How common is thyroid disease in women with diabetes? Should women with diabetes be tested for thyroid disease? If so, when?
How common is thyroid disease in women with diabetes? Should women with diabetes be tested for thyroid disease? If so, when?
I am a Type 1 diabetic, diagnosed at age 18 in 1972. Have been using a pump since 1982, staying good control ever since (A1C around 6.7%). So this is what happened this morning:
· Woke up at 4:00 am with a reading of 41. I just didn’t feel like getting a juice, laid down and went back to sleep for 90 minutes (that in itself is very unusual for me—I always treat my lows immediately).
· Got up at 5:30 am, removed my pump, and took a 10 minute shower, reconnecting my pump immediately.
· Tested at 6:00 am and was 93.
· Tested again before breakfast at 6:45 am and was 195!!!! Felt like crud! Bolused 1.6 u – didn’t eat breakfast.
· At 7:10, I was 218!
· At 7:34, was 208, bolused 1.0 unit
· Blood sugar returned to normal about 10:30 am, then I finally ate some yogurt and bolused normally. Everything has been normal rest of the day.
Was this a matter of my body taking care of that 41 BG by shooting my own glucagon into my system from my liver? I was ready to change out my infusion set, but since the BG’s were coming down once I started bolusing (albeit VERY slowly), I decided to wait, which worked out OK. Certainly not a fun way to start the day!
Thanks for any insight you can provide.
I've been hearing a lot about Diabetic Neuropathy lately. What is it? and how do I know if I have it?
Hi! I was just informed (by a friend) that, because I have diabetes I am at a higher risk for celiac disease? Is this true?
Thanks in advance,
Celiac disease, also called celiac sprue, nontropical sprue, or gluten-sensitive enteropathy, is an autoimmune disorder that damages the small intestine and interferes with absorption of nutrients from food. People with celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley. It can also be found in medicines, vitamins, and lip balm. When people with celiac disease eat these foods or use these other items, their immune system responds by damaging or destroying the villi lining the small intestine. Villi are normally responsible for allowing nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. If villi are not working correctly, one can become malnourished.
Celiac disease is genetic. It seems more common in those with family members with other autoimmune disorders such as type 1 diabetes, autoimmune thyroid disease, autoimmune liver disease, rheumatoid arthritis, Addison’s disease, and Sjogren’s syndrome or if the person has an autoimmune disorder themselves. Sometimes the disease is triggered for the first time after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.
Symptoms of celiac disease vary from person to person. Symptoms can occur in the digestive system or other parts of the body. Digestive symptoms are more common in infants and young children and may include abdominal bloating and pain, chronic diarrhea, vomiting, constipation, pale, foul-smelling, or fatty stool, irritability, and weight loss. Malabsorption of nutrients can be detrimental to a child’s normal growth and can result in failure to thrive, delayed growth and short stature, delayed puberty, and dental enamel defects. Adults are less likely to have digestive symptoms. They have unexplained iron-deficiency anemia, fatigue, bone or joint pain, arthritis, bone loss or osteoporosis, depression or anxiety, tingling numbness in hands and feet, seizures, missed menstrual periods, infertility or recurrent miscarriage, canker sores inside the mouth, and an itchy skin rash called dermatitis herpetiformis. Some people with the disease may not have any symptoms at all.
Diagnosis of celiac disease is through blood tests detecting autoantibodies consisting of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). A person should continue to eat gluten foods during this time to make a clear diagnosis. If antibodies are at high levels they will have a biopsy of the small intestine.
The final step is a gluten free diet, and if symptoms go away, a diagnosis is confirmed. Treatment is a gluten free diet no matter what the symptoms are. This diet is very cumbersome, and a person should meet with a dietitian for education on label reading and for foods that one should avoid.
I have been going through menopause for about a year now and my blood sugar control has suffered. I want to know: Can menopause cause fluctuations in my blood sugars? and can you tell me what should I expect during menopause as a woman with diabetes?
Happy Thanksgiving Ladies! With the holiday season already here, it’s hard to believe another year has flown by!! For me personally, the year 2010 is a big one as I will turn 50 years old AAGGHH…That’s scary!! Along with this age milestone also comes that time in a woman’s life called Menopause. Some people refer to it as “mental pause” as we peri-menopausal and menopausal women cannot remember anything. Some call it “Men o Pause” as we tend to be very moody and may feel less loving to the men in our lives!Going through menopause can be very challenging to most women and when you also have diabetes, you can be faced with a double challenge.
First, menopause means the cessation of the menstrual cycle. A woman is not considered postmenopausal until one year after her last menstrual cycle. During menopause, there is a decrease in the hormones estrogen and progesterone. The fluctuating hormone levels can cause many symptoms which may include hot flashes, weight gain, vaginal and urinary symptoms, and sleep disturbances.
The hormones, estrogen and progesterone affect how your cells respond to insulin. So, when these hormones are fluctuating, you can also experience fluctuations in blood sugar levels. Blood sugars become less predictable and more variable. When you have diabetes and are taking either insulin or an oral agent that can cause low blood sugar, it is often hard to distinguish between a hot flash and an insulin reaction. If you gain weight during menopause, you may need more insulin or oral medications. With these issues, if blood sugar is higher, that makes you at higher risk for infections. Typically women see a higher rate of vaginal and/or urinary tract infections. If you have had the typical sleep disturbances, you may be less able to deal with your life stresses due to sleep deprivation which can also cause higher blood sugar levels. All in all diabetes and menopause together can be very challenging!
Personally, I have dealt with some of these issues as I am stepping into the next phase of life (menopause). My blood sugars have been much more unpredictable. While many of my patients have had issues with high blood sugars, seemingly unexplainable, I have had issues with low blood sugars and have had to decrease my insulin dose fairly significantly. And the ole question of “Is it a hot flash or a low blood sugar?” keeps coming up.
So what do we do in this crazy time of life? First, measure blood sugars much more often. Again, for me because of the lows, I have had to set up stricter guidelines for myself because of the severity of the lows and my inability to feel them. Keep logs of your readings and discuss them with your physician as your diabetes medications may need to be changed during this period of time. Eat a more healthful meal plan including whole grains, fruits , and vegetables. Exercise more regularly and consistently. Both of these things can help prevent the weight gain often associated with menopause as well as help with the other common side effects of menopause.
With the holiday season soon approaching, do you have any tips or suggestions on how to mantain my good diet? I know that pretty soon work parties, family gatherings and other social events full of sweets and high fat goodies will be around. It's tempting to forget about my diabetes and splurge at these types of events. What would you advise I do so that I can enjoy these functions without being overly concerned about what I'm eating?
TIPS ON EATING DURING THE HOLIDAYS
I've been sick for the past couple of days and my blood sugars are wrecking havoc! I'm trying the best that I can but I don't feel well due to the illness and feel even worse because my blood sugars are out of control. Do you have any suggestions for what I need to do to manage my diabetes while being sick?
It’s that time of year again…the cold and flu season. We have discussed this one time before but it deserves reiteration. The basic sick days guidelines for people with diabetes include
1) Always take your diabetes medication. Illness can make blood sugars
2) Monitor blood glucose more frequently (every 2-4 hours) especially if your blood sugars are higher than usual
3) Take your temperature every 4 hours
4) Eat or drink carbohydrates
5) If you have type1 diabetes check for ketones if the blood sugar is >240 mg/dl. You can buy “ketostix” at the drugstore which are dipsticks you test your urine with for ketones
You should contact your physician if your blood sugars are >300 mg/dl 2 times in a row or stay above 200mg/dl or you have persistent vomiting/nausea, a fever of 101.5 or higher, can’t keep fluids down for more than 4 hours, have rising ketone levels (type 1) or are sick for more than 24 hours. Your physician needs to know your symptoms, temperature, your blood sugars and ketones, the medicine you took, and the last time you took the medicine.
If you can’t eat regular foods, replace with liquid carbohydrate. Some recommend 10-15 grams every hour you are awake. The main focus should be to prevent dehydration so keep the fluids coming and some nutrition to replace what you are missing from regular food. Examples of 15grams of liquid would include regular (not diet) soft drinks like coke or ginger ale, jello, and broth type soups. If you are able to consume foods, you may want to stick with bland foods like saltine crackers, puddings, soups, and yogurt.
Given that it is the time of year for colds and/or the flu, it’s a good idea to have these fluids and foods around the house so you are prepared. Also if you do have Type 1 diabetes, make sure you have ketostix that are in date. Also all of us with diabetes should get a flu shot annually. Wash your hands a lot, use hand sanitizers, and stay away from those that are sick. Good luck!
My endocrinologist keeps telling me that I need to get eye exams on a yearly basis. Every time I see my endo my A1c is fine and all of my labs come back normal. I don't feel like seeing another doctor when it doesn't seem necessary. Why is it important to get an annual eye exam and what will happen during the exam?
Hi fellow DiabetesSisters,
This past weekend, I had a very frightening experience that I would like to share with you in hopes of making everyone more aware. As a person with Type 1 diabetes, I have certainly had my share of low blood sugar. Technically, low blood sugar is defined as any number less than 70 mg/dl. Hypoglycemia is the result of excess insulin in the blood which causes the sugar level to drop. Symptoms can vary from person to person as well as in severity but most commonly people feel shaky, sweaty, rapid heart rate, and anxiety, irritability. We all are usually aware of our symptoms and treat with the appropriate 15 grams of carbohydrate and within 10- 15 minutes, we feel better and the hypoglycemia goes away. If the symptoms are ignored, or no treatment is given, blood sugar could continue to fall, which can result in behavior change, confusion, stupor, and unconsciousness. Usually when a person’s blood sugar drops, the body releases the hormones glucagon and epinephrine. Glucagon spurs the liver to release stored glucose and epinephrine signals the liver to produce more glucose. These hormones are also responsible for the warning signs of hypoglycemia.
Some of us may no longer have these typical warning signs of low blood sugar. We do not feel them either at all or not every time. This situation is called hypoglycemia unawareness - simply you are not aware of the low sugar. It can be caused by nerve damage that affects the body’s ability to secrete epinephrine. People with type 1 diabetes can have impaired epinephrine secretion. Often people with very tight blood glucose control may also lose their ability to sense low sugars. Often, we healthcare people will advise our patients with hypoglycemia unawareness to let their blood sugars “run a little higher” to help reestablish those symptoms of hypoglycemia. With out those warning signs, again, a person may end up with a severe low leading to confusion, disorientation or unconsciousness. Sometimes, the symptoms may come back after a period of higher blood sugars but sometimes they do not. People with hypoglycemia unawareness need to be very vigilant about checking their blood sugar to protect themselves and those around them.
Here’s my story. As you may know, I’ve had diabetes for 41 years and again have had my share of low sugars. I also do not always feel my lows so yes I too have hypoglycemia unawareness. I have found myself many times needing someone’s help when I have been “out in the north 40” so to speak. This past Sunday, I had to get up very early as I was going to be in a horse show. So at 4:30 am I awoke, checked my BG which was high at 200mg/dl. I took my usual correction dose and changed my pump site as well. I packed my car with all I would need for the day, let the dog out and was on my way to the barn to load my horse on the trailer and get to the show. I checked the time in my car and it was 5:38 am. I drove about a mile down the road and that’s the last thing I remember until I found myself on a dirt road trying to back up my car. Two people were out side my car window telling me I was about to run into a ditch. I rolled down the window and asked them where I was. They thought I was drunk and tried to take my keys away from me. I told them I had diabetes and needed to check my blood sugar. One of them said his grandmother had diabetes. My blood sugar at that time was 40mg/dl. They gave me some Gatorade and I found some glucose tabs in my purse which I also ate. My blood glucose rose to 75 mg/dl within about 15 minutes. By this time it was about 6:10 am. I had driven about 10-15 miles from my house pretty much unconscious and somehow ended upon a dead end street in another town. Thank God I didn’t hurt anyone or myself and that these two people were so nice to me. They led me back to the main road and off I drove to the barn to try to make it to the horse show. I admit I was a bit disoriented by this whole thing but made it to and through the horse show and even won a few ribbons. But by the end of the day, the gravity of this situation hit me. Wow I really need to pay closer attention especially when I am going to be driving. I already check my blood sugar about 10 times a day but I just need to remember even when I am in a hurry, trying to get a million things done that with diabetes not everything happens the same way every time so double checking blood sugar before getting behind the wheel of a car is my new rule.
Every month when I have my period I experience fluctuations in my blood sugar levels. Why does this occur? I've asked my other "DiabetesSisters" if this happens to them as well. For some, it doesn't but for others, it does. Some of my friends have high blood sugars a few days before their period starts (like me) while my other female friends' blood sugars go low!! What gives??
Unfortunately, there have been very few studies in the area of menstruation and blood sugar control. The common finding is that menstruation’s affect on blood sugar control is varied depending on the individual. As a result, blood sugar testing during this time is the only way to know how it affects that particular woman’s blood sugar.
One study by Villanova University College of Nursing revealed decreased insulin sensitivity during menstruation being the most common issue. This decreased insulin sensitivity means that the insulin that patients were taking or the pancreas was producing were not sufficient to lower blood sugar, resulting in hyperglycemia or high blood sugar. According to studies and reports, this decreased insulin sensitivity could be related to hormone fluctuations during different phases of the menstrual cycle or from symptoms of Premenstrual Syndrome (PMS) such as bloating, cramps, and mood swings. During menstruation estrogen and progesterone are at their lower levels. These are hormones that are produced by the ovaries in reaction to stimulation of Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) all needed in normal menstruation. Estrogen and Progesterone are at their peak in the premenstrual phase. This is where they stimulate the endometrium to prepare a thick layer of blood vessels that will support a fertilized egg should pregnancy occur. Progesterone is thought to be the main culprit in decreased insulin sensitivity. This thought does not have much in the form of explanation.
In some cases DKA can occur with fluctuations. Some feel that insulin sensitivity during menstruation is similar to the dawn phenomenon, in which all people with diabetes do not experience it. Dawn phenomenon is when someone with diabetes has very high blood sugar (hyperglycemia) in the early morning due to the release of certain hormones. These hormones are called counterreulatory hormones and they work against the action of insulin. The hormones glucagon, epinephrine, growth hormone, and cortisol all increase blood sugar when needed by stimulating the liver to release glucose and inhibiting glucose utilization.
H.I. Cramer was the first researcher to notice fluctuations in blood sugar due to menstruation. His findings were published in the Canadian Medical Association Journal in 1942. He found that 38% of the women reported that menstruation had changed their diabetes control. 70% of those women reported deterioration of control by experiencing hyperglycemia. 30% experienced hypoglycemia and improved control.
Studies also show increased insulin sensitivity or no affect in women as well. Mechanisms for changes in blood sugar control continue to be undermined. It is very difficult to document as there are other factors affecting insulin sensitivity. Also, women in the age range for menstruation are very busy and hard to recruit for further studies (I know you all are smiling right now as you know this to be true!).
Some feel with increasing technology in diabetes, such as Continuous Glucose Monitoring (CGM) will be able to make it easier for women to identify patterns and make decisions on how to improve control during menstruation. The best thing is to test blood sugar frequently during premenstrual syndrome and menstruation and determine individual needs.
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