More Information on Hypoglycemia

If you haven't figured it out yet, your body does not like low blood glucose and does its best to correct the condition. The body does store some glucose in the muscles and the liver in the form of glycogen. When the body needs glucose, the liver breaks down glycogen stores and releases glucose into the blood. When the liver or you body is short of glycogen, gluconeogenesis can occur. Gluconeogenesis is the term for making new sugar in the body.

The liver and even the kidneys, to some extent, can take the building blocks from proteins (amino acids) and convert them into glucose. This is why drinking alcohol is discouraged for people with diabetes. The liver is prevented from making new glucose when it is processing alcohol. This is the reason alcohol can cause hypoglycemia. Insulin is the hormone that lowers blood glucose. Just about all of the other hormones (adrenaline, glucagon, cortisol, and growth hormone) can raise blood glucose levels.

When prescribed correctly and taken correctly, both insulin and oral diabetes pills can work well at controlling blood glucose levels without causing hypoglycemia. It is when you take too much medication or eat less food that you can cause hypoglycemia. If the body's defenses are down or not a match for the amount of medication taken, then hypoglycemia will result.

The following are the symptoms of mild hypoglycemia and include, hunger, trembling, rapid heartbeat, increased pulse, sweating, heavy breathing, tingling, nausea, weakness, and nightmares., If you think these are bad, here are the symptoms of moderate to severe hypoglycemia. They include, headache, slow thinking, lack of coordination, trouble concentrating, blurred vision, anger, dizziness, slurred speech, seizure, coma, and potential death.

With the above symptoms, don't count on being able to predict your blood glucose levels by the way your feel. The only sure way of knowing is by testing. Newly diagnosed patients often have some of the symptoms when they are still above 100 mg/dl. This is because their body has adapted to a higher blood glucose level and when the medication acts, some medications do bring the blood glucose level down rapidly. This can cause false hypoglycemia. This is the reason for testing to prevent over reacting and eating carbs because you body is giving you a false alarm. As your body adapts to the lower blood glucose levels, the false alarms will stop.

The official level for hypoglycemia is 70 mg/dl. Readings above this and below 100 mg/dl are considered normal. This is a reason to keep blood glucose tablets and if your blood glucose test is less than 70 mg/dl then you need to follow the rule of 15.

The rule of 15:

Treat low blood glucose with 15 grams of carbohydrates/

Wait 15 minutes, then test again.

If your blood glucose had not risen 15 to 20 points, repeat the procedure.

Remember that if your blood glucose is below 50 mg/dl, then it is better to take 30 grams of carbohydrates and then test in 15 minutes. Low blood glucose can happen if you eat too few carbohydrates, and especially if you skip a meal. Learn that once you start feeling of any of the symptoms, your body can continue the symptoms for 15 to 25 minutes after eating glucose tablets. This is because of the hormones released by your body to combat hypoglycemia and it takes time for these hormones to settle down.

If you continue to eat until your felt better, you will likely eat too much. This would then result in raising your blood glucose level to a higher level than needed. Then you would need to possibly take more medication and the roller coaster ride begins.

Part 3 of 4

Information on Hypoglycemia

The technical term for low blood glucose (or as most writers say – low blood sugar) is hypoglycemia. Many people that have type 2 diabetes seldom experience hypoglycemia. It all depends on the medication they are using to manage diabetes. Example – metformin taken by itself generally will not cause hypoglycemia. On the other end, insulin is very apt to cause hypoglycemia if the person using it is not careful.

People with type 2 diabetes that use exercise and diet to manage their diabetes are not at risk for hypoglycemia. The type 2 people taking the oral medications below are at risk for hypoglycemia -

1. D-Phenylalanine Derivative There is only one drug in this class, Starlix or nateglinede.
2. Sulfonylureas This is a multi-drug class. The medications are Amaryl or glimepiride, DiaBeta or glyburide, Diabinese or chlorpamide, Glucotrol or glipizide, Glucogtrol XL or glipizide long acting, Glynase or glyburide, and Micronase or glyburide. The two generic only are tolazamide and tolbutamide.
3. Meglitinide This has one drug in its class, Prandin or repaglinide.

Note of concern – several of the sulfonylureas are combined with other oral medications, but this does not mean they will not cause hypoglycemia.

Then there is insulin which affects everyone using this medication. More care needs to be used with insulin. Don't get me wrong, care needs to be used for all diabetes medications, but insulin creates it own special care.

The causes of hypoglycemia include:

1. Too much injected insulin
2. Too much or too strong a dose of an oral medication
3. Improper period of time between medication and meals
4. Skipped or delayed meals
5. Not eating enough carbohydrates
6. More exercise than usual
7. Drinking alcohol on an empty stomach

#1. Be sure you are reasonably accurate in your carbohydrate count. Until you understand the correction ratio, be careful in not over injecting insulin.

#2. Too strong a dose of an oral medication can be dangerous. Always ask the doctor how much food is required for the prescribed dose. Always ask the doctor what to do if you only eat two meals per day. Don't forget to ask the doctor what to do if you don't feel good and may not eat a meal.

#3. This is an important point and you should not inject insulin or take an oral medication if you will not be eating within the necessary time frame. Accidents do happen and what do you do when someone arrives as you are ready to eat,

#4. Skipping or delaying meals and taking medication is a dangerous way to bring on hypoglycemia.

#5. This is important. The oral medication dose size can determine the amount of carbohydrates you must eat. This is why you must discuss this with your doctor to decrease or increase the size of your oral medication. Those using insulin can adjust the units of insulin injected based on the number of carbohydrates you will be consuming or even wait until you have finished eating to know how many carbohydrates you consumed.

#6. Not testing before exercise can create problems if you over exercise and do not have high enough blood glucose levels. Yes, over exercising can cause hypoglycemia.

#7. If you insist on having your alcohol, be aware that this can cause hypoglycemia, especially if you drink on an empty stomach. Make sure that you have an adequate amount of carbohydrates on board. Drinking excessive amounts of alcohol can result can result oh hypoglycemia problems.

As a person using insulin as a type 2, hypoglycemia needs to be taken seriously. I can speak from experience and while one doctor of mine keeps telling me to let my A1c rise, I have found that if I am more careful and eat less carbohydrates, I don't need as much insulin and my concern about hypoglycemia also has become less of a concern. My problem lately has been making sure that before I test, I have properly washed my hands and paying attention the finger I would be testing on.

Part 2 of 4

PWD Seem Not to Understand Hypoglycemia

Do you know the symptoms of hypoglycemia? According to the survey conducted by the American Association of Diabetes Educators (AADE) many people with diabetes (type 1 and type 2) are unsure of how to manage hypoglycemia. An online survey showed that many patients with diabetes are concerned about experiencing hypoglycemia but are unsure of how to prevent and manage the condition.

The online survey, which polled more than 1000 adults with type 1 and type 2 diabetes resulted in the following:

1. 60 percent of respondents have experienced hypoglycemia.
2. 19 percent of these have visited the emergency room for treatment.
3. 40 percent experienced nighttime hypoglycemia.
4. 84 percent felt anxiety.
5. 68 percent felt frustration.
6. 60 percent felt fear of nighttime hypoglycemia.

Then the next important data showed (from the 1000):

1. 62 percent expressed concern about experiencing hypoglycemia.
2. 81 percent perceived hypoglycemia as a significant health concern.
3. 98 percent reported understanding the importance of controlling hypoglycemia.
4. 81 percent acknowledged the health consequences if not treated appropriately.

The findings showcase a need for further education about hypoglycemia. People living with diabetes may be unaware of the causes, symptoms as well as the methods of preventing and managing hypoglycemia as evidenced by the following survey findings:

• Of respondents who had not experienced hypoglycemia, approximately 42 percent were unable to define it correctly
• Less than one third (30 percent) of respondents cited avoiding alcohol as a way to prevent hypoglycemia
• Nearly half (49 percent) were not aware that taking glucose tablets could help treat an episode

Hypoglycemia can be a debilitating complication for people with diabetes, but it is often under recognized. This means that people with diabetes should be taught the warning signs and symptoms of hypoglycemia. Then these same people need to be taught how to effectively manage and prevent hypoglycemia from happening.  Hypoglycemia occurs when blood sugars reach a low level, usually 70mg/dl (3.9 mmol/L) or below. Hypoglycemia can affect people living with type 1 or type 2 diabetes, who are on insulin or multiple therapies for diabetes. Symptoms of hypoglycemia include shakiness, dizziness, fatigue, confusion and  lack of coordination. In severe cases, hypoglycemia can lead to unconciousness, seizures, or death.

To treat hypoglycemia, those living with diabetes should regularly check their blood sugar levels. If levels are 70mg/dl or lower, it is recommended to consume 15-20 grams of carbohydrates and check levels again 15 minutes following consumption. If low blood sugar levels continue, repeat. Once blood sugar returns to normal, the individual should consume a small snack if the next planned meal or snack is more than an hour or two away to prevent recurrence of hypoglycemia.

Part 1 of 4

Investors in Afrezza Don't Appreciate Questions

A person that says he is a researcher is calling me out for my recent blog on Afrezza. If he is indeed a researcher, why does he need to hide under a user name? Oh, probably because he may be afraid of exposing his true investing nature in Afrezza.

I do appreciate him for promoting my blog. I am not confused as he tries to portray me, but I will not use Afrezza. I think until many other issues are put to rest, many people will wait and make sure that Afrezza will not end up as Exubera did – being pulled from the market for lack of use. Many of the people posting are investors and are forcing issues like joining diabetes forum websites and in essence advertising Afrezza. Most of the good forums are deleting these posts and when they republish them, they are banned as a participant from the forum. All forums will accept paid advertising, but will delete advertising that is free in this manner.

Some people with diabetes that I have talked to are afraid of what it will do to their lungs and some are afraid of lung cancer. I just tell them that if they are afraid, then wait until Afrezza has been on the market for five to seven years and this will confirm or deny their fear. Others have said the acute bronchospasm that has been observed will cause them not to use it. One said this applies to him as he has been recently diagnosed with COPD and therefore he would not consider using it.

Others in our support group are now saying that the research into smart insulin may be worth waiting for, as rodent testing has been very positive. The researchers are now developing the smart insulin into a therapy for human use. The sad part of this is that it will not be ready for clinical trials for another 2 to 5 years. Presently, this is being targeted for people with type 1 diabetes, but maybe it will become available “off label” for type 2.

Either way, I have to wonder if inhaled insulin will be that popular. It may be among the younger people with diabetes, but without testing in the elderly, many may avoid using it.

Still Learning about Sleep Apnea

I thought I had learned a lot about sleep apnea, but the lessons keep coming. I am now on my third CPAP machine and I am happy that I still ask questions. It seems that sometimes I ask too many questions as I am still searching for the right combination of machine, mask, and supplies to give me a great night's sleep. A question I asked recently has resulted in more problems as I believe an incorrect adjustment was made instead of the one I asked for.

I have had to change from a nasal mask to a full-face mask because of problems of breathing through my mouth. This will require some getting used to for me. Another problem that will require adapting is from a machine with an easy fill humidifier to one that cannot be filled beyond a certain level. Overfill slightly and then the air hose from the machine to the mask needs to be removed and the water drained out of the air hose. Then, while the machine is off, the humidifier needs to be drained to the right level. Fun, fun, and more fun for me.

I am happy that this CPAP machine runs more quietly than the previous machines, but I do miss the large capacity water container of my first CPAP for humidity. The last two have had small containers that only last for a day.

I have received questions from other readers and friends that wonder how I can tolerate wearing a mask of any type and sleep. I can only say that with the rest I am receiving by wearing the mask and using my CPAP, I would not want to sleep without it. I can remember how tired and sleepy I was before the CPAP machine that as long as I need it, I will use it.

A friend of Allen and me, who also has diabetes, refuses to wear a mask because he is so claustrophobic. He has even refused to use an oral device. He will not shut the bathroom door when he is using it and refuses to have a curtain for his shower. To play a joke on him one day, as he was getting his coat out of the closet, Allen pushed him in and shut the door. Allen will not do that again as he now has removed the door and refuses to put it back. Other closet doors are now missing in his home. Allen recently said he had been shown the results of the last sleep study by our friend and the apneas were almost normal. Our friend is happy about this as he has lost weight and had also refused surgery and another treatment.

While my CPAP machine is a true BiPAP or as others call it, an AutoPAP, I do like it as it is set with two settings, one for the lowest pressure, and one for the highest pressure. Then the machine self adjusts as I sleep to keep me breathing and not having apneas. I used a different source for my machine than previously because I felt I was not obtaining reliable service or even caring service. The number of problems just kept multiplying.

More on Blood Glucose Variables

This article from the Mayo Clinic covers some of the variables that I missed in my blog here on variances in blood glucose levels. This was written by a female and covers more than I hinted at in my blog.

Most of us understand that increased carbohydrate intake or decreased physical activity will raise our blood glucose level. When these are relatively consistent, then we need to think about the other variables that will affect our blood glucose levels. And yes, hormonal fluctuations caused by illness, injury, surgery, emotional stress, puberty, menses, and menopause can affect blood glucose levels.

Physical or emotional stress – This can cause the release of hormones called catecholamines, which often cause hyperglycemia or high blood glucose. Even if you don't have diabetes, you can develop hyperglycemia during severe illness. For those of us that have diabetes, we may need more insulin or oral diabetes medications during illness or stress. This should be something you talk to your doctor about if this happens to you.

The puberty variable – For children, insulin requirements increase during growth and especially during puberty. The cause, in part, can be attributed to the growth hormone as well as the sex hormones, estrogen and testosterone.

The menstruation and menopause variable – For girls and women, these times in life present unique challenges to blood glucose management. Estrogen and progesterone can induce temporary resistance to insulin, which can last up to a few days and then drop off.

Many women report having higher blood glucose levels a few days before beginning their period. Then when menstruation begins, some women continue to have hyperglycemia while others experience a sharp drop in blood glucose levels. During menopause, women often notice their blood glucose levels are more variable or less predictable than before.

For women with type 1 diabetes, significant hyperglycemia can lead to emergency complications such as diabetic ketoacidosis or diabetic hyperosmolar syndrome. For these conditions, immediate treatment is needed. Persistent hyperglycemia puts you at increased risk for long-term complications such as cardiovascular disease, blindness, or kidney failure.

Contrary to the advice of the American Diabetes Association and the American Association of Clinical Endocrinologists, frequent testing and recording of your blood glucose values will show patterns and make it easier for you and your doctor to manage your diabetes.

Always be proactive and ask your doctor to help you establish a 'sick day plan' to help you respond in the event of illness or injury. If you experience continued hyperglycemia, don't hesitate to ask your doctor to help you adjust your diabetes treatment regimen.

Diabetes - If You Drink Alcohol – Read This

Dr. Rosalind Breslow, Ph.D., an epidemiologist in NIAAA's Division of Epidemiology and Prevention Research led a study that appears in the February 2015 issue of Alcoholism: Clinical and Experimental Research. Dr. Breslow said the results of the study does not report actual, but potential rate of drinking and medication use that overlap.

About 42 percent of U.S. Adults who drink also report using medications that are known to interact with alcohol. This is based on a study from the National Institutes of Health. In those over 65 years of age who drink alcohol, nearly 78 percent report using alcohol-interactive medications. These findings show that a substantial percentage of people, who drink regularly, particularly older adults, could be at risk of harmful alcohol and medication interactions. Dr. Breslow suggests that people talk to their doctor or pharmacist about whether they should avoid alcohol while taking their prescribed medications.

This research is among the first to estimate the proportion of adult drinkers in the United States who may be mixing alcohol-interactive medications with alcohol. Dr. Breslow emphasizes the resulting health effects can range from mild (nausea, headaches, loss of coordination) to severe (internal bleeding, heart problems, difficulty breathing).

“Combining alcohol with medications often carries the potential for serious health risks,” said Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of NIH. “Based on this study, many individuals may be mixing alcohol with interactive medications and they should be aware of the possible harms.”

Some of the alcohol-interactive medications reported in the survey were blood pressure medications, sleeping pills, pain medications, muscle relaxers, diabetes and cholesterol medications, antidepressants and antipsychotics. Based on recent estimates, about 71 percent of U.S. adults drink alcohol.

You have probably seen warnings on medicines you have taken. The danger is real and the warnings should be heeded. In addition to these dangers, alcohol can make a medication less effective or even useless, or it may make the medication harmful or toxic to your body.  Some medicines that you might never have suspected can react with alcohol, including many medications which can be purchased “over-the-counter,” that is, without a prescription. Surprise, even some herbal remedies can have harmful effects when combined with alcohol. Small amounts of alcohol can make it dangerous to drive, and when you mix alcohol with certain medicines, you put yourself at even greater risk. Combining alcohol with some medicines can lead to falls and serious injuries, especially among older people.

Women, in general, have a higher risk for problems than men. When a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount. As a result, women are more susceptible to alcohol-related damage to organs such as the liver.

And remember, older people are at particularly high risk for harmful alcohol–medication interactions. Aging slows the body’s ability to break down alcohol, so alcohol remains in a person’s system longer. Older people also are more likely to take a medication that interacts with alcohol. And in fact, they often need to take more than one of these medications.

Do You Understand Depression - Part 3

The causes of depression are many and varied. Some people are genetically predisposed to have a higher chance of having episodes of depression throughout their lifetime. If you have a parent or a sibling that has experienced depression, then you are at a higher risk for depression. Once you have depression, this is a predictor of future episodes.

Your environment is another cause of depression. Stressors and triggers can come from your home, work, and even memories can negatively affect your thoughts. Negative thoughts can affect not only mood and feelings, but also behavior and daily living. Depression can lead to self-isolation, poor nutrition, and little exercise. From my reading, I have learned that the brain and its neurotransmitters change during an episode of depression and all these factors negatively affect biology.

This is why when you have mild depression, you need to take steps to stop it there. If you have someone that understands you and can be a sounding board, make use of him or her and let him or her help you. If this does not work, then seek counseling and don't let depression get the better of you.

Depression negatively affects behavior by decreasing engagement in recreational activities and making chores and hygiene more likely to be deferred. Not being able to keep up with responsibilities at work and at home can lead to additional negative thoughts. Ever-increasingly negative thoughts, biology, and behavior all then enhance the feeling of depression. This can become a vicious cycle. What starts as something minimal can quickly snowball into severe and debilitating depression that negatively affects the biological, psychological, and social aspects of your life.

The first paragraph above says a lot and there are the people with diabetes that I am concerned about. Because some people are at higher risk for depression than others, the rest of the people around this person need to be aware that depression can negatively affect all areas of a person's life. The feelings of hopelessness and distorted thoughts and judgment can lead to self-harm and suicide. As with any disease, the symptoms and causes of depression for people with diabetes can be problems with unknown magnitude.

Like most diseases that go untreated, depression negatively affects quality of life and has complications, the most serious of which is suicide. This why I blog and our support group is working to do interventions. If anyone you know is suffering from depression, please assist them in obtaining treatment immediately.

Warning, leave certified diabetes educators (CDEs) out of this, as they avoid being in the room with anyone with diabetes that talks about depression. I have blogs up over the years where CDEs have done just this and I have been able to help a few of their victims. They can't seem even to pass this information to the person's doctor for follow-up.

Some blogs that I have found helpful include this about why are your missing work, this blog about restoring happiness, and this blog about other bloggers writing about handling depression. The last link is this on about some depression drugs causing hypoglycemia and this should be known before accepting some depression drugs.