My husband’s grandmother is 84 and has diabetes. Although she is fiercely independent, she cannot look after herself properly and will have to go into a residential home. Can you let me know of any homes that cater especially for people with diabetes?

Because diabetes is becoming increasingly common in the elderly, the staff in most residential homes are experienced in looking after people with diabetes. They will probably be happy to do urine tests, ensure that diet is satisfactory and see that she gets her tablets and, if necessary, insulin injections.

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My wife, who developed diabetes a few weeks ago, is about to return to work. I feel that she should wear some sort of identity disc or bracelet showing that she has diabetes but she is reluctant to wear anything too eyecatching. Have you any suggestions?

It is very important that all people with diabetes, especially those on insulin, should wear some form of identification. Accidents do happen and it may be vital for any medical emergency team to know that your wife has diabetes.

Medic-Alert provides stainless steel bracelets or necklets which are functional if not very beautiful. They can also be obtained in silver, gold plate, and 9-carat gold. Medic-Alert’s.

SOS/Talisman produces a medallion which can be unscrewed to reveal identification and medical details. These can be bought in most jewellers and come in a wide range of styles and prices, including some in 9-carat gold. Other products are always coming on to the market, and Balance, the magazine produced by Diabetes UK, usually carries advertisements.

I recently enquired about having electrolysis treatment for excess hair. I was told that, as I had diabetes, I would need a letter from my doctor stating that my diabetes did not encourage hair growth. Could I use wax hair removers instead?

There is no objection to your having electrolysis. Diabetes does not cause excessive hair growth. It sounds as though the firm doing the electrolysis is being overcautious.

People with diabetes can use the same methods of hair removal as those without diabetes – no special precautions are needed.

Could you tell me what ointment to use for skin irritation?

The most common cause of skin irritation in people with diabetes is itching around the genital region (pruritus vulvae). The most important treatment is to eliminate glucose from the urine by controlling diabetes. However, the itching can be relieved temporarily by cream containing a fungicide (e.g. nystatin).

I have recently been given afoot spa and was surprised to see a caution on the side of the box that it is not suitable for people with diabetes. Is this true?

If you have neuropathy (nerve damage), you should check with your diabetes team before using the spa. If you don’t have neuropathy, make sure that you check the temperature of the water carefully and don’t soak your feet for too long as this will make the skin soggy, easily damaged and prone to infection.

DIABETES CLINICS

My CP is starting a diabetes clinic in the local group practice and tells me that I no longer need to attend the hospital clinic. It’s much more convenient for me to go to see my CP but will this be all right?

You are fortunate that your general practitioner has a special interest in diabetes and has gone to the trouble of setting up a special clinic in the practice for this. Many GPs and practice nurses have had special training in diabetes and these general practice-based diabetes clinics are becoming more common.

They usually work well as long as you have uncomplicated diabetes and are well controlled, but you should be aware of the sort of care you can expect: Diabetes UK’s recommendations are given at the end of this section. We are sure that your hospital specialist will know about your CP’s new clinic and may even attend it from time to time. If you have any anxieties, why not discuss them with your doctor?

My CP is keen to test my urine every year to ‘look for evidence of kidney damage’. This sounds very frightening. Please explain.

The test goes by the name of microalbuminuria. For years nurses in diabetic clinics have asked for a urine sample which they test for protein. This is a crude test and is only positive when there is a lot of protein in the urine. The new test is very sensitive and detects minute traces of albumin (the body’s most common protein). Research has shown that protein detected in such small amounts is the first sign of kidney damage but at this early stage it can be reversed. This damage can be slowed by keeping the blood pressure below 135/75 and controlling the blood glucose – HbA1c 7% or less. The result of this test is often presented as a ratio of albumin (the protein) to creatinine, which corrects for the flow of urine at the time. The best result is to have a ratio of less than 0.5. The top limit of normal is usually quoted as 3.5 for women and 2.5 for men. If left untreated, the amount of protein in the urine will increase until it can be detected by conventional urine testing sticks. Over a period of years, this may progress to kidney failure and the possible need for dialysis or a kidney transplant. At the early stage of microalbuminuria, this process is reversible by control of blood pressure and glucose. There is good evidence that people with normal blood pressure and microalbuminuria can be protected by treatment with a tablet called an ACE inhibitor.

BLOOD GLUCOSE TESTING

I have trouble obtaining enough blood to perform a blood sugar test. Is there anything that I can do to make this easier?

The good news is that many of the new meters need only tiny amounts of blood in order to perform a test. However, if you are having trouble obtaining enough blood then try warming your hands by washing them in warm water before you start, and drying them thoroughly before pricking your finger. When squeezing the blood out of your finger, try ‘milking’ the blood out gently, allowing the finger to recover between each squeeze. Do not squeeze so hard that you blanch the finger white.

I am about to buy a meter that allows blood to be taken from the arm. Are there any problems with arm testing?

At the time of writing there are three meters that allow blood for testing to be taken from the arm. They are the OneTouch Ultra from LifeScan and the FreeStyle Freedom and Freestyle Mini from Abbott. The OneTouch Ultra and FreeStyle use strips that allow a tiny blood sample to be taken, which makes arm testing feasible. Under certain conditions, samples taken from the arm may differ significantly from fingertip samples, such as when blood glucose is changing rapidly:

• following a meal;
• after an insulin dose;
• when taking physical exercise.

Arm samples should only be used for testing prior to, or more than two hours after meals, an insulin dose or physical exercise. Fingertip testing should be used whenever there is a concern about hypoglycaemia (such as before you drive a car), as arm testing may not detect hypoglycaemia. Obtaining sufficient blood from the arm is not always easy but for some it is a welcome alternative to fingertip pricking. Your health professional should be consulted before you begin arm testing.

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I have heard that there is a way of obtaining blood from a finger using a laser. Is this true?

The Lasette is a single shot laser that makes a small hole in the finger to obtain a drop of blood, but it is not a blood glucose monitoring device. The use of laser light, as opposed to a steel lancet, reduces tissue damage, and many users of the device report feeling less pain than when using a traditional lancet. It weighs just less than 260 g (9 02). However, it is very expensive. It is slightly smaller than a videocassette.

I would like to measure my own blood glucose levels, but as I am now blind I do not know if this is possible. Can it be done?

After a long spell when no speaking meters were available there is now the new SensoCard Plus Meter which will speak instructions and also speak the result. The meter has recently come down in price. Strips are available on prescription and your pharmacist would need to contact the company, Cobolt Systems Ltd, directly. It also supplies control solution to check that the meter is working properly, and software to download results from a computer.

Source: Canadian Health and Care Mall at acanadianhealthcaremall.com

Global Canadian Pharmacy: Other illnesses associated with diabetes

I have recently had a severe cough and cold and have been given ‘diabetic’ cough medicine by the doctor. Since then my blood glucose has been very high. Could this be due to the medicine?

Antibiotic syrup and cough linctus are often blamed for making diabetes worse during an illness such as flu or a chest infection. In fact a dose of antibiotic syrup only contains about 5 g of sugar and will have very little effect on your blood glucose. It is the illness itself that unbalances the diabetes. In general, medication from your doctor will not upset your diabetes.

Any infection or serious illness will cause a rise in blood glucose and it is important to test your blood if you feel unwell. If you are taking insulin you will probably need to increase the dose during the illness and it is very important to continue regular insulin injections even if you are not eating. If you are vomiting and unable to keep fluids down you will need hospital admission for intravenous fluids. Vomiting can sometimes be a sign of ketoacidosis, which may be fatal if untreated.

The rules for illness are:

• Test blood at least four times a day;
• If tests are high take extra doses of short-acting insulin;
• If the tests are low, take a sugary drink such as Lucozade to treat the hypo;
• Never stop insulin.

It is of course possible to get over a bad cold by carrying on with your normal dose of insulin and accepting bad control for a few days. However, this means that your mouth and nose will be slightly dehydrated and it may take longer before you feel back to normal. You will probably feel better more quickly if you adjust your insulin and try to keep the blood glucose near normal.

I have noticed that I suffer from more colds since developing diabetes. Could this be due to the diabetes?

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Many people make this observation, but there is no real reason why the common cold should be more common in diabetes. However, a relatively minor cold may upset your diabetes control and lead to several extra days of feeling unwell (see previous question). This may make it a more memorable event. To repeat the previous advice, never stop insulin.

What is the best treatment for someone suffering from hay fever? I understand that some products can cause drowsiness, which could affect my balance and be confused with a hypo.

You can use exactly the same treatment for your hay fever as people without diabetes, as it does not affect your control. Antihistamines are often used for hay fever and these may make you feel sleepy, but this should be easy to distinguish from a hypo. Remember that, if you are on antihistamines, you should be very cautious about drinking alcohol. Hay fever can also be alleviated by using a nasal spray to reduce the sensitivity of the membranes in the nose.

Diabetes and the Consequences

It is no laughing matter when one contracts this horrible disease. Early symptoms might include headaches, dizziness, thirst, hunger and a few other mild out of sort’s conditions. It’s when the other more serious symptoms start that one generally becomes very anxious.

The feet may lose feeling, the centre of the brain feels numb, the eyes are not what they used to be and balance is fading. You head to the doctor’s and a sucrose tolerance test is ordered. You suspect high blood sugar because you have a sweet tooth and a great love of chocolate and ice cream. So will that explain why you are so thirsty, particularly when you wake up in the morning? What about that funny feeling in your tongue?

Some of these symptoms go with high cholesterol and high blood pressure and these too are warning signs for diabetes.

During my lifetime there have come and gone many with the disease and the thing noticed most about them is the smell of their breath. It is a somewhat sickly artificial smell that might be explained by the intake of insulin. My grandmother had diabetes and that smell was prominent on her breath and would see me avoiding coming too close to her face, although her affection was much sought after.

Lately some diabetics have come to my attention in hospitals where they were having lower limbs removed. In the eye hospital some were being treated for blindness and other things.

This is a preventable disease although if you have the diabetic gene it only takes careless abuse of your body to get it. Obesity is one of the primary causes and here blood pressure and cholesterol are always present. People with the latter can contract heart disease, suffer strokes and die suddenly. All types of viagra medications online at global canadian pharmacy

These are all reasons to avoid sugar at all costs and yet parents feed masses of it to their children. Soft drinks or sodas are full of it, some worse than others. Chocolate bars and candies are quite potent poisons and ice cream loaded with sugar is also full of fat.

The most common symptoms of onset diabetes are well known among medical researchers and doctors. But these common symptoms can be misleading due to the fact that these symptoms also appear in diseases other than diabetes.

The common symptoms of onset diabetes are excessive urination, dramatic weight loss in a short period time, extreme thirstiness, sudden bouts of impaired or blurred vision, and a constant feeling of listlessness and no energy. These are the common signs, but just because you do not have any of these symptoms does not mean that are protected from the disease.

When a person has this illness, it means that his body cannot regulate the amount of glucose in his blood stream. This means that either his body is not making enough insulin to convert the glucose into energy. Or the body is producing enough insulin, but for some reason the body is not able to make use of the insulin. In either case, the end result is that the body ends up with too much glucose in the bloodstream. Extended periods of too much blood glucose is bad for the body. It can cause drastic shocks to the system as well as the gradual shutting down of the body organs of the body.

The symptoms of the disease are recognized at different points for the two main types of diabetes. For type 1 or juvenile diabetes, although there is no definitive age, these symptoms usually start to show up around the age of 14 or so. For “adult” onset diabetes or type two diabetes, the symptoms – if they appear at all, normally begin to show up in the early twenties. It is worth noting, however, that type two diabetes is showing up earlier and earlier in the population. This is primarily due to the fact that it is basically triggered by diet and obesity. And as the American diet seems to get worse every year, teenagers get fatter each year, and the incidences of this disease increases every year.

Most of the aforementioned symptoms of onset diabetes are signs that can be observed either by careful observation or sight. But there are medical symptoms as well. For example, obesity – especially in those with pear shaped bodies – has a very close correlation to diabetes. High blood pressure is another medical condition that has a high correlation to diabetes. High fat levels in the blood is yet another symptom that diabetes may be present. And there are many others as well. Again, the presence of any of these symptoms does not indicate diabetes – but the presence of any of them, and especially the presence of more than one of them, is a sign that you should probably have your doctor test for diabetes.

As mentioned before, some people with illness do not manifest any obvious symptoms. That is why it is good to periodically have your blood sugar tested during your physical. This is especially true if you have a family history of diabetes or if you fall into any of the high risk groups that are known to be susceptible to the disease.

Almost twenty-one million people in the US are living with diabetes and an estimated 6.2 million of these people don’t know that they have diabetes because they are undiagnosed.People with diabetes, on average, have medical expenditures that are 2.3 times higher than non-diabetics, according to the American Diabetes Association. Another study in Population Health Management estimates that diabetes is costing our nation $218 billion dollars in health care every year. Yet, most diabetes cases are preventable or reversible through exercise, weight loss, and healthy living.

I find myself wondering. What if the 6.2 million people who were undiagnosed knew they had diabetes? Or the estimated 57 million Americans with Pre-Diabetes were educated on how they could mange their health and avoid becoming a Type 2 Diabetic?

Being diagnosed as Pre-Diabetic does not mean that Type 2 diabetes is inevitable. If you lose weight and increase your physical activity, you can prevent or delay diabetes and even return your blood glucose levels to normal (ACSM 2006). (See sidebar for diabetes terms defined)

This is a very important point that many people do not understand – if you exercise and lose weight you can prevent or delay diabetes.

Do you know the signs of diabetes?Take a look around you. Do you see any signs of diabetes in your friends and family right now? (See sidebar for common signs of diabetes) It is very possible that there are people that are diabetic (or will become diabetic) around you every day. The Center for Disease Control and Prevention estimates that one in three Americans may develop diabetes in their lifetime. Those statistics are staggering and PREVENTABLE for most.

What about Type 2 diabetics that have been diagnosed? What if we educated them that through diet and exercise they could reduce their medication or eliminate it? What would this do for our health care crisis? I know that we’d first have to break through many myths, magic solutions, and limiting beliefs. The pharmaceutical companies won’t be happy with me letting this secret out either. But, what the heck, our health care system is in a crisis! Our Nation is sick! There, I said it. So let’s get down to the business of taking some personal responsibility for our health.

Many of you who are trying to understand diabetes and take responsibility for your health immediately have several questions:

• Should you cut out sugar?
• Is your weight putting you at risk?
• If you are skinny, you don’t have to worry, right?
• Can exercise and diet really help YOU?
• How do I control blood sugar levels?

And then there are the issues that you might not even know to ask about:

• Having diabetes for more than five years can increase your likelihood of developing cardiovascular disease
• Regular exercise can make you more sensitive to insulin, which can reduce medication dosages

First, let’s talk about insulin, the prime medication that keeps diabetics functioning and then you can see the answers clearly to your questions.

How does insulin work? Insulin is the main hormone that controls the entry of blood sugar from the blood stream into the cells of the body to be used as energy. How does exercise influence the insulin hormone? Exercise has an insulin-like effect on the body. When exercising, your muscles require a steady flow of sugar to keep contracting and keep you moving. Exercise increases the rate at which your muscles take up the sugar from your blood stream; so exercise acts the same as insulin by emptying the excess sugar in your blood stream into your muscles. This action, therefore, lowers your blood sugar. One twenty minute walk a day can lower glucose levels by twenty points.

Here is a great example to explain insulin’s function in your body. Think of insulin as a bus for a moment. Glucose (sugar) is the passenger. There are two types of diabetics. Type 1 diabetics manufacture no insulin (or have no bus), which, according to the Center for Disease Control, is 5% – 10% of all diagnosed cases. The second type (Type 2), have insulin resistance, which means the bus is there, but it is not picking up passengers and, there are less buses running the route. According to the Center for Disease Control, Type 2 diabetes accounts for 90%-95% of all diagnosed cases.

When you exercise, your muscles work harder than usual and require more fuel than usual; so your muscles send out their own buses to pick up the sugar in the bloodstream and carry it back to the muscles. Working muscles take over for insulin and (for Type 2 diabetics) they can even show the buses (insulin) how to work again (pick up passengers).

Exercising has many benefits for a diabetic. It increases glucose uptake by the cells, improves insulin sensitivity by improving glucose metabolism and reduces the risk of cardiovascular disease. Reduction of blood glucose levels improves insulin sensitivity by making it more effective. Exercise may reduce dosage requirements or need for medication and improve the ability to lose and/ or maintain body weight if combined with an intuitive diet. (See sidebar for Safe Exercise Check List)

There are many popular myths about diabetes. Here are a few that I hear often.

Myth #1 – Diabetics can’t eat sugar or sweets and the only reason they have diabetes is because they ate too much sugar. Yes, simple carbohydrates or sweets do raise your blood glucose levels but if you eat them in moderation and make them part of your meal plan, you can safely eat an occasional sweet

Myth #2 – If I’m skinny I’m fine. Diabetes is only a disease that obese people get.
Not completely true, 20% of people with Type 2 Diabetes are slim. Yes, being obese does put you at risk for Type 2 Diabetes, high blood pressure and high cholesterol. The key thing to remember is that there is not an atypical “diabetes” body type, genetic trait, race, age or gender. Type 2 diabetes is caused by lifestyle choices and diabetes is a disease to take seriously.

Myth #3 – There is no natural remedy for Diabetes. If I take insulin or insulin sensitivity drugs I can continue with my same lifestyle choices and be alright. Well there is a natural remedy, it is called exercise and balanced eating. You can keep a tight control on diabetes by monitoring your glucose levels, combining exercise with balanced eating, or use medication.

Myth #4 – Well I’m only borderline and 170 mg/dl blood sugar reading is normal for me. You may feel normal being a diabetic but high glucose levels are not safe. There is no such thing as borderline. You either are a diabetic or you are not a diabetic. This is a serious disease that requires you to take personal responsibility for your body. There is serious health complications associated with diabetes, especially when you are stressing your body with high blood sugar levels. You have to start to make lifestyle changes so that you can live a quality life over the long term.

Myth #5 – Exercise! What can that do for me? Blah! Blah! Healthy Lifestyle Blah! Yeah, Yeah, I know. The American Diabetic Association recommends 150 minutes of exercise a week. This is exercise of 20-60 minutes, in continuous sessions, 3-5 times a week. The Diabetes Prevention Study revealed that exercising for a total of two hours a week can reduce the risk of developing diabetes by 50%, that can be as little as 20 minutes, 6 days a week. Take a short, ten minute walk before and after work and you can prevent diabetes or lower your glucose levels.

The fact is, over 90% of diabetes cases are preventable and can be maintained with some natural remedies such as exercising, healthy eating, and/or combined with low doses of medication without tapping into our health care system to the tune of $218 billion. Start gradually and exercise a little everyday until you build up to the recommended guidelines. Eat a balanced, healthy diet and lose the all or nothing approach. Get educated about your disease, determine what your beliefs are about diabetes and make lifestyle changes starting today. (See sidebar Want to Learn More)

Diabetes is serious but you can do something about it!

Side Bars:

Diabetes Terms Defined
Type 1 = Auto immune disease that destroys insulin producing cells in the pancreas. The body cannot manufacture its own insulin because the beta cells of the pancreas that are responsible for insulin production are destroyed. About 5-10% of all diagnosed cases (CDC 2005)

Type 2 = body loses its sensitivity to insulin so the body’s cells are unable to utilize insulin properly (also knows as insulin resistance or adult onset diabetes). About 90% – 95% of all diagnosed cases (CDC 2005)

Pre-Diabetes = If you have a fasting plasma glucose test (FPG) and your levels are 100 mg/dl to 125 mg/dl you are diagnosed as showing signs of becoming a diabetic unless you make some lifestyle changes

Gestational Diabetes = When pregnancy hormones interfere with the mothers insulin, causing glucose levels to rise. This is a form of insulin resistance that in most cases ends with the birth of the child.

Metabolic Syndrome = A combination of medical disorders that increases the risk factors of developing cardiovascular disease, obesity, hypertension, low high-density lipoprotein (HDL), high cholesterol levels and elevated plasma triglyceride levels.

Hypoglycemic = abnormally low blood sugar levels which could be caused by excessive insulin, or your diet. Signs would be: trembling or shakiness, nervousness, rapid heart beat, increased sweating, headache, impaired concentration or attentiveness, unconsciousness and coma

Hyperglycemic = abnormally high blood sugar levels. Signs would be: frequent urination, great thirst, nausea, abdominal pain, dry skin, disorientation, labored breathing, and drowsiness.

Do you know the signs of diabetes? Some very telltale signs include:

• frequent thirst, hunger and urination
• weight loss
• fatigue
• crankiness
• frequent infections
• blurred vision
• cuts/ bruises that are slow to heal
• tingling and numbness in hands and feet
• recurring skin, gum and bladder infections

Safe Exercise Check List

• Get physician clearance before starting any exercise program
• Test your blood glucose level before exercise, immediately after exercise, and again two hours after exercise
• Follow general guidelines for a safe exercise session; warm-up, cool-down, stretch, adhere to an intensity of Type 1 (3 to 5 RPE) and Type 2 (3 to 6/7 RPE), drink plenty of water
• Wear well-fitting, well cushioned, supportive shoes
• Wear polyester or cotton polyester socks so that your feet stay dry and minimize trauma to the foot
• Avoid strenuous, high-impact or static activity unless specifically approved by your doctor
• Carry a carbohydrate snack with you of 10-15 grams of carbohydrate
• Wear identification that tells others you have diabetes in case of a hypoglycemic response
• Know and monitor signs of exercise induced hypoglycemia
• Do not exercise if <90 mg/dl or >250 mg/ dl blood glucose levels or if you have ketones in your urine
• If you have autonomic neuropathy, peripheral neuropathy, neuropathy, retinopathy or any other related conditions to diabetes, you must get a doctors approval before starting an exercise program. These conditions require specific and strict guidelines.
• Exercise with a partner until you know your response to exercise
• Always check your feet before and after exercise for lesions
• Drink plenty of water. A good rule is to take a mouthful or two at least every fifteen minutes

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Understanding the causes of diabetes is an important pre-requisite in controlling the disease. The pancreas produces a hormone, insulin, which enables the cells of the body to absorb glucose in order to convert it into energy. The condition of diabetes comes about when the pancreas does not produce enough insulin, or the body fails to properly utilise its own insulin, or both. Consequently, glucose accumulates in the blood and this can lead to various complications.

Acute Complications include diabetic ketoacidosis and hyperglycemia. Lack of adequate control of the disease may result in coma. Long-term complications include cardiovascular disease, several types of nerve damage, chronic kidney failure and retinal damage, which may eventually cause blindness. Microvascular damage may lead to erectile dysfunction and poor healing of wounds. The latter, especially of the feet, can result in gangrene, which may require amputation.

Diabetes is the most significant cause of blindness amongst non-elderly adults in the developed world. It is also the leading cause of non-traumatic amputation in adults.

Of the many known types of diabetes, the three main types are:

* Type 1 diabetes Here the body fails to produce insulin. Between five and ten per cent of diabetics have this type. Most of these take insulin injections. It appears to be triggered by an infection, mainly viral, where the beta cells, which make insulin, are destroyed. Other possible causes are exposure to chemical toxins in food and exposure as a baby to cow’s milk. Some individuals have inherited a susceptibility to these triggers. Type 1 is sometimes known as juvenile diabetes as it is usually diagnosed in those younger than 30.

* Type 2 diabetes This results from a resistance to insulin, where the body cells fail to respond to insulin properly. This is the type that most people diagnosed with diabetes have. Both types 1 and 2 are at least partly inherited, more so if both parents have type 2 diabetes.

* Gestational Diabetes Women who have high blood sugar levels during pregnancy, without ever having had diabetes before, are said to have gestational diabetes. About 4% of all pregnant women are affected. It may develop into type 2 or, rarely, type 1.

Less frequent causes of diabetes include:

• Certain drugs, some of which are toxic to the beta cells of the pancreas, and others which cause a rise in the blood sugar level.
• Any disease or illness which causes damage or inflammation to the pancreas, thereby affecting its ability to produce insulin.
• Certain syndromes, such as Down’s, may cause a state of hyperglycemia, which could result in permanent diabetes.

The possibility of developing type 2 diabetes increases with:

• physical inactivity
• advancing age, and
• obesity

Myths About the Causes of Diabetes

Diabetes is not caused by eating sweets or the wrong types of food. This may, however, result in obesity and a consequent development of type 2 diabetes.