High Blood Pressure in Early Pregnancy Raises Birth Defect Risk

A new study suggests that high blood pressure during early pregnancy is what raises the risk of major birth defects -- not the medicines used to control the condition, as previously thought.

Pregnant women have been warned for years to avoid drugs called ACE inhibitors during the later stages of pregnancy to avoid the possibility of birth defects. But whether it was safe to take them during the first trimester wasn't clear.

A 2006 paper concluded no, and two later studies found an increased risk with other blood pressure drugs as well.

Researchers behind a new, larger study suggest it's the high blood pressure itself that is responsible for the higher risk of birth defects, not the medications.

Compared to women without high blood pressure, those with the condition were more likely to have babies with congenital heart, brain or spinal cord defects regardless of whether they were taking ACE inhibitors, other medications, or getting no treatment at all, the study found.

Dr. De-Kun Li and colleagues from Kaiser Permanente in California examined data covering more than 460,000 pregnant women and their babies from 1995 to 2008 for the study, which was paid for by groups including the U.S. Agency for Healthcare Research and Quality and the Department of Health and Human Services.

Dr. James Walker, a spokesman for Britain's Royal College of Obstetricians and Gynaecologists who was not linked to the research, said it was reassuring that blood pressure drugs taken in early pregnancy probably weren't raising the risk of birth defects.

He said ACE inhibitors are not commonly prescribed to pregnant women because of past concerns, and that the main worry has been getting them off the drugs as soon as they are pregnant.

"What this study does is reassure us women can stay on the drug until they're pregnant and then stop," he said. "You never know how long someone is going to take to get pregnant and if they come off a blood pressure drug for too long, it could be bad for them."

ACE inhibitors are used mainly to treat high blood pressure and heart failure. They work by relaxing the blood vessels and improving blood flow.

The researchers looked at pharmacy databases to see whether the women took any blood pressure drugs during their pregnancy and medical records to look for birth defects. The scientists adjusted for potential confounders like diabetes and obesity.

The study, published online Tuesday in the journal BMJ, found similar rates of birth defects among children of pregnant women who took ACE inhibitors in their first trimester compared to women with untreated high blood pressure, those who took other blood pressure drugs, and those with normal blood pressure.

The numbers ranged from about five percent to eight percent and the differences could have been due to chance.

The researchers concluded that it was high blood pressure, not any medication, that was likely responsible for the problem.

Since earlier studies raised questions about the safety of taking ACE inhibitors once they were pregnant, it's unclear how many women are still commonly prescribed the drugs, among the most popular blood pressure medicines.

In the U.S., the Food and Drug Administration advises women to switch from ACE inhibitors to other drugs once they are pregnant, but there is no warning against using them, as there is for use in the second and third trimesters of pregnancy.

Scientists aren't sure why high blood pressure in pregnant women could result in birth defects, but suggest there could be physiological changes in mothers that affect fetal growth.

Women's Health -  Published October 19, 2011Associated Press

 

Frequently Asked Questions About High Blood Pressure

Answers to your frequently asked questions about hypertension, commonly called high blood pressure.

1. What Causes High Blood Pressure?

While the cause of high blood pressure in most people remains unclear, a variety of conditions -- such as getting little or no exercise, poor diet, obesity, older age, and genetics -- can lead to hypertension.

2. What Is Systolic and Diastolic Blood Pressure?

The blood pressure reading is measured in millimeters of mercury (mm Hg) and is written as systolic pressure, the force of the blood against the artery walls as your heart beats, over diastolic pressure, the blood pressure between heartbeats. For example, a blood pressure reading is written as 120/80 mm Hg, or "120 over 80". The systolic pressure is 120 and the diastolic pressure is 80.

3. What Is a Normal Blood Pressure?

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure has classified blood pressure measurements into several categories:

• "Normal" blood pressure is systolic pressure less than 120 and diastolic pressure less than 80 mmHg
• "Prehypertension" is systolic pressure of120-139 or diastolic pressure of 80-89 mmHg
• Stage 1 Hypertension is blood pressure greater than systolic pressure of 140-159 or diastolic pressure of 90-99 mmHg or greater.
• Stage 2 Hypertension is systolic pressure of 160 or greater or diastolic pressure of 100 or greater.

 4. What Health Problems Are Associated With High Blood Pressure?
Several potentially serious health conditions are linked to high blood pressure, including:

• Atherosclerosis: a disease of the arteries caused by a buildup of plaque, or fatty material, on the inside walls of the blood vessels. Hypertension contributes to this buildup by putting added stress and force on the artery walls.
• Heart Disease: heart failure (the heart can't adequately pump blood), ischemic heart disease (the heart tissue doesn't get enough blood), and hypertensive hypertrophic cardiomyopathy (enlarged heart) are all associated with high blood pressure.
• Kidney Disease: Hypertension can damage the blood vessels and filters in the kidneys, so that the kidneys cannot excrete waste properly.
• Stroke: Hypertension can lead to stroke, either by contributing to the process of atherosclerosis (which can lead to blockages and/or clots), or by weakening the blood vessel wall and causing it to rupture.
• Eye Disease: Hypertension can damage the very small blood vessels in the retina.

5. How Do I Know if I Have High Blood Pressure?

High blood pressure often doesn't have any symptoms, so you usually don't feel it. For that reason, hypertension is usually diagnosed by a health care professional on a routine visit. This is especially important if you have a close relative who has hypertension or embody risk factors for it.
If your blood pressure is extremely high, you may have unusually strong headaches, chest pain, and heart failure (especially difficulty breathing and poor exercise tolerance). If you have any of these symptoms, seek treatment immediately.

6. What Is the Treatment for High Blood Pressure

High blood pressure treatment usually involves making lifestyle changes and, if necessary, drug therapy.
Lifestyle changes for high blood pressure include:

• Losing weight.
• Quitting smoking.
• Eating a healthy diet, such as the DASH diet.
• Reducing the amount of salt in your diet.
• Regular aerobic exercise (such as brisk walking).
• Limiting alcohol drinking.

High blood pressure drugs include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, diuretics, beta-blockers, and calcium channel blockers.

7. What Are the Side Effects of High Blood Pressure Drugs?

As is true with any medication, high blood pressure drugs have side effects. Among the most common are the following:

• Diuretics: headache, weakness, joint or muscle pain, low potassium blood levels.
• ACE inhibitors: dry and persistent cough, headache, diarrhea, high potassium blood levels.
• Angiotensin receptor blockers: fatigue, dizziness or fainting, muscle pain, diarrhea.
• Calcium channel blockers: dizziness, trouble breathing, heart rhythm problems, ankle swelling.
• Beta-blockers: dizziness or lightheadedness, decreased sexual ability, drowsiness, low heart rate.

8. What Type of Diet Should I Follow if I Have High Blood Pressure

A healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, is very effective at lowering high blood pressure. The DASH diet calls for a certain number of daily servings from various food groups, including fruits, vegetables, and whole grains.
The following steps can also help:

• Eating more fruits, vegetables, and low-fat dairy foods
• Eating less of foods that are high in saturated fat and cholesterol, such as fried foods
• Eating more whole grain products, fish, poultry, and nuts
• Eating less red meat and sweets
• Eating foods that are high in magnesium, potassium, and calcium

9. When Should I Call My Doctor About High Blood Pressure?

If you are diagnosed with high blood pressure, it's important to see your doctor on a regular basis. He or she can answer your questions during these visits.
However, there may be other times when you may need to speak to your doctor. For instance:

• If you aren't responding to the prescribed treatment and your blood pressure is still high.
• If you are having any side effects from the blood pressure medication. If this happens, your doctor may wish to adjust the dosage of the medication or put you on another medication.

10. Are There any Drugs that Cause High Blood Pressure?

Some drugs that you take for another condition may cause high blood pressure. These include amphetamines, Ritalin, corticosteroids, hormones (including birth control pills), migraine medications, cyclosporine, and erythropoietin.

Also, many over-the-counter medications that contain pseudoephedrine and ephedrine (for example, allergy, cold, and asthma medications and appetite suppressants) can cause hypertension.
Don't stop taking any prescribed medication, including high blood pressure drugs, on your own without talking to your doctor.

© 2009 WebMD, LLC. All rights reserved.

Diabetes: 5 Steps to Total Body Care

If you have type 2 diabetes, you know that blood sugar control, a balanced diet, weight management, regular exercise, and checkups are vital to your health. Taking special care of every part of your body to avoid serious complications is just as critical.
Among some of your biggest concerns with diabetes care are:

• Foot infections
• Chronic skin infections
• Gum disease and tooth loss
• Vision problems
• Heart disease and blood circulation problems

Diabetes Body Care: It's for Everyone

The need to take care of yourself isn't just for adults; with the epidemic of childhood obesity, type 2 diabetes has also become more prevalent among children, teens, and young adults.

"In hospitals, we're seeing first-time patients in their late 20s and 30s who have uncontrolled blood sugar and severe skin infections that probably started as a boil or a spider bite," says Philip Orlander, MD, director of endocrinology at The University of Texas Medical School at Houston.

How can diabetes so dramatically damage the body? If blood sugar is uncontrolled, blood vessels and nerves become damaged, while the body becomes less able to fight infections.

Controlling blood sugar is the bottom line in preventing these problems, but personal care routines -- simple things you can do every day -- can dramatically reduce your risks, too.

5 Steps to Total Diabetes Body Care

Your feet, skin, eyes, heart, and teeth and gums need special attention if you have diabetes. Here are steps you can take to care for these parts of your body:

1. Foot Care and Diabetes 
Common foot problems can cause many complications, including athlete's foot, fungal infections in nails, calluses, corns, blisters, bunions, dry skin, sores, hammertoes, ingrown toenails, and plantar warts.

While anyone can have these problems, they're more critical for people with diabetes because:

• If you have nerve damage, you may not feel small wounds that need treatment.
• Poor blood flow can slow wound healing.
• If you're immune suppressed, you may be more prone to infection.
• Damaged foot muscle nerves may prevent your foot from aligning properly, causing you to put more pressure on one area of the foot, leading to foot sores and pressure point ulcers.

Prevention tips: Make time for foot care daily. Wash, dry and examine the tops and bottoms of your feet. Check for cracked skin, cuts, scratches, wounds, blisters, redness, calluses, and other changes. Use antibiotic creams recommended by your doctor and apply sterile bandages to protect cuts. Prevent ingrown toenails by cutting toenails straight across; don't cut corners. Don't go barefoot and always protect your feet.
Make sure you wear properly fitting footwear.

If you develop even minor foot problems, treat them right away or see a doctor. And see a foot doctor (podiatrist) every two or three months.

Checking your feet daily means you can catch small things and get them treated before they become serious. Make it part of your daily morning routine -- it doesn't take long.

2. Skin Care and Diabetes 
Bacterial infections, fungal infections, and itching are common skin problems anyone can develop, but they're especially problematic for people with diabetes because of poor blood flow and because the body may not be fighting infection well. Avoid extremely serious complications. Don't ignore these problems:

• Bacterial infections like boils (hair follicle infections) require antibiotic treatment.
• Fungal infections include the yeast-like fungus called Candida albicans, which often occurs in warm, moist folds of the skin: under the breasts, around the nails, between fingers and toes, and in the armpit and groin areas.
  
  • Jock itch(in the genitals and thighs), athlete's foot (between the toes), ringworm (on the feet, groin, chest, abdomen, scalp, and nails) and vaginal infections are very common when blood sugar isn't controlled. These may require treatment with prescription medications, though occasional over-the-counter antifungal treatments may work.
  • A fungal infection called mucormycosis (contracted from soil fungus and decaying plants) can become extremely serious, especially for those with out of control type 2 diabetes. It may start as a sinus infection that gets worse, and can spread to the lungs and brain. Symptoms are sinus infection, fever, eye swelling, skin redness over the sinus area; occasionally ulceration can occur with drainage. See a doctor immediately; this can be life-threatening.
  • Itching caused by dry skin, a yeast infection, or poor blood flow (in the legs especially) is often a result of diabetes. Using lotion or creams can provide relief.

Other skin conditions are caused by poor blood supply and some by your body's resistance to using insulin.

Rashes, bumps, and blisters can also occur; some require treatment, some don't. You need to know which is which and get them treated when necessary.

For instance, eruptive xanthomatosis, a skin condition, is caused by high cholesterol and fat levels in the blood. It appears on the backs of arms, legs, and buttocks as firm, yellow, waxy, pea-like bumps which are typically itchy and surrounded by red halos. Medication to control fat levels in the blood help, as does controlling blood sugar.

Prevention tips: Boost your body's ability to fight infection, and help prevent dry skin, by controlling you blood sugar. Use talcum powder in areas prone to infections and use moisturizing lotions and soaps when needed. (Don't put lotions between toes; extra moisture there can trigger fungus growth.)

And remember, see your doctor for treatment of skin problems that won't go away -- especially foot problems and fungal infections. These can be very serious, and require treatment with prescription medication.

3. Eye Care and Diabetes
Diabetes can damage the blood vessels in the eyes, leading to serious preventable problems like cataracts, glaucoma, and retinopathy.

• With a cataract, the eye's lens becomes cloudy, blurring vision. While anyone can get cataracts, they may develop at an earlier age -- and progress more quickly -- if you have diabetes.
• Glaucoma occurs when pressure builds inside the eye due to fluid not draining properly. The pressure damages the eye's nerves and blood vessels, harming vision.
• Retinopathy is caused by blood vessel damage in the eyes, and if not diagnosed and treated early, can lead to blindness.

Prevention tips: Prevent these problems from becoming serious by making sure your blood sugar is under control and see an eye doctor for an annual exam.

4. Teeth and Gum Care with Diabetes 
Most people develop gum problems during their lives but, if you have diabetes, your risks are higher for serious gum disease -- and for getting it at an earlier age.

That's because, with diabetes, your body is more vulnerable to bacteria and infection. High blood sugar levels can make gum disease worse, resulting in bleeding, tender gums, and gums that pull away from teeth. In time, you may need gum surgery to save your teeth.

Other mouth problems that are a risk:

• Gum inflammation
• Poor healing after dental treatment
• Dry mouth
• Burning mouth or tongue

Prevention tips: Brush after every meal, floss daily, and see your dentist twice a year. Be sure to tell your dentist you have diabetes and bring a list of the medications you take.

Discuss any mouth infections or difficulties in controlling blood sugar levels with your dentist, and make sure blood sugar is under control before routine dental procedures. If you're having dental surgery, your dentist should consult with your diabetes doctor about your medications and the need for an antibiotic.

5. Caring for Your Heart When You Have Diabetes 
Heart disease, heart attack, and stroke are very serious concerns for anyone with diabetes, but they can also be prevented.

Buildup of cholesterol on blood vessel walls (hardening of the arteries) is the most common cause of heart disease and stroke. When blood sugar levels are higher than normal, this damaging process escalates - reducing blood flow to the heart and brain and increasing heart attack and stroke risks. The heart's pumping ability can also be affected, leading to heart failure.

Prevention tips: Follow your doctor's advice in keeping blood sugar, blood pressure, and cholesterol in check.

If you have diabetes, your cholesterol and blood pressure levels must be lower than for the average person - so you must take your prescribed medications. Lose weight if you are obese, exercise regularly, and eat a heart-healthy diet low in fat and salt. Quit smoking and talk to your doctor about taking a daily aspirin.

And, finally, make sure you're getting good medical care for your diabetes. "If you're trying everything lifestyle changes, nutrition, medication but if blood sugar is not getting better, you may need a new doctor," says Orlander.

By Jeanie Lerche Davis
© 2008 WebMD, LLC. All rights reserved.

Visit out online store at http://www.goldeneramart.com for all of your  diabetes care products

Diabetic Nerve Pain: Descriptors & Possible Causes

Skip to content

Understanding Diabetic Nerve Pain

Nerves allow your body to feel temperature, pain, and other sensations. Over time, diabetes can harm nerves in the feet and legs and less often in the hands and arms. The pain usually occurs in both feet and may seem to extend into the legs as time passes. Similarly, both hands would be affected, and this pain may travel up the arms. Healthcare providers call this diabetic nerve pain. The pain can develop on its own, or it may also be caused by light touch or movement.

Possible Causes of Diabetic Nerve Pain

The prevalence of diabetic nerve pain is estimated to be 20% to 24% among patients with diabetes, affecting both people with type 1 and type 2 diabetes. It is also estimated that 10% to 20% of patients with diabetic nerve pain have pain severe enough to require treatment. No one yet knows exactly what causes the nerve damage. Having high blood sugar (glucose) levels over time is likely to be involved. While diabetic nerve pain can occur at any time, those who have had diabetes for a long time may be more likely to develop pain. People who have had problems controlling their blood sugar levels, have high blood pressure, and/or are overweight may also have a greater risk of developing diabetes-related nerve damage.

Fortunately, research has shown that diabetic nerve pain may be prevented through improved control of blood sugar. Other measures to improve your overall health include maintaining a healthy diet, exercising, lowering your blood pressure, lowering your cholesterol, avoiding smoking, and reducing the amount of alcohol you drink. There are options to help manage diabetic nerve pain, such as Cymbalta or nonmedicinal treatments, like acupuncture. Ask your doctor what you can do.

Note: Before beginning or changing an exercise program, please consult your healthcare provider.

Diabetic Nerve Pain Descriptors

Diabetic nerve pain has been described by some patients as constant or that it comes and goes. Words commonly used to describe diabetic nerve pain can include burning or shooting pain in the feet and legs, and you may have increased sensitivity to touch. Everyday things that come into contact with the painful area may cause pain, such as bedsheets or socks that touch your feet. Some people diagnosed with nerve damage due to diabetes experience numbness and muscle weakness.
Do you suspect that you have diabetic nerve pain? Do any of these words describe your pain?

• Aching
• Burning
• Numbness
• Shooting
• Stabbing
• Throbbing
• Tingling

Fortunately there is help. Through a complete treatment plan prescribed by your doctor and support of family and friends, you can learn to help manage your diabetic nerve pain.

Treatment Options for Diabetic Nerve Pain

Prescription Treatment Is Available

Cymbalta may be able to help improve your diabetic nerve pain. Cymbalta is indicated for the management of neuropathic pain associated with diabetic peripheral neuropathy. Cymbalta is not a narcotic and can be taken once a day. As with all medicines, results may vary from person to person. Learn more about Cymbalta and how it is believed to work.

Talk with Your Doctor about Pain You Believe Is Due to Your Diabetes

Even if you and your doctor have talked about your pain before, talk about it again if it continues to be an issue. You can help your doctor understand how much the pain is affecting your life and how it makes you feel. Only your doctor can diagnose diabetic nerve pain and determine if Cymbalta is right for you. Read more tips for talking to your doctor about diabetic nerve pain.

Put Together a Complete Treatment Plan

Work together with your doctor to create a plan to help manage your diabetic nerve pain. Along with medication, your plan may include lifestyle changes. Some healthcare professionals may suggest:

• Glucose control
• Relaxation techniques
• Acupuncture

• Blood pressure control
• Quitting smoking
• Avoiding alcohol

• Healthy diet
• Medication
• Exercise

WebMD does not endorse any specific product, service, or treatment. 
©2005-2011 WebMD, LLC. All rights reserved.

Managing Your Diabetes Care: When Low Blood Sugar Has No Symptoms

No one with diabetes welcomes signs of a low blood sugar, also known as hypoglycemia. These physical and emotional changes, such as shakiness, dizziness, sweating, moodiness, and anxiety, signal that your blood sugar is dropping and must be treated quickly.

But what if your body stops giving you these warning signs? Losing the ability to feel low blood sugar is known as hypoglycemic unawareness. If you have it, you could lose consciousness without ever knowing that your blood sugar has dropped.

Who Gets Hypoglycemic Unawareness?

Low blood sugars can happen to anyone with diabetes, whether you take insulin or other medications to control your blood sugars. Low blood sugars most commonly happen in people with type 1 diabetes. It impairs the body’s ability to respond to subsequent drops in blood sugar.


Losing the ability to feel low blood sugars is most common in people with type 1 diabetes, although it can happen in those with type 2 diabetes as well. The longer you’ve had diabetes, the higher your risk of hypoglycemic unawareness. Low blood sugar symptoms can start fading after you've had diabetes for as little as five years. By 20 years, they may be too faint to recognize or only occur after your blood sugar becomes severely low.

You may also be at higher risk for hypoglycemic unawareness if:

• You have neuropathy, or nerve damage.
• You have strict blood glucose control and you are on an intensive insulin regimen, have a history of severe low blood sugars, or a recent episode of low blood sugars.
• You take certain medications for your heart or high blood pressure.

What Causes Hypoglycemic Unawareness? 

When your blood sugar starts to drop too low, your body normally stops releasing insulin and starts releasing other hormones. These include glucagon and epinephrine. These hormones help stabilize blood sugars.

Epinephrine is the same hormone that helps us during our “flight or fight” reactions. It also causes the low blood sugar signs that people with diabetes usually recognize. But if someone keeps having low blood sugar reactions, their body may dampen the release of epinephrine. Without the symptoms of low blood sugar that epinephrine causes, someone with diabetes may not realize that their glucose levels are dropping.

If your blood sugar levels get too low, you may pass out and need emergency treatment.

Treatment for Hypoglycemic Unawareness

See your doctor if you start to lose the ability to feel your low blood sugars coming on. You may be able to regain that ability within weeks. Your doctor can develop the best treatment plan for you.

Set your targets for blood sugar higher than usual.
This is usually done for a few weeks.
Test your blood glucose levels as often as possible.
This should always include at bedtime and before and after exercise. Ideally, your blood sugar should also be checked before and after meals. Your doctor may advise you to test at other times.
Use a continuous glucose monitor (CGM).
Although this doesn’t replace the need to prick your finger, a CGM may be more convenient than having to step up your blood testing. A CGM can alert you to lows even during the night.
Modify your risks of hypoglycemia.
Review the risks for low blood sugar and take steps to reduce your risk. For example, you may need to adjust your insulin doses to better match your diet and exercise or to be more consistent with your meals and intake of carbohydrates.

Recognizing Other Symptoms of Hypoglycemia
Although it's possible that you could not have the physical and mood symptoms associated with hypoglycemia, the mental symptoms will still show up. These include:

• Trouble concentrating
• Slowed speech
• Slowed thinking
• Lack of coordination

When these symptoms start to appear, you'll be at a blood glucose level where you can still treat hypoglycemia on your own. Mental symptoms of low blood sugar are more subtle than the classic symptoms. But if you are aware of the times of day when your blood sugar normally drops, you can watch for them.

Preventing Hypoglycemic Unawareness

The only specific way to prevent hypoglycemic awareness from developing is to avoid low blood sugar episodes as much as possible. These steps may help:

• Check your blood glucose levels often.
• Talk with your doctor about your target blood glucose level.
• Recheck and treat low or dropping sugar levels, even if you feel OK. Avoid activities such as driving.
• Let your friends and family know about the possibility of hypoglycemic unawareness and teach them the signs they should watch for.

This content is selected and controlled by WebMD's editorial staff and is brought to you by Rite Aid.
© 2011 WebMD, LLC. All rights reserved. 

Diabetes and Your Mouth

 4 Signs You May Have a Problem

Diabetes puts you at risk for dental problems. It impairs your ability to fight bacteria in your mouth. Having high blood sugar encourages bacteria to grow and contributes to gum disease. You may have gum disease if you have:

• Gums that are red, sore, bleeding, or swollen, or that pull away from your teeth
• Loose teeth

Control Diabetes to Keep Your Smile

Well-controlled diabetes contributes to a healthy mouth. If you have poorly controlled or high blood sugar, your risk increases for dry mouth, gum disease, tooth loss, and fungal infections like thrush. Since infections can also make your blood sugar rise, your diabetes may become even harder to control. Keeping your mouth healthy can help you manage your blood sugar.

See Your Dentist Regularly

People with diabetes are prone to oral infections. You should get dental checkups at least twice a year. Let your dentist know you have diabetes and what medicines you take. Regular checkups and professional cleanings can help keep a mouth healthy. And your dentist can teach you the best ways to care for your teeth and gums at home.

Keep Plaque at Bay

Sticky plaque -- food, saliva, and bacteria -- starts to form on your teeth after you eat, releasing acids that attack your tooth enamel. Untreated plaque turns into tartar, which builds under gum lines and is hard to remove with flossing. The longer it stays on your teeth, the more harmful it is. Bacteria in plaque causes inflammation and leads to gum disease. Having high blood sugar often makes gum disease worse.

Brush Daily, Brush Right

Brushing your teeth twice a day not only keeps your breath sweet, but also helps rid your mouth of bacteria that makes up plaque and can lead to oral infections. To brush properly, point your bristles at a 45-degree angle against your gums. Use gentle back-and-forth strokes all over your teeth -- in front, in back, and on chewing surfaces -- for two minutes. If holding a toothbrush is hard for you, try an electric toothbrush. Also brush your gums and tongue

Floss Every Day

Flossing helps control plaque. It can reach where a toothbrush can't, like between the teeth. Floss daily with floss and interdental cleaners that carry the American Dental Association (ADA) seal. Ask your dentist for tips if you're not sure how to floss. Like everything else, flossing gets easier with practice.

Take Care of Your Dentures

Loose-fitting or poorly maintained dentures can lead to gum irritation and infections. It's important to talk to your dentist about any changes in the fit of your dentures. When you have diabetes, you are at a higher risk of fungal infections like thrush. And poorly maintained dentures can contribute to thrush, too. It's important to remove and clean your dentures daily to help reduce your risk of infection.

Toss the Tobacco

Tobacco products -- including cigarettes, cigars, smokeless tobacco, and pipes -- are bad for anyone's mouth. But if you have diabetes and you smoke, you are at even greater risk of developing gum disease. Tobacco can damage gum tissue and cause receding gums. It can also speed up bone and tissue loss, leading to lost teeth. Motivate yourself to quit. List your reasons for quitting, set a date, and get the support of family and

Prepare for Oral Surgery

Well-controlled blood sugar reduces your risk of infection and speeds healing. If you need oral surgery, tell your dentist and surgeon you have diabetes beforehand. Your doctor may recommend that you wait to have surgery until your blood sugars are under control.

4 Steps to Protect Your Health

The same steps that ensure a healthy mouth also help you manage your diabetes.

• Eat a healthy diet.
• Don't smoke.
• Keep up with your diabetes medications.
• See your dentist regularly to reduce your risk of developing a serious problem.

Know the Warning Signs

Regular dental checkups are important because your dentist can spot gum disease even when you don't have any pain or symptoms. But you should examine your teeth and gums yourself for early signs of trouble. Infections can move fast. If you notice redness, swelling, bleeding, loose teeth, dry mouth, pain, or any other oral symptoms that worry you, talk to your dentist right away.

This content is selected and controlled by WebMD's editorial staff and is brought to you by Colgate Total

Diabetes and Weight Loss: Finding the Right Path

If you've got diabetes, losing weight can get you off insulin and other medications. Create a safe diabetes weight loss plan with the help of experts.

There's no question about it: If you're overweight and have type 2 diabetes, dropping pounds lowers your blood sugar, improves your health, and helps you feel better

But before you start a diabetes weight loss plan, it's important to work closely with your doctor or diabetes educator - because while you're dieting, your blood sugar, insulin, and medications need special attention.

Make no mistake -- you're on the right path. "No matter how heavy you are, you will significantly lower your blood sugar if you lose some weight," says Cathy Nonas, MS, RD, a spokeswoman for the American Dietetic Association and a professor at Mount Sinai School of Medicine in New York City.

A National Institutes of Health study found that a combination of diet and exercise cuts the risk of developing diabetes by 58%. The study involved people who were overweight (average body mass index of 34) and who had high -- but not yet diabetic -- blood sugar levels.

"We know it's true -- that if someone with diabetes loses 5% to 10% of their weight, they will significantly reduce their blood sugar," Nonas tells WebMD.

"We see it all the time: people can get off their insulin and their medication," she says. "It's wonderful. It shows you how interwoven obesity and diabetes are."

Even losing 10 or 15 pounds has health benefits, says the American Diabetes Association. It can:

• Lower blood sugar
• Reduce blood pressure
• Improve cholesterol levels
• Lighten the stress on hips, knees, ankles, and feet

Plus, you'll probably have more energy, get around easier, and breathe easier.

On a Diabetes Weight Loss Plan, Watch for Changes in Blood Sugar

Cutting back on just one meal can affect the delicate balance of blood sugar, insulin, and medication in your body. So it's important to work with an expert when you diet.

Check with your doctor before starting a diabetes weight loss plan, then consult with a diabetes educator or nutritionist, advises Larry C. Deeb, MD, a diabetes specialist in Tallahassee, Fla. and president-elect of the American Diabetes Association.

"Don't try to lose weight on your own," says Deeb. "With a doctor and a good nutritionist, it's very safe to do. This is very important if you're taking insulin or medications."

Go for the Right Balance in a Diabetes Weight Loss Plan

Christine Gerbstadt, MD, a spokeswoman for the American Dietetic Association, warns: "You don't want to run the risk of high or low blood sugar while you're dieting," she tells WebMD. "You want tight glucose control while you lose weight."

Gerbstadt suggests cutting 500 calories a day, "which is safe for someone with diabetes," she says. "Cut calories across the board -- from protein, carbohydrates, and fat -- that's the best way." She recommends that people with diabetes maintain a healthy ratio of carbs, fat, and protein. The ideal:

• 50% to 55% carbs
• 30% fat
• 10% to 15% protein

Watch the Carbs in a Diabetes Weight Loss Plan

For people with diabetes, a refresher course on carbs may also be in order, Gerbstadt says.

That's because carbs have the biggest effect on blood sugar, since they are broken down into sugar early in digestion. Eating complex carbs (whole-grain bread and vegetables, for example) is good because they are absorbed more slowly into the bloodstream, cutting the risk of blood sugar spikes, Gerbstadt explains.

"Worst case scenario is sliced white bread," she says. "Whole-wheat bread is an improvement. Adding a little peanut butter is even better."

Simply cutting lots of carbs -- a common dieting strategy -- can be dangerous, Gerbstadt says. When your body doesn't have carbs to burn for fuel, your metabolism changes into what's known as ketosis -- and fat is burned instead. You'll feel less hungry, and eat less than you usually do -- but long-term ketosis can cause health problems.

"Ketosis decreases oxygen delivery to the tissues, which puts stress on eyes, kidneys, heart, liver," Gerbstadt says. "That's why the low-carb, high-protein Atkins diet is not really safe for people with diabetes. Diabetics need to try to stick with a more balanced diet so your body can handle nutrients without going into ketosis."

Special Challenges when Following a Diabetes Weight Loss Plan

"For anyone, losing weight is challenging enough," Luigi Meneghini, MD, tells WebMD. Meneghini is director of the Kosnow Diabetes Treatment Center at the University of Miami School of Medicine. "For people who inject insulin, it's even more difficult because they have to eat when they have low blood sugar. When you have to reduce calorie intake, prevent overmedication, and eat to correct your low blood sugar, it's very challenging."

Indeed, both low and high blood sugar levels are the two big concerns for people with diabetes.

Low Blood Sugar (hypoglycemia) occurs when the amount of insulin in the body is higher than your body needs. In its earliest stages, low blood sugar causes confusion, dizziness, and shakiness. In its later stages, it can be very dangerous -- possibly causing fainting, even coma.

Low blood sugar is common when people lose weight because cutting calories and weight loss itself affect blood sugar levels. If you don't reduce your insulin dosage or pills to match new blood sugar levels, you'll be risking high blood sugar.

High Blood Sugar (hyperglycemia) can develop when your body's insulin level is too low to control blood sugar. This happens when people on insulin or sugar-lowering medications don't take the correct dose or follow their diet.

The Effects of Exercise on Diabetes

One of the benefits of exercise is that it helps keep your blood sugar in balance, so you won't have to cut as many calories.

"Walk an extra 20 minutes a day, and you can eat a little bit more," Gerbstadt explains, and instead of cutting 500 calories, "you can cut back just 200 or 300 calories, and still get excellent results in weight loss. You'll also control your blood sugar. And the weight will be more likely to stay off if you lose it slowly, safely."

Keep in mind: Each type of exercise affects blood sugar differently.
Aerobic exercise -- running or a treadmill workout -- can lower your blood sugar immediately.

Weight lifting or prolonged strenuous exercise may affect your blood sugar level many hours later. This can be a problem, especially when you're driving a car. It is one of the many reasons that you should check your blood sugar before driving. It's also a good idea to carry snacks such as fruit, crackers, juice, and soda in the car.

"With physical activity, you burn blood sugar as well as sugar stored in muscle and in the liver," explains Meneghini. "People using insulin or medications to simulate release of insulin should closely monitor blood sugar levels when they begin exercising more. Over time, as you exercise regularly, you can reduce doses of medications and insulin."

Getting Started on Your Diabetes Weight Loss Plan

Losing weight is never easy. That's where a diabetes educator or a nutritionist can help, advises Deeb A diabetes educator or nutritionist can develop a program that fits you and your lifestyle -- a program with realistic goals, he says.

"You will need a meal plan, one that you can follow every day. You'll need to know how to alter your insulin and medication based on what you're eating and whether you're exercising more," Deeb tells WebMD.

"That's the safest way to lose weight."

A consultation with a diabetes educator or dietitian/nutritionist can cost from $60-$70. Typically, insurance covers the first two visits, but may not cover additional visits, says Meneghini.

Reasonably priced diabetes support groups and classes are available, frequently through hospitals. Ask your doctor or physician assistant for recommendations.

There are also diabetes web sites with in-depth exercise and weight loss information, including:

• American Diabetes Association at http://www.diabetes.org
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) http://diabetes.niddk.nih.gov/

"Information is power, and the better informed you are, the better decisions you can make," says Meneghini.

By Jeanie Lerche Davis
WebMD Feature
Copyright ©2009, WebMD, LLC.

15 Must-Know Facts About Incontinence Surgery

Studies have found that 85 percent to 90 percent of women are completely dry within a year after surgery.

Think about your goals, and whether you might be able to achieve them without an operation.
"Everyone needs to make their own decision," says Harvey Winkler, MD, co-chief of urogynecology and director of female pelvic medicine and reconstructive surgery at North Shore–Long Island Jewish Health System in Great Neck, N.Y. Surgery is the best approach, he says, "if you're looking for the one-shot deal that's going to give you the best dryness option."
It's no guarantee of a cure, but studies have found that 85 percent to 90 percent of women are completely dry within a year after surgery.

Try Kegels first

Exercises to strengthen the pelvic floor, known as Kegels, are the most basic and noninvasive approach to treating stress incontinence.
If you're willing to do these exercises several times a day, indefinitely, you can expect a 70 percent improvement in your symptoms, says Dr. Winkler.
Consider bulking agents
There are outpatient procedures in which bulking materials like collagen or silicone are injected around the urethra. Although these procedures can offer short-term relief, especially for people who don't respond to surgery, they have to be done repeatedly because your body will eventually eliminate the injected material.
There also are several medications that are sometimes prescribed, including drugs for treating muscle spasms and antidepressants, but they tend to be more effective for treating mild or moderate stress incontinence.

The sling's the thing

The most popular surgical treatment for stress incontinence is the mid-urethral sling or tension-free sling procedure.
The surgeon loops a thin strip of material—usually synthetic mesh, but occasionally some of your own tissue or tissue taken from a cadaver——to support the bladder and urethra.
This helps you shut off the flow of urine when you sneeze, cough, or do something else that could cause leakage, says Thinh Duong, MD, an associate at Southern California Permanente Medical Group, in Los Angeles.

Mesh can be a problem

You may have heard warnings about the use of mesh in gynecological surgery. The FDA says side effects of mesh are potentially serious and include urinary problems, infections, and pain during sex, although it is still reviewing the risk associated with slings for incontinence.
Dr. Duong says the risk of complications is low for sling procedures because they require a relatively small piece of mesh (other procedures use larger pieces of mesh). In addition, synthetic materials that have been associated with higher rates of infection have been taken off the market.
Here are some important questions to ask your doctor before a procedure, according to the FDA.

Find the right surgeon

You should seek a surgeon who has done a fellowship in urogynecology or female pelvic medicine and reconstructive surgery, Dr. Winkler says. Ask how many procedures he or she does a year. Some gynecologists go to weekend training sessions to learn how to place a particular type of sling, but this isn't enough, Dr. Duong says.
It's also key, he says, to ask about the complications associated with the procedure, as well as which complications your potential surgeon has seen and how he or she dealt with them.

It's often an outpatient procedure

Sling procedures are often done on an outpatient basis, meaning you don't have to spend the night in a hospital.
They can be done under local anesthesia, Dr. Winkler says, whereas a different type of procedure called retropubic suspension is usually done under general or spinal anesthesia and involves a hospital stay.
Post-surgical pain can usually be tamed with ibuprofen, he says.

You may need a catheter at first

You may go home with a catheter after surgery if you have difficulty urinating on your own, or can only urinate very slowly.
You may need to use a catheter at first to empty your bladder a few times a day. Difficulty in urinating rarely persists, and you may need to have the sling readjusted or removed.

You'll need to limit activity

After surgery, you'll want to avoid stressing the surgical area so your body can heal. Your surgeon will advise you to avoid heavy lifting, exercise, having intercourse, or using tampons, typically for at least a couple of weeks.
If, at this point, you aren't leaking or experiencing pain, your doctor may allow you to return to your normal activities.
"I tell people to plan for a week off," says Dr. Winkler, although he says some of his patients have had the procedure on a Thursday and gone back to work on a Monday.


Complications are possible
As is the case with any type of surgery, complications — including bleeding, infection, or damage to surrounding blood vessels and organs—can occur.
Major complications, such as significant bleeding and blood vessel injuries, occur about 1 percent of the time, says Dr. Duong.
The mesh may also find its way out of the vaginal incision, and while this can be distressing, it's an easy complication to fix.

You may need a repeat surgery

About 15 percent to 20 percent of the time, the sling surgery is unsuccessful, and may need to be repeated.
You can take steps to help make the second surgery more successful, such as making sure you get adequate rest after the procedure, losing weight if you are overweight, not smoking, and keeping your pelvic muscles strong with Kegels. But if you did all these things and the surgery still didn't work for you, your chances might not be as good the second time around.
In general, Dr. Duong tells patients to expect a 50% to 60% success rate with repeat surgery.

It may change your life

Debbie S., 42, had been living with stress incontinence for years.
"I have four kids and I just was at the point where I couldn't sneeze or laugh without leaking," she recalls. After talking with friends, she opted for the sling. "It's just a quick, easy, in-and-out procedure," she says.
"It was actually, literally, a life-changer," says Debbie, about a year after having the surgery. She says she can now enjoy a good laugh with no fear of leaking. "I would really recommend it to anybody."

Surgery is less common for urge incontinence

Behavioral therapy, physical therapy, and medication are still the first-line therapies for urge incontinence, which is most common in the elderly and involves frequent urination with little warning.
Medications for urge incontinence, which can be caused by overactive bladder, usually work by relaxing the overly twitchy organ.
Bladder training, which involves teaching yourself to urinate less frequently, can also be effective.

Tibial nerve stimulation

Insurers recently started covering a technique called tibial nerve stimulation, in which a needle containing an electrode is placed near your ankle, stimulating one of the nerves responsible for bladder control.
A 2010 study found that about half of people reported a significant improvement in their urge incontinence symptoms after 12 weeks of once-weekly half-hour sessions, compared with 20 percent of people in the placebo group.

Anne Harding (from MSN/Health)

Copyright © 2009 Health Media Ventures, Inc. All rights reserved.