Homeopathic Treatment for Diabetes

The Big Diabetes Lie

The ICTM is a program which contains a team of professional doctors who have taken the time to scientifically research type 2 diabetes, the best treatment for the disease and ways to enhance healthy living. This program uses a seven step by step method to enhance healthy living and discard the lie about diabetes disease that it is a lifetime killer disease. All the methods used in this program have gone through testing and proven to work effectively and treat the type 2 diabetes permanently. The creator of this program has taken a step further to assure you that this program has zero risks and guarantees you a 60-day total money refund on any user who feels not satisfied with the program. Owing to the many benefits that come with this unique program like getting the full treatment of type 2 diabetes, discarding all the prescribed drugs by doctors and avoiding insulin now and then, saving on cost and the great testimonial from those who have tried it. I highly recommend this program to every person who craves to live a healthy lifestyle and be diabetic free. Read more...

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How does diabetes affect the kidneys

Generally, the changes produced in the kidneys by diabetes occur very slowly, taking place over years (Table 2.2, Figure 2.4). If they are recognized early, they can - with the right treatments - be reversed. The changes start, at the onset of diabetes, with an increase in the size of the kidneys and in the amount of blood passing through them. This first, early stage is known as 'the hypertrophy and hyperfunction stage' (stage 1) because of the enlarged kidneys, enriched in blood. Even at this stage, a rise in the amount of protein in the urine is often observed. If the diabetes is properly controlled, these changes can usually be reversed within weeks or months. The protein also disappears from the urine. The progression of these changes in the kidneys depends strongly on the state of the body's metabolism. If the blood composition is good - that is, if the haemoglobin A1c (HbAlc) concentration is near-normal, namely between 6 and 7 , the diabetes will barely affect the kidneys in...

How failing kidney function affects diabetes management

To achieve good blood sugar control in the presence of failing kidney function is a difficult task for patient and doctor. There are various reasons for this. In some people with diabetes the insulin sensitivity changes, for reasons that are often unclear the tissues no longer respond as well to insulin. This can lead to a worsening of the diabetes. Insulin - whether made by the body or injected as a drug - is partly broken down in the kidneys. When the kidneys are not functioning properly, less insulin is metabolized, so that the effect of the insulin is prolonged. This partially compensates for the reduced insulin sensitivity mentioned above, but can also result in hypoglycaemia -dangerously low blood sugar. Someone who has advanced nephropathy often also suffers from other complications of diabetes. These may include damage to the nerves that regulate the gastrointestinal tract. Then food is no longer digested and absorbed properly. Typical signs are bloating, feeling full,...

When blood pressure is too high in people with diabetes

In people with Type 1 diabetes, blood pressure usually rises only as a result of kidney damage. Whereas previously mainly normal blood pressure readings were obtained, as soon as microalbuminuria appears, the blood pressure begins to rise, although at first it may stay in the normal range. For example, if under normal albuminuria it was 125 80 mmHg, after the onset of microalbuminuria it might rise to 130 85 mmHg, then later to 135 90 mmHg. This is why there is no 'official' value for hypertension, but a rise in blood pressure compared with earlier values indicates increased stress for the heart, kidneys and blood vessels. Should macroalbuminuria then develop, or even renal failure, the blood pressure rises sharply if it is not treated promptly. As well as people with Type 1 diabetes, every second or third person with Type 2 diabetes shows raised blood pressure as soon as metabolic disease begins. Because there is often no visible cause for the high blood pressure, people talk about...

The GP Contract Clinical Quality indicators for diabetes

DM 1 The practice can produce a register of all patients with diabetes mellitus DM 2 The percentage of patients with diabetes whose notes record BMI in the previous 15 months DM 3 The percentage of patients with diabetes in whom there is a record of smoking status in the previous 15 months except those who have never smoked where smoking status should be recorded once DM 4 The percentage of patients with diabetes who smoke and whose notes contain a record that smoking cessation advice has been offered in the last 15 months DM 5 The percentage of diabetic patients who have a record of HbAlc or equivalent in the previous 15 months DM 6 The percentage of patients with diabetes in whom the last HbA1c is 7.4 or less (or equivalent test reference range depending on local laboratory) in last 15 months DM 7 The percentage of patients with diabetes in whom the last HbA1c is 10 or less (or equivalent test reference range depending on local laboratory) in last 15 months DM 8 The percentage of...

Delivery of eye care for patients with diabetes

Patients should know that they have diabetes mellitus and that the condition requires care. General population screening for diabetes mellitus with existing methods is considered neither appropriate nor beneficial, although use of such methods to reach subpopulations with a very high prevalence of diabetes mellitus might be both appropriate and feasible for some Member States. Patients should receive adequate care for diabetes mellitus. The only means of preventing diabetic retinopathy is regulating blood sugar, blood pressure and other risk factors that can be controlled by patients, under the guidance of their care provider. Often, however, physicians do not care for diabetes patients in the manner indicated by the results of randomized controlled trials. Patients should undergo periodic eye examinations. Professional organizations advocate annual eye examinations for patients with diabetes and prompt treatment when indicated. Nevertheless, many patients with diabetes are not...

Evaluation and improvement of eye care for patients with diabetes mellitus

The performance of systems for eye care for patients with diabetes, even in developed countres, leaves much to be desired. Application of a systems approach to the current systems indicates that alternatives should be explored to improve performance in every area of eye care for patients with diabetes in countres throughout the word.

United Kingdom Prospective Diabetes Study

These studies are notable for two additional findings. First, there is no threshold below which diabetic retinopathy does not occur when glycosylated haemoglobin is elevated rather, there is a linear relationship between achieved glycosylated haemoglobin level and the risk for visual complications of diabetes. Secondly, persons receiving intensive control had a significant rate of hypoglycaemic reactions, which might argue against such aggressive control in every situation. The choice of a 'target' glycosylated haemoglobin level is therefore arbitrary, involving consideration of the benefits and costs for each patient and thus for each society. The findings of the United Kingdom Prospective Diabetes Study (19771999) were similar to those of the Diabetes Control and Complications Trial for persons with type 2 diabetes mellitus (36,37). In addition, it highlighted the independent role of systemic hypertension (or its control) in potentiating the development and worsening the progression...

Principles In Eye Care For Patients With Diabetes

Diabetic retinopathy remains the leading cause of new-onset blindness in populations of working age, even in the United States (21) and other industralized countres. Despite clearly defined clinical standards for evaluating and treating diabetic retinopathy cost-effectively, for a variety of reasons (see below), effective treatments such as laser surgery are underused. It has been estimated that 50 of adults with diabetes mellitus in the United States do not receive the recommended annual eye care that would allow diagnosis and treatment of diabetic retinopathy (38-41). Studies have also shown that many persons who require sight-preserving laser surgery do not receive it (42,43). It has been reported that about 26 of patients with type 1 and 36 of those with type 2 diabetes mellitus have never had their eyes examined (44). These patients tend to be older, less educated and to have had a more recent diagnosis than those receiving regular eye care. They are also likely to live in rural...

Chapter The consequences of uncontrolled diabetes

A new approach to diabetes recognition and treatment is needed because the conventional wisdom has failed us. America is in the midst of a diabetes epidemic. Over the past 20 years, the number of adults diagnosed with diabetes has more than doubled, and children are being diagnosed with diabetes in alarming numbers. Diabetes has rapidly emerged as a leading culprit in the epidemic of heart disease that is sweeping the country, and it is a leading cause of amputation and blindness among adults. The long term consequences of uncontrolled diabetes are severe blindness, kidney failure, increased risk of heart disease, and painful peripheral nerve damage. Today, most practitioners focus treatment on strict blood sugar control. While diabetes is characterized by excess blood glucose (the form of sugar used by cells as energy), this simplified approach can actually hasten the progression of the most common form of diabetes and does nothing to address the damage it causes. It is crucial that...

The Difference between Type and Type Diabetes

There are two types of diabetes type-1 and type-2. Underlying either form of diabetes is a disorder of insulin production, use, or both. Insulin is a hormone responsible for transporting glucose into cells. When there is excess glucose in the blood, insulin is secreted from the pancreas and signals the liver and muscles to store glucose as glycogen. Insulin also stimulates adipose tissue to store glucose as fat for long-term energy reserves. Insulin receptors are found in all cells throughout the body. In a healthy person, blood glucose levels are extremely stable (Kumar V et al 2005). Normal fasting glucose levels range between 70 and 100 mg dL. Type-1 diabetes. Type-1 diabetes, formerly known as insulin-dependent diabetes, is an autoimmune condition that occurs when the body attacks and destroys the cells (called beta cells) that make insulin. Type-1 diabetes accounts for about 5 to 10 percent of cases. Because type-1 diabetics can no longer make insulin, insulin replacement therapy...

Program for Early Diabetics

There are acute differences between the early stages of diabetes and the advanced stages. Thus, it doesn't make sense to treat all people with type-2 diabetes the same. In the early stages of the disease, people suffer from both hyperglycemia and hyperinsulinemia. Rather than take drugs that further increase the level of insulin in the blood, people with type-2 diabetes would do better to pursue therapies that increase the sensitivity of insulin receptors on the cell membranes. One of the best defenses against mild to moderate type-2 diabetes and hyperinsulinemia is improved diet and exercise. Although the disease has a genetic component, many studies have shown that diet and exercise can prevent it (Diabetes Prevention Program Research Group 2002 Diabetes Prevention Program Research Group 2003 Muniyappa R et al 2003 Diabetes Prevention Program Research Group 2000). One study also showed that while some medications delay the development of diabetes, diet and exercise work better. Just...

Metformin Increasing Insulin Sensitivity

The standard practice in mainstream medicine is to try to medicate. Medications are sometimes required but I believe they should be initially used in crisis situations and later, only if proper diet and exercise are not getting the desired results. Metformin is one of the more popular drugs of choice. In addition to diet and exercise, the prescription drug Metformin has been proven to increase insulin sensitivity in people with mild to moderate hyperglycemia but the main mechanism of action is to suppress glucose production by the liver, thus decreasing the glucose load on the body by decreasing the amount of glucose that the liver makes. Metformin is now the most commonly prescribed oral anti-diabetic drug in the world. It works by increasing insulin sensitivity in the liver (Joshi SR 2005). It also has a number of other beneficial effects, including weight loss, reduced cholesterol-triglyceride levels, and improved endothelial function. Metformin is tolerated better than many other...

Drug Therapy for Advanced Diabetics

Some people, however, will not have the benefit of this knowledge before their type-2 diabetes advances to a more dangerous stage. In severe hyperglycemia, the pancreas becomes burned out after producing high levels of insulin for a long time. Insulin levels drop as a result of decreased production, and blood glucose levels are allowed to rise to very high, toxic levels. Although diet and exercise, along with supplementation, are still strongly recommended, a number of prescription drugs might also be necessary. Sulfonylurea drugs stimulate pancreatic secretion of insulin. Unfortunately, they are often prescribed as first-line treatment for mild to moderate type-2 diabetics, even when their use is inappropriate. By increasing levels of insulin, which are already raised, sulfonylurea drugs actually hasten the progression of early type-2 diabetes by exhausting insulin receptors faster, which causes the pancreas to burn out more quickly. Sulfonylurea drugs should really be considered a...

Recent studies on diabetes and the benefit of good glucose control

Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA. BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. METHODS We randomly assigned 3234 non-diabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in...

Chapter Introduction to Tomas ideas on a Healthy Diabetic Diet

If you are anything like I was when I was diagnosed, you want quick easy answers about what to eat and how to get healthy. I can tell you what works well for me, and others I have worked with, but understanding it will take some time and study on your part. I recommend you start with this book, then go to Diabetic-Diet-Secrets.com, bookmark the site and visit it often until you have a clear understanding of what makes a healthy diabetic diet and you feel confident in planning a healthy meal There are a small percentage of type-2 diabetics that will have problems regardless of what they do. There is also a small percentage that will not have major problems even if they do nothing. The majority of us can benefit greatly from proper nutrition and exercise. If my formula does not work for you, reduce the carbohydrates and increase the good fats. It was not my experience (or the experience I have heard from many other sources) to have lots of time with my medical team to teach me how to...

Other Types of Diabetes

People whose blood contains more glucose than normal, but less than occurs in diabetes, may be diagnosed with a condition called impaired glucose tolerance (IGT). Some women experience a rise in their blood glucose level during pregnancy. These women have a condition called gestational diabetes mellitus (GDM). Their blood glucose levels usually return to normal after their babies are born. Other types of diabetes may occur as a result of diseases of the pancreas or the endocrine (gland) system, genetic disorders, or exposure to chemical agents.

Remember The care of diabetes is a team effort involving you your physician and the diabetes education staff where you

Diabetes Handbook What is Diabetes This handbook embodies the approach of the diabetes care team at the University of Massachusetts Medical Center. Different diabetes care teams may approach some aspects of diabetes care in ways that differ from those in this handbook. While most teams are in close agreement regarding the GENERAL PRINCIPLES of diabetes care, they may differ in the DETAILS. There can be more that one right way to approach a specific issue in diabetes management. Always remain in touch with your diabetes care team, and bring any questions you may have about the materials in this handbook to their attention

Psychological Aspects of Diabetes

Some people just don't believe they have diabetes. They don't see why they need to follow a diabetes care plan. Other people understand in their minds that they have diabetes, but still do not follow their care plans. These are forms of denial. It can take time to overcome denial, but the sooner you accept your diagnosis and begin learning about your diabetes, the sooner you'll achieve independence and good health under your care plan. Most people diagnosed with diabetes experience anger. It is perfectly normal to feel this way at times, but you won't help yourself by remaining angry and hostile all the time. Try talking to family members, friends, or others with diabetes to get these feelings out. And consider directing the energy you're using on anger to something positive by volunteering or fund raising for diabetes organizations. Maybe you feel guilty that something you did caused your diabetes. Was it all the candy you ate All that binge eating Are you being punished for...

Social Aspects of Diabetes

Job discrimination is against the law, but it happens. Employers who have had bad experiences with employees who had diabetes may be reluctant to hire you. Title V of the Federal Rehabilitation Act of 1973 defines diabetes as a handicap if it is used to exclude qualified workers from jobs, promotions, or other employment activities. This law may protect you against unfair employment practices if you work for People with diabetes are banned by law from certain types of employment. Regulations of the US Department of Transportation bar people with Type I (insulin-dependent) diabetes from driving trucks on interstate routes (these regulations are being changed to allow people with diabetes who follow strict guidelines to drive trucks on interstate highways). People with diabetes cannot serve in the armed forces or hold commercial pilot's licenses. In some states, they cannot join police forces. Federal Occupational Safety and Health Administration (OSHA) guidelines limit the types of...

Your Guide To Better Diabetes Care Rights Roles

An individual with diabetes can, in general, lead a normal, healthy, and long life. Looking after yourself and learning about your diabetes provide the best chance to do this. Your doctor and the other members of the health-care team (made up of doctors, nurses, dietitians, and chiropodists) are there to advise you and to provide the information, support, and technology for you to look after yourself and live your life in the way you choose. It is important for you to know what your health-care providers should provide to help you reach these goals and what you should do.

Goals for People with Type I Diabetes

Learning that you have Type I diabetes may be frightening, but you can help yourself by learning to control your condition. Keep the following goals in mind Balancing diet, exercise, and insulin If you have Type I (insulin dependent) diabetes, your body is producing no insulin. With an absolute lack of insulin, you have probably experienced the most common symptoms, excessive thirst (polydipsia), frequent urination (polyuria), extreme hunger (polyphagia), extreme fatigue, and weight loss. When you were diagnosed with Type I diabetes your blood sugar was probably over 300 mg and ketones were present in your urine. When you were diagnosed with Type I diabetes your blood sugar was probably over 300 mg and ketones were present in your urine. Without insulin, these symptoms progress to dehydration, resulting in low blood volume, increased pulse rate, and dry, flushed, skin. Ketones accumulate in the blood faster than the body is able to eliminate them through the urine or exhaled breath....

Controlling Type I Diabetes

CftntroLlhig TypE I DiabEtes CftntroLlhig TypE I DiabEtes To control your diabetes, your health-care provider will prescribe a regimen of insulin injections, diet, and exercise, and you will learn to monitor your blood glucose level. Insulin injections are necessary because your body does not produce insulin to funnel glucose into your cells. For information on insulin, see Chapter 8. Your diabetes diet Is a well-balanced meal plan that controls the types and amounts of food you eat. For information on the diabetes diet, see Chapter 6. Exercise reduces your insulin requirements by increasing the efficiency of the insulin you inject. Exercise also improves muscle tone and increases strength and well being. For information on exercise programs for people with diabetes, see Chapter 7. Monitoring your blood glucose provides the information necessary to design your diabetes care program and remain in good control. For information on monitoring, see Chapter 5.

Goals for People with Type II Diabetes

With Type II diabetes, you can enjoy a healthy, normal life by maintaining control of your condition. Keep the following goals in mind Learning about your diabetes and how to take care of yourself Minimizing the risk of complications by maintaining good blood sugar levels If you have Type II (non-insulin dependent) diabetes, your body has a relative deficiency of insulin. The beta cells in your pancreas are producing some insulin, but the insulin is either too little or isn't working properly to let glucose get into your cells to produce energy. If your Type II diabetes is not controlled, excess glucose accumulates in your blood, resulting in hyperglycemia, or high blood sugar. Your symptoms have come on so slowly that you may not have noticed them. You may have experienced some of the following more tired, increased thirst, frequent urination, dry, itchy skin, blurred vision, slow-healing cuts or sores, more infections than usual, numbness and tingling in feet. If Type II diabetes...

Controlling Your Type II Diabetes

To control your Type II diabetes, you need to eat right, stay active, monitor your control, follow your diabetes educator's or doctor's orders, and have regular checkups. Eating right helps you control your weight. Weight is the most important factor in Type II diabetes control. Eat healthy foods, and if you are overweight, follow a meal plan to lose weight. For information on nutrition for people with diabetes, see Chapter 6. Staying active with exercise burns calories to help you control your weight. Exercise also stimulates insulin functioning to make the insulin your body produces work more effectively. For information on exercise programs for people with diabetes, see Chapter 5. Following your diabetes educator's or doctor's ordersmeans sticking to your diet, exercise, and blood glucose monitoring instructions every day. Be sure to take prescribed medications at the correct times.

This handbook embodies the approach of the diabetes care team at the University of Massachusetts Medical Center

While most teams are in close agreement regarding the GENERAL PRINCIPLES of diabetes care, they may differ in the DETAILS. There can be more that one right way to approach a specific issue in diabetes management. Always remain in touch with your diabetes care team, and bring any questions you may have about the materials in this handbook to their attention

Exercise for the Overweight Person with Type II Diabetes

You may not feel like exercising because you are tired, and moving around takes a lot of effort. But you'll feel better when your diabetes is in good control, and you can help make this happen by following your diet and exercising. Exercise decreases your appetite and helps your own insulin work better. Exercise also burns up food calories and calories stored in body as fat. By using more calories than you eat, you'll lose weight, and when you lose weight, you'll be able to move with less effort. Exercise and Diabetes

Exercise for People with Type I Diabetes

But you must take extra food every hour during strenuous exercise to balance the calories you are burning. And you must always have fast acting sugar with you in case of a reaction . An insulin reaction is still possible hours after exercising. During prolonged, strenuous exercise (longer than 1 hour) sugar may be borrowed from your muscles and liver. Your body replenishes these stores over the next 12 - 24 hours.

Check With Your Diabetes Educator Or Doctor For Advice On Insulin Adjustments

Exercise speeds absorption of insulin, so avoid injecting into parts of your body that will be exercised during your activity. If you are planning leg muscle exercise (jogging, skiing, cycling), inject insulin into the abdomen or arms. For arm muscle activities (scrubbing walls, doing push ups, washing the car), inject into the abdomen or leg. For sports that use all body muscles (swimming, basketball), the safest place to inject is the abdomen. Always watch for signs of hypoglycemia (see Chapter 8). Don't wait until you finish exercising to treat a reaction. Stop immediately, treat the reaction, and wait 5 minutes before resuming activity. Exercising at the same time each day is beneficial, but not always possible. Keep in mind your insulin peak times and avoid exercising at these times. Also be aware that exercising at very high or low temperatures may cause you to burn more calories.

Oral Medications for Type II Diabetes

Since their introduction in the late 1950s, oral hypoglycemic agents have helped millions of people with Type II diabetes maintain control of their blood glucose levels. There are now several different kinds of oral medications for diabetes that act in very different ways. Follow the hyperlinks for more detailed information. 1. Pills that help put more insulin in the bloodstream the Sulfonylurea (sulfa containing) Type Pills You can only take a sulfa-containing pill for your diabetes if your liver and kidney function are good. 2. A new pill that helps put more insulin in the bloodstream The newest pill for persons with Type 2 diabetes, released in the spring of 1998, is called Prandin. It is meant to be used either alone or in combination with the Glucophage pill (see below). It is taken just before a meal and helps put more insulin in the bloodstream. It's not yet clear who would get the most benefit from it, but it may be useful if you are taking Glucophage but still do not have...

Diabetes Complications

People with diabetes are vulnerable to a variety of complications over time. Health-care providers all agree that strict control of blood sugar makes complications less likely. This was shown clearly by the Diabetes Control and Complications Trial. Control of blood sugar is the best way to minimize the risk of complications. Even the very best control may not be able to eliminate all complications, and the risk of increases with the length of time you have diabetes. Diabetes complications affect the eyes, kidneys, nerves, and large and small blood vessels. Here is a list.

Diabetes and the Family

P.- Gestational Diabetes Part II Advice for Parents of Children with Diabetes Part III What School Personnel Should Know About the Student with Diabetes 4 General Information 4 Insulin Reactions 4 General Advice 4 Teacher Information This chapter addresses special concerns of families coping with diabetes. Part I focuses on the special needs of women with diabetes during pregnancy. Part II provides advice for parents of children with diabetes. Part III provides information for school personnel who have contact with students who have diabetes.

Contemporary Diabetes

LoGerfo, md, 2006 The Diabetic Kidney, edited by Pedro Cortes, md and Carl Erik Mogensen, md, 2006 Obesity and Diabetes, edited by Christos S. Mantzoros, md, 2006 Diabetic Retinopathy, edited by Elia J. Duh, md, 2008 Diabetes and Exercise edited by Judith G. Regensteiner, phd, Jane E.B. Reusch, md, Kerry J. Stewart, edd, Aristidis Veves, md, dsc, 2009

Adipose Tissue Insulin Resistance and Lipotoxicity

Type 2 diabetes is characterized by insulin resistance (at the level of skeletal muscle, adipose tissue, and liver) and by impaired P-cell function (68,129-134). Both genetic and acquired defects have been shown to play a role in affecting insulin action and insulin secretion. Among the acquired defects, obesity and glucotoxicity (135-137) have received special attention as both are believed to worsen insulin resistance and possibly contribute to the decline in P-cell function. Dissecting the role of genetic factors from those attributed to obesity and or hyperglycemia itself has been particularly challenging. Equally difficult has been to define the sequence of events that results in the development of insulin resistance, and ultimately T2DM, in genetically predisposed subjects. For instance, it can be argued that adipose tissue insulin resistance may be the initiating event as it is present in nonobese normal glucose-tolerant subjects with a FH of type 2 diabetes long before the...

FFAInduced Insulin Resistance Early Studies

In 1963, Randle et al. (153) demonstrated that incubation of rat muscle with fatty acids diminished insulin-stimulated glucose uptake. They proposed a glucose fatty-acid cycle (better known later as the Randle cycle) that revolved around the notion that cardiac and skeletal (diaphragm) muscle could shift readily back and forth between carbohydrate and fat as sources of energy for oxidation, depending on substrate availability. In its original formulation of the Randle cycle, oxidation of fatty acids led to inhibition of the Krebs cycle and glucose oxidation, impairing glycolytic flux, and eventually leading to product inhibition of hexokinase function and glucose transport. More specifically, fat oxidation in muscle led to substrate accumulation of acetylCoA and citrate, which inhibited both pyruvate dehydrogenase (PDH) and phosphofructokinase (PFK), respectively. As a consequence of this inhibition, glucose-6-phosphate (G-6-P) would increase within the cell and inhibit hexokinase,...

Role of Mitochondrial Dysfunction in Muscle Insulin Resistance

Impaired muscle insulin action at an early stage in life could be the result from an intrinsic genetic inability of muscle to increase its oxidative capacity upon demand, as reported in lean FH+ subjects and or an acquired defect from excessive exogenous substrate (i.e., FFA) as in obesity and T2DM. Diminished lipid oxidative capacity has been reported by many laboratories in insulin-resistant lean FH+ and obese individuals, as well as in patients with T2DM (133, 134, 184, 206, 215-218). In Mexican-American FH+ subjects from San Antonio, Texas (219) , and in Caucasian populations (220), it has been reported that there is a coordinate reduction of genes involved in oxidative metabolism in insulin-resistant diabetic and nondiabetic FH+ Mexican-Americans. Several studies have manipulated FFA availability to muscle and shown that a reduction of FFA availability prevents FFA-induced insulin resistance. Knockout mice with deletions in the fatty acid transport protein 1 (FATP1) or...

Can Weight Loss andor Exercise Reverse Muscle Insulin Resistance

It is unquestionable that cardiorespiratory fitness reduces the risk of CVD and that low rates of physical activity are associated with a greater risk of developing insulin resistance, obesity, MS, and T2DM (51, 231-233). In the midst of an epidemic of obesity and diabetes, renewed interest has developed in understanding the molecular pathways by which exercise appears to reverse defects associated with insulin resistance reviewed in-depth under .234-236) . While the role of exercise will be reviewed in other chapters, a few points deserve attention. First, as discussed in the previous section, it is important to recognize that lipid accumulation in skeletal muscle and insulin resistance are not just the result of excessive fatty acid supply, but likely the combination of increased supply and a reduced capacity of muscle to use it as a fuel for energy needs. Because disruption in lipid metabolism FFA flux appears to be causal in the development of insulin resistance, it follows that...

Role Fatty Acids in the Control of Insulin Secretion

In the fasting state, plasma FFA (not glucose) is the primary energy substrate for sustaining insulin secretion (378). Following a meal, pancreatic P-cells switch from using FFA to glucose as the preferred energy source. This occurs as glucose enters the P-cell by high-capacity, low-affinity GLUT2 transporters and is rapidly phosphorylated to glucose-6-phosphate (G-6-P) by glucokinase that acts as the glucose sensor or pacemaker for insulin secretion (379). Glucokinase is the rate-limiting step for insulin secretion as the capacity of GLUT2 to transport glucose inside the P-cell is much greater than the capacity of glucokinase to phosphorylate it. Most of the glucose is then converted through glycolysis to pyruvate (P-cells have limited capacity to generate glycogen or lactic acid from glucose), entering the mitochondria and generating ATP through the Krebs cycle as acetyl-CoA. This promotes the formation of citrate, which is transported to the cytoplasm inhibiting CPT-1, which is the...

Type Diabetesa Matter of Cell Life and Death

In type 2 diabetes, the p cells of the pancreas fail to produce enough insulin to meet the body's demand, in part because of an acquired decrease in p-cell mass. In adults, pancreatic p-cell mass is controlled by several mechanisms, including p-cell replication, neogenesis, hypertrophy, and survival. Here, I discuss evidence supporting the notion that increased p-cell apoptosis is an important factor contributing to p-cell loss and the onset of type 2 diabetes. Interestingly, a key signaling molecule that promotes p-cell growth and survival, insulin receptor substrate 2 (IRS-2), is a member of a family of proteins whose inhibition contributes to the development of insulin resistance in the liver and other insulin-responsive tissues. Thus, the IRS-2 pathway appears to be a crucial participant in the tenuous balance between effective pancreatic p-cell mass and insulin resistance. Concurrent with the obesity epidemic, the incidence of type 2 diabetes is increasing at an alarming rate...

Selected Metabolic Aspects Of Diabetesg

A lay person would describe diabetes as too much sugar in the blood. So would J the iceberg, albeit one of profound pathogenetic impact. Type 2 diabetes is, in fact, a syndrome in which resistance to insulin in peripheral tissues is present for years, secretory mechanisms in response to the insulin resistance begin to fail, relative and subsequently absolute insulin deficiency occurs resulting in clinical hyperglycemia. Consequently, the signs and symptoms of polyuria and polydipsia become apparent associated with elevated HbAlc and exacerbation of hyperlipidemia. Many of the metabolic derangements typical of diabetes can be understood in terms of a few seminal actions of insulin. The dependence of acetyl CoA carboxylase activity on insulin in the liver results, in the case of insulin resistance, in failure of production of malonyl CoA, the first intermediate in fatty acid synthesis. Accordingly, fatty acid synthesis declines in the liver, in turn causing an increase in hepatic...

Cardiovascular Disease In Type Diabetes

Type 1 diabetes is characterized by an absolute loss of beta cells such that there is almost a total absence of insulin secretion (1). The majority of patients who develop type 1 diabetes have an autoimmune process that destroys the beta cells. There is another group of individuals who have type 1 diabetes in which beta-cell function is severely reduced in the absence of autoimmune destruction and in which the etiology of the beta-cell dysfunction is unknown. In type 1 diabetes, -g Table 4 Differences in Metabolic Profiles Between Insulin-Sensitive and Insulin-Resistant Type 2 Diabetic Patients Insulin-sensitive Insulin-resistant as a consequence of the development of obesity, which appears to be a result of intensive insulin treatment (12) or poorly controlled glycemia that leads to hypertriglyceridemia, excessive activation of vascular cell protein kinase C, increased production of advanced glycosylation end products (AGEs), endothelial dysfunction, and oxidative stress (13). Type 1...

Insulin Resistance In The Natural History Of Type Diabetes

Reduced insulin-dependent glucose transport is frequently found in nondiabetic relatives and offspring of patients with type 2 diabetes (5). This observation, as demonstrated in families and populations with a high incidence of type 2 diabetes, suggests that insulin resistance may be a primary factor in the development of type 2 diabetes and the early development of accelerated atherosclerosis. As such, the natural history of type 2 diabetes suggests that patients may be euglycemic and have normal insulin levels for many years before the development of the disease. In the presence of obesity and a family history of diabetes, insulin resistance typically is present and the individual will need to increase insulin secretion, particularly after meals, to compensate for the insulin resistance (1-4). Eugly-cemia is maintained, therefore, as long as the individual continues to sustain the compensatory hyperinsulinemia required to overcome the resistance (1-4). As recently reviewed from the...

Cellular Events Defining Insulin Action

Understanding the cellular mechanism(s) of action in the insulin-sensitive tissues responsible for insulin resistance would be important in the goal of identifying As stated, the aspect of insulin resistance that has been the most well described insulin stimulation (1,5). Specifically, this is represented by a reduction in the insulin-stimulated storage of glucose as glycogen in both muscle and liver in insulin action will be presented in order to fully understand the potential cellular abnormalities contributing to insulin resistance. Figure 2 Schematic representing clinical and laboratory findings in the natural history of type 2 diabetes. (Reprinted with permission from Ref. 92.) Figure 2 Schematic representing clinical and laboratory findings in the natural history of type 2 diabetes. (Reprinted with permission from Ref. 92.) The insulin signaling cascade, which results in the biological action of insulin in insulin-sensitive peripheral tissues (e.g., fat or muscle) begins with...

Insulin Stimulated Glucose Transport

The generation of the second messengers following insulin receptor binding and activation promotes cellular glucose transport into the cell. The enhanced insulin-stimulated glucose transport is mediated by translocation of a large number of glucose transporters from an intracellular pool to the plasma membrane (42). The glucose transporters consist of at least five homologous transmembrane proteins (Glut-1, -2, -3, -4, and -5) encoded by distinct genes, and have distinct specificities, kinetic properties, and tissue distribution that define their clinical role (42). Glut-1 and Glut-4 are two major glucose transporters that have been identified in skeletal muscle. Whereas Glut-1 may be primarily involved in basal glucose uptake, Glut-4 is considered the major insulin-responsive glucose transporter. In addition to skeletal muscle, Glut-4 is expressed in insulin target tissues such as cardiac muscle and adipose tissue. In normal muscle cells, Glut-4 is recycled between the plasma...

Assessment Of Clinical Insulin Resistance

A number of techniques that differ in sophistication, complexity, and sensitivity are currently available to assess the degree of insulin resistance in patients (67,68). lin resistance is the euglycemic hyperinsulinemic clamp technique (67,68). In this procedure, exogenous insulin is infused to maintain a constant plasma insulin level above fasting while glucose is infused at varying rates to keep the blood glucose within a fixed range. The amount of infused glucose required to maintain the blood glucose at the target level over time is an index of insulin sensitivity. As described, the more glucose that has to be infused per unit time in order to maintain the fixed glucose level, the more sensitive the patient is to insulin. With this procedure, the insulin-resistant patient requires much less infused glucose to maintain the basal level of blood glucose. The clamp procedure, therefore, provides a measure of insulin-stimulated whole-body glucose disposal (M value). More specifically,...

Clinical Interventions In The Management Of The Insulin Resistance Syndrome

Insulin resistance syndrome is associated with an increased morbidity and mortal- ity. A more relevant question is whether improvement of insulin resistance with practical and reliable test to assess insulin resistance, or a way to serially measure interventions that increase insulin sensitivity. These interventions include a calorie-restricted diet, weight reduction, exercise, and pharmacological intervention with agents such as metformin and glitazones (5). Most clinicians will readily agree that, in those subjects who do comply, a calorie-restricted diet will markedly ameliorate insulin resistance. Insulin sensitivity, in these cases, is significantly increased very early after initiating the calorie-restricted diet and this reduction is observed even before significant weight loss has occurred. Clinically, a reduction in insulin resistance is reflected by an improvement in glycemic control or a marked decrease in the need for exogenous insulin or higher doses of oral antidiabetic...

Cardiovascular Complications In Diabetes

Diabetes plays a powerful role in the development of cardiovascular diseases (810). The incidence of cardiovascular disease is two times higher in men with diabetes and three times higher in women with diabetes than nondiabetic subjects (10). Haffner et al. (11) reported that the risk of developing a myocardial infarction in type 2 diabetic patients without a previous history of myocardial infarction is similar to that of nondiabetic patients who have had a prior myocardial infarction. Diabetic patients have a twofold increase in the prevalence of hypertension compared with nondiabetic subjects (5). Hypertension is even more common in certain ethnic groups with type 2 diabetes. Almost twice as many African Americans and three times as many Hispanic Americans as compared with white non-Hispanic subjects have coexistent diabetes and hypertension (5). The coexisting hypertension and diabetes continue to rise dramatically in western countries as the overall population ages and as obesity...

Pathogenesis Of Hypertension In Diabetes

Several factors are involved in the pathogenesis of hypertension in patients with diabetes mellitus. These include genetic factors, sodium retention, and hyperin-sulinemia. Genetic predisposition plays an important role in the development of hypertension in both type 1 and type 2 diabetes. The higher prevalence of hypertension in certain ethnic groups, such as African Americans, suggests the role of genetic factors (5). Diabetic patients with hypertension are reported to have high frequencies of family history of hypertension (23). Elevated levels of sodium-lithium countertransport activity (24,25) and sodium-hydrogen countertransport activity (26) have also been found to play a role in the genetic predisposition to hypertension.

Clinical Trials Relevant To Treatment Of Hypertension And Prevention Of Cardiovascular Complications In Diabetes

Treatment of hypertension is crucial for the reduction of cardiovascular complications. There have been a considerable number of prospective randomized trials showing the benefits of treating hypertension in diabetes. The SHEP (Systolic Hypertension in the Elderly Program) trial showed that treatment of isolated sys- -o tolic hypertension in elderly type 2 diabetic patients with a diuretic, chlorthali-done, was associated with a significant decrease in the 5-year rates of cardiovas- S cular events and mortality compared to placebo (66). Similarly, in the Systolic Hypertension in Europe (Sys-Eur) Trial, treatment of isolated systolic hypertension in elderly patients with type 2 diabetes with an intermediate-acting calcium channel blocker, nitrendipine, showed a significant decline in cardiovascular J events and mortality compared to placebo (67). In both of these studies, the absolute risk reduction with active treatment compared with placebo was significantly larger for diabetic...

Platelet Function And Diabetes Mellitus

Patients with diabetes, particularly those with macrovascular disease, have an increased circulating platelet mass secondary to increased ploidy of megakaryocytes. In addition, platelets isolated from the blood of subjects with diabetes exhibit impaired capacity to mediate vasodilatation, apparently because of release of a short-acting platelet-derived substance(s) that interferes with the ADP-induced dilatory response seen in normal vessels with intact endothelium. Platelets from diabetic subjects demonstrate increased reactivity. They exhibit increased degranulation and increased aggregation in response to diverse stimuli. In addition, the procoagulant capacity of platelets from subjects with diabetes mellitus is increased. Thus, the generation of coagulation factor Xa and of thrombin is increased by three- to sevenfold in samples of blood containing platelets from diabetic as opposed to nondiabetic subjects. One potential mechanism responsible for the increased platelet reactivity...

Fibrinolysis And Diabetes

Decreased fibrinolytic system capacity is observed consistently as judged from analysis of blood from patients with diabetes mellitus, particularly those with type 2 diabetes. We have found that impaired fibrinolysis in subjects with type 2 diabetes mellitus, not only under baseline conditions but also in response to insulin-resistant states such as obesity, hypertension, and the polycystic ovarian syndrome. Increased expression of PAI-1 is a marker of increased risk of acute myo-cardial infarction as judged from its presence in relatively young, long-term survivors of acute myocardial infarction compared with age-matched subjects who had not experienced any manifestations of overt coronary artery disease. Because the endogenous fibrinolytic system influences the evolution and persistence of thrombosis and the rapidity and extent of lysis of thrombi associated with vascular damage and its repair, overexpression of PAI-1 is likely to exacerbate both development and persistence of...

Causes Of Insulin Resistance

Insulin resistance may be caused by rare genetic defects that alter insulin binding to its cellular receptors or cause defects in receptor or postreceptor signal trans-duction (1). Recently, defects in the nuclear receptor, PPARy, have also been linked to syndromes of severe insulin resistance (2). In addition, some endocrine-metabolic syndromes, such as Cushing's syndrome, acromegaly, and polycystic ovary syndrome, are associated with insulin resistance because of the hormonal imbalances associated with these conditions. However, in the most common forms of insulin resistance, single gene defects have not been identified and the development of insulin resistance represents a complex interaction among a poorly understood array of predisposing genetic factors and acquired environmental factors that modify insulin sensitivity. Among the latter, the most prominent are obesity (particularly intra-abdominal obesity), physical inactivity, and increasing age. It is also now well documented...

The Insulin Resistance Syndrome

Insulin resistance and hyperinsulinemia are frequently associated with a cluster of clinical and biochemical abnormalities that have been described with increasing detail and given a variety of names including deadly quartet, syndrome X, insulin resistance syndrome, metabolic syndrome, and cardiovascular dysmeta-bolic syndrome (9-13). Many prefer to call it insulin resistance syndrome because insulin resistance and the resulting hyperinsulinemia appear to be the underlying abnormalities from which the other features of the syndrome are derived (see Chap. 7). The hallmarks of insulin resistance syndrome are obesity, particularly central or intra-abdominal obesity, glucose intolerance, or type 2 diabetes mellitus, hypertension, a dyslipidemia characterized by elevated triglycerides, low HDL cholesterol and small dense LDL cholesterol, a hypercoagulable state characterized by alterations in both thrombosis and fibrinolysis and increased has been added to the list of characteristic...

Detection And Diagnosis Of Abnormal Glucose Metabolism In Insulin Resistance Syndrome

In 1997, the American Diabetes Association Expert Committee on the Diagnosis and Classification of Diabetes Mellitus established a new classification system 125 mg dL (6.1 to 6.9 mmol L) and (3) diabetes mellitus > 126 mg dL (7.0 -o to 11.1 mmol L) and (3) diabetes mellitus > 200 mg dL (11.1 mmol L). Diabe- 5 L) in conjunction with classic symptoms of diabetes, including polyuria, polydip- J sia, and unexplained weight loss. To establish a diagnosis of diabetes using either a The rationale used for establishing these diagnostic categories is that several studies have demonstrated a close, although not perfect, association between a fasting plasma glucose concentration of 126 mg dL and the 2-h OGTT value of 200 mg dL and both of these levels correlate well with the appearance of microvascular complications of diabetes including retinopathy, nephropathy, and neuropathy. It is also recognized that IFG and IGT are both conditions that are associated with an increased risk of...

Measurement Of Insulin Resistance

Several methods have been used to assess insulin resistance, but most are not readily available or practical for use in clinical practice. The easiest approach is to measure fasting plasma glucose and insulin concentrations or the glucose and insulin responses during an OGTT or test meal. The higher the insulin concentration in relation to the glucose level, the more insulin resistant the subject. One can also obtain similar information by measuring the C-peptide concentration in the fasting and stimulated states. Various methods have been developed to analyze glucose and insulin data, one of the most widely used being the homeostasis model (HOMA) that is most effectively used in large-population studies to assess insulin resistance and beta-cell function (44,45). A major drawback for using plasma insulin concentrations from individual patients is the wide range of normal values and lack of standardization of insulin assays used by clinical laboratories, both of which make...

Impaired Glucose Tolerance And Type Diabetes

Obesity is a well-recognized risk-factor for development of type 2 diabetes, but alone is insufficient to cause glucose intolerance. Thus, while it is generally accepted that women with PCOS are predisposed to type 2 diabetes (13,14), the development of diabetes cannot be attributed solely to the obesity that typically accompanies PCOS. Initial studies placed the prevalence of diabetes in PCOS at approximately 20 (8). More recent data have established that the prevalence of impaired glu- -o cose tolerance and type 2 diabetes mellitus among women with PCOS is even higher, with consistency across populations of varied ethnic and racial backgrounds (14,15). In two recent, large prospective studies, the prevalence of IGT g was between 30 to 40 and that of type 2 diabetes between 5 to 10 (14,15). < j These prevalences approximate those in Pima Indians who have one of the highest Ji rates of diabetes in the world (16). Evidence for an enhanced rate of development J of diabetes is also...

Heart Disease And Prediabetic States

The duration of diabetes influences the development of CAD in patients with type 1 diabetes, but such a relationship has not been demonstrated in those with type 2. Therefore, it is unclear whether the duration of asymptomatic hyperglyce-mia, or the state of impaired glucose tolerance, may have an important role on the development of CAD preceding the overt manifestations of type 2 diabetes (31,32). Several studies have shown that the mortality rate due to CAD was higher in patients with impaired glucose tolerance compared to normoglycemic men, although it was smaller when compared to that of patients with overt diabetes. At least one study has demonstrated that the risk of CAD increases linearly with fasting blood glucose levels in patients with impaired glucose tolerance, whereas the fasting insulin level has been implicated as a possible independent risk factor for CAD mortality in another study. Early impairment of LV diastolic function has been documented not only in patients...

Role Of Diabetes In The Genesis Of

There are several clinical, angiographic, and biological features particular to DM that increase the propensity for developing CAD in diabetic patients. In the aggregate, these risk factors increase the likelihood for sustaining a clinical event and have important prognostic implications. Endothelial dysfunction, platelet and coagulation abnormalities, and metabolic disorders associated with DM play a major role in accelerating the process of atherosclerosis and generating coronary thrombosis. The interplay of these factors and processes affects healing after arterial wall injury. The diffuse and distal nature of coronary atherosclerosis may contribute to incomplete revascularization and may increase the risk of surgical or percutaneous revascularization in diabetic patients.

Use of Pharmacotherapy for CAD and MI in Diabetics

In women and in non-insulin-requiring diabetics. Many factors, including a MI prognosis among diabetic patients. evaluated results from 4529 diabetic patients from a total sample of 43,073 pa- J firmed the important benefit of thrombolysis in diabetic patients. The absolute reduction in mortality was greater in diabetic patients than in nondiabetics (3.7 vs. 2.1 ), despite a greater 35-day mortality rate in diabetics (13.6 vs. 8.7 ). Diabetics also had a modestly higher absolute risk of developing hemorrhagic stroke than nondiabetics (0.6 vs. 0.4 ). This difference was not statistically significant. 2. Insulin-Glucose Infusion Long-term mortality in diabetic patients who are hospitalized for acute MI may be reduced by an insulin-glucose infusion followed by multidose insulin treatment. In the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study, an infusion of insulin and glucose followed by daily subcutaneous injections of insulin resulted in a 52...

Surgical And Interventional Management Of Cad In Diabetics

Several clinical trials have demonstrated that outcomes after myocardial revas-cularization are different in diabetic patients compared to nondiabetic patients. These differences should influence treatment decisions. Over the last decade, percutaneous coronary intervention (PCI) has gained increasing acceptance as an alternative to CABG surgery in selected patients. However, several reports demonstrating reduced long-term survival in diabetic patients treated with standard coronary balloon angioplasty have led to concerns regarding the use of PCI in this group of patients. A complete understanding of the mechanisms responsible for the reduced survival is of critical importance in the management of diabetic patients. The operative and procedural management of diabetics with symptomatic CAD will be discussed based on the type of intervention employed. This section will detail the short- and long-term clinical outcomes associated with standard balloon PCI, PCI with stents, and CABG...

B Cabg Surgery in Patients with Symptomatic CAD and Diabetes Mellitus

As described previously, the BARI trial has shown that patients with DM and angiographic multivessel CAD randomized to an initial strategy of CABG surgery have a striking reduction in mortality compared to diabetic patients randomized to balloon PCI. Further, post hoc analyses of three smaller trials comparing CABG with balloon PCI in patients with stable CAD demonstrated potentially conflicting results in diabetic subjects. In the CABRI trial, diabetic patients fared worse in a manner similar to that seen in BARI. By contrast, the RITA-1 and EAST trials demonstrated similar outcomes in diabetic patients treated with CABG or balloon PCI. Results from retrospective studies and registries bear on the role of CABG in diabetic subjects. A caveat in the interpretation of these results is that such databases of diabetic patients who have undergone coronary intervention may not be generalizable to more unselected groups. Further, the prognosis in such nonrandomized cohorts can be influenced...

In Patients With Diabetes

Most diabetic patients with CHF have it in conjunction with some other known cause(s) of CHF, usually coronary artery disease and or hypertension. Thus, there are relatively few patients with CHF in whom the only predisposing factor is diabetes. Stated another way, although there is strong evidence that cardiomyopa-thy is caused by diabetes, it is unusual for it to account for overt CHF by itself. Moreover, in an individual patient, it is usually impossible to delineate the qualitative and quantitative contributions of diabetic cardiomyopathy as opposed to hypertension or ischemia caused by coronary artery disease. As noted above, diabetes in combination with hypertension and coronary artery disease is not merely additive, but interacts with either or both in a way that seems to potentiate myocardial failure. Accordingly, when diabetic patients have CHF in association with coronary artery disease, they typically have conventional manifestations of myocardial ischemia (i.e., acute and...

Treatment Of The Hormonal And Metabolic Abnormalities Of Diabetes

Control of hyperglycemia retards progression of microvascular disease in both type 1 and type 2 diabetes. Accordingly, stringent glycemic control is imperative. Yet glycemic control exerts only a modest impact in retarding progression of macrovascular disease. Clearly other steps are needed. The recently initiated BARI 2D trial has been designed to provide information useful in this regard. Patients are being assigned randomly to stringent and comparable glycemic control with regimens that are either insulin-sensitizing (focusing on glitazones and metformin) or inulin-providing (focusing on insulin and sulfonylureas) regimens. Thus, the potential value of reduction of insulin resistance is being assessed. The effects of the two approaches on activation of coagulation, platelets, and fibrinolysis will be clarified as well. Because patients with type 2 diabetes are insulin-resistant, provision of exogenous insulin may be the most successful means for providing an adequate supply of...

Atherogenesis In The Prediabetic State

Diabetes emphasizes the profound acceleration of progression of atherosclerosis that occurs long before diabetes becomes overt. The prediabetic state provides particularly fertile ground for germination of vulnerable plaques. Thus, a focus on treatment in the prediabetic state is likely to be important in preventing cardiovascular events later in ultimately diabetic subjects. One example is women with the polycystic ovary syndrome. These subjects are insulin-resistant and often have postprandial hyperglycemia. They are also often hypertensive. They are at increased risk for coronary artery disease. Accordingly, therapy designed to ameliorate insulin resistance is under intense investigation.

Vcardiomyopathy And Diabetes

Induction of cardiomyopathic changes in hearts of animals rendered insulin deficient is a well-recognized phenomenon. Accordingly, the term ''diabetic cardio- a myopathy'' has been extant for decades. Implicated derangements include impaired function of the sarcoplasmic reticulum, an organelle responsible for the uptake and release of intracellular calcium and, therefore, pivotal in modulating cardiac contractility. However, cardiomyopathy changes may not be related exclusively to metabolic derangements typical of insulin deficiency. They occur also in hearts of patients with type 2 diabetes whose hyperglycemia is well controlled. Patients with diabetes who sustain acute myocardial infarction exhibit greater impairment in ventricular function and more severe congestive heart failure normalized for infarct size than do nondiabetic subjects. Factors implicated in causing such derangements include limitation of energy supply attributable to insulin resistance in the myocardium and...

Controversy Is Glucosamine Safe in Diabetes

In 1999 a letter to the journal Lancet raised questions about whether glu-cosamine supplements could increase glucose (blood sugar) levels, cause insulin resistance, and lead to or aggravate diabetes. The questions raised in this letter were widely reported in the University of California Berkeley Wellness Letter, the Tufts University Health & Nutrition Letter, and other publications toward the end of that year (the delay resulting from publication schedules). These newsletters warned that glucosamine supplements could lead to or worsen diabetes. were speculative and based only on limited animal research. In contrast, clinical experiences with humans indicated that glucosamine supplements had a tendency to slightly lower blood sugar levels, which would reduce the risk of diabetes. One researcher reported that glucosamine supplements improved wound healing, reduced headaches, and eased inflammatory bowel disease in patients. None of these side benefits were reported by the...

How Common Is Diabetes

Full-blown adult-onset diabetes affects an estimated 15 million Americans, about half of whom have not been officially diagnosed with the disease. (Juvenile-onset diabetes is an autoimmune disease that is rarely reversible.) However, as many as 70 million Americans have some degree of insulin resistance or Syndrome X. Syndrome X refers to a cluster of insulin resistance, high blood pressure, abdominal obesity, and elevated cholesterol and triglycerides. (For more information see my previous book Syndrome X.) Basically, anyone eating the typical American diet is consuming foods that increase the risk of insulin resistance, Syndrome X, and diabetes.

Blood Sugar and Insulin The Basics

You need to know a little about normal metabolism to understand how so many of us are developing prediabetes and then diabetes. Metabolism represents the body's processes that direct energy into storage, such as in fat, or into fueling normal growth, development, and physical activity. Carbohydrates (including complex starches and simple sugars), fat, and protein are the three nutrient groups in our diet that provide the energy and building blocks for metabolism and growth. Carbohydrates and fat provide most of the energy to keep our body's machinery working, including our muscles for locomotion and our vital organs such as brain, liver, heart, lungs, and kidneys. For sugar to gain entry to most cells, it must be carried across the cell wall by glucose transporters. This is where insulin first comes into play. Insulin is a hormone, which means it is a protein that is made and secreted by specialized cells and then circulates in the bloodstream and affects other organs and their...

Type and Type Diabetes

The two main forms of diabetes are called type 1 and type 2 diabetes. Although they have different causes and, to a great extent, affect different categories of people, they share three main features. First, type 1 and type 2 diabetes are both characterized by metabolic abnormalities that include high levels of blood sugar in the circulation, as well as increased levels of other nutrient breakdown products that are released from their storage sites. See Table 1.1. Second, decreased insulin secretion or a decreased sensitivity to insulin action is the reason for these metabolic abnormalities. In the case of type 1 diabetes, the body makes no or very little insulin because the insulin-secreting islets have been harmed or destroyed. In type 2 diabetes, the body cannot meet the increased insulin demands brought on by a condition called insulin resistance. table i.i How We Diagnose Diabetes table i.i How We Diagnose Diabetes Diabetes* level Prediabetes level *To make a diagnosis of...

Type Diabetes The Twentieth and Twenty FirstCentury Epidemic

For years, type 2 diabetes was called adult-onset diabetes because it usually begins later in life. In recent years, however, as more children have become heavier at earlier ages, type 2 diabetes has increasingly been seen in teenagers and young adults. Of all peo- ple with diabetes, more than 90 percent have type 2 diabetes. Unlike type 1 diabetes, the development of type 2 diabetes is strongly influenced by lifestyle. There are two underlying causes of type 2 diabetes. One is the development of insulin resistance. This condition causes the tissues of the body to become less sensitive to the effects of insulin. As a result, sugar circulating in the blood does not leave the blood and enter the body's cells as easily. For the blood sugar to be lowered effectively and for the other jobs of insulin to be carried out, more insulin is required. The second cause of type 2 diabetes is the inability to increase insulin to cope with increased demand. Insulin resistance, decreased insulin...

Metabolic Syndrome Diabetes Plus

Metabolic syndrome is a constellation of problems that often includes diabetes or prediabetes. What are the other conditions Being overweight, especially when extra pounds accumulate around the midsection having high or borderline-high blood pressure having high triglyceride levels and having low HDL (good) cholesterol. Specifically, you have metabolic syndrome if you have diabetes or prediabetes and two or more of the following researchers think that the impact of the metabolic syndrome on health is more than the sum of its parts. Over the years, this collection of health risks has gone by many names. Besides the deadly quartet, it has also been called syndrome X, insulinresistance syndrome, diabesity, and the dysmetabolic syndrome.

Why Diabetes and Metabolic Syndrome Matter

The ultimate impact on health of type 2 diabetes and metabolic syndrome is through cardiovascular disease. The cluster of features associated with type 2 diabetes or the metabolic syndrome is a highly potent recipe for heart disease and stroke. People with type 2 diabetes or the metabolic syndrome have at least a two-to fivefold increased risk of cardiovascular disease. The relative risks are even higher in women with diabetes compared with their counterparts who are nondiabetic. In addition, in the United States, type 2 diabetes is the major cause of blindness, kidney failure, amputations, and neurological complications, such as impotence. Type 2 diabetes decreases life span by an average of seven to twelve years.

How Our Lifestyle Has Made Us Vulnerable to Diabetes

In 1985, an estimated 30 million cases of diabetes existed worldwide. This number increased to 177 million in 2000 and is estimated to rise to at least 370 million by 2030, almost all from type 2 diabetes associated with aging, obesity, and inactivity. In the United States, the numbers of cases of diabetes and obesity have risen in parallel. Diabetes and prediabetes affect 18 million and almost 40 million persons, respectively, and the metabolic syndrome affects almost 25 percent of the U.S. population. It is all too easy to ascribe these alarming statistics to the increased numbers of the very obese and the very old. But only about 2.3 percent of the population is severely obese and only 3.3 percent of the population is older than eighty small percentages. The major public health problem is not caused by very large or very old people. Most cases of diabetes and prediabetes are caused by the ever-increasing population that is overweight or only modestly obese. The fraction of the U.S....

Lifestyle and Type Diabetes

You can see now why lifestyle is so important in causing (and potentially preventing) type 2 diabetes. During the same time that our lifestyle has changed, type 2 diabetes has transformed from a disease that was barely recognized to one that affects 8 percent of the entire adult population, 13 percent of those older than forty, and 20 percent of those older than sixty-five. Being obese substantially increases the risk of developing diabetes, but even being a little bit overweight increases the chances of developing diabetes. Similarly, our sedentary lifestyle, independent of obesity, increases the risk of developing type 2 diabetes. Inactivity leads to insulin resistance and prediabetes, both of which lead to type 2 diabetes. Some of the pernicious effects of inactivity are secondary to obesity, but inactivity also makes our muscles less sensitive to the effects of insulin. In addition to advancing age, being overweight or obese, and inactivity, inheritance plays a large role in...

Why Weight Is Important to Diabetes Prevention and Treatment

Use this math to your advantage to develop effective ways to achieve and maintain a healthy weight. In Chapter 1, we briefly described how being overweight alters the way the body metabolizes food, which can lead to high blood-sugar levels. So careful attention to weight is a key part of any diabetes prevention or treatment program. This book will describe a proven program to maintain a healthy weight. How do we know it works It's based on principles tested and proved in a major clinical trial called the Diabetes Prevention Program (DPP). We will share with you not only what we've learned during the development and conduct of the DPP and other studies but the stories of people who have made the program work for them. Next, we will briefly describe how the science of diabetes prevention and care evolved. Then we'll tell you how to put those principles to work for you.

The Diabetes Prevention Program

With support from the National Institute of Diabetes, Digestive and Kidney Diseases of the National Institutes of Health, a group of clinical investigators from around the United States developed a program with the goal of preventing diabetes and put that program to a scientific test. The Diabetes Prevention Program, or DPP as it was called, involved 3,234 people who did not have diabetes but who were at high risk for developing diabetes. The DPP was the largest study of lifestyle changes to prevent diabetes that has ever been conducted. The study participants were all adults (older than twenty-five) and overweight or obese, and they all had impaired glucose tolerance (IGT). IGT is a condition in which blood-sugar levels are elevated after a standardized test called the oral glucose tolerance test, but not high enough to be considered diabetic. People with this condition are on the road to developing diabetes, which is why IGT is now called prediabetes. The DPP volunteers were...

Medication to Prevent Diabetes

The Diabetes Prevention Program study tested not only the impact of lifestyle. It also tested the value of a medicine, metformin, in preventing diabetes. Metformin is a medicine that is commonly used to treat diabetes. It works primarily by decreasing the amount of sugar made by the liver and by reducing insulin resistance. 139 As reviewed in Chapter 2, type 2 diabetes develops gradually. In the years that it is developing, but before it causes symptoms or blood test abnormalities that lead to its diagnosis, there is slowly increasing insulin resistance. The resistance of the body's tissues to the effects of insulin causes blood-sugar levels to rise, especially after meals. This, in turn, causes the pancreas to make more insulin. Eventually, the pancreas becomes fatigued from overwork, insulin secretion fails, and full-blown type 2 diabetes results. Because slowly developing insulin resistance underlies type 2 diabetes, it made sense that using a medication that reduces insulin...

How People with Type Diabetes Successfully Manage Their Diabetes

The tricks to successfully managing type 1 diabetes and maintaining the near-normal blood-glucose levels necessary to stay 48, healthy are paying attention to your daily schedule, understand ing the effects of your lifestyle on blood sugars, and adjusting your insulin to maintain blood-sugar levels in the range you and your health-care team agree is right for you. Maintaining some consistency in mealtimes and meal sizes will help during the early stages of adjustment however, as time goes on you will learn how to adjust even if you have inconsistencies. For example, if you planned to eat a large Sunday breakfast of cereal, eggs, toast, and orange juice, you would check your blood sugar before starting to eat. If you found that your blood-sugar level was on the high side let's say 150 mg dL you would consider giving ten units of rapid-acting insulin, approximately four units more than the usual dose, because of your relatively high blood-sugar level and the greater carbohydrate content...

Lifestyle Changes to Treat Type Diabetes and Associated Diseases

If you have type 2 diabetes, it should come as no surprise that lifestyle has a major impact on your diabetes especially your blood-sugar control and that lifestyle changes can have a beneficial effect. As explained in Chapter 1, type 2 diabetes represents the end of a long and somewhat complicated road on which insulin resistance, or decreased insulin sensitivity, and the inability to make enough insulin contribute to rising blood sugars. At first, blood-sugar levels begin to rise slightly after meals because, in the setting of insulin resistance, the breakdown products of the meal are not normally stored in the muscle and liver. During this pre- 149 diabetic phase, there are no symptoms and fasting blood-sugar levels remain in the near-normal range. Prediabetes can sometimes be detected with a fasting blood-sugar test, but more often a stress test called a glucose-tolerance test is required. In most persons who are destined to develop diabetes, the next five to ten years are...

Special Issues for People with Diabetes

If you have diabetes you need to be careful of certain things. Your Feet All people with diabetes need to take extra-special care of their feet. Neuropathy (one of the long-term complications of diabetes that affects the nerves in your feet) may affect your ability to sense minor trauma. This can be compounded by decreased circulation and structural changes of the foot. Even minor repetitive trauma from weight bearing and poorly fitting shoes can lead to abrasions, blisters, and callus formation. Penetrating infections can spread from the skin to the bones, and this can lead to the need for an amputation. ioning to absorb the impact. With appropriate foot gear and some caution, most people with diabetes can participate in a wide variety of exercises.

Understanding Diabetes

Diabetes mellitus, or diabetes, is an illness in which there is an abnormally high level of glucose in the blood. Depending on how high your glucose level is and how long it has been high, you may feel fairly well, or you may be so sick that you require hospitalization. Usually, your doctor will test you for diabetes if you have symptoms such as thirst, frequent urination, weight loss, blurred vision, and fatigue. This chapter helps you understand how diabetes is defined and classified and how physicians test for the disease. The liver is in charge of taking up and releasing glucose into the bloodstream. After a meal, the blood carrying nutrients from digestion first flows through the liver, which removes the excess glucose. When the glucose level in the blood drops (for example, after fasting or exercising), the liver does the opposite and releases glucose into the bloodstream. The liver knows how to regulate the level of glucose in the blood because it receives signals from...

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. Type 1 Diabetes In the United States, there are approximately 1 million people with type 1 diabetes, and about thirty thousand new cases are diagnosed each year. Type 1 diabetes can occur at any age and in any ethnicity, but is more common in children and young adults of Caucasian ancestry. Most cases occur in families where there is no history of type 1 diabetes, but when you have a family member with type 1 diabetes, your risk of getting the disease is higher. Over the past forty years, there has been an increase in the incidence of type 1 diabetes in many countries, and it is occurring in...

Diabetes And Problems With Skin And Nails

There are a number of skin and nail problems that are more commonly seen in people with diabetes. These include the following Acanthosis nigricans, a darkening of the skin at the back of the neck and under the armpit. The skin has a velvety feel. This condition occurs in people with type 2 diabetes who are very insulin resistant. It does not require any treatment. Necrobiosis lipoidica diabeticorum. This is seen mostly in people with type 1 diabetes. There is a thinning of the skin on the shins with a reddish yellowish discoloration. Sometimes it can be ulcerated in the middle. Treatment is usually with steroid injections or creams. Lipohypertrophy, a localized swelling, is caused by repeated insulin injections in one spot. Insulin absorption becomes more erratic in these areas. Stopping injections of insulin in the affected area usually leads to recovery. Shin spots, or diabetic dermopathy, are brown, oval patches on the shins (and sometimes on the forearms) of people with diabetes....

Diabetes And Circulatory Problems

People with diabetes, especially those with type 2 diabetes, are two to five times more likely to have problems with circulation to the heart, the legs, and the head when compared to individuals without diabetes. This is because diabetes predisposes a person to a condition called atherosclerosis. If you imagine a blood vessel as a water or drainage pipe, then atherosclerosis is buildup in the pipe narrowing the channel and impairing the flow. In the case of the blood vessel the buildup, called plaque, consists of a core of inflammatory cells, cholesterol, and lipids with a fibrous cap of smooth muscle cells (see Figure 3-1). The plaque can narrow the blood vessel, impairing blood flow. Occasionally the fibrous cap can rupture, and when this happens a blood clot forms, causing an acute blockage of the blood vessel. If the acute blockage happens in one of the blood vessels to the heart, it results in a heart attack. If it occurs in one of the blood vessels supplying brain tissue, it...

Diabetes And Female Sexual Dysfunction

Women with diabetes are at increased risk for sexual arousal disorder that is, inadequate vaginal and clitoral swelling in response to sexual arousal. A small research study showed that in women with type 1 diabetes, sildenafil improved arousal, orgasm, and sexual enjoyment. A woman with diabetes should discuss problems of sexual arousal with her physician. The symptoms of diabetes depend upon the degree of insulin deficiency If the insulin deficiency is modest so that the glucose levels are only slightly elevated, there may be no symptoms and diabetes may be discovered on routine testing. If the insulin deficiency is moderate, the presentation may be of bladder infection, vaginal or penile yeast infection, or increased nighttime urination. If the insulin deficiency is severe, there may be thirst, frequent urination, weight loss, tiredness, and blurred vision. If untreated there can be progression to diabetes ketoacidosis (in type 1 patients) or hyperosmolar coma (in type 2 patients).

Certified Diabetes Educator

The certified diabetes educator (CDE) will educate you about the kind of diabetes you have and your medication options. She will educate you about the importance of controlling glucose, lipids, and blood pressure to prevent complications and about the effects of exercise and emotions on glucose control. She will also show you how to use glucose monitors, how to treat high and low glucose levels, and how to exercise safely. If you are on insulin, she will teach you how to inject insulin and how to use your insulin pens or pumps.

The ADA and Other Sources of Diabetes Related Information

The American Diabetes Association has an excellent website, and it also publishes many self-help books for patients. You can also seek out local diabetes support groups through your local hospital or pharmacist or by searching on the Internet. There are support groups that cater to people with type 1 and type 2 diabetes, those using insulin pumps, and families who have children with diabetes. These groups enable people with diabetes to share experiences and enhance their knowledge about diabetes self-management. There are also many Internet websites devoted to diabetes. They vary in the quality of information they provide, so you may want to go to the websites of professional organizations like the ADA first. You can also look at the Canadian Diabetes Association and the British Diabetes Association websites (see Resources). Once you get good basic information, then you can go to websites that cater to specific issues like insulin pumps or diabetes and exercise. Information about...

Diabetes Medicine Combinations

Many people with diabetes are on more than one medicine to control glucose levels, and pharmaceutical companies make combination pills that is, a pill containing two different diabetes medicines. Since many insurance companies make their customers pay a part of the cost of each prescription (a copayment), the combination pill has the benefit of eliminating one of the copayments. However, the disadvantage of these combinations is that you lose some of the flexibility of adjusting the individual doses of the medicines. Also, if you need to discontinue one of the two medications, you may have to go back to the doctor and get a prescription for the single medicine that you are continuing. The combination pill usually has a different name, and often patients (and physicians) forget that the pill contains two different medicines. If you are prescribed a combination pill, make sure that you are not taking both a combination pill and one of the components of the combination pill as a separate...

Fastacting Insulin Preparations

There are four fast-acting insulin preparations Regular insulin Insulin lispro Insulin aspart Insulin glulisine Table 6-9 Characteristics of the Currently Available Insulins Table 6-9 Characteristics of the Currently Available Insulins Insulin Preparations Insulins lispro, aspart, glulisine Insulin glargine Insulin detemir

The Technical Side of Regular Insulin

Regular insulin consists of aggregates of six molecules of insulin complexed to two zinc ions (a hexamer). After subcutaneous (under the skin) injection, the regular insulin hexam-ers become diluted by the tissue fluids and become monomers (single molecules), which then enter the circulation and have their effects. a shorter period of time about four hours (rather than six hours). These properties make these insulins more effective at controlling the glucose rise after meals. Clinical studies have shown that when these insulin analogs are used in an optimal manner, you can achieve improved glucose control with less risk of hypoglycemia. However, there are some cautionary notes first, because the peak level of the insulin with the analogs is higher after a meal, it is important for you to be more precise in counting the carbohydrates you are consuming. Regular insulin is more forgiving of errors in carbohydrate counting. Also, if you were to consume a very fatty meal, which delays...

Longacting Insulin Preparations

There are three long-acting insulin preparations NPH insulin Insulin glargine (brand name Lantus) Insulin detemir (brand name Levemir) Mixing regular insulin with a fish protein called protamine forms a crystal (neutral protamine Hagedorn, NPH), which dissolves slowly when injected subcutane-ously, so that the effect on average lasts for about eight hours (shorter duration for very small doses and longer duration for large doses). The crystals of NPH insulin appear white to the naked eye, and they tend to settle in the insulin vial. This is why you should mix the NPH insulin (by rolling the bottle between the palms of your hands) before drawing it up in the syringe. Insulin glargine is human insulin that is modified so that it is soluble in a more acidic solution. It looks clear in the bottle, and when injected it precipitates in the tissues and is then slowly released into the bloodstream. Since it is acidic, the manufacturer recommends it should be given as a separate injection and...

Exubera Inhaled Insulin

Inhaled insulin is not a new insulin it is simply an old insulin (regular insulin) that is delivered into the body in a different way. You use an inhaler (very much like an asthma inhaler) to inhale the insulin powder, which is available in 1 mg and 3 mg blister packs. The 1 mg pack is equivalent to 3 units of insulin, and the 3 mg pack is about 8 units of insulin. Three 1 mg inhalations are not equivalent to one 3 mg inhalation you get one-third more insulin with the former. This is because three separate inhalations result in more insulin being absorbed than one larger-dose inhalation. Only about 10 percent of the delivered dose gets into the circulation, so an average adult has to inhale 300 to 400 units of insulin a day. The inhaled insulin is rapidly absorbed the insulin profile is very much like the injected fast-acting insulin analogs, except it lasts longer (up to six hours). The biggest unanswered question about inhaled insulin is whether it will damage the lungs if used for...

Using An Insulin Pump

An insulin pump is a device the size of a pager. It contains a syringe or reservoir filled with a fast-acting insulin, a battery-powered syringe plunger, and a small computer to control the insulin delivery. The syringe is attached to tubing, which in turn is attached to a small plastic tube (cannula) inserted under the skin (see Figure 6-1). The pump can be programmed to put tiny drops of insulin into the subcutane- Figure 6-1 Insulin Pump ous tissues every three to ten minutes day and night this is the basal insulin. When you eat, you can program the pump to give a bolus of insulin for the food. Thus, when you are on the pump, you use only a fast-acting insulin to provide both your basal and bolus needs. Often, people with type 1 diabetes will decide to go on an insulin pump for their diabetes control. The pump does not check glucose levels, nor does it decide how much insulin to give. It does allow you to tailor your basal insulin to your needs. With a pump, you are better able to...

Setting Up Your Insulin Pump

Show you how to fill a reservoir without getting bubbles and how to prime the tubing. An inch of bubble in your tubing is equivalent to half a unit of insulin. Thus, having bubbles in your tubing can reduce the amount of insulin you are getting and can lead to high glucose levels. Once the tubing is primed, you can insert the infusion set and attach the tubing. A 0.3- to 1.0-unit bolus may be needed to fill the dead space in the infusion set. The pump trainer should teach you how to use a pump using saline (salt water, as opposed to insulin). Ideally, you should do this for about a week before your planned initiation of insulin in the pump. During this time, you can practice changing sets, filling reservoirs, priming tubes, and adjusting basal and bolus doses.

The Cure for Type Diabetes

A pancreas transplant will cure type 1 diabetes. So why doesn't everyone with type 1 diabetes get a pancreas transplant There are two reasons. First, there are only a limited number of donor pancreata available a few thousand whereas there are about a million people with type 1 diabetes. Second, people who get an organ transplant have to be on medicines to prevent the body's immune system from attacking and rejecting the organ. These immunosuppressive medicines have serious side effects, such as making the individual more susceptible to infections and increasing the risk of developing a cancer in the future. You are likely to be offered a pancreas transplant if you have kidney failure and you are on a list for a donor kidney. Because getting two organs simultaneously has additional risks, some restrictions do apply. For example, if you have a history of heart attacks or strokes, you may not be a candidate for simultaneous pancreas-kidney transplant. A pancreas transplant alone that...

Nutrition in Type Diabetes

Most people with type 1 diabetes are of normal body weight, and they usually do not need to be on a calorie-restricted diet. They also do not tend to have the cholesterol abnormalities that are commonly seen in patients with type 2 diabetes. The American Diabetes Association recommends that an adult should obtain These recommendations also apply to lean individuals without diabetes. In other words, this is a normal, healthy diet. You should have a good idea of how much carbohydrate you are going to eat at a meal, because it will affect how much insulin you should take before the meal. Estimating the carbohydrate content of a meal is called carbohydrate counting or carbohydrate exchange. You need two pieces of information to count carbohydrates

Your Diet for Type Diabetes

People with type 2 diabetes are frequently overweight, so advice about nutrition is directed not only at controlling carbohydrate intake, but also at limiting calories. (I discuss caloric restriction and weight loss in Chapter 10.) If you have type 2 diabetes, there are several reasons why you still need to estimate the carbohydrate content of your food Abnormalities in insulin secretion mean that eating a high-carbohydrate meal results in high glucose levels immediately after the meal. You want to avoid these high postmeal glucose levels because they can contribute to increases in HbA1c levels (see Chapter 5). If you are using insulin injections, you need to count carbohydrates in order to adjust your insulin doses (just like people with type 1 diabetes). According to the ADA, a normal, healthy diet for people with diabetes should consist of The glucose rise after eating is due to the carbohydrates in the meal, and therefore all people with diabetes should learn carbohydrate...

Adjust the Insulin Dose

Before exercise, adjust the bolus or basal insulin, or both, in anticipation of the exercise. A bolus of a fast-acting insulin analog lasts for about four hours, and the peak is at about one to one and a half hours. If you exercise within two hours, you will need to cut back on the premeal bolus (to 50 to 75 percent of your usual dose). Making an adjustment in basal insulin dosing is easier if you are on an insulin pump. If you are planning for exercise of long duration (longer than ninety minutes), you may want to cut back the amount of your basal insulin for up to two hours before the exercise. If you are participating in competitive sports, you may find that the adrenaline rush means that you may have to increase your basal insulin temporarily for up to two hours before the exercise. Adjusting the basal dosage of the long-acting insulins like glargine or detemir is trickier you can try cutting back to 50 to 80 percent of the dose on the days you exercise. Any high glucose levels...

Exercise and Type 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 when you exercise if you take sulfonylureas, nateglinide, or repaglinide, you can get low glucose levels with exercise. Prepare for this by taking your meter and some glucose tablets or juice with you. If hypoglycemia occurs when you exercise, talk to your doctor about reducing the dose of your sulfonylurea medication.

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). You should also carry a travel letter from your doctor explaining that you have type 1 or 2 diabetes and the medications you are using to treat it. This note should also include the medicines you are taking for other conditions as well as any food and drug allergies you have. Also obtain a spare prescription for all your medications in case you lose your supplies or your stay is prolonged. Wear your MedicAlert bracelet at all times, and carry a card or letter explaining that you have diabetes written in the languages of the places you are visiting. Keep a...

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 the vial before drawing up your insulin into the syringe. Check your blood glucose frequently during the flight. You may need a little more insulin because you are inactive. If you are traveling alone and are concerned that you might experience hypoglycemia, tell the flight attendants that you have diabetes so they can keep an eye on you.

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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