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
Surviving Abundance: Overweight Kids In Crisis
Source: WHROTV on YouTube
A half hour documentary, produced by WHRO, examines the epidemic of childhood obesity. Childhood health professionals paint a grim picture for the future of overweight children unless we begin to make systemic changes that support more healthy choices. Local, state and national childhood health experts, including William H. Dietz, Jr., MD, PhD, Director of Nutrition & Physical Activity at the Center for Disease Control and Prevention, discuss steps we can take to turn the tide, and the program highlights organizations with exemplary programs which encourage healthier lifestyles.
Surviving Abundance was produced in collaboration with the Consortium for Infant and Child Health (CINCH), a community partnership to promote health and prevent disease among all children in Hampton Roads.
Type 2 Diabetes – Prevent Prediabetes and Diabetes Before It’s Too Late!
By Beverly H. Piepers
Diabetes is a disease no one wants to find out they have. However, if there is a good thing about this illness is that it can be prevented long before it’s ever diagnosed. So many people are walking around in a constant state of prediabetes and have absolutely no idea they are heading down a dark, potentially fatal road. If you have prediabetes or are overweight, you have an opportunity to turn your life around and improve your health.
Prediabetes is a medical condition that can be treated well in advance of turning into full-blown Type 2 diabetes…it is defined as having a fasting blood sugar reading of 100 to 125 mg/dL (5.5 to 6.9 mmol/L). This blood sugar level is not high enough to give you a diagnosis of Type 2 diabetes, but it surely means if you do not intervene now, you are well and truly on your way.
Recently, the Diabetes Prevention Program study proved conclusively that people with prediabetes are able to prevent the development of the disease by making simple changes in their diet and increasing their level of physical activity. Many of these people are able to return their blood sugar levels back to a normal range.
Another part of the study showed that certain medications might help to delay the development of Type 2 diabetes, but exercise and diet actually worked better than the medications. Simply exercising 30 minutes a day at a moderate pace, paired with a 5 to 10% reduction in body weight equaled a 58% reduction in diabetes.
The American Diabetes Association (ADA) is working hard to help people grasp their risk of developing prediabetes. The idea is to try to “turn back the clock” so that people can know their risk early and prevent diabetes from ever becoming a problem at all.
Among some of the recommendations being made by the ADA are certain dietary suggestions. For instance, people with prediabetes should be eating:
- a lot of fruits and vegetables from every color of the rainbow -
- they need to consume non-starchy vegetables such as broccoli, green beans and spinach with meals-
- another recommendation would be to add more whole-grain foods over processed grain products that you normally see in the interior section of your grocery store -
- including more fish in the diet is also a recommendation along with choosing lean cuts of meat and non-fat dairy such as skim milk -
Of course, there are many other tips and tricks that a prediabetic can use to avoid contracting the illness.
Stopping Type 2 diabetes in its tracks before it becomes a potentially life-threatening disease is so important as it is growing more and more prevalent in today’s society. Fast food and on the go lifestyles are not helping people to understand that their Type 2 diabetes risk is growing daily.
To discover answers to questions you may be asking yourself about Type 2 Diabetes, click on this link… Natural Diabetes Treatments
Clicking on this link will help you to learn more about Type 2 Diabetes Solutions… Beverleigh Piepers RN… the Diabetes Detective.
Beverleigh Piepers is the author of this article. This article can be used for reprint on your website provided all the links in the article are complete and active. Copyright (c) 2010 – All Rights Reserved Worldwide
Article Source: http://EzineArticles.com/?expert=Beverleigh_H_Piepers
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
Tips for Teens: Dealing With The Ups and Downs of Diabetes
Tips For Teens: Dealing With The Ups and Downs of Diabetes
Feelings
Many teens like you deal with diabetes everyday. Most of the time, it’s not a problem, you just deal with it. But sometimes, you may just want it to go away.
Do you ever…
- Ask “why me?”
- Think you’re the only one who feels sad, mad, alone, afraid, or different?
- Get tired of others teasing you if you are overweight?
- Blame yourself or your family for your diabetes?
All of these feelings are normal. Lots of teens who have diabetes feel the same way. It’s okay to get angry, feel sad, or think you’re different every now and then. But then you need to take charge and do something to feel better.
Everyone feels down sometimes. You are not alone.
Still down?
Reach out for help. Talk to someone in your family or where you worship, a friend, a school counselor, teacher, or your doctor or diabetes educator. It might help to write down your feelings in a journal. If you still feel down or sad, ask your parents to help you find a counselor.
It is okay to ask for help.
Speak up
There are many people who care about you and want to help you stay healthy and happy. Your health care team (diabetes educator, dietitian, doctor, nurse, psychologist, and social worker) can help you learn how to make healthy food choices, be more active, and feel good about yourself. Stay in touch with them. Let your health care team know how you feel and what you need.
Let your school know what’s up
You or your parents need to give the school nurse, teacher, or other school staff a copy of your diabetes care plan. Let people at your school know you have diabetes and that you need to eat healthy foods, eat your meals, take your medicine on time, and be physically active.
Don’t let diabetes stop you from joining in school activities. You can do all the things your friends do and then some!
Mom, Dad, other family members, get with it!
It’s easier to manage diabetes when the whole family works at it with you. So…
- Ask your family to choose the same healthy foods you eat—fruits and vegetables; whole grain breads; and low-fat meats, milk, and cheese. Ask them to keep healthy foods in the house and not tempt you with cookies, cake, candy, or regular soda.
- Get everyone moving by being more physically active. Play hard. Shoot hoops, throw a ball, ride bikes, or go for a walk — together. Being active can also help you relax and lower stress.
What’s healthy for you is healthy for everyone in your family.
Want to meet other teens who feel like you do?
- Programs and support groups for teens with diabetes can be found in clinics, health centers, or hospitals. Ask your diabetes educator or doctor for help to find one that works for you.
- Head to a diabetes or weight loss summer camp. You will do all the things that other campers do: swim, hike, dance, and more. But the best part is that everyone has diabetes or is there to lose weight, just like you. Some groups may have funds to help pay for teens to attend summer camps.
- Find a pen pal or email buddy. Sometimes it is good to share how you feel about having diabetes with someone else.
- Check out the resources at the end of this tip sheet.
Still my friend?
Ever worry that your friends may have wrong ideas about diabetes?
- Tell them that you have diabetes. You don’t have to keep it to yourself. The more people know about diabetes, the more they will understand. Explain that your body needs help to use the food you eat.
- Be sure everyone knows that no one can catch diabetes from you.
- Good friends help each other out. They understand your needs and offer support. Hang on to friends who help you make healthy food choices when you are eating out.
Ever have kids make fun of you about your diabetes or weight?
Teasing hurts. The best thing is to just walk away.
talk to someone…write down your feelings in a journal…write to a pen pal…email a buddy…stay in touch
Take Action!
It’s time for YOU to do something about your diabetes care.
- Set goals for what you will do. Start small and work your way up. For example: “I will cut down on regular soda and drink water instead.” When that’s going well…take the next step. Add another goal—“I will dance or bike ride a couple of times a week.” Then add a new goal—“I will eat smaller servings of cookies, burgers, and fries.”
- Try to make each new goal just a bit harder. After you shoot hoops twice a week, try adding another activity on three other days. Raise the goal until you reach a level that works for you.
- Avoid goals that will be too hard to meet. For example, rather than saying you’ll never eat a burger or a candy bar again, say you’ll only eat one a week.
- Tell your family or friends about your goals. Maybe they’ll be active with you or help out some other way.
- Reward yourself when you reach each goal. Keep in mind that rewards can be anything—not just food. You do not have to reach all your goals at once. Start with one or two, then add more.
Write down your top three goals—use the chart on the back page!
Write down your Top 3 Goals
Choose goals that you really can meet. Put in the date when you set the goal and when you met it.
Got it.
Take it one step at a time. Make healthy food choices, be more active, and work towards a healthy weight. Soon you’ll see progress and feel great.
Attention visually impaired visitors: To use common screen reading programs with PDF documents, please visit access.adobe.com, which provides a set of free tools that convert PDF documents to simple HTML or ASCII text.
Source:
About 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat and blood pressure and those who are overweight. The causes are probably different for different types of diabetic neuropathy. Researchers are studying how prolonged exposure to high blood glucose causes nerve damage. Nerve damage is likely due to a combination of factors: Symptoms depend on the type of neuropathy and which nerves are affected. Some people with nerve damage have no symptoms at all. For others, the first symptom is often numbness, tingling, or pain in the feet. Symptoms are often minor at first, and because most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Symptoms can involve the sensory, motor, and autonomic—or involuntary—nervous systems. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe. Symptoms of nerve damage may include: Symptoms that are not due to neuropathy, but often accompany it, include weight loss and depression. Diabetic neuropathy can be classified as peripheral, autonomic, proximal, or focal. Each affects different parts of the body in various ways. Peripheral neuropathy affects: Autonomic neuropathy affects: Proximal neuropathy affects: Focal neuropathy affects: Peripheral neuropathy, also called distal symmetric neuropathy or sensorimotor neuropathy, is nerve damage in the arms and legs. Your feet and legs are likely to be affected before your hands and arms. Many people with diabetes have signs of neuropathy that a doctor could note but feel no symptoms themselves. Symptoms of peripheral neuropathy may include: These symptoms are often worse at night. Peripheral neuropathy may also cause muscle weakness and loss of reflexes, especially at the ankle, leading to changes in the way a person walks. Foot deformities, such as hammertoes and the collapse of the midfoot, may occur. Blisters and sores may appear on numb areas of the foot because pressure or injury goes unnoticed. If foot injuries are not treated promptly, the infection may spread to the bone, and the foot may then have to be amputated. Some experts estimate that half of all such amputations are preventable if minor problems are caught and treated in time. Autonomic neuropathy affects the nerves that control the heart, regulate blood pressure, and control blood glucose levels. Autonomic neuropathy also affects other internal organs, causing problems with digestion, respiratory function, urination, sexual response, and vision. In addition, the system that restores blood glucose levels to normal after a hypoglycemic episode may be affected, resulting in loss of the warning symptoms of hypoglycemia. Normally, symptoms such as shakiness, sweating, and palpitations occur when blood glucose levels drop below 70 mg/dL. In people with autonomic neuropathy, symptoms may not occur, making hypoglycemia difficult to recognize. Problems other than neuropathy can also cause hypoglycemia unawareness. For more information about hypoglycemia, see the fact sheet Hypoglycemia at www.diabetes.niddk.nih.gov/dm/pubs/hypoglycemia. The heart and blood vessels are part of the cardiovascular system, which controls blood circulation. Damage to nerves in the cardiovascular system interferes with the body’s ability to adjust blood pressure and heart rate. As a result, blood pressure may drop sharply after sitting or standing, causing a person to feel light-headed or even to faint. Damage to the nerves that control heart rate can mean that your heart rate stays high, instead of rising and falling in response to normal body functions and physical activity. Nerve damage to the digestive system most commonly causes constipation. Damage can also cause the stomach to empty too slowly, a condition called gastroparesis. Severe gastroparesis can lead to persistent nausea and vomiting, bloating, and loss of appetite. Gastroparesis can also make blood glucose levels fluctuate widely, due to abnormal food digestion. For more information, see the fact sheet Gastroparesis at www.digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis. Nerve damage to the esophagus may make swallowing difficult, while nerve damage to the bowels can cause constipation alternating with frequent, uncontrolled diarrhea, especially at night. Problems with the digestive system can lead to weight loss. Autonomic neuropathy often affects the organs that control urination and sexual function. Nerve damage can prevent the bladder from emptying completely, allowing bacteria to grow in the bladder and kidneys and causing urinary tract infections. When the nerves of the bladder are damaged, urinary incontinence may result because a person may not be able to sense when the bladder is full or control the muscles that release urine. Autonomic neuropathy can also gradually decrease sexual response in men and women, although the sex drive may be unchanged. A man may be unable to have erections or may reach sexual climax without ejaculating normally. A woman may have difficulty with arousal, lubrication, or orgasm. For more information, see the fact sheets Nerve Disease and Bladder Control and Sexual and Urologic Problems of Diabetes at www.kidney.niddk.nih.gov. Autonomic neuropathy can affect the nerves that control sweating. When nerve damage prevents the sweat glands from working properly, the body cannot regulate its temperature as it should. Nerve damage can also cause profuse sweating at night or while eating. Finally, autonomic neuropathy can affect the pupils of the eyes, making them less responsive to changes in light. As a result, a person may not be able to see well when a light is turned on in a dark room or may have trouble driving at night. Proximal neuropathy, sometimes called lumbosacral plexus neuropathy, femoral neuropathy, or diabetic amyotrophy, starts with pain in the thighs, hips, buttocks, or legs, usually on one side of the body. This type of neuropathy is more common in those with type 2 diabetes and in older adults with diabetes. Proximal neuropathy causes weakness in the legs and the inability to go from a sitting to a standing position without help. Treatment for weakness or pain is usually needed. The length of the recovery period varies, depending on the type of nerve damage. Focal neuropathy appears suddenly and affects specific nerves, most often in the head, torso, or leg. Focal neuropathy may cause: Focal neuropathy is painful and unpredictable and occurs most often in older adults with diabetes. However, it tends to improve by itself over weeks or months and does not cause long-term damage. People with diabetes also tend to develop nerve compressions, also called entrapment syndromes. One of the most common is carpal tunnel syndrome, which causes numbness and tingling of the hand and sometimes muscle weakness or pain. Other nerves susceptible to entrapment may cause pain on the outside of the shin or the inside of the foot. The best way to prevent neuropathy is to keep your blood glucose levels as close to the normal range as possible. Maintaining safe blood glucose levels protects nerves throughout your body. For additional information about preventing diabetes complications, including neuropathy, see the Prevent Diabetes Problems Series at www.diabetes.niddk.nih.gov/dm/pubs/complications. Doctors diagnose neuropathy on the basis of symptoms and a physical exam. During the exam, your doctor may check blood pressure, heart rate, muscle strength, reflexes, and sensitivity to position changes, vibration, temperature, or light touch. Experts recommend that people with diabetes have a comprehensive foot exam each year to check for peripheral neuropathy. People diagnosed with peripheral neuropathy need more frequent foot exams. A comprehensive foot exam assesses the skin, muscles, bones, circulation, and sensation of the feet. Your doctor may assess protective sensation or feeling in your feet by touching your foot with a nylon monofilament—similar to a bristle on a hairbrush—attached to a wand or by pricking your foot with a pin. People who cannot sense pressure from a pinprick or monofilament have lost protective sensation and are at risk for developing foot sores that may not heal properly. The doctor may also check temperature perception or use a tuning fork, which is more sensitive than touch pressure, to assess vibration perception. The doctor may perform other tests as part of your diagnosis. The first treatment step is to bring blood glucose levels within the normal range to help prevent further nerve damage. Blood glucose monitoring, meal planning, physical activity, and diabetes medicines or insulin will help control blood glucose levels. Symptoms may get worse when blood glucose is first brought under control, but over time, maintaining lower blood glucose levels helps lessen symptoms. Good blood glucose control may also help prevent or delay the onset of further problems. As scientists learn more about the underlying causes of neuropathy, new treatments may become available to help slow, prevent, or even reverse nerve damage. As described in the following sections, additional treatment depends on the type of nerve problem and symptom. If you have problems with your feet, your doctor may refer you to a foot care specialist. Doctors usually treat painful diabetic neuropathy with oral medications, although other types of treatments may help some people. People with severe nerve pain may benefit from a combination of medications or treatments. Talk with your health care provider about options for treating your neuropathy. Medications used to help relieve diabetic nerve pain include: Duloxetine and pregabalin are approved by the U.S. Food and Drug Administration specifically for treating painful diabetic peripheral neuropathy. You do not have to be depressed for an antidepressant to help relieve your nerve pain. All medications have side effects, and some are not recommended for use in older adults or those with heart disease. Because over-the-counter pain medicines such as acetaminophen and ibuprofen may not work well for treating most nerve pain and can have serious side effects, some experts recommend avoiding these medications. Treatments that are applied to the skin—typically to the feet—include capsaicin cream and lidocaine patches (Lidoderm, Lidopain). Studies suggest that nitrate sprays or patches for the feet may relieve pain. Studies of alpha-lipoic acid, an antioxidant, and evening primrose oil have shown that they can help relieve symptoms and may improve nerve function. A device called a bed cradle can keep sheets and blankets from touching sensitive feet and legs. Acupuncture, biofeedback, or physical therapy may help relieve pain in some people. Treatments that involve electrical nerve stimulation, magnetic therapy, and laser or light therapy may be helpful but need further study. Researchers are also studying several new therapies in clinical trials. To relieve mild symptoms of gastroparesis—indigestion, belching, nausea, or vomiting—doctors suggest eating small, frequent meals; avoiding fats; and eating less fiber. When symptoms are severe, doctors may prescribe erythromycin to speed digestion, metoclopramide to speed digestion and help relieve nausea, or other medications to help regulate digestion or reduce stomach acid secretion. To relieve diarrhea or other bowel problems, doctors may prescribe an antibiotic such as tetracycline, or other medications as appropriate. Sitting or standing slowly may help prevent the light-headedness, dizziness, or fainting associated with blood pressure and circulation problems. Raising the head of the bed or wearing elastic stockings may also help. Some people benefit from increased salt in the diet and treatment with salt-retaining hormones. Others benefit from high blood pressure medications. Physical therapy can help when muscle weakness or loss of coordination is a problem. To clear up a urinary tract infection, the doctor will probably prescribe an antibiotic. Drinking plenty of fluids will help prevent another infection. People who have incontinence should try to urinate at regular intervals—every 3 hours, for example—since they may not be able to tell when the bladder is full. To treat erectile dysfunction in men, the doctor will first do tests to rule out a hormonal cause. Several methods are available to treat erectile dysfunction caused by neuropathy. Medicines are available to help men have and maintain erections by increasing blood flow to the penis. Some are oral medications and others are injected into the penis or inserted into the urethra at the tip of the penis. Mechanical vacuum devices can also increase blood flow to the penis. Another option is to surgically implant an inflatable or semirigid device in the penis. Vaginal lubricants may be useful for women when neuropathy causes vaginal dryness. To treat problems with arousal and orgasm, the doctor may refer women to a gynecologist. People with neuropathy need to take special care of their feet. The nerves to the feet are the longest in the body and are the ones most often affected by neuropathy. Loss of sensation in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers. More than half of all lower-limb amputations in the United States occur in people with diabetes—86,000 amputations per year. Doctors estimate that nearly half of the amputations caused by neuropathy and poor circulation could have been prevented by careful foot care. Follow these steps to take care of your feet: For additional information about foot care, contact the National Diabetes Information Clearinghouse at 1–800–860–8747. See the publication Prevent diabetes problems: Keep your feet and skin healthy at www.diabetes.niddk.nih.gov/dm/pubs/complications_feet. Materials are also available from the National Diabetes Education Program, including the fact sheet Take Care of Your Feet for a Lifetime at www.ndep.nih.gov/campaigns/Feet/Feet_overview.htm. The National Institute of Diabetes and Digestive and Kidney Diseases conducts and supports research to help people with diabetes. A complete listing of clinical research studies, including those related to diabetic neuropathies, can be found at 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. For more information, contact the following organizations: American Diabetes Association American Urological Association Foundation American Podiatric Medical Association Centers for Disease Control and Prevention Juvenile Diabetes Research Foundation International Lower Extremity Amputation Prevention Program National Diabetes Education Program National Digestive Diseases Information Clearinghouse National Heart, Lung, and Blood Institute Information Center National Institute of Neurological Disorders and Stroke National Kidney and Urologic Diseases Information Clearinghouse Pedorthic Footwear Association You may also find additional information about this topic by visiting MedlinePlus at www.medlineplus.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. Source: 1 Information Way 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 was originally reviewed by Peter J. Dyck, M.D., Peripheral Neuropathy Research Laboratory, Mayo Clinic Rochester, Rochester, MN; Eva L. Feldman, M.D., Ph.D., Department of Neurology, University of Michigan, Ann Arbor, MI; and Aaron I. Vinik, M.D., Ph.D., Strelitz Diabetes Research Institute, Eastern Virginia Medical School, Norfolk, VA. Dr. Feldman also reviewed the updated version of the publication. This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.
Diabetic Neuropathies: The Nerve Damage of Diabetes
Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness—loss of feeling—in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs.What causes diabetic neuropathies?
What are the symptoms of diabetic neuropathies?
What are the types of diabetic neuropathy?
Neuropathy Affects Nerves Throughout the Body
What is peripheral neuropathy?
Peripheral neuropathy affects the nerves in your toes, feet, legs, hands, and arms.What is autonomic neuropathy?
Autonomic neuropathy affects the nerves in your heart, stomach, intestines, bladder, sex organs, sweat glands, eyes, and lungs.Hypoglycemia Unawareness
Heart and Blood Vessels
Digestive System
Urinary Tract and Sex Organs
Sweat Glands
Eyes
What is proximal neuropathy?
What is focal neuropathy?
How can I prevent diabetic neuropathies?
How are diabetic neuropathies diagnosed?
Foot Exams
Other Tests
How are diabetic neuropathies treated?
Pain Relief
Gastrointestinal Problems
Dizziness and Weakness
Urinary and Sexual Problems
Foot Care
Points to Remember
Hope through Research
For More Information
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NIH Publication No. 08–3185
February 2009
s
Diabetes Foods – A Realistic Approach to Diabetic Menu Planning
By Ben Freeman
If you are diabetic, you must learn all about the food for diabetics and how to incorporate the same in your regular meal plan. One of the best ways of treating diabetes is by controlling your food intake; it helps in relieving the symptoms of the condition. It is imperative to know what you must eat and what you must avoid when you are diabetic.
Scientists have cited that in the next two decades the global rate of patients with Type 2 diabetes would be twice the present number, which indeed is alarming. It is only through a proper diet for diabetics that you can actually control the condition and relieve yourself from the diabetes symptoms.
Ideally a diet containing higher amounts of fiber and lower amounts of fats is what is recommended for a diabetic patient. One has to cut out saturated and trans fats from their diet and also reduce the use of sugar and sweet foods. Saturated fats include animal fats like lard, butter and cheese, cream, chocolate and milk.
Foods for Diabetics – What You Can Eat
A diabetes menu can include adequate portions of carbohydrates. However, there is a measured portion for every individual which is better recommended by the doctor. Carbohydrates are the valuable sources of energy, minerals and essential vitamins. It provides you body with healthy fiber as well that helps in maintaining the blood glucose levels. Peas, beans, barley, oats and other foods belonging to these groups are loaded with fiber. You can include whole grain products like bread and some diabetic cookies for the purpose. These foods are very much a part of the regular American diabetes diet.
You must include a lot of vegetables in your regular diabetic diet plan; vegetables are the perfect foods for diabetics. You can include a wide variety of vegetables like tomatoes, broccoli, carrots, spinach, cucumbers and cabbage. You can have them raw as salads or cooked with very little oil.
Fruits are good foods for diabetics as well, but as they contain natural sugars it is better to choose fruits with caution. Although diabetics need at least 2 servings of fruits regularly, you must avoid canned fruits as they are packed with sugary preservatives. Instead you can have whole fruits.
Proteins are a must for every diabetes meal. You can include lean meat, tofu, peanut butter, egg whites, fish, poultry, nuts and bans as some of the richest sources of proteins.
Foods to Avoid
There are certain foods that diabetics must not take. If you want to control the rising and falling blood glucose levels, you have to be strict about what you are eating.
Carbohydrates as stated above are good for diabetics when eaten in moderation. However, there are certain carbohydrates that you cannot eat, such as corn and potatoes. They are harmful.
Fruits are not recommended for diabetics due to high sugar content. Although natural, sugar has the same effect in any form. Less sugary fruits should be chosen in this respect.
Milk and milk products are strictly restricted, especially full cream milk. The skimmed version should be fine if taken in moderation.
Sweets and fats are better to be avoided. They have no nutritional value and they only add up to your tension and anxiety and increasing blood glucose numbers.
Ben Freeman is an ex-diabetic who writes passionately about how to reverse diabetes. Visit his diabetes foodssite and discover proven ways to plan a diabetic menu.
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Diabetes and Pregnancy
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Diabetes and Pregnancy
Diabetes is often diagnosed in women during their childbearing years and can affect the health of both the mother and her unborn child. Poor control of diabetes during pregnancy increases the chances for birth defects and other problems for the baby. It can cause serious complications for the woman, also. Proper healthcare before and during pregnancy can help prevent birth defects and other poor outcomes.
About Diabetes
Diabetes is a condition in which the body cannot use the sugars and starches (carbohydrates) it takes in as food to make energy. The body either makes no insulin or too little insulin or cannot use the insulin it makes to change those sugars and starches into energy. As a result, extra sugar builds up in the blood.
The three most common types of diabetes are:
Type 1
The pancreas makes no insulin or so little insulin that the body can’t use blood sugar for energy. Type 1 diabetes must be controlled with daily insulin.
Learn more about type 1 diabetes and pregnancy here:
Type 2
The body either makes too little insulin or can’t use the insulin it makes to use blood sugar for energy. Sometimes type 2 diabetes can be controlled through eating a proper diet and exercising regularly. Many people with type 2 diabetes have to take diabetes pills, insulin, or both.
Learn more about type 2 diabetes and pregnancy here:
Gestational
This is a type of diabetes that is first seen in a pregnant woman who did not have diabetes before she was pregnant. Often gestational diabetes can be controlled through eating a healthy diet and exercising regularly. Sometimes a woman with gestational diabetes must also take insulin.
For most women with gestational diabetes, the diabetes goes away soon after delivery. When it does not go away, the diabetes is called type 2 diabetes. Even if the diabetes does go away after the baby is born, half of all women who had gestational diabetes develop type 2 diabetes later. It’s important for a woman who has had gestational diabetes to continue to exercise and eat a healthy diet after pregnancy to prevent or delay getting type 2 diabetes. She should also remind her doctor to check her blood sugar every 1 to 3 years.
Learn more about gestational diabetes and pregnancy here:
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The Diabetes Epidemic Among African Americans
WHAT IS DIABETES?
Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes can lead to serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications.
Diabetes is one of the leading causes of death and disability in the United States. Total health care and related costs for the treatment of diabetes run about $174 billion annually.
WHAT ARE THE DIFFERENT TYPES OF DIABETES?
Type 1 diabetes (formerly called juvenile diabetes) results when the body’s immune system attacks and destroys its own insulin-producing beta cells in the pancreas. People with type 1 diabetes must have insulin delivered by injection or a pump. Symptoms of type 1 diabetes – increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue – usually develop over a short period of time. If type 1 diabetes is not diagnosed and treated, a person can lapse into a life-threatening coma.
Type 1 diabetes accounts for approximately 5 percent of all diagnosed cases of diabetes in adults.
Type 2 diabetes (formerly called adult-onset diabetes) occurs when the body does not make enough insulin or cannot use the insulin it makes effectively. This form of diabetes usually develops in adults over the age of 40 but is becoming more prevalent in younger age groups – including children and adolescents. The symptoms of type 2 diabetes – feeling tired or ill, unusual thirst, frequent urination (especially at night), weight loss, blurred vision, frequent infections, and slow-healing wounds – may develop gradually and may not be as noticeable as in type 1 diabetes. Some people have no symptoms.
Type 2 diabetes accounts for about 90 to 95 percent of all diagnosed cases of diabetes in adults.
A person is more likely to develop type 2 diabetes if they:
o have a family history of diabetes
o are a member of an ethnic group like African Americans
o are overweight or obese
o are 45 year old or older
o had diabetes while pregnant (gestational diabetes)
o have pre-diabetes (glucose levels are elevated but not high enough to be diagnosed as diabetes)
o have high blood pressure
o have abnormal cholesterol (lipid) levels
o are not getting enough physical activity
o have polycystic ovary syndrome (PCOS)
o have blood vessel problems affecting the heart, brain or legs
* have dark, thick and velvety patches of skin around the neck and armpits (This is
called acanthosis nigricans.)
Gestational diabetes develops during pregnancy. Women who have had gestational diabetes have a 35 to 60 percent chance of developing diabetes, mostly type 2, in the next 10 to 20 years.
HOW MANY AFRICAN AMERICANS HAVE DIAGNOSED AND UNDIAGNOSED DIABETES?
4.9 million; 18.7 percent of all non-Hispanic blacks ages twenty and older have diagnosed and undiagnosed diabetes
12.6 percent had diagnosed diabetes according to age adjusted 2004-2006 national survey data
WHAT IS THE LINK BETWEEN CARDIOVASCULAR DISEASE AND DIABETES?
Cardiovascular disease is the leading cause of death for people with diabetes – about two out of three people with diabetes die of heart disease or stroke.
Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes.
The risk for stroke is two to four times higher among people with diabetes.
About 67 percent of adults with diabetes also have high blood pressure.
Smoking doubles the risk for heart disease in people with diabetes.
WHAT CAN AFRICAN AMERICANS DO TO PREVENT HEART DISEASE OR STROKE AND OTHER DIABETES COMPLICATIONS?
Diabetes is a self-managed disease. People with diabetes must take responsibility for their day-to-day care. The chances of having diabetes complications can be reduced or delayed significantly by keeping blood glucose (blood sugar), blood pressure, and cholesterol levels (called the ABCs of Diabetes) in the target range.
The National Diabetes Education Program recommends the following targets for reducing the risk of heart disease and stroke for most people with diabetes:
A1C (Blood Glucose) Less than 7 percent **
(check at least twice a year)
Blood Pressure Less than 130/80 mmHg
(check every doctor’s visit)
Cholesterol (LDL) Less than 100 mg/dl
(check once a year)
**Targets should be individualized – less stringent targets may be advised with severe hypoglycemia, limited life expectancy, other medical conditions, or longstanding diabetes.
People with diabetes can manage their disease by eating healthy foods, being physically active, taking diabetes medicine as prescribed and testing blood glucose levels.
Community education and support programs can help people with diabetes and their families to manage their diabetes.
CAN TYPE 2 DIABETES BE PREVENTED?
YES! The Diabetes Prevention Program (DPP), an important trial sponsored by the National Institutes of Health, and the DPPOS, the 10 year follow up study to the DPP, showed that type 2 diabetes can be delayed or prevented in overweight adults with pre-diabetes, including African Americans. Pre-diabetes is a condition where blood glucose levels are higher than normal, but not yet high enough for a diagnosis of diabetes.
Risk factors for pre-diabetes are the same as those listed for type 2 diabetes.
To prevent diabetes, the people who participated in the DPP study:
Lost 5 to 7 percent of their body weight (that is 10 to 14 pounds for a person who weighs 200 pounds).
Were physically active for 30 minutes a day, 5 days a week. Most participants chose brisk walking.
Made healthier food choices and limited the amount of calories and fat in their diet.
WHERE CAN I GO FOR MORE INFORMATION?
For more information about preventing and controlling diabetes, call 1-888-693-NDEP (1-888-693-6337) or visit the National Diabetes Education Program website at www.YourDiabetesInfo.org.
Source: Adapted from the Centers for Disease Control and Prevention. National Diabetes Fact Sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
Updated January 2011
Lack of Sleep Leads to Weight Gain
By Samuel Peterson
Lack of sleep makes the body low on energy and thus, lethargic. Apart from this it makes us skip all the exercises in the day and to add to it, we indulge in eating sugary and fatty food. Once we gain weight, these tendencies tend to continue and harm all efforts to lose the extra pounds also.
Many experts have researched and concluded that that if the body gets less sleep than it needs the appetite for high calorie food increases. The whole idea to eat healthy is disrupted and we thus, put on weight. The human body has many hormones and two of these affect the appetite and the satiety levels. Ghrelin results in eating more and the other Leptin stops the appetite and encourages expenditure of energy.
Lack of sleep results in increased levels of Ghrelin and reduced levels of Leptin, which means we eat much more than the body wants. Sleep deprived people eat high calorie food and put on weight. The extra calories that we consume tend to accumulate around the stomach. The increased waistline is very dangerous as it increases the risk of type II diabetes.
Insulin levels get altered in the body due to less of sleep thus, increasing the risk of diabetes. The body’s tolerance for glucose is said to decrease when it does not get sufficient sleep. Ideally the glucose levels act perfectly when one gets about nine hours of sleep at night. It is not that if you sleep less for one night you tend to put on weight as the next day you will be eating sugary food. This causes a problem if lack of sleep becomes a routine.
The extent of the problem when one sleeps less can be controlled by being careful what you eat. Sleeping less after a healthy diet can still lead to increased weight but the amount can be controlled. An unhealthy diet with insufficient sleep hours apart from causing weight gain makes it extremely difficult to reduce weight.
The problem of less sleep and obesity is also noticed in children. Doctors say that if you sleep properly it is not certain that you will lose weight but this is a fact, lack of sleep will lead to weight gain. Sound sleep is very essential for the body to function the way it has to. To get a proper sleep one needs to take proper rest. The body needs it and you need to give it, there is no alternative to it.
One should exercise early in the day and not before bedtime. Exercise is said to help one sleep properly, only if done at the right time. One needs to eat right, like adequate proteins. Whole grains and fibre rich food is very essential for the body. Many people think alcohol calms you but if had near bedtime it tends to disrupt sleep. It increases calories and results in less sleep thus, the weight gain.
The key to a healthy body is to give it sufficient sleep and rest. The body works like machinery and it also needs its share of care and rest to keep working the way it is designed to.
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Diabetes and Pregnancy, Why Women Should Worry
By Eddie Lamb
There are many concerns a woman will have during her pregnancy, and one that can easily be put to rest with a simple test is gestational diabetes mellitus or more commonly known as diabetes during pregnancy. Gestational diabetes can arise during the second or third trimesters, and can cause complications for the mother as well as the unborn child. Diabetes during pregnancy occurs in a relatively small percentage of expectant mothers, and can often be controlled by diet and exercise throughout the pregnancy.
Many doctors will routinely test for diabetes in pregnancy between 24 and 28 weeks of gestation, especially if a woman has risk factors that will increase her odds of developing it. These risk factors include a history of high blood pressure, obesity, ethnicity and a family history of diabetes. Women who have experienced diabetes in pregnancy in the past have a greater chance of developing it again in subsequent pregnancies. Women who are pregnant at an older age also have a greater risk of diabetes in pregnancy.
The test will include fasting and then drinking glucola, which is a mixture of concentrated sugar. Once the glucola is ingested, a blood test is done to check blood sugar levels. If gestational diabetes is diagnosed, a program of diet and exercise will be prescribed to try to control the diabetes during the pregnancy.
What Does Diabetes in Pregnancy Look Like?
Often diabetes during pregnancy is diagnosed before symptoms become obvious. Some of the symptoms that can show up are an increase in hunger, thirst and urination, recurrent vaginal infections and increased blood pressure. Many women complain of fatigue, although this is not a good test, since fatigue is a common symptom of pregnancy. Often sugar will show up in urine during a routine test and this will prompt the doctor to proceed with the glucose test.
It is important to diagnose and treat diabetes in pregnancy as quickly as possible, since it can cause complications during pregnancy. Risks to the mother include raised blood pressure which can lead to a dangerous condition known as ecclampsia. It can also increase the chances of a woman developing Type 2 diabetes later in life. The unborn child can have problems with its heart or kidneys as a result of the mother’s diabetes during pregnancy.
Diabetes during pregnancy is certainly an unwanted complication, but fortunately it can be diagnosed easily and treated effectively. The important thing to remember is to stay on schedule with prenatal visits to the doctor so that the doctor can stay on top of any potential problems.
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Eddie Lamb publishes an abundance of vital information on a range of health topics. We believe a better understanding of your condition can help reduce unnecessary anxiety. You’ll find a host of useful articles all about pregnancy listed on our site map page at http://www.pregnancyunderstood.com
Diabetes – The Perfect Storm
By Caleb Hellerman
(CNN) — The number of Americans with diabetes will nearly double in the next 25 years, and the costs of treating them will triple, according to a new report.
The figures, in a University of Chicago report released Friday, add fuel to the congressional debate regarding reining in the cost of health care.
By 2034, 44.1 million Americans will be living with diabetes — nearly twice the current number of 23.7 million, according to the report, published in the December issue of the journal Diabetes Care. About 90 percent of those with diabetes have type 2, a version of the condition that develops over time.
Accounting for inflation, the direct medical cost of treating them will rise from $113 billion annually to $336 billion, the report says.
Current health care proposals in Congress attempt to slow the growth of spending on chronic diseases such as diabetes by funding programs to prevent disease in the first place, and by offering incentives for insurers and medical providers to encourage early treatment through so-called “accountable care organizations.”
In those organizations, doctors might be paid a flat fee to treat a diabetes patient for a year, with bonuses if they meet certain benchmarks of patient health.
The staggering numbers in the new paper dwarf potential savings that have lately been discussed. For example, Health and Human Services Secretary Kathleen Sebelius earlier this month released a report urging improvements in diabetes care. If the most successful statewide programs for controlling diabetes could be duplicated nationwide, it estimates, annual savings from reducing hospitalizations and treatment for various complications would total $216 million.
The numbers are disturbing, said Dr. Elbert Huang, an assistant professor of medicine at the University of Chicago. He said he considers the predictions “very conservative” because they don’t account for the growing proportion of overweight children and teenagers, who are at higher risk for developing diabetes.
The estimates also don’t factor in immigration, or the rising population of ethnic minorities. Latinos and African-Americans suffer diabetes at higher rates than the U.S. population as a whole.
Type 1 diabetes is a condition in which a person loses the ability to break down glucose in the blood and turn food into energy. The condition often develops when people are young.
In type 2 diabetes, the condition develops over time. The process is complex, but aside from ethnic background, risk factors include having a family history of diabetes, high blood pressure or heart disease. The most common risk factor is simply being overweight.
Even modest weight loss will reduce the chance of developing type 2 diabetes, according to the Centers for Disease Control and Prevention.
More ambitious lifestyle changes, such as diet, regular exercise and assistance through counseling lowered the risk of diabetes by 58 percent, even without medication, in a major federally funded study.
The model used by Huang and his colleagues assumes that the prevalence of diabetes in each age group will stay constant, but that the number of cases will grow as the population gets older. For the Medicare-eligible population alone, the paper predicts the diabetes caseload will rise from 8.2 million people to 14.6 million, and that the total annual cost of treatment will go from $45 billion to $171 billion.
To estimate cost, the researchers assumed that the standard progression of the disease, and mix of therapies used to treat it, will remain constant. According to a 2005 federal report, nearly three in four adults with diabetes uses oral medication to control the disease. About one in four takes insulin.
Diabetes is the leading cause of kidney failure, according to the American Diabetes Association, and nerve damage and damaged blood vessels are also common. About 15 percent of diabetics require amputation of a lower extremity at some point in their life, according to a 1998 paper in Diabetes Care.
It’s certainly possible that medical breakthroughs will improve care, but it’s unlikely to lead to lower costs, Huang said. “In the past, in general, medical discoveries have driven costs up, not down.”
The study was funded by the company Novo Nordisk, which makes insulin delivery systems to treat diabetics. Novo Nordisk approved the final manuscript, but the authors say the company did not play a role in designing the study or collecting data.
“Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened health care system,” the report concludes.
The new report is concerning, but doesn’t change the big picture of health care spending, said Jonathan Gruber, an MIT economist who has schooled many politicians about the intricacies of health care.
“Even without this change, over the next 75 years we’ve made promises that exceed the revenues we have to pay for them,” he said.
There’s no compelling evidence that better preventive care can significantly reduce the cost of treating diabetes, Gruber said, but he believes accountable care organizations could make a big impact. He also likes the idea of allowing insurers to charge higher premiums to people who don’t meet certain health benchmarks, such as losing weight if they’re obese.
“The thing about diabetes, it’s among the most preventable of major illnesses,” Gruber said. “We need to put patient financial incentives at stake.”
Huang said he won’t be surprised if the surge in diabetes turns out to be even worse than he projects.
“Prior estimates have all said there would be a dramatic rise in the diabetes type 2 population,” he said, but in every case “the actual [diabetic] population has ended up being larger than the estimates.”
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Source: CNN by Caleb Hellerman, (published November 27, 2009).
Caleb Hellerman is CNN Medical News senior producer.
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Type 2 Diabetes: What Doctors Don’t Tell You
By Emily Saar
Original published October 12, 2007. Reprinted here November 10, 2009.
Emily Saar is a recovered type 2 diabetic as a result of using Eleotin and the owner of http://www.BetaTherapy.com. Visit to learn more about Eleotin and the truth about diabetes.
http://www.BetaTherapy.com
View all articles by Emily Saar Type 2 Diabetes: What Doctors Don’t Tell You
According to the CDC (Center for Disease Control) type 2 diabetes is an epidemic that affects more than 18,000,000 people in the U.S alone. Statistics prove that more than 2,500 people daily are diagnosed with this disease. Almost everyone knows someone who has it. It is estimated that 1 in 4 Americans have type 2 diabetes, many do not know they have it.
Type 2 diabetes is a silent killer of thousands every year. It doesn’t come on overnight and it isn’t painful (at first). In fact, a majority of people who are newly diagnosed with type 2 diabetes are usually being treated for another problem. Many do not take this disease seriously enough to do anything about it until complications begin to surface.
Complications vary from person to person, but the first signs of type 2 diabetes usually include: extreme thirst, dry itchy skin, tingling in the hands and feet, increased urination, increased hunger and blurry vision. Untreated, it can eventually lead to: poor circulation, nerve damage, blindness, amputations, heart disease, stroke, kidney failure, dialysis and death. Pretty serious complications.
Twenty years ago, type 2 diabetes was a disease most commonly diagnosed in people over 50. Today, our children are being diagnosed. What a sad future they have to look forward to. Life expectancy is shortened by at least 12 years along with a lifetime of insulin shots, medications and eventually dialysis.
Healthcare professionals deal with this epidemic by prescribing medications. Many of these drugs are very harmful and even deadly. Most have to be taken for life and lose their effectiveness over time, meaning the doses will have to be increased or other drugs added to the original prescription. Considering the complications associated with type 2 diabetes, our healthcare system profits quite nicely from this disease.
Avandia, a very common diabetes medication, was once thought to be a very effective drug in treating type 2 diabetes. Until it started killing
people. Now known as a drug that increases risk of heart attack by 70%, many patients went scrambling to their doctors to change their meds, not knowing the amount of damage already done by this drug. This FDA approved drug. Avandia is not the only one. Almost all diabetes drugs carry some type of harmful side-effects from headaches and vomiting to heart and liver failure.
Knowing the amount of money the pharmeceutical companies make from type 2 diabetes and all of it’s complications, it’s no wonder a cure has never been found. Think carefully about what would happen if an FDA approved cure was made available. Entire wings of hospitals would shut down, doctors that specialize in diabetes would be out of work and dialysis clinics would fold. This is a very small part of the revenue made by other complications such as blindness, physical therapy due to amputations, heart institutes would lose hundreds of millions. There is just too much money to lose in making a cure available.
Canada has had a natural type 2 diabetes herbal remedy available to the public since 1999 called Eleotin. Researched for more than 20 years, Eleotin works on a metabolic level to lower blood sugars naturally and reverse type 2 diabetes by correcting the causes.
Type 2 diabetes has two main causes. Insufficient insulin produced by the pancreas (beta cell damage) or insulin resistance, when cells in the body resist insulin that is made. Eleotin restores beta cell function, restores the health of the pancreas and strengthens insulin receptors to make them more sensitive to the insulin naturally made by the body. Eleotin has no harmful side-effects, is made entirely from herbs used as foods in many countries. It is even safe for children.
Eleotin is sweeping the globe. Almost 100,000 people worldwide have used Eleotin. Many have reversed their type 2 diabetes completely. It’s time we take this disease more seriously and stop waiting for the FDA approved cure that will never appear. How many years have we dumped money into diabetes research? Where is their cure? For many thousands of people who have used Eleotin, they have already found theirs.
Source: Emily Saar
Why You Should Be Using Cinnamon As A Natural Remedy
Posted October 24, 2009
By Keith Henry
Keith Henry is the Director of Phase 3 ministries Inc. He is a medical missionary herbalist and Naturopathic Doctor Candidate. Grab his amazing free report “Emergency Herbal Medicine” at http://www.phase 3 Ministries.com
Cinnamon the botanical name being Cinnamomum Zeylanicum, is a small, bushy green tree. The dried leaves and/or dried bark of this tree form a constituent of many spice mixtures and medicines. Both add to the taste and flavor of food in addition to its medicinal value.
Cinnamon is purported to be a natural insulin sensitizer without any known adverse events. Both in vitro and in vivo animal studies have shown that cinnamon is an insulin sensitizer.
Studies suggest that cinnamon may have a regulatory effect on blood glucose, making it particularly advantageous for people with Type 2 diabetes.
Studies also indicate that merely 1/2 teaspoon of cinnamon per day can lower LDL cholesterol.
In other studies, cinnamon has revealed an astounding ability to stop medication-resistant yeast infections.
In a study published by researchers at the U.S. Department of Agriculture in Maryland, cinnamon reduced the proliferation of leukemia and lymphoma cancer cells. Cinnamon had an anti-clotting effect on the blood.
In a study at Copenhagen University, patients given one-half a teaspoonful of cinnamon powder mixed with one tablespoonful of honey each morning prior to breakfast had considerable relief in arthritis pain after just one week and could walk with no pain at all after a month’s time.
When added to food, Cinnamon inhibits bacterial growth and development as well as food spoilage,
hereby making it a natural food preservative.
An additional study determined that smelling cinnamon boosts cognitive function as well as memory. Moreover, researchers at Kansas State University discovered that cinnamon fights the E. coli bacteria in juices that are unpasteurized. Cinnamon is also a great source of manganese, fiber, iron, and calcium.
Cinnamon has also been used in “brain tonics” to improve memory. Additionally, it is considered useful for anxiety, depression and mental tension. Cinnamon is also regarded as a very effective remedy for irritating cough, common cold, allergic rhinitis, and acute and chronic sinusitis.
Gynecologists that practice Ayurvedic medicine recommend cinnamon in menorrhagia (excessive bleeding during menses) and there have been medical trials that have supported this recommendation.
Women suffering from the condition known as menorrhagia are usually treated by the use of birth control pills in conventional medication. The failure to control the excessive monthly bleeding by use of contraceptive pills when it occurs is replaced with another so called “cure”.
The woman may sometimes be offered the unhappy choice of undergoing a hysterectomy in such cases-this being the second so called cure of conventional medication. So Cinnamon is at least a viable option.
So cinnamon can be a very potent natural “medicine” that lends help in digestive, respiratory and gynecological problems. Thus when used correctly the benefits just might be above what you expected.
Source: Keith Henry
Type 2 Diabetes Epidemic
By Mike Fletcher
According to the American Diabetes Association (ADA), there are 15.7 million Americans who have diabetes. This disease is the main cause of blindness in people between the ages of twenty and seventy and is the sixth leading cause of death in the U.S.
If this disease is not properly managed, diabetes can cause kidney disease, hypertension, heart disease, edema, neuropathy, and infections of the mouth, feet, skin, lungs and genitalia. The skin infections do not heal properly and can even lead to amputation of extremities.
Type 2 diabetes has become the most common form of disease affecting 90-95 percent of the people who have diabetes. For people who have type II diabetes, not enough insulin is manufactured by the pancreas. Another problem is that the cells can become insulin resistant. When this happens, glucose accumulates in the blood instead of entering the cells.
Type 2 diabetes usually develops later in life; however, the disease is now becoming more common in people in their thirties and even late twenties.
The most common risk factors among those who develop this condition include diet, weight, race, age, lack of exercise and genetics. The most common ethnic groups to have type 2 diabetes are Latinos, American Indians, African-Americans, and American Asians.
The real danger of diabetes is the complications associated from inconsistent insulin levels and elevated blood glucose. One dangerous complication is diabetic ketoacidosis (DKA), or another dangerous condition known as hyperosmolar syndrome. DKA happens when insulin levels are so low that the body starts metabolizing stored fat to use as fuel. When the fat breaks down, a by-product is released that is known as ketones which cause the body to become too acidic.
Ketoacidosis is typically seen in those with type 1 diabetes, but can happen to those with type 2 as well. The symptoms can include nausea, sweet breath, having a hard time breathing and confusion which can lead to a coma.
Hyperosmolar syndrome is a result of elevated blood sugars accompanied with dehydration. This condition is more common in those with type 2 diabetes who also take steroid medications. Hyperosmolar syndrome can also be a result of a stress from another illness. Symptoms can include confusion, tiredness, and in the most severe cases, coma. Often, in older adults, type 2 diabetes is not discovered until the symptoms of hypersmolar syndrome are reported to a doctor.
If you have recently been diagnosed with diabetes, you probably have a lot of questions and may even have a hard time grasping the severity and the responsibilities that come with this condition. It must now become a priority to take care of your body. If you are overweight, it is time to drop those extra pounds. You will also need to cut back on sugars, eat more fiber, and limit fours and white rice and to start a regular exercise regime.
You will also want to make an appointment with an optometrist make sure that your eyes are in good shape.
Source: Mike Fletcher
Soy Joins The Fight To Control Blood Sugar
By Dee Overly
Dee Overly is a mother and artist who discovered the health benefits of soy milk and now sells a Soymilk Maker at http://www.SoymilkCrossroads.com. Stop by and pick up your free Vegan recipe book and check out the blog.
View all articles by Dee Overly The relationship between soy foods and long-term health benefits has been the topic of many discussions among physicians and health organizations for several years now. Studies have been conducted that prove the link between high soy diets and lower heart disease, strong bone mass and cancer prevention. Now studies are being conducted regarding the relationship between a soy diet and blood glucose or sugar levels. Believe it or not, it seems soy may aid the body in this fight as well.
Soy and Diabetes Study
Recently, Iranian researchers reported to the Journal of Diabetes Care that their findings coincided with previous work. They found that soy protein had a significant impact on risk factors associated with Type-2 diabetic patients with kidney disease.
The study followed forty-one patients for a total of four years. All of the patients were Type-2 diabetics and suffered from some type of kidney disease. Twenty of the patients were given a diet of animal, plant, and soy protein, while the remainders were given a diet of just animal and plant proteins.
Results concluded that the patients who added the soy to their diets showed a lowering of blood sugar levels. Patients saw a dramatic drop in cholesterol levels and triglycerides, the number one cause of cardiovascular disease. This is great news for the 18 million Americans suffering from diabetes, because they are three
times more vulnerable to heart problems.
Another study involving diabetics and a soy diet was focused on those patients with severe kidney disease. Results concluded that soy protein seemed to improve kidney function, perhaps even better than completely avoiding all protein, which is the typical treatment.
Soy May Help in Prevention
As for those of you who are not diabetic and don’t ever want to be, soy is great for you as well. One study conducted on Chinese women found that eating a diet with large amounts of tofu, a soy product, protected them from Type-2 diabetes. Women who consumed the most soy in the study had 50% less sugar detected in their urine than the control group.
Researchers contribute the great benefit of soy to the proteins and isoflavones present in soybeans. The isoflavones stop fat tissue buildup and enhance the body’s ability to break down the fat. As a result, the blood glucose levels are lowered and the body doesn’t have to work as hard to produce insulin.
There is currently no data that suggests how much soy is needed in order to eliminate risk factors for diabetes. However, the Food and Drug Administration suggests that Americans eat a healthy 25 grams of soy protein per day in order to aid the body in disease control and in lowering risk factors, in particular, lowering cholesterol. Further studies are being conducted regarding diabetes patients and soy diets as well as soy used to lower the risk factors associated with Type-2 diabetes.
Source: Dee Overly
Pediatric Diabetes – Caring for a Diabetic Child
By Min Zhu
Min Zhu, and author and mother, provides information on diabetic children. For more information, visit http://mominneed.com/health/diabetes/
Despite our best efforts as parents or caregivers, children will become sick. One such illness which is becoming increasingly prevalent is pediatric diabetes. However, keeping a diabetic child healthy is dependent on being informed about the disease, its symptoms, and treatments. Caring for the child with diabetes is the responsibility of all persons who, at some time or other, has to take care of that child. As such, parents need to ensure that all care givers are informed about their diabetic child’s dietary needs.
Most children tend to have type I diabetes, previously known as juvenile diabetes, although children are increasingly being diagnosed with type 2 diabetes as well. Type I diabetes occurs when the pancreas does not work and does not produce any insulin. Insulin is needed to help break down sugars (glucose) in our body to help it work efficiently. When this breakdown of sugars does not happen, as in the case of type I diabetes, the sugar stays in the blood stream.
Because insulin is important in breaking down sugars in the body to use for energy, insulin has to be taken to control the illness. Therefore type I diabetes is also called insulin-dependent diabetes. Exercise and diet are also important helping to control this type of diabetes. Caring for the child with diabetes means that you will need to recognize the signs of the illness, as well as any resulting reactions that can occur. The main signs of pediatric diabetes are:
Breath smelling like fruit
Constant hunger
Pulse beating faster than normal
Headaches
Being weak and dizzy
Difficulty concentrating
Vision becoming foggy
Skin tending to be cold and moist
Experiencing seizures
Next, you should be able to identify when the child is in crisis, suffering either a hypoglycemic or hyperglycemic episode, and you should know what to do help in either case. Hyperglycemia occurs when the sugar levels are too high. Rising sugar levels are generally a result of eating too much, not taking the correct amount of insulin, or not exercising enough. When a child is hyperglycemic, treatment by medical professionals is needed. A child suffering from high blood sugar will complain of the following:
Weakness
Extreme thirst
Needing to urinate frequently
Not seeing clearly
Not being hungry
With hypoglycemia (low blood sugar), the symptoms vary from child to child, but some of the typical signs include:
Clumsiness
Sudden mood changes
Sweating
Hunger
Seeming confused
Trembling
Headache
Tingling feeling around the mouth
The first course of action is to increase the child’s sugar intake by giving them something sweet to drink, such as regular soda, fruit juice or glucose tablets. Once the child is feeling better, you should give them something more solid to eat. If the child is too weak to swallow or is unconscious, administer the recommended dosage of glucagon and call for immediate medical assistance. Glucagon is a medication given by injection to rapidly increase the level of glucose in the blood. It is normally the first course of treatment in severe hypoglycemia.
Diet is a major part of keeping the diabetic child healthy. The caregiver has the responsibility to ensure that the child eats what is recommended. It is also important to talk with the child and let them know that they will get really sick if they eat too many sweets or other foods that can pose a risk. It is also important to let others, such as teachers, know that a diabetic child may need to snack to boost their sugar and energy levels. The child with diabetes must also have regular meals.
Exercise is important as well, and there is no reason why the diabetic child cannot participate in all regular physical activity. Exercise helps to control blood sugar levels. However, suffering from pediatric diabetes should not exert themselves before meal time. Also, they will need to have a snack, such as juice, crackers or a fruit, handy, as they will need to replace sugar lost during physical activity.
Most importantly, children should be taught how to test their blood sugar levels during the course of the day, once they are able to do soon their own. This is important so that they can take insulin or eat something as needed.
Caring for the diabetic child, while calling for more vigilance in terms of their eating habits can be stress free once you and others taking care of the child know what to do and follow the rules. Also, make sure that emergency numbers are close at hand and that the child learns how to recognize symptoms of potential trouble and take corrective actions.
Source: Min Zhu
How Can Flaxseeds Help With Diabetes?
By Kerry Ng
Kerry Ng is a successful Webmaster and publisher of The Coffee Blog. For more great helpful information about Coffee visit The Coffee Blog
http://www.greatcreditcardtips.com
How can Flaxseeds Help with Diabetes?
Diabetes is a very debilitating disease that is caused by many different factors. There are two main types of diabetes, type 1 (juvenile) and type 2 (adult-onset) of this disease. There are also other subforms of it such as gestational diabetes.
What Causes Diabetes?
How this disease is cause depends on the type of the disease. Type 1 diabetes is an autoimmune disease that generally strikes before the age of 20. This disease is caused when for a reason still not pinpointed by doctors, a person’s immune system starts attacking the cells in the pancreas that produce beta cells. These beta cells are what notify person’s body of when to use glucose and how much to use. A person that has type 1 of this disease therefore has difficulty regulating their body’s glucose levels because of this disease. There is still no cure for type 1 of this disease.
Individuals that are afflicted with type 2 diabetes generally fall prey to this disease when they are adults. This disease is more likely when people have several contributing factors present. Type 2 of this disease’s contributing factors include smoking, drinking excessively, obesity, family history, and being a part of certain ethnic backgrounds. Type 2 of this disease can generally be reducedin severity and even cured if a person adjusts certain bad habits such as eating a better diet and quitting smoking.
Gestational diabetes affects pregnant women that generally have many of the same contribute factors that individuals with type 2 of this disease have. However, women with gestational diabetes generally do not experience this disease after they are no longer pregnant. However, women that have had gestational diabetes in the past are far more likely to have it in any future pregnancies as well.
Diabetes and Flaxseeds
Flaxseeds and flax seed oil can be potentially helpful in treating this disease. This is due to the fact that the oil may actually have the ability to help stabilize blood sugar levels (glucose). While this does not necessarily treat the cause of the disease, it can lessen the severity of it. This property of flax seed oil is still being researched and has yet to be proven by scientists.
Individuals considering purchasing flaxseeds or flax seed oil to help with their diabetes should consult their doctor first. This will help consumers avoid potentially negative side effects they may experience with the oils. Or perhaps it does not react well with many of their current medications. They can also discuss with their doctor whether or not the potential benefits of the oil outweigh the potential risks.
Source Kerry Ng
Epigenetics and Type 2 Diabetes by Rachael Moeller Gorman
Posted August 15, 2009
The New Heredity
By Rachael Moeller Gorman
For hundreds of years, people in the tiny parish of Överkalix, in northern Sweden, have endured bad times and celebrated good ones with little connection to the outside world. To the north and west are Lapps, and to the east, Finns. Though they technically speak Swedish, residents of Överkalix use a dialect that makes them virtually unintelligible to fellow Swedes.
But since the sixteenth century, the people of Överkalix have kept impeccable records of their lives. Clergy logged births, causes of deaths, and land ownership; other historical records noted harvests and crop prices. When epidemiologist Gunnar Kaati arrived 20 years ago, he found an extensive set of meticulous data for this isolated, homogeneous population—a perfect foundation for the large, multigenerational study he hoped to conduct. Kaati wanted to use the data to probe a new idea in clinical medicine—that exposure to certain environments during crucial points in development might determine whether a child would suffer disease years later.
We’re familiar with the notion that the environment is linked to disease—that a diet high in saturated fat may clog arteries and cause heart disease or that radiation mutates DNA and can lead to cancer. But in the emerging field of the fetal and developmental origins of adult disease, more subtle factors such as the amount of food a mother ate during pregnancy or the type of mothering she provided directly after birth may determine whether her child will develop cardiovascular disease or be left neurologically susceptible to overstress years later.
These effects, some researchers believe, have nothing to do with mutations in the DNA code. Rather, they seem to involve what are known as epigenetic changes: structural alterations to the DNA double helix. The notion is that we experience periods in development when our bodies are programmed to collect information about our environment, then readjust our growth depending on what we find. To make this readjustment, our bodies flick genes on or off, sending us on an irreversible trajectory. For example, if a mother doesn’t eat much during pregnancy, that may signal to her fetus that he is about to emerge into a food-poor environment, and he may be born smaller, with a slower metabolism, than if his mother had eaten heartily. Epigenetic changes can lead to, say, type 2 diabetes years later if the world the adult finds—such as a world full of food—is different from that forecast by the fetus.
Kaati took this idea a step further. He wanted to know not just whether a child’s own early environment caused common diseases later in life but whether the environment a child’s parents or even grandparents encountered had an impact. Animal studies suggest that such effects may persist in DNA for generations, and Kaati’s work, still at an early stage, hints that the same thing may happen in humans. Genes might “remember” what our ancestors ate, felt and experienced, altering our own lives generations later.
For many students of biology and evolution, such ideas immediately bring to mind Jean-Baptiste Lamarck, who theorized that traits acquired by an organism during its life can be passed on to its offspring. The classic example is the giraffe that stretches its neck to reach a tree’s top leaves and then gives birth to longer-necked young. Lamarck died 30 years before the 1859 publication of Charles Darwin’s Origin of Species, which detailed evolution as we now know it—a process by which chance differences (later recognized as mutations) improved an individual’s chance of survival and thus ensured the propagation of those traits. Each man proposed a similar result, but by very different mechanisms; in Lamarck’s view, alterations in a species were more immediately driven by environmental change, whereas Darwin saw a longer process of passive natural selection. The subsequent discovery of genes—the primary unit of natural selection— added credence to Darwin’s theory, and Lamarck’s was shelved, seemingly laughable compared with what had been learned about the body’s sophisticated mode of transferring traits.
Yet advances in epigenetic research suggest that Lamarck may have been onto something. As with the giraffe’s tall tree, environmental factors such as lack of food or inattentive mothering appear to alter our epigenomes and sometimes even those of our offspring. (Some researchers think epigenetic changes have helped speed evolution, causing more rapid alterations than could be explained by mutations alone.)
Though Lamarck’s work may have prefigured modern epigenetics, the term itself wasn’t coined until 1942, by a developmental biologist named Conrad Waddington. In Waddington’s view, epigenetics was what we now call developmental biology—the study of how, during development, our genes give rise to our phenotype, the way we look and behave. By the 1990s a new definition had emerged, and today we consider epigenetics the study of changes in gene expression attributable not to alterations in DNA sequence (mutations that change the protein made by a gene) but in DNA structure (alterations to the scaffolding that carries the code, which can turn entire genes off so they make no protein at all).
Though there are several ways these structural changes can happen, the best known—and the focus of most epigenetic research—is DNA methylation, which occurs when a small chemical compound called a methyl group attaches to a cytosine, one of the four nucleotides in the DNA code. Methylation turns off nearby genes in two ways: by blocking transcription factors from attaching to the gene (and thus keeping those factors from translating the gene’s code into a protein) and by altering the configuration of the DNA itself to make the gene less physically available for transcription. (In addition, some recent studies have suggested that methylation may sometimes alter the configuration to turn genes on.) When a cell divides and copies its DNA, it also copies the methyl group, so the same genes remain shut down in the replicated cells.
As an organism develops from a single cell into its final form, epigenetic mechanisms help cells become distinct tissues. So while every cell contains the same DNA code, each type of tissue—hair, heart, brain—differentiates itself through a unique combination of gene expressions. Epigenetic mechanisms turn off the genes that aren’t needed for a particular tissue type and help determine which proteins are expressed.
In recent years research has hinted that epigenetic mechanisms may be responsible for much more than just normal development. Development is inherently plastic, with organisms able to take a number of different paths depending upon the environment into which a fetus was introduced. But once certain developmental decisions are made, they are irreversible. David Barker, a professor of clinical epidemiology at the University of Southampton in England, has studied this idea in humans since the 1990s. In multiple studies he and others have found that babies with birth weights on the lower end of normal who grow up in affluent societies are much more likely to develop coronary heart disease, type 2 diabetes and hypertension as adults than are heavier babies. Barker has theorized that smaller babies are prepared for a diet low in carbohydrates and fat, and when they encounter just the opposite in the real world, they are predisposed to metabolic illnesses.
To see a mismatch between a baby’s real and predicted environment, consider the Dutch famine of 1944–45 and its legacy. When German forces cut off food supplies to parts of the Netherlands for six months, expectant mothers who starved during the final trimester were more likely to have babies who later developed type 2 diabetes. Programmed to expect hard times, these children grew up in an improving postwar environment. Researchers think epigenetic changes might have occurred in genes that regulate sugar absorption and metabolism. Other studies have linked a baby’s environment to kidney problems, asthma, osteoporosis and mental illness as an adult.
All these studies are merely correlational, with researchers noting that certain populations, having undergone a particular environmental stress early in life, have sometimes fallen ill years later. That raises questions of exactly how this may occur, whether epigenetics is the true mechanism and if there is anything to be done about it. While that has yet to be answered conclusively in humans, animal studies may be pointing the way.
For the purposes of epigenetics research, the agouti mouse is particularly apt. Its fur color is determined by the level of methylation on a piece of DNA found near the agouti gene. As a result, genetically identical offspring may look completely different from one another. One mouse might be yellow (indicating little methylation), another brown (a lot of methylation) and a third mottled (some cells with methylated genes, some not).
Randy Jirtle, an epigenetics researcher at Duke University, was intrigued by those tendencies and wanted to know whether early environmental influences could change the mouse’s levels of methylation. In a 2003 experiment, he fed agouti mothers folic acid, vitamin B12, choline and betaine—all methyl supplementers—during pregnancy. This not only increased the babies’ DNA methylation near the agouti gene but also boosted the likelihood that they would be brown, establishing that changes in DNA methylation are the mechanism that connects a mother’s diet to her offspring’s gene expression.
Then, in a 2006 study, Jirtle fed the mothers genistein, a component of soy, and found that it too increased methylation, making the offspring more likely to be brown. Next, he tracked the offspring’s adult weight and found that they were less likely to be obese. That’s because the agouti gene also governs the part of the brain that affects satiation. “The big question is how something that happens early, as a result of benign environmental influences, is linked to susceptibility to common diseases 20 or 30 years later,” says Jirtle. “At least for the agouti mouse, that link is DNA methylation.”
At about the time Jirtle was doing his mice experiments, Michael Meaney, a neuroendocrinologist at McGill University in Montreal, was working with rats, testing the methylation of a gene important to the stress response—a glucocorticoid receptor gene in the brain. It turns out it’s not just what a mother eats but also how she treats her babies that affects their epigenome—the pattern of epigenetic marks that accumulates throughout development. Some rat mothers are particularly attentive to their pups, excessively licking and nursing during the first week after delivery. Studies have shown that the pups of these mothers are less fearful as adults and less fazed by stressful situations.
Meaney found striking differences in methylation patterns between pups with highly attentive mothers and those with neglectful mothers. Less attentive mothering resulted in more methylation near the glucocorticoid receptor gene, turning it off; better mothering kept it on, producing more receptors and better regulation of the rats’ stress response. To confirm his findings, Meaney transferred pups born to neglectful mothers to highly attentive ones immediately after birth; the methylation patterns of these adoptees were almost indistinguishable from those of the attentive mothers’ natural offspring, and the adopted pups grew up to be as fearless as the natural pups. Although these epigenetic changes happened only during one crucial period—the first week after delivery—their impact persisted into adulthood. Yet when Meaney injected a compound into adult rats that demethylated key genes, neglected animals became less fearful. His work provides the first evidence that the way a mother takes care of offspring might change them forever by altering the epigenome.
These studies demonstrate how a less than ideal environment during a critical developmental period may have long-lasting effects. Now, Michael Skinner, a molecular bioscientist at Washington State University in Pullman, is going further, showing that such exposure may change the lives of the altered animals’ descendants too.
Skinner exposed pregnant rats to the toxin vinclozolin, a hormonelike compound known as an endocrine disrupter, during days eight through 15 of their embryos’ development—when the cells that will become sperm are particularly open to epigenetic changes. He found that almost all males in four subsequent generations descended from the vinclozolin-exposed rats had far fewer and less vigorous sperm than normal and were also more likely to be infertile. Moreover, these effects appeared to relate to patterns of DNA methylation.
“The exposure to vinclozolin apparently reprogrammed the remethylation in the male germ line permanently,” Skinner says. In a later study, he found that vinclozolin exposure during the same period not only caused reproductive defects but also led to a number of adult diseases, including prostate disease, kidney disease and tumor development. It even dampened the rats’ chances of finding a mate.
Skinner was the first to show that epigenetics propagates the effects of the environmental exposure of one generation to multiple subsequent generations. “We have a clearly transgenerational effect for four generations and a very high frequency of disease,” he says.
During his years working with the Överkalix data, Kaati has tried to link environmental developments in the parish with possible epigenetic changes in residents. He has followed the lives of people born in 1890, 1905 and 1920 and consulted crop data compiled during the lives of their parents and grandparents. His goal was to find how much food was available to people during one crucial stage of development: the slow growth period (SGP) before puberty begins (between ages eight and 10 for girls and nine and 12 for boys).
In a series of studies published since 2001, Kaati has shown that when food was scarce during a father’s SGP, his son was far less likely to die of cardiovascular disease. And if a paternal grandfather had plenty to eat during his SGP? His grandchild tended to have a shorter life, and his son had a quadrupled risk of dying of diabetes. (These findings may seem to contradict those of Barker and the Dutch famine researchers, yet the crucial difference may be that a child, during his SGP, requires little food, whereas a fetus requires a great deal.) But while these patterns suggest possible epigenetic links, researchers don’t know yet whether there’s a causal connection or which mechanism might be involved. Still, they have their suspicions. “The slow growth period is a time when sperm cells are maturing and during which information is imprinted on those cells,” says Kaati. “For our study’s next phase, we want to see whether these mechanisms extend beyond the three generations we have discovered.”
And if future studies confirm what Kaati and his fellow researchers suspect? “It might be dangerous to overeat during the slow growth period,” he says. “That’s what is happening now, with kids becoming fatter and fatter.” The resulting harm might conceivably persist for generations to come.
But because these studies are preliminary, researchers are cautious. “There’s almost a wish that epigenetic phenomena affect our lives—that when we change our diet, for example, it might change the way our genes are expressed,” says Adrian Bird, a molecular geneticist at the University of Edinburgh who specializes in methylation. “But we have a way to go before we can be sure.”
Several initiatives may boost this research. The National Institutes of Health names epigenetics one of four “grand challenges in biomedical health/research” that “can be uniquely addressed by NIH as a whole.” Therapies that could turn on important genes, especially for the treatment of cancer, are being developed, and some drugs are believed to modify the epigenome for such diseases as epilepsy and bipolar disorder.
There’s also some concern that industrial chemicals may need to undergo testing to make sure they don’t alter the epigenome in a way that could lead to disease. “In the future, we’ll need to test compounds for their ability not only to mutate our DNA but also to alter the epigenome,” says Duke’s Jirtle.
The field of epigenetics may just be dawning, but it could someday change the way doctors approach medicine. “If you think of the genome as a computer’s hardware, then the epigenome is the software that tells the computer how to work,” says Jirtle. “I think we’ll discover that many diseases aren’t the result of hardware problems—mutations—at all. They’ll turn out to be due to software—epigenetic—problems.”
Dossier
1. “Environmental Epigenomics and Disease Susceptibility,” by Randy L. Jirtle and Michael K. Skinner, Nature Reviews: Genetics, April 2007. A thorough review of the environment’s effects on the epigenome, it uses vivid diagrams and photos to illustrate key points.
2. “Transgenerational Response to Nutrition, Early Life Circumstances and Longevity,” by Gunnar Kaati et al., European Journal of Human Genetics, April 2007. The latest in Kaati’s series of fascinating studies on health in an isolated Swedish village shows that food supply during childhood can alter disease risk generations later.
3. Epigenetics? [http://epigenome.eu] This European site tackles the tough field of epigenetics for the general public with in-depth feature stories, frequent updates from the laboratory and the latest news.
Source: Rachael Moeller Gorman
Diabetes Signs In Toddlers
Awareness of Signs of Diabetes in Toddlers Helps Provide Them With Immediate Medication
Posted August 13, 2009
By Ann Nelson
Diabetes is common around the world. There may be several people who may not be even aware that they may be suffering from diabetes. It is a disease not just limited to adults; it can also affect toddlers as well. It is becoming common with growing children as well. This type of diabetes is called as juvenile diabetes or Type 1 diabetes. Children may not be even aware that there is something wrong with them. But, there are certain signs that parents and elders should be aware of, to recognize the signs of diabetes in toddlers.
You can start medical treatment at early stage and ensure that their blood sugar levels remain stable and they live a healthier life. There are different symptoms that can be seen in toddlers. However, there are few signs which should ring the warning bells in the minds of elders. Amongst children suffering from diabetes, whenever they eat, the food is broken down and sugar is released and absorbed into the bloodstream. It is carried to the cells to be used as energy for the different activities. However, the pancreas does not respond with insulin which leads to cells being unable to use the sugar. The cells are starved for energy and the sugar builds up in the blood. The children feel tired and fatigued due to lack of energy.
When there is excess sugar in the blood, the kidneys sense its level and start getting rid of it through urine. The point when kidneys allow sugar to enter the urine is called renal threshold. When the kidneys flush out excess sugar, it also takes the water in which it is dissolved. Thus the most common symptom is the excessive need to urinate. This is called polyuria. This in turn leads to dehydration. The body demands more water and the child feels increasingly thirsty. This is called as polydipsia. Children may also get the feeling of a dry sticky mouth or sore dry throat. Such children need huge quantity of water or any other fluids.
Even if there is reduction in the amount of fluids there is excess urination. To avoid dehydration you should allow them to have fluids. Some children may even start wetting the bed. The loss of sugar, dehydration and the inability to use blood sugar leads to weight loss even if they may be experiencing increase in appetite. It may be followed by tiredness, drowsiness and weakness. You may also notice diaper rash that is not ready to heal in spite of using various creams.
There are other serious signs of diabetes among toddlers like stomach pain, feeling of nausea, vomiting and labored breathing. If you notice any of these signs you should immediately approach your doctor for future action. You have to ensure that you monitor the blood sugar levels regularly. It may be a very traumatic experience for toddlers to get insulin shots regularly. Learn the proper way to provide adequate medication and care for your child. Create schedules for providing them with appropriate diet and medication.
Diabetes can be frightening for anyone but when it affects toddlers it causes great anxiety as the little ones are unable to tell what is happening to them. Make schedules for your child and stick to them if you want to control diabetes. The health of your kids is your priority and by being aware you can ensure that you child does not suffer from the ill effects and gets relief to the maximum possible extent. Drink lots of water because it is calorie free and helps to flush away the toxins. Did you know that flavored carbonated water has no calories, sugar, body, sweetener, color or preservatives? Want to know more about carbonated flavored water? Check out carbonatedseltzerwater.com
Reading all I can about diabetes and health. Found an excellent site at adviceondiabetes.com with a free ebook with more than 500 diabetes recipes.
Source: Ann Nelson
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