April 21, 2015

Alzheimer's Disease – Part 3

If you have a loved one or a parent that you are having difficulty with, forget about everything, and ask your parent if they wish to name you in their medical power of attorney. If they wish to name another sibling or a friend, don't get upset, but ask questions. Maybe the friend lives closer or communicates with your parent every day. Just maybe they trust a sibling more than you and the sibling lives closer. In this case, contact the sibling and inform them of the situation if they are not aware. If they have the medical power of attorney, then step back and let them act.

Yes, you may have good reason to be concerned about a parent, but unless the parent feels they have control, you may not get anywhere. Having a medical power of attorney is an important document and should be obtained while the parent can understand what the medical power of attorney means. Waiting until something happens, and your parent is unable to act on legal matters, may leave the door open to other siblings that may not have your parent's interest and wellbeing in mind, but their own interests.

This is my own opinion and I do not like it when other writers omit this from the discussion or leave it as the last item for discussion. This writer omits this entirely and focuses on other issues. Concern for older parents or aging relatives is a valid concern for a geriatrician as is their safety.

For better health and wellbeing in older adults or parents, it is not enough identifying the underlying health and life problems, although it is a key place to begin. It is understood that a difficult parent or older relative can cause immeasurable frustration and stress.

Dr. Leslie Kernisan lays out four actions that families can take when older parents or relatives are actively resisting help. To this I would add – are the proper legal documents in place and understood by everyone concerned. Here is her list:
#1. Consider the possibility of cognitive impairment. Do not assume that this is the cause, as the parent or older relative may be making health and safety decisions that you don't agree with or feel is wrong.

#2. Make sure you’ve heard and validated your parents’ emotions. This surprised me, but I realized that it is true. Logical arguments can often fail to convince people that we have emotional relationships with, such as parents or older relatives. All people care about having their emotions validated. People also want to feel connection, love, and self-worth.
Whether or not your parent or older relative might be cognitively impaired, it is crucial to remember this. If there is potential Alzheimer’s, it can be even more important to help a parent feel heard and validated because this will reduce stress and help the brain function better. If you can afford it, consider investing in a few sessions with a relationship therapist or another person trained to facilitate family conversations. It can be especially productive to work with someone experienced in helping families address aging issues, like a geriatric care manager

#3. Review your parents’ goals and what trade-offs they might be willing to make. Doctors want to prevent falls, injuries, illnesses, and new medical problems.
People with older parents or relatives generally want what their parents want – to live as long as possible. But, there can be real problems with this as they age. The older adults in our lives want autonomy and independence and this is when the conflicts happen and can cause real dilemmas.

There is usually no easy answer to this conflict. Once an older person becomes more vulnerable in body or mind, you cannot have perfect safety as well as perfect independence. When the trade-offs are identified and goals discussed, it’s usually possible to help everyone feel better.

Common goals of older adults include:
  • Living in their own home for as long as possible
  • Dictating the terms of their daily life
  • Living their usual life for as long as possible
  • Minimizing pain, illness and suffering
  • Spending quality time with family and loved ones
  • A good quality of life, which generally means more enjoyable activities and fewer stressful or burdensome activities.

    Safety is important, but don’t fall into the trap of assuming it should always be your family’s No. 1 priority. Because when faced with a trade-off between safety and autonomy, most older adults choose autonomy. This is especially true of people with dementia. An approach called “positive risk-taking” is now being advocated as a way to make communities more dementia-friendly.

#4. Distinguish what you need from what your parents or older relatives need. This is probably the most difficult part for the younger generation because they refuse to recognize what fear is driving them.

Some common underlying issues include:
  • A need to minimize guilt
  • A fear of conflict with other siblings
  • A fear that a parent is going to decline further and require more help
  • A desire to know that a parent is happy and comfortable
  • A desire for control and for knowing what will happen next
  • A fear that what is happening to our parents might eventually happen to us.

    People being people, we all have a tendency to try to address our needs by wanting other people to do something differently, or by trying to keep things from changing. But as the relationship experts have been telling us for decades, the best approach is to accept that things change and to focus on what we can do differently. We shouldn't try to meet our own needs by controlling what others do.

    Even when you become informed, are thoughtful in your approach, and obtain the right kind of assistance, helping older parents through this stage of life will be a challenge. Of course, you will worry about them. And they will probably never be entirely free of reluctance to make changes and accept help.

    Some families get stuck in a rut of conflict and frustration, whereas others find ways to move forward more constructively. It might feel like an extra effort to do these things. But by investing in your ability to better navigate these difficult situations with your parents, your family will get closer to what we all want: less stress for ourselves and better quality of life for our parents.

April 20, 2015

Alzheimer's Disease – Part 2

You can support your loved one with Alzheimer's by learning more about how the condition progresses. There are seven stages in the progression of Alzheimer's and they don't always happen neatly or fit neatly into the seven stages. The symptoms might vary, but they can be a guide and help you plan for your loved one's care. The seven stages include:

Stage 1: Normal Outward Behavior. When your loved one is in this early phase, he/she won't have any symptoms that you can spot. Only a PET scan, an imaging test that shows how the brain is working, can reveal whether he/she has Alzheimer's. As the person moves into the next 6 stages, your loved one with Alzheimer's will see more and more changes in his/her thinking and reasoning.

Stage 2: Very Mild Changes. You still might not notice anything amiss in your loved one's behavior, but he may be picking up on small differences, things that even a doctor doesn't catch. This could include forgetting a word or misplacing objects.
At this stage, subtle symptoms of Alzheimer's don't interfere with the ability to work or live independently. Keep in mind that these symptoms might not be Alzheimer's at all, but simply normal changes from aging.

Stage 3: Mild Decline. It's at this point that you start to notice changes in your loved one's thinking and reasoning, such as:
  • Forgets something he just read
  • Asks the same question over and over
  • Has more and more trouble making plans or organizing
  • Can't remember names when meeting new people
You can help by being your loved one's "memory" for him, making sure he pays bills and gets to appointments on time. You can also suggest he/she ease stress by retiring from work and putting legal and financial affairs in order.

Stage 4: Moderate Decline. During this period, the problems in thinking and reasoning that you noticed in stage 3 get more obvious, and new issues appear. Your loved one might:
  • Forget details about himself/herself
  • Have trouble putting the right date and amount on a check
  • Forget what month or season it is
  • Have trouble cooking meals or even ordering from a menu
You can help with everyday chores and your loved one's safety. Make sure he/she isn't driving anymore, and that someone isn't trying to take advantage of your loved one financially.

Stage 5: Moderately Severe Decline. Your loved one might start to lose track of where he is and what time it is. He/she might have trouble remembering his/her address, phone number, or where he/she went to school. Your loved one could get confused about what kind of clothes to wear for the day or season.

You can help by laying out the clothing in the morning. It can help him/her dress by himself/herself and keep a sense of independence. If your loved one repeats the same question, answer with an even, reassuring voice. Your loved one might be asking the question less to get an answer and more just to know you're there.

Even if your loved one can't remember facts and details, he/she might still be able to tell a story. Invite your loved one to use his/her imagination at those times.

Stage 6: Severe Decline. As Alzheimer's progresses, your loved one might recognize faces but forget names. He/she might also mistake a person for someone else, for instance, thinking the spouse is his/her parent. Delusions might a set in, such as thinking he needs to go to work even though he no longer has a job. You might need to help him/her go to the bathroom. It might be hard to talk, but you can still connect with him/her through the senses. Many people with Alzheimer's love hearing music, being read to, or looking over old photos.

Stage 7: Very Severe Decline. Many basic abilities in a person with Alzheimer's, such as eating, walking, and sitting up, fade during this period. You can stay involved by feeding your loved one with soft, easy-to-swallow food, helping him/her use a spoon, and making sure he/she drinks. This is important, as many people at this stage can no longer tell when they are thirsty.

Please remember that as your loved one evolves into the later stages, some words may be hurtful. When this happens, do not get upset at your loved one, as they do not realize what they are saying.

April 19, 2015

Alzheimer's Disease – Part 1

Alzheimer's disease and diabetes do have a link. The Mayo Clinic recognizes this, as do a few other organizations. A few organizations reject the link and more state that the link is in question and acknowledge that the evidence is conflicted. New research suggests that those with insulin resistance or diabetes are at significantly higher risk of developing one of today's most devastating and incurable neurological disorders: Alzheimer's disease.

The connection between diabetes and Alzheimer's is yet another compelling reason for those who value their health to address issues of impaired insulin sensitivity before it is too late. Although diabetes is an epidemic, it is also preventable and reversible through strategies that incorporate dietary changes, lifestyle modifications, and nutritional supplementation.

Alzheimer's cost the US $130 billion in 2011 alone. One of the biggest risk factors is having type 2 diabetes. This kind of diabetes occurs when liver, muscle, and fat cells stop responding efficiently to insulin, the hormone that tells them to absorb glucose from the blood. The illness is usually triggered by eating too many sugary and high-fat foods that cause insulin to spike, desensitising cells to its presence. As well as causing obesity, insulin resistance can also lead to cognitive problems such as memory loss and confusion.

While medical researchers have yet to pinpoint a single cause of Alzheimer's disease, they have uncovered some of the basic biochemical processes that underlie the hallmark mental changes seen in Alzheimer's.

First, Alzheimer's sufferers exhibit a marked decline in levels of acetylcholine, a neurotransmitter (that is, a chemical messenger of the nervous system) that is vitally important to memory formation and retention in certain regions of the brain. Second, Alzheimer's patients demonstrate an accumulation of harmful beta amyloid deposits, or senile plaques, in the brain. Third, brain autopsies of Alzheimer's patients show signs of significant oxidative damage induced by free radicals. Finally, new research indicates that advanced glycation end products may also initiate this dreaded condition.

Feeding animals (in this case rats) a diet designed to give them type 2 diabetes leaves their brains riddled with insoluble plaques of a protein called beta-amyloid, one of the calling cards of Alzheimer's. We also know that insulin plays a key role in memory. Taken together, the findings suggest that Alzheimer's might be caused by a type of brain diabetes. If that is the case, the memory problems that often accompany type 2 diabetes may in fact be early-stage Alzheimer's rather than mere cognitive decline.

While declining levels of acetylcholine and formation of beta amyloid plaques in the brain are characteristic of Alzheimer's, oxidative damage and the accumulation of advanced glycation end products occur in both Alzheimer's disease and diabetes. These biochemical similarities may be a telling link between the two seemingly different diseases.

Scientists from Kaiser Permanente in Oakland, CA, reported that diabetic individuals with very poor blood glucose control experienced a dramatically increased risk of dementia and Alzheimer's. Their eight-year study, which tracked 22,852 patients, aged 50 or above with type II diabetes, sought to determine whether elevated glycosylated hemoglobin, a marker of long-term blood glucose control, correlated with an increased risk of dementia. They found that patients with very poor blood glucose control were more likely to develop dementia.

Researchers from the Mount Sinai School of Medicine in New York City discussed the link between diabetes-related toxins and impaired memory function. Advanced glycation end products (AGEs) are increased in people with diabetes, as well as in those with cardiovascular and kidney disease. They are also found in the brains of people with Alzheimer's, and laboratory findings suggest that AGEs may contribute to the formation of Alzheimer's plaques and tangles. The researchers evaluated nearly 200 cognitively healthy people aged 70 or older using tests of memory and thinking ability, and measured AGE levels in their blood. They found that those with the highest AGE levels fared significantly worse on six different tests than those with low AGE levels. This relationship could not be explained by factors such as gender, educational level, heart disease, or related conditions such as high blood pressure. The researchers concluded that dietary and lifestyle interventions to decrease advanced glycation end products in the blood deserve further study for preventing or delaying Alzheimer's disease.

Most of recent research points to a link between diabetes and Alzheimer's Disease. How firm this link is still is in doubt, but more evidence is now in the affirmative.

April 18, 2015

Insulin Resistance – Part 2

Type 2 diabetes is the type of diabetes that occurs later in life or with obesity at any age. Insulin resistance precedes the development of type 2 diabetes, sometimes by years. In individuals who will ultimately develop type 2 diabetes, it has been shown that blood glucose and insulin levels are normal for many years, until at some point in time, insulin resistance develops.

At this point, high insulin levels are often associated with central obesity, cholesterol abnormalities, and/or high blood pressure (hypertension). When these disease processes occur together, it is called the metabolic syndrome.

One action of insulin is to cause the body's cells (particularly the muscle and fat) to remove and use glucose from the blood. This is one way by which insulin controls the level of glucose in blood. Insulin has this effect on the cells by binding to insulin receptors on the surface of the cells. You can think of it as insulin "knocking on the doors" of muscle and fat cells. The cells hear the knock, open up, and let glucose in to be used. With insulin resistance, the muscles don't hear the knock (they are resistant). So, the pancreas is notified that it needs to make more insulin, which increases the level of insulin in the blood and causes a louder knock.

The resistance of the cells continues to increase over time. As long as the pancreas is able to produce enough insulin to overcome this resistance, blood glucose levels remain normal. When the pancreas can no longer produce enough insulin, the blood glucose levels begin to rise. Initially, this happens after meals, when glucose levels are at their highest and more insulin is needed, but eventually while fasting too (for example, upon waking in the morning). When blood sugar rises abnormally above certain levels, type 2 diabetes is present and can be diagnosed.

While the metabolic syndrome links insulin resistance with abdominal obesity, elevated cholesterol, and high blood pressure; several other medical conditions are specifically associated with insulin resistance. Insulin resistance may contribute to some of the conditions listed.
  1. Type 2 Diabetes
  2. Fatty liver disease
  3. Arteriosclerosis
  4. Skin Lesions
  • Acanthosis nigricans
  • Skin tags
  1. Reproductive abnormalities in women
  • Polycystic ovary syndrome (PCOS)
  • Hyperandrogenism
  1. Growth abnormalities
A doctor can identify individuals likely to have insulin resistance by taking a detailed history, performing a physical examination, and simple laboratory testing based on individual risk factors.

In general practice, the fasting blood glucose, A1c, and insulin levels are usually adequate to determine whether insulin resistance and/or diabetes are present. The exact insulin level for diagnosis varies by assay (by laboratory). However, a fasting insulin level above the upper quartile in a non-diabetic patient is considered abnormal.

Management of insulin resistance is accomplished through lifestyle changes such as diet, exercise, and disease prevention, and medications. Insulin resistance can be managed in two ways. First, the need for insulin can be reduced. Second, the sensitivity of cells to the action of insulin can be increased.

The need for insulin can be reduced by altering the diet, particularly the carbohydrates in the diet. Carbohydrates are absorbed into the body as they are broken up into their component sugars. Some carbohydrates break and absorb faster than others. These carbohydrates increase the blood glucose level more rapidly and require the secretion of more insulin to control the level of glucose in the blood. Since foods are rarely eaten in isolation, it can be argued that the glycemic index of each food is less important than the overall profile of the whole meal and associated drinks.

Several studies have confirmed that weight loss, and even aerobic exercise without weight loss, increase the rate at which glucose is taken from the blood by muscle cells as a result of improved sensitivity.

Over the past decade, insulin resistance has gained significance, in its own right, as a contributor to the metabolic syndrome. Timely intervention can delay the onset of overt type 2 diabetes. Future studies must assess longer intervals than research to date in order to determine the duration for treatment to prevent the development of type 2 diabetes and related complications.

Lifestyle changes in nutrition and physical activity are clearly important to delay the development of type 2 diabetes in individuals with insulin resistance and are the primary recommendation for prevention of diabetes in high-risk individuals. Metformin is the only drug recommended by guidelines, for those patients at highest risk. Education about these changes must be directed to all groups at risk for type 2 diabetes. Childhood obesity is epidemic and on the rise in the developed countries. Changes must be made in homes and school cafeterias to ensure healthier nutrition.

Please read this recent blog by Gretchen Becker on insulin resistance. Then read this blog by David Mendosa on insulin resistance and cocoa

April 17, 2015

Insulin Resistance – Part 1

Many do not consider this a diabetes complication, but I am including it as one.  Diabetes and insulin resistance are well linked and generally, insulin resistance precedes diabetes or metabolic syndrome. You can prevent or stop insulin resistance in its tracks by being physically active, losing extra pounds, and, in some cases, taking the prescription drug metformin.

If you have insulin resistance, your body doesn't respond as well as it should to the insulin it makes. That leaves your blood glucose levels higher than they should be. As a result, your pancreas has to make more insulin to manage your blood glucose.

Insulin resistance is a condition in which the cells of the body become resistant to the hormone insulin.
  • Insulin resistance may be part of the metabolic syndrome, and it has been associated with higher risk of developing heart disease.
  • Insulin resistance precedes the development of type 2 diabetes.
  • Insulin resistance is associated with other medical conditions, including fatty liver, arteriosclerosis, acanthosis nigricans, skin tags, and reproductive abnormalities in women.
  • Individuals are more likely to have insulin resistance if they have any of several associated medical conditions. They also are more likely to be insulin resistant if obese or of Latino, African-American, Native American, or Asian-American heritage.
  • While there are genetic risk factors, insulin resistance can be managed with diet, exercise, and proper medication.
You may also have heard of "insulin resistance syndrome," as being called metabolic syndrome. It includes:
  • Waist size of 40 inches or more in men and 35 inches or more in women.
  • High levels of triglycerides (a type of fat in the blood): Your levels are 150 units or higher, or you're taking medicine to control your triglycerides.
  • Low levels of "good" (HDL) cholesterol: Less than 40 units for men and less than 50 units for women.
  • High blood pressure: Your blood pressure is 130/85 or higher, or you're taking medicine to treat high BP.
  • Blood glucose levels that are above normal: Your fasting blood glucose levels are 100 mg/dl or above, or you're taking medicine to treat high blood glucose levels.
  • Pregnancy is also a cause in insulin resistance
  • Infection or severe illness promotes insulin resistance
  • Stress also promotes insulin resistance
  • Inactivity and excess weight will activate insulin resistance
  • During steroid use insulin resistance rises to the extreme
You can't tell that you have insulin resistance by how you feel. You'd need to get a blood glucose meter that checks your blood glucose levels. Likewise, you wouldn't know if you have most of the other conditions that are part of insulin resistance syndrome (high blood pressure, low "good" cholesterol levels, and high triglycerides) without seeing your doctor.

If you already have insulin resistance, you can take actions that will help your health.
  • Exercise. Go for at least 30 minutes a day of moderate activity (like brisk walking) 5 or more days a week. If you're not active now, work up to that if you are medically able.
  • Get to a healthy weight. If you're not sure what you should weigh or how to reach a weight loss goal, ask your doctor. You may also want to talk with a nutritionist and a certified personal trainer.
  • Eat a healthy diet. Think fruits, vegetables, nuts, beans, fish, legumes, and other protein.
Some people with insulin resistance may also need to take the prescription drug metformin to help control it.

Warning: Another source says this - Thiazolidinediones (TZDs) comprise another class of diabetes drugs which increase sensitivity to insulin, including pioglitazone (Actos) and rosiglitazone (Avandia). These medications are no longer used routinely, in part because of liver toxicity that requires monitoring of liver blood tests. This class of diabetes drugs is known for increasing or causing weight increase.

The person's body may not be producing enough insulin to meet their needs, so some glucose can't get into the cells. Glucose remains in the bloodstream, causing high blood glucose levels. In many cases, the person may actually be producing more insulin than one might reasonably expect that person to need to convert the amount of food they've eaten at a meal into energy. Their pancreas is actually working overtime to produce more insulin because the body's cells are resistant to the effects of insulin. Basically, the cells, despite the presence of insulin in the bloodstream, don't become unlocked and don't let enough of the glucose in the blood into the cells.

Scientists don't know exactly what causes this insulin resistance, and many expect that there are several different defects in the process of unlocking cells that cause insulin resistance. Medications for type 2 diabetes focus on different parts of this insulin-cell interaction to help improve blood glucose control. Some medications stimulate the pancreas to produce more insulin. Others improve how the body uses insulin by working on this insulin resistance. Physical activity also seems to improve the body's ability to use insulin by decreasing insulin resistance, which is why activity is so important in diabetes management.

April 16, 2015

Diabetes During Pregnancy – Part 2

Why did I change the topic from gestational diabetes to diabetes during pregnancy. The material is pointing to all types of diabetes and this made the topic more comprehensive than just covering only gestational diabetes. Part 1 was for all women. Hopefully this part will cover the rest.

Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.
Complications in your baby can occur as a result of gestational diabetes, including:
  • Excess growth. Extra glucose can cross the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to require a C-section birth.
  • Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal.
  • Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
  • Death. Untreated gestational diabetes can result in a baby's death either before or shortly after birth.
Complications in the mother can also occur as a result of gestational diabetes, including:
  • Preeclampsia. This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.
  • Subsequent gestational diabetes. Once you've had gestational diabetes in one pregnancy, you're more likely to have it again with the next pregnancy. You're also more likely to develop diabetes, typically type 2 diabetes, as you get older.
About 25 years ago, a family friend developed gestational diabetes and did what was necessary to have a healthy baby. When the doctor told her that she could have gestational diabetes with future children, she told the doctor she would not. I don't know what she did, but she had two more children and did not have gestational diabetes. About a year ago, she surprised me when she sent me an email and asked why she now had type 2 diabetes.

I asked her if the doctor had told her this could happen, and she admitted that he had, but after her third baby was born, he said that her chances had gone down. I asked if she had eased up on her care and forgot what she had done to avoid gestational diabetes. This caused a pause in our emails and I did not push it. A month has now passed since she finally replied. I know how difficult her response was and she had to admit that she had stopped the level of care she had set for herself with the children, but that she was now off all medications and would work to stay off for as long as she could.

I congratulated her for that and asked if she knew that she was now in a battle to manage diabetes for the remainder of her life. Yes, was her response and her children and husband were helping her. She also stated that her husband also has type 2 diabetes and the children are aware of the possibility of genetics and the odds of type 2 diabetes affecting them.

I could write a lot more, but instead I will urge you to read this which is a reasonable discussion of gestational diabetes. Then I suggest reading this article which covers the three types of diabetes.

April 15, 2015

Diabetes During Pregnancy – Part 1

Diabetes and pregnancy is a special concern because what the mother does during pregnancy can definitely affect the baby and its life for good or bad. Let me be very clear that this is not an easy topic for me and my children were born without gestational diabetes and other complications. As such, I may miss some points that are important.

Whether you are a person with type 1 diabetes, type 2 diabetes, or do not have diabetes, there are some steps every woman needs to take before starting a family. Yes, starting a family requires more planning when you are a mother-to-be with diabetes, but these steps should also be carefully considered for all mothers-to-be. 

The following are all important:
See an OB GYN if at all possible or a doctor that does understand pregnancy. Set up an appointment approximately three to six months before you plan to conceive. For women without diabetes, some of these will not be done.
  • Order an A1C test to find out if your diabetes is controlled well enough for you to stop using birth control.
  • Test your blood and urine for diabetes-related kidney complications.
  • Look for other problems linked with diabetes, like organ, nerve, or heart damage.
  • Take your blood pressure.
  • Rule out thyroid disease (if you have type 1 diabetes).
  • Check your cholesterol and levels of a type of blood fat called triglycerides.
  • Suggest an eye exam to screen for glaucoma, cataracts, and retinopathy.
  • Do other blood work looking for various vitamin and mineral deficiencies.
  • Recommend pre-conception counseling.
Pre-conception counseling is important for all women planning to conceive, but is especially important for women with diabetes and those that have had gestational diabetes with a previous child. The session will be educational and should help you become physically, emotionally, and healthy for pregnancy. The points for discussion will include at least the following:
  1. Your weight: Try to reach your ideal body weight before you get pregnant. If you have a few extra pounds, losing them will help prevent complications from diabetes. If you’re underweight, adding pounds can make you less likely to deliver a low-birth-weight baby.
  1. Your lifestyle: If you smoke or drink alcohol, you'll need to stop. Smoking during pregnancy affects both you and the baby before, during, and after birth. When you smoke, the nicotine (the addictive substance in cigarettes), carbon monoxide, and other toxins travel through your bloodstream and go directly to your baby. These substances can:
  • Deprive you and the baby of oxygen.
  • Raise the baby’s heart rate.
  • Boost the chances of a miscarriage or a stillbirth.
  • Increase the odds of a premature, low-birth-weight baby.
  • Make the baby prone to future problems with the lungs or breathing.
Drinking alcohol during pregnancy can lead to a pattern of birth defects that includes mental retardation and certain physical problems. No amount of alcohol is known to be safe while pregnant, and there’s no safe time during pregnancy to drink.
  1. Prenatal vitamins: At least one month before you get pregnant, start taking a daily vitamin that has folic acid. It’s been shown to lower the risk of having a baby with a neural tube defect like spina bifida, a serious condition in which the brain and spinal cord don’t form normally. The CDC recommends you take 400 micrograms of folic acid daily before conception and throughout pregnancy. Most drugstores sell over-the-counter prenatal vitamins that don’t require a prescription.
  1. Your blood sugar: The doctor will check to see if your blood sugar is in control. This is key, because you may not know you’re pregnant until the baby has been growing for 2-4 weeks. High blood sugar during the first 13 weeks can cause birth defects, lead to miscarriage, and put you at risk for diabetes complications. Get screened for gestational diabetes at 24 weeks, even if you don’t have symptoms.
  1. Your medications: You'll need more insulin during pregnancy, especially the last 3 months. The doctor will tell you how to adjust your dose. If you take diabetes pills, the doctor may switch you to insulin, because some of these drugs can harm the baby. So can some high blood pressure treatments used with diabetes. Bottom line: Discuss all medications and dietary supplements you take with your doctor.
  1. Meal planning: You’ll need to make some changes while you’re pregnant to avoid swings in blood sugar levels. You’ll also need to take in more calories to feed your growing baby.

April 14, 2015

Sexual Dysfunction in Men and Women – Part 2

Continued from prior blog.

Issues for both sexes:
  • Urinary infections are more common in people with poorly controlled diabetes and can cause discomfort for women during intercourse and for men during urination and ejaculation. These generally are temporary complications, but they can recur. Sexual activity should be stopped during treatment of urinary tract and yeast infections, which also are relatively common in people with diabetes.
  • Sexually transmitted diseases (STDs) can be transmitted easily because of the dry, cracked skin found in many people who have diabetes. This makes it important to practice safe sex.
  • Chronic high blood glucose levels can lead to reduced testosterone and may contribute to decreased sexual interest (libido).
  • Chronic high blood glucose can lead to abnormal nerve function, leading to pain with only light touch.
  • Heightened sense of pain associated with neuropathy can make sexual relations uncomfortable.
  • Because intercourse is exercise, people with diabetes should watch for signs of hypoglycemia (low blood glucose) after sex.
Other factors:
  • People with diabetes (particularly men whose disease is poorly controlled) may have too little or too much of certain hormones, such as prolactin, testosterone, or thyroid hormone. Generally these conditions can be treated with pills.
  • Certain drugs for heart problems, high blood pressure, anxiety, depression, pain, allergies, and weight control sometimes cause impotence. Switching medications may solve the problem.
  • Stress and other mental health problems can cause or worsen sexual dysfunction, as can smoking and alcohol use.
  • Physical problems not caused by diabetes, such as accidents that injure nerves, prostate surgery, and spinal cord injuries, can cause impotence.
See your doctor: Make an appointment to see your doctor if you are experiencing sexual dysfunction. Your doctor should perform a physical exam, which includes:
  • Medical history, including questions about morning erections (a sign that the impotence probably is not due to a physical problem); how long the problem has occurred; and whether you are experiencing anxiety or stress
  • A physical exam and review of diabetes complications
  • Lab tests to check hormone levels
  • Review of medicines taken
  • Occasionally additional testing, including measurements of erections, an ultrasound, and/or neurological and other tests done at the doctor's office or by you at home.
People with diabetes can lower their risk of sexual and urologic problems by keeping their blood glucose, blood pressure, and cholesterol levels close to the target numbers their doctor recommends. Being physically active and maintaining a healthy weight can also help prevent the long-term complications of diabetes. For those who smoke, quitting will lower the risk of developing sexual and urologic problems due to nerve damage and also lower the risk for other health problems related to diabetes, including heart attack, stroke, and kidney disease.

For information from another source, please read this article.