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Diabetes and it's impacts live chat: Mar'13

Tags: diabetes , diet , sugar

Whether you currently live with diabetes or are concerned about prevention, our expert Dr Mark Vanderpump was on hand to answer your questions.

Ruth asked: Hello. Can anyone get type 2 diabetes or do you have to have a certain gene to be at risk?

Dr Mark Vanderpump commented: Dear Ruth. It is true there is a genetic predisposition to type 2 diabetes and there are thought to be many genes implicated which result in insulin resistance. I normally advise people that if your mother or father had type 2 diabetes, then your lifetime risk is approximately 50%. It is also more common in certain ethnic groups.

Ruth commented: I see, thanks

AXA PPP asked: Hi Mark, we have received a question from one of our twitter followers, who asks. How can you prevent diabetes from occuring in middle age?

Dr Mark Vanderpump commented: Given the underlying problem of insulin resistance as the casue of type 2 diabetes, it is important to make your body as insulin sensitive as possible which mean cardiovascular exercise and a good diet. The key thing is to check your waist circumference - collecting weight around the belly button is a sign of possible future diabetes.

Luis Osvaldo asked: How likely are children born to a family where one parent has type 1 diabetes to develop the condition themselves?

Dr Mark Vanderpump commented: I advise my patients with type 1 diabetes that the risk of having a child with type 1 diabetes is 5%.

Jon asked: Are artificial sweeteners safe for diabetics?

Dr Mark Vanderpump commented: There may be health issues with artificial sweetners but in moderation no greater risk in patients with diabetes that in those without.

Heather asked: What are the complications of using birth control pills while having diabetes?

Dr Mark Vanderpump commented: No risk extra in patients with diabetes. It is more important to ensure that you don't have an unprepared pregnancy.

 

Anonymous30 asked: How can a diabetic athlete maintain the ability to compete at a high level?

Dr Mark Vanderpump commented: This is a very complicated issue! An excellent website is runsweet.com which has a question and answer facility - hopefully you also have access to specialist support from your diabetes team.

Jess asked: Is diabetes associated with any other conditions? I have an underactive thyroid, does this make me more at risk at all?

Dr Mark Vanderpump commented: Type 1 diabetes is an example of an organ specfic autoimmune disease. Other examples include an under- or overactve thyroid, pernicious anaemia (Vit B12 deficiency) and Coeliac disease. Although apprx 1/3 of women and 1/10 of men with type 1 diabetes have thyroid disease, it is quite rare for type 1 diabetes to occur in a patient with thyroid disease. There is no good evidence that type 2 diabetes is more common in those with thyroid disease as it is not due to autoimmune disease.

ianto asked: My BMI is right on the cusp between healthy and overweight. I'm aware of (and trying to cut down) my sugar consumption - however should I be worried about diabetes risk due to this?

Dr Mark Vanderpump commented: The risk of diabetes increases with increasing BMI (that is your weight in Kg divided by your height in m2). The main issue is where the fat is and it is recognised that waist circumference is probably a better marker of risk than BMI. The following waist measurements show when your risk starts to rise:
White Europeans and Africans: ≧37 inches in men and 31.5 inches in women
South Asians and Chinese:  ≧35.5 inches in men and 31.5 inches in women.

ianto commented: Thanks for response - my waist measurement currently falls well below 37 so I'll make sure it stays that way!

Kerr asked: Can diabetes be reversed?

Dr Mark Vanderpump commented: Type 1 diabetes is a permanent destruction of the insulin producing cells in the pancreas so not possible for these patients. Type 2 diabetes can be so successfully be treated by lifestyle that blood sugars can be normalised but your body still has the history of diabetes having existed even for a short time so we don't ever view this as a reversal.

Kerr asked: Also, can diabetics still drink beer, wine etc?

Dr Mark Vanderpump commented: Yes in moderation. There are some specific factors like an increased risk of hypoglycaemia for those on insulin and an awareness of the calories in alcohol.

Anonymous31 asked: Hi there, what supplements would you recommend for a type 2 diabetic?

Dr Mark Vanderpump commented: A well balanced diet is key and I don't recommend anything specifcally. In my part of London we seem to be all Vitamin D deficient due to a lack of sunlight so worth checking that blood level! One other thing for those on Metformin is that there are some people who are predisposed to Vitamin B12 deficiency so that is worth checking. Women trying to get pregnant need high dose Folic acid supplements.

ninja asked: How can people with diabetes manage the emotional side of living with the condition? Is there specialised help available?

Dr Mark Vanderpump commented: A good question and a difficult issue. There are local diabetes support networks/patient groups which might be available and some find helpful. Diabetes UK may be able to help. There are increasing community psychological services available for people with diabetes in some areas. Check with your GP/Practice Nurse or your diabetes specialist team.

ninja asked: What advice would you give to someone restricting insulin for weight loss? How can they overcome this?

Dr Mark Vanderpump commented: There are potential health issues so this needs to be following advice from a specialist Diabetes dietician and your Diabetes Consultant. It is possible to lose weight safely without restricting insulin. The key is communication and ongoing support from your specialist team. This is one area where specialist Psychological advice may be very helpful.

Dan asked: I heard that weight loss can be a symptom of diabetes. Why is this? I thought diabetes came with eating too much sugary things?

Dr Mark Vanderpump commented: In the newly diagnosed patient with insulin deficiency fat and muscle are broken down as without insulin the sugar cannot be used for energy.

Anonymous32 asked: Does taking insulin cause weight gain?

Dr Mark Vanderpump answered: Again a controversial area. Insulin doesn't automatically mean weight gain but most studies demonstrate that patients commenced on insulin may gain up to 5Kg in weight in the first year after starting. Improving diabetes control inevitably means that the body becomes more efficient at storing fat. I warn my patients that they have to be even more careful with their diet and continue their exercise programme to ensure that they gain as little weight as possible.

Jack4 asked: What diets are safe for those with diabetes t2?

Dr Mark Vanderpump answered: Hopefully you will have received the support of a Dietician. The key principles are avoiding extreme diets, portion control (particularly starch ie bread, rice, pasta and potatoes) and moderation of your existing diet. Aiming for slow sustained weight loss is key and of course adding exercise.

Callie asked: I love to exercise but I'm worried it can cause my blood sugar levels to drop hours later. Is that possible?

Dr Mark Vanderpump answered: Hypoglycaemia (low blood sugars) is a risk for those on insulin or certain type of tablets. Sometimes you will have to adjust your treatment to ensure that the risk is minimised. Blood sugar monitoring is also important to provide you with confidence that your sugars are not falling too low even hours after exercise.

Dave asked: When I get sick, I have the hardest time controlling my blood sugars. Why?

Dr Mark Vanderpump answered: When we are unwell we produce stress hormones that work against insulin and make you more insulin resistant. Increased blood sugar monitoring, maintaining your carbohydrate and fluid intake, careful adjustment of medication and early medical support are important. Avoid the temptation to stop medication without medical advice. Testing for ketones in the urine/blood in type 1 diabetes is also crucial.

Ruth asked: My sister (21) was just diagnosed with type 2 diabetes. I want to be supportive. How can I help?

Dr Mark Vanderpump answered: Newly diagnosed patients with type 2 diabetes should be offered an education programme called DESMOND or equivalent. Why not go along or be there for her at doctor or nurse appointments? Diabetes UK have a good website for information for patients and their relatives so understanding what she is being told is important will be helpful.

Ruth commented: Great thanks!

Jools asked: Hi, I'm training for a marathon and I'm concerned about my type 2 diabetes. How can I prevent my diabetes effecting me during the race?

Dr Mark Vanderpump answered: The answer depends a little on the medication you may be taking. I mentioned earlier that the runsweet.com website has very informative advice for marathon runners. I would suggest getting advice to ensure you are medically fit to run a marathon from your doctor is important (eg risk of heart disease). Support from a Dietician regarding the diet leading up to the marathon would be useful. Prevention of hypoglycaemia during the race requires a pre-race management plan of your treatment regime with your specialist. People with diabetes also measure fingerprick blood sugars whilst they are running.

Jools commented: Thanks, I wasn't aware of that site, will have a look. J.

Dr Mark Vanderpump answered: Ok just had a look myself and although aimed at patients with type 1 diabetes has some useful information which common to both type 1 and type 2

Many thanks to everyone who joined our chat this afternoon and special thanks to Dr Mark Vanderpump.

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If you missed our live chat and have any further questions relating to diabetes, then why not ask our panel of experts a question?

 

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