Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Not only is the variety of insulin preparations growing, so are the methods
for administering insulin.
Pre-filled insulin pens
In the past, insulin was available only in an injectable form that involved
carrying syringes (which a few decades ago were made of glass and required
sterilization), needles, vials of insulin, and alcohol swabs. Needless to say,
patients often found it difficult to take multiple shots each day, and, as a
result, good blood sugar control was often compromised. Many pharmaceutical
companies are now offering discreet and convenient methods of delivering
insulin.
Both Novo Nordisk and Lily have an insulin pen delivery system. This
system is similar to an ink cartridge in a fountain pen. A small pen-sized
device holds an insulin cartridge (usually containing 300 units). Cartridges are
available in the most widely used insulin formulations, such as those listed in
the table above. The amount of insulin to be injected is dialed in by turning
the bottom of the pen until the required number of units is seen in the
dose-viewing window. The tip of the pen consists of a needle that is replaced
with each injection. A release mechanism allows the needle to penetrate just
under the skin and deliver the required amount of insulin. The cartridges and
needles are disposed of when finished and new ones simply are inserted. In many
cases, the entire pen is disposed of. These insulin delivery devices are less
cumbersome than traditional methods.
Insulin pump
The most recently available advance in insulin delivery is the insulin pump.
In the U. S., MiniMed, Deltec and Disetronic market the insulin pump. An insulin
pump is composed of a pump reservoir similar to that of an insulin cartridge, a
battery-operated pump, and a computer chip that allows the user to control the
exact amount of insulin being delivered. Currently, pumps on the market are
about the size of a pager or beeper. The pump is attached to a thin plastic tube
(an infusion set) that has a cannula (like a needle but soft) at the end through
which insulin passes. This cannula is inserted under the skin, usually on the
abdomen. The cannula is changed every two days. The tubing can be disconnected
from the pump while showering or swimming. The pump is used for continuous
insulin delivery, 24 hours a day. The amount of insulin is programmed and is
administered at a constant rate (basal rate). Often, the amount of insulin
needed over the course of 24 hours varies depending on factors like exercise,
activity level, and sleep. The insulin pump allows for the user to program many
different basal rates to allow for this variation in lifestyle. In addition, the
user can program the pump to deliver additional insulin during meals to cover
the excess demands for insulin caused by the ingestion of carbohydrates with the
meal.
Over 50,000 people worldwide are using an insulin pump. This number is growing dramatically as these devices become smaller and more user-friendly. Insulin pumps allow for tight blood sugar control and lifestyle flexibility while minimizing the effects of low blood sugar (hypoglycemia). At present, the pump is the closest device on the market to an artificial pancreas. More recently, newer models of the pump have been developed that do not require a tubing, in fact - the insulin delivery device is placed directly on the skin and any adjustments needed for insulin delivery are made through a PDA like device that must be kept within a
6 foot range of the insulin delivery device, and can be worn in a pocket, kept in a purse,
or on a tabletop when working.
Probably the most exciting innovation in pump technology is the ability to use the pump in tandem with newer glucose sensing technology. Glucose sensors have improved dramatically in the last few years, and are an option for patients to gain further insight into their patterns of glucose response to tailor a more individual treatment regimen. The newest generation of sensors allows for a real time glucose value to be given to the patient. The implantable sensor communicates wirelessly with a pager-sized device
that has a screen. The device is kept in proximity to the sensor to allow for transfer of data, however, it can be a few feet away and still receive transmitted information. Depending on the model, the screen displays the blood glucose reading, a thread of readings over time, and a potential rate of change in the glucose values. The sensors can be programmed to produce a "beep" if
blood sugars are in a range that is selected as too high or too low. Some can provide a warning beep if the drop in blood sugar is occurring too quickly.
To take things one step further, there is one particular sensor that is new to the market that is designed to communicate directly with the insulin pump. While the pump does not yet respond directly to information from the sensor, it does "request" a response from the
patient if there is a need for adjustments according to the patterns it is programmed to detect. The ultimate goal of this technology is to
"close the loop" by continuously sensing what the body needs, and then
responding by providing the appropriate dose of insulin. While this technology
is a few more years in the making, the strides in this direction continue to
grow.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Hypoglycemia is a syndrome caused by low blood sugar. Symptoms of hypoglycemia include palpitations, trembling, intense hunger, sweating, nervousness, and weakness. Consuming lifesavers, table sugar, soda, and juice are good treatment options for hypoglycemia.
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include: intermittent claudication, rest pain, numbness in the extremities, and more. Treatment for peripheral artery disease include: lifestyle measures, medication, angioplasty, and surgery.
Hyperglycemia is a serious health problem for diabetics. There are two types of hyperglycemia, 1) fasting, and 2)postprandial or after meal hyperglycemia. Hyperglycemia can also lead to ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome (HHNS). There are a variety of causes of hyperglycemia in people with diabetes. Symptoms include increased thirst, headaches, blurred vision, frequent urination and more. Treatment can be achieved through lifestyle changes or medications changes. Carefully monitoring blood glucose levels is key to prevention.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
Radiculopathy, a condition in which a nerve or nerves along the spine are compressed causing pain, numbness, weakenss, and tingling along the nerve(s). Some causes of radiculopathy include bone spurs, disc hernation, osteoarthritis, tumors, infection, and neuropathy. Treatment depends on the are of nerve compression. Surgery is generally not required.
Orthostatic hypotension symptoms include lightheadedness, weakness, blurred vision, and syncope or passing out. Causes of orthostatic hypotension include dehydration, anemia, medication, blood loss, low blood pressure, heat related illnesses and more. Treatment of orthostatic hypotension depends on the underlying cause.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
A diabetic diet, or diabetes diet helps keep blood glucose levels in the target range for patients. Exercise and medication may also help stabilize blood glucose levels. Keeping track of when you take your diabetic medicine, keeping track of food choices, eating the proper amount of fruits, vegetables, carbohydrates, and fats will also help maintain proper blood glucose levels.
Diabetes-related foot problems can affect your health with two problems: diabetic neuropathy, where diabetes affects the nerves, and peripheral vascular disease, where diabetes affects the flow of blood. Common foot problems for people with diabetes include athlete's foot, fungal infection of nails, calluses, corns, blisters, bunions, dry skin, foot ulcers, hammertoes, ingrown toenails, and plantar warts.
Prader-Willi syndrome is a condition characterized by severe floppiness (hypotonia), poor growth, delayed development, and poor feeding problems in early infancy later followed in infancy by excessive eating that may lead to extreme obesity. The genitals in both females and males are underdeveloped and most are infertile. Prader-Willi syndrome is related to chromosome 15.
The risks for developing type 2 diabetes include family history, ethnicity, birth weight, metabolic syndrome, and obesity. Warning signs pointing to an increased risk for developing type 2 diabetes include irregular menstruation, impaired fasting glucose, inflammatory markers, and other risks. Gestational diabetes is also a risk factor for developing type 2 diabetes later in life. Prevention of type 2 diabetes can be achieved through a healthy diet (Mediterranean diet), exercise, weight control, not smoking, and medication.
In the United States diabetes is the most common cause of kidney failure. High blood pressure and high levels of blood glucose increase the risk that a person with diabetes will eventually progress to kidney failure. Kidney disease in people with diabetes develops over the course of many years. albumin and eGFR are two key markers for kidney disease in people with diabetes. Controlling high blood pressure, blood pressure medications, a moderate protein diet, and compliant management of blood glucose can slow the progression of kidney disease. For those patients who's kidneys eventually fail, dialysis or kidney transplantation is the only option.
Diabetes and eye problems are generally caused by high blood sugar levels over an extended period of time. Types of eye problems in a person with diabetes include glaucoma, cataracts, and retinopathy. Examples of symptoms include blurred vision, headaches, eye aches, pain, halos around lights, loss of vision, watering eyes. Treatment for eye problems in people with diabetes depend on the type of eye problem. Prevention of eye problems include reducing blood pressure, cholesterol levels, quitting smoking, and maintaining proper blood glucose levels.
Managing your diabetes is important. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information is also provided in this article.
Having diabetes can mean early onset and increased severity of bladder symptoms (urinary incontinence and urinary tract infections) and changes in sexual function. Men may have erectile dysfunction; and women may have problems with sexual response and vaginal lubrication. Keep your diabetes under control, and you can lower your risk of sexual and urologic problems.
Taking care of a disease such as diabetes is a life-long process. Learn how to care for yourself or loved one with diabetes in situations such as illness, work, school, travel, or a natural disaster.
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