Diabetes FAQ's
Q. Can metoprolol raise sugar levels?
A. Beta-blockers, such as metoprolol, can occasionally cause hyperglycemia (high blood sugar). Beta-blockers can also mask signs of hypoglycemia (low blood sugar) such as increased heart rate and tremors. If you have experienced changes in your blood glucose levels, notify your physician. Keeping your blood glucose levels within the normal range will help you feel better and prevent the long-term complications of diabetes.
Q. Can you get type 2 diabetes from high blood pressure?
A. High blood pressure, high cholesterol, high triglycerides and obesity are all risk factors for diabetes. Keeping these risk factors under control may help to decrease the chance of developing diabetes. Keep in mind, genetics and other idiopathic causes also play a significant role. To determine if you are at risk for developing diabetes, take the Diabetes Risk Test at www.diabetes.org.
Q. Do you have to eat within a 1/2 hour of taking Glucotrol®?
A. Glucotrol® (glipizide) regular release tablets are recommended to be taken 30 minutes before a meal. Glucotrol® XL, the extended release form, is usually taken daily with breakfast, or as directed by your physician.
Q. I have type 2 diabetes and I am taking Glucophage®. Three days ago, I discovered that I am pregnant. Can I continue taking Glucophage®? Shall I stop Glucophage® and take insulin? If yes, what is the type of insulin to be taken?
A. Medications are given pregnancy risk categories, which are assigned according to information regarding the drug's potential to cause fetal harm in animals and/or humans. These categories are A, B, C, D, and X, with A being the most safe and X being the least safe. Glucophage® (metformin HCl) is a category B agent which means that either animal reproduction studies have not shown any adverse events and no studies have been done in pregnant women, or adverse events were present in animal studies but could not be reproduced in human studies. Insulin therapy is usually the drug of choice during pregnancy. The type and amount of insulin is determined by your physician. We recommend that you contact your physician immediately for further direction.
Q. How does hyperglycemia cause weight loss?
A. Rapid weight loss is a common symptom of Type 1 diabetes. Insulin is the medium through which glucose travels from the bloodstream into cells and tissues throughout the body. Once glucose enters muscle and fat cells it can then be used to give the cells energy and keep the body running. People with type 1 diabetes produce no insulin. Without insulin, the body cannot properly utilize glucose resulting in hyperglycemia. The body compensates by using fat, protein and glycogen stores for energy. Excess glucose in the bloodstream is carried to the kidneys, which normally filter glucose back into the bloodstream. Once the amount of glucose exceeds that which the kidneys can filter, glucose is excreted into the urine. The result is excessive urination and possibly sudden loss of weight.
Q. I am taking Levemir® and am having a problem with weight gain. Do all insulin's promote fat accumulation and weight gain? I would like to know which ones do not cause weight gain so I can switch. I feel like I am retaining ALL of the food I eat and not processing it properly.
A. Unfortunately, all insulin products can cause weight gain as a side effect. Some studies suggest that Levemir® (insulin detemir) causes less weight gain compared to other insulin products. Cutting calories (without skipping meals) and exercising daily can help you prevent unwanted weight gain. If you have type 2 diabetes, some medications may actually promote weight loss and decrease your insulin needs. Contact your physician to discuss your insulin therapy and lifestyle modification options. A registered dietician can also help you create a well balanced meal plan.
Q. Is there a "chart" of how much insulin to take? I have never been informed. I am a heart patient and very concerned.
A. There are general guidelines for the initiation of insulin therapy, but regimens are based on a number of patient-specific factors and should be individualized. If you are unclear about your insulin dosage and administration, contact your physician.
Q. What effect would or does Vanadium have on blood sugar? Is this safe supplement to use if done with the knowledge of one's physician?
A. Vanadium is a trace mineral that has been used by some to treat a number of conditions, including diabetes. There is some evidence that very high doses of Vanadium can increase the body's sensitivity to insulin in patients with Type 2 diabetes, potentially resulting in a decrease in blood glucose levels. However, prolonged use of this product at high doses may not be safe. Due to insufficient reliable evidence regarding the use of this supplement in diabetes, it is currently not recommended.
Q. What is a normal non-fasting blood sugar level?
A. The normal range for non-fasting blood glucose (sugar) taken 1-2 hours after a meal is less than 180 mg/dl. The normal range for blood glucose taken before a meal is 70 – 130mg/dl. These ranges are for non-pregnant adults.
Q. My feet are a wreck. The tops of my feet feel like they have been burned, and are sensitive to the touch. The bottoms of my feet feel as if they are bruised. When I first touch them they hurt, but any other touches after they feel normal. What is going on with me?
A. People with diabetes can develop foot problems that most often occur when there is damage to the nerves, called neuropathy. This damage results in a loss of feeling in your feet causing tingling, burning or numbness. It is very important to keep your blood glucose levels as close to normal to reduce the risk of complication related to diabetes. We recommend consulting your physician regarding your symptoms for a proper diagnosis and treatment.
Q. What is a glucose tolerance test?
A. An oral glucose tolerance test (OGTT) is used to diagnose pre-diabetes and diabetes. Patients are asked to fast overnight in preparation for the test. After an initial blood sample is drawn, the patient drinks a liquid containing at least 75 grams of anhydrous glucose dissolved in water. Additional blood samples are drawn every 30 to 60 minutes for 2 hours. A patient is classified as having impaired glucose tolerance (IGT) if their two hour plasma glucose level is 140 – 199 mg/dl. A level greater than 200mg/dl is considered a diagnosis of diabetes.
Q. I have had diabetes for the two years with high sugar levels, but have found no symptoms of tiredness, skin itching or dry mouth or any other. I found my blood sugar in the range of 100 to 270mg/dl. I also checked my eye sight once in a six month found every thing normal. What is the solution to control blood sugar level within the control range?
A. Lifestyle modifications such as diet, exercise and meal planning are the initial recommendations for treatment of high blood sugar, followed by medication therapy if necessary. Self monitoring of blood glucose is also an important component of diabetes treatment. The American Diabetes Association recommends the following blood glucose guidelines for non-pregnant women: 70-130 mg/dL before meals and less than 180 mg/dl 1-2 hours after the start of a meal. Blood glucose goals are often individualized for each patient by their physician, so your goals may differ from the above mentioned figures. If you are unable to maintain normal glucose levels we suggest contacting your physician to determine the next step in your treatment plan.
Q. How does a blood glucose monitor work?
A. Most meters available on the market currently work through an enzyme electrode process. This process begins when a drop of blood from the patient is deposited onto the test strip. A chemical then reacts with the blood and sends an electric current into the monitor. The monitor then measures this electric charge to determine the blood glucose level for the patient.
Q. Is Januvia® safe for the long term treatment of diabetes?
A. Januvia® (sitagliptin) was approved by the FDA in October 2006. It is indicated as monotherapy and combination therapy as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. There is not a significant amount of long-term data available for this product. There have been post marketing reports of pancreatitis in patients taking Januvia®. Pancreatitis is a serious adverse event and can manifest as inflammation or infection of the pancreas and has been seen after initiation of therapy. As with any treatment, notify your doctor if you experience any unusual symptoms while taking Januvia®.
Q. I would really like to understand the general progression of treatment in diabetes type 2 and what treatment options a diabetic can expect along the way. At the moment I understand most people start with diet and excercise, progress to oral medications such as a sulphonylurea and metformin. What I understand less is once those have failed, there seem to be a number of injectable treatments available (such as Byetta), but I do not know exactly what they are or what they do.
A. An appropriate treatment plan for patients with type 2 diabetes should be tailored to the stage of their condition and conducted using a step-wise approach. Treatment for patients with new-onset type 2 diabetes begins with a combination of lifestyle changes (e.g. diet and exercise) and metformin therapy (if not contraindicated). Over 1-2 months, metformin treatment should be increased to its maximal tolerated and effective dose. If blood glucose goals are not achieved, a basal insulin or sulfonylurea can be added to the regimen. If A1C is still not achieved, other oral agents or intensive insulin therapy should be considered. Some newer therapies can also be considered in certain clinical situations. Byetta® (exetanide) and Victoza® (liraglutide [rDNA origin]) are incretin mimetics. They lower post-meal blood glucose levels by increasing insulin secretion following a meal. Symlin® (pramlintide) is a synthetic version of a hormone called amylin that works together with insulin to decrease blood glucose levels in the body. Symlin is given before meals and works to decrease post meal elevation of blood glucose levels..
