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  Chat Transcript
Open Q&A – James Bingham, M.D., October 22, 2012

 Dr. Bingham @ Unity:
 Welcome to the Unity Diabetes Online Community! I’m Dr. Bingham, an endocrinologist at the Unity Diabetes Center, and I’ll be hosting today’s chat. We’re glad you could join us today. I’m excited to answer all of your diabetes-related questions. 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. Bingham @ 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.
 JBanks:
 What services does Unity diabetes department offer?
 Dr. Bingham @ Unity:
 Unity offers a comprehensive set of services to allow our patients to better manage their diabetes. We offer diabetes education (either 1:1 or in diabetes classes) as well consultations with either my partner Dr. Rajamani or myself.
 sassy35:
 When should you see a doctor at the Diabetes Center instead of just your regular doctor?
 Bren:
 Any chance to reverse early or pre-diabetes?
 Dr. Bingham @ Unity:
 We have the tools and the technology that are necessary to help patients better manage their diabetes. We have extensive experience with insulin pumps as well as continuous glucose sensors.
 JBanks:
 Thanks, sassy35. I had the same question about when to see a specialist.
 Ellie:
 In an ideal situation, how often would you like your patients to test their blood sugar?
 JBanks:
 Do I need to have a referral from my primary care physician?
 Dr. Bingham @ Unity:
 As far as when to see a specialist - there is no absolute answer. Certainly patients who don't feel that there diabetes is under good control is a reason to see a specialist. Also most patients with Type 1 diabetes can benefit from seeing a specialist as well as patients considering therapy with an insulin pump.

Wow - great questions - I will type as fast as I can!
 Dr. Bingham @ Unity:
 As far as reversing diabetes or pre-diabetes - can this be done - YES. The data suggests that lifestyle changes are far more effective than medication in this setting. In a very important clinical trial called the Diabetes Prevention Project - in patients with pre-diabetes - walking 30 minutes a day, five days a week was twice as effective as medication in preventing the progression to diabetes.
 Bren:
 That's great news. Thanks, Dr. Bingham!
 Dr. Bingham @ Unity:
 In reference to frequency of testing blood sugars - this is very variable based on the patient's situation. It could range from a few blood sugar checks per week for someone on no medications for their diabetes to several (four or more) times per day if someone is on an intensive insulin regime, pregnant, etc. If you are wondering it’s always best to ask your doctor.
 Ellie:
 Thank you.
 Newbury:
Will pregnancy make diabetes symptoms worse?
 Dr. Bingham @ Unity:
In reference to the question about referrals - most patients do not need a referral to see an endocrinologist (even if they require a referral to see other specialists such as surgeons).
 Dr. Bingham @ Unity:
Diabetes in pregnancy can be challenging, and in reference to the prior question of who can benefit from seeing a specialist : this is certainly one group of people that can really benefit from seeing an endocrinologist. Diabetes often gets "worse" in pregnancy because some of the hormones produced during pregnancy cause the mother to become more resistant to insulin. Also , most oral agents (pills) for diabetes are not considered safe in pregnancy. To be continued…
 JBanks:
 Once I start seeing a specialist, how often should I return? My insurance has a limit on the number of office visits.
 Dr. Bingham @ Unity:
 Finally - our goals for blood sugar control during pregnancy are very strict - much lower than for other patients.
 Newbury:
 Is there anyway to tell if the pregnancy will be safe for the mother and baby before getting pregnant?
 Dr. Bingham @ Unity:
 As far as frequency of visits – this depends on the situation. For patients who have poor sugar control and are starting on new medications (including insulin): I usually see them in follow-up every 2 months. For more stable patients: I usually see them every 3-4 months. For some patients who have been very stable over time: I see them just twice a year.
 JBanks:
 Thanks.
 Dr. Bingham @ Unity:
 There is no test to tell how a patient with diabetes will do during a pregnancy (or if the baby will be healthy). In general, for patients who are considering pregnancy we really want the blood sugar control to be excellent - our goal hemoglobin A1C (blood test that shows the 3 month blood sugar average) is 6.0%.
 Dr. Bingham @ Unity:
 Also - if they are on pills for their diabetes, we will often transition them over to insulin (as insulin is the safest treatment of diabetes in pregnancy) before they start trying to become pregnant.
 Bren:
 For pre-diabetes, will insulin injections help or should just control by diet and exercise?
 Dr. Bingham @ Unity:
 We typically do not use insulin for pre-diabetes. Per published guidelines, the diabetes drug metformin (glucophage) can be used.
 Dr. Bingham @ Unity:
 Any other final questions?
 Dr. Bingham @ 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 Thursday, November 8 at 12 p.m.
 Newbury:
 Thank you very much for your time!
 Dr. Bingham @ Unity:
 We will have a special guest from the American Diabetes Association, Kelly Mueller, who will join Joy Valvano, C.D.E. and talk about the relationship between diet, exercise, and diabetes. Kelly will also share information about their upcoming panel discussion and screening of the HBO documentary “Weight of the Nation” on November 13.
 Bren:
 Very helpful... good night!
 JBanks:
 Thank you again!
 
 
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