Managing diabetes
- May 22, 2009 2:50 PM |
- By Your Voice
An estimated 250 million people around the world have diabetes - and about a third of them don't even know it.
Perhaps you're showing some of the symptoms:
- You seem to be thirsty all the time.
- You're always tired.
- You can never get enough sleep.
- You've lost weight.
- You're urinating a lot more than you used to.
Anne Belton, RN
The study, published in the Lancet, suggests that rising obesity levels across Canada are contributing to the onset of the disease.
Diabetes -- or complications from the disease -- now kills 3.8 million people a year or about the same number as HIV/AIDS.
Dr. Sara Meltzer
If you're diagnosed with diabetes, you may have to come to terms with major changes to your lifestyle - and the possibility of serious long-term complications.
But - for most people - diabetes can be successfully managed.
Dr. Sara Meltzer and Anne Belton, RN, co-authored Diabetes in Adults, a guide to help teach people how to adjust their lifestyles to keep diabetes under control.
They address issues such as:
- Insulin and other medications.
- Possible complications and how to avoid them.
- Issues related to pregnancy and conception.
- How diabetes affects aging.
Meltzer - an associate professor of medicine and obstetrics and gynecology at McGill University - has practiced endocrinology for 25 years. Belton - a consultant on health teaching and resource development in the field of diabetes - chaired the Diabetes Education Section of the Canadian Diabetes Association.
They'll take your questions on living with diabetes.
How to participate
Remember, when sending in your question:
- A short question is better than a long one.
- One question is better than many.
- If a question needs some context, keep it brief.
- Preference will be given to questions from those who give a full name and location.
- Questions may be edited for length and clarity.
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Comments (14)
What is the ideal A1C for a Type 1 diabetic. I can keep mine around 7, but my team seems to want me below that.
I have been a Type 1, insulin dependent, diabetic for 16 years. There is no diabetes in my family, although I had gestational diabetes with my 3rd child. Six years after his birth I became diabetic. Are my children at greater risk of developing diabetes?
Dr. Sara Meltzer and Anne Belton, RN, respond:
The current A1C target level recommended by the Canadian Diabetes Association is less than or equal to 7%. Some countries do recommend an A1C of 6.5% or even as low as 6%, but the potential benefit (reducing complications) has to be weighed against the increased risk of hypoglycemia.
All studies where the A1C has been lowered to levels less than 7% have resulted in increased episodes of hypoglycemia. If certain complications such as neuropathy, inability to sense hypoglycemia or underlying heart disease are present, the increased risk of hypoglycaemia may cause more problems. Your personal health team will determine the range of glucose and A1C that is best for you.
In terms of risks for your children, they are low for getting type 1 diabetes … in the range of 1-3% chance. If glucose levels were elevated in the pregnancy, the children may have an increased risk of obesity and glucose intolerance as young adults than if there was no glucose abnormality in the pregnancy.
I have been a diabetic for ten years and have seen a kidney specialist who told me that diabetics need to watch their potassium levels carefully. They should not overeat nuts, bananas, oranges, carrots and potatoes. To get the water soluable potassium out of vegetables one should first peel the vegetables and soak the vegetables in water for several hours and then drain the water off prior to cooking them. I have also discovered that diet sodas contain potassium. Many heart and stroke patients, amputees, and dialysis patients are diabetics. If there was a cure for diabetes many of the hospital costs could be lowered drastically. How much does diabetes complications cost our health system nationally?
Dr. Sara Meltzer and Anne Belton, RN, respond:
In general, people with diabetes do not have any problems with potassium simply due to diabetes. If there is evidence of kidney disease, too much potassium intake may cause problems. It is rare that special food preparation is needed to avoid potassium and this would best be discussed with a local dietitian experienced in treating the combination of diabetes and kidney disease.
Your comments about costs of diabetes to the health care system are correct. According to the Canadian Diabetes Association by 2010 diabetes will cost the health care system in Canada $15.6 billion a year and that number is rising. That is not just the cost of complications but of all care.
I am male 51 yrs old. I am taking 30/70 humilin insulin 40cc morning and evenings, but every morning my blood sugar level 8-10mmo(which should be less than 6.8mmo. . Even my eye specialist told due to diabetes now it starts effecting to your eyes and I have to care for that.I kept requesting to family physian from long while ago to make my appointment for specialist or dieticain. But always says it was fine, don't worry.
Please let know, is it right or wrong that level in every morning???
Dr. Sara Meltzer and Anne Belton, RN, respond:
The recently published Clinical Practice Guidelines from the Canadian Diabetes Association recommend fasting blood glucose (early morning after not eating all night) blood glucose levels of 4 – 7 mmol/L. You might want to check your levels 2 hours after you have eaten meals on occasion, to see if they are within the recommended target levels (5-10 mmol/L).
It may be reasonable for other health reasons (heart disease) to have glucose levels in the upper range of these levels. If you find high numbers, you could ask your family MD to refer you to a dietitian and find out if you can change anything in your eating habits which may help improve your glucose levels.
Ideally, anyone with diabetes should see a registered dietitian, if there is one available. If the glucose values continue to be elevated despite these efforts, perhaps your family physician would reconsider referral.
Has statistical evidence been established between Onset menopause and diabetes?
Dr. Sara Meltzer and Anne Belton, RN, respond:
NO.
The acceptable blood sugar rate is 5-7. My question is that for everyone regardless of your size, weight,height or metabolism.
Dr. Sara Meltzer and Anne Belton, RN, respond:
The targets recommended by the Canadian Diabetes Association are 4-7 mmol/L fasting (before eating in the morning) and 5 – 10 mmol/L 2 hours after eating for most people. However these targets may be adjusted for some people, for instance during pregnancy, for very young children, for someone who has other debilitating disease. They are not usually adjusted for size, weight, height or metabolism.
Are there any drugs(RX's) that Diabetics should not take?
Dr. Sara Meltzer and Anne Belton, RN, respond:
In general, there are some drugs that would cause problems if taken by someone with diabetes, particularly if there are complications present. It is VERY IMPORTANT that your doctor or particularly doctors, if you have more than one, are aware of any medications that you may be taking, either by prescription or over the counter.
When you go to a doctor, bring either all your medications, or at least a list which you can get from your pharmacy of any medications that you take with their dosages.
Your personal health team would be most able to warn about medications which may be contra-indicated due to either your diabetes or by interactions with the other medications that you may be taking.
My husband was diagnosed about 1987. He is 67 now. He has been taking insulin by needle ever since. His sugar has been out of control most of the time. He does not exercise and eats secretly. This past winter he has had alot of laser surgery on an eye, and really does not see very well. He still does not acknowledge his disease, prefers to think he has "heart disease" which he may have a bit of now. I am pretty angry because he has not cared for himself and now he wants sympathy for the outcomes, and I am not very sympathetic. QUESTION: What is the best way to handle a person like this? Ignore their complaints and just let the health care professionals deal with it?
Dr. Sara Meltzer and Anne Belton, RN, respond:
This is a difficult situation – certainly difficult for you. It sounds as if your husband has never really accepted that he has diabetes, and this may have happened for different reasons. At this stage we would suggest he need to talk to a psychologist or social worker but we also realize that he may not want to if he does not think there is anything wrong. It puts you in a very difficult position.
Reminding him he is eating the wrong thing or watching what he is eating or being the “diabetes police” will definitely not help – that kind of “nagging” will probably make matters worse. If he won’t talk to someone you could go and ask for help on how to manage your own anger. It is always very difficult when someone you love does not look after themselves.
If you have diabetes and have heart diease(blockages) is there one diet to battle both of these dieases. Is it low fat for the heart or is it low carbs for the diabetes.
thanks
Dr. Sara Meltzer and Anne Belton, RN, respond:
People who have diabetes and follow the principles of healthy eating are eating a diet that is low fat. People with diabetes do not necessarily eat low carbs, but they spread the carbs out through the day and try to eat mostly healthy carbs (high fibre, less concentrated sugar).
Generally, people with diabetes should not have less than 45% of their daily energy from carbohydrate, as carbohydrate-rich foods have many important vitamins and nutrients needed by the body. It has even been shown that diets that provide more than 60% of total energy from carbohydrate that have low glycemic index and high fibre (eg. vegetarian diets) can improve blood glucose and lipids in people with type 2 diabetes.
It is ideal if you can work out with the dietitian the eating pattern that works best for you and is likely to help both the diabetes and heart disease.
I have type 2 (first evidenced when I was 51, 14 years ago).
1) Is Sucralose a useful substitute for sugar?
2) On nutrition labels which item (e.g., calories) of combination of items is most useful to us?
3) Is there a rough guide to alcohol consumption?
Thanks.
Tom Kane
Dr. Sara Meltzer and Anne Belton, RN, respond:
Sucralose is a safe substitute according to Health Canada.
On a label look first at the serving size, then look at the amount of carbohydrate in that serving. You can find out from a dietitian how many carbohydrates you should be having at each meal (it is different for everyone). Most people with diabetes do not count calories, however, total calorie intake in a day which is more than you need will lead to weight gain. Again, a dietitian can give you a clearer idea of YOUR caloric needs.
Alcohol – recommendation is as for all Canadians: men up to 14 drinks a week with no more than 2/day and for women up to 9 drinks a week with no more than 2 a day. A standard drink is 12 oz beer, 5 oz wine or 1.5 oz spirits.
I recently tested 100 mg/dL glucose serum which I am told is pre-diabetes. Can this condition be reversed with lifestyle changes (diet & exercise?
Dr. Sara Meltzer and Anne Belton, RN, respond:
Yes several studies have shown that people who have “prediabetes” can go back to normal and may delay or prevent the development of diabetes. The best way to do this was with diet and exercise. People who modified their diets and lost about 5% of their weight and exercised for at least 150 minutes a week had a reduced risk of developing diabetes of 58% after 4 years.
A couple of medications have also been tried in people with “prediabetes” – they worked but not as well as the diet and exercise.
1) I'm a 46 year old man who was diagnosed with type 1 diabetes in '96 - i was 34 at the time. After using both my left and right waist/abdomen areas for injnection sites over the years, I'm now finding bumps and outright muscle discomfort when i stretch in certain positions. It was suggested to me that i might try my thighs as injection sites, and i would do it, except that they're really muscle bound and it's extremely uncomfortable. Is there a way i can continue with the waist area without increasing the amounts of bumps (hard areas)?
2) Is there any bonafied breakthroughs for cures via gene cell replacement therapy that is accessible to the avg. diabetic?
3) Related to question 2: Do you suppose that the diabetes supply business, i.e., the makers of glucometers, insulin, etc, have a vested interest in maintaining the status quo? They would obviously be out of a lot of money if indeed there was a cure for type 1 or 2.
Thank-You
Dr. Sara Meltzer and Anne Belton, RN, respond:
1. If you have bumps you should not inject in them as your insulin will not be absorbed as well as it should be. The bumps (called lipohypertrophy) will go away and you will be able to use those sites again. You could try using the side / back of your upper arm or reaching around to the “lover’s handles” area on your back. Also, there are very short needles which would allow you to inject straight in and still not reach the muscles in your thighs.
2. The research they are doing regarding giving people new islet cells requires that people take anti-rejection medications for the rest of their lives. Anti-rejection medications have side effects. The possibility of stem cells providing a precursor cell to develop new islet cells is being investigated, but as yet, is not done outside of research settings. For the moment, the best option is to get the best glucose control you can to be sure that you will be free of complications as long as possible. That way, once they find an effective technique for replacing islet cells, you would be able to fully benefit from it!
3. I have heard that many times and I am absolutely sure that no one is holding back on a cure for diabetes.
Will stem cell research-that is planting healty pancreas cells help produce enough insulin to stop taking insulin injections? Also, have there been cases of pancreas transplant to replace defective (not producing insulin) with healty pancreas?
Thank you.
Dr. Sara Meltzer and Anne Belton, RN, respond:
In the case of type 1 diabetes, there is a chance that the autoimmune process that caused the body to “reject” the islet cells initially will still be active, so to gain functional islet cells, there is a need to take anti-rejection drugs. In the case of type 2 diabetes where there may be a need for more cells but no destructive process occurring, increasing the numbers of islet cell may help, but there may still be a need for anti-rejection drugs.
Pancreas transplants are already a reality in a few specialized centres. In Canada, this is usually not done alone but may be tried if someone already needs a kidney transplant due to renal failure. In that situation, they would already require the anti-rejection drugs so there is limited long-term added risk to add the pancreas transplant. The surgery, however, is not easy and carries significant risks of its own.
Anti-rejection drugs have serious side effects as they work to reduce the body’s defense system that tries to reject the new organ, they also mean that risks of unusual infections and onset of cancer can be increased. Thus, transplant of organs is not taken on lightly and must be worth the risks.
MY BLOOD GLUCVOSE LEVELS ARE SLIGHTLY ELEVATED. MY DOCTOR HAS PRESCRIBED 500 mg.
METFORMIN TWICE DAILY. I WAS TO START WITH
ONE HALF THAT AMOUNT. I HAVE TAKEN THIS ABOUT A WEEK, AND HAVE BEEN GETTING SEVERE CLUSTER
HEADACHES. CAN THIS BE A REACTION TO THE MEDICATION?
Dr. Sara Meltzer and Anne Belton, RN, respond:
You should speak to your pharmacist or your doctor.
How do I deal with the depression of not being able to manage this problem I must almost addictaly eat? Why am I turned away by Ontario Disability when I can not get work or work when I am out of control? I have asked for gym membership and fuel to get thee but no goverment support is avable i know the people in the clinince want to help but ther is more to this problem than one factor if I am allowed to comment. thanks
Dr. Sara Meltzer and Anne Belton, RN, respond:
Your problems are very specific to the area where you live and the circumstances of your life. There is no question that your own health professionals are more likely to be able to determine how or what can be done. Each provincial health system has specific options and criteria to determine availability of support and criteria for disability.
We would suggest that you direct the question that you wrote to your health team or to the local Ontario health services. If there is a support group that you can find through the Canadian Diabetes Association or your area’s health clinics, they may be an additional resource to help deal with your emotional difficulties. It is important that you communicate your needs to your doctor as clearly as possible.