Ask an Expert FAQs — Your Complications Questions Answered

1. I have diabetes and another chronic condition. How do I manage them both/all?
2. I've been experiencing tingling, pain, and/or strange sensations in my extremities. Is this normal? What can I do?
3. What are the signs that you may lose a limb?
4. I have a wound infection that won't go away. What do I do?
5. I am showing signs of kidney damage. Can it be reversed?
6. What alternative therapies are available to treat diabetes?
7. What makes a person a good candidate for a kidney transplant?
8. What kind of treatment is there for neuropathy? Are there supplements that could help?
9. Does Thyroid medication affect weight loss? If so, when is the proper time of day to take Thyroid medicine to maximize weight loss?
10. I have thyroid disease, so my metabolism is never on tract. How do I manage both thyroid, diabetes and high blood pressure all at the same time?
11. Would an underactive thyroid have any affect on diabetes?
12. Are prediabetes and hyperthyroidism related?


Didn't find your question? Click here for more expert answers to questions from dLife members.


Q: I have diabetes and another chronic condition. How do I manage them both/all?

A: You don't mention what other chronic conditions, so it may be difficult to answer your specific need. Many patients also suffer from other conditions such as arthritis, heart disease, or digestive problems. If you have arthritis exercise may be difficult but not impossible. Individuals with arthritis are encouraged to be as active as possible to keep their joints moving. Water aerobic programs are especially helpful if you have any joint disease. If you have a heart condition and you are restricted in your physical activity, attending a cardiac rehab program may help you engage in physical activity under supervision.

Having any chronic disease is very difficult and you may experience a very complex medication regimen. Be sure to keep an accurate list of all your medications and have each of your doctor's review it to ensure that there is not untoward interaction between your medications. Also ask your pharmacist to review your medications to ensure they can be taken together. Timing of medication is very important; some medications should not be taken at the same time or should be taken with food or without. Discuss with your pharmacist any special instructions regarding your medications. Also if you are taking any supplements or herbal medication be sure your doctor and the pharmacist are aware of them to be sure they do not interact with your prescription medications.

If you have specific dietary needs regarding your condition, ask to consult with a dietitian who will help you chose the best foods for your health.
Be educated. The more information you have about any condition will enable you make the best choices for your health. Talk to your diabetes educator about resources that may be available to help you deal with your problems.

Support groups can also be helpful in managing your diabetes or your other chronic disease. It is important to realize you are not alone and there is support is available. Talk to your local diabetes educator about any support groups that may be available. - Kathleen Gold, RN, MSN, CDE

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Q: I've been experiencing tingling, pain, and/or strange sensations in my extremities. Is this normal? What can I do?

A: It is important that you talk to your physician to determine what the cause of these abnormal sensations is. Diabetic neuropathy is a very common complication of diabetes. Long term elevated blood glucose levels affect nerve endings. Any nerve may be affected but the long nerves of the hands and feet are the most common. When the nerves are damaged they perceive sensations differently. It is important to discuss this with your health care professional so your symptoms may be evaluated and the cause determined. For additional information about neuropathy you may find the following link helpful: http://www.dlife.com/diabetes/information/complications/neuropathy/diabetic-neuropathy.html - Kathleen Gold, RN, MSN, CDE

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Q: What are the signs that you may lose a limb?

A: Signs of decreased circulation include coolness to the touch, loss of hair on the legs and/or feet, decreased pulses and decreased sensation. When this occurs the risk of infection increases. If blood sugar levels are or have been elevated this puts you at a higher risk for severe infection. When a wound becomes infected, it will generally exhibit the traditional signs and symptoms of infection which include redness, warmth, pain, and swelling, possibly leading to oozing, without signs of healing. Wounds like this don't appear overnight, which is why daily foot checks are so important. Any time a sore, blister, red spot, or anything unusual develops, it is extremely important to treat it carefully, including early medical intervention if healing is not occurring at a reasonable rate (daily improvement). Before loss of a limb would occur, the limb would become severely infected, generally leading to gangrene (tissue in the surrounding area becoming black), before amputation would take place. Although it is a very grim thought, the good news lies in early intervention and tight blood glucose control, which can help prevent such maladies. You may want to check out the amputation information on dLife for additional information. - Anne Carroll, RN, CDE

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Q: I have a wound infection that won't go away. What do I do?

A: 1.) Follow your doctor's orders! 2.) Keep your blood sugar as close to normal as possible at all times. 3,) Take your antibiotics. 4.) Withstand the whirlpool treatment (if it has been ordered.) 5.) Have the dressing changed as directed. 6.) Consider hyperbaric treatment (time spent sitting in a small cubicle that compresses oxygen into the body to help promote healing.) 7.) Warn all your friends and relatives about the importance of early treatment. 8.) Exercise as tolerated to try and promote circulation to the area. 9) Elevate the area regularly, if so directed, to prevent swelling in the area. If your wound infection involves the foot, click here for more information. - Anne Carroll, RN, CDE

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Q: I am showing signs of kidney damage. Can it be reversed?

A: Kidney damage from diabetes may be reversible if you are newly diagnosed. Otherwise, it cannot be reversed. However you can do a lot of things to slow it down.

When many people with type 2 diabetes are first diagnosed, blood sugars and blood pressure have been running high and this causes protein to spill out into the urine. This is called microalbuminuria and may be reversed bringing both blood pressure and blood sugar into control. Microalbuminuria can also occur later after a person has had diabetes for several years or more. This may indicate that kidney damage has occurred and the usual cause is high blood sugar, high blood pressure and high cholesterol.

Good blood sugar control is the most important thing that you can do to prevent and slow down the progression of kidney disease. Study after study of diabetes complications has strongly indicated that lowering blood sugar levels lowers risk for all diabetes complications and progression of these complications.

A major study was published in 1993 called the DCCT. This study on children with type 1 diabetes indicated that people with signs of early kidney disease like microalbuminuria could decrease their risk for further disease progression by 50%. Another major study called the UKPDS indicated that people with type 2 diabetes could reduce risk of developing kidney disease by 25% if they controlled blood sugar levels. This study also indicated that for every 1% drop in A1C (a lab test that tells you your 3-month blood sugar average), people could expect a 35% reduction in risk for developing diabetes complications.

So, the basics for both prevention and slowing down all diabetes complications are the same. Many call this the "ABCs" of diabetes management. You want to keep:

A - average blood sugar as close to normal as possible
B - blood pressure under control
C - cholesterol levels under control.

Most diabetes specialists recommend that your 3 month average blood sugar should be at least under 7% and as close to 6% as possible. 4-6% are normal values, so if you can get your A1C to 6%, it is as if your blood does not have diabetes at all and this is great.

It is recommended that most adults with diabetes keep blood pressure less than 130/80 and total cholesterol should be under 200. Triglycerides should be under 150. Good cholesterol (HDL) should be over 45 if you are a man and over 55 if you are a female. Bad cholesterol (LDL) should be under 70 if you have risk factors for heart disease and most experts recommend that if you are newly diagnosed with diabetes your LDL should be lowered even if it is in a good range already.

Your doctor may prescribe a blood pressure pills called ACE Inhibitors or ARBs even if you do not have high blood pressure. In people with diabetes, these pills have shown to prevent and delay the progression of kidney disease. To control high blood pressure, many people need more than one type of pill. It is also a good idea to follow a low salt meal plan, exercise and maintain a healthy weight. Cholesterol levels are controlled by diet, exercise and pills. Many people need more than one pill to reach cholesterol, blood pressure and blood sugar targets.

In addition, here are some other things you can do to decrease the progression of kidney disease:

• Learn the signs & symptoms of and how to prevent urinary tract infection
• See your doctor every 3-6 months
• If you smoke, stop.
• Contact a Certified Diabetes Educator and a Registered Dietitian
• Keep informed – join a diabetes support group, check out Internet sites such as the American Diabetes Association's site, subscribe to a good diabetes magazine

Finding out that you have diabetes complications is very hard, but I want you to remember this. Diabetes is not a death sentence, nor does it cause kidney disease or blindness or any other of those bad complications you have heard about. It is UNCONTROLLED diabetes that causes complications and makes them worse. Keep your ABC's in range, for many people who keep these numbers in target end up being healthier than their friends that don't have diabetes. And, don't despair. There are treatments for every type of diabetes complication and these treatments are getting better all the time. Good luck. – Donna Yuscavage, RN, BSN, CDE

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Q: What alternative therapies are available to treat diabetes?

A: The answer is LOTS. Way more than can be included in a FAQ list like this so check out this link for more information! - Donna Yuscavage, RN, BSN, CDE

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Q: What makes a person a good candidate for a kidney transplant?

A: The main factors that would qualify a person to be a good candidate for a kidney transplant would be that they are on considered a high priority patient, such as someone with Type 1 diabetes with end stage kidney disease. The individual would need to be free of heart, vascular or lung problems prior to the transplant procedure. They should have a healthy immune system in order to withstand the immunosuppressant therapy. Often times, the potential candidate is asked to participate in a psychological evaluation to assess whether they will be able to deal with the stress of the transplant and adhere to the rigorous medical regimen after the surgery. These of course, are very general guidelines and every patient is evaluated individually. This is a question best asked to the physician of any individual who feels they may have reached this stage of kidney disease.

For a very thorough explanation about kidney disease, treatment options and further information regarding transplantation, visit the website below:

http://www.dlife.com/diabetes/information/complications/kidney/diabetes-kidney.html

- Missy Porteous, MS, RD, CDE

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Q: What kind of treatment is there for neuropathy? Are there supplements that could help?

A: There is a wonderful explanation of the various treatments available for this condition on the dLife.com website. The link is listed below. Be sure to read not only the first page, but click also on the links to the right of the screen that have information specifically about peripheral and autonomic neuropathy:

While various medications, such as neurontin for example, exist as treatment for peripheral neuropathy, many people do wish for some types of homeopathic remedies as well. Capsaicin crème, which is derived from Cayenne pepper, has been shown to be quite effective in reducing the pain associated with peripheral neuropathy. According to the American Diabetes Association, other non pharmacological treatments that may be effective are Relaxation training, hypnosis or biofeedback (biofeedback is also helpful for treating incontinence) Photo energy therapy There has been much said about the possible effectiveness of alpha lipoic acid. This supplement has been widely used in Germany to treat peripheral neuropathy and has been suggested as useful for treating cardiovascular autonomic neuropathy.

However, long-term trials are needed to determine whether alpha lipoic acid actually slows the progression of neuropathy or just improves symptoms. Many other supplements have also been suggested as useful treatments for neuropathy, but the research has not been conclusive enough to substantiate the claims just yet. Until then,  good to remember that our best defense against future and further nerve damage is prevention. By keeping our blood sugars within our goal range as much as humanly possible, with a healthy diet, regular (low impact) physical activity and stress and medication management, we are applying a fabulous treatment regimen itself. - Missy Porteous, MS, RD, CDE


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Q: Does Thyroid medication affect weight loss? If so, when is the proper time of day to take Thyroid medicine to maximize weight loss?

A: The purpose of thyroid replacement therapy is to replace the thyroid hormone that is lacking. Weight loss could be a side-effect of the therapy. This medication is NOT prescribed for weight control.

The general recommendations for taking thyroid medicine:

It works best on an empty stomach and when taken 1 hour before any other medications. Do NOT take thyroid hormone with calcium, iron, multivitamins, alumin hydroxide antacids, colestipol, or other medicines that bind bile acids, or fiber supplements.

Each person responds to thyroid medicine slightly differently. Your doctor who prescribed the medication can provide details of your thyroid hormone status.

Healthful eating and regular exercise are still the most effective and safest method for weight control. No meal and exercise plan? Talk with a registered dietitian about establishing a personal meal and exercise plan that includes your favorite foods. You will learn how to make better food choices, read food labels, and modify favorite family recipes. You will also learn to control your blood glucose! – Liz Quintana, EdD, RD, LD, CDE


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Q: I have have thyroid disease, so my metabolism is never on tract. How do I manage both thyroid, diabetes and high blood pressure all at the same time?

A: One of the primary parts of balancing everything out, as you mentioned, is to be sure to visit your physician on a very regular basis, as recommended, to have your blood work and other medical issues closely monitored as the medication management is just as important as the food and nutrition plan.

As far as diet goes, it is first important to consider if you are within a healthy weight range, as fluctuations in your weight as well as erratic eating schedules can disrupt glucose, weight and blood sugar /blood pressure control. 3 meals per day is not necessary, however a structured plan of eating is very helpful as this can make your blood glucose levels more predictable and weight more stable.

To know your calorie needs, other factors such as your daily activity level, height and weight need to be considered. That's why it is highly recommended that you meet in person with a registered dietitian/certified diabetes educator who can review your lifestyle, medical management and status as well as your personal food preferences and work out a plan that is right for you. It is true that there is no one right way to eat- this must be personalized for every person with diabetes in order to achieve the best results. Best of luck to you! – Janice Baker, B.Sc., MBA, RD, CDE, CNSC, BC-ADM


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Would an underactive thyroid have any affect on diabetes?

Since the thyroid has a significant effect on metabolism, this can cause weight changes which in turn can affect diabetes control. This is why treatment for other medical issues, such as thyroid disease, is an an important part of overall diabetes management. Soy flour can be used partially in place of regular flour, however the ratio does depend on the type of recipe that you are using the flour for.

Additionally, if you are being treated for thyroid disease, the use of concentrated soy products should be discussed with your physician, preferably an endocrinologist who specializes in diabetes, thyroid disease and other hormonal disorders. – Janice Baker, B.Sc., MBA, RD, CDE, CNSC, BC-ADM


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Are prediabetes and hyperthyroidism related?

Diabetes and thyroid disease are both endocrine, or hormone, problems. When thyroid disease occurs in someone with diabetes, it can make blood glucose control more difficult. With low thyroid hormone levels (hypothyroidism), your metabolism slows down. With high thyroid hormone levels (hyperthyroidism), your metabolism speeds up.

Tell your doctor about any symptoms you have. A physical exam and simple blood tests can identify hyper- or hypothyroidism. If you have hyperthyroidism, medicines and other treatments can help slow your metabolism by controlling the release of thyroid hormone. If you have hypothyroidism, your doctor can prescribe thyroid hormone pills to speed up your metabolism. You will need follow-up blood tests every few months to adjust your dosage of thyroid hormone. – Liz Quintana, EdD, RD, LD, CDE


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Click here for more Frequently Asked Questions

Last Modified Date: January 07, 2014

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by Nicole Purcell
I had a work dinner last night with some leadership from my office. I always find diabetes etiquette at these things to be kind of tricky. It was a four course meal, with salad, soup, entree' and dessert and coffee. There was also a selection of gluten free and non-gluten free dinner rolls. I felt way too full of questions for waitress... "Could I get my dressing on the side? How much sugar is in it?" A course later...