Heart disease and high blood sugar readings

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

I have gestational diabetes

Q: Hello Ginny,

I am 8 months of pregnancy. They found Gestational diabetes I have. Could you please let me know about special diet what I should use during last 9th month?

Thank you very much!

A:What did your doctor tell you to do? Did they want you to see a dietician? Did they want you to test your blood sugar levels?

It is best to see a registered dietician to help you design a diet that will help the higher than normal blood sugars that you are having but still provide your growing baby with the calories and nutrients that he/she needs. The dietician will also recomend the correct number of calories for you. It usually turns out to be about 2,200 to 2,500 calories a day if you are of average weight. If you are overweight the dietician may ask you to lower the amount of calories.

The dietician will teach you how to balance your diet. Diets are very individual but usually about 10-20% of the calories come from protein (meat, eggs, cheese, fish); less than 30% of the calories come from fat and the rest of the calories come from carbohydrates (bread, rice, fruit, milk, cereals ect). The dietician will teach you how to choose the healthiest carbohydrates.

In addition to the diet, your doctor may ask you to exercise 3-5 times each week to help control your blood sugar levels too.

To make sure the diet and exercise are working, your doctor may ask you to test your blood sugar at the clinic or use a blood sugar meter at home. It is important to know what these blood sugar numbers are! If the numbers remain high even after you change your diet and add exercise, your doctor may ask you to take insulin. Not many women need to take insulin but the blood sugar levels must be normal in order for you to have a healthy baby. Your doctor may need to monitor you and your baby more closely during these last few weeks. They may do ultrsounds, non-stress testing and/or other fetal movement charting. The doctor will be checking to see if the baby is growing normally. Most women are able to have a normal labor and vaginal delivery but some doctors will deliver the baby earlier or may suggest a cesarean section if the baby becomes too large.

After delivery, your doctor will also check to make sure your blood sugar level have returned to normal. It will be important to check again at the baby's six week check up and every 1-3 years to make sure your blood sugar levels are still normal.

Please contact your doctor right away and ask: Do I need to see a dietician? Should I exercise? Should I test my blood sugar? It will be important for the health of your baby!

Good luck, Ginny

Cold and Flu medication for diabetics

Q: Hi Ginny,

I am 67 and have been a type 2 diabetic for 6 years now. I have recently pick up a cold and can not shake it. I have been able to find Diabetic Tussin cough syrup, but unable to find Diabetic Tussin cold and flu tablets. I have been to all of the stores & pharmacies within a 10 mile radius of my home in Kearns and the only thing I can find is Cold-Eze which is a tablet that you have to let dissolve in your mouth and you have to take one every hour. (very inconvenient). My question is, do you know of any stores/pharmacies in the Salt Lake Valley that actually stock a regular supply of diabetic items (cold/flu meds, vitamins, testing supplies, etc.)?

Most of the stores I have been in stock only a token supply and it is mostly creams, sugar free snacks and maybe a bottle or two of Diabetic Tussin cough syrup. When I questioned some of them about their meager display, their response is there is not a big enough call for those items and they end up having to get rid of some items due to expired expiration dates. Yet right across the aisle is three shelf's of at least 20 brands of cold & flu medications which you know are not going to all be bought before the expiration dates. I wish the neighborhood grocery/super market stores would realize that there are a lot of diabetics in the world and we get colds also and we don't want to have to running to our doctor to get medication just for a cold. I would like to be able to buy something off of the shelf for 8 or 9 dollars, rather the paying the doctor for a visit and paying for a prescription.

Thanks for letting me bend you ear.

A: I was so interested in your comments, I began to search for answers and comments about cold medications too. Just as you did, I called many pharmacies and diabetes supply stores in the Salt Lake Valley. The answers I received were very similar to the answers you received---there isn't enough of a demand so often the supplies become outdated and must be thrown away. There is generally a minimum amount the stores must order from large suppliers and if the supplies are not sold by a certain date, they must be thrown away. Most pharmacies, large or small, can not afford to lose any money.

Many pharmacists stated that there is a worry that active ingredients (the ingredients that treat the symptoms) or inactive ingredients (the ingredients that don't have any treatment value but are fillers or give a flavor) in the medications may affect patients with diabetes. If there is even a slight chance that patients will be harmed, the company will print on their labels that their product is not for patients who have diabetes. How can we decide which ones may be O.K.??? Our physicians can be the ones who can help us decide. I know it is expensive, but you want the best advice you can find to choose products that will help you and not harm you.

After checking with several Internal Medicine physicians and Eye, Ear, Nose and Throat specialists, there does seem to be a very simple procedure that may help stuffy noses without using any medication. A recent article by Pynnonen, Mukerji, Kim, Adams and Terrell found that saline irrigation or nasal washing was more effective that a saline spray. A patient I spoke to also uses this procedure to help with his stuffy nose that he gets at times from allergies. This procedure is not done frequently in the United Stated, but it seems to be gaining in popularity. Check with your physician to see if this simple procedure can be done safely at home to relieve some of the symptoms you get when you have a cold.

Thanks for your very interesting letter.

Good luck to you, Ginny

Vegetarian and diabetes diets

Q: Dear Ginny,

Kindly tell me any website where I could get access to diet planning of diabetes patients. In the meantime, kindly send a menu for 1400 caloric vegetarian menu with 40% CHO, 40 Fat and 20 Protein.

A: There are several on line sites that you can direct patients to learn about vegetarian diets. Try www.MayoClinic.com, www.Veggie123.com and for a free diet www.SparkPeople.com. A book can be ordered from the American Dietetic Association "Becoming Vegetarian" for $5.00. It is difficult to just send a diet plan without knowing what type of vegetarian diet your patient is looking for.

• Are they Lacto-ovo Vegetarian: eating mostly plant foods but also eating eggs and dairy?
• Are they Lactovegetarian: eating no meat, no eggs but eating dairy?
• Are they Vegan: eating no animal proteins or animal by products?
• Are they just avoiding red meat?

I would direct your patient to a registered dietitian to be sure they obtain the diet they prefer and obtain a well rounded diet so the nutrients that are at times missing in a vegetarian diet are present: calcium, Vitamin B12, Iron and Zinc.

Prediabetes concerns

Q: Hello! I found this Q&A board through Diabetes Daily.

This past January I was told that because my fasting BS was 104 and my A1C being 6.4% that I have early adult onset diabetes. It was quite a shock because I don’t fit the typical profile. I am and always have been the ideal weight for my height, exercised all my life, eaten sensibly and avoided desserts (except small portions occasionally).

My GP informed me that at some point he would put me on medication. Three months later my A1C decreased to 6.1% and my doctor was pleased and merely stated that I should keep on doing what I have been doing. I’m sure you hear this all the time. I did cut back on my carbs and that must have explained the decrease in the A1C reading I did fail to mention that no one to my knowledge had diabetes in my family. In my excitement that my A1c was lower, I didn’t ask my GP about medication and he didn’t mention it at that particular visit.

I have a few questions………….is it possible that I may never get diabetes, how do I keep from losing weight if I cut out so many carbs I’m already compensating by eating walnuts, Omega peanut butter and using more olive oil in cooking, and should I see an endocrinologist for better information?

I am checking my BS upon waking, before meals as well as postprandial. The lowest reading I had was 83 and the highest 120 after a meal.

Any information you can send me is appreciated.

I am female and 59 years of age. My total cholesterol is 220, but the breakdown numbers are good and the reason it’s high is because my HDL is so high, which is a good thing:

• HDL = 120
• LDL = 87
• Triglyceride = 64

Thank you in advance for your response.

A: It sounds like you are doing everything right for your body!

The changes you have made have given you glucose readings that are in the normal range. It is important to control your diabetes when it is in the very early stages in order to help prevent any possible complications. We don't know why some people develop Type 2 diabetes when there is no family history and weight is normal. It is not something that you have caused.

Often, the first medication of choice is Metformin. Your physician may not have thought you needed to start this medication, or any other, because the glucose readings looked like they had improved. Your lifestyle changes have helped control the diabetes. Be sure and stay in touch with your physician and continue with your follow up appointments so you can keep track of the glucose readings to see if you need medication.

If you do need medication, you have not failed!!! Remember diabetes is a progressive decline in beta cell funtion (beta cells are our cells that produce insulin) and often over time your body may just need some extra help. Your glucose readings will let you know if any medication is needed. You want to have a healthy diet, healthy weight and feel physically strong. If you are too hungry and your food intake is too small, please see a diabetes dietician who will help determine a carbohydrate, fat and protein intake that will work well for you.

You are doing such a good job!!!

Ginny