7 Principles for Controlling Diabetes for Life.

These 7 principles, or steps, will help you manage your diabetes and live a long and active life. Every person who has diabetes has different needs. Talk to your health care team about a treatment plan that is best for you. Diabetes affects almost every part of the body and good diabetes care requires a team of health care providers. They include doctors, diabetes educators, nurses, dietitians, pharmacists, mental health workers, eye specialists, foot specialists, dentists, and social workers.

It Is Important to Control Diabetes

Taking good care of diabetes will make you feel better and can lower your chances of getting heart disease, stroke, eye disease that can lead to a loss of vision or even blindness, nerve damage that may cause a loss of feeling or pain in the hands, feet, legs, or other parts of the body and lead to problems such as lower limb amputation or erectile dysfunction, kidney failure, gum disease and loss of teeth, etc.

Principle 1: Learn as Much as You Can About Diabetes

The more you know about diabetes, the better you can work with your health care team to manage your disease and reduce your risk for problems.
Diabetes is always a serious disease. Terms that suggest that diabetes is not serious, such as “a touch of diabetes,” “mild diabetes,” and “sugar’s a little high,” are not correct and should no longer be used.

Many People Who Have Diabetes
Do Not Know It

Principle 2: Get Regular Care for Your Diabetes

If you have diabetes, it is important to

* See your health care team regularly
* Make sure your treatment plan is working. If it is not, ask your health care team to help you change it.

Principle 3: Learn How to Control Your Diabetes

Diabetes affects many parts of the body. To stay healthy, it is important to know how to eat the right foods, how to be physically active, and how to look after yourself.

Principle 4: Take Care of Your Diabetes ABCs

A major goal of treatment is to control the ABCs of diabetes: A1C (blood glucose average), Blood pressure, and Cholesterol. You can do this in many ways.

* Follow a meal plan that was made for you.
* Be active every day.
* Take your medicine as prescribed.
* Before taking any non-prescription medicines, vitamins, or herbal products, ask your pharmacist how they may affect your diabetes or prescription medicines.
* Test your blood glucose on a routine basis.

Principle 5: Monitor Your Diabetes ABCs

To reduce your risk for diabetes problems such as blindness, kidney disease, losing a foot or leg, and early death from heart attack or stroke, you and your health care team need to monitor the diabetes ABCs: A1C, Blood pressure, and Cholesterol. Talk to your health care team about how to reach your target numbers.

Principle 6: Monitor Your Diabetes

Ask your Doctor what to do if your blood glucose is often higher or lower than it should be.

Principle 7: Get Checked for Long-Term Problems and Treat Them

See your health care team regularly to check for problems that diabetes can cause. Regular check-ups help to prevent problems or find them early when they can be treated and managed well. Along with the checks of your A1C, blood pressure, and cholesterol (see Principle 5), here are some tests that you will need:

* Triglycerides (a type of blood fat)
* Dilated eye exam to check for eye problems
* Foot check
* Complete foot exam to check for circulation, loss of feeling, sores, or changes in shape
* Urine test to check for kidney problems
* Dental exams to prevent gum disease and loss of teeth

a WebMD article

Pre-Diabetes :: A Serious Concern

Prediabetes

Also called: Chemical Diabetes, Borderline Diabetes, Impaired Fasting Glucose, Subclinical Diabetes, Impaired Glucose Tolerance, IFG, Latent Diabetes, IGT

A patient is diagnosed as having prediabetes when glucose (blood sugar) is higher than normal but not high enough to be diagnosed as diabetes. At least 43 million Americans have this condition, according to estimates by the government. Prediabetes is almost always present in an individual before type 2 diabetes develops.

Screening for prediabetes is an effective strategy for identifying individuals who are at risk for developing type 2 diabetes. By identifying the individuals with prediabetes, physicians can intervene sooner with a plan of treatment. Changes in lifestyle, such as diet, weight loss and exercise, are usually included in the treatment. These interventions have been successful in delaying or preventing type 2 diabetes.

Detection and treatment of prediabetes also may reduce the risk of heart disease, stroke and other complications. The damage that occurs to organs and body systems from type 2 diabetes, such as diabetic neuropathy and diabetic retinopathy, can actually start during prediabetes. Treatment of prediabetes promotes a healthier lifestyle, which in turn can prevent type 2 diabetes and medical complications.

About prediabetes

Prediabetes exists when a person has glucose (blood sugar) levels higher than normal but not high enough to be diagnosed as diabetes. It often, but not always, escalates to type 2 diabetes, which accounts for an estimated 90 to 95 percent of cases of diabetes. In the past, mildly elevated levels of glucose were often ignored. Today, glucose levels slightly above the normal range are a warning sign for an individual to take prompt action to prevent type 2 diabetes. In addition to being a strong risk factor for diabetes, prediabetes increases a person’s risk for heart disease and stroke, the U.S. Centers for Disease Control and Prevention (CDC) warns. Worldwide, there has been a steady increase in the number of people diagnosed with diabetes. Given the facts, scientists are researching ways to identify people at risk for diabetes earlier. Unlike type 1 diabetes, it is believed that that with early identification, type 2 diabetes may be delayed or even prevented. A diagnosis of prediabetes has emerged as a condition for predicting individuals at risk for type 2 diabetes. Prediabetes can be diagnosed by a physician using standard glucose tests. A fasting blood glucose test (FPG) or an oral glucose tolerance test (OGTT) can be used to identify the condition. These tests measure the level of glucose in the blood. If the level of glucose is found to be within a certain elevated range, prediabetes is diagnosed. The range, in milliliters per deciliter of blood, is 100 to 125 mg/dL for a fasting blood glucose test and 140 to 199 mg/dL for an oral glucose challenge test. Even glucose at the high range of normal may be a concern. A recently completed 12-year Israeli study of more than 13,000 troops found that those with fasting glucose of 95 to 99 mg/dL were several times more likely than those with lower glucose to become diabetic. Studies conducted by the U.S. Department of Health and Human Services indicate that individuals with prediabetes will likely develop type 2 diabetes within 10 years unless changes are made to their lifestyle. In addition, women diagnosed with prediabetes are at a high risk of developing gestational diabetes during pregnancy. Treating prediabetes helps prevent the onset to type 2 diabetes and is important for other reasons as well. Research has shown that medical complications linked to diabetes may actually start in the prediabetes stage. The heart, blood vessels, kidneys and eyes may be damaged during the prediabetes stage. Treatment and prevention in the prediabetic state may slow down the damage of vital organs and body systems. Recent research shows that: Almost 8 percent of the (prediabetic) participants in the Diabetes Prevention Program developed early-stage diabetic retinopathy. People with prediabetes are more likely to develop chronic kidney disease than those with normal glucose, mainly because of cardiovascular risk factors such as high blood pressure. Prediabetes increases the risk of heart disease, according to a nine-year study of more than 28,000 patients. The type of nerve damage associated with diabetes (diabetic neuropathy) can be present in people with prediabetes. Prediabetic women have increased risk of urinary incontinence, which can be improved with weight loss. A condition related to prediabetes that also often develops before type 2 diabetes is insulin resistance, an impairment in the body’s ability to use insulin to process glucose for energy. In addition, people with prediabetes may have a cluster of cardiovascular risk factors known as metabolic syndrome. Reviewed By: Gary Pepper, M.D., FACP

Exams & Tests :: When & What

Exams and Tests

People with type 2 diabetes should see a health professional every 3 to 6 months throughout life for tests and exams to monitor the condition and adjust treatment. You also need yearly screening tests for eye problems (diabetic retinopathy) and kidney problems (diabetic nephropathy).

Every 3 to 6 months :: Visit your health professional for:

* A review of your blood sugar levels since your last checkup. Your health professional may evaluate whether your treatment needs to be changed.
* A blood pressure check. Keep your blood pressure below 130/80 mm Hg.6 If you have high blood pressure, ask whether you should monitor your blood pressure at home.
* An examination of your feet for signs of injury, infection, or other foot problems.
* A hemoglobin A1c or similar test (glycosylated hemoglobin, or glycohemoglobin). If your blood sugar levels are stable and your treatment hasn't changed, this test may be done every 6 months.

Every 6 months :: Visit your dentist for an exam to check for gum problems.

Every year :: Visit an ophthalmologist or optometrist for a dilated eye exam (ophthalmoscopy) to look for signs of diabetic retinopathy and glaucoma, which is increasing in people with diabetes. Some health professionals may recommend less frequent eye exams if you have no signs of diabetic retinopathy or glaucoma.

Visit your health professional for:

* A fasting cholesterol (LDL and HDL) and triglyceride test. If your levels are normal, you may be tested every 2 years.
o Keep your LDL cholesterol level less than 100 mg/dL (2.60 mmol/L), your triglyceride level less than 150 mg/dL (1.7 mmol/L), and if possible, men need to keep their HDL cholesterol level more than 40 mg/dL and women more than 50 mg/dL.7
* A thorough examination of your feet, including testing your ability to feel a thin, flexible piece of plastic.
* A urine test for protein, an indicator of kidney damage. Either of the following tests may be done:3
o Microalbuminuria dipstick test, to estimate the amount of protein in a urine sample
o Spot urine test for microalbuminuria, to measure the exact amount of protein in a urine sample

If one of these urine tests shows 30 micrograms or more of protein per milligram (mcg/mg) of creatinine in your urine, you have some amount of kidney damage.

Other possible tests You may also need:

* A blood glucose test. This test may be used to check the accuracy of your blood sugar meter to see whether your home blood sugar tests are reliable. It also may be done if your health professional is adjusting your diabetes medicine.

* An electrocardiogram (ECG or EKG), if you have had a heart attack or have heart disease or high blood pressure. An EKG may be done after a diabetes diagnosis even if you have not had a heart attack, because people with diabetes have a higher-than-average risk of heart disease. The test also provides a baseline against which to compare future tests in case of chest pain.

* An exercise electrocardiogram (treadmill EKG test) before you begin a vigorous exercise program.

* An electromyogram (EMG) and nerve conduction study, if your health professional suspects that you may have diabetic neuropathy.

* An ankle-brachial index (ABI) measurement, which can be used to test for peripheral arterial disease if you are older than 50.

From : WebMD

Drugs for Diabetes :: Unscrupulous Advertisements

Drugs for diabetes: unscrupulous advertisements
Ashok Kumar Das


As diabetes is a chronic disease, it has become common for unethical people to offer instant cures, and even advise patients to stop treatment with time- tested anti- diabetic agents.

Research is going on, both in type I and type II diabetes, to look into various facets of immune modulation, pancreatic transplants, etc. However, though diabetes can be controlled, at present it cannot be cured. Despite this fact, some people claim that diabetes can be cured, which is completely unethical. Many clinicians find patients being swayed by the claims of advertisements of indigenous medicines, and stopping their treatment. Practitioners and councils of these disciplines do not look into such instances and try to stop this practice. The common belief that ayurvedic drugs are harmless can be very dangerous. Many of these preparations contain toxic metals which if not adequately purified can cause grave harm.

Adjunct, not substitute
Many of the so- called cures are either plant- or metal- based. These agents have some blood sugar lowering properties. However, they cannot control blood sugar. The common belief that a ‘nature cure‘ is more physiological and less harmful is not always true especially in the case of diabetes. These agents, if taken in the proper form and in proper doses can help reduce the doses of either insulin or other oral hypoglycemic agents. Insulin is vital for the sustenance of life. It is almost criminal to claim that type I diabetes patients can live without insulin, or that any other agent can be a proper alternative to insulin. Many patients have lost their lives due to the unethical promotion of these home remedies. Manufacturers purport to back their tall claims with the recommendations of reputed doctors. However, investigations reveal that such statements are quoted in part and out of context.

Importance of control
The fundamental principle of diabetes management is to achieve adequate blood sugar control. Various trials have conclusively proved that strict control of diabetes can be very beneficial for the patient. Complications like gangrene can be reduced by 40 per cent to 60 per cent, simply by controlling blood sugar strictly. This cost- effective treatment needs to be popularised amongst patients as well as doctors. Regular self- monitoring of blood sugar levels is the cornerstone of blood sugar control. This can be done by any patient and at any level of health care. Effective patient education on the importance of blood sugar control will drastically reduce the money spent on treatment of complications. Many manufacturers of “wonder drugs” advocate less stringent blood sugar control. This can cause grave harm to the patient and set in complications like retinopathy and nephropathy.

Early detection, adequate blood sugar control and prompt recognition and treatment of complications remain key elements in tackling diabetes, from the point of view of individual patients as well as public health. However, awareness of these aspects in society and the medical profession is low. One important factor which contributes significantly to the current problem is the unequal distribution and availability of doctors in the country. Diabetes is a disease of both urban and rural areas, but rural diabetics are forced to depend on unqualified or untrained practitioners for the diagnosis and treatment. The large — and increasing — number of diabetic patients may be viewed by unscrupulous people as a golden opportunity to make a quick buck at the expense of vulnerable people.

Need to communicate
Another factor responsible for the prevalent situation is doctors’ apathy and lack of will to spend time with diabetics. Diabetes is a chronic disease linked to lifestyle which includes diet. Doctors must establish proper communication with patients. Besides drugs, other aspects of the treatment such as diet control, stress management and exercise can be implemented only if the patient is motivated and is involved in the treatment. This requires lot of effort on the doctor’s part.

In today’s commercialised practice, doctors don’t spend this time, as a result of which patients go for “wonder cures” for want of adequate scientific information. Quackery in diabetology is emerging as a major factor with serious public health implications, given the large numbers of diabetics expected in the future. There is a desperate need to provide doctors and paramedics with proper training, and to develop cadres of health workers trained in the basic management of diabetes.

In conclusion, there are many misconceptions about diabetes and its treatment, and they have not been dispelled by the medical profession. There is an urgent need for a patient education movement to prevent unethical treatments in diabetes. Diabetes is a relentless disease. Its advance can only be controlled, not stopped. The medical profession has an ethical duty to keep abreast of all new developments which could benefit their patients, and work with their patients to reduce the serious effects of the disease.

India has successfully tackled health care challenges like small pox. However, as a slow killer, diabetes is in a different league and needs a different strategy. At the same time, drugs and doctors cannot control the public health problems of diabetes. We require a cadre of health- care workers to educate patients in diet control, stress management, lifestyle changes and other non- medical aspects of treatment. Doctors, paramedics and other health care workers must be trained in scientific methods of diabetes management with cost- effective technology which is applicable to our country. Only this can prevent unethical exploitation of patients.

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Ashok Kumar Das, Dean, JIPMER, Pondicherry

Diabetes & OMEGA~3

Author: Donald Rudin, MD, Clara Felix

DIABETES AND OMEGA-3

Although it was known in ancient times, diabetes has been an increasingly common problem in this century. It is now among the leading causes of death from noninfectious disease in the United States.

Two hormones produced by the pancreas--insulin and glucagon--cooperate to keep blood sugar, called glucose, at the correct level. When glucose levels are too high, the pancreas sends out insulin to force glucose from the bloodstream into the body's cells. If glucose levels are too low, glucagon sends glucose into the bloodstream for additional energy.

Diabetes occurs in two forms. The most serious form--called juvenile or Type 1 diabetes--usually strikes in childhood. It may arise from an attack by the immune system on either the insulin-producing cells of the pancreas or on the insulin receptors within the tissues. In juvenile diabetes, an essential fatty acid deficiency can cause the immune system to turn against the body instead of defending it.

The more common form--called adult-onset or Type 2 diabetes--usually appears later in life. In people who are predisposed by heredity to this form of diabetes, a diet high in sugar and fiberless carbohydrates can eventually stress the insulin production mechanism. Hypoglycemia, or low blood sugar, may represent an early phase of diabetes, in which a hair-trigger response from the overworked pancreas sends out too much insulin. Eventually, the body stops responding to the pancreas's signals, and blood levels of both insulin and sugar go up.

As we've seen, all hormones, including insulin and glucagon, exert their control over the cells by stimulating production of local regulatory chemicals called prostaglandins. In turn, the prostaglandins pass the message of the hormones to the individual cells. The prostaglandins are made from essential fatty acids. Therefore, a deficiency of essential fatty acids, or of the vitamins or minerals they need to be effective, interferes with prostaglandin production. This can intensify adult-onset diabetes even though adequate insulin is produced.

The essential fatty acids also affect the ability of the body's cells to respond to insulin. In a 1993 study, Australian researchers learned that insulin resistance is related to what kinds of fatty acids make up the cell membranes. The more Omega-3 and Omega-6 fatty acids there are in the cell membranes of adult diabetics, the more their tissues respond to insulin.

Some diabetics seem to be blocked from converting short-chain Omega-6 linoleic acid into the longer-chain acids needed for both cell membranes and prostaglandins. Noted researcher David Horrobin and others are using supplements which contain an Omega-6 oil called gamma linolenic acid (GLA), to bypass the blocked processes. Damage to nerves, a big problem for many diabetic persons, has been halted or even reversed by GLA supplements.

Degeneration of the eye's retina--the projection screen on which light that passes through the eye is thrown--is a common cause of blindness in severe cases of diabetes. An Omega-3 oil called DHA is the most abundant polyunsaturated fat in the retina, an oil that is normally made by the body from the basic Omega-3 oil, ALA. However, the high blood-sugar levels seen in diabetes block the conversion of ALA into DHA. The block may be partly overcome by eating foods, mainly fatty fish, that contain ample amounts of ready-made DHA.

As we've seen in the case of cancer, studies now indicate that dietary fiber can help to prevent diabetes or to affect its course by reducing insulin requirements. I think Omega-3 supplements can do the same thing. A fiber deficiency, coupled with an Omega-3 deficiency, magnifies all the blood sugar problems seen in diabetes. Normally, fiber acts as a buffer in the digestive tract by slowing the release of sugar into the bloodstream.

THE DISEASE-REDUCING POTENTIAL OF OMEGA-3

Since I began to study Omega-3 deficiencies in the early 1980s, research in this field has seen an exponential surge. Between 1985 and 1993, close to 5,000 medical studies on Omega-3 fatty acids emerged worldwide. If anything, the pace has quickened since then, as more and more optimistic reports on Omega-3 benefits in terms of heart disease and other ailments are confirmed.

The original focus of these studies was on the cardiovascular system, but it soon expanded to include studies on cancer, arthritis, psoriasis, and various inflammatory and immune disorders, including kidney disease. Though the emphasis remains on heart disease--the major killer in industrialized countries such as the United States--it is becoming evident that many of these conditions are a result of modernization, and that balancing the essential fatty acids in our diet will rid us of some of the diseases that plague our modern world.

Get The Most From Your Next Doctor's Visit

People with diabetes need a lot of information. To get the right information, you must share many details about your health with your Doctor.

Talk openly about:

• Symptoms
• Any problems you’ve had, including stressful events
• Any changes in your life, including any illnesses since your last appointment
• Why you need help controlling your blood sugar
• Any medicines you have heard about and would like to know if they are right for you
• How you think your medicines are working

Learn about your condition. Take part in treatment decisions. Ask questions.
Remember: There’s no such thing as a dumb question.

This check list can help you recall issues to discuss with your doctor. You can list more details below each item:

* I have severe or frequent low blood sugar(s).
* My blood sugars are higher than my target numbers.
* I’ve noticed a change in my vision, had a sore that was slow to heal, or had other problems that might mean a complication.
* I’m not sure how to take my medicine (list all medicines you’re taking).
* I have high or low blood sugar that I can’t explain.
* I’m not sure how to tell if my medicine is working.
* I’ve had some problems following my Diabetes Action Plan.
* I feel worried and/or depressed about my diabetes.
* I’ve made these changes to my eating and physical activity program.
* Other changes, concerns, or questions.

I am taking these medicines (include any new prescriptions your doctor gives you today):
* Name
* Dose
* When to take it
* If I miss a dose
* Possible side effects

When you’re at your doctor’s office:
* Bring your blood sugar records and go over them at each visit.
* Be honest about your lifestyle and habits, like exercise and meal planning.
* Discuss any prescription medicines, over-the-counter drugs, herbal treatments, or supplements that you take.
* Make a list of questions before your visit.