Diabetes Basics

 Being sick stresses your body, and stress can raise your blood glucose. Any kind of stress—physical or mental—can have that effect. So when you are sick, you have to take extra precautions to be sure your blood glucose doesn't go too high.

It's hard when you are not feeling well, but when you are sick you need to monitor more closely. The ADA recommends that you check your blood glucose and urine ketone levels every 4 hours. If your blood glucose level is high, it's a sign you need more insulin. If your urine ketones are 3+ or higher, it's a sign you need more insulin and probably some fast acting carbohydrate like regular soda, as well.

Many women with diabetes have swings in blood glucose control around the time of menstruation. There are many possible reasons for this, from changes in behavior (eating more food) to hormonal changes (high estrogen levels before the period begins can increase your insulin requirements). Young women seem to have the largest swings in blood glucose during their monthly cycle and need to adjust their insulin. Older women also have erratic swings in hormone levels and may have a challenge with maintaining blood glucose control. As you become familiar with your body's rhythm, you may find that the changes in your insulin needs become predictable from month to month. Monitor your blood glucose often and adjust your insulin as necessary during your menstrual period.

Probably because low blood glucose makes you feel tired. The classic signs and symptoms of low blood glucose include sweating, hunger, nervousness, and agitation. However, many people with diabetes do not have the usual symptoms. Some people have no symptoms at all!

Other people have unusual symptoms of low blood glucose. In some people, a change in their personality can occur, so that they become hostile and combative. Some people simply look "glassy-eyed," "spacey," or are mildly confused. It is very important to know what your low blood glucose symptoms are, so that your friends and family will know when to help you.

Ketones in the urine show that fat is being burned for fuel by your body. This typically occurs when you do not have enough insulin in your body to metabolize sugar as fuel or when you are fasting. Thus, spilling ketones into your urine means either that your body is dangerously low on insulin or that your diet is working. When ketones build up due to a lack of insulin, the condition is called "ketoacidosis," and it can be dangerous.

Ketoacidosis is more common in type 1 diabetes, occurring when people are first diagnosed with diabetes, when they stop taking insulin for some reason, or when they are ill. Most people develop symptoms that make them consult a doctor, such as stomach pain, nausea or vomiting, rapid breathing, frequent urination, extreme thirst, or fatigue.

If you are on a diet that does not provide enough calories to your body, then your body burns fat for energy. This is the effect you want from your diet, because burning fat will cause you to lose weight. A by-product of fat metabolism, however, is ketones, and these ketones spill into your urine just as they do in ketoacidosis. If you are feeling fine and controlling your blood glucose, then the ketones in your urine are probably a safe result of your diet.

There are a number of reasons for someone to feel tired and want to sleep all the time. If your blood glucose is too high, it may make you very sleepy and lack energy. You may get very sleepy after eating a meal, a feeling that might be caused by an increase in your blood glucose. Your tiredness may be a side effect from your medications. Medicines associated with making you feel tired are some ulcer medications, antihistamines, blood pressure medications, treatment for stomach emptying problems (gastroparesis), and most antidepressants.

Ask your pharmacist or physician whether any of your medications could be causing your tiredness. You may have a thyroid problem that shows up as tiredness. Finally, you may be depressed and not realize it. Many people with depression sleep excessive numbers of hours and yet never feel rested. Other symptoms of depression include loss of appetite, disinterest in activities that you once enjoyed, and frequent crying spells. Talk to your health care team about these symptoms. There are simple ways to identify depression and good treatments available.

Two factors raise your blood glucose after a low blood glucose reaction. First, the hormones that your body naturally releases into your blood to combat low blood glucose slowly raise the level of blood glucose. Second, the food you eat raises your blood glucose. Many people with diabetes eat or drink too much after a low blood glucose reading. Low blood glucose causes intense hunger. All of these factors can cause high blood glucose levels 2–4 hours or longer after eating. It's important to drink only a small amount (1/2 glass) of juice or milk, or eat glucose tablets, and then recheck your blood glucose in 30 minutes. If you eat a larger amount of food, then cover the food with extra regular insulin.

 Unfortunately, most people do gain weight as they get older. There are several reasons. As you get older, your activity level changes to less strenuous exercise. For example, in the 20- to 30-year-old age-group, many people jog, play tennis, work out at health clubs, etc. In later years, people change activities to include golf, bowling, and watching television.

As your activities change, you burn fewer calories. If you're still eating the same amount of food that you always have, weight gain will follow. In addition, recent studies have suggested that older people are actually more efficient at storing food as fat. This means that for the same amount of food eaten, more exercise is needed to use it up. You should gradually decrease the amount of food that you eat as you get older to keep your body weight normal. In general, the leaner you are, the longer you will live.

You may have a fungal infection of your fingernails. Fungal infections of the skin, such as "athlete's foot," are more common in people with diabetes. These fungal infections can occasionally involve unusual areas of the body, such as your nails, scalp, or groin. A fungal infection of your fingernails is not a serious threat to your overall health, but it may make your nails brittle and unsightly. You can also spread the infection to other areas of your body, such as your scalp, by scratching with infected nails.

You should see your health care team or a dermatologist to have your infection treated. They can take a sample from under your nails and examine it under the microscope to confirm the diagnosis. Nail infections are difficult to cure, and you will probably require treatment with an oral drug for several months. Because these drugs may damage your liver or bone marrow, you may need to have blood tests every few weeks to monitor your blood cell counts and your liver function. After all of this effort, you may be rewarded with a return of healthy fingernails.

Lispro (Humalog) is a rapid-acting insulin, so it is recommended that you take lispro 0–15 minutes before eating a meal. However, this advice may not apply if you have high blood glucose levels. You may need to inject and wait for your blood glucose to come down before eating. This will ensure lower blood glucose levels after eating.

A recent study examined the effect of varying the timing of the lispro insulin injection before breakfast in people who had blood glucose levels of 180 mg/dl. This study showed that for 5 hours after breakfast, blood glucose levels remained lower when the lispro insulin was injected 15 or 30 minutes before eating compared to an injection right at mealtime. Lispro insulin is a significant advance in insulin therapy and allows you to correct high blood glucose levels much more rapidly than if you use regular insulin. However, it is good to be aware of the need for proper timing of the lispro insulin injection if you have high blood glucose levels before mealtime.

Over time, high blood glucose levels can damage both blood vessels and nerves in your body. This can result in poor blood flow to your hands and feet in addition to your legs, arms, and vital organs. Poor blood flow to these areas increases your risk of infections, heart problems, stroke, blindness, foot or leg amputation, and kidney disease. In addition, you can either lose the feeling in your feet or have increased pain in your feet and legs. Damage to your feet can occur from mild injuries, and you may not know it. Finally, damage to blood vessels and nerves can lead to sexual problems that are difficult to treat. For all these reasons, you should make a major effort to avoid high blood glucose levels in your body.