Ask Ginny About Diabetes In Utah

Practical Meal Plans

noreply@blogger.com (UtahDiabetes) — Wed, 08 Jun 2011 01:49:00 +0000

Q: Hi Ginny,

I am having trouble finding a nutritionist/dietitian to help me with meal plans. The books are some help, but not very personal or adaptable. I went to one that my insurance will pay for when I was first diagnose, but her suggestions were not really practical and we didn't have a good repore. I need practical doable plans for a single person. Eating a half a banana is not practical, just wasteful. Any suggestions?

Thank you.

A: First, let me tell you how sorry I am that your appointment wasn’t what you needed. I don’t know who your insurance is with, but insurance providers usually have lists of dietitians that are contracted with them. You may want to start your search with your insurance provider. Ask your insurance company to help you find another dietician. You can also check with your insurance to see if your primary care physician has a diabetes educator or care manager in his/her clinic who could help you. At your next diabetes visit, be sure and take all the information you were previously given. Take a few minutes at the beginning of the visit to let the new dietician know your exact needs. Your statement “I need a practical doable plan for a single person” would be a great place to start. If you were given a certain number of carbohydrates to eat at each meal, be sure and add that information too. If you need or want sample meal plans, be sure and ask because that would be very easy for a dietician to provide. Please let us know what happens in your search.

Do not give up! You are paying for this service and you should get the exact information you need from the visit. ginny

Diabetes meters and supplies in Salt Lake City

noreply@blogger.com (UtahDiabetes) — Wed, 25 May 2011 00:49:00 +0000

Q: There used to be a store on 33rd south in Salt Lake City Utah, where you could get diabetic products. It has now moved. I need to get my free style lite test strips somewhere other than through my insurance. My insurance wants me to get a different meter that is not the qualtiy that I currently have and there are probaly better meter now than what I have. If you could give me some information on the above, I would appreciate it.

A: I think the store you are looking for is either the Diabetes Specialty Center at 3793 South State, 801-483-1100 or JQ Medical at 2370 Ft. Union Boulevard, 801-942-8582.

First check with your insurance company to see what type of meters they will cover, often there are several meters. The next step would be to look at the meters to see if you like them and would feel comfortable using one of them. You can look on line for pictures of the covered meters but I think the best option would be to go to either of the diabetes supply stores to see the meters in person. The staff at either store should be able to give you advice about obtaining the supplies that will work for you. Be sure and look because the meters have changed over the past few years and you might find another one you really like!

Take care, ginny

Blood Sugar & Insulin

noreply@blogger.com (UtahDiabetes) — Mon, 10 Jan 2011 18:20:00 +0000

Q: Hi. It seems my blood sugar stays about the same, even though I have increased my insulin gradually over the past year. I am frustrated and wonder why it isn't responding.

A: This is a frustrating problem. There are some things to consider. How high are your blood sugar readings? What insulin are you using to bring the readings down? How much has the insulin dose changed over the past year?

Often using just a long lasting insulin will work to bring the blood sugar readings in range. Sometimes if the blood sugar readings are 140-200 range, increasing the dose by 1-2 units a week, gradually brings the readings into a more normal range without overdoing it. Often when the readings are running higher, increasing the long lasting insulin by 3 units every 3 days usually brings the readings in range in a week or so. Keeping very close track of the blood sugar readings when you start taking insulin or change the dose, helps to make sure the amount is correct. Each body has different needs and our blood sugar readings let us know if our medications are helping the way they should. If your readings continue to be high the type of medication and the dose you are taking may not be correct. Your body may now need the help of another medication or a change in the amount of insulin you are taking.

Please contact your doctor or diabetes nurse educator to let them know that the dose and the instructions you were given are not working. They may also have some additional ideas about other lifestyle changes that may help your blood sugar readings too. Please also discuss how frustrated you are.

Please let us know what happens. ginny

Type 1 - Fat Stores for Energy

noreply@blogger.com (UtahDiabetes) — Tue, 14 Sep 2010 00:01:00 +0000

Q: Hi Ginny,

I was diagnosed with type I when I was 8 (I'm 27 now). I take good care of myself, my last a1c was a 5.1 in April 2010 and they're usually in the 5 - 5.5 range. No diabetic complications of any kind, I'm fitter than most non-diabetics and my other blood tests are great as well. I don't have a sweet tooth and I try and keep my carb intake under 100g a day, but my metabolism is insanely fast so it's not always easy to do. I rarely go to the doctor for diabetes info - they have not been of help to me in many years and I seem to do better with the information I read and by testing new things on myself. My last resort is usually to go see an endo if I can't get a question answered or find my answer through a credible source so here I am. Anyway...onto the question....

Question

Do diabetics use fat stores for energy like a non-diabetic? I'm not entirely sure about this since glucagon exists for emergencies to release glycagen, but if diabetics don't produce natural glucagon, would the body revert to breaking down fat for a lot blood sugar?

Meaning, if there was little to no insulin in my body, or maybe just a small daily dose of lantus, would my body break down fat stores to utilize as energy? I'm asking because I want to shed some fat (probably just 2-3 pounds) so I can make a weight class for a rowing shell and need to find out how this works so I can find a way to work around this.

Thanks,
f.

A:

[From Dr. Robert E. Jones, MD, Medical Director of the Utah Diabetes Center.]

Ginny,

I agree that fat cells in people with T1DM are similar to non-diabetics.

Insulin is anabolic (allows us to store fat/glycogen) and anti-catabolic (prevents the breakdown of fat and glycogen). When insulin levels are low (such as fasting in non-diabetics or insufficient insulinization in people with T1DM), free fatty acids are released from fat cells. People with T1DM are clearly different because non-diabetics will make just enough insulin to maintain normal glucose levels whereas those with diabetes get hyperglycemic. Glucagon, growth hormone and catechols also interact by promoting lipolysis (fat breakdown) and hepatic glucose production, and in the case of people who have a pancreatectomy, ketosis is delayed several hours in comparison to people with T1DM who stop their insulin. This last observation has been attributed to glucagon deficiency in pancreatectomized individuals. Glucagon secretion in most folks with T1DM continues for many years post diagnosis, and autonomic insufficiency with catechol deficiency is a late complication.

I would encourage him to exercise and not lower his basal insulin dose.

Rob

[From Lisa Loertscher RD, CD, CDE]

Hi F.,

Kudos to you for maintaining excellent control of your diabetes without issues of low blood glucose! Staying consistent with your healthy lifestyle/personal health profile and losing 2-3 pounds requires continued vigilance with adequate basal and rapid insulins while creating an overall calorie deficit to induce weight loss.
To lose weight you basically need to consume less calories than you burn each day (or burn more calories than you eat). If you're eating a low carb diet, <100 g/day, take a look at the amount of fat and protein calories you're eating and cut back on these calories to create a deficit. Consistently choose leaner proteins like skinless poultry, fish, loin & sirloin cuts of beef and pork; cottage cheese as opposed to cheddar and Swiss and less fried and/or deep-fried foods. Watch the added fats such as salad dressings, mayo, butter and healthy oils and nuts as these pack a lot of calories in small volumes. By reducing your calories by 500 a day, you can theoretically lose one pound a week since one pound equals 3500 calories. Another way to reduce calories is to limit your overall fat grams to 65 per day.

Continue your regular exercise, monitoring your glucose frequently. While moderate-intensity exercise can cause hypoglycemia in type 1 DM, very strenuous high-intensity exercise like rowing at maximal exertion can cause an adrenaline response that can elevate your blood glucose rather than lowering it. The point is you may not have to consume additional carbohydrate before strenuous exercise, as you do with moderate exercise, unless you are hypoglycemic before you start. Checking blood glucose before and after exercise, and sometimes during, is the only way to know your glycemic response to various types and intensities of exercise. You may be able to avoid treating high BG resulting from intense exercise sessions with additional insulin, which as you know is a storage hormone.

I hope this is helpful. Best of luck to you in reaching your goals with rowing!

Lisa

Fasting or Non-Fasting A1C

noreply@blogger.com (UtahDiabetes) — Wed, 18 Aug 2010 15:55:00 +0000

Q: My husband had a fasting a1c test and today she said the test wasnt run as a fasting A1C, it was non fasting listed in the medical chart. Could the 7.5 be different if they were done for nonfasting, compare to fasting 14 hours?

thank you

A: The A1C test can be drawn fasting or nonfasting. It is an average of all the glucose readings over the past 3 months--maybe a little more heavily weighted by the blood sugar readings over the past few weeks, but not too much. The readings don't change quickly, like our glucose readings using our meters.

Fasting or not, and given the variations in laboratory results, take the reading for what it is---a general idea of how the blood glucose control has been going. If it's causing worries, have the test repeated. Talk to your diabetes educator and your doctor to see if they think it would be best to tighten the diabetes control a little.

Take care, ginny

Diabetes Burnout

noreply@blogger.com (UtahDiabetes) — Wed, 30 Jun 2010 16:38:00 +0000

Q: Do you know anything about diabetes burnout? Sometimes it feels like everything isn't worth the fight.

A: I think everyone who has diabetes, has experienced some form of Diabetes Burnout!!!

Google search "Diabetes Burnout". There are several sites that you may find helpful.

Check out DLife Bookshelf “Diabetes Burnout: What to do when you can’t take it anymore” by William Polanski. Also try “What you should know about Diabetes Burnout” by Gary Gilles. Another great site is the Joslin Diabetes Center that has “Avoid Diabetes Burnout”.

All these sites give ideas that can help us take a different view of our self care.

ginny

Insulin Pump & C-peptide

noreply@blogger.com (UtahDiabetes) — Sat, 22 May 2010 02:43:00 +0000

Q: Hello i have had diabetes for 22 yrs my doc wanted 2 put me on a insulin pump but after lab work she stated i couldnt get one because of my labs somethimg about my pancreas...can u explain this 2 me?? thanks

A: I think the test you had was something called a C-peptide.

When our pancreas produces insulin, it starts off as a large molecule. It divides into two pieces, insulin and C-peptide. We don’t know what C-peptide does, but we know when it is present in the blood, the body is making its own insulin. C-peptide is measured in a blood sample to see if the body is still making insulin.

Sometimes this is important if you want an insulin pump. Often an insurance company does not want to cover the cost of a pump for a body that is still able to produce its own insulin.

Normal results for C-peptide is usually .5 to 2.0 ng/mL. Be sure and check the values from the laboratory where your test was run and ask your physician exactly what your number was.

To make sure that the results really reflect how much insulin your body is producing, you may have been asked to fast or not eat for 8 to 12 hours before the test was drawn. Any food you eat may trigger your pancreas to produce any insulin it can----which would make the results higher than they usually are.

Check again with your doctor. Follow the directions very carefully before the blood is drawn.

Are you seeing an endocrinologist? They may be able to write a letter in your behalf. Each pump company also has specialty nurses that may be able to help you as well.

Best of luck to you! ginny

FRESH food, not processed

noreply@blogger.com (UtahDiabetes) — Tue, 23 Mar 2010 18:43:00 +0000

Q: Ginny,

I am a recently diagnosed Type 2 diabetic being treated with heavy exercise and Metformin 500 mg. 1 per day. I have not been able to find anything advising me on the correct balance of Fat, Carbs and Protein ( as grams please) I should strive for each day. My doctor advised a high protein diet, but I'm questioning that suggestion.

Also, so much food has sugar in it and my goal is to try and eat fresh as it is possible, but how many grams of sugar are safe in a diabetic diet.

Thanks so very much for the help.

J.

A: J., Your physician may have suggested a high protien/low carbohydrate diet to help your body manage your response to carbohyrate metabolism (all carbohydrates turn into glucose).

We think it is importat to have a healthy diet and the basis is cutting down on highly processed foods, especially highly processed carbohydrates---not all carbohydrates. Generally people can begin with 45 grams of carbohydrates per meal---healthy carbohydrates like fresh fruit and whole grains.

I am going to forward your note to a great dietician, Lisa, who will probably give you more information as well as ask you for more information:

what are your lipid levels,
what is your blood pressure,
how much do you weigh?

The amounts that would help you lose weight are very different than the amounts that you need if you are at a normal weight. As you begin your meal plan, think FRESH food, not processed food in boxes.

The meal plans for people with diabetes aren't diets per say---it is a healthy life style. They are meal plans that would be healthy for any human being. You want a meal plan that makes sense. You do not need a degree in chemistry to be able to make healthy choices.

Good luck to you. I will forward Lisa's response to you.

ginny

Byetta & Treating Diabetes

noreply@blogger.com (UtahDiabetes) — Tue, 02 Mar 2010 23:13:00 +0000

Q: Have a question that i would like to ask you about diabetes. What is the downside of using byetta for treating diabetes?

Thanks, B.

A: Dear B., After working with many patients that are taking Byetta, there seems to be just a few downsides:

1) This medication needs to be injected twice a day. (Even patients who did not want to inject any medication, have found that the injections do not hurt and are not hard to do) and

2) The biggest side effect seems to be nausea. (Many patients look at the nausea as a positive because they then don't eat as much). Nausea time varies from just the first few injections to several weeks, but for most patients it decreases over time. A very few patients have stopped the medication due to vomitting. Other side effects that have been noted are diarrhea, dizziness, headache, jittery feelings and an acid stomach.

If you also take an oral medication that contains a sulfonylura, be sure and discuss your dose and any possible low blood sugars with your doctor before you start your Byetta.

If you want additional information, also look at www.Byetta.com, check with your pharmacist or certified diabetes educator.

Take care, ginny

Fasting Blood Sugar & A1C

noreply@blogger.com (UtahDiabetes) — Tue, 23 Feb 2010 19:24:00 +0000

Q: Hello,

Thank you for addressing my question!

I have done a few home fasting glucose tests after many evenings of going to the bathroom and came out with different numbers each time. One morning it was 121, the next morning 97, another 105, and this morning 80. Here's my question, when I have my cholesterol and thyroid test done this week they will be doing an A1C. With the numbers up and down, will this one test be able to determine if I'm pre-diabetic or not? My test will be at 9:45 am after an evening fast. I know an A1C gives an average, however if there isn't any previous A1C, what do they compare this one to? I'm thinking if I'm running under 100 the day of the test, how can the test determine weather or not my sugar was elevated on the two previous occasions.

Thanks,
M.

A: M., What great questions!

Lets start with the fasting glucose readings you have done. Normal is generally 70-100. Prediabetes is occuring when fasting numbers are between 100-126. Diabetes is diagnosed when fasting numbers are above 126 on two occasions. You and your physician will talk about your fasting readings, your AIC test and together will decide about a diagnosis of prediabetes and what kind of treatment you may need. There are options of exercise, diet changes and medications.

You are right, the AIC test is an average of all your glucose readings. It is an average of the readings over the past 3 months. The results are given in a percent, with 4-6% being normal. The test is looking at how much of the red blood cells are coated with sugar or glucose. The higher the average glucose has been, the greater the percent of the red blood cell membrane is coated in glucose. In addition to the AIC percent reading, the tests are now coming with a calculated average glucose reading too. Here is an example:

Your AIC is 4.4%. That means only 4.4% of each red blood cell membrane is coated in sugar or glucose. That is a very normal amount. To find your average glucose reading with a AIC of 4.4%, we multiple the AIC by 28.7 which equals 126.28. Now we subtract 46.7 which equals 79.58, which means that over the past 3 months, your average glucose readings were 79. Each day the readings may change a little, but if there isn't a diagnosis of Diabetes, the swings are usually very small.

Please take care and be sure and discuss your test results throughly with your physician, ginny

Agent Orange & Diabetes

noreply@blogger.com (UtahDiabetes) — Tue, 16 Feb 2010 22:56:00 +0000

Q:ginny,

my diabetes has been determined to be related to my exposure to agent orange in Viet-Nam.... My treatment consists of Metformin, glypicide and of course, exercise, a controlled diet, and closely monitering my blood sugar..

What is my long term prognosis if I closely follow my treatment program?

My concern is,,,,,, Will a committment to such treatment be effective if agent orange is the cause of diabetes or will agent orange demand different treatment?

A: J., There are no guarantees with any treatment, but whatever you do to keep your blood sugars in the normal range, keep your lipids in the normal range and your blood pressure normal will give you the best chance for a healthy life. I do not know how agent orange is thought to affect human bodies in regards to diabetes, but I will begin to check. Give me a chance to check with an endocrinologist and get more information to you.

It is sometimes difficult to control blood sugars, blood pressure and blood cholesterols but the treatment of medications, a healthy diet and exercise will help with all of them.

I will post any information about agent orange as soon as I can. Please take care, ginny

Q:Thank you Ginny,

I only asked my questions inregards to agent orange because I have no known diabetes history in my family and all treatment for diabetes seems to be the same without regard to causation..... this seems peculiar to me for I believe there are some health issues that treatment is somewhat different when considering the cause of the illness...

It just seems the medical profession is only treating the symptoms of diabetes and not the particular cause suffered by individual cases..

But........ I must admit to harboring some anger at having this darn disease and I have no choice but to endure it and am the last person qualified to tell my doctor what to do...

Thank you again for your response and I look forward to hearing from you again...

J.

Cooking for friends with diabetes

noreply@blogger.com (UtahDiabetes) — Wed, 09 Dec 2009 22:38:00 +0000

Q: Hello Ginny,

I have a girlfriend and I like her a lot. When we started dating she told me that she has diabetes type II. She is so kind and she has cooked dinner a few times for me and I love it, but I’d like to cook for her more often, however I need to be conscious about her Carbs intake. She told me that she is allowed 45g of Carbs per meal and I was wondering if you have recipes that I can cook that would be within that amount of allowable Carbs intake per meal, or at least point to what direction I should go in order to abtain such recipes.

Please let me know. Thanks.

A: How lovely that you want to cook a dinner for your friend!

Most people with diabetes watch their carbohydrate intake carefully. You said your friend is having 45 grams of carbohydrates per meal. What are carbohydrates? They are all the starches (bread, pasta, rice, cereal, potatoes, corn, beans and lentils), fruits (fresh, frozen, dried and juice) and milk products (milk, yogurt, ice cream) that we eat. Each general serving is approximately 15 grams. A serving is about 1/2 cup.

Your friend is trying to have 3 carbohydrate servings per meal. What would a dinner for her look like? A big salad; a serving of fish, chicken or beef (spices are great but be careful with sauces); and vegetables (broccoli, cauliflower, zuchinni, spinach ect.). So far we don't have many carbohydrates in the meal. Some patients are tracking very intensively and count salad and vegetables. If these are in servings dishes, your friend could help herself and either count them or not. Now, if you wanted to add carbohydrates like potatoes and dinner rolls, place these in serving dishes as well. If there are choices for people with diabetes, that is such a plus. Your friend can put the amounts on her plate that fit in with her personal plan and what she chooses to have at the meal.

There are great cookbooks that you can check out too: Betty Crocker's "Diabetes Cookbook", "1,001 Delicious Recipes for People with Diabetes" by Sue Spitler and "The Everything Diabetic Cookbook" by Pamela Hahn.

I am also sending your note to my friends, Lisa and Ann, to see if they have more information to add.

Happy cooking, ginny

Carbohydrates, Calories or Medication

noreply@blogger.com (UtahDiabetes) — Mon, 23 Nov 2009 17:50:00 +0000

Q: Dear Ginny,

I have a Brother-in-law who is at least 300 pounds that he's Diabetic. His Doctor told him to have 75 carbs per meal, and because of that he's gained 15 pounds in a short time.'

I also have a brother who also is Diabetic and although he wasn't that heavy, his Doctor told him to have 35 carbs per meal, he's lost about 40 pounds and is doing well.

I believe my Son-in-law is eating too many Carbs. Am I right or do you think this is correct?

Thank you

L.

A: L., It is so very hard to give specific advice when I have not seen your son-in-law.

If he has gained 15 pounds in a very short time, he wants to be sure and check in with his physician and make sure that the weight gain is not a side effect of any medication he is taking. If the weight gain is not caused by medication, overall calorie intake may be the cause. He may be eating more food than his body needs.

Blood sugar levels are most often affected by carbohydrate intake. If blood sugars are high, we usually ask patients to look very closely at the number and kinds of carbohydrates they are eating. When patients begin to decrease very processed carbohydrates in favor of whole grains, they decrease fat and salt intake as well. This often begins to make a difference with their weight.

I will ask a friend of the Ask Ginny site, Lisa Loertscher, a dietician, to look at your letter and see if she has additional information to add.

-ginny

D-Tips: Who Do You Know That Is Resilient?

noreply@blogger.com (Ginny Burns) — Tue, 17 Nov 2009 23:59:00 +0000

Dr. Terri Flint has volunteered to join "Ask Ginny & Friends" to help answer your questions about diabetes.

Terri is the Director of Intermountain Employee Health Services, including Employee Health and the Employee Assistance Program. She has worked in this role for over 10 years and has worked for Intermountain Healthcare for 19 years. Dr. Flint has a PhD in Social Work and has been a clinical Social Worker for 29 years. Her areas of expertise are change management, communication and building resilience.

Terri also writes "D-Tips for Healthy Living," sponsored by the American Diabetes Association. D-Tips are periodic emails to help individuals cope with the psychological issues created by having diabetes. I know you will find D-Tips interesting, informative and that your family will benefit in your quest for better physical and mental health!

D-Tip: Who Do You Know That Is Resilient?

There are great examples of resilient people around us. Corrie Ten Boom was a survivor of Jewish war camps and her book The Hiding Place is a remarkable story of how her faith, forgiveness and sense of humor helped her survive. Michael J. Fox, the actor struck with Parkinson's Disease, has continued to make people laugh and inspire others to increase funding for the study of this disease. In his book Always Looking Up, Michael writes that for everything this disease has taken, something with greater value has been given. Take a look around. Who do you know that is resilient? What do they do differently?

The American Diabetes Association would like to hear from you. Contact Dr. Terri Flint at d-tips@diabetes.org to have your questions addressed in one of the upcoming D-Tips. Come hear Dr. Terri Flint talk about Coping with Diabetes at the 2010 American Diabetes Association Expo on February 27, at South Towne Expo Center. Visit http://diabetes.org/saltlakecityexpo regularly for Expo updates.

Nutrition & Diabetes

noreply@blogger.com (Ginny Burns) — Tue, 06 Oct 2009 20:24:00 +0000

Q: I am a 50 yr old male and I have had type 2 for about 2 yrs.
I would like to know if there are classes locally that discuss diet. Specifically guidelines, portion size shortcuts to help me get the suggested amounts of vegetables fruits etc.
I really want to be able to ask questions about my personal situation because I have some other health concerns as well, so the online stuff is kind of frustrating because it all seems to be so general in nature. I live in the Millcreek area. Any info would be greatly appreciated.
Thanks, D

A: D….You bet there is. I am going to suggest seeing a dietician one-on-one so you can ask all the questions that you need to ask first.

Classes will certainly give you a lot of information and you will probably want to take a class too, but because you are frustrated and have many specific questions, I think a one-on-one appointment would be the place to start.

In the Millcreek area, there are several sites that may work for an appointment with a dietician: St. Mark's Hospital, University of Utah Diabetes Center and Memorial Clinic. Check with your insurance carrier to see which site would be covered. You will learn so much that will help you.

good luck, ginny

Get Active with Diabetes (video)

noreply@blogger.com (UtahDiabetes) — Thu, 03 Sep 2009 18:01:00 +0000

Who to turn to for diabetes information

noreply@blogger.com (UtahDiabetes) — Mon, 22 Jun 2009 21:14:00 +0000

Q: Hi Ginny,

I am looking for a diabetes educator and also wondering if I should choose a doctor that's more specialized in diabetic care than my family doctor. I live in Springville and have heard about a doctor in American Fork - not remembering his name at this moment....

I have recently lost 8 pounds and I'm interested in eating according to the LDS word of wisdom. I have just looked at a Doctor Richard Bernstein book and thought I'd rather die than follow his eating plan - He said he hadn't eaten any fruit for over 25 years!

I could be pretty close to needing insulin. I don't have insurance and had to stop using Byetta because it was too expensive. I did see the ad with the info about getting an A1c test at the health department, but it looks like old info from last November. Is that being offered this month..of June.

I'm also wondering if there's anyone - like you - who could explain to me the differences in ways to deal with my diabetes. I see a lot of different choices and wonder if there's anyone who can help me find my best choices.

Sorry about all the questions. I'd be very glad to hear from you and look forward to your advice.
Thanks so much, Carol

A: I think the person you thought about seeing in American Fork is Dr. Von Welch. Please call his office and make an appointment and fill out financial assistance paperwork.

Dr. Welch will be able to direct your care to the educators in the hospital, Jill and Elise, and to the Diabetes Center in Provo if you need to go there. Dr. Welch's clinic should be able to help you with medication assistance as well as a A1c test.

There are many different dietary plans you can follow, but being consistent in your carbohydrate intake is very important. Most dietary plans for people who have diabetes have patients lower their intake of refined, processed carbohydrates and use whole grain high fiber carbohydrates for their charbohydrate choices.

Dr. Welch and the educators in the hospital will be able to help you find a dietary plan that you will feel comfortable using.

Good luck to you, ginny

Diabetes Diet and Insurance Issues

noreply@blogger.com (Ginny Burns) — Tue, 31 Mar 2009 20:11:00 +0000

Q: Ginny,
My name is Jennifer, and I'm pretty sure I have Type II Diabetes. My HgA1C was last checked two years ago, and it was 5.9. My doctor told me I'd be diagnosed at 6.0, so I haven't had it rechecked because I don't have insurance and if I'm diagnosed, I'll never have insurance. My husband's employer doesn't offer group insurance.
Anyway, I am about 40-50 lbs. overweight, and I have the basic knowledge of what I should be eating, but I don't want to. I have no desire for healthy food whatsoever. I not only have no desire for it, it sometimes makes me feel sick. I know it's backwards, and I really need to get a handle on my cravings, but they've been out of hand for about eight years and I've never been able to beat them.
I cannot do moderation. I try and I end up eating 1 lb. of chocolate or more. Chocolate is the main problem. I know I'm not healthy and I know that I need to be conscious of my eating not only for weight control, but to control my diabetes.
Can you recommend a dietician who has had experience with addictions and might not charge too much for consultations? I need to do something. Thanks.
Jennifer

A: You are right that you need to do something. Can you go to a clinic and get a blood test? There are low cost or free clinics that may be able to test you.

Check with the

University of Utah Med Center at 801-581-2121;
Maliheh clinic at 415 East 3900 South at 801-266-3700; or
Sorenson Clinic at 855 California Avenue at 801-977-0502.

If your physician is in a clinic and you want to continue to see him/her, please apply for financial assistance. You need some information about what is happening to your body so you will know where to begin.

Sometimes when blood sugar levels are high, people become very hungry and describe the same symptoms you have described in your letter. The best place to start, I think, is to see if you have diabetes and what your blood sugar readings are. Anyone who can help you with a diagnosis will be able to direct you to a dietician.

Find out if you have diabetes first, o.k.? Remember, knowledge is power!!!

Good luck to you, Ginny

Diabetes and Burning Feet

noreply@blogger.com (Ginny Burns) — Tue, 24 Mar 2009 17:00:00 +0000

Q: Ginny,
My husband has trouble with his feet, not horrible trouble though. He complains of them being like they are on fire on the top of them. He also says that they feel like the circulation is weird. He has a family history of diabetes, his dad takes medication for his and so does his sister. Do we need to be concerned about this problem? His shoes bother him because of the heat. Usually rubbing and massaging them helps but he is always complaining about this.

A: Yes, please be concerned about your husband's feet.

His physician can test his fasting glucose to see if his fasting glucose is 126 or higher and diabetes can be diagnosed. If the test is normal, his physician may ask him to complete a glucose tolerance test; a test that will watch what your husband's body does with 75 grams of glucose. Does your husband see a podiatrist, a specialist who deals with feet? Between your husband's physician and a poditrist hopefully some treatment will begin soon and be successful. ginny

Ginny

Foot problems and diabetes

noreply@blogger.com (Ginny Burns) — Wed, 04 Mar 2009 00:21:00 +0000

Q: My husband is 37 years old. He has lost a significant amount of weight lately. He refuses to go to a doctor (because he said he needs to find a good one).
He finally went to a dermatologist for his feet because he couldn’t hardly walk. They are “Really” sensitive/red dry and cracked, and can never seem to get them just right. He asked the dermatologist if it was a sign of diabetes… The doctor said NO.
He works with a lady that has had diabetes since she was 3 and tells him it is, and can be related. I also have heard it can be.
Do you think it is a sign of diabetes? She has also tested him while at work before, because she has to do hers several times, and he has scared her before with his results. Do you think you can give me a referral (recommended doctor) that takes BC/BS insurance? I am just really concerned for him. Cancer and Diabetes run in his family.
Thanks.

A: Your husband needs a primary care physician. Please call Blue Cross Blue Shield (BXBS) and get the names of physicians who are on your plan. You want to have him see someone who is trained to deal with diabetes. Problems with feet often occur as the glucose levels rise. Other symptoms are urinating more frequently (especially at night), feeling very hungry, losing weight, feeling very tired, having pain or numbness in your feet and feeling very thirsty.

Please make an appointment for him to be evaluated and tested.

If he is diagnosed with diabetes, a fasting glucose level 126 or higher, he may need to follow up with a specialist. Since he has BXBS he may want to call the University of Utah Diabetes Center. They will work with his Primary Care Physician to take care of your husband. Please have his glucose levels tested so he can determine what his next step should be.

Please do this right away, Ginny

Possible cure for Type 1 using cancer drugs?

noreply@blogger.com (Ginny Burns) — Tue, 03 Mar 2009 21:19:00 +0000

Q: What's the latest in the possible cure for Type 1 using the 2 already approved cancer drugs? Are there any local studies?

A: I think the two cancer drugs you are talking about are the drugs Imatinib (Gleevec) and Sunitnib (Sutent). These are drugs that block an enzyme that is believed to be a factor in autoimmune diseases. The studies looking at these drugs is being done at the University of California with mice. There is no study calling for patient participation yet that I know of.

Harvard University has been studying how to activate genes that tell cells how to transform themselves and begin working another way. They are studying how to change cells in the pancreas that make gut enzymes that help digest food and have them make insulin instead. This has also been done in mice but they think it is at least two to five years from being tried in humans.

There may be other studies, but two clinical trials that I know of who are accepting patients are:

A drug called Otelixizumab is under investigation in the DEFEND trial. This study is looking at how the beta cells in the pancreas are destroyed by the body itself and they wonder if the drug can stop or slow down the destruction process. This study is under way in phase 3 clinical trials and they are accepting volunteers. You must be a Type 1 and have been diagnosed with Type 1 in the last 90 days. Check defend@tolerx.com or call 1-877-515-6672.

At Massachusetts General Hospital there is a study under way by Denise Faustman, in phase 1 clinical trials, studying the Bacillus Calmette-Guerin (the TB vaccine) which seems to decrease the abnormal immune cells that attack and destroy the beta cells. Since the BCG vaccine has been used safely for about 80 years, they are busy trying to determine the doses that are needed and the possible side effects. They are accepting volunteers for future clinical trials. Look up DiabetesTrial@partners.org to email this study group for more information. Scientists are getting closer and closer to finding a solution for Type 1.

Stay healthy until there is a cure for us!

Ginny Burns RN MEd CDE

Diabetes progression and prevention

noreply@blogger.com (Ginny Burns) — Tue, 03 Mar 2009 17:17:00 +0000

Q: Ginny,
I have read several obits lately indicating people have died from complications of type 2 diabetes, which I have had for a little over a year. I have my A1c level down to 5.8 and have lost 35 lbs. If I continue to eat sensibly and keep my Alc level in acceptable range will I avoid those complications? Or will my condition worsen?
Thank you for your info,
Judy

A: Judy, You have done a great job! Remember, the leading cause of complications (blindness, end-stage renal disease, and non-tramatic amputations) is not diabetes. The leading cause is UNCONTROLLED diabetes.

We do not know if your body will need more assistance, with more or different medications as time goes on, but your meter will help you. As you test your blood sugar levels you will be able to track whether the numbers continue to be safe. If the numbers become unsafe, you and your physician will be able to decide what the next step for you should be.

Ginny

What Is Type 3 Diabetes?

noreply@blogger.com (Ginny Burns) — Tue, 03 Mar 2009 16:24:00 +0000

Q: What is Type 3 diabetes and how serious is it?
Pat

A: Type 3 is a fairly new term. It generally means a type of diabetes that is mixture of Type 1 and Type 2 (the old term was Type 1.5).

Patients who have Type 1 diabetes no longer make insulin. This type of diabetes generally is considered an auto immune disease where the body destroys its own cells in the pancreas that make insulin.

Type 2 diabetes occurs when the body becomes unable to process insulin properly and becomes resistant to it's own insulin. Over 95% of the people who have diabetes, have Type 2 diabetes.

Type 3 patients are often adults or children who have Type 1 diabetes, gain weight, and develop the signs of insulin resistance, which can also include high blood pressure and abnormal cholesterol.

A report from the Children's Hospital in Pittsburgh stated about 25% of children who were diagnosed with Type 1 diabetes also had symptoms of insulin resistance. Tests can be done to determine if a patient falls more in line with autoimmune distruction or insulin resistance. Sometimes patients fall in the middle. Medications are looked at carefully to decide which would work the best. Most physicians will use the medications that will lower the glucose readings first.

Regardless of the Type of diabetes, glucose levels need to be controlled. All abnormal glucose readings can damage a body: Type 1, Type 2 and Type 3.

Please take care, Ginny

Future with Type 2 Diabetes

noreply@blogger.com (Ginny Burns) — Mon, 23 Feb 2009 21:25:00 +0000

Q: Thanks for giving us this opportunity to ask questions!
My husband (age 57) has had Type II diabetes for about 3 years. He does everything right, monitoring all his levels, lotions his feet every day, exercises regularly, goes to the doctor every 6 months. We are improving our diet (although slowly). My question is: If he continues to maintain this schedule, what will life be like in 10 or 20 years with diabetes?
P

A: Dear P,

Your husband is doing everything right: keeping track of his blood sugar levels and his HgbA1c levels. The studies tell us that people who keep their levels in a normal range have fewer complications. For people who have Type 2 diabetes, the big three areas he needs to watch (with the help of his physician and you) are his glucose levels, blood pressure and cholesterol. Eating well and exercising will help with all three.

Remember, complications do not generally come from diabetes, they come from UNCONTROLLED diabetes.

Good luck to you both! Ginny

Heart disease and high blood sugar readings

noreply@blogger.com (Ginny Burns) — Mon, 23 Feb 2009 21:21:00 +0000

Q: My husband has been diabetic for 14 years now. Recently he had a 6 by pass surgery, since then he has not been able to control his levels. We have tried different medications. But he remains high like over 400-500 maybe higher, our machine only goes to 500 then it says high. Then also he drops very low and I had to get the paremedics here to revive him. I dont know what to do.

A: Please follow up with your husband's family practice or internal medicine doctor, his cardiologist and the diabetes educators that you may have met while your husband was in the hospital.

The medications are used to lower the blood sugars---they match up with everything that makes the blood sugars go up---illness, stress and carbohydrates. If at times he is very high and then drops very low, there isn't a good match. Please meet with his doctors and the diabetes educators to learn more about what the medications are doing and how you can make better matches with the food he is eating.

Is there a diabetes clinic close to you? Please call for an appointment right away.

Please let me know how everything turns out. We want to make sure the blood sugars become lower and much steadier.

Ginny Burns