If You Have Diabetes, Your Risk for Glaucoma May Be Higher

In one of the American study they estimated 3 million Americans have glaucoma, which can stealthily cause vision loss even before people realize they have the disease. People with diabetes face special risks from glaucoma. This January during Glaucoma Awareness Month, through its EyeSmart (TM) campaign, the American Academy of Ophthalmology in partnership with the American Glaucoma Society and the Glaucoma Research Foundation, remind Americans that knowing your glaucoma risks can save your sight and that people with diabetes need to be extra-vigilant.

Both diabetes and glaucoma are leading causes of blindness. In their early stages these diseases often have few symptoms, so damage may occur before people know they need treatment. Several large studies suggest that people with diabetes are more likely to develop glaucoma, and other data shows that glaucoma patients who are diabetic are more likely to suffer vision damage. If caught early, diabetes and glaucoma can usually be managed and vision can be saved.

About Glaucoma: Glaucoma damages the optic nerve that transmits images from the eye to the brain. As glaucoma worsens, cells also die in the retina -- a special, light-sensitive area of the eye -- which further reduces the optic nerve's function. In the most common form of the disease, primary open-angle glaucoma, often a patient first notices that her peripheral vision is reduced, then that other areas of her visual field are blank. But in many people glaucoma-related vision changes are so gradual that they go unnoticed, which is why regular eye exams are so important. Symptoms of the less common but more immediately dangerous closed-angle glaucoma include blurred vision, severe eye pain and headache, rainbow-colored halos around lights, and nausea and vomiting. Anyone with these symptoms needs to be seen by an Eye M.D. right away.

The Reason why Diabetics Suffer Bluriness and Dizziness

When glucose levels are too high in the body, the result would be a chemical imbalance in the body. There would be deep emotional pain, depression or stress felt by the individual as the liver and pancreas lose control of the amount of glucose in the body. This can also result in dizziness and later on unconsciousness. When glucose levels are too low, because of an oversupply of insulin, the individual experiences fatigue, weakness, hunger, heavy perspiration and anger. Here dizziness also occurs, as the body is unable to provide the necessary energy for its normal processes. Diabetes also slowly causes degeneration of the eye function. This is called diabetic retinopathy. This is the result of the degeneration of the retinal nerves of the eyes. Also, the blood vessels towards the eyes burst because of the thickened character of the blood because of the oversupply of glucose. Diabetes affects the liver functions. With the oversupply of glucose in the bloodstream, the liver works double time to keep the balance. Thus a sudden increase or spike in the blood glucose levels affects the retina and this causes blurred vision. The repeated blurring of the vision is a portent of further damage to the eyes due to diabetes. Diabetes causes problems to the cardiovascular system. The veins towards the heart are clogged because of the thickened blood and the smaller veins because of the diabetes. This means the blood rich with oxygen cannot travel fast and properly throughout the body, leading to a form of dizziness for the individual.

Dizziness and Blurred Vision

Dizziness relates to the body’s equilibrium and this is highly dependent upon the body’s central nervous system. This together with the inner ears, eyes and sensory receptors in the skin, muscles and joints add up all the necessary information for the proper sense of balance of the body. Diabetes affects the nervous system of the body by cellular degeneration. The incomplete information makes the individual dizzy during bouts of high glucose levels. Blurred vision is one of the early symptoms of diabetic retinopathy. The retinal nerve of the eyes degenerate slowly because of the inadequate supply of nutrients to the eyes and the cellular decay caused by the cell’s inability to process glucose. Also, the blood vessels of the eyes also degenerate because of the thickening of the walls of the veins and the overall increase in viscosity of the blood. These are the effects of the body’s inability to produce insulin for the proper management of glucose in the body. Dizziness and blurred vision are symptoms of both short term and long term blood glucose problems leading to diabetes. These two symptoms are a result of hyperglycemia, which is one of the general consequences of diabetes. This is a result of having too little or inadequate insulin in the body. Another cause is despite the presence of insulin, the body is unable to metabolize the hormone. If you experience blurriness in vision at any given time especially after a meal, it would mean that there is too much glucose in the bloodstream. Conversely, there is too little insulin present to regulate this problem as the liver goes on overdrive to process the extra glucose. This can be easily remedied by taking insulin intravenously or antidiabetes medication. On the other hand, if you experience dizziness when you stand up, difficulty in breathing or even sudden unconsciousness, you have been carrying a very high glucose level for quite sometime. This is a very dangerous situation because the liver and pancreas has been unable to regulate the amount of glucose in the body and the major organs are already feeling the crush of diabetes.

Diabetes and Foot Problems

Introduction:
For people with diabetes, having too much glucose (sugar) in their blood for a long time can cause some serious complications, including foot problems.

How Can Diabetes Affect My Feet?
Diabetes can cause two problems that can affect your feet.

Diabetic neuropathy
Uncontrolled diabetes can damage your nerves. If you have damaged nerves in your legs and feet, you might not feel heat, cold, or pain. This lack of feeling is called "sensory diabetic neuropathy." If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected. The muscles of the foot may not function properly because the nerves that make the muscles work are damaged. This could cause the foot to not align properly and create too much pressure in one area of the foot. It is estimated that up to 10% of people will develop foot ulcers. Foot ulcers occur because of nerve damage and peripheral vascular disease.

Peripheral vascular disease
Diabetes also affects the flow of blood. Without good blood flow, it takes longer for a sore or cut to heal. Poor blood flow in the arms and legs is called "peripheral vascular disease." Peripheral vascular disease is a circulation disorder that affects blood vessels away from the heart. If you have an infection that will not heal because of poor blood flow, you are at risk for developing ulcers or gangrene (the death of tissue due to a lack of blood).

What Are Some Common Foot Problems of People With Diabetes?
Anyone can get the foot problems listed below. For people with diabetes, however, these common foot problems can possibly lead to infection and serious complications, such as amputation.
Athlete's foot, Fungal infection of nails, Calluses, Fungal infection of nails, Foot ulcers, Hammertoes, Ingrown toenails, Plantar warts.

Can These Foot Problems Be Prevented?
Proper foot care can help prevent these common foot problems and/or treat them before they cause serious complications. Here are some tips for good foot care:
1. Take care of yourself and your diabetes. Follow your health care provider's advice regarding nutrition, exercise, and medication. Keep your blood glucose level within the range recommended by your doctor.
2. Wash your feet in warm water every day, using a mild soap. Do not soak your feet. Dry your feet well, especially between the toes.
3. Check your feet every day for sores, blisters, redness, calluses, or any of the other problems listed above. If you have poor blood flow, it is especially important to do a daily foot check.
4. If the skin on your feet is dry, keep it moist by applying lotion after you wash and dry your feet. Do not put lotion between your toes. Your doctor can tell you which type of lotion is best to use.
5. Gently smooth corns and calluses with an emery board or pumice stone. Do this after your bath or shower, when your skin is soft. Move the emery board in only one direction.
6. Check your toenails once a week. Trim your toenails with a nail clipper straight across. Do not round off the corners of toenails or cut down on the sides of the nails. After clipping, smooth the toenails with an emery board.
7. Always wear closed-toed shoes or slippers. Do not wear sandals and do not walk barefoot, even around the house.
8. Always wear socks or stockings. Wear socks or stockings that fit your feet well and have soft elastic.
9. Wear shoes that fit well. Buy shoes made of canvas or leather and break them in slowly. Extra wide shoes are also available in specialty stores that will allow for more room for the foot for people with foot deformities.
10. Protect your feet from heat and cold. Wear shoes at the beach or on hot pavement. Wear socks at night if your feet get cold.
11. Keep the blood flowing to your feet. Put your feet up when sitting, wiggle your toes and move your ankles several times a day, and don't cross your legs for long periods of time.
12. If you smoke, stop. Smoking can make blood flow problems worse.
13. If you have a foot problem that gets worse or won't heal, contact your doctor for advice and treatment.
14. Make sure your diabetes doctor examines your feet during each check-up. An annual foot exam should be performed which should include an inspection of the skin -- he or she may check for redness or warm of the skin. The exam will also be to check for pulses and temperature of your feet and an assessment of sensation to the foot with something called a monofilament.
15. See your podiatrist (foot doctor) every two to three months for check-ups, even if you don't have any foot problems.

When Should I Contact My Doctor?
Contact your doctor if you experience any of the following problems:
Changes in skin color.
Changes in skin temperature.
Swelling in the foot or ankle.
Pain in the legs.
Open sores on the feet that are slow to heal or are draining.
Ingrown toenails or toenails infected with fungus.
Corns or calluses.
Dry cracks in the skin, especially around the heel.
Unusual and/or persistent foot odor

World Diabetes Day 2009

World Diabetes Day, on the 14th November every year, has grown from humble beginnings to become a globally-celebrated event to increase awareness about diabetes. Comprising hundreds of campaigns, activities, screenings, lecture, meetings and more, World Diabetes Day is proving internationally effective in spreading the message about diabetes.

Who introduced World Diabetes Day?
World Diabetes Day was jointly introduced by the World Health Organisation (WHO) and the International Diabetes Federation (IDF). The global diabetes awareness campaign was introduced amidst concern over an escalating diabetes epidemic.

Why is November 14th World Diabetes Day?
November 14 th is a significant date in the diabetes calendar because it marks the birthday of the man who co-discovered insulin, Frederick Banting. Banting discovered insulin in 1922, alongside Charles Best. Read more in the Diabetes.co.uk history of diabetes. World Diabetes Day is internationally recognised and is now an official United Nations Day.

Where is World Diabetes Day celebrated?
World Diabetes Day is celebrated throughout the world. A truly global event, World Diabetes Day occurs in over 200 diabetic member associations, in over 160 different countries. Further associations, medical professionals, and individuals all over the world join together to celebrate World Diabetes Day.

How do people celebrate World Diabetes Day?
World Diabetes Day is celebrated in a vast number of ways around the globe. These include a range of activities and events, including meetings and lectures to spread public information, sporting events for adults and children, television and radio programmes, leaflet and poster campaigning, exhibitions and conferences and much, much more.

Is World Diabetes Day the same every year?
World Diabetes Day is different every year, because each year a theme is decided upon to help those most in need. For instances, 2004 saw World Diabetes Day themed Diabetes and Obesity.

This year, World Diabetes Day is concerned with diabetes in children and adolescents.

The Natural Solution for Lowering Blood Sugar

Some of the most promising alternative therapies for high blood sugar come from nature's pharmacy, which isn't surprising. Plants and herbs have long been part of traditional response to diabetes, and they may be the closest thing to "real" medicine in the entire alternative arsenal. In fact, some countries, such as Germany, require doctors to study herbal medicine as part of their medical training.

GYMNEMA: THE SUGAR BLASTER
In India and Africa, where Gymnema sylvestre can be found creeping in tropical forests, the woody plant has been used for centuries as a remedy for diabetes. In fact, its name in Hindi is gurmar, which means "sugar destroyer". It got its reputation in part because chewing its leaves is said to make you insensible to the taste of sweetness, but there's probably more to it than that. Lab analyses have found that gymnema boosts the activity of enzymes that help cells take up glucose, so there's less of it floating in the blood. More than a decade ago, animal studies found that it brings down blood sugar - but not in animals that had had their pancreases removed. These revelations have led researchers to theorize that gymnema may battle high blood sugar by:
• Boosting the realese of insulin by making cells in the pancreas more permeable
• Stimulating insulin-making beta cells in the pancreas
• Increasing the number of beta cells.

FENUGREEK: A POTENT SPICE
In Mediterranean and near Eastern countries, fenugreek has a long history as a spice and flavor enhancer, but that's not all it's been used for over the centuries. Early Greek and Latin catalogs of medicines list it as a therapy for high blood sugar. Animal research and a handful of small human studies suggest that ancients were on to something. In one study, for example, 60 people with type 2 diabetes who took a total of 25 grams of fenugreek powder in two equal doses at lunch and dinner for six months dropped their fasting blood sugar from an average 151 to 112.

Fenugreek seems to make the stomach empty more slowly, hinder the absorption of carbohydrates, and put the brakes on the movement of glucose through the body - all of which may be due to the fact that fenugreek is extremely high in fiber.

BITTER MELON: A STRONG VEGETABLE
Although it's a staple of Chinese and Indian cuisine, bitter melon lives up to its name - or names: It's also known as bitter gourd, bitter apple, and bitter cucumber. Cultivated in tropical areas of Asia, Africa, and South America, it's been used as a contraceptive, a therapy for psoriasis, and a variety of other purposes. Mainly, though, it's been hailed for lowering blood sugar, and the fruit and seed are loaded with chemicals that appear to have an impact on glucose or insulin (one of the chemicals is similar to cow insulin).

Lab and animal studies suggest that bitter melon may work on several levels, such as boosting insulin secretion, improving the ability of cells to absorb glucose, and hindering the release of glucose from the liver. One of the largest studies of bitter melon in people with type 2 diabetes lasted only two days, but it caused significant drops in blood sugar.

15 Point Healthy Lifestyle Checklist

To make things easier for you, I’ve put together a checklist so you can make lifestyle changes, which will help control or prevent diabetes and heart problems.
Remember, don’t try to change everything at once. Instead, choose a few things you think you can manage right now, then come back to the list at a later date and make some additional changes:
**Check off each bullet point as you make each change successfully**

• I will eat at least 5 servings of fruits and vegetables each day.
• I will eat less fat, especially saturated fat, trans fat, hydrogenated oils, lard, and shortening.
• I will regularly choose lean meats and healthy meat substitutes, such as dried beans and peas (kidney beans, soy bean, chickpeas), lentils, and tofu.
• I will get healthy fats from olive or canola oil, nuts, avocados, and oily fish (1-2 times each week) for example fresh tuna, salmon, or mackerel.
• I will use baking, roasting, or grilling, rather than frying foods most of the time.
• I will focus on getting lots of fiber into my diet, from healthy foods such as oatmeal, oat bran, fruits, vegetables, dried beans and peas.
• I will make sure I am not eating too much salt—maximum of 6g per day.
• I will choose water and other low-calorie drinks, rather than sodas, juices, and other sugar-laden drinks. I will also try to control my alcohol consumption (no more than 1 to 2 drinks per day).
• I will watch my calorie and fat intake by cutting back on sugary, fatty junk food, such as potato chips, cookies, cakes, and full-fat ice cream.
• I will control my portion sizes—healthy plate proportions are ¼ meat or alternative, ¼ carbohydrate, ½ vegetables or salad.
• I will try to be more physically active—aiming for at least 30 minutes, 5 times each week.
• I will take my medications at directed by my doctor.
• I will quit smoking.
• I will try to maintain a healthy weight.
• I will continue to monitor my ABCs—A1C (try to maintain below 7), blood pressure (below 130/80 mmHg), and cholesterol (HDL men: above 40 mg/dl, HDL women: above 50 mg/dl; triglycerides: below 150 mg/dl; and LDL: below 100 mg/dl).

Natural Choices for Painful Neuropathy Alternatives for this Painful Nerve Condition

Peripheral neuropathy may be one of the most common conditions you've never heard of -- and it is indeed common. Estimates are that it affects as many as two-thirds of people with diabetes, 10% to 20% of people with cancer and 8% of all people over age 55. One reason may be that neuropathy is not an isolated medical condition. Rather, it results from other medical problems including vitamin deficiencies, autoimmune disorders and heavy metal exposure, in addition to diabetes and cancer. Symptoms generally come on gradually over a period of weeks or even months, starting in the toes and sometimes the fingers. They include burning and tingling sensations, numbness, and occasional sharp, sudden pains similar to electrical shocks. Intensity of symptoms varies widely, from mild annoyance... to numbness severe enough to impair function... to debilitating pain.

MEDICAL TREATMENTS

Mainstream medical doctors often treat peripheral neuropathy with pharmaceutical drugs, but they all have serious side effects, including dizziness, sleepiness, dry mouth, blurred vision, weight gain, nausea, headache and in serious cases, allergic reaction and confusion, among others. Given the problems with pharmaceuticals, I called Mark Stengler, ND, a regular contributor to Daily Health News, to find out about natural approaches to the problem. The first step is to find the root cause and correct it as much as possible. For example, people with diabetes must control blood sugar levels to help slow further peripheral neuropathy development. People who suspect vitamin deficiencies should see a holistic physician for blood level tests and to help them establish a healthy diet and vitamin protocol. They must also avoid or greatly reduce alcohol consumption. Those having chemotherapy should alert the supervising doctor immediately if numbness or tingling starts in their feet or hands. The doctor may be able to alter the drugs somewhat to keep the neuropathy from escalating. However, when chemo-related peripheral neuropathy begins weeks or even months after completion of chemotherapy -- as is often the case -- the next step is to seek treatment to alleviate the discomfort and possibly help reduce or even heal it. This advice holds true for other causes of peripheral neuropathy as well, although you should check with your doctor to be sure it is appropriate for you.

NATURAL APPROACHES

The natural substance with the longest record for helping both diabetic peripheral neuropathy and chemotherapy-induced peripheral neuropathy is alpha lipoic acid, a powerful antioxidant that scavenges many harmful free radicals. (Note: Alpha lipoic acid can reduce blood sugar levels so your doctor should monitor your medication and blood sugar for the duration.) It’s not a quick solution however -- Dr. Stengler says to wait eight to 12 weeks before assessing results. The other natural substance he recommends is acetyl-L-carnitine, which he says has a regenerative effect on the nerves. Again, stay on acetyl-L-carnitine therapy for eight to 12 weeks to assess its efficacy.

Does alcohol and tobacco use increase the risk of diabetes?

Answer

Yes, alcohol and tobacco use increases the risk of type 2 diabetes. While studies show that drinking moderate amounts of alcohol (one drink a day for women and two drinks a day for men) may actually lower the risk of diabetes, the opposite is true for people who drink greater amounts of alcohol. Heavy alcohol use can cause chronic inflammation of the pancreas (pancreatitis), which can impair its ability to secrete insulin and ultimately lead to diabetes. Tobacco is equally harmful. Tobacco use can increase blood sugar levels and lead to insulin resistance. And the more you smoke, the greater your risk of diabetes. Heavy smokers — those who smoke more than 20 cigarettes a day — almost double their risk of developing diabetes, when compared with nonsmokers.

Diabetes and high blood sugar:

Complications from diabetes come on over time, and damage has often started before we realize something is wrong.

Cardiovascular System
The heart actually has the largest blood vessels in the body so why is it damaged? First of all, it is the job of the heart to pump the thick, sticky blood through all the narrowed vessels in the body. The heart also has many small vessels that feed and nourish it. When blood sugars are high, they do not get the circulation they need. So not only are we asking the heart to work twice as hard, we are depriving it of nutrition to give it strength. Cardiovascular Disease is the most common cause of death in people with diabetes. But there are support and therapy strategies that have been proven effective.

Nerve Damage and Disease
Amputations and ulcers, especially in the feet, are more frequent in patients with poorly controlled diabetes. Decreased circulation to feet and legs leads to damage and loss of nerve function. The nerves lose their ability to sense pain, pressure, touch, or temperature correctly, which results in tingling and numbess of the feet and toes (fingers, too). This condition is called peripheral neuropathy.
Autonomic neuropathy occurs when there is nerve damage affecting the automatic processes in your body such as heart rate or sweating, so they do not work as they should. The stomach may not process food correctly. The heart rate or blood pressure does not speed up or slow down in response to exercise, exertion, rest, standing, or sitting. Autonomic neuropathy also contributes to the absence of chest pain with heart attack, and can cause sweating at inappropriate times or in specific areas, leaky bladder, pupils that do not constrict or dilate as needed, sexual dysfunction, and decreased ability to sense an infection or hypoglycemia.

Vision Problems
Retinopathy, macular edema, glaucoma, and cataracts are the more common eye disorders related to diabetes.
Eye disease is typically progressive, and there are usually no symptoms until damage has occurred. You may have 20/20 vision yet one day have complete vision loss due to a hemorrhage. This is the reason a yearly eye exam is so important. An eye doctor will be able to see the changes occurring before vision is at risk. Laser surgery can destroy the abnormal vessels in the eye and prevent their regrowth.

So What's The Good News?
Believe it or not, there is some good news. The whole process of long-term complications started with sticky red blood cells. The good news is that red blood cells only live two to three months. That means that in three months of keeping your blood sugar levels nearer to normal, you have a whole new set of unsticky red blood cells. This turnover eliminates the cops, slow cars, and semi-trucks from the freeway, and prevents further damage to the road. When blood sugar levels come down, the stickiness decreases on the walls of the arteries and veins, and triglycerides and cholesterol levels are reduced. So where lanes of traffic were closed, we now have open roads. Where damage has been done, we may not be able to repair it, but with improved control, we can prevent further complications and slow or stop the progress of any existing ones. Keeping blood sugars close to normal is the best way to prevent complications. Unlike genetics, age, or sex, it is the one component we have some control over.

Rheumatoid Arthritis Linked to Type 2 Diabetes, Heart Disease

A new study says that people with rheumatoid arthritis may be as much at risk of cardiovascular disease as that of type 2 diabetes.

Rheumatoid arthritis (RA) is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Apart from joints, RA can also cause inflammation in other organs as well.

While people with RA have long been known to be susceptible to cardiovascular disease, this is the first study to compare this risk with the risk of developing type 2 diabetes.

In the study, researchers measured the frequency of fatal and nonfatal cardiovascular disease in 335 RA patients followed for three years, as compared to 1,852 people in the general population.

The researchers observed that cardiovascular disease occurred in nine percent of patients with RA and among 4.3 percent of the general population- i.e. the incidence of 3.30 people per 100 people per year for those with RA, and 1.51 people per 100 people per year for those in the general population.

Patients with type 2 diabetes and non-diabetic patients with RA have similar risk ratios for developing cardiovascular disease (2.02 and 2.22, respectively), as compared the general population,
The researchers concluded that the risk of cardiovascular disease is not only high in people with RA as compared to the general population, but it equals that of people with type 2 diabetes

Diabetes and Hair loss

Diabetes is a disease which is directly linked with hair loss resulting from hormone imbalance. It is one of the early symptoms of diabetes. The disease requires proper treatment to avoid further complications and side effects.

For the loss of hair, stress is another factor that causes it. When the body cannot metabolize carbohydrates properly, it causes diabetes and leads to several skin ailments. Bruises and wounds take longer time to heal in the body. As a result, the recovery rate becomes slow and obstructs the further growth of hair. This causes visible hair reduction. Diabetics are unable to maintain a normal re growth cycle as they become prone to early infection. Bacterial and fungal infections on the scalp can also cause hair loss. The disease increases anxiety which ultimately promotes hair loss. That is why there is a direct relation between diabetes and hair loss.

Studies show that a healthy person loses around fifty to hundred strands per day. If hair loss increases more than the usual, then you must seek doctor’s help. He can check the problem thoroughly and make his conclusion accordingly. If the diabetes is not treated in time, it can further promote hair loss. Diabetic patients must take proper care of their health to avoid any complications. It is essential to exercise regularly to increase blood circulation in the body. A diabetic person also suffers from autoimmune problem. In such a situation, small bald patches are formed on the scalp. This ailment is known as alopecia area. Medical stress and side effects of different medicines may be another factor for hair loss. It normally depends on the individual’s health to respond to various medications and sometimes they have an adverse effect on his health and hair.

The diabetes may also affect a person’s health by dysfunctional thyroid gland, skin rash vitiligo and pernicious anemia. Type second diabetes is usually caused by hormonal imbalance which leads to polycystic ovary syndrome. This condition is related to insulin resistance which reduces the ability of cells to react on insulin. It is essential to detect diabetes at an early stage so that recovery from hair loss can be possible early. Some of the common symptoms of diabetes are blurred vision, frequent urination, acute hunger, increased thirst, unusual weight loss, fatigue and unnecessary irritation.

To check the diabetes, monitoring the blood sugar level from time to time is essential, failing which the complications lead to damage of blood vessels and nerves, loss of functioning of the kidneys, loss of sensation, heart disease and strokes.

It is better to seek doctor’s advice in severe condition who can guide about the required precautions. The doctor prescribes different lotions and oils to provide relief to the patient. Balanced diet is also very important and the patient must include lots of green vegetables and fruits to make his diet balanced in every form. It is advisable to drink sugar free juices to detoxify the body. Drinking lots of water can also help to keep the system clean.

Lantus and Cancer Risk

Some news has come out in the last couple of days about a possible link between Lantus and an increased risk of some types of cancer.
Now, they are telling people not to panic and not to stop taking their Lantus!!!!
Like the last scare with Rosiglitazone, where there was initially some big concerns about increased cardiovascular risks as a result of trials that were not necessarily looking for CV risks, and which from later studies it was found that there was no significant difference in CV risk between Avandia and other common diabetic drugs - I myself stopped taking Avandia because of that scare and really did myself a disservice because the drug was actually really good at keeping my BG under control.
When I first heard the news about Lantus - which I take twice a day - my immediate reaction was, "better make an appointment with the endo and get off this evil stuff!"
But then I remembered my experience with Avandia. Lantus actually works very well for me and less hypos - a much smoother ride than protophane. So this time I've decided I'm not going to panic, and sit back and wait for the outcome of further trials.
I guess there are always risks/benefits that have to be weighed up with any drugs.

Diabetes Screening

High risk individuals:

• Age >45 yrs with minimal physical activity
• obesity
• First degree relatives with diabetes
• Previous h/o diabetes during pregnancy or women who have delivered babies more than 4.5kgs weight
• Hypertensive
• Altered lipid profile ( HDL <35>250 )
• PCOS
• IGT/IGF on previous testing

How to screen for DM

OGTT to be done every year.
Normal –    FBS<100mg/dl  2hrs <140mg/dl
IFG / IGT –       100-125             140-199
DM -                >126                  >200

If a person is confirmed to be a diabetic he/she should undergo annual checkup which should include screening for diabetes related complications like in eyes, kidney, nerves and heart. Patients should check their blood sugars (FBS /PPBS) regularly(Once in a week) and HbA1c once in 3 months.

Smoking Cessation

Tobacco use increases the risk of micro- and macro vascular complication of diabetes and is one of the most preventable causes of death worldwide. Each year, 430,000 deaths are attributable to tobacco use in U.S. alone, more than alcohol abuse, automobile accidents, AIDS, homicide, suicide, heroin and cocaine combined. compared to age – matched non smokers , persons who smoke 1 pack of cigarettes per day are 14 times more likely to die from cancer of the esophagus : twice as likely to suffer an MI or stroke : and twice as likely to die from heart diseases or cancer of the bladder. At any age, the risk of death is doubled in smokers compared with nonsmoking age-matched controls, and the risk associated with smoking is dose dependent. Despite these statistics, many physicians do not routinely ask patients about cigarette smoking or offer counseling about smoking cessation. The increased cardiovascular risk attributable to smoking returns to baseline soon after cessation of tobacco use, emphasizing the importance of intervention. By 12-18 months, most of the increased cardiovascular risk has disappeared, and by 3-5 years, the risk of vascular events is no different than that of a non smoker. As a physician, there is virtually nothing more effective at improving a patient’s long term prognosis than convincing and helping him or her to stop smoking .if a physician discusses this topic even briefly with the smoker and makes a strong statement about the medical necessity of discontinuing this habit, a person’s chances of permanent cessation of smoking is doubled.

Strategies to assist patients willing to quit smoking

Step 1: Strategies for implementation
Help the patient with a quit plan
1. Have patient set quit date, ideally within 2 weeks.
2. Have patient tell family, friends, and coworkers about quitting and request their understanding and support.
3. help patient anticipate withdrawal symptoms and discuss ways to resist urges and cravings (clean the house ;take 5 minutes walk ; do stretching exercise ; put a toothpick , cinnamon gum , or lemon drop in mouth ;take several slow deep breaths; brush teeth ; call a non smoking friend and talk).
4. Have patient remove tobacco products from their environment: throw out ashtrays; clean clothes, car, and carpets.
5. Encourage patients to learn as much about how to quit smoking as possible. Useful sources for reading materials include:

American heart association, 7272 Greenville Avenue, Dallas, TX 75231, (800) 242-8721; www.americanheart.org.
American cancer society ,1599 Clifton road, NE, Atlanta, A 30329,(800) 227-2345;www.cancer.org
National cancer institute ,Bethesda,MD 20894,(202) 4- cancer (422-6237);www.nci.nih.gov
For pregnant women : American college of obstetricians and gynecologists,409 12th street ,SW,Washington , DC 20024,(202) 638-5577; www.acog .org

Step 2:
Provided practical counseling
1. Total abstinence is essential.” not even a single puff after you quit.”
2. Identify what helped and hinders previous quit attempts.
3. Discuss challenges / triggers and how to overcome them.
4. Since alcohol can cause relapse, the patient should consider limiting /obtaining from alcohol while quitting.
5. Patients should encourage housemates to quit with them or not to smoke in there presence.
6. Provide a supportive clinical environment while encouraging the patient to quit:” My staff and I are available for you.

Step 3: Strategies for implementation
Recommend approved drug therapy
1. Recommend the use of first-line drug therapy (varenicline, bupropion,NRT) to all smokers trying to quit, except in special circumstances (e.g., medical contraindications, pregnant/breastfeeding women, adolescent smokers). If drug therapy is used with lighter smokers (10-15 cigarettes/day), consider reducing the dose of NRT; no dosage adjustment is necessary for sustained-release bupropion.
2. Some studies suggest that bupropion may be more effective than NRT for achieving permanent cessation of tobacco use, and that some synergism between the two approaches may exist. There are insufficient data to rank-order these medications, So initial therapy must be guided by factors such as clinician familiarity with the medications, contraindications foe selected patients, patients preference ,previous patient experience with a specific therapy (positive or negative), and patient characteristics (e.g., history of depression, concerns about weight gain). Sustained-release bupropion hydrochloride and NRT, in particular nicotine gum, have been shown to delay but not prevent weight gain. Sustained –release bupropion hydrochloride and nortriptyline hydrochloride are particularly well-suited for patients with a history of depression.
3. There is evidence that combining the nicotine patch with either nicotine gum or nicotine nasal spray increase long-term abstinence rates compared to a single form of NRT, based on a meta-analysis.
4. The nicotine patch in particular is safe in patients with cardiovascular disease. However, the safety of these products has not been established for the immediate post-MI period or in patients with severe or unstable angina.
5. Long-term therapy may be helpful for smokers who report persistent withdrawal symptoms. A minority of individuals who successfully quit smoking use NRT medications (gum, nasal spray, and inhaler) long term. The long-term use of these medications does not present a known health risk, and the FDA has approved the use of sustained-release bupropion hydrochloride for long-term maintenance.
6. Clonidine and nortriptyline may be considered when first-line medications are contraindicated or not helpful.

Diabetes and Erectile Dysfunction

Erectile dysfunction (ED) is when a man has trouble getting or keeping an erection. ED becomes more common as you get older. But male sexual dysfunction is not a natural part of aging.

Some people have trouble speaking with their doctors about sex. But if you have ED, you should tell your doctor. ED can be a sign of health problems. It may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. If you don't see your doctor, these problems will go untreated.

Your doctor can offer several new treatments for ED. For many men, the answer is as simple as taking a pill. Getting more exercise, losing weight or stopping smoking may also help.

Under skin sensor to improve diabetes control

Staffs at Southampton General Hospital are using sensors placed under the skin of diabetic patients to measure the impact of exercise on glucose levels.

The devices are fitted to patients’ stomachs, who also wear watch-like armbands that check how active they are being.

The 12-month study will be the first in the UK to examine how activity impacts on blood glucose levels whilst also taking diet and insulin intake into account.

Thirty people aged 18 to 75 will take part in the trial; the aim of which is to provide further details on how to manage type one diabetes.

The sensors contain a tiny electrode, inserted under the skin that takes around 300 readings a day. This connects to a transmitter, which is attached to the skin with an adhesive patch.

Each participant can wear the devices for two weeks at a time with the sensors replaced every three days. Both electrode and transmitter are waterproof, light and durable. The armbands are worn for two periods of two weeks.

Study lead Professor Christopher Byrne, head of endocrinology and metabolism said: "At the moment, it is uncertain how day-to-day variation in physical activity influences blood glucose in people with Type 1 diabetes."

"But thanks to monitoring devices, such as the two we are trialling, we will gauge a better understanding of the link between physical activity and glucose control in diabetes."

It’s also hoped the study will help diabetics to understand the influence of exercise on glucose control and how it can help to reduce diabetic complications, he added.

Diabetes UK is funding the study.

Diabetes and Stem cell

Study: Stem Cells May Reverse Type 1 Diabetes – TIME

A stem cell treatment allows the regrowth of insulin-producing Beta cells in type 1 diabetes patients

Study: Stem Cells May Reverse Type 1 Diabetes

By Alice Park Monday, Apr. 13, 2009, Biophoto Associates / Photo Researchers

Researchers have used injections of patients’ own stem cells to reverse the course of type 1 diabetes, reports a research team from the University of São Paulo in Brazil and Northwestern University in Chicago.

The findings, published in the current issue of the Journal of the American Medical Association, exemplify the remarkable gains made by diabetes researchers, who are battling a continuously spreading disease that now affects nearly 8% of adults and children. (See the top 10 medical breakthroughs of 2008.)

The research team, led by Dr. Julio Voltarelli of the University of Sao Paulo, is the first to successfully treat type 1 diabetes patients with their own stem cells. The group first reported its initial achievement in 2007, with 15 type 1 diabetes patients who received their own stem cells and no longer needed insulin to control their blood sugar levels.

In the new study, a follow-up of their previous work, Voltarelli and his colleagues detailed the same success with an additional eight patients, and also confirmed that in the majority of them, the stem cell transplant led to an appreciable repopulation of functioning insulin-producing beta cells in the pancreas.

via Study: Stem Cells May Reverse Type 1 Diabetes – TIME.

Online ED Programme

Being Engaged: Good for Diabetics

Staying physically engaged is good for everyone in today’s world, especially for people with diabetes. Activity makes insulin in the body work harder and faster, which means you may need less insulin or diabetes pills to control your Diabetes. Moderate activity lowers the risk of heart disease, high blood pressure and may reduce the risk for Colon Cancer (Cancer in Colon, Rectum or Appendix). It can also control and improve your blood fat levels, reduce your body fat and help you lose weight.

Staying active also keeps your joints, muscles and bones healthy and strong. It helps in increasing your energy; reduce depression, anxiety, and stress; and affects your mood as well. In short, being active helps you have a longer, happier and a healthier life.

So all you require is to get up on your feet and move around which makes you use energy two to three times more than when you are seated.

Activities you can start up with

· Get up to change TV channels instead of using a remote control
· Iron your clothes while watching TV
· Walk around your house during TV commercials
· Wash dishes, load the dishwasher, or load the clothes in Washing Machine or dryer during commercials
· Mop the kitchen floor
· Vacuum the living room
· Sweep your sidewalk
· Wash and polish your car
· Use a rake instead of a leaf blower
· Use a push lawn mower instead of an electric one
· Plant and maintain a garden
· Walk your pet
· Push your baby in a stroller
· Play actively with children
· Volunteer to work for a school or hospital or do some social work which includes any physical activity
· Walk to the subway or bus stop
· Take the stairs instead of the elevator or escalator
· Stand or walk around while you’re on the phone
· Walk during your break, while the oven is preheating, or while waiting for your turn at some place
· Run errands that require walking, such as grocery shopping
· Park your car farther away from your destination
· Take a walk with someone you want to talk with

Consult your doctor before increasing your level of physical activity. If you have not been active lately, start with just 5 to 10 minutes of an activity and work up to longer or harder activity sessions.

INSULIN PUMPS

Insulin Pumps- An electronic device for controlling Diabetes mellitus

An insulin pump is a battery powered, computerized device which delivers insulin subcutaneously as programmed, to people who have it installed on their body (generally Diabetics).


Various parts of the Insulin Pump

• The pump is about the size of a pager.
• Inside it, is a vial of insulin with a gear driven plunger.
• There is a 21to 43 inches long, thin tube attached to the pump.
• The other end of the tube has a needle or the catheter.

Utilities of the Insulin Pump

• The Insulin Pump controls and gets your blood glucose (blood sugar) level closer to normal, working better than insulin injections.
• The wide variations in blood sugar levels can be avoided as this device smoothes out blood glucose swings.
• Human body needs less insulin at night and more at dawn, and only Insulin Pumps can take care of night time lows and morning highs. One can adjust the insulin rate according to the body needs with these pumps.

Usage of Insulin Pumps

• The needle on the catheter is inserted under the skin, usually in the abdomen or thigh.
• Insulin is delivered via the tube, catheter/ needles into the body.

Programming the Insulin Pump

• The pump can be programmed as per how much insulin is required by a person and at what times.
• It also can be programmed to give tiny amounts of insulin continuously throughout the day and night (Basal), just the way a normal pancreas does and deliver extra insulin just before the meal (Bolus).

For how long does one wear the Insulin Pump?

• The insulin pump is to be worn pretty much all the time. It can be kept inside or outside the clothes.
• It should be removed before showers and swimming to avoid damage to the machine.
• Having the pump off, for more than one hour, may result in need for an injection of insulin.
• One can carry on with all his/ her regular works with pump.
• As a precaution it is mandatory to check the patient’s Blood Sugar level every day.

Precautions

Ketoacidosis

Although the pump works regularly, there is a rare chance of, the pump getting blocked and hinder the passage and delivery of insulin into the body. This may cause Ketoacidosis- a dangerous build up of ketones in blood. That is the reason why patients on pump are advised to check blood sugar daily.


Infection

• Sometimes the skin, where the needle or the catheter enters the body may become infected. To lessen the chances of infection, the area where the needle is to be inserted should be cleaned thoroughly.
• Also the site where the needle enters the body should be changed every 48 hours.

Skin allergy

Some people may develop allergic reaction around the catheter. In such cases, non- allergenic tape or Teflon catheters can be tried.

TRAVEL GUIDELINES FOR DIABETES

Ø Pack sufficient medical supplies for entire trip. Carry them with you.
Ø Bring two glucose monitors with strips, lancets and extra batteries. Pack them into two separate bag.
Ø Carry simple carbohydrate sources such as glucose tablets, gel, candy or juice packs to treat hypoglycemia.
Ø Wear medical identification bracelet, necklace. Also have a letter from your health care provider verifying your need for the medical supplies to treat diabetes adequately.
Ø Pack portable food sources such as snack mix, peanut butter crackers, granola bars, or fruit for nourishment when meals are missed or delayed.
Ø Keep a travelers emergency kit with medication for nausea, vomiting, diarrhea, and fever, include bandages, antibiotic ointment, sterile gauze and adhesive tape.
Ø Pack all prescriptions medications in their original labeled vials.
Ø In advance, know what medical coverage is available to you as you travel. Have appropriate phone numbers and insurance cards with you.
Ø If using pump : carry not only sufficient pump supplies for the entire trip but also backup intermediate/ long acting insulin and syringes in case of pump malfunction.

FOOT CARE GUIDELINES:

• Wash and dry feet well every day
• Wear well fitting shoes and clean, dry, cotton shocks.
• Never walk barefoot.
• Follow the contour of toe when trimming toe nails. To prevent ingrown nails, do not cut into the corners.
• Apply moisturizing lotion daily.
• Avoid using lotions that are perfumed or that contain alcohol.
• See a podiatrist regularly for removal of corns, warts and calluses.
• A yearly foot evaluation is recommended.
• Buy shoes mid day, when feet are their largest. Break in new shoes gradually.
• Leather shoes will stretch and mold to the foot and provide less pressure areas.
• Notify your health care provider within 24 hours if your foot becomes infected or injured.
• Keep the area clean, dry and covered.
• Apply antibiotic ointment and gauze wrap as needed. Try to stay off the foot as much as possible until it is evaluated.

Skin Care Tips for Diabetics

Always maintain your diabetes under control – high blood glucose levels can lead to bacterial and fungal infection, moreover it tends to result in dry skin for diabetics.
Keep your skin clean

Ø Take bath in warm water, hot water can dry out the skin.
Ø Use moisturizers to avoid drying of skin.
Ø Drink plenty of water
Ø Keep your home humid during cold and dry months.
Ø Protect your skin from sun – Use water proof sunscreen with an SPF of at least 15.
Ø Areas where skin touches skin need to be kept dry. Using powder on these areas can help keep them dry.
Ø Treat minor skin problems – check with your diabetics care provider


Note: If you are prone to skin problems, ask your diabetes care provider about adding a skin doctor (dermatologist).

Skin Care Tips for Diabetics

Always maintain your diabetes under control – high blood glucose levels can lead to bacterial and fungal infection, moreover it tends to result in dry skin for diabetics.
Keep your skin clean

Ø Take bath in warm water, hot water can dry out the skin.
Ø Use moisturizers to avoid drying of skin.
Ø Drink plenty of water
Ø Keep your home humid during cold and dry months.
Ø Protect your skin from sun – Use water proof sunscreen with an SPF of at least 15.
Ø Areas where skin touches skin need to be kept dry. Using powder on these areas can help keep them dry.
Ø Treat minor skin problems – check with your diabetics care provider
Note: If you are prone to skin problems please consult a diabetologist as well as a dermatologist .

Diabetics care - on a sick day

A diabetic should increase hydration at least by 8 oz/hour and if you are unable to eat drink caloric beverages such as ginger ale, apple juice or broth. Reducing or skipping the regular diet will lower the glucose level so it is better to maintain the usual diet, also adjust the type of food required to maintain the necessary nutrition.

Check your blood glucose every four hours and record it, incase if the glucose reading is more than 250 mg/dl then the urine ketoses should be checked. Consult with the physician if fever, vomiting or diarrhea persists for more than 24 hours or if the symptoms are similar.

During sick days take complete rest and never try to lower your glucose levels by exercising. Maintain the intake of usual insulin dose, usage of insulin supplements may be needed to reduce high glucose levels caused by illness.

Situations in which diabetics should avoid vigorous physical activities

Physical activities cannot be the same for every one all the time, in some special cases especially In type 1 diabetes, exercise can worsens hyperglycemia (>300mg/dl) and ketosis. Vigorous activities are best avoided.
Things to be noted in:
Hypoglycemia
Patients on insulin are at risk, added carbohydrate consumption is required if pre-exercise glucose levels are less than 100mg/dl and for patients on other medicines, preventive measures are not required
Retinopathy
Vigorous aerobic or resistance exercises- contraindicated and there is a risk of developing vitreous hemorrhage or retinal detachment.
Peripheral neuropathy
Excess physical activities may lead to loss of protective sensation; also there is a high risk of skin break down, infection and Charcot joint destruction. It is best advised to go for non- weight bearing exercises like Swimming, bicycling, arm exercises etc.
Autonomic neuropathy
Physical activities here can increase the exercise induced injury and also it can decrease cardiac responsiveness, postural hypotension, impaired thermoregulation, impaired night vision due to impaired pupillary reaction and unpredicted carbohydrate delivery from gastroparesis.
The best solution is to individualize the physical activity according to the cardiac status.
Some Special precaution to be kept in mind
**Feet should be inspected for any cuts blisters and infection
**Avoid exercises in extreme hot and cold climates
**Avoid exercises during periods of poor metabolic control
Benefits of exercise
**Improvement in insulin sensitivity
**Reduction of height
**Reduction in weight
**Improvement in lipid profile
**Improvement in cardiovascular function
**Sense of well being

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

Significance of exercise for healthy life

It is a well known fact that regular physical activity improves health and wellbeing. So what does physical activity mean? Bodily movement produced by the contraction of skeletal muscle that requires energy expenditure in excess of resting energy expenditure. Whereas exercise is a subset of physical activity: planned, structured, and repetitive bodily movement performed to improve or maintain one or more component of physical fitness.
Exercises are of two types:
Aerobic
Anaerobic
Aerobic exercise consists of rhythmic, repeated and continuous movements of the same large muscle groups like walking, cycling, jogging, swimming etc…
Resistance exercise are activities that use muscular strength to move a weight or work against a resistive load like weight lifting, exercises using weight machines.
The American Diabetes Associations has recommended a minimum of 150 min moderate intense aerobic physical activity every week. And in the absence of contraindication, resistance exercises three times a week.
Frequency and type of exercise
At least 30 min of moderate intensity exercise daily.
90 min/week of vigorous exercise.
Should be distributed over at least 3 days/week, with no more than 2 consecutive days
without physical activity.

ENERGY EXPENDITURE ON VARIOUS PHYSICAL ACTIVITIES
ACTIVITY :KCAL/HR
Cleaning/mopping : 210
Gardening: 300
Watching TV: 86
Cycling(15km/hr) : 360
Running : 12km/hr : 750
10km/hr : 655
8km/hr : 522
6km/hr : 353
Walking(4km/hr) :160
Shuttle :348
Table tennis :245
Tennis : 392
Volley ball :180
Dancing :372
Fishing :222
Shopping :204
Typing :108
Sleeping :57
Standing :132
Sitting :86
Some of the general principles to be followed while exercising:
Daily exercise preferred
Start slow- have a warming up and cooling down period
Chest pain during exercise- stop exercise
Well fitting sports shoes
Carry sweets/sugar
Individualize exercise prescription
Reduce dose of insulin
Several well-planned studies have confirmed the benefits of yoga practices among diabetics.
And some of the best practiced Yogasanas are:
Ardha baddhapadma paschimoottasana
Eka pada galavasana
Shalabasana
Padahasthasana
Suptaveerasana
Adomukha matsyasana
Urdhwa prasarita padasana
Chatushpadasana
Mahamudhra
Urdhwa dhanurasana
Bhujangasana

Will buccal insulin succeed in the market…..?

Oral Recosulin is a rapid mist technology which allows precise insulin dose delivered via simple, cosmetically acceptable metered dose inhaler in form of fine aerosolized droplets directly into the mouth. This technology utilizes the formation of micro fine thin membranes to encapsulate and protect the insulin molecule. The system introduces fine particulate aerosol at high velocity (100 miles per hour) into the patient’s breath. The mouth deposition is dramatically increased compared with conventional technology. This oral aerosol formulation is rapidly absorbed through the bucal mucosal lining and in the oropharynx region. It provides the plasma insulin levels necessary to control postprandial glucose rise in diabetic patients.

This novel, pain free, oral insulin formulation has a critical series of attributes:
1. Rapid absorption
2. Simple (user-friendly) administration technique
3. Precise dosing control
4. Bolus delivery of drug

Dosage and administration:
One puff of oral-recosulin delivers 10 units of regular insulin. Approximately 1 unit of regular insulin is absorbed into systemic circulation of patient after taking 1 puff of oral-recosulin.
The patient should be relaxed and breathing normally. The mouth piece of the device placed in mouth at the end of normal exhalation. The patient sprays oral-recosulin into the mouth. Patient is asked to hold breath for 5 second (by counting slowly to 5)
This procedure is repeated until correct numbers of puffs are administered.
It is recommended that oral-recosulin be given in divided doses with 50% of the dose before the meal and remaining after the meal.

The indications of oral-recosulin are:
1. Oral-recosulin is indicated depending on the type of diabetes.
2. It is recommended as bolus insulin for use with basal insulin for better compliance and control of postprandial glucose rise.
3. It can be used in combination with sulfonylureas, metformin and pioglitazone and other anti-diabetic agents for glycemic control in patients who do not achieve satisfactory glycemic control with oral therapy alone.
4. It can be used for insulin initiation in patients needing insulin for diabetes control.
5. It can be used for control of postprandial hyperglycemia in igt patients not adequately managed with standard treatment protocol.
6. It can be used for achieving glycemic control in ifg patients not adequately managed with standard treatment protocol.

Unique features:
It has been shown to be fast, flexible, safe and simple. Most important it is well accepted by both patients as well as doctors
1. Needle free, pain free therapy: intensive diabetes therapy requires at least 3-4 injections per day. Oral-recosulin provides needle free administration of insulin for treatment of diabetes
2. Rapid insulin absorption: oral-recosulin is absorbed in blood stream faster than injected insulin
3. Short duration of action: acts similar to rapid acting insulin analogue for control of postprandial glucose rise.
4. No risk of hypoglycemia: rapid absorption avoids prolonged tail exceeding postprandial state as common with subcutaneous insulin.
5. Higher patient compliance: needle free, pain free insulin therapy should increase compliance
6. Better quality of life: the small size of device makes it convenient to carry anywhere and to use comfortably in public. Since dosing time before meal is greatly reduced this offers a more flexible lifestyle. The improved compliance, which leads to a better quality of life.

The Debate
--> Though the main advantage of Oral Buccal insulin is to avoid injection prick, a long acting/intermediate insulin has to be injected anyway. So injection cannot be completely avoided.
--> Moreover when only 1 unit of insulin is systemically absorbed with 1 puff, it will be cumbersome for a patient requiring >10 units of insulin. So its difficult for patients who need >20 units of insulin
--> The droplets may not be deposited in the lung parenchyma but there is no literature to explain their deposition elsewhere in the respiratory tract during accidental inhalation.
--> As insulin treatment has to be continued for years together, the long term effect particularly carcinogenic effect on the buccal mucosa is unknown.
--> It’s bioavailability while taking hot or cold food is not known
--> The cost of a single puff is more than rs.1000. A patient may need at least 20-25 puffs/day minimum. So the daily expenditure for insulin is very high
--> In a country like USA where insurance covers a patient’s expenditure on hospitalization & medicine, exubera (nasal insulin) was not affordable. Similarly buccal insulin which carries same disadvantages like exubera may have to struggle in the market to establish its place
--> Probably the time will give us the result.

Onset of action - 10 minutes
Peak level - 50 minutes
Duration of action - 150 minutes
Bioeffectiveness - 7-10% of s.c. injected insulin when given in same dose

Sleeping, Snoring and Diabetes

1. What is the link between Diabetes and Sleep Disorders?
• Lack of sleep or poor quality sleep is clearly linked with poor control of diabetes
• Diabetes patients often have associated sleep problems that are not diagnosed or treated appropriately
2. What are the common sleep disorders associated with diabetes?
• Poor control of diabetes leads to increased urination at night which can disrupt sleep.
• Patients with diabetes are at increased risk of having Restless leg syndrome and Periodic Limb movements which creates an uneasy feeling in their legs which can cause insomnia (lack of sleep) or fragmented sleep pattern which leads to ‘non refreshing’ sleep.
• Although diabetes is not a direct risk factor for snoring and Sleep Apnea, these disorders often co-exist because obesity is a common factor for both these problems.
3. What is snoring?
• Snoring is caused due to reduction in flow of air through the upper airway. Most often it is not associated with a structural obstruction and is caused due to collapse of upper airway muscles.
• Snoring is not a laughing matter and could be a warming signal of underlying Sleep Apnea.
4. What is Sleep Apnea?
• Sleep Apnea is a common, but under diagnosed problem which is present in 2-4% of the general population.
• The commonest presenting symptoms of Sleep Apnea are snoring and irregular breathing at night along with daytime fatigue and sleepiness.
• Most often patients are unaware of the fact that they snore or stop breathing at night, but spouses and others who witness are worried and disturbed by these symptoms.
• Daytime sleepiness and fatigue may be eventually lead to poor work performance, work related accidents and also road traffic accidents. Such patients are often branded as ‘lazy or incompetent’ when in fact their symptoms are due to a treatable medical problem.
5. How is Sleep Apnea diagnosed?
• Not all who snores may have Sleep Apnea.
• The only way to make a clear diagnosis of Sleep Apnea is to undergo a sleep study (polysomnograph) which is a test done overnight when various parameters including brain wave patterns, snoring and breathing patterns, oxygen levels, heart rate and leg movements during sleep are monitored to diagnosed and assess the severity of the problem.
6. How do we treat Sleep Apnea?
• Simple ‘Sleep hygiene’ measures like diet and exercise for weight loss, sleeping on the side, early and light dinner, avoidance of smoking, alcohol and caffeine would help.
• There are no medications to treat Sleep Apnea
• Mild Sleep Apnea is often treated with sleep hygiene measures and/or special oral appliances which are customized and created by prosthodontists.
• Moderate or severe Sleep Apnea can be treated with special devices called Continuous Positive Airway Pressure (CPAP) or surgery.
7. What is the relationship between Sleep Apnea and Diabetes?
• Obesity which is a common underlying risk factor can lead to Diabetes (TypeII), Sleep Apnea, Hypertension and heart disease.
• Patients with untreated Sleep Apnea will have poor control of diabetes and hypertension, but the good news is that treatment will improve control.
Source: Dr N Ramakrishnan
Director, Nithra Institute of Sleep Science

Looking at these scenarios MV Hospital for Diabetes and Diabetes research centre in collaboration with ‘Nithra Institute of Sleep Science’ has recently launched an exclusive diagnostic facility for Sleep Disorders among diabetics. This is the first diabetic centre in India to bring this specialty to the reach of many diabetics. The rapid changing lifestyle and eating habits has led to a spurt in obesity which has increased the occurrence of diabetes. So with MV Hospital’s increased focus on treatment of Type 2 diabetes, the launch of diagnostic lab is a welcome move for many patient belonging to this segment of diabetes.

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

Sleeping,Snoring and Diabetes

1.What is the link between Diabetes and Sleep Disorders?

* Lack of sleep or poor quality sleep is clearly linked with poor control of diabetes

* Diabetics patients often have associated sleep problems that are not diagnosed or treated appropriately.

2. What are the common sleep disorders associated with diabetes?

* Poor control of diabetes leads to increased urination at night which can disrupt sleep

* Patients with diabetes are at increased riskof having restless leg syndrome and prriodic limb movements which creates an uneasy fleeing and periodic limb movements which creates an uneasy fleeing in their legs which can cause insomia(lack of sleep) or fragmanted sleeop pattern which leads to 'non - refereshing 'sleep

* Although diabetes is not a direct risk factor for snoring and sleep apnea,these disorders often coexist because obesity is a common factor fotr bth these problems.

3. What is snoring?

* Snoring is caused due to reduction in

TAKE CARE WHILE YOU EAT THIS FESTIVE SEASON

Excessive food and drink consumption over the festive period could increase your risk of developing Type 2 diabetes. Over-indulgence in too many calorific treats such as cakes, pies, desserts; etc can lead to an increased waistline.http://www.blogger.com/img/blank.gif
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A large waist automatically increases the risk of developing type 2 diabetes http://www.blogger.com/img/blank.gifby eleven times. The risk waist measurements are 80cm or more for Asian women, 90 cms or more for Asian men. As well as having a large waist, people are more likely to develop Type 2 diabetes if they are overweight, over the age of 40, South Asian http://www.blogger.com/img/blank.giforigin, or have a family history of Type 2 diabetes. If a person has two or more of these risk factors then a regular diabetes test is essential.

Diabetes is a serious condition that can lead to heart disease, stroke, kidney failure, blindness and amputation. So it is very important to
*Eat a healthy balanced diet
*Maintain a healthy weight
*Be physically active.
So this festive season adopt count and eat policy and Keep an eye on the quantity you consume.

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website