Diffuse Neuropathy

Diffuse neuropathy is a kind of nerve problem that affects many parts of the body. There are two types of diffuse neuropathy. Peripheral neuropathy affects the feet and hands and autonomic neuropathy affects the internal organs. Autonomic neuropathy can affect a lot of body processes and systems, everything from sexual response in both women and men, digestive problems that cause weight loss, even regulation of body temperature and sweat.

Focal Neuropathy

This kind of diabetic neuropathy appears suddenly and affects specific nerves, most often in the torso, leg or head. Symptoms can include severe pain in an area of the body, eye and hearing problems or even paralysis on one side of the face called Bell’s palsy. Carpel tunnel syndrome is a common symptom of focal neuropathy. This type of neuropathy is unpredictable and most often occurs in older people who have mild diabetes. Although it’s painful, it tends to improve by itself without causing long-term damage.

How is it diagnosed?
Your doctor should use a simple screening test to check sensation in the feet. This should be done once a year. You may also have an ultrasound if your urinary tract is affected. Nerve studies or biopsies in which a sample of your tissue is removed and studied are also possible. Your doctor may refer you to a specialist who may conduct other kinds of tests depending on your symptoms and the kind of neuropathy you have.

What is the treatment?
The first step is to bring blood sugar under control. Good control of blood sugar can also help prevent future problems. Your doctor may change, add or adjust medications.

Tips to help

• Ask your doctor to suggest an exercise routine that is right for you. Many people who exercise regularly find the pain of neuropathy less severe. Aside from helping you reach and maintain a healthy weight, exercise also improves the body’s use of insulin, helps improve circulation and strengthens muscles. Check with your doctor before starting exercise that can be hard on your feet, such as running or aerobics.
• A variety of drugs are being tested for their effect on improving neuropathy including ace inhibitors and aldose reductase inhibitors.
• If you smoke try to stop because smoking makes circulatory problems worse and increases the risk of neuropathy and heart disease.
• Reduce the amount of alcohol you drink. Recent research has indicated that as few as four drinks per week can make neuropathy worse.
• Take good care of your feet.

Why check your feet?
компютриhotel furnishing in Bulgaria If you have peripheral neuropathy, your feet are especially vulnerable. That’s because one of the symptoms of this kind of neuropathy is a loss of feeling. You should check your feet carefully every day for cuts, bruises and sores because you might not feel a pebble in your sock that’s causing a sore or even feel a blister.

If you notice anything unusual, see a doctor as soon as possible because foot infections and sores can be difficult to treat in people with diabetes. Your doctor should check your feet at every visit and at least once a year. Your doctor should check to see how much sensation you have in your feet.

Foot care tips

1. Work with your health care team to keep your blood sugar within good range. Click on Benefits of tight control.
2. Wash your feet every day in warm, not hot, water. Dry your feet well, even between the toes.
3. Smooth corns and calluses gently with a pumice stone.
4. Check your feet every day. Look for cuts, blisters, red spots and swelling. Use a mirror to check the bottoms of your feet if you can’t see or ask a family member for help.
5. Keep skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between the toes.
6. Trim toenails each week or when needed. Trim the nail to the shape of the toe and file the edges with an emery board or file.
7. Wear shoes and socks all the time. If you have diabetes, you should never walk barefoot. Wear comfy shoes and always check inside your shoes before wearing to be sure there are no objects inside.
8. Keep the blood flowing to your feet. Keep your feet up when sitting. Wiggle your toes and move your ankles up and down for five minutes, two or three times each day. Don’t smoke. Limit alcohol.
9. Protect your feet from hot and cold by wearing shoes at the beach or on hot pavement. Wear socks at night if your feet get cold.
10. Be more active. Plan your physical activity program with your doctor. Click on Exercise tip of the week.
11. Check with your doctor. Have your doctor check your bare feet and find out whether you’re likely to have serious foot problems. Remember that you may not feel the pain of an injury.

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What is it?
About 20 percent of the people with Type 1 diabetes develop this disorder in which the stomach takes too long to empty. People with Type 2 diabetes get it also, but less often. Diabetes damages the vagus nerve, which is the nerve that keeps food moving through the digestive tract. Gastroparesis can cause food to harden into solid masses and can cause blockages and bacteria problems. The fact that the stomach isn’t working properly can also disturb the absorption of glucose and make it harder to control blood sugar.

Symptoms of Gastroparesis
You should let your doctor know if you have these symptoms of gastroparesis:

• Nausea
• Vomiting
• An early feeling of fullness when eating
• Weight loss
• Abdominal bloating
• Abdominal discomfort

How is it diagnosed?
You may have a test involving drinking or eating barium, a substance that will help your doctor actually see whether your stomach is working properly. You also might eat a food with a slightly radioactive substance that will show up on a scan. This will produce an image that your doctor can see. There is also a test that measures electrical and muscular activity in the stomach. It involves having a tube inserted through the throat and into the stomach. The tube has a wire that can measure how your stomach is working and digesting. Your doctor might also use a kind of scope via the esophagus to look at the lining of the stomach.

Treatment
The primary treatment goal for gastroparesis is to regain control of blood glucose levels. Your doctor may re-adjust your insulin level and treat the gastroparesis with medication. Your doctor may also have you work with a dietitian to change your diet, and you may be asked to eat six small meals a day rather than three large ones. Other options are parenteral nutrition which means nutrition will be delivered directly into your bloodstream instead of by eating or a jejunostomy, which is a feeding tube. Both of these treatments are usually temporary.

Several drugs are used to treat gastroparesis, including:

• Metoclopramide (Reglan) - stimulates contractions of the stomach muscle to move food along
• Erythromycin - an antibiotic that has similar effects as Reglan
• Antiemetics - used to reduce nausea and vomiting.

Your doctor will prescribe medication or change your insulin dosing to help combat the effects of gastroparesis. It is a chronic condition, so treatment is aimed at regaining control of blood glucose levels.

Changes in Eating Habits Can Help Control Gastroparesis
Your doctor or dietitian will give you specific instructions. Their recommendations may include:

• Eat 6 small meals a day instead of 3 large ones. If less food enters the stomach each time you eat, it may not become overly full.
• Try several liquid meals a day until your blood glucose levels are stable and the gastroparesis subsides. They provide all the nutrients in solid foods, but can pass through the stomach faster.
• Avoid fatty and high-fiber foods. Fat naturally slows digestion, and fiber is difficult to digest.
• Avoid some high-fiber foods such as oranges and broccoli which contain material that cannot be digested. The indigestible parts will remain in the stomach too long and may form a solid mass called a "bezoar." This can be dangerous if bezoars block the movement of food into the small intestine.

Diabetic Neuropathy
Diabetic neuropathy is a nerve disorder caused by diabetes. Sometimes it involves numbness and pain in hands, feet or legs, but nerve damage can also affect other systems in your body. Neuropathy can come on suddenly and cause problems with digestion, gastroparesis, heart problems, bladder infections, impotence, weight loss and weakness. Symptoms can come and go. Sometimes problems occur for only a short time.

Who gets diabetic neuropathy?
Estimates are that after living with the disease for 25 years, about 50 percent of people with diabetes have some kind of neuropathy. People with diabetes who smoke, drink alcohol or have poor glucose control seem to have more neuropathy than other people with diabetes.

Tight control of blood glucose has a tremendous impact on preventing this disease. In 1993, the federal study, Diabetes Control and Complications Trial, revealed that tight control, keeping blood sugar levels as close to the normal range as possible, reduced the risk of developing neuropathy by 60 percent. Tight control means frequent testing of blood sugar, basing insulin intake on the basis of diet and exercise, following a diet and exercise plan, and staying in close contact with a health care team whose members are skilled at treating diabetes.

Diabetic Eye Disease
Diabetic eye disease refers to a group of eye problems that people with diabetes may have as a complication of the disease. All of these diseases can cause vision loss or even blindness. They include diabetic retinopathy, damage to the vessels of the retina; cataract, clouding of the eye’s lens and glaucoma, an increase in fluid pressure inside the eye that leads to optic nerve damage and vision loss.

Who gets diabetic retinopathy?
Anyone who has diabetes. The longer you have diabetes, the more likely you’ll get it. Nearly half of all people with diabetes will develop some degree of the disease. The National Eye Institute estimates that as many as 24,000 people with diabetes lose their vision every year.

How can it be prevented?
Retinopathy can be slowed or even halted by visiting your eye doctor. If you are between 10 and 29 years old and have had diabetes for at least five years, you should have an annual dilated eye exam. If you are 30 or older, you should have an annual dilated eye exam, no matter how short a time you have had diabetes. More frequent exams may be needed if you have eye disease, according to the American Diabetes Association.
Tight control of blood glucose has a tremendous impact on preventing this disease. In 1993, the federal study, Diabetes Control and Complications Trial, revealed that tight control reduced the risk of developing retinopathy by a whopping 76 percent. In people who already had eye disease at the start of the study, tight control slowed the progression of the disease by 54 percent.

What are the symptoms of retinopathy?
There may be no signs or, at first there may be few signs of this disease. An annual eye exam is the best way to catch it in its early stages. A doctor can detect the blood vessel changes in the eye that signal the presence of retinopathy. Blurred vision may occur when the macula–the part of the retina that provides sharp, central vision–swells from fluid leaking from vessels.

What is the treatment?
Your eye care professional may suggest laser surgery in which a strong light beam is aimed onto the retina to shrink the abnormal vessels. Laser surgery has been proven to reduce the risk of severe vision loss from this type of diabetic retinopathy by 60 percent. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.

Hypertension and Diabetic Kidney Disease

High blood pressure is a major factor in the development of kidney problems in people who have diabetes. Both a family history of high blood pressure and the presence of the disease seem to increase chances of developing kidney disease.
Hypertension is not just a cause of kidney disease, but it’s also a result of damage created by the kidney disease. Physical changes in the kidneys contribute to high blood pressure creating a dangerous spiral.

Treating Diabetic Kidney Disease

*Intensive management - Tight control of blood glucose has shown a lot of promise for people at the beginning stages of diabetic kidney disease. This means keeping blood glucose levels close to normal. To have tight control, you have to test blood sugar four times or more per day, give insulin on the basis of food and exercise, follow a nutrition and exercise plan and keep in close contact with a health care team that understands diabetes.

*Lower blood pressure - Medications used to lower blood pressure can slow the progress of kidney disease. One medication, an angiotensin-converting enzyme (ACE) inhibitor, has been shown to prevent progression to stages IV and V. Calcium channel blockers, another type of blood pressure-lowering medications, also show promise. Ask your doctor whether you might benefit from receiving an ACE inhibitor. Be sure to monitor your blood pressure. Use lifeclinic.com to record measurements and track your pressure.

*Low protein diets - A diet containing reduced amounts of protein may help. Most Americans eat too much protein, enough to cause harm to people with diabetes. Talk to a diabetic nutritionist or your doctor and ask if you should reduce the protein in your diet.

Diabetic Kidney Disease

Diabetes is the most common cause of kidney failure. However, it’s also true that most people with diabetes don’t go on to have end-stage kidney disease (ESRD). There are many things you can do to control your diabetes and minimize your risk of kidney failure including stopping smoking and keeping blood pressure under control. A federal study called the Diabetes Control and Complications Trial proved in 1993 that intensive management of diabetes can reduce the risk of kidney disease by 50 percent.
Intensive management (called tight control) means frequent testing of blood sugar, calculating insulin intake on the basis of diet and exercise, following a diet and exercise plan, and talking often with a health care team whose members are skilled at treating diabetes.

What happens?
Early in diabetes, the blood-filtering units of the kidneys are damaged. This means important proteins are lost in the urine. A urine test that measures protein can show beginning diseases. Later in the disease, the kidneys can’t remove waste products from the blood.

What are the stages?
There are five stages of diabetic kidney disease with the last stage being kidney failure. On average it takes a person with diabetes over 20 years to progress to the end stage. Both types of diabetes, Type 1 and Type 2, can lead to kidney disease. Type 1 is more likely to lead to end-stage kidney failure.

About 40 percent of people with Type 1 diabetes develop severe kidney disease and end-stage kidney failure by the age of 50. Type 2 causes 80 percent of the end-stage kidney failure in African Americans and Native Americans. The key to preventing kidney disease in people with both types of diabetes is not smoking, getting regular blood pressure and urine protein tests, and preventing high blood sugar.
Often there are no symptoms of the disease until it progresses to the late stages. When symptoms do appear they include:

• Fatigue
• Insomnia
• Weakness
• Vomiting
• Swelling

Stage I - The flow of blood through the kidneys increases and the kidneys get bigger. People can stay in this stage indefinitely or advance to Stage II after many years.

Stage II - Small amounts of blood protein known as albumin leak into the urine. This is called microalbuminuria.

Stage III - The loss of albumin and other proteins speeds up. Some patients develop high blood pressure. The kidneys continue to lose the ability to filter waste. Many people are first diagnosed with kidney disease at this stage.

Stage IV - In this stage large amounts of urine are passed through the kidneys and high blood pressure almost always occurs.

Stage V - The ability of the kidneys to filter waste almost stops. Kidney dialysis or transplants are treatment options.

Ways to prevent diabetes kidney problems
You can prevent diabetes kidney problems through the following means:

• Keep your blood glucose levels under control. Talk to your doctor about your HbA1c test and what your goal should be.
• Keep your blood pressure under control (130/85 mmHg or lower).
• Have your kidneys checked at least once a year by having your urine tested for small amounts of protein.
• Talk to your doctor about being placed on an ACE inhibitor to protect your kidneys.
• Have any other kidney tests that your doctor recommends.
• See your doctor right away if you think you have a bladder or kidney infection.

Heart Disease and Stroke
Having diabetes puts you at increased risk for heart disease and stroke. This is the biggest cause of death for people with diabetes. The disease process changes your body and can make you prone to fatty deposits in your arteries. These deposits can cause a heart attack. Diabetes can also make your blood more likely to clot and this can result in heart attack and stroke. The disease also puts you at risk for high blood pressure, which is a major cause of both heart disease and stroke.

Reducing Heart Disease in People with Diabetes

• Coronary artery disease — People with type 2 diabetes are 2 to 4 times more likely to develop coronary artery disease than others. The statins have been found effective in lowering high LDL cholesterol and blood triglycerides in people with type 2 diabetes.
• Hypertension — About 40% of middle-aged people with type 2 diabetes have high blood pressure, a figure that rises to 60% in those over the age of 75. ACE-inhibitors are the preferred medications for treating hypertension, because in addition to lowering blood pressure, they also improve the body’s response to insulin and slow the progression of diabetic kidney disease. Target blood pressure in people with diabetes is 130/80 mmHg. Based on the results of a major research study (HOPE trial), experts believe that everyone with diabetes - even if blood pressure is normal, should be taking an ACE-inhibitor.
• Clotting abnormalities - People with diabetes are prone to blood clots, due to the abnormal "stickiness" of their platelets and a lack of certain blood proteins that slow the breakdown of clots. Low-dose aspirin is recommended for its ability to reduce the tendency of the blood to clot, unless you have a bleeding disorder or stomach ulcer. The latest government survey of health and nutrition found that as many as 8 million people with diabetes who might benefit from aspirin therapy are not using it. Only 37% of people with diabetes and cardiovascular disease were taking low-dose aspirin. The percent was even lower - only 13% — for those with CVD risk factors.

Both Type 1 and Type 2 diabetes are associated with long-term complications that threaten life and the quality of life. The disease is the leading cause of adult blindness, end-stage kidney disease(ESRD) and amputations (as a result of nerve disease).

People with diabetes are two to four times more likely to have coronary heart disease and stroke than people who don’t have it. Diabetes complicates pregnancy and results in more birth defects than babies born to women without the disease.

• Heart disease is the leading cause of diabetes-related deaths. Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes.
• The risk of stroke is two to four times higher.
• An estimated 60 to 65 percent of people with diabetes have high blood pressure.
• Diabetes is the leading cause of new cases of blindness in adults 20 to 24 years old.
• More than half the limb amputations in the United States occur among people with diabetes.

It’s important to know how serious the complications of diabetes can be. If you have diabetes, you will be the person most responsible for working to avoid the worst effects of the disease. You will want to know about these problems so that you can be alert to detecting them and preventing them. Diabetes care is a 24-hour-a-day effort, and preventing complications is worth establishing good self-care routines. The most effective way to avoid complications from either type of diabetes is to keep your blood sugar levels as close to normal as you can.

Diabetes Basics - Diagnosis

The only way you can be sure you have diabetes is by getting a test. The American Diabetes Association (ADA) now recommends that everyone over age 45 should have a fasting plasma glucose test. If test results are normal, the test should be repeated every three years. If you have risk factors for diabetes, you should be tested at a younger age and more often. The high risk factors include:

• Being more than 20 percent above your ideal body weight or having a body mass index (BMI) of greater than or equal to 27. The BMI is the ratio of weight in kilograms to height in meters squared. Your doctor can give you information on your BMI.
• Calculate Your Body Mass Index.
• Having a mother, father, brother or sister with diabetes.
• Being African American, Alaska Native, Pacific Islander American, Hispanic, Native or Asian American.
• Giving birth to a baby weighing more than 9 lbs or having diabetes during pregnancy (gestational diabetes).
• Having an HDL cholesterol level less than 35 mg/dL (HDL is the ’good’ cholesterol) or trigylcerides (certain kinds of body fat) greater than 250 mg/dL.
• Having blood pressure at or above 140/90 millimeters of mercury (mmHg).
• Having abnormal glucose levels when previously tested for diabetes.

Fasting Plasma Glucose
This is the preferred test for diabetes. To have this test, you have to fast at least eight hours or overnight. You will have a blood sample drawn and examined for glucose. Most people have a level between 70 and 110 milligrams of glucose per deciliter of blood. A level of 126 mg/dl or higher on two tests given on two different days confirms a diagnosis of diabetes. (Previously a level of 140 mg/dl or higher was used to diagnose diabetes, but in 1997, the guidelines were revised because by the time a person got a diagnoses of diabetes with a level of 140 mg/dl, serious damage to the body had often already occurred. By lowering the diagnostic levels to 126 mg/dl, early control of the disease can begin and risk of complications is lower.)

Random Blood Glucose Test
You don’t have to fast to have this test, which is sometimes used if symptoms are present. Blood samples are taken shortly after eating or drinking. A blood glucose level of 200 mg/dl or higher points to diabetes, but it must be confirmed on another day with a fasting plasma glucose, an oral glucose tolerance test or another random blood glucose of over 200.

Oral Glucose Tolerance Test
For this test you have to fast at least eight hours and not have smoked or drank coffee. Your fasting plasma glucose is tested from a blood sample. After the test you will be asked to drink a sweet glucose syrup and then your glucose level will be measured from a blood sample taken two hours after you drink the liquid. There can be up to four blood samples taken to measure the blood glucose level. The American Diabetes Association expert committee recommends that this test be eliminated because it is a difficult and time-consuming test.

Glucose Challenge
This is a test your doctor may give you to see if you have gestational diabetes, diabetes developed during pregnancy. You may be given this test if you are age 25 or older, are overweight, have a close relative with diabetes or if you are Hispanic, Native American, Asian or African American or a Pacific Islander. This test is given between the 24th and 28th weeks of pregnancy. You will be given a glucose drink and if an hour later, your glucose is 140 mg/dl or higher, your doctor may suspect gestational diabetes. You may then be given an oral glucose tolerance test.

Impaired Fasting Glucose
Impaired fasting glucose is a new diagnostic category. If your blood sugar is measured between 110 and 125 mg/dL, it means you have impaired fasting glucose. This means your blood sugar is greater than normal, but less than the level of a person diagnosed with diabetes. It’s thought that around 13.4 million adults, about 7 percent of the US population, have impaired fasting glucose. It’s suspected that some people with impaired fasting glucose go on to develop diabetes. Talk to your doctor to see if exercise and eating a healthy diet will bring your blood sugar closer to normal.

Diabetes and Pregnancy

Pregnancy is a very special time in any woman’s life. It is a time of great joy but also of anxiety and questions such as: How will I cope with the pregnancy? With labor and delivery? Will my baby be OK? These questions may be even more troublesome for women with diabetes. Until fairly recently, pregnancy was risky for women with diabetes. Fortunately, today with good medical care and rigorous self-management, most women with diabetes have a successful pregnancy and a healthy baby - provided that they pay close attention to glucose levels and work hard to keep them as close to normal as possible.

On this site we will cover three aspects of diabetes and pregnancy:

• The woman with diabetes who wants to get pregnant — what you can do to help prepare your body for a healthy pregnancy
• The woman with diabetes who is pregnant — what you can do to help make your pregnancy smooth and your baby healthy
• The woman who develops diabetes while pregnant, called gestational diabetes — how to best manage your diabetes and your pregnancy

Type I Diabetes
Type I diabetes is more common among whites than Asian, Hispanic, Native and African Americans. If you have a close relative with the disease, you are more likely to develop Type I.

Type II Diabetes
Type II diabetes also tends to run in families. In fact there seems to be even stronger evidence for some kind of genetic cause for Type II than for Type I diabetes. Type II is more common among Asian, Hispanic, Native and African Americans.
Although Type II diabetes usually develops after age 40, about half of all people diagnosed with the disease are older than 55. This may be because as people age, they tend to become more sedentary and to gain weight. Eating too much food and being inactive can make you obese and you are more likely to develop Type II diabetes if you are obese. Obesity is, by far, the greatest risk factor for this kind of diabetes.
Where the weight is distributed seems to be a factor, too. If you tend to have an apple-shaped body in which you store fat around the tummy, you are more at risk for Type II diabetes. Those with a pear shape in which fat is stored in the hips are somewhat less at risk.

Gestational Diabetes
Any woman can develop gestational diabetes during pregnancy, but some women are more at risk than others. Some risk factors include obesity, a family history of diabetes, having previously given birth to a very large baby, a stillbirth, a child with a birth defect or having too much amniotic fluid. Women who are older than 25 are at higher risk than younger women. About 135,000 women develop gestational diabetes every year.

Some women, about 3 to 5 percent of all pregnant women, get this form of diabetes during pregnancy. It usually ends when the baby is born, but some women who have gestational diabetes go on to develop diabetes when they get older. Some studies have reported that almost 40 percent of women who have gestational diabetes will go on to develop type 2 diabetes. So, if you have had gestational diabetes, you need to see your doctor every year and ask to be screened for type 2 diabetes.

Gestational diabetes usually doesn’t cause birth defects, but one of the problems is the possibility of having a baby that is considerably larger than normal. There is also the risk that the baby might have low blood sugar right after it’s born.

Gestational diabetes happens when the body doesn’t make enough insulin and resists the action of insulin because of hormones. The condition develops about midway through the pregnancy. Although most women with this condition are treated with diet, some women may need insulin. The problem can’t be treated with pills because the medication can harm the baby.

Diabetes Basics - Type 2 Diabetes

Type 2 diabetes used to be called ’non-insulin-dependent diabetes mellitus’ or adult-onset diabetes. It differs from type 1 diabetes in that the body makes some insulin, but not enough; also, the body can’t use the insulin efficiently.

Type 2 diabetes is the most common type of diabetes, accounting for 90 to 95 percent of all diabetes. It usually develops after the age of 40. However, in the late 1990’s, its incidence increased among young people. Experts are trying to determine why that is happening; they think it may be related to the increased incidence of obesity and sedentary lifestyles among young people in the US.

About 80 percent of those with type 2 diabetes are overweight. It is more common among people who are older, sedentary or obese, or have a family history of the disease. It may reappear in women who had gestational diabetes. It is more common among people of Asian, Hispanic, African or Native American ancestry.

Type 2 diabetes is a progressive disease that can cause significant, severe complications such as heart disease, kidney disease, blindness and loss of limbs through amputation. Treatment differs at various stages of the condition. In its early stages, many people with type 2 diabetes can control their blood glucose levels by losing weight, eating properly and exercising. Many may subsequently need oral medication, and some people with type 2 diabetes may eventually need insulin shots to control their diabetes and avoid the disease’s serious complications.

Even though there is no cure for diabetes, proper treatment and glucose control enable people with type 2 diabetes to live normal, productive lives.

A major advance for people at risk of developing type 2 diabetes - such as family members of those with the condition - occurred recently when it was shown that diet and exercise can prevent or delay type 2 diabetes. People at high risk, who already had early signs of impaired glucose tolerance, significantly reduced their risk by losing only 5-7 percent of their body weight and performing moderate physical activity for 30 minutes/day. Taking the diabetes medication metformin also reduced the risk.

About blood sugar testing

To control your diabetes, you absolutely have to know your blood sugar numbers. Testing your blood sugar is the only way to know whether your blood sugar is too high, too low or just right. There are two common tests to measure your blood sugar–the hemoglobin A1c test and daily finger-stick tests. You need to do both of these in order to really get a true picture of your blood sugar control. There are also some relatively new tests that you need to know about.

Hemoglobin A1c test

(Pronounced he-mo-glo-bin A-one-C) measures your blood sugar control over the last three months. It’s the best way to know if your blood sugar is under control.

What is the A1c Testing goal?

A hemoglobin A1c goal for people with diabetes is less than 7 percent but not everyone can meet that goal. Each person should try to get as close as possible. A change in your treatment plan is almost always needed if your test result is over 8 percent. Ask for a hemoglobin A1c test at least twice a year. If your treatment changes or your blood sugar stays too high, you should get a hemoglobin A1c test every three months until your blood sugar level improves.

Common causes of high blood sugar include eating too much food, eating the wrong foods, lack of physical activity, stress, a need to change medication and infections or illness.

This table shows the correlation between blood glucose levels as measured daily and the longer-term measure of blood glucose status, the HbA_1c. It is important to note, however, that this data was derived from the Diabetes Control and Complications Trial, a long-term study of intensive therapy in patients with type 1 diabetes. The patients in this study measured their blood glucose levels 7 times a day - and we know that hardly any people with diabetes monitor that often! Your ’mean blood glucose’ level is probably derived by your glucose meter from the measurements you took over the previous 14 days. If you only measure when you know your levels are high - or low - or only before meals, etc., then your mean blood glucose levels will be skewed. For these reasons, it is important that you obtain an HbA_1c blood test regularly and be aware of that number, too. It is an important indicator of long-term blood glucose levels.

What is hypoglycemia?

If your blood sugar drops too low, you can have a low blood sugar reaction called hypoglycemia. A low blood sugar reaction can come on fast. Generally, a level below about 60 mg/dl is called low blood sugar. It may occur once or twice a week if you have Type 1 diabetes. Hypoglycemia is much less common with Type 2 diabetes, but it can happen especially with some medications. People who have tight control of their diabetes are more at risk for low blood sugar and so are the elderly. Studies have shown that 50 percent of severe low blood sugars occur between midnight and 8 a.m. Talk to your diabetes educator about what to do.

What causes hypoglycemia?

Hypoglycemia can occur for a number of reasons:

• Delaying or skipping a meal
• Eating too little food at a meal
• Getting more exercise than usual
• Taking too much diabetes medicine, especially insulin, sulfonylureas, or meglitinides
• Drinking alcohol

What are the symptoms of hypoglycemia?

You feel shaky, nervous, tired, sweaty, cold, hungry, confused, irritable or impatient. It’s always important to test to be sure that you actually are having low blood sugar.

Teach your family members and friends the signs and symptoms of low blood sugar. You should also wear a bracelet and carry a card in your wallet that says you have diabetes. The card should also say if you’re an insulin user.

What is the treatment for hypoglycemia?

1. If you feel that your blood glucose is too low, test it. If it is 70 mg/dl or lower, you should eat or drink 15 grams of carbohydrate quickly 1/2 cup of fruit juice, such as:
   • 1-2 teaspoons of sugar or honey
   • 1/2 cup of regular soda
   • 5-6 pieces of hard candy
   • Glucose gel or tablets (take the amount noted on the package to add up to 15 grams of carbohydrate)
   • 1 cup of milk
2. Test your blood sugar again in 15 minutes. If it is still below 70 mg/dl, eat another 15 grams of carbohydrate. If your blood glucose is not low but your next meal is an hour away, have a snack with starch and protein, such as:
   • Crackers and peanut butter or cheese
   • Half a ham or turkey sandwich
   • Crackers or cereal with a cup of milk

The American Diabetes Association (ADA) states that milk is better than juice or glucose because it has lactose, fat and protein that will help keep your blood sugar remain steady over time. A candy bar or other high fat sweets can raise blood sugar too high after you eat them and can contribute to weight gain.

Adult family members should also know how to inject glucagon, a hormone that causes your liver to release glucose. Your doctor can prescribe a glucagon kit. Always keep it in the same place and make sure family and friends know where it is. It is extremely important that those around you know what to do in an emergency.

The federal government conducted a landmark study from 1983 to 1993 that profoundly changed the management of diabetes. The study involved 1,441 volunteers with Type 1 diabetes at 29 medical centers in the United States and Canada. The United Kingdom Prospective Diabetes Study in 1998 produced similar results for people with Type 2 diabetes.

The results from both studies proved that the level of blood sugar control predicts the onset and severity of diabetes-related complications for both types of diabetes. This means that if you have diabetes, if you can keep your blood sugar levels as close as possible to normal, you can live a normal life span with few or even no complications at all.

If you can control your blood sugar level, in the short run, you will:

• Feel better.
• Stay healthy.
• Have more energy.
• Prevent the signs and symptoms of high blood sugar such as feeling very thirsty and tired, urinating often, losing a lot of weight, having blurred vision, and having cuts and bruises that are slow to heal.

In the long run, you will:

• Lower your chances of having eye disease, kidney disease, nerve damage and heart disease.
• Enjoy a better quality of life.

How to reach tight control?

Test your blood sugar levels several times each day. It is valuable to test blood sugar levels as often as you feel it is giving you meaningful information.

• Adjust medication doses according to food intake and exercise.
• Follow a diet and exercise plan. For people with Type 2 diabetes, regular exercise and maintaining a healthy weight may forestall the use of medication.
• Stay in close contact with a health care provider skilled in helping patients manage diabetes.

Who shouldn’t strive for tight control?

Tight control isn’t recommended for everyone because of age or other health factors, and can increase the risk of low blood sugar episodes. Your doctor can help you decide if tight control is for you, but it isn’t recommended for the following people:

• Children under 13
• People with heart disease or advanced complications
• People with a history of frequent, severe hypoglycemia (low blood sugar episodes)
• Older adults

Know your blood sugar numbers

Everyone has some sugar in his or her blood. The normal amount of sugar in the blood ranges from about 70 to about 120 in people who don’t have diabetes. Blood sugar goes up after eating, but returns to normal range within one to two hours.

A good blood sugar range for most people with diabetes is from about 70 to 120. This is before a meal — like before breakfast — or four to five hours after your last meal. Your blood sugar should be less than 200 about two hours after your last meal. However, these goals vary depending on the person. For an elderly person, it might be better to have higher blood sugar and not worry so much about complications than risk having low blood sugar. You’ll need to work out your personal goal with your health care team.

Remember, the fact that you feel fine doesn’t mean you can skip testing your blood sugar. You can feel fine and still have high blood sugar.

If you have Type 1 diabetes, your body doesn’t make insulin which helps sugar from food be turned into energy. If you have Type 2 diabetes, your pancreas does not make enough insulin and your body can’t use it properly. Sometimes, eating a healthy diet and getting enough exercise will control Type 2 Diabetes. Sometimes, your doctor will give you medication. However, diabetes medications that lower blood sugar never, never take the place of healthy eating and exercise. Some people, after a few years of taking oral medication, will need to begin taking insulin.

Insulin

How it works
Insulin lowers blood sugar by moving sugar from the blood into the cells of your body. Once inside the cells, sugar provides energy. If you take insulin, you’ll need to eat on time and match your insulin injections to your meals. Your insulin should peak at the same time blood sugar levels from meals are also peaking.
Work with your health care team to establish a meal plan and to work out how to take your insulin in relation to your meals. It’s important to plan for those ’what if’ situations that come up and to know what to do. A few basic tips include:

• Remember, you need some insulin in your body all of the time.
• You need some insulin before you eat a meal. Match the dose to the estimated amount of carbohydrates in the meal. Your diabetes educator can show you how.
• You may need additional insulin to lower your blood sugar if it is high sometimes.
• By testing your blood sugar at least four times a day, you’ll have the knowledge you need to moderate your insulin, activity and eating so that your blood sugar is under good control.

A rough guideline to remember is that one unit of insulin lowers blood sugar by 50 mg/dL and covers about 10 to 15 grams of carbohydrate.
How often?
Most people with diabetes need at least two insulin shots a day for good blood sugar control. Some people take three or four shots a day to have a more flexible plan.

When to take?
You should take insulin 30 minutes before a meal if you take regular insulin alone or with a longer-acting insulin. If you take lispro (Humalog), or insulin aspart (Novolog), two insulins that works really fast, you should take your shot just before you eat.

This type of diabetes used to be called ’juvenile diabetes’ or ’insulin-dependent diabetes.’ Type 1 diabetes accounts for about 5 to 10 percent of all diagnosed diabetes, so it’s less common than type 2. It’s an autoimmune disease, which means that your immune system (the body’s system for fighting infection) has gone haywire and is destroying the cells in your pancreas that produce insulin.

Without insulin, your body can’t use sugar and fat broken down from the food you eat. When sugar can’t get into your cells, your blood sugar rises and it’s this high blood sugar level that damages your body. A person with type 1 diabetes can’t make insulin. If you have this disease, you have to take insulin in order to live. Type 1 diabetes develops most often in children or young adults but can occur at any age. It can come on suddenly, often after an illness. There is no cure for type 1 diabetes, but because of new knowledge about the disease and new medical advances, good self-care is now possible. A person with diabetes can live a healthy life and avoid or experience few complications from the disease.

Diabetes of any kind is a disorder that prevents the body from using food properly. Normally, the body gets its major source of energy from glucose, a simple sugar that comes from foods high in simple carbohydrates (e.g., table sugar or other sweeteners such as honey, molasses, jams, and jellies, soft drinks, and cookies), or from the breakdown of complex carbohydrates such as starches (e.g., bread, potatoes, and pasta). After sugars and starches are digested in the stomach, they enter the blood stream in the form of glucose* (figure 1). The glucose in the blood stream becomes a potential source of energy for the entire body, similar to the way in which gasoline in a service station pump is a potential source of energy for your car. But, just as someone must pump the gas into the car, the body requires some assistance to get glucose from the blood stream to the muscles and other tissues of the body. In the body, that assistance comes from a hormone called insulin. Insulin is manufactured by the pancreas, a gland that lies behind the stomach. Without insulin, glucose cannot get into the cells of the body where it is used as fuel. Instead, glucose accumulates in the blood to high levels and is excreted or spilled into the urine through the kidneys.

Diabetes is a chronic disease that affects as many as 16 million Americans. For reasons that are not yet clear, diabetes is increasing in our population to the point where public health authorities are calling diabetes an "epidemic" that requires urgent attention.

Of the 16 million people with diabetes, about one-third of them don’t even know they have it. Every year, 800,000 additional cases are diagnosed. It affects over six percent of the population now, and it is projected that nearly nine percent of all Americans will have diabetes by the year 2025. Health care costs for diabetes are estimated to be nearly $100 billion per year in the US.

People with diabetes are unable to use the glucose in their food for energy. The glucose accumulates in the bloodstream, where it can damage the heart, kidneys, eyes and nerves. Left untreated, diabetes can develop devastating complications. It is one of the leading causes of death and disability in the United States.

However, the good news is that with proper care, people with diabetes can lead normal, satisfying lives. Much of this care is "self-managed," meaning that if you have this condition, you must take day-to-day responsibility for your own care.

Most important to managing the disease is to know as much about it as you can. The first thing to know is what kind of diabetes you have. There are three types:

* Type 1 diabetes
* Type 2 diabetes
* Gestational diabetes

Type 1 Diabetes Symptoms

The symptoms of Type I diabetes often come on suddenly and very severely. They include:

• being exceptionally thirsty
• dry mouth
• the need to urinate often
• weight loss (even though you may be hungry and eating well)
• feeling weak and tired
• blurry vision

Type 2 Diabetes Symptoms

Sometimes, people with Type II diabetes don’t notice any symptoms or the symptoms are experienced gradually. They include:

• blurry vision
• cuts or sores that are slow to heal
• itchy skin, yeast infections
• increased thirst
• dry mouth
• need to urinate often
• leg pain

Diabetes often goes undiagnosed because many of its symptoms seem so harmless. Recent studies indicate that the early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes.

Some diabetes symptoms include:

Diabetes Problem Solver Further Reading . . .
Pinpoint the danger signs of diabetes-related trouble in 60 seconds or less with The Diabetes Problem Solver. Also, get symptoms, risks, course of action, treatment, and prevention information on a wide array of conditions. Check out more books on healthy living here.

* Frequent urination
* Excessive thirst
* Extreme hunger
* Unusual weight loss
* Increased fatigue
* Irritability
* Blurry vision

If you have one or more of these diabetes symptoms, see your doctor right away.