When the Heart gets Tired

Your Heart

Local St. Maarten health professionals received an update on hypertension statistics and were made aware of an interesting statistic: the prevalence of  heart attack rate is lower and heart failure rate is higher in comparison to people with hypertension and coronary disease in The Netherlands or the USA.  Lifestyle and genes might have a relation.

All of us lose some blood-pumping ability in our hearts as we age. But the more serious loss that we call heart failure, results from the added stress of health conditions that either damage the heart or make it continuously work too hard. In fact, all of the behaviors that you probably associate with heart disease or heart attack — such as having high blood pressure, smoking, being overweight, eating foods high in fat and cholesterol, not exercising and having diabetes — can also cause heart failure. In some cases people who develop heart failure were born with structural heart defects, while in others a virus damaged the heart muscle.

Compensatory Mechanisms

The body has several mechanisms to compensate for heart failure. The body’s first response to duress and strain, including that due to heart failure, is to release the fight-or-flight hormones,  like epinefrin (adrenalin). These hormones cause the heart to pump faster and more forcefully. They help the heart increase the amount of blood pumped out (cardiac output), sometimes to a normal circulating amount of blood required, and thus help compensate partially and temporarily for the heart’s impaired pumping ability.

People who do not have heart disease usually benefit from release of these hormones when more work is temporarily required of the heart. However, for people who have chronic heart failure, this response results in increased demands on an already damaged heart. Over time, the increased demands lead to further deterioration of heart function.

Another of the body’s main compensatory mechanisms for heart failure is to decrease the amount of salt and water excreted by the kidneys. Retaining salt and water instead of excreting it into urine increases the volume of blood in the bloodstream and helps maintain blood pressure. The larger volume of blood also stretches the heart muscle, enlarging the heart chambers, particularly the ventricles, which pump blood out of the heart.

The more the heart muscle is stretched, the more forcefully it contracts. At first, this mechanism improves heart function, but at some point, stretching no longer helps but instead weakens the heart’s contractions (like a rubber band being overstretched). Consequently, heart failure worsens.

Another important compensatory mechanism is enlargement of the muscular walls of the ventricles (ventricular hypertrophy). When the heart must work harder, the heart’s walls enlarge and thicken, as biceps muscles enlarge after months of weight training. At first, the thickened heart walls can contract more forcefully. However, the thickened heart walls eventually will become stiff, worsening diastolic dysfunction. Eventually, the contractions become weaker, causing systolic dysfunction.

The more common forms of heart failure — those due to damage that has accumulated over time — can’t be cured. But they can be treated, quite often with improvement in symptoms. We tend to think of treatment as something from our doctors — like a pill or a surgical procedure. That’s not the case with heart failure. Rather, successful treatment depends on your willingness to get involved in managing this condition, whether you’re the one diagnosed or you’re caring for someone who is. The three most important treatment strategies include…

  • Lifestyle changes
  • Medications
  • Surgery


Following recommendations about diet, exercise and other habits can help to alleviate symptoms, slow the disease’s progression and improve everyday life. In fact, people with mild to moderate heart failure often can lead nearly normal lives as a result of:

  • Quit smoking
  • Lose weight
  • Avoid alcohol
  • Eat a low-saturated-fat, low-sodium diet
  • Exercise on your own or participate in a structured rehabilitation program
  • Reduce stress

Making these changes is easier said than done. Dealing with new restrictions and responsibilities is challenging, but working these changes into your routine one at a time can make a real difference.


Most people with heart failure take a number of medications that work in different ways. Some help to improve circulation by strengthening the heart muscle’s pumping action or expanding the blood vessels. Others help to reduce the amount of water and sodium in the body, which in turn reduces the heart’s workload..

ACE Inhibitors such as captopril,  ramipril or lisinopril are most used locally ACE inhibitors (angiotensin-converting-enzyme inhibitors) are now considered first-choice treatment and are the cornerstone of heart failure drug therapy.  ACE inhibitors have been proven to slow the progression of heart failure. They are a type of vasodilator, which are medications that cause the blood vessels to expand, lowering blood pressure and reducing the heart’s workload. ACE inhibitors prevent the body from creating angiotensin, a substance in the blood that causes vessels to tighten and raises blood pressure.
There are some side effects to look out for when taking an ACE inhibitor. Some people develop a persistent cough.

Diuretics (Water Pills)hydrochlorothiazide, furosemide, spironolactone or indapamide are common examples. Diuretics are prescribed for almost all patients who have fluid buildup in the body and swelling in the tissues. A diuretic causes the kidneys to remove more sodium and water from the bloodstream than usual and convert it into urine. This helps to relieve the heart’s workload, since there’s less fluid to pump throughout the body. It also decreases the buildup of fluid in the lungs and other parts of the body, such as the ankles and legs. Different diuretics remove fluid at varied rates and through different methods.

Many people find it best to take diuretics in the morning so trips to the bathroom to urinate happen during the day. Taking diuretics in the evening or at night often results in interrupted sleep, because the urge to empty the bladder continues for hours. Furosemide is a special fast and short acting diuretic which may be taken as well around 4pm to relieve water before bedtime Spironolacton is a mild diuretic but has also a beneficial effect on the heartmuscle.

Vasodilators i.e isosorbide dinitrate, hydralazine , rilmedine
Vasodilators cause the blood vessel walls to widen or relax, allowing blood to flow more easily. We’ve already described one type of vasodilator, called ACE inhibitors. People who can’t tolerate an ACE inhibitor are often prescribed other types of vasodilators  to relieve symptoms and improve their tolerance for exercise.

Nitroglycerin tablets are a type of vasodilator prescribed to ease chest pain. Patients are usually instructed to take one, wait five minutes, and take another if the chest pain is still there. If the chest pain doesn’t go away after  3 pills, they should call an a doctor right away.

Side effects to watch out for include a drop in blood pressure upon sitting or standing, which can cause fainting or dizziness; headaches; flushing; heart palpitations, which feel like the heart is pounding or racing; and nasal congestion.

Digoxin (Lanoxin)
Digoxin increases the force of the heart’s contractions, which can be beneficial in heart failure. This relieves heart failure symptoms, especially when the patient isn’t responding to ACE inhibitors and diuretics. Most people continue taking the drug even after they feel well, to keep the heart working effectively.

Beta Blockers i.e carvedilol  metoprolol , atenolol.
The heart tries to compensate for its weakened pumping action by beating faster, which puts more strain on it. Beta blockers reduce the heart’s tendency to beat faster. The drugs block specific receptors (“beta receptors”). This allows the heart to maintain a slower rate and lowers blood pressure. Beta blockers are used for mild to moderate heart failure and often with other drugs such as diuretics, ACE inhibitors and digoxin.

Angiotensin II Receptor Blockers ie losartan, valsartan, telmisartan ACE inhibitors prevent the formation of  angiotensin II. Rather than lowering levels of angiotensin II , angiotensin II receptor blockers prevent this chemical from having effects on the heart and blood vessels. This keeps blood pressure from rising. Angiotensin II receptor blockers don’t appear to cause any significant side effects.

Calcium Channel Blockers ie amlodipine and nifedipine
Muscles of the heart and blood vessels need calcium to contract. Calcium channel blockers are used to treat the high blood pressure often associated with heart failure, because these drugs interfere with calcium’s role in the contraction of these muscles. This causes the muscles to relax. This lowers blood pressure and can improve the blood circulation in the heart. These medications aren’t used often to treat heart failure.

As with most drugs that improve the blood flow through the body, calcium channel blockers can cause headaches, facial flushing and dizziness. They also can cause ankle swelling. These symptoms generally disappear with continued treatment.

Drugs to be aware off

Anti-inflammatory painkillers (Ibuprofen, Aleve etc.) can give water retention (salt) and vasoconstriction esp. in the kidneys which may increase symptoms of heart failure.  Since these drugs are available without prescription one has to be careful with them.


Surgery is the other treatment option for heart failure. In some cases coronary artery bypass surgery (or a non-surgical procedure known as angioplasty) can ease heart failure symptoms by increasing blood flow to the heart.

The New Cholesterol Guidelines

The New Cholesterol Guidelines

Bringing the Science to your Dinner Table

Cholesterol is a waxy substance produced by the body and found in foods that come from animals. Cholesterol is needed by your body to make hormones, skin oils, digestive juices and vitamin D. You could not live without some cholesterol in your body.

However, too much cholesterol is a major risk factor for heart disease, particularly LDL (low density lipoprotein) cholesterol. LDL causes the build-up of fatty deposits within your arteries, reducing or blocking the flow of blood and oxygen to your heart.

It is estimated that millions of people are at much greater risk for heart disease than previously realized. This means more and more people will be walking away from their doctor’s office with a cholesterol-lowering drug prescription in hand. Medications aside, the new guidelines also vividly illustrate the growing epidemic of poor dietary habits, obesity, hypertension, hyperlipidemia and sedentary lifestyles that lead to the number one killer in the “Civilised World” today.

Measure your LDL and other blood lipids

Everyone age 20 and older should have their cholesterol checked at least every five years through a blood test. The guidelines recommend you have a complete “lipoprotein profile” that measures total cholesterol, LDL, high-density lipoprotein (HDL, the good cholesterol that may help prevent heart disease), and triglycerides, another type of fat in the blood stream. The test should be performed after fasting.

Low density lipoprotein (LDL) goal values:

  • Less than 70 mg/dL for those with heart or blood vessel disease and for other patients at very high risk of heart disease (those with metabolic syndrome,(obese, diabetes, hypertension)
  • Less than 100 mg/dL for high risk patients (for example: some patients who have diabetes or multiple heart disease risk factors)
  • Less than 130 mg/dL otherwise

Total cholesterol (TC) goal values:

  • 75-169 mg/dL for those age 20 and younger
  • 100-199 mg/dL for those over age 21

High density lipoprotein (HDL) goal value:

  • Greater than 45 mg/dl (the higher the better)

Triglyceride (TG) goal value:

  • Less than 150 mg/dl

Should I take cholesterol-lowering medication?

Drugs to reduce LDL include the “statins,” bile acid sequestrants, nicotinic acid and fibric acid. If your LDL and heart-disease risk are both high, doctors may prescribe medications at the same time as lifestyle changes. For others, medication may be added if six to 12 weeks on the TLC plan fail to adequately reduce LDL. Those who are started on a cholesterol-lowering medication will need to continue lifestyle changes.

Identifying those with metabolic syndrome

A group of specific risk factors, known as the metabolic syndrome, raise your risk for coronary disease at any LDL cholesterol level. If you have three of the following risk factors, you may have metabolic syndrome, and need more rigorous cholesterol lowering:

  • Abdominal obesity (a waistline over 35 inches in women and 40 inches in men)
  • Triglycerides of 150 of higher
  • Low HDL (lower than 40 in men and lower than 50 in women)
  • Blood pressure of 130/85 mm Hg or higher
  • Fasting glucose of 110 mg/dL or higher

Middle-aged men (age 35-65) are predisposed to abdominal obesity and the metabolic syndrome. As a result, they carry a relatively high risk for heart disease. For those with high risk, intensive LDL reducing strategies should be followed.

Because of all the above the guidelines for nutrition, physical activity and weight control in the treatment of elevated cholesterol have been modified and called the “Therapeutic Lifestyle Changes” (TLC) treatment plan. Even if you come out with a gold star on your cholesterol level and overall risk for coronary heart disease, most of us would surely benefit from implementing these guidelines.  Why the word therapeutic in the TLC guidelines?, because if you would stick to it you probably have a better effect than taking medications.
The following table can help you implement the guidelines into practical terms you and your family can enjoy and reap heart-healthy benefits:

New TLC guidelines

Why?  What does this mean?
Why?: Saturated Fat – less than 7% of total calories
What does this mean? Saturated fats are thought to have the most potent cholesterol raising potential.
Examples: Fatty cuts of meat, skin on poultry, egg yolks, lard, butter, palm oil, coconut oil, desserts and sweets, fried foods and most snack foods and fast foods.
Why?: Trans Fat – as little as possible
What does this mean? Trans fatty acids are formed when a liquid fat is turned into a solid one; a process called hydrogenation.
Examples: Limit foods with the following ingredients: partially hydrogenated oil, hydrogenated oil, stick margarine and shortening. Limit your intake of fried foods, cakes, pies.

Why?: Polyunsaturated Fat – up to 10% of total calories
What does this mean? Diets moderate in polyunsaturated fats are generally recommended. .
Examples: Margarine, soybean, safflower, sunflower, cottonseed and corn oils, pumpkin and sunflower seeds, most salad dressings and mayonnaise.

Why?: Monounsaturated Fat – up to 20% of total calories
What does this mean? Most desirable source of fat in the diet.
Examples: Olive and canola oils, nuts, nut butters and oils (e.g. peanut butter, almond oil), avocados and olives.

Total Fat – 25% – 35% of total calories

All of the fat you consume on a daily basis should not exceed 35% of total calories.
All of the sources of fat noted above.
Dietary Cholesterol – less than 200 milligrams each day
Excesses in dietary cholesterol have been linked to increases in coronary heart disease.
Cholesterol comes from two sources – that which your body creates and that which is found in animal products (meat, poultry, fish, egg yolks and dairy contain dietary cholesterol)

Carbohydrates – 50% of total calories

Why?: Carbohydrates are the building blocks of a heart-healthy diet.

What does this mean? Choose complex carbohydrates (instead of refined ones with white flour) to get the maximum nutritional benefit from these foods.
Examples: Whole grain or oat based breads, crackers, pastas and cereals, other whole wheat/grain based flour products; brown or wild rice; couscous, quinoa, barley, buckwheat; lentils, split peas and beans; fruits and vegetables.

Fiber – 20-30 grams per day

Why?: Dietary fiber, specifically the viscous (soluble) form, is associated with a decrease in cholesterol and contributes to a host of other health benefits.
What does this mean? All of the above complex carbohydrate food sources.

Examples: Aim for a minimum of 10 or more grams of viscous (soluble) fiber each day by increasing oats, barley, lentils, split peas, beans, fruits and vegetables

Protein – Approximately 20% of total calories

Dietary protein can come from both plant and animal sources and is an essential nutrient to good health. The problem is, many protein sources (especially animal sources) contain a lot of saturated fat and cholesterol so choose your protein sources wisely.
Major sources of protein in the diet: beef, veal, pork, fish, chicken, legumes like lentils and beans, dairy products, nuts, seeds and soy foods.
Total Calories – balance energy intake with output to achieve or maintain a desirable body weight
Excessive calories, regardless of the source, results in weight gain.

General advise: Aim to consume 4-6 small meals and snacks daily. Avoid skipping meals and eating late at night.

You may wonder HOW it is you can incorporate these guidelines into your and your families hectic lifestyle. Take the following steps one day at a time and focus first on the foods in your diet that are high in saturated fat and cholesterol. Start making simple substitutions for saturated fats with mono and polyunsaturated fats, couple this with a focus on fruits, vegetables and whole grains, some physical activity and you are well on your way towards reaching your nutritional goals. Below is an example of how the TLC guidelines would be implemented for someone on a 1,800-calorie diet. You may require more or less calories for weight loss or maintenance, see your registered dietitian or physician for more information on your caloric needs.


For a 1,800-calorie diet

  • Saturated fat, <7% of calories
  • 14 grams or less per day

Polyunsaturated fat, up to 10% of calories

  • Up to 20 grams per day

Monounsaturated fat, up to 20% of calories

  • Up to 40 grams per day

Total fat, 25% to 35% of calories

  • Between 50 and 70 grams per day

Carbohydrate, 50% to 60% of calories

  • Between 225 and 270 grams per day

Protein, about 15% of calories

  • Around 67 grams per day


  • Less than 200 milligrams per day


  • 20-30 grams per day with a focus on viscous (soluble) fiber

If the above is still to difficult to implement in your dietary habits, the statins are for most people a effective strategy to maintain or even regain better cardiovascular health and lower their risks for heart attack and stroke.



Viral and bacterial infections are by far the most common causes of illness for most people. They cause things like colds, pneumonia, measles, mumps, malaria, AIDS and so on. The job of your immune system is to protect your body from these infections. The immune system protects you in three different ways:

  1. It creates a barrier that prevents bacteria and viruses from entering your body.
  2. If a bacteria or virus does get into the body, the immune system tries to detect and eliminate it before it can make itself at home and reproduce.
  3. If the virus or bacteria is able to reproduce and start causing problems, your immune system is in charge of eliminating it.

Sometimes your immune system is not able to activate itself quickly enough to outpace the reproductive rate of a certain bacteria, or the bacteria is producing a toxin so quickly that it will cause permanent damage before the immune system can eliminate the bacteria. In these cases it would be nice to help the immune system by killing the offending bacteria directly.
Antibiotics work on bacterial infections. Antibiotics are chemicals that kill the bacteria cells but do not affect the cells that make up your body. For example, many antibiotics interrupt the machinery inside bacterial cells that builds the cell wall. Human cells do not contain this machinery, so they are unaffected. Different antibiotics work on different parts of bacterial machinery, so each one is more or less effective on specific types of bacteria.

Antibiotic Resistance

Bacteria aren’t particularly intelligent. However, it is possible, and unfortunately all too common, for bacteria to “learn” how to survive even with antibiotics around.

There are several ways that bacteria can become resistant. All of them involve changes in the bacteria’s genes.

  • Bacterial genes mutate (change), just like the genes of larger organisms mutate. Some of these changes happen because of chemical or radiation exposure; some just happen randomly, and no one’s sure quite why. If bacteria with a changed gene is less susceptible to an antibiotic, and that antibiotic is around, the less susceptible (and more resistant) version of the bacteria is more likely to survive the antibiotic and continue to multiply. This is particularly likely to happen if the amount of antibiotic around isn’t quite enough to kill all of the bacteria quickly — as can happen if you don’t take enough of the antibiotic to keep its level in your body high, or if you stop taking the antibiotic too early. This is why when you are prescribed an antibiotic you MUST take it exactly as prescribed, and for as long as it was prescribed. It’s also why we don’t (or shouldn’t) give you an antibiotic for an illness like a cold that isn’t likely to be bacterial: the antibiotic will kill off the susceptible bacteria, leaving bacteria that are resistant to that antibiotic.
  • Although there are many different species of bacteria, some bacteria can “trade” genes with other bacteria. If you have a relatively harmless bacteria in you — say, in your mouth or your intestines (both places are chock full of bacteria) — and you’ve used (or overused or misused) antibiotics some of those harmless bacteria will become resistant to the antibiotics you’ve  used. They can then give the resistance genes they have developed to other, harmful bacteria.
  • There are viruses around that attack bacteria rather than plants, animals, or people. Most of these viruses just kill the bacteria, but sometimes the viruses can copy genes, like the antibiotic resistance genes, from one kind of bacteria to another.

Kinds of Antibiotics

There are now so many different antibiotics on the market that it’s hard to keep track of them all.

Penicillins and Cephalosporins

In the early 20th century, Alexander Fleming discovered that a mold called Penicillium (the cells are pencil-shaped when you look at them under a microscope) produces chemicals which kills most of the bacteria nearby. (The mold is green when it grows in large amounts, and is often found on bread. This, however, does not mean that eating moldy bread will cure your ear ache… or anything else. There are other things produced by molds, too.) Sometime later, another mold was found which produced a bacteria-killing chemical; this chemical and its cousins were called “cephalosporins” after the mold it came from.

The vast majority of antibiotics are either penicillins or cephalosporins; chemical changes have been made to the molecules over the years to improve their bacteria-fighting abilities and to help them overcome breakdown and “immunity” of resistant bacteria. Most bacterial cells have double layers on their outside. The outermost layer, the “cell wall”, is similar to the outer layer of plant cells, but is missing in human and animal cells. This wall must grow along with the cell, or the growing cell will eventually become too big for the wall and burst and die. Penicillins and cephalosporins kill bacteria by messing up the wall-building system. Since we don’t have cell walls, and plants have a different wall-building system, neither we, nor animals, nor plants are affected by the medicine.

Penicillins and cephalosporins usually don’t cause many problems for a patient. Like all antibiotics, they can cause mild side effects like diarrhea. Less common side effects include rashes (which may or may not imply a true allergy) and hives (which usually means you’re allergic to the medicine). The rarest — and scariest — side effect is “anaphylactic” allergy, in which your airway swells up when you take a dose of the medicine, sometimes to the point where you can’t breathe.

Macrolides (Erythromycin, Klaricid, Azithromycin)

Erythromycin is another antibacterial produced by a mold. There are a couple of new relatives of erythromycin (azithromycin and clarithromycin) that work the same way, but kill more bugs and have slightly fewer side effects. The erythromycin-like antibiotics are also known as macrolides.

Macrolides works by blocking the bacterial cell’s machinery for making new proteins. Since proteins both make up much of the cell’s structure and make the enzymes that direct all the cell’s chemical reactions, blocking protein manufacturing makes the cell unable to function. Macrolides in low doses will stop bacteria from growing and multiplying, but you need a higher concentration to kill the bacteria. However, if you can stop growth until your immune system kicks in, that will help you get rid of the infection.

Since all protein making is affected, erythromycin can slow down or kill any bacteria, even those without cell walls. Because of this, we use the erythromycins for several diseases, including bacterial bronchitis, chlamydia, and whooping cough, that penicillins and cephalosporins can’t touch.

The biggest problem with these medicines is that they can irritate the stomach. Always take erythromycin with food or milk. The same goes for clarithromycin. Azithromycin doesn’t irritate the stomach nearly as much as the others and should be taken on an empty stomach.


The sulfas (more properly “sulfanilamides” or “sulfonamides”) were the first man-made antibiotics to be developed. They interfere with certain “manufacturing” systems in the bacterial cell, including ones that bacteria use to produce new DNA for new bacteria. Sulfas can stop bacteria from growing, but they cannot actually kill the bacteria.

Sulfas also have a tendency to produce allergic reactions. We use sulfas nowadays mainly in combination with another drug which attacks a different part of the bacteria. The drugs we usually combine with sulfas are either erythromycin or trimethoprim

Trimethoprim-Sulfamethoxazole (Septra, Bactrim)

Trimethoprim (TMP) is another man-made antibiotic. Like the sulfas, trimethoprim blocks an important step in the bacteria’s system for making new DNA — but it’s a different step. By itself, TMP can kill bacteria, but very slowly. Usually, though, we use TMP in combination with sulfamethoxazole (SMX), and the combination of TMP and a sulfa kills bugs better. In fact, bacteria that are partly resistant to either TMP or SMX can still be killed by the combination of the two. The combination is widely used for urinary tract infections, airway and skin infections.


Nitrofurantoin is another synthetic antibiotic, used mainly for urinary tract infections.(Since it is excreted in the urine, it concentrates in the bladder very nicely.) Nitrofurantoin stops bacteria from growing, and can kill bacteria with a high enough level, by blocking the bacteria’s ability to use energy it makes by “digesting” nutrients like sugar, and by blocking other chemical reactions that use the same system. It should be taken with food ie yoghurt to prevent upset stomach. Resistance is limited and it can be taken safely during pregnancy

Aminoglycosides (Gentamycin, Tobramycin)

The aminoglycosides are drugs which stop bacteria from making proteins; they work by attaching permanently to the protein machinery. Since they attach permanently, the bacterial cell will die if it gets enough of the drug. They can be used by themselves, or along with penicillins or cephalosporins to give a two-pronged attack on the bacteria.

Since aminoglycosides are broken down easily in the stomach, they can’t be given by mouth and must be injected or given IV When injected, their side effects include possible damage (temporary or permanent) to the ears and to the kidneys; this can be minimized by checking the amount of the drug in the blood and adjusting the dose so that there is enough drug to kill bacteria but not too much of it. Generally, aminoglycosides are given for short time periods, and in hospital settings.


The chinolones or quinolones, of which the best known is ciprofloxacin (Cipro®:), interfere with an enzyme called DNA gyrase that is essential for duplication of bacterial DNA. (Bacteria have only one long chromosome (DNA molecule); the chromosome gets twisted during replication, like a telephone cord, and, again like the telephone cord, the chromosome can become so twisted that nothing more can be done with it. DNA gyrase is the “untwisting” enzyme.) This interference is completely different from the interference of other antibiotics with bacterial “machinery”, and so bacteria that are resistant to other antibiotics may be sensitive to the chinolones.

However, bacteria can develop resistance to the chinolones, too.

Chinolones should not be taken together with calcium or antacids since it reduce the absorption.

Tetracyclines (Doxycyline)

Tetracycline kills bacteria and protozoa by inhibiting the manufacture of specific proteins needed by the organisms to survive.
Tetracycline Antibiotics is a group of antibiotics produced by certain sepcies of the fungus Streptomyces. Tetracycline drugs (also known as broad-spectrum antibiotics) are effective against many different types of bacteria.

Doxycycline is used in the treatment of infections of the skin, bone, stomach, respiratory tract, sinus, ear, and urinary tract. Lyme disease and certain sexually transmitted diseases (gonorrhea and chlamydia) can also be treated with Doxycycline. Doxycycline is also recommended for the treatment of Anthrax.

Tetracyclines enhance sensitivity for sunlight and are preferably taken on empty stomach.

Male Menopause, Does Testosterone Replacement Benefit?

Male Menopause, Does Testosterone Replacement Benefit?

For decades, older women have taken hormone replacements to replenish estrogen and progesterone levels lost to aging, called Menopause. We have learned during the years that hormone replacement can be beneficial but not without risk for the stimulating effects of the hormones. Long term use (>5 yrs) is therefore advised in general for women. More recently, testosterone (the most important male hormone) supplements have been used by aging men to improve their quality of life, Male Menopause or Andropause has been described as the male decline in testosterone levels. In 2003, the number of elderly American men taking testosterone replacement therapy was already 1 million, and the number has been growing faster in recent years. Lets have a look at the current studies on effect and safety.

Testosterone and its Effects


It’s not clear that naturally falling testosterone levels cause any signs and symptoms in men. Studies of men who have very low levels of testosterone due to diseases and treatments may offer some clues to the role testosterone plays in a man’s body as he ages. According to those studies, testosterone deficiency can have several effects on the body, including: Decreased sexual function , Loss of bone density, Loss of muscle mass, Increase in fat mass, Reduced muscle strength, Memory loss, Mood changes and depression.

Potential benefits Potential risks
Improve muscle mass and strengthCause skin reactions
Increase bone mineral densityCause fluid retention
Thicken body hair and skinCause baldness
Improve sexual desireStimulate noncancerous growth
of the prostate and cause urinary symptoms
Boost energyCause testicle shrinkage
Decrease irritability and depressionCause acne
Improve cognitive functionStimulate growth of prostate cancer that’s already present
Stimulate blood productionEnlarge breasts
table: pro's and cons of using testosterone supplement

Some men experience these signs and symptoms, but don’t have unusually low levels of testosterone. Others may have low levels of testosterone, but don’t experience any signs and symptoms that would prompt them to seek treatment.

Testosterone replacement therapy can help older men deficient in the hormone reduce their risks of heart disease, diabetes, and death, according to new research presented at the annual meeting of The Endocrine Society.

The goal of testosterone treatment is to keep the levels within normal range. Low levels of testosterone are common with age, occurring in about 20% of 70-year-olds. Low levels of testosterone are associated with the metabolic syndrome — a cluster of risk factors such as abnormal cholesterol and high blood pressure that boost risk of heart disease, stroke, and type 2 diabetes as well as other risks to health.

The Studies found that testosterone replacement therapy reduced the metabolic syndrome risk factors and did so in a similar way in all the age ranges studied.

Testosterone Replacement Therapy and Heart Disease Risks

In the first study 95 men, aged 34 to 69, with low levels of testosterone were included.
All had metabolic syndrome. Those who have this diagnosis must have three of five risk factors: increased waist circumference, low “good” cholesterol or HDL, high triglycerides, elevated blood pressure, and elevated blood sugar.

They were treated for at least a year. Every three months, they measured cholesterol, waist circumference, and other parameters.

The testosterone replacement was given as a long-acting injection (Nebido), every three months. The men were not given a special diet or exercise program.

The supplemental testosterone reduced total cholesterol, “bad” LDL cholesterol, triglycerides, and body mass index while improving “good” HDL cholesterol. The men lost their pot bellies, appr. three or four inches off the waist, and a reduction by one-fourth to one-third of their total cholesterol. No adverse effects were reported.

Testosterone Replacement Therapy: No Age Effects?

In a second study, the same 95 men were divided into three groups, based on age: less than 57, 57 to 63, and older than 63.

They found the older men and the younger men had similar improvement in their risk factors.

Precautions with testosterone supplementation

It is well known that with prostate cancer, the cancer is usually dependent on testosterone. Prostate cancer is a slow-growing tumor. Cancer must be ruled out before starting supplements, and routine prostate checkups are advised.

A test to monitor red blood cell formation, called a hematocrit, is needed, too. The potential increase in red blood cells, can theoretically boost heart attack or stroke risk.

Testosterone and Death Risk

Low testosterone levels are associated with an increased risk of death, according to Robin Haring, a researcher from Germany.He evaluated data on nearly 2,000 men, aged 20 to 79, following them for seven years until August 2007. He noted testosterone levels, age, weight, smoking habits, and physical activity. During the follow-up, 226 men died. Men with low testosterone have a more than twofold higher risk of death during the follow-up period.

They were more likely to die of cardiovascular disease and cancer, but not of other causes.

Testosterone Replacement Therapy: Long-Term Effects Unknown

The problem area  about supplemental testosterone is the lack of knowledge on long-terms effects. Testosterone [in excess] can increase blood pressure and compromise kidney function. These problems can be seen with bodybuilders using large doses of testoterone or an equivalent derivative. If health risks with the low supplementation to “natural” levels can induce similar problems has not be seen yet in studies, sideeffects were not significant but patients were also filtered on possible prostate problems. With influx of new ways of taking TRT we wonder how this market will develop. Low testosterone levels are not [yet] indicated as a disease so reimbursement by insurance is nill. Dermal patches and gels and (long acting) injections range in price between $20 – 200 monthly excluding the tests and consultation fees.  Allthough the studies show that restoring testosterone when it is low improves metabolic syndrome factors and could help prevent type 2 diabetes and cardiovascular risks as with other therapies lifestyle changes can also have a significant effect on the hormone levels and the mentioned risk factors, especially the good old watch what you eat (and how much) and exercise !

Skin Problems and What They Look Like

Herpes Zoster

Do you have skin problems?

Is your skin itching, breaking out, covered in a rash, or playing host to strange spots? Skin inflammation, changes in texture or color, and spots may be the result of infection, a chronic skin condition, or contact with an allergen or irritant. While having reported earlier on these topics you can easier recognize the common adult skin problems with this picture library from WebMd.

Shingles (herpes zoster)
Shingles starts with burning, tingling, or very sensitive skin. A rash of raised dots develops into painful blisters that last about two weeks. Shingles often occurs on the trunk and buttocks, but can appear anywhere. Most people recover, but pain, numbness, and itching linger for many — and may last for months, years, or the rest of their lives. Treatment with antiviral drugs like aciclovir  may reduce symptoms if taken at start of symptoms. Steroids and antidepressants are sometimes used to control pain.

Hives (urticaria)
Hives, a common allergic reaction that looks like welts, are often itchy, stinging, or burning. They may appear anywhere and last minutes or days. Severe hives can cause difficult breathing (get immediate medical attention if this occurs). Medications, foods, or food additives, temperature extremes, and infections like strep throat can cause hives. Removing the trigger often resolves the hives in days or weeks. Antihistamines can provide quick relief preferably taken orally. Steroids applied locally or prescribed orally may be indicated as well.

A non-contagious rash of thick red plaques covered with silvery scales, psoriasis usually affects the scalp, elbows, knees, and lower back. The rash can heal and recur throughout life. The cause of psoriasis is unknown, but skin inflammation may be triggering new skin cells to develop too quickly. Treatments include steroid or retinoid creams, light therapy, and medications.


Eczema describes several non-contagious conditions where skin is inflamed, red, dry, and itchy. Stress, irritants (like soaps), allergens, and climate can trigger flare-ups though they are not eczema’s cause, which is unknown. In adults, eczema often occurs on the elbows and hands, and in “bending” areas, such as inside the elbows. Treatments include cortisone creams, pills, shots, antibiotics, antihistamines, or phototherapy.


Also called Acne rosacea is often beginning as a tendency to flush easily, rosacea causes redness on the nose, chin, cheeks, forehead, even in the eyes. The redness may intensify over time, taking on a ruddy appearance. If left untreated, bumps and pus-filled pimples can develop, with the nose and oil glands becoming bulbous. Rosacea treatment includes medications (antibiotic cream), as well as surgery to remove blood vessels or correct nose disfigurement.

The bulbous nose is often associated with alcoholism, yet there is no direct relation since Rosacea can occur at the latter stages of life without alcohol involved.

Rash from Poisonous Plants
Contact with sap from poison ivy and its relatives of which we have a few on St. Maarten causes a rash in most people. It begins with redness and swelling at the contact site, then becomes intensely itchy. Blistering appears within hours or a few days. The typical rash is arranged as a red line on an exposed area, caused by the plant dragging across the skin. The rash usually lasts up to two weeks.

These rashes in the begin stages are sometimes mistakenly diagnosed as Hives (Urticaria) until the blisters appear.

Not everyone has such an extensive reaction to Poison Ivy and sometimes a mere itch with a light redness lasting a couple of hours is all some people experience.

Razor Bumps
Razor bumps are tiny, irritated bumps that develop after shaving. The sharp edge of closely shaven hair can curl back and grow into the skin, causing irritation and pimples, and even scarring. To minimize razor bumps, take a hot shower before shaving, shave in the direction of hair growth, and don’t stretch the skin while shaving. Use a single blade. Rinse with cold water, then apply moisturizer.

Don’t use electrical shavers since they have the tendency to pull the hairs for a closer shave.

Skin tags
A skin tag is a small flap of flesh-colored or slightly darker tissue that hangs off the skin by a connecting stalk. Usually found on the neck, chest, back, armpits, under the breasts, or in the groin area, skin tags are not dangerous and usually don’t cause pain unless they become irritated by clothing or nearby skin rubbing against them. A doctor can remove a skin tag by cutting, freezing, or burning it off.

Removal of skin tags is only a temporary solution and under most circumstances will return.

At the heart of acne lies the pimple — a plug of fat, skin, and keratin. When open, the plug is called a blackhead, closed, a whitehead. Often seen on the face, chest, and back, acne is caused by many things, including hormones. To help control it, keep oily areas clean and don’t squeeze pimples (it may cause infection and scars). Only three medications are proven effective for acne treatment: benzoyl peroxide, retinoids, and antibiotics.


Athlete’s Foot
A fungal infection that can cause peeling, redness, itching, burning, and sometimes blisters and sores, athlete’s foot is mildly contagious, passed by direct contact or by walking barefoot in areas such as locker rooms, or near pools. The fungi then grow in shoes, especially tight ones without air circulation. It’s usually treated with topical antifungal creams and lotions or oral medications for more severe cases.



Usually brown or black, moles can be anywhere on the body, alone or in groups, and generally appear before age 20. Some moles (not all) change slowly over the years, becoming raised, developing hair, and/or changing color. While most are non-cancerous, some moles have a higher risk of becoming cancerous. Have a dermatologist evaluate moles that change, have irregular borders, unusual or uneven color, bleed, or itch.


Age or liver spots (lentigines)
These pesky brown spots are not really caused by aging, though they do multiply as you age. They’re the result of sun exposure, which is why they tend to appear on areas that get a lot of sun, such as the face, hands, and chest. Bleaching creams, acid peels, and light-based treatments may lessen their appearance.

To rule out serious skin conditions such as melanoma, see a dermatologist for proper identification.

Melasma (Pregnancy Mask)
Melasma (or chloasma) is characterized by tan or brown patches on the cheeks, nose, forehead, and chin. Although usually called the “pregnancy mask,” but it can also happen when other factors raise the estrogen level like taking birthcontrol pills. Melasma may go away after pregnancy but, if it persists, can be treated with prescription creams and over-the-counter products. Skin of color is even more sensitive for uneven pigmentation sometimes due to irritants in facial cosmetics.

Use a sunscreen at all times if you have melasma, as sunlight worsens the condition.

Cold sores (fever blisters)
Small, painful, fluid-filled blisters on the mouth or nose, cold sores are caused by the herpes simplex virus. Lasting about seven to 10 days, cold sores are contagious until completely crusted over.

Triggers can include fever, too much sun, stress, or menstruation. Antiviral pills or creams can be used as treatment, but call your doctor if sores contain pus, you have a fever greater than 100.5°, or if your eyes become irritated.

Caused by contact with the contagious human papillomavirus, warts can spread from person to person or via contact with something used by a person with the virus. You can prevent spreading warts by not picking them, covering them with bandages, and keeping them dry. In most cases, warts are harmless, painless, and go away on their own. If they persist, treatments include freezing, surgery, lasers, and chemicals.

Diabetes Demystified

Diabetes Demystified

What is diabetes?

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar levels that result from defects in insulin secretion, or action, or both. Diabetes mellitus, commonly referred to as diabetes was first identified as a disease associated with “sweet urine,” and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine.

Normally blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime.

What causes diabetes?

Insufficient production of insulin, production of defective insulin (which is uncommon), or the inability of cells to use insulin properly and efficiently leads to hyperglycemia and diabetes. Glucose is a simple sugar found in food. Glucose is an essential nutrient that provides energy for the proper functioning of the body cells. Carbohydrates are broken down in the small intestine and the glucose in digested food is then absorbed by the intestinal cells into the bloodstream, and is carried by the bloodstream to all the cells in the body where it is utilized. However, glucose cannot enter the cells alone and needs insulin to aid in its transport into the cells. Without insulin, the cells become starved of glucose energy despite the presence of abundant glucose in the bloodstream. In certain types of diabetes, the cells’ inability to utilize glucose gives rise to the ironic situation of “starvation in the midst of plenty”. The abundant, unutilized glucose is wastefully excreted in the urine.

Insulin is a hormone that is produced by specialized cells (beta cells) of the pancreas. In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood. After a meal, the blood glucose level rises. In response to the increased glucose level, the pancreas normally releases more insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels after a meal. When the blood glucose levels are lowered, the insulin released from the pancreas is turned down. In normal individuals, such a regulatory system helps to keep blood glucose levels in a tightly controlled range. In patients with diabetes, the insulin is either absent, relatively insufficient for the body’s needs, or not used properly by the body. All of these factors cause elevated levels of blood glucose (hyperglycemia).

What are the different types of diabetes?

There are two major types of diabetes, called type 1 and type 2. Type 1 diabetes was also called insulin dependent diabetes mellitus (IDDM), or juvenile onset diabetes mellitus. In type 1 diabetes, the pancreas undergoes an autoimmune attack by the body itself, and is rendered incapable of making insulin. The patient with type 1 diabetes must rely on insulin medication for survival.

Type 2 diabetes was also referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult onset diabetes mellitus (AODM). In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body’s needs. In many cases this actually means the pancreas produces larger than normal quantities of insulin. A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and muscle cells).

While it is said that type 2 diabetes occurs mostly in individuals over 30 years old and the incidence increases with age, we are seeing an alarming number patients with type 2 diabetes who are barely in their teen years. In fact, for the first time in the history of humans, type 2 diabetes is now more common than type 1 diabetes in childhood. Most of these cases are a direct result of poor eating habits, higher body weight, and lack of exercise.

While there is a strong genetic component to developing this form of diabetes, there are other risk factors – the most significant of which is obesity. There is a direct relationship between the degree of obesity and the risk of developing type 2 diabetes, and this holds true in children as well as adults. It is estimated that the chance to develop diabetes doubles for every 20% increase over desirable body weight.

What are diabetes symptoms?

  • Excessive urination
  • Unquenchable thirst
  • Fatigue, nausea and vomiting
  • Infections of the bladder, skin, and vaginal areas.
  • Numbness in hands, legs or feet.
  • Blurred vision
  • Dry, itchy skin

How is diabetes diagnosed?

The fasting blood glucose test (sugar) is the preferred way to diagnose diabetes. It is easy to perform and convenient. After the person has fasted overnight (at least 8 hours), a single sample of blood is drawn and sent to the laboratory for analysis. This can also be done accurately in a doctor’s office using a glucose meter.

Normal fasting plasma glucose levels are less than 100 milligrams per deciliter (mg/dl) (5.6mmol/l)

Fasting plasma glucose levels of more than 126 mg/dl (7mmol/l) on two or more tests on different days indicate diabetes.

A random blood glucose test can also be used to diagnose diabetes. A blood glucose level of 200 mg/dl (11.1mmol/l) or higher indicates diabetes.

What are the acute complications of diabetes?

Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNS). Occurs in patients with type 2 diabetes. Usually occurs when patients are ill or stressed. Symptoms include frequent urination, drowsiness, lethargy, and decreased intake of fluids. HHNS is not typically associated with nausea, vomiting, or abdominal pain.

Hypoglycemia (low blood sugar (glucose)). In patients with diabetes, the most common cause of low blood sugar is excessive use of insulin or other glucose-lowering medications, to lower the blood sugar level in diabetic patients in the presence of a delayed or absent meal. When low blood sugar levels occur because of too much insulin, it is called an insulin reaction. Sometimes, low blood sugar can be the result of an insufficient caloric intake or sudden excessive physical exertion. Blood glucose is essential for the proper functioning of brain cells. Therefore, low blood sugar can lead to central nervous symptoms such as dizziness, confusion, weakness and tremors.

What are the chronic complications of diabetes?

These diabetes complications are related to blood vessel diseases and are generally classified into small vessel disease, such as those involving the eyes, kidneys and nerves ,and large vessel disease involving the heart and blood vessels .Diabetes accelerates hardening of the arteries (atherosclerosis) of the larger blood vessels, leading to coronary heart disease, angina or heart attack, strokes, and pain in the lower extremities because of lack of blood supply.

Eye Complications

The major eye complication of diabetes is called diabetic retinopathy. Diabetic retinopathy occurs in patients who have had diabetes for at least five years. Diseased small blood vessels in the back of the eye cause the leakage of protein and blood in the retina. Disease in these blood vessels also causes the formation of small aneurysms , and new but brittle blood vessels. Spontaneous bleeding from the new and brittle blood vessels can lead to retinal scarring and retinal detachment, thus impairing vision.

To treat diabetic retinopathy a laser is used to destroy and prevent the recurrence of the development of these small aneurysms and brittle blood vessels. Approximately 50% of patients with diabetes will develop some degree of diabetic retinopathy after 10 years of diabetes, and 80% of diabetics have retinopathy after 15 years of the disease. Poor control of blood sugar and blood pressure further aggravates eye disease in diabetes.

Cataracts and glaucoma are also more common among diabetics. It is also important to note that since the lens of the eye lets water through, if blood sugar concentrations vary a lot, the lens of the eye will shrink and swell with fluid accordingly. As a result, blurry vision is very common in poorly controlled diabetes. Patients are usually discouraged from getting a new eyeglass prescription until their blood sugar is controlled. This allows for a more accurate assessment of what kind of glasses prescription is required.

Kidney damage

Kidney damage from diabetes is called diabetic nephropathy. The onset of kidney disease and its progression is extremely variable. Initially, diseased small blood vessels in the kidneys cause the leakage of protein in the urine. Later on, the kidneys lose their ability to cleanse and filter blood. The accumulation of toxic waste products in the blood leads to the need for dialysis. Dialysis involves using a machine that serves the function of the kidney by filtering and cleaning the blood. In patients who do not want to undergo chronic dialysis, kidney transplantation can be considered.

The progression of nephropathy in patients can be significantly slowed by controlling high blood pressure, and by aggressively treating high blood sugar levels. Angiotensin converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs) used in treating high blood pressure may also benefit kidney disease in diabetic patients.

Nerve damage

Nerve damage from diabetes is called diabetic neuropathy and is also caused by disease of small blood vessels. In essence, the blood flow to the nerves is limited, leaving the nerves without blood flow, and they get damaged or die as a result (a term known as ischemia). Symptoms of diabetic nerve damage include numbness, burning, and aching of the feet and lower extremities. When the nerve disease causes a complete loss of sensation in the feet, patients may not be aware of injuries to the feet, and fail to properly protect them. Shoes or other protection should be worn as much as possible. Seemingly minor skin injuries should be attended to promptly to avoid serious infections. Because of poor blood circulation, diabetic foot injuries may not heal. Sometimes, minor foot injuries can lead to serious infection, ulcers, and even gangrene, necessitating surgical amputation of toes, feet, and other infected parts.

Diabetic nerve damage can affect the nerves that are important for penile erection, causing erectile dysfunction (ED, impotence). Erectile dysfunction can also be caused by poor blood flow to the penis from diabetic blood vessel disease.

Diabetic neuropathy can also affect nerves to the stomach and intestines, causing nausea, weight loss, diarrhea, and other symptoms of gastroparesis (delayed emptying of food contents from the stomach into the intestines, due to ineffective contraction of the stomach muscles).

The pain of diabetic nerve damage may respond to traditional treatments with gabapentin (Neurontin), phenytoin (Dilantin) or carbamazapine (Tegretol) with topically applied capsaicin (an extract of pepper).

Gabapentin (Neurontin), phenytoin (Dilantin), and carbamazepine (Tegretol) are medications that are traditionally used in the treatment of seizure disorders.

The pain of diabetic nerve damage may also improve with better blood sugar control, though unfortunately blood glucose control and the course of neuropathy do not always go hand in hand. Newer medications for nerve pain have recently come to market .Pregabalin (Lyrica) which has an indication for diabetic neuropathic pain and duloxetine (Cymbalta) are newer agents used in the treatment of diabetic neuropathy.

Diabetes management: How lifestyle, daily routine affect blood sugar

Above all, stay positive. The good habits you adopt today can help you enjoy an active, healthy life with diabetes.

Diabetes management requires awareness. Know what makes your blood sugar level rise and fall — and how to control these day-to-day factors.

When it comes to diabetes management, blood sugar control is often the central theme. After all, keeping your blood sugar level within your target range can help you live a long and healthy life with diabetes. But do you know what makes your blood sugar level rise and fall? The list is sometimes surprising.


What to do:

Be consistent. Your blood sugar level is highest an hour or two after you eat, and then begins to fall. But this predictable pattern can work to your advantage. Simply eating about the same amount of food at about the same time every day can help you control your blood sugar level.

Even out your CARBS. Carbohydrates have a bigger effect on your blood sugar level than does protein or fat. Eating about the same amount of carbohydrates at each meal or snack will help keep your blood sugar level steady throughout the day.

Coordinate your meals and medication. Too little food in comparison to your diabetes medications — especially insulin — may result in dangerously low blood sugar (hypoglycemia). Too much food may cause your blood sugar level to climb too high (hyperglycemia). Your diabetes health care team can help you strike a balance.


Physical activity is another important part of your diabetes management plan. When you exercise, your muscles use sugar (glucose) for energy. Regular physical activity also improves your body’s response to insulin. These factors work together to lower your blood sugar level. The more strenuous your workout, the longer the effect lasts. But even light activities — such as housework, gardening or being on your feet for extended periods — can lower your blood sugar level.

What to do:

Get doctor’s OK to exercise. This is especially important if you’ve been inactive and plan to start exercising regularly.

Adjust your diabetes treatment plan as needed. If you take insulin, you may need to adjust your insulin dose before exercising or wait a few hours to exercise after injecting insulin. Or your doctor may suggest other changes to your diabetes treatment plan.

Exercise good judgement. Check your blood sugar level before, during and after exercise, especially if you take insulin or medications that can cause low blood sugar. Drink plenty of fluids while you work out. Stop exercising if you experience any warning signs, such as severe shortness of breath, dizziness or chest pain.


Insulin and other diabetes medications are designed to lower your blood sugar level. But the effectiveness of these medications depends on the timing and size of the dose. And any medications you take for conditions other than diabetes can affect your blood sugar level, too.

What to do:
Store insulin properly – Insulin that’s improperly stored or past its expiration date may not be effective.

Report problems to your doctor. If your diabetes medications cause your blood sugar level to drop too low, the dosage or timing may need to be adjusted.

Be cautious with new medications. If you’re considering an over-the-counter medication or your doctor prescribes a new drug to treat another condition — such as high blood pressure or high cholesterol — ask your doctor or pharmacist if the medication may affect your blood sugar level. Sometimes an alternate medication may be recommended.

Monitoring you blood glucose levels.

Everyone with diabetes should test their blood sugar, or glucose, levels regularly. Knowing your blood sugar levels allows you to alter your diabetes management strategy if your levels aren’t near your target blood sugar.

Traditional Home Blood Sugar Monitoring. The traditional method of testing your blood sugar involves pricking your finger with a lancet (a small, sharp needle), putting a drop of blood on a test strip and then placing the strip into a meter that displays your blood sugar level. Meters vary in features, readability (with larger displays or spoken instructions for the visually impaired), portability, speed, size, and cost. Current devices provide results in less than 15 seconds and can store this information for future use. These meters can also calculate an average blood sugar level over a period of time. Some meters also feature software kits that retrieve information from the meter and display graphs and charts of your past test results. Blood sugar testing is usually recommended before meals, after meals, and at bedtime. Frequency and timing of blood sugar measurements should be individualized. Your health care provider will tell you when and how often you should check your blood sugar.

The chart below gives you an idea of where your blood sugar level should be throughout the day. Your ideal blood sugar range may be different from another person’s and will change throughout the day.

Time of TestIdeal for Adults With Diabetes
Before meals70-130 mg/dl (3.9-7.2mmol/l)
After mealsLess than 180 mg/dl (10mmol/l)
*Source: American Diabetes Association, 2009

Hemoglobin A1c test

The hemoglobin A1c test — also called HbA1c, glycated hemoglobin test, or glycohemoglobin — is an important blood test used to determine how well your diabetes is being controlled. Hemoglobin A1c provides an average of your blood sugar control over a six to 12 week period and is used in conjunction with home blood sugar monitoring to make adjustments in your diabetes medicines.

Lifestyle Changes for Diabetics.

Make a commitment to managing your diabetes. Learn all you can about diabetes. Make healthy eating and physical activity part of your daily routine. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it.

Take care of your teeth. Diabetes may leave you prone to gum infections. Brush and floss your teeth at least twice a day. And if you have type 1 or type 2 diabetes, schedule dental exams at least twice a year. Consult your dentist right away if your gums bleed or look red or swollen.

Identify yourself. Wear a tag or bracelet that says you have diabetes. Keep a glucagon kit nearby in case of a low blood sugar emergency — and make sure your friends and loved ones know how to use it.

Schedule a yearly physical and regular eye exams. Your regular diabetes checkups aren’t meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications, as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.

Keep your immunizations up-to-date. High blood sugar can weaken your immune system. Get a flu shot every year, and get a tetanus booster shot every 10 years. Your doctor may recommend the pneumonia vaccine or other immunizations as well.

Pay attention to your feet. Wash your feet daily in lukewarm water. Dry them gently, especially between the toes. Moisturize with lotion, but not between the toes. Check your feet every day for blisters, cuts, sores, redness or swelling. Consult your doctor if you have a sore or other foot problem that doesn’t start to heal within a few days.

Keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medication may be needed, too.

If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including heart attack, stroke, nerve damage and kidney disease. In fact, smokers who have diabetes are three times more likely to die of cardiovascular disease than are nonsmokers who have diabetes, according to the American Diabetes Association. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco.

If you drink alcohol, do so responsibly. Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so only in moderation and always with a meal. Remember to include the calories from any alcohol you drink in your daily calorie count.

Take stress seriously. If you’re stressed, it’s easy to abandon your usual diabetes management routine. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly, which only makes matters worse. To take control, set limits. Prioritize your tasks. Learn relaxation techniques. Get plenty of sleep.

Above all, stay positive. The good habits you adopt today can help you enjoy an active, healthy life with diabetes.