Maxy sez : Shoe Shopping With Diabetes

If you have diabetes, choosing the right shoes can help protect your feet from injury. Learn which styles could put you at risk for complications.
By Mary Elizabeth Dallas, HealthDay News
Medically Reviewed by Farrokh Sohrabi, MD
If you are living with diabetes, shopping for shoes is more than a matter of style. By following some simple guidelines to ensure a good, comfortable fit, you can prevent potentially serious foot problems.

Even minor foot problems, like calluses or blisters, can lead to serious diabetes-related complications. Diabetes can cause poor blood flow to your feet, making it more difficult for wounds to heal, sometimes resulting in infections and possibly amputation. Complicating matters, poorly controlled diabetes can also lead to nerve damage called peripheral neuropathy. This may cause you to lose sensation in your feet, so you may not feel potentially harmful cuts or blisters. To help protect your feet and overall health, it's important to know what to look for in diabetes shoes.

"It's all about prevention," said Katherine Dux, DPM, a podiatrist at Loyola University Medical Center in Maywood, Ill., who treats patients with diabetes. "Any friction in the shoe could lead to irritation and possible blister formation. This could lead to trouble down the road."

Before you shop for diabetes footwear, it's important to have your feet evaluated by a podiatrist to determine your risk for infections or complications, said Dr. Dux. Based on this assessment, the doctor can recommend exactly which types of shoes will be best for your feet.

What to Look For in Diabetes Footwear
Even if your diabetes is under control and your feet are healthy, there are a number of factors you should consider when selecting shoes. By looking for certain characteristics and avoiding others, you can protect against irritation, infections, ulcers, and potentially worse foot problems.

First, look for a shoe that has a large enclosed front, as well as a closed back and top. Shoes that expose your toes or heels increase your risk for injury and infection. You may love slip-on shoes, sandals, clogs, and mules, but they could trip you up when it comes to diabetes foot care.

Other good shoe features for a person with diabetes include:

Adjustable Closure. Look for shoes that have laces or Velcro. The built-in flexibility allows you to tighten or loosen your shoes depending on whether or not your foot is swelling.

Wide Toe. Steer clear of shoes with narrow or pointed toes. "It's best to stay with a shoe that has a wider toe box area as well as something with increased depth to the toe box," advises Christina Sigur, DPM, a podiatrist at Wake Forest Baptist Medical Center in Winston-Salem, N.C. Shoes with a round or wide toe box provide your feet with more room and are less likely to cause irritation.

Low Heel. Flats or shoes with heels less than two inches high are a better option than shoes with higher heels. Lower-heeled shoes reduce the amount of pressure applied to the ball of the foot.

Soft Material. Choose styles made from soft materials, such as leather, mesh or a pliable synthetic fabric. Since feet tend to swell throughout the day, these softer fabrics will give and allow for swelling. Breathable fabrics will also prevent the build up of moisture within the shoe, Dux added.

Cushioned Inner Sole. It’s important to choose footwear with a good amount of cushioning inside the shoe. This added support helps reduce foot pressure and the risk for developing foot ulcers, or sores, and other complications, Dr. Sigur noted.

Hard Outer Sole. Although the inside of your shoe should provide support with cushioning, the outer sole of any shoe you select should be hard. This will help protect your feet from rough or sharp objects and provide shock absorption.

When to Use Therapeutic Diabetes Shoes
For some people with diabetes, a podiatrist may recommend therapeutic shoes. "People with foot deformities, such a hammer toes and bunions, are at greater risk for irritation from ill-fitting shoes," Dux said.

Therapeutic shoes are advisable for anyone with diabetes who also has a history of any one of the following:

An amputation of any part of their foot or toe
Foot ulceration
Calluses that lead to an ulceration
Neuropathy or nerve damage
A foot deformity such hammer toes, bunions, flat feet, or high arches
Poor circulation in their lower extremities
At the Shoe Store
If it’s time for some new kicks, consider shopping later in the day. Since feet tend to swell throughout the day, Dux recommends visiting the shoe store in the afternoon or evening in order to get a more accurate sizing of your foot.

And don’t forget to bring your socks. Experts recommend that people with diabetes wear socks to decrease the friction in shoes and soak up extra moisture to prevent infections. To ensure a proper fit, it's important to always try on shoes with the socks you intend to wear with them.

Finally, ask a trained sales professional to measure both of your feet. One foot is typically larger than the other. You’ll want to determine which one is longer and base your shoe size off of that foot to get the best fit.

Other Ways to Protect Your Feet
Consider Fit, Not Fashion. The type of shoes you wear should have less to do with fashion and have everything to do with proper fit. "Shoes should feel comfortable from the moment you put them on,'" Dux said. "There is no true break-in period for shoes." Dux adds that shoes should never feel tight, rub, or cause irritation.

Inspect Your Feet Daily. It's important to routinely remove your shoes and inspect your feet for problems or signs of irritation, such as redness or marks along the top, sides, or sole. This is particularly true when wearing new shoes. "Any areas of redness or marks that do not resolve in 10 to 15 minutes could be an indication that the shoes need to be addressed or adjusted," Dux noted.

Visit a Podiatrist Regularly. People with diabetes who do not have any foot problems should still be evaluated by a podiatrist annually. Anyone diagnosed with peripheral neuropathy — or those with a history of calluses or foot ulcers — should be reassessed more frequently, according to experts.


Know When to Buy New Shoes. Whether or not to replace a pair of shoes depends on how often you wear them. For everyday shoes, however, Sigur says a good rule of thumb is to change them at least once a year since the interior cushioning of the shoe wears down over time.

Maxy sez :How to Stabilize Your Blood Sugar

Keeping blood sugar under control is key for good management of type 2 diabetes. Here’s how to navigate this sometimes complicated course of diabetes care.
By Madeline R. Vann, MPH                Medically Reviewed by Justin Laube, MD
Blood sugar testing tools can help you track how diet, exercise, and other lifestyle changes are affecting your blood sugar levels.B. Boissonnet/Alamy
Life with type 2 diabetes can sometimes seem like an hourly or even minute-by-minute effort to stabilize your blood sugar. All of the recommendations and drugs you’ve been given as part of your type 2 diabetes treatment plan are intended to help you reach — and keep — healthy blood sugar levels most of the time. But doctors are learning that to control type 2 diabetes well, better information about why blood sugar matters and how to manage it is essential.

The Facts About Diabetes and Blood Sugar
As the American Diabetes Association (ADA) explains, your body needs sugar (glucose) for fuel, and there’s a fairly complicated process that makes it possible for your body to use that sugar. Insulin, which is made by the pancreas, is the hormone that enables the cells in your body to take advantage of sugar.

Type 2 diabetes occurs when your body isn’t able to remove sugar from your blood. This can happen if your body stops being sensitive to insulin or if it starts to respond in a delayed or exaggerated way to changes in your blood sugar.

Diabetes is signaled by an elevated blood sugar level of more than 126 milligrams per deciliter (mg/dL) for a fasting blood test, or more than 200 mg/dL at any time during the day. It can also be indicated by a hemoglobin A1C level of 6.5 percent or higher, a measure of the percentage of blood sugar attached to hemoglobin in the blood during the past two to three months. (Hemoglobin is a protein in red blood cells that transports oxygen throughout the body. So an A1C of 6.5 means that 6.5 percent of your red blood cells have sugar attached to them.)

Unchecked high blood sugar gradually damages the blood vessels in your body. Over the long term, this slow, progressive harm can lead to a dangerous loss of sensation in your legs and feet, a loss of eyesight and kidney function, and an increased risk for heart disease and stroke.

Both high and low blood sugar are health threats. "Having low blood sugar can lead to hypoglycemia, which puts people at risk for confusion and loss of consciousness, so it can be life threatening. Fluctuations in the opposite direction, or high blood sugar, can cause fatigue and dehydration," explains endocrinologist Laure Sayyed Kassem, MD, an assistant professor of medicine at Case Western Reserve University School of Medicine in Cleveland. "Good diabetes control can help reduce the risks for heart attacks, strokes, visual deficits, kidney disease, and peripheral artery disease.”

Strategies to Stabilize Blood Sugar
Getting your blood sugar to healthy levels may take trial and error, but there are steps to help you achieve it.

“Having a daily routine is critical for good diabetes control," Dr. Kassem says. "That means following your meal plan, exercising regularly, being consistent with blood sugar testing, and following up regularly with your doctor." Tracking carbohydrates is particularly important. “Big variations in carbohydrate intake from day to day can lead to fluctuations in blood sugars,” she adds. For example, when you consume excess carbohydrates, the body digests them like sugar and sends them straight to the bloodstream, increasing the risk of blood sugar spikes.

Follow these specific strategies to help control blood sugar:
Exercise :  A regular exercise program has been shown to help manage blood sugar levels over time, and taking a varied approach to fitness is good for diabetes and health in general. Participants in a 12-week program who exercised for an hour three times a week using both aerobic and resistance training had improved diabetes management, according to research published in February 2015 in the Journal of Sports Medicine and Physical Fitness. So mix it up with strength training, aerobic workouts, and any other activities you enjoy.

Weight : Loss If you’re overweight, it will be easier to stabilize blood sugar more effectively if you lose even a few pounds. “For most people with diabetes, losing just 5 or 10 pounds can make a difference in diabetes control or the need for medication,” says endocrinologist Joseph Aloi, MD, section chief and professor of endocrinology and metabolism at Wake Forest Baptist Health in Winston-Salem, North Carolina.

Diet:  Many people with diabetes achieve better control over their blood sugar by limiting the kinds of foods that can cause blood sugar to spike. For example, your doctor might recommend cutting back on carbohydrates and eating more lean protein, fruits, and vegetables. Fiber can be so helpful that sprinkling even a small amount of a fiber supplement onto a meal that otherwise might spike blood sugar can help stabilize it, Dr. Aloi says, because fiber slows down the body's digestive process.

Drinking :  Wisely Alcohol can cause an immediate rise in blood sugar and then a drop a few hours later. It’s best to stick to moderate amounts and have some solid food with your beverage.

Medication:  Your doctor may recommend different types of medication at different times during your diabetes treatment. Treatment options include the following:

Biguanides, the drug class that includes metformin, help your body use insulin more effectively and may also reduce the amount of blood sugar made by the liver.
Sulfonylureas cause certain cells in your pancreas to make more insulin, though low blood sugar (hypoglycemia) is a possible side effect.
Meglitinides, a class of drugs that includes repaglinide, cause your pancreas to make more insulin, with hypoglycemia as a possible side effect.
Thiazolidinediones, a class that includes pioglitazone, may help insulin work better.
Alpha-glucosidase inhibitors, a class including acarbose, stop the body from breaking down starches and may be used to prevent a spike in blood sugar after a meal.
DPP-4 inhibitors allow GLP-1, a gut-based hormone naturally found in the body, to last longer and help stabilize blood sugar levels.
SGLT2 inhibitors cause excess glucose to be eliminated in the urine.
Insulin may be necessary to help your body use blood sugar more effectively.
Asking More Questions:  Don’t be shy about asking your doctor or diabetes educator about how to interpret blood sugar numbers, or for clearer instructions to help stabilize blood sugar. “You should know what your medications are for and what your goals are,” Aloi says. Strategies to stabilize blood sugar are most effective when you understand how they work and how to use them. And the answers may be as close as your phone. When Australian researchers offered telephone counseling to 94 adults with type 2 diabetes, they found it improved diabetes management, according to a study published in September 2014 in the Internal Medicine Journal.

Blood Sugar Testing Options
Specific recommendations for testing blood sugar depend on your type of treatment. "If it’s oral treatment, stagger the tests because this gives us a better idea of blood sugars through the day. It allows us to tailor medication better. But people on insulin have to be tested at regular times every day,” Kassem explains.

From self-tests to lab tests, from daily testing to testing every few months, these different blood sugar tests can give you a more complete picture of your diabetes and how to go about managing it best:

Testing Strips and Glucose Monitors These are fingertip blood sample tests you can do at home. Depending on the status of the diabetes and your doctor’s recommendations, you may need to test multiple times a day to keep tabs on your blood sugar levels. Get to know your condition better by keeping a diary of your meals and activities and the blood sugar levels that result.

Use these self-check blood sugar testing tools to find out how your body responds to changes in your diet, exercise, and overall health. There are many brands of monitors, each with their own lancets and testing strips, so talk to your doctor about which design is best for you and about how often you should be checking your blood sugar levels at home.

Lab Work Your doctor will often order lab-drawn blood sugar tests as part of your regular office visits to monitor how well you’re managing diabetes and other chronic health conditions.

A1C Tests This is a lab-drawn blood test that provides your doctor with information about how your blood sugar control has been over the past three months. Every time your A1C drops by a point, you cut the risk of diabetes complications by about 30 percent, Aloi says.

Responding to High or Low Blood Sugar Levels
As you learn more about living with diabetes and monitoring your blood sugar levels, you’ll experience times when your blood sugar levels are too high or too low. But don’t panic over these results, Aloi says. The complications of diabetes are caused by poor blood sugar control over the long term — typically not by the occasional short-lived elevations in your blood sugar levels. Still, it's important to be aware of the long-term effects of blood sugar that’s too high (hyperglycemia) or too low (hypoglycemia), and how it’s treated.

Hyperglycemia
Blood sugar levels that are too high for too long are considered hyperglycemia. If your blood sugar is more than 240 mg/dL, you should also check for ketones in your urine before you take steps to lower your blood sugar, according to the ADA. Rarely, someone with type 2 diabetes will develop diabetic ketoacidosis (DKA), a serious condition characterized by high blood sugar, low insulin and the presence of moderate to high ketone levels. DKA is a medical emergency and requires urgent medical care.

Ways to treat hyperglycemia include the following:
Exercise. Physical activity is a good way to bring down blood sugar. Aloi points out that 10 minutes of exercise used to be the recommendation for children with type 1 diabetes as a way to stabilize blood sugar before insulin was commonly available. But if you have high levels of ketones in your urine, hold off on exercise because it may make that situation worse. Let your doctor know if your blood sugar or ketone levels are too high for an extended period of time.

Change your diet. High blood sugar can result from eating too much or eating the wrong foods. If you’ve strayed from your diabetes diet, get back to eating healthy as your doctor recommends. Making your very next meal high in protein and fiber should help. Whatever you do, don’t fast.

Aloi notes that many people with diabetes get frustrated over their somewhat unpredictable response to food and decide not to eat in an attempt to lower blood sugar levels. Fasting causes stress, which can actually cause your blood sugar levels to go up or stay up.

Adjust your medication. Blood sugar that’s too high may call for a medication change, but only with your doctor’s advisement. Talk to your doctor about what to do in response to high blood sugar levels before you alter your medication plan.

Hypoglycemia
For many people, low blood sugar can lead to dizziness and feeling ill, and it can be extremely dangerous if it results in loss of consciousness, according to the ADA. You need about 15 grams of carbohydrates to bring your blood sugar levels up. Many people carry glucose tablets with them just in case, but 4 ounces of juice or soda, four or five crackers, or a tablespoon of honey will also do the job. Test your blood sugar again in about 20 minutes to make sure it’s back to more acceptable levels.

If you have episodes of low blood sugar, wear a medical identification bracelet or necklace in case you’re unable to treat yourself.

Some people find a formula that works well to stabilize their blood sugar and they can depend on it, day after day. For others, blood sugar levels can seem like a moving target. If this sounds like you, build a partnership with your diabetes care team — including your primary care provider, endocrinologist, nutritionist — and together you can find strategies for better blood sugar control that work for you.

Maxy Sez : What is Hyperglycemia? How to Prevent, Detect, and Treat High Blood Sugar

By Kristeen Cherney Medically Reviewed by Kacy Church, MD
Something as simple as a big meal or an intense workout can cause your blood sugar to spike, but the issue occurs when your body can’t bring your levels back down due to insulin resistance or a lack of insulin.

People with type 2 diabetes have insufficient insulin and insulin resistance, leading to hyperglycemia, or high blood sugar.Alex Luengo/Alamy
If you have to pee frequently, are constantly fatigued despite getting enough rest, or have suddenly lost weight, you may have hyperglycemia, or high blood sugar. (1)

But what exactly causes hyperglycemia, when is it dangerous, and how can uncontrolled blood sugar affect your future health?

How Is Hyperglycemia Diagnosed Exactly?
If you have insulin resistance, prediabetes, type 1 diabetes, gestational diabetes, or type 2 diabetes, your body isn’t able to use the hormone insulin correctly. Insulin is critical for regulating blood sugar levels because it helps ferry blood sugar, or glucose, to our cells and muscles for immediate energy or to store for later use.

Typically, your doctor will diagnose you with insulin resistance, prediabetes, or diabetes after seeing that your blood sugar levels are abnormal. Often, the test they’ll use is the hemoglobin A1C, or A1C test for short, says Gregory Dodell, MD, assistant clinical professor of medicine, endocrinology, diabetes, and bone disease at the Icahn School of Medicine at Mount Sinai in New York City.

A1C is a two- to three-month average of your blood sugar levels, says Dr. Dodell, explaining that the test measures the percentage of sugar that’s attached to your red blood cells. 

Here’s what your A1C result means: 

Less than 5.7 percent: normal
5.7 to 6.4 percent: prediabetes
Over 6.5 percent: diabetes
If your A1C is over 6.5 percent on two or more separate occasions, you likely have diabetes.

Dodell explains your doctor may also test your blood sugar levels through a fasting glucose test. Here’s what those results mean: 

Less than 100 milligrams per deciliter (mg/dL): normal

100 to 125 mg/dL: prediabetes (or impaired fasting glucose)

Over 125 mg/dL: diabetes

Just like A1C, if your fasting glucose level is over 125 mg/dL on two separate occasions, you likely have diabetes.

Glucose is your body’s primary energy source, which you get from many of the foods you eat, from fruit and bread to veggies and quinoa. 

While many people tend to associate high blood sugar most closely with type 2 diabetes, other conditions are linked with hyperglycemia, too.

Here’s a primer on hyperglycemia.

What Are Some of the Common Signs and Symptoms of High Blood Sugar?
If you regularly monitor your blood sugar, you’ll see elevated readings from blood or urine samples. But physical symptoms of the condition may show up as well.

In addition to frequent urination, fatigue, and sudden weight loss, symptoms of hyperglycemia may include: 

Intense hunger
Irritability
Wounds or sores that won’t heal
Increased thirst
Infections (including those in the gums, on the skin, or in the vagina) that are frequent
Ketones in the urine (ketones are byproducts of fat or muscle that appear when insulin is insufficient)
Blurry vision
Frequent headaches
What Are the Health Consequences of High Blood Sugar?
These symptoms can worsen if you don’t treat high blood sugar. Too-high blood sugar levels can even lead to a life-threatening condition called diabetic ketoacidosis, also called diabetic coma. 

During ketoacidosis, your body breaks down large amounts of fat at once, and as a result, ketones are excreted and sent to your urine. But when there are too many ketones, your body can’t keep up with this excretion process, causing ketones to accumulate in your bloodstream. Signs of ketoacidosis from high blood sugar can include dry mouth along with fruity-smelling breath, nausea, and shortness of breath. You may even have anxiety and vomiting. 

Another possible complication of high blood sugar is called hyperglycemic hyperosmolar syndrome. With this condition, your blood glucose readings may be 600 mg/dL or higher. It’s caused when you do have enough insulin, but your body’s not using it right. The glucose isn’t used up by your body, and instead transfers to your urine. Hyperglycemic hyperosmolar syndrome is considered a life-threatening emergency. Signs may include dehydration, and even coma. 

With consistently high blood sugar, you’re also at risk for several health complications down the line — from stroke and heart disease, to vision problems (retinopathy) and nerve damage (neuropathy). 

What Are the Different Causes of High Blood Sugar?
High blood sugar can be seen in various forms of diabetes, including type 1, type 2, and gestational.

People with type 1 diabetes experience high blood sugar because their bodies don’t produce insulin. On the other hand, if you have type 2 diabetes or gestational diabetes, you might have adequate insulin, but your cells and muscles can’t absorb it properly due to insulin resistance. 

But you can also develop hyperglycemia if you don’t have diabetes. In these cases, episodes of hyperglycemia are usually temporary. Your blood sugar may rise after eating a large meal or as a result of a high-endurance workout. Emotional stresses and illnesses can also cause these fluctuations. 

Are You at Risk for High Blood Sugar? How to Know
You may be at risk for high blood sugar if you have diabetes and you: 

Eat too many processed or fast foods
Don’t exercise regularly
Eat large meals, or engage in binge eating
Are under a lot of stress on a regular basis, either from work, dating, or another factor
Have recurring illnesses
People with type 1 diabetes may develop high blood sugar if they haven’t taken enough insulin, or if they have type 2 diabetes and have been prescribed insulin but the insulin isn’t working as it should. 

Genetics can also play a role, especially if you have a family history of diabetes, says Dodell. He explains that certain health conditions can raise your risk for high blood sugar, including damage to the pancreas — such as pancreatic cancer or pancreatitis — infection, pain, and polycystic ovarian syndrome, a hormone disorder that can cause infertility. (11)

The Best Foods to Eat to Help Avoid or Lower Your High Blood Sugar
While there’s no such thing as a hyperglycemia diet per se, your eating choices still play an important role in regulating your blood sugar levels.

First, know you can’t just cut all carbs or avoid foods with sugar to prevent blood sugar spikes. After all, healthy foods such as fruits and veggies also contain carbs and sugar. The value of carbs differs based on their complexity, and sugar in food is different from blood sugar.

That said, you should try to avoid these foods to help prevent blood sugar spikes: 

White bread, pasta, and rice
Packaged and processed snacks, such as chips, pretzels, cookies, and candy
Soda or juice
Fast food
Foods high in saturated fat, such as hot dogs, bacon, and sausage
Foods high in trans fats, like baked goods and margarine
Foods that can raise your cholesterol, like liver, red meat, and full-fat dairy
Tracking your carb intake, especially if you have diabetes, is also critical for avoiding blood sugar spikes.

To help keep your blood sugar levels steady, the Mayo Clinic also recommends eating fish twice a week, as well as concentrating on plant-based fats and fiber-rich foods regularly. 

Because eating large meals is a common culprit for causing blood sugar spikes, it’s best to eat smaller meals throughout the day, rather than three big meals. Cutting down on overall portion sizes can also help. 

If you do have a larger meal than normal, you may need to up your insulin dose to compensate. (5) One study found that nutritional excess in pregnant women even increased the risk of hyperglycemia and fatty liver disease in both mother and fetus. 

Consider using the plate method, which can help you control your portions, or working with a dietitian to come up with a custom meal plan for you. 

How Lifestyle Changes Can Also Help You Avoid Hyperglycemia
Exercise is one of the best ways to get rid of high blood sugar. But if you have ketoacidosis, you should not exercise but rather go to the emergency room. You’ll want to check your urine for ketones to be safe, especially if your glucose reading is 240 mg/dL or higher. 

When you exercise, your body uses glucose as its primary energy source. This, in effect, will help bring down your blood sugar levels. Working out regularly can therefore lower your A1C. (7)

The positive effects of regular exercise are unmistakable. According to the American Diabetes Association, working out can lead to blood sugar-reducing effects for up to 24 hours. (7)

Work with your healthcare provider or hire a personal trainer to figure out which exercises are best for you, based on your goals and your overall fitness level. Some exercises can affect your blood sugar more than others. For instance, high-intensity workouts, such as running or spinning, burn more glucose, while longer bouts of low-intensity exercises, like walking, burn more fat. Either option can help increase insulin sensitivity. You should also measure your sugar before and after each workout. (7)

Diabetes Medication That Can Help You Control Your Blood Sugar
If you’ve been diagnosed with diabetes, your doctor will likely discuss medication options to help bring your blood sugar down. If you have prediabetes, on the other hand, you’ll likely lean on diet and lifestyle changes to help stabilize your numbers, though in some cases, you may need medication, Dodell says.

Diabetic ketoacidosis is treated with emergency insulin and fluids administered intravenously. (5) But the goal with blood sugar control is to prevent this type of medical emergency from happening in the first place. If your blood glucose readings are consistently higher than usual, you may not be getting enough insulin. Talk to your doctor about adjusting your dosage. You should also tell them about any other prescription or over-the-counter medication you take, as these could be affect your blood sugar, too. Corticosteroids for inflammation are just one example.

If you’re receiving emergency medical treatment for high blood sugar complications, your doctor may administer fluids and electrolytes. 

How Using Technology Can Help You Keep Your Blood Sugar Levels Balanced
If you have diabetes, the American Diabetes Association recommends wearing a medical ID bracelet in case your blood sugar spikes to a dangerous range. You can even attach a USB drive to the bracelet with key personal information that a medical professional might need to help treat you in case of an emergency. 

The Takeaway on Preventing and Treating Hyperglycemia
Avoiding and treating hyperglycemia is a three-tiered process — this includes taking your treatments as directed, exercising, and eating a healthy diet with smaller portions. (5)

The effort is worth it: Getting your blood sugar under control can ultimately help increase your quality of life now and help ward off complications in the future.


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Maxy sez : Why Does Type 2 Diabetes Cause Your Feet to Go Numb?

  High blood sugar that's uncontrolled can lead to serious complications, like pain, numbness, and injury in the feet and legs.
By Jennifer Laskey   Medically Reviewed by Justin Laube, MD
If you’re concerned you may have neuropathy or if you experience cracks, pus, ulcers, or other signs of infection in your feet, please see your doctor.Chris Rout/Alamy

Numbness in the feet is a symptom of neuropathy or nerve damage, one of the most common long-term complications of type 2 diabetes. Neuropathy is caused by poor blood sugar control that persists over a long period of time.

“The higher the blood sugars and the longer they stay high, the greater the chance of the person developing neuropathy,” says Joel Zonszein, MD, director of the Clinical Diabetes Center at the University Hospital of the Albert Einstein College of Medicine, Montefiore Health System in the Bronx, New York.

“The nerves that get affected by high sugars tend to be the longest nerves in the body,” explains Dr. Zonszein. These nerves go from the spine to the toes, which is why the feet get affected before the arms or hands. Diabetic neuropathy also tends to be bilateral. “Both feet will be affected equally,” he says.

If blood sugar remains poorly controlled, it can lead to serious complications. In the feet, diabetic neuropathy can not only cause numbness but pain and injuries. It can change the shape of your feet, deforming them so they no longer fit into regular shoes. It can also dry out and damage your skin, cause calluses and ulcers on your feet, and interfere with circulation. The numbness also makes it hard to tell if there is a cut or injury which can increase your risk of infections and amputation.

People with diabetes are also at an increased risk for amputation. In 2010, approximately 73,000 non-traumatic lower-limb amputations were performed on adults (20 years or older) diagnosed with diabetes, according to the American Diabetes Association.

The good news is that most amputations are preventable when you manage your diabetes well, take good care of your feet, and wear proper footwear. If you have circulatory problems or you’ve already been diagnosed with neuropathy, you’ll benefit from seeing a podiatrist as well as your endocrinologist.

If you’re concerned you may have neuropathy or if you experience any redness, cracks, pus, ulcers, or other signs of infection in your feet, Zonszein advises going to see your doctor immediately.

The most effective way to prevent or delay diabetic nerve damage is to maintain good control of your blood sugar. Controlling blood pressure and cholesterol is also important. “Lipids [can] have an indirect effect on neuropathy,” says Zonszein.

He also emphasizes the importance of exercise and a healthy diet — and maintaining a healthy weight; which will address your overall cardiovascular and cholesterol health. “Patients who are overweight or obese tend to develop more neuropathy and more arthritic problems and pain in their feet because of the [extra] weight,” he adds.

Finally, your doctor may also want to check to make sure you don’t have a vitamin B deficiency. One of the most common medications used to treat diabetes, Metformin, can cause a deficiency in folic acid and vitamin B-12 in about 10 percent of the people who take it, warns Zonszein.

While maintaining good blood sugar control can help prevent or delay neuropathy, there is no cure once the nerves are damaged for a long period of time; the medications that are available only treat symptoms and slow the progression of the disease. However, researchers have seen some promising results in recent studies with mice. One published in the July 2015 issue of the Journal of Neurophysiology suggests that fish oil (specifically omega-3 fatty acids) may help reverse or slow the progression of diabetic neuropathy.

Overall, Zonszein says that he has been seeing less and less neuropathy, which he attributes to earlier diagnosis, better treatments, and patients working with their doctors to take charge of the disease. “People with diabetes are doing much better nowadays. We’re seeing complications less often and much later in the disease,” he says. “That’s an important message to patients."

Maxy sez : Can Thin People Get Type 2 Diabetes?

 America's growing waistlines have been linked to the rise in type 2 diabetes, but normal-weight people may still be at risk. Find out if you could be one of them.
By Beth W. Orenstein
Medically Reviewed by Lindsey Marcellin, MD, MPH
Almost 90 percent of people with type 2 diabetes are overweight or obese, according to government statistics, and it's known that carrying excess weight ups your diabetes risk. The reason is that fat interferes with your ability to use insulin — insulin moves sugar (glucose) from your blood to your cells, which need the sugar for energy. But don't think you're off the hook if you're thin — you still can be at risk for type 2 diabetes, even if you're not heavy.

The risk for developing type 2 diabetes may be smaller if you're thin, but it's still real, especially if you're older, says Christopher Case, MD, who specializes in endocrinology in Jefferson City, Mo.

It's not known exactly how many thin or normal-weight people have type 2 diabetes, but part of that may be because there is no standard definition for "thin," Dr. Case says. "They may not look obese," Case says, but any excess weight, especially around the stomach, is a risk factor.

One of the reasons people can have high blood sugar and develop diabetes whether they're thin or obese is because weight, though a contributing factor, is not the only factor.

Type 2 Diabetes Could Be in Your Genes

Genetics plays a role in developing type 2 diabetes. Studies show that people who have a close relative (parent or sibling) with type 2 diabetes have a greater than three times higher risk of developing the disease than those with no family history, Case says.

Genetics may explain why some people who are thin develop type 2 diabetes and why an obese person might not, he says.

African-Americans, Asians, Hispanics, and Native Americans also are at greater risk for type 2 diabetes.

Lifestyle Choices Raise Your Diabetes Risk 

These other risk factors, often associated with people who are overweight, can plague thin people, too:

Triglyceride levels and hypertension. Having high triglycerides, one of the lipid (fat) components, in your blood and having high blood pressure both increase  your risk.
Inactivity. If you lead a sedentary lifestyle, your risk for diabetes increases, no matter your weight.
Smoking. If you smoke, you are at higher risk for developing type 2 diabetes, regardless of your body weight. "Smokers tend to have lower body weight, and therefore you may see some thin smokers with type 2 diabetes," Case says.
4 Ways to Reduce Your Diabetes Risk

Diabetes is a serious condition that can put you at risk for a stroke or heart disease. Diabetes also can cause kidney disease and blindness. It's not something you want to deal with if you don't have to.

Here are ways to reduce your risk for developing type 2 diabetes:

Eat a healthy diet. Even if you don't need to lose weight, Case says, you want to eat a diet that is low in saturated fat and high in complex carbohydrates, such as whole grains and vegetables. Choose low-fat meats and dairy products. Limit simple sugars and saturated fats.
Get regular exercise. If you need to, you can start slow — walk just 15 minutes a day. Build up to 30 minutes a day at least five days a week. Choose an activity that  you like so that you're sure to stick with it. Find a friend to exercise with as motivation.
Manage your blood pressure. Because high blood pressure is a risk factor, it's important to keep your blood pressure within normal limits. Eat less salt in your diet, reduce stress with exercise and relaxation techniques, and limit alcohol consumption.
Quit smoking. If you're at risk for diabetes, you don't want to add to it by smoking. Smoking can raise your bad cholesterol and your blood pressure, both risk factors for diabetes. You can find a way to quit. Talk to your doctor.
Even if you are thin, you can be at risk for diabetes, especially if you smoke, have a family history of the disease, or are older. Talk to your doctor and adjust your lifestyle to lower your risk.

Maxy sez : 7 Diabetes Symptoms You Shouldn’t Ignore

It’s time to start listening to your body. Help avoid serious complications of type 2 diabetes by knowing the warning signs.
By Beth W. Orenstein
Medically Reviewed by Farrokh Sohrabi, MD
Blood sugar that’s consistently out of whack increases your risk of health problems throughout your body, including your heart, blood vessels, eyes, kidneys, and nerves. Resulting complications could lead to disabling, even life-threatening, conditions — and that’s why, if you have type 2 diabetes, practicing good diabetes management and maintaining blood sugar control is a must.

Being aware of possible complications and their symptoms is one of the first steps to successfully managing diabetes, says Gerald Bernstein, MD, director of the diabetes management program at Mount Sinai Beth Israel Hospital in New York City. Educating yourself may help you delay or prevent complications from happening.

Start here, by reading about seven signs of diabetes complications that should never be ignored.

Confusion, dizziness, and shakiness:
 These symptoms are often a sign of low blood sugar (hypoglycemia). “People describe it as feeling nervous or anxious,” says Lori Zanini, RD, CDE, a spokeswoman for the Academy of Nutrition and Dietetics.  Blood sugar is usually considered low when it falls below 70. If left untreated, blood sugar that goes too low could cause you to pass out and need emergency medical treatment.

If you feel any of the symptoms of hypoglycemia, check your blood sugar. If your number is less than 70, eat 15 grams of carbohydrate such as 3 glucose tablets, 4 ounces of orange juice, or 2 tablespoons of raisins. Wait 15 minutes and then check your blood sugar again. If it hasn’t gone above 70, eat 15 more grams of carbohydrate, wait 15 minutes, and recheck your blood sugar. If you continue to experience symptoms, call your doctor or seek medical treatment. Zanini advises carrying hard candy or glucose tablets with you so you can react as soon as you feel yourself getting shaky.

Excessive urination and thirst:
 Conversely, thirst and a consistent need to urinate could be signs that your blood sugar is too high. Over time, high blood sugar (hyperglycemia) can lead to serious complications, including kidney damage, heart disease, and nerve damage. You can help prevent and treat high blood sugar by exercising, following your diabetes meal plan, and taking your medications as prescribed. If you continue to experience episodes of high blood sugar, work with your doctor to see if you need to make lifestyle changes or adjustments to your treatment plan.

Call your doctor or seek medical treatment if your blood sugar levels remain high for a prolonged period of time. If left untreated, high blood sugar could lead to severe complications that require emergency care, such as diabetic coma.

Blurry vision and pressure in your eyes:
 Uncontrolled diabetes can increase your risk for several eye conditions, including diabetic retinopathy, glaucoma, and cataracts. If left untreated these conditions can lead to vision loss and eventually cause blindness. It’s important to have regular eye exams and report any concerns to your eye doctor between visits. Call your doctor if you experience a sudden change in vision, or if you have blurry vision, floaters, or pressure in your eyes.

Wounds that don’t heal. Diabetes decreases blood flow, and uncontrolled diabetes can result in poor circulation. This can keep wounds from healing because nourishing blood cells can’t get where they're needed. Wounds can turn into ulcers and sores that could become infected. And if they get serious enough, infections may need amputation. Regularly inspect your body, especially your feet, for cuts or bruises and treat them immediately, before they have a chance to worsen. See your doctor if your wound becomes infected or doesn’t heal.

Loss of feeling in your feet :
Neuropathy, or nerve damage from poor circulation, especially in your limbs, is a diabetes complication that can prevent you from feeling heat or cold or a cut on your foot that could then go untreated. Always wear good fitting shoes, inspect your limbs down to each toe and the soles of your feet every day, and seek medical attention for problems that won’t go away.

Swelling of hands, face, feet, and ankles. Swelling can be a sign that your kidneys aren’t functioning properly. Other symptoms of kidney malfunction may include upset stomach, weakness, difficulty sleeping, and difficulty concentrating, according to the American Diabetes Association. Poorly functioning kidneys can be life-threatening — they don’t filter waste from your blood as they should. Keep your blood pressure and your blood sugar within your target ranges to avoid damaging your kidneys, and have your doctor regularly monitor your kidney function with blood tests.

Chest, jaw, or arm pain :
These symptoms may be signs of heart attack, says Linda Siminerio, RN, PhD, CDE, director at the University of Pittsburgh Diabetes Institute and a professor at the University of Pittsburgh School of Medicine. Diabetes can weaken your blood vessels and allow plaque to build up in your arteries. Plaque can break off and damage your heart muscle, resulting in a heart attack or, if the plaque goes to the brain, a stroke. Heart attacks and strokes are the leading cause of death for people with diabetes, according to the National Diabetes Information Clearinghouse. If you suspect you're having a heart attack, call 911. “Seek medical attention immediately," Siminerio says.

Work as a Team to Manage Diabetes :

You and your team of health care providers — which may include your doctor, an endocrinologist, eye doctor, podiatrist, diabetes educator, nutritionist, and others — should be working together to manage your diabetes and prevent complications. “It takes a village to manage diabetes,” Siminerio says. “Living healthy and eating healthy can make a dramatic difference in good diabetes management.”

Maxy sez : When Is Low Blood Pressure Too Low?

Some people naturally have low blood pressure, known as hypotension. However, when high blood pressure suddenly becomes low blood pressure, it could be cause for concern.
By Krisha McCoy      Medically Reviewed by Michael Cutler, DO, PhD
Low numbers may be the sign of dehydration or nutrient deficiencies.Alamy
Low blood pressure, or hypotension, may be a sign of good health and of a decreased risk of heart disease. But not always. At times, continually low blood pressure or a sudden drop in blood pressure can lead to worrisome symptoms and even serious health problems.

Understanding Hypotension
A blood pressure reading contains two numbers: systolic pressure and diastolic pressure. Systolic pressure is the top or first number in your blood pressure reading; it indicates the pressure within your arteries when your heart pumps out blood. Diastolic pressure is the bottom number, and shows the pressure in your arteries while your heart is filling with blood.

If your blood pressure is 120/80 millimeters of mercury (mm Hg) or lower, it’s considered normal. Generally, if the blood pressure reading is under 90/60 mm Hg, it is abnormally low and is referred to as hypotension. Some adults regularly have a blood pressure in the hypotensive range, but have no symptoms at all and do not require treatment. In serious cases, though, hypotension can result in a decreased supply of oxygen and nutrients to your brain, which can eventually lead to life-threatening shock.

Anyone can develop hypotension, but certain groups of people are more likely to experience it, and there are different types. For instance, orthostatic (positional) hypotension, which occurs when you stand up after sitting or lying down, is more common in older adults. Typically, “your body has certain compensatory mechanisms to prevent your blood pressure from falling when you stand up,” explains Willie Lawrence, MD, an interventional cardiologist at Research Medical Center in Kansas City, Missouri, and a spokesperson for the American Heart Association. But, he adds, “orthostatic hypotension is a problem for some people because these reflexes that should occur, don’t occur.”

Symptoms of Hypotension
Most doctors do not consider hypotension a problem unless it is associated with certain signs and symptoms, which may include:
Dizziness
Fainting
Fatigue
Problems concentrating
Blurry vision
Nausea
Clammy, pale skin
Shortness of breath
When Low Blood Pressure Can Strike
Some people have naturally low blood pressure, and they don't experience any symptoms. But for those who are used to having high blood pressure, episodes of low blood pressure can signal a problem and can cause the symptoms listed above.

An onset of hypotension is more likely to occur when you:

Are on bed rest for a long period of time, and then resume an upright posture
Are in your first 24 weeks of pregnancy
Have lost a large amount of blood
Are dehyrdrated
Are taking certain medications, such as blood pressure lowering medications; certain heart medications; certain Parkinson's disease medications; tricyclic antidepressants; or medications to treat erectile dysfunction
Have a heart problem, such as a very slow heart beat, heart valve problems, heart attack, or heart failure
Have an endocrine problem, such as hypothyroidism, parathyroid disease, Addison's disease (an adrenal gland disorder), low blood sugar, or diabetes
Have a severe infection that enters your blood stream
Are experiencing anaphylaxis, a life-threatening allergic reaction
Have a neural disorder that affects your blood pressure
Have a nutrient deficiency, such as low vitamin B12 and folic acid levels

When Do You Need Medical Care for Hypotension?
If your blood pressure is always on the low side and you do not have any of the above symptoms, there is usually no cause for concern. Similarly, if you have a single at-home blood pressure reading that is abnormally low without any symptoms, you probably do not need to see your doctor. It is normal for your blood pressure to rise and fall over time, and your body is usually able to get your blood pressure back to normal.

But, says Dr. Lawrence, “when you sense there’s a recurrent problem, or there’s no clear explanation for what’s happened, you need to seek medical advice."

If your blood pressure drops suddenly and you are experiencing symptoms like dizziness, you should call your healthcare provider. They can assess your situation and rule out underlying problems, such as internal bleeding, serious infection, or allergic reaction.

Treatment for hypotension will depend on the cause of the low blood pressure. Immediate steps might include:

Lying with your feet above your heart
Drinking fluids
Avoiding hypotension triggers like prolonged standing
After evaluation by a doctor, recommendations may include:

Avoiding alcohol
Adjusting your diet
Adjusting your medications (possibly lowering dosages)
Taking blood pressure raising medications, such as fludrocortisone (Florinef) and midodrine (ProAmatine)
Wearing compression stockings
People who experience shock related to hypotension will need emergency treatment to restore blood flow to their organs and raise their blood pressure back to normal.

It’s important to determine whether your low blood pressure is “a primary problem or secondary problem,” notes Lawrence. A primary problem means that the body’s reflexes are not working as they should. Secondary causes mean that the low blood pressure is a result of things like dehydration or the effects of certain medications. “Some anti-hypertensive [medications] are more likely to cause hypotension than others, and a lot of it is dose-dependent,” says Lawrence. “In most people, there will be some easily identifiable secondary cause, or some easy solution to what may even be a chronic problem that has no secondary cause, and that’s why it’s important to see your doctor, so they can make an appropriate assessment.”

Keep track of your blood pressure readings, even if you don’t have any health issues, so that you know what your personal “normal” reading is. And if your blood pressure is being monitored, talk to your doctor about the blood pressure target range that’s best for you.