Ed
does it discolor your feet and leg??

James Mulinda, MD
No. However, if diabetes is advanced enough to cause vascular disease, then discoloration may occur. When this occurs, the risk for ulceration or skin breakdown increases. If you'd like to schedule an appointment, with a PENN physician, please call 1-800-789-PENN.

Ellen
what are your feelings about diabetics using the Atkins diet to control sugars

Seth Braunstein, MD, Ph.D.
The Atkins diet or low carbohydrate diets in my opinion are useful in patients with type 2 diabetes who are overweight. On these diets, patients lose weight and blood sugar becomes much more easily controlled. Sometimes, medications can be discontinued.

Marla
What's happening with islet cell transplants?

Seth Braunstein, MD, Ph.D.
Islet cell transplants are being performed at the University of Pennsylvania Medical Center
and multiple other centers in the country. They have been very successful but are still considered experimental. They are useful in patients with Type 1 Diabetes but are not probably useful in patients with Type 2 diabetes.

Anne
I was just diagnosed with diabetes and the only thing I was told was to see a video at our local hospital and buy the book Sugarbusters and I didn't have to come back for any more blood work. What does this mean?

Mark Noveck, MD
I recommend that you see a qualified internist. There are many variations of diabetes. Perhaps you do need medication and perhaps not. You can find a Penn physician near you and schedule an appointment by calling 1-800-789-PENN.

Bill
I am concerned about my daughters weight, she is 13 and is 190 lbs., is she at risk to getting diabetes? I had a sister who had passed with Type 1 Diabetes at age 21. Both my wife and myself are not over weight at all. Please provide me with some general information regarding this matter. By the way, she is going to her physician on Monday 4-21-03 and I'm demanding a complete physical.

Thank You,
Bill

Seth Braunstein, MD, Ph.D.
Yes your daughter is at increased risk of developing type 2 diabetes especially if there is a family history of type 2 diabetes. Increased activity and weight reduction would help reduce this risk.

Ruth
I am a type 2 living with diabetes and I am managing with food and exercise through my doctor. Is there a known cause. What causes it? Also do you have names of water therapy places for City Line Ave. area?

James Mulinda, MD
A. Diabetes mellitus is a condition in which the body does not produce enough insulin or does not use it correctly. Your body needs insulin to convert food to energy. When you don't have enough insulin, sugar builds up in the bloodstream.

Moderator
While the cause of type 2 diabetes is unknown, there are several factors that predispose to it's development, including family history, obesity, and lack of exercise.

Water Therapy is available at the Jewish Community YMCA at City Line and Haverford Avenues.

Tony
Good evening people my question is how does one know the beginning signs of kidney problems. Thank You

Mark Noveck, MD
A screening test is a random urine sample for microalbumin. It shows early leakage of protein from the kidneys before there is clinical damage. We have medication that can prevent progression of kidney disease. This has been of great benefit in decreasing the incidence of serious long-term complications.

Sharon
I have a 14 year old with juvenile diabetes, she is going through the same misconceptions a s the man you just had on TV, can you give me any suggestions to help her wake up and see the danger signs, before it is too late?

Seth Braunstein, MD, Ph.D.
Sometimes adolescents do well with diabetes support groups and also talking to nurse educators experienced in handling teenagers. Children's Hospital is a good resource for finding these experience people.

Edie
how does it affect eyesight? Dizziness, or funny feelings when shifting sight from one place to another very quickly?

Seth Braunstein, MD, Ph.D.
High glucose values can cause blurriness of vision, which is reversible when blood sugars become controlled. Diabetes also can cause damage to the eye which can result in impairment of vision which is a more serious situation and requires consultation with an eye specialist. Treatments are available to reverse or arrest the progression of some types of diabetic eye disease and to preserve sight. For more information or to arrange an appointment at Penn Eye Care at the Scheie Eye Institute, call 1-800-789-PENN.

Jerry
My count runs 162 and 7.2 over a three month period. Is this too high and can I control it with diet instead of pills? What is considered a truly high count that requires medication? Thank you...

Mark Noveck, MD
This is adequate; but probably could be better. I am not sure if you are on medication or not; there are oral medications that could improve your sugar without the risk of low sugar. One must weigh the risk of low sugar against better control.

Bob
About 2 years ago, I had a blood test that showed my sugar level at 460. My doctor said that I was diabetic. I got a monitor and with pills, got my numbers down to 100-140 range. Now, I even stay in that range without taking any Glipizide. Am I a diabetic for life or was this something that can go away? My family does have a history of it.

James Mulinda, MD
Yes, diabetes is a life-long disease. However, it can be effectively controlled by following a healthy diet and exercise regimen. For more information, please call 1-800-789-PENN.

Bernadette
my doctor diagnosed me with diabetes, 3 days ago, based on a blood test with result of 129. I was upset and bought the testing kit and have been testing every day since, at no time were the results near 129, the highest was 114, I'm confused !

Seth Braunstein, MD, Ph.D.
A fasting glucose value of 126 mg/dl or greater, done in the chemistry laboratory from a blood sample drawn from the arm, is diagnostic of diabetes. One abnormal value should be confirmed on a separate day by another abnormal test. It is important to make sure that the test is done in the morning after at least an 8 hour overnight fast.

Finger stick glucose meters that you use at home or that the doctor uses in the office are not accurate enough to make a diagnosis of diabetes.

A test could be slightly abnormal such as yours but if it is not confirmed on a second test a diagnosis of diabetes should not be made.

David
Dr. I have type II diabetes and my blood sugar is about 136 each morning. I take Glucotrol XL 5mg's 3x a day, Avandia 8mg's twice a day, and Glucophage XR 500mg once a day. I like to know if this is to much medication or should I as my doctor is I should go on something else?

Mark Noveck, MD
There is no such thing as "too much medicine". You need to take as much medication as necessary to control your sugar. I think a sugar of 136 is very good (and by the way, you should always be asking your doctor questions, that's what he is there for).

Ruth
I am living with type 2 diabetes and is controlled with food and diet with my doctor. I would like to become a diabetes educator. I would like some information to do this.

James Mulinda, MD
Yes, you can become a diabetes educator. There are some basic training requirements. Further information can be obtained from the American Diabetes Association.

Susan
What can be done about a complication
called gastroparesis? My husband has been in the hospital several times in the last few months We are told this may be the problem. He has type 1 diabetes

Seth Braunstein, MD, Ph.D.
There are some medications that are sometimes effective in gastroparesis. Consultation with a diabetes specialist or gastroentrologist who is experienced in this area may be helpful. If you would like more information or would like to arrange an appointment, please call 1-800-789-PENN.

Tony
Where can I get information about aquatic therapy in the suburbs

Moderator
Water Therapy is available at the Jewish Community YMCA at City Line and Haverford Avenues.

Marla
I have been a diabetic since age 2. I am now 51. I would like to volunteer for islet cell transplant. How do I go about it? Are there anti-rejection drugs involved? What are the risks of those compared to diabetes?

Seth Braunstein, MD, Ph.D.
Anti-rejection medications are necessary after islet cell transplant. For more information about this trial, logon to pennhealth.com and click on the Penn Vital Signs banner for more information.

Kate
How common is severe hypoglycemia in non-insulin dependent diabetics

James Mulinda, MD
Hypoglycemia is common in patients taking insulin or certain types of blood sugar lowering medications. Often times, this occurs when medication is taken without eating.

Stephan
What percentage of patients do you treat that continue to smoke once diagnosed with diabetes? My mother has been on the "pump" for about 2 years. She is not getting any better. She's been to the Jocelyn Institute and still the disease has progressed. She has a host of complications, pain and neuropathy and continues to smoke. What can we do to get this person back on track?

Mark Noveck, MD
Smoking is an addictive disease and I don't need to go into depth about its deleterious effects on anyone's health. I can appreciate your concern for your mother; be that as it may, the smoker has to want to quit. There are many modalities for smoking cessation (support groups, RX medications, OTC meds), but until she is ready, there is little we can do.

Keep working on her !

Leonard
Is this transplantation only for type I Diabetes ?

Seth Braunstein, MD, Ph.D.
Currently, the only Type 1 diabetics are eligible for islet cell transplant.

Ed
I have no score only discoloring in my feet and legs and no pain but my mom has diabetes I guess my chances are greater ????

James Mulinda, MD
Often times, people will present with complications of diabetes before they are actually diagnosed. Additionally, family history is a known risk. To be sure, one has to be checked by a physician. To schedule an appointment with a PENN physician, please call 1-800-789-PENN.

viewer
my father is diabetic -- type 2 I guess -- though he doesn't need to take Insulin. He has equipment to check his sugar levels, but never has. How often should he be checking??

Mark Noveck, MD
If he doesn't check his sugar, how does he know he doesn't need insulin ? This is a specific question that needs to be addressed with his doctor. Every case has to be individualized.

David
Dr. I am 5'7" and about 220 lbs. and started taking ultra Carb pills to help bring my weight down. This is a good idea for people with type 2 diabetes?

Seth Braunstein, MD, Ph.D.
Weight loss is important in patients with Type 2 diabetes who are overweight. I am not familiar with Ultra Carb so I can't comment on whether it's safe or worthwhile.

Brett
I am a Type 1 diabetic, how can I see about enrolling in the Islet Cell transplant study?

Seth Braunstein, MD, Ph.D.
For more information about this trial, logon to pennhealth.com and click on the Penn Vital Signs banner for more information.

Jim
Can you recommend an neuropathy specialist in the Lehigh Valley

Seth Braunstein, MD, Ph.D.
I am not familiar with the area ask your physician for a good neurologist.

Joseph
I have no history on my side, but my wife does, and my 26y/o son now has type one. Would I be considered a donor for islet transplant for my son?

Seth Braunstein, MD, Ph.D.
Currently, islet cells are obtained only from cadavers, not from living donors.

Jackie
I was recently diagnosed w/ niddm type 2. I'm on actos and ncs diet. my doctor ordered blood work for 3 months from now. should I be checking my blood sugars at home with a machine or wait the three months for the hgb Aic?

James Mulinda, MD
It is very important for someone with diabetes to monitor their own blood sugar. The three month A1C that is performed in a doctor's office provides an overall picture, but does not help with the daily fluctuations.

Virginia
I found out I had Type II diabetes. I'm on Advandiabut my sugar level is between 185-225. I see my internist. Should I now see a Specialist. Have been on Avandia for 3 weeks.

Mark Noveck, MD
I am a general internist and I manage cases like yours all the time. At this point you do not need to see a specialist. However, you have not been on the medicine long enough to tell how it is working. Given that you are on once a day oral medicine, in my opinion it's probably not necessary to check your sugars all the time. However, 3 months for a follow-up does seem long; I would see you back in 1 month.

Donato
good evening, I have bee type 2 for 13 years I am 38 years old last year I had a heart attack and didn't know it, final result was a triple bypass, I am now disabled, my sugars right now are out of control,275-300 plus, cant seem to get them under control, I am going for another a1c and my dr. says I will most likely end up on insulin, will I then be a type1 or still type and still take my oral meds, I am really bummed about this, but I understand if I want to live I must not let this beat me. thank you

Seth Braunstein, MD, Ph.D.
Whether you need insulin or not, you are still at Type 2 diabetic. Your doctor may choose to keep you on some of your oral agents when he adds insulin to better control your glucose.

Roland
You should check your blood glucose 2 hours after a meal. Does this mean 2hours after the "first bite" of food or 2 hours after completing the meal?

Mark Noveck, MD
After completing the meal.

Athena
My mom has Diabetes, she would like to know if she can make an appointment?

Mark Noveck, MD
Call Penn Line, 1-800-789-PENN. They will help find a Penn doctor in her neighborhood.

Roger
Hello! I'm 50 and have type 2 diabetic with high blood pressure, high cholesterol and I am obese. My first question is to know if we are looking towards a cure in my lifetime. My second question is to know if there is a maximum number of grams of carbs that I should have on a daily basis. Thanks!

James Mulinda, MD
Roger, we are hopeful that a cure may be found in our lifetime. In the meantime, strict diabetes control is important to avoid complications.

The appropriate carbohydrate intake is based on individual assessment by a healthcare provider. For more information, or to schedule an appointment with a PENN physician, please call 1-800-789-PENN.

frank
I have type 2 diabetes. I use insulin (70-30) and humilin R .I try to keep my blood sugar under 200 by the use of R .My usual sugar is 140-200. Am I making a mistake by using to much R to regulate it?

Seth Braunstein, MD, Ph.D.
I agree that it is important to keep your glucose as normal as possible by any means possible. Your doctor should be able to advise you how to use regular insulin in combination with your other insulin to best achieve this goals.

Edward
I am a 40 year old male who just found out a year ago that I have diabetes. My question is that I have a problem trying to keep my weight? I have lost 25 pounds since I learned that I have diabetes. I have been sticking to a diet, every time I gain weight I lose it again. There seems to be a lot of solutions for a person to lose weight but none to gain. Please help! Thanks Ed.

Seth Braunstein, MD, Ph.D.
You may lose weight if your diabetes is under poor control. Home glucose monitoring and the A1C test would help determine this. Ask your doctor.

Jen
my husband is a type 1 diabetic, and so were three of his brothers. How great of a role do you feel genetics plays in type 1 diabetes??? I am pregnant with our first child.

Mark Noveck, MD
There is often a genetic component to diabetes, very strong in some families. Your husband's seems to be one of those. Your children may be at higher risk, but all pediatricians routinely screen for this. Good luck to you !

Susan
My husband has had type 1 diabetes for 28 years. He is under good control and is starting to have some of the effects (gastro) have you heard of the gastro pacemaker? He gets sick nausea often and has been hospitalized 4 times since Feb?

Seth Braunstein, MD, Ph.D.
Some centers are experimenting with "gastric pacemakers." Consult a gastroenterologist.

Roland
I am a Type 2 diabetic under good control with diet. However I get hungry quite often a short time, 1-2 hours, after meals. Is there an easy way to balance carbs to avoid this?

James Mulinda, MD
Sometimes eating smaller meals more frequently may reduce the hunger sensation. However, one has to be careful not to increase calorie intake in the process. Sometimes increasing fiber, such as from vegetables, may result in bulk, reducing the hunger sensation without a significant increase in calories.

Kate
Good Evening...how common is severe hypoglycemia in non-insulin dependent diabetics?

Seth Braunstein, MD, Ph.D.
Severe hypoglycemia, which is defined as hypoglycemia requiring someone else's assistance, is uncommon in patients with Type 2 diabetes unless renal disease or inappropriate doses of insulin or oral agents are being used. Often adjustments in medications will reduce episodes of hypoglycemia in patients with both type 1 and type 2 diabetes.

Bruce
I'm 49 year old male, newly diagnosed about 3 months ago, controlling with diet and need to begin exercise as recommended by my doctor. I have arthritis and prior knee injuries that make long walks painful. What other exercises can I do?

Mark Noveck, MD
I am at the gym all the time. They all have great equipment for all types of bodies. You can ride the stationary bike; use the cross-trainer; do low-impact aerobics; and do some light weight-lifting. However, I recommend you consult one of the personal trainers to tailor a program specifically for you (they are professionals just like your doctor). It is well worth the money. Get moving, no excuses !

John
I have been diagnosed with type 2 diabetes for 2 years. I have kept it well in control with diet and exercise and vitamin supplements. my question is why is that my blood sugar at bedtime is always well within range between 95and 110 yet upon waking up it will be between 115 and 125 and the sometimes spiking to 140 but will eventually return to normal throughout the day?

James Mulinda, MD
This is called fasting hyperglycemia. In type 2 diabetes, the liver continues to make excessive glucose overnight because it does not respond to insulin appropriately.

Tami
Hello,
I have a family history of type 2 diabetes and have recently experienced many of the signs i.e. weight loss, fatigue, frequent urination and blurred vision; however I had a physical and my glucose serum is 85mg/dl. Are there other tests to determine diabetes ?

Seth Braunstein, MD, Ph.D.
Occasionally, a fasting glucose of less than 126 mg/dL or even less than 110 mg/dL can be present in patients with mild diabetes. These patients have glucose values two hours after drinking a 75 gm glucose test drink of greater than 200 mg/dL. Discuss with your physician whether you should have this simple test done.

Tony
Does neuropathy ever go away?

Mark Noveck, MD
No. There have been many research efforts to date, but no consistently effective medicine has been discovered. Efforts are continuing. However, good sugar control may improve symptoms, and there are many medications we use to alleviate (but not cure) the condition.

Peggy
My son, age 31, has been a type I diabetic since age 3. He is now on a pump. In the last 3 years he has had 2 auto accidents related to hypoglycemia, would he be considered a patient that could be considered for islet transplant research?

Seth Braunstein, MD, Ph.D.
Yes, he may be a candidate for islet cell transplant. Call 1-800-789-PENN for more information or logon to pennhealth.com, click on the Penn Vital Signs banner.

Marla
I am interested in Islet cell transplants. How can I find out about this?

Seth Braunstein, MD, Ph.D.
Call 1-800-789-PENN for more information or logon to pennhealth.com, click on the Penn Vital Signs banner.

Brenda
I an having a problem holding my bladder for sometime. I have no problem driving in the day, but at night it is not clear as it should be at night. Can you tell me what I can do. I have had a eye screen and they say that my eyes are okay.

Mark Noveck, MD
I cannot specifically answer your questions, but I am not sure that your problems are all related to diabetes. You may need some specialty evaluations, but your family physician should be overseeing your care. Have you seen him / her ?

Alan
I have been taking Glucotrol XL 5 mg for about five years and been well under control (I exercise 3 to 4 times a week for
1 hr or more in hospital controlled gym)
Question is that in recent weeks I have noticed that my blood sugar readings have been higher than usual and 2 or 3 times have spiked over 200 when usual range is
less than 100 up to 140. I recall reading somewhere that diabetic medication sometimes stops being as effective as it was originally. Is this true? If so, can a higher dose of the same or different med
correct the problem? Thank you for your insight.

James Mulinda, MD
Yes. A single oral agent tends to fail eventually, requiring changes in dosage or addition of other medications.

Tina
Hi! Diabetes does run in my family. My mom and her dad had it, both diagnosed when they were over 40. Recently, my 1/2 brother was diagnosed as having diabetes, my 1/2 sister does not have diabetes. I do not have it, YET, I am 39. So far, no one else ( meaning the grandkids/ great grand kids) was diagnosed. What are the chances for the kids, my sister and I?

Seth Braunstein, MD, Ph.D.
You are at increased risk for diabetes for developing type 2 diabetes. You can reduce your risk by exercising, and maintaining normal body weight.

Jerry
My daughter has had type 1 diabetes since the age of 5. I have read about islet cell transplants but I'm not sure how to get involved or how to become part of a study. At the age of 5 she was treated by your hospital. My daughter is now 23 years old.

Moderator
For more information or to arrange an appointment, please call 1-800-789-PENN or log on to pennhealth.com.

Brett
Can taking a greater number of insulin shots per day help prevent the long term complications of Type 1 diabetes?

James Mulinda, MD
Yes. This was shown in a landmark study of Type I diabetics, called the DCCT.

Barbara
After Having been diagnosed 32 years ago with Type 1, now on the pump. My sugars have been better and easier to control but, I still am having a lot of complications continuing to arise. After Open Heart, a Stroke and circulation's problems .. Should I at some point in my future also expect the other complications to fall into place , even when I am controlled?

Seth Braunstein, MD, Ph.D.
Unfortunately, in some patients despite excellent control, complications can develop. For most patients whoever, the risk is reduced with better glucose control.

jamal
I was diagnosed with type II diabetes a year and half ago. I had control of my blood sugar but a month ago it raised up to the 400s. I also have a tingling in my right toe. the hospital I go to gave me glucafage but advised me take insulin. my question is their uniform answer to a diagnoses for diabetes type II

Moderator
Jamal, there is no one medicine to control your sugar. The challenge of treating diabetes is your physician's use of many different medicines in combination. The most important thing you can do is keep your regular follow-up appointments to maximize your doctor's efforts to help you.

Gordon
If my blood sugar readings have gone from 160/180 to present levels of under 120 am I still in danger? This has been done all thru eating differently.

James Mulinda, MD
The risk was greatly reduced, as a blood sugar reduction of 30-60 mg/dl has been shown to reduce complications by 25-65 percent.

Joe
I have type 2 diabetes and I am 60 years old. I am taking 1&1/2 tablets of gylburide at 5mg and also am taking glucophage 3 times a day at 500 mg a tablet. My sugar was at 120. Is that a good number to be at?

Mike
I am a46 year old type 1 diabetic and my sugar levels are all over the place. I've already had a 4-way by-pass
at age 40 and had laser treatments at Lankenau hospital for my eyes. I'm very interested in the eyelet implants and
how I could become eligible for this procedure.

Moderator
For more information or to arrange an appointment, please call 1-800-789-PENN or log on to pennhealth.com.

Gloria
Why 3 months to determine A.L.C average.

Seth Braunstein, MD, Ph.D.
Gloria-The A1C is dependent on the life of the red blood cell which is about three months. Testing
more than every three months is unusually not necessary or helpful.

Mary
I have type 2 (65yrsold) can this cause very very severe leg cramps? much worse than "charley Horse" Thanks

Mark Noveck, MD
I can't diagnose you over the Web. It sounds like you may have idiopathic leg cramps (quite common and benign). You may have vascular clogging (potentially more serious). You need to pay a visit to your doctor for an exam and possibly some testing.

Susan
Seth Braunstein MD: Re Gastro paresis, he already has an appointment in MAY with Dr Lichtenstein is he good in this area? He sees an endro. in our area already - with good control...

Seth Braunstein, MD, Ph.D.
Susan, Yes, he is excellent.

Cass
Hi, Can you tell me some of the noticeable symptoms of having diabetes? I know they are not conclusive but would like to know what some common ones are. Thanks

Seth Braunstein, MD, Ph.D.
Cass, There are several warning signs and symptoms of diabetes mellitus.

These include:

• excessive thirst
• frequent urination
• unexplained weight loss
• blurry vision
• fatigue or weakness
• tingling or numbness of the hands or feet
• frequent skin, gum, bladder
• or vaginal infections

Diane
I am a white, 115 lb. 5'6' female who was diagnosed 10 months ago w/diabetes. I have just started to use insulin. I am active( runner) eat well and have no history in my family. I am devastated. Could I be a candidate for an Islet transplant? I have two small children, ages 41/2 and 9 and a very supportive husband.

James Mulinda, MD
Diane,
This sounds like Type 1 diabetes. Islet cell transplantation is presently reserved for patients with severe complications. Hopefully, it will become more readily available in the future.

Bonnie
I am having problems with numbness in my feet neuropathy? If I am able to get my sugar in control will any of the feeling in my feet come back. Or is there treatments that will help. My sugar runs around 200.

James Mulinda, MD
Bonnie--Improving glucose level often improves neuropathy symptoms. There are some other medications that help relieve the symptoms of neuropathy but they do nothing for the process
that causes the damage to the nerves.

Pamela
What do you do if you are out driving a car and your sugar drops to 56 and you have the sweats but you think it is hot flashes until you get home and take your sugar and find out that it has dropped? What can you take when you are out somewhere?

Mark Noveck, MD
There are concentrated sugar caplets / gummies, sold in the drugstore. You should always carry some in your purse. But your symptoms may not be from hypoglycemia -- you don't know unless you check your sugar, which is admittedly difficult in traffic. So you should check it as soon as you get home. A HGB A1C on regular basis may help to determine if your sugars are generally too low.

Norma
Can you tell me why physical illness and stress affects your glucose levels??

Seth Braunstein, MD, Ph.D.
Stress and physical illness often elevate hormones that increase resistance to the action of insulin. This makes pills and even insulin by injection less effective.

Sam
My diabetes was detected in Oct., I started with pills, which did not work then went to insulin twice a day. Last week my doctor had me stop the needles and just take pills. my sugar has between 85-125 through the whole day, but I am thirsty, not like when I first got diabetes, but I am just dry?

James Mulinda, MD
Sam,
With blood sugar levels ranging from 85-125 mg/dl, thirst is probably not a result of blood sugar levels, as these are in the normal range.

Joan
My husband was diagnosed in Oct with type 2. His sugar was 270. He is being treated with Actos twice a day. His sugar is now between 170 to 190. Is this acceptable or should we be doing more?

Mark Noveck, MD
This is still a little high. BTW, Actos is usually a once-a-day medicine. Either he needs more, or the addition of another agent.

Leonard
I am 58 and was diagnosed with type II diabetes. Both my sister and mother died off type I. How do you know or how can you tell the difference?

James Mulinda, MD
Roy,
Normal fasting blood sugar is less than 110 mg/dl, and after meals, less than 140 mg/dl.

Roy
What is the normal range blood sugar ?

James Mulinda, MD
Roy,
Normal fasting blood sugar is less than 110 mg/dl, and after meals, less than 140 mg/dl.

Ruth
is there a medicine for neuropathy

James Mulinda, MD
Ruth,
Yes. Several different medicines are available, depending on the individual.

Eddie
I am a 41 year old with type 1 diabetes. I have been a diabetic for 17 years and have just begun insulin pump therapy. So far I am happy with the results. My last HG1Ac test results came back and my Dr is concerned about my heightened potassium levels and wants me to get some more blood tests, is a high potassium level something to be concerned about?

Seth Braunstein, MD, Ph.D.
Eddie, Very high potassium levels can be dangerous and may require treatment.

jamal
is there a difference in your blood sugar when you have a cold are the flu.

Mark Noveck, MD
The physiologic stress of acute medical illnesses of all types can raise the blood sugar. Not usually colds, but certainly flu and other bacterial infections.

Mary
My A1C level is 11. I take Metformin 500 mg 2x daily, and have added 1x daily 5mg glucotrol xl in the last month. My daily tests range around 200 sometimes 150. I need dental extractions. What precautions such as antibiotics should I take and can this be done at a Dentist office?

Seth Braunstein, MD, Ph.D.
Mary, Your doctor and dentist can advise you whether antibiotics are necessary. Your diabetes does not prevent you from having dental extraction done as an outpatient.

Bob L
I just had 2 islet cell transplants in Miami. How many has Penn done and is there a support group for your patients?

Moderator
For more information or to arrange an appointment, please call 1-800-789-PENN or log on to pennhealth.com.

Jackie
if I let my blood sugar get high by not taking my actos, will I lose weight?

Mark Noveck, MD
Possibly - but it is NOT a healthy way of losing weight ! You are doing it at the risk of damaging your body.

Nancy
I am a Type II. I take Avandia 1x per day, and have cut out all the things that were my primary diet ...cake candy, pretzels, etc. My blood sugar has remained about 240 and I find I am hungry all the time. What else can I do?

James Mulinda, MD
Nancy,
With blood sugars in the 200 range, the dose may need to be changed and other medications may need to be added. One needs to reevaluate overall care with a healthcare provider. For more information, or to schedule an appointment with a PENN physician, please call 1-800-789-PENN.

Cheri
Who can I talk to find out if I would qualify for research trial for islet cell transplants?

Moderator
For more information or to arrange an appointment, please call 1-800-789-PENN or log on to pennhealth.com.

Andrea
I was just diagnosed in may 2002 with mild diabetes. So far my a1c is 6 and sugar levels are near normal. I have family history of diabetes every one of my brothers and even my half brother has it. I was the oldest at 52 to get it. I am in aqua aerobics and never had any symptoms. I am on glucophage and advandia. Can I ever come off meds. Thank you for great show.

Seth Braunstein, MD, Ph.D.
Andrea, If you achieve normal body weight and continue exercise, you may be able to stop medications

Bernadette
Does depression affect blood sugar levels?

James Mulinda, MD
Bernadette,
Yes. Depression tends to increase blood sugars. Sometimes people eat more when they are depressed.

Gordon
Does the A1C test show each days reading for the 3 months or just the highest level for that time period?

Mark Noveck, MD
The A1C test is a running average of your sugars for the last 3 months. That is all it is. It gives a general idea of your control.

Marcella
I have a two-part question. My mother is a 82 years old, female of color who has had diabetes for the past 42 years. Within the past five years she has been experiencing a tremendous amount of numbness, gritty sand feeling and tingling in her right foot which is now affecting her left foot. I as well as her neurologist, podiatrist and pain specialist believe she has diabetic neuropathy but her endocrinologist does not believe so. Would you please tell me your take on this? If you think it is neuropathy would you please recommend a physician. The second part of my question is I recently had an A1C with a result of 6.1. I have read that an A1C of 7 or above is positive for diabetes. What is the correct number? Thank you.

Seth Braunstein, MD, Ph.D.
Marcella, Your mother may have neuropathy due to diabetes or another unrelated condition. You could seek consultation with a neurologist who specializes in neuropathy, call 1-800-789-PENN.The second part of your question--Hemoglobin A1C cannot be used to diagnose diabetes.

Jackie
Should a Type 2 diabetic check their blood sugars at home? or is it safe to wait every 3 months for blood work at the doctors office (hemiglobin AIC)?

Mark Noveck, MD
There is a wide difference of opinions. It is my feeling that many mild Type II's do not need intensive home monitoring. I have many patients that I follow with every 3 months A1C's if they are well controlled.

JOHN
I have had type II diabetes for 12 years. I have been able to maintain control however, for the past 6 months after my doctor changed my medicine from prandin to starlite, my glucose control has been in the mid two hundred, my lifestyle and way of eating have not changed significantly however, I did lose my daughter last march 2000. Can you advise?

Seth Braunstein, MD, Ph.D.
John, Your sugars may be higher because of the change in medication. Starlix in general is less potent than Prandin.

Dorthea
my diabetes is way out of control, the only time it has been controlled is when I was hospitalized. I am on a new medicine Lantas that is not working. What I am not getting is the nutrition part of this. I know not to eat surgar and things with sugar but it is not working for me

James Mulinda, MD
Dorthea,
It is very important for diabetics to have continuing diabetes education and to reevaluate their plan of care with a healthcare provider.

Carole
I have no symptoms of diabetes but it runs in my family. My Dr. says not to worry about it. My blood sugar runs on average about 120

Mark Noveck, MD
He is right. Your sugar is normal. Do not worry about it. You should be checked yearly; sooner, if symptoms occur.

Marla
gastric bypass for obese out of control diabetic??

James Mulinda, MD
Yes, it is a possibility.

Walter
Is it possible to get my brother into the cell transplant program. He has had type 1 diabetes since he was seven and refuses to take care of himself. He likes to keep his blood sugar levels below 130 and has been hospitalized many time for insulin shock. It is getting to the point were it is dangerous to leave him alone!!!

Moderator
For more information or to arrange an appointment, please call 1-800-789-PENN or log on to pennhealth.com.

Jackie
thank you for your help. Happy Easter!

Jim
I have been a type 1 diabetic for over 25 years and within the past 2 years have developed what my doctor says is acid reflux. It only happens at night and when I lay on my side. I desperately feel I have to cough something and feel a burning in my throat. If I do cough up anything it is only phlem. When the episode is severe, I am sore the next day in my throat, chest, and stomach. IKG and stress test cleared my heart as a possible cause.

2nd ? is I am tired all the time and fall asleep easily. What could this be attributed to?

Jim

Mark Noveck, MD
It sounds like you do have reflux. Has your doctor prescribed anything for you ? A trial of medication could be diagnostic. With regards to your fatigue, it could be anything. Your doctor can run a series of routine tests and advise you.

Mary
I have had type 1 diabetes for 30 years. I would like to know if and how I can get islet transfers. I understand that it is still experimental. I recently went from 110 to 95 lbs. My doctor switched me from Regular and NPH to Humulog and Lantus insulin. This does not appear to have helped as I still look like a skeleton, am weak and have sporadic chest pain. I would gladly undergo an experimental procedure as the alternative seems grim.

Moderator
For more information or to arrange an appointment, please call 1-800-789-PENN or log on to pennhealth.com.

Anna
What foods should a pre-renal patient be eating?

James Mulinda, MD
Anna,
It depends on level of renal function and should be decided by a healthcare provider.

Leonard
By the Way THANK YOU for your time ;-)))

Tracy
I was diagnosed with type 2 about5 mos. ago. I'm still very much in the denial stage. I miss meals and meds. does this also cause organ damage? also are there any support groups in the Chester pa. area?

Seth Braunstein, MD, Ph.D.
Tracy, If missing medications or erratic eating leads to elevations in glucose values, which of course it may, then it may have an effect on increasing your risk of complications. I am not aware of support groups in the Chester County area, perhaps call 1-800-789-PENN to see if they can help.

Peggy
I have been taking 500 mg of Glucophage for 4 years. Over the past few months my sugar reading is higher in the morning than at 11:00 the night before. What causes this. Also, I understand that sugars can dip and then spike overnight. Why?

Lori
I am a type II diabetic. Although I take medication(actos, glucovance) my blood sugars still run from 70 to 310. How "dangerous" are these levels?

James Mulinda, MD
Lori,
It is best to maintain a fasting blood sugar level between 70-110 mg/dl and after meals, less than 140 mg/dl.

Michael
I have had type 1 IDDM for 20 years now, and am starting to see some symptoms of complications. I would love to get in the research for the eyelet transplant. I have 4 beautiful children and am afraid that I may not be able to see them grow due to this disease. Is there anyway to apply?

Moderator
For more information or to arrange an appointment, please call 1-800-789-PENN or log on to pennhealth.com.

Sue
Good evening, I have a question. I am 40/f and have type II diabetes. Recently, my sugar has gone out of control 200-250 range. My doctor doubled my meds. Amaryl 2mg. I also have HepC and am not on treatment. Do you think my Dr. should have put me on new meds? Just when my sugar starts to get to that normal range, up it goes again. I eat well and exercise. I have also recently quit smoking (8 weeks) could this be contributing to my problem? I have smoked for 27 years.
P.S. I have also gained about 15 lbs. Thank you so much for your help! Sue

Mark Noveck, MD
Indeed, your weight gain is probably contributing to your recently elevated sugars. Also you are likely eating more because you are not smoking. Try to find low-calorie substitutes (I know it is hard). Lots of ice water and diabetic mints. You are on a low dose of Amaryl and there is plenty of room for further increase, but you may need to add a different med also. I am glad you quit smoking, it is the best thing you can do for your health. The long-term benefits far outweigh any weight gain or short-term rises in blood sugar. See your doctor more frequently to work on the sugar.