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Monday, December 19, 2011

Taking care of diabetes during holidays

More than 20 million Americans are living with diabetes, and another 40 million are in the early stages of the disease. Managing diabetes can be a challenge all year long, but the holidays can pose special problems. All those extra treats, meals and drinks can add up to extra pounds and higher glucose levels. But a little planning, and will power, can keep diabetes in check, according to Susan Steinweg, a registered nurse and a certified diabetes educator. She's also the coordinator of Carroll Hospital Center's Diabetes Center.

Why are the holidays a particularly perilous time for those with diabetes?

Typically, the holidays are a time for traditions, family and food, and nurturing through food is a common theme. Individuals with diabetes often feel obligated to partake of these tempting delicacies, and once they do, like all of us, they often overindulge. This overindulgence can lead to weight gain and blood glucose level elevations.

What is a good strategy for handling the season?

Do not go to any holiday gatherings "starving." Have a healthy snack before attending. Bring a platter of fresh-cut vegetables with low-fat dip to share and to nibble on. Choose only the food items that are "worth it" and sample them. Do not feel obligated to try everything or to eat everything once you have put it on your plate.

When not at parties or gatherings, continue to be careful with your food choices and increase your activity level. Walking is a great way of burning calories that otherwise would be stored as fat, resulting in weight gain.

What happens if you do overindulge at a party? Do drinks count?

Strive not to overindulge at a party. You will feel sluggish and tired as a result, and you will lack energy to participate in holiday activities. Most folks regret overeating mentally and physically. However, if you should overindulge, exercise more and cut back on portion sizes throughout your day.

Alcoholic beverages do count. Your body recognizes alcohol as a toxin and immediately tells the liver to "detoxify" the alcohol. The calories are immediately stored as fat. People living with diabetes must be especially careful when consuming alcohol, as their blood glucose could drop suddenly, causing safety issues, including loss of consciousness, falls and accidents.

People with diabetes should always include a light snack when consuming alcohol to prevent sudden drops in their blood glucose. Many alcoholic beverages contain sugary mixes and fruit juices, which also will affect a person's blood glucose in a negative way. So stick to one light beer or a glass of wine, and avoid mixed drinks unless they are mixed with diet tonic. One mixed drink (with diet tonic) should be the "limit."

What about pre-diabetes?

Like all of us, people with "pre-diabetes" need to also pay particular attention to their intake over the holidays. Pre-diabetes is the state that occurs when a person's blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. In other words, it is the very early stages of diabetes. Most people with "pre-diabetes" have an opportunity to slow their progression to diabetes by eating well, exercising and losing 5 percent of their body weight. Though it may not be realistic to lose weight during the holidays, certainly focusing on making healthy choices, cutting portion sizes and getting plenty of exercise can be steps in the right direction.

What are the long-term repercussions for those who don't manage their disease well?

Diabetes is a sneaky disease. Early on in their diagnosis, most folks do not notice any symptoms of diabetes. They spend some time in denial doubting that they even have it. It is hard to believe that you have diabetes if you don't feel any different, and that makes it easy to ignore.

However, diabetes that is not well controlled can lead to serious complications. These very debilitating complications can include heart and circulatory issues, kidney disease, eye disease, neuropathy ("pins and needle" sensations, pain, burning in the hands and feet) and erectile dysfunction.

Early diagnosis, education and support from certified diabetes educators are essential. We help people understand their diabetes — how to monitor their blood glucose levels using a meter and how to care for themselves, for example —and we're here to answer any diabetes health-related questions they may have.

Diabetes is hereditary, so if you have diabetes, make sure your loved ones are screened regularly

Tuesday, December 13, 2011

12 Tips to Avoid Diabetes Complications


1. Choose Carbs Carefully

Diabetes doesn't mean you have to cut carbs completely. Choose carbohydrates that break down in the body slowly, providing steady energy. Reach for whole grains, beans, nuts, and fresh vegetables and fruits. Yes, you can eat fruit even though it's sweet. It's about eating the right amounts of carbohydrates at each meal. A registered dietitian can help you learn how much is right for you.

2. Lose Weight If You Need To

Start small. If you are overweight, shedding just a few pounds can improve the body's ability to use insulin. It'll help lower your blood sugar and improve your blood pressure and blood fats. You'll also have more energy. Ready? Aim to burn more calories than you eat. To start, try cutting fat and calories from your diet, such as chips or fries.

3. Get Enough Sleep

Getting too much or too little sleep can increase your appetite and cravings for high-carb foods. That can lead to weight gain, increasing your risk for complications such as heart disease. So shoot for seven or eight hours of sleep a night. If you have sleep apnea, treating it can improve your sleep and lower your blood sugar levels.

4. Be Active: Exercise and Diabetes

Pick something you like -- walking, dancing, biking, or just marching in place while you're on the phone. Do it a half-hour a day; work up to that if you need to. Exercise can help you lower your cardiovascular risks, cholesterol, and blood pressure levels, and keep your weight down. Exercise also relieves stress and may help you cut back on diabetes medication.

5. Monitor Your Blood Sugar Daily

You know you're supposed to check it. And actually checking your blood glucose levels can help you avoid diabetes complications, like nerve pain, or keep them from getting worse. Checking it can also help you see how foods and activities affect you, and if your treatment plan is working. Your doctor can help you set a target glucose level range. The closer you get to your target, the better you'll feel.

6. Manage Stress

When you have diabetes, stress can cause your blood glucose levels to rise. Get rid of whatever physical or mental stresses you can. Learn coping techniques to deal with others. Relaxation techniques such as breathing exercises, yoga, and meditation may be especially effective if you have type 2 diabetes.

7. Say No to Salt

Reduce the salt in your diet. It may help lower blood pressure and protect your kidneys. Not salting the food on your plate may not be enough. Most of the salt in Americans' diets comes from processed foods. Avoid convenience foods and use fresh ingredients when you can. Season with herbs and spices instead of salt when you cook.
Adults age 51 and older, and individuals with high blood pressure, diabetes, or chronic kidney disease should reduce their sodium intake to 1,500 mg a day -- that's less than half a teaspoon of salt.

8. Heart Disease Risk and Diabetes

Heart disease can be a serious diabetes complication. Keep an eye on your risk by getting these ABCs checked:
A1C level. This is a measure of your average blood sugar control for the last 2-3 months. You may need it checked two or more times a year. Talk to your doctor about setting a goal.
Blood pressure. Goal: below 130/80 mm Hg.
Cholesterol. Goal: LDL below 100 mg/dl; HDL above 40 mg/dl; and triglycerides below 150 mg/dl.

9. Take Care of Bumps and Bruises

Diabetes raises your risk of infection and slows healing, so treat even simple cuts and scrapes quickly. Properly clean your wound and use an antibiotic cream and sterile bandage. See a doctor if it's not better in a few days. Check your feet every day for blisters, cuts, sores, redness, or swelling. Moisturize them to prevent cracks.

10. Break Your Smoking Habit

People with diabetes who smoke are two times more likely to die prematurely than those who don't. Quitting helps your heart and lungs. It lowers your blood pressure and risk of stroke, heart attack, nerve damage, and kidney disease. Ask your doctor about help for quitting tobacco.

11. Pick Super Foods, Don't Supersize

There's no single diabetes diet. But here are basics to keep in mind: Enjoy super foods like berries, sweet potatoes, fish with omega-3 fatty acids, and dark green, leafy vegetables. Look at food labels and avoid saturated fat and trans fats. Instead, opt for mono and polyunsaturated fats like olive oil. A registered dietitian can give you personalized advice.

12. Set Up Doctor Visits

Expect to see your doctor two to four times a year. If you take insulin or need help balancing your blood sugar levels, you may need to visit more often. Also get a yearly physical and eye exam. You should be screened for eye, nerve, and kidney damage, and other complications. See a dentist twice a year. And be sure to tell all health care providers that you have diabetes.

Reviewed by Brunilda Nazario, MD on September 09, 2011
© 2011 WebMD, LLC. All rights reserved.












Tuesday, December 6, 2011

Diabetes: Treating Wounds and Injuries

No matter how small or superficial a wound is, you should not ignore it if you have diabetes, says Daniel Cohen, DPM, a podiatrist with Medical Associates of Brevard in Brevard County, Fla. If you stub your toe, get a blister from tight shoes, or nick your chin while shaving, you probably give it little thought. But if you have diabetes, you should seek proper treatment.
Knowing how to treat minor wounds will help you avoid infection and speed healing.

Why Diabetic Wounds Can Cause Problems

Diabetes is a chronic disease where your body can't use glucose, or sugar, the way it should. It can cause a number of complications, including some that make it harder for wounds to heal. These include:
  • Nerve damage (neuropathy). When you have neuropathy, you may not feel the pain of a cut or blister until it has grown worse or become infected.
  • Weakened immune system. When the body's natural defenses are down, even a minor wound may become infected.
  • Narrow arteries. People with clogged arteries in their legs are more likely to develop wounds, have severe wound infections, and have problems healing. Narrowed arteries makes it harder for blood to get to the wound. Blood flow promotes healing, so anything that blocks it can make wounds more likely to become infected.

How to Treat a Diabetic Wound

If you have a wound, no matter how small, take the following steps to avoid infection and promote healing:
  • Take care of the wound immediately. Even a minor wound can become infected if bacteria are allowed to build up after injury.
  • Clean the wound. Rinse the wound under running water to remove dirt. Don't use soap, hydrogen peroxide, or iodine, which can irritate the injury. Then apply antibiotic ointment to prevent infection, and cover the wound with a sterile bandage. Change the bandage daily, and use soap to clean the skin around the wound. Inspect your wound daily for any signs of infection.
  • See your doctor. Don't take any chances -- have your doctor check minor skin problems or areas of redness before they turn into larger problems. Err on the side of caution, says podiatrist and wound specialist Robert Snyder, DPM, medical director of the Wound Healing Center at University Hospital in Tamarac, Fla., and incoming president of the American Academy of Wound Management in Washington, D.C. "It's far easier to treat a minor skin problem before it becomes serious," he says.
  • Keep pressure off the wound as it heals. For example, if your wound is on the bottom of the foot -- a common place for diabetic people to develop calluses and blisters -- stay off it as much as possible so it will have a better chance to heal, says Snyder.

Foot Wounds Are Dangerous

Feet and ankles are particularly vulnerable to diabetic wound problems, according to Cohen. "Wound healing below the knee is a different dynamic than in other parts of the body," he says. "These areas are prone to swelling, which can inhibit healing. Also, if you have a wound on your arm, you can immobilize it. This is much harder with a foot wound."
But it's not easy for people with diabetes to avoid foot wounds because they are more likely than other people to have calluses, dry skin and nerve damage. All of these combined  can lead to an increased risk of ulcers (open sores) and can lead to infections. Along with loss of  feeling in their feet, many people with diabetes also have vision problems. So they may neither feel nor see a small wound until it becomes serious, says Snyder.  
A wound that becomes serious may do more than cause pain and inconvenience. It may cause so much damage to tissue and bone that amputation becomes the only option.
Research shows that an ulcer precedes most lower limb amputations in people with diabetes. That's why it's so important to care for a wound before it becomes serious -- or, if at all possible, prevent wounds in the first place.

How to Prevent Wounds

The best way to avoid wound problems is to prevent wounds in the first place:  
  • Check your feet daily. Look for blisters, calluses, chafing, and redness. "This is the single most important thing you can do to avoid diabetic foot problems," says Cohen. If you have trouble seeing, have someone else check your feet every day.
  • Pay attention to your skin. Check for small, seemingly minor skin problems like infected hair follicles or inflamed areas around the fingernails. If you notice a problem, speak with your doctor.
  • Moisturize your feet. Use moisturizer to keep the skin on your feet soft and supple. But don't use lotions between your toes because this can lead to an fungal infection. To treat athlete's foot, Cohen recommends using a gel rather than a cream antifungal product because gels don't leave a moisture residue between the toes.
  • Wear proper footwear. Wearing well-fitting shoes can help you avoid blisters. Closed-toe shoes reduce the risk of foot injury. "We advise our patients to wear close-toed shoes, even around the house, " says Cohen. If you have trouble finding shoes that fit properly, speak to your doctor. You may need a custom-made shoe.
  • Inspect your shoes every day. People with diabetic neuropathy may walk around with a pebble or other object in their shoe without knowing it is there, says Snyder.  You should also check for tears or rough areas on the inside of the shoe.
  • Choose the right socks. Buy socks that wick moisture away from skin.  Avoid socks with seams. Socks made specifically for people with diabetes are available in many specialty stores and online.
  • Wash your feet daily. After washing, dry them carefully, including between the toes.
  • Smooth away calluses. After your bath or shower, use an emery board or pumice stone to gradually remove calluses. Never cut calluses with  scissors or a nail clipper.
  • Keep toenails clipped and even. Ingrown toenails can lead to foot problems. Have your doctor check your feet regularly.
  • Manage your diabetes. Preventing serious foot wounds also means keeping your diabetes under control. This includes monitoring blood sugar, blood pressure, and cholesterol levels; eating healthfully; taking the medications your doctor prescribes; exercising regularly; not smoking; and having regular medical checkups.
Snyder emphasizes the importance of consistent preventive care for people with diabetes. "If you have diabetes, you should have a team of specialists who you see for regular medical checkups, including a podiatrist and an ophthalmologist, as well as your primary care doctor," he says.

By Constance Matthiessen
© 2010-2011 WebMD, LLC. All rights reserved.

Monday, December 5, 2011

The Dangers of Prehypertension

It's Not High Blood Pressure, Yet, but You Still Need to Address It

Is your blood pressure creeping up? ... Not quite in the high blood pressure range, but not normal, either?
That's prehypertension. And though it's not high blood pressure -- yet -- it may not be as harmless as you thought.
Here's what you need to know about prehypertension, and why you need to nip it in the bud.
First, the numbers:
  • Normal blood pressure is below 120/80.
  • Prehypertension is blood pressure that ranges from 120-139 for the top number or 80-89 for the bottom number.
  • High blood pressure (hypertension) is 140 or higher for the top number, or 90 or higher for the bottom number, or you are taking a blood pressure medication.
The top number is your systolic pressure, which is the force of blood against your arteries as your heart beats. The bottom number is diastolic pressure, which is the pressure on your arteries when your heart relaxes between beats.

Stroke Risk

Having prehypertension may make you more likely to have a stroke, especially in people younger than 65, a recent study shows.

"If you have prehypertension, and you're under 65, it really matters," says researcher and neurosciences professor Bruce Ovbiagele, MD, of the University of California, San Diego. "Most people who get to 65 already have hypertension."

Ovbiagele's team also found that stroke was more likely for people at the upper end of the prehypertensive range. But even if your blood pressure is not that high, it's wise to take action if your blood pressure is heading in the wrong direction.

"No matter what you consider your break point, any increase in blood pressure is generally a bad thing," says Richard Stein, MD, who directs the exercise, nutrition, and cardiovascular program at New York University's Center for Prevention of Cardiovascular Disease.

"It's causing the heart muscle to beat against a higher pressure, so [the heart] is becoming thicker," Stein says, adding that high blood pressure is also stressful for the kidneys.

Becoming More Common

More than a quarter of U.S. adults -- 28% -- have prehypertension, according to CDC estimates. About 20% of people who have prehypertension will go on to develop hypertension, Ovbiagele says. High blood pressure is the leading cause of stroke and also a major risk factor for heart disease and kidney damage.

Prehypertension and hypertension are on the rise. They've become more common as the U.S. becomes more obese and sedentary, Stein says. You're also more likely to get prehypertension if you have diabetes, high cholesterol, or a family history of high blood pressure, Stein says.

Prehypertension is a particular problem among African-Americans. Researchers have reported that African-Americans with prehypertension develop high blood pressure a year sooner than Caucasians. Although the reasons why are unclear, experts do know that "blood pressure is very difficult to control in African-Americans," Ovbiagele says.

Stealth Threat

Prehypertension, like hypertension, doesn't show signs or symptoms. Many people don't know they have it, and doctors often overlook it, Ovbiagele says.

How do you know if you have it? The only way to know is to check your blood pressure, Stein says. In otherwise healthy people, elevated systolic and/or diastolic blood pressure on two separate occasions -- taken two or three days apart -- is enough to be diagnosed with high blood pressure. You can take your blood pressure at home with a blood pressure monitor, or use the machine at your local pharmacy or grocery store, if it has one.

If it's consistently within the prehypertension range, tell your doctor so that you can get it under control before it becomes hypertension.

Taking Charge of Your Blood Pressure

The good news is, you can slow the progression to hypertension. Here's what experts recommend:
  • Eat healthfully. Consider following the DASH diet, which focuses on eating more fruits, vegetables and whole grains, and less saturated fat, total fat, and cholesterol. It also restricts sodium, which can raise blood pressure, and emphasizes foods rich in calcium, potassium, and magnesium, minerals that help lower blood pressure. 
  • Watch the salt. Although a recent study showed that lowering your salt intake may raise cholesterol and triglycerides, most experts still recommend cutting back on salt. Be on the lookout for sodium in canned, prepared, and processed foods. Avoid sprinkling too much salt on foods. The American Heart Association recommends limiting your intake to 1,500 mg a day.
  • Move more. Get at least 30 minutes of moderate activity every day, most days of the week.
  • Get to a healthy weight. Extra pounds make prehypertension more likely. Physical activity and healthy eating can help you shed extra weight.
  • Limit alcohol. Try to drink no more than two drinks a day if you're a man or no more than one if you're a woman. If you don't drink, don't start.
  • Curb stress. It's unclear whether chronic stress, by itself, can raise your blood pressure in the long run. But it can make you more likely to overeat and to skip exercise, Stein says. So try to change your circumstances, or at least how you deal with them, by practicing stress reduction techniques such as meditation.
  • Check your blood pressure. If you can, buy a home monitor, and take your blood pressure twice day: once in the morning and once at night, Stein says. "One very high reading is concerning, but one alone isn't enough," he says. "You want to see how it changes over time."
By Winnie Yu
WebMD Feature

© 2011 WebMD, LLC. All rights reserved.


Thursday, December 1, 2011

Controlling Diabetes: When Pills Aren't Enough

You Don't Check Your Blood Sugar

People with type 2 diabetes can often keep their blood sugar levels under control with diet, exercise, and medicine. But unless you check your blood sugar level every day with a meter, you won't have the most accurate results. Any person with diabetes can benefit from checking their blood sugar. And when you track your results in a log, your doctor can tell how well you're responding to your treatment plan over time.


You're Thirsty, and You Have to Go 


Thirst and frequent urination are two classic diabetes signs caused by too much sugar in your blood. As your kidneys work harder to filter out the sugar, they also pull more fluids from your tissues, which is why you have to go to the bathroom more often than usual. Thirst is your body's way of telling you it needs to replenish the liquids it's losing. If you don't drink more fluids, you can dehydrate.

You're Wiped Out

Fatigue is another signal that your blood sugar isn't under control. When sugar is staying in your bloodstream instead of being diverted to your body's cells, your muscles don't get enough fuel to use for energy. You might feel only a little tired, or your fatigue might be so bad that you need a nap. Sometimes people with diabetes feel especially tired after eating a big meal.

The Room Is Spinning

Feeling dizzy or shaky can be a sign of low blood sugar or hypoglycemia. Because your brain needs glucose to function, a drop in blood sugar can be dangerous -- even life-threatening -- if you don't address it. A glass of fruit juice can bring up your blood sugar in the short term. But if you're regularly feeling shaky, talk to your doctor. You may need to adjust your medications or diet.

Your Hands and Feet Swell

If you have high blood pressure as well as diabetes, the two conditions can damage the kidneys' ability to filter wastes and fluid over time. As water builds up in your body, your hands and feet may swell -- a warning sign that you may have kidney disease. You can preserve the kidney function you have by taking your diabetes and blood pressure medicines as prescribed, and watching the protein in your diet.

You Have Numbness or Tingling

Nerve damage (called peripheral neuropathy) can be another sign of chronically elevated blood sugars. It results in numbness or tingling in your hands and feet, or inability to feel pain or temperature changes. See your podiatrist for regular foot exams. People with neuropathy may not realize they have been injured from a cut or that a wound is becoming infected. Or they may be oversensitive to pain. They might experience severe and constant pain from otherwise painless stimulation.

You Have Stomach Trouble

Diabetes also damages the nerve that helps your stomach empty and move food smoothly through your digestive tract. When your stomach can't empty quickly enough, a condition called gastroparesis, you may deal with unpleasant abdominal problems like diarrhea, constipation, or incontinence. Many people also have problems eating or swallowing. Gastroparesis also can make it harder to control your diabetes.

You're Losing Your Sight

High blood sugar and high blood pressure both can damage the sensitive structures in your eyes and threaten your vision. Diabetic retinopathy -- caused by damage to the blood vessels in the eye -- is the biggest cause of blindness in adults. Blurred vision, spots, lines, or flashing lights are signs that it's time to see your eye doctor. Get your eyes checked now, before your vision has a chance to deteriorate.

You're Losing Weight

Losing unwanted pounds is always a good idea to manage type 2 diabetes. But if you're losing weight quickly, without trying, or without doing anything different, it may be a sign that your blood sugar is too high. When your glucose is high, it gets flushed out of the body in urine, taking the calories and fluids you consume with it.

You Have Recurring Infections

Frequent or recurring infections are sometimes a sign of high blood sugar. You might experience gum disease, urinary tract infections, bacterial or fungal infections of the skin, or, if you're a woman, yeast infections. Other infections might include pneumonia and respiratory infections, kidney and gallbladder infections, and severe bacterial middle ear and fungal sinus infection

Cuts and Bruises Won't Heal

If your blood sugar isn't well controlled, you might find that cuts and bruises are slow to heal. Tending to injuries, however small, is important because it reduces the risk of infections in people with diabetes. Infections themselves can also worsen blood sugars, which makes it even harder for your immune system to fight off the infection

Keep Control

Don't panic about diabetes complications -- try to avoid them by carefully following your doctor's treatment plan. Take your medicine, eat a healthy diet, and exercise to keep your blood sugar levels in check. Use your meter to test your blood sugar so you know that it's staying in the recommended range. An A1C test at least twice a year will give you a good snapshot of your blood sugar control over time.

When to Call Your Doctor

Any new or unusual symptoms are worth making a call to your doctor. Call if you feel dizzy or your blood sugar drops, or if you have severe symptoms like uncontrolled vomiting, dizziness, numbness or tingling, or blurred or double vision that doesn't go away. Also call if you're having trouble controlling your blood pressure on your own.
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© 2011 WebMD, LLC. All rights reserved.