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.

Diabetes Warning Sign: Thirst

Diabetes Warning Sign: Thirst

One of the first symptoms of type 2 diabetes may be an increase in thirst. This is often accompanied by additional problems, including dry mouth, increased appetite, frequent urination -- sometimes as often as every hour -- and unusual weight loss or gain.

Insulin: Turning Glucose Into Energy

Insulin: Turning Glucose Into Energy

1) After eating, the stomach breaks carbohydrates down into sugars, including glucose. 2) Glucose enters the bloodstream and stimulates the release of insulin from the pancreas.  3) Insulin and glucose travel in the blood to all the body’s cells. Insulin allows glucose to enter the cells and be used as fuel.
Excess glucose is stored in the liver.

Type 2 Diabetes: What Is It?

Type 2 Diabetes: What Is It?

Type 2 diabetes strikes people of all ages, and early symptoms are subtle. In fact, about one out of three people with type 2 diabetes don’t know they have it. Diabetes is a chronic condition that thwarts the body’s ability to change food into energy. This allows sugar levels to build up in the blood, which can increase the risk of heart disease, loss of vision, and other serious complications.

Diabetes Warning Sign: Headaches

Diabetes Warning Sign: Headaches

As blood sugar levels become more abnormal, additional symptoms may include headaches, blurred vision, and fatigue.

Diabetes Warning Sign: Infections

In most cases, type 2 diabetes is not discovered until it takes a noticeable toll on health. One red flag is troubling infections, such as:

• Cuts or sores that are slow to heal.
• Frequent yeast infections or urinary tract infections.
• Itchy skin, especially in the groin area.

Panel Recommends Hepatitis B Vaccine for Diabetes Patients

Panel Recommends Hepatitis B Vaccine for Diabetes Patients

Oct. 25, 2011 -- Do you have diabetes? Get the hepatitis B vaccine, says the Advisory Committee on Immunization Practices (ACIP).
By a 12-2 vote, the ACIP strongly recommended the hepatitis B vaccine for diabetes patients under age 60 who have not been fully vaccinated. It also urged hepatitis vaccination of some older diabetes patients.
Up to age 60, people with diabetes have twice the risk of hepatitis B as those without diabetes. Yet only 17% of those living with diabetes (and 26% of those without diabetes) have been fully vaccinated against hepatitis B.
Diabetes patients over age 60 may also be at increased risk. There have been a number of devastating outbreaks in nursing homes where hepatitis B was accidentally spread by shared glucose monitors.

Lifetime Protection Against Hepatitis B

The ACIP balked at making a stronger recommendation for older diabetes patients. Committee members were strongly influenced by the cost of vaccinating all over-60 people with diabetes. Also a factor in their decision is data showing that the vaccine is less likely to be effective in those who are frail and elderly.
The hepatitis vaccine is most effective in young adults. If they haven't already been vaccinated, people should get the hepatitis B vaccine as soon as they learn of their diabetes diagnosis, the ACIP advises. The three- or four-dose series offers protection that usually lasts a lifetime.
The hepatitis B virus infects the liver. While some people fight off the infection, others don't. Some 1.25 million Americans have long-lasting (chronic) hepatitis B infection. In the U.S., hepatitis B kills 3,000 to 5,000 people a year.
The ACIP is made up of independent experts who advise the CDC and FDA on vaccination policy. The committee's recommendations form the basis of the U.S. immunization schedules.

Diabetes Warning Sign: Erectile Dysfunction

Diabetes Warning Sign: Erectile Dysfunction

Erectile dysfunction could be a complication of diabetes. Diabetes can cause damage to blood vessels and nerve endings in the penis causing impotence. It’s estimated between 35% and 70% of men with diabetes will have at least some degree of impotence in their lifetime.

Risk Factors You Can Control

• Being overweight, defined as a body mass index (BMI) over 25.
• Sedentary lifestyle.
• Abnormal cholesterol and blood fats, such as HDL "good" cholesterol lower than 35 mg/dL or a triglyceride level over 250 mg/dL.
• High blood pressure greater than 140 /90 in adults.
• Smoking.

Diabetes Linked to Precancerous Colon Growths

Diabetes Linked to Precancerous Colon Growths

Nov. 4, 2011 (Washington, D.C.) -- People with diabetes may be at increased risk for precancerous colon growths called adenomas, a new study suggests.
Researchers compared colonoscopy results from 278 people with diabetes with those from 278 people without the disorder. Nearly all were male, and the average age was around 65.
A total of 29% of those with diabetes had at least one adenoma, compared with 21% of those without diabetes.
People with diabetes also had more adenomas and more advanced adenomas than those who were diabetes-free.
The association between diabetes and precancerous colon growths remained after taking into account age, weight, and race -- three factors that affect diabetes risk.
Francis C. Okeke, MD, a research fellow at the Veterans Affairs Medical Center in Bronx, N.Y, presented the findings here at the annual meeting of the American College of Gastroenterology.

12 Tips to Avoid Diabetes Complications

No Cause and Effect

Other studies have linked diabetes to precancerous colon growths and colon cancer, but the results have been inconsistent.
None proves that diabetes causes or directly contributes to adenoma growth or colon cancer.
"Diabetes and adenomas are two very common conditions. But we need more data before we can say one causes the other," says March Seabrook, MD, a gastroenterologist in Columbia, S.C. He was not involved with the research.
The analysis took into account some, but not all, diabetes risk factors that could affect the results, Seabrook tells WebMD.

The Role of Insulin

Okeke tells WebMD that insulin and other hormones might explain the link between diabetes and precancerous colon growths.
People with diabetes often have high levels of the blood-sugar-regulating hormone insulin, for example. High levels of insulin may promote the growth of cells, including precancerous and cancer cells, he says.
Still, "more study is needed," Okeke says.
For now, people with diabetes should continue to follow general recommendations for colon cancer screening, Seabrook says.
The guidelines call for screening to begin at age 50 if there are no risk factors, he says. Diabetes is not currently a risk factor.
If the findings are validated and diabetes does turn out to cause precancerous colon growths or colon cancer, "we may have to screen people with diabetes at a younger age, and at shorter intervals, than people without diabetes," Seabrook tells WebMD.
A total of 25.8 million Americans have diabetes, according to the American Diabetes Association. Over 1.1 million have colorectal cancer, according to the American Cancer Society.
The new study was presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

Does Prediabetes Lead to Diabetes?

Does Prediabetes Lead to Diabetes?

Q: At my last checkup, my doctor told me I have prediabetes. Does that mean I'll ultimately develop diabetes?

A: Almost everyone who develops type 2 diabetes develops prediabetes first. But not everyone who has prediabetes -- defined as having levels of glucose (a type of sugar in the blood) that are higher than normal but not yet diabetic -- ends up with diabetes. In fact, changing your lifestyle can significantly delay or even prevent type 2 diabetes.
Those changes can include losing a moderate amount of weight (5% to 10% of your body weight -- about 8 to 16 pounds for a 160-pound woman), getting regular exercise (about 30 minutes daily), and eating healthy meals. There are lots of good eating plans for delaying or preventing diabetes -- most emphasize a variety of vegetables, fruits, fish, lean chicken, beans, low-fat dairy, egg whites, soy, and whole grains.
Quitting smoking, drinking alcohol only moderately (if you drink already), and reducing stress all help keep your blood glucose levels under control.
You should also know that prediabetes puts you at risk for other conditions, such as heart disease and stroke. In fact, prediabetes is now considered one of America's most serious health problems (one in four adults has it). Knowing how to keep it in check can prevent diabetes from developing in the future.