Web Chat on Diabetes with Dr. Abbas Kitabchi, Department of Medicine, UT Medical Group, Inc. (The following is an edited transcript of questions and answers from a web chat held on Wednesday, March 26, 2003 on WREG, News Channel 3)

Moderator: Welcome to this week's chat.

Dr. Kitabchi: Hello, I am Dr. Abbas Kitabchi, UT Medical Group endocrinologist and professor at the University of Tennessee Health Science Center. Today our topic is diabetes. Type 2 diabetes, which is adult onset diabetes, is reaching an epidemic proportion--about 6% of the population has type 2 diabetes. Diabetes is a lifestyle disease. In other words, it is contributed to by hereditary factors, lack of exercise, sedentary lifestyle and eating inappropriate diet.

What's worse is that children are now developing type 2 diabetes as a result of less exercise at school, more TV and computer time, and poor diet.

I welcome your questions on diabetes today.

Q: Yes, My dad (He's in his mid 50's) just got diagnosed with diabetes a few months ago. He is over weight and I think they said that was one of the causes. If he loses weight and starts to get in shape can that cure his diabetes? Is there a cure?

Dr. Kitabchi: Yes, it is possible for a person with his type of diabetes to lose weight and require no medication. He will not lose his diabetes, but he will not have the signs and symptoms if he stays fit.

Thanks! I'll make him go to the gym with me then.

Q: My question is about whether the tendency to develop diabetes is inherited. My grandfather was diabetic & died of complications from it in his early 60’s. Years ago, my father said that he was told that in each following generation the likelihood of developing diabetes diminished & if it did appear it would be later in life and less severe. I’m curious if this information is correct - it has been at least 30 years since he told me this.

Dr. Kitabchi: African-Americans and native Americans have a greater incidence of diabetes. Ethnicity, obesity, sedentary lifestyle, and family history and diabetes during pregnancy all increase your chances of having diabetes. Women whose newborn baby weighed 9 pounds or greater at birth have a greater chance for developing the disease.

The majority of Caucasian patients develop diabetes after the age of 50; native Americans and African-Americans may develop it earlier. Diabetes is hereditary. In other words, the chance of an identical twin having diabetes is about 80 percent. When did your grandfather develop the diabetes? do you know if your grandfather had type 1 or 2 diabetes? What age did he develop the disease? Did your father also have the disease?

Response: I'm not really sure - I don't believe it was in childhood but a little later, maybe in his 20's or 30's. This would have been many years ago as he died in the 1950s. I know that the diabetes was severe in his later years but he died when I was a small child so my memories are fuzzy. My dad died in his late 50's but not of diabetes. He never showed any signs of it nor has anyone else in my immediate family.

Dr. Kitabchi: Diabetics usually die of cardiovascular disease. Type 1 is not hereditary, and that's probably what your grandfather had. Usually it gets very severe and requires insulin for life.

Q: I'm really noticed my dad is real bad about eating high fat foods too. You know, fries, steaks, burgers etc. is there anything I need to watch out for? What are the best foods I should encourage him to eat to help with his condition?

Dr. Kitabchi: Encourage him to eat natural food, low-sugar and no saturated fat.

Q: So stay away from red meet more or less?

Dr. Kitabchi: A healthy diet low in saturated fat (red meat is just one example) and low in sugar is best.

Response: OK, I think you got me on the right path. Thank you much.

Q: I am a 55-year old that was diagnosed with type II diabetics in September of last year. Recently I have noticed about 4 or 5 blisters on the side and bottom of my right foot. I have to wear a certain shoe for my work, could this foot wear be the cause of this blistering and how serious a problem could this blistering be as it relates to my condition?

Dr. Kitabchi: Yes. diabetics usually have a hidden insensitivity to pain, called neuropathy. Therefore it's quite possible that you've been wearing tight shoes without feeling the pain. It is therefore very important to see a podiatrist (foot doctor) as well as a physician to evaluate the condition.

Q: I have type 2 diabetes and can't seem to get blood sugar under 200; I think it's diet. Is there a diet or diet program you could recommend?

Dr. Kitabchi: Again, exercise and diet are the first lines of defense; food that is low in saturated fat and low in free sugar, low in white rice and mashed potatoes is good. Wheat bread, lentils, beans, and 3 veggies a day with fresh fruit are good. Also good are nuts and polyunsaturated oil like canola oil and olive oil.

Response: I believe it probably was type 1 and thanks for the help.

Q: My husband is a type 2 diabetic. I have trouble with portion sizes for him when it comes to pasta or rice etc. How do you know what is a healthy portion. This is his biggest challenge; he likes to eat.

Dr. Kitabchi: First of all, pasta and rice are not healthy food for diabetics. If they eat it, it has to be less than one cup. I suggest that instead of those foods you serve him fish and chicken with green vegetables and beans, such as lentils or chickpeas.

Q: I have heard about an insulin patch, what do you think about it?

Dr. Kitabchi: The insulin patch is not yet available. It is in the early stages of development and will be quite a while before we can suggest its use.

Q: My fiancé has diabetes and I have several questions. First I was curious will she always need to have insulin injections? Also we've discussed having children and I really want a family. Can diabetes or the insulin injections effect the child negatively? What's the risk any child we have will have diabetes?

Dr. Kitabchi: First what kind of diabetes does your fiancé have? How old was she when it was diagnosed and is there a family history of it?

Response: I'm not sure what type but she was 23 or 24 (she is 28 now) and it seems she has to have a shot every day. I don’t think there is any family history that I know of. She kind of embarrassed about it and doesn’t like to talk about it. I didn't want to make her feel pressured or uncomfortable I guess I basically I wanted to find out more about her condition before I spoke to her about it.

Dr. Kitabchi: Your fianceé is probably a type 1 diabetes. Type 1 is autoimmune and not hereditary. It shouldn't affect her ability to have children as long as her fasting blood sugar remains 70-120 (before meals) and blood sugar after meals remains between 100-140. During pregnancy, her blood sugar must be much lower. If she plans to get pregnant, it's important that her blood sugar be well controlled before conceiving or the possibility of abnormalities will be great.

Response: I know she is very healthy and watches the blood sugar like a hawk so I feel much better now. Thank you very much. I’ll check out the site you mentioned too. Thanks again

Q: My Doctor says I am insulin resistant; what does that mean? My blood sugar ranges from 35 to 210 sometimes.

Dr. Kitabchi: Insulin resistant means you probably are overweight and your body has to pump a lot of insulin to keep your blood sugar controlled. One way to approach this is to lose weight and exercise, watch your diet.

Response: I do watch my diet. I am overweight but still my blood sugar goes up and down. What is a good diet to be on ? Can I take anything that will help my blood sugar regulate?

Dr. Kitabchi: If you're interested, ,we have a research program called "Look Ahead" you can join. Call 901-448-8400. This is a weight loss program for type 2 diabetics.

Q: Is there a web site?

Dr. Kitabchi: You can go to http://www.diabetes.org for more information. UT Medical Group's website is http://www.utmedicalgroup.com.

Response: Thank You!

Q: My dad is 60 and a size 19 shirt. He is diabetic and struggles with his diet. He cuts out sugar and uses substitutes but still continues to gain little by little. Is there a diet plan that he can follow to help out. He still eats potatoes and normal "man" food. I plan on confronting him soon and want to have some ammo.

Dr. Kitabchi: Your father needs to cut out red meat, lard, butter, sugar, potatoes, and white rice. He needs to start eating wheat bread, nuts, polyunsaturated fat, get away from fried food. Most importantly, eat small portions.

Response: Easier said than done according to mom. Is the Look Ahead program something that someone from Oklahoma could get hooked up with?

Dr. Kitabchi: Yes, it is quite possible. But you may fit our criteria for the above study. I suggest you call 901-448-5803 and see if we can help.

Q: Can someone with type 2 diabetes get off medication with diet and exercise?

Dr. Kitabchi: Yes, an earlier question dealt with that. It is possible to get off medication with diet and exercise, but the diabetes itself doesn't disappear--the symptoms go away however while you stay fit.

Response: Thanks for the web site and all the good information

Q: Are high protein diets good for type 2 diabetics?

Dr. Kitabchi: Yes, high protein diets are good for diabetics as long as your kidney function is OK. Hi protein means high in fish, chicken, legumes, etc., not red meat.

Q: What about the Atkins diet?

Dr. Kitabchi: The Atkins diet (original) has tremendous amount of saturated fat which is bad for arteries and heart. However, a modified version which would be hi protein, low carb, and fat consisting of polyunsaturated or monounsaturated is good.

Q: I have recently been diagnosed as borderline. What is the best book I can get for diet info on all foods and diets to follow? This runs rampant in my family I need good direction.

Dr. Kitabchi: You can really benefit from diet and exercise. If you go to http://www.diabetes.org, you will find a number of resource books listed.

Q: I am willing to purchase a reference book, just thought you might know which is the best?

Dr. Kitabchi: There are so many, it's hard to know the level you would be most comfortable with. It's best to look at the ADA website referenced earlier.

Q: I think that my husband thinks by taking his medication that he can continue to eat as he pleases. So hard to get through to him that he needs to cut back on portion sizes.

Dr. Kitabchi: There are support groups throughout the area and classes as well. You might get your husband to one of those. Most of the area hospitals have one; you might call the hospital nearest you for information. Also the local American Diabetes Assn. chapter can help; call 901-682-8232.

Response: Thanks

Q: How close are we to a cure?

Dr. Kitabchi: As we are learning more about the mechanism of production of diabetes, we learn more about prevention. Now we are at the point of being almost sure we can prevent type 2, and probably in another decade can show progress toward preventing type 1.

Since most people with type 2 diabetes suffer from cardiovascular disease like high blood pressure, heart disease, etc., we are trying to prevent this by interventions of lifestyle. We have a program which is sponsored by the National Institutes of Health in 26 different centers in the country; UT is one. We will work with patients to develop proper lifestyle.

Without interfering with your medical care you are under from your physician, we work with the patient on lifestyle issues. If interested, you can call us at 901-448-8400 or 1-800-916-2606. Or you can visit http://www.lookAHEADstudy.org.

We also are looking for men who are newly discovered diabetics--African-Americans or Caucasians. Also people who are not diabetic but who are obese. We are interested in studying the metabolism of both groups. We need only 10 people in each group. You can call 901-448-5803 for more information. If you can't get through on 901-448-5803, try 901-448-2610.

Signs and symptoms of diabetes include frequent urination, fatigue, thirst, unexplained weight loss, and feeling hungry. Sometimes blurred vision. If you have these symptoms, you should see your primary care physician to be checked.

Q: Two weeks ago my doctor’s office called and stated that results of my recent blood test.

Dr. Kitabchi: What were the results of your test?

Response: They stated my blood sugar level was in the low 300's and advised to take Metformin 500mg tablets twice daily and to check it daily and to come to the office in a month and a half. My blood sugar has been running in the low 200's is this OK or should I contact the doctor’s office about making an earlier appointment

Dr. Kitabchi: If you have type 2 and have children, be aware that many adolescents develop type 2 diabetes. They need to be seen by a pediatrician and can be referred to a specialist for further treatment.

Q: I have a huge problem with my type one diabetes. I have legally been said dead 23 times and I need someone’s help because, now I'm pregnant. Can you help me?

Dr. Kitabchi: how old are you?

Q: I’ll be 20 in May. I got diabetes from a four wheel accident.

Dr. Kitabchi: You cannot get diabetes from an accident. If you had to visit a doctor after the accident, perhaps that's when it was first diagnosed.

Q: My pancreas was crushed by the 4- wheeler. Do you know of anyone doing pancreas transplants?

Dr. Kitabchi: call your endocrinologist for specific guidance on your condition. Yes, we are doing pancreas transplants. You can call 901-448-5924 for more information.

Q: Everybody I go see after a few visits say I'm too difficult of a case a will have to find some one else.

Dr. Kitabchi: You can call 901-448-5228 and we'll try to help.

Response: Thank you, I'll call now

Q: Is it possible to take a natural hormone or something after age 60?

Dr. Kitabchi: The majority of people who have type 2 diabetes can probably do a lifestyle intervention to control diabetes.

Dr. Abbas Kitabchi: Thank you for all your questions today. I have to return to my office. I've enjoyed the conversation. Good-bye.

This is Channel 3. Thanks for logging onto our chat today. Dr. Kitabchi has to leave now, but you can access the web sites he mentioned or call the numbers above for more information. Be sure to tune in next week for our Wednesday chat.

We hope today's chat was helpful. You can also visit the UT Medical Group web site at www.utmedicalgroup.com .

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