Diabetes and The Promise of Stem Cells

I’d like to delve a little more into stem cell research in relation to disease and more specifically diabetes. I’d also like to make something clear, right from the start.

I am not in favor of embryonic stem cell research.

Further, reports I have read  indicate that the results of embryonic stem cell research are dismally poor and, in some cases, have had disastrous results. Several studies I read indicate the development of cancers from treatments with embryonic stem cells.

In contrast, research into disease and the use of adult stem cells is very encouraging to say the least. Most of the reports I have read deal with the introduction of the adult stem cells right into the affected area. Be that cartilage, liver, pancreas or whatever. I even read one study that showed regeneration in a damaged heart resulting from stem cell introduction.

In a process very similar to islet transplant procedures where islets, (which contain beta cells that produce insulin), are injected into the pancreas, (one must take anti-rejection drugs the rest of one’s life), adult stem cells are injected into the pancreas and have been shown to repair the damaged areas.

One study I read on this said that the injected stem cells were made to ‘glow’ through some technical process in order to track them. The results showed that the injected adult stem cells “became” the various pancreatic cells, including regrowth of islets and beta cells, and showed areas of repair done by the introduced cells.

For those with diabetes, (either type 1 or type 2), imagine being able to use your own stem cells, (thereby having no fear of rejection), to repair the damaged areas of the pancreas and start producing islets with their insulin producing beta cells. Allowing you to produce your own insulin once again and eliminating the need for any more shots.

Oh, I look for this day. My fingertips are sore. My belly has at least one or two bruises going all the time. The lows are awful, and fluctuation in my glucose levels makes my moods swing wildly at times. If I can, someday, have an injection that will effectively cure my diabetes, made from my own adult stem cells, I am right in line.

For now I take StemEnhance. It does not claim to be a cure of any kind, for anything. However studies show a relationship between stem cell production, and various health problems. This product only promises and has been proven to, increase the amount of stem cells ones own body produces and releases. If I can increase the amount of stem cells available to repair my body, I am going to do it.

The testimonials for those who take it are amazing, including some people I know personally, and can back up with personal observation. I have also read from numerous detractors, but none have convinced me that the concept is invalid. If you wish to know more, click on the link provided. Please view the video(s) on that site

Treatments for Diabetes

There are several different treatment options for diabetic people. Your doctor could have you on a diet, oral medication, insulin injections, or a combination of them. It doesn’t matter if you are on oral medication, insulin injections, or both, diet is still going to be a required part of your diabetes control.

In Germany they are using adult stem cells from your own body (no fear of rejection) to combat diabetes in both type 1 and type 2 diabetes. They are having good success at controlling both hyperglycemia (high blood sugar) and hypoglycemia (acute low blood sugar).

Now I know a little about stem cells because one thing that I take is called Stem Enhance and it stimulates the body’s release of stem cells increasing the amount of stem cells available to help your body heal itself. Stem cells, it seems, are the body’s building blocks and are the only cells that can become any other cell in the body, unlike specific cells. A bone cell can only become, or replicate, as another bone cell, a skin cell may only become, or replicate, as another skin cell, and on and on.

A stem cell can become any other cell. Therefore, the injections of stem cells into the damaged pancreas can have startling effects, becoming new pancreatic cells and replacing damaged areas with healthy cells. I actually read a study on this a year or so ago, before I started taking the Stem Enhance product.

For me this is exciting news and perhaps this procedure will be available in Canada in the future. I can imagine being free of taking needles. I know that Canadian scientists are studying the relationship between stem cells and their benefits to some diseases, including diabetes. There have been some clinical trials here with the injections of stem cells, but you have to be in severe straights to qualify for these. I am under control so I don’t qualify. I look forward to a time when these treatments will be available to more people.

Another treatment for diabetes is the insulin pump. A tiny tube, so small you cannot feel it, is put under your skin, this attaches to a small machine that uses a fast acting insulin. It continuously injects a basal amount of insulin. A basal amount is used to keep your glucose at a level when you are not eating. You tell the machine to give extra when you are eating a meal. I am told that more and more diabetics are using this now as it frees one from injections several times a day and is more convenient.

Gastric banding has, in cases of extreme obesity and diabetes been used as a treatment. By reducing the weight of an individual, you also reduce the need for insulin and, if enough weight is lost, may reduce the need for anything but diet to control type 2 diabetes. This all depends on the individual as each case is different.

Islet transplant is another experimental treatment that holds promise for the diabetic. Islets are taken from a donor pancreas and transplanted to the pancreas of a diabetic. Islets are found in clusters in the pancreas and contain beta cells. Beta cells produce insulin. The human trials conducted so far in this area are showing great promise.

Below is a video I found on Utube about another study for a drug that could be of benefit for diabetics.

Some Expert Information

I found this on u-tube and thought it would be just the ticket for those of you who prefer to listen to something as opposed to reading. I know that sitting and reading something can be rather dry, especially if it is not something meant for entertainment, like a good novel. As we go along I will post more information in this fashion. Sometimes it is easier for me too, than going through a lot of technical information and transposing it into terms the average person can understand, me included. Seeing things explained can go a long way toward understanding, and saves a lot of words trying to describe it.

The Importance of Exercise and Diet

So much today is written of the importance of diet and exercise for all and when one has diabetes it is truly essential that one participate in being active and eat wisely. This is true whether you are a type 1 or a type 2 diabetic.

Diet is very important in the life of a diabetic. Most food is turned to glucose in the body. The cells then take the glucose from the blood stream and convert it to energy. Insulin is produced by the pancreas and allows all the cells to take the glucose from your blood and convert it.

For a diabetic, either the pancreas doesn’t produce insulin (type 1), or doesn’t produce enough insulin or the cells ignore the insulin produced (type2). When the cells ignore the insulin produced it is called insulin resistance.  It is my understanding that with most type 2 diabetics it is a combination of not enough insulin produced and insulin resistance.

A diabetic, (whether type 1 or type 2), needs to balance calorie intake with the medications so that your bodies glucose levels don’t rise or drop dramatically. This is especially important for insulin dependent diabetics. If you are overweight, losing the excess can go a long way to maintaining optimal health. It will help lower the amount of insulin you need to take, (and for some enable them to get off insulin) and is far better for your heart health and will also help you avoid or reduce other complications. You need to be rigorous in following a strict diabetic diet.

Keep close watch on your intake of fats and carbohydrates. These will raise your blood sugars and fats are high in calories to boot.

Proteins are a good choice for diabetics as they do not raise blood sugars like carbs and fats, and should make up 12% to 20% of caloric intake for the day. A gram of protein equals about 4 calories. It is great for a bedtime snack to help maintain glucose levels. My doctor told me that making sure I had enough protein with each meal or snack also helped keep blood sugar levels steadier as it inhibits the quick uptake of the glucose created by carbohydrates.

A very rich source of protein is fish. Soy and lentils are also high protein foods, along with many kinds of beans such as kidney beans, baked beans etc.

Carbohydrates are the highest source of blood sugar, but don’t eliminate them! It is recommended that 40-60% of your daily calories come from carbohydrates.

Generally carbohydrates are one of two types. Complex carbohydrates are found in fruit, vegetables, whole grains and starches. Simple carbohydrates are found in table sugar and processed foods.

Complex carbohydrates, those we get from vegetables and whole grains are the best because they take longer for the body to break down. They also contain fiber which is essential in preventing heart disease. They also promote weight loss and aid in preventing type 2 diabetes. However starchy food like potatoes and pasta should be very limited and simple carbs should be avoided all together if possible.

Fats can be good or bad depending on the source. Saturated fats (such as red meats) and trans fatty acids, (made from plant fats artificially and are found in fried foods, processed foods and margarine), should be avoided. Those with diabetes should try and stick with monounsaturated and polyunsaturated fats found in plant products. These should make up about 30-35% of your calory intake.

Plants, fruits, whole grains and nuts are all  high in  fibers. Fibers  help cleanse the body by passing waste and water through the intestine to be removed as solid waste. They also aid in proper food digestion, help keep a healthy weight, decrease cholesterol levels, and are good for the heart.
As with all you do, consult your doctor or diabetic nurse/clinic for good dietary controls and suggestions.
I found the diabetic nurses at the clinic very helpful in helping me find out what my caloric intake should be for the day and for advice on what foods I should avoid.

Exercise not only helps burn off the calories, it helps your body utilize the sugars, and helps reduce the weight. One side effect of insulin is weight gain. And it is a “catch 22". The more insulin you use, the more weight you gain; the more weight you gain, the more insulin you need. It can almost defeat one.
Exercise can help lose those extra pounds, but you must use caution! If you exercise too much, or too little, it can have a negative affect on your blood sugars. They could go suddenly down (hypoglycemia) or increase very quickly (hyperglycemia). Keep food and medications on hand when you are exercising so that you can deal with extreme variations in blood sugar quickly.

For those who are, for one reason or another restricted in the physical activity they can participate in take a look at my friend Kim's site at http://startfitnessnow.com She was a trainer for the show "The Biggest Loser" and has some wonderful exercise programs for everyone from beginner to advanced. There is even one that can be done from a sitting position. She also offers some expert advice on her site from Dr. Singh to do with nutrition. Some of her information focuses on diabetes.

Diabetes Neuropathies: Prevention, Diagnoses and Treatments

Prevention:
Keeping your blood glucose levels as near to normal range is the best way of preventing neuropathy. This is the best way to protect the nerves throughout your body.

And how I know how difficult this can be. Especially at this time of year. Christmas is almost upon us and with it comes all the wonderful treats made for the season. Almost every home you go in to has platters of cookies, cakes, chip and dips, ciders and eggnogs. It is so very easy to over eat and ignore our blood sugars. Make sure you eat regular meals and take your insulin. I find that, if I have eaten and followed my regime, it is far easier to resist the temptations put in front of me. I will also take only a nibble or two of a treat. Maybe 2 or 3 chips. Or one cookie. And then leave the rest alone. At least I have had a taste and it doesn’t usually affect my blood glucose by very much at all.
                       
Diagnoses of Diabetic Neuropathies:

Usually diabetic neuropathy is diagnosed by your doctor based on symptoms and physical exam. Your doctor will most likely check your heart rate, reflexes, muscle strength, and blood pressure. He/she may also test your sensitivity to changes in position, vibration, light touch, or temperature.

If you feel you have symptoms, talk to your doctor so that he can test you. We know our own bodies better than anyone and when it is not reacting normally to anything, we can tell. Listen to your body. If your feet are going numb, even slightly, let your doctor know. The same goes for your hands or any other part of your body. Don’t ignore warning signs like tingling, weakness, pounding in the ears, the sensation of hearing your own heartbeat, or even small injuries that you don’t feel at the time of injury. Early detection of neuropathies will help you and your doctor combat it.

Foot Exams:

Because I have signs of peripheral  neuropathy now my doctor does a comprehensive foot exam about every six months, though it is recommended once a year for most diabetics. Your doctor will examine the skin, muscles, circulation, sensation and bones in your feet.

When I had my first exam at the diabetic clinic they used a feather, with me not looking, to see if I could feel it. I couldn’t. Then she used a nylon monofilament (like a bristle on a hairbrush), poking my feet with it, again with me not looking. (Some will use a pin instead). I could feel that.

These tests will indicate to your doctor whether you have lost the protective sensation in your feet (and other areas). Loss of sensation can cause you to develop foot sores or have unnoticed injuries that may not heal properly.

Your doctor may also use a tuning fork to test your sensitivity to vibration. It is more accurate than touch pressure. Checking temperature sensitivity is another test he may use.


Other Tests:
Though not often needed to diagnose neuropathy, there are other tests used to tell him what type of nerve damage there is and to what extent it has progressed.

To show how organs, like the bladder and urinary tract, preserve a normal structure and whether the bladder is emptying properly he may do an ultrasound.

Your doctor may check on the flow of electrical current through a nerve using a nerve conduction study. This can tell him what type of neuropathy is there and to what extent the nerves are damaged.

To test muscle response to electrical signals sent by nearby nerves he may order an electromyography.

A heart rate variability test will tell your doctor how the heart is responding to deep breathing and changes in blood pressure and posture.

Treatment of Diabetic Neuropathies:

The best and first treatment of diabetic neuropathies, and to prevent further damage, is to bring your diabetes under control and keep it in normal range. This will include taking medication and insulin as directed, planning meals, testing often for blood glucose levels, and physical activity.

As a note, the amount of physical activity you do can greatly affect your blood glucose levels and thereby affect how much insulin you will need to take.

To begin with your symptoms may seem to get worse, however getting and keeping your blood glucose levels controlled well will help lessen them in the long run.

For instance, at first I couldn’t see well. My vision was very blurry. As I got my blood glucose levels under control, the sugar build up at the back of my eyes that was causing the blurriness was lessened and, over time, my eyesight cleared. (As much as it ever does as I already wore glasses.) This was NOT caused by a neuropathy, but because I had gone undiagnosed for so long.

When you have high blood sugar that is uncontrolled it can cause a buildup of sugar/glucose behind the eyes, affecting vision. By bringing blood glucose under control, this will clear up and your vision will revert to what it normally was.

Keeping your blood glucose levels under control may also prevent or delay further problems. As scientists learn more, new treatments to help slow, prevent or even reverse the nerve damage may become available.


Other  treatments depend on the type of nerve problem and symptom.

Pain Relief

Oral medications are usually used for painful diabetic neuropathy, though other treatments could help some. Those with severe nerve pain my find relief from a combination of medications and treatments.

Some oral medications used to help relieve diabetic nerve pain include:

tricyclic antidepressants, such as amitriptyline, imipramine, and desipramine (Norpramin, Pertofrane)
other types of antidepressants, such as duloxetine (Cymbalta), venlafaxine, bupropion (Wellbutrin), paroxetine (Paxil), and citalopram (Celexa)
anticonvulsants, such as pregabalin (Lyrica), gabapentin (Gabarone, Neurontin), carbamazepine, and lamotrigine (Lamictal)
opioids and opioid-like drugs, such as controlled-release oxycodone, an opioid; and tramadol (Ultram), an opioid that also acts as an antidepressant
Duloxetine and pregabalin are approved by the U.S. Food and Drug Administration specifically for treating painful diabetic peripheral neuropathy.

Many experts say to avoid over-the-counter medications like acetaminophen or ibuprofen. They may not work very well and can have serious side affects. Often antidepressants can help relieve pain. This does not mean you have to be depressed to have them be effective. Some medications are not recommended for use in older patients or those with heart disease. All medications have some side effects.

Topical treatments (applied to the skin) can be effective depending on your type of neuropathy. These include capsaicin cream and lidocaine patches (lidoderm, lidopain), as well as nitrate sprays or patches used on the feet for pain relief.

Studies of alpha-lipoic acid, an antioxidant, and evening primrose oil have shown that they can help relieve symptoms and may improve nerve function.

A device called a bed cradle can keep sheets and blankets from touching sensitive feet and legs.

Acupuncture, biofeedback, or physical therapy may help relieve pain in some people.

Treatments that involve electrical nerve stimulation, magnetic therapy, and laser or light therapy may be helpful and are being studied further. Researchers are also studying several new therapies in clinical trials.

Gastrointestinal Problems

Eating small, frequent meals, avoiding fats and eating less fiber can relieve mild symptoms of gastroparesis (indigestion, belching, nausea, vomiting). If your symptoms become severe erythromycin may be used to speed digestion or perhaps metoclopramide (which also helps to relieve nausea). There are other medications as well that help regulate digestion or reduce stomach acid.

I take a combination of Nexium and metoclopramide to help with the nausea, along with eating small meals frequently.

To relieve diarrhea or other bowel problems, doctors may prescribe an antibiotic such as tetracycline, or other medications as appropriate.


Dizziness and Weakness

Have you ever stood up too fast and had the room spin? A rapid change in blood pressure is the culprit in most cases. Blood pressure and circulation problems can cause light-headedness, dizziness, or fainting. Sitting or standing slowly may help. Raising the head of your bed, or wearing elastic stockings can also aid in preventing these episodes.

Treatment with salt-retaining hormones or increasing salt in the diet may be of benefit for some.

High blood pressure medications may be used.

When muscle weakness or loss of coordination is a problem, physical therapy may be of  help

Urinary and Sexual Problems:

Drinking plenty of fluid can help prevent urinary tract infections. An antibiotic will most likely be prescribed if you do develop a urinary tract infection. For those who suffer from incontinence, urinating at regular intervals—every 3 hours, for example--- may be helpful as you may not be able to tell when the bladder is full.

To treat erectile dysfunction in men, the doctor will first do tests to rule out a hormonal cause. Some oral medications have been developed and are available to help men get and maintain an erection by increasing blood flow to the penis. There are also injections that are injected right into the penis or inserted into the urethra at the tip of the penis. Mechanical vacuum devices have also been used to increase blood flow to the penis. A  surgically implanted inflatable or semirigid device in the penis have been used as well.

Vaginal lubricants may be useful for women when neuropathy causes vaginal dryness. To treat problems with arousal and orgasm, the doctor may refer women to a gynecologist.

Foot Care

The nerves affected most often by neuropathy are those to the feet. These nerves are the longest in the body. Loss of sensation in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers.

More than half of all lower-limb amputations occur in people with diabetes—86,000 amputations per year in the US alone. Doctors estimate that nearly half of the amputations caused by neuropathy and poor circulation could have been prevented by careful foot care.

Follow these steps to take care of your feet:

Clean your feet daily, using warm—not hot—water and a mild soap and dry them with a soft towel drying carefully between your toes. Avoid soaking your feet.

Inspect your feet and toes every day for cuts, blisters, redness, swelling, calluses, or other problems. Use a mirror—laying a mirror on the floor works well—or get help from someone else if you cannot see the bottoms of your feet. Notify your health care provider of any problems.

Moisturize your feet with lotion, but avoid getting the lotion between your toes.

File corns and calluses gently with a pumice stone. After a bath is best because they have become softer and easier to work with.

Keep your toenails cut  to the shape of your toes, filing the edges with an emery board.

Always wear shoes or slippers to protect your feet from injuries. Prevent skin irritation by wearing thick, soft, seamless socks.

Make sure your shoes fit well and allow your toes to move. Wear new shoes for only an hour or so at a time, breaking them in slowly.

Make sure your shoes have no tears, sharp edges, or objects inside them that could injure your feet before putting them on.

If you need help taking care of your feet, make an appointment to see a foot doctor, also called a podiatrist.

Points to Remember

• Diabetic neuropathies are nerve disorders caused by many of the abnormalities common to diabetes, such as high blood glucose.

• Neuropathy can affect nerves throughout the body, causing numbness and sometimes pain in the hands, arms, feet, or legs, and problems with the digestive tract, heart, sex organs, and other body systems.

• Treatment first involves bringing blood glucose levels within the normal range. Good blood glucose control may help prevent or delay the onset of further problems.

• Foot care is an important part of treatment. People with neuropathy need to inspect their feet daily for any injuries. Untreated injuries increase the risk of infected foot sores and amputation.

• Treatment can include pain relief and/or other medications depending on the type of nerve damage.

• Smoking in itself causes circulatory problems which greatly increases the risk of foot problems and amputation. If you smoke, ask your health care provider for help with quitting.

Though I have interjected much of my own experiences, my technical information has come from the NDIC (National Diabetic Information Clearing House). This material is not copyrighted and is available for all to use. Check out the site at

http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/index.htm 

Other Resources and information links:

www.ClinicalTrials.gov. Studies and clinical trials

American Diabetes Association

1701 North Beauregard Street

Alexandria, VA 22311

Phone: 1–800–DIABETES (342–2383)

Email: AskADA@diabetes.org

Internet: www.diabetes.org

American Urological Association Foundation

1000 Corporate Boulevard

Linthicum, MD 21090

Phone: 1–866–RING–AUA (746–4282)

or 410–689–3700

Fax: 410–689–3800

Email: patienteducation@auafoundation.org

Internet: www.auafoundation.org

www.UrologyHealth.org

American Podiatric Medical Association

9312 Old Georgetown Road

Bethesda, MD 20814–1621

Phone: 1–800–FOOTCARE (366–8227)

or 301–581–9200

Fax: 301–530–2752

Email: askapma@apma.org

Internet: www.apma.org

Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion

Division of Diabetes Translation

4770 Buford Highway NE, Mail Stop K–10

Atlanta, GA 30341–3717

Phone: 1–800–CDC–INFO (232–4636) or 770–488–5000

Email: cdcinfo@cdc.gov

Internet: www.cdc.gov/diabetes

Juvenile Diabetes Research Foundation International

120 Wall Street

New York, NY 10005–4001

Phone: 1–800–533–CURE (2873)

Fax: 212–785–9595

Email: info@jdrf.org

Internet: www.jdrf.org

Lower Extremity Amputation Prevention Program

Health Resources and Services Administration

5600 Fishers Lane

Rockville, MD 20857

Phone: 1–888–ASK–HRSA (275–4772)

Internet: www.hrsa.gov/leap

National Diabetes Education Program

1 Diabetes Way

Bethesda, MD 20892–3560

Phone: 1–800–438–5383

Fax: 703–738–4929

Email: ndep@mail.nih.gov

Internet: www.ndep.nih.gov

National Digestive Diseases Information Clearinghouse

2 Information Way

Bethesda, MD 20892–3570

Phone: 1–800–891–5389

Fax: 703–738–4929

Email: nddic@info.niddk.nih.gov

Internet: www.digestive.niddk.nih.gov

National Heart, Lung, and Blood Institute Information Center

P.O. Box 30105

Bethesda, MD 20824–0105

Phone: 301–592–8573

Fax: 240–629–3246

Email: nhlbiinfo@nhlbi.nih.gov

Internet: www.nhlbi.nih.gov

National Institute of Neurological Disorders and Stroke

P.O. Box 5801

Bethesda, MD 20824

Phone: 1–800–352–9424 or 301–496–5751

Internet: www.ninds.nih.gov

National Kidney and Urologic Diseases Information Clearinghouse

3 Information Way

Bethesda, MD 20892–3580

Phone: 1–800–891–5390

Fax: 703–738–4929

Email: nkudic@info.niddk.nih.gov

Internet: www.kidney.niddk.nih.gov

Pedorthic Footwear Association

2025 M Street NW, Suite 800

Washington, DC 20036

Phone: 1–800–673–8447 or 202–367–1145

Fax: 202–367–2145

Email: info@pedorthics.org

Internet: www.pedorthics.org

Complications of Diabetes (Neuropathy) Part 2

Good day to you all. I’d like to get right back in to our discussion on neuropathies caused by diabetes. These I also know something about as I have and do experience a number of them already. This has been caused partly by going so many years undiagnosed, allowing the diabetes to run rampant through my body.

One type of neuropathy I deal with is peripheral neuropathy. My feet, as I said in my previous post, have shown signs of neuropathy since I was diagnosed. My hands have carpal tunnel syndrome and I have custom made casts for both. It is A-typical (not typical), and linked to the diabetes. I often don’t feel it when I have hurt myself. I do some light woodworking and most of my own home renovations and I must be very careful handling my power tools. Often I don’t know I have cut myself until I see the blood flowing. A dangerous thing to be sure.

I suffer several of the symptoms listed below. Numbness and insensitivity to pain I deal with daily. When a new area is going to go permanently numb, I will first feel tingling, burning and prickling in that area, sometimes for several months. Often through the day I have unexplained sharp pains and cramps. And loss of balance and coordination just to round things off and make life interesting.

Peripheral neuropathy is responsible for damage in the arms and legs. The lower extremities (feet and legs) are usually affected before the upper extremities (hands and arms). Often diabetics feel no symptoms. Regular diabetic appointments with your doctor are recommended because he may be able to detect signs of neuropathy that you can’t yet.

Symptoms of peripheral neuropathy include:

• numbness or insensitivity to pain or temperature

• a tingling, burning, or prickling sensation

• sharp pains or cramps

• extreme sensitivity to touch, even light touch

• loss of balance and coordination

• These symptoms are often worse at night

Muscle weakness and loss of reflexes can be caused by peripheral neuropathy. Loss of reflex at the ankle can change the way a person walks. Foot deformities, like hammertoes and the collapse of the mid-foot can result.

Having feet that are numb or have lost feeling makes it easy not to notice injuries.

For instance, a few days ago I sliced the bottom of my foot, on the ridge back of the toes. I barely felt it, even to walk on. Had I not immediately taken care of it I would run the risk of infection. The infection can then spread to the bone resulting in amputation. Not something anyone would want.

A few years ago I had a friend who was diabetic. He had an injury to his ankle and despite being under a doctor’s care infection set in. He has now had several amputations to that leg as the doctors attempt to get rid of the infection that had spread to the bone. Every time the infection has started once again in the stump.

Please take care of ANY injuries promptly and if there is ANY sign of infection get in to your doctor immediately. If you are diabetic don’t try to care for an infection yourself. Your immune system is weak and may need help to battle it. Even a very small cut, if it won’t heal, can cause a life and/or limb threatening infection.

Autonomic neuropathy affects the nerves that control the heart, regulate blood pressure, and control blood glucose levels. Other internal organs can also be affected. Problems with digestion, respiratory function, urination, sexual response, and vision can result. One may not experience the warning symptoms of hypoglycemia because the system that restores blood glucose levels to normal after a hypoglycemic episode (low blood sugar) can be affected,

I know something about hypoglycemia unawareness. I used to have definite signs of having a “low”. Shaking, sweating, nausea, weakness, and palpitations. I only had to get below a 5 to start feeling the signs. Now I don’t feel them. I am nauseous much of the time to begin with, so I no longer have that signal to rely on. The symptoms don’t happen now till I am under a 4 and usually not till I am approaching a reading of 3.5 or less.

The heart and blood vessels are part of the cardiovascular system. This is the system that controls blood circulation. Autonomic neuropathy can affect this system as well. When the nerves are damaged in this system it interferes with the body’s ability to adjust blood pressure and heart rate. Blood pressure can drop sharply after sitting or standing, making one feel light-headed or even cause one to faint. Damage to the nerves that control heart rate can make your heart rate stay high instead of rising and falling. A normal part of body function and physical activity.

Nerve damage to the digestive system most commonly causes constipation. It can also cause the stomach to empty too slowly, a condition called gastroparesis. It can cause persistent nausea, vomiting, bloating, and loss of appetite. Something I suffer from. Because you cannot digest your food properly gastroperesis can cause your blood glucose to fluctuate wildly. Damage to the esophagus can make it difficult to swallow, and damage to the bowels can cause constipation alternating with frequent, uncontrolled diarrhea, especially at night. A faulty digestive system can also cause weight loss.

Autonomic neuropathy often affects the organs that control urination and sexual function. The bladder cannot empty completely, which can allow bacteria to grow in the bladder and kidneys, causing urinary tract infections. When the nerves of the bladder are damaged, a person may be unable to sense when the bladder is full or control the muscles that release urine. Urinary incontinence, either partial or total, can be a result. Many of us, as we get older, experience some incontinence. Like dribbling when we laugh, etc. The neuropathy makes it worse, of course.

Autonomic neuropathy can also decrease sexual response, although the sex drive may not change. A man may not be able to get an erection or may climax without ejaculating normally. A woman may have difficulty with arousal, lubrication, or orgasm.

The nerves that control sweating can be affected by autonomic neuropathy too. Damage to the nerves can prevent the sweat glands from performing properly and the result is that the body cannot regulate it’s temperature properly. This damage can also cause profuse sweating at night or while eating. Something I go through on a regular basis, though in my case menopause is a factor as well.

Autonomic neuropathy can affect the eyes. The pupils become less responsive to changes in light. A person may not be able to see well when a light is turned on in a dark room because the eyes won’t adjust quickly to the change, or you could have trouble with your night vision while driving. It seems to me that my vision is not only affected when in a dark room, or for driving but, due to the fact I wear bi-focal lenses now, I have a hard time focusing or getting the correct distance from the page to use either the upper portion of my glasses, or the lower portion meant for reading. On my computer my head is at an awkward angle in order to see the screen. Often this causes eye strain, and neck strain resulting in headaches.

Proximal neuropathy, sometimes called diabetic amyotrophy, amongst other names too hard to understand, starts with pain in the thighs, hips, buttocks, or legs, normally on one side of the body and is more common in those with type 2 diabetes and in older adults with diabetes. It causes weakness in the legs and difficulty going from a sitting to a standing position without help. Treatment for weakness or pain is usually needed. The recovery period varies, depending on the type of nerve damage.

Focal neuropathy appears suddenly and affects specific nerves, most often in the head, torso, or leg.
It may cause an inability to focus, double vision, aching behind one eye, paralysis on one side of the face, (called Bell’s palsy), severe pain in the pelvis or lower back, pain in the front of a thigh, pain in the side, stomach or chest, pain on the outside of the shin or inside of the foot, chest or abdominal pain (sometimes mistaken for heart disease, a heart attack, or appendicitis.It happens mostly in older adult diabetics and is painful and unpredictable, though it does tend to improve on its own over weeks or months and no long-term damage is caused.

People with diabetes also tend to develop nerve compressions, (or entrapment syndromes). Of these the most common is carpal tunnel syndrome. Carpal tunnel syndrome is typified by numbness and tingling of the hand and occasionally muscle weakness or pain. Other nerves susceptible to entrapment can cause pain on the outside of the shin or the inside of the foot.


I think I have covered most of the effects and types of neuropathy so, at this point I would like to thank my readers for coming back. I hope you are finding the information valuable and I look forward to your comments. The next installment(s) will be addressing prevention, diagnoses and treatment of diabetic neuropathies.

Complications of Diabetes (Neuropathy) part 1

Well here I am again. I woke up this morning with my feet half asleep and slightly numb. Ah ha, I thought, here are my next several posts. The complications of diabetes.

These can be many and varied, including, but I think, not limited to :

• diabetic neuropathy: the nerve damage
  
• heart disease and stroke
• diabetic retinopathy (diabetic eye disease)
  
• erectile dysfunction
• hypoglycemia (low blood glucose)
  
• kidney disease and failure
• sexual and urological problems
• stomach nerve damage (gastroperisis)
  
• liver damage

There are several on the list that I now know something about. Like diabetic neuropathy.

When I was first diagnosed and attended my first diabetic clinic they tested my nerve feeling in my feet. First they had me look away and (I saw afterward) ran a feather around my feet. I couldn't feel it. A sign of some nerve problems already.

Next they poked my feet with something (a pin I think). This I could feel, indicating that the nerve damage wasn't too bad yet, but was definitely there.


Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness—loss of feeling—in the hands, arms, feet, and legs.

These symptoms depend on the type of neuropathy and which nerves are affected.

The first symptom is often numbness, tingling, or pain in the feet. This is often minor at first and because most nerve damage occurs over several years, mild cases may go undetected for a long time. However, for some people the onset of pain can be sudden and severe. Symptoms can involve the sensory, motor, and autonomic—or involuntary—nervous systems.

Symptoms of nerve damage may include:

• numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
• wasting of the muscles of the feet or hands
• indigestion, nausea, or vomiting
• diarrhea or constipation
• dizziness or faintness due to a drop in blood pressure after standing or sitting up
• problems with urination
• erectile dysfunction in men or vaginal dryness in women
• weakness

Though my muscles are not wasted, yet, I fight with just about everything on the list! Even as I write this my hands are fairly numb. My toes and half my feet are going numb off and on, depending on where I put them.


I don't have vomiting most of the time. I have constant nausea which I take another medication for. And acid reflux disease, a severe form of indigestion which I take yet another medication for. I have gone through several medications and developed a resistance to them so I have had to change every so often.

I experienced numbness, and tingling. My feet and hands go numb (what most would call "going to sleep") quite a bit, and on the side of my knee I had felt a tingling sensation, (somewhat itchy too when it tingled), for a long time. Now the area is just numb. At least on the surface. I can still feel a good poke in those areas though.

I have bouts of alternating diarrhea and constipation. The bouts of diarrhea are the worst. I can't go out of my home or be very far from a bathroom, which makes it difficult to work at times even though I only work part time, one or two days a week. When it hits, with absolutely NO warning, I need a bathroom NOW!!

If I am faced with a bout of constipation I only have problems when my system starts working again. Then I experience excruciating cramps and pain until I am able to relieve myself. Often I will go from constipation right into a bout of diarrhea. Not a whole lot of fun to say the least.

Everywhere I go, I scope out where the nearest bathrooms are. I don't go out and visit much anymore either because I find it embarrassing to be hit with a bout of diarrhea while visiting.

Is it any wonder that some fight with symptoms that are not due to neuropathy, but often accompany it, including weight loss and depression.

Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs.

Up to 70 percent of diabetics have some type of neuropathy. And it can develop at any time, though there is an increased risk the older you are and the longer you have had diabetes. The highest rates of neuropathy are amongst people who have had diabetes for at least 25 years.

Diabetic neuropathy also seems to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat, high blood pressure and those who are overweight. Many diabetics on insulin become overweight. A side effect of insulin is weight gain and it's a catch 22. The more weight you gain the more insulin you need, the more insulin you need, the more weight you gain.

The causes are probably different for different types of diabetic neuropathy. Nerve damage is likely due to a combination of factors:

• metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin
• neurovascular factors lead to damage of the blood vessels that carry oxygen and nutrients to nerves
• autoimmune factors cause inflammation in nerves
• mechanical injury to nerves, like carpal tunnel syndrome
• inherited traits that increase susceptibility to nerve disease
• lifestyle factors, such as smoking or alcohol use

Classifications of diabetic neuropathy are peripheral, autonomic, proximal, or focal. Each affects different parts of the body in different ways.

• Peripheral neuropathy, the most common type, causes pain or loss of feeling in the toes, feet, legs, hands, and arms.
• Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual function and response, and perspiration and can affect the nerves that serve the heart and control blood pressure, nerves in the lungs and eyes. It can cause hypoglycemia unawareness as well, a condition in which people no longer have the warning symptoms of low blood glucose levels.
• Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs.
• Focal neuropathy is the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain. Any nerve in the body can be affected.

Peripheral neuropathy affects:

• toes
• feet
• legs
• hands
• arms

Autonomic neuropathy affects:

• heart and blood vessels
• the digestive system
• the urinary tract
• sex organs
• sweat glands
• eyes
• lungs

Proximal neuropathy affects:

• thighs
• hips
• buttocks
• legs

Focal neuropathy affects:

• eyes
• facial muscles
• ears
• pelvis and lower back
• chest
• abdomen
• thighs
• legs and feet

I think I will stop here for today. Tomorrow I will discuss the various types of neuropathy in a bit further depth. I hope this blog on diabetes is helpful to some, especially those newly diagnosed. Till my next post, God bless.

Diagnosed with Diabetes (part 2)

Well, I have tried most of the day to figure out what I am going to write today. I woke up this morning and took my blood sugar reading. Down around a 4. Not a good start to the day.

When you start with a slight low, you need to be able to adjust the amount of insulin you take with your first meal of the day. But it also means that much of the day, at least for me, will be spent in a fog. The brain just does not want to work right. Getting into any project can be a struggle. I feel scattered and unable to settle for more than a minute or two.

And that's from only a slight low.

I try to keep my numbers in the 6 range, but under a 7. I used to feel anything below a 5. These days I don't feel the lows until I hit around 3 or less so I tend to take more readings during the day than most people. If you are a professional driver you are not supposed to even get behind the wheel if you are under a six and insulin dependent. If you're caught by the DOT you can have your drivers license suspended or revoked! They like you to stay between a 6 and an 8.

One thing I have been able to do, right from the start almost, is self adjust my insulin based on what my numbers are, what I am going to be doing, and most importantly, what type of meal I am eating.

Anything high in carbohydrates is going to mean a little more insulin. A full meal versus a sandwich will make a big difference in how much insulin you take. A salad will require very little insulin, a loaded sandwich with all the trimmings will take more than a plain one, and a full meal will require more yet.

You must eat a protein with everything you eat, be it a snack or a meal. Protein helps your body process what you have eaten a little more slowly and enables your insulin to work better by doing so. Sugar or carbohydrates are a "quick" boost and sometimes your body will process these quicker than your insulin works, resulting in a low. This is one reason that when you have a low and take whatever glucose tabs or liquid you take, they tell you that, if your next meal is more than a half hour away, eat. The sugar/glucose boost will only act for a short time and your body needs food to work with the insulin.

It doesn't take much either. 4 oz of meat with a meal, a handful of peanuts with a snack or one egg with your morning toast. I keep a variety of things on hand like peanuts in the shell, a trail mix, pre-boiled eggs in the fridge. I have little packages of glucose tablets all over the place. In my van, my purse, some of my coat pockets and at home. I am likely to find one almost anywhere that I frequent. Being a security guard I even have some in my "kit" that I take to work with me. Most of what it holds are things to make the time pass. Like a portable DVD player, (DVD's chosen just before I head out), police scanner, two way radios, a book, CD's and Walkman, stuff like that. But in there too are things like a tin of nuts, glucose tablets, maybe some candy or a chocolate bar.

It is always advisable to keep these things around where you are. At your desk, in your vehicle, purse and anywhere handy so that when you do have a low you can deal with it right away.

One thing I don't do is use sugar substitutes. I have researched a lot of them and from what I can glean, most of them are capable of causing more problems than they are worth. But that is my choice. I know a number of diabetics who drink a lot of diet pop and use things like Stevia or Splenda as a sugar substitute and they seem to do fine. I don't like the back taste many of them have either, so I just limit my sweets.

Carbohydrates are the big problem for me, and most diabetics and lets face it, carbs are the cheapest food. For those of us on very limited incomes this can pose a problem. Proteins are expensive for the most part. Meats and cheeses (not the processed stuff) are expensive and on a limited budget many of us don't get much of it. But there are other things available. One very high protein is various types of beans. Chili con carne is almost all beans and meat and very high protein for example. A good bean salad is a good protein source. Lima beans, if you can tolerate them, are also good. Even a can of pork and beans can replace meat for a meal.

One of the hardest things, especially at this time of year, is being invited out to a meal. Many times there are treats and specialty items that are really not good for diabetics.

I remember being invited to a Christmas get together at a friends house when I first was starting to learn about controlling my disease. There were platters of treats all around the house and I didn't take any. I was afraid to. I had eaten my dinner, taken my insulin and now, here was all this extra food hanging around. There were chips, cookies, cake bars, candies, dips etc. just waiting to be nibbled on. Anyone who knows me well, knows I am the original cookie monster. I love cookies (as long as they don't have chocolate bits in them). And potato chips!! MMMM.
Another favorite snack food of mine.

After that I didn't take any invitations. I was afraid to. I was just new to this and didn't know what I could eat and get away with. It's not that way now. I eat pretty much whatever I want, but I limit the amount I eat. It may be only a nibble, a bite or two, but I can say that I had some. And that makes me feel that I am not left out of things.

There are many good cook books out for diabetics now and I would suggest you invest in one or two. Especially if you are newly diagnosed. Places like Save-on-Foods also have free "clinics" where they will teach and show you many of the products you can have. Go to one. Go to a few. Everything you learn about your disease will help you to learn to control it, and sometimes it's even fun. Some of my friends even cook diabetic for me when they invite me over. God Bless their hearts.

It's not such a bad idea to invest in a small kitchen scale. I found it handy when I was newly diagnosed. When I went to the diabetic clinic, the teaching on proper amounts of each food per serving was done in measurements. With the scale I was able to measure the amounts and get a good feel for "diabetic" serving sizes. This helped to be able to start judging how much insulin I would need for a meal. Even if I ate more than suggested serving sizes, I was able to start judging how much more insulin I would need for that meal. And keeping track of that also helped me judge the insulin needed for smaller sized meals.

Well, that's all for now. I hope you're enjoying the posts and that they are at least somewhat informative. Back soon with more.

Diagnosed with Diabetes (part 1)

I have chosen for my first blog a subject that my life seems to revolve around... diabetes.
First off, if you have any two or more of the following symptoms, please, please be insistent with your medical provider that you be tested properly.

• uncontrollable thirst
• frequent urination
• rapid weight loss or gain (it can strike either way)
• blurring of vision
• frequent headaches
• weakness, extreme fatigue
• extreme hunger
• irritability
• cuts or sores that are slow to heal
• itchy skin/yeast infections
• dry mouth
  
• leg pain
  

For me the worst symptoms were the thirst, urination, rapid weight gain, hunger, blurring vision, and extreme fatigue.

It is an insidious disease that went undiagnosed in me for around 17 years, until I could not even find the energy to get from my bedroom at one end of my 53ft trailer to the living room at the other end. This was not for lack of trying to get proper testing done.

At 35yrs old I was told that I needed to take a glucose tolerance test every year because I was then a "borderline" diabetic. (I had for several years previously been told I had hypoglycemia.)But my life was somewhat nomadic and, though I asked many times for the test I was told I needed, in Canada glucose tolerance testing was not done anymore as a primary detection.

Instead they did a "fasting" glucose test, which for me was exactly the WRONG test to do. I always tested normal. No one would listen.

I had a rapid weight gain around this time, packing on over 60 pounds in less than 6 months. Something that is not exactly the norm for most. Far more common is weight loss. It took a long time for my normally 100 pound body to adjust to carrying around what amounted to a second me! I guess part of the problem was the extreme hunger I experienced, along with the fact that I had had a very high metabolism and was used to eating a lot just to maintain weight. If I skipped a meal, I lost, so I was used to snacking throughout the day on high calorie foods.

The metabolism changed. I was tired all the time. I was thirsty all the time. (In the end drinking about 5 gallons of water a day! ) I couldn't be away from a bathroom. I was always hungry. I couldn't see properly, everything was blurry, even though I had my eyes tested only a few months previously.

There was a convenience store less than a city block away from me and I could not make it to there without taking a large bottle of water with me and asking for the bathroom as soon as I got there.

I should interject here that the cycle starts with frequent urination as your body tries to rid itself of the excess glucose in your bloodstream. The thirst is caused from being dehydrated due to this, and the extreme tiredness comes from your body not getting any sustenance from the food you eat, which is why most people lose weight.

Though I asked many times over the intervening years for the glucose tolerance testing, I was told I didn't need it because my fasting test was normal. At last, over 50 years old and so sick I could barely stand up for more than a few minutes, I went in and demanded something be done. The doctor gave me attitude, saying with a very heavy sigh that he would do a random test and asking me how long since I last ate. It had only been an hour or so since I had had a teen burger at A&W so my body would just be processing that meal.

He took the blood test stating that, "if it's not over a 7 , I will go no further." in a very snide tone. Normal range is between 5 and 7.

His tone changed the next day when I was called in for an emergency appointment. I was sitting at 28 for the test and it would have gone higher over the next hour or so. He told me I should be in the hospital, but there was no room so I was put on a waiting list to see a diabetic clinic nurse and explore my treatment options and learn about controlling my disease.

Even though it was an expected diagnosis, I was worried and starting asking several people I knew about it. Many told me it was really nothing. Many had type 2 diabetes and only had to follow a diet and take a pill. Don't listen to them! Diabetes is a progressive and life threatening illness and needs to be cared for properly, like it or not.

I was so sick by then that pills weren't touching it, even though, after my diabetic clinic appointment (almost 2 months after diagnosis), I was put on the maximum dosage. A simple diet change was not an option. Every test they do when you are found to have diabetes was 4 - 5 times normal ranges.

So on to insulin I went (two kinds... long acting used for a base, and a shorter acting when I ate).... plus the pills to combat the insulin resistance. Still at maximum dosage.

Along with these came (as is quite common), high blood pressure medication, and high cholesterol medication. And, of course, the changes in diet that are needed to help.

I was told that sometimes people can get off the insulin after their pancreas has had a rest from producing what was needed. This did hold true for me. After about a year on insulin I was able to work myself off it and just kept using the pills and diet to help control the disease.

A year and a half later though, I started feeling some of the old symptoms once again. I had felt them throughout the time I was off insulin, but was told that my 3 month tests showed that I was within range and I was doing well. I know if I ate too much, I would get so tired I couldn't focus. I used it as a sleeping pill. Jack up my sugars in the evening and I would sleep like a baby.

Not a good practice for sure and not recommended.

But I hid most of this from my doctor at that time.... it was my rebellion you see.... I didn't want to be diabetic and have to watch everything I did... so I didn't. The only yardstick I measured anything by was the 3 month test (A1C I think it is called, or HA1C, something like that). And the only reason I kept taking that is because I couldn't keep my professional drivers license without a Dr.'s report every three months.

There are costs to diabetes one doesn't even think about at first. Not only did I have 3 month checks on my long term average, but to hold my drivers license cost me about $200/year! Eye exams, doctors reports (not to mention that every time I went in for the eye exams my prescription had changed again due to the changing sugar buildup and reduction in my ocular areas). I have since let my professional license go and dropped to a regular class 5, so now all the extra tests are every two years.

At first the onus was on me and I would get papers in the mail every six months to a year to take to the doctor and ophthalmologist. I had (and still have to as far as eye exams go) to pay for these exams, over and above normal fees. And an optometrist was not sufficient because extra testing is involved when you are diabetic. Now much of the onus is on the doctor. The government in Canada has made the doctors responsible to send in the reports every three months and the papers are sent to him. I no longer have to keep track of the elapsed time between testing. His office calls me, makes arrangements for testing at the hospital lab, and books me an appointment that includes the diabetic nurse at his office. At least for the basics. The eye exam papers still come to me, but not as often since I reduced my license class.

Without these reports, and being in good control, you can lose your driver's license completely! Your driver's license costs more too when you renew it! For me it was a difference of $35/year (BC has a 5 year renewal but diabetics get dinged, it seems, every year).

Well, I had had a little freedom from thinking about the disease much (I had even stopped taking any blood sugar readings on my testing kit, trying hard to ignore my illness), but now I was sickening again. Too tired to do much, increasing thirst/urination once again, and just feeling generally lousy all the time. So back to the doc I went to tell him I was going to start on insulin once again.

Only this time the insulin wasn't working as well. I had to take 4 to 5 times the dosage I had been on and still couldn't bring my numbers down. I was down to two pills a day for the diabetes, plus the high blood pressure meds and cholesterol meds which I had never stopped taking. These had to increase once again too. Even taking my blood pressure pills regularly and on time I was often sitting in stroke range (very high), so another was added. And a change in insulin for the long acting dose. The dose was tripled!

I implore you, don't play with this disease. I know that it seems to take over your life and everything you do, or eat revolves around it. Even the amount of activity you have that day effects your numbers and your body does it's own thing too. One day you will be in good control and the next day everything is out of whack even though you ate the same things, did the same activities and to all extents and purposes had an identical day. Your body decides it is going to have a low... or a high... and there is nothing you can do about it. It is frustrating to say the least, but diligent care is the only thing that will keep the progression of the disease slowed down.

By playing with it as I did, I now have "diabetic pain" in my legs, extreme itching which I have to take yet another pill for, and neuropathy has started in my feet and other areas of my body causing numbness in those areas that is annoying and does not go away.

I think I will stop here for today, else this post may get too long to absorb :). I will continue this discussion in a day or so.