Type 2 Diabetes: Yesterday, Today & Tomorrow

• Diabetes, Type 2

 

YESTERDAY

• No proven strategies existed to prevent the disease or its complications.
• The only ways to treat diabetes were the now-obsolete forms of insulin from cows and pigs, and drugs that stimulate insulin release from the beta cells of the pancreas (sulfonylureas). Both of these therapies cause dangerous low blood sugar reactions and weight gain. Patients monitored their glucose levels with urine tests, which recognized high but not dangerously low glucose levels and reflected past, not current, glucose levels. More reliable methods for testing glucose levels in the blood had not been developed yet.
• While scientists knew that genes played a role (i.e., the disease often runs in families), they had not identified any specific culprit genes.
• National efforts were not being made to combat obesity—a serious risk factor for the disease. Fewer people developed type 2 diabetes compared to today because overweight, obesity, and physical inactivity were not pervasive.
• Patients were almost exclusively adults—the reason that the disease was formerly called “adult onset diabetes.” It was rare in children or young adults.

TODAY

• Type 2 diabetes can be prevented or delayed. The NIH-funded Diabetes Prevention Program (DPP) clinical trial (http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/) found a lifestyle intervention (modest weight loss of 5 to 7 percent of body weight and 30 minutes of exercise 5 times weekly) reduced the risk of getting type 2 diabetes by 58 percent in a diverse population of over 3000 adults at high risk for diabetes. In another arm of the study, the drug metformin reduced development of diabetes by 31 percent.
• Based on the DPP findings, the National Diabetes Education Program developed the education campaign, “Small Steps. Big Rewards. Prevent Type 2 Diabetes.” to help people at high risk take the necessary steps to prevent the disease (www.ndep.nih.gov).
• Ongoing NIH translational research efforts are testing cost effective ways to deliver the DPP-proven lifestyle change in real-world settings. This vigorous effort is needed to address the escalating prevalence of type 2 diabetes which now affects 7.8 percent of Americans, disproportionate affects minorities, and is conservatively estimated to be the seventh leading cause of death in the U.S.
• Type 2 diabetes is increasing in children, in tandem with rising obesity rates. This trend is alarming because, as younger people develop the disease, the complications, morbidity, and mortality associated with diabetes are all likely to occur earlier. Also, offspring of women with type 2 diabetes are more likely to develop the disease. Thus, the burgeoning of diabetes in younger populations could lead to a vicious cycle of ever-growing rates of diabetes.
• The SEARCH for Diabetes in Youth Study (www.searchfordiabetes.org) has provided the first national data on incidence and prevalence of diabetes in youth. About 3700 youth under 20 years old are diagnosed with type 2 diabetes each year, and the disease is particularly prevalent in minority youth.
• Research has vastly expanded understanding of the molecular underpinnings of diabetes and its complications. Recent work has boosted to nearly 40 the number of gene regions associated with increased risk of type 2 diabetes, laying the foundation for new approaches to prevention and therapy.
• NIH-supported clinical trials validated a marker called hemoglobin A1C (A1C). This marker reflects average blood sugar control over a 3 month period. This technology, along with tests that allow patients to monitor their own blood glucose throughout the day, helps make better blood glucose control achievable for many people with type 2 diabetes.
• Because lower A1C levels have been shown to be predictive of longer life and fewer complications, the test has helped speed development and approval of better forms of insulin and new diabetes medicines that work though a variety of mechanisms. New drugs are available that lower glucose without weight gain or even with modest weight loss. Several agents targeting the specific metabolic abnormalities of type 2 diabetes are now available and can be combined, thus delaying the need for insulin.
• Tight blood sugar control has become a standard of treatment for most diabetes patients based on results from NIH clinical trials demonstrating that keeping A1C below 7 can prevent or delay devastating disease complications.
• A large clinical trial showed that older patients with longstanding type 2 diabetes at high risk of heart disease do not benefit from more intensive blood glucose control than is currently recommended. These findings spare patients from unneeded therapy and provide important data to help individualize therapy, with less stringent A1C targets suggested for some people such as those with advanced diabetes complications.
• Clinical trials have shown that blood pressure and lipid control reduce diabetes complications by up to 50 percent. Physicians are now much better equipped to prevent and control heart disease, which often accompanies diabetes, and is the leading cause of death in people with diabetes.
• Nationwide improvements in risk factor control show research-proven strategies are being translated into practice. Improvements in control of cholesterol, blood glucose, and blood pressure have added an estimated one year to the expected lifespan of a person with type 2 diabetes since 1992, and improved quality of life by reducing the incidence of burdensome complications like blindness, lower limb amputations, kidney failure, and coronary heart disease.
• As a result of research proving their benefits, Medicare now covers blood glucose self monitoring materials and diabetes education services, helping people to better control their diabetes.
• Kidney disease can be detected earlier via urine tests. Therefore, patients can be treated earlier to slow the rate of kidney damage. Improved control of glucose and blood pressure prevents or delays progression of kidney disease to kidney failure. With good care, less than 10 percent of patients develop kidney failure.
• With timely laser surgery and appropriate follow-up care, people with advanced diabetic retinopathy can reduce their risk of blindness by 90 percent. A recent study showed a drug which limits blood vessel growth can be an important supplement to laser therapy for diabetic macular edema.
• The NIH spent over $1.1 billion on diabetes research in fiscal year 2009. In 2007, total costs attributable to diabetes for Americans was estimated at $174 billion—an increase of 32 percent since 2002.

TOMORROW

• Research will find better ways to bring proven diabetes prevention strategies to more people at lower cost.
• Earlier and more aggressive treatment approaches may help better prevent diabetes complications.
• New understanding of the biology of obesity and insulin resistance is informing the development of new therapeutics to prevent and treat type 2 diabetes.
• Identification of susceptibility genes for diabetes and its complications will enable earlier implementation of prevention measures targeted to those at highest risk.
• Research on the effect of maternal diabetes on offspring may help to break the vicious diabetes cycle.
• Continued research on the mechanisms underlying the development and progression of disease complications will result in the ability to predict who is likely to develop them. Personalized treatments could then be developed to preempt complications. This strategy would dramatically improve the health and well-being of patients.
• NIH clinical trials will identify new approaches to prevent and treat the emerging problem of type 2 diabetes in children.

For more information, contact The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): NIDDKinquiries@nih.gov
The National Institute of Diabetes and Digestive and Kidney Diseases www.niddk.nih.gov

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Diabetics get Blood Vessels Made From Donor Cells

 

By MARILYNN MARCHIONE, AP Medical Writer

2:28 p.m., June 27, 2011

 

Three dialysis patients have received the world’s first blood vessels grown in a lab from donated skin cells. It’s a key step toward creating a supply of ready-to-use arteries and veins that could be used to treat diabetics, soldiers with damaged limbs, people having heart bypass surgery and others.

The goal is to one day have a refrigerated inventory of these in various sizes and shapes that surgeons could order up as needed like bandages and other medical supplies.

The work so far is still early-stage. Three patients in Poland have received the new vessels, which are working well two to eight months later. But doctors are excited because this builds on earlier success in about a dozen patients given blood vessels grown in the lab from their own skin – a process too long and expensive to be practical.

“This version, built from a master donor, is available off the shelf and at a dramatically reduced cost,” estimated at $6,000 to $10,000, said Todd McAllister, chief of Cytograft Tissue Engineering Inc., the San Francisco-area company leading the work.

The American Heart Association considers it so promising that the group featured it on Monday in the first of a new series of webcasts about cutting-edge science.

“This is tremendously exciting,” because the failure of blood vessels used in dialysis is “a huge public health problem,” said Duke University‘s Dr. Robert Harrington, a heart expert who had no role in the work.

If a larger study getting under way now in Europe and South America shows success, “this is big news,” Harrington said.

Kidney failure, which is common in diabetics, requires dialysis to filter wastes from the blood through a connection between an artery and a vein called a shunt. It gets punctured several times a week to hook patients up to the dialysis machine, and complications include blood clots, clogging and infection.

What’s more, patients often run out of suitable sites for these shunts as problems develop. Plastic versions have high rates of failure and complications, too. Doctors have long wished for a natural substitute.

The lab-grown vessels are free of artificial materials. They don’t involve stem cells, so they’re not controversial.

Researchers start with a snip of skin from the back of a hand, remove cells and grow them into sheets of tissue that are rolled up like straws to form blood vessels.

So far, these lab-grown vessels have been tolerated by the recipients’ immune systems; no anti-rejection medicine or tissue matching is needed. That’s not surprising because lab-grown skin is already used to treat many burn victims.

“There are literally hundreds of thousands of patients that could use this technology,” McAllister said.

Each year, nearly 400,000 Americans undergo dialysis and half of them use plastic shunts. More than 160,000 people lose limbs because of poor circulation that might be improved with lab-grown vessels.

About 300,000 people have heart bypass operations using blood vessels taken from other parts of the body to create detours around clogged heart arteries. Some heart patients say the leg wound from removing the long vein to create heart bypasses hurts more than the chest wound for the open-heart surgery.

In 2005, Cytograft reported success with its first attempt at dialysis shunts using patients’ own skin. Some of the early work was sponsored by the National Heart, Lung and Blood Institute.

The new work, using donor cells, makes this advance more practical for wide use, said Dr. Timothy Gardner, a heart surgeon at Christiana Care Health Services in Newark, Del., and former American Heart Association president.

“It provides the option or the opportunity for off-the-shelf graft availability as opposed to something that has to be built from the individual’s own cells,” he said.

Cytograft plans a study in Europe and South America comparing 40 patients getting the lab-grown vessels to 20 getting plastic shunts. Studies also are planned on a mesh version for people with poor leg circulation. 

Online:

Company and video: http://www.cytograft.com

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Source:  The Associated Press/San Diego Union-Tribune

Diabetic Foot Care – Podiatrist in Jacksonville, FL

Source: Uploaded by webpowervideo on Dec 3, 2009 to YouTube

According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.

Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation.

With a diabetic foot, a wound as small as a blister from wearing a shoe that’s too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it’s at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror.

Here’s some basic advice for taking care of your feet:

Always keep your feet warm.Don’t get your feet wet in snow or rain.
Don’t put your feet on radiators or in front of the fireplace.
Don’t smoke or sit cross-legged. Both decrease blood supply to your feet.
Don’t soak your feet.
Don’t use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.

Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office.
Use quality lotion to keep the skin of your feet soft and moist, but don’t put any lotion between your toes.

Wash your feet every day with mild soap and warm water.
Wear loose socks to bed.
Wear warm socks and shoes in winter.
When drying your feet, pat each foot with a towel and be careful between your toes.
Buy shoes that are comfortable without a “breaking in” period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don’t wear the same pair everyday. Inspect the inside of each shoe before putting it on. Don’t lace your shoes too tightly or loosely.

Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.
When your feet become numb, they are at risk for becoming deformed. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced “sharko”) foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn’t hurt. Diabetic foot ulcers and early phases of Charcot fractures can be treated with a total contact cast.

The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot’s movement and supports its contours if you don’t put any weight on it. To use a total contact cast, you need good blood flow in your foot. The cast is changed every week or two until your foot heals. A custom-walking boot is another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should keep from putting your weight on the Charcot foot. Surgery is considered if your deformity is too severe for a brace or shoe.

Visit our website: http://www.firstcoastfootclinic.com

Financial Help for Diabetes Care

 

Financial Help for Diabetes Care

On this page:
•Medicare
•Medicaid
•State Children’s Health Insurance Program (SCHIP)
•Health Insurance for Those Not Eligible for Medicare or Medicaid
•Health Insurance after Leaving a Job
•Health Care Services
•Hospital Care
•Kidney Disease: Resources for Dialysis and Transplantation
•Prescription Drugs and Medical Supplies
•Prosthetic Care
•Classroom Services
•Technological Assistance
•Food and Nutrition Assistance for Women with Diabetes or Gestational Diabetes
•Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) Benefits
•Local Resources
•Acknowledgments
•National Diabetes Education Program

 

Diabetes treatment is expensive. According to the American Diabetes Association, people with diabetes spend an average of $11,744 a year on health care expenses—more than twice the amount spent by people without diabetes.

Many people who have diabetes need help paying for their care. For those who qualify, a variety of governmental and nongovernmental programs can help cover health care expenses. This publication is meant to help people with diabetes and their family members find and access such resources.

Medicare

Medicare is federal health insurance for the following groups:

• people 65 or older
• people younger than 65 with certain disabilities or amyotrophic lateral sclerosis (ALS), also called Lou Gehrig’s disease
• people of any age with end-stage renal disease—permanent kidney failure requiring dialysis or a kidney transplant

Medicare Health Plans

People with Medicare can choose how to get their health and prescription drug coverage. The following options are available:

• Original Medicare
• Medicare Advantage Plans—such as health maintenance organizations (HMOs) or preferred provider organizations (PPOs)
• other Medicare health plans

Original Medicare. Original Medicare, managed by the Federal Government, has two parts: Medicare Part A is hospital insurance and Medicare Part B is medical insurance. People in this plan usually pay a fee for each health care service or supply they receive.

People who are in Original Medicare can add prescription drug coverage—Medicare Part D—by joining a Medicare Prescription Drug Plan. These plans are run by insurance companies and other private companies approved by Medicare.

People can also choose to buy insurance to help fill the gaps in Part A and Part B coverage. This insurance is known as Medigap or Medicare Supplement Insurance.

Medicare Advantage Plans. Medicare Advantage Plans are health plan options, like an HMO or PPO, approved by Medicare and offered by private companies. These plans are part of Medicare and are sometimes called Part C or MA Plans. Medicare Advantage Plans provide Medicare Part A and Part B coverage and usually Medicare Part D coverage. The companies that run these plans must follow rules set by Medicare. Not all Medicare Advantage Plans work the same way. People considering one of these plans should find out the plan’s rules before joining.

Other Medicare Health Plans. Other Medicare health plans include Medicare Cost Plans, Demonstrations/Pilot Programs, and Programs of All-Inclusive Care for the Elderly (PACE). These plans provide hospital and medical insurance coverage, and some also provide prescription drug coverage.

To get more information about Medicare coverage, see “More Information about Medicare.”

Medicare Covers Diabetes Services and Supplies

Original Medicare helps pay for the diabetes services, supplies, and equipment listed below. Coinsurance or deductibles may apply. In addition, Medicare covers some preventive services for people who are at risk for diabetes. A person must have Medicare Part B or Medicare Part D to receive these covered services and supplies.

Medicare Part B helps pay for

• diabetes screening tests for people at risk of developing diabetes
• diabetes self-management training
• diabetes supplies such as glucose monitors, test strips, and lancets
• insulin pumps and insulin if used with an insulin pump
• flu and pneumonia shots
• foot exams and treatment for people with diabetes
• eye exams to check for glaucoma and diabetic retinopathy
• medical nutrition therapy services for people with diabetes or kidney disease, when referred by a doctor
• therapeutic shoes or inserts, in some cases

Medicare Part D helps pay for

• diabetes medicines
• insulin, but not insulin used with an insulin pump
• diabetes supplies like needles and syringes for injecting insulin

People who are in a Medicare Advantage Plan or other Medicare health plan should check their plan’s membership materials and call for details about how the plan provides the diabetes services, supplies, and medicines covered by Medicare.

More details are available by calling 1–800–MEDICARE (1–800–633–4227) and requesting the free booklet Medicare Coverage of Diabetes Supplies & Services. This booklet is also available at www.medicare.gov/publications/pubs/pdf/11022.pdf (PDF, 4.7 MB) *.

More Information about Medicare

More information about Medicare is available at www.medicare.gov, the official U.S. Government website for people with Medicare. The website has a full range of information about Medicare including free publications like Medicare & You, the official Government handbook about Medicare, and Medicare Basics—A Guide for Families and Friends of People with Medicare. Through the Medicare website, people can also

• find out if they are eligible for Medicare and when they can enroll
• learn about their Medicare health plan options
• find out what Medicare covers
• find a Medicare Prescription Drug Plan
• compare Medicare health plan options in their area
• find a doctor who participates in Medicare
• get information about the quality of care provided by nursing homes, hospitals, home health agencies, and dialysis facilities

Calling 1–800–MEDICARE (1–800–633–4227) is another way to get help with Medicare questions, order free publications, and more. Help is available 24 hours a day, every day, and is available in English, Spanish, and other languages. TTY users should call 1–877–486–2048.

Medicare information can also be obtained from the following agencies or programs:

• Each state has a State Health Insurance Assistance Program (SHIP) that provides free health insurance counseling. A state’s SHIP may have a unique name. SHIP counselors can help people choose a Medicare health plan or a Medicare Prescription Drug Plan. The phone number for the SHIP in each state is available by by calling Medicare or visiting www.medicare.gov and selecting “Find Helpful Phone Numbers and Websites” under “Search Tools.”
• The Social Security Administration can provide information about eligibility for Medicare. People can contact the agency at 1–800–772–1213, visit its web-site at www.socialsecurity.gov, or check with their local Social Security office to learn if they are eligible for Medicare.
• State Medical Assistance (Medicaid) offices in each state can provide information about help for people with Medicare who have limited income and resources. The phone number for each state’s Medicaid office can be obtained by visiting www.medicare.gov or calling Medicare.

People who enroll in Medicare can register for MyMedicare.gov, a secure online service, and use the site to access their personal Medicare information at any time. People can view their claims, order forms and publications, and see a description of covered preventive services.

Help for People with Medicare Who Have Limited Income and Resources

People who have Medicare and have limited income and resources may qualify for help paying for some health care and prescription drug costs from one of the following programs:

• Extra help paying for Medicare prescription drug coverage. Those who meet certain income requirements may qualify for extra help from Medicare to pay prescription drug costs. People can apply for this help by calling Social Security; visiting www.socialsecurity.gov to apply online; visiting their local Social Security office; or by contacting their State Medical Assistance (Medicaid) office. Each state’s SHIP can provide information and answer questions about this program.
• State pharmacy assistance programs (SPAPs). Several states have SPAPs that help certain people pay for prescription drugs. Each SPAP makes its own rules about how to provide drug coverage to its members. Information about each state’s SPAP can be obtained by calling Medicare or the state’s SHIP.
• Medicaid programs for people with Medicare. State Medicaid programs help pay medical costs for some people with Medicare who have limited income and resources. People who qualify for both Medicare and Medicaid may get coverage for services that aren’t fully covered by Medicare, such as nursing home and home health care. States also have programs called Medicare Savings Programs that pay Medicare premiums and, in some cases, may also pay Medicare Part A and Part B deductibles and coinsurance. More information is available at www.medicare.gov. The phone number for the State Medical Assistance (Medicaid) office for each state can be obtained by calling Medicare. Each state’s SHIP can also provide more information.

Medicaid

Medicaid, also called Medical Assistance, is a joint federal and state government program that helps pay medical costs for some people with limited income and resources. Medicaid programs and income limits for Medicaid vary from state to state. The State Medical Assistance (Medicaid) office can help people find out whether they qualify for Medicaid or provide more information about Medicaid programs. To contact a state Medicaid office, people can

• search for Medicaid information for a state at www.GovBenefits.gov
• visit www.medicare.gov and select “Find Helpful Phone Numbers and Websites” under “Search Tools,” or call 1–800–MEDICARE (1–800–633–4227) and say “Medicaid”
• check the government pages of the phone book for the local department of human services or department of social services, which can provide the needed information

 

State Children’s Health Insurance Program (SCHIP)

SCHIP is a federal and state government partnership to expand health coverage to uninsured children from families with income that is too low to afford private or employer-sponsored health insurance but too high to qualify for Medicaid. The free or low-cost coverage is available to eligible children younger than 19.

SCHIP provides an extensive package of benefits including doctor visits, hospital care, and more. Information about the program is available at www.insurekidsnow.gov or by calling 1–877–KIDS–NOW (1–877–543–7669). Callers to the toll-free, confidential hotline are automatically connected to their state’s program.

Health Insurance for Those Not Eligible for Medicare or Medicaid

People who are not eligible for Medicare or Medicaid may be able to purchase private health insurance. Many insurers consider diabetes that has already been diagnosed a pre-existing condition, so finding coverage may be difficult for people with diabetes. Insurance companies often have a specific waiting period during which they do not cover diabetes-related expenses for new enrollees, although they will cover other medical expenses that arise during this time.

Certain state and federal laws may help. Many states now require insurance companies to cover diabetes supplies and education. The Health Insurance Portability and Accountability Act (HIPAA), passed by Congress in 1996, limits insurance companies from denying coverage because of a pre-existing condition. Information about HIPAA is available at www.dol.gov/dol/topic/health-plans/portability.htm.

More information about these laws is available from each state’s insurance regulatory office. Some state offices may be called the state insurance department or commission. This office can also help identify an insurance company that offers individual coverage. The National Association of Insurance Commissioners’ website, www.naic.org/state_web_map.htm, provides a membership list with contact information and a link to the website for each state’s insurance regulatory office.

The Georgetown University Health Policy Institute offers consumer guides on health insurance topics, including guides for each state about getting and keeping health insurance. The guides are available at www.healthinsuranceinfo.net.

Health Insurance after Leaving a Job

When leaving a job, a person may be able to continue the group health insurance provided by the employer for up to 18 months under a federal law called the Consolidated Omnibus Budget Reconciliation Act, or COBRA. People pay more for group health insurance through COBRA than they did as employees, but group coverage is cheaper than individual coverage. People who have a disability before becoming eligible for COBRA or who are determined by the Social Security Administration to be disabled within the first 60 days of COBRA coverage may be able to extend COBRA coverage an additional 11 months, for up to 29 months of coverage. COBRA may also cover young people who were insured under a parent’s policy but have reached the age limit and are trying to obtain their own insurance.

More information is available by calling the U.S. Department of Labor at 1–866–4–USA–DOL (1–866–487–2365) or visiting www.dol.gov/dol/topic/health-plans/cobra.htm.

If a person doesn’t qualify for coverage or if COBRA coverage has expired, other options may be available:

• Some states require employers to offer conversion policies, in which people stay with their insurance company but buy individual coverage.
• Some professional and alumni organizations offer group coverage for members.
• Most states have a high-risk health insurance pool or other means for covering people otherwise unable to get health insurance. Information about high-risk pools is available at www.nahu.org/consumer/hrpguide.cfm.
• Some insurance companies also offer stopgap policies designed for people who are between jobs.

Each state insurance regulatory office can provide more information about these and other options. The National Association of Insurance Commissioners’ website, www.naic.org/state_web_map.htm, provides a membership list with contact information and a link to the website for each state’s insurance regulatory office. Information about consumer health plans is also available at the U.S. Department of Labor’s website at www.dol.gov/dol/topic/health-plans/consumerinfhealth.htm.

Health Care Services

The Bureau of Primary Health Care, a service of the Health Resources and Services Administration, offers primary and preventive health care to medically underserved populations through community health centers. For people with no insurance, fees for care are based on family size and income. Information about local health centers is available by calling 1–888–ASK–HRSA (1–888–275–4772) and asking for a directory, or by visiting the Bureau’s website at www.bphc.hrsa.gov.

The Department of Veterans Affairs (VA) runs hospitals and clinics that serve veterans who have service-related health problems or who simply need financial aid. Veterans who would like to find out more about VA health care can call 1–800–827–1000 or visit www1.va.gov/health.

Many local governments have public health departments that can help people who need medical care. The local county or city government’s health and human services office can provide further information.

Hospital Care

People who are uninsured and need hospital care may be able to get help from a program known as the Hill-Burton Act. Although the program originally provided hospitals with federal grants for modernization, today it provides free or reduced-fee medical services to people with low incomes. The Department of Health and Human Services administers the program. More information is available by calling 1–800–638–0742 (1–800–492–0359 in Maryland) or visiting www.hrsa.gov/hillburton.

Kidney Disease: Resources for Dialysis and Transplantation

Kidney failure, also called end-stage renal disease, is a complication of diabetes. People of any age with kidney failure can get Medicare Part A—hospital insurance—if they meet certain criteria. To qualify for Medicare on the basis of kidney failure, a person must

• need regular dialysis

or

• have had a kidney transplant

and must

• have worked long enough—or be the dependent child or spouse of someone who has worked long enough—under Social Security, the Railroad Retirement Board, or as a government employee

or

• be receiving—or be the spouse or dependent child of a person who is receiving—Social Security, Railroad Retirement, or Office of Personnel Management benefits

People with Medicare Part A can also get Medicare Part B. Enrolling in Part B is optional. However, a person needs to have both Part A and Part B for Medicare to cover certain dialysis and kidney transplant services.

Those who don’t qualify for Medicare may be able to get help from their state to pay for their dialysis treatments. More information about dialysis and transplantation is available by

• calling Social Security at 1–800–772–1213 or visiting www.socialsecurity.gov for information about the required amount of time needed under Social Security, the Railroad Retirement Board, or as a government employee to be eligible for Medicare based on kidney failure
• visiting www.medicare.gov to read or download the booklet Medicare Coverage of Kidney Dialysis and Kidney Transplant Services or calling 1–800–MEDICARE (1–800–633–4227) to request a free copy; TTY users should call 1–877–486–2048
• reading the National Kidney and Urologic Diseases Information Clearinghouse’s publication Financial Help for Treatment of Kidney Failure, available at www.kidney.niddk.nih.gov or by calling 1–800–891–5390
• visiting Medicare’s “Dialysis Facility Compare” at www.medicare.gov/dialysis for important information about chronic kidney disease and dialysis, including choosing a dialysis facility

Information about financing an organ transplant is available from the following organization:

United Network for Organ Sharing (UNOS)
P.O. Box 2484
Richmond, VA 23218
Phone: 1–888–894–6361 or 804–782–4800
Fax: 804–782–4817
Internet: www.unos.org

Prescription Drugs and Medical Supplies

Health care providers may be able to assist people who need help paying for their medicines and supplies by directing them to local programs or even providing free samples.

A free nylon filament—similar to a bristle on a hairbrush—is available to check feet for nerve damage. The filament, with instructions for use, can be obtained by calling 1–888–ASK–HRSA (1–888–275–4772) or by accessing www.hrsa.gov/leap.

Prescription drug coverage for those eligible for Medicare is available through Medicare’s Prescription Drug Plans and many Medicare Advantage Plans. More information is available at the Medicare website at www.medicare.gov.

Drug companies that sell insulin or diabetes medications usually have patient assistance programs. Such programs are available only through a physician. The Pharmaceutical Research and Manufacturers of America and its member companies sponsor an interactive website with information about drug assistance programs at www.PPARx.org.

Also, because programs for the homeless sometimes provide aid, people can contact a local shelter for more information about how to obtain free medications and medical supplies. The number of the nearest shelter may be listed in the phone book under Human Service Organizations or Social Service Organizations.

Prosthetic Care

People who have had an amputation may be concerned about paying their rehabilitation expenses. The following organizations provide financial assistance or information about locating financial resources for people who need prosthetic care:

Amputee Coalition of America
900 East Hill Avenue, Suite 205
Knoxville, TN 37915–2566
Phone: 1–888–AMP–KNOW (1–888–267–5669)
Fax: 865–525–7917
Internet: www.amputee-coalition.org

Easter Seals
230 West Monroe Street, Suite 1800
Chicago, IL 60606
Phone: 1–800–221–6827
Fax: 312–726–1494
Internet: www.easterseals.com

Classroom Services

Public agencies and other organizations that provide services and assistance, such as providing special equipment, to children with diabetes and other disabilities and to their families are listed on the State Resource Sheets published by the National Dissemination Center for Children with Disabilities (NICHCY). Each state’s resource sheet lists the names and addresses of agencies in the state. The free resource sheets are available at www.nichcy.org/states.htm or by contacting

NICHCY
P.O. Box 1492
Washington, DC 20013
Phone: 1–800–695–0285
Fax: 202–884–8441
Email: nichcy@aed.org
Internet: www.nichcy.org

College-aged students who have diabetes-related disabilities may be faced not only with the costs of tuition, but also with additional expenses generally not incurred by other students. These costs may include special equipment and disability-related medical expenses not covered by insurance. Some special equipment and support services may be available at the educational institution, through community organizations, through the state vocational rehabilitation agency, or through specific disability organizations. The names and addresses of these and other agencies are also listed in the State Resource Sheets available from the NICHCY.

The HEATH Resource Center, an online clearinghouse on postsecondary education for individuals with disabilities, offers information about sources of financial aid and the education of students with a disability. Contact the clearinghouse at

The George Washington University
HEATH Resource Center
2134 G Street NW
Washington, DC 20052–0001
Phone: 202–973–0904
Fax: 202–994–3365
Email: AskHEATH@gwu.edu
Internet: www.heath.gwu.edu

Technological Assistance

Assistive technology, which can help people with disabilities function more effectively at home, at work, and in the community, can include computers, adaptive equipment, wheelchairs, bathroom modifications, and medical or corrective services. The following organizations provide information, awareness, and training in the use of technology to aid people with disabilities:

Alliance for Technology Access (ATA)
1304 Southpoint Boulevard, Suite 240
Petaluma, CA 94954
Phone: 707–778–3011
Fax: 707–765–2080
Email: ATAinfo@ATAccess.org
Internet: www.ATAccess.org

United Cerebral Palsy (UCP)
1660 L Street NW, Suite 700
Washington, DC 20036
Phone: 1–800–872–5827 or 202–776–0406
Fax: 202–776–0414
Email: info@ucp.org
Internet: www.ucp.org/ucp_channelsub.cfm/1/14/86

Food and Nutrition Assistance for Women with Diabetes or Gestational Diabetes

Food, nutrition education, and access to health care services are available through the U.S. Department of Agriculture’s Women, Infants, and Children (WIC) program. The WIC program provides assistance to women during pregnancy or the period following childbirth and to infants and children up to age 5. Applicants must meet residential, financial need, and nutrition risk criteria to be eligible for assistance. Having diabetes or gestational diabetes is considered a medically based nutrition risk and would qualify a woman for assistance through the WIC program if she meets the financial need requirements and has lived in a particular state the required amount of time. The WIC website provides a page of contact information for each state and Indian tribe. Contact the WIC’s national headquarters at

Supplemental Food Programs Division
Food and Nutrition Service—USDA
3101 Park Center Drive
Alexandria, VA 22302
Phone: 703–305–2746
Fax: 703–305–2196
Email: wichq-web@fns.usda.gov
Internet: www.fns.usda.gov/wic

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) Benefits

The Social Security Administration pays disability benefits through the SSDI and SSI programs. These benefits are not the same as Social Security benefits. To receive SSDI benefits, a person must be unable to work and must have earned the required number of work credits. SSI is a monthly amount paid to people with limited income and resources who are disabled, blind, or age 65 or older and meet certain other conditions.

More information is available by calling Social Security at 1–800–772–1213 or contacting the local Social Security office for more information. TTY users should call 1–800–325–0778. A “Benefit Eligibility Screening Tool” is available at www.socialsecurity.gov to check whether a person is eligible for benefits.

Local Resources

Local resources such as the following charitable groups may offer financial help for some of the many expenses related to diabetes:

• Lions Clubs International can help with vision care. Visit www.lionsclubs.org.
• Rotary International clubs provide humanitarian and educational assistance. Visit www.rotary.org.
• Elks clubs provide charitable activities that benefit youth and veterans. Visit www.elks.org.
• Shriners of North America offer free treatment for children at Shriners hospitals throughout the country. Visit www.shrinershq.org.
• Kiwanis International clubs conduct service projects to help children and communities. Visit www.kiwanis.org.

In many areas, nonprofit or special-interest groups such as those listed above can sometimes provide financial assistance or help with fundraising. Religious organizations also may offer assistance. In addition, some local governments may have special trusts set up to help people in need. The local library or local city or county government’s health and human services office may provide more information about such groups.

The National Diabetes Information Clearinghouse (NDIC) gathered information from various agencies and organizations to try to provide the most comprehensive and helpful information possible. Changes may occur in these programs from the time this fact sheet is published. Please contact each organization directly for the most up-to-date information. The NDIC welcomes corrections and updates to the information in this fact sheet. Updates should be sent to ndic@info.niddk.nih.gov.

Source:

National Diabetes Education Program

1 Diabetes Way
Bethesda, MD 20814–9692
Phone: 1–888–693–NDEP (1–888–693–6337)
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndep@mail.nih.gov
Internet: www.ndep.nih.gov

The National Diabetes Education Program is a federally funded program sponsored by the U.S. Department of Health and Human Services’ National Institutes of Health and the Centers for Disease Control and Prevention and includes over 200 partners at the federal, state, and local levels, working together to reduce the morbidity and mortality associated with diabetes.

Top 4 Ways to Manage Your Diabetes at Weddings and Graduations

 

A Type 2 diabetic diet and meal plans is all about controlling the number of calories people with diabetes eat. Because, unused calories become body fat. And, excess fat cells reduce insulin’s ability to remove sugar from the blood.

With the summer just around the corner, it’s time to gear up for weddings, graduations, cookouts, and other celebrations that, often, involve large amount of food and small amounts of sugar-free options. Here are some tips to help you eat healthy & diabetic food plan (without having to take your own food) to this summer’s events.

Snack Beforehand
A healthy snacks for diabetics and diabetic dessert before attending a summertime event may help to satisfy you for longer than if youCarrots was to attend the event on an empty stomach. Have a handful of carrots with peanut butter about thirty minutes before the event. The sugar in the carrots will give you energy while the protein in the peanut butter will help you stay full.

Stay Hydrated
While you certainly don’t want to make it through an event drinking water alone, water can help you to feel full if the healthy food for diabetes options is limited. Water will not only hydrate your body and keep you cool from the summer heat, but water will also keep your stomach from growling until you can get your hands on something healthier.

Skip the Bread and Buns
Bread is a normal part of many summertime meals. Whether you are served a roll at a fancy wedding reception, or a bun with that char-broiled burger, it’s important to remember that Diabetics need to be cautious when it comes to dining on diabetes carbohydrates. Therefore, remove (or avoid) the bread in order to stay in better control of your blood sugar level. And hey – don’t worry about people staring at you for eating a bun-less burger – skipping unnecessary carbs can be trendy, especially in the swimsuit season!

Appreciate the Veggie Tray
Nearly all hosts and hostesses will set out a fruit and veggie tray for their guests, regardless of the kind of event. Veggie Tray Therefore, even if everything else on the table is cooked in grease, fried, or filled with sugar, healthy snacks of diabetes & food-seeking folks can find something to nosh on.
Pile your plate high with a variety of veggies and add a small portion of cheese and wheat crackers for fully well-rounded diabetic diet meals that would delight even the most meticulous nutritionist. Warning: stay away from dips, unless it’s a low-sugar yogurt dip. Veggie dips can quickly tack on an additional 300 or more calories without to what would otherwise be a healthy meal.

Typefreediabetes offers a full line of diabetic supplies, including; male incontinence products, diabetic footwear, diabetic strips, durable diabetes medical equipment, diabetic dessert and many other home health care products and supplies. Typefreediabetes offers quality products at discounted prices on a wide selection of quality name brand equipment and supplies.
Click for  Diabetes gifts

About the Author:

TypeFreeDiabetes.com is the premier source for your diabetic needs on-line. At TypeFreeDiabetes.com, you can enjoy a balanced diabetic lifestyle by learning about – how to control blood sugar, lower body fat, diet to prevent diabetes, reduce diabetes medications and reverse diabetes complications.

Source: http://www.articlesbase.com/diseases-and-conditions-articles/top-4-ways-to-manage-your-diabetes-diet-at-weddings-and-graduations-4731112.html

FDA Approves New Treatment for Type 2 Diabetes

A-Z Index

FDA NEWS RELEASE

For Immediate Release: May 2, 2011

FDA approves new treatment for Type 2 diabetes

The U.S. Food and Drug Administration today approved Tradjenta (linagliptin) tablets, used with diet and exercise, to improve blood glucose control in adults with Type 2 diabetes.

People with Type 2 diabetes do not produce or respond normally to insulin, a hormone that regulates the amount of glucose in the blood. Over time, high blood glucose levels can increase the risk for serious complications, including heart disease, blindness, and nerve and kidney damage.

“This approval provides another treatment option for the millions of Americans with Type 2 diabetes,” said Mary Parks, M.D., director of the Division of Metabolism and Endocrinology Products in the FDA’s Center for Drug Evaluation and Research. “It is effective when used alone or when added to existing treatment regimens.”

Type 2 diabetes is the most common form of the disease, affecting between 90 percent and 95 percent of the 24 million people in the United States with diabetes. Tradjenta increases the level of hormones that stimulate the release of insulin after a meal by blocking the enzyme dipeptidyl peptidase-4 or DPP-4, which leads to better blood glucose control.

Tradjenta was demonstrated to be safe and effective in eight double-blind, placebo-controlled clinical studies involving about 3,800 patients with Type 2 diabetes. The studies showed improvement in blood glucose control compared with placebo.

Tradjenta has been studied as a stand-alone therapy and in combination with other Type 2 diabetes therapies including metformin, glimepiride, and pioglitazone. Tradjenta has not been studied in combination with insulin, and should not be used to treat people with Type 1 diabetes or in those who have increased ketones in their blood or urine (diabetic ketoacidosis).

Tradjenta will be dispensed with an FDA-approved Patient Package Insert that explains the drug’s uses and risks. The most common side effects of Tradjenta are upper respiratory infection, stuffy or runny nose, sore throat, muscle pain, and headache.

Tradjenta is marketed by Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Conn., and Indianapolis-based Eli Lilly Co.

For more information:

• Approved Drugs: Questions and Answers

Source: FDA – U.S. Food and Drug Administration

4 Steps to Control Your Diabetes For Life

NDEP is a partnership of the National Institutes of Health, the Centers for Disease Control and Prevention, and more than 200 public and private organizations.

• Tengo diabetes
• ¿Corro riesgo?

 

4 Steps to Control Your Diabetes. For Life.

4 Steps to Control Your Diabetes. For Life.

Also available in these languages:

Cambodian, Chinese, Gujarati, Haitian Creole, Hindi, Hmong, Indonesian, Japanese, Korean, Laotian, Samoan, Spanish, Tagalog, Thai, Tongan, Vietnamese

Related Publications

Take Care of Your Heart. Manage Your Diabetes (in English)

(NDEP-52EN)

This patient education sheet explains the link between diabetes and heart disease. It encourages patients to work with their health care team to set targets and manage their blood glucose, blood pressure, and cholesterol. It includes a record form to track target numbers.

Tips to Help You Stay Healthy

(NDEP-8)

This tip sheet helps people work with their health care team to make a successful diabetes action plan.

In addition to a downloadable file (PDF) of the four-page tip sheet, online only, two-page PDF versions in two-color and black &white formats are available for ease of printing.

Find Similar Publications

To find similar publications based on keywords and/or audience, click the links below:

Diabetes Status: I Have Diabetes

Audiences:General Audience, Asian American and Pacific Islander, Older Adults, Adults

Keywords:A1C, Blood Pressure, Blood Glucose, Cholesterol

View more Publications »

These four steps help people with diabetes understand, monitor, and manage their diabetes to help them stay healthy. This publication is excellent for people newly diagnosed with diabetes or who just want to learn more about controlling the disease.

Publication date: 11/01/2009

 

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Contents

• Introduction
• Step 1: Learn about diabetes.
• Step 2: Know your diabetes ABCs.
• Step 3: Manage your diabetes.
• Step 4: Get routine care.
• My Diabetes Care Record
• Where to get help

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This booklet presents four key steps to help you manage your diabetes and live a long and active life.

Diabetes is a serious disease. It affects almost every part of your body. That is why a health care team may help you take care of your diabetes:

• doctor
• dentist
• diabetes educator
• dietitian
• eye doctor
• foot doctor
• mental health counselor
• nurse
• nurse practitioner
• pharmacist
• social worker
• friends and family

You are the most important member of the team.

The marks in this booklet show actions you can take to manage your diabetes.

• Help your health care team make a diabetes care plan that will work for you.
• Learn to make wise choices for your diabetes care each day.

 

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Step 1: Learn about diabetes.

Diabetes means that your blood glucose (blood sugar) is too high. There are two main types of diabetes.

Type 1 diabetes – the body does not make insulin. Insulin helps the body use glucose from food for energy. People with type 1 need to take insulin every day.

Type 2 diabetes – the body does not make or use insulin well. People with type 2 often need to take pills or insulin. Type 2 is the most common form of diabetes.

Gestational (jes-TAY-shon-al) diabetes – occurs in some women when they become pregnant. It raises her future risk of developing diabetes, mostly type 2. It may raise her child’s risk of being overweight and developing type 2 diabetes.

Diabetes is serious.

You may have heard people say they have “a touch of diabetes” or that their “sugar is a little high.” These words suggest that diabetes is not a serious disease. That is not correct. Diabetes is serious, but you can learn to manage it!

It’s not easy, but it’s worth it!

All people with diabetes need to make healthy food choices, stay at a healthy weight, and move more every day.

Taking good care of yourself and your diabetes can help you feel better. It may help you avoid health problems caused by diabetes such as:

• heart attack and stroke
• eye problems that can lead to trouble seeing or going blind
• nerve damage that can cause your hands and feet to hurt, tingle, or feel numb. Some people may even lose a foot or a leg.
• kidney problems that can cause your kidneys to stop working
• gum disease and loss of teeth

When your blood glucose is close to normal you are likely to:

• have more energy.
• be less tired and thirsty and urinate less often.
• heal better and have fewer skin, or bladder infections.
• have fewer problems with your eyesight, feet, and gums.

• Ask your health care team what type of diabetes you have.
• Learn why diabetes is serious.
• Learn how caring for your diabetes helps you feel better today and in the future.
  

 

---

Step 2: Know your diabetes ABCs.

Talk to your health care team about how to manage your A1C, Blood pressure, and Cholesterol. This can help lower your chances of having a heart attack, stroke, or other diabetes problems. Here’s what the ABCs of diabetes stand for:

A for the A1C test (A-one-C).

It shows what your blood glucose has been over the last three months. The A1C goal for many people is below 7. High blood glucose can harm your heart and blood vessels, kidneys, feet, and eyes.

B for Blood pressure.

The goal for most people with diabetes is below 130/80.

High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.

C for Cholesterol (ko-LES-ter-ol).

The LDL goal for people with diabetes is below 100.
The HDL goal for men with diabetes is above 40.
The HDL goal for women with diabetes is about 50.

LDL or “bad” cholesterol can build up and clog your blood vessels. It can cause a heart attack or a stroke. HDL or “good” cholesterol helps remove cholesterol from your blood vessels.

• Ask your health care team:
  • what your A1C, blood pressure, and cholesterol numbers are
  • what your A1C*, blood pressure, and cholesterol numbers should be
  • what you can do to reach your targets
• Write down all your numbers on the record card at the back of this booklet.

*An A1C of less than 7 is the goal for many people but not for everyone. Talk to your health care team about what A1C target is right for you.

---

Step 3: Manage your diabetes.

Many people avoid the long-term problems of diabetes by taking good care of themselves. Work with your health care team to reach your ABC target. Use this self-care plan.

• Follow your diabetes meal plan.If you do not have one, ask your health care team to help you develop a meal plan.
  • Eat healthy foods such as fruits and vegetables, fish, lean meats, chicken or turkey without the skin, dry peas or beans, whole grains, and low-fat or skim milk and cheese.
  • Keep fish and lean meat and poultry portions to about 3 ounces (or the size of a deck of cards). Bake, broil, or grill it.
  • Eat foods that have less fat and salt.
  • Eat foods with more fiber such as whole grain cereals, breads, crackers, rice, or pasta.
• Get 30 to 60 minutes of physical activity on most days of the week. Brisk walking is a great way to move more.
• Stay at a healthy weight by using your meal plan and moving more.
• Ask for help if you feel down. A mental health counselor, support group, member of the clergy, friend, or family member who will listen to your concerns may help you feel better.
• Learn to cope with stress. Stress can raise your blood glucose. While it is hard to remove stress from your life, you can learn to handle it. NDEP’s Diabetes HealthSense provides online access to resources that support people with diabetes in making changes to live well. For more information visit www.YourDiabetesInfo.org/HealthSense.
• Stop smoking. Ask for help to quit. Call 1-800-QUITNOW (1-800-784-8669)
• Take medicines even when you feel good. Ask your doctor if you need aspirin to prevent a heart attack or stroke. Tell your doctor if you cannot afford your medicines or if you have any side effects.
• Check your feet every day for cuts, blisters, red spots, and swelling. Call your health care team right away about any sores that do not go away.
• Brush your teeth and floss every day to avoid problems with your mouth, teeth, or gums
• Check your blood glucose. You may want to test it one or more times a day. Use the card at the back of this booklet to keep a record of your blood glucose numbers. Be sure to show it to your health care team.
• Check your blood pressure if your doctor advises.
• Report any changes in your eyesight to your health care team.

• Talk with your health care team about your blood glucose targets. Ask how and when to test your blood glucose and how to use the results to manage your diabetes.
• Use this plan as a guide to your self-care.
• Discuss how your self-care plan is working for you each time you visit your health care team.

 

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Step 4: Get routine care.

See your health care team at least twice a year to find and treat any problems early.

At each visit be sure you have a:

• blood pressure check
• foot check
• weight check
• review of your self-care plan shown in Step 3

Two times each year have an:

• A1C test – it may be checked more often if it is over 7

Once each year be sure you have a:

• cholesterol test
• triglyceride (try-GLISS-er-ide) test – a type of blood fat
• complete foot exam
• dental exam to check teeth and gums – tell your dentist you have diabetes
• dilated eye exam to check for eye problems
• flu shot
• urine and a blood test to check for kidney problems

At least once get a:

• pneumonia (nu-mo-nya) shot

• Ask your health care team about these and other tests you may need. Ask what yours results mean.
• Write down the date and time of your next visit.
• Use the card at the back of this booklet to keep a record of your diabetes care.
• If you have Medicare, ask your health care team if Medicare will cover some of the costs for
  • learning about healthy eating and diabetes self-care
  • special shoes, if you need them
  • medical supplies
  • diabetes medicines

 

---

My Diabetes Care Record

Record your targets and the date, time, and results of your tests. Take this card with you on your health care visits. Show it to your health care team to remind them of tests you need.

My Diabetes Care Record card

Self Checks of Blood Glucose

Record your targets and the date, time, and results of your checks. Take this card with you on your health care visits. Show it to your health care team.

Self Checks of Blood Glucose card

---

Where to get help:

Many of these groups offer items in English and Spanish.

National Diabetes Education Program
1-888-693-NDEP (1-888-693-6337)
www.YourDiabetesInfo.org

Diabetes HealthSense
An online library of resource for living well.
www.YourDiabetesInfo.org/HealthSense

National Kidney Disease Education Program
1-866-4-KIDNEY (1-866-454-3639)
www.nkdep.nih.gov

National Institute of Diabetes and Digestive and Kidney Diseases
National Diabetes Information Clearinghouse
1-800-860-8747
www.niddk.nih.gov

American Association of Diabetes Educators
1-800-TEAM-UP4 (1-800-832-6874)
www.diabeteseducator.org

American Diabetes Association
1-800-DIABETES (1-800-342-2383)
www.diabetes.org

American Dietetic Association
1-800-366-1655
www.eatright.org

American Heart Association
1-800-AHA-USA1 (1-800-242-8721)
www.americanheart.org

Centers for Disease Control and Prevention
1-800-CDC-INFO (1-800-232-4636)
www.cdc.gov/diabetes

Centers for Medicare & Medicaid Services
1-800-MEDICARE (1-800-633-4227)
www.medicare.gov/navigation/manage-your-health/preventive-services/diabetes-screening.aspx

Source:

What I Need to Know About Diabetes Medicines

 

What I need to know about Diabetes Medicines

On this page:

• What do diabetes medicines do?
• What targets are recommended for blood glucose levels?
• What happens to blood glucose levels in people with diabetes?
• Medicines for My Diabetes
• Types of Diabetes Medicines
• What do I need to know about side effects of medicines?
• For More Information
• Acknowledgments

Inserts:

• Insert A: My Diabetes Medicines
• Insert B: Questions to Ask about Your Diabetes Medicines
• Insert C: Types of Insulin
• Insert D: Glyset and Precose (Alpha-Glucosidase Inhibitors)
• Insert E: Glucophage, Glucophage XR, and Riomet (Biguanides)
• Insert F: Starlix (D-Phenylalanine Derivative)
• Insert G: Januvia (DPP-4 Inhibitor)
• Insert H: Prandin (Meglitinide)
• Insert I: Amaryl, DiaBeta, Diabinese, Glucotrol, Glucotrol XL, Glynase PresTab, Micronase, tolazamide, and tolbutamide (Sulfonylureas)
• Insert J: Actos and Avandia (Thiazolidinediones)
• Insert K: Actoplus Met, Avandamet, Avandaryl, Duetact, Glucovance, Janumet, and Metaglip (Combination Diabetes Pills)
• Insert L: Symlin (Amylin Mimetic)
• Insert M: Byetta (Incretin Mimetic)
• Insert N: About Low Blood Glucose

What do diabetes medicines do?

Over time, high levels of blood glucose, also called blood sugar, can cause health problems. These problems include heart disease, heart attacks, strokes, kidney disease, nerve damage, digestive problems, eye disease, and tooth and gum problems. You can help prevent health problems by keeping your blood glucose levels on target.

Everyone with diabetes needs to choose foods wisely and be physically active. If you can’t reach your target blood glucose levels with wise food choices and physical activity, you may need diabetes medicines. The kind of medicine you take depends on your type of diabetes, your schedule, and your other health conditions.

You may need diabetes medicines to reach your blood glucose targets.

Diabetes medicines help keep your blood glucose in your target range. The target range is suggested by diabetes experts and your doctor or diabetes educator. See below for more information about target levels for good health.

 

What targets are recommended for blood glucose levels?

The National Diabetes Education Program uses blood glucose targets set by the American Diabetes Association (ADA) for most people with diabetes. To learn your daily blood glucose numbers, you’ll check your blood glucose levels on your own using a blood glucose meter.

Target blood glucose levels for most people with diabetes
My targets:

Before meals:
70 to 130 mg/dL^*

1 to 2 hours after the start of a meal:
Less than 180 mg/dL

* Milligrams per deciliter.

Also, you should ask your doctor for a blood test called the A1C at least twice a year. The A1C will give you your average blood glucose for the past 3 months.

Target A1C result for people with diabetes
My targets:

Less than 7 percent

Your personal A1C goal might be higher or lower than 7 percent. Keeping your A1C as close to normal as possible—below 6 percent without having frequent low blood glucose—can help prevent long-term diabetes problems. Doctors might recommend other goals for very young children, older people, people with other health problems, or those who often have low blood glucose.

Talk with your doctor or diabetes educator about whether the target blood glucose levels and A1C result listed in the charts above are best for you. Write your own target levels in the charts. Both ways of checking your blood glucose levels are important.

If your blood glucose levels are not on target, you might need a change in how you take care of your diabetes. The results of your A1C test and your daily blood glucose checks can help you and your doctor make decisions about:

• what you eat
• when you eat
• how much you eat
• what kind of exercise you do
• how much exercise you do
• the type of diabetes medicines you take
• the amount of diabetes medicines you take

 

What happens to blood glucose levels in people with diabetes?

Blood glucose levels go up and down throughout the day and night in people with diabetes. High blood glucose levels over time can result in heart disease and other health problems. Low blood glucose levels can make you feel shaky or pass out. But you can learn how to make sure your blood glucose levels stay on target—not too high and not too low.

What makes blood glucose levels go too high?

Your blood glucose levels can go too high if: 

• you eat more than usual
• you’re not physically active
• you’re not taking enough diabetes medicine
• you’re sick or under stress
• you exercise when your blood glucose level is already high

        Some diabetes medicines can also lower your blood glucose too much. Ask your doctor whether your diabetes medicines can cause low blood glucose. SeeInsert N for information about low blood glucose.

The results of your blood glucose checks can help you make decisions about your diabetes medicines, food choices, and physical activity.

 

Medicines for My Diabetes

Ask your doctor what type of diabetes you have and write down your answer.

I have:

• type 1 diabetes
• type 2 diabetes
• gestational diabetes
• another type of diabetes: ____________________

Medicines for Type 1 Diabetes

Type 1 diabetes, once called juvenile diabetes or insulin-dependent diabetes, is usually first found in children, teenagers, or young adults. If you have type 1 diabetes, you must take insulin because your body no longer makes it. You also might need to take other types of diabetes medicines that work with insulin.

Medicines for Type 2 Diabetes

Type 2 diabetes, once called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. It can start when the body doesn’t use insulin as it should, a condition called insulin resistance. If the body can’t keep up with the need for insulin, you may need diabetes medicines. Many choices are available. Your doctor might prescribe two or more medicines. The ADA recommends that most people start with metformin, a kind of diabetes pill.

Medicines for Gestational Diabetes

Gestational diabetes is diabetes that occurs for the first time during pregnancy. The hormones of pregnancy or a shortage of insulin can cause gestational diabetes. Most women with gestational diabetes control it with meal planning and physical activity. But some women need insulin to reach their target blood glucose levels.

Medicines for Other Types of Diabetes

If you have one of the rare forms of diabetes, such as diabetes caused by other medicines or monogenic diabetes, talk with your doctor about what kind of diabetes medicine would be best for you.

 

Types of Diabetes Medicines

Diabetes medicines come in several forms.

Insulin

If your body no longer makes enough insulin, you’ll need to take it. Insulin is used for all types of diabetes. Your doctor can help you decide which way of taking insulin is best for you.

• Taking injections. You’ll give yourself shots using a needle and syringe. The syringe is a hollow tube with a plunger. You will put your dose of insulin into the tube. Some people use an insulin pen, which looks like a pen but has a needle for its point.
• Using an insulin pump. An insulin pump is a small machine about the size of a cell phone, worn outside of your body on a belt or in a pocket or pouch. The pump connects to a small plastic tube and a very small needle. The needle is inserted under the skin and stays in for several days. Insulin is pumped from the machine through the tube into your body.
• Using an insulin jet injector. The jet injector, which looks like a large pen, sends a fine spray of insulin through the skin with high-pressure air instead of a needle.
  If your body no longer makes enough insulin, you’ll need to take it.

What does insulin do?

Insulin helps keep blood glucose levels on target by moving glucose from the blood into your body’s cells. Your cells then use glucose for energy. In people who don’t have diabetes, the body makes the right amount of insulin on its own. But when you have diabetes, you and your doctor must decide how much insulin you need throughout the day and night.

What are the possible side effects of insulin?

Possible side effects include:

• low blood glucose (for more information, see Insert N)
• weight gain

How and when should I take my insulin?

Your plan for taking insulin will depend on your daily routine and your type of insulin. Some people with diabetes who use insulin need to take it two, three, or four times a day to reach their blood glucose targets. Others can take a single shot. Your doctor or diabetes educator will help you learn how and when to give yourself insulin.

Types of Insulin

Each type of insulin works at a different speed. For example, rapid-acting insulin starts to work right after you take it. Long-acting insulin works for many hours. Most people need two or more types of insulin to reach their blood glucose targets.

Look at the list of types of insulin on Insert C. Check off the names of the kinds of insulin you take. Then print and write the names of your insulins under My Insulins in the chart on Insert A.

Diabetes Pills

Along with meal planning and physical activity, diabetes pills help people with type 2 diabetes or gestational diabetes keep their blood glucose levels on target. Several kinds of pills are available. Each works in a different way. Many people take two or three kinds of pills. Some people take combination pills. Combination pills contain two kinds of diabetes medicine in one tablet. Some people take pills and insulin.

Diabetes pills help people with type 2 diabetes or gestational diabetes keep their blood glucose levels on target.

Your doctor may ask you to try one kind of pill. If it doesn’t help you reach your blood glucose targets, your doctor may ask you to:

• take more of the same pill
• add another kind of pill
• change to another type of pill
• start taking insulin
• start taking another injected medicine

If your doctor suggests that you take insulin or another injected medicine, it doesn’t mean your diabetes is getting worse. Instead, it means you need insulin or another type of medicine to reach your blood glucose targets. Everyone is different. What works best for you depends on your usual daily routine, eating habits, and activities, and your other health conditions.

For information about the different kinds of pills and what they do, see the inserts. You’ll see the brand name and the generic name—the scientific name—for each medicine. Find your diabetes pills and check off the names. Then print and write the names of your diabetes pills under My Pills and Injected Medicines in the chart on Insert A.

Injections Other Than Insulin

In addition to insulin, two other types of injected medicines are now available. Both work with insulin—either the body’s own or injected—to help keep your blood glucose from going too high after you eat. Neither is a substitute for insulin.

See the cards in the pocket of this booklet for more information about these injected medicines. Check off the kinds you take. Then write the names of your injected medicines under My Pills and Injected Medicines in the chart on Insert A.

Talk with your doctor if you have questions about your diabetes medicines. Do not stop taking your diabetes medicines without checking with your doctor first. See Insert B for a list of questions to ask your doctor about your medicines.

 

What do I need to know about side effects of medicines?

A side effect is an unwanted problem caused by a medicine. For example, some diabetes medicines can cause nausea or an upset stomach when you first start taking them. Before you start a new medicine, ask your doctor about possible side effects and how you can avoid them. If the side effects of your medicine bother you, tell your doctor.

 

For More Information

To find diabetes educators—nurses, dietitians, and other health professionals—near you, call the American Association of Diabetes Educators toll-free at 1–800–TEAMUP4 (1–800–832–6874). Or go to www.diabeteseducator.org and see the “Find a Diabetes Educator” section.

For additional information about diabetes, contact

American Diabetes Association
National Service Center
1701 North Beauregard Street
Alexandria, VA 22311–1742
Phone: 1–800–DIABETES (1–800–342–2383)
Fax: 703–549–6995
Email: AskADA@diabetes.org
Internet: www.diabetes.org

Juvenile Diabetes Research Foundation International
26 Broadway, 14th Floor
New York, NY 10004
Phone: 1–800–533–CURE (1–800–533–2873)
Fax: 212–785–9595
Email: info@jdrf.org
Internet: www.jdrf.org

National Diabetes Education Program
1 Diabetes Way
Bethesda, MD 20814–9692
Phone: 1–888–693–NDEP (1–888–693–6337)
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndep@mail.nih.gov
Internet: www.ndep.nih.gov

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. Consult your doctor for more information.

 

Acknowledgments

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This booklet was reviewed by Stuart T. Haines, Pharm.D., University of Maryland School of Pharmacy, Baltimore.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

---

Source

National Diabetes Information Clearinghouse

1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov

The National Diabetes Information Clearinghouse (NDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1978, the Clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public. The NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.

---

NIH Publication No. 11–4222
October 2010

Foot Health Critical for People With Diabetes

 

Foot Health Critical for People With Diabetes

April is Foot Health Month. Remember: Don’t take foot health for granted—especially if you have diabetes. Prevent foot problems by controlling diabetes and practicing good foot health.

Diabetes and Foot Health

Almost 26 million people in the United States have diabetes and many more are at high risk for developing diabetes. Problems with the legs and feet caused by diabetes are common and can be severe. These problems cause suffering and reduce one’s quality of life. In recognition of Foot Health Month, April 2011, the Centers for Disease Control and Prevention’s Division of Diabetes Translation (CDC/DDT) wants to make sure that you are aware that people with diabetes can develop many different foot problems and to remind you that foot health should not be taken for granted.

In 2006 alone, about 65,700 people with diabetes had a leg or foot amputated. This is more than 60% of the amputations of legs and feet not resulting from an injury, such as from a car crash. Many of these amputations could be prevented by taking good care of your feet and your health:

• Learning to manage your diabetes
• Making healthy food choices
• Staying at a healthy weight
• Being physically active every day
• Taking your medicines even when you feel good
• Having your doctor give you a comprehensive foot exam every time you visit (but at least four times a year)
• Checking your feet for sores and other injuries every day
• Wearing shoes that fit right and do not rub or pinch your feet, or cause blisters. Never walking barefoot or while wearing just socks.

Links to Foot Health Resources

The National Diabetes Education Program (NDEP), jointly led by CDC/DDT and the National Institutes of Health, provides several web pages and publications with helpful information on foot care and diabetes care. Click on the web links below and see the Foot Health Facts section of this feature for important information on diabetes prevention and control, foot health, and what you can do to maximize your likelihood for good health in the future.

Take Care of Your Feet for a Lifetime is a booklet from NDEP with information on foot care and how to avoid foot problems.

Cuide sus pies durante toda su vida es un folleto ilustrado de NDEP que le ayuda a cuidar sus pies y ofrece consejos para evitar problemas graves de los pies.

4 Steps to Control Your Diabetes. For Life.  [PDF - 2.87MB] These four steps help people with diabetes understand, monitor, and manage their diabetes to help them stay healthy. This publication, available in English, Spanish, and other languages, is excellent for people newly diagnosed with diabetes or for those who want to learn more about controlling the disease. It has information on the importance of getting routine care to avoid diabetes complications.

Feet Can Last a Lifetime: A Health Care Provider’s Guide to Preventing Diabetes Foot Problems is a foot care guide from NDEP targeted to health care professionals.

What should I do on a regular basis to take care of my feet?is a CDC diabetes web page with a list of simple ways to care for and avoid potential problems with your feet.

Chapter 9. Foot Problemsin DDT’s Take Charge of Your Diabetespublication compiles tips for diabetes control and care along with information on diabetes and its health complications.

Foot Health Facts

• 
• These are some of the ways that diabetes can harm your feet:  
  • Diabetes slows blood flow to certain areas of the body, especially limbs such as the legs, which impairs your body’s ability to heal injuries.
  • Diabetes nerve damage may cause you to no longer feel pain in your feet, and you may not realize you have a wound or injury that needs care.
• Diabetic nerve damage appears to be more common in people who have had problems controlling their blood glucose (sugar) levels, in those with high cholesterol or high blood pressure, in overweight people, and in people older than 40 years.
• These are some signs of problems with your feet or legs. If you experience any of these symptoms, you need to contact your health care provider or a podiatrist (foot doctor) right away.
  • You may feel pain in your legs or cramping in your buttocks, thighs, or calves during physical activity.
  • Your feet may tingle, burn, or hurt.
  • You may lose the sense of touch or not be able to feel heat or cold very well.
  • The shape of your feet may change over time.
  • The color and temperature of your feet may change.
  • You may lose hair on your toes, feet, and lower legs.
  • The skin on your feet may become dry and cracked.
  • Your toenails may turn thick and yellow.
  • Fungus infections may appear between your toes.
  • You may experience blisters, sores, ulcers, infected corns, and ingrown toenails.

• Esta página en español

 

Contact Us:

• Centers for Disease Control and Prevention
  1600 Clifton Rd
  Atlanta, GA 30333
• 800-CDC-INFO
  (800-232-4636)
  TTY: (888) 232-6348
  24 Hours/Every Day
• cdcinfo@cdc.gov

Content source: National Center for Chronic Disease Prevention and Health Promotion, Division of Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, 24 Hours/Every Day – cdcinfo@cdc.gov

Insulin Pump Therapy

Dr. Steven Edelman discusses how insulin pump therapy works, who can benefit from using an insulin pump, and common concerns people have before starting.

Source: UCtelevision on YouTube

Diabetes and Depression

Diabetes at Work: What’s Depression Got to Do with It?

The purpose of “Diabetes at Work: What’s Depression Got to Do with It?” is to provide employers with information about the association between diabetes and depression, the economic cost of untreated depression, and the role that employers can take to help employees who are experiencing both illnesses.

The following case study describes the experience of an employee who has both diabetes and depression.

Case Study:

Cindy S. is a 52-year old employee at Networth Industries, Inc. More than 5 years ago, Cindy was diagnosed with diabetes. For the last 2 months, Cindy has found that she is less interested in tasks that she used to enjoy at work such as analyzing data, reporting the findings to management, and presenting the results to national stakeholders. Most days, it is difficult for Cindy to get out of bed and to make it to work on time. Once there Cindy finds herself distracted and unable to complete tasks that used to take her only an hour to finish. Cindy has noticed that she feels sad most of the time and has had trouble sleeping and remembering to take her diabetes medication. Cindy has thought about telling her supervisor that she feels depressed, but she worries about whether she will lose her job because she now has both diabetes and depression.

This case study highlights several of the concerns and challenges that employees with diabetes and depression may experience at the workplace. This Web page will review key topics highlighted in the case study and the role of the employer when their employee experiences both diabetes and depression. The topics that will be covered include the following:

• An introduction and statistics related to depression and diabetes
• The symptoms of depression
• Gender differences and depression
• The seriousness of depression in diabetes
• Concerns for employers when their employee has diabetes and depression
• The impact that depression can have on job functioning
• How depression may manifest in the workplace
• The Americans with Disabilities Act
• How an employer can help an employee who has depression
• Treatment options
• Resources for diabetes and depression

Depression and Diabetes: Is There a Link?

Evidence suggests that an association between depression and diabetes exists, but it is not clear which comes first or why they are often linked. What is clear is that both depression and diabetes can be effectively managed and treated.

Anyone can develop depression, but people with diabetes may be at greater risk. Depression might result from the daily burden of having diabetes.1 Recent research has reported that depression is twice as common in people who have diabetes than it is in people who do not have this disease. In addition, the chances of becoming depressed increases as diabetes complications worsen.

Additional information from research on depression and diabetes suggests that depression alone may also increase the likelihood of a person developing type 2 diabetes. In fact, research shows that depressed adults have a 37% increased risk of developing type 2 diabetes.

Clinical depression is one of the most costly illnesses in the world. It is also a leading cause of disability in the United States and worldwide. Approximately 70% of people who have depression are employed; depression results in 400 million lost work days a year. It is estimated that the annual salary-equivalent cost of major depression due to work loss in the U.S. labor force is $44 billion per year.¹³

Although depression can occur at any age, it tends to affect people in their prime working years, 25-44 years of age, and, if untreated, can last a lifetime.

Employers should know that there are several treatment options available to assist employees who are experiencing depression in the workplace. Research has shown that 80% of those who seek treatment show improvement. Depression does not have to be a debilitating disease.

What are the Symptoms of Depression?

Depression is a medical condition that should be diagnosed and treated by a trained healthcare professional, such as a primary care provider, psychiatrist, psychologist, or a social worker. Occupational health nurses, wellness coordinators, employers, supervisors and co-workers can be the first to recognize signs of depression in a fellow employee.

Depression is more than occasionally feeling sad, stressed, or irritable. People with depression tend to have some ofthe following symptoms most of the day for at least two weeks:

• Frequent feelings of sadness that last most of the day
• Decreased interest in most things that were once enjoyed
• Loss of self-esteem or feelings of guilt and worthlessness
• Sleep problems, such as sleeping too much or having trouble sleeping
• Difficulty concentrating or making decisions
• Unintentional changes in weight (weight loss or gain)
• Irritability or restlessness
• Decreased energy
• Possible thoughts of death or suicide

Who Gets Depression?

While anyone can develop depression—there are some differences based on gender.

• Women are twice as likely to become depressed as men. About 10-25% of all women will be depressed during their lives.
• Men have a lower risk for depression than women, but when they are depressed they are more likely to go undiagnosed and less likely to seek help. Men may experience the typical symptoms of depression, but they may also feel more angry and irritable. They may also be more likely to try and relieve their condition with alcohol or drug abuse. Depression increases the risk for suicide and men who have suicidal thoughts are more likely to die of suicide than women with suicidal thoughts. However, suicidal thoughts in all individuals should be taken very seriously and the person who has those thoughts should be evaluated by a mental health professional.

Why is Depression in Diabetes Serious?

Depression in diabetes is very concerning for several reasons:

• Individuals who are depressed may have more difficulty following the medical treatment that their health care team establishes challenging. For example, depressed persons might not take their medication as prescribed or monitor their glucose levels as health care professionals recommend.
• Depression can result in poor physical and mental functioning, so a person is less likely to maintain regular physical activity.
• Individuals who are depressed might adopt unhealthy behaviors, such as a sedentary lifestyle and/or a poor diet.
• Social isolation is also common for people who are depressed, which decreases opportunities for social support that is often needed for self-management of diabetes.
• Untreated depression in diabetes can result in
  • Hyperglycemia (high blood glucose)
  • Poor metabolic control
  • Decreased quality of life
  • Increased health care usage and costs
  • Increased risk of mortality
• Untreated depression places people with diabetes at risk for complications that could be avoided. These complications include—
  • Heart disease
  • Blindness
  • Amputations
  • Erectile Dysfunction
  • Stroke
  • Kidney disease

DID YOU KNOW THAT…

Treating depression may help a person’s mood and glucose control.

Why Should Employers Be Concerned?

Depression in people who also have diabetes is associated with increased health care costs. Total health care expenditures for individuals with depression was 4.5 times higher than for individuals without depression.

Like diabetes, depression is serious, common and costly, but also potentially preventable and definitely treatable. Yet many people who have both diabetes and depression do not seek treatment for their depressive symptoms. Although depression affects more than 19 million Americans every year, fewer than half seek treatment.

Depression is often unrecognized and undertreated in health care settings. Researchers have found that only 30% of patients with depression and diabetes receive adequate treatment for depression and fewer than 20% complete more than four visits for psychotherapy.

There are many reasons why employees may be reluctant to seek out help for depression:

• Cost. Some people may avoid seeking medical attention for chronic conditions, such as depression and diabetes, because of the additional cost and burden that it may place on the individual or family budget. There could also be concern about the cost associated with lost time from work.
• Stigma. Many people feel there is a stigma associated with depression. Employees might also be concerned with how employers and colleagues will respond if the employee discloses that he or she is depressed.
• Shame. Some employees may be embarrassed or self-conscious about needing to ask for help, or may view depression as a “weakness” or as being their fault.
• Being uninformed.
  • Some employees may not be aware of available treatment options. Some who have begun treatment might not have been aware that medications take time to yield the desired levels for benefit. Such persons sometimes discontinue medications before the medications had time to work.
  • Some employees may be unaware of health benefits that their employer provides and what their insurance may cover.
  • In addition, some individuals may be unaware that they are depressed or they may believe that they can take care of themselves on their own.
• Cultural differences. Research regarding ethnic minorities’ attitudes toward seeking professional mental health care has yielded inconsistent results. For example, in one study, mistrust and opinions about mental illness was found to negatively impact help-seeking behavior among African Americans. Other studies have found more positive attitudes towards mental health treatment and medication options for African Americans and Hispanics.

How Does Depression Impact Job Functioning?

Depression can interfere with job functioning in several ways. For example, depression can affect a person’s ability to perform tasks, to think clearly, or to communicate with others.

People who suffer from depression sometimes have difficulty—

• Sustaining concentration
• Maintaining stamina
• Handling pressures, deadlines, and multiple tasks
• Interacting with others
• Responding to negative feedback
• Responding to change

How Might Untreated Depression Manifest Itself in the Workplace?

Untreated depression can manifest itself in the following ways at the work site:

• Consistent late arrivals or frequent absences
• Irritability
• Substance use or abuse
• Low morale
• Increased lack of cooperation or an inability to work with others
• Decreased productivity
• Problems concentrating
• Safety problems as a result of problems with attention
• Poor work or missed deadlines
• Decreased interest in one’s work
• Frequent complaints of body aches or fatigue

Employers, supervisors, and co-workers can be the first to recognize significant changes in an employee’s work habits, behaviors, performance, and attendance. However, employers must also be aware that individuals with psychiatric or physical disabilities have rights, which are covered under the Americans with Disabilities Act.

What Legal Rights do Employees have When They have a Physical or Psychiatric Disability?

The Americans with Disabilities Act:

• prohibits employment discrimination against individuals with disabilities in the private sector, and in state and local governments,  and it
• prohibits discrimination in all employment practices, including:
  • job application procedures,
  • hiring,
  • firing,
  • advancement,
  • compensation,
  • training, and
  • other terms, conditions, and privileges of employment.

The Americans with Disabilities Act covers qualified individuals with physical and psychiatric disabilities, such as mental disorders. Diabetes or depression would be considered a disability under the Americans with Disabilities Act if the disease substantially limits one or more of a person’s major life activities, such as eating or caring for oneself. Diabetes would also be considered a disability when it causes side effects or complications that substantially limit a major life activity.

The Americans with Disabilities Act prohibits employers from asking employees and job applicants whether they have a psychiatric or physical disability. Disclosure about one’s mental or physical condition is a personal decision and an employee should not be coerced into informing an employer or colleagues about their health. However, if the employer has concrete reasons to believe that a physical or psychiatric condition may be affecting an employee’s ability to perform their job, the employer may ask questions or have the employee obtain a medical examination.

If an employee discloses that he or she has a physical or psychiatric disability, the employer may only ask whether there is a need for a reasonable accommodation and type of accommodation needed.

For more information about disability and diabetes in the workplace please visit: www.eeoc.gov./facts/diabetes.html.

What Accommodations Must an Employer Make for an Employee with a Disability?

Individuals with disabilities can perform all types of jobs in a variety of settings. However, employers may exclude such persons from certain positions because of stereotypes and fears about what types of work such individuals can perform. Employees with diabetes and/or depression may require a change in their workplace setting to allow them to better manage their condition.

Under the Americans with Disabilities Act, employers must make reasonable accommodations to individuals with a known disability.37 Examples of reasonable accommodations might include:

• Time-off for scheduled medical appointments
• Regular work schedules
• Meal breaks
• A place to test blood sugar levels
• Clear delineation of performance expectations
• Schedules which allow for flex-time
• Extending additional leave to allow an employee to keep his or her job after a hospitalization.

Think back to the case study of Cindy S, repeated here.

Case Study:

Cindy S. is a 52-year old employee at Networth Industries, Inc. More than 5 years ago, Cindy was diagnosed with diabetes. For the last 2 months, Cindy has found that she is less interested in tasks that she used to enjoy at work such as analyzing data, reporting the findings to management, and presenting the results to national stakeholders. Most days, it is difficult for Cindy to get out of bed and to make it to work on time. Once there Cindy finds herself distracted and unable to complete tasks that used to take her only an hour to finish. Cindy has noticed that she feels sad most of the time and has had trouble sleeping and remembering to take her diabetes medication. Cindy has thought about telling her supervisor that she feels depressed, but she worries about whether she will lose her job because she now has both diabetes and depression.

Points to consider:

What legal protection does Cindy S. have under the Americans with Disabilities Act?

• In order for Cindy to have any legal protection under the Americans with Disabilities Act, the diabetes or the depression must substantially limit Cindy’s major life activities. More information is needed to determine whether her condition(s) limit her major life activities, such as thinking, eating, or caring for herself.

What accommodations must the employer make to assist Cindy S. in returning to the work site?

• If it has been determined that diabetes or depression substantially limits Cindy’s major life activities, then her employer must make reasonable accommodations. These adjustments could include:
  • Time-off for scheduled medical appointments
  • A place to test blood sugar levels
  • Schedules which allow for flex-time

How can the employer assist Cindy S. if she discloses that she has depression?

• The employer should handle this situation with confidentiality.
• Employers should not attempt to treat a person with diabetes, but instead provide the employee with the assistance needed to receive the appropriate care.
• If an employee assistance program exists, the employer should assist the employee with seeking such services.

How Can an Employer Help an Employee who is Depressed?

If an employee is struggling with depression, the employer can be a valuable resource.

In reaching out to an employee who has disclosed that he or she is suffering from depression, employers should remember to handle this situation with confidentiality.

Employers should avoid trying to diagnose or treat a person with depression. Instead, the primary objective of the employer should be to assist the employee with receiving the appropriate, professional help needed, such as through an employee assistance program, which may be available at the work site.

In providing assistance to an employee with depression, employers should—

• Be empathetic and understanding
• Avoid critical or shaming statements
• Emphasize that depression is treatable
• Provide information to employees about symptoms of depression and treatment options.

Employers can also raise awareness about depression by—

• Educating management and employees about depression and effective treatment options
• Informing employees of the availability of an employee assistance program
• Provide an easily accessible behavioral health system
• Including depression recognition screenings and stress management at health fairs
• Developing a return-to-work plan for employees who have been absent from work due to depression

To learn more about depression resources that are available, please visit the “Resources” section of this Web page.

Can Depression be Treated?

There is good news! Depression, with or without diabetes, can be treated. It is important to diagnose depression early and accurately to reduce the risk of developing diabetes and/or diabetes complications. Treating depression has also been found to improve diabetes control. In addition, appropriate treatment and monitoring of depression can increase workplace productivity, lower absenteeism, and decrease disability costs.

There are currently a variety of highly effective interventions available for treating depression. The majority of depressive disorders can be treated with either psychotherapy (talk therapy), antidepressants, or both treatments together. A combination of psychotherapy and medication has been identified as being most effective. Psychotherapy allows people the opportunity to learn skills to reduce their depression or to address underlying issues associated with the depression.

In treating diabetes and depression, it is important for the health care team (e.g., the family doctor, endocrinologist, diabetes health care team, psychiatrist, social worker, or clinical psychologist) to all work closely together. Occupational health nurses or other work site medical professionals also play an important role in this health care team. Work site medical professionals may have suggestions for employers on how to deal with depression in the workplace. In addition, such health professionals may also be able to provide employees with referrals for mental health professionals who practice in specific communities near the work site or that are convenient for the employee.

Where Can Employers Find More Information about Diabetes at Work?

The National Diabetes Education Program (NDEP), which is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention, provides information for employers on its Web site: http://www.diabetesatwork.org/.

DiabetesAtWork.org can help businesses and managed care companies to assess the impact of diabetes in the workplace, and provide intuitive information to help employees manage their diabetes and take steps toward reducing risks for related complications, such as heart disease.

DiabetesAtWork.org can help you:

• Develop a diabetes prevention or management program.
• Estimate the number of employees in your company with diabetes.
• Estimate the total cost of diabetes in your company.
• Choose or design a health plan for people with diabetes.
• Obtain support from leadership for a diabetes program.

NDEP also maintains a Web site, http://www.yourdiabetesinfo.org/ which has educational materials on diabetes prevention and control for business professionals. On the YourDiabetesInfo.org Web site, employers can find out more information about diabetes, such as:

• How business leaders can become more involved in workplace and community activities to help control diabetes related complications to reduce the human and economic impact of this serious disease.
• How to plan a workshop for employers and business coalitions to address diabetes in the workplace.

Resources for Diabetes Prevention and Control

The following resources provide information, products, and tools about diabetes prevention and control:

American Association of Diabetes Educators
http://www.diabeteseducator.org/*

American Diabetes Association
http://www.diabetes.org/*

Centers for Disease Control and Prevention
www.cdc.gov/diabetes

Diabetes Action Research and Education Foundation
http://www.diabetesaction.org/*

Diabetes Education and Sports Association
http://www.diabetes-exercise.org/*

Diabetes Prevention Program
www.bsc.gwu.edu/dpp/manuals.htmlvdoc*

National Diabetes Information Clearinghouse
diabetes.niddk.nih.gov
diabetes.niddk.nih.gov/spanish/index.asp (Spanish Web page)

The National Diabetes Education Program
http://www.yourdiabetesinfo.org/*
www.cdc.gov/diabetes/ndep
http://www.diabetesatwork.org/*
http://www.betterdiabetescare.nih.gov/

Resources for Depression

Several resources are available for employers and employees who are dealing with depression issues at the workplace. These resources include:

Agency for Health Care Policy and Research
Depression is a treatable illness No 5
www.AHRQ.gov/consumer

American Academy of Family Physicians
Patient Education Information
familydoctor.org/handouts/587.html*

American Psychiatric Association
http://www.psych.org/*
http://www.healthyminds.org/*

American Psychological Association
http://www.apa.org/*

A Pathway for Life Long Mental Health: A Mental Health Resource Guide
http://www.freedomfromfear.org/*

Depression and Bipolar Support Alliance
http://www.dbsalliance.org/*

Depression Booklet:
http://www.1on1health.com/

Depression Health Center
my.webmd.com/medical_information/condition_centers/depression/default.htm

Depression in the Workplace Magazine
www.managedcaremag.com/workplace

Depression Screening Test: An Online Self-test for Depression
psychcentral.com/depquiz.htm

Depression—You Don’t Have to Feel that Way. American Family Physician. Published by the American Academy of Family Physicians. March 1, 2000. www.aafp.org/afp/20000301/1523ph.html*

Mental Health Matters: Self Help Center: Video and Audio Tapes.
www.mental-health-matters.com/selfhelp/m_media.php

National Alliance on Mental Illness
http://www.nami.org/*

National Business Group on Health. An Employer’s Guide to Behavioral Health Services: A Roadmap and Recommendations for Evaluating, Designing, and Implementing Behavioral Health Services. www.businessgrouphealth.org/pdfs/fullreport_behavioralhealthservices.pdf*

National Institute of Mental Health
http://www.nimh.nih.gov/

• For NIMH’s publications on depression, please call Toll-free 1-800-421-4211
• For NIMH’s publication on diabetes and depression, visit: www.nimh.nih.gov/publicat/index.cfm

National Mental Health Association
http://www.nmha.org/*

SONRISA: A curriculum toolbox for Promotores/Community Health Workers to address mental/emotional health issues associated with diabetes. Southwest Center for Community Health Promotion, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona. Available at: www.caldiabetes.org/content_display.cfm?contentID=705&categoryID=75*

The Partnership for Workplace Mental Health

• A Mentally Healthy Workforce—It’s Good for Business http://www.workplacementalhealth.org/*

Article Source: 

The U.S. Department of Health and Human Services’ National Diabetes Education Program is jointly sponsored the National Institute of Diabetes and Digestive and kidney Diseases of the Institutes of National Health and the Division of Diabetes Translation of the Centers for Disease Control and Prevention with the support of more than 200 partner organizations.

Foot Care For Diabetics

With the estimated

 

 

 

 

 

By Shaun Parker

 

Shaun Parker is a leading podiatrist and chiropodist in London, with many years of experience in foot care. Find out more about chiropody at: http://www.gotosee.co.uk/therapies/Podiatry-(Chiropody).htm.

Not only do diabetics have to keep an eye on their diet, monitor their blood sugar levels and administer insulin shots, they must also ensure their feet are free from infection. With an estimated 120 million diabetics worldwide, podiatry has its work cut out treating the foot problems associated with diabetes. Foot ulcers, infections and even amputation are among the risks diabetics face from poor foot care. However, by following some simple guidelines, and regular visits to a podiatrist, diabetics can keep their feet clean, healthy and reduce the risk of disability.

People with diabetes have impaired nerve and circulatory function. Nerve damage can lead to a loss of sensation in the extremities, often the feet. An insensitivity to pain means the diabetic may not feel a blister, cut or sore on their foot. Poor circulation means that blood flow to the foot is reduced, impacting on the resistance to infection or the healing of an existing infection. An aggressive infection can potentially lead to the loss of a toe, foot or leg. Every year in the UK, nearly 5,000 diabetics need an amputation arising from a foot infection.

Half of all foot ulcers and amputations on people with diabetes could be prevented through improved foot care. Diabetics should develop a daily routine of inspection and cleaning along with periodic examination by a podiatrist. Diabetics should inspect their feet every morning and night checking for blisters, cuts and inflammation or toenail problems. It may be necessary to use a mirror to see the sole of the foot or ask someone else to take a look. Feet should be washed in warm water using a mild soap and dried carefully but thoroughly(paying particular attention to between the toes). Once dry, the feet should be moisturised. Podiatrists sell a specialist foot moisturiser that can prevent dry skin from cracking, however this shouldn’t be used between the toes as this can cause a fungal infection.

Toenails should be cut straight and across but not too short as this can lead to an ingrowing nail. Also file down any edges to prevent snagging. Socks should be clean, dry, changed daily and not be too tight around the ankle as this can restrict circulation (remember, diabetics can have poor circulation to the extremities). Before putting on shoes, diabetics should check inside and shake them out; a small stone can easily cause a cut or irritation to the foot. When at home, avoid walking around the house in bare feet; wear slippers with a hard rubber sole. Diabetics are advised to avoid walking in bare feet on any occasion as the risk of a scratch or cut is possible on any surface. Heat should never be applied to the feet with hot water bottles or heat pads. If feet get cold in bed at night, wear a clean pair of socks instead.

Even following all these guidelines, diabetics are as prone to corns and calluses as non-diabetics. However, diabetics should not use corn plasters or chemical agents to treat the problem. Regular podiatry visits will clear up any skin problems and if creams or solutions are needed the podiatrist will recommend safe products. A podiatrist can also give advice on correctional devices like orthotics that can be placed in the sole of the shoe to ease pressure on the foot and prevent blisters forming.

Awareness, common sense, cleanliness and treatment from a trained podiatry practitioner can prevent diabetics from developing foot problems that can potentially lead to disastrous consequences.

Source: Shaun Parker

How to Use Insulin Pens: video 6:16 min.

Source: postcare.com on YouTube

Uploaded by postcarecom on Nov 8, 2007

http://www.PreOp.com

This program will demonstrate the use of insulin pens.
The goal is to inject the insulin into the subcutaneous tissue between the top layer of the skin, the dermis and the underlying muscle layer.
Insulin pens are devices that can provide an easy way to carry and give insulin when away from home. Also, for people who are not comfortable working with syringes and bottles to draw up and measure individual doses, the pens provide a convenient and accurate alternative.
There are two types of insulin pens: * those that are completely disposable after providing a single dose of insulin * and those that use disposable cartridges to provide multiple doses. * If you use more than one type of insulin, you must use a separate pen for each type. The basic method of use is similar for both pens and there are four main steps to be learned.

An insulin pen has three components. * A base which contains the mechanism for measuring the correct dose. * A holder for the cartridge of insulin * and a cap, which is removed and replaced by the needle prior to the injection.

Follow the manufacturer’s instructions to remove the cap, separate the base from the cartridge holder by unscrewing it.
Rewind the base dose regulating mechanism back to zero and put down the base.

Pick up the cartridge holder. Shake out the used cartridge.
Check that the new cartridge contains the correct insulin and insert it, metal end first, into the holder.
Screw the cartridge holder back onto the base. * Keep a record of all your injections and also record when you begin a new cartridge. * Subtract the total insulin used in previous injections from the total of 150 units in each cartridge to be sure you have enough insulin left for the next dose.

Clean the end of the cartridge holder and the projecting cartridge with an alcohol swab.
Remove the seal from the end of the new needle unit. Don’t touch the exposed needle or allow it to touch any other object.
Screw the needle unit onto the end of the cartridge holder.
Pull the outer shield off the needle. Do not throw it away. You will need it later to remove the needle unit from the pen.

Pull the inner shield off the needle and discard it. Hold the pen upright and tap the cartridge holder to enable air bubbles to escape through the needle.

Dial the dose knob so that #1 is in the dose scale window and prime the pen according to the manufacturer’s instructions.
Hold the needle upright. Press in the injection button at the end of the unit and check that insulin comes out of the tip of the needle. If no insulin is seen, continue to dial up one unit at a time and press the injection button until insulin is seen. A new cartridge may take 4-6 units before insulin flows.

Dial in your dose of insulin in addition to the units needed to produce the insulin flow. For example, if it took 4 units to start the insulin flow and your insulin dose is 20, the total in the dose scale window will be 24. * Choose and clean the injection site as usual.

Pinch the skin and insert the needle through the skin at a 90Ë? angle. Press the injection button at the end of the needle and wait 5 seconds for the injection to be completed before removing the needle from the skin. * The needle must be removed from the pen immediately after the injection is finished.

Place the outer needle shield that you had saved on the counter top with the opening facing up.
Without holding onto the shield, insert the pen needle carefully into the shield and push down firmly. Grip the shield and unscrew the needle from the pen.

Dispose of the shielded needle into the puncture proof container that you have reserved for your needles. Store all pens that are in use at room temperature.

Diabetes and Sexual Problems: Topics A to Z

Posted June 7, 2009

 

 

Search   Email to a friend   Print this page   PDF Version * (446 KB) Also see: Erectile Dysfunction Nerve Disease and Bladder Control Urinary Incontinence in Men Urinary Incontinence in Women Urinary Tract Infections in Adults

Home : Diabetes A-Z List of Topics and Titles : Sexual and Urologic Problems of Diabetes     Sexual and Urologic Problems of Diabetes Diabetes and Sexual Problems What sexual problems can occur in men with diabetes? What sexual problems can occur in women with diabetes? Diabetes and Urologic Problems Who is at risk for developing sexual and urologic problems of diabetes? Can diabetes-related sexual and urologic problems be prevented? Points to Remember Hope through Research For More Information Troublesome bladder symptoms and changes in sexual function are common health problems as people age. Having diabetes can mean early onset and increased severity of these problems. Sexual and urologic complications of diabetes occur because of the damage diabetes can cause to blood vessels and nerves. Men may have difficulty with erections or ejaculation. Women may have problems with sexual response and vaginal lubrication. Urinary tract infections and bladder problems occur more often in people with diabetes. People who keep their diabetes under control can lower their risk of the early onset of these sexual and urologic problems. Diabetes and Sexual Problems Both men and women with diabetes can develop sexual problems because of damage to nerves and small blood vessels. When a person wants to lift an arm or take a step, the brain sends nerve signals to the appropriate muscles. Nerve signals also control internal organs like the heart and bladder, but people do not have the same kind of conscious control over them as they do over their arms and legs. The nerves that control internal organs are called autonomic nerves, which signal the body to digest food and circulate blood without a person having to think about it. The body’s response to sexual stimuli is also involuntary, governed by autonomic nerve signals that increase blood flow to the genitals and cause smooth muscle tissue to relax. Damage to these autonomic nerves can hinder normal function. Reduced blood flow resulting from damage to blood vessels can also contribute to sexual dysfunction. [Top] What sexual problems can occur in men with diabetes? Erectile Dysfunction Erectile dysfunction is a consistent inability to have an erection firm enough for sexual intercourse. The condition includes the total inability to have an erection and the inability to sustain an erection. Estimates of the prevalence of erectile dysfunction in men with diabetes vary widely, ranging from 20 to 75 percent. Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes. Among men with erectile dysfunction, those with diabetes may experience the problem as much as 10 to 15 years earlier than men without diabetes. Research suggests that erectile dysfunction may be an early marker of diabetes, particularly in men ages 45 and younger. In addition to diabetes, other major causes of erectile dysfunction include high blood pressure, kidney disease, alcohol abuse, and blood vessel disease. Erectile dysfunction may also occur because of the side effects of medications, psychological factors, smoking, and hormonal deficiencies. Men who experience erectile dysfunction should consider talking with a health care provider. The health care provider may ask about the patient’s medical history, the type and frequency of sexual problems, medications, smoking and drinking habits, and other health conditions. A physical exam and laboratory tests may help pinpoint causes of sexual problems. The health care provider will check blood glucose control and hormone levels and may ask the patient to do a test at home that checks for erections that occur during sleep. The health care provider may also ask whether the patient is depressed or has recently experienced upsetting changes in his life. Treatments for erectile dysfunction caused by nerve damage, also called neuropathy, vary widely and range from oral pills, a vacuum pump, pellets placed in the urethra, and shots directly into the penis, to surgery. All of these methods have advantages and disadvantages. Psychological counseling to reduce anxiety or address other issues may be necessary. Surgery to implant a device to aid in erection or to repair arteries is usually used as a treatment after all others fail. Retrograde Ejaculation Retrograde ejaculation is a condition in which part or all of a man’s semen goes into the bladder instead of out the tip of the penis during ejaculation. Retrograde ejaculation occurs when internal muscles, called sphincters, do not function normally. A sphincter automatically opens or closes a passage in the body. With retrograde ejaculation, semen enters the bladder, mixes with urine, and leaves the body during urination without harming the bladder. A man experiencing retrograde ejaculation may notice that little semen is discharged during ejaculation or may become aware of the condition if fertility problems arise. Analysis of a urine sample after ejaculation will reveal the presence of semen. Poor blood glucose control and the resulting nerve damage can cause retrograde ejaculation. Other causes include prostate surgery and some medications. For additional information about erectile dysfunction, see the fact sheet Erectile Dysfunction, available from the National Kidney and Urologic Diseases Information Clearinghouse at 1–800–891–5390. Retrograde ejaculation caused by diabetes or surgery may be helped with a medication that strengthens the muscle tone of the sphincter in the bladder. A urologist experienced in infertility treatments may assist with techniques to promote fertility, such as collecting sperm from the urine and then using the sperm for artificial insemination. [Top] What sexual problems can occur in women with diabetes? Many women with diabetes experience sexual problems. Although research about sexual problems in women with diabetes is limited, one study found 27 percent of women with type 1 diabetes experienced sexual dysfunction. Another study found 18 percent of women with type 1 diabetes and 42 percent of women with type 2 diabetes experienced sexual dysfunction. Sexual problems may include decreased vaginal lubrication, resulting in vaginal dryness uncomfortable or painful sexual intercourse decreased or no desire for sexual activity decreased or absent sexual response Decreased or absent sexual response can include the inability to become or remain aroused, reduced or no sensation in the genital area, and the constant or occasional inability to reach orgasm. Causes of sexual problems in women with diabetes include nerve damage, reduced blood flow to genital and vaginal tissues, and hormonal changes. Other possible causes include some medications, alcohol abuse, smoking, psychological problems such as anxiety or depression, gynecologic infections, other diseases, and conditions relating to pregnancy or menopause. Women who experience sexual problems or notice a change in sexual response should consider talking with a health care provider. The health care provider will ask about the patient’s medical history, any gynecologic conditions or infections, the type and frequency of sexual problems, medications, smoking and drinking habits, and other health conditions. The health care provider may ask whether the patient might be pregnant or has reached menopause and whether she is depressed or has recently experienced upsetting changes in her life. A physical exam and laboratory tests may also help pinpoint causes of sexual problems. The health care provider will also talk with the patient about blood glucose control. Prescription or over-the-counter vaginal lubricants may be useful for women experiencing vaginal dryness. Techniques to treat decreased sexual response include changes in position and stimulation during sexual relations. Psychological counseling may be helpful. Kegel exercises that help strengthen the pelvic muscles may improve sexual response. Studies of drug treatments are under way. [Top] Diabetes and Urologic Problems Urologic problems that affect men and women with diabetes include bladder problems and urinary tract infections. The urinary tract. Bladder Problems Many events or conditions can damage nerves that control bladder function, including diabetes and other diseases, injuries, and infections. More than half of men and women with diabetes have bladder dysfunction because of damage to nerves that control bladder function. Bladder dysfunction can have a profound effect on a person’s quality of life. Common bladder problems in men and women with diabetes include the following: Overactive bladder.Damaged nerves may send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. The symptoms of overactive bladder include urinary frequency—urination eight or more times a day or two or more times a night urinary urgency—the sudden, strong need to urinate immediately urge incontinence—leakage of urine that follows a sudden, strong urge to urinate Poor control of sphincter muscles. Sphincter muscles surround the urethra—the tube that carries urine from the bladder to the outside of the body—and keep it closed to hold urine in the bladder. If the nerves to the sphincter muscles are damaged, the muscles may become loose and allow leakage or stay tight when a person is trying to release urine. Urine retention. For some people, nerve damage keeps their bladder muscles from getting the message that it is time to urinate or makes the muscles too weak to completely empty the bladder. If the bladder becomes too full, urine may back up and the increasing pressure may damage the kidneys. If urine remains in the body too long, an infection can develop in the kidneys or bladder. Urine retention may also lead to overflow incontinence—leakage of urine when the bladder is full and does not empty properly. Diagnosis of bladder problems may involve checking both bladder function and the appearance of the bladder’s interior. Tests may include x rays, urodynamic testing to evaluate bladder function, and cystoscopy, a test that uses a device called a cystoscope to view the inside of the bladder. Treatment of bladder problems due to nerve damage depends on the specific problem. If the main problem is urine retention, treatment may involve medication to promote better bladder emptying and a practice called timed voiding—urinating on a schedule—to promote more efficient urination. Sometimes people need to periodically insert a thin tube called a catheter through the urethra into the bladder to drain the urine. Learning how to tell when the bladder is full and how to massage the lower abdomen to fully empty the bladder can help as well. If urinary leakage is the main problem, medications, strengthening muscles with Kegel exercises, or surgery can help. Treatment for the urinary urgency and frequency of overactive bladder may involve medications, timed voiding, Kegel exercises, and surgery in some cases. Urinary Tract Infections Infections can occur when bacteria, usually from the digestive system, reach the urinary tract. If bacteria are growing in the urethra, the infection is called urethritis. The bacteria may travel up the urinary tract and cause a bladder infection, called cystitis. An untreated infection may go farther into the body and cause pyelonephritis, a kidney infection. Some people have chronic or recurrent urinary tract infections. Symptoms of urinary tract infections can include a frequent urge to urinate pain or burning in the bladder or urethra during urination cloudy or reddish urine in women, pressure above the pubic bone in men, a feeling of fullness in the rectum If the infection is in the kidneys, a person may have nausea, feel pain in the back or side, and have a fever. Frequent urination can be a sign of high blood glucose, so results from recent blood glucose monitoring should be evaluated. The health care provider will ask for a urine sample, which will be analyzed for bacteria and pus. Additional tests may be done if the patient has frequent urinary tract infections. An ultrasound exam provides images from the echo patterns of sound waves bounced back from internal organs. An intravenous pyelogram uses a special dye to enhance x-ray images of the urinary tract. Cystoscopy might be performed. Early diagnosis and treatment are important to prevent more serious infections. To clear up a urinary tract infection, the health care provider will probably prescribe antibiotic treatment based on the type of bacteria in the urine. Kidney infections are more serious and may require several weeks of antibiotic treatment. Drinking plenty of fluids will help prevent another infection. The following publications, available from the National Kidney and Urologic Diseases Information Clearinghouse at www.kidney.niddk.nih.gov or by calling 1–800–891–5390, provide additional information about urologic problems: Bladder Control for Women Cystoscopy and Ureteroscopy Imaging of the Urinary Tract Nerve Disease and Bladder Control Pyelonephritis (Kidney Infection) in Adults Urinary Incontinence in Men Urinary Tract Infections in Adults Urodynamic Testing What I need to know about Urinary Tract Infections Your Kidneys and How They Work Your Urinary System and How It Works [Top] Who is at risk for developing sexual and urologic problems of diabetes? Risk factors are conditions that increase the chances of getting a particular disease. The more risk factors people have, the greater their chances of developing that disease or condition. Diabetic neuropathy and related sexual and urologic problems appear to be more common in people who have poor blood glucose control have high levels of blood cholesterol have high blood pressure are overweight are older than 40 smoke are physically inactive [Top] Can diabetes-related sexual and urologic problems be prevented? People with diabetes can lower their risk of sexual and urologic problems by keeping their blood glucose, blood pressure, and cholesterol levels close to the target numbers their health care provider recommends. Being physically active and maintaining a healthy weight can also help prevent the long-term complications of diabetes. For those who smoke, quitting will lower the risk of developing sexual and urologic problems due to nerve damage and also lower the risk for other health problems related to diabetes, including heart attack, stroke, and kidney disease. For additional information about preventing diabetes complications, see the Prevent Diabetes Problems Series, available from the National Diabetes Information Clearinghouse at 1–800–860–8747. The series is also available at www.diabetes.niddk.nih.gov/dm/pubs/complications. [Top] Points to Remember The nerve damage of diabetes may cause sexual or urologic problems. Sexual problems in men with diabetes include erectile dysfunction retrograde ejaculation Sexual problems in women with diabetes include decreased vaginal lubrication and uncomfortable or painful intercourse decreased or no sexual desire decreased or absent sexual response Urologic problems in men and women with diabetes include bladder problems related to nerve damage, such as overactive bladder, poor control of sphincter muscles, and urine retention urinary tract infections Controlling diabetes through diet, physical activity, and medications as needed can help prevent sexual and urologic problems. Treatment is available for sexual and urologic problems. [Top] Hope through Research The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) was established by Congress in 1950 as one of the National Institutes of Health of the U.S. Department of Health and Human Services. The NIDDK conducts and supports research on diabetes, glucose metabolism, and related conditions. NIDDK-supported research on the sexual and urologic complications of diabetes includes research conducted as part of the Epidemiology of Diabetes Interventions and Complications (EDIC) study. The EDIC is an observational follow-up study of people who originally participated in the Diabetes Control and Complications Trial (DCCT). The DCCT showed that intensive blood glucose control can reduce the risk of complications of type 1 diabetes. EDIC study results suggest that tight glucose control can delay the onset of erectile dysfunction in men with type 1 diabetes. A recent study focused on urinary incontinence in women at high risk for developing type 2 diabetes who participated in the NIDDK-sponsored Diabetes Prevention Program (DPP). The women had pre-diabetes, a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Women who were in the DPP group that used a lifestyle change approach to diabetes prevention and lost 5 to 7 percent of their weight through dietary changes and increased physical activity were compared with those in other DPP groups who received standard education and maintained a stable weight. The women in the lifestyle intervention group had fewer problems with urinary incontinence than women in the other groups. This finding adds to other results of the DPP study that indicate the value of lifestyle changes for preventing or delaying the development of type 2 diabetes. Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory. [Top] For More Information American Diabetes Association 1701 North Beauregard Street Alexandria, VA 22311 Phone: 1–800–DIABETES (342–2383) Email: AskADA@diabetes.org Internet: www.diabetes.org American Urological Association Foundation 1000 Corporate Boulevard Linthicum, MD 21090 Phone: 1–866–RING–AUA (746–4282) or 410–689–3700 Fax: 410–689–3800 Email: patienteducation@auafoundation.org Internet: www.auafoundation.org www.UrologyHealth.org Juvenile Diabetes Research Foundation International 120 Wall Street New York, NY 10005–4001 Phone: 1–800–533–CURE (2873) Fax: 212–785–9595 Email: info@jdrf.org Internet: www.jdrf.org National Diabetes Education Program 1 Diabetes Way Bethesda, MD 20814–9692 Phone: 1–888–693–NDEP (6337) TTY: 1–866–569–1162 Fax: 703–738–4929 Email: ndep@mail.nih.gov Internet: www.ndep.nih.gov National Kidney and Urologic Diseases Information Clearinghouse 3 Information Way Bethesda, MD 20892–3580 Phone: 1–800–891–5390 TTY: 1–866–569–1162 Fax: 703–738–4929 Email: nkudic@info.niddk.nih.gov Internet: www.kidney.niddk.nih.gov The National Diabetes Information Clearinghouse collects resource information about diabetes for the NIDDK Reference Collection. This database provides titles, abstracts, and availability information for health information and health education resources. You may view the results of the automatic search on sexual and urologic problems of diabetes. If you wish to perform your own search of the database, go to NIDDK Reference Collection. This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (463–6332) or visit www.fda.gov. Consult your doctor for more information. [Top] National Diabetes Information Clearinghouse 1 Information Way Bethesda, MD 20892–3560 Phone: 1–800–860–8747 TTY: 1–866–569–1162 Fax: 703–738–4929 Email: ndic@info.niddk.nih.gov Internet: www.diabetes.niddk.nih.gov The National Diabetes Information Clearinghouse (NDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1978, the Clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public. The NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes. Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was originally reviewed by Jeanette S. Brown, M.D., Women’s Continence Center, University of California at San Francisco; Kevin T. McVary, M.D., Department of Urology, Northwestern University; and Hunter Wessells, M.D., Department of Urology, University of Washington. This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired. NIH Publication No. 09–5135 December 2008 [Top]

Source: Natinal Diabetes Information Clearinghouse, (NDIC)

Free Diabetes Supplies

 

 

 

Posted June 5, 2009

By Roger Thompson

The average person with diabetes spends more than $13,000 in medical care annually while the typical person without diabetes only spends approximately $3,000 per year on health care. While this cost sounds high, the toll of uncontrolled blood glucose levels and associated complications is a lot higher.

Think of all the prescriptions, lab work, and doctor’s visits as a form of preventive maintenance. Free diabetes supplies are provided to those who cannot afford to purchase them. There are also some insurance companies that provide these services. In fact, the majority of diabetes service companies are affiliated with health insurance companies, which is why you can get free diabetes supplies.

So, how do you get free diabetes supplies? Most companies that focus on providing health services and supplies for diabetics give out free supplies and will even ship them at no extra cost. However, you need to be covered by health insurance. Once you are covered, you will have to find a medical supply company that has either free or low cost diabetes supplies. Most of these places will deliver your supplies directly to your home for free.

Testing is important for diabetics because carefully monitoring blood glucose can give valuable information, helping to obtain great control which can seriously delay the progression of long term diabetic complications. Blood glucose is easy to monitor at home, using thumb prick blood tests. Many people who test this way daily do not actually understand how serious and important it is for them to do so.

Frequent monitoring can answer a lot of questions about diet and exercise, and what is happening over a long term period. Not only can monitoring blood glucose allow the diabetic control of his or her day to day – It can also indicate changes over time and help predict long term complications.

Health experts say that the ultimate goal of diabetics should be to get their blood glucose levels as close to normal as possible. However, if you have any medical conditions that affect your ability to control your glucose level, then these levels may be a bit higher. Therefore, it is important that you always have reliable blood glucose monitors, meters and other equipment so that you can check your present blood sugar levels.

Of course, this can be very costly because you have to pay for blood glucose monitors and test strips. It is actually these test strips that can leave a big hole in your pocket, which is why free diabetes supplies are very much appreciated by many diabetics. You should know that free diabetes supplies are safe to use as long as they have not expired because if they are expired they can be dangerous because they may not detect your glucose levels accurately.

Even if you decide to purchase large quantities of your supplies they will still cost you a lot of money, which is why it is advantageous to try to get them for free if you can.

Source: Roger Thompson

When Your Child is Diagnosed With Diabetes

 

 

 

 

Home About Diabetes and Pre-diabetes Resources for Health, Education, and Business Professionals Awareness Campaigns Partnerships About NDEP What’s New? Publications Catalog Contact Us Site Map Search NIDDK When Your Child Is Diagnosed with DIABETES:
PARENTS’ QUESTIONS for the Health Care Team
Parents of children with diabetes often have concerns about the disease, its impact on their family, and how to keep their children safe and healthy. Use these questions to talk with your child‘s health care team and learn about your child‘s diabetes care needs at diagnosis and later on as well. To find out more about possible answers, use the links under each set of questions.

What are the different types of diabetes?

Which type of diabetes does our child have?

Will it ever go away?

www.ndep.nih.gov/diabetes/WhatIs/WhatIs.htm

www.ndep.nih.gov/diabetes/youth/youth_FS.htm

www.jdrf.org

What does this mean for other members of our family?

Does it mean our other children will get diabetes too?

What about other family members?

www.ndep.nih.gov/diabetes/youth/youth_FS.htm#Identifying

www.ndep.nih.gov/diabetes/prev/prevention.htm

www.ndep.nih.gov/diabetes/youth/youth.htm
(See Tips for Kids: Lower Your Risk for type 2 Diabetes)

What are my child’s treatment goals?

How can we help our child meet these goals?

How often will our child need to visit you each year?

www.ndep.nih.gov/diabetes/youth/youth_FS.htm#Treatment
(See Treatment Goals and Family Support)

www.ndep.nih.gov/diabetes/pubs/4_Steps.pdf*

www.ndep.nih.gov/diabetes/youth/youth.htm
(See Tip Sheets for Kids with Type 2 Diabetes)

What other health care team members can help care for our child’s diabetes?

How do we contact them?

www.ndep.nih.gov/diabetes/youth/youth_FS.htm (See Visiting the Health Care Team)

How can we work together as a family to help our child?

How can we help our child check blood glucose, take insulin, eat healthy foods, be more active, and learn about diabetes?

Who can help us work together as a family?

www.ndep.nih.gov/diabetes/youth/youth_FS.htm (See Helping Children Manage Diabetes)

What emotional issues might our child and family face?

Will diabetes affect the way our child behaves?

When do we start letting our child manage his/her own diabetes care?

Who can help us cope with these issues?

www.ndep.nih.gov/diabetes/youth/youth.htm (See Tips for Teens with type 2 Diabetes: Dealing with the Ups and Downs of Diabetes)

www.ndep.nih.gov/diabetes/youth/youth_FS.htm#Transition (See Transition to Independence )

www.ndep.nih.gov/resources/SchoolNurseNews.htm (See Understanding Emotional & Psychological Considerations of Children with Diabetes: Tips for School Nurses)

www.diabetes.org/for-parents-and-kids/living-with-diabetes/age-related-issues.jsp

www.diabetes.org/for-parents-and-kids/living-with-diabetes/reactions.jsp

Should we tell friends and family about our child’s diabetes?

www.diabetes.org/for-parents-and-kids/living-with-diabetes/friends-family.jsp

Who can help us if we don’t have medical insurance?

www.insurekidsnow.gov/questions.asp

www.usgovinfo.about.com/od/medicarehealthinsurance/a/schip.htm

What resources are there to help our child in school?

www.ndep.nih.gov/diabetes/pubs/Youth_NDEPSchoolGuide.pdf*
www.ndep.nih.gov/diabetes/youth/youth_fs.htm#diabetes (See Diabetes at School)
www.diabetesinchildren.com

What research is going on?

Three large nation-wide studies are under way.

The TODAY study wants to find the best ways to care for type 2 diabetes in children and teens and has begun in 13 medical sites. To find out if you can join go to www.TODAYstudy.org.

Type 1 Diabetes TrialNet is a group of studies looking at ways to prevent or to treat type 1 diabetes early. To find out if you can join go to www.diabetestrialnet.org/public.html or call1- 800- HALT- DM1(1-800-425-8361).

The SEARCH for Diabetes in Youth study will help us learn about how type 1 and type 2 diabetes differ, what medical problems arise, the health care children receive, and how diabetes shapes their daily lives. www.searchfordiabetes.org

A lot of other research is going on. To find studies in your area, talk to your health care team and visit the JDRF and ADA (links below).

Additional Resources for Parents and Children

National Diabetes Education Program
www.ndep.nih.gov or call 1-800-438-5383

Juvenile Diabetes Research Foundation International (JDRF)
www.jdrf.org or call 1-800-223-1138

Children with Diabetes
www.childrenwithdiabetes.com

American Diabetes Association ( ADA )
www.diabetes.org or call 1-800-DIABETES (1-800-342-2383)

*PDF files require the free Adobe Acrobat Reader application for viewing.

The U.S. Department of Health and Human Services’ National Diabetes Education Program is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention

August 2006 Reviewed by Janet Silverstein, M.D. Professor, Department of Pediatrics, University of Florida

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Source: NDEP, (National Diabetes Education Program)

Diabetes and Social Security Disability Insurance

For those of you that may eventually find that your diabetic condition has stopped you from working you may be eligible for Social Security Disability payments. This is important! It is not widely publicized. You can find loads of information about SSDI (Social Security Disability Insurance) at www.socialsecurity.gov.

FoodSpook

Diabetes SSI Disability, Do You Have the Right Team?
Posted May 4, 2009

By Matt Berry

Diabetes, with its myriad complications and side effects, has come to be known as the fifth-deadliest disease in the country. While many are able to notice symptoms and receive a diagnosis with plenty of time to get it in check, there will always be others who don’t realize they have diabetes until they begin to suffer from some of its more serious side effects.

With all the different forms of pain and suffering diabetes can cause, as well as how difficult it can make daily life, it’s important that every diabetic find a team to support them. In some cases, the team is comprised solely of medical professionals. In other instances, it might be made up of medical professionals, various specialists, and retailers that focus on diabetic needs.

For those that have found themselves facing too many effects of the illness to continue working in a day-to-day full-time capacity, part of this team might include an attorney who specializes in social security disability benefits. Whoever the team is comprised of though, it’s important that they all work together and are aware of each other, as that will help them make decisions to benefit the patient.

Building a Team: While the diabetic patient has quite a bit of responsibility, the team they’re surrounded with can also be a huge help in keeping their health and life on track. The patient, therefore, needs to be extremely careful when selecting doctors, specialists and a SSI Diabetes Social Security Lawyer (Attorney) as members of their team. Developing a rapport and trust with each of these team-members will ultimately serve to make managing their diabetes even easier.

Importance of Your Doctor: A primary care doctor is integral to any diabetic support team, as this is often where referrals to specialists will come from. For some, their primary care doctor will be an endocrinologist who what specialized training and certifications in diabetic care. If an endocrinologist isn’t available, a primary care doctor could be a family practice doctor or internist who has had experience with diabetes. When considering new doctors, especially one who will be a cornerstone of the diabetic’s support team, asking them some of the following questions might be helpful.

- What kind of diabetes training have you had? What percentage of your patients are diabetics? -
Who do I turn to for back-up care when you’re not available? Will you accept my insurance? Are there any other fees I’ll be responsible for? If the answers to those questions seem satisfactory, and the patient feels that the doctor listened to and responded well to their concerns, it may be a perfect match.

Importance of Your Social Security Lawyer: A Social Security Disability Lawyer specializing in diabetes cases is often another cornerstone of the diabetic support team. When it isn’t possible for patients to work a full-time job and support themselves, a Social Security lawyer or attorney can help file an application to receive social security disability benefits. The process for receiving diabetes SSI disability can be long and complicated, which is why it’s imperative that the benefits attorney selected has sufficient experience.

Similar questions to those that were asked of the doctor also apply when interviewing attorneys.

- What percentage of your patients are diabetics? (Your lawyer should have extensive experience with diabetes cases as well as other medical conditions that are often associated with the disease.)

- How will you work with my medical support team to gather the information you’ll need? (The answer should be that your attorney has a sufficient legal team that can assist you and will track your claim as it moves through the Social Security system.)

- What kind of fees will I be responsible for? (The answer should be “none” unless you are awarded Social Security disability benefits). As the diabetes social security benefits case hinges on whether or not diabetes has made it impossible for the patient to work, communication between the doctor, patient and SSI disability attorney must be open and clear. With trusted and experienced doctors and a diabetes SSI disability attorney, the patient will be well-situated to care for their diabetes in all aspects of their life.

Matt Berry is a Social Security attorney . As a Social Security lawyer (attorney) he works with various disabled with Social Security Disability impairments.

Source: Matt Berry

Buying Diabetes Medical Supplies on The Internet

Home Advice

By Trevor Price

Did you know you can save a lot of money by buying your diabetes medical supplies on the Internet? Are you also aware that many of these retailers are not based in the U.S. and therefore not subject to FDA laws or standards? If you’re considering the purchase of your diabetes supplies and equipment online, keep reading to find out what you can do to protect yourself.

U.S. Supplier If you’re buying diabetes medical supplies off a web-based company, look for one that’s either based in the United States or your own country. Even if the prices are better, a supplier stationed in a foreign land isn’t held to the same quality standards as one here.

Remember, this is your health. On top of potentially being unsafe, importing foreign drugs or medical equipment may be against the law and could get you into serious trouble with U.S. customs. So, don’t risk your health or your record by buying medical supplies from outside the country.

Prescription Required When Needed Not all types of insulin require a prescription, but if yours requires one either nationally or in your state, then always purchase from a seller that obligates you to submit proof of prescription.

Buying a prescription-only product without a prescription is illegal. Check the Shipping Policy Before you buy from an online retailer, find out how the goods are shipped. Are they properly protected against breakage and possible contamination? How fast do they ship and by what methods? If they send your product by ground then how do they ensure the package won’t be pierced or possibly damaged? And don’t forget to include the shipping costs into your total costs calculation. If the shipping is outrageous, then your online deal may not be such a steal after all.

Scan Customer Reviews Before you buy a product online, you should read the customer reviews of both the online retailer and the product itself. For example, if you’re in the market for a new test strip system, be sure to peruse the customer reviews of other users. They should be right on the retailer’s website. You should also read retailer reviewers. It’s here that customers talk about a retailer’s customer service, their shipping fees, return policy and the overall buying experience.

To find reviews for online retailers, try sites like Nextag or Froogle. Be Wary of Purchasing on eBay Unless a seller has a stellar reputation with strong customer feedback from buyers who have purchased diabetes medical supplies specifically, then stay away. eBay is full of expired products, recalled brands and rejected stock items that aren’t suitable for the regular market. Unless you’re buying from a seller that has excellent feedback from customers who have purchased diabetes medical supplies in the past, then you should stay away.

Your purchase of any equipment for the care of diabetes is nothing to take lightly. Though we all want to save money on health care costs, none of us should take undue risks related to the quality of those items.

For great information on the treatment of various diseases and conditions – please visit diseasetreatmenttips.com – a popular site about tackling ailments – such as Rheumatoid Arthritis pain relief – natural sleeping aids – and many more!

Source: Trevor Price

Camp-DT 2007 Diabetes-Teens.Net

Source: Diabteens, Reprinted from YouTube

Diabetes Topics, A to Z

 

Home : Diabetes A-Z List of Topics and Titles     Diabetes A-Z List of Topics and Titles A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A A1C (PDF, 134 KB) * A1C, Sickle Cell Trait, and Other Hemoglobin Variants African Americans and Diabetes African Americans and Kidney Disease African Americans, Hemoglobin Variants, Sickle Cell Trait, and the A1C Test Alternative Therapies for Diabetes Am I at Risk for Gestational Diabetes? (PDF, 1.17 MB) * Am I at Risk for Type 2 Diabetes? American Indian Resources American Indians, Alaska Natives, and Diabetes Asian Americans, Pacific Islanders, and Diabetes Asian Americans, Hemoglobin Variants, Sickle Cell Trait, and the A1C Test Autonomic Neuropathy   Our materials come in various formats Awareness and Prevention Series Brief overviews to raise awareness among people not yet diagnosed. Easy-to-Read Booklets Basic information presented in easy-to-understand terms. Fact Sheets In-depth information for patients, health professionals, and students. National Diabetes Education Program Booklets, fact sheets, CDs, and more for consumers, health care providers, and organizations.

Diabetes Home | Diabetes A to Z | Introduction | Treatments | Complications | Statistics | Clinical Trials | NDEP | Awareness and Prevention | Additional Resources | Order Publications | About Us | Información en Español

Contact Us | Health Information

The NDIC is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

National Diabetes Information Clearinghouse

1 Information Way

Bethesda, MD 20892–3560

Phone: 1–800–860–8747

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: ndic@info.niddk.nih.gov

Source: National Institute of Health, (NIH)

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