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  Chat Transcript
Open Forum with Dr. Rajamani
February 15, 2012
Dr. Rajamani @ Unity:
 Welcome to the Unity Diabetes Online Community! I’m Dr. Rajamani. I’m glad you could join us for our latest online chat today. Today I’m hosting an open discussion, so feel free to ask me any diabetes-related question you want.
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, and there might be a slight delay as I respond to each question.
 Dr. Rajamani @ Unity:
 It may take a few minutes for me to type answers to your questions, so please stay logged-in to the chat to see my response, even if it takes a few minutes. And you might need to refresh every few minutes to keep up with the latest posts in the chat if you switch to another application on your computer.
Let’s get started.
 lucyblue:
 I take a lot of insulin shots a day – 4-5 shots a day. Do you think I would be a good candidate for a pump?
 Dr. Rajamani @ Unity:
 People who are on multiple shots could move to a pump (NO SHOTS!). Do you count carbohydrates and adjust the dose of your insulin?
 K77DF:
 How do I know if it's time to see an endocrinologist to help manage my diabetes?
 jalbert:
 Is there a relationship between PCOS and developing diabetes?
Dr. Rajamani @ Unity:
 Hi K77DF. Most problems with diabetes could be managed by your primary provider. If you are having problems with uncontrolled sugars in spite of intervention that may be a reason to see an endocrinologist. An insulin pump is usually managed by endocrinologists who have experience with pump therapy.
K77DF:
 Would my PCP refer me if he feels I need it, or should I ask? How do you define "uncontrolled sugars"?
 Dr. Rajamani @ Unity:
 Hi jalbert. Patients with PCOS may have glucose intolerance or diabetes mellitus. This is because of insulin resistance, and unlike type 1 diabetes mellitus, they have higher levels of insulin resistance.
 jalbert:
 What is the difference between insulin resistance and DM? How does one find out if they have insulin resistance and what are treatment options? Are there symptoms of insulin resistance?
 Dr. Rajamani @ Unity:
 Diabetes mellitus is a generic term for any condition with high sugars. In children usually there are insufficient insulin levels and this caused diabetes mellitus. In many patients with type 2 diabetes the insulin produced does not work well and this contributes to high sugars. Patients who are overweight may have insulin resistance. A reduction in weight will improve insulin resistance.
 Dr. Rajamani @ Unity:
 Diabetes mellitus is a generic term for any condition with high sugars. In children usually there are insufficient insulin levels and this caused diabetes mellitus. In many patients with type 2 diabetes the insulin produced does not work well and this contributes to high sugars. Patients who are overweight may have insulin resistance. A reduction in weight will improve insulin resistance.
 Dr. Rajamani @ Unity:
There are usually no symptoms of insulin resistance until a person develops symptoms of diabetes mellitus.
 lucyblue:
 Can people with type 1 diabetes have insulin resistance?
 jalbert:
 Should anyone who is overweight be checked for insulin resistance? Do you consider insulin resistance "pre-diabetes"?
 Dr. Rajamani @ Unity:
 Yes lucyblue. Some patients with type 1 DM not only have less insulin but the insulin that they do produce or that they use does not work well because these patients are overweight with type 1 DM. Some meds such as steroids may also contribute to resistance.
 Dr. Rajamani @ Unity:
 jalbert – exercise works like insulin and will help to bring down insulin resistance and improve blood glucose.
 lucyblue:
 Ok. Good to know. So it's best to lose weight to reduce insulin resistance, and exercise…anything else you can do?
 Dr. Rajamani @ Unity:
 Insulin resistance may predispose to pre-diabetes. The way to diagnose pre-diabetes is with blood tests.
 lucyblue:
 Are there any foods, vitamins or supplements that help reduce insulin resistance?
 K77DF:
 My father was recently told he is pre-diabetic and needs to lose weight and change his diet. Has anyone else been through this? What works best to get things under control?
 Dr. Rajamani @ Unity:
 lucyblue –  I don’t know if there are any well studied foods or supplements but some people feel that cinnamon helps.
 lucyblue:
 OK – I like cinnamon!
 K77DF:
 Wow – you never know what you'll learn on these chats!
 Dr. Rajamani @ Unity:
 K77DF – It’s hard to be told that you need to exercise and lose weight. (Don’t we all need to!) If your father can begin to walk and gradually increase the time of exercise it does help. Avoiding foods high in carbs also helps.
 Dr. Rajamani @ Unity:
 I think it's hard to know what to eat and this is a big question for many people. Talking to a nutritionist may help you to learn more about healthy foods.
 Dr. Rajamani @ Unity:
 There are also a lot of nice websites which talk about carb content and this will help to learn how much you should be eating.
 lucyblue:
 Yes, a website that I like to use is calorieking.com – it gives all the nutrition facts on the food you type in the search box, including the total carbs.
 K77DF:
 Sometimes I feel like I'm the only one that can't get their diet right – do you see a lot of patients in the same boat?
 Dr. Rajamani @ Unity:
 There are also apps that you can upload to a smart phone if you use one to help you when you need that info and to track carbs and exercise.
 lucyblue:
 They also have a book you can buy that lists calories, carbs and fat grams of most food.
 Dr. Rajamani @ Unity:
 K77DF – It's hard to walk away from foods that are rich in carbs.
 lucyblue:
 The book is called the Calorie King Calorie, Fat and Carbohydrate Counter.
 Dr. Rajamani @ Unity:
 That is a nice book. The website for that is calorieking.com.
 lucyblue:
 Oh my K77DF – I can assure you, you are not alone in that. I find snacking to be the hardest thing – especially at night.
 K77DF:
 Lucyblue – What are the names of the apps you suggested?
 Dr. Rajamani @ Unity:
 Has anyone used Siri to check on carbs?
 K77DF: 
 Does it really work? It talks back to you and tells you the # of carbs?
 jalbert:
 So, the million dollar question – what is the best way to lose weight?
 Dr. Rajamani @ Unity:
 Jalbert – I would share that million with you if I knew the answer. There are so many different ways. It is important that you choose one way that you can sustain and like.
 Dr. Rajamani @ Unity:
 Unity has a preventive exercise program that is fun. Please check our website.
 K77DF:
 I'll look for that – thanks.
 K77DF:
I  just found it. It looks really useful – thanks for the advice, Dr. Rajamani.
 Dr. Rajamani @ Unity:
 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. 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. Be sure to join us for our next chat Wednesday, February 29 at 7 p.m. with Marilyn Konezny on understanding what your blood glucose numbers mean and pattern management.
 
 
 
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