Monday, April 18, 2016

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Strength Training

Strength training (also called resistance training) makes your body more sensitive to insulin and can lower blood glucose. It helps to maintain and build strong muscles and bones, reducing your risk for osteoporosis and bone fractures.

The more muscle you have, the more calories you burn – even when your body is at rest.

Preventing muscle loss by strength training is also the key to maintaining an independent lifestyle as you age.

We Recommend: doing some type of strength training at least 2 times per week in addition to aerobic activity.

Below are examples of strength training activities:

Weight machines or free weights at the gym
Using resistance bands
Lifting light weights or objects like canned goods or water bottles at home
Calisthenics or exercises that use your own body weight to work your muscles (examples are pushups, sit ups, squats, lunges, wall-sits and planks)
Classes that involve strength training
Other activities that build and keep muscle like heavy gardening
There are other types of activity that you can add to your fitness routine. Learn more about activity throughout the day, stretching and balance exercises.

Aerobic exercise

Types of exercises.

Two types of physical activity are most important for managing diabetes: aerobic exercise and strength training.

Aerobic Exercise

Aerobic exercise helps your body use insulin better. It makes your heart and bones strong, relieves stress, improves blood circulation, and reduces your risk for heart disease by lowering blood glucose and blood pressure and improving cholesterol levels.

We Recommend: Aiming for 30 minutes of moderate-to-vigorous intensity aerobic exercise at least 5 days a week or a total of 150 minutes per week. Spread your activity out over at least 3 days during the week and try not to go more than 2 days in a row without exercising.

Note: Moderate intensity means that you are working hard enough that you can talk, but not sing, during the activity. Vigorous intensity means you cannot say more than a few words without pausing for a breath during the activity.

Get Started

If you haven't been very active recently, you can start out with 5 or 10 minutes a day. Then, increase your activity sessions by a few minutes each week. Over time, you'll see your fitness improve, and you'll find that you're able to do more.

If you are just starting out, you may want to check out our starting walking plan.

Find the Time

If your busy schedule doesn't allow you to exercise for a 30-minute period during the day, you have the option to break it up into bouts of 10 minutes or more. Research has shown that the health benefits are similar when you do this!

For example, you might take a brisk 10-minute walk after each meal. Or you could try doing 15 minutes of aerobics in the morning before work and another 15 minutes when you get home.

If you are trying to lose weight and keep it off, most people need to do closer to 60 minutes of aerobic exercise per day.

Below are some examples of aerobic activities:

Brisk walking (outside or inside on a treadmill)
Bicycling/Stationary cycling indoors
Dancing
Low-impact aerobics
Swimming or water aerobics
Playing tennis
Stair climbing
Jogging/Running
Hiking
Rowing
Ice-skating or roller-skating
Cross-country skiing
Moderate-to-heavy gardening

Exercise

Exercise, or physical activity, includes anything that gets you moving, such as walking, dancing, or working in the yard. Regular physical activity is important for everyone, but it is especially important for people with diabetes and those at risk for diabetes.

That doesn't mean you need to run a marathon or bench-press 300 pounds. The goal is to get active and stay active by doing things you enjoy, from gardening to playing tennis to walking with friends. Wondering how much activity you should be doing and what your options are?

Here are some ideas to help you get moving and start making exercise part of your daily routine.

Exercise

Sunday, April 17, 2016

Emergency

Tips for Emergency Preparedness

We have always needed to be ready for emergencies. Wherever you live, there is the chance of something happening to disrupt your daily life, whether it's a hurricane, an earthquake, a tornado, or a blizzard.

Recent concerns about terrorist attacks have simply increased our awareness of the need to be prepared if a disaster strikes.

Have a Plan

Everyone is now advised to have a plan in place in the case of an emergency, and people with diabetes must consider proper diabetes care when they make emergency plans.

Emergency Supplies

Consider storing three days worth of diabetes supplies, which, depending on how you take care of your diabetes, could include oral medication, insulin, delivery supplies, lancets, extra batteries for your meter and/or pump, and a quick-acting source of . You may also want to have an extra emergency kit.

All these items should be kept in an easy-to-identify container, and stored in a location that is easy to get to in an emergency.

Emergency Contacts

Your emergency supply kit should also contain a list of emergency contacts and, if you are a parent of a child in school or daycare, physician's orders that may be on file with your child's school or day care provider. As always, it is a good idea to wear medical identification that will enable colleagues, school staff members, or emergency medical personnel to identify and address your medical needs.

If you are a parent of a child with diabetes, it is important that your child's school has clearly identified the school staff members who will assist your child in the event of an emergency evacuation.

For those who are away from home, consider informing your colleagues, friends, and family members about your diabetes and where your emergency supply kit is kept.

Taking a few minutes right now to gather supplies and inform those around you about your diabetes, may make a world of difference in maintaining control and staying healthy under stressful circumstances.

Oral Drugs

The first treatment for type 2 diabetes blood glucose (sugar) control is often meal planning, weight loss, and exercising.

Sometimes these measures are not enough to bring blood glucose levels down near the normal range. The next step is taking a medicine that lowers blood glucose levels.

Only people with type 2 diabetes can use pills to manage their diabetes, people with type 1 diabetes must use insulin.

These pills work best when used with meal planning and exercise. This way you have three therapies working together to lower your blood glucose levels.

Diabetes pills don't work for everyone. Although most people find that their blood glucose levels go down when they begin taking pills, their blood glucose levels may not go near the normal range.

Will They Help?

What are the chances that diabetes pills will work for you? Your chances are low if you have had diabetes for more than 10 years or already take more than 20 units of insulin each day. On the other hand, your chances are good if you developed diabetes recently or have needed little or no insulin to keep your blood glucose levels near normal.

Diabetes pills sometimes stop working after a few months or years. The cause is often unknown. This doesn't mean your diabetes is worse. When this happens, oral combination therapy can help.

Even if diabetes pills do bring your blood glucose levels near the normal range, you may still need to take insulin if you have a severe infection or need surgery. Pills may not be able to control blood glucose levels during these stressful times when blood glucose levels shoot up.

Also, if you plan to become pregnant, you will need to control your diabetes with diet and exercise or with insulin. It is not safe for pregnant women to take oral diabetes medications.

There is no "best" pill or treatment for type 2 diabetes. You may need to try more than one type of pill, combination of pills, or pills plus insulin.

There are different types, or classes, of drugs that work in different ways to lower (blood ) levels:

· Sulfonylureas

· Biguanides

· Meglitinides

· Thiazolidinediones

· DPP-4 inhibitors

· SGLT2 Inhibitors

· Alpha-glucosidase inhibitors

· Bile Acid Sequestrants

Sulfonylureas

Sulfonylureas stimulate the beta cells of the to release more . Sulfonylurea drugs have been in use since the 1950s. (Diabinese) is the only first-generation sulfonylurea still in use today. The second generation sulfonylureas are used in smaller doses than the first-generation drugs. There are three second-generation drugs: (Glucotrol and Glucotrol XL), (Micronase, Glynase, and Diabeta), and (Amaryl). These drugs are generally taken one to two times a day, before meals. All drugs have similar effects on blood levels, but they differ in , how often they are taken, and interactions with other drugs.

Biguanides

Metformin (Glucophage) is a . Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the . Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. It is usually taken two times a day. A side effect of may be diarrhea, but this is improved when the drug is taken with food.

Meglitinides

Meglitinides are drugs that also stimulate the beta cells to release insulin. (Prandin) and (Starlix) are meglitinides. They are taken before each of three meals.

Because sulfonylureas and meglitinides stimulate the release of insulin, it is possible to have (low blood glucose levels).

You should know that alcohol and some diabetes pills may not mix. Occasionally, chlorpropamide and other sulfonylureas, can interact with alcohol to cause vomiting, flushing or sickness. Ask your doctor if you are concerned about any of these side effects.

Thiazolidinediones

Rosiglitazone (Avandia) and pioglitazone (ACTOS) are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and and also reduce glucose production in the liver. The first drug in this group, troglitazone (Rezulin), was removed from the market because it caused serious liver problems in a small number of people. So far rosiglitazone and have not shown the same problems, but users are still monitored closely for liver problems as a precaution. Both drugs appear to increase the risk for heart failure in some individuals, and there is debate about whether may contribute to an increased risk for heart attacks. Both drugs are effective at reducing and generally have few side effects.

DPP-4 Inhibitors

A new class of medications called DPP-4 inhibitors help improve A1C without causing hypoglycemia. They work by by preventing the breakdown of a naturally occurring compound in the body, GLP-1. GLP-1 reduces blood glucose levels in the body, but is broken down very quickly so it does not work well when injected as a drug itself. By interfering in the process that breaks down GLP-1, DPP-4 inhibitors allow it to remain active in the body longer, lowering blood glucose levels only when they are elevated. DPP-4 inhibitors do not tend to cause weight gain and tend to have a neutral or positive effect on levels. Sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina) are the DPP-4 inhibitors currently on the market in the US.

SGLT2 Inhibitors

Glucose in the bloodstream passes through the , where it can either be excreted or reabsorbed. Sodium-glucose transporter 2 (SGLT2) works in the kidney to reabsorb glucose, and a new class of medication, SGLT2 inhibitors, block this action, causing excess glucose to be eliminated in the urine. Canagliflozin (Invokana) and dapagliflozin (Farxiga) are SGLT2 inhibitors that have recently been approved by the FDA to treat . Because they increase glucose levels in the , side effects can include urinary tract and yeast infections.

Alpha-glucosidase inhibitors

Acarbose (Precose) and (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea.

Bile Acid Sequestrants

The bile acid sequestrant (BAS) colesevelam (Welchol) is a cholesterol-lowering medication that also reduces blood glucose levels in patients with diabetes. BASs help remove cholesterol from the body, particularly LDL cholesterol, which is often elevated in people with diabetes. The medications reduce by binding with bile acids in the digestive system; the body in turn uses cholesterol to replace the bile acids, which lowers cholesterol levels. The mechanism by which colesevelam lowers glucose levels is not well understood. Because BASs are not absorbed into the bloodstream, they are usually safe for use by patients who may not be able to use other medications because of liver problems. Because of the way they work, side effects of BASs can include flatulence and constipation.

Oral combination therapy

Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects. Switching from one single pill to another is not as effective as adding another type of diabetes medicine.

Insulin

People with type 1 diabetes must use insulin.

Some people with type 2 diabetes can manage their diabetes with healthy eating and exercise. However, your doctor may need to also prescribe oral medications (pills) and/or insulin to help you meet your target blood glucose levels.

INSULIN

Insulin is a naturally occurring hormone secreted by the pancreas. Many people with diabetes are prescribed insulin, either because their bodies do not produce insulin (type 1 diabetes) or do not use insulin properly (type 2 diabetes).

There are more than 20 types of insulin sold. These insulins differ in how they are made, how they work in the body, and how much they cost. Your doctor will help you find the right type of insulin for your health needs and your lifestyle.

Although it is a common practice to try pills before insulin, you may start on based on several factors, including the following:

· How long you have had diabetes

· How high your is

· What other medicines you take

· Your overall health

Combination Therapy

Because diabetes pills seem to help the body use insulin better, some people take them along with insulin shots. The idea behind this "combination" therapy is to try to help insulin work better.

Insulin Basics

· There are different types of depending on how quickly they work, when they peak, and how long they last.

· Insulin is available in different strengths; the most common is U-100.

· All insulin available in the United States is manufactured in a laboratory, but animal insulin can still be imported for personal use.

Inside the , beta cells make the insulin. With each meal, beta cells release insulin to help the body use or store the it gets from food.

In people with , the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots to use from meals.

People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with need diabetes pills or insulin shots to help their bodies use glucose for energy.

Insulin cannot be taken as a pill because it would be broken down during digestion just like the in food. It must be injected into the under your skin for it to get into your blood. In some rare cases insulin can lead to an allergic reaction at the site. Talk to your doctor if you believe you may be experiencing a reaction.

Types of Insulin

· , begins to work about 15 minutes after injection, peaks in about 1 hour, and continues to work for 2 to 4 hours. Types: Insulin glulisine (Apidra), insulin lispro (Humalog), and insulin aspart (NovoLog)

· Regular or usually reaches the bloodstream within 30 minutes after injection, peaks anywhere from 2 to 3 hours after injection, and is effective for approximately 3 to 6 hours. Types: Humulin R, Novolin R

· generally reaches the bloodstream about 2 to 4 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 18 hours. Types: NPH (Humulin N, Novolin N)

· reaches the bloodstream several hours after injection and tends to lower glucose levels fairly evenly over a 24-hour period. Types: Insulin detemir (Levemir) and insulin glargine (Lantus)

Premixed insulin can be helpful for people who have trouble drawing up insulin out of two bottles and reading the correct directions and dosages. It is also useful for those who have poor eyesight or dexterity and is convenient for people whose diabetes has been stabilized on this combination.

In 2015 an inhaled insulin product, Afrezza, became available in the U.S. Afrezza is a rapid-acting that is administered at the beginning of each meal and can be used by adults with type 1 or type 2 diabetes. Afrezza is not a substitute for long-acting insulin. Afrezza must be used in combination with injectable long-acting insulin in patients with type 1 diabetes and in type 2 patients who use long-acting insulin.

· Inhaled insulin begins working within 12 to 15 minutes, peaks by 30 minutes, and is out of your system in 180 minutes. Types: Technosphere insulin-inhalation system (Afrezza)

Insulin Storage and Syringe Safety

Although manufacturers recommend storing your insulin in the refrigerator, injecting cold insulin can sometimes make the more painful. To avoid this, many providers suggest storing the bottle of insulin you are using at room temperature. kept at room temperature will last approximately 1 month.

Remember though, if you buy more than one bottle at a time to save money, store the extra bottles in the refrigerator. Then, take out the bottle ahead of time so it is ready for your next injection.

Here are some other tips for storing insulin:

· Do not store your insulin near extreme heat or extreme cold.

· Never store insulin in the freezer, direct sunlight, or in the glove compartment of a car.

· Check the expiration date before using, and don't use any insulin beyond its expiration date.

· Examine the bottle closely to make sure the insulin looks normal before you draw the insulin into the .

If you use regular, check for particles or discoloration of the insulin. If you use NPH or lente, check for "frosting" or crystals in the insulin on the inside of the bottle or for small particles or clumps in the insulin. If you find any of these in your insulin, do not use it, and return the unopened bottle to the pharmacy for an exchange and/or refund.

Syringe Reuse

Reusing syringes may help you cut costs, avoid buying large supplies of syringes, and reduce waste. However, talk with your doctor or nurse before you begin reusing. They can help you decide whether it would be a safe choice for you. If you are ill, have open wounds on your hands, or have poor resistance to infection, you should not risk insulin syringe reuse. Syringe makers will not guarantee the sterility of syringes that are reused.

Here are some tips to keep in mind when reusing syringes:

· Keep the needle clean by keeping it capped when you're not using it.

· Never let the needle touch anything but clean skin and the top of the insulin bottle.

· Never let anyone use a syringe you've already used, and don't use anyone else's syringe.

· Cleaning it with alcohol removes the coating that helps the needle slide into the skin easily.

Syringe Disposal

It's time to dispose of an insulin syringe when the needle is dull or bent or has come in contact with anything other than clean skin.

If you can do it safely, clip the needles off the syringes so no one can use them. It's best to buy a device that clips, catches, and contains the needle. Do not use scissors to clip off needles — the flying needle could hurt someone or become lost.

If you don't destroy your needles, recap them. Place the needle or entire syringe in an opaque (not clear) heavy-duty plastic bottle with a screw cap or a plastic or metal box that closes firmly. Do not use a container that will allow the needle to break through, and do not recycle your syringe container.

Your area may have rules for getting rid of medical waste such as used syringes. Ask your refuse company or city or county waste authority what method meets their rules. When traveling, bring your used syringes home. Pack them in a heavy-duty holder, such as a hard plastic pencil box, for transport.

Tight Diabetes Control

Keeping your levels as close to normal as possible can be a lifesaver. Tight control can prevent or slow the progress of many of diabetes, giving you extra years of healthy, active life.

But tight control is not for everyone and it involves hard work.

What Does Tight Control Mean?

Tight control means getting as close to a normal (nondiabetic) as you safely can. Ideally, this means levels between 70 and 130 before meals, and less than 180 two hours after starting a meal, with a glycated hemoglobin () level less than 7 percent. The target number for glycated hemoglobin will vary depending on the type of test your doctor's laboratory uses.

In real life, you should set your goals with your doctor. Keeping a normal level all the time is not practical. And it's not needed to get results. Every bit you lower your blood glucose level helps to prevent complications.

How Does It Help?

No one knows why high glucose levels cause complications in people with diabetes. But keeping glucose levels as low as possible prevents or slows some complications.

For the Diabetes Control and Complications Trial (DCCT), researchers followed 1,441 people with for several years. Half of the people continued standard diabetes treatment while the other half followed an intensive-control program. Those on intensive control kept their blood glucose levels lower than those on standard treatment, although the average level was still above normal.

The results? Here's what they found in the tight-control group as compared with the standard-treatment group:

· Diabetic eye disease started in only one-quarter as many people.

· Kidney disease started in only half as many people.

· Nerve disease started in only one-third as many people.

· Far fewer people who already had early forms of these three complications got worse.

Living With Tight Control

To get tight control, you must do the following:

· Pay more attention to your diet and exercise.

· Measure your blood glucose levels more often.

· If you take , change how much you use and your schedule.

Getting Intense With Insulin

In , you provide yourself with a low level of insulin at all times and take extra insulin when you eat. This pattern mimics the release of insulin from the normal .

There are two ways to get more natural levels of insulin: multiple daily injection therapy and an . Both are good methods. Your choice should depend on which best fits your lifestyle.

In multiple daily injection therapy, you take three or more insulin shots per day. Usually, you take a shot of short-acting or before each meal and a shot of intermediate- or at bedtime.

With an insulin pump, you wear a tiny pump that releases insulin into your body through a plastic tube. Usually, it gives you a constant small dose of Regular insulin. You also have the pump release extra insulin when you need it, such as before a meal.

With either method, you must test your blood glucose levels several times a day. You need to test before each shot or extra dose of insulin to know how many units to take and how long before eating to take it. Also, you may want to test 2-3 hours after eating to make sure you took enough insulin. You must adjust your insulin dose for how much you plan to eat and how active you expect to be.

Getting Started

You do not need to figure these things out on your own. Whatever method you choose, your health care team (your doctor, , , and other health care professionals) should spend a lot of time teaching you about it. Your team will help you make guidelines for how much insulin to take and when.

You will also come up with guidelines for eating and exercising. These guidelines may change several times as you test them out.

You shouldn't try tight control on your own. A good health care team is a must. Choose a doctor who understands diabetes well or is willing to learn for your sake. Your doctor should have ties with other health professionals you need, such as dietitians and a mental health worker.

If you live in a small town, look at your options carefully. You may be better off driving to a city to see a specialist.

Keeping It Going

Starting a program of tight control is exciting. But it can also be overwhelming. How do you keep from running out of energy?

Here are some tips:

· Start slowly.
For example, you might start by checking your blood glucose more times each day. Get used to that first. Then start multiple daily injections. Once you're used to those, add your new exercise program and make the changes in your diet.

· Be honest.
If you are newly diagnosed with diabetes, look honestly at yourself. Are you still angry and depressed that you have diabetes? If so, you already have a big challenge facing you. You may want to wait to try tight control until after you've come to terms with the changes in your life.

· Keep your goals realistic.
No matter how hard you try, your blood glucose readings will not be perfect every time. If they are often too high or too low, you should talk to your doctor about whether your plan needs to be adjusted. But if "wrong" levels happen only sometimes, that's life. With practice, you will become more skilled at choosing the right insulin doses for various situations.

· Take a break.
If you need to, take a breather from the new routine. Having some time off may make it easier to stick to your plan when you start again.

Pluses and Minuses

One big reason to try tight control is to prevent complications later. But tight control has effects you can enjoy right now:

· You will probably feel better and have more energy.

· You can vary your activities more.

· You're not locked into having your meals at the same time each day.

· It can reduce the risk of birth defects.

But the DCCT found two major problems with tight control:

· Hypoglycemia
People on tight control had three times as many low blood glucose reactions (hypoglycemia). You will need to be alert to the symptoms of so that you can treat yourself quickly. Also, you should always check your blood glucose levels before you drive. If you often have low blood glucose reactions when you try tight control, talk to your doctor. You may need to ease up on your goals or go back on standard therapy for a while.

· Weight Gain
People on tight control gained more weight than people on standard insulin treatment. The average in the DCCT was 10 pounds. If you are concerned about putting on pounds, work with your dietitian and doctor to devise a meal and exercise plan to prevent it.

You should also consider the cost:

· You will need to see your health care team more often.

· Pumps cost thousands, and pump supplies run $60 to $80 a month

· Multiple injection therapy is much cheaper, but you will still use more supplies, like test strips and syringes, than before.

What About Type 2 Diabetes?

The DCCT studied only people with type 1 diabetes. But doctors believe that tight control can also prevent complications in people with .

Most people with type 2 diabetes do not take insulin. You may be wondering how you can achieve tight control without it.

One way is to lose weight. Shedding excess pounds may bring your glucose levels down to normal. The key to losing weight and keeping it off is changing your behavior so that you eat less and exercise more. Your doctor should work with you to find an eating and exercise plan you can stick to.

Even if you don't need to lose weight, exercise is helpful in controlling your blood glucose levels. It makes your cells take glucose out of the blood.

You will need to check your blood glucose regularly. You should decide with your doctor how often. Once a day or even once a week may be enough for some people with type 2 diabetes.

If exercise and good eating habits are not enough to keep your glucose under control, you doctor may prescribe pills. And if these don't work, you may need to take insulin. People with type 2 diabetes should talk to their doctors before starting tight control.

Tight Control Is Not for Everyone

Tight control is not safe for everyone with diabetes.

Children should not be put on a program of tight control. Having enough glucose in the blood is vital to brain development. Some doctors say that tight control should wait until a child reaches 13; others say after the age of 7 is okay.

Elderly people probably should not go on tight control. Hypoglycemia can cause strokes and heart attacks in older people. Also, the major goal of tight control is to prevent complications many years later. Tight control is most worthwhile for healthy people who can expect to live at least 10 more years.

Some people who already have complications should not be on tight control. For example, people with end-stage kidney disease or severe vision loss probably should not try it. Their complications are probably too far along to be helped. Some people who have coronary disease or disease should not try tight control.

People who have probably should not go on tight control