DIABETES, INCORPORATED

Expert Q&A

Ask the Endocrinologist/Diabetologist
Lamont G. Weide, MD, PhD

Please read the Disclaimer

Question:
How does diabetes effect the Black male? How does it effect the body, the family, the person? What types of diabetes can a person have?

Answer:
Minorities-native americans, black, hispanics-all have a greatly increased incidence of diabetes, mostly type 2.

There are 2 major kinds of diabetes.

type 1 diabetes is when the pancreas fails to make insulin. This places the person at risk for diabetic ketoacidosis. Without insulin persons with type 1 diabetes will die. These individuals usually require 30-40 units of insulin/day, although the amount varies. Although often thought of as young diabetes, type 1 can occur at any age.

type 2 diabetes is related to insulin resistance. Most of these persons are overweight. The insulin that they make is not enough to deal with their blood sugars. Persons with type 2 diabetes may take pills or insulin. This also can occur at any age. In fact, this type of diabetes is occurring at an alarming rate in Native Americans.

Complications can occur in both types of diabetes and is related to the degree of control.

Question:
Our daughter was ten years old when she was diagnosed with Diabetes. (She is not 21 and doing well, thank you!) We have two other children, now 19 and 14 (another daughter and a son)... What are the chances that they might develop Diabetes? (We know of no other diabetics in either my husband's family or mine except for type II in my Grandfather when he was in his 70's).

Thank you! Katie Baldwin, Yankton, SD

Answer:
The chances of developing type 1 diabetes with one sibling with type 1 diabetes is increased to 3%. Without any type 1 diabetes the risk of getting type 1 diabetes is approximately 0.3%. With type 2 diabetes the risks are higher if a first degree relative has type 2 diabetes and nearly 50% if both parents have type 2 diabetes. Occasionally there are families that run very high risks of diabetes but this is rare.

Question:
I am looking for some info in regards to how a person "under the influence" of diabetes reacts to changes in their metabolism. I recently started dating someone with, I think, type 2 diabetes...he is taking an oral medication before meals. I have observed a wide range of behavior. He is not particularly careful about when and what he eats. I'm guessing that perhaps may be a reason for his emotional mood swings?? Any info you may be able to steer my way in regards to life with a diabetic would be appreciated.

Answer:
Blood glucose swings up and down can cause emotional changes in persons with diabetes. I have noticed that some men with low blood sugars have a tendency toward anger or violence. Each person is an individual, however, and generalizations are very difficult to make. If you are noticing a pattern, then these may be related to blood sugars. The degree of control can regulate the swings. If the person does not demonstrated the ability or desire to put efforts into control then it is unlikely that things will improve. I would also caution about using "bad blood sugars" as an excuse for intolerable behavior. I would suggest that you think twice before committing to a relationship with someone with erratic mood swings. If the person is willing to work to control the sugars and this controls the mood swings then I think you have a correlation. However, if no effort is exerted or there is no correlation then you have to question the wisdom of exposing yourself to violent outbursts or behavior.

Question:
My father in law had oesophage cancer which has been operated. Now he has problems with hypoglycemia and had already two crisis and was in the hospital. How to explain why rapid sugars are making hypoglycemia and what is the link between his stomach which is now smaller? Best regards, Madelaine, Biochemist

Answer:
True hypoglycemia (low blood sugars) in someone without diabetes is rare. It can occur with certain tumors or in persons who have had intestinal surgery. Sometimes this type of surgery makes the stomach empty faster, or it may not be present at all, and the insulin and glucoses do not match. It can help in this situation to eat multiple small meals each day and avoid the "standard" 3 large meals per day.

Question:
Do you have to be maxed out on glyberide (4 pills) before you can start taking glucophase, or can you start earlier? My wife is type II, and is taking 2 glyberide pills per day.

Answer:
Combination therapy is very effective. There are many different combinations. Glyberide and metformin (glucophage) is one and you do not need to be "maxed" out on 1 drug first. However, the glucose values may be the determining factors. Some patients may even be on 3 oral drugs plus insulin. Metformin and Rezulin is a very effective combination.

Question:
I'm a 29 year old woman with mitral valve prolapse. My maternal grandmother had and dies of illnesses related to her diabetes. My mother does not have it. I don't have it but am extremely sensitive to sugar highs and lows. I get desperate to eat and very irritable when I'm hungry. I do not have a weight problem. I do not have diabetes, but I'm curious about how adult diabetes manifests itself and if it's onset can be triggered by diet and health? I've heard that diabetes skips a generation on your mother's side. Please let me in on some information or tell me where I should  look for it.
Thank you, Ali

Answer:
Diabetes does not skip a generation. The genes must be present to be passed on. However, whether one can control their weight will have a critical impact on the sugars and the development of diabetes. Exercise can also play a role. Within normal sugars a person should not really be sensitive to any changes and this should not account for irritability. Normal glucoses are 70 to 110. Sugars outside of this range are NOT normal, even though they may not be diagnostic of diabetes.

Question:
Is there any correlation between flatulence and diabetes?

Answer:
There is no correlation between flatulence an diabetes.

Question:
Where can I get islet cell transplantation done? Do you do transplantations?

Answer:
At the present time there are only 2 locations that I would go to for islet cell transplantation is the US. These are the University of Minnesota (Dr. David Sutherland) and the University of Miami (Dr. Camillo Ricordi). They both have protocols running and have the most experience.

Question:
Everywhere I look I see that diabetics need to have a good glucose control but I haven't seen info on what the normal range control should be. In the morning, one hour after a meal, two hours, etc. Someone told me the ranges have changed, is that true?
Pam

Answer:
Normal glucoses range from 70-110, these have not changed! You more likely are referring to target glucoses which should be individualized fro patients. In general, we would like to see pre-meal glucoses less than 120 and post-meal glucoses less than 160. Depending on the patient and the situation these values may be adjusted for the safety of the patient.

Question:
What is the incidence of diabetes of Jewish origin?

Answer:
Interesting question. I do not have specific information concerning the incidence of diabetes in people of Jewish origin. I would suggest you contact Dr. Peter Gottlieb at the University of Colorado in Denver.
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