Dr. Calof Answers Questions - November 18, 2015

November 18, 2015

The contents of the Providence Medical Group website are for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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. What are some diabetic neuropathy solutions?
  2. What causes diabetic neuropathy and nerve pain?
  3. At what HgA1C number should a person start taking medication?
  4. Do pre-diabetics need to take medication?.
  5. If a person has 3 kidneys does each kidney have an adrenal gland and can that lead to health problems?
  6. How can you tell the difference between hot flashes and high blood sugars?
  7. Can aggressive life-style changes normalize blood sugar?
  8. Is carbonated water good for you?
  9. How can you measure ½ oz of nuts or seeds (what does it look like)?
  10. How much sodium is in one teaspoon of salt?
  11. What are the diabetic health benefits of of juicers?
  12. Are there benefits of a gluten free diet?
  13. What is your opinion of the link between statins and diabetes?
  14. Why do steroids elevated the A1C?
  15. Can you have an elevated A1C and high normal fasting glucose? Why?
  16. I am not pre-diabetic or diabetic, I have a random blood glucose level of 103 mg/dL, but I am osteoporotic. I heard it is not good to exercise or do weight training if you are osteoporotic, is that true?
  1. What are some diabetic neuropathy solutions?
    1. Good control of diabetes over time is the key to treating diabetic neuropathy. There is no cure for neuropathy, but keeping your blood sugar within a target range can reduce symptoms and prevent them from getting worse.
    2. To help control your diabetes, eat food that is good for you, exercise, and take medications and/or insulin according to your doctor’s recommendations. This will do more than anything else to help prevent diabetic neuropathy from getting worse.
    3. Further treatment depends on the specific type of diabetic neuropathy that you have along with your current symptoms.
    4. Speak with your doctor and possibly see a neurologist for ongoing care recommendations.
  2. What causes diabetic neuropathy and nerve pain?
    1. Prolonged exposure to high blood sugar can damage delicate nerve fibers, causing diabetic neuropathy. Why this happens isn't completely clear, but a combination of factors likely plays a role, including the complex interaction between glucose, nerves and blood vessels.
    2. High blood sugar interferes with the ability of the nerves to transmit signals. It also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.
    3. There are many reasons, including genetic factors, autoimmune factors, smoking, and alcohol use that may predispose someone to develop diabetic neuropathy.
    4. Reference:  http://www.joslin.org/info/diabetic_neuorpathy_nerve_damage_an_update.html
  3. At what HgA1C number should a person start taking medication?
    1. Generally with diagnosis, lifestyle changes and oral medications are first in line. There are various choices of therapy recommendations based on A1C and other medical problems. 
    2. In general, treatment at diagnosis of DM type 2 is recommended. 
    3. Pre-diabetics may be offered medication on top of lifestyle treatments. 
  4. Do pre-diabetics need to take medication?
    1. Not always, lifestyle therapy and risk reduction is key in pre-diabetes. 
    2. Due to significantly higher risk of disease, control of cholesterol and/or hypertension may necessitate medications even if no medications are started for pre-diabetes. 
  5. If a person has 3 kidneys does each kidney have an adrenal gland and can that lead to health problems?
    1. As long as your kidneys are functioning normally and there is no anatomical problem, both kidney and adrenal function should be normal.
  6. How can you tell the difference between hot flashes and high blood sugars?
    1. The best and only way to tell for sure is to test your blood sugar.  If you're a woman "of a certain age" either is possible.
  7. 7. Can aggressive life-style changes normalize blood sugar?
    1. There are many cases of significant changes in weight, food intake and exercise that have brought blood glucose and A1C down to normal levels.  There is even more data that bariatric surgery can “normalize” blood sugar levels.  Yes, it is possible, but once you developed the disorder, if there is a change in diet/lifestyle/weight, the sugar will climb back up. 
    2. Lifetime vigilance and living healthy is the key to lifetime of normalized blood sugar—I don’t think there is anything wrong with living a healthy lifestyle!
    3. The earlier we diagnose diabetes and prediabetes, the earlier we can make changes to a healthier lifestyle, and prevent complications. 
  8. Is carbonated water good for you?
    1. Don’t worry about carbonation. Scare stories about its purported detrimental effects continue to pop up, but a number of studies have shown that there’s really no danger. The notion that the carbonation in sodas is bad for bones comes from studies performed in the early 1990s, which suggested that drinking soda, specifically cola, raises the risk of bone fractures among adolescent girls and older women who were former college athletes. No such association was found for non-cola drinks. The National Osteoporosis Foundation (NOF) states that there is no connection between the carbonation in soft drinks and bone loss and that certain carbonated mineral waters (the ones rich in calcium and those that are more alkaline) have actually been shown to improve bone health.
    2. Soft drinks are bad for teeth, especially in children. But the carbonation isn’t to blame; it’s the high sugar content of sweetened carbonated beverages that is responsible for tooth decay, which is now the most common childhood disease – five times more common than asthma, according to the American Dental Association.
    3. Drinking unsweetened carbonated water can improved indigestion and make you feel more full, which can decrease the calories you would consume with a meal.
    4. Reference: http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-blog/carbonated-water/bgp-20056174
  9. How can you measure ½ oz of nuts or seeds (what does it look like)?
    1. A 1-ounce serving of almonds, for example, is generally about 23 nuts. More often, however, the standard 1-ounce serving is conveyed in traditional by-volume terms -- for most nuts and seeds, a 1-ounce serving is approximately 1/4 cup.
    2. An average 1-ounce serving of nuts or seeds provides about 175 calories.
    3. To get half an ounce you would have about 14 nuts or 1/8 cup.  This would supply approximately 90 calories.
  10. How much sodium is in one teaspoon of salt?
    1. 2,325 mg sodium is in 1 teaspoon or 6 grams of table salt.
    2. Many healthier diets recommend <2000 mg sodium daily. 
  11. What are the diabetic health benefits of of juicers?
    1. It certainly helps the bottom line of the seller!
    2. We always recommend eating the fruits and vegetables in their natural state or baked/steamed/boiled. 
    3. Juicing/smoothies remove the valuable fiber from the whole vegetable/fruit.  You will obtain a smoothie that is higher in calories, and will make you feel more hungry after 1-2 hours than eating the contents in their original state. 
    4. You may have a glucose spike after consuming the smoothie as it is easier to digest and enter the bloodstream than solid food.
    5. Juicing and/or smoothies are a great way to gain weight if that is your goal.
  12. Are there benefits of a gluten free diet?
    1. This is a complicated answer. 
    2. Celiac disease occurs in about 1% of the total population. Celiac disease is more common in people with type 1 diabetes.
    3. There are also many people who are gluten intolerant (also called a gluten sensitivity). When these people eat foods that contain gluten, they experience symptoms similar to those with celiac. However, they test negative for celiac disease and actual damage to their small intestine does not occur. More research about gluten intolerance is needed, but if you experience uncomfortable symptoms when you eat gluten-containing foods, you may fall into this category. Please discuss your symptoms with your doctor.
    4. Many people assume that a gluten-free diet is always healthy diet. While there are many nutritious gluten-free foods (such as beans, vegetables, fruit, and nuts), there are also many processed gluten-free foods available at a premium. Remember that a package of gluten-free cookies or buttery crackers is not any better for you than wheat-based cookies or crackers. These are still highly processed foods that are usually high in calories and added sugar. Like any other eating plan, it is still important to choose the most nutritious foods whenever possible.
    5. If you have diabetes, eliminating gluten from your diet “just to try it” may add unnecessary stress and restrictions when meal planning. Unless you have one of these health conditions or your healthcare provider has told you to avoid gluten for another reason, there is no need to complicate meal planning by eliminating it.
    6. See more at: http://www.diabetes.org/mfa-recipes/tips/2014-01/gluten-free-diets-the.html
  13. What is your opinion of the link between statins and diabetes?
    1. Statin medications (statins) are drugs that help lower cholesterol levels in the blood to help prevent coronary heart disease for those at risk or who already have experienced some form of cardiovascular disease. Statins do carry certain risks that need ongoing physician monitoring. Some recent studies highlight how important it is to manage diabetes risk factors when taking statins especially in individuals who are at high risk for developing diabetes.
    2. Bottom line: don’t stop taking your statin, talk to your doctor about your concerns.
    3. http://health.clevelandclinic.org/2015/07/take-statins-what-you-need-to-know-about-diabetes-risk/
  14. Why do steroids elevated the A1C?
    1. Medications such as prednisone, and all other forms of steroid, whether inhaled, injected, topical or intravenous drip, can significantly increase glucose levels in patients with diabetes as well as individuals with impaired glucose tolerance or pre-diabetes.
    2. Steroids affect release of other hormones, including catecholamines (fight/flight hormones) and glucagon, all of which increase blood glucose levels.
    3. Steroids also stimulate the liver to make more glucose, which, in turn, promotes the deposition of liver glycogen. Prolonged exposure to steroids leads to a diabetic-like state due to the increase in plasma glucose. 
  15. Can you have an elevated A1C and high normal fasting glucose? Why?
    1. Yes.
      1. An elevated A1C correlates with elevated average blood glucose levels.
      2. Even though you wake up with a “normal” fasting blood glucose, your daytime blood glucose levels may be quite elevated, especially post meal, at a time you are not testing your blood glucose level.
  16. I am not pre-diabetic or diabetic, I have a random blood glucose level of 103 mg/dL, but I am osteoporotic.  I heard it is not good to exercise or do weight training if you are osteoporotic, is that true?
    1. It sounds like your random glucose level is in the normal range.
    2. It sounds like you may have received incorrect information.  Please be sure to check with your doctor first, and if there are no contraindications, restart your exercise activity.
    3. The National Osteoporosis Foundation recommends two types of exercises that are both important for building and maintaining bone density:  weight-bearing and muscle-strengthening exercises.
    4. Reference:  http://nof.org/exercise