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

Future with Type 2 Diabetes

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

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