Beware of alternative causes of neuropathy in diabetes

Diabetes in Control: Disasters averted

Not All Neuropathies in Diabetes are Caused by Diabetes
May 10, 2016

A woman, 57 years of age, type 2 diabetes, metformin 1,000mg twice daily for 12 years, came in with weakness, anemia, tingling of fingers and toes. Her A1C had always been below 7%. Some in my office thought she had developed diabetic peripheral neuropathy. I could not disagree, but I also knew metformin can cause vitamin B12 deficiency. I immediately ordered lab including a B12 level. Sure enough, her B12 was low. We recommended B12 lozenges, 500mcg daily, and her symptoms as well as her B12 levels improved. This was good news because neurological symptoms don’t always improve with B12 therapy, but hers did. (My comment: they need to be treated within six months of onset)
Lessons Learned:
• For patients taking metformin, check B12 levels at least annually.
• Consider recommending B12 supplementation to patients who take metformin, or at least teach of the possibility of this side effect.
• Teach patients who are on metformin therapy to eat foods high in vitamin B12 such as animal sources of foods including beef, poultry, seafood, eggs, dairy and foods fortified with B12.
• When a patient with diabetes presents with peripheral neuropathy, check vitamin B12 levels, and treat accordingly.

Diabetes awareness mama: managing mood changes in your type 1 child

This article is from the mother of a type one son who has recently started school. She discusses ways to help other parents of children in the same situation in her blog.

https://diabetesawarenessmama.com/2017/07/05/managing-mood-changes/

Managing mood changes
July 5, 2017
Hannah Foreman-Wenneker
Today I would like to open the doors on what goes on behind the scenes of a T1D child. What do they feel that we parents cannot see? What do they want to tell us but are too young to possess the vocabulary or verbalise their emotions? These, and many more questions, often race through my mind. Taking on the full time job of a pancreas isn’t just about calculating carbohydrates, night time blood tests or insulin pump therapy; it is equally as important to understand the side effects this disease has on your child’s brain and subsequently, personality.
It all starts with the physiology of diabetes. I will never be able to fully appreciate what our son physically and mentally feels when he experiences a hypo or hyper, I can only describe to you what I have been told. According to the experts: diabetics, when a child is having a hypo they feel weak, dizzy, confused and shaky. This fantastic 3 minute video of four woman describing how they physically feel and mentally react during a hypo is well worth your time.
It is quite common for a T1D to suffer from ‘hypo-unawareness‘, particularly in young children who are naturally less aware of their body and how it functions. Hypo-unawareness is physically dangerous, but it is also a mental battle for the patient and for those who care for them. When our son Noah, is feeling these symptoms his insulin pump will give me a warning alarm (caveat: there is a 20 minute, give or take, communication delay between his body and the pump) and I can treat the hypo for its physical effects.

There is no medical treatment for the mental effects of a hypo. In our experience, Noah morphs from an adorable kitten to a roaring lion in a nano-second. He goes from “Mummy I love you to the universe and back” to a vein-popping, red faced animal screaming inaudible words that make no sense anyway. Unlike typical child-like tantrums (which he naturally has too, yey! these appear as is if from nowhere.

Sometimes his behaviour is quicker to burst forth than the pump’s warning alarm and we can tell he is having a hypo simply from his monumental meltdown over inconsequential nothingness. Even though I know his diabetes is just ‘having a conversation with me’, I confess, I sometimes feel embarrassed when we are out in public. There are occasions when I have been in the supermarket or walking down the street and Noah’s diabetes wants to have another ‘chat’ with me. Millions of parents know the look you get from strangers on the street; you know the one, it appears that you cannot control your own child. I get those same looks but sometimes I just want to scream ‘you have no idea what he battles with inside!‘

Noah can also become confused during a hypo and he finds it difficult to concentrate. Whilst these are less fiery side-effects they cause me more long-term concern than the tantrum-style behaviour. I know the meltdowns will become easier as he gets older but he has already started school and now I find myself wondering how hypos will affect him in the future. How will Noah cope with T1D together with his education? Will it impact his academic ability? How can we help him now to learn to overcome these issues down the line?
According to this scholarly article we are already using the best possible therapy to support Noah’s mood and behaviour. ‘Continuous subcutaneous insulin infusion’ or insulin pump therapy has been very effective in reducing the frequency of hypos in T1Ds and the results show improved mood and behaviour changes in young children. So is that all that we have at hand to help? My answer to this is: I don’t think so.

Whilst it is notoriously difficult to measure neurological impact of T1D and, from what I can gather, is something that experts vary in opinion on, frequently the following cognitive elements are reported to be affected by T1D: intelligence (general ability), attention, processing speed, memory, and executive skills. I am not a scientist and I haven’t done any research into this, I am also only two years in as a T1D carer but my firm belief today is that all of these cognitive domains can also be greatly influenced by the parents, teachers, siblings, social circles, mentors and extended family etc. who surround the child.
And what about hypers? Someone once described to me that a hyper is like having a massive hangover, but without the nausea part. The patient is very thirsty, has severe headaches and lethargy. It isn’t rocket science to realise that these are not attributable feelings to a productive day at school or work.

For the last year, Noah experiences an (as yet) unresolved hyper every morning after his breakfast. His glucose levels soar, sometimes triple the amount of a non-T1D and try hard as we might, we haven’t yet fixed this ‘bug’ in his daily routine. Nevertheless, off he marches every morning to school, feeling like he drank himself under the table the night before. For now, I simply admire his strength but I worry about when he becomes a teenager, how will he find the will to keep concentrating on math, or history or grammar when he mentally becomes aware that he has a choice?
And speaking of teenagers, puberty is a notoriously challenging period for many diabetics, but I will leave this topic for another day, another year even. The underlying point here is that T1D presents enormous challenges both physically and mentally. Both require a bachelor degree level of understanding to deliver optimal short and long term care. Both take place behind the scenes and in front of a crowd but T1D is so massively misunderstood by many (including me before my son’s diagnosis) that raising awareness and understanding is a monumental challenge, but one that many can be proud to be passionate about.
#weneedacure

 

Public Health Collaboration Conference 2018: Achieving your optimal blood sugar target

Videos of the lectures given at the Public Health Collaboration conference 2018 which was held in May over the royal wedding weekend have now been released on You Tube.

You can see my talk, Achieving your optimal blood sugar target, as well as others, on the link below. There are a wide variety of lifestyle topics discussed. Happy viewing.

 

https://www.youtube.com/results?search_query=public+health+collaboration+conference+2018

Hypo Awareness Week

the hypo awareness logo on the Diabetes DietIt’s Hypo Awareness Week—what’s your favourite symptom?!

Kidding. Apart from a brief spell of time as a food-obsessed teenager when a hypo gave me the legit excuse to eat half a packet of Lucozade tablets, most of us hate the hypo.

From people who’ve found themselves in supermarkets eating handfuls of cereal from boxes (one of our lovely readers), to those nasty little spells where your mind goes blank and gives you a taste of what dementia might be like, most of us would banish hypos from our lives if we could.

The symptoms include:

  • hunger—your stomach might growl
  • turning pale and sweaty
  • tingling lips
  • shakes or trembling
  • dizziness
  • feeling tired
  • a fast or pounding heartbeat (palpitations)
  • becoming irritated, tearful, stroppy or moody
  • seeing floaters (a little blob of bright colour that moves) when you close your eyes or experiencing blurred vision

Most diabetics I’ve spoken to will add in another symptom—we don’t like others telling us we’re hypo. It’s to do with hypos making us irritable, and also because many of us strive to lead independent lives. Someone else noticing you’re unwell before you do undermines that ambition. Please bear with us and try not to mind our irritation.

We can’t moan about the symptoms too much, though. Still getting them after decades of diabetes is A. Good. Thing. If you lose the signs that your blood sugar levels have dipped too low, you risk passing out or having a seizure, and ultimately an untreated low blood glucose level can kill.

There are plenty of causes, such as

  • when you skip or miss a meal
  • if you take too much insulin to cover a meal
  • your basal rate being too high
  • exercise
  • unplanned activity
  • alcohol
  • changes to your routine

And because diabetes is a b***h to women, your cycle interferes with diabetes control too. Most women experience insulin resistance in the week or so leading up to their period and thus will need to take extra insulin to cover it. But the day the insulin resistance eases off can vary—it might be the day you get your period, it could be a few days later and BANG, higher than normal insulin doses, hypos left, right and centre…

 

Want to add any of your unusual symptoms or any scenarios you have found yourself in, thanks to a hypo? We love your comments…

FreeStyle Glucose Monitoring – an Update

freestyle libre on the Diabetes DietHashtag love the NHS—and the NHS in Scotland if we’re going to be specific.

Off I trotted to the diabetic clinic on Thursday armed with my best persuasion skills. Oh pleasy-weasy dear doctor, may I have a FreeStyle Libre flash glucose monitoring system? One of my arguments was going to be—Hey, you won’t be paying for it for too long. Did you see the recent research that tells me I can expect to knock eighteen years off my life expectation?!*

In the end, my polished debate wasn’t needed. Just as well as I couldn’t sell hot-water bottles to the Inuit. Or ice-cold beer to Australian sun-bathers for that matter. I brought the subject up. The doctor queried the number of blood tests I do per day and voila. I’m on a list. I’ll need to go to an education event and after that, a letter wings its way to my GP recommending she prescribes the sensors.

Sensors

Flash glucose monitoring for those of you who aren’t familiar with it is where you wear a sensor on your body (usually your upper arm) and you can take a reading from it using a monitor. It differs from blood testing in that it’s super quick and easy. You don’t need to prick your finger and you can check endlessly and the sensor works through your clothing.

Those of us who tend towards obsessive compulsive disorder—it’s hard not to when you’ve got diabetes—might baulk at that, but I am looking forward to monitoring what happens to me during exercise. And when I’m eating.

The device doesn’t come with an alarm—i.e. a warning when your blood sugar goes too far up or down, or it changes rapidly but there is software for that. The cat lover in me is delighted the manufacturers chose to call the software MiaoMiao, and this sends readings to your phone every five minutes, and will warn you of spikes.

Hello Big Brother!

You can even connect it to others’ devices, so they can monitor you too. I’ll skip that as it feels too Big Brother-y to me. Most type 1s hate other people telling them when they are hypo. Imagine how much worse this would be!

Incidentally, all this new diabetes-related tech has had a knock-on effect on the hospital I go to. Thursday’s clinic was running one hour late because it was so busy. The doctor told me he can’t get the GP support (where a GP handles some of the patients to gain experience in diabetes care), thanks partly to the fast development of new tech.

Our GPs are under so much pressure, it’s too difficult for them to keep up with all the tech that type 1s use these days—pumps, continuous glucose monitoring, flash glucose monitoring, software and more. My appointments have been spaced eight months apart for the last few years and that’s likely to change to a year from now on.

But in the meantime, I have my new toy and a whole heap of questions for Google. Can you wear it in the steam room? How much is MiaoMiao? How many actual blood tests do I still need to do to calibrate the thing?

Thanks again NHS Scotland. I look forward to reporting back.

 

*Whatevs. I debated discussing the research here and decided it wasn’t useful. Doom-laden stuff is such a turn-off isn’t it? 

My Favourite Health & Fitness Freebies

free sign on the Diabetes DietA continuous glucose monitoring system, the MiniMed 670G self-adjusting insulin pump, a personal trainer AND an unlimited food budget so I can buy organic, ethically sourced food all the time…

And, whoops—you interrupted me there in the middle of a reverie relating to the things I’d have to help me manage my diabetes if money were no object. The top of the range monitoring and pump therapy tech is obvious while the food and exercise one less so—but activity and an excellent low-carb diet can help you manage your blood glucose levels.

Stable blood glucose levels don’t guarantee you riches or the partner of your dreams, but a person who doesn’t ride the blood sugar roller coaster is far more energetic, and free to pursue what they want unhindered by the hell of mood swings.

In the meantime, what can we fiscally challenged diabetics do so we can fix our blood glucose levels to the best of our abilities? Here are suggestions for freebies that can help you manage your condition…

YouTube—otherwise known as the exercise channel in our house. Online, you’ll find tens of thousands of exercise uploads—from yoga to Pilates, barre classes, HIIT workouts and weight-lifting. You could spend several years working your way through them and not do the same workout twice. If you find gyms off-putting or their membership fees too expensive, YouTube’s perfect. Look for workouts that don’t need equipment either.

Start with walking workouts (Lesley Sansome’s Walk at Home channel is great). Fitness Blender’s videos are explained well, and the exercises done at a speed you can keep up with. Jessica Smith TV does a huge variety of workouts that offer different fitness benefits, and Heart and Soul Fitness does the same.

MyFitnessPal—there are studies that claim food tracking helps you maintain your weight. Food logs are useful for we diabetics too as they allow us to work out how much insulin we need for meals we eat regularly. MyFitnessPal has a huge database, but you can also add your own recipes and the site will give you a full nutritional breakdown of each.

MySugr – a free app for logging blood sugar results and additional information such as insulin does, exercise, weight, blood pressure and more. The app is useful, but if you don’t log for a day or so you will struggle to remember all the information you need to input for a complete picture of what is going on.

The internet—thanks to the world-wide web, there’s a wealth of information at our fingertips. As a teenager and twenty-something with diabetes, I only knew one or two others with the condition, and we didn’t meet up regularly to swap notes. Now there are forums, websites, charities, blogs, recipes and more online where we can find out more about the ol’ defunct pancreas problem.

A word to the wise… We all know the internet allows unprecedented freedom of speech, which is mostly for the good. But it’s also a place where information spreads unchecked. Blogs—and I include this one too—offer opinions and personal experience, which do not always equate to fact and recommendations suitable for you. Still, the Diet Doctor, Diabetes.co.uk, radiabetes.com and diabetesdaily.com offer gems. (I  apologise if I missed your great site out—limited room here.)

NHS 70 logo on the Diabetes DietAnd finally…drum roll… the NHS! Here in the UK, we folks with type 1 diabetes get free healthcare and prescriptions. I mump and moan occasionally about wanting the latest tech, but I’ve had diabetes for more than 30 years and in that time, I’ve never paid for medications, appointments or equipment. Our fabulous healthcare system has existed 70 years now. It’s shaky on its feet sometimes, but you can’t argue with the wonderful principles at its core—free healthcare for all, based on clinical need.

What are your favourite diabetes freebies? And what websites or blogs do you like?

Treating hypos post sugar tax

Lucozade just isn’t what it used to be. With the sugar tax affecting the diabetics favourite emergency beverage the Independent Diabetes Trust have compiled a list of substitutes that you may wish to use.

For shear portability and cuteness Emma and I are great fans of Jelly Babies but you may have your own.

 

5-7 Dextrosol

4-5 Glucotabs

60 mls Glucojuice (one bottle)

150-200mls pure fruit juice

3-4 heaped teaspoons of sugar dissolved in water

4-5 Jelly Babies