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Many people with diabetes need to check their blood sugar on a regular basis because it allows us to identify trends and adjust medications to improve blood sugars. It really depends on the medications youÕre taking whether or not you need to check your blood sugar. For example, there are a lot of medications for type 2 diabetes where you probably never have to check your blood sugar at all. Whether your blood sugar is checked needs to be individualized Ð you need to talk to your diabetes provider to figure out if it would help you at all. On the other hand, people who are taking insulin do need to check their blood sugar because there are a lot of different doses of insulin and we just canÕt adjust those doses without having some information about what the blood sugar is doing. If youÕre only taking one injection of insulin a day (like many people with type 2 diabetes) you might be okay just checking your blood sugar once or twice a day. On the other hand, people with type 1 diabetes who are taking 3 or 4 injections a day or using a pump, it might be necessary for you to check your blood sugar 4, 5, or even more times a day. It really depends on what treatment you have, whether or not you should check your blood sugar.
There are a lot of different ways that people end up having diabetes and there are a lot of right ways to manage diabetes. When you see your doctor, there isnÕt just one treatment Ð there is usually a whole range of options. You have to work with your doctor to figure out which option is right for you because goals are different for different people and what people are willing to do to control their condition is going to be different. Diabetes is all about self-management and for patients being involved in their own care to figure out what they want and how to get it.
PeopleÕs blood sugar goals vary a lot. For some people, we like blood sugars to be as close to normal as possible. But other people Ð especially people who are older, have other medical problems, are taking a lot of other medications Ð weÕre happy with their blood sugars being a little bit higher. The whole purpose of controlling blood sugar is to prevent long term complications. What happens on a day-to-day basis doesnÕt matter as much as what happens long term. Younger, healthier people can have lower blood sugar goals. As people age, we back off a little bit on what those goals can be. If you have diabetes, you really need to talk to your doctor about what those goals should be.
Sometimes people wonder if menstrual periods or menopause can affect their blood sugar control. The answer to that is Ð well, sure, maybe. The fact is that so many things can affect blood sugar control: whether youÕre stressed, sick, didnÕt get enough sleep that night, ate a lot, exercised a lot, etc. There are so many things that can affect your blood sugar that something like menstrual periods and menopause are just on a long list of things that can contribute. EveryoneÕs body will respond a little differently and itÕs certainly important to keep an eye on trends to see if you can detect a pattern of a blood sugar change because of menopause or menstrual periods Ð itÕs going to depend a lot from patient to patient.
Both type 1 and type 2 diabetes run in families Ð there is definitely a genetic component to both of them. This is particularly strong in type 2 diabetes because people with type 2 diabetes typically have a lot of relatives who have diabetes as well. People with type 1 diabetes may not have as many relatives with diabetes. In type 2, since itÕs an asymptomatic condition, itÕs really important to be tested because if you have a relative with diabetes, your risk is much increased. People with relatives who have diabetes need to be tested for type 2 diabetes.
Often when people are diagnosed with diabetes, they get sad because they think ÒNow I can never eat chocolate cake again.Ó But thatÕs not what weÕre recommending these days for people with diabetes. A healthy diet for someone with diabetes is the same as a healthy diet for any of us. All of us should make healthy food choices as much as possible and try to avoid the less healthy food choices. We should try to eat apples instead of apple pie. But that doesnÕt mean that when you visit your grandmother and she made her famous apple pie that you canÕt have it once. You just try to choose the healthy more often and the unhealthy less often. We donÕt focus on particular foods Ð there are no foods you canÕt eat and there are no foods that you should be eating. We want people to overall have a healthy pattern of eating and healthy habits in general. Specific food changes are not as important.
There are a number of supplements out there on the market that people are interested in taking because theyÕve been implicated in diabetes treatment. Some of the common ones are: Chromium, Vanadate, Cinnamon, Nopalitos. These are all things that have been associated, even in some research, to reduce blood sugars. The trouble is that we donÕt have a lot of research that shows that these are effective or safe. They may or may not be effective Ð we just donÕt have enough research to answer that question. The most important thing is that we donÕt have enough research to tell us if theyÕre safe Ð so we generally do not recommend these supplements for treating diabetes because we donÕt want patients to be harmed and we just donÕt know if they are safe or not.
Classic type 1 diabetes is an autoimmune problems, so people with type 1 diabetes very frequently have other autoimmune problems such as thyroid problems, early ovarian failure, and sometimes certain kinds of anemia or hepatitis. So when people have type 1 diabetes, we look for those other conditions as well. In type 2 diabetes, itÕs also associated with other classic abnormalities. Sometimes with type 2 diabetes, we talk about the metabolic syndrome or the insulin-resistant syndrome. The classic features of the insulin-resistant syndrome are all of the risk factors for diabetes: hypertension, abnormal cholesterol, heart disease, and being overweight. All of those things go with type 2 diabetes Ð so if a person has one of those conditions, we look for the other ones.
Diabetes associated with a lot of other medical problems. And so the reason we treat diabetes is to prevent these other problems. So high blood sugar is associated with eye, kidney, and nerve disease. Diabetes is the leading cause of blindness in the country, the leading cause of needing to have dialysis because of kidney failure. And it’s also the leading cause of nontraumatic foot amputations. Those are associated with high blood sugar so we control the blood sugar to try to reduce those. The other complications of diabetes are heart disease and strokes. Diabetes increases the risk of those conditions two to threefold.
We know a lot about what causes complications associated with type two diabetes and type one diabetes and fortunately, we have good strategies to reduce a lot of those complications. Importantly, you need to control your blood sugar. So if you have a blood sugar that’s as close to normal as possible, that reduces a lot of the complications of diabetes, especially the eye, kidney and nerve disease. But we also know that people with diabetes are at high risk for cardiovascular disease, for heart attacks and strokes. And just taking care of your blood sugar doesn’t do that. There’s other things that you need to do, and these are the strategies to reduce heart disease. The traditional risk factors: don’t smoke, control your blood pressure, controlled your blood cholesterol. There’s also certain kinds of medications such as drugs called statins, and drugs called ace inhibitors, and angiotensin receptor blockers. Those specific medications can reduce complications associated with diabetes. Strategies like aspirin have also been associated to reduce heart disease in people with diabetes.
A pretty common myth is that diabetes occurs when someone eats too much sugar. Eating too much sugar isnÕt good for anybody because sugar is one of those things with Òempty calories.Ó Eating sugar can indirectly cause diabetes because the biggest cause of type 2 diabetes is being overweight. If someoneÕs eating too much sugar, they can be more likely to be overweight but sugar itself is not really the cause of type 2 diabetes.
A lot of people with type 2 diabetes wonder if they can ever come off of the medications. Once theyÕve started on medications, can they ever stop? The good news is that for many patients, the answer is Òyes.Ó Especially shortly after diabetes has been diagnosed (in the first ten years or so) if a person loses weight, they can often come off of their medication. ThatÕs the really good news Ð you can do something about it. Some people (especially people who have had type 2 diabetes for a long time) they will always need some kind of medication and even weight loss wonÕt change things at that point. But many people can come off of their medications just by losing weight.
Unfortunately, we donÕt have a cure for type 1 diabetes. WeÕre still looking hard but at this point, we donÕt have a cure. On the other hand, with type 2 diabetes we do have a cure for most people: diet and exercise. Most of the increase in the prevalence of diabetes that weÕve seen in the past few decades are directly associated with obesity. Most people with type 2 diabetes can make the disease go away or at least make it less severe if they maintain a healthy body weight.
Cinnamon is a spice found in many things like pumpkin spiced lattes and baked goods. But if youÕre using it to help control your blood sugar, the amount found in these foods is not usually enough to make a difference. Most of the studies on cinnamon for diabetes have been with doses around 1, 3, or 6 grams. The only way you can really get this is through supplementation. But the science is actually mixed: for some people, it does help them reduce their blood sugar and fasting glucose but for others, it doesnÕt make the same difference. And if you take too much, it can harm your kidneys. So if youÕre going to try cinnamon as an adjuvant treatment for your diabetes, make sure you get the right dose and not to take too much. And donÕt use it as a replacement for your mainstream medications.
Aside from eating a diet rich in colorful, pigmented fruits and vegetables Ð thereÕs one antioxidant in particular that benefits patients with diabetes and itÕs called Alpha-Lipoic Acid. This helps with some of the nerve side effects with diabetes and itÕs found in things like nutritional yeast, liver, kidney, broccoli, and potatoes.
Water is what most of your body consists of but most people arenÕt staying adequately hydrated. There are some great strategies that you can employ to get more water into your body and to be your healthiest self. The thing that I like to do is to take lemon slices and lime slices along with different herbs like mint to add to my water so that it tastes great and I enjoy drinking it all day long.
The best way to know if youÕre Vitamin D deficient is to get your blood tested. I recommend that you go to your doctor at least once a year to get the simple blood test to find out if you have sub-optimal levels. Symptoms of Vitamin D deficiency can include things like Osteoporosis, Seasonal Affective Disorder, mood disorders (like anxiety and depression), and many other things. So make sure to get your blood tested and check your levels.
Vitamin D is one of the most important hormones in your body because it has such far-reaching effects in different organ systems. It regulates calcium and phosphorous absorption, which is very important for bone health. It also has effects on your immune system function Ð so when your levels get low in the winter, you get sick more often. Finally Ð it has effects as a pre-hormone to your sex steroids, which include testosterone, estrogen, and progesterone. So if youÕre low on Vitamin D and you optimize it by supplementation or getting more sun exposure, you can actually improve the health of your hormones.
Supplementing with Vitamin D may not be the first thing you think of when you get a diagnosis of diabetes. But research has shown that it can actually help improve your hemoglobin A1c and your fasting blood glucose. So itÕs actually quite important to supplement with it (if youÕre low) because this can help you better manage your diabetes.
Weightlifting is one of the best ways you can get in shape, but it is very important to make sure not to hurt yourself in the process. So I recommend starting very simple with something like the Ò7 Minute Workout.Ó ItÕs a few exercises using your body weight and if you can accomplish that, you can move on to something more rigorous. The next thing IÕd recommend is that you go to a gym, talk to a trainer, and learn a few different exercises with dumbbells and barbells. A typical weightlifting regimen consists of 6-8 exercises with 12-15 reps each at a weight you can comfortably lift. Over time, youÕll find yourself getting stronger and youÕll be able to lift more weight.
Omega-3Õs are a type of fatty acid found in our foods. There are three main kinds: EPA, DHA, and ALA. EPA and DHA are found in things like fish, whereas ALA is found in things like nuts and seeds. These are very important for our health. Things like brain health, eye health, heart health, memory, and fertility are all impacted by Omega-3Õs. But part of the problem with Western diets is that we have too much Omega-6 (which is found in things like processed food and fried foods.) This throws off the balance between Omega-3Õs and Omega-6Õs and this can lead to a predisposition for disease.
When someone has diabetes, what that means is that their blood sugar is too high Ð thatÕs what defines diabetes. Really, though, diabetes is a spectrum of disease because thereÕs a lot of ways to get blood sugar thatÕs too high. On the one hand, we have classic type 2 diabetes where people are making plenty of insulin (the hormone that controls blood sugar) but they donÕt respond to it very well. TheyÕre resistant to it, so they have high blood sugar. On the other end of the spectrum, you have type 1 diabetes. In that type of diabetes, people are making no insulin at all. They are very sensitive to it and respond to it but they donÕt make it, so they have diabetes. In between these two spectrums, you have a lot of other things that contribute to the development of high blood sugar. You have certain medications that cause diabetes, certain illnesses and other medical problems that can cause it Ð so thereÕs a lot of overlap sometimes between the conditions and you canÕt always tell if itÕs type 1 or type 2.
In the United States, about 1 in 11 or 1 in 12 people have diabetes. The most common kind of diabetes is type 2 diabetes Ð which represents about 90-95% of all cases. Even though about 1 in 11 or 12 people have it, that statistic changes a lot depending on your risk factors for diabetes. For any given person or population, the prevalence might be much higher.
The classic symptoms of diabetes are the symptoms of high blood sugar. Those symptoms are: someone could be hungry all of the time, they can have to urinate all of the time, theyÕre very thirsty, sometimes they will unexpectedly and unintentionally lose a lot of weight Ð those are the classic symptoms. But itÕs really important for people to realize that you can have very high blood sugar and no symptoms at all. ItÕs one of those silent diseases. Even though you donÕt have symptoms of diabetes, that doesnÕt mean you donÕt have diabetes and it doesnÕt mean youÕre not at risk of developing complications of high blood sugar. ItÕs really important for people to get tested and realize if they have it because it may be completely asymptomatic.
Because people with diabetes often have no symptoms at all, itÕs important for people to be tested for diabetes. Anyone with a diabetes risk factor needs to be tested. ItÕs currently estimated that about 1 out of 3 people with diabetes donÕt even know they have it. You canÕt be treated well if you donÕt know you have it. If you have a risk factor (age over 45, being overweight, having hypertension, having abnormal cholesterol, having heart disease, having a large baby, having gestational diabetes, having certain conditions like polycystic ovarian disease, etc.) you should get a test. The test can be ordered by your primary care physician. It is a blood test in most cases and itÕs really easy. The most common test right now is a blood test called Hemoglobin A1c that can be tested without having to fast Ð we test it at any time. Sometimes people will use a fasting glucose but you have to fast for that. ThereÕs another test called an Oral Glucose Tolerance Test that takes a lot of time. We donÕt use that a lot anymore but sometimes (especially pregnant women) will be tested for diabetes by an Oral Glucose Tolerance Test. What that means is someone goes to the lab, drinks some sweet sugary stuff, and their blood sugar is checked about two hours later.
Screening TestsThe people who have risk factors for type 2 diabetes need to be screened. The screening test is a very simple blood test. The most common blood test used right now is called a Hemoglobin A1c Ð it reflects your blood sugar for the last two or three months. WeÕve got cutoffs that tell us if you have diabetes or if you are at risk for diabetes and it can be done at any time of the day. Your primary care doctor can order it Ð you donÕt have to be fasting for it. People can also sometimes be tested with a fasting blood sugar and sometimes people use a test called an Oral Glucose Tolerance Test. ThatÕs when you go to a lab, you drink some sugary stuff, and they test your blood sugar in about two hours. ThatÕs the test thatÕs often used for pregnant women these days. If one of those tests is abnormal, itÕs usually repeated just to confirm the condition. However, if you have classic symptoms of diabetes Ð if youÕre thirsty all of the time, youÕre drinking a lot of water, youÕre having to urinate a lot Ð classic symptoms and one abnormal test, thatÕs good enough for a diagnosis.
In classic type 1 diabetes, people have just stopped making insulin. Their pancreas (the organ that makes insulin) doesnÕt work anymore. ThatÕs usually an autoimmune problem Ð itÕs something that people are born with and we donÕt know what causes it or how to prevent it. An autoimmune destruction of the cells that make insulin cause the person to be insulin-deficient and thatÕs what causes type 1 diabetes.
In patients with type 1 diabetes, their bodies donÕt produce insulin. You need insulin to survive. Patients with type 1 diabetes need to take insulin for the rest of their lives. Unfortunately, we donÕt have an easy way to give insulin so most people with type 1 diabetes are best treated with 3 or 4 injections of insulin a day or with an insulin pump. An insulin pump is a medical device that continuously infuses insulin into the body. Those are the only approved treatments right now for type 1 diabetes.
Unfortunately, there are no strategies now to prevent type 1 diabetes. A lot of research has been done in this area but we still havenÕt found anything that will prevent type 1 diabetes.
Type 2 diabetes is caused by two main metabolic problems: one of those problems is that the body is not making enough insulin (the hormone that controls blood sugar.) The other metabolic problem is that the body is not responding to insulin very well Ð itÕs called insulin resistance. Even when insulin is present, the body just doesnÕt react very well.
The most important treatment for people with type 2 diabetes is maintaining a healthy body weight. If someone is overweight with type 2 diabetes, they really need to make healthy food choices, reduce their caloric intake, be more physically active, and lose weight. When they achieve a healthy body weight, they need to keep being active with diet and exercise in order to maintain it. With type 2 diabetes, there are around a dozen medications that are approved for treating it in addition to diet and exercise when that is not enough. Some of those medications are injectable and some of those are pills Ð it really depends on what kind of diabetes and where you are, which one is right for you.
In the last few decades, weÕve learned a lot about what causes diabetes and the complications associated with diabetes. For example, weÕre very confident that if we reduce the blood sugar and keep it as normal as possible, weÕll reduce eye, kidney, and nerve disease associated with diabetes. Unfortunately, in order to reduce heart attacks and strokes that are associated with diabetes, we have to do something other than just controlling the blood sugar. We have to aggressively target cardiovascular risk factors. Some of the research thatÕs going on right now is to find out if any particular strategy of blood sugar lowering is better than the others at reducing heart attacks and strokes. A couple of diabetes drugs have been approved for reducing heart disease Ð even in non-diabetes. ThatÕs a big deal in diabetes research right now Ð is what particular strategy do we need to do to reduce the complications? ItÕs pretty clear that itÕs not just lowering the blood sugar Ð how weÕre lowering the blood sugar might make a difference. WeÕre learning more about that every year.
The best way to prevent an amputation is of course to take good care of your diabetes, blood pressure, cholesterol, all of the things that one does to minimize the diabetic state. But in addition, one needs to be very careful when cutting oneÕs toenails that you donÕt break the skin and many diabetics actually go to a podiatrist to have their toenails clipped. In addition, you want to carefully wash your feet, you want to take very good care of them Ð often massaging them periodically with oil to keep the skin moist and supple so it doesnÕt crack and allow sores and infection to start. Basically, extra good skin and nail care are important in a diabetic and it is recommended that diabetics visit a podiatrist periodically to make sure that foot care is maximal because thatÕs such a common thing to happen that diabetics lose toes and lose their feet and even their leg.
The diabetic state can damage the nerves to the foot and that can result in two types of problems. One: the diabetic may have severe foot pain, which keeps them awake at night and may require a variety of different medications so that they can sleep. The second one actually deadens the feeling in the foot and puts anesthesia because it kills the nerves and then people can bang their foot and cut their foot and not feel it. So repeated trauma and repeated injuries to the foot can eventually result in such severe damage to the foot that itÕs no longer useful.
A complication that can occur in diabetes is damage to the kidney and, by the way, yet another is damage to the eye. LetÕs talk about each of those: Damage to the kidney occurs because the diabetic state can eventually through time destroy the little filtering mechanism in the kidney and therefore we stop making urine and all of the poisons in the blood build up in the blood. ThatÕs called renal failure or Uremia. That requires treatment with dialysis or with a new kidney Ð a transplant. In the eye, there can be damage to small blood vessels that eventually lead to blindness. In fact, the number one cause of blindness in the United States is the diabetic state.
Diabetic kidney disease cannot be reversed once it starts but what one can do is delay the onset by excellent diabetic and blood pressure control. Of course, that means good lifestyle, taking the medication, letting your doctor keep an eye on it. In fact, some diabetics take such good care of themselves that they never develop kidney disease. Others who donÕt take good care of their diabetic state develop kidney disease at a young age and require dialysis.
When we physicians first notice that the kidney is being damaged in diabetes, we try and make measures to tighten the control of the diabetes on the patient. ItÕs important for the patient to stay well hydrated so that the kidney is flushed all of the time. Then, as we noted before: we may start on medication, which can decrease the rate of progression. Once the process gets rolling and the patient develops quite severe damaged kidneys, then the treatment is dialysis to take over for the kidney and eventually transplantation for the patient to have a new kidney.
What one needs to do to decrease the risk for diabetic kidney disease is the same as with all of the other complications with diabetes: Good diabetic control, which consists of paying attention to diet, exercise, medication, and visits to the physician. Basically Ð the healthy diabetic lifestyle combined with the appropriate medication. All of these things will result in good control of the diabetes and a marked decrease in the rate with which diabetic kidney disease develops.
Berberine is one of the best studied alternative treatments for diabetes. It’s derived from plants like Golden Seal and Oregon Grape, and it’s been used in Chinese medicine for thousands of years. One recent study in 2008 showed that Berberine was as effective as Metformin for lowering hemoglobin A1c and fasting glucose, but Berberine actually outperformed Metformin in the same study for lowering cholesterol and triglycerides.
In our daily lives, just by doing things like breathing and being exposed to things like smoke or pollution produces oxidative stress in our bodies. These reactive oxygen species can be neutralized by antioxidants consumed in our diet, primarily. So where do you get these from? You get these from richly pigmented fruits and vegetables Ð things like red peppers, oranges, yellow squash, green kale, blueberries, dark chocolate, and wine.
Chocolate is rich in antioxidants but unfortunately most of the chocolate sold in stores is loaded with things like milk and sugar, which pretty much negates the benefits that you get from it. So you can consume high cacao content chocolate (something like 85% or above) but if thatÕs too bitter for your taste, you can also supplement with a product called CocoaVia, which is a very potent source of coco flavanols and it has proven scientific evidence to increase blood flow in the body.
Living in a very hectic world with so many different signals coming at us in different directions Ð it can be really hard to quiet that inner voice thatÕs constantly talking over all of the sounds around us. Meditation is one of the solutions to help really calm your inner self and widen that space between perception and reaction so that when things happen, you donÕt react to them so fast. For me, meditation has been the most important tool that I have found to manage stress. Starting with something as little as 3 minutes a day and graduating up to 20 minutes a day can make a huge difference in how you feel when you wake up every morning.
Yoga has many far-reaching positive effects on the body, starting with balance and stability, which can be a problem as people age. It also helps you with activating the parasympathetic nervous system, which is also known as the Òrest and digestÓ function in your body and helps you directly counteract the stress of daily life.
The first thing you need to know is that being sedentary is almost never safe for a person with diabetes. One of the things that I recommend to my patients is to start low, go slow, and titrate up. That means getting at least 3,000 steps in a day. If you can make that, then the next goal is to get 10,000 steps in a day. Also very important is weightlifting because that helps generate more muscle tissue, which improves your metabolism. Finally, I really like yoga because this is a great stress reducer and stress can definitely affect your blood sugar.
Exercise is one of the best prescriptions you can take for diabetes. When youÕre exercising, your muscle cells donÕt need insulin to take in blood glucose. Furthermore, exercise makes your cells more sensitive to insulin.
If you have diabetes and you start exercising, you might find the added benefit of having a decreased insulin need. Because when youÕre exercising, your body doesnÕt need as much insulin to take up glucose. So itÕs very important to talk to your doctor about when you start your exercise program because your insulin needs are going to change over time and you may need to lower your dose.
Wine and chocolate contain large quantities of anti-oxidants. However, theyÕre easy to over-indulge in. Dark chocolate is probably the best form you can consume. You really want to avoid the kinds that contain milk and sugar because these are basically negating all of the health benefits. So go for the highest percentage of cacao and the lowest amount of sugar you can find. Now in terms of wine: red wine is often the highest antioxidant form of wine with pinot noir having the highest levels detected. But again: itÕs quite important to recognize that moderate drinking in men is two glasses a day and for women, only one. So keep it in moderation and enjoy it sparingly.
Glucose is one of the most important biomarkers of our health and our lifestyle. ItÕs directly correlated to the food that we eat as well as the stress that weÕre under and if you spend a lot of time sedentary or sitting a desk all day, that also can increase your blood glucose over time. Tracking glucose is especially important for individuals with pre-diabetes and diabetes because these diseases are characterized by abnormal glucose metabolism.
Omega-3Õs come from things like fatty fish Ð like salmon, halibut, herring, sardines. But if youÕre a vegetarian or vegan, you might be finding your Omega-3Õs through things like flax seeds, walnuts, and hemp seeds. The Omega-3Õs found in plant sources are not officially converted in our bodies to the kinds of Omega-3Õs that are very beneficial like EPA and DHA. So if you are a vegetarian or vegan, you might want to supplement with algae oil. If youÕre a person who doesnÕt like to eat fish, you might also consider supplementing with fish oil but itÕs very important for you to find the highest quality source you can look for because many of the supplements that have fish oil in them can easily go rancid. So I recommend to my patients to find good brands that are pharmaceutical-grade that have high percentages of EPA and DHA.
One of the common things that happens is that the patient comes in carrying a bag full of glasses, complaining that none of them work. TheyÕve seen three different eye doctors and theyÕre really struggling. One of the things on the list of potential problems is that the patient might have diabetes. What happens in the diabetics is that when their sugar is not well controlled, the lens of their eye kind of swells and then gets a little thinner so that their prescription is just changing all over the place. ItÕs really important for these patients to get their sugar under nice control and then it makes it a lot more reliable to prescribe a pair of glasses.
Diabetes can affect oneÕs eyes in many different ways. Some people just come in for a diabetic eye exam and they donÕt really have any symptoms at all Ð everythingÕs fine. But they should get checked once a year to make sure theyÕre not developing a problem. Some patients come in because theyÕve had a big change in their glasses prescription and they need that adjusted. ItÕs not unusual for people with diabetes (particularly ones that have sugar thatÕs pretty poorly controlled) to have rather dramatic swings in their prescriptions.
People can make their lives easier with retinopathy if, for one, they get their eyes examined. Having an up to date glasses prescription is really helpful. Treating any other coexisting problems like cataracts can also be really helpful for patients. Ultimately, getting the retinopathy under control will afford patients the best possible prognosis with regards to their vision.
Lifestyle choices that people can make to really help their prognosis with regards to developing diabetic eye disease revolve around the same things that people try to do to allow them to live healthier in general with diabetes. These include a healthy diet, low carbohydrate diet, a nice regular exercise regimen, keeping your blood sugar under control, keeping your blood pressure under control, and importantly: following up with your primary care doctor.
It probably sounds kind of scary to patients when they know all of the things that can go wrong with the diabetic eye. But the vast majority of patients do really well. If the blood sugar level is nicely controlled, the blood pressure is well controlled, patients are watching their diet, have some type of regular exercise regimen, and follow up with their primary care doctors Ð the expectations are that theyÕll maintain really good vision and be able to avoid many of the diabetic eye problems.
One of the risk factors for developing diabetic eye disease is simply the length of time that an individual has had diabetes. ThatÕs not really something you can control because you got diagnose when you got diagnosed Ð itÕs in the past. But thereÕs still a lot you can do: the blood sugar level being nicely controlled will afford you a much better prognosis. Also, thereÕs a correlation with regards to blood pressure: people with diabetes who might also have blood pressure issues will do much better if not just their blood sugar is controlled but also their blood pressure. A nice diet and exercise regimen and following up with some diligence with your primary care doctor will help people with diabetes try to avoid diabetic eye disease.
Retinopathy can affect your daily life in all sorts of ways. Some patients may have absolutely no symptoms at all if the retinopathy is relatively mild. However, if they have rather extensive retinopathy or theyÕve had bleeding in the eye, their vision may be such that they canÕt even see the big ÒEÓ on an eye chart.
The back of the eye is called the retina. One of the most devastating complications of diabetes is diabetic retinopathy. Retinopathy happens when blood vessels start to get leaky Ð whether itÕs blood products or actually fluid leaking into the retina, the retina wonÕt work right. It can get swollen, it can get traction from fibrovascular tissue forming in the back of the eye. Retinopathy is one of the leading causes of blindness.
There are many treatments for diabetic retinopathy. Most commonly, medications are given into the eye through an injection. Laser treatment can also be done. For the most advanced cases, real surgery may be necessary.
There is a major connection between diabetes and heart disease. In fact, diabetes is one of the most important risk factors for developing hardening of the arteries (we call it athlerosclerosis Ð that is the cholesterol deposits and scarring in the walls of the arteries) and that leads to heart attacks and strokes. One of the most feared complications of diabetes are those two things: heart attacks and strokes.
There are two distinct forms of heart disease that are related to diabetes: The commonest one is the hardening of the arteries (the atherosclerotic process) that leads to heart attacks and can also lead even to sudden death when people collapse and die at home or even out in town. The second diabetic heart disease is less common: itÕs when the diabetes affects the ability of the heart to squeeze. In other words, it decreases the heart function so that patients develop heart failure. With heart failure, people are short of breath, they develop swollen ankles, theyÕre fatigued, and it is also a very lethal complication of diabetes.
What happens in a heart attack is that the blood supply to a piece of the heart muscle is cut off and the heart muscle dies. This can, of course, damage the heart so much that the person dies from the heart attack (if itÕs a very big one) or it can damage the heart to the degree that patients develop heart failure Ð shortness of breath, fatigue, and swelling of their legs. The diabetic who has a heart attack is at higher risk for complications in the healing period after the heart attack than a person who has a heart attack who hasnÕt had diabetes. One of the reasons for that is that weÕre treating not only the physical complication of the injury to the heart but weÕre also treating the chemical reactions that occur to the diabetic state is often worsened immediately after something like a heart attack (just like after an infection) so you have a more complicated patient to take care of who is at higher risk for other complications (such as heart failure) or even from not surviving the heart attack.
Diabetics have a number of risk factors that go along with the diabetic state. They are: kidney damage, high blood pressure, and abnormal fats in the blood. Kidney damage is very common in diabetics and that complicates the situation when patients have a heart attack and also makes patients more likely to have a heart attack. The same thing is true about the fats in the blood. Diabetics have high triglyceride fats (which are bad) and low HDL fats (which are good.) So that increases the risk for arthrosclerosis and it increases the likelihood of a patient developing hardening of the arteries and a heart attack. Finally, when there is damage to the kidney, often that engenders high blood pressure. So the damaged kidney is bad in two ways: both because it makes the heart attack issue more complicated and also because it increases the likelihood of a heart attack and, by the way, also a stroke.
Actually, a lot of it has to do with lifestyle changes. For example: people should keep their weight down into the ideal range and if they are obese, they should work on a diet to get their weight down. They should exercise regularly Ð that doesnÕt mean going to the gym and lifting 250 pounds, it means just regular exercise like walking for 30-40 minutes a day or stationary bicycle or swimming or ice skating or whatever Ð one can mix it up. But itÕs important to get some exercise every day Ð that also works against the diabetic state. Also Ð the diet: watch out for all of those simple Carbs. I always call them the four white substances: white sugar, white flour, white potatoes, white rice. Keep those to a minimum in the diet. Lots of fruits and vegetables, lots of lean meats and fish and poultry. And, of course, keep your weight down and exercise regularly. All of those three things can markedly diminish the chance of developing diabetes or can help make the diabetic state much more mild. And of course Ð follow your doctorÕs instructions. Take your pills or the insulin, check your sugar, be sure as a diabetic that youÕre getting your eyes checked regularly and your feet checked regularly because often little sores on the feet end up resulting in amputation. So follow through with your doctor and work on your lifestyle.
Good diabetic control decreases the chance that the patient will develop hardening of the arteries or athlerosclerosis. It also decreases the chance that the patient will develop kidney damage with increased blood pressure. The combination of the diabetic state and high blood pressure puts people at a very high risk for stroke, a high risk for developing hardening of the arteries, and a high risk that even one of the blood vessels in the brain will burst and cause a brain hemorrhage, which also causes a stroke. So a diabetic state thatÕs not well controlled and high blood pressure are bad partners because they really markedly increase the risk of a stroke.
There are two ways to treat a stroke and it’s similar whether you have diabetes or not. The first one consists of trying to open up the blood vessel that’s been blocked. You can only do that in the first two to three hours after the stroke starts. So if the stroke is already well beyond that, then it consists of blood thinners to try and prevent the clot from extending, as well as controlling blood pressure to some degree. And then also just the overall improvement in the diabetic state. Better control of blood sugar, better control of blood pressure, taking care of that you’re taking your medicines, that you’re touching base with your doctor. In other words, all the things that we’ve talked about before, control the diabetes, control the blood pressure, control the cholesterol, and then we use blood thinners, usually. Sometimes milder blood thinners like aspirin or Clopidogrel and sometimes more powerful blood thinners such as Warfarin or Rivaroxaban or Apixaban.
The warning signs of a stroke coming on consist of an unusual period where the person canÕt speak for a few minutes, or notices that when they are eating food that one side of their mouth is drooping and maybe the food dribbles out, or their arm or their leg suddenly becomes week for a transient period of time (like a few minutes.) ThatÕs usually sometimes called a mini-stroke or a transient ischemic attack Ð that is a brief period when the blood didnÕt get to some of the parts of the brain. Usually it resolves quickly but it is a warning that a bigger stroke is coming on and just like the chest pain that people have when they exert themselves argues for Òwatch out for a heart attackÓ Ð those little symptoms like a sudden loss of some function is a warning signal for Òhey, watch out for a bigger stroke coming.Ó
When the blood flow is decreased or cut off to the foot, first of all: the patient may feel a lot of pain because tissues are dying in the foot, so thatÕs number one. Number two: the color of the toes and the foot may change, you may have areas that are pale, you may have areas that have become purple-ish or blue, and you may have sores on the bottom of a foot or on the tips of the toes that donÕt heal. All of those are signs that thereÕs not adequate blood flow going to the foot and that amputation might be around the corner if things are not corrected.
Amputation is necessary when parts of the foot die Ð the toes or even the whole foot. That way, the area is not going to heal unless you cut the foot back or the leg back to a point where thereÕs good blood flow, then the skin and the muscle and the bone will heal. Otherwise, youÕre just going to have areas of dead tissue that might be sources of infection and also itÕs not a useful foot anymore because those dead tissues canÕt be used, the muscles canÕt be used, so you really need to cut that off and then fit the patient for an artificial limb Ð either an artificial foot or an artificial lower leg Ð that enables them to walk again.
Diabetics (particularly those in whom the blood sugar levels are not really well controlled) can develop earlier cataracts than is normal. Cataracts happen when the lens of the eye gets cloudy. Diabetics can get a particularly aggressive type of cataract that comes on rather quickly called a Posterior Subcapsular Cataract. With that type of cataract, itÕs almost like looking through ground glass. So theyÕll get a lot of glare like a dirty windshield or something Ð a ton of glare. TheyÕll also start having problems with their reading vision.
One of the biggest roadblocks to patients getting treated for their diabetes is that they’re scared. Sometimes people just don’t want to find out the answer and they’re concerned that they won’t be able to handle the news or something. First of all, there may not be anything wrong at all. The vast majority of people with diabetes don’t even have problems. Certainly, you don’t know if you’re the one that does but if you treat it early, you should be able to do something to really help you. Patients that are well controlled tend to do very well. Patients that have very limited access to health care or haven’t been taking care of themselves for whatever reason (maybe they’re just really busy) – those are the people that we’re more concerned about and tend to see more widespread diabetic eye disease.
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