Conducting intensive insulin treatment

Intensive insulin treatment is essential in type 1 diabetes if you hope to prevent the complications of the disease. This means measuring your blood glucose at least before each meal and at bedtime, plus using both short-acting and longer-acting insulin to keep the blood glucose between 80 and 100 before meals and less than 140 after eating. How you do this is the subject of this section. In a person who doesn't have type 1 diabetes, a small amount of circulating insulin is always present in...

Enlist Help to Fight Food Temptation

Ever since Adam and Eve, the problem of temptation has been on the front burner. For a diabetic, the constant temptation is to eat foods that do not further your major diabetic goal, which is to control your blood glucose. The opportunities for screwing up your diet are boundless. Just like your exercise partner, your food partner your significant other can make staying on your diet a lot easier for you. If your partner cooks most of the meals in your household, he or she has a responsibility...

Navigating the Health Insurance System

You can get insurance for your medical care several ways. This section describes the most common forms. If you or your child has diabetes, you can count on several things being true when you interact with the medical insurance system in the United States. You will pay more out-of-pocket than families without diabetes even when you have coverage. And you may be denied coverage more often. If you are an older adult with diabetes, you can expect to spend one and a half times as much for medical...

Symptoms of hypoglycemia

Your body doesn't function well when you have too little glucose in your blood. Your brain needs glucose to run the rest of your body, as well as to function intellectually. Your muscles need the energy that glucose provides in much the same way that your car needs gasoline. So, when your body detects that it has low blood glucose, it sends out a group of hormones that rapidly raise your glucose. But those hormones have to fight the strength of the diabetes medication that has been pushing down...

Causes of hypoglycemia

Hypoglycemia results from elevated amounts of insulin driving down your blood glucose to low levels, but an extra high dose of insulin or sulfonylurea medication isn't always the culprit that elevates your insulin level. The amount of food you take in, the amount of fuel (glucose) that you burn for energy, the amount of insulin circulating in your body, and your body's ability to raise glucose by releasing it from the liver or making it from other body substances all affect your blood glucose...

Its the Glucose

Testing for prediabetes Defining diabetes by the blood glucose Finding treatments for diabetes Meeting actual patients and their stories rhe Greeks and Romans knew about diabetes. The way they tested for the condition was prepare yourself by tasting people's urine. In this way, the Romans discovered that the urine of certain people was mellitus, the Latin word for sweet. (They got their honey from the island of Malta, which they called Mellita.) In addition, the Greeks noticed that when people...

Harbor Village

Acclaimed by Gourmet Magazine as a gold cup restaurant commanding the respect of Chinese gastronomics, Harbor Village was serving award-winning food in Hong Kong for many years before coming to San Francisco and later Los Angeles. In an environment reminiscent of the fine restaurants of Hong Kong, the Chinese chefs prepare dim sum that has been called the finest in the United States. The seafood is prepared fresh from their fish tanks. Dishes are made up of fresh local ingredients, yet the...

Understanding the Importance of the Accord Study

The ACCORD study is a study of 10,250 people who have had T2DM and are at high risk to have a heart attack. The average hemoglobin A1c was 8.2 percent, which is higher than the average patient with T2DM. The patients were randomized into two treatment arms, a standard treatment arm that had a goal of an A1c target between 7 and 7.9 percent and an intensive treatment arm that had a goal of an A1c target less than 6 percent. All patients already had known heart disease and at least two other risk...

Detecting Prediabetes

Diabetes does not suddenly appear one day without previous notification from your body. For a period of time, which may last up to ten years, you may not quite achieve the criteria for a diagnosis of diabetes, but you aren't quite normal either. During this time, you have what's called prediabetes. A person with prediabetes does not usually develop eye disease, kidney disease, or nerve damage all potential complications of diabetes, which I discuss in Chapter 5 . However, a person with...

Roche Diagnostics

Roche Diagnostics, which did not sell meters originally, merged with Boehringer Mannheim and now sells its meters. The batteries in these meters are replaceable at home. The meters may be used at alternate sites besides the fingers. i Accu-ChekAviva This meter works with diabetes management software DMS . It has a very large memory, storing up to 500 blood glucose values, with 7-, 14-, and 30- day averages on-screen. It requires a tiny sample of blood. It comes with Spanish language...

Lifting Weights

Lift Dumbbells Over Your Head

Weight lifting is a form of anaerobic exercise. See the sidebar earlier in this chapter if you're not sure what anaerobic exercise is. It involves the movement of heavy weights, which can be moved only for brief periods of time. It results in significant muscle strengthening and increased endurance. Doctors are looking for drugs that can increase insulin sensitivity see Chapter 10 . You need look no further. Lifting weights has been shown in several studies to accomplish this. Writing in...

Preventing type diabetes

Doctors can predict type 2 diabetes years in advance of its actual diagnosis by studying the close relatives of people who have the condition. This early warning period offers plenty of time to try techniques of primary prevention which I explain in the Preventing type 1 diabetes section, earlier in this chapter . After a doctor discovers that someone's blood glucose levels are high and diagnoses type 2 diabetes, complications such as eye disease and kidney disease see Chapter 5 usually take...

Sulfonylureas

Scientists discovered sulfonylureas accidentally when they noticed that soldiers who were given certain sulfur-containing antibiotics developed symptoms of low blood glucose. When scientists began to search for the most potent examples of this effect, they came up with several different versions of this drug. Sulfonylureas all have the following characteristics i They work by making the pancreas release more insulin. i They are not effective in type 1 diabetes where the pancreas is not capable...

Realizing risks to mother and baby

Whether you have diabetes before pregnancy or develop gestational diabetes, you face many considerations regarding your own health and the health of your baby. Persistently high blood glucose left untreated has major consequences for both mother and fetus. If high glucose is present early in the pregnancy, the result may be congenital malformations physical abnormalities that may be life threatening in the fetus. In the third trimester, the growing fetus may exhibit macrosomia abnormal...

Hypoglycemia Kills Brain Cells

Hypoglycemia see Chapter 4 often comes on fast and leaves you with a headache or a general feeling of weakness and sometimes confusion. Because of this, people have believed that low blood glucose, especially if it occurs repeatedly, may destroy mental functioning. People who have had repeated episodes of hypoglycemia have shown no loss of mental functioning. Children may have different results because their brains are still developing. Fortunately, your body is supplied with hormones to...

Aqua

Situated in a grand post-1906 earthquake building on California Street, Aqua is located in the heart of San Francisco's bustling Financial District. At Aqua, owner Charles Condy and Executive Chef Michael Mina have joined forces to redefine dining and to pay elegant tribute to the flavors of the sea. The contemporary American design, combining a relaxed yet elegant ambiance, has set the stage for Chef Mina's imaginative menu. Since becoming the Executive Chef of Aqua, Michael Mina's intensely...

Unorthodox Methods Can Cure Diabetes

In Chapter 17, I talk about some treatments that don't work. Those treatments are just the tip of the iceberg. Many treatments do not help you and may hurt you. Whenever a problem affects a huge number of people, others are eager to exploit this potential gold mine. How can you know if what you read in your favorite magazine or see on the j Z Internet is actually useful Check it out with your physician, your diabetes FrAll educator, or other members of your team see Chapter 11 . They will know...

Considering Heart Disease

The major cause of death in the elderly person with diabetes is a heart attack. Strokes and loss of blood flow in the feet are also much more common in diabetics than nondiabetics. Usually, elderly diabetics suffer not only from diabetes but also have high blood pressure and high cholesterol, are overweight or obese, and do little exercise. Although many of these patients have had a diagnosis of diabetes for a relatively short time, they have actually suffered from the metabolic syndrome for...

Obesity and Type Diabetes in Children

The epidemic of obesity, which has spread to children in the United States in the past few decades, has led to a much higher prevalence of type 2 diabetes in children than was ever seen before. Overweight or obesity is present in as many as 25 percent of all children. Only a fraction of these children go on to develop diabetes. There are a number of conditions that can cause obesity in children but they represent probably 1 percent of the causes. Most of them can be diagnosed during the course...

Knowing Where You Cant Work

You may have grown up watching Eliot Ness on television and had your heart set on being a member of the Federal Bureau of Investigation. If you require insulin, forget it. The FBI has a policy called a blanket ban on hiring certain groups of people, including people with diabetes who take insulin. A blanket ban does not take into account the condition of the individual, the past employment history, the way the person manages his or her diabetes, or the responsibilities of the position. It...

Checking the TSH

Because there is a higher incidence of thyroid disease among people with diabetes and because thyroid disease is often confused with other conditions, a screening test called the thyroid stimulating hormone level is done at the time that diabetes is diagnosed and every five years thereafter if it is normal. TSH is produced by the pituitary gland in the brain. When the thyroid gland makes the right amount of thyroid hormone, the pituitary produces the right amount of TSH to keep it working...

The Part of Tens

Rich Tennant

I'il have ko lettuce iilled, tkree carroi gla ed, tve celery rosied, gt gt 7 he part of tens puts it all together and gives the most valuable techniques for thriving with diabetes. With just a little background from the other parts, you can use this section to really fine-tune your diabetes care. You find the ten commandments of excellent care, along with ten major myths about diabetes that you can discard. Finally, you find out how to utilize the skills and knowledge of the people around you,...

Basics of neuropathy

How high glucose levels damage nerves remains uncertain. Doctors do know that the part of the nerve, called the axon, that connects to other nerves or to muscle becomes degenerated. The damage may be vascular in some cases, resulting from a cut-off of blood to the nerve, and metabolic in others, resulting from chemical toxins produced by the metabolism of too much glucose. Diabetic neuropathy occurs in any situation where the blood glucose is abnormally elevated for ten years or more. It is...

Il Fornaio

Il Fornaio eel for-NIGH-oh means the baker in Italian. The company began as a baking school outside Milan, Italy, in 1972, created in response to the disappearing art of centuries-old Italian baking. In 1981, Il Fornaio came to the United States and has since grown to include some of the most successful restaurants and bakeries in America. Today, you can enjoy Il Fornaio's authen tic Italian food and baked goods at any of 21 locations in California, Portland, Seattle, Las Vegas, Denver, and...

Glyco Mark Test

This test is relatively new in the United States but has been used in Japan for several years. It differs from the hemoglobin A1c test in two important ways 1 Results take two weeks rather than three months to change. 1 Better control is marked by a higher rather than a lower number for the GlycoMark test. The test is based on the normal presence of 1.5 anhydroglucitol 1,5 AG in the blood. As blood glucose rises and more of it gets into the kidneys, it blocks the return of 1,5 AG to the blood...

Explain Hypoglycemia

,f you take either insulin or one of the sulfonylurea medications see Chapter 10 , you may become hypoglycemic. Occasionally, hypoglycemia can be so severe that you're unaware of the problem. At that point, someone in your environment needs to know the symptoms of hypoglycemia and how to treat it. Chapter 4 contains all that information. You may want to make a list of the signs and symptoms of hypoglycemia and pass it around to your family and friends. You should keep that list and an emergency...

Your Baby or Preschooler Has Diabetes

If your infant or preschooler is diagnosed with diabetes, you may feel overwhelmed. The information in this section can help you understand that this diagnosis isn't the end of the world it's the beginning of many years of special care for your child. Although type 1 diabetes does not usually show up in babies, it can, and you should know what to expect when it does. Obviously, your baby is not verbal and cannot tell you what is bothering him or her. For this reason, you may miss the fact that...