Archive for the ‘Recently Diagnosed’ Category

Anger

Friday, October 5th, 2007

Diabetes is the perfect breeding ground for anger. Anger can start at diagnosis with the question, “Why me?” You may dwell on how unfair diabetes is: “I’m so angry at this disease! I don’t want to treat it. I don’t want to control it. I hate it!”

One reason diabetes and anger so often go hand in hand is that diabetes can make you feel threatened. Life with diabetes can seem full of dangers – insulin reactions or complications. When you fear these threats, anger often surges to your defense.

While it’s true that out-of-control anger can cause more harm than good, that’s only part of the story. Anger can also help you assert and protect yourself. You can learn to use your anger. You can even put it to work for better diabetes care.

Anger and Self-Care

Anger worked against Mary H., a woman in her mid-fifties who was diagnosed with diabetes six months ago. She was furious. She saw diabetes as not just a threat to her health, but also to her whole way of life. A very proud woman, active in community and social affairs, she found it impossible to be open about her “weakness.” She didn’t want her friends to prepare special foods for her. She even felt her husband now saw her as an “invalid” and that she was “less of a woman” to him. Denial fueled Mary’s anger at diabetes.

The Anger Circle

Mary was stuck in an anger circle. She was angry at diabetes for changing her life. She refused to face her health care needs because she refused to change her life. Her diabetes went uncared for and her blood sugar levels stayed high. As the disease went on poorly controlled, Mary felt worse. Her anger at diabetes grew.

If you find yourself in an anger circle, like Mary, you don’t have to stay stuck. One way to break the circle comes from Dr. Weisinger’s Anger Work Out Book by Hendrie Weisinger, PhD. He suggests you do three things:

1. Figure out what’s making you angry. How is that anger affecting your life? Keep track of when you feel angry. Each evening, think back over the day. When were you angry? What time was it? Who were you angry at? What did you do about it?

After several weeks, read over your notes. See any patterns? When Mary read her anger diary, she learned that social situations made her angry. She did not like talking about her diabetes in public. She felt angry if friends asked her what she could eat or made special food. When she and her husband tried to go out with friends, she felt her diabetes was the center of attention.

2. Change the thoughts, physical responses, and actions that fuel your anger. Look for warning signs that your anger is building. Do you feel tense? Are you talking louder and faster? When you feel anger taking over, calm yourself by:

  • talking slowly
  • slowing your breathing
  • getting a drink of water
  • sitting down
  • leaning back
  • quieting yourself. Silence is golden in these situations.

These steps don’t mean you stop feeling angry. Instead, they mean you are taking charge of your anger.

3. Find ways to make your anger work for you. Your anger diary can help. Read your notes again. Look at each situation. Ask yourself – How was my anger helping me cope? Mary decided her anger was helping her avoid talking about her diabetes with others. She decided to try answering questions in a matter-of-fact way. But she found that talking about diabetes in public still made her furious.

Mary’s anger told her something very important. She still hadn’t accepted having diabetes. To get more support, she joined her local American Diabetes Association. Meeting other people with diabetes helped her feel less alone. She also realized that having diabetes did not make her less of a person.

Slowly, she was able to enjoy her friends again. She was able to talk openly about her disease and also tell her friends that she didn’t want special treatment.

Let anger be your ally

The goal is not to get anger out of your life. You may go on feeling angry about the same things. When you feel threatened, afraid, or frustrated, anger is a normal response. But you can put your anger to work for you. Your anger may be a signal that you need to take action. A few sessions with a skilled counselor might help.

Anger can be a force for action, change, and growth. The better you understand your anger, the better you will be able to use it for good self-care.

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Gastroparesis

Thursday, October 4th, 2007

Gastroparesis is a disorder affecting people with both type 1 and type 2 diabetes, where the stomach takes too long to empty its contents. It happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.

Just as with other types of neuropathy, diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves.

Signs and Symptoms

Signs and symptoms of gastroparesis (delayed gastric emptying) are:

  • heartburn
  • nausea
  • vomiting of undigested food
  • an early feeling of fullness when eating
  • weight loss
  • abdominal bloating
  • erratic blood glucose (sugar) levels
  • lack of appetite
  • gastroesophageal reflux
  • spasms of the stomach wall

These symptoms may be mild or severe, depending on the person.

Complications of Gastroparesis

Gastroparesis can make diabetes worse by making it more difficult to manage blood glucose. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise.

If food stays too long in the stomach, it can cause problems like bacterial overgrowth because the food has fermented. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine.

Diagnosis

The diagnosis of gastroparesis is confirmed through one or more of the following tests.

Barium X-ray

After fasting for 12 hours, you will drink a thick liquid containing barium, which covers the inside of the stomach, making it show up on the X-ray. Normally, the stomach will be empty of all food after 12 hours of fasting. If the X-ray shows food in the stomach, gastroparesis is likely. If the X-ray shows an empty stomach, but the doctor still suspects that you have delayed emptying, you may need to repeat the test another day. On any one day, a person with gastroparesis may digest a meal normally, giving a falsely normal test result. If you have diabetes, your doctor may have special instructions about fasting.

Barium Beefsteak Meal

You will eat a meal that contains barium, which allows the doctor to watch your stomach as it digests the meal. The amount of time it takes for the barium meal to be digested and leave the stomach gives the doctor an idea of how well the stomach is working. This test can help find emptying problems that do not show up on the liquid barium X-ray. In fact, people who have diabetes-related gastroparesis often digest fluid normally, so the barium beefsteak meal can be more useful.

Radioisotope Gastric-Emptying Scan

You will eat food that contains a radioisotope, a slightly radioactive substance that will show up on the scan. The dose of radiation from the radioisotope is small and not dangerous. After eating, you will lie under a machine that detects the radioisotope and shows an image of the food in the stomach and how quickly it leaves the stomach. Gastroparesis is diagnosed if more than half of the food remains in the stomach after two hours.

Gastric Manometry

This test measures electrical and muscular activity in the stomach. The doctor passes a thin tube down the throat into the stomach. The tube contains a wire that takes measurements of the stomach’s electrical and muscular activity as it digests liquids and solid food. The measurements show how the stomach is working and whether there is any delay in digestion.

Blood tests

The doctor may also order laboratory tests to check blood counts and to measure chemical and electrolyte levels.

To rule out causes of gastroparesis other than diabetes, the doctor may do an upper endoscopy or an ultrasound.

Upper Endoscopy

After giving you a sedative, the doctor passes a long, thin tube called an endoscope through the mouth and gently guides it down the esophagus into the stomach. Through the endoscope, the doctor can look at the lining of the stomach to check for any abnormalities.

Ultrasound

To rule out gallbladder disease or pancreatitis as a source of the problem, you may have an ultrasound test, which uses harmless sound waves to outline and define the shape of the gallbladder and pancreas.

Treatment

The most important treatment goal for diabetes-related gastroparesis is to manage your blood glucose levels as well as possible. Treatments include insulin, oral medications, changes in what and when you eat, and, in severe cases, feeding tubes and intravenous feeding.

Insulin for blood glucose control

If you have gastroparesis, your food is being absorbed more slowly and at unpredictable times. To better manage blood glucose, you may need to

  • take insulin more often
  • take your insulin after you eat instead of before
  • check your blood glucose levels frequently after you eat and administer insulin whenever necessary

Your doctor will give you specific instructions based on your particular needs.

Medication

Several drugs are used to treat gastroparesis. Your doctor may try different drugs or combinations of drugs to find the most effective treatment.

Meal and Food Changes

Changing your eating habits can help control gastroparesis. Your doctor or dietitian will give you specific instructions, but you may be asked to eat six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. Or the doctor or dietitian may suggest that you try several liquid meals a day until your blood glucose levels are stable and the gastroparesis has improved. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

The doctor may also recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion — a problem you do not need if you have gastroparesis — and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars.

Feeding Tube

If other approaches do not work, you may need surgery to insert a feeding tube. The tube, called a jejunostomy tube, is inserted through the skin on your abdomen into the small intestine. The feeding tube allows you to put nutrients directly into the small intestine, bypassing the stomach altogether. You will receive special liquid food to use with the tube. A jejunostomy is particularly useful when gastroparesis prevents the nutrients and medication necessary to regulate blood glucose levels from reaching the bloodstream. By avoiding the source of the problem (the stomach) and putting nutrients and medication directly into the small intestine, you ensure that these products are digested and delivered to your bloodstream quickly. A jejunostomy tube can be temporary and is used only if necessary when gastroparesis is severe.

It is important to note that in most cases treatment does not cure gastroparesis — it is usually a chronic condition. Treatment helps you manage gastroparesis, so that you can be as healthy and comfortable as possible.

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Diabetes and Pregnancy

Wednesday, October 3rd, 2007

You have the good fortune to live when you do. Health care providers no longer discourage women with diabetes from becoming pregnant.

We now know that the key to a healthy pregnancy for a woman with diabetes is keeping blood glucose (sugar) in the target range — both before she is pregnant and during her pregnancy. To do this, you need a diabetes treatment plan that keeps meals, exercise, and insulin in balance. This plan will change as you change with pregnancy. You will also need to check your blood glucose often and keep a record of your results. With your blood glucose in the target range and good medical care, your chances of a trouble-free pregnancy and a healthy baby are almost as good as they are for a woman without diabetes.

Before Pregnancy
Find out what precautions a person with diabetes needs to take before getting pregnant.

Good Prenatal Care
Learn how to take care of yourself and your baby when you have diabetes and you are pregnant.

Delivery
Find out what to expect when you deliver your baby.

After Delivery
Get tips on breastfeeding and how to take care of yourself after delivery.

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Pre-diabetes

Tuesday, October 2nd, 2007

Before people develop type 2 diabetes, they almost always have “pre-diabetes” — blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. There are 54 million people in the United States who have pre-diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes.

Research has also shown that if you take action to manage your blood glucose when you have pre-diabetes, you can delay or prevent type 2 diabetes from ever developing. Together with the National Institute of Diabetes and Digestive and Kidney Diseases, the American Diabetes Association published a Position Statement on “The Prevention or Delay of Type 2 Diabetes” to help guide health care professionals in treating their patients with pre-diabetes.

There is a lot you can do yourself to know your risks for pre-diabetes and to take action to prevent diabetes if you have, or are at risk for, pre-diabetes. The American Diabetes Association has a wealth of resources for people with diabetes. People with pre-diabetes can expect to benefit from much of the same advice for good nutrition and physical activity. The links on this page are cornerstones of successful management of pre-diabetes.

How to Tell if You Have Pre-Diabetes
Learn how you may be at risk for pre-diabetes.

How to Prevent Pre-Diabetes
Pre-diabetes is a serious medical condition that can be treated. The good news is that the recently completed Diabetes Prevention Program study conclusively showed that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity.

Frequently Asked Questions about Pre-Diabetes
How do I know if I have pre-diabetes? What is the treatment for pre-diabetes? Learn the answers to these questions and more in this section.

Common Concerns
In this section, learn more about common concerns that people with diabetes face every day. These include what happens when you’re sick, and when you travel, should you get a flu/pneumonia shot, and dealing with feelings like anger and depression.

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Recently Diagnosed – Type 2

Monday, October 1st, 2007

If you or someone you care for has recently been diagnosed with diabetes, you are no doubt experiencing a range of emotions. Fear, anger, denial, frustration, depression and uncertainty are just a few of them, and are very common. You are not alone. This area of our Web site can help ease your fears and teach you more about living with diabetes, caring for someone with diabetes, and connect you with others affected by diabetes who will listen and share their own experiences.

Finding out you or someone you love has diabetes is scary. But don’t panic. Diabetes is serious, but people with diabetes can live long, healthy, happy lives. The links below will direct you to basic information, expert advice and peer support.

Straight Answers About Type 2 Diabetes

Find answers to common basic concerns associated with being recently diagnosed, and learn about diabetes conditions, treatments and complications.

Type 2 diabetes
Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin.

Pre-diabetes
Before people develop type 2 diabetes, they almost always have “pre-diabetes” — blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes.

Diabetes Myths
Find the truth about some of the most common myths about diabetes.

Common Concerns
This section addresses various areas to help you live with type 2 diabetes. What do you do when you’re sick? What do you do when you travel? Can you get a flu shot with diabetes? How do you cope with having type 2 diabetes? Are you being discriminated against because you have diabetes? You’ll find answers to these questions, and more in this section.

Managing Your Diabetes

Health Information For Women
Learn how to help ensure the health and well-being for yourself.

Health Information For Men
Learn how to help ensure the health and well-being for yourself.

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