Brunilda  Nazario, MD
Biography

	How often should I be testing? My husband's count is 284 at 90 mins. after lunch. What is ideal? Why is my doc always making an issue about me checking my carbs? My fasting level is 120-155. Should my meds be changed?
	Diabetes Meal Plans

When living with diabetes, so much of your long-term success depends on what you do today to manage your levels. What's the best way to do this? And what are the proper levels? We got some guidance from WebMD's in-house expert, Brunilda Nazario, MD, when she offered tracking tips and took our questions on on Oct. 5, 2004.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Support for this University course was provided by Medical Mutual.

MEMBER QUESTION:
I'm type 2 and confused as to the cause and effect of diet and Bg levels. If the level is high first thing in the morning after not eating 10-12 hours, how does lowering carb intake at other times affect that reading?

NAZARIO:
The answer is not simple. The cause of type 2 diabetes is multifaceted; to blame its development on diet is wrong.

We still can't pinpoint type 2 diabetes to simply diet or simply genetics or simply weight. It's much more complicated. These things do play a role but do not play a single role in type 2 diabetes in any one person.

Having said that, the management of type 2 diabetes requires targeting these areas, which includes, under one umbrella, lifestyle modifications:

• Diet
• Exercise
• Medical management

Diet does not include restriction of carbs but a restriction of calories . Go to well-respected sites like the American Diabetes Association, the American Dietetic Association, and WebMD and look at the various diabetic diets or diets in general, because there is no specific diet that is for diabetics, they're all classified as well-balanced diets. What they do specify is a restriction of calories so that an individual can lose weight.

One of the major risk factors for the development of type 2 diabetes is a person's weight, more so than a person's family history. So an individual can have many family members with type 2 diabetes but that doesn't guarantee that person will develop type 2 diabetes. But if that individual carries excess weight, you will push that pivotal point and they may well develop type 2 diabetes.

Exercise is another key target area in the management of type 2 diabetes. Not so much in helping an individual lose weight, or even in improving their cardiovascular fitness (a diabetic individual does not die of diabetes, they die of heart disease), but in that exercise improves insulin function. So exercise improves blood sugars in people with diabetes. It basically turns back the metabolic abnormalities that occur.

Having said that, blood sugars are elevated in individuals with type 2 diabetes because of a second malfunction that occurs.

We all normally release small amounts of sugar that's stored in our liver at night. The key phrase was small amounts of sugar. The reason that this occurs is we don't eat at night. This mechanism protects us from becoming hypoglycemic (low blood sugars) while we sleep. Individuals with type 2 diabetes have an exaggeration of this response. They flood their system at night with high blood sugars.

"We still can't pinpoint type 2 diabetes to simply diet or simply genetics or simply weight. It's much more complicated."

MEMBER QUESTION:
Do other illnesses or physical problems cause higher readings?

NAZARIO:
There are lots of reasons for high sugars to occur. Stress causes the release of many hormones in the body. Many of those hormones are commonly called the fight-or-flight response. These hormones prepare the body for several different types of attack:

• Illness
• Injury
• Surgery
• Even starvation

Sugar is an important source of energy for the body. It's the primary source of energy. When the body is under stress your body still functions and still requires a source of energy. These hormones kick in to continuously provide a source of energy and prevent the body from dropping its blood sugar. This can occur in any person.

I have seen very well-controlled diabetics whose sugar suddenly is out of control, even though they do everything right: They exercise, eat right, check their sugars -- and yet suddenly their sugars are spiking or erratic. Well then it's time for detective work. I'll:

• Check urine
• Check for infections on the skin
• Swab their throats
• Listen to their lungs
• Ask for subtle symptoms that might signal the start of an infection somewhere

It's a typical scenario we'll see in clinical practice.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician.