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  Chat Transcript
Open Q & A and Eating Healthy to Manage Blood Sugar - Dr. Bingham and Cassie Wright, C.D.E., Septeber 24, 2013

Cassie@Unity:  
 Welcome to the Unity Diabetes Online Community! I’m Cassie Wright, a certified diabetes educator at Unity Diabetes & Endocrinology Services, and I’ll be hosting today’s chat.
Cassie@Unity:   
We have a special guest tonight: Dr. James Bingham, Endocrinologist from Unity Diabetes & Endocrinology Services. I’m glad you could join us today. We’re excited to answer all of your questions.
Cassie@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.
Cassie@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. 
Cassie@Unity: 
Let's get started! 
 Dr. Bingham @ Unity:
Hi everyone. 
Cassie@Unity: 
Welcome Dr. Bingham, it’s great to have you!
Dr. Bingham @ Unity:  
Thanks for inviting me Cassie.
Dr. Bingham @ Unity:   
Anyone with questions? 
sassy35: 
Do you have any suggestions for web sites where I can find low carb recipes? 
Cassie@Unity:  
To get things started, I had hoped you would share a little information about Invokana. I have heard a lot about it, but have yet to hear of patients using it. Could you share about it’s function and who it might be beneficial for? 
Cassie@Unity:   
Great question Sassy35!  
Cassie@Unity:    
My personal favorite is the recipe index at Dlife. Here is a link to the site: http://www.dlife.com/diabetes/diabetic-recipes/
Cassie@Unity:  
It is really simple to use, I never come up short for ideas!   
Dr. Bingham @ Unity:    
Invokana is a new oral medication for Type 2 diabetes. It is the first in a family of drugs called SGLT-2 inhibitors. It works by causing sugar to come out of the blood stream and into the urine. It also tends to lower blood pressure and can be associated with a small amount of weight loss. It does have a significant risk of side effects including yeast infections and urinary infections. 
Cassie@Unity:  
Very interesting. What kind of A1C reduction might a patient expect using it?  
Dr. Bingham @ Unity:  
The average A1C reduction with Invokana is around 1% with this medication. It is approved for use with other pills for diabetes as well as insulin. 
Cassie@Unity:   
Very good to know, thank you. 
Cassie@Unity:    
Dr. Bingham, given our topic tonight, do you have favorite lifestyle changes you encourage patients to make in an effort to improve blood sugar control? 
 Dr. Bingham @ Unity:  
 Finally, like all new medications, it has limited coverage on many insurance plans.
 Cassie@Unity:    
I have heard it is very expensive! 
sassy35:
Thanks for the URL - do they have ideas for snacks too? 
 Dr. Bingham @ Unity: 
I think that the biggest lifestyle change for patients with diabetes is to quit smoking. As far lifestyle changes, exercise may have the ability to prevent progression of diabetes, and of course weight loss is also critical.
 Wade:
Dr. Bingham since Invokana increases glucose in the urine will that affect a 19A physical?
Cassie@Unity:     
Sassy35, they do! You can search a number of ways, but one of them is by course (breakfast, lunch, snack, appetizer etc.) I personally love searching based on what ingredients I may have on hand.
Dr. Bingham @ Unity:  
Excellent question. For those who may not be familiar - 19A is a part of the NY state law that governs people who drive as part of their job (shuttle drivers, bus drivers, etc.). I doubt that the 19A laws have been changed yet since the medicine has been approved. If the A1C is OK, I don't think it would be a problem but I don't do occupational medicine so I don't know the specific requirements.
Cassie@Unity:      
Dr. Bingham, I agree! Aside from addressing nutrition habits, I too address exercise, smoking cessation, and weight loss as key components in improving diabetes control. 
Dr. Bingham @ Unity:   
Cassie - what is your favorite "app" for patients who are carb counting on the go - for example when they go out to eat?
Cassie@Unity:       
Thank you for your question Wade. What a great question!  
 cwfan:
Is there a degree of weight loss that correlates with improvements in hgbA1c? 
 Cassie@Unity:     
Dr. Bingham, I have had great success with patients using myfitnesspal. It is easily accessible for most operating systems and has a huge database.  
Dr. Bingham @ Unity:    
Thanks, Cassie 
 Cassie@Unity:     
It has everything ranging from meals made at home to fast food or fine dining options. It also tracks a number of other useful nutrients. Good question!  
 Dr. Bingham @ Unity:  
Any amount of weight loss can help with diabetes control. Even in patients who are very overweight - a 5-10 pound weight loss can lead to a significant improvement in sugar control.
Jane@Unity:
Someone in my class asks: How much cholesterol should we have a day? 
Cassie@Unity:      
Cwfan, when I first meet with a patient I typically help them set a goal to lose 7% of their body weight if they have pre-diabetes, and 10% if they have a diagnosis of diabetes. These percentages have been proven in research to improve blood sugar control and ultimately improve a patient's A1C.
Jane@Unity: 
Is there such thing as an "insulin patch"? 
cwfan: 
 Thanks Dr. Bingham and Cassie.
Cassie@Unity:       
Jane, the National Cholesterol Education Program recommends less than 200 mg per day. 
Cassie@Unity: 
Here is a link to a great resource for your class to peek at. http://my.clevelandclinic.org/heart/prevention/nutrition/atp3.aspx
Dr. Bingham @ Unity:   
 I will let Cassie answer the cholesterol question. In reference to an insulin patch - there is no "patch" available. There are disposable devices that act like a simple insulin pump - delivering a small amount of insulin all the time, and then additional insulin (by pressing buttons on the device) when the person eats.
Cassie@Unity:  
It addresses sources of fat and cholesterol in our diet. It may be a useful tool for your patients to take home and read if they are interested in improving their cardiovascular health!  
Cassie@Unity:   
Sadly, 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. 
Dr. Bingham @ Unity:  
Thanks everyone! 
Cassie@Unity:    
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. 
Cassie@Unity: 
 Be sure to join us for our next chat Tuesday, October 8 at 8 p.m. with Joy Valvano. Joy will be holding an open Q&A session to answer all of your diabetes questions with a special guest from the Unity Wound Care Center!
 sassy35:
Thanks Cassie and Dr, Bingham! 
Cassie@Unity:     
Thank you, Dr. Bingham for offering your insightful expertise! I really enjoyed chatting. 
 
 
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