Type 1 cont.
I have to carry a purse for the rest of my life with 3 needles.
Complications due to T1 diabetes.
Uncontrolled diabetes can give rise to many complications these are either acute or short tem; and chronic or long term. Acute problems are due to either low blood sugar causing hypoglycemia or high blood sugar causing hyperglycaemia or diabetes ketoacidosis. Chronic late complications associated with diabetes are high blood pressure and heart problems leading to heart attacks and heart failure; difficulty in vision and eye problems leading to blindness; kidney problems, leading to kidney failure; nerve damage primarily leading to problems of the foot but also to problems such as diarrhoea, constipation, nausea, vomiting etc. arising from damage to nerves in other parts of the body.
EYE:
Damage to the retina, the innermost layer of the eye caused by prolonged and inadequate blood glucose control is called diabetic retinopathy. In this condition the small blood vessels in the eye are affected - the arteries supplying blood to the retina become narrow and leaky and the veins become enlarged and twisted causing fluid to leak into the retina causing swelling of the retina. Reduced oxygen supply to the retina stimulates formation of more new blood vessels, which are not stable, and bleed. Fibrous bands are formed which sometimes pull and tear the retina from the underlying attachment.
# nother symptom is double vision - it means two objects are seen when only one exists. It occurs when the nerves controlling the eye muscle are damaged.
# Cloudy vision - can occur because of cataract and swelling of the retina, it may occur over a period of months.
# Floating spots in the visual field - The vitreous of the eye (transparent gel like substance that helps keep the shape of the eye) contains small transparent threads, which lose their transparency with age and may be seen as dark spots or lines.
# Curtain like shadows in the eye - A retinal detachment or major bleeding in the retina may cause curtain like shadows in the front of the eye. Red irritated eyes may be due to infection in the eye and sudden pain in the eye may be due to raised pressure in the eye (glaucoma).
FEET:
Loss of sensation can be due to a variety of causes ranging from vitamin deficiency, to nerve disease. Nerve disease may be caused by compression of the nerve due to thickening and compression against the head of a bone. Consult a qualified doctor who can examine and diagnose the condition.
In persons with diabetes this is most likely to be nerve damage caused by prolonged improper blood glucose control. It is often reversible in the early stages by good glucose control and although not fully reversible, in the later stages further progression can be halted. Even in persons with diabetes the other causes must be looked for and ruled out by proper medical examination.
The important precautions, that persons with impaired/lost sensation in the feet can take is to ensure use of proper fitting shoes, clean and comfortable socks. Examining the feet at regular intervals. Always keeping the feet clean and dry. Proper cutting of toenails is also very important.
SKIN:
Although Necrobiosis Lipoidica affects only one of every 300 people with diabetes, this disease of the legs can be very disfiguring. Women are three times as likely as men to encounter this problem. On the right, the large lesion in the lower shin in one of John's patients shows advanced changes. The thin, translucent-appearing skin reveals blood vessels and other subcutaneous tissues that are not normally visible. An early NL lesion can be seen near the bottom and another intermediate lesion is at the top.
* EMedicine provides an excellent overview of Necrobiosis Lipoidica
* The Dermatology Online Journal has pictures and information
* Another picture of NL from MedlinePlus
* plus some tips from FAQ at Listserve.
Good blood sugar control likely prevents NL from occurring. Once it arrives, current treatments usually have only a modest impact.
Diabetic Dermopathy
Diabetic dermopathy refers to roundish, slightly-indented patches of skin that are brown or purplish in color. Most frequently seen on the shins, they usually occur in skin that has been injured or traumatized. Although it can occasionally be seen in people without diabetes, it almost always occurs in those who are older or who have had diabetes for at least a couple of decades.
Diabetic dermopathy appears to be linked to slow healing. John Walsh, P.A. has seen several cases of discoloration improve or disappear entirely following improved blood sugar control and low doses of zinc. Use of 15 mg. to 25 mg of chelated zinc a day for several weeks appears to help the lesions resolve over several months, especially when combined with near normal blood sugars.
Some example pictures from UC Davis Online Journal plus closeups and more pictures.
Fungus Infection in Diabetes
Fungal Infections
Both fungi and bacteria feed on high glucose levels, and the skin is a favorite site for fungi to flourish. Tinea pedis, which occurs between the toes and occasionally the fingers, is most often caused by trichophyton rubrum and trichophyton mentagrophytes. The widespread fungal infection with scaling and cracking in the left hand of the 50 year old man on the right is one example of a tricophyton infection that responded well to topical Loprox, a prescription antifungal cream.
Candida albicans is another commonly seen fungus and is the most likely to affect the groin and vaginal areas. Candida albicans and also cryptococcus neoformans can affect the skin, although these two plus aspergillus varieties are the most likely to create a systemic infection in those who have a weakened immune system. Three other fungi, blastomyces dermatitidis, coccidioidies immitis (largely seen in the southwest US), and histoplasma capsulatum (more common in the midwest US) can cause direct systemic infection.
One study in South Africa of 100 people with diabetes and another 100 without diabetes found that fungal infections were two and a half times as likely with diabetes, especially in people whose average blood sugar was above 160 mg/dl.
Candida Infections Occur:
* in the mouth (thrush)
* around nails
* on nails (onychomycosis)
* between fingers and toes (tineapedis)
* under breasts
* in corners of the mouth
* under the foreskin
* in armpits and groins
* in the vagina
Fungal infection of the nails is referred to as onychomycosis (on-ee-koh-my-ko-sis). A good picture is available from Skin Site. Nail fungus can be treated with repeated applications of Penlac®, a liquid that is brushed onto the nail. Fungi do not like vinegar, and vinegar soaks of the toenails (15 to 20 minutes every other day) can help get rid of the infection. Be sure to thoroughly dry the feet and between the toes after all soaks, showers, etc.
Tinea pedis, or athlete's foot, can be treated with Mycotin® Spray between the toes, but the source of the fungus should also be addressed by sprinkling Tinactin® powder in all shoes and in socks before use. Thorough drying between the toes after a bath or shower, use of sandals in all public bath areas, and using wool or synthetic socks rather than cotton socks which stay wet, can all help reduce future infections.
Three antifungal pills can also be tried for nail, vaginal, or systemic fungal infections:
* Sporanox® (itraconazole), 200 mg a day for 12 weeks, or 200 mg a day for 7 days and then repeated after 2-3 weeks off
* Lamasil® (terbinafine), 250 mg a day for 12 weeks
* Diflucan® (fluconazole), 100 mg a day
Unfortunately, liver toxicity and liver failure can occur with these oral antifungal agents. They can also cause a widespread reaction of the skin and mucous membranes called Stevens-Johnson Syndrome. Other side effects include nausea, upset stomach, headache and tiredness. Check with your physician whether the benefits of these medications outweigh their potential risks. Liver tests may be needed before and during treatment.
Natural, over-the-counter treatments can be tried for some external fungal infections, but effectiveness and strength will vary in different products. Pau D'Arco is reported to be helpful for vaginal yeast infections. Manex manuka cream and gehwol cream may have some ability to reduce skin fungi and will also moisturize the skin at the same time. Other natural treatments, like tea tree oil or melaleuca alternifolia may have some effect, and Kolorox may be particularly helpful against candida
Complications due to T1 diabetes.
Uncontrolled diabetes can give rise to many complications these are either acute or short tem; and chronic or long term. Acute problems are due to either low blood sugar causing hypoglycemia or high blood sugar causing hyperglycaemia or diabetes ketoacidosis. Chronic late complications associated with diabetes are high blood pressure and heart problems leading to heart attacks and heart failure; difficulty in vision and eye problems leading to blindness; kidney problems, leading to kidney failure; nerve damage primarily leading to problems of the foot but also to problems such as diarrhoea, constipation, nausea, vomiting etc. arising from damage to nerves in other parts of the body.
EYE:
Damage to the retina, the innermost layer of the eye caused by prolonged and inadequate blood glucose control is called diabetic retinopathy. In this condition the small blood vessels in the eye are affected - the arteries supplying blood to the retina become narrow and leaky and the veins become enlarged and twisted causing fluid to leak into the retina causing swelling of the retina. Reduced oxygen supply to the retina stimulates formation of more new blood vessels, which are not stable, and bleed. Fibrous bands are formed which sometimes pull and tear the retina from the underlying attachment.
# nother symptom is double vision - it means two objects are seen when only one exists. It occurs when the nerves controlling the eye muscle are damaged.
# Cloudy vision - can occur because of cataract and swelling of the retina, it may occur over a period of months.
# Floating spots in the visual field - The vitreous of the eye (transparent gel like substance that helps keep the shape of the eye) contains small transparent threads, which lose their transparency with age and may be seen as dark spots or lines.
# Curtain like shadows in the eye - A retinal detachment or major bleeding in the retina may cause curtain like shadows in the front of the eye. Red irritated eyes may be due to infection in the eye and sudden pain in the eye may be due to raised pressure in the eye (glaucoma).
FEET:
Loss of sensation can be due to a variety of causes ranging from vitamin deficiency, to nerve disease. Nerve disease may be caused by compression of the nerve due to thickening and compression against the head of a bone. Consult a qualified doctor who can examine and diagnose the condition.
In persons with diabetes this is most likely to be nerve damage caused by prolonged improper blood glucose control. It is often reversible in the early stages by good glucose control and although not fully reversible, in the later stages further progression can be halted. Even in persons with diabetes the other causes must be looked for and ruled out by proper medical examination.
The important precautions, that persons with impaired/lost sensation in the feet can take is to ensure use of proper fitting shoes, clean and comfortable socks. Examining the feet at regular intervals. Always keeping the feet clean and dry. Proper cutting of toenails is also very important.
SKIN:
Although Necrobiosis Lipoidica affects only one of every 300 people with diabetes, this disease of the legs can be very disfiguring. Women are three times as likely as men to encounter this problem. On the right, the large lesion in the lower shin in one of John's patients shows advanced changes. The thin, translucent-appearing skin reveals blood vessels and other subcutaneous tissues that are not normally visible. An early NL lesion can be seen near the bottom and another intermediate lesion is at the top.
* EMedicine provides an excellent overview of Necrobiosis Lipoidica
* The Dermatology Online Journal has pictures and information
* Another picture of NL from MedlinePlus
* plus some tips from FAQ at Listserve.
Good blood sugar control likely prevents NL from occurring. Once it arrives, current treatments usually have only a modest impact.
Diabetic Dermopathy
Diabetic dermopathy refers to roundish, slightly-indented patches of skin that are brown or purplish in color. Most frequently seen on the shins, they usually occur in skin that has been injured or traumatized. Although it can occasionally be seen in people without diabetes, it almost always occurs in those who are older or who have had diabetes for at least a couple of decades.
Diabetic dermopathy appears to be linked to slow healing. John Walsh, P.A. has seen several cases of discoloration improve or disappear entirely following improved blood sugar control and low doses of zinc. Use of 15 mg. to 25 mg of chelated zinc a day for several weeks appears to help the lesions resolve over several months, especially when combined with near normal blood sugars.
Some example pictures from UC Davis Online Journal plus closeups and more pictures.
Fungus Infection in Diabetes
Fungal Infections
Both fungi and bacteria feed on high glucose levels, and the skin is a favorite site for fungi to flourish. Tinea pedis, which occurs between the toes and occasionally the fingers, is most often caused by trichophyton rubrum and trichophyton mentagrophytes. The widespread fungal infection with scaling and cracking in the left hand of the 50 year old man on the right is one example of a tricophyton infection that responded well to topical Loprox, a prescription antifungal cream.
Candida albicans is another commonly seen fungus and is the most likely to affect the groin and vaginal areas. Candida albicans and also cryptococcus neoformans can affect the skin, although these two plus aspergillus varieties are the most likely to create a systemic infection in those who have a weakened immune system. Three other fungi, blastomyces dermatitidis, coccidioidies immitis (largely seen in the southwest US), and histoplasma capsulatum (more common in the midwest US) can cause direct systemic infection.
One study in South Africa of 100 people with diabetes and another 100 without diabetes found that fungal infections were two and a half times as likely with diabetes, especially in people whose average blood sugar was above 160 mg/dl.
Candida Infections Occur:
* in the mouth (thrush)
* around nails
* on nails (onychomycosis)
* between fingers and toes (tineapedis)
* under breasts
* in corners of the mouth
* under the foreskin
* in armpits and groins
* in the vagina
Fungal infection of the nails is referred to as onychomycosis (on-ee-koh-my-ko-sis). A good picture is available from Skin Site. Nail fungus can be treated with repeated applications of Penlac®, a liquid that is brushed onto the nail. Fungi do not like vinegar, and vinegar soaks of the toenails (15 to 20 minutes every other day) can help get rid of the infection. Be sure to thoroughly dry the feet and between the toes after all soaks, showers, etc.
Tinea pedis, or athlete's foot, can be treated with Mycotin® Spray between the toes, but the source of the fungus should also be addressed by sprinkling Tinactin® powder in all shoes and in socks before use. Thorough drying between the toes after a bath or shower, use of sandals in all public bath areas, and using wool or synthetic socks rather than cotton socks which stay wet, can all help reduce future infections.
Three antifungal pills can also be tried for nail, vaginal, or systemic fungal infections:
* Sporanox® (itraconazole), 200 mg a day for 12 weeks, or 200 mg a day for 7 days and then repeated after 2-3 weeks off
* Lamasil® (terbinafine), 250 mg a day for 12 weeks
* Diflucan® (fluconazole), 100 mg a day
Unfortunately, liver toxicity and liver failure can occur with these oral antifungal agents. They can also cause a widespread reaction of the skin and mucous membranes called Stevens-Johnson Syndrome. Other side effects include nausea, upset stomach, headache and tiredness. Check with your physician whether the benefits of these medications outweigh their potential risks. Liver tests may be needed before and during treatment.
Natural, over-the-counter treatments can be tried for some external fungal infections, but effectiveness and strength will vary in different products. Pau D'Arco is reported to be helpful for vaginal yeast infections. Manex manuka cream and gehwol cream may have some ability to reduce skin fungi and will also moisturize the skin at the same time. Other natural treatments, like tea tree oil or melaleuca alternifolia may have some effect, and Kolorox may be particularly helpful against candida