Diabetic nerve damage (also called diabetic neuropathy) is a problem for many people with diabetes. Over time, high blood glucose levels damage the delicate coating of nerves. This damage can cause many problems, such as pain in your feet. There’s a lot you can do to take charge and prevent nerve damage. 

A recent study shows that controlling your blood glucose can help prevent or delay these problems. Controlling your blood glucose may also help reduce the pain from some types of nerve damage.

Some Signs of Diabetic Nerve Damage

Some signs of diabetic nerve damage are pain, burning, tingling, or loss of feeling in the feet and hands. It can cause you to sweat abnormally, make it hard for you to tell when your blood glucose is low, and make you feel light-headed when you stand up.

Nerve damage can lead to other problems. Some people develop problems swallowing and keeping food down. Nerve damage can also cause bowel problems, make it hard to urinate, cause dribbling with urination, and lead to bladder and kidney infections. Many people with nerve damage have trouble having sex. 

For example, men can have trouble keeping their penis erect, a problem called impotence (erectile dysfunction). If you have any of these problems, tell your health care provider. There are ways to help in many cases.

Protecting Your Nerves from Damage

Keep Your Blood Glucose in Control : 

High blood glucose can damage your nerves as time goes by. Work with your health care team to keep your glucose levels as close to normal as you can.

Have a Physical Activity Plan : 

Physical activity or exercise may help keep some nerves healthy, such as those in your feet. Ask your health care team about an activity that is healthy for you.

Get Tested for Nerve Damage :

Nerve damage can happen slowly. You may not even be aware you’re losing feeling in your feet. Ask your health care provider to check your feet at each visit. At least once a year, your provider should test how well you can sense temperature, pinprick, vibration, and position in your feet. If you have signs of nerve damage, your provider may want to do more tests. Testing can help your provider know what is wrong and how to treat it.

Check Your Feet for Changes :

If you’ve lost feeling in your feet, you’ll need to take special care of them. Check your feet each day.

Wear shoes that fit well. You’ll read more about foot care in the next chapter.

Heart and blood vessel problems are the main causes of sickness and death among people with diabetes. These problems can lead to high blood pressure, heart attacks, and strokes. Heart and blood vessel problems can also cause poor circulation (blood flow) in the legs and feet.

You’re more likely to have heart and blood vessel problems if you smoke cigarettes, have high blood pressure, or have too much cholesterol or other fats in your blood. Talk with your health care team about what you can do to lower your risk for heart and blood vessel problems. Ask about taking a daily aspirin to help prevent heart and blood vessel problems.

Signs of Heart and Blood Vessel Problems

If you feel dizzy, have sudden loss of sight, slur your speech, or feel numb or weak in one arm or leg,

you may be having serious heart and blood vessel problems. Your blood may not be getting to your brain as well as it should.

Danger signs of circulation problems to the heart include chest pain or pressure, shortness of breath,

swollen ankles, or irregular heartbeats. If you have any of these signs, go to an emergency room or call your health care provider right away

Signs of circulation problems to your legs are pain or cramping in your buttocks, thighs, or calves during physical activity. Even if this pain goes away with rest, report it to your health care provider.

Preventing and Controlling Heart and Blood Vessel Problems

Eat Right and Get Physical Activity

Choose a healthy diet, low in salt. Work with a dietitian to plan healthy meals. If you’re overweight, talk about how to safely lose weight. Ask about a physical activity or exercise program for you. See pages 14–18 to read more about healthy choices for food and physical activity.

Don’t Use Tobacco

Smoking cigarettes causes hundreds of thousands of deaths each year. When you have diabetes and also use tobacco, the risk of heart and blood vessel problems is even greater. One of the best choices you can make for your health is to never start smoking—or if you smoke, to quit.

At least once a year, your health care provider will ask you about tobacco use. If you smoke, talk to your provider about ways to help you stop.

Check Your Blood Pressure

Get your blood pressure checked at each visit. Record these numbers on the record sheets starting on page 91. If your blood pressure is higher than 130/80, ask what steps to take to reach your goal.

If your blood pressure is still high after 3 months, you may need medicine to help control it. Many medicines are available to treat high blood pressure. If you have side effects from the medicine, ask your health care provider to change it. Talk to your health care team about whether you need medicine to take charge of your blood pressure.

Check Your Cholesterol

Get your cholesterol checked once a year. Record the results on page 101. Your total cholesterol should be lower than 200 mg/dL (milligrams per deciliter). Ask your health care team to explain what your HDL and LDL levels are.

If your cholesterol is higher than 200 mg/dL on two or more checks, you can do several things to lower it. You can work with your health care team to improve your blood glucose control, you can lose weight (if you’re overweight), and you can cut down on foods that are high in fat and cholesterol. Ask your health care team about foods that are low in fats. Also ask about a physical activity program.

Ask your health care provider what steps to take to reach your LDL cholesterol goal. You may need a

medicine to help control it. Ask if you need aspirin to prevent heart attack or stroke.

Ask If You Need an Electrocardiogram (EKG)

If you’re having heart and blood circulation problems, an EKG may help you and your health care provider know if you need to change your treatment.

Because of high blood glucose, people with diabetes are more likely to have problems with their teeth and gums. There’s a lot you can do to take charge and prevent these problems. Caring for your teeth and gums every day can help keep them healthy. Keeping your blood glucose under control is also important. Regular, complete dental care helps prevent dental disease.

Signs of Dental Disease

Sore, swollen, and red gums that bleed when you brush your teeth are a sign of a dental problem called gingivitis. Another problem, called periodontitis, happens when your gums shrink or pull away from your teeth. Like all infections, dental infections can make your blood glucose go up. Healthy teeth and gums depend on regular care and controlling your blood glucose levels.

Preventing Dental Problems

Keep Your Blood Glucose Under Control High blood glucose can cause problems with your teeth and gums. Work with your health care team to keep your glucose levels as close to normal as you can.

Brush Your Teeth Often

Brush your teeth at least twice a day to prevent gum disease and tooth loss. Be sure to brush before you go to sleep. Use a soft toothbrush and toothpaste with fluoride. To help keep bacteria from growing on your toothbrush, rinse it after each brushing and store it upright with the bristles at the top. Get a new toothbrush at least every 3 months.

Floss Your Teeth Daily

Besides brushing, you need to floss between your teeth each day to help remove plaque, a film that forms on teeth and can cause tooth problems. Flossing also helps keep your gums healthy. Your dentist or dental hygienist will help you choose a good method to remove plaque, such as dental floss, bridge cleaners, or water spray. If you’re not sure of the right way to brush or floss, ask your dentist or dental hygienist for help.

Get Regular Dental Care Get your teeth cleaned and checked at your dentist’s office at least once every 6 months. If you don’t have a dentist, find one or ask your health care provider for the name of a dentist in your community. See your dentist right away if you have trouble chewing or any signs of dental disease, including bad breath, a bad taste in your mouth, bleeding or sore gums, red or swollen gums, or sore or loose teeth.

Give your dentist the name and telephone number of your diabetes health care provider. Each time you visit, remind your dentist that you have diabetes. Plan dental visits so they don’t change the times you take your insulin and meals. Don’t skip a meal or diabetes medicine before your visit. Right after breakfast may be a good time for your visit.

Diet - There is not a known remedy that will cure diabetes without a reformation along the lines that caused it. The number one dietary consideration for diabetes must be a strict vegetarian, low calorie, alkaline diet of high quality natural foods. Plenty of whole grains, bran and oatmeal are very beneficial in diabetes, as well as raw vegetables of all kinds - red cabbage, cauliflower, watercress, brussel sprouts, okra, cucumbers, onions, etc. 

A big emphasis needs to be placed on raw foods as they stimulate the pancreas and increase insulin poduction. Green beans and cucumber juice contain a hormone needed by the cells of the pancreas in order to produce insulin. No table sugar should be used. When sugar is eaten and absorbed into the blood stream, it requires insulin and a trace element called chromium to move the sugar from the blood stream into the cells where it can be burned for energy. 

In the diabetic the insulin is missing. There fore sugar piles up in the blood stream and cannot move into the cell. When insulin is given, the sugar is able to move into the cell and the sugar level will drop in the blood stream. If chromium is missing, the blood sugar will rise again, for the sugar is still not able to enter the cell. 

Chromium is available in many natural foods (especially whole grains), but most of it is removed when foods are refined. The average American diet is lacking in chromium. At birth we have a good supply of chromium, but as we get older we gradually lose it if we do not eat properly. 

Many older individuals are deficient in chromium. Why is this happening? When refined sugar is eaten, it requires chromium to be utilized. If none is taken in with food, chromium from the body stores, if available, has to be used. Thus chromium is gradually depleted and sickness occurs.

What about fresh fruits, as they contain sugar? Fresh fruits of all kinds are excellent for the diabetic. The sugar in fresh fruit is fructose sugar and is very different from the refined table sugar (which is sucrose sugar). When we eat sugar or starch our body breaks it down into simple sugar and the blood then carries it to the cells of the body. 

For this simple sugar to enter the cells it needs insulin and chromium, but if you have eaten only fructose sugar (the good kind that is found only in fresh fruits), no insulin is needed for the sugar to enter the cells. This is why a diabetic can eat all the fresh fruit desired, but no canned or frozen fruit juices (even if they are supposedly all natural). All of these are refined; they have been heated (even the frozen ones) and are hard for a diabetic to assimilate.

Use no free fats - only natural fats as found in avocados, nuts, etc. Recent studies show excess fat intake can decrease the number of receptors and/or deactivate them. This results in the gradual build up of sugar in the bloodstream. Dr. James Anderson, one of the most respected authorities on diabetes in the world, did a study with Dr. Kiehm.

They took thirteen diabetics off the 34 percent fat, 23 percent protein diet prescribed by the American Diabetes Association and fed them a 9 percent fat diet of mostly natural high fiber, starchy foods. Blood sugar levels were significantly lowered in all thirteen. All five patients taking oral drugs and four of the eight patients taking insulin were able to discontinue their medication completely.

Diabetics should discontinue the use of baking powder or soda, as these decrease the activity of the pancreatic juices, which are used in the body to digest protein, fats and carbohydrates. The pancreas is one of the most important organs of digestion. Fasting is usually not advisable for diabetics. Avoid all mental nervous stresses and strains. Avoid constipation; the bowels must be kept loose with at least three good eliminations every day. This is imperative to improved health.

Herb Tea - Tea, made from any one of the following herbs is beneficial: raspberry leaves, red root or dandelion root. Mix one tsp. of herb per 8 oz. of distilled water. Let steep for 20 minutes or longer. Drink three cups daily.

Exercise - Exercise will lower the blood sugar and enable the diabetic to require less insulin. Deep breathing and lots of exercise of hard physical labor will help keep the fire of the metabolic processes burning fast, and this will diminish the need for insulin.

Sunlight - The effect of direct sunlight on the body's sugar metabolism parallels that of insulin. Sunlight facilitates the absorption of glucose into the cells of the body and stimulates the body to convert its blood sugar (glucose) into stored sugar (glycogen). This is minimal in a normal individual but dramatic in diabetics. A diabetic must gradually expose his body to the sunlight. Diabetics who choose to sunbathe should always keep in touch with their physician as their insulin dosage will have to be decreased.

In conclusion, diabetes is unknown in countries where people can't afford to overeat. Americans may be the richest people in the world, but they are also one of the sickest. In America, a new diabetic is discovered every 50 seconds. I want to encourage all to eat in moderation, only those things that are wholesome and natural.

Source : Natural Medicine By Dr. Hoover

High blood glucose, or hyperglycaemia, is one of the most common health problems of pregnancy. Hyperglycaemia in pregnancy can be a result of either previously existing diabetes in a pregnant woman, or the development of insulin resistance later in the pregnancy in a condition known as gestational diabetes. 

Unlike diabetes in pregnancy, gestational diabetes resolves once the pregnancy ends. Hyperglycaemia in pregnancy is categorised as either diabetes in pregnancy or gestational diabetes, depending on blood glucose values obtained during screening.

Risks and complications

Any unmanaged hyperglycaemia in pregnancy can result in birth complications that can affect both mother and child including: increased risk of preeclampsia, obstructed labour due to fetal macrosomia and hypoglycaemia at birth for the infant.

As the prevalence of both obesity and diabetes in women of childbearing age continue to rise in all regions, so will the prevalence of hyperglycaemia in pregnancy. In addition, women who develop gestational diabetes have an increased lifetime risk of developing type 2 diabetes.2 Babies born to mothers who have hyperglycaemia in pregnancy are also at an increased risk of developing type 2 diabetes later in life.

Prevalence

IDF estimates that 21.4 million or 16.8% of live births to women in 2013 had some form of hyperglycaemia in pregnancy. An estimated 16% of those cases were due to diabetes in pregnancy and would require careful monitoring during the pregnancy and follow-up post-partum.

There are some regional differences in the prevalence (%) of hyperglycaemia in pregnancy, with the South-East Asia Region having the highest prevalence at 25.0% compared to 10.4% in the North America and Caribbean Region. A staggering 91.6% of cases of hyperglycaemia in pregnancy were in low- and middle-income countries, where access to maternal care is often limited.

The prevalence of hyperglycaemia in pregnancy increases rapidly with age and is highest in women over the age of 45 (47.7%), although there are fewer pregnancies in that age group. This explains why just 23% of global cases of hyperglycaemia in pregnancy occurred in women over the age of 35, even though the risk of developing the condition is higher in these women.

Estimating prevalence

There is great diversity in the methods and criteria used for identifying women with hyperglycaemia in pregnancy, which increases the difficulty of making comparisons between studies and generating estimates on prevalence.

However, the recent

publication of a guideline from the World Health Organization on diagnosing hyperglycaemia in pregnancy will contribute to a standard approach to estimating prevalence.

Data on hyperglycaemia in pregnancy from studies were available for 34 countries across all IDF Regions. Although each of the Regions was represented, the majority of the studies were carried out in high-income countries. More information is available on the methods used to generate the estimates at www.idf.org/diabetesatlas.

For most people, blood glucose levels that stay higher than 140 mg/dL (before meals) are too high. Talk with your health care team about the glucose range that is best for you. Eating too much food, being less active than usual, or taking too little diabetes medicine are some common reasons for high blood glucose (or hyperglycemia). Your blood glucose can also go up when you’re sick or under stress. Over time, high blood glucose can damage body organs. For this reason, many people with diabetes try to keep their blood glucose in balance as much as they can.

Some people with type 2 diabetes may not feel the signs of high blood glucose until their blood glucose is higher than 300. People with blood glucose higher than 300 are more likely to have dehydration. Dehydration can become a serious problem if not treated right away. Your blood glucose is more likely to go up when you’re sick—for example, when you have the flu or an infection. You’ll need to take special care of yourself during these times. 

Signs of High Blood Glucose

Some common signs of high blood glucose are having a dry mouth, being thirsty, and urinating often. Other signs include feeling tired, having blurred vision, and losing weight without trying. If your glucose is very high, you may have stomach pain, feel sick to your stomach, or even throw up. This is an emergency and you need to go to the hospital right away.

If you have any signs that your blood glucose is high, check your blood. In your logbook or on your record sheet, write down your glucose reading and the time you did the test. If your glucose is high, think about what could have caused it to go up. If you think you know of something, write this down beside your glucose reading.

Preventing High Blood Glucose

Keep a balance

Try to stay with your food and activity plan as much as you can. Drink water. Take your diabetes medicine about the same time each day. Work with your health care team to set goals for weight, blood glucose level, and activity.

Test your blood glucose

Keep track of your blood glucose and go over your records often. You’ll learn how certain foods or activities affect your glucose. Show your records to your health care team. Ask how you can change your food, activity, and medicine to avoid or treat high blood glucose. Ask when you should call for help.

Taking Care of Yourself When You’re Sick

Keep Taking Medicine

Be sure to keep taking your diabetes pills or insulin. Don’t stop taking them even if you can’t eat. Your health care provider may even advise you to take more insulin during sickness.

Keep Eating

Try to eat the same amount of fruits and breads as usual. If you can, eat your regular diet. If you’re having trouble doing this, use carbohydrate choices or servings: eat enough soft foods or drink enough liquids to take the place of the fruits and breads you usually eat.

Drink Liquids

Drink extra liquids. Try to drink at least 1/2 cup (4 ounces) to 3/4 cup (6 ounces) every half-hour to hour, even if you have to do this in small sips. These liquids should not have calories. Water, diet soda pop, or tea without sugar are good choices.

Check for Changes

• Weigh yourself every day. Losing weight without trying is a sign of high blood glucose.
• Check your temperature every morning and evening. A fever may be a sign of infection.
• Every 4 to 6 hours, check how you’re breathing and decide how alert you feel. Having trouble breathing, feeling more sleepy than usual, or not thinking clearly can be danger signs.

Call for Help

Ask your health care provider when you should call. During your sick times, you may need to call every day for advice. You should call your health care provider or go to an emergency room if any of the following happens:

• You feel too sick to eat normally and for more than 6 hours can’t keep food or liquids down.
• You have severe diarrhea (loose bowel movement).
• You lose 5 pounds or more without trying to.
• Your temperature is over 101°F.
• Your blood glucose level is lower than 60 mg/dL or stays over 300 mg/dL.
• You’re having trouble breathing.
• You feel sleepy or can’t think clearly.

In general, a blood glucose reading lower than 70 mg/dL is too low. If you take insulin or diabetes pills, you can have low blood glucose (also called hypoglycemia). Low blood glucose is usually caused by eating less or later than usual, being more active than usual, or taking too much diabetes medicine. Drinking beer, wine, or liquor may also cause low blood glucose or make it worse.

Low blood glucose happens more often when you’re trying to keep your glucose level near normal. This is no reason to stop trying to control your diabetes. It just means you have to watch more carefully for low levels. Talk this over with your health care team.

Signs of Low Blood Glucose

Some possible signs of low blood glucose are feeling nervous, shaky, or sweaty. Sometimes people just feel tired.

The signs may be mild at first. But a low glucose level can quickly drop much lower if you don’t treat it. When your glucose level is very low, you may get confused, pass out, or have seizures.

If you have any signs that your glucose may be low, test it right away. If it’s less than 60 to 70 mg/dL, you need to treat it right away. 

Treating Low Blood Glucose

If you feel like your blood glucose is getting too low but you can’t test it right then, play it safe go ahead and treat it. Eat 10 to 15 grams of carbohydrate right away.

Check your blood glucose again in 15 minutes. Eat another 10 to 15 grams of carbohydrate every 15 minutes until your blood glucose is above 70 mg/dL.

Tell family members, close friends, teachers, and people at work that you have diabetes. Tell them how to know when your blood glucose is low. Show them what to do if you can’t treat yourself. Someone will need to give you fruit juice, soda pop (not diet), or sugar.

If you can’t swallow, someone will need to give you a shot of glucagon and call for help. Glucagon is a prescription medicine that raises the blood glucose and is injected like insulin. If you take insulin, you should have a glucagon kit handy. Teach family members, roommates, and friends when and how to use it.

Waiting to treat low blood glucose is not safe. You may be in danger of passing out. If you get confused, pass out, or have a seizure, you need emergency help. Don’t try to drive yourself to get help. Be prepared for an emergency.

There’s good news for people with diabetes.

Studies show that keeping your blood glucose (also called blood sugar) close to normal helps prevent or delay some diabetes problems. Through careful control, many problems such as eye disease, kidney disease, heart disease, nerve damage, and serious foot problems can be prevented or slowed. People who have type 1 diabetes as well as people who have type 2 diabetes can benefit by keeping their blood glucose levels closer to normal.

Keeping a Balance

As the turtle makes steady progress, so too must those with diabetes continue to maintain healthy lifestyles and stick to daily routines that involve regular exercise, good nutrition, glucose monitoring, and regular visits to health care providers. To keep your glucose at a healthy level, you need to keep a balance between three important things:

• What you eat and drink.
• How much physical activity you do.
• What diabetes medicine you take (if your doctor has prescribed diabetes pills or insulin).

A Few Things About Food

Here are some tips for making healthy eating choices:

1. Eat regular meals. Ask your health care team to help you choose a meal plan. Your dietitian may suggest you eat three meals and a snack or two every day at about the same times. Eating every 4 to 5 hours can help control blood sugar.

2. Eat a variety of foods. Choose a variety of foods to eat so that your body gets the nutrition it

3. Eat less fat. Avoid fried foods. Foods that are baked, broiled, grilled, boiled, or steamed are

more healthy to eat. Eat meats that have little fat. When you eat dairy products (cheese, milk, yogurt, and others), choose those that have little or no fat or cream.

4. Eat less sugar. You may find that eating less sugar helps you control your blood glucose level.

Here are some things you can do to eat less sugar:

• Eat more high-fiber foods, like vegetables, dried beans, fruit, and whole grain breads and cereals.
• Drink water and other drinks that have no added sugar.
• Eat fewer foods that have extra sugar, such as cookies, cakes, pastries, candy, brownies, and sugared breakfast cereals.
• Talk with your health care team about ways to sweeten food and drinks without using sugar.

5. Eat less salt. Eating less salt may help control your blood pressure. Here are some ways to eat

less salt:

• Use less salt when you prepare foods.
• Cut down on processed foods, such as foods you buy in cans and jars, pickled foods, lunch meats (“cold cuts”), and snack foods, such as chips.
• Taste your food first before adding salt. You may not need to add any.
• Use herbs and spices instead of salt to flavor your food.

6. A word about drinking alcohol: Alcohol can cause health problems, especially for people with diabetes. It adds calories and doesn’t give your body any nutrition. Drinking alcohol may cause dangerous reactions with medicines you take. Your blood glucose can go down too low if you drink beer, wine, or liquor on an empty stomach. If you want to include a drink in your food plan once in a while, ask your health care team how to do so safely.

A Few Things About Physical Activity

1. It’s important to be active. Physical activity has many benefits. It can help you control your blood glucose and your weight. Physical activity can help prevent heart and blood flow problems. Many people say they feel better when they get regular exercise.
2. Start with a little. If you haven’t been doing any physical activity, talk to your health care team before you begin. Walking, working in the yard, and dancing are good ways to start. As you become stronger, you can add a few extra minutes to your physical activity. If you feel pain, slow down or stop and wait until it goes away. If the pain comes back, talk with your health care team right away.
3. Do some physical activity every day. It’s better to walk 10 or 20 minutes each day than one hour once a week.
4. Choose an activity you enjoy. Do an activity you really like. The more fun it is, the more likely you will do it each day. It’s also good to exercise with a family member or friend.

If you’re already active now, but want to become more active, talk to your health care team about a

safe exercise plan.