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  Chat Transcript
Open Q & A - Dr. Bingham, Endocrinoligist, Unity Diabetes & Endocrinology Services, January 28, 2014

Dr. Bingham @ Unity:
Welcome to the Unity Diabetes Online Community! I’m Dr. Bingham, an endocrinologist from Unity Diabetes & Endocrinology Services, and I’ll be hosting today’s chat. I’m glad you could join us today. We’re excited to answer all of your diabetes questions.

rainbow:
What is Insipidus diabetes?

Dr. Bingham @ Unity:
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. 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.

Dr. Bingham @ Unity:
Diabetes insipidus is a hormone disorder where people do not make a hormone called anti-diuretic hormone. This causes excessive urination - up to 20 liters/day! It is not associated with high blood sugars.

rainbow:
Can someone have Diabetes insipidus and Diabetes?

Dr. Bingham @ Unity:
Sure, could happen – I don't believe I have ever seen it. Diabetes insipidus usually happens when there is damage to the pituitary gland.

lucyblue:
HI Dr. Bingham, should I be concerned if my blood sugars are always above 200?

rainbow:
Thank you Dr. Bingham

Jane@Unity:
Is it important to have your Vitamin D level checked if you have diabetes?

Dr. Bingham @ Unity:
I appear to have lost the prior questions. I believe there was a question about concern if blood sugars are always over 200. Yes, this is a concern as it means that the person has diabetes, and it is not under good control. I would recommend contacting your doctor to discuss.

sassy35:
What's a good A1C level?

Dr. Bingham @ Unity:
Re: Vitamin D – there is no particular concern between Vitamin D and diabetes. However, vitamin D deficiency is very common in Rochester, so always a good idea to get it checked.
lucyblue:
Is it recommended that everyone with diabetes meet with an endocrinologist? When should you see an endocrinologist for your diabetes?

Dr. Bingham @ Unity:
A good A1C level depends on the situation. The American Diabetes Association recommends an A1C of < 7. Goals are often lower in pregnant women and can be higher in patients over age 80.

rainbow:
My cat has diabetes and may have to go on insulin, where is the best place to inject insulin and does one check the cats blood sugar?

Dr. Bingham @ Unity:
There are no official guidelines for when a patient should see a specialist for their diabetes. However if blood sugars/A1C are not under good control or a having complications from the diabetes, that might be a reason to see a specialist.

sassy35:
What if the patient has had gestational diabetes...are A1C goals different?

Dr. Bingham @ Unity:
I love cats, but rainbow I can't answer your question about where to inject a cat with insulin or whether BGs are checked. In humans we typically recommend injecting in the abdomen, thighs or arms.

lucyblue:
What is considered "not under good control" in diabetes?

rainbow:
Thanks Dr. Bingham, I will check with my vet.

Dr. Bingham @ Unity:
For gestational diabetes, or diabetes that occurs during pregnancy (and resolves with the delivery of the baby), we typically strive for a lower A1C - of around 6 - to try and minimize the risk of complications for both the baby and the mom. However, goals are different for each patient depending on their unique situation, rate of hypoglycemia, etc.

Dr. Bingham @ Unity:
As far as what is not good control – if the A1C is not at goal (again goal differs from person to person) or if the person is having too frequent (or severe) low sugars- I would say that was not good control.

lucyblue:
Ok, thanks Dr. Bingham.

lucyblue:
Dr. Bingham, what do you think is the key to managing diabetes?

Dr. Bingham @ Unity:
One question I frequently hear about is pre-diabetes. Pre-diabetes is a disorder where the blood sugars are above normal, but not high enough to be in the diabetes range. The best treatment – based on a large study – was regular exercise.

rainbow:
Does the cold weather have any effect on blood sugars?

Dr. Bingham @ Unity:
I think there are several keys to managing diabetes - a good partnership with your doctor is important. Education is absolutely critical – we have diabetes education classes at the Unity Diabetes & Endocrinology Services. Also, diet and exercise are really the foundation for the management of all diabetes.

Dr. Bingham @ Unity:
Rainbow - cold weather should not really have a big effect on blood sugars. However - it can have a huge effect if insulin freezes. Once insulin freezes it is no longer active/will not lower blood sugars. Once the insulin thaws - it won't look different - it just doesn't work. This happened to a patient of mine a couple of weeks ago - very dangerous. Especially now that patients are getting insulin "mail order" so the package could be out in the cold for hours. Also - if it is picked up at the pharmacy and then is left in a car outside overnight.

rainbow:
Good to know, thanks.

Dr. Bingham @ Unity:
It is 8:30 - unless there are any other last 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.

rainbow:
Thanks Dr. Bingham,

Dr. Bingham @ Unity:
Be sure to join us for our next chat Tuesday, February 11 at 8 p.m. with Colleen Gladstone, C.D.E. Colleen will be holding an open Q&A session and sharing important information about heart health with special guests, Dr. Joan Thomas, Chief of Cardiology, Unity Health System and Marc Natale from the American Heart Association!

lucyblue:
Thanks Dr. Bingham!
 

 
 
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