Both type 1 and type 2 diabetes share one central feature: elevated blood sugar (glucose) levels due to absolute or relative insufficiencies of insulin, a hormone produced by the pancreas. During and immediately after a meal, digestion breaks carbohydrates down into sugar molecules (of which glucose is one) and proteins into amino acids. Right after the meal, glucose and amino acids are absorbed directly into the bloodstream, and blood glucose levels rise sharply. The rise in blood glucose levels signals important cells in the pancreas, called beta cells, to secrete insulin, which pours into the bloodstream. When insulin levels are high, the liver stops producing glucose and stores it in other forms until the body needs it again. About 2 - 4 hours after a meal both blood glucose and insulin are at low levels, with insulin being slightly higher. Without insulin to move glucose into cells, blood glucose levels become excessively high, a condition known as hyperglycemia. Weakness, weight loss, frequent urination, and excessive hunger and thirst are among the initial symptoms.
About 5% of pregnant women develop a form of type 2 diabetes, usually temporary, in their third trimester called gestational diabetes.
Type 1 diabetes is usually a progressive autoimmune disease, in which the beta cells that produce insulin are slowly destroyed by the body's own immune system. Researchers have found at least 18 genetic locations, labeled IDDM1 - IDDM18, that are related to type 1 diabetes. Most people who develop type 1 diabetes, however, do not have a family history of the disease. Some research suggests that viral infections may trigger the disease in genetically susceptible individuals. Conditions that damage or destroy the pancreas, such as pancreatitis, pancreatic surgery, or certain industrial chemicals can cause diabetes. Type 1 diabetes can occur at any age but usually appears between infancy and the late 30s, most typically in childhood or adolescence. Children with type 1 diabetes may also be restless, apathetic, and have trouble functioning at school. The FPG test is not always reliable, so a repeat test is recommended if the initial test suggests the presence of diabetes, or if the tests are normal in people who have symptoms or risk factors for diabetes. Patients who have the FPG and OGTT tests must not eat for at least 8 hours prior to the test. The results of a blood glucose test tell the patient and doctor how well the diabetes is controlled for only the day of the test.
Once a blood sugar molecule sticks to a hemoglobin molecule, which are found in every red blood cell, it never lets go (a process called glycation). Therefore, an elevated hemoglobin A1c level tells the doctor and the patient how well controlled the patients diabetes has been over the last 3 months or so. Measuring glycosylated hemoglobin is not generally used for making an initial diagnosis of diabetes, since a normal level does not rule out diabetes.
Elevated levels of glycosylated hemoglobin are strongly associated with most if not all of the complications of diabetes.
Type 1 diabetes is characterized by the presence of a variety of antibodies that attack the islet cells.
Cardiac exercise testing should be considered for adult patients with any symptoms or electrocardiogram findings, or before starting an exercise program. Protect the heart and aim for healthy lipid (cholesterol and triglyceride) levels and control of blood pressure. Healthy eating habits, along with good control of blood glucose, are the basic goals, and several good dietary methods are available to meet them.
Protein should provide 12 - 20% of daily calories, although this may vary depending on a patient’s individual health requirements.
To avoid hypoglycemia, patients should inject insulin in sites away from the muscles they use the most during exercise. Before exercising, avoid alcohol and if possible certain drugs, including beta blockers, which make it difficult to recognize symptoms of hypoglycemia.
Insulin-dependent athletes may need to decrease insulin doses or take in more carbohydrates, especially in the form of pre-exercise snacks. Patients with diabetes and high blood pressure need an individualized approach to drug treatment, based on their particular health profile. Angiotensin-converting enzyme (ACE) inhibitors reduce the production of angiotensin, a chemical that causes arteries to narrow. Calcium-channel blockers (CCBs) decrease the contractions of the heart and widen blood vessels. Nearly all patients who have diabetes and high blood pressure should take an ACE inhibitor (or ARB) as part of their regimen for treating their hypertension. The primary safety concern with statins has involved myopathy, an uncommon condition that can cause muscle damage and, in some cases, muscle and joint pain. Although lowering LDL cholesterol is beneficial, statins are not as effective as other medications -- such as niacin and fibrates -- in addressing HDL and triglyceride imbalances. Fibrates, such as gemfibrozil (Lopid) and fenofibrate (Tricor), are usually the second choice after statins. In virtually all cases, wound care requires debridement, which is the removal of injured tissue until only healthy tissue remains. Administering hyperbaric oxygen (oxygen given at high pressure) is showing promise in promoting healing. Total-contact casting (TCC) uses a cast that is designed to match the exact contour of the foot and distribute weight along the entire length of the foot. Nonprescription analgesics, such as aspirin, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs).
Topical medications, particularly capsaicin (the active ingredient in hot peppers), are applied to the skin to relieve minor local pain.
Tricyclic antidepressants, such as amitriptyline (Elavil) or doxepin (Sinequan), are effective in reducing pain from neuropathy in many patients. Duloxetine (Cymbalta), a serotonin and norepinephrine reuptake inhibitor, is approved for treatment of pain associated with diabetic peripheral neuropathy. Anti-seizure drugs used for peripheral neuropathy pain relief include gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol), and valproate (Depakote). Although not proven to be beneficial, patients may also try transcutaneous electrostimulation (TENS), a treatment that involves administering mild electrical pulses to painful areas. Tight control of blood sugar and blood pressure is essential for preventing the onset of kidney disease.
ACE inhibitors are the best class of blood pressure medications for delaying kidney disease and slowing disease progression in patients with type 1 diabetes.
For patients with diabetes who have microalbuminuria, the American Diabetes Association strongly recommends ACE inhibitors or ARBs. A doctor may recommend a low-protein diet for patients whose kidney disease is progressing despite tight blood sugar and blood pressure control.
Intensive blood sugar control during pregnancy can reduce the risk for health complications for both mothers and babies.
To prevent birth defects that affect the heart and nervous system, women with diabetes should take a higher dose of folic acid from the time of conception up to week 12 of pregnancy.
Women with diabetes should have an eye examination during pregnancy and up to a year afterward. Many patients experience significant weight gain from insulin administration, which may have adverse effects on blood pressure and cholesterol levels. A diet plan that compensates for insulin administration and supplies healthy foods is extremely important. The goal of intensive insulin therapy is to keep blood glucose levels as close to normal as possible. Table 1:Glucose Goals for Patients with Diabetes Standard insulin therapy usually consists of one or two daily insulin injections, one daily blood sugar test, and visits to the health care team every 3 months. Insulin requirements vary depending on many non-nutritional situations during the day, including exercise and sleep. The patient must also maintain a good diet plan and should visit the health care team of doctors, nurses, and dietitians once a month.
Because of the higher risk for hypoglycemia in children, doctors recommend that intensive treatment be used very cautiously in children under 13 and not at all in very young children. The catheter at the end of the insulin pump is inserted through a needle into the abdominal fat of a person with diabetes. Learning to use the pump can be complicated, although over time most patients find the devices are fairly easy to use. Insulin pumps are more expensive than insulin shots and occasionally have some complications, such as blockage in the device or skin irritation at the infusion site. Pramlintide (Symlin) is a new type of injectable drug that can help control postprandial hyperglycemia, the sudden increase in blood sugar after a meal. Both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) are of concern for patients who take insulin.
Different goals may be required for specific individuals, including pregnant women, very old and very young people, and those with accompanying serious medical conditions. Home monitors are about 10 - 15% less accurate than laboratory monitors, and many do not meet the standards of the American Diabetes Association. To monitor the amount of glucose within the blood a person with diabetes should test their blood regularly.
Continuous glucose monitoring systems (CGMS) use a needle-like sensor inserted under the skin of the abdomen to monitor glucose levels every 5 minutes. GlucoWatch is a battery-powered wristwatch-like device that measures glucose by sending tiny electric currents through the skin, a technique called reverse iontophoresis. Hemoglobin A1c (also called HbA1c , HA1c, or A1C) is measured periodically every 2 - 3 months, or at least twice a year, to determine the average blood-sugar level over the lifespan of the red blood cell. Some research has suggested that children (particularly thin children) are at higher risk for hypoglycemia because the injection goes into muscle tissue. Patients who intensively control their blood sugar should monitor blood levels as often as possible, four times or more per day. In adults, it is particularly critical to monitor blood glucose levels before driving, when hypoglycemia can be very hazardous. Patients who are at risk for hypoglycemia should always carry hard candy, juice, sugar packets, or commercially available glucose substitutes.
If the patient is helpless (but not unconscious), family or friends should administer three to five pieces of hard candy, two to three packets of sugar, half a cup (four ounces) of fruit juice, or a commercially available glucose solution. If there is inadequate response within 15 minutes, the patient should receive additional sugar by mouth and may need emergency medical treatment, possibly including an intravenous glucose solution. Family members and friends can learn to inject glucagon, a hormone, which, in contrast to insulin, raises blood glucose. Patients with type 1 diabetes should always wear a medical alert ID bracelet or necklace that states that they have diabetes and take insulin. Patients should inspect their feet daily and watch for changes in color or texture, odor, and firm or hardened areas, which may indicate infection and potential ulcers.
When washing the feet, the water should be warm (not hot) and the feet and areas between the toes should be thoroughly dried afterward.
Gently use pumice to remove corns and calluses (patients should not use medicated pads or try to shave the corns or calluses themselves).
Intensive control of blood glucose and keeping glycosylated hemoglobin (HbA1c) levels below 7%. Diabetic ketoacidosis (DKA) is a life-threatening complication caused by insulin deficiency.
The process is usually triggered in insulin-deficient patients by a stressful event, most often pneumonia or urinary tract infections. Severely low insulin levels cause excessive amounts of glucose in the bloodstream (hyperglycemia). These fatty acids are converted into chemicals called ketone bodies, which are toxic at high levels. Cerebral edema, or brain swelling, is a rare but very dangerous complication that occurs in 1% of ketoacidosis cases and results in coma, brain damage, or death in many cases.
Other serious complications from DKA include aspiration pneumonia and adult respiratory distress syndrome.
If the condition persists, coma and eventually death may occur, although over the past 20 years, death from DKA has decreased to about 2% of all cases. Life-saving treatment uses rapid replacement of fluids with a salt (saline) solution followed by low-dose insulin and potassium replacement. Patients with type 1 diabetes are 10 times more at risk for heart disease than healthy patients. Both type 1 and 2 diabetes accelerate the progression of atherosclerosis (hardening of the arteries). In type 1 diabetes, high blood pressure (hypertension) usually develops if the kidneys become damaged.
Impaired nerve function (neuropathy) associated with diabetes also causes heart abnormalities. Atherosclerosis is a disease of the arteries in which fatty material is deposited in the vessel wall, resulting in narrowing and eventual impairment of blood flow.
Diabetic nephropathy, the leading cause of end-stage renal disease (ESRD), occurs in about 20 - 40% of patients with diabetes. Diabetes is responsible for more than half of all lower limb amputations performed in the U.S.
People with diabetes who are overweight, smokers, and have a long history of diabetes tend to be at most risk. In general, foot ulcers develop from infections, such as those resulting from blood vessel injury. Charcot foot is initially treated with strict immobilization of the foot and ankle; some centers use a cast that allows the patient to move and still protects the foot. Diabetes accounts for thousands of new cases of blindness annually and is the leading cause of new cases of blindness in adults ages 20 - 74.
The early and more common type of this disorder is called nonproliferative or background retinopathy. If the capillaries become blocked and blood flow is cut off, soft, "woolly" areas may develop in the retina's nerve layer.
Type 1 diabetes is associated with a slightly reduced bone density, putting patients at risk for osteoporosis and possibly fractures. Women with diabetes should also be aware that certain types of medication can affect their blood glucose levels. It is also important for women to closely monitor their blood sugar levels during pregnancy.
Major advances in islet-cell transplantation are allowing more patients to come off insulin or reduce their use of it.
As soon as there are sufficient numbers of islets available for transplantation, the patient is given intravenous antibiotics and oral vitamins E, B6, and A. Once the islets have been isolated, they are injected directly in a major vein in the patient's liver. Specific drugs, such as tacrolimus, sirolimus, or rapamycin (Rapamume), are used to suppress the immune system. This procedure is still investigational but has helped some patients with severe type 1 diabetes to become free of insulin injections. A major obstacle for the islet cell transplantation is the need for two or more donor pancreases to supply sufficient islet cells. Whole pancreas transplants and double transplants of pancreases and kidneys are proving to have a good long-term success rate for some patients with type 1 diabetes. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, Tamborlane WV, Beck RW, Bode BW, Buckingham B, Chase HP, et al. SEARCH for Diabetes in Youth Study Group, Liese AD, D'Agostino RB, Hamman RF, Kilgo PD, Lawrence JM, et al. Writing Group for the SEARCH for Diabetes in Youth Study Group , Dabelea D, Bell RA, D'Agostino RB, Imperatore G, Johansen JM, et al. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Seeing as today is World Diabetes Day, I thought this would be the perfect time to share my latest adjustment to our diabetes care and organization. I previously posted a series of printables that I still use some of but have recently decided to simplify how my son and our family log is blood readings and insulin doses, medications and any notes or important information. A great tip for anyone monitoring their child's blood levels is use a colour code to see patterns in blood sugar levels. On another note, when we were at our last clinic visit I mentioned that our insulin pens felt like they were breaking.
Self-monitoring of Blood Glucose or SMBG is considered to be an important part in diabetes management. IDF Diabetes Atlas (Fifth Edition), 2011 estimates that India has more than 60 million people diagnosed with diabetes. The number is expected to grow more than double by 2030.
Dr Roshani Sanghani, Consultant Endocrinologist at P D Hinduja National Hospital says, “Monitoring at home is very important.
Roy says people with diabetes need to monitor at regular intervals as suggested by their physicians. Sidhartha Roy refuses any such possibility. “SMBG is a structured way of monitoring your blood glucose. The decision of recommending SMBG for individuals in type 2 group may largely be determined by personal preferences, cost and individual and healthcare system resources. As published in IDF Guideline for type 2 diabetes 2012, studies performed among insulin-treated individuals with type 2 diabetes suggest that SMBG is required to titrate the insulin dose while avoiding hypoglycaemia. About UseHEALTH, as an online and print platform, elegantly guides the healthcare stakeholders through the trajectory of healthcare that witnesses fascinating changes on a daily basis due to increased technological intervention and other structural changes to create a ‘community of practice’ of healthcare stakeholders.
Foods that are high in sodium, saturated fats, cholesterol, and trans fat can elevate your risk for heart disease and stroke.
Try replacing the meat on your plate with omega-3 fatty acid-rich cold-water fish such as salmon, mackerel, and herring. As the fastest growing consumer health information site a€” with 65 million monthly visitors a€” Healthlinea€™s mission is to be your most trusted ally in your pursuit of health and well-being. Two major trends in healthcare are the shift toward wireless devices and the use of incentives to promote healthy living.
One of the more controversial issues in diabetes today is the use of the A1c test to diagnose diabetes instead of the current standards of fasting plasma glucose (FPG – measures blood glucose after a 12-14 hour fast) or oral glucose tolerance tests (OGTT – blood glucose is measured after the patient consumes a standardized amount of glucose). In mid-2009, a committee of diabetes experts from around the world jointly produced a series of guidelines for diagnosing diabetes using the A1c test.
Possibly one of the most highly talked about sessions at the 2009 ADA Scientific Sessions was given by Dr. Since A1c can be used to approximate a person’s average glucose level, some have suggested that A1c be expressed in terms of an average blood glucose level rather than as a percentage.
Plugging the meter into my computer was also the easiest encounter with diabetes software to date.
Like we said, we're head over heels for the improvements that this meter is showing us – such as the lack of cords and ease of data analysis (an easy-on-the-eyes meter doesn’t hurt as well – the device feels much like a consumer device). We were fortunate to sit down with this year’s American Association of Diabetes Educators (AADE) Diabetes Educator of the Year, Mary M. Mary: The inpatient experience is when the person with diabetes is the most vulnerable, so I think that it is important to have somebody with expertise in diabetes to help patients during their hospital stay.
Mary: For years, blood glucose levels were ignored and the glycemic goal was to get the patient home without severe hypoglycemia during their hospital stay. Mary: Currently in the hospital setting, we have hospital glucose meters, but we do not have continuous glucose sensors.
Mary: I think the patient needs to be as informed as possible about their condition and how diabetes is impacting their current hospital stay.
Our glucose strips are stored at a regulated temperature and the meter is assessed for accuracy. Mary: Patients who are going to have surgery should have a recent hemoglobin A1c test done within one month of their surgery. Mary: Well, patients come into the inpatient setting and are not expecting to have to go home on insulin, so the news of needing to go home on insulin comes as a shock to patients.
I think diabetes educators are dedicated individuals who are striving to improve the lives of patients with diabetes. Mary: I think diabetes educators are dedicated individuals who are striving to improve the lives of patients with diabetes. I know that some kids use the CGMs, but that’s pretty rare – it can be too much technology, too much hardware for a child. In many ways, Garrett’s day revolves around blood checks: before breakfast, and then – with the help of his school nurse – before morning snack, lunch, and afternoon snack, and then before dinner and then before evening snack.
My heart goes out to those parents, 30, 50, 70 years ago, who would put their diabetic child to bed and just hope their precious bundle would wake up in the morning.
Nowadays, many parents set their alarm clocks for overnight checks, but I’m a night owl, typically at my computer long after everyone else has gone to sleep.
At least he took a shower before bed tonight, so he has that freshly scrubbed fragrance that reminds me that sometimes boys do get clean. Going on vacation requires planning and packing for everyone, but for a person with diabetes, there’s a bit more in the carry-on than toiletries and a paperback. I packed a modest (read: big enough to hold a reclining chair) suitcase and a carry-on bag that was stuffed to the gills with diabetes goodies. I proceeded to try almost all of the batteries in my suitcase, and they all refused to work. Aside from the “what to pack” aspect of traveling is actually being a “diabetic in the wild.” Since my husband and I were off on a tropical vacation, there was plenty of sand, sun, and salt water to contend with. Also, an extra t-shirt on hand is a very handy item for covering up your insulin pump or CGM while you’re laying out on the beach. A little preparation, a little “winging it,” and a good sense of humor help me enjoy the experience of traveling. We received quite a few questions from readers since the debut of our TalkBack column in the previous issue of diaTribe. I just found two types, but will not have a chance to get them and try them out before leaving. From what I see so far, they basically require a finger-stick and then you mail the dried blood sample back to a lab. The home A1c tests are generally accurate and most have NGSP (National Glycohemoglobin Standardization Program) accreditation—that is, they are reasonably accurate and can produce results with values equivalent to the DCCT (a landmark trial investigating the relationship between A1c and diabetes complications).
They are less accurate and precise than the expensive laboratory instruments found in a reference laboratory, but accurate enough and about as accurate as the tests the doctors do in their own offices.
This column is not intended as a replacement for personal medical advice, and you should always consult your doctor before making changes to your treatment or management practices. Our frequent contributor, Dana Lewis, alerted us to this handy tool for recording blood glucose numbers during the day. Janis Roszler was named the 2008 American Association of Diabetes Educators (AADE) Diabetes Educator of the year and is particularly enthusiastic about bringing worldwide awareness and education to people living with diabetes. Janis: As diabetes educators, we ask patients to engage in self-care behaviors that are necessary to improve their health. Janis: One reason that I wrote my second book, “Diabetes on Your OWN Terms,” is because I think that patients receive the wrong messages. Management hyperglycemia type 2 diabetes: patient, Glycemic management in type 2 diabetes mellitus has become increasingly complex and to some extent controversial with a widening array of pharmacological agents. Management persistent hyperglycemia type 2 diabetes, Initial treatment of patients with type 2 diabetes mellitus includes education with emphasis on lifestyle changes including diet exercise and weight reduction when.


BackgroundThe two major forms of diabetes are type 1, previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, and type 2, previously called non-insulin-dependent diabetes mellitus (NIDDM) or maturity-onset diabetes. Here, insulin and other hormones direct whether glucose will be burned for energy or stored for future use. In addition to secreting digestive enzymes, the pancreas secretes the hormones insulin and glucagon into the bloodstream.
In type 2 diabetes, the body does not respond properly to insulin, a condition known as insulin resistance.
It is unknown what first starts this cascade of immune events, but evidence suggests that both a genetic predisposition and environmental factors, such as a viral infection, are involved. The IDDM1 region contains the HLA genes that encode proteins called major histocompatibility complex. The odds of inheriting the disease are only 10% if a first-degree relative has diabetes, and even in identical twins, one twin has only a 33% chance of having type 1 diabetes if the other has it. Over the past 40 years, a major increase in the incidence of type 1 diabetes has been reported in certain European countries, and the incidence has tripled in the U.S. Certain drugs can also cause temporary diabetes, including corticosteroids, beta blockers, and phenytoin. SymptomsThe process that destroys the insulin-producing beta cells can be long and insidious.
Widespread screening of patients to identify those at higher risk for diabetes type 1 is not recommended. The oral glucose tolerance test (OGTT) is more complex than the FPG and may overdiagnose diabetes in people who do not have it. This test examines blood levels of glycosylated hemoglobin, also known as hemoglobin A1c (HbA1c).
If a patient with diabetes has elevated blood glucose on many days, more blood glucose molecules will stick to the hemoglobin molecule.
These antibodies are referred to as autoantibodies because they attack the body''s own cells -- not a foreign invader.
The earliest manifestation of kidney disease is microalbuminuria, in which tiny amounts (30 - 300 mg per day) of protein called albumin are found in the urine. The American Diabetes Association recommends that patients with type 1 diabetes have an annual comprehensive eye exam, with dilation, to check for signs of retina disease (retinopathy). All patients should be screened for nerve damage (neuropathy), including a comprehensive foot exam. People with type 1 diabetes must coordinate calorie intake with medication or insulin administration, exercise, and other variables to control blood glucose levels. People with diabetes, whether type 1 or 2, are at risk for a number of medical complications, including heart and kidney disease.
It increases sensitivity to insulin, lowers blood pressure, improves cholesterol levels, and decreases body fat. These include weight reduction (when needed), following the Dietary Approaches to Stop Hypertension (DASH) diet, smoking cessation, limiting alcohol intake, and limiting salt intake to no more than 1,500 mg of sodium per day. Strict control of blood pressure is critical for preventing complications of diabetes and has proven to improve survival rates. They include atorvastatin (Lipitor), lovastatin (Mevacor and generics), pravastatin (Pravachol), simvastatin (Zocor and generics), fluvastatin (Lescol), and rosuvastatin (Crestor). Niacin has the most favorable effect on raising HDL and lowering triglycerides of all the cholesterol drugs.
Taking a daily aspirin reduces the risk for blood clotting and may help protect against heart attacks.
Fortunately, severe and even moderate vision loss is largely preventable with tight control of blood glucose levels.
Patients with severe diabetic retinopathy or macular edema (swelling of the retina) should see an eye specialist who is experienced in the management and treatment of diabetic retinopathy. In some cases, hospitalization and intravenous antibiotics for up to 28 days may be needed for severe foot ulcers.
Debridement may be accomplished using chemical (enzymes), surgical, or mechanical (irrigation) means.
Felted foam uses a multi-layered foam pad over the bottom of the foot with an opening over the ulcer. It is generally reserved for patients with severe, full thickness diabetic foot ulcers that have not responded to other treatments, particularly when gangrene or an abscess is present. Alternative treatments -- such as hypnosis, biofeedback, relaxation techniques, and acupuncture -- have also been reported to help some patients manage pain.
Neuropathy also impacts other functions, and treatments are needed to reduce their effects.
Studies indicate that phosphodiesterase type 5 (PDE-5) drugs, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis), are safe and effective, at least in the short term, for many patients with diabetes. Strict control of these two conditions produces a reduction in new cases of nephropathy and a delay in progression of the disease. Microalbuminuria is an accumulation of protein in the blood, which can signal the onset of kidney disease (nephropathy). Protein-restricted diets can help slow disease progression and delay the onset of end-stage renal disease (kidney failure).
Doctors recommend that pregnant women with pre-existing diabetes monitor their blood sugar levels up to 8 times daily.
TreatmentInsulin is essential for strict control of blood glucose levels in type 1 diabetes. It is important to manage heart disease risk factors that might develop as a result of insulin treatment. The basal component of the treatment attempts to provide a steady amount of background insulin throughout the day. Meals require a boost (a bolus) of insulin to regulate the sudden rise in glucose levels after a meal. Injections of insulin under the skin ensure that it is absorbed slowly by the body for a long-lasting effect. Insulin is available in several forms, including: standard, intermediate, long-acting, and rapid-acting. Insulin lispro (Humalog) and insulin aspart (Novo Rapid, Novolog) lower blood sugar very quickly, usually within 5 minutes after injection. Regular insulin begins to act 30 minutes after injection, reaches its peak at 2 - 4 hours, and lasts about 6 hours.
Regimens generally include combinations of short and longer-acting insulins to help match the natural cycle.
An insulin pump can improve blood glucose control and quality of life with fewer hypoglycemic episodes than multiple injections. Some are worn externally and are programmed to deliver insulin through a catheter in the skin or the abdomen.
Studies indicate that even very young children (ages 2 - 7 years) can successfully use insulin pumps and that the pumps may help improve blood sugar control. Dosage instructions are entered into the pump's small computer, and the appropriate amount of insulin is then injected into the body in a calculated, controlled manner. In spite of early reports of a higher risk for ketoacidosis with pumps, more recent studies have found no higher risk. Pramlintide is injected before meals and can help lower blood sugar levels in the 3 hours after meals.
Side effects may include nausea, vomiting, abdominal pain, headache, fatigue, and dizziness. Most doctors believe, however, that they are accurate enough to indicate when blood sugar is too low. While fingerprick self-testing provides information on blood glucose for that day, the HbA1c test shows how well blood sugar has been controlled over the period of several months. These tests should always be performed during illness or stressful situations, when diabetes is likely to go out of control.
Pinching the skin so that only fat (and not muscle) tissue is gathered or using shorter needles may help.
For example, taking a fast-acting insulin (insulin lispro) before the evening meal may be particularly helpful in preventing hypoglycemia at bedtime or during the night.
This approach can help prevent complications due to vascular (blood vessel) abnormalities and nerve damage (neuropathy) that can cause major damage to organs, including the eyes, kidneys, and heart. Blood glucose control helps the heart, but it is also very important that people with diabetes control blood pressure, cholesterol levels, and other factors associated with heart disease. Other triggers include alcohol abuse, physical injury, pulmonary embolism, heart attacks, or other illnesses. Among young patients, the youngest children and boys of any age are at higher risk for hypoglycemia. Hypoglycemia unawareness is a condition in which people become accustomed to hypoglycemic symptoms. Mild symptoms usually occur at moderately low and easily correctable levels of blood glucose. Heart attacks account for 60% of deaths in patients with diabetes, while strokes account for 25% of such deaths. Severely restricted blood flow in the arteries to the heart muscle leads to symptoms such as chest pain.
With this condition, the tiny filters in the kidney (called glomeruli) become damaged and leak protein into the urine.
Patients with ESRD have 13 times the risk of death compared to other patients with type 1 diabetes.
It is a common complication that affects nearly half of people with type 1 or type 2 diabetes after 25 years. Studies show that tight control of blood glucose levels delays the onset and slows progression of neuropathy.
People who have the disease for more than 20 years and are insulin-dependent are at the highest risk.
Numbness from nerve damage, which is common in diabetes, compounds the danger since the patient may not be aware of injuries. Charcot foot or Charcot joint (medically referred to as neuropathic arthropathy) occurs in up to 2.5% of people with diabetes.
When the acute phase has passed, patients usually need lifelong protection of the foot using a brace initially and custom footwear.
Patients with no signs of retinal damage or low risk factors for retinopathy may only require screening every 2 - 3 years.
People with diabetes face a higher risk for influenza and its complications, including pneumonia, possibly because the disorder neutralizes the effects of protective proteins on the surface of the lungs. Women with diabetes face a significantly higher risk for urinary tract infections, which are likely to be more complicated and difficult to treat than in the general population. Depression, in turn, may increase the risk for hyperglycemia and complications of diabetes.
The changes in estrogen and other hormonal levels that occur during perimenopause can cause major fluctuations in blood glucose levels. Up to a third of young women with type 1 diabetes have eating disorders and under-use insulin to lose weight.
Two or three organs are usually needed in order to supply enough islet cells to have any effect on insulin production.
This generally requires multiple pancreas donors in order to achieve complete independence from insulin therapy. However, many of these insulin-independent patients needed to resume insulin injections within 2 years. Unfortunately, there are not enough pancreases available to make this procedure feasible for even 1% of patients. The operations help to prevent further kidney damage, and long-term studies indicate that they may even eventually reverse some existing damage. Kidney damage caused by diabetes most often involves thickening and hardening of the internal kidney structures.
Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes.
The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study.
Autologous nonmyeloablative hematopoietic stem cell transplantation in newly diagnosed type 1 diabetes mellitus.
A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Now he relies on blood tests and insulin injections at least 4 times a day just to stay alive.We are raising money to help fund Diabetes Research so one day there might be a cure. While its utility in insulin-requiring diabetes is proven, the role of monitoring in non-insulin-requiring type 2 diabetes is highly debated. With 63 million people diagnosed with diabetes and around 32 million with undiagnosed diabetes, India is a country with the largest diabetic population, second only to China. Structured self-monitoring can help patients see a pattern that they themselves as well as their healthcare professional can effectively use as a part of ongoing diabetes management. Every diabetic needs to know their control on sugar frequently. It also helps doctors to adjust medications accordingly. The monitoring throws out data points of hyperglycaemia and hypoglycaemia at different times like fasting, postprandial, before sleep. Sidhartha Roy attributes this to the fact that India being a self–pay market that also results in lower percentage of usage. We still don’t have the culture of specific diabetic health educators who will spread the awareness”, says Dr Pahuja. Any test which is used for diagnosis should give  consistent results and SMBG devices are still inconsistent in that sense”, says Dr Pahuja. Diagnostic tests are for more precise testing. SMBG devices readings may show slight variations but these devices are very helpful to check sugar at home.
It will help us to plot graphs, find trends and learn more about diabetes,” says Dr Sanghani while talking about the future development she wants to see in SMBG devices.
SMBG may help type 2 diabetes patients who are on insulin or sulphonylurea drugs because the information about a patient’s glucose level is useful to refine and adjust insulin dosages, resulting in an improved glycemic control, says a study published in ADA Diabetes Care. Both of which will support, guide, and inspire you toward the best possible health outcomes for you and your family. Nathan made the case that A1c has not been included as a standard test because the early laboratory methods for measuring it were inaccurate.
Using a mathematical formula, the A1c percentage can be converted to an estimated average blood glucose level (for the past three months), abbreviated to eAG.
Bloomgarden concluded that, although A1c is an appealing tool for monitoring long-term glycemia, it has a fundamental problem in that its relationship with blood sugar can be different between individuals. Most meters and pieces of diabetes technology are incremental improvements in quality of life for people with diabetes, so it's hard to get excited about yet another “new” meter. It's rechargeable, so you can plug it in for a few minutes or overnight while you're sleeping – the familiar wall charger is also included. Once removing the cap, the meter can be stuck into any computer port that accepts USB devices. Happily, I didn't have to download anything – once you open the USB icon that shows up on your screen, it immediately launches the software and synchronizes your data onto the program without having to push a single button. You can choose which “reports” to share, such as a pie or bar graph showing above, below, and within-range results.
Sullivan RN, MSN, C-ANP, CDE (University of San Francisco Medical Center, San Francisco) for a frank discussion about the importance of diabetes educators and the state of diabetes therapy—past, present, and future.
There's been a lot of controversy lately over how to correctly manage blood glucose in hospitals. But with the publication of the Van den Berghe study in 2001 (Leuven 1 [published in the New England Journal of Medicine in 2001]), hospitals began to focus on inpatient glycemic control. However, other trials were not able to replicate Van den Berghe’s findings without causing significant hypoglycemia. Throughout the diabetes community and beyond, there seems to be the implication that tight control really didn't have that much of a difference in the patient’s outcome. I think that it is important for hospitals to assess their hypoglycemia rates with their insulin delivery and to modify their insulin delivery to reduce hypoglycemia.
So the current continuous glucose monitoring technology you don't think would be sufficient in the hospital setting? While I do support patients doing their own diabetes care as much as possible—they can keep their own glucose meter at their bedside—unfortunately, we can't rely on that data for administering insulin. Do you try to educate both the patient and the family while they're in the hospital in order to, maybe be able to avoid future hospitalizations? They should bring to the hospital a current list of their medications and dosages, a glucose meter, and if on an insulin pump extra reservoirs, infusion sets, and pump batteries. Focusing on how they feel, in my experience, is a very effective strategy when starting patients on insulin. I think if the various insulin pen companies could make the cost of the insulin pen the same price as it is for a vial and syringe, or better yet, even less, then I think we would have more pen usage here in the United States. I think anything we can do to change the hearts and minds of people about diabetes, the better the care will be for patients with diabetes.
As parents, our biggest fear is a nighttime low – his blood sugar crashes while he’s asleep, and he doesn’t wake up and doesn’t make any noise that would alert my wife or me. Continuous glucose monitors are designed to alarm if your blood sugar falls below a certain level, and the alarms are loud enough to wake the whole house.
Future generations of CGMs will be simpler and more integrated into pumps, so perhaps their use by children will be much greater.
That Garrett, and many other type 1 kids, subject themselves to that routine and rarely complain is a miracle, nothing less. The coaches are great, but we would never expect them to tend to Garrett’s medical needs, so I attend virtually every game and practice with his meter and a juice box. So I don’t mind doing the checks, though this isn’t exactly the routine I would sign up for. If he’s high (over 180), I’ll correct him by pressing a couple of buttons on his insulin pump. Maybe it was the extra cheese on his pizza at dinner, or maybe I miscalculated his carbs at snack, or maybe the recent lowering of his basal rate went too far, or maybe this is the metabolic life of an 8-year-old boy – chaotic, random, inscrutable. Last month, my husband and I celebrated our first wedding anniversary by flying to Miami and taking a cruise to the Bahamas. Why I'm always toting a bag that makes my shoulders ache after a few hours of carrying it on my shoulder. For me, I found a few useful things to bring along on the beach (aside from sunscreen for my pasty Irish skin). If you are like me and you stay attached to your pump while you lay on the blanket, make sure you keep it covered. SugarDash is a mini-logbook that you can download from the internet, print out and fold, and it has enough spaces to enter 19 different glucose values each day for a week. To start our conversation, could you give us some background on how you got involved in diabetes?
Accessibility to educators is still difficult, so can you discuss access to education and what can be done to improve it? I sense a frustration in people starting diabetes treatment, and they question why things are not moving faster. The release of insulin into the blood lowers the level of blood glucose (simple sugars from food) by enhancing glucose to enter the body cells, where it is metabolized. After delivery, blood sugar (glucose) levels generally return to normal, although 25% of these women develop type 2 diabetes within 15 years. Children are more likely to inherit the disease from a father with type 1 diabetes than from a mother with the disorder. Epidemics of Coxsackie virus, as well as mumps and congenital rubella, have been associated with incidence of type 1 diabetes. At the point when insulin production bottoms out, however, type 1 diabetes usually appears suddenly and progresses quickly. Some doctors recommend it as a follow-up after FPG, if the latter test results are normal but the patient has symptoms or risk factors of diabetes. Blood tests for these autoantibodies can help differentiate between type 1 and type 2 diabetes. Testing should be performed yearly and perhaps every other year for patients with good lipid control and no evidence of heart disease. Microalbuminuria is also a marker for other complications involving blood vessel abnormalities, including heart attack and stroke. Patients who lose sensation in their feet should have a foot exam every 3 - 6 months to check for ulcers or infections. Patients should meet with a professional dietitian to plan an individualized diet within the general guidelines that takes into consideration their own health needs. On the other hand, studies suggest that more than one-third of women with diabetes omit or underuse insulin in order to lose weight. People with diabetes and risk factors for myopathy should be monitored for muscle symptoms. Combining a statin with one of these drugs may be helpful for people with diabetes who have heart disease, low HDL, and near-normal LDL levels. However, some patients who take high-dose niacin can experience increased blood glucose levels. It can help relieve pain but has significant side effects, including nausea, constipation, and headache. Unfortunately, tricyclics may cause heart rhythm problems, so patients at risk need to be monitored carefully. If diabetes affects the nerves in the autonomic nervous system, then abnormalities of blood pressure control and bowel and bladder function may occur. Typical side effects are minimal but may include headache, flushing, and upper respiratory tract and flu-like symptoms. However, patients with end-stage renal disease who are on dialysis generally need higher amounts of protein.
Patients on dialysis usually need injections of erythropoiesis-stimulating drugs to increase red blood cell counts and control anemia.
This includes checking your blood glucose before each meal, 1 - 2 hours after a meal, at bedtime, and possibly during the night. Tight blood glucose control is the best way to prevent major complications in type 1 diabetes, including those that affect the kidneys, eyes, nerve pathways, and blood vessels. Insulin glargine matches parts of natural insulin and maintains stable activity for more than 24 hours.
For example, one approach in patients who are intensively controlling their glucose levels uses 3 injections of insulin, which includes a mixture of regular insulin and NPH at dinner. The patient and doctor must determine the amount of insulin used -- it is not automatically calculated. Pramlintide is used in addition to insulin for patients who take insulin regularly but still need better blood sugar control. Patients with type 1 diabetes have an increased risk of severe low blood sugar (hypoglycemia) that may occur within 3 hours following a pramlintide injection. The patient should also undergo yearly urine tests for microalbuminuria (small amounts of protein in the urine), a risk factor for future kidney disease. It may also occur in a person with type 1 diabetes who is not consistent with insulin therapy, or who has an acute illness or infection that makes their diabetes difficult to control.
The most serious consequences of neuropathy occur in the legs and feet and pose a risk for ulcers and, in unusually severe cases, amputation. Patients with diabetes should be aware of other warning signs of a heart attack, including sudden fatigue, sweating, shortness of breath, nausea, and vomiting.


The consequences of both poor circulation and peripheral neuropathy make this a common and serious problem for all patients with diabetes. About 85% of amputations start with foot ulcers, which develop in about 12% of people with diabetes. Related conditions that put people at risk include peripheral neuropathy, peripheral artery disease, foot deformities, and a history of ulcers.
Early changes appear similar to an infection, with the foot becoming swollen, red, and warm. People with diabetes are also at higher risk for developing cataracts and certain types of glaucoma. The two primary abnormalities that occur are a weakening of the blood vessels in the retina and the obstruction in the capillaries -- probably from very tiny blood clots. Patients beginning a new or vigorous exercise program should have their eyes examined, as well as all patients planning pregnancy. Everyone with diabetes should have annual influenza vaccinations and a vaccination against pneumococcal pneumonia. In terms of sexual health, diabetes may cause decreased vaginal lubrication, which can lead to pain or discomfort during intercourse. Long-term use (more than 2 years) of birth control pills may increase the risk of health complications. Studies indicate that high blood sugar levels (hyperglycemia) can affect the developing fetus during the critical first 6 weeks of organ development. Women with diabetes also face an increased risk of premature menopause, which can lead to higher risk of heart disease. Adolescents with diabetes are at higher risk than adults for ketoacidosis resulting from noncompliance. Researchers are continuing to work on refining the Edmonton protocol so that its benefits can be more sustainable and long lasting. Researchers are looking for alternative approaches including the use of umbilical cord cells, embryonic or adult stem cells, bone marrow transplantation, and other types of cellular therapies. There is some evidence that heart disease and diabetic neuropathy improve after pancreas transplantation (although not retinopathy).
However, if they are taking tablets for sugar-control and sugar goes out of control, they need to check. It can under-estimate or over-estimate when sugars are extremely low or high”, adds Dr Pahuja. These might include people recently diagnosed with diabetes, those with more erratic lifestyles, people having problems of hypoglycaemia  and those particularly keen to tighten their blood glucose control. The impact of monitoring on patient wellbeing must also be considered as some studies suggest adverse psychological effects. Foods rich in good fatsa€”monounsaturated and polyunsaturated fat a€” can help lower cholesterol levels, according to the Harvard School of Public Health. Participants with this program, which is organized through an employer or insurance provider, submit blood glucose readings to the inTouch website via their cell phone.
In short, the A1c test allows physicians to approximate a person’s average blood glucose over the past three months. In his talk, he defended the use of A1c for both diagnosis and long-term monitoring of diabetes. An expert committee found in 2003 that the A1c test was not yet accurate enough for clinical diagnosis, but Dr. In particular, he noted that individual differences can alter how A1c correlates with average blood sugar.
Thus, he believes that it is too early to use A1c as a sole measure for diagnosing diabetes, and that interpretations such as eAG should be used with caution. But this time I was pleasantly surprised – I’ve seldom been so excited to use a meter and upload the data as I was with the Bayer Contour USB. It begins charging, and the screen shows the battery level and a warning not to test while the device is plugged in. Once the software appears, you can customize the length of time you want it to show (past three months, past two weeks, etc) and review. My favorite reports are the “standard day” and “standard week,” which standardizes your test results for one day or one week.
In this interview, Mary discusses how she got involved with diabetes, nuances in treating patients with diabetes in hospitals, technology, education, and transitioning patients to more advanced care. Now the results of an additional study in patients, the NICE-SUGAR study, has been published. And a lot of times you can't even use their fingers for a fingerstick because of other complications. In-patients have problems with rapid fluid shifts so there may be problems with accurate sensing by the sensor. I asked him to have his wife bring the meter in so that I could assess the meter’s accuracy and thank God I did because his strips were expired by a year! We can only use our hospital insulin because we need to know how the insulin was stored and when the vial was opened. There is a negative connotation to having to use a syringe, plus patients have difficulty seeing the numbers on the syringe. And of course, it would be fabulous if we had an accurate, automatic closed-loop insulin delivery system for patients. False alarms can be quite aggravating, and whoever is sleeping with you may be looking for a new partner if the thing keeps going off in the wee hours of the morning. Garrett uses the OmniPod insulin pump, but we still check his blood sugar the old-fashioned way, with a finger prick and a meter. Before then, maintaining near-normal blood sugars with urine tests was virtually impossible.
If he’s low, I’ll prop him up and put a juice box to his mouth, and he’ll sip from the straw without opening his eyes. Preparing for a day at work keeps my purse stocked with diabetes supplies, but traveling by air and then by sea for a week is a whole different carry-on entirely. Why when someone says, "Oh, do you have a pen?" or "Anyone have some gum?" or "Hey, would anyone happen to have grape flavored glucose tabs?" - I'm their go-to girl. Prepared, I unscrewed the battery cap, pulled out the dead battery, and slid in a brand new Energizer AAA. An extra towel or t-shirt is good to wrap up the pump in, keeping it cool and away from the heat of the sun.
It is so great reading about others who wrestle with the real-life issues associated with managing the highs & lows of BG along with everything else life throws at us. While you may not need all the spaces, the fact that they are already marked with time of day makes it easier to track when you tested. At that time, I had no particular opinion about working in the world of diabetes, but when I started doing it, I fell in love with the fact that a patient’s behavior makes a difference, which isn’t the case with most medical conditions. If blood glucose levels get too low, the pancreas secretes glucagon to stimulate the release of glucose from the liver.
New advances in genetic research are identifying other genetic components of type 1 diabetes. Risk FactorsType 1 diabetes is much less common than type 2 diabetes consisting of only 5 - 10% of all cases of diabetes. Eating disorders have become a serious problem within the general population and are especially dangerous in patients with diabetes. Because patients with diabetes may have silent heart disease, they should always check with their doctors before undertaking vigorous exercise. Although combinations of statins and fibrates or niacin increase the risk of myopathy, both combinations are considered safe if used with extra care. Moderate doses of niacin can control lipids without causing serious blood glucose problems. Erythromycin, domperidone (Motilium), or metoclopramide (Reglan) may be used to relieve delayed stomach emptying caused by neuropathy.
However, these drugs -- darbepoetin alfa (Aranesp) and epoetin alfa (Epogen and Procrit) -- can increase the risk of blood clots, stroke, heart attack, and heart failure in patients with end-stage kidney disease when they are given at higher than recommended doses. Intensive insulin treatment in early diabetes may even help preserve any residual insulin secretion for at least 2 years. Insulin glargine now offers the most consistent insulin activity level, but other intermediate and long-acting forms may be beneficial when administered twice a day.
This rapid action reduces the risk for hypoglycemic events after eating (postprandial hypoglycemia).
Lente (insulin zinc) is another intermediate insulin that peaks 4 - 12 hours and lasts up to 18 hours. Another approach uses 4 injections, including a separate short-acting form at dinner and NPH at bedtime, which may pose a lower risk for nighttime hypoglycemia than the 3-injection regimen. Newer, prefilled pens (Humulin Pen, Humalog) are disposable and allow the patient to dial in the correct amount. They work by administering a small amount of insulin continuously (the basal rate) and a higher dose (a bolus dose) when food is eaten. This requires an initial learning period, including understanding insulin needs over the course of the day and in different situations and knowledge of carbohydrate counting. Home tests are available for measuring A1C but they tend not to be as accurate as the laboratory tests ordered by doctors.
Shoes with a rocker sole reduce pressure under the heel and front of the foot and may be particularly helpful. Longer survival rates are probably due to improvements in monitoring and tighter control of blood glucose. Other contributing factors are lack of health insurance and intentionally reducing insulin doses in order to lose weight, which occurs with adolescent girls in an effort to keep weight down. It affects about 25% of patients who use insulin, nearly always people with type 1 diabetes. Urine tests showing microalbuminuria (small amounts of protein in the urine) are important markers for kidney damage. Symptoms of kidney failure may include swelling in the feet and ankles, itching, fatigue, and pale skin color.
Peripheral neuropathy usually starts in the fingers and toes and moves up to the arms and legs (called a stocking-glove distribution).
Lowering triglycerides, losing weight, reducing blood pressure, and quitting smoking may help prevent the onset of neuropathy. If these processes affect the central portion of the retina, swelling may occur, causing reduced or blurred vision. In this more severe condition, new abnormal blood vessels form and grow on the surface of the retina.
Therefore, it is important that women with pre-existing diabetes (both type 1 and type 2) who are planning on becoming pregnant strive to maintain good glucose control for 3 - 6 months before pregnancy. Young people who do not control glucose are also at high risk for permanent damage in small vessels, such as those in the eyes. These studies are still in very early stages, but researchers predict that there will be major advances in these fields in the coming years. However, this procedure has significant surgical and postsurgical complications in patients with diabetes. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.
In these spaces we put his blood reading from his metre and then what insulin dose he gets. They come is cool colours now and the delivery of insulin, although it takes a little getting used to, is a lot smoother. Monitoring gives a rough but fair estimate about whether sugar is going low or high,”  explains Dr Roshani Sanghani.
Given the large increase in the prevalence of type 2 diabetes, it will be important to define the role of SMBG so that resources can be used appropriately. The site then integrates their blood sugar measurements with other laboratory results as well as dietary goals. So, when your blood sugar is consistently high, it is reflected by a higher than normal A1c. His main argument was that A1c better indicates a person’s long-term exposure to high blood glucose than either fasting glucose or glucose tolerance. Nathan argued that current methodology allows for much more consistent and accurate measurements than what was available in 2003.
Factors that can interfere with this relationship include certain genetic variations, race, age, and certain disease states such as kidney failure or anemia (iron deficiency). The lancet device could use some improvement though – it is curved and a bit awkward for smaller hands to hold and prick fingers with. The testing itself is quick, with it counting down and then showing the result in large numbers on the entire digital screen. It doesn't have to be plugged in and fully recharged; you can unplug it any time if you need to test. Says diaTribe advisory board member Jane Seley, "The truth is, few patients care to download their meter - perhaps because of the hassle factor, but my guess is that the majority choose not to download because they have not been taught what to do with the information." Thus, you may need to decide how useful the improved downloading capability will be for you.
NICE-SUGAR has the advantage of being performed in multiple centers in multiple countries with computerized insulin delivery.
I would love to see the development of a glucose sensor that's accurate and can be used with IVs. Regarding insulin pumps, yes, I do support patients being on insulin pumps, but hospitals should develop protocols to make it safe for patients to use pumps in the inpatient setting. Also, pump patients will need to be able to demonstrate to hospital personnel that they know how to navigate their various insulin pump screens because they may need to change their pump basal rates while hospitalized. I grab the glucose meter and head into his bedroom, where my son is visible in the nightlight’s amber glow. But make no mistake: preventing overnight lows is one of the most compelling features of this technology. But he pouts when he loses and will cry after striking out and his teachers are concerned that he’s too competitive when he plays four-square at recess. There’s also a space underneath the glucose values where you can record each day’s events (like exercise, meals, etc.).
If there is tension between a partner, a friend, or a spouse, it makes it more difficult to implement important self-care behaviors. Nevertheless, like type 2 diabetes, the incidence of type 1 diabetes among children and adolescents has been rising over the past few decades. A doctor uses the results from a creatinine blood test to calculate the glomerular filtration rate (GFR). Patients with diabetes should monitor their carbohydrate intake either through carbohydrate counting or meal planning exchange lists. Limit trans-fats (hydrogenated fat found in snack foods, fried foods, and commercially baked goods) to less than 1% of total calories.
Some evidence suggests that they contribute to about 20% of cases of recurrent ketoacidosis in young women.
Short-acting insulin delivered continuously using a pump is proving to a very good way to provide basal rates of insulin. Optimal timing for administering this insulin is about 15 minutes before a meal, but it can also be taken immediately after a meal (but within 30 minutes).
The older Minimed system measures glucose over a 72-hour period and has wireless communication between the monitor and an insulin pump. About a quarter of the time, the results differ significantly from actual fingerstick tests, however. Usually the condition is manageable, but, occasionally, it can be severe or even life threatening, particularly if the patient fails to recognize the symptoms, especially while continuing to take insulin or other hypoglycemic drugs. In such cases, hypoglycemia appears suddenly, without warning, and can escalate to a severe level.
The outlook of end-stage renal disease has greatly improved during the last four decades for patients with type 1 diabetes, and fewer people with type 1 diabetes are developing ESRD. The bones may crack, splinter, and erode, and the joints may shift, change shape, and become unstable.
One 10-year study reported that survival rate at 10 years was 76%, and two-thirds of the patients had both pancreas and kidney function.
If you use Humapens instead of syringes for insulin and you haven't replaced them in a few years ask your diabetes team about these! There are recommendations from bodies like ADA (American Diabetes Association) and AACE (American Association of Clinical Endocrinology) in patients of type 2 diabetes for SMBG,” he adds further. Using this data, participants can monitor trends with their diabetes, and nurse coaches can explain the results and offer suggestions on what the next steps might be. The test is simpler for patients (no fasting or ingestion of glucose is necessary), and its results are more consistent than either FPG or OGTT. Potentially most importantly, A1c levels do not vary drastically from day to day in a person.
Unlike our previous concern with the Animas Ping’s digital screen, this digitized screen is modern, bright, and easy to read and navigate, even in very bright daylight. In the day report, it shows morning, midday, and evening numbers; in one case, it was easy to see that I had a lot of mid-morning lows and more after-dinner elevation than I had realized. They should contact their diabetes care provider for help regarding what they should do with their diabetes medications while withholding foods and fluids prior to surgery or an outpatient procedure. But now he sleeps soundly beneath his Spiderman blanket, and I quickly prick his finger – more than 12,800 finger pricks in his young life, but who’s counting? Even though I had a tattered box in my medical bag with an almost-expired bottle of Lantus in it, and even though I had enough syringes to finish the trip without the pump, coming off the pump isn't easy. SugarDash is small enough to fit into your glucose meter case and may be easier to carry around than a regular logbook. While type 2 diabetes has been increasing among African-American and Hispanic adolescents, the highest rates of type 1 diabetes are found among Caucasian youth. The GFR is an indicator of kidney function; it estimates how well the kidneys are cleaning the blood. Ketoacidosis is a significant complication of insulin depletion and can be life threatening. Ultralente insulin peaks at 10 hours and lasts up to 20 hours but varies greatly in activity from day to day. Even a single recent episode of hypoglycemia may make it more difficult to detect the next episode.
It typically develops in people who have neuropathy to the extent that they cannot feel sensation in the foot and are not aware of an existing injury. Major hemorrhage or retinal detachment can result, causing severe visual loss or blindness. Any duplication or distribution of the information contained herein is strictly prohibited. We started doing this about four years ago as he was part of a study at Sick Kids and it was not only required but turned out to be good practice. There has been a great deal of debate on how to interpret and express A1c results, however. FPG and OGTT, on the other hand, are sensitive to factors such as stress and forgetting to fast. Bloomgarden argued that it would be inappropriate to use A1c as a standard for the entire population, especially when people with diabetes have high rates of anemia and kidney failure. Unlike some other meters that give you a few seconds to squeeze extra blood if you don't get enough on the first try, the USB meter gives you an error message. Additionally, it's helpful to spot consistent problem areas over a week, such as a high that occurs the same day each week or a recurring problem with lows after working out – especially helpful if you are not using a continuous glucose monitor.
I think major reasons why patients don't want to use insulin is 1) the social aspect; they think people are going to think they're addicts, 2) they don't want to see the needle, and 3) they don’t have the confidence to know that they're dosing correctly. Their erratic schedules, unpredictable diets, and growing bodies cause their insulin needs to change by the day if not the hour, but back in the Dark Ages, without home blood tests, the parents lacked the information they needed to make the adjustments. I did it once before and it was a hassle of highs and lows - not what I wanted to wrangle with while I was on vacation.
If you're like me and you love to swim around like an awkward little dolphin, you'll find that the infusion set can get covered in salt and sticky sand.
With vigilant monitoring and by rigorously avoiding low blood glucose levels, patients can often regain the ability to sense the symptoms. Instead of resting an injured foot or seeking medical help, the patient often continues normal activity, causing further damage. Doctors generally recommend transplants in cases of end-stage kidney failure or when diabetes poses more of a threat to the patient's life than the transplant itself.
Until February 2010, people with diabetes needed a prescription to sign up for inTouch-diabetes. Because of this, doctors can be confident that a patient’s A1c has not been influenced by arbitrary short-term factors.
He also cited data from a large US census showing that many people that would be diagnosed with diabetes using FPG had A1cs lower than 6.5%, which could lower the rate of legitimate diabetes diagnoses. Kilpatrick worried that using this measure would be confusing to patients, since the values may be different from what they see with their home blood glucose measurements. I cringe when I have to teach patients how to use syringes because the accuracy and precision of dosing is just not there. Dana will be going to the American Diabetes Association (ADA) conference with us this summer and hopefully coming back with even more tips – parents, Dana is also a moderator of ADA's Planet D online community, a safe place for kids to explore, discover, and connect with other kids living with diabetes. Everyone needs to become aware of the importance of regular physical activity, sleep, healthy food choices, and portion control. However, even very careful testing may fail to detect a problem, particularly one that occurs during sleep. But now, the FDA has cleared the program for those without prescriptions, broadening its availability. Zachary Bloomgarden, summed up the many talks that were given on the A1c test at the 2009 American Diabetes Association (ADA) Scientific Sessions (for our coverage of this meeting, see Conference Pearls from diaTribe #16).
This could lead them to question whether to trust the results from their blood glucose meter or their A1c. But also thankfully, I was prepared to deal with whatever happened, thanks to my overstocked bag of supplies.
We are about to set sail for Bermuda (followed by sailing to the Caribbean) any day from the mouth if the Chesapeake.
We need to get these lessons out to the general population as taking care of their health will ward off a lot of diseases, especially type 2 diabetes. Although no prescription is needed, the program is only available through certain health insurance plans and employers. He argued that because of this and worries about the accuracy of the A1c-blood glucose relationship, that eAG was premature for clinical use. It's approximately the same length and thickness of a smart phone, so that with an improved lancet device and smaller bottle of strips it would be easy to slip in your pocket on the go. As a result, finding a lab, much less having a doctor’s order to get a test is problematic at best. While my husband packed his suitcase and brought a backpack as a carry-on, I brought just a wee bit more.
If the water bottle doesn’t do the trick, or if there's a malfunction with you pump, it's important to keep an insulin pen in your beach stash. Nathan disagreed, however, noting that expressing A1c as average glucose would allow all diabetes measurements and glycemic targets to be expressed with the same units.



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Comments

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