BLOOD FAT MEDICATIONS FOR PEOPLE WITH TYPE II DIABETES
Cholesterol and triglycerides have garnered most of the health news headlines in the past few years. Westerners have been told they have to follow a low-cholesterol, low-fat diet to reduce their risks for heart disease.
As a person with diabetes, you are among that very same group of persons who should be watching fat and cholesterol. As with the risk for high blood pressure, you have some strikes against you in the blood fat area, too. You probably have been eating a high-fat diet most of your life, are overweight, and have diabetes. The first line of treatment for above-normal blood fat levels is diet and exercise. Sound familiar? Your diabetes meal plan is designed to lower your overall fat intake. And your exercise programme helps burn kilojoules and fat. In some people, both can work to bring blood fat levels into the normal range.
Other recommendations for treatment of your diabetes apply in the blood fat area too: learn to cope with stress. Stop smoking. Be moderate in your alcohol intake or abstain completely.
When diet and exercise alone are not effective for lowering blood fat levels, your doctor can prescribe drug treatment. There are drugs to reduce both cholesterol and triglycerides, and sometimes these drugs are used in combination to increase effectiveness and reduce the potential for damage, especially to the kidneys.
*30/210/5*
SEVERE HYPERGLYCEMIA: KETOACIDOSIS IN PEOPLE WITH DIABETES
How do I know that I am getting ketoacidotic?
For most people the first stage is a persistently high blood glucose level, usually associated with an infection or some other illness. You can test for ketones in the urine yourself. Buy the ketone testing sticks or get them from your doctor. If you cannot get your glucose level down within twenty-four to forty-eight hours by increasing your insulin and you have a lot of ketones in the urine, call your diabetic adviser.
If this happens when your usual doctor is away, remember that another doctor may be less familiar with your diabetes than your own so you will need to do some explaining. If you know that things have really got out of hand and you have ketones in the urine or symptoms of ketosis, insist on going to the hospital.
Starvation ketosis
Less frequently, people with diabetes develop starvation ketosis. Your blood glucose level may be low or high and you have lots of ketones because you have not been able to eat enough, for instance, during an illness when you vomited. Again, if you are not managing to eat very much and feeling ill, it is worth checking for ketones.
The risk of ketoacidosis is the reason why you must never stop your insulin.
Hospital treatment When you are in the hospital, ketoacidosis is treated by infusing plenty of saline (salty water) with potassium into a vein. Treatment also includes either continuous intravenous insulin infusion or hourly intramuscular insulin injections. Your blood acid levels, glucose and potassium will be checked frequently. The infection or other illness which caused the ketoacidosis will be treated. You may be admitted to the intensive care unit so that a close eye can be kept on you. You should feel much better within a couple of days.
Ketone testing It is useful to have a ketone testing kit in the house, but do not become obsessed with ketones. Virtually all insulin-treated diabetics show ketones occasionally. These usually settle with adjustments in diet or insulin. The time to worry is if you are showing a lot of ketones in every urine specimen.
*27/102/5*
SEVERE HYPERGLYCEMIA: KETOACIDOSIS IN PEOPLE WITH DIABETES
How do I know that I am getting ketoacidotic? For most people the first stage is a persistently high blood glucose level, usually associated with an infection or some other illness. You can test for ketones in the urine yourself. Buy the ketone testing sticks or get them from your doctor. If you cannot get your glucose level down within twenty-four to forty-eight hours by increasing your insulin and you have a lot of ketones in the urine, call your diabetic adviser.If this happens when your usual doctor is away, remember that another doctor may be less familiar with your diabetes than your own so you will need to do some explaining. If you know that things have really got out of hand and you have ketones in the urine or symptoms of ketosis, insist on going to the hospital.
Starvation ketosis Less frequently, people with diabetes develop starvation ketosis. Your blood glucose level may be low or high and you have lots of ketones because you have not been able to eat enough, for instance, during an illness when you vomited. Again, if you are not managing to eat very much and feeling ill, it is worth checking for ketones.
The risk of ketoacidosis is the reason why you must never stop your insulin.
Hospital treatment When you are in the hospital, ketoacidosis is treated by infusing plenty of saline (salty water) with potassium into a vein. Treatment also includes either continuous intravenous insulin infusion or hourly intramuscular insulin injections. Your blood acid levels, glucose and potassium will be checked frequently. The infection or other illness which caused the ketoacidosis will be treated. You may be admitted to the intensive care unit so that a close eye can be kept on you. You should feel much better within a couple of days.
Ketone testing It is useful to have a ketone testing kit in the house, but do not become obsessed with ketones. Virtually all insulin-treated diabetics show ketones occasionally. These usually settle with adjustments in diet or insulin. The time to worry is if you are showing a lot of ketones in every urine specimen.
*27/102/5*
MICRONUTRIENTS FOR DIABETICS
The vitamin and mineral needs of patients with diabetes who are healthy appear to be adequately met by the RDAs. Furthermore, a patient’s response to vitamin and mineral supplement is largely determined by nutritional state, so only patients with micronutrient deficiencies respond favourably.
People who are at greatest risk of micronutrient deficiency and who may require evaluation for vitamin/mineral supplements include those on extreme weight-reducing diets, strict vegetarians, the elderly, pregnant or lactating women, those taking medications known to alter macronutrient metabolism, patients in poor metabolic control (e.g., with glycosuria), patients with a malabsorption disorder or in a critical care environment, and patients with a congestive heart failure or myocardial infarction. There appears to be no justification for routine prescription of vitamin and mineral supplements for the majority of patients with diabetes.
Chromium deficiency is associated with elevated blood glucose, cholesterol and triglyceride levels in animal models. However, it is unlikely that most individuals with diabetes are chromium deficient. Three double-blind crossover studies of chromium supplementation in people with diabetes did not show any improvement of blood glucose control. In people with impaired glucose tolerance (IGT) who consumed a diet deficient in chromium for 4 weeks, chromium supplementation improved glucose tolerance.
Magnesium depletion has been associated with insulin sensitivity, which may improve with oral supplementation. Magnesium should be repleted only if hypomagnesaemia is demonstrated.
*7/356/5*
MICRONUTRIENTS FOR DIABETICSThe vitamin and mineral needs of patients with diabetes who are healthy appear to be adequately met by the RDAs. Furthermore, a patient’s response to vitamin and mineral supplement is largely determined by nutritional state, so only patients with micronutrient deficiencies respond favourably.People who are at greatest risk of micronutrient deficiency and who may require evaluation for vitamin/mineral supplements include those on extreme weight-reducing diets, strict vegetarians, the elderly, pregnant or lactating women, those taking medications known to alter macronutrient metabolism, patients in poor metabolic control (e.g., with glycosuria), patients with a malabsorption disorder or in a critical care environment, and patients with a congestive heart failure or myocardial infarction. There appears to be no justification for routine prescription of vitamin and mineral supplements for the majority of patients with diabetes.Chromium deficiency is associated with elevated blood glucose, cholesterol and triglyceride levels in animal models. However, it is unlikely that most individuals with diabetes are chromium deficient. Three double-blind crossover studies of chromium supplementation in people with diabetes did not show any improvement of blood glucose control. In people with impaired glucose tolerance (IGT) who consumed a diet deficient in chromium for 4 weeks, chromium supplementation improved glucose tolerance.Magnesium depletion has been associated with insulin sensitivity, which may improve with oral supplementation. Magnesium should be repleted only if hypomagnesaemia is demonstrated.*7/356/5*