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Ask the Expert: Living it Up While Living With Diabetes

Misha Zilbermint Mihail "Misha" Zilbermint, MD
Director of Endocrinology, Diabetes and Metabolism Care at Suburban Hospital

Accommodating diabetes (or prediabetes) can be tricky in the best of circumstances, and not just for the one with the diagnosis. Friends and family may not know how best to handle meals, parties and social situations, and striking that balance between being part of a celebration and being healthy is tough for all parties involved.

Dr. Mihail Zilbermint, board certified endocrinologist, offers some perspective on diabetes for friends and family, guides on diet management, and how to mix the routine with the exciting while in social settings.

I was recently diagnosed with type 2 diabetes and my wife won’t give me the same meals she cooks for the rest of our family because she is worried about my glucose levels. Is there a way that I can still eat the same food as my family?

Yes, of course. You and your family can eat the same foods, within reason. You should not eat too much and avoid foods high in simple carbohydrates (like sugar, white breads, pastries and potatoes, all of which will elevate your glucose) as much as possible.

Diabetes runs in my family, but I haven’t been diagnosed with it. How do you diagnose prediabetes? How accurate are the tests?

Prediabetes used to be known as “borderline” diabetes – it’s a condition where your body is starting to have higher than normal blood sugar, but it’s not yet in the diabetic range. Without action, it will may become diabetes in 5-10 years. So, the earlier you know, the better.

You should ask your doctor to order a fasting blood glucose test and/or Hemoglobin A1c test. Hemoglobin A1c is a test that indicates your average level of blood sugar over the past two to three months. A fasting glucose level between 100 and 125 mg/dL or a Hemoglobin A1c between 5.7 and 6.4 percent are suspicious for prediabetes. Blood tests are pretty accurate; some people need a second test for verification.

What do I need to do to stop the progression of prediabetes to diabetes? Are drugs the only way to keep things under control?

Medication isn’t the only option for most people. First, you have to modify your lifestyle. Focus on losing weight and start exercising. Second, you can discuss with your doctor if metformin, an oral diabetes medicine that helps control blood sugar level, is a good choice for you. I often prescribe metformin to patients with prediabetes.

My dad has been diagnosed with type 2 diabetes, but I suspect he’s not tracking his blood sugar as well as he should be. How often does someone need to check their hemoglobin A1C?

You father should ask his doctor to check his hemoglobin A1c every three months (see the earlier question for more about the hemoglobin A1c test), unless his diabetes is well controlled. You can learn more about blood glucose monitoring at http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/diabetes/_22,selfmonitoringofbloodglucose/.

I’m trying to adjust my diet to control my sugar levels, but I’m unsure which diet to choose because there are so many options. How would I know which diet is right for me?

I agree with you that maintaining a caloric balance over time is crucial to keeping your weight steady. Researchers are still unsure which diet is optimal for the general population. For example, the Mediterranean diet was recently found to have a number of health benefits — see more at http://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/take-your-diet-to-the-mediterranean. Personally, I advocate a diet that consists of vegetables, grains, dairy products and protein-rich food rather than one of the very restrictive diets, which most people have a lot of difficulty sticking to. I do, however, recommend avoiding soft drinks and sweetened beverages.

I have a friend who came to Suburban Hospital because of chest pain, but while he was there the doctors also found diabetes. How does the diagnosis process work? Will diabetes complicate his treatment for chest pain?

We order Hemoglobin A1c tests on all patients with elevated sugar levels. Now at Suburban Hospital we have an Inpatient Diabetes Management Service, which sets up an individualized plan for patients with diabetes. We often discontinue oral anti-diabetes medications and give some insulin to keep sugars in check. This helps us to fight the infection faster.

I’m not obese; do I still need to be checked for diabetes? What symptoms should I be aware of?

The American Diabetes Association recommends testing in all adults with body mass index (BMI) >25 kg/m2 and at least one risk factor. If you have no risk factors (e.g. family history, high blood pressure, high cholesterol) the screening should begin at the age of 45.

I have a relative with type 2 diabetes who will eat something sugary and say it’s not a problem, because she can take extra insulin. I don’t want to second-guess her, but is this safe to do?

It is a challenging question. Yes, your relative may take some extra insulin for an extra piece of cake. However, I would discourage this practice, because it promotes weight gain.

If someone with diabetes wants to drink at a party, what’s the best way to do so? Are any types of alcohol a better choice than others?

According to a study from Israel, one glass of wine (white or red) a day may modestly decrease sugar levels. Note that people in the study only had one drink a day, so don’t overdo it!