The Insulin Pump – Advanced Insulin Delivery

In high school during class, I saw one of my classmates fiddling with a small electronic device that resembled a pager. I asked her what it was and she told me it was an insulin pump. I then proceeded to ask her what it was for and she explained that it helped her manage her diabetes. I had no idea what any of that meant until I did my own research. I found that the greatest benefit of using an insulin pump is that it delivers insulin to the body throughout the day; this allows for more accurate and precise dosages of insulin, as well as better control of blood glucose levels. The downside of using an insulin pump is that the pump has to be carried at all times and serves as a constant reminder of the condition.

What is an insulin pump?

The insulin pump is not a new invention – it has actually been around since the 1970’s – and it continues to be used to effectively manage diabetes. It’s a small electronic device – about the size of a deck of cards – that helps to deliver insulin to a diabetic through the subcutaneous tissue. The pump consists of the main pump unit that holds an insulin reservoir. This is attached to a piece of thin tubing with a needle (cannula) at the end – the infusion set – which is connected into the subcutaneous tissue and held in place with an adhesive patch; it remains connected to the body and controls the amount of insulin delivered by the press of a button.

Insulin Pump Diagram from
http://www.diabetes.co.uk

The advantages of using an insulin pump

An insulin pump helps to deliver fast acting insulin throughout the day in order to keep blood glucose levels in a desired range. The rate at which an insulin pump infuses insulin is known as the basal rate and it can be set or changed at any time with the press of a button. Insulin delivery can be programmed to provide different amounts of insulin at different times during the day and night.

When more insulin is needed to address excess carbohydrates from a meal, it’s easily achieved through the push of a button. Insulin pumps can deliver a bolus of insulin in order to cope with high blood glucose levels.

One of the other popular benefits of using an insulin pump is that it decreases the number of injections compared to traditional delivery methods such as through a needle and syringe or an insulin pen. The infusion site is typically changed every two to three days compared to traditional insulin delivery methods that require multiple injections throughout the day.

The use of an insulin pump also helps to reduce the likelihood of hypoglycemia or low blood glucose levels. There is a greater risk of hypoglycemia when taking insulin through injections because larger dosages of insulin need to be taken at a single time. The steady flow of insulin helps to reduce the risk of hypoglycemic episodes which is especially helpful at night during sleep.

Disadvantages of using an insulin pump

Although insulin pumps have become very popular among people with diabetes there are still some drawbacks to to their use. Because the pump is attached to the body, it serves as a constant reminder to wearers and to others of the disease of diabetes.

Using an insulin pump also increases the risk of skin infection at the catheter site which is why the infusion site needs to be changed every two to three days.

Another concern when using a pump is that the cannula can come out from the infusion site which results in no delivery of insulin. This is one of the biggest issues of wearing an insulin pump because if it goes unnoticed for several hours, it can result in diabetic ketoacidosis.

Also not all insurance providers cover the cost of an insulin pump. Insulin pump therapy is more expensive compared to the traditional needle and syringe.

If using a pump is a possible solution for insulin therapy, then a few questions need to be asked:

• Am I okay with having a device attached to me reminding me and everyone else that I have diabetes?
• Am I comfortable with the device and operation of the pump?
• Am I committed to checking my blood glucose levels at least four times throughout the day?
• Am I ready to have a full understanding of insulin, carbohydrate consumption, and activity levels to solve problems related to my blood glucose?
• Do I have a healthcare team that is experience with insulin pumps?

Diabetes in India – An Upcoming Epidemic

There has been a dramatic rise in the amount of people type 2 diabetes throughout the world due to longer life expectancy, obesity, and sedentary lifestyles. The prevalence of type 2 diabetes can be seen especially in developing countries such as India. In fact India hosts an estimated 35 million people with diabetes – the largest in the world – accounting for 8% of the total adult population.

From a scientific perspective, the question that needs to be asked is why diabetes is so prevalent in India. The answer is multifaceted with genetic factors, environmental influence like obesity typically associated with an increase in living standard and changes in socio-economic status causing the migration from rural India to more urban areas.

In fact there are patterns displaying the geographical distribution of diabetes in India; rough estimates show that the distribution of diabetes in rural areas is a quarter of urban populations for India and related subcontinent countries like Nepal, Bhutan, Sri Lanka and Bangladesh. Studies performed by the Indian Council of Medical Research revealed that areas of Northern India had a lower distribution of diabetes in the population.

Although diabetes is less prevalent in the rural population, diabetes treatment including screening, medication and education is also less available. The disproportionate allocation of medical resources, lack of education and illiteracy between urban and rural areas may be a cause of improper diabetes screening and preventive care services. This then results in patients not following diabetes management/protocol.

There are a number of other challenges that plague diabetes care in India such as lack of HbA1c test which determines the amount of glucose concentration in the blood. The unavailability of this test prevents proper insulin treatment for diabetes. Additionally, there is no consistency regarding Indian guidelines for diabetes treatment resulting in a wide variation of treatments across the country.

In India, diabetes continues to grow to epidemic proportions affecting family and society. Many factors are a cause of the increase in diabetes such as the migration from rural to urban areas, the economic boom and the related lifestyle changes but despite the prevalence of diabetes, there remains an insufficient amount of studies to investigate the details of the disease within the country, with geographical, socioeconomic and ethnic background playing a large role. The disease has become highly visible across all areas of society within India creating an urgent demand for research and intervention at regional and national levels In order to reduce the long term affects the disease will have in the future.

3 Best Winter Boots for Diabetics (Part 2)

And we’re back with part 2 in our discussion of the best winter boots for diabetics! You can find Part 1 of our discussion here, which focuses on winter boots for men. To recap, there are a couple of major differences that make diabetic winter boots different from normal boots which are the extra depth construction and removable insoles – standard features in diabetic footwear – allowing the use of prescription orthotics for a personalized fit.

Today, we’ll be focusing on diabetic winter boots for women. Standard features that winter boots need to have include a waterproof construction to keep feet dry and a heat retaining interior to keep feet warm; additional features that are of benefit are durable outsoles with aggressive tread patterns.

Best Women’s Winter Boots for Diabetics – P.W. Minor Women’s Tribeca – $154

P.W. Minor Women’s Tribeca wins the competition! If you don’t mind spending a little more for a high quality boot, this is the go to choice because of its lightweight construction. These chukka boots have a waterproof, full grain leather upper to keep feet dry; it also has a Thinsulate lining for extra warmth and a Dri-Lex treatment to control odor and keep feet feeling fresh. The boot is available five different widths from Narrow (2A) all the way up to XX-Wide (4E) which is perfect for a variety of foot types. The full length insole helps to cushion each step and it can also be removed to use personal orthotics.

• Waterproof, full grain leather upper
• Thinsulate lining with Dri-Lex treatment</li
• Full length, removable insole with Dri-Lex cover</li
• Biomechanical rubber outsole that is slip resistant for everyday settings

Runner Up – Propet Women’s Madison Strap – $90

The Propet Madison Strap is a great winter boot for diabetics not only because of the price point at $90 but also because of the many features to keep feet feeling great during the winter season. The Sealtex waterproof construction keeps water from entering while the Vaporex lined insole helps to maintain a warm interior temperature. What’s also great is the extra volume construction that provides a deeper fit thanks to the removable insole and extra insole spacer. For people that have difficulty putting on boots, the adjustable hook-and-loop strap is perfect because it creates an extra large opening for easy on and off. The boot is also available as a lace-up.

• Nylon upper with Scotchgard treatment for salt resistance
• Hook and loop closure and faux shearling lining
• Sealtex Waterproof construction
• Extra Volume construction
• Removable, heat retaining Vaporex insole

Honorable Mention – Drew Women’s Glacier – $195

It was a close competition but the reason I think that the
The Drew Glacier receives honorable mention as it’s created as a hiking/trail boot rather than strictly as a winter boot. It has a waterproof nubuck and textile upper and a waterproof lining, however now insulation to keep feet warm during the winter. The aggressive tread on the outsole provides excellent traction even on hard packed snow; added and double depth construction provides a very deep shoe to fit prescribed orthotics. The Drew Shoes Glacier is available in the Narrow (2A) width up to the X-Wide (3E) width.

• Waterproof nubuck and textile upper with waterproof lining
• Rubber outsole with aggressive tread pattern
• Firm heel counter
• Tempered steel shank
• Added and double depth with removable footbed and spacer
• Fits prescribed orthotics

This brings a conclusion to our review of the best diabetic winter boots for both men and women. I hope this two part series was informative and helps with future purchases.

3 Best Winter Boots for Diabetics ( Part 1)

Autumn is upon us and that means winter will soon be knocking at the door – it’s going to get cold and wet – and that is definitely something to consider when trekking out of the warm house for even the smallest task! In order to keep warm, we layer up and wear thick winter clothes, but what about our feet? Feet need attention too during the winter time and this is especially the case for diabetic feet.

People with diabetic foot problems already have a variety of issues that they need to be aware of – poor circulation, slow healing, swelling, ulcers, and infections – with the cold winter weather adding to the list. The wet weather can easily lead to foot fungus while the cold temperature can further affect circulation as well as causing frost bite – another possibility for amputation!

To help maintain foot health during the cold and wet winter months, I’ve gone ahead and compiled a list of the best diabetic winter boots. This will be a two part post with the first part for men’s winter boots and the second for women’s winter boots. The boots reviewed are based on my own personal opinion and research information found from customer reviews, product description, features, and price point.

Best Winter Boots for Men with Diabetes – Drew Rockford – $276

The Drew Rockford is by far the best diabetic boots for men during the winter months – the reason I say this is because of the range of size and width combinations available! These boots start at a Men’s Size 8 with a Medium width and go all the way up to a Men’s Size 16 in the XX-Wide width or 6E. It’s a great choice for men with larger and wider feet; also available in three different color combinations: black, brown, and wheat nubuck. Other features that make these diabetic boots stand out are the following:

• Plus Fitting System for added and double depth, the Rockford comes with  a moldable insole and a removable spacer underneath the insole
• Tempered steel shank to help offload weight when walking
• Waterproof leather upper
• Dupont ThermoLite waterproof membrane lining keeps feet warm and dry
• Slip resistant outsole (non-industry)
• Medicare Coded HCPCS A5500 for reimbursement purposes

Runner Up – Propet Camp Walker Hi – $100

The Propet Camp Walker Hi is available in two colors: black and brown. What I really like about it is the suede and mesh upper because it just looks very fashionable and something not typically seen. It’s also available in multiple size and width combinations starting from a Men’s 7, MEDIUM to a Men’s 16, XX-WIDE 5E/3W; one caveat however is that the shoes are not available in a WIDE width so there are only 3 width options to choose from. The best selling point about this boot is the price point of $100 because you’re getting a full featured boot at a great deal.

• Weather resistant suede and mesh upper
• Sealtex waterproof bootie
• Removable footbed
• Medicare Coded HCPCS A5500 for reimbursement purposes

Honorable Mention – Propet Blizzard – $100

The Propet Blizzard takes honorable mention in our ranking of diabetic winter boots. It has all the essential features needed in a winter boot such as heat retention, waterproof protection, and a durable upper that is water and stain resistant – a real steal at $100! The only reason that it didn’t rank high is that the Propet Blizzard is not coded for diabetic use and cannot be reimbursed by Medicare.

• Scotchgard treated leather upper with rubber toe
• Sealtex waterproof bootie construction
• Thinsulate lining for added warmth
• Vaproex heat retaining insoles can be replaced with personal
• orthotics

There you have it – top three winter boots for people with diabetes and other foot conditions that require a removable insole and wider fit! If you have any questions, please feel free to contact me or simply leave a comment. Stay tuned for next weeks post for the Best Winter Boots for Women!

The Secrets of Sugar from Nat Geo

I found this National Geographic video on YouTube explaining the detrimental effects sugar has on our body. Today’s post is short, but fill with information thanks to Nat Geo. If you can spare 45 minutes, I highly recommend watching this!

Swollen Feet: Symptoms, Causes, and Prevention

“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.

In 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.

Other 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.

3 Huge Benefits of Walking for Diabetics

Walking is a simple form of exercise that everyone in good health can perform but the benefits of walking for people with diabetes is huge! Not only is it one of the most popular physical activities for people with diabetes but it is also the most widely recommended because of its low impact on joints but also because it is readily available to anyone – it requires no special equipment and can be performed just about anywhere!

A steady regimen of walking – thirty minutes to an hour each day – can bring great results in lasting health benefits as well as helping to control diabetes. Below are three health benefits for managing diabetes that are a result of establishing a regular walking routine.

1. Better Glucose Control

Physical activity such as exercise helps muscles to absorb sugar in the blood. This prevents glucose from building up in the blood stream which can be detrimental to a diabetic. Although this effect can last for hours and even days, it is not permanent which is why implementing a regular walking routine is a great option for continued control of blood glucose levels.

2. Improved Cardiovascular Health

People with diabetes are much more susceptible to heart disease. In fact diabetics are at least twice as likely to have heart disease or suffer from a stroke, compared to someone who does not have diabetes ¹. Walking helps to improve cardiovascular function which in turn helps to reduce the risk of heart disease.

3. Weight Management

Incorporating regular walks into a daily routine is an effective way of managing weight. Pairing exercise with a good diet helps to lower weight and also reduce other health risks.

Consult a Health Care Provider!

Before starting any new exercise regiment, a health care provider should always be consulted – especially for diabetics – to make sure it’s okay to increase activity levels. An additional concern for people with diabetes is foot problems so a consultation with a podiatrist might also be in order before starting a new exercise regiment.

Get Walking!

Once the go-ahead has been given, start by taking it slow. A major point of emphasis when starting any new exercise regiment is to avoid injury. Another key point is to make sure that walking becomes a part of the daily routine in order for long term improvements in health. The optimum walking duration is about forty-five minutes to an hour at five to seven days a week; remember to gradually build up the duration and frequency of walks in order to prevent injury for long term success.

Other recommendations to help with motivation and maintain the new regiment are walking with other people such as family members and friends. Another suggestions is joining a local walking group or a Meet Up; this also allows for social accountability and encouragement among peers, increasing the likelihood that walking becomes part of a daily routine.

So what’s the hold up? The only thing that is preventing improved health as a diabetic is ourselves; take action towards a better you today!

¹ http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetes-heart-disease-stroke/Pages/index.aspx#connection

Fish and Diabetes

“Salmon” by Camilo Rueda Lopez licensed under CC BY 2.0

Fish is one of my favorite proteins to eat – it’s flavorful, full of nutrients including healthy fats, and easy to prepare. In fact diabetes experts recommend eating fish to improve cardiovascular because of the omega-3 fatty acids which have been show to decrease the risk of arrhythmia (abnormal heartbeats) which can actually lead to sudden death.

If you haven’t had any experience with fish other than the frozen fish sticks at the super market, you’ve definitely been missing out! Fish does not require a lot of work to taste fantastic – a some herbs here and a dash of seasoning there and the natural flavors blend to make fish a great option for a diabetic diet!

Why Fish is Such a Great Choice for Diabetics!

Most fish have low amounts of unhealthy saturated and trans fat, as well as cholesterol. Instead the fat that it does contain is a natural source of heart-healthy omega-3, unsaturated fat which helps to lower total cholesterol as well as LDL cholesterol in the blood. Another benefit for eating fish is that the protein is of high quality. Fish also lacks any carbohydrates so it will not cause a sudden spike in blood glucose. Also, most fish is cooks quickly and is an ideal choice for a quick and easy meal that everyone will enjoy.

How Many Servings of Fish Should I Eat?

It is recommended by the American Heart Association to eat fish high in omega-3 at least twice a week, with each serving being about 3.5 oz after cooking. Fish is a great replacement for red meat and poultry.

One caveat however is that larger sea fish should be limited because of the mercury levels. For women that are pregnant or breastfeeding, should limit their intake of fish that have high levels of mercury. The great thing however is that there is still a large selection of fish types that are low in mercury while still being high in omega-3, including salmon, anchovies, herring, trout, sardines, and mackerel!

One of my favorite ways to prepare fish is with a lot of Asian influence. I found a recipe on YoutTube that gives a quick rundown and explanation for a healthy, steamed white fish that packs knockout flavor! Full recipe was taken from Special Fork.

Steamed Fish with Ginger and Green Onions

Ingredients
1 fish filet (3/4 to 1 lb)
2 tbsp soy sauce (substitute for light soy sauce if desired)
1 tbsp oyster sauce
1 tsp sugar (optional)
2 cloves of garlic, minced
Fresh ginger, thinly cut lengthwise
Green onion, thinly sliced diagonally
3 tbsp olive oil or sesame oil (optional)

Directions
1. Add water to a steamer pot that is big enough to fit the fish filet
2. Cover steamer pot and heat over high, bringing the water to a boil; reduce heat until water is at a low roll
3. Place fish on a heatproof plate
4. Small bowl, combine soy sauce, oyster sauce, sugar (optional), and garlic; mix well and drizzle over the filet. Sprinkle with ginger and green onion.
5. Place fish filet and plate into the steam and steam for 8-10 minutes until the fish is no longer translucent. Ladle sauce over the fish

Optional
Heat in a pan 3 tbsp of olive oil and then pour over the fish – CAREFUL – the oil and liquid will splash! This adds extra flavor!

Fermented Foods and Health Benefits for Diabetics

“Homemade Sauerkraut” by mokapest licensed under CC BY 2.0

Fermentation occurs when carbohydrates (sugars and starches) are converted into alcohol and carbon dioxide – this process is caused by bacteria and/or yeast and is actually one of the oldest methods used to preserve food! Lacto-fermentation is the use of lactobacillus – a naturally occurring bacteria – to convert sugars into lactic acid. It may sound strange and unsanitary to use bacteria to preserve food but lactobacillus is actually a “friendly” bacteria also known as a probiotic, which is found in our digestive system to  and helps to ease digestion. For people with diabetes, fermented foods are a great food option as they provide a variety of healthy benefits including blood glucose control.

During the fermentation process, lactobacillus metabolize sugars and starches producing lactic acids – this gives off the sour and acidic taste commonly associated with fermented foods. The lactic acid produced by fermentation actually blocks carbohydrates from entering the blood and turning into blood sugar, thus reducing spikes in blood glucose levels. If you think about it, the fermentation process pre-digests the food making it easier to eat as well as having the nutrients readily available.

The benefits of nutrients being readily available because of fermentation can be seen in cabbage which is very nutrient dense in its raw form but is also difficult to digest when raw. When cabbage is fermented as sauerkraut or kimchi, it becomes much easier to digest and the high amounts of vitamin K and C, as well as the polyphenols and antioxidants are then easily assimilated into the body.

Fermented foods can also dramatically improve digestive health by supplying good bacteria to the digestive system while maintaining and increasing the number of beneficial microorganisms in the intestines. Alison Clark of the British Dietetic Association reported that “Between 70 and  80% of our immune cells are in the gut. Fermented foods stimulate bacteria that help with immunity.”

Other benefits include the unique ability to protect the stomach and intestinal linings by balancing the production of stomach acid. When hydrochloric acid (stomach acid) is too low, fermented foods help to increase the acidity of gastric juices; when there is too much acid, fermented foods help to protect the stomach and intestines.

Fermented foods also help to promote regular bowel movements. Fermented foods that are traditionally made help with the production of acetycholine which is a neurotransmitter that helps with the transmission of nerve impulses promoting better bowel movements. Other beneficial side effects include the release of digestive juices and enzymes from the stomach, pancreas, and gallbladder to aid in digestion while creating short chain fatty acids which serve as an energy source for the production of new intestinal tissue.

Unfortunately because of the industrial model for food production, many traditionally fermented foods have changed into something unrecognizable to speed up the process. If interested in making your own fermented foods take a look at the Nourished Kitchen’s section on fermented food recipes as well as the Savory Lotus’ guide to eating more fermented foods!

Coffee, Caffeine and Diabetes

Some days I’m not really a morning person while other days I am. One thing that I do love about mornings is waking up and enjoying a nice cup of joe (coffee).  When I hear coffee, the first thing that comes to mind is Starbucks and their various sugar filled concoctions; but let me inform you that I’m the type of coffee drinker that really enjoys the taste and flavor of plain, black coffee. Even though I enjoy a cappuccino as a morning meal once in a blue moon, I withhold from using cream and sugar in my coffee. Coffee not only gives me an extra boost in the morning but a CNN Health article states that coffee may help reduce the risk of type 2 diabetes. Well I’m a coffee lover and love hearing news about coffee so I decided to dig deeper.

I found a great website showing the health benefits of coffee and explored some of the studies reference regarding coffee and type 2 diabetes. Studies indicated that the development of type 2 diabetes can be reduced with moderate coffee consumption; in fact multiple studies have shown the positive correlation between coffee consumption and reduction in type 2 diabetes. Habitual coffee consumption was also associated with greater insulin sensitivity with one study having results showing that coffee consumption lead to higher fasting glucose and insulin concentrations.

On the other hand, caffeine by itself seems to have a negative effect on managing type 2 diabetes as it can lead to glucose intolerance, insulin resistance and an increase in blood glucose levels when ingesting caffeine with carbohydrates.

The good thing is that the majority of research on diabetes and caffeine reveals that caffeine does not increase the risk of someone developing type 2 diabetes and actually helps to decrease the risk. But for people that are already diagnosed with type 2 diabetes, their caffeine consumption should be limited as it impairs glucose metabolism in diabetics while also increasing blood glucose levels. The big takeaways are that if you have not been diagnosed with type 2 diabetes, then drinking coffee will lower your chances of developing the disease. But if you are already a diabetic (type 1 or 2), then coffee and caffeine intake may need to be limited as caffeine impairs glucose metabolism, reduces insulin sensitivity and raises blood glucose levels.

For some fun coffee humor as well as insightful facts about coffee, take a look at the following sites with fun doodles:

The Oatmeal

I Love Coffee