Posts Tagged ‘Type 1 diabetes’

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Pancreas transplantation

Sunday, November 18th, 2007

In people with type 1 diabetes, the islet cells in the pancreas no longer produce insulin. So it seems logical that giving a new pancreas to a person with type 1 diabetes would cure their disease. Usually it does.

But the cure can be worse than the disease. The body has a complex system for telling its own parts from foreign parts. To fool the body into accepting the donor organ, doctors try to match the donor and recipient for a blood protein called human leukocyte antigen (HLA) type. Patients with a transplanted organ must take immunosuppressive drugs in order to prevent the immune system from fighting the new organ. The side effects of these drugs may be worse than the problems caused by diabetes, and the operation itself is serious. One to two people in 10 die within a year of getting a pancreas transplant. However, there are situations where a person has such severe complications from diabetes that having a pancreas transplant and taking these immunosuppressive drugs is no worse. People with kidney transplants have to use these drugs anyway so, for these people, pancreas transplants can be worthwhile.

When the transplant takes, the patient no longer has diabetes and is unlikely to get it again. Insulin shots and frequent blood glucose testing are no longer necessary. Restoring normal blood glucose levels may stop complications from worsening, although many more studies are needed.

Pancreas transplants can be rejected, and roughly half of them are. Pancreases attached so that they drain into the bladder are rejected less often than pancreases attached in other body sites. When a transplant fails, the person gets diabetes again.

Remember that pancreas transplants work only for people with type 1 diabetes. The major problem in people with type 2 diabetes isn’t a failing pancreas, but the body’s inability to respond to insulin in the right way.

Partial pancreas transplantation

Unfortunately, there are not enough cadaver pancreases to go around because not enough people sign up to be organ donors, and each pancreas must meet strict guidelines. When a whole cadaver pancreas is not available, a person can receive a portion of a pancreas from a living relative.

When a patient with diabetes is receiving a kidney transplant from a living relative, it is usually beneficial to perform a partial pancreas transplant at the same time. Since the transplanted kidney will become damaged by diabetes over time, transplanting a partial pancreas from the same donor will help control blood glucose levels and protect the new kidney from further damage. Transplant success seems higher when patients and donors are matched for HLA types, and a pancreas transplanted along with a kidney is less likely to fail than a pancreas transplanted alone.

Benefits and risks

Pancreas transplants are safest in people who do not have heart or blood vessel disease. Before you get a transplant, your doctor will check your circulatory system to see if it is healthy enough to risk the operation.

As with any operation, the healthier you are, the better you can withstand the physical stress of surgery. Possible side effects of surgery include bleeding and infection.

Immunosuppressive drugs are hard on the body, but people who get transplants must take these drugs the rest of their lives. Azathioprine and cyclosporine, two commonly used drugs, make it more likely for you to get infections and have other side effects. You will need to avoid people who have infections, such as a cold or the flu. Also, you should not be immunized without first checking with your doctor. These drugs can also damage the kidneys. For example, using either of these medicines for many years could increase your risk for some cancers.

A recenty study (JAMA, 2003) has indicated that, for patients with functioning kidneys, survival rates of patients who receive pancreas-only transplants are worse than the survival rates of patients who manage their diabetes with conventional therapy (insulin, diet, etc.). Therefore, the decision to have a pancreas-only transplant should be very carefully considered by both the patient and physician. Because of the lower survival rates seen with pancreas-only transplants, and because a pancreas transplanted along with a kidney is less likely to fail than a pancreas transplanted alone, pancreas transplants are nearly always done only in people with type 1 diabetes who are getting or already have a transplanted kidney.

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Posted in Conditions & Treatments, Pancreas transplantation, Transplantation | 1 Comment »

Taking Aspirin to Protect Your Heart

Sunday, November 18th, 2007

What are the benefits of taking aspirin?

Studies have shown that taking a low-dose aspirin every day significantly lowers the risk of heart attacks. Aspirin can benefit people at high risk of a heart attack, such as those with diabetes and other risk factors such as high blood pressure. It can also help people with diabetes who have had a heart attack or a stroke, or who have heart disease. However, aspirin’s effects have not been studied in people under age 30.

How does aspirin lower my risk for a heart attack?

Exactly why aspirin works is not completely understood, but it may be because it helps keep red blood cells from clumping together. These cells seem to clump together more readily in people with diabetes. When blood cells clump, a blood clot can form and narrow or block a blood vessel. This can lead to a heart attack or stroke.

Is aspirin safe for everyone?

Taking a daily low-dose aspirin is not safe for everyone — it’s best to ask your health care provider whether you should take aspirin. In some people, aspirin can irritate the lining of the stomach, resulting in pain, nausea, vomiting, or bleeding. You should avoid taking aspirin if:

  • you’re allergic to it
  • you have a tendency to bleed
  • you’ve recently had bleeding from your digestive tract
  • you have liver disease that’s currently active
  • you’re under 21 years of age

Check with your health care provider to see if aspirin therapy is right for you.

How much aspirin should I take every day?

Your health care provider can suggest the lowest possible dosage for you. Most people take a pill containing a dosage between 75 and 162 milligrams. The low-dose version may be labeled “baby aspirin.”

What form of aspirin is recommended?

Some health care providers recommend the enteric-coated form of aspirin. This form of aspirin is coated with a substance that allows it to pass through the stomach without dissolving. Instead, the aspirin is absorbed in the intestine, decreasing the risk of side effects.

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Taking Care of Your Heart

Wednesday, November 14th, 2007

Maybe your health care provider has told you that you are at high risk for heart disease. Or, perhaps you already have had a heart attack. Having diabetes means that you are much more likely to have coronary artery (heart) disease, a heart attack, or a stroke.

The good news is that you can take steps to prevent heart disease or reduce your chances of having another heart attack. Lifestyle changes, such as choosing foods wisely and being physically active, as well as taking medication can help.

What is coronary artery disease?

Coronary artery disease is caused by a narrowing or blocking of the blood vessels that go to your heart. It’s the most common form of heart disease. Your blood carries oxygen and other needed materials to your heart. Blood vessels to your heart can become partially or totally blocked by fatty deposits. A heart attack occurs when the blood supply to your heart is reduced or cut off.

What steps can I take to prevent coronary artery disease?

You can lower your risk by keeping your ABCs of diabetes on target with wise food choices, physical activity, and medication. Losing weight can also help you manage your ABCs and prevent heart disease. Every step you take will help. The closer your numbers are to your targets, the better your chances of preventing heart disease or cutting your risk for another heart attack. If you smoke, get help to quit.

A is for A-1-C

An A-1-C is the blood glucose (sugar) check “with a memory.” It tells you your average blood glucose for the past 2 to 3 months. The American Diabetes Association (ADA) recommends that people aim for an A-1-C below 7.

B is for blood pressure

Your blood pressure numbers tell you the force of blood inside your blood vessels. When your blood pressure is high, your heart has to work harder than it should. The ADA recommends that you keep your blood pressure below 130/80 (said as “130 over 80”) mmHg.

C is for cholesterol

Your cholesterol numbers tell you the amount of fat in your blood. Some kinds, like HDL cholesterol, help protect your heart. Other kinds, like LDL cholesterol, can clog your blood vessels and lead to heart disease. Triglycerides are another kind of blood fat that raises your risk for heart disease.

What can I do to reach my ABC targets?

Making wise food choices, being physically active, and taking medications can help you reach your targets.

Make wise food choices

Many people find that changing what they eat can make a big difference in their blood glucose, blood pressure, and cholesterol levels. Below are several strategies for making wise food choices. Determine which ones you would be willing to try. For more information about how to make these changes, talk with your health care team.

· I’ll eat less fat, especially saturated fat (found in fatty meats, poultry skin, butter, 2% or whole milk, ice cream, cheese, palm oil, coconut oil, trans fats, hydrogenated oils, lard, and shortening).

· I’ll choose lean meats and meat substitutes.

· I’ll switch to low-fat or fat-free dairy products.

· I’ll eat at least 5 servings of fruits and vegetables each day.

· I’ll cut back on foods that are high in cholesterol (such as egg yolks, high-fat meat and poultry, and high-fat dairy products).

· I’ll choose the kinds of fat that can help lower my cholesterol, such as olive oil or canola oil. Nuts also have a healthy type of fat.

· I’ll eat fish two or three times a week, choosing kinds that are high in heart-protective fat (such as albacore tuna, herring, mackerel, rainbow trout, sardines, and salmon).

· I’ll cook using low-fat methods (such as baking, roasting, or grilling foods or by using nonstick pans and cooking sprays).

· I’ll eat more foods that are high in fiber (such as oatmeal, oat bran, dried beans and peas like kidney beans, fruits, and vegetables).

· I’ll eat less salt and sodium.

Lose weight or take steps to prevent weight gain

· I’ll cut down on calories and fat.

· I’ll try to be more physically active than I am now.

Be physically active

Before you start a new routine, check with your health care team to find out which activities will be safe for you. Then think about how you can add more activity to your routine. If you’re just starting out, begin with 5 minutes a day and gradually add more time. Then work up to doing a total of about 30 minutes of aerobic exercise, such as brisk walking, most days of the week.

Take medications

Medications are available to help you reach your ABC targets and lower your risk of another heart attack. You may need several medications to stay on track.

Some types of blood pressure and cholesterol-lowering medications can protect your heart. Your health care provider can provide information about which medications are best for you.

Aspirin can also help lower your risk of heart disease. Ask your provider whether taking a low-dose aspirin every day would be wise.

What can help me quit smoking?

If you’re ready to quit, talk with your health care team. They can help you find ways to quit. Joining a support group or smoking-cessation program can also help.

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Ketoacidosis

Tuesday, November 13th, 2007

Ketoacidosis (key-toe-ass-i-DOE-sis) is a serious condition that can lead to diabetic coma (passing out for a long time) or even death. Ketoacidosis may happen to people with type 1 diabetes.

Ketoacidosis occurs rarely in people with type 2 diabetes. But some people — especially older people — with type 2 diabetes may experience a different serious condition. It’s called hyperosmolar nonketotic coma (hi-per-oz-MOE-lar non- key-TOT-ick KO-ma).

Ketocidosis means dangerously high levels of ketones. Ketones are acids that build up in the blood. They appear in the urine when your body doesn’t have enough insulin. Ketones can poison the body. They are a warning sign that your diabetes is out of control or that you are getting sick.

Treatment for ketoacidosis usually takes place in the hospital. But you can help prevent ketoacidosis by learning the warning signs and checking your urine and blood regularly.

What are the warning signs of ketoacidosis?

Ketoacidosis usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. The first symptoms are:

  • Thirst or a very dry mouth
  • Frequent urination
  • High blood glucose (sugar) levels
  • High levels of ketones in the urine
  • Next, other symptoms appear
  • Constantly feeling tired
  • Dry or flushed skin
  • Nausea, vomiting, or abdominal pain (Vomiting can be caused by many illnesses, not just ketoacidosis. If vomiting continues for more than 2 hours, contact your health care provider.)
  • A hard time breathing (short, deep breaths)
  • Fruity odor on breath
  • A hard time paying attention, or confusion

 

Ketoacidosis is dangerous and serious. If you have any of the above symptoms, contact your health care provider IMMEDIATELY, or go to the nearest emergency room of your local hospital.

 

How do you know if you have large amounts of ketones?

A simple urine test can detect ketones. You use a test strip, like a blood testing strip. Ask your health care provider when and how you should test for ketones. Many experts advise to check your urine for ketones when your blood glucose is more than 240 mg/dl.

When you are ill (when you have a cold or the flu, for example), check for ketones every 4 to 6 hours. And check every 4 to 6 hours when your blood glucose is more than 240 mg/dl.

Also, check for ketones when you have any symptoms of ketoacidosis.

What if you find higher-than-normal levels of ketones?

If your health care provider has not told you what levels of ketones are dangerous, then call when you find moderate amounts after more than one test. Often, your health care provider can tell you what to do over the phone.

Call your health care provider at once if:

  • Your urine tests show large ketones
  • Your urine tests show large ketones and your blood glucose level is high
  • You have vomited more than twice in four hours and your urine tests show high ketones

Do NOT exercise when your urine tests show ketones and your blood glucose is high. High levels of ketones and high blood glucose levles can mean your diabetes is out of control. Check with your health care provider about how to handle this situation.

What causes ketoacidosis?

Ketones mean your body is burning fat to get energy. Moderate or large amounts of ketones in your urine are dangerous. They upset the chemical balance of the blood.

Commonly, the flu, a cold, or other infections may sometimes bring on ketoacidosis.

Here are three basic reasons for moderate or large amounts of ketones:

  1. Not getting enough insulin. Maybe you did not inject enough insulin. Or your body could need more insulin than usual because of illness. If there is not enough insulin, your body begins to break down body fat for energy.
  2. Not enough food. When people are sick, they often do not feel like eating. Then, high ketones may result. High ketones may also occur when someone misses a meal.
  3. An insulin reaction (low blood glucose). When blood glucose levels fall too low, the body must use fat to get energy. If testing shows high ketones in the morning, the person may have had an insulin reaction while asleep.
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Foot Complications

Sunday, November 11th, 2007

People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications.

Foot problems most often happen when there is nerve damage, also called neuropathy, which results in loss of feeling in your feet. Poor blood flow or changes in the shape of your feet or toes may also cause problems.

Neuropathy

Although it can hurt, diabetic nerve damage can also lessen your ability to feel pain, heat, and cold. Loss of feeling often means you may not feel a foot injury. You could have a tack or stone in your shoe and walk on it all day without knowing. You could get a blister and not feel it. You might not notice a foot injury until the skin breaks down and becomes infected.

Nerve damage can also lead to changes in the shape of your feet and toes. Ask your health care provider about special therapeutic shoes, rather than forcing deformed feet and toes into regular shoes.

Skin Changes

Diabetes can cause changes in the skin of your foot. At times your foot may become very dry. The skin may peel and crack. The problem is that the nerves that control the oil and moisture in your foot no longer work.

After bathing, dry your feet and seal in the remaining moisture with a thin coat of plain petroleum jelly, an unscented hand cream, or other such products.

Do not put oils or creams between your toes. The extra moisture can lead to infection. Also, don’t soak your feet – that can dry your skin.

Calluses

Calluses occur more often and build up faster on the feet of people with diabetes. This is because there are high-pressure areas under the foot. Too much callus may mean that you will need therapeutic shoes and inserts.

Calluses, if not trimmed, get very thick, break down, and turn into ulcers (open sores). Never try to cut calluses or corns yourself – this can lead to ulcers and infection. Let your health care provider cut your calluses. Also, do not try to remove calluses and corns with chemical agents. These products can burn your skin.

Using a pumice stone every day will help keep calluses under control. It is best to use the pumice stone on wet skin. Put on lotion right after you use the pumice stone.

Foot Ulcers

Ulcers occur most often on the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by your health care provider right away. Neglecting ulcers can result in infections, which in turn can lead to loss of a limb.

What your health care provider will do varies with your ulcer. Your health care provider may take x-rays of your foot to make sure the bone is not infected. The health care provider may clean out any dead and infected tissue. You may need to go into the hospital for this. Also, the health care provider may culture the wound to find out what type of infection you have, and which antibiotic will work best.

Keeping off your feet is very important. Walking on an ulcer can make it get larger and force the infection deeper into your foot. Your health care provider may put a special shoe, brace, or cast on your foot to protect it.

If your ulcer is not healing and your circulation is poor, your health care provider may need to refer you to a vascular surgeon. Good diabetes control is important. High blood glucose levels make it hard to fight infecton.

After the foot ulcer heals, treat your foot carefully. Scar tissue under the healed wound will break down easily. You may need to wear special shoes after the ulcer is healed to protect this area and to prevent the ulcer from returning.

Poor Circulation

Poor circulation (blood flow) can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. You can control some of the things that cause poor blood flow. Don’t smoke – smoking makes arteries harden faster. Also, follow your health care provider’s advice for keeping your blood pressure and cholesterol under control.

If your feet are cold, you may be tempted to warm them. Unfortunately, if your feet cannot feel heat, it is easy for you to burn them with hot water, hot water bottles, or heating pads. The best way to help cold feet is to wear warm socks.

Some people feel pain in their calves when walking fast, up a hill, or on a hard surface. This condition is called intermittent claudication. Stopping to rest for a few moments should end the pain. If you have these symptoms, you must stop smoking. Work with your health care provider to get started on a walking program. Some people can be helped with medication to improve circulation.

Exercise is good for poor circulation. It stimulates blood flow in the legs and feet. Walk in sturdy, good-fitting, comfortable shoes. Don’t walk when you have open sores.

Amputation

People with diabetes are far more likely to have a foot or leg amputated than other people. The problem? Many people with diabetes have artery disease, which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation. Most amputations are preventable with regular care and proper footware.

For these reasons, take good care of your feet and see your health care provider right away about foot problems. Ask about prescription shoes that are covered by Medicare and other insurance. Always follow your health care provider’s advice when caring for ulcers or other foot problems.

One of the biggest threats to your feet is smoking. Smoking affects small blood vessels. It can cause decreased blood flow to the feet and make wounds heal slowly. A lot of people with diabetes who need amputations are smokers.

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