Diabetes

How to Avoid Diabetes

Diabetes is a serious disease. Following your diabetes treatment plan takes round-the-clock commitment. But your efforts are worthwhile. Careful diabetes care can reduce your risk of serious — even life-threatening — complications.

Here are 10 ways to take an active role in diabetes care and enjoy a healthier future.

1. Make a commitment to managing your diabetes.

Members of your diabetes care team — doctor, diabetes nurse educator and dietitian, for example — will help you learn the basics of diabetes care and offer support and encouragement along the way. But it's up to you to manage your condition. After all, no one has a greater stake in your health than you.

Learn all you can about diabetes. Make healthy eating and physical activity part of your daily routine. Maintain a healthy weight. Monitor your blood sugar level, and follow your doctor's instructions for keeping your blood sugar level within your target range. Don't be afraid to ask your diabetes treatment team for help when you need it.

2. Don't smoke.

If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including heart attack, stroke, nerve damage and kidney disease. In fact, smokers who have diabetes are three times more likely to die of cardiovascular disease than are nonsmokers who have diabetes, according to the American Diabetes Association. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco.

3. Keep your blood pressure and cholesterol under control.

Like diabetes, high blood pressure can damage your blood vessels. High cholesterol is a concern, too, since the damage is often worse and more rapid when you have diabetes. When these conditions team up, they can lead to a heart attack, stroke or other life-threatening conditions.

Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Sometimes medication is needed, too.

4. Schedule yearly physicals and regular eye exams.

Your regular diabetes checkups aren't meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications — including signs of kidney damage, nerve damage and heart disease — as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.

5. Keep your vaccines up to date.

High blood sugar can weaken your immune system, which makes routine vaccines more important than ever. Ask your doctor about:

• Flu vaccine. A yearly flu vaccine can help you stay healthy during flu season as well as prevent serious complications from the flu.
• Pneumonia vaccine. Sometimes the pneumonia vaccine requires only one shot. If you have diabetes complications or you're age 65 or older, you may need a five-year booster shot.
• Hepatitis B vaccine. The Centers for Disease Control and Prevention (CDC) currently recommends hepatitis B vaccination if you haven't previously been vaccinated against hepatitis B and you're an adult aged 19 to 59 with type 1 or type 2 diabetes. The most recent CDC guidelines advise vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you're age 60 or older and have diabetes and haven't previously received the vaccine, talk to your doctor about the whether it's right for you.
• Other vaccines. Stay up to date with your tetanus shot and its 10-year boosters. Depending on the circumstances, your doctor may recommend other vaccines as well.

• 6. Take care of your teeth.

  Diabetes may leave you prone to gum infections. Brush your teeth at least twice a day, floss your teeth once a day, and schedule dental exams at least twice a year. Consult your dentist right away if your gums bleed or look red or swollen.

  7. Pay attention to your feet.

  High blood sugar can damage the nerves in your feet and reduce blood flow to your feet. Left untreated, cuts and blisters can lead to serious infections. To prevent foot problems:
  • Wash your feet daily in lukewarm water.
  • Dry your feet gently, especially between the toes.
  • Moisturize your feet and ankles with lotion.
  • Check your feet every day for blisters, cuts, sores, redness or swelling.
  • Consult your doctor if you have a sore or other foot problem that doesn't start to heal within a few days.

  8. Consider a daily aspirin.

  Aspirin reduces your blood's ability to clot. Taking a daily aspirin can reduce your risk of heart attack and stroke — major concerns when you have diabetes. Ask your doctor whether daily aspirin therapy is appropriate for you, including which strength of aspirin would be best.

  9. If you drink alcohol, do so responsibly.

  Alcohol can cause low blood sugar, depending on how much you drink and whether you eat at the same time. If you choose to drink, do so only in moderation and always with a meal. Remember to include the calories from any alcohol you drink in your daily calorie count.

  10. Take stress seriously.

  If you're stressed, it's easy to neglect your usual diabetes care routine. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly, which only makes matters worse. To take control, set limits. Prioritize your tasks. Learn relaxation techniques. Get plenty of sleep.
  Above all, stay positive. Diabetes care is within your control. If you're willing to do your part, diabetes won't stand in the way of an active, healthy life.

What is hyperemesis gravidarum (severe morning sickness)?

Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy. (1) In fact, the words ‘hyperemesis’ (pronounced ‘hye-pur-em-ee-sis’) and ‘gravidarum’ (pronounced ‘gra-vid-ah-room’) literally translate to ‘excessive vomiting’ ‘during pregnancy’. (10)

What are the symptoms of hyperemesis gravidarum (HEG)?

The main symptoms of hyperemesis gravidarum are:

• continued and severe nausea and vomiting – particularly if vomiting occurs more than 3-4 times a day and prevents one from keeping down food or fluids
• weight loss – which may be over 10% of body weight
• nutritional deficiencies
• infrequent urination
• dehydration – which in turn may cause headaches, palpitations, confusion andhypotension (low blood pressure) when standing
• fainting
• feeling tired and dizzy
• ketosis caused by a raised number of poisonous acidic chemicals in the blood
• pale skin
• jaundice
• muscle wasting
• Ptyalism – excessive secretion of saliva (1-4, 13)

How long does hyperemesis gravidarum last?

Hyperemesis gravidarum can last much longer than normal morning sickness – which tends to settle down around 12-14 weeks of pregnancy. Hyperemesis gravidarum generally diminishes around 21 weeks into the pregnancy, but it may continue much longer. (1, 2)

What causes hyperemesis gravidarum?

There are several theories regarding what causes hyperemesis gravidarum. Some theories concern the hormonal changes that occur in pregnancy. In particular, theories focus on the increase in human chorionic gonadotropin (hCG). This hormone is said to be associated with the peak in symptoms of morning sickness. There have been difficulties with directly demonstrating a link between hCG concentrations and severity of morning sickness however due to the variation in hCG concentrations in the population. (2, 3, 5)

Other potential causes of hyperemesis gravidarum include:

• emotional changes
• nutritional deficiencies – in particular a deficiency in vitamin B6
• gastric problems
• increased estrogen levels (1, 2)

How common is hyperemesis gravidarum?

According to the NHS, hyperemesis gravidarum is thought to affect around 1 in 200 women. (1) Estimates do, however, vary depending on how hyperemesis gravidarum is defined. The estimated incidence rates of severe morning sickness tend to be between 0.5% and 2% of pregnancies. (1, 3, 4)

Who is most likely to develop hyperemesis gravidarum?

Certain women are more likely to develop hyperemesis gravidarum than others. These include:

• women who suffer from migraines
• women who have previously suffered from motion sickness
• those with a family history of hyperemesis gravidarum
• women with a multiple pregnancy – such as twins or triplets
• increased bodyweight
• a female fetus
• women who have had hyperemesis gravidarum in a previous pregnancy
• molar pregnancies – where a mass of abnormal cells (referred to as a “mole”) grow instead of the normally developing baby
• fetal anomalies e.g. trisomy 21 and hydrops fetalis (6-9)

How is hyperemesis gravidarum diagnosed?

Diagnosis of hyperemesis gravidarum involves:

• determining weight loss - via weight measurement
• determining electrolyte imbalance - via blood tests

A doctor may also assess overall condition, such as ability to perform daily activities and psychological state of mind. Many women with hyperemesis gravidarum feel ambivalent towards their pregnancy due to their symptoms. (4, 6, 7)

It is also important for other causes of the symptoms of hyperemesis gravidarum to be ruled out. In particular, the following causes should be dismissed:

• gastrointestinal problems – such as gastric outlet obstruction from peptic ulcer disease
• metabolic disorders such as thyroid problems
• diabetic ketoacidosis
• Addison’s disease
• hypercalcemia
• liver problems – such as viral hepatitis
• kidney stones
• urinary tract infection
• neurological disorders
• migraines
• molar pregnancy
• HELLP syndrome
• pancreatitis
• appendicitis
• gallbladder disease (3, 11, 12, 13)

How is hyperemesis gravidarum treated?

In the early stages of hyperemesis gravidarum, the following is advised:

• rest
• eating small pieces of dry toast, crackers, or bananas before getting out of bed
• consuming ginger-containing foods or drinks
• eating small meals several times a day and not allowing yourself to get too hungry or too full
• eating a diet high in protein and complex carbohydrates and low in fatty foods
• eating bland or dry foods
• drinking plenty of water
• acupressure on the inside of the wrist – this may be done by pressing a finger against the wrist or wearing a special wristband
• anti-nausea medications may be prescribed by a doctor, however, it is important that the potential benefits and risks have first been considered (2, 3, 4, 10)

For more severe cases of hyperemesis gravidarum, hospitalization for a few days may be necessary. Whilst in hospital the following treatments may be given:

• intravenous (IV) fluids to treat dehydration
• parental nutrition (nutrition by vein)
• treatment for ketosis (1, 2, 3, 4)

Is hyperemesis gravidarum harmful to your baby?

In most mild cases of hyperemesis gravidarum no harm is caused to the baby. However, severe hyperemesis gravidarum, in particular the weight loss and nutritional deficiencies, may cause problems for fetal growth. This may lead to the baby being born with a low birth weight.

Other problems that may occur as a result of severe hyperemesis gravidarum include:

• premature labor
• pre-eclampsia
• Mallory-Weiss tears – tears to the stomach due to excessive vomiting
• Wernicke’s encephalopathy – which causes disorientation, confusion and potentially coma due to a lack of thiamin (1, 2, 3, 6)

If you experience hyperemesis gravidarum in your first pregnancy, will you necessarily experience it in a future pregnancy?

It is thought that around two-thirds of women who experience hyperemesis gravidarum in their first pregnancy will also experience it in a future pregnancy. (14)