Diabetic Complications Tips

Gastroparesis in Diabetes

The term "gastroparesis" stems from the Latin word "gastro" meaning stomach. Gastroparesis is the condition whereby the stomach takes too long to empty following a meal. It is caused by nerve damage to the nerves that lead to the stomach - a type of diabetic neuropathy.

The symptoms include:

* heartburn
* nausea
* vomiting undigested food
* an early feeling of fullness
* abdominal bloating
* erratic blood glucose values
* reflux (GERD)
* spasms of the stomach walls

Because gastroparesis impacts the processing of foods, the most significant effect is erratic blood glucoses, which are difficult to stabilize. Food that remains in the stomach for long periods can ferment and promote bacterial growth. It can also harden, causing blockage to the bowel.

Diagnosis is usually confirmed using a barium swallow or gastric-emptying scan, which tracks the movement of food from the stomach to the bowel.

The keys to treating gastroparesis include:

1. Managing your blood glucose - more
frequent glucose testing, and changing
your medication regime.
2. Adjusting your diet - reduce fiber and
fats, which are slow to digest, reduce
your portion sizes and eat more
frequently. You may need to try liquid
foods until your sugars stabilize.
3. Medication - some medications can
promote movement of food from the
stomach to the intestine, while other
can help in managing heartburn and reflux
4. If these interventions are not
effective, placement of an external tube
may be indicated, to bypass the stomach.

There is no cure for gastroparesis, only management of the condition, because it is a result of nerve damage associated with diabetes.

The best treatment is prevention by following your diabetic care plan to reduce the risk for complications such as diabetic neuropathy, which can result in gastroparesis.

Contact your physician for more information about gastroparesis and how you can help to avoid this complication of your diabetes.

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Diabetes and Anemia

Anemia is a decrease in the amount of iron or red blood cells in your blood, which is partly regulated by your kidneys.

When you think of anemia, you might think of diabetes as a cause. However, studies show that there may indeed be a relationship between Type I diabetes and anemia. In fact, up to 15% of men and women with diabetes also have anemia.

In persons with diabetes, kidney disease or damage is one of the most serious complications.

Kidney function is an important indicator of hemoglobin levels in the blood. Hemoglobin is what gives the red blood cell its color. In patients with diabetes, kidney disease is a serious complication. Your kidneys also have a key role in the production of erythropoetin - the substance your body uses to stimulate creation of red blood cells. So, with decreased erythropoetin and hemoglobin levels the end result is anemia.

Symptoms can include fatigue, decreased concentration, mild confusion and weakness. Treatment options are generally focused on increasing the circulating iron stores or, in severe cases, blood transfusions or administration of additional erythropoetin.

With any treatment, of course, there are risks and side effects, so talk to your Endocrinologist or Primary Care Physician about testing and treatment for anemia.

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The Dawn Phenomenon

How often have you gone to bed with a perfectly acceptable blood sugar level, only to wake up with a high one? You know you did not raid the fridge in the middle of the night, so what causes it?

This is called the Dawn Phenomenom (DP), so-named because of the timing of the high blood sugar, and this is normal response in human beings. It becomes a problem for the diabetic person because the fluctuations in blood sugar contribute to other side effects and increase the risk for serious complications.

It is normal for our body to release glucose, while we sleep, and this occurs in response to several hormones, including cortisol, epinephrine, growth hormone and glucagon. They are released to help your body heal and repair during your sleep, and have the effect of countering anti-diabetic medications.

The best to determine if you have DP is to wake up in the middle of the night and check your blood sugar. If the value is high, and then your morning value is also high, you may have DP.

How can you prevent DP?

1. Limit your carbs in the evening. Make your bedtime snack one of fats and
proteins.
2. Exercise in the evening to bring your sugars down a bit before you go to bed. Remember to monitor your blood sugars when you exercise so that you do not
drop too low.
3. Talk to your doctor about adjusting your medications. You may need to increase your evening oral agent or long acting insulin to "cover" the morning sugar.
4. Don't skip meals or your medications. Your body becomes accustomed to receiving calories and medications at regular times, and omitting them can put your system out of sync, worsening the problem.

Mild elevations are not abnormal, and should not be cause for concern unless they are above your diabetic plan range. As always, talk with your doctor about the best way to manage your blood sugar fluctuations to decrease the risk for complications.

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Diabetes and Falls in the Elderly

If you have ever experienced an episode of low blood sugar, you understand how diabetes can contribute to safety concerns and falls.

With low blood sugar comes dizziness, weakness, nausea and sweating. Vision can become altered, level of consciousness can lessen, and our ability to walk safely is then also effected, due to changes in our equilibrium.

For those with diabetes, especially in a care setting such as a Nursing Home or Assisted Living Facility, blood glucose testing is one of the first steps taken for evaluating the cause of falls. Though there are many reasons that an elderly person may fall, best practice dictates ruling out the most simple causes, first. In the case of the diabetic patient, low blood sugar is at the top of the list and easily assessed, using a glucometer.

Hypoglycemia (low blood sugar) is defined as a blood glucose less than 80 mg/dl. Some persons may not develop symptoms until their sugar is much lower. Repeated episodes of hypoglycemia warrant evaluation by a physician and may require adjustments in your anti-diabetic medications or insulin.

Plan ahead for your safety:
* keep an emergency kit of glucose for
use when you feel your blood sugar
dropping
* respect your body and do not try to
walk "just a little farther," go to
the bathroom or any other activity if
you feel that your blood sugar may be
low - treat then resume your activity
* educate your family and friends about
your disease so that they can provide
assistance in the event that you do
fall, or fear that you might
* notify your physician of any falls,
or episodes of low blood sugar, so
that he can appropriately treat you

Be safe - know your body, know your disease, know how to respond to low blood sugar to prevent falls!

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Diabetic Amyotrophy

Diabetic amyotrophy is a type of nerve damage that is distinct from other types of diabetic neuropathy. It is characterized by the wasting of the muscles in the pelvis and thigh, with pain usually starting in the thigh.

Diabetic amyotrophy is generally one-sided, though it can occur bilaterally. The ability to feel external sensations is not usually affected or is minimally impacted, initially.

Most commonly, diabetic amyotrophy occurs in middle-aged women, though some cases have occurred in young persons with uncontrolled disease.

The only treatment for diabetic amyotrophy is controlling blood sugars. Consistent regulation of blood glucose can provide some relief and stabilization of symptoms, however there is no cure, and the residual damage appears to be permanent.

Contact your doctor immediately if you have pain in one or both thighs, or develop weakness in your lower extremities. Catching diabetic amyotrophy early can reduce progression and further nerve damage.

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Somogyi Effect

Similar to the Dawn Phenomenom, the Somogyi Effect involves fluctuations in your blood sugar that occur during the night. However unlike DP, your blood sugar drops during the night and then rebounds in the morning. That is why the other name for this condition is Rebound Hyperglycemia.

When your blood sugar drops during the night, your body attempts to compensate by burning glucose from your muscles, liver and fat, resulting in an increase in your blood glucose for the morning.

The best way to check for this condition is so set your alarm for 2 AM and test your blood sugar. If the glucose reading is low, and your subsequent morning value is high (and you did not skip your evening snack or change your medications), then you may have Somogyi Effect (SE).

So, how do you treat SE?

1. Aim for a slightly higher bedtime blood glucose. This can help prevent
hypoglycemia during the night.
2. Add some carbs and fats to your dinner or evening snack, to give a long slow
burn to sustain blood glucose during the night.
3. Keep a blood sugar diary, and record the 2 AM values several times to see if
there is a pattern, and if your interventions are working.
4. Talk with your doctor about adjusting your medications or diet to prevent the rebound phenomenom.

As always keep your doctor informed of your blood sugars, monitor your diet and exercise to sustain and stabilize your metabolism, to reduce the risk for complications.

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Lipodystrophy

For those with diabetes, there are many potential complications. One of the most common complications is lipodystrophy, a condition that creates divots in the fat layer, making the area feel lumpy.

Lipodystrophy can occur when insulin is repeatedly injected into the subcutaneous tissue -- the third layers of skin, which contains fat and connective tissue that houses larger blood vessels and nerves. When the body pulls the insulin from the fatty tissue, the result is fatty atrophy - or shrinking of the fat tissue - at the injection site. This causes lipodystrophy, or divots in the skin. This is not reversible and the best treatment for this common complication is prevention.

The best way to avoid this potential complication of insulin injection is to routinely rotate your injection sites. Your Diabetes Educator, physician, or other healthcare provider can give you a reference chart, to help you effectively rotate your sites. This information is also available from the American Diabetes Association.

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Ketoacidosis

Ketoacidosis - an increase in the acid content of the blood - occurs when blood sugars are very high or are uncontrolled. In the absence of enough insulin to assist in the transport of sugar into your body's cells (to use for fuel) the body begins to use muscle and fat for energy, instead.

When one thinks of diabetic complications, the top five usually include: heart disease, kidney failure, peripheral neuropathy, diabetic retinopathy and ulcers. However, one of the most common complications is ketoacidosis.

The use of muscle and fat produces ketones - an acidic byproduct that eventually consumes the body's natural buffers. The rise in the blood acid levels is ketoacidosis, which depletes body water and electrolytes, and the result is a medical coma.

Sometimes infection, heart attack, stroke, surgery or stress can precipitate the ketoacidosis as your body attempts to compensate for the stressful event.

Symptoms you may see prior to coma include excessive thirst, fruity (alcoholic) breath, and confusion. Treatment includes hydration and administration of insulin, however the best treatment is prevention:

* monitor your blood sugars
* take you insulin as directed
* know the symptoms and how to treat
them
* call your doctor

You and your knowledge of your disease are the first best defense against diabetic ketoacidosis.

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Pre-Eclampsia and Diabetes

For the pregnant diabetic, there are concerns regarding blood glucose management, risk for kidney damage and elevated blood pressure, during the pregnancy, however the most serious concern in Pre-Eclampsia.

Pre-Eclampsia is a very serious condition chracterized by abnormally high blood pressure, and generally occurs later in pregnancy. Due to the high blood pressure, visual disturbances are common, as well as headache, seizures, and proteinuria - an effect of damage to the kidney from the elevated blood pressure. The body attempts to compensate by shunting fluid elsewhere, resulting in edema in the hands, feet and face.

The most significant risk factor is previous history, however diabetes and obesity quadruple the risk, making the number of diabetic women affected as high as 50%, according to the University of Glascow.

The cure for Pre-eclampsia is delivery of the baby and placenta. Since the condition can result in premature labor and delivery, there are risks to the baby, as well, including low birth weight, neurologic damage, birth trauma and low blood sugar.

The key to treatment is prevention of complications:

1. Closely monitoring blood pressure
2. Frequently check urine for protein
3. Blood tests to monitor liver and kidney
function
4. Watch for edema, headaches and abdominal
pain
5. Learn the warning signs
6. Keep in close communication with your
obstetrician and endocrinologist

Early risk assessment and ongoing monitoring can help ensure a healthy pregnancy for both mother and baby, and decrease the risk for negative outcomes and complications.

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Why does diabetes cause intense thirst?

Sometimes simply knowing the "whys" in regards to your disease can make a big difference. Let's take a look at one of the many symptoms of diabetes: excessive thirst.

It's All About Glucose

The reason that diabetes causes excessive thirst is a bit scientific. When glucose reaches a certain concentration point in your bloodstream, your kidneys will stop being able to pull more glucose out of the water in your body.

This causes a chain reaction that leads to the build up of osmotic pressure in your kidneys. After this occurs your body really can't absorb water back into your bloodstream and, occasionally, the reverse begins to happen. Water begins to get siphoned out of your bloodstream. Because of this many sufferers of diabetes will slowly fall into dehydration.

Early Symptom

Excessive thirst is one of the earliest known symptoms for someone that is suffering from diabetes. Unfortunately it is a rather vague symptom and could mean any number of things. Typically the thirst symptom doesn't stand out in Type 1 and Type 2 sufferers until other symptoms have cropped up, as well. This makes targeting thirst as an indicator incredibly difficult, and should not be relied upon as a tactic to identifying diabetes.

Dehydration itself seems like a minor issue, but it really isn't. When your kidneys begin betraying you like this it will lead to a chain reaction of bigger and bigger issues that could lead to ketoacidosis, severely elevated blood sugar levels, and eventually death. Being aware of your symptoms is very important.

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Get Off Cigarettes and Reduce Your Risk for Diabetes & Complications

Diabetes is a serious metabolic disease that results from the body's inability to make insulin or its inability to utilize the insulin that is made. Certain lifestyle habits can help or hinder your ability to manage diabetes. Smoking in particular can have a seriously negative effect on your health when you have diabetes.

The Link Between Smoking and Diabetes

A study published in the American Journal of Epidemiology found that smoking 16 to 25 cigarettes a day increased the risk of developing type-2 diabetes threefold. If you have other risk factors for diabetes such as family history, obesity or being part of a group known to have a higher risk, find smoking cessation help immediately to maintain good health and avoid this life-threatening disease.

Damage From Smoking

The chief reason smoking is a health hazard is its effect on blood vessels. Years of smoking cause blood vessel walls to weaken, making the heart work harder to pump blood to the farthest points of the body. This weakness in the vessel walls can lead to a number of problems within the circulatory system. In addition, the nicotine itself causes an increase in a type of hemoglobin that is associated with higher blood sugar.

Diabetic Health Issues Related to Smoking

• Heart disease


• Stroke


• Circulatory problems


• Problems with wound healing


• High blood pressure


• Cancers of the mouth and throat


• Impotence


• Pregnancy complications, such as miscarriage and stillbirth

Group support programs to help stop smoking, nicotine replacement products and medications can help people to stop smoking and reduce the number of complications that smoking causes to those with diabetes.

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