Tips to Avoid Diabetes Complications

Choose Carbs Carefully

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

Lose Weight If You Need To

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

Get Enough Sleep

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

Be Active: Exercise and Diabetes

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

Monitor Your Blood Sugar Daily

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

Manage Stress

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

Say No to Salt

Reduce the salt in your diet. It may help lower blood pressure and protect your kidneys. Not salting the food on your plate may not be enough. Most of the salt in Americans' diets comes from processed foods. Avoid convenience foods and use fresh ingredients when you can. Season with herbs and spices instead of salt when you cook.

Adults age 51 and older, and individuals with high blood pressure, diabetes, or chronic kidney disease should talk with their doctor about how much to reduce their sodium intake. In general, people with diabetes should decrease to less than 2,300 mgs per day, however your doctor may recommend lower amounts.

Heart Disease Risk and Diabetes

Heart disease can be a serious diabetes complication. Keep an eye on your risk by getting these ABCs checked:

A1C level. This is a measure of your average blood sugar control for the last 2-3 months. You may need it checked two or more times a year. Talk to your doctor about setting a goal.

Blood pressure. Goal: below 140/80 mm Hg.

Cholesterol. Goal: LDL to 100 mg/d or lessl; HDL above 40 mg/dl in men and greater than 50 in women; and triglycerides below 150 mg/dl.

Take Care of Bumps and Bruises

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

Break Your Smoking Habit

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

Pick Super Foods, Don't Supersize

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

Set Up Doctor Visits

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

Brief

Under normal circumstances, the glucose (sugar) levels in your blood rise after you eat a meal or snack. In response, the body produces a hormone called insulin, which is necessary in order for the body to convert glucose in your bloodstream into usable energy. But if insulin isn’t available, or if the body isn’t using it correctly, your blood glucose will remain elevated, and that can be harmful to your body. The latter describes diabetes mellitus, a serious health condition that affects millions of people. There are actually three variations of this disease, but all characterized by abnormally high levels of glucose in the bloodstream.

Type 1 Diabetes

This form of diabetes is an autoimmune disorder, meaning your own immune system is damaging your body and causing the disease. In type 1 diabetes, the immune system attacks and destroys cells of the pancreas (called beta cells), which are the only cells in the body that manufacture insulin. Type 1 diabetes used to be called “insulin-dependent” because people with Type 1 diabetes must take insulin via pump or injection to survive. It is sometimes called “juvenile-onset” diabetes, because it usually makes its appearance during childhood or young adulthood. Between 5% and 10% of people with diabetes have type 1, which doesn't have a cure. Type 1 diabetics must work to manage the disease for the rest of their lives.

Who’s at risk? 
No one knows exactly what causes type 1 diabetes. According to the Centers for Disease Control (CDC), the risk factors for developing type 1 diabetes include autoimmune, genetic, and environmental factors (such as viruses). While it’s most often diagnosed in children, type 1 diabetes can occur at any age and is most prevalent in Caucasians.

Can it be prevented? 
Unfortunately, there is no way to prevent this form of diabetes.

What are the symptoms? 
The destruction of the body’s beta cells can begin years before a person notices symptoms, which usually appear suddenly. These include: increased thirst and urination, persistent hunger, weight loss, blurred vision, and severe fatigue.

How is it treated? 
Since they can’t make insulin on their own, people with type 1 diabetes must supply the body with insulin by using a pump or injections. Without a steady supply of insulin, type 1 diabetics can develop diabetic ketoacidosis, a life-threatening condition.

Type 2 Diabetes
In the early stages of type 2 diabetes, the pancreas is still manufacturing insulin, but for some reason the cells of the body are not using it properly—a condition known as insulin resistance. In response, the pancreas produces more and more insulin, wearing itself out and eventually losing its ability to produce insulin to keep blood glucose levels in the normal range. Similar to type 1 diabetes, high levels of blood glucose result, making it difficult for the body to use this glucose as fuel. Type 2 diabetes used to be called “non-insulin-dependent” or “adult-onset” or diabetes, but more and more cases are being diagnosed in children. Between 90% and 95% of diabetes cases are type 2. Like individuals with type 1, type 2 diabetics must also work to manage the disease for the rest of their lives.

Who’s at risk? 
The risk factors for developing type 2 diabetes include advanced age, obesity (80% of people with type 2 diabetes are overweight), a family history of diabetes, a history of gestational diabetes (see below), physical inactivity, and race/ethnicity.  African Americans, Hispanic/Latino Americans, American Indians, Native Hawaiians and Pacific Islander Americans are at particularly high risk for type 2 diabetes.

Can it be prevented? 
There are many ways to prevent this form of diabetes. Eating a healthy diet and getting sensible amounts of physical activity to achieve and maintain a healthy weight can help prevent or delay the development of type 2 diabetes.

What are the symptoms? 
The symptoms of type 2 diabetes appear gradually, but some people who have type 2 diabetes won’t have any symptoms at all. Many symptoms are similar to those of type 1 diabetes, such as increased thirst, increased urination, weight loss, blurred vision and fatigue. Other signs include frequent infections and slow-healing wounds.

How is it treated? 
People with type 2 diabetes can control their blood glucose levels by following a healthy diet and exercise program, losing excess weight and using medication prescribed by their doctors.

Gestational Diabetes
Some women develop this form of diabetes during the third trimester of pregnancy, in which the body still manufactures insulin, but pregnancy hormones prevent insulin from working properly. Treatment is necessary to prevent the abnormally high blood sugar levels from injuring the fetus.

Who’s at risk? 
Gestational diabetes is more common among certain racial/ethnic groups (African Americans, Hispanic/Latino Americans, and American Indians). It also occurs more frequently among women who are over 25 years old, are obese, have a family history of diabetes, or have previously delivered a baby that weighed over 9 pounds. Although the gestational diabetes usually resolves itself after delivery, 5% to10% of women with gestational diabetes are diagnosed with type 2 diabetes after delivery, and 20% to 50% will develop type 2 diabetes within 10 years.

Can it be prevented? 
The risk for developing gestational diabetes can be lowered by losing excess weight and staying physically active prior to conception, and then continuing to make healthy food choices and staying physically active during pregnancy. Women who have been diagnosed with gestational diabetes can lower their risk for developing type 2 diabetes by continuing these healthy habits after delivery, breastfeeding their children, and visiting their doctors regularly for checkups.

What are the symptoms? 
Usually, gestational diabetes doesn’t have any symptoms. But when symptoms occur, they are very similar to those of both type 1 and type 2 diabetes: increased thirst and urination, persistent hunger, weight loss despite increases in appetite, blurred vision, and severe fatigue. Other signs include nausea, vomiting, and frequent infections to the bladder, vagina and/or skin.

How is it treated? 
Since gestational diabetes can be problematic to your baby’s health and increase the risk of complications during delivery, treatment must begin right after diagnosis. This usually involves close monitoring and control of blood glucose levels by following a special eating plan (developed by your doctor and/or registered dietitian) and getting regular exercise. Some treatment plans may also include diabetes pills or insulin injections, if prescribed by your doctor.

If left unchecked, all forms of diabetes can cause serious health  consequences. If you exhibit any of the symptoms of diabetes, or if you are at high-risk for developing it, talk to your doctor. It’s never too early to start a diabetes prevention program.

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Diabetes Type 1

Type 1 Diabetes Symptoms, Causes and Treatment

What Is Type 1 Diabetes?

Type I diabetes usually starts in childhood, but can occur in adults (30 to 40-year-olds). The pancreas cannot make insulin to help body cells convert sugar into energy, which causes the sugar to build up in the blood that can cause life-threatening complications. Individuals with type I diabetes must take some form of insulin for the rest of their lives.

Warning Sign: Unusual Thirst

Symptoms of type I diabetes may appear suddenly and can include the following:

·        Frequent urination (polyuria)

·        Drinking more water because of excessive thirst (polydipsia)

·        Feeling excessively hungry (polyphagia)

·        Dry mouth

·        Fruity breath

·        Fatigue

·        Weight loss

Warning Sign: Weight Loss

Because the blood sugar levels remain high and the body then metabolizes fat for energy, people with type I diabetes develop unintentional weight loss, and an increase in appetite. Because glucose metabolism is disrupted, they also feel a lack of energy and may be drowsy for extended periods.

  

Warning Sign: Skin Problems

The disruption in glucose metabolism in people with type I diabetes causes other problems such as a higher risk for bacterial infections, fungal infections, and skin changes that result in itching and dry skin. Poor blood circulation in the skin also may occur. Girls with type I diabetes are at risk for vaginal yeast infections, while babies who have the disease can develop severe diaper rash due to the yeast Candida albicans. The diaper rash can spread to other areas of the body such as the stomach and legs.

More Dangerous Signs

People with untreated type 1 diabetes can experience serious symptoms such as blurry vision, numbness or tingling in the extremities (especially the feet), loss of consciousness, and diabetic coma. In contrast to high sugars in the blood, occasionally people with type I diabetes can get low blood sugars (hypoglycemia) when their blood glucose level falls suddenly.

In people with type 1 diabetes loss of consciousness, diabetic coma, and in some cases hypoglycemia are medical emergencies. Some people who are undiagnosed may have no warning signs, yet still can develop diabetic coma or hypoglycemia.

More Dangerous Signs: Ketoacidosis

The problem with type I diabetes is that the person’s cells are deprived of the sugar they need for energy. Without the insulin produced by the pancreas, sugar has difficulty entering the body’s cells. Consequently, the body cells start burning fat for energy, which causes ketones to build up in the blood. These acids can change the person’s blood pH level and can trigger a life-threatening coma. This is termed diabetic ketoacidosis. Diabetic ketoacidosis is a medical emergency that needs to be treated quickly, usually in a hospital setting.

Type 1 vs. Type 2 Diabetes

In people with type I diabetes, the body’s immune system attacks and destroys pancreatic cells (Beta cells) that produce insulin. In people with type II diabetes, the pancreas is not attacked and usually produces insulin. However, people with type II diabetes, for numerous reasons, cannot use the available insulin effectively. People with type II diabetes can have the same symptoms as people with type I diabetes, but people with type I diabetes usually have the symptoms occur more rapidly

What Causes Type I Diabetes?

Researchers are not sure why a person's immune system attacks its own insulin producing cells. However, researchers and clinicians suspect that genetic susceptibility and environmental factors raise the risk for developing type I diabetes. Scientists have identified genes and gene regions that raise the risk of developing type I diabetes, but they are not the only factors that cause the disease. Researchers suggest that environmental triggers such as a viral infection or perhaps dietary or pregnancy-related factors may also play a role in developing type I diabetes.

Who Gets Type 1 Diabetes?

Although type I diabetes can develop at any age, about two-thirds of new cases are diagnosed in individuals under the age of 19. Researchers have noted two peak times for development of type I diabetes; the first is in early childhood and the second occurs at puberty. Type I diabetes affects males and females equally, and is more common in Caucasians than in other ethnic groups.

Diagnosing Type 1 Diabetes

Simple blood tests can indicate the presence of abnormal sugar levels in the blood. If a person has any symptoms of diabetes, a fasting blood sugar test or even a random blood sugar test is usually the first step in diagnosis. A hemoglobin A1c test can reveal average blood sugar levels for the past 2 to 3 months. In most cases these tests are repeated on at least two separate days. Other tests used are the glucose tolerance test or testing for certain specific antibodies in the blood.

Long-Term Complications

Unfortunately, undiagnosed or prolonged high blood sugar levels can result in damage to organ systems in the body over time. People with type I diabetes have a high risk of vision problems, heart disease, stroke, kidney failure, gum disease, tooth loss, and nerve damage (especially in the hands and feet). Other organs may also be damaged.

Monitoring Your Blood Sugar

For people with diabetes, complications that can damage organ can be prevented or reduced by regulating their blood sugar (glucose level). This is done by pricking the finger and putting a drop of blood on a test strip. The strip is in placed in a monitor that reads the glucose level. Close monitoring of glucose levels allows the individual to regulate their blood sugar by either medication if the sugar is high, or taking in sugar if the level is low. If a person with diabetes is able to keep blood sugar level in or near the normal range, they will decrease the likelihood of developing complications and have more energy and fewer problems related to diabetes.

 

Continuous Glucose Monitoring

Another device that measures glucose is termed a continuous glucose monitoring system. Although it’s not designed for day-to-day monitoring or long-term use, it is designed to discover trends in blood sugar levels. It’s a cell phone sized device that records an average glucose value every five minutes for about 72 hours.

Diabetes Treatment: Insulin Shots

Every person with type I diabetes needs to take insulin to help their body process sugar in the blood. Most people with type 1 diabetes take insulin in the injectable form and require several shots per day. You and your doctor can adjust your insulin shots based on results of blood sugar testing. As stated previously, the goal is to keep glucose levels in the blood within normal range as often as possible.

Insulin Reaction Warning Signs

Although insulin is a wonderful drug that helps people with diabetes, it needs to be used carefully. If a person takes too much insulin it is possible the blood sugar level will lower into dangerous levels. This situation is termed an insulin reaction (low blood sugar due to excessive insulin). Too much insulin can result in symptoms that may be mild, moderate, or severe, depending on how low and how long the low blood sugar levels exist in a person's blood. Some signs and symptoms of low blood sugar include fatigue, excessive yawning, mild confusion, decreased coordination, sweating, muscle twitching, and pale skin. As these symptoms get progressively worse, seizures, loss of consciousness, and even death may occur.

Neutralizing an Insulin Reaction

Although most people with diabetes who take insulin daily are careful, mistakes can result in an insulin reaction (low blood sugar). People with diabetes, especially type I diabetes, are advised to carry about 15 grams of a quick-acting carbohydrate at all times. Quick-acting carbohydrates are foods or drinks containing glucose that is rapidly absorbed into the body and the blood. Examples include a half-cup of fruit juice or a non-diet soda, five Life Savers (small hard candies), two tablespoons of raisins, one cup of milk, or three glucose tablets. These carbohydrates may resolve mild to moderate insulin reactions. For severe reactions, a drug called glucagon should be injected under the skin by a family member or friend familiar with treating severe insulin reactions and the person should be seen by a medical health care professional.

Diabetes Treatment: Insulin Pump

Although many people administer insulin through several shots per day, some people may be able to utilize an insulin pump. This pump delivers insulin round-the-clock by pushing insulin through a thin tube inserted into the person's skin. People with diabetes are encouraged to discuss the advantages and disadvantages of this insulin delivery system with their doctor.

How Well Is Your Treatment Working?

There is a test called the hemoglobin A1c blood test that is used to help determine how well a person is managing their blood glucose levels. This test measures how well the blood sugar has been controlled over about a 2 to 3 month time span. If the results show poor blood sugar control (high A1c levels), it suggests that the person's insulin therapy, dietary habits, and/or physical activity be modified to lower blood sugar levels into a more normal range.

Pancreatic Islet Cell Transplant

Some people with diabetes fail insulin therapy and may have reactions to the insulin that is injected. These people may be candidates for a procedure that some clinicians consider experimental. The procedure is a transfer of healthy insulin-producing cells from a donor into the pancreas of the patient with type I diabetes. Although there are benefits to this procedure, there are also drawbacks including medications with serious side effects that must be used to prevent rejection of the donor cells, and the probability that the transplanted cells may only function for a few years.

Type 1 Diabetes and Exercise

Most people benefit from exercise; people with type I diabetes also can benefit, but they need to take precautions to prevent sudden drops in blood glucose levels. People with type I diabetes should check their blood sugars before exercising, and may require eating a snack before or during exercise. In addition, they may need to adjust their insulin dosage before exercising to ensure they stay within normal ranges of blood glucose. People with type I diabetes also may need to check their urine for ketones – ketones suggest that your blood sugar is too high. Strenuous activity needs to be avoided if ketones are detected or if your blood sugar level is either high or low before exercise.

Type 1 Diabetes and Diet

People with type I diabetes, like everyone else, need to eat a well-balanced diet. This will help their insulin therapy and reduce the chance of diabetic complications. Even a person with type I diabetes can eat sweets as long as it is part of a well-balanced diet. That is not to say they can eat anything all the time – it means there are no foods people with diabetes should consider off-limits but they do need to consider how sweets (for example, a thin slice of pie) can fit into their well-balanced diet. Healthcare workers such as dietitians can help people with diabetes plan a well-balanced and varied diet.

Type 1 Diabetes and Pregnancy

Women with type I diabetes need to let their doctors know if they plan to become pregnant because if they are in poor control of their blood sugars, complications including birth defects may occur. Planning ahead, even before conception, to control blood sugar levels can lower the risk of miscarriage and birth defects. Good blood sugar control can reduce other complications during pregnancy such as high blood pressure or retinal damage in the mother.

Type 1 Diabetes in Children

Diagnosis of diabetes in children is a life-changing situation because it affects the whole family. Parents must help children monitor blood sugar and plan family meals that are appropriate for the child with diabetes and other family members. Insulin dosages must be monitored and blood sugar levels also need to be checked by child’s caregivers. Diabetes in children is a 24-hour-a-day problem that needs to be considered when a child is attending school and participating in extracurricular activities. Parents and their children need to make arrangements to follow through with insulin treatments even while the child is at school. These arrangements need to be planned in advance as not every state or school may participate in the child’s care the same way.

Hope for an Artificial Pancreas

Researchers are attempting to develop an artificial pancreas. This device is a combination of an insulin pump and continuous glucose monitoring system controlled by a computer program. The goal is for the system to release insulin in response to blood sugar levels and to reduce the release of insulin if blood sugar levels drop. The goal is to have a device that mimics the function of a normal pancreas. Some early trials of experimental devices suggest this device may be available in the future.

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