How often should I measure my blood sugars?

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 need to measure blood sugar 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 need to monitor blood glucose 1-2 time’s 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. 

My father has diabetes, is there a chance I will get diabetes?

Diabetes does have a genetic link. If one or more members of your family have diabetes, then your chances of developing diabetes are high. 

Studies indicate that diabetes tends to occur in 30% of people who already have family members with diabetes. 

In the meantime, you should continue to get your blood sugars tested regularly, change your diet and watch your weight. The lower the weight, the less likely you will develop diabetes.

I am a 21 year old male, weigh 205 pounds and am always thirty and need to go the bathroom often. Do you think I have diabetes?

From what you have described, you may have diabetes. Being overweight is a risk factor for type 2 diabetes. 

Moreover. feeling thirty and increased urination also go with diabetes. The first thing you should do is see your doctor and get a blood test. 

You can check your urine for sugar but this really is meaningless until your diabetes has been confirmed. In the meantime, start cutting down on your weight, eat less sugary foods and change your diet.

What are the common symptoms of diabetes?

In general, excessive thirst and increased urination are the two most common symptoms of diabetes. 

Many people need to get up several times in the night to urinate. Often one may develop blurred vision and excessive fatigue. The only way to confirm your diagnosis is to have your blood sugars tested by a doctor. 

Once you have been diagnosed with diabetes, you will need to monitor your blood sugars often

Are there any other methods to monitor blood sugar besides finger pricking?

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. Now this method is starting to face stiff competition.

The discomfort and inconvenience of finger pricking is one reason people with diabetes do not 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 blood from these alternative sites is that level of blood sugar obtained is not always accurate, especially in cases where the sugar levels may be quickly increasing or decreasing.

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, Reynaud’s, collagen vascular disease). When using the infrared devices, it is important to periodically compare the blood sugar with a finger prick to ensure that levels between the two methods are within a close range

Can stem cells cure my diabetes?

There is a lot of work being done on stem cells. However, most of the data are still in the infancy stage and in experimental animals. Even if this technology works, it will only be applicable to type 1 diabetics.


There is ongoing research showing that stem cells taken from the testes can be transformed into cells that secrete insulin. In type 1 diabetics, the immune system attacks and destroys the cells of the pancreas that make insulin.
The recent experimental studies show that the transformed cells can bring down blood glucose levels. However, the number of stem cells required is massive and the insulin produced is minuscule. So far, the technology seems to help diabetic mice only and lot of work is needed before the same technology can be applied to humans.


Similar work involving injections of fetal and adult cells from the pancreatic beta cells to type 1 diabetics has been done before but the results have never been satisfactory. Other work has attempted to coax adult diabetic cells to start becoming young and start producing insulin- however, in most cases this has resulted in growth of cancer cells. Now researchers are focusing on the cells from the testes that can easily be coaxed into acting young and made to produce insulin without mucking around too much with the genes. With the testes cells, few of them become cancerous. The aim of these studies is to use testes cells, make them young and enable them to produce insulin.


The other advantage of this technique is that the cells come from the patient himself and thus there is no problem of adverse immune reactions as would occur with foreign cells. So far, it is not known if the immune system in humans would recognize the testes cells as foreign and destroy them. In humans, testes cells do not normally circulate free in blood.

Therefore, for those who are diabetics there is still a long ways before a cure for type 1 diabetes will come. In the meantime, continue using your insulin, exercise and do not smoke. This will not cure your diabetes, but it will help prevent complications of diabetes.

Insulin pumps: Should you buy one? Part 1

For many diabetic individuals, monitoring blood sugar and taking diabetic medications or administering insulin every single day can be a chore. Now scientists have come up with an insulin pump.

The insulin pump delivers a constant amount (basal) rate of insulin 24 hours a day to control your blood sugar. One can program the pump to administer additional doses of insulin after a meal or to correct high levels of sugar.

The insulin pump is about the size of a thin wallet and can be carried on a belt underneath the clothing. A thin plastic tubing from this pump is then tunneled under the skin using a special needle. This tunneled site needs to be rotated every 2-3 days.

The insulin pump needs to be programmed for it to work.

Advantages of an insulin pump include the following:

- The pump controls your blood sugar levels without you having to worry about needles and syringes. Your basal rate is preprogrammed. If you do decide to eat an extra meal or have high sugar, all you have to do is press the button and a supplemental dose of insulin is delivered.

- Instead of giving insulin needle injections 2-6 times a day, you rotate the tubing site every 2-3 days.

- There is less time wastage and you do not need to carry a bunch of syringes and needles wherever you go

- In general, individuals who use the insulin pump have much better control of their blood sugars and hence fewer diabetic complications

- Individuals who use the insulin pump also have fewer incidences of hypoglycemia (low sugar).

Diabetes control via brain surgery?

Recently a group of surgeons from Pittsburg indicated that type 2 diabetes could be controlled by some type of brain surgery. Surgeons at Allegheny General Hospital in Pittsburgh conducted a small study of 10 patients with progressive type 2 diabetes. The surgeons compressed a part of the brain known as the medulla oblongata. It is believed that this part of the brain has some control over the pancreas. The patients were not permitted to make any alterations in their weight, diet, exercise for about 12 months after undergoing this brain surgery. This same type of procedure is often used to treat certain nerve compression symptoms.

Dr. Peter Jannetta, the neurosurgeon in charge of the study, reasons that decompression of the nerve in the medulla oblongata, which controls the pancreas, could ease function of type 2 diabetes.
 
The pancreas is the organ which makes the hormone insulin that burns the blood glucose. In type 2 diabetes, patients either can’t release the insulin from the pancreas, do not make enough insulin or the body becomes resistant to the effects of insulin.

In Dr Jannetta’s study, 7/10 patients had better blood glucose control after surgery. These patients were able to decrease their anti diabetic medication dose and one patient was able to come of his anti diabetic medication completely.
Current estimates indicate that close to 24 million people live with diabetes in the USA alone and that the numbers are increasing each year. If type 2 diabetes is left untreated, it can lead to blindness, kidney failure, stroke and heart attack.

So what does this mean for the diabetic patient?

Put it mildly- do not believe all the BULL you read. This is an insane study. Just causing the pancreas to release more insulin is not the answer to treating type 2 diabetes. In the majority of type 2 diabetics, there is insulin in the body, it just does not work because of resistance. In addition, this study had only 10 patients and the study was not even randomized. 

Secondly, brain surgery is not very safe and complications can be devastating. You may lower your diabetic medications but the surgery may paralyze you, cause blindness and hearing loss and even your speech may become garbled- and these are permanent complications. For consumers who have common sense, avoid such cockamanny nonsensical procedures to treat type 2 diabetes. 

If you have type 2 diabetes, walk more, eat less sugar and do not smoke. Pharmaceutical drugs we have may not be the ideal answer, but they are a lot safer than some crazy brain surgery!

When should I check my blood sugar levels?

Most people who have just been diagnosed with diabetes need to check the blood sugars at least 4-6 times a day.

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 blood sugar 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 1-2 times 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.

I have just been diagnosed with type 2 diabetes. Is there any reason why I cannot eat honey?

Sure, you can eat Honey. There is no hard and fast rule why you cannot eat honey. Diabetics can eat anything they want, as long as it is in moderation. The bottom line is that you do should not eat too much sugar. Eat just enough honey that fulfils your daily calorie requirements. Perhaps one teaspoon with your coffee or tea. Make it a habit of monitoring your blood sugar afterwards. If your sugar stays high, then cut down the honey to half a teaspoon.

There are many reports on the medical benefits of honey, but rest assured, too much honey is not good.

 

Honey contains fructose, which can significantly raise your blood sugar levels. Almost all syrups and foods containing fructose can immediately raise blood sugars and should be consumed in limited amount by all people.

A tablespoon of honey roughly contains about 70 calories and contains 8 grs of fructose.  

Remember too much of any one particular food is not a good thing.

Can Diabetes cause carpal tunnel syndrome?

Yes, diabetes can cause carpal tunnel syndrome. When diabetes is long standing it can impair nerve function and lead to development of the carpal tunnel syndrome. High glucose levels can alter conduction and induce structural changes in nerves. It is estimated that at least 33% of diabetics have some degree of carpal tunnel syndrome.

Carpal tunnel syndrome is caused by compression of the median nerve in the wrist. Other causes of carpal tunnel include obesity, hypothyroidism and rheumatoid arthritis. Individuals who use their wrist for certain types of repetitive work are also prone to carpal tunnel syndrome. The pinched nerve causes numbness, tingling and pain in the finger, wrist and forearm.

Carpal tunnel syndrome in diabetes develops gradually and can occur even when blood sugars are in good control.

Once carpal tunnel syndrome has been diagnosed, treatment includes protecting the wrists, injecting steroids in the wrist, wearing a splint and altering the job. Surgery should be a last resort for diabetics with carpal tunnel syndrome. In simple, the results of surgery suck. Many individuals who have carpal tunnel surgery develop recurrence and are in usually in a worse shape than before.

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. The company that makes Avandia is Glaxo and it insists that that the drug is safe. However, after having made billions from sale of this drug it can hardly claim otherwise.


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.

Victoza: A new drug for type 2 diabetes

The FDA has just approved a new drug for type 2 diabetes. Called Victoza (liraglutide), this drug is administered as an injection once a day. Victoza can help lower blood sugars in combination with changes in duet, and exercise.

Victoza is not the drug of first choice for diabetics and is only approved for use in individuals who have fail to lower blood sugars with diet and exercise.

The drug belong to call of drugs known as glucagon-like peptides receptor agonists and helps the pancreas manufacture more insulin following a meal.

Five large trials have shown that Victoza works quite well in diabetics. However, one major side effect of Victoza is that a number of individuals did develop pancreatitis (painful inflammatory disorder of the pancreas).

The recommendations are that Victoza should be stopped when patients experience abdominal pain and should not be restarted if blood tests confirm the presence of pancreatitis. Moreover, Victoza should be used with great caution in individuals who have had previous episodes of pancreatitis.

Unlike other diabetic drugs, Victoza does not have any damaging effects on the heart.

Other points of note is that there is also concern that Victoza may increase the risk of thyroid cancer and induce allergic skin reactions.

At the moment, Victoza is not as a first line treatment for type 2 diabetes until more is known about the drug. Because of its potential complications, Victoza should only be taken by individuals whose risk of diabetes outweighs concern for pancreatitis or cancer of the thyroid.

The drug is made by Novo Nordisk and does not come cheap. A single (1.2 mg) dose costs $8 a day. Considering its potential for harm and cost, diabetic patients are best advised to start altering their diet and enter an exercise program. Lifestyle alterations to reduce blood sugar do work, can be done safely and are devoid of complications.

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.

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?

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.

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.

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.

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.