Tuesday

Very Interesting topic reported by the BBC. Interestingly I had read reports that indicated that a lower blood glucose level was target to achieve. I think that this adds a bit od 'sense' - the right blood sugar level is what we should aim for. I aim for around 7, but achieve around 7.5


Diabetes sugar 'can go too low'

Diabetes disrupts blood sugar levels
Intense treatment to lower blood sugar in patients with diabetes could prove nearly as harmful as allowing glucose levels to remain high, a study says.
Cardiff researchers looked at nearly 50,000 patients with type 2 diabetes and found the lowest glucose levels linked to a heightened risk of death.
Significant differences in death rates between patients on insulin and those taking tablets are also flagged up.
But there could be various explanations for this, experts noted.
Patients taking insulin-based treatments have been urged not to stop taking their medication as a result of the Cardiff University study, which is published in The Lancet.
Changing treatments
Using data from GPs, the team identified 27,965 patients with type 2 diabetes whose treatment had been intensified to include two oral blood glucose lowering agents - metformin and sulphonylurea.
It is crucial to remember that blood glucose targets should always be agreed by the person with diabetes and their healthcare team according to individual needs and not according to a blanket set of rules
Dr Iain FrameDiabetes UK
A further 20,005 patients who had been moved on to treatment which included insulin were added to the study.
Patients whose HbA1c levels - the proportion of red blood cells with glucose attached to them - were around 7.5%, ran the lowest risk of dying from any cause.
For both groups this risk went up by more than half if levels dropped to 6.4%, the lowest levels recorded. For those with the highest levels the risk of death increased by nearly 80%.
But the risks appeared to be particularly pronounced among those on the insulin-based regimen than those on the combined treatment.
Irrespective of whether their HbA1c levels were low or high, there were 2,834 deaths in the insulin-taking group between 1986 and 2008, nearly 50% more than in the combined group.
'Don't stop'
The authors acknowledged there could be various factors associated with this, such as these being older patients with more health problems, who perhaps had had diabetes for a longer period of time. They also make reference to a possible link between use of insulin and cancer progression that had been reported in a different study.
"Whether intensification of glucose control with insulin therapy alone further heightens risk of death in patients with diabetes needs further investigation and assessment of the overall risk balance," wrote lead author Dr Craig Currie.
"Low and high mean HbA1c values were associated with increased all-cause mortality and cardiac events. If confirmed, diabetes guidelines might need revision to include a minimum HbA1c value."
Dr Iain Frame, head of research at Diabetes UK, described the study as "potentially important" but stressed it had limitations.
"It is not clear what the causes of death were from the results reported. Furthermore, when it comes to the suggestion made in this research that insulin could increase the risk of death, we must consider important factors such as age, the duration of their diabetes and how the participants managed their condition.
"It is crucial to remember that blood glucose targets should always be agreed by the person with diabetes and their healthcare team according to individual needs and not according to a blanket set of rules."
While people would be able to manage their condition for a period with diet, exercise and even tablets, many would eventually have to move on to insulin, he noted.
"We would advise people with type 2 diabetes who use insulin not to stop taking their medication. However, if they are worried about blood glucose targets, they should discuss this with their healthcare team."

Thursday

Obvious to some, but perhaps not to all. Here is some very good advice from Yahoo Health on handling illness when you already have diabetes

What happens when you are sick
When you are sick, your body reacts by releasing hormones to fight infection. But these hormones raise blood sugar levels and at the same time make it more difficult for insulin to lower blood sugar. When you have diabetes, even a minor illness can lead to dangerously high blood sugar. This may cause life-threatening complications, such as diabetic ketoacidosis or a hyperosmolar state.
Plan ahead
Work with your doctor to make a sick-day plan for you or your child with diabetes. Discuss your target blood sugar goal during an illness, how you should adjust your insulin dose and timing (if you take insulin), and when you need to contact your doctor for help. Also, make sure you know how often to check blood sugar and urine ketone levels. Keep your plan in a convenient place, and include contact information in case you need to reach your doctor at night or on the weekends.
Steps to take during an illness
Here are some general sick-day guidelines:
Continue taking your pills for diabetes (if you have type 2 diabetes) or insulin, even if you are vomiting and having trouble eating or drinking. Your blood sugar may continue to rise because of your illness. If you cannot take your medicines, call your doctor and discuss whether you need to adjust your insulin dose or other medicine.
Try to eat your normal types and amounts of food and to drink extra fluids, such as water, broth, carbonated drinks, and fruit juice. Encourage your child to drink extra liquids to prevent dehydration.
If your blood sugar level is higher than 240 milligrams per deciliter (mg/dL), drink extra liquids that do not contain sugar, such as water or sugar-free cola.
If you cannot eat the foods in your regular diet, drink extra liquids that contain sugar and salt, such as soup, sports drinks, or milk. You may also try eating foods that are gentle on the stomach, such as crackers, gelatin, or applesauce. Try to eat or drink 50 grams (g) of carbohydrate every 3 to 4 hours. For example, 6 saltine crackers, 1 cup (8 fl oz) of milk, and ½ cup (4 fl oz) of orange juice each contain approximately 15 g of carbohydrate.
Check your blood sugar at least every 3 to 4 hours, or more often if it is rising quickly, even through the night. If your blood sugar level rises above 240 mg/dL and your doctor has told you to take an extra insulin dose for high blood sugar levels, take the appropriate amount. If you take insulin and your doctor has not told you to take a specific amount of additional insulin, call him or her for advice.
If you take insulin, do a urine test for ketones every 6 to 12 hours, especially if your blood sugar is higher than 300 mg/dL. Call your doctor if you have more than 2+ or moderate ketones in your urine. Check your child's urine for ketones at least every 6 hours, even through the night.
Weigh yourself and check your temperature, breathing rate, and pulse frequently if your blood sugar is higher than 300 mg/dL. If you are losing weight and your temperature, breathing rate, and pulse are increasing, contact a doctor. You may be getting worse.
Don't take any nonprescription medicines without talking with your doctor. Many nonprescription medicines affect your blood sugar level.
When to call your doctor
Minor illnesses in people with diabetes—especially children with type 1 diabetes—can lead to very high blood sugar levels and possible emergencies. When children are sick, watch them closely for signs that they need immediate medical attention. Call 911 or other emergency services if you or your child has:
Symptoms of diabetic ketoacidosis (DKA), such as abdominal pain, vomiting, rapid breathing, fruity-smelling breath, or severe drowsiness.
Symptoms of dehydration, such as a dry mouth and very yellow or dark urine. Dehydration is particularly dangerous in children and may be caused by vomiting and diarrhea.
A low blood sugar level that continues.
It may not be necessary to call your doctor every time you or your child with diabetes has a mild illness, such as a cold. But it is a good idea to call for advice when you are sick and:
Your blood sugar level is higher than 240 mg/dL after taking the adjusted amount of insulin in your sick-day plan.
You take oral diabetes medicine and your blood sugar level is higher than 240 mg/dL before meals and stays high for more than 24 hours.
You have more than 2+ or moderate ketones in your urine.
You still have a fever and are not feeling better after a few days.
You are vomiting or having diarrhea for more than 6 hours.
When you are sick, write down the medicine(s) you have been taking and whether you have changed the dosage of your diabetes medicines based on your sick-day plan. Also note changes in your body temperature, weight, blood sugar, and urine ketone levels. Have this information handy when you talk to your doctor.

Credits
Author
Caroline Rea, RN, BS, MS
Editor
Susan Van Houten, RN, BSN, MBA
Associate Editor
Tracy Landauer
Associate Editor
Pat Truman, MATC
Primary Medical Reviewer
Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer
Stephen LaFranchi, MD - Pediatrics and Pediatric Endocrinology
Last Updated
December 3, 2008