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Health
Tips from Cougars
Diabetes
Type
1 and Type 2
DIABETES,
TYPE 1
WHAT IS IT?
Diabetes is a flaw in the way your body handles the sugars it takes
from food. The body turns them into glucose-also called blood sugar-which
it uses for energy. Glucose can serve as fuel only after it moves
into your cells, and that's where diabetes gets in the way. A hormone
called insulin helps glucose enter the cells. Type 1 diabetes begins
when the pancreas, a flat organ tucked behind your stomach, stops
making insulin. Without insulin, sugar that should go to your cells
builds up in your blood instead. This can cause a number of problems.
Some, such as increased thirst, increased urination, or blurred
vision, may come on quickly. Others, such as heart or kidney disease,
may not show up for years. Type 1 diabetes is less common than type
2, in which the pancreas does make insulin but the body has trouble
using it. About 10 percent of people who know they have diabetes
have type 1-about 800,000 in the United States. Type 1 used to be
called insulin-dependent diabetes mellitus (IDDM) because people
who have it need insulin shots to stay healthy. It was also called
juvenile-onset because almost all of the diabetes that children
have is type 1. If your child has type 1 diabetes, or if you do,
you will manage it with insulin shots. A person with diabetes also
needs to eat good, fresh food and to not skip meals. Once you learn
to manage the problem, the chances are good for a long, healthy,
active life.
WHAT IS HAPPENING?
When you eat something-an apple or a piece of bread, for instance-digestion
breaks down the complex sugars in the food into a simple sugar,
glucose. The glucose then enters your bloodstream: Your blood sugar
goes up. Your pancreas should respond by pouring insulin into your
blood. Insulin acts like a key that opens cell walls so the sugar
can get in. If your pancreas doesn't make enough insulin, the cells
stay locked. Sugar remains in your blood instead, and your cells
starve in the midst of plenty. You may feel weak and tired because
your cells don't get the fuel they need. Your body will try to flush
out the excess sugar in your blood; that's why you might urinate
a lot and become dehydrated. Over time, the extra sugar in your
blood can damage your blood vessels and nerves. This raises your
risk of a number of health problems, including heart and kidney
disease, infections, and even blindness. Also, when your body can't
use sugar for energy, it turns to its next best source: fat. Burning
more fat than normal releases extra amounts of chemicals called
ketones. This can lead to a life-threatening problem called ketoacidosis.
For these reasons, it is vital to manage type 1 diabetes with diet,
exercise, and insulin.
WHAT CAUSES IT?
Experts think type 1 diabetes begins when a person's own immune
system-the body's disease-fighting system-destroys certain cells
in the pancreas that produce insulin. No one is sure why this happens
to some people, and so far there seems to be no way to prevent it.
It is not the result of anything you did. All the things that put
you or your child at risk are beyond your control. Still, a person
who has type 1 diabetes can do a lot to manage the problem and to
keep it from leading to other ailments such as heart or kidney disease.
People who have type 1 diabetes tend to have some or all of these
things in common:
Age Almost all diabetes that children have, up to the mid-teenage
years, is type 1. Overall, about half the people who get it are
young adults under age 30.
Family Diabetes tends to run in families. If a close relative
such as a mother, father, brother, or sister has it, a child has
a much greater chance of getting the disease than if no one in the
family has it.
Race Whites are more likely to have type 1 diabetes than
are people of other races. Experts aren't exactly sure why.
WHAT YOU CAN DO FOR YOURSELF
If your child has type 1 diabetes, you can help by making sure he
or she knows it can be handled without much trouble. Diabetes is
lifelong, but it doesn't have to take over anyone's life. Then tell
your child these basic facts: You'll need to eat good food, watch
your weight, and get some exercise. You'll also want to be sure
to take insulin as often as your doctor prescribes. Your goal is
to keep your blood sugar level close to normal throughout the day.
It may take time for you and your doctor to come up with a treatment
plan that works for you. Your team of doctors, nurses, and dietitians
will help you figure out what foods, amounts of insulin, and types
of exercise will keep you healthy. Because the level of sugar in
your blood goes up and down during the day, you'll need to check
it often to make sure your treatment plan is working. People who
take insulin should check four times a day-before each meal and
at bedtime. When your blood sugar is too high or too low, there
are simple things you can do to get it back to normal. To check,
you'll use a glucose monitor: You prick your finger to get a drop
of blood, then put the drop on the monitor, which reads it for the
amount of glucose present. If you keep a daily log of readings,
you and your doctor can tell how your exercise habits, diet, and
insulin affect your blood sugar level. Your doctor can tell you
how often you should check and can help you find a monitor that
fits your needs. You'll also need frequent checkups-every three
months or as often as your doctor advises-to make sure your diabetes
isn't causing other problems.
Watch out for high blood sugar When you're taking insulin,
you'll need to make sure you're taking the right amount on the right
schedule. If you don't have enough insulin in your blood, you can
get high blood sugar (hyperglycemia). Over a long time, even levels
only slightly above normal can cause health problems. You will surely
have high blood sugar if you quit taking insulin. Keep insulin on
hand, and take it on schedule. You may also have a "spike"-a sharp
rise in blood sugar-if you eat more carbohydrates (such as candy,
fruit, cereal, bread, or pasta) than usual. You may feel no symptoms
from a short spike, so you need to keep track of your blood sugar
levels with frequent tests. Stress can also cause a spike, as can
some infections. The flu, for instance, can make your glucose levels
go up sharply. Call your doctor for advice if you have diabetes
and you come down with the flu.
Watch out for low blood sugar Another challenge is low blood
sugar (hypoglycemia). It can result from taking too much insulin.
It can also happen if you skip a meal or don't eat enough, if you
exercise too much, or if you drink too much alcohol and miss meals.
If your blood sugar is low, you may feel your heart pounding and
be unable to think clearly. You may also feel:
Dizzy. Weak. Hungry.
In addition to those symptoms, you may have:
Sweaty skin. A headache. Blurred vision. Slurred speech. Trembling.
At the first sign, eat or drink something with half an ounce of
sugar, such as a half cup of fruit juice, a cup of skim milk, five
or six pieces of hard candy, or three large marshmallows. Always
carry a source of sugar with you so you can treat yourself as soon
as you feel symptoms of low blood sugar. If you don't do anything,
you may become too dizzy or weak to help yourself. You may even
faint. Then someone else must give you a shot of glucagon, a hormone
that quickly raises blood sugar levels. Make sure your family and
friends know the symptoms of hypoglycemia and what to do to help.
Wear identification Wear a medical alert tag that says you
have type 1 diabetes. Make sure your family knows what to do if
you have a problem with low or high blood sugar and you can't help
yourself.
Guard against infections If you have diabetes and don't keep
your blood sugar under control, you have a higher risk of certain
infections than other people. If you do get an infection, it may
be harder to heal. The body fights infection with white blood cells.
When blood sugar is high, the white cells can't do their job well.
If you notice an infection, call your doctor right away. An infection
that spreads can lead to the loss of a foot or leg-in fact, diabetes
is the leading cause of lost limbs among older adults.
Signs of Infection include:
>> Place that is swollen, red, warm, or painful.
>> Pus from a sore or wound.
>> Fever.
>> Red streaks from a wound.
You'll need to be extra careful with your feet. Inspect them every
day. Look for trouble spots such as calluses, blisters, or cuts.
Treat them promptly. Clean sores with hydrogen peroxide; you can
buy it at a drugstore. Keep your feet dry and air them out. Here
are some other tips for keeping them in shape:
>> Be sure to wash your feet every day with warm-not hot-water
and soap.
>> Pat them dry; rubbing too hard can hurt skin that may be
tender. Remember to dry between your toes.
>> For dry skin, use skin lotion. Avoid getting lotion between
toes.
>> Don't walk around barefoot.
>> Always wear clean socks. Change them at least once a day.
>> Make sure new shoes fit well. When you're breaking them
in, wear them no more than two or three hours a day.
>> Cut each toenail straight across and not too short; leave
some of the white nail at the end. Don't cut the corners.
>> Call your doctor before you begin to treat calluses or
corns.
Eat the right stuff (see heart)
WHAT YOUR DOCTOR CAN DO FOR YOU
Insulin injections
Your doctor will prescribe insulin, and you'll give yourself insulin
shots several times a day. You can't take insulin in a pill, because
your intestines destroy it during digestion. After a while the shots
will become part of your daily routine.There are several types of
insulin; they vary mainly by the amount of time they take to take
effect and by how long each shot goes on working. Most likely you'll
mix a fast-acting type and a slower-acting one to get the effects
of both. The types most people use are human insulin that has been
genetically engineered to reduce the risk of an allergic reaction.
How much you need will depend on your age, blood glucose levels,
diet, and exercise habits. Other health problems, such as a cold
or the flu, can change your insulin needs. Your doctor will work
with you to find the type and amount that work best for you.
Pro: Helps your body use food for energy
and prevents high or low blood sugar. Helps prevent complications
of diabetes, such as eye and kidney disease. Seldom has side effects.
Con: May cause hypoglycemia. Small
risk of skin irritation or infection at injection sites. May cause
more severe allergic reaction. Requires close attention to meal
planning, exercise, and other lifestyle choices. Requires regular
checks of blood sugar.
Intensive Insulin Therapy
Intensive insulin therapy calls for up to four insulin injections
a day to keep blood sugar levels at normal or near-normal levels
throughout the day. The goal is to mimic as closely as possible
the function of a healthy, insulin-producing pancreas.
Pro: Researchers found that in patients
who followed this plan, eye problems fell by almost 70 percent,
nerve damage by 60 percent, and kidney damage by about 40 percent.
Con: Requires several finger pricks
throughout the day to check blood glucose levels, and tight control
of diet and exercise.
Humalog
People who use regular insulin must time their injections carefully
around their meals. A form of insulin called Humalog (insulin lispro)
makes timing easier for some. Instead of injecting 30 to 60 minutes
before eating, you can inject Humalog right before you eat or up
to fifteen minutes before. It acts quickly to lower blood glucose
levels after a meal.
Pro: Allows greater flexibility in
meal planning. Can make it easier to tightly control blood sugar
levels.
Con: If you don't eat within 15 minutes
of taking lispro, your blood sugar can drop dangerously low.
External Insulin Pump
Some people with diabetes use an insulin pump rather than insulin
injections. The pump is about the size of a pager and is worn outside
of the body. The pump has a computer chip that allows the user to
program how much insulin the machine will deliver. A clear plastic
tube from an insulin reservoir feeds insulin to the body through
a catheter in the abdominal area.
Pro: Provides some freedom from the
strict scheduling demands of traditional insulin programs. Gives
users a sense of independence and limits the number of needle sticks.
Con: Users must carefully watch their
pump for malfunctions since any error can cause blood insulin levels
to rapidly drop.
SOME WORDS YOU MAY HEAR
Acidosis: buildup of acid in the tissues. Too little insulin,
or resistance to insulin because of an infection, can lead to a
type of acidosis called ketoacidosis.
Alpha cell: cell in the pancreas that makes a hormone called
glucagon. Beta cell: cell in the pancreas that makes insulin.
Carbohydrates: a group of compounds containing carbon, hydrogen,
and oxygen. They include simple sugars such as glucose and chains
of sugars that make up more complex substances such as starch.
Endocrine system: network of hormone-producing glands and
other organs. Called endo- (meaning inward) because endocrine glands
release hormones straight into the spaces between the cells around
them; from there, the hormones seep into the bloodstream.
Euglycemia: normal blood sugar level. Glucagon: hormone that
quickly raises blood sugar levels.
Glucose: most common simple sugar, also known as blood sugar
or dextrose. Glucose can be used by cells for energy, stored as
glycogen in the muscles and liver, or changed to fat for storage.
Glycogen: form of glucose stored in muscle and liver. Cells
can easily change glycogen into glucose for energy.
Hormone: any of many powerful chemicals that travel through
the bloodstream from endocrine cells to cells at other points, affecting
the way those "target" cells behave. Effects include muscle mass,
height, the body's response to stress, and whether a person has
certain ailments such as diabetes.
Hyperglycemia: high blood sugar level.
Hypoglycemia: low blood sugar level.
Insulin: hormone that helps cells take in glucose to produce
energy. Lack of insulin, or resistance to it, causes diabetes.
Islets of Langerhans: part of the pancreas with both alpha
and beta cells, where insulin and glucagon are produced.
Ketoacidosis: acidosis caused by the rapid production of
ketone bodies. Ketone bodies: substances formed during the breakdown
of fat. Too many in the blood causes ketoacidosis.
Pancreas: organ in the back of the upper abdomen. Part of
the digestive system, it secretes digestive enzymes and makes the
hormones insulin and glucagon.
Protein: compounds that form the basic building blocks of
our tissues and help regulate chemical processes.
Type 1 diabetes: used to be known as insulin-dependent diabetes
mellitus (IDDM) or juvenile-onset diabetes. It occurs when the pancreas
stops making almost any insulin. People who have it need insulin
shots.
Type 2 diabetes: used to be known as non-insulin-dependent
diabetes mellitus (NIDDM) or adult-onset diabetes because it most
often begins in people over age 40. Type 2 diabetes occurs most
often when a person's cells resist insulin. Many people with this
type of diabetes need no insulin shots for five to ten years after
they're diagnosed. About half, though, sooner or later do have to
inject insulin.
LATEST DEVELOPMENTS
New insulin delivery systems Several researchers are looking
at new methods to deliver insulin without injections, including....
Implantable Insulin Pump: The pump is placed under the skin
in the lower abdomen and delivers a continuous flow of insulin through
a catheter. It frees users from having to inject themselves. Studies
show that the pump provides improved control over glucose levels,
and that it's effective in treating both type 1 and type 2 diabetes.
Every three months, the unit needs to be refilled with insulin.
This requires a minor outpatient procedure. The device itself must
be replaced every three years. More than 600 devices have been implanted
in patients, and clinical trials are currently closed to new applicants.
The pump is not yet approved for sale in the United States.
Inhaled Insulin Delivery Systems: Several companies are developing
systems that deliver insulin through inhalation, using devices that
are somewhat like asthma inhalers. When you inhale the insulin into
your lungs, it's quickly absorbed into the bloodstream. One system
uses insulin that comes in a dry powder form, the other uses liquid
insulin. Both systems are still in development.
Insulin Patch: Some researchers are trying to develop an
insulin patch that releases a continuous, low dose of the hormone
through the skin. Right now, though, scientists are still trying
to find a reliable method to get insulin through skin. The patch
is still in development and not available to the public.
Glucose Monitors
To keep a close eye on blood glucose levels, most people with diabetes
take blood samples with repeated finger pricks. Some researchers
are looking at more convenient, less painful ways to take blood
glucose readings. Here are some products on the horizon:
Glucose Monitor Watch: The GlucoWatch uses a very low electrical
current to extract glucose through the skin. A sensor in the watch
reads the glucose levels. It allows people to check their levels
automatically up to three times each hour. A recent study found
that the watch is almost as accurate as the common finger pricking
method. Approval by the Food and Drug Administration is pending.
AtLast System: Just approved by the FDA, this monitoring
system includes a lancing device, a glucose monitor, and a disposable
test strip that can be applied to parts of the body other than the
finger to get blood samples. The advantage of this system is that
it eliminates the common problem of sore fingertips.
Lasette: This device, recently approved by the FDA, uses
a laser to make a small hole in the finger to draw blood. The Lasette
is portable and battery-operated. Most patients who have used the
device say it's less painful than the usual finger-prick method
and that it doesn't cause as much soreness.
SPECIAL DRUGS AND FOODS TO WATCH
Some medicines and foods can affect your blood sugar levels:
>> Aspirin can lower blood sugar if you take large amounts
over a long time.
>> Some asthma and cold medicines contain chemicals that can
raise blood sugar. Avoid those with phenylephrine, epinephrine,
or ephedrine. Also, some herbal teas sold as decongestants have
the same effect. Don't drink teas that contain ma huang or ephedra.
>> Fish oil, which some people take to lower cholesterol levels,
may raise blood sugar levels.
>> The caffeine in coffee, tea, sodas, hunger suppressants,
and diuretics (drugs used to increase urine flow) may also raise
glucose levels.
PREVENTING LOW BLOOD SUGAR
DURING EXERCISE
You need to stay as active as you can if you have diabetes. But
exercise can sometimes make it hard to control your insulin and
blood sugar levels.
>> Ask your doctor if you should change the amount of insulin
you take on days you plan to be most active. Also ask if there's
anything special you should or shouldn't eat.
>> Monitor your blood glucose levels just before and after
exercising to see how different types of exercise and foods affect
your levels.
>> Keep fruit juices nearby. If you run, walk, or bike, take
a bottle of juice with you in case you get the warning signs of
low blood sugar.
WHEN YOUR CHILD HAS A SICK DAY
For a child who has diabetes, sick days can present special problems.
That's because an illness tends to raise your child's blood sugar
levels and weaken the effects of insulin. You can do a lot to prepare
for those days.
Have a plan
Talk to your child's doctor ahead of time about what to do on sick
days, including...
>> How often to test your child's blood sugar level.
>> How often to test your child's urine for ketones.
>> What to do if your child won't eat, has diarrhea, or is
vomiting.
>> What over-the-counter medications are okay. When to call
for advice.
As soon as your child starts feeling sick, do a blood sugar test
and start acting on the plan.
Don't skip an insulin dose
Even if your child isn't eating, be sure he or she takes normal
doses of insulin. Your doctor may also advise extra insulin on sick
days. Ask what level of blood sugar will tell you it's time to increase
the dose.
Have the right supplies
Keep plenty of mild foods on hand for days when nausea or vomiting
make it hard for your child to eat-for instance, fruit juices, chicken
broth, applesauce, and gelatin. Have a supply of the common medications-cough
medicine and antinausea suppositories-that your child's doctor approves.
Keep on hand a fluid-replacement drink such as Pedialyte, and nondiet
soft drinks or sports drinks, if the doctor says these are okay
for your child.
Know the signs of trouble
Besides keeping an eye on blood sugar and ketone levels, watch for
signs of dehydration if your child is vomiting or has diarrhea.
The signs include dry mouth, sticky saliva, sunken eyes, sleepiness,
dark urine or infrequent urination, crying with no tears, and restlessness.
If vomiting or diarrhea keeps on for more than two hours, or if
your child is unusually weak or sleepy or has trouble breathing,
take him or her to an emergency room right away.
DIABETES, TYPE 2
WHAT IS IT? Diabetes is a flaw in the way your body handles
the sugars it takes from food. The body turns them into glucose-also
called blood sugar-which it uses for energy. Glucose can serve as
fuel only after it moves into your cells, and that's where diabetes
gets in the way. A hormone called insulin helps glucose enter the
cells. You have diabetes when your body has trouble using insulin
or when it doesn't make enough insulin. Either way, sugar that should
go to your cells builds up in your blood instead. There are two
main types of diabetes-type 1 and type 2. Most people with diabetes
have type 2. It used to be known as adult-onset diabetes because
it tends to affect people over 40. It was also called non-insulin-dependent
diabetes mellitus (NIDDM) because some people who have it don't
need insulin shots to control their blood sugar, as people with
type 1 diabetes do. About half of the people with type 2, though,
do need insulin sooner or later.
The good news: You can do a lot to prevent type 2 diabetes by making
smart choices about such things as your diet and exercise habits.
If you already have it, these same choices can help you control
it. Medications can also help. Once you learn to manage type 2 diabetes,
chances are you can go on living a healthy, active life.
WHAT IS HAPPENING?
When you eat something, digestion breaks down the complex sugars
in the food into a simple sugar, glucose. The glucose then enters
your bloodstream: Your blood sugar goes up. Your pancreas, a flat
organ tucked behind your stomach, should respond by pouring insulin
into your blood. Insulin acts like a key that opens cell walls so
the sugar can get in. Type 2 diabetes typically comes on when your
cells begin to resist the action of insulin, even though your pancreas
is making plenty of it. It's as if you still have your key, but
someone has changed the lock. Your blood sugar goes up and your
cells begin to starve in the midst of plenty. In response, your
pancreas pumps out still more insulin, but it can't make enough
to keep up with the rising blood sugar. Over time, your pancreas
may become so exhausted by the effort to produce insulin that it
stops producing enough. You may feel weak and tired because your
cells can't get all the fuel they need. Other symptoms, such as
increased thirst, increased urination, or blurred vision, may also
come on quickly. The extra sugar in your blood can damage your blood
vessels and nerves. This raises your risk of a number of health
problems including heart and kidney disease, infections, and even
blindness. That's why it's vital to do all you can to prevent diabetes-or
if you have it, to manage it with diet, exercise, and medication.
WHAT CAUSES IT?
Experts aren't sure why one person gets type 2 diabetes and another
doesn't, but we do know factors that can raise risk. A few, such
as age, race, and family history, are beyond your control. But you
can do plenty about many others.
THINGS YOU CAN'T CHANGE
Age Type 2 diabetes most often develops in people over 40,
and it's most common in those over 65. In fact, one person in every
ten over age 65 has it.
Family Diabetes runs in families. If a close relative such
as your mother or father has it, you have a greater chance of getting
the disease than if no one in your family has it.
Race Native Americans are four to ten times as likely to
develop type 2 diabetes as whites, Mexican Americans about three
times as likely, and African Americans twice as likely. Experts
aren't sure why.
Pregnancy Some women get diabetes when they're pregnant.
This is called gestational diabetes. It most often goes away after
the baby is born, but if a woman has had gestational diabetes, her
risk goes up that she'll have type 2 diabetes later in life.
THINGS YOU CAN CHANGE
Being overweight If you're fatter than you should be, your
risk of getting diabetes triples. Extra pounds make it harder for
your body to use insulin well. In fact, three in four people with
type 2 diabetes weigh more than they should anyway for good health.
If you already have diabetes, you'll find it harder to keep your
insulin and blood sugar levels in balance if you're also overweight.
Worse, being overweight further raises your already high risk of
other problems linked to diabetes, such as heart disease and stroke.
Diet What you eat plays a big role in your risk of getting
type 2 diabetes. It can also raise your risk of problems such as
heart disease if you already have diabetes. Those risks climb if
you eat too much fat-in foods such as red meat and whole dairy products-and
not enough whole grains, fruits, and vegetables.
Lack of exercise If you don't get much exercise, you're more
likely to get type 2 diabetes than more active men and women. Experts
aren't sure how exercise works, but it appears that staying active
helps insulin unlock cell walls so glucose can get in. If you already
have diabetes, lack of exercise can be very dangerous. It makes
controlling your blood sugar and insulin levels much harder. Lack
of activity also raises your risk of heart disease and other problems
diabetes can cause.
Stress Your natural response to stress causes many changes
in your body, including a short-term rise in blood sugar levels.
The kind of stress we all run into at home and at work is no big
deal, and it's clear that stress does not cause diabetes. If you
already have diabetes, though, stress can make it harder to control.
WHAT YOU CAN DO FOR YOURSELF (see
type 1)
WHAT YOUR DOCTOR CAN DO FOR YOU
Many people keep their type 2 diabetes in check with just diet changes,
weight control, and exercise. If you need more help, your doctor
may prescribe insulin shots or medication that you take by mouth.
You may take one of a class of pills called oral hypoglycemic agents
to bring down your blood sugar level. Some of these pills make the
pancreas release more insulin, which lowers the amount of sugar
in your blood. Others slow the rate at which sugar enters your blood.
There are several types: sulfonylureas, metformin, and acarbose.
Sulfonylureas These drugs make the pancreas release more
insulin. Trade names include Amaryl, Diabeta, Glucotrol, and Micronase.
You might take them once a day.
Pro: Cause few side effects in most
people.
Con: Can cause weight gain, hypoglycemia,
or upset stomach.
Metformin The trade name of this drug is Glucophage. It works
by slowing the rate at which sugar enters the bloodstream from the
liver. This helps keep blood sugar from rising too quickly and gives
the pancreas more time to release enough insulin. The number of
pills you take in a day will depend on your diet and exercise habits.
Pro: Works well to lower glucose levels
in most people.
Con: Can cause weight loss, nausea,
and diarrhea. May increase the risk of a problem called lactic acidosis,
most often for heavy drinkers or people whose kidneys don't work
well. Symptoms of acidosis include tiredness, rapid breathing, shortness
of breath, and severe weakness.
Acarbose The trade name of this drug is Precose. It works
to slow the rate at which sugar enters the bloodstream from the
intestinal tract.
Pro: Works well for people who get
high blood sugar right after eating.
Con: Can cause gas and diarrhea.
Insulin Many people with type 2 diabetes don't need insulin,
but some do. You can't take insulin in a pill because your intestines
destroy it during digestion, so if you do need insulin, you'll have
to give yourself insulin shots. There are several types of insulin.
They vary mainly by the amount of time they take to start working
and by how long each shot goes on working. Most likely you'll mix
a fast-acting type and a slower-acting one to get the effect of
both. How much you need will depend on your age, blood glucose levels,
diet, and exercise habits. Other health problems, such as a cold
or the flu, can change your insulin needs.
Pro: Helps your body use food for energy
and prevents high or low blood sugar. Helps prevent complications
of diabetes, such as eye and kidney disease. Seldom has side effects.
Con: Small risk of skin irritation
or infection at injection sites. Requires close attention to meal
planning, exercise, and other lifestyle choices. Requires regular
checks of blood sugar. May cause hypoglycemia.
Intensive Insulin Therapy
Intensive insulin therapy calls for up to four insulin injections
a day to keep blood sugar levels at normal or near-normal levels
throughout the day. The goal is to mimic as closely as possible
the function of a healthy, insulin-producing pancreas.
Pro: Researchers found that in patients
who followed this plan, eye problems fell by almost 70 percent,
nerve damage by 60 percent, and kidney damage by about 40 percent.
Con: Requires several finger pricks
throughout the day to check blood glucose levels, and tight control
of diet and exercise.
Humalog
People who use regular insulin must time their injections carefully
around their meals. A form of insulin called Humalog (insulin lispro)
makes timing easier for some. Instead of injecting 30 to 60 minutes
before eating, you can inject Humalog right before you eat or up
to fifteen minutes before. It acts quickly to lower blood glucose
levels after a meal.
Pro: Allows greater flexibility in
meal planning. Can make it easier to tightly control blood sugar
levels.
Con: If you don't eat within 15 minutes
of taking lispro, your blood sugar can drop dangerously low.
External Insulin Pump
Some people with diabetes use an insulin pump rather than insulin
injections. The pump is about the size of a pager and is worn outside
of the body. The pump has a computer chip that allows the user to
program how much insulin the machine will deliver. A clear plastic
tube from an insulin reservoir feeds insulin to the body through
a catheter in the abdominal area.
Pro: Provides some freedom from the
strict scheduling demands of traditional insulin programs. Gives
users a sense of independence and limits the number of needle sticks.
Con: Users must carefully watch their
pump for malfunctions since any error can cause blood insulin levels
to rapidly drop.
NEW DIET FINDINGS
Results from the Nurses' Health Study, an ongoing study of more
than 65,000 women, suggest that diet may be even more important
in preventing type 2 diabetes than anyone had thought. Women in
the study whose diets contained foods with lots of carbohydrates
but little fiber-"starchy" foods such as white rice, white bread,
and potatoes, for example-were two-and-a-half times more likely
to get type 2 diabetes than the women who ate these foods sparingly
and got lots of fiber from whole grain cereals and bread. Why? When
you eat lots of starchy, low-fiber foods-those with a high "glycemic
index"-your digestive system quickly breaks them down, which raises
your blood sugar level. Then your pancreas has to work extra hard
to produce enough insulin to process the rapid influx of sugar.
Researchers think that over time, this repeated load on your pancreas
can exhaust it. They suggest foods with a low glycemic index that
put less stress on your pancreas.
Some low-glycemic foods:
green beans
corn squash
tomatoes
cabbage
bell peppers
peas
lentils
beans
apples
apricots
cherries
grapefruit
grapes
oranges
pears
peaches
whole grain
breads
high-fiber breakfast cereals
brown rice
semolina pastas with durum wheat
PREVENTING LOW BLOOD SUGAR DURING EXERCISE
(see type 1)
BURNING CALORIES TEN EASY WAYS (see
heart)
LATEST DEVELOPMENTS
Focus on Syndrome X
Experts have long known that people with type 2 diabetes are much
more likely than others to have high blood pressure and high triglycerides.
Many researchers now believe that these problems and type 2 diabetes
are the result of a single underlying cause: insulin resistance.
They suspect that insulin resistance can begin to damage your health
long before it shows up as diabetes or another problem such as heart
disease. These researchers call the group of problems that result
from insulin resistance Syndrome X. The two main risk factors for
Syndrome X are lack of exercise and being overweight. That means
the best treatments for Syndrome X are regular activity and weight
loss. In fact, the American Diabetes Association recently declared
that the best "drug" for insulin resistance is exercise. If the
researchers are correct about the role of insulin resistance in
heart disease, it could mean that the best way to knock down such
things as high blood pressure or high cholesterol is to treat insulin
resistance with lifestyle changes and perhaps medication. They suggest
that anyone at risk for cardiovascular disease or diabetes should
have blood tests to check for high blood sugar.
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