Sleeping Difficulties Increase Risk of Eye Disease in People with Diabetes

People with Type 2 diabetes who have obstructive sleep apnea (OSA) are more at risk of losing their sight due to severe retinopathy, as well as foot problems and possible amputation because of neuropathy....

Researchers from the University of Birmingham looked at 231 people with Type 2 diabetes of whom 149 had OSA, a sleep disorder caused by disturbed breathing. They found there were twice as many people with severe retinopathy (48 percent) in the group with OSA compared to the group without OSA (20 percent).

In a separate study, the researchers found that OSA was also linked to neuropathy. They looked at 230 people with Type 2 diabetes of whom 148 had OSA. They found that 60 percent of the group with OSA had neuropathy compared to 22 percent in the group without OSA.

According to Dr. Iain Frame, Director of Research at Diabetes UK, said, "We already know that there is a high prevalence of OSA in people with Type 2 diabetes. However, this is the first time that the link between OSA and retinopathy, and neuropathy in people with Type 2 diabetes has been examined. This research suggests that if someone with Type 2 diabetes also has this sleeping disorder they are more at risk of developing these serious complications compared to someone with the condition who does not have OSA."

"As being overweight is a risk factor for both OSA and Type 2 diabetes, this is yet another reason to highlight the importance of good weight management through a healthy diet and regular physical activity. In people with Type 2 diabetes, the increasing severity of OSA is associated with poorer blood glucose control and the treatment of sleep disorders (in this case by losing weight) has the potential to improve diabetes control and energy levels."

In both studies, the association between OSA and the two diabetes complications in people with Type 2 diabetes was independent of age, gender, ethnicity, blood pressure, blood glucose levels, smoking and cholesterol.

"Our work highlights several important issues," stated Dr. Abd Tahrani, who led the research. "Our results emphasized what is already known -- that OSA is very common in patients with Type 2 diabetes, much higher than OSA prevalence in the general population. Furthermore, our results suggest that OSA is not an innocent bystander in patients with Type 2 diabetes and might contribute to morbidities associated with this condition. Whether OSA treatment has any impact on these complications will need to be determined."

Actress Zsa Zsa Gabor's lower leg to be amputated

LOS ANGELES (Reuters)– Actress Zsa Zsa Gabor was admitted to hospital in Los Angeles on Sunday to undergo a partial amputation of her right leg, her husband told Reuters.

Gabor, believed to be 93 and in ill health since July when she broke her hip, has been infected by a lesion that turned gangrenous, her husband Frederic Prinz von Anhalt said.

After doctors warned she would die unless her leg was amputated above the knee, Gabor was "screaming and yelling" about wanting to spend New Year's Eve at home for her traditional celebration of champagne and caviar, he said.

She was finally admitted to UCLA Medical Center and was being prepared on Sunday evening for surgery, he said.

Gabor faces obvious complications because of her age but a successful operation could add a few years to her life, said her spokesman John Blanchette.

As an actress, the Hungarian-born Gabor is best known for her roles in the 1950s movies "Moulin Rouge" and "Lili."

Along with her sisters Eva and Magda, she was a fixture on Hollywood's social circuit where she called everyone "dah-ling" in her thick accent.

She has been married nine times and earned a degree of infamy in 1989 when she served a three-day jail term for slapping a Beverly Hills policeman who had pulled her over. Unbowed, she emerged from jail complaining about the food.

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.

What Is Peripheral Artery Disease?

Peripheral artery disease (PAD) can sometimes go undetected, so it's important to know the symptoms. Plus, learn about the possible complications of PAD and how the condition is treated.

Restricted blood flow anywhere in your body can be a serious health problem that can ultimately affect your heart. When blood flow to the legs is reduced, the condition is called peripheral artery disease, or PAD, explains Joshua A. Beckman, MD, director of the Cardiovascular Fellowship Program at Brigham and Women's Hospital and assistant professor at Harvard Medical School in Boston. PAD occurs when arteries in the legs become hardened due to the build-up of plaque (cholesterol and other fatty substances) — a condition called atherosclerosis.

Who Develops PAD
"PAD often develops in people who smoke or have diabetes," says Dr. Beckman. In addition, it is commonly found in people who are between the ages of 50 and 69. In people above the age of 65, approximately 20 percent of men and 16 percent of women have PAD.

Other risk factors for PAD include:
Having high blood pressure
Having high cholesterol
Having a history of heart disease
Undergoing hemodialysis to treat kidney disease
Having had a stroke

"About half of the people who have PAD do not have specific symptoms and have no way to know they have the disease," says Beckman. "Of the half that do have symptoms, the majority describe feeling discomfort in an area like the calf, hip or thigh while walking."

If you have any of the risk factors for PAD, you should ask your doctor about PAD even if you aren’t experiencing symptoms. Your doctor can still diagnose PAD through one or more tests.

Signs of PAD
The pain people with PAD experience while walking is called intermittent claudication. You may feel a burning, aching, heaviness, or leaden feeling because the exercising muscle is demanding more blood than can be delivered due to poor blood flow in the legs. "The discomfort occurs only with walking and is typically relieved with a few minutes of rest," says Beckman.

It can be easy to discount this pain as arthritis, a result of aging, or an injury from exercise. But if you continue to notice these symptoms when you walk, and they stop when you rest, PAD could be the reason.

When PAD worsens and blood flow is severely restricted, the feet and legs may be painful even without exercise.

Risks of Untreated PAD
Untreated PAD can lead to heart attack or stroke. People with untreated PAD are six to seven times more likely to experience heart attack or stroke than those without the disease. Beckman estimates that the risk of death in those with untreated PAD is 15 to 30 percent over five years.

Amputation is also a risk of untreated PAD, though it isn't common in either people who do not experience PAD symptoms or in those who experience intermittent pain. But between 1 and 2 percent of people with PAD may either experience severe pain in their legs while resting, a wound on their foot that won't heal, or even gangrene, says Beckman. Then amputation is a more serious threat unless action is taken.

Treating PAD
Treatment for PAD usually entails a combination of prescribed medication and a healthier lifestyle to manage atherosclerosis, lower cholesterol and blood pressure levels, and improve blood flow in your legs.

Here are steps your doctor may recommend to treat and manage PAD:

Quit smoking
Take medications to manage contributing health problems, like high cholesterol and high blood pressure
Take anti-clotting medications to prevent blood clots
Walk and get other exercise frequently
Achieve and maintain a healthy body weight
Eat a healthy diet of low-cholesterol, low-fat, and low-calorie foods

In some cases, blockages in the legs may need to be opened up with a catheter in a procedure called angioplasty and propped open with a small tube called a stent. In cases of severe PAD, bypass surgery may be needed to reroute blood flow in the legs.


By Diana Rodriguez
Medically reviewed by Pat F. Bass III, MD, MPH

Lowered Risk of Amputatation When Podiatrists are Involved

People with diabetic foot problems can lower their risk of leg amputation by relying on coordinated care that includes a podiatrist, according to a recent study. For instance, those with diabetes-related foot ulcers can reduce their risk of amputation by 31 percent. In a study published online in the journal Health Services Research, researcher Frank Sloan, Ph.D., and colleagues looked at six years of Medicare claims data on nearly 190,000 diabetic patients with foot problems. The study included about 118,000 patients diagnosed as stage one, about 32,000 in stage two, 31,000 in stage three, and 55,000 in stage four (some participants experienced more than one stage).

“This study shows that coordinated care substantially reduces amputation rates,” said David Armstrong, DPM, a podiatrist and co-founder of the Southern Arizona Limb Salvage Alliance. “We already knew that when care teams are developed to prevent amputation, in every case, we see success. The study documents that this is true across the country.” Armstrong has no affiliation with the study.

Diabetics need to take special care of their feet to avoid the possibility of amputation

More than 18 million American adults suffer from diabetes, a chronic disease in which the pancreas stops producing insulin, the hormone that enables people to turn food into energy.

The disease, over time, can cause poor blood circulation and nerve damage in the feet, making them vulnerable to ulcers, infections, deformities and brittle bones.
Dr. Jasen Langley, a podiatrist with Kimball Medical Center in Lakewood, is trying to create public awareness of this growing problem. In cooperation with the hospital, he heads diabetes education classes and a monthly support group, designed to help individuals manage their diabetes.

"People with diabetes are 10 times more likely to have a lower limb amputated than people without diabetes," said Langley, whose office is in Howell. "They must always be vigilant and should see a podiatrist at the first sign of trouble. Early treatment can keep diabetic foot problems from progressing and reduce the risk of amputations."

At a recent program, Langley talked about the key factors in preventing serious damage to the foot and ankle areas.
"The most important thing a diabetic can do is have good blood sugar control," Langley said. "Once the sugar is under control, the manifestations of problems will actually slow down. You won't see them as quickly as you do in an uncontrolled diabetic."

Good blood sugar control can be achieved by medications, a proper diet and exercise, doctors say.

Wear sneakers
Seventy-two-year-old Edie Berg knows all about fighting blood sugar. She has been battling diabetes for more than seven years and started using insulin in 2004 to better maintain control.

"I like the insulin because I was getting some high numbers and that can be scary," said Berg, who lives in Howell. "The insulin has given me better control of my blood sugar. If I get a high number, I just take a little bigger dose of insulin."
Berg has been taking steroids for many years to combat chronic obstructive pulmonary disease (COPD), a lung disease that makes it difficult to breathe. She was told by doctors that her blood sugar numbers would increase because of the steroids, but it wasn't until 2000 that diabetes set in.

Fortunately, Berg has not had any problems with her feet. She credits a healthy diet and regular trips to the doctor. "I go every two months to the doctor and my feet are always checked," Berg said. "Dr. Langley always wants me to make sure I wear sneakers. He says, "If one foot rubs against another and you can't feel it, that's the first sign of trouble.' When I rub my feet together, it tickles, so I know I am OK."

Diabetes costs more than $132 billion a year in the United States, including direct medical expenses as well as indirect costs such as lost work, disability and premature death, according to the Centers for Disease Control and Prevention in Atlanta.

Langley said many younger doctors are being more aggressive in their treatment of diabetics, which can help prevent surgery and reduce the financial toll.
"If a foot becomes bad enough that you need surgery, that can run in the neighborhood of $50,000, $60,000," Langley said. "That really takes a toll on the family and the insurance companies. That is why you are seeing the media and the Diabetes Association embarking on a more aggressive campaign to get the word out on the disease."

Diabetic Foot Care Important

Why is Diabetic Foot Care Important?
Many people know somebody who is diabetic who has had a toe, or even a foot or leg amputated. This is the worst-case assumption and points at the critical importance of foot care for a diabetic. Foot care is a specially important part of care for people with diabetes. But proper diabetic foot care and attention can keep most serious foot diseases.

Daily Foot Care Guide for Diabetic
1. Clean your feet every day using mild soap and warm water. Assure the water temperature with your hand or elbow before putting your feet in the water.
2. Dry your feet well. Make sure to dry between toes.
3. Look at your feet. Check for any breaks, dry skin, cuts, redness, swelling, and change in temperature.
4. Apply lotion to dry or cracked skin and to soles of feet. Do not put lotion between toes.
5. Call Central Kansas Podiatry Associates right away if you have any sign of infection such as swelling, redness, drainage, fever, or chills.

A Major Cause of Amputation in Diabetics

A major cause for leg amputation in diabetics is an infection in the foot or ankle. Because many diabetics do not recognize the signs of a foot or ankle infection, the condition often goes untreated and can rapidly lead to amputation.

Early signs of an infection to the foot or ankle include any area that is red, hot, & swollen. A diabetic may also notice an unexplained elevation of their blood sugar. As the infection progresses, the person may experience nausea, vomiting, fever & chills.

Infection in diabetics needs to be treated early and aggressively. Diabetes can decrease the body’s ability to fight infection. When this happens, a simple foot infection can lead to leg amputation in a matter of days.

Open wounds, blisters, athlete’s foot, and cracks in the skin can leave a diabetic susceptible to a foot or ankle infection. If you are diabetic and you notice any area of your foot or ankle that is red, hot & swollen, or you have an open wound or a blister, call your foot and ankle specialist immediately! Remember, aggressive & early treatment of infection in diabetics can greatly reduce the need for amputation.

Foot Doctors Can Help Diabetics Avoid Amputation

Podiatrists detect conditions that might lead to limb loss, experts say.

FRIDAY, Aug. 6 (HealthDay News) -- Being treated by a podiatrist helps diabetes patients reduce their risk of amputation, research shows.

Podiatrists, also called podiatric physicians, are medical specialists of the foot, ankle and lower leg.

"More than half of all amputations in the U.S. are related to diabetes. Podiatrists are detecting conditions that can lead to amputation. That's just what we do," study co-author Dr. James Wrobel, an associate professor of medicine at Rosalind Franklin University of Medicine and Science in North Chicago, said in a university news release.

The study of nearly 29,000 diabetes patients, aged 18 to 64, found that those who had had at least one visit with a podiatrist prior to receiving a foot ulcer diagnosis had a lower risk of amputation and hospitalization (nearly 15 percent and 17 percent, respectively).

The study findings were presented in July at a meeting of the American Podiatric Medical Association in Seattle.

Complications related to diabetes are the leading cause of non-traumatic lower limb amputation in the United States and cost an estimated $3 billion a year, according to the Amputee Coalition of America. An estimated 24 million Americans have diabetes and 86,000 undergo amputations each year, based on information from the U.S. Centers for Disease Control and Prevention.

Diabetes Diagnosis for MI Man: Dog Ate Toe

Most pet owners would be irate if their dog bit off one of their toes, but Jerry Douthett, of Rockford, MI is nothing but grateful: this canine feat may have saved his life. Douthett was alerted to the seriousness of a bone infection in his foot, resulting from previously undiagnosed Type II diabetes, when his terrier Kiko bit off his big toe while he was passed out drunk, according to The Grand Rapids Press

"Jerry had had all these Margaritas, so I just let him sleep," his wife, Rosee, a registered nurse told the Michigan paper. "But then I heard these screams coming from the bedroom, and he was yelling, 'My toe's gone, my toe's gone!'" He suspected for months something was wrong with his foot, but the 48-year-old musician had only recently scheduled an appointment to see a doctor. Douthett was rushed to the hospital by Rosie where doctors amputated the rest of his toe and diagnosed him with Type II diabetes.

http://www.mlive.com/news/grand-rapids/index.ssf/2010/08/dog_eats_rockford_mans_big_toe.html

Surgical site infection risk in patients with diabetes

Surgical procedures are often unavoidable in patients with diabetes, and can even help reduce future risk of ulceration. But high postoperative infection rates in this patient population pose additional challenges to practitioners.

With 7.8% of the United States population (~23.6 million people) estimated to be diabetic, one can see how diabetes has become an increasing challenge for the medical community. It has been estimated that nearly a third of these patients are unaware of being diabetic. This prevalence will rise, as nearly 25% of adults over 60 are diabetic and there are increasing numbers being diagnosed in younger patients. Approximately 366 million people will have diabetes worldwide by the year 2030, most of these in developing countries. Foot disorders such as ulcers, infection, Charcot neuroarthropathy and peripheral arterial disease (PAD) are the most common causes of hospital admissions in diabetics. As diabetes mellitus is considered a lifelong condition, one can see the true impact on the healthcare system overall.

Peripheral neuropathy is one of the most common complications found in diabetics, prevalent in anywhere from 14-60% of the diabetic population. Peripheral neuropathy leads to sensory, motor and autonomic dysfunction, and this loss of protective sensation often causes these patients to fail to seek timely medical care for their conditions.

Foot surgery in patients with DM can be elective or preventative. Due to concerns with increased infection rates and slow healing of skin and bony structures in diabetics, elective surgery is performed with extreme caution. Prophylactic or preventative surgery is performed in those diabetics with pre-ulcerative areas, bony prominences and stable, non-infected ulcers. The purpose is to prevent ulcerations due to these bony prominences or to assist in healing of current ulcerations. Multiple types of surgeries can be performed based on the underlying bony deformity found, including hammertoe repair, bunion repair, metatarsal osteotomies, bone resections, Achilles tendon lengthenings for ulcers in the forefoot area and many more. Fracture repair is often required in diabetic patients. Those patients with Charcot foot deformity not treatable with bracing may require surgical intervention also.

It has been noted that diabetic patients without neuropathy can be treated with standard surgical technique and post-op care, but those who are neuropathic should have more fixation, be seen more often and remain non-weightbearing for approximately double the time period.

Peripheral arterial disease can also complicate the surgical site in diabetics, especially those with an insensate foot. Lack of blood flow to the surgical site not only affects the patient’s ability to heal the site quickly, but can also lead to an inability to fight off potential infection at the surgical site in the diabetic patient. Surgical site infections are infections that occur with 30 days of a surgical procedure, or within 1 year if an implant was inserted and is related to the surgery. One study found that by controlling factors such as hypothermia, blood glucose levels, removing hair from the surgical site and administering procedure-specific pre-operative antibiotics for an appropriate time frame, infection risk can be decreased.

One study showed a post-op infection rate of 6.7% in diabetic patients with neuropathy but no open wound undergoing forefoot surgery. A recent study was performed to examine wound infection rates involving 57,183 patients with ankle fractures undergoing repair. This study showed that non-diabetic patients had an infection rate of 1.4% after surgery. Diabetics without neuropathy or other comorbidities had a rate of 3.55% and diabetics with neuropathy or other comorbidities had an infection rate of 7.71%. Other reviews have found similar percentages, indicating that there is an obvious increased risk of infection in diabetics undergoing foot and ankle surgery. This implies that foot and ankle surgeons must have appropriate protocols in place to lessen these infection rates in their patients. First and foremost, comorbidities such as peripheral neuropathy and peripheral arterial disease must be diagnosed and managed prior to preventative surgery.

New Study Demonstrates Dramatic Impact of Podiatric Care

Patients with diabetes who receive medical and surgical care provided by a podiatrist are less likely to suffer hospitalization or amputation than patients who do not receive care from a podiatrist, according to a new study from Thomson Reuters. Thomson Reuters is an internationally respected research firm with expertise in the health-care market.

The study, sponsored by APMA, examined records for more than 32,000 patients with diabetes under 65 and matched health and risk factors for those who had podiatry visits to those who did not. Care by a podiatric physician, defined as at least one pre-ulcer visit, was associated with lower risk of hospitalization and amputation. James Wrobel, DPM, presented the results at the American Diabetes Association Scientific Sessions this weekend in Orlando, Florida.

"The dramatic results of the study demonstrate the important role of today's podiatrist," said APMA President Kathleen Stone, DPM. "As a profession, we make a significant impact on patient outcomes and health-care costs. As more diabetic patients receive high-quality medical care by podiatrists prior to developing ulcers, we will see even greater reductions in cost and improvements in patients' quality of life. The next step is to confirm these findings with prospective pilot programs that identify high-risk patients and provide preventive foot care services by podiatrists."

Mildred discusses Kansas Podiatrist Dr. Weaver's Diabetic Foot Care

Mildred has had lots of foot problems due to diabetes. She wanted you to know how great Dr. Ben Weaver's care has been. Take a look!