Treatment and Support
Top Treatment and Support Topics
What are clinical trials for diabetes?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Scientists are conducting research to learn more about diabetes, including the following studies
The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE External link) is following more than 5,000 people across the country who have type 2 diabetes to find out which combination of two diabetes medicines is best for blood glucose, also called blood sugar, management; has the fewest side effects; and is the most helpful for overall health in long-term diabetes treatment.
TrialNet External link is conducting research studies around the world, including risk screening for relatives of people with type 1 diabetes, monitoring for people at risk, and innovative clinical trials aimed at slowing down or stopping the disease.
Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you NIH external link.
Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.
An insulin pump is about the size of a small cell phone. It gives you a basal dose of short- or rapid-acting insulin per hour. When you eat or when blood sugar is high, you calculate the dose, and the insulin in the pump delivers the bolus.
The pump delivers insulin through a thin plastic tube placed semi-permanently into the fatty layer under your skin, usually in the stomach area or back of the upper arm. Your doctor or health education specialist will show you how and where to place the tube.
Advantages of insulin pumps
Have been shown to improve A1C.
Deliver insulin more accurately.
Deliver bolus insulin easier.
Eliminate unpredictable effects of intermediate- or long-acting insulin.
Provide greater flexibility with meals, exercise, and daily schedule.
Can improve physical and psychological well-being.
Disadvantages of insulin pumps
May cause weight gain.
Can be expensive.
May cause infection.
May cause diabetic ketoacidosis (very high blood sugar) if the system is stopped or stops working correctly.
Can be a constant reminder of having diabetes.
Training is necessary.
Make sure to talk to your doctor and diabetes educator when your lifestyle or needs change. They will know about the latest devices and have tips to make taking insulin and all aspects of diabetes easier to manage. Need help finding a diabetes educator? Find a diabetes education program in your area.
If you have diabetes, here’s a way to keep standing on your own two feet: check them every day—even if they feel fine—and see your doctor if you have a cut or blister that won’t heal. There’s a lot to manage if you have diabetes: checking your blood sugar, making healthy food, finding time to be active, taking medicines, going to doctor’s appointments. With all that, your feet might be the last thing on your mind. But daily care is one of the best ways to prevent foot complications.
About half of all people with diabetes have some kind of nerve damage. You can have nerve damage in any part of your body, but nerves in your feet and legs are most often affected. Nerve damage can cause you to lose feeling in your feet.
Feeling No Pain
Some people with nerve damage have numbness, tingling, or pain, but others have no symptoms. Nerve damage can also lower your ability to feel pain, heat, or cold.
Living without pain sounds pretty good, but it comes at a high cost. Pain is the body’s way of telling you something’s wrong so you can take care of yourself. If you don’t feel pain in your feet, you may not notice a cut, blister, sore, or other problem. Small problems can become serious if they aren’t treated early.
Diabetes mellitus is associated with a variety of musculoskeletal (MSK) manifestations affecting the hand, which can significantly affect a patient’s quality of life. While a great deal of attention is paid to the chronic microvascular complications of diabetes, the MSK complications are often ignored in clinical practice. It is important to diagnose them as their presence has been found to correlate with chronic microvascular complications of diabetes especially retinopathy. We describe a case of a young male with long-standing type 1 diabetes mellitus and chronic microvascular complications, who presented to us with several manifestations of diabetic hand syndrome.
Diabetes mellitus is associated with a constellation of debilitating musculoskeletal (MSK) disorders affecting hand, commonly referred to as diabetic hand syndrome. These include limited joint mobility (LJM) (also known as diabetic cheiroarthropathy), Dupuytren’s contracture, stenosing tenosynovitis (trigger finger), carpal tunnel syndrome (CTS), Charcot neuroarthropathy, reflex sympathetic dystrophy and a variety of hand infections which these individuals are predisposed to [1-3]. Timely recognition of these conditions not only helps in instituting proper treatment to decrease morbidity and disability, but also aids in early identification of vascular complications of diabetes which are found to be related to hand symptoms.
November is diabetes
awareness month, and it is the perfect time to review the key role that pharmacists play in helping patients manage this chronic condition.
Diabetes has widespread effects, especially in the United States, with 11.3% of those 20 and older having type 2 diabetes mellitus (DM). And this percentage is growing. For every 4 people who have type 2 DM, about 1 is undiagnosed. Some of the factors that put a person at risk for diabetes include a family history of the disease, obesity, physical inactivity, high blood pressure, and high cholesterol. Pharmacists are in a prime position to identify these and other risk factors in patients. However, not all patients have textbook presentations. The disease can sometimes go undetected and without symptoms until it reaches an emergency state. This is particularly true in patients who do not receive routine medical care or have an established relationship with a primary-care physician. Routine and simple tests such as blood glucose testing conducted at health fairs and wellness clinics at pharmacies across the country are an example of how a simple test conducted in the pharmacy or by the pharmacy team may provide an efficient method for identifying a patient with a potential diagnosis and help direct them to appropriate medical attention.
Because pharmacists are the most accessible health care providers, they are key players in the betterment of patients’ health, not just in terms of screening but in the lifelong management of the disease. For those who are diagnosed, pharmacists are able to provide counseling about monitoring glucose levels and how to manage out-of-range levels, including developing an action plan for what to do if sugar levels go too low. Pharmacist can help patients select the most appropriate hypoglycemic management strategy on an individual basis. Pharmacists can counsel on an appropriate diet and exercise routine to compliment medication management in treating diabetes. This can be especially useful in underserved areas where access to nutritionists or dieticians may be unavailable. The number of treatment options for diabetes has increased substantially over the past few years, and pharmacists are best positioned to help patients understand the fundamentals and intricacies regarding the medication as well as helping them understand which medications may be best suited for them. Pharmacists can also help guide patients through the management of adverse effects, knowing when and how to treat these so that therapy can be continued and when it might be better to switch to an alternative treatment regimen. For patients requiring insulin, the pharmacist can help instruct the patient on how to administer the medication, as well as answer common questions and concerns.
With prompt diagnosis, proper lifestyle changes, and appropriate pharmacotherapy, patients can minimize and/or delay the complications that uncontrolled diabetes can cause. Integrating simple ways to ensure that pharmacists follow up with diabetic patients, not just when new medications are prescribed but at each and every refill, can help improve the health and quality of life for these patients and make every month, not just November, one where they are aware of, understand, and are invested in the best possible management of the disease.
This article was co-written by Lauren Speakman, PharmD candidate at the Harrison School of Pharmacy at Auburn (Alabama) University.
Your Diabetes Care Schedule
There’s a lot to do to manage diabetes. Starting with daily care you do yourself, to lab tests and visits with your health care team, all are important for diabetes management.
Use this list to stay on schedule with self-checks, exams, and appointments throughout the year.
Got questions about everyday diabetes care? Ask your doctor about a referral for diabetes self-management education and support (DSMES) services. If you already have a referral, find a diabetes care and education specialist.
Blood sugar checks
Check up to several times a day as directed by your doctor. Keep a record of your numbers and share with your health care team during your next visit.
Use a mirror if you can’t see the bottom of your feet or ask a family member for help. Let your doctor know immediately if you have any cuts, redness, swelling, sores, blisters, corns, calluses, or other change to the skin or nails.
Take the amount prescribed by your doctor, even when you feel good.
Get at least 150 minutes a week of moderate activity, such as brisk walking or riding a bike.
Eat healthy foods that give you the nutrition you need and help your blood sugar stay in your target range.
Every 3 Months
If your treatment has changed or if you’re having trouble meeting your blood sugar goals, have this test every 3 months.
If you’re having trouble meeting your treatment goals, visit your doctor every 3 months. Your blood pressure and weight will be checked, and your self-care plan and medicines will be reviewed. Ask your doctor to check your feet if you’ve ever had diabetes-related foot problems.
Every 6 Months
Get your teeth and gums cleaned at least once a year (more often if your doctor recommends), and let your dentist know that you have diabetes.
If you’re meeting your treatment and blood sugar goals, have this test every 6 months.
If you’re meeting your treatment goals, visit your doctor every 6 months. Your blood pressure and weight will be checked, and your self-care plan and medicines will be reviewed. Ask your doctor to check your feet if you’ve ever had diabetes-related foot problems.
Dilated eye exam
You may need this exam more often if you have diabetes-related eye problems.
Complete foot check
Endocrinologists are doctors who specialize in glands and the hormones they make. They deal with metabolism, or all the biochemical processes that make your body work, including how your body changes food into energy and how it grows.
They may work with adults or kids. When they specialize in treating children, they're called pediatric endocrinologists.
What Do Endocrinologists Do?
They cover a lot of ground, diagnosing and treating conditions that affect your:
Bone metabolism, like osteoporosis
Pituitary, a pea-sized gland at the base of your brain that keeps your hormones balanced
Reproductive glands (gonads): ovaries in women, testes in men
Endocrinologists are licensed internal medicine doctors who have passed an additional certification exam.
They go to college for 4 years, then medical school for 4 more years. Afterward, they work in hospitals and clinics as residents for 3 years to get experience treating people. They'll spend another 2 or 3 years training specifically in endocrinology.
The whole process usually takes at least 10 years.
Where to Find One
An endocrinologist can work in:
A medical practice with other endocrinologists
A group with different kinds of doctors
You can search for one on the American Association of Clinical Endocrinologists website.
Some don't see patients. They may work in universities or medical schools, where they teach medical students and residents or do research.
When to See an Endocrinologist for Diabetes
Your regular doctor can treat diabetes, but they might refer you to an endocrinologist when:
You're brand new to diabetes and need to learn how to manage it.
They don't have a lot of experience treating diabetes.
You take a lot of shots or use an insulin pump.
Your diabetes has gotten tough to manage, or your treatment isn't working.
You have complications from diabetes.
You can always ask to go to an endocrinologist, too, even though your doctor doesn't suggest it first. When you see one, you'll still need to visit your primary doctor as well. They'll work together.
Source: Medical News Today
Managing blood sugar is the key to living well with diabetes, and eating well is the key to managing blood sugar. But what does it mean to eat well? Simply put, eat healthy foods in the right amounts at the right times so your blood sugar stays in your target range as much as possible.
Work with your dietitian or diabetes educator to create a healthy eating plan, and check out the resources in this section for tips, strategies, and ideas to make it easier to eat well.
A meal plan is your guide for when, what, and how much to eat to get the nutrition you need while keeping your blood sugar levels in your target range. A good meal plan will consider your goals, tastes, and lifestyle, as well as any medicines you’re taking.
A good meal plan will also:
Include more nonstarchy vegetables, such as broccoli, spinach, and green beans.
Include fewer added sugars and refined grains, such as white bread, rice, and pasta with less than 2 grams of fiberexternal icon per serving.
Focus on whole foods instead of highly processed foodsexternal icon as much as possible.
Carbohydrates in the food you eat raise your blood sugar levels. How fast carbs raise your blood sugar depends on what the food is and what you eat with it. For example, drinking fruit juice raises blood sugar faster than eating whole fruit. Eating carbs with foods that have protein, fat, or fiber slows down how quickly your blood sugar rises.
For more information, see Carb Counting.
You’ll want to plan for regular, balanced meals to avoid high or low blood sugar levels. Eating about the same amount of carbs at each meal can be helpful. Counting carbs and using the plate method are two common tools that can make planning meals easier too.
Keeping track of how many carbs you eat and setting a limit for each meal can help keep your blood sugar levels in your target range. Work with your doctor or a registered dietitian to find out how many carbs you can eat each day and at each meal, and then refer to this list of common foods that contain carbs and serving sizes. For more information, see Carb Counting.
It’s easy to eat more food than you need without realizing it. The plate method is a simple, visual way to make sure you get enough nonstarchy vegetables and lean protein while limiting the amount of higher-carb foods you eat that have the highest impact on your blood sugar.
Start with a 9-inch dinner plate (about the length of a business envelope):
Fill half with nonstarchy vegetables, such as salad, green beans, broccoli, cauliflower, cabbage, and carrots.
Fill one quarter with a lean protein, such as chicken, turkey, beans, tofu, or eggs.
Fill one quarter with carb foods. Foods that are higher in carbs include grains, starchy vegetables (such as potatoes and peas), rice, pasta, beans, fruit, and yogurt. A cup of milk also counts as a carb food.
Then choose water or a low-calorie drink such as unsweetened iced tea to go with your meal.
Diabetes Emergency Kit
As we’re living through a global pandemic and various natural disasters, emergency preparedness has taken on a whole new significance. While emergency situations are stressful and challenging for anyone, they can be potentially life-threatening to a person with a chronic medical disease such as diabetes.
Diabetic symptoms can occur anytime, and if you or a loved one has hypoglycemia or other insulin reactions, your symptoms can quickly become severe, causing you to faint, go in shock, or even lead to dangerous health problems. That’s why advance preparation is a key defense for chronic disease management during emergencies.
Whether an unexpected natural disaster occurs such as a blizzard, hurricane, flood, earthquake, fire, tornado, or an unforeseen situation of dealing with an auto breakdown, having an emergency diabetes kit can save your life.
That’s why we created the My Diabetes Emergency Plan. Launched in 2006, in response to the aftermath of Hurricane Katrina, the My Diabetes Emergency Plan is a convenient checklist that contains all of the essential items those with diabetes need to have readily available in the event of an emergency.