not really given any direction. I got a glucose meter and have been watching my diet and monitoring my bg rates for the last 5 days. My highest reading was 184 and lowest 119. My fasting is always quite high (163 thur, 151 fri, 149 sat, 129 sun) but going down every day. Are my numbers very high? Should I be extremely worried or just keep doing a low carb diet/exercise regimen and watch my numbers and can this be reversed? Thanks!

Dr. Pauline Shipley (NorthShore):
The more numbers are moderately elevated. They are not extremely high. We sometimes see people in the 300-400s. Over time, you and your doctor should decide if medication is needed. Diet and exercise is a good start to moving these numbers to normal without medication. You should continue to test to see if they are improving or not and should absolutely share this information with your physician.

Tannin (Chicago, IL) - 10:07 AM:
What can someone with type 2 diabetes (not taking insulin) do when experiencing outlier high numbers as opposed to a type 1 who can correct with extra insulin?

Dr. Pauline Shipley (NorthShore):
The acute event is difficult to treat. You should always be well hydrated and be sure to bring these events to the attention of your physician if they occur more than a few times a a week. If they are, you may be in need of medication adjustment.

Taylor (Naperville, IL) - 10:08 AM:
What is the likelihood for me, a type 1 diabetic since the age of 13, to pass along the disease to my children? Does diabetes follow a heredity pattern?

Dr. Pauline Shipley (NorthShore):
The rate of passing it on in women is 4% and in men it is 7%. There is some hereditary pattern, but not nearly as much as with Type II diabetes.

Dan (Mount Prospect) - 10:10 AM:
I was recently diagnosed with Type II diabetes. With the holidays approaching and family gatherings, I'm concerned about food consumption. Is it okay to partake of the big meals? Should I be testing my glucose levels more frequently as a result?

Dr. Pauline Shipley (NorthShore):
Yes, you should test more frequently so you can identify what trigger foods are sending your levels upward. As you're participating in the meals, control your quantities and portion sizes to help control your blood sugars.

Jay M. (Buffalo Grove, Illinois) - 10:11 AM:
A good friend of mine has diabetes and was talking about checking his feet regularly. What is the purpose in checking toes, heels, etc.? What's he looking for?

Dr. Pauline Shipley (NorthShore):
Diabetics are at risk for diabetic neuropathy which decreases sensation in their feet so they may not notice if a problem is developing because of a loss of pain sensation. They're also at risk for decreased circulation. Problems such as a cut, sore or ulcer can become a bigger problem quickly. The skin also tends to be drier. When we ask people to look at their feet we are looking for evidence of blisters, dry skin, caullouses and changes in the shape of the foot for pressure points. All these can lead to greater problems. We also recommend that they see the podiatrist at least twice a year for general foot care.

Taylor (Naperville, IL) - 10:15 AM:
I am on insulin pump therapy but I always seem to get calcium deposits at my injection site, what could this be due to? How can I eliminate them?

Dr. Pauline Shipley (NorthShore):
You need to discuss this with your diabetes educator. A different infusion set may help you, but I suggest speaking to them to make sure.

Tannin (Chicago, IL) - 10:16 AM:
But if I see a high reading of closer to 200 even though it hasn't happened in months, is there anything I can do immediately? I've heard drinking a lot of water helps, but am I just fooling my meter like this?

Dr. Pauline Shipley (NorthShore):
Other than staying hydrated, you can't really adjust it. You need to discuss this with your physician.

Steven Boone (Oroville, CA) - 10:17 AM:
I'm taking Lantus <25 units> at bedtime for Type 1 diabetes. On a forum I frequent I've been told that I should split this into 2 doses. I'm not really into injecting myself once a day let alone twice a day. Does a twice-a-day dose really work better than once a day?

Dr. Pauline Shipley (NorthShore):
At 25 units, it's not necessarily better to take it twice a day. We sometimes split dosages at more than 50 units. If your control is good, there is no reason to split.

Becky B (Highwood) - 10:18 AM:
I have an uncle who has problems with his feet and says it is becasue of his diabetes, why would blood sugar level cause pain in the feet?

Dr. Pauline Shipley (NorthShore):
He has neuropathy. The pain is accumulation of years of diabetes, but some people experience worsening of pain when their blood sugar is especially elevated. The pain comes from damage to the nerves caused by diabetes.

Jim (Glenview, IL) - 10:20 AM:
This is similar to an earlier question. I have type 2 diabetes. I have two young children (ages 4 and 7). If heredity plays a role, then is there anything my kids can do to significantly reduce the chances that they might get type 2 when they're older?

Dr. Pauline Shipley (NorthShore):
Absolutely. It's very important they be trained now to eat a healthy diet and not become overweight. That is their greatest chance at avoiding developing diabetes. Healthy diet and exercise habits instilled in them now can reap many benefits in the future.

Steve S. (Glenview, IL) - 10:21 AM:
I am an insulin dependent Type II, on a sliding scale. I know I should exercise, but I am afraid of crashing if I burn too much energy. How should I start out and control this?

Dr. Pauline Shipley (NorthShore):
It's always best to start slow with an activity such as walking. Always carry your meter and glucose tablets with you. If you start to feel low sugar you can treat it. A snack or energy bar prior to exercise can decrease the chance of your blood sugar dropping.

Tannin (Chicgo, IL) - 10:23 AM:
How would I qualify for an insulin pump? Are there people who absolutely should not use one?

Dr. Pauline Shipley (NorthShore):
An insulin pump is an individual evaluation by your physician. If you're not on insulin, you wouldn't qualify. This is a tough question to answer and would be better suited as a discussion with your physician.

Tannin (Chicago, IL) - 10:34 AM:
I know exercising helps lower your blood sugar levels so why is it recommended not to exercise if your blood sugar is over a certain number?

Dr. Pauline Shipley (NorthShore):
If your blood sugar is high, that indicates that you don't have enough insulin in your body at the momnent of exercise. When we exercise our muscles, if they can't get glucose in them (which requires insulin), they start to make their own insulin which makes your blood sugar higher. That's why you don't start exercise with high blood sugar.

Steven Boone (Oroville, CA) - 10:37 AM:
Is there an average number for basal insulin? In other words, let's say the pancreas secretes 70 units of insulin per day to someone who's not diabetic, then someone who is a type 1 diabetic should require the same dosage on average? What I'm trying to figure out is if the 25 units I'm taking puts me in a good range, rather than what others might need in a higher dosage. My FBG is usually 100, and 2 hours after meals I'm usually at around 110.

Dr. Pauline Shipley (NorthShore):
The pancreas normally makes an average of 25-40 units a day in a completely normal person. Even some Type I diabetics can have some insulin resistance. It's not a matter of how much insulin you take. It's a matter of if your control is in the desired range.

Tim K. (Glenview, IL) - 10:39 AM:
My father has put on considerable weight over the last couple years in relation to another medical condition. He's been tested for Diabetes and always told he doesn't have it. But he does exhibit symptoms of it, like decreased sensation in his feet. What are the best tests to confirm or rule out Diabetes?

Dr. Pauline Shipley (NorthShore):
The diagnosis of diabetes is made by having two abnormal blood sugar levels. The first can be a fasting blood sugar over a level of 126. The second is a two-hour post-meal sugar that is over 200. Any combination of two abnormal numbers meeting this criteria is a diagnosis of diabetes. Any two random blood sugar levels over 200 also make a diagnosis of diabetes.

Dr. Pauline Shipley (NorthShore) - 10:45 AM:
Building on the last question, I would like to talk about pre-diabetes. This is fasting blood sugars between 101 and 126 and post-meal sugars more than 140 but less than 200. A combination of these means a diagnosis of pre-diabetes. If these criteria are met, a physician will advise a regimen of diet, exercise and weight loss to delay or prevent progression to diabetes.

Steven Boone (Oroville, CA) - 10:45 AM:
When they say that diabetes is a progressive disease do they mean it's progressive when "untreated", or it's still progressive no matter how much control you think you have over it?

Dr. Pauline Shipley (NorthShore):
It is progressive even with treatment. It's not uncommon for people with Type II to require increasing amounts of medication to keep their diabetes under control as the years go by. The most important thing is not how much medication it takes, it is to keep your diabetes under control to prevent complications.

Tannin (Chicgo, IL) - 10:47 AM:
I’ve heard that type 2 diabetes is “curable”, is there any truth to that?

Dr. Pauline Shipley (NorthShore):
No, it's not curable. It's controlled. It can be controlled by diet. Once again, if the weight is regained that allowed you come off medication, you will once again be diabetic. Think of it as remission, not cure.

Moderator (Moderator) - 10:50 AM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

Noelle (Chicago, IL) - 10:51 AM:
I see my general practicioner for diabetes management (I am type 2), but have been told by a nutritionist and others that I should see an endocrinologist. What are the advantages to this? Is this necessary or can my GP be the core of my diabetes management team?

Dr. Pauline Shipley (NorthShore):
It depends on your control. If you're having problems with control and your physician feels you need the expertise of an endocrinologist then that would be the time to see one. I advise that you have this discussion with your GP and come to a decision based on that discussion.

Taylor (Naperville, IL) - 10:52 AM:
What is the recommended type of insulin used with insulin pump therapy (Humalog, Regular, Apidra)

Dr. Pauline Shipley (NorthShore):
It should be an insulin analog, either a humalog, novalog or apidra. I no longer use regular insulin because it has a longer duration of action. Again, discuss this with your physician.

Tannin (Chicago, IL) - 10:53 AM:
Why do I see my numbers rise when I get sick?

Dr. Pauline Shipley (NorthShore):
When you're sick, your body makes hormones to fight the illness. Those same hormones raise blood sugar which is why when you're sick you need to test your blood sugar more frequently. Even though you may not be eating normally, you still need to take some or all of your medication. Contact your physician for instructions.

Dr. Pauline Shipley (NorthShore) - 10:55 AM:
If there is a final question, please submit it now and I will gladly answer it.

Steven Boone (Oroville, CA) - 10:56 AM:
I've been progressivly been walking farther and farther each day since I was diagnosed 3 months ago. I've lost 18 pounds since July but it seems to be tapering off. Could the decrease in weight loss be due to muscle buildup replacing the weight of the fat i'm burning?

Dr. Pauline Shipley (NorthShore):
It could also be that your body is entering a plateau phase. It happens to all people that are losing weight. There are times that you have to persevere when losing weight. Congratulations on your weight loss!

Dr. Pauline Shipley (NorthShore) - 11:00 AM:
Thank you all for the great questions! I hope that you found this chat to be informative and a good resource about diabetes. Again, more information is available at northshore.org/diabetes. We had some great questions from outside of the Chicago area and I encourage you to continue to discuss your diabetes with your physician. If you have any questions or would like to make an appointment with a NorthShore physician to discuss your diabetes, please call physician referral at 847.570.5020.

Moderator (Moderator) - 11:01 AM:
Thank you again for participating in our chat today. For more information please visit our Diabetes pages .

Also, a transcript of this chat will be available shortly.
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