Exercise and Diabetes

Exercise and Diabetes

Did you know you can lower high blood pressure and help control your diabetes by taking action and becoming more physically active?

First you need to admin, honestly, how active you currently are. Are you doing a little, but ready to do more? Are you working out three days per week, or are you just getting started? No matter where you are now, there is always room for improvement.

If you have kids, you are setting an example for them to follow, will it be a healthy lifestyle or one of a couch potato?
-Go for a brisk walk around the neighborhood.
-Ride a bike to the store, to work, or just for fun.
-Play an outdoor game such as basketball, catch with an American football, or set up a volleyball or badminton net.

Be realistic about your goals and your actual activity level. Ten minutes of exercise each day is better than NO exercise, so start small and work you way up in time and in intensity. The goal is to increase your heart rate to exercise your heart muscle, and sweat some toxins out of your pores!

Other activites that count as exercise include sit-ups or push-ups, heavy gardening, lifting weights (use canned foods if you must) and dancing.

Track your progress on a calendar. For example, mark on Tuesday: 15 minute walk; Wednesday: 20 min. dancing; Thurs: Planted 3 shrubs… and so on.

If you are walking 30 minutes a day already, try adding just ten more minutes to your journey. Lifting weights? Add more weight or do more repetitions. Just keep adding!

One of my favorite tips to keeping an active lifestyle is to “mix it up” – while I prefer certain physical activities over others, when I find myself bored, looking for excuses not to work out, or reaching a plateau on my weight/fitness goals, I will try something new at the gym, such as a different group fitness class. Or I will change up my route on my bike rides. It is really fun to take your bike and ride in different parks or other areas near your house. Go for a walk in someone else’s neighborhood, just keep doing it!

A1c Diabetes Tests at Philipsburg Pharmacy

An A1C test is a blood test that reflects your average blood glucose levels over the past 3 months. The A1C diabetes tests are sometimes called the adult hemoglobin A1C, HbA1c, glycated hemoglobin, or glycohemoglobin test. Hemoglobin is the part of a red blood cell that carries oxygen to the cells.Philipsburg Pharmacy in St Maarten offers the A1c Diabetes test for clients in addition to the regular glucose test we currently offer.

This A1c test will give you your average glucose level over the last 2 months time period.

The hemoglobin A1c test is an important blood test that shows you how well your diabetes is being controlled through your day to day activities, and your diet. Hemoglobin A1c provides an average of your blood sugar control over the past 2 to 3 months and is used along with home blood sugar monitoring and helps your physician make adjustments to your diabetes medicines.

Hemoglobin is found in red blood cells, which carry oxygen throughout your body. When your diabetes is out of control, or your blood sugar level is too high, sugar builds up in your blood and combines with your hemoglobin. The average amount of sugar in your blood can be found by measuring your hemoglobin A1c level. If your glucose levels have been high over recent weeks, your hemoglobin A1c test will be higher.

What’s a Normal A1c TestResult?
For people without diabetes, the normal range for the hemoglobin A1c test is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% indicate increased risk of diabetes, and levels of 6.5% or higher indicate diabetes. Because studies have repeatedly shown that out-of-control diabetes results in complications from the disease, the goal for people with diabetes is a hemoglobin A1c less than 7%. The higher the hemoglobin A1c, the higher the risks of developing complications related to diabetes.

Make sure to have your hemoglobin A1c level tested here at Philipsburg Pharmacy, the BEST St Maarten Pharmacy in Philipsburg.

 

Preventing Type 2 Diabetes

preventing-type-2-diabetes

Preventing Type 2 diabetes is a matter of some will power. People with diabetes have a problem with blood sugar. Their blood sugar, or blood glucose, can climb too high. Having high levels of sugar in your blood can cause a lot of trouble. Diabetes raises your risk for heart disease, blindness, amputations, and other serious issues. But the most common type of diabetes, called type 2 diabetes, can be prevented or delayed if you know what steps to take. Continue reading “Preventing Type 2 Diabetes”

November is Diabetes Awareness Month

November is Diabetes Awareness Month

Did you know that more than 8 percent of Americans have diabetes?

November is Diabetes Awareness Month, making this a great opportunity to discuss this disease and its risk factors.

Some risk factors include:

      Family history

 

      Blood pressure

 

      Weight

 

    Activity levels

These are just a few of the factors that can affect your chances of developing diabetes.

Preventing the onset of Type 2 diabetes can sometimes be helped or delayed losing excess body fat and engaging in a healthy exercise program approved by your doctor.

Your healthcare professional, including your pharmacist, can tell you how to get practical advice about medications, insulin, and glucose meters to help you manage your diabetes.

Blood Sugar Control

Insulin Schematic

Why your life depends on You!

The key to understanding blood sugar control is to understand the role played by special cells in your pancreas, called Beta-Cells. These tiny cells are scattered throughout your pancreas and their job is to produce insulin, store it, and release it into the blood stream at appropriate times.

The beta-cells of a healthy person who has not eaten in a while release a small amount of insulin into the blood stream throughout the day and night in the form of very small pulses every few minutes. This is called “basal insulin release.

Maintaining this steady supply of insulin is important. It allows the cells of the body to utilize blood sugar even if some time has passed since a meal.

The steady insulin level as another function, too. A dropping insulin level signals the liver that blood sugar is getting low and that it is time to add more glucose. When this happens, the liver converts the carbohydrate it has stored, (known as glycogen) into glucose, and dumps it into the blood stream. This raises the blood sugar back to its normal level.

Regular functioning of insulin

When a healthy person starts to eat a meal, the beta-cells kick into high gear. Their stored insulin is released immediately. Then, if the blood sugar concentration rises over 100 mg/dl, (5.5 mmol/L) the beta-cells start secreting more insulin into the blood stream. This early release of stored insulin after a meal is called “First Phase Insulin Release.” In a healthy person it keeps the blood sugar from rising to very high levels because it is available to meet most of the glucose that comes from the digestion of the current meal.
After completing the first phase insulin release, the beta-cells pause. Then, if blood sugar is still not back under 100 mg/dl (5.5 mmol/L), they push out another, smaller second phase insulin response which takes effect about an hour after the meal and, in a healthy person, brings the blood sugar back down to its starting level, usually by two hours after the start of a meal.

It is this combination of a robust first phase insulin response followed by a functional second phase insulin response that keeps the blood sugar of a normal person from ever rising over 140 mg/dl(7.8 mmol/L) even after a high carbohydrate meal.

When first phase release fails, or when second phase insulin response is sluggish, blood sugars start to rise to higher levels after a meal and take longer to return to normal. This condition is called “impaired glucose tolerance.” If the blood sugar rises over 200 mg/dl (11 mmol/L) after a meal the same condition is called “Diabetes.”

First and second phase insulin release may fail to do their jobs for several reasons. The most common is a condition called insulin resistance in which some receptors in the liver and the muscle cells stop responding properly to insulin. This means that though there is lots of insulin circulating in the body, the muscles and liver (but not, alas, the fat cells) don’t respond until the insulin levels rise much higher.

So when a person’s cells become insulin resistant, it will take a lot more insulin than usual to push circulating glucose into cells. Eventually the body may not be able to produce enough insulin to clear all the dietary carbohydrate from the bloodstream and blood sugars will rise to abnormal levels.

If your beta-cells are normal, and if insulin resistance at the muscles and liver is your only problem, over time you may be able to grow new pancreas islets filled with new beta-cells that can store even more insulin for use in first and second phase insulin response. In this case, though your blood sugar may continue to rise into the impaired range and take longer than normal to go back down to normal levels, your blood sugar response may never deteriorate past the impaired glucose tolerance stage to full-fledged diabetes. This is what happens to most people who have what is called “Metabolic Syndrome.” Unfortunately, if you have impaired glucose tolerance, there is no way of knowing if you fall into this group or if your rising blood sugars are caused by failing or dying beta-cells.

First phase insulin release also fails because beta-cells are dysfunctional or dying. This can happen along with insulin resistance, or without it. Studies have found that some thin, non-insulin resistant relatives of people with Type 2 Diabetes already show signs of beta cell dysfunction.

If beta-cells are dying or not working properly. The remaining beta-cells may be working full-time just to keep up with the need for a basal insulin release so they can’t store any excess in those granules for later release.

Scientists have discovered dozens of different genetic defects which cause beta-cells to fail or die in humans and animals. This means that one person’s Type 2 Diabetes can behave quite differently from that of another person, depending on what exactly is broken in their blood sugar control system. This is why drugs that work well for one person may do little for another person.

Whatever the reason for the failing first phase insulin release there’s an ugly feedback mechanism that kicks in when blood sugar levels rise because of that failing first phase insulin release: High levels of circulating glucose themselves are toxic to beta-cells, a phenomenon called “glucose toxicity”. So as blood sugars rise these high blood sugar concentrations further damage and or kill more beta-cells, making insulin release even less able to control blood sugar concentrations.

When first phase insulin release is weak or missing your blood sugar may easily rise over the 200 mg/dl (11 mmol/L) level currently defined as “diabetes.”

At that point, two bad things happen. When the concentration of glucose in your blood reaches 200 mg/dl (11 mmol/L) your cells become insulin resistant even if they weren’t insulin resistant before, so it takes a lot more insulin to lower your blood sugar from that point on.

And, even worse, the lack of a robust insulin response to the rising glucose may erroneously be interpreted by your liver as a sign that blood sugar is too low and that it is time to dump more glucose into the bloodstream. So in addition to the glucose coming in from your recent meal you also have to contend with additional glucose dumped by your poor old confused liver.

As you become more diabetic, and your second phase insulin response grows weaker, it may take four or five hours for your beta-cells to secrete enough insulin to bring your blood sugar level down to its fasting level. And, in fact, during the day your blood sugar may never get back to its fasting level because the glucose coming in from your next meal comes into the bloodstream before the glucose from the previous meal has completely cleared. Only at night, while you are sleeping, may your beta-cells finally secrete enough insulin to get your blood sugar down low enough that you wake up with a normal fasting blood sugar.

However, since it took all the insulin your beta-cells could make to get back to that normal blood sugar and they will have had no chance to store any extra insulin to take care of your breakfast. As soon as you throw that morning bagel down the hatch, blood glucose will rise, and once again your beta-cells will have to spend many hours trying to bring it back down.

Eventually, even the long hours of the night will not be enough time for your beta-cells to produce enough insulin to bring your blood sugar back to normal, and now, perhaps a decade after you achieved diabetic post-meal numbers, you will finally start seeing diabetic fasting blood sugar levels.

image – exploding-diabetes

This process explains why for many people who become diabetic–particularly middle-aged women, the fasting blood sugar level is the very last measurement to become abnormal. Only when a whole night isn’t long enough for your beta-cells to bring your blood sugar back down to normal or near-normal levels will you become diabetic by a fasting blood sugar test. That is why lately more emphasis is put on the measurement and control of post meal sugar control. It has been calculated that less then 40% of the people that have a  fpg <120 and HbA1C of 7 have post meal glucose <200mg/dl. This is a scary statistic considering the amount of diabetics that have worse data and consider themselves under good control!

People whose fasting blood sugar numbers have risen along with their post-meal numbers have generally lost more beta-cell function than those who still maintain normal or near-normal fasting blood sugars. This is why as soon as you discover that your post-meal blood sugars are rising beyond a normal level, it is so important to start controlling those abnormal post-meal blood sugars immediately. By doing so, you may be able to lower any insulin resistance, preserve your remaining beta-cells and keep your fasting blood sugar from ever deteriorating.

Even after you have been diagnosed as having a type 2 diabetic fasting plasma glucose, you may still have a good number of beta-cells left–anywhere from 40 to 60%. If you can reduce your insulin resistance through weight loss, exercise, and the use of drugs that counter insulin resistance, and if you keep your carb intake low to avoid blood sugar spiking, those cells may be able to produce enough insulin to control your blood sugar.

Even more important, if you keep your blood sugar under the damage-limit of 140 mg/dl (7.8 mmol/L) at all times, you may be able to keep glucotoxicity from murdering the rest of those cells.

Some studies mostly in cell-cultures and animal models have demonstrated that giving stressed beta-cells a rest can sometimes restore function. A few studies suggest this can also be done in humans.

One way of “resting” beta-cells is to use injected insulin as soon as type 2 diabetes is diagnosed, particularly if your blood sugars are very high at the time of diagnosis. If you take the burden off your beta-cells by supplementing insulin, there’s some suggestion that they may recover some of their ability to produce insulin later on so that you can go off insulin and retain much better control. You’ll still have to limit carbs and address any problems you have with insulin resistance through weight loss, exercise, and insulin-sensitizing drugs. But you’ll have an easier time doing it.

Every Tuesday and Thursday from 10 a.m. till noon, you can come to the Philipsburg Pharmacy for a free Diabetes and Blood-pressure check-up.

Diabetes and Your Love Life

Erectile Dysfunction Graph

To understand how diabetes leads to Erectile Dysfunction (ED), you first have to understand how erections work. Getting an erection is really a complicated process.

Anatomy of an Erection

In the shaft of the penis there are two side-by-side chambers of spongy tissue called the corpora cavernosa. They’re mainly responsible for erections. Just below them is another chamber called the corpus spongiosum. The urethra, which carries semen and urine, runs through the center of it.

The corpora cavernosa are made of small arteries and veins, smooth muscle fiber, and empty spaces. The chambers are wrapped in a sheath of thin tissue.

When you get an erection, nerve signals from your brain or from the nerve endings in your penis cause the smooth muscle of the chambers to relax and arteries to dilate, or open wider. This allows a rush of blood to fill the empty spaces.

The pressure of blood flow causes the sheath of tissue around the chambers to press on veins that normally drain blood out of the penis. That traps blood in the penis. As more blood flows in, the penis expands and stiffens, and you have an erection.

When the excitement ends, the smooth muscle contracts again, taking pressure off the veins and allowing blood to flow back out of the penis.

Diabetes: A Perfect Storm for Erectile Dysfunction

Many common problems related to diabetes all come together to cause erectile dysfunction. That’s why various studies show that 35% to 75% of men with diabetes will develop some degree of erectile dysfunction. If you are having difficulty getting erections, there may be a number of things going on in your body.

Nitric oxide is a chemical released into the bloodstream by the lining of blood vessels. It acts as a kind of chemical messenger that tells the smooth muscles and arteries in the penis to relax and let in blood.

High blood sugar, which must be managed carefully if you have diabetes, causes blood vessel and nerve damage that affects many processes in the body. Sexual response is one of them. Damage to the blood vessels blocks the release of nitric oxide. A lack of nitric oxide results in constricted blood vessels and reduces blood flow to the penis.

What’s more, according to the American Diabetes Association, 73% of adults with diabetes have high blood pressure or take blood pressure medication. The combination of high blood pressure and diabetes also increases the risk for blood vessel damage, further reducing blood flow.

High cholesterol is also common in people with diabetes. LDL cholesterol, or what’s called “bad” cholesterol, can interfere with the ability of blood vessels to dilate. High cholesterol levels result in fatty deposits in artery walls. This buildup of fatty deposit can reduce blood flow.

Some of the choices that men with diabetes make also feed into this “perfect storm.” Smoking, especially. Smoking by itself reduces blood flow all through the body.

Last but not least, feeling badly about your health can lead to erectile dysfunction. For most men, erectile dysfunction is mainly a physical problem, but the mind always plays some part in sexual arousal.

Although having diabetes means that you may encounter problems with your sexual functioning, you really can turn it around. By living a healthy lifestyle and working with your doctor, you can get your diabetes under control and treat erectile dysfunction if it becomes a problem for you.

If you have diabetes and it has caused erectile dysfunction (ED), you still have every reason to be optimistic about the future and a healthy sex life. There are many proven treatments you can try.

A doctor’s first choice for treating erectile dysfunction is usually one of the pills called PDE5 inhibitors. First there was Viagra. Now there’s also Levitra and Cialis. All three drugs work in similar ways. They don’t increase sexual desire. They make it physically possible to get an erection when you are aroused.

No one of them has been proven to work better than the others, although there can be a different individual response. But the time they take to start working and the duration of their effects vary. That’s something you may want to consider based on your sexual habits. For example, does spontaneity matter to you, or do you usually plan sex ahead of time?

Viagra starts working in about 15 to 30 minutes and its effects last about four hours. Levitra starts working in about 30 to 60 minutes and lasts four to five hours. Cialis starts working in about 30 to 60 minutes and lasts as long as 36 hours. Take note that Viagra is most affected by slow absorption if you take it after a meal.

These drugs are not good for every man. Men who take nitrate drugs for chest pain or alpha blockers for high blood pressure or prostate problems shouldn’t take Cialis, Levitra or Viagra. Other reasons why you may not be able to take these drugs include:

  • High blood pressure that isn’t under control
  • Very low blood pressure
  • A heart attack or stroke in the past six months
  • Kidney or liver disease
  • Retinitis pigmentosa (an eye disease)

Other Treatments for Erectile Dysfunction

If erectile dysfunction pills are out of the question, or if they haven’t worked for you, don’t worry. There are other good options.

Alprostadil is another drug for erectile dysfunction. However, it’s not a pill. One brand, called MUSE, is an alprostadil pellet that you insert into the tip of your penis with an applicator. It widens blood vessels and relaxes smooth muscle tissue in the penis, allowing blood to fill the spongy tissue that makes the penis erect.

Injections directly into the penis are another way to deliver alprostadil. Phentolamine and papaverine are additional drugs that are injected into the penis to treat erection problems. When injecting these drugs there is some risk that your erection may last too long, a condition that can require medical treatment.

Next, you may want to try a vacuum device, or “penis pump.” This is typically a clear plastic cylinder with a bulb or plunger and a constriction band.

You put your penis in the cylinder and start pumping. The suction creates a vacuum, so blood rushes in to fill the spaces in the spongy tissue of the penis, creating an erection. The erection lasts only as long as the blood stays in, so you slide the band down around the base of your penis, trapping the blood. It’s safe to keep the band on for up to 30 minutes.

Alternative Treatments for Erectile Dysfunction

Currently, no herb or supplements have been proven to help with erectile dysfunction. Herbs and supplements that some people believe are helpful include:

  • Ginseng
  • Horny goat weed
  • Ginkgo biloba
  • Muira puama
  • Pycnogenol
  • L-arginine
  • Damiana

Before trying any alternative treatment, be sure to ask your doctor about it first. Herbs and supplements, whether they help with erectile dysfunction or not, have real effects on the body. They could cause dangerous reactions with other medicines you might be taking.

Every Tuesday and Thursday from 10 a.m. till noon, you can come to the Philipsburg Pharmacy for a free Diabetes and Blood-pressure check-up.

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.

Food

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.

Exercise

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.

Medication

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.