Also Part 3: hhttp://www.sugarstats.com/2008/04/09/interview-with-dr-anita-ramsetty-endocrinologist-part3/

During the month of March SugarStats is posting segments from a series of interviews between Nedrra Lanakila, parent of a Type 1 Diabetic and partner of SugarStats, and Dr. Anita Ramsetty of EndocrineHelp.com, an online medical practice specializing in endocrinology and diabetes.

Nedrra Lanakila (N):As the endocrinologist, how often would you like the diabetic to test or put their stats into their SugarStats management and tracking service? How many times a day or a week would you like to see those stats entered?

Dr. Anita Ramsetty (A): It sort of depends on the situation that the patient finds themselves in. This [blood glucose self testing] is what I would ask them to do in person as well.

Some individuals are newly starting out. The term ‘mild diabetes’ isn’t really a term, but it’s probably the best way I can describe it. They don’t have huge fluctuations in their glucoses during the day, they still have a decent amount of their own insulin production, they’re not on a lot of medication and numbers don’t bounce around too much.

For those individuals I generally ask them to check their blood sugars maybe twice a day, ideally three times a day. If they can put it in daily I think is a great habit. Then it becomes like brushing your teeth: you’ve got your data in and you’re good to go for the next day. Without getting into individual cases, I think a daily habit of putting them into SugarStats would be ideal so you never lose track of what’s going on and you don’t have to backtrack and have four days worth of sugars to catch up on.

That being said, I think that different patients will require different levels of intensity in how often they need to document – if you really need to come down to talking about what’s ideal for each person.

There are some people who’ll have lots of glucose excursions, or they’re on pumps, or they’re patients who are pregnant or they require a lot of checking for other reasons. Diets are changing, hormones are changing, different patterns in life may be changing.

As an example, I’ve found that patients who work at night tend to have very odd schedules and they also can have wide glucose excursions between the weekdays and the weekends when they don’t work at night.

So I think there’s some situations that putting in glucoses every day, or at least every other day is almost a must because you have so many things to catch up on, so much data to document that it could become overwhelming. In an ideal situation I would encourage people to view it just like a brushing your teeth habit: just do it daily and keep right on track.

N: As a doctor who is analyzing this data, how important would it be to you to see the diabetic’s input: their physical activity, food and resting times which we also offer at SugarStats.com, aside from just their blood glucose monitoring and the level of insulin they are receiving?

A: It’s very, very important. Those are questions that we would normally ask in person, and that I would ask over the phone as well.

If it’s already put into the system, that helps me out tremendously in being able to see what their patterns are. And, for the patient to be able to see what their patterns are!

If you have three days where you can see, “Oh my blood sugar dropped off after that morning walk.” You’ll see it already and I might not have to point it out to you. So it’s very important to put in the daily activity patterns. Particularly when there have been ‘events’, or they have very high blood sugars or low blood sugars.

And, dietary patterns: People tend to eat differently on weekends – they tend to eat differently on days off. That’s also very, very important.

N: What about very active diabetics? Athletes or people who are still in school and are active in some sort of physical or team activity?

A: I’ve found that at the very beginning of athletes starting an athletic program is where some of the difficulties tend to happen. People do respond to exercise in slightly different ways. Most individuals will have some low blood sugars after they exercise, particularly if it’s some sustained exercise.

I just had a question pop up about this on an online medical question community that I also host where someone said, ‘I had no idea what happened. I had my usual breakfast and then my blood sugar was low for three hours! And oh, by the way I had been on the exer-cycle for half an hour before I had breakfast.’ Then the mystery was solved right there.

I think for people who are just starting off on an exercise regiment who are losing weight rapidly, they need to get into the habit of checking their blood sugars definitely before they eat, and definitely before they start the exercise regiment and right after. And probably for each hour afterwards, for several hours.

There’s no telling how your body actually will respond to the exercise regiment that you’re on. Once you have that under your belt and you know what will happen, you’ll have a little system of your own where you’ll know how much extra carbohydrate to take before you engage in your exercise regiment that day. Then it becomes a little bit easier to predict and you don’t have to check it quite as frequently.

For people who are in school, particularly the college students or high school students who are very involved in other activities: they’re studying, under stress, doing activities, doing athletics, they’re up all night studying for various reasons, they too I recommend getting into the habit of checking their blood sugars at least three or four times a day.

Definitely if they have symptoms! I have too many individuals who’ve assumed a high or a low and been wrong in either direction, with sometimes serious consequences. It’s a tough habit to come by but once it gets going I think it’s a lot better.

Athletes are a very special group. I have great admiration for people who are in athletic programs who have diabetes, particularly Type 1 Diabetes which tends to be more of a challenge to control.

A few years ago we had one of the Australian Olympic Medalists who is a Type 1. I was so excited reading his information. This is a group that’s becoming more and more public as we develop better ways to help treat diabetes and better technologies to be able to keep their blood sugar steady.

But the loop still isn’t closed. It’s still not at that beautiful ‘closed loop system’ that everybody wants. We’ll get there someday, but until then we still have to check the blood sugars fairly frequently.

N: Let’s address the parents who must be very active in the care for their young diabetic children. What would you have to say to guide them?

A: Adults are my “piece of the pie” because I did adult endocrinology. I’ve spent some time in pediatric endocrinology during my training a few years ago, but in general the youngest people I see in my clinic are probably down to about age 16. When I did spend time in the pediatric clinic, it was sort of a different ballgame.

In general, avoiding harm is something you want in everybody. But in kids it’s particularly at the top of the list. And for them, harm comes in two sides of the coin: one is that you don’t want their blood sugars going too high because that clearly does damage. Not just in the long term, but in the short term they could end up getting in trouble if their blood sugars get too high, acidosis etc. Even without acidosis they could become very, very sick.

But I have also run into this problem: Very well meaning parents can be overly aggressive and have the blood sugars run too low. That can put children into a lot of trouble as well.

I think with kids, it’s a bit of a tight rope that you walk, but their sugars are usually allowed to run a little bit looser than we do for adults so that the children don’t run into low blood sugar problems. They generally are not as articulate in saying “I don’t feel well – something’s wrong.” Or, knowing what to do if they feel low, particularly if they are very young children.

It is up to the parents to take control of that and try to avoid the very low blood sugars while at the same time trying to keep them without being too high.

The parents of children who have Type 1 Diabetes are probably some of the most dedicated parents I’ve ever come across. It takes parenting, love and childcare to a whole new level that many of us just don’t understand. I think they tend to do a lot of reading, they’re extremely well educated on the subject—and they keep all their appointments!

When it comes down to it, your kids tend to be the most important aspect in your lives. I think the parents tend to do a good job even though it’s a tough situation to be in.

N: So how does SugarStats.com’s management and tracking service support your diabetic patient so that you are best able to be of service to them?

A: SugarStats.com really is a brilliant website because a lot of what’s involved with the SugarStats website is at the core of what we [medical establishment] would like to do and what I try to do in my own practice: encourage individuals to really take charge of their own health care.

Know what’s going on and take the bull by the horns, so to speak. I think, with the SugarStats site, in and of itself, it helps people do that. You provide the tools for them to put their sugars up, understand what’s going on, see what patterns might emerge and track things more easily.

That is very empowering and very educational for people to see. So, on the one side in terms of patient care, it’s a huge step for people to be so involved and, it advances what they’re doing in their own medical care.

For us, in the medical practice, it basically is all of your information gift wrapped and handed to us because it’s all tracked: we have all the numbers that we need, all the trends that we need, and it probably would cut half of the time off of the visit. It actually makes things much more streamlined for us to be able to look at the patterns and determine what needs to be done.

In addition, it takes care of part of the patient education, so I think SS is brilliant.
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Dr. Anita Ramsetty
Senior endocrinologist, SugarStats Medical Advisory Team
Medical Director, EndocrineHelp.com

To reach Dr. Ramsetty you can email her at endodocs@endocrinehelp.com or go to EndocrineHelp.com.

For more information about this blog or if you’re an expert in diabetes, have personal experiences or a story to tell about diabetes, please contact Nedrra Lanakila at nlanakila@sugarstats.com

• Welcoming our Newest Endocrinologist Blogger: Dr. Anita Ramsetty
• Interview with Dr. Anita Ramsetty, Endocrinologist - Part3
• Interview with Dr. Anita Ramsetty, Endocrinologist - Part1
• TechAddress Interviews SugarStats
• “Sweet” conversations
• SugarStats.com Interview on Episode 34 of the DiabetesPowerShow.com Podcast

This entry was posted on Friday, March 14th, 2008 at 4:41 pm and is filed under Diabetes Tips, Health Interview, Treatment.
Tags: Diabetes Blog, Diabetes Doctor, Diabetes Interview, Diabetes Specialist, Diabetic Interview, Diabetic Tips, EndocrineHelp.com, Endocrinologist, Part 2 Interview.
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