Joslin

Located in the Longwood Medical Center in Boston, MA, Joslin Diabetes Center is an affiliate of Harvard Medical School and is the world’s largest diabetes research center, diabetes clinic, and provider of diabetes education. Joslin Diabetes was founded in 1898 in Boston by Elliott P. Joslin, a renowned diabetes physician who firmly believed that the key to managing diabetes is with patient involvement, education and empowerment. Joslin focuses solely on research, care and treatmentof diabetes, its complications and related conditions . In addition, Joslin has the world’s largest team of board-certified physicians treating diabetes and its complications, as well as the largest staff of Certified Diabetes Educators anywhere in the world. The main Joslin center is in Boston, but there are are over 40 Joslin Affiliates located in hospitals throughout the country, and internationally, too. For more information, visit Joslin’s website at www.joslin.org.

“Poly” in Greek means more than usual or excessive and “uria” refers to a constituent of urine. So “polyuria” is an increase in urination. This increase can occur in one with diabetes when blood glucose levels are over 180 mg/dL. The body tries to lower blood glucose levels by excreting the glucose through the urine. Polyuria is a common symptom experienced by many when they are first diagnosed with diabetes or when blood glucose levels are running higher than usual. It is often accompanied by polydipsia, which is increased thirst. The increased thirst develops because the body is getting rid of too much fluid through the urine — so polyuria and polydipsia are two symptoms that usually come together. The best way to avoid polyuria is to keep blood glucose levels less than 180 mg/dL. Another reason for increased urination is a bladder infection. If your blood glucose levels are within target range and you are still having increased urinary frequency, it is best to see your doctor to determine the cause.

Hi,

Please see my answer to the similar question that you asked on May 2.

The amount of carbohydrate a person needs, whether he or she is a marathoner or not, varies from person to person and is based on many factors, such as age, gender, body weight, activity level and overall diabetes control. That’s why we recommend everyone with diabetes meet with a dietitian for a thorough nutrition assessment, which can help determine that person’s carbohydrate requirements. There are dietitians who specialize in sports medicine, and you may be able to find someone in your community by doing a search on the Academy of Nutrition and Dietetic’s website at www.eatright.org. Referring someone who is training for a marathon to an exercise physiologist or personal trainer well-versed in diabetes management is also ideal; he or she can work with the person’s dietitian to fine-tune their eating plan, based on their level and extent of training. Also, there are two books written by a diabetes expert that may be helpful: “The Diabetic Athlete” and “Diabetic Athlete’s Handbook,” both by Sheri Colberg.

Please see the previous questions and postings on Victoza, as they will likely answer any questions you might have.

Gas, nausea and diarrhea are fairly common side effects of metformin. These symptoms often subside over time, and they can sometimes be avoided or lessened by gradually increasing the dose. You can certainly talk to your doctor about switching to Glucophage and see if that lessens your symptoms any. Another option is to ask your doctor about taking the extended-release version of metformin (metformin ER). And if that’s not tolerated, talk to your doctor about other medication options, in addition to your glyburide.

Aspartame is really neither good nor bad. Aspartame is a nonnutritive sweetener, meaning that it contains virtually no calories or carbohydrate. It’s been extensively studied and researchers have found no health risks from using aspartame. However, some people note individualized side effects, such as headaches or dizziness and attribute these symptoms to aspartame. There’s also some controversy about nonnutritive sweeteners and whether they cause weight gain or an increased craving for sweets. Again, studies aren’t conclusive on these issues. Certainly, if you think that aspartame is giving you any side effects, you may want to avoid it and either try another type of sweetener or just avoid sweeteners altogether.

You may be able to get free meters from your doctor’s office or by using a mail-in rebate provided on the blood glucose meter box. If you have insurance, most meters are covered by your insurance as long as the doctor writes a prescription for it. It is best to check with your insurance company as to which meter they prefer you use. If a preferred meter is used, the insurance company will cover it, but if you buy one that is not its preferred one, you may have to pay for it out of pocket. Once you get the meter, the cost of the strips is where the real expense is. Blood glucose strips cost about $1.00 each, so it will be important for you to get a meter that is preferred by your insurance company. If you are self-pay, the generic meters put out by big box stores or by chain pharmacies may be a better option for you.

An insulin pump is a small, computerized device about the size of a pager that delivers insulin continuously throughout the day and night. The pump attempts to mimic the normal release of insulin (much like a pancreas), although the user must “tell” the pump how much insulin is to be delivered. Most pumps are attached by an infusion set with a thin catheter that is inserted right underneath the skin; a few newer types of pumps are attached via a self-adhesive disposable pod that contains insulin and delivers insulin through a small canula inserted underneath the skin. There are a lot of benefits to using an insulin pump, including more stable blood glucose levels, improved diabetes control, fewer injections, less hypoglycemia and more precise “matching” of your insulin to your food intake. However, using an insulin pump is a lot of work. Pump therapy requires extensive education, both in terms of how to use the pump and how to insert the infusion set, as well as determining your basal rates and bolus doses. This requires frequent blood glucose checking (often 6 to 8 times a day), keeping detailed glucose and food records, and precise carbohydrate counting. It also means, at least initially, more frequent visits with your provider and/or diabetes care team. Not everybody is able and/or willing to do all of this. The decision to wear a pump should be made jointly between the person thinking about using one and his or her healthcare provider. You should learn as much as you can about pump therapy, and discuss any concerns or questions that you may have with your provider before going on a pump. You might also ask your provider to refer you to a diabetes educator or a diabetes program to learn more about insulin pumping. And, you can find out more about insulin pump therapy by visiting Joslin Diabetes Center’s website at
http://www.joslin.org/info/the_advantages_and...

You describe a situation in which metformin was quite helpful in controlling your blood glucose, but you are now unable to take metformin due to kidney disease. After metformin, you have been on several other diabetes medications including Januvia, Glyburide, and Prandin. You asked about Victoza. This medication is in the GLP-1 receptor agonist class of medications and is associated with improvement in diabetes control as well as promoting weight loss. Victoza is injected subcutaneously once daily and can be associated with GI side effects such as nausea or vomiting. By itself, Victoza is not associated with hypoglycemia, as you had when you were taking Glyburide. You should review with your healthcare provider which diabetes medications would work best in your particular situation.

Muscle loss is an interesting topic because a lot of things can contribute to it. The primary reasons for muscle loss are a lack of exercise, weight loss, and even the aging process itself. To maintain or build muscle, the best type of exercise involves some kind of resistance, such as weight training. Here at Joslin, we recommend aerobic activity (such as jogging, biking or swimming) at least 150 minutes a week with some weight lifting added in. Some believe that eating protein can help build muscle, but there is not a lot of research to substantiate this. When you have diabetes, muscle wasting can sometimes occur when there is not enough insulin in the blood stream. This can happen, for example, with people who have type 1 diabetes, but do not know it yet. Before they are diagnosed, people with type 1 can experience a lot of weight loss, both fat and muscle. Once they start taking insulin, the weight and muscle mass return to normal. This can happen to a person with type 2 diabetes, but it is less common.

The issue of whether to eat a bedtime snack or not, as well as what to eat for a snack, remains somewhat controversial. Not everyone with diabetes needs to eat a bedtime snack, and sometimes eating before bed can lead to higher blood glucose levels the next morning. On the other hand, not eating a snack at night can trigger the liver to release glucose into the bloodstream overnight, “thinking” that the body is lacking fuel. Usually, the result is a high blood glucose the next morning. That being said, if you decide to eat a bedtime snack, choose wisely. This means aiming for about 15 grams of a healthy carb food that won’t “spike” blood glucose levels. Good choices are 4-6 whole-grain crackers, a slice of whole-grain toast, 3 cups of popcorn, 6 ounces of Greek-style yogurt or a piece of fruit. To help even out and sustain blood glucose levels throughout the night, add a small amount of a food that contains fat, such as a tablespoon of peanut or almond butter, a handful of nuts or a slice of cheese. You should check your blood glucose before bed, a few times in the middle of the night (such as at 2 or 3 am) and of course, first thing in the morning, to see how the snack works for you. Keep in mind that it often requires a little bit of experimentation to find out what works best for you.

Even people who are following a low-carbohydrate (carb) diet need to eat some carb. Carbohydrate provides the body with energy, much like gasoline fuels your car. Carb is found in all fruit and fruit juices; starches, like bread, pasta, cereal and rice; milk and yogurt; and desserts. One carbohydrate serving or choice contains 15 grams of carb. You need to know what a serving size is for the type of carb food that you want to eat. For example, one half of a medium banana and ¾ cup of blueberries each contain 15 grams of carb. You also need to know how much carb to aim for at each of your meals and snacks, as this will determine how much of certain foods you can eat. If you’re not sure how much carb you need, ask your physician for a referral to a dietitian.

All blood glucose meters are allowed by industry standards to be 15% to 20 % off. In other words, any time you are checking with a meter the reading can be off by that amount. People think there is one blood gluocse number, but in reality, meters just give us an estimate of what the actual blood glucose is — so for this reason, it’s not that helpful to compare one meter to another. When using the same meter, you can compare one reading to the next, and when doing this, we would not expect the number to vary more than 20 %. If you find your readings are varying by more than this, you may want to get a new meter. Blood glucose meters are required by the Food and Drug Administration (FDA) to meet certain minimum accuracy standards in order to be approved and sold, so in general, all meters are equally accurate. If you are getting a lot of variation in the numbers, make sure you are getting enough blood onto the strip, as an inadequate sample can give you a falsely low reading. Also, make sure you are washing your hands with soap and water before you check because food residue on the hands can give you a falsely high reading.

I assume that you are having neuropathic foot pains that worsen with low blood glucose levels. If you are referring to neuropathic pains related to your diabetes, there are well-described instances where these pains can worsen when diabetes control improves significantly. This is called treatment-induced neuropathy. It has been described mostly in relation to individuals with diabetes and chronically elevated blood glucose levels (A1c 12-16%) who have a rapid improvement in diabetes control with insulin therapy. The onset of the treatment-induced pain usually occurs within 6 weeks of rapid glucose control. The good news is that treatment-induced neuropathic pain is typically self-limited and will improve over time. Talk with your healthcare provider about whether you may have treatment-induced neuropathic pains and whether you might benefit from evaluation from a neurologist.

When we are not eating, as happens overnight, our liver produces glucoseas the body’s way of keeping blood glucose levels from going too low. Think of the liver as a glucose-making machine and insulin as the switch that makes the machine turn on or off. However, when you don’t have enough insulin in the blood stream, the liver loses its ability to to regulate itself. This is why people with diabetes can go to bed with a blood glucose level in range and wake up with a reading that is elevated, causing a lot of frustration and confusion. The best way to treat this problem is with medications that either decrease glucose production in the liver (metformin), or increase insulin in the bloodstream (sulfonylureas or injected insulin). Some research has indicated that a lowfat low-carb, high-protein snack in the evening, such as cottage cheese or turkey breast, might also help.

There are several ways to determine how much mealtime insulin to take to “cover” carbs. One method is to use what is known as the “1500” or “1800 Rule.” One needs to calculate the entire daily dose of insulin (both mealtime, such as NovoLog, Humalog or Apidra and basal insulin, such as Lantus or Levemir) and divide that amount into 1500 or 1800. (Whether to use 1500 or 1800 depends on the type of insulin that is used and you should ask your healthcare provider which to use.) The resulting number is a starting point for determining and fine-tuning the insulin-to-carb ratio. Another way to figure out insulin coverage for carbohydrate is to keep food records for several days, add up the carbohydrate at a particular meal, say, breakfast, and note how much mealtime insulin you took to cover those carbs (this, however, assumes that your pre- and post-meal glucose levels were within your target range). Sometimes healthcare providers will start a person off with a “1:15 ratio,” which assumes 1 unit of insulin covers 15 grams of carb. Of course, this approach can be way off for people who usually require much more or less insulin. It’s important to keep in mind that one may have a different “ratio” for each meal. If you’re interested in trying what is often called “advanced carb counting,” I’d strongly encourage you to meet with a dietitian who is well-versed in diabetes, because this level of carb counting is more of an art than a science. It requires careful and accurate carb counting (weighing/measuring foods, label reading, using carb-count books or a database), logging of both food and blood glucose, and frequent blood glucose monitoring (before and after meals) to evaluate the ratio and then fine-tune it if it’s not correct. Also, in addition to using a ratio, one needs to establish a correction or sensitivity factor which also requires frequent blood glucose checking. If all of this sounds daunting or complicated, realize that it is! Advanced carb counting really isn’t a “do it yourself” process, at least initially. Having guidance from a dietitian or diabetes educator who has experience with advanced carb counting can save you a lot of time and frustration, and help ensure that you’re being as accurate and precise as you can.

The condition that we used to call “borderline diabetes” is now referred to as “pre-diabetes.” Pre-diabetes is a condition in which blood glucose levels are higher than they should be, but not high enough to be called diabetes. Pre-diabetes can be diagnosed in three ways: by measuring hemoglobin A1C, by measuring blood glucose first thing in the morning in a laboratory, or by administering an oral glucose tolerance test (OGTT). You mentioned that your post-meal glucose is 140, which, when an OGTT is given at your doctor’s office, is within the range of pre-diabetes. A reading of 140 using a blood glucose meter after a meal is not an accepted way of diagnosing pre-diabetes or diabetes. If you have not done so already, ask your doctor to check you for pre-diabetes using one of the three tests that I mentioned above. If your results indicate that you have pre-diabetes, the good news is that you can prevent it from becoming diabetes in several ways. First, meet with a dietitian for a healthy eating plan that is balanced in carbohydrate and that can help prevent or limit “spikes” in blood glucose after eating. Second, if you need to lose weight, aim to lose between 5 to 10 percent of your body weight. The dietitian can help you with this, as well. Third, aim to be physically active for at least 30 minutes most days of the week. That may sound challenging, but you’re already being active and you can break up your 30 minutes of activity into three 10-minute segments throughout the day, if need be. Walking is a simple and inexpensive way to get your activity in, but yard work and housework count too! Including fiber in your eating plan is certainly healthy and may help with your blood glucose levels. Swallowing a small amount of vinegar before meals has also been shown in some studies to reduce spikes in blood glucose after meals, but it’s not known how much one would need to take to see a benefit. If you have not, you should check with your doctor or dietitian about whether taking vinegar is helpful and if so, how much is safe to take. Vinegar is an acid and there’s a risk of burning or irritating your throat if you consume too much. Finally, when you see your doctor, request that you regularly be checked for pre-diabetes and diabetes.

Levothyroxine is a replacement for the hormone that the thyroid makes to help regulate metabolism. If your thyroid is unable to make enough of this hormone, it is likely that your doctor will prescribe it for you. If you don’t have enough thyroid hormone, you may experience weight gain, fatigue, dry skin, constipation and a slow heartbeat. Levothyroxine and other thyroid medications are not weight loss or diet medications; they are intended to supplement or replace the hormone that your body makes naturally. I was unable to find any indication that people with diabetes should not take levothyroxine. However, it’s possible that this medication may affect blood glucose levels, at least when one first starts taking it, so doses may need to be adjusted. If your levothyroxine dose is not regulated, it may make losing weight more difficult (which is why you need to have your thyroid hormone levels checked regularly), but not impossible. You should talk to your doctor or pharmacist, however, who can provide you with more guidance and information about levothyroxine than I can. In terms of losing weight, my advice to you is this: ask your doctor for a referral to a dietitian who can help you with an eating plan that will help you lose weight, and can also provide coaching and support. A dietitian can also discuss other weight loss options with you, such as joining a commercial program (Weight Watchers, Jenny Craig, etc.), or a a local weight loss support group, trying a meal replacement program, and bariatric procedures . He or she may also be able to help you get started with exercises that don’t hurt your knees and back. Or, your doctor may be able to refer you to a physical therapist or exercise physiologist for an exercise program that’s tailored to your needs. This may include a water exercise program at your local Y or community center or using an armchair exercise video, for example. It can be hard to go it alone when you are trying to lose weight and get healthy, so take advantage of the resources that are available and, most importantly, find a source of support to keep you motivated and on track. Finally, talk to your doctor about the pain you are having. Again, there are options for helping you deal with this, such as medication, massage, acupuncture and specific exercises that can strengthen your muscles.

There are a number of known causes of leg/foot cramps at night. Some of these causes include foot problems (such as flat feet), low potassium or low calcium levels, dehydration, hypothyroidism (underactive thyroid) or are associated with underlying neuropathy. However, most people who develop leg cramps at night have no obvious reason. You should discuss the issue with your healthcare provider to ascertain whether you might have any underlying reason for developing leg cramps at night. There are a number of treatments available, including preventive measures such as adequate stretching, use of proper foot wear, and adequate hydration. Medications are used in some circumstances, but you should discuss the issue of medications with your healthcare provider.

Dry skin, particularly on the feet,is not uncommon for people with diabetes. The best way to treat dry skin is to wash the feet daily with soap and water, rinse and dry well and apply a moisturizer. There are lots of “diabetic creams” on the market, but we do not recommend one over the other. Have your husband try something basic —, alcohol-free and thicker in consistency so it doesn’t wipe right off. If the cracking and drying are very severe, he will want to see his physician, because there are prescription creams he can try. Also, your husband should avoid soaking his feet, because this can dry them out even more.

It’s important for your fiancé to let his physician know that he is concerned about his high blood glucose levels and that he wants his treatment plan reviewed. The doctor should be asked why he or she is hesitant to change his medication? The doctor may have reasons for this, or may not feel confident in what to do. Before switching doctors, he may want to find out if the doctor is willing to refer him to an endocrinologist and a diabetes educator. Endocrinologists specialize in diabetes and can work with the doctor to provide medication recommendations. Diabetes educators help people with lifestyle changes — nutrition and physical activity — and may also help determine what medication choices might best work with your fiance’s schedule. If he asks about these alternatives and still find that his doctor is not willing to have a conversation with him, then it may be time to look for a new physician.

Because of the PCOS, your daughter is at higher risk for developing type 2 diabetes. The good news is that metformin will not only help her PCOS, it also is a medication we sometimes give to people at risk to help prevent type 2 diabetes. In addition to this though, to prevent type 2 diabetes we recommend the following:

1) Get 150 minutes of physical activity every week — 30 minutes 5 days per week
2) Lose 5 to 7% of your body weight if you are overweight
3) Eat a healthier diet

You will notice it does not take a lot of weight loss to prevent diabetes. For example, a 5 to 7 % weight loss for someone who weighs 200 lbs, is equivalent to 10 to 14 lbs. By “healthier diet” we mean one that is lower in saturated fats and contains less processed, sugary foods. Eating more fresh fruits and vegetables, brown rice, whole wheat products and meats lower in fat, such as chicken and fish, are all excellent changes that your daughter could make. If she is already doing all of the above, then she is well on her way to preventing diabetes. If she needs some guidance around how to change her diet, seeing a registered dietitian would be a good choice

There are a number of other options if one cannot tolerate metformin. For some who cannot tolerate regular metformin, extended release metformin may be better tolerated. If both regular and extended release metformin are not tolerated, other oral medication options include a sulfonylurea (such as Glipizide or Glimepiride), a DDP-4 inhibitor (Januvia, Tradjenta, or Onglyza), or a TZD(such as Actos). There are a number of injectable medications that can be used as well, including Byetta, Bydureon or Victoza. Also, insulin would also be an alternative. Each of these medications has their own benefits and side effects. You should talk with your healthcare provider about which medication he or she would recommend given your particular circumstances.

The diagnosis for diabetes can be made in the following ways: by having

1) a fasting blood glucose over 126 mg/dL‘ or
2) an oral glucose tolerance test result of 200 or above; or,
3) an A1C of 6.5% or above; or
4) a random blood glucose of over 200 with symptoms of diabetes.

If one of the first three tests mentioned above is used, a second test with similar elevated results is needed to confirm the diagnosis. For example, if a person has a fasting blood glucose of 132 and an A1C of 6.7 %, then they have diabetes. If a person has only had one of these tests, then the diagnosis cannot be confirmed. The diagnosis of pre-diabetes is made by having a fasting blood glucose between 100 and 125 mg/dL, or an A1C of between 5.7 % and 6.4 %, or a 2- hour oral glucose tolerance test result of140-199 mg/dL. The test used to determine if pre-diabetes exists does not need to be confirmed by a second test.

Metformin is the most common medication used in the treatment of type 2 diabetes. It works by decreasing the amount of glucose secreted by the liver. Because it does not increase the amount of insulin secreted by the pancreas, it is generally not associated with hypoglycemia (usually defined as blood glucose less than 60-70 mg% with symptoms). If you are taking other medications that are associated with hypoglycemia (especially a sulfonylurea or insulin), then adding metformin can aggravate the tendency for hypoglycemia, but by itself it is not typically associated with hypoglycemia. I would suggest that you review with your healthcare provider what factors might be contributing to low blood glucose levels in your situation.

Losing weight and keeping weight off can be challenging without including physical activity as part of your program. I’d recommend that you ask your neurologist about types of exercise that you CAN do. While strenuous exercise may be out of the question for now, chances are there are other options to choose from, such as a water exercise class, swimming or even chair exercises. If you get the green light from your neurologist to exercise, you might think about meeting with an exercise physiologist, a physical therapist or a qualified personal trainer who can help you develop a physical activity program that is safe and effective for you. And you’re right to be thinking about an eating plan that you can stay with longer-term so that you don’t end up gaining your weight (and possibly even more) back. Using smaller plates and cutting back on food portions is a great place to start. It takes time to lose weight, and the goal for most people is to lose one to two pounds per week. A dietitian can give you more guidance and structure, taking into consideration the foods that you like, along with your daily schedule, your diabetes medications, and other factors. Your primary care physician can give you a referral to see a dietitian. You could also consider a commercial program, such as Weight Watchers, Jenny Craig or Nutrisystem – all of these programs have plans for people with diabetes, and their plans are well-balanced and nutritious, and can be followed long-term. Diets such as Medifast or HMR, for example, are options for people who need to lose weight quickly (under a physician’s supervision). However, some people find them difficult to follow and they’re not intended to be followed long-term. The downside with these types of diets is that many people end up regaining their weight.

Being “sensitive” to insulin means that the cells respond normally to insulin when they come in contact with it. In other words, when insulin brings glucose to the cell to be transported inside the cell, it can do so without any problems — there is no “resistance.” When the body is not sensitive to insulin, the mechanisms that allow glucose to move from the blood stream into the cell are not working correctly, which is what we call “insulin resistance.” Insulin resistance results in more of the glucose remaining in the blood stream and causes high blood glucose. In order to explain this, we often use the example of a key. Think of insulin as a key trying to open a door. When the key fits well and is working correctly the door opens without any difficulty, but if it is misshapen or rusty, it cannot fit into the lock and the door will not open. The key fitting well is an example of the cell being sensitive to the insulin, the key not fitting well is what we call “insulin resistance.” There is a lot of research being conducted to try and determine why this happens. It is not completely understood why some people are resistant to their own insulin and others are not. But we do know that eating less fat, losing weight and exercising more can help cells become more sensitive to insulin.

Unless you’re allergic to peanuts, you can really eat any type of peanut butter. Peanut butter contains a healthy type of fat that may help lower blood cholesterol and reduce the risk of heart disease. And because of its fat and protein content, peanut butter can keep you feeling fuller for a longer amount of time. Some people prefer the natural type of peanut butter (with the oil on top), and many brands of natural peanut butter are free of sugar and salt, as well. However, in general, most brands of peanut butter contain about 95 calories, 8 grams of fat and 3 grams of carbohydrate per tablespoon. Even the reduced-fat peanut butter contains 95 calories per tablespoon (along with 6 grams of fat and 8 grams of carb). You can certainly fit peanut butter into your eating plan, but you might speak with a dietitian about the portion size that’s best for you. You might also see a newer type of peanut butter in some grocery stores or health food stores: this peanut butter has 85% of its fat removed, which turns it into a powder. You reconstitute the powder with water, which then develops the same consistency (and supposedly, the same flavor) as regular peanut. It may be worth a try!

If your pancreas is not producing enough insulin, you will need to take medicine to make up for the lack of sufficient insulin. The type of medicine you are prescribed will depend on how insulin deficient you are. When you say “shut down” it sounds like your doctor feels that you are producing very little insulin. If this is the case, you will most likely need to take insulin by injection several times a day. The reason for taking it several times a day is because the body needs a constant supply of insulin – referred to as “basal insulin” — all day long. Basal insulin is taken one to two times each day. In addition to this, your body needs extra insulin, called “bolus insulin,” to cover your meals.B olus insulin is taken with meals and snacks. If your body is still making insulin but not quite enough, there are pills to help your pancreas make more insulin on its own. If you have type 1 diabetes, you will have to take injections of insulin, if you have type 2 diabetes, your doctor might prescribe pills first and then add insulin as well. It really just depends on what your blood glucose levels are. If you do not understand what type of diabetes you have or what your options are, it might be a good idea to see an endocrinologist, which is a doctor who specializes in diabetes .

Chocolate, especially dark chocolate, provides quite a few health benefits, including a possible decreased risk of stroke, heart disease and cancer, thanks to antioxidants called flavonoids. The less processed and the darker the chocolate, the more flavonoids the chocolate contains. However, the downside to eating any type of chocolate is its calorie and fat content. A one-ounce piece of dark chocolate contains 156 calories, 11 grams of fat (7 of them are saturated fat) and 14 grams of carbohydrate (about the amount of carb in 1 slice of bread or a small piece of fruit). Too many chocolate binges may lead to higher-than-desired blood glucose readings and weight gain. It’s normal to crave certain foods, particularly sweet and/or higher-fat foods, now and then. It may be helpful to allow yourself one or two small pieces of chocolate each day in order to prevent the cravings in the first place. The key, though, is to keep the portions small, and not end up eating a large candy bar, for example. If your cravings occur frequently, think about what may be triggering them. Are you skipping meals or going too long without eating? Do your cravings appear when you’re under stress or feeling down about something? Anxiety, depression, boredom, hunger and even thirst are common triggers for binges. If you think any of these are reasons for your chocolate binges, consider meeting with a dietitian to discuss a healthy eating plan and meal schedule. If emotions are triggering the cravings, think about meeting with a behavioral health specialist to address the causes and explore other, more healthful ways of handling stress.

Gestational diabetes is diabetes that develops for the first time during pregnancy. During pregnancy, there is resistance to the effects of insulin, thus predisposing some woman to develop diabetes. Gestational diabetes is partly related to the secretion by the placenta of hormones that promote higher blood glucose levels. Gestational diabetes develops when the pancreas is not able to compensate for the insulin resistance caused by these placental hormones. Gestational diabetes is commonly diagnosed with a glucose tolerance test that is done at 24-28 weeks of gestation. Treatment of gestational diabetes can decrease the chance of having a large baby (over 9 lbs) as well as other complications with the mother. Also, women who develop gestational diabetes are more likely to develop type 2 diabetes later in life and will need to be closely followed. You should discuss any concerns that you have about gestational diabetes with your healthcare provider .

Gaining weight on metformin is unusual. In fact metformin is one of the diabetes drugs that can help people lose a few pounds. Other anti-diabetes medications, such as glyburide or glipizide, can make people gain weight, but not usually metformin. Sometimes, as the A1C and blood glucose levels improve, some may gain weight because the body is absorbing more of the glucose from the food being eaten rather than losing it through the urine. This is a good thing. It is not good to have excess glucose floating around in the blood stream, and, if left untreated this can cause complications over time. You may also want to think about other reasons you could be gaining weight. Have you been less active then you use to be? Is it just a matter of getting older and experiencing the normal changes associated with age? Could this be a side effect from other medications you are on? You will want to ask these questions first; then, if you have no explanation for the weight gain, let your provider know — but it is not likely that this is a side effect of the metformin.

Tradjenta and Glimepiride are both medications that can be used in the treatment of type 2 diabetes. Tradjenta is in the DPP-4 inhibitor class and Glimepiride is in the sulfonylurea class. Tradjenta is taken once daily with or without food. Glimepiride is taken once or twice daily (depending on your prescription) – usually before meals (breakfast and/or supper). These 2 medications are quite compatible and can be taken together. If you are taking both medications once daily, then you could certainly take both in the morning before breakfast. Why don’t you discuss the timing of the medications with your healthcare provider, as he or she will know your individual case best.

As you know, high blood glucose levels can predispose one to yeast infections so it it is essential to improve your diabetes control to help treat and prevent these yeast infections. Although ingestion of lactobacillus (acidophilus) will decrease yeast in the gastrointestinal tract, there are no definitive studies suggesting that they are beneficial in the treatment of skin yeast infections associated with high glucose levels in diabetes. However, there are effective topical medications to treat skin yeast infections, such as clotrimazole, miconazole or nystatin. You should discuss with your health-care provider which topical medication he or she would recommend and also what you can do to better control your blood glucose levels.

My first suggestion is that you meet with a dietitian. A dietitian can help you develop an eating plan that’s tailored to you, and can also provide you with suggestions, tips and recipes for meals. There are also a number of healthy cookbooks and meal planning guides that can help you with your meals. Joslin Diabetes Center has several cookbooks (visit their website at www.joslin.org/store, and the American Diabetes Association has a meal planning guide called “Month of Meals”, available on their website at http://www.shopdiabetes.org/101-american-diab.... Finally, look into nutrition and/or healthy cooking classes or programs in your community, either through your local hospital or adult education programs.

There is no one right answer to your question. Some people do better (in terms of managing blood glucose levels and controlling weight) by eating smaller amounts of food more often during the day. Going much longer than 4 hours without eating can sometimes lead to eating too much at the next meal. Also, some studies show that spacing out carbohydrate over the course of the day can help with blood glucose control. My suggestion is for you to consider what your daily routine is like and plan your meals accordingly. For example, if you eat breakfast at 6:30 am and lunch isn’t until 12 pm, it might be a good idea to eat a small snack at about 10 am. Or if you eat lunch at noontime and dinner isn’t until 7 pm, again, plan to eat a snack at about 3 or 4 pm. You might also consider meeting with a dietitian to help you develop an eating plan based on your schedule, your food preferences and your weight goals. He or she can also discuss other ways to help prevent diabetes.

The amount of carbohydrate, or carb that one should eat varies from person to person. Your carb needs are based on a number of factors, such as your age, gender, activity level, body weight and glucose levels. Also, it’s best to think about your carb goals on a meal-by-meal basis, rather than for the entire day. Aiming for a consistent, or set amount of carbohydrate at each of your meals and snacks each day can help you better manage your diabetes. It’s helpful to meet with a dietitian who can determine the right amount of carbohydrate for you, as well as help you develop an eating plan that’s based on your lifestyle and your food preferences. In the meantime, to get you started until you see a dietitian, aim for about 30 to 45 grams of carbohydrate for each of your meals, and if you eat snacks during the day, aim for about 15 grams of carb.

Frequent urination is a common symptom when blood glucose levels are excessively elevated (usually over 200-250 mg%). Although excessive urination can occur with elevated blood glucose, many patients with diabetes can have elevated blood glucose without this symptom. There are other causes of frequent urination that include a bladder infection (frequent urination, often with burning with urination) or excessive fluid intake. A rare cause of excessive urination is diabetes insipidus (caused by a deficiency of one of the pituitary hormones). If you are having frequent urination, it is important to have an evaluation by your healthcare provider to determine the cause. If frequent urination is related to high glucose levels, adjustments in diet/exercise or medications will alleviate this symptom.

The best way to lower blood glucose naturally is to increase your physical activity to at least 150 minutes per week of aerobic activity. We usually recommend 30 minutes of moderate activity, 5 times per week if possible. The other way to lower blood glucose naturally is by having and following a meal plan. This involves meeting with a nutritionist, reviewing what you normally eat and then coming up with a plan for a certain amount of carbohydrate per meal. For men who are trying to lose weight, this amount can range anywhere between 45 to 75 grams of carbohydrate per meal depending on your activity level. If you are already doing both of those things and your blood glucose levels remain high, then usually medications are needed and, for most people, that means starting metformin. There are some herbal remedies out there on the market that claim to lower blood glucose, however, the problem is that these remedies are not regulated by the FDA, e and they not been extensively researched. For this reason, in general, we don’t make recommendations regarding natural remedies. The benefit of prescribed medications is that we know the doses are standardized, they have been used extensively and are deemed safe by the FDA.