Health Archives - Page 2 of 9 - Diabetes Counselling Online

Diabetic Nerve Damage: Neuropathy

January 11, 2015 by Imagine_David Leave a Comment

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood glucose can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet.

Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild; for others, diabetic neuropathy can be painful, disabling and even fatal.

Diabetic neuropathy is a common serious complication of diabetes. Yet you can often prevent diabetic neuropathy or slow its progress with tight blood glucose management, and a healthy lifestyle.

Clinical context

Pain and paraesthesia are common peripheral neuropathic symptoms, and if the autonomic nervous system is involved, gastrointestinal, bladder and sexual problems arise.

Diabetic neuropathic complications increase the burden of self-care and overall management.

The clinical focus is on prevention via good glycaemic control, and early recognition facilitated by good history and routine sensory testing.

New modalities are arriving to assist in the management of diabetic neuropathies.

Before any treatment is instigated, exclusion of non-diabetic causes of neuropathy is suggested. This includes assessment for vitamin B12 deficiency, hypothyroidism, renal disease and review of neurotoxic drugs including excessive alcohol consumption.

Autonomic neuropathy

Autonomic neuropathy may result in:

orthostatic hypotension (also called postural hypotension, is a form of low blood pressure that can cause dizziness. It happens when the blood vessels do not constrict (tighten) as you stand up, which makes you feel dizzy) with >20 mmHg drop
impaired and unpredictable gastric emptying (gastroparesis), which can cause a person’s blood glucose levels to be erratic and difficult to control. Pro-kinetic agents such as metoclopramide, domperidone or erythromycin may improve symptoms
diarrhoea
delayed/incomplete bladder emptying
erectile dysfunction and retrograde ejaculation in males
reduced vaginal lubrication with arousal in women
loss of cardiac pain, ‘silent’ ischaemia or infarction
sudden, unexpected cardiorespiratory arrest especially under anaesthetic or treatment with respiratory depressant medications
difficulty recognising hypoglycaemia
unexplained ankle oedema.

Cardiovascular autonomic neuropathy should be suspected by resting tachycardia (>100 bpm) or orthostatic reduction in BP (a fall in SBP >20 mmHg on standing without an appropriate heart rate response). This applies to people not currently on antihypertensive agents that may cause variations in BP responsiveness such as beta blockers. It is associated with increased cardiac event rates.

Diagnosis

The diagnosis of diabetic neuropathy may include:

taking a medical history for symptoms typical of neuropathy
checking your feet and legs for responses to stimuli such as temperature, light touch, pain, movement and vibration
checking the reflexes at your ankles and knees
tests to exclude other possible causes of neuropathy (such as low vitamin B₁or thiamine levels).

Treatment

Damaged nerves cannot be repaired. However, the risk of further complications in the feet can be reduced by:

vigilance – regular inspection of the feet for early signs of trouble or potential problem areas (such as breaks in skin, signs of infection or deformity
getting help at the first sign of trouble – early treatment of foot ulcers gives the best chance that they will heal
good foot and nail hygiene
choosing appropriate socks and shoes properly fitted to the shape of your foot
avoiding activities that may injure the feet. Check shoes for stones, sticks and other foreign objects that might hurt your feet every time before putting your shoes on.

A referral to a podiatrist may be appropriate for assessment and ongoing preventive management of foot complications.

Treatment for painful neuropathy

Appropriate pain management can significantly improve the lives of people with diabetes and painful neuropathy. A number of different medications are available, which produce comparable effects.

Most people would begin with one of either:

serotonin-norepinephrine reuptake inhibitors (such as venlafaxine, duloxetine)
tricyclics antidepressants (such as amityptiline)
anti-epileptics (such as gabapentin, pregabalin).

If one type fails to provide the response required, it is usual to switch to or add another. If all three agents alone or in combination fail, then opioid analgesics and tramadol may be used as second-line treatments.

Prevention of diabetic neuropathy

Be guided by your doctor, but general suggestions to reduce the risk of diabetic neuropathy include:

Maintain blood glucose levels within the target ranges.
Exercise regularly.
Maintain a healthy weight for your height.
Stop smoking.
Reduce your blood pressure and lipid (fat) levels through diet and lifestyle changes, and medication where appropriate
Consult your doctor promptly if you have symptoms including pain, numbness or tingling in your hands or feet.
Have your feet checked at least yearly by your doctor, podiatrist or diabetes educator, or more often if you have signs of problems with your feet or other complications of your diabetes.

Although, potential health complications due to diabetes may happen; don not live in fear, by watching the amount and types of food you eat, exercising, and taking any necessary medications, you may be able to prevent short and long-term diabetes complications.

Keeping blood glucose close to normal can help prevent the long-term complications of diabetes.
Manage high blood pressure.
Monitor your blood sugar level and A1c.
Have regular reviews with your diabetes care team.

Talk to your health care professional team: ask questions and get answers that you understand….. prevention is better than a decreased quality of life.

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Hypoglycaemia at School

January 7, 2015 by Imagine_David Leave a Comment

Children of all ages require a safe and effective plan for those times when not under their parents supervision

‘Hypo’ or a low blood glucose level is one of the fears for all people living with diabetes.

A low blood glucose level will often occur unexpectedly, sometimes without an obvious cause.

For the child with diabetes, a low blood glucose level may lead to loss of concentration and behaviour change – possibly disruptive behaviours.

Talk to your child’s school about diabetes to help your child attain an education without discrimination

Education and Care Services National Act and Regulations: Australia

“In January 2012 new national legislation (Education and Care Services National Act and Regulations) requires a type 1 diabetes policy for all services providing or intending to provide education and care on a regular basis to children under the age of 13 years. This includes outside school hours programs. More information on the medical conditions section of this legislation can be found on the Australian Children’s Education and Care Authority website http://www.acecqa.gov.au/national-regulations” from HERE (Diabetes Australia Victoria)

As a parent of a child living with diabetes it is in your best interest to communicate with the headmaster of your childs school before or at enrolment

Duty of Care

Schools have a legal responsibility to provide:

a safe environment
adequate supervision

When the school knows that certain students have diabetes, staff (including relief staff) need to know enough about diabetes to ensure the safety of those students (especially in regard to hypoglycaemia and safety in sport). Parents/guardians have a responsibility to advise the school of their child’s medical condition and the particular requirements for the management of their child’s diabetes. For children with special requirements, a written individual management plan incorporating medical recommendations should be developed with the school in collaboration with the parents/guardians and doctor. This should be attached to the student’s records. from Diabetes Australia

Hypoglycaemia Symptoms

A very good multimedia presentation from the Royal Childrens Hospital, Melbourne, can be found HERE

Managing Hypo

Managing hypoglycaemia

Hypoglycaemia (“Hypo”) means a low level of glucose in the blood. This is a blood glucose value of less than 4.0 mmol/L.

Hypoglycaemia can be caused by:

Too much insulin
Vigorous exercise without extra carbohydrate
Missing or delayed meals
Not eating all serves of carbohydrate
Alcohol intake

If you would like to share, or debrief, about your experiences please visit our Forum or Facebook

Research

“The management of type 1 diabetes in Australian Primary Schools” by Diabetes Nurse Practitioner, Associate Lecturer UWS Anne Marks HERE

Children using insulin pump therapy were more likely (97%) to receive insulin at school than children using injections (55%)
Children in the study who were able to self-administer insulin were more likely to receive insulin (93%) at school than children who were unable to self-administer insulin (65%)

Parent Concerns:

62% reported that they had current concerns about diabetes management at school

Difficulty participating in school activities

Inclusion at meal times

Lack of independence

Missing school, classroom activities or time with peers

Safety

Lack of staff to assist with care

Impact on parental employment

Increased workload of teachers who are willing to assist with care

Other Resources

Helping the Student with Diabetes to Succeed

sample-emergency-care-plans-for-hypoglycemia-and-hyperglycemia-508

Kind Regards,

David, Diabetes Educator @ Diabetes Counselling Online

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Diabetes and Hearing Loss

December 23, 2014 by Imagine_David Leave a Comment

**Some evidence shows people living with diabetes are at an increased risk of some level of hearing loss**

As people living with diabetes are at a greater risk of developing hearing loss, audiological tests to monitor auditory (hearing) function should be introduced into comprehensive packages of care provided by diabetes services.

The American Diabetes Association report, ‘Standards of medical care in diabetes – 2014’ recommends that hearing impairment be assessed and addressed as one of the common comorbid conditions that may complicate the management of diabetes.

The Australian RCGP Microvascular disease risks does not includehearing loss as a risk

Renal (kidney) impairment and CKD
Neuropathy (nerve damage)– peripheral, autonomic
Retinopathy (damage to the eye) more HEAR

Further research and evidence-based outcomes may support the introduction of indicators to identify hearing difficulties in the diabetes population. More HEAR

In one research paper, sensorineural hearing loss was more common in people living with diabetes than in the control nondiabetic patients, and severity of hearing loss seemed to correlate with progression of disease as reflected in serum creatinine. This may have been due to microangiopathic (small blood vessel) disease in the inner ear.

A review of the literature by these authors, and their study, suggests a moderate link between poor blood glucose control and progression of hearing loss.

Because audiologic data from patients with diabetes not experiencing hearing loss was not available, the exact impact of diabetes on hearing loss is still not clear.

However, this study does demonstrate that data mining can be used to identify poorly defined disease relationships and suggests that screening all patients with diabetes for hearing loss in a prospective manner may be useful for a clearer understanding of this disease process. More HEAR

Don't wait for your wheels to fall off..... talk to your doctor about having your hearing tested — ***Don’t wait for your wheels to fall off….. talk to your doctor about having your hearing tested***

The American Speech Language and Hearing Association comments that “building epidemiological evidence depends on a robust definition of a condition, so that results can be compared across studies.

For hearing impairment, however, no definitive definition has been established. Recently, using audiometric data from the National Health and Nutrition Examination Study, investigators evaluated hearing impairment using high-frequency (3000-, 4000-, 6000-, and 8000-Hz) as well as low- or middle-frequency (500-, 1000-, and 2000-Hz) averages, at two levels of severity (>25 and >40 dB HL), in both the worse and better ear (Bainbridge, Hoffman, & Cowie, 2008).

The results demonstrated that the prevalence of hearing impairment depends on how the condition is defined, but a greater prevalence of hearing impairment was observed among adults with diagnosed diabetes than without, regardless of the definition used”

**Talk to your doctor about having your hearing tested**

The data also suggest that people living with diabetes may experience hearing loss at earlier ages.

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Navigating the Australian Health System

December 18, 2014 by Imagine_David Leave a Comment

Navigating the Australian health care System

Health care in Australia is divided between Federal and State responsibility.

To make the most of the system it is wise to understand how to navigate these systems, so you can get the best ‘value’ to enable your diabetes self care plan to be most efficiently and affordably implemented.

The International Diabetes Foundation recognises that “People with diabetes have the right to understand their disease, make informed choices and receive care based on best practice. They must be part of the team that manages their condition.This can only be achieved if interdisciplinary teams and people with diabetes have the information and tools to make changes based on best practice and recognized improvement strategies are used to support meaningful system change.”

All too often people living with diabetes do not get the opportunity to have the specialist input from a diabetes educator or dietitian.

To make your diabetes self care plan most effective it is in your best interest to have an appropriate level of diabetes self management education.

A diabetes educator provides diabetes self-management education for people with diabetes. They play a major role in self-empowering the person with diabetes by focusing on an individual’s needs, providing knowledge, motivation and support to aid the prevention of diabetes related health complications.

Diabetes Educators have many years experience (some living with diabetes themselves) and can provide you with tailored education, upon the following:

Self blood glucose monitoring.
Oral hypoglycaemic agents.
Insulin initiation and titration.
Sick day guidelines.
Hypoglycaemia recognition and management.
Complication risk management.

Accredited Practising Dietitians can, in addition, provide you with a nutritional assessment and advice tailored to your individual needs, in addition to education upon the following:

Influence of nutrition on blood glucose control.
Carbohydrate counting and information.
Weight management.
Blood lipid management.
Related health issues.
Complication management.
Hypoglycaemia recognition and management.

State Health Systems:

State health systems often provide services such a diabetes self management education courses at community health centres or in public hospitals.

These courses may be a combination of individual and group self management education sessions, usually run by a diabetes educator and a dietitian. These diabetes self management programs are usually free.

Whatever type of diabetes you have been diagnosed with, this is a good place to start.

To find out more about what is available in your area make contact with your local hospital or community health service.

005 — **Navigating the System to Better Health**

Another way to find your local diabetes self management programs is via Diabetes Australia or ADEA.

What’s Next

By initially connecting with these state funded health care professionals, you can then navigate the Medicare system with your GP to connect in an affordable manner with other members of your health care team. e.g. podiatrist, exercise physiologist, psychologist/counsellor etc (ALL of whom are covered by the Medicare system).

Medicare – Federal Government Funding

Talk with your GP about the Medicare system, whats available to people with chronic health issues like diabetes.

The Chronic Disease Management (formerly Enhanced Primary Care or EPC) — GP services on the Medicare Benefits Schedule (MBS) enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers.

A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.

Whether a patient is eligible for CDM services is a clinical judgement for the GP, taking into account the patient’s medical condition and care needs, as well as the general guidance set out in the MBS.

Patients who have a chronic medical condition and complex care needs and are being managed by their GP under a GP Management Plan (item 721) and Team Care Arrangements (item 723) are eligible for Medicare rebates for certain allied health services on referral from their GP.

In summary:

Maximum of five (5) services per patient each calendar year
Medicare rebate of $48.95 per service, with out-of-pocket costs counting towards the extended Medicare safety net
Patient must have an Enhanced Primary Care (EPC) plan prepared by their GP (your GP is paid to produce this for you)
GP refers to allied health professional (referral NOT required if that health care professionals happens to be available for free in the State health care system)
Allied health professional must report back to the referring GP

CAUTION: In creating the Chronic Disease Management Plan ensure YOU and your GP knows who is available in the State health system for you to enable the best use of this plan.

Team Care Arrangements (item 723)

Provides a rebate for a GP to coordinate the preparation of TCAs for a patient who has a chronic or terminal medical condition and also requires ongoing care from a multidisciplinary team of at least three health or care providers.
In most cases the patient will already have a GPMP in place (but this is not mandatory).
The minimum claiming period is once every twelve months, supported by regular review services.
Involves the GP collaborating with the other participating providers on required treatment/services, agreeing to arrangements with the patient, documenting the arrangements and a review date in the patient’s TCAs, and providing copies of the relevant document to the collaborating providers.

**With good self care knowledge everything is possible.**

A Diabetes Self-Management Plan Review form can be downloaded here Diabetes. This document shows a guide to the goals made in collaboration between the doctor and the person living with diabetes.

CAUTION: If you have more than one of these in place, e.g 2 different doctors making 2 different plans for you, your health care provider may end up out of pocket and may charge you the full fee for service – with no rebate owing to you.

Any questions? Please ask, even the smallest of questions.

Kind Regards,

David, Diabetes Educator @ Diabetes Counselling Online

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Sleep & Diabetes

December 17, 2014 by Imagine_David Leave a Comment

“I slept so badly last night; I simply have no energy to exercise.” — **“I slept so badly last night; I simply have no energy to function.”**

How are you sleeping at night? All too often, the answer is the same: not well.

Diabetes and sleep problems often go hand in hand. Diabetes can cause sleep loss, and there’s evidence that not sleeping well can increase the risk of developing diabetes.

Symptoms

Symptoms associated with insufficient sleep include feeling tired, irritability, slurred speech, blurred vision, memory loss, inability to concentrate, episodes of confusion, hallucinations, nausea, impotence and reduced sexual drive. Extreme sleep deprivation can cause psychosis and death. However, there are no documented cases of a healthy human dying from sleep deprivation (although mortality from accidents does occur). Before death occurs in healthy, sleep-deprived humans, the brain forces itself to have ‘micro-sleeps’.

Evidence

In the past decade, there has been growing evidence that too little sleep can affect hormones and metabolism in ways that promote diabetes.

Current data suggests that the relationship between sleep restriction, weight gain and diabetes risk may involve at least three pathways: 1. alterations in glucose metabolism; 2. upregulation of appetite; 3. decreased energy expenditure. from The Metabolic Consequences of Sleep Deprivation

A 1999 Lancet study at the University of Chicago – the researchers monitored the blood glucose levels of 11 healthy young men who were allowed only four hours of sleep per night — from 1 a.m. to 5 a.m. — for six nights.

That study showed that after only a week of short bedtimes, their glucose tolerance was impaired. There could be dramatic effects even after only a week.

After 6 nights of little sleep, the men had higher-than-normal blood glucose levels. (The levels were not high enough to be diagnosed as diabetes, however). The effects went away once the men were back on their normal sleep schedule.

Experts also believe that chronic sleep deprivation may lead to elevated levels of the stress hormone, cortisol. Elevated cortisol may in turn promote insulin resistance, in which the body can’t use the hormone insulin properly to help move glucose into cells for energy.

Low Sleep = High Blood Sugar?

High blood glucose level is a red flag for sleep problems among people with diabetes.

Diabetes and sleep problems often go hand in hand. Diabetes can cause sleep loss.

If the blood glucose level is high the kidneys want to pass this excess glucose out in the urine. Getting up to pee in the middle of the night disturbs the sleep.

People who are tired will eat more because they want to get energy from somewhere. That may mean over-eating during the day > higher blood glucose level at night> getting up to pee>poor sleep etc etc.

Eating well throughout the day – having a safe and effective diabetes self care plan – to have your blood glucose level on target may have you be able to sleep better at night.

Low Sleep = Low Blood Sugar?

Conversely, having a hypo during the night is likely to wake you and destabilise your sleep.

A wise action to take would be to measure your blood glucose level occasionally at 2-3 am in order to exclude overnight hypoglycaemia.

The Link Between Lack of Sleep and Weight

Some studies show that people who get less sleep tend to be heavier than those who sleep well. People who are tired will eat more because they want to get energy from somewhere. That may mean over-eating during the day > higher blood glucose level at night> getting up to pee>poor sleep etc etc.

Sleep loss could also affect energy expenditure via its impact on the levels of leptin and ghrelin. Since several human studies have demonstrated reduced levels of leptin after sleep loss, it is possible that the reduction in leptin is associated with a reduction in energy expenditure. Similarly, the increase in ghrelin after partial sleep restriction could be associated with a decrease in NEAT (Non-exercise activity thermogenesis). *Experimental evidence is currently lacking to support either hypothesis*

Sleep Apnea?

There is also a link between diabetes and sleep apnea, a sleep disorder marked by loud snoring and pauses in breathing while you sleep. The culprit may be excess weight, which can cause fat deposits around the upper airway that obstruct breathing. So being overweight or obese is a risk factor for sleep apnea as well as diabetes.

If you have diabetes, are overweight, and snore, tell your doctor. You may need a sleep study.

Sleep apnea can prevent a person from getting a good night sleep, which can worsen diabetes. In sleep studies, you are monitored while you sleep for sleep disorders such sleep apnea.

There are many effective treatments for sleep apnea. These include lifestyle changes such as weight loss for mild cases and devices to open up blocked airways for more significant cases.

Sleep: How Important?

In general, people living with diabetes have to be very careful about sleep. Anything that throws off your routine can make you feel a lack of energy and fatigue. The more fatigued you feel, the more your motor is running, and the more likely you are to develop insulin deficiencies.

How Much Sleep?

On average, we need 7.5 hours per night, but your sleep requirement is genetically determined and varies.

It can be about four hours on the short end to 10 or 11 on the long end.

Want to know if you are sleep-deprived? The answer is simple…..If you use an alarm clock, you are. If you were getting adequate sleep, your brain would awaken you before the alarm goes off.

HELP

Improve your sleep habits: SNORE Australia

MJA (Medical Journal of Australia) Sleep Disorder Supplement

Australasian Sleep Association

So, turn off your electronic device…. and go get some sleep!

Kind Regards,

David,

Diabetes Educator @ Diabetes Counselling Online

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