Diabetics may have hypoglycemia, also called low blood glucose or insulin reaction. It happens when a person misses a meal or eats less than usual, perform strenuous exercise or takes too much insulin or oral medication; these may cause the blood glucose level to drop too low and produce insufficient amount of energy for body activities. In most cases, when patients’ glucose level is below 70 gm/dL (3.8 mmol/L), it is then treated as hypoglycemia. Please consult your health provider for the target blood glucose range that is best for you.
If hypoglycemia is untreated, it can lead to confusion, coma or convulsions.
People with diabetes can prevent hypoglycemia by following regular daily schedules. Remember to check the blood glucose regularly, and take necessary actions when you have low blood glucose.
Hyperglycemia is also called high blood glucose; it happens when the body does not have enough insulin or when the body can not use insulin properly.
It is caused by overeating, not taking enough diabetes medication, stress or illness.
High blood glucose happens gradually, patient may not notice the sign; please consult your doctor for your target blood glucose range that best suits you.
Hyperglycemia may lead to long-term complications, such as heart disease, kidney disease nerve damage and etc. It can be avoided if you can control your blood glucose within the health range. Talk to your health care provider about the best way to treat hyperglycemia.
This information is for general care for people with diabetes. If you need a more specific guideline, please consult your healthcare provider for detail suggestions.
Diabetes mellitus (DM) is characterized by an abnormally high blood sugar level due to insufficient amounts of the insulin hormone. Tuberculosis (TB) is an infectious disease caused by bacteria called Mycobacterium tuberculosis, which typically attacks the lungs. Some studies show that people with diabetes, especially Type 2, are 3-4 times more likely to get TB than those who do not have diabetes.
The UTSPH (University of Texas School of Public Health - Brownsville Regional Campus) outlined results from 3 new studies about Diabetes and TB:
• Type 2 diabetes is associated with an altered immune response to TB, which has particularly been found in patients with chronically high blood sugar.
• Patients with diabetes and TB take longer to respond to anti-TB treatment.
• Patients with active TB and Type 2 diabetes are more likely to have multi-drug resistant TB.
Symptoms of Tuberculosis:
• Chest pain
• Coughing up blood or bloody sputum
• Rapid weight loss
• Night sweats
• If you have diabetes and a chronic cough, ask to be tested for tuberculosis, especially if you have recently been to or live in an area where the rate of tuberculosis is high.
As a diabetic, how do I protect myself from tuberculosis?
If you have diabetes, it's essential that you boost your immune system to avoid getting tuberculosis and other illnesses. The following strategies are recommended:
• Control your blood sugar
The risk of tuberculosis increases when hyperglycemia is uncontrolled so it is important to monitor your blood glucose levels daily and take your insulin injections or other diabetes medication, as prescribed. Also, try to eat a healthy diet that contains low-glycemic foods.
• Be more physically active
Exercise can give your immune system a healthy workout, while it also releases stress and tension that weaken your immune system.
The tuberculosis bacteria are airborne and transmitted through inhalation of droplets from coughing, sneezing, or talking in close proximity with an infected person.
• Avoid standing too close to people when they are coughing.
• Wash your hands frequently, especially when you have been around people with chronic coughs.
• Wear a mask. A special, high-microfiltration mask will keep the TB bacteria from invading your respiratory system.
• Do not share the same tableware with people who have TB.
• Get more fresh air.
This information is a general care guideline for people with diabetes and tuberculosis. If you have been diagnosed with diabetes and/or tuberculosis, please visit your health care provider to design a specific plan fit for your needs.
Diabetic neuropathy is long-term damage to nerve fibers. High blood sugar levels can damage blood vessels causing serious nerve damage over time. Different types of nerves can be affected, including sensory, motor, and autonomic nerves. Sensory nerves cause people to feel pain, temperature changes, and other sensations. Motor nerves give control and tone our muscles, while autonomic nerves control involuntary functions, such as sweating.
Anyone who has diabetes can develop nerve damage, but diabetics can be more susceptible based on the following factors.
Poor blood sugar control
This is the greatest risk factor for every complication of diabetes, including nerve damage. Keeping blood sugar consistent with your target range is the best way to protect the health of your nerves and blood vessels.
Length of time you have diabetes
Your risk of diabetic neuropathy increases with the length of time that you have had diabetes, especially if your blood sugar isn't well controlled. Peripheral neuropathy is most common in people who have had diabetes for at least 25 years
Diabetes can cause damage to the kidneys, which can increase the toxins in the blood and contribute to nerve damage.
Smoking narrows and hardens your arteries, reducing blood flow to your legs and feet. This makes it more difficult for wounds to heal
There are four types of diabetic neuropathy: proximal, peripheral, autonomic and focal
Peripheral Nerve Damage
Peripheral Nerve Damage is the most common type in diabetics, affecting the person’s legs, arms, hands, and feet. The most common symptom is experiencing less sensation in their feet. The nerve damage can affect the person’s feet and eventually spread up to their legs. This lack of sensation in their feet makes them more prone to injury. This type of neuropathy combined with poor circulation can easily lead to ulcers and infections.
Autonomic Nerve Damage
Autonomic nerves control involuntary functions, such as blood pressure, body temperature, breathing, pulse rate, and the digestive system. These nerves also play a role in the erectile function of men. The fibers of the autonomic system reach every part of the body and are connected to the brain and spinal cord.
Autonomic neuropathy can cause changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure. Autonomic neuropathy can also cause hypoglycemia (low blood sugar) unawareness, a dangerous condition in which people no longer experience the warning signs of hypoglycemia.
Proximal Nerve Damage
Instead of affecting the ends of nerves, like peripheral neuropathy, proximal neuropathy affects nerves closer to your hips or shoulders. This type of neuropathy is more common in people with type 2 diabetes and senior adults. The nerves in the arms, legs, and abdomen may be affected. Symptoms are usually on one side of the body, although they may spread to the other side too. Most people improve at least partially over time, though symptoms may worsen before they get better. This condition is often marked by:
Focal Nerve Damage
Focal nerve damage or mononeuropathy is damage to just one nerve. The nerve may be in a person’s arm, leg, or face. It's most common in seniors and often comes on suddenly. Although this type of nerve damage can cause severe pain, it usually doesn't cause any long-term problems. Signs and symptoms depend on which nerve is involved and may include:
Symptoms usually diminish and disappear on their own over a few weeks or months.
The good news is that many of the risk factors for diabetic neuropathy are under your control. So while you may not be able to prevent nerve pain and damage completely, you may be able to help slow it down. You can reduce your risk of nerve damage and other diabetes complications by keeping your blood sugar level under tight control.
The better your blood sugar is controlled, the less likely nerve damage will progress. Through frequent self-testing, you can monitor your diabetes on a day-to-day basis to avoid hyperglycemia. A healthy lifestyle helps lower your chance of heart disease, stroke, and other serious health problems, be aware of the risk of complications, and work to control the ones you can monitor.
This material is general information for diabetes and neuropathy. Please consult your healthcare provider for a more individualized treatment plan for your health.
Diabetes is a serious health problem that affects millions of people in the world. People are always encouraged to eat healthy and do more physical activities to lower the risk or prevent diabetes. When diabetes is not well controlled, health complications will begin to follow. One example of a serious complication is Chronic Kidney Disease (CKD). Studies have shown that diabetes has become the major cause of kidney failure.
Chronic Kidney Disease
Chronic kidney disease means that the kidney does not have the ability to perform its functions. A healthy kidney should:
Once the kidney is damaged, they will not be able to filter your blood or perform other tasks. As a result, the waste can start to build up in your blood. There are five stages of CKD. Initially, people at early stages usually feel fine. When CKD has reached the kidney failure stage, then patients might feel really sick, in which a transplant or dialysis would be the only way to survive.
**Ref: National Kidney Foundation, Diabetes and Chronic Kidney Disease
How can diabetes harm the kidneys?
There are three common damages that diabetes can do to the kidney
Tips to prevent kidney disease?
Tests to see how your kidneys are doing
Perform the tests listed below regularly to keep track of your progress, in order to get a better understanding of what is affecting how your kidneys are functioning.
This material is general information for diabetes and kidney disease. If you need a more specific treatment for your health, please consult your healthcare provider.
Diabetes is a disease in which the body cannot use glucose correctly. People diagnosed with diabetes have complications such as kidney, nerve, eye, heart and feet diseases. What many people are not aware of is that Diabetes can also cause foot problems.
A high blood glucose level can cause people to experience pain in their feet. When your blood sugar level is high, the nerves and blood vessels in your feet and legs could become damaged. It is important to control and lower your blood sugar level because studies have shown that it can reduce the risk of nerve damage. If not properly treated or managed, the nerve and vascular damage in the feet can lead to hard to heal ulcers, which has become one of the contributing factors to the increasing rate of amputations for people with diabetes.
There are three conditions that may result in foot problems for diabetes:
- Neuropathy: the damage of the nerves in the feet and legs. Individuals may experience numbness and tingling in their feet, which may progress to pain. Diabetics might also develop dry skin that can lead to cracking, which increases the risk of infection and wounds.
- Vascular Disease: Blood vessels can become damaged over time from chronic hyperglycemia which causes the blood vessels that supply oxygen and nutrients to the legs and feet to narrow and harden. This causes pain and can impact your ability to fight infections. Another symptom is the swelling of your legs and feet.
- Foot Deformities: Nerve damage and other minor food injuries can eventually lead to a change in the physical structure of the bones in the feet. A changing bone structure will affect the normal pressure distribution and can eventually cause foot deformities, which can lead to the development of foot ulcers and wounds.
Five Easy Steps to Healthy Feet
Serious foot problems are preventable with proper care. Start with the following five
Manage your diabetes by
Practice good foot care habits by
Inspect your feet every day by
Treat Problems right away by
Visit your healthcare provider regularly
This information is for general foot care guidelines for people with diabetes. If you need a more specific treatment for your health, please consult your health care provider.
With the characteristics of high mortality and disability rate and multiple complications, diabetes is becoming one of the major concerns in world public health. Eye disease is one of the primary diabetic complications. It is a complication that people with diabetes face when blood glucose levels are not well managed. This material is prepared for people with diabetes to give some ideas to avoid eye problems. If you have diabetes, please have a dilated eye examination at least once a year
What is Diabetes Eye Disease?
Diabetes eye disease is a complication of diabetes and it may lead to blindness. There are no symptoms in the early stages of diabetic eye disease. Diabetes eye disease includes diabetic retinopathy, cataracts and glaucoma.
Diabetic retinopathy is the most common diabetic eye disease that can lead to vision loss. It is estimated that 40.8% of adults aged 40 and older with diabetes have diabetic retinopathy. It is caused by changes in the blood vessels of the retina, often resulting in blurry vision or blindness. There are two treatments for this complication; one treatment is using laser to seal the bleeding blood vessels and the other treatment is to suction out the blood in the eye. Before making any decisions, please consult with your physician for more details.
Cataract is an eye complication where clouding of the eyes’ lens occurs. This usually leads to blocking of light and affecting the patient’s vision. People with diabetes also tend to get cataracts at a younger age, and this complication can progress quickly. In order to remove the cataract, surgery is necessary.
Glaucoma is a complication that occurs when pressure builds up in the eye. The pressure may damage the optic nerve and gradually lead to vision lost. Diabetes has an increased chance of getting glaucoma when compared to others; the longer a person has diabetes, the higher the chance of this complication. Treatments for glaucoma include medication, laser therapy and surgery.
What are the signs of diabetes retina damage?
How to prevent diabetes eye problems?
When to see an eye care professional?
This information is for general eye care of people with diabetes. If you have eye problems, please visit your eye care professional for detail suggestions.
The number of patients with both diabetes and HIV has been steadily increasing in the last decade. Early detection and better management have led to improved survival rates for HIV patients with diabetes. Patients with diabetes and HIV are more susceptible to other metabolic disorders. In the future, as the treatment of HIV evolves and access to therapy is increased, the number of diagnosed HIV-associated diabetics is bound to grow more. This makes understanding how to manage it essential.
What is the relationship between HIV and diabetes?
HIV and diabetes are both chronic diseases that significantly affect lifestyle. Studies suggest that anti-retroviral therapy (ART) may cause diabetes in some HIV positive people.
The three drugs in the anti-retroviral drug “cocktail” are a protease inhibitor (PI) and two nucleoside reverse transcriptase inhibitors (RTIs). These drugs help stop the virus from replicating and spreading throughout the body. A study of HIV-positive patients suggests that the interaction of the three drugs in the cocktail causes fat to collect in the patient’s abdominal area. The cocktail is also responsible for weight loss in the arms, legs and face.
In addition, the drugs may interfere with certain proteins that are involved in controlling the body’s absorption of blood sugar. This can lead to the development of diabetes. ART is associated with insulin resistance, a common cause of Type 2 diabetes.
Studies show that five to twenty percent of patients on PI-based ART will develop insulin resistance and about one to five percent will actually develop diabetes.
How does HIV affect people who already have diabetes?
It is likely that a patient with diabetes that starts taking ART may find it difficult to control their diabetes. This could lead to an increase in the risk of developing heart disease and other diabetes-related complications.
It is believed that patients with both HIV and diabetes can live a healthy lifestyle, as long as they have access to good care and keep their diabetes under control by following a healthy diet and exercise regimen.
Some unique specifications of diabetes management for patients with HIV are listed and discussed below:
Lifestyle modifications, including changes in diet, frequent exercise and quitting of smoking are important. Psychological support should be offered to help patients deal with the stress of having both diabetes and HIV.
Psychosocial support is an integral part of effective diabetes management. It is even more important for patients who have to handle the increased stress of diabetes and HIV.
Strategies to support behavioral change need to be individualized based on culture, age and gender. The WATER approach, coined at Bharti Hospital, Karnal, India, is an effective method of motivational interviewing. WATER stands for Welcome Warmly, Ask and Assess, Tell the Truth, Explain it with Empathy, and Reassure and encourage to Return. These five points encapsulate the basic principles of diabetes/HIV counseling, and they provide an easy method for teaching health care providers how to work with patients.
Training on how to cope also should be provided to all HIV patients. It should focus on enhancing positive coping strategies, confidence and self-esteem.
Some Other Health Factors to Watch
It’s important to monitor the factors that can contribute to the risk of heart disease and strokes. These include high blood pressure, blood glucose, cholesterol and triglyceride levels. Visit your doctor for check-ups regularly. HIV patients with diabetes can work with their health care providers to achieve successful diabetes control by timely monitoring and managing HIV and other health concerns. Keeping your diabetes under control or decreasing your risk of getting diabetes, will give you the best chance for overall good health.
People with diabetes are twice as likely to be at risk of having a heart attack or stroke than someone without diabetes. Heart disease is the leading cause of early death among people with diabetes. Making changes to your lifestyle and keeping your blood glucose under control can help reduce the risk of heart disease and stroke.
People with diabetes can keep track of the ABC’s of diabetes to make sure their blood glucose levels are under control. Talk to your health care provider about the best targets for you.
A is for A1c
A1c tests reflect your average blood glucose control over the past 3 months. The higher your A1c level, the higher your risk of diabetes complications. Even a small drop in A1c reduces the risks of heart disease. Keeping your A1c result less than 7% is very important.
B is for Blood Pressure
People with diabetes often have high blood pressure because they have narrowed blood vessels, which create a smaller opening for blood to flow through. High blood pressure increases your risk for heart and kidney disease. The ideal blood pressure is less than 130 over 80 mmHg.
C is for Cholesterol
Too much Cholesterol in your blood can clog your arteries and lead to heart disease. Target lipid levels for people with diabetes are:
Total cholesterol: less than 200 mg/dL
LDL (bad) cholesterol: less than 100 mg/dL
HDL cholesterol: more than 40 for men, more than 50 for women mg/dL
Triglycerides: less than 150 mg/dL
Heart and Blood Vessel Disease
Two major types of heart and blood vessel disease that are common in people with diabetes are coronary artery disease and cerebral vascular disease. Diabetes can also make your blood cholesterol level too high. When cholesterol is too high, your blood vessels become narrowed or clogged.
Coronary artery disease is caused by a narrowing or blocking of the blood vessels that go to your heart. When the blood supply is reduced or stopped, it can result in a heart attack.
Cerebral vascular disease affects blood flow to the brain, leading to stokes and TIAs (risk for a future stroke).
Warning Signs of Heart Disease
A stroke, sometimes called a "brain attack", occurs when blood supply to part of your brain is interrupted and brain tissue is damaged. The most common cause is a blocked blood vessel. Again, diabetes contributes to damaged blood vessels that become more prone to blockage. Stroke can cause physical problems, such as paralysis, problems with thinking or speaking, and emotional problems.
Warning signs of a stroke
Typical warning signs of a stroke develop suddenly and can include:
Sometimes, one or more of these warning signs may happen and then disappear. It is important to take immediate action if you have any of these signs.
Tips to prevent or reduce the risk of heart disease and stroke
This information is general guidelines to prevent heart disease for people with diabetes. If you need a more specific treatment, please consult your health care provider for more detailed suggestions.
Diabetes affects millions of people each year globally and it can also cause problems with your eyes, heart, kidneys, nerves and teeth. People with diabetes are at higher risk for gum and tooth diseases such as cavities, gingivitis and periodontal disease.