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All Diabetes Alerts
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Insulin: You’ve Got Choices
Approximately 40% of people with type 2 diabetes eventually require some type of insulin treatment to control their blood glucose, either because their diabetes gets worse or it no longer responds to oral drugs. Many people with type 2 diabetes take insulin in combination with a sulfonylurea, metformin, or a thiazolidinedione. More...
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The Challenge of “Brittle” Diabetes
An important goal of diabetes treatment is tight glucose control, which means keeping your blood glucose level as close to normal as possible. But staying in good control is difficult, especially for people with “brittle” diabetes. What does this old-fashioned term mean? More...
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Microalbuminuria: What It Means
There are many causes of kidney disease, but having diabetes is a common one. Both elevated blood glucose and high blood pressure (another frequent problem among those with diabetes) damage blood vessels in the kidneys, just as they harm blood vessels throughout the body. In fact, a vicious cycle may develop. As your kidneys weaken, blood pressure often rises, and that in itself damages the kidneys further. More...
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"Bloodless" Glucose Testing: Where We Stand
Self-testing of blood glucose with a blood glucose meter is one of the central elements of caring for your diabetes. But results from many studies indicate that people with diabetes should be more aggressive in their daily monitoring of blood glucose levels if they want to reduce their risk of diabetes complications. Recently a reader asked us: Is there a way to check your blood glucose level that doesn't require a needle prick? Here’s what we know … More...
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Promising Therapies for Macular Edema
Laser therapy, also called laser photocoagulation, is more effective and produces fewer side effects than corticosteroids injected into the eye for the treatment of diabetic macular edema according to a large, two-year multicenter study reported in the journal Ophthalmology (Volume 115, page 1447). Here’s what the study revealed. More...
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Battling Blood Pressure: How Low Should You Go?
Many people with diabetes are unaware of the number one threat to their health: cardiovascular disease. In fact, one survey found that 68% of people with diabetes did not consider cardiovascular disease as a serious potential complication, focusing instead on vision, nerve, and kidney disease. A recent study looks at cardiovascular disease, blood pressure, and diabetes …
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Is Diabetes in Your Genes?
Approximately 24 million people in the United States have diabetes. In fact, in the United States, nearly 10% of adults age 20 and older have diabetes. And a large number -- more than 10 million -- are age 60 or older. If you’re in this huge group, you may wonder if you inherited your diabetes. Here’s the answer, in brief. More...
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Are Your Feet at Risk?
If you have diabetes, it’s critically important to pay attention to your feet. Shoes that rub or pinch can cause foot ulcers, a major diabetic complication. In fact, one study says that ill-fitting shoes are the most common precipitator of foot ulcers. And if not detected and treated early, foot ulcers can become infected and even lead to amputation. More...
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Preventing Hypo- or Hyperglycemia During Exercise
Everyone knows that regular physical activity is essential for good health, and research continues to prove that's especially true if you have diabetes. An analysis of more than 100 studies involving nearly 10,500 participants found that individuals with diabetes who were physically active had lower HbA1c levels (hemoglobin A1c test is used to assess blood glucose control of the previous two or three months) than those who did not exercise. More...
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Should You Take Avandia for Diabetic Retinopathy?
If you have diabetic retinopathy, what can you do to slow its progression? Of course, tight blood glucose control lessens the risk that retinopathy will get worse. And treating other conditions, such as high blood pressure and abnormal cholesterol levels, may also slow progression. What about Avandia? A reader asks: I’ve heard that the diabetes medication Avandia can slow the progression of diabetic retinopathy. Should everyone with this condition be taking it? More...
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Why You Should Consider Insulin Therapy For Type 2 Diabetes
Approximately 40% of people with type 2 diabetes eventually require some type of insulin treatment to control their blood glucose, either because their diabetes gets worse or it no longer responds to oral drugs. But now a study in The Lancet suggests that starting insulin early may do more than just control diabetes – it may induce remission in type 2 diabetes. More...
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Meet the Diabetes Nurse Educator
If you have diabetes, you probably rely on your endocrinologist or primary care physician for the basics of your treatment plan, including diet and medications. Increasingly, however, the day-to-day management of diabetes falls to a diabetes nurse educator, a person with a Certified Diabetes Educator (CDE) credential. In this Health Alert, Johns Hopkins explains the role of the nurse educator. More...
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Diagnosing Diabetes with the HbA1c Blood Test
Type 2 diabetes usually develops gradually over many years and the initial symptoms may be almost unnoticeable. In fact, many people find out that they have type 2 diabetes when a routine laboratory test shows high blood glucose levels. Increasingly endocrinologists are using the hemoglobin A1c (HbA1c) test -- which is now used to monitor glucose control in existing patients -- to diagnose diabetes. More...
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Why Is My Blood Glucose High?
Keeping blood glucose levels within normal range can be a frustrating challenge for someone with diabetes. Many patients wonder: Why do my blood glucose levels sometimes go up for seemingly no reason? Here are some insights from Johns Hopkins. More...
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Keeping Tabs on Your Glucose 24-7
Several high-tech devices can monitor glucose levels 24 hours a day rather than at just one point in time, giving you unprecedented information on how well you are managing your diabetes. Most useful to avoid hypoglycemic episodes in those whose diabetes requires insulin, continuous monitoring can benefit all individuals with either type 1 or type 2 diabetes. But is a continuous glucose monitor really right for you? Here's information to help you decide. More...
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What Is the Glycemic Index?
If you have diabetes, you may be wondering, 'What is the glycemic index, and should I use it to help control my blood glucose levels?' In this Health Alert, Johns Hopkins endocrinologist Dr. Christopher D. Saudek sheds light on this controversial topic. More...
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More Good News About Exercise and Diabetes
Should you exercise if you have diabetes? The answer is a resounding, 'Yes.'
A recent study found that people with type 2 diabetes who walked three miles a day -- or performed an equivalent amount of physical activity -- lost weight and lowered their heart rate, blood pressure, cholesterol and triglyceride levels, and HbA1c. … More...
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Your Guide to Key Diabetes Lab Tests and Physical Exams
If you have diabetes, you are not alone. It is estimated that 21 million people in the United States have diabetes –- 90-95% of these people have type 2 diabetes. The good news is that diabetes is very treatable. Despite your diabetes, you can lead a normal, productive life if you stay in good control and see your doctor regularly. In this Health Alert, Johns Hopkins provides a checklist of tests for people with diabetes. … More...
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Am I a Good Candidate for an Insulin Pump?
Insulin pumps are primarily used by people with type 1 diabetes, but more type 2 diabetes patients are starting to use the pump. The biggest advantage of the insulin pump is improved blood glucose control. For example, in a four-month study of 79 people with diabetes, pump users had an average HbA1c level that was 0.8 percentage points lower than that of people on injected insulin therapy. In this Health Alert Johns Hopkins experts answer… More...
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Focus on Gastroparesis
Delayed emptying of the stomach, called gastroparesis, has several possible causes but usually is a complication of diabetes.
Gastroparesis -- literally 'paralyzed stomach' -- is a serious condition manifested by delayed emptying of stomach contents into the small intestine after a meal. There is no cure for gastroparesis, but treatment can speed gastric emptying and relieve gastrointestinal symptoms. … More...
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Putting Your Feet First
Do you take good care of your feet? Many people with diabetes don't and risk foot ulcers or worse. In this Health Alert Johns Hopkins specialists provide the essentials of good foot care for people with diabetes.
People with type 2 diabetes are at higher risk for slow-healing foot injuries that can become infected and progress to amputation. The underlying reasons are poor blood flow to the extremities and less sensation to pain due to… More...
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If the Shoe Fits, Wear It
If you have diabetes, it's particularly important to take good care of your feet and to always wear comfortable, well-fitting shoes. Here are some tips to keep in mind.
Foot health or fashion fetish -- you make the call. If you have diabetes, it would be wise to put your feet first and take a pass on attractive but ill-fitting shoes. What would otherwise be a small blister that heals in a few days could, in… More...
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Myths and Misconceptions About Insulin Therapy
It's unfair. You followed your doctor's orders -- ate a healthy diet and exercised -- yet you still need insulin for your diabetes. Many people with diabetes who need insulin view it with concern, fear, or even panic. If you feel this way, here is a discussion of some myths and misconceptions about insulin therapy, which may make you feel more comfortable about starting this treatment. … More...
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Nutrition and Diabetes -- Taking the Mystery Out of Mealtime
Michelle Bravo, diabetes educator at the Johns Hopkins Comprehensive Diabetes Center, talks about the basics of good nutrition for people with diabetes.
When you were diagnosed with diabetes, one of your first questions probably was: What should I eat? An excellent question, because more than any other health problem, diabetes requires careful attention to your diet, including what foods you choose and how much and when you eat them. Here is some nutritional information you'll want… More...
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Using a Continuous Glucose Monitor
People with diabetes are encouraged to check their blood glucose levels frequently. And now the availability of the continuous glucose monitor (a sensor device) makes testing easier and less painful.
Self-testing of blood glucose with a blood glucose meter is the backbone of diabetes management. Results from the Diabetes Control and Complications Trial (DCCT) indicate that people with diabetes should be more aggressive in their daily monitoring of blood glucose levels if they want to reduce… More...
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The Deadly Duet
For every five-point increase in blood pressure, your risk of a heart attack or stroke increases by 20–30%. Add in having diabetes, and that risk is two to four times higher. Diabetes also increases the risk of developing kidney and eye disease. And having high blood pressure makes these two diabetes complications even more likely. So it’s no wonder that some experts refer to diabetes and hypertension as the “deadly duet.” More...
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Older Is Better
Johns Hopkins researchers compare 10 of the top type 2 diabetes medications and give metformin the top grade.
Metformin, a type 2 diabetes drug taken orally and in widespread use for more than a decade has been found to have distinct advantages over nine other, mostly newer medications used to control the chronic type 2 diabetes, according to a study by researchers at Johns Hopkins. … More...
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Diabetes and Memory Impairment
The link between type 2 diabetes and poorer cognitive functioning may be due to wide swings in post-meal (postprandial) blood sugar (glucose) levels, an Italian study suggests.
Researchers studied 156 older people with type 2 diabetes. The participants were between the ages of 60 and 78 and were taking either repaglinide (Prandin) or glyburide… More...
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Is Stress Reduction the Missing Step in Your Diabetes Plan?
Controlling stress may help improve your blood glucose control. Biofeedback, yoga, or another stress-reduction technique may help.
If you’re a chronic worrier or blow your cool too easily, take heed: All that fretting and fussing may be bad for your blood glucose levels. Psychological stress as well as anxiety can distract you from following a healthy glucose-control regimen and can produce changes in your body chemistry that make diabetes more difficult to manage. … More...
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Focus on Fiber
Researchers discover that insoluble fiber may improve insulin sensitivity.
If you have diabetes, you probably know that the right diet can help keep your blood glucose levels in check and help prevent obesity, high blood pressure, and elevation of blood lipids (total cholesterol, LDL cholesterol, and triglycerides), all of which increase your risk of developing diabetes complications. … More...
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What Causes Type 1 Diabetes?
Researchers are still trying to identify the risk factors that lead to type 1 diabetes. It’s possible that combined genetic susceptibility and an environmental trigger – perhaps a virus – may cause this serious autoimmune disease.
When our bodies are humming along smoothly, we rarely think about all the complex processes that are going on. But when we don’t feel well and we’re unable to perform our usual activities, we want to know what’s causing the… More...
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Research Findings on Diabetes, Alzheimer's Risk, and Vision Problems
Diabetes Update 1 -- High Levels of Insulin May Increase Alzheimer's Risk
Elevated levels of insulin can cause inflammation in the brain that may increase the risk of Alzheimer’s disease (AD). This finding was reported in the Archive Of Neurology (Volume 62, page 1539).
Researchers studied 16 healthy adults aged 55–81 years who were given a high dose of insulin by infusion one day and a saline placebo infusion another day. Both days, participants gave… More...
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Research on the Impact of Stress and Adiponectin on Blood Glucose Levels
Diabetes Update 1: Stress Increases Glucose Levels After Meals In People with Type 1 Diabetes
When people with type 1 diabetes experienced an acute psychological stress after eating, their glucose levels dropped at an abnormally slow rate, this study in Diabetes Care (Volume 28, page 1910) showed. Moderate stress didn’t affect glucose concentrations when people with type 1 diabetes were fasting. … More...
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Recognizing and Treating Hypoglycemia
Patients with diabetes who take insulin are susceptible to hypoglycemia (low blood glucose) when they administer too much insulin, delay or miss a meal, exercise without first eating a snack, or drink alcohol on an empty stomach. But insulin treatment isn’t the only cause of hypoglycemia. More...
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Nonadherence and Diabetes - An Update
A national study suggests that only a small number of Americans with diabetes have key health markers under control -- putting them at risk for complications such as heart disease, stroke, and kidney failure. Government researchers found that among 441 adults with diabetes included in a periodic national health study, only 7.3% had their blood glucose, blood pressure, and cholesterol at recommended levels. More...
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Balancing Carbohydrates and Type 2 Diabetes
Studies indicate that eating carbohydrates along with foods containing protein can markedly increase the body’s insulin production.
If you have type 2 diabetes, the right diet can help keep your blood glucose levels in check and help to prevent obesity, high blood pressure, and elevation of blood lipids (total cholesterol, LDL cholesterol, and triglycerides), all of which increase your risk of developing diabetes complications.
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Yet Another Good Reason to Eat More High-Fiber Foods
Eating high-fiber foods slows digestion and helps to prevent a rapid rise in blood sugar.
Efforts to prevent type 2 diabetes are especially important for people with known risk factors for developing the disease, such as those with prediabetes, obesity, a family history of diabetes, and a personal history of diabetes during pregnancy (gestational diabetes). The risk of diabetes is also elevated among blacks, Hispanics, Asians, and Native Americans. More...
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Closing the Loop on the Insulin Pump
The marriage of the insulin pump and the new continuous glucose sensor could result in a true artificial pancreas in the not-too-distant future.
The insulin pump has been available in the U.S. for people with diabetes since the 1980s. The insulin pump delivers a small amount of insulin into the body throughout the day and also allows you to deliver a larger (bolus) dose before meals. Manufacturers of the insulin pump are introducing new features that could enable insulin pump users to get better results.
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Should You Be Taking Byetta?
Byetta (Exenatide), an injected drug for type 2 diabetes, has been approved by the FDA for use in combination with orally administered diabetes drugs. Byetta is prescribed for people who have not achieved optimal glycemic control with metformin, sulfonylurea drugs, or combined metformin-sulfonylurea therapy. In a study of 336 people with inadequately controlled type 2 diabetes, researchers randomly assigned half of the group to self-administered injections of Byetta twice a day at a dose of either 5 or 10 micrograms. More...
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Controlling Medication-Related Weight Gain
Some diabetes drugs have an unwanted side effect -- excess pounds.
Diabetes medications that help control blood glucose levels are essential for people with type 2 diabetes. Unfortunately, insulin, sulfonylureas, and thiazolidinediones can cause weight gain -- a special concern for many people with type 2 diabetes who are already overweight or obese. Despite the potential for weight gain, these medications are valuable treatments for type 2 diabetes, and when used properly More...
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How To Control Blood Glucose Levels During an Illness
Getting sick (even a cold or flu) can trigger a rise in blood glucose levels. Knowing what steps to take to control glucose can help you feel better and stay in good control!
People with diabetes must be especially careful when suffering from an illness like a cold or the flu. Illness not only affects your eating, sleeping, and exercise—habits closely linked to blood glucose control—it may cause the liver to make and release glucose into… More...
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Taking Care of Diabetes Foot Problems
People with diabetes need to pay special attention to their feet for a number of reasons. Diabetes-related nerve damage can reduce feeling in the feet, making it difficult to detect a foot injury. Diabetes can also impair blood circulation and wound healing by narrowing the arteries supplying blood to the legs. A wound on the foot that does not heal can turn into an ulcer (deep sore) that may become infected and possibly even require an amputation if untreated.
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