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When Should Diabetics Take Insulin?

Treatment

Treatment

Treatment for diabetes aims to keep your blood glucose levels as normal as possible and control your symptoms to prevent health problems developing later in life. If you've been diagnosed with type 2 diabetes, your GP will be able to explain your condition in detail and help you understand your treatment. They'll also closely monitor your condition to identify any health problems that may occur. If there are any problems, you may be referred to a hospital-based diabetes care team. Making lifestyle changes If you're diagnosed with type 2 diabetes, you'll need to look after your health very carefully for the rest of your life. This may seem daunting, but your diabetes care team will be able to give you support and advice about all aspects of your treatment. After being diagnosed with type 2 diabetes, or if you're at risk of developing the condition, the first step is to look at your diet and lifestyle and make any necessary changes. Three major areas that you'll need to look closely at are: You may be able to keep your blood glucose at a safe and healthy level without the need for other types of treatment. Lifestyle changes Diet Increasing the amount of fibre in your diet and reducing your sugar and fat intake, particularly saturated fat, can help prevent type 2 diabetes, as well as manage the condition if you already have it. You should: increase your consumption of high-fibre foods, such as wholegrain bread and cereals, beans and lentils, and fruit and vegetables choose foods that are low in fat – replace butter, ghee and coconut oil with low-fat spreads and vegetable oil choose skimmed and semi-skimmed milk, and low-fat yoghurts eat fish and lean meat rather than fatty or processed meat, such as sausages and burgers grill, bake, poach or steam food instead of frying Continue reading >>

Insulin And Type 2 Diabetes: What You Should Know

Insulin And Type 2 Diabetes: What You Should Know

Insulin and Type 2 Diabetes If your health care provider offered you a medication to help you feel better and get your blood sugar under control, would you try it? If so, you might be ready to start taking insulin. Does insulin immediately make you think of type 1 diabetes? Think again. Between 30 and 40 percent of people with type 2 diabetes take insulin. In fact, there are more people with type 2 diabetes who take insulin than type 1 because of the much larger number of people with type 2. Experts believe even more people with type 2 should be taking insulin to control blood sugar -- and the earlier, the better. With an increase in people developing type 2 at a younger age and living longer, more and more people with type 2 will likely be taking insulin. "If you live long enough with type 2 diabetes, odds are good you'll eventually need insulin," says William Polonsky, Ph.D., CDE, associate clinical professor of psychiatry at the University of California, San Diego; founder and president of the Behavioral Diabetes Institute; and author of Diabetes Burnout: What to Do When You Can't Take It Anymore (American Diabetes Association, 1999). Producing Less Insulin Naturally Over Time Research has shown that type 2 diabetes progresses as the ability of the body’s pancreatic beta cells to produce insulin dwindles over time. Your beta cells -- the cells in the pancreas that produce insulin -- slowly lose function. Experts believe that by the time you're diagnosed with type 2 diabetes, you've already lost 50-80 percent of your beta cell function and perhaps the number of beta cells you had. And the loss continues over the years. "About six years after being diagnosed, most people have about a quarter of their beta cell function left," says Anthony McCall, M.D., Ph.D., endocri Continue reading >>

Type 2 Diabetes And Insulin

Type 2 Diabetes And Insulin

Getting Started When most people find out they have Type 2 diabetes, they are first instructed to make changes in their diet and lifestyle. These changes, which are likely to include routine exercise, more nutritious food choices, and often a lower calorie intake, are crucial to managing diabetes and may successfully lower blood glucose levels to an acceptable level. If they do not, a drug such as glyburide, glipizide, or metformin is often prescribed. But lifestyle changes and oral drugs for Type 2 diabetes are unlikely to be permanent solutions. This is because over time, the pancreas tends to produce less and less insulin until eventually it cannot meet the body’s needs. Ultimately, insulin (injected or infused) is the most effective treatment for Type 2 diabetes. There are many barriers to starting insulin therapy: Often they are psychological; sometimes they are physical or financial. But if insulin is begun early enough and is used appropriately, people who use it have a marked decrease in complications related to diabetes such as retinopathy (a diabetic eye disease), nephropathy (diabetic kidney disease), and neuropathy (nerve damage). The need for insulin should not be viewed as a personal failure, but rather as a largely inevitable part of the treatment of Type 2 diabetes. This article offers some practical guidance on starting insulin for people with Type 2 diabetes. When to start insulin Insulin is usually started when oral medicines (usually no more than two) and lifestyle changes (which should be maintained for life even if oral pills or insulin are later prescribed) have failed to lower a person’s HbA1c level to less than 7%. (HbA1c stands for glycosylated hemoglobin and is a measure of blood glucose control.) However, a recent consensus statement from Continue reading >>

Exercising Safely With Diabetes

Exercising Safely With Diabetes

Regular and safe physical activity is especially important for people with diabetes. Blood Sugar and Exercise The most common concern people have about exercise and diabetes is how to keep their blood sugar levels from getting too high or too low. Here are some general guidelines to follow: Exercise at the same time every day, if possible. This will help you find out how exercise affects your blood sugar. Check your blood sugar before exercising. If your blood sugar is less than 100 before you start to exercise, eat a carbohydrate snack. If your blood sugar is 250 or higher, don't start exercising until your blood sugar level is under 250. Exercise with a friend who knows that you have diabetes and knows how to help if your blood sugar gets too low. Make sure you have ID with you that lets people know you have diabetes. If you're sick or have an infection, don't exercise until you're feeling better. Being sick affects your blood sugar. Taking insulin or diabetes pills to lower blood sugar Blood sugar can go too low (hypoglycemia) during exercise if you take too much insulin, the insulin is absorbed too quickly, or the insulin peaks during exercise. It can also happen if you take insulin or pills and don't eat enough carbohydrate. Here are some things you can do: If your blood sugar is less than 100 before you exercise, eat at least 30 grams of carbohydrate before you begin. This will help keep your blood sugar level from dropping too low during exercise. Bring a carbohydrate snack with you whenever you exercise in case your blood sugar level drops too low during or right after you exercise. If your exercise will last for more than an hour, check your blood sugar after each hour of exercise. If your blood sugar is 100 or less, you should eat a carbohydrate snack. Check y Continue reading >>

Diabetes And Illness

Diabetes And Illness

It is very important to know how to cope with illness if you have diabetes or know or care for somebody with diabetes. If in doubt, always seek advice from your doctor or nurse straightaway. Any illness or other type of stress will raise your blood sugar (glucose) levels, even if you are off your food or eating less than usual. People with diabetes are unable to produce more insulin to control the glucose level. The increased glucose level can make you become very lacking in fluid in the body (dehydrated). Acting quickly and following advice helps to keep your glucose levels in the normal range or only slightly high. Because it can sometimes be very difficult to control your blood glucose levels, treatment in hospital may be needed. Hospital treatment may also be needed if you become very dehydrated. What happens to my diabetes when I am unwell? When a person with diabetes is unwell the sugar level in the blood tends to increase. This can happen even with a very mild illness such as the common cold. The blood sugar (glucose) may go up even if you are not eating properly or are being sick (vomiting) or have loose or watery poo (diarrhoea). The increase in blood sugar may make you very lacking in fluid in the body (dehydrated). What should you do when you are unwell? Contact your GP or practice nurse for advice if you are not sure. You may also need treatment for the illness that is making you feel unwell. If you check your blood sugar (glucose) levels then these checks should be more regular. A practice nurse or district nurse can help with checking blood glucose levels, especially if you don't usually check them regularly. Continue eating as normally as possible. If you don't feel like eating, replace your solid food with soup, milk, ice cream, fruit juice, sugar or hon Continue reading >>

Common Questions About Diabetes Medicines

Common Questions About Diabetes Medicines

How do I know if my diabetes pill is working? The best way to find out how well your diabetes pill is working is to test your blood sugar. Ask a member of your health care team what time of day is best for testing. You'll want to test when your diabetes medicine is expected to be most active in your body. Keep a record of your blood sugar levels (PDF) during that time to see if they're at or near your goal. If your levels are at or near your goal and you're not having any problems with the medicine, then it's probably working well. If you're still not sure, talk to your doctor or other member of your care team. Can I stop taking my diabetes medicine after my blood sugar is under control? It's reasonable to think that after a person gets good blood sugar control, it means the end of managing diabetes. But that's not the case. People with type 1 diabetes aren't able to make their own insulin, so they will always need to take insulin shots every day. For people with type 2 diabetes who are on medicine, the answer isn't as clear. Sometimes when people are first diagnosed, they start on pills or insulin right away. If the person also works hard to control diabetes with diet and exercise, he or she can lower the need for medicine and might be able to stop taking it altogether. As long as the person is able to keep blood sugar levels normal with diet and exercise, there isn't a need for medicine. However, type 2 diabetes changes over time. The change can be fast or slow, but it does change. This means that even if a person was able to stop taking medicine for a while, he or she might need to start taking it again in the future. If a person is taking medicine to keep blood sugar normal, then it's important to keep taking it to lower the chances for heart disease and other healt Continue reading >>

Insulin For Type 2 Diabetes: When, Why, And How

Insulin For Type 2 Diabetes: When, Why, And How

Blood sugar control is one of the most important parts of type 2 diabetes management. Although you may be able to treat the condition at first with oral medication and lifestyle changes, such as exercise and weight loss, most people with type 2 diabetes eventually need to take insulin by injection. "There are several scenarios in which insulin treatment should start, including in patients with significant hyperglycemia who are symptomatic," explained Alaleh Mazhari, DO, an associate professor of endocrinology at Loyola Medicine in Maywood, Illinois. "In these cases, the need for insulin may be short-term. Other situations include patients who are on multiple diabetic medications with uncontrolled diabetes, and uncontrolled diabetes in pregnancy, to name a few." Here's what you need to know about taking insulin in the short term and the long term. Insulin for Short-Term Blood Sugar Control Doctors use a blood test called a hemoglobin A1C test to measure average blood sugar control over a two- to three-month period. The treatment target for most people with diabetes is an A1C of 7 percent or less; those with higher levels may need a more intensive medication plan. "The American Association of Clinical Endocrinologists recommends starting a person with type 2 diabetes on insulin if their A1C is above 9 percent and they have symptoms," said Mazhari. Symptoms of type 2 diabetes include thirst, hunger, frequent urination, and weight loss. Research published in February 2013 in the journal The Lancet Diabetes & Endocrinology reviewed several studies that focused on the temporary use of insulin to restore sugar control in people with type 2 diabetes. The results showed that a two- to five-week course of short-term intensive insulin therapy (IIT) can induce remission in patients Continue reading >>

Diabetes Medications: Blood Glucose Management Before Surgery

Diabetes Medications: Blood Glucose Management Before Surgery

F A C T S H E E T F O R P A T I E N T S A N D F A M I L I E S When you have diabetes, managing your blood glucose is always important. But before you have surgery, it’s vital. This sheet tells you why— and explains what you can do to prepare. Why is my blood glucose so important right now? Studies show that people with well controlled blood glucose have fewer problems during and after surgery. But unfortunately, staying in control might not be so easy. Surgery can cause big problems in blood glucose levels — even if you normally have things under control. Here’s why: • Surgery is stressful. Stress usually increases before, during, and after surgery. Beforehand, you’re probably a bit nervous. During and after surgery, your body is stressed, trying to heal itself. And unfortunately, stress makes your body release hormones that make it even more difficult than usual to regulate blood glucose. • You may go off your normal meal plan. Often your doctor will give you special instructions about eating and drinking in the hours before surgery. And for a few days after, you might not eat normally either. Going off your meal plan can cause changes in blood glucose levels. • Depending on what type you take, you may be told to stop taking your diabetes medications before surgery. Or you may need to switch to a different medication, or adjust your dose. The stress and changes that surgery brings can push your blood glucose too high — or too low. Very high or low blood glucose can be dangerous at any time. But they’re especially risky when they happen during or after surgery. They can cause dangerous complications and slow your recovery. So to avoid problems, feel better, and get well faster — control your blood Continue reading >>

Insulin For Type 2 Diabetes: Who, When, And Why?

Insulin For Type 2 Diabetes: Who, When, And Why?

Physicians who treat people with type 2 diabetes face difficult choices when selecting the best medical therapy for each patient. The decision process is further complicated by the fact that because type 2 diabetes is a progressive disease, therapeutic agents that were initially successful may fail five or ten years later. As recently as 1994, there were only two options for patients with type 2 diabetes: insulin and the sulfonylureas (such as glyburide and glipizide). The good news is that today, seven totally different classes of medications are available, as well as much better insulins. The bad news is that many physicians are more confused than ever, especially when faced with the option of combining two, three, or even more drugs at one time. In addition, the past several years have seen the advent of six combination drugs (such as Glucovance, Avandamet, and Janumet), with more on the way. Faced with this explosion of therapeutic options, many physicians are reluctant to start insulin therapy even when it is clearly indicated. Insulin Resistance and Deficiency in Type 2 Diabetes Most patients with type 2 diabetes suffer from two major defects: insulin resistance and beta cell “burnout.” Insulin resistance typically precedes outright diabetes by several years, appearing in adults and children who are overweight, sedentary, and have a genetic predisposition to diabetes. Patients with insulin resistance are often diagnosed with the metabolic syndrome, which predisposes them to both type 2 diabetes and cardiovascular disease. When food is ingested, insulin is secreted by the beta cells into the bloodstream. The insulin travels to the liver or muscles, where it attaches to receptors on the surface of the cells like a key in a lock. In non-diabetic people, this proc Continue reading >>

Can You Have Low Blood Sugar With Type 2 Diabetes?

Can You Have Low Blood Sugar With Type 2 Diabetes?

back to Overview Know-how Type 2 A tag-team approach on low blood sugar with type 2 diabetes. Markus recently wrote an article on our German language blog talking about low blood sugar with type 2 diabetes. The question (“can I have low blood sugar with type 2 diabetes?”) is very common, and it’s easy to see why it’s of concern. So I’ve helped Markus bring his German post to life here in English. I hope it helps! Here’s Markus: Low blood sugar In 2014, results from the DAWN2 study were announced. It was the largest study of its kind (15,000 participants) on the “fears & needs of people with diabetes and their families.” One result stood out: The gravest fears are related to low blood sugars, especially at night. Up to 69% of the participants share this fear! So! Can you have low blood sugar with type 2 diabetes? Yes! Of course! But let’s think about who exactly is at risk – and why. It’s common to think: Type 1 diabetes = at risk for lows Type 2 diabetes = not at risk for lows But that isn’t correct at all, so we should wipe it from our mind. So… what do I need to know? Maybe it’s more accurate to say that people with type 2 diabetes who take certain types of medication are more at risk for lows. We’re getting closer! But to get to the truth, we should take a look at someone without diabetes. Is it possible for them to have lows, too? Theoretically yes, especially if doing long-lasting physical activities without proper food intake. Additionally, extreme stress and binge drinking are also common causes of low blood sugar for people without diabetes. However, it’s pretty rare because as soon as BG’s drop below 80 mg/dl (4.4 mmol/L), the natural counterregulatory system kicks in, raising blood sugar back to normal levels. I’ve never exp Continue reading >>

Insulin Treatment

Insulin Treatment

Insulin is a hormone made in your pancreas, which lies just behind your stomach. It helps our bodies use glucose for energy. Everyone with Type 1 diabetes and some people with Type 2 diabetes need to take insulin – either by injection or a pump – to control their blood glucose levels (also called blood sugar levels). Injecting insulin Insulin is injected using a syringe and needle, or an insulin pen or needle. The needles used are very small as the insulin only needs to be injected under the skin (subcutaneously) – not into a muscle or vein. Once it's been injected, it soaks into small blood vessels and is taken into the bloodstream. As your confidence grows and you become more relaxed, injections will get easier and soon become second nature. The most frequently used injection sites are the thighs, buttocks and abdomen. You may be able to inject into your upper arms, but check with your diabetes team first as this isn't always suitable. As all these areas cover a wide skin area, you should inject at different sites within each of them. It is important to rotate injection sites, as injecting into the same place can cause a build up of lumps under the skin (also known as lipohypertrophy), which make it harder for your body to absorb and use the insulin properly. The three groups of insulin There are three groups of insulin – animal, human (not from humans but produced synthetically to match human insulin) and analogues (the insulin molecule is like a string of beads; scientists have managed to alter the position of some of these beads to create 'analogues' of insulin). Nowadays, most people use human insulin and insulin analogues, although a small number of people still use animal insulin because they have some evidence that they otherwise lose their awareness of Continue reading >>

Insulin Administration

Insulin Administration

Insulin is necessary for normal carbohydrate, protein, and fat metabolism. People with type 1 diabetes mellitus do not produce enough of this hormone to sustain life and therefore depend on exogenous insulin for survival. In contrast, individuals with type 2 diabetes are not dependent on exogenous insulin for survival. However, over time, many of these individuals will show decreased insulin production, therefore requiring supplemental insulin for adequate blood glucose control, especially during times of stress or illness. An insulin regimen is often required in the treatment of gestational diabetes and diabetes associated with certain conditions or syndromes (e.g., pancreatic diseases, drug- or chemical-induced diabetes, endocrinopathies, insulin-receptor disorders, certain genetic syndromes). In all instances of insulin use, the insulin dosage must be individualized and balanced with medical nutrition therapy and exercise. This position statement addresses issues regarding the use of conventional insulin administration (i.e., via syringe or pen with needle and cartridge) in the self-care of the individual with diabetes. It does not address the use of insulin pumps. (See the American Diabetes Association’s position statement “Continuous Subcutaneous Insulin Infusion” for further discussion on this subject.) INSULIN Insulin is obtained from pork pancreas or is made chemically identical to human insulin by recombinant DNA technology or chemical modification of pork insulin. Insulin analogs have been developed by modifying the amino acid sequence of the insulin molecule. Insulin is available in rapid-, short-, intermediate-, and long-acting types that may be injected separately or mixed in the same syringe. Rapid-acting insulin analogs (insulin lispro and insulin a Continue reading >>

Diabetes: Dealing With Low Blood Sugar From Insulin

Diabetes: Dealing With Low Blood Sugar From Insulin

Low blood sugar (hypoglycemia) occurs in people with diabetes when the sugar (glucose) level in the blood drops below what the body needs to function normally. If your blood sugar drops below 70 milligrams per deciliter (mg/dL), you may have symptoms, such as feeling tired, weak, or shaky. If your blood sugar drops very low (usually below 20 mg/dL) and you do not get help, you could become confused or drowsy or even lose consciousness and possibly die. If you are pregnant, your baby could be harmed. Low blood sugar can develop if you take too much insulin, do not eat enough food or skip meals, exercise without eating enough, or drink too much alcohol (especially on an empty stomach). You can usually treat mild—and sometimes moderate—low blood sugar by eating something that contains sugar. You should teach your friends and coworkers what to do if your blood sugar is very low. How to deal with low blood sugar emergencies Here are some ways you can manage low blood sugar. Be prepared Always be prepared for the possibility of having a low blood sugar level. Keep some quick-sugar foods with you at all times. If you are at home, you will probably already have something close at hand that contains sugar, such as table sugar or fruit juice. Carry some hard candy or glucose tablets with you when you are away from home. Quick-sugar foods are foods you need to eat to raise your blood sugar. Know the symptoms of low blood sugar, such as sweating, blurred vision, and confusion. Post a list of the symptoms where you will see it often, and carry a copy in your wallet or purse. Add any symptoms you have noticed that may not be on the list. Be sure that your partner (and others) knows your early symptoms, including the signs of low blood sugar at night. Wear medical identification. Continue reading >>

Insulin: The Holy Grail Of Diabetes Treatment

Insulin: The Holy Grail Of Diabetes Treatment

Insulin is a hormone made by beta cells in the pancreas. When we eat, insulin is released into the blood stream where it helps to move glucose from the food we have eaten into cells to be used as energy. In people with type 1 diabetes, the body produces little or no insulin as the cells that produce insulin have been destroyed by an autoimmune reaction in the body. Insulin replacement by daily injections is required. In people with type 2 diabetes the body produces insulin but the insulin does not work as well as it should. This is often referred to as insulin resistance. To compensate the body makes more but eventually cannot make enough to keep the balance right. Lifestyle changes can delay the need for tablets and/or insulin to stabilise blood glucose levels. When insulin is required, it is important to understand that this is just the natural progression of the condition. RMIT University have produced a short overview of insulin, a drug that keeps in excess of one million Australians alive. Watch the video to understand why insulin is important and why so many Australians rely on it to stay alive. Copyright © 2015 RMIT University, Prepared by the School of Applied Sciences (Discipline of Chemistry). At this stage, insulin can only be injected. Insulin cannot be given in tablet form as it would be destroyed in the stomach, meaning it would not be available to convert glucose into energy. Insulin is injected through the skin into the fatty tissue known as the subcutaneous layer. You do not inject it into muscle or directly into the blood. Absorption of insulin varies depending on the part of the body into which you inject. The tummy (abdomen) absorbs insulin the fastest and is the site used by most people. The buttocks and thighs are also used by some people. While i Continue reading >>

Timing Of Exercise And Your Insulin Levels

Timing Of Exercise And Your Insulin Levels

Timing of Exercise and Your Insulin Levels By Sheri Colberg, Ph.D., FACSM, is a must read for everyone. Not only does this feature apply to insulin dependent patients, but the information is for all patients whether they have diabetes or not. Timing of Exercise and Your Insulin Levels By Sheri Colberg, Ph.D., FACSM The timing of exercise may also play a big role in your body’s responses. For instance, you’re less likely to experience low blood sugars if you exercise before breakfast, especially before taking any insulin. At that time of day, you have only your basal insulin (the insulin that covers your body’s need for insulin at rest separate from food intake) on board, so your circulating levels will generally be low, but you usually have higher levels of cortisol, a hormone that increases your insulin resistance, to compensate. If you exercise after breakfast and a quick-acting insulin injection, your insulin dose may affect whether you get low because the dose will affect your levels of circulating insulin. In one study, exercisers with type 1 diabetes did 60 minutes of moderate cycling starting 90 minutes after taking their regular dose with an insulin pump and eating breakfast. To prevent lows, they reduced their rapid-acting insulin boluses by 50 percent and took no basal insulin. Their morning insulin reductions, however, turned out to be less than afternoon ones made for a similar workout. Thus, if you often develop hypoglycemia during exercise, you might be better off exercising before taking any insulin to cover breakfast instead of afterward or later in the day. Anyone with type 2 diabetes who still makes insulin is also more likely to have glucose levels drop if exercising after breakfast or another meal (as opposed to before) because of the insulin t Continue reading >>

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