Hypoglycemia – Low Blood Glucose (Blood Sugar): American Diabetes Association®

Treat hypoglycemia (sometimes called an insulin reaction) as soon as possible. Untreated, hypoglycemia can cause a seizure or unconsciousness. See the article below for more information.

Source: Hypoglycemia – Low Blood Glucose (Blood Sugar): American Diabetes Association®

Products that help with hypoglycemia are called glucose tablets. You can purchase them here on Amazon.com. They work faster than any other food or drink. Keep them on you at all times. Hypoglycemia isn’t anything to mess with.

Pregnancy and Gestational Diabetes

What is Gestational Diabetes?

Gestational diabetes is the most common medical condition complicating pregnancy today. 5% of pregnancies in England, 25% of pregnancies in Asia, and 4% of pregnancies in the United States have complications with gestational diabetes (Stewart, 2014) (Chasan-Taber, 2012). In the United States alone that’s about 200,000 cases annually (Chasan-Taber, 2012). Two-thirds of women with type 2 diabetes had gestational diabetes when pregnant (Chasan-Taber, 2012).

The World Health Organization (WHO) defines gestational diabetes as “carbohydrate intolerance resulting in hyperglycemia of variable severity with onset or first recognition during pregnancy” (Hunt, 2014). What this means is that a woman who typically have normal glucose tolerance lack the insulin in their third or fourth trimester for both her and the child living inside her. During the third and fourth trimester, both mother and child have an increased demand for insulin. Most women have a pancreas that can handled the need to increase natural insulin. Those that can’t have hyperglycemia (high glucose levels in their blood).

What causes gestational diabetes?

According to Buchanan, et al (2012) there are three reasons women have gestational diabetes.

  1. Less than 10% of women have immune markers that point to type 1 diabetes but did not develop type 1.
  2. About 5% have a genetic disposition to type 2 diabetes.
  3. Last and most prevalent is due to obesity and chronic insulin resistance.

Care for the mother after the birth of a baby is dependent on which of the three reasons gestational diabetes occurred. Your doctor will know what direction to take. Follow his guidelines.

What are the risks for women with gestational diabetes?

Below are risks to women who have gestational diabetes. This does not mean women with gestational diabetes will have issues such as these. But they are at a higher risk and research shows there is a tendency for some of these issues to occur.

  • Women with gestational diabetes are at a high risk of developing diabetes later in life.
    • 10% develop diabetes soon after pregnancy.
    • 20% – 60% develop diabetes within 5 – 10 years after delivery (if specific interventions are not taken to reduce the risk of diabetes). Research shows that not all women will get diabetes but the majority will.
  • Other risks are due to complications with having diabetes. I will not go into this in this article, I have written other articles that provide those risks.

What are the risks to offspring?

There are several risks to the unborn baby even after birth.

  • Increased risk of obesity during childhood and adolescents.
  • Gestational diabetes can influence fetal development.
  • Higher risk of spontaneous abortions and congenital anomalies.
  • Excessive fetal growth.
  • Neonatal hypoglycemia (low blood glucose).
  • Polycythemia (increased concentration of hemoglobin in the blood)

What if I have gestational diabetes?

  1. Most OB/GYN specialists test for gestational diabetes early and throughout pregnancy. This is important for the welfare of the baby. Following your doctor’s advice on care if you have developed gestational diabetes is critical.
  2. Make sure your doctor also refers you to a dietician to help you get the nutrients you and your child need.
  3. Your doctor should provide you with a glucose meter. Use it often. Check your glucose first thing in the morning, one hour after each meal and at bedtime. Write down the date & time, and the glucose level and share it with your doctor.
  4. There is research stating that insulin(injection), if needed, is better than MetFORmin(pill) because insulin does not cross the placenta and MetFORmin does. Check with your doctor.

What Next?

If you have or had gestational diabetes, eat healthy. Exercise. If you are overweight, loose the weight. Being overweight adds to the risk of type 2 diabetes. Make sure your child does the same. If you can prolong or keep from getting diabetes the better off you and your child are. If you have questions or comments, please let me know.

References:

Stewart, Z.A. (2014). Gestational Diabetes. Medicine, 43(1), 44-77. Doi:10.1016/mpmed.2014.10.010

Hunt, K.F. (2014). Gestational Diabetes. Obstetrics, Gynaecology and Reproductive Medicine, 24(8), 238-244. Doi:10.1016/j.ogrm.2014.05.005

ScD, Chasan-Taber, L. (2012). Gestational Diabetes, Is It Preventable?. American Journal of Lifestyle Medicine, 6(5), 395-406. Doi:10.1177/1559827611434401

Buchanan, T. A., Xiang, A. H., & Page, K. A. (2012). Gestational diabetes mellitus: Risks and management during and after pregnancy. Nature Reviews Endocrinology, 8(11), 639-649. doi:http://dx.doi.org/10.1038/nrendo.2012.96

Do I have Prediabetes?

Prediabetes occurs before the onset of diabetes and can be diagnosed by your physician in two ways. One way is called an A1C test. This is a blood test to determine the amount of glucose surrounding the red blood cells for the last three months. Normal A1c is below 5.7%. the nice thing about this test is that it does not require fasting. So, your physician can typically know very quickly the results of the test. The other way of knowing if you have prediabetes is called a glucose tolerance test. In this test your glucose level is checked before eating. You are then given a glucose drink and checked two hours after you drink it. Prediabetes has a fasting blood glucose level between 100 – 125 and an A1C between 5.7% – 6.4%.

According to the World Health Organization, having prediabetes does not mean it will develop into full type 2 diabetes. In many cases, it does not. As a matter of fact, people diagnosed with prediabetes and made lifestyle modifications have a 40% to 70% risk reduction of developing type 2 diabetes later (Tabak, 2012). But 70% of people with prediabetes eventually develop type 2 diabetes because they do not make the necessary changes to diet and exercise.

There are other risk factors associated with prediabetes besides developing type 2 diabetes. I am not saying that if you have prediabetes you will have these issues. Only that studies have linked prediabetes to them. So, don’t panic. Just be concerned. It takes time for many of the issues to take place. I just want you to be aware that going unchecked or doing nothing about prediabetes can have its complications.

  • Compared with someone who has normal glucose levels, prediabetes is associated with Microangiopathy (a disease affecting the small blood vessels in the body) with more advanced Atherosclerotic Vascular Damage (where the arteries become narrowed and hardened due to buildup of plaque around the artery wall) more so than someone who does not develop prediabetes.
  • It has also been linked to vascular disease and higher risk of coronary heart disease.
  • There is also risk of periodontal disease (disease that causes destruction of the supporting structures of the teeth).
  • Cognitive dysfunction.
  • Neuropathy (a disease of the peripheral nerves causing numbness, weakness and pain).
  • Retinopathy (disease of the retina resulting in impaired or loss of vision).
  • Kidney disease.
  • Changes in blood pressure.
  • Sleep apnea and sleep disorders.
  • Liver disease

If you have prediabetes here are a few steps to follow that can decrease the onset of type 2 diabetes and in some cases, reverse prediabetes all together. Of course, always check with you physician and or dietician for your specific dietary needs.

  1. Increase your vegetable and fiber intake in your daily diet.
  2. Decrease processed foods in your diet. This is not only healthier, most processed foods are high in carbohydrates. Keep this to a minimum.
  3. Begin an exercise routine. Exercise is proven to be a major factor in preventing diabetes and lowering your glucose level.
  4. Talk to your doctor about prescribing Metformin. This prescription drug lowers the risk of type 2 diabetes by 45% and has no serious adverse side effects.

Control your prediabetes. Do not let it control you. Do what you can to prevent the onset of diabetes because once you have it you will find controlling your glucose level is not easy to do. It takes a lot of work.

References:

Found March 17, 2017 on the World Wide Web at https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis/a1c-test.

Burson, Rosanne DNP, ACNS-BC, CDE; Moran, Katherine DNP, RN, CDE, Prediabetes, (May 2014), Home Healthcare Nurse, Retrieved from http://ovidsp.tx.ovid.com.contentproxy.phoenix.edu.

Dr Adam G Tabák, MD, Christian Herder, PhD, Wolfgang Rathmann, MD, Eric J Brunner, PhD, Prof Mika Kivimäki, PhD, Prediabetes: a high-risk state for diabetes development, (June 2012), The Lancit, 379 (9833).

Martin Buysschaert, Jose´ Luı´s Medina, Michael Bergman, Avni Shah & Jaqueline Lonier (March, 2015). Endocrine. 48(2). Found on the World Wide Web at http://web.b.ebscohost.com.contentproxy.phoenix.edu/ehost/pdfviewer/pdfviewer?sid=95a42c83-0128-403a-9c6c-4110f3d469d7%40sessionmgr102&vid=1&hid=124

 

Type 2 Diabetes and alcohol. Is it Safe for me to Drink?

I get a lot of questions about drinking alcoholic beverages and type 2 diabetes. I want to first begin with what research shows, then I will end with my own experiences. If you have any type of diabetes you and your doctor need to decide if drinking is something you should be doing.

Research

According to a study published in Revista panamericana de salud pública (2012) found that the risk of diabetes is higher for people who are heavy drinkers and for people who abstain from alcohol altogether versus people who are light drinkers. That’s right. If you only drink one to two drinks per day and no more than 14 drinks per week you are less likely to have diabetes than those who drink more than that or do not drink at all. The study does state, though, “the empirical evidence is not extensive, and the studies are not usually well controlled (e.g., there is no separation between lifetime abstention and former drinkers, and no control for volume when the effects of binges are assessed)” (Babor, et all,  2012). The study also states that measures are often inconsistent and do not take into consideration other health issues. So that this with a grain of salt.

This study also found that heavy drinkers do not typically take their medications or follow prescribed therapies. It is recommended that health care professional routinely ask patients who have diabetes about their drinking habits. Whether patients will be truthful or not is under debate. Many patients consistently lie about self-managed health practices.

Why would non-drinkers be at a higher risk for diabetes than moderate drinkers? Because alcohol (other than beers) lowers blood-sugar levels. Of course, this depends on the mixers you use with liquor. It stands to be cautious. If you are taking insulin your glucose level could become dangerously low (hypoglycemia).

Healthline.com states, “People with diabetes should be particularly cautious when it comes to drinking alcohol because alcohol can make some of the complications of diabetes worse. For starters, alcohol impacts the liver in doing its job of regulating blood sugar. Alcohol can also interact with some medications that are prescribed to people with diabetes. Even if you only rarely drink alcohol, talk with your healthcare provider about it so that he or she knows which medications are best for you.”

Here’s my take:

When I talked to my doctor and then my dietician about alcohol consumption both told me a drink now and then was okay but it depends on what you drink. Beer has a lot of carbohydrates so it will increase your glucose levels. Even light beer has carbs in them. White wine and sweet wines have carbohydrates but dry, red wines (Pinot Noir, Merlot, Cabernet, etc.) do not have carbs. Whiskey’s have not carbohydrates but rum does. And if you are mixing liquor with fruit juice or cola, then there are carbs associated with what you are mixing it will.

So I did my own test because I like a drink every once in awhile and if I had to cut it out of my diet that was fine but frankly, if I can have a drink once in awhile that is great too. Here is what I found related to my diabetes and health. Let me first state that I do not have any other health issues. My heart, lungs, kidneys and all other organs are fine. I exercise and I diet and control my glucose level. I am also rarely sick.

I checked my glucose level and it was normal. I drank two beer (12 oz. bottle of an IPA) and checked my glucose level about two hours later. My glucose level was at 250. So beer for me was not a good idea. Sometime later (not that day) I had a glass of pinot noir because that is the wine I really like. Again, my glucose level was normal and I had to glasses mainly because it is so good one is not enough. I checked my glucose level two hours later and it did not go up. So, for me, red, dry wine is fine. Sometime later one evening I decided to have 4oz. of whiskey on ice (I sipped it slowly. I didn’t chug it!). Again, my glucose level was normal when I started and normal two hour later. Then I went to bed. About 2:00AM I woke up shaking, sweating and my heart was pounding. My glucose level was at 45! Way too low.

 

So, I know I must be careful. Whiskey can dangerously lower my glucose level. What if I had not woken up? That scared me.

When drinking alcohol;

  • Talk to your physician first! See how your medication reacts to alcohol. Most medications for diabetes recommend no alcohol while taking the drug. Your doctor will know how alcohol reacts to your medication and also knows all your health issues.
  • If you and your doctor are okay with having a drink, do what I did. Test your body’s reaction first. If you are on insulin, have it handy in case your glucose level goes up. And have sugar pills handy in case it goes down.
  • Drink moderately. Don’t binge drink and don’t overdo it.
  • IF YOU HAVE LIVER OR KIDNEY PROBLEMS, alcohol will worsen these issues.

 

I am not recommending that you drink. I do drink occasionally. Not every day and I do not get intoxicated. It scares me to think what would happen if I became intoxicated, passed out and then my glucose level drops and I don’t wake up. Diabetes is a serious disease and should not be taken lightly. If your doctor says you shouldn’t drink then… don’t drink.

Live long and prosper (Spock, 1967).

References:

Babor T, Rehm J, Jernigan D, Vaeth P, Monteiro M, Lehman H. Alcohol, diabetes, and public health in the Americas. Rev Panam Salud Publica. 2012;32(2):151–5.

Healthline.com (2016). http://www.healthline.com/health/type-2-diabetes/facts-diabetes-alcohol

Diabetes and the Eyes

The National Eye Institute defines Diabetic Eye Disease as two conditions that affect the eyes of people with diabetes. both are defined below.

  • Diabetic Retinopathy – This is caused by high blood sugar that damages tiny blood vessels in the retina. The retina’s job is to detect light and send signals through the optic nerve to the brain. High blood sugar damages the blood vessels causing hemorrhaging (bleeding) which blurs vision. If gone unchecked new, abnormal blood vessels form on the retina and can lead to scarring and loss in the retina.
  • Diabetic Macular Edema (DME) – the Macula (part of the Retina) provides sharp, straight-ahead vision that is used for reading, recognition, and driving. When this is damaged due to high blood glucose, fluid builds up in the Macula, causing vision loss. About half of the people with diabetes have this problem.

What are the symptoms of Diabetic Retinopathy and DME?

There are no symptoms of either disease other than blurred or loss of vision. If not treated immediately, the risk of permanent loss of vision increases greatly.

How can the disease be detected?

Your eye doctor can perform a series of tests to determine whether someone with diabetes has Diabetic Retinopathy or DME (see the National Eye Institute website for more detailed information on tests). The results of the tests can determine changes in blood vessels, leaking, swelling, changes in the lens, and damage to the nerve tissue.

What can you do to prevent Diabetic Retinopathy?

Damage to the eyes due to diabetes can sometimes be reversed if caught early and reduce the risk of blindness by 95 percent. People with diabetes can prevent eye damage by doing two things:

  1. Control your diabetes. Controlling glucose levels slows the onset of Diabetic Retinopathy. Research shows that people who keep glucose levels close to normal are less likely to develop this disease.
  2. See your eye doctor two to three times a year. Early detection means there is a better chance of prevention. Only your eye doctor can determine through examination if you have Diabetic Retinopathy or DME.

 

For more information go to https://nei.nih.gov/health/diabetic/retinopathy.

 

 

Hiking with Diabetes – 7 Steps to Ensure a Great Experience

When I was in my early 20s a friend of mine told me he was going backpacking in the Jefferson Wilderness Area located in Oregon and asked if I would like to go. The trail he was hiking would lead to Marion Lake, not far from Mount Jefferson. Living in Salem Oregon at the time and only a two-hour drive, I accepted. I had never backpacked before but it all sounded fun. I borrowed a backpack from a neighbor and filled it up with camping gear. I had the time of my life! Later I would head into the Jefferson Wilderness Area, hiking the Pacific Crest Trail, and camping several nights under the star filled sky listening only to the slight breeze and small animals that walked around at night searching for a meal. I had the best times of my life there. I even took my children hiking and camping as early as 5 years old. But mostly I went by myself.

Ten years later I found out I had diabetes and I was told that I could no longer hike several days because it was hard to manage my glucose level. If something went wrong I could die. Which can be true if you are not very careful. That did not stop me. I CONTROL MY DIABETES. IT DOESN’T CONTROL ME. At 54 years old, I still backpack and I still love doing it. If you have diabetes and you love the outdoors like I do, here are a few things you should do to make sure your visit is worry free.

1.     I must keep my insulin cold. Instead of taking freezer packs with me that are heave and eventually thaw out, I use Frio Cooling Products. These work great when you are gone for several days and need to keep your insulin cold. I use them all the time.

2.     Always, always take candy, trail mix, and or a powdered sugar supplement you add to water with you. Hiking burns a lot of carbohydrates. Even if you have diabetes and are not on insulin you can get hypoglycemia (low blood sugar). Take plenty with you. There have been many times I have needed it. If you are hiking in the wilderness there isn’t anyone to help you if you pass out due to hypoglycemia.

3.     Test your glucose level often. Every one-to-two hours. If it starts to get low, eat something.

4.     Don’t over eat! Sometimes when we are burning carbohydrates we tend to over eat. Yes, you will need to eat more because you are burning more. But overeating isn’t good either.  Again, test often. Keep you glucose level as close to normal as you can.

5.     Let your doctor know you are hiking. He can give you medical advise tailored to your health.

6.     If you hike alone (and I do) let someone close to you know when you are leaving, where you are going, and when you will return. I give my wife a map and highlight the trails I will be on. She drops me off and picks me up. There is rarely cell phone service so far away from civilization. Someone needs to know when to call for help and know where you are hiking so someone can find you in case everything goes wrong. Which leads me to my last point…

7.     When I give my wife a map highlighting the trails I will be hiking, I do not stray from those trails. If something goes wrong my wife and emergency personnel need to know where to find me. If I stray from my original plan, I may wind up dead and no one will know where I am.

I love hiking. I love the wilderness. Being careful and following these steps is the difference between a great backpacking trip and a dangerous one. Be safe. Hiking with diabetes isn’t for everyone. If you like to hike it is not over if you develop diabetes. It just means you have to be better prepared and more cautious.

Diabetes and Teeth – 4 Steps in Preventing Disease

In a study done in 2011 only 58 percent of people diagnosed with diabetes visit a dentist regularly (Elangovan, et al, 2014). This presents a problem because complications from having diabetes is one of the worst issues related to gum and teeth decay. According to Phillips, et al (2008) here are some of the issues with your teeth and gums related to diabetes:

  • After age 40 vascular disease begins to accelerate, affecting the fine vessels that supply your teeth as well as the rest of your body.
  • Lack of saliva due to high glucose levels prevents the washing away of debris and bacteria, causing dry mouth and disease.
  • High glucose levels also cause your immune system to weaken which also prevents your body to fight mouth disease and cause caries, periodontal disease, and dental and periodontal destruction and infection.

Going unchecked, these issues can require root canals, tooth extractions, and urgent surgical extraction of pus.

Diseases described above are very preventable is you see a dentist regularly, and brush and floss often. Going unchecked can cause inflammation with then causes the gums to deteriorate. And if you think tooth loss is just cosmetic, think again. In diabetes, tooth loss means you cannot eat harder fruits and vegetables. That means eating softer food that generally are not good for controlling glucose levels.

Below are a few steps you can take to prevent gum disease and tooth loss.

  1. If you are not seeing a dentist, make an appointment now. Because the development of poor gums and teeth is gradual catching issues early will prevent a lot of headache later. Don’t procrastinate!
  2. Once you have seen a dentist he will set up a schedule for you to have your teeth cleaned and checked. A hygienist cleans my teeth, takes x-rays, and tests my gums for deterioration. Then the dentist reviews the results and takes a good look at my gums and teeth.
  3. Don’t miss the appointments. I see my dentist twice a year and that seems to be working for me. But don’t be surprised if your dentist wants to see you more than that.
  4. Make sure your dentist sends your results to your physician. Your physician can go over the results with you to help you control your diabetes.

 

References:

Phillips, Patrick J, MBBS, MA(Oxon),F.R.A.C.P., M.R.A.C.M.A., & Bartold, Mark, BDS, BDSDent(Hons),PhD., D.D.Sc,. (2008). Dental problems in diabetes: Add a dentist to the diabetes team. Australian Family Physician, 37(7), 537-9. Retrieved from https://search.proquest.com/docview/216308684?accountid=458

Satheesh Elangovan, BDS, ScD, DMSc, Ruth Hertzman-Miller, MD, MPH, Nadeem Karimbux, DMD, MMSc, and Donald Giddon, DMD, PhD, (2014). A Framework for Physician-Dentist Collaboration in Diabetes and Periodontitis. Practical Pointers, 32(4), 188-192. Retrieved from https://search.proquest.com