Dr. Richard A. Guthrie, M.D.

Probably not. Some studies have indicated some relation between diabetes & Via. D def. but more as def. a cause of diabetes. Other studies have shown no relationship. Vitamin D def. is more likely due to too little enriched dairy products &/or to little sunshine. More of these could solve the problem or oral Vit. D supplements should correct.

Diabetes is inherited via recessive genes so she must get a gene from each parent. So diabetes in one side of the family and not in the other does not increase the chance of diabetes. So if dad has diabetes or is a carrier of the gene, he could pass that gene on to the child but if chid gets a normal gene from you, the child is a carrier but should not have diabetes. The problem is are you a carrier? If so the child COULD get diabetes. For those having the genes, there are environmental factors that can influence development of he disease. For Type 1 DM, viral infections & other as yet unidentified factors may influence development. For Type 2 DM diet & wt control are important. So do watch diet & limit sweets. We all have a sweet tooth we must control as this may cause other problems as well (tooth decay, etc.) So watch that & do not let the child become obese as that increases chance of diabetes, heart disease & some cancers.

These are good questions some of which are under study & we do not have answers yet. Since you have gestational diabetes, you are carrying the diabetes genes & will pass that on to the child. It takes a gene from both parents though for the child to have diabetes. So the problem is does your spouse carry the gene. We don't know the genes for diabetes especially Type 2, so we can't test him. How well you manage the diabetes during the pregnancy probably has little effect on whether the child will develop diabetes but poor control will have other adverse effects such as big babies with difficult delivery, post delivery hypoglycemia & hypocalcemia, jaundice & other problems in the baby. So control your blood sugar well during the pregnancy and don't worry about the future.

Don't worry about insulin injections. I have taken them for 25 yrs & it's no big deal with modern pens, small needles, and other equipment. The American Diabetes Association, the American Association of Clinical Endocrinologist, & other organizations have produced guidelines that say start insulin at Hba1c of 9% or above.

To answer this, I would need more information. What is the level of self-care your mother is capable of? Does she live with you or are you close? How is her eyesight, dexterity, her mind, etc.? In general, pens can help, pre-drawing a week's doses of insulin, setting clocks for reminders, visiting nurses, etc., can help. I can't give specifics for her without the above information.

Stevia is an extract from a plant grown in Africa (although can be grown in your own garden). It has been used in Africa for hundreds of years and has no known bad effects. There are always articles appearing in the literature to debase artificial sweeteners. You need to know the source of this literature. There are no good scientific studies to say that any of the artificial sweeteners, including Stevia are harmful. If there was evidence that they were harmful, the FDA would pull them from the market. Brown sugar is unrefined sugar and is no different in its effects in people with diabetes than white sugar. It should be avoided just as white or refined sugar. The problem with any sugar is that they are empty calories and are quickly absorbed so give a rapid rise in blood glucose. They are OK to treat low sugar, but not good for everyday control or wt. maintenance.

Type 1 diabetes is the more serious disease and occurs most often in younger people such as children. It can occur in adults. My mother was in her 50's, as was I, when we developed Type 1 diabetes. The definition of this disease is the lack of insulin secretion. So these people have damage from the immune system that destroys their insulin producing cells (beta cells) in the pancreas and thus are dependent on insulin from the outside to live.
Type 2 diabetes is a different disease. It begins with the bodies resistance to insulin and an increase not a decrease in blood insulin levels. Later the pancreas may wear down from the need for hyper secretion of insulin & go into failure. The patient may then need insulin to control blood glucose but is not dependent upon it to live. This disease occurs mostly in adults but there is an increasing incidence in children with the epidemic of obesity (which causes insulin resistance) in children. I have treated a 4 yr. old child with Type 2 diabetes. The genetic background which interacts with environmental factors to cause these two diseases are different as are the environmental factors. Type 2 diabetes is usually associated with obesity while people with Type 1 are usually slender & have lost wt. prior to diagnosis. There is overlap in these 2 diseases, however, with some children with Type 1 getting overwt. & developing simultaneous Type 2 -- what is now called Double diabetes. Type 2 patients can also lose all their insulin producing ability & be dependent on insulin for life. It is like 2 roads that may eventually come together to produce the same symptoms, but how you got there was different.

No it does not. What it means is that you have been good & gotten the diabetes under control. Diabetes is a genetic disease we get from our parents & we cannot change our genetics. We can control circumstances & life style & make it better. You have done that well & should complement yourself. You still have diabetes but it under control. Lapse into overeating, under exercising, wt. gain & obesity and you will see your diabetes come back & HbA1c go up. Congrats. on what you have achieved.

What should you do to lose wt.? Simple decrease your food intake & increase your calorie burning (exercise). Never depend on medications to lose wt. They are a help but life style change is more effective. Remember Newton's law of thermodynamics: Energy is neither increased or decreased in the universe, it is only changed from one form into another. So if you consume more energy (food) than you expend for energy (activity & exercise) the excess energy consumed is converted to another for (fat). To get rid of the fat you must burn more energy (exercise) than you consume (food). Medications are a help but cannot do the job without your help. The medications just help you not want as many calories, they do not help you burn calories. Consult a dietician & an exercise specialist to help you outline a good program that fits your capabilities.

Diet in persons with diabetes is a complicated & much discussed issue. It is too complex to discuss here. Also without more information, it would be impossible to give much more advice. The elevated creatinine indicates she has kidney disease & that would influence the diet. She should see a dietician who is knowledgeable in diets for diabetes & in renal disease diets and a physician to control her diabetes & renal disease.

To answer this question I would need more information. How well is the diabetes controlled? Have you seen a urologist? There are many causes of recurrent UTI. See a urologist to be sure there is no anatomical problem with the urinary tract (polyps, etc.). Other causes are sexual trauma, etc. All these causes can be corrected. As for diabetes, high sugar content of the urine can lead to UTI as can partial paralysis of the bladder from diabetic neuropathy. Again, a urologist can test for urinary retention. As to the diabetes, be sure to be in control so there is minimal sugar in the urine. Luraglitide and metformin are good treatment. The glicticide is a sulphonylurea drug that is "out of style" today because of hypoglycemia and wt. gain. You should not take a drug of the SGLT2 class since these drugs increase the sugar in the urine. If your diabetes is not in good control, I would recommend starting a GLP2 RA or insulin to get optimal control and keep sugar out of the urine.

With the small amount of information you sent, is impossible to say why this is happening. I would need to know things like your age, degree of diabetic control, meds you are taking, etc. including what type of diabetes you have. If you still have high blood sugars then you are not putting the carbohydrate into the cells but losing the calories in the urine. So get the blood sugars under control & see a dietician to get a good diety plan.

This question is hard to answer without knowing something about her level of control, drugs she is on, general state of health, etc. I would also need to know how low the blood sugar was. In general. most hypoglycemia does little or no permanent damage but severe lows can cause brain damage & should be avoided at all costs especially in the very young and the elderly. If this is a recurrent problem she should see her physician and get her medication adjusted. It is also important to look at other reasons for the lows. Over 90% of lows are not due to the wrong meds or the wrong doses but due to errors by the patient such as timing of meds, med errors, not matching food, exercise & meds, etc. This should be looked into & be sure she has received the proper & completer education in self care.

You may not need insulin injections forever. I assume you have type 2 diabetes and are not now taking insulin. With time though your pancreas loses its ability to make insulin in spite of what drugs you are taking to help. Insulin then may be needed. Blood sugar must be controlled to prevent serious complications. If that requires insulin, don't hesitate to take it. Its not so bad. I have taken it for 25 years. If you are overweight that creates insulin resistance and creates the need to take insulin. If you lose weight, your insulin resistance goes down and you might come off insulin. There are several insulin regimes you could tray y such as a very long acting insulin combined with a GLP1 RA in one shot/d instead of 2.

It is difficult to answer this without more information. What medicine are you taking now, dosage, timing, etc., and what are your other blood sugar values? You gave only after lunch. Here is a general answer only: Blood sugars need to be controlled and there is no value at which you start a given drug. 280 after lunch is way too high and something should be done to bring it down. If that something is insulin, then so be it. Fasting blood glucose should be below 110 and never over 120. After meals should be below 140 and never exceeding 180. What is your HbA1c? It should be below 7%. If not at these levels and are on several oral agents at max doses, the insulin is needed. With this high of a post meal BS, I would go to a 4 dose insulin schedule of a long acting insulin at bed time and a short acting insulin with each meal and stop all oral agents except metformin.

First of all 8000 mg metformin/d exceeds the max dose level recommended which is 2500 mg/d. 2nd Sitigliptin is not a very effective drug. Most oral agents will lower the HbA1c by about 2 points. Sitagliptin lowers it by 0.3-0.5%. For you I would 1) lower the metformin to 1000 mg 2x/d 2) check kidney function-at your age & dose of metformin you better have good kidney function as you are at risk of lactic acidosis. 3) I would stop the sitagliptin and go to a stronger agent. This could be an SGLT2 drug and/or a GLP1-RA drug of which there are many on the market-some you take daily & some weekly by injection. Finally if none of this works there is always insulin. It always works though you & your Dr need to know about the different insulins & how to use them.

It is impossible to answer this question without more information. There are many reasons for wide fluctuations of BG. She may be on the wrong medicine, or the wrong doses, or she may not be getting the medicines at the right time to coincide with the food or activity. Without knowing what medicine or medicines she is on & doses & timing between meds & food & her activity patterns and most important the pattern of her BG over several days or weeks, I cannot give you a better answer. Talk to her physician. Take him or her at least 2 weeks of BG measures done 4x/d and look for patterns that may show the cause.

Yes you can reduce your blood sugar (BS) with diet, wt. loss & exercise. I do not have enough information to completely answer your question. How old are you, what is your Ht. & Wt (BMI) and what was your BS? Also was a Hemoglobin A1c done & what was it? If I had this info. I could better answer your ? about medication. There are degrees of loss of insulin production and this governments BS & HbA1c. The more loss of insulin production you have in your pancreas cells the more medication. If your diabetes is early & you still have a lot in insulin production the taking the strain off the insulin production by diet, exercise & losing wt. may prevent medication for now. If you have lost a lot of insulin production you may need medication. Also remember that insulin production is lost with time and even if medication is not needed now, it may be in the future so good followup with your Dr. will be needed.

Glycemic index was developed in Canada a number of years ago & can be helpful in planning diet. It compares a measured amount of food to a base # of 100. So a potato may have a high index (say 98), while some other food may be low (say 56). The low index will give a lessor amount of carbohydrate (though not less calories) than a high index food & slower absorbtion. The index can be helpful in planning diets but there are some caveats. For example: Potatoes have a high index but put gravy on them & calories go up but the index goes down because the gravy slows absorption. Surprisingly ice cream has a low index though high calorie for the same reason. The index may be helpful in planning & controlling BS but does not tell you about calories so is not useful for weight loss. The best for weigh for wt. control is control portion size but not so much what you eat-the exception being not to binge & watch junk foods.

Yes it will. Not knowing what your treatment & level of control is now, I cannot give you specific advice-only general. In the past, we had few tools to control diabetes & the toll on the baby was very bad. Miscarriage was high as was big babies that had multiple problems after delivery such as breathing problems, prematurity, low BS, low calcium, etc. They also had a high incidence of congenital anomalies such as spina bifida, heart defects, etc. We have learned though, that these problems are associated with high BS in the mother and can be prevented. I have now cared for hundreds of pregnant women that have had normal babies. BUT BS has to be controlled. For pregnancy I try to keep Fasting BS less than 90-95, and post meals BS <120. HbA1c should be checked frequently and be <6.5%. Since some oral drugs will cross the placenta and may effect the baby, for gestational diabetes & certainly for diabetes I would always use insulin & give it as basal-bolus (4x/day) with careful BS monitoring Fasting & 1-2 hr post meal daily. With this kind I therapy you chances of having a good baby are great. Get you BS under good control before pregnancy & keep it in control. I can't guarentee you a good baby but The above will increase your chances for a good healthy baby to the same as a woman who does not have diabetes. Good luck. Have a healthy baby and enjoy the experience.