The New Nation - Internet Edition

Easir Abedin

By following a diabetes treatment plan, you are trying to keep an even balance of glucose and insulin in the blood at all times. Just like on the ocean, 4-foot waves are fine and normal, but 12-foot waves can mean rough sailing ahead! Since extremely high or low blood glucose levels are hard on your body, it is important to try to keep your blood glucose levels as even as possible to avoid long-term complications. It is important to understand the effects that stress and illness can have on your blood glucose levels and be prepared to handle them effectively.

Stress

In response to daily stresses and strains, our bodies will often tap into their stored glucose supplies. By doing this, we fuel our cells to make the extra energy we need to get us through a tough situation. Of course, sudden supplies of new glucose in the bloodstream can raise the level rather quickly.

Several things cause stress responses within the body:

Sudden fright or anger

Fever or infection

Growth spurts

Rapid weight gain

Illness

As with other kinds of stress, illness often makes the blood glucose goes up. Things like a bad cold, the flu, or a serious injury can increase your need for more glucose. The body often responds to illness by pumping stored glucose into the system. This is why it is important to keep taking your insulin, even though you may not feel like eating. Without insulin, your body glucose level can soar too high to control. The doctor will have special instructions to help you.

Prevention is key!

To prevent serious cases of hyperglycaemia, it is important that you never stop taking your insulin. When you are sick, check your blood glucose frequently and take extra insulin (as directed by your physician) when you blood glucose is too high.

Complications

Finding the right balance of nutrition, exercise, and insulin and/or oral medication is the key to living well with diabetes. Working day-to-day to achieve good blood glucose control is essential to avoid complications.

Hypoglycaemia

Hypoglycaemia, or 'hypo', occurs when blood sugar levels are too low and fall below 4 mmol/L.

Hypoglycaemia happens most often to people who use insulin; however, people who use oral medications can also experience hypoglycaemia.

It can be caused by:

Too little food, skipping meals or snacks

Taking alcohol

Doing extra exercise without taking extra food

Taking too much insulin

A drop in blood glucose can happen suddenly and can be dangerous. It can cause you to faint if not treated right away. Most people can tell when their blood glucose level is low.

Hypoglycaemia occurs most frequently during the night or before lunch.

The symptoms of hypoglycaemia include:

Nervousness

Fainting

Feeling dizzy or confused

Hunger

Confusion and trouble thinking clearly

Headaches and vision changes

Mood changes

Sweating

What to do

If you experience any of these symptoms, check your blood glucose level.

If you cannot do a blood glucose test right away, stop all activity and take some form of glucose. If your blood glucose levels are low, the important thing is to get some glucose into your bloodstream right away!

Eating or drinking something that changes into glucose quickly is the best way, like half a cup of fruit juice, or three dextrose tablets or some hard candies. Important: Diet soft drinks and artificial sweeteners should not be used to treat low blood glucose.

When you start to feel better, eat your next meal early, or have a good snack or meal to make sure your blood glucose does not start to fall again.

Drug stores sell special glucose gels or tablets for this purpose. You should carry them with you always.

It is also a good idea to keep extra snacks and glucose tablets in your car, at work and on your bedside table, just in case.

Having a hypo does not necessarily mean that you are not controlling your diabetes.

Why did the hypo occur?

If you have a hypo, ask yourself the following questions:

Have I missed a meal? Was my meal late? Did I eat less than usual at my last meal?

Did I give myself the correct dose of insulin at my last injection?

Have I been especially active in the last hour? Did I remember to take some extra carbohydrate before I started?

If symptoms occur frequently, tell your doctor, as you may need to change your insulin dose.

Severe hypoglycaemia

Occasionally, you may not spot your warning signs for hypoglycaemia and you may become unconscious. If you become unconscious and cannot swallow, than you may need an injection of glucagon.

Glucagon is a hormone that occurs naturally in our bodies and it will raise your blood glucose level by a small amount for a short while. It forces the body to make more glucose - in a hurry. You should return to consciousness almost immediately after it's given.

Some people with type 1 diabetes keep a ready-to-use glucagon kit on hand, just in case.

It is important that someone in your family (or a friend) knows how to give you this injection. Explain to your family how to care for you if they find you unconscious.

If glucagon is not available, they should call for emergency assistance and advise that you are a diabetic. They should not try to give you anything by mouth.

Hyperglycaemia

Hyperglycaemia, or 'hyper', occurs when blood glucose levels are too high, usually over 11 mmol/L, when the blood glucose measurement is taken 1-2 hours after a meal.

Hyperglycaemia occurs when there is too little insulin in the blood. It can lead to ketoacidosis, a condition in which acetone-like substances called ketones are excreted in the urine.

Hyperglycaemia and ketoacidosis can happen if you stop taking insulin, you reduce your insulin dose, or if your sensitivity to insulin decreases.

Periods of illness, such as urinary or respiratory tract infections, are times when hyperglycaemia can easily occur.

Hyperglycaemia and ketoacidosis are typically present when you first discover that you have type 1 diabetes.

Hyperglycaemia can be caused by:

Too little insulin

Did you skip the last dose or give too little?

Too much food

Did you over-eat during the last few hours?

Exercise

Did you forget to do or change the time?

Stress or illness

Are you getting ill? Under unusual pressure? Going through a difficult or exciting emotional experience?

When signs of hyperglycaemia appear, it is important to take immediate action.

Symptoms of hyperglycaemia include:

Extreme thirst and dehydration

Extreme tiredness and drowsiness

Stomach cramps

Dry and flushed skin

Frequent urination

Rapid and deep breathing

Fruity breath odour (acetone-like breath)

But others get no signal at all. Remember you can run a quick blood glucose test at any time, just to check things out.

If your blood glucose is high and your urine shows ketones, contact your doctor immediately.

Long-term complications

Three very important things that you need to take care of right from the start of a diagnosis of diabetes are:

Your feet

Diabetes is hard on the nerves, especially in your feet and legs. This can cause you to lose feeling in these areas and make your feet vulnerable to injury or sores that you may not discover immediately.

Protect your feet by wearing soft, well-fitted shoes that are comfortable and don't rub or pinch anywhere.

Never go barefoot! Hot temperatures or sharp objects are harder to feel, so it's easier to get burned or cut without noticing it. An infection could set in before you know it.

Be sure to cut your toenails so that they have no rough places or sharp corners.

Keep your feet clean.

Keep your feet dry.

Keep your feet soft using lotion (except between the toes) and powder.

Keep your feet safe - always wear shoes and socks.

Buy good walking shoes - they are worth the money.

Podiatrists specialize in taking care of feet. They can help you care for things like calluses or corns and will give you excellent advice about how to protect your feet from possible problems.

It is important to check your feet every day to catch problems early. Every time you shower or bath, take time to check your feet for breaks in the skin or signs of rubbing.

Use good light to check your feet and be especially alert for blue, bright red or white areas - they often mean that the blood supply is being cut off to the area.

Healthy feet are so important in diabetes care that your doctor will probably check them every time you visit the office.

If your doctor forgets to check, remind him/her!

Your eyes

Diabetes can cause eye problems - even before you notice problems in your vision. In fact, diabetes is a leading cause of blindness.

You should have your eyes checked by an ophthalmologist (eye specialist) at least once a year, because it requires special skill to find and treat these eye problems before they become serious. Be sure to inform your eye specialist of your diabetes before your checkup.

Your teeth

With diabetes, it is easier to get a gum infection. Good brushing, flossing and regular visits to your dentist will help you avoid problems with your teeth.

Be sure to tell your dentist you have diabetes so that he can thoroughly check your gums at each visit.

Take good care of yourself!

It's better to ask questions of your doctor, diabetes educator, dietitian or other diabetes team member too often rather than too little.

(Easir Abedin, M.Sc Microbiology (D.U),MBA is Assistant Manager Quality Control NOVO Healthcare and Pharma Ltd.)

A food allergy is an immune system response. It occurs when the body mistakes an ingredient in food -- usually a protein -- as harmful and creates a defense system (antibodies) to fight it. Allergy symptoms develop when the antibodies are battling the "invading" food. The most common food allergies are peanuts, tree nuts (such as walnuts, pecans and almonds), fish, and shellfish, milk, eggs, soy products, and wheat.

What Is Food Intolerance?

Food intolerance is a digestive system response rather than an immune system response. It occurs when something in a food irritates a person's digestive system or when a person is unable to properly digest or breakdown, the food. Intolerance to lactose, which is found in milk and other dairy products, is the most common food intolerance.

What Are the Symptoms of Food Allergy?

Symptoms of a food allergy can range from mild to severe, and the amount of food necessary to trigger a reaction varies from person to person. Symptoms of food allergy may include:

Rash or hives

Nausea

Stomach pain

Diarrhea

Itchy skin

Shortness of breath

Chest pain

Swelling of the airways to the lungs

Anaphylaxis

What Are the Symptoms of Food Intolerance?

Symptoms of food intolerance include:

Nausea

Stomach pain

Gas, cramps or bloating

Vomiting

Heartburn

Diarrhea

Headaches

Irritability or nervousness

How Common Are Food Allergies and Intolerances?

Food allergies affect about 2 to 4% of adults and 6 to 8% of children. Food intolerances are much more common. In fact, nearly everyone at one time has had an unpleasant reaction to something they ate. Some people have specific food intolerances. Lactose intolerance, the most common food intolerance.

What Causes Food Allergies and Intolerances?

Food allergies arise from sensitivity to chemical compounds (proteins) in food. They develop after you are exposed to a food protein that your body thinks is harmful. The first time you eat the food containing the protein, your immune system responds by creating specific disease-fighting antibodies (called immunoglobulin E or IgE). When you eat the food again, it triggers the release of IgE antibodies and other chemicals, including histamine, in an effort to expel the protein "invader" from your body. Histamine is a powerful chemical that can affect the respiratory system, gastrointestinal tract, skin or cardiovascular system.

As a result of this response, allergy symptoms occur. The allergy symptoms you have depend on where in the body the histamine is released. If it is released in the ears, nose and throat, you may have an itchy nose and mouth, or trouble breathing or swallowing. If histamine is released in the skin, you may develop hives or a rash. If histamine is released in the gastrointestinal tract, you likely will develop stomach pains, cramps or diarrhea. Many people experience a combination of symptoms as the food is eaten and digested.

What Causes Food Allergies and Intolerances?

Food allergies often run in families, suggesting that the condition can be inherited.

There are many factors that may contribute to food intolerance. In some cases, as with lactose intolerance, the person lacks the chemicals, called enzymes, necessary to properly digest certain proteins found in food. Also common are intolerances to some chemical ingredients added to food to provide color, enhance taste and protect against the growth of bacteria. These ingredients include various dyes and monosodium glutamate (MSG), a flavor enhancer.

Substances called sulfites are also a source of intolerance for some people. They may occur naturally, as in red wines or may be added to prevent the growth of mold.

Salicylates are a group of plant chemicals found naturally in many fruits, vegetables, nuts, coffee, juices, beer and wine. Aspirin also is a compound of the salicylate family. Foods containing salicylates may trigger symptoms in people who are sensitive to aspirin. Of course, any food consumed in excessive quantities can cause digestive symptoms.

How Can You Tell the Difference Between a Food Allergy and Intolerance?

Food allergies can be triggered by even a small amount of the food and occur every time the food is consumed. People with food allergies are generally advised to avoid the offending foods completely. On the other hand, food intolerances often are dose related.

People with food intolerance may not have symptoms unless they eat a large portion of the food or eat the food frequently. For example, a person with lactose intolerance may be able to drink milk in coffee or a single glass of milk, but becomes sick if he or she drinks several glasses of milk.

Food allergies and intolerances also are different from food poisoning, which generally results from spoiled or tainted food and affects more than one person eating the food. Your healthcare provider can help determine if you have an allergy or intolerance, and establish a plan to help control your symptoms.

How Are Food Intolerances Diagnosed?

Most food intolerances are found through trial and error to determine which food or foods cause symptoms. You may be asked to keep a food diary to record what you eat and when you get symptoms, and then look for common factors.

Another way to identify problem foods is to go on an elimination diet. This involves completely eliminating any suspect foods from your diet until you are symptom-free. You then begin to reintroduce the foods, one at a time. This can help you pinpoint which foods cause symptoms. Seek the advice of your healthcare provider or a registered dietitian before beginning an elimination diet to be sure your diet provides adequate nutrition.

How Are Food Intolerances Treated?

Treatment is based on avoiding or reducing your intake of problem foods and treating symptoms when they arise.

What Causes Food Allergies and Intolerances?

Food allergies often run in families, suggesting that the condition can be inherited.

There are many factors that may contribute to food intolerance. In some cases, as with lactose intolerance, the person lacks the chemicals, called enzymes, necessary to properly digest certain proteins found in food. Also common are intolerances to some chemical ingredients added to food to provide color, enhance taste and protect against the growth of bacteria. These ingredients include various dyes and monosodium glutamate (MSG), a flavor enhancer.

Substances called sulfites are also a source of intolerance for some people. They may occur naturally, as in red wines or may be added to prevent the growth of mold.

Salicylates are a group of plant chemicals found naturally in many fruits, vegetables, nuts, coffee, juices, beer and wine. Aspirin also is a compound of the salicylate family. Foods containing salicylates may trigger symptoms in people who are sensitive to aspirin. Of course, any food consumed in excessive quantities can cause digestive symptoms.

How Can You Tell the Difference Between a Food Allergy and Intolerance?

Food allergies can be triggered by even a small amount of the food and occur every time the food is consumed. People with food allergies are generally advised to avoid the offending foods completely. On the other hand, food intolerances often are dose related.

People with food intolerance may not have symptoms unless they eat a large portion of the food or eat the food frequently. For example, a person with lactose intolerance may be able to drink milk in coffee or a single glass of milk, but becomes sick if he or she drinks several glasses of milk.

Food allergies and intolerances also are different from food poisoning, which generally results from spoiled or tainted food and affects more than one person eating the food. Your healthcare provider can help determine if you have an allergy or intolerance, and establish a plan to help control your symptoms.

How Are Food Intolerances Diagnosed?

Most food intolerances are found through trial and error to determine which food or foods cause symptoms. You may be asked to keep a food diary to record what you eat and when you get symptoms, and then look for common factors.

Another way to identify problem foods is to go on an elimination diet. This involves completely eliminating any suspect foods from your diet until you are symptom-free. You then begin to reintroduce the foods, one at a time. This can help you pinpoint which foods cause symptoms. Seek the advice of your healthcare provider or a registered dietitian before beginning an elimination diet to be sure your diet provides adequate nutrition.

How Are Food Intolerances Treated?

Treatment is based on avoiding or reducing your intake of problem foods and treating symptoms when they arise.

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