Dr. Calof Answers Questions - November 10, 2015

November 10, 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. When a person is diagnosed with diabetes, is insulin always prescribed as a treatment?
  2. Why does diabetes/pre-diabetes cause thirst?
  3. Does daily testing cause damage to your fingers over time?
  4. Should pre-diabetics test their blood sugar daily?.
  5. How long after eating is too long to test your blood sugar?
  6. Is pregnancy not recommended for pre-diabetics?
  7. Any recommended apps for diabetes management (diet, exercise, blood sugar management)
  8. My blood sugar is <100 mg/dL, and my A1c is 6.3%. I am active, exercise, and control my carbs carefully, while keeping a normal weight. Can I prevent pre-diabetes from transforming to diabetes type 2?
  9. My A1c is 6.4% after three months. Do I need to improve my lifestyle?
  10. I feel I have most of all the symptoms of diabetes and pre-diabetes, thought my random sugar test is 83 mg/dL. Should I still be concerned?
  11. Is it true if I eat late at night my sugars will have higher readings in the morning?
  12. My readings are higher early morning, when I am fasting. Why? Can you please explain?
  13. I recently started taking Metformin 500 mg twice a day. What level of A1c or other metrics would allow me to stop taking Metformin/Glucophage?
  14. Does vitamin D reduce blood sugar? If so, to what degree?
  15. Can you name a few foods the public believes are good for you, but really aren’t?
  16. What is the serving size for rice? Is it for cooked or uncooked rice?
  17. Is it better for a person with diabetes eating a regular diet to eat five meals a day rather than three meals a day?
  18. Can taking probiotics have an impact on your chances of getting diabetes?
  19. Which vitamins would you recommend for diabetics?
  1. When a person is diagnosed with diabetes, is insulin always prescribed as a treatment?
    1. If a person is diagnosed with Type 1 diabetes, then yes. People with type 2 diabetes do not always have to take insulin right away. Insulin use is more common in people with type 1 diabetes. The longer someone has type 2 diabetes, the more likely they will require insulin. Just as in type 1 diabetes, insulin is a way to control your blood glucose level. There are several reasons people with type 2 diabetes may want to use insulin: It can rapidly bring your blood glucose level down to a healthier range. If your blood glucose level is excessively high when you are diagnosed with type 2 diabetes, your doctor may advise that you use insulin to lower your blood glucose level—in a way this works faster than diet and exercise. Insulin will give your body a respite .
    2. Often after having type 2 diabetes for a long time, oral medications may not work as well as they used to. If that happens, insulin is a way to keep blood glucose (blood sugar) levels in control.
  2. Why does diabetes/pre-diabetes cause thirst?
    1. Increased thirst in people with diabetes can sometimes be an indication of higher than normal blood glucose levels.
    2. Your body organs (such as your muscles) are, in fact, dehydrated when there’s too much glucose (sugar) in your blood. Your body pulls fluid from the tissues to try to dilute the blood and counteract the high glucose in your blood, in order to dispose of it in your urine.  This is in turn, is also associated with increased urination.  Your body will be dehydrated due to the water loss and signal your brain that you need to drink more.
  3. Does daily testing cause damage to your fingers over time?
    1. Daily testing, even multiple times a day, should not cause damage to your fingers.  It is recommended that you vary the sites and fingers daily.  Sometimes, people may choose to use the same finger and the same spot because everyone has a favorite, and also because calluses build up and cut down on the discomfort.
    2. You should try to use a different finger each day or each time.  If your blood sugar readings are generally consistent, you can even try alternate site testing, such as using the palm of your hand, if you want to get away from your fingers periodically. Talk to your diabetes provider first.
  4. Should pre-diabetics test their blood sugar daily?
    1. There is no evidence that supports blood glucose testing in pre-diabetes.  If you are interested in testing, you may try testing one to two hours after meals. This is called post prandial testing.  This would provide information on how high your blood sugars increase after eating, as well as provide information on the quality of the meal.  This is only to provide more information, which should be reviewed with your doctor/diabetes specialist.
  5. How long after eating is too long to test your blood sugar?
    1. This depends on many factors, and your doctor will be able to give you more specific guidance on recommended testing intervals. Is should be mo more than two hours after a meal, however. We ask our patients to keep a log of blood sugars before and two hours after a certain meal each day for a few days to weeks before a doctor's visit; that way, we can review the log to see whether there are any abnormal spikes in the glucose levels.
    2. Sometimes, if there is a lot of trouble getting people to comply with fingerstick testing, we ask just to check when they remember, as long as they can tell us what time the blood sugar was tested, and the time, and hopefully content, of their last meal.
  6. Is pregnancy not recommended for pre-diabetics?
    1. It is always best to decrease risks of developing diabetes by getting to a normal weight and controlling your blood sugar to a normal level prior to pregnancy.  It is best to discuss risks of pregnancy with your doctor and obstetrician.
  7. Any recommended apps for diabetes management (diet, exercise, blood sugar management)?
    1. a. In this age of technology, there are many excellent tools for tracking your metrics as a diabetic. There are paper-based trackers and many apps available, and even more in development. My advice is to try them first, don’t pay for an app you will not use.
  8. My blood sugar is <100 mg/dL, and my A1c is 6.3%. I am active, exercise, and control my carbs carefully, while keeping a normal weight. Can I prevent pre-diabetes from transforming to diabetes type 2?
    1. Lifestyle modification can reduce sugar levels and decrease progression to DM type 2 by 56% and a 50% decrease in risk of diabetic complications. Achieving a normal/close to normal blood sugar is important in preventing type 2 diabetes and complications.
    2. Tabák et al. Lancet. 2012 Jun 16; 379(9833): 2279–2290. Prediabetes: A high-risk state for developing diabetes.
  9. My A1c is 6.4% after three months. Do I need to improve my lifestyle?
    1. A1c of 6.4% is good. ADA recommends <6.5% and AACE recommends <7% in DM type 2, in appropriate patients.  In pre-diabetes, this is very close to 6.5% which would the diagnose one with type 2 diabetes.  There are many variables, including your co-morbidities. In other words, we would need to review your history and your exam to be able to determine if 6.4% is “a good number”.
  10. I feel I have most of all the symptoms of diabetes and pre-diabetes, thought my random sugar test is 83 mg/dL. Should I still be concerned?
    1. There may be many reasons you may have symptoms of pre-diabetes.  This would be a good time to see your doctor and discuss your symptoms and concerns.
  11. Is it true if I eat late at night my sugars will have higher readings in the morning?
    1. If you have diabetes, late-night snacks aren't necessarily off-limits — but it's important to make wise choices.  Late-night snacks add extra calories, which can lead to weight gain. And if you snack after your evening meal — especially if the foods contain carbohydrates — you may wake up the next morning with a high blood sugar level.  If late night meals are a permanent fixture in your life, work on making them heavy on the vegetables and light on the fat and starch. Whether you eat at 5 or 9 p.m. you can still have great blood glucose control.
  12. My readings are higher early morning, when I am fasting.  Why? Can you please explain?
    1. There are several reasons why your glucose rises in the morning. One of these is insulin resistance—a condition in which your body's muscle and fat cells are unable to use insulin effectively to lower blood glucose. Insulin resistance also affects how your liver processes, stores, and releases sugar, especially between meals and at night. The liver is supposed to release small amounts of glucose when you're not eating. But in type 2 diabetes, the liver dumps stored glucose into the bloodstream, especially at night. So, while your hormones are causing a natural rise in blood glucose, your liver is releasing even more sugar into your system. And because your insulin resistance prevents your muscle and fat cells from using the sugar, your blood glucose level rises in the morning.
  13. I recently started taking Metformin 500 mg twice a day. What level of A1c or other metrics would allow me to stop taking Metformin/Glucophage?
    1. Metformin is one of the first and safest medications we have, used in treatment of diabetes, pre-diabetes, and PCOS. Your medication regimen would be reviewed and medications adjusted if your sugars have normalized and your other risk factors such as high blood pressure, high cholesterol levels, and BMI are in the normal/low risk ranges. This would be best reviewed with your doctor who can appropriately assess risks and benefits of therapy.
  14. Does vitamin D reduce blood sugar? If so, to what degree?
    1. Low vitamin D levels have been associated with diabetes and poor glucose control.  This finding is not one of causation, but a correlation. This means that a low vitamin d was found in individuals with poor glucose control, but we have no evidence that low vitamin D causes poor glucose control.  It is certainly a good idea to replace low vitamin D stores. 
    2. The new 2010 recommended daily allowance (RDA) is 600 IU for those 1-70 years of age and pregnant or breastfeeding women, and 800 IU for those over 71 years of age. An adequate blood level of vitamin D is 20 nanograms per milliliter, which can be achieved through daily 20 minute skin-arms and legs-exposure to sunlight.  There are many doses of vitamin D that have been used in various disease states.  You would need to review your vitamin D levels. Please do not attempt to self-medicate with vitamin d because overdoses can lead to severe complications.  Also Vitamin D is not regulated by the FDA. There is no guarantee of strength, purity or safety of products, and effects may vary.
    3. A good reference article can be found here:  http://www.mayoclinic.org/drugs-supplements/vitamin-d/safety/hrb-20060400?p=1
  15. Can you name a few foods the public believes are good for you, but really aren’t?
    1. Sports drinks, bottled ice teas and protein or energy bars are loaded with sugar. I recommend always reading the labels before buying any “health” foods.
  16. What is the serving size for rice? Is it for cooked or uncooked rice?
    1. Serving size for white rice is ½ cup cooked rice.  It has 22 grams of carbohydrate, almost no fiber and 2 grams of protein.  It is enriched (meaning nutrients are added, but not naturally found in the rice after processing) with some vitamins.
  17. Is it better for a person with diabetes eating a regular diet to eat five meals a day rather than three meals a day?
    1. We know that eating a healthy balanced diet, taking regular physical activity and maintaining a healthy weight, together with taking any medication prescribed by your doctor, is vital for effective management of type 2 diabetes.
    2. The 2-meal a day, 3-meal a day, or 5-meal a day diets all have a role in controlling diabetes, as long as total number of calories is decreased. 
  18. Can taking probiotics have an impact on your chances of getting diabetes?
    1. Gut flora, as it relates to overall health is crucial in preventing and controlling diabetes. There is some evidence that very early (within the first 27 days) intake of probiotics may be associated with decreased risk/prevention of type 1 diabetes.
    2. There is no clear causation at this time, and no evidence in type 2 diabetes. 
  19. Which vitamins would you recommend for diabetics?
    1. Mostly I don’t recommend a vitamin supplement, because all your nutrients should come from natural sources first.  But if your doctor feels a multi-vitamin is necessary, it should contain:
      1. Most people should look for a supplement that contains 100% Daily Value (%DV) of each of the following vitamins and minerals:
        • Vitamin A (preferably in the form of beta-carotene)
        • Folic acid
        • Niacin
        • Vitamin B1 (thiamine)
        • Vitamin B2 (riboflavin)
        • Vitamin B6
        • Vitamin B12
        • Vitamin C
        • Vitamin D
        • Vitamin E
        • Copper
        • Zinc
    2. More is not better and there is evidence it may be harmful to take supplements, especially in excessive doses.