Diabetes Diet and Insurance Issues

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

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

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?

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

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?

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