• Diabetic Amyotrophy

    Approximately one percent of people with diabetes develop diabetic amyotrophy. Also, referred to as proximal diabetic neuropathy, this is a type of peripheral nerve disease. It is a diabetes complication that affects the nerves, mostly affecting the thighs, buttocks, hips and lower legs. The symptoms that occur are the result of damage to these nerves in these areas of the body. While rare, all people with diabetes mellitus should know about diabetic amyotrophy, so that they can tell when it is time to see their doctor.

     

    CAUSES OF THIS TYPE OF DIABETIC NEUROPATHY

    The majority of people who develop this condition have Type 2 diabetes and are over age 50. Men develop it more often than women. It is caused by nerve damage that can result from high blood sugar levels. Because of this, people with uncontrolled Type 2 diabetes are at the highest risk for diabetic amyotrophy.

    When blood sugar levels remain high over time, this can cause damage to nerves throughout the body. Glucose levels that are high over a prolonged period of time may also cause issues with how the nerves send signals throughout the body. In addition, the capillaries can also experience damage from prolonged high glucose levels. These blood vessels are responsible for sending nutrients and oxygen to the nerves. Without adequate nutrients and oxygen, the nerves eventually become damaged.

     

    POSSIBLE SYMPTOMS

    Once symptoms begin, they tend to progress over time. Then, over months or years, they gradually lessen. However, most people will continue to have at least some symptoms to some degree over the long-term. The following are possible symptoms of this type of diabetic neuropathy:

    • Sudden pain in the buttocks, hips or thighs that can sometimes be severe

    • Losing reflexes in your lower limbs, such as the knee-jerk reflex, when the doctor is testing your reflexes by tapping your knee

    • Weight loss that is unintentional

    • Leg weakness that can make it hard to stand up when you are seated

    • Losing muscle tissue in the affected areas, such as your thighs

     

    In most cases, only one side of the body is affected. However, in rare cases, the condition may start to affect the other side of the body. Those with this condition tend to experience the symptoms in the lower body, from the hips down. The pain is usually one of the first symptoms. It may not be severe enough when it starts to cause alarm, but can become severe over time.

    GETTING A DIAGNOSIS

    To diagnose diabetic amyotrophy, doctors start with a full medical history that includes evaluating how well your diabetes is managed. Doing an A1c blood test can tell your doctor about the management of your blood sugar levels over approximately three months. If the test and other information indicates that your blood sugar levels have been uncontrolled, this can provide some insight regarding the cause of your pain, weakness and other symptoms.

    Two tests that may be ordered include electromyography and nerve conduction studies. Electromyography looks at your muscle health and the health of the nerves that are responsible for controlling them. This test involves strategically inserting thin needles into the affected muscles. The doctor will look at a monitor to get information about your muscle's electrical activity. You may be asked to flex the muscle being tested during the exam.

    In most cases, nerve conduction studies are performed during the same visit. This test measures how quickly electrical signals are traveling through a nerve. Instead of thin needles, this test uses patches that are placed over the nerves that are being tested. A monitor provides the doctor with information regarding the speed of the nerve signals so that they can determine if there are abnormalities.

     

    TREATMENT OPTIONS

    Treating this condition is the same as treating peripheral neuropathy. There are different medications and therapies that may be helpful. In many cases, your doctor will prescribe more than one treatment to help to control your symptoms. The following medications might be considered:

    • Over-the-counter pain medicines may be recommended to reduce your discomfort. To help with pain related to inflammation, medicines like naproxen or ibuprofen might be recommended.

    • Antidepressants may help with nerve pain.

    • Anti-seizure medicines affect your nerves to reduce associated pain.

    • Topical medicines, such as capsaicin cream, might be helpful to reduce pain. In some cases, a lidocaine patch could be used, since it can numb a small area that is especially painful.

     

    Your doctor might also recommend different therapies for this condition. Physical therapy is common, especially if your weakness or pain are moderate to severe. This therapy involves different exercises that can improve your pain, mobility and weakness. In some cases, occupational therapy might also be recommended if your symptoms are making it difficult to perform your usual daily activities. Other types of therapy that might be helpful include:

    • Intravenous immune globulin and plasma exchange might be considered if physical therapy and medications are not reducing your symptoms enough. This therapy works to suppress immune activity.

    • Transcutaneous electrical nerve stimulation may help with pain. It involves using different frequencies of a gentle electric current to affect your nerves.

     

    PREVENTION METHODS

    There is no way to 100 percent prevent this diabetes complication. However, keeping your blood sugar levels in check can reduce your risk significantly. The first step is monitoring your glucose levels regularly so that you can determine if they are getting too high. You should also take all of your medications exactly as directed. If your treatment regimen is not keeping your blood sugar levels within the healthy range, talk to your doctor about making adjustments. Other ways to help to maintain healthy blood sugar levels include:

     

    • Exercise most days of the week to increase insulin sensitivity, allowing your body to use blood glucose more effectively

    • Reduce your intake of carbohydrates, and when you do eat carbohydrates, stick to complex carbohydrates since these will not cause an acute spike in your glucose levels (examples of complex carbohydrates include whole grains, beans and lentils)

    • Eat more fiber to reduce how quickly your body absorbs sugar and digests carbohydrates to reduce blood sugar spikes

    • Stay hydrated by drinking plenty of water to aid your kidneys in essentially flushing out excess glucose

    • Eat smaller portions more frequently to better regulate your blood sugar levels

    • Keep your stress under control since glucose levels can be negatively affected by excessive stress

    • Make sure to get enough sleep to ensure better insulin sensitivity

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  • 1CC Syringe

    If you have diabetes and are insulin dependent, it is important that you have syringes that can accommodate the dosages that you need to inject. The syringes that you use should also be easy to handle and to read so that you can be sure that you are always properly dosing your insulin. If you are getting too much or too little of the medicine, this could have a negative impact on your blood sugar levels. Learning more about a 1cc syringe ensures that you have the knowledge necessary to determine if this is the best syringe size for you.

     

    READING A PLASTIC SYRINGE

    When you get your insulin syringes, it is important to look at the markings carefully. Different manufacturers may design their syringes differently, causing the markings to look different. It is important that you can read the markings clearly so that you are drawing up the proper insulin dose each time. If you switch to a different brand, look at a syringe when you are still at the pharmacy so that if you have questions, the pharmacist can help to ensure that you are reading the markings correctly.

    One cubic centimeter (cc) equals one milliliter (mL). So, when you draw up one cc of insulin, you are drawing up one mL of insulin. Since insulin is typically measured in units, it is important to know how these numbers translate to units of insulin. When you draw up one unit of insulin, this is equal to 0.1 milliliters. One cc or one mL of insulin is equal to 100 units of insulin.

     

    IS YOUR INSULIN SYRINGE THE RIGHT SIZE?

    An insulin syringe that can hold 1cc is ideal for those who need to inject 50 to 100 units of insulin in a single dose. To determine if 1cc is the right size for you, make note of the insulin doses that you inject regularly. If your average dose is 30 to 50 units of insulin, for example, a ½-cc syringe is generally sufficient. However, if you are administering higher doses at least a few times a week, it makes sense to move up to a syringe that holds 1cc because this will result in you needing to do fewer injections.

     

    WHAT IS THE BEST NEEDLE FOR YOUR INSULIN SYRINGES?

    A syringe and needle work together to allow you to inject your insulin, so it is imperative that they are compatible. When you are using a 1cc syringe, you have options regarding the best type of needle. There are several factors to consider regarding needles, and once you determine which factors apply to you, it will be much easier to choose a needle and properly inject your insulin

    Insulin needles come in varying lengths, with the average being about eight to 12.7 millimeters. Since insulin is meant to be injected into your body's subcutaneous tissue, a needle that is eight millimeters is usually sufficient. However, adults who are larger might need a longer needle to ensure that the insulin gets into the proper area. Your doctor will help you choose a needle length that works best with your body type.

    The next factor to consider is the width of the needle which is measured by its gauge. When the gauge measurement is higher, this means that the needle is actually thinner. For example, a 31 gauge is thinner than a 30 gauge. Insulin needles are typically 28 to 31 gauge. This gauge range will work with any syringe that holds 1cc of insulin, so you can choose the gauge that is the most comfortable for you.

     

    HOW TO DRAW INSULIN INTO A SYRINGE

    It is imperative that you draw insulin into your syringe properly. By doing this, you are using a safe technique and ensuring that you are getting the full dose of insulin. Proper drawing up of your insulin will also make it easier to ensure that you are pulling the proper dose into the syringe. Follow these steps when you draw up your insulin into your syringe:

    • Wash and dry your hands

    • Place the insulin vial between your hands and roll it approximately 10 times

    • Use an alcohol swab to wipe off the top of the insulin vial

    • Attach your syringe and needle if they are not already attached

    • Draw air into the syringe that is equal to how much insulin you will draw into the syringe (for example, if you will be injecting 10 units of insulin, draw 10 units of air into the syringe)

    • Place the needle into the insulin vial and inject the air

    • Turn the vial upside down and carefully draw the proper units of insulin into your syringe

    • Withdraw the needle and syringe from the vial

    • Inspect the syringe for air bubbles and remove them by flicking the plastic syringe in the area where the bubbles are present

     

    PROPER STEPS TO INJECT YOUR INSULIN USING A NEEDLE AND SYRINGE

    Once you have your insulin dose drawn into your diabetes syringe, it is time to inject it. You should not fill your syringe until you are ready to inject. You need to use the proper injection technique to make the process as comfortable as possible. This will also make sure that you are getting the full dose of insulin in the syringe. Use the following steps to inject your insulin:

    • Choose a place on your upper arm, side of your thigh or abdomen to inject your insulin

    • Avoid areas where you have bruising or a wound

    • Use an alcohol swab to clean your skin at the injection site

    • Using your index finger and thumb, pinch the injection site gently (use your non-dominant hand for this)

    • Hold the needle and syringe straight and insert it into the pinched skin (use your dominant hand to hold the needle and inject your insulin)

    • Push the plunger on the syringe to inject the insulin into your body

    • Leave the needle in your skin for approximately five seconds

    • Withdraw the needle from your skin

    • Apply gentle pressure to the injection site for about 10 seconds so that none of the insulin that you just injected will leak out

    • Dispose of your syringe and needle properly

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  • Diabetes Bag

    Living with diabetes can present a variety of challenges. Having your diabetes supplies available at all times makes it easier to maintain your blood sugar levels. A diabetes bag makes it easy to have all of your diabetes accessories and supplies in one convenient place. Learning about the bags that are available and what to put in them helps to ensure that you are always able to manage your diabetes no matter where you are.

    WHAT TYPES OF BAGS ARE AVAILABLE?

    There are several bag options to carry your diabetes supplies. If you want to carry your supplies hands-free, consider one that is in the style of a backpack or a fanny pack. These should zip up so that none of your supplies fall out when you are moving around. If you carry a handbag, consider one that will fit inside to minimize how many bags you have to carry with you.

    You might also consider a hard case, especially if your insulin comes in a glass vial. A hard case will protect the vials against breakage if you accidentally drop it. These usually snap shut so that the contents remain secure. Some hard cases will be divided into different compartments, allowing you to organize your supplies in a way that allows you to access everything quickly.

    These bags come in multiple sizes. You should consider the items that you need to take with you. For example, when taking multiple medications for diabetes, you will likely need a larger bag than someone who only needs to carry a vial of insulin and a few syringes. You can set your items out and take some measurements to get a general idea about the best size of bag to hold all of your diabetes supplies.

    WHAT SHOULD YOU PUT IN YOUR DIABETES CASE OR BAG?

    There are several diabetic accessories that you should include in your compact diabetes case. You want to have all of the items you need to maintain your glucose levels and check them. To start preparing your diabetes case, you should make a list of the essentials so that you do not forget anything. The following items should be put in a supply bag for diabetes:

    • Your diabetes medications, including any insulin vials, insulin pens or pills that you are taking

    • Alcohol swabs and bandages for when you need to test your blood sugar

    • Your glucose meter with test strips and lancets

    • Backup batteries for your blood glucose monitor

    • A card that includes the type of diabetes you have, the medicines that you take and your doctor's contact information

    • Small sugary snacks for times when your blood sugar gets too low

    • Needles and syringes if you use insulin

    • A small flashlight so that you can see your diabetes kit in the dark

     

    HOW TO PACK A DIABETES BACKPACK

    Once you choose a diabetes bag that fits your needs and you have all of your supplies ready, it is time to pack it. You should have enough of your medication to get you through at least 24 hours to be safe and when you are going to be away longer than this, carry enough medication for as long as you will be gone plus two days to give yourself a little extra just in case you get delayed returning home. You should have two lancets and test strips for each test. For example, when you test twice a day, you need four lancets and four test strips per day. This gives you extra just in case you need to repeat a blood sugar test.

    Ensure some diversity regarding the foods that you bring with you. For example, bring some fresh fruit, some hard candy and some glucose tablets just in case your blood sugar gets too low. Pack enough alcohol swabs and bandages to cover each blood sugar check that you need to perform. Make sure that your bag has a little extra room so that if you remember something that you need to add at the last minute, your bag will be able to accommodate it.

    KEEPING YOUR INSULIN COOL IN YOUR DIABETES TRAVEL CASE

    Insulin contains preservatives to keep it fresh and effective. However, if your insulin gets too warm, it will eventually no longer work. After insulin remains in an environment with too high of a temperature for too long, the protein will start to break down as bacteria starts to grow in the liquid. You should keep your insulin at 36 to 46 degrees Fahrenheit to keep it safe to use.

    When you are home, keep your insulin vials in your refrigerator. You should not keep it in your diabetes supply bag 24/7. When you are out, you can use cold packs to maintain a safe temperature for your insulin vials. There are bags that are insulated that will help to keep your insulin cool for longer. Also, when you use insulin pens, follow the storage and travel instructions that come with them to keep them safe.

     

    ENSURING THAT YOUR DIABETES TRAVEL BAG MEETS TSA STANDARDS

    When you plan to travel by airplane, you need to ensure that your diabetes travel bag meets all TSA standards so that you can carry it on the plane with you. Since your diabetes supplies often include needles and syringes, sharp lancets and prescription drugs, you need to ensure that you are following all TSA regulations or else you might have some trouble when you are trying to board. Use the following as a guide to ensure that your diabetes case passes TSA inspection:

    • Insulin: If you take insulin, it is imperative that you have it on the plane with you. Be careful because when you put it in a bag that you check, the temperature and pressure changes in the luggage area on a plane could negatively affect your insulin. The TSA allows you to bring insulin on board even if it exceeds their rule of no liquids over 3.4 ounces. However, the prescription information should be clearly visible so that they know that it is legally prescribed to you. This is especially important for international travel. You are also allowed to bring cold packs to keep your insulin at the proper temperature.

    • Glucagon: You should carry this in its pharmaceutically labeled container to get it onto a plane.

    • Needles and syringes: You can bring these on a plane, but you need to have the prescription from your doctor with you. It is best to bring the box that these diabetes supplies come in since it will have the pharmaceutical label.

    • Lancets: Your lancets should be with your glucose monitor when you fly. They must have the manufacturer label attached and be capped to pass airport security.

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  • Insulin Pen Needles

    Safely administering your insulin in the most convenient way possible is important. This helps to ensure that you get your doses on time and that the amount of insulin that you are taking is within the prescribed range. Insulin has to be injected, but you have some options and one of these is insulin pen needles. These needles work with a device that looks and functions similar to a pen. For some people, these are easier to use than a traditional needle and syringe for injecting insulin.

    WHAT IS A PEN NEEDLE FOR INSULIN?

    Pen needles are becoming a more popular way to inject insulin. For some people, this insulin delivery method is easier compared to having to draw up insulin and use a normal needle and syringe to inject the medication. These needles attach to a pen that holds the insulin. The needles themselves are hollow, allowing the insulin to come through them.

    There is a plastic hub that the needle is embedded in. The plastic part is what attaches to the pen. They may snap into place or screw on, depending on the pen needle and pen that you are using. Once the needle is attached to the pen, you will follow the instructions for the pen to inject the insulin into your body.

     

    WHO SHOULD CONSIDER A PEN NEEDLE FOR INSULIN?

    Unless you need to self-mix your insulin, you can usually use a pen needle to inject insulin. These devices are especially ideal for people who need to inject insulin several times per day. Some people see insulin pens as less scary compared to a normal syringe and needle, making it easier to inject insulin as needed throughout the day. The following are other advantages of using a pen needle for insulin:

    • It is easier to carry a pen and pen needle with you when you need to inject insulin away from your home

    • Most types of insulin can be injected using these devices

    • The dosage is more precise, resulting in less insulin being wasted

    • You will not have to draw up your own insulin, allowing for better control over the dosage

    • You use a dial on the pen to determine the insulin dosage

    WHAT ARE THE SIZES FOR PEN NEEDLES?

    Insulin pen needles come in different sizes, allowing you to choose the one that is the easiest for you to use. When determining the right size, you have to consider the gauge and length of the pen needle. Millimeters are used to measure the needle's length. The lengths range from four to 12.7 millimeters, with four millimeters being the shortest needle available. The thickness of the needle is the gauge. The higher the number, the thinner the needle. For example, a needle that is 27 gauge, is thicker than one that is 32 gauge.

    DO YOU NEED TO PRIME A PEN NEEDLE FOR INSULIN?

    You must prime your pen before you inject your insulin. This ensures that there is no air that will inject with the insulin. When your pen is properly primed, you will get the correct dose of insulin. Air in the needle may cause you to get too much or too little of the medicine, which could negatively affect your blood sugar levels. You should follow the instructions that come with your pen to ensure that you have it primed properly and always prime the needle before every injection.

    WHAT ARE THE DIFFERENT TYPES OF INSULIN?

    Your doctor may prescribe more than one type of insulin, depending on what controls your blood sugar levels the best. There are five types of injectable insulin. It is important to understand what these are so that you know why your doctor prescribed a specific type of insulin. The five insulin types that are injected include:

    • Rapid-acting: They peak in about 30 to 90 minutes, start working in under 15 minutes and the total duration is approximately three to five hours.

    • Intermediate-acting: They peak in about eight hours, start working in one to three hours and the total duration is approximately 12 to 16 hours.

    • Regular: They peak in about two to four hours, start working in 30 to 60 minutes and have a total duration of three to five hours.

    • Long-acting: They have little to no peak, start working in about one hour and have a total duration of approximately 20 to 26 hours.

    • Pre-mixed/combination: These are a combination of regular and intermediate insulin. The peak time, start time and duration depend on the exact combination of insulins.

    WHEN AND HOW DO YOU INJECT INSULIN USING A PEN NEEDLE?

    Pen needles for insulin are used according to the prescription that your doctor provides. Some people need to inject insulin more often than others. In most cases, you will check your blood sugar, and this will determine the dose of insulin that you need to inject. Your doctor will give you a chart and when you get your blood sugar reading, it will tell you what dose you need to inject at that glucose level.

    For long-acting insulins, you may inject these on a regular schedule. Then, your doctor will give you a short-acting insulin to help to bring down your blood sugar levels when they get too high. You will use the same technique with a pen needle no matter which type of insulin you are injecting. If the needle is eight millimeters or longer, lift the skin before injecting the insulin. For needles that are six millimeters or shorter, you do not have to lift the skin.

    Before you inject your insulin, you should use an alcohol swab to cleanse the injection site and wash your hands with water and soap. Ensure that the needle is properly attached to the pen by following the instructions that come with these items. Determine if you need to lift your skin based on the length of the pen needle for insulin that you are using. Then, use a 90-degree angle to insert the needle into your skin to inject the insulin.

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  • Diabetes Log Book

    Diabetes is a condition that you have to put effort into daily. When you take the right precautions and live your life in a diabetes-friendly way, you can manage your condition. One tool that you can use to manage your diabetes is a diabetes log book. With a glucose log sheet, you can track your numbers to find patterns with your blood sugar levels. You also have options that allow you to track things like your diet so that you can see how foods are influencing your glucose levels.

     

    WHEN IS A GLUCOSE LOG A GOOD IDEA?

    A glucose log is an easy way to see where your numbers are at, over the long-term. It is easy to check your sugar at least once a day to see what your lifestyle is doing to it. When you keep this information in a blood sugar log, you can look back and find trends in your numbers. This makes it easy to see if you need to make changes to your diet or medicine regimen to see if there are better ways to bring your levels down. The following situations would benefit from using a diabetes log book:

    • Despite your best efforts, you are having trouble keeping your glucose within range

    • You have gestational diabetes, or you are at risk for it

    • You are controlling your glucose using insulin or an insulin pump

    • While you do not have any noticeable symptoms, your sugar levels are often low

    • Your glucose levels are consistently high, causing you to have ketones present in your urine

     

    HOW TO USE A BLOOD SUGAR LOG?

    Exactly how you use a glucose log will depend on the format that you choose. However, the general steps are the same. You will want to input a daily date or a date range, depending on the format of the log. Take note of the ranges that your doctor wants you to strive for and put this at the top of the log pages for easy reference. Now, you want to write down your glucose levels when you check them with the time. It is also ideal to make a note about whether the level was checked when you were fasting or after you had a meal.

    Most logs have a space where you can write down the foods that you eat. When you are writing these down, you should also track the carbohydrates and sugar in each of the foods because these two nutrients have the biggest impact on your blood sugar levels. Make sure to write down everything, including things like condiments and dressings. Most people don't realize that several of these can have a high sugar content. You also need to make note of what you are drinking since many drinks, such as fruit juices that seem healthy, can have a high sugar content.

     

    TYPES OF DIABETES LOGS

    When it comes to using a diabetes log book, you have a variety of options. You can find several types of free printable blood sugar charts online. Just print these out and put them into a binder or a folder to keep them in the right order. With so many types available, you can find one that uses a format that you prefer. It is important that you like the format and find it easy to use so that you can keep it filled out each day.

    You can find weekly, monthly and daily formats for these logs. If you need to track your blood sugar three or more times daily, it is best to choose a daily one. This will give you more space and flexibility with the frequent checks that you need to do. If you only need to check once a day, a monthly log can work for you. A weekly log is a good balance and it makes it easy to write down your blood sugar levels and the foods that you are eating so that you get a full seven-day picture of what is happening with your glucose levels.

     

    WHY IT IS IMPORTANT TO CONTROL YOUR GLUCOSE LEVELS

    You must control your blood glucose levels to avoid the potential complications that can occur if your sugar levels get too high. The first thing you need to be able to recognize are the symptoms that occur when your blood sugar is high. For some people these are not as noticeable as others, so make note of these possible symptoms so that you can be on the look out for them. The symptoms of high blood sugar include:

    • Frequent urination

    • Unexplained weight loss

    • Fatigue

    • Blurry vision

    • Frequent infections

    • Increased thirst

    • Extreme hunger

    • Ketones present in your urine

    • Feeling irritable

    • Sores or wounds that are slow to heal

    When high blood sugar levels are not brought down quickly, you are at risk for a variety of health complications. Some of these are irreversible, so it is important to do what you can to avoid experiencing them in the first place. Some of the complications can result in issues like needing a kidney transplant or a limb amputation. The following are possible complications of high blood sugar:

    • Nerve damage, especially in the feet and legs

    • Eye damage

    • Skin conditions

    • An increased risk of Alzheimer's disease

    • Cardiovascular disease

    • Kidney damage

    • Foot damage

    • Hearing impairment

    • Depression

     

    CONTROLLING YOUR BLOOD SUGAR

    When you are filling out your printable glucose log sheets, you can input the foods that you are eating. It is important to keep an eye on the carbohydrates that you are eating. The complex carbohydrates can help to stabilize your levels while simple carbohydrates can cause sudden spikes and crashes. Just make sure that the complex carbohydrates that you are eating have plenty of fiber as this nutrient also helps you to maintain proper glucose levels.

    Keep your sugar intake low to avoid spikes and drops in your blood sugar. You can eat fruits and other healthy foods that contain natural sugars but remember that these too can increase your glucose levels, so you will want to monitor your blood sugar when you are eating them. Healthy fats and protein are also important for people with diabetes. Overall, a balanced diet is best to ensure that you are getting enough nutrients while also controlling your sugar levels.

    You should also monitor your levels on a regular basis. Your doctor will provide you with information about how often you should be testing your blood. Approximately two hours after you eat, your levels should be 180 mg/dL or lower. When you have been fasting, your sugar levels should not exceed 125 mg/dL. Your doctor will provide you with the details regarding the levels that you should be striving for based on your individual blood sugar needs.

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