Living with Diabetes

Leg pain can have varying causes. Injuries, muscle cramps, and growing pains are common causes of leg pain in children. We would suggest consulting with your child’s physician to determine the cause.

Fruit is a healthy food which contains fiber and many vitamins and minerals. However, fruits contain carbohydrates, which can affect your sugar levels, and need to be included in your meal plan. We suggest speaking with your physician or dietitian concerning the amount, frequency and types of fruits you can eat.

In general, oral medications may be added, changed or a dosage adjustment may be necessary if a patient is unable to reach their glucose goals with their current therapy. When treatment with lifestyle modification and one or two oral agents fail, insulin therapy may be introduced. It would be best to consult with your physician regarding your concerns since treatment of diabetes is customized to each individual patient and many factors are taken into account when a physician initiates a treatment plan.

The answer to this would depend on what test was given and when. In order to diagnose diabetes your physician must complete at least one of the following blood tests: a fasting plasma glucose test, an oral glucose tolerance test, an A1C test, or a random plasma glucose test. The results will determine if you have impaired glucose tolerance (IGT), also known as pre-diabetes (a relatively high risk for the future development of diabetes), diabetes, or are normal. 
•    The fasting plasma glucose test measures the blood glucose level first thing in the morning after a person does not eat (fasts) for at least 8 hours (usually overnight). The fasting plasma glucose test defines pre-diabetes as blood glucose levels between 100 and 125 mg/dl and diabetes as blood glucose levels at 126mg/dl or above. The normal fasting blood glucose level is less than 100 mg/dl. 
•    The oral glucose tolerance test measures blood glucose levels first thing in the morning after a person fasts and then again 2 hours after the person ingests a drink that contains glucose. With this test, pre-diabetes is defined as a 2-hour blood glucose level between 140 and 199 mg/dl and diabetes as a 2-hour blood glucose level at 200mg/dl or above. A normal 2 hour blood glucose level is less than 140 mg/dl. 
•    The A1C test measures the percentage of glycated hemoglobin, or HbA1C, in the blood. This test measures the average blood glucose over the past 2-3 months. With this test, pre-diabetes is defined as an A1C range of 5.7-6.4% and diabetes as a reading of ≥ 6.5%. 
•    The random (or casual) plasma glucose test is taken at any time, regardless of the timing of the last meal. A person with classic symptoms of hyperglycemia (excessive thirst, frequent urination, weight loss, sometimes with extreme hunger, and blurry vision) or hyperglycemic crisis (condition of extremely high blood glucose levels requiring emergency care) can continue to be diagnosed with a random plasma glucose test. A level of 200mg/dl or higher in these patients indicates a diagnosis of diabetes. 

It is at the physician’s discretion and the availability and practicality of the tests to determine which is used to diagnose diabetes. Patients with test results diagnostic of diabetes (who do not have symptoms of hyperglycemia or hyperglycemic crisis) should have a repeat test to rule out laboratory error and confirm the diagnosis.     

If you are concerned about developing diabetes, that you have diabetes, or are having any of the symptoms of diabetes, we recommend that you speak with your doctor for an examination and appropriate testing. 

Januvia is a medication that, along with diet and exercise, helps lower blood glucose levels in adults with type 2 diabetes. It is not approved for use in children by the Food and Drug Administration (FDA). Januvia can be used with insulin; however, the incidence of hypoglycemia (low blood sugar) is increased when Januvia is added to insulin therapy and a lower dose of insulin may be needed to decrease the risk of hypoglycemia. Please consult with your physician regarding the use of these products together.

Although an interaction is possible, metformin and levothyroxine are often safely used together. However, as your low thyroid condition corrects with the use of a thyroid hormone (such as levothyroxine) changes in blood glucose may occur. We recommend monitoring your blood sugar periodically and alerting your physician to any changes; especially when therapy is added, dosage is changed, or a product is discontinued, as your diabetes medication may need to be adjusted.

Mild weight loss has been reported with metformin therapy along with taste disturbances, such as a metallic taste in the mouth. Metformin can also rarely cause a serious condition called lactic acidosis. Symptoms of this condition can be unusual tiredness, dizziness, severe drowsiness, chills, blue/cold skin, muscle pain, fast/difficult breathing, slow/irregular heartbeat, stomach pain with nausea, vomiting, or diarrhea. We suggest letting her physician know immediately of her tiredness so he/she can determine if it is due to this medication. If her side effects persist, the physician may need to lower her dosage or change her to another medication. 

Yes, when treatment with lifestyle modification and one or two oral agents fail, insulin therapy is typically introduced. While the thought of insulin may be scary, it is an effective treatment. You may need to increase the number of times per day you monitor your glucose levels to help prevent highs and lows from occurring. Please discuss your concerns about starting therapy with your healthcare provider. He/she can teach you how to recognize the symptoms of high and low glucose levels and how to treat these conditions should they occur.  

Both product manufacturers offer assistance programs for the above mentioned medications; however, certain restrictions do apply.  We suggest visiting each of the products websites where you will be able determine if you are eligible and enroll in their respective programs.  Below are the links for the sites:
•    Novolog: https://www.novolog.com/user/register.aspx?copay=true
•    Lantus: https://www.lantus.com/sign-up/copay-registration.aspx?mo=1

General plasma/serum blood glucose level guidelines according to the American Diabetes Association (ADA) for non-pregnant people with diabetes are as follows:

•    Before meals: 70-130 mg/dl (3.9-7.2 mmol/l)
•    Peak after a meal (1-2 hours after the start of a meal): Less than 180 mg/dl (less than 10 mmol/l)

We suggest that you consult with your physician to determine what specific goals are appropriate for you.