Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. According to the American Diabetes Association, there are 23.6 million children and adults in the United States alone, or 7.8% of the population, who have diabetes however, 5.7 million people (or nearly one quarter) are unaware that they have the disease.
In the country of India, diabetes, with its attendant acute and long term complications, and the myriad of disorders associated with it, is a major health hazard. In fact, India has long passed the stage of a diabetes epidemic and the problem has reached "pandemic" proportions, creating a very large public health problem that is growing astronomically year after year. In fact, in 1995, it was estimated that 125.7 million people were affected by diabetes and it has been forcasted that by the year 2025, that number will reach almost 300 million. Today, India is home to around 40 million diabetics, giving India the dubious distinction of being home to the largest number of diabetics in any one country.
Type 2 diabetes is the most common form of diabetes. In a patient with type 2 diabetes, insulin is being made, but not enough. When there is not enough insulin, glucose (blood sugar) cannot get into the body's cells. This extra glucose builds up in the bloodstream, overflows into the urine, and passes out of the body. As a result, the body loses a lot of its "fuel" even though there are large amounts of glucose in the blood. Over a long period of time, the high glucose levels can start to damage important organs in the body.
High blood glucose can happen if:
- Not enough insulin is produced by the pancreas
- Enough insulin is being produced by the pancreas, but the cells need much more than what is normally made (also called insulin resistance)
- "Helper Hormones" in the gut (intestines) do not work as well as they should
- The liver may produce too much glucose on its own at the wrong times — such as during and after meals
If diabetes is not controlled, long-term problems can develop as a result of high blood glucose (blood sugar) levels in the body. People with diabetes have a higher chance of developing high blood pressure, high cholesterol levels, or both. Either can lead to serious medical problems such as stroke and heart attacks. People with poorly controlled diabetes also have a higher risk of developing eye and kidney problems, as well as nerve damage, especially in the feet.
Uncontrolled diabetes may lead to:
- Increased risk of stroke or heart attack
- Kidney problems
- Vision problems that could lead to blindness
- Uncomfortable or painful tingling in feet and/or hands (nerve damage)
- Decreased circulation in the legs and feet
- Increased risk of serious foot problems
- Problems with digestion of food
- Infections that are slow to heal
There are important steps that can be taken to help prevent these serious problems:
- If the patient's blood pressure and cholesterol numbers are not what they should be, the patient should be encouraged to make lifestyle changes, as well as start or adjust medications
- The patient should have their eyes dilated and checked by an eye doctor once a year
- The patient should have a yearly kidney test on blood and urine
- The patient should check their feet every day and make sure their health care provider looks at their feet at every visit
Diabetes Maintenance Schedule
Every 3 months
Many studies show that the chance of developing diabetes complications goes down when blood glucose (blood sugar) is well controlled. There are two ways of tracking blood glucose control:
1. Self-monitoring of blood glucose
- Self-monitoring of blood glucose is important and will help determine the level of control being achieved over the diabetes. Blood glucose could be checked 2 hours after the start of a meal to see h ow well their regimen is working.
- Patients should work with their health care provider to determine how many times and when to check their blood glucose.
2. A1C blood test
The A1C test measures average blood glucose levels over the past three months.
The American Diabetes Association has guidelines that help set goal s for the proper blood glucose levels. Having better control of the blood glucose can have a positive effect on the patient's overall health. Many studies show that the closer a patient is to these goals, the better chance they have of avoiding additional health complications.
Goals for Adults with Diabetes (individual health care providers may have specific goals for individual patients:
Blood Glucose Controls *
A1C < 7 %
- Prepradial blood glucose 70 - 130 mg/dL
(before a meal)
- Postprandial blood glucose < 180 mg/dL
(2 hours after a meal)
* Adapted from the American Diabetes Association Guidelines 2008
Another risk for diabetics is hypoglycemia which is when blood glucose levels are too low. It is important that patient's carry a quick source of blood glucose with them at all times such as 5-6 pieces of hard candy or 3-5 glucose tablets. If a patient develops hypoglycemia, act quickly. They should check their blood glucose and treat the hypoglycemia with one of the glucose sources immediately, then wait 15-20 minutes and check their blood glucose again. If the blood glucose is still low and the symptoms have not subsided, repeat this treatment. Hypoglycemia symptoms include being irritable, sweaty, nervous, shaky, hungry, clumsy, confused, dizzy and/or drowsy. After the patient feels better, it is critical that they eat regular meals and snacks as planned to keep their blood glucose from going so low again.
Wait 15 or 20 minutes and check the blood glucose again. If the blood glucose is still low and the symptoms of hypoglycemia don't go away, repeat this treatment. After the patient feels better, they should eat regular meals and snacks as planned to keep the blood glucose from going too low. In fact, a healthy meal plan is one of the most important things a diabetic can do to help control their diabetes. Eating healthy means choosing and preparing the right kinds of foods. A registered dietitian can help diabetics to develop a meal plan that works for their individual circumstances.
Often people think that only sugary food or "sweets" cause blood glucose (blood sugar) to increase. In fact, almost all foods are broken down into glucose. That is why it is so important to understand how to balance meals in order to not overload the body with glucose.
Carbohydrates: Foods with carbohydrates, or "carbs" have the most effect on blood glucose levels. Carbohydrates are found in starchy foods (like bread, cereal, potatoes, corn, rice, pasta) and in fruit, milk, yogurt, and sweets. Since many healthy foods contain carbohydrates, they are important to include in the diet.
Proteins: Protein is found mostly in animal products, nuts, some dairy products, and beans. Each person's body needs protein to work properly.
Fats: Diabetic s should choose healthier fats and limit high-fat foods to help reduce the risk of heart disease, a major threat for people with type 2 diabetes.
"Rate Your Plate" Test
Draw an imaginary line through the center of a plate, then draw a line to divide the top section into two.
Eating large amounts of foods that contain carbohydrates can cause higher after-meal blood glucose levels. Measure portions at home until the patient learns to estimate. Eating less can reduce after-meal blood glucose and weight. Talk to a registered dietitian or other diabetes educator about how many carbohydrates should be eaten at each meal.
Exercise, along with diet, supplements and medication, can help individuals control their diabetes in many ways. Be sure to consult with a health care provider before starting an exercise program. Exercise is good because it has the following effects:
- Burns calories by making the body use glucose, which helps lower blood glucose levels
- May help to lose weight which makes the body more sensitive to the insulin it produces
- Improves circulation
- Reduces stress
- Improves mood
- Increases bone strength
- Lowers the risk of heart disease and cancer
- Helps lower cholesterol and blood pressure
However, even when all of these steps are taken, nerve damage called diabetic peripheral neuropathy can still develop which can cause tingling, pain, numbness, or weakness in the feet and/or hands. Nerves send messages to and from the brain about pain, temperature and touch, telling muscles when and how to move. Diabetic peripheral neuropathy can block some or all of those messages from reaching the brain , causing a dramatic decrease in the ability to feel any kind of sensation in the feet or hands.
About half of all patient's with Type 2 diabetes experience diabetic peripheral neuropathy, and once this has occurred, it is even more important to pay special attention to the feet and hands because they may not notice an injury due to this loss of sensation. As a result, it is critical to check the condition of the feet on a daily basis by using a mirror and their hands to feel for hot or cold spots, bumps, dry skin, sores, cuts, breaks in the skin, corns, calluses, blisters, red areas, swelling, ingrown nails and nail infections.
Reversing diabetic peripheral neuropathy is extremely difficult, and according to most endocrinologists, may be nearly impossible. In fact, there are no typical treatments. Some do prescribe blood thinners in an effort to increase the body's circulation to solve the problem. Although blood thinners may help initially, over a longer period of time the affects of these medications seem to wear off. In addition, blood thinner side affects include serious bleeding, headache, abdominal pain, indigestion, diarrhea, vomiting, difficulty breathing, reduced blood clotting capability, easy bruising, muscle aches, dizziness and nose bleeds.
A new, innovative method though can help reverse lower extremity diabetic neuropathy faster then ever before. The cr17 Hurricane combined with the Camara Myofacial Method utilizes vibration and percussion to more effectively break up adhesion and promote greater blood flow within the lower extremities and surrounding tissue, enabling the patient to regain full range of motion and strength in a much shorter amount of time than with other treatments and usually with less pain.