Questions and Answers - General Information


Q: In the past three days my husband’s breath has smelled strongly acidic. Is this related to his diabetes?
A: If his glucose levels have been elevated, he could be breaking down fat for fuel at a rapid rate.  This produces ketones, which can produce fruity or acidic breath.  You can purchased ketone strips at the pharmacy to test urine for the presence of ketones. If this persists and if his glucose stays elevated in spite of any efforts on his part for correction, have him see his physician.  

Q: I read that people with diabetes should not use heating pads. Why not?
A: This recommendation is more of a caution for those who have neuropathy and may not feel if the pad gets too hot and could be burned as a result.

Q: Do I need to fast before having an A1C test?
A:  No, fasting is not required for an A1C because the test measures your average blood glucose levels over the past three months.

Q: What is ketoacidosis and what are the symptoms?
A: Ketoacidosis is the build-up of ketones (a by-product of rapid fat breakdown in the body) and can be life-threatening if left untreated.  This would generally not occur unless glucose levels were very elevated over a longer period where the cells, needing fuel, rapidly break down fat to help keep you alive.  At that point, one may be in a diabetic coma.  In pregnancy, it is important for good control to prevent ketoacidosis so ketone bodies do not form, as they can cross the placenta and be toxic to the fetus.  Symptoms may include fruity smelling breath, high blood sugar, excessive thirst, frequent urination, nausea and vomiting.  If concerned, you can buy strips at the pharmacy to test urine for the presence of ketones.

Q: Why do I need to fast for 10 hours before a fasting glucose blood test?
A: This time frame gives your body a chance to digest all food in your system to more readily determine what your true fasting blood sugar is. Carbs, proteins and fats all digest at a different rate and a larger meal will take longer to digest. A fasting blood sugar of 126 repeated twice is a diagnosis of diabetes.

Q: Does drinking black coffee impact a fasting test?
A: Caffeine is a central nervous system stimulator, and may have a short term effect on blood sugars. Only water should be consumed prior to testing.

Q: How would I know if I am diabetic? What are the signs? 
A: Frequent urination, rapid weight loss, dizziness, and excessive thirst are just some of the symptoms associated with, but not exclusive to diabetes.  This is certainly truer of those on the path to type 1 diabetes.  Many others will only know by getting a blood test to see if their fasting levels are elevated. 100-125 is generally considered pre-diabetes, 126 and greater with 2 tests is a diagnosis of diabetes.  I suggest you request a fasting glucose test for starters.

Q: If I have some of the risk factors for diabetes, how often should I be tested to find out if I do have it or not? 
A: If you are not experiencing any symptoms, an annual physical should be enough. Your glucose levels should be under 100; ideally between 80-90. If you are experiencing any symptoms such as weakness, frequent urination, increased hunger or thirst, or frequent infections, then get a fasting test now.

Q: Is it possible to stop being diabetic?
A: Once you have diabetes, you will always have it, but you can manage it to the point that it appears as if you don't have it. What this means is that you can get your blood sugars under control and within normal ranges, and maintain the healthy lifestyle required to stay within range. Learn all you can at this time on how to manage diabetes and live with it. You will find, for the most part, that an active lifestyle with healthy foods in moderate amounts will allow you a "normal" quality life.

Q: My fingertips hurt from testing. Does it matter if I get my blood sample from somewhere else on my body?
A: Fingertips (on the sides of tips) offer a more reliable capillary flow and reading because changes in glucose levels are detected here more rapidly. This is especially important when treating hypoglycemia. If you wish to use an alternative site such as your forearm or thigh where the blood flow is less, make sure you are using a meter that requires a smaller blood sample. You may want to discuss this with your physician.

Q: I am new to diabetes and am having trouble sticking myself for testing my blood sugar.
A: The first step in pricking your finger is to wash your hands with soap and water when at home. Make sure your hands are warm, and have your hand pointing down so the blood can flow to the tips. Pick any finger, using another finger to support it or lay it on its side so that you can stick the side of the tip, not directly on the tip of the finger. There are many nerve endings in your tips, and this area can be very sensitive. The good news is that the meters today require very little blood. You need to either ask your pharmacist or your physician's office to help get you started. Once you are shown, then you can practice and more assured of the readings you are getting.

Q: Does obesity cause type 2 diabetes?
A: Obesity is not the cause of type 2 diabetes, but is a strong contributor if one is genetically disposed. In my many years of counseling, I have seen very few folks with a BMI over 30 - in the obese classification - that don't have elevated or elevating glucose. Increased body fat appears to interfere at the cellular level with the uptake of glucose from the bloodstream into the cell: the job of insulin. This creates a condition called insulin resistance. Unless lifestyle changes are made towards better eating habits and activity, pre-diabetes will usually blossom into diabetes.

Q:  If a 13 year old is diagnosed with diabetes, is it always type 1 and necessary to be on insulin or can it be controlled by diet? 
A:  No, the diagnosis of a child is not always type 1 diabetes. With childhood obesity so common now, we are seeing type 2 diabetes at much younger ages. Those who are truly type 1 require insulin to live. If your child is not requiring insulin at this time, it may be true that he/she may need it in the future if the pancreas is on a path to no longer being able to produce insulin. There are tests that can help determine this. Discuss this with your physician. Following a healthy lifestyle and eating whole foods is most important with or without medication.

Q: How can I help my young adult son with type 1 diabetes get a good night sleep? He has trouble falling and staying asleep. 
A: Many people have this problem and there is no one answer. The first goal would be to maintain stable glucose levels, as fluctuating levels can certainly affect good sleep. A cup of hot herbal sleep tea 1/2 before bed may help him relax and be able to fall asleep easier. Supplementing with Melatonin, a sleep hormone produced by the body, can often help. Quieting his mind is key; some people benefit by listening to relaxation tapes at night. Exercise during the day can also make for better sleep at night. The most important factor is that he wants to take steps to sleep better and overall maintain a better quality of life.

Q: I read that with type 2 diabetes, the production of insulin goes down with age. Does it ever go down to nothing? Is it possible to test how much insulin my body still produces? 
A: It is possible to have your production of insulin cease over time, but usually this is not the case for type 2 diabetes. It is even less likely if you live a healthy lifestyle for both diet and activity. You can have your insulin output measured with a C-Peptide test. If your body truly no longer makes insulin, as the case with type 1 diabetes, and you are not injecting insulin, you will die. There are those with type 2 diabetes who do require insulin to have any semblance of good levels, but can survive without insulin for some period of time, but with high levels.  

Q: While being treated for pancreatitis in the ICU for the second time, I was told that my blood sugar was 422 and that I am diabetic. I have not gained any weight, I am on a pretty strict diet and yet my sugar doesn't run under 200 for more than a day even though I am taking 75 units of Lantus. My doctor has told me to hold off on increasing the units until our next visit. I have not been diagnosed with type 1 or 2! Are there any other tests that could help diagnose the type of diabetes I have?
A:  If you were truly type 1, you would require insulin for survival. At the moment, you appear to be type 2, requiring insulin to help lower your numbers. Each bout of pancreatitis may be affecting the insulin producing cells a bit more, resulting in a reduced ability of your body to produce sufficient insulin to keep your levels in a better range. At this time, your physician is probably trying to see if you stabilize at 200 or less and perhaps begin to lower on your own as your cells possibly start producing more insulin again. The C peptide test can give an indication of how much insulin your cells are producing. It does appear you need further discussions of this with your physician.

Q: My boyfriend is diabetic. He is a bit of a rebel and doesn’t test his levels. At least once a month he turns into what I call a "zombie". He starts to get sweaty/clammy, he tends to be forgetful, he repeats himself, and this last time he was totally out of his right mind and became violent. When I confronted him about it afterwards, he had no recollection of doing it. How do I help him? 
A: Erratic glucose levels can mimic bipolar behavior and potentially be harmful to you both.  He is obviously experiencing high/low glucose level swings.  He does need to take this seriously, see his physician assuming he has one, and follow with a diabetes eating/lifestyle plan.  He should be testing his levels.  He may need medication to help get his levels under control.  Being a rebel is fine about some things, but not about a condition that can be life threatening if left unmanaged.  If he refuses to do anything to better control himself, you may have to take a tough love stand for your own well-being and possible protection.

Q:  If a 13 year old is diagnosed with diabetes, is it always type 1 and necessary to be on insulin or can it be controlled by diet? 
A:  No, the diagnosis is not always type 1 diabetes at a young age, as was typically more so in past years. With childhood obesity so common now, we are seeing type 2 diabetes at much younger ages. Those who are truly type 1 require insulin to live. If your child is not requiring insulin at this time, it may be true that he/she may need it in the future if the pancreas is on a path to no longer being able to produce insulin. There are tests that can help determine this. Discuss this with your physician. Following a healthy lifestyle and eating whole foods is most important with or without medication.

Q:  Does having lows blood sugar readings of 60 or 70 affect my A1C level? 
A:  A1C is a 1.5 to three month average of your glucose levels. It does not specify highs vs. lows. The goal of good control is not to have erratic swings in sugars, as this creates wear and tear on the neuropathic system. Being in the 70's is very normal (symptom free) for many people and better overall than levels over 100. Just continue to follow a very healthy lifestyle with attention to eating unrefined foods as much as possible, as blood sugars are always subject to change over the life cycle.

Q: Can I drink water during the two hour period before testing my blood sugar?
A:  Of course! Water is a major nutrient, as we are composed of at least 60% water. It is calorie free, so it will not raise your blood sugar. It is most important that you stay well hydrated, as elevated glucose can be most dehydrating, leading to headaches and dizziness. The textbook recommendation is to drink half your body weight in ounces of water throughout the day.

Q: Can a diabetic use a hot tub? 
A:  This has been a controversial issue for some time, but should really be treated on an individual basis. The first consideration is that the hot tub should be very clean, which would probably rule out many commercial tubs that accommodate lots of people in a day. Don't go in with any open sores, cuts, etc. Poor circulation in hands/feet may also be cause for avoidance if one has reduced ability to sense high heat. If your physician doesn't see an obstacle, start with a few minutes, working up to a maximum of about ten. Be mindful of chlorine which may be irritating.

Q: Do people with diabetes need to use special toothpaste? 
A:  Generally speaking, no, because you are not ingesting toothpaste. However, you do want to pay attention to the ingredients in things like cough syrup and other medicaitons over the counter that may have sugar in them. Many products have sugar free versions. Always ask your pharmacist when you aren't clear about the best product to buy for diabetes.

Q: It has been just a few weeks since my diagnosis of type 2 Diabetes and I am a bit freaked out because I've yet to see anybody mention their A1c being anywhere in the same ball park as mine, which is 11. Am I in huge trouble or what? 
A:  That is very high and needs to come down somewhat gradually so as not to experience feelings of low blood sugars. Taking charge of your food and lifestyle is the path to stay on. Insulin at this time may help to detoxify your beta cells, giving your pancreas a rest while you move into a more normal range. Be patient with yourself, but diligent. You didn't develop diabetes over night; you may have been pre-diabetic for some time. The closer you get to more normal weight, the better your chances for better control with less medication.

Q: Why are people with diabetes supposed to be so careful about treating cuts and other injuries?
A:  A person who has poorly controlled diabetes may find it takes longer to stop the bleeding or to heal the cut. This the same caution for any wound, especially on the feet, which is why people with diabetes are encouraged to check feet daily for even a small splinter. If you maintain good levels that have been established with your physician, then healing times should be similar to anyone else who is basically healthy.

Q: Can diabetes cause a person's feet to have a bad odor? 
A:  Diabetes left unchecked may be involved in a foot infection, which can certainly cause an odor. Any build up of bacteria or fungus can do the same. Be sure your feet are thoroughly washed with soap before bed, inspect your feet for any cuts, splinters, etc, and when wearing socks, they should be cotton. A yearly visit to a podiatrist is recommended for persons with diabetes. I suggest you at least pose this question to your physician.

Q: Can the low blood sugar that I experience from time to time be a sign that I could be heading down the road to diabetes? 
A: Right now, it is most important that you learn to eat correctly for hypoglycemia (i.e. low blood sugar). This would mean to eat a small meal or snack every few hours. Food should be unrefined: no sugary starchy white stuff. Instead, eat lots of veggies, legumes and fish if you eat it. A handful of dry roasted nuts can curb a low blood sugar episode. What's needed are small doses of protein. Left unchecked over time, it is possible for hypoglycemia to advance into hyperglycemia, and then on to diabetes.

Q: Why do I get extremely tired and fall asleep after eating a meal? This is true when I eat any food with greater simple sugars, desserts especially. I am sleepy within an hour of eating.
A: You are most likely "carb sensitive", which means that those refined carbohydrates will quickly turn into sugar in your body, and release a good dose of serotonin to the brain. This is a hormone that has a very calming effect and, for someone like yourself, will help to put you to sleep! I would suggest you now experiment with eating only complex carbs and shifting more into veggies, fish, and legumes for awhile to see if that helps you become more alert. This will also help your blood sugar numbers come down.

Q: What is "Brittle Diabetes"?
A: "Brittle" is a term used when one has had diabetes for a long time, and in spite of a solid focus on maintaining a healthy lifestyle and good medication management, it becomes harder to control blood sugars. This is more often the case with insulin dependent diabetes. Some folks do better with an insulin pump in such cases.

Q: Can very low blood sugars cause depression and cause someone to act like a different person, ex. extreme anger and hostility?
A: Erratic blood sugars can cause mood swings, such as one would expect with untreated bipolar disorder. If you have ever gone for long periods without food and experienced a feeling of irritability as a result, magnify that many times for blood sugars dropping suddenly too low, or blood sugars that roller coaster day to day. I hope that this person is willing to do what is suggested to get glucoses into a more normal range.

Q: I was recently diagnosed with type 2 diabetes and now I have my first bought of cold/ bronchitis since my diagnosis. How do I know when I should see my doctor vs. let the illness run its course?
A: When you have diabetes and are ill enough to where your blood sugars go too high and/or your illness doesn’t come under control in a normal course, you should certainly seek medical attention. Stay well hydrated. With diabetes, you may find you now respond to illness differently so do not hesitate to talk to your health care team if you have any questions.

Q: How can I prevent diabetes? I am 14 and overweight and diabetes runs in my family.
A: Be very active, and learn as much as you can about healthy eating. Learn to love anything from the veggie world, and make fruits your choice when you crave something sweet. Drink plenty of water and cut out sodas, chips and other snack “junk” foods. Just because there is diabetes in your family, it doesn’t mean you have to get it if you start now with lifestyle changes. Learn as much as you can.

Q: Can eating before a gestational diabetes glucose test cause the results to be inaccurate? Before the one hour glucose test, I ate a whole bagel with cream cheese, and whole banana and about 12 oz. of apple juice before I drank the liquid for the test. No one told me not to eat or drink before the test. My reading came back as 157 and now after being on the diet for 3 days, my blood sugar levels have not gone over 80 and have gone as low as 52. My question is could the test have been wrong and should I ask to be retested?
A: Oh my! I do hope you informed them of that high carb breakfast for what should have been a fasting test. However, you are still higher than you should be; 110-120 one hour post meal is what is followed by some of the more "tight control" oriented practitioners. You would do well to watch your carbohydrate intake, especially in the morning, but you should not have blood sugars this low during the day. A fasting reading of 80-90 is good; under 120 two hours post meal is acceptable by some standards. Testing for ketones is also important if you truly have gestational diabetes. Revisit this with your health care team and ask them what their blood sugar criteria is.

Q: How does smoking affect diabetes?
A: Diabetes is considered a cardiovascular disease and smoking negatively affects the cardiovascular system. Smoking also depletes the body of ascorbic acid (vitamin C), a major antioxidant - a cell protector - and can deposit lead and other unwanted chemicals into the fatty tissues of the body. This can definitely interfere with metabolism and good blood sugar control.

Q: What impact would my husband’s diabetes have on our future child if we decide to have a baby?
A: It is not a given that you would give birth to a child with diabetes though the genes may be present. The most important focus would be for him to first get blood sugars under control and be in good health. (Yes, this is important for the father as well as the mother). Then, follow a healthy lifestyle as the child grows, to avoid some of the triggers that might manifest later in life. This applies to both type 1 and type 2 diabetes.

Q: Does fasting make diabetes symptoms worse? My doctor also told me that if I lose all the weight I need to, the condition would disappear. Is this true?
A: In general blood sugars are far better managed with a controlled, regular eating pattern. Erratic eating, such as fasting and then eating large amounts, is perceived by the body as "binge" eating. Your doctor is right in that diabetes is very well managed when one is living a healthy lifestyle. Weight loss is secondary to consistently good habits.

Q: Do I use the first or the second drop of blood when testing my blood sugar?
A: With most strips now, you can touch them with the first drop. It takes far less blood than it used to in order to get a good sample. One drop is all that is needed.

Q: Is it OK for my 14 year old daughter with type 1 diabetes to get her belly button pierced or a small tattoo? 
A: This is touchy. As a general rule, we say piercings/tattoos are not good ideas because they can be an invitation to infection. I suggest you consult with the nurse in her physician's practice. The conditions would have to be most sterile for any piercings - or pedicures for that matter. If your daughter's blood sugars are in exquisite control, and your medical team knows of a place that has met some standard, then something small may work, particularly if your daughter is rebellious, and would go out and do this on her own, but in poor conditions. Weigh and balance your decision after some detective work.

Q: What is the best way to test for type 1 diabetes? Is there a chance that a blood test is wrong?
A: Type 1 diabetes means that without taking insulin, you cannot live. There are those who still produce some insulin, but not at sufficient amounts so to control their blood sugars without taking insulin. This is referred to as type 1.5 diabetes. Your physician can order a C-Peptide test which can give you some idea of how much insulin your pancreas is producing. Type 1 diabetes often comes on fast and strong, with rapid weight loss, thirst, frequent urination, then stabilizes for a period until the cells stop insulin production. Type 2 diabetes is much more common than type 1.

Q: Is it normal for someone to go from healthy to insulin diabetic very quickly? I have been overweight for years and have been having my blood sugar checked at bi-annual doctor’s appointments, always to be told it was “fine”. All of a sudden my A1c is 10.1 with a fasting blood sugar of 329 and I was diagnosed as type 2 diabetic and placed on insulin immediately.
A: With blood sugars over 300, it is now the thought of many endocrinologists to start a person on insulin to detoxify the beta cells of the pancreas. This may only be for a short period if lifestyle changes are diligently made. Sometimes, it is a shift to oral medication, or none at all. Over the years, one may need a return to insulin and/or other medications. Take charge of your lifestyle habits and get all the education you can on managing this disease.

Q: How does diabetes affect your mood and thinking process?
A: With or without diabetes, when blood sugars are not in balance, fatigue, dizziness, "fuzzy" thinking, mood swings, and other symptoms may result. With insulin-requiring diabetes, this can be an even greater challenge to maintain stable blood sugars, but is very achievable with the right monitoring and support. Having a disease like diabetes does provide greater challenges for stable health and moods, but does not negate the ability to attain and maintain them.

Q: Is it possible that weight gain and morphine use caused me to develop type 2 diabetes? I had a morphine pump that leaked into my bloodstream and all through my body when it wasn't supposed to for about a month and, as a result, I gained in excess of 50 pounds.
A: The stress that caused you to be placed on the pump in the first place, plus the probability that you have a genetic disposition to diabetes, triggered further by weight gain, is now surfacing as diabetes. If you are now returning to your normal weight and following a healthy lifestyle, you may very well get back under 100 fasting and hopefully not much over 90. Many people have had blood sugars over 100 but under 126 for years - known as pre-diabetes. Pre-diabetes is just now being more aggressively focused upon for diabetes prevention. A good plan right now is to align yourself with someone who understands healthy eating for diabetes, and become as active as you can.

Q: Will losing a large amount of weight help me to avoid the diabetes that runs in my family? I am 19 years old and very overweight. I recently took my blood sugar a few times and the results scared me: 170 when I woke up. 
A: Changing your lifestyle which will ultimately result in body composition changes and weight reduction can certainly keep diabetes in check. You surely have a wake-up call, and now is the time to get guidance in eating and begin a regular exercise program. Be most dedicated to yourself now, as 170 fasting would indicate diabetes. With perseverance, you can stay in control.

Q: Can diabetes prevent someone from losing weight? I know I am at high risk of getting diabetes but when I diet, it doesn't make a difference and I can't lose weight. I play lots of sports and am not lazy. 
A: Diabetes in and of itself does not generally cause you to retain weight. Sometimes the medications a person is taking will often interfere, contributing to levels of fluid retention. Be as active as you can, striving to become a "lean machine", even if the numbers on the scale don't immediately change. Be very honest with yourself about your food intake/portions vs. activity levels. If you can locate a nutritionist in your area who also will suggest appropriate vitamin/mineral compounds and carbohydrate vs. protein amounts, that may be the boost you need.

Q: Can a type 2 diabetic become a type 1 diabetic after several years and how can I find out? My recent blood test showed that my pancreas is 1.5 and I understand this is very low.
A: Yes, you can become type 1 after years of being type 2. What this would mean is that you cannot live without taking insulin. It sounds as though you had a C-Peptide test, and discovered that your insulin reserves are low. If you have a practitioner in your area who understands nutritional therapies, this may help preserve and improve what insulin production you have. Eat whole, unrefined, organic foods as much as possible. Stay active, and work on the "tough" one: stress reduction.

Q: Since I have been a "bad" diabetic by not eating what I'm supposed to, can I reverse the damage I assume I have already done to my body? I have been type 2 for about eight years and am taking Avandia, Glucophage, Lipitor, Lizinopril. 
A: I don't have a crystal ball, but getting a handle on things now can certainly slow down and possibly arrest further damage. It sounds like you may need to start from square one with nutrition and overall management. Appropriate vitamin/mineral supplementation can also be helpful. It is better late than never; it's time to find out!

Q: I have type 1 diabetes. What are the chances that my child will develop type 1 as well?
A: While there is a genetic component to type 1 diabetes, environmental factors play a role as well. Research suggests that genes account for less than halfthe risk for developing type 1 diabetes. 90% of children who develop type 1 diabetes do not have a relative with this disease and it is reported that only 15% of people with type 1 diabetes have a first-degree relative, such as a parent, with diabetes. There are certain genes called HLA markers associated with diabetes risk which can be identified at birth. Research is ongoing and very active in the field of diabetes and genetic markers soupdated information could be available in the near future.

Q: I am not diabetic according to medical tests. However, I can have a normal blood sugar reading of about 90 before breakfast and then after a moderate cereal-toast breakfast, my blood sugar will go over 200. Why does this happen?
A: Have you had an Oral Glucose Tolerance Test? Newer research is placing more emphasis on the after meal glucose elevations as opposed to just monitoring fasting glucose. You are experiencing hyperglycemia, which as an initial diagnosis, generally manifests as slowly elevating fasting glucose. Ideally, your fasting glucose should be closer to 80. 100 is pre-diabetes.

I would suggest that your breakfasts now consist of more protein and less carbs. Good choices include egg, yogurt, nut butter, cheese, meat, oatmeal, etc. Target for 20-30 grams of protein at each meal. Any carbs you eat should have fiber: whole grain toast toast, fresh fruit, etc. Breakfast cereals generally don't fit these criteria unless you search for a type with higher fiber. I suggest an overabundance of plant foods now, to clean out your system a bit, giving your liver a work break. This should help to fine tune your metabolism. Make sure you have essential fatty acids in your intake: fish/plant foods are main sources.

Q: What is normal glucose levels with the finger prick method (meter) on both one and two hour tests for non-diabetics? I only have seen fasting and two hour levels. I began testing one and two hours after beginning a meal. I have had the following elevations on one hour (174,139,155,161 and 196.) On the two hour test I have had (79,157,190,109,101,152 and 128.) My fasting levels are between 89 and 94, and the control shows the meter works fine. So it seems my fast is always ok; my one hour is always pretty high, and my 2 hour is a mix of high and normal. I have had really severe neuropathy for several years, and no other test results (like MRI's) show any problems.
A: Your readings are high and I would consult an endocrinologist, especially if you already have undefined neuropathy. In fact, more emphasis is now being placed on 2 hour levels than on fasting levels. 94 for a fasting also reflects an upward trend.

Severe neuropathy would reflects years of hyperglycemia, and would generally manifest first as peripheral neuropathy. "Severe" implies that you already have loss of sensation, compromised sight, etc. If this describes you, and you have not been referred to specialists before now, referral is long overdue. Have you been taking any nutritional supplements, or working a practitioner who understands this application? B vitamins and magnesium are compromised with neuropathy, and should be taken together with a nutrient dense diet. All diabetic diets are not equal in terms of balance and nutrient quality. Choose your practitioners now carefully; seek second opinions as necessary.

Information on the "Question and Answer" pages should not be relied on for medical or technical advice. Always consult your healthcare team. Diabetes Action and Jane DeVane cannot be responsible for errors or wrongful use of the information available on this website. The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician/medical team.