|Frequently Asked Questions|
These are some of the questions visitors to this site most often ask.
- When is the best time to test my blood sugar?
Because it is post-meal blood sugars that most greatly stress your beta cells, the best time to test your blood sugar is the time, after eating, when blood sugars are the highest. For most people this will be somewhere between 1 hour and 90 minutes after they begin to eat their meal.
Testing first thing in the morning is useful if you are trying to adjust an insulin dose, but it is very easy to have a near normal fasting blood sugar while running dangerously high post-meal numbers and if you only test in the morning you may be lulled into a false sense of security. Not only that, but without testing after meals, you will never learn what foods are raising your blood sugars to harmful levels.
- If I cut out carbohydrates and fats there is nothing left to eat. What can I do?
All research to date suggests that fats are only harmful to your heart and arteries when they are eaten along with enough carbohydrates to raise blood sugars. If you are eating a diet that is low enough in carbohydrates that your blood sugars stay at normal levels (under 100 mg/dl most of the time) you can safely eat all kinds of fat except for trans fats (hydrogenated oils).
Think of there being a sliding scale for fats and carbohydrates, as carbohydrates go down, fats can go up. Just remember that if you boost your carb intake, you must drop your fat intake or you will run into trouble.
- Which supplements do you recommend?
I consider almost all supplements to be a huge waste of money. You can read the research that demonstrates this HERE.
- What is a Normal Blood sugar?
If you test truly normal people (which I have done) you will see that they can eat a huge slice of chocolate cake or a waffle with syrup without going over 120 mg/dl (6.6 mmol/l) 45 minutes after eating, and that by 2 hours they are usually back under 100 mg/dl.(5.5 mmol/l). This is pretty much what studies with continuous glucose monitors show for normal people, too. Normal blood sugars appear to mean fasting blood sugars in the 70s too mid-80s, and a mild spike up to around 120 mg/dl after eating a significant amount of carbohydrates, followed by a return to under 100 mg/dl by 90 minutes.
Normal people do get higher blood sugars when eating carbohydrates first thing in the morning than they do eating the same load of carbohydrate at any other time of day, as do most people with diabetes.
A normal A1c is probably under 5%, as above that level the risk of significant heart disease begins to rise, though many people with otherwise normal blood sugars will test between 5% and 5.4%. Based on what I've seen people reporting over the years, I've concluded A1c is not an accurate gauge of average blood sugar in the lower part of the range.The fasting blood sugar and spikes after meals are a much better index of blood sugar control.
- My Doctor doesn't Take my Concerns Seriously
This is probably the single most common question visitors send me. It occurs in various forms. The most serious are doctors who prescribe drugs that don't seem to be effective, or which have unacceptable side effects, followed by doctors who brush off concerns about very high blood sugars, often refusing to diagnose patients as diabetic despite repeated meter readings over 200 mg/dl.
There is only one thing you can do about a doctor like this. Fire him! The fact is, there are frightening numbers of doctors in practice whose last training in diabetes took place in the early 1980s when we had neither the diagnostic tools (meters) or the drugs available to help people get tight control. Many others are so burned out after treating people who ignore their diabetes that they treat anyone who isn't going blind or losing their kidneys (yet!) as a treatment success. Yet others rely on the outdated ADA guidelines which say that anyone with an A1c of 7% and post-meal readings under 200 mg/dl is doing great, and ignore the more stringent, and healthy guidelines promoted by endocrinologists.
If you have diabetes of any type you need to find a younger doctor who keeps up with current research, preferably one who has a personal interest in diabetes. A good doctor should be willing to work with you to help you attain the normal blood sugars you deserve. They should also treat with respect any studies you bring them for discussion. The doctor who says, "Trust me, and ignore all that stuff you hear on the web" is a dangerous doctor. Diabetes success is about YOU taking control of your disease and YOU making the changes needed to survive. No doctor can do it for you. Good doctors welcome your involvement with your treatment.
- I think I may have MODY or I have been told I have MODY but cannot get appropriate treatment.
This web site has risen very high on the Google search for information about MODY and I am hearing from an increasing number of people who have had a tough time getting help with these unusual genetic syndromes. Some of these people are thin diabetics diagnosed with Type 2 who are not responding to drugs for Type 2 or who have learned, as I have, that they are not significantly insulin resistant. Others have been diagnosed with the genetic tests. All encounter the problem that very few doctors have any information about MODY and those endocrinologists who do, often have information that is a decade out of date.
All you can do if you are in this situation is keep an eye on Dr. Hatterley's research diabetesgenes.org and this site to see what the latest is in MODY research. Bring your research to the doctor for discussion and if your doctor does not take you seriously find a new doctor who is willing to work with you.
Legitimate treatments for the most common variant, MODY-3, which also seems to be useful for many thin, non-insulin resistant "Type 2s" whether or not they have diagnosed MODY are as follows:
1. Very low dose Postprandial Insulin (2-5 units per meal).
2. Sulfonylurea drugs such as Amaryl in very low doses, though these drugs may cause hunger or hypos.
3. Byetta. This drug is starting to look like a very good solution for many people with MODY.
Keep in mind that with MODY as with all forms of diabetes the most important thing you can do is keep your blood sugar as close to the normal range as possible.
If you think you or a family member may have MODY and have a family history of kidney disease insist that your doctor refer you to a kidney specialist because there are some forms of MODY that involve genetically-caused, subtle, congenital kidney abnormalities.
- I don't know if I have MODY or LADA
The main difference between MODY diabetes and LADA (a form of adult-onset autoimmune diabetes) is that people with LADA usually have various autoimmune antibodies, like GAD antibodies and islet antibodies that are markers for autoimmune disease. People with LADA also have low C-peptide or fasting insulin test results.
People with LADA see their blood sugars deteriorate much more swiftly than people with MODY, too. If your doctor tells you that you are a Type 2 but none of the Type 2 drugs help and your blood sugar deteriorates very swiftly over the next year, you need to be tested for GAD-antibodies and treated as if you were a Type 1 diabetic. If your doctor doesn't understand this you must fire him and, ideally, see an endocrinologist. If that isn't possible, see a doctor who has some expertise in treating Type 1 diabetes.
MODY diabetes, in contrast, often shows up in adolescence or during a first pregnancy, it has a much slower progress and there are NO GAD-antibodies present. People with the most common MODY syndrome may also have normal fasting C-peptide results because the flaw in this case is in the secretion of insulin in response to rising glucose and fasting secretion is still near normal.
If you are a thin person diagnosed with diabetes that is not controlled perfectly with diet and exercise you need antibody testing and either a C-peptide or fasting insulin test. Based on the findings there you should be able to get a good diagnosis and treatment.
- What can I do about my Husband, Son, Friend, etc. whose blood sugars are out of control?
Many people give up attempting control because they have experienced depressing failures when they have followed standard medical advice. They've tried low fat diets that made them fatter and worsened their blood sugars. They've taken oral drugs that gave them terrible side effects while doing little to lower their blood sugars.
It is very hard to convince someone who has been deteriorating for years that they can turn things around if previous failures have made them feel hopeless. Hopelessness makes people go into denial. After all, if you are doomed and there is nothing you can do about it, why would you want to think about diabetes at all?
So when you see someone you care about ignoring their diabetes, the best thing you can do is to let them know that there is a lot of very new research and new treatments available now that work much better than those that were being recommended even five years ago. Then give them a copy of the "How to Lower Your Blood Sugar" flyer. The technique described on the flyer works extremely well for most people who try it, including many who have failed with every other approach they've tried.
If the problem is that your friend or relative has a doctor who is giving them out-of-date, substandard care, all you can do is point them to resources like this site that give them objective, scientifically-based information about what happens to people who follow outdated advice and allow their blood sugars to remain at dangerous levels.
Whatever you do, don't nag! If you make another person's diet or blood sugar level something they are supposed to fix for YOU, you've turned the issue into a battle over control, and this may make the person resist your advice and worsen their health to prove you can't make them do what they don't want to do.
In the end, each person with diabetes has to decide, on their own, to do something about improving their health. You can give people the tools, but only they can decide to use them.
Dealing with someone who won't take the steps needed to control their diabetes can be a lot like dealing with a person who is an alcoholic. If someone else's diabetes is causing a problem in your life and in your relationship with them, you may learn a lot about what you can do, and what you can't, by attending 12 step meetings intended for people impacted by another person's addictive behavior.