Shirley Bullock's Blog - Posts Tagged "diabetes"

Geri is a nurse and the main character from Forever Promised. She has decided to write medical minis for the lay person.

Geri’s Medical Minis

In the United States there has been a surge in diagnosis of diabetes. Diabetes is a leading health care burden. Along with the diagnosis of diabetes, there is a growing list of complications; including heart disease, kidney disease, and several other chronic diseases.
Is this a new phenomenon? Has the incidence of disease increased, or have we become better at detecting it?
Diabetes is a chronic disease that affects the small blood vessels. Three symptoms are polyuria (frequent urination), polyphagia (increased hunger), polydipsia (increased thirst), weight loss and blurred vision.
The earliest known record on diabetes is in 1552 B.C. A Persian doctor named Avicenna. described gangrene, secondary to diabetes. In the first century, Arateus described it as "the melting down of flesh and limbs into urine." Greek doctor, Galen, mistakenly diagnosed it as a kidney ailment.

Until the 11th century "water tasters" were called in to taste the patient's urine. It was said a diabetic's urine tasted like honey, thus the Latin word for honey 'mellitus' is added to diabetes.

Indians saw if ants were attracted to the urine. Hippocrates made no mention of it, possibly because it was well known as an automatic death sentence.

Here in 1888, we are just now working with diet. Some chemical tests have come out to recognize sugar in the urine. Sadly, as researchers are trying to find how to help their patients with diet, they die within a year of malnutrition. Dr. O’Neal says that some doctors prescribe bleeding or opium.

Hello, I’m back with a little more information for the lay person on diabetes.
In the 19th century French researcher, Claude Bernard, studies the pancreas and links it and the liver to metabolism. Pavlov discovered that gastric secretions were linked to the nervous system.
I always wanted to visit Italy, but this information gives me pause; Italian diabetes specialist, Catoni, isolated patents under lock and key to get them to follow their specialized diets.
German scientist George Zuelzer found an injectible extract for high blood sugar but it had extreme side effects.
In 1919 Frederick Madison Allen opened the first United States clinic. It was named the Physiatric Institute of New jersey. Wealthy patients with diabetes, high blood pressure and Bright’s disease flocked to the clinic.
1920 Dr Banting conceives the idea for insulin. In 1921 a depancreatized dog was successfully treated with insulin.
In 1940 research made a link to diabetes and long term kidney and eye disease.
1944 Insulin syringes became standardized.
1955 Oral drugs were prescribed.
In 1959 two types of diabetes were recognized; Type 1 Juvenile, and Type 2 Adult Onset.
In the 1960’s home monitoring started. In 1969 a German student by the name of Paul Langerhans discovered that the pancreas contained two systems of cells. One set was named the “Islets of Langerhans”
In 1970 we see home use of the glucose meters. Doctors started performing laser eye therapy.
The first biosynthetic human insulin was made in 1983.
The advent of the insulin pen was in 1986.
The 1900’s diabetes researched surged by leaps and bounds.

Tools of the trade
Hi this is Geri. I hoped you enjoyed the little history lesson on diabetes. I want to be as easy to understand as possible. Many people have pre-diabetes for years before they are formally diagnosed.
If your doctor says you have pre-diabetes; with life-style changes many can avoid the disease all together.
If you have the symptoms of increased thirst, appetite, weight gain or loss, and vision changes the first thing to do is make an appointment with your primary care physician.
Depending on the doctor and your insurance he or she might take over your diabetes care or send you to a specialist called an ‘Endocrinologist’. Please go to your first visit ‘fasting, i.e. no food or drink since midnight. The doctor will want to do some lab tests, including a fasting blood sugar, an A1C (this test will tell how high your blood glucose has been for the past three months) and some kidney function tests.
If you have access to a computer, read a little on diabetes and write down your questions. Don’t rely on memory.
During the visit, if you are tested positive, the doctor will ensure you have an accu check machine or a blood glucose monitor. This machine will become your life line, ensuring how well you will be able to keep your diabetes under control.
Today’s blood glucose machine is not a ball and chain; many are very small, fitting into sports pockets and purses. Various machines allow you to take blood from other areas of your body avoiding sore fingertips. They are highly affordable enabling you to keep one with you and one at bedside.
The kit usually contains, blood check strips, monitor, and a finger pricking device. There will usually be a pocket in the back for a log to write down your results.
Most all insurances will pay for a monitor including Medicare. If you are uninsured, many pharmaceutical companies offer machines free of charge if you use their strips and finger sticks.
Read the directions thoroughly. Play with the machine enabling you to use it with ease.
See you all next week for other aspects of diabetes care.

‘

Why Should I Control My Blood Sugar?

Remember here in 1888 there is very little we could do for diabetes. Most people die at a very young age wishing they had the help you do now.
I don’t mean to scare you but: High blood sugar can lead to problems such as: heart disease, nerve damage, stroke, circulation problems, eye disease and kidney disease. We all know people who have lost limbs, sight, kidneys and their lives from complications of diabetes.
Here are some daily things to do to help prevent some of the above problems you can do the following: follow your diabetes meal plan, exercise, take your medication as prescribed, check your blood sugar, check your feet daily, brush and floss your teeth, find positive ways to cope with stress and don’t smoke, if you do quit!
Every six months get an A1C lab test and see your dentist.
Every year get a cholesterol and blood fat check, dilated eye exam, kidney exam, flu shot and foot exam.
At every office visit please get a foot inspection, and your blood pressure and weight monitored.
Take your blood sugar log and discuss taking a pneumonia shot.
Once again I don’t intend on superseding your doctor’s advice, these are just a few hints. Geri

A Spoonful of Sugar and Some Medicine Go Down

Hello, everyone! I would like to introduce you to a very dear friend of mine, Dr. Patrick O’Neal. If it wasn’t for Doc and his wife, Sara I would not have survived my trip. He wants to share these medical facts that are now available to everyone in 2011.
See ya, Geri.

Hello, I am Dr. O’Neal, and if you are diabetic you need to be knowledgeable about your medicine regime. Remember that each person’s metabolism is different and you cannot do things exactly as your Aunt Hattie or your Brother Bob.
Know the name of your pill and the amount that you take. Know when to take your pill. Make a list of your medications and carry it with you. Call me, ahem, I mean your health care provider about any side effects you may experience.
Never stop or change the dosage of your medicine without calling your physician. A good resource is your pharmacist. Get to know them by name and become comfortable with asking them questions about prescription and over the counter medications.
Just a reminder if you have Type 1 diabetes, you must take insulin to live. With Type 2 diabetes you may be prescribed pills, insulin or both. Your health care provider will teach you how to take your medicine. It is always good to join a support group, most hospitals host them.
Thank you for allowing me to talk to you. Geri will be back next time. Oh, and Sara says ‘Hi’.
Best regards, Dr. Patrick O’Neal

Looks like nothing noteworthy is happening nationally today. But I have good news, the first meeting of the Shakespeare club is meeting tonight at Doc's. Sara told me that we will be getting a library soon! Yeah!

Looks like we all need to do something to make today a memorable one in our lives!

Cheers, Geri

Exercise
Hello all. Here in 1888 we don’t hear much about exercise and dangers of becoming a couch potato. From housework to farm work everything is pretty much labor intensive here.
Not so in 2011. Obesity has become a leading negative health factor, opening the way to other diseases such as heart, lung, and endocrine diseases such as diabetes.
Regular exercise is a key part of your diabetes treatment plan. For most people with type 2 diabetes, exercise helps keep blood sugars in a healthy range. Exercise may also: reduce stress, increase energy, increase strength and range of motion, help control blood pressure and cholesterol. It will also make your insulin work more effectively.
Choose an exercise you enjoy, make plans to include it in your day, and find an exercise buddy. If you haven’t exercised for a while start out slowly. Check with your doctor first. Adding a five minute walk to your day may be a good start. Work up to at least 30 minutes a day. I am not asking you to try out for the Olympics just add a little movement to your day.
Drink plenty of sugar free fluids like water. Check your blood sugar before and after you exercise since people with diabetes are at higher risk for a low blood sugar episode during, and several hours after exercise.
Wear good fitting shoes while exercising and check your feet before and after exercise.
Include a warm up and a cool down with each workout. Avoid intense workouts outdoors if it is humid, smoggy or cold. Water exercise is one of the best you can participate in.
There are several things you need to carry with you when you exercise. Phone numbers of family and doctors in case of an emergency. Make sure you have a cell phone or change to make a phone call. Blood sugar monitor, diabetes identification, something to treat a low blood sugar such as glucose tablets.
These are just a few extra reminders. I am off to horseback ride!
(Well, yeah the horse is the one exercising, but it does help keep my muscles supple! (laugh) Geri.

The Diagnosis
Hello, Geri once again. I was helping Dr. O’Neal with a new patient yesterday and he turned out to be diabetic. You are lucky to be alive in 2011 instead of 1888. We have no way to monitor this patient, or treat him.
We last left our discussion with going to the doctor and procuring an accu check machine. He with your help will set a realistic goal range for your readings.
Normal glucose readings are usually 70mg/dl-120mg/dl. Your reading was over 120mg/dl and that is called HYPERGLYCEMIA. The causes of hyperglycemia (high blood glucose) are too much food, too little medication, sickness, infection, stress, and less exercise than normal.
You may not have any symptoms but these are common when your glucose is high: hungry, headache, nausea, slow healing wounds, weight loss, thirsty, blurry vision, frequent urination and fatigue.
You should have worked out a treatment plan on what to do when your glucose is high. Do you remember how to check it? Your accu check machine.
Some doctors will want you to check the ketones in your urine at a certain number. Ketones form when the body starts to use its own fat instead of sugar for energy. They act like a poison to your body. They are extremely harmful to your kidneys. Please call your doctor immediately.
When you have high blood glucose, drink plenty of sugar free liquid, and follow your doctor’s recommendations.

Foot and Skin Care
For diabetics

Skin care and foot care have become a necessity not a luxury. Diabetics are prone to foot disease because of poor circulation in the extremities. Even the smallest blister can become life threatening without treatment.
Your primary health provider will probably recommend that you go to a Podiatrist (doctor who specializes in feet). Most health insurances including Medicare will cover routine diabetic foot care because it is so important to your overall health.
Here is an overview of foot care:
• Keep your feet dry
• Wash with mild soap every day
• If feet are dry use a lotion everywhere except between toes
• Use fresh, clean socks every day to absorb perspiration away from skin
• You should inspect your feet for breaks in skin and rashes
• If your feet are cold you could have poor circulation
• If you find hot spots you may have an infection
• Don’t go barefoot, skin sensation is decreased in diabetics and you could procure an injury and not know it
• To avoid ingrown toenails, cut your toenails straight across
• Wear comfortable, well fitting shoes made of leather. Don’t try to break in new shoes…remember those new shoe blisters? They are really a no-no. Leather helps your feet breathe.
• Go to a health care specialist in shoes. Most insurances pay for diabetic shoes including Medicare.
• When buying new shoes do so in the afternoon when your foot is larger. Walk for short periods, you may need extra padding to prevent rubbing.
• Do not work on calluses, corns, warts or ingrown nails yourself.
• Go to the doctor if…
• You have an open sore
• You have an infection in a blister or cut or around a rash
• You have a red tender toe
• If you have any kind of puncture wound
• Report any loss of sensation.

If you have skin problems a Dermatologist might be in order. Your skin could be too dry, and diabetics are prone to yeast infections.
• If you have dry skin use soaps like Dove or Keri.
• Dry well after bathing.
• Observe skin folds such as arm pits, groin area, underbelly, behind knees, under breasts, and behind ears.
• Above areas easily get fungal infections. Use talcum powder or what your doctor orders.
• Avoid hot baths and showers, decreased sensation leads to burns.
• If you have dry skin use Alpha-Keri lotion post bath.
• During the weather you may need extra moisturization to prevent chapping.
• Wear cotton underwear and avoid genital deodorant sprays
• Unless your doctor advises against it, drink lots of water
• Treat open areas of skin immediately with soap and water. Clean with peroxide. Never use any medicine unless you have discussed it with the doctor. (This is one of the things you might want to write down and have in your medicine counter.) Cover with gauze and paper tape.
• If you find pus, redness, swelling
• Ringworm , jock itch, athlete’s feet, vaginal itching
• Blisters and bumps on legs, buttocks, arms, behind ears
• Rashes or lumps near insulin injection sites
• Call your doctor if any of the above happens.

See you next time, and forget the sun tan, try the new sprays they are safer! Geri

Hypoglycemia
The rule of 15

Hypoglycemia is too little glucose in your blood. Causes are too little food, too much medication, and extra exercise.
You may feel any of these symptoms: tired, weak, irritable, confused, blurry vision, headache, dizzy, numb, sweaty and shaky. Please be aware that some symptoms overlap with those of hyperglycemia. You must pay special attention, and check your blood glucose often to know which symptom you are having. Please do not guess!
Treatment of low blood sugar: test your blood. If you can’t check it and are having symptoms treat it anyway.
The low blood sugar rule is called the Rule of 15.
Eat 15 grams of carbohydrate such as 3-4 glucose tablets, 15g glucose gel, ½ cup of juice or regular soft drink, 1 cup of milk or 1 Tbsp of honey or sugar. Wait 15 minutes and retest.
If blood sugar continues to be low or you still have symptoms, repeat Rule of 15. If meal or snack is scheduled soon, go ahead and eat. Be aware if it goes back up it may become low once again in an hour if you don’t eat.
Always wear a diabetes identification bracelet.

Help! I am diabetic and I’m Sick!

When you are sick with a cold, flu or infection your blood sugar can go higher than your normal. It is important to have a sick plan in place before you are sick. This is one of the things you need to talk over with your physician.
Call your health care provider if you: have two blood sugars in a row over 300mg/dl or several low blood sugars in a row. Lose five pounds or more when you are sick. Have vomiting or diarrhea for more than six hours, can’t eat solid foods for more than 24 hours, and can’t keep liquids down, feel dizzy, confused or in pain.
Never stop taking your diabetes pills or insulin without talking to your health care provider, check your blood sugar at least every four hours when you are sick, and drink water to prevent dehydration.
Try your upmost to eat regular meals. If you can’t here are some foods you can utilize to keep your carbohydrate intake about the same: ½ cup pudding, 4-6 crackers, ½ cup regular gelatin, or ½ cup juice.
Remember your accu check machine is your best friend. If at all possible keep one with you and have another at your bedside. I hate being sick. Please take care of yourself, Geri.