Diabetes Care

Diabetes is a disease in which a blood sugar called glucose, the body's main source of fuel for energy, builds up to unhealthy levels in the blood.

Diabetes is caused by the body's failure to make or properly use insulin, a hormone produced in the pancreas, which helps the body's cells take in blood sugar.

The three most common forms of diabetes are:

Type 1 (or "juvenile") diabetes happens when the body's disease-fighting immune system mistakenly begins to attack the cells that produce and release insulin. As these cells die, high levels of blood sugar build up in the blood.
Type 2 diabetes is the most common form of diabetes, accounting for 90% to 95% of diabetes cases. The body needs insulin to let blood sugar into cells for energy conversion or storage. When cells do not respond properly to insulin (insulin resistance) or the body does not produce enough insulin, sugar levels in the bloodstream rise, resulting in type 2 diabetes.
Pregnancy-related (or "gestational") diabetes occurs in some expectant mothers. When found early in a pregnancy (during the first trimester), it's likely to be either type 1 or type 2 diabetes that was already present, but made worse by the pregnancy. Diabetes that develops during the later trimesters is likely to go away after the pregnancy ends, although women who get diabetes temporarily during pregnancy are more likely to develop the disease permanently later on.

who gets diabetes?

More than 11 million Americans have been diagnosed with type 2 diabetes. And, since the symptoms often appear gradually, nearly 6 million more have this condition and don't even know it.

Several factors make it more likely that a person will develop diabetes. Some of these risk factors can be controlled and some can't.

Controllable risk factors:

Obesity. You're at a higher risk for type 2 diabetes if you're 20% or more above your healthiest body weight.
Lack of physical activity. A "couch potato" lifestyle can lead to unhealthy blood sugar levels.
High blood pressure and/or high cholesterol. Either or both of these conditions make you more prone to type 2 diabetes.

Uncontrollable risk factors:

Family history. Your risk is higher if you have an immediate family member with diabetes.
Gestational diabetes or delivering a baby more than 9 pounds. Women who had diabetes during pregnancy or had a large baby are at greater risk for developing diabetes later.
Age. Type 2 diabetes is more common in people over age 40, but it's increasing among younger people and children due to poor diet and lack of activity.
Ethnic group. African Americans, Hispanics, Native Americans, and Asian Americans are more likely than Caucasians to develop diabetes.

The more risk factors you have, the likelier it is that you will develop type 2 diabetes. But most cases can be linked to two things that can be controlled-too much weight and too little physical activity.

symptoms of diabetes

Many people with type 2 diabetes never show any symptoms fore they're diagnosed. If there are symptoms, they may develop very gradually.

The most common symptoms of type 2 diabetes are:

Frequent urination
Excessive thirst
Unusual weight loss
Extreme hunger
Blurry vision

Symptoms may also include:

Tingling or numbness in the hands or feet
Fatigue
Very dry skin
Sores that are slow to heal
Repeated or long-lasting infections

Individually, these symptoms might not seem important. But the sooner you address the high blood sugar levels that use them, the better your chances are of preventing implications later on.

when to call your doctor

Low Blood Sugar
Even when you're doing your best to control your diabetes, your blood sugar can get too low (hypoglycemia) or too high (hyperglycemia); these are reasons to call your doctor right away.

This can occur when you eat too little or not frequently enough, exercise more than usual, take too much diabetes medicine, or drink alcohol. Symptoms include pale skin, sweating, fast heartbeat, shakiness, headache, and confusion. If you feel these symptoms, test your blood sugar. If it's low, eat or drink something sugary, such as glucose tablets, hard candy, or fruit juice.

Call your doctor if you have more than one unexplained episode in a week or if you faint.

High Blood Sugar
This can lead to two potentially life-threatening conditions: Hyperosmolar hyperglycemic state (HHS) can occur when you're sick or stressed and the body becomes dehydrated. Symptoms include extreme thirst, frequent urination, headache, weakness, drowsiness, restlessness, and an inability to speak.

Test your blood sugar if symptoms appear. If you have HHS, your level could be 600 mg/dL or more. Call your doctor immediately.

Ketoacidosis occurs when acids called ketones build up in your blood. It happens mostly in people with type 1 diabetes. The symptoms come on slowly, and include dry mouth, thirst, blurred vision, nausea, stomach pain, and frequent urination.

If you develop these symptoms, test your blood sugar. If it's over 300 mg/dL two days in a row, call your doctor.

Goals for Blood Glucose Control

Time of Check	Goal plasma blood glucose ranges for the non-diabetic	Goal plasma blood glucose ranges for people with diabetes
Before Breakfast (fasting)	< 110	90 - 130
Before lunch, supper and snack	< 110	90 - 130
Two hours after meals	< 140	< 160
Bedtime	< 120	110 - 150
Ale (also called Glycosylated hemoglobin Alc, HbAlc or glycohemoglobin Alc)	< 6%	<7%

< = less than
> = greater than

Helping Yourself

There's one simple secret to keeping your blood sugar in check no matter what your day brings: Be prepared.

Diabetes on the job

Talk with your doctor about what you can do during your workday to manage your condition. And be sure to:

Eat meals at the same time every day.
Follow your schedule for taking your medicines and testing your blood sugar.
Describe the signs of low blood sugar to close coworkers. You may need their help if you experience low blood sugar.
Keep sugar snacks or glucose pills in your desk in case of experiencing low blood sugar. Always carry some with you.
Tell the company nurse that you have diabetes.
Keep tabs on your stress levels. Try deep breathing and relaxation exercises, or simply step away from the office for a few minutes.

Dealing with sick days

You and your doctor should create a "sick day" plan. In general, when you're sick:

Check your blood sugar four times a day. If it's higher than 300 mg/dL, use a home test to check your urine for ketones.
Keep taking your diabetes medications.
Drink water or sugar-free drinks to stay hydrated.
Try to eat normally. If your stomach can't handle it, try items like cream soups or fruit juice bars.
Check any over-the-counter medicines for sugar. Ask your pharmacist for sugar-free options.

Call your doctor if your blood sugar stays higher than 240 mg/dL or lower than 70 mg/dL; if you've been vomiting or had diarrhea for several hours; or if your urine has high ketone levels.

Healthy Eating

Eating right can help you lower your blood sugar levels, cholesterol levels, and blood pressure. And lower blood sugar can help keep you from developing, or delay the ons t of, serious complications of type 2 diabetes.

Healthy eating is also an important step in reaching and keeping a healthy weight, something that's especially important for people with type 2 diabetes.

Go slowly

Changing your eating habits can be challenging. So make changes gradually. Start by adding fruits and vegetables, eating less meat, or fewer sweets.

You'll probably find that you need to shrink the portions of food you eat. One serving of specific food is probably smaller than you think. For example:

One serving of meat is about the size of a deck of cards
One serving of bread is one slice
One serving of pasta is about the size of a baseball

Add physical activity to your eating plan and you're on your way to a healthy weight. The most successful weight-loss plans are slow and simple: eat right and exercise and you'll lose one half to two pounds a week.

There's no such thing as a "diabetic diet." But you still may be confused about just what you can and can't have. Here's the lowdown on some common misunderstandings about various foods:

Carbohydrates. Some meal plans call for you to count grams of carbohydrates (sugar and starch). Spreading out the carbohydrates you eat throughout your day may help you manage your blood sugar.
Sugar. Most experts now say small amounts of sugar are fine, as long as they are part of your meal plan.
Alcohol. You should discuss the use of alcohol with your doctor. Many people with diabetes can have an occasional alcoholic drink-as long as it's part of their food plan.
Artificial sweeteners. These can replace sugar, but beware of high-calorie, processed foods made with sugar substitutes.

Tips for planning healthy meals

Make sure your dietitian knows your personal and cultural food preferences when coming up with your meal plan. If it includes foods that you dislike, or if something you love is left out, you're less likely to stick with it.

Eat a variety of foods. A plateful of different-colored foods will help ensure you're getting items from all the food groups. Include high-fiber choices such as fruits, vegetables and whole grains.
To control your intake of salt which can affect blood pressure, limit convenience foods and replace table salt with other seasonings.
Watch portions. Eat only the amount of food in your meal plan. Eat about the same amount of food each day.
Eat meals about every four to five hours. Do not skip meals.
Eat meals and snacks at regular times every day. If you are taking a diabetes medicine, eat your meals and take your medicine at the same times each day.

Tips for eating out

Review your food plan for the day and choose a menu item that fits.
Go to a restaurant with a variety of dishes.
Portions in restaurants often are large. Divide the dishes into healthy portions and take home the rest.
Try to eat out at regular meal times. If you can't, have a healthy snack to tide you over. Or, swap your bedtime snack for a late dinner.
If you're tempted by dessert, see if one might fit into your food plan and split it with a friend.
Don't be afraid to ask the server about cooking methods or ingredients. Many chain restaurants make nutrition information available at the restaurant or online.

Keep Tabs on Your Health

Regular testing tells you and your doctor how well your diabetes-control efforts are working. Here are some tests your doctor will probably want you to have.

Blood sugar. The most important test is one you do yourself-the blood sugar readings you may take several times a day. Your healthcare provider will tell you how often to test your blood sugar each day. Regular blood sugar testing is the best way to tell how well you're controlling your blood sugar levels.
Hemoglobin A1c.The HbA1c test is a simple blood test that indicates how blood sugar levels have been controlled during the last 2 to 3 months. HbA1c complements daily blood sugar monitoring by providing the "big picture" of diabetes control. It can be performed in a physician's office or with one of the new home testing devices.
Microalbuminuria. Every year, or perhaps more often, your doctor will do a test that measures the amount of protein in your urine (microalbuminuria). This test usually requires you to collect your urine over 24 hours. A positive test indicates that blood vessels to your kidneys may be damaged. Your doctor may prescribe medicines to stop further damage.
Cholesterol. Cholesterol and triglyceride levels in your blood should be measured at least once a year to help prevent heart disease. If you can't control your cholesterol levels with diet and exercise, your doctor may prescribe medication.
Blood pressure. Your blood pressure should be measured at each doctor visit. Again, your doctor may prescribe drugs if you have high blood pressure that doesn't come down with diet and exercise.
Feet. Your doctor should do a complete foot examination on a regular basis to look for conditions that could lead to slow-healing sores or require amputation.
Eyes and teeth. At least once a year, you should have an eye exam to check for any eye disorders. Your teeth and gums should be checked by a dentist every six months.

Information source: GlaxoSmithKline and 1on1health, www.1on1health.com

Eastgate Drug