Diabetes Care - FAQs

Diabetes Mellitus Frequently Asked Questions

By

Tejas Limaye

Just for Hearts

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What are common eye problems associated with diabetes?

The common eye problems associated with diabetes including the following:

· GLAUCOMA

· CATARACTS

· RETINOPATHY

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TM Diabetes Mellitus –Frequently Asked Questions 2015

What is GLAUCOMA?

Sometimes, the interior of the eye can be subjected to a buildup of pressure. This

results in a condition known as Glaucoma. The pressure pushes the blood

vessels that carry blood to the retina and optic nerve leading to its damage. As a

consequence vision is gradually lost. People with Type 2 diabetes are twice as

likely to develop glaucoma as compared to non-diabetics.

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What exactly do you mean by CATARACTS?

If the normally clear lens in your eye becomes cloudy, it is known as a cataract.

People with Type 2 diabetes are twice as likely to develop this eye condition. With

cataracts, the eye's clear lens clods, blocking light. Leading to blurred vision.

Sunglasses or glare control glasses can go a long way towards preventing mild

cataracts. For cataracts that interferes greatly with vision, surgery often helps

people see clearly again.

What is Diabetic Retinopathy?

Diabetes can destroy the small blood vessels that supply blood to the retina,

causing them to leak blood to the retina, causing them to leak blood or other

fluids into the eye. This condition is known as diabetic retinopathy. The simple

truth is that the longer you have had diabetes, the more likely you are to have

retinopathy.

If it is diagnosed early enough, retinopathy can often be slowed or stopped

altogether. High blood sugar, high blood pressure, duration of diabetes and

heredity are important factors influencing the development of diabetic

retinopathy. Diabetics who keep their sugar levels closer to normal are less likely

to have retinopathy. Huge strides have been made in the treatment of diabetic

retinopathy and various treatment options are available. However, the success

of these treatments depends on early diagnosis. The best result occurs when

sight is still normal. However, once the damaged has been done, the effects are

usually permanent.






What steps can be taken to prevent eye problems?



All it takes is a little attention to a few details:

l Keep your blood sugar levels under control.

l Keep your blood pressure under control.

l Quit smoking

How often should you see an eye specialist?

You should see your eye specialist at least once a year. An annual dilated eye

examination is a must if you are 10-29 year old and have had diabetes for at least

5 years. But if you are 30 or more, you will have to get your checkups regularly,

even if you have a short diabetic history. More frequent checkups may be

necessary if you already have an eye disease.

An eye checkup for diabetics is required if:

l

l Reading becomes troublesome.

l You have double vision.

l One or both of your eyes hurt.

l You see sports or floaters.

l Your side vision is affected.

Be sure to discuss your exercise program with your eye specialist.

Some activities can raise the pressure inside your eye and lead to bleeding

in the retina.

Your vision becomes blurry.






Why is exercise important for people with diabetes?


TM

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Diabetes Mellitus –Frequently Asked Questions 2015

Exercise is beneficial for diabetics in two ways. To begin with, exercise can take

some glucose out of the blood to use for energy during after exercise. This is

essential because exercise lower blood glucose levels. Secondly, it helps delay

or stop large blood vessel ailments and heart disease. The latter is the leading

killer of people with diabetes. All people with increased risk of heart disease, to

reach and maintain a healthy weight, and to enjoy themselves. An additional

benefit for many people with diabetes is that exercise, plus healthy Diet and

lifestyle habits, can help them achieve good blood glucose control.

How do I get started?

Your first steps toward a more active lifestyle should begin with a thorough

medical examination. This is the only way to make sure your exercise

programme meets your individual needs. One exercise programme does not

suit all. Everyone is different, and your exercise plan needs to be based on

your healthcare team will give you the confidence of knowing that you're

doing all you can to avoid the pitfalls and read only the benefits of exercise.

Is it a good idea to drink fluids while I exercise?

Drinking fluids while exercise is a good idea. In fact you should sip some fluid

every 10min while you exercise. Also try to drink something not only while

exercise but also before and after. This helps prevent dehydration and helps to

replenish the fluids and nutrients your body loses during exercise. This is

especially important for people with diabetes.




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I am elderly and it is rather bard for me to get around. Should I still try

to exercise?

You should try to exercise regardless of your age. It is difficult to get out, you

can do various stretches at home and even while sitting down. As our bodies

age, warming up with stretching exercise become more and more important.

You may find that after properly stretching exercise become more and more

important. You may find that after properly stretching, you can do more than

what you thought you could.

I have both diabetes and arthritis. Can I still workout?

Yes you can, but try two things to make exercise safer. Firstly, make sure you

stretch before all exercise, which will strengthen your muscle and make you

feel better.

Is there a limit to the types of exercise a person with diabetes can do?

There is no limit to what people with diabetes can do. Barring another medical

condition, people with diabetes can do anything and everything. You can walk,

cycle, swim, or like. These are only examples and everyone is different. So be

sure to ask your physician if you should have any limit imposed on your exercise

program.

If I workout at the gym, what is the best machine I can use on a daily

basis?

Stair climbers and treadmills are excellent machines to use at the gym. They

simulate walking, running and climbing which can help burn fat, build

endurance, and strengthen the cardio-vascular system. Weightlifting can also

provide a great workout. The important thing is to find something you enjoy,

and exercise safety.











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What is the best exercise to improve my blood-sugar levels?

Walking seems to be an excellent exercise for a majority of people. Again, it is

best to consult your physician to tailor an exercise program to fit your particular

situation.

As part of my workout is it helpful to ride on a stationary bicycle?

Riding a stationary bicycle not only gives you a greater aerobic workout, but it

also strengthens your legs and helps build muscular endurance.

If I lower my blood sugar levels, is there a possibility that I could gain

weight?

Yes, there is that possibility. To decrease your chances of gaining weight, start

exercising more often and more intensely and reduce the amount of food that

you eat. Consult your diet and exercise program accordingly.

If I have diabetes, what is the most effective way to lose weight?

Regular exercise and good nutrition is the key to weight loss. Regular exercise

helps you lose weight by burning calories and increasing your metabolism.

Eating well balanced meals and controlling your calorie intake can further your

weight loss effects.











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If I am planning on losing weight, why can't I just diet instead of exercise?

If you want to achieve permanent weight loss, most diet doesn't work

themselves. A diet that severely restricts calories is dangerous for anyone,

especially if one has diabetes. Exercise, combined with your diet plan, helps

maintain weight loss and strengthens your body. Exercise can do more than

simply make you feel good. It can also help control your blood sugar.

Who is at risk of developing Heart Diseases?

The risk of heart disease among diabetics is further increased by other factors

such as high blood pressure, high cholesterol, a family history of heart disease,

smoking habits, obesity or a sedentary lifestyle.

What are the symptoms of heart disease?

The common symptoms of heart disease include breathlessness, dizziness,

pain in the chest, arms, Shoulder, or back, visual disturbance, tiredness,

swelling of the ankles or feet etc.

How to minimize the risk of heart disease?

Although diabetics are at a greater risk, simple precautions such as

controlling blood sugar, blood pressure and cholesterol, eating a heart-

healthy diet and regular exercise can help prevent the development of heart

disease.

Why you need to Control your blood sugar?

High blood sugar can make blood vessels throughout the body clog up and

create circulation problems, which can lead to many complications such as

heart attack and stroke. Keeping your sugar as close to normal as possible

significantly lower the risk of heart disease.











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If you smoke, quit smoking

Smoking narrows blood vessels and increases the levels of fact of fat in your

blood. Cessation of smoking makes you less vulnerable to heart disease and

stroke.

Does high blood pressure affect heart disease?

Diabetics with high blood pressure are at the greatest risk of developing heart

disease. Therefore, control of blood pressure is of paramount importance in

protecting the heart. Losing weight, reducing salt in the diet and appropriate

medication will help you control your blood pressure.

In what range should my cholesterol be?

You can decrease your cholesterol by changing your eating habits and by

doing regular exercise. If diet and exercise fail to bring your cholesterol to

normal, your doctor may need to prescribe a suitable medication.

Target cholesterol levels for adult's diabetes are as follows:

Cholesterol

Target level

LDL cholesterol

<100 mg/dL

HDL cholesterol

>45 mg/dL

Triglyceride

<200 mg/dL











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Will my eating habits also affect my cholesterol levels?

The food you eat affect your blood sugar and cholesterol levels, which are

very important not only for your heart but for your overall health as well. Our

dietician will help in finding the best eating plan for you.

Which Exercise will help me to reduce my cholesterol levels?

Regular aerobic exercise (such as walking or swimming), which involves your

heart, lungs and more muscles, can help improve your cholesterol and your

overall cardio-vascular fitness. However, be sure to discuss your exercise

programme with your doctor.

Is Aspirin Safe?

Research shows that talking aspirin may help prevent heart attacks in people

with Type-2 diabetes. Aspirin is beneficial not only for those who have had a

heart attack but also for those who are at a risk of having one. However, do

not start talking aspirin without first discussing it with your doctor.

Regular exercise, healthy diet and proper medication to control your blood

sugar, blood pressure and cholesterol would certainly help in keeping your

heart strong and healthy.

How does Type 2 diabetes damage kidneys?

In diabetes, high levels of glucose reduce the ability of the kidney to stop

necessary proteins from being filtered into urine. If this condition is not

treated in time it may further damage the kidney leading to Dialysis or

Kidney Transplant.











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Who gets kidney disease?

Factor that can influence this disease include

l Genetics

l Blood sugar control

l Blood pressure

The better you keep Type 2 diabetes under control, the lesser are the chance of

your suffering from kidney failure. Blood pressure too should be kept under

control. The longer you have Type 2 diabetes, the higher is the risk of kidney

disease

What are the symptoms of kidney disease?

The symptoms don't appear until it is almost too late. Also when they do appear,

the symptoms are not specific. The first symptom is the fluid buildup. You may

feel puffy, and feel fluid in your body. Other symptoms include loss of sleep,

exhaustion, poor appetite, upset stomach, nausea, weakness and difficulty in

concentrating.

What are the treatment measures for kidney disease?

When kidney disease is diagnosed early several treatment measures may keep

it from getting worse. If diagnosed latter A person may require Dialysis or a

kidney transplant. The most important treatment measure is to keep blood sugar

levels as close to normal as possible. Another important treatment measure is

effective control of blood pressure. Even a mild rise in blood pressure can

quickly worsen the condition.











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How do I keep my blood pressure in control?

The simplest way to do so is reduce weight, eat less salt and avoid alcohol and

tobacco. When these methods fail, certain medicines may be used to lower

blood pressure. Low-protein diet also helps. Low protein diets have been shown

to slow the progression of kidney damage. Once kidneys fail, these treatments

are no longer useful. Dialysis is then essential. The person must, at this point,

choose between continuing with dialysis and getting a kidney transplant.

The health of your kidney can be maintained if you keep blood sugar levels and

your blood pressure under control.

How do I measure my blood sugar levels?

There are two ways in which you can do so, namely testing sugar in urine or in

blood.

l Urine sugar testing

Urine sugar testing remains the simplest, cheapest and painless method for

long-term monitoring of diabetes. Urine sugar testing is the most practical

way to judge day-to-day diabetes control among patients who do not or

cannot perform home blood sugar testing.

l Blood sugar control testing:

This can be done in two ways – either in a pathology laboratory or at home.

Laboratory blood sugar testing is precise and can also help in testing the

accuracy of other methods of monitoring sugar levels. Testing blood sugar

at home is also known as SMBG (self-Monitoring of blood Glucose). This is

a useful tool, particularly for who take insulin. Home testing is done with the

help of a meter and test strips. This method involves finger pricking to draw

blood and is relatively more expensive.

Good blood sugar levels are usually in the following ranges:

l 80-120 mg/dl on walking and before meals.

l 200 mg/dl or less after having meals.











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What is Glycosylated Hemoglobin? ( HbA1C )

Blood and urine glucose testing provide useful information on day-to-day

management of diabetes. However, these tests cannot provide the patients and

the doctor with a reliable measure of diabetes control over an extended period of

time. This limitation can be overcome by performing a glycosylated hemoglobin

test that accurate the previous two-three months of diabetes control. This test

has to be performed two to three times a year.

A test reading of less than 7 per cent indicates that diabetes is well under control

whereas a reading of above 8 percent suggests an increased risk of eve

disease, kidney disease or never damages.

What other important assessments should I do?

l Lipid profile: To be done yearly or more often. As necessary.

l Kidney function tests (renal profile): To be conducted yearly.

l Blood pressure measurement: To be done every 6 months or more

often, if not under control.

l Eye examination: Dilated fundoscopic examination to be done yearly

on all diabetic patients.

l Foot examination: At least once every six months or more often

as necessary.

l Weight: To be assessed every six months.

l Doctor consultation: Minimum of once every six months if all above

mentioned assessments are under control. Otherwise, more often,

as necessary. Know your diabetes status well to be

in control of the situation.












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What is Hypoglycemia?

A drop in blood sugar level than normal is known as Hypoglycemia.

How common is it in Type 2 Diabetes?

It is not every common in people with Type 2 diabetes (those taking oral

medications) if you follow your diet and medication regimes properly.

What are the warning symptoms?

The initial symptoms include cold sweat, hunger, weakness, nervousness,

trembling of hands rapid heartbeat. However, if hypoglycemia persists, it might

affect the brain leading to headache, blurred vision, abnormal behavior,

confusion, and in severe cause, even loss of confusion, and in severe cases,

even loss of consciousness.

What are the causes?

Too little food or a delayed meal, increased exercise without an additional snack,

an common causes of hypoglycemia.

How to treat hypoglycemia?

Immediate treatment will rapidly restore you to normal. As soon as the warning

symptoms occur. STOP whatever you're doing. This is especially important if

you are doing something, which might involve risk to yourself or others, such as

operating machinery or driving. IMMEDIATELY consume 2-3 tsp of sugar and a

glass of water or a couple of biscuits, a glass of orange/apple juice or sweetened

milk or two teaspoons of honey. However, don't have chocolate or candy bar to

treat low blood sugar, since the fat in these items slows down absorption.












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A word of warning

Although the aim is to prevent hypoglycemia, you mustn't achieve this by

running a constant high blood sugar. A high blood sugar may prevent

hypoglycemic reactions, but over a prolonged period, it will cause serious and

permanent damage.

Can diabetes be cured?

No, but if it is properly managed through lifestyle modification and or medication,

a diabetic can lead a healthy and normal life.

Can diabetes be prevented?

Yes. Modifying lifestyle early on in life can prevent weight control. Increased

physical activity is vital in the prevention of Type 2 diabetes. Besides, people

with risk of developing Type 2 diabetes should have check-ups regularly. This is

because early detection and treatment can substantially reduce the risk of

developing complications. It is important to note that management of high blood

pressure and raised blood fats is equally impotent.

What is the relationship between being overweight and type 2 Diabetes?

It's a pretty direct relationship. About 80% of people with type 2 diabetes are

overweight. Excess fat leads to INSULIN RESISTANCE i.e. body's inability to

use insulin, which leads to elevated blood pressure, abnormal blood lipids and

type 2 diabetes.

Will menopause affect diabetes?

Yes. The changes in hormonal levels and balance, may lead increase blood

glucose levels. Women with diabetes are also at risk of developing premature

menopause and consequent increased risks of cardiovascular disease.












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Is it okay for women to drink alcohol, if so, how much?

The ADA's (American Diabetes Association) recommendations are 1 drink

per day. One drink is defined as: 360ml beer and 360ml of a wine.

Is it possible to have just 'slight' diabetes?

There is nothing like 'slight' diabetes. Either you will have diabetes or you

won't. Any diabetic condition (type-1 or type-2) demands medical attention

and careful lifestyle choices.

What is Pre Diabetes?

A: Pre Diabetes is when a person's blood glucose levels are higher than

normal but not high enough to be Type 2 Diabetes. People with Pre Diabetes

are more likely to develop type 2 diabetes and may have some problems

from diabetes already.

Who should get tested for Pre Diabetes?

People in these groups should be tested:If you are overweight and age 45 or older, you should be checked for Pre Diabetes during your next routine medical office visit.If your weight is normal and you're over age 45, you should ask your doctor during a routine office visit if testing is appropriate.For adults younger than 45 and overweight, your doctor may recommend testing if you have any other risk factors for diabetes or Pre Diabetes, including:

n high blood pressuren low HDL cholesterol and high triglyceridesn a family history of diabetesn a history of gestational diabetes or giving birth to a baby weighing more than 9 poundsn belonging to an ethnic or minority group at high risk for diabetes












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How often should I be tested?

If your blood glucose levels are in the normal range, get checked every three

years, or more often if your doctor recommends it. If you have Pre Diabetes, you

should be checked for type 2 diabetes every one or two years after you are told

you have Pre Diabetes.

What is the treatment for Pre Diabetes?

Treatment consists of losing a modest amount of weight (7% of total body

weight) through healthy eating and moderate exercise, such as walking, 30

minutes a day, five days a week. Don't worry if you can't get to your ideal body

weight. Losing just 5-10 Kgs can make a big difference.If you have Pre Diabetes,

you are at a 50% increased risk for heart disease or stroke, so your doctor may

wish to treat or counsel you about cardiovascular risk factors, such as tobacco

use, high blood pressure, and high cholesterol.

Is Pre Diabetes the same as Impaired Glucose Tolerance or Impaired

Fasting Glucose?

Yes. Doctors sometimes refer to high blood glucose levels as Impaired Glucose

Tolerance (IGT) or Imapired Fasting Glucose (IFG), depending on what test was

used to detect it.

How many people with Pre Diabetes go on to develop type 2 diabetes?

One major study, the Diabetes Prevention Program, showed about 11% of

people with Pre Diabetes developed type 2 diabetes each year during the

average three years of follow-up. Other studies show that many people with Pre

Diabetes develop Type 2 Diabetes in 10 years.












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Could I have Pre Diabetes and not know it?

Absolutely. People with pre diabetes don't often have symptoms. In fact, millions

of people have diabetes and don't know it because symptoms develop so

gradually, people often don't recognize them. Some people have no symptoms

at all. Symptoms of diabetes include:

l unusual thirstl frequent urinationl blurred visionl extreme fatiguel frequent infectionsl cuts/bruises that are slow to heall tingling/numbness in the hands/feetl recurring skin, gum, or bladder infections

Can people with Type 2 Diabetes eat sweets?

Yes, people with diabetes can enjoy sweets.

There's an old idea that sweets are verboten for those with diabetes, but that's

no longer correct. It's true that the carbohydrates in sweets can raise your

glucose levels, but you have to be smart about sugary foods and sweets while

making a choice. Sweets pack in a lot of calories and they tend to be high in fat,

particularly in unhealthy saturated fat. So anyone with diabetes needs to be

careful about which sweet and how many they eat.












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Can people with Type 2 Diabetes drink alcohol?

Yes. Generally, the recommendations for people with diabetes are: women it's

ONE drink a day, for men it's TWO. However, the amount of alcohol you drink --

and whether you drink alcohol at all -- should be affected by how you manage

your condition, what medications you're on, and your overall health.One

precaution: some diabetes medications can increase the risk of hypoglycemia

(low BSL) when you're drinking alcohol. So if you're at higher risk of

hypoglycemia (low BSL), be careful and take precaution.

What impact does physical activity have on Type 2 and Pre Diabetes?

Physical activity is crucial for people with type 2 diabetes and Pre Diabetes. It

lowers blood glucose and helps in effective insulin utilization. It also helps

lower blood pressure and boost levels of good HDL cholesterol, which

reduce your risk of heart and blood vessel disease.. Exercise plays a main role in

maintaining weight loss.

How much and what types of exercise are recommended for people with

Type 2 DM and Pre Diabetes?

Always start with small steps -- Walking is easy. Find time to walk a few times a

week for 20 minutes. Work your way up to 30 minutes five times a week. You

need to find physical activities that you enjoy, since you need to incorporate

them into your life permanently. Using weights and resistance training can be a

good idea too. The higher the percentage of muscle and the lower the

percentage of fat in your body, the better your insulin utilization by body.












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Does eating too much sugar causes diabetes?

Diabetes is not caused by eating too much sugar. Type 1 diabetes is caused by a

destruction of the insulin (a hormone)-produced by pancreas, which is not

related to sugar consumption. Type 2 diabetes results from the body's inability to

respond to insulin normally. The tendency to get type 2 diabetes is genetically

inherited in most cases. With a guided exercise regime and following a planned

diet, the average person can eat sweets.

What are the complications of Type 2 Diabetes?

Having a continuous high Blood Glucose Levels may cause problems to other

body organs, such as Heart, Kidneys, Nerves, Feet, Eyes, Bone and joint

disorders.Other long term complications of type 2 diabetes include skin

problem, digestive problems, sexual dysfunction and oral problems.

Are diet and exercise beneficial even after diabetes develops?

Research has clearly shown that diet and exercise help people with type 2 diabetes control their blood glucose, blood pressure, and cholesterol in the short term. Also diet and exercise lower the risk of developing heart disease and stroke and the other complications of diabetes.

What is stress?

You experience stress, when your body feels as if it is under attack. Sources of

stress can be physical like injury or illness and mental like marital, professional

or fiscal problems. As a response to stress, the body great up to take action.

This is known as the “fight-or-flight” response. In the fight-or-flight response the

levels of many hormones shoot up. The net effect is to make o lot of energy

available to the cells through a release of stored glucose and fat. These cells are

then primed to help the body get away from “danger”.












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How does stress affect diabetes?

In diabetics, stress can alter blood sugar levels. It does this in two ways. Firstly

through lifestyle. People suffering from stress may drink more alcohol or

exercise less. They may not have time to check their sugar levels or plan good

meals. Secondly, stress hormones may also alter blood sugar levels directly.

How do we cope with Stress?

You have some control over reaction to stress you can learn to relax and reverse

the body's hormonal response to stress, and, of course, you can change your

lifestyle to your response to stress is determined, to a large extent, by your

approach to stress. For example, some people have a problem-solving attitude.

They try to change their situation to get rid of stress. Other people convince

themselves to accept the problem as okay. These two methods of coping are

usually helpful. People who use them tend to have less blood sugar elevation in

response to mental stress.

Other ways to reduce mental stress

Some sources of stress are never going to go away no matter what you do

Diabetes is one of those. Still there are ways of reducing diabetic stress. Support

groups can help. Knowing other people in the same situation helps you feel less

lonely and introduces you to new problem-solving techniques. There are other

ways to fight stress as well as sometimes adding positive things to your life can

help. You can starts an exercise program or join a sports team. You can take up a

new hobby or learn a new craft. You can volunteer to contribute to a worthy

cause.












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Few Techniques to measure your Stress and Blood Glucose Level

It's easy to find out whether mental stress affects your glucose control. Before

checking your glucose levels, rate your mental stress level on a scale of one to

ten. Write down your glucose level next to it. After a week or two, look for a

pattern. Drawing a graph may help you see trends better. If high stress levels

frequently occur with high glucose level, and low stress level with low glucose

levels, it implies that stress affects your glucose control.











Health & Medicine

Diabetes Care - FAQs