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Tight Glucose Control in the Hospital

How Important is tight glucose control while you are in the hospital ?

Most everyone with diabetes knows how important tight glucose control is. However, many are concerned with their hospital health care professionals who are not overly concerned with their glucose levels during their stay.
Even today, most scientists don’t know what the best glucose levels are for hospitalized patients with or without diabetes. Recent studies have looked into the question of whether the possible damage from hypoglycemia from intensive insulin therapy is more harmful than any caused by a temporary period of too high glucose levels.
The study in March 2009 compared glucose levels in the ICU of patients with Type 1 and Type 2 diabetes, along with non-diabetics because severely sick patients have a rise in glucose levels. Half of the patients were put on a strict glucose goal of 81-108mg/dl. The other half had a target of 180mg/dl or less.
Ninety days later, it was found that the intensive control group had a 14% higher death rate than the less controlled group. The researchers concluded that intensive glucose control in the ICU is putting patients at an increased risk of severe hypoglycemia and the risk of dying within 90 days. Therefore, they advise against tight glucose control in the ICU.
Other studies have shown no greater death rate, but a 6-fold increase in the risk of severe hypoglycemia. Neither study supports the current guidelines for use of insulin therapy in the ICU .
In another study, in individuals with diabetes who were hospitalized for various reasons, low blood sugar occurred in approximately 8% of the patients. Each additional day with a hypoglycemic episode was linked with an 85% increase in the risk of death while hospitalized.
If you plan on being in the hospital, it is recommended that you ask your doctor what kind of control he wants you to maintain during your stay, and make sure he conveys that to the hospital staff.
(Diabetes Self-Management Sept/Oct 2009,Pharmacy Times Sept 2009)

Diabetes and your Feet

Diabetes and Your Feet

    Diabetics have to take special care of their feet, or they can become more susceptible to problems in two ways: reduced blood circulation and nerve damage.

Here’s what to look for and some prevention ideas.

If your feet are constantly cold, your legs are sore when you walk, or your feet hurt in bed at night, you may be suffering from poor blood circulation. This, in turn, can slow down the process of healing when you have cuts or other damage to your feet.

Staying physically active is one way to help improve your circulation. You also need to control your blood fat and sugar levels, as well as your blood pressure. Massage is an effective tool to incorporate in your daily foot check routine to ensure increased circulation, manage blood glucose levels and blood pressure.

And of course, don’t smoke. My mother was a smoker and it causes so many complication with many medications and most importantly her circulation. I picked up smoking from my mother’s bad habit at a young age and am very happy to say I have not been a smoker in over 8 years. I am proof quitting cold turkey works when you are committed to it. I knew in my heart I would NOT allow smoking to kill me slowly anymore.

If your feet are numb, you have a burning sensation on the soles of your feet or pins and needles in your feet, you have signs of possible nerve damage.

Foot nerves are the longest in our bodies and are therefore susceptible to damage by diabetes. If these nerves are damaged, the feelings are lessened, so we could have the cuts or blisters that can lead to ulcers, and we wouldn’t even know about it.

Check your feet regularly to be sure there are no signs of injury. If you develop corns or calluses, have them treated immediately by a podiatrist. Wash and dry carefully between your toes, and keep your nails trimmed and smooth.

Everyone likes to have their feet pampered, but for us diabetics it not only feels good, it also prevents serious health problems in the future. So book that foot massage now!

Massage can become costly when it is not covered by insurance. As a solution, check out my FREE REPORT on the benefits of massage for diabetics.

Claim your Free Report: “The Benefits of Diabetes Massage” www.diabetesmassage.com

Metoclopramide Warning

Stronger Warning On Drug Metoclopramide (Brand Name Reglan)

    If your are on the drug metoclopramide (brand name Reglan) for intestinal problems like gastroparesis (delayed stomach emptying due to nerve damage) or other GI problems, you should be aware of the new stronger box warning alerting MD’s and users of the drug. Patients taking the drug for longer than recommended may have a higher chance of developing tardive dyskinesia, a serious neurological disorder whose symptoms may remain even after you discontinue the drug.
Tardive dyskinesia is caused by long term use of certain kinds of drugs, mostly anti-psychotics. Symptoms include things like involuntary, repetitive movements of the face and limbs, such as lip smacking, sticking out the tongue, grimacing, and rapid eye and finger movements. The warning was already in the labeling, but the FDA decided to increase the warning because of increased reports of this bad side effect.
Metoclopramide is meant to be used for short term treatment of GI problems for no longer than three months. The FDA found that 15% of users were taking it for longer than this, thereby increasing their chances of tardive dyskinesia. If you are taking this medication, you may want to speak with your doctor concerning this new increased warning, especially if you have been on it for more than 3 months.
(Diabetes Self Management Sept/Oct 2009)

Juice That Lowers Your Blood Sugar

The Juice That Can Lower Blood Sugar Levels

Did you know blueberries may help lower your blood glucose levels and insulin resistance?
A study in Canada had overweight men that were at risk of heart disease and diabetes, drink 1 cup of wild blueberry juice daily for 3 weeks. At the end, they found their blood glucose had dropped by approximately 10% and their insulin resistance decreased, as compared to a control group that drank a placebo juice.
Researchers theorized the benefits might stem from the high levels of anthocyanins in the juice and it’s beneficial effects on the pancreas. Frozen wild berries also worked as well.
(Men’s Health Nov. 2009)

Diabetes and Traffic Accidents

Can Having Diabetes Increase the Chance of Having A Traffic Accident?

    Is it possible that diabetes could affect a person’s driving ability to the point that it would increase your risk of having a traffic accident?

According to a new Norwegian study, this may be the case. In a 30 month study, the analysis showed that diabetics who took insulin either  alone or with other diabetic medications were 40% more likely than people not taking diabetes drugs to be injured in a traffic   accident. The researchers theorized it may be due to extremely low hypoglycemia, which occurs more often when taking insulin than when on medications alone.
This serves as a reminder to diabetics on insulin to always be aware of their blood glucose levels and know the signs of hypoglycemia.
Boy, I hope the insurance companies in the U.S. don’t get a hold of this .

What is the Glycemic Index?

THE GLYCEMIC INDEX

    Not all carbohydrates raise blood glucose equally. Brown rice may make your levels spike, while milk chocolate containing the same number of carbohydrates may raise it much less. This can be explained by the glycemic index (GI), which ranks foods based on how much they may raise glucose levels. And some people, whether they follow a lower- or higher-carb diet, pay attention to their foods’ GI, too. So, should you?
Here’s one thing experts in both the lower- and higher-carb diet camps agree on: The answer is no.

As you can see from the example above, low-GI foods aren’t always the smartest choice. (Hint: Brown rice is more nutritious than chocolate.) Many healthy foods actually have what the diet calls a medium or high GI. But that doesn’t mean you should swear off fruits and grains.

According to low-carb proponent Richard Bernstein, MD, FACE, FACN, too many factors affect a food’s GI to make the diet worthwhile. Take, for instance, an apple. Its glycemic index differs based on variety, how long it remained on the tree, how long it sat in the bin in the orchard and again in the store, and so on. Trying to calculate GI based on those details is nearly impossible.

William Yancy, Jr., MD, MHS, a researcher at the Center for Health Services Research in Primary Care at Durham (N.C.) VA Medical Center and associate professor of medicine at Duke University Medical Center, conducted a study that compared a low-carb diet and a low-GI diet. He found that the low-carb way of eating better improved blood glucose control.
“When low-GI diets are compared to high-GI diets, some short-term studies showed benefit and some did not. However, two one-year studies reported no benefit in A1C from the low-GI diets in the end,” says Marion J. Franz, MS, RD, CDE, a dietitian in Minneapolis. One study of people with type 2 diabetes found virtually no distinction between a low-GI and high-GI diet when it came to weight loss and glucose control.

Diabetes Basics Video

Here is a great video on the basics of what diabetes is.

And here is one on Type 2 Diabetes.

The New Science Of “Epigenetics”

EPIGENETICS

Explanations of how diabetes develops and progresses often involves two things: genes and environment. In other words, you may be born with a genetic disposition to diabetes that is then triggered by an environmental event or behavior. As it turns out, though, these factors aren’t always so separate. Scientists are finding that the environment can affect and even permanently modify genes themselves. How and why this happens is the subject of an emerging field of research called epigenetics. And the evidence suggests that diabetes may both cause epigenetic changes and be caused by them. It’s a classic of what came first, the chicken or the egg.

The prefix epi- means “on top of” or “in addition to”; epigenetics is the modification of the surface and message of a gene without altering the underlying DNA sequence. It’s something like making a proofreading mark on a document.

For people with diabetes, high or low blood glucose may trigger epigenetic changes. Some research suggests that these changes to genes may spur the development of diabetic complications, such as kidney damage and heart disease. Even a brief exposure to high blood glucose may cause an epigenetic change that stays in your body. This is called hyperglycemic memory, and it may explain why some people with diabetes get complications in spite of having good blood glucose control on average.

The development of both type 1 and type 2 diabetes is known to be influenced by the environment. Researchers are looking into what types of environmental factors, from nutrients and toxins to behavior and lifestyle, can trigger these epigenetic changes that raise or lower diabetes risk.

Scientists suspect that a mother’s nutrition while pregnant or a child’s diet during early life may even cause epigenetic changes that persist into adulthood. For the diabetes population, this is important because the pancreas’s insulin-producing beta cells replicate very early in life and then stop. “So a cell with epigenetic changes [from early life] just stays there.” And if epigenetic changes are transferred between cells through replication, then these changes in early life may have an even greater effect since they will be passed from the mother cell to the daughter cell throughout growth.

Epigenetics is a young field and a challenging one. Just identifying epigenetic changes to genes is difficult, a bit like trying to find a single out-of-place word in a long novel. Even so, researchers may someday discover through the study of epigenetics that the key to diabetes resides at the intersection of where genes and the environment meet.

Are Carbs The Enemy?

ARE CARBS THE ENEMY?

When it comes to diabetes, there may be no topic more fraught with controversy than carbohydrates. Sure, everyone agrees that the body uses carbs for energy in the form of glucose. But how much carbohydrate should people with diabetes really eat?
That question has divided researchers, doctors, dietitians—and people with diabetes themselves. Some insulin users in particular find that their blood glucose is far easier to control when they limit the carbs in their diet. Others think people with diabetes deserve to eat (and enjoy) the same healthy diet recommended for all Americans. All are deeply passionate on the subject. And, in a sense, they may all be right.

Today, most people with diabetes are encouraged to eat a balanced diet of lean meats and dairy, whole grains, healthy fats, and fruits and vegetables. This concept is backed by the American Diabetes Association (ADA) as well as the American Heart Association and American Dietetic Association, and it incorporates recommendations from agencies like the Department of Agriculture and the Department of Health and Human Services. While the ADA does not specify exact grams or percentages of calories from carbohydrate, the approach is generally moderate in carbs. According to Marion J. Franz, MS, RD, CDE, a registered dietitian and nutrition/health consultant in Minneapolis, studies have shown that people with diabetes generally get about 40 to 45 percent of their calories from carbs.

The moderate-carb approach stresses that grains should come in the form of whole grains instead of refined grains (like white flour), which have been stripped of important vitamins and minerals. Research has shown that eating a moderate-carb, high-fiber diet (like one that includes whole grains) may improve post-meal glucose levels and lower the risk for cardiovascular disease.

Indeed, a lot of those newly diagnosed with diabetes are happy to find out that they can still have most of their favorite foods, in moderation—as long as they lower their blood glucose with medication and exercise. (People who control their diabetes without medication or who take oral drugs will need to watch how carbs affect their glucose levels and then work with their doctor to determine the right number of carbs and amount of medication needed to stay in good glucose control.) Gone are the days of “diabetic diets” that were meager and confining. Today, the idea is that people with diabetes can eat everything recommended to those without the disease. “If we look at what’s important for all of us,” says Franz, “it’s important to eat healthy foods in the right portion sizes.”

People with diabetes looking for a one-size-fits-all “right” way to eat are going to come up short. There probably is no one way to eat that works for everyone. For some, all but nixing carbs is the ideal way to normalize blood glucose levels. For others, eating a higher-carb diet and covering the carbs with insulin or oral medications wins. This is all part of the reason that the American Diabetes Association stresses that meal plans should be geared to fit each person’s individual lifestyle.

So what should you do if you have diabetes and you’re trying to eat healthfully? First of all, keep in mind that what works for someone else may not necessarily work for you—and vice versa. You may need to experiment a bit to see how different methods affect your blood glucose levels. Consider making an appointment with a registered dietitian, who can review your individual needs and circumstances and help you tailor a nutrition plan that’s right for you. In the end, the best diet is the healthy one you’re able to follow.

Join the Million Challenge

Dear Fellow Diabetics,

As someone with type 2 diabetes, you know far too well the toll diabetes takes on your day-to-day life. Therefore, today is your chance to help loved ones avoid going through something similar by learning their risk for type 2 diabetes.

Are you up for the challenge?

Today is the 23rd annual American Diabetes Association Alert Day. Encourage your friends and family to take the Diabetes Risk Test to find out if they are at risk for type 2 diabetes.

Share the Diabetes Risk Test with your friends and family by going to the site at the bottom of this post.

Just by taking the test, they will become a part of the Join the Million Challenge, an effort to have 1 million people join the Stop Diabetes® movement.

There has never been a more urgent time for people to know their risk. New reports from the Centers for Disease Control and Prevention show:

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One in three Americans is at risk for type 2 diabetes; and
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One in four people with diabetes is unaware that he or she has the disease.

Please help us spread the word about the Join the Million Challenge. Chances are someone you love is at risk.

Together we can Stop Diabetes once and for all.

http://stopdiabetes.diabetes.org/site/PageServer?pagename=SD_homepage

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