Diabetes Health Talk

Amputations Much More Common in Diabetics

Being diabetic, this is what i’m always concerned about. So I adjust my lifestyle accordingly.

Diabetics are eight times more likely than non-diabetics to have a lower limb amputated, according to a report published this month in the journal Diabetes Care.

The findings are based on a study of all lower limb amputations performed due to clogged leg arteries in residents of an area of Sweden from 1997 to 2006.

During the study period, 62 women and 71 men with diabetes and 79 women and 78 men without diabetes had a lower limb amputated, Dr. Anton Johannesson, of Lund University, Sweden, and colleagues report.

The rates of initial one-sided amputation per 100,000 persons per year were 197 for diabetic men and 192 for diabetic women, compared with just 24 for nondiabetic men and 22 for nondiabetic women.

In diabetics and nondiabetics, lower limb amputation rates rose with age.

The most common type of amputation was transtibial (an amputation above the foot but below the knee) accounting for 74 percent of all lower limb amputations, the investigators note.

Such an uncomfortable thought that amputations from diabetes are so common. Most, though, are preventable by limiting your carb intake, taking your medication and exercising. It is hard work, but that’s what motivates me to keep my carb count low by buying low carb bread, tortillas and wraps. Gone are the high starchy, carb loaded foods. Now I walk about 1 1/2 - 2 hours per day and I make certain to take all my medications at the correct time.

Amputations are life changing, no doubt, but if one has been amputated, there are many means and ways to live with one.

Diabetic Coma’s have been joked about by comedians, threatened to us by mothers if we didn’t eat our leafy greens and hinted at by nurses who see us each visit.

But what are they, exactly? CNN’s health section breaks it down for us.

coma is a state of unconsciousness. A diabetic coma is a life-threatening diabetes complication.

If you have diabetes, dangerously high blood sugar (hyperglycemia) or dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma. If you lapse into a diabetic coma, you’re alive — but you can’t awaken or respond purposefully to sights, sounds or other types of stimulation. Left untreated, a diabetic coma can be fatal.

A diabetic coma doesn’t strike out of the blue. You’ll first experience signs and symptoms of high blood sugar or low blood sugar.

High blood sugar
If your blood sugar level is too high, you may experience:

Increased thirst
Frequent urination
Dry mouth
Nausea
Vomiting
Shortness of breath
Low blood sugar
If your blood sugar level is too low, you may feel:

Shaky or nervous
Tired
Sweaty
Hungry
Irritable
Confused

Prolonged blood sugar extremes — blood sugar that’s either too high or too low for too long — may cause various conditions, all of which can lead to a diabetic coma.

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When a state judge ruled late last year that qualified nurses are the only school personnel who can give insulin shots to children with diabetes, he exacerbated an enormous problem.

Although I do not have kids, I would be upset at this ruling. I would probably hire a nurse to go to school and give my kids their insulin shots.

Most California schools do not have full-time nurses. Now, the parents of an estimated 15,000 diabetic children are scrambling — pushing school districts to hire nurses, driving to schools to administer the insulin shots and in some cases choosing home schooling.

Many doctors and diabetes advocates are outraged. Scores of lay people — babysitters, siblings, grandparents — regularly administer insulin, and they see no reason why trained, nonmedical school staff, like teachers or clerks, should not be allowed to help students. They fear the massive shortage of school nurses means children are not getting insulin shots in a timely manner. And they say diabetes is being used as a political tool to force school districts to hire more nurses — an unlikely scenario given the state’s $42 billion budget deficit.

“It’s untenable to expect nurses to be the sole provider of insulin in schools,” said Dr. Darrell Wilson, a pediatric endocrinologist at Stanford University and the Lucile Packard Children’s Hospital. “To say that only a nurse can do this is spectacularly unnecessary. This is not a complicated procedure.”

In 2007, a class-action lawsuit against the California Department of Education produced an agreement that allowed nonmedical personnel to administer insulin injections to students if no nurse was available.

Is there a youth with diabetes in your life? If they are overwieght, chances are, they have tried using their diabetes type-1 or type-2 to lose weight.

More and more teenagers with diabetes type-1 or type-2 are skipping insulin shots or pills, fasting, using diet aids, vomiting or using laxatives in order to shed a few pounds. While they may be successful in shedding weight, many may not know the danger they are putting their health in.

They may be causing themselves heart, kidney, liver or eye problems or failure. Their heart and other organs must work harder to compensate by not taking care of themselves. Closely monitor their medications, if you must, to ensure they are taking the proper dosages at the proper times.

If they are concerned about weight loss, sit down and calmly discuss proper nutrition, exercise. Try not to turn it to a lecture, because that’s the surest way to lose their attention. What most people respond to is some listening to them and gently showing them proper eating and exercise habits. Will it happen overnight? No. But, it will happen, over time, by showing proper eating habits, fixing fresh foods with herbs and spices.

Find an activitiy that appeals to them: walking is the best activity known to humankind. There are many health benefits, and weight loss is among them. In 2007, I lost 41 pounds by cutting out fried, fatty, high colesterol foods and walking from 30-60 minutes every day. It’s just one pound a week (the FDA’s recommended weightloss).

Maintaining healthy blood sugar levels may be important not just for people with diabetes. New research suggests that good blood sugar levels are correlated with good brain health as we age. Lapses in memory as we age (sometimes referred to as “senior moments”) are a normal part of aging. The latest study suggests that as blood sugar (medically referred to as glucose) levels rise when we age, it may lead to more memory lapses, compared to people who maintain healthy blood glucose levels.

The study suggests that exercising to improve blood sugar levels could be a way for some people to stave off the normal cognitive decline that comes with age.

“This is news even for people without diabetes since blood glucose levels tend to rise as we grow older. Whether through physical exercise, diet or drugs, our research suggests that improving glucose metabolism could help some of us avert the cognitive slide that occurs in many of us as we age,” reported lead researcher Scott A. Small, M.D., associate professor of neurology at Columbia University Medical Center.

Although it is widely known that the early stages of Alzheimer’s disease cause damage to the hippocampus, the area of the brain essential for memory and learning, studies have suggested that it is also vulnerable to normal aging. Until now, the underlying causes of age-related hippocampal dysfunction have remained largely unknown.

Previously, using high-resolution brain imaging, Dr. Small and his colleagues discovered that decreasing brain function in one area of the hippocampus, called the dentate gyrus, is a main contributor of normal decline in memory as we age.

In this new study, funded by the National Institute on Aging (NIA), the American Diabetes Association and the McKnight Brain Research Foundation, the researchers mapped out the specific areas of the hippocampus impacted by late-life diseases like diabetes and stroke.

This new study looked at measures that typically change during aging, like rising blood sugar, body mass index, cholesterol and insulin levels. The research found that decreasing activity in the dentate gyrus only correlated with levels of blood glucose.

In people with type 1 diabetes, adequate control of blood sugar over the long haul helps reduce the risk of diabetes-related eye and kidney disease, new data suggest.

The findings stem from a look at 1,441 type 1 diabetic patients followed for roughly 9 years as part of the pivotal Diabetes Control and Complications Trial (DCCT).

By analyzing hemoglobin A1C levels over time — a standard indicator of long-term blood sugar control — the researchers observed that increasing variability in hemoglobin A1C heightens the risk of new or worsening diabetic retinopathy (damage to the retina) and diabetic kidney disease.

Specifically, for every 1 percent increase in hemoglobin A1C, they found that the risk of retinopathy increased more than twofold and the risk of diabetic kidney disease increased nearly twofold.

The findings suggest that the long-term stability of blood sugar, and not just the average blood sugar control, predict the risk of these complications, study investigator Dr. Eric S. Kilpatrick of Hull Royal Infirmary in Hull, England, noted in an interview with Reuters Health.

“It is probably another reason to aim for stable good glycemic control rather than only good glycemic control,” Kilpatrick said.

However, blood sugar management “is only part of the story,” he added. It is as important, he said, to ensure that blood pressure and cholesterol levels are “tightly controlled” in order to reduce the complications of diabetes.

Researchers at the University of Warwick have discovered high doses of thiamine - vitamin B1 - can reverse the onset of early diabetic kidney disease.

Kidney disease, or diabetic nephropathy, develops progressively in patients with type 2 diabetes. Early development of kidney disease is assessed by a high excretion rate of the protein albumin from the body in the urine, known as microalbuminuria.

The research is led by Dr Naila Rabbani and Professor Paul J Thornalley at Warwick Medical School, University of Warwick, in collaboration with researchers at the University of Punjab and Sheik Zaid Hospital, Lahore, Pakistan.

The team has discovered taking high oral doses of thiamine can dramatically decrease the excretion of albumin and reverse early stage kidney disease in type 2 diabetes patients.

In a paper published online in the journal Diabetologia, the team show 300 mg of thiamine taken orally each day for three months reduced the rate of albumin excretion in type 2 diabetes patients. The albumin excretion rate was decreased by 41% from the value at the start of the study. The results also showed 35% of patients with microalbuminuria saw a return to normal urinary albumin excretion after being treated with thiamine.

Forty patients with type 2 diabetes aged between 35 and 65 years old took part in the trial. They were randomly assigned a placebo or 3 x 100mg tablets of thiamine a day for three months.

The Warwick research group has already conclusively proven that type 2 diabetes patients have a thiamine deficiency. In an earlier study led by Professor Paul Thornalley at Warwick Medical School, the research team showed that thiamine deficiency could be key to a range of vascular problems for diabetes patients.

Dr Rabbani said: “This study once again highlights the importance of Vitamin B1 and we need to increase awareness. Professor Thornalley and I are planning a foundation at the University of Warwick to further education and research in thiamine deficiency.”

Why are people with diabetes at high risk of nerve pain, heart disease, and blindness?

Over time, high blood sugar slowly injures the blood vessels, nerves, and organs in your body. The higher your blood sugar is — and the longer it stays high — the worse the damage is. Smoking and alcohol ratchet up the damage several more notches.

“Damage is slow and occurs over a period of years — but it probably begins when blood sugar is at mildly elevated levels,” says Ronald Goldberg, MD, associate director of the Diabetes Research Institute at the University of Miami Medical Center. “You may not be diagnosed with diabetes, but the damage has already begun.”

The damage from diabetes shows up a bit differently in everyone — whether it attacks the nerves, eyes, or kidneys, Goldberg tells WebMD. “Genetics probably influence which complications you are more susceptible to.”

The problem is, “many people have diabetes a lot longer than they realize,” says Ziemer. “Most have diabetes an average of five to seven years before they’re diagnosed.”

Diabetes Complications: The Risks You Face
As blood vessels, nerves, and organs become damaged, your risk of diabetes complications increases. These are the most serious:

Heart disease, heart attack, heart failure, and stroke risks are doubled. Heart disease and stroke cause at least 65% of deaths from diabetes.
Major eye complications (diabetic retinopathy) are linked to blood vessel problems in the eyes. Diabetes is a leading cause of preventable blindness; cataracts and glaucoma are also common.
Reduced blood flow to nerves and high blood sugar results in nerve pain, burning, numbness (peripheral neuropathy).
Serious leg and foot infections, even gangrene and amputation, are due to poor blood circulation, lack of oxygen and nutrients to tissue, and nerve damage.
Kidney damage (diabetic nephropathy) is a common risk for people with diabetes.

New evidence discovered by researchers at The University of Texas School of Public Health Brownsville Regional Campus shows that patients with Type 2 diabetes may be at increased risk of contracting tuberculosis because of a compromised immune system, resulting in life-threatening lung infections that are more difficult to treat.

The World Health Organization estimates that 180 million people in the world have diabetes, and that number is expected to double by 2030. Also, according to the WHO, each person with active, untreated TB infects on average 10 to 15 people per year. “You do the math and it adds up to a major public health threat,” McCormick said. “If you have Type 2 diabetes in an area with high rates of TB, your chances of getting TB goes up. In countries where a third of the population is infected with TB, this becomes a real issue.”

In a recently published study in linical Infectious Diseases, researchers reported that the immune systems of patients with Type 2 diabetes and tuberculosis respond differently compared with patients with TB alone. “This immune impairment may be what makes patients with diabetes so susceptible to TB,” said Fisher-Hoch, whose career as a scientist was recently honored with a Hall of Fame Award from Women In Technology International.

Restrepo and her colleagues found that innate and type 1 cytokine responses were significantly higher in patients with tuberculosis who had diabetes than in the control group of patients with TB and no diabetes. The effect was consistently and significantly more marked in diabetic patients with chronic hyperglycemia, or uncontrolled high blood sugar. Diabetes results in the body’s ineffective use of insulin. If left uncontrolled, the chronic high sugar in the bloodstream can affect the critical immune system and damage the body’s systems, especially the nerves, the retina of the eyes and blood vessels.

“These findings are the opposite of what we were expecting,” Restrepo said. “These innate and type 1 cytokines are typically associated with TB protection, but in patients with diabetes, it appears the cytokines are not effective. Diabetics may have more advanced TB with more bacteria, and hence, more stimulation for secretion of type 1 cytokines.”

The researchers wrote, “More detailed knowledge of the underlying mechanisms should focus on the effect of chronic hyperglycemia on the immune response to help in understanding the enhanced susceptibility of diabetic patients with tuberculosis.”

In a large U.S. population-based study presented at the 73rd Annual Scientific Meeting of the American College of Gastroenterology, metabolic syndrome patients had a 75 percent higher risk of colorectal cancer compared to those without metabolic syndrome.

Dr. Donald Garrow and Dr. Mark Delegge of the Medical University of South Carolina in Charleston analyzed data of patients who reported a history of metabolic syndrome and colorectal cancer from the National Health Interview Survey (NHIS), a comprehensive nationally representative study conducted each year by the National Center for Health Statistics.

Metabolic syndrome was defined as having a combination of three common chronic medical conditions: hypertension, diabetes and elevated cholesterol. The risk of colorectal cancer among patients with metabolic syndrome was determined by multivariate logistic regression analysis, controlling for age, race, gender, obesity, smoking and alcohol use.

“Since individuals with the metabolic syndrome have a significantly higher lifetime risk of colorectal cancer, they should closely adhere to published guidelines for colorectal cancer screening,” said Dr. Garrow.

About Metabolic Syndrome
Metabolic syndrome refers to a group of risk factors linked to overweight and obesity that increase your chance for heart disease, stroke, diabetes and other serious health problems.

Having just one of these conditions — increased blood pressure, elevated insulin levels, excess body fat around the waist, or abnormal cholesterol levels — contributes to your risk of serious disease. Losing weight, eating a healthy diet, and exercising routinely can help to reduce your risk of metabolic syndrome.

New Education Tools From GI Experts Address Obesity and GI Disease
The American College of Gastroenterology recognizes that the epidemic of obesity is of particular relevance to gastroenterologists because of the clearly documented associations of obesity with a number of gastrointestinal disease risk factors and outcomes, including mortality rates and unfavorable risk profiles.

The ACG has developed new resource tools to help physicians incorporate patient education on the risks overweight and obesity. These educational resources on weight and GI health are available on the ACG Web site at www.acg.gi.org/obesity.

Studies show it works but cost, long-term effectiveness unclear

Typically, type 2 diabetes is managed through a combination of lifestyle modifications, including changes in diet and increased physical activity, various medications and sometimes insulin injections. Adding surgery to the mix would represent a seismic shift in the management of the disease.

Dr. Philip R. Schauer, director of the Cleveland Clinic Bariatric and Metabolic Institute and past president of the ASMBS, concedes that some endocrinologists are uncomfortable with the notion of treating diabetes surgically.

“Essentially, it’s the quintessential medical disease, and for somebody to suggest surgery as a potential treatment or ‘cure,’ that’s a very radical concept,” he said. But Schauer believes the evidence thus far shows great potential. “I think an astute investigative clinician would recognize that there’s enough there to say, ‘Wow, we really should look at this,’” he said.

Prominent medical journals such as the Journal of the American Medical Association and the New England Journal of Medicine have recently reported findings that bolster the argument for a surgical approach.

In one pivotal study, Australian researchers compared conventional diabetes care with gastric banding. After two years, patients in the surgical group were five times more likely to experience a remission of their type 2 diabetes than those receiving the usual treatments.

In another study, a U.S. team compared two groups of obese patients — one that had gastric bypass surgery and one that did not and followed them for an average of seven years. Deaths from diabetes were 92 percent lower among patients who had the surgery.

Most diabetes experts would like to see more data on the long-term safety of these procedures before forging ahead. There are also unanswered questions about the cost-effectiveness of bariatric surgery, which averages $17,000 to $25,000 per procedure, according to the ASMBS.

Not to long ago, my co-author here at Diabetes Health Talk wrote about risk of developing Type 2 diabetes being linked to trace levels of arsenic in tap water. While the article warned of the research still needed until a definitive answer would be provided, there’s no reason not to start taking precautions on your own now.

Millions of homes install water filters for their drinking water, while others (guilty as charged!) figure it’s a lot of hassle and prefer tap water. The marketing folks are constantly trying to get us to change our mind, insisting that the filtering systems are necessary, and now science might be beginning to agree with them. The researches of the above study showed an increase in risk of diabetes in tap water, and now studies show that filtration helps decrease those levels.

Arsenic is found naturally in rocks and soil and tends to make it’s way to our water supply when minerals dissolve. Large levels can elad to brain disturbances, abdominal pain, organ failure and can be fatal if untreated. It’s also linked to the cause of many cancers, and other diseases - including diabetes. That study was the first to link the smaller, approved amounts of arsenic found in our tap water to the disease.

As a result, Researchers urge consumers to limit their consumption of pure tap water and to rely on filters until more standards are put in place to test the arsenic levels and their effects. So reconsider those filtration devises on your drinking water at home. After all, its a small thing that might help a large issue - why not take a little step to help protect you and your family?

Diabetes Can Cause Sexual Problems in Women Too

Although not as common as erectile dysfunction, sexual problems due to diabetes can affect women too. More than a third of women with diabetes may experience sexual dysfunction related to their disease, according to the Joslin Diabetes Center in Boston.

In a separate 2005 study, researchers in Turkey used questionnaires to evaluate sexual desire, arousal, lubrication, orgasm, satisfaction, and pain during intercourse among 127 married women. The sample included 21 women with type 1 diabetes, 50 with type 2 diabetes, and 56 women without diabetes. Overall, 71% of the women with type 1 and 42% of the women with type 2 experienced sexual dysfunction, versus 37% in the control group.

Symptoms of female sexual dysfunction include:

Decreased or total lack of interest in sexual relations
Decreased or no sensation in the genital area
Constant or occasional inability to reach orgasm
Dryness in the vaginal area, leading to pain or discomfort during sexual relations

Diabetes control is crucial for avoiding or minimizing sexual problems.High blood sugar, for example, can damage the blood vessels and nerves that make intercourse enjoyable.

Nerve damage may make it difficult or impossible for women to achieve orgasm.

For men, being grossly or morbidly overweight or having high cholesterol or high blood pressure can contribute to erectile dysfunction.

To lower your risk of sexual and urological problems, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends:
• Keeping your blood glucose, blood pressure, and cholesterol in check
• Being physically active and maintaining a healthy weight
• Quitting smoking

Head on over to Internet Shop Girl for some Robeez for your feet.

I hate it. Every doctor since I was in highschool - when I was a whole 5′6″ and 150 pounds of butt and boobs - told me that whatever was wrong with my body related to the fact that I was overweight. I played basketball everyday for 4 years, then when I quit that, I worked on my feet every day for 8 hours after school - even though I ate McDonalds a lot (I worked there, after all) I was in the best shape of my life. When I fell and hurt my knee my senior year? You betcha. It was because I was fat. Lose some weight, he said, and you’re knee will quit hurting.

I’m no longer anything close to 150, and haven’t been since, and I’m well used to the looks and smirks and whispers and outright statements like:

You’re blood pressure must be so high. (It’s not.)
You’re cholesterol must be through the roof! (It’s not.)
I bet you’re diabetic - you’re too heavy to be healthy.

Guess what? I’m not diabetic, and other then being out of shape (Well, round IS a shape, but I digress) and heavier then I should be by several pounds, I’m doing allright. I’ll never forget the day my skinny ass husband came home in a rampage because HIS bloodwork came back way worse then mine… I was very amused indeed, and he quit trying to get me to do gastric bypass finally.

A lot of times, however, the obesity is a symptom of the disease. In my perusal of the internets today, I came across a site called Blood Sugar 101, where there is a whole bunch of articles on Diabetes, causes and maintenance. one of those is an article called “You did NOT eat your way to Diabetes.”

While obesity and diabetes often go hand in hand, it’s incorrect to say that the latter is caused by the former. The problem comes when doctors decide that you won’t make an effort to control the disease, because you let yourself get fat. It could lead to getting poor care, so be SURE when you pick a practitioner, it is someone who is willing to work with you instead of against you, even in something that seems so simple.

This is not to say that you shouldn’t take the steps to control your weight and get in shape when diagnosed with diabetes, as Type 2 can be controllable through diet and exercise. The point is to make sure that you have a doctor who listens to you, who understands that they go hand in hand, and that one is not always the cause of the other. If you need a judge, go to the courtroom. You need help controlling your disease, get a doctor that cares.

There is a TON of info on the Sugar 101 site - I’ll go into some more in the coming days.

I’ve written about some of the complications from diabetes - including yeast infections.

“>Gestational diabetes, which is on the rise nationwide, is becoming more recognized as a significant risk to mothers and their babies. In the news, here is an article about gestational diabetes - and what might cause it. I confess that I don’t understand a lot of what is being said in the article - but it sounds like they (the infamous “they”) might be getting a handle on why gestational diabetes happens.

At the least, it looks like they have the sequencing down - the timing of when it starts and when it stops - or the body starts using insulin again properly. There is talk about “islets” and “menin” and “prolactin”. You know . . . all that scientific jargon that none of us really understands - but when it HELPS us, we are thrilled. Right? Right.

———————–

In other news . . .

The swimming continues - I am getting to be more comfortable putting my face in the water. What?!! You already do that when you swim? Well, friends, I do not like to have my face in the water - there may be psychological reasons for that, but I am not going to worry too much about all that. I am taking it slowly and now get my face wet a lot more often than I used to 8 weeks ago when I started swimming with my daughter.

8 weeks - tomorrow starts week 9.

Last week a coworker came up behind me and mentioned “you know, you are trimming down!” I thanked her and sort of shook my head. Later in the day I got curiouser and curiouser and finally went to the back bathroom to step onto the medical type scale there . . . .

. . . . drum roll, please . . . .

I have lost EIGHTEEN pounds!

Yeah, you coulda knocked ME over, too. How awesome is that? I knew that my (brand new!!!) work slacks were starting to be a bit loose in the legs and seat . . . but I hadn’t thought too much about it really.

May just have to have them taken in soon.

It’s a nice problem to have, right? Right.