Alzheimer’s disease begins at the synapse, the space where neurons connect. The biggest bad guy in this disease is a sticky protein called beta-amyloid. Either too much is made or not enough is cleared away, and as beta-amyloid accumulates, it creates a gooey clog in the synapse, preventing the neurons that meet there from communicating. As a result, the information those neurons carry can’t be transmitted or retrieved. The beta-amyloid “goo” prevents these two neurons from “talking” to each other. We notice this molecular event because we forget something.
When too much beta-amyloid causes the synapse to fail, we begin to see the symptoms of Alzheimer’s. There are many risk factors that can contribute to having too much beta-amyloid. What are these risk factors?
First, let’s imagine a seesaw-style scale and the risk factors, which each vary in weight, are being piled on one arm of the scale. When that arm hits the floor, we have Alzheimer’s.
Risk Factors
1. Age
The biggest risk factor for developing Alzheimer’s is age. For reasons we still don’t entirely understand, as we get older, we accumulate more beta-amyloid. The chances of being diagnosed with Alzheimer’s increase steadily as we age. Right now, the risk of Alzheimer’s doubles every year after the age of 65. About half of people who are 85 and older have Alzheimer’s.
2. Genetics
Another risk factor is genetics. There is a rare form of Alzheimer’s called Familial Alzheimer’s, which always begins well before the age of 65 (typically in the 40s and 50s) and runs in families, that is autosomal dominant. This means that a single genetic mutation causes the disease. Picture the seesaw scale again. Genetic mutation is the only risk factor on the scale, and the arm is sitting on the floor.
Scientists have discovered three genetic mutations that cause this early-onset Familial Alzheimer’s. All three of these mutations result in molecular changes that cause an excess of beta-amyloid.
But this type of genetic risk factor is relatively rare, accounting for only about 5%of Alzheimer’s cases. The contribution of genetic risk factors to the development of Alzheimer’s for the vast majority of cases weighs much less on the scale, tipping the arm only a little bit.
For example, ApoE4 is a known genetic risk factor for Alzheimer’s. Forty to 65% of people with Alzheimer’s carry at least one copy of this mutation. But you can have two copies of this mutation (one inherited from each parent) and not have the disease. Again, imagine the arm of the scale tipped a bit with each copy of this mutation, but the arm is still well above the floor. Likewise, you can have zero copies of ApoE4 but have Alzheimer’s. The arm of your scale would be free of ApoE4 but piled high with other risk factors that tipped the scale over, leading to expression of the disease.
3. Head Trauma
Prior experience with head trauma, especially if consciousness was lost, increases the risk of developing Alzheimer’s. Always wear a seat belt and helmets.
4. Diabetes
In a recent study out of Japan that looked at over 1000 men and women over the age of 60, it was found that people with diabetes (especially type 2) were twice as likely to develop Alzheimer’s. Researchers are now trying to understand the molecular mechanisms that link diabetes to Alzheimer’s. It’s thought that the link may be twofold.
Nerve cells require a lot of energy to do the work of communicating. They get this energy from oxygen and glucose in the blood. With diabetes, cells lose their ability to respond to insulin, the molecule that transports glucose from the blood into the neurons, and so neurons have to cope with less glucose. Diabetes also often leads to damaged blood vessels, which compromises the delivery of oxygen to the nerves in the brain. Neurons already struggling to communicate despite too much beta-amyloid may lose the battle if glucose and oxygen are deprived.
Think of the scale arm with a bunch of risk factors piled on it. It’s hovering above ground but fighting to maintain that position. Things aren’t looking good for that synapse, but it’s still managing to function. Those neurons are still able to talk to each other. We aren’t showing any symptoms of Alzheimer’s yet. Add diabetes, and less oxygen and glucose to provide the energy the neurons need, and the scale arm goes crashing to the ground. Now we have Alzheimer’s.
5. Cardiovascular Disease
Eighty percent of people with Alzheimer's disease also have cardiovascular disease. Scientists are trying to better understand the link between heart health and Alzheimer’s disease, but we do know a few things about this relationship.
Cholesterol drives the production of beta-amyloid. For a brain that is already struggling to keep beta-amyloid levels in check, high cholesterol can be a risk factor that tips the scale. Doctors prescribe statins for people diagnosed with Alzheimer’s to help keep cholesterol levels down.
Again, the neurons in your brain need a lot of oxygen to do their job. If you have high blood pressure and if you have plaques in your blood vessels, your blood vessels are less efficient at delivering this oxygen to your brain. Not enough oxygen can be the weight that tips the Alzheimer’s scale.
All the risk factors for heart disease (things like poor diet, lack of exercise) are also risk factors for Alzheimer’s. And this means that things like a healthy, Mediterranean diet (whole grains, red and purple fruits and vegetables, fish, nuts) and exercise may not only protect the heart, they may protect us from Alzheimer’s. In fact, in animal studies, exercise has been shown to clear beta-amyloid better than any pharmaceutical we know of. Think of diet and exercise as weights on the other arm of the scale.
There is currently no cure for Alzheimer’s, but understanding these risk factors offers us some good news. While we can’t do anything about getting older or the genes we’ve inherited from our parents, eating smart, keeping cholesterol levels and blood sugar low, exercising, wearing a helmet when bicycling or skiing, and wearing a seat belt in the car are among the things we can do to keep the arm of the Alzheimer’s scale from tipping to the ground.
Showing posts with label adults diabetes. Show all posts
Showing posts with label adults diabetes. Show all posts
Monday, February 27, 2012
Wednesday, August 31, 2011
Fat Disrupts Sugar Sensors Causing Type 2 Diabetes
US researchers say they have identified how a high-fat diet interferes with the body's sugar sensors and triggers type 2 diabetes....
The authors argue that a deeper understanding of the processes involved could help them develop a cure. One of the main risk factors for type 2 diabetes is being overweight -- rising obesity levels have contributed to a doubling of diabetes cases in the last 30 years.
Sugar in the blood is monitored by pancreatic beta cells. If sugar levels are too high then the cells release the hormone insulin, which tells the body to bring the levels back down. Key to this is the enzyme GnT-4a. It allows the cells to absorb glucose and therefore know how much is in the blood.
Researchers at the University of California and the Sanford-Burnham Medical Research Institute say they have shown how fat disrupts the enzyme's production. Experiments on mice showed that those on a high-fat diet had elevated levels of free fatty acids in the blood. These fatty acids interfered with two proteins - FOXA2 and HNF1A - involved in the production of GnT-4a. The result: fat effectively blinded cells to sugar levels in the blood and the mice showed several symptoms of type 2 diabetes. The same process also took place in samples of human pancreatic cells.
Lead researcher Dr. Jamey Marth said, "The observation that beta cell malfunction significantly contributes to multiple disease signs, including insulin resistance, was unexpected."
He suggested that boosting GnT-4a levels could prevent the onset of type 2 diabetes: "The identification of the molecular players in this pathway to diabetes suggests new therapeutic targets and approaches towards developing an effective preventative or perhaps curative treatment." "This may be accomplished by beta cell gene therapy or by drugs that interfere with this pathway in order to maintain normal beta cell function."
Dr. Iain Frame, Director of Research at Diabetes UK, said, "The researchers have linked their results in mice to the same pathways in humans and although they did not show they could prevent or cure type 2 diabetes, they have shown it is a theory worth investigating further."
"We will watch this with great interest and hope this early work will eventually lead to some benefit to people with type 2 diabetes."
The authors argue that a deeper understanding of the processes involved could help them develop a cure. One of the main risk factors for type 2 diabetes is being overweight -- rising obesity levels have contributed to a doubling of diabetes cases in the last 30 years.
Sugar in the blood is monitored by pancreatic beta cells. If sugar levels are too high then the cells release the hormone insulin, which tells the body to bring the levels back down. Key to this is the enzyme GnT-4a. It allows the cells to absorb glucose and therefore know how much is in the blood.
Researchers at the University of California and the Sanford-Burnham Medical Research Institute say they have shown how fat disrupts the enzyme's production. Experiments on mice showed that those on a high-fat diet had elevated levels of free fatty acids in the blood. These fatty acids interfered with two proteins - FOXA2 and HNF1A - involved in the production of GnT-4a. The result: fat effectively blinded cells to sugar levels in the blood and the mice showed several symptoms of type 2 diabetes. The same process also took place in samples of human pancreatic cells.
Lead researcher Dr. Jamey Marth said, "The observation that beta cell malfunction significantly contributes to multiple disease signs, including insulin resistance, was unexpected."
He suggested that boosting GnT-4a levels could prevent the onset of type 2 diabetes: "The identification of the molecular players in this pathway to diabetes suggests new therapeutic targets and approaches towards developing an effective preventative or perhaps curative treatment." "This may be accomplished by beta cell gene therapy or by drugs that interfere with this pathway in order to maintain normal beta cell function."
Dr. Iain Frame, Director of Research at Diabetes UK, said, "The researchers have linked their results in mice to the same pathways in humans and although they did not show they could prevent or cure type 2 diabetes, they have shown it is a theory worth investigating further."
"We will watch this with great interest and hope this early work will eventually lead to some benefit to people with type 2 diabetes."
Thursday, May 12, 2011
Salt Guidelines for Diabetes Patients Questioned
Researchers are challenging guidelines that urge diabetes patients to cut back on salt in their diet....
In a study that seems to turn conventional wisdom on its head, they found patients with the highest levels of sodium in their urine had the smallest risk of dying over a 10-year period.
Dr. Elif I. Ekinci of the University of Melbourne in Victoria and colleagues write, "Such data call into question universal recommendations that all adults should endeavor to reduce their salt intake."
Although it isn't the first time findings like these have surfaced, the Australian researchers, like others before them, relied on observations only and didn't actually run an experiment to test the direct impact of eating more or less salt.
Instead, they followed 638 people with longstanding Type 2 diabetes, often accompanied by heart disease and high blood pressure. At the outset of the study, all the patients were in their 60s on average and nearly half of them were obese. "These are precisely the patients in whom more aggressive lifestyle interventions are often applied," the researchers note.
All the patients were treated at a single diabetes clinic, and doctors determined the daily amount of sodium in their urine when the study began. The average amount of sodium in their urine, 4.2 grams per day, was in line with earlier global surveys, the researchers say.
Over the decade the study spanned, 175 patients died, mostly due to heart disease.
For every extra 2.3 grams of sodium in their urine, their risk of dying during the study dropped by 28 percent -- even after accounting for kidney disease, age and other factors likely to be important.
"This is unexpected," Dr. Ekinci, who also worked on the study. "It raises the possibility that in people with Type 2 diabetes, low salt intake is not always beneficial."
According to the 2010 Dietary Guidelines for Americans, they should eat no more than 1.5 grams of sodium -- about two-thirds of a teaspoon of salt -- per day.
Most Americans consume more than twice that amount, U.S. government researchers said last year in a study that pointed to foods like pizza, cookies and meats as the main culprits.
At this point, nobody is recommending any change to the current dietary advice, because the new study doesn't prove that extra salt helps diabetics live longer.
The main problem is that the patients who had lower sodium levels in their urine were sicker and older, said Dr. Paul Elliott, who studies the link between diet and high blood pressure at Imperial College London. "Although the authors used statistical models to try to 'correct' for these imbalances, it remains likely that the results are still confounded by them," he said.
That reasoning seems to be bolstered by the finding that higher blood pressure was tied to longer survival in the study, "which just isn't plausible," added Elliott.
"The reality is that reducing sodium has many effects, some good like reducing average blood pressure, and others bad." For instance, reducing sodium increases insulin resistance, which is the main problem in diabetes. It also ups the production of certain other hormones that have been linked to heart disease.
Diabetes Care, online February 2, 2011
In a study that seems to turn conventional wisdom on its head, they found patients with the highest levels of sodium in their urine had the smallest risk of dying over a 10-year period.
Dr. Elif I. Ekinci of the University of Melbourne in Victoria and colleagues write, "Such data call into question universal recommendations that all adults should endeavor to reduce their salt intake."
Although it isn't the first time findings like these have surfaced, the Australian researchers, like others before them, relied on observations only and didn't actually run an experiment to test the direct impact of eating more or less salt.
Instead, they followed 638 people with longstanding Type 2 diabetes, often accompanied by heart disease and high blood pressure. At the outset of the study, all the patients were in their 60s on average and nearly half of them were obese. "These are precisely the patients in whom more aggressive lifestyle interventions are often applied," the researchers note.
All the patients were treated at a single diabetes clinic, and doctors determined the daily amount of sodium in their urine when the study began. The average amount of sodium in their urine, 4.2 grams per day, was in line with earlier global surveys, the researchers say.
Over the decade the study spanned, 175 patients died, mostly due to heart disease.
For every extra 2.3 grams of sodium in their urine, their risk of dying during the study dropped by 28 percent -- even after accounting for kidney disease, age and other factors likely to be important.
"This is unexpected," Dr. Ekinci, who also worked on the study. "It raises the possibility that in people with Type 2 diabetes, low salt intake is not always beneficial."
According to the 2010 Dietary Guidelines for Americans, they should eat no more than 1.5 grams of sodium -- about two-thirds of a teaspoon of salt -- per day.
Most Americans consume more than twice that amount, U.S. government researchers said last year in a study that pointed to foods like pizza, cookies and meats as the main culprits.
At this point, nobody is recommending any change to the current dietary advice, because the new study doesn't prove that extra salt helps diabetics live longer.
The main problem is that the patients who had lower sodium levels in their urine were sicker and older, said Dr. Paul Elliott, who studies the link between diet and high blood pressure at Imperial College London. "Although the authors used statistical models to try to 'correct' for these imbalances, it remains likely that the results are still confounded by them," he said.
That reasoning seems to be bolstered by the finding that higher blood pressure was tied to longer survival in the study, "which just isn't plausible," added Elliott.
"The reality is that reducing sodium has many effects, some good like reducing average blood pressure, and others bad." For instance, reducing sodium increases insulin resistance, which is the main problem in diabetes. It also ups the production of certain other hormones that have been linked to heart disease.
Diabetes Care, online February 2, 2011
Tuesday, April 19, 2011
How to Reduce After Breakfast Blood Sugars 40%
A high-protein, low-carbohydrate snack before breakfast attenuates post-breakfast hyperglycemia....
Previous studies have shown a considerable reduction in hyperglycemia after the second meal of the day, provided that breakfast had been taken. The preservation of this effect in Type 2 diabetes was not confirmed until recently. Postprandial hyperglycemia acts as an independent risk factor for cardiovascular disease, a major cause of death in subjects with Type 2 diabetes. It was hypothesized that post-breakfast hyperglycemia in subjects with Type 2 diabetes could be improved non-pharmacologically by using a high-protein, low-carbohydrate prebreakfast snack.
Researchers studied 10 men and women with diet- and/or metformin-controlled Type 2 diabetes. Metabolic changes after breakfast were compared between 2 days: breakfast taken only and soya-yogurt snack taken prior to breakfast.
The results showed that there was a significant lower rise in plasma glucose on the snack day. The incremental area under the glucose curve was 450 ± 55 mmol · min/l on the snack day compared with 699 ± 99 mmol · min/l on the control day (P = 0.013). The concentration of plasma free fatty acids immediately before breakfast correlated with the increment in plasma glucose (r = 0.50, P = 0.013).
This study demonstrated for the first time that the provision of a practical, high-protein, low-carbohydrate snack prior to breakfast reduced by 40% the postprandial plasma glucose increment in people with Type 2 diabetes. These findings confirm a potent expression of the second-meal effect in people with Type 2 diabetes. The importance of the present observation is that a more practical means of improving glucose tolerance could potentially be of therapeutic benefit in people with Type 2 diabetes.
Researchers observed no effect of the prior snack on insulin secretion after breakfast. The mechanism underlying the second-meal effect has been shown to be due to suppression of plasma FFA, allowing greater storage of glucose as muscle glycogen. They had previously demonstrated a strong negative correlation between the decrease of preprandial plasma FFA levels and the postmeal glucose increment. In the present study, a significant positive correlation was found between prebreakfast plasma FFA and the rise in postprandial plasma glucose concentration.
The snack used in the present study was empirically designed. It will be important to optimize both the composition of the snack and the interval before breakfast to maximize the benefit of this approach. In everyday life, the gap between snack and breakfast would have to be accommodated, for instance, by delaying breakfast until mid-morning. Although the snack induced a small increase in plasma glucose, it was minimal and unlikely to contribute to the hyperglycemic burden. The sample size was dictated by prior power calculation (80% power with 10 subjects).
The study demonstrated that a high-protein, low-carbohydrate snack before breakfast attenuates postbreakfast hyperglycemia and further studies must determine whether long-term use is associated with improvement in A1c.
Previous studies have shown a considerable reduction in hyperglycemia after the second meal of the day, provided that breakfast had been taken. The preservation of this effect in Type 2 diabetes was not confirmed until recently. Postprandial hyperglycemia acts as an independent risk factor for cardiovascular disease, a major cause of death in subjects with Type 2 diabetes. It was hypothesized that post-breakfast hyperglycemia in subjects with Type 2 diabetes could be improved non-pharmacologically by using a high-protein, low-carbohydrate prebreakfast snack.
Researchers studied 10 men and women with diet- and/or metformin-controlled Type 2 diabetes. Metabolic changes after breakfast were compared between 2 days: breakfast taken only and soya-yogurt snack taken prior to breakfast.
The results showed that there was a significant lower rise in plasma glucose on the snack day. The incremental area under the glucose curve was 450 ± 55 mmol · min/l on the snack day compared with 699 ± 99 mmol · min/l on the control day (P = 0.013). The concentration of plasma free fatty acids immediately before breakfast correlated with the increment in plasma glucose (r = 0.50, P = 0.013).
This study demonstrated for the first time that the provision of a practical, high-protein, low-carbohydrate snack prior to breakfast reduced by 40% the postprandial plasma glucose increment in people with Type 2 diabetes. These findings confirm a potent expression of the second-meal effect in people with Type 2 diabetes. The importance of the present observation is that a more practical means of improving glucose tolerance could potentially be of therapeutic benefit in people with Type 2 diabetes.
Researchers observed no effect of the prior snack on insulin secretion after breakfast. The mechanism underlying the second-meal effect has been shown to be due to suppression of plasma FFA, allowing greater storage of glucose as muscle glycogen. They had previously demonstrated a strong negative correlation between the decrease of preprandial plasma FFA levels and the postmeal glucose increment. In the present study, a significant positive correlation was found between prebreakfast plasma FFA and the rise in postprandial plasma glucose concentration.
The snack used in the present study was empirically designed. It will be important to optimize both the composition of the snack and the interval before breakfast to maximize the benefit of this approach. In everyday life, the gap between snack and breakfast would have to be accommodated, for instance, by delaying breakfast until mid-morning. Although the snack induced a small increase in plasma glucose, it was minimal and unlikely to contribute to the hyperglycemic burden. The sample size was dictated by prior power calculation (80% power with 10 subjects).
The study demonstrated that a high-protein, low-carbohydrate snack before breakfast attenuates postbreakfast hyperglycemia and further studies must determine whether long-term use is associated with improvement in A1c.
Monday, April 18, 2011
Thermometer to save diabetics losing limbs
A new handheld device could greatly reduce the number of ulcers and limb amputations in people with diabetes.
The device provides early warning of complications which, if left untreated, can lead to the limb becoming so damaged it needs to be removed.
Around 100 Britons a week undergo an amputation as a result of diabetes. The disease can cause significant damage to the nerves and blood vessels — possibly because they are exposed to such high levels of blood sugar.
Nerve damage: Red areas highlight possible inflammation
Nerve damage can lead to loss of feeling in the feet, meaning sufferers might not feel a cut, blister or sore. Left untreated, such injuries can develop into serious ulcers and infections.
Poor circulation exacerbates the problem — reduced blood and oxygen supply to the area makes healing difficult.
Four out of ten people with diabetes are thought to have lost some feeling in their feet, and nearly half will suffer a foot wound or ulceration in their lifetime.
In some cases, wounds can remain open for months or even years, vastly increasing the risk of life-threatening infection.
If an infection sets in deeply, or affects the bone, antibiotics alone might not be enough. Gangrene can set in and amputation might be the only course of action.
Even if patients don’t end up so drastically affected, they can still suffer from ulcerations, infections and the foot can become deformed.
Diabetes affects 2.8 million people in the UK, with more than one million thought to be undiagnosed. It is caused by too much sugar — glucose — in the blood. There are two variants of the condition, type one and type two.
Type one can be present from birth and is caused by the destruction of insulin-producing cells.
However, around 90 per cent of those who suffer with diabetes have type two, which is triggered by obesity.
In this case, the body is unable to produce enough insulin. The condition can be controlled by following a healthy lifestyle.
The new device — a battery-powered thermometer — has been developed by U.S.-based Dibetica Solutions to be used at home by people with diabetes and some existing nerve damage.
It uses infrared light to measure changes in foot temperature — a rise in temperature is a sign of inflammation and damage. The readings can help alert a patient that a sore or ulcer is developing, before it even breaks the surface of the skin. They can then seek medical attention.
The gadget is designed to be used daily — the patient measures six sites on each foot and compares the temperatures.
If this temperature difference is more than four degrees Fahrenheit (2C), for two days or more, a problem might be brewing and they need to contact their doctor.
Previous studies have shown the device cut ulcer rates by a third, compared to people who didn’t use the gadget.
Now a larger, clinical trial is under way at Oslo University Hospital, in Norway, to see whether the device can prevent future foot ulcers in patients who have previously suffered with this complaint.
Cathy Moulton, clinical adviser at the charity Diabetes UK, says the device could be successful as long as patients are vigilant in taking their temperature every morning: ‘There is evidence showing that temperature changes could identify signs of neuropathy (nerve damage).
‘To reduce the risk of ulcers which could lead to amputations, Diabetes UK recommends that people with diabetes regularly check their feet looking for discolouration, damage to the skin, swollen areas, and if the foot feels very hot or cold.
‘If there are any changes such as these, they should see their doctor as soon as possible.
‘It is also vital that people with diabetes have access to a podiatrist and specialist care if any foot problems do develop.’
The device provides early warning of complications which, if left untreated, can lead to the limb becoming so damaged it needs to be removed.
Around 100 Britons a week undergo an amputation as a result of diabetes. The disease can cause significant damage to the nerves and blood vessels — possibly because they are exposed to such high levels of blood sugar.
Nerve damage: Red areas highlight possible inflammation
Nerve damage can lead to loss of feeling in the feet, meaning sufferers might not feel a cut, blister or sore. Left untreated, such injuries can develop into serious ulcers and infections.
Poor circulation exacerbates the problem — reduced blood and oxygen supply to the area makes healing difficult.
Four out of ten people with diabetes are thought to have lost some feeling in their feet, and nearly half will suffer a foot wound or ulceration in their lifetime.
In some cases, wounds can remain open for months or even years, vastly increasing the risk of life-threatening infection.
If an infection sets in deeply, or affects the bone, antibiotics alone might not be enough. Gangrene can set in and amputation might be the only course of action.
Even if patients don’t end up so drastically affected, they can still suffer from ulcerations, infections and the foot can become deformed.
Diabetes affects 2.8 million people in the UK, with more than one million thought to be undiagnosed. It is caused by too much sugar — glucose — in the blood. There are two variants of the condition, type one and type two.
Type one can be present from birth and is caused by the destruction of insulin-producing cells.
However, around 90 per cent of those who suffer with diabetes have type two, which is triggered by obesity.
In this case, the body is unable to produce enough insulin. The condition can be controlled by following a healthy lifestyle.
The new device — a battery-powered thermometer — has been developed by U.S.-based Dibetica Solutions to be used at home by people with diabetes and some existing nerve damage.
It uses infrared light to measure changes in foot temperature — a rise in temperature is a sign of inflammation and damage. The readings can help alert a patient that a sore or ulcer is developing, before it even breaks the surface of the skin. They can then seek medical attention.
The gadget is designed to be used daily — the patient measures six sites on each foot and compares the temperatures.
If this temperature difference is more than four degrees Fahrenheit (2C), for two days or more, a problem might be brewing and they need to contact their doctor.
Previous studies have shown the device cut ulcer rates by a third, compared to people who didn’t use the gadget.
Now a larger, clinical trial is under way at Oslo University Hospital, in Norway, to see whether the device can prevent future foot ulcers in patients who have previously suffered with this complaint.
Cathy Moulton, clinical adviser at the charity Diabetes UK, says the device could be successful as long as patients are vigilant in taking their temperature every morning: ‘There is evidence showing that temperature changes could identify signs of neuropathy (nerve damage).
‘To reduce the risk of ulcers which could lead to amputations, Diabetes UK recommends that people with diabetes regularly check their feet looking for discolouration, damage to the skin, swollen areas, and if the foot feels very hot or cold.
‘If there are any changes such as these, they should see their doctor as soon as possible.
‘It is also vital that people with diabetes have access to a podiatrist and specialist care if any foot problems do develop.’
Tuesday, April 12, 2011
What Are These Dry Patches on My Face?
Q: When my diabetes acts up, I notice that dry patches break out on my face. Why might this happen, and what could it be?
A: I need more information to answer your question definitively, but it could be either tinea versicolor or tinea corporis, two types of fungal infection. Unfortunately, neither really fits your description. High blood sugar levels, however, can contribute to the development of fungal infections, which are treated with antifungal creams. Next time you experience an outbreak, see your doctor for a visual diagnosis, a comprehensive examination, and treatment. Other types of rashes associated with diabetes are Acanthosis nigricans, which usually appears as a darkening around the neck and other skin folds, and Necrobiosis lipoidica, which occurs as patches that turn into yellowish plaques on the legs.
A: I need more information to answer your question definitively, but it could be either tinea versicolor or tinea corporis, two types of fungal infection. Unfortunately, neither really fits your description. High blood sugar levels, however, can contribute to the development of fungal infections, which are treated with antifungal creams. Next time you experience an outbreak, see your doctor for a visual diagnosis, a comprehensive examination, and treatment. Other types of rashes associated with diabetes are Acanthosis nigricans, which usually appears as a darkening around the neck and other skin folds, and Necrobiosis lipoidica, which occurs as patches that turn into yellowish plaques on the legs.
Tuesday, March 22, 2011
Diabetes to double or triple in U.S. by 2050: government
WASHINGTON (Reuters Life!) – Up to a third of U.S. adults could have diabetes by 2050 if Americans continue to gain weight and avoid exercise, the Centers for Disease Control and Prevention projected on Friday.
The numbers are certain to go up as the population gets older, but they will accelerate even more unless Americans change their behavior, the CDC said.
"We project that, over the next 40 years, the prevalence of total diabetes (diagnosed and undiagnosed) in the United States will increase from its current level of about one in 10 adults to between one in five and one in three adults in 2050," the CDC's James Boyle and colleagues wrote in their report.
"These are alarming numbers that show how critical it is to change the course of type-2 diabetes," CDC diabetes expert Ann Albright said in a statement.
"Successful programs to improve lifestyle choices on healthy eating and physical activity must be made more widely available because the stakes are too high and the personal toll too devastating to fail."
The CDC says about 24 million U.S. adults have diabetes now, most of them type-2 diabetes linked strongly with poor diet and lack of exercise.
Boyle's team took census numbers and data on current diabetes cases to make models projecting a trend. No matter what, diabetes will become more common, they said.
"These projected increases are largely attributable to the aging of the U.S. population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer," they wrote.
Diabetes was the seventh-leading cause of death in the United States in 2007, and is the leading cause of new cases of blindness among adults under age 75, as well as kidney failure, and leg and foot amputations not caused by injury.
"Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years," Boyle's team wrote.
The numbers are certain to go up as the population gets older, but they will accelerate even more unless Americans change their behavior, the CDC said.
"We project that, over the next 40 years, the prevalence of total diabetes (diagnosed and undiagnosed) in the United States will increase from its current level of about one in 10 adults to between one in five and one in three adults in 2050," the CDC's James Boyle and colleagues wrote in their report.
"These are alarming numbers that show how critical it is to change the course of type-2 diabetes," CDC diabetes expert Ann Albright said in a statement.
"Successful programs to improve lifestyle choices on healthy eating and physical activity must be made more widely available because the stakes are too high and the personal toll too devastating to fail."
The CDC says about 24 million U.S. adults have diabetes now, most of them type-2 diabetes linked strongly with poor diet and lack of exercise.
Boyle's team took census numbers and data on current diabetes cases to make models projecting a trend. No matter what, diabetes will become more common, they said.
"These projected increases are largely attributable to the aging of the U.S. population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer," they wrote.
Diabetes was the seventh-leading cause of death in the United States in 2007, and is the leading cause of new cases of blindness among adults under age 75, as well as kidney failure, and leg and foot amputations not caused by injury.
"Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years," Boyle's team wrote.
Monday, February 28, 2011
Only 7% of the 60 Million with Prediabetes Are Aware
Measuring glycated hemoglobin levels may be an appropriate means of catching patients with prediabetes....
Ronald Ackerman, MD, MPH, of Indiana University, and colleagues reported in Preventive Medicine that, HbA1c testing yielded similar probabilities for developing diabetes and heart disease as those estimated by using the 2003 American Diabetes Association definition for prediabetes. "The A1c test may provide a badly needed, clinically practical indicator of the composite risk for incident diabetes and cardiovascular disease," they wrote.
Fasting plasma glucose and two-hour plasma glucose, two commonly used tests for assessing diabetes and prediabetes, are limited because they require a patient to return on a separate day after an overnight fast and remain in the office for 2-3 hours which is a potential barrier to test completion, the researchers said.
Measuring HbA1c is easier -- it requires only one blood draw. In June 2009, the International Expert Committee, which represents several major diabetes groups, recommended using HbA1c to diagnose diabetes.
The recommendations of the committee have stirred up some controversy, still, the researchers said, only about 7% of patients with prediabetes -- who are thus at risk for later diabetes and heart disease -- are aware of their status.
To estimate the risks of developing diabetes and cardiovascular disease for adults with different HbA1c levels, Ackerman and colleagues assessed data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006.
Among adults who met the 2003 ADA definition for prediabetes, the probabilities for developing Type 2 disease over 7.5 years and cardiovascular disease over 10 years were 33.5% and 10.7%, respectively.
The researchers found that using HbA1c alone -- with a range of 5.5% to 6.5% defining prediabetes -- would identify a population with comparable risks for diabetes and heart disease (32.4% and 11.4%, respectively).
But using a slightly higher cutoff -- beginning at 5.7% -- would identify increased risks of 41.3% for diabetes and 13.3% for heart disease.
These risks are comparable to those seen in patients enrolled in the Diabetes Prevention Program, which had an enrollment criteria of both elevated fasting plasma glucose and impaired glucose tolerance, the researchers said.
Thus, they concluded, using a bottom cutoff of 5.7% for diagnosing prediabetes may be more appropriate.
Either way, they said, HbA1c measurement "should be considered a means of identifying greater numbers of patients at risk for diabetes and heart disease" -- especially because "of its practical nature and wide availability."
The study was limited by its use of cross-sectional data, and it may be lacking in generalizability. For instance, a greater number of African Americans would be identified as having prediabetes than if using fasting plasma glucose or two-hour plasma glucose testing, the researchers noted.
Ronald Ackerman, MD, MPH, of Indiana University, and colleagues reported in Preventive Medicine that, HbA1c testing yielded similar probabilities for developing diabetes and heart disease as those estimated by using the 2003 American Diabetes Association definition for prediabetes. "The A1c test may provide a badly needed, clinically practical indicator of the composite risk for incident diabetes and cardiovascular disease," they wrote.
Fasting plasma glucose and two-hour plasma glucose, two commonly used tests for assessing diabetes and prediabetes, are limited because they require a patient to return on a separate day after an overnight fast and remain in the office for 2-3 hours which is a potential barrier to test completion, the researchers said.
Measuring HbA1c is easier -- it requires only one blood draw. In June 2009, the International Expert Committee, which represents several major diabetes groups, recommended using HbA1c to diagnose diabetes.
The recommendations of the committee have stirred up some controversy, still, the researchers said, only about 7% of patients with prediabetes -- who are thus at risk for later diabetes and heart disease -- are aware of their status.
To estimate the risks of developing diabetes and cardiovascular disease for adults with different HbA1c levels, Ackerman and colleagues assessed data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006.
Among adults who met the 2003 ADA definition for prediabetes, the probabilities for developing Type 2 disease over 7.5 years and cardiovascular disease over 10 years were 33.5% and 10.7%, respectively.
The researchers found that using HbA1c alone -- with a range of 5.5% to 6.5% defining prediabetes -- would identify a population with comparable risks for diabetes and heart disease (32.4% and 11.4%, respectively).
But using a slightly higher cutoff -- beginning at 5.7% -- would identify increased risks of 41.3% for diabetes and 13.3% for heart disease.
These risks are comparable to those seen in patients enrolled in the Diabetes Prevention Program, which had an enrollment criteria of both elevated fasting plasma glucose and impaired glucose tolerance, the researchers said.
Thus, they concluded, using a bottom cutoff of 5.7% for diagnosing prediabetes may be more appropriate.
Either way, they said, HbA1c measurement "should be considered a means of identifying greater numbers of patients at risk for diabetes and heart disease" -- especially because "of its practical nature and wide availability."
The study was limited by its use of cross-sectional data, and it may be lacking in generalizability. For instance, a greater number of African Americans would be identified as having prediabetes than if using fasting plasma glucose or two-hour plasma glucose testing, the researchers noted.
Thursday, February 10, 2011
Is There a 'Safe' Blood Sugar Level?
Q: What is the "safe" blood sugar level? I have heard several opinions from other diabetics, and I am very confused. I was told that it was 154 about a year ago, and my doctor didn't recommend daily monitoring. At one time on a morning fasting, my level was 74.
— Theresa,
A: Yes, there is a safe blood sugar level. It is the optimum range that safely provides the body with adequate amounts of energy. For the average person, it is 70 to 105 mg/dl in a fasting state. (Diabetes is diagnosed when the fasting blood glucose level is at or above 126 mg/dl.)
Glucose values vary depending on the time of day, your activity level, and your diet. Your sugar level of 154 mg/dl, which is high, may not have been determined while you were fasting. If it had been, a physician would have repeated the test. Your doctor did, and your level was determined to be normal at 74 mg/dl.
In this case, daily monitoring is probably not necessary. If your levels are elevated in the future, you will be diagnosed with diabetes. Treatment can include lifestyle modification, diet, and exercise. If these strategies are not adequate to control your blood glucose level, your physician may prescribe oral medicines or insulin. Having a laboratory examination during your yearly physical and maintaining a healthy lifestyle are adequate for now.
Why is it important to keep your glucose level within a normal range? An excess of glucose in the bloodstream causes various chemical changes that lead to damage to our blood vessels, nerves, and cells. Each cell in the body has a function that requires energy, and this energy comes primarily from glucose. The energy allows you to perform various tasks, including talking and walking. It allows your heart to beat and your brain to produce chemicals and signals that help you think, breathe, regulate your internal temperature, and digest and absorb food. The body is a veritable industrial complex! But this complex is also quite delicately balanced. The very cells that process glucose and convert it to energy can be damaged by excess glucose. Imagine a car engine being damaged when it is flooded with gasoline.
A lack of glucose is also extremely detrimental to the body and can have serious consequences — including death. Without a source of energy to fuel the vital functions of the body, these functions cease.
Good luck with your blood glucose management, and don't hesitate to ask your doctor about ways to maintain and improve your health.
— Theresa,
A: Yes, there is a safe blood sugar level. It is the optimum range that safely provides the body with adequate amounts of energy. For the average person, it is 70 to 105 mg/dl in a fasting state. (Diabetes is diagnosed when the fasting blood glucose level is at or above 126 mg/dl.)
Glucose values vary depending on the time of day, your activity level, and your diet. Your sugar level of 154 mg/dl, which is high, may not have been determined while you were fasting. If it had been, a physician would have repeated the test. Your doctor did, and your level was determined to be normal at 74 mg/dl.
In this case, daily monitoring is probably not necessary. If your levels are elevated in the future, you will be diagnosed with diabetes. Treatment can include lifestyle modification, diet, and exercise. If these strategies are not adequate to control your blood glucose level, your physician may prescribe oral medicines or insulin. Having a laboratory examination during your yearly physical and maintaining a healthy lifestyle are adequate for now.
Why is it important to keep your glucose level within a normal range? An excess of glucose in the bloodstream causes various chemical changes that lead to damage to our blood vessels, nerves, and cells. Each cell in the body has a function that requires energy, and this energy comes primarily from glucose. The energy allows you to perform various tasks, including talking and walking. It allows your heart to beat and your brain to produce chemicals and signals that help you think, breathe, regulate your internal temperature, and digest and absorb food. The body is a veritable industrial complex! But this complex is also quite delicately balanced. The very cells that process glucose and convert it to energy can be damaged by excess glucose. Imagine a car engine being damaged when it is flooded with gasoline.
A lack of glucose is also extremely detrimental to the body and can have serious consequences — including death. Without a source of energy to fuel the vital functions of the body, these functions cease.
Good luck with your blood glucose management, and don't hesitate to ask your doctor about ways to maintain and improve your health.
Saturday, January 22, 2011
Are Sports Drinks Safe for Diabetics?
Q: I am working outside this week as a volunteer for a sports event. The temperature is about 110 degrees. We are constantly given sports drinks to replenish our electrolytes. As a diabetic, is it safe for me to drink these?
— Nancy
A: While it is important to prevent dehydration and replace electrolytes that you might lose through excessive sweating, you must also consider the amount of carbohydrates and calories that you are consuming throughout the day. Below is information on some common sports drinks. You can see the difference in the amount of carbohydrates and calories.
Gatorade: 50 calories, 14 carbohydrates (grams)
Mountain Dew Sport: 95 calories, 24 carbohydrates (grams)
All Sport: 70 calories, 19 carbohydrates (grams)
Rehydrate: 40 calories, 10 carbohydrates (grams)
Performance: 100 calories, 25 carbohydrates (grams)
So for example, if you consume four 8-oz bottles of Gatorade, you have taken in 200 calories and 56 grams of carbohydrates — and those values double if you are drinking 16-oz bottles. The calories and carbohydrates can add up quickly, causing high sugar levels.
The best practice is to look at each brand’s calorie and carbohydrate counts and the number of drinks that you are consuming a day to determine if it is within your daily caloric and carbohydrate requirements. It's also a good idea to supplement sports beverages with plain water.
— Nancy
A: While it is important to prevent dehydration and replace electrolytes that you might lose through excessive sweating, you must also consider the amount of carbohydrates and calories that you are consuming throughout the day. Below is information on some common sports drinks. You can see the difference in the amount of carbohydrates and calories.
Gatorade: 50 calories, 14 carbohydrates (grams)
Mountain Dew Sport: 95 calories, 24 carbohydrates (grams)
All Sport: 70 calories, 19 carbohydrates (grams)
Rehydrate: 40 calories, 10 carbohydrates (grams)
Performance: 100 calories, 25 carbohydrates (grams)
So for example, if you consume four 8-oz bottles of Gatorade, you have taken in 200 calories and 56 grams of carbohydrates — and those values double if you are drinking 16-oz bottles. The calories and carbohydrates can add up quickly, causing high sugar levels.
The best practice is to look at each brand’s calorie and carbohydrate counts and the number of drinks that you are consuming a day to determine if it is within your daily caloric and carbohydrate requirements. It's also a good idea to supplement sports beverages with plain water.
Friday, January 21, 2011
Can Diabetes Be Cured?
Q: I'm 47 years old and was recently diagnosed with diabetes. I'm about 25 pounds overweight and lead a sedentary lifestyle, but I'm starting a diet and an exercise program. Will my diabetes go away if I lose weight, watch my diet, and exercise regularly?
— Mary, Wichita
A:It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetesThe length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100 mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
— Mary, Wichita
A:It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetesThe length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100 mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
Thursday, January 20, 2011
Diabetes + Depression Increases Risk of Dying from Heart Disease
Depression and diabetes appear to be associated with a significantly increased risk of death from heart disease and risk of death from all causes over a six-year period for women....
Depression affects close to 15 million U.S. adults each year and more than 23.5 million U.S. adults have diabetes, according to background information in the article. Symptoms of depression affect between one-fifth and one-fourth of patients with diabetes, nearly twice as many as individuals without diabetes. Diabetes and its complications are leading causes of death around the world.
An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues studied 78,282 women aged 54 to 79 in 2000 who were participating in the Nurses' Health Study. The women were classified as having depression if they reported being diagnosed with the condition, were treated with antidepressant medications or scored high on an index measuring depressive symptoms. Reports of Type 2 diabetes were confirmed using a supplementary questionnaire.
During six years of follow-up, 4,654 of the women died, including 979 who died from cardiovascular disease. Compared with women who did not have either condition, those with depression had a 44 percent increased risk of death, those with diabetes had a 35 percent increased risk of death and those with both conditions had approximately twice the risk of death.
When considering only deaths from cardiovascular disease, women with diabetes had a 67 percent increased risk, women with depression had a 37 percent increased risk and women with both had a 2.7-fold increased risk.
"The underlying mechanisms of the increased mortality risk associated with depression in patients with diabetes remains to be elucidated," the authors write. "It is generally suggested that depression is associated with poor glycemic control, an increased risk of diabetes complications, poor adherence to diabetes management by patients and isolation from the social network." In addition, diabetes and depression are both linked to unhealthy behaviors such as smoking, poor diet and a sedentary lifestyle, and depression could trigger changes in the nervous system that adversely affect the heart.
"Considering the size of the population that could be affected by these two prevalent disorders, further consideration is required to design strategies aimed to provide adequate psychological management and support among those with longstanding chronic conditions, such as diabetes," the authors conclude.
Depression affects close to 15 million U.S. adults each year and more than 23.5 million U.S. adults have diabetes, according to background information in the article. Symptoms of depression affect between one-fifth and one-fourth of patients with diabetes, nearly twice as many as individuals without diabetes. Diabetes and its complications are leading causes of death around the world.
An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues studied 78,282 women aged 54 to 79 in 2000 who were participating in the Nurses' Health Study. The women were classified as having depression if they reported being diagnosed with the condition, were treated with antidepressant medications or scored high on an index measuring depressive symptoms. Reports of Type 2 diabetes were confirmed using a supplementary questionnaire.
During six years of follow-up, 4,654 of the women died, including 979 who died from cardiovascular disease. Compared with women who did not have either condition, those with depression had a 44 percent increased risk of death, those with diabetes had a 35 percent increased risk of death and those with both conditions had approximately twice the risk of death.
When considering only deaths from cardiovascular disease, women with diabetes had a 67 percent increased risk, women with depression had a 37 percent increased risk and women with both had a 2.7-fold increased risk.
"The underlying mechanisms of the increased mortality risk associated with depression in patients with diabetes remains to be elucidated," the authors write. "It is generally suggested that depression is associated with poor glycemic control, an increased risk of diabetes complications, poor adherence to diabetes management by patients and isolation from the social network." In addition, diabetes and depression are both linked to unhealthy behaviors such as smoking, poor diet and a sedentary lifestyle, and depression could trigger changes in the nervous system that adversely affect the heart.
"Considering the size of the population that could be affected by these two prevalent disorders, further consideration is required to design strategies aimed to provide adequate psychological management and support among those with longstanding chronic conditions, such as diabetes," the authors conclude.
Tuesday, January 4, 2011
Diabetes And Feet: Why A Podiatrist Is A Vital Part Of A Diabetic’s Care
Diabetes is a serious disease that affects millions of Americans, and that number is going to astronomically grow as the baby boomer generation ages further. Complications associated with diabetes can be devastating, and can lead to organ failure and even death. Foot-related complications in particular are very common in diabetes, and unfortunately cause the majority of leg amputations performed by surgeons. Comprehensive care by a podiatrist can identify foot problems early before they lead to leg loss, and in many cases can prevent those problems in the first place. This article will discuss the ways a podiatrist can protect diabetic feet, and ultimately save a diabetic’s limb and life.
Diabetes is a disease in which glucose, the body’s main source of ‘fuel’, is not properly absorbed into the body’s tissues and remains stuck in the bloodstream. Glucose is a type of ’sugar’ derived from the body’s digestion of carbohydrates (grains, breads, pastas, sugary food, fruits, starches, and dairy) The body needs a hormone called insulin, which is produced in the pancreas, to coax the glucose into body tissue to fuel it. Some diabetics are born with or develop at a young age an inability to produce insulin, resulting in type 1 diabetes. The majority of diabetics develop their disease as they become much older, and the ability of insulin to coax glucose into tissue wanes due to a sort of resistance to or an ineffectiveness of the action of insulin. This is called type 2 diabetes. Diabetes can also develop from high dose steroid use, during pregnancy (where it is temporary), or after pancreas disease or certain infections. The high concentration of glucose in the blood that remains out of the body tissue in diabetes can cause damage to parts all over the body. Organs and tissue that slowly are damaged by high concentrations of glucose stuck in the blood include the heart, the kidneys, blood vessels, the brain, the nerve tissue, skin, and the immune and injury repair cells. The higher the concentration of glucose in the blood, and the longer this glucose is present in the blood in an elevated state, the more damage will occur. Death can occur with severe levels of glucose in the blood stream, although this is not the case in most diabetics. Most diabetics who do not control their blood glucose well develop tissue damage over a long period of time, and serious disease, organ failure, and the potential for leg loss does eventually arrive, although not right away.
Foot disease in diabetes is common, and one of the more devastating and taxing complications associated directly and indirectly with high blood sugar. Foot disease takes the form of decreased sensation, poor circulation, a higher likelihood of developing skin wounds and infections, and a decreased ability to heal those skin wounds and infections. Key to this entire spectrum of foot complications is the presence of poor sensation. Most diabetics have less feeling in their feet than non-diabetics, due to the indirect action increased glucose has on nerve tissue. This decreased sensation can be a significant numbness, or it can be a mere subtle numbness that makes sharp objects seem smooth, or erases the irritation of a tight shoe. Advanced cases can actually have phantom pains of burning or tingling in addition to the numbness. With decreased sensation comes a much greater risk for skin wounds, mostly due to the inability to feel pain from thick calluses, sharp objects on the ground, and poorly fitting shoes. When a wound has formed as a result of skin dying under the strain of a thick corn or callus, from a needle or splinter driven into the foot, or from a tight shoe rubbing a friction burn on the skin, the diabetic foot has great difficulty starting and completing the healing process. Untreated skin wounds will break down further, and the wound can extend to deeper tissue, including muscle and bone. Bacteria will enter the body through these wounds, and can potentially cause an infection that can spread beyond the foot itself. A diabetic’s body has a particularly difficult time defending itself from bacteria due to the way high glucose affects the very cells that eat bacteria, and diabetics tend to get infected by multiple species of bacteria as well. Combine all this with decreased circulation (and therefore decreased distribution of nutrients and chemicals to preserve foot tissue and help it thrive), and one has all the components in place for a potential amputation. Amputations are performed when bacteria spreads along the body and threatens death, when wounds and foot tissue will not heal as a result of gangrene from advancing tissue death and infection, and when poor circulation will not allow the tissue to thrive ever again. The statistics following a leg amputation are grim: about half of diabetics who undergo one amputation will require an amputation of the other foot or leg, and about that same number in five years will be dead from the heart strain endured when one’s body has to expend energy to use a prosthetic limb.
A podiatrist can ensure that all the above complications are significantly limited, and in some cases prevented all together. Podiatrists are physicians who specialize solely in the care of foot and ankle disease, through medicine and surgery. The attend a four year podiatric medical school following college, and enter into a two or three year of hospital-based residency program after that to hone their advanced reconstructive surgical skills, and to study advanced medical. Podiatrists are generally considered the experts on all things involving the foot and ankle, and their unique understanding amongst other medical specialties of how the foot functions in relationship to the leg and ground (biomechanics) allows them to target therapy towards controlling or changing that function in addition to treating tissue disease. A great majority of the problems that lead to diabetic amputations start off as problems related to the structure of the foot and how it relates to the ground and to the shoe worn above. Controlling or repairing these structural problems will often result in prevention of wounds, which in turn will prevent infection, gangrene, and amputation.
To start with, a podiatrist will provide a diabetic patient with a complete foot exam that takes into account circulation, sensation, bone deformities, and skin issues, and pressures generated by walking and standing. From this initial assessment, a protection and treatment course can be created specific to the individual needs of the diabetic for maintenance, protection, and active treatment of problems that do develop. Commonly performed maintenance services include regular examinations several times a year to identify developing problems, care of toe nails to prevent a diabetic with poor sensation from accidentally cutting themselves when attempting to trim their nails, regular thinning of calluses to prevent wounds from developing, and repetitive education on diabetic foot problems to ensure proper habits are followed. Preventative services include using special deep shoes with protective inserts in diabetics at-risk for developing wounds from regular shoes, assessment of potential circulation problems with prompt referral to vascular specialists if needed, and possible surgery to reduce the potential of wounds to develop over areas of bony prominences. Active treatment of foot problems performed by a podiatrist involves the care and healing of wounds, the treatment of diabetic infections, and surgery to address serious foot injury, deep infections, gangrene, and other urgent problems. Because of a podiatrist’s unique understanding of the way the foot structure affects disease and injury, all treatment will be centered around the principles of how the foot realistically functions in conjunction with the leg and the ground. This becomes invaluable in the struggle to prevent diabetic wounds and infections, while allowing one to remain mobile and active at the same time.
The essential goal of a podiatrist in caring for a diabetic patient is to prevent wounds, infections, and the amputations that result. This philosophy is called limb salvage, and it is accomplished through the above listed methods. Because of the severity of foot disease as a complication of diabetes, a podiatrist is an integral part of a diabetic’s care, and sometimes can even be the physician that diagnoses diabetes in the first place if foot disease appears as an early symptom of undiagnosed diabetes. For these reasons, all diabetics should be assessed by a podiatrist for potential problems, and those at-risk for foot wounds and infections should have regular foot examinations and preventative treatment. As a final note, online resources by podiatrists discussing diabetic foot issues abound, including a regular blog by this author (thediabeticfoot.blogspot.com). While these resources do not replace a diabetic foot exam, they do help educate diabetics on how best to care for their feet, and what to do if problems develop. This can lead to better knowledge and understanding of foot issues when diabetics begin to see a podiatrist regularly, and can help prevent early foot complications from developing.
Diabetes is a disease in which glucose, the body’s main source of ‘fuel’, is not properly absorbed into the body’s tissues and remains stuck in the bloodstream. Glucose is a type of ’sugar’ derived from the body’s digestion of carbohydrates (grains, breads, pastas, sugary food, fruits, starches, and dairy) The body needs a hormone called insulin, which is produced in the pancreas, to coax the glucose into body tissue to fuel it. Some diabetics are born with or develop at a young age an inability to produce insulin, resulting in type 1 diabetes. The majority of diabetics develop their disease as they become much older, and the ability of insulin to coax glucose into tissue wanes due to a sort of resistance to or an ineffectiveness of the action of insulin. This is called type 2 diabetes. Diabetes can also develop from high dose steroid use, during pregnancy (where it is temporary), or after pancreas disease or certain infections. The high concentration of glucose in the blood that remains out of the body tissue in diabetes can cause damage to parts all over the body. Organs and tissue that slowly are damaged by high concentrations of glucose stuck in the blood include the heart, the kidneys, blood vessels, the brain, the nerve tissue, skin, and the immune and injury repair cells. The higher the concentration of glucose in the blood, and the longer this glucose is present in the blood in an elevated state, the more damage will occur. Death can occur with severe levels of glucose in the blood stream, although this is not the case in most diabetics. Most diabetics who do not control their blood glucose well develop tissue damage over a long period of time, and serious disease, organ failure, and the potential for leg loss does eventually arrive, although not right away.
Foot disease in diabetes is common, and one of the more devastating and taxing complications associated directly and indirectly with high blood sugar. Foot disease takes the form of decreased sensation, poor circulation, a higher likelihood of developing skin wounds and infections, and a decreased ability to heal those skin wounds and infections. Key to this entire spectrum of foot complications is the presence of poor sensation. Most diabetics have less feeling in their feet than non-diabetics, due to the indirect action increased glucose has on nerve tissue. This decreased sensation can be a significant numbness, or it can be a mere subtle numbness that makes sharp objects seem smooth, or erases the irritation of a tight shoe. Advanced cases can actually have phantom pains of burning or tingling in addition to the numbness. With decreased sensation comes a much greater risk for skin wounds, mostly due to the inability to feel pain from thick calluses, sharp objects on the ground, and poorly fitting shoes. When a wound has formed as a result of skin dying under the strain of a thick corn or callus, from a needle or splinter driven into the foot, or from a tight shoe rubbing a friction burn on the skin, the diabetic foot has great difficulty starting and completing the healing process. Untreated skin wounds will break down further, and the wound can extend to deeper tissue, including muscle and bone. Bacteria will enter the body through these wounds, and can potentially cause an infection that can spread beyond the foot itself. A diabetic’s body has a particularly difficult time defending itself from bacteria due to the way high glucose affects the very cells that eat bacteria, and diabetics tend to get infected by multiple species of bacteria as well. Combine all this with decreased circulation (and therefore decreased distribution of nutrients and chemicals to preserve foot tissue and help it thrive), and one has all the components in place for a potential amputation. Amputations are performed when bacteria spreads along the body and threatens death, when wounds and foot tissue will not heal as a result of gangrene from advancing tissue death and infection, and when poor circulation will not allow the tissue to thrive ever again. The statistics following a leg amputation are grim: about half of diabetics who undergo one amputation will require an amputation of the other foot or leg, and about that same number in five years will be dead from the heart strain endured when one’s body has to expend energy to use a prosthetic limb.
A podiatrist can ensure that all the above complications are significantly limited, and in some cases prevented all together. Podiatrists are physicians who specialize solely in the care of foot and ankle disease, through medicine and surgery. The attend a four year podiatric medical school following college, and enter into a two or three year of hospital-based residency program after that to hone their advanced reconstructive surgical skills, and to study advanced medical. Podiatrists are generally considered the experts on all things involving the foot and ankle, and their unique understanding amongst other medical specialties of how the foot functions in relationship to the leg and ground (biomechanics) allows them to target therapy towards controlling or changing that function in addition to treating tissue disease. A great majority of the problems that lead to diabetic amputations start off as problems related to the structure of the foot and how it relates to the ground and to the shoe worn above. Controlling or repairing these structural problems will often result in prevention of wounds, which in turn will prevent infection, gangrene, and amputation.
To start with, a podiatrist will provide a diabetic patient with a complete foot exam that takes into account circulation, sensation, bone deformities, and skin issues, and pressures generated by walking and standing. From this initial assessment, a protection and treatment course can be created specific to the individual needs of the diabetic for maintenance, protection, and active treatment of problems that do develop. Commonly performed maintenance services include regular examinations several times a year to identify developing problems, care of toe nails to prevent a diabetic with poor sensation from accidentally cutting themselves when attempting to trim their nails, regular thinning of calluses to prevent wounds from developing, and repetitive education on diabetic foot problems to ensure proper habits are followed. Preventative services include using special deep shoes with protective inserts in diabetics at-risk for developing wounds from regular shoes, assessment of potential circulation problems with prompt referral to vascular specialists if needed, and possible surgery to reduce the potential of wounds to develop over areas of bony prominences. Active treatment of foot problems performed by a podiatrist involves the care and healing of wounds, the treatment of diabetic infections, and surgery to address serious foot injury, deep infections, gangrene, and other urgent problems. Because of a podiatrist’s unique understanding of the way the foot structure affects disease and injury, all treatment will be centered around the principles of how the foot realistically functions in conjunction with the leg and the ground. This becomes invaluable in the struggle to prevent diabetic wounds and infections, while allowing one to remain mobile and active at the same time.
The essential goal of a podiatrist in caring for a diabetic patient is to prevent wounds, infections, and the amputations that result. This philosophy is called limb salvage, and it is accomplished through the above listed methods. Because of the severity of foot disease as a complication of diabetes, a podiatrist is an integral part of a diabetic’s care, and sometimes can even be the physician that diagnoses diabetes in the first place if foot disease appears as an early symptom of undiagnosed diabetes. For these reasons, all diabetics should be assessed by a podiatrist for potential problems, and those at-risk for foot wounds and infections should have regular foot examinations and preventative treatment. As a final note, online resources by podiatrists discussing diabetic foot issues abound, including a regular blog by this author (thediabeticfoot.blogspot.com). While these resources do not replace a diabetic foot exam, they do help educate diabetics on how best to care for their feet, and what to do if problems develop. This can lead to better knowledge and understanding of foot issues when diabetics begin to see a podiatrist regularly, and can help prevent early foot complications from developing.
Friday, December 24, 2010
When to Test Children for Diabetes
Q: My husband is a type 1 diabetic, and we didn't know that until he went for a physical and the doctor said his body was in "ketosis" (shutting itself down). We didn't expect that since he looked healthy, and we didn't recognize any symptoms except frequent urination. At what age should we have our three children (ages 13, 15, and 16) checked? Are there more obvious signs in children? Do you recommend any particular diet as a starting point for better eating? Sorry for the many questions, I am just trying to keep my info straight. Thank you very much in advance for your time in answering this. Have a great day.
— Christina, Kansas
A:
These are all great questions. Discovering that you or a loved one has type 1 diabetes can be overwhelming — and troubling to parents who worry that their children are at risk of developing the disease. How wonderful that you are thinking about trying to prevent that from happening!
There isn't a definitive answer to your question regarding early screening. First of all, even though your husband has type 1 diabetes, it does not mean that your children will invariably develop the disease. In fact, very few children of diabetic parents do. The bad news is that we do not have a way to determine who will and who won't. Second, even when we know the specific inherited tendencies for diabetes, there are many factors in the environment that are yet undiscovered triggers. If we knew these factors, we might then be able to work on reducing their influence. Third, we do not know the rate at which a person who carries the genetic risk actually develops diabetes. They may develop the disease early or it may take many years for diabetes to establish a foothold. Fourth, we do not have an effective treatment or preventive measure to stave off type 1 diabetes among those who are at greatest risk of developing it.
In light of all these factors, the best way to move forward is to do the following:
Make sure your children get regular checkups and talk to your pediatrician about new developments in early diagnosis and prevention efforts. There are ongoing studies, the results of which will teach us more about how to proceed. There might also be research projects that your children might participate in that may give them access to genetic and immunology tests not available to the general public. These tests can give you a better idea of your children's specific odds of developing diabetes.Have your children undergo blood glucose tests starting now, biannually or annually, to prevent severe symptoms such as ketosis from being the stimulus for a diagnosis.
Watch out for the following signs and symptoms: excessive thirst, frequent urination, weight loss, fatigue, or blurred vision; and much less common signs of ketosis, including nausea and vomiting, abdominal pain, lethargy, and decreased alertness and rapid breathing. These are the same signs and symptoms as in adults.While there are no specific dietary supplements or diet recommendations, a healthy lifestyle and maintaining a healthy weight will help in general. Specific recommendations depend on your children's caloric needs, activity level, and preferences. I frequently tell my patients that their first loyalty is to nutrition — making sure they have adequate nutrients (i.e., vitamins, minerals, and protein intake) necessary for survival. In the children's case, it is important to take their growth and developmental needs into account. You might consult a dietitian for specific suggestions.
Finally, coping with a diabetic parent can be a frightening experience for children. I would advise that you and your husband normalize the daily routines of his care, which include home blood glucose testing, doctor's visits, diet and exercise regimens, insulin injections, and discussing the symptoms of high and low sugar levels. This way, you can avoid crises and show your children that diabetes is a condition that can be managed as long as you take care of yourself. This knowledge will help them a great deal in the event that they are someday diagnosed with diabetes, however small the odds may be. Best wishes to you and your husband and children. I hope all goes well.
— Christina, Kansas
A:
These are all great questions. Discovering that you or a loved one has type 1 diabetes can be overwhelming — and troubling to parents who worry that their children are at risk of developing the disease. How wonderful that you are thinking about trying to prevent that from happening!
There isn't a definitive answer to your question regarding early screening. First of all, even though your husband has type 1 diabetes, it does not mean that your children will invariably develop the disease. In fact, very few children of diabetic parents do. The bad news is that we do not have a way to determine who will and who won't. Second, even when we know the specific inherited tendencies for diabetes, there are many factors in the environment that are yet undiscovered triggers. If we knew these factors, we might then be able to work on reducing their influence. Third, we do not know the rate at which a person who carries the genetic risk actually develops diabetes. They may develop the disease early or it may take many years for diabetes to establish a foothold. Fourth, we do not have an effective treatment or preventive measure to stave off type 1 diabetes among those who are at greatest risk of developing it.
In light of all these factors, the best way to move forward is to do the following:
Make sure your children get regular checkups and talk to your pediatrician about new developments in early diagnosis and prevention efforts. There are ongoing studies, the results of which will teach us more about how to proceed. There might also be research projects that your children might participate in that may give them access to genetic and immunology tests not available to the general public. These tests can give you a better idea of your children's specific odds of developing diabetes.Have your children undergo blood glucose tests starting now, biannually or annually, to prevent severe symptoms such as ketosis from being the stimulus for a diagnosis.
Watch out for the following signs and symptoms: excessive thirst, frequent urination, weight loss, fatigue, or blurred vision; and much less common signs of ketosis, including nausea and vomiting, abdominal pain, lethargy, and decreased alertness and rapid breathing. These are the same signs and symptoms as in adults.While there are no specific dietary supplements or diet recommendations, a healthy lifestyle and maintaining a healthy weight will help in general. Specific recommendations depend on your children's caloric needs, activity level, and preferences. I frequently tell my patients that their first loyalty is to nutrition — making sure they have adequate nutrients (i.e., vitamins, minerals, and protein intake) necessary for survival. In the children's case, it is important to take their growth and developmental needs into account. You might consult a dietitian for specific suggestions.
Finally, coping with a diabetic parent can be a frightening experience for children. I would advise that you and your husband normalize the daily routines of his care, which include home blood glucose testing, doctor's visits, diet and exercise regimens, insulin injections, and discussing the symptoms of high and low sugar levels. This way, you can avoid crises and show your children that diabetes is a condition that can be managed as long as you take care of yourself. This knowledge will help them a great deal in the event that they are someday diagnosed with diabetes, however small the odds may be. Best wishes to you and your husband and children. I hope all goes well.
1 in 3 Americans will have diabetes by 2050
In the United States, 1 in 3 people will have Type 2 diabetes by 2050 if current trends continue, according to a new report from the Centers for Disease Control and Prevention.
The projections, released today, are alarming to U.S. health officials, who say the numbers highlight the need for interventions to keep the number of new cases from climbing.
Currently, 1 in 10 Americans has Type 2 diabetes. But if new cases develop as projected, its prevalence could double or triple over the next 40 years, said Ann Albright, director of the Division of Diabetes Translation at the CDC.
"We can't have that, it's unsustainable," Albright told MyHealthNewsDaily.
Type 2 diabetes is the most common form of diabetes, and is triggered by a
combination of unchangeable factors, such as family history and race, and controllable factors, such as obesity and inactivity, according to the Mayo Clinic.
It's also the seventh leading cause of death in the United States, according to 2007 data, and is the leading cause of leg and foot amputations, kidney failure and new cases of blindness in adults under age 75, according to the CDC.
The costs of diabetes add up to about $174 billion a year, the CDC said.
Explaining the increase
An aging population and the growth of minority populations are expected to add to the disease's prevalence, Albright said. African-Americans, Latinos, Native Americans and certain Asians and Pacific Islanders are at high risk of developing diabetes.
Advances in medicine, which may help people with the disease live longer, and better detection of diabetes are other reasons why its prevalence could dramatically increase by 2050, she said. Right now, 24 million Americans have Type 2 diabetes, but a quarter of them don't know it, according to the CDC.
And because people are living longer, more cases are likely to come from older people. The percentage of people ages 65 and older with diabetes is expected to increase; it was 12.4 percent in 2000, but will be 19.6 percent in 2030, Albright said.
"We're living longer, but Type 2 diabetes does get more prevalent as you age," she said. "The body's ability to use insulin does gradually decline, but that can be slowed by maintenance, diet and regular physical activity."
Need for interventions
Right now, about 60 million people in the United States have pre-diabetes — a stage of insulin resistance before full-blown diabetes. If these people don't change their exercise and eating habits now, they will develop diabetes in the next three to six years, Albright said.
"They don’t have a big window," she said.
It will take a combination of personal decisions and policy changes to turn the diabetes rate around. Making healthy food more accessible and implementing prevention programs will help, she said.
One such program is the CDC's new National Diabetes Prevention Program, which aims to provide people with information about diabetes, promote lifestyle changes and reduce disparities between different groups.
A clinical trial showed that high-risk people who went through this prevention program reduced their risk of developing diabetes by 58 percent, according to the report.
"It's not enough for research to be done, you need to get the [information] in people's hands," Albright said. The intervention program makes use of the research, but "environmental and lifestyle changes need to complement it to be successful."
MyHealthNewsDaily Copyright © 2010. All rights reserved.
The projections, released today, are alarming to U.S. health officials, who say the numbers highlight the need for interventions to keep the number of new cases from climbing.
Currently, 1 in 10 Americans has Type 2 diabetes. But if new cases develop as projected, its prevalence could double or triple over the next 40 years, said Ann Albright, director of the Division of Diabetes Translation at the CDC.
"We can't have that, it's unsustainable," Albright told MyHealthNewsDaily.
Type 2 diabetes is the most common form of diabetes, and is triggered by a
combination of unchangeable factors, such as family history and race, and controllable factors, such as obesity and inactivity, according to the Mayo Clinic.
It's also the seventh leading cause of death in the United States, according to 2007 data, and is the leading cause of leg and foot amputations, kidney failure and new cases of blindness in adults under age 75, according to the CDC.
The costs of diabetes add up to about $174 billion a year, the CDC said.
Explaining the increase
An aging population and the growth of minority populations are expected to add to the disease's prevalence, Albright said. African-Americans, Latinos, Native Americans and certain Asians and Pacific Islanders are at high risk of developing diabetes.
Advances in medicine, which may help people with the disease live longer, and better detection of diabetes are other reasons why its prevalence could dramatically increase by 2050, she said. Right now, 24 million Americans have Type 2 diabetes, but a quarter of them don't know it, according to the CDC.
And because people are living longer, more cases are likely to come from older people. The percentage of people ages 65 and older with diabetes is expected to increase; it was 12.4 percent in 2000, but will be 19.6 percent in 2030, Albright said.
"We're living longer, but Type 2 diabetes does get more prevalent as you age," she said. "The body's ability to use insulin does gradually decline, but that can be slowed by maintenance, diet and regular physical activity."
Need for interventions
Right now, about 60 million people in the United States have pre-diabetes — a stage of insulin resistance before full-blown diabetes. If these people don't change their exercise and eating habits now, they will develop diabetes in the next three to six years, Albright said.
"They don’t have a big window," she said.
It will take a combination of personal decisions and policy changes to turn the diabetes rate around. Making healthy food more accessible and implementing prevention programs will help, she said.
One such program is the CDC's new National Diabetes Prevention Program, which aims to provide people with information about diabetes, promote lifestyle changes and reduce disparities between different groups.
A clinical trial showed that high-risk people who went through this prevention program reduced their risk of developing diabetes by 58 percent, according to the report.
"It's not enough for research to be done, you need to get the [information] in people's hands," Albright said. The intervention program makes use of the research, but "environmental and lifestyle changes need to complement it to be successful."
MyHealthNewsDaily Copyright © 2010. All rights reserved.
Tuesday, December 14, 2010
Diabetes is the 6th leading cause of death in the United States
LANGLEY AIR FORCE BASE, Va. - Diabetes is the sixth leading cause of death in the United States, claiming more than 180,000 victims annually. Part of the debilitation of diabetes is the effect the disease has on feet, resulting in painful sores, immobility and potential amputation. However, with attention and preventative measures, some effects may possibly be avoided.
According to Maj. Hjalmar Contreras, 633d Medical Group podiatrist, diabetic foot infections are the most common reason for hospital admissions among diabetic patients, accounting for 25 percent of all diabetic admissions.
“Without proper care, diabetic patients may develop ulcers on their feet, which occur in 15 percent of diabetic patients,” said Contreras.
Diabetes affects the feet in two ways: contributing to vascular disease and damaging nerves. Vascular disease impairs circulation, creating an oxygen deficiency in tissues. This deficiency could result in poor healing, infections and even gangrene. Symptoms of vascular disease include changes in the skin of the feet, such as lack of hair or thinning of skin, absent peripheral pulses and arterial Doppler abnormalities.
“Diabetes and smoking pose the greatest risk of peripheral vascular disease,” said Contreras, noting that PVD is 30 times more prevalent in diabetic patients.
Diabetes also damages the three nerve systems -- autonomic, sensory and motor -- resulting in a loss of feeling in the feet. This condition is known as diabetic neuropathy. Symptoms of neuropathy include a loss of protective sensation, dry flaky skin and foot deformities.
Most of the aforementioned conditions can be avoided or limited by prevention, said Contreras. To help prevent complications from diabetes, follow these 10 guidelines:
1. Inspect your feet daily. Check for cuts, scrapes, bruises or blisters.
2. Never soak your feet. There’s little way of knowing what may be in the water, and contaminants may irritate or cause infections. Wash your feet in lukewarm water, and carefully dry between toes.
3. Moisturize your feet. Use lotions and creams. Do not use petroleum jelly, and do not apply any topical solution between toes.
4. Cut toenails straight across, leaving the front edge. Don’t pull or rip off nail edges.
5. Never use chemical corn removers on your feet. These may cause blisters, burning holes in the skin. Never cut calluses with razors -- use a pumice stone instead.
6. Change your socks daily. Keep socks clean and dry, and avoid tight socks and stockings.
7. Never walk barefoot. Check the insides of your shoes daily.
8. Avoid smoking.
9. Wear shoes that fit. Tip: leather shoes easily adapt to feet and may provide more comfort.
10. Get annual check-ups.
“Controlling your glucose levels decreases chances of foot problems by 50 percent,” added Contreras.”While developing complications from diabetes may not be completely avoidable, practicing sound prevention measures will greatly diminish the chances of problems occurring.”
According to Maj. Hjalmar Contreras, 633d Medical Group podiatrist, diabetic foot infections are the most common reason for hospital admissions among diabetic patients, accounting for 25 percent of all diabetic admissions.
“Without proper care, diabetic patients may develop ulcers on their feet, which occur in 15 percent of diabetic patients,” said Contreras.
Diabetes affects the feet in two ways: contributing to vascular disease and damaging nerves. Vascular disease impairs circulation, creating an oxygen deficiency in tissues. This deficiency could result in poor healing, infections and even gangrene. Symptoms of vascular disease include changes in the skin of the feet, such as lack of hair or thinning of skin, absent peripheral pulses and arterial Doppler abnormalities.
“Diabetes and smoking pose the greatest risk of peripheral vascular disease,” said Contreras, noting that PVD is 30 times more prevalent in diabetic patients.
Diabetes also damages the three nerve systems -- autonomic, sensory and motor -- resulting in a loss of feeling in the feet. This condition is known as diabetic neuropathy. Symptoms of neuropathy include a loss of protective sensation, dry flaky skin and foot deformities.
Most of the aforementioned conditions can be avoided or limited by prevention, said Contreras. To help prevent complications from diabetes, follow these 10 guidelines:
1. Inspect your feet daily. Check for cuts, scrapes, bruises or blisters.
2. Never soak your feet. There’s little way of knowing what may be in the water, and contaminants may irritate or cause infections. Wash your feet in lukewarm water, and carefully dry between toes.
3. Moisturize your feet. Use lotions and creams. Do not use petroleum jelly, and do not apply any topical solution between toes.
4. Cut toenails straight across, leaving the front edge. Don’t pull or rip off nail edges.
5. Never use chemical corn removers on your feet. These may cause blisters, burning holes in the skin. Never cut calluses with razors -- use a pumice stone instead.
6. Change your socks daily. Keep socks clean and dry, and avoid tight socks and stockings.
7. Never walk barefoot. Check the insides of your shoes daily.
8. Avoid smoking.
9. Wear shoes that fit. Tip: leather shoes easily adapt to feet and may provide more comfort.
10. Get annual check-ups.
“Controlling your glucose levels decreases chances of foot problems by 50 percent,” added Contreras.”While developing complications from diabetes may not be completely avoidable, practicing sound prevention measures will greatly diminish the chances of problems occurring.”
Wednesday, December 8, 2010
Foot Care Is Essential With Diabetes
From inspecting your feet for sores to keeping your skin dry, proper foot care is essential when you have diabetes. Practice these tips to reduce the risk of infection and protect your feet.
You may think of diabetes as a blood sugar problem, and it is. But the nerve and blood vessel damage caused by diabetes can also become a problem for your feet if you develop neuropathy and lose feeling in your feet or hands or get an infection. To ensure the best possible foot health, follow these 11 easy tips to avoid injury, and your feet will be healthy longer.
1. Nerve damage is a complication of diabetes that makes it hard to feel when you have sores or cracks in your feet. “Patients with diabetes are looking for any changes in color, sores, or dry, cracked skin,” says Dr. Weaver. Place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.
2. When people with diabetes develop nerve damage or neuropathy, it’s hard to tell if the bath water is too hot. “They won’t realize they are actually scalding their skin,” explains Dr. Weaver. Stepping into a bath before checking the temperature can cause serious damage to your feet, and burns and blisters are open doors to infection. Use your elbow to check the water temperature before getting into the tub or shower.
3. Shoe shopping for people with diabetes requires a little more attention to detail than you may be used to. At CKPA we advise looking for shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot. Likewise, seek socks without seams, preferably socks that are padded and made from cotton or another material that controls moisture.
4. Wearing shoes with good coverage outside to protect your feet makes sense to most people, but even inside your house, puttering around without shoes puts your feet at risk for small cuts, scrapes, and penetration by splinters, glass shards, and the misplaced sewing needle or thumbtack. If you have neuropathy, you might not notice these dangerous damages until they become infected. It’s best to wear shoes at all times, even in the house.
5. Make sure that drying your feet is part of your hygiene routine. “The space between the toes is very airtight,” When the skin has excess moisture it will break down, leading to infection.” Prevent this by toweling off thoroughly after washing your feet and by removing wet or sweaty socks or shoes immediately. You can use Ameriglel lotion to moisturizer and help prevent dry, cracked skin — just avoid putting it between your toes.
6. Attend to bunions, calluses, corns, hammertoes, and other aggravations promptly, so they don’t lead to infection due to pressure sores and uneven rubbing. Even seemingly harmless calluses may become problems if you ignore them. See a podiatrist, a doctor who specializes in foot care, instead of heading to the pharmacy for an over-the-counter product for feet — some products are irritating to your skin and can actually increase the risk of infection even while they treat the bunion, callus, or corn on your foot.
7. Wearing the correct shoes is so important, orthotic footwear is a great investment in protection and comfort. Shoes made especially for people with diabetes are available at Central Kansas Podiatry Associates, or you can visit with Dr. Weaver for advice. Medicare will cover one pair of diabetic shoes a year, with the addition of three inserts to reduce pressure on your feet. Your doctor may recommend this type of diabetic shoe if you have an ulcer or sore that is slow healing and to help prevent..
8. People with diabetes benefit from exercise, but you still must go easy on your feet. Many fitness classes and aerobics programs include bouncing, jumping, and leaping, which may not be the best activities for your feet, especially if you have neuropathy. Instead, look into programs, such as walking, that don’t put too much pressure on your feet. Just make sure you have the right shoe for whatever activity you choose.
9. The dangers of smoking run from your head to your feet. “The nicotine in a cigarette can decrease the circulation in the skin by 70 percent,” says Dr. Weaver. So if you smoke, you are depriving your feet of the nutrient- and oxygen-rich blood that helps keep them healthy and fights infection. “Diabetic patients already have risk factors that compromise their blood vessels. It’s never too late to stop smoking,”
10. “There’s a direct relationship between blood sugar level and damage to the nerve cells,” says Dr. Weaver. Out-of-control blood sugar leads to neuropathy, which will make it hard to know when your feet are at risk or being damaged. The better you are at controlling your blood sugar, the healthier your feet will be over the long term. Finally, if you already have an infection, high blood sugar levels can make it hard for your body to fight it.
11. Your doctor and your diabetes team are great sources of information if you need ideas and inspiration for taking care of your feet, quitting smoking, or staying on top of your “numbers” — your weight, blood sugar, and other measures of health, such as blood pressure. Of course, if you notice any changes in your feet that concern you, it’s a good idea to call us and come see Dr. Weaver before your next regularly scheduled check-up.
You may think of diabetes as a blood sugar problem, and it is. But the nerve and blood vessel damage caused by diabetes can also become a problem for your feet if you develop neuropathy and lose feeling in your feet or hands or get an infection. To ensure the best possible foot health, follow these 11 easy tips to avoid injury, and your feet will be healthy longer.
1. Nerve damage is a complication of diabetes that makes it hard to feel when you have sores or cracks in your feet. “Patients with diabetes are looking for any changes in color, sores, or dry, cracked skin,” says Dr. Weaver. Place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.
2. When people with diabetes develop nerve damage or neuropathy, it’s hard to tell if the bath water is too hot. “They won’t realize they are actually scalding their skin,” explains Dr. Weaver. Stepping into a bath before checking the temperature can cause serious damage to your feet, and burns and blisters are open doors to infection. Use your elbow to check the water temperature before getting into the tub or shower.
3. Shoe shopping for people with diabetes requires a little more attention to detail than you may be used to. At CKPA we advise looking for shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot. Likewise, seek socks without seams, preferably socks that are padded and made from cotton or another material that controls moisture.
4. Wearing shoes with good coverage outside to protect your feet makes sense to most people, but even inside your house, puttering around without shoes puts your feet at risk for small cuts, scrapes, and penetration by splinters, glass shards, and the misplaced sewing needle or thumbtack. If you have neuropathy, you might not notice these dangerous damages until they become infected. It’s best to wear shoes at all times, even in the house.
5. Make sure that drying your feet is part of your hygiene routine. “The space between the toes is very airtight,” When the skin has excess moisture it will break down, leading to infection.” Prevent this by toweling off thoroughly after washing your feet and by removing wet or sweaty socks or shoes immediately. You can use Ameriglel lotion to moisturizer and help prevent dry, cracked skin — just avoid putting it between your toes.
6. Attend to bunions, calluses, corns, hammertoes, and other aggravations promptly, so they don’t lead to infection due to pressure sores and uneven rubbing. Even seemingly harmless calluses may become problems if you ignore them. See a podiatrist, a doctor who specializes in foot care, instead of heading to the pharmacy for an over-the-counter product for feet — some products are irritating to your skin and can actually increase the risk of infection even while they treat the bunion, callus, or corn on your foot.
7. Wearing the correct shoes is so important, orthotic footwear is a great investment in protection and comfort. Shoes made especially for people with diabetes are available at Central Kansas Podiatry Associates, or you can visit with Dr. Weaver for advice. Medicare will cover one pair of diabetic shoes a year, with the addition of three inserts to reduce pressure on your feet. Your doctor may recommend this type of diabetic shoe if you have an ulcer or sore that is slow healing and to help prevent..
8. People with diabetes benefit from exercise, but you still must go easy on your feet. Many fitness classes and aerobics programs include bouncing, jumping, and leaping, which may not be the best activities for your feet, especially if you have neuropathy. Instead, look into programs, such as walking, that don’t put too much pressure on your feet. Just make sure you have the right shoe for whatever activity you choose.
9. The dangers of smoking run from your head to your feet. “The nicotine in a cigarette can decrease the circulation in the skin by 70 percent,” says Dr. Weaver. So if you smoke, you are depriving your feet of the nutrient- and oxygen-rich blood that helps keep them healthy and fights infection. “Diabetic patients already have risk factors that compromise their blood vessels. It’s never too late to stop smoking,”
10. “There’s a direct relationship between blood sugar level and damage to the nerve cells,” says Dr. Weaver. Out-of-control blood sugar leads to neuropathy, which will make it hard to know when your feet are at risk or being damaged. The better you are at controlling your blood sugar, the healthier your feet will be over the long term. Finally, if you already have an infection, high blood sugar levels can make it hard for your body to fight it.
11. Your doctor and your diabetes team are great sources of information if you need ideas and inspiration for taking care of your feet, quitting smoking, or staying on top of your “numbers” — your weight, blood sugar, and other measures of health, such as blood pressure. Of course, if you notice any changes in your feet that concern you, it’s a good idea to call us and come see Dr. Weaver before your next regularly scheduled check-up.
Tuesday, December 7, 2010
Fearful of Complications
Q: I've had type 1 diabetes since I was a kid (I'm now 42). It's well controlled, but lately I'm starting to be really anxious about complications. What can I do to save myself from all the scary things that can happen to me as I get older?
– Brooke
A: Let me start by congratulating you on controlling your blood sugar — it is extremely important to your health. The discipline with which you've controlled your type 1 diabetes thus far, and close collaboration with your doctor, will surely help reduce your risk of worrisome complications.
Over the last several years, a number of studies have shown us that diabetes-related complications are the consequence of both poor glucose control and conditions such as high blood pressure and high cholesterol. The latter are associated with advancing age, genetic risk, and an unhealthy lifestyle. As long as you continue to control your blood sugar, with close follow-up from your doctor, then concentrating on lifestyle factors is the best way to improve your odds of avoiding complications.
As you grow older, regular exercise and ideal body weight maintenance become increasingly important components of diabetes care, blood pressure control, and lipid (cholesterol) management. Having a sustained normal or near-normal glucose level, blood pressure below 120/80, and a low cholesterol level (low-density lipoprotein level below 100 mg/dl) will stave off bad outcomes.
Besides home glucose monitoring, keep track of your glycosylated hemoglobin (hemoglobin A1c) level. Levels below 7 percent are associated with reduced complications — I prefer maintaining this level closer to 6 percent. Other risk factors you can change through exercise and a healthful diet include a high triglyceride level and a reduced level of high-density lipoprotein (HDL-C). A triglyceride level below 150 mg/dl and an HDL-C level above 40 mg/dl are associated with better health outcomes.
As an adult over age 40, you might be able to take daily aspirin, which considerably reduces cardiovascular risk. Do seek the advice of your doctor on this and other specific treatment and monitoring recommendations. Most important, if you use tobacco, stop. Quitting smoking is the single most critical step you will ever take toward preventing many of the diabetes-related complications.
– Brooke
A: Let me start by congratulating you on controlling your blood sugar — it is extremely important to your health. The discipline with which you've controlled your type 1 diabetes thus far, and close collaboration with your doctor, will surely help reduce your risk of worrisome complications.
Over the last several years, a number of studies have shown us that diabetes-related complications are the consequence of both poor glucose control and conditions such as high blood pressure and high cholesterol. The latter are associated with advancing age, genetic risk, and an unhealthy lifestyle. As long as you continue to control your blood sugar, with close follow-up from your doctor, then concentrating on lifestyle factors is the best way to improve your odds of avoiding complications.
As you grow older, regular exercise and ideal body weight maintenance become increasingly important components of diabetes care, blood pressure control, and lipid (cholesterol) management. Having a sustained normal or near-normal glucose level, blood pressure below 120/80, and a low cholesterol level (low-density lipoprotein level below 100 mg/dl) will stave off bad outcomes.
Besides home glucose monitoring, keep track of your glycosylated hemoglobin (hemoglobin A1c) level. Levels below 7 percent are associated with reduced complications — I prefer maintaining this level closer to 6 percent. Other risk factors you can change through exercise and a healthful diet include a high triglyceride level and a reduced level of high-density lipoprotein (HDL-C). A triglyceride level below 150 mg/dl and an HDL-C level above 40 mg/dl are associated with better health outcomes.
As an adult over age 40, you might be able to take daily aspirin, which considerably reduces cardiovascular risk. Do seek the advice of your doctor on this and other specific treatment and monitoring recommendations. Most important, if you use tobacco, stop. Quitting smoking is the single most critical step you will ever take toward preventing many of the diabetes-related complications.
Sunday, December 5, 2010
Foot Pain at Night
Q:
I have neuropathy in my feet. It can be extremely painful at night, and it keeps me awake most nights. Is there any way to reduce the pain, and will this ever subside?
— Debbie, Wichita, KS
A:
Neuropathy is a painful and distressing complication of diabetes. In some people, it disappears on its own over a period of about 12 months. In others, however, it persists. There are medicines your doctor can prescribe to relieve your symptoms.
The U.S. Food and Drug Administration has approved two drugs, duloxetine and pregabalin, to treat the foot pain from diabetic neuropathy. Duloxetin is an antidepressant, and pregabalin is used to treat seizure disorders. Both have some side effects. Duloxetin can cause nausea, sleepiness, dizziness, decreased appetite, hot flashes, and constipation. Pregabalin can cause sleepiness and confusion and can also lead to dependence.
You might consider other kinds of treatment too, both traditional and not. In one Australian study, the antioxidant alpha-lipoic acid was shown to reduce pain. And other medications — including some antiseizure medications, antidepressants, and opiates — have been used with some success. Some people have used acupuncture, topical creams containing capsaicin (a substance found naturally in hot peppers), and other alternative therapies. Of course, many of these treatments have not been well studied enough to determine their effectiveness.
I would advise you to consult with your doctor to decide which treatment works best for you. It's important to remember, of course, that none of these medicines cure the underlying cause of neuropathy. That's why it's important to focus on tight glucose management. The basic problem that leads to neuropathy is nerve and blood vessel damage caused by high blood glucose levels.
Learn more in the Everyday Health Type 2 Diabetes Center.
I have neuropathy in my feet. It can be extremely painful at night, and it keeps me awake most nights. Is there any way to reduce the pain, and will this ever subside?
— Debbie, Wichita, KS
A:
Neuropathy is a painful and distressing complication of diabetes. In some people, it disappears on its own over a period of about 12 months. In others, however, it persists. There are medicines your doctor can prescribe to relieve your symptoms.
The U.S. Food and Drug Administration has approved two drugs, duloxetine and pregabalin, to treat the foot pain from diabetic neuropathy. Duloxetin is an antidepressant, and pregabalin is used to treat seizure disorders. Both have some side effects. Duloxetin can cause nausea, sleepiness, dizziness, decreased appetite, hot flashes, and constipation. Pregabalin can cause sleepiness and confusion and can also lead to dependence.
You might consider other kinds of treatment too, both traditional and not. In one Australian study, the antioxidant alpha-lipoic acid was shown to reduce pain. And other medications — including some antiseizure medications, antidepressants, and opiates — have been used with some success. Some people have used acupuncture, topical creams containing capsaicin (a substance found naturally in hot peppers), and other alternative therapies. Of course, many of these treatments have not been well studied enough to determine their effectiveness.
I would advise you to consult with your doctor to decide which treatment works best for you. It's important to remember, of course, that none of these medicines cure the underlying cause of neuropathy. That's why it's important to focus on tight glucose management. The basic problem that leads to neuropathy is nerve and blood vessel damage caused by high blood glucose levels.
Learn more in the Everyday Health Type 2 Diabetes Center.
Thursday, September 30, 2010
Diabetes Differences, Demystified
Understanding the Types of Diabetes
Diabetes management varies, depending on what type of diabetes you have. This guide will help you understand the many different types of diabetes.
By Krisha McCoy, MS
Medically reviewed by Pat F. Bass III, MD, MPH Print Email If you have diabetes, your body has problems producing or effectively using insulin, which can cause your blood glucose levels to be out of control. There are several different causes of insulin problems, and your treatment plan will depend on which type of diabetes you have.
Type 1 Diabetes: An Autoimmune Disease
With type 1 diabetes, which used to be called juvenile diabetes, your body does not produce insulin or produces very little. Type 1 diabetes is known as an autoimmune disease because it occurs when your immune system mistakenly attacks the insulin-producing cells in your pancreas.
Type 1 diabetes usually develops in children and young adults and accounts for 5 to 10 percent of diabetes cases in the United States. Symptoms may include thirst, frequent urination, increased hunger, unexplained weight loss, blurry vision, and fatigue.
People who have type 1 diabetes need to take insulin injections daily to make up for what their pancreas can’t produce.
Type 2 Diabetes: The Lifestyle Connection
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Type 2 diabetes, which used to be called adult-onset diabetes, is the most common form of diabetes, accounting for 90 to 95 percent of diabetes cases. While most people who develop type 2 diabetes are older, the prevalence of type 2 diabetes in children is on the rise.
The exact cause of type 2 diabetes is largely unknown, but the disease tends to develop in people who are obese and physically inactive. People who have a family history of diabetes or a personal history of gestational diabetes are also at increased risk of developing type 2 diabetes.
Symptoms of type 2 diabetes usually develop gradually, and are similar to symptoms of type 1 diabetes.
Treatment for type 2 diabetes usually includes dietary changes, regular physical activity, and oral diabetes medications to help control blood glucose. If left untreated, serious health conditions such as heart disease or stroke can develop.
Gestational Diabetes: A Pregnancy Concern
Gestational diabetes is a condition that occurs in 3 to 8 percent of pregnant women during late pregnancy. Its cause is thought to be pregnancy-related hormonal fluctuations and a shortage of insulin that often occurs during pregnancy.
Many women with gestational diabetes have no symptoms, so it is important to get screened for this condition during pregnancy. Gestational diabetes can lead to problems such as high-birth-weight babies, breathing problems in the baby, and high blood pressure in the mother during pregnancy. Gestational diabetes is usually treated with dietary changes and exercise, and sometimes insulin injections.
Women who have had gestational diabetes have a 40 to 60 percent chance of developing type 2 diabetes within 5 to 10 years after their pregnancy.
Other Types of Diabetes
Latent autoimmune diabetes in adults, or LADA, is a less common form of diabetes that usually affects people over the age of 30. In LADA, what looks like type 2 diabetes at first eventually develops into a condition more closely resembling type 1 diabetes.
People with LADA make enough insulin at first, but their immune system later begins making antibodies against insulin-producing cells of the pancreas. Patients will usually require insulin injections as part of their treatment. It is estimated that up to 10 percent of people with type 2 diabetes have LADA.
"Double diabetes" occurs when someone with type 1 diabetes develops resistance to the insulin they are taking, a hallmark of type 2 diabetes. This condition is more and more frequently seen in children, especially those who are overweight or obese.
All types of diabetes require attention to keep blood glucose in check, but the medical plan differs by diabetes type. Getting the right diagnosis is the first step.
Diabetes management varies, depending on what type of diabetes you have. This guide will help you understand the many different types of diabetes.
By Krisha McCoy, MS
Medically reviewed by Pat F. Bass III, MD, MPH Print Email If you have diabetes, your body has problems producing or effectively using insulin, which can cause your blood glucose levels to be out of control. There are several different causes of insulin problems, and your treatment plan will depend on which type of diabetes you have.
Type 1 Diabetes: An Autoimmune Disease
With type 1 diabetes, which used to be called juvenile diabetes, your body does not produce insulin or produces very little. Type 1 diabetes is known as an autoimmune disease because it occurs when your immune system mistakenly attacks the insulin-producing cells in your pancreas.
Type 1 diabetes usually develops in children and young adults and accounts for 5 to 10 percent of diabetes cases in the United States. Symptoms may include thirst, frequent urination, increased hunger, unexplained weight loss, blurry vision, and fatigue.
People who have type 1 diabetes need to take insulin injections daily to make up for what their pancreas can’t produce.
Type 2 Diabetes: The Lifestyle Connection
There's more content below this advertisement. Jump to the content.
Type 2 diabetes, which used to be called adult-onset diabetes, is the most common form of diabetes, accounting for 90 to 95 percent of diabetes cases. While most people who develop type 2 diabetes are older, the prevalence of type 2 diabetes in children is on the rise.
The exact cause of type 2 diabetes is largely unknown, but the disease tends to develop in people who are obese and physically inactive. People who have a family history of diabetes or a personal history of gestational diabetes are also at increased risk of developing type 2 diabetes.
Symptoms of type 2 diabetes usually develop gradually, and are similar to symptoms of type 1 diabetes.
Treatment for type 2 diabetes usually includes dietary changes, regular physical activity, and oral diabetes medications to help control blood glucose. If left untreated, serious health conditions such as heart disease or stroke can develop.
Gestational Diabetes: A Pregnancy Concern
Gestational diabetes is a condition that occurs in 3 to 8 percent of pregnant women during late pregnancy. Its cause is thought to be pregnancy-related hormonal fluctuations and a shortage of insulin that often occurs during pregnancy.
Many women with gestational diabetes have no symptoms, so it is important to get screened for this condition during pregnancy. Gestational diabetes can lead to problems such as high-birth-weight babies, breathing problems in the baby, and high blood pressure in the mother during pregnancy. Gestational diabetes is usually treated with dietary changes and exercise, and sometimes insulin injections.
Women who have had gestational diabetes have a 40 to 60 percent chance of developing type 2 diabetes within 5 to 10 years after their pregnancy.
Other Types of Diabetes
Latent autoimmune diabetes in adults, or LADA, is a less common form of diabetes that usually affects people over the age of 30. In LADA, what looks like type 2 diabetes at first eventually develops into a condition more closely resembling type 1 diabetes.
People with LADA make enough insulin at first, but their immune system later begins making antibodies against insulin-producing cells of the pancreas. Patients will usually require insulin injections as part of their treatment. It is estimated that up to 10 percent of people with type 2 diabetes have LADA.
"Double diabetes" occurs when someone with type 1 diabetes develops resistance to the insulin they are taking, a hallmark of type 2 diabetes. This condition is more and more frequently seen in children, especially those who are overweight or obese.
All types of diabetes require attention to keep blood glucose in check, but the medical plan differs by diabetes type. Getting the right diagnosis is the first step.
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