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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    When a child has diabetes, the family’s potential for stress is high. The child with diabetes, parents and siblings all feel their own share of stress. Stress is a physical and mental reaction to perceived danger. Conditions that seem uncontrollable or require emotional and behavioral change tend to be perceived as a threat.

    When the body and mind sense a threat, they get ready to either run or fight. Whether the threat is real or imagined, the body prepares for survival by turning up some bodily functions while turning others down. In either case, over time these changes are serious and over time are harmful.

    Over time, stress is harmful because it causes so much wear and tear on the body. For example, the heart works faster and harder in preparation for physical action. The increase in pulse and blood pressure causes a strain on the heart, veins and arteries.

    Prolonged stress also has a negative impact on other bodily systems:
    • Immune
    • Digestive
    • Renal (kidney)
    • Reproductive
    In addition, the ability to think clearly and to make good decisions is impaired when the mind is burdened with worry, anxiety or fear. This constant mental strain can also increase the risk for depression.
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    Signs of a diabetic emergency include:
    • Changes in the level of consciousness
    • Changes in mood
    • Rapid breathing and pulse
    • Feeling and looking ill
    • Dizziness and headache
    • Confusion
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    A , Integrative Medicine, answered
    Gymnema sylvestre certainly could serve as the backbone of a natural diabetes program. It has been used in India for the treatment of diabetes for more than 2,000 years. Used primarily for type 2 diabetes, its benefits extend to type l and it continues to be recommended today in India. The leaves help raise insulin levels. Gurmar, an extract of gymnema, tends to be a blood sugar balancer, lowering glucose significantly only in hyperglycemic people. It also significantly improves cholesterol and triglyceride levels.
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    A , Endocrinology Diabetes & Metabolism, answered
    There are plenty of professional athletes who have both type 1 and type 2 diabetes, and my own medical practice includes people with diabetes who are marathoners, endurance cyclists, basketball, tennis and soccer players, swimmers and even water polo players. So there is no reason that someone with diabetes should play or compete in athletics, whether it’s just for fun or at a high competitive level. But performing your best on the field, court, track or in the water requires that you understand what happens to your blood sugar when you are playing or competing. 

    Everyone knows that exercise is good for blood sugar control as well as for your general health. But that doesn’t necessarily mean that blood sugar will drop when you begin exercising or playing. The release of adrenaline and other hormones that are required for athletic performance may actually raise blood sugar in the short-term. Many people find that during competition their blood sugar actually rises as their body makes sugar available from storage to power your muscles. Many times this is followed by a fall in blood sugar levels an hour or more after the athletic performance ceases. So exercise or athletic competition is sometimes accompanied by rapid or wide fluctuations in blood sugar levels. 

    It’s important to understand how your body and your blood sugar reacts to exercise or athletic competition. It is often necessary to do a lot more fingerstick blood sugar testing than usual to figure out exactly what your pattern of blood sugar fluctations is during the athletic activity. The good news is that once you figure out your pattern, it is usually more or less the same when you repeat the same activity.

    My suggestion in most cases is that one someone undertakes a new exercise or athletic competition that they test at the start of the activity and frequently during the exercise -- maybe every half hour or so -- until a couple of hours afterward. This will establish a pattern. If the person finds that her blood sugar falls during exercise, then she will need to eat some healthy, carbohydrate-containing food before starting the exercise. If another person’s blood sugar first rises, but then falls fairly quickly after the exercise is over, then he will need to eat something after exercising. For someone using short-acting insulin, the dose necessary for a meal that either precedes or follows exercise may need to be adjusted downward to account for the sugar used by the exercise. 

    Once someone knows his or her pattern of rises and falls with exercise or competition, it will not be necessary to check nearly as frequently, and in some cases not at all if the person feels well and generally can sense low blood sugar reactions well. But it’s important to re-do the frequent testing when ratcheting up the exercise as the pattern may be somewhat different or the rise and fall in glucose levels may be more pronounced.
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    A Internal Medicine, answered on behalf of

    A large study published in the New England Journal of Medicine demonstrated that Continuous Glucose Monitoring (CGM) therapy significantly reduced the A1C level in adult patients with type 1 diabetes without an increased risk of low blood sugar reactions -- always a concern when medicating to keep blood sugar readings on the low side. A person's A1C level is his or her average blood glucose level over three months. It makes sense that people with type 2 diabetes would get similar benefits from CGM.

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    A , 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 , Endocrinology Diabetes & Metabolism, answered
    The first thing a person needs to do is to establish his or her pattern of glucose variation with exercise because this varies a lot from one person to the next. It’s natural to think that blood sugar goes down with exercise, and if often does. But with intense or competitive exercise, the adrenaline that’s released during the activity will usually raise the sugar. Some people find that they are very high at the end of intense exercise and then have a rapid fall or “crash” in their blood sugars a couple of hours later. 

    I suggest that when you start exercising or increase the intensity of your exercise, test your blood sugar at the start of the exercise, at the end and an hour or two afterward. You may need to test during the exercise -- maybe every 30 minutes or so if it’s especially intense -- and you may need to test longer after finishing. Do this a few times until it’s clear what happens to you. Then it will be more clear what to do. If you have a big rise with intense exercise, I don’t usually recommend taking more oral medication or more insulin because the number is likely to fall within an hour or two of finishing and you can cause a severe low sugar reaction by trying to prevent the high. But you may be able to modify what you eat before exercising, especially if you ingested a lot of carbohydrate expecting the number to fall. If you do go down during exercise, you may need to eat before the activity, or you may need to eat at the end to prevent a low sugar. Sometimes people will need to modify their medication regimen to account for exercise. For example, one may need to take less insulin or a reduced dose of oral diabetes medication on the days that he or she is exercising. If you bring your record of what happens to you when you exercise to your doctor, the two you can figure out best how to handle the ups and downs.  
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    Nowadays, we hear about carbohydrate all the time. Foods that contain carbohydrate raise blood glucose. If you have diabetes, by keeping track of how many carbohydrates you eat and setting a limit for your maximum amount to eat, you can help to keep your blood glucose levels in your target range.
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    A Nutrition & Dietetics, answered on behalf of
    In years past, diabetes treatment meant strict control over your daily diet. But that's no longer the case. Thanks to newer insulin types, you and other kids with diabetes can be flexible in your eating habits. You can eat as much or as little as you need to satisfy your hunger. For you, meal planning is more about these basic principles:
    • Eat a variety of foods. This is the best way to make sure you're getting the energy, vitamins, and minerals you need to grow, play, work, and stay healthy.
    • Allow yourself treats once in a while -- but don't overdo it. There are no "bad foods" or "good foods" in your meal plan. But just like everybody else, you need to make healthy choices.
    • Try to stick to a schedule. Have your meals and snacks at about the same time every day, and don't "graze" in between.
    • Pay attention to carbohydrates (carbs) in your meals and snacks. 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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    Here's how to check your blood glucose level with a glucose meter:
    1. After washing your hands, insert a test strip into your meter.
    2. Use your lancing device on the side of your fingertip to get a drop of blood.
    3. Gently squeeze or massage your finger until a drop of blood forms. (Required sample sizes vary by meter.)
    4. Touch and hold the edge of the test strip to the drop of blood, and wait for the result.
    5. Your blood glucose level will appear on the meter's display.
    Note: All meters are slightly different, so always refer to your user's manual for specific instructions.

    Other tips for checking:
    • With some meters, you can also use your forearm, thigh or fleshy part of your hand.
    • There are spring-loaded lancing devices that make sticking yourself less painful.
    • If you use your fingertip, stick the side of your fingertip by your fingernail to avoid having sore spots on the frequently used part of your finger.
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