Diabetes

Diabetes

Diabetes mellitus (MEL-ih-tus), often referred to as diabetes, is characterized by high blood glucose (sugar) levels that result from the body’s inability to produce enough insulin and/or effectively utilize the insulin. Diabetes is a serious, life-long condition and the sixth leading cause of death in the United States. Diabetes is a disorder of metabolism (the body's way of digesting food and converting it into energy). There are three forms of diabetes. Type 1 diabetes is an autoimmune disease that accounts for five- to 10-percent of all diagnosed cases of diabetes. Type 2 diabetes may account for 90- to 95-percent of all diagnosed cases. The third type of diabetes occurs in pregnancy and is referred to as gestational diabetes. Left untreated, gestational diabetes can cause health issues for pregnant women and their babies. People with diabetes can take preventive steps to control this disease and decrease the risk of further complications.

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  • 1 Answer
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    A Phil Southerland, Healthcare, answered
    Not every athlete with diabetes uses a pump. It’s a matter of personal preference. If you don’t like doing shots, and you don’t want to do more than four shots a day, I’d definitely recommend asking your doctor about an insulin pump.

    There are a million ways when it comes to diabetes control. Each person needs to have what they feel is the best bag of tricks to do it properly. On the Race Across America team, we had six riders on the pump and two on Lantus. Personally, I use a combination of Lantus, Apidra (a fast-acting insulin) and the continuous glucose monitor. My co-founder, Joe Eldridge, a professional cyclist, uses the pump with Apidra and the glucose monitor. Athletes are always trying to fine tune what we do and to do it better.
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    A Phil Southerland, Healthcare, answered
    The benefit of a continuous blood glucose monitor is that it allows unpredictability to be manageable. You see these trending arrows and you can make adjustments on the fly.

    If you just check your blood sugar right before a run or ride, you’re going to go an hour before you check again. There is an entire hour you don’t know what your blood sugar was. With a continuous glucose monitor, you can see if it’s going up or down, and you can make proactive adjustments that make those unpredictable times extremely manageable.
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    A Phil Southerland, Healthcare, answered
    In the past there has definitely been a stigma associated with diabetes. Here I am, an athlete and one of the best controlled people with diabetes in the world, and I still get people who, when I’m drinking soda or eating cake, will say, “You can’t have that. You have diabetes.”

    When I was younger it infuriated me, and I’d get mad and argumentative. As I’ve grown older, I realize it’s an opportunity I have to educate people. I would just suggest that if it’s possible, use it to educate your friends.
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    A Phil Southerland, Healthcare, answered
    During the two- or three-hour window after strenuous exercise it’s crucial to know where your blood sugar is and do constant monitoring. It will be different today than it will be tomorrow. This is something all of our athletes with type 1 must do.

    After exercise, the body is going through a lot of hormonal changes. Whatever glucose gets produced in the bloodstream to help with exercise, whatever you eat during exercise that your body doesn’t use during the event, combined with the body’s cortisol production can cause a big spike in blood sugar immediately following exercise for about an hour-and-a-half period. It’s common among all of our athletes to give a bolus immediately following exercise to prevent this post-exercise spike. (Bolus is the term we use to describe delivering insulin.)

    At that point, it’s about tinkering with the right number to find out how much insulin you need. To dampen the spike, we will, the second we’re done with exercise, do a bolus of 4 units of insulin. If I want to eat, I would double the insulin I would normally do – but that’s just in that one hour period after exercise. Everyone is a little bit different. The one consistency we’ve seen is the spike immediately following exercise and the drop in blood sugar in the hour and a half post exercise.
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    AIntermountain Registered Dietitians, Nutrition & Dietetics, answered on behalf of Intermountain Healthcare
    Food is made up of three main nutrients: fat, protein, and carbohydrate. Of these, carbs have the biggest effect on your blood glucose. For this reason, you need to match your insulin intake to your carbohydrate intake ("cover" your carbs). You can do this by carefully measuring your insulin doses and counting carbs in your meals and snacks.
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    Healthy blood sugar levels can be maintained by balancing carbohydrate intake, insulin, and exercise. Children should receive individualized nutritional guidance, as weight and growth considerations need to be accounted for as well as the blood sugar levels. Generally, it is important to have consistent snacks and meals throughout the day. The Diabetes Food Pyramid separates food groups based on carbohydrates and protein content. People with diabetes should consume more whole-grain foods, beans, fresh vegetables and fruits, low-fat milk, and lean meats and minimize sweets and fats in their diets. Proper caloric intake is also important to allow children to grow and maintain a healthy weight.
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  • 4 Answers
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    Now that you have diabetes, you need to check your blood glucose regularly, every day. This is the only way you can know how much insulin or food to take at different times. To check your blood glucose, you need to prick your finger to get a tiny sample of blood, then use a small machine called a glucose meter to read the sample and display your blood glucose level. There are many different meter models to choose from. Your doctor or diabetes educator will help you get a meter and show you how to use it. It may take some practice. Follow the directions that come with your meter.
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    Blood glucose goals for children are looser compared to adults. For example, the target range may be 100 to 200 mg/dl. Most children under the age of 6 or 7 are not yet able to be aware of and respond to oncoming low blood glucose, and it’s very important to limit episodes of low blood glucose. Tailor goals to the age and abilities of the child and be flexible with goals as the child grows.
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    AIntermountain Registered Dietitians, Nutrition & Dietetics, answered on behalf of Intermountain Healthcare
    Blood glucose levels naturally vary. They rise after a meal, then go down as the body uses up the glucose provided by the food. Here's how it normally works:
    • As your blood glucose starts to rise after a meal, the pancreas responds by releasing insulin. The insulin moves the glucose out of the bloodstream and into the cells to be used for energy. This prevents blood glucose from getting too high.
    • When your blood glucose gets low -- as can happen when you don't eat for a while -- the liver responds by releasing extra glucose into your bloodstream.
    With insulin helping glucose get into the cells, and the liver preventing blood glucose from dropping too low, blood glucose levels can stay within a healthy range.
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    AIntermountain Registered Dietitians, Nutrition & Dietetics, answered on behalf of Intermountain Healthcare
    You didn't give your child diabetes -- and there's nothing you could have done to prevent it. Try not to blame yourself. And don't feel guilty about having to give injections or do finger sticks as part of diabetes care. It's natural to want to take away your child's hurt, and it's no fun when your child resists. But now that your child has diabetes, injections and finger sticks are part of life. So remember: You aren't hurting your child, you are caring for her.

    Well-meaning friends or family may say you're lucky that your child's disease has been diagnosed and can be treated. But you probably don't feel very lucky right now. You may feel overwhelmed by all that you have to learn. You may feel frightened by what can happen if your child's blood glucose gets too high or too low.

    These feelings are normal and appropriate. Diabetes is serious -- and you must take it seriously. At the same time, realize that with time and practice, you can learn the skills needed for proper diabetes care. The worry you may feel today will ease as you adjust to your "new normal."