Diabetes Symptoms To Never Ignore

Watch out for signs of heart disease, uncontrolled blood sugar, infection, eye problems, and more

People living with diabetes learn to manage their disease with proper diet, regular exercise, and medication.  Success is measured by how well you can control your blood sugar. 

However, many factors can affect blood sugar besides diet and activity. Illness, stress, social drinking, and women’s menstrual cycles can all influence blood sugar levels and upset your normal routine. 

If you have diabetes, you may know that and make adjustments accordingly.  But some symptoms of trouble are always reasons to seek medical advice, whether it’s a call to your doctor or a trip to the emergency room. 

“Truthfully, with the ability of people to test their blood sugar at home, we can treat many more things at home than we used to be able to,” says Andrew Drexler MD, who directs UCLA's Gonda Diabetes Center. 

This does not mean you should problem solve without your doctor’s help, he adds, but rather, that you might be able to substitute a phone call for a trip to the emergency room.    

Here are the diabetes symptoms you should never ignore. 

Frequent Urination, Extreme Thirst or Hunger, or Blurry Vision

These are three common warning signs of uncontrolled blood sugar.

With any of these symptoms, you should test your blood sugar and call your doctor.  Depending on how high your blood sugar is, medication may fix the problem or you may have to seek medical care to replace fluids and electrolytes and to get blood sugar back under control. 

If left unchecked, high blood sugar can lead to serious, life-threatening conditions.  Type 1 diabetes patients can develop diabetic ketoacidosis, which happens when the body starts breaking down fats instead of sugars and a dangerous buildup of ketones (byproducts of fat metabolism) occurs.

 In type 2 diabetes patients, hyperosmolar coma can occur.  “It’s essentially uncontrolled diabetes, which leads to dehydration and altered consciousness and which could be fatal if untreated,” says endocrinologist Adrian Vella, MD, of the Mayo Clinic in Rochester, Minn. 

Acting Drunk

Strange behavior can also signal low blood sugar. This can happen when a person’s medication works too well and overshoots the target. 

Drinking some juice or eating a snack usually is enough to raise sugar levels and normalize behavior.  Often, however, the diabetic patient is not in the state of mind to recognize that something is wrong.  If no one else is around to prompt you, your blood sugar may sink low enough to cause you to lose consciousness. 

Most of the time, patients will recover on their own, but if they are taking certain medications, emergency medical treatment may be required. 

“If it’s either a long-acting pill that can cause hypoglycemia,” such as the sulfonylurea drugs chlorpropamide, glyburide, or glimepiride, “or a long-acting insulin that can cause hypoglycemia, then it very well may be necessary to go to the emergency room,” Drexler tells WebMD. 

Infections, Swollen or Bloody Gums, Foot Sores

Have your doctor check a cut that’s infected, swollen or bloody gums, or a wound that won’t heal. And watch out for a sore on the foot, which may be the first sign of a diabetic foot ulcer. 

All diabetes patients should get regular foot exams by a health care professional -- and check their own feet on a daily basis -- even if sores are not present. And remember to bathe your feet daily in warm (but not hot) water, following up with a moisturizer, to prevent dry skin, which may crack and lead to infection.

“Infections in diabetics can get out of control and they need to be taken very seriously,” says Drexler. 

Fungal infections occur more frequently in diabetes patients, Vella tells WebMD.  “Fungal infections of the skin are more likely to occur when your blood sugar is consistently above the magic number of about 180-200 [mg/dL],” he says.  “That’s because hyperglycemia itself actually interferes with the white blood cells’ ability to respond to such infections.” 

A red, itchy rash -- especially in moist areas such as skin folds -- can signal a fungal infection.

Eye Problems, Including "Floaters"

If you develop sudden changes in vision, experience eye pain, or see spots or lights floating in your field of vision, call your doctor. You may need to see an ophthalmologist. People with diabetes are at increased risk of an eye condition called retinopathy, which can lead to vision loss.

Even without eye symptoms, diabetes patients should see an ophthalmologist yearly for a routine eye exam.

Heart Disease Symptoms -- and Not Just Chest Pain

Patients with diabetes have an increased risk of cardiovascular disease and twice the normal rate of related emergency events, such as heart attack and stroke. 

So get any potential heart disease symptoms checked out.And keep in mind that heart symptomsaren't always predictable.

 “It can sometimes be shoulder pain, it can sometimes present just as nausea," Drexler says. "But if there’s any suspicion that it’s cardiac in origin, it’s very important to go to the ER." 

It's also possible to have heart disease that doesn't have obvious symptoms, so make sure you see your doctor regularly and have your cardiovascular risk factors evaluated.

Taking Precautions

Will Ryan of Alford, Mass., who has had diabetes for 30 of his 70 years, was driving home one night a felt a sharp pain in his chest.  “It was more intense than just a muscle pull,” says Ryan, author of a blog called the Joyful Diabetic.  It lasted only a few seconds, but it happened again before he got home.  He went to the ER, where an ECG showed normal heart function. 

Taking Precautions continued...

Less than a week later, he woke up with his heart pounding and his pulse racing at 90 beats per minute - higher than usual for Ryan.  A second ECG was also normal, but given two possible heart-related events, a cardiologist ordered a heart monitor. 

Over two weeks, the monitor picked up more curiosities.  “I had a number of instances where my heart rate dropped below 40,” Ryan says.  “I was not aware of it because I was sleeping.” 

Ryan agreed to a stress test, which showed his heart was oxygen deprived, suggesting that one of the blood vessels feeding his heart was blocked.  Cardiac catheterization confirmed the blockage, but also showed that Ryan’s other blood vessels had taken up the slack such that no treatment was required. 

“I probably had a heart attack, but I never knew it,” Ryan says, adding that doctors told him this was not uncommon in people with diabetes. 

Ryan says he’s very aware of his body’s signals from living with his disease, but he has never been complacent. This recent experience has only reaffirmed that unusual symptoms deserved medical attention. 

Thank You WebMD

Diabetes: Mental Health At Risk

Diabetes can lead to a decline in memory, thinking speed, and mental flexibility in middle age, but controlling the blood sugar disorder might prevent some of these effects, new research from the Netherlands suggests.

Reuters reports that while the mental decline may be invisible to the individual, the fact that the drop-off starts accumulating in middle age puts diabetics at greater risk later on because of reduced "brain reserves," Dr. David Knopman, of the Mayo Clinic in Rochester, Minnesota, told Reuters Health.

"Like a bicycle tire that's been partially deflated -- you'll be OK riding around but if you develop another little leak you'll be much closer to a flat tire much faster," said Knopman, who was not involved in the Dutch study.

Astrid Nooyens and colleagues at the National Institute for Public Health and the Environment in the Netherlands examined the health records and mental acuity scores of more than 2,600 men and women between the ages of 45 and 70 who enrolled in a large ongoing study into lifestyle effects on health.

At the five-year mark, of the 139 participants with type 2 diabetes, 61 were diabetics at the beginning of the study and 78 developed the chronic disease within the next five years.

The study confirmed the findings of earlier research, by Knopman and others, of an association between diabetes and declines in such mental functions as the ability to think quickly and recall words, but this is the first project to test memory and demonstrate how quickly the drop-off can occur.

Over a five-year period, decline in overall mental functioning in people with type 2 diabetes, while small, was nearly 3 times more pronounced than in non-diabetics.

But it didn't take many years for the impact to be felt. Even those who developed diabetes after beginning the study saw twice as much of a decline as their non-diabetic counterparts.

Compared to the "healthy" participants, participants who had long-term diabetes registered the largest declines in mental function. Those who developed diabetes during the trial saw less pronounced declines than their long-term counterparts in most areas except information processing, where they appeared to do a little better than the "healthy" people.

Type 2 diabetes is characterized by high blood sugar levels caused by the body's inability to process sugar properly. The illness can usually be controlled through diet and exercise but may also require drugs.

The Nooyens group found that while memory continues to decline for those with diabetes, the drop-off in thinking speed appears to occur in the first five years and then level off. That led the authors to suggest that early treatment and control of blood sugar levels could help thinking speed, but probably not memory, they note in the journal Diabetes Care.

The researchers found that for a small group of people who had lived with diabetes for nearly seven year, blood sugar levels did not explain the entire decline in mental function. In those people, they suspect other conditions related to diabetes such as high blood pressure and obesity.

The study did not look at whether patients with well-controlled diabetes experienced less mental decline compared to their poorly controlled counterparts, although the authors point out that there are other reasons, such as heart disease, to control sugar levels as well.

They also note that the random blood tests of both the long- and short-term diabetics suggested what treatment they were getting was "insufficient."

Coffee Ameliorates Effects Of Hyperglycemia, Say Researchers

Drinking coffee may help prevent diabetes, according to a new study published in the Journal of Agricultural and Food Chemistry (2010;58(9):5597-603).

Researchers fed either water or coffee to a group of laboratory mice commonly used to study diabetes. Coffee consumption prevented the development of high-blood sugar and also improved insulin sensitivity in the mice, thereby reducing the risk of diabetes.

Coffee also caused a cascade of other beneficial changes in the fatty liver and inflammatory adipocytokines related to a reduced diabetes risk. Additional lab studies showed that caffeine may be “one of the most effective anti-diabetic compounds in coffee,” the scientists said.

Researchers at Nagoya University have also reported evidence that drinking coffee may help prevent diabetes, and that coffee can ameliorate the effects of fatty liver, hyperglycemia and improve insulin sensitivity.

The research, published in the Journal of Agricultural and Food Chemistry, fed diabetes-prone mice either water or diluted coffee for five weeks. The coffee-drinking mice showed improved insulin sensitivity, reduced fatty liver and lower levels of inflammatory adipocytokines - all factors known to reduce the risk of type 2 diabetes.

Previous research has also linked coffee drinking to lowered risk of diabetes. A meta-analysis of research, conducted last year at the George Institute for International Health at the University of Sydney, found that each cup of coffee was associated with a 7% reduction in the excess risk of diabetes, and those drinking 3-4 cups a day had a 25% lower risk between those drinking 0-2 cups.

Even decaffeinated coffee had an effect, with those drinking 3-4 cups of decaf a day clocking a 33% lower risk than non-drinkers. Tea had less of an effect, with 3-4 cups a day translating to one-fifth lower risk than those who drank none.

These protective effects appeared to be independent of other potentially confounding variables. The link between decaf coffee and lowered risk suggests that the active component is more than just caffeine, although the Nagoya research suggests it may be one of the most effective components.

Nicer Than Needles: Insulin Pills for Diabetes Finally in Clinical Trials

After years of research and anticipation, insulin pills that could make it easier for millions of patients worldwide to manage diabetes are finally moving ahead in clinical trials and a step-closer to the medicine cabinet. That's among the topics highlighted in a two-part cover story on drug manufacturing in the current issue of Chemical & Engineering News (C&EN), ACS' weekly newsmagazine.

C&EN Senior Correspondent Ann Thayer notes that drug manufacturers have tried for years to develop oral insulin without much success. Insulin is a peptide hormone that people with diabetes currently take by injection to bring their blood sugar to within normal levels. But doing so requires uncomfortable, inconvenient injections that can make patients reluctant to use the drug frequently enough to adequately control their blood sugar.

An oral form of insulin could help solve this problem. However, stomach acids and enzymes easily destroy insulin and other protein-based drugs. Scientists have had difficulty finding an effective way to eliminate this problem.

They've responded to this challenge by developing special coatings for insulin pills that prevent stomach acid from destroying them. Scientists also are using additives that make it easier for the intestine to absorb large molecules like insulin. After years of setbacks, signs of success may be at hand.

Several insulin pills are now in various stages of clinical trials, and proof of concept may allow them to move into late-stage and more rigorous clinical testing. Only time will tell, however, whether these much-anticipated pills will make it to the market.

Diabetes: High-Tech Tattoo For Monitoring Blood Sugar

Technology has once again come to the rescue of diabetics, trying to make diabetes management easier. Now researchers have given people with diabetes one more reason to join the tattoo craze: a special tattoo under development could help them monitor their blood sugar.

A research team at the Massachusetts Institute of Technology (MIT) is developing a glucose "tattoo" that could give people with diabetes a visual track of their blood sugar, and reduce the need for the painful finger pricks required for traditional monitors.

The glucose tattoo ink, which would be injected under the skin, would be made from a substance that can reflect infrared light back through the skin to a watch-sized monitor that the person with diabetes wears over the ink. That substance is a carbon nanotube, a cylinder-shaped object much less than a hair-width in diameter and commonly used for optics and electronics applications.

"Carbon nanotubes will fluoresce in infrared light, and we can decorate the tubes so they fluoresce in response to glucose," says senior researcher Michael Strano, the Charles and Hilda Roddey associate professor of chemical engineering at MIT.

"When you shine a light on the nanotubes, they'll shine light back at a different wavelength to a watch-type (device) that could tell how much glucose is around," said Strano. Right now Strano and his colleagues are testing out the technology on animals to check for unforeseen immune or allergic reactions before testing it on humans.

This is a great example of how technology is improving health care and quality of life for people with certain health care conditions. Currently, people with type 1 diabetes generally must conduct finger-prick monitoring several times a day. If they don't stay on top of it, they can suffer uncomfortable and even dangerous symptoms stemming from their diabetes.

By having this special ink injected under their skin, and by consistently checking the small monitor worn over it, people with diabetes can get a "real-time" feed on their glucose. They can note and take action when they see their blood sugar climbing or dropping; they don't have to wait until they can get to a convenient place to conduct a finger prick or, worse, until they start to feel ill.

The device also opens up an avenue of thought: if special ink can alert people with diabetes to dropping glucose levels, could an automatic, implanted glucose dispenser or pump be far behind? It's interesting to ponder how technology - much of which, like the carbon nanotubes, already exist for other uses - can help us maybe not cure diseases like diabetes, but at least treat them in a way that takes the burden off the patient. What ideas do you have?

Thank you Alisa Ulferts

Diabetes: How To Treat Wounds And Injuries

No matter how small or superficial a wound is, you should not ignore it if you have diabetes.

If you stub your toe, get a blister from tight shoes, or nick your chin while shaving, you probably give it little thought. But if you have diabetes, you should seek proper treatment.

Knowing how to treat minor wounds will help you avoid infection and speed healing.

Why Diabetic Wounds Can Cause Problems

Diabetes is a chronic disease where your body can't use glucose, or sugar, the way it should. It can cause a number of complications, including some that make it harder for wounds to heal. These include:

• Nerve damage (neuropathy). When you have neuropathy, you may not feel the pain of a cut or blister until it has grown worse or become infected.
• Weakened immune system. When the body's natural defenses are down, even a minor wound may become infected.
• Narrow arteries. People with clogged arteries in their legs are more likely to develop wounds, have severe wound infections, and have problems healing. Narrowed arteries makes it harder for blood to get to the wound. Blood flow promotes healing, so anything that blocks it can make wounds more likely to become infected.

How to Treat a Diabetic Wound

If you have a wound, no matter how small, take the following steps to avoid infection and promote healing:

• Take care of the wound immediately. Even a minor wound can become infected if bacteria are allowed to build up after injury.
• Clean the wound. Rinse the wound under running water to remove dirt. Don't use soap, hydrogen peroxide, or iodine, which can irritate the injury. Then apply antibiotic ointment to prevent infection, and cover the wound with a sterile bandage. Change the bandage daily, and use soap to clean the skin around the wound. Inspect your wound daily for any signs of infection.
• See your doctor. Don't take any chances - have your doctor check minor skin problems or areas of redness before they turn into larger problems. Err on the side of caution - it's far easier to treat a minor skin problem before it becomes serious.
• Keep pressure off the wound as it heals. For example, if your wound is on the bottom of the foot - a common place for diabetic people to develop calluses and blisters - stay off it as much as possible so it will have a better chance to heal.

Foot Wounds Are Dangerous

Feet and ankles are particularly vulnerable to diabetic wound problems. Wound healing below the knee is a different dynamic than in other parts of the body. These areas are prone to swelling, which can inhibit healing. Also, if you have a wound on your arm, you can immobilize it. This is much harder with a foot wound.

But it's not easy for people with diabetes to avoid foot wounds because they are more likely than other people to have calluses, dry skin and nerve damage. All of these combined  can lead to an increased risk of ulcers (open sores) and can lead to infections.

Along with loss of  feeling in their feet, many people with diabetes also have vision problems. So they may neither feel nor see a small wound until it becomes serious. 

A wound that becomes serious may do more than cause pain and inconvenience. It may cause so much damage to tissue and bone that amputation becomes the only option.

Research shows that an ulcer precedes most lower limb amputations in people with diabetes. That's why it's so important to care for a wound before it becomes serious - or, if at all possible, prevent wounds in the first place.

How to Prevent Wounds

The best way to avoid wound problems is to prevent wounds in the first place:   

• Check your feet daily. Look for blisters, calluses, chafing, and redness. This is the single most important thing you can do to avoid diabetic foot problems. If you have trouble seeing, have someone else check your feet every day.
• Pay attention to your skin. Check for small, seemingly minor skin problems like infected hair follicles or inflamed areas around the fingernails. If you notice a problem, speak with your doctor.
• Moisturize your feet. Use moisturizer to keep the skin on your feet soft and supple. But don't use lotions between your toes because this can lead to an fungal infection. To treat athlete's foot, use a gel rather than a cream antifungal product because gels don't leave a moisture residue between the toes.
• Wear proper footwear. Wearing well-fitting shoes can help you avoid blisters. Closed-toe shoes reduce the risk of foot injury.
• Inspect your shoes every day. People with diabetic neuropathy may walk around with a pebble or other object in their shoe without knowing it is there.  You should also check for tears or rough areas on the inside of the shoe.
• Choose the right socks. Buy socks that wick moisture away from skin.  Avoid socks with seams. Socks made specifically for people with diabetes are available in many specialty stores and online.
• Wash your feet daily. After washing, dry them carefully, including between the toes.
• Smooth away calluses. After your bath or shower, use an emery board or pumice stone to gradually remove calluses. Never cut calluses with  scissors or a nail clipper.
• Keep toenails clipped and even. Ingrown toenails can lead to foot problems. Have your doctor check your feet regularly.
• Manage your diabetes. Preventing serious foot wounds also means keeping your diabetes under control. This includes monitoring blood sugar, blood pressure, and cholesterol levels; eating healthfully; taking the medications your doctor prescribes; exercising regularly; not smoking; and having regular medical checkups.

Never ever forget the importance of consistent preventive care. Your life depends on it. 

News Updates: Getting To The Bottom Of Diabetes Management

Even as us diabetics suffer from a cramped lifestyle more than anything else, there comes news of esoteric research that brings good cheer to our sullen lot.

One such item caught my eye in the Times of India today. It seems that big bottom is good for you because it raises the levels of good cholesterol that protects against hardening of arteries and also cuts the risk of diabetes.

The IANS report said scientists also claim that people with lots of moles are years younger biologically than those with mark-free skin. They may retain their youthful looks for longer and could also be at lower risk of a host of age-related diseases, such as heart disease or osteoporosis.

One of the studies shows having a generous rear end rather than a pot belly, cuts levels of bad cholesterol and raises levels of good cholesterol that protects against hardening of arteries and also cuts the risk of diabetes.

Studies have also linked short legs to higher levels of liver and heart disease and diabetes.

Good news is also for those who store fat on the lower half of their body as chunky thighs prolong life.

So there you are. While thin people like me have much to gain in our diabetes management, our well endowed friends can raise a toast to breakthough research that may make our lives less miserable.

# I have been reporting tainted killer diabetes drug Avandi which was been put on watch after a series of damning studies that made two US Senators publish a highly critical report on Avandia. A Food and Drug Administration advisory panel will consider possible further restrictions on the drug next month. 

Meanwhile, Reuters reported that pharma giant GlaxoSmithKline Plc has settled thousands more lawsuits brought by patients alleging its Avandia diabetes drug caused heart attacks, in a move that may defuse potentially massive claims over the medicine.

A company spokeswoman said on Tuesday that consolidated cases which had been due to come to court in Philadelphia this month had been settled. She declined to give further details and said the terms remained confidential.

The first product liability case involving Avandia will now go to court in the United States in October, she added.

The move follows the separate settlement of some 700 cases last month for about $60 million.

Analysts estimate Glaxo had faced a total of 13,000 claims for damages involving Avandia, of which around 5,000 were consolidated in Philadelphia, and there had been fears it could face damages of up to $6 billion.

However, last month's relative modest settlement deal and the latest settlement in Philadelphia suggests the amount paid out by the British-based drugmaker is likely to be a lot lower.

"This implies that close to half of the cases have now been settled and should ease some fears about Vioxx-type liabilities," said Deutsche Bank analyst Mark Clark.
He believes the cost is likely to be comfortably covered by the company's 2 billion pounds ($2.9 billion) of litigation provisions.

And the total could be a lot less than that. Assuming the average pay-out rate of around $86,000 per claimant for the first 700 cases was applied to all 13,000, the amount would be just over $1.1 billion.

Merck & Co Inc agreed a $4.85 billion settlement with plaintiffs in 2007 after its arthritis pain drug Vioxx was pulled from the market in 2004.

Commercially, Avandia is no longer a major product for Glaxo, with sales declining sharply following controversy over the drug's heart risks in 2007, and the medicine is set to lose exclusivity in the United States in 2012. But worries about liability claims have spiked up since February.