[acb-diabetics] Good article especially for new diabetics

[Patricia LaFrance-Wolf]

I came across this article on the Mayo Clinic site. Much of it is common
knowledge to those on the list who are veterans, but it might be helpful for
some who aren't. It reads quickly, even though it is fairly long. It's
concise and accurate, and covers everything.

Dave

From: 

 
<http://www.mayoclinic.com/health/type-1-diabetes/DS00329/DSECTION=treatment
s-and-drugs>
http://www.mayoclinic.com/health/type-1-diabetes/DS00329/DSECTION=treatments
-and-drugs

Treatments and drugs

By Mayo Clinic staff

CLICK TO ENLARGE

Insulin pump

　

Treatment for type 1 diabetes is a lifelong commitment to:

a.. Taking insulin

b.. Exercising regularly and maintaining a healthy weight

c.. Eating healthy foods

d.. Monitoring blood sugar

The goal is to keep your blood sugar level as close to normal as possible to
delay or prevent complications. Although there are exceptions, generally,
the goal is to keep your daytime blood sugar levels between 80 and 120 mg/dL

(4.4 to 6.7 mmol/L) and your bedtime numbers between 100 and 140 mg/dL (5.6
to 7.8 mmol/L).

If managing your diabetes seems overwhelming, take it one day at a time. And
remember that you're not in it alone. You'll work closely with your diabetes
treatment team - doctor, diabetes educator and registered dietitian - to
keep your blood sugar level as close to normal as possible.

Insulin and other medications

Anyone who has type 1 diabetes needs insulin therapy to survive.

Types of insulin are many and include:

a.. Rapid-acting insulin

b.. Long-acting insulin

c.. Intermediate options

Examples are regular insulin (Humulin R, Novolin R, others), insulin
isophane (Humulin N, Novolin N), insulin lispro (Humalog), insulin aspart
(NovoLog), insulin glargine (Lantus) and insulin detemir (Levemir).

Depending on your needs, your doctor may prescribe a mixture of insulin
types to use throughout the day and night.

An inhaled insulin (Exubera) was previously available, but the manufacturer
stopped selling the drug because too few people were using it. Since it was
taken off the market, this drug has been linked to an increased number of
lung cancers in people with a history of smoking. However, because the
additional number of lung cancer cases is so small, it's not clear if
there's a link to the medication. If you used Exubera and have a history of
smoking, discuss these concerns with your doctor.

Injection options to get insulin into your body currently include injection
and insulin pump infusion. Insulin can't be taken orally to lower blood
sugar because stomach enzymes interfere with insulin's action.

Insulin injections can be done using:

a.. A fine needle and syringe

b.. An insulin pen - a device that looks like an ink pen, except the
cartridge is filled with insulin

c.. An insulin pump - a device about the size of a cell phone worn on the
outside of your body. A tube connects a reservoir of insulin to a catheter
that's inserted under the skin of your abdomen. There's also a wireless pump
option that's available in most areas. You wear a pod filled with insulin on
your body that has a tiny catheter that's inserted under your skin. The
insulin pod can be worn on your abdomen, lower back, or on a leg or an arm. 

The programming is done with a wireless device that communicates with the
pod.

Whichever pump you use, it's programmed to dispense specific amounts of
rapid-acting insulin automatically. This steady dose of insulin is known as
your basal rate, and it replaces whatever long-acting insulin you were
using. When you eat, you program the pump with the amount of carbohydrates
you're eating and your current blood sugar, and it will give you what's
called a "bolus" dose of insulin to cover your meal and to correct your
blood sugar if it's elevated. Some research has found an insulin pump to be
more effective at controlling blood sugar levels than injections are.

Oral medications are sometimes prescribed as well, such as:

a.. Pramlintide (Symlin). An injection of this medication before you eat can
slow the movement of food through your stomach to curb the sharp increase in
blood sugar that occurs after meals.

b.. High blood pressure medications. Even if you don't have high blood
pressure, your doctor may prescribe medications known as
angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor
blockers (ARBs), because these medications can help keep your kidneys
healthy in addition to lowering blood pressure. It's recommended that people
with diabetes have blood pressures less than 130/80 millimeters of mercury
(mm Hg).

c.. Cholesterol-lowering drugs. As with high blood pressure drugs, your
doctor may not wait until your cholesterol is elevated before he or she
prescribes cholesterol-lowering agents known as statins. Cholesterol
guidelines are more aggressive for people with diabetes because of the
elevated heart disease risk. The American Diabetes Association recommends
that low-density lipoprotein (LDL, or "bad") cholesterol be below 100 mg/dL

(2.6 mmol/L) and that high-density lipoprotein (HDL, or "good") cholesterol
be over 50 mg/dL (1.3 mmol/L). Triglycerides, another type of blood fat, are
ideal when they're less than 150 mg/dL (1.7 mmol/L).

Healthy eating and counting carbohydrates Contrary to popular perception,
there's no such thing as a diabetes diet. 

You won't be restricted to a lifetime of boring, bland foods. Instead,
you'll need plenty of:

a.. Fruits

b.. Vegetables

c.. Whole grains

These foods are high in nutrition and low in fat and calories. And they mean
fewer animal products and sweets. This is actually the best eating plan,
even for people without diabetes.

You'll need to learn how to count the carbohydrates in the foods you eat so
that you can give yourself enough insulin to properly metabolize those
carbohydrates. A registered dietitian can help you create a meal plan that
fits your health goals, food preferences and lifestyle.

Physical activity

Everyone needs regular aerobic exercise, and people who have type 1 diabetes
are no exception. Get your doctor's OK to exercise. Then choose activities
you enjoy, such as walking, swimming or biking. What's most important is
making physical activity part of your daily routine. Aim for at least 30
minutes of aerobic exercise most days of the week. Stretching and strength
training exercises are important, too. If you haven't been active for a
while, start slowly and build up gradually.

Remember that physical activity lowers blood sugar, often for long after
you're done working out. If you begin a new activity, check your blood sugar
level more often than usual until you know how that activity affects your
blood sugar levels. You might need to adjust your meal plan or insulin doses
to compensate for the increased activity. If you use an insulin pump, you
can set a temporary basal rate to keep your blood sugar from dropping. Ask
your doctor or diabetes educator to show you how.

Blood sugar monitoring

Depending on what type of insulin therapy you select or require -
single-dose injections, multiple-dose injections or insulin pump - you may
need to check and record your blood sugar level at least four times a day,
and probably more. Careful monitoring is the only way to make sure that your
blood sugar level remains within your target range. Be sure to wash your
hands before checking your blood sugar levels to get the most accurate
reading.

Even if you take insulin and eat on a rigid schedule, the amount of sugar in
your blood can change unpredictably. With help from your diabetes treatment
team, you'll learn how your blood sugar level changes in response to:

a.. Food. What and how much you eat will affect your blood sugar level. 

Blood sugar is typically highest one to two hours after a meal.

b.. Physical activity. Physical activity moves sugar from your blood into
your cells. The more active you are, the lower your blood sugar level. To
compensate, you might need to lower your insulin dose before unusual
physical activity.

c.. Medication. You need insulin to lower your blood sugar level. But other
medications you take may affect your blood sugar level as well, sometimes
requiring changes in your diabetes treatment plan.

d.. Illness. During a cold or other illness, your body will produce hormones
that raise your blood sugar level. This might require changes in your
diabetes treatment plan.

e.. Alcohol. Alcohol can cause either high or low blood sugar, depending on
how much you drink and if you eat at the same time. If you choose to drink,
do so in moderation, which means no more than one drink a day for women and
two drinks or fewer daily for men.

f.. Stress. The hormones your body may produce in response to prolonged
stress may prevent insulin from working properly.

g.. For women, fluctuations in hormone levels. As your hormone levels
fluctuate during your menstrual cycle, so can your blood sugar level -
particularly in the week before your period. Menopause may trigger
fluctuations in your blood sugar level as well.

Continuous glucose monitoring (CGM) is the newest way to monitor blood sugar
levels, and may be most helpful for people who have developed hypoglycemia
unawareness. Continuous glucose monitors attach to the body using a fine
needle just under the skin that checks blood glucose level every few
minutes. CGM isn't yet considered as accurate as standard blood sugar
monitoring, so it's not considered a replacement method for keeping track of
blood sugar, but an additional measure.

Situational concerns

Certain life circumstances call for different considerations.

a.. Driving. Hypoglycemia can occur at any time, even when you're driving. 

It's a good idea to check your blood sugar anytime you're getting behind the
wheel. If it's below 70 mg/dL (3.9 mmol/L), have a snack and then retest
again in 15 minutes to make sure it's risen to a safe level. Low blood sugar
makes it hard to concentrate or to react as rapidly as you might need to
when you're driving.

b.. Working. In the past, people with type 1 diabetes were often refused
certain jobs just because they had diabetes. Fortunately, advances in
diabetes management and anti-discrimination laws have made such blanket bans
largely a thing of the past. However, type 1 diabetes can pose some
challenges in the workplace. For example, if you work in a job that involves
driving or operating heavy machinery, hypoglycemia could pose a serious risk
to you and those around you. You may need to work with your doctor and your
employer to ensure that certain accommodations are made, such as your having
a quick break for blood sugar testing and fast access to food and drink any
time so you can properly manage your diabetes and prevent low blood sugar
levels. There are federal and state laws in place that require employers to
make reasonable accommodations for people with diabetes.

c.. Being pregnant. Because the risk of pregnancy complications is higher
for women with type 1 diabetes, experts recommend that women have a
preconception evaluation and that A1C readings should be less than 7 percent
before you attempt to get pregnant. Some drugs, such as high blood pressure
medications and cholesterol-lowering medications, may need to be stopped
before pregnancy. The risk of birth defects is increased for women with type

1 diabetes, particularly when diabetes is poorly controlled during the first
six to eight weeks of pregnancy, so planning your pregnancy is key. Careful
management of your diabetes during pregnancy can decrease your risk of
complications.

d.. Being older. As long as you're still active and have normal cognitive
abilities, your diabetes management goals will likely be the same as they
were when you were younger. But, for those who are frail, sick or have
cognitive deficits, tight control of blood sugar may not be practical. If
you're caring for a loved one with type 1 diabetes, ask his or her doctor
what the new diabetes goals should be.

Investigational treatments

a.. Pancreas transplant. With a successful pancreas transplant, you would no
longer need insulin. But pancreas transplants aren't always successful - and
the procedure poses serious risks. You would need a lifetime of potent
immune-suppressing drugs to prevent organ rejection. These drugs can have
serious side effects, including a high risk of infection and organ injury. 

Because the side effects can be more dangerous than is the diabetes,
pancreas transplants are generally reserved for those with very
difficult-to-control diabetes.

b.. Islet cell transplantation. Researchers are experimenting with islet
cell transplantation, which provides new insulin-producing cells from a
donor pancreas. Although this experimental procedure has met with problems
in the past, new techniques and better drugs to prevent islet cell rejection
may improve its future chance for success. However, islet cell
transplantation still requires the use of immune-suppressing medications,
and just as it did with its own natural islet cells, the body often destroys
transplanted islet cells, making the time off insulin short-lived. 

Additionally, a sufficient supply of islet cells isn't available for this
treatment to become more widespread.

c.. Stem cell transplant. In a 2007 Brazilian study, a small number of
people newly diagnosed with type 1 diabetes were able to stop using insulin
after being treated with stem cells made from their own blood. Although stem
cell transplants - which involve shutting down the immune system and then
building it up again - can be risky, the technique may one day provide an
additional treatment option for type 1 diabetes.

Signs of trouble

Despite your best efforts, sometimes problems will arise. Certain short-term
complications of type 1 diabetes require immediate care. Left untreated,
these conditions can cause seizures and loss of consciousness (coma).

Low blood sugar (hypoglycemia). This occurs when your blood sugar level
drops below your target range. Ask your doctor what's considered a low blood
sugar level for you. Blood sugar levels can drop for many reasons, including
skipping a meal, getting more physical activity than normal or injecting too
much insulin.

Learn the symptoms of low blood sugar, and test your blood sugar if you
think your blood sugar levels are dropping. When in doubt, always do a blood
sugar test. Early signs and symptoms of low blood sugar include:

a.. Sweating

b.. Shakiness

c.. Hunger

d.. Weakness

e.. Anxiety

f.. Dizziness or lightheadedness

g.. Pale skin

h.. Rapid or irregular heart rate

i.. Fatigue

j.. Headaches

k.. Blurred vision

l.. Irritability

Later signs and symptoms of low blood sugar, which can sometimes be mistaken
for alcohol intoxication in teens and adults include:

a.. Lethargy

b.. Confusion

c.. Behavior changes, sometimes dramatic

d.. Poor coordination

e.. Convulsions

If you develop hypoglycemia during the night, you might wake with
sweat-soaked pajamas or a headache. Thanks to a natural rebound effect,
nighttime hypoglycemia might cause an unusually high blood sugar reading
first thing in the morning.

If you have a low blood sugar reading, have some fruit juice, glucose
tablets, hard candy, regular (not diet) soda or another source of sugar. 

Then retest your blood sugar in about 15 minutes to make sure it has gone up
into the normal range. If it's not in the normal range, re-treat with more
sugar (juice, candy, glucose tablets or another source of sugar) and then
retest in another 15 minutes. Keep doing this until you get a normal
reading. It's a good idea to eat a meal or snack once you've gotten a normal
reading. A mixed food source, such as peanut butter and crackers, can help
stabilize the blood sugar.

If a blood glucose meter isn't readily available, treat for low blood sugar
anyway if you have symptoms of hypoglycemia, and then test as soon as
possible.

Always carry a source of fast-acting sugar with you. Left untreated, low
blood sugar will cause you to lose consciousness. If this occurs, you may
need an emergency injection of glucagon - a hormone that stimulates the
release of sugar into the blood. Be sure you always have a glucagon
emergency kit available - at home, at work, when you're out - and make sure
it hasn't expired.

Hypoglycemia unawareness. Some people may lose the ability to sense that
their blood sugar levels are coming down, because they've developed a
condition known as hypoglycemia unawareness. With hypoglycemia unawareness,
the body no longer reacts to a low blood sugar with symptoms such as
lightheadedness or headaches. The more you experience low blood sugars, the
more likely you are to develop hypoglycemia unawareness. The good news is
that if you can avoid having a hypoglycemic episode for several weeks, you
may start to become more aware of impending lows.

High blood sugar (hyperglycemia). Your blood sugar can rise for many
reasons, including eating too much, eating the wrong types of foods, not
taking enough insulin, or illness.

Watch for:

a.. Frequent urination

b.. Increased thirst

c.. Blurred vision

d.. Fatigue

e.. Nausea

f.. Irritability

g.. Hunger

h.. Difficulty concentrating

If you suspect hyperglycemia, check your blood sugar. You might need to
adjust your meal plan or medications. If your blood sugar is higher than
your target range, you'll likely need to administer a "correction" using an
insulin shot or through an insulin pump. A correction is an additional dose
of insulin that should bring your blood sugar back into the normal range. 

High blood sugar levels don't come down as quickly as they go up. Ask your
doctor how long to wait until you recheck. If you use an insulin pump,
random high blood sugar readings may mean you need to change the pump site.

If you have two consecutive blood sugar readings above 250 mg/dL (13.9
mmol/L), test for ketones using a urine test stick. Don't exercise if your
blood sugar level is high or if ketones are present. If only a trace or
small amounts of ketones are present, drink extra fluids to flush out the
ketones.

If your blood sugar is persistently above 300 mg/dL (16.7 mmol/L), call your
doctor or seek emergency care.

Increased ketones in your urine (diabetic ketoacidosis). If your cells are
starved for energy, your body may begin to break down fat - producing toxic
acids known as ketones.

Signs and symptoms of this serious condition include:

a.. Nausea

b.. Vomiting

c.. Abdominal pain

d.. A sweet, fruity smell on your breath

e.. Weight loss

If you suspect ketoacidosis, check your urine for excess ketones with an
over-the-counter ketones test kit. If you have large amounts of ketones in
your urine, call your doctor right away or seek emergency care. Also, call
your doctor if you have vomited more than once and you have ketones in your
urine.

　

　

　

[Non-text portions of this message have been removed]

　

　

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