Ask the doctor - diabetes

I have Type 1 diabetes and use a kind of insulin called Mixtard 30. I was shocked when my GP told me it’s being withdrawn in a few weeks – how can life-saving medications be taken away from patients without notice?

Unfortunately, any pharmaceutical company can stop making a medicine at any time – sometimes for safety reasons, sometimes because not enough people are using it to make its ongoing manufacture viable, sometimes because newer and better alternatives are freely available. On the whole, these companies are very responsible, and will try to make alternative arrangements if possible. In this case, the company gave six months’ notice that it was stopping production of Mixtard 30, although that’s not long if you’ve been taking it for years. In fact, there are lots of newer alternatives, which statistically provide better control and have fewer side effects. You must speak to your GP, consultant or diabetes nurse as soon as possible to ensure a smooth transition.
Dr Sarah Jarvis, Good Housekeeping (Nov 10)  

I have type 2 diabetes and my doctor used to tell me to take a mini aspirin every day to reduce my risk of heart disease. Now he’s told me to stop. Why?

Because UK guidelines for taking aspirin when you have diabetes recently changed. It used to be recommended routinely, but experts now say you shouldn’t take it if you don’t have heart or circulatory problems. New research suggests the possible side effects, such as stomach irritation, abnormal bleeding, and peptic ulcers may outweigh the possible benefits. But if you already have heart disease or are at risk of stroke, the benefi ts continue to outweigh the risks. Doctors therefore now give personal advice about the mini aspirin, rather than recommending it as routine. For more information, visit diabetes.co.uk.
Dr Sarah Brewer, Prima (Oct 10)

I'm 43 and have Type 2 diabetes. I'd always understood that my risk of heart attack was high, and that I needed to take aspirin to reduce it. Now the nurse in the clinic has told me I should stop it - why?

You're quite right that having diabetes increases your risk of heart attack as well as stroke. That's why your GP will be keeping a careful eye on your cholesterol and blood pressure, as well as your blood sugar. For people who have had a heart attack, taking a small dose of aspirin (75mg a day) cuts the risk of another attack by almost a quarter. Aspirin can cause bleeding, especially from the stomach, but the benefits certainly outweigh these risks for most people. However, recent research suggests that if you have diabetes, you don't get the same benefi t from aspirin. Since the risks of bleeding are the same, for many people with diabetes this may outweigh the benefits, which is why you have been advised to stop.
Dr Sarah Jarvis, Good Housekeeping (Aug 10) 

I have type 2 diabetes and wonder why most doctors are reluctant to recommend chromium supplements? I've found that taking them helps to reduce my glucose levels.

Low levels of chromium have been linked with poor glucose control, and a lack of chromium has been identified as a risk factor for type 2 diabetes in some people. But it's likely that supplements will only help people with type 2 diabetes who have a marked chromium deficiency. It may also depend on the genes you've inherited. Even so, 11 randomised controlled trials, involving almost 1700 people, have shown that taking chromium supplements could significantly improve at least one measure of glucose control. A review of 41 studies published in the journal Diabetes Care in 2007, also showed they significantly improved glucose levels in people with diabetes.

They're certainly worth trying as long as you keep a close eye on your sugar levels and know how to adjust your medication if your diabetes control improves.
Dr Sarah Brewer, Prima (Feb 10)

My 14-year-old son has Type 1 diabetes and it's proving incredibly difficult to manage his condition. He hates his life being ‘controlled' and rarely checks his blood-sugar levels. How can I help?

It's common for young people with Type 1 diabetes - which involves taking insulin and regular blood-sugar checks using a finger prick - to resent the limitations it imposes on them. Unfortunately, poor blood-sugar control at this age can increase the risk of blindness, kidney failure and other problems later on. The children's diabetes nurse specialist at your son's hospital clinic will probably have seen it all before and may be able to offer advice. One option is the new Didget blood-sugar meter, which connects directly to Nintendo DS and DS Lite gaming systems. Young people can join a web community where they can play online games and earn points for testing regularly. The points let them buy items in the games and unlock mini-games - a major incentive for any teenager, in my experience.
Dr Sarah Jarvis, Good Housekeeping (Dec 09)

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

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

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 netdoctor.co.uk