Sonia Gaztambide
President of the Spanish Diabetes Society, has responded to readers on the occasion of the World Day of this disease held on November 14.

They are beneficial as a complement in the control of basal glycemia, the injet of L-carnitine, ca, mg and zn?, How is the flex-pee less effective at night or in the morning?
10:05 11/12/2012
There is no scientific evidence that they influence glucose control.
The effectiveness of the levemir does not depend on the moment in which it is injected.It must be injected according to glycemic control to try to neutralize blood glucose levels.

What is the glycemic range as a goal in type 1 diabetes?
10:07 11/12/2012
It depends on the different Cosenses, Americans, Canadian Europeans, etc ... In general terms in pre-private situation, around 100 mg/dl is advised (it can reach up to 120 mg/dl) and in a postprandial situation the ideal would not be to overcome the140 mg/dl.In any case, these figures must always be adjusted individually, depending on whether there are chronic complications or other limitations that make the control objectives higher.

82 -year -old woman for 20 years has controlled her glucose with various oral antidiabetics, for 6 months she has taken a tablet table plus 12 insulin glargine lantus solostar, not low from 8 glycosilada, however the two glucose shots, tomorrowAnd night, they are between 90 and 120, I could indicate what is it because it does not lower the glycosilada of 8 mg/dl?Thanks Dra.
10:11 11/12/2012
First of all, telling him that a glycosylated hemogosilada of 8% can be sufficient control for an 82 -year -old person.But it has fallen more due to other times of the day, the figures have been higher.To know it, postprandial controls should be done to try to adjust the treatment more.But I insist for your age this hemoglobin is enough.

Hello good morning. A pleasure in greeting him. I could tell me what test, type of analysis or how many analysis must be done when the sugar is fluctuating in the red zone, to know safely if you are diabetic?
10:15 11/12/2012
The diagnosis of diabetes is done when there are symptoms (urinating a lot, drinking a lot, eating a lot and despite losing weight, etc.) and there is a blood glucose at any time of the day equal to or greater than 200 mg/dl.Another way is when at least twice) a glycemia equal to or greater than 126 mg/dl in a fasting situation.Also when confirmed with an oral overload with 75 g of glucose that at 120 minutes the blood glucose is greater than 200 mg/dl.Other situations such as when fasting glycemia is between 110-125 mg/dl or when at 2 hours of an oral glucose overload it is between 140 and 200 mg/dl, they are situations (altered basal blood glucose or poor tolerance to glucose)They have a greater risk of making diabetes in the future but are not diabetes.

Hello Sonia, I am Pedro Gustavo Medical Surgeon and at the same time medical advisor for a Paraguay Pharmaindustria, he consults the following, currently the massive use of metformin in high doses of 2000 mg has been greatly enhanced up to 2 or 3 shots with the main meals, and I observe that several Pharmaindustrias have launched the Metformin LP, my consultation is as follows: it is necessary that this antidiabetic results from being of programmed action, when by its mechanism of action the metformin meets the optimal conditions to exert an associated hypoglycemic effector not with sulfonylureas or insulins
10:19 11/12/2012
I do not know if I have understood the question of scheduled action, which I suppose you refer toprolonged release.If so, I confess that I have no news of this new pharmaceutical preparation.In any case, metformin is an excellent drug as hypoglycemic, unless tolerance is not good in some patients.The intention of a prolonged release drug is a unique shot and facilitating adhesion to the treatment that you know as the greater the number of times a day that a patient should take a drug the risk of being forgotten is greater.In this line I would see with good eyes a drug of a unique shot up.

For when inhaled insulin?In 2013?
10:23 11/12/2012
There is no close forecast as far as I know.

What opinion does you have about surgery for the treatment of type 2 diabetes
10:26 11/12/2012
It can be and is a therapeutic weapon in patients with obesity.It would not be a universal treatment and we do not know the long -term effects.What is universal is the realization of a healthy diet and walk at least, at a good step, 30 minutes every day, trying to integrate that exercise in our daily lives (lowering a stop before bus or subway to force us to walk 10 more minutes more minuteson the first leg or just around work, etc ...).

I am convinced that the work he does as president is necessary and fundamental, the work carried out by Adiaco the Association of Diabetes de Antequera and its region has contributed to the improvement of the quality of life of diabetic@s that we reside here, we hear many advances inDiabetes, but thinks that it will take a long time or more or less how much to become a reality and if you really are in the work by those who are responsible, which will lead to great hope to all of us who suffer from this disease
10:31 11/12/2012
Since the discovery of insulin in 1921 there have been many advances.Now, if by advances, we understand the cure of diabetes, it is clear that it has not been reached.However, we have many insulins and oral drugs that help improve control;Insulin administration systems have improved a lot (I remember the glass syringes and the highest caliber and length needles, which had to be boiled and saved in alcohol ...);glucose measurement systems (pills to see urine glucose, reactive strips that had to be washed in a water jet ...), ... all this to make a little easier the person with diabetes.

Good afternoon doctor, is stevia better than saccharin to sweeten?Cinnamon has some true effect thank you very much
10:36 11/12/2012
They are non -caloric sweeteners, so it doesn't matter;It depends on the taste of the consumer.As far as cinnamon is not a diabetes treatment.

What can replace the insulin NPH 12-0-4, deque an old man of 86 years for 12 by DM 2, has a decrease in FG, postprandial hyperglycems and low blood glucose figures on an empty stomach, with good quality of life?
10:40 11/12/2012
Obviously the treatment does not go too well especially if it has low blood glucose figures that in an 86 -year -old person should be avoided.I would need to reduce insulin dose or delete suppressing the dose of the night in my opinion and assess whether you really need insulin.Anyway, that should consult with your doctor.

Do you think that insulin administration guidelines protocols in diabetes control can improve even more or on the contrary, we have reached the top, how much we can do with a scheduled insulinization system?
10:43 11/11/2012
I do not know what is to come but it has gone from the administration of three doses of insulin to a dose of insulin and again at 3-4-5 doses of different insulins in an attempt to adapt to the improvement of the profilepatient glucemic.Even to insulin adsinsitration with a continuous infusor andBolus administration depending on meals.Also in capillary glucose measurement devices that assess trends, in systems that measure glucose in the tissue and allow us to see their result in real time, ....

Postprandial glycemia can be used at 2 hours as DX of diabetes when using the Vildagliptin for type2 diab can be used as a starting drug
10:47 11/12/2012
An oral glucose overload with 75 g can be used or there are equivalent "meals" that are used in clinical trials.The diagnosis should always be confirmed.That is, it is not worth with a single time.
In the last consensus in the treatmation of diabetes, American and European, any drug is accepted according to the patient's situation.Indeed, it can be valued.

Thirst recommends prescribing glycemic self -analysis in those cases where there is a health professional formed in diabetes, a patient formed and a plan accepted by the 2 to include it in treatment;Doesn't you think that this extreme positioning, in times of crisis and cuts, can suppose decisions about cuts that politicians do (especially in type 2 patients)?
10:51 11/12/2012
It does not seem to me an extreme positioning, it is minimal.The glucose measurement aims to modify treatment to improve control.For this, it is essential that the patient knows what he has to do with the result and for this he must have been educated by his doctor or nurse and therefore has had an agreement.

Thirst has opened towards other groups such as nursing, psychology, nutrition ... Does the diabetes units of Spanish hospitals follow this path? Is there a significant advance or are they still anchored in scarcely pluridisciplinary teams?
10:53 11/12/2012
In this country with 17 autonomies the variations are many.The minimum team is a doctor and nurse and it is desirable to join other groups but the reality is that we are quite far from the ideal but we must continue working for it.

Today there are 4 autonomies in which patients perform pharmaceutical co -payment for reactive strips: (Galicia, Canarias, Valencia and Andalusia).From € 0.45 to € 2.26, patients have to pay that rate.The rest of the patients pay nothing.This inequality, in the long run, does not believe that it affects the control of diabetes?What positioning is thirst in this issue of clear inequality in the SNS?
11:00 12/11/2012
It is clear that by being transferred health every autonomy does what it wants and this violates equity.Thirst is against this.

Metformin can be used in diabetic pregnant women instead of insulin
11:01 11/12/2012
There are several studies with positive results.The Group of Diabetes and pregnancy of thirst today is not using it but it is possible that in the future in some specific groups it decides to use it.

what are glycemia values ​​to start insulin in diabetic pregnant women and which are considered normal values
11:03 11/12/2012
The control glycemia values ​​are around 95-100 mg/dl on an empty stomach and at the time 140 mg/dl and at 2 hours 120 mg/dl.If with an adequate diet and exercise these objectives are not achieved, it would be necessary to start treatment with insulin.

Consider that the creation of diabetic foot units should be part of a national health plan, such as children's vaccination campaigns or prevention campaigns of Mama?
11:07 11/12/2012
In many places it is possible that there are diabetic foot units even if it is not "formal".What is really important is that the diabetic foot prevents and for this it is important that the person with diabetes knows from the first moment its importance.When an ulcer appears there should be a route for adequate attention.isImportant the connection between the primary/specialized care doctor and a reference in vascular surgery, rehabilitation, ... so that we all do the same things.The campaign should be done about foot care.

Is our health system prepared and innovated to apply the advances and scientific advances that can be discovered both in the diagnosis and in the treatment of DM1?
11:09 11/12/2012
At this time the diagnosis of Dmtipo 1 is made according to clinical criteria and the measurement of different types of autoantibodies in front of different parts of the pancreas and with HLA and these determinations are contemplated in the SNS

Is stem cell transplantation possible in type 1, when can there be a forecast?
11:11 11/12/2012
At this time, real transplant can be done with donor pancreas, or with the cells obtained from probably more than one pancreas.The transplant with stem cells is not performed and it is very difficult to establish a time.He goes step by step and I feel unable to make a prediction

Farewell
11:13 11/12/2012
I hope I have been useful with my answers.I encourage everyone to demand in their environment the education in diabetes that is the cornerstone of the control.Until always.
Sonia Gaztambide