Diabetes Symptoms

Approximately 21 million people in the United States have diabetes, and each year approximately one million new cases of diabetes are diagnosed. Nonetheless, many people who have diabetes remain undiagnosed. Diabetes is a disease of excess sugar (glucose) in the blood. Men and women of all ages and ethnic groups are affected by diabetes. If diabetes goes undiagnosed it could become life threatening.

Type 2 diabetes is more common than Type 1 diabetes. Approximately 90% of persons living with diabetes have Type 2 diabetes. Diabetes affects over 10% of Americans over the age of 65.

In Type 1 diabetes, symptoms of high blood glucose (sugar) appear suddenly or quickly, while in Type 2 diabetes, the symptoms appear more gradually over time.

Diabetes Treatments

How diabetes is treated depends on varying factors. The type of diabetes a person is diagnosed with, the progression of the disease prior to diagnosis and accompanying complications will factor into the treatment equation early on. Living with diabetes is a matter of learning to control blood sugar levels through lifestyle and medication. The basics of diabetes treatment are the same for all patients once baseline sugar levels are determined and target sugar levels are in control.

Two things are basic to treating type 1 diabetes and type 2 diabetes: 1) Maintaining a healthy diet and physical activity are key basic steps, and 2) Testing to monitor blood glucose levels, so adjustments can be made to diet and exercise when called for. In addition, insulin therapy may be required. Insulin injections are a necessity for type 1 diabetes patients, and may or may not be needed to treat patients with type 2 diabetes. Type 2 diabetes patients may take additional oral medications (with or without insulin) to help control blood glucose levels at target rates or they may control their blood sugar with meal planning and exercise only.

Diet

People with diabetes require no more special diet than the average person who eats healthy. Advancements in the understanding of diabetes have revealed that while a healthy diet is vastly beneficial to people living with diabetes, there are no special diet foods required by diabetics. What is healthy for anyone is healthy eating for people with diabetes.

The difference in diet for a person with diabetes is creating a consistent diet routine, balancing fats, proteins, and carbohydrates in particular. Carbohydrates turn to sugar in the blood, so limiting carbohydrates and being aware of carbohydrate intake is essential to good diabetes control.
Follow these tips for developing a healthy diet to aide in diabetes control.

• Eat a variety of healthy foods including fruit, vegetables, meat and proteins (nuts, dairy, grains).
• Choose foods high in fiber.
• Moderate portion sizes according to your meal plan. Learn to recognize portion sizes at a glance (for example, 1 cup of cooked rice is the size of your fist).
• Eat smaller snacks and meals more frequently throughout the day (especially for women with gestational diabetes).
• Do not miss meals or your blood sugar will fluctuate.
• Be consistent in meal times, snack time, and portion sizes. This makes blood sugar levels more consistent and predictable.
• Choose leaner protein like fish, shellfish, poultry and lean meats.
• Choose unsaturated fat found in nuts, nut butters, olive or canola oil and avocado.
• Limit intake of table sugars (it is no longer held that diabetics cannot have any sugar; rather, sugars must be moderated and factored into a healthy diet plan).
• Understand labels on 'sugar-free', 'no-sugar added', and artificially sweetened products.
• Seeking the counsel of a registered dietitian who will assist you with a practical plan to guide you toward the best blood sugar and diabetes control. You will benefit dramatically from educational information provided by doctors and educators while you learn how to read labels and learn the differences between foods and their components, healthy or otherwise.

Don’t know what to cook? Get healthy diabetic cooking tips and browse our diabetic recipes.

Exercise

The benefits of exercise for people with diabetes are many, and are not entirely different from the benefits enjoyed by those who do not have diabetes. It is beneficial in the short-term and the long-term. Short-term benefits are such that glucose is lowered due to the energy expended or used during the time of exercise. Long-term benefits are such that your insulin works more efficiently.

For diabetics, exercise helps improve the body's ability to use insulin. People with Type 2 diabetes with low or poorly functioning natural insulin can increase their body's ability to access the insulin they do have and improve overall blood sugar levels.

Additionally, physical activity and exercise decrease body fat. Lower amounts of body fat increase the body's sensitivity to insulin, improving the function of insulin whether natural or injected. Other benefits of exercise for diabetes patients include improved muscle strength, bone density, higher energy levels, and improved circulation. Coincidentally, cholesterol levels are positively affected, another complicating risk enhanced by diabetes. As many of the complications of diabetes are directly attributed to poor circulation and hardening blood vessels and arteries, exercising to improve these factors overall contributes to longevity and quality of life.

While exercise is an essential component in maintaining diabetes, it is important to get educated about how the body works and reacts to physical activity. Continuous moderate exercise improves sugar consumption and results in lowered glucose levels. Short, strenuous activity on the other hand, can trigger stress responses and increase glucose levels. There are also times when glucose levels may be high and exercising could contribute to the problem.

For these reasons, regular exercise regiments and limitations need to be discussed and planned with the help of a treating physician and diabetes educator. Staying well hydrated and monitoring sugar levels before and after exercise are important. Careful record keeping of sugar results help plan appropriate exercise routines, while predicting when a particular activity may necessitate meal or insulin adjustments.

Insulin

People living with diabetes may require daily insulin therapy. This will depend on the type of diabetes a person has and how well their body is able to process insulin .
There are different kinds of insulin , but all serve the same basic purpose. Insulin is a blood hormone that is needed to move blood sugar into cells where it is used as fuel energy. Without insulin, sugars remain in the bloodstream and cause a variety of physical complications. When a person with diabetes either does not produce insulin or cannot use their own, insulin must be injected to continue the job of sugar processing.

Insulin may be rapid-acting, short acting, intermediate, long-acting, or pre-mixed. Which insulin is taken is determined by factors such as how the individual patient's body reacts to insulin , how quickly the reaction is, the frequency and ability to take multiple injections, age, target glucose levels, and lifestyle and activity. Only a doctor can determine the right insulin to take, and adjustments are likely to be made to achieve maximum benefits. Insulin dosing schedules will vary similarly, and are also dependent upon the type of insulin being taken.

Diabetes research and development continues to strive towards easy living and disease maintenance. Alternative insulin delivery systems, like oral medications and insulin pump systems (continuously pumping insulin through a catheter in the abdomen) show promise towards lessening the burden of diabetes insulin therapy on patients. Open dialogue with treating physicians is recommended as a means of determining if the time is right for an individual diabetes patient to pursue new insulin options.

Oral Medications

Not all diabetes medications are insulin. In fact, oral medications are taken by a number of diabetes patients whose bodies still produce some natural insulin (majority of type 2 patients).

Oral diabetes medications may stimulate the pancreas to produce more insulin, or improve the ability of insulin to move sugar and function in the body. Oral diabetes medications may also help break down starch components and slow glucose levels. Other medications combine one or more medications.
As type 2 diabetes progresses, oral medications may be continued to support insulin injections if they become necessary.

Emerging Treatments

Diabetes treatments evolve rapidly. In addition to insulin pumps and painless testing procedures, Islet cell transplantation is showing promise in reducing insulin dependency (although unlikely to eliminate the need at this time). Alternative supplements and medications are being explored as well, but are less well regulated, so alternative options should only be pursued in collaboration with treating physicians.
Importance of Diabetes Treatments

Living with Diabetes

Living with diabetes is a balancing act of sorts. Learning to balance exercise, medication, testing, and diet can be overwhelming, but the result is well worth the effort. With good control of diabetes, the quality and longevity of life can soar to great heights. Complications are prevented and lessened with good continuous blood sugar control, maintaining health of body systems.

As living with diabetes becomes an accepted lifestyle choice, life for diabetes patients is close to normal as compared to those without the disease. In fact, the quality diet and lifestyle choices made may mean diabetes patients live better than many average people who pay no heed to good health practices. Diabetes is a lifestyle more than it is a disease when managed through good habits and effective treatments with the collaboration of well trained medical professionals.

Diagnosing Diabetes

How are diabetes and pre-diabetes diagnosed?

The following tests are used for diagnosis:

• A fasting plasma glucose test measures your blood glucose after you have gone at least 8 hours without eating. This test is used to detect diabetes or pre-diabetes.
• An oral glucose tolerance test measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a glucose-containing beverage. This test can be used to diagnose diabetes or pre-diabetes.
• In a random plasma glucose test, your doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.

Positive test results should be confirmed by repeating the fasting plasma glucose test or the oral glucose tolerance test on a different day.

Fasting Plasma Glucose (FPG) Test

The FPG is the preferred test for diagnosing diabetes due to convenience and is most reliable when done in the morning. Results and their meaning are shown in table 1. If your fasting glucose level is 100 to 125 mg/dL, you have a form of pre-diabetes called impaired fasting glucose (IFG), meaning that you are more likely to develop type 2 diabetes but do not have it yet. A level of 126 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.

Table 1. Fasting Plasma Glucose Test

*Confirmed by repeating the test on a different day.

Oral Glucose Tolerance Test (OGTT)

Research has shown that the OGTT is more sensitive than the FPG test for diagnosing pre-diabetes, but it is less convenient to administer. The OGTT requires you to fast for at least 8 hours before the test. Your plasma glucose is measured immediately before and 2 hours after you drink a liquid containing 75 grams of glucose dissolved in water. Results and what they mean are shown in table 2. If your blood glucose level is between 140 and 199 mg/dL 2 hours after drinking the liquid, you have a form of pre-diabetes called impaired glucose tolerance or IGT, meaning that you are more likely to develop type 2 diabetes but do not have it yet. A 2-hour glucose level of 200 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.

Table 2. Oral Glucose Tolerance Test

*Confirmed by repeating the test on a different day.

Gestational diabetes is also diagnosed based on plasma glucose values measured during the OGTT. Blood glucose levels are checked four times during the test. If your blood glucose levels are above normal at least twice during the test, you have gestational diabetes. Table 3 shows the above-normal results for the OGTT for gestational diabetes.

Table 3. Gestational Diabetes: Above-Normal
Results for the Oral Glucose Tolerance Test

Note: Some laboratories use other numbers for this test.

For additional information about the diagnosis and treatment of gestational diabetes, see the NIDDK booklet What I Need to Know About Gestational Diabetes.

Random Plasma Glucose Test

A random blood glucose level of 200 mg/dL or more, plus presence of the following symptoms, can mean that you have diabetes:

• increased urination
• increased thirst
• unexplained weight loss

Other symptoms include fatigue, blurred vision, increased hunger, and sores that do not heal. Your doctor will check your blood glucose level on another day using the FPG or the OGTT to confirm the diagnosis.

Children with Diabetes

Having a child diagnosed with a chronic illness such as diabetes can be devastating for a parent. One day the world is perfect and the next, your entire family is thrown into a whirlwind of doctor's visits, testing, maintenance, and lifestyle change.

When the initial shock has worn off, the attitude must become one of action. Diabetes can be treated and diabetic children can live very normal lives. The key to living as normal a life as possible is to educate all involved—yourself, your family, your child's school, and your child. Through education, a collaborative action plan can be enacted, and medical care becomes a commonplace occurrence.

Type 1 diabetes is the most common form affecting children

Most children have type 1 diabetes (formerly referred to as Juvenile Diabetes). In type 1 diabetes patients, the pancreas does not produce insulin. Therefore, insulin must be injected for the body to survive. Insulin aides the body by helping blood sugar (glucose) enter cells of the body where it is used as energy. When there is not insulin to accompany glucose into the body's cells, blood sugars build up and body function suffers.

Type 2 diabetes is less common in children, however, as the obesity epidemic among children increases, so does the incidence of Type 2 diabetes in youth. When a person has type 2 diabetes they either do not produce enough insulin or their bodies are unable to efficiently use the insulin produced (insulin resistance). A sedentary lifestyle and obesity increases the prevalence of insulin resistance in children.

Diabetes can develop at any age

Diabetes can present in children at any time. Even children younger than one year old can develop diabetes, but the symptoms in children so young are often mistaken for other health problems, or dismissed as normal, passing infections. This is why it is important to learn the symptoms associated with diabetes, and report even seemingly small abnormalities to your pediatrician.
Symptoms of diabetes

Look for the same symptoms in children as in adults for detection of diabetes. These symptoms include:

• Frequent urination
• Excessive thirst
• Rapid weight loss (especially when unexplained or accompanied by increased food intake)
• Excessive feelings of hunger
• Dizziness
• Itchy or dry skin
• Vision difficulty
• Tingling/numbness in extremities
• Moodiness
• Tiredness/fatigue
• Difficulty Healing
• Frequent Infections

In young children, additional or different symptoms may present, including:

• Failure to grow or gain weight (often dubbed 'Failure to Thrive')
• Dehydration
• Severe diaper rash (unresponsive to treatment)
• Persistent vomiting, especially when accompanied by weakness/drowsiness

Diagnosis of diabetes in children

Doctors diagnose diabetes in children by running thorough blood and urine tests. Levels of glucose will be checked, as well as other diabetic markers. Expect your doctor to collect blood and urine for testing. Urine collection in very small children is done by placing a special collection bag over the penis or vaginal opening. Sticky-tape backed wings around the mouth of the collection bag hold it in place in the child's diaper until voiding occurs.

Caring for a child with diabetes

Children diagnosed with type 1 diabetes are immediately treated to combat the buildup of sugars in the blood and prevent further complications. Injections of insulin will be started so that blood sugars can be metabolized and reduced. If necessary, intravenous fluids will be administered to re-hydrate the child. When IV fluids are not needed and complications are not present, new diabetes patients are not usually hospitalized.

Your pediatrician will arrange for thorough diabetes education for you and your child (when age permits), as well as siblings. Diabetes education covers all aspects of controlling and maintaining the disease. Practical procedures such as how to administer insulin injections and blood testing will be discussed, as well as coping with the disease and all the associated emotions.

The dietary needs of children with type 1 diabetes are the same as children without the disease. It is important, however, to pay particular attention to good nutrition, and most importantly, eating frequently. Diabetic children cannot miss meals, as the insulin injected is calibrated to process dietary sugars, and when there is no source of sugar from the child's diet, the insulin will metabolize everything available in the blood. This results in a condition known as hypoglycemia (low blood sugar) and serious complications can occur. Maintaining blood sugar at adequate levels is a balancing act which leaves no room for children to miss meals. Mealtimes should remain constant, given in relatively same sized portions and at the same time of day. Special 'diabetic' foods are unnecessary. Simply following a normal diet plan as advised by your doctor or dietician is the best course for all children.

Insulin is used by the body more quickly during times of increased physical activity, so children should eat more frequently when they are active as well. Additionally, diabetic children should have a supply of foods at the ready when symptoms of hypoglycemia (low blood sugar) arise. Snacks such as fruit, peanut butter, granola bars, yogurt and pudding are a few good food supplies to keep nearby.

Diabetic children of all ages should be schooled in the control of their disease and recognition of complications to the extent their age allows. Education and involvement gives children a measure of control and helps them to alert caregivers when they are feeling poorly. Even very young children can be given the control of choosing where to test or inject insulin, all the while taking steps towards independent control of the disease they will live with.

Older children are encouraged to take an active role in their treatment and disease maintenance. Children as young as eleven can test their own blood and administer insulin injections with adult supervision. As parents, you may feel ill at ease with this, but treating diabetes as part of mainstream living helps children cope with their disease without anxiety, and hence they go on to lead full and normal lives unhindered.

School and Daycare

Children with diabetes can participate normally in school and daycare, but it is important to inform the school and work with the school nurse to educate teachers and aides working closely with your child. School and daycare personnel need to know a diabetic child's need for frequent snacks and meals, and accommodations must be made for the child to eat more frequently than regularly planned if necessary.

The rights of diabetic children are protected under federal law. Section 504 of the Rehabilitation Act of 1973, the Individuals with Disabilities Act, and the Americans with Disabilities Act of 1992 are three federal laws that protect the rights of children with diabetes in school and daycare settings (among others). Under these laws, diabetic children cannot be discriminated against and schools (or daycares) may be required to make necessary accommodations for your diabetic child if need be. These laws also mandate accommodations to seamlessly assimilate diabetic children into everyday school life and activities.

A very important part of educating school and childcare personnel in the control of diabetes is educating them to the warning signs of hypoglycemia and emergency responses. Drive home the importance of preventing low blood sugar with frequent snacking. Provide educators with written meal and actions plans, and emergency response procedures. Make sure this information is conveyed to transportation providers as well. Bus drivers are every bit as important a link in the chain of response and prevention.

Testing

Blood sugar testing to determine blood glucose levels is essential in effective diabetes control for children with diabetes. On their own, symptoms are not enough to be relied on for necessary medication and dietary adjustment. Testing is important to determine how close (or far from) normal glucose levels diabetes patients are. When testing reveals blood sugar levels that are too high or too low, insulin and food intake can be adjusted to return sugar to normal ranges.

Your child's doctor will regularly monitor results and order in-depth testing as necessary, but the majority of your child's diabetes testing will be done at home with a blood glucose monitor (glucometer). How often your child's blood glucose levels need to be tested will be tailored to your child's situation. Your pediatrician will work with you to determine the frequency of testing and teach you how to interpret the results, but generally speaking, diabetes patients need to test blood glucose levels four or more times a day.
Target levels for blood glucose monitoring are as follows:

• Before meals: 90 to 130 mg/dL
• Two hours after a meal: under 180 mg/dl
• Bedtime: 100 to 140 mg/dl

Typically, your child's blood should be tested before meals and at bedtime, and one to two hours after a meal.

Your child's doctor will instruct you as to proper testing procedures. Before you begin, you and your child should wash your hands thoroughly so as not to throw off the results of blood glucose monitoring. Collect the amount of blood needed to test with the equipment you have chosen. Generally, a finger stick is all that is needed, and this will be applied to a test strip inserted in the glucometer. When results seem inaccurate, double check with a second test or a backup glucose meter. Clean your equipment as recommended by the manufacturer to keep it in good working order.

Record the results of each blood glucose metering, and have school and childcare personnel do the same. Use a log book to keep a record of the glucose level, and include the foods eaten with the time of the test. Include in your record the amount and time of insulin injections and any other medications your child has been taking. Glucose levels help with short term adjustments, but the predominant use is to determine a long term plan of action for your child to keep blood sugars maintained at good, normal (or very close) levels.

Blood Glucose Monitoring Systems

Medical professionals will help you explore glucose monitoring equipment that is right for accurately testing your child's blood sugar. A variety of testing equipment and supplies are available, and advancing technology is changing the field regularly. There are several factors to consider when choosing blood glucose testing equipment.

Traditional glucose monitors test a small amount of blood collected by pricking a finger. The test strip is placed into the meter and then it absorbs the small drop of blood – like a straw. Within seconds, the blood sugar reading appears. Different meters have varying requirements for accuracy in filling target areas on a test strip and so some meters are easier to use than others.

Glucose meters are also available to test at alternative sites of the body. Sample blood may be taken from the arm, thigh, or palm of your hand. While these meters minimize trauma to the fingertips caused by repeated testing, it should be noted that alternative testing sites detect changes in blood sugar at different levels. When sugar levels change quickly, it will first be detected in the fingertips, and so a fingertip meter may still be required for some testing; during symptoms of hypoglycemia, a traditional fingertip meter should be used for maximum accuracy.

Laser blood collection systems have been approved for glucose monitoring as well. A small laser light beam draws blood to the surface, replacing finger sticks with the less painful alternative.
Continuous blood glucose monitoring systems are emerging. Some devices place a tiny catheter into the abdomen and taken continuous readings for up to seventy-two hours. The benefit to these glucose measuring systems is being able to see a graph of glucose readings throughout the day without having to prick your fingers, only to calibrate the machine.

Advancements towards pain-free glucose monitoring are progressing, however, there is no current replacement for traditional systems. There are, however, some things to consider when choosing the right testing system for your child. Compare several meters and consider display options, size, portability, speed, and ease of use (including how difficult applying blood to the target area is). Cost will factor into your decision a great deal, but remember an unreliable, inexpensive pump that needs to be frequently replaced may cost you more in the long run. Also, include the cost of test strips and local availability in your calculations. Your child's doctor and local pharmacist can help you decipher the varied testing systems and their features.

Doctor's Visits

As your child's diabetes falls under control and doctor's visits diminish in frequency, accurate recordkeeping will become more important in the maintenance of your child's disease. Bring your recorded results and logs with you to your child's doctor's visits. Note any abnormalities, illnesses, changes in health, emergency measures, and questions you or your child have. This will be an important tool to make adjustments in your child's treatment.

The relationship between you, your child, and your child's treating physician should be one of trust and respect. Together, you are all working towards the same goal: healthy control of your child's diabetes. Choose pediatricians that are knowledgeable in your child's disease and with whom you are comfortable working with frequently over long periods of time.

Living with Diabetes

A diagnosis of diabetes in a child is overwhelming. Use every resource available to you and your child to learn as much as you can about controlling and maintaining childhood diabetes. Educate your child, make them an active partner in managing their disease. Educate those around you- friends, family, teachers- and make living with diabetes an accepted part of your child's life. When diabetes is dealt with as a straightforward task met head-on, and proper care and education are learned, living with diabetes becomes a controllable, if unfortunate, fact of your child's life, vastly diminishing anxiety and subsequent complications.

Gestational Diabetes

Estrogen, cortisol, and other hormones produced by the placenta begin to block the effects of insulin during pregnancy. If the pancreas can not produce enough additional insulin to overcome the effects of the hormones, diabetes results.

Patients are usually asked to test their blood glucose levels:

• Fasting
• 2 hours from the start of a each meal

It is critical that these blood sugars are in the range listed above. Notify your doctor and/or dietitian/nurse if these numbers are higher.

Nutrition

Avoid simple carbohydrates such as fruit juice, cakes and candy. Evenly distribute carbohydrates (starch, fruit, milk) during meals and snacks. Do not drink more than ONE eight ounce glass of milk at one time. Do not have milk or fruit at breakfast when the blood sugar tends to be higher UNLESS you have tested your blood and find the results are within a healthy range. Have no more than 30 grams of carbohydrates for breakfast UNLESS you have tested your blood and find the results are within a healthy range. Do not use Sweet n’ Low (saccharine) because it crosses the placenta. Stevia has not been adequately tested so it is advisable not to use it. Equal/Nutrasweet (Aspartame) can be used moderately (2-4 servings per day) as can Splenda (sucralose). Another option available is Zsweet (contains the plant based sugar alcohol, erythritol) or other natural sweeteners with zero impact on blood glucose.

Please test your blood sugar so you can see how food, beverages, stress, exercise, etc. are affecting YOUR body. Everyone is different. And OF COURSE you must check with your doctor for specific recommendations.

Exercise

Light exercise is important for your health and to lower your blood sugar. If you are already in an exercise program, you may exercise at higher intensities with the approval of your doctor.

Ketones

Ketones (a toxic by-product that results from improper fat breakdown) must be checked each morning at your first urination. This is done by placing the ketone strip in the urine stream. If you have not eaten enough carbohydrates, your body must get its energy from another source. The body then breaks down fat for fuel. If your body is not utilizing the carbohydrates efficiently, high blood sugar results and ketones again are used for fuel by breaking down fat.

• If ketones are positive and blood sugar is normal or low, CALL YOUR DIETITIAN for an adjustment in your diet.
• If ketones are positive and blood sugar is high, CALL YOUR DOCTOR.
• If ketones are negative and blood sugar is high, CALL YOUR DIETITIAN for an adjustment in your diet.
• If ketones are negative and blood sugar is normal, YOU ARE DOING VERY WELL and continue what you are doing.

Sugar does pass from the mother to baby through the placenta. Insulin does not pass from mother to baby. After the 12th week of pregnancy, the baby can make its own insulin. If the mother consistently has high blood sugar, the baby will overproduce insulin. Excess sugar or insulin will cause your baby to gain weight which will result in an overweight baby.

Keep track of your baby’s movements by counting fetal movements or "kicks." After the 26th week of pregnancy when your baby is most active, start "kick counting." After a meal, sit on a comfortable chair and write down how many times your baby moves.

Pre-Diabetes

The concept of pre-diabetes was unveiled to the American public by then Health and Human Services Secretary, Tommy Thompson in 2002. Currently, the American Diabetes Association warns that 57 million people have this condition. By contrast, there are 23.6 million people in the United States with diabetes, 17.9 are already diagnosed, however, nearly one quarter of them (5.7 million) are not aware they have the disease.

Q. What is pre-diabetes?

A. In layman's terms, people with pre-diabetes have blood glucose levels that fall into the range between normal and diabetic. That is, they have elevated blood sugar, but it isn't quite high enough to classify it as diabetes. Your doctor may refer to this as impaired glucose tolerance or, possibly, impaired fasting glucose. No matter what it is called, pre-diabetes means having blood sugar that is higher than it should be.

Q. What does pre-diabetes do?

A. Pre-diabetes serves as a warning. Patients with this condition have a significant risk of developing Type 2 diabetes within 10 years and are at a 50% greater risk of having a stroke or heart attack.
Pre-diabetes can also jump start damage associated with diabetes, especially to the circulatory system and the heart, before a person fully develops Type 2 diabetes.

Q. Should I get tested?

A. Perhaps. If you are aged 45 or older, it is recommended that you get tested. If you are aged 45 or older and overweight, it is strongly recommended that you get tested. If you are 44 or younger and have risk factors for Type 2 diabetes, it is recommended that you get tested.

Q. What are the risk factors for Type 2 diabetes?

A. Being overweight or obese. A family history of diabetes, especially a parent or sibling. Being of American Indian, Alaskan Native, African, Hispanic/Latino, Pacific Islander or Asian descent. A history of gestational diabetes or large babies at birth (at least 9 pounds). High blood pressure, abnormal cholesterol levels--example: low HDL and/or high LDL or triglycerides. A sedentary lifestyle with little to no exercise. A diagnosis or PCOS (PolyCystic Ovarian Syndrome, sometimes called PCOS). Any other medical condition associated with insulin resistance. A history of cardiovascular disease

Q. What is the test like?

A. Your doctor may offer you a fasting glucose test or an oral glucose tolerance test (pregnant women often receive these). The fasting glucose test will require you to abstain from food and drink for several hours and have blood drawn in a lab.

The glucose tolerance test will also require you to fast for several hours before having blood drawn. After your blood is drawn, you have to drink a glucose-rich beverage and wait approximately one hour. Your blood will be drawn a second time. An hour later, it will be drawn a third time. You will probably have a final draw one hour later.

There are a couple of things to note about the glucose tolerance test. First, individuals with sensitive skin may wish to use cotton balls and pressure to clot the draw sites rather than bandages. Removing and applying new bandages to the testing site may cause undo irritation to the skin. Second, definitely bring something to keep you busy. You probably don't want to spend three hours with only waiting room magazines to read.

Your doctor may also consider ordering a hemoglobin A1c (HB A1c or A1c) to get an idea of what your blood sugar has been like for three months prior to the test. This is a simple blood draw that can be completed at the same time as a fasting glucose test or glucose tolerance test.

Q. How long will it take to get the results of your test?

A. It should not take longer than a few business days. Your doctor will probably call with the results and let you know if further follow up is required.

Q. How is pre-diabetes treated?

A. The good news is that pre-diabetes is generally reversible with simple lifestyle modifications, including eating healthier and getting more exercise. Prescription medications are generally not included as a first line of defense against pre-diabetes. It should be noted, however, that studies indicate using Glucophage (also known as Metformin) in patients with pre-diabetes may hinder the development of Type 2 diabetes.

Your doctor will probably want you to work on losing weight, exercise more and improve your diet. You won't have to turn your lifestyle around overnight; you can incorporate improvements over a period of time to ease the transition.

Your doctor may also want to monitor your blood sugar while you are making the necessary lifestyle changes and continue to do so once you have reduced your sugar to normal levels.
Is there any good news?

Yes! The good news is that pre-diabetes is largely reversible. The better news is that, if you do reverse it, you significantly reduce your chances of developing Type 2 diabetes. As an added bonus, the lifestyle modifications required to reverse pre-diabetes may have a greater overall positive impact on your health.

Type 1 Diabetes

Type 2 Diabetes

When you have Type 2 diabetes, you have high blood glucose levels because of a lack of insulin or the inability of your body to properly use the insulin. The first basic reason for Type 2 diabetes is the pancreas inability to produce enough insulin or the body cannot process it. The other reason for Type 2 diabetes is insulin resistance, which occurs as a result of poor diet and lack of exercise. Although Type 2 diabetes can develop for anyone at any age, it appears most frequently in middle-aged and older adults. Eight percent of the American population over 20 years old has Type 2 diabetes.

Type 2: Genetic or Preventable?

Although genetics may cause a person to be more likely to develop Type 2 diabetes, the disease may be brought on due to factors such as poor diet and lack of exercise. Because of this, individuals have some level of control over when and if they ever have Type 2 diabetes. Health issues such as obesity later in life often bring this disease on and in many cases, Type 2 diabetes can be completely controlled through diet and exercise.

Warning Signs of Types 2 Diabetes

Although no symptoms may be present when you have diabetes, there may be warning signs that you may have increased blood glucose levels and be at risk of developing Type 2 diabetes, such as:

• Urinating frequently
• Extreme hunger or thirst
• Fatigue
• Weight gain
• Irritability
• Ongoing skin, gum or bladder infections
• Numbness or tingling sensation in your feet or hands
• Blurry vision
• Frequent infection
• Bruises and cuts are slow to heal

If you are experiencing any of these symptoms, you should discuss them with your treating physician immediately to find out if you are at risk of developing Type 2 diabetes.

Treating Type 2 Diabetes

Unlike Type 1 diabetes, which needs to be controlled with regular administration of insulin, Type 2 diabetes can be prevented and controlled through exercise, diet and healthy living habits.
Changes to your lifestyle can be difficult and take time to incorporate into your daily routine. However, by following certain lifestyle changes, you can avoid long-term problems from diabetes and live an active life. Consider the following suggestions to take proper care of yourself with Type 2 diabetes:

• Follow a diabetes meal plan that incorporates healthy choices from the food pyramid.
• Make healthy food choices such as fruits, vegetables, fish, meat and low-fat milk.
• Bake, broil or grill food and avoid frying.
• Minimize your salt and fat intake, avoid sugar and eat smaller portions.
• Remain at a healthy weight for your height and keep the extra pounds off
• Get 30 to 60 minutes of physical activity or exercise daily.
• Avoid getting stressed out and quit bad habits such as smoking or excessive alcohol consumption.
• Monitor your blood glucose level daily and make sure to schedule regular visits with your treating physician to test your blood glucose level, blood pressure and cholesterol.
• Brush and floss your teeth daily.
• Check your overall condition every day; sores on your feet, blurry vision and ongoing infections should be reported to your doctor immediately.
• If you are upset about your condition, talk to someone such as a friend, family member or counselor about it to help you cope.

By making these simple lifestyle changes, you can keep Type 2 diabetes at bay and enjoy a great sense of physical and emotional well-being. People with Type 2 diabetes often have a team of professionals to assist them with their condition, including their treating physician, diabetes educator, eye doctor, dentist, podiatrist, social worker, nurse or nurse practitioner, dietitian, counselor, social worker, pharmacist, family and friends.

If healthy lifestyle changes do not lower blood glucose levels significantly, your treating physician may decide to administer medicine or insulin to lower your blood sugar. By enlisting a team to help monitor the condition, Type 2 diabetics have enough care and assistance to lead productive, pleasurable lives.

Risks of Type 2 Diabetes

People with Type 2 diabetes need to make permanent lifestyle changes to control their disease and enlist a team of professionals to help them monitor their condition. A blood glucose monitor can be used at home to track sugar levels in the body and those with Type 2 diabetes should have an A1C test done regularly to reveal blood glucose levels over the past three months. The goal during an A1C test is to get below a "7" for optimum health (according to the American Diabetes Association).

When you have diabetes, you are a greater risk of developing other ailments including:

• Stroke or heart disease
• Neurological damage that makes your feet or hand numb which can even lead to amputation for certain folks
• Blurriness of vision, eye problems and potential blindness
• Frequent infections
• Dry skin with wounds or bruises that heal slowly
• For men, the possibility of erectile dysfunction exists
• For women, the possibility of vaginal dryness or inability to reach orgasm
• Fatigue and irritability
• Gastrointestinal problems
• Kidney difficulties or kidney shut down
• Nerve damage, referred to as nephropathy
• Increased risk of tooth decay and gum disease

There are also certain conditions that are specific to people with Type 2 diabetes. With ongoing monitoring and control of your disease, the following conditions may be prevented:

• Hypoglycemia, or low blood sugar
• Hyperglycemia, or high blood sugar
• Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), usually seen in older people with Type 2 diabetes, where blood sugar levels rise and pass through your urine, causing frequent urination and possible dehydration, seizure, coma or even death
• Hemochromatosis, a genetic disease of iron overload can damage the pancreas and lead to diabetes known as “bronze diabetes” since the excess iron tints the skin with a bronze or gray tone.
• Frozen shoulder, formally called Adhesive Capsulitis, which makes moving your shoulder difficult or impossible

Additionally, if you are a Vietnam veteran with Agent Orange exposure and Type 2 diabetes, you may be eligible for disability compensation.

By monitoring your blood glucose levels, maintaining a healthy lifestyle every day, taking all necessary medications and scheduling regular appointments with members of your treatment team, you can ensure your ongoing well-being as a Type 2 diabetic. If you experience unusual symptoms such as nausea, vomiting, frequent urination, fever, dry skin, sores, infection, dry mouth, odd smelling breath, shortness of breath, fatigue or confusion, you should call your doctor right away to rule out serious complications.

Living with Type 2 Diabetes

As a Type 2 diabetic, you need to consistently monitor your blood sugar level, blood pressure and cholesterol to make sure you are in the best of health. It is also necessary to take note of changes in your body, such as sores on your feet, dry skin or mouth and fatigue and tell your doctor about them immediately so ensure your condition is not progressing.

When you have Type 2 diabetes, a healthy lifestyle is no longer a choice but a necessity. Eating a well-balanced diet and getting regular exercise are essential to maintain optimum health and ward off the effects of Type 2 diabetes. Even when you go on vacation or during emergencies, you must maintain a proper diet, get regular physical activity and monitor your blood glucose levels. It is critical that you try to maintain a healthy lifestyle otherwise you can cause serious damage to your body. If you need to take medications, you need to have enough on hand and make sure you administer them on a regular schedule.

Finally, it is normal for you to have feelings of anger, denial or depression about diabetes. On occasion, you may even be the victim of discrimination at work or school because of your disease. If these situations arise, discuss them with a counselor or diabetes professional who can help you to handle them. By taking proper care of yourself, staying in constant communication with your treating physician and minimizing stress, you can live a long, healthy life with Type 2 diabetes.

A1c Testing

The A1c test is an important diagnostic test for people with diabetes or who may be at risk for diabetes. An A1c test measures the Average Blood Glucose (ABG) in the body over the previous 90-120 days. Although monitoring your own glucose levels at home on a daily basis is crucial for people with diabetes, an A1c test complements self-monitoring by offering a more complete picture of how your treatment program is performing over the long term.

The A1c test is also known as a hemoglobin A1c test. Hemoglobin is an oxygen-carrying protein found in red blood cells. Red blood cells live for about 120 days, or the lifespan of a red blood cell, and then are replaced by new ones. Each red blood cell carries a “memory” of daily blood glucose levels throughout its lifetime. When surplus glucose is in the bloodstream, it hooks up with hemoglobin, causing higher A1c levels. These A1c levels are “remembered” by the red blood cells and can be analyzed by an A1c test. Specifically, the A1c test shows whether your ABG is above normal by measuring the percentage of glycated hemoglobin. In a non-diabetic person, about 5% of all hemoglobin is glycated (or, attached to glucose). In a person with diabetes, this percentage can jump to 25% in extreme cases.

When too much glucose is in the bloodstream, hemoglobin cannot deliver as much oxygen as is needed by the body’s cells. Without oxygen, the cells suffer damage. Numerous studies have reliably linked above-normal A1c results with complications such as nerve, eye, kidney, and cardiovascular disease.

If your diabetes treatment program is not working effectively enough, an A1c test alerts your healthcare team that further adjustments are needed. Diabetics should have an A1c test at least twice per year. In some cases, it is advisable to perform the test every 3 months, such as when you’ve begun a new medication or when your blood glucose readings are not yet under control.

Although the A1c test is an important tool for diabetes management, it is vital to emphasize that the test is not a replacement for daily monitoring of blood glucose levels. An A1c test can’t help you adjust your insulin dosages, for example. Check with your doctor to determine how the A1c test should fit into your diabetes management.

Blood Glucose Testing

Diabetes & Cholesterol

Often times, people with diabetes focus so intently on monitoring their blood sugar that they forget to keep track of other important health indicators. Cholesterol is one of those things. Checking cholesterol levels is important for everyone, since too much cholesterol can lead to heart disease. People with diabetes are already at risk for heart disease, so they should take extra care to monitor their numbers when it comes to cholesterol. Testing at least once a year is recommended.

What is Cholesterol?

Cholesterol is a waxy lipid that is found in foods like meat, eggs, and dairy products. A lipid (incorrectly thought of as a synonym for fat) is a substance that dissolves in fat. The body needs cholesterol to build cell walls and to produce things like hormones, vitamin D, and bile. But when excess cholesterol is in your bloodstream, it can cling to your arteries, making them harden and get narrower. This is called atherosclerosis, a serious condition that can lead to heart disease.

Cholesterol is carried through the blood by proteins. Together, the molecules form what is called a lipoprotein. There are two kinds of lipoproteins:

• LDL, or low-density lipoproteins. LDLs are often called “bad” cholesterol, as they are responsible for the hardening of the arteries. When reading your cholesterol numbers, you want your LDL levels to be LOW. The target number for people with diabetes is a reading of less than 100.
• HDL, or high-density lipoproteins. HDLs are know as “good” cholesterol because they do the opposite of LDLs: they help clean out the arteries and keep them from getting blocked. When reading your cholesterol numbers, you want your HDL levels to be HIGH. For men with diabetes, the target number is more than 40. For women with diabetes, the number should be more than 50. Remember, keep the low, low, and the high, high!

A third substance which is usually monitored during cholesterol testing is triglycerides, a fat found in vegetable oil and animal fats. High triglycerides increase your risk of heart attack and stroke, so you want your levels to be low. For people with diabetes, aim for numbers that are less than 150.

Your cholesterol levels can be affected by many factors such as smoking, alcohol, and certain illnesses. Some medications can hurt your cholesterol levels, too. These include beta-blockers (a blood-pressure drug), oral estrogens (birth control), and thiazide diuretics (another blood-pressure treatment). Check with your doctor to find out what you can do about optimizing your cholesterol levels—your heart will thank you!

Diabetes & Exercise

Prior to starting an exercise program; or if making significant changes in your physical activity level; schedule a complete physical and consider other consultations to determine if there may be changes necessary in your eating plan and medications. An exercise physiologist may be able to help you determine the activities that best suit your individual needs.

Regular Physical activity can provide the following benefits:

• Strength and flexibility improvements / increases
• Cardiovascular system toning and conditioning
• Blood pressure, blood sugar and weight reduction
• Lowering triglyceride levels / Raising HDL (good cholesterol) Levels
• Insulin sensitivity improves
• Other improvements: Hemoglobin A1C reduction, Sense of Well-Being and Attitude Enhancement

Safe Exercise Rules:

• Have your physician screen for: possible nerve, kidney or heart disease complications, and for any evidence of retinopathy.
• Usually any evidence of health concerns does not mean that exercise must be avoided; but special precautions may need to be adhered to in order to safely proceed with your workouts.The physician may recommend an EKG ( electrocardiogram) and a stress test on a treadmill which may detect heart abnormalities.
• Know your limits. Do not over exercise. Listen to your body. If you have pain, fatigue, or shortness of breath this could lead to injuries.
• Begin with gentle stretching and 5 to 10 minutes of warm up movements
• Proceed to 20-30 minutes of aerobic activity that is not too intense; but definitely gets your heart muscle pumping.
• Remember you should be able to have a conversation with your workout partner during your workout; and not be too short of breath.
• Exercise will help to burn calories and helps you stay at a healthy weight or lose weight.
• Remember to cool down by keeping your arms and legs moving at a relaxed pace: step side to side or walk in place for a few minutes after your workout.

Diabetes Foot Care

As someone with diabetes, you already know that there are many things you need to keep track of: your blood glucose level, your weight, your cholesterol, your blood pressure, your diet, and so forth. But when was the last time you checked ... your feet?

Feet are especially prone to damage from diabetes.

Here are three of the main reasons why the health of your feet are at risk if you have diabetes:

• Diabetes causes nerve-damage. This is called diabetic neuropathy. If the nerves in your feet are damaged, then you may not be able to feel pain, heat, or cold. You could develop a sore or a cut on your foot and never know that it is there.
• Diabetes causes poor circulation throughout the body. When blood flow is poor to the legs and feet, this is called peripheral vascular disease. Without good circulation, it is difficult for the body to heal itself properly when injuries occur.
• Diabetics are more susceptible to infections. Coupled with poor circulation, an infection in the foot is hard to fight. Untreated, such an infection can lead to very serious consequences.

Fortunately, you can help prevent foot problems by paying special attention to the care of your feet.

Here are the Top Ten steps you can take to help maintain your feet.

1. Choose your shoes carefully for proper fit. The shoes you select should be comfortable when you try them on and should not need to be broken-in. Ill-fitting shoes can cause calluses and other foot problems that you may not be able to feel. You may wish to consider buying special footwear designed for people with diabetes.

2. Always wear shoes or socks, even around the house. This lessens the chance of accidental injury to your feet and protects your feet from the damaging effects of heat or cold.

3. Wash your feet every day in warm water (not too hot), but do not soak them, as this can cause skin to dry out. Dry your feet thoroughly, especially between the toes, since excess moisture can cause chaffing.

4.  If your skin is dry, apply a diabetic foot cream after you’ve washed and dried your feet. Do not use cream between the toes unless the lotion is specially made for that area.

5. Inspect your feet every day for bruises, redness, calluses, cuts, ingrown toenails, and so forth. Use a mirror to check the bottoms of your feet if you cannot bend over or if your eyesight is poor. You can also ask a family member, friend, or nurse to check your feet for you. If you do find an injury, always consult with your doctor on the best way to help it heal.

6. Have your doctor show you how to gently use a pumice stone to control corns or calluses. Removing corns or calluses yourself may not be a good idea, as you may damage the skin.

7. Trim your toenails regularly. Ideally, do this after washing, as the toenails will be soft and easier to clip. It is best to trim the toenails following the natural curve of your toe, rather than in a rounded shape. Do not cut into the corners of your toenails or you may break the skin. File any rough edges with an emery board.

8. Stop smoking. Smoking decreases the flow to small blood vessels, a problem that is pronounced in people with diabetes who already suffer from poor circulation.

9. Exercise. Physical activity increases the circulation throughout the body, which will help your feet and legs. If you are unable to walk, consider alternative exercises such as swimming or pedaling a recumbent bicycle.

10. Have your doctor check your feet at least four times a year. He or she should check your sense of feeling and your blood flow, as well as show you how to properly care for your feet.

Diabetes Wound Care

Many people with diabetes will experience problems caring for wounds during their lifetime. Wounds heal more slowly for people with diabetes and require special care.

Care of the skin is one of the most important aspects of routine diabetes maintenance. Without proper precautionary measures, minor cuts or injuries can quickly turn into serious problems. Diabetics often heal more slowly than normal because of reduced blood flow to affected areas. Diabetics also may not notice injuries right away if they suffer from diabetic neuropathy, nerve damage which can numb sensations and pain.

People with diabetes need to take extra care when they develop a wound. Here are a few guidelines to follow for wound care and prevention.

1.  For uninfected wounds or minor burns, people with diabetes may apply antibiotic ointments to prevent infection. If signs of infection occur, such as redness, pain, or inflammation, seek the help of your medical advisor.

2. Wounds and ulcers should be cleaned daily with mild soap and covered with dressings or bandages, as wounds heal best when covered and moist.ⁱ Moist dressings do not need to be changed as frequently as moist-to-dry dressings, so they are convenient to the patient. Moreover, moist dressings usually lessen pain and reduce the number of re-injuries compared to dressings that allow the wound to dry out.ⁱⁱ

3. For serious wounds, especially infected ones, consult with a doctor for treatment recommendations immediately. Skin infections in people with diabetes usually require prescription medications, such as antibiotics or ointments specially formulated for people with diabetes.

4. During routine skin care, people with diabetes should avoid using any implement that abrases the skin, such as pumice stones and callus or corn removers. These products can potentially do damage to delicate or injured skin.

5. Keep skin hydrated by using moisturizing lotions to prevent cracking, which can lead to infection.

6. Monitor your blood glucose levels carefully to help wounds heal more quickly.

7. Foot wounds are especially prevalent in people with diabetes. Avoid walking barefoot to prevent foot injuries. To promote healing of foot wounds or ulcers, people with diabetes should alleviate the pressure to the area as much as possible. Application of medicines and dressings is also important to speed healing. You may wish to wear therapeutic shoes or socks that are designed to address the needs of people with diabetes.

Proper care and prevention of wounds can help people with diabetes avoid serious complications. Be sure to inspect your feet and body every day for signs of cuts or injury, and to treat each problem right away.

i http://www.podiatrists.org/visitors/foothealth/general/diabwound/
ii http://www.orthopedictechreview.com/issues/junjul99/pg51.htm

Happy Feet, Healthy You

April is Foot Health Awareness Month. Most of us overlook our feet when we think about our health. For people with diabetes, foot care is essential to preventing complications and serious conditions. Here are ways to maintain proper foot care and avoid potential complications such as nerve damage or amputation.

1. Keep blood sugars monitored daily and maintain your 3 month blood sugar average (HbA1C) at 6.5% - 7%. Controlling your HbA1C gives you an opportunity of not developing peripheral neuropathy - a common diabetes complication that affects the nerves due to excess sugar in the blood. Nerve damage or neuropathy usually begins with severe pain and tingling, eventually leading to numbness and loss of sensation. With a loss of sensation, you may be prone to an infection from an foot injury you can't feel.
2. Examine your feet and legs daily - especially the soles of your feet and between the toes. Check for corns, calluses, open cuts, skin color changes, hot spots, blisters, swelling, athletes foot and ingrown toe nails. This will help you avoid more serious wounds.
3. Wash your feet daily and use mild soap. Remember to wash & dry each toe as a single unit and use luke warm water. Use a soft towel to dry them. Remember not to soak your feet which adds to skin breakdown and fungus. Usually an over the counter product like Lamasil can help treat fungus but always check with your physician.
4. Apply lotion when you are done with your shower or bath and the foot is still moist for maximum absorption. People with diabetes have extremely dry skin, especially when the HbA1C is out of control. A plain white, non-fragrant cream is best. Avoid putting lotion between your toes, which can lead to fungus. Powder such as corn starch is acceptable for usage in between the toes.
5. If your insurance covers podiatrist visits, let your podiatrist be responsible for nail trimming. The appointment cycle is usually every 2-3 months depending on how fast your nails grow. Keep your nails trimmed to avoid ingrown toenails. Your podiatrist can watch out for fungus called onychomycosi, which can become a chronic problem for people with diabetes.
6. Never walk barefoot inside or outside and try to wear closed toe shoes and socks. This will help you avoid injuries or wounds. In the summer, sturdy sandals with thick soles and protection near the toes help reduce perspiration and risk of fungus. Changing shoes daily helps dry out perspiration from the previous day. Spraying with Lysol once a week can also be helpful. Wear slippers in the house, pool shoes in the ocean or pool, and socks to bed if your feet are cold.
7. Be careful in the bath or hot tub. Make sure the temperature is 105 degrees – anything less can increase infection rate and anything more can increase a burn risk.
8. Try to elevate your feet when you are home, especially when they swell at the end of the day. Treat yourself after a long day!
9. Ask your podiatrist about diabetic footwear which may be covered yearly by Medicare. Today's footwear styles are attractive and versatile.
10. Ask your doctor or podiatrist about vitamin supplements. Alpha lipoic acid, an antioxidant, and B-100 complex can reduce symptoms of neuropathy. Speak with your doctor about topical pain relievers such as Neuragen PN, or oral medications such as Neurontin, Cymbalta, Lyrica, Topamax and others.
11. Finally – make sure to have your physician check your feet during every regular check-up.

Keep your feet moving, clean, protected, healthy and very happy!

Meters & Test Strips

Diabetes affects millions Americans. Statistically, the growth of diabetes is at near epidemic proportions. Studies show that over six percent of America's population is estimated to be affected by the disease. Healthcare authorities agree that these circumstances demand urgent attention, yet all are unclear on the exact reason for the increase.

Treatment Required

Diabetes mellitus is a disease that requires constant management. Many people do not know they have diabetes until their symptoms become severe. Without proper treatment and management you can suffer from complications that are related to diabetes. With proper care, however, you can lead a normal and fulfilled life. By taking care of yourself in the early stages, you may prevent more serious health issues later. Self-monitoring devices make it easier for people with diabetes to monitor and manage their diabetes. You can decide if this is something that will suit your personal needs.

A person with diabetes does not have the ability to utilize the glucose in their food for energy. Therefore, it builds up in their bloodstream where it can cause damage to the heart, kidneys, eyes and nerves. After being diagnosed with diabetes you will have to take personal responsibility for your care and management with the counsel of your healthcare provider.

Diabetes Glucose Meters

Self-monitoring blood glucose is now easier and more accurate than ever with the improved technology of blood glucose meters. Glucose meters are battery operated devices that measure blood glucose levels. They work by reading small blood sample from a disposable test strip. The blood glucose test strip is placed inside the meter and the meter measures the amount of glucose in your blood.

Choosing A Diabetes Meter

There are several factors to consider when choosing a blood glucose meter. The first thing you want to do is find a meter that is reliable and trustworthy of managing your blood glucose levels. This is a personal decision based on your lifestyle needs at home, school, work, or play.. Your Certified Diabetes Educators (CDE) or other healthcare provider can inform you of how often your blood glucose levels need to be tested.

Meters will vary in many ways. When choosing a meter you will want to consider the following:

• The amount of blood needed for testing.
• The speed of testing.
• The size of the meter.
• The meter´s ability to store test results in memory.
• The cost of the meter and supplies.

Diabetes Meter Brand Comparison

Next you will want to compare brands. Below is a list of brands and information to assist you in your decision.

Abbott Diabetes Care - Optium

The Optium is designed not to begin testing until there is enough blood on the test strip. This reduces errors and test strip waste. The Optium allows you to test from your forearm or your fingertip. It features the TrueMeasure™ test strip technology that makes testing more accurate. This advanced technology reduces the effects of substances such as aspirin, acetaminophen, and vitamin C to provide a glucose specific test result. The Optium requires a blood sample size of 0.6 micro liters and provides a test result in five seconds. It features an easy to read display, 450 test result memory with weekly and monthly averaging, and downloads to a data management program on your personal computer.

Abbott Diabetes Care - Precision Xtra

The Precision Xtra was designed to make advanced diabetes management simple. It also features the benefits of the TrueMeasure™ test strip technology. The Precision Xtra is a small meter that requires a blood sample size of 0.6 micro liters. Test results are produced in five seconds. The Precision Xtra stores 450 test results, has the capability of testing blood ketone, and is downloadable to your personal computer.

Abbott Diabetes Care - FreeStyle Freedom

The FreeStyle Freedom is ideal for people who are on the go. It allows for alternate site testing on your forearm, upper arm, hand, and thigh. The FreeStyle Freedom test strip requires the smallest blood sample in the world of 0.3 micro liters. It will produce a test result in five seconds. The FreeStyle Freedom has four programmable patient reminder alarms, stores 250 test results with a 14-day result average, and downloads on your personal computer.

Abbott Diabetes Care - FreeStyle Lite

The FreeStyle Freedom features alternative site testing on your fingertip, hand, upper arm, forearm, calf, or thigh. It has a large numeric display, more discreet, with both backlight and portlight, but smaller to hold.  It uses the code-free strips that are compatible with the FreeStyle Freedom Lite meter.   The freestyle Freedom requires a blood sample of 0.3 micro liters and produces results in five seconds. It also has four programmable patient reminder alarms, stores 250 test results with a 14-day result average, and downloads on your personal computer.

Abbott Diabetes Care - FreeStyle Freedom Lite

The FreeStyle Freedom Lite features alternate site testing on your fingertip, hand, upper arm, forearm, calf, or thigh, and no strip coding is necessary! See your accurate glucose test results within 5-seconds on the large easy to read numeric display that is larger and very comfortable to hold. FreeStyle Freedom Lite uses the code-free strips that are compatible with the FreeStyle Lite meter.  It requires 0.3 micro liters,  and produces results in five seconds. It also has four programmable patient reminder alarms, stores 400 test results, provides results in 7, 14 and 30 day.

Accu-Chek Active

The Active requires a blood sample size of 1 micro liter and provides test results in five seconds. The Accu-Chek Active test strips are touchable and easy to use. It features alternate site testing, stores 200 test results, and is downloadable to your personal computer.

Accu-Chek Advantage

The Advantage requires a blood sample size of 4 micro liters and provides test results in twenty-six seconds. The Comfort Curve test strips have a unique curve to fit your finger for easier blood application. It stores 450 test results and is downloadable to your personal computer.

Accu-Chek Aviva

The Aviva uses the multiclix lancing device and a 6-test strip cartridge that requires a blood sample size of 0.6 micro liters and provides test results in five seconds. It features alternate site testing, stores 500 test results, and is downloadable to your personal computer.

Accu-Check - Compact

The Compact provides test results in seven seconds. The Compact test strips requires a blood sample size of 1.5 micro liters. It features alternate site testing, stores 100 test results, and is downloadable to your personal computer. The Compact Test Strip Drum holds 17 test strips.

Ascensia Breeze 2

The Breeze 2 features an easy load AUTODISC that holds ten test strips. It does not carry individual test strips and does not requiring any coding at all.  It also allows for alternate site testing.  It  can store up to 420 tests and 7, 14, or 30 day averages.

Ascensia Contour

The Contour adjusts automatically for variables that can affect accuracy. The Contour test strips are convenient and easy to use. It requires a blood sample size of 0.6 micro liters and produces test results in 15 seconds. The Contour stores 240 test results and is downloadable to your personal computer. It offers alternate site testing on the finger, palm, forearm, thigh, or abdomen.

Advocate

This meter comes in three different models, a talking, an autocode talking, and also a talking with built in blood pressure monitor.  It requires a tiny sample size of 0.7 microliters.  Alternate site testing.  You have your results in only 7 seconds on a large screen for easier visibility.  Allows for uploading results onto a computer.

Nova Max

The Nova Max Blood Glucose Monitoring System requires a blood sample of 0.3 micro liters and produces results in five seconds. Both the BD test strips or Nova Max Testing Strips are designed specifically for this monitoring device. It will store 400 test results and offers alternate site testing for added comfort.

Prestige IQ Diabetes Meter

Fast accurate results within seconds.  14 & 30 day averages.  Display that is large and easy to read.  It is compatible to upload results to the computer.

Prodigy Talking Diabetes Meter Kit

The Prodigy is an affordable talking diabetes meter. The Prodigy test strip requires a blood sample of 0.6 micro liters and produces results in six seconds. The Prodigy will store 450 test results and will download to your personal computer.  This meter also comes in an auto code talking version also, the Prodigy Auto Code Diabetes Meter.

True Track Diabetes Monitor

Requires only a 0.1 microliter blood sample.  Fast, accurate results in 10 seconds.  Alternate site testing.

Manufacturers of Blood Glucose Meters

Another important factor to weigh in when choosing a diabetes meter is the manufacturer. You want to buy a meter from a company that is dedicated to providing top quality products to its customers. Listed below you will find some background information on a few reputable companies that manufacture diabetes meters.

Abbott Diabetes Care

Abbott is a global health care company that has been established for over 100 years. They are also responsible for brands such as FreeStyle and Precision. Abbott is highly motivated to find new medicines, technologies, and health management techniques to improve the lifestyle of someone with diabetes. It is more than just their job it is their daily goal to help their customers live enjoyable and healthy lives.
Read more about Abbott / FreeStyle diabetes testing

Roche

Roche has been established for over 100 years and is a well-known name among consumers. They work hard to discover and develop diabetic healthcare solutions to enhance quality of life. The two units of operation at Roche are pharmaceuticals and diagnostics.

Bayer

Bayer is a well-known name among consumers and is responsible for many firsts in diabetes healthcare. In 1964, they developed the first dry reagent blood sugar test that enabled people to monitor blood sugar levels from their own home. Bayer under the former name of Miles introduced the first portable blood glucose meter. Bayer is dedicated to improve and enhance quality of life through diagnosis, prevention, and treatment. Today, it is a world leader in diabetes innovations.

Diagnostic Devices, Inc.

Diagnostic Devices is a leader in research and development of new products to improve and manage the health of patients with diabetes and other disorders.

Home Diagnostics, Inc.

Home Diagnostics, Inc. is one of the leading providers of diabetes products.  Home Diagnostics, Inc. also works closely with healthcare providers to help them more affordably monitor and manage their patients with diabetes.

Sun Coast

Diabetic Supply of Suncoast offers products that help patients monitor their blood glucose levels and blood pressure. Diabetic Supply of Suncoast's innovative talking monitors are an invaluable aid to patients with limited visibility. Loss of vision affects millions of diabetics, and if you are one of those, these unique talking monitors can help you to care for yourself independently and effectively.

Glucose Meter Training

Each glucose meter works a little differently and you need to be familiar with how it works in order to accurately read your results. First you should read the instructions included with your glucometer. You may also want to get with your healthcare provider to see if training is available through a diabetes educator. In addition, a toll-free number is provided on the back of all meters.  There are customer service agents available for you 24 hours/7 days a week to assist you in using your monitor.

It would be a good idea to take your meter to your physician at you next scheduled check-up and test the results of your glucometer against the physician´s lab results to ensure your meter is working properly. If problems are detected then you may need to contact the manufacturer.

An Important Side Note

It is very important that you wash and dry your hands thoroughly before and after testing. You may also choose to prep the area that will be used to draw the blood sample with alcohol. There are several factors that could impair the accuracy of your test if your hands are unclean or wet. Be sure to check instruction guide for conditions that could interfere with readings.

New Technology

One of the biggest research projects is to find the most noninvasive glucose meter. Everyone hates to have his or her finger pricked. Researchers are working on a pain free infrared spectroscopy. This device will measure the glucose levels by directing a light onto the surface of the skin.

Take Control of Your Health

The main goal for a glucose meter is that it will track your glucose levels over time, help you to recognize individual patterns to improve meal or snack choices, help you recognize emergency situations, and educate you on how to manage your blood glucose levels.

New Diabetes Diagnosis

You may be feeling overwhelmed with your diagnosis. Feelings of anger, fear or guilt are normal. The first steps to successful management of your diabetes are to learn about your health condition and understand your treatment plan.

Consider sharing your feelings with friends and loved ones. Health care professionals and diabetes support groups offer assistance with working through negative emotions. People with diabetes are no different than anyone else: everyone has "low" or "blue" days, so remember to talk to someone if your emotions are getting in the way of taking care of yourself.

Diabetes has no cure, but together with your healthcare team, you can successfully treat diabetes and live your life fully. Diabetes is mostly a "self-management" condition, and with proper knowledge you can take charge and manage your diabetes.

Share the knowledge you have learned from your diabetes healthcare team with family and friends so they can better understand diabetes management.

Remember: There is no cure for diabetes, but with the proper diabetes self-management plan and appropriate treatments, diabetes can be controlled, and complications can be prevented or delayed.

When You Are Sick

Diabetes is part of your life. It’s very important to take care of it when you’re sick, when you’re at school or work, when you travel, or when you’re pregnant or thinking about having a baby. Here are some tips to help you take care of your diabetes at these times.

Take good care of yourself when you have a cold, the flu, an infection, or other illnesses. Being sick can raise your blood glucose. When you’re sick, do the following:

• Check your blood glucose every 4 hours. Write down the results.
• Keep taking your diabetes medicines. Even if you can’t keep food down, you still need your diabetes medicine. Ask your doctor or diabetes educator whether to change the amount of diabetes medicine you take.
• Drink at least a cup (8 ounces) of water or other calorie-free, caffeine-free liquid every hour while you’re awake.
• If you can’t eat your usual food, try drinking juice or eating crackers, popsicles, or soup.
• If you can’t eat at all, drink clear liquids such as ginger ale. Eat or drink something with sugar in it if you have trouble keeping food down.
• Test your urine for ketones if
  • your blood glucose is over 240
  • you can’t keep food or liquids down
• Call your health care provider right away if
  • your blood glucose has been over 240 for longer than a day
  • you have moderate to large amounts of ketones in your urine
  • you feel sleepier than usual
  • you have trouble breathing
  • you can’t think clearly
  • you throw up more than once
  • you’ve had diarrhea for more than 6 hours

Diabetic Neuropathy

Diabetic neuropathy is one of the most common conditions that affects people with diabetes. Learn about the four types of diabetic neuropathy, as well as its causes, symptoms, and treatment.

Diabetic neuropathy refers to the nerve damage caused by diabetes. While there are many contributing risk factors for neuropathy, such as inherited traits and injuries, high blood glucose levels are likely a main cause of this condition. Diabetic neuropathy is still being studied, but it is believed to be affected by low levels of insulin, unusual blood fat levels, and the long-term nature of diabetes.

There are four main classifications of diabetic neuropathy, and each one affects different parts of the body.

1. Peripheral neuropathy affects the legs, feet, and toes, and to a lesser extent, the arms and hands. Peripheral neuropathy causes pain or loss of feeling in the affected areas. Some people with diabetes experience burning or prickling sensations, become very sensitive to touch, or lose balance or coordination. Foot injuries must be given particular attention for people with peripheral neuropathy.

2. Autonomic neuropathy has many varied effects, especially on the heart and blood vessels, the digestive system, the urinary tract, sex organs, sweat glands, and the eyes. Autonomic neuropathy can affect blood pressure, sexual activity, and normal functioning of the bowel and bladder. This condition may also cause people with diabetes to be unable to recognize the symptoms of low blood sugar. Autonomic neuropathy may cause weight loss, a sustained high heart rate, and reduced night vision.

3. Proximal neuropathy affects the thighs, hips, and buttocks. Diabetics may experience pain and a weakening of the legs. Proximal neuropathy is more common in Type 2 diabetes and in older people who have diabetes.

4. Focal neuropathy generally affects the eyes, face, ears, pelvis, lower back, thighs, and abdomen, though any nerve in the body may experience focal neuropathy. This condition causes weakness or pain in muscles due to the weakening of the affected nerve(s). It is most common in older people who have diabetes, but does not cause long-term damage and is self-healing over time.

To prevent diabetic neuropathy, your best course of action is to keep your blood sugar levels under control to prevent nerve damage. In addition, diabetic neuropathy may be treated with many methods:

• Proper foot care, including daily inspection for injuries.
• Pain relievers, hypnosis, acupuncture, and other pain-relieving methods.
• Medication for digestive problems.
• Eating small, frequent meals that are lower in fat and fiber, or other diet modifications as specified by your doctor.
• Wearing elastic stockings to improve circulation.
• Antibiotics to clear up infections and to help regulate digestive problems.
• Medications to increase sexual function.

Diabetic Retinopathy

Diabetes can have serious effects on your vision. It is the number one cause of legal blindness in the United States.ⁱ Both Type 1 and Type 2 diabetes can cause damage to your eyes.

Retinopathy – Diabetes is the leading cause of new blindness in 20-74 year old Americans.  Most cases are preventable.  About 40-45% of Americans with diabetes have some form of diabetic retinopathy, which simply means damage to the retina caused by diabetes. In this condition, blood vessels to the eyes are damaged, causing vision impairment or loss. Retinopathy can occur when the blood vessels that supply the retina with nourishment are blocked. The retina sends out signals to the body to grow new blood vessels to replace the blocked ones, which is called proliferative diabetic retinopathy. The blood vessels grow along the retina and the surface of the eye, and are quite fragile. They may leak blood into the eye, which can cause blurred vision or even blindness.

Macular Edema – Macular edema can be another form of diabetic retinopathy. When fluid leaks into the center of the eye, the macula, it can swell. This causes blurred or distorted central vision, since the macula helps us see straight ahead.

Cataracts – Cataracts are the clouding of the clear tissue at the front of the eye. People with diabetes have twice the risk of developing cataracts.ⁱⁱ

Glaucoma – Glaucoma is a condition in which fluid builds up in the eye, causing the pressure to increase. This high pressure can damage the optic nerve, causing headaches and loss of vision.

Preventing Damage

There are many things can you do to guard against the effects of diabetes on your eyes. The most important is to have an annual dilated eye examination. Many stages of eye damage, such as diabetic retinopathy, do not have symptoms, so this eye examination is crucial. An eye exam should test your visual acuity using a vision chart. Your eye doctor should also inspect your retina and optic nerve for damage, such as leaking blood vessels or any swelling (macular edema). People with proliferative diabetic retinopathy can reduce their risk of blindness by 95% if they receive treatment and proper follow-up care in a timely manner.ⁱⁱⁱ

Monitoring your blood sugar is another good preventative measure in caring for your eyes. Both the rate and the progression of eye damage can be slowed when your blood glucose levels are under control. Quitting smoking and controlling your blood pressure are two additional health measures than can lower the risk of damage to your eyes.

i http://www.eyesod.com/articles/diabetes_reeves.htm
ii Vision Complications at dLife
iii http://www.nei.nih.gov/health/diabetic/retinopathy.asp#2c

Erectile Dysfunction

Erectile dysfunction, sometimes called "impotence," is the repeated inability to get or keep an erection firm enough for sexual intercourse. The word "impotence" may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.

Erectile dysfunction, or ED, can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED and estimating its incidence difficult. Estimates range from 15 million to 30 million, depending on the definition used. According to the National Ambulatory Medical Care Survey (NAMCS), for every 1,000 men in the United States, 7.7 physician office visits were made for ED in 1985. By 1999, that rate had nearly tripled to 22.3. The increase happened gradually, presumably as treatments such as vacuum devices and injectable drugs became more widely available and discussing erectile function became accepted. Perhaps the most publicized advance was the introduction of the oral drug sildenafil citrate (Viagra) in March 1998. NAMCS data on new drugs show an estimated 2.6 million mentions of Viagra at physician office visits in 1999, and one-third of those mentions occurred during visits for a diagnosis other than ED.

In older men, ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. Incidence increases with age: About 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience ED. But it is not an inevitable part of aging.

ED is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for ED. Urologists, who specialize in problems of the urinary tract, have traditionally treated ED; however, urologists accounted for only 25 percent of Viagra mentions in 1999.

How does an erection occur?

The penis contains two chambers called the corpora cavernosa, which run the length of the organ (see figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum.

Erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.

What causes erectile dysfunction (ED)?

Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases—such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease—account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED.

Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. Smoking, being overweight, and avoiding exercise are possible causes of ED.

Also, surgery (especially radical prostate and bladder surgery for cancer) can injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

In addition, many common medicines—blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug)—can produce ED as a side effect.

Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases. Men with a physical cause for ED frequently experience the same sort of psychological reactions (stress, anxiety, guilt, depression). Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as not enough testosterone.

How is ED diagnosed?

Patient History

Medical and sexual histories help define the degree and nature of ED. A medical history can disclose diseases that lead to ED, while a simple recounting of sexual activity might distinguish among problems with sexual desire, erection, ejaculation, or orgasm.

Using certain prescription or illegal drugs can suggest a chemical cause, since drug effects account for 25 percent of ED cases. Cutting back on or substituting certain medications can often alleviate the problem.

Physical Examination

A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to touching, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can point to hormonal problems, which would mean that the endocrine system is involved. The examiner might discover a circulatory problem by observing decreased pulses in the wrist or ankles. And unusual characteristics of the penis itself could suggest the source of the problem—for example, a penis that bends or curves when erect could be the result of Peyronie's disease.

Laboratory Tests

Several laboratory tests can help diagnose ED. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measuring the amount of free testosterone in the blood can yield information about problems with the endocrine system and is indicated especially in patients with decreased sexual desire.

Other Tests

Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of ED. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then ED is likely to have a physical rather than psychological cause. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.

Psychosocial Examination

A psychosocial examination, using an interview and a questionnaire, reveals psychological factors. A man's sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse.

How is ED treated?

Most physicians suggest that treatments proceed from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men regain sexual function.

Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of blood pressure medicine.

Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.

Psychotherapy

Experts often treat psychologically based ED using techniques that decrease the anxiety associated with intercourse. The patient's partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when ED from physical causes is being treated.

Drug Therapy

Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat ED. Since that time, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) have also been approved. Additional oral medicines are being tested for safety and effectiveness.

Viagra, Levitra, and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for either Levitra or Cialis is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. A lower dose of 5 mg is available for patients who take other medicines or have conditions that may decrease the body's ability to use the drug. Levitra is also available in a 2.5 mg dose.

None of these PDE inhibitors should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, tell your doctor if you take any drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure. Your doctor may need to adjust your ED prescription. Taking a PDE inhibitor and an alpha-blocker at the same time (within 4 hours) can cause a sudden drop in blood pressure.

Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs—including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone—are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.

Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when rubbed on the penis.

A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.

Research on drugs for treating ED is expanding rapidly. Patients should ask their doctor about the latest advances.

Vacuum Devices

Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. The devices have three components: a plastic cylinder, into which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body.

One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after erection is attained and during intercourse.

Surgery

Surgery usually has one of three goals:

1. to implant a device that can cause the penis to become erect
2. to reconstruct arteries to increase flow of blood to the penis
3. to block off veins that allow blood to leak from the penile tissues

Implanted devices, known as prostheses, can restore erection in many men with ED. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have diminished in recent years because of technological advances.

Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid. Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.

Surgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch or fracture of the pelvis. The procedure is almost never successful in older men with widespread blockage.

Surgery to veins that allow blood to leave the penis usually involves an opposite procedure—intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes the rigidity of the penis during erection. However, experts have raised questions about the long-term effectiveness of this procedure, and it is rarely done.

Hope through Research

Advances in suppositories, injectable medications, implants, and vacuum devices have expanded the options for men seeking treatment for ED. These advances have also helped increase the number of men seeking treatment. Gene therapy for ED is now being tested in several centers and may offer a long-lasting therapeutic approach for ED.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsors programs aimed at understanding the causes of erectile dysfunction and finding treatments to reverse its effects. NIDDK's Division of Kidney, Urologic, and Hematologic Diseases supported the researchers who developed Viagra and continue to support basic research into the mechanisms of erection and the diseases that impair normal function at the cellular and molecular levels, including diabetes and high blood pressure.

Points to Remember

• Erectile dysfunction (ED) is the repeated inability to get or keep an erection firm enough for sexual intercourse.
• ED affects 15 to 30 million American men.
• ED usually has a physical cause.
• ED is treatable at all ages.
• Treatments include psychotherapy, drug therapy, vacuum devices, and surgery.

Heart Disease

Did you know that according to the American Diabetes Association, around two-thirds of people with diabetes die from heart disease or stroke? That's why it's so important to lower the risk factors for these conditions as much as possible.

The American Heart Association recognizes that there are many factors we can’t control when it comes to the risk of heart disease: getting older, heredity and race, and even gender.ⁱ However, there are many things we can do to protect the health of our heart.

Quitting smoking is one of the most important measures people can take, since smokers have 2-4 times the risk than nonsmokers of developing heart disease. Adding physical activity not only keeps the heart in shape, but also benefits blood pressure, cholesterol, and blood sugar levels. Losing weight and excess body fat is another effective way to guard against heart disease and stroke. Excess abdominal fat is a particular risk factor for heart disease, so keeping the waist to 35" or under for women and 40" or under for men is widely recommended. Along with losing weight, lowering blood cholesterol levels and keeping blood sugar levels under control are important for preventing heart problems.

For people with diabetes, striking a balance between lowering blood sugar levels and controlling heart-risk factors (such as high blood pressure and cholesterol) may be more important than previously thought. A recent study of 10,000 people with Type 2 diabetes who also had a high risk of heart disease was sponsored in part by the National Heart, Lung, and Blood Institute. The scientists leading this study found that for these patients, lowering the blood sugar levels too much actually led to an increase in the death-rate.ⁱⁱ Reducing patients' blood sugar levels closer to normal raised their risk of death over patients whose blood sugar levels were slightly above what was previously considered to be optimal.

These results go against decades of research that recommends bringing blood sugar levels down to near-normal levels as much as possible. For now, the authors of study are unable to pinpoint why these results occurred, so further research is ongoing. Doctors still agree, however, that the overall effect of lowering blood sugar produces greater benefits than not. Speak with your doctor for more information on how diabetes, heart disease, and stroke are related, and for the best treatment options for you.

i http://www.americanheart.org/presenter.jhtml?identifier=4726
ii http://www.boston.com/news/health/articles/2008/02/11/diabetes_study_upends_another_long_held_belief/

Kidney Disease

People with diabetes have a high risk of developing kidney problems. In fact, diabetes is the number one cause of Chronic Kidney Disease (CKD) in the United States. Yet according to Dr. Joseph Coresh, MD, PhD, less than 10% of people with kidney disease are even aware that they have a problem.ⁱ

The kidneys are crucial for maintaining a healthy body. They filter both toxins and extra fluid from the bloodstream. In people with diabetes, excess sugar in the blood makes the filters in the kidneys, called nephrons, work harder than usual. Eventually, the nephrons and the blood vessels running through them become overworked. Consequently, the kidneys suffer damage. They work and less efficiently, leading to a build-up of toxins in the body.

Many of the symptoms of kidney disease are easy to miss, as they could be caused by any number of reasons. Some of the symptoms include:ⁱⁱ changes in urination (burning sensation, difficulty in urinating, blood in the urine); fluid retention, causing swelling of the legs, ankles, feet, face, or hands; fatigue; skin rashes or itching; nausea or vomiting (also leading to weight loss); shortness of breath; coldness; dizziness or memory problems; and pain in the legs, back, or side. High blood pressure can also be an indicator of kidney disease, since even mild hypertension can impair the healthy functioning of the kidneys.ⁱⁱⁱ

A reliable way to diagnose kidney problems is with a GFR test. The GFR, or glomerular filtration rate, is a measure of how well your kidneys are working. The GFR test tells how much creatinine is in your blood. Creatinine, which is formed when the muscles work, is a waste product that can accumulate over time. When the kidneys aren’t functioning properly, the creatinine levels rise. The GFR test gives a numerical “grade” that tells whether your kidneys are working optimally or not.

There are some important steps that people with diabetes can take to prevent or slow the progress of kidney disease. First and foremost is controlling your blood sugar. Keeping hypertension in check is important, too. Some high blood pressure medicines can even help to protect the kidneys. Finally, avoiding certain medications that are toxic to the kidneys is a good idea. These medications include some pain killers, such as those which combine aspirin, acetaminophen, and caffeine. Ask your doctor about the effects of pain killers such as aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs.^iv

i http://www.sciencedaily.com/releases/2007/11/071106164813.htm
ii http://www.lifeoptions.org/kidneyinfo/ckdinfo.php?page=4
iii http://www.netwellness.org/healthtopics/kidney/kidneysigns.cfm#g
iv http://www.kidney.org/ATOZ/atozItem.cfm?id=23

Men & Diabetes

We had the privilege of talking with Dr. Richard Bergenstal, the Vice President of Medicine & Science of the American Diabetes Association (ADA; www.diabetes.org). Dr. Bergenstal has dedicated 30 years of his career to making life better for people with diabetes.

The ADA surveyed 1,000 men with type 2 diabetes, age 40-60, as well as 1,000 female spouses of men who have type 2 diabetes. The survey assessed their general knowledge of type 2 diabetes and associated complications.

The ADA's "National Men's Health Education Survey" revealed:

• Only 30% of men seemed to know "a lot" about their disease.
• 60% of men surveyed felt more information could help them better manage their diabetes.
• Men with type 2 diabetes were likely to get less enjoyment out of their lives and that diabetes has negatively impacted their sex lives.
• More than ⅓ of men surveyed experienced four or more symptoms associated with low testosterone. Some symptoms of low testosterone include: depressed mood, erectile dysfunction and fatigue.

According to the ADA there are 12 milllon men in the U.S. who have diabetes. In addition to common complications from diabetes, diabetes complications can also specifically affect men in the following ways according to the ADA:

• Men with diabetes are at greater risk for erectile dysfunction caused by nerve damage.
• Testosterone deficiency is common in men with diabetes, regardless of the type.
• Men with type 2 diabetes are twice as likely to have low testosterone. Symptoms of low testosterone can include: diminished interest in sex, erectile dysfunction (ED), reduced lean body mass, decreased bone mineral density and depressed mood and fatigue.

The ADA is recommending men be more proactive in managing their diabetes including: "monitoring the ABCs of diabetes which include A1c (a measure of blood glucose), blood pressure and cholesterol."

In our interview, Dr. Bergenstal emphasized that men with diabetes need to be aware of the physical aspects of disease, but they also need to be aware of the emotional and sexual issues stemming from diabetes.

Listen to Dr. Richard Bergenstal's interview for his viewpoint regarding how men with diabetes can be proactive in managing their diabetes to improve their overall health and quality of life.

The ADA has information on its website dedicated to men's health issues. For more information and to download a free copy of the ADA's booklet "Modern Man's Guide to Living Well With Diabetes," please visit www.diabetes.org/menshealth.

Support Systems

Diabetes is a condition that requires vigilance and self-education, but people with diabetes don’t have to go through it all on their own. Developing a support system is a very important factor in diabetes self-management.

Being diagnosed with diabetes is difficult enough. What’s even more stressful is realizing the sheer volume of information that people with diabetes need to learn about in order to care for themselves effectively. It can truly seem overwhelming at times. But people with diabetes aren’t alone. There is a crucial support system that many patients don’t even know about: diabetes educators.

Diabetes educators are health professionals such as doctors, nurses, dieticians, social workers, and exercise physiologists. Most of these educators are Certified Diabetes Educators (CDEs), having undergone special training to give patients with diabetes the most knowledgeable care possible. A recent study published in Diabetes Careⁱ shows that patients who attend diabetes education classes or who consult with a nutritionist have a one-third lower hospitalization rate. The study also found that hospitalization costs associated with diabetes were lowered by more than $11,500 for patients who received diabetes education.

Diabetes educators teach patients about the disease and give valuable health information on how to carry out daily activities and how to self-manage diabetes. Some of the basic behaviors that diabetes education focuses on are proper nutrition, appropriate physical activity, medication management, risk-reduction, and glucose monitoring. Diabetes educators also provide counseling to help patients navigate the emotional ups and downs of being diagnosed and learning to manage their own care.

Beyond diabetes educators, patients need to develop a strong support system to help them through the rough spots and to safeguard their health. This support team should include the patient’s primary physician, pharmacist, social worker, and specializing physicians such as eye doctors, dentists, and podiatrists. Each of these professionals can help ensure that every aspect of diabetes care is managed optimally to give the patient the best quality of life.

Last but not least, people with diabetes will need the support and understanding of family and friends. Instead of feeling that your condition may be an inconvenience to loved ones, allow them to show their caring and support by assisting you in your daily life. If family and friends understand the disease and how it can affect your life, they can be your first and best line of protection when it comes to your well-being. Educate your loved ones about diabetic symptoms and care so that they can be alert to warning signs. They’ll help you stay healthier—and happier, knowing that you don’t have to go it alone.

i http://www.reuters.com/article/healthNews/idUSCOL07004720080430?feedType=RSS&feedName=healthNews

Research Resources

American Diabetes Association
Diabetes Research Foundation
Joslin Diabetes Center
Juvenile Diabetes Research Foundation (JDRF)
National Diabetes Information Clearinghouse (NDIC)

Curing Diabetes

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), along with other private and government agencies that support diabetes programs, conduct research and use statistics to help deal with this growing problem of diabetes. Within the past few years, the research that these institutions have done have helped develop better ways to manage diabetes, inject insulin, successful kidney and pancreas transplants, and newer and better drugs to help deal with this growing disease.

Because type 2 diabetes is more complex than type 1 diabetes, a cure for type 2 diabetes will not be found until more research is done on insulin resistance in the body. Because type 1 diabetes has to do with the failure of one function in one organ, there are more research opportunities available for type 1 diabetes. Some techniques for curing type 1 diabetes includes the transplanting of beta cells into mice and humans, but these patients will still have to take a drug to protect the transplanted tissue. Some alternatives include isolating the beta cells from the immune system by transplanting them into a semi-permeable container. Another research technique is through stem cell research which may be able to foster re-growth of islet cells in the human pancreas. The only patients, who have been cured of diabetes, are those who have received a kidney-pancreas transplant.

About Jeanna Rhoulhac

Jeanna Rhoulhac, certified diabetes educator, specialist in adult weight management

Jeanna Rhoulhac, RD, LD/N, CDE, has been dedicated to helping people with diabetes for almost 20 years. Jeanna’s interest in diabetes began at an early age as her maternal grandmother had type 2 diabetes. From this, she developed an interest in learning more about how the foods we consume can impact our health.

Jeanna is a certified diabetic educator who received her BS degree in Dietetics and Nutrition from Andrews University and became a registered dietitian in 1981. Jeanna has practiced dietetics in clinical hospital and community settings. In 2002, Jeanna became a certified diabetic educator (CDE) and currently works in as a Clinical Nutritionist with a specialization in Adult Weight Management in Fort Lauderdale, Florida.

Providing her clients with an individualized plan of care is very important to Jeanna, who strives to motivate and support her clients in every way. Jeanna especially loves seeing fears and anger turn into hope, happiness and a positive outlook on life.

Jeanna is very active in professional associations. She currently serves on the Administrative Councils for both the South Florida Association of Diabetes Educators and the Broward County Dietetic Association, Inc. Most recently, she presented a lecture on " Herbal Remedies and Natural Healing with Vitamin and Mineral Supplements" to the ADA Support Group at North Broward Medical Center (May 2008). In addition, Jeanna currently is certified as a Project Power Ambassador by the American Diabetes Association.

About Kimberly Mistiszyn

Kimberly Mistiszyn, O.D., is a board certified optometric physician in both Florida and Pennsylvania. She currently practices at The Rand Eye Institute in Deerfield Beach, Florida. The Rand Eye Institute has played an integral role in supporting diabetes research through its connection with the Diabetes Research Institute (DRI) Foundation. Dr. Mistiszyn is part of a team of doctors who provide comprehensive eye evaluations to diagnose and treat ocular diseases including diabetic retinopathy and glaucoma. She provides pre- and post-operative care to all types of surgical patients including cataract, corneal and refractive surgery.

Dr. Mistiszyn discovered her love for vision health in the summer of 1995 when she worked for a local ophthalmologist in Hazleton, Pennsylvania. She came back to work every summer while on break from college and then in May 1999 graduated Magna Cum Laude from Lycoming College with a Bachelor of Science degree in Biology. From there she moved on to Pennsylvania College of Optometry (PCO) in Philadelphia, Pennsylvania, where was awarded clinical honors and became a member of the Gold Key International Optometric Honor Society and the Beta Sigma Kappa National Optometric Honor Society. While an optometric student, Dr. Mistiszyn took part in a humanitarian trip to Guatemala where she evaluated and treated patients from undeveloped areas of Guatemala. During this trip she discovered her passion for treating ocular diseases, which would lead her to complete an ocular disease residency at the Wilkes-Barre Veterans Medical Center in Wilkes-Barre, Pennsylvania, following her graduation from PCO in May 2003. Dr. Mistiszyn really took an interest in diabetes and the retina after working alongside a retinal specialist during her residency. Her commitment to helping diabetes patients became more personal when her mom was diagnosed with type 2 diabetes. Dr. Mistiszyn is dedicated to providing hope and treatment to people with this devastating disease. One of Dr. Mistiszyn’s goals is to provide education, awareness and hope to people who are affected by diabetes so that they can prevent and avoid any severe ocular complications.