Welcome to Advance Diabetes Care Centre

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Health Implications


The Long-term Picture

Diabetes is linked to the development of a number of serious complications. The risk of developing complications exists whether you have type 1 or type 2 diabetes. Heart disease, for example, strikes many people with diabetes - particularly when they do not manage their diabetes well. Fortunately, by managing your diabetes, you can lessen your risk of heart disease and all the other complications.


Achieving good blood sugar levels play a large part in preventing complications, but it's suspected that genetics may also have a say. However, good control will reduce your chances of developing complications - and this means that, to a large extent, you are in control of your future.


If you already have developed a diabetes-related complication, rest assured that with early diagnosis and modern treatment results will be very good.


What Is A Heart Attack?



A heart attack (also known as a Myocardial Infarction or MI ) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen, causing injury to the heart muscle. Injury to the heart muscle causes chest pain and pressure. If blood flow is not restored within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to die for six to eight hours at which time the heart attack usually is "complete." The dead heart muscle is replaced by scar tissue in six to eight week.


What Is A Stroke ?



The same theory applies to the Brain attack or strocke. End Result of that will obviously be paralysis in different grades.Brain Death whether of small areas or of large areas, occurs much faster within few minutes, as compared to the Heart Muscle Death.


Your Genetics with your life style & lipid levels may act as fuel. Diabetes & High Blood Pressure act as fire on the fuel.


Your Arteries…


Diabetes can cause blood vessel problems such as atherosclerosis (the build-up of plaque deposits in the blood vessels). This build-up can be particularly serious when it affects the coronary arteries, which supply your heart with blood.Some blocks can occur in your leg arteries and your Brain Arteries. All these are known as macrovascular disease.


We don't know yet why people with diabetes are more likely to develop cardiovascular disease. But, research has found that high blood sugar levels do cause damage to the arteries.


-> Taking Care of Your Arteries
-> Maintain good blood sugar levels.
-> Don't smoke.
-> Eat a well-balanced, low-fat diet. Consult a dietitian.
-> Keep a healthy weight.
-> Exercise regularly.
-> Check your blood pressure regularly.


Also, have your doctor regularly check your cholesterol and blood fat (triglyceride) levels.


Heart Disease and Stroke


People with diabetes are at very high risk of heart disease, also known as cardiovascular disease (CVD) and stroke (cerebrovascular disease). In fact, up to 80% of people with diabetes will die as a result of a heart attack or stroke. In addition, people with diabetes may develop these types of problems at a younger age and die from these events at rates much higher than people without diabetes (3 times higher for men and 5 times higher for women).


Reducing risk



The good news is that people with diabetes can lower their risk of heart disease and stroke considerably by paying careful attention to all of their risk factors. Working with your healthcare team to achieve the following targets is the key to good diabetes management. Achieving and maintaining a healthy weight through regular physical activity and healthy eating are important, but most people with diabetes will also require a number of medications to reach these goals.


Blood glucose target:

A1C of at least under 6.5 % (A1C is a blood test that is an index of your average blood glucose level over the preceding 120 days)
Blood pressure target:
130/80 mm Hg or lower
LDL (“bad”) cholesterol target:
less than 70 -100 mg% or lower

Controlling high blood glucose: Most patients with type 2 diabetes will require at least 1 or 2 medications (pills and or/insulin) to achieve recommended blood glucose targets. Diabetes is a progressive disease, so frequently increased doses and additional medications will likely be needed over time.

Controlling high blood pressure: In addition to the general healthy lifestyle advice above, it may also help to limit intake of salt and alcohol. Many patients will be prescribed a drug called an ACE inhibitor, which not only lowers blood pressure, but also offers protection against CVD. Again, frequently 2 or 3 blood pressure-lowering drugs are required.

Lowering high cholesterol: Most people with diabetes will be prescribed a drug called a statin to lower LDL (“bad”) cholesterol. Other drugs may sometimes also be used to increase HDL (“good”) cholesterol and to lower other blood fats such as triglycerides.

Daily aspirin therapy is also often recommended for people with diabetes. Aspirin helps prevent blood clots from forming. Aspirin is available without a prescription, but is not safe for everyone. Talk to your doctor about whether aspirin is safe for you and the dose you should take. For people who can’t take aspirin or who find it upsets their stomach, or in other specific situations, a prescription blood thinner called clopidrogel will sometimes be used.

Quit smoking. Smoking is a deadly habit. One of the best things you can do for your heart, diabetes and overall health is to quit now. Anyone who has tried to quit knows that it can be very challenging, so ask for help. You will increase your chances of success if you have support from your healthcare team and family. If at first you don’t succeed, try and try again.

Blood glucose target:

At every diabetes-related visit, your doctor should take your blood pressure. You should have your A1C measured every 3 months to monitor your blood glucose control.
Your blood lipid (fat) levels should be measured at least every 1 to 3 years (and possibly more often if you are on medications).

Ask your doctor for all of your test results and work closely with him or her to achieve the targets shown above.Don’t be afraid to ask questions about your medications or your lifestyle changes. The more you know about your disease and its treatments, the more you can participate in your own care.

Diabetes and the Eye

Diabetes is a disease that prevents your body from making or using insulin to break down sugar in your bloodstream.

How Does Diabetes Affect The Eye?

Diabetes and its complications can affect many parts of the eye. Diabetes can cause changes in nearsightedness, farsightedness and premature presbyopia (the inability to focus on close objects). It can result in cataracts, glaucoma, a lack of eye muscle coordination (strabismus) and decreased corneal sensitivity.

Visual symptoms of diabetes include fluctuating or blurring of vision, occasional double vision, loss of visual field and flashes and floaters within the eyes. Sometimes these early signs of diabetes are detected in a thorough optometric examination. The most serious eye problem associated with diabetes is diabetic retinopathy.

What Is Retinopathy?

Diabetic retinopathy occurs when there is a weakening or swelling of the tiny blood vessels in the retina of your eye, resulting in blood leakage, the growth of new blood vessels and other changes. If diabetic retinopathy is left untreated, blindness can result. Several factors that increase the risk of developing retinopathy include smoking, high blood pressure, drinking alcohol and pregnancy.

Can Vision Loss From Diabetes Be Prevented?

Yes, in a routine eye examination, your optometrist can diagnose potential vision threatening changes in your eye that may be treated to prevent blindness. However, once damage has occurred, the effects are usually permanent. It is important to control your diabetes as much as possible to minimize your risk of developing retinopathy.

How Is Diabetic Retinopathy Treated?

n the early stages diabetic retinopathy can be treated with laser therapy. A bright beam of light is focused on the retina, causing a burn which seals off leaking blood vessels. In other cases, surgery inside the eye may be necessary. Early detection of diabetic retinopathy is crucial.

How Can Diabetes Related Eye Problems Be Prevented?

Monitor and maintain control of your diabetes. See your physician regularly and follow instructions about diet, exercise and medication. See your optometrist, for a thorough eye examination when you are first diagnosed as a diabetic, at least annually thereafter, and more frequently if recommended.

There May Be No Warning

Some people receive no warning signs of diabetic eye disease, but sometimes the following symptoms develop:

-> Blurry vision
-> Double vision
-> Rings, flashing lights, or blank spots
-> Dark spots or floaters
-> Pain or pressure in the eyes
-> Trouble seeing out of the corners of your eyes 

Also, have your doctor regularly check your cholesterol and blood fat (triglyceride) levels.

People with Diabetes May Develop Glaucoma

People with diabetes are at very high risk of People with diabetes are 40% more likely to suffer from glaucoma(increased pressures within the eyeball - can actually destroy the vision) than people without diabetes. The longer someone has had diabetes, the more common glaucoma is. Risk also increases with age.

People with Diabetes May Develop Cataracts

If you have diabetes, your chances of developing cataracts is increased. People with diabetes tend to get cataracts at a younger age and have them progress faster.

Diabetic Retinopathy Damages the Retina

When blood sugar levels become too high, blood vessels in the retina weaken. The blood and fluid inside the blood vessels begins to leak out. New blood vessels grow, but they are fragile and may leak fluid. This causes the retina to swell and become deprived of nutrients and oxygen, causing vision loss and possibly blindness. Please see the images on this page.


Laser Surgery Slows the Progression of Diabetic Eye Disease

Laser surgery can be used to shrink the abnormal blood vessels or seal leaking blood vessels in the retina. The risk of vision loss from diabetic retinopathy is greatly reduced in some people after having laser surgery.

What is diabetic nephropathy?

Nephropathy is the deterioration of the kidneys. The final stage of nephropathy is called end-stage renal disease, or ESRD.

Diabetes is the most common cause of ESRD, accounting for more than 44 percent of cases. About 20 million people in the US have diabetes, and more than 44,000 people have ESRD as a result of diabetes. Both type 1 and type 2 diabetes can lead to diabetic nephropathy, although type 1 is more likely to lead to ESRD.

There are five stages of diabetic nephropathy, or deterioration of the kidneys. The fifth stage is ESRD. Progress from one stage to the next can take many years, with 23 years being the average length of time to reach stage five.

What causes diabetic nephropathy?

Hypertension, or high blood pressure, is a complication of diabetes that is believed to contribute most directly to diabetic nephropathy. Hypertension is believed to be both the cause of diabetic nephropathy, as well as the result of damage that is created by the disease. As kidney disease progresses, physical changes in the kidneys often lead to increased blood pressure.

Uncontrolled hypertension can make the progress toward stage five diabetic nephropathy occur more rapidly.

Can diabetic nephropathy be prevented?

The onset and progression of diabetic nephropathy can be slowed by intensive management of diabetes and its symptoms, including taking medications to lower blood pressure.

Treatment for diabetic nephropathy:

Specific treatment for diabetic nephropathy will be determined by your physician based on:

your age, overall health, and medical history extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference
Treatment may include any, or a combination of, the following:
proper diet

strict monitoring and controlling of blood glucose levels, often with medication and insulin injections medication (to lower blood pressure)
Treatment for ESRD often initially includes dialysis to cleanse the blood, and, eventually, kidney transplantation.


Diabetes and Men's Sexual Health


The lay media portrays sex as endlessly exciting, gratifying and straightforward affair. However, for many people and couples the reality is quite different. Sexual problems are very common, but because sex often involves complex emotions, patients (and doctors) can find these problems difficult to raise and discuss. The focus of this article is erectile dysfunction (ED), a common sexual problem in men with diabetes.


Definition of ED

ED is defined as the persistent inability to get or maintain an erection that is satisfactory for sexual activity. Most men will experience erectile problems during their life, but if the problem lasts for 3 months or longer, it is clinically defined as ED.


Although ED affects most men at some point in their lives, it is much more common in men with diabetes. In fact, in up to 12% of men with diabetes, ED is the first sign that leads to the diagnosis of diabetes. Fifty percent of men will experience ED within 8 - 10 years of diagnosis of diabetes. Older men with a longer duration of diabetes, poor blood glucose control, and who smoke, have high blood pressure, high cholesterol and heart disease, are at highest risk.


Diabetes causes damage to the walls of the blood vessels, which affects circulation and blood flow to the penis. In addition, nerve damage can affect erection quality. ED can also be a side effect of drugs that are often prescribed to men with diabetes (these include some blood pressure-lowering drugs and anti-depressants).


Diagnosing ED

— the first step is getting help The first step is telling your doctor that you are having sexual problems. He or she will ask you specific questions about the quality of your erections and sexual intercourse. Your doctor may also do a physical exam, check your blood pressure, your heart function and order other tests for your eyes, kidneys, blood glucose control and cholesterol.


The Clinical Practice Guidelines recommend that all men with diabetes should be screened for ED at the time of diagnosis of diabetes, and periodically thereafter. If your doctor doesn’t bring up the topic, you should.


Treating ED

There are a number of effective treatments for ED. It is important for sexual partners to be involved in any discussion about treatment choices.


Drugs called PDE5 inhibitors (available in India under the trade names Viagra, Cialis and Megalis etc.) help a man achieve and maintain an erection. With sexual stimulation, these drugs increase blood flow to the penis, allowing an erection to occur naturally. Please note, without sexual stimulation erections will not come.


They can be used safely in most men with diabetes, including select elderly men. However, they are not safe for men with certain heart conditions or men who take nitrates (which are often used to treat angina).


For men who can’t take PDE5 inhibitors or find that they don’t work, other options include other drugs, injections, hormone replacements, mechanical devices such as vacuum constriction devices, implants and surgery.
It also makes sense (for many health reasons other than ED) to keep your blood glucose, blood pressure and cholesterol in the target range, to quit smoking and start exercising. These will all lead to better overall health and, in turn, better sexual health. ED is a real medical problem that needs to be treated by a real medical team. Do not attempt to self-diagnose or self-treat based on what you read on the internet. If you have questions about ED or any aspect of healthy sexual functioning, talk to your doctor or a member of your diabetes healthcare team.


Caution : Ask your Diabetologist before taking any drugs for ED.


Skin problems


People with diabetes are more prone to skin problems than people who do not have diabetes. This is largely due to fluctuations in blood glucose levels. When blood glucose levels are high, the body loses fluid and the resulting dehydration can lead to dry skin on the legs, feet and elbows.
Dry skin can crack, letting germs that can cause infections into the body. H igh blood glucose levels also lower resistance to infections and slow healing, which, in turn, can increase the risk of skin infections or boils. These may take a long time to heal.
Because people with diabetes often have reduced nerve sensitivity and circulation in their hands and feet, it can sometimes be difficult to identify skin problems. What's more, the nerve damage associated with diabetes can cause a decrease in sweating, which helps to keep skin soft and moist. Decreased sweating in the feet and legs can cause dry skin.
As many as one-third of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, such problems are sometimes the first sign that a person has diabetes. Rough, dry and scaly skin affects at least 75 percent of people over the age of 64 who have diabetes.


Skin disorders associated with diabetes


"All Diabetics are prone to different skin infections " Some non-infectious conditions are as under.


Necrobiosis lipoidica diabeticorum is caused by changes in skin cells, which are associated with blood flow through the body's tiny blood vessels called capillaries. It first appears as a dull, raised area of fairly large spots or sores; after a while, it develops a shiny surface, similar to a scar. It may be yellow-brown to purple, with a pronounced violet or purple border.


The skin may get thin and crack, but usually heals, often leaving a brownish depressed scar. It is associated more with type 1 diabetes than type 2. Also called shin spots, diabetic dermopathy involves the appearance of small, round lesions that are raised at the edges, which may also crack. Dermopathy, caused by changes in the small blood vessels, often looks like light brown, scaly patches and may be oval or circular. Some people mistake them for age spots. The patches do not hurt, open up or itch.


Bullosis diabeticorum are small to large nodules blisters that develop underneath the skin and may rupture. While they are sometimes quite large, they are usually painless. There is no treatment and the blisters heal on their own, usually within three to four weeks and tend to leave no scars. The best way to prevent and treat these blisters is to maintain good blood glucose control.



Most often associated with being overweight, Acanthosis nigricans causes velvety, light brown to black markings, usually on the neck, under the arms or in the groin. In most cases, elevated levels of insulin cause acanthosis nigricans by activating insulin receptors in the skin and forcing the skin to grow abnormally. Reducing the circulating insulin through a special diet can lead to a rapid improvement.


Tips for keeping skin moist :- ->Keep blood glucose levels under good control (4 – 7 mmol/L before eating; 5 – 10 mmol/L two hours after eating).
-> Drink plenty of fluids.
->Bathe or shower in warm (not hot) water, as hot water can dry out skin.
->Avoid taking long baths and washing excessively, as this can also cause loss of oil in the outer layers of the skin, causing further dryness.
->Dry skin well after bathing or showering and then check for any areas that may be slightly red or particularly dry, as they may need special attention. (If this is the case, ask your doctor for a referral to a dermatologist for special treatment.)
->If possible, take fewer showers/baths in the winter to preserve your skin's moisture, as skin is drier during this time than in other months.
->Keep skin moist by using a lotion or cream after bathing. 
->Wear cotton underwear, as it allows air to circulate better than synthetic materials ->Use a humidifier to prevent your house becoming too dry in winter because of radiators or forced air heating.
->Luckily, most skin conditions can be prevented or easily treated if caught early.
->Talk to a member of your health care team, if you are concerned about your skin.

Peripheral arterial disease (PAD)


Peripheral Arterial Disease (PAD) is a common circulatory problem in which narrowed arteries reduce the blood flow to your limbs.

When you develop peripheral arterial disease, your extremities — usually your legs — don't get enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking — a condition called intermittent claudication.

Of perhaps greater concern is that peripheral arterial disease is likely to be a sign of / part of widespread accumulation of fatty deposits in your arteries (atherosclerosis) else where in other arteries as well. This condition may be reducing blood flow to your heart and brain as well.

You can often successfully treat peripheral arterial disease, at least initially with exercise, with a healthy diet and, most important, by quitting smoking if you smoke. Early diagnosis and treatment are important to stop the progression of peripheral arterial disease and give you a leg up on reducing your risk of heart disease and stroke.

Signs and symptoms

About half of people with peripheral arterial disease have mild or no symptoms. About one-third to one-half develop more severe symptoms, including intermittent claudication.

Intermittent claudication is characterized by muscle pain or cramping in your legs or arms that is triggered by a certain amount of activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is most common.

Other signs and symptoms of peripheral arterial disease include:

Leg numbness or weakness - Neuropathy can add to the problem Cold legs or feet
Sores on your toes, feet or legs that won't heal
A change in the color of your legs - initially may become red when hanging down
Hair loss on your feet and legs
Changes in your nails - brittle, distorted
If peripheral arterial disease progresses, pain may even occur when you're at rest or when you're lying down. This is called ischemic rest pain. It may be intense enough to prevent sleep or wake you from sleep. You may be able to temporarily relieve the pain by hanging your legs over the edge of your bed or by walking around your room.

Screening and diagnosis Your doctor may find signs of PAD during a physical examination. These include:
A weak or absent pulse below a narrowed area of your artery
Whooshing sounds (bruits) over your arteries that can be heard with a stethoscope
Evidence of poor wound healing in the area where your blood flow is restricted
Decreased blood pressure in your affected limb
Your doctor may also rely on one or more of the following tests to diagnose PAD:

Ankle-brachial index (ABI). This diagnostic test compares the blood pressure in your ankle with the blood pressure in your arm. To get a blood pressure reading, your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.

Angiography. This form of imaging allows your doctor to view blood flow through your arteries as it happens. By injecting a contrast material (dye) into your blood vessels, your doctor is able to trace the flow of the contrast material using imaging machines. Angiography can be done using X-ray imaging or procedures called magnetic resonance angiography (MRA) or computed tomography angiography (CTA).

Additional tests Beyond the diagnosis of peripheral arterial disease, your doctor will be concerned with identifying your risk for heart attack and stroke. You may undergo a variety of tests aimed at assessing your risk for these problems.
These tests may include:

Electrocardiogram (ECG). An electrocardiogram is a diagnostic test in which electrode patches are attached to your skin to measure electrical impulses in your heart. Your doctor may monitor an ECG during and after the treadmill test. Blood tests. Doctors can check your blood to measure cholesterol and check the level of C-reactive protein, which is a marker for heart disease. Ultrasound. This test is done to make sure you do not have an aneurysm of the aorta or blood vessels.

All the about tests are done at PG Medical Center.

Register yourself for yearly / half-yearly diabetes care Packages at our center.

We offer you specialized diabetes footwear as per your needs.

Information about Diabetes and Neuropathy

Although all diabetics are at risk from neuropathy, the chances of developing this complication increase

•Duration of Diabetes:the longer you have diabetes. Those who have suffered from diabetes for more than 25 years are most at risk from neuropathy and your doctor will provide you with further information about diabetes neuropathy at this stage.
-Long stature/Height
-Patients With Hypertension/dyslipidemia
-Males are more prone

The most effective way to prevent diabetes neuropathy is to maintain a healthy blood sugar level.  This means paying attention to your diet, taking regular exercise and ensuring you are taking your prescribed medicine properly.

What can I do to diabetic foot problems? 
Every person with diabetes - with or without any of these risk factors - should take proper care of their feet. Routine foot inspection and preventive care can minimize or prevent foot problems. Below are things to make sure you ask your doctor about:

  • You should have a thorough foot examination by a professional at least once a year. This includes checking the sense of feeling and the pulses in your feet. (See box.)
  • Ask for a risk evaluation. Specific follow-up and treatment will be based on what risk category your feet are in. Ask for special instructions for people with high-risk feet, if applicable.
  • If you have lost some sensation in your feet, they should be visually inspected at every visit. Take off your shoes and socks at every visit and make sure this happens.
  • Ask your provider to check your footwear to make sure that the style and fit are appropriate for the condition of your feet. Ask if special shoes would help your feet stay healthy.

Components of a good foot exam:

At least once a year, everyone with diabetes should have a thorough foot examination. It should include an assessment of:

  • Protective sensation - using a monofilament or vibratory sensation test
  • Foot structure
  • Biomechanics - including any limits in joint mobility or problems with gait and balance
  • Vascular status - including questions about painful walking and determination of pulses in your feet
  • Skin integrity - especially between your toes and on the ball of your foot
  • Increased pressure on the soles of your feet; areas of warmth, redness, or callus formation may be indicative of tissue damage

Many diabetes treatment programs operate regular foot clinics to help patients with routine foot care and to make sure that preventive measures are taken. Some pharmacists specializing in diabetes care offer similar programs. Be sure to take advantage of any foot care programs that are available to you.

Preventive foot care - for all 
Of course, the best way to prevent foot problems is to keep your blood glucose under control. But there are also specific things you should do EVERY DAY to make sure your feet stay fit. Here are some of them:

  1. Examine your feet EVERY DAY to look for cuts, sores, blisters, redness, etc. If you have anything of that nature, and it doesn't heal in a day or two, notify your doctor. If you have trouble seeing or reaching your feet, ask someone to help, or use a mirror to help you see better.

  2. Wash your feet EVERY DAY with lukewarm water and mild soap. Dry them carefully and thoroughly with a soft towel. Dust your feet with talcum powder, which will help keep them dry.

  3. Don't soak your feet - this will make your skin too dry.

  4. If you have dry skin on your feet, use a moisturizing lotion to prevent cracking - but NEVER use a lotion or cream between your toes, as this can lead to infection.

  5. If you have corns or calluses, DO NOT cut them, don't use corn plasters or liquid corn and callus removers - they can damage your skin. Check with your doctor or foot care specialist who may advise you to use a pumice stone to smooth calluses or corns.

  6. Keep your toenails trimmed. Trim them with toenail clippers after you have washed and dried your feet. Trim the nails following the shape of your toes, and smooth them with an emery board or nail file. Don’t cut into the corners of the nail, which could trigger an ingrown toenail. If your nails are very thick or yellowed, have a foot care specialist trim them.

  7. Don't go barefoot - not even indoors. Always wear socks, stockings, or nylons with your shoes to help avoid blisters and sores. Choose soft socks made of cotton, wool, or a cotton-polyester blend, which will help keep your feet dry. Avoid mended socks or those with seams, which can rub to cause blisters.

  8. Avoid wearing socks or hose that are too tight around your legs. Knee-high or thigh-high stockings as well as elasticized men's dress socks can constrict circulation to your legs and feet.

Choose the proper footwear - for all
Choosing the right footwear is an important part of foot care, since poorly fitted shoes are involved in as many as half of serious foot problems. Here are some tips for choosing the best footwear:

  1. Wear well-cushioned walking shoes or athletic shoes. If you have foot deformities such as hammertoes or bunions, you may need extra-wide shoes or depth shoes. Depth shoes have more room in them to allow for different shaped feet and toes or for special inserts made to fit your feet. If problems are severe, custom-molded shoes are available. Medicare provides coverage for some special shoes; your doctor or foot care specialist can help determine if you qualify.

  2. Don't wear shoes with high heels or pointed toes. They can create pressure, which might contribute to bone and joint disorders as well as diabetic ulcers.

  3. Don't wear open-toed shoes or sandals with a strap between the first two toes. They increase the chance that you'll injure a toe.

  4. When you buy new shoes, be sure your feet are properly measured and fitted. Your feet can change size and shape, so an experienced shoe fitter should measure them whenever you get new shoes. Shoes should fit both the length and width of your foot, with room for your toes to wiggle freely.

  5. Your new shoes should be sturdy and comfortable. They should have leather or canvas uppers, which breathe to keep your feet from getting sweaty. Avoid vinyl or plastic shoes, because they don't stretch or breathe.

  6. When you get new shoes, break them in gradually so you won't get blisters.

Shake your shoes before you put them on. Even a small pebble in your shoe can lead to problems.
Special care for high-risk conditions
If you do have any of the high-risk conditions, there are specific things you should do to keep your feet healthy.

  • If you have neuropathy or evidence of increased pressure on the soles of your feet, wear well-cushioned walking shoes or athletic shoes.
  • If you have lost some sensation in your feet, be sure to carefully inspect them often to identify any problems early.
  • If you have calluses, have a foot care specialist treat them.
  • If you have bony deformities such as hammertoesor bunions, you may need extra-wide shoes or depth shoes. In extreme cases, custom-molded footwear may be needed.
  • Promptly treat minor skin conditions such as dry skin or athlete's foot to keep them from progressing.
  • Have a complete foot examination every 3 to 6 months.

A formal, comprehensive program has been developed at the Gillis W. Long Hansen's Disease Center in Carville, LA, known as the "LEAP program" for Lower Extremity Amputation Prevention. It consists of 5 relatively simple activities:

  • Annual foot screening to identify people who have lost protective sensation
  • Patient education in self-management, with emphasis on proper foot care
  • Daily self-inspection of the foot
  • Appropriate footwear selection
  • Management of simple foot problems such as dry skin, nail and callus care, and basic wound management

In a number of large clinical centers where formal preventive care programs such as this have been implemented, the rate of amputations has been reduced by as much as 85%.



Diabetes & Thyroid disease

People with diabetes experience thyroid disorders more frequently than the general population. Both diabetes and thyroid disease involve the endocrine system, a group of glands that helps to regulate the body's metabolism. The thyroid is a butterfly-shaped gland in the lower neck just beneath the skin in front of the windpipe and weighs about 15 to 20 grams.

It helps to regulate the body's metabolism, a broad term referring to all of the chemical reactions carried out in the body's cells, including digestion. If the gland releases too much thyroid hormone, metabolism speeds up (hyperthyroidism). If it releases too little, metabolism slows down (hypothyroidism).

Almost one-third of people with type 1 diabetes have thyroid disease. This is because type 1 diabetes is one type of autoimmune disease, in which the immune system attacks a gland or organ of the body. Patients with one kind of autoimmune disease are at risk of developing another type.

Thyroid disorders are more common in females, and up to 30% of women with type 1 diabetes have thyroid disease. What's more, the rate of inflammation of the thyroid gland in women with diabetes who have given birth is three times higher than women who do not have diabetes. There also appears to be a higher than normal occurrence of thyroid disorders in people with type 2 diabetes, with hypothyroidism being the most common.

Thyroid disorders can have a significant effect on blood glucose levels and, left untreated, can affect diabetes control. An overactive thyroid may increase insulin requirements, while an underactive thyroid can decrease insulin requirements.

Symptoms of hypothyroidism are common in people with type 2 diabetes and can be misidentified because people with this condition may experience fatigue, weight gain, feeling cold, dry skin and hair, heavy menstrual cycles, constipation and slowed thinking.

There are three treatment options for people with hyperthyroidism:
->anti-thyroid drugs, which slow down the thyroid's hormone production; ->radioactive iodine therapy, which destroys thyroid cells in order to reduce the amount of thyroid hormone produced; or
->surgical removal of the thyroid gland. Hypothyroidism is usually treated with a synthetic thyroid hormone called levothyroxine sodium (taken in pill form once a day). Treatment continues for the rest of one's life. Because hypothyroidism can decrease insulin requirements, insulin regimens may need to be adjusted.

Because of the link between diabetes and thyroid disease, people with diabetes should be tested for thyroid disorders every three to five years. The thyroid stimulating hormone (TSH) test, which measures the amount of TSH produced naturally by the body, is the best test of thyroid function.

A TSH level that is lower than normal may indicate an overactive thyroid, while an elevated TSH level may indicate an underactive thyroid. If you experience symptoms, it is important to consult your doctor, as these may be signs or symptoms of thyroid disease.

Digestive Problems

Digestive problems are relatively common among people with diabetes. The most common is constipation, affecting nearly 60% of people with diabetes. Diarrhea and other gastrointestinal symptoms may also occur. For instance, diabetes is also one of the most common causes of gastroparesis (delayed emptying of the stomach).

Gastroparesis occurs when nerves to the stomach become damaged or stop working. The vagus nerve controls the movement of food through the digestive tract, and when damaged, the muscles of the stomach and intestines no longer work normally, and the movement of food slows or stops.

High blood glucose levels associated with diabetes can damage the blood vessels that carry oxygen and nutrients to the nerves. Over time, this process damages the vagus nerve and disrupts its normal functioning. The erratic stomach emptying and poor absorption associated with gastroparesis make blood sugar levels harder to control.

Gastroparesis affects up to 75% of people with diabetes, causing bloating, loss of appetite and, in some cases, vomiting and dehydration. Symptoms include heartburn, nausea, vomiting of undigested food, an early feeling of fullness when eating, weight loss, abdominal bloating, erratic blood glucose levels, lack of appetite, reflux and spasms of the stomach wall. Symptoms may be mild or severe, depending on the individual, but gastroparesis tends to be a chronic condition.

The main treatment for gastroparesis in people with diabetes is to regain control of blood glucose levels. This may include prescribing insulin or oral medications, changing your meal plan and, in severe cases, feeding tubes and intravenous feeding. People with diabetes who are already on insulin may need to take insulin more often, take it after a meal instead of before and check blood glucose levels more frequently after eating and administer insulin whenever necessary.

Changes in eating habits may help control symptoms. For example, it may be easier to eat six small meals a day so that the stomach does not become overly full. Consuming several liquid meal replacements a day may help stabilize blood glucose levels. These provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

Avoidance of fatty and high-fibre foods may aid digestion, as fat naturally slows digestion and fibre is difficult to digest. Some high-fibre foods, such as oranges and broccoli, contain material that cannot be digested easily and remain in the stomach too long, possibly causing blockages.

In very severe cases, surgical intervention may be needed to treat gastroparesis. Different drugs or combinations of drugs may be used to treat gastroparesis. These include metoclopramide, which stimulates stomach muscle contractions to help empty food and reduces nausea and vomiting, and erythromycin, an antibiotic that also improves stomach emptying.

If you experience any digestive problem for more than a few weeks, it is important to speak to your physician or diabetes educator, who can help to determine the steps you can take to control the problem.

Remember functional gastroparesis improves with diabetes correction.

Diabetes And Depression

Depression is twice as common in people with diabetes as in the general population, and major depression is present in at least 15% of people with diabetes. Depression is also associated with poorer blood glucose management, health complications and decreased quality of life, so people with diabetes should be screened regularly for this disorder.

The association between depression and diabetes is unclear. Depression may develop because of stress but also may result from the metabolic effects of diabetes on the brain. Studies suggest that people with diabetes who have a history of depression are more likely to develop diabetic complications than those without depression.

Despite the enormous advances in brain research in the past 20 years, depression often goes undiagnosed and untreated. It often takes a mental health professional to recognize these symptoms, inquire about their duration and severity, diagnose the disorder and suggest appropriate treatment.

Research shows that depression leads to poorer physical and mental functioning, so a person is less likely to follow a required meal or medication plan. Treating depression with psychotherapy (“talk” therapy), medication or a combination of these treatments can improve a patient's well-being and ability to manage diabetes.

In people who have diabetes and depression, scientists report that psychotherapy and antidepressant medications have positive effects on both mood and blood glucose management.

Prescription antidepressant medications are generally well tolerated and safe for people with diabetes. Specific types of psychotherapy can also relieve depression. However, recovery from depression takes time. Antidepressant medications can take several weeks to work and may need to be combined with ongoing psychotherapy. Not everyone responds to treatment in the same way. Prescriptions and dosing may need to be adjusted.

Therefore, treatment for depression in the context of diabetes should be managed by a mental health professional, such as a psychiatrist, psychologist or clinical social worker who is in close communication with the physician providing diabetes care. This is especially important when antidepressant medication is needed or prescribed, so that potentially harmful drug interactions can be avoided.

People with diabetes who develop depression, as well as people in treatment for depression who subsequently develop diabetes, should make sure to tell any physician they visit about the full range of medications they are taking.

It is important to remember that depression is a disorder of the brain that can be treated in addition to whatever other illnesses a person might have, including diabetes. If you think you may be depressed or know someone who is, don't lose hope. Seek help for depression.