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Taking a Walk on the Net

My grandmother had diabetes and sometimes she took me to the doctor with her. The visits weren’t so bad because I stayed in the waiting room looking at the pictures on the wall, talking to the other people waiting and reading the magazines. I wasn’t supposed to talk to strangers but my logic a s a kid was that we were all there together for the same thing – to see the doctor so we were sort of a group and not strangers.

At that time the internet hadn’t exploded and hadn’t gotten to the point where you could get a ton of information in just a few minutes by going on a computer and just clicking once you found what you needed.

Today, the internet is astounding. There are many internet companies such a Google, Yahoo and a whole lot more. You can find just about anything you need if you have a computer or use one at the library.

My grandmother died of complications from diabetes. It was before the internet was jam packed with information. Her information came from the doctor and she trusted him.

If you go onto Google right now and type in diabetes, the first page alone will bring up about 13 entries in the middle (they are usually from sources who won’t try to advertise, sell you something or somehow get your money. There are about 10 entries on the right hand margin of the page so unless you need to buy something stay away from these. They are selling and for every sale Google or Yahoo or whomever their information is on, gets some money. If you decide to buy something compare well and know that the company is reputable.

As for the main information just on page 1, there is information from the American Diabetes Association, WebMD Diabetes Center, National Institutes of Health (NIH), Mayo Clinic, Medicine Plus: Diabetes (operated by NIH), Diabetes Risks, Symptoms, Causes and Treatment by emedicinehealth.com.

This is just the first page and there is enough information here to look at your symptoms if you haven’t been diagnosed and decide if you should go to the doctor. There is enough information for you to figure out what to ask the doctor, what to eat and what not to eat, what medications are available and how they work, and more.

There are at least 20 more pages just like this one, including news on various issues that have to do with diabetes including discoveries of new medications that do less harm to the body and control diabetes more efficiently.

Not to harp on it, but this is all on the first page. You can click at the very top of the page on “news” and you’ll get important news on the latest discoveries and treatments, efforts to get more help and funding for diabetes, and more.

So when you have even 15 quiet minutes, get on the computer, type in diabetes when your search engine comes up and find the things you need to know. It’s a great experience, answers questions and is much faster than the old way.

Judge Sonia Sotomayor is being talked about by everyone lately. That is as it should be – she has been nominated by President Barak Obama to sit on the Supreme Court of the United States.

There is another reason, however, that some people are talking about her, as well. Judge Sotomayor was diagnosed with type 1 diabetes on her 10th birthday. One hundred years ago – or even a few decades ago, getting a good job would have been nearly impossible for Judge Sotomayor or even getting a botton-of-the-barrel job.

There was no real understanding of diabetes or disabilities, and there was certainly no understanding that diabetes did not have to be a disability. Once insulin was discovered in 1921, many things started changing for people with diabetes. It made it possible for them to excel and contribute just like anyone else.
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Diabetes is a very insidious disease and most people have diabetes or pre-diabetes before they or their doctor realize it. Why? In most cases people begin to experience a symptom or two and can attribute it to something else. For instance, if you start to experience extreme thirst, especially on a regular basis, you may attribute it to the food you are eating. For instance, garlic or spicy food can cause extra thirst, so you might not attribute the thirst from diabetes. Why would you?

Another symptom of diabetes is excessive urination. Most people don’t associate that issue with diabetes. Some men associate it with prostrate issues. Other individuals associate it with the fact that they drink a lot of water or other liquids, which goes back to excessive thirst and drinking a lot.

Quite often individuals with diabetes or pre-diabetes experience tingling in their hands arms and eventually pain in their feet. Instead of associating these symptoms of diabetes, they think of carpal-tunnel, bad shoes and other issues when in reality, the problem could be neuropathy – damage to the nerves – due to diabetes. It is essential to check with your doctor regarding this – especially if your feet are tingling, burning, feeling like you are walking on sand or throbbing. This is usually a sign that you may have diabetes.

There used to be few treatments for diabetes, but now ther are any number of medications available, including insulin, to treat the symptoms. There are special diets, various medications to deal with the neuropathy, pain and other related issues.

If you are experiencing any of these symptoms or any combination of them see your doctor and let him or her know. The reason that diabetes is often not diagnosed is that the symptoms are never reported to the doctor. If you discuss this with your doctor and he/she does not order tests to see if you have diabetes, push harder for one. If that does not work, consult another doctor for a second opinion. Many internists and endocrinologists deal with diabetes a great deal and are experts in identifying and treating the disease.

Diabetes starts long before the symptoms appear. The sooner your doctor can start tracking blood glucose levels, the sooner you can start avoiding diabetes. Researchers have now found after tracking over 6,500 people that glucose levels begin to change up to 13 years before the onset of diabetes. If it is possible to deal with those changes early, it is possible to change diet, exercise and a few other lifestyle habits that will delay or eliminate the chances of a person getting diabetes.

If you already have symptoms such as excessive thirst, tingling or pain in your hands and feet, having to urinate more than often or vision changes, check with your doctor as soon as possible and get tested. Getting tested for diabetes has become much more simple than in the past and the results are more accurate. Once you know if you have diabetes or pre-diabetes you will be able to start treating it so that it does less damage to your body.

Since diabetes is so insidious, it is important to look for the signs in the paragraph above. Diabetes is different for everyone, but diet, exercise, regular visits to your doctor, using a glucose monitor daily – as many times as your doctor prescribes – and taking any medication or insulin your doctor gives you is essential to warding off more serious problems and complications.

Some people have neuropathy as a result of diabetes. Usually their feet tingle, burn or hurt and their hands and sometimes arms tingle or have throbbing pain. This is because the nerves are being damaged by the diabetes. Your doctor can prescribe medication that will deal with both the pain and work with the nerves.
There are many more choices of medication and treatment for diabetes than there were even a decade ago.

A close family friend was diagnosed with diabetes many years ago when the options were basically oral medication or insulin shots. I remember how painful the glucose checks were because the lancets were much more midievel than they are now. She took pills and changed her diet and finally had to go on insulin shots. Other than that and some extra exercise – in her case, walking more – she lived for many years after the diagnosis. When she finally had to go on dialysis, at first she went to the hospital to have it done and then she got a portable dialysis machine that she could use at home. When her feet hurt, she used an electric wheel chair when she went shopping every week.

She lived a full life with her children and grandchildren and died in her early 80′s which is considered at least 2 years longer than average. She lived to see her 4th grandchild turn 1. That was her last grandchild, so this was a special gift. She told me that she knew she was going to die soon because of some of the acute changes in her body but she said she was OK with dying because she had a long life, traveled, had a wonderful husband, children and grandchildren and had outlived most of her friends. She was not unhappy about dying, but she said it wouldn’t be her first choice. What she did say that was profound was that because she did what her doctor said, changed her diet, lost weight early in the game and took her glucose measurements and her medication like clockwowrk every day, she was in charge of her diabetes, it was not in charge of her. She said that because of this, she kept the more difficult symptoms under control much longer and she lived much longer, too.

When you hear someone who has diabetes and is at the end of their life and knows it telling you these things, it is sobering. What she said has changed my life and the lives of others, helping them to live healthier – either to avoid diabetes or to control their diabetes. Whether you have diabetes or not, the information she gave me is invaluable for all of us.

Diabetes brings on a host of issues including the nerve pain called diabetic neuropathy. If you are suffering from diabetic neuropathy treatment is important.

Some symptoms og diabetic neuropathy are obvious: pain in your feet. But more subtle signs of neuropathy are just as critical to notice and get treatment for.

“We ask whether people are having unusual tingling or numbness,” says Dace L. Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle. Those symptoms are signs of possible nerve damage, and are just as important as nerve pain.
Nerve pain and damage in your hands or feet is called peripheral neuropathy.

Continued glucose control can help reduce the possible risk of complications such as diabetic neuropathy, says the American Diabetes Association (ADA). Nerve damage caused by diabetes generally occurs over years and is due to a prolonged high blood sugars, as well as other factors. If you are doing what you can to control your diabetes, it will help to control your neuropathy and protect your nerves, as well.

There are three main things that you can do to keep your diabetic neuropathy and diabetes under control:

Get – and keep – Your Blood Sugar Under Control
The experts all agree: the first step in treating diabetic nerve pain is to bring your glucose levels under control.

The best ways to do this are to use your glucose meter throughout the day. “We suggest that people get a better picture of what’s happening to their blood sugar levels throughout the day,” says Trence. “Sometimes that can be helpful, particularly if the person hasn’t been checking that frequently.”

In addition, Meet your target.
While individual blood glucose goals may vary, the National Diabetes Information Clearinghouse (NDIC) gives these general guidelines:
before meals: 90 – 130 mg/dL
1 to 2 hours after starting a meal: less than 180 mg/dL
Your doctor may have advised different numbers for you, based on your symptoms of nerve pain and other diabetes complications. Always follow your doctor’s specific advice on the glucose goal that’s right for you.

Make sure to Eat right.
A diet that helps treat nerve pain is really no different than a good, healthy, balanced diet, says Trence. “The emphasis is really on blood sugar control,” she says. A good diet outlines what to eat, when to eat, how much to eat, and allows for healthy snacks.

Be active and exercise.
Try to be active for 30 minutes on most days. Exercise helps to lower your blood sugar, so it’s a way to help manage diabetes complications like nerve pain – and help keep your blood pressure and blood fats under control. Talk to your doctor about what is right for you.

Take the A1c test.
In addition to your glucose meter, this test shows whether you’re controlling your blood sugar over time. The A1c test is a simple blood test that measures the average amount of glucose in your blood for the previous 2 to 3 months, and the NDIC recommends taking it at least twice a year. But you can do it more often. “Most of us are really believing it should be done every 3 to 4 months,” says Trence. “It’s such a powerful piece of information to have, to complement a patient’s own blood sugars.”

Strict blood sugar control means an average level of A1c of less than 7%. If your test results are higher than 8%, you should talk to your doctor about any necessary changes in how you’re managing your diabetes. An A1c higher than 7% means that you have a greater chance of eye disease, kidney disease, and nerve damage.

Consider your diabetes medications.
“Sometimes, the blood sugar just has not achieved the target that is ideal,” says Trence, “so we switch therapies to get better control.” A side benefit may be relief from nerve pain. In a recent study in Diabetes Care, published by the ADA, people who used insulin injections for strict glucose control were less likely to get neuropathy. And those on an intensive regimen of taking insulin 3 or more times a day lowered their chances of tingling, burning, and other symptoms of neuropathy by 64% – a significant benefitn
Make sure to treat your nerve pain. There are many options to soothe diabetic nerve pain, depending on your symptoms and their severity.

Talk to your doctor about self care.
Warm baths and frequent walks, for some people, can relieve mild symptoms of peripheral nerve pain. Ask your doctor if baths and walks are safe for you, since they could interfere with healing if you have cuts or sores in your feet. Wear shoes that fit well and allow your toes to move.

Ask about pain medications.
Pain can be a difficult symptom to control, so it may take time to find the right treatment for you. Cymbalta and Lyrica are the only FDA-approved medications for the treatment of painful diabetic neuropathy; however, your doctor might suggest other treatments thar can be effective for pain control including
Prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs), Narcotics, Antidepressants such as Amitril, Norpramin or Tofranil.Antiseizure medications such as Dilantin, Tegretol, Neurontin or Lamictal
or other medications block or reduce the release of chemicals that cause pain to be transmitted.

You can also try other therapies. Acupuncture works to treat nerve pain for some people, says Trence, as does anodyne therapy, a treatment that uses infrared light to soothe pain, usually done in a physical therapy office.

“[Vitamin] B-12 actually can work,” says Trence. “The problem is that if you take too much of it, it can cause its own neuropathies.”

Surgical decompression of multiple peripheral nerves (called the Dellon procedure) is an alternative method for treating diabetic neuropathy.

Once your nerve pain is under control, there are things you can do to try to delay further damage to your nerves. Keep close daily control of your glucose, and avoid big swings in blood sugar. Keep exercising regularly and eating right. Lose weight if you need to, since excess weight puts more pressure on painful feet. Take special care of your feet -which is essential since nerve damage is so common in the feet.

Evidence of insulin resistance and changes in blood sugar linked to type 2 diabetes can be measured more than a decade before the disease actually occurs. This poses a problem for people with prediabetes because
the prevention efforts that focus on people with prediabetes may come too late to make a big difference.

The findings were presented today at the 69th Scientific Sessions of the American Diabetes Association in New Orleans, and they also appear in the latest online issue of the journal The Lancet.

Researchers monitored more than 6,500 British civil servants without diabetes for up to 13 years, during which time they repeatedly measured insulin sensitivity and fasting and non-fasting glucose levels. During an average follow-up of 10 years, 505 of the study participants developed type 2 diabetes.

The most specific findings were that there was a steady trend in fasting glucose as early as 13 years prior to the diagnosis of type 2 diabetes, with fasting glucose levels rising rapidly three years before diagnosis. In addition, glucose levels after eating (post-meal glucose) began to increase rapidly starting three years prior to diagnosis, and insulin sensitivity began to decline steeply five years before diagnosis.

Beta-cell function — a measure of insulin production — began to increase three to four years prior to diagnosis, as the pancreas tried to compensate for increases in blood glucose by producing more insulin. Insulin production dropped precipitously in the three years prior to a diagnosis of type 2 diabetes.

“The main addition of this study is that it shows for the first time a clear picture of the timeline to diabetes,” study co-author Daniel R. Witte, MD, of the University College London tells WebMD.

Witte says the timeline suggests three distinct phases in the progression to diabetes, which may require different disease prevention strategies.

During the first phase, which occurs six or more years before diagnosis, glucose levels remain relatively stable but insulin resistance increases along with insulin secretion.

“This is the time when relatively straightforward lifestyle changes, like increasing physical activity, changing diet, and reducing obesity, could have the biggest impact,” he says.

The second phase of progression to disease is characterized by increased beta-cell activity as the pancreas produces more insulin to compensate for insulin resistance.

Witte says prevention efforts during this period may require more aggressive lifestyle intervention along with blood-sugar regulating medications like metformin.

During the final phase toward progression, which Witte refers to as the unstable phase, insulin production drops and blood glucose levels rise dramatically and rapidly.

The study suggests that people who are generally considered to have prediabetes are in this final phase or close to it.

“We hypothesize that prevention would be more effective before this unstable period, but more research is needed to identify people at this stage of disease development.”

Quotes and some information from WebMD