Diabetes Treatment & Products Tips

Skin Care Products for Persons with Diabetes

A common complaint among diabetics is that their skin seems drier than most, itchy and prone to feeling rough. This is in part to the body's own method of controlling blood sugar. Your body pulls fluids from several "available" sources, in order to dilute the sugar in the blood. This can result in constipation, dry eyes and mouth and, of course, dry skin.

Many diabetic supply products are available to help combat the dry skin associated with diabetes, including a full line of products created especially for diabetics, called DiabEase.

The key ideas in diabetic treatment and skin care include:

* keeping the feet free of excess
moisture
* using quality emollients
* treating calluses and corns carefully
* avoiding products that irritate

Keys to remember:

1. Though pleasant fragrances are nice,
some can irritate the sensitive skin of
the diabetic. Lean toward
hypoallergenic products without
excessive chemical additives and
fragrances.

2. Use lotion or cream immediately following
bathing to help retain some of the
moisture present on the skin. Do not
lotion between the toes - keep this area
clean and dry.

3. If you have a callous or corn, see a
Podiatrist or other qualified healthcare
provider for treatment and removal - do
not try to remove the corn yourself.

4. Though foot soaks feel great, avoid
prolonged soaking, as this causes
maceration of the skin and can promote
entrance of bacteria and subsequent
infection.

Your healthcare provider can recommend products to help you combat dry skin associated with your diabetes, and this will go a long way in preventing the complications of skin irritation, wounds and skin infection.

Glucometers - What's in a Name?

There are numerous glucometers currently on the market for diabetics. Many have special features, all are very portable, and they come with their own type of lancets, lancing devices and test strips.

The major brands of glucose meters include:

* Bayer - maker of Ascensia Contour

* Abbott - maker of Medisense meter and

Precision

* Johnson & Johnson - maker of LifeScan

OneTouch Ultra

* Roche - maker of AccuCheck

* Therasense - maker of FreeStyle

* Home Diagnostics - maker of Prestige

So, what IS in a name, when it comes to glucometers? Well, in the above list, there are four well-known pharmaceutical companies.

This means that not only do these companies provide you with the glucose meter and necessary glucose testing supplies, but they can also provide you with insulin, oral anti-diabetic agents and emergency diabetes medications, such as glucose tablets, needed to help you manage your disease.

Each company and meter offers varying levels of performance, different features and a set of key diabetes management tools, designed to work with the glucometer.

In determining which glucometer - and in essence which company - to go with, take a look at the features, performance and supplies, to make sure that they meet your individual self-management needs.

Effectively Managing Your Insulin

Insulin is a medication used in diabetes treatment. Like many other medications, there are considerations to remember in the storage and management of insulin in order to keep it usable, and decrease the risk for side effects and other potential problems.

Here are some keys to managing your insulin to get the best results:

1. Take it at the same time each day - Your

body learns to regulate itself around

your insulin-administration times, and

will do so more effectively, if it knows

when the next does will be

2. Replace your insulin vial every 30 days,

if you store it at room temperature -

Insulin expires 30 days after opening,

if left at room temperature.

3. Keep back-up insulin supplies in the

fridge - Your insulin will keep until

the labelled expiration date, if the

vial is sealed and stored in the

fridge. Once opened, the vial is

generally good for 90 days - usually

more than enough time to use it up - as

long as you keep it in the fridge

between uses.

4. Mix your insulin - If you are using NPH

or mixed insulin, such as 70/30 or

75/25, roll the vial in your palms

to warm and mix it before your draw it

up for administration. This will ensure

uniform consistency and proper

concentration of your mix. Do not shake

the insulin, as you will add bubbles to

the mixture and may cause some breakdown

of the insulin.

5. Toss insulin that has changed color

or developed sediment - sediment or

color change can indicate a contaminant

or that the insulin has gone beyond its

expiration date. Using discolored or

sedimented insulin can be harmful.

6. Draw clear to cloudy - If you use both

regular and NPH insulin, always draw the

clear insulin first (the regular). If

you draw the cloudy insulin first, you

may inadvertantly get some into the

clear vial, which will then become

cloudy, ruining your regular insulin.

7. Don't mix Lantus - Lantus insulin does

not mix with anything. If you are

receiving regular or NPH insulin, and

Lantus, they must be given in separate

injections, or sedimentation will occur.

Do not ever use insulin with sediment.

8. Keep a log - Track your blood sugars and

insulin usage so that you can trend the

results. This information will help you

and your doctor determine the correct

dosage and dosing schedule to provide

optimal control of your blood sugars.

9. Follow doctor's order - Do not self-

adjust your insulin dosage unless you

have experience and the go-ahead from

your physician. Results can be

disastrous, including hypoglycemia,

ketoacidosis and coma.

Managing your insulin effectively will help you better manage your diabetes, and reduce the risk for side effects and complications.

The Role of Insulin in Diabetes Treatment

Insulin assists your body in managing blood sugar, by transporting the sugar circulating in your bloodstream, into your cells, to be used as fuel.

Insulin is normally created by cells in your pancreas called "islet cells." If your body does not make enough insulin, or loses the capacity to effectively use the insulin that your pancreas creates, you may need to have supplemental injections of insulin to control your blood sugars. This is called Type I diabetes, or insulin-dependent diabetes.

Without insulin to transport the sugar into the cells, the sugar remains in your bloodstream, giving you high blood glucose readings.

If the cells do not have sugar to use for fuel, your body then begins to use muscle and fat, as a fuel source. The byproducts of muscle and fat metabolism are called ketones, which are a poison to your system, and can cause coma and death.

Having enough usable insulin in your bloodstream is a key part of your diabetes treatment, and in controlling your blood sugars and preventing build-up of ketones in your body.

If your body is unable to make enough insulin, or a usable type of insulin, your physician will prescribe insulin injections to help your body metabolize sugar and reduce the risk for complications associated with high blood sugar.

Low or Non-Invasive Blood Glucose Testing

Currently, testing your blood sugar requires a pricking your skin to obtain a drop of blood. Pricking is painful.

There are reports of minimally-invasive or non-invasive devices being developed in Europe. One device involves a needle being inserted under the skin for up to three days at a time, so that a monitor can check blood glucose levels.

Completely non-invasive devices are also being developed. The theory is that a device can use types of light (e.g. infra-red or lasers) to measure blood glucose levels without breaking the skin, like a pulse oximeter reads oxygen levels through the skin.

Currently, the devices being tested in Europe can read blood sugar without breaking the skin, however most need to be calibrated regularly, which requires a traditional finger-prick test.

In the United States, Cygnus Inc., a diabetes supply company in California, has created GlucoWatch® G2™ Biographer - a second-generation model of the non-invasive glucose monitoring device that was approved by the FDA, in March 2001, for use by people with diabetes. This device is worn on the forearm, and measures glucose via interstitial fluid.

Interstitial fluid (ISF) is the fluid that fills blisters when we damage our skin by burning and it can be extracted from the top layers of skin without the use of a lancet.

Though most insurance do not currently cover the use of this new device, the future holds great promise of increased availability of minimally-invasive, or non-invasive - blood glucose testing devices.

The Role of the Diabetes Educator

A Diabetes Educator is often a Registered Nurse who specializes in the care and treatment of persons with diabetes.

The Diabetic Educator has received special education and training, usually has an advanced degree and has completed a minimum number of supervised clinical hours in educating patients with diabetes.

Your Diabetes Educator will:

* assess individual education needs

* help identify self-management goals

* provide education and support to help

achieve those goals

* assist in evaluating progress

The goal of the Diabetes Educator is to help the diabetic patient and their family, understand the disease and learn how to manage it, to reduce the risk of complications and to promote quality of life.

Just as you would want a specialist, such as a Physical Therapis, to help you get stronger after an accident or stroke, so you would also want a Diabetic Educator to help you select the right diabetes supplies and manage your disease.

The Insulin Pump

For some persons with diabetes, routine self-injection is difficult or impractical, either due to lifestyle or severity of their disease. Good glucose control is one of the key factors in reducing the risk for complications.

By using a diabetes insulin pump, you can match your insulin to your lifestyle, rather than injecting insulin and making changes in your life to match the injection.

Insulin pumps provide both a consistent rate of insulin infusion - called a basal rate - and bolus doses, which you self-administer by pressing a button. The boluses are programmed for a set dose of insulin, so that you can press the button to cover your carbs at mealtimes and manage periods of high blood sugars.

The pump is aobut the size of a deck of cards. It is attached to a very small tubing, connected to a needle inserted in the fatty tissue of your abdomen.

Where do you put it? The pump can be worn in a small carrying case clipped to your waist band or belt, on a band around your arm, or even in a pocket or fanny pack. They are water-resistant, but not waterproof so you shouldn't take them swimming or in the shower with you, however you can disconnect them for short periods to allow you to swim and bathe.

For many people, the insulin pump provides freedom from frequent injections of insulin, which can be both painful and inconvenient, and the benefits include:

* more stable blood glucose levels

* lower A1C values (test to check your

overall blood sugar control)

* flexibility in eating (you can bolus

when you eat)

* freedom from repeated injections

But, they are not perfect, either. The downside to using insulin pumps include:

* Expense - they are not cheap and

your insurance may not cover it

* It can be annoying to be connected to

a device day in and day out

* Risk for ketoacidosis if your pump is

off for too long, or becomes

disconnected

* May need a hospital stay to be

trained on how to use it

* Can contribute to weight gain

Only you and your doctor can decide if the insulin pump is for you. There are several models to choose from, with varying features, to match your lifestyle.

Talk to your doctor or diabetic educator about the insulin pump and the risks and benefits for you.

Toenail Care

Toenail care for the diabetic is a vital part of diabetic treatment, due to the complications associated with the disease, including impaired circulation and decreased sensation in the hands and feet.

There are 5 keys to remember with toenail care:

1. Cut straight across - cutting around the
corners of your nails may cause them to
grow into the skin, putting you at risk
for injury and infection.
2. File rough edges - snags or jagged edges
can injure the skin on adjacent toes, or
cause scratches on the other leg
3. Get a Podiatrist to trim thick or fungal
nails, to avoid injury to the nail and
skin.
4. Be consistent - do your nail care every
week. Use the time to give your feet a
good check-up.
5. Report any breaks in the skin, corns,
callouses, or injuries to your
physician. Prompt intervention can
prevent infection.

Persons with diabetes are at an increased risk of infections and injuries to their feet, due to nerve damage and impaired circulation - potential complications of their disease.

Keeping your feet healthy includes proper toenail care to prevent injury and infection.

Choosing the Right Syringe

Does choosing the right syringe really make a difference in treating my diabetes? The answer is a resounding YES!

For persons with diabetes, there are several factors to consider when choosing a syringe, including:

* amount of insulin to be injected

* dexterity

* vision

* numbness of the fingers or hands

* body weight/mass

1) The amount of insulin to be injected

determines how big of a syringe you will

need to draw up your insulin in one

syringe.

- If you take more than 40 units of

insulin, it is best to choose the 1 cc -

100 unit - syringe.

- Doses between 40 and 50 units, on a

50 unit syringe, make the plunger

very long, and it is harder to handle.

- If you have nerve damage in your fingers,

or impaired dexterity, you may not get

the correct dose, or you could injure

yourself attempting to inject.

2) Dexterity impacts the size of syringe you

may want to use as well, as available

syringes have different barrel

circumferences.

- If you have trouble moving your fingers,

due to neuropathy or arthritis, a smaller

barrel may be harder to handle.

3) Vision is also a factor. Print on many

insulin syringes is very small, making it

difficult to see.

- Larger-barrelled syringes have slightly

larger numbers, and some may be printed

in darker or bolder lettering.

4) Numbness of the fingers and hands makes

handling syringes challenging, since it

is hard to sense them.

- Larger syringe barrels or those with

safety covers, may be easier to handle,

than smaller syringes. The safety covers

add diameter to the barrel.

5) Body weight or mass. Smaller thinner

persons do not have as much fat tissue to

penetrate when injecting the insulin.

- For persons with larger body mass or

thicker fat layers, a syringe with a 5/8

inch needle is a better choice.

- For very thin persons, a syringe with a

1/2 inch needle may work best.

Choosing the right syringe is as important as choosing the right lancet or lancing device; the right syringe will make self-care of your disease easier, and will then increase the effectiveness of your treatmen, and reduce your risk of complications.

Talk to your physician, pharmacy or diabetes supply company about the different syringes that are available, to help you choose the right one for you.

Types of Insulin

For Type I diabetes, insulin is required to help control blood sugars. There are 3 primary types of insulin:

* short acting
* intermediate acting
* long acting

1. Short acting insulin is called "regular" insulin. This insulin peaks within 30 minutes of administration and its effect last only a few hours. This insulin is good for controlling brittle or unpredictable blood sugars, and is usually given 3-4 times each day.

2. Intermediate-acting insulin is usually called "NPH." This insulin peaks within 2-4 hours, and lasts approximately 8 hours. This insulin is often given 2 times a day, in the morning and evening, to provide blood sugar stability throughout the day and night.

3. Long acting insulin usually refers to Lantus. This insulin is given once daily and provides blood sugar stability for 24- hours. It can be given in the morning or evening, but it is best to choose a time and stick with it, since overlapping the times can impact your blood sugars.

Insulin is an important part of your diabetes treatment, if you have Type I diabetes. The type of insulin that your physician prescribes will be based on your blood sugar readings, the stability of your blood sugars, and other factors which can impact your blood glucose, such as medications or infections.

As always, talk to your physician about the insulin that has been prescribed and the best way to manage your blood sugars.

Nasal Spray Insulin

Nastech Pharmaceutical Co. is developing an insulin nasal spray, which could provide an alternative for millions of diabetes patients. Being able to avoid injections, is a pleasant idea for both patients and physicians, can reduce local complications such as lipo-dystropy - shrinking and dimpling of the fat tissues.

Currently, several pharmaceutical companies, who create and distribute diabetic supplies, are testing inhaled insulins that can be administered through nasal spray or metered-dose inhalers similar to those used by asthmatics.

Though commercial availability of insulin inhalers and nasals sprays is still some years away, the hope for insulin administration without injection, keeps us watching for these types of medical advances, that can improve self-care and decrease the risk for complications of this serious disease.

Choosing the Right Lancet and Lancing Device

Lancets, like glucometers, come in a variety of designs and types. It is important to pick the one that is right for you. Lancing devices also come in different styles.

So, what should you look for in a lancet?

* Point size - Lancets come in varying

point sizes. The smaller the lancet

point, generally the less painful the

sample collection will be.

* Needlepoint or blade lancet - Some

lancets, especially those used to

collect larger samples of blood, have

blade-like edges, which make a small

incision when they enter the skin

* Lancet size - For persons with

nerve damage in the fingers or

arthritis, small lancets may be hard

to load into the lancet device or use

manually.

What about a lancing device?

* Shape - Lancing devices come in

different shapes. Depending on your

dexterity or nerve damage in your

fingers, one type may be easier to

handle than another.

* Ease of loading - Some lancing

devices are set up so you insert the

lancet, then remove the protective

cap. This can be technically

challenging even for someone with

good eyesight, hand-eye coordination

and no nerve damage.

Of course, diabetic supply companies make glucometers and have lancets and lancing devices that go with their machines, however that does not mean that the lancets or lancing devices are the right ones for you.

Your pharmacy will have different styles of lancets and lancing devices on hand. Ask them if you can see the different devices, to find the one that works the best for you, then work with your doctor to get it ordered for you.

Grief and Coping with Diabetes

Diabetes, like many other chronic diseases, impacts not only your physical body, but also your self-image. With change - even positive change - comes a period of adjustment.

Feeling symptoms of grief and depression is a normal response to being diagnosed with a serious disease or a significant change in your life. Diabetes is both of these.

Seek help from a professional to process the grief. A qualified counselor or Social Worker can help you identify the core components of your grief, and assist you in identifying ways to get through it.

Taking baby steps will help you develop new ways to cope with this big change, and get through your grief, is an important part of your diabetes treatment. Baby steps may be small, but they still get you there!

Oral Anti-Diabetic Agents

There are three primary types of diabetes, including Type I, Type II and Gestational. For Type II diabetes, treatment usually consists of diet changes, weight loss and the use of oral anti-diabetic agents, also called anti-hyperglycemic drugs.

There are 5 classes of oral agents:
* sulfonylureas
* biguanides
* alpha-glucosidase inhibitors
* thiazolidinediones
* nonsulfonylurea secretagogues

Each class of drug aids in the control of blood glucose in a different way.

1. Sulfonylureas work by causing your pancreas to release more insulin into the blood stream. These include glipizide and glyburide.

2. Biguanides lower blood sugar by decreasing the amount of sugar produced by the liver, and increasing the amount of sugar absorbed by muscle cells and by decreasing the body's insulin resistance. Glucophage is a biguanide.

3. Alpha-glucosidase inhibitors act by reversible inhibition of the enzymes that break down sugars in the gastrointestinal tract. Enzyme inhibition therefore delays and reduces the peak of postprandial blood glucose. An example of an alpha-glucosidase inhibitor is Acarbose.

4. Thiazolidinediones lower blood sugar by decreasing insulin resistance.

5. The mechanism of action of the nonsulfonylurea secretogogues, is similar to that of the sulfonylureas. Unlike sulfonylureas, however, they have a "quick on-quick off" action that reduces the incidence of late post-meal hypoglycemia. Prandin is one.

Regardless of the class of oral anti-diabetic agent that your doctor prescribes for you, it is vital that you:

* take it as directed
* monitor your blood sugars
* eat according to your meal plan
* notify your physician of any high or
low blood sugar concerns

With proper management, and adherence to your diabetes treatment, including diet, weight loss, exercise and medication control, you can decrease your risk of developing Type I diabetes, and the complication associated with your disease.

Socks and the Diabetic Foot

One primary complication of diabetes is disease of the blood vessels, especially in the hands, legs and feet. This predisposes the person with diabetes to getting ulcers, which are slow to heal, or which may not heal at all, due to poor circulation.

Taking care of the diabetic foot, has three key focuses:

1. Inspection - look at your feet every day
to check for cracks, corns, sores and
infections
2. Shoes - proper fitting shoes do not rub
or cause blisters, callouses or
abrasions on the foot, while providing
good support
3. Keeping the feet clean and dry -
moisture causes maceration of the skin,
which can allow bacteria to get into the
skin and cause infections

This is where the socks come in! Ideally, the perfect diabetic sock will keep your feet dry, provide a cushion layer in your shoes to prevent rubbing, and will not bind or cause irritation within the shoe. This is an important part of your diabetic treatment and these products are available through most diabetes supply companies.

Things to look for in socks:

1. The best socks are cotton or cotton-
blend to wick away moisture and keep
your feet cool and comfortable.

2. Seamless socks are best, but turning non-
seamless socks inside-out will also
decrease pressure on the toes from the
sock seam.

3. Avoid thin socks or those with
inconsistent thickness from heal to toe,
as they may not provide proper
cushioning and protection with your shoe.

There are variety of sock products available that can help keep your feet cool, dry, comfortable and healthy. Talk to your physician, Podiatrist, Diabetic Educator or Orthotist for sock recommendations.

Combining Oral Anti-Diabetic Agents and Insulin

When you are diagnosed with diabetes, the physician will tell you whether it is Type I or Type II.

Traditionally, Type I diabetes is treated with insulin, whereas Type II is treated with oral anti-diabetic agents.

Often, however, persons with Type I diabetes need the additional support and blood sugar control afforded by both insulin and oral anti-diabetic agents.

Insulin specifically joins with sugars in your bloodstream and assists them into your cells where they are used for fuel, and can be administered via injection of diabetes insulin pump. Oral agents - classified into 5 different groups -provide additional support by:

* Causing your pancreas to release more
insulin into the blood stream
* By decreasing the amount of sugar
produced by the liver
* Increasing the amount of sugar
absorbed by muscle cells
* Decreasing the body's insulin
resistance
* Inhibiting the enzymes that breakdown
sugars in the intestines

By adding more insulin through injection, encouraging the pancreas to produce more, while controlling sugar breakdown and absorption, your blood sugars are more stable.

Stable blood sugars provide better overhealth and decreased risk for complications associated with blood sugar fluctuations.

Shoe Shopping for the Diabetic Foot

For the diabetic person, proper foot care is essential to prevent ulcers, injuries and infections.

Diabetic foot care has several components, includings:

* daily inspection
* socks that wick away moisture and
prevent rubbing
* proper toenail care
* supportive footwear

When you are looking for shoes, make sure that you include these key things:

1. Wide toe box - shoes that are narrow at
the toe can press your toes together, press toenails into adjacent toes,
compress nerves in the feet and can negatively impact your balance and gait

2. Supportive arch. A person
with flat feet cannot comfortably wear a
shoe with a high arch. Conversely,
someone with a high arch would suffer
without support in the arch.

3. Proper length - avoid buying shoes where
your toes touch the ends or sides of the
shoes, to prevent rubbing and irritation

4. Breathable construction - shoes that are
made of vinyl, latex or other materials
that do not breathe, prevent your feet
from drying out. Moist feet grow yeast,
and can develop openings in the skin.

5. Low heels - avoid high heels, as this
places pressure on the toes and balls of
the feet, increasing the risk for toe
and skin injury

Your feet are central to gait and balance, enable you to drive and use other equipment, and support your body weight.

Injuries, infections and amputations resulting from poor diabetic control and inadequate foot care, can seriously impact your ability to be active and healthy.

Talk to your doctor or Diabetic Educator about diabetic footwear and how to select the right shoes to keep you on your feet, or contact your local diabetic supply company for footwear options.

The Insulin Pen

For those with Type I Diabetes, insulin is a daily routine which can be both time-consuming and inconvenient.

You test your blood sugar, determine your insulin dose (if you are on sliding scale dosing), draw up your dose and inject. Then, if you have regularly scheduled insulin, you need to draw that up and inject it, too.

The task of drawing up insulin can be challenging for persons with:

* vision problems
* tremors
* numbness in the fingers or hands
* arthritis or other hand conditions

There is good news, however. Insulin pens are now available from most diabetes supply companies. The pens allow you to simply dial the correct dose of insulin for injection, rather than drawing it up with a syringe.

The pens have replaceable cartridges that contain insulin. Once inserted into the pen, you can administer several rounds of insulin injections before needing to change the cartridge, and without ever picking up a syringe.

This is especially helpful for elderly diabetics who have difficulty seeing the small numbers on an insulin syringe, may not have the dexterity to draw the correct dose, or have hand conditions that limit their fine motor control.

The Insulin Pens are covered by most insurances, and are easy to use.

If you would like more information about Insulin Pens, contact your physician or Diabetes Educator.

Why Should I See a Podiatrist?

A Podiatrist is a physician that specializes in the care and treatment of the feet, including those with diabetes.

As with any specialty, the Podiatrist has received additional education and training that helps them focus on caring for those with foot problems.

Diabetes can cause problems in the feet and legs, including blood vessel disease, ulcers, nerve damage and changes in the skin.

A Podiatrist knows the best way to manage corns and callouses, how to trim even thick, fungal toenails to prevent injury, and how to treat ulcers and skin conditions that effect your feet.

Podiatrists can bill Medicaid, Medicare and private insurance companies for their services. Some will even make "house calls" to nursing homes and assisted living facilities, since some residents in these settings cannot easily make office visits.

Ask your physician or Diabetic Educator for a referral to a Podiatrist in your area.