Monitoring your blood sugar. Depending on your treatment plan, you may check and record your blood sugar as often as several times a week to as many as four to eight times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. People who receive insulin therapy also may choose to monitor their blood sugar levels with a continuous glucose monitor. Although this technology doesn’t yet replace the glucose meter, it can provide important information about trends in blood sugar levels.
Antihyperglycemic therapy in type 2 diabetes: general recommendations. *If patient does not tolerate or has contraindications to metformin, consider agents from another class in Table 8.1. #GLP-1 receptor agonists and DPP-4 inhibitors should not be prescribed in combination. If a patient with ASCVD is not yet on an agent with evidence of cardiovascular risk reduction, consider adding.
The right amount of carbohydrates varies by how you manage your diabetes, including how physically active you are and what medicines you take, if any. Your health care team can help you create a personal eating plan based on carbohydrate counting.
“Secondary” diabetes refers to elevated blood sugar levels from another medical condition. Secondary diabetes may develop when the pancreatic tissue responsible for the production of insulin is destroyed by disease, such as chronic pancreatitis (inflammation of the pancreas by toxins like excessive alcohol), trauma, or surgical removal of the pancreas.
Alcohol use: Moderate or eliminate consumption of alcohol. Try to have no more than seven alcoholic drinks in a week, and never more than two drinks in an evening. One drink is considered 1.5 ounces of liquor, 6 ounces of wine, or 12 ounces of beer. Excessive alcohol use is a known risk factor for type 2 diabetes. Alcohol consumption can cause low or high blood sugar levels, nerve pain (neuritis), and an increase in triglycerides.
Ethnicity, particularly when a close relative had type 2 diabetes or gestational diabetes. Certain groups (such as African Americans, Native Americans, Hispanic Americans, and Japanese Americans) have a greater risk of developing type 2 diabetes than non-Hispanic whites.
126 mg/dL or more Diabetes mellitus (type 2 diabetes) Type 2 diabetes develops when your body doesn’t make enough insulin or develops “insulin resistance” and can’t make efficient use of the insulin it makes. It greatly increases your risk of heart disease and stroke.
Type 1 diabetes is most common among people of non-Hispanic, Northern European descent (especially Finland and Sardinia), followed by African Americans, and Hispanic Americans. It is relatively rare among people of Asian descent.
Management of hyperglycemia in type 2 diabetes: a patient-centered approach – position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), Silvio Inzucchi et al., Diabetes Care, doi: 10.2337/dc12-0413, published online 19 April 2012.
Acanthosis nigricans: A dark, “velvety” patch of skin can appear in the armpits, groin, and neck folds, and over the joints of the fingers and toes. It is an indicator of high insulin and is seen more commonly in African Americans.
Make snacks a combo of filling fiber and lean protein: an apple with low-fat cheese, peanut butter on a slice of 100% whole-grain toast, 1/4 cup hummus with carrots … even some packaged snacks with the right combo of nutrients can work too. Eating fiber and protein together will slow down the rate at which you digest and absorb carbs, creating a more gradual rise in blood sugar afterwards. While prediabetics and type 2 diabetics are less likely to experience dramatic spikes or crashes, it’s still a good idea to keep snacks on hand for any potential highs or lows.
Monogenic Forms of Diabetes: Neonatal Diabetes Mellitus and Maturity-Onset Diabetes of the Young (National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases)
Over the past 20 years, dramatic advances in insulin delivery have improved insulin pumps. An insulin pump is composed of a reservoir similar to that of an insulin cartridge, a battery-operated pump, and a computer chip that allows the user to control the exact amount of insulin being delivered. Current pumps on the market are about the size of a pager or beeper. The pump is attached to a thin plastic tube (an infusion set) that has a cannula (like a needle but soft) at the end through which insulin passes. This cannula is inserted under the skin, usually on the abdomen. The cannula is changed every two days. The tubing can be disconnected from the pump while showering or swimming. The pump continuously delivers insulin, 24 hours a day. The amount of insulin is programmed and is administered at a constant rate (basal rate). Often, the amount of insulin needed over the course of 24 hours varies, depending on factors like exercise, activity level, and sleep. The insulin pump allows the user to program many different basal rates to allow for variations in lifestyle. The user can also program the pump to deliver additional insulin during meals, covering the excess demands for insulin caused by eating carbohydrates.
But some pleasant news: When consumed in moderation and made with whole ingredients and without added sugar, fruit smoothies can be a good food for diabetes. Consider stocking your fridge with unsweetened frozen fruit so you can whip up one in a hurry for breakfast. Adding ingredients with protein, such as yogurt or a small amount of nut butter, will also help your body break down the carbohydrates more slowly, leading to less of a spike in blood sugar.
According to a review of clinical trials published in December 2014 in JAMA Surgery, people with diabetes who underwent bariatric surgery had greater weight loss than those who received nonsurgical treatment, and the surgery was more effective in helping obese participants get diabetes under control. An article on the notable Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently trial, which was published in February 2017 in the New England Journal of Medicine, suggests that gastric bypass surgery and sleeve gastrectomy helped people with diabetes attain better glycemic control than medication alone. Compared with the medication-only group, people who underwent the surgeries also saw greater reductions in heart disease risk and medication use, as well as an improved quality of life.
High in soluble fiber, oats are slower to digest than processed carbs. Eat them and you’ll release glucose into the bloodstream more slowly, which will prevent spikes in your blood-sugar levels. In a 2012 study from Sweden’s Karolinska University, researchers found that eating four servings whole grains daily reduced the risk for developing prediabetes by 30 percent. Other research shows that if you eat whole grains you experience less inflammation, which could lower the odds of your developing insulin resistance, heart disease, and high blood pressure. These science-backed strategies can work to reverse diabetes.
Doctors also recommend you limit how often you bathe when your skin is dry, use natural and mild products to clean your skin (instead of many harsh, chemical products sold in most stores), moisturize daily with something mild like coconut oil for skin, and avoid burning your skin in the sun.
Miscarriage is the medical term for the spontaneous loss of pregnancy from conception to 20 weeks gestation. Risk factors for a woman having a miscarriage include cigarette smoking, older maternal age, radiation exposure, previous miscarriage, maternal weight, illicit drug use, use of NSAIDs, and trauma or anatomical abnormalities to the uterus. There are five classified types of miscarriage: 1) threatened abortion; 2) incomplete abortion; 3) complete abortion; 4) missed abortion; and (5 septic abortion. While there are no specific treatments to stop a miscarriage, a woman’s doctor may advise avoiding certain activities, bed rest, etc. If a woman believes she has had a miscarriage, she needs to seek prompt medical attention.
Exenatide (Byetta) originated from an interesting source: the saliva of the Gila monster! Scientists observed that this small lizard could go a long time without eating. They discovered a substance in its saliva that slowed stomach emptying, thus making the lizard feel fuller for a longer time. This substance resembled a gut hormone naturally found in humans known as glucagon-like peptide-1 (GLP-1). The enzyme DPP-IV breaks down GLP-If one could make a substance like GLP-1 but that resisted breakdown, it would have potential benefit. Such efforts developed exenatide.
Statins, which are medicines to reduce LDL (“bad”) cholesterol levels, can slightly increase the chance that you’ll develop diabetes. However, statins help protect you from heart disease and stroke. For this reason, the strong benefits of taking statins outweigh the small chance that you could develop diabetes.