Expert Q & A
Now that I'm 50, do I need a colonoscopy?
Is coffee bad for diabetes?
Can a doctor see diabetes-related complications in my eyes?
Could my husband's smoking habit harm my health?
Is it true that diabetes increases my risk of gum disease and that gum disease could raise my blood sugar?
If my levels are normal, why does my doctor advise taking a cholesterol-lowering drug?
Can cold and allergy medicines affect blood sugar?
Where can I get help paying for prescription medicines?
Testing makes my fingers sore. What can I do?
Are there special warm-weather concerns for people with diabetes?
I recognize signs of diabetes in a friend. How can I convince her to see a doctor?
Can people with diabetes donate blood?
Do blood sugar levels change with the menstrual cycle?
Q. Now that I'm 50, my doctor says that I should have a colonoscopy. Do I really need it?
A. Beginning at age 50, men and women at average risk should be screened for colon cancer, the third leading cause of cancer death. In fact, after considering personal risk factors, some health care professionals may recommend screening at an even earlier age. For example, research shows that having diabetes may increase your risk of colon cancer. You can help reduce that risk by following a healthy diet, exercising regularly, and taking prescribed medications to control your blood sugar. Also, avoid drinking excessive amounts of alcohol and smoking. And make an appointment today to have a colonoscopy. In many cases, thanks to colon cancer screenings, polyps can be found and removed before they turn into cancer.
–Donald A. Garrow, MD, clinical instructor in the division of general internal medicine at the Medical University of South Carolina in Charleston
Q. Is coffee bad for diabetes?
A. At the University of Minnesota, we recently studied coffee consumption and the prevalence of diabetes in more than 28,000 women over an 11-year period. We found that women who drank more than 6 cups of any type of coffee a day were 22% less likely to develop diabetes than women who drank no coffee. This reduced risk held true regardless of the women's weight, diet, or physical activity level. Why does coffee appear to be beneficial? We don't know for sure, but what we do know is that coffee contains powerful antioxidants that may have beneficial health effects. These compounds may also help the body process carbohydrates more effectively. Just stay away from any kind of coffee prepared without a filter. Coffee prepared by this method contains substances that may raise levels of LDL (bad) cholesterol. Also, if your doctor has told you to avoid caffeine to manage high blood pressure, stick with decaf.
–Mark A. Pereira, PhD, associate professor of epidemiology and community health at the University of Minnesota in Minneapolis
Q. Can a doctor tell if I have diabetes-related complications simply by looking in my eyes?
A. The eyes do indeed provide a window into the human body. Although an eye exam is not a conclusive test of your heart or kidney health, damage to the small blood vessels in your eyes indicates that problems may be developing in the small blood vessels throughout your body. That's one reason why it's so important to have a comprehensive eye exam with an eye doctor at least once a year. If you are diagnosed with retinopathy (damage to the blood vessels in the retina), it is very important to consult with your primary care doctor to make sure your blood sugar, blood pressure, and blood cholesterol are under control. In addition to following your eye doctor's instructions, follow a healthy diet, exercise, and take your medication as prescribed.
John I. Loewenstein, MD, associate professor of ophthalmology at Harvard Medical School in Boston
Q. I quit smoking many years ago after I was diagnosed with diabetes, but my husband still smokes. Could his habit harm my health?
A. You made a smart move when you decided to quit smoking. Smoking is one of the most important modifiable risk factors for heart disease. In people who already have a high risk of heart disease—such as people with type 2 diabetes—smoking is particularly dangerous. The good news: People who quit smoking have only half the risk of those who continue to smoke, regardless of how long they smoked before quitting. The benefits of quitting smoking begin immediately and increase with time. Even if you don't smoke, secondhand smoke still appears to increase the risk of heart disease. Because you have diabetes, you already have a higher risk of a heart attack, so it's wise to take every precaution to reduce that risk. If you can convince your spouse to quit, you'll probably improve his health and yours. As a compromise, you might convince him to smoke outside the home.
–Thomas K. Houston, MD, assistant professor of medicine at the University of Alabama at Birmingham
Q. My dentist told me that diabetes increases my risk of gum disease and that gum disease could raise my blood sugar. Is this true?
A. Many studies show that people with diabetes are more likely to develop gum (periodontal) disease than people without diabetes. This higher risk may stem from the increased risk of infections common in people with poorly controlled diabetes. Preliminary research indicates that the connection also works in reverse, with gum disease raising blood sugar levels. We don't know why, but we suspect that gum disease triggers inflammation in the body, which raises blood sugar levels. For these reasons, you should visit your dentist regularly, floss daily, and brush after meals.
–Robin Goland, MD, endocrinologist and codirector of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York City
Q. If my levels are normal, why does my doctor advise taking a cholesterol-lowering drug?
A. Even with normal cholesterol levels, someone with diabetes has as great a risk of dying of a heart attack as someone without diabetes who has already had a heart attack. High blood sugar levels over time can lead to increased deposits of fat and other materials along the artery walls. These deposits may affect blood flow, increasing the risk that the artery will become clogged. Increased risk of inflammation in people with diabetes may also contribute. For these reasons, doctors often prescribe medications to reduce levels of LDL (bad) cholesterol. More recently, we have learned that some drugs also reduce levels of inflammation, protecting you from a heart attack even if your LDL cholesterol is normal.
–Gary Enzmann, MD, endocrinologist and medical director of the Joslin Diabetes Center Affiliate at Swedish Medical Center in Seattle
Q. Can cold and allergy medicines affect blood sugar?
A. Over-the-counter liquid antihistamines and decongestants can affect blood sugar levels because of a key ingredient: sugar. Check labels on liquids to make sure sugar isn't one of the top 3 ingredients. Solid formulas—tablets and capsules—generally don't contain enough sugar to have an effect. You could also ask your pharmacist to recommend a sugarfree product. Be sure to monitor your blood sugar, and consult your doctor if you see a change in levels.
—Peggyann Zaenger, PharmD, pharmacist and advisor for the American Pharmacists Association
Q. Where can I get help paying for prescription medicines?
A. The Partnership for Prescription Assistance (PPA) connects you to more than 475 patient assistance programs through a toll-free number (1-888-477-2669) and a user-friendly Web site (pparx.org). In turn, these assistance programs link you to more than 2,500 brand-name and generic prescription medications at little or no cost. All you need to do is tell PPA the medication(s) you're taking and answer a few questions. In minutes, you'll receive a list of programs for which you might qualify. If you're applying online, you can print out the applications; if you're applying by phone, PPA will mail the applications. Each patient assistance program has its own timeline, but many patients receive medications in 2 to 3 weeks. PPA is sponsored by Pharmaceutical Research and Manufacturers of America (PhRMA).
—Ed Belkin, vice president of communications and public affairs for PhRMA
Q. Testing makes my fingers sore. What can I do?
A. The tops of the fingers have the highest concentration of nerve endings, so try taking a blood sample from the sides of your fingertips using a very thin finger-pricking device. Before pricking your finger, shake your hands down by your sides and "milk" your fingers by pushing the blood down to the ends of the fingertips. This way, you'll most likely get a good drop and won't need to prick multiple times. Keep rotating the fingers and locations that you use to keep any one finger from getting pricked too often. If you still have trouble, consider a meter that allows for samples from the forearm, thigh, base of the thumb, and upper arm. Check with your doctor first, though, because samples from these sites typically do not capture rapidly changing blood sugar levels as well as samples from a traditional finger prick.
—Melinda D. Maryniuk, RD, CDE, associate director of affiliated programs at Joslin Diabetes Center in Boston
Q: Are there special warm-weather concerns for people with diabetes?
A: Dehydration is a big concern, so be sure to drink plenty of water. It's also a good idea to avoid strenuous outdoor activity in hot conditions. If you need to be outdoors, stay in the shade as much as possible and check your blood sugar levels more often than usual. Don't forget to carry identification with you, in case of emergency. If you carry insulin, use a cooler to keep it at the recommended 59° to 89°F. Ask your diabetes educator for more hot-weather solutions specific for you.
—Donna Rice, RN, certified diabetes educator and president of the American Association of Diabetes Educators
Q: I recognize signs of diabetes in a friend. How can I convince her to see a doctor?
A: If your friend mentions frequent urination, intense hunger or thirst, unexpected weight loss, tingling in the hands and feet, or vision changes, she may have diabetes. Sometimes there are no symptoms at all, but she could be at higher risk if she's overweight or has a family history of diabetes. Undiagnosed diabetes can lead to health complications that include heart, vision, and kidney problems. It's important to let her know that you're concerned for her health. Try saying, "It may be nothing, but please get checked out by a doctor." Let her know that diabetes is controllable. If she is scared, offer to go with her to the doctor's office.
—Janis Roszler, RD, LD/N, certified diabetes educator
Q: Can people with diabetes donate blood?
A: As long as you're feeling healthy, you can donate blood. Healthy means that you feel well and can perform normal activities. It also means that you are being treated and have your diabetes under control—with lifestyle modifications, oral medications, or insulin. There's only one automatic decline for a person with diabetes: having received an injection after 1980 of bovine (beef) insulin made from cattle from the United Kingdom, because of concerns about mad cow disease.
—Stephanie Millian, director of biomedical communications for the American Red Cross
Q: Do blood sugar levels change with the menstrual cycle?
A: Every woman's body is different, so menstruation may or may not affect blood sugar. But for many women, levels increase around the third week of their cycle and may remain elevated for up to 5 days. The natural release of hormones that occurs around the time of menses can cause a woman's body to be resistant to insulin, resulting in higher blood sugar levels. Some women may note lower levels the first couple days after their period. If you suspect that changes in your levels could be related to your menstrual cycle, share your blood sugar readings and menstruation dates with your doctor. Only your doctor can determine whether treatment adjustments are needed.
—Arlene Loeschen, MSN, advanced diabetes management nurse practitioner and certified diabetes educator at Diabetes Centers of America in Katy, Texas
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