Diabetes and Your Mouth

We diabetics have to pay even more attention to our teeth and gums than other people.

We are at greater risk of cavities, gum disease and tooth infections. Not only that, but those infections can cause our blood sugar to rise, so it becomes a vicious cycle.

Here are some mouth problems common in diabetics.

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Plaque

Plaque is, of course, a problem for many people, not just diabetics. But it's caused by starches and sugars, and of course we have more than our share of those! So diabetics are highly prone to plaque.

Dry mouth

Sometimes my mouth is so dry in the morning I can hardly speak, I'm sure you know how that feels. But it's more than just inconvenient, it's dangerous to the health of our mouths. You see, saliva washes away many of the bacteria that cause cavities and gum disease. Dry mouth cuts the amount of saliva available for this job, so the result is more cavities and gum disease. Dry mouth sometimes also creates inflammation of the soft tissue in the mouth, making eating difficult and unpleasant.

While there are artificial saliva substitutes, which your dentist can tell you about, you can usually stimulate your own saliva by sucking on a sugar-free hard candy. I like no-sugar-added Ricola for this purpose. And of course, drinking water helps.

Fungal infections

Not only do we diabetics have less saliva than we need, but the saliva we do have is high in sugar content, so it's double trouble for us. This can cause a fungal infection called candiasis, commonly known as thrush. It produces sore red or white spots in the mouth. Medication can help though, so ask your dentist.

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As a diabetic, you must pay great attention to oral hygiene. Brush your teeth twice a day, and floss daily. Examine your gums for signs of problemsóand always visit your dentist at least twice a year.

Culturally Specific Programs Urged in Diabetes Care

Diabetes remains an epidemic in the U.S., but experts are now more concerned that certain populations may not be getting the right kind of treatment because of their ethnic and cultural beliefs.

Physicians can't use a one-size-fits-all approach to treating patients with diabetes; physicians, families and community leaders must work together to develop culturally specific programs, according to Dr. Kevin McKinney, Minority Health Affairs Committee chairman of the American Association of Clinical Endocrinologists.

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Cultural viewpoints of medicine and disease only compound the issue, said McKinney, who spoke at a recent American Medical Association media briefing on diabetes.

For instance, in some societies, religion influences one's physical and emotional well-being equally. When an illness occurs, a family may seek out the advice of a religious leader before consulting a physician, which would delay treatment and increase the risk of complications.

"Most people in these communities don't even know they're at risk," McKinney said. "They may know about diabetes and its effects, but they're unaware that living a healthy lifestyle can help reduce their risk."

McKinney stresses that education is the key to eliminating the prevalence of diabetes in certain communities and suggests programs that pair education with a cultural activity.


"Programs held at community and religious centers can focus on diabetes risk factors and some of the healthier approaches to traditional foods that may help in reducing those risks," McKinney said.

More than 21 million Americans now have diabetes - a number that experts say may climb as high as 31 million by the year 2050. Every 24 hours, another 4,100 people in the United States are diagnosed with the disease.

But despite these dire statistics, Dr. Frank Vinicor, director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention, says that the medical community is making great strides to combat this epidemic.

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"We know that you do not have to develop type 2 diabetes if you're at high risk, and that if you do have diabetes, you don't have to lose your eyes, your feet or your heart," Vinicor said at the briefing.

The overall outlook for diabetes is beginning to improve, Vinicor said.

"The rates of amputations and end-stage kidney disease due to diabetes are actually beginning to fall," he said. "The preliminary data indicate that fewer people with diabetes are dying. So we're seeing some light at the end of the tunnel."

Diabetes: What Type Of Insulin Is Right For Me?

Rapid onset-fast acting insulin

Rapid onset-fast acting insulin always looks clear. It is fast acting and starts to work within one to 20 minutes. It peaks about one hour later and lasts from three to five hours. When you use this type of insulin, you must eat immediately after you inject.

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The two rapid onset-fast acting insulin types currently available are:

1. NovoRapid (Insulin Aspart)
2. Humalog (Lispro).

Short acting insulin

Short acting insulins always look clear. They begin to lower blood glucose levels within half an hour, so you need to have your injection half an hour before eating.

Short acting insulin has a peak effect at two to four hours, and lasts for between six and eight hours. Short acting insulin types currently available include:

1. Actrapid
2. Humulin
3. Hypurin Neutral (bovine - highly purified beef insulin).

Intermediate acting insulin

Intermediate acting insulins always look cloudy. They have either protamine or zinc added to delay their action. These insulins begin to work about 90 minutes after you inject, peak at four to 12 hours, and last for 16 to 24 hours.

Intermediate acting insulins currently available include:

1. With protamine added ñ Protaphane, Humulin NPH and Hypurin Isophane (bovine).

Preventing Diabetes

You'll need to keep an eye on your blood sugar levels and take treatment for your diabetes for the rest of your life. If you don't have good control of your blood sugar you'll be at risk from damage to the blood vessels and nerves, with problems such as deterioration in eyesight, stroke, kidney disease and infections.

As your doctor has already explained, careful diet and pills are all that are needed in most cases.

If you're overweight, simply eating less and losing weight can be enough to allow the insulin to work more effectively.

Why Use Insulin Pumps?

The number of people using insulin pump therapy to manage their diabetes is growing rapidly; roughly 250,000 people around the world use an insulin pump. Their reasons for choosing the pump are many, but generally "pumpers" all agree that it gives them tighter control and more flexibility -- both in terms of their schedule and lifestyle. This control and flexibility includes advantages such as:

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1. Eating what you want, when you want
2. Worrying less about low blood sugars ("hypoglycemia")
3. Living life on your terms, not a schedule of snacks and shots

There are many scientific studies that demonstrate that insulin pump therapy results in better outcomes for teens and adults with type 1 diabetes. There are also studies that show that insulin pump therapy works well in toddlers and pre-school children.

Diabetes, Glaucoma Put Millions At Risk for Unexpected Blindness

Unexpected sight loss is more common than you may think. Blindness often happens without prior warning signs and in people unaware they are at risk.

The two most common culprits of unexpected sight loss are diabetes and glaucoma. These diseases are known as the "sneak thieves of sight" because symptoms may not occur in the early stages. By the time a person realizes something is wrong, irreversible vision loss often occurs.

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In fact, diabetic eye disease is the leading cause of blindness in adults. An average of 55 Americans go blind from the disease each day. The numbers threaten to rise sharply as diabetes becomes increasingly common due to poor eating habits, infrequent exercise and an aging population. One in three children born in the United States five years ago are expected to become diabetic during their lives.

Diabetes causes partial or complete loss of vision in as many as 70 percent of those who have it. Yet 30 percent of all people who have diabetes don't even know they have it. Even people who know they have diabetes downplay the risks they face.

According to a survey of diabetics sponsored by Lions Clubs International, 60 percent were not worried about going blind or losing a limb. In reality, 74 percent of diabetics will develop serious complications that could lead to loss of sight or a limb or kidney failure.

Glaucoma, on the other hand, is a group of eye diseases that slowly damage the fine nerves that connect the eye to the brain. For most people, this damage occurs when pressure in the eye is too high. When these nerves are damaged, vision loss may result.

Glaucoma is the second-leading cause of blindness in the United States. But like diabetes, not enough people know about it: An estimated 4.2 million Americans have glaucoma but half are not aware of it.

Diabetes and glaucoma are especially prevalent among blacks and Hispanics. These groups are believed to have a genetic predisposition to the diseases and are much more at risk than Caucasians. Others particularly at risk for glaucoma are people over 60, those with a family history of glaucoma, diabetics and the very near-sighted.

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The good news for those at risk is that a dilated eye exam can detect the two diseases and early treatment can prevent vision loss. Vision experts urge at-risk people to have regular eye exams.

Raising awareness of diabetic eye disease and glaucoma is key to preventing unnecessary blindness. Lions Clubs International works with Lions clubs, community groups and individuals to publicize the need for early detection and timely treatment of the two diseases. The Lions Eye Health Program provides materials for distribution at health fairs, senior citizen centers and similar gatherings. It also offers strategies for raising awareness of the eye diseases.

The Risk of Gestational Diabetes in Future Pregnancies

If you are diagnosed with gestational diabetes in pregnancy the chances are very high you
will also get the disease in future pregnancies.  There have been cases where this hasn't
happened and there may be steps you can take to lessen your chances of getting it again.

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Before you plan on becoming pregnant again, start to follow the diabetic diet you were given during your previous pregnancy.  It will provide a lot of the nutrients your body needs and will start you off on the right track to eating right while pregnant.  Maintaining a healthy body weight is also crucial to prevent a reoccurrence of diabetes in pregnancy.  If you are overweight, even losing 10-15 pounds before becoming pregnant will help your body better manage the insulin production and use.

A risk factor for getting gestational diabetes in the future is also based on how soon in
your pregnancy you were diagnosed.  Some woman do not find out they have diabetes in
pregnancy until the final weeks before the birth while others may be diagnosed as early
as the first trimester.  The earlier you are diagnosed the greater the chance that you will
also have the same problem again.

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When planning your next pregnancy, book an appointment with your doctor.  Let him or
her know your plans and a blood test will be ordered.  Your doctor can order a blood test
that will show you average blood glucose levels for the previous few months.  This will
make sure that before you become pregnant you blood glucose levels are at an optimal
level.  And if they are not it is recommended that you do not become pregnant until they
are under control.  Not having your blood sugars under control before you become
pregnant can lead to complications for the baby during the crucial first weeks of
development.

Gestational Diabetes: What Happens after the Baby is Born

The light at the end of the tunnel with gestational diabetes is that the condition is only
present when you are pregnant.  In almost all cases once your baby is born your pancreas
will continue to produce enough insulin for your and your body will process it properly.

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In the rare case where it does not, it is likely that you were diabetic prior to becoming
pregnant and the diagnosis did not happen until the routine screening for pregnant
women.  In either case, your doctor will have you continue to monitor your blood glucose
levels after the birth of your baby.  At a minimum you should test for two days afterwards
but your doctor may request that you test for a period of up to two weeks.

During this time you will not be taking insulin.  Your doctor is going to want to see how your body is processing your food without the help of additional insulin.  It is recommended to continue with the diabetic diet going forward, it is a healthy way to eat and if you are breastfeeding it will ensure that you and your baby are getting the nutrients you need. Another reason to continue with the diabetic lifestyle even after it is determined that you no longer have gestational diabetes is to prevent getting type 2 diabetes.

You are at an increased risk of becoming insulin resistant (also known as type 2 diabetes) once you have had gestational diabetes.  Continue to eat the foods you would have while pregnant
and watch your portion sizes.  After your doctor gives the okay, resume a routine of
physical activity even taking your baby for a walk in the stroller.

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You will probably feel a sense of relief once your doctor pronounces you diabetes free
and you can concentrate on enjoying your new baby.

When your Blood Sugar is Too Low

In a perfect diabetic world, you take your insulin, eat your meals and exercise and your
blood glucose levels remain stable.  But things happen, you take your insulin late, you eat
a light meal and then spend all afternoon running errands.  This is a recipe for
hypoglycemia, a condition when your blood glucose levels fall dangerously low.

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Hypoglycemia isn't so much a hazard for the baby but it is for a mom with gestational
diabetes.  The best way to prevent this from happening is to know the signs and how you
feel when you blood sugar is getting low and to carry emergency supplies with you at all
times.

Some of the symptoms of low blood sugar include feeling:

• Hungry.
• Nauseous.
• Light-headed.
• Faint.

In the case of any of these symptoms, you should test your blood sugar right away and have something to eat.  The best choice is a glass of juice or another food item that is considered fast-acting such as a piece of fruit or a piece of candy.  Carry something with you at all times and a regular snack too.  If you are out and need to eat (say you are stuck in your car during a traffic jam) it is important to have food with you.

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Other precautions that you should take when you have gestational diabetes include
carrying a card or another item that identifies you have diabetes and what type of insulin
you are taking.  The worse case scenario is you passing out and the people who come to
help you need to know that you are diabetic.  Make sure people at work and your family
members are aware of your condition and know what warning signs to look for if you
need help and when to bring your some juice or something else to eat.