Welcome! This is written primarily for people with Type 2 Diabetes. Some information covers all types of diabetes. Always keep a positive attitude is my motto.
I am a person with diabetes type 2 and write about my experiences and research. Please discuss medical problems with your doctor. Please do not click on the advertisers that have attached to certain words in this section. They are not authorized and are robbing me by doing so.
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
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
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.
Type 2 Diabetes
Fatty liver disease
Reproductive abnormalities in
Polycystic ovary syndrome (PCOS)
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
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
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
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
You may also have heard of "insulin
resistance syndrome," as being called metabolic syndrome. It
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
Pregnancy is also a cause
in insulin resistance
Infection or severe illness
promotes insulin resistance
Stress also promotes
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
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
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:
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
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
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:
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
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
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.
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
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.
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:
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.
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
Raise the baby’s heart rate.
Boost the chances of a miscarriage
or a stillbirth.
Increase the odds of a premature,
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
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
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.
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.
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.
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.
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
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
Physical problems not caused by
diabetes, such as accidents that injure nerves, prostate surgery,
and spinal cord injuries, can cause impotence.
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
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
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.
In my research for this topic, the
sources on the first ten pages were between 7 to 1 and 9 to 1 about
the problem happening for men. In addition, many of the listings
were about men that did not have diabetes. I don't believe for a
minute that women don't have problems and I base that on TV
advertising recently for products for women in menopause and post
menopause to make sex less painful (diabetes not mentioned).
Out-of-control blood sugar levels can
lead to blood vessel and nerve damage that hamper sexual performance
and enjoyment. This can cause diabetes-related sexual dysfunction in
men as well as in women. Men and women with diabetes also should be
aware of sexual function issues that affect both sexes.
Other factors can cause or exacerbate
sexual dysfunction, including psychological issues,
self-consciousness, and fear of failure. If you are experiencing
impotence or sexual dysfunction, it's important to see your doctor
for an accurate diagnosis of your condition.
Sexual problems (sexual dysfunction)
are common among people with diabetes, particularly in older men who
have had diabetes for years. In addition, many medical experts
believe that women with diabetes experience sexual difficulties as a
result of complications from the disease. People who experience
sexual difficulties can lead more enjoyable, fulfilling sexual lives
by learning about common causes and symptoms of sexual difficulties,
treatment options, and how to talk it over with a sex partner.
At any given time an estimated 30
million American men experience impotence (erectile dysfunction),
defined as the inability to achieve or maintain an erection
sufficient for intercourse more frequent than one out of four times.
Sexual difficulties in people with diabetes are not always related
to their disease.
Impotence can occur in men of any age,
but it most often affects older men. A recent study of 1,300 males
found some degree of erection difficulty in 52 percent of
participants ages 40 to 70. Over 50 percent of the estimated 10
million men with diagnosed type 2 diabetes experience impotence. In
men whose diabetes is well controlled, the rate of impotence is
about 30 percent. Approximately 35 percent of women with diabetes
may experience some form of sexual dysfunction related to their
disease. Of people with complications from diabetes, 50 to 70
percent of men and 40 to 50 percent of women may have sexual
difficulties because of nerve damage.
Sexual dysfunction in men:
Diabetes can cause nerve and
artery damage in the genital area, disrupting the blood flow
necessary for an erection. This is more common in older men who
have had diabetes for a long time. High cholesterol, high blood
pressure and obesity - all common among men with diabetes - as well
as smoking, can contribute to the problem.
Some men with diabetes experience
retrograde ejaculation, which means that the ejaculate goes backward
into the bladder instead of being discharged during climax. This
condition does not affect orgasm, but it can make it difficult to
father a child.
Sexual dysfunction in women:
Diabetes-related nerve damage can
cause vaginal dryness that makes intercourse uncomfortable.
Nerve damage also can lead to loss
of sensation in the genital area, making orgasm difficult or
impossible to achieve.
Our April meeting on April 11 turned
out to be more relaxed than I thought it would be. Jason had
received the materials from Brenda and was ready to have the
presentation. First, Tim had Brenda's daughter give us an update on
Brenda's progress and recovery. Brenda has returned home, but has a
full-time nurse and other people coming in during the weekdays for
physical therapy and speech therapy. Then Tim introduced the new
person, Joyce and asked for a vote for membership. The voice vote
was unanimous and Jason was given the floor.
Learning how to interpret blood glucose
readings is the topic and Jason felt with what he and Brenda had
prepared before the heart problem, we should understand more about
our food intake or reducing foods or eliminating some foods from our
menu. Jason continued that by using the health logs to adjust
medications if the doctor allowed or recommended this for certain
illnesses, it should be possible if we understand our blood glucose
Tim brought up the first slide which
explained the necessity of testing before a meal and testing at
various times after the meal. The before meal test (preprandial
test) should be determined by the type of medication being taken.
Oral medications can vary on how quickly the medication takes effect
and the same applies to insulin.
The after meal test is more variable
and depends on the medication, the individual, and the food consumed.
Only testing will help you decide the best time to test
postprandial. Jason said his best time is about 2 hours after last
bite and I know that several of you test about 90 minutes after first
bite and a few test at 90 minutes after last bite. Others test a one
hour after first or last bite. All times are fine and only you can
determine this from tests. The one warning Jason stated is being
consistent with first or last bite.
Jason then said that he tested every 15
minutes after last bite to determine when he had the highest blood
glucose reading and stopped when he had the reading start down.
Jason said to do this with several different meals and many different
food combinations. Most were all near 2 hours when his blood glucose
Jason said that without the twin tests,
preprandial and postprandial, one reading is worthless as it does not
tell you what the increase in blood glucose levels are and you
will not know what foods or food combinations may be causing the
spike in blood glucose levels.
Then Jason asked if we wanted him to
cover hypoglycemia and hyperglycemia since Bob has written about
both? Only one person said he would still want it talked about. Tim
asked if the resources I had used were part of what Brenda and Jason
had prepared. Jason answered that I have been part of the discussion
and much of what I had written was from the same sources.
Jason said several of what they had
came from my blogs and they had borrowed the book that I used. Gale
asked to speak and said she would like to work with the person that
wanted Jason to cover the topics as she felt that if she could get
their notes and use my blogs, she could explain it to her. The
person said she would accept that, as she was the only one that felt
there was something she missed and at the same time did not want to
hold the group back.
Tim asked Jason and me if we would
supply information and answer questions Gale had that would help.
Both of us said we were available by email or telephone to assist if
needed. Our newest member, Joyce, who had joined that evening, asked
if she could participate since she was not aware of what had been
covered in my blogs. She admitted that she did not understand the
terms other that she was guessing that one was about having lows and
the other about having highs from something the doctor had talked
about when she was still in shock from her diagnosis.
Gale agreed and thanked her for
speaking up. Tim asked if anyone else would want to do this. No one
spoke up and Tim asked Stan, who had joined the previous meeting, if
he was having any problems. Stan said that my blogs were what he
needed and had read many of them. He continued that the blogs on the
complications were what he needed and he was asking me questions that
he had, and I was helping him gain confidence in researching
With that, Tim ended the meeting.
Several people gathered around Gale and Tim decided to let that
happen. I was ready to leave and several of us headed home.