The National Hurricane Center is predicting another above normal hurricane season. Natural disasters occur each year and it is important that people with diabetes plan for the devastation that can be caused by a catastrophe.

It is recommended that all diabetic patients create a waterproof insulated emergency kit that includes the following essential items:

1. Diabetes Medications, including insulin and syringes
2. Glucose testing strips, lancets and a glucose testing meter
3. Glucose tabs and gels
4. Antibiotic ointments/creams for external use
5. Glucagon emergency kits
6. Prepackaged snacks
   

You should also include extra batteries for the glucose meter and insulin pump. If you are using a pump, extra pump supplies and backup insulin and syringes should be available. The disaster kit should be replenished twice a year.

You should be able to provide information about your insulin dose and the names and dosages of the all medications taken. It would help to know your prescription number so that other pharmacies throughout the country can refill your prescription.

It is important for diabetics to develop self management skills for disaster preparedness. Work with your health care team to understand what to do in emergencies. You should understand how to adjust your medications to maintain good diabetic control and how to treat high and low blood sugars.

No more insulin shots! It is what so many people with diabetes have been waiting for, however it has some limitations. Inhaled insulin is a powdered form of rapid acting insulin that is absorbed by the lungs through the use of a hand held inhalation device. Inhaled insulin is currently marketed as Exubera and is the first noninjectable form of insulin available in the US.
Inhaled insulin is a rapid acting form of insulin that is taken within 10 minutes of eating. It has been shown to be as effective as injecting short acting insulin and can significantly improve blood sugar control for patients with Type 2 diabetes who are on oral diabetes medications. Although some patients with type 1 diabetes can use inhaled insulin to replace short acting insulin, it does not replace the long acting (basal) insulin that is required for diabetes control.

People taking inhaled insulin can experience a cough, a slight decrease in lung function and low blood sugars. It is important for your health care professional to monitor your sugar and lung function while on inhaled insulin. Exubera is not recommended for those who smoke or have recently stopped smoking or for patients with asthma or other lung diseases. Your health care provider will obtain a baseline lung test to be sure that you can take Exubera and will monitor your lung function while you are taking inhaled insulin.

Exubera is especially beneficial as adjunct therapy to control post meal blood sugar elevations in patients who are on oral diabetes medications or who are taking basal insulin therapy. Exubera is a good option for patients who are taking insulin before each meal and are bothered by frequent injections. Inhaled insulin may also be helpful if your sugar is uncontrolled on oral diabetes medications and your doctor has recommended injected insulin but you are do not wish to use needles.

There are many possible reasons for fatigue with diabetes. If your blood sugar is too high, you lose energy and stamina. Often nighttime urination disrupts sleep and is associated with increased fatigue. If you get excessively tired after eating it could be due to an elevated blood sugar levels. Low blood sugars can also cause drowsiness. Fatigue can also occur when blood sugars fluctuate widely. It is important for you to work with your diabetes professional to learn proper dosing and timing of your medication to avoid high and low blood sugar levels and to minimize rollercoaster blood sugar fluctuations.

It is very important that you checkyour blood sugar before driving or operating heavy equipment. Driving is like using a deadly weapon. If you operate a vehicle when your blood sugar is too high or too low your driving ability may be impaired.

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Many medications required by diabetic patients for concurrent diseases like high blood pressure are often associated with fatigue. You should work with your health care team to change or adjust the timing of your medicines
Many patients with diabetes experience depression. Diabetes burnout can occur in some patients when they are overwhelmed by the complexities of managing their diabetes. It helps todevelop a support team and to increase your knowledge of diabetes so that you feel empowered and in control.
There is a higher incidence of other diseases like thyroid disease in patients with diabetes. Heart disease must also be excluded. Women with heavy periods should get their iron level checked and levels of vitamin B12 and Vitamin D should also be checked
Sleep apnea occurs in many overweight patients with diabetes. Sleep apnea results in a decrease in restful REM sleep and is associated with daytime drowsiness.
It is advisable for you get a comprehensive physical examination and laboratory testing to determine the cause of your fatigue

When your blood sugar (glucose) is elevated you will lose weight because you lose glucose and calories in the urine. When your blood sugar is under control, glucose will be used for energy and excess calories are stored as fat. I have had some patients purposely maintain elevated sugars as a method of weight control. The high blood sugars, however, will result in an increased risk of diabetic complications and blood vessel disease . High blood sugars also are associated with increased fatigue due to loss of nutrient energy and loss of sleep due to frequent nighttime urination. Increased fatigue makes it difficult to maintain lifestyle habits like increased physical activity that result in long term healthy weight loss.
It is important to understand how your insulin works. You must think like your pancreas (the organ that produces insulin) and match your insulin with your anticipated activity and food intake. Failure to decrease the appropriate insulin dose in anticipation of decreased food intake or increased activity can cause your blood sugar to plunge. Patients then may overeat causing an elevated blood sugar and more weight gain.
Proper dosing and timing of insulin therapy can help prevent weight gain. For most patients the use of an insulin pump or of a flat long acting basal insulin such as Lantus or Levemir combined with premeal injections of a short acting insulin (Humalog., Novolog, Apidra or Regular) provides the most flexibility and the least weight gain.
The addition of a diabetes medication such as metformin (Glucophage) or an incretin ( Byetta or Symlin) can minimize weight gain and promote weight loss.
Healthy lifestyle habits with at least 30 minutes of moderate physical activity (such as brisk walking) combined with a healthy eating plan that enables you to achieve and and maintain your ideal weight remains the cornerstone of diabetes treatment.

Weight gain can occur with the use of insulin, sulfonylureas and with thiazolidinediones . This is an important concern because many people with Type 2 diabetes are already overweight.
Weight gain with diabetes medications occurs for a number of reasons. Insulin and sulfonylureas like Amaryl (Glimeride), Glucotrol (Glipizide) , or Diabeta- Micronase (Gyburide) may cause low blood sugar and stimulate increased food intake. Thiazolidinediones (Actos Avandia) cause fat cells to enlarge and may cause fluid retention.
Despite the potential for weight gain, these medications are valuable treatments for diabetes. When used properly the benefits of these medications greatly outweigh the risks.
It is important to match diabetes medication with changes in food intake and activity. It may be necessary to take less diabetes medication on days that your are more active. Proactive dosing and timing of diabetes medications can often avoid low blood sugars that are associated with overeating. Work with your health care team to understand how your diabetes medication works so that you can prevent blood sugar highs and lows.

The addition of another diabetes medication such as metformin (Glucophage) or an incretin ( Byetta or Symlin) can minimize weight gain and promote weight loss.
The use of a fat blocker (Xenical) can also improve weight loss. We are also hoping that the soon to be released “antimunchie” medication rimonabant (Acomplia) will make it easier for patients with diabetes to lose weight.
Permanent lifestyle change remains the mainstay in prevention of weight gain with diabetes. It is important to increase physical activity to at least 30 minutes a day and to achieve and maintain a healthy weight with a prudent diet.

More than half of diabetic men age 50 or older experience some degree of erectile dysfunction. Men with diabetes are three times more likely to experience sexual problems than men without diabetes.

Erectile dysfunction can result from physical or psychological problems. Relationship issues and psychological factors like stress, fatigue or depression can contribute to erectile dysfunction.

Psychological factors can interfere with how the body produces and responds to hormones and can prevent erections from occurring.

Poor blood sugar control and high blood sugars can damage the nerves and blood vessels responsible for erections. This can reduces blood flow to the penis and prevent erections from occurring

Many of the medications that are often prescribed to men with diabetes, can have side effects that cause difficulties with sexual functioning. Medications for blood pressure, depression or anxiety may also contribute to erectile dysfunction.

One test that we use to differentiate physical from psychological causes of erectile dysfunction is called the “stamp test” Three to five postage stamps (from a roll) are looped and around the penis before sleeping. If the penis is capable of erection, it usually happens during REM sleep and stamp perforations will be broken upon awakening

It is best to check with your health care professional before drinking alcohol. If your blood sugar is not well controlled or if you have certain diseases like liver disease or high triglycerides (a type of body fat), you may be advised not to drink alcohol. Excessive alcohol can also damage the liver, irritate the stomach lining and damage the pancreas.

If you choose to use alcohol, you should limit the amount to 1drink of alcohol per day for women and 2 drinks per day for men. One drink of alcohol containing beverage is defined as 12 oz beer (about 150 calories) , 5oz wine (about 100 calories) or 1.5 ounce shot glass of hard liquor (about 100 calories).

Always drink alcohol with a meal or with food. Alcohol can prevent your body from producing and storing sugar. This can cause your blood sugar to go too low especially when it is taken with insulin and certain diabetes medications. Even one alcoholic beverage on an empty stomach could cause a prolonged low blood sugar and even loss of consciousness.

Alcohol has 7 calories per gram compared with carbohydrates which have only 4 calories per gram and that can contribute to weight gain. Mixed alcoholic drinks may contain carbohydrates that raise the blood sugar.
Alcohol may also impair judgment and interfere with the ability to maintain optimal diabetes control. Sometimes treatment for low blood sugar is delayed because alcoholic intoxication appears deceptively similar to a low blood sugar reaction

Extensive studies are underway to attempt to prevent or delay the onset of type 1 diabetes, however at this time there is no way to prevent type 1 diabetes.

Type 2 diabetes can be prevented in many people by making lifestyle changes . A recent study demonstrated that lifestyle modification can prevent or delay diabetes by an average of 58% in less than three years. Lifestyle changes included a healthy diet associated with modest (approximately 7%) weight loss and maintaining moderate physical activity such as brisk walking approximately 150 minutes a week. Treatment with medications like metformin has also been shown to decrease the occurrence of diabetes. It is important to note that some of the medications that prevent diabetes may have side effects while lifestyle change is beneficial for the heart and blood vessels and can reduce the occurrence of many other health problems.

The best way to prevent diabetes is to maintain a healthy weight and exercise regularly.

Insulin resistance means that your body can not use insulin properly. This causes your blood sugar to rise and increases your risk of developing type 2 diabetes, heart disease and stroke. Most people with type 2 diabetes have some element of insulin resistance. Early in the disease, people with type 2 diabetes may have normal or even high levels of insulin, however the insulin does not work as well as it should.

Insulin resistance is often part of metabolic syndrome. Metabolic syndrome is associated with a high risk of heart and blood vessel disease. Metabolic syndrome is diagnosed if you have three or more of the risk factors listed below:

1. Increased abdominal fat (waist >40” for men and more than 35” for women)
2. High triglycerides ( >150mg/dL. Triglycerides are form of body fat . High triglyceride levels are associated with an increase risk of heart and blood vessel disease)
3. Low HDL levels (<50mg/dL for women and < 40mg/dL) for men. HDL is the good cholesterol that protects your heart and blood vessels)
4. High blood pressure (higher than 130/85 mm Hg)
5. High fasting blood sugar (greater than 100mg/dL after 8 hours of not eating)

Insulin resistance can also be associated with other health problems such as polycystic ovary disease. Polycystic ovary disease is a hormonal disorder often associated with irregular periods and infertility.

Often you can prevent or reverse insulin resistance and metabolic syndrome by prudent eating, increased physical activity and achieving a healthy weight. Decreasing your abdominal fat can help you to prevent diabetes and other serious health problems. Sometimes medications to overcome insulin resistance may be prescribed by your health care professional.

Family history plays a larger role in the development of type 2 diabetes. Many people with type 1 diabetes have no known family history of diabetes. The relative risk of developing diabetes is as follows

Some of the high family history association of diabetes with type 2 diabetes may also occur because of learned behaviors such as diet and physical activity. In general, if you have a strong family history of diabetes, the older you are and the more you weigh, the more likely you are to develop diabetes.