Adjusting Your Insulin for Time Changes

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

Diabetic Eye Disease

Diabetic eye disease includes three conditions diabetic retinopathy, cataracts, and glaucoma. At the back of the eye on the retina are tiny blood vessels that nourish the nerves of the eye. High glucose levels or high blood pressure can injure the cells lining these blood vessels (retinopathy). The earliest visible abnormalities are pinhead red dots next to the blood vessels that may come and go these are called microaneurysms or dot hemorrhages. Further injury then causes leakage of blood and...

Driving and Hypoglycemia

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

Gestational Diabetes

Being pregnant increases the body's insulin needs. Diabetes develops when a pregnant woman has limited beta cell capacity and cannot respond to the additional insulin demand. This is referred to as gestational diabetes. Often glucose levels become normal after delivery, but anyone who has experienced gestational diabetes has a higher risk of developing type 2 diabetes in the future. There is more information about gestational diabetes in Chapter 13. The level of glucose in the blood is...

Insulin

Insulin does all this by its effects on liver cells, muscle cells, and fat cells (see Figure 1-2). In the liver, insulin makes the liver cells convert glucose into glycogen, a storage form of glucose, and make triglycerides, a storage form of fat. In the muscles, insulin allows the glucose transport into the muscle cells. In the fat tissues, insulin stops the breakdown of triglycerides and release of fatty acids into the bloodstream. Glucagon acts in an opposite manner to insulin it...

Introduction

Chances are that you have picked up this book because you or someone you love has just been diagnosed with diabetes or has had diabetes for a while and you are trying to understand the disease and how to take care of it. Like all medical conditions you may find the language, medicines, and treatment recommendations complicated and confusing. You may also have heard that diabetes can cause blindness, nerve damage, or kidney failure, and you may be fearful that this could happen to you. It is...

Preventing Hypoglycemia

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

Trans Fatty Acids Trans Fats

Trans fats are harmful because they increase the risk of heart disease. They are produced when vegetable oils are converted into semisolid fats such as margarine and vegetable shortening. They are also known as partially hydrogenated vegetable oils. There are some naturally produced trans fats in dairy products, but most of the trans fats in our diet are man-made. Manufacturers put them in food products to increase the product shelf life for example, crackers stay crispy longer. The problem is...

Treating Hypoglycemia

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

Understanding Home Monitoring

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

Of Diabetes Genes and Environment

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

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...

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...

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...

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 Fungal infections of the skin (athlete's foot) and nails (onychomycosis), which require treatment with antifungal medicines. 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....

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...

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...

Diabetes And Erectile Dysfunction

The ability to get an adequate erection depends upon adequate blood flow to the penis and intact nerve function. Men with diabetes whose nerves to the penis are damaged and or whose blood supply to the penis is reduced may not be able to get a strong erection. Before blaming nerve damage and blood supply problems for erectile dysfunction, however, it is important to exclude other causes such as low testosterone levels, medicines (for blood pressure and depression), alcohol, and cannabis...

Stacking Insulin and Overaggressive Treatment of High Glucose Levels

Some people with diabetes do not like their glucose levels to be high, and they treat every high glucose level aggressively. These individuals who stack their insulin that is, give another dose of insulin before the first injection has had its full action can leave themselves open to hypoglycemia. A common mistake is to give insulin before a meal and then check the glucose level again an hour or two later and give additional insulin without realizing that the premeal insulin is still getting...

Side Effects

The main side effects of these medicines are weight gain and fluid retention. The weight gain tends to be around the abdomen. Despite the weight gain, the glucose levels generally fall. Fluid retention can cause ankle swelling, and in individuals with heart disease these medicines can cause heart failure. The symptoms of heart failure include swelling of the legs and shortness of breath on exertion. The fluid retention is more of a problem if you are also on insulin. The FDA has emphasized that...

Insulin Preparations Available in the United States

Regular insulin Insulin lispro Humalog Insulin aspart Novolog Insulin glulisine Apidra 70 percent NPH 30 percent regular 70 30 insulin 50 percent NPH 50 percent regular 50 50 insulin 75 percent NPL 25 percent insulin lispro Humalog Mix 75 25 50 percent NPL 50 percent insulin lispro Humalog Mix 50 50 70 percent insulin aspart protamine 30 percent insulin aspart Novolog Mix 70 30 Exubera 1 mg and 3 mg blister packets of powdered regular insulin

What Does Hypoglycemia Feel Like

The first time a person with diabetes gets a low glucose reaction usually at a glucose level of about 54 mg dl, he or she usually gets shaky, sweaty, and hungry. Other symptoms include anxiety and nausea. These are very much like the symptoms you get when you are extremely nervous and are called autonomic symptoms. It's your body's way of telling you that your glucose is low and you should eat. If these autonomic symptoms are ignored, the glucose levels fall into a range where the brain is...

Chapter

Effects of repeated hypoglycemia on cognitive function a psy-chometrically validated reanalysis of the Diabetes Control and Complications Trial data. Diabetes Care 1999 Aug 22 8 1273-77. Briscoe VJ, Davis SN. Hypoglycemia in type 1 and type 2 diabetes. Physiology, Pathophysiology, and Management Clinical Diabetes 2006 24 115-21. de Galan BE, Schouwenberg BJ, Tack CJ, Smits P. Pathophysiology and management of recurrent hypoglycaemia and hypoglycaemia unawareness in...

Info

Depends on the inheritance pattern of the susceptible immune genes. Source Adapted from Atkinson MA, Maclaren NK. The pathogenesis of insulin-dependent diabetes mellitus. NEngl J Med 1994 331 1428-36. When the beta cells are attacked by the immune system, the body produces four types of antibodies against the proteins made by the beta cells glutamic acid decarboxylase GAD antibody, islet cell antibody ICA , ICA 512 antibody, and insulin antibody. Your doctor can measure these autoantibodies if...

Working with Small Insulin Doses

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

Diabetes

One of the problems with diabetes is that the person with the disease usually feels fine and there are no symptoms even when the glucose levels are in the 100 to 200 mg dl range. Therefore, it is easy to ignore the diabetes. Eventually, there are symptoms, but often, they are due to diabetes-related complications. It is therefore important for people with diabetes to understand the consequences of poor glucose control and to make the effort to control the diabetes even when they feel well. You...

Gestational Diabetes And Risk For Type Nongestational Diabetes

If you have gestational diabetes, your risk of developing type 2 diabetes in the future is 5 to 50 percent. Therefore, you should have a two-hour 75-gram oral glucose tolerance test OGTT six to ten weeks after delivery. With tight glucose control and careful management of diabetes complications, women with diabetes can have healthy babies Optimal glucose control before conception and early in pregnancy reduces the risk of fetal malformations. Later in pregnancy, tight glucose control reduces...

Panax Quinquefolius American Ginseng

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