Introduction
Kathryn Teng, MD
Cleveland_Clinic_Host: The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. There are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately, 5.7 million people (or nearly one quarter) are unaware that they have the disease.
Individuals who have diabetes need to have a partnership with their medical care provider in order to monitor and treat their condition. Dr. Teng is available to discuss any questions you may have related to diabetes. Her hour online health chat will address Diabetes Symptoms, Prevention and Treatment Update: How you and your doctor can work together in the prevention and treatment of Diabetes.
Dr. Kathryn Teng joined the Department of Internal Medicine of Cleveland Clinic in 2007. She is currently a Staff Physician of the Cleveland Clinic and an Assistant Professor of Medicine at Case Western Reserve University's Lerner College of Medicine. She graduated Phi Beta Kappa from the University of Virginia with a B.A. in Biology. She then matriculated to Vanderbilt University School of Medicine, obtaining her M.D. in 1997.
She continued her clinical training at Vanderbilt University Medical Center, doing an internship in OB/GYN and a residency in Internal Medicine. She joined the staff of Massachusetts General Hospital in 2000 and built a thriving, busy clinical practice there. She was an Instructor in Medicine at Harvard Medical School and played an active role in training medical students and residents.
Since joining the staff of Cleveland Clinic, Dr. Teng continues to commit her time to her growing clinical practice and to the teaching of medical students and residents.
Cleveland_Clinic_Host: For information about Cleveland Clinic Medicine Institute or to schedule an appointment with Dr. Teng or one of her colleagues, please visit us on our web site clevelandclinic.org/medicine or call us at 216.444.5665 or toll free at 800.223.2273 ext 4-5665.
Diabetes Overview & Diagnosis
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Kathryn Teng, MD. We are thrilled to have Dr. Teng here today for this chat. Let’s begin with some general questions about Diabetes.
trailerp: What are some common symptoms of diabetes?
Speaker_-_Dr__Kathryn_Teng: The most common symptoms are: unusual weight loss, fatigue, blurred vision, increased thirst or urination. However, in the early stages of diabetes, there may be no symptoms. It is important to screen for diabetes beginning around age of 40, or earlier if you have risk factors. Early detection and treatment are important to prevent and delay complications of diabetes.
sassfrass: What is the difference between Type I and Type II diabetes?
Speaker_-_Dr__Kathryn_Teng: The difference lies in the causes. Type I diabetes results from the destruction of the insulin-producing beta cells in the pancreas. This is usually an autoimmune process. Type II diabetes is a spectrum of abnormalities involving glucose metabolism as well as other metabolic processes. This usually involves insulin resistance in which higher amounts of insulin are needed to maintain normal glucose levels.
meannotlean: I am 55 years old and have been diagnosed as pre-diabetes type 2. What does this mean? I also have elevated cholesterol.
Speaker_-_Dr__Kathryn_Teng: Pre-diabetes is a condition that represents an increased risk for diabetes. Both diabetes and high cholesterol levels are risk factors for heart disease and stroke. I would urge you to work on diet and exercise changes to improve on both of these areas.
newtonm: Is a person pre-diabetic with a A1C of 6.0 and glucose of 114?
Speaker_-_Dr__Kathryn_Teng: Yes. Pre-diabetes is defined as a fasting blood glucose of 100-125.
Diabetes Risk Factors
conundrum: What are some risk factors for diabetes?
Speaker_-_Dr__Kathryn_Teng: The major risk factors are central obesity, autoimmune diseases, and high triglycerides.
Central obesity refers to weight around the waistline area. Certain autoimmune diseases that have shown a correlation to diabetes are: thyroid &. Polycystic Ovarian Syndrome (PCOS).
eyeofnewt: What, if any, effect does stress have on either type of diabetes?
Speaker_-_Dr__Kathryn_Teng: Stress is shown to have an effect on Diabetes in some literature. Stress from illness or injury can result in elevations of glucose levels. Stress does not usually cause diabetes directly, but it can unmask undiagnosed glucose intolerance.
Diabetes Prevention
clapper: How can I prevent diabetes?
Speaker_-_Dr__Kathryn_Teng: To help prevent diabetes you need to maintain a normal/healthy weight, exercise regularly, as well as eat a balanced diet of fruits/vegetables and whole grains. You should limit your intake of simple sugars (white breads, pastas, rice, potatoes, junk food, and fast food). For some with a genetic predisposition, diabetes may not be preventable. However, you can delay your need for medicines and the development of long term complications with the steps listed above.
newtonm: I exercise 3 days a week for 2-2 1/2 hours each day. Is this sufficient?
Speaker_-_Dr__Kathryn_Teng: According to the American Heart Association, yes, this amount of time spent exercising is considered adequate. However, it is important that time spent in cardiovascular or aerobic exercise is at least 30-40 minutes each day.
Diabetes & Blood Glucose
molliebrown: Are the glucose readings as accurate with alternate injection sites besides the finger sticks? Is the abdomen the most accurate?
Speaker_-_Dr__Kathryn_Teng: Finger sticks are the most accurate readings. Transcutaneous monitoring devices similar to insulin pumps are useful for optimizing diabetes control but are less accurate, and patients who use these devices still need to perform finger stick measurements at various times.
gooda: Pre-diabetic - what’s the best time besides morning to test with Glucose monitor? How many times a day should I test myself with monitor? (poke finger)
Speaker_-_Dr__Kathryn_Teng: There is really no best time. It is often helpful to check in the morning (after a supposed longer fasting period during the night) and then one other time during the day (after or before dinner). In the pre-diabetes stage, it is usually not necessary to check your sugar more than once a day. It may be helpful to check once a day but to vary the time of day every 2-3 days.
bialomizy: My first glucose score in the morning is usually 135 or lower. By noon, after medication (Amaryl 2 mg), it can dip to 67-90. Do I still need to take the medication?
Speaker_-_Dr__Kathryn_Teng: Yes. The medication is designed to lower the blood glucose. Your question is really dependent on the timing of your next medication dosage. Amaryl® is usually prescribed once daily. I would recommend that you keep a blood glucose log and share it with your primary care physician at your next appointment.
jx: Why is your glucose highest in the morning when you fast for a long time? (Type II Diabetes)
Speaker_-_Dr__Kathryn_Teng: After a prolonged fast, your glucose level should be low. If it is high, this may be related to the timing of your last meal or the timing of your medications. Keeping a detailed log of your medication times, meal times and blood sugars will help your doctor to advise you further.
criley71wva: What causes blood sugar sensitivity levels to elevate-high and very low?
Speaker_-_Dr__Kathryn_Teng: Blood sugar levels normally peak after eating food with a high sugar load. Blood sugar levels decrease after a period of not eating. The amount that these levels fluctuate depends on the foods eaten, medications, and the body’s production of insulin to regulate the blood sugar levels.
emw123: Does drinking water with a meal, (as opposed to coffee) have a relationship to the glucose manufacturing in the body?
Speaker_-_Dr__Kathryn_Teng: No, unless you are drinking coffee with cream and sugar.
doublem: I have extreme difficulty pricking my finger to get blood. Could you please give me information on any other way to check glucose numbers?
Speaker_-_Dr__Kathryn_Teng: You may be a candidate for subcutaneous monitoring, however as addressed in a previous question, this method is not considered as accurate as a finger stick.
Diabetes Management
gooda: If you are diagnosed with “pre-diabetes,” can you eat right and exercise enough for it to go away?
Speaker_-_Dr__Kathryn_Teng: The diagnosis of pre-diabetes is a risk factor for developing diabetes, not an absolute certainty. So, yes, diet and exercise can normalize blood sugars and reduce your future risk of developing diabetes.
cost29: If the A1C is brought down to below 7, what chance is there to get off of the diabetes medication?
Speaker_-_Dr__Kathryn_Teng: I assume you are speaking of a situation in which you work really hard on diet and exercise and lose weight, resulting in lower blood sugar levels. In this situation, it is possible to come off medications at least for a period of time, as long as you can maintain a HBA1C below 7 off medications.
Diabetes & Medication
gooda: Are there any new medicines being released to prevent Type II Diabetes? For pre-diabetics to start taking?
Speaker_-_Dr__Kathryn_Teng: No new medicines or data on this at this time. Metformin®
has been used in some situations for pre-diabetes. Diet and exercise are very important for treatment of pre-diabetes.
batce: Being a Type II diabetic using oral medications, how long before exercise should one eat?
Speaker_-_Dr__Kathryn_Teng: This will vary depending on the person. Physical activity is important to lower insulin resistance and improve glucose tolerance, and we encourage regular exercise. You should monitor you glucose levels frequently while starting your exercise program to determine how to adjust your meal times and medications.
merryberry: Do some Type II meds cause weight gain or loss?
Speaker_-_Dr__Kathryn_Teng: Yes. The medicines that tend to cause weight loss or are weight neutral are Metformin®, Byetta®, and Januvia®. Other meds tend to cause some degree of weight gain.
coolness: Is diabetes always treated with insulin?
Speaker_-_Dr__Kathryn_Teng: No, diabetes is not always treated with insulin. Insulin is a very effective and inexpensive method to treat diabetes. However, it is not the only method. Treatment can include diet changes, exercise, oral medication, and/or insulin therapy.
stungh: What are the benefits between inhaled insulin versus injected insulin?
Speaker_-_Dr__Kathryn_Teng: Inhaled insulin is a fairly new technology. The first inhalers were very cumbersome to use and dose adjustments could not be made in small enough increments to make it practical for many.
Other insulins that can be delivered by inhalation or other non-injectable methods are in various stages of development, but at this time, injected insulin is the main form of insulin used. We now have many forms of injectable insulin that make it easier to control blood glucose levels.
godly: Does Lovenox® interfere with hemoglobin A1C numbers?
Speaker_-_Dr__Kathryn_Teng: No - according to the Physicians' Desk Reference (PDR), there is no interaction.
Diabetes & Nutrition
gooda: Do you recommend eating a low glycemic diet for pre-diabetes?
Speaker_-_Dr__Kathryn_Teng: Yes. A low glycemic diet is part of the diet recommendation for pre-diabetes as well as diabetes.
emw123: Who decides how many carbohydrates can be consumed and when to eat them? Is it standard or individual to each person? Who decides the diet?
Speaker_-_Dr__Kathryn_Teng: The American Diabetes Association has recommendations about what percentage of calories should come for carbohydrates/sugars, At Cleveland Clinic, we recommend that you work with a nutritionist to individualize your personal nutrition plan.
marymary: I am a vegetarian and I went on a diet to lower my borderline diabetes. There was a sharp rise in my triglycerides. How can I adjust this?
Speaker_-_Dr__Kathryn_Teng: I would recommend a consult with a nutritionist to determine what in your diet is causing the sharp rise in your triglycerides.
scanlonj: Can I exchange bread carbs for veggie carbs?
Speaker_-_Dr__Kathryn_Teng: If I understand this question correctly, in general you should not exchange bread and veggie carbs for one another. This is because bread/starches have higher carbohydrate content than vegetables. This is an excellent question to follow up with a nutritionist.
Diabetes Complications
kman3: Should a diabetic have a neuropathy work-up if not aware of symptoms? When is it recommended?
Speaker_-_Dr__Kathryn_Teng: Yes. Your doctor will assess for neuropathy at least yearly as part of a routine exam. Evidence of neuropathies can be seen with abnormal clinical neurologic exams and foot exams.
clumsyone: Can a regular Optometrist do a diabetic retinal exam? Mine did. Is that good enough?
Speaker_-_Dr__Kathryn_Teng: Dilated retinal exams are best performed by an Ophthalmologist. These individuals are specifically trained to detect retinal changes associated with diabetes. Many Optometrists do not routinely perform a dilated retinal exam as part of the routine eye exam.
pardly: What is diabetic ketoacidosis? How serious is it? What are the consequences? How does one avoid it?
Speaker_-_Dr__Kathryn_Teng: DKA (diabetic ketoacidosis) is very serious and can result in death. Avoidance requires strict glucose control and early diagnosis of diabetes.
Diabetes & Other Conditions
plunkett: Family history of diabetes. Is there a correlation between diabetes, kidney cell damage and a greater risk of kidney cancer?
Speaker_-_Dr__Kathryn_Teng: There is a correlation between diabetes and kidney failure. No correlation with kidney cancer. The risk for developing diabetic kidney disease includes: the duration of diabetes, poor control of diabetes, family history of nephropathy (kidney disease) particularly in a sibling and hypertension (high blood pressure).
criley71wva: Can Carcinoid Syndrome cause unusual spikes in blood glucose levels? What causes diabetic crisis to occur?
Speaker_-_Dr__Kathryn_Teng: I am not aware that Carcinoid Syndrome causes unusual spikes in blood glucose levels, but you might direct your questions to a specialist in Carcinoid tumors. In terms of diabetes crisis, I will assume you are referring to diabetic ketoacidosis or DKA. This results from acute insulin deficiency and usually occurs when the blood glucose level is quite elevated. It is often associated with Type 1 Diabetes. DKA can occur in the setting of infection, concurrent illness, and inadequate insulin treatment.
bobross_2: Do you plan to do an Ankle Brachial Index (ABI) on diabetic patient?
Speaker_-_Dr__Kathryn_Teng: According to Cleveland Clinic protocol, we are ordering ABI’s on diabetic patients who have symptoms of peripheral vascular disease. Several medical committees continuously review research data to update our policies and protocols.
Closing
concap: If you have diabetes should you be going to an Endocrinologist or continue with treatment with a family doctor?
Speaker_-_Dr__Kathryn_Teng: You do not need to see an endocrinologist. Most family doctors or internists manage diabetes very well and are able to follow your diabetes needs on a more regular and frequent basis. An endocrinologist can be helpful to manage complicated diabetes issues – people with very labile blood sugars despite standard medications or people who need more complicated medical regimens, such as insulin pumps.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Kathryn Teng is now over. Thank you again Dr. Teng for taking the time to answer our questions today.
Speaker_-_Dr__Kathryn_Teng: It has been my pleasure to join you today in this type of forum. Please do not hesitate to contact your primary care physician if you have any questions or concerns about diabetes. Diabetes is a disease that is very common and can be treated.
More Information
- For information about Cleveland Clinic Medicine Institute or to schedule an appointment with Dr. Teng or one of her colleagues, please visit us on our web site clevelandclinic.org/medicine or call us at 216.444.5665 or toll free at 800.223.2273 ext 4-5665.
- Some interesting articles about this topic from Cleveland Clinic may be found at the following links:
- A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit eclevelandclinic.org/myConsult
- If you need more information, contact us, chat online or call the Center for Consumer Health Information at 216.44.3771 or toll-free at 800.223.2272 ext. 4-3771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!
This chat occurred on March 23, 2009.
