Thursday, November 29, 2007

Foods Don't Contribute to Your Blood Sugar

Fat, such as oil, butter, margarine, or mayonnaise (or any fat exchange) will not goose your blood sugar. Yet, many people suspect that the butter on a buttered bagel raises their glucose when one slice of toast with jelly doesn't. Logic leads you to the conclusion that the toast and bagel are bread so what's the difference? The bagel weighs in at the equivalent of 4 to 5 slices of bread. This is significantly more carbohydrate than one slice of bread, even with a bit of jelly. Similarly, people sometimes think that the fat of fried plantain or potato must have been the culprit and raised their glucose, because the boiled version behaved itself. Look again. Fried stuff tastes better so we usually eat more of it! There is potato in both meals, but the larger portion of fried potato results in more carbohydrate in that meal. The underlying message to this is that portions count - larger portions mean more carbohydrate and higher blood sugar.

Hidden sugars
Watch out for "hidden" sugar in foods. In cooking, sugar helps with browning. Added sugar also enhances flavors, especially in fast foods. And when a muffin or goodie shouts "fat free" on the label, it's usually loaded with sugar. These are all examples of where sugar can hide in food. Watch out and steer clear.

The right fats
You don't need to aim for a very low-fat diet. You can keep your calories under control and still enjoy dressings and spreads. Just remember to select fats that are low in saturated fat, low in hydrogenated oils, and rich in mono-unsaturated fat. Olive and canola oils are the champions, here. Select soft margarines in the tub, not the stick. These choices will help you to keep your "bad" blood cholesterol down and your "good" blood cholesterol up. Check the "Nutrition Facts" labels for fat content.

Artificial sweeteners
Sugar-free soft drinks will not raise your blood sugar. However, some research has shown that when carbohydrate cravings are not satisfied with a real carbohydrate, artificial sweeteners may increase the desire for starchy or sweet foods leading a person to overindulge on carbohydrate-rich foods. My advice is to be sure to include some real carbohydrates that you can indulge in: popcorn, flavored rice cakes, or cubed fresh fruit!
). Start with a call to your doc or CDE for the "OK" and make your walk 5 to 7 days a week for 15 minutes the first week. Add 5 minutes every week until you meet yourself coming and going.

Sweet Without Sweeteners

Our sweet taste buds can be fooled ... some of the time. Cinnamon and nutmeg always seem to "sweeten" foods and beverages without adding carbohydrate. Some work at the US Department of Agriculture even suggests that about ½ tsp of cinnamon may help to lower blood sugars.

To get the best blood sugar control whether you have Type 1 or Type 2 diabetes, start with a convenient blood glucose meter to measure your blood sugars, and a daily carbohydrate goal from your doctor. Once you have developed a routine amount of carbohydrate at each meal, you will soon see how to take the mystery out of controlling blood sugar.

Foods Contribute to Your Blood Sugar Fluctuations

The amount of carbohydrates in your diet, and the type of carbohydrates, are the most significant dietary factors that cause blood sugar fluctuations. Remember, carbohydrate includes starches and sugars. So, any food that is starchy (breads, cereals, potatoes, rice, beans, and noodles, for example) or sweet (fruits, juices, syrups, candy, soft drinks, and ice cream, for example) will contribute to your blood sugar level after they're eaten.

Natural sugar foods
Some foods may not taste particularly sweet but contain significant amounts of natural sugar. They include milk, carrots, tomatoes, ketchup, and some tart fruit juices such as grapefruit and even lemon juice. These are very healthful foods and should be included in your diet if you wish. The goal isn't to eliminate them, just budget them. The popularity of smoothies and juiced vegetable-fruit blends presents a challenge to managing dietary carbohydrates. I like to say, "If you can't put them down, you've got to tally them up." Those carbohydrates do count. A 12 oz. smoothie with fruit pieces, milk, yogurt, or protein powder may have as much as 50 grams of carbohydrate. Also, take a close look at canned meal replacements like Slimfast. Even if it's all you eat at a meal, build the carbohydrate into your budget. Depending on your activity level and medication regimen, you might actually need more carbohydrate to prevent hypoglycemia (low blood sugar).

Artificially sweetened foods

Artificially sweetened foods and beverages are sometimes blessings and sometimes not. Don't be surprised if one day, after a trip to the movies, your blood sugar shoots up. It could be that the "diet" soda you bought was the real thing. This error happens more times than you'd think. It's a delight to get a "no sugar added" yogurt or ice cream. But read carefully: there is carbohydrate (usually milk sugar, lactose) in that food. One major brand of no-sugar-added yogurt recently replaced some of the aspartame with fructose. Although it won't spike your blood sugar, it's best to count that fructose into your total carbohydrate (at least it still tastes yummy).

"Light" foods
Look out also for some "light" foods that have removed some of the original caloric sweetener (such as sucrose, corn syrup solids, or high fructose corn syrup) and replaced it with a very low calorie sweetener (such as aspartame or asulfame-potassium). There is usually still quite a bit of sugar in that food or beverage. Logic tells us that even if a sweet and tasty food is advertised as: "no sugar added", it must have something going on. If "sugar" is defined only as "sucrose" (table sugar), then food producers can sweeten it with honey, apple sauce, fruit juice concentrate, rice syrup or any of a host of other carbohydrate-rich products that can still affect your blood sugar. Try to look at the label or product information before dining on those. Sugar alcohols (sugar-like molecules such as sorbitol) will have a negligible effect on your blood sugar but they are quite high in calories. I suppose our eyes see "sugar free" and we want that to mean no sugar, no carbohydrate, no calories and scrumptious taste. Well, maybe one day it will, but not yet.

About half of the protein molecules in your food can be turned into glucose in your liver. This means that a 12 oz. portion of chicken or fish at dinner containing about 84 grams of protein (remember the exchange list? 1 oz. of meat has 7 grams of protein) will turn into about 42 grams of glucose by morning. Cut the protein serving in half (6 oz.) and enjoy 2-3 carbohydrate exchanges. Your kidneys may thank you someday.

The glycemic index
Thanks to studies on the "glycemic index" (the power of a food to raise your blood sugar) of foods, it is now known that some high carbohydrate foods, even pure table sugar (sucrose), have surprisingly little effect on blood sugars. Fortunately these are also filling and nutrient-rich foods. Enjoy an occasional splurge on these: all beans and peas, most vegetables, and nuts. Just remember that these are still carbohydrates, and need to be balanced with exercise or insulin.

Tuesday, October 23, 2007

Diabetic Retinopathy - Treatment & Prevention


Diabetic retinopathy is treated in many ways depending on the stage of the disease and the specific problem that requires attention. The retinal surgeon relies on several tests to monitor the progression of the disease and to make decisions for the appropriate treatment. These include: fluorescein angiography, retinal photography, and ultrasound imaging of the eye.
The abnormal growth of tiny blood vessels and the associated complication of bleeding is one of the most common problems treated by vitreo-retinal surgeons. Laser surgery called pan retinal photocoagulation (PRP) is usually the treatment of choice for this problem.
With PRP, the surgeon uses laser to destroy oxygen-deprived retinal tissue outside of the patient’s central vision. While this creates blind spots in the peripheral vision, PRP prevents the continued growth of the fragile vessels and seals the leaking ones. The goal of the treatment is to arrest the progression of the disease.
Vitrectomy is another surgery commonly needed for diabetic patients who suffer a vitreous hemorrhage (bleeding in the gel-like substance that fills the center of the eye). During a vitrectomy, the retina surgeon carefully removes blood and vitreous from the eye, and replaces it with clear salt solution (saline). At the same time, the surgeon may also gently cut strands of vitreous attached to the retina that create traction and could lead to retinal detachment or tears.
Patients with diabetes are at greater risk of developing retinal tears and detachment. Tears are often sealed with laser surgery. Retinal detachment requires surgical treatment to reattach the retina to the back of the eye. The prognosis for visual recovery is dependent on the severity of the detachment.

Researchers have found that diabetic patients who are able to maintain appropriate blood sugar levels have fewer eye problems than those with poor control. Diet and exercise play important roles in the overall health of those with diabetes.
Diabetics can also greatly reduce the possibilities of eye complications by scheduling routine examinations with an ophthalmologist. Many problems can be treated with much greater success when caught early.

Diabetic Retinopathy - Signs & Symptoms, Detection & Diagnosis

Signs and Symptoms

The affect of diabetic retinopathy on vision varies widely, depending on the stage of the disease. Some common symptoms of diabetic retinopathy are listed below, however, diabetes may cause other eye symptoms.

* Blurred vision (this is often linked to blood sugar levels
* Floaters and flashes
* Sudden loss of vision

Detection and Diagnosis

Diabetic patients require routine eye examinations so related eye problems can be detected and treated as early as possible. Most diabetic patients are frequently examined by an internist or endocrinologist who in turn work closely with the ophthalmologist.
The diagnosis of diabetic retinopathy is made following a detailed examination of the retina with an ophthalmoscope. Most patients with diabetic retinopathy are referred to vitreo-retinal surgeons who specialize in treating this disease.

Diabetic Retinopathy- Overview


Diabetes is a disease that occurs when the pancreas does not secrete enough insulin or the body is unable to process it properly. Insulin is the hormone that regulates the level of sugar (glucose) in the blood. Diabetes can affect children and adults.

How does diabetes affect the retina?

Patients with diabetes are more likely to develop eye problems such as cataracts and glaucoma, but the disease’s affect on the retina is the main threat to vision. Most patients develop diabetic changes in the retina after approximately 20 years. The effect of diabetes on the eye is called diabetic retinopathy.
Over time, diabetes affects the circulatory system of the retina. The earliest phase of the disease is known as background diabetic retinopathy. In this phase, the arteries in the retina become weakened and leak, forming small, dot-like hemorrhages. These leaking vessels often lead to swelling or edema in the retina and decreased vision.
The next stage is known as proliferative diabetic retinopathy. In this stage, circulation problems cause areas of the retina to become oxygen-deprived or ischemic. New, fragile, vessels develop as the circulatory system attempts to maintain adequate oxygen levels within the retina. This is called neovascularization. Unfortunately, these delicate vessels hemorrhage easily. Blood may leak into the retina and vitreous, causing spots or floaters, along with decreased vision.
In the later phases of the disease, continued abnormal vessel growth and scar tissue may cause serious problems such as retinal detachment and glaucoma.

Friday, October 12, 2007

Diabetes ABC’s

An important concept that has is used by organizations is to “Manage the ABCs of Diabetes.”

(A) is for A1C.
This test shows average blood sugar for the past 2 to 3 months. An A1C test can help monitor how well the treatment plan is working. The ADA recommends that an A1C test be completed twice a year.

(B) is for Blood Pressure. The American College of Physicians has made the following important recommendations.
· Blood Pressure control must be a priority if the person has hypertension and type 2 diabetes.
· Blood pressure should be checked with each visit to the doctor and the goal should be a reading of no more than 135/80.
· Thiazide diurectics or ACE inhibiorts are types of medication that the doctor might prescribe to control blood pressure.

(C) is for Cholosterol.
Colesterol numbers tell the amount of fat in the blood. HDL cholesterol helps protect the heart. LDL cholesterol can clog arteries and lead to heart disease. Triglycerides are another kind of blood fat the can affect the risk of heart attack or stroke. The American Diabetes Association recommends that cholesterol be checked at least once a year.

Diabetes Insulin Resistance of Pregnancy

One of the dominant metabolic effects of normal pregnancy is an increase in insulin resistance, probably induced by placental hormones including progesterone and placental lactogen. This leads to higher postprandial glucose concentrations that are considered to improve fetal growth; it is termed 'facilitated anabolism'. Fasting glucose concentrations decrease as a result of placental glucose transfer and in the later stages of pregnancy, there is also enhanced maternal lipolysis. This is considered to spare glucose for the fetus and is termed 'accelerated starvation'.

In genetically predisposed women, the normal insulin resistance of pregnancy may lead to the diagnosis of DM for the first time, termed 'gestational diabetes'. This may disappear within hours of giving birth depending on individual factors such as islet b-cell function and predisposing factors such as obesity. Women with pre-existing DM require higher doses of insulin during pregnancy and patients who are usually controlled using oral hypoglycemic agents are transferred to insulin at this time.

The effects of pregnancy-induced insulin resistance in women with DM lead to poorer control of blood glucose and also an increased likelihood of ketoacidosis. The hyperglycemia in early pregnancy has considerable effects on the development of the fetal pancreas. Maternal ketoacidosis leads to fetal loss.

Diabetes Complications

Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations.

Some of the complications that can arise from diabetes are:

Heart disease and stroke
· Heart disease and stroke account for about 65% of deaths in people with diabetes.
· Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
· The risk for stroke is 2 to 4 times higher among people with diabetes.

High blood pressure
· About 73% of adults with diabetes have blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg) or use prescription medications for hypertension.

· Diabetes is the leading cause of new cases of blindness among adults aged 20-74 years.
· Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

Kidney disease
· Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2002.
· In 2002, 44,400 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico.
· In 2002, 153,730 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico.

Nervous system disease
· About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems.
· Almost 30% of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling).
· Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

· More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
· In 2002, about 82,000 nontraumatic lower-limb amputations were performed in people with diabetes.

Dental disease
· Periodontal (gum) disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes.
· Almost one-third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 millimeters or more.

Complications of pregnancy
· Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies.
· Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child.

Other complications
· Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma.
· People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.

Glucose Metabolism Physiology

Glucose is an essential fuel for the body. The amount of glucose in the bloodstream is regulated by many hormones, the most important being insulin.

Insulin has been described as the "hormone of plenty" it is released when glucose is abundant and stimulates the following:

Muscle and fat cells to remove glucose from the blood

Cells to breakdown glucose, releasing its energy in the form of ATP (via glycolysis and the citric acid cycle)

The liver and muscle to store glucose as glycogen (short-term energy reserve)

Adipose tissue to store glucose as fat (long-term energy reserve)

Cells to use glucose in protein synthesis

Glucagon is the main hormone opposing the action of insulin and is released when food is scarce.
Whereas insulin triggers the formation of glycogen (an energy-requiring process, or an anabolic effect), glucagon triggers glycogen breakdown, which releases energy (a catabolic effect). Glucagon also helps the body to switch to using resources other than glucose, such as fat and protein.

Blood glucose levels are not constant they rise and fall depending on the body's needs, regulated by hormones. This results in glucose levels normally ranging from 70 to 110 mg/dl.

The blood glucose level can rise for three reasons: diet, breakdown of glycogen, or through hepatic synthesis of glucose.

Eating produces a rise in blood glucose, the extent of which depends on a number of factors such as the amount and the type of carbohydrate eaten (i.e., the glycemic index), the rate of digestion, and the rate of absorption. Because glucose is a polar molecule, its absorption across the hydrophobic gut wall requires specialized glucose transporters (GLUTS) of which there are five types. In the gut, GLUT2 and GLUT5 are the most common.

The liver is a major producer of glucose. It releases glucose from the breakdown of glycogen and also makes glucose from intermediates of carbohydrate, protein, and fat metabolism. The liver is also a major consumer of glucose and can buffer glucose levels. It receives glucose-rich blood directly from the digestive tract via the portal vein. The liver quickly removes large amounts of glucose from the circulation so that even after a meal, the blood glucose levels rarely rise above 110 mg/dl in a non-diabetic.

The rise in blood glucose following a meal is detected by the pancreatic beta cells, which respond by releasing insulin. Insulin increases the uptake and use of glucose by tissues such as skeletal muscle and fat cells. This rise in glucose also inhibits the release of glucagon, inhibiting the production of glucose from other sources, e.g., glycogen break down.

Use Glucose - Once inside the cell, some of the glucose is used immediately via glycolysis. This is a central pathway of carbohydrate metabolism because it occurs in all cells in the body, and because all sugars can be converted into glucose and enter this pathway. During the well-fed state, the high levels of insulin and low levels of glucagon stimulate glycolysis, which releases energy and produces carbohydrate intermediates that can be used in other metabolic pathways.

Make Glycogen - Any glucose that is not used immediately is taken up by the liver and muscle where it can be converted into glycogen (glycogenesis). Insulin stimulates glycogenesis in the liver by:

Stimulating hepatic glycogen synthetase (the enzyme that catalyzes glycogen synthesis in the liver)

Inhibiting hepatic glycogen phosphorylase (the enzyme that catalyzes glycogen breakdown in the liver)

Inhibiting glucose synthesis from other sources (inhibits gluconeogenesis)

Insulin also encourages glycogen formation in muscle, but by a different method. Here it increases the number of glucose transporters (GLUT4) on the cell surface. This leads to a rapid uptake of glucose that is converted into muscle glycogen.

Make Fat - When glycogen stores are fully replenished, excess glucose is converted into fat in a process called lipogenesis. Glucose is converted into fatty acids that are stored as triglycerides (three fatty acid molecules attached to one glycerol molecule) for storage. Insulin promotes lipogenesis by:

Increasing the number of glucose transporters (GLUT4) expressed on the surface of the fat cell, causing a rapid uptake of glucose
Increasing lipoprotein lipase activity, which frees up more fatty acids for triglyceride synthesis

In addition to promoting fat synthesis, insulin also inhibits fat breakdown by inhibiting hormone-sensitive lipase (an enzyme that breaks down fat stores). As a result, there are lower levels of fatty acids in the blood stream.

Insulin also has an anabolic effect on protein metabolism. It stimulates the entry of amino acids into cells and stimulates protein production from amino acids.

Fasting is defined as more than eight hours without food. The resulting fall in blood sugar levels inhibits insulin secretion and stimulates glucagon release. Glucagon opposes many actions of insulin. Most importantly, glucagon raises blood sugar levels by stimulating the mobilization of glycogen stores in the liver, providing a rapid burst of glucose. In 10 18 hours, the glycogen stores are depleted, and if fasting continues, glucagon continues to stimulate glucose production by favoring the hepatic uptake of amino acids, the carbon skeletons of which are used to make glucose.

In addition to low blood glucose levels, many other stimuli stimulate glucagon release including eating a protein-rich meal (the presence of amino acids in the stomach stimulates the release of both insulin and glucagon, glucagon prevents hypoglycemia that could result from unopposed insulin) and stress (the body anticipates an increased glucose demand in times of stress).

The metabolic state of starvation is more commonly found in people trying to lose weight rapidly or in those who are too unwell to eat. After a couple of days without food, the liver will have exhausted its stores of glycogen but continues to make glucose from protein (amino acids) and fat (glycerol).

The metabolism of fatty acids (from adipose tissue) is a major source of energy for organs such as the liver. Fatty acids are broken down to acetyl-CoA, which is channeled into the citric acid cycle and generates ATP. As starvation continues, the levels of acetyl-CoA increase until the oxidative capacity of the citric acid cycle is exceeded. The liver processes these excess fatty acids into ketone bodies (3-hydroxybutyrate) to be used by many tissues as an energy source.

The most important organ that relies on ketone production is the brain because it is unable to metabolize fatty acids. During the first few days of starvation, the brain uses glucose as a fuel. If starvation continues for more than two weeks, the level of circulating ketone bodies is high enough to be used by the brain.

This slows down the need for glucose production from amino acid skeletons, thus slowing down the loss of essential proteins.

Diabetes is often referred to as "starvation in the midst of plenty" because the intracellular levels of glucose are low, although the extracellular levels may be extremely high.

As in starvation, type 1 diabetics use non-glucose sources of energy, such as fatty acids and ketone bodies, in their peripheral tissues. But in contrast to the starvation state, the production of ketone bodies can spiral out of control. Because the ketones are weak acids, they acidify the blood. The result is the metabolic state of diabetic ketoacidosis. Hyperglycemia and ketoacidosis are the hallmark of type 1 diabetes.

Hypertriglyceridemia is also seen in diabetic ketoacidosis . The liver combines triglycerol with protein to form very low density lipoprotein (VLDL). It then releases VLDL into the blood. In diabetics, the enzyme that normally degrades lipoproteins (lipoprotein lipase) is inhibited by the low level of insulin and the high level of glucagon. As a result, the levels of VLDL and chylomicrons (made from lipid from the diet) are high in diabetic ketoacidosis .

Thursday, October 11, 2007


Diabetes is a disturbance of the metabolism of sugar by the body. This results in a build-up of sugar in the blood and a lack of sugar inside the body’s cells, which need it to function properly. Large amounts of sugar are lost in the urine. It is caused by a lack of insulin or an insensitivity of cells to the effect of insulin.

Most young diabetics require insulin, which has to be injected under the skin. Older patients may be treated by oral medications or, if mild, by a special low-sugar diet. It is very important to make sure that the blood sugar level is kept within normal limits. Tight control of the blood sugar will influence the development of complications later in the disease. Most diabetics monitor their own blood sugar by using a glucometer or by dipstick urine testing for sugar.

The high blood sugar levels damage small blood vessels and, in time, this may lead to damage to eyes, kidneys, heart, nervous system and general circulation.

The longer the diabetes is present, the more likely are complications to develop. This is true for all diabetics; irrespective of how the disease is being treated i.e. insulin, oral medication or diet.

If control of blood sugar levels is good from the time of diagnosis, then the risk of developing complication is significantly reduced.

During pregnancy, the complications tend to worsen, as can happen if high blood pressure, high cholesterol or other general illnesses develop in the diabetic.

Vision is often transiently blurred during periods of poor control, illness or when treatment is begun. This blurring usually settles when the diabetes is controlled.

Vision can be threatened or lost by cataract (clouding of the lens), glaucoma (raised pressure in the eyeball) and retinopathy (damage to the essential membrane or ‘seeing’ layer at the back of the eye.

Clouding of the lens tens to occur at an earlier age in diabetics when compared to the non-diabetic population. It causes blurring of vision, glare in sunlight or difficulties with bright lights at night. The lens clouding is usually worse in poorly controlled diabetes mellitus.

Diabetics have a higher rate of developing glaucoma than non-diabetics. There are no symptoms of the raised pressure in the eye and it can only be detected by special pressure measuring test by the Ophthalmologist (eye doctor) or Optometrist (Optician). This test is carried out routinely during an eye test in most adults. Glaucoma can lead to blindness if undetected or untreated.
The duration of the diabetes and the level of control of the disease are the most important factors, which determine the amount of damage that occurs to the retina. (‘Seeing’ membrane at the back of the eye). Retinopathy (damage to the retina) is the commonest cause of blindness in diabetics and is often preventable and treatable. However, there are often no symptoms and the retinopathy can only be detected by specific examination of the back of the eyes

Often there are no symptoms at all, even in the presence of serious, sight-threatening diabetic eye disease. It is very important to have an eye examination carried out regularly so that problems can be detected and treated as early as possible. This will protect vision in the majority of diabetics with a retinopathy, which can threaten vision significantly. The earlier the treatment is carried out, the better the outcome in most patients.

“Cobwebs” or “floaters” or “clouds” are serious symptoms in any diabetic and the Ophthalmologist must carry out an immediate eye examination.

Clouding of vision or glare may indicate that a cataract has developed. This is usually successfully treated by the surgical removal of the cloudy lens and replacing it with a plastic lens.

Glaucoma does not cause any symptoms, except in very advanced disease when tunnel vision has developed. The damage caused by glaucoma is irreversible, so prevention of this damage development is possible by early diagnosis and treatment to control the disease. The risk of developing glaucoma is significantly higher if there is a family history of the disease.


When the lens has become cloudy and causes poor vision, it can be removed by an operation and replaced with a plastic lens.

Drops have to be instilled in to the eye regularly and on a long-term basis. Essential tests to check that the glaucoma is controlled have to be carried out regularly by the Ophthalmologist. Regular clinic appointments must be kept to make sure that the treatment is working.

Regular eye examinations will detect any disease affecting the eyes of diabetics. Since there are no symptoms in most cases, this examination is essential ton prevent serious damage to the sight. If this damage is not detected early, then sight will be lost and in severe cases, it will lead to blindness.

Laser treatment carried out as early as possible will prevent sight loss in the majority of patients. Te eye doctor will determine those patients who need to have this treatment and since it is usually painless, it is carried out in the out patients using a special laser machine and contact lens. This lens is removed after the laser treatment.

If planning a pregnancy, all female diabetics should have a special eye examination beforehand and will have regular check-ups during the pregnancy. Often, if eye disease is present before pregnancy, it is best treated before conception as pregnancy can make the eye disease worse. Laser treatment can be safely carried out during the pregnancy if deemed necessary.

Good control of blood sugars is critical in preventing and slowing down the progression of the damage to the retina caused by diabetes.

1. Always aim to keep the diabetes under tight control
2. Ensure that any high blood pressure or high blood cholesterol or fat levels are treated and monitored
3. Attend for regular diabetic check-ups with the doctor.
4. Keep an accurate record of appointments and blood sugar levels
5. Regularly check the vision in each eye separately (e.g. by reading the newspaper).
6. Make sure that an eye examination is carried out regularly. If an appointment is missed, seek another immediately.
7. Report any change in vision immediately.
8. If planning a pregnancy, have an eye examination by an Ophthalmologist before conception.
9. Remember – there are often NO symptoms, even when serious eye disease is present

Tuesday, September 18, 2007

Glucose Tolerance Test - GTT

Alternative names
Oral glucose tolerance test


The glucose tolerance test is a laboratory method to check how the body breaks down (metabolizes) blood sugar.

How the test is performed

Glucose is the sugar that the body uses for energy. Patients with untreated diabetes have high blood glucose levels. Glucose tolerance tests are one of the tools used to diagnose diabetes.

The most common glucose tolerance test is the oral glucose tolerance test (OGTT). You can not eat or drink anything after midnight before the test. For the test, you will be asked to drink a liquid containing a certain amount of glucose. Your blood will be taken before you do this, and again every 30 to 60 minutes after you drink the solution. The test takes up to 3 hours.

Blood glucose levels above normal limits at the times measured can be used to diagnose type 2 diabetes or gestational diabetes (high blood glucose during pregnancy). Insulin levels may also be measured. (Insulin is the hormone produced by the pancreas that moves glucose from the bloodstream into cells.)

The intravenous glucose tolerance test (IGTT) is not often used. In this test, glucose is injected into your vein for 3 minutes. Blood insulin levels are measured before the injection, and again at 1 and 3 minutes after the injection. This test may predict the development of type 1 diabetes in some patients.

How to prepare for the test

Make sure you eat normally for several days before the test.

Do not eat or drink anything for 12 hours prior to the test. You can not eat during the test.

Ask your health care provider if you are using medications that can interfere with the test results.

How the test will feel

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the test is performed

The oral glucose tolerance test is used to screen pregnant women for gestational diabetes between 24 and 28 weeks of pregnancy. It may also be used to in cases where the disease is suspected, despite a normal fasting blood glucose.

Normal Values

Normal blood values for a 75-gram oral glucose tolerance test used to check for type 2 diabetes:

* Fasting: 60 to 100 mg/dL
* 1 hour: less than 200 mg/dL
* 2 hours: less than 140 mg/dL. Between 140-200 mg/dL is considered impaired glucose tolerance or pre-diabetes. This group is at increased risk for developing diabetes. Greater than 200 mg/dL is diagnostic of diabetes mellitus

Normal blood values for a 50-gram oral glucose tolerance test used to screen for gestational diabetes:

* 1 hour: less than 140 mg/dL

Normal blood values for 100-gram oral glucose tolerance test used to screen for gestational diabetes:

* Fasting: less than 95 mg/dL
* 1 hour: less than 180 mg/dL
* 2 hour: less than 155 mg/dL
* 3 hour: less than 140 mg/dL

Note: mg/dL = milligrams per deciliter

What abnormal results mean

Greater than normal levels of glucose may mean you have diabetes or gestational diabetes.

However, high glucose levels may be related to another medical problem (for example, Cushing syndrome).

What the risks are

The risks of drawing blood from a vein include:

* Excessive bleeding
* Fainting or feeling lightheaded
* Hematoma (blood accumulating under the skin)
* Infection (a slight risk any time the skin is broken)
* Multiple punctures to locate veins

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Special considerations

Interfering factors:

* Acute stress (for example, from surgery or an infection)
* Vigorous exercise

Several drugs may cause glucose intolerance, including:

* Thiazide diuretics (for example, hydrochlorothiazide)
* Beta-blockers (for example, propranolol)
* Oral contraceptives (birth control pills)
* Corticosteroids (for example, prednisone)
* Certain psychiatric medications

Before having the test, let your health care provider know if you are taking any of these medications.

Gestational diabetes - Diabetes in pregnancy

Diabetes can develop during pregnancy in a woman who hasn't previously had the condition. This is called gestational diabetes, which affects two to three per cent of pregnant women. If it is not properly controlled, it can lead to problems for the mother or her baby.

What is gestational diabetes?

Gestational diabetes develops in women during pregnancy because the mother's body is not able to produce enough insulin. Insulin is a hormone that enables the body to break down sugar (glucose) to be used as energy. Without sufficient insulin the amount of sugar in the blood rises.

High blood sugar levels in the mother's body are passed through the placenta to the developing baby. This can cause health problems.

Gestational diabetes usually begins in the second half of pregnancy, and goes away after the baby is born. This makes it different to the more common forms of diabetes which, once they occur, are permanent.

What causes gestational diabetes?

The cause of gestational diabetes is unknown. It is thought that the hormones produced during pregnancy may block the action of insulin. Gestational diabetes can happen if the mother's body can't produce enough extra insulin to counteract this blocking effect.

Risk factors

Although there is no clear reason why some women get gestational diabetes, women are more at risk if they:

  • have a family history of type II (adult-onset) diabetes
  • are over the age of 35
  • are obese
  • have previously given birth to a large baby
  • have previously given birth to a baby born with an abnormality
  • have previously had a stillbirth late in pregnancy


In most women, gestational diabetes causes no symptoms. Some women do get symptoms of high blood sugar, such as increased thirst, increased need to pass water and increased hunger, although these are also common later on in pregnancy anyway.

The effects of gestational diabetes

Effects on the fetus during pregnancy

  • Having high blood sugar can cause the baby to grow larger, which can make delivery difficult and potentially cause injuries to both mother and baby during birth. In some cases a caesarean section is necessary.

Effects on the baby after birth

  • The baby may have low blood sugar (hypoglycaemia) after birth. This is because the baby's pancreas makes extra insulin in response to the mother's high blood sugar levels. Shortly after birth, the baby may continue to make extra insulin even though high levels of blood sugar are no longer present. After a pregnancy affected by gestational diabetes, the newborn baby's blood sugar level is checked regularly. Sometimes babies are given an early feed of a sugar (glucose) solution through a drip (fed directly into a vein) to correct low blood sugar.
  • It is more likely that the newborn baby will develop jaundice (yellowing of the skin and whites of the eyes). This is not serious and usually fades over a few weeks, without the need for medical treatment.
  • There is an increased risk that the baby will be born with congenital problems, such as a heart defect. Sometimes, infants can be born with respiratory distress syndrome, in which the baby has problems breathing because his or her lungs have not matured as normal. This usually clears up with time.
  • There is also a slightly higher chance of stillbirth or death as a newborn, but if detected and the glucose levels well managed, death is rare.
  • There may be an increased risk of the baby developing type II diabetes or being overweight later in life.

Effects on the mother

Gestational diabetes is not an immediate threat to the woman's health. Most women with gestational diabetes whose blood sugar levels stay within the safe range deliver their babies without complications. However, in some women it can result in high blood pressure.

Women who get gestational diabetes are more likely to develop gestational diabetes in future pregnancies, and are at a higher risk of developing type II diabetes later in life.

Diagnosing gestational diabetes

Urine is routinely tested for sugar throughout pregnancy, and high blood sugar, if present, is usually detected between 24 and 28 weeks of pregnancy.

The only way to confirm gestational diabetes is with a glucose tolerance test, which needs to be carried out after eight hours without food. The woman is given a solution of glucose to drink, and then blood samples are taken and analysed at different intervals to see how the body deals with the glucose over time.

If a doctor believes a woman is likely to develop gestational diabetes, this test may be carried out earlier than 24-28 weeks. Any woman whose medical history means she's at a greater risk of diabetes, or is concerned about any symptoms should see her GP.



The most important part of treatment is to control blood sugar levels. For many women, this means regular testing of blood sugar (glucose) levels, a carefully planned diet and regular exercise.

Home glucose testing kits are available from chemists. These usually involve taking a tiny blood sample with a pinprick device. The blood is put onto a strip and inserted into a glucose measuring device, which gives the blood glucose level.

Doctors usually advise blood glucose testing once a week, although for some women this may need to be more often. Glucose needs to be measured in the morning before breakfast and again two hours after breakfast. Some women may also need to test levels in the mid-afternoon.

A doctor or dietician can give advice about what and how much to eat. A meal plan will probably consist of a variety of foods including plenty of starchy fillers such as bread, pasta, rice and potatoes, and at least five portions of fruit and vegetables each day.

It's important to limit consumption of sugary foods like cakes, biscuits and soft drinks. A diet that is low in fat is also desirable. This can be acheived by avoiding full-fat dairy products such as butter and cream, and limiting fatty meat, pies, sausages and burgers. Grilling, steaming or microwaving food rather than frying or roasting means less fat is added during cooking.

Gentle, regular exercise such as walking can help reduce blood sugar levels and promote a sense of well-being. A doctor or midwife can advise about suitable exercise during pregnancy.


Despite making the above lifestyle changes, a few women's blood sugar levels remain too high, and they may need daily injections of insulin. The extra insulin will not cross the placenta and will not affect the baby. Any woman who needs to take insulin will be taught how to take it by her doctor or nurse.

It is possible to have too much insulin and this can cause low blood sugar (hypoglycaemia). Common symptoms of this are weakness, shaking, hunger and sweating. For people taking insulin, it is a good idea to keep a snack handy at all times in case low blood sugar develops.

After the birth

In almost every case, gestational diabetes disappears on its own after delivery. To be sure, doctors may check the mother's blood sugar levels a few times after the birth.


To help reduce the risk of getting gestational diabetes, women should make healthy lifestyle choices, such as eating a balanced diet, taking regular exercise and maintaining the correct weight for their height

Sunday, September 16, 2007

Diabetes Diagnosis -Tests

Introduction - Diabetes Diagnosis -Tests

Blood and urine tests help show if your diabetes treatment is working and can alert your doctor to early signs of diabetes complications, such as kidney disease.

Glycated hemoglobin test

A glycated hemoglobin test, also called a glycosylated hemoglobin test or hemoglobin A1C test, reflects your average blood sugar level for the two- to three-month period before the test. Your doctor uses it to determine how well you're managing your blood sugar.

How the test is done

A lab technician takes a sample of blood from a vein in your arm and sends the blood sample to a lab for analysis.

Recommended results

Normal ranges often vary among laboratories. The American Diabetes Association (ADA) recommends that your glycated hemoglobin level be 7 percent or less.

How often to have the test

How often you have this test depends on the type of diabetes you have and how well you're managing your blood sugar. If your blood sugar is consistently within your doctor's recommended target range, the ADA recommends that you have this test twice each year. If you start a new diabetes medication regimen or have trouble keeping your blood sugar within target range, the ADA recommends that you have this test four times each year.

Serum creatinine test

This test measures the level of creatinine in your blood. Creatinine is a chemical waste product that's produced when you use your muscles. If your kidneys aren't functioning properly, they aren't able to remove as much creatinine from your blood.

How the test is done

A lab technician takes a sample of blood from a vein in your arm and sends the blood sample to a lab for analysis.

Recommended results

The normal ranges are:

* Women. 0.7 to 1.2 milligrams per deciliter (mg/dL)
* Men. 0.9 to 1.4 mg/dL

How often to have the test

People with diabetes typically have this lab test at least once each year.

Urine microalbumin test

A urine microalbumin test assesses the health of your kidneys by screening for protein leakage into your urine. If your kidneys become damaged, waste products normally filtered out by your kidneys remain in your blood, and protein (albumin) that should remain in your blood leaks into your urine.

How the test is done

When you visit your doctor, you provide a fresh urine sample. The urine is sent to a laboratory for analysis, or a technician in your doctor's office performs the test using a chemically treated test strip. In addition, your doctor may ask you to collect all of your urine in a container over a 24-hour period and bring it in to be assessed.

Recommended results

Results of the urine microalbumin test are measured as milligrams (mg) of protein leakage. Typically, here's what your results will mean:

* Less than 30 mg is normal.
* 30 to 299 mg indicates early-stage kidney disease (microalbuminuria).
* 300 mg or more indicates advanced kidney disease (macroalbuminuria).

Without appropriate treatment, your kidneys are likely to fail within a few years of developing macroalbuminuria.

How often to have the test

The frequency of urine microalbumin testing depends on your individual situation. In general, you have the test yearly after your diagnosis, but you may need it more often if your levels are high. Talk with your health care team about how often you need the test.

Lipids test

A lipids test measures the level of fats (lipids) in your blood. A rising level of certain blood fats can alert your doctor to an increased risk of blood vessel damage. The test measures the level of two such substances, which increase your heart disease risk: low-density lipoprotein (LDL), the "bad" cholesterol, and triglycerides. The test also determines your level of high-density lipoprotein (HDL), the "good" cholesterol, which protects against heart disease.

How the test is done

A lab technician takes a sample of blood from a vein in your arm and sends the blood sample to a lab for analysis.

Recommended results

Optimal levels are:

* LDL: Less than 100 milligrams per deciliter (mg/dL)
* HDL: Greater than 40 mg/dL if you're a man or greater than 50 mg/dL if you're a woman
* Triglycerides: Less than 150 mg/dL

How often to have the test

The ADA recommends that you have this test at least once each year and more often if your levels aren't normal or you're taking lipid-lowering medication.

Tuesday, September 11, 2007

Diabetic Diet

Popular misconceptions about nutrition and diabetes include the idea that a "diabetic diet" is a "sugar free diet"; or that refined sugar is "bad" and "natural sweeteners" are "good". Can "non-sugar" foods be eaten in any amounts? Can a person with diabetes "cheat" every once in a while? What IS a "diabetic diet"? Because so many questions and misunderstandings exist, it is important for a person with diabetes to be able to understand the fundamentals of nutrition, one of several essential elements of successful diabetes management.

There is actually no such thing as a single "diabetic diet". The diet that a person with diabetes follows to help manage his or her blood sugar levels is based on the same nutrition principles that any healthy person, with or without diabetes, should follow for good health. When a person with diabetes sees a Registered Dietitian for nutrition counseling, the goal is to create a nutrition plan. This will help the person manage his or her blood sugar levels, reduce the risk of heart disease and other diet-related conditions, maintain a healthy weight, as well as meet the person’s nutritional, lifestyle, social, and cultural needs.

The energy that we get from foods, measured in calories, comes from three types of nutrients: fats, proteins, and carbohydrates. Any food that provides calories will raise blood sugar. When foods are digested, they are broken down into the body’s basic fuel-- glucose, a type of sugar. The glucose is absorbed by the bloodstream, and is then known as blood glucose or blood sugar. In a person without diabetes, insulin is released by the pancreas after a meal or snack to allow the glucose in the blood to get into the body’s cells, where it is burned for energy. This brings the level of glucose in the blood back down to the normal range. If insulin is not produced or is not working properly, the glucose can not enter the cells to be used, and it builds up in the bloodstream. This results in high blood sugar, and this condition is known as diabetes.

Although all foods that provide calories are converted into glucose by the body, certain nutrients have a more direct effect on the blood’s glucose level. Fats in foods are eventually digested and converted into glucose, but this can take up to 6 to 8 or more hours after a meal, and the release of glucose into the blood is v e r y s l o w ... Protein in foods (such as meats, poultry, fish, eggs, soy and other beans, and milk) takes about 3 to 4 hours after a meal to "show up" as blood glucose.

Carbohydrates, on the other hand, take only about half an hour to an hour after a meal to be turned into blood glucose. The word "carbohydrate" actually means "sugars and starches." Chemically, a starchy food is just a "chain" of glucose molecules. In fact, if a starchy food like a soda cracker is held in the mouth for a few minutes, it will start to taste sweet as the digestive enzymes in the saliva begin to break the starch down into its glucose parts.

Any food that is high in any type of carbohydrate will raise blood glucose levels soon after a meal. Whether a food contains one ounce of sugar (natural or refined) or one ounce of starch, it will raise blood glucose the same amount, because the total amount of CARBOHYDRATE is the same. Although a glass of fruit juice and the same amount of sugary soda may seem like a "good" versus "bad" choice, each will raise blood glucose about the same amount. This information regarding the amount of carbohydrate in different foods is the center of a nutrition management tool for people with diabetes called Carbohydrate Counting. Foods high in carbohydrates include starches such as rice, pasta, breads, cereals, and similar foods; fruits and juices; vegetables; milk and milk products; and anything made with added sugars, such as candies, cookies, cakes, and pies.

The goal of a diabetes nutrition plan is to provide a mixture of fats, carbohydrates, and proteins at each meal at an appropriate calorie level to both provide essential nutrients as well as create an even release of glucose into the blood from meal to meal and from day to day. A Registered Dietitian assesses the nutritional needs of a person with diabetes and calculates the amounts of fat, protein, carbohydrate, and total calories needed per day, and then converts this information into recommendations for amounts and types of foods to include in the daily diet. The total number of meals and snacks and their timing throughout the day can differ for each person, based on his or her nutritional needs, lifestyle, and the action and timing of medications.

Overall, a nutrition plan for a person with diabetes includes 10 to 20 percent of calories from protein, no more than 30 percent of calories from fats (with no more than 10 percent from saturated fats), and the remaining 50 to 60 percent from carbohydrates. Carbohydrate foods that contain dietary fiber are encouraged, as a high fiber diet has been associated with decreased risks of colon and other cancers. For people with high blood cholesterol levels, lower total fat and saturated fat contents may be recommended. Sodium intake of no more than 3000 mg per day is suggested; for people with high blood pressure, sodium should be limited to 2400 mg per day or as advised by a physician.

One "diabetic diet" definitely does not fit all. In fact, ANY food can fit into the diet of someone with diabetes, with the help and guidance of a Registered Dietitian. Managing blood glucose levels does not have to mean giving up favorite foods, sweets, or restaurants and fast foods. Each person with diabetes has very different nutritional and personal needs, making ongoing assessment and counseling with a Registered Dietitian an essential element of successful diabetes management.

Monday, September 10, 2007

Oral Diabetes Medicines

Why did my doctor prescribe oral diabetes medicine for me?
If you have type 2 diabetes, your body's tissues do not get enough insulin. This results in high blood sugar levels. Some people who have type 2 diabetes don't make enough insulin. Other people make enough insulin but their bodies are not able to use it properly.

Some people who have type 2 diabetes need to take insulin in shots to help control their blood sugar levels. Most take pills by mouth (oral medicine) to help control their diabetes. Some people take insulin and oral medicines.

What are some common oral diabetes medicines?There are 5 types of oral diabetes medicines. Your doctor will decide which type of medicine is right for you.

Sulfonylureas help your body make more insulin. These are the most common type of oral diabetes medicine. Some examples of sulfonylureas include acetohexamide (brand name: Dymelor), chlorpropamide (brand name: Diabinese), glipizide (brand name: Glucotrol) and glyburide (brand names: DiaBeta, Glynase, Micronase).

Metformin (brand name: Glucophage) helps control blood sugar in a couple of ways. It helps your body use insulin better. It also helps your body make less sugar and reduces the amount of sugar your body absorbs from food. It almost never causes hypoglycemia (low blood sugar).

Meglitinides help your body make more insulin. Examples include nateglinide (brand name: Starlix) and repaglinide (brand name: Prandin). These pills are usually taken with meals.

Thiazolidinediones help your body use insulin better. They also help your body make less sugar. There are 2 thiazolidinediones: pioglitazone (brand name: Actos) and rosiglitazone (brand name: Avandia).

Alpha-glucosidase inhibitors help your body absorb sugar more slowly to keep your blood sugar lower. This type of medicine is taken every time you eat a meal. There are 2 alphaglucosidase inhibitors: acarbose (brand name: Precose) and miglitol (brand name: Glyset).

Sometimes two kinds of medicines are given together. For example, glyburide combined with metformin (brand name: Glucovance), glipizide combined with metformin (brand name: Metaglip) and rosiglitazone combined with metformin (brand name: Avandamet).

Do these medicines have any side effects?

Like most medicines, these drugs can cause side effects. Your doctor may want to see you or want you to have tests (like liver tests) to check for problems. However, the side effects usually are not severe and are not common. Side effects of oral diabetes medicines may include the following:

Nausea and vomiting
Gas and bloating
Decreased appetite
Headache and/or muscle aches
Flu- or cold-like symptoms
Talk to your doctor about any side effects you may be having.

Will a diabetic drug interact with my other medicines?
If you take 2 or more drugs at the same time, how the drug works can change. When this happens, the risk of side effects increases. This is called a "drug-drug interaction." Vitamins and herbal supplements can affect the way your body processes drugs too.

Drug-drug interactions can be dangerous. Be certain that your doctor knows all of the over-the-counter and prescription medicines, vitamins and herbal supplements that you are taking. Also, talk to your doctor before you take any new over-the-counter or prescription medicine or use a vitamin or herbal supplement.

Certain foods or drinks can also keep your medicine from working the way it should or make side effects worse. This is called a "drug-food interaction." For example, if you’re taking an oral diabetes medicine, drinking alcohol can increase your risk of low blood sugar.

Know the signs

People who have diabetes need to know the signs of hyperglycemia (high blood sugar ) and hypoglycemia (low blood sugar). Make sure your family members, friends and coworkers know how to help you in an emergency situation.

Signs of low blood sugar:
Cold sweats and pale, cool skin
Fast heartbeat
Extreme hunger
Diarrhea or gas

Exercising more than usual can sometimes cause low blood sugar. Keep candy, juice or glucose tablets on hand to treat low blood sugar. Call your doctor if your symptoms become severe or bothersome.

Signs of high blood sugar:
Increased hunger
Increased thirst
Increased urination

Eating more than you usually do, forgetting to take your diabetes medicine, or taking another medicine that you don't usually take can all cause high blood sugar. Call your doctor if any of the above symptoms become severe.

Herbs and Vitamins for Diabetes

Herbs and Vitamins for Diabetes

Diabetes is characterized by higher than normal blood sugar or blood glucose levels in the body. While a certain amount of glucose is necessary for proper cell nutrition, abnormally high glucose levels can be harmful to your health and can lead to serious complications.

Glucose needed for proper cell metabolism is found in the food we eat and is also produced by the liver and muscles. However, without the aid of insulin produced by the pancreas, glucose is not able to enter the cells. Consequently, if insulin levels are too low or the insulin doesn't work properly, glucose is not able to enter the cells, remains in the blood, and increases blood levels of glucose that lead to diabetes.

There are three primary types of diabetes.

Type 1 diabetes, formerly known as juvenile diabetes or insulin-dependent diabetes, is commonly diagnosed in adolescents, teenagers, or young adults. In type 1 diabetes, the pancreas is unable to make insulin because the body's immune system has attacked and destroyed the pancreas cell responsible for insulin production. Traditional treatments for type 1 diabetes includes taking insulin shots or using an insulin pump, making dietary changes, exercise, taking aspirin daily, and strictly controlling blood pressure and cholesterol.

Type 2 diabetes, formerly known as adult-onset diabetes or non-insulin-dependent diabetes, is by far the most common form of diabetes in the world. People can develop type 2 diabetes at any time during their life even during early childhood. In type 2 diabetes, the pancreas is unable to produce enough insulin and the fat, muscle, or liver cells do not use it properly. Obesity can drastically increase the probability of developing type 2 diabetes. Traditional treatments for type 2 diabetes include using doctor prescribed diabetes medications, dietary changes, regular exercise, taking aspirin daily, and controlling blood pressure and cholesterol.

Gestational Diabetes

While not as common as type 1 or type 2, gestational diabetes can develop during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had gestational diabetes is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the increased hormone levels during pregnancy or from a shortage of insulin in the body during pregnancy.

People with diabetes have a high risk of contracting a number of ancillary health conditions including heart disease and atherosclerosis. In addition, those with diabetes have a higher mortality rate if they also have high homocysteine levels.

Vitamin supplements that may help diabetics

Alpha lipoic acid (improve insulin sensitivity and symptoms of diabetic neuropathy)

Brewer's yeast (providing approximately 60 mcg of chromium per tablespoon)

Chromium (improve glucose tolerance in type 1 and 2 diabetes

Evening primrose oil (improve nerve function and relieve pain of diabetic neuropathy)

Fiber (may control blood sugar levels as well as oral diabetes drugs)

Glucomannan (absorption of dietary sugar)

Magnesium (for magnesium deficiency)

Other vitamin supplements with possible effects.

Multivitamin and Mineral Supplements (reduce the risk of infection if used regularly)

Vitamin E (may improve glucose tolerance)

Vitamin B6 (improve symptoms of diabetic neuropathy)

Vitamin B12 (reduces nerve damage caused by diabetes)

Vitamin B1 (may help reduce blood sugar levels)

Biotin (needed to process glucose)

Coenzyme Q10 (protect against effects of diabetes-induced depletion)

L-carnitine (reduces cholesterol and triglycerides)

Niacinamide (useful in the very early stages of type 1 diabetes)

Zinc (lower blood sugar in type 1 diabetes)

Vitamin D (needed to maintain adequate blood levels of insulin)

Inositol (needed for normal nerve function)

Taurine (restore blood taurine to normal levels in type 1 diabetes)

Fish oil (improves glucose tolerance, high triglycerides, and cholesterol levels)

Manganese (for manganese deficiency)

Herbal supplements that may help diabetics

Cayenne (topical application can relieve symptoms of diabetic neuropathy)

Psyllium (improve control of blood glucose and cholesterol)


Other herbs with possible effects.

Asian/Korean ginseng (improve blood sugar control and energy type 2 diabetes)

Gymnema (stimulate production of insulin in people with type 2 diabetes)

Aloe vera (reduce the amount of drug glibenclamide required to manage blood sugar)

Bitter melon (improve blood-sugar control in people with type 2 diabetes)

Bilberry (lower risk of some diabetic complications - cataracts and retinopathy)

Gastroparesis and Diabetes

Gastroparesis is a disorder affecting people with both type 1 and type 2 diabetes, where the stomach takes too long to empty its contents. It happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.

Just as with other types of neuropathy, diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves.

Signs and Symptoms

Signs and symptoms of gastroparesis (delayed gastric emptying) are:

vomiting of undigested food
an early feeling of fullness when eating
weight loss
abdominal bloating
erratic blood glucose (sugar) levels
lack of appetite
gastroesophageal reflux
spasms of the stomach wall
These symptoms may be mild or severe, depending on the person.

Complications of Gastroparesis

Gastroparesis can make diabetes worse by making it more difficult to manage blood glucose. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise.

If food stays too long in the stomach, it can cause problems like bacterial overgrowth because the food has fermented. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine.


The diagnosis of gastroparesis is confirmed through one or more of the following tests.

Barium X-ray

After fasting for 12 hours, you will drink a thick liquid containing barium, which covers the inside of the stomach, making it show up on the X-ray. Normally, the stomach will be empty of all food after 12 hours of fasting. If the X-ray shows food in the stomach, gastroparesis is likely. If the X-ray shows an empty stomach, but the doctor still suspects that you have delayed emptying, you may need to repeat the test another day. On any one day, a person with gastroparesis may digest a meal normally, giving a falsely normal test result. If you have diabetes, your doctor may have special instructions about fasting.

Barium Beefsteak Meal

You will eat a meal that contains barium, which allows the doctor to watch your stomach as it digests the meal. The amount of time it takes for the barium meal to be digested and leave the stomach gives the doctor an idea of how well the stomach is working. This test can help find emptying problems that do not show up on the liquid barium X-ray. In fact, people who have diabetes-related gastroparesis often digest fluid normally, so the barium beefsteak meal can be more useful.

Radioisotope Gastric-Emptying Scan

You will eat food that contains a radioisotope, a slightly radioactive substance that will show up on the scan. The dose of radiation from the radioisotope is small and not dangerous. After eating, you will lie under a machine that detects the radioisotope and shows an image of the food in the stomach and how quickly it leaves the stomach. Gastroparesis is diagnosed if more than half of the food remains in the stomach after two hours.

Gastric Manometry

This test measures electrical and muscular activity in the stomach. The doctor passes a thin tube down the throat into the stomach. The tube contains a wire that takes measurements of the stomach's electrical and muscular activity as it digests liquids and solid food. The measurements show how the stomach is working and whether there is any delay in digestion.

Blood tests

The doctor may also order laboratory tests to check blood counts and to measure chemical and electrolyte levels.

To rule out causes of gastroparesis other than diabetes, the doctor may do an upper endoscopy or an ultrasound.

Upper Endoscopy

After giving you a sedative, the doctor passes a long, thin tube called an endoscope through the mouth and gently guides it down the esophagus into the stomach. Through the endoscope, the doctor can look at the lining of the stomach to check for any abnormalities.


To rule out gallbladder disease or pancreatitis as a source of the problem, you may have an ultrasound test, which uses harmless sound waves to outline and define the shape of the gallbladder and pancreas.


The most important treatment goal for diabetes-related gastroparesis is to manage your blood glucose levels as well as possible. Treatments include insulin, oral medications, changes in what and when you eat, and, in severe cases, feeding tubes and intravenous feeding.

Insulin for blood glucose control

If you have gastroparesis, your food is being absorbed more slowly and at unpredictable times. To better manage blood glucose, you may need to

take insulin more often
take your insulin after you eat instead of before
check your blood glucose levels frequently after you eat and administer insulin whenever necessary
Your doctor will give you specific instructions based on your particular needs.


Several drugs are used to treat gastroparesis. Your doctor may try different drugs or combinations of drugs to find the most effective treatment.

Meal and Food Changes

Changing your eating habits can help control gastroparesis. Your doctor or dietitian will give you specific instructions, but you may be asked to eat six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. Or the doctor or dietitian may suggest that you try several liquid meals a day until your blood glucose levels are stable and the gastroparesis has improved. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

The doctor may also recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion -- a problem you do not need if you have gastroparesis -- and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars.

Feeding Tube

If other approaches do not work, you may need surgery to insert a feeding tube. The tube, called a jejunostomy tube, is inserted through the skin on your abdomen into the small intestine. The feeding tube allows you to put nutrients directly into the small intestine, bypassing the stomach altogether. You will receive special liquid food to use with the tube. A jejunostomy is particularly useful when gastroparesis prevents the nutrients and medication necessary to regulate blood glucose levels from reaching the bloodstream. By avoiding the source of the problem (the stomach) and putting nutrients and medication directly into the small intestine, you ensure that these products are digested and delivered to your bloodstream quickly. A jejunostomy tube can be temporary and is used only if necessary when gastroparesis is severe.

It is important to note that in most cases treatment does not cure gastroparesis -- it is usually a chronic condition. Treatment helps you manage gastroparesis, so that you can be as healthy and comfortable as possible.

Diabetes and Men's Sexual Health

Sex is an important part of life and relationships. But diabetes can affect a man’s sex life. Some men with diabetes have impotence, also called erectile dysfunction or ED. ED is when a man can no longer have or keep an erection. Over time, blood vessels and nerves in the penis can become damaged. This can lead to ED. If you have ED, there is hope. There are ways to treat ED. ED is not a normal part of getting older, and it doesn’t happen to all men who have diabetes. ED can also be caused by other conditions, such as prostate or bladder surgery. Talk with your health care team about new therapies.

If you have ED or some other sexual problem, it’s normal to feel embarrassed or upset. You may blame yourself or your partner. Some men feel guilty and angry. Others feel like there’s no hope. These feelings can make it hard to talk openly with your partner or your doctor. But talking about ED means you’re a step closer to getting help.

In Search of Answers

Today, there are many ways to treat ED and more are on the way. If one thing doesn’t work, something else might.

Here are some options:

Taking pills to treat ED

Putting medicine called prostaglandins (prahs-ta-GLAND-ins) into your penis

Using a vacuum tube and pump that you put over your penis. The pump creates a vacuum in the tube. The vacuum draws blood into the penis. A band is placed around the base of the penis so you keep the erection after you take off the vacuum tube

Having surgery to put a device in the penis. Surgery can also fix blood vessels so more blood will flow to the penis

Certain medicines, such as some pills for high blood pressure or depression, may cause ED. Pills for stomach ulcers or heartburn also may cause it. Ask your doctor if ED is a side effect of any of your medicines. There may be other pills you can take. Remember, talk with your doctor or diabetes educator before trying any treatment for ED or before stopping any of your medicines.

It’s not easy to accept that you have ED. And it can be even harder to talk about it, especially with your partner. Even if your doctor doesn’t ask about ED, talk about it if you’re having problems. Talking about ED is the only way to learn about treatments and get help.

Family Ties

Diabetes doesn’t affect your ability to become a father. But you and your partner might have questions about starting a family. Talk with your health care team if you have questions or concerns.

Here are some tips:

Not every man with diabetes gets ED
ED is not the end of your sex life
You can get help. There are several treatment options
Talk with your partner and your doctor or diabetes educator to get help

Depression and Anxiety

Diabetes raises your risk for depression. Depression is a medical condition that’s more serious than just feeling a little sad. Depression can lead to ED, and ED can cause men to feel depressed. People with diabetes sometimes feel they have a lot to worry about. They worry about their health, their future, and all the other stresses in their life. For some men, having sexual problems once in a while makes them worry about developing ED all the time. Lots of worry, also called an anxiety disorder, can lead to ED. Talk with your health care team if you have these feelings. Medicine or counseling can help with both depression and anxiety disorder

Your Body's Well Being

Make it a priority to take good care of your body. The time you spend now on eye care, foot care and skin care, as well as your heart health and oral health, could delay or prevent the onset of dangerous diabetes complications later in life. In addition, one of the best things you can do for your body is to stop smoking.

Heart Disease and Stroke
People with diabetes have extra reason to be mindful of heart and blood vessel disease. Diabetes carries an increased risk for heart attack, stroke, and complications related to poor circulation.

Skin Care
As many as one-third of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, such problems are sometimes the first sign that a person has diabetes. Luckily, most skin conditions can be prevented or easily treated if caught early.

Foot Care
People with diabetes can develop many different foot problems. Foot problems most often happen when there is nerve damage in the feet or when blood flow is poor. Learn how to protect your feet by following some basic guidelines.

Eye Care
Diabetes can cause eye problems and may lead to blindness. People with diabetes do have a higher risk of blindness than people without diabetes. Early detection and treatment of eye problems can save your sight.

Oral Health & Hygiene
If you have diabetes, you are at a higher risk for gum disease and other mouth-related problems. Learn more about maintaining good dental health.

Kicking the smoking habit is hard, but worth the work. Tobacco has many bad health effects, particularly for people with diabetes. No matter how long you've smoked, your health will improve when you quit.

Alcohol is everywhere: at family gatherings, at cookouts, after the company softball game, and at parties. One very common question is "What would you like to drink?" If you have diabetes, what do you say?

Stress results when something causes your body to behave as if it were under attack. Sources of stress can be physical, like injury or illness. Or they can be mental, like problems in your marriage, job, health, or finances.

Insulin Routines

Insulin Therapy

With the help of your health care team, you can find an insulin routine that will keep your blood glucose near normal, help you feel good, and fit your lifestyle. People diagnosed with type 1 diabetes usually start with two injections of insulin per day of two different types of insulin and generally progress to three or four injections per day of insulin of different types. The types of insulin used depend on their blood glucose levels. Studies have shown that three or four injections of insulin a day give the best blood glucose control and can prevent or delay the eye, kidney, and nerve damage caused by diabetes.

Most people with type 2 diabetes may need one injection per day without any diabetes pills. Some may need a single injection of insulin in the evening (at supper or bedtime) along with diabetes pills. Sometimes diabetes pills stop working, and people with type 2 diabetes will start with two injections per day of two different types of insulin. They may progress to three or four injections of insulin per day.

Insulin Delivery

Many people who take insulin use a syringe. Other choices are insulin pens and pump therapy. Some insulin pens contain a cartridge of insulin that is inserted into the pen and some come already filled with insulin and are discarded after all the insulin has been used. The insulin dose is dialed on the pen, and the insulin is injected through a needle, much like using a syringe. Cartridges and prefilled insulin pens only contain one type of insulin. Two injections must be given with an insulin pen if using two types of insulin.

Fine-Tuning Your Blood Glucose

Many factors affect your blood glucose levels. These include:

what you eat

how much and when you exercise

where you inject your insulin

when you take your insulin injections



Self Monitoring

Checking your blood glucose and looking over results can help you understand how exercise, an exciting event, or different foods affect your blood glucose level. You can use it to predict and avoid low or high blood glucose levels. You can also use this information to make decisions about your insulin dose, food, and activity.

Site Rotation

The place on your body where you inject insulin affects your blood glucose level. Insulin enters the blood at different speeds when injected at different sites. Insulin shots work fastest when given in the abdomen. Insulin arrives in the blood a little more slowly from the upper arms and even more slowly from the thighs and buttocks. Injecting insulin in the same general area (for example, your abdomen) will give you the best results from your insulin. This is because the insulin will reach the blood with about the same speed with each insulin shot.

Don't inject the insulin in exactly the same place each time, but move around the same area. Each mealtime injection of insulin should be given in the same general area for best results. For example, giving your before-breakfast insulin injection in the abdomen and your before-supper insulin injection in the leg each day give more similar blood glucose results. If you inject insulin near the same place each time, hard lumps or extra fatty deposits may develop. Both of these problems are unsightly and make the insulin action less reliable. Ask your health care provider if you aren't sure where to inject your insulin.


Insulin shots are most effective when you take them so that insulin goes to work when glucose from your food starts to enter your blood. For example, regular insulin works best if you take it 30 minutes before you eat.

Too much or not enough insulin?

High morning blood glucose levels before breakfast can be a puzzle. If you haven't eaten, why did your blood glucose level go up? There are two common reasons for high before-breakfast blood glucose levels. One relates to hormones that are released in the early part of sleep (called the Dawn Phenomenon). The other is from taking too little insulin in the evening. To see which one is the cause, set your alarm to self-monitor around 2 or 3 a.m. for several nights and discuss the results with your health care provider.

The Basics of Insulin

Types of Insulin

Rapid-acting insulin, such as insulin lispro (Eli Lilly), insulin aspart (Novo Nordisk), or insulin glulisine (sanofi-aventis), begin to work about 5 minutes after injection, peak in about 1 hour, and continue to work for 2 to 4 hours.

Regular or Short-acting insulin (human) usually reaches the bloodstream within 30 minutes after injection, peaks anywhere from 2 to 3 hours after injection, and is effective for approximately 3 to 6 hours.

Intermediate-acting insulin (human) generally reaches the bloodstream about 2 to 4 hours after injection, peaks 4 to 12 hours later and is effective for about 12 to 18 hours.

Long-acting insulin (ultralente) reaches the bloodstream 6 to 10 hours after injection and is usually effective for 20 to 24 hours. There are also two long-acting insulin analogues, glargine and detemir. They both tend to lower glucose levels fairly evenly over a 24-hour period with less of a peak of action than ultralente.

Premixed insulin can be helpful for people who have trouble drawing up insulin out of two bottles and reading the correct directions and dosages. It is also useful for those who have poor eyesight or dexterity and is a convenience for people whose diabetes has been stabilized on this combination.

Characteristics of Insulin

The three characteristics of the four types of insulin are onset, peaktime, and duration.

Onset is the length of time before insulin reaches the bloodstream and begins lowering blood glucose.
Peaktime is the time during which insulin is at maximum strength in terms of lowering blood glucose.
Duration is how insulin continues to lower blood glucose.
Insulin Strength

All insulins come dissolved or suspended in liquids. However, the solutions have different strengths. The most commonly used strength in the United States today is U-100. That means it has 100 units of insulin per milliliter of fluid. U40, which has 40 units of insulin per milliliter of fluid, is not used in the U.S., but is still used in Europe and in Latin America. If you're traveling outside of the U.S., be certain to match your insulin strength with the correct size syringe.

Insulin Additives

All insulins have added ingredients. These prevent bacteria from growing and help maintain a neutral balance between acids and bases. In addition, intermediate and long-acting insulins also contain ingredients that prolong their actions. In some rare cases, the additives can bring on an allergic reaction.

Animal Insulins

For many years, the insulin used by people with diabetes was produced from the pancreases of pigs and cows. Synthetic human insulin derived from genetically engineered bacteria first became available in the 1980s, and now all insulin available in the United States is manufactured in a laboratory. Although the development of synthetic human insulin was a boon for most people, especially those who were allergic to the animal insulins, a few people find that they can manage their diabetes better using animal insulins.

About Insulin and other drugs

Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from food. In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots to use glucose from meals. People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with type 2 diabetes need diabetes pills or insulin shots to help their bodies use glucose for energy. Insulin cannot be taken as a pill. The insulin would be broken down during digestion just like the protein in food. Insulin must be injected into the fat under your skin for it to get into your blood.

There are many different insulins for many different situations and lifestyles and there are more than 20 types of insulin sold in the United States. These insulins differ in how they are made, how they work in the body, and price. Insulin is made in labs to be identical to human insulin or it comes from animals (pigs). Future availability of animal insulin is uncertain.

HBA1C Test for Diabetes

Because you have diabetes, you and your doctor, diabetes educator, and other members of your health care team work to keep your blood glucose (sugar) at ideal levels. There are two powerful reasons to work for effective blood sugar control:

You will feel better.You may prevent or delay the start of diabetes complications such as nerve, eye, kidney, and blood vessel damage.
One way to keep track of your blood sugar changes is by checking your blood sugar at home. These tests tell you what your blood sugar level is at any one time.

But suppose you want to know how you've done overall. There's a test that can help. An A1C (also known as glycated hemoglobin or HbA1c) test gives you a picture of your average blood glucose control for the past 2 to 3 months. The results give you a good idea of how well your diabetes treatment plan is working.

In some ways, the A1C test is like a baseball player's season batting average. Both A1C and the batting average tell you about a person's overall success. Neither a single day's blood test results nor a single game's batting record gives the same big picture.

How HbA1C Works
You know from the name that the test measures something called A1C. You may wonder what it has to do with your blood sugar control. Hemoglobin is found inside red blood cells. Its job is to carry oxygen from the lungs to all the cells of the body. Hemoglobin, like all proteins, links up with sugars such as glucose.

You know that when you have uncontrolled diabetes you have too much sugar in your bloodstream. This extra glucose enters your red blood cells and links up (or glycates) with molecules of hemoglobin. The more excess glucose in your blood, the more hemoglobin gets glycated. It is possible to measure the percentage of A1C in the blood. The result is an overview of your average blood glucose control for the past few months.

Thanks for the Memories
How does the A1C test look backward? Suppose your blood sugar was high last week. What happened? More glucose hooked up (glycated) with your hemoglobin. This week, your blood glucose is back under control. Still, your red blood cells carry the 'memory' of last week's high blood glucose in the form of more A1C.

This record changes as old red blood cells in your body die and new red blood cells (with fresh hemoglobin) replace them. The amount of A1C in your blood reflects blood sugar control for the past 120 days, or the lifespan of a red blood cell.

In a person who does not have diabetes, about 5% of all hemoglobin is glycated. For someone with diabetes and high blood glucose levels, the A1C level is higher than normal. How high the A1C level rises depends on what the average blood glucose level was during the past weeks and months. Levels can range from normal to as high as 25% if diabetes is badly out of control for a long time.

You should have had your A1C level measured when your diabetes was diagnosed or when treatment for diabetes was started. To watch your overall glucose control, your doctor should measure your A1C level at least twice a year. This is the minimum. There are times when you need to have your A1C level tested about every 3 months. If you change diabetes treatment, such as start a new medicine, or if you are not meeting your blood glucose goals, you and your doctor will want to keep a closer eye on your control.

How Does It Help Diabetes Control?
How can your A1C test results help your control?
Here are two examples.

Bob D., 49 years old, has type 2 diabetes. For the past seven years, he and his doctor have worked to control his blood sugar levels with diet and diabetes pills. Recently, Bob's control has been getting worse. His doctor said that Bob might have to start insulin shots. But first, they agreed that Bob would try an exercise program to improve control.

That was three months ago. Bob stuck to his exercise plan. Last week, when the doctor checked Bob's blood sugar, it was near the normal range. But the doctor knew a single blood test only showed Bob's control at that time. It didn't say much about Bob's overall blood sugar control.

The doctor sent a sample of Bob's blood to the lab for an A1C test. The test results would tell how well Bob's blood sugar had been controlled, on average, for the past few months. The A1C test showed that Bob's control had improved. With the A1C results, Bob and the doctor had proof that the exercise program was working. The test results also helped Bob know that he could make a difference in his blood sugar control.

The A1C test can also help someone with type 1 diabetes. Nine-year-old Lisa J. and her parents were proud that she could do her own insulin shots and urine tests. Her doctor advised her to begin a routine of two shots a day and to check her blood sugar as well.

Lisa kept records of all her test results. Most were close to the ideal range. But at her next checkup, the doctor checked her blood and found her blood sugar level was high. The doctor sent a sample of Lisa's blood for an A1C test. The results showed that Lisa's blood glucose control had in fact been poor for the last few months.

Lisa's doctor asked Lisa to do a blood sugar check. To the doctor's surprise, Lisa turned on the timer of her meter before pricking her finger and putting the blood drop on the test strip. The doctor explained to Lisa and her parents that the way Lisa was testing was probably causing the blood sugar test errors.

With time and more accurate blood sugar results, Lisa and her parents got better at using her results to keep food, insulin, and exercise in balance. At later checkups, her blood sugar records and the A1C test results showed good news about her control.

A1C tests can help:

Confirm self-testing results or blood test results by the doctor

Judge whether a treatment plan is working Show you how healthy choices can make a difference in diabetes control.
Test Limit

Although the A1C test is an important tool, it can't replace daily self-testing of blood glucose. A1C tests don't measure your day-to-day control. You can't adjust your insulin on the basis of your A1C tests. That's why your blood sugar checks and your log results are so important to staying in effective control.

It is important to know that different labs measure A1C levels in different ways. If you sent one sample of your blood to four different labs, you might get back four different test results.

For example, an 8 at one lab might mean that blood glucose levels have been in the near-normal range. At a second lab, a 9 might be a sign that, on average, blood glucose was high. This doesn't mean that any of the results are wrong. It does mean that what your results say depends on the way the lab does the test.

Talk to your doctor about your A1C test results. Know that if you change doctors or your doctor changes labs, your test numbers may need to be "read" differently.

The A1C test alone is not enough to measure good blood sugar control. But it is good resource to use along with your daily blood sugar checks, to work for the best possible control.