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  Chat Transcript
Open Q & A - Dr. Bingham, June 25, 2013

 
 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.
diabeeeeeeeeeeeetes:  
 Hello Dr. Bingham.
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. 

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.

Sue_Di_Monis:  
 Hi Dr. Bingham. I have had Type 2 Diabetes for several years, controlled with pills quite well until recently. My PCP and I are now trying to figure out what's next. He briefly mentioned the possibility of starting Byetta to be injected twice a day. What would be the benefit of this medication over insulin, which I understand I might be able to take just once a day?
Dr. Bingham @ Unity:
I like your screen name.:-) One of the advantages of Byetta is that, unlike insulin, it is not associated with low sugars. Although it is not a weight loss drug, people who are on it can lose weight. Also, there are two other drugs in the same family: one is given once a day and one is given once a week, to minimize the number of injections.
 diabeeeeeeeeeeeetes:
Hello Dr. Bingham, If I had gestational diabetes that went away, should I worry?
 Dr. Bingham @ Unity:
People with gestational diabetes are at higher risk of developing type 2 diabetes – about 40% of people who have gestational diabetes (diabetes in pregnancy that resolves with delivery) will develop Type 2 diabetes within 10 years. Also, if you decide to have another baby, it is very likely that you will develop gestational diabetes with that pregnancy.
diabeeeeeeeeeeeetes:  
Oh thank you doc! :) 
Sue_Di_Monis:   
LOL, thanks! Losing a few pounds sounds great. Do you happen to know what the average weight loss is? Also, regarding the drugs you mentioned taken with less frequency, do you know if they might be more expensive? I understand Byetta is a Tier 2 drug. I have heard of some of the ones you speak of such as Bydureon. Do you know if that is a Tier 3?
 Dr. Bingham @ Unity:  
Average weight loss is 8 pounds with these medications – some people lose more, some less/none. You would have to consult your insurance company, as the "tier" structure for drugs varies with each plan.
 Sue_Di_Monis:   
OK, good to know. Thanks for your help. 
Insulinomania:  
Hello Dr. Bingham! Given that Type 1 and Type 2 diabetes have different pathogeneses, is there a difference in their neuropathies? For example: progression and treatment. 
Dr. Bingham @ Unity:   
Good question. Diabetic neuropathy (nerve pain) can occur in patients with either type of diabetes. The progression of neuropathy varies in each patient, but there is no difference between Type 1 and Type 2. Also, treatment is individualized but the medications are the same regardless of the type of diabetes. Keeping blood sugars under good control is the best way to prevent neuropathy or prevent neuropathy from getting worse. 
Insulinomania:   
Thanks Dr. Bingham! :) 
 Dr. Bingham @ Unity:   
One question that many of my patients ask is will gastric bypass cure my diabetes. The answer is no. It may allow people to control their diabetes without medication, but if patients don't follow a prudent diet they are at risk for regaining much of the weight that is lost shortly after surgery, and the blood sugar can rise again requiring medication.
Dr. Bingham @ Unity: 
Any other questions tonight? 
 Sue_Di_Monis:   
 Have you seen much incidence of significant weight regain in your patients who have undergone gastric bypass?
 debadee48:
 Hello Dr. Bingham. I am a kidney transplant recipient since 2008 and up until that time never had diabetes. Since I starting taking Prednisone, I have become diabetic. Will I ever completely control my diabetes?
 Jane@Unity:
 Dr. Bingham, would you be able to reverse a complication if you get your blood sugar under control?
 Dr. Bingham @ Unity: 
 Yes, I certainly have. Data from Europe suggests that patients who lose weight after gastric bypass regain about 1/2 the weight they originally lost by 10 years after the surgery, which is very significant for the many young adults who are choosing to have this surgery.
Sue_Di_Monis:  
 Good information. Thanks!
diabeeeeeeeeeeeetes:  
 Bye doc, thank you for your answers!
Dr. Bingham @ Unity:  
 Prednisone (steroids) can cause blood sugars to become elevated (we call his steroid-induced hyperglycemia). It is absolutely possible to control diabetes that is caused by steroids, however in my experience, it often responds poorly to pill medication but very well to insulin therapy.
 aqs:
Dr. Bingham- I have been treated for Type 2 for 10+ years, adding insulin for the last 2+ years. Sometimes I have trouble concentrating and feel kind of like I'm in a fog. Can any of this be due to long term effects of using the meds? 
 debadee48: 
 Thank you Dr Bingham.
 Dr. Bingham @ Unity: 
aqs - trouble concentrating/feeling in a fog can be due to many different conditions. I don't think these symptoms are likely due to the diabetes medication. Whenever you have a symptom like this, it is important to make sure you are not having a low blood sugar. You would need to discuss with your doctor to look into this further.
 Dr. Bingham @ Unity: 
In response the question about complications – some complications (nerve pain, blurry vision from high sugars) can be reversed with improvement in blood sugar control. Other complications can't be reversed but good control can decrease/halt the progression of complications.  
Dr. Bingham @ Unity:  
We are coming up on 8:30 - any other final questions tonight? 
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.  
 Dr. Bingham @ Unity: 
Be sure to join us for our next chat Tuesday, July 23 at 8 p.m. with Elva Parker. Elva will be holding an open Q&A session and sharing important information about dental health!  
 
 
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