Answered by: Dr. Mariela Glandt

The tingling in your daughter’s feet is most likely due to the high sugars she had been experiencing before she was diagnosed with diabetes. Fortunately, this should resolve once her sugars become controlled.  These symptoms are not related to the complication of diabetes referred to as “diabetic
neuropathy”.

Diabetic neuropathy usually presents after many years of high sugars. Large studies, such as the Diabetes Control and Complications Trial, have shown that controlling the sugars can greatly decrease the chances of developing neuropathy.
She should continue to exercise and to control her sugars as much as possible.  For vegetarians, it’s also important to check vitamin B12 levels. As long as your daughter follows up regularly with a doctor, she should enjoy life and not worry about the complications of diabetes.

Answered by: Dr. Mariela Glandt

There are many conditions that can lead to edema and these should be fully worked up by your physician. These conditions can depend on your age, how much time you spend on your feet, other medical conditions you may have, medications you may take, and a plethora of other factors, including whether this swelling is in one leg or both. However, fluid retention prior to menses can certainly occur, and the reasons for this are very poorly understood. There does not seem to be any direct connection between high blood sugars and edema of the legs.

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

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.

Answered by: Dr. Mariela Glandt

It can be very frustrating sometimes to find the right doctor that meets your needs.  Until you meet the right doctor, you should really try to make a big effort to do everything you can to control your sugars through lifestyle changes.  This means that you should cut back on carbohydrates as much as possible (for example rice, potatoes, cakes, breads, all juices, and sodas) and try to exercise every single day at least 30 minutes- even if it’s just a simple walk. All of this will make a big difference to your blood glucose numbers. I am assuming that you are not taking any medications, but if you are taking medications, then monitor your blood sugar levels because you might be surprised just what a difference your lifestyle changes can make and the numbers might actually go low. Good luck with your search!

Answered by: Dr. Mariela Glandt

It is true that many over the counter decongestants have warnings for patients with diabetes. This is to be sure that the patients contact their physicians to determine if it would be safe or not to take these medications.  Many of the decongestants can cause blood pressure to rise, and could even cause problems with high pressure in the eyes.
You can safely use things like saline drops or spray, a nasal douche, Vicks or other smelly ointments, hot steam, or a vaporizer, provided you take precautions to disinfect it properly.  Another option, diabetic Tussin for cough, which has no sugar.  Ask your health care provider which is best for you.

Answered by: Dr. Mariela Glandt

When you get sick, blood sugar becomes harder to control. Your blood sugar level can rise even before you realize you are sick.
In a time of illness, the body releases a hormone called cortisol, which causes a worsening of insulin resistance. This means that the amount of insulin you normally take is now not enough. This can sometimes seem counterintuitive, because when you are feeling sick you may be eating less than you would normally eat.  One of the biggest mistakes people make when they get sick is that they use less insulin than they normally would when, in fact, there’s a good chance they need more.
Even if you are vomiting and/or you are not eating for a period of over 6 hours, you may find that you still need a lot of insulin.  You should check your blood sugar every four to six hours.  You might need to adjust your dose, per physician recommendation. The key is to work closely with your medical professional, check frequently, and adjust accordingly.
Also, don’t forget to drink fluids to prevent dehydration, and to replace the fluids that your body loses due to high blood sugar, fever, vomiting, and diarrhea.
Make sure the drinks are caffeine-free, since caffeine would only add to the dehydration.
The most important thing to remember is that you should continue your medications, check your blood sugar frequently, and ask your medical professional if you have any questions or uncertainties.