Ask an expert about diabetes 

Diabetes is a chronic disease that affects around 2.2 million people in the UK. We are hosting a web chat with consultant endocrinologist, Dr Sarita Naik. Dr Naik specialises in treating patients with diabetes at University College Hospital where she also leads the antenatal service. Her particular interests are type 1 diabetes and insulin pump therapy.

Dr Naik answered questions from the public on a variety of diabetes related topics. You can read the transcript of the web chat below.

12:35 UCLH: 
Good afternoon and welcome to our web chat. We will begin at 14:00 (2pm), but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 14:00 (2pm)

Dr Sarita Naik will be joining us to take your questions on diabetes and will try to answer as many questions as possible within the hour long web chat.
1:57 Dr Sarita Naik: 
Good afternoon everybody, my name is Dr Sarita Naik. I'm a consultant endocrinologist here at UCLH and I specialise in diabetes. I'm here and ready to take your questions.
1:57 [Comment From Zoe: ] 
My mum has type 1 diabetes and an underactive thyroid. She also had Graves Disease when she was young (treated with surgery hence the underactive thyroid now). I also have an underactive thyroid and had Graves Disease prior to having children (only treated with medicine). How much should I worry about getting type 1 diabetes and is there anything I can do to prevent it or should do to be monitored?
1:58 Dr Sarita Naik: 
Hi Zoe. Thanks for your question. You do have a higher risk for developing type 1 diabetes when you have an immediate family member with type 1. However the risk is slightly lower if you have a mother with diabetes than if you have a father with diabetes. Your risk for developing diabetes may be anywhere between 1 in 25 people and 1 in 100 depending on the age of your mum when you were born. At the moment we do not have any good treatments for preventing type 1 diabetes. But it is good to be aware of the signs which are feeling thirsty, passing more urine than normal, weight loss and fatigue. If you have any symptoms you should see your GP as soon as possible.
1:59 [Comment From Donna Sarjant: ] 
My latest HbA1c was 45 (127mmols when diagnosed) but my daily readings still remain on the high side, waking between 8 - 12 and anywhere between 6 - 15 during the day. Should this be investigated? My gp has classed me as being MODY type 5 but this has never been confirmed by testing and Ive never seen any type of specialist.
2:00 Dr Sarita Naik: 
Hi Donna. Thanks for this. Well done on improving your HbA1c. It sounds like you still have some fluctuations with your blood glucose (BG) levels. The HbA1c gives an overall average of your BG levels over a period of about 2 months. Sometimes the HbA1c does not always reflect the changes we see in BG levels. I think it would be worth going back to see your GP to discuss this and review your treatment. Occasionally we do see a discrepancy between your readings and the HbA1c - there are a number of different reasons for this and a diabetes specialist would be able to discuss this with you in more detail. MODY (maturity diabetes of the young) is a specific type of diabetes associated with one genetic change and you will often have a strong family history of diabetes. Type 5 is quite specific and can be associated with kidney problems as well. You would need a blood test to diagnose this and it would be worth discussing with a specialist first.
2:01 [Comment From Becky: ] 
What is the advantage of using an insulin pump over multiple daily injections for type 1 diabetes? Does it improve HbA1c?
2:03 Dr Sarita Naik: 
Hello Becky. Thanks for asking about this. Yes insulin pumps can be useful as they deliver insulin in a different way to injections and your background insulin is replaced by a steady drip of short-acting insulin. Pump treatment can certainly help people to improve their HbA1c although it doesn’t work in everyone. You may benefit from a pump particularly if you have problematic hypos or if it is difficult to bring your HbA1c below 8.5% (69 mmols). It is always worth discussing this with your diabetes specialist team to see whether a trial of pump therapy can help you.
2:06 [Comment From Govind: ] 
When is the best time to take metformin or glicazide? before of after food? together or separately?
2:06 Dr Sarita Naik: 
Hi Govind – yes it can be very confusing knowing when to take your medication. Gliclazide should be taken before you eat and metformin should be during or after the meal to limit some of the side-effects.
2:11 [Comment From Saleem Samad: ] 
i am type 2 pre diabetic, there is no regular check at my GP surgery and I have purchased a glucose meter to monitor myself and control my diabetes. how often should I check myself and should it be before meals, in the morning or night? Is it better to do HbA1c test every 3 months?
2:12 Dr Sarita Naik: 
Hi Saleem. Thanks for the question. Pre-diabetes means that you have a high risk for developing type 2 diabetes in the future. You don’t generally need to do any blood glucose monitoring at this stage. We recommend that you have an HbA1c on a yearly basis to see if anything has changed. The main thing to focus on is lifestyle. If you have a healthy balanced diet, exercise regularly and lose weight you can significantly reduce the risk of developing diabetes in the future.
2:17 [Comment From Kev: ] 
Hi there , can you let me know why some NHS organisations fund a constant blood glucose monitor that talks to your pump and others do not? I unfortunately get well looked after by one that does not but feel this system would help with night time hypos etc. Thanks
2:17 Dr Sarita Naik: 
Hello Kevin – that’s a good question. Continuous glucose monitoring (CGMS) can help some people improve their diabetes control and also alert you to hypos particularly when it is harder to pick these up when you are sleeping. We need a lot of good studies showing the benefit before the NHS will fund it for more people throughout England and we don’t have that at the moment. Until then it is a bit of a postcode lottery. However more specialist teams are working with their local CCGs to ensure that the people who really need this can have access to it.
2:20 [Comment From Ahmed: ] 
How should I plan for my mother’s old age with type 1 diabetes?
2:21 Dr Sarita Naik: 
Hi Ahmed – thanks for this. It is an important problem. The main thing is to work with the specialist diabetes team to find the right insulin regimen which will ensure that your mother is at low risk of hypos (low blood glucose levels) and one that is not too complicated for her to manage.
2:28 [Comment From Jan: ] 
Hello Dr NaiK. I am type 1 diabetic. My pre-meal and pre-bedtime readings are generally in target. My HbA1c is 55mmols, but I am struggling to improve this due to post meal readings. What is your best advice for reducing post meal glucose spikes? I am on multiple injections.
2:28 Dr Sarita Naik: 
Hi Jan - it sounds like you are doing really well to keep your HbA1c around 55mmols. However you are right that post meal spikes are a problem for many people taking mealtime insulin. One of the problems is the timing of the injection. Although the short-acting insulins (like novorapid or Humalog) work reasonably quickly, they don’t always work as quickly as we think. They start to work after 10 minutes but the main peak of action is around 90 minutes and often your glucose level will have spiked by that time. We recommend that you take the insulin around 10-15 minutes before you eat (provided your blood glucose level is high enough) but also having more low glycaemic index (GI) carbs can also help. Low GI carbs are absorbed more slowly and can help to reduce the post-prandial spike.
2:30 [Comment From John: ] 
I'm type 2. Have come across diabetic ice cream. Is it all right to est it?
2:31 Dr Sarita Naik: 
Hi John – we don’t generally recommend diabetic foods as they have replaced the sugar with sorbitol. Sorbitol is a laxative and doesn’t taste as good as the real thing! Regular ice-cream and chocolate etc is ok as long as it is in moderation and more of a treat.
2:32 [Comment From Bhavna: ] 
Are there any tell tale signs that you may have diabetes apart from having a blood test done? is it likely that I will get it if my mum has it?
2:35 Dr Sarita Naik: 
Hello Bhavna – thanks for your question today. Does your mother have type 2 diabetes? If that is the case you will have a higher risk of getting type 2 diabetes but this will depend on your age and weight. Sometimes you do not have any symptoms early on and it is best to have a blood test with your GP called an HbA1c. However it is also sensible to watch out for the symptoms which could be increased thirst/passing more urine than usual/weight loss or fatigue.
2:42 [Comment From Guest: ] 
What is the latest thinking around links between T1 and having autoimmune diseases. What research is going on in this area?
2:42 Dr Sarita Naik: 
Hello - type 1 diabetes is linked to other autoimmune conditions such as thyroid problems and coeliac disease. There is ongoing research particularly in Cardiff and Cambridge looking at treatments that can alter the immune response in the body so that some of the pancreatic function can be reserved. But it is likely to be a few more years before we find a useful treatment that we can use in clinical practice.
2:50 [Comment From Brian: ] 
Could type 1 diabetes be a contributory factor of Plantar Fasciitis?
2:58 Dr Sarita Naik: 
Hi Brian – the risk factors associated with plantar fasciitis are being overweight, spending a lot of time on your feet (with work or hobbies) and mechanical factors such as being flat-footed. It is worth seeing a podiatrist to discuss footwear and supports that may help. Type 1 diabetes is generally associated with other musculoskeletal conditions.
3:00 [Comment From Brian: ] 
Are you aware of any literature/websites that provide advice to help the mental side of managing T1?
3:00 Dr Sarita Naik: 
Hi Brian – I’m glad you asked this question. I think the mental side of managing type 1 diabetes is often neglected and we know that anxiety and depression is often associated with diabetes. Sometimes getting support from your peers is helpful – take a look at this website and you should find some useful tips. Diabetes UK will also have some useful ideas about getting support. Some specialist units will also have a diabetes psychologist which many people find helpful.
3:04 [Comment From Vim: ] 
Can specific diet eg cutting out carbohydrates help incontrolling diabetes?
3:04 Dr Sarita Naik: 
Hi Vim – thanks for this. Yes carbohydrates can are the main source of glucose in food. Many people find that reducing carbohydrates is a useful way of managing diabetes or improving control. But we generally don’t recommend cutting out carbohydrates completely. Sometimes low glycaemic index carbs (which are absorbed more slowly) are also useful.
3:06 [Comment From Maggie: ] 
My son had Guillian Bare syndrome. Does having had an auto immune condition once before mean he is likely to have another one like diabetes?
3:06 Dr Sarita Naik: 
Hi Maggie – I hope your son made a good recovery. Guillan-Barre is not usually associated with type 1 diabetes. Type 1 is usually associated with other autoimmune conditions such as coeliac disease, overactive or underactive thyroid and Addisons disease.
3:09 Dr Sarita Naik: 
Thanks for all your questions today. It was good to chat! Sorry we couldn't answer all the questions today - Diabetes UK is always a good resource.
4:18 UCLH: 
That concludes the web chat! Thank you for all of your questions and apologies to those whose questions we were not able to answer today.

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