Is the Mediterranean diet good for Diabetic Patients? Part 3

Conclusion

This study reinforces what has previously been well known- ie that benefits of a healthy lifestyle should not be ignored, despite recent discoveries of newer anti-diabetic drugs.

All diabetics should understand that lifestyle changes are essential in the management of diabetes. In the long run, patients are much better off if the dietary advice they receive is more along the lines of a Mediterranean diet.

However, even though the results of the above study are great, one has to be practical. The patients in the above study received intense nutritional support for a long time, something that is not normally available or affordable by most patients in North America. In the study, dieticians and nutritionists frequently emphasized diet and lifestyle changes. Whether similar advice from physicians only will deliver such good results remains to be seen.

There is little doubt that the role of diet and lifestyles can have a marked improvement in diabetics. All diabetics need to know about portion amounts (supersize is out), nutritional values of whole foods and role of exercise. Perhaps with this news, health care professionals will start to be more forceful and reinforce benefits of lifestyle and diet.

For the most part, health care workers have always emphasized medical therapy alone as a key to success. With this study comes an important reminder. Patient management is a complex synergistic interaction between medical therapy and life style changes. Both need to be emphasized to achieve the best results.

http://www.medscape.com/cardiology

Is the Mediterranean diet good for Diabetic Patients? Part 2

The results

Of the 155 patients who had a raised HbA1c level of >7% at the onset, less than 1/5th (only 22 individuals) still had raised HbA1c level after three months. At the end of six months, individuals on both diets had decreased levels of HbA1c.
Individuals consuming both diets, lost weight and had decreases in blood glucose and HbA1c levels, but the reductions were more noteworthy in those who consumed the Mediterranean-diet.

The Mediterranean diet also postponed the need for high blood pressure medications irrespective of weight loss. Further, more patients who consumed the Mediterranean diet also had higher increases in HDL-cholesterol levels (good cholesterol) and lowering of fats.

Overall, the results showed that with sustained nutritional guidance, only 44% of newly diagnosed diabetic patients on a Mediterranean diet vs. 70% of those on a low-fat diet needed drug treatment as well as diet to manage their diabetes. Moreover, individuals on the Mediterranean diet also had a significant decrease in some risk factors that affect the heart.

Is the Mediterranean diet good for Diabetic Patients? Part 1

The incidence of diabetes has skyrocketed globally in the last 3 decades. Further, there are millions more individuals with diabetes that have not been diagnosed. To date, the treatment of type 2 diabetes is done with drugs and sometimes insulin. Now, there is some evidence that by consuming a low carbohydrate Mediterranean diet, recently diagnosed diabetic patients may postpone the need for pharmaceutical drugs to control this chronic disorder.

There has been a lot of evidence gathered over the past 2 decades that the Mediterranean diet does improve risk factors for heart disease and diabetes. Further, the American Diabetes Association fervently advocates a low carb or a low fat diet in overweight individuals with type 2 diabetes. However, there have not been many studies that have compared the two diets in diabetic individuals.

A recent study from italy just published has fascinating results (Annals of Internal Medicine (Sept 1, 2009).

The Study

To evaluate the effectiveness of these two accepted diets in delaying anti diabetic drug therapy, researchers in Italy studied 215 obese patients with newly diagnosed type 2 diabetes. All patients had sedentary lifestyles, had a body mass index > 25 kg/m2, and had a HbA1c of between 7-11%. The conclusion of the study was to look at the time when anti diabetic drugs were introduced to control blood sugars. Other data also looked at weight changes, control of blood pressure and levels of blood glucose and cholesterol. All individuals received regular solid advice from dieticians on the value of diet and exercise and were educated how to make different diets at home.
The individuals in the study were then arbitrarily allocated to one of the following diets for four years:

- A Mediterranean diet that consisted of whole grains,
vegetables, fruits, less red meat but ample poultry, fish.
Less than 30 percent of calories were from derived from olive oil.

- A low-fat diet based on American Heart Association
recommendations that included whole grains, high fat snacks, and
limited number of sweet foods. Less than thirty percent of
calories were obtained from fat.

Status of diabetes was determined by measurement of HbA1c levels at baseline and every three months.

Does intense control of blood sugars result in more benefits in diabetics?

For many years, it has always been believed that tighter control of blood sugars is beneficial to avoid complications of diabetes. There are some physicians who rigidly manage their diabetic patients with very strict blood sugar control. There are other physicians who believe that intense control of blood sugars is not as important.

In the recent study published in the lancet, investigators combined results from 5 large trials to shed further light on the confusing question of whether intensive glycemic control reduces risk for cardiovascular outcomes. Data from United Kingdom Prospective Diabetes Study (UKPDS), the PROspective pioglitAzone Clinical Trial In macroVascular Events (PROactive), the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), the Veterans Affairs Diabetes Trial (VADT), and the Action to Control Cardiovascular Risk in Diabetes trial (ACCORD) were evaluated.

Follow-up of nearly 163,000 person-years revealed that intensive glucose-lowering treatment significantly decreased incidence of nonfatal myocardial infarction and episodes of chest pain from coronary disease. However, researchers observed no statistically significant effect for stroke or death rate. The mean reduction in glycated hemoglobin (A1c) was 0.9%. The study also found that low sugar (hypoglycemic) events were more common among the intensively treated patients, but the proportion in either group that experienced severe events was fairly low.
Also evident in these trials was that individuals who received intensive treatment had gained a mean of 2.5 kg more weight than those on standard treatment.

So what does all this mean for the diabetic patient?

The above studies indicate that tight control of blood sugars may provoke episodes of hypoglycemia and also be associated with weight gain. However, one should not be misled and relax their efforts to achieve tight glucose control. Tight sugar control has many other benefits that are not always evident. At the moment, the American Diabetes Association has concluded that there is no need for major changes in blood sugar control targets. The tight sugar control does offer some benefits to the heart. Further, the ADA also recommends that for maximal benefit all diabetics should also make an effort to control their blood pressure and high cholesterol.

Ray KK, Seshasai SR, Wijesuriya S, et al
Lancet. 2009; 373:1765-1772

for more on diabetic supplies, please visit www.medexsupply.com

Life style changes and diabetes: part 2

Doctor visits: It is very important to see a physician regularly because of the multitude of complications that can occur. It is essential that the health care worker regularly examine your feet and eyes. Blood work to ensure that the kidneys are working should also be routinely done.

Immunizations: All diabetics should be updated on immunizations because high sugars can weaken the immune system. High sugars also makes one more prone to numerous infections.

Oral hygiene: High sugars can destroy your gums and teeth from recurrent infections. Brush your teeth frequently and get regular dental exams.

Foot care: There is no other more devastating complication than the diabetic foot. When diabetes is not controlled, the majority of individuals will eventually end up with amputations of their toes or their legs. One should avoid all trauma to the feet and wear proper protective shoes. All injury or infection of the feet must be immediately seen by a physician.

Blood pressure: Most diabetics develop a high blood pressure because of stiffening of their blood vessels. The blood pressure must be maintained within normal limits and routine checks up are a must.

Smoking; This social habit worsens and increases risk of every type of diabetic complication. In simple, diabetics should not smoke. The majority who do smoke will have their feet/legs amputated or die from a heart attack.

Stress: Stress is bad for all disorders and diabetes is no exception. Stress can worsen blood sugar and make it difficult to control. Relax, sleep well and live an active life.

While diabetics can live a normal life, they have to make an extra effort to ensure that their blood sugars are kept under control. Exercise in any form should be a part of everyday life for all diabetics.

For more on diabetic supplies, please visit www.medexsupply.com

Can Life style changes improve my diabetes?

Diabetes is a chronic disease and if neglected can cause numerous irreversible complications. While we do not have a cure for the disease, there are many changes in lifestyle one can adopt to delay onset of complications. By adopting a positive lifestyle one can live a fruitful life with minimal complications.

Physical activity: Like everyone, all diabetics should exercise on a regular basis. Regular exercise will prevent weight gain and help control blood sugar. For those diabetics who start to exercise, glucose levels should be measured more frequently to ensure that low sugar levels do not occur. A lot of evidence has accumulated in the past decade indicating that exercise leads to better control of not only blood sugar, but also blood cholesterol.

Learn about diabetes: Being knowledgeable about the disease can help one appreciate the disorder and adjust accordingly. All diabetics should regularly see an endocrinologist and a nutritionist. The more one is educated about the disorder, the better treatment they can receive.

Wear a medical bracelet: This important tag will ensure that all health care workers know your condition, will immediately identify and treat any serious complications that may arise.

Glucagon: All diabetics should keep a glucagon kit nearby in case of low blood sugar emergency. Make sure those around you know how to use the kit. Low blood glucose problems are more common in type 1 diabetics.

As a diabetic, what foods should i eat?- part 2

One should try and eat a healthy diet which derives at least 20-20% daily calories from protein, 30% of less from fat and the rest from carbohydrates. One should become a label based shopper and check which foods are sugar and fat free. Some labels even mention which foods are good for the diabetic.

When it comes to alcohol, there is no rule on how much on should drink. Alcohol is known to lower sugar and so drink it with your meals. And do not go overboard. One should not treat the diabetes and at the same time require treatment for alcoholism. Do be aware that brandy and some liqueurs have very high sugar content.

Because diabetes increases the risk of heart disease, one should make every attempt to control the cholesterol levels. Combination of cholesterol and diabetes is bad news. There are drugs to decrease cholesterol levels, but the first choice of therapy is exercise and this is highly recommended.

For those who can afford it, a consult with a decent nutritionist or a dietician may help. These professionals can help you with develop a well balanced diet and monitor your progress. However, there is a lot of free literature on how diabetics can manage their diet on cyberspace and there is absolutely no need to pay a dietician for some common sense advice. The best website for good information on diabetes is the American Diabetes Association.

Diabetes does not mean that one can not enjoy food. In moderation, almost all types of food can be eaten by the diabetic.

for more on diabetic supplies, please visit www.medexsupply.com

As a diabetic, what foods should I eat?

Unfortunately, Type 1 diabetes can not be prevented nor can it be cured. It is a serious chronic disease and the individual has to adapt to it. Diabetes is relatively easy to control but when the sugars are allowed to run high, devastating complications can occur. To avoid diabetic complications, one needs to make changes in lifestyle and eating habits- this will make one’s life a lot bearable and hassle free. These changes include:

Nutrition

Proper nutrition is an integral component of diabetes management and of diabetes self-management education. Yet many misconceptions exist concerning nutrition and diabetes. Despite what everyone thinks there is no such thing as a diabetic diet. One should reduce the intake of total fat, mainly saturated fat, which is known to worsen diabetes and make control of blood glucose difficult. Except for omega 3 fatty acids, most fats have an adverse effect on insulin action. Some dieticians recommend that intake of unsaturated fatty acids are beneficial in the long term management of diabetes.

Recent studies also indicate that there is a decreased risk of diabetes with increased intake of whole grains and dietary fiber. Although few micronutrients may affect glucose and insulin metabolism, data to document their role in the development of diabetes are scant. In fact moderate amount of alcohol intake has recently been shown to increase insulin sensitivity and improve glucose control. However, recommending alcohol consumption as therapy may lead to worsening of the social problems related to alcoholism, not to mention its damaging effects on the liver.

The best way to control diabetes is being smart and selecting foods which will keep not only the sugar down, but will also help to control weight gain and decrease cholesterol. This can be approached by changing to a diet with fewer calories and less fat- this can be accomplished by eating more fresh fruit, vegetables, sea food and legumes instead of daily steak and hamburgers.

Victoza: part 2

How does Victoza work?

Victoza is actually a glucagon like peptide that works by stimulating release of insulin from pancreas when blood sugar levels become too high. The drug can also reduce appetite and lead to weight loss.

How often does Victoza have to be administered?

Victoza can be taken any time as long as you take it the same time each day.

What are benefits of Victoza?

Victoza is recommend as good treatment choice for initial therapy, Experts indicate that besides causing weight loss, it is virtually free of low-blood-sugar reactions, something no patient likes to see. Finally, it does have positive benefits with regard to blood pressure, particularly systolic blood pressure

Does the drug have side effects?

There are reports that the drug can cause thyroid enlargement or cancer in rats.
The final decision now rests with the FDA and investors fear the agency will err on the side of caution, delaying -- and possibly blocking -- the drug's U.S. launch.

If Victoza wins FDA approval, it will the first-line treatment for newly diagnosed patients. That is because the drug stimulates insulin production by beta cells of the pancreas.

for more on diabetic supplies, please visit www.medexsupply.com

Victoza- once a day drug for diabetes?

One of the latest novel medications developed to treat type 2 diabetes is Victoza. Made by the pharmaceutical company, Novo Nordisk of Denmark, Victoza has gained a lot of favorable reports. Victoza® is the brand name for Liraglutide and is the first once a day drug for treatment of type 2 diabetes. Unlike previous oral hypoglycemic drugs, Victoza is actually human glucagon like peptide and is only administered via an injection. Experts in diabetes claim that Victoza has several advantages for diabetics.

These include:

Can be combined with metformin or other oral hypoglycemic agent in patients with poor sugar control despite maximal tolerated dose of metformin or other oral hypoglycemics.

The drug can help diabetics lose weight.

It does not cause profound drop in blood sugars.

The drug is undergoing final evaluation by the FDA and news of its release in the North American market is expected soon. Clinical Studies from Europe involving thousands of diabetic patients have shown that Victoza can lower blood glucose and help reduce weight. Further, unlike other oral hypoglycemics, it does not cause a profound drop in blood sugars.

External Shock Wave Therapy: Part 2

So what does all this mean?

Diabetes is a complex disease and there is no single ideal treatment for a diabetic ulcer. In the present study, only 30 patients were studied and the blood supply to the foot was not fully documented. If there is no blood supply to the leg, there is no therapy today that can heal an ulcer. Further, ESWT requires treatment for 1-2 minutes every 72 hours and only 50% of diabetic wounds close after 2 months. By the way, one should note that conventional treatment in the same study resulted in 33% of wound closure. Therefore, the difference was not that great.

Further, ESWT is only experimental and not the panacea for a diabetic foot ulcer. Individuals who have diabetes should take great care of their feet, control their blood sugars, wear protective shoes, and not smoke. For those who already have an ulcer, remember hundreds of such exotic therapies have come and gone. Continue with the present therapy, select a good wound care physician. Finally, never ever let a podiatrist touch your feet without first talking to your vascular surgeon.

http://www.medscape.com/viewarticle/704114

External Shock therapy for Diabetic foot

Individuals with diabetes who have an ulcer or an open wound on the leg or foot often go through numerous procedures to help the wound heal. The primary problem in many diabetics is poor blood supply but a number of diabetics also develop neuropathic ulcers from pressure or trauma and have good blood supply. At present, the conventional treatments to heal diabetic foot ulcer include treatment of infection, debridement, relief from any pressure and restoring blood supply to the leg or foot. Despite the wide variety of present treatments, the majority of wounds in diabetic never heal with these therapies. In the end, many diabetics end up having amputations of a toe(s), foot, or leg.

Over the last few years, Italian scientists have been studying the role of external shock wave therapy (ESWT) and promotion of healing of certain diabetic foot ulcers. The Italian scientists started to experiment with shock wave therapy in combination with the current standard treatment. Their research work revealed that shock waves could help tissues heal.

In a small study of 30 patients with diabetic foot ulcers, patients were administered shock wave therapy administered every 1-2 minutes for 72 hours at a time. After 20 weeks, only 50% of diabetics had wound closure in 60 days. Of the Diabetics who were treated with conventional therapy, 33% had wound closure in a slightly longer time interval.

With these results, the Italians are now promoting external shock wave therapy to heal all types of ulcers.

New Insulin Pump: Part 2

Paradigm Veo is made by Medtronic and is only available in the UK for diabetics who already are using the older insulin pumps. The great advantage of this latest machine is that it comes with a dynamic continuous blood sugar monitoring capability.

In the UK, the pump currently sells for $5 000 but the price is expected to drop slightly in the near future. The Paradigm Veo is only suitable for type 1 diabetics and will be of great benefit for children.

Until a cure for type 1 diabetes is obtained, the paradigm Veo will make a major difference in the quality of lives of type 1 diabetics. Achieving normal blood glucose levels, avoiding diabetic complications, not having to frequently prick the fingers and checking blood sugars will hopefully be a thing of the past for a few diabetic patients.

For more on diabetic supplies, please visit www.medexsupply.com

A New Insulin Pump- Paradigm Veo

There are many types of insulin pumps and generally, they work well. The only problem with the currently available insulin pumps is that they are not able to simultaneously sense blood sugar levels and change the insulin release accordingly. People who use insulin pumps have to prick themselves frequently in order to check blood glucose levels. Now, Medtronic has designed an insulin pump that mimics the human pancreas. The pump - called the Paradigm Veo - automatically stops the flow of insulin to the body if blood sugar levels fall too low.

This is fantastic news. The major problem with current insulin pumps is that many people frequently develop too low sugar levels and never know about it. Now this new pump is designed to help prevent hypoglycemic attacks - commonly known as "hypos" - which can leave diabetics in a coma and can be lethal.

Studies in England reveals that Paradigm Veo alerts the patient if their glucose levels drop too low, and stops them from getting more insulin if they do not respond to the alert.

The pump has all the latest technology and will have a great impact on diabetics and quality of life. The pump is designed to give the diabetic more flexibility and reduce anxiety about frequent blood glucose monitoring. Further, studies show that the pump can maintain normal levels of glucose without too much hassle.

Can one use herbs to treat diabetes?

First the facts. Type 1 diabetes has only treatment- insulin. There is no substitute for it. There is no herb, lotion, potion, cream, pill, or drug that can replace this vital medication. The consumer is well advised not to replace the insulin with herbs for type 1 diabetes because the consequences can be lethal.

The treatment of type 2 diabetes is quite varied and involves a multidisciplinary approach, including weight loss, eating proper foods and medications. The role of herbs in type 2 diabetes remains a puzzle. Every single day, there is a new herb that is claimed to lower blood sugar; there are thousands of such anecdotal reports.

Some of the common herbs which are presently being studied for their role in diabetes include stevia, bilberry gymnome, and jambul. Many other herbs including Konjac mannan, American ginseng, Ipomoea batatas, Momordica charantia, nopal, aloe Vera, and fenugreek have been reported to lower blood sugar. However, the results are neither consistent nor always reproducible. For most of these herbs, there is no scientific evidence that they actually work in diabetes. Most of the “medical benefits” of these herbs are offered by dealers and vendors of health supplements who have a vested financial interest.

While most herbs are safe and can be taken as supplements, one should not substitute them for their standard conventional anti diabetic medications without first discussing the issue with a health care professional.

For the moment, the American Diabetes Association has argued against the use of herbs because the industry is not regulated and the quality is not controlled. One cannot even be sure if the same supplement bought in different stores will have the same property. In the last few years, numerous Chinese herbal products have been found to contain actual prescription anti diabetic drugs. These were drugs banned more than 20 years ago. Given these uncertainties and problems with fake supplements, the consumers should be cautious when it comes to use of herbs for diabetes.

For a type 2 diabetic, the best medical advice is to exercise and reduce weight. This therapy alone has been shown to significantly reduce blood sugars, lower blood pressure and decrease cholesterol. This approach is not only cheap and safe but the results are guaranteed is one is dedicated and motivated.

For your diabetic supplies, please visit www.medexsupply.com

Artificial Sweeteners & Diabetes Part 2

Choices of Sweeteners

The FDA has a list of approved artificial sweeteners for use in foods. The artificial sweeteners available on the market include aspartame (nutra sweet, equal), Saccharin (Sweet N Low, sugar Twin,), Acesulfame (Sunett, sweet one) and sucralose (Splenda). Of these aspartame is the least recommended for both diabetics or non diabetics. Of all the artificial sweeteners that can be used by diabetics, Saccharin is the most widely recommended.

Concern

For the past 2 decades, artificial sweeteners have received a lot of media attention regarding their safety. The internet is full of anecdotal stores about artificial sweeteners and how they cause cancer. Rest assured, these artificial sweeteners have been thoroughly studied by the National Cancer Institute. These sweeteners are quite safe and have no ability to cause cancer. However, the only one of concern is aspartame is that it is not safe for individuals who have a hereditary disease called phenyl ketonuria.

What the consumer has to understand is that just taking sugar away from the diet does not make the food low calorie. If one eats too much of any food, calories will be added and one will get fat. The one major difference between sugar free products and natural fruits/vegetables is that the former foods almost never provide adequate amount of valuable nutrients.

For your diabetes supply products, please visit www.medexsupply.com

Artificial Sweeteners & Diabetes

Everyone loves sugar but with the rampant increase in obesity and diabetes, the role of sugar in our diet is being questioned. We all tend to eat too much sugar and that is not good. To avoid sugar, many individuals now use artificial sweeteners also sometimes known as sugar substitutes.

Artificial sweeteners have been around for many decades and most are naturally occurring chemicals but there are also a number of synthetic compounds. These sweeteners provide the sweetness without as many calories. Because the sweeteners are many times sweeter than sugar, only a small amount is required to create the same sweetness as sugar. Adoption of artificial sweeteners in the diet is often one of the first changes made by people who are trying to lose weight.

The other group of individuals who also use artificial sweeteners are diabetics. These individual want the food to taste sweet but without the extra calories or raising the blood sugar levels. As such, artificial sweeteners are okay for use by diabetics but all diabetics have to watch out for many other “sugar free products”.

These sugar free products tend to contain artificial sweeteners made of sorbitol and mannitol; both of which come packed with calories and can immediately increase your blood sugar levels. In addition, in some individuals, these sugar alcohols (sorbitol) can also cause diarrhea.

Common “sugar free foods”, which are known to contain sorbitol include sugar free cookies, chocolates and even some types of flour. These sugar free substitutes are quite misleading and can undermine one’s effort to lose weight or control the diabetes.

Can a Diabetic go for a pedicure? Part 3

All diabetics have to understand that any small infection can become dangerous so going to a pedicurist is always a risk. Manicurist and pedicurist are not health care workers and have no idea what diabetes is or how dangerous it can be. Any time there is a cut in the skin, bacteria can grow. In addition, bacteria thrive when the sugar levels are high.

Therefore, whether to use a pedicure is personal choice but it is definitely not recommended. If you do use one, then there are something’s you should look for at the saloon or spa.

If you have no abnormality in your feet, and your diabetes is suitable well controlled, a pedicure is safe as long as the technician/podiatrist is competent.

What to ask at the spa

Remember you are the patient paying for a service, so speak up.

If you are visiting a spa where you do not know anyone, ask them if they know how to look after a diabetic. If the answer is no or there is hesitancy, go elsewhere

Never allow the technician/podiatrists to stick sharp objects or cut anything besides the toenails and perhaps the callus-and tell them to be gentle

Check out the salon or spa for sanitation and hygiene.

Determine how they clean their equipments. Look at the conditions of the tools. Commons sense approach will immediately tell you if the place is clean or dirty.

Some saloons even allow you to buy your own equipment, which are only used on you

If you have diabetes, the onus is on you to tell the technicians what you want. Tell them to avoid very cold or very hot water. Avoid very sharp razors, apply cotton in-between each toe web space and be gentle

If you plan to have a pedicure do not shave for at least 48 hrs prior to the procedure. Shaving can sometimes cause injury or lacerate the skin thus making it easier for bacteria to enter the skin during a pedicure

In the final analysis, whether you have a pedicure or not depends to whom you listen and what you believe. In any case, to protect your feet, wear proper shoes, keep the skin well hydrated, protect your feet at all times, and exercise on a regular basis.

If you smoke, rest assured, you will end up losing not only your toes but also your feet. For the diabetic, the only way to prevent feet complications is by being proactive. Make it a habit of examining your feet regularly for skin breaks and infections. Moreover, try and keep your sugars on the low side.

For your diabetic supplies, please visit www.medexsupply.com

Can a Diabetic go for a pedicure? Part 2

Before you rush off for a pedicure, go and see your health care provider. Let the doctor first assess your feet to ensure that you have no acute infection, reduced sensation,, broken skin , nail infection or decreased blood supply. If any of these conditions exist then it is best not to go to a pedicurist.

The other alternative is to go to a podiatrist. These health care professionals can help you trim nails, remove corns, and calluses safely (but they also charge a lot). However, many podiatrists never assess the blood supply to the foot and quickly start mucking around with knives and blades. There are countless reports of podiatrists who have cut off more tissue or nails without first assessing the pulses in the foot. While nothing happens most times, there are instances where a diabetic can end up losing a toe or even a foot.

Podiatrists are not bona fide surgeons and have little or no training in vascular surgery. One should never let a podiatrist cut or excise any part of your toe or foot without a prior clearance from a vascular surgeon- this advice may sound drastic but it can be limb saving.

Cyberspace is full of such cases where podiatrists have done more harm than good and there have been many litigations against podiatrists.

Can a Diabetic go for a pedicure?

Well, the answer to this question deserves some explanation but in general the answer is NO.

Most people ignore their feet. Individuals brush their teeth, comb their hair, take care of their pimples, wash their back side after pooping; but when it comes to their feet most individuals just could not care less. Feet may not be attractive, but if you are a diabetic, feet are a blessing. Hundreds of diabetics develop severe and life-threatening infections from minor skin trauma in the toes or foot and end up getting amputations.

For diabetics, taking care of their feet should be the highest priority. Once an amputation of even the small toe has taken place, your lifestyle is forever altered (most diabetics who end up losing one toe, usually lose more in the future). Diabetics have two major problems. One is that the blood supply gradually decreases due to atherosclerosis. In this scenario, the blood vessels narrow and after 10-20 years of diabetes, there is no blood supply to the foot.

Some diabetics have excellent blood supply to their feet but they develop severe damage to their nerves (neuropathy). These individuals are unable to sense any trauma. In both cases, any breaks in the skin, even an ingrown toenail can develop into a major infection.

How effective is Byetta for diabetes? Part 2

Physicians recommend that Byetta should be taken at the same time every day for the maximal benefit.

Side effects

Like any other drug, it does have a few common side effects like:

- Nausea
- Low blood sugar
- Vomiting
- Diarrhea
- Headaches
- Dizziness

These side effects are transient and often get better with time. Constipation is also another complication which is now being observed more frequently with Byetta.

Dosage

Byetta is available in two strengths in prefilled syringes.

- Byetta 5 mcg (gives 60 doses)
- Byetta 10 mcg (gives 60 doses)

The Byetta kits do not come with needles which need to be purchased. Initially, blood sugars have to be more frequently monitored to ensure that Byetta is working well.

All type 2 diabetics should understand that the most effective way to reduce blood sugars is by decreasing body weight, regular exercise and a change in lifestyle. Only when these efforts, fail should someone try drug therapy.

At the moment, Byetta is an excellent drug of choice for obese diabetic who want to control their blood sugars and also lose weight.

for your diabetic supplies, please visit www.medexsupply.com

How effective is Byetta for my diabetes?

In general, type 2 diabetes is treated with diet, exercise, and oral anti diabetic drugs. Now there is a new drug called Byetta (exenatide) to treat type 2 diabetes. The drug is administered as an injection but is not like insulin at all and not meant to treat type 1 diabetes. At present, Byetta is only approved for use in combination with special oral anti diabetic drugs. Incidentally, this drug was first discovered in the saliva of the Gila monster lizards.

Byetta works by mimicking the hormone incretin- this means it mimics incretin and increases insulin production when food is consumed. It also causes the liver to produce less sugar. Another benefit of the drug is that it reduces motility in the stomach, thus giving the patient a sensation of a full stomach. This leads to less food consumption and hence more weight loss. Several studies have shown that over 24-30 weeks, one can lose close to 2-3 kgs.

Byetta is available as an injection which can be given under the skin of abdomen, thighs, or upper arms. It is usually administered twice a day before the two heavy meals of the day. The meals should be at least six hours apart. To be effective Byetta must be injected within 60 minutes before the meals. It should not be injected once the meal has been consumed or more than 60 minutes before a meal is eaten.

Alternative Health Supplements for Type 2 Diabetes

The number of complimentary and alternative care medical treatments that are sold to cure or prevent diabetes and its complications are enough to full up a whole book- but in reality there are only a handful that are beneficial. The internet is inundated with sites selling cures for diabetes with powerful ads, astonishing claims, but very few scientific data. For the consumer the alternative health care market is a maze because each claim is stronger than the one before. There are thousands of anecdotal reports, which attest to the fact that these supplements cure diabetes, prevent heart attacks, improve sex life, and even restore memory.

Unfortunately, the alternative health care market is flooded with charlatans whose only ambition is to make money off desperate people- offering false promises.

The few alternative health care supplements that have been shown to be of benefit both in diabetics and those with heart problems are the following:

- alpha lipoic acid (ALA)
- chromium
- Coenzyme Q10
- garlic
- Magnesium
- omega-3 fatty acids

Of these six, only omega 3 fatty acid has lived up to expectations. The data on the other five supplements are not reproducible nor can they be verified. Some people say these supplements do wonders and others say the exact opposite. Until controlled clinical trials are held, the status of these supplements will always be questionable.

Treating Type 2 Diabetes with Dietary Supplements

Many people appear to be dissatisfied with conventional diabetic therapy and have turned to complimentary and alternative health care. What the consumer has to understand is that diabetes is a chronic disorder and there is no magic bullet anywhere. The only way to prevent complications of diabetes is by better sugar control.

Facts

The role of complimentary and alternative medicine (CAM) for the treatment of type 2 diabetes is not clear cut. There are many reports of health supplements decreasing blood sugars but all the reports are anecdotal. Controlled or randomized trials are lacking and there is no scientific proof that these supplements work. The one health supplement, which has been shown to be beneficial, is omega 3 fatty acids. This substance does not directly affect blood sugars but does help lower blood cholesterol and even helps reduce high blood pressure.

All consumers should know that health supplements bought in food stores should not be a replacement for the standard diabetic medications. It is unsafe to replace your insulin or oral hypoglycemic agents with alternative health care supplements without first consulting with your physician.

It is vital that anyone who uses or is thinking of using alternative health care supplements discuss the issue with their health care provider. This is to ensure safety and proper management of diabetes.

Most alternative health care supplements have been around for decades and overall most are safe when used at low doses by healthy people. However, at high doses there is always the potential of interacting with conventional medicines. Type 2 diabetics must be aware that other herbs, nutrients or supplements can alter the blood sugars- make them either too high or too low. If this happens, the doses of the conventional drugs must be adjusted.

Finally, the majority of alternative health care is unregulated. Both the product quality and quantity vary from place to place. Fake and counterfeit products are not unheard off. There have been many reported cases of actual drug contaminants in the health supplements to mimic conventional drugs. With such an unregulated industry, the consumer should be well acquainted with the old adage- "Buyer Beware".

Gestational Diabetes-Part 2

Treatment of gestational diabetes is not difficult; the blood sugars have to be frequently monitored and treated with insulin. Once the diagnosis of gestational diabetes has been made, the mother must make a change in her diet and avoid sugary foods.

Diets consisting of vegetables, whole grains and fruits are recommended. Exercise is highly recommended for all women with gestational diabetes. Exercise can help lower the blood sugars by forcing the glucose into the cells where it is utilized and stored.

Further, exercise helps maintain weight and reduces overall body swelling. The types of exercises may include regular walking, cycling, swimming or light jogging.

Prognosis

Females who develop gestational diabetes have a higher risk of developing both obesity and diabetes later on in life. Gestational diabetes can also increase the risk of developing pre-eclampsia in the mother.

Pre-eclampsia is a serious medical disorder characterized by elevated blood pressure, retention of water and excretion of protein in the urine. If untreated, it can be life threatening to both the mother and the fetus. All mothers with a diagnosis of gestational diabetes are carefully followed by their physician to ensure that the sugar levels do not get out of control. The baby’s growth is regular monitored with serial ultrasound.

Gestational Diabetes-Part 1

Testing for gestational diabetes

Screening for gestational diabetes is now a routine part of prenatal care. Blood glucose levels are routinely checked in the 2nd and 3rd trimester. If there is a history of diabetes in the family, the glucose levels are checked much early on in the first trimester. If the fasting blood sugars are elevated, all individuals have to undergo a glucose challenge test to confirm the diagnosis.

The majority of women who develop gestational diabetes deliver healthy babies. However, if the glucose levels are persistently high during pregnancy, some complications can occur. These include: Increased weight of baby is common in mothers who are diabetic or develop diabetes during the pregnancy.

The persistent high glucose can cross into the placenta and into the fetal circulation. The baby responds by making more insulin to counter the high glucose. Insulin also has the ability to induce growth and thus the fetus usually grows large. It is not unusual for diabetic mothers to give birth to babies which weight more than 10 pounds. Low blood sugars can also occur in the baby soon after birth. This is because the baby has been exposed to high sugars while in the womb and has high levels of insulin to counteract the sugars.

When the baby is delivered, the glucose from the mother is suddenly discontinued because the placenta is clamped but the insulin levels remain high. The elevated insulin can cause a profound hypoglycemia. This can be easily treated by administering glucose via an intravenous. Difficulty with the lung expansion or respiratory distress syndrome does occur in babies that are delivered early. This condition makes breathing difficult because the lungs are still immature.

Long Term Complications of Diabetes

Both type 1 and type 2 diabetes have profound long term complications if the blood sugar is not well controlled. These complications usually take years to establish but in some cases may occur prematurely if the individual smokes and is non compliant with therapy. The complications are not only irreversible but can be life or limb threatening. The most common long term complications of diabetes include:

Heart disease: The majority of diabetics will develop narrowing of blood vessels in the heart. This will lead to a decrease in blood supply and hence decreased oxygen to the heart. Heart attacks and congestive heart failure are common in diabetes for this reason. Further, the coronary vessels narrow extensively and neither medical treatment nor surgery is an effective solution. Almost 3/4th of diabetics die from heart disease. While there is no sure fool proof method of preventing heart disease in diabetics, it is recommended that the blood sugar be tightly controlled and that the individual take an aspirin on a regular basis.

Neuropathy (nerve damage): With time almost all diabetic develop some degree of nerve damage. All nerves in the body can be affected by diabetes but it is the nerves in the legs that are most affected. The typical signs and symptoms of nerve damage include tingling, numbness, burning or pain that usually begins in the toes and migrates upwards. Often this nerve pain is confused with blood insufficiency. When the nerve damage progresses, one can lose all sensation. When the sensation is lost, the majority of diabetics develop serious infections and trauma to their joints and bone, often leading to amputations. Nerve damage cannot be completely prevented but can be delayed by better sugar control.

Kidney damage (nephropathy): One of the most serious complications of diabetes is kidney damage. Initially, diabetics may filter out the body protein in small amounts. If this is neglected, the kidney damage progresses and leads to complete shutdown. Once the kidney fails, all diabetics end up on dialysis or require a kidney transplant. The prognosis of diabetic patients with renal failure is poor.

Eye damage: diabetes can damage the blood vessels of the inner eye and lead to blindness. Other complications include cataracts, glaucoma and retinal detachment. To prevent these complications, it is essential that all patients regularly see their eye doctor.

Diabetic foot: diabetes causes narrowing of the blood vessels in the legs. Over time this leads to decreased blood supply to the feet. The individual may complain of pain in the thigh or legs when walking. Even minor trauma can lead to a serious infection(s) which can threaten the limb. The combination of narrowed blood vessels and neuropathy often leads to amputation of the limbs/toes in most diabetics.

Oral care: Almost all diabetics develop infections and ulcers in their mouth and gums. This is more likely to occur if the blood sugar levels are not controlled. Proper hygiene and blood glucose control are vital if oral care is to succeed. Poor oral hygiene worsens the prognosis. It is essential that all diabetics regularly see an oral hygienist. It is now believed that diabetes can also lead to premature development of osteoporosis and Alzheimer’s disease.

The only way to prevent the long term complications of diabetes is by better sugar control, maintaining a healthy weight and a eating a proper diet.

For more on diabetic supplies, please visit www.medexsupply.com

What should a Diabetic Eat? Part 2

The best way to control diabetes is being smart and selecting foods which will keep not only keep the sugar down, but will also help to control weight gain and decrease cholesterol. This can be approached by changing to a diet with fewer calories and less fat- this can be accomplished by eating more fresh fruit, vegetables, sea food and legumes instead of daily steak and hamburgers.

One should try and eat a healthy diet which derives at least 20-20% daily calories from protein, 30% or less from fat and the rest from carbohydrates. One should become a label based shopper and check which foods are sugar and fat free. Some labels even mention which foods are good for the diabetic.

When it comes to alcohol, there is no rule on how much one should drink. Alcohol is known to lower sugar and so drink it with your meals. And do not go overboard. One should not treat the diabetes and at the same time require treatment for alcoholism. Do be aware that brandy and some liqueurs have very high sugar content.

Because diabetes increases the risk of heart disease, one should make every attempt to control the cholesterol levels. Combination of cholesterol and diabetes is bad news. There are drugs to decrease cholesterol levels, but the first choice of therapy is exercise and this is highly recommended.

All diabetics should be involved with a nutritionist or a dietician. These individuals can help you with develop a well balanced diet and monitor your progress. They can also teach you about the foods you eat and how they affect your glucose levels and help you coordinate your diabetes and medications to eating. The dietician will work with you to create a healthy eating plan that will include all your favorite foods.

Diabetes does not mean not enjoying food. In moderation, almost all types of food can be eaten by the diabetic. There is sufficient information online for diabetics and there is absolutely no need to buy any fancy books on diabetic diets.

For more on diabetic supplies, visit www.medexsupply.com

What should a Diabetic Eat? Part 1

Unfortunately, once diabetes has been acquired, it can not be prevented nor can it be cured. It is a serious chronic disease and the individual has to adapt to it. Diabetes is relatively easy to control but if neglected the complications of diabetes are devastating. To avoid the complications, the following changes in lifestyle will make one’s life a lot bearable and hassle free. These changes include:

Nutrition

Medical nutrition therapy is an integral component of diabetes management and of diabetes self-management education. Yet many misconceptions exist concerning nutrition and diabetes. Despite what everyone thinks there is no such thing as a diabetic diet. Dieticians, therapists, fitness experts and nutritionists have all gone overboard trying to create imaginary diabetic diets.

A common sense attitude to food is all that is needed.

Try and reduce the intake of total fat, mainly saturated fat, which is known to worsen diabetes and make control of blood glucose difficult. Except for the omega 3 fatty acids, most fats have an adverse effect on insulin action. Some dieticians recommend that intake of unsaturated fatty acids are beneficial in the long term management of diabetes.

Recent studies also indicate that there is a decreased risk of diabetes with increased intake of whole grains and dietary fiber. Although few micronutrients may affect glucose and insulin metabolism, data to document their role in the development of diabetes are scant. Infact moderate amount of alcohol intake has recently been shown to increase insulin sensitivity and improve glucose control.

However, recommending alcohol consumption as therapy may lead to worsening of the social problems related to alcoholism, not to mention its damaging effects on the liver.

Inhaled Insulin for Diabetes- Too much hype! Part 2

Exubera was ideal if you met the following criteria:

You only used short acting insulin to control your diabetes. Exubera was not available with longer acting insulin formulations

The inhaler was ideal for individuals who had never smoked. Smoking generally destroys the lung wall linings and there is no guarantee that that exact dose of insulin will be absorbed.

Individuals with asthma, COPD, emphysema or bronchitis generally were not good candidates for Exubera. These conditions are associated with lung damage which may prevent the insulin from getting absorbed into the blood stream.
You had no allergies to human insulin.

Most health care practitioners had to deal with lung function before prescribing the inhaled insulin and many individuals had to undergo lung functions testing- which only increased the costs.

Of the individuals who used Exubera, most remain satisfied. A number of studies showed that Exubera could control blood sugars but it still was not as good as the injectable insulin. Erratic absorption of inhaled insulin had been reported and a few individuals had developed either low or high sugars.

Exubera was only ideal for a diabetic who simply wanted to control his blood sugars after a meal. Exubera did not replace the standard long acting insulin and one still needed to get the blood sugar levels monitored on a regular basis.

As of Dec 2007, Exubera is no longer available in the USA.

Final point

The inhaling device for exubera was pretty large and cumbersome. Even though light weight it was about the size of a flashlight.

For more on diabetic supplies, please visit www.medexsupply.com

Inhaled Insulin for Diabetes- Too much hype! Part 1

Insulin has been the standard treatment of diabetes for the better part of the century. Unfortunately it can only be administered via an injection. The chief reason why insulin cannot be taken as a pill is because it is rapidly destroyed by acid in the stomach. Over the years, many types of insulin formulations have been developed, but so far none have worked and insulin injections remain the cornerstone of diabetes treatment.

In the last decade, however, insulin which could be inhaled did become available. Known as Exubera, this inhaled short acting insulin was used to treat both type 1 and 2 diabetes.

Exubera is powderized insulin and came in prepackaged formulations. The package containing the insulin is placed inside a specially designed inhaler. The inhaler is placed in the mouth and activated. The insulin which is inhaled as a fine powder usually starts to work within 10-15 minutes.

Exubera only contained the short acting insulin form. It worked anywhere from 3-6 hours. Most individuals used Exubera 10 minutes prior to a meal.

Inhaled insulin was not for everyone and each individual has to discuss the pros and cons with the physician.

What is HbA1c and How does it relate to Diabetes?

The diagnosis of diabetes is usually straightforward. Any one of the following tests may be diagnostic for the presence of diabetes:

- If one has a persistently elevated fasting blood sugar (> 126 mg/dl).
- If the non fasting blood sugar is > 200 mg/dL or greater in people with symptoms
- The individual has an abnormal oral glucose tolerance test, with a 2-hour glucose value of 200 mg/dL or greater.

Once the diagnosis of diabetes is made, all individuals undergo other tests to ensure that they have not developed any complications of diabetes. Your doctor may order a glycated Hemoglobin A1C test (HbA1c).

HbA1c is simply hemoglobin which has been attached to glucose molecules. Hemoglobin is found in red blood cells which have a life span of about 8-12 weeks. Normally if the blood glucose levels are normal or well controlled, the sugar does not bind to hemoglobin.

However, if the sugars have been poorly controlled and are high, they get attached to the hemoglobin and this is known as glycation of the hemoglobin molecule. So measuring HbA1c gives an idea how well the glucose levels have been over the long term. The higher the glucose levels, the greater will be the levels of HbA1c. Some patients come to see their physician and tell them that their blood sugars have been great and well controlled. Well, by measuring the HbA1c levels, the physician can immediately tell how well the glucose levels have been over the last 3-4 months.

The test is simple to perform and requires some blood. Results are usually available within an hour. The normal HbA1c ranges from 3.5-5.5%. In diabetes about 6.5%-7% is good.

Measuring HbA1c indicates your average blood sugar level over the past 2-3 months. Generally a target level of HbA1c less than 7% is preferred.

The current guidelines recommend routine screening for type 2 diabetes beginning at age 45, especially if you're overweight. If the results are normal, the test should be repeated every three years. If the results are borderline, the test should be repeated every year.

For more on diabetic supplies, please visit www.medexsupply.com

Current advances in blood sugar monitoring 2

Infra red light monitors have been developed which use a beam of light to penetrate the skin and measure levels of sugar in the blood. However, these devices are not accurate and the levels of blood sugar can vary depending on the blood pressure, temperature of the skin or the presence of a skin ailment (lupus, ulcer, Raynaud’s, collagen vascular disease). When using the infra red devices, it is important to periodically use the finger prick to ensure that levels between the two methods are within a close range.

Skin wearing devices like a watch are also available. The watch uses small electrical currents to sense the fluid below the skin. If the levels of sugars are too high or too low the watch will sound an alarm. The negative aspect of the watches is that many individuals do develop skin irritation. Further these devices do not work if the skin is wet (e.g. if you sweat a lot). Like the infra red device, one has to periodically monitor blood sugar by the finger prick method to ensure that the two methods do not give drastically different results.

Continuous blood glucose monitoring is now available with devices placed under the skin. The device then transmits the reading to a small LCD device worn on the body. If the levels of sugars are too high or too low, the device will sound an alarm. These subcutaneous sensors are not cheap. The average price is about $1500 and the site must be rotated every few days. Like any of the above methods the device must be compared to the finger prick method to ensure that it is giving reliable readings.

No matter what device one uses to monitor blood sugar, it is important to write the blood sugar levels and show them to your health care professional. If your readings are too high or too low, your medications may need to be adjusted. In some cases, the physician may recommend a change in diet or exercise.

Current advances in blood sugar monitoring 1

Blood glucose measurements using finger pricks has always been the Gold standard. This method has been thoroughly analyzed and found to be reproducible, reliable and generates consistent results. But now this method is starting to face stiff competition.

The discomfort and inconvenience of finger pricking is one reason people with diabetes don't check their blood sugar as often as they should. Finger pricking is uncomfortable and is painful. To counter the finger pricking, researchers have been trying to develop novel ways to measure blood glucose. The following are alternatives available today:

Blood can also be obtained from the upper arm, thigh or abdomen. These alternative sites of obtaining blood are much less painful than the finger prick. The only problem with getting from alternative sites is that levels of blood sugar obtained are not always accurate especially in cases where the sugar levels may be quickly increasing or decreasing.

Target Blood Levels for Diabetics

The number of individuals with diabetes is in the millions and there are many more individuals who have no idea that they have high levels of glucose. Diabetes is a chronic disorder and when the blood sugar levels are neglected, the consequences can be severe. Anyone who has been diagnosed with diabetes or has elevated levels of glucose needs to monitor the levels. Patients who take charge of their own glucose monitoring have been shown to have fewer complications, less hospital admissions and it is cost effective in the long run.

Target Blood glucose levels

All diabetic patients should have some idea about their target levels before and after meals. These target levels are generally determined by your health care professional. Healthy non-diabetic individuals generally have blood glucose levels in-between 70-120 mg/dl before a meal and less than 120 mg/dl 2 hours after a meal. Individuals who have diabetes should target the following levels:

Levels before meals (also known as fasting blood sugars) should range from 90-130 mg/dl or 5-7 mmol/l.

After meals the sugar levels generally go up. One should measure the levels 2 hrs after a meal and these levels should be less than 180 mg/dl or 10mmol/l.

Just before bedtime, the blood glucose levels should range from 110-160 mg/dl or 6-8 mmol/l.

Before exercise the levels of blood sugar should be above or close to 70 mg/dl but not more than 250 mg/dl. The high levels of glucose before an exercise can increase the chance of precipitating ketoacidosis in type 1 diabetics. The high levels of glucose also cause severe polyuria and polydipsia.

The target levels of blood sugars do vary depending on the situation. For those who are sick, pregnant or receiving drugs like corticosteroids, the target levels may be on the higher side. With age, the blood glucose levels do tend to be on the higher side. It is highly recommended that all diabetics make an effort to have their blood glucose within the target range. However, in many cases this can be difficult but one should try and get as close to the target levels as possible.

There is a lot of evidence that diabetic individuals who maintain their blood glucose levels on the low side generally have fewer complications. Even when the complications do develop they are not as severe and can be more easily managed.

At Medexsupply one can obtain a wide range of diabetic supplies including blood glucose monitors, kits, lancets, infusion sets, test strips and glucose tablets.

Diabetic socks- Should not be too tight part 2

Buy socks made from cotton because they can absorb moisture. Socks made from nylon and other material may look elegant but are not good for diabetic feet. Do not buy socks with a tight binding top which is meant to prevent the socks from sliding. These socks can decrease blood flow to the legs.

The socks should be seamless. Socks with seams generally have the ability to limit blood supply. While this may not be a big deal for a non diabetic, it is very important for a diabetic.

The socks should be slightly thick to protect the sole and toes from the external trauma or friction in the shoes. Thick fabric socks promote even blood circulation and decrease the chance of blister formation.

Today, many diabetic socks come with a reinforced heel for protection. In addition, some socks also have an antimicrobial fabric that will decrease the chance of an infection. If you have an open ulcer or a wound, buy socks which are light colored so that you can observed the wound drainage.

There are diabetic socks available in all styles, colors and sizes. Many are elegant and can be worn on a daily basis. Diabetic socks can be bought online but it is important to try out a pair first. Above all else, diabetic socks should feel comfortable.



Diabetic sock are relatively cheap. The average cost of a pair of socks starts around $5 and above. Of course, there are some which are better than others. The graded pressure socks generally cost about $15 and above. To ensure that your socks maintain elasticity and shape, always hand wash your socks and air dry them.



All diabetic should know that buying a great pair of diabetic socks is only one aspect in preventing the foot complications. One should also try and keep the glucose under control, exercise on daily basis (or at least walk) and avoid smoking.



For more on diabetic socks, please visit www.medexsupply.com

Diabetic socks- Should not be too tight part 1

Diabetics develop many complications and one of the more serious one is infection of the toes and foot. The combination of decreased blood supply and neuropathy significantly increases the chance of foot infections. The failure to sense pain often leads to severe deformities and it is not uncommon for diabetics to have their toes or even feet amputated.

All diabetics should take steps to prevent complications to their feet and toes.

Besides good hygiene, excellent foot care and wearing proper shoes; there is also a need to wear proper socks.

There are many types of diabetic socks available, in various styles, designs and brand names. Some diabetic socks can be worn just above the ankle whereas others can stretch up to the knee. Some socks are stretchable with even pressure and others come with graded pressure which is highest at the toe. The graded pressure socks are designed to help blood move up the leg.

Before buying socks for your diabetes, there is one thing you must understand. Diabetics already have decreased blood supply to their feet; so it is very important that you do not buy socks which have high gradient of pressure. All this will do is further decrease the blood from getting to your feet and make the situation worse. Graduated compression socks are designed for people with venous problems like varicose veins and not for diabetics.

So select a pair of socks with a mild pressure gradient (less than 7 mmHg). Socks with high gradients should only be worn by diabetics if the feet are swollen.

Avandia and Type 2 Diabetes- is it Safe? Part 2

So is Avandia Safe?

Although Avandia does have some risks, the drug is generally safe. Individuals who are already taking Avandia should not abruptly discontinue the drug until they have discussed the issue with their health care provider.

Individuals who already have heart failure or a have suffered a prior heart attack need to be more cautious and speak to their physician. The decision whether to continue or discontinue Avandia rests primarily between you, your physician and your cardiologist.

Individuals who do not want to take Avandia do have alternatives and can take other drugs like:

- Metformin
- Glipizide
- Sitagliptin
- Insulin
- Actos

One should always be aware that there is no drug which is completely safe. Like Avandia, all the above diabetic drugs also have certain side effects

At present, research is undergoing to determine what the real side effects of Avandia are and the true incidence. For those are already on Avandia and have had no problems, they should continue with the drug. For those who have heart failure, a discussion with their physician is recommended.

All diabetics should take other measures to control their blood glucose including exercise, maintaining a decent weight and eating healthy. Controlling blood cholesterol levels and lowering blood pressure will also go a long ways in reducing your risk of a heart attack.

Avandia and Type 2 Diabetes- is it Safe? Part 1

Over the years there have been a number of newer oral anti diabetic drugs introduced in the North American market. One of these drugs is Avandia (rosiglitazone). It is used primarily for the treatment of type 2 diabetes. One problem which has surfaced with newer drugs is that the data from the clinical trials are not always completely released or often the real complications are missed or never mentioned. And Avandia falls into that category.

Avandia is a type of drug that is classified as a thiazolidinediones. It is used to treat type 2 diabetes and taken as an oral pill. Avandia lowers blood sugars by making it much easier for the blood glucose to enter the body.

What's the concern about Avandia?

Avandia has been widely used in North America but recently there have been reports that the drug has the ability to cause serious side effects. The following complications appear to have been reported with the drug:

-excessive weight gain
-Swelling of the body with fluids which may aggravate heart failure. There have
been a fair number of cases reported with Avandia precipitating heart failure.
-liver damage
-reports of heart attacks

There are also recent reports that Avandia use can lead to premature bone loss leading to osteoporosis. This often results in fractures of the hip and wrist.

The manufacturer does mention the potential of increased incidence or worsening of heart failure when taking the drug.

Primrose Oil and Diabetes

The last two decade has seen a number of alternative health care products on the market and one of them is evening primrose oil. Almost everyone seems to be taking this supplement nowadays to treat not only medical disorders but also as a preventive aid for a varying number of diseases.

The primary ingredient in evening primrose oil (EPO) is omega-6 essential fatty acid- an unsaturated fatty acid that is thought to account for all the benefits of the supplement. Primrose oil has been extensively used in Europe and Asia as an empiric treatment to treat many medical disorders- folklore rather than science has been the chief marketing tool for its “miracle” properties.

One disorder where primrose oil has gained prominence is diabetes. There are some anecdotal reports that regular intake of EPO can help reduce blood sugars. The manufacturers of Primrose oil do recommend the supplement on a regular basis for its anti diabetic effects. The oil is sold as a capsule which is relatively cheap. There are also some reports among diabetics who report that primrose oil can reduce the numbness, tingling and pain in their feet.

There are no clinical trials and the anti glycemic effects are not seen in all diabetics. At best less than 5% of individuals see any effect and the blood lowering effects are neither consistent nor predictable. There is very little scientific evidence to indicate that primrose oil alone can lower blood sugars.

EPO is generally safe when taken as recommended. It does have a few side effects like nausea, bloating, abdominal cramps, headaches and loose stools when excessive amounts are ingested.

All diabetics should understand that Primrose oil is not a substitute for insulin or any of the currently available anti diabetic medications. While it may lower blood sugars in some individuals, the mechanism remains unknown. At present there is not enough information to recommend the safe use of evening primrose oil during pregnancy or in women who are breastfeeding.

For more on diabetic supplies, please visit www.medexsupply.com

Coenzyme Q10 and diabetes Part 2

Another problem with CoQ10 sold in health food stores is that the dose of the supplement is not regulated. It is available in a wide range of concentrations and sold under many generic names. And each product appears to have a different concentration of CoQ10.

There are also reports of contamination of CoQ10 products with various chemicals. Since many of these health supplements are made in the Orient and not well regulated, it is wise for all diabetics to check with their health care provider before they start CoQ10.

For the present, all diabetics should know that CoQ10 is not a substitute for insulin or any of the other oral diabetic medications.

For more on diabetic supplies, please visit www.medexsupply.com

Coenzyme Q10 and diabetes Part 1

Coenzyme Q10 , otherwise known simply as CoQ10, is very popular health supplement. Millions of individuals take this supplement on a daily basis. It is a substance which has a very similar structure to some of the water soluble vitamins.

CoQ10 is present in the human body is varying concentrations. What it does in the body is still a puzzle but current laboratory evidence indicates that it may play a role in the production of energy at a cellular level. CoQ10 is found in highest concentration in the liver, brain, kidney, lungs and heart- parts of the body which are associated with high consumption and generation of energy.

However, the levels of CoQ10 are not consistent in all individuals and we still do not know whether it is a substrate or a product during the generation of energy.

The alternative health care market has been hyping up the substance as a treatment for many medical disorders. In cyberspace, it appears that CoQ10 is a cure for everything in the medical dictionary.

There is no correlation between the levels of CoQ10 and disease. Some people have high levels and have disease; but there are people who have low levels of CoQ10 and have no evidence of a medical disorder.

One area where CoQ10 is heavily marketed is in the treatment of type 2 diabetes. There are many anecdotal reports, chiefly made by the manufacturers of CoQ10, that it can lower blood glucose levels in diabetics. This finding is not universal and seen in less than 3-5 percent of individuals. Many diabetics do take CoQ10 but see no benefit. So far there is no scientific evidence that CoQ10 can lower blood sugars or prevent the complications of diabetes. It’s use in medicine remains controversial.

Cinnamon and Diabetes

Cinnamon is a small plant widely grown in Sri Lanka. The leaves have a delicate aroma because of the presence of certain aromatic oils. There are several species of the cinnamon plant all of which are grown in Sri Lanka and neighboring countries. The bark of the plant has been used as a flavoring agent in cooking for centuries. Besides cooking, cinnamon is also used as a flavoring agent in desserts, candies, tea, coffee and liqueurs. Asian typically use cinnamon to flavor foods.

In medicine, cinnamon has gained a reputation as a giant disease killer. It is said to cure the common cold, diminish diarrhea, relieve toothache and can help fight bad breath. In cyberspace, there is nothing that cinnamon can’t cure.

In the last decade, the alternative health food industry has been marketing cinnamon as a treatment for diabetes. What is so surprising is that there is not a single scientific study in North America which has demonstrated that cinnamon can lower blood sugars. All the reports, save for one study, are anecdotal.

The one and only large study from Pakistan indicated that cinnamon was quite effective in lowering blood glucose levels in diabetics. The study also revealed that within a span of a month, both cholesterol and sugar levels dropped significantly. Cinnamon was consumed as capsules containing anywhere from 1-3 grs per day.

However, the study was of a short duration and other researchers have not been able to replicate these results.

According to the FDA there are two basic types of cinnamon sold in the USA- c zeylanicum and c cassia. Only C. cassia is sold in stores. In the study from Pakistan, the type of cinnamon used was not listed.

There have been numerous studies on cinnamon-some show that it does lower blood glucose and others show that it does not. For the moment, cinnamon should be used as a food flavoring agent. It is known to be safe. For diabetics, cinnamon is not yet the panacea for control of blood sugar and more controlled trials are needed to see whether it does anything.

For more information on diabetic supplies, please visit www.medexsupply.com

What is “pre-diabetes?” Part 2

Besides Age, other risk factors for prediabetes include:

Overweight: Individuals who have a body mass index (BMI) ≥25 or if Asian American or if Pacific Islander > 26 . BMI over 23-25 is a very high independent risk factor for prediabetes

Blood pressure: The recommended BP should be less than 140/90 mm/Hg. If the blood pressure is uncontrolled and remains untreated, damage to blood vessels, brain and heart can occur. This is further worsened in the presence of diabetes.

Lipid levels:

HDL cholesterol < 40 mg/dL for men
HDL cholesterol < 50 mg/dL for women
Triglyceride level ≥250 mg/dL

Family History: If diabetes is present in a parent, siblings, the chance of another family member developing diabetes are very high.

Ethnicity: Diabetes is generally more aggressive and prone to occur in the following populations: African American, American Indian, Asian American, Hispanic/Latino, or Pacific Islander heritage.

Gestational diabetes: If a female has given birth to a heavy baby (more than 9 pounds or more, she may be at risk for developing prediabetes.

Sedentary lifestyle: A sedentary life style with no or minimal exercise is a high riskfactor for developing prediabetes.

If an individual has any of the above features he /she is a candidate for prediabetic screening. Prior to the screening, it is essential that one measures random fasting blood sugars, if they are elevated, then a visit to the physician is highly recommended.

For more details on diabetic supplies, please visit www.medexsupply.com

What is “pre-diabetes?” Part 1

Pre-diabetes is medical terminology that is used to describe the condition that occurs when an individual’s blood glucose levels are persistently higher than normal but not high enough for a diagnosis of diabetes. Most individuals have no idea they may have prediabetes. The condition is generally identified from blood work that was supposedly done for some other medical disorder.

Individuals with prediabetes may have elevated blood glucose levels as determined by a blood glucose meter, but formal testing is required to determine how the severe the prediabetes is.

Testing in these individuals usually reveals elevated fasting glucose or impaired glucose tolerance - both of which are a high risk factor for 2 diabetes. In general, many individuals who have prediabetes, will develop type 2 diabetes within a period of 5-10 years. Once prediabetes has been identified, it is highly recommended that the individual change his or her lifestyle to prevent full blown diabetes from occurring.

Solid evidence from the Diabetes Prevention Program indicates that individuals who have been diagnosed with prediabetes can delay or prevent the onset of Type 2 diabetes though modest changes in their lifestyle. Thus, current recommendations for health care professionals are to screen for Prediabetes in high risk individuals.

Criteria for identifying individuals with Prediabetes are:

Identifying individuals at risk for diabetes include the following:

Age: The risk of pre-diabetes increases with age.

- Age 45 or older and overweight
- Age 45 or older without any other risk factors
- Younger than 45, overweight.

Diabetics and Travel Part 2

When flying, always carry some diabetic supplies on board the plane. If there is an emergency you want to be able to access the supplies immediately. If you are traveling with family or a friend, have them carry some extra supplies for you.

Wearing a medical bracelet is a great idea for all diabetics. If the trip is going to be long, carry an extra sugary drink or snacks.

All diabetics should carry with them a decent pair of shoes and socks. While it is fun to go barefoot in the ocean, at all other times the feet should be protected. Getting your foot traumatized or infected away from home can create unnecessary headaches.

These days one can even request a diabetic meal far in advance of the trip.

If you do not have travel insurance, you should get some. If you already are covered with a medical insurance carrier, ask them before hand what is covered while you travel.

Different companies have different coverage polices. The last thing you want at the end of a nice long vacation is to be stuck with a huge bill.

For more on diabetic supplies, please visit www.medexsupply.com

Diabetics and Travel Part 1

Individuals who have diabetes simply can’t rush to the airport and catch the next flight out. Travel for diabetics requires advanced preparations. Traveling inside North America or Europe is fine, but anywhere else and one can run into problems.

In many countries outside of North America, health care facilities are not well established. Besides the language barrier, one may not even be able to find the right supplies.

Prior to any trip, even if it is in North America, prepare well ahead of time. Go and see your health care provider to ensure that there are no immediate problems with your diabetes. If you are a diabetic and have an immediate problem like elevated sugars, ketones in the urine, fever or vomiting, the best advice is to cancel your trip.

All diabetics should carry a letter from the physician which explains the disease, your overall health and what medications you are presently taking. In addition, one should always get a prescription for additional medical supplies for the trip. You never know with travel these days. Reports of lost luggage are a daily occurrence..

Besides medications, all diabetics should also carry extra supplies of syringes, lancets, glucose meter and other accessories. Take enough to last for the duration of the trip. Never think that you will buy extra supplies at your destination. If you are carrying syringes with you, do declare them with customs prior to your trip otherwise you will have unnecessary delays trying to explain your situation when you come back.

Diabetic Shoes- Everything you wanted to know- Part 4

The following requirements must be met to ensure Medicare payment.

You must have a certificate of medical necessity for the diabetic shoes and this must be documented in the medical records. Do not order any shoe on the presumption that your physician will write you a letter. And never ever be pressured by sales person or the health care professional.

Anytime you get pressure from a sales person, simply walk away- they are just it in for the money.

The shoes and insoles must be prescribed by a podiatrist or a physician and provided by a podiatrist, orthotist, prosthetist, or pedorthist.

If you have coverage through a medical insurance carrier, call and ask what steps you need to follow to get the maximum coverage.

What if you have no medical insurance?

Many individuals have no medical coverage and need diabetic shoes but can’t afford them. In such a case, get a good pair of sandals, take care of your feet, maintain your blood glucose at appropriate levels, wear a decent pair of socks and take great care when trimming your nails. And do not smoke or if you do- quit.

Buyer Beware

Finally, remember the shoe industry including many health care professionals will recommend you buy these expensive shoes for trivial reasons. Because the shoes are quite expensive, always get a second opinion.

Diabetic Shoes- Everything you wanted to know- Part 3

When to wear the diabetic shoes

For the maximum foot protection the shoes must be worn on a daily basis. The shoes must be worn every time one ventures outside the home. At the end of the day, the feet should always be assessed for the sores or ulcers. Diabetic shoes also come with insoles which can be custom designed.

The insoles are made of special material that is less traumatic to the skin and is able to absorb the pressure during walking. The insoles also distribute the body weight evenly to the rest of the shoe. The insoles generally last 4-6 months.

Medicare and coverage

In the last few years, Medicare and many medical insurance carriers do cover the cost of diabetic shoes and insoles. If you do not have any type of medical coverage, the cost of diabetic shoes usually starts around $700 and above.

Medicare will cover the cost of one pair of diabetic shoes and inserts for people with diabetes if you have been shown to have need for them. To make sure you are eligible for Medicare and the other insurance carriers, one needs to have the foot examined by a health care professional and be shown to have a need to protect the feet due to neuropathy.

Diabetic shoes-Everything you wanted to know- Part 2

Need a prescription

Once a prescription for a shoe has been obtained, one can visit a shoe store which specializes in orthotic wear. One should never buy diabetic shoes online because these shoes need to be worn to assess their comfort ability, fit and safety.

Go online and surf

Never buy the first pair of shoes recommended. Look around, go online and browse over the internet. Check the shoes to ensure it has adequate ventilation and spacious. Try the shoes to make sure the balance is okay when you walk.

The internet is inundated with sites selling diabetic shoes and accessories. While the majority sell decent shoes, many simply want to sell you these expensive shoes when you do not even need them.

Diabetic shoes today come in all styles and fashion; besides being therapeutic they can also be worn as casual wear.

Diabetic Shoes- Everything you wanted to know- Part 1

The problem

Diabetes is a chronic disorder and can present with serious complications. One of the most dreadful complications of diabetes is foot infections. If the foot infection gets out of control, an amputation is often the end result. The problem with diabetes is that even if the blood glucose levels are well monitored, many patients develop a neuropathy. The diabetic neuropathy seriously limits the ability to sense all types of trauma and is a leading cause of foot damage and infections. The neuropathy leads to the development of pressure sores and ulcers on the heels and soles of the feet.

Prevention

One of the best ways to prevent foot trauma and avoid infections is to get a proper pair of diabetic shoes. Unlike the past, the diabetic shoes available today are light weight, comfortable and offer solid protection to the foot.

Before buying

Before one buys diabetic shoes, one should get a physical exam by a health care professional to assess the feet and blood circulation. The type of shoe will depend on the degree of foot deformity, presence of an ulcer or any prior toe amputation. The shoes are always custom designed to offer the maximum protection and safety. The majority of diabetic shoes are spacious and are designed in a way so as to avoid pressure on the heels or the soles.

Need a prescription

Once a prescription for a shoe has been obtained, one can visit a shoe store which specializes in orthotic wear. One should never buy diabetic shoes online because these shoes need to be worn to assess their comfort ability, fit and safety.

When to test blood sugar levels? Part 2

Testing for blood sugar levels

Testing of blood sugar is not difficult. There are many portable kits available today for home use. To test the blood sugar levels one needs a few items including a blood sugar monitor, test strips, a lancet and alcohol swabs. The majority of blood sugar monitors available today are light weight and portable.

The majority of these monitors have varied storage facilities like tracking time, date of each test and can also store your data. Some of the current devices also come with zip drives so that the information can be transferred to your PC.

Monitoring of blood sugar unfortunately involves a pin prick on your finger tip with a special lancet. Today there are a variety of lancet devices which will allow you to adjust the depth of the prick. Those with thick skin need deeper penetration. It does sound painful but eventually one gets used to it.

At Medexsupply one can obtain a wide range of diabetic supplies including blood glucose monitors, kits, lancets, infusion sets, test strips and glucose tablets.

When to test blood sugar levels? Part 1

The testing for blood sugar levels is more rigorous just after the diagnosis of diabetes. Once the diagnosis of diabetes has been established, the measurement of blood sugars does depend on the type of diabetes and treatment.

Individuals who have type 1 diabetes often need to measure the levels anywhere from 3-6 times a day, at least before and after each meal.

Individuals with diabetes who exercise also need to monitor their sugars before and after exercise and just before going to sleep.

Individuals with type 1 diabetes who are ill or have a change in their routine (like traveling), stress or have been diagnosed with other medical disorder may need more frequent monitoring of blood sugar levels.

Individuals with Type 2 diabetes generally require less frequent glucose monitoring. Most of these individuals initially monitor the blood glucose 1-2times day if they are on any type of diabetic medications.

Individual who are managing their type 2 diabetes with diet and exercise alone need to monitor their sugars less often.

How To Select a Blood Glucose Monitor

In general, there is no good or bad blood glucose monitor. The choice is dependent on a number of factors which include:

Cost: There are many blood glucose monitors. Today, almost every medical supply company has discounts, sells, rebates and trade INS and thus, these devices are affordable by most diabetic individuals. However, the cost is usually comes with the supplies that go with the monitor. There are some insurance companies which do offer some type of medical coverage for the monitor and supplies. Presently Medicare does cover all the costs that can occur with blood glucose monitoring

User friendly: Some blood glucose devices are a lot easier to use than others. The later models only require a tiny blood sample which means that blood can be obtained with a minor skin prick (also less painful). Some also come with a large LCD screen which is useful for people with visual impairment.

Multisite devices are more versatile and allow you to prick your self on other parts of the body rather than the finger tip alone.

Size: For those of you do not like to carry large bags or purses, there are some smaller models which can fit into your pocket

Time: Some blood glucose monitors give you the results in as little as 5-10 seconds and others take about a minute.

Accuracy: All glucose monitors require a drop of blood to be applied on a special strip of paper. While this sounds like a simple concept, the older machines required careful preparation and often were not accurate even if there was only a minor error. The newer automatic machines are more accurate, reliable and do eliminate the errors caused by preparation of the blood sample.

Software: The latest devices have now programmable features like time, date, memory and storage capacity. With a Zip Drive one can download the data from the monitors and add it to the PC. This is important for individuals who have very labile diabetes and require constant adjustment of insulin doses.

If you are not sure what machine is best for you, talk to your health care professional.

At Medexsupply one can get a wide range of diabetic supplies including blood glucose monitors (ONE TOUCH Life Scan, Accu-Chek, Ascensia, Prestige), kits, lancets, infusion sets, test strips and glucose tablets.

Lancets for Diabetics Part 2

Today, whenever you buy a blood glucose monitor, a lancet device is almost always included in the kit. All lancet devices come with short and long lancet covers which allow for different degree of penetration in the skin.

Individual who have thin skin, children or elderly with delicate skin usually need superficial penetration. Those with hard and thick skin need deeper penetration. Sometimes one may have to use a different depth of penetration on different fingers.

Lancet devices are relatively easy to use. The lancet has a snap button which if pushed triggers the device. Lancet devices are relatively cheap. Most important to understand is that these devices or the blades should never be shared. Even though the risk of transmitting serious infections is low, it definitely is real.

Once the lancet is used, it should always be disposed off in a biohazard container. And never use a lancet that has been previously used by someone else.

At Medexsupply one can obtain a wide range of diabetic supplies including blood glucose monitors, kits, infusion sets, test strips and glucose tablets. Medexsupply carries lancets made by Graham Field, Owen Mumford, Surgilance, Sherwood, Bayer, Reliamed and Accu-Chek