Can Herbs Treat Diabetes?

Standard treatment for people with diabetes consists of careful meal planning, a regular exercise program, monitoring blood sugar levels and, when necessary, taking medications. By actively managing their disease and keeping blood sugar levels as close to normal as possible, people with diabetes not only feel better, they also help prevent the long-term complications, such as vision loss, heart attack, stroke, and kidney and nerve damage, that commonly develop when blood sugar levels are regularly too high.
Since there is no cure for diabetes, maintaining good health requires a lifelong commitment to blood sugar control--on-again, off-again efforts are not effective. The self-care requirements of diabetes, or any chronic disease, can be psychologically difficult to adjust to, and resisting the need to follow a regular, day-in and day-out, care plan is a common reaction. The result is that some people seek alternative treatments, if not outright "miracle cures," that seem easier or more "natural" and that allow them to avoid dealing with the realities of a chronic disease.
A so-called diabetes remedy that is gaining popularity today is herbal treatment, with a variety of plant-derived preparations being promoted as capable of controlling blood sugar levels. In fact, herbal treatment for diabetes is not new. Plants and plant extracts were used to combat the disease as early as 1550 B.C., with as many as 400 "prescribed" before the development earlier this century of effective medications to control diabetes. However, claims for the benefits of herbal treatments should be viewed with caution for several reasons.
Keep in mind that few of the herbs that reportedly lower blood sugar have been adequately studied to determine their actual effects. Although some of those that have been studied, often in animals rather than humans, do show a slight ability to lower blood sugar, their effects are not strong or predictable enough to adequately manage diabetes.
Of serious concern is the fact that herbal remedies are unregulated, and no preparation standards have been set for them. This means you can’t be sure the product you buy contains the ingredients its label promises in the amounts it promises, that its active ingredients are actually absorbed by the body or that it was manufactured safely and contains no harmful contaminants. The label may not mention known toxic effects, a particular problem since people often take excessive doses of herbal remedies believing that because they are "natural" they are also safe, so serious side effects can be a problem. Nor will there be information about how the herb may interact with other conventional medications a person may also be taking.
People who decide to try herbs may find they feel better, and therefore assume their diabetes is under control. Unfortunately, this is likely to be an illusion created by some preparations that produce a feeling of well-being without controlling excess sugar in the blood.
People considering, or already using, herbal or other alternative treatments for diabetes should discuss this interest with their physician, even if they fear looking silly or getting a lecture. A lot of progress in treating diabetes has been made since the time when nothing more effective than herbs was available. People with the disease do best when they work closely with their physician to be sure they gain the benefits of this knowledge.

The "Diabetic" Diet

Popular misconceptions about nutrition and diabetes include the idea that a "diabetic diet" is a "sugar free diet"; or that refined sugar is "bad" and "natural sweeteners" are "good". Can "non-sugar" foods be eaten in any amounts? Can a person with diabetes "cheat" every once in a while? What IS a "diabetic diet"? Because so many questions and misunderstandings exist, it is important for a person with diabetes to be able to understand the fundamentals of nutrition, one of several essential elements of successful diabetes management.
There is actually no such thing as a single "diabetic diet". The diet that a person with diabetes follows to help manage his or her blood sugar levels is based on the same nutrition principles that any healthy person, with or without diabetes, should follow for good health. When a person with diabetes sees a Registered Dietitian for nutrition counseling, the goal is to create a nutrition plan. This will help the person manage his or her blood sugar levels, reduce the risk of heart disease and other diet-related conditions, maintain a healthy weight, as well as meet the person’s nutritional, lifestyle, social, and cultural needs.
The energy that we get from foods, measured in calories, comes from three types of nutrients: fats, proteins, and carbohydrates. Any food that provides calories will raise blood sugar. When foods are digested, they are broken down into the body’s basic fuel-- glucose, a type of sugar. The glucose is absorbed by the bloodstream, and is then known as blood glucose or blood sugar. In a person without diabetes, insulin is released by the pancreas after a meal or snack to allow the glucose in the blood to get into the body’s cells, where it is burned for energy. This brings the level of glucose in the blood back down to the normal range. If insulin is not produced or is not working properly, the glucose can not enter the cells to be used, and it builds up in the bloodstream. This results in high blood sugar, and this condition is known as diabetes.
Although all foods that provide calories are converted into glucose by the body, certain nutrients have a more direct effect on the blood’s glucose level. Fats in foods are eventually digested and converted into glucose, but this can take up to 6 to 8 or more hours after a meal, and the release of glucose into the blood is v e r y s l o w ... Protein in foods (such as meats, poultry, fish, eggs, soy and other beans, and milk) takes about 3 to 4 hours after a meal to "show up" as blood glucose.
Carbohydrates, on the other hand, take only about half an hour to an hour after a meal to be turned into blood glucose. The word "carbohydrate" actually means "sugars and starches." Chemically, a starchy food is just a "chain" of glucose molecules. In fact, if a starchy food like a soda cracker is held in the mouth for a few minutes, it will start to taste sweet as the digestive enzymes in the saliva begin to break the starch down into its glucose parts.
Any food that is high in any type of carbohydrate will raise blood glucose levels soon after a meal. Whether a food contains one ounce of sugar (natural or refined) or one ounce of starch, it will raise blood glucose the same amount, because the total amount of CARBOHYDRATE is the same. Although a glass of fruit juice and the same amount of sugary soda may seem like a "good" versus "bad" choice, each will raise blood glucose about the same amount. This information regarding the amount of carbohydrate in different foods is the center of a nutrition management tool for people with diabetes called Carbohydrate Counting. Foods high in carbohydrates include starches such as rice, pasta, breads, cereals, and similar foods; fruits and juices; vegetables; milk and milk products; and anything made with added sugars, such as candies, cookies, cakes, and pies.
The goal of a diabetes nutrition plan is to provide a mixture of fats, carbohydrates, and proteins at each meal at an appropriate calorie level to both provide essential nutrients as well as create an even release of glucose into the blood from meal to meal and from day to day. A Registered Dietitian assesses the nutritional needs of a person with diabetes and calculates the amounts of fat, protein, carbohydrate, and total calories needed per day, and then converts this information into recommendations for amounts and types of foods to include in the daily diet. The total number of meals and snacks and their timing throughout the day can differ for each person, based on his or her nutritional needs, lifestyle, and the action and timing of medications.
Overall, a nutrition plan for a person with diabetes includes 10 to 20 percent of calories from protein, no more than 30 percent of calories from fats (with no more than 10 percent from saturated fats), and the remaining 50 to 60 percent from carbohydrates. Carbohydrate foods that contain dietary fiber are encouraged, as a high fiber diet has been associated with decreased risks of colon and other cancers. For people with high blood cholesterol levels, lower total fat and saturated fat contents may be recommended. Sodium intake of no more than 3000 mg per day is suggested; for people with high blood pressure, sodium should be limited to 2400 mg per day or as advised by a physician.
One "diabetic diet" definitely does not fit all. In fact, ANY food can fit into the diet of someone with diabetes, with the help and guidance of a Registered Dietitian. Managing blood glucose levels does not have to mean giving up favorite foods, sweets, or restaurants and fast foods. Each person with diabetes has very different nutritional and personal needs, making ongoing assessment and counseling with a Registered Dietitian an essential element of successful diabetes management.

Carbohydrate Counting

Carbohydrate counting is one of several methods of meal planning used by people with diabetes. This relatively new approach was one of the meal planning methods used in the Diabetes Control and Complications Trial (DCCT), and it is based on recent advances in the study of diabetes management.
Carbohydrates in the diet have a direct effect on blood glucose levels. All foods that provide calories are converted into glucose by the body. While fats and proteins in a meal are eventually converted by the body into glucose to use for energy, carbohydrates (sugars and starches) are converted to blood glucose quickly- within an hour or so after a meal. Therefore, the level of glucose in the blood after a meal will be directly related to the amount of carbohydrate just eaten.
With the help of a Registered Dietitian, a person with diabetes can determine the amount of carbohydrate that should be eaten per day and at each meal and snack. The total amount of carbohydrate needed daily is based on a person’s calorie needs- carbohydrate should comprise 50 to 60 percent of the day’s calorie intake. For consistent blood glucose levels, the amount of carbohydrate eaten should be spread throughout the day; this will allow for a relatively even release of glucose into the blood from meal to meal and from day to day. For example, a person who needs about 1800 calories a day would need about 225 to 270 grams of carbohydrate a day, distributed evenly among the person’s meals and snacks. The total number of meals and snacks and their timing throughout the day can differ for each person, based on his or her nutritional needs, lifestyle, and the action and timing of medications.
According to recent research, the amount of carbohydrate in a meal is more important than the type of carbohydrate. Foods high in carbohydrates include starches such as rice, pasta, breads, cereals, and similar foods; fruits and juices; vegetables; milk and milk products; and anything made with added sugars, such as candies, cookies, cakes, and pies. Although a glass of fruit juice and the same amount of sugary soda may seem like a "good" versus "bad" choice, each will raise blood glucose about the same amount, because the total amount of CARBOHYDRATE is the same.
Contrary to the "old" philosophy of diabetes management in which sweets were "not allowed", refined sugars such as sucrose can be included in the diet of a person with diabetes, provided that the total carbohydrate content of that meal or snack remains the same. To use the carbohydrate counting method, then, it is very important to know your carbohydrate goal (the number of grams of carbohydrate to eat) for each meal and snack, as well as the carbohydrate content of different foods. Determining the amount of carbohydrate in foods can be done in several ways. The Nutrition Facts labels on packaged foods are very helpful: just look for the Total Carbohydrates line, which will give the carbohydrate content in grams per serving. Be sure to note the serving size listed on the label, as the nutrition information refers to one serving of that food. For people with diabetes who are familiar with the foods and serving sizes in the Exchange Lists for Meal Planning system, the conversion to carbohydrate counting is simple- each Starch, Fruit, and Milk exchange serving contains roughly 15 grams of carbohydrate. The carbohydrate content of foods can also be found in various reference books and charts available in the Nutrition or Food sections of most book stores.
A word of caution: while counting carbohydrates can help manage blood glucose levels, it can also lead to weight gain if the fat and protein contents of foods are ignored. A lot of foods contain both carbohydrate and fat, such as many desserts, which will dramatically increase the calorie content of your food choices and could lead to added pounds. A medium banana and a chocolate candy bar both contain about 30 grams of carbohydrate, but the chocolate bar also contains an extra 15 grams of fat and 150 calories!
For more information on carbohydrate counting and meal planning for people with diabetes, see a Registered Dietitian.

Restaurants, Fast Foods, and Good Nutrition

Kendra Blanchette, RD, CDE

According to the National Restaurant Association, Americans spent 44 percent of their food dollars outside the home in 1996. For many people, fast foods are a daily staple. Although eating out can pose a challenge to good nutrition, it is possible to include fast foods and restaurant meals in a healthful diet- even for people with diabetes. The key to following a diabetes meal plan away from home is to learn how to translate "menu language" into useful information for making smart food choices.
For example, foods described as fried, creamed, au gratin, and sautéed are going to be high in fat. The same goes for foods prepared or served with a lot of cheese, butter, cream, oil, or mayonnaise. Condiments such as salad dressings and tartar sauce should be used in small amounts- ordering them "on the side" is a good idea to help control the amount actually eaten. Other words to look for that signal "high fat" are:

Hollandaise, Mornay, Béchamel, or Bernaise sauce

Gravy, roux, ghee Tempura

Scaloppini, parmigiana, alfredo, carbonara

Romanov, stroganoff

Scalloped

Buttery, flaky, crispy, rich

Croissant, pastry, pie, turnover

Chowder

The amount of fat in a restaurant or fast food meal can be greatly reduced by making even small changes. Just by ordering a hamburger without cheese, 55 calories and 5 grams of fat can be saved. "Hold the mayo", and save another 100 calories and 10 grams of fat! Ordering a salad or a clear soup with a meal in place of french fries or another high fat side dish is also a way to avoid extra fat.
People with diabetes also need to be aware of the carbohydrate content of foods when planning a meal. Added sugars in foods can contribute significantly to a meal’s total carbohydrate content, so they can not be overlooked when making food selections. While desserts and regular sodas are obviously high in sugar, be aware that foods prepared with sweet and sour, teriyaki, barbecue (BBQ), and similar sauces likely will be high carbohydrate choices as well.
At most fast food restaurants, a chart or pamphlet outlining the nutritional content of menu items is available upon request. In addition, as of May 2, 1997, all eating establishments have to follow requirements for nutrition and health claims on menu items such as "Heart Healthy" or "Light", and give customers the nutrition information for these items when requested. Claims on a menu that promote a nutrition or health benefit must meet certain criteria established by the Food and Drug Administration (FDA) and the U.S. Department of Agriculture. For example, a restaurant meal that contains 26 grams of fat (40 percent of the Daily Value for fat) can not be labeled "Heart Healthy" on the menu. These claims therefore can be very helpful when making food choices consistent with a diabetes meal plan.
Overall, fast food and other restaurants offer many different choices. Following a diabetes meal plan while dining out requires knowledge of the principles of good nutrition, as well as an understanding of food vocabulary and menu descriptors. Learn as much as possible about foods and frequented restaurants: by making smart choices, any food can fit into a healthful diet.

Insulin

Since people with type I diabetes do not make insulin, which is necessary to maintain life, they must take insulin shots every day. Insulin cannot be taken in pill form. Some people with type II diabetes, who make insulin but can't use it effectively, may also be helped by taking insulin.
The goal of insulin treatment is to keep blood sugar as close to normal levels as possible throughout the day. So the amount of insulin needed and the number of times per day it is taken will vary according to each person's unique needs. Some of the factors that determine the amount and timing of insulin doses are body weight and build, level of physical activity, daily food intake, other medications being taken, general health and emotional state. Most people need at least two insulin shots per day, and some need more than one kind of insulin.
When a person first begins taking insulin, schedule and/or dose changes are made until optimal blood sugar control is achieved. So it is important for a person with diabetes to keep in regular touch with his or her doctor.

Insulin Types

Different types of insulin have different action times, or length of time they take to begin acting and length of time their effect lasts. Since people don't all respond the same way to these different types of insulin, people with diabetes must work with their doctor to find the type or types that work best for them.

• Ultra Short-Acting Insulin: HUMALOG
• Short-Acting Insulin: Regular (R) and Semilente (r) (S). These preparations start and stop working more quickly than other types of insulin.
• Intermediate-Acting Insulin: NPH (N) and Lente(r) (L). These insulins take longer to start working and work longer than short-acting insulins.
• Long-Acting Insulin: Ultralente(r) (U). This insulin starts acting slowly and last the longest.
• Combination Insulins: 70/30 insulin contains 70 percent NPH and 30 percent Regular insulin, so the Regular begins working quickly, and the NPH takes over when the Regular is stopping. 50/50 insulin has equal parts of the two preparations.

Insulins also differ based on the source from which they were derived. Human insulin is made through DNA technology or a special chemical process; beef insulin comes from cows; and pork insulin comes from pigs. The source of insulin is referred to as its species.

Insulin Purchasing and Care

All insulin bottles sold in the U.S. have orange caps and are marked "U-100," which is referred to as its concentration. They contain 10 milliliters of fluid, with 100 units of insulin in each milliliter, for a total of 1,000 units of insulin per bottle. (U-40 insulin bottles, with red caps, are found in some countries outside the U.S., and U-500 insulin is available by prescription.)
Each insulin box is marked with an expiration date, which should be checked before purchase. Always be sure to check not only the expiration date but the species, brand name, type and concentration of the insulin to be sure you are getting what your doctor has prescribed. And be sure you will use the entire bottle of insulin before it expires. Using the wrong insulin, or using insulin that has passed its expiration date, can affect your diabetes control.
The syringes used for your insulin injections must match the concentration of the insulin. If you use U-100 insulin, use syringes that have orange tops and that come in packages marked U-100. Be sure you buy syringes that hold your full dose of insulin.
Regular insulin should be clear, with no color, cloudiness or thickening. All other insulins should have an even, cloudy appearance after gentle shaking, like skim milk. They should have no insulin at the bottom of the bottle, no clumps in the liquid or on the bottom and no solid particles that give the bottle a frosty look.
Make sure to look at insulin carefully before using it-if it doesn't look right, it may not work correctly.
Store the insulin bottle you are using, as well as extra bottles, in the refrigerator; do not allow them to freeze. Insulin should not be shaken hard or tossed around.
Unrefrigerated insulin should be kept as cool as possible (below 86 degrees F) and away from heat and light. It should not be left in a parked car. When traveling by plane, keep your insulin and syringes in a carry-on bag to avoid having it get lost. (Insulin packed in bags that are checked may freeze in the cargo section of a plane, leading to loss of efficacy.

Insulin Injection Sites

Insulin injections can be given in a variety of sites on your body, including your thighs, upper arms, buttocks and abdominal area. Within each of these areas, there are many sites that can be used.
The insulin injected gets into your blood faster from some areas than from others, which can have an effect on your blood sugar. Talk to your doctor for more information about sites and about any adjustments you need to make for the various sites you are using.

Preparing and Injecting Insulin

Always begin your preparation by washing your hands. To prepare a single insulin dose, gently mix the insulin by rolling the bottle between your palms, turning it over end to end a few times or gently shaking it. If you are using a new bottle, remove the flat colored cap, but not the rubber stopper or metal band under the cap.
Clean the rubber stopper on the top of the bottle with an alcohol swab. Then remove the cover from the needle and pull the plunger back to the line that indicates your dosage to pull air into the syringe. Holding the insulin bottle upright, push the needle through the rubber stopper until the tip is in the insulin, then press the plunger to push air into the bottle of insulin.
Turn the bottle and syringe upside down. Hold the bottle with one hand and use the other hand to pull back on the plunger to pull insulin into the syringe, filling it to the line that marks your dosage.
Check the syringe for any air bubbles. If there are bubbles, use the plunger to push the insulin back into the bottle, then slowly pull insulin into the syringe again, repeating until there are no large air bubbles in the syringe. Finally, double-check that your dose level is correct, then pull the needle out of the rubber stopper. If you must lay the syringe down before using it, be sure to cover it for protection. If the insulin is cold, you may want to warm it slightly by rolling the syringe gently between your palms.
Preparing your own mixed dose of insulin requires special instructions, which your doctor will give you if necessary.
Now you are ready to choose your injection site and clean it with an alcohol swab. Then pinch up a large area of skin and push the needle straight into it, ensuring that the needle is all the way in before you push the plunger all the way down. This pushes the insulin into your body.
Pull the needle straight out. Do not rub the injection site.
Safely dispose of your used needles and syringes. Your doctor or pharmacist can offer suggestions for environmentally safe disposal.

Allergic Reactions

All insulins have added ingredients to prevent spoilage and to prevent bacteria from forming, and, in some insulins, to prolong their action times. Sometimes, people can develop allergic reactions to these ingredients.
If you experience any dents, redness or swelling at your injection sites, or groups of small bumps, similar to hives, check with your doctor:

Diabetes and Menopause

Menopause is a process that occurs over a period of five to 10 years. It begins when a woman's body slows down its production of estrogen and progesterone, the hormones responsible for ovulation and maintaining pregnancy, and ovulation and menstrual periods become irregular and eventually cease. The average age for most women to have their last period is 51, although the process can begin any time from age 40 to the late fifties.
The hormone fluctuations that characterize menopause may wreak havoc on your hard-earned blood glucose control. With less progesterone, you may have greater insulin sensitivity, but with less estrogen can also come increased insulin resistance. And the lack of these hormones can also cause other changes which can worsen diabetes complications. For example, lowered estrogen levels increase the risks of cardiovascular disease, which is already higher for people who have diabetes, and osteoporosis.
Added to these problems, many women find that they gain weight and become less active during this time, which compounds blood glucose control difficulties.
So it is vitally important to plan a nutritious, low-fat diet, with calcium supplements if needed, and to maintain, even increase, your activity level. These measures will help lower your risk of cardiovascular disease by keeping your cholesterol level low and protect your bones against the thinning of osteoporosis.

Hormone Replacement Therapy

Women should also discuss with their doctor whether hormone replacement therapy to reduce symptoms of menopause (such as hot flashes) and reduce the risks of heart disease, stroke, osteoporosis and vaginitis might be suitable for them.
In the past, estrogen alone was given to menopausal women, which turned out to increase the woman's risk of uterine cancer. However, today a woman who still has her uterus is given a form of progesterone along with the estrogen to prevent this complication. Also, some studies have suggested that hormone replacement therapy may increase the risk of breast cancer, although a post-menopausal woman's risk of dying from heart disease is far greater than the risk of developing cancer from taking hormones. Still, many doctors are reluctant to prescribe hormones for their patients who are already at high risk for developing breast cancer. (Hormone replacement is not considered appropriate for most women who have already had breast cancer or who have some other health problems.)
For women with diabetes, there is the additional consideration of the need to deal with the possible effects of hormone levels on blood glucose control.
Whether you should use hormone replacement is a personal decision you should make after getting all the facts from your physician.

Yeast Infections

After menopause, the risk of vaginal yeast infections (vaginitis) increases for women with diabetes. As estrogen levels decrease, yeast and bacteria have an easier time growing, especially if blood glucose levels are frequently too high. (That's because yeast thrives in warm, moist places with a good supply of food--glucose.) Here are some ideas for preventing yeast infections after menopause.

• Work at keeping your blood glucose levels under control.
• Bathe regularly to keep the vaginal area clean.
• Consider hormone replacement therapy.
• If you are particularly bothered by yeast infections, try eating low-fat yogurt that contains Aactive cultures@ daily; there is some evidence that the bacteria in yogurt can help prevent yeast from growing in the digestive tract and prevent vaginitis.

Diabetes and Sexual Performance

Having diabetes can affect every aspect of your life, including your sex life. While discussing such matters can be embarrassing for some people, sex is a natural part of life, and your health care professional can offer information that can help you keep your sexual life satisfying.

Sexual Activity and Diabetes

People who use insulin need to consider and plan for the effects of sexual activity on their overall condition, especially the possibility of a low blood sugar after sex. Here are some measures that can help prevent such a reaction.

• Test your blood sugar before having sex. As annoying as this may seem, it is preferable to having to manage severe low blood glucose afterward.
• Eat just before or right after active sex, just as you do with exercise.
• Consider having a snack before going to sleep.
• People who use an insulin pump may want to unhook it during lovemaking to help avoid a low blood sugar reaction. The length of time the pump can be kept off without an injection will depend on your activity level while off the pump.

General Sexual Issues

Keep in mind that many people, both men and women, experience sexual problems at some time, whether they have diabetes or not. Although people are often reluctant to discuss such matters with medical professionals, you can be assured that your doctor is used to hearing people=s sexual concerns. Best of all, once your concerns are out in the open, your doctor will very often be able to offer advice or treatment to resolve them.
Many problems related to sexual performance are caused by physical problems, some may be related to the medications used to treat those problems, and sometimes sexual problems have psychological roots. It is important to share any concerns you have about sexual matters with your doctor or another member of your health care team so the cause can be determined and addressed.

Special Concerns of Women

In women, diabetes control is often affected by the MENSTRUAL CYCLE, BIRTH CONTROL choices must take diabetes into account, and there are special considerations related to PREGNANCY and MENOPAUSE.
When blood glucose levels remain high over long periods, nerves or blood flow to sexual organs can be damaged, which can interfere with sexual function. Your health care provider can suggest techniques to overcome these problems.
Some women with diabetes suffer from poor bladder control, or neurogenic bladder. To prevent problems from occurring with this condition, women should be sure to empty their bladder both before and after intercourse. (This will also help prevent bladder infection.)

Special Concerns of Men

The major sexual concern of men with diabetes is IMPOTENCE, or handling the anxiety related to this possibility.

Diabetes Control and a Woman's Menstrual Cycle

It is common for women with type I diabetes to have difficulty with blood glucose control during the week prior to their menstrual period, with glucose levels being either higher or lower than usual. This problem seems to be more prevalent in women who say they suffer from the symptoms associated with premenstrual syndrome (PMS).

The culprits appear to be the female hormones estrogen and progesterone, although the reason they have this effect isn't entirely understood.

During the first half of each cycle, levels of these hormones are relatively low. During the second part of the cycle, after ovulation, estrogen and progesterone levels increase, causing the lining of the uterus to thicken in preparation for nourishing a fertilized egg. If fertilization does not happen, the ovary stops making these two hormones, and their sudden loss causes the uterus to shed the lining that is not needed; this shedding is known as menstruation.

Some investigators believe that in some women, high levels of progesterone leads to temporary insulin resistance, with insulin less able to bind to receptor proteins on the surface of cells, causing higher than normal blood glucose levels, while in other women, high estrogen levels increase insulin sensitivity, leading to blood glucose levels that are lower than normal. Other researchers believe that it is the bloating, water retention, irritability, depression and cravings for carbohydrates and fats typical of PMS that are to blame for blood glucose control gone out of whack.

To see what effect your menstrual cycles may be having on your blood glucose control, check your daily blood glucose charts over the past few months, marking the day your period started each month. Then see if there is a pattern--for example, blood glucose levels that are consistently higher or lower than normal during the week before your period. (If you are not recording your blood glucose levels, why not start now!)

There are some measures you can try if you find a relationship between poor blood glucose control and your menstrual periods.

If you think your abnormal blood glucose readings may be due to PMS, first try to address your PMS symptoms: Stick with your meal plan and eat at regular intervals as much as possible; limit salt intake (salt contributes to bloating), and cut back on alcohol, chocolate and caffeine, which can affect not just your blood glucose level but your mood as well. And keep up your regular exercise to help reduce mood swings and weight gain.

Even after addressing PMS symptoms, you may still need to make changes in how you handle food, exercise and even medication in the days prior to your period in order to achieve good blood glucose control. It is best to make one change at a time, so you will know which adjustments are most effective.

If your blood glucose levels tend to rise before your period, add some extra exercise to your daily routine, avoid eating extra carbohydrates, and talk to your doctor about temporary, gradual increases to your insulin dose. (You will need to work closely with your doctor to adjust the dosage so it is right for you.)

If your blood glucose levels tend to be too low before your period, you can try reducing your exercise and increasing your carbohydrate intake (with healthy, not junk, foods). You may also want to talk to your doctor about a temporary, gradual decrease in the amount of insulin you take.

Sexual Concerns of Men with Diabetes

Impotence is often the subject of jokes, but as men age (and for many men with diabetes), impotence is no laughing matter. It is primarily a problem of men in their fifties or older, and men with diabetes are at higher risk. In fact, 50 to 60 percent of men over the age of 50 who have diabetes have some degree of impotence. (Impotence refers to the frequent, not occasional, inability to become or stay erect.)
Impotence can have both psychological and physiological causes. Impotence with a psychological basis often begins suddenly, while impotence with a physical cause usually comes on slowly, beginning with a less rigid penis and fewer erections, and worsens over time, until the man is unable to sustain an erection. In men with diabetes, it is most often caused by nerve- or blood vessel-related problems of the disease. For example, if blood vessel damage prevents blood flow to the penis, it can no longer become erect, or if the nerves that signal the penis become damaged, the result can be failure to become erect.
The best way for a man with diabetes to avoid physiological impotence is to maintain good blood glucose control, as well as avoid smoking, decrease alcohol intake and keep blood pressure normal. But when impotence becomes a concern, a frank discussion with your doctor can get to the root of the problem.
Determining the cause of impotence, which must be done before appropriate treatment can be recommended, may involve a number of different tests. As part of an evaluation, it is also important to inform your doctor about any medications you are taking, including items you buy without a prescription, because some drugs taken for common ailments can contribute to impotence. If medication may be causing impotence, your doctor may be able to change or adjust it. However, you should never stop taking any prescribed medication without consulting with your doctor. Smoking and drinking alcohol can also contribute to impotence.
Today, doctors can offer a variety of treatments for physiological impotence, so going through the diagnostic procedures is well worth the effort. Common treatments include injecting a drug directly into the penis to produce an erection lasting 30 to 60 minutes; using a vacuum pump to produce an erection; and implanting a device (penile prosthesis) in the penis to produce erections. Your doctor will discuss the benefits and risks of each of these treatments to help you make a decision about which, if any, of these options is best for you.
If the impotence is believed to have a psychological basis, your physician can refer you to a therapist who specializes in dealing with sexual issues.

DIABETES

Diabetes is a disorder of the body's metabolism, the process of converting the food we eat into energy. Insulin is the major factor in this process, which begins when food is broken down during digestion to create glucose, the main source of fuel for the body. This glucose passes into the bloodstream, where insulin, a hormone secreted by the pancreas (a large gland behind the stomach), allows it to get into the cells.
In people with diabetes, one of two parts of this system fails to work properly:

• the pancreas produces little or no insulin (Type I); or
• the body's cells do not respond to the insulin that is produced (Type II).

Types of Diabetes

There are two major types of diabetes. Type I, or insulin-dependent, diabetes is sometimes referred to as juvenile diabetes because it most often begins in childhood (although it may also occur in adults). Because the body does not manufacture insulin, people with Type I diabetes must take insulin shots to live. Less than 10 percent of people who have diabetes have Type I.
In Type II diabetes, also referred to as adult-onset-diabetes, the body may make insulin, but either it makes too little, or it can't use what it makes--the insulin is there, but it can't escort the glucose through the entrances to the cells. Type II diabetes occurs most commonly in people over age forty

The Importance of Good Diabetes Control

This insulin failure causes glucose to build up in the blood, so the body is deprived of its main source of energy. Moreover, the high level of glucose in the blood can cause damage to blood vessels, eyes, kidneys and nerves.
There is no cure for diabetes, so the key to good health for people who have this disorder is to control it: to keep the blood sugar level as near to normal as possible. Good control can go a long way toward Prevention of Complications of Diabetes related to the heart and circulatory system, eyes, kidneys and nerves.
Good control of blood sugar levels are/is possible by planning what you eat, staying physically active, taking your medication as directed and checking your blood sugar level often.

How To Achieve Better Diabetes Control

A number of advances in recent years have made improved blood sugar control easier to achieve.
Many people with Type I diabetes have seen improved control with intensive insulin therapy, using multiple daily injections or an insulin pump. The Food and Drug Administration (FDA) has approved Humalog, a new, very fast-acting insulin, which should help control the rise in blood sugar that occurs immediately after eating. And research is continuing on the development of an implantable insulin pump that would make injections a thing of the past.
New pills for the treatment of Type II diabetes are now available. Glucophage (metformin) works by sensitizing the body to insulin. Unlike other diabetes pills, which tend to promote weight gain, Glucophage use often results in weight reduction. Some people with Type II diabetes who have been taking insulin are able to stop it when Glucophage is added to their treatment program. Precose (acarbose), another new pill, works by blocking the absorption of starch, resulting in less of a rise in blood sugar immediately after eating.
Improvements continue to be made in home blood glucose monitoring devices, with newer instruments being smaller, faster, and requiring less blood than older models.
One of the best indicators of how well your diabetes is controlled is the GLYCOSYLATED HEMOGLOBIN TEST, which shows your average blood sugar level over the past three months. By using these test results to improve your diabetes control, you can reduce your risk of complications of diabetes.

The Importance of Diabetes Education

Despite all the advances in diabetes treatment, education remains the cornerstone of diabetes management. People with diabetes, unlike those with many other medical problems, can't just take pills or insulin in the morning, then forget about their health the rest of the day. Differences in diet, exercise levels, stress and other factors may all affect blood sugar levels. So the more people with diabetes learn how these factors affect them, the better control they will be able to achieve.
People also need to know what they can do to help prevent or decrease the risk of complications of diabetes. For example, it is estimated that proper foot care can eliminate 75 percent of all amputations performed on people with diabetes!
Although diabetes education classes are useful for providing general information, we at the Diabetes and Hormone Center of the Pacific believe education should be tailored to the specific needs of each patient. Our Center provides a comprehensive evaluation of each patient's medical condition, current activities and dietary intake, performed by a team that includes a physician, a diabetes educator and a dietitian. An individualized treatment plan is then developed to address each person's physical, emotional, dietary and educational needs.

ORAL DIABETES MEDICATIONS

While some people with type II diabetes can achieve blood glucose control by following a prescribed meal plan and exercising regularly, others will need to add oral medication to their daily routine.
Oral medications, however, are not for everyone with type II diabetes. They are most likely to help people who have had high blood glucose levels for less than 10 years, are normal weight or above rather than very thin and are willing to follow the prescribed meal plan. They are not prescribed unless there is some insulin secretion by the pancreas.
Most oral medications for diabetes are sulfonylurea drugs. They lower blood glucose levels by encouraging the pancreas to produce and release more insulin. Commonly prescribed drugs in this category are Orinase (tolbutamide), Tolinase (tolazamide), (Dymelor (acetohexamine), Diabeta or Micronase (glyburide), Glucotrol (glipizide), Diabinese (chloropropamide) and Amaryl (glimepiride).
These medications increase the risk of hypoglycemia, especially when meals are skipped or too much alcohol is consumed, so people who take them should be alert to any necessary precautions. Sulfonylurea drugs should not be taken by people who are allergic to sulfa drugs or who are pregnant, and should be used with caution by people with significant liver or kidney disease.
A newer type of medication, belonging to a class of drugs called biguanides, was approved in 1994. This medication, metformin (brand name Glucophage) helps lower blood glucose by decreasing the liver’s release of stored glucose, hindering the absorption of glucose from food being digested in the small intestine; it may also lower insulin resistance in the muscles. Metformin is effective in about 80 percent of people who try it.
Metformin has three distinct advantages:

• Because it decreases glucose release rather than increases insulin activity, the risk of very low blood glucose levels (hypoglycemia) is reduced.
• It helps lower high blood fat levels.
• It helps promote weight loss.

Metformin is especially useful for people who are allergic to sulfa drugs or are prone to hypoglycemia; it cannot be used in people who have kidney failure or severe cardiac or respiratory disease. People who take metformin should not drink alcohol.
These two types of oral medications are not an either/or proposition. Metformin can be used along with a sulfonylurea for people whose blood glucose levels are poorly controlled on just the sulfonylurea and a meal plan.
The latest medication to join the arsenal of diabetes treatment is acarbose (brand name Precose). It helps keep after-meal blood glucose levels from going as high as they could by temporarily blocking the action of enzymes that help digest starches. This improves long-term glucose control, as shown by lowered glycosylated hemoglobin levels.
The timing and duration of action of different oral diabetes medications vary widely, so it is important to follow your prescribed medication schedule exactly and report any possible side effects to your doctor. Also, check with your doctor before taking any other medications, either prescription or nonprescription. Sometimes, other drugs you take can interact with your diabetes medication, or have a direct effect on your blood glucose levels, so you’ll need to be prepared for any such actions.
It is possible that, after a period of time, your body will stop responding to oral medications. If this happens, your doctor may recommend adding insulin to your daily routine, either with or without your oral medication. This requires some adjustment, but you will benefit from the improved blood glucose levels you will be able to achieve.

HUMALOG

Humalog is a new type of insulin. A small structural difference from the insulin commonly taken by people with diabetes, allows it to start working more rapidly, and its effect stops sooner, so it functions more like a normal insulin response system.
Humalog's rapid action makes timing of mealtime injections simpler. With regular human insulin, injections need to be taken 30 to 60 minutes before eating. Humalog is taken just 15 minutes before mealtime, allowing people with busy, irregular schedules to fit diabetes into their lives rather than requiring them to change their lives to fit diabetes.
With Humalog, the rise in blood sugar that typically occurs immediately after eating can be more easily controlled. Humalog reaches its peak effect in 30 to 90 minutes, whereas regular human insulin may take up to six hours to peak.
Humalog also has a shorter duration of action--approximately five hours as compared to six to 16 hours for regular human insulin. Note, however, that because of this shorter duration, people whose basal insulin levels are inadequate, such as those with type I diabetes, will also need to take longer acting insulin, such as NPH, Lente or Ultralente for optimal glucose control.
This new form of insulin results in less variation in absorption than regular human insulin, and it may also lower the risk of nighttime (midnight to 6 a.m.) low blood sugar reactions in people with type I diabetes. In clinical trials, there were no significant differences in adverse reactions with Humalog as compared to regular human insulin.
Anyone with type I or II diabetes who requires rapid-acting insulin in their current regimen can use Humalog. Dosing is equivalent to regular human insulin, making the change easy. An adjustment of dose or schedule of longer-acting insulin may be needed when a patient changes to Humalog.
If you think Humalog may be right for you, talk to your doctor. Any change in insulin should be made cautiously and only under medical supervision.

Oral Medication versus Insulin

With proper consideration and expert advice from certified endocrinologist, a dietitian, a nurse educator, and mental health professional, collectively known as the diabetes team, proper treatment can ensure effectiveness and convenience for those diagnosed with diabetes.

Diabetes is clinically identified as the state with which the body excretes a substance in amounts more than the average, most common of which is the diabetes mellitus. This type refers to either the problem in the body’s insulin production (Type 1) or insulin absorption (Type 2) which results to excess sugar in the body. Insulin is the hormone responsible for regulating sugar level and absorption in the cells.

The general factors that trigger diabetes are heredity, immunological damage to the pancreas or virus infections. Treatment varies from such factors as the patient’s blood glucose profile, age, and type of diabetes correspond to different treatments, although the usual medication starts with oral drugs.
Oral Diabetic Medication
For NIDDM or non-insulin-dependent diabetes mellitus, known as Type 2 diabetes, would usually prescribe metformin and second-hand sulfonylureas. These improve insulin sensitivity and decreases hepatic glucose production and intestinal absorption of glucose. However, adverse reactions are also noted for using oral medication such as diarrhea, nausea, vomiting, flatulence, abdominal bloating, taste perversion and anorexia. However, when the effect ceases insulin therapy may be administered by the diabetes team.

Insulin Detemir

Switching from oral medication to insulin detemir would definitely be based on previous medication and sound consideration of your endocrinologist. Insulin determir aids in controlling blood sugar level and glucose metabolism through the binding of insulin receptors, inhibiting the liver’s release of glucose and the facilitating of muscle and fat’s cellular uptake. Through subcutaneous injection (under the skin), insulin detemir is injected either once or twice a day depending on the patient’s glucose level, and may also come in insulin cartridges and vials.

As categorized earlier, when there is a rejection of the insulin excreted by the pancreas, sugar accumulates in an abnormal level in the blood. This non-absorption of insulin may lead to diseases such as kidney failure, diseases of the heart and blood vessels and may further lead to pancreatic failure, in which case the diabetes patient needs to be injected with insulin.

In such cases that the patient under insulin detemir medication experiences symptoms such as those listed below, the medical expert should be notified immediately.

• Hypoglycemia or low blood sugar levels
• Weight gain or loss of appetite
• Sodium retention
• Rash
• Injection site reactions
• Lipodystrophy
• Pruritus
• Seizures
• Shakiness and sweating
• Dizziness or loss of consciousnes

An important reminder for patients, among others, is to never reuse or borrow any syringes or needles. Properly dispose them while those in stock should be stored in the refrigerator, but should never be frozen. Several reminders should also be observed by the patients as well:

The solution should be colorless and has no visible particles before administering them.

Regularly check glucose level so as to avoid hyperglycemia and/or hypoglycemia.

Hard candies, glucose tablets, or any other quick sources of simple sugar are good to carry around in case of hypoglycemia.

Never stop or change the amount of dosage without consulting a doctor.

Before planning pregnancy, a woman should again consult with a doctor first.

For diabetes patients, switching from oral medication to insulin detemir might cause another change in daily routines or habits. However, health is of primary importance and should be followed once prescribed.

Donate Exercise Trademil for Diabetic Patients

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DIABETES AND ITS TREATMENT

Diabetes Foods to Eat-You Have a Lot to Eat Without Fear

Diabetes foods to eat-Is it threatening you and feel restricted to eat only certain items of foods? No, take it positively that you have a lot of foods to eat with an option to nutrition and taste. If you strike a balance for items and quantum of the diabetes diet to eat, you will be the goal winner in extending your life along a healthy line for a long way. In such situation, many others will feel jealous of your health. Don’t think that you are prone to diet controlled diabetes but feel happy that you are a normal person to eat varieties of foods but to measured quantum. Nowadays most of the people irrespective of age and sex are easily susceptible to insulin resistance diabetes.

More of the bad rumors and myths, the consoling message is that people suffering from the so called acquired disorder in metabolism have a choice to eat foods as natural cure for diabetes. Though you have no free option for extended varieties to eat, the diabetes foods prescribed for you are quite accessible and relishable without incurring you additional cost to keep your diabetes blood sugar levels. Believe that you have sure cure just around the corner. You are enabled to reshape and rebuild your old cells with new ones provided you have the right choice of diabetes foods to eat supplemented with herbs and exercise.

Vegetables:
Vegetables with more fiber content are recommended. Fiber content is insisted for the reason that it doesn’t allow fats and blood glucose to deposit in the blood flow. The micro level fiber molecules flush out the saturated fats and glycogenic bonds as waste products from the body and consequently lower blood sugar levels. Most veggies are low in calories but high in volume.

In this list you can add to your dish the French bean, also known as the kidney bean. Bean decoction prepared from fresh bean pods removing the seeds and boiled in water is a good medicinal food to eat for diabetics. Soya bean is also a healthy nutrition food for diabetics which is rich in protein and poor in starch to help reducing diabetes urine sugar.

Onion, raw or cooked, is another home remedial food which is cheap and best to keep a check on blood glucose levels. It reduces the sugar levels in blood and the more it is eaten the faster it would help to lower blood sugar. Recipes of bitter guard and cauliflower are also best for lowering blood sugar levels.

Fruits and animal foods:
There are some fruits with nuts like guava and red grapes which are good for controlling blood sugar. The amino acids in fruits help lowering blood glucose. All fish varieties may be included as much as you can.

Warnings: All diabetic foods should be boiled and not fried. You have the maximum nutritious and medicinal value if the vegetables are eaten in raw form. Vitamins are destroyed when fully in full boiled. Again whole grains are to give good results.

Following these tips is itself the best way of treatment for diabetes. Along with these, you should know the additional description of diabetes foods to avoid and diabetes fruits to eat

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