Diabetes Complications and Preventing – Part 2

Eye Damage (Diabetic Retinopathy)

To protect your vision, see an eye doctor at least once a year. He should dilate your pupils while you're there. People with type 1 diabetes who are older than 10 should start these visits within 3 to 5 years of diagnosis. If you have type 2 diabetes, make an appointment as soon as you’re diagnosed. If you have problems, you’ll need to go more often. If you get pregnant, schedule a comprehensive exam during the first trimester and a follow-up later in your pregnancy.

Gastroparesis

Diabetes can damage the nerves that control your stomach so they stop working properly. Known as gastroparesis, this condition causes it to take too long to empty. That makes it hard for you to manage blood sugar levels. Sometimes a change in diet can help. There are medications and other treatments, too.

Erectile Dysfunction

Diabetes makes men more likely to get erectile dysfunction or become impotent. Sometimes all you need to do is adopt a healthier lifestyle, quit smoking, exercise regularly, and reduce stress. It's important to talk to your doctor about these problems. He can suggest medications or remedies like a vacuum constriction device and other products.

Skin Problems

Many people with diabetes will have a skin condition related to it at some time in their lives. The sugar in your blood provides a perfect breeding ground for bacteria and fungi. It also lowers your body's ability to heal itself. Fortunately, most of these problems can be prevented and treated if caught early on. If you have type 2 diabetes and don’t take care of yourself, a minor scratch could turn into a serious infection.

Infection

Type 2 diabetes slows your body's ability to fight infection. High sugar levels in your body's tissue means bacteria grow more easily and infections set in more quickly. Common sites for them are your bladder, kidneys, vagina, gums, feet, and skin. Early treatment can prevent serious complications.

Dental Problems

The less controlled your blood sugar is, the more likely you’ll have problems in your mouth. That’s because the disease harms white blood cells, which are your body's main defense against oral infections. Brush, floss and rinse with antiseptic mouthwash each day. See your dentist for regular cleanings and checkups.

Diabetes Complications and Preventing – Part 1

How to Prevent Diabetes Complications

If you have diabetes, you spend a lot of time keeping it under control. That’s good because it can cause a lot of complications that can affect nearly every organ in your body. Learn what you can do to prevent these problems.

Heart Disease

This is one of the most common diabetes complications. In office visits, your doctor may do tests that screen for heart disease to help you prevent serious problems. At every visit, he’ll check your blood pressure. He’ll probably test your blood for cholesterol level and triglycerides at your first visit. And he should do an EKG as part of a complete medical record. Learn more about your risks for heart disease. Does it run in your family? Do you smoke? Make a prevention plan that includes weight loss, regular exercise, and stress management, as well as keeping your blood pressure, cholesterol, and triglycerides at normal levels.

What Are the Complications of Diabetes?

Stroke

Symptoms of a stroke include:

• Sudden weakness on one side of the face or body
• Numbness in the face, arm, or leg
• Trouble speaking
• Trouble seeing
• Dizziness

If you have any of these, see a doctor immediately. He may refer you to a neurologist or other stroke specialist.

Kidney Disease (Diabetic Nephropathy)

If you have diabetes, get your urine tested every year to look for kidney disease. Your doctor should do a creatinine blood test to check how these organs are working. He’ll also check your blood pressure regularly. It's key to slowing this disease. Your reading should be less than 130/80.

Nerve Damage (Diabetic Neuropathy)

Over time, diabetes can cause nerve damage. You might feel numbness, burning, or pain in your hands, feet, or legs. If your skin loses feeling, you may not notice small wounds that could grow to become bigger ones. Check these parts of your body daily for redness, calluses, cracks, or other damage. If you notice any of these symptoms, tell your doctor right away.

Diabetic Shock – Part 2

How Is Hypoglycemia Treated?

If your hypoglycemia is mild or moderate, the best way to raise your blood sugar level quickly is to eat or drink some form of sugar. You might take glucose tablets, which you can buy at the drug store. Alternatively, you may want to drink a half a cup of fruit juice or eat five to six pieces of hard candy.

Other snacks you can use to raise your sugar level include:

• One-half cup of regular soda -- not diet
• Cup of milk
• 1 tablespoon of sugar
• 1 tablespoon of honey
• One-quarter cup raisins
• 2 large or 6 small sugar cubes dissolved in water

You can also ask your doctor or certified diabetes educator (CDE) for recommendations for other snack items that can help raise your blood sugar level when you need to.

After you've taken a snack, wait 15 minutes and check your blood sugar level again. If it is still low, eat another snack, then wait 15 minutes and check it again. Repeat the process until your blood sugar level is in its normal target range.

If you lose consciousness, you will need immediate medical attention. It's important that you educate the people in your family and the people you work with about diabetic shock and about what to do if it happens. Someone should call 911 or arrange to get you to an emergency room if that's not possible.

You can ask your doctor to prescribe a glucagon rescue kit and then teach others how to use it. Glucagon is a natural hormone that rapidly causes the level of sugar in your blood to rise. If you are unconscious, someone injecting you with glucagon even before emergency help arrives can prevent further complications and help you recover.

Can Diabetic Shock Be Prevented?

There are things you can do to lower your risk of diabetic shock or hypoglycemia.

One of the most important things to do is to understand the medication you are using, whether it is insulin or a pill that increases the body's production of insulin. Ask your doctor how and when to take the medication and be sure to always take the recommended dose at the recommended time. Also,  ask your doctor to explain when you need to make adjustments to your medicine when there is a change in your schedule or routine.

Be sure to follow your meal plan, eating the right amount of the proper food at the right time. Don't skip any meals or snacks, especially before going to sleep or exercising. Discuss your snacks with your dietitian. Some snacks may be better than others at certain times for preventing hypoglycemia. During periods of more intense physical activity, be sure to eat more carbohydrates.

Be sure you check your blood glucose level routinely according to the plan you've worked out with your doctor. Also, check it before you begin to exercise and at regular intervals during exercise or other exertion. And check it again after you've finished any physical activity.

Discuss your use of alcohol with your doctor. Your doctor can help you understand how to drink safely so you don't increase your risk of hypoglycemia.

Are There Special Precautions People with Diabetes Should Take Because of Hypoglycemia?

Because hypoglycemia can occur quickly at any time, always be sure that you carry with you or have quick access to snacks that raise your blood sugar.

Never drive a car if you have hypoglycemia or suspect it is coming on. Diabetic shock can cause you to pass out behind the wheel. If you are driving and notice symptoms, stop and check your blood sugar. If it's low, take a snack and don't start driving until the level is back in the normal range.

Wear a medical ID bracelet or carry a card that identifies you as having diabetes. Be sure the card says what to do if you've become unconscious.

Be sure your family members know what hypoglycemia is and what not to do -- give you insulin, put their hand in your mouth, try to give you food or fluids -- if you pass out.

The most important precaution is to always follow the diabetes plan you've worked out with your doctor. Not only will it lower your risk for hypoglycemia. It will also help prevent long-term, major complications.

Diabetic Shock – Part 1

Diabetic shock, or severe hypoglycemia, is a serious health risk for anyone with diabetes. Also called insulin reaction, because of too much insulin, it can occur anytime there is an imbalance between the insulin in your system, the amount of food you eat, or your level of physical activity. It can even happen while you are doing all you think you can do to manage your diabetes.

The symptoms of diabetic shock may seem mild at first. But they should not be ignored. If it isn't treated quickly, hypoglycemia can become a very serious condition that causes you to faint, requiring immediate medical attention. Diabetic shock can also lead to a coma and death. It's important that not only you, but also your family and others around you, learn to recognize the signs of hypoglycemia and know what to do about them. It could save your life.

What Is Hypoglycemia?

Hypoglycemia is a low level of blood sugar. The cells in your body use sugar from carbohydrates for energy. Insulin, which normally is made in the pancreas, is necessary for sugar to enter the cells. It helps keep the levels of sugar in the blood from getting too high.

It's important to maintain the proper level of sugar in your blood. Levels that are too high can cause severe dehydration, which can be life threatening. Over time, excess sugar in the body does serious damage to organs such as your heart, eyes, and nervous system.

Ordinarily, the production of insulin is regulated inside your body so that you naturally have the amount of insulin you need to help control the level of sugar. But if your body doesn't make its own insulin or if it can't effectively use the insulin it does produce, you need to inject insulin as a medicine or take another medication that will increase the amount of insulin your body does make. So, if you need to medicate with insulin, it becomes your responsibility to see that you have the amount of insulin you need when you need it.

When to take insulin or another medication and how much to use depends on when, what, and how much food you eat. It also depends on your level of physical activity since the cells in your body use more sugar when you are active. Hypoglycemia is basically a reaction to too much insulin in your system. The insulin speeds up the lowering of the blood glucose level. Then without eating or with your body burning sugar faster because of physical activity, the level of sugar becomes dangerously low.

What Causes Hypoglycemia?

Several things can cause hypoglycemia. Your blood sugar level could be low if you:

• Become more physically active than usual
• Miss a meal
• Change when or how much you normally eat
• Take your insulin or medication at a different time than usual
• Drink alcohol excessively without eating

Are There Symptoms of Hypoglycemia or Warning Signs of Diabetic Shock?

The symptoms of hypoglycemia can be classified as mild or early, moderate, and severe. Mild symptoms include:

• Dizziness
• Irritability
• Moodiness or sudden changes in behavior
• Hunger
• Shakiness
• Sweating
• Rapid heart beat

Moderate symptoms include:

• Confusion
• Headache
• Poor coordination

When hypoglycemia becomes severe, symptoms include:

• Fainting and unconsciousness
• Seizures
• Coma

Hypoglycemia can also occur overnight while you sleep. Symptoms include:

• Crying out in your sleep
• Nightmares
• Damp pajamas or sheets resulting from perspiration
• Waking tired, irritable, or confused

If you experience any possible signs of hypoglycemia, it's important to check your blood sugar to make sure it isn't low. If it is, you should treat it quickly or seek emergency care. If you can't check your blood sugar level for some reason, you should go ahead and treat yourself for low blood sugar if you notice symptoms or seek emergency care. If symptoms are moderate, severe, or you are unable to help yourself, seek emergency medical attention.

Treatments for Type 2 Diabetes – Part 2

Continued from the prior blog.

Other medicines help insulin work better. They lower insulin resistance from your cells so your pancreas doesn't have to work as hard. Doctors call these thiazolidinediones, TZDs, or glitazones.

Some slow the digestion of food with complex carbohydrates, like bread, pasta, rice, potatoes, and corn. This keeps your blood sugar from shooting up after you eat. These are alpha-glucosidase inhibitors.

Some work by letting your kidneys pee out extra sugar. They're SGLT2 inhibitors.

Cholesterol-lowering drugs called bile acid sequestrants can also help lower your blood glucose.

You can take these medications by themselves or in combination with others, including insulin. Some pills have more than one kind of drug. More on diabetes drugs in the next blog.

Injectable Drugs These medications slow how quickly food leaves your stomach and make you feel full. And they tell your liver to back off making glucose around mealtimes.

Some also help your pancreas make insulin. These are GLP-1 receptor agonists. Some of them you take every day, while others last a week.

A different drug acts like a hormone, amylin, that your pancreas sends out with insulin. You only take pramlintide (Symlin) if you're also using insulin.

Insulin People with type 2 diabetes sometimes need insulin. It could be a short-term fix for a stressful situation, or because other medicines aren't enough to control their blood sugar.

You can take insulin with a needle and syringe, with a device called an insulin pen, or with an inhaler. Some people use an insulin pump to get it continuously.

Types of insulin are grouped by how fast they start to work and how long their effects last. You might have to use more than one kind of insulin. Some insulins come pre-mixed.

Weight Loss Surgery

Of course, this gets rid of extra pounds. And that alone will help control your blood sugar.  However, be aware that many bariatric surgeons will rush you into surgery with out doing all the necessary tests and explaining all the requirements you will need to do for the rest of your life.

But it also raises the level of hormones in your gut called incretins. These tell your pancreas to make insulin. Over time, you may be able to take less medication.

It isn't for everyone, though. Doctors usually recommend weight loss surgery only for men who are at least 100 pounds overweight and women with at least 80 extra pounds.

Part 2 of 2 Parts

Treatments for Type 2 Diabetes – Part 1

You have many options to manage diabetes. Diet, exercise, and medication work together to bring your blood glucose under control. Your doctor may help you figure out if you need to take medicine, which kind is right for you, and how often you should take it.

Over your lifetime, you'll probably handle your disease in different ways. Sometimes medications stop working, and you'll have to switch. You'll need to adjust to changes in your body as you age. In addition, researchers are looking for new diabetes medicines and ways to treat it.

Check Your Blood Sugar Your blood glucose number tells you how well your treatment is working. Your doctor should let you know how many times a day you need to check it. It will depend on what diabetes medications you're taking.

Many doctors follow ADA and won't tell you to test your blood glucose unless you are using insulin.

Diet and Exercise There's no one-size-fits-all diabetes diet. You'll need to pay attention to carbs, fiber, fat, and salt to manage your blood glucose and avoid the complications of diabetes. How much and when you eat are important, too. Talk to your diabetes team or a registered dietitian to help you plan your meals and snacks. Registered dietitians may be of minor help as they promote high carbohydrate low fat, which will cause you to gain weight.

Physical activity -- from working out to doing chores -- lowers your blood glucose levels. It helps your cells use insulin. It also helps your muscles use glucose. Make sure you check your blood glucose before and after exercise.

Eating right and being active will help you lose extra pounds and stay at a healthy weight. That will also help control your blood sugar.

Pills Oral medications are often the first kind of medicine people with type 2 diabetes try when diet and exercise alone aren't enough to keep their blood sugar in a healthy range. There are many of them, and they work in different ways.

A drug doctors often prescribe tells your liver to hang on to some of the glucose it makes. The generic name is metformin.

Some medications tell your pancreas to make more insulin. These are meglitinides and sulfonylureas.

One kind keeps your body from breaking down hormones that give your pancreas the "go" signal for insulin. This means they work longer when you need to lower your blood sugar after a meal. They're known as DPP-4 inhibitors.

Part 1 of 2 parts

Better A1C Test Being Developed

Scientists say their mathematical formula improves accuracy of standard blood screen. The study appears in the Oct. 5 issue of Science Translational Medicine. Industry-funded researchers say they have developed a way to improve the accuracy of a standard diabetes test.

"We think our approach will enable many patients and their doctors to do a better job controlling blood sugar levels and reduce the long-term risks of heart attack, stroke, blindness and kidney failure associated with diabetes,” said Dr. John Higgins, associate professor of systems biology at Harvard Medical School in Boston.

At issue is the HbA1c test, also known as the A1c test, which is used to diagnose diabetes. It also identifies people with prediabetes and provides insight into how well blood sugar is controlled over a three-month period among those monitoring their disease. “The A1c test measures how much sugar a person's blood cells have soaked up since the time the cells were produced," Higgins said.

"Before the test was available, patients and clinicians only knew what a person's current blood sugar level was. But effective treatment of diabetes depends on knowing what the blood sugar level has been since the previous checkup," Higgins explained. "The HbA1c test provided the first available estimate of a patient's blood sugar level over the past several weeks."

For millions of diabetics worldwide, the A1c test forms the basis of their treatment. In the United States alone, more than 29 million Americans have diabetes, according to the U.S. Centers for Disease Control and Prevention.

The test can be inaccurate, however. How much that matters is up to debate.

Higgins said the errors are significant. But another specialist, Dr. Joel Zonszein, said the test is rarely inaccurate and "is a good test for the great majority" of patients. "Patients with diabetes can be properly monitored and treated with the tools we have," said Zonszein, director of clinical diabetes at Albert Einstein College of Medicine's University Hospital in New York City.

"In my experience, the main issue is that individuals with diabetes don't often check their A1c values," said Zonszein, who wasn't involved with the new research.

For the new study, Higgins and his colleagues used an advanced mathematical formula, or algorithm, to analyze blood sugar levels through the HbA1c test. This enabled the scientists to account for variations in the age of blood cells among different people, Higgins said. Hemoglobin in red blood cells accumulates sugar over time, and is a major reason for differences in test results, he said.

In more than 200 patients included in the study, Higgins said the new approach reduced significant errors from about one in three to about one in 10. These were errors large enough to affect treatment decisions, he said. Since people with diabetes often get A1c tests every three months, Higgins said the new approach could improve their monitoring and treatment.

Higgins declined to estimate how much it would cost to add the new calculations to existing tests. But he anticipates the extra expense would be less than the cost of the A1c test itself. And in defense of any higher pricing, he added, "diabetes becomes very expensive if blood sugar levels are not well-controlled."

The study was funded by the U.S. National Institutes of Health and Abbott Diagnostics, a company that develops laboratory medical tests. The study authors, including Higgins, are listed as inventors on a patent application linked to the findings.

Higgins said the researchers are looking for partnerships that would allow labs to use the algorithm to improve HbA1c testing.

Zonszein said the study findings appear valid, although the algorithm "has not been challenged and/or compared with other possible mathematical models."

For now, however, "this is research, and it is not a practical model that needs to be implemented," he said.