Diabetes FAQ's
Q. I need to know what my glucose numbers should be up to 3 hours after eating as I sometimes forget to check at the 2 hour mark.
A. The postprandial (after-meal) blood glucose level recommendation for non-pregnant adults with diabetes is < 180 mg/dl. Peak postprandial glucose levels occur at 1-2 hours after the beginning of a meal. Levels taken 3 hours after the start of the meal should be even lower.
Q. I am on 24 units of Humalog and 46 units of Lantus. When I inject the Lantus lately it burns. Every 2 weeks my doctor ups my insulin, how much is too much insulin?
A. Burning may occur at the injection site with Lantus because of the acidic pH of the solution. You should let your physician know that you are experiencing this side effect. Specific maximum dosage information is not available for insulin. Each dose should be individualized based on the doctor's careful monitoring of blood glucose levels and other clinical parameters.
Q. My Father has diabetes and lately he started to feel a tingling and numbness sensation in his foot. I give him a foot massage daily, but he is not feeling better. Is there anything I can do or any medication he can take to help feel his foot again?
A. Numbness and tingling may be a sign of neuropathy. It is one of the most common complications for people with diabetes. Neuropathy is damage to the nerves that run throughout the body, connecting the spinal cord to muscles, skin, blood vessels, and other organs. The cause of neuropathy is unknown and currently there is not a cure. There are different types of neuropathy which are classified based on the type and number of nerves affected and the parts of the body affected. Treatment is targeted at treating the symptoms associated with neuropathy. Each person is treated on an individual basis, depending on their specific symptoms. Currently, many doctors recommend that people with neuropathy closely manage blood sugar levels, exercise regularly, and maintain an ideal weight. Various medications are used to treat the symptoms of neuropathy such as pain medications (narcotics and some seizure medications), topical creams (for pain), and antidepressants (for depression, insomnia, and anxiety). Additionally, physical therapy, massage, and acupuncture have been used to help treat diabetic neuropathy. Speak with your father's doctor to determine the best treatment for his specific symptoms.
Q. I have been able to control high numbers in the day with metformin 500mg before breakfast; however, I am not able to control it at night while sleeping. Would it do any harm to take my metformin after having a little cereal before bedtime?
A. Regular release metformin is generally dosed once or twice a day initially, and then slowly increased to a maximum daily dose of 2550mg/day. Extended-release metformin is dosed initially at 500mg per day with the evening meal. It can be increased in increments of 500mg weekly to a maximum daily dose of 2000mg. If your current regimen is not providing adequate blood glucose control, contact your physician. He or she will determine if a change in dosing or administration is needed.
Q. What do you do when there is no insurance and money to buy the insulin that you need? My husband has type 1 diabetes and needs Humalog 75/25 Pens. What can we do?
A. Many pharmaceutical companies offer prescription assistance for patients without insurance coverage.
The Partnership for Prescription Assistance (PPA) is a program created to help qualifying patients without prescription coverage obtain medications at a reduced price or free of charge through public or private programs. Their mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. You may contact the PPA by phone at 1-888-4PPA-NOW (1-888-477-2669) or though the internet at www.pparx.org.
The Together RX Access program allows qualifying patients to save on certain prescription medications. This card is made possible through a coalition of pharmaceutical companies. To enroll, you may call 1-800-444-4106 or enroll online at www.togetherrxaccess.com.
The Rite Aid Rx Savings Card and prescription savings program provides eligible Rite Aid customers the ability to save money on their prescription drugs immediately at the time of service with no enrollment fee. You may contact your local Rite Aid store or our Customer Service department at 1-800-RITEAID (1-800-748-3243) for further information.
Finally, you may also contact the manufacturer of his medication directly in order to obtain information about available patient assistance programs. Humalog 75/25 pens are manufactured by Eli Lilly and Co. You may contact them at 1-800-545-5979. If your husband is on other medications, you may submit your question along with the name of his medications (including manufacturer if it is a generic product) to our "Ask The Pharmacist" service and we would be happy to provide you with the manufacturer contact information.
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. Do I need to go to the hospital if my blood sugar is over 300?
A. Hyperglycemia should be treated as soon as you detect it. Untreated hyperglycemia may lead to serious problems.
Short term (days to weeks) hyperglycemia can lead to increased urination, increased thirst, weight loss, blurred vision, fatigue, nausea, and can also lead to many fungal and bacterial infections. More serious complications include diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHNKS).
Diabetic ketoacidosis (DKA), also known as diabetic coma, occurs when the body lacks insulin and breaks down fats for energy. When this occurs the body produces ketones which can be found in the urine. Ketoacidosis occurs when the body does not eliminate all of all the ketones in the urine and they build up in the blood. This is a life-threatening situation and needs immediate treatment. DKA is associated with blood glucose levels from 200-2,000mg/dL. Symptoms of DKA include unexplained blood glucose greater than 250mg/dL, fruity smelling breath, dry mouth, nausea, vomiting, fever, abdominal pain, low blood pressure, shortness of breath, dehydration, increased heart rate, shock, and coma. Medical assistance is needed from hospital staff. Treatment includes insulin infusions, fluid replacement, and potassium replacement.
Hyperosmolar hyperglycemic non-ketotic syndrome (HHNKS) can be life-threatening and is associated with blood glucose levels greater than 600mg/dL. Symptoms of HHNKS include dehydration, excessive thirst, low blood pressure, glucose in the urine but no ketones, hallucinations, sensory deficits, rapid eye movements, paralysis on one side of the body, loss of vision in half of the visual field, seizures, and a partial or total loss of the ability to comprehend spoken or written language and express ideas. Medical assistance is needed from hospital staff. Treatment also includes fluid replacement, potassium replacement, and insulin infusions.
Long term (years) hyperglycemia can lead to coronary artery disease, skin breakdown, infections, peripheral vascular disease which may lead to amputation of limbs, loss of vision, numbness and tingling in the extremities, feet problems, skin ulcers, joint problems, and kidney problems. Extremely high blood glucose readings are a medical emergency and require medical assistance.
If your blood glucose levels are high, consult your physician for evaluation. If you are experiencing extremely high blood glucose levels and have any of the symptoms listed above, go to the nearest hospital for medical assistance.
Q. How do you get type 2 diabetes? Is it true it is inherited?
A. Type 2 diabetes results from two factors. First, there is a genetic factor in which a predisposition to diabetes is inherited. Secondly, environmental factors play a key role. Obesity is a strong risk factor which includes eating too much fat, too little carbohydrate and fiber along with too little exercise. It seems that lifestyle affects the development of type 2 diabetes more than a high genetic risk.
Q. I had blood work done about a year ago and my results were an A1C of 5.6 and a glucose of 103. I started feeling a lot worse after meals and my new doctor has taken another blood sample and diagnosed me with pre-diabetes. He wants me to start taking Byetta. I am sure my new numbers were worse, but I am just wondering if this is overkill. Does it make sense to be taking something like Byetta with numbers like I have? Should Byetta be used for pre-diabetes?
A. People with pre-diabetes are generally started on a diet and exercise program. Those at very high risk of developing type 2 diabetes (people with pre-diabetes and other risk factors such as A1C >6%, hypertension, low HDL cholesterol, elevated triglycerides, or family history of diabetes in a first-degree relative, and who are obese and under 60 years of age) may also be treated with metformin (unless contraindicated), an oral medication for the management of type 2 diabetes. Byetta is indicated to improve blood glucose levels in people with type 2 diabetes, when used with diet and exercise program. If you are feeling uncomfortable about using Byetta, talk to your physician. He will be able to better explain why he feels this medication is appropriate for you at this stage of your condition.
Q. Recently I was diagnosed with type 2 diabetes. I was in my rose garden when a thorn drew blood on my outer arm. I thought I could save myself from sticking myself with my diabetes needle; so, I took some blood with my test strip. It was 136, which is high for me. I rechecked with a prick to my finger using a new test strip and it was 89, much better. Why the difference?
A. It's not surprising that you saw a difference in your blood glucose numbers. Blood drawn from alternate sites can produce different results. Blood drawn from the fingertip will give the most accurate reading of your glucose level at the time of the blood draw. Blood drawn from the forearm will give a reading of your glucose level 20 to 30 minutes before the blood draw. This lag occurs because of reduced capillary flow and capillary density in the forearm. Alternate site testing is best reserved for times when your blood glucose levels are somewhat stable. It is not recommended for times when your levels could be low and undetected, such as during or after exercise or illness, and in those people who cannot feel the symptoms of low blood sugar.
Q. Is it harmful to continue Lantus injections when pregnant?
A. Lantus (insulin glargine) is classified as Pregnancy Category C (either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women, or studies in women and animals are not available). Medications in Category C should only be given if the potential benefit justifies the potential risk to the fetus. More information is needed before Lantus is used routinely in pregnant women, although some physicians may choose to continue their patients on Lantus therapy throughout pregnancy. It has been recommended that women with preexisting diabetes taking insulin glargine be transitioned to NPH insulin, before pregnancy if possible or at the first prenatal visit. Please consult your physician to determine if Lantus is appropriate for you during pregnancy, or if a change in therapy is needed.
Q. Is it safe to take metformin and Zovia 1/35 together?
A. A potential drug interaction is listed between metformin and Zovia. Oral contraceptives have been reported to decrease the blood glucose lowering effects of antidiabetic medications. However, this interaction is more common in patients receiving greater than 50 mcg of ethinyl estradiol. Zovia 1/35 contains 35 mcg of ethinyl estradiol. Although an interaction between metformin and Zovia is possible, it is considered low in severity. It is recommended to closely monitor your blood glucose levels and report any alterations to your physician particularly when first starting or stopping the oral contraceptive.
Q. When is the proper time to take diabetes medication? I had always been told that I should take diabetes medication 30 minutes before meals. Recently, a label on my glipizide said "take with food". I'm confused?
A. There are two tablet formulations of glipizide, a regular release tablet and extended release tablet. The regular release formulation should be taken 30 minutes before eating and the extended release formulation should be taken with breakfast. Review your medication label to determine which formulation you have been prescribed. If you are still unsure, contact the pharmacist where your prescription was filled for further clarification.
Q. I am a 55 year old male, non-smoker, non-drinker who weighs 74kg. In the morning before meals, my glucose level is 120. Is this normal or I should start treatment?
A. In order to diagnose diabetes the doctor must complete at least one of the following blood tests: a fasting plasma glucose test, an oral glucose tolerance test, and/or an A1C test. The results will determine if you have pre-diabetes (a relatively high risk for the future development of diabetes), diabetes, or are normal.
The fasting plasma glucose test measures the blood glucose level first thing in the morning after a person does not eat (fasts) overnight. The fasting plasma glucose test defines pre-diabetes as blood glucose levels between 100 and 125 mg/dl and diabetes as blood glucose levels at 126mg/dl or above. The normal fasting blood glucose level is less than 100 mg/dl.
The oral glucose tolerance test measures blood glucose levels first thing in the morning after a person fasts and then again 2 hours after the person ingests a drink that contains glucose. With this test, pre-diabetes is defined as the 2-hour blood glucose level between 140 and 199 mg/dl and diabetes as the 2-hour blood glucose level at 200mg/dl or above. The normal 2 hour blood glucose level is less than 140 mg/dl.
The A1C test measures the percentage of glycated hemoglobin, or HbA1C, in the blood. It is a test that measures your average blood glucose for the past 2-3 months. With this test, pre-diabetes is defined as an A1C range of 5.7-6.4% and diabetes as a reading of ≤ 6.5%.
Your fasting blood glucose reading of 120mg/dl falls into the pre-diabetes category. Lifestyle modification (e.g. diet and exercise) is often the first step in treatment for people with pre-diabetes. Medication may also be prescribed for those at very high risk of developing diabetes. Please contact your physician to report your blood glucose readings and to determine if treatment is required.
Q. My fasting glucose was 101 mg/dL and the normal range is 70-99. Is this indicative of DM type II?
A. According to the American Diabetes Association, a fasting blood glucose result between 100mg/dL and 125mg/dL is considered pre-diabetes. This means that you have an increased risk of developing diabetes. A fasting blood glucose level equal to or greater than 126mg/dL is indicative of diabetes.
Q. Can you give me an estimate of the number of patients with type 1 and type 2 diabetes treated with insulin?
A. According to the CDC's 2007 National Diabetes Fact Sheet, 14% of patients with diabetes (Type 1 and 2) require the use of insulin, 13% require the use of insulin as well as oral medication, 57% take oral medication only, and 16% do not take insulin or oral medication.
Q. Is there any method of taking insulin without needle use? If so, is it a new product or in the research stage only, i.e. a patch or an oral liquid?
A. At the present time, the only route of delivery for insulin is by injection or insulin pump, which also uses a needle to administer the insulin. There was an orally inhaled insulin on the market a few years ago called ExuberaŽ (insulin human, rDNA origin); however, it was removed from the market due to poor acceptance of the product by both patients and physicians.
Q. What I should do if my coworker, who has type 1 diabetes, goes into hypoglycemic shock at work? Is there anything specific we can do to help him? He got really bad a couple weeks ago (very weak and nauseous). All he says is call an ambulance if he passes out.
A. If someone goes into hypoglycemic (low blood sugar) shock, the best measure is to seek medical assistance immediately and call 911.
You can help your coworker by learning to recognize the signs and symptoms of hypoglycemia and how to respond to this condition. Some symptoms of hypoglycemia include chills, cold sweats, blurred vision, dizziness, drowsiness, shaking, rapid heart rate, weakness, headache and fainting. Most people with diabetes carry glucose tablets or gel to treat low blood glucose levels. If your coworker is suffering from hypoglycemia, is alert, and doesn't have a glucose tablet or gel on hand, their blood sugar can be raised quickly by eating a quick source of sugar such as table sugar, hard candy, or drinking a glass of fruit juice or non-diet soda. If your coworker uses insulin, then they should also carry a glucagon injection with them. Make sure that they instruct one or more people in the office on when and how to administer this if necessary.
Patients with diabetes can also suffer from hyperglycemia (high blood sugar) which can result in loss of consciousness at extremely high levels. If this occurs a different protocol would be followed. Additional information regarding both of these issues can be found at www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/.
Again, the most important fact to remember is that if a patient with diabetes loses consciousness, call 911.
Q. My husband has recently been diagnosed with diabetes. He spent an entire week in the hospital before they could get the sugars stable. Since he has been home he has stopped taking the insulin because he says it makes his sugar level very low and he feels weak. It has been 3 weeks now with no insulin and his sugar levels go from 60 to 101. He is starting to have bad headaches and he believes he should not take the insulin at all. Do you think he could have been diagnosed incorrectly?
A. In order to diagnose diabetes a physician must complete at least one of the following blood tests: a Fasting Plasma Glucose Test, an Oral Glucose Tolerance Test, and/or a hemoglobin A1C test. These tests are usually repeated for confirmation. Unfortunately, we cannot determine whether your husband was diagnosed incorrectly. He should let his physician know that he has stopped taking his insulin and we also suggest that he record his daily blood sugar readings into a log to discuss during his next visit with his physician.
Q. Are the kits for doing an at-home A1C test accurate? I see my doctor frequently but want to see if changes in insulin have had large effect on A1C.
A. The A1C test measures a patient's average blood glucose control over the previous 2-3 months. Traditionally, people have visited their doctors for these tests; however, home A1C kits are now available. There are many factors that can affect the accuracy of these home test kits (i.e. hemoglobin variants, hemolytic anemia, pregnancy, proper usage and storage).
The American Diabetes Association recommends that patients with diabetes have their A1C tested at least twice a year and more often if necessary. If you are seeing your physician on a regular basis, there is really no need for additional testing at home. Although the A1C test is an important tool, it can not replace daily self-testing of blood glucose since the A1C test does not measure day to day control. In addition, insulin dosage cannot be adjusted on the basis of an A1C test result alone. This is why daily blood glucose checks and logging results are such an important part of keeping blood sugar in control.
If you do decide to perform a home A1C test, please discuss your results with your physician.
Q. What multivitamin is recommended for a person with Type 2 Diabetes? Is Vitamin D a good source as well?
A. According to the ADA, the majority of people with diabetes do not need additional vitamin and mineral supplementation. Individualized meal planning should include food choices to meet recommended dietary allowances (RDAs)/dietary reference intakes (DRIs) for all micronutrients. We suggest contacting your physician and/or a registered dietitian to help determine if you are receiving adequate amounts of vitamins and minerals through your diet and to determine if supplements are needed.
Q. My husband has a pre-prandial sugar of 144 and a post-prandial level of 200. He is 33 years old and I want to know if we plan for a family now, would there be any problem?
A. There are a few small studies that have shown that some men with diabetes can experience fertility issues. Diabetes can cause retrograde ejaculation which is when the semen enters the bladder instead of exiting the penis. In certain cases, this may cause infertility. Please note that these studies are small and additional studies are needed to further evaluate this possible complication. We would suggest contacting your husband's physician and/or endocrinologist about your concerns.
Q. What is the bedtime glucose goal for diabetes control?
A. We have found several different recommendations for a bedtime blood glucose goal. These recommendations range between 100-160mg/dL. Please consult with your physician to help set target levels specific to your own diabetes management.
Q. My 90 year old mother was on a regimen of oral glipizide 2 x per day and 16 units of Levemir insulin. After a 2 week period of elevated glucose readings the Dr. discontinued the glipizide and increased her insulin to 40 units. She has still not stabilized. Why did he discontinue the glipizide? It seems he should have kept her on glipizide and increased the insulin.
A. Unfortunately, we do not have enough information concerning your mother's situation to determine exactly why her physician discontinued the glipizide and increased insulin. One possible explanation is that glipizide works by stimulation pancreatic islet cells which results in increased secretion of the body's own insulin. This increase in insulin secretion helps to lower glucose levels. If your mother's pancreatic islet cells are not functioning, or there isn't a sufficient number of them functioning, then increasing the glipizide dosage would not be helpful. We recommend asking your mother's physician for an explanation so that you better understand her treatment plan.
Q. I take metformin and it makes me go to the bathroom quiet a bit but some friends of mine told me that after a while my body will get used to the med. How long does it take for the med to take control and not make me go to the bathroom so much?
A. Gastrointestinal side effects (i.e. nausea, vomiting, abdominal discomfort, flatulence, diarrhea, metallic taste) from metformin occur in approximately 30% of patients who take it. There is no specific time frame that has been documented regarding when these side effects may subside, if at all. We recommend that you consult with your physician to determine if you should continue with the metformin or consider an alternate therapy.
Q. What are the ADA guidelines for physician check-ups pre/post fall? For example, what are physicians required to test during check-ups for patients with diabetes (e.g. sensation, light touch, etc.) before/after a fall?
A. Each year the American Diabetes Association (ADA) publishes the Clinical Practice Recommendations, Standards of Medical Care in Diabetes. The recommendations for 2010, Section V, Diabetes Care, address physician care standards for treatment of the patient with diabetes. This includes what should be included in a medical exam. We reviewed this section and did not find any reference to care after a patient fall. The complete recommendations for patient care are extensive and can be reviewed on-line at http://care.diabetesjournals.org/content/33/Supplement_1/S11.full.
The ADA has also prepared a suggested checklist of things your health care provider should do as part of a good first visit as well as follow-up visits. The checklist can be found at www.diabetes.org/living-with-diabetes/treatment-and-care/who-is-on-your-healthcare-team/your-first-visit.html.
Q. I have been injecting myself in my stomach. I tried my left arm and then my right thigh, but the bruising was awful and it was painful. Where else can I take my injections?
A. The abdomen, upper back of the arms and outer thigh are preferred sites when injecting insulin. Insulin enters the blood at different speeds depending on the site used. Insulin shots work fastest when given in the abdomen. Insulin arrives in the blood a little more slowly from the upper arms and even more slowly from the thighs and buttocks. To get the best results from your insulin, it is best to use the same general area for injection at the same time each day. For example, take your morning insulin in your abdomen and your afternoon or evening insulin in your arm. This consistency helps your body better absorb the insulin over random injection sites. Also, it is important to rotate within each injection site. If you inject insulin in the same spot each time, a hard lump may develop which will decrease how well the insulin is absorbed. If you are having a lot of pain when you inject your insulin, consult you physician about using a different needle gauge or length.
Q. Should a person with diabetes avoid sugar, carbonated beverages with sugar, and other foods in which sugar is an ingredient?
A. It is important to eat regular meals and snacks with the proper proportions of carbohydrates, proteins and fats. A person with diabetes should only eat small amounts of sugar; it doesn't need to be avoided completely. Sugary foods such as cookies, pies, cakes and ice creams contain few nutrients and are high in calories. It is best to limit the amount of these types of foods. Remember that sugar found in fruits, juices, vegetables, and starches can also raise blood glucose. We recommend that you speak with your physician or a registered dietician to help devise a meal plan that is appropriate for you. This plan should include the amount of sugar that your physician or dietician feels is appropriate for you to consume.
Q. I have pre-diabetes. I have started to take a low dose of metformin. How does this drug work to improve my insulin resistance?
A. Metformin belongs to the class of drugs known as biguanides. It works by helping to restore the body's proper response to the insulin it naturally produces and by decreasing the amount of sugar that the liver makes and the stomach/intestines absorb.
Q. When I test my blood sugar if it is high, how do I get it to come down?
A. Hyperglycemia (elevated blood glucose levels) may be controlled with oral diabetes medications and/or insulin therapy. Exercise is also a common treatment for hyperglycemia. (Please note: If your blood sugar is higher than 240mg/dL, check your urine for ketones before exercising. If there are ketones in the urine, do not exercise, this could cause the blood sugar level to increase further. Contact a doctor if this occurs.)
Other measures that may be taken to help decrease your blood sugar include changing your diet and increasing water consumption. If altering your diet and exercise do not work, you may need to have the doctor adjust your oral medication or insulin. If your blood sugar is higher than normal, you should not give yourself additional medication or insulin without consulting with your physician unless otherwise directed to do so.
Q. My mom is abroad and she has diabetes (not sure which type). She is 58 years old. What is the risk of her being in a 3rd world country with no treatments? Her glucose has been very high in 300. What should I do?
A. Hyperglycemia (elevated blood glucose levels) should be treated as soon as it is detected. Untreated hyperglycemia may lead to serious problems.
Short term (days to weeks) hyperglycemia can lead to increased urination, increased thirst, weight loss, blurred vision, fatigue, nausea, and can also lead to many fungal and bacterial infections. More serious complications include diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHNKS).
Diabetic ketoacidosis (DKA), also known as diabetic coma, occurs when the body lacks insulin and breaks down fats for energy. When this occurs the body produces ketones which can be found in the urine. Ketoacidosis occurs when the body does not get rid of all the ketones in the urine and they build up in the blood. This is a life-threatening situation and needs immediate treatment. DKA is associated with blood glucose levels from 200-2,000mg/dL. Symptoms of DKA include unexplained blood glucose greater than 250mg/dL, fruity smelling breath, dry mouth, nausea, vomiting, fever, abdominal pain, low blood pressure, shortness of breath, dehydration, increased heart rate, shock, and coma. Medical assistance is needed from hospital staff. Treatment includes insulin infusions, fluid replacement, and potassium replacement.
Hyperosmolar hyperglycemic non-ketotic syndrome (HHNKS) can be life-threatening and is associated with blood glucose levels greater than 600mg/dL. Symptoms of HHNKS include dehydration, excessive thirst, low blood pressure, glucose in the urine but no ketones, hallucinations, sensory deficits, rapid eye movements, paralysis on one side of the body, loss of vision in half of the visual field, seizures, and a partial or total loss of the ability to comprehend spoken or written language and express ideas.
We suggest that your mother seek medication attention if her levels continue to remain elevated.
