Diabetes Treatments

by the Whittier Institute for Diabetes. BASICS OF DIABETES CARE AND MANAGEMENT is designed to improve your knowledge of the diabetes disease process. …

Shopping For Diabetes Care Products

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Wondering what products will best suit your needs when your have diabetes?
Heres a checklist of diabetes care products available at Costco and Costco Pharmacy Soap and Cream: As a person with diabetes you should keep your skin and feet moist and free of irritation Use a mild soap that doesnt irritate your skin Keep your skin and feet moist by rubbing in a cream after you bathe except between your toes Sugar substitutes: One of several types of sugar substitutes can replace sugar in coffee, tea, cereal, and even in cooking and baking Nutrition Bars Drinks: Several brands of liquid drinks and nutrition bars formulated specifically for people with diabetes are now available They are convenient and easy to use for a snack; to manage low blood glucose; or before, during, or after exercise Some are nutritionally complete food supplements Aspirin: Studies show that an aspirin a day may keep heart problems away from people with diabetes You might want to take a daily dose of aspirin if you have certain risk factors for heart disease, such as a family history, high blood pressure, abnormal blood fats, etc Ask your healthcare provider if you
should take an enteric-coated aspirin each day Lancets devices to get blood from your finger: Make sure the lancets you buy fit the spring loaded device with which you prick your finger Feet Hands Pain: Capsaisin is an ointment made from the juice of hot peppers It may relieve pain in your feet and hands Alcohol swabs: Use them to wipe your skin prior to a insulin injection and to wipe your fingers before blood tests Anti-fungal Products: Are found in cream, spray, or powder form They can cure Athletes
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Foot and relieve the pain and itching Toothbrush and dental floss: As a person with diabetes you have a greater risk of dental problems Prevent dental problems by brushing your teeth after each meal and flossing daily Sugar-free cough and cold remedies: To limit the amount of carbohydrates you consume when you take cough and cold formulas Vitamins: There are several reasons you might want to take a multivitamin or a specific vitamin or mineral For example, if you eat less than 1,200 calories a day you should take a multivitamin If you dont get enough calcium, you might want to take a calcium supplement Some research, though still inconclusive, has found that antioxidants
vitamins C and E might help prevent damage from high blood glucose in people with diabetes Considerations for Seniors: High blood glucose for many years can damage nerves that move food through the body Costco and Costco pharmacy stock many popular remedies Laxatives and stool softeners: From mineral oil, to Epsom salts, to docusate sodium Theres also a natural choice: Metamucil It comes regular and sugar-free High blood glucose for many years can also damage nerves to the bladder The effect can be lack of ability to completely empty your bladder or leaking of urine Fitted undergarments, briefs and underpads can help you continue the activities you enjoy
Written by Hope S Warshaw, MMSc, RD, CDE Considerations for Seniors information from Sue McLaughlin, RD, CDE

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Advances In Diabetes Care
There have been remarkable advances in diabetes care and management over the last 80 years Prior to the discovery of insulin in the early 1900s, the treatments for diabetes included: bleeding, exercise, opium, and diets-including starvation diets, and diets low in carbohydrates and high in fat and protein The latter diet was difficult to adhere to, but extended the
lives of people with diabetes by approximately 1 year With the discovery of insulin in 1921, people with diabetes now had a treatment for their condition Originally extracted from the pancreases of cows and pigs the liquid was very impure, large doses were needed and caused abscesses at the injection site Insulin became readily available in 1923 This insulin was short-acting, so multiple doses were needed throughout the day to control diabetes symptoms In the 1930s, the first long-acting insulin Protamine Zinc Insulin PZI became available In the 1940s Neutral Protamine Hagedorn NPH insulin was first manufactured and is still widely used today Also in the 1940s, the first standardized insulin syringe was made of glass Syringes needed to be sterilized through boiling, and the needles needed to be sharpened regularly In the 1950s, adding zinc to insulin produced new types of insulin including Lente, Ultralente also still used today and Semilente In the late 1970s and early 1980s, we saw many new advances in diabetes care products These included blood glucose monitoring, disposable insulin syringes, insulin infusion pumps, insulin pens, and Glucagon and Human insulins In the 1990s this
trend continued And in 1993, the Diabetes Control and Complications Trial DCCT, the longest, largest diabetes study ever undertaken, demonstrated that intensive therapy and excellent diabetes control prevented or delayed the longwwwdiabetesdigestcom/costco

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term complications associated with type 1 diabetes w New Insulins More In 1996, the first rapid-acting insulin analog, Humalog, became FDA approved And in 2002 NovoLog, another rapid-acting analog, was introduced In 2001, Lantus, became the first and currently only longacting analog available Other advances: The Continuous Glucose Monitoring System CGMS became available in 1999 The GlucoWatch received FDA approval and is the first non-invasive glucose monitoring device Today there are computer programs to download information about blood glucose, insulin, exercise and other details; at-home and mail-away HbA1c kits, and even mail-away kits to check kidneys are available While we have come a long way in diabetes care, we still are where we started in some respects: The trend of treatment remains multiple daily injections to control type 1 diabetes But now, our treatment goals are quite different, given the technology at our
disposal Specifically, our goals are to control of blood glucose levels–not simply to control the symptoms w Insulin Pens These are a new option for people with diabetes requiring multiple insulin injections Insulin pens can be helpful for those who want the convenience of carrying insulin in a discreet way An insulin pen looks like a pen with a cartridge Some pens use replacable cartridges of insulin; other pen models are totally disposable A fine, short needle, similar to the needle on an insulin syringe, is on the tip of the pen Users turn a dial to select the desired dose of insulin and press a plunger on the end to deliver the insulin just under the skin For people who use NPH or 70/30 pre-mixed human insulin, a new insulin injection device is now available The InnoLet insulin doser is a convenient, accurate way to administer and manage insulin treatments without the traditional insulin vial and syringes–it is more similar to an insulin pen Therefore, pen needles will need to be purchased separately and may require a prescription in some states It is a pre-filled device, and unlike most insulin pens, it is disposable Continued on page 24
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continued:

Advances In
Diabetes Care
their pocket When sleeping, you can lay it next to you or you can clip it to your pajamas You can even remove the pump for an hour or two for special occasions and still maintain glucose control Pump therapy offers people with diabetes a unique way to gain tight control of their blood sugar levels–and the chance to feel better Getting blood sugar under control helps people with diabetes to avoid the low blood sugar symptoms such as headaches, dizziness, nausea, fatigue, and serious damage to their bodies In fact, one study showed that switching to insulin pump therapy decreased the incidence of serious low bloodsugar events nearly 85 during the first year Tight control can also help people with diabetes avoid high blood sugar levels that are toxic to the body and can destroy tissue — including delicate nerve issue This is how eyes, feet and kidneys can be damaged Near normal blood glucose levels can reduce the risk of damage associated with diabetes including: Retinopathy eye disease by up to 76 Kidney damage by up to 56 Neuropathy nerve damage by up to 60 w What Might the

w Better Precision Syringes/Finer Needles Healthcare providers have prescribed insulin
doses in 1/2 unit increments for a long time Usually for children with diabetes, adults requiring small doses of insulin, and people using intensive regimens It can be difficult for people with diabetes to use the spaces between the marked lines on traditional 30 unit and even 50 unit syringes if they are injecting smaller doses of insulin The new BD UltraFine II Short Needle Half-Unit Scale 30 unit insulin syringe offers people with diabetes a more precise way to measure these very small doses of insulin with clear, alternating markings for doses in 1/2 unit increments Also, BD has recently introduced a new insulin pen needle, known as the BD Ultra-Fine III Mini pen needle It is 5 mm 3/16 in long and even thinner, 31 gauge, than its predecessors This new needle may make injections even less intimidating and more comfortable for people with diabetes or caregivers who needs to give injections w Insulin Pumps These high technology products are miniature, computerized pumps They are about the size of a beeper, weigh about 3 ounces, and deliver insulin through a flexible plastic tube attached to the body The pump mimics a healthy pancreas by offering insulin delivery in two ways First,
it provides a rhythmic, continuous drip of insulin, which is known as the basal dose, all day long Second, the pump allows you to add an additional amount of insulin when you eat This extra dose is called a bolus You request your bolus with a simple push of a button You usually determine the size of the bolus by estimating the amount of carbohydrate you will be eating The pump can be worn on clothing: many women hook it to their bra or tuck it into a skirt Most men just wear it like a pager or keep it in
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Future Bring?
New products and developments are being investigated every day: new technologies to measure blood glucose, new insulins such as analogs, and new ways to give insulin These include insulin by mouth and even inhaled insulin The hope is still to find a cure for diabetes Researchers continue to pursue many avenues including developing an artificial pancreas, transplants to cure diabetes, and ways to prevent diabetes from happening all together The possibilities are endless
Sources: Jodi Moore, RN, BSN, CDE; Natl Institutes of Health
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METER COMPARISON CHART
Monitor Picture Monitor Manufacturer
Glucometer DEX 2 Ascensia DEX 2 Bayer

Test
Memory Date, Time, 100 results Date, Time, 120 results Date, Time, 200 results Date, Time, 100 results

Test Time sec 30

Sample Size l 3-4
Small

Additional Features and Comments Unique 10-test cartridge eliminates the need to open and handle individual strips Automatically calibrates Users can download their results to a computer Simple and easy to use Normal blood glucose testing is accomplished without pushing a button Use a single button to manage data Choose from fingertip to forearm testing Accurate results in 5 seconds Very small sample required Value priced meter Only two simple steps for accurate result Has a snap-in code key, making calibration simple Can download results to computer Uses Comfort Curve or Advantage test strips The one with the drum Automatically calibrates Underdosing detection - will not start without adequate sample Download results to a computer or beam to a PDA 3 simple steps from start to finish Lightweight meter designed for portability with an easy-to-read display Allows users to download results to a computer Only glucose monitor that measures ketone levels East-to-read display with backlight display 7, 14, 28 day averages Download results to
computer Small meter size Test on arm or finger No cleaning necessary 14 and 30-day averaging Compact and fast Very portable Test on arm or finger Provides 14 day average No cleaning necessary

Glucometer Elite XL Ascensia Elite XL Bayer

30

3
Small

Accu-Chek Active Roche

5

1
Small

Accu-Chek Advantage Roche

25

4
Small

Accu-Chek Compact Roche

Date, Time, 100 results

15

3
Small

FreeStyle TheraSense

Date, Time, 250 results

15

3
Small

Precision Xtra MediSense

Date, 20/30 Time, 450 Glucose/ Ketones results

25
Small

One Touch Ultra LifeScan

Date, Time, 150 results Date, Time, 150 results

5

1
Small

Fast Take LifeScan

15

25
Small

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Borderline Diabetes: What Should I Eat?

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First, lets define what Borderline Diabetes is and is not Diabetes is defined as having a fasting blood glucose level of 126 mg/dL or greater on two separate occasions If diabetes symptoms exist and you have a random blood glucose taken at any time that is equal to or greater than 200 mg/dL, and a second test shows the same high blood glucose level, then you have diabetes

In general, people who have a fasting blood glucose in the 110125 mg/dL range are defined
as having pre-diabetes If your healthcare provider gives you an oral glucose tolerance test, and at two-hours your blood glucose is 140-199 mg/dL, you have pre-diabetes This is what your healthcare provider is probably referring to when he/she says you have borderline diabetes Be sure to ask your healthcare provider what your exact blood glucose test results are when he tells you that you have borderline diabetes Some healthcare providers are not as familiar with the new national guidelines for diagnosing diabetes They may be telling you that you have borderline diabetes, when in fact you have actual diabetes What should you eat? Its not so much what you should eat, but how much If you are overweight, your first and foremost goal should be to lose weight This means working with a dietitian to determine the quantity and type of food you should eat at each meal One of the key issues in losing weight is controlling portion size
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Your dietitian can help you learn to make food choices that cut down on the amount of fat you eat: More foods that are broiled and fewer foods that are fried Cut back on the amount of butter you use in cooking More fish and chicken, and only lean cuts of
beef More meatless meals, or reorient your meals so that your dinner plate has more vegetables, fruit and starches on it, and less meat
Your dietitian will show you how you can continue to eat all the foods you love — just not in the same amounts as you have in the past Having diabetes does not mean that you cant eat certain foods The solution isnt to avoid foods with sugar in them

Rather, to lose weight if you are overweight and cut back on portions Along with weight loss, your goal will be to begin an exercise program, if you arent exercising regularly now Why? Exercise will help you use the insulin you produce to convert the food you eat into energy This will help keep your blood glucose lower If you have a small piece of cake with a meal, follow it up with a brisk walk Results of a large US nationwide study released in August 2001, showed that people with prediabetes can reduce their risk of type 2 diabetes by 58 with an intensive lifestyle modification program that results in modest, sustained weight loss and about 30 minutes per day of moderate exercise
Reprinted with permission from the Web site of copyright holder Joslin Diabetes Center wwwjoslinorg, Copyright 2002 All
rights reserved

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The Pressure Is Rising

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Did you know that more than half of all people with diabetes have high blood pressure? High blood pressure is especially common among those with type 2 diabetes and among African Americans and Latinos New studies have shown the benefits of keeping your blood pressure close to normal 120/80 if you have diabetes When your blood pressure is lower, your risk for strokes and a heart attack is also lower You also lower your risk for the other complications of diabetes as well, including eye and kidney damage

WHAT IS HIGH BLOOD PRESSURE?
Blood pressure is the force of the blood pushing against the walls of your blood vessels When the blood pressure is high, the blood is pushing too hard and damages the blood vessel walls Fat and cholesterol can stick to the damaged walls and cause clogs and blood clots Your blood pressure is measured by two numbers Both the top and bottom numbers are important The top or higher number tells you the pressure in the vessels as the blood is pumped out of the heart The bottom or lower number tells you the pressure between beats when the heart is relaxed Take note: If you have diabetes
and high blood pressure and have in the past been told that blood pressure of 130/85 was your goal, that was correct prior to 2002 However, that goal was changed in 2002 by the American Diabetes Association to 130/80 Have your blood pressure checked by your healthcare provider every three months How can you help lower your blood pressure? Getting regular exercise by walking or through other activities helps lower your blood pressure and your blood sugar It helps you to handle stress as well Some people find that eating less salt helps to lower their blood pressure Keeping your weight where you want it, not smoking, moderate alcohol intake, and eating less saturated fat can all help you to lower your blood pressure — while lowering your risk for other types of heart problems as well There are also medicines available to lower blood pressure One type class of medication often taken by people with diabetes are called ACE inhibitors Others are: ARBs, beta blockers, diuretics, and calcium channel blockers Some people may need more than one type of pill The more we learn about the relationship of high blood pressure to diabetes, the more important it is to take the right steps to lower
your blood pressure level
Written by Martha M Funnell, MS, RN, CDE 30 wwwdiabetesdigestcom/costco

State-of-the-Heart-in-Diabetes
Alan Garber, MD, PhD, a national authority in cardiovascular disease in patients with diabetes and a Professor of Medicine at Baylor College of Medicine recently authored the State-of-theHeart-in-Diabetes survey It revealed that almost two-thirds 63 of older Americans with diabetes believed they could be doing more to further reduce their risk for a stroke or heart attack, although 34 percent felt there was nothing more they could do Those motivated to do more desire to lead a full and vital life 63 and want to minimize the potential burden to their families of caring for someone with a disability 65 Dr Garber also noted in the study that an ACE inhibitor used to control blood pressure called ramipril Altace was found to reduce the risk of heart attack and stroke in people 55 or older with diabetes plus one additional risk factor, even if they were already taking other medications The survey showed that for people with diabetes the major benefit of taking such a therapy would be the knowledge that they were doing everything they could to live life to the
fullest 81 while reducing risk of hospitalization 80 and the chance of family members having to care for them 72

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Pick the Accu-Chek Meter thats right for you

A DIFFERENCE

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BD Ultra-FineTM II 30 Gauge Lancet

Brand A 23 gauge

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Uses Accu-Chek Comfort Curve Test Strips with the accuracy of palladium Curved strip guides finger to target area for easier blood application Easy-to-read, large, bold display 100-value memory with time and date Uses Accu-Chek Compass Diabetes Management Software Brand C 25 gauge Brand B 25 gauge

Glucometer DEX
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FREE COSTCO DIABETES CLUB
To join the Costco Diabetes Club: Send in this form, together with a paragraph about what you like best about Costcos Healthy Living With Diabetes magazine As a Costco Diabetes
Club Member you will receive diabetes samples and information on a regular basis
NAME __________________________________________________________________________ ADDRESS _______________________________________________________________________ CITY_________________________________ STATE______ ZIP___________________________
E-MAIL ADDRESS IF ANY: ________________________________________________________________
CHECK ONE BOX TO RATE THE MAGAZINE 1POOR, 5EXCELLENT 1___ 2 ___ 3 ___ 4 ___ 5 ___ ARE YOU TYPE 1 TYPE 2 YEAR DIAGNOSED: __________________

Note: By sending in this form I hereby give permission to your company to send me free diabetes information on a regular basis Limit one per household CT

MAIL COMPLETED FORM AND NOTE TO: H CRIMSON, PO BOX 26, TALLMAN, NY 10982

FOCUS ON: Diet Exercise

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Most medical conditions can be better managed, and controlled, with proper diet and exercise Diabetes is no exception In fact, not only will healthy living help to control your blood sugar, but some people with Type 2 diabetes will either no longer need medicine or they will need less medicine to control their blood sugar How your diabetes responds to healthy living depends on your
commitment and genetic make up Yet, no matter what the outcome, a healthy diet together with regular exercise is a win-win situation for people with either Type 1 or Type 2 diabetes

dangerous because the medicine you took in the morning is still working in the afternoon to lower your blood sugar The medicine doesnt know youve stopped eating and you can get hypoglycemia Also, do not eat between meals If youre hungry drink some water, tea, or diet soda Avoid sweets like candy, jelly, soda, honey, ice cream, or cake because these foods are loaded with carbohydrates and fat Since diabetes increases your risk for heart disease, avoid fatty foods Cook with little or no oil and avoid fried foods Besides helping your diabetes, eating healthy protects your overall health Yet, despite the fact that people know good diet and good health go hand in hand, diet is the most difficult habit for people to change We love to eat and most of us have been raised on a high fat and sugar-loaded diet The most important thing to understand is that healthy food does taste good Ultimately, you want to change your diet from the meat/starchheavy Western diet to a more healthy-heart/diabetes friendly Eastern
diet of fish and vegetables If you want to keep your dinner plate interesting, there are several excellent diabetic cookbooks that can show you how to make delicious but healthy food Another tip is to make these dietary changes over several months Too often, people try to change how they eat overnight only to end up miserable, missing the foods they used to enjoy This is why diets fail Try to make two healthy changes every week This gives you time to adjust and helps you stick to your new diet

Exercise Diet
Having diabetes means you have to change the way you live and part of this change includes your diet The first lesson about diet is to keep it regular Eat at the same time every day and dont skip meals Eating at the same time makes your blood sugar more predictable Skipping a meal is
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Before starting on any exercise program, a through examination and medical history should be performed by your healthcare provider People who have diabetes should pay particular attention to blood vessel complications Another important area to discuss is the estimated calories you will burn during exercise and strategies to lessen the risk of hypoglycemia Food intake, both before and after
exercise, should be reviewed Because approximately 50 of the calories burned
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during exercise come from a carbohydrate source with the remainder coming from fat, you can calculate that in a 30 minute exercise session, where an activity like cycling at 8 mph burns about 10 cal/min, a person would need to consume about 38g of carbohydrates 50 of 300 kcal 150 kcal or 375 g of carbohydrate We know this because each gram of carbohydrate is 4 kcal, and 150 divided by 4 is 375 These calculations, while a little confusing at first, can be a really valuable tool with some practice and guidance Regarding aerobic activity, training sessions should begin slowly Allow 8 to 12 weeks to reach a desired training level At a minimum, three to four 20 to 30 min sessions are needed to see a benefit To estimate your predicted maximal heart rate: take 220 and subtract your age in years You should be working at about 60 to 70 of this maximum rate to ensure a safe, effective workout For example, if you are 40 years old, calculate as follows: 220 - 40 180 and 70 of 180 126 This means your heart rate should be up to 126 beats per minute It is also important to remember to add a
warm up and cool down period to your workout to help prevent injury In addition to the above information, the American Diabetes Association has made the following recommendations for exercising: Carry an ID card and wear a bracelet that identifies you as having diabetes Be alert for signs of hypoglycemia during and after exercise Drink plenty of fluids before, during, and after exercise Measure blood sugar levels and act if the reading is less than 80mg/dL or greater than 240mg/dL

After several months of a healthy diet and exercise, you wont believe how much more energy you have and how much better you feel A healthy diet and exercise is not just for people with diabetes Everyone, no matter what their health, should eat right and exercise For people with diabetes, the right diet and exercise can add healthy and active years to your life
Article written by Dr Jonathan Berkowitz, an Assistant Professor of Medicine at the University of California San Francisco/Fresno Exercise Section: Ruchi Mathur, MD

BE AWARE OF THE DIABETES HEART CONNECTION

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ore than two-thirds of Americans with diabetes do not realize they have a much higher than normal risk of heart disease and stroke, a
survey commissioned by the American Diabetes Association and the American College of Cardiology, shows So many people just do not make the connection between diabetes and heart disease, noted Health and Human Services Secretary Tommy Thompson Sixty-five percent of people with diabetes in the United States die from heart attacks or strokes Unfortunately, most of them are not aware of the link between diabetes and heart disease and the things they can do to reduce their risks Heart disease and stroke kill about 40 percent of the population overall and heart disease is the No 1 killer in most industrialized countries But the same factors that can produce heart disease - obesity, poor diet and a lack of exercise — also can lead to diabetes, so people with diabetes carry an extra risk Your healthcare provider should be talking to you about the risk of heart disease and stroke About half of those surveyed said their healthcare providers never discussed ways to reduce the risks for heart disease and stroke, such as lowering blood pressure or cholesterol And a third of the smokers said their healthcare providers did not advise them to quit

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Diabetes
Questions Answers

Q A

How do you heal cracked heels for someone with diabetes?

Dry skin also called xerosis is one of the many skin problems associated with diabetes as is slow healing Rough, dry and scaly skin affects about 75 percent of people with diabetes age 64 and older Dry, itchy skin can set the stage for skin infections In severe cases, the skin loses its suppleness and cracks, becoming red and inflamed Rubbing and scratching can aggravate dry skin, causing more itching and inflammation and potentially leading to infection The legs, feet, hands and face are particularly susceptible to dry skin, which is primarily attributed to environmental factors Dry skin may be present in a person with diabetes year round, but it often worsens in the winter, when heat in the home decreases indoor humidity and there is increased exposure to cold, dry winds outdoors Addressing environmental factors is the foundation of treatment and prevention, including keeping the temperature as low as is comfortable and increasing the humidity through the use of humidifiers Bathe no more than once a day, and avoid extremely hot baths and showers Use moisturizing, unscented cleaning bars or body
wash instead of harsh soaps Blot skin dry after showering or bathing, leaving some water on the skin Apply an emollient, such as petroleum jelly, or products containing lanolin, in liberal amounts to prevent water from evaporating from the skins surface Because deep, reddened cracks need to be disinfected to heal, apply an antibiotic ointment Drink plenty of water and liquids to keep your skin moist from the inside, too Severe dry skin may require treatment with a prescription medicine that is stronger or more effective than over-the-counter remedies If dryness lasts longer than a couple of weeks, see your healthcare provider or Costco Pharmacist There may be another cause for the dryness Athletes foot, for example, is a common skin problem that can cause dryness and itching
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Can a person with Type 2 diabetes have problems with their gums especially around their wisdom teeth

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People with diabetes, both Type 1 and Type 2, are more prone to infections They also have more difficulty healing from wounds and abrasions Gums are exposed to mechanical abrasion from chewing foods and are also exposed to a variety of oral bacteria that can cause gum infections The gum around wisdom
teeth are especially vulnerable because there is frequently a flap of gum tissue on the back side of the wisdom tooth—readily trapping food and bacteria and difficult to clean

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Q A

I have glaucoma and problems with the retina, because of my diabetes, and I like to read a lot I would like to know if reading is going to aggravate my eyes conditions?

The major long term complication of diabetes is damage to blood vessels throughout the body Damage to blood vessels in the kidneys can lead to kidney failure, damage to vessels to the nerves can lead to diabetic neuropathy, damage to vessels in the legs can cause diabetic foot ulcers, damage to vessels in the retina can cause diabetic retinopathy Blood vessel damage by diabetes in the retina can lead to bleeding underneath the retina and blindness Laser treatments are used to destroy these abnormal retinal blood vessels and prevent bleeding Most importantly, studies have clearly shown that optimal long term control of high blood glucose and blood pressure are important in preventing progression of diabetic retinopathy Tight control of blood glucose can also help slow down the progression of diabetic kidney, nerve, and heart
disease
Source: The University of Alabama at Birminghams Dear Doctors column wwwdiabetesdigestcom/costco

Source:lapsf.com