S:
I don't know how someone with diabetes and maybe lupus can exercise when one hardly has the strength to get through everyday daily chores.

Ronald Barg, MD:
Musculoskeletal problems or complications from diabetes can limit a patient’s ability to exercise. In most cases this can be overcome to some degree with an individualized exercise program. This is something a patient can frequently develop in conjunction with their physician. In some complicated cases a referral to a Physiatrist (specialist in Rehabilitation Medicine) can be helpful.

Nambi:
I am a 38 yr old male. I have been taking 22units of 70/30 humilin in the morning and 18 units at night since I was diagnosed with diabetes 5 years ago. Do I qualify for the islets transplant?

Ronald Barg, MD:
Islet Cell transplantation is an experimental treatment for type I diabetes. Based upon the information supplied this is probably type II diabetes and as such you would not be a candidate at this time. I would recommend that you discuss this further with your physician.

Teri:
How long can the honeymoon period for Type I diabetes last?

Ronald Barg, MD:
Type I diabetes results from an autoimmune process that destroys the islet (insulin producing) cells of the pancreas. This process occurs over months to years. A “honeymoon” phase can occur after the diagnosis of diabetes is made where a patient can be controlled with little or no insulin. Not all patients have this phase clinically and the duration is very variable. Usually the time can be measured in months rather than days, weeks or years.

S:
Does urinating a lot have a lot to do with diabetes?
Or could it just be Irritable bladder syndrome?

Ronald Barg, MD:
Frequent urination can be a symptom of many problems. Diabetes and Irritable Bladder are two of them. If you have these symptoms evaluation by your physician should help in determining the cause and eliminating the presence of certain problems.

Doris:
I am taking 30 mgs of Actos a day. I have been on this medicine a year. Does this cause swelling in ankles and wrists. Also, my doctor put me on fluid pills, 40 mgs once a day but the swelling is still there. Is this a side effect? Does all diabetes medicine have swelling as a side effect or it is my body chemistry or am I not on the right type of medicine? I have been on Advanta 8 mg, Amaryl 30 mgs once a day, Glucofage XL 500mg and regular Glucofage. All 4 medications gave me hives because I was allergic. Actos was the only one that did not cause hives but is causing swelling or water retention.

Ronald Barg, MD:
Different medications have different potential side effects. One of the more common side effects of Actos is fluid retention, which causes swelling. This can sometimes be managed with diuretics, but may also require discontinuation of the medication. You should speak with your physician about this and not change any medication without consulting him/her.

C.T.Binder:
My type II diabetes is currently out of control (300 mg/dl) and I am maxed out on oral meds (Glucophage XR 2000mg & Amaryl 4 mg) next step is insulin if I don't loose the weight (5'9" and 275lbs). I start at the Abington Weight Management Center next week. My question concerns two problems (symptoms?) I've had for a while now. 1. I get very sleepy if I sit still, almost pass out like narcolepsy. 2. My hands have become very sensitive and frequently erupt in Eczema outbreaks (I do wear lined rubber gloves while washing dishes). Are these symptoms related to my diabetes? Thank you for your time.

Ronald Barg, MD:
It is unlikely that your sleepiness is related to diabetes. It may however be related to your weight problem. Sleep apnea is a condition related to obesity that can cause sleepiness. This is something you should discuss with your physician. The diagnostic test for sleep apnea is a sleep study where you spend the night in a sleep lab. Diabetes can cause dryness of your hands however your problem sounds more severe than this. I would recommend that you have your skin condition evaluated by your primary care physician or a dermatologist so that an accurate diagnosis can be made and effective treatment prescribed.

Steve:
I am type 1 and take 20 units of lantus/glargene in the evening and take novolog (short acting) as needed. I have been getting this strange dizzy feeling for the past couple days. Could it be because I am nearing the end of my vial of lantus/glargene and it has lost a little potency? I do keep it in the fridge all the time. I appreciate your time and wish everyone the best. I really enjoyed your program this evening.

Ronald Barg, MD:
I am not aware of any problem with alteration of potency of the newer insulin preparations based on the bottom of the vial or lack of refrigeration. I would check to expiration dates on the medication to make sure they have not expired. I would also check your blood sugars at the time of the dizzy spells you are having. If you have concomitant hypoglycemia (low blood sugar) you may need to have your medication adjusted. This should be done in conjunction with your physician. Alternatively the dizziness may be unrelated to your diabetes and is something that should be evaluated by your physician.

Guy:
At a recent physical I had a fasting blood sugar of 128. My physician diagnosed me as a diabetic and sent me to an ADA education program. I am strictly diet controlled (using ADA 2000 cal diet) along with an exercise program. My morning fasting blood sugar (self-monitoring averages 113. My pre dinner blood sugar averages 97. The highest A.M. blood sugar I have measured is 127. Am I a diabetic? And why would my pre-dinner blood sugar be lower than my morning fasting blood sugar.

Ronald Barg, MD:
The ADA definition of diabetes is two fasting blood sugars in a stable patient above 126. Based upon the information you gave it appears that you do have diabetes. Your condition is controlled through diet, however does require consistent monitoring. You may require treatment at a later time. It is not uncommon in-patient with early diabetes to have higher fasting blood sugars than sugars later in the day. This is related to a hormonal surge that occurs at approximately 4 AM while people sleep. This causes an increase in blood sugar.

H. Ash:
Is the medication, which you mentioned earlier, for beginning kidney disease something other than an ACE inhibitor?

Ronald Barg, MD:
ACE inhibitors and ARB (angiotension receptor blockers) are used to prevent or retard the progression of kidney disease in diabetes. Although these are the agents most frequently cited in this circumstance, tight control of hypertension with other medications can also be effective in preventing progression of kidney disease.

Roy:
What is the best range for your blood sugar.

Ronald Barg, MD:
Goal blood sugars need to be individualized based upon many factors. A general guide is to keep fasting blood sugars below 120 and 2-hour post parricidal (after meals) blood sugars below 140. Glycohemoglobins should be maintained below 7.0. These ideal values can not always be achieved in individual patients.

R.J.:
Dr.s besides being Diabetic, I have high Cholesterol and Triglyserides. My Dr. has me on Zocor20 mgs. but advises me to take two 500Mg.of Niacin daily. I have read and heard this is not a good mix? Please give me your thoughts. Thank you

Ronald Barg, MD:
Control of lipids is very important in diabetic patients to prevent cardiac and peripheral vascular disease. Although there is an increased risk of liver side effects from the combination of Niacin and Zocor this combination is frequently used when necessary to achieve adequate control of cholesterol and triglyceride abnormalities. Monitoring by your physician for potential toxicity is important in the use of these medications. The decision to use this combination should be based on an individual evaluation weighting the benefits with the risks.

Bonnie:
Does an AIC result of a 10 in a 13 year old boy confirm juvenile diabetes - the boy has been sick with flu like symptoms for at least a week, and did intake large quantities of liquids. Also, what is insulin shock?

James Mulinda, MD:
Diabetes diagnosis depends on blood sugar level. A1C helps understand overall control. Diagnosing juvenile diabetes is best done by a healthcare provider. Insulin shock often refers to too much insulin causing a dangerously low blood sugar that results in a change in behavior or even passing out.

Gene:
I am 76 and have been diagnosed with type 2. For 3 years I have had a severe burning sensation in my tongue. This is very uncomfortable. I thought I heard that this could be a side effect fom diabetes. If so can it be treated and if so how? And where can I go?

James Mulinda, MD:
You should have this evaluated by a healthcare provider. To schedule an appointment with a PENN physician, call 1-800-789-PENN.

George:
Is it o.k. to inject insulin directly from the refrigerator or should it be brought to room temp. first? Thanks.

James Mulinda, MD:
It is best at room temperature. Additionally, many insulins require that you gently mix or shake them to avoid particulate crystals before injecting.

C.T.Binder:
Are severe Eczema outbreaks (on hands) related to high blood sugar levels (300 mg/dl)?

James Mulinda, MD:
No. However, there are certain skin disorders that rarely present at the same time as diabetes. A health care provider would be able to help distinguish them. To schedule an appointment with a PENN physician, please call 1-800-789-PENN.

Nancy:
Since I was switched to Lantus, I have noticed an appreciable weight gain with LESS caloric intake and continued exercise. Do you see this with other diabetics using Lantus - and what is the best way to reduce that weight gain?

James Mulinda, MD:
Sometimes weight gain comes with improved diabetes control. Also certain medicines when used with Insulin can increase weight gain. A good nutrition and exercise program can help under the supervision of a healthcare provider, nutritionist and dietitian. To find out more about our diabetes programs, please call 1-800-789-PENN.

Mary Jean:
I have had diabetes for 44 years, and am 47 years old. I am extremely interested in islet transplants, because for the past ten years there have been no indications of low or dangerous blood sugars. Am I a possible/likely candidate for an islet transplant or research?

James Mulinda, MD:
Islet cell transplant is still in its early stages and specific criteria for enrollment. Contact 1-800-789-PENN for a health care provider that can help discuss the criteria.

Jen:
Have you heard anything about banking cord blood to use the stem cells to treat type I diabetes?

James Mulinda, MD:
Stem cell research is still investigational and not widely used yet.

Joy:
I take actos and medformin when I am in normal range of 70 to 120. I feel light-headed, what causes that?

James Mulinda, MD:
Light-headedness is caused by several factors and should be fully investigated. In some diabetics, neurapathy plays a role. To schedule an appointment with a PENN physician, please call 1-800-789-PENN.

Lynn:
What is the most potent drug for type II?

James Mulinda, MD:
Insulin

Anna:
I have been a diabetic for 17 yrs. have neuropathy in feet, gastroparies, CHF and now pre-renal. What foods should I be eating? Stopped drinking sodas and limited my intake of meat. What else should I be doing to avoid renal failure?

James Mulinda, MD:
Certain medications can help greatly in reducing renal damage progression. Nutrition choices depend on how advanced the disease is. Smoking and tobacco are known to worsen neuropathy.

S:
I don't know how someone with diabetes and maybe lupus can exercise when one hardly has the strength to get through everyday daily chores.

James Mulinda, MD:
Any exercise, however small, can be gradually increased as tolerated under a health provider's supervision.

Teri:
My 11 year old son just was diagnosed with Type I diabetes. What advances have been made with the closed loop pump?

Mark Noveck, MD:
You should schedule an appointment with a doctor. To schedule an appointment with a PENN physician, please call 1-800-789-PENN.

Tracy:
Are there any support groups in the Coatsville, PA. area?

Mark Noveck, MD:
Call the American Diabetes Association at 610-828-5003.

Iris:
I am an insulin diabetic and my doctor said my type of diabetes is brittle. I have a hard time keeping it under control. What do you suggest?

Mark Noveck, MD:
“Brittle” diabetes is diabetes that is hard to control. Some people are very sensitive to Insulin. The best thing you can do is frequent home glucose monitoring, and show the numbers to your doctor.

Norma J.:
Maybe I missed my answer, but can you tell me how/if sickness and stress causes blood sugar to go out of control. My husband has been sick and his blood sugar was always around 180. It climbed to 460 and he is now on insulin. It is possible for illness to cause this?

Mark Noveck, MD:
Adrenaline release from sickness and stress can raise blood sugar levels. I cannot specifically answer your question about your husband without knowing the particulars. He should speak to his physician.

Lisa:
I was told that my hemoglobin AIC was 7.1 & that was considered a diabetic by my insurance Co. Is that True?

Mark Noveck, MD:
It is possible, but one cannot diagnose diabetes from a Hgb A1C. See your doctor for further testing.

Tami:
Thank you, since my tests were taken after fasting which resulted to glucose of 85mg/dl are you suggesting I ask about the 75 gm glucose drink as an additional test?

Mark Noveck, MD:
A glucose tolerance test may be helpful.

Bill:
My feet feel like they are burning, is there something I should do?

Mark Noveck, MD:
Speak with your doctor!

Gloria:
Hello, I am interested in the upcoming islet transplant trials and I was wondering about qualifying for trial and its cost, like would any insurance programs pick up some of the expenses? Or just how do they work this? Thanks Gloria // type 1 diabetic, age 50

Mark Noveck, MD:
If you would like more information, please call 1-800-789-PENN.

Lori:
What is considered low/high blood sugar levels? Are 74 or 310 "dangerous" levels?

Mark Noveck, MD:
Low is less than 60; high is over 126. 74 is normal; 310 should be treated!

Tony:
Is it true with diabetes that the symptoms are the same on BOTH legs and not just one. Burning numbness etc?

Mark Noveck, MD:
Often, but not necessarily

Cass:
What should your numbers be for diabetes? Last time mine where 160 I am on Amaryl 4mg. Is that a good medicine? Sometimes I seem to get headaches would that give me headaches.

Mark Noveck, MD:
Amaryl is good medicine. To assess control, you need more than just a fasting sugar; the ideal Hgb A1c should be around or below 7.

Brenda:
I am a diabetic and I am taking insulin and glucophage Xr twice a day and also taking axid, fosmax,lipor, calcium. Do all of the medicines have the same side effect? At night some time I can't breath.

Mark Noveck, MD:
These medicines all do different things and all are useful. Discuss your breathing problem with your doctor.

R.J.:
Dr.'s I have been essentially on the same medication for 12 yrs. except for increases of the two drugs.Glucotrolxl 10 mg and Glucophage xe 500mg.'s which I take the glicophage three of then @ dinner. Should I consider having my Dr. change my medication? My blood glucose avg. is about 155.
Thank you

Mark Noveck, MD:
If you are doing well on the medications (sounds like you are), there is no need to change.

Linda:
My dear husband has been hospitalized 5 times in 2 years for gastroparesis due to his diabetes. If this continues will he eventually lose the use of his stomach? What will happen if so?

Mark Noveck, MD:
If gastroparesis is severe, a feeding tube can be placed through the abdominal wall into the small intestine to bypass the stomach. This is not a complicated procedure.

Lynn:
How should I respond to a relative who said, "you caused your own diabetes by not losing weight."

Mark Noveck, MD:
Diabetes is a disease with multiple causes, many of which are genetic, many others are unknown. While obesity does not help it, it does not “cause” it.

CJWINSTON:
My doctor prescribed Metformin. At the dosage prescribed I would get overactive bowels at the most inconvenient times - in a word get home ASAP. My doctor is a "MY WAY OR THE HIGHWAY" TYPE even though after my diagnosis I got my sugars down to between 90 and 140 every single day with the change in diet and swimming over near the Palestra. I DREAD going back to this doctor because I feel that my desire to maintain my condition with diet, exercise and as little medicine as possible will not be heard. Please advise. Thank you.

Mark Noveck, MD:
You may want another physician's opinion. You can talk with the counselors at PENNHealth by calling 1-800-789-PENN for a physician who has a convenient location near you.

Ron:
Any suggestions in what can be done to improve erectile dysfunction in diabetics. My hA1C has always been between 6 and 6.8. I may have had diabetes a few years before it was diagnosed. Major symptoms were that my nails were growing in layers and jock itch, thirsty and frequent urination.

There is a big problem in that when anyone discusses "frequent urination" when discussing diabetes, they never define it. "More than usual" won't cut it because it happens so slowly.

Type II with Novolog insulin and oral meds.

Mark Noveck, MD:
Viagra often works very well in diabetics. There are also 2 new medications in the pipeline for ED due to be released soon.

Marc:
I have type 2 d.m. I am taking prandin & Glucophage my a.m. sugar is 160 lately. I am feeling anxious, having difficulty concentrating, extremely tired and weak in my legs, dizzy, my mind feels like I am drifting please help.

Mark Noveck, MD:
You may be having episodes of low blood sugar. You should check your finger-sticks when these symptoms occur.