Exercise can be an effective way to get your blood sugar under control. Get motivated to start — and stick to — an exercise plan.
By Krisha McCoy, MS
Medically reviewed by Pat F. Bass III, MD, MPH Print Email Exercise is important for everyone, but it can be especially important for your health if you have diabetes. People who exercise regularly are better able to control their diabetes, thereby reducing their risk of diabetes complications.
Diabetes and Exercise: Why It’s Important to Stay Fit
If you have diabetes, you have an increased risk of developing certain health conditions, including heart attack, stroke, kidney disease, and nerve problems. By following your doctor's recommendations for keeping your blood glucose levels under control, you can reduce your risk of developing these complications.
Researchers have found that people who exercise regularly have:
Lower blood glucose levels
Lower blood pressure
Better cholesterol levels
Improved ability to use insulin
Decreased risk of stroke
Decreased risk of heart diseaseStronger bones
Less chance of falling
Easier weight loss
Less body fat
More energy
Reduced stress levels
In addition, if you use insulin to treat your diabetes, exercise can be part of the daily schedule that you and your diabetes health care team develop to control your blood glucose levels.
Diabetes and Exercise: Getting Started
Talk with your diabetes health care team before you begin an exercise program. They can help you design an exercise program that is safe and effective for you. Make sure to ask about any limitations. If you have heart disease, kidney disease, eye problems, or foot problems, there may be some physical activities that you should not do.
To get started with an exercise program:
Find physical activities you like. Choose activities that you enjoy doing and that are convenient. Try new activities, such as walking, dancing, swimming, or bicycling, until you find one you like.Schedule your workouts. Make exercise part of your schedule, just like work and doctor appointments. Aim to work out for at least half an hour on most or all days of the week.Slowly increase your time and intensity. Don't start out doing too much, or you may get burned out. Begin with just a few minutes, and add a little time, distance, or intensity to your workouts each week.Find an exercise partner. Ask a friend or neighbor to join you in your exercise plan. For many people, having a person who is counting on you will make you less likely to skip a workout. Keep a workout journal. Each time you exercise, write down what you did and what your blood glucose levels were. That way you can keep track of your progress and see how activity affects your diabetes control. Diabetes and Exercise: A Note about Hypoglycemia
Although exercise is an excellent way to help control your blood glucose levels, it is not without its risks. One of the most serious risks of exercising when you have diabetes is a condition called hypoglycemia.
With hypoglycemia, increased activity causes your blood glucose to fall to dangerously low levels. This can happen while you are exercising or even many hours later. Hypoglycemia can make you feel shaky, weak, and confused. If your blood glucose levels drop low enough, hypoglycemia could cause you to faint or have a seizure.
Talk with your doctor about strategies for preventing hypoglycemia. You may need to have a snack before you exercise or closely monitor your blood glucose levels before, during, and after exercising.
In addition to eating healthfully and taking insulin or other diabetes medications, exercise is a valuable tool for keeping you healthy. Commit to a regular exercise program, and you will not only have better control over your diabetes, but you will also gain more self-confidence and a better sense of well-being.
Showing posts with label controling blood sugars. Show all posts
Showing posts with label controling blood sugars. Show all posts
Friday, April 22, 2011
Thursday, April 14, 2011
American Diabetes Association's New Clinical Practice Recommendations Promote A1c as Diagnostic Test for Diabetes and Pre-Diabetes
Faster, easier test could help reduce number of undiagnosed with diabetes and pre-diabetes.
The American Diabetes Association's (ADA) new Clinical Practice Recommendations being published as a supplement to the January issue of Diabetes Care call for the addition of the A1c test as a means of diagnosing diabetes and identifying pre-diabetes. The test has been recommended for years as a measure of how well people are doing to keep their blood glucose levels under control.
"We believe that use of the A1c, because it doesn't require fasting, will encourage more people to get tested for Type 2 diabetes and help further reduce the number of people who are undiagnosed but living with this chronic and potentially life-threatening disease. Additionally, early detection can make an enormous difference in a person's quality of life," said Richard M. Bergenstal, MD, President-Elect, Medicine & Science, ADA.
"Unlike many chronic diseases, Type 2 diabetes actually can be prevented, as long as lifestyle changes are made while blood glucose levels are still in the pre-diabetes range."
A1c is measured in terms of percentages. The test measures a person's average blood glucose levels over a period of up to three months and previously had been used only to determine how well people were maintaining control of their diabetes over time. A person without diabetes would have an A1c of about 5 percent.
Under the new recommendations, which are revised every year to reflect the most current available scientific research, an A1c of 5.7 -- 6.4 percent would indicate that blood glucose levels were in the pre-diabetic range, meaning higher than normal but not yet high enough for a diagnosis of diabetes. That diagnosis would occur once levels rose to an A1c of 6.5 percent or higher.
The ADA recommends that most people with diabetes maintain a goal of keeping A1c levels at or below 7 percent in order to properly manage their disease. Research shows that controlling blood glucose levels helps to prevent serious diabetes-related complications, such as kidney disease, nerve damage and problems with the eyes and gums.
The A1c would join two previous diagnostic tests for diabetes, Fasting Plasma Glucose (FPG) and the Oral Glucose Tolerance Test (OGTT), both of which require overnight fasting. Because the A1c is a simple blood test and does not require fasting, allowing patients this option could increase willingness to get tested, thereby reducing the number of people who have Type 2 diabetes but don't yet know it.
According to the Centers for Disease Control and Prevention, one-fourth of all Americans with diabetes, or 5.7 million people, don't realize they have it. Another 57 million have pre-diabetes and 1.6 million new diagnoses are made every year.
The American Diabetes Association's (ADA) new Clinical Practice Recommendations being published as a supplement to the January issue of Diabetes Care call for the addition of the A1c test as a means of diagnosing diabetes and identifying pre-diabetes. The test has been recommended for years as a measure of how well people are doing to keep their blood glucose levels under control.
"We believe that use of the A1c, because it doesn't require fasting, will encourage more people to get tested for Type 2 diabetes and help further reduce the number of people who are undiagnosed but living with this chronic and potentially life-threatening disease. Additionally, early detection can make an enormous difference in a person's quality of life," said Richard M. Bergenstal, MD, President-Elect, Medicine & Science, ADA.
"Unlike many chronic diseases, Type 2 diabetes actually can be prevented, as long as lifestyle changes are made while blood glucose levels are still in the pre-diabetes range."
A1c is measured in terms of percentages. The test measures a person's average blood glucose levels over a period of up to three months and previously had been used only to determine how well people were maintaining control of their diabetes over time. A person without diabetes would have an A1c of about 5 percent.
Under the new recommendations, which are revised every year to reflect the most current available scientific research, an A1c of 5.7 -- 6.4 percent would indicate that blood glucose levels were in the pre-diabetic range, meaning higher than normal but not yet high enough for a diagnosis of diabetes. That diagnosis would occur once levels rose to an A1c of 6.5 percent or higher.
The ADA recommends that most people with diabetes maintain a goal of keeping A1c levels at or below 7 percent in order to properly manage their disease. Research shows that controlling blood glucose levels helps to prevent serious diabetes-related complications, such as kidney disease, nerve damage and problems with the eyes and gums.
The A1c would join two previous diagnostic tests for diabetes, Fasting Plasma Glucose (FPG) and the Oral Glucose Tolerance Test (OGTT), both of which require overnight fasting. Because the A1c is a simple blood test and does not require fasting, allowing patients this option could increase willingness to get tested, thereby reducing the number of people who have Type 2 diabetes but don't yet know it.
According to the Centers for Disease Control and Prevention, one-fourth of all Americans with diabetes, or 5.7 million people, don't realize they have it. Another 57 million have pre-diabetes and 1.6 million new diagnoses are made every year.
Thursday, April 7, 2011
Diabetes Tied to Poor Impulse Control
Patients with newly diagnosed Type 2 diabetes were significantly more likely to show poor impulse control in psychological testing than healthy people....
In the standard Go/NoGo test of impulse control, newly diagnosed diabetics made about 50% more errors of commission than normal controls, regardless of whether they were overweight.
The differences were not attributable to cognitive impairment, the researchers concluded, because diabetic patients performed as well as controls on the Wisconsin Card Sorting Test of executive function.
"Our results showed that middle-aged, newly diagnosed, and medication-free patients with Type 2 diabetes have a particular neuropsychological deficit in inhibitory control of impulsive response, which is an independent effect of diabetes apart from being overweight," Yasuhiko Iwamoto, MD, of Tokyo Women's Medical University in Japan, and colleagues wrote.
They suggested the findings could help explain why diabetic patients find it difficult to make the recommended lifestyle adjustments such as avoiding high-fat foods and maintaining daily exercise.
The researchers explained that decision-making about daily activities relies on brain functions in different cerebral regions, mixing predictions of future rewards and punishments, inhibition of impulsive responses, and executive functions.
Overeating, they explained, occurs when the prospect of immediate reward overwhelms inhibitions that derive from awareness of negative consequences. "In such conditions, rapid reward prediction or impulsive response to environmental stimuli prevails over the preparations by executive function," Iwamoto and colleagues asserted.
Earlier studies had indicated that reward predictions by overweight individuals tend to be higher than those of normal weight people, and their impulse control was generally lower. Consequently, the Japanese researchers sought to test diabetic patients for performance on psychological tests that measure these functions.
The Go/NoGo test for impulse control involved showing participants one of two letters, N or H, with instructions to press a button when they saw the N but not H. Pressing the button in response to H was an error of commission, and failing to press it when shown the N was an error of omission. The test also measured reaction times, including slowed responses that sometimes followed errors.
Prediction of future rewards was evaluated with so-called reversal and extinction tasks.
In the former, participants won points for correctly switching images on a computer screen that randomly replaced each other. The extinction task was structured the same way, except that participants stopped winning points for executing the reversal after nine correct responses; at that point, they received points for not responding to the stimulus.
As on a TV game show, correct responses were signaled with a pleasant chime sound, whereas errors were announced with a buzzer. Participants were also assessed for clinical depression and for standard laboratory measures of glycemia and insulin resistance. A total of 27 newly diagnosed Type 2 diabetic patients and 27 non-diabetic controls participated. All participants in both groups were men, and none of the diabetic patients were taking medications for diabetes. The diabetic group included 16 who were overweight (mean BMI 29.8). There were 11 overweight controls (mean BMI 27.6).
Response inhibition in the Go/NoGo test was significantly decreased in the diabetic patients, the researchers reported. In a combined measure of commission and omission errors, labeled d', diabetic patients had a mean value of 2.55 compared with 3.22 for controls (P=0.001).
The difference was most pronounced for errors of commission, with a mean of 10 for patients versus about 6 for controls (P=0.002).
The researchers found a significant interaction between Go/NoGo performance and glycated hemoglobin levels, with an r2 value of 0.287 for d' versus HbA1c (P=0.024). Scores did not differ significantly by weight, although there was a trend toward reduced impulse control in overweight participants. Diabetes did not affect reaction times, overall or after errors, but weight did affect them, with faster reaction times in overweight participants.
Iwamoto and colleagues also found that diabetes status did not affect scores on the reversal and extinction tests. Overweight participants made about 40% more errors on the extinction test compared with normal-weight individuals (P=0.029) but not on the reversal test.
Achievement scores on the Wisconsin Card Sorting Test were similar in all patient groups stratified by weight and diabetes status.
So-called perseverative errors (involving continuous repetition of a response) appeared more common in normal-weight diabetic participants, but rates of these errors varied widely among individuals and the group difference was not statistically significant.
"Our study included only newly diagnosed patients with Type 2 diabetes, suggesting the possibility that the neuropsychological deficits in response inhibition may contribute to the behavioral problems leading to chronic lifestyle-related diseases, such as Type 2 diabetes," they wrote.
However, they acknowledged that the causal arrow could point in the other direction -- that "metabolic changes with diabetes affect brain functions and cause neuropsychological deficits."
Indeed, the researchers observed, some earlier studies have found that metabolic improvements in diabetic patients lead to improved cognitive performance.
"Further longitudinal studies will be useful to detect progression or improvement of neuropsychological deficits associated with metabolic change," Iwamoto and colleagues wrote.
They also recommended more studies into the potential causal role of impulsivity in development of Type 2 diabetes. If confirmed, psychobehavioral interventions aimed at improving impulse control could be beneficial in preventing or treating the disease
In the standard Go/NoGo test of impulse control, newly diagnosed diabetics made about 50% more errors of commission than normal controls, regardless of whether they were overweight.
The differences were not attributable to cognitive impairment, the researchers concluded, because diabetic patients performed as well as controls on the Wisconsin Card Sorting Test of executive function.
"Our results showed that middle-aged, newly diagnosed, and medication-free patients with Type 2 diabetes have a particular neuropsychological deficit in inhibitory control of impulsive response, which is an independent effect of diabetes apart from being overweight," Yasuhiko Iwamoto, MD, of Tokyo Women's Medical University in Japan, and colleagues wrote.
They suggested the findings could help explain why diabetic patients find it difficult to make the recommended lifestyle adjustments such as avoiding high-fat foods and maintaining daily exercise.
The researchers explained that decision-making about daily activities relies on brain functions in different cerebral regions, mixing predictions of future rewards and punishments, inhibition of impulsive responses, and executive functions.
Overeating, they explained, occurs when the prospect of immediate reward overwhelms inhibitions that derive from awareness of negative consequences. "In such conditions, rapid reward prediction or impulsive response to environmental stimuli prevails over the preparations by executive function," Iwamoto and colleagues asserted.
Earlier studies had indicated that reward predictions by overweight individuals tend to be higher than those of normal weight people, and their impulse control was generally lower. Consequently, the Japanese researchers sought to test diabetic patients for performance on psychological tests that measure these functions.
The Go/NoGo test for impulse control involved showing participants one of two letters, N or H, with instructions to press a button when they saw the N but not H. Pressing the button in response to H was an error of commission, and failing to press it when shown the N was an error of omission. The test also measured reaction times, including slowed responses that sometimes followed errors.
Prediction of future rewards was evaluated with so-called reversal and extinction tasks.
In the former, participants won points for correctly switching images on a computer screen that randomly replaced each other. The extinction task was structured the same way, except that participants stopped winning points for executing the reversal after nine correct responses; at that point, they received points for not responding to the stimulus.
As on a TV game show, correct responses were signaled with a pleasant chime sound, whereas errors were announced with a buzzer. Participants were also assessed for clinical depression and for standard laboratory measures of glycemia and insulin resistance. A total of 27 newly diagnosed Type 2 diabetic patients and 27 non-diabetic controls participated. All participants in both groups were men, and none of the diabetic patients were taking medications for diabetes. The diabetic group included 16 who were overweight (mean BMI 29.8). There were 11 overweight controls (mean BMI 27.6).
Response inhibition in the Go/NoGo test was significantly decreased in the diabetic patients, the researchers reported. In a combined measure of commission and omission errors, labeled d', diabetic patients had a mean value of 2.55 compared with 3.22 for controls (P=0.001).
The difference was most pronounced for errors of commission, with a mean of 10 for patients versus about 6 for controls (P=0.002).
The researchers found a significant interaction between Go/NoGo performance and glycated hemoglobin levels, with an r2 value of 0.287 for d' versus HbA1c (P=0.024). Scores did not differ significantly by weight, although there was a trend toward reduced impulse control in overweight participants. Diabetes did not affect reaction times, overall or after errors, but weight did affect them, with faster reaction times in overweight participants.
Iwamoto and colleagues also found that diabetes status did not affect scores on the reversal and extinction tests. Overweight participants made about 40% more errors on the extinction test compared with normal-weight individuals (P=0.029) but not on the reversal test.
Achievement scores on the Wisconsin Card Sorting Test were similar in all patient groups stratified by weight and diabetes status.
So-called perseverative errors (involving continuous repetition of a response) appeared more common in normal-weight diabetic participants, but rates of these errors varied widely among individuals and the group difference was not statistically significant.
"Our study included only newly diagnosed patients with Type 2 diabetes, suggesting the possibility that the neuropsychological deficits in response inhibition may contribute to the behavioral problems leading to chronic lifestyle-related diseases, such as Type 2 diabetes," they wrote.
However, they acknowledged that the causal arrow could point in the other direction -- that "metabolic changes with diabetes affect brain functions and cause neuropsychological deficits."
Indeed, the researchers observed, some earlier studies have found that metabolic improvements in diabetic patients lead to improved cognitive performance.
"Further longitudinal studies will be useful to detect progression or improvement of neuropsychological deficits associated with metabolic change," Iwamoto and colleagues wrote.
They also recommended more studies into the potential causal role of impulsivity in development of Type 2 diabetes. If confirmed, psychobehavioral interventions aimed at improving impulse control could be beneficial in preventing or treating the disease
Wednesday, March 30, 2011
The Lowdown on Glycemic Load
Carbohydrates are controversial when it comes to diet these days. But what separates the good from the bad is a food's glycemic load, which has a big impact on blood sugar levels.
Every food you eat affects your body differently, and not just in terms of your long-range health, but also in the way it is processed and the effect it has on your energy level and blood sugar.
Glycemic Load and Diet: The Basics
The glycemic load is a classification of different carbohydrates that measures their impact on the body and blood sugar. The glycemic load details the amount of carbohydrates a food contains and its glycemic index, a measurement of its impact on blood sugar. “The glycemic index ranks foods based on how quickly they're digested and get into the bloodstream," says Sandra Meyerowitz, MPH, RD, a nutritionist and owner of Nutrition Works in Louisville, Ky. “Its glycemic load takes into consideration every component of the food as a whole, so it's a different number. It changes everything."
Because the glycemic load of a food looks at both components, the same food can have a high glycemic index, but an overall low glycemic load, making it better for you than it originally might have appeared.
Glycemic Load and Diet: The Effect on Your Health
Foods with a low glycemic load keep blood sugar levels consistent, meaning that you avoid experiencing the highs and lows that can be caused by blood sugar that jumps too high and quickly drops — the candy bar effect.
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Watching the glycemic load of the foods you eat can have a big impact on your health in many ways. A diet focused on foods with a low glycemic load can:
Make it easier to lose weight and avoid the dreaded diet plateau
Keep blood sugar levels more consistent
Burn more calories
Help prevent insulin resistance and diabetesLower heart disease risk
"It makes more sense to use the glycemic load because when you eat a food you don’t just eat one food by itself — you eat a whole bunch of foods together," says Meyerowitz. Looking at the total picture of foods you eat, rather than just the individual pieces, gives you a clearer and more accurate picture of the foods that make up your diet.
Glycemic Load and Diet: Glycemic Loads in Favorite Foods
It's tough to figure out on your own if a food has a high or a low glycemic load, but as a general guideline, the more fiber a food has the better. Here is a glycemic load reference list with many common foods to let you know which are low, medium, and high.
Foods with a low glycemic load of 10 or less:
Kidney, garbanzo, pinto, soy, and black beans
Fiber-rich fruits and vegetables, like carrots, green peas, apples, grapefruit, and watermelon
Cereals made with 100 percent bran
Lentils
Cashews and peanuts
Whole-grain breads like barley, pumpernickel, and whole wheat
Whole-wheat tortillas
Tomato juice
Milk
Foods with a medium glycemic load of 11 to 19:
Whole-wheat pasta and some breads
Oatmeal
Rice cakes
Barley and bulgur
Fruit juices without extra sugar
Brown rice
Sweet potato
Graham crackers
Foods with a high glycemic load of 20 or more:
High-sugar beverages
Candy
Sweetened fruit juices
Couscous
White rice
White pasta
French fries and baked potatoes
Low-fiber cereals (high in added sugar)
Macaroni and cheese
Pizza
Raisins and dates
Focusing on the glycemic load of foods is particularly important for people with diabetes to help maintain a steady blood sugar, but everyone can benefit from understanding and monitoring the glycemic load in their diet.
By Diana Rodriguez
Medically reviewed by Christine Wilmsen Craig, MD
Every food you eat affects your body differently, and not just in terms of your long-range health, but also in the way it is processed and the effect it has on your energy level and blood sugar.
Glycemic Load and Diet: The Basics
The glycemic load is a classification of different carbohydrates that measures their impact on the body and blood sugar. The glycemic load details the amount of carbohydrates a food contains and its glycemic index, a measurement of its impact on blood sugar. “The glycemic index ranks foods based on how quickly they're digested and get into the bloodstream," says Sandra Meyerowitz, MPH, RD, a nutritionist and owner of Nutrition Works in Louisville, Ky. “Its glycemic load takes into consideration every component of the food as a whole, so it's a different number. It changes everything."
Because the glycemic load of a food looks at both components, the same food can have a high glycemic index, but an overall low glycemic load, making it better for you than it originally might have appeared.
Glycemic Load and Diet: The Effect on Your Health
Foods with a low glycemic load keep blood sugar levels consistent, meaning that you avoid experiencing the highs and lows that can be caused by blood sugar that jumps too high and quickly drops — the candy bar effect.
There's more content below this advertisement. Jump to the content.
Watching the glycemic load of the foods you eat can have a big impact on your health in many ways. A diet focused on foods with a low glycemic load can:
Make it easier to lose weight and avoid the dreaded diet plateau
Keep blood sugar levels more consistent
Burn more calories
Help prevent insulin resistance and diabetesLower heart disease risk
"It makes more sense to use the glycemic load because when you eat a food you don’t just eat one food by itself — you eat a whole bunch of foods together," says Meyerowitz. Looking at the total picture of foods you eat, rather than just the individual pieces, gives you a clearer and more accurate picture of the foods that make up your diet.
Glycemic Load and Diet: Glycemic Loads in Favorite Foods
It's tough to figure out on your own if a food has a high or a low glycemic load, but as a general guideline, the more fiber a food has the better. Here is a glycemic load reference list with many common foods to let you know which are low, medium, and high.
Foods with a low glycemic load of 10 or less:
Kidney, garbanzo, pinto, soy, and black beans
Fiber-rich fruits and vegetables, like carrots, green peas, apples, grapefruit, and watermelon
Cereals made with 100 percent bran
Lentils
Cashews and peanuts
Whole-grain breads like barley, pumpernickel, and whole wheat
Whole-wheat tortillas
Tomato juice
Milk
Foods with a medium glycemic load of 11 to 19:
Whole-wheat pasta and some breads
Oatmeal
Rice cakes
Barley and bulgur
Fruit juices without extra sugar
Brown rice
Sweet potato
Graham crackers
Foods with a high glycemic load of 20 or more:
High-sugar beverages
Candy
Sweetened fruit juices
Couscous
White rice
White pasta
French fries and baked potatoes
Low-fiber cereals (high in added sugar)
Macaroni and cheese
Pizza
Raisins and dates
Focusing on the glycemic load of foods is particularly important for people with diabetes to help maintain a steady blood sugar, but everyone can benefit from understanding and monitoring the glycemic load in their diet.
By Diana Rodriguez
Medically reviewed by Christine Wilmsen Craig, MD
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.
Wednesday, January 19, 2011
Managing Diabetes With a Cold or Flu
Got the sniffles? Here's what you need to know when managing diabetes and fighting off a cold or the flu. Sick days bring everyone down. But if you have type 2 diabetes, you have some special considerations when you are burdened with a cold or the flu — for example, choosing the right cold medicine or checking in with your doctor to find out about changes in the dosing of your medications.
Diabetes care means being prepared for the days when you would rather not drag yourself out of bed for a glucose check or a snack.
Pick the Right Cold Medicine
“A lot of [cold and flu] medications, particularly cough syrup, are high in glucose,” says internist Danny Sam, MD, the program director of the residency program at Kaiser Permanente in Santa Clara, Calif. His practice specializes in adult diabetes.
If you have diabetes, your best bet is a medicine that is clearly labeled sugar-free. Almost every major pharmacy has a store brand of sugar-free cold or cough medicine, says Dr. Sam. If you have questions, ask your pharmacist for help.
Check Blood Sugar Often
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“Diabetes is not as well controlled when you are sick,” observes Sam. This is because when your body fights infection, it releases a chemical cascade that can alter your body’s glucose and insulin response. As a result, you may need to check your blood sugar more often than you usually do. People with type 2 diabetes may need to check their blood sugar four times a day, and should check their urine for ketones anytime their blood sugar level is higher than 300 mg/dL.
Other medications you may need to take when you are sick can affect your blood sugar levels:
Aspirin may lower blood sugar levels
Certain antibiotics may decrease blood sugar levels in those taking some oral diabetes medicationsDecongestants may raise blood sugar levels
Adjust Your Plan
“You have to monitor your blood sugar more frequently and you may have to adjust your meds,” Sam says. Some people may find their blood sugar spiking more frequently, while other people, especially those plagued by stomach flu or diarrhea, may be facing hypoglycemia, or low blood sugar. Either way, you need to know how to respond to these unusual dips and spikes in blood sugar.
“Touch base with your doctor to get instructions on how to adjust medications,” says Sam. This is especially important if your blood sugar readings stay higher than 240 mg/dL for more than 24 hours.
Alternatively, before cold and flu season sets in, you can talk to your diabetes care team about how to make medication dose decisions if you should get sick. Find out what the acceptable range of blood sugar change is — and exactly when you should call your doctor. Write these instructions down in a notebook so that you can easily refer to them when you do get sick.
But there are some things you shouldn’t change: Unless your diabetes care team or doctor has instructed otherwise based on your blood sugar levels, keep taking your diabetes medications as prescribed.
Feeling Better Without Meds
Remember, as miserable as you feel right now, colds and the flu do not last forever. If you want to feel better, take care of yourself. That means:
Stay hydrated. Drink lots of fluids. Small sips can help you stay hydrated even if you are vomiting frequently.
Snack. You may not feel like it, but you should eat regularly. Snack on fluids like soup or milk, or small portions of easy-to-digest foods like applesauce, crackers, and vanilla wafers. It’s also a good idea to keep written track of the medications you take, both for diabetes and cough and cold symptoms, as well as the results of your blood sugar tests and other details of your illness.
Illness Prevention Strategies
We’d all like to avoid getting a cold or the flu. If you have type 2 diabetes, your best bet for avoiding sickness is to keep your disease under control. “Control blood sugar when well,” advises Sam.
Out-of-control blood sugar makes it harder for your body to fight off infections, including those that lead to colds and the flu. If you can keep your blood sugar under control during your healthy days, you will have fewer sick days and, when you do get sick, your body will be able to bounce back faster.
It’s also a good idea to get your annual flu shot and other vaccinations that are recommended for your age range.
By Madeline Vann, MPH
Medically reviewed by Lindsey Marcellin, MD, MPH
Diabetes care means being prepared for the days when you would rather not drag yourself out of bed for a glucose check or a snack.
Pick the Right Cold Medicine
“A lot of [cold and flu] medications, particularly cough syrup, are high in glucose,” says internist Danny Sam, MD, the program director of the residency program at Kaiser Permanente in Santa Clara, Calif. His practice specializes in adult diabetes.
If you have diabetes, your best bet is a medicine that is clearly labeled sugar-free. Almost every major pharmacy has a store brand of sugar-free cold or cough medicine, says Dr. Sam. If you have questions, ask your pharmacist for help.
Check Blood Sugar Often
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“Diabetes is not as well controlled when you are sick,” observes Sam. This is because when your body fights infection, it releases a chemical cascade that can alter your body’s glucose and insulin response. As a result, you may need to check your blood sugar more often than you usually do. People with type 2 diabetes may need to check their blood sugar four times a day, and should check their urine for ketones anytime their blood sugar level is higher than 300 mg/dL.
Other medications you may need to take when you are sick can affect your blood sugar levels:
Aspirin may lower blood sugar levels
Certain antibiotics may decrease blood sugar levels in those taking some oral diabetes medicationsDecongestants may raise blood sugar levels
Adjust Your Plan
“You have to monitor your blood sugar more frequently and you may have to adjust your meds,” Sam says. Some people may find their blood sugar spiking more frequently, while other people, especially those plagued by stomach flu or diarrhea, may be facing hypoglycemia, or low blood sugar. Either way, you need to know how to respond to these unusual dips and spikes in blood sugar.
“Touch base with your doctor to get instructions on how to adjust medications,” says Sam. This is especially important if your blood sugar readings stay higher than 240 mg/dL for more than 24 hours.
Alternatively, before cold and flu season sets in, you can talk to your diabetes care team about how to make medication dose decisions if you should get sick. Find out what the acceptable range of blood sugar change is — and exactly when you should call your doctor. Write these instructions down in a notebook so that you can easily refer to them when you do get sick.
But there are some things you shouldn’t change: Unless your diabetes care team or doctor has instructed otherwise based on your blood sugar levels, keep taking your diabetes medications as prescribed.
Feeling Better Without Meds
Remember, as miserable as you feel right now, colds and the flu do not last forever. If you want to feel better, take care of yourself. That means:
Stay hydrated. Drink lots of fluids. Small sips can help you stay hydrated even if you are vomiting frequently.
Snack. You may not feel like it, but you should eat regularly. Snack on fluids like soup or milk, or small portions of easy-to-digest foods like applesauce, crackers, and vanilla wafers. It’s also a good idea to keep written track of the medications you take, both for diabetes and cough and cold symptoms, as well as the results of your blood sugar tests and other details of your illness.
Illness Prevention Strategies
We’d all like to avoid getting a cold or the flu. If you have type 2 diabetes, your best bet for avoiding sickness is to keep your disease under control. “Control blood sugar when well,” advises Sam.
Out-of-control blood sugar makes it harder for your body to fight off infections, including those that lead to colds and the flu. If you can keep your blood sugar under control during your healthy days, you will have fewer sick days and, when you do get sick, your body will be able to bounce back faster.
It’s also a good idea to get your annual flu shot and other vaccinations that are recommended for your age range.
By Madeline Vann, MPH
Medically reviewed by Lindsey Marcellin, MD, MPH
Monday, January 17, 2011
Out-of-Control Sugar Cravings
Q: I am a type 2 diabetic. I do well with meals, but I crave something sweet (like cookies, cake, candy) constantly, and most times I lose the battle to resist. How can I get rid of this craving once and for all?
— Jacqueline, Kansas
A: Despite popular beliefs about how blood sugar levels relate to craving, there is very little if any evidence indicating this to be true. Food cravings are largely a psychological phenomenon that relates to old habits and learning. The most likely reason that we see cravings in folks like you who have developed type 2 diabetes may simply be that the history of eating patterns that contributed to the development of the diabetes is persisting. Here's the good news: As is the case with all learned behavior, cravings can be "unlearned."
Cravings can arise in several ways. If you have used food to reward yourself, make yourself feel better when stressed or upset, or celebrate certain special events, depending on how frequently you do this, those foods can become associated with any of the above examples. When you feel these emotions, or are in the situations associated with that food, that association triggers thoughts about the food — in other words, a craving. The problem is that over a lifetime, the number of subtle triggers that become solidly paired with these foods grows. So it’s sometimes impossible to put your finger on the cause of the craving, which leads people to assume it’s being triggered by some internal physiological need (which is probably not the case).
The good news is that there is a simple answer: Stop pairing consumption of the craved food with the craving. Of course, even simple answers are not always easy. Fighting cravings can be tough. They are powerful and very real. So here are a few tips to get you started:
Delay. Wait 10 to 20 minutes (or as long as you can) before giving into the craving. In the best-case scenario, often the craving will subside in that time period, and you will not eat the food at all. However, even at those times when you aren’t able to fully fight off the craving, the time delay helps reduce its power.
Distract. Just thinking about the craved food during the delay can maintain the power of the craving. By distracting yourself and trying not to think about the craved food, you will ensure that the craving weakens.
Avoid. Finding alternatives to your most difficult-to-control foods that are equally satisfying and consuming these in moderation in a planned way (not in response to a craving) allows you to not feel deprived while controlling consumption of the food. Alternatively, some people seem to do well consuming a small amount of the actual craved food at planned times, but recent evidence suggests that this may in fact prolong the removal of the cravings.
Remember, you can take control of cravings.
— Jacqueline, Kansas
A: Despite popular beliefs about how blood sugar levels relate to craving, there is very little if any evidence indicating this to be true. Food cravings are largely a psychological phenomenon that relates to old habits and learning. The most likely reason that we see cravings in folks like you who have developed type 2 diabetes may simply be that the history of eating patterns that contributed to the development of the diabetes is persisting. Here's the good news: As is the case with all learned behavior, cravings can be "unlearned."
Cravings can arise in several ways. If you have used food to reward yourself, make yourself feel better when stressed or upset, or celebrate certain special events, depending on how frequently you do this, those foods can become associated with any of the above examples. When you feel these emotions, or are in the situations associated with that food, that association triggers thoughts about the food — in other words, a craving. The problem is that over a lifetime, the number of subtle triggers that become solidly paired with these foods grows. So it’s sometimes impossible to put your finger on the cause of the craving, which leads people to assume it’s being triggered by some internal physiological need (which is probably not the case).
The good news is that there is a simple answer: Stop pairing consumption of the craved food with the craving. Of course, even simple answers are not always easy. Fighting cravings can be tough. They are powerful and very real. So here are a few tips to get you started:
Delay. Wait 10 to 20 minutes (or as long as you can) before giving into the craving. In the best-case scenario, often the craving will subside in that time period, and you will not eat the food at all. However, even at those times when you aren’t able to fully fight off the craving, the time delay helps reduce its power.
Distract. Just thinking about the craved food during the delay can maintain the power of the craving. By distracting yourself and trying not to think about the craved food, you will ensure that the craving weakens.
Avoid. Finding alternatives to your most difficult-to-control foods that are equally satisfying and consuming these in moderation in a planned way (not in response to a craving) allows you to not feel deprived while controlling consumption of the food. Alternatively, some people seem to do well consuming a small amount of the actual craved food at planned times, but recent evidence suggests that this may in fact prolong the removal of the cravings.
Remember, you can take control of cravings.
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.”
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