Medical Questions Answered » Diabetes

What are the most reliable sources of information on diabetes?

admin — Fri, 10 Jun 2011 15:55:00 +0000

I have mentioned several sources throughout this book that will give you reliable information. For most of these I have given websites rather than phone numbers. Information is likely to be more reliable and less biased if it is from a federal, state, or local government site or from a charitable organization (like the American Diabetes Association or the Juvenile Diabetes Research Foundation), rather than from a commercial company that makes money from selling diabetes drugs and supplies. If you do not have access to the internet, then I suggest you contact your local health department and ask for diabetes information. Here is a list of the websites that I have
mentioned throughout the book:

The American Diabetes Association www.diabetes.org
The Juvenile Diabetes Research Foundation www.jdrf.org
Continuous glucose monitoring systems: www.dexcom.com or
www.medtronic.com or www.glucowatch.com
Quitting smoking: www.freeclear.com
Emergency identification: www.medicalert.com
Portion size: www.platemethod.com
Carbohydrate counting: www.calorieking.com
Walking and pedometers: www.walkamerica.org or www.americaonthemove.org or www.10kaday.com or www.shapeup.org
Insulin pumps: www.diabetes.org/type-1-diabetes/insulinpumps.jsp
Alternate and complementary therapies: nccam.nih.gov/health/diabetes/
Shared Care Plans: www.sharedcareplan.org
Research and clinical trials: www.clinicaltrials.gov/info/resources

Let me give you one last resource that you might find helpful. I have tried to answer all the common questions that I get about diabetes in this book. I asked a few dozen people I know who have diabetes themselves or who work with people who have diabetes.Their questions have also been included in the book. But it may be that you still have questions that did not appear in the book and that you would like to have answered. Maybe you have follow-up questions. I have set up a weblog to accompany this book. If you have more questions, I invite you to write to me at www.morediabetesanswers.com. I will do my best to read your questions and post answers that anyone can look at. And if we end up doing a second edition of The Diabetes Answer Book, then I will include the best of these new questions in that book.

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Does diabetes affect your sex drive?

admin — Thu, 09 Jun 2011 15:52:00 +0000

Yes, it can. People usually feel most romantic and interested in sex when they are relaxed and can be spontaneous. It is hard to feel like that if you are embarrassed that you have lumps and bruises from where you give your insulin shots or if you are worried about your blood glucose dropping too low. It is not very romantic to tell your partner to stop in the middle of lovemaking so that you can check your blood glucose. If your diabetes is out of control and you feel exhausted, stressed, and thirsty, this will affect your sex drive. If you have a yeast infection and need to go to the bathroom a lot, this can interfere with sex. Whether you have diabetes or not the most important thing to do to help your sex drive is to have good communication with your partner. There is no reason you can’t have as healthy and enjoyable a sex life as anyone without diabetes. Just like with other aspects of life, having diabetes means there are more things for you to think about and adjust, but with a loving partner and a good attitude, your sex drive should be as good as anyone else’s. If it is not, you should talk to your doctor about it.

How can I tell if I am really depressed or not?

admin — Thu, 09 Jun 2011 15:51:00 +0000

Sometimes it can be really hard to tell. You may just be feeling hopeless and frustrated and feel that you have no way out of your situation. Here are some things to ask yourself. Are you having trouble falling asleep? Do you feel as if you have no energy, you can’t
concentrate, and you are tired all the time? Are you losing interest in doing things that used to give you pleasure? Have you no interest in food? Are you overeating? Are you feeling bad about yourself and as though you have let yourself and other people down?

Although none of these things by itself means you are depressed, if you answered “yes” to more than one of them, you should talk to your doctor so that he or she can do a more complete evaluation. Having depression is a real illness, just like getting influenza or pneumonia. It is not your fault. It is nothing to be ashamed about or blame yourself for. It can be treated. In fact, if it is not treated, it will be hard for you to be successful or happy in any aspect of your life. If you think you may be depressed, please ask for help as soon as possible.

What should I do when I get frustrated and depressed about my diabetes?

admin — Thu, 09 Jun 2011 15:50:00 +0000

It is completely normal to get frustrated and depressed about having diabetes. Diabetes puts restrictions and burdens on you that interfere with your everyday life. There are likely to be days when you are just sick of it and want to forget about it completely and pretend you don’t have diabetes. Maybe that’s how you feel most days.

Many books have been written on this topic. Here are two that many of my patients have found to be helpful: Psyching Out Diabetes: A Positive Approach to Your Negative Emotions by Richard R. Rubin and Diabetes Burnout: What to Do When You Can’t Take It Anymore by William H. Polonsky. Dick Rubin and Bill Polonsky are both clinical psychologists and certified diabetes educators. They are also incredibly warm and down-to-earth human beings who have spent years working with people with diabetes and helping them overcome their frustrations. You will find many practical tips and approaches in these books.

There are two aspects of your frustration that you should think about. The first thing to do is find one or more people with whom you can share your frustration. Do you know some other people who have diabetes? Does your local clinic or hospital offer support groups? You will be amazed at how much better you feel when you hear other people describing some of the same things that have frustrated you. You may be surprised at how much you have figured out that you didn’t realize. You may find yourself offering suggestions to help other people with diabetes and hearing new things to try from them.

This brings me to the second thing to focus on when you feel frustrated. Try to be very specific about what things are frustrating you. Make a list. How many things on that list are really due to your
diabetes, and how many are caused by other things in your life? Try to think up possible solutions for some of them. If the problem is that you don’t understand why a certain thing is happening, try to find out. The answers in this book are an attempt to explain some common frustrations that you may have. And if you have figured out why something is frustrating you about your diabetes, see if you can come up with some new ideas for things that you could do differently that might help.

A very popular and useful support group that offers structured and practical advice is called “Living Well with Chronic Illness.” These groups were developed by Dr. Kate Lorig and her colleagues at Stanford University and are available in more than twenty-seven states in the United States. They provide a wonderful opportunity to share ideas with other people who are dealing with some of the same frustrations as you. Ask at your local clinic or hospital if these
support groups are available near you.

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How much should my family and friends know about diabetes?

admin — Wed, 08 Jun 2011 15:46:00 +0000

The best answer is, “As much as you want them to know and as much as you think they can cope with and understand in order to be helpful to you.” You need to use your own judgment. A distant relative whom you are not close to doesn’t need to know much of anything, but for people you sleep with or live close to, it can be very helpful to you if they understand something about what it is like for you having diabetes. You should all be eating the same, healthy diet, for example. If you take pills or insulin that are likely to push your blood glucose down below normal from time to time, then your close family ought to know how to tell that your blood glucose is too low and what they can do to help you bring your blood glucose up.If there is a chance you could pass out unconscious from hypoglycemia during the night, then it might be helpful to have a close family member know how to give you an injection of glucagon to bring you out of it. If you have younger children who might be scared by this or would be too young to give you an injection, you could still ask them to call 9–1-1 or a neighbor or friend.

How can I tell if new treatments that I hear about in the media would be good ones for me?

admin — Wed, 08 Jun 2011 15:44:00 +0000

It is getting more and more common for pharmaceutical companies to advertise directly to consumers. The new drug always sounds great, of course. How can you tell if it really would be good for you? One approach is to use reputable sources for getting your information. Websites like the American Diabetes Association are likely to be less biased than a pharmaceutical company’s own website, for example. It also helps to look at the information being presented very carefully. Don’t be taken in. Don’t accept things at face value.

Let me give you some practice. Let’s say a pharmaceutical company called PharmDrug, Inc., does a marketing splash for their new “wonder drug” called Fixitol. Everywhere you go, you see ads for Fixitol: “FIXITOL fixes everything in your life! A recent randomized, doubleblind, placebo-controlled clinical trial showed that taking FIXITOL improved everything by a dramatic 300 percent compared to placebo! Only 10 percent of patients had significant side effects. Ask your doctor about FIXITOL!” Sounds too good to be true, right? Well, you know what they say, “If something seems too good to be true…it probably is!”

Let me explain what some of these technical words actually mean and then show you how, without actually lying, PharmDrug, Inc. could be misleading you. If a trial is “randomized,” this means that people who take part are picked at random to either get the new treatment (in our example they would be given the new drug Fixitol) or not. If the clinical trial uses a “placebo,” this means that the people who don’t get Fixitol will get a pill that looks identical to Fixitol but has no active ingredients in it (a placebo is sometimes called a “dummy pill” or “sugar pill”). When a trial is “double-blind,” this means that nobody knows who is taking the real Fixitol and who is taking the dummy pill. The participants don’t know and neither do the doctors and nurses looking after them. This is really important, since you are more likely to feel better if you think you are taking the real drug, and the doctors and nurses are likely to treat you differently if they know that you are on the real drug.

A randomized, double-blind, placebo-controlled clinical trial is the best way to test a new drug. It is the “gold standard.” But even if the clinical trial used this approach, it is still possible for PharmDrug, Inc., to mislead you by the way they report the results. Let’s say that two thousand people participated. One thousand of them took Fixitol, and one thousand took the placebo pills. One person in the placebo group said that “everything was better” at the end of the trial, and three people in the Fixitol group said that “everything was better.” It is technically correct to say that this is a threefold difference (or a 300 percent improvement) between Fixitol and the placebo. But only four people out of the two thousand who participated in the clinical trial actually got any benefit at all. So only 0.3 percent of people taking Fixitol got any benefit, and the other 99.7 percent didn’t. Doctors would need to put five hundred people on Fixitol in order to be sure that one of them would get any benefit.

And what about those side effects? First of all what do they mean by “significant” side effects? They may make light of symptoms that you would find unpleasant. And to say that “only” 10 percent of participants got side effects means that one hundred people who took Fixitol felt worse on it. So the real results of this well-designed clinical trial are that for every five hundred people who start on Fixitol, fifty will get side effects that make them feel worse, and only one will get better. When you put it like that, Fixitol doesn’t seem like such a great drug to take, does it?

If you want more information from a reliable source check out http://clinicaltrials.gov/info/resources. If you are interested in understanding more details about the statistics used by pharmaceutical companies, you can find books as simple as Statistics for Dummies all the way to college-level textbooks.

How often should I see my diabetes doctor?

admin — Tue, 07 Jun 2011 15:37:00 +0000

It depends on how complicated your diabetes treatment is, how confident you are about what you are doing, and how much support you feel that you need or want. You certainly ought to be seen at least once a year for a planned visit. Even if you have already got the eye, foot, and blood pressure checks and the laboratory tests that I mentioned, it is still a good thing to go over your goals and targets with your doctor at least once a year. If you are having frustrations or are making changes to your treatment, then you may need to be seen more often than once a year. Some doctors (and books) recommend that you should be seen every three months if you have
diabetes, but I don’t think that is always true. How often you are seen should depend on what you want to get out of the visit.

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How often should I get laboratory tests?

admin — Tue, 07 Jun 2011 15:36:00 +0000

It depends on how old you are, what other medical conditions you have, and what treatment you are on. You should know what your HbA1c level is, when it was last checked, and what target you are trying to reach. If you are above this target, then your HbA1c should be checked every three months, and you should be making changes to how you manage your diabetes until you get to your target. If you are already at your HbA1c target, it is still a good idea to have your HbA1c checked once or twice a year to make sure it stays there. If your body gradually makes less insulin, or if you become more stressed or resistant to insulin, then your HbA1c might drift up. You will get quite a good idea how your overall blood glucose is doing by doing your own blood glucose tests, but keeping track of your HbA1c is also a good idea.

You should probably get a urine test for microalbuminuria once a year to check how well your kidneys are doing. A blood test for creatinine is another helpful kidney test to check on. It is good to know what your LDL cholesterol, HDL cholesterol, and triglycerides are. You may not need to get these done every year. It depends on your age and whether you are on treatment to keep them in a normal range. It is easier to remember to get things checked once a year; but in truth, some things don’t need to be checked that often, and other things need to be checked more often than once a year.

Depending on what drugs you are on, it might be good to get your potassium checked or a test to see how well your liver is doing. This test is sometimes called a liver function test, or LFT. The laboratory measures how much of the enzyme alanine aminotransferase (ALT) is in your blood. If your liver is inflamed or irritated, then it releases more ALT into your blood. This can sometimes be due to a drug that you are taking, but the ALT can also be higher than normal if your blood glucose level is too high.

How often should I get a physical?

admin — Tue, 07 Jun 2011 15:34:00 +0000

This is a tricky thing to answer, because it depends so much on how healthy you are. Some people like the reassurance of getting an “annual physical,” as if this gives you some kind of guarantee that you are healthy, like when you take your car in for a checkup every five thousand miles. But in truth, when you take your car in they don’t check everything. They check some specific things like your oil and fluid levels, the wear and tear on your tires, and how well your brakes work, for example. The same is true for a “physical.” It may make you feel better to have a doctor listen to your heart and lungs or press on your belly, but unless you have specific symptoms, doing those things doesn’t always do much to keep you healthy.

If you have diabetes and are feeling well, it still makes sense to have your feet examined at least once a year to see that the sensation on your feet is normal, that the shape of your feet is normal, and that the circulation is good. It makes sense to have an eye exam by a trained
optometrist or ophthalmologist every year or two to make sure that your eyes are healthy. Screening your eyes and feet make sense, because it is possible for them to get damaged without you knowing about it. If problems are detected earlier, the treatments to keep you healthy are much easier than if you wait until you have an ulcer on your foot or you notice you can’t see as well as you used to. Checking your blood pressure at least once a year also makes sense for the same reason. Your blood pressure might be too high, but you wouldn’t know about it unless you check it yourself with a blood pressure machine or come in and get your blood pressure checked as part of a physical. But apart from checking those specific things, I am not sure that a physical exam is very helpful unless you have new symptoms or concerns.

How can I get the most out of my relationship with my health care team?

admin — Mon, 06 Jun 2011 15:33:00 +0000

Finding someone whom you connect with and who “gets” who you are and what matters to you is really important. Just like in other important relationships in your life, there are some indefinable qualities about this. You can sometimes just “tell” if this doctor or nurse is someone you can relate to or not.

How do you like to communicate: by phone, by email, in writing, in person? What options does your health care team offer you for communication? Clear communication is a key thing to building a good relationship. Do you need to come in for this visit, or could you get your questions answered by phone or email? If you are coming in for a visit, what is the purpose, and how long will you have with your health care team? If you have a lot of questions, it is good to write them down in case you forget when you are with your health care team. Do you really have a team? Does your doctor work with a nurse or dietitian or pharmacist who understands about diabetes and is part of the team? If so, which is the best person to ask about different concerns you have?

I love using email with my patients, not as a replacement for faceto-face visits but as a way to enhance them. I encourage my patients to email me or write to me before we meet so that I know what questions and concerns they have. If the list is really long, I can make sure I have enough time, or I will suggest a longer appointment or that we only talk about some of them at this visit and make another appointment to go over the rest.

it is important for you to be able to see your health care team when you have a particular problem or concern. But even if you feel fine, I think it is a good idea to have at least one visit a year to go over the “big picture.” This is a good time to update your Care Plan, if you have one. You can go over your life goals or the targets for your HbA1c, blood pressure, cholesterol, for example. You can make sure that you are up to date with your eye exams and foot exams. It gives you an opportunity to ask about any new drugs or tests that you have heard of.

Hopefully your health care team will be enthusiastic about helping you with all of these things and might even keep track of when you are coming due for eye exams and other screening tests. If not, then you might be better looking for a new doctor and health care team that you can work better with.