Questions for Your Doctor

If you were recently diagnosed with type 2 diabetes, ask your doctor these questions at your next visit. In the meantime, I will give you my answers and possible things for you to think about when you ask your doctor.

#1. Does having diabetes mean that I am at higher risk for other medical problems? My answer is yes. Think of heart disease, neuropathy, and the diabetes complications. There are other possibilities and your doctor may be aware of your family history, which could affect the answer.

#2. Should I start seeing other doctors regularly, such as an eye doctor? My answer again is yes. I had several doctors that I saw on a regular basis – some were quarterly and others were 2 times a year. There should be no doubt about this and the doctors you may need to see will depend on your medical history and how well your doctor knows diabetes. I often see the dentist as a doctor to see on a regular basis and especially if you have type 2 diabetes.

3. How often should I test my blood sugar, and what should I do if it is too high or too low? This will depend on the medication you are taking. I test about six times per day as I only eat twice a day and use insulin. The two “experts”, Dr. Ratner of the ADA and Dr. Garber of the AACE don't believe we need to test if on oral medications and that we should rely on the A1c. Even some professional organizations do not believe we should be testing. To this I say BS and I know better to operate completely in the dark to manage diabetes effectively. Read my blog here about testing.

4. Are there any new medications that I could use to help manage my diabetes? I will only use metformin or insulin. Every oral diabetes medication has side effects to be concerned about. Your doctor should discuss the side effects with you. If the doctor does not do this or side steps the question, refuse the new medication.

5. Does diabetes mean I have to stop eating the foods I like best? My answer is – maybe.  There are some foods you will probably eliminate such a potatoes and rice.  By using your blood glucose meter before (preprandial) and after (postprandial) your meal is the best way to discover what to restrict or eliminate from your meal plan.  

6. How can exercise make a difference in my diabetes? It can help make blood glucose easier to manage, is my answer. Do realize that for some people, other medical conditions may prevent most types of exercise.

7. If I'm overweight, how many pounds do I have to lose to make a difference in my health? This will depend on how much you are overweight. I say if you are greater than 10 percent overweight, then the full amount needs to be lost. The “experts” all agree that 5 to 7 percent of the weight will help reduce the problems and help in diabetes management.  The best thing to do is lose the weight.

8. Are my children at increased risk for the disease? This will depend on whether you pass the genetic properties for diabetes, but in general your children will have the opportunity to avoid diabetes if they learn how to eat properly and exercise at a young age.

9. What is the importance of diet in diabetes? Diets are worthless because they fail. It is the food plan that you develop using your blood glucose meter that work. Generally, a low carb food plan may be the best for many.

10. Do I need to take my medications even on days that I feel fine? This will depend on the medication you are taking, how often you are taking it, and what your blood glucose level is at the time you are to take the medication. Generally, unless your blood glucose level is above 150 mg/dl when you are to take your medication, you should not. The best answer is to have this conversation with your doctor.

Diabetes Questions to Ask Your Doctor – Part 3

Part 3 of 3 Parts

Are you ready for you doctor appointment? The following is the rest of the questions to ask your doctor if you suspect diabetes or if you have just received a diagnosis of diabetes, type 2. The 14 questions can be read here. I am quoting the questions and adding my comments to give possible solutions. I have split the two-part questions.

Will I always need medications/insulin? It is always too early to be sure, but if possible, the goal should always be to get off medications if possible. Until you have attempted this, there is no way of knowing if you will always need medications and insulin is a medication and should not be considered the medication of last resort or as a punishment as many doctors are prone to do. If you have a doctor that does this, please do your health a favor and find a different doctor.

How will you evaluate whether these medications are the best treatment for me?

Your doctor should do a complete evaluation, noting any allergies, foods that cause problems, and several tests to determine kidney health, and heart health before prescribing medications for diabetes. Then the doctor should discuss with you what the findings recommend and then discuss the side effects with you so that together you can make a decision. A doctor that does not do any of this is not a doctor to be retained.

What are the long-term complications of diabetes, and how can I avoid them?

There are not long-term or short-term complications. They are complications and they need to be avoided if possible.

Complications don't cause themselves. Poor or no management of diabetes – meaning not testing, not losing weight, not eating balanced meals, not making other lifestyle changes, and no blood glucose management is what causes the complications. So what are the complications? Retinopathy, neuropathy, nephropathy, atherosclerosis, and deafness are the most common, and many don't include deafness. The first three and deafness are grouped together under the term microvascular complications because they result from damage to the small blood vessels. The macrovascular complication is atherosclerosis, which is caused by damage to the large blood vessels.

Retinopathy causes damage to the retina, which may lead to poorer eyesight or blindness. Neuropathy causes damage to the nerves, which cause pain and can be more than annoying pain. Nephropathy causes damage to the kidneys or increased renal problems leading to kidney failure or chronic kidney disease (CKD). Deafness or hearing loss is caused by the eardrum losing the ability to transmit sound because of short blood supply. Atherosclerosis can lead to heart attacks, stroke, or poor healing of wounds in the feet and legs. This is the cause of amputations.

Although these are not complications, there is a strong relationship with diabetes and as such, they are called comorbidities. The 2012 ADA guidelines listed the following:

1. Hearing impairment,

2. Obstructive sleep apnea,

3. Fatty liver disease,

4. Low testosterone in men,

5. Periodontal disease,

6. Certain cancers,

7. Fractures, and

8. Cognitive impairment.

Then for the 2013 guidelines, they added depression, almost as an afterthought.

How do other factors such as high cholesterol and high blood pressure affect me if I have diabetes? As studies are beginning to prove, some types of cholesterol are less of a problem than thought and even the ADA has raised the blood pressure threshold for blood pressure for people with diabetes. I will not quite go to the extreme to wish statins away, but their usefulness may be in doubt, but at present are still needed. Extremely high blood pressure should be lowered with medications until changes can be made in lifestyles that make high blood pressure normal.

How often should I be seeing my doctor to optimize my diabetes management?

This will be determined by your doctor and the medication(s) you are taking. People with type 2 diabetes and not on medications may be limited to one time per year. People on most oral medications will probably be seeing a doctor only twice a year. And, people with type 2 diabetes and using insulin will probably be seeing a doctor four times per year or maybe less. The American Diabetes Association in their efforts to deny people with type 2 diabetes the treatment they need have lowered treatment expectations and some of those that are in positions of authority are making statements that some people with type 2 diabetes only need to see a doctor once a year and may not need to test at all. See my blog here for what some ADA officers are saying. You may also read this about the position of ADA and how Joslin may have affected the situation.

How often you see your doctor may also depend on how often your insurance company will reimburse the doctor for office visits.

Diabetes Questions to Ask Your Doctor – Part 2

Part 2 of 3 Parts

Are you ready for your doctor appointment? The following are more of the questions to ask your doctor if you suspect diabetes or if you have just received a diagnosis of diabetes, type 2. The 14 questions may be read here, but I have separated the two part questions to answer them more completely. I am quoting the questions and adding my comments to give possible solutions.

What are the warning signs or symptoms that my blood glucose levels are too high? The most common symptom is none at all. This is the reason many people do not know they have type 2 diabetes. The best idea is to know your family and if there is a history of diabetes. Many of the signs of diabetes can also be indicative of other problems, therefore is best to see a doctor for an accurate diagnosis. Some of the signs are tiredness, increase in urination, thirst, weight loss, change in vision, moodiness, and a few others. Some people do become irritable when they get too high, but there are no firm numbers when this happens. Read this article for more.

If you already have a diagnosis, testing is the best way to detect high BG levels. Dehydration can occur of high blood glucose levels are allowed to stay for several hours. Treatment to lower blood glucose levels is important and should be started quickly. Read these articles here and here for a better understanding of high BG or properly hyperglycemia.

What do I do if my blood glucose levels are too high? There is a multitude of possible solutions. Be honest with yourself as the only person you will be hurting is yourself. Eating food out of anger is not wise, yet this often happens the first few weeks when patients are angry about the diagnosis. Then later if you are in denial, you can also overeat or eat out of anger as well. I can say that both anger and denial are useless, but this will not prevent it from happening. Soon or later, this will happen, as they are two of the four stages people are quite likely to experience.

Yes, medication (the prescribed medication) is one way to bring down high blood glucose levels, but only take the medication when you are directed to on the medication. Walking or some exercises are another aid to bringing BG levels down. If during the first month or two you are not able to bring your blood glucose down with the medication or medications you are taking, then please investigate insulin and be prepared to talk to your doctor about this.

The most reliable method of bringing blood glucose levels down is by adapting a food plan that works for you. Because there is no exact food plan for people with diabetes, you will need to find what works for you.

What are the warning signs or symptoms that my blood glucose levels are too low? Hypoglycemia causes symptoms such as hunger, shakiness, nervousness, sweating, dizziness or light-headedness, sleepiness, confusion, difficulty speaking, anxiety, and weakness. Hypoglycemia can also happen during sleep. Some signs of hypoglycemia during sleep include crying out or having nightmares, finding pajamas or sheets damp from perspiration, and feeling tired, irritable, or confused after waking up.

The best way to determine the level of hypoglycemia is to test. If you have a diabetes diagnosis, then you should have a supply of glucose tablets on hand at all times. Don't take this lightly if you live alone. If you have a family, then make sure they know where all supplies (including the glucose tablets) are located. I lived alone for about three years and I kept my testing supplies on the nightstand when I went to bed along with the glucose tablets. One person that I know has a small refrigerator in the bedroom with other supplies that he relies on, but I have been fortunate that I have never needed to go that far.

What do I do if my blood glucose levels are too low? If you are capable, be sure to test as soon as you feel that you are low. Now if this is within the first months of your having diabetes, then you should be concerned any time you reading is below 80 mg/dl (4.4 mmol/l) and consider this a low. If you are below this but not below 70 mg/dl (3.9 mmol/l) take one glucose tablet and test 15 minutes later. If you are back above 80 mg/dl, then consider yourself okay. If you are not back above 80 mg/dl, take a second glucose tablet and test again 15 minutes later. Repeat if necessary.

A fairly simple rule to follow is to subtract the number of the reading from 80 and divide by 15 to determine the number of glucose tablets to take. This means that if the number is 45 mg/dl (2.5 mmol/l) this would be 35 or three tablets you should take and test about 15 to 20 minutes later. Yes, I am suggesting a full tablet for 5 mg/dl that would be the remainder. Repeat as necessary with one glucose tablet until you are above 80 mg/dl.

If you live alone and do not have glucose tablets, call 911 immediately if you are able. Yes, this can be a little drastic, but rather than take chances with unknown carbohydrates that are not as fast acting, I would suggest this. Some would suggest other remedies like juice. However, they may work, but are not as fast acting and the low could become severe, putting you in a coma and at risk of death. This is the reason for always having glucose tablets on hand.

How can I change my lifestyle and diet in a way that will be healthy? Or maybe not ideal, but more healthy. If you are a person that has led a sedentary life, then it is time to start some exercise that you enjoy and can maintain on a daily basis. Your goal should be at least 10,000 steps on a daily basis. Always make sure that you discuss this with your doctor before starting for medical reasons. This will give your doctor the opportunity to know what you are planning and be able to give you the go-ahead or say whoa; you will cause this or that problem. He may have suggestions that will allow for exercise in a safe manner that will not cause harm. Always start slowly and warm up to prevent injury.

For food plan (forget diet) you need to discuss this with a nutritionist that understands diabetes. Some will suggest a registered dietitian (RD), but be careful here. Many, but not all, will mandate (never a good thing) whole grains and that you consume so many carbohydrates and this may not work for you. There are so many food plans that it is difficult to know what is best for you. I would suggest maintaining a food log and blood glucose test results to see how different foods affect you. Generally, highly processed foods should be limited if not eliminated. If your budget allows, convert to fresh foods where possible and foods that have limited processing. This blog may be of help.

What are the side effects of my medications/insulin? Here is the resource you should use and become familiar with and maybe bookmark it. Find the medication or medications you are taking and look them up in the tables.

Diabetes Questions to Ask Your Doctor – Part 1

Part 1 of 3 Parts

Are you ready for your doctor appointment? The following is some of the questions to ask your doctor if you have recently received a diagnosis of diabetes, type 2. Some questions just lead to more questions and can make it difficult to follow what is and what is not important to know immediately. I have tried to stay with what is important at the start and good to learn at the beginning of your journey. Each question tells you which of my blogs contain an applicable discussion if you wish to read more or I will refer you to a blog by another writer.

I have tried to sprinkle in the acronyms that you will learn and see very often. I will also try to point out terms that you will need to learn. Why? Because you will see them used by most people that have had diabetes for several years and once you learn the language, you can learn to read without a dictionary. You may still want one handy, and there are several online. I prefer this medical dictionary, but I will also use this medical dictionary. There are others and you may search for them and see if you like them.

An example is blood sugar (BS), which I do not like, but most writers insist on using this term. Correctly, both scientifically and medically, the term should be blood glucose (BG). I would urge people new to diabetes to read this by David Mendosa. One example that I see all too often is the use of the word glucometer. This is correct only if you are referring to the meter registered to Bayer as a trademark. Correctly, your meter is just that, a meter. Also, be careful as most people refer to a meter and test strip as a unit even though you must change test strips.

The 10 questions are really 14 questions and I have divided them accordingly.

1. Should I check my blood sugar levels at home with a glucose monitor? How often should I check them?

2. What are my goals regarding blood sugar levels?

3. What are the warning signs or symptoms that my blood sugars are too high? What do I do if my blood sugars are too high?

4. What are the warning signs or symptoms that my blood sugars are too low? What do I do if my blood sugars are too low?

5. How can I change my lifestyle and diet in a way that will be healthy?

6. What are the side effects of my medications/insulin?

7. Will I always need medications/insulin? How will you evaluate whether these medications are the best treatment for me?

8. What are the long-term complications of diabetes, and how can I avoid them?

9. How do other factors such as high cholesterol and high blood pressure affect me if I have diabetes?

10. How often should I be seeing my doctor to optimize my diabetes management?

I will list each question and give my response as a patient to them. They are still questions worth considering for asking your doctor, but you will not see them answered this way.

Should I check my blood sugar levels at home with a glucose meter? Yes, you definitely should check (test) your blood glucose at home, at work, or where ever you are when testing is needed or desired. Many doctors discourage this for various reasons and this is wrong. Many doctors do not want you to know what they are or do not want you to be depressed with the high readings. If your doctor does not have a meter to give you one and a prescription for more strips, then insist (even demand) on a prescription for a meter, lancet device, lancets, and test strips before you let the doctor leave the exam room. If your doctor remains uncooperative, then you have a decision to make about possible change in doctors. For your diabetes health, the sooner you make this decision, the healthier you can be.

Testing is the only way you have for determining how different foods and food quantities affect your blood glucose (BG – is the acronym). A term you will see in blood glucose management is self-monitoring of blood glucose (SMBG – is the acronym). You will also need to test more frequently in the beginning to learn how long before you reach the high level of your BG. Many suggest one hour after first bite and for some people this can be too early. If you are a speedy eater (gobble down your food), this may work; however, studies have shown that you should eat slower for greater blood glucose management. Some writers do use the word control for the same meaning. Some will suggest testing more often until you are comfortable with when your high level of BG happens. I suggest starting at the one-hour mark and testing every half hour the first few times. When the reading is lower than the previous reading, then you may stop.  Your high point has occurred between these two readings.

Having said this, I must warn you that most, if not all, insurance companies will limit the number of test strips they will reimburse for your use. Therefore, your budget may not allow for the testing you should attempt. And, these vital test strips are expensive.

How often should I check my blood glucose? This is not an easy question to answer, even for new people with type 2 diabetes. This will depend to a great extent on your medication(s), what your insurance will cover, your budget, and your comfort zone. Many people with type 2 do purchase extra test strips out of their own pocket because they can afford this. Those people with a limited budget that are on oral medications probably will need to use what the insurance will reimburse. People on sulfonylureas that have had problems with hypoglycemia should encourage their doctor to write a letter explaining this and asking for additional test strips. There are other combinations that may cause use of extra test strips and your doctor should make you aware of them and request extra test strips. Please read my blog here for some of the oral medications that can create troublesome hypoglycemia.

How often you test will depend on your desire to bring diabetes under good management and your budget. You will also need to find out how willing your doctor is to go to bat for you with the insurance company for additional testing supplies. Some companies will allow some extra test strips in the first few months, but then want to restrict you thereafter. Other insurance companies will only allow a set number of test strips per day. I recommend that you talk with your insurance company to find out what they are willing to allow. You may need to bargain with them and attempt to convince them of the need for allowing more test strips for the first three to five months. Don't be surprised if you are denied, but it is still worth the effort.

What are my goals regarding blood glucose levels? This will depend on what you are willing to tolerate. I suggest reading this for an excellent guide. Some people set lower goals and do not like being over 125 mg/dl (milligrams per deciliter) at the high point in BG. For a person just getting started, my link is a good goal. Try not to have fasting BG under 80 mg/dl, especially at first. Gain some confidence in what you are doing before letting the numbers become overly important. Yes, learn first, and then work toward them. Do not become discouraged when you cannot achieve them the first few weeks. Remember you did not develop diabetes overnight, and it can take time to set goals and achieve them. These are goals you are working to achieve and you have a lot to learn at first. I have been at this for over nine years, and there are times when I have difficulty in maintaining the range of numbers I want to achieve.