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Diabetes And Hypertension: A Position Statement By The American Diabetes Association

Diabetes and Hypertension: A Position Statement by the American Diabetes Association

Diabetes and Hypertension: A Position Statement by the American Diabetes Association

Hypertension is common among patients with diabetes, with the prevalence depending on type and duration of diabetes, age, sex, race/ethnicity, BMI, history of glycemic control, and the presence of kidney disease, among other factors (1–3). Furthermore, hypertension is a strong risk factor for atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications. ASCVD—defined as acute coronary syndrome, myocardial infarction (MI), angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origin—is the leading cause of morbidity and mortality for individuals with diabetes and is the largest contributor to the direct and indirect costs of diabetes. Numerous studies have shown that antihypertensive therapy reduces ASCVD events, heart failure, and microvascular complications in people with diabetes (4–8). Large benefits are seen when multiple risk factors are addressed simultaneously (9). There is evidence that ASCVD morbidity and mortality have decreased for people with diabetes since 1990 (10,11) likely due in large part to improvements in blood pressure control (12–14). This Position Statement is intended to update the assessment and treatment of hypertension among people with diabetes, including advances in care since the American Diabetes Association (ADA) last published a Position Statement on this topic in 2003 (3).
DEFINITIONS, SCREENING, AND DIAGNOSIS
Blood pressure should be measured at every routine clinical care visit. Patients found to Continue reading

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Calculating Insulin Dose

Calculating Insulin Dose

You'll need to calculate some of your insulin doses.
You'll also need to know some basic things about insulin. For example, 40-50% of the total daily insulin dose is to replace insulin overnight.
Your provider will prescribe an insulin dose regimen for you; however, you still need to calculate some of your insulin doses. Your insulin dose regimen provides formulas that allow you to calculate how much bolus insulin to take at meals and snacks, or to correct high blood sugars.
In this section, you will find:
First, some basic things to know about insulin:
Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This is called background or basal insulin replacement. The basal or background insulin dose usually is constant from day to day.
The other 50-60% of the total daily insulin dose is for carbohydrate coverage (food) and high blood sugar correction. This is called the bolus insulin replacement.
Bolus – Carbohydrate coverage
The bolus dose for food coverage is prescribed as an insulin to carbohydrate ratio.The insulin to carbohydrate ratio represents how many grams of carbohydrate are covered or disposed of by 1 unit of insulin.
Generally, one unit of rapid-acting insulin will dispose of 12-15 grams of carbohydrate. This range can vary from 4-30 grams or more of carbohydrate depending on an individual’s sensitivity to insulin. Insulin sensitivity can vary according to the time of day, from person to person, and is affected by physical activity and stress.
Bolus – High blood sugar correction
(also k Continue reading

Does diabetes cause itching?

Does diabetes cause itching?

People with diabetes experience skin itching at higher rates than those without the condition. Ultimately, itching can lead to excessive scratching, which can cause discomfort and pain.
A study of nearly 2,700 people with diabetes and 499 without diabetes found that itching was a common diabetes symptom. An estimated 11.3 percent of those with diabetes reported skin itching versus 2.9 percent of people without diabetes.
A person with diabetes should not ignore itchy skin. Dry, irritated, or itchy skin is more likely to become infected, and someone with diabetes may not be able to fight off infections as well as someone who does not have diabetes.
There are a variety of treatments available that can help to reduce diabetes-related skin itching so that a person can be more comfortable and avoid other skin complications.
Causes of diabetes itching
There are many reasons why a person with diabetes might experience itching more often than someone else. Sometimes itching can result from damaged nerve fibers located in the outer layers of skin.
Often, the cause of diabetes-related itching is diabetic polyneuropathy or peripheral neuropathy. This condition occurs when high blood glucose levels damage nerve fibers, particularly those in the feet and hands.
Before the nerve damage occurs, the body experiences high levels of cytokines. These are inflammatory substances that can lead to a person's skin itching.
Sometimes, persistent itchiness may indicate that someone with diabetes is at risk of nerve damage, so the itchiness should never be ignored.
Also, people with diabetes can expe Continue reading

Diabetes and the Importance of Sleep

Diabetes and the Importance of Sleep

To paraphrase the old Cole Porter love song: Birds do it, bees do it, even educated fleas do it. Let's do it, let's . . . sleep?
"Sleep is a biological imperative," says Stuart Quan, M.D., a Harvard Medical School professor of sleep medicine and editor of the Journal of Clinical Sleep Medicine. "You can't not sleep," he says.
Virtually all animals sleep. Fruit flies have been shown to have sleep cycles, and even sea sponges have sleeplike periods, Quan says. While experts have different theories on why we sleep, it's well proven that getting too little has serious consequences for your health and diabetes. Shorting yourself on shut-eye can worsen diabetes and, for some people, even serve as the trigger that causes it.
People who don't sleep enough may:
-- impair the body's use of insulin.
-- have higher levels of hormones that cause hunger.
-- crave junk food.
No snooze, you lose
People who don't get enough sleep often have higher levels of chronic inflammation and insulin resistance. Lack of sleep also can increase production of cortisol (the body's primary stress hormone), impair memory and reflex time, elevate blood sugar, and increase appetite -- ultimately promoting weight gain, says Carol Touma, M.D., an endocrinologist at the University of Chicago who focuses on sleep research and metabolism.
And the more you weigh, the worse you sleep. Research by Madhu H. Rao, M.D., an endocrinologist at the University of California, San Francisco, found that a person's body mass index (BMI) affects slow-wave sleep, the deep sleep cycles needed for maximum rest. Very preliminary re Continue reading

Low Blood Sugar? 8 Warning Signs if You Have Diabetes

Low Blood Sugar? 8 Warning Signs if You Have Diabetes

Do you know the No. 1 cause of blood sugar dips? Changes in food intake. You may go too long without eating carbohydrates, or step up your activity without adding extra food. Certain diabetes medications, such as insulin, can cause low blood sugar as well. Either way, these situations can cause hypoglycemia, or low blood sugar.
And it’s sometimes difficult to tell for sure when you’re experiencing problems.
Symptoms may vary from person to person; not everyone has the same warning signs. The problems are sometimes mild, but if they’re severe and left untreated, they could lead to seizures or unconsciousness.
Here’s what you need to know to recognize hypoglycemia when it happens — as well as steps you can take to help avoid the problem.
What are the most common signs of trouble?
Health professionals typically define hypoglycemia as blood sugar in a non-pregnant adult that is lower than 70mg/dl.
However, experts don’t define the severity by the number, but rather by the symptoms:
Mild. In this case, low blood sugar can be treated by the person with diabetes alone.
Moderate. The person experiencing low blood sugar is alert enough to ask for help, but he or she does require assistance.
Severe. This person is completely unable to self-treat and may be awake or unconscious. Talk to your doctor to see what target levels are safe for you.
If you suspect you’re dealing with hypoglycemia, here are the most common symptoms to watch for:
Sweating– One of the first signs of hypoglycemia is sweating or clammy skin. It often occurs regardless of the temperature outside.
Hu Continue reading

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