SparkMD-Frequently Asked Questions about Diabetes Mellitus

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Frequently Asked Questions about: Diabetes Mellitus
Note: Information provided below is intended as a source of information and a guide. For specific details about your own health, speak to your doctor. (Revised 7/20/00) 1. Why me? 2. What causes diabetes? 3. How do I know if I have diabetes? 4. Could I still have diabetes even if I do not have those symptoms? 5. What is an HbA1C? 6. Why do I need any treatment? I don’t feel sick now. If I just cut out sweets will my diabetes go away? 7. But I love to eat. Are there pills to help me control my appetite? 8. Will I have to give myself insulin injections to manage my diabetes? 9. Who can use pills to treat diabetes? 10. Are there side effects to the pills used to treat diabetes. I read in the paper that they cause liver damage . Can that be true?
1. Why me?
Answer: Genes are part of the problem. We have known for years that diabetes, or the predisposition to develop diabetes is an inherited problem.. If you have been recently diagnosed with diabetes look to your family. Men and women with diabetes usually have a relative with diabetes. If it is not your mother or father who carried the diabetes gene or genes then it may have been your grandmother or grandfather. Genes are not the entire answer. Identical twins have the same genes but when raised in different environments only one-the twin who overeats and does not exercise will develop diabetes. If there is a diabetes gene lurking somewhere in your family tree, there are actions you can take to delay, ward off or even prevent the symptoms of diabetes from developing and disrupting your life. These include sensible eating, proper diet and exercise to help keep diabetes at bay.
2. What causes diabetes?
Answer: Diabetes occurs when there is an imbalance between what you eat and your body’s ability to convert that food into useful energy. Consider what happens when you have a slice of a pepperoni pizza. The ingredients in the pizza once swallowed are absorbed through your digestive tract, then broken down into smaller components. The dough in the pizza crust is broken down to a sugar called glucose, the pepperoni , a source of protein and is converted to amino acids, whereas the pizza’s oil and cheese are reduced to smaller fat droplets (lipids) called triglycerides. Your body uses all- glucose, amino acid and triglyceride fragments as building blocks for the strength and power you need for every day activities but body relies on insulin to transform glucose, amino acid and triglyceride to useful sources of energy. Without insulin blood levels of glucose, amino acids and lipids build up and when that happens your body’s metabolism stutters and fails. Blood sugar –glucose- levels rise, amino acids cannot be used to build muscle strength and lipids start to clog your arteries. That is what happens in diabetes Only when the balance between the foods you eat and the insulin you need is restored can your body’s metabolic machinery start working efficiently to restore your health.
3. How do I know if I have diabetes?
Answer: High blood sugar-glucose- levels are the hallmark of diabetes. Your body can tolerate modest elevations in blood glucose levels up to 140-180 mg/dl without causing symptoms but when blood glucose levels remain consistently elevated above 300 mg/dl men and women experience characteristic symptoms of: a. Increased thirst b. frequent urination c. recurrent infections d. blurry vision e. poor wound healing f. unusual fatigue and drowsiness after meals
4. Could I still have diabetes even if I do not have those symptoms?
Answer: Yes. The only way to know for sure whether or not you do have diabetes is to go to your doctor and have your blood sugar –glucose-level measured. Blood glucose values are abnormal and indicative of diabetes mellitus when you have: a. After Overnight Fasting- 140 mg/dl on at least two occasions b. More than 200 mg/dl after a glucose tolerance test c. Hemoglobin A1C (HbA1C) over 6.5%
5. What is an HbA1C?
Answer: All parts of your body including your red blood cells rely on glucose for energy. When glucose enters your red blood cell it bonds with oxygen carrying hemoglobin to form hemoglobin A1C. ( HbA1C). The higher the blood glucose, the higher the HbA1C. Since each red blood cell stays in your circulation for at least three months, the HbA1C level is an accurate reflection of your average blood glucose level over that period of time. Early on HbA1c levels are usually high but then fall to normal levels with effective treatment.
6. Why do I need any treatment? I don’t feel sick now. If I just cut out sweets will my diabetes go away?
Answer: Diet helps and indeed is the cornerstone for all successful diabetes treatment, but a resolution to cut out hot fudge sundaes and candy bars is not enough. A properly balanced diet that involves three meals a day designed to provide a sensible allotment of protein, fats and carbohydrates is crucial. Your doctor may have a diet plan or he may refer you to a dietician to help tailor a diet just for you. Fad diets are usually not effective and often very dangerous.
7. But I love to eat. Are there pills to help me control my appetite?
Answer: No. Pills that are purported to control appetite like amphetamines rarely work as a long term solution and also worsen diabetes. You can stay on a diet that is tasty and sensible and will help control your diabetes. Once you do you will feel great because you will know that you are able to be in control. Many of my patients do very well with diet alone. Others have to take supplements like insulin or pills in addition to diet to achieve maximal control over their diabetes.
8. Will I have to give myself insulin injections to manage my diabetes?
Answer: It depends on the severity of the diabetes and the insulin deficit. When a person’s pancreas stops making insulin completely as is often the case when children or teenagers develop diabetes then insulin injections are necessary. Often a combination of different types of insulin, some with a rapid onset of action and others with more prolonged and sustained blood sugar lowering capacity are needed to bring blood glucose levels down to normal. Work with your doctor, or if he is not familiar with the latest developments in this are ask for a referral to - an endocrinologist -someone who has received special training in the management of patients with diabetes.
9. Who can use pills to treat diabetes?
Answer: When diabetes develops later in life the pancreas seems to make some, but not enough insulin. In that instance pills that encourage additional insulin output from the sluggish pancreas help raise the blood insulin level and allow the body to bring blood glucose levels closer to normal. Still other pills improve the efficiency of insulin’s actions (insulin sensitizers). When the insulin that your pancreas releases is not as effective as it once was because your body has become resistant to insulin, another generation of pills are specifically designed to overcome your body’s insulin resistance. Often a combination of pills is required to first stimulate your pancreas to release additional insulin, then insulin sensitizers to make sure your body responds well to the additional insulin and finally others to overcome the bodies insulin resistance to maximize the effectiveness of whatever additional insulin is now in your blood stream.
10. Are there side effects to the pills used to treat diabetes. I read in the paper that they cause liver damage . Can that be true?
Answer: All pills even aspirin and other over the counter medications can cause side effects. Side effects seen with treatments for diabetes include: a. Low blood sugar-hypoglycemia-can occur with pills or insulin b. Liver damage-has occurred with troglitazone (Rezulin), and insulin sensitizer that is no longer on the market and rarely with rosiglitazone (Avandia) but not as yet with pioglitazone ( Actos). Your doctor will do blood tests to check whether your liver has been damaged. c. Lactic acidosis a rare complication of metformin ( Glucophage) therapy. Side effects, when they occur are usually reversible with proper treatment. Speak to your primary care doctor or endocrinologist.