Type 1 Diabetes; Do Not be Caught Unawares

Diabetes mellitus, more commonly referred to as Diabetes, is a group of related diseases in which a person’s blood sugar level is higher than normal. This occurs either because the body cannot produce enough insulin or, the insulin being produced is not used by the body efficiently. Glucose is used by the body to provide the energy which enables us to perform all of our regular bodily functions. It is manufactured by the liver and derived from the foods we eat. The hormone insulin is produced by the pancreas and enables the cells of the liver, muscle and fatty tissue to extract the glucose from the blood and store it in the liver and muscles. When the body does not produce enough insulin, or if the insulin does not function the way it should, the glucose remains in the blood stream instead of being absorbed into the cells. Your blood glucose level then becomes elevated resulting in pre-diabetes or diabetes.

Type 1 diabetes occurs when the body produces little or no insulin and is most common in children, adolescents, or young adults. (aka: juvenile diabetes and insulin-dependent diabetes mellitus). Its exact cause is yet to be determined but it is believed that the body's white blood cells attack the insulin-producing pancreatic beta cells and within a period of 5 - 10 years the beta cells are completely destroyed and the body no longer produces insulin.

Symptoms

While some people will have no symptoms others may experience:

• Feelings of tiredness or fatigue
• Increased appetite
• Constant thirst
• Urinating very often
• Weight loss without trying
• Blurred vision
• Loss of feeling or tingling in the feet
•  Deep, rapid breathing
• Dry skin and mouth
•  Increased pulse rate
•  Nausea or vomiting
•  Stomach pain

Complications

Over time, if left untreated high blood glucose levels can become life threatening or lead to severe disabilities such as:

•  Kidney disease and kidney failure (diabetic nephropathy)
•  Damage to the blood vessels that supply the legs and feet (peripheral vascular disease)
• Pain and numbness to the feet, stomach and intestines, heart, and other body organs as a result of nerve damage (diabetic neuropathy)
• Stroke and increased risk of a heart attack.
• Worsening of eyesight or blindness due to eye disease (diabetic retinopathy)
• Swelling or thickening of the eye's macula (the part of your eye responsible for detailed, central vision)
• Foot sores or ulcers (which can result in amputation)
• Infections to the skin, female genital tract, and urinary tract
• High blood pressure
• High cholesterol
• Erectile dysfunction

 Treatment

Type 1 diabetes may develop within a relatively short time span and can be very severe at its onset, oftentimes requiring treatment at a medical facility. It’s a chronic (lifelong) disease which is not preventable and for which there is no cure to date. However, good diabetes care and management can prevent or delay the onset of more serious complications associated with this disease. Presently the only form of treatment is by introducing insulin through injections or an insulin pump. The pump delivers the insulin continuously while injections must be taken from one to four times a day.

Selfcare

It is extremely important that the diabetic person be proactive in learning how to manage their illness. Following the proper procedures will enable you to live a long, healthy and relatively normal life. It all begins with regular self-monitoring of your blood sugar level through the use of a blood glucose meter, lancet and test strip and the keeping of accurate records of your test results (this provides a means for your doctor to determine how well his recommendations are working). Along with taking your insulin you need to:

• Have a balanced meal plan
• Maintain a healthy weight
• Be physically active
• Maintain your cholesterol and other blood fats in your target range
• Maintain your blood pressure at or close to target level
• Manage your stress effectively
• Regularly visit your dentist, doctor and optometrist/ophthalmologist.
• Check and care for your feet daily

It is vital that you constantly be aware of your blood sugar level and consult your doctor, health care provider or 911(depending on the severity) at the first signs that something is awry. Should you experience: blood sugar levels which are higher than the goals set by your doctor, shortness of breath, extreme thirst and drinking and frequent urination, severe abdominal pain, numbness, tingling, pain in your feet or legs, spasms characterized by sensations of choking or suffocating, severe nausea and vomiting, and inability to drink liquids or eat.


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Your heart medication is more effective at bedtime

Paul Taylor: Globe and Mail Update

A new study on heart medications adds credence to that old saying, “timing is everything.”

Canadian scientists found that drugs known as ACE inhibitors – used to treat high blood pressure and heart failure – are far more effective when taken before going to sleep. In fact, when administered during wake time, they are no better than placebos, according to the findings published in the Journal of the American College of Cardiology.

This new study is part of a burgeoning field of research known as chronotherapy, in which medical treatments are timed to correspond with the body’s natural 24-hour circadian rhythm.

The researchers at the University of Toronto and the University of Guelph already had good reason to believe the principles of chronotherapy may apply to these drugs. Previous research has shown that the cardiovascular system goes through a daily cycle, with blood pressure normally rising in the morning and dipping at night.

For their study, they gave a short-acting ACE inhibitor, called captopril (brand name Capoten), at different times of day to laboratory mice with high blood pressure. Heart tissues from the rodents were then examined as part of the analysis.

“We found that when we gave this drug at sleep time, the structure and function of the heart was significantly improved,” said the study’s lead author, Tami Martino of the University of Guelph. However, when the drug was given while the rodents were awake, it seemed to “have no effect at all” in terms of protecting the heart from the damage caused by high blood pressure, she added.

Although the study involved rodents, the researchers are confident the results also apply to people. “I wouldn’t have any hesitation saying that, in most cases, you should give ACE inhibitors at night to patients with hypertension,” said Michael Sole, the study’s senior author who works at the Peter Munk Cardiac Centre at the University Health Network in Toronto.

He noted that many people diagnosed with hypertension suffer from high blood pressure during the day as well as the night. But elevated blood pressure at night is especially harmful because the heart is never given a chance to recuperate. “Sleep is not just for the brain; it is a very important period when our organs – including the heart – undergo repair,” said Dr. Sole.

Pharmaceutical companies have introduced long-acting ACE inhibitors – such ramipril (Altace) and enalapril (Vasotec) – to control blood pressure for extended periods and keep the body on an even keel. But these medications can cause serious side effects – including kidney problems – in some patients.

Dr. Sole said it may be better to use a short-acting medication, like captopril, at night when the heart is in “repair mode” particularly in patients who find it hard to tolerate the side effects.

“If you time the drugs to match the body’s natural physiology you can make them more effective,” added Dr. Martino.

Unfortunately, the researchers noted, many patients who are prescribed long-acting ACE inhibitors take them in the morning, reducing the drug’s potential benefit because the medication wears off during the night.

When hypertension is uncontrolled or poorly managed, it can lead to heart attacks, strokes and kidney damage.

What to do to stop prediabetes from becoming diabetes.

By Winnie Yu
WebMD Feature

Reviewed by Laura J. Martin, MD

 

If you’ve just learned you have prediabetes, you’re not alone. According to the American Diabetes Association, there are 79 million people in the U.S. who have elevated blood sugars, but who don’t yet qualify for a diagnosis of diabetes. About 11% of people with prediabetes go on to develop type 2 diabetes within three years.

The same factors that cause prediabetes also cause diabetes. That includes lifestyle (diet and physical activity) and any risk you inherited from your family. Prediabetes can be diagnosed based on various blood tests, including the fasting blood glucose test, the oral glucose tolerance test, and the A1C glycated hemoglobin blood test. The results of those tests, in someone with prediabetes, are out of the healthy range but fall short of the diabetes range.

As scary as a prediabetes diagnosis might be, it’s best to treat this news as a wake-up call. “It’s an opportunity to initiate lifestyle changes or treatments, and potentially retard progression to diabetes or even prevent diabetes,” says Gregg Gerety, MD, chief of endocrinology at St. Peter’s Hospital in Albany, N.Y. “We know this not only through supposition but from clinical research.”
Tackling prediabetes with lifestyle changes is often the best way to start. Here’s what experts recommend you do to stop the progression to diabetes:

1. Become More Active

Regular physical activity is critical to reducing your risk for developing diabetes. But if it's been a while since you exercised, start by building more activity into your routine by taking the stairs or doing some stretching during TV commercials, says Patti Geil, MS, RD, CDE, author of What Do I Eat Now?
Let your doctor know that you're planning to start adding more activity to your day -- your doctor should be one of your biggest fans.
“Physical activity is an essential part of the treatment plan for prediabetes because it lowers blood glucose levels and decreases body fat,” Geil says. Ideally, you should exercise at least 30 minutes a day, five days a week.
Can’t commit to a regular workout? Want to squeeze in more activity? Consider wearing a pedometer and tracking your steps. “Walking 10,000 steps a day is the equivalent of walking about five miles,” Geil says.

2. Lose Some Weight.

You don't have to whittle yourself down to your ideal weight. Losing relatively small amounts of weight can make a difference.
The Diabetes Prevention Trial found that people who had prediabetes who did 30 minutes a day of moderate exercise and lost 5% to 7% of their body weight were able to cut their odds of getting diabetes by 58%. For someone who weighs 200 pounds, that means losing just 10-14 pounds.

3. See Your Doctor More Often

People with prediabetes need more than an annual check-up. They should see their doctors every three to six months, Gerety says. “Regular check-ups affirm and encourage patients to go in that direction and provide some barometers for success,” he says.
Patients who are doing well can get positive reinforcement from their doctors, while those who are not can get back on track. “Patients like some tangible evidence of success or failure,” Gerety says.

4. Eat a Healthy Diet

Break it down into simple steps:

• Load up on fruits and vegetables, especially the less-starchy kinds such as spinach, broccoli, carrots, and green beans. 
• Build more high-fiber foods into your day. 
• Choose whole grain foods instead of processed grains -- for example, brown rice instead of white rice.

Also, swap out high-calorie foods. “Drink skim milk rather than whole milk, diet soda rather than regular soda,” Geil says. “Choose lower-fat versions of cheese, yogurt, and salad dressings.”
And be smart about your snacks. Rather than nosh on high-fat, high-calorie chips and desserts, try eating fresh fruit, whole-wheat crackers with peanut butter or low-fat cheese, Geil says.
Your doctor or a registered dietitian should be able to give you advice specific to your needs.

5. Get Support and Get Informed

Losing weight, eating a healthy diet, and exercising regularly isn’t easy. But it's a lot easier if you have people helping you out, holding you accountable, and cheering you on, says Ronald T. Ackermann, MD, MPH, an associate professor of medicine at Indiana University School of Medicine.
Consider joining a group where you can pursue a healthier lifestyle in the company of others with similar goals.
A certified diabetes educator may also help you learn about what you need to do to prevent your prediabetes from becoming diabetes. You can find one at the American Association of Diabetes Educators at www.diabeteseducator.org.

6. Make Sleep a Priority

Not getting enough zzzzzs on a regular basis doesn’t just make you tired and grumpy. It also increases stress hormones in your body, which causes the body to store fat and make it hard for you to lose weight, says Theresa Garnero, APRN, BC-ADM, MSN, CDE, author of Your First Year With Diabetes (American Diabetes Association). It also interferes with your body’s ability to use insulin effectively, and may be a risk factor for prediabetes and type 2 diabetes.
To help establish good sleep habits, go to bed and wake up at the same time every day. Wind down before you turn out the lights. Use the bedroom for sleep and sex only. Minimize caffeine after lunch if you have trouble sleeping.

7. Upgrade Your Outlook

Having the right mindset can help you tackle prediabetes. That means nixing blame and making a commitment to the best choices for your health, Garnero says.
Accept that you won’t do things perfectly every day, but pledge to do your best most of the time.
“Make a conscious choice to be consistent with everyday activities that are in the best interest of your health,” Garnero says. “Tell yourself, ‘I’m going to give it my best. I’m going to make small changes over time.

Good habits are key to diabetes management

By Dr. Jeffrey Freeman

If you have diabetes, you know that it can affect every area of life. People with diabetes must be vigilant about their health, to maintain good quality of life and prevent potential diabetes complications.

More than 25.8 million people in the United States have diabetes, 7 million people are undiagnosed, and 1.9 million people have been diagnosed with diabetes in 2010, according to the American Diabetes Association. Because diabetes increases the risk of other serious, chronic conditions and terminal diseases, it's critical to make a commitment to healthier habits to delay the onset of the long-term effects of diabetes and related diseases.

Common diabetic complications include:

Kidney disease. Diabetes can damage the blood vessels in your kidneys, making it harder for them to filter waste. Each year, more than 100,000 U.S. residents are diagnosed with kidney failure and diabetes is the most common cause. This is why some diabetics eventually need dialysis, or in severe cases, a kidney transplant.

Cardiovascular disease. Diabetes increases your risk for heart disease and stroke, particularly if you smoke, have high blood pressure, are overweight or have a family history of heart disease. It is not uncommon to have both high blood pressure and diabetes — which more than doubles the risk for cardiovascular disease, according to the American Heart Association. The risk of stroke is also two to four times higher among people with diabetes.

Eye problems. Diabetes can damage the retina, causing fluid leakage and swelling in the eye that can lead to blurry vision and, in severe cases, blindness. In fact, diabetes is the number one cause of blindness in adults ages 20 to 74.

Nerve damage. Nearly 70 percent of people with diabetes have nervous system damage. This can include impaired sensation or pain in the feet or hands, slowed digestion of food, carpal tunnel syndrome, erectile dysfunction, or other nerve problems. The loss of feeling in the legs and feet can be particularly dangerous, because this make it hard to tell if there is a foot sore or an injury. Sores can become infected — in some cases resulting in a foot or leg amputation. Good foot health is critical for diabetics.

People with diabetes are susceptible to a host of other health issues as well, including gum disease, pregnancy complications, and a weakened immune system, making them more susceptible to illnesses like pneumonia or the flu.

Diabetes is a complex condition to manage, so your doctor will probably involve other professionals in your care: a nutritionist or dietitian, certified diabetes educator, and other specialists such as an eye doctor, an endocrinologist (a doctor who specializes in hormonal disorders), a podiatrist (a foot doctor), a dentist, and possibly, an exercise trainer. If you are a diabetic, you should see your doctor every four to six months if your treatment involves oral medication or diet — or every three to four months if you're receiving insulin shots. This is however, at the discretion of your physician. At each visit, your doctor will test your blood, check your blood pressure and your feet, and discuss your general well-being, including any recent illnesses or unusual symptoms.

Whether your diabetes diagnosis is recent or you have had diabetes for years, diabetes management begins with controlling your blood sugar. Keeping blood sugar near normal helps reduce risks for diabetes complications. A healthy diet, regular exercise, and weight maintenance are imperative. Regular checks of your blood sugar level — which show the effect of your diet, exercise and any prescribed medication — also provide an overview of how well you're controlling your diabetes.

You should test your blood sugar regularly at home, and your doctor will check it during scheduled exams. Your doctor will provide guidance on how often and when to check your blood sugar level and will recommend a target level based on your health history and treatment plan. If you cannot control your blood sugar with diet and exercise alone, your doctor may prescribe medication or insulin injections.

Dr. Jeffrey Freeman is a graduate of the College of Osteopathic Medicine and Surgery, Des Moines, Iowa. He completed a rotating internship at Pontiac Osteopathic Hospital, Pontiac, Mich., and a residency in internal medicine at John F. Kennedy Memorial Hospital. He is board certified in internal medicine and endocrinology and metabolism by the American Osteopathic Board. Freeman has been a member of the Pottstown Memorial Medical Center medical staff since March 1996.

Treatment options for women suffering from incontinence

By E. William Johnson, MD, MPH

Atlantic Urology Associates, Core Physicians

Female incontinence is a common problem among women of all ages and can be extremely debilitating. Some women find themselves having to get up several times during the night, while others find themselves using the bathroom every hour.

Others find themselves embarrassed by uncontrollable leaking when laughing, coughing or sneezing. This condition often becomes disruptive to their lives as women plan their days around bathroom locations. The sense or feeling of needing to go to the bathroom may be constantly in their mind.

Although this is upsetting, some women may feel unsure about speaking to their physician about the problem or worry that there is little more they can do than wear a protective undergarment. Others may feel that this is a normal thing to experience after having a baby, entering menopause or a part of aging they cannot control. Women may give up after the first medication they tried did not work.

While one medication may not work for every woman, there are a number of treatment options and lifestyle changes women can make to help decrease these episodes of incontinence.

Initially, you should speak with your primary care provider about your concerns related to incontinence. If appropriate, you will be referred to a urologist, a physician who specializes in the diagnosis and treatment of diseases of the urinary tract and urogenital system.

When you meet with a urologist, the urologist will begin to determine the type of urinary incontinence that you are experiencing. A urodynamics study that measures how the bladder and urethra are performing their job of storing and releasing urine may be employed in making a diagnosis. This study can help your urologist understand how well your bladder and sphincter muscles work.

As the urologist works to determine what is causing your incontinence, you may be asked to keep a journal of your diet and fluid intake to determine if your diet, drinking habits or medications may be partially responsible. For example, certain foods are known to irritate the bladder and avoiding or consuming them in moderation may help decrease symptoms. Some foods that are considered bladder irritants include: chocolate and spicy foods such as peppers, chili or curry powder and tomatoes. Drinks that may irritate your bladder include coffee, tea, soft drinks, chocolate milk, citrus juices and all alcoholic beverages. Certain medications may also affect bladder function such as painkillers, cold and allergy medications, stimulants and some prescriptions.

The urologist will approach your treatment plan based on the kind of incontinence you are experiencing. The first type is stress incontinence, which occurs when you have a "leak" when coughing, laughing or sneezing. Some women experience this during pregnancy or after childbirth. Another type of incontinence is urge incontinence, which is also known as overactive bladder. Women find they have to go all the time and often have a hard time making it to the bathroom. Many women have a mixed diagnosis with both urge incontinence and stress incontinence. Incontinence can be caused by nerve problems, bladder muscle wall problems or over stimulation of the bladder.

One thing a urologist might suggest in cases of stress incontinence is that you begin using Kegel exercises to strengthen the pelvic floor or work with a physical therapist who may offer other exercises to strengthen those muscles to help lessen these episodes. There are no medications for stress incontinence, but there are prescription medications that might help women with urge incontinence. Although some women may experience side effects such as dry mouth or constipation when taking these medications, many women have successfully decreased the symptoms of urge incontinence when using these medications.

Patients with stress incontinence who do not experience relief after physical therapy may be candidates for a urethral sling, which is placed inside the vagina and under the urethra during an outpatient procedure in the operating room.

A device that emits a constant low level stimulation to the nerves of the bladder may be an option for women with urge incontinence, whose symptoms have not improved after diet or lifestyle changes. By targeting the communication problem between the pelvic nerves and the bladder, the device is able to calm the bladder, which helps decrease the frequent urge to go. The device functions on its own, and can be adjusted using an external device, similar to how a pacemaker works. This minimally invasive procedure is done in an outpatient setting and it takes less than one hour to place the device in your body. Like medication, this treatment approach may not work for everyone.

One other new treatment that has yielded positive results in women employs acupuncture for the bladder by stimulating the ankle nerve. The treatment includes 30-minute treatments in the doctor's office or clinic every week for 12 weeks.

Women are twice as likely as men to experience urinary incontinence, but it does not have to be part of your life permanently. If you have been carrying the burden of living with urinary incontinence in silence, make an appointment to see your primary care provider or a urologist. Whether you need to simply modify your diet, try medication or eventually decide to try the new minimally invasive treatments for incontinence, there are many options available to help you live an active and healthy life free from incontinence.

E. William Johnson, MD, MPH, is a urologist with Atlantic Urology Associates, a Core Physicians' practice with locations in Exeter, Portsmouth and Plaistow. Dr. Johnson's philosophy is to treat each patient as if he were treating a family member by considering both the total pictures of their lives and their long term outcomes. His goal is to provide patients with the most up to date care and treatment options in a compassionate and personal manner. For information, call 658-1277 or visit www.corephysicians.org.