Of Diabetes Genes and Environment

Diabetes occurs as an interaction between the genes that you inherit and the environment in which you live. In type 1 diabetes, we know a fair bit about the genes, but relatively little about how environmental factors impact the disease. In contrast, for type 2 diabetes, the genetic causes are largely unknown, but we know that obesity and lack of exercise are important environmental risk factors. In the United States, there are approximately 1 million people with type 1 diabetes, and about...

Panax Quinquefolius American Ginseng

Several small studies reported an improvement in fasting glucose and HbA1c with 3 grams of American ginseng. The studies are of limited duration (eight weeks). Reported side effects of American ginseng include insomnia, high blood pressure, and anxiety. The ADA review found that there was inadequate evidence to support use of herbal medicine or mineral supplements in the treatment of diabetes. If you decide to use them, buy your supplements from reputable suppliers those with USP (United States...

Monitoring Lipids Cholesterol Levels

Heart disease is a risk factor in people with diabetes, especially if you have type 2 diabetes, long-standing type 1 diabetes, or complications from type 1 diabetes. In type 2 diabetes, the risk of heart attack is increased twofold. This is the same frequency as nondiabetic individuals who have already had a previous heart attack. Under these circumstances, your LDL cholesterol should be below 100 mg dl ideally around 70 mg dl. Have your lipid levels checked annually by your physician, and more...

What About Alcohol

Should you count the carbohydrates in the alcohol you drink When you drink alcohol, it is metabolized (that is, broken down) by the liver, and there is less glucose production while the alcohol is being broken down. In people with diabetes who are on insulin, this can cause hypoglycemic reactions. It is therefore important that you drink alcohol with a meal rather than on an empty stomach. The recommended amount of alcohol is the same as for people without diabetes two drinks for men and one...

Testing For Autoimmune Diseases

I mentioned in Chapter 3 that people with type 1 diabetes are at risk for other autoimmune diseases, especially thyroid disease and celiac disease. When your child is diagnosed with type 1 diabetes, he should also be screened for autoimmune thyroid disease. His doctor will do these thyroid tests at intervals or if there is a problem with your child's growth, because low thyroid hormone levels can slow down growth. In celiac disease, eating foods containing gluten (that is, those derived from...

Toddlers Ages One to Three

With toddlers, it is best to establish a schedule with food and insulin injections. This can be challenging, especially with a child who refuses to eat or is a picky eater. Hypoglycemia is the biggest concern with this age group, and often it is best managed by giving insulin after a meal. Other steps that you can take include the following Establish a routine for checking glucose and injections. Use a glucose meter that requires the smallest blood sample and gives quick results. Test glucose...

Managing Diabetes Supplies

Take adequate supplies for your diabetes management when you travel. In fact, take twice the amount of diabetes medication and supplies that you will normally need. If you are on an insulin pump (see Chapter 6), take some basal insulin such as insulin glargine and syringes in case you have a pump failure. Keep the insulin cool by packing it in an insulated bag with refrigerated gel packs, or use Frio packs (see friouk.com index.php). Also take glucose tablets, gels, and snacks for treatment of...

Diabetes Management on the Airplane

If food will not be served on your flight, take food and fast-acting carbohydrate with you. If it is a long flight with a meal (and keep in mind that in-flight meals are rare these days), it is not necessary to order a special meal on the plane, but it is a good idea to have some food with you (two to three snacks) in case the meal is delayed. Inject your insulin dose after your meal arrives. Since the pressure in an airplane is different than the pressure on the ground, do not inject air into...

Nervous System Complications

Nerve damage to the feet can stop you from recognizing injury, and as a result you can develop calluses, foot ulcers, or even a Charcot's foot (see Chapter 3). If you have significant peripheral neuropathy, you should avoid pounding the pavement and try non-weight-bearing exercises such as swimming, rowing, and cycling instead. When you buy athletic footwear, choose shoes with cushioned midsoles and socks that wick away moisture. Autonomic neuropathy can dull the classic warning signs of...

Exercise and Type 2 Diabetes

If you have type 2 diabetes and you are on insulin, you will face issues similar to those of a person with type 1 diabetes (see the tips and advice in the preceding section), except that generally, your glucose levels will be more stable. This is principally because most patients with type 2 diabetes still have functioning beta cells in their pancreas, with a significant contribution of their own insulin. If you take oral diabetes medications, you cannot assume that your health will be fine...

Artificial Sweeteners

Used in moderation, table sugar (sucrose) can be a part of your diet. However, if you are having problems with glucose control or you are trying to limit your carbohydrate intake (for weight loss or lowering triglycerides), reducing the amount of sugar you eat may be important to you. If this is the case, you have the option of using sweeteners that do not raise blood glucose levels. Aspartame (NutraSweet) consists of two major amino acids, aspartic acid and phenylalanine, which combine to...

Effect On Intellectual Function

Do repeated low glucose levels affect intellectual function Research studies that looked at this topic have not given clear answers. Part of the problem is that many subjects who have severe hypoglycemic reactions also have other complications from the diabetes that could impact intellectual function. What is reassuring is that in the DCCT (a big research study of type 1 diabetes), severe hypoglycemic episodes did not result in decreased intellectual function over eighteen years of follow-up....

Lack of Glucagon Response

In new onset diabetes, glucagon levels rise in response to a falling glucose level, and this is the most important factor preventing a further fall in the glucose level. People with diabetes longer than five years lose this glucagon response. As a result, these individuals are at a significant disadvantage in protecting themselves against falling glucose levels. People who have diabetes because of pancreatitis or pancreatic surgery also lack glucagon and so are at increased risk for...

Failure to Adjust for Exercise

In Chapter 9, I explain why people with diabetes, especially type 1 diabetes, can find glucose control with exercise particularly challenging. Hypoglycemia can occur during or even several hours after exercise, and so glucose levels need to be monitored and food and insulin adjusted. Failure to do this can lead to hypoglycemia. Unexpected exercise can also be a challenge I remember seeing a sixty-eight-year-old woman with type 1 diabetes in my office, and during her visit the fire alarm went...

Overestimation of Carbohydrate Intake

One of the most common reasons for recurrent hypoglycemia is injecting too much insulin or taking too much oral medication for the amount of carbohydrates ingested. You may overestimate the amount of carbohydrate in the food or eat less than planned, or you may be delayed in eating after taking the insulin or medicine. For example, a number of times, I have had patients inject a dose of insulin in the car before they went to a restaurant. At the restaurant, the food did not come at the expected...

What Should My Glucose Levels Be

In people without diabetes, glucose values can be in the 60 to 70 mg dl range or even lower with prolonged fasting. The problem with diabetes is that if you are taking medicines that can cause hypoglycemia, like insulin and sulfonylureas, a glucose level around 60 is of concern because it could go down even further. The ADA defines a glucose level of 70 mg dl or less as hypoglycemia, even if you feel fine and show no symptoms. Thus, if you are on medicines that can cause hypoglycemia, you...

Pramlintide How It Works

Pramlintide limits the glucose rise after meals by slowing stomach emptying and lowering the postmeal glucagon levels. (See Table 6-7.) It also causes modest weight loss two to four pounds on average. When beta cells release insulin, they also release another protein called islet amyloid polypeptide (IAPP or amylin). The normal function of IAPP is not well understood, but it may have a role in appetite regulation. Pramlintide is a modified form of IAPP. It is approved for use by people with...

Understanding Home Monitoring

Blood glucose monitoring at home is an important part of diabetes management and serves a number of purposes. First, monitoring at home makes it easier to detect low blood glucose reactions, because you cannot rely on how you feel to detect low glucose levels. When aiming for the glucose targets mentioned in Table 5-1, many people with diabetes develop hypoglycemic unawareness (see Chapter 7), meaning they can have glucose levels in the 40s and 50s and still feel quite fine. For this reason,

Monitoring Glucose Levels

When you have diabetes, your glucose levels fluctuate much more than those of people without diabetes. In people without diabetes, fasting glucose levels in the morning are usually between 60 and 100 mg dl. Before each meal, the levels are below 100 mg dl. The peak values one to two hours after a meal are in the 120s and usually stay below 140, even after a meal rich in carbohydrates. With current therapies, it is difficult to achieve normal glucose levels when you have diabetes. Even when...

Preventing Hypoglycemia

As you aim to get HbA1c levels (see Chapter 5) close to normal, the risk of hypoglycemia goes up. You can take the following measures to limit the risk Set realistic targets aim to keep premeal glucose levels between 90 and 130 rather than at 80. Also, if you have recently had a severe hypoglycemic reaction, then for about six weeks aim to keep your glucose around 150. This will help you recover your ability to sense hypoglycemia to some degree. Learn to count carbohydrates and adjust insulin...

Treating Hypoglycemia

Treating hypoglycemia is fairly straightforward eat or drink any food that has a lot of glucose and is easily absorbed. Sources of glucose include glucose tablets and gels that you can buy at your pharmacy. Fruit juice and nonfat milk are also good sources. Foods with a lot of fat such as chocolate are not as good because the fat will delay the absorption of the glucose. Fructose does not raise the blood glucose, but most foods that have fructose, such as honey and fruits, also have a lot of...

Adjusting Your Insulin for Time Changes

The body's sensitivity to insulin varies throughout the day and night. You are most insulin sensitive early in the night and most resistant early in the morning. These changes in insulin sensitivity are due to the daily fluctuations in the levels of hormones, particularly cortisol. The internal body clock that regulates these hormones gets cues from environmental light and temperature. When you go to a different time zone, the body clock and the hormones reset to the new light-dark cycle. This...

Working with Small Insulin Doses

Giving the small doses of insulin can be challenging. Eli Lilly and Novo Nordisk make pens that will deliver in half units, but the minimum dose is 1 unit. Becton, Dickinson and Company makes an ultrafine short-needle insulin syringe with half-unit markings. You can also ask your pharmacy to dilute the insulin. Eli Lilly makes a diluent for NPH, regular, and Humalog insulin. Similarly, Novo Nordisk makes a diluent for Novolin regular, and this can also be used for NovoLog. For U50 insulin, the...

Info

Severe kidney failure macroalbuminuria Treating High Blood Pressure Helps the Kidneys Medicines that reduce blood pressure stop the kidney damage from getting worse. Usually your doctor will first prescribe a medicine called angiotensin converting enzyme (ACE) inhibitor. The side effects of ACE inhibitors include an increase in the potassium and creatinine levels in the blood, occasionally a cough, and, rarely, facial swelling. The rise in potassium can usually be managed by taking a diuretic...

Chapter

Nutrition recommendations and interventions for diabetes. Diabetes Care 2007 Jan 30 (Suppl 1) S48-S65. American Diabetes Association Task Force for Writing Nutrition Principles and Recommendations for the Management of Diabetes and Related Complications. American Diabetes Association position statement evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. J Am Diet Assoc 2002 Jan 102 (1)...

The Dex Com Medtronic and Abbott Systems

The DexCom, Medtronic MiniMed, and Abbott Pharmaceutical (not yet available) systems all work in a similar way. The sensor is a tiny flexible probe that you insert under the skin in the same way you insert an insulin pump infusion set can-nula (see Chapter 6). The sensor measures the glucose concentration in the tissue fluid every five minutes for about three to seven days before it needs replacing. All the systems have software available to download the data into your computer. These systems...

Driving and Hypoglycemia

Some of the medicines used to treat diabetes (insulin, sulfonylureas, repaglinide, and nateglinide) can cause hypoglycemia, which can affect reflexes and judgment. In addition, long-term diabetes complications, especially vision problems and neuropathy, may interfere with driving ability. There have been a number of research studies that have looked at the impact of diabetes on car accidents. Generally speaking, the impact appears to be modest if it exists at all. It does seem that the risk for...

Salt and Potassium

High blood pressure occurs frequently in people with type 2 diabetes and with diabetic kidney disease. Reducing your salt intake can help lower the blood pressure. You can reduce the amount of salt in your diet by Avoiding or reducing intake of foods with high salt content such as canned foods, pickled vegetables, soy sauce, teriyaki sauce, and tomato sauce. Cooking with less salt. Instead, use herbs, spices, and lemon juice for flavoring. Another element that you might need to think about in...