Insulin Delivery 101 – Injections

Insulin Injection
Standard Insulin Syringe

Being a diabetic creates a life that a follows different sets of rules than non-diabetics. Management of blood glucose is an everyday event that can lead to catastrophic and even deadly outcomes if not properly addressed. Insulin is the hormone that helps the body use or store the blood glucose it gets from food. There are different types of systems for insulin delivery with each one having its own advantages and disadvantages. It’s important to determine the option that is most suitable for specific lifestyles.

Needle and Syringe

The most common form of insulin delivery for diabetics is by injection using either a needle and syringe or an insulin pen. Insulin injection also requires less education and training than the use of an insulin pump.

The most common and affordable insulin delivery is in the form of direct subcutaneous injections using a needle and syringe. The greatest benefit of this delivery system is the cost savings and the fact that insurances will provide coverage compared to other delivery systems like an insulin pen or pump.

The biggest difficulty however is that insulin delivery via needle and syringe is a very involved process taking multiple steps. It is also performed manually which can lead to possible errors; it’s up to the patient to make sure the proper dose is given.

Insulin Pens

Insulin Pens

Insulin pens have become more popular around the world with 95% of insulin-treated patients in Europe, Asia, Australia, and Scandinavia using pens. There are two different types of pen systems: durable and prefilled.

A durable pen has an insulin cartridge that can be replaced. Once the insulin cartridge is empty, the cartridge is disposed of and replaced with a new one. Prefilled insulin pens are also known as disposable insulin pens because they can be thrown away after use. The pen is prefilled with insulin and once the cartridge becomes empty, the entire system including pen and cartridge is discarded.

Insulin pens are very easy to use and one of the big advantages for using them is its ability to adjust the amount of units needed. Insulin pens feature an adjustable knob or dial – at the end of the pen opposite the needle – that can be calibrated to deliver variable units of insulin. Other advantages of insulin pens are the convenience of transportation, compared to a traditional vial and syringe. Insulin pens also provide more accurate dosages and are easier to use for patients that have motor skills or visual impairments.

Although they are easy to use and convenient to transport, insulin pens are usually more expensive than the traditional vial and syringe method and insurance coverage for insulin pens vary widely in the United States. It is also not possible to mix two different types of insulin (short acting and long acting) with a pen.

Injection of insulin via needle and syringe or by pen is the most common insulin delivery system and both take little education compared to more complicated delivery systems like an insulin pump. In the next segment, the discussion will be in regards to delivery of insulin using a pump.


See Clearly with Diabetes!

Diabetic Vision Loss
Seeing is believing and yesterday, I took for granted how lucky I am to have my sense of sight. I tried to put in my contacts yesterday and as soon as my they got close to touching my eyes, a burning sensation occurred – like soap in your eyes – that caused immense pain. I thought I had gotten soap on my contacts or some sort of residue on the lens; I tried at least five different pairs (I wear daily disposables from Acuvue) but it was the same result each time.

I ended up going to the local optometrist at Costco for a checkup and I explained my situation. After examination, she informed me that my eyes were indeed dry and I also had allergens on my pupil which was causing the burning sensation when putting on my contacts. She told me to use lubricating eye drops and just deal with the pain because it would go away once the contacts are in place.

From this experience in itself, I realized how lucky I am to be able to see and I wanted to point out the related dangers between having diabetes and the loss of vision. When diabetes is not being properly managed and blood glucose levels are out of control, complications to the eye can occur resulting in loss of vision and even blindness. In fact Dr. Gary Rankin who is an ophthalmologist at the Retina and Diabetic Eye Center explains that 80% of diabetics (type 1 and 2) will develop retinopathy – acute damage to the retina of the eye caused by damage of its blood vessels – within ten to fifteen years of being diagnosed with diabetes.

The three most common forms of eye diseases caused by diabetes are listed below:

Diabetic macular edema (DME) which is the build-up of fluid in the macula – the part of the retina controlling the most detailed vision abilities -due to leaking blood vessels.

Vitreous hemorrhage occurs when blood vessels in the retina leak into the vitreous space of the eye, which is filled with clear gel in the space between the lens and the retina.

Retinal detachment is the result of abnormal blood vessels stimulating the growth of scar tissue. Complete detachment of the retina to the back of the eye can occur resulting in vision loss.

Anatomy of the Eye
If you have diabetes, it’s highly recommended that you see an eye care professional such as an optometrist or ophthalmologist at least once a year and opt in for the dilated eye exam, which allows the eye care professional to look in the pupil to see inside of the eye more easily and determine if there is any damage to the retina.

Losing your vision may seem scary but diabetic retinopathy can be easily managed. The best way to prevent loss of vision by diabetes is to keep blood glucose levels in control. Keeping A1C levels under control at 7.0 or less is extremely important as it helps to reduce the risk of developing diabetic retinopathy. In fact the American Diabetes Association says that even if retinopathy develops, patients with tight control of their blood sugar tend to have mild, non-sight threatening retinopathy.

I can only imagine how difficult the experience of losing your sight must be. Being a diabetic creates a lot of “what if” thoughts but luckily, those what if’s can be controlled by smart and healthy choices. Remember to always keep blood glucose levels in check, eat healthy, exercise, and be grateful for the blessings bestowed upon us.

Alcohol and Diabetes – You Wont Believe What Drinking Red Wine Does for Diabetes!

Alcohol is a double edged sword in the nutrition world. A little enjoyment each day has shown positive benefits in mental well-being such as reduced stress while also improving physical health by lowering the risk of cardiovascular disease. There can however be “too much of a good thing” and drinking too much alcohol can hinder cardiovascular health by damaging heart muscles. Excessive alcohol consumption can also limit the effectiveness of white blood cells in the body which are responsible for keeping bacterial invaders at bay.

A recent study however has shown a positive relationship between the moderate consumption of red wine and management of type 2 diabetes.The study consisted of 224 participatents between ages 40 to 75 over a two year period consisting of alcohol abstaining type 2 diabetics that had their diabetes under control. They were randomly assigned to 150 ml of mineral water (control), white wine, or red wine with dinner for two years with wines and mineral water being provided by the study. All groups in this study followed a Mediterranean diet without restrictions on caloric intake. 87% of participants completed the trial with 80% drinking their daily dose of wine.

The results revealed that high-density lipoprotein (HDL) cholesterol – the good kind of cholesterol – was increased significantly through the consumption of red wine while also having a more beneficial cholesterol ratio compared to the group that only drank mineral water. Participants that were in the wine group also had improved quality of sleep. This study suggests that moderate consumption of red wine among well controlled diabetics can be part of a healthy diet and is not only safe but also helps to modestly decrease cardio-metabolic risk.

Red wine contains a number of unique antioxidants that are hard to obtain through other sources. The alcohol in red wine also helps to manage post-meal spikes in blood sugar by absorbing the sugar and calories in the meal.

The Negative Effects of Soda Pop

From my previous post regarding soda and diabetes, I’ve stumbled upon even more information revealing soda to be detrimental to overall health.

A typical 12 oz can of soda contains 35 grams of sugar which is equal to about nine teaspoons! A new review in the Journal of the American College of Cardiology – the most comprehensive review on sugar-sweetened beverages to date –  has found that drinks high in sugar (soda, energy drinks, and any artificially sweetened drinks) can have an adverse affect on the heart increasing the risk of heart attack, heart disease, and stroke. This review was performed by Vasanti Malik who is a nutrition research scientist at Harvard’s T.H. Chan School of Public Health in Boston and Frank Hu, MD, PhD, a Professor of Nutrition and Epidemiology at Harvard’s T.H. Chan School of Public Health.

The paper reviewed data from recent epidemiological studies revealing that consuming one or two servings a day of sugar-sweetened beverages has been linked to the following:

  • a 16% increased risk of stroke
  • a 35% greater risk of heart attack or fatal heart disease, and
  • a 26% greater risk of developing type 2 diabetes

The reason why these sugary beverages have such an impact on overall health is because of fructose’s behavior in the body. Compared to glucose which is metabolized in the gastrointestinal tract and used as fuel for the bodies cells, fructose is metabolized in the liver and converted to fat compounds (triglycerides) leading to fatty liver, increase in LDL (bad) cholesterol, and insulin resistance which is a key factor in developing type 2 diabetes.

Hu explains that fructose is rarely consumed in isolation and the major source in our diet comes from fructose-infused drinks containing sucrose and high fructose corn syrup. Hu also states that their findings reveal the urgent need for public health strategies that call for a reduction in the consumption of these drinks.

Although halting the consumption of sugar infused drinks isn’t going to be the cure-all for heart disease and diabetes, it can definitely play a role in reducing the epidemic to have a measurable impact.

To better educate the consumer, the U.S. Department of Agriculture has proposed a new labeling system identifying the amount of sugar added to a product, compared to the amount that naturally occurs. Hopefully this will play a role in reducing the daily intake of these sugar infused drinks.

Want Type 2 Diabetes? Drink More Soda!

“Sugarland aka Supermarket” by Vox Efx licensed under CC BY 2.0

You like soda? Me too! You like diabetes? I didn’t think so! Well if soda is part of your regular diet, then you’re headed for the land of high blood sugars, insulin resistance, obesity, and a whole range of detrimental health issues. In fact, a recent study published by the British Medical Journal (BMJ) estimates that the consumption of sugary sweetened drinks may be responsible for nearly two million cases of diabetes over a period of ten years in the United States, and 80,000 in the United Kingdom.

This study was performed at the University of Cambridge under the Medical Research Council (MRC) Epidemiology Unit with the aid of an international team of researchers. The study assessed whether the chronic consumption of drinks sweetened by sugar whether artificial (high fructose corn syrup) or natural (juice) had any association with the prevalence of type 2 diabetes (T2D), as well as to estimate whether the 10-year risk was attributed to the consumption of sugary drinks in the US and UK.

Seventeen different observation studies took place and the researches found that the habitual consumption of drinks sweetened by sugar had a positive association with the frequency of T2D, excluding the status of obesity.

There was less evidence regarding an association between artificially sweetened drinks and fruit juices with T2D, but researches found little benefit for the consumption of these types of drinks as a substitution, concluding that these these drinks are unlikely to serve as a healthy alternative for preventing T2D.

One point of emphasis that the researchers stressed however was that the studies analyzed were onlyu observational, thus no definitive conclusions could be made between the cause and effect relationship. Although only observational, the researchers assumed a small correlation and estimated that new diagnosis of T2D events in the US to be two million and 80,000 in the UK from 2010 to 2020.
The study was lead by Dr. Fumiaki Imamura who was the lead author; he stated that the

“…findings together indicate that substituting sugar sweetened drinks with artificially sweetened drinks or fruit juice is unlikely to be the best strategy in reducing the risk of developing type 2 diabetes: water or other unsweetened beverages are better options.”

There have been multiple studies done regarding the link between high calorie beverages loaded with sugars; this is just another one to add to the list. By having self control and limiting what goes into our bodies, we have better control of our health and well being.

The complete study can be found here.

“Mart Bittman Soda Quotation” by licensed under CC BY 2.0
“Mart Bittman Soda Quotation” by licensed under CC BY 2.0

Swollen Feet: Symptoms, Causes, and Prevention

“Morning and Evening Feet” by Hope and Megan licensed under CC BY 2.0
“Morning and Evening Feet” by Hope and Megan licensed under CC BY 2.0

Swollen feet and ankles – also known as edema – actually occurs quite often in people. For people in good health, swelling in the feet and ankles can occur occasionally and is easily addressed by elevating and resting the feet, reducing the blood flow to these swollen extremities.

Swelling in the feet and ankle have a multitude of minor or temporary causes which can be a result of standing or walking for extended periods, as well as sitting for lengthy periods of time due to travelling. Other factors that can influence swelling is diet; salty foods are a major caused of edema as it causes water retention in order to dilute the level of salt in the body. Other factors that may cause foot, leg, and ankle swelling is being overweight as well as increased age.

Swelling is a result of fluid build-up in the areas between the cells in the body. The body is actually having difficulty fighting gravity and recirculating blood and fluids back up the legs toward the heart and through the lymphatic system. This build-up of fluid causes the feet, ankles and even legs to swell.

Leg WedgeIn minor cases of temporary swelling that are not accompanied by other symptoms, the first line of treatment is elevation. Elevating the legs above the heart helps fluid to flow away from the legs not only using the body’s natural fluid transport system but also by the assistance of gravity. Elevation of the legs also helps to reduce pressure on the knees, calves, thighs and lower back. One device that helps with elevation is a leg wedge – use during sleep – as it can be highly effective in the reduction of swelling.

Compression SocksOther health tools that can aid in the reduction of swelling include compression stockings which helps with temporary relief for swelling by providing graduated compression on the foot, ankles, and legs to aid in circulation. Compression socks are also an excellent option for people that spend extended periods of time standing or sitting. They not only help to prevent and/or reduce swelling but also help to reduce fatigue in the lower extremities.

Tips to Help Prevent and Reduce Minor Swelling

  • Wear properly fitting shoes and socks that don’t cause excess binding
  • Don’t wear tight clothing that can restrict blood flow in the legs
  • Avoid prolonged periods of standing
  • Walk regularly to improve muscle activity and circulation
  • Take breaks when travelling to stand and move around
  • Avoid putting weight on the feet when sitting
  • Drink plenty of water and limit salt intake
  • Maintain a healthy body weight

Swelling of the lower extremities which occurs with other symptoms may be a sign of more serious health problems affecting the heart, kidney, liver, or blood vessels. A physician should always be consulted regarding health issues.

Be sure to consult a physician if:

  • Increase in the swelling of one or both legs
  • Redness occurs with swelling
  • Swelling occurs with pain

It is of utmost importance to pay attention to your feet. There are checks and balances in the body that help circulation and feet do not simply become swollen on their own. If certain activities may be causing swelling, it might be best to stop those actives altogether. A simple change in lifestyle and diet can improve overall health as well as prevent other f0ot related problems.