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Are Low Blood Sugars a Normal Part of Having Diabetes?

>> Tuesday, November 27, 2012

Diabetes is a condition that is diagnosed on the basis of elevated blood sugars.  We know that high blood sugars over time can cause damage to the heart, kidneys, eyes, nerves, and other organs, so an important part of diabetes treatment is to keep blood sugars as normal as possible.  Some medications used to treat diabetes can cause low blood sugars if more is taken than what is needed.  So, is having low blood sugars a normal part of being treated for diabetes?

(for THE BOTTOM LINE, skip to below)

As I discussed at this weekend's Rocky Mountain Internal Medicine conference in Banff, Canada, my first point on this important topic is that having low blood sugars in diabetes is more common than we think.  Several studies have demonstrated that if blood sugars in diabetics are continuously monitored for 24 hours, a significant proportion of people are having low blood sugars - and don't know it.  There are a couple of reasons why you may not know you are having lows:  symptoms of lows (shakes, sweats, heart pounding, etc) decrease after 10-15 years of having diabetes, and older people may not get these symptoms even early in their diabetes.   Low sugars can have some atypical symptoms as well, such as nightmares.  A fall in the middle of the night in an older individual could be due to a low blood sugar, so if this is happening, it's important to check.

My second point is that low blood sugars have many negative effects.  A low sugar can be dangerous if it happens behind the wheel of a car or while operating machinery - this is why it's mandatory to check sugars before doing these things, if you are on medications that can cause low blood sugars.  A severely low sugar can cause a seizure or heart rhythm problems, though fortunately, severely low sugars are not common, especially if diabetes is managed well.  

An important aspect of having low blood sugars that is sometimes overlooked is the effect that low sugars has on quality of life.  Having a low sugar is a scary feeling, and people who have had lows often fear - a lot - the possibility that it could happen again, and their family does too.  Seven to 10% of people who have a low blood sugar while at school or work will go home and miss the rest of the day, and some will miss the next day too.  Having a low sugar requires taking in carbohydrate calories to correct it, which can make it harder for overweight people to lose weight.   Having low sugars is expensive too, as it ends up costing in lost time at work, extra meter strips to check sugars, and so on.

The good news is that not all medications to treat diabetes cause lows.  Insulin and two classes of oral medications for Type 2 diabetes called sulfonylureas (includes glyburide, gliclazide, and others) and meglitinides (includes repaglinide) are the ones that can cause low blood sugars.  There are many other classes of medications to treat Type 2 diabetes that do not cause low blood sugars.

As far as insulin goes, insulin is required to treat Type 1 diabetes, and it is also required for many Type 2 diabetics, depending on how advanced their diabetes is.  However, there are different kinds of insulins available, some with lower risk of low sugars than others.

Some diabetes medications can also be adjusted depending on what you feel like eating.  For these medications, lower doses can be taken if less food is eaten to avoid a low blood sugar, rather than having to eat a regimented meal pattern every day to avoid your diabetes medication causing a low blood sugar.     Some diabetes medications can also be decreased for days that you are more active, rather than having to eat more on active days to avoid having a low sugar.

THE BOTTOM LINE:  Low blood sugars do NOT have to be a normal part of having diabetes.  I'm a big believer in adjusting diabetes medications to fit a person's lifestyle, rather than a patient having to alter their lifestyle to fit their medications (and avoid lows).   If you are struggling with low blood sugars as part of your diabetes treatment, speak to your doctor to find out what can be done to decrease the risk of lows, or possibly eliminate the risk entirely.

Dr Sue Pedersen © 2012 

Follow me on Twitter for daily tips! @drsuepedersen


Bariatric Surgery and Bone Health

>> Tuesday, November 20, 2012

The decision to undergo obesity (bariatric) surgery is a complex one, as the potential benefits and potential risks are many.  A longterm potential complication that is often overlooked is the effect that bariatric surgery can have on bones.

As outlined in an excellent review by Brzozowska and colleagues, the effect of bariatric surgery on bone health is not well understood.  As the potential effects, as well as what we know (and don't) is quite variable depending on what type of bariatric surgery is performed, here are a few notes organized by procedure:  (you can also read more about the procedures in general here)

Gastric Bypass Surgery:  We know that gastric bypass alters bone metabolism in favor of bone breakdown.  In many cases, this is at least partially due to vitamin D and/or calcium deficiency - both require supplementation lifelong after gastric bypass, and inadequate replacement will cause bone depletion over time.  There are many other factors involved as well - several hormones made in the fat tissue and the gut that change after gastric bypass surgery have been implicated in changes in bone metabolism as well.

Sleeve Gastrectomy:  As a newer procedure, very little is known about the effect of sleeve gastrectomy on bone.  The available data suggests that sleeves do affect bone metabolism and can cause bone loss over time.

Gastric Banding:  It is not known whether gastric banding has an adverse effect on bones or not - studies done so far have shown conflicting results.  Gastric banding is a less invasive procedure that doesn't cause calcium or vitamin D deficiency, and doesn't cause as many hormonal changes as the other two surgeries.  (That being said, gastric banding is falling out of favor due to its poor longterm efficacy and high reoperation rates over the long term.)

A few important caveats to the above discussion:

1.  It is not known whether changes in bone metabolism seen with bariatric surgery result in an increase in fracture risk - more study is needed.

2.  The long term effect on bone metabolism is not known, as most studies done to date are only a year or two in duration.  Longer term studies will help us to understand the effect on long term fracture risk as well, which is the most important outcome measure.

3.  The effect on bones may be different not only by the type of surgical procedure, but also by age and gender - again, more study is needed.

The Bottom Line: Anyone having bariatric surgery should have a baseline bone density done before surgery, and bone density should be monitored after surgery as well (guidelines are available here).   While adequate calcium and vitamin D is an important component of bone health, there is much more about the effects of bariatric surgery on bone that we still don't understand.

Dr Sue Pedersen © 2012 

Follow me on Twitter for daily tips! @drsuepedersen


Struggles with Weight or Cholesterol? Turn Off Your Light At Night!

>> Wednesday, November 14, 2012

It is a well known fact that not getting enough sleep is a risk factor for obesity.  However, if you think you ARE one of the lucky ones who actually does get enough sleep, ask yourself if you are getting enough sleep in darkness?  A new study suggests that people who are exposed to light at night (even if they are sleeping) may be at an increased risk of carrying extra body weight, and even of having higher cholesterol!

The study, published in the current issue of the Journal of Clinical Endocrinology and Metabolism, examined body weight and cholesterol levels amongst older people (average age 73) in Japan.  Researchers went into participants' homes and recorded exposure to light overnight, and found that those who are exposed to light overnight were 89% more likely to be obese, and 72% more likely to have cholesterol problems, compared to those who sleep in the dark.  

While this study needs to be repeated in a younger population to know if these findings hold true outside of older age, there is already lots of evidence that sleep deprivation increases the risk of obesity, and that blue light exposure in particular (including from computer and mobile device screens) makes it harder to fall asleep - a habit that is particularly relevant for younger generations.

The Bottom Line:  Lights Out!

Dr Sue Pedersen © 2012 

Follow me on Twitter for daily tips! @drsuepedersen 


Raspberry Ketone Myth Busting (not fat busting)

>> Tuesday, November 6, 2012

In the last few months, I've been hearing an awful lot about raspberry ketones, and I've been asked frequently as to whether there is any substance to the weight loss claims.  Time to bust the myths! (hmmm this may already answer the question...)

Raspberry ketone is a chemical that gives raspberries their smell.  It's used as a perfume in cosmetics, and has been studied as a potential skin whitener.

Studies in test tubes have shown that raspberry ketone can increase fat breakdown in fat cells and increase release of a hormone called adiponectin (I'll get back to this later).  Rat experiments have suggested some anti obesity potential of raspberry ketone.

The use of raspberry ketone as a weight loss aid really took off when a certain physician/celebrity promoted it on his TV show, based on the above studies, and testimonial evidence from people who have used it with success.

HOWEVER.  Raspberry ketones have NOT been studied in humans in proper clinical trials, and there is therefore no scientific study or evidence to support the safety or benefit of using raspberry ketones in humans.  From a safety perspective, it has been suggested that raspberry ketone has a stimulant effect, and there have been reports of people taking them experiencing palpitations.  Raspberry ketones may interfere with a long list of medications, including blood thinners, antidepressants, and others.

From a benefit perspective, there is no study in humans to show the effect on body weight, and no study in humans to show the effect on adiponectin levels in the living body. Adiponectin is a 'good' hormone, in that higher levels are associated with a better metabolic profile and lower body fat.  However, while raspberry ketone may increase adiponectin in a test tube, we have no idea if this actually happens in real life.

When the pharmaceutical industry tries to develop a drug to treat obesity, it goes through very rigorous clinical trials that start with test tube data, followed by huge amounts of animal study, then small human studies, then big human clinical trials.  This all happens before a medication can hit the shelves.  These steps are important for our health and safety, so that we have a good understanding of the benefits and risks of medications before we start prescribing them.

In contrast, like other drugs in the herbal industry (and yes they should be considered to be drugs), little to no study is required before they end up on shelves.  In the case of raspberry ketone, we have no idea if it results in weight loss in humans, and even worse, we do not understand the potential side effects or dangers of taking it.

A special thank you to Steven Niles, Certified Diabetes Educator, for the first heads' up!

Dr Sue Pedersen © 2012

Follow me on Twitter for daily tips! @drsuepedersen 



I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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