Questions and Answers
Doing Time with Diabetes
Q: As a prisoner I have no control over finger-sticks because we are not allowed to have our own testing devices. The prison has only two monitors used for 40 to 50 inmates one after another without cleaning. As a result, I'm wondering how accurate the readings are. I realize that the reading would have a + or - of about 10%, but with the mass usage would this be in a viable range or is it a waste of time?
Walter J. Taylor
State Farm, Va.
A: Most monitors are accurate in everyday use under optimal conditions; however, blood glucose test results can be affected by many things. Some of these things are:
- On meters which rely on an optical window to read a color change on the strip, too much or too little light during testing can affect the results.
- Improperly maintained monitoring equipment can give erroneous results from dirt, blood or lint building up on the optical window.
- Commonly used medication such as vitamin C and ibuprofen, among others, can affect test results.
- Certain substances in the blood can cause inaccurate results with some testing systems. These may include high lipid levels and elevated uric acid levels.
- Blood drop size is often a factor in inaccurate readings. Many systems require very large drops of blood for accurate testing, but will proceed with a test in spite of an inadequate sample.
In situations where one meter is used by multiple people, infection control is a concern. With some systems blood enters the monitor, creating the need for frequent cleaning and a change of test platform for each user. With most biosensor-based systems blood never enters the meter, eliminating infection control concerns.
Linda Warren, RN, CDE
Alcohol and Blood Sugar
Q: I find that a glass of dry red wine with dinner helps keep my blood sugar down. But what happens if I drink too much? Drinking too much may be a problem for many more people with diabetes than we realize.
A: In general, alcohol lowers blood sugars. However, one should not look to alcohol for blood sugar control. The reasons for caution are many. One is that alcohol interferes with gluconeogenesis (the conversion of glycogen to glucose) for the length of time it is in the body. Hence, your body's ability to control blood sugar levels even without diabetes over a 24-48 hour period becomes impaired.
Alcohol can be responsible for unpredictable low blood sugars hours after it has been ingested, and this can be dangerous for some. In your diet, alcohol is counted like a fat unless it happens to be a sweet drink - in which case it is counted like fat exchanges and additional starch or fruit exchanges depending upon how sweet it is and how much you drink. These are added calories that do not provide essential nutrients and may not be needed. In general, we recommend drinking in moderation (which can be defined as one to two drinks one to three times a week), and only when consuming food.
Beth Beller, RD, CDE
ND Labs Inc.
Sulfonylureas - Are they Worth the Risk?
Q: I am writing about an issue that I feel must be addressed. The issue is the continuing high rate of mortality among those persons with type 2 diabetes who are treated with sulfonylureas. So far as I know there has been no study which has refuted the findings of the University Group Diabetes Study (UGDS). (Diabetes, 19 [supplement 2] 747-830, 1970).
The UGDS showed that persons treated with tolbutamide and diet had about two-and-a-half times the rate of mortality as those treated with diet modification alone. These findings resulted in a Food and Drug Administration special warning of increased risk of cardiovascular mortality for sulfonylureas. (Physicians' Desk Reference, 1991, pages 2244-2245).
If one person with type 2 diabetes per 100 has died each year because of treatment with this class of drugs, then they have died from a preventable cause.
DIABETES HEALTH could make a great public health contribution by raising this issue among your distinguished Advisory Board and among your many type 2 readers.
While this effort is less dramatic than the search for a cure, it surely would be a fertile field for activism and a good cause.
A: The UGDS was a large-scale study that was designed to determine whether control of blood glucose levels could decrease vascular complications in type 2 diabetes. The study was discontinued because of the perceptions that there was a higher incidence of cardiovascular deaths in the group treated with tolbutamide. However, the study was criticized and has been largely ignored by the medical community due to poor study design. Still, warnings about sulfonylureas (and the biguanide metformin) to this day are included on the package inserts of these drugs. Most endocrinologists feel that the benefits of these drugs far outweigh their risks. It should also be noted that no study has replicated the UGDS findings.
Irl B. Hirsch, MD
Univ. of Washington School of Medicine
Retinopathy or Time for New Glasses?
Q: My friend has diabetes. He is 75 years old and having five- minute lapses where his eyes can't focus and everything is blurry unless he closes one of his eyes; then it clears. Could this be connected with his diabetes?
Ryan Lee Taves
A: Diabetes may affect one's eyes, but it certainly is not responsible for all vision problems. In fact, your friend may need nothing more than a checkup for new eyeglasses. However, some potentially serious causes could be responsible, including circulation deficiencies of the eye and brain. Therefore, I would definitely suggest an eye exam at which time the presence or absence of diabetic retinopathy as a contributing factor could be checked.
Everett Ai, MD
Director, Retina Unit
California Pacific Medical Center
Up in Smoke
Q: My daughter was diagnosed with type I diabetes a year ago. She is just starting junior high, and unfortunately this is the age where she will be exposed to cigarettes and marijuana. Could you please provide an explanation of what smoking does to a person with diabetes. Also, what is known about the effects of marijuana on people with diabetes? I would like to know about both the immediate and long-term effects.
Lucy B. Smallsreed
A: In this day and age, everyone knows the dangers of cigarettes. Smoking causes chronic bronchitis, sinus infection and emphysema. Besides damaging the lungs, cigarettes can cause cancer, heart disease and may affect sexual functioning.
Since people with diabetes often develop complications such as heart disease and circulatory problems, smoking can aggravate these complications even further.
As far as marijuana is concerned, it may impair the thought process and a person may forget to adhere to his/her diabetes regimen. Forgetting proper diet and medications can seriously affect a person with diabetes and cause damaging long-term complications.
To do or not to do - that is the question. Ultimately, the answer will be your daughter's.
Peter A. Lodewick, MD
Medical Director, Diabetes Care Center