Dr. Calof Answers Questions About Diabetes

January 02, 2015

After speaking at a series of patient meetings on the subject of Diabetes, Dr. Olga Calof, M.D. has compiled a list of the top questions and answers that are important to those dealing with this condition.

  1. My non fasting glucose is 95 mg/dL. My feet burn at times.  Should I see a doctor?
  2. My dad died from diabetes complications.  My brother developed diabetes last year.  Am I at risk for this disease?
  3. Does glucose testing done at home correlate with the HbA1C test?
  4. Please explain the difference between type 1 and type 2 diabetes.
  5. Are “sugar spots” a true sign of diabetes?  The light skin spots known as sugar spots showed up approximately one year before I was diagnosed with a HgA1C of 12.9% and a blood sugar of 12,650mg/dL.
  6. My doctor has me taking 3 metformin/day. Can I take those all at once or should I be splitting them throughout the day?
  7. Can anxiety/panic disorder affect or cause type 1 diabetes?
  8. Do fertility drugs increase blood sugar?
  9. Do diabetic medications cause bladder or kidney cancer?
  10. Does cinnamon help control sugar levels?
  11. If the test results show HgA1C levels of 7.5% and eAG shows 111 mg/dL do I have uncontrolled diabetes?
  12. Does an eAG of 111 mg/dL mean I am a diabetic?
  13. What causes pancreatitis, and how can it be prevented?
  14. Why do diabetic people “need” a quick sugar fix when they’re feeling weak or run down?
  15. If my doctor gave me medicine for diabetes, but my sugar after meals is usually below 116 mg/dL, do I need to take my medicine?
  16. What is the reality of how artificial sugar is processed in our body?
  17. I am exercising in a gym doing treadmill, elliptical and sit-ups (150x) for 1-1.5 hours. I am not losing weight. Is there anything more I can do?
  18. What is better for diabetics, whole wheat, white whole-wheat, or white bread?
  19. On the subject of obesity, how much is overweight?
  20. If you are diabetic, can you reverse that and become non-diabetic?
  21. Is it possible to not even get diabetes, once diagnosed as pre-diabetic?
  22. Helpful websites to browse for more information
  1. My non fasting glucose is 95 mg/dL. My feet burn at times.  Should I see a doctor?
    1. The short answer is YES, schedule an appointment to see your doctor. 
    2. A random blood sugar of 95 milligrams per deciliter (mg/dL) at home leads to more questions.  Is this a random blood sugar (taken anytime during the day), or a fasting blood sugar (done after an eight hour fast).  This is an important piece of information, but not enough to allow any conclusions to be made.   
    3. To be diagnosed with diabetes, you must meet one of the following criteria:
      1. Have symptoms of increased thirst, increased urination, and unexplained weight loss, and a blood sugar level equal to or greater than 200 mg/dL. This is for a blood sugar test done at any time, whether or not you fast (random plasma glucose test or random blood sugar test).
      2. Have a fasting blood sugar level of 126 mg/dL or greater. A fasting blood sugar test (fasting plasma glucose) is done after not eating or drinking anything but water for eight hours.
      3. Have a 2-hour oral glucose tolerance test (OGTT) result that is 200 mg/dL or greater. An OGTT is most commonly done to check for diabetes that occurs with pregnancy (gestational diabetes).
      4. Have a hemoglobin A1c that is 6.5% or higher.
      5. The diagnosis of diabetes must be confirmed by repeating the same blood sugar test or doing a different test on another day.
    4. If the results of your fasting blood sugar test are between 100 mg/dL and 125 mg/dL, your OGTT result is between 140 to 199 mg/dL (2 hours after the beginning of the test), or your hemoglobin A1c is 5.7% to 6.4%, you have prediabetes. This means that your blood sugar is above normal, but not high enough to be diabetes
    5. In answer to this question, if your random blood sugar level was 95 mg/dL, it would not fit into any of the above categories. Therefore, further evaluation is warranted, and you may schedule a visit with your doctor.  
    6. Most often, neuropathy is the cause of burning feet. Damaged nerve fibers are more likely to become overactive and misfire. The damaged nerves send pain signals to the brain even though there is no wound or injury. While diabetes and alcohol abuse are by far the most common causes of neuropathy in the legs, many other conditions can cause neuropathy or a burning sensation in the feet. Before reviewing a list of all the possible causes here, I would recommend visiting your doctor.
  2. My dad died from diabetes complications.  My brother developed diabetes last year.  Am I at risk for this disease?
    1. Yes, you may be at risk for diabetes. 
      1. Researchers don't fully understand why some people develop type 2 diabetes and others don't. It's clear, however, that certain factors increase the risk, including:
        1. Weight. Being overweight is a primary risk factor for type 2 diabetes. The more fatty tissue you have, the more resistant your cells become to insulin. However, you don't have to be overweight to develop type 2 diabetes.
        2. Fat distribution. If your body stores fat primarily in your abdomen, your risk of type 2 diabetes is greater than if your body stores fat elsewhere, such as your hips and thighs.
        3. Inactivity. The less active you are, the greater your risk of type 2 diabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
        4. Family history. The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes.
        5. Race. Although it's unclear why, people of certain races and ethnicities — including African-Americans, Hispanics, American Indians and Asian-Americans — are more likely to develop type 2 diabetes.
        6. Age. The risk of type 2 diabetes increases as you get older, especially after age 45. That's probably because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes also is increasing dramatically among children, adolescents and younger adults.
        7. Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes can progress to type 2 diabetes.
        8. Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing type 2 diabetes increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes.
        9. Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
  3. Does glucose testing done at home correlate with the HbA1C test?
    1. One test, unlikely, but multiple checks may correlate.
      1. As important as the A1C is, it is not a substitute for frequent self-monitoring. Only regular blood sugar checks show you how meals, activity, medications and stress affect your blood sugar at a single moment in time, as well as over the course of a day or week.
      2. In fact, without regular self-testing to provide day-to-day insights, an A1C result can be confusing. Because it gives a long-term view, a person with frequent highs and lows could have an in-range A1C result that looks quite healthy. 
      3. If you had multiple checks, at various times, and the average was 95mg/dL, it may be extrapolated to an HgA1C of 5%, completely normal. These are just 2 data points in the spectrum of diabetes management. The only way to get a complete picture of your blood sugar control is by reviewing your day-to-day self-checks along with your regular A1C tests, and working closely with your health care team to interpret the results.
  4. Please explain the difference between type 1 and type 2 diabetes.
    1. Type 1 diabetes
      1. Type 1 diabetes, which used to be called juvenile diabetes, develops most often in young people; however, type 1 diabetes can also develop in adults. In type 1 diabetes, your body no longer makes insulin or enough insulin. This may happen because the body’s immune system, which normally protects you from infection by getting rid of bacteria, viruses and other harmful substances, has attacked and destroyed the cells that make insulin, or something has happened that has damaged the pancreas and prevents it from producing insulin.
      2. Treatment for type 1 diabetes includes:
        1. Taking shots, also called injections, of insulin
        2. Sometimes taking medicines by mouth
        3. Making healthy food choices
        4. Being physically active
        5. Controlling your blood pressure levels. Blood pressure is the force of blood flow inside your blood vessels.
        6. Controlling your cholesterol levels. Cholesterol is a type of fat in your body’s cells, in your blood, and in many foods
    2. Type 2 diabetes
      1. Type 2 diabetes, which used to be called adult-onset diabetes, can affect people at any age, even children. However, type 2 diabetes develops most often in middle-aged and older people. People who are overweight and inactive are more likely to develop type 2 diabetes.
      2. Type 2 diabetes usually begins with insulin resistance — a condition that occurs when fat, muscle and liver cells do not use insulin to carry glucose into the body’s cells to use for energy. As a result, the body needs more insulin to help glucose enter cells. At first, the pancreas keeps up with the added demand by making more insulin. Over time, the pancreas does not make enough insulin when blood sugar levels increase, such as after meals. If your pancreas can no longer make enough insulin, you will need to treat your type 2 diabetes.
      3. Treatment for type 2 diabetes includes:
        1. Taking diabetes medicines
        2. Making healthy food choices
        3. Being physically active
        4. Controlling your blood pressure levels
        5. Controlling your cholesterol levels
  5. Are “sugar spots” a true sign of diabetes?  The light skin spots known as sugar spots showed up approximately one year before I was diagnosed with a HgA1C of 12.9% and a blood sugar of 12,650mg/dL. 
    1. These “sugar spots” may have been an early warning sign to see your doctor and review possible causes.
    2. Skin conditions linked to diabetes:
      1. Scleredema diabeticorum: This condition causes a thickening of the skin on the back of the neck and upper back. It is rare, but can affect people with type 2 diabetes. The treatment is to bring your blood glucose level under control. Lotions and moisturizers may help soften the skin.
      2. Vitiligo: Vitiligo is a condition that affects skin coloration. With vitiligo, the special cells that make pigment (the substance that controls skin color) are destroyed, resulting in patches of discolored skin. Vitiligo often affects the chest and abdomen, but may be found on the face around the mouth, nostrils and eyes. This condition is more commonly associated with type 1 diabetes.
    3. Problems associated with insulin resistance:
      1. Acanthosis nigricans: This is a condition that results in the darkening and thickening of certain areas of the skin, especially in the skin folds. The skin becomes tan or brown and is sometimes slightly raised and described as velvety. Most often the condition, which typically looks like a small wart, appears on the sides or back of the neck, the armpits, under the breast and at the groin. Occasionally, the tops of the knuckles have a particularly unusual appearance. Acanthosis nigricans usually strikes people who are very overweight. There is no cure for acanthosis nigricans, but losing weight may improve the condition. Acanthosis nigricans usually precedes diabetes. There are other conditions that also are known to cause acanthosis nigricans, including acromegaly and Cushing's syndrome. This condition is a skin manifestation of insulin resistance in most people.
    4. Problems associated with reduced blood supply to the skin:
      1. Skin problems linked to atherosclerosis: Atherosclerosis is the narrowing of blood vessels from a thickening of the vessel walls due to plaque buildup. While atherosclerosis most often is associated with blood vessels in or near the heart, it can affect blood vessels throughout the body, including those that supply blood to the skin. When the blood vessels supplying the skin become narrow, a lack of oxygen causes changes to the skin such as hair loss, thinning and shiny skin, especially on the shin. Other symptoms include thickened and discolored toenails and cold skin. Because blood carries the white blood cells that help fight infection, injuries to legs and feet affected by atherosclerosis heal more slowly.
      2. Necrobiosis lipoidica diabeticorum (NLD): NLD is caused by changes in the collagen and fat content underneath the skin. The overlying skin area becomes thin and red. Lesions form and most often are found on the lower parts of the legs and can become open sores if injured. Lesions have fairly well-defined borders between normal skin and affected lesions. Sometimes, NLD is itchy and painful. As long as the sores do not break open, treatment is not necessary. If the sores do break open, see your doctor for treatment.
      3. Diabetic dermopathy: Also called shin spots, this condition develops as a result of changes to the blood vessels that supply the skin. Dermopathy appears as a shiny round or oval lesion of thin skin over the front lower parts of the lower legs. The patches do not hurt and rarely cause itching or burning. Treatment generally is not necessary.
      4. Digital sclerosis: Digital sclerosis is a condition in which the skin on your toes, fingers, and hands, becomes thick, waxy and tight. Stiffness of the finger joints also may occur. The treatment is to bring your blood glucose level under control. Lotions and moisturizers may help soften the skin.
      5. Eruptive xanthomatosis: This condition may occur when triglycerides rise to extremely high levels. Severe resistance to insulin makes it difficult for the body to clear the fat from the blood. With extreme elevations in these blood fats, people are at risk for pancreatitis, an inflammation of the pancreas. Eruptive xanthomas appear as firm, yellow, waxy pea-like bumps on the skin. The bumps -- which are itchy and surrounded by red halos -- usually are found on the eyes, elbows, face and buttocks. They also can be seen on the back side of the arms and legs as well as in the creases of the extremities. Treatment for eruptive xanthomatosis consists of controlling the level of fats in your blood. The skin eruptions will resolve over several weeks. Drugs that control different types of fats in the blood (lipid-lowering drugs) may also be needed.
    5. Rashes, bumps and blisters:
      1. Diabetic blisters (bullous diabeticorum): In rare cases, people with diabetes develop blisters that resemble burn blisters. These blisters can occur on the fingers, hands, toes, feet, legs or forearms. Diabetic blisters usually are painless and heal on their own. They often occur in people who have severe diabetes and diabetic neuropathy. Bringing your blood glucose level under control is the treatment for this condition.
      2. Disseminated granuloma annulare: This condition causes sharply defined, ring- or arc-shaped areas on the skin. These rashes most often occur on the fingers and ears, but they can also occur on the chest and abdomen. The rash can be red, red-brown or skin colored. Treatment usually is not required, but sometimes a topical steroid medication, such as hydrocortisone, may help.
  6. My doctor has me taking 3 metformin/day. Can I take those all at once or should I be splitting them throughout the day?
    1. Metformin is the generic name for several medications.  It may come in short-acting and ong-acting form. The long-acting form has letters such as ER or XL after the name. 
    2. The short-acting form is recommended to take twice or three times daily with food or after eating.
    3. The long-acting forms may be taken once, at the same time each day. This may simplify the regimen for many patients. Your regimen would be discussed and recommended by your primary care physician.
    4. The brand names for metformin are:
      1. Fortamet
      2. Glucophage
      3. Glucophage XR
      4. Glumetza
      5. Riomet — a liquid form of metformin
  7. Can anxiety/panic disorder affect or cause type 1 diabetes?
    1. First, the exact cause of type 1 diabetes is unknown. In most people with type 1 diabetes, the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas. Genetics may play a role in this process, and exposure to certain environmental factors, such as viruses, may trigger the disease.
    2. We have learned the chronic stress can lead to the development of depression.  Depression may be associated with the development of type 2 diabetes. No clear correlation has been found, but many associations have been noted.
  8. Do fertility drugs increase blood sugar?
    1. Fertility drugs work by increasing the levels of certain hormones in your body to help induce fertility and conception.  There are several hormones involved in reproductive endocrinology and infertility management, such as:
    2. Progesterone may increase insulin resistance.
    3. Estrogen may increase insulin sensitivity.
    4. Some drugs used to treat infertility are the same medications used to treat diabetes. These include, Metformin/Glucophage, which improves insulin sensitivity.
  9. Do diabetic medications cause bladder or kidney cancer?
    1. There has been talk and published data that some medications, such as Pioglitazone/Actos, may increase risk of bladder cancer. However, this risk is very small, if any, and has not led to the FDA removing these medications from the market. 
    2. Pioglitazone is still widely available and still has a role treating diabetes. It is available in generic form and is a very good “insulin sensitizer.”
      1. Actos improves how the body uses insulin.
      2. Actos decreases the amount of glucose released by the liver.
      3. Actos does not cause the body to make more insulin, therefore, when used alone, it does not cause low blood glucose (hypoglycemia).
    3. It must be mentioned that diabetes increases the risk of developing cancer, and diminishes responses to treatment.
    4.  No specific diabetic medication has been directly linked with renal/kidney cancer.
  10. Does cinnamon help control sugar levels?
    1. Whether cinnamon can lower blood sugar is a topic of debate — but recent research suggests that cinnamon may be helpful as a supplement to regular diabetes treatment in people with type 2 diabetes.
    2. A 2012 review of several recent studies concluded that the use of cinnamon had a potentially beneficial effect. One study published in 2009 found that a 500 mg capsule of cinnamon taken twice a day for 90 days improved hemoglobin A1C levels — a reflection of average blood sugar level for the past two to three months — in people with poorly controlled type 2 diabetes (hemoglobin A1C levels greater than 7 percent).
    3. More research is needed to confirm these findings and determine how cinnamon supplementation leads to these benefits. One theory is that cinnamon increases insulin action. 
    4. If you have diabetes, remember that treatment is a lifelong commitment of blood sugar monitoring, healthy eating, regular exercise and, sometimes, diabetes medications or insulin therapy. Consult your doctor if you have questions or concerns about your diabetes treatment plan.
    5. Cinnamon is not a substitute for diabetic therapy that may be recommended by your doctor.
  11. If the test results show HgA1C levels of 7.5% and eAG shows 111 mg/dL do I have uncontrolled diabetes?
    1.  Average glucose, known as eAG, directly correlates to your A1C. eAG as reported by a lab, may help you understand your A1C value better because eAG is reported in units you may be more familiar with. A1C is reported as a percent (7% for example) and eAG uses the same units (mg/dl) as your glucose meters.
    2. With an HgA1C of 7.5%, your eAG is 169 mg/dL.
    3. With an eAG of 111 mg/dL, your A1C is 5.5%.
    4. It seems there is a discrepancy between the eAG and the HgA1C in this case. There may be several reasons:  the results might have been taken from separate occasions, so please recheck the levels reported. The HgA1C is a calculation based on the average normal age of red blood cells. The HgA1C might be decreased in conditions that decrease red blood cell age, such as recent transfusions or increased erythropoiesis secondary to breakdown of red blood cells, or blood loss.  While conditions increasing red blood cell age, such as asplenia (absence of spleen), tend to increase HbA1c levels.  In all these instances, even if HbA1c itself is measured correctly, a given value of A1c% will correspond to a different average serum glucose concentration.
  12. Does an eAG of 111 mg/dL mean I am a diabetic?
    1. This value corresponds to an HgA1C of 5%, which is entirely normal, in a non-diabetic range. Diabetes may be diagnosed at an HgA1C level of >6.5%.
  13. What causes pancreatitis, and how can it be prevented?
    1. Pancreatitis occurs when digestive enzymes produced in your pancreas become activated while inside the pancreas, causing damage to the organ.
      1. A number of causes have been identified for acute (sudden attack) pancreatitis and chronic (long-standing) pancreatitis, including:
      2. Alcoholism
      3. Gallstones
      4. Abdominal surgery
      5. Certain medications
      6. Cigarette smoking
      7. Cystic fibrosis
      8. Endoscopic retrograde cholangiopancreatography (ERCP), when used to treat gallstones
      9. Family history of pancreatitis
      10. High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism)
      11. High triglyceride levels in the blood (hypertriglyceridemia)
      12. Infection
      13. Injury to the abdomen
      14. Pancreatic cancer
    2. Prevention of pancreatitisconsists of limiting exposure to anything that may provoke the attack.  How this may affect you, should be discussed with your doctor.
  14. Why do diabetic people “need” a quick sugar fix when they’re feeling weak or run down?
    1. These may be symptoms of hypoglycemia (low blood sugar).
    2. Hypoglycemia is a condition that can cause symptoms characterized by abnormally low blood glucose (blood sugar) levels, usually less than 70mg/dL.
    3. People with diabetes get hypoglycemia (low blood sugar) when their bodies do not have enough sugar to use as fuel.
    4. Several things can cause hypoglycemia, including diet and some medications. Certain medical conditions can also make hypoglycemia more common in people with diabetes. Exercise also can trigger hypoglycemia.
    5. The only way to know for sure is to check your blood glucose, if possible. We recommend treating symptoms if you are unable to check your blood sugar levels. Severe hypoglycemia has the potential to cause accidents, injuries, coma and death. Therefore it is very important to recognize and treat it as soon as possible.
    6. Treatment
      1. Consume 15-20 grams of glucose or simple carbohydrates (See below.)
      2. Recheck your blood glucose after 15 minutes.
      3. If hypoglycemia continues, repeat.
      4. Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away.
    7. Commonly used 15 grams of simple carbohydrates:
      1. Glucose tablets (follow package instructions)
      2. Gel tube (follow package instructions)
      3. Two tablespoons of raisins
      4. Four ounces (1/2 cup) of juice or regular soda (not diet)
      5. One tablespoon sugar, honey, or corn syrup
      6. Eight ounces of nonfat or 1% milk
      7. Hard candies, jellybeans or gumdrops (see package to determine how many to consume).
  15. If my doctor gave me medicine for diabetes, but my sugar after meals is usually below 116 mg/dL, do I need to take my medicine?
    1. Normal pre-meal blood sugars are 70-90 mg/dL, and normal 1-2 hour post-meal blood sugars are <120 mg/dL. Most non-diabetic individuals may be <100 mg/dL after a meal.
    2. It is possible that the medication you are taking is helping the sugars stay controlled.  In many cases, medications may be continued even when the HgA1C is controlled.  It is certainly worth your while to review your test results with your doctor.
  16. What is the reality of how artificial sugar is processed in our body?
    1. Different sweeteners have different advantages and disadvantages. If you worry about the calories, then stay away from sugar. If you are most concerned about taste quality, sugar generally tastes best.
    2. Some artificial sweeteners can have side effects. If you eat too much sorbitol, for instance -- a type of sweetener called a "sugar alcohol" -- it can trigger gas and diarrhea. This is because your body doesn't digest sorbitol as well.
    3. Artificial sweeteners contain no calories, so they may aid in weight loss. Yet research suggests fake sugar in diet sodas teases your body by pretending to give it real food.  But when your brain doesn't get the fuel in the form of sugar it expects, it becomes confused on how to respond.
    4. As your body gets “tricked” by the sugar substitute, you crave more food and become susceptible to overeating in order to feel satisfied. The result? You feel even hungrier and less full, which can lead to weight gain.
  17. I am exercising in a gym doing treadmill, elliptical and sit-ups (150x) for 1-1.5 hours. I am not losing weight. Is there anything more I can do?
    1. The keys to weight loss in my clinic:  Decrease your calorie intake, keep a diary and exercise for weight maintenance.
    2. Cutting calories through dietary changes seems to promote weight loss more effectively than does exercise and physical activity. But,physical activity also is important in weight control.
    3. The key to weight loss is to consume fewer calories than you burn. For most people, it's possible to lower their calorie intake to a greater degree than it is to burn more calories through increased exercise. That's why cutting calories through lifestyle changes is generally more effective for weight loss. But doing both — cutting calories and exercising — can help give you the weight-loss edge. Exercise can help burn even more calories than just dieting. Just don’t consume more food because you exercised.
    4. Exercise also is important because it can help you maintain your weight loss. Studies show that people who lose weight and keep it off over the long term get regular physical activity.
    5. The exercise regimen listed in the question above is excellent, great for glucose control and cardiovascular health, but may not be sufficient to lose weight. Some degree of calorie restriction might be needed. Please take the opportunity to discuss this further with your doctor and diabetic team.
  18. What is better for diabetics, whole wheat, white whole-wheat, or white bread?
    1. It may seem like it doesn't add up, but white whole-wheat bread is made with whole grains, just as is regular whole-wheat bread. White whole-wheat bread is made from the whole grain — bran, germ and endosperm — similar to that of regular whole-wheat bread.
    2. The difference between white whole-wheat bread and regular whole-wheat bread is in the type of wheat used. White whole-wheat bread is made from white wheat, which lacks bran color. It also has a milder flavor and softer texture.
    3. In contrast, regular whole-wheat bread is made from red wheat, which is darker in color. It has a slightly bitter taste and a coarser texture. So even though both types of bread are made with whole grains, they have a different color, taste and texture.
    4. Regular white bread is made with refined grains, which go through a process that strips out certain parts of the grain — along with some of the nutrients and fiber. Although refined grains are enriched — they have some of the nutrients added back — they may not have exactly the same composition as whole grains.
    5. If you prefer the taste and texture of white bread, but want the natural nutritional benefits of whole wheat, choose white whole-wheat bread. But, be sure to read the label. Choose breads that say "100 percent whole grain" or lists "whole wheat" as the first ingredient. If the label doesn't say "whole" first, it isn't a whole-grain product. For example, a product label may simply say "white wheat," which is not the same as white whole-wheat. 
    6. Learning to read labels takes some skill. Read the label, and if possible, look for more protein, higher fiber content. You may find that by eating healthier choices, you lose the cravings for processed foods.
  19. On the subject of obesity, how much is overweight? 
    1. For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the "body mass index" (BMI). BMI is used because, for most people, it correlates with their amount of body fat.
    2. An adult who has a BMI between 25 and 29.9 is considered overweight.
    3. An adult who has a BMI of 30 or higher is considered obese.
    4. See the following table for an example.
    5. Height Weight Range BMI Considered
      5' 9" 124 lbs or less Below 18.5 Underweight
        125 lbs to 168 lbs 18.5 to 24.9 Healthy weight
        169 lbs to 202 lbs 25.0 to 29.9 Overweight
        203 lbs or more 30 or higher Obese
  20. If you are diabetic, can you reverse that and become non-diabetic?
    1. There is no cure for diabetes. Neither type 1 (juvenile-onset or insulin-requiring) diabetes or type 2 (adult-onset) diabetes ever goes away.
    2. Patients diagnosed with type 2 diabetes may discover that if they are overweight at diagnosis and then lose weight and begin regular physical activity, their blood glucose may return to normal. Does this mean diabetes has disappeared? It means the diabetes is diet-controlled and in remission, but it has not gone away. 
    3. There are many books out with the title of ‘reversing diabetes’ which implies controlling it to the point of ‘normal’ blood sugar levels. We call this diabetes type 2, diet-controlled. 
  21. Is it possible to not even get diabetes, once diagnosed as pre-diabetic?
    1. YES!
    2. Without intervention, prediabetes is likely to become type 2 diabetes in 10 years or less.
    3. Take the advice of your doctor and put it to action. 
  22. Helpful websites to browse for more information:
    1. Joslin Diabetes Center at http://www.joslin.org/index.html
    2. American Diabetes Association at http://www.diabetes.org/