Answered by: Dr. Mariela Glandt

Exercising can be difficult as a type 1 diabetic, but the benefits far outweigh the risks.
Because hypoglycemia can occur during, immediately after, or many hours after exercising, the key is to always have your glucometer on you and to carry some fast-acting carbohydrate with you at all times in case of hypoglycemia.  In your case, I would try having a snack right before starting to exercise, especially if your glucose is less than 100mg/dL at that point.   This way, you will avoid having high sugars while you are at work, but it will give you a buffer as you exercise.  Also, plan ahead to decrease your basal insulin for the day and night you are exercising. I recommend when starting intense exercise to monitor frequently to better understand how your particular body responds to different situations.  The more frequently you check, the more you can learn, and you can use that knowledge to make an insulin regimen that works for you. 
Be sure to consult your doctor about any changes you might make in your insulin regimen.
 

Answered by: Dr. Mariela Glandt

This is a great question, with contradictory answers.
On the one hand caffeine has been shown to have adverse effects on
glucose metabolism, producing higher average daytime glucose
concentrations and higher sugar and insulin responses after meals,
both when tested (albeit for short time) in the lab and in people
carrying out their normal life.  These effects may not be too
significant in real life, given that all sorts of stressors can
increase our sugar levels.

On the other hand, there is also evidence for a relation between
long-term coffee intake and risk of type 2 diabetes mellitus. Numerous
epidemiological studies have evaluated this association and, at this
moment, at least fourteen out of eighteen cohort studies revealed a
substantially lower risk of type 2 diabetes mellitus with frequent
coffee intake. Moderate coffee intake (>/=4 cups of coffee/d of 150 mL
or >/=400 mg of caffeine/d) has generally been associated with a
decrease in the risk of type 2 diabetes mellitus.

Clearly we need more information.  For now, I would still say that if
you want to have a cup of coffee, enjoy.

Answered by: Dr. Mariela Glandt

Several new studies have shown as much as a two-fold increase in the risk
of cancers of the colorectum, breast, endometrium, kidney (renal cell
tumors), liver and pancreas among type 2 diabetes patients.  This
seems to be in line with the hypothesis that increased insulin levels
might promote cancer.  This is still a relatively new concept and the
diabetes community is still considering whether type 2 diabetes should
be considered a specific and independent risk factor for these various
forms of cancer.  For the time being, any type 2 diabetic should be
sure to comply with the standard recommendations for cancer screening.

Answered by: Dr. Mariela Glandt

It is definitely true that being on oral medications reduces the amount of insulin you need, but you must find out why you were taken off the oral pills when you came into the hospital – were the doctors concerned about your heart, kidneys, or did they just want to manage your sugars as an inpatient with insulin, which is a very common scenario.  Once you know the answer then you will know if you can go back on the oral medication or not.

Answered by: Dr. Mariela Glandt

Usually if a treatment regimen is working, meaning there are no major hypoglycemias, no weight gain, and good HbA1c,  the practice is to continue with that regimen. However, there is no single right way to treat diabetes. There are often many different ways to control the condition. Perhaps there was something about treatment with Januvia that was making your doctor uncomfortable. You should ask him in order to understand his thought process, and his decision to change your medication. And do keep your doctor informed of your progress.  It’s very important that he know what’s going on.
 

Answered by: Dr. Mariela Glandt

Niacin has always been known to be effective, but it’s a difficult drug to take because of the possible side effects. What’s interesting about the article I think you are referring to, which was published last month in the New England Journal, is that not only does niacin improve cholesterol, but more importantly – artherosclerotic disease, which is what cholesterol causes.  The study showed regression of carotid intimal thickening, which is a way of looking at artheroclerotic disease.
The HDL raising properties of nicotinic acid occur with dosages as low as 1 to 1.5 g/day. In contrast, the VLDL and LDL lowering effects are typically seen with higher doses (3 g/day). In one study, for example, nicotinic acid in a dose of 500 mg three
times a day  raised HDL cholesterol by 20 percent, but reduced LDL cholesterol by only 5 percent. In comparison, a higher dose of 1.5 g three times a day produced more prominent changes of 33 percent (HDL elevation) and 23 percent (LDL reduction).
In the study that you are referring to, the final dose of extended-release niacin was 2000 mg per day in 75% of patients, 1500 mg per day in 3% of patients, 1000 mg per day in 12% of patients, and 500 mg per day in 10% of patients.