Ask the doctor - diabetes

Read expert medical advice with doctors' questions and answers from Prima, SHE and Good Housekeeping

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Should I cut out coffee?

I have Type 2 diabetes. Is it true that I should limit my coffee intake? I can control the diabetes by diet rather than drugs, but I drink five mugs of filter coffee a day. Is that all right?

Some research suggests that people with Type 2 diabetes who drink coffee and tea every day may find it more difficult to maintain good
glucose control. One study showed that in volunteers consuming caffeine equivalent to four cups of coffee a day, blood glucose levels were significantly higher after meals than when not consuming caffeine. This post-meal rise in glucose levels is especially harmful to the circulation. So to maintain good glucose control it does make sense to reduce your caffeine intake. But talk to your GP before making signifi cant dietary changes, especially if you are on medication to lower glucose levels.

Dr Sarah Brewer, Prima (Oct 09)

 

I have diabetes and I know that keeping my blood sugar under control is important. I'm on medication to do this but recently it lowered my blood sugar so much that I had a ‘hypo' and collapsed. Now I'm terrified to take my medicine for fear of having another. What can I do?

Raised blood sugar can cause serious damage to your body in the long term. That's why we encourage people with diabetes to bring their blood sugar down. Recent evidence has shown that the benefits of tight blood sugar control (to about the same levels as people who don't have diabetes) will last a lifetime, cutting your risk of kidney, eye and heart disease. However, some medicines used to lower your blood sugar can cause it to drop too much, causing ‘hypos'. Sulphonylurea medicines are taken by millions of people with diabetes in the UK. They certainly work, but they cause more problems with low blood sugar than any other tablet for diabetes. In the past they've been used because we didn't have anything better. However, newer drugs like pioglitazone or the ‘gliptin' drugs may offer the same blood-sugar-lowering benefits with less risk of low sugar. Talk to your GP about whether one of these might suit you better.

Dr Sarah Jarvis, Good Housekeeping (Aug 09)

 

Can cinnamon ward off diabetes?

I've read that cinnamon can lower blood sugar levels and possibly even ward off diabetes. Both my father and two aunts developed Type 2 diabetes later in life and I'm keen to protect myself. Is it worth adding cinnamon to my food or hot drinks? And how much is a healthy amount?

Alternative practitioners have been recommending cinnamon as a natural way to control blood sugar levels for some years and there is now growing scientific evidence to back their claim. Type 2 diabetes tends to develop later in life and occurs because the body is less efficient at producing, or using, the hormone insulin, which controls blood sugar levels. The condition is more common in people who are overweight or obese and does tend to run in families - so it is important that you take steps to reduce your risk. The theory is that cinnamon spice is packed with an antioxidant, which mimics insulin and helps to restore blood sugar levels. One study from Pakistan found that volunteers with Type 2 diabetes given three or six grams of cinnamon powder a day, after meals, reduced their blood sugar levels by about 20 per cent compared with a control group. This is the equivalent of just half a teaspoon of cinnamon a day.

More research is needed to confirm these findings, but the good news is that including cinnamon in your diet is not going to do you any harm and could be beneficial. The most important thing is that you make sure you follow a healthy lifestyle by eating a balanced diet - one low in sugar and salt, and containing plenty of fruit and vegetables. Regular exercise is also important in helping to reduce blood sugar levels and maintaining a healthy weight. Cinnamon can be used as part of this healthy lifestyle. This doesn't mean indulging in spicy cakes and puddings. Think about stirring cinnamon into your porridge in the morning, adding it to stewed fruits or flavouring your tea.   

Dr Louise Selby, SHE (July 09)

 

Four years ago, I developed diabetes during pregnancy. Called gestational diabetes, it went away after my daughter was born. But could it increase my risk of diabetes in the future?

Gestational diabetes (GDM) is thought to develop when your body can't produce enough insulin to meet the needs of pregnancy. Most cases occur in the second trimester, when there's less risk to the baby, and are picked up by routine blood tests.

Blood glucose levels can be controlled by diet, or you may be prescribed insulin. Metformin tablets can also be prescribed and these work by reducing the glucose produced by liver cells. GDM usually goes away after a baby is born, but women have a 20 per cent higher risk of developing Type 2 diabetes later, while 5-10 per cent will be diagnosed with Type 1 diabetes. To reduce your risk, follow a healthy diet, as your chance of diabetes is increased if you are overweight. For more advice, visit www.diabetes.org.uk.

Dr Louise Selby, SHE (May 09)

 

Why won’t my GP give me weight-loss tablets?

 

I have type 2 diabetes and am obese. I’ve tried to lose weight with little success – will tablets help? My GP says my weight is self-inflicted and won’t even discuss them.

I assume you’re talking about the various tablets now licensed for weight loss. I’m afraid they’re no substitute for diet and exercise, and there isn’t a quick solution. However, I think your GP is being harsh and perhaps a little short-sighted by dismissing your problems as self-inflicted. Patients need help and support, not blame. What’s more, the consequences of being overweight (diabetes and heart disease to name just two) may prove more expensive to your GP’s budget in the long term than support to lose the weight now. Since you have type 2 diabetes, you should be able to make an appointment with the dietician – do take along a food diary when you see her. Then talk to your practice nurse about self-help groups for weight loss, or ask about seeing her for regular checks. Tablets can help, and you might be eligible for them, but they should really only be a last resort.
Dr Sarah Jarvis, Good Housekeeping
 

Diabetes and blood sugar meter

I developed type 2 diabetes several years ago, but wasn’t aware of it until recently. I’ve been told the condition is at an advanced stage and have been advised to test my blood sugar levels regularly – but I can’t get on with the fiddly meter I was recommended. I don’t want to buy another one, only to have the same problem. What can I do?

Sadly, the symptoms of type 2 diabetes can be mild and non-specific to begin with, so it's often many years before you discover you have it - and, as you've found, complications can be developing even before you're diagnosed. The most important point is your close relatives must be tested, since having type 2 diabetes in the family will hugely increase their risk of developing the disease. As for your meter, the array of different brands is very confusing and the best thing would be to discuss the options face to face: your local diabetes specialist nurse should be just the person. Most hospitals have one of these nurses available - they should be able to give you demonstrations of the various models and talk through what will work for you.
Dr Sarah Jarvis, Good Housekeeping
 

Checking blood sugar

I have type 2 diabetes and have recently started taking insulin. I’m determined to check my blood sugar levels, but don’t want a bulky meter. Any suggestions?

Good for you for taking control. As you've already discovered, some blood testing kits can be complicated and awkward to carry around. Several of my patients are now using the Aviva blood monitoring system, which is simple to use, small enough to fit in your pocket, includes a lancing device that you don't need to touch and has an easy-to-read screen.
Dr Sarah Jarvis, Good Housekeeping

 

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The answers to specific problems may not apply to everyone and are not substitutes for professional medical advice. If you're worried, see your GP. For more information, visit www.netdoctor.co.uk