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How can you stop worrying about complications of diabetes? In my practice as a diabetes educator, some people are almost paralyzed by the fear of developing diabetes complications.

Many of you have had diabetes a long time and are from an era when we didn’t have as many tools, treatments, and the understanding of diabetes that we have today. Education concerning the reduction of modifiable risk factors for the chronic complications of diabetes is an essential goal of diabetes education self-management training today.

You need information about risk factors to make informed decisions in your diabetes care and prevent or reduce complications. Studies such as the Diabetes Control and Complications Trial demonstrate that these complications aren’t inevitable.

Fear of diabetes complications manifests itself in obsessive compulsive behaviors in some people with diabetes. Some examples:

• Constant worrying
• Blood glucose monitoring 20 plus times per day
• Frequent and over correction of blood glucoses and tolerating frequent episodes of low blood glucose
• In severe cases, strained family relations and job loss

Where is the happy medium? It’s so hard to find, but knowing you have good care and control can put a lot of fears to rest.

some risk factors and possible treatment strategies for hypoglycemia unawareness.

 

Risk factors

Long-standing type 1 diabetes. Reduced awareness of hypoglycemia is common among people who have long-standing insulin-dependent diabetes. Many of those who’ve had diagnosed diabetes for 15 to 20 years report having lost their ability to perceive low blood glucoses and to often failing to treat and prevent severe hypoglycemia.

 

Severe hypoglycemia is an episode in which the person with diabetes is unable to treat him or herself and needs the assistance of another person. This includes prompting by a relative or friend to drink juice or eat.

 

Being an older adult and having type 2 diabetes. There also have been an increasing number of hypoglycemia unawareness episodes in those with type 2 diabetes; adults older than 65 seem to be most at risk.

 

Treatment options

 

Strict avoidance of hypoglycemia. Strict avoidance of hypoglycemia for several weeks to months can restore at least partial awareness of warning symptoms. Strategies for avoiding hypoglycemia when you have hypoglycemia unawareness or don’t experience the warning symptoms include:

 

• Aim for a higher blood glucose target
• Try to more accurately count carbohydrates
• Avoid overcorrection or stacking of insulin doses
• Test your blood glucose and adjust your insulin dose more frequently
• Consider blood glucose awareness training education programs to help you learn to identify new symptoms and improve recognition
• Consider a personal continuous glucose monitor (CGM) that sounds an alarm when your glucose gets too low
• Consider a service dog that can recognize low blood glucose

A recent study in “Diabetes Care” looks at the decisions you make about whether to drive or not while having low blood glucose. Driving with severe hypoglycemia (low blood glucose) may impair driving performance and increase your chances of getting a traffic ticket or having an accident.

People with type 1 diabetes and normal awareness or poor awareness of low blood glucose, and people with type 2 diabetes with normal awareness of low blood glucose participated. Some of the type 2 people were on insulin and others on diabetes pills that could cause low blood glucose.

In general, those with type 1 diabetes and normal awareness appeared to make safe decisions about driving with low blood glucose, those with type 1 diabetes and poor awareness of low blood glucose levels often made the decision to drive when they shouldn’t.

Those with type 2 diabetes and normal awareness often made potentially dangerous decisions about driving and low blood glucose.  In the type 2 group, participants were older and many were on oral diabetes medication only.

The study shows that if you have diabetes, you aren’t always so good at determining whether you should drive while having low blood glucose prior to or during driving.

What should you do? Test your blood glucose prior to driving, especially if you have poor awareness of low blood glucose. If it is below 100 mg/dl or 5.5 mmol/L, eat carbohydrates and don’t drive until the blood glucose is above 100 mg/dl or 5.5 mmol/L. If the drive will be a long distance, check your blood glucose every 2 hours.

Diabetes management is serious business, but every once in a while, you need a good laugh. You’ve probably heard the saying, “Laughter is the best medicine.”

After a hearty laugh, have you noticed how good you feel? We feel more focused, alert and relaxed. Several research studies demonstrate that humor relieves stress and tension, decreases pain and often diffuses conflict. Humor reduces stress hormones and increases immune cells and infection-fighting antibodies. You feel good after laughing because laughter releases endorphins, the “feel-good hormones” that promote an overall sense of well-being and help relieve pain.

Uncontrolled diabetes can control your health. Help prevent these serious diabetes complications by learning the warning signs.

People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check — that means maintaining good blood sugar control — and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes.

Heart Attack

Heart disease and stroke are the top causes of death and disability in people with diabetes. If you experience any of the following heart attack warning signs, call doctor immediately:

Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning

Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms

Shortness of breath

Nausea or lightheadedness

Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort.

Stroke

Stroke warning signs may include:

Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body

Feeling confused

Difficulty walking and talking and lacking coordination

Developing a severe headache for no apparent reason

If you suddenly experience any of these stroke symptoms, call doctor immediately. As with a heart attack, immediate treatment can be the difference between life and death.

Nerve Damage

People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. As a result, various foot and skin problems can occur, including:

Foot problems. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don’t feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb.

Skin problems. Diabetes can make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even the most minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.

If you notice any of the following symptoms, see your doctor:

Inflammation and tenderness anywhere on your body

Red, itchy rash surrounded by small blisters or scales

Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect

Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes

Sharp pain that gets worse at night

Muscle weakness that makes walking difficult

Bladder infections and problems with bladder control

Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea

Erectile dysfunction in men and vaginal dryness in women

Kidney Disease

Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.

Typically, you won’t notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:

Swelling in your ankles and legs

Leg cramps

A need to go to the bathroom more often at night

A reduction in your need for insulin

Nausea and vomiting

Weakness and paleness

Itching

The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.

Eye Problems

People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.

Call your doctor if you notice any of these warning signs:

Blurry vision that lasts for more than two days

Sudden loss of vision in one or both eyes

Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes

A sensation of seeing “flashing lights”

Pain or pressure in one or both eyes

Hyperglycemia

Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn’t always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include:

Frequent urination

Extreme thirst

Feeling tired and weak

Blurry vision Feeling hungry even after eating

If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.

The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don’t smoke.

Report any unusual signs or symptoms to your doctor. Together you can work to prevent these diabetes-related health complications.

 

In order to know what insulin resistance is, we must first understand insulin. It is a hormone that is produced in the pancreas to regulate the level of glucose in the blood. Glucose is a simple sugar which our body uses for energy. The glucose is delivered from the foods we eat. So the more we eat, the more insulin our body needs to counter the glucose in the bloodstream. Most of the work provided by insulin is to metabolize carbohydrates (sugar & starches), lipids (fats), and proteins.

In other words, it remove other by-products of food from the body by stimulating fat cells to form fats from fatty acids. It uses the kidney and liver cells to turn amino acids into proteins. Insulin also keep the liver and kidneys from making glucose from partially-metabolized material. This is important because that can damage those body organs over a period time.

Insulin resistance is a condition where the body cells just don’t use insulin correctly. Many people suffer from this because their fat, muscle, and liver cells fail to use the insulin efficiently. If the pancreas delivers short on its production of insulin to help glucose enter the cells, then the bloodstream builds an excess of glucose. This condition increases the risk of developing pre diabetes, type 2 diabetes, and cardiovascular disease.

Causes of insulin resistance
Insulin resistance precedes the development of type 2 diabetes. People may have insulin resistance or pre diabetes for years and not even know it. In some cases, both may appear simultaneously. Symptoms usually are nonexisting unless your doctor performs test to determine otherwise. There are several causes that include the following:

• §genetic factors
• §overweight (obesity)
• §lack of physical activity
• §stress
• §metabolic syndrome
• §pregnancy
• §steroid use
• §illness or infection

You are more than likely to develop a resistance to insulin if you are overweight and have a body mass index (BMI) of 25 or above. Other causes or risk factors that increases your chances include high blood pressure, a low count of HDL cholesterol, being 40 or older, previously having gestational diabetes, and close family members with type 2 diabetes.

Conditions associated with insulin resistance
At this point, it goes without saying that pre diabetes and type 2 diabetes are closely associated with insulin resistance. Yet, there are other conditions that may be caused by or is a result of having this problem. Below is a listing of medical conditions that bear this out.

• §Fatty Liver

It can be a mild or severe case. Fat accumulation in the liver is the result of out of control lipids (fats)

• §arteriosclerosis

The continous thickening and hardening of artery walls, usually medium and large arteries. It is likely to cause coronary artery disease (heart attacks) and strokes.

• §Abnormal growth

Actual linear growth and a coarsening of features can be noticed

• §Skin Lesions

Skin tags and/or acanthosis nigricans

• §PCOS

PolyCystic Ovarian Syndrome, a hormonal problem usually affecting young women

Diagnosing insulin resistance
You may think that blood test administered for pre diabetes is also testing for insulin resistance. However, this is not always the case. It can be checked by measuring blood levels, but a more refined and reliable test is known as the “euglycemic clamp”. In a nutshell, it measures the quantity of glucose needed to make up for greater than normal insulin levels without leading to hypoglycemia in a patient. The testing procedure generally takes about two hours to complete. It is an expensive procedure and a bit complex, which is why it isn’t commonly done at small doctor offices. In fact, it is mostly used for research purposes.

While there are genetic factors that play in the likelihood of you becoming insulin resistant, it can be avoided or managed through a healthy lifestyle. Regular exercise and a good diet can do this alone. However, medication is an option to include if diet and exercise doesn’t work.

Prolonged high blood glucose levels can cause gum disease (periodontal disease) and other dental problems. How? The buildup of sugar in your blood glucose can settle into your teeth and gums just as if you directly ate a sugary treat and did not brush afterward. Good oral care, along with keeping your blood sugars in check, is important to keep your mouth healthy.

Like you, I read articles all the time on the Internet such as: “The Top 5 Fruits Diabetic Should Never Eat,” “Can a Diabetic Eat Fruit?” or “Eat Low Carb Fruit. “These headlines are misleading information that annoys diabetes educators. The implication here is –fruit is not good. Fruit is all carbohydrate, so the difference in their carbohydrate content is the amount you eat! If a fruit is dried (reduced in water content), then its carbohydrate is concentrated. For example 17 small grapes equal two tablespoons of raisins.

Fruit is a welcomed part of a healthy diet for anyone, and also a person with diabetes. Fruit provides vitamins, minerals, fiber, and antioxidants. Fruits are all carbohydrate, and tend to have a low GI index because of the fructose and fiber content. Fructose is slower to convert to blood sugar than sucrose, and the fiber in fruit delays digestion even more.

But let’s talk about portions. The Exchange Lists were designed to define a portion of fruit to provide 15 grams of carbohydrate, and about 60 calories. So if you ate 1 cup of cubed cantaloupe or 12 sweet fresh cherries, or ½ cup of mango or ¾ cup of blueberries, you would consume 15 grams of carbohydrate. If you doubled the serving, you would be consuming 30 grams of carbohydrate. Fruit juices are sparingly recommended—1/2 cup of apple juice, or orange juice, and 1/3 cup of grape juice or prune juice is 15 grams of carbohydrate.

The ripeness and variety of a singular piece of fruit may actually be higher or lower in carbohydrate, and thus have a less predictable effect on your blood sugar. If you are fond of certain fruit, consider testing your blood sugar before and after a measured amount to get a personal picture of the glycemic effect.

Lastly, pay attention to the serving sizes, and you will notice that the watery fruit you can have more often than the dense fruit for 15 grams.

So the next time someone tells you that you can’t eat a banana because you are diabetic, remember that all fruit is fine in measured amounts. A banana is two fruit servings, or roughly 30 grams of carbohydrate. Eat a balanced diet, and don’t load up on lots of fruit at one sitting!