Diabetic Coma in Type 2 Diabetes

Diabetic coma -- also known as hyperglycemic hyperosmolar nonketotic syndrome -- is a serious complication that can happen to a person with type 2 diabetes who is ill or stressed. Diabetic coma occurs when the blood sugar gets too high and the body becomes severely dehydrated. Unlike ketoacidosis, which typically occurs in people with type 1 diabetes and produces similar symptoms, no ketones are formed in diabetic coma. So rarely is there an acid build up in the blood. Ketoacidosis rarely occurs in people with type 2 diabetes.

The CDC reports that diabetic coma occurs most often among people who are older than 60. This may be because older people often have an altered sense of being thirsty and are more likely to become dehydrated. Most sufferers have a history of diabetes, but for some, the disease is undiagnosed or untreated.

In most cases, there is a history of excess thirst and urination for weeks prior to diagnosis. Excess urination and extreme elevations of blood sugar levels lead to dehydration throughout the body, including cells becoming dehydrated. The severe loss of body water can lead to shock, coma, and death. Death rates can be as high as 50%.

People who are especially at risk include those who are chronically ill or disabled.

What Causes Diabetic Coma?

Causes of diabetic coma can include:

• Infection
• Heart attack
• Kidney failure
• Medicines (diuretics, heart medication, or steroids)
• Illness
• Bleeding ulcer
• Blood clot
• Uncontrolled blood sugar

What Are the Early Symptoms of Diabetic Coma?

Early symptoms that may lead to diabetic coma if not treated include:

• Increased thirst
• Increased urination
• Weakness
• Drowsiness
• Altered mental state
• Headache
• Restlessness
• Inability to speak
• Paralysis

If you have any of these symptoms, test your blood sugar and call your doctor if your blood sugar is high. Diabetic coma typically occurs when blood sugar reaches 600 mg/dL (milligrams per deciliter) or more.

How Is Diabetic Coma Treated?

Once early symptoms of a diabetic coma are noticed, treatment typically requires intravenous fluids as ordered by your doctor and may require insulin. It can lead to death if left untreated.

How Can Diabetic Coma Be Prevented?

Diabetic coma can be prevented by the following:

• Check your blood sugar regularly, as recommended by your health care provider.
• Check your blood sugar every four hours when you are sick.
• Take special care of yourself when you are sick.

Diabetes and Alcohol

Diabetes and Alcohol

Alcohol is processed in the body very similarly to the way fat is processed, and alcohol provides almost as many calories. Therefore, drinking alcohol in people with diabetes can cause your blood sugar to rise. If you choose to drink alcohol, only drink it occasionally and when your diabetes and blood sugar level are well-controlled. If you are following a calorie-controlled meal plan, one drink of alcohol should be counted as two fat exchanges.
It is a good idea to check with your doctor if you are overweight or have high blood pressure or high triglyceride levels before drinking alcohol. If you are in doubt about whether drinking alcohol is safe for you, check with your doctor.

Effects of Alcohol on Diabetes

Here are some other ways that alcohol can affect diabetes:

• While moderate amounts of alcohol can cause blood sugar to rise, excess alcohol can actually decrease your blood sugar level -- sometimes causing it to drop into dangerous levels.
• Beer and sweet wine contain carbohydrates and may raise blood sugar.
• Alcohol stimulates your appetite, which can cause you to overeat and may affect your blood sugar control.
• Alcohol can interfere with the positive effects of oral diabetes medicines or insulin.
• Alcohol may increase triglyceride levels.
• Alcohol may increase blood pressure.
• Alcohol can cause flushing, nausea, increased heart rate, and slurred speech.

Diabetes and Alcohol Consumption Dos and Don'ts

People with diabetes should follow these alcohol consumption guidelines:

• Do not drink more than two drinks of alcohol in a one-day period. (Example: one alcoholic drink = 5-ounce glass of wine, 1 1/2-ounce "shot" of liquor or 12-ounce beer).
• Drink alcohol only with food.
• Drink slowly.
• Avoid "sugary" mixed drinks, sweet wines, or cordials.
• Mix liquor with water or diet soft drinks.

Monitoring Blood Sugar and Avoiding Diabetes Complications

Monitoring Blood Sugar and Avoiding Diabetes Complications

Maintaining control of blood glucose (blood sugar) is a fact of life for people with diabetes. Uncontrolled blood glucose levels can cause serious health complications that affect nearly every system and organ in your body. Regular blood sugar tests throughout the day can help you maintain safe blood glucose levels and lower the risks for a host of diabetes complications:

Cardiovascular Disease and Stroke. Cardiovascular disease is one of the most common complications of diabetes, leading to heart attack, stroke, angina, and coronary artery disease. About 65% of people with diabetes die from cardiovascular disease and stroke. Adults with diabetes are two to four times more likely to have heart disease or suffer a stroke than people without diabetes.

Hypertension (High Blood Pressure). People with diabetes are also at greater risk of developing hypertension (high blood pressure), which increases the risk of heart attack, stroke, kidney disease, and eye problems.

High Cholesterol Levels. People with diabetes, especially those with poorly controlled blood sugars, tend to have elevated levels of triglycerides and lower levels of healthy HDL cholesterol. People with type 2 diabetes tend to have similar LDL or "bad" cholesterol levels compared to those without diabetes, but their LDL particles seem to be smaller and more prone to cause damage. These abnormalities also increase the risk of heart disease for people with type 2 diabetes.

Vision Loss or Blindness. Diabetes is the leading cause of blindness for American adults High blood sugar leads to blurred vision, glaucoma, cataracts, and can cause loss of vision or blindness (diabetic retinopathy). Keeping your blood sugars under control will greatly reduce your risks of diabetes-related eye complications.

Diabetic Neuropathy (Nerve Damage). Diabetic neuropathy can lead to problems throughout your body, including the nerves that control your senses of vision, hearing, and taste. Nerve damage can also cause you to lose the ability to feel heat, pain, or cold. Small cuts or other wounds, like blisters, might not get noticed, or heal slowly, increasing the risk for skin infections and ulcerations.
Diabetic neuropathy can affect the nerves that control your digestive system. Diabetic gastroparesis is a disorder in which the movement of food through the digestive tract is slowed or stopped. This type of nerve damage can cause wide fluctuations in blood sugar and make glucose control difficult. In men with diabetes, diabetes can damage nerves and blood flow in the penis, leading to erectile dysfunction.

Kidney Disease. The kidneys filter waste products out of your blood.  But kidney disease affects more than just your blood. Diabetes is the leading cause of kidney failure. Kidney disease doubles your risk of heart attack, stroke, and early death. High blood sugars progressively damage your kidneys over time, and signs of kidney damage also represent a risk factor for heart disease.

Skin Conditions. A host of skin problems are associated with diabetes. Fungal infections, yeast infections, itching, blisters, and boils are common skin issues for people with diabetes. Even though anyone can develop these skin conditions, diabetic people can be more susceptible to infections and slow healing. About one-third of people with diabetes will develop a diabetes-related skin disorder during their life.

Controlling Diabetes: When Pills Aren't Enough

Diabetes and weight loss: It is the yin and yang of optimal health. There's no question about it. If you're overweight and have type 2 diabetes, dropping pounds lowers your blood sugar, improves your health, and helps you feel better.
But before you start a weight loss plan, it's important to work closely with your doctor or diabetes educator -- because while you're losing weight, your blood sugar, insulin, and medications need special attention.
Make no mistake -- you're on the right path. "No matter how heavy you are, you will significantly lower your blood sugar if you lose some weight," says Cathy Nonas, MS, RD, a spokeswoman for the American Dietetic Association and a professor at Mount Sinai School of Medicine in New York City.
A National Institutes of Health study found that a combination of diet and exercise cuts the risk of developing diabetes by 58%. The study involved people who were overweight (average body mass index of 34) and who had high -- but not yet diabetic -- blood sugar levels.
"We know it's true -- that if someone with diabetes loses 5% to 10% of their weight, they will significantly reduce their blood sugar," Nonas tells WebMD.
"We see it all the time. People can get off their insulin and their medication," she says. "It's wonderful. It shows you how interwoven obesity and diabetes are."
Even losing 10 or 15 pounds has health benefits, says the American Diabetes Association. It can:

• Lower blood sugar
• Reduce blood pressure
• Improve cholesterol levels
• Lighten the stress on hips, knees, ankles, and feet

Plus, you'll probably have more energy, get around easier, and breathe easier.

Diabetes, Weight Loss, and Changes in Blood Sugar

Cutting back on just one meal can affect the delicate balance of blood sugar, insulin, and medication in a body with diabetes. So it's important to work with an expert when you diet to lose weight.
Check with your doctor before starting a weight loss plan, then consult with a diabetes educator or nutritionist, advises Larry C. Deeb, MD, a diabetes specialist in Tallahassee, Fl.
"Don't try to lose weight on your own," says Deeb. "With a doctor and a good nutritionist, it's very safe to do. This is very important if you're taking insulin or medications."

The Right Balance for Diabetes and Weight Loss

Christine Gerbstadt, MD, a spokeswoman for the American Dietetic Association, warns that if you have diabetes, "you don't want to run the risk of high or low blood sugar while you're dieting. You want tight glucose control while you lose weight."
Gerbstadt suggests cutting 500 calories a day, "which is safe for someone with diabetes," she says. "Cut calories across the board -- from protein, carbohydrates, and fat -- that's the best way." She recommends that people with diabetes maintain a healthy ratio of carbs, fat, and protein. The ideal:

• 50% to 55% carbs
• 30% fat
• 10% to 15% protein

Overcoming Objections to Injections

Overcoming Objections to Injections

There was a time when doctors couldn't get anywhere near Sherri Buffington with a needle. "I was deathly afraid of needles," recalls the 44-year-old senior legal secretary from Sicklerville, N.J. "I've been petrified of needles since I was a little kid."
Then in 2004, Buffington was diagnosed with diabetes. When oral medications didn't control her disease, her doctor prescribed an injectable prescription medication along with insulin. Taking these drugs meant she would have to inject herself, sometimes three times a day. "I was apprehensive," she says. "But I felt that if this was going to help me, I'd have to grin and bear it and just do it."
Buffington is far from the only diabetes patient with needle anxiety. More than a third of people with diabetes approach their injections with a sense of dread, and nearly as many feel that injections are the hardest part of managing their condition. The fear can be severe enough to prevent some diabetes patients from taking the medicines they need to control their blood sugar. In fact, one survey found that more than half of patients skipped insulin injections from time to time, often because they feared the pain.
"I always tell patients that having a fear of needles is normal and natural," says Evan Sisson, PharmD, a diabetes educator and assistant professor in the Department of Pharmacotherapy and Outcomes Science at the Virginia Commonwealth University School of Pharmacy. Sisson and other diabetes educators help diabetes patients overcome their fear of shots, so it doesn't become an obstacle to controlling their blood sugar.

Why Injections Are Important

Everyone with type 1 diabetes must take insulin injections, because their body doesn't produce this hormone. People with type 2 diabetes take injected insulin or other prescription injectables when pills and lifestyle changes aren't lowering their blood glucose enough.
Why injections? “Injections are the most effective," says Robert R. Henry, MD, professor of medicine in the Division of Endocrinology and Metabolism at the University of California, San Diego and president of Medicine & Science at the American Diabetes Association.
Skipping insulin injections can be extremely dangerous for people with type 1 diabetes. When glucose isn't available for energy, the body starts burning fat instead. That can lead to a state called ketoacidosis, in which acids called ketones build up and poison the body.
With type 2 diabetes, the risk of skipping medications or injections isn't as immediate. But over time, fluctuating blood sugar levels can damage organs like the eyes, kidneys, and heart. Research has found that people who are afraid of their insulin injections have poorly controlled blood sugar and experience more diabetes-related complications. Overcoming needle anxiety can be a key element to preventing these complications.

Combination Therapy for Diabetes

Combination Therapy for Diabetes

Many people with type 2 diabetes can manage blood sugar levels effectively on oral diabetes medications and lifestyle changes alone. Others will need to combine oral diabetes medications with injectable diabetes drugs in order to bring their blood glucose levels into a healthy range. Finding the right combination is the key to managing diabetes successfully.
For years, insulin was the only injectable diabetes medication available to help control blood sugar. Today, several newly approved injectable diabetes drugs are available. A growing number of medication options are also available, so doctors can individualize diabetes treatment with greater precision than ever before.

Combining Diabetes Medications for Optimal Effect

How will your doctor decide the best diabetes drug regimen for you? “The first principle is to make life as easy and therapy as effective as possible,” says Daniel Einhorn, MD, president of the American Association of Clinical Endocrinologists and medical director of the Scripps Whittier Diabetes Institute in La Jolla, Calif. “Type 2 diabetes is a lifelong problem. We want to choose therapies that people can easily live with.”
One factor is how comfortable people feel giving themselves injections. “Some patients are fine with injectable medications. Others will do anything not to have to give themselves injections,” says Eleftheria Maratos-Flier, MD, professor of medicine at Beth Israel Deaconess Medical Center in Boston.
 The second principle of combination diabetes drug therapy, according to Einhorn, is choosing medication therapies that work in complementary ways. “Today we have a variety of drugs that work in very different ways, so combinations can be especially effective,” says Einhorn.
One of the most commonly used oral drugs, metformin (sold under the brand names Blumetza, Fortamet, Glucophage, and Riomet), is considered the cornerstone of most combination therapy. It works by decreasing the amount of glucose produced by the liver. Metformin can be paired with insulin or with a GLP-1 agonist, which stimulates insulin production.
Doctors may also combine insulin with a GLP-1 agonist and a thiazolidinedione oral medication  (Actos and Avandia), which sensitizes the body to insulin. For people comfortable with using injectable drugs, doctors may recommend one of the two new GLP-1 agonists, Byetta and Victoza.  For people who don’t want an injectable drug, the alternative is a DPP-4 inhibitor (Januvia, Tradjenta, and Onglyza), which is taken orally. Both of these classes of drugs work in a similar way and are considered equivalent.

Weighing the Pros and Cons of Drug Combinations

Minimizing adverse effects is also important. Some diabetes medications can cause blood sugar levels to drop too low, causing hypoglycemia. The oral medication sulfonylurea (DiaBeta, Glynase, Micronase), which has long been used for type 2 diabetes, poses a moderate risk of causing hypoglycemia. Many doctors prefer to prescribe metformin, which is much less likely to cause hypoglycemia. Metformin is often paired with a GLP-1 agonist because these new injectable drugs work only when blood sugar levels are high, further avoiding  hypoglycemia.

Non-Insulin Diabetes Injectables

Non-Insulin Diabetes Injectables

When insulin was first discovered in 1921, it's not an overstatement to say that it revolutionized the treatment of diabetes. No longer was diabetes considered a death sentence. For the first time, people with diabetes could expect to live longer, fuller lives.
Insulin transformed diabetes treatment, but for many decades it was the only drug available to treat diabetes. Then came another mini-revolution with the introduction of the first oral, non-insulin drugs to treat type 2 diabetes, including metformin and the sulfonylurea class of drugs.
Today, metformin is the first drug doctors usually recommend for people with type 2 diabetes who need to take medication. Researchers have still been on the hunt for other diabetes treatment options because metformin doesn't work for everyone who has diabetes. Some people who take this drug still have trouble controlling their blood sugar and A1C number.
In recent years, new drugs have been introduced that offer more options for people with type 1 and type 2 diabetes. In 2005, the U.S. Food and Drug Administration approved two injectable non-insulin medications -- pramlintide (Symlin) and exenatide (Byetta). Then in 2010, the FDA also approved the drug liraglutide (Victoza).
Unlike insulin, which lowers blood sugar by pulling glucose from the bloodstream into cells, these drugs cause the body to release insulin, or work with insulin to control blood sugar levels.
Here's a rundown of the three non-insulin injections your doctor might recommend for controlling your blood sugar levels -- how they work, who they help, and what side effects they can have.
Pramlintide (Symlin)
What it is: Symlin is a man-made version of a hormone called amylin, which is produced along with insulin by the pancreas when blood glucose levels rise.
Who can take it: Symlin is designed for people who aren't able to get their A1C number down to the recommended less than 7.0% using other medications. It's approved for people with type 1 diabetes who are taking insulin, and people with type 2 diabetes who are taking insulin, a sulfonylurea drug, and/or metformin.
What it does: You take Symlin with insulin after a meal. The two drugs work together to lower your blood sugar. Symlin also slows your body's digestion of food, which puts less sugar into your bloodstream. In addition to controlling your A1C levels, Symlin helps reduce your appetite, so you eat less.
Side effects: The most common side effects of Symlin are nausea, stomach pain, diarrhea, and vomiting. Starting this drug at a low dose and increasing it slowly can help combat the nausea. Symlin can also cause a drop in blood sugar (hypoglycemia) if you don't adjust the amount of insulin you're taking.

Exenatide (Byetta)
What it is: This diabetes drug’s discovery comes from an unlikely source -- the saliva of the Gila monster, a huge desert-dwelling lizard. Byetta is actually a man-made version of a hormone called glucagon-like peptide-1 (GLP-1), which is found in Gila monster spit. Your intestines normally release this hormone when you eat.