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  Chat Transcript
Open Q&A - Dr. Bingham, Endocrinologist, Unity Diabetes & Endocrinology Services, June 3, 2014

Dr. Bingham @ Unity:
Welcome to the Unity Diabetes Online Community! I’m Dr. Robert Bingham, an endocrinologist from Unity Diabetes& Endocrinology Services, and I’ll be hosting tonight’s “Ask the Expert” chat. I am glad you could join me; I’m ready to answer all of your diabetes-related questions.
Dr. Bingham @ Unity:
Before we get started let me just tell you how I’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.
Dr. Bingham @ Unity:
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:
Anyone with questions tonight?
lucyblue:
Dr Bingham, do you recommend continuous glucose monitoring for people who are on an insulin pump?
Dr. Bingham @ Unity:
Good question. There are two kinds of continuous glucose monitor uses. For everyone's benefit - a continuous glucose monitor is a small filament (think short flexible wire) that is inserted just underneath the skin. It measures the glucose in the fluid in between cells (which correlates with blood sugar) frequently - usually every 5 minutes.
Dr. Bingham @ Unity:
One use of a continuous sensor is for a patient that is having trouble controlling their blood sugars to wear a sensor (that records the information, but does not display it to the patient) for 3-5 days. At the end of this time, the sensor is removed and the blood sugar data downloaded/analyzed. I think this is very helpful for many pump patients. Most insurance companies will pay for this 1-2 X/year.
Dr. Bingham @ Unity:
A second option is for the patient to wear a sensor all the time, and this sensor displays the blood sugar (usually on the patient's insulin pump). This also has the ability to alarm if the blood sugar is too high or too low.
Dr. Bingham @ Unity:
A sensor that is worn all the time can be helpful for some patients who do not feel when their blood sugar is low. The technology for the sensor is getting better but is still not perfect. Also - the sensor (and the supplies needed to use it) are very expensive. Because of this, it is often difficult to get the insurance companies to pay for sensors.
Dr. Bingham @ Unity:
Most importantly - the sensor does not replace blood sugar testing - the patient still needs to test their blood sugar multiple times/day. Also - the sensor does not automatically adjust the insulin pump settings to regulate the blood sugar.
lucyblue:
Thanks Dr. Bingham!
KC :
Hi Dr. Bingham. I have heard so many negative things about diet soda in the news recently. How, if at all, does diet soda contribute to weight gain and blood glucose control? What do you recommend to your patients as far as a limit for diet soda intake or better alternatives (other than water - which I already know is the best).
Dr. Bingham @ Unity:
KC - good question. My personal feeling is that diet soda is not that bad - particularly in comparison to regular pop/soda. There is some data (unsure of scientific strength of this data) that diet pop can increase appetite, leading to weight gain. I don't think diet pop raises blood sugar, although some of my patients have reported this. The caffeine in any liquid may have a slight effect on raising blood sugar.
KC :
Thanks Dr. Bingham. Good news about diet soda being ok. Bad news about the caffeine.
Dr. Bingham @ Unity:
Any other questions tonight?
KC :
This is just another comment on my soda question (I hope I am not hoarding the conversation) but I heard that, when you drink diet soda, it tricks the body into thinking that it needs insulin to process carbohydrates, so the body produces more insulin. Is there any truth to this at all? I would think that would be a good thing, but I guess not.
Jane@Unity:
Should I eat every two hours while awake? I feel tired if I do not eat every two hours. Sometimes my blood sugar goes too low.
lucyblue:
Do all people with diabetes eventually end up on insulin?
Dr. Bingham @ Unity:
KC - although I do like my Diet Coke - I am not an expert on this topic. I am not aware of any scientific data to show that diet soda increases insulin secretion.
Dr. Bingham @ Unity:
Jane - a common complaint that I here often. I think it is important to sort out if the blood sugar is low when you are feeling tired - for example if you are feeling tired and you check your blood sugar and it is 100 - then the feeling tired is not due to a low sugar. If you feel tired, and every time you check your sugar it is low, this is an issue that needs attention. If you have diabetes, you may need medication adjustment.
KC :
OK. Thanks again, Dr. Bingham. You have reassured me that my diet pop at lunch is ok! Have a good night.
Dr. Bingham @ Unity:
If you don't have diabetes and are having low sugars - that also needs medical attention - either way I would recommend talking with your doctor.
Dr. Bingham @ Unity:
Lucyblue - not all patients with diabetes end up on insulin, but many patients do. Unfortunately Type 2 diabetes (adult onset) is often progressive - so the body tends to make less insulin over time, which causes pill medications to be less effective, blood sugars rise, and patients need insulin to control their diabetes.
lucyblue:
That's interesting...thanks for the insight
Dr. Bingham @ Unity:
Although diabetes can progress despite our best efforts - the best way to avoid needing insulin therapy is careful attention to diet, weight loss (if overweight), and most importantly regular exercise.
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 I 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.
Dr. Bingham @ Unity:
Be sure to join us for our next chat on Tuesday, June 17 at 8 p.m. with Cassie Wright, C.D.E., and Dr. Michele Jamison, Chair of Ophthalmology at Unity Health System. They will be holding an open Q&A session and sharing valuable information about diabetes and good eye care.

 
 
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