I recently read an article titled, “Strategies for Insulin Injection Therapy in Diabetes Self- Management,” by the American Association of Diabetes Educators.  It stated that there is a lot of evidence showing the benefits of insulin therapy.  However, insulin continues to be under used in the United States compared to other countries.  Only 29% of adults with diabetes in the U.S. use insulin.  The results of two surveys recently completed showed that one-third of patients fail to take their insulin as ordered by the doctor and 29% skip their doses¹.  This tells us that there are many barriers to insulin use, resulting in poor blood sugar control and an increase in complications.

In spite of the importance of insulin therapy both doctors and patients try to avoid it.  Doctors tend to prescribe it as a last resort.  The Diabetes Attitudes, Wishes and Needs (DAWN) study showed that, in the U.S, insulin therapy is started later than in other countries².  The reasons were based on physician beliefs that insulin should be delayed and patient’s lack of education on insulin.

Patient barriers include:                                            

• False information on insulin

• They no longer have control

• Fear of needles and pain

• Weight gain

• Fear of hypoglycemia

• Too complicated to learn

Physician barriers include:

• Patient will not continue taking the insulin

• Patient will gain weight

• Patient resistance

• Patient lack of education

As an educator, I believe that insulin therapy should be started earlier in the treatment of newly diagnosed diabetes whether type 1 or type 2, control can be achieved sooner.  Patients can delay the onset of complications that occur too early and too frequently.   

Do you think adding insulin to your medication regimen would help you? 

^{1 Supplement to The Diabetes Educator Vol. 37. NO 6 American Association of Diabetes Educators  pg.2-7.}

^{2 Supplement to The Diabetes Educator Vol. 37. NO 6 American Association of Diabetes Educators  pg.2-7.}

Have You Made Your New Year’s Resolution?  Now is the time to start.  Look back over the past year and think about what you may want to change, fine-tune or learn. Here are some suggestions.

I will:

• test my blood glucose daily and know my target range
• keep my doctor appointments
• eat three portion controlled meals per day, no skipping or delaying
• drink more water
• check feet daily and use moisturizing lotion daily
• eat small amounts of protein with each snack
• make better choices when eating away from home
• go for a walk sometime during the day
• always take my diabetes medications
• relax and treat each day as a new day
• make an appointment with a dietitian to review meal plan (Medicare covers 2 hours of medical nutrition therapy with a physician order every calendar year following initial training)
• set one new goal every three months
• call a CDE at CCS Medical with questions regarding diabetes

I have made my diabetes New Year’s resolutions. Have you?

Have you or a loved one ever found yourself in this scenario? 

You were diagnosed with type 2 diabetes recently and now you have lost interest in things. The holidays are the happiest time of the year but you are sad.  You don’t understand what is going on. You may also be struggling with managing blood sugar levels and you have stopped testing altogether.

You talk with your doctor about your feelings and she performs a mental health screening. She tells you that there is a link between diabetes and depression. A 10 year study at the Harvard School of Public Health found a relationship between diabetes and depression, called a “two-way street”.  This means that diabetes puts people at risk for depression, and people with depression are at risk for type 2 diabetes.  The doctor says she will pay close attention to your mental health and the psycho-social aspect of diabetes care.  It is comforting to know that you are not alone and there is help for this problem.

Help yourself, if you have experienced any symptoms of depression, ask your doctor for a screening.  Remember, treating depression in people with diabetes can improve diabetes care. Also, people with depression can decrease their risk for type 2 diabetes. Both of these conditions can be treated and managed.

^{References: http://www.hsph.harvard.edu/news/feat}

The holidays can be a challenge for people with diabetes and the stress can be too much with all the activities going on.  You are probably preparing for entertaining, family visits, buying gifts and parties.  Besides all of this, you are working full time, therefore, diabetes care is put on the back burner.

Here are some tips to plan for a relaxing and enjoyable holiday season:

• Plan your schedule, make a list of gifts to purchase and do some shopping online
• Always carry glucose tablets and your blood glucose meter in your car, purse or pocket
• Carry a healthy snack like nuts, a small apple with cubes of cheese or peanut butter and crackers instead of eating in the food court
• Keep your exercise schedule, it can reduce stress
• Prepare your traditional holiday food with healthier ingredients
• Bring a pre-mixed light alcoholic drink for fewer carbohydrates. Follow the American Diabetes Association alcohol guidelines for women 1 oz. and men 2 oz. per day.
• When traveling, get all prescription medication (insulin/pills) filled ahead of time. Take syringes, lancets, test strips, pump supplies and batteries

Enjoy your holiday season while effectively still managing your diabetes!

Do you have any tips for the holiday season?

Have you heard of the term “Dawn Phenomenon” or the “Somolgyi” effect? Many people with diabetes haven’t, and yet it happens quite often.

The “Dawn Phenomenon” is a sudden rise in blood sugar between 3:00am and 6:00AM. It occurs in type 1 diabetics and occasionally in people with type 2 diabetes. It is caused by the body’s reaction to hormones that are released when you sleep. The result is an increase in blood sugar due to lack of insulin in the blood stream.

The “Somolgyi” effect, also known as the “rebound” effect, is a period of low blood sugars followed by high blood sugars. It usually happens in the middle of the night. Normally this occurs as a result of taking too much insulin or an oral medication that works at the wrong time.  When the blood sugar is low the body releases hormones and stored sugar is released from the liver which also results in high blood sugars.

How do you know which one you have? This is the fun part! Your doctor will ask you to test your blood sugar between 2:00AM and 3:00 AM a few nights in a row. If the blood sugar is normal or high at this time, suspect the dawn phenomenon. However, if your blood sugar is consistently low during this time, you are experiencing the “Somolgyi” effect, caused by too much night time insulin or too small of a bedtime snack for the insulin given.

What can you do? Ask your doctor about an insulin pump to manage your diabetes.  One of the features that the pump can do well is stop the dawn phenomenon. You can set different basal rates to increase or decrease insulin according to your needs.

Feel free to share your “Dawn Phenomenon” or “Somolgyi” effect stories…what steps did you take to overcome this?

You may have found yourself in this situation:

You scraped your foot while working outside.  You actually didn’t even know it had happened until you saw that your foot was bleeding.  After you washed and dried the area it appeared fine.  A couple of weeks later you notice that your foot is swollen, red, and painful to touch, plus a dark scab has covered the area. You are now concerned because you have heard people with diabetic foot wounds can develop complications quickly.

In this situation or when you develop a diabetic foot ulcer, the most important thing to do is to go see your doctor for an assessment of the wound and circulation.  Good blood flow to the area is very important for healing.  Diabetes can reduce blood flow to legs and feet even when you do not have a diabetic wound.  Other factors such as blood sugar control, smoking and diabetes eye or kidney problems can also be a risk for slow healing.  The doctor says that because you have feeling loss in your feet (Peripheral Neuropathy), you were unable to feel the pain when you cut your foot.  Your wound is cleaned by removing the dead tissue from the area, which is called debriding.  A treatment regimen is set up for you to follow when you get home for good diabetic foot care  You will need to clean and cover the wound twice a day with wound dressings and antibiotics are prescribed for the infection.  Following the treatment plan ordered by the doctor is very important for the wound to heal.

The underlying cause of this situation is uncontrolled diabetes which will also need to be managed more closely starting right away!

Has this ever happened to you?  What prevention steps can you recommend?

Have you been wondering what has caused your blood sugars to elevate? Your first instinct is to look at your food intake or lack of exercise.  But there are other things that can affect your blood sugar readings, and STRESS is one of them.  Your body’s stress hormones, such as cortisol, can increase in the blood stream when you are stressed out.  The major function of these hormones is to help boost energy, this is referred to as the “fight or flight” reaction.  It causes tremors, fast heart beat and shakiness.  These hormones send your blood sugars skyrocketing to boost energy when needed.

Here are some ways to prevent this from happening:

• Make time for yourself and do something you enjoy
• Have an exercise routine
• Take a break when you feel overwhelmed

What is your biggest stressor and how do you cope with it to keep your blood sugar under control?

Yesterday I went to see my dentist for a routine visit.  We got to talking and she commented on how the diabetic patients that she treats have a very poor understanding on how diabetes can affect their teeth.

Did you know that people with diabetes are likely to experience tooth loss?  Why is this?  It is because bacteria is always present in the mouth, even though we don’t like to think about it.  When blood sugars are high, the bacteria will settle into the gums and results in gum disease.  The germs destroy the bone around the tooth and promote infection.

What signs and symptoms should you look for?

•      Bleeding gums when brushing and flossing
•      Gums appear red, irritated and swollen
•      Loose teeth
•      Puss oozing around the tooth
•      Mouth odor

How can you prevent this from happening?

•       Control blood sugars
•       Routine visits to your dentist

Remember it is easier to prevent gum disease than treat it!  What additional steps can you recommend to stay on top of your dental hygiene?

I talk with patients daily about blood sugar testing. When questioned why they are testing less than their doctor has ordered, their excuses are too many to list.

When I hear this, I look back on my own life with diabetes over the past 51 years.  When diagnosed with diabetes that many years ago, I had urine test tape.  When placed in the urine the tape would turn colors.  I would compare it to the color chart and the chart would tell me the range the sugar was in.  I then progressed to the Clinitest which measured the amount of glucose in the urine, this was the only way for diabetics to keep a check on their glucose levels at the time. These tests were unreliable and you can imagine how happy I was when the blood glucose meters became available.  Now, I could actually see a specific number associated with my test.  It improved the ability to control my diabetes and my medications could be adjusted properly. This is why I encourage people to test their blood sugars as prescribed by their doctor.

We have come a long way in diabetes testing management. There are so many types of diabetes blood glucose meters on the market that you are bound to find one that fits your needs.  Blood sugar testing is the most important thing you can do to manage your health and prevent complications.

If you have been managing diabetes for quite a few years - what is your favorite benefit of the new blood glucose meters?