Diabetes FAQ

A: Researchers believe diabetes is caused by a combination of genetic and environmental factors. While a person may be genetically predisposed to having either type 1 or type 2 diabetes, it takes an environmental trigger to actually set the wheels in motion.
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Q: What tests are recommended for diagnosing diabetes?

A: A fasting blood plasma glucose test, performed first thing in the morning, is the preferred test for diagnosing type 1 or type 2 diabetes. However, a diagnosis of diabetes can be made based on a random (i.e., any time of day) plasma glucose test and an oral glucose tolerance test (OGTT). The findings should be confirmed with a follow up test on a subsequent day.
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Q: What should my blood glucose levels test at?

A: Everyone has individual goals for diabetes management. You should work with your doctor to set your target goals for self-monitored blood glucose levels. However, the American Diabetes Association suggests the following general guidelines for people with type 1 and type 2 diabetes*:

Fasting or before meals (preprandial) - 90 to 130 mg/dl (5.0 to 7.2 mmol/l)
At bedtime - 110 to 150 mg/dl (6.1 to 8.3 mmol/l)
Two hours after eating (postprandial) - under 180 mg/dl (<10.0 mmol/l)
The American Association of Clinical Endocrinologists suggests slightly different goals for SMBG*:
-Fasting - <110 mg/dl
-Two hours postprandial - <140 mg/dl

*Note: all values are plasma.

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Q: Is type 2 diabetes curable or reversible?

A: At this point in time, there is no known cure for type 1 or type 2 diabetes. While symptoms of type 2 diabetes can be well controlled with diet and exercise in some people with type 2 diabetes, they continue to have the disease even if their blood glucose levels remain within target ranges.
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Q: What is an A1c test?

A: An A1c test, also called a hemoglobin A1c, HbA1c, or glycosylated hemoglobin test, is a measurement of your long-term blood glucose management. The blood test, which the American Diabetes Association (ADA) recommends at least twice yearly, represents an average of the last three months of blood glucose levels. The ADA suggests that patients and their providers try to keep their A1c at 7% or lower, while the American Association of Clinical Endocrinologists (AACE) recommends a target of 6.5% or less.
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Q: I have type 2 diabetes, and just started insulin. Does that mean I'm type 1 now?

A: No. Many people with type 2 diabetes who can't adequately control their blood glucose levels with diet, exercise, or oral medications go on insulin. The type of diabetes you have is defined by the cause, not the treatment. People with type 1 diabetes have experienced beta cell destruction and make insufficient insulin to control their blood glucose levels. People with type 2 generally make enough insulin, but they are resistant to its effects. To further complicate things, people with type 1 diabetes can become insulin resistant, and people with type 2 diabetes can experience some degree of beta cell destruction. However, this usually occurs many years post-diagnosis, and doesn't change the fundamental type of diabetes you have.
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Q: How does exercise lower blood glucose levels?

A: Several ways. When you work out, your muscles use glycogen-a glucose source stored in muscle tissue-for energy. With prolonged exercise, the muscles take up glucose at an accelerated rate, turning to blood glucose once glycogen stores have been depleted. In addition, if you have type 2 diabetes and are overweight, exercise can help you lose excess body fat, which will in turn decrease your insulin resistance. The blood glucose lowering affect of exercise can last for up to 72 hours after a work out. It's important to note, however, that exercise can also have a hyperglycemic (or high blood glucose) effect on some people. In particular, long sessions of very strenuous exercise can cause blood sugars to rise. Always consult with your diabetes care provider before starting an exercise program.
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Q: Can I still drink alcohol now that I have diabetes?

A: Yes, but moderately. Two drinks for adult men and one drink for adult women is the recommended maximum daily alcohol intake for most people with diabetes. Certain prescription drugs and medical complications may make drinking alcohol unadvisable (i.e., with certain medications, when specific complications exist). You should talk to your endocrinologist or physician about your specific medical history and drinking. Alcohol can also cause hypoglycemia, so carry a fast-acting carbohydrate source if and when you do choose to drink.
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Q: Why are carbohydrates so important in diabetes care?

A: Carbohydrates are important because they're your body's main source of glucose. Overload on dietary carbohydrates and your blood glucose levels rise. That's why knowing the quantity of carbohydrates you're eating, and other related nutrient qualities of your food, is so important.
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Q: Now that I have diabetes, do I cut all sugar out of my diet?

A: Eating right with diabetes is more about moderation and healthy food choices then severe dietary restriction. While you do need to manage your intake of all carbohydrates (i.e., starchy vegetables and grains and cereals as well as sugar), people with diabetes can occasionally enjoy foods containing sugar as part of their overall daily meal plan. It should be remembered, however, that sugar is calorie-rich and nutrient-poor, so moderation is key. Many people with diabetes prefer to use artificial sweeteners and sugar substitutes for its lower calorie content and minimal impact on blood glucose levels. A registered dietitian can help you create a meal plan that works for you.
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Q: Does having diabetes affect your interest in sex?

A: Yes, diabetes can impact the sex drive and performance of both men and women. Erectile dysfunction (ED; also known as impotence) may occur as a result of nerve or blood vessel damage associated with diabetes. In addition, emotional factors such as depression and stress that can be associated with diabetes may affect libido.
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Q: What is prediabetes?

A: Prediabetes is a condition that precedes type 2 diabetes. It's also called impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), depending on the test used to diagnose it. People with prediabetes have higher than normal blood glucose levels, but they aren't elevated enough to be diagnosed as diabetes.
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Q: What kind of doctor should treat my diabetes?

A: There's no definitive answer to that question. You can find diabetes care providers that are family and/or general practitioners, endocrinologists (doctors that specialize in diabetes and other hormone-based disorders), osteopaths, and internal medicine specialists. Many people prefer to see an endocrinologist that specializes in diabetes care; however, factors such as bedside manner, communication, and diabetes care philosophy may also factor into your decision. A doctor that listens to his patients, stays up-to-date on the latest advances in diabetes management, and works closely with you to develop a diabetes care plan that fits your lifestyle is worth his weight in gold, no matter what the initials are that follow his name.
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Q: What other diabetes care specialists should I see beyond my doctor?

A: Everyone with a diagnosis of diabetes should see a certified diabetes educator (or CDE) in either a class or individual setting to learn the specifics of diabetes management and how they apply to each person's individual living situation. A registered dietitian (or RD) who has experience in diabetes meal planning is also an important member of the care team. She can help you with meal planning, carb counting, dietary exchanges, and other food-related diabetes issues. Other members of your diabetes care team may include an ophthalmologist (eye doctor), or podiatrist (foot doctor).
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Q: What makes my blood sugar go up?

A: Blood glucose levels go high for a variety of reasons-illness, stress, injury, improper diet, and medication, to name a few. In addition, some prescription drugs taken for other conditions (e.g., estrogens and corticosteroids) can cause hyperglycemia. If your blood glucose levels are consistently running too high, talk to your doctor about possible culprits and how to adjust your treatment plan accordingly.
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Q: What is an insulin pump?

A: An insulin pump is a small electronic device that provides a continuous, low flow of insulin (called a basal rate) to the wearer via an infusion line. The end of the infusion line has a small needle called an insertion set that is pushed just under the surface of the skin. The user can program the pump to deliver a larger dose of insulin (called a bolus) to correct high blood glucose levels or cover food they eat. Although many people who use insulin pumps have type 1 diabetes, the pump is also an effective therapy for people with type 2 diabetes who are on insulin and have difficult-to-control blood glucose.
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Q: Why do I go to bed with normal blood sugar levels and wake up with high levels when I haven't eaten all night?

A: Morning highs are typically caused by one of two things: The Somogyi effect (also called rebound hyperglycemia) or Dawn Phenomenon.
With the Somogyi effect, you may be experiencing hypoglycemia (or low blood glucose episodes) during the night. In reaction to these untreated lows, your body releases stress hormones and the subsequent high blood glucose levels that you're seeing in the morning. The Dawn Phenomenon is an early-morning (4:00 to 8:00 AM) natural rise in blood glucose levels that is caused by a release of hormones as your body prepares to meet the day.
Sometimes these morning highs can be avoided by a bedtime snack at night or other adjustments in insulin or medication. Talk to your doctor about any unexplained irregularities in blood glucose levels and how you might adjust your treatment plan accordingly.
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Diabetes Frequently Asked Questions

Answers

Q: What causes diabetes?