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Don’t guess. Ask! Our experts have the answers on diabetes. – Dr. Rajamani, November 9, 2011

ayw 16:42:36:
Can stress lead to diabetes?
dhooper 16:51:48:
Does a physical exam every year check for diabetes?
Bruce76 16:57:47:
I'm 35, 5'10”, 235 lb. I'm also a smoker. I was told that I have signs of pre-diabetes. If I have to choose one, should I lose some weight or should I stop smoking?
Dr. Rajamani @ Unity 17:00:31:
Welcome to the Unity Diabetes Online Community! I’m Dr. Rajamani, an endocrinologist at the Unity Diabetes Center. I’m so glad you could join us for our latest online chat today. Today’s chat is an open forum to discuss any questions you have regarding diabetes, I hope that I can answer them for you.


Before we get started let me just tell you how we’ll address your questions and comments today. I answer questions one at a time, in the order that they are posted to the site. We’ll do our best to answer all of your questions within the hour.

Let’s get started!
Dr. Rajamani @ Unity 17:02:01:
Hi ayw,
Stress can contribute to elevated blood sugars in people who do not have diabetes or raise blood sugars in people who already have diabetes. This can improve when the stress resolves.
Dr. Rajamani @ Unity 17:02:46:
And now to answer the second question: That is a really interesting question. The labs at the time of the physical can check for diabetes if a blood test is done for the blood sugar or to test the hemoglobin A1c (HbA1c) which is a measure of your blood glucose averaged for the last 2-3 months.
ayw 17:03:23:
Hi Dr. Rajamani, will chronic stress cause permanent damage in terms of diabetes?
Dr. Rajamani @ Unity 17:04:04:
Bruce76, I see you are really interested in trying to be more healthy. You are overweight and need to lose weight. I know it is hard to stop smoking but you really should try to lose weight and stop smoking. Even if you lose 10-15 lbs with weight loss your risk of developing diabetes will decrease significantly.
lwaecker 17:04:40:
Hi Dr. Rajamani, what blood tests can I have to determine if I have pre-diabetes?
Dr. Rajamani @ Unity 17:05:15:
Stress can be terrible for everything. It not only affects diabetes but also your general health and things like blood pressure. It is important to try to find ways to decrease stress.
Dr. Rajamani @ Unity 17:06:47:
Hi lwaecker,
There are two tests you can do. A fasting blood glucose between 100 and 126 suggests pre-diabetes. Hemoglobin A1c between 5.6 and 6.5 suggests pre-diabetes.
Bruce76 17:07:34:
Well, the problem is that every time I stop smoking, I gain more weight. There is really not a way to get ahead. I really want to know if smoking does more harm or overweight?
lwaecker 17:08:44:
Thank you Dr. Also, what are some of the symptoms of diabetes? I am wondering if there is something that might make someone think that possibly they have it.
Dr. Rajamani @ Unity 17:10:03:
Bruce76, I know this is difficult. Both being overweight and smoking increase your risk of heart disease. Many people gain weight after stopping smoking as sometimes they taste food better and their appetite returns. They should therefore combine this with trying to be careful with the foods they eat.
Dr. Rajamani @ Unity 17:11:21:
lwaecker: The symptoms of diabetes are increased thirst, passing urine more frequently and occasionally blurry vision. This usually occurs when the blood sugar is very high.
Dr. Rajamani @ Unity 17:12:17:
You can also suspect that you may develop diabetes if members of your family have diabetes.
lwaecker 17:14:15:
When you go for checkups and get blood tests do they usually look to see if the patient is diabetic? I am a little curious now because I am always thirsty and sometimes have blurry vision. I think it's because of my bad eyes but I am still curious if they normally check the blood work to ensure the patient is or isn't diabetic.
Dr. Rajamani @ Unity 17:15:34:
Bruce76: Have you noticed that you are more hungry when you stop smoking? You may also want to talk to a nutritionist to help you with foods you can eat or reach for.
Trina 17:15:36:
There's no history of diabetes in my family despite us all being pretty big. Are there other risk factors that predispose one to the disease?
Dr. Rajamani @ Unity 17:17:12:
lwaecker: Most panels ordered for a physical do have blood glucose. If you have had blood work recently I would check with your doctor about the result and to see if blood glucose was checked.
lwaecker 17:18:33:
Ok thank you Dr. I will definitely do that. Diabetes does run in my family so it is something I should check.
Dr. Rajamani @ Unity 17:20:28:
Trina: If you are overweight you are at increased risk for diabetes or if you are African American or Hispanic.
Rudy123 17:23:21:
Hi - what is your opinion concerning artificial sweeteners?
Dr. Rajamani @ Unity 17:25:13:
Hi Rudy: I don't like them! I think they fool your body into thinking that you are getting some calories and the body produces hormones in response to them to conserve calories (so they may be "fooling" your body).
Dr. Rajamani @ Unity 17:26:23:
How about Stevia as sweetener? It's from a natural plant.
Bruce76 17:28:07:
How about Stevia as sweetener? It's from a natural plant.
Rudy123 17:30:22:
Do you think a diabetes educator is worthwhile to help me with my diet?
Dr. Rajamani @ Unity 17:33:03:
Bruce76: I think Stevia is a sweetener that can cause a similar process. I would use sugar substitutes in moderation.
Dr. Rajamani @ Unity 17:35:36:
Rudy123: Many people do not fully understand how different foods can affect your body and blood sugar. I think an educator is often very helpful in working with you to select foods, learn about your medicines, plan meals, advise you on treatment options and help you in several different ways.
Dr. Rajamani @ Unity 17:37:50:
I'd like to ask the group whether they have ever met with a diabetes educator?
NYRunner 17:38:38:
My wife is pregnant and that has caused diabetes. There are a lot of restrictions on what she can eat. I'm worried that the baby won't get enough nutrition. Any comments or suggestions?
Dr. Rajamani @ Unity 17:39:04:
If you are in Rochester you may already know that the best diabetes educators are at Unity :)
NYRunner 17:39:13:
No, I haven't. Is there anybody you can recommend? What's the cost?
Dr. Rajamani @ Unity 17:40:58:
NYRunner: I think that is a perfect situation where a diabetes educator and nutritionist can answer questions about your wife's nutritional needs during pregnancy. The educator can work with your wife and wife's doctor to advise her about nutrition and medications if any.
NYRunner 17:42:08:
What's the cost of seeing a diabetes educator at Unity?
Dr. Rajamani @ Unity 17:43:07:
NYRunner: At Unity you could schedule an appointment with a diabetes educator by calling 585-368-4560. If you do have insurance you may want to check with them about any co-pay. Unity can assist you with a financial assistance program if you qualify.
Dr. Rajamani @ Unity 17:46:11:
Unity does offer gestational diabetes classes on a weekly basis where your wife can also be in a group with others in a similar situation.
JudyM 17:48:11:
I had gestational diabetes when I had my son 3 years ago. We're thinking about having another child but worried that gestational diabetes may become permanent. Is that possible?
Dr. Rajamani @ Unity 17:50:59:
Hi JudyM: When you have been diagnosed to have gestational diabetes previously your risk of developing diabetes is increased by nearly 50%. So before your next pregnancy, it would be important to see if you have diabetes before pregnancy as you may want to control blood sugars if increased before any planned pregnancy.
JudyM 14:52:55:
Thanks Dr. Rajamani.
Dr. Rajamani @ Unity 14:53:02:
JudyM: You could ask your doctor to do a fasting glucose and a hemoglobin A1c before pregnancy.
JudyM 17:55:46:
I checked my blood sugar level about a year ago and it was fine. I'm worried if the 2nd child will make me permanently diabetic.
Dr. Rajamani @ Unity 18:00:42:
That’s all the time we have for today. I’ve really enjoyed our conversation and hope that I was able to provide some insight for you about diabetes. If we didn’t get to your question today or if you think of another question later on – feel free to jump into the conversation in the forum, or submit a question using our “Ask an expert” feature. This online community is a great resource, so I invite you to stay awhile, and look at all of the different kinds of information on the site.
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