• Prepare a Healthy and Well-Balanced Meal – Fresh foods such as vegetables and plants are suggested to be served to your husband in moderation. A healthy diet is mixed with veggies, protein, starches and carbohydrates
• Change His Smoking Habits – Smoking and other types of tobacco intake increase the risk of experiencing various diabetes complications, including stroke, nerve damage, heart attack and kidney disease. According to the American Diabetes Association, a diabetic patient who smokes is three times more likely to die of cardiovascular disease than one who doesn’t smoke. Try to help your husband quit smoking
• Do Exercises – Outdoor activities and regular exercise can go a long way towards keeping high blood pressure and cholesterol under control. High blood pressure and cholesterol are great concerns for diabetes patients, worsening the disease
• Regularly Seek Medical Exam for Eyes – Physicals or routine eye exams benefit diabetic patients a lot. During the physical exam, ask your doctor to check any diabetes-related complications such as signs of kidney damage, heart disease, nerve damage, as well as other medical problems. Signs of retinal damage, cataracts and glaucoma can be found out during the eye check
• Upgrade Vaccination – Your husband’s immune system can be weakened by high blood sugar. Keeping vaccination up to date is more important than ever
• Flu vaccine helps one stay healthy and prevents serious conditions from the flu
• Pneumonia vaccine is good for diabetes complications, in case your husband is 65 or older
• Your doctor, diabetes nurse educator and dietitian may offer help and encouragement along the way. But it is up to you to manage your husband’s condition. Learn more information about diabetes, monitor his blood sugar level, and follow the doctor’s instructions for keeping his blood sugar level within the target range

Now researchers from the Columbia University College of Physicians and Surgeons, New York, report that this surgery can improve insulin sensitivity in diabetic patients much more effectively than weight loss diet.

The results of this study are to be presented at The Endocrine Society’s 92nd Annual Meeting in San Diego. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

How Bariatric Surgery Benefits Type 2 Diabetes Patients?

The ability of the body to pass glucose from the blood stream to the cells is called insulin sensitivity. As in type 2 diabetic patients, this ability is impaired, the blood sugar level rises. Roux-en-Y gastric bypass is the most common weight loss surgery.

Here, size of the stomach is reduced and the digestive tract is given a new route bypassing the stomach and part of small intestine. After the surgery, the diabetic patients are found to have normal or at least vastly improved control over blood sugar. Medication for this ailment is also discontinued by many.

Knowledge Gained from the Research Study:

• The study comprised of two groups with seven obese type 2 diabetic patients in each group.
• Group one patients underwent this surgery and group two patients initiated 800 calorie diet on regular basis.
• At the end of the study, patients from both the groups lost 8 percent of their body weight.
• But group one patients lost this weight in 3.5 weeks and group two patients had to wait for 8 weeks to see the same result.
• Group one patients completely discontinued their medications while group patients reported of 55 percent drop in their intake of medicines.

It is believed by the researchers that bariatric surgery results in some hormonal changes which cause these beneficial results in type 2 diabetes patients. Further research is focused on gaining more insight on the underlying mechanism of this beneficial finding.

Basics of Diabetes: It is an auto-immune disorder. An ailment is called so when our body’s protection system turns hostile and starts disrupting the normal functioning of cells or pose threat to their existence.
Diabetes is of two types namely, type 1 and type 2. The former affects children below the age of 20 years and the latter affects adults and elderly mostly.
The food we eat gets converted to glucose, which is the source of energy for our body. When it enters blood, it is either supplied to the cells which require it or is stored for later use. A chemical called insulin carries out this task.
In type 2 diabetic patients, this hormone is not produced in sufficient amount. In type 2 diabetic people, the insulin produced is not recognized by the body. The cause of such a behavior is unknown yet. The consequence is rise in blood sugar level or diabetes which is an undesirable condition increasing the risk of several complications in the body.

What is Somogyi Effect?

Type 1 diabetic patients require supply to insulin manually into their body several times a day, to keep the blood sugar level in check. They induced insulin using injections. Dr. Somogyi found that excess intake of insulin can lead to rise of blood sugar level in the body.
This finding is against common sense as, presence of insulin should bring down the blood sugar level and excess presence of insulin should further bring the blood sugar level down. When the levels come down the normal, the condition is called hypoglycemia. Its counterpart is the condition hyperglycemia.

How Somogyi Effect Takes Place?

This effect is a result of normal bodily response to a crisis situation. Just like less insulin production is a threat to the body, its excess dosage can also lead to hypoglycemia.

When such excess intake of insulin dosage happens regularly, the body experiences hypoglycemia state often. As a response to this critical state, the body signals release of glucose from liver to raise the blood sugar level and two other hormones epinephrine and cortisol are also released.

These hormones inhibit the interference of the insulin to bring down the rise in blood sugar level for several hours.
This is how, an excess dose of insulin at night times, leads to higher blood sugar level in the morning at times, experienced by regular users of insulin injections or type 1 diabetic patients.

How to Prevent Somagyi Effect?

There are no scientific evidences to prove that this effect as of now. Though the effect is known to diabetic patients and doctors, it remains controversial owing to lack of proof. Latest research studies even suggest that the effect can even be a false one. However, for those who are aware of this phenomenon, there are certain ways to prevent Somagyi effect. They are:

• Blood sugar measuring devices can be used to measure the levels 6-8 times a day.
• Measuring the blood sugar at night times is very crucial and beneficial in keeping a track of this effect.
• Blood sugar reports should be preserved and monitored on weekly and monthly basis.

Top 10 Research Facts on Diabetes Foods:

Fenugreek: According to the Indian Council of Medical Research, intake of 25-50 grams of these seeds is useful. A component Pectin present in these seeds keeps the glucose level in check.

Spinach: A study was carried out by the Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts in 2004. The study found that one cup of boiled spinach has 156 mg of magnesium. Intake of this leafy vegetable has inverse effect on the blood sugar level.

Azadirachta Indica: The leaves of the tree, according to ayurveda, have the quality of stimulating the beta cells in the pancreas responsible for producing insulin.

Onion: A research study carried out way back in 1977 revealed that lower levels of chromium mineral increases insulin production. A cup of onion daily fulfils 20 percent of the requirement of this mineral.

Garlic: Research study carried out in November 2008 at the Suzuka University of Medical Science, Japan, found that garlic contains two substances Allixin and Vanadium. They are found to influence the genes in the diabetic patients in such a way that the pancreas starts producing insulin in high levels.

Rinds of Citrus Fruits: A component called d- Limonene present in 51.24 percent in rinds of citrus fruit. The research was carried out in October 2009 at the Institute of Biotechnology, Hungkuang University, Taiwan.

Carrots: This vegetable gets its natural color because of the component Carotenoid. This component is found to be a power antioxidant fighting with the complications of free radicals in diabetic people. Researchers at the University of Minnesota School of public health found that it reduces the risk of diabetes to half as well.

Apple: Research study has found that eating this fruit decreases the need of insulin hormone by 35 percent. A natural healing component of this fruit beneficial to the diabetic people is pectin. The Glycemic rating index of apple is 38. Its glycemic load for 120 gms of consumption is only 6.

Capsicum: A substance Capsaicin separated from this vegetable and given to diabetic people reduced the blood sugar level by 23 percent. Results of the findings were published in the journal Phytotherapy Research, in March 2004.

Drumsticks: Researchers at the Department of Nutritional Science, Faculty of Applied Bioscience, Tokyo University of Agriculture, Sakuragaoka, Setagaya-ku, Tokyo, Japan, have found that leaves of this vegetable contains a component Quercetin-3-glucoside which can bring down the blood sugar level under control gradually.

What is Insulin Resistance?

We get energy from the food we eat. Insulin is the carrier of glucose or energy of our body to the building blocks of life, cells. The cells use this energy for carrying out vital functions in our body and store some of the energy as fat for later use.

In type 2 diabetes patients, the cells which produce insulin (the beta cells) are targeted by cells of the immune system. It is the natural protection system of our body. Why cells of our own body turn hostile and attack the beta cells is unclear. This makes diabetes an auto-immune disorder.

The consequence is the insulin produced by these impaired beta cells being less effective in its basic task. It cannot inhibit the rise of glucose levels as the body itself refuses to recognize this hormone. This undesirable condition is insulin resistance.

How Obese People are Prone to Insulin Resistance (IR)?

Researchers from the Salt Institute for Biological Studies discovered the relation between obesity and IR last year. The results of their findings were published in the online edition of the journal Nature in June 2009. The study was funded by the National Institutes of Health.

They found that a process called ER (endoplasmic reticulum) stress is overly active in obese people leading to IR. ER stress is caused by consumption of high fat diet.

Whenever the body is in short of energy, the liver initiates excess production of glucose. This process is called gluconeogenesis. The ER is the protein factory inside the cells. When gluconeogenesis is underway, protein production is stopped for a while. This situation is called ER stress.

But in obese people, both the processes are abnormally active. This leads to uncontrolled production of glucose once the process begins.

Mechanism of Abnormal Gluconeogenesis in Obese People:

Cells follow chemical instructions called genes to carry out their routine functions. The genes get activated when they receive appropriate signals from what are known as the signaling molecules. Two molecules CRTC2 and CREB, instruct the genes for glucose production.

The molecule CRTC2 is generally present outside a cell. On receiving appropriate signal, it enters inside the cell and binds with CREB. This development instructs the genes to initiate glucose production.

Research carried out on experimental mice suffering from insulin resistance has revealed that in these mice, CRTC2 remains stuck in the “ON” state, and this is how abnormal gluconeogenesis takes place. The findings can be extended on humans too.

In this way, abnormality in ER stress and gluconeogenesis processes, cause obese people be at higher risks of developing insulin resistance (or type 2 diabetes).

Insulin is responsible for carrying glucose or energy to the cells of the body. This energy is either utilized by the cells for carrying out their functions or is stored as fats for later use. When there is absence of this hormone, the glucose level starts rising in the blood itself. This is the undesirable condition called diabetes mellitus.

Absolute shortage of the hormone insulin causes DKA. The body is compelled to burn the stored fatty acids in the cells. In this process, substances called acidic ketone bodies are produced which are responsible for most of the signs of DKA.

Diabetic patients are at higher risks of getting this disease. Pre-diabetic patients are diagnosed with DKA in the initial stages. Illness like heart disease, stroke, influenza, pneumonia, gastroenteritis and conditions like eating disorder, pregnancy and use of cocaine can lead to DKA. It is prevalent among African, Hispanic and African-American people.

Symptoms of Diabetic Ketoacidosis:

• Coma
• Vomiting
• Nausea
• Breath odor
• Breathing difficulty
• Confusion
• Abdominal pain
• Rapid pulse
• Drowsiness
• Sweet smelling acetone breath
• Rapid breathing
• Dehydration
• Low blood pressure
• Headache due to swelling of brain tissue
• Tender abdomen
• Excessive thirst
• Excessive urine production
• Lethargy
• Stupor
• Loss of the pupillary light reflex

Blood and urine tests can diagnose this condition. Acidity of blood and presence of bicarbonate in the urine is checked. Normally the pH of blood is between 7.35-7.45. The bicarbonate is normally above 20 mmol/l. According to the American Diabetes Association, the severity of DKA in adults can be categorized in three stages. They are:

Mild: If blood pH is between 7.25-7.30 and bicarbonate level is between 15-18 mmol/l.

Moderate: If blood pH is between 7.00-7.25 and bicarbonate level is between 10-15 mmol/l.

Severe: If blood pH is between below 7.00 and bicarbonate level is below 10 mmol/l.

Treatment of Diabetic Ketoacidosis: The goal of treatment is to replace the lost fluids and suppress the blood sugar levels and ketone production with insulin.  Some of the methods employed are:

Fluid Replacement: Quick saline infusion up to 10ml/kg in repeated doses should be given to adults for treating severe case of dehydration.

Insulin: Ketone production and blood sugar level is brought under control by giving insulin at 0.1 unit/kg per hour. However, there is difference in opinions and guidelines on the amount of insulin given once the blood sugar level decreases.

Potassium: Insulin reduces the potassium levels by distributing it among body cells. If its level falls below 3.3mmol/l, insulin insertion should be stopped. Low potassium concentration can lead to irregularities in heart beats. That is why, heart beats are to be monitored with repeated measurement of potassium levels.

Symptoms:

• Diarrhea
• Constipation
• Dizziness
• Impotence
• Bladder infection
• Abnormal sensations
• Diabetic gastroparesis
• Peripheral neuropathy
• Vomiting
• Problems with urination
• Weakness
• Wasting of muscles of hands and feet
• Depression

Causes:

Life Style Factors: Smoking and alcohol consumption increase the progression of the condition.

Mechanical Injury: Traumatic conditions involving damage to the nerves like carpal tunnel syndrome.

Genes: When the disease is inherited, the chances of nerve damage are higher.

Autoimmune Factors: They are unknown reasons which cause swelling of the nerves.

Metabolic Factors: Abnormal fat levels, high glucose levels, low insulin levels in the blood and long duration of the disease.

The mechanism of how exposure to high blood sugar levels causes nerve damage is still studied by researchers.

Types of Diabetic Neuropathy and the Affected Locations in the Body:

Peripheral Neuropathy: Hands, arms, toes, feet and legs.

Autonomic Neuropathy: Eyes, lungs, heart, blood vessels, digestive system, urinary tract, sex organs, sweat glands.

Proximal Neuropathy: Hips, thighs, buttocks, legs.

Focal Neuropathy: Thighs, feet, legs, lower back, pelvis, abdomen, chest, ears, facial muscles and eyes.

Treatment of Diabetic Neuropathy Complications: The best way to prevent the onset of this condition is to maintain a low blood sugar level or at least keep it in check. Some of the treatment options to deal with the complications are:

Pain Relief: Oral medications are prescribed by the doctor to relief the pain. Some of these medications are antidepressants like imipramine, desipramine, amitriptyline, venlafaxine, duloxetine, paroxetine, citalopram and bupropion. Anticonvulsants like pregabalin, lamotrigine, gabapentin and carbamazepine are also prescribed. However, the United States Food and Drug Administration has approved only duloxetine and pregabalin as medicines to treat this condition.

Physical therapy, biofeedback, acupuncture, laser or light therapy, magnetic therapy and electrical nerve stimulation are some of the alternative treatment options to relieve pain.

Gastrointestinal Problems: Indigestion, belching, vomiting or nausea are the mild symptoms of this condition. Small and frequent meals are advised by the doctors to treat it. As severity increases, medicines like erythromycin and metoclopramide to speed up digestion and secretion of stomach acids.

Dizziness: Intake of salt in the diet is opted by few. Sitting or standing slowly is practiced by many to counter circulation and blood pressure problems. Wearing elastic stockings and raising the head of the bed is found to be beneficial by many.

Foot Care: Feet nerves are the worst affected parts of the body by this condition. Diabetic neuropathy causes 86,000 amputations every year in the lower limb area in this country. This calls for their special attention and care of feet. Sensation is lost easily in this region and this makes any infection or sore go unnoticed initially until it leads to infection. Foot ulcers also result due to impaired circulation of blood in the region. Some of the tips to follow to ensure foot care are:

• Use mild soap and warm water to clean the feet daily. Soft towel should be used to dry it especially between the toes.
• Moisturizing lotion can be used but should not be applied between the toes.
• Any swelling, cuts, blisters, calluses or redness should be informed to the doctor immediately.
• An emery board can be used to file toenails and pumice stone can be used to file corns and calluses.
• Thick, seamless and soft socks with slippers or shoes can prevent feet injuries.
• Inspection of the shoes before wearing them for any tears or sharp edges is a good practice.
• New shoes should be selected in such a way that they fit well and allow the toes to move comfortably.
• They should be tried in breaks wearing for only an hour at a time.

Initially there are no symptoms. But as the disease progresses, the mother develops signs like excessive thirst and other milder symptoms of type 2 diabetes. Some of the risk factors of this disease are:

• Being over weight
• Being 25 years or above
• Having a family history of this disease
• Being African American, American Indian, Asian American, Hispanic/Latino, or Pacific Islander
• Being pre-diabetic
• Given birth to a baby more than 9 pounds

A simple blood test can reveal whether a mother is suffering from this ailment. If the blood glucose level is higher than 95 on fasting, above 180 after an hour of having food, above 155 after two hours and above 140 after three hours, it is confirmed that the patient suffers from gestational diabetes.

Some of the complications to the baby are breathing problems, low glucose in the blood, born with excess fat leading to delivery complications and high risk of developing type 2 diabetes for the entire life along with the mother. This disease goes away after the delivery of the baby. But it can return again if a woman becomes pregnant.

Treatment of Gestational Diabetes:

• Taking plain meal can keep the blood sugar in control. There can be two-three small meals and equal number of snacks every day.
• Carbohydrate foods should be replaced by fruits, vegetables, cereals, whole grains and bread.
• Physical exercises like walking and swimming are beneficial in keeping the glucose level in check.
• Severe cases can be treated by injecting insulin into the body artificially through pump devices, as it is not available in the form of pills.

Symptoms of Type 2 Diabetes:

• Skin infections
• Skin rashes
• Skin ulcers
• Poor skin healing
• Athlete’s foot
• Urinary tract infection
• Thrush
• Flaky skin
• Dry itchy skin
• Foot tingling
• Hand tingling
• Foot numbness
• Hand numbness
• Candida
• Weight loss
• Blurred vision
• Paresthesias
• Erectile failure
• Peripheral neuropathy
• Absent periods
• Unusual dryness of vagina
• Premature menupose
• Malaise
• Weight gain
• Dehydration
• Drowsiness
• Tiredness
• Excessive thirst, hunger and urination
• Muscle weakness, aches and cramps
• Headaches
• Acne
• Irritability
• Tinea
• Vomiting
• Nausea
• Rapid pulse
• Fruity acetone breath
• Breathing difficulty
• Abdominal pain and bed wetting in children

Causes of Type 2 Diabetes:
The food we eat gets converted to energy or glucose. Insulin is the hormone which carries glucose to the cells. The cells either make use of the energy for carrying out various functions of our body or store it for later use.

In the body of a person suffering from type 2 diabetes, the produced insulin is not recognized by the body. It is not used appropriately. As a result, the presence of glucose in the blood increases. This undesirable state is type 2 diabetes.

There are some factors which are responsible for the onset of this disease. They are:

Life Style: A study found that people who exercise regularly, have healthy diet, do not smoke, consume alcohol moderately have 82 percent less risk of getting this disease.

Medical Conditions:

• Obesity is responsible for 55 percent of type 2 diabetes cases.
• High blood pressure
• High cholesterol levels
• Excess of cortisol
• Testosterone deficiency
• Conditions like Syndrome X
• CHAOS
• Reavan’s syndrome
• Cushing’s syndrome
• Chronic pancreatitis
• Thyrotoxicosis
• Acromegaly
• Pheochromocytoma
• Chronic pancreatitis

Role of Genes: This disease can be inherited by family members. Change in the normal structure of the gene (technically called mutation) Islet Amyloid Polypeptide, also leads to early onset of this disease.

Use of Certain Medicines: Intake of drugs like thiazide diuretics, niacin, calcium channel blockers, somatropin, protease inhibitors, phenothiazines, beta-blockers, fluoroquinolones, corticosteroids and atypical antipsychotics can also cause this disease.

Treatment of Type 2 Diabetes:
The treatment of this disease aims at reducing the complications associated with the disease and preserving the quality of life of the patient. When diagnosed early, this disease can treated very well.

• According to the recommendations of the American Diabetes Association, two and a half hours of exercise per week is essential for preventing this disease along with the intake of healthy diet.
• Modest weight loss of even 2-5 kgs or 4-5 pounds can substantially rise insulin sensitivity in the body as per research studies.
• Use of drugs like metformin, valsartan and rosiglitazone can further delay the disease.

Symptoms of Type 1 Diabetes:
Unfortunately, the symptoms of this disease remain latent mostly, but originate nearly 13 years prior to the diagnosis. Some of the signs to watch out for are:

• Fatigue
• Feeling hungry
• Blurry eyesight
• Frequent urination
• Frequent thirst
• Weightloss
• Tingling feeling in feet
• Headache
• Nervousness
• Rapid heart beat
• Weakness
• Shaking
• Deep breathing
• Flushed face
• Stomach pain
• Dry skin and mouth
• Nausea
• Vomiting
• Fruity breath odor

Causes of Type 1 Diabetes:
The food we eat has to eventually get converted into energy. This energy is utilised by cells to carryout various functions of our body. A hormone called insulin is responsible for providing cells with glucose or body energy. The cells store excess of energy or glucose for later use.

Special type of cells called beta cells present in an organ, behind stomach, called pancreas produce insulin. For some unknown reasons, in a type 1 diabetic patient’s body, the beta cells stop producing insulin. Within 5-10 years, our own body completely destroys these beta cells and natural insulin production is stopped for ever inside the body.

As a result, the food we eat does gets converted to glucose. But absence of insulin leads to its presence in the blood itself, without reaching its ultimate destination, the cells. As there is rise in the levels of glucose in the blood, an undesirable condition called type 1 diabetes prevails.

Treatment of Type 1 Diabetes:
A simple blood test is used to diagnose this disease. According to the 2010 recommandations of the American Diabetes Association, the conditions and their associated sugar levels are:

• Normal if below 5.7 percent
• Prediabetic if between 5.7 percent and 6.4 percent
• Diabetic if above 6.4 percent

There is no cure for this disease yet. It means it can only be treated. Some of the treatment methods are:

Insulin: This hormone can artifically be injected into the body to meet its requirement. It does not come in a pill form. There is a device called insulin pump which makes the substance enter into the blood stream anywhere between 1-4 times per day.

Diet: It is a must that type 1 diabetic patients eat food nearly at same times per day. They follow a strict diet after consulting a registered dietician or nutrition counsellor.

Physical Activity: Regular physical activities like walking or jogging keeps the blood sugar levels in control and decrease the excess requirement of insulin in the body. The exercise should be done at a specific time as a part of a routine schedule.

Foot Care: Diabetic patients should take special care of their foot. A small sore can lead to severe infection and even amputation of limbs as the blood vessels get easily damaged by this disease.