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gt;gt;After some false starts, she found Atlanta Endocrine Associates—part of Atlanta Center for Endocrinology, Diabetes, Metabolism, and Nutrition. There, medical director Scott Isaacs, MD, an endocrinologist and obesity specialist, offers an intensive weight-loss program designed for people with weight-related health problems, such as diabetes. In April 2010, Blasko started on the Decision Free plan. She received low-calorie entrees and shakes, met weekly with nurses who helped her manage her medical issues and with nutritionists who taught her how to put together healthy meals, and she attended regular support groups.gt;gt;The plan worked, big-time. By February, Blasko had lost 50 pounds. She no longer needed meds to stabilize her blood sugar, or the drug she'd been on for high blood pressure; both were at normal levels. "At my last checkup, my doctor told me I basically wasn't diabetic anymore," marvels Blasko, now 100 pounds lighter than when she started. "I didn't know that was possible."gt;gt;gt;gt;The end of diabetes?gt;gt;gt;You read that right: Blasko essentially reversed her diabetes. And, most people with type 2 diabetes—which afflicts 1 out of every 10 women in the U.S.—could do the same, according to Osama Hamdy, MD, PhD, medical director of the Obesity Clinical Program at the Joslin Diabetes Center in Boston. "We've been treating diabetes for 40 years by adding more and more medications, with no big improvements," says Dr. Hamdy. "But if you act early, keep the weight off, and maintain a healthy lifestyle, you can put this disease in remission forever."gt;gt; gt;gt;It's no secret that excess weight and diabetes go hand in hand, due to the powerful impact that pounds have on blood sugar. There's even a term for this unhealthy alliance: "diabesity." Yet the integrated focus on diabetes management and weight control found at centers like Dr. Isaacs's and Dr. Hamdy's is surprisingly rare.gt;gt;"It's frustrating, says Dr. Isaacs. "Diabetes guidelines all say start with diet and exercise, but many treatment programs don't. Meanwhile, standard weight-loss programs are completely focused on diet and exercise, and no accommodations are made for changing medical conditions." When a diabetic loses weight, for instance, her medication needs may change.gt;gt;gt;gt;The cost of a curegt;gt;gt;So why isn't medically supervised weight loss a key component of every diabetes program? For one thing, shedding pounds is ; Dr. Isaacs says that many diabetes experts focus on meds because they don't see much long-term success with weight management. Another major reason is cost. "Insurance often won't cover this kind of care, and many hospitals don't have the resources to offer it," says Dr. Hamdy.gt;gt; Certainly, the price of treatment varies. Dr. Isaacs's program starts at $25 a week for classes, plus $80 to $100 weekly for food. The Joslin Center offers a 12-week program called Why WAIT, which features a diet and exercise plan and costs $5,000. (YOU-Turn is a seven-day version followed by six months of weekly phone coaching and support.) Sometimes these services are covered by insurance, but that depends on the patient and her plan. Either way, the approach is worth the money, Dr. Hamdy says. "The costs of this condition are huge. With the number of people with diabetes approaching 20 million in the U.S., we'd save so much if similar programs were implemented nationwide."gt;gt;For former diabetics like Blasko, the payoff is obvious: "If not a penny of the program were covered, I'd still say it was worth it. I probably would have paid more."gt;gt; ]]> Nola Lopez

gt;gt;While dieting and exercise can lower blood sugar—so the insulin they do make is more effective—sometimes that's not enough. gt;gt;That's where a complex variety of drugs come in. These drugs work in different ways to help lower blood sugar to safe levels and are often more effective when used in combinations. gt;gt;Among adults with diabetes, 57% take oral medication and 12% take both insulin and oral medication, according to the Centers for Disease Control and Prevention. gt;gt;gt;Most people start with metformingt; gt;The first drug people take is usually gt;metformingt;, an oral medication that is found in the brand-name drugs Glucophage and Glucophage XR. As time goes on and diabetes progresses (natural insulin production can decline over time), their doctor often adds another type of oral medication, insulin, or some other injectable drug to the regimen. gt;gt;Metformin is a biguanide that decreases the liver's excess glucose production. If it's not controlling blood sugar on its own, doctors might add a gt;sulfonylureagt;, which stimulates the pancreas to make more insulin. Or they might add a gt;thiazolidinedionegt;, which increases the body's sensitivity to insulin.gt;gt;Now that multidrug therapy is common practice among endocrinologists, more drugs are available in a single pill. For example, metformin has been combined with sulfonylureas (called Metaglip and Glucovance) and sitagliptin (called Janumet). In addition, doctors might consider adding the injectable medications gt;Byetta (exenatide)gt; or Symlin (pramlintide acetate), to a patient's metformin, says Dace Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle. gt;gt;"The thinking is that if you treat people with two drugs instead of one, you can get down to the targeted levels quicker and it stays down there longer," said Dr. Trence. gt;gt;gt;You may also need to take insulingt;gt;Daytime activity can increase the body's sensitivity to insulin, so an oral drug, such as metformin, may control the fasting blood sugar. But since people are sedentary at night, they may need long-lasting insulin shot before bedtime.gt;gt;"That will carry them into the next day," Dr. Trence said.gt;gt;In time, they may also need a short-acting insulin, which is taken just before eating, to control blood sugar after meals.gt;gt;Patients estimate the amount of insulin they need based on their exercise, calorie and carbohydrate consumption, and their blood-sugar readings, said Glenn Cunningham, MD, an endocrinologist and professor at Baylor College of Medicine in Houston. gt;gt;gt;You may not need to take medication forevergt;gt;The primary challenges are making sure the blood sugar doesn't get too low from all the medications, a condition known as gt;hypoglycemiagt;, as well as preventing weight gain. There's more risk with certain drugs (such as insulin and sulfonylureas), than others. However, uncontrolled diabetes can lead to coronary heart disease, kidney failure, blindness, limb amputations, and premature death. gt;gt;"We have to remember the cost of not doing the job," said Daniel Einhorn, MD, an endocrinologist and medical director of the Scripps Whittier Institute for Diabetes in La Jolla, Calif.gt;gt;People who shed excess weight may—or may not—be able to come off their diabetes treatment. Genetics plays a role, as well as how far the disease has progressed. If a person has more vulnerable beta cells—the cells that make insulin in the pancreas—they'll need more medication, regardless of weight loss. ]]> Drug combos can often get blood sugar down quicker and for longer. (JERRY TOBIAS/VEER)

gt;gt;This relatively new class of drug helps combat insulin resistance by making your body more sensitive to insulin. The first thiazolidinedione was approved for sale in the U.S. in 1997. It was sold under the brand name Rezulin (troglitazone), but was pulled from the market in March 2000 due to the risk for severe liver problems.gt;gt;Avandia and Actos were approved by the U.S. Food and Drug Administration (FDA) in 1999. However, in 2011, the FDA decided to strictly limit access to Avandia (including medications that contain it, such as Avandamet and Avandaryl).gt;gt;As of November 2011, only patients in a special mail-order program will be able to take it, including those with no other blood-sugar-lowering options; patients who have already safely taken it; or people who acknowledge the risks, but would still like to take it. gt;gt;In 2007, a gt;studygt; suggested that Avandia was associated with an increased risk of heart attack and heart failure, a condition in which the heart becomes enlarged and pumps inefficiently. Shortly after, another gt;studygt; found that Actos also boosted the risk of heart failure, although it reduced the risk of heart attack, stroke, and death overall. Both studies were widely covered in the news.gt;gt;The FDA added a "black box" warning to the class of drugs in 2007, noting that they should not be used in people with gt;heart failuregt;. And in 2008, the FDA and GlaxoSmithKline notified doctors and pharmacists that patients had to be given a medication guide in each Avandia prescription (a step reserved for drugs that "pose a serious and significant public health concern").gt;gt;In 2010, the FDA limited Avandia's use to only those patients with type 2 diabetes who couldn't control their blood sugar with other medications. The agency made its decision after reviewing several studies looking at the link between the drug and heart attack risk.gt; gt; gt; gt; gt; gt; gt; gt; gt;gt; gt; gt; gt; gt; gt;gt; gt; ]]>

gt;gt;I was scared, because I knew there is no cure for diabetes. But I wasn’t really surprised because it runs in my family. Still, I was shocked when someone told me I actually had the condition. gt;gt;I started out taking oral medications and altering my diet, but I really only followed it some of the time. I was in college and none of my friends had diabetes—plus I didn’t feel sick. Then, in my mid-20s, I started feeling differently about diabetes; I was more aware of the possible consequences of not taking care of myself.gt;gt;gt;I started having complicationsgt; gt;In my early 30s, I began to have complications like bruising and tingling in my arms and legs.gt;gt;So I started writing the symptoms down and talking to my doctor about them. I began to pay attention to the annual exams I needed, and saw an eye and foot doctor to make sure everything was okay. But by the time I started taking my oral medications diligently, they weren’t able to control my blood sugar anymore.gt;gt;I was so determined to not take insulin—I thought taking it meant failure. I was so terrified of insulin. I tried a couple different combinations of medication, but they still weren’t working.gt;gt; Then, a couple of years ago, I was hospitalized. I had an infection, and my blood sugar was wreaking havoc when the doctors tried to cure it. My doctor told me as soon as I got there that I didn’t have a choice any more; the oral medications weren’t going to work, so I would have to start taking insulin. I spent two weeks in the hospital and began using insulin there.gt;gt; Now I take two different types of insulin each day—NovoLog, a fast-acting insulin that I use three times a day before meals, and Lantus, a long-term one I take at bedtime.gt;gt; When I was in the hospital, they were good about explaining how to use everything, and I went home with vials and syringes. When I got home, however, I was very nervous about giving myself shots. I was worried I was going to get the wrong dose or have air bubbles. I talked with my doctor about my concerns and was able to get insulin injection pens. These are prefilled pens; you just dial the dosage, screw the needle to the top, and inject. It’s really easy.gt;gt;I travel a lot because of my job as an event planner. I was worried at first that it would be a burden, getting around with the vials and syringes. I was afraid I would have to scale back on the thing I love the most. I quickly realized, though, that it wasn’t going to be the case.gt;gt; Insulin pens are very easy to carry with me. At first I was self conscious about it and would go to the ladies’ room when I needed a shot. But they are so easy to use, and it’s not painful at all. Now I just have the pen in a case in my purse, and I can angle it under the table and give myself a quick shot anytime.gt;gt;gt;gt;I did gain weightgt; gt;There were a few things I didn’t expect when I started using insulin, including weight gain. I have pretty much always had an issue with my weight, so that has been very difficult for me. I’ve gained 30 pounds. I’ve been trying to combat weight gain by stepping up my diet and exercise plan. It is slowly beginning to come off.gt;gt; I’ve also been worried about my blood sugar dropping too low. I was concerned it would happen at night while I was asleep, and I actually did have that happen. However, your body wakes you up, and I knew what to do to deal with it.gt;gt; I don’t have a lot of lows. They are few and far between for me. But I was concerned about it happening again in a time or place where I couldn’t do anything about it, like in my car during rush hour. I talked to a nurse about it, and she told me to carry a tube of Life Savers. They absorb quickly, and now I have something in my purse to quickly reverse hypoglycemia when I’m traveling.gt;gt;All of these issues are just minor ones. Things are a lot better for me now. Insulin has freed me up because I don’t have to worry about getting sick or having complications. I feel better and have more energy now. And the issues I was starting to have with my kidneys went away once my blood sugar was regulated.gt;gt;I think people need to get as much education about insulin as possible. I had such a fear of the unknown. But if I had known that it was so easy to use insulin, I totally wouldn’t have been scared about it. It’s your life—it can be the difference between life and death. It’s not a failure—it’s doing what’s best for your body. ]]> Chuck Fazio

gt;insulin therapygt;, there are two important factors to consider: How much insulin do you need to take? When do you need to take it? And both are very personal.gt;gt;"You can't paint everyone with type 2 diabetes with the same brush," says Mark Feinglos, MD, division chief of endocrinology, metabolism, and nutrition at the Duke University School of Medicine, in Durham, N.C. "You need to tailor the regimen to an individual's needs."gt;gt;A person with type 2 diabetes might start off on half a unit of insulin per kilogram of body weight per day, especially if there is not much known about the nature of his or her diabetes. Still, it is not unusual to need more like 1 unit, says Dr. Feinglos. (One unit per kilogram would be 68 units per day for someone who weighs 150 pounds, which is about 68 kilograms.)gt;gt;A lot depends on your specific health situation. People with type 2 diabetes suffer from gt;insulin resistancegt;, a situation in which the body loses its ability to use the hormone properly. Early in the course of the disease, the insulin-producing cells of the pancreas respond to insulin resistance by churning out even more of the hormone. Over time, though, insulin production declines.gt;gt;Taking insulin can help you overcome the body's insulin resistance, though many factors can affect your dosage. If your body is still sensitive to insulin but the pancreas is no longer making much insulin, for example, Dr. Feinglos says that you would require less insulin than someone who is really resistant to insulin. gt;gt;"But the most important issue is not necessarily how much you need to take," he adds. "Rather, it's the timing of what you to take. Timing is everything."gt;gt; gt; gt;gt;One shot a day or more?gt;gt;If you wake up with high blood sugar in the morning, it's very likely that you will need at least a once-a-day injection combined with oral drugs, says Dr. Feinglos. Oral medication can lower your insulin resistance, and a long-acting, once-a-day insulin shot (usually taken at bedtime) can mimic the low level of insulin made by the pancreas. (And the shots may not be how you picture them—painful and complicated. You can use gt;pen-like injectorsgt; that have short, thin needles and that allow you to dial the amount of insulin you require, rather than draw it up from a vial using a syringe.)gt;gt;If your blood sugar tends to spike after meals despite using medication and watching what you eat, you may have to take a dose of rapid-action insulin before every meal. gt;gt;"There's controversy over how much better you can really do with additional shots," says John Buse, MD, PhD, director of the Diabetes Care Center at the University of North Carolina School of Medicine, in Chapel Hill. "I don't see much improvement in overall glucose control in many patients with the rapid-acting insulin taken at meals. And it does promote weight gain and low blood sugar. Is the burden worth the benefit?"gt;gt;Either way, a once-a-day long-acting formulation is usually the best way to start, according to Dr. Buse. A standard initial dose might be 10 units. The dosage is then increased until blood sugar levels are lowered into the normal range.gt;gt;"If a person still has substantial insulin secretion left in their pancreas, one shot a day is probably more than enough to top it off," agrees Robert Rizza, MD, professor of medicine and executive dean of research at the Mayo Clinic, in Rochester, Minn. "But if you're really running out of insulin and can't store it between meals, then you may need to take both the long- short-acting injections." gt;gt; gt; gt;gt;Taking insulin with mealsgt;gt;If you do end up taking insulin at meals, the doctors agree that it is particularly important to match food intake with insulin, while also accounting for physical activity. (Exercise naturally lowers blood sugar, so if you're working out, you may need to take that into account.)gt;gt;"Some people recommend matching insulin to carbohydrate counts," says Dr. Buse. "Others suggest eating a set serving of carbohydrates at each meal for a particular dose of insulin."gt;gt;Even more crucial, according to Dr. Feinglos, is moderating food intake before insulin is ever initiated. "If you're not controlling the calories first, and just start giving insulin," he warns, "then all a patient is going to do is gain weight and get more insulin resistant and end up needing larger doses of insulin." gt;gt;gt;It can be a vicious cycle.gt;gt;"The relationship between food and exercise with medicine is so critical in diabetes," he adds. "If you just keep pouring medicine into the problem, it doesn't really solve it."gt;gt;Nevertheless, a patient may do everything right—eat well, work out, and routinely take his or her medicine—but still require more insulin over time due to the progressive nature of the disease. Adjustments can come through higher doses, increased frequency of injections, or both.gt;gt;On a positive note, with improved diet and exercise, some patients are actually able to reduce their intake, even to the point of discontinuing insulin injections altogether. gt;gt;"There are multiple ways to get to the same point," says Dr. Rizza. "The bottom line is to keep blood sugar normal." ]]> Getty Images

gt;control blood sugargt; than ever before, including no less than six classes of oral medication and an injectable drug based on lizard venom, gt;Byettagt;. gt;gt;Still, just because one certain drug—gt;insulingt;—has been around for nearly a century doesn't mean that it should be considered as less useful or less important than other "more modern" medications. In fact, insulin's tried-and-true safety record and ironclad ability to lower blood sugar in all patients make some doctors more likely to recommend it sooner rather than later in some people with type 2 diabetes.gt;gt;"Insulin is an appropriate choice at any point," says John Buse, MD, PhD, director of the Diabetes Care Center at the University of North Carolina School of Medicine, in Chapel Hill. "You can start it as the first therapy for diabetes. In some countries, such as Germany, many doctors advocate that as the best approach." gt;gt;Insulin therapy has gt;gotten easier over the yearsgt;, making the drug less painful and simple to use than in the past. gt;gt;But even if this therapy doesn't seem suitable for you right now, don't be afraid to use it if your doctor thinks it can help control your blood sugar in the future. Elevated blood sugar basically acts as a poison in the body, so if other treatments aren't working, you'll need to do whatever it takes to get it into the safe zone.gt;gt;Most fears about insulin are unwarranted, or at least outdated, says Dr. Buse.gt;gt; gt; gt;gt;Why insulin?gt; gt;About 90% to 95% of people with diabetes have type 2 diabetes, while 5% to 10% have type 1. Of adults with either type 1 or 2 diabetes, only 14% use insulin, 13% use insulin and oral medication, 57% take oral medication only, and 16% control blood sugar with diet and exercise alone, according to the CDC. gt;gt;Unlike type 1 diabetes, type 2 is sometimes defined by the development of insulin resistance—a loss of sensitivity to the hormone—which causes the insulin-producing cells of the pancreas to work hard to overcome the resistance, and over time, stop functioning at all.gt;gt;Most people with this type of diabetes eventually stop making natural insulin at some point. (As opposed to early on in the course of the disease, when insulin resistance can cause the pancreas to produce higher-than-normal levels of insulin.)gt;gt;People with type 2 diabetes can benefit from insulin therapy because it can lower blood sugar by overcoming insulin resistance or supplement their own natural production of insulin—if there is any. It can be used alone or in combination with oral medication to get blood sugar down.gt;gt;Sometimes gt;oral medicationsgt; are sufficient to lower blood sugar, but they may not help everyone or may stop working over time, notes Robert Rizza, MD, professor of medicine and executive dean of research at the Mayo Clinic, in Rochester, Minn.gt;gt;"Nearly everyone with type 2 diabetes will eventually need to start taking insulin," says Dr. Rizza. gt;gt;However, this can depend on how young you were when you were diagnosed with type 2, how well controlled your blood sugar has been over time, or the progression of the condition over time.gt;gt;The younger a person is when he or she gets diabetes, the more likely that milestone will be reached, Dr. Buse speculates. Someone diagnosed in their 60s, for example, may only have a one-in-three chance of ever needing external insulin. gt;gt; gt; gt;gt;How safe is insulin?gt;gt;When gt;blood sugargt; or gt;hemoglobin A1C testsgt;—a measure of blood sugar control over the previous three months—rise despite oral medications, it is probably time to look for further help.gt;gt;"Insulin has been around for almost 90 years and we robustly understand its issues," Dr. Buse notes. "On the other hand, there's actually some fear of the unknown with the newer oral therapies." Most oral medications have a very safe track record, but not all. For example, the U.S. Food and Drug Administration recently restricted Avandia due to a link with heart attacks and strokes.gt;gt;But insulin has its pros and cons too. It can trigger weight gain, which is not uncommon with diabetes treatments that improve the body's ability to absorb and process blood sugar.gt;gt;Lifestyle changes and blood sugar monitoring, for example, can usually compensate for any effects on weight. And insulin can cause blood sugar to go too low, a condition known as hypoglycemia. However, this is uncommon, and usually treatable with a source of sugar, such as glucose tablets. gt;gt;One thing insulin is not, however, is painful. While that may have been true 90 years ago, insulin needles are much smaller and thinner nowadays.gt;gt;"As a middle-aged man, if you hold the needle up to the face, it's a little hard to even see the width of the needle," says Dr. Buse. "They are very polished and lubricated. It's basically a painless experience—definitely less painful than pricking your finger to get a blood sugar result, which most patients already do at least daily."gt;gt;There is even evidence to suggest that early insulin therapy can increase the body's natural insulin secretion, although it is not yet clear if this actually benefits patients over the long term.gt;gt; gt; gt;gt;Going off insulingt;gt;And many people also assume that starting insulin therapy means a lifetime of shots. This is not always true. "Lots of people come off insulin after getting the religion," Dr. Buse says, referring to the improvements in insulin sensitivity sparked by weight loss and exercise. gt;gt;If a patient starts off overweight and sedentary, his or her body might require 100 units of insulin to keep the blood sugar controlled, offers Dr. Rizza. "Maybe their pancreas can secrete 80, so they need to take insulin to top it off," he explains. "But if they lose weight and their requirement subsequently drops to 60 units, they may be able to stop using insulin."gt;gt;The example of a bariatric surgery patient is even more dramatic, he adds. After losing a substantial amount of weight with the procedure, he or she often no longer needs the outside help of the hormone.gt;gt;Some patients also hold the misconception that insulin injections lead to an increased risk of diabetic complications. "This, too, results from the old days when we didn't treat the condition as intensely and doctors only put people on insulin after they had recognized problems brewing," Dr. Buse explains.gt;gt;"We now know that insulin is as, or arguably more, effective than any other therapy as far as preventing the disabling complications of diabetes," he adds. "Insulin doesn't cause complications; it prevents them." ]]> Getty Images

gt;Wimergt; shares his health struggles on his gt;bloggt; and in motivational talks as a member of the National Speaker Association of Central Florida.]]> gt;gt;As a nurse I was even making home visits to people who had had their feet and legs amputated due to diabetes. However, I never thought it would happen to me. It was sheer hubris, I know, but I thought that as a medical person I really didn’t need to follow the rules.gt;gt;I knew that extreme thirst and frequent urination are signs of high blood sugar. Still, the symptoms can creep up on you. Before you realize it, you have already done damage to your body. I had a tremendous thirst—I would drink a 64-ounce thermos full of water and still be thirsty. I had to literally drop what I was doing at times to go to the bathroom.gt;gt;gt;Oral medications weren’t workinggt;gt;I tried to manage my blood sugar with oral medication, but couldn’t. So I decided to go on insulin. It was frustrating because I gained a lot of weight when I started taking it. At one point, I was 300 pounds. One of the side effects of insulin is that you get hungry. You are hungry and you eat; then you get too fat and have too much insulin. It’s a cycle.gt;gt;After a few years, I started doing better. But I got tired of insulin and quit taking it. Then, about four years ago, my wife, who is also a nurse, put her foot down. She said I had to do something different. I went to an endocrinologist who put me on Lantus, which is a once-daily insulin shot, and Byetta (exenatide), a drug I take twice a day that helps control blood sugar and curb my appetite.gt;gt;When I first started taking Byetta, I was really sick. The first month I was so nauseated I could eat hardly anything. Then the second month, I doubled the dose, but could handle it a little better. By the third month it was okay and now it doesn’t bother me. I have noticed, though, that I have to eat at least something about 30 minutes before I take it or I don’t have any appetite all day. I won’t eat much of anything that day.gt;gt;Insulin is also much easier to take now than it was in the late 1980s. You can give the shots in your arms, stomach, or other areas, and the needles are so much smaller.gt;gt; The shots, though, were never really a problem for me. The biggest issue I had was with the old portable, handheld glucose monitors. You had to give yourself a pretty good cut with the lancet to get enough blood to use the monitor. After a while, you would run out of places on your fingers and you had to stop using it until they had time to heal.gt;gt;The newer lancets are much easier because they are smaller, and you need less blood for the glucose monitors. It makes a big difference—it is so much easier to be compliant now.gt;gt;gt;gt;I had two heart attacksgt;gt;If I could give anyone advice, it would be to take your medications. Over the past 22 years, I have had three strokes, two heart attacks, and seven stents. All of those have come from the debilitating affects of diabetes.gt;gt; Back when I was first diagnosed, doctors knew diabetes was bad, but not like they do today. They know now that the disease affects so many parts of your body. And we know that aggressively controlling your diet and exercise and maintaining your medications can halt or radically slow down the side effects.gt;gt; Strictly following my regimen over the past four or five years has reversed some of the damage. My glomerular filtration rate (a measure of kidney function) used to be 44, which was low for my age. When I wasn’t taking my medication, it went down to 32, which is near dialysis levels. Now it’s back up to 42.gt;gt;Once I got used to the diet and began a regular routine, I didn’t have many problems. The ones who have the problems are teens, who don’t want to follow the rules, and old farts like me, who also don’t want to follow the rules!gt;gt;The biggest problem I have now is low blood sugar, which sometimes happens when people take insulin. It’s bad news when it’s high, but the effects are more gradual. When you have low blood sugar, you can go into a coma very quickly. I know when it’s coming on because I get nervous and irritable. I just have to make sure I’m always prepared for it.gt;gt;It has been interesting being on both sides of the line, as a patient and a nurse. I try to tell people what I have learned. I make sure my feet are clean and dry. And if I travel, I carry Neosporin around with me to treat any cuts and open sores. (Diabetes can reduce the body’s ability to heal properly, and the feet are especially vulnerable.)gt;gt;Aggressively controlling your diet and using insulin regularly is the best way to contain diabetes. Exercise is one of the best ways to maintain good blood sugar balance too.gt;gt; And, most importantly, you have to be aware of the signs—especially if you have a family history of diabetes, which gives you a higher probability of getting it. If you have tremendous thirst and urgent urination, there is already damage to your pancreas.]]>

gt;gt; gt;Q:gt; gt;I have type 2 diabetes. Do I to take insulin?gt; gt;gt; gt;A:gt; gt;For people with type 2 diabetes, insulin is a very nice tool that's better if used sooner rather than later. (Unlike in type 2 diabetes, in type 1 diabetes insulin is a requirement, not an option.) What happens in type 2 diabetes is that physicians may use insulin as a threat, an “if you” thing—if you don't lose some weight, if you don't do some exercise, if you don't follow the diet, then you're going to wind up on insulin. That's really not how people with type 2 diabetes should view insulin—as a punishment. Insulin is a very, very safe therapy, and people should not hesitate to use it if needed. gt;gt; The people with type 2 diabetes who must take insulin are those who are unable to control their blood sugar even while on several different oral medications. But if you start using insulin before you reach that point, you can help preserve the function of your insulin-producing pancreatic cells for a longer time. And the longer you continue to make your own natural insulin, the longer you can get by with a less complicated insulin regimen, possibly taking just one shot a day.gt; gt;gt; gt;Q:gt; gt;But I'm afraid of shots!gt; gt;gt; gt;A:gt; gt;You don't need to be, if you're talking about insulin. If you're picturing big syringes that you have to boil and sterilize, think again. Modern insulin needles are very thin and disposable—no sterilizing necessary. There are also insulin pens equipped with an insulin cartridge and disposable needles that are so simple even a child can use them. Either type of delivery system makes using insulin very easy and virtually painless—really.gt;gt; If you pinch the injection site before giving yourself a shot, it will hurt even less. Still, the needles are so small these days that pain is not really an issue any more.gt; gt;gt; gt;Q:gt; gt;Won't too much insulin cause me to go into a coma?gt; gt;gt; gt;A:gt; gt;Theoretically yes, if you take lots and lots of insulin. But in reality, the kind of severe hypoglycemia (low blood sugar) that would cause someone to go into a coma is extremely rare in people with type 2 diabetes. Hypoglycemia is a bigger risk for those with type 1 diabetes.gt; gt;gt; gt;Q:gt; gt;Will I have to take insulin forever?gt; gt;gt; gt;A:gt; gt;It depends. Many people can eliminate their need for insulin if they eat less, exercise more, and lose weight, and if their beta cells (which make insulin in the body) are still functioning adequately. But if your doctor has waited to prescribe insulin until you can no longer make this hormone on your own, then yes, you will have to be on insulin for the rest of your life.gt; gt;gt; gt;Q:gt; gt;Why can't I just take a pill?gt; gt;gt; gt;A:gt; gt;Some diabetes medications aren't great to use long-term, while insulin is extremely safe. Rather than waiting to take insulin until you're on several different oral agents—none of which are working any more—it's better to start well before you've added a second or even a third medication.gt; gt;gt; gt;Q:gt; gt;How many times a day do I have to take insulin?gt; gt;gt; gt;A:gt; gt;If you can start insulin really early in the course of the disease, one shot a day may do the trick. People whose disease has progressed further may need to take it several times a day, typically with each meal.gt; gt;gt; gt;Q:gt; gt;Won't I gain weight?gt; gt;gt; gt;A:gt; gt;Weight gain is the first sign that your diabetes is under control, whether it's with oral agents or insulin, because your body starts being able to process sugar again. But the weight is typically gained in a healthier pattern; you may notice that your clothes fit you differently. I tell patients to pay more attention to how their clothes fit than to what their weight is.gt; gt;gt; gt;Q:gt; gt;Will I ever be able to get on a plane with needles?gt; gt;gt; gt;A:gt; gt;Airport security employees are pretty familiar and comfortable with diabetic fliers bringing their equipment with them. First, you should notify the security officer that you have diabetes and are carrying supplies with you. As long as any insulin you bring with you has a professionally printed label identifying the medication (the original box it came in usually carries this labeling), you'll be fine. gt;gt; You are allowed to take insulin, insulin-loaded dispensing products, unused syringes, and other supplies through the checkpoint once they have been screened. You may want to bring a note from your doctor stating that you have diabetes and need insulin treatment, just to be sure. But nobody has ever come to me and told me that they've had trouble bringing their insulin and other supplies on a plane.gt; gt;gt; gt;Q:gt; gt;How do I prevent hypoglycemia?gt; gt;gt; gt;A:gt; gt;Hypoglycemia occurs when you have too much insulin in the body, so blood sugar drops too low. Symptoms include anxiety and confusion, sweating, hunger, and, in rare cases, seizures and comTo prevent this, make sure to match your insulin intake to your food intake, which can take some trial and error. And you should always have a sugar source on hand; eating some will quickly reverse hypoglycemiI advise patients to buy glucose tablets. While candy can work too, you'll be less tempted to snack on the tablets, which aren't all that tasty.gt; gt;gt; gt; gt;Q:gt; gt;How can I exercise while taking insulin?gt; gt;gt; gt;A:gt; gt;Exercise is great because it's a natural way to lower your blood sugar. However, if you're taking insulin you need to take this into account when planning your day. You may experience low blood sugar during exercise, or afterward. Again, having a sugar source handy—watered-down Gatorade, glucose tablets, candy—is important, and can quickly reverse blood sugar that is too low.gt; gt;gt; gt;Q:gt; gt;What kind of food can I eat while taking insulin?gt; gt;gt; gt;A:gt; gt;You will still have to eat a healthy diet. You can eat as much fish, poultry, and green vegetables (with the exception of peas) as you like, as these are less likely to affect blood sugar as much as carbohydrate-rich food. You'll need to match your insulin to the amount of carbohydrates you eat in a meal. However, some foods can make it harder for the insulin to control your rise in blood sugar.gt;gt; You should limit starchy vegetables like potatoes, corn, and peas, which can cause blood sugar to rise. With fruit you also need to be careful. Berries are okay, but pineapples and grapes and cherries are tough. gt;gt; Eating a piece of fruit as an afternoon snack is a very reasonable thing to do, but not as a before-bed snack or first time in the morning, which can make it harder for insulin to control blood sugar.(That is because hormones that are associated with waking up make it more difficult for insulin to work, and when you're asleep, your sugar will rise because you're burning fewer calories.) It can take some trial and error to figure out what food you can eat while keeping blood sugar in the safe zone.gt; gt;gt; gt;Q:gt; gt;How do I store insulin?gt; gt;gt; gt;A:gt; gt;Once insulin has been opened, for pretty much all types of insulin you can store it at room temperature for about six weeks. It doesn't have to be refrigerated. However, you should keep it in a relatively cool place, especially if the room temperature in your home is 85° or more.gt; gt;gt; gt;Q:gt; gt;What IS insulin? Is it a drug or a hormone?gt; gt;gt; gt;A:gt; gt;In a way, it's both. But first and foremost, insulin is a hormone. The beta cells of the pancreas make insulin and release it when you eat a meal. It lowers the blood sugar by multiple mechanisms, but basically by causing cells to take the sugar out of the blood. And for people who aren't making enough insulin on their own, and must take it to treat their diabetes, insulin is, technically, a drug.gt; gt;gt; gt;Q:gt; gt;What exactly is insulin resistance?gt; gt;gt; gt;A:gt; gt;Insulin resistance occurs when a person becomes less sensitive to the hormone and he or she needs to release more and more insulin to lower the blood sugar by the same amount. Insulin resistance further depletes the insulin-producing cells of the pancreas and leads to progression of diabetes. Obesity is a major contributor to insulin resistance, while a healthy diet and physical activity can help improve insulin sensitivity.gt; gt;gt; gt;Q:gt; gt;Can insulin prevent diabetes complications, like nerve damage, heart disease, and blindness?gt; gt;gt; gt;A:gt; gt;There is evidence to suggest that if taking insulin leads to better blood sugar control, people are less likely to develop complications. And the earlier you are able to get your blood sugar under tight control, the better your chance of avoiding these complications.gt; gt;gt; gt;Q:gt; gt;What if I skip my insulin? Could I die?gt; gt;gt; gt;A:gt; gt;Odds are you won't. But it depends on how often or for how long you skip your insulin. I tell my patients who use insulin multiple times a day that if they miss a shot, they need to cut the carbohydrate content of the food they eat that day, drink more water to counter the dehydration associated with higher blood sugar, and eat more green vegetables and less starch.gt; gt;gt; gt;Q:gt; gt;What is an insulin pump? Do I need one?gt; gt;gt; gt;A:gt; gt;Probably not. An insulin pump is basically a system for delivering the hormone to your body. It can be adjusted to release different amounts throughout the day. While these devices can be helpful for people with type 1 diabetes, for most type 2 diabetics they're not necessary.gt; gt;gt; gt;Q:gt; gt;Can I get addicted to insulin?gt; gt;gt; gt;A:gt; gt;If you're asking whether your body can become dependent on insulin, it depends. If your body is still producing some insulin on its own, there's a chance you could reduce your need for extra insulin by eating healthier, becoming more active, and losing weight. However, if your body can no longer produce any insulin on its own, you will indeed be dependent on it, but not because you're taking insulin as a drug. In type 2 diabetes, insulin resistance damages your natural insulin-producing cells and this may increase your need for taking insulin as a drug. Disease progression can leave you dependent on insulin—not the insulin itself.gt; gt;gt; ]]>

gt;gt;I started off taking pills and lost some weight. But then I quit taking the pills and started eating more again and gained the weight back. I had to go back on the pills. Each time I dropped the weight, my blood sugar would stabilize.gt;gt; Eventually, the pills weren’t enough to keep my blood sugar normal, and my doctor said I was going to have to go on insulin. I wasn’t really having any symptoms at the time—she was just checking my blood sugar levels, and they weren’t controlled.gt;gt;I was really upset when I found out. I didn’t want to go on insulin and have to take a shot. I don’t like needles and didn’t want to have to do that every day.gt;gt;I started out taking Lantus, which is one shot daily. That would control my sugar for the whole day. I was using insulin needles, but I got used to that; it was only once a day and it worked.gt;gt; gt;My blood sugar is now better controlledgt; gt;But then I began eating too much of the wrong foods, and my sugar would go up and get out of control. So I’m on a mixture of that insulin and NovoLog. I take three shots a day now using an insulin pen.gt;gt;For me, the pen is easier because it’s not like filling up the insulin needles—you just dial it up and give yourself a shot. Most of the time it doesn’t hurt when I give myself the shots. Sometimes it does, but I do it anyway. It works fine for me.gt;gt;Still, it’s inconvenient. You have to remember that you have to take the shots every day, three times a day. If you go out, you have to take all of that extra equipment with you. If you go on vacation, you have to have all of your supplies together and make sure you have enough for the whole time you’ll be gone. You have all of these things you have to do to prepare yourself.gt;gt; It does help to keep my blood sugar under control. My numbers are better, but I know that if I eat something wrong my sugar is going to go up. I can pretty much eat what I like as long as I leave the desserts alone and not have as many carbs. And I always check my sugar right before I eat.gt;gt;If I lose some weight, I may be able to get off of the insulin at some point. You just have to keep working at it. Don’t eat so much and get plenty of exercise. Those are the best things you can do for yourself. ]]>

gt;gt;Experts use words like "epidemic" and "worldwide crisis" when they talk about it: Millions of people have it and a staggering number are expected to get it (300 million worldwide by 2025, according to gt;one studygt;). gt;gt;Diabetes doesn't get the attention of, say, cancer or scary viruses. One reason might be because type 2 diabetes is so incredibly common—about 20% of people over age 60 get it. A large chunk of the population just seems to have the genetic programming to develop the disease with age. gt;gt;gt;Type 2 diabetes is showing up in young peoplegt; gt;However, diabetes is also on the rise because our modern lifestyle—lots of food and little exercise—speeds up the process. gt;gt;So people who might have developed this "old-age disease" in their 60s and 70s are now developing the disease much earlier due to obesity and lack of exercise; sometimes in their teens or in childhood. gt;gt;Anyone can get diabetes. But some people are at much gt;higher riskgt;, particularly those who are obese. (Are you overweight? Use this gt;body mass index calculatorgt; to find out.)gt;gt;One in three children born in the U.S. in 2000 will develop diabetes at some point in their life (including more than half of Hispanic females), according to a Centers for Disease Control and Prevention gt;study published in 2003gt;.gt;gt;But not all is gloom and doom. If you have diabetes, you have a lot more control over the disease now than just about any other point in history. And if you have prediabetes, you have a good chance of gt;preventing or delayinggt; the disease by making lifestyle changes or taking medication. gt;gt;gt;What happens in the body when you have type 2 diabetesgt; gt;With type 2 diabetes, the muscles and liver that normally take up blood sugar and use it for energy begin to lose their sensitivity to the hormone insulin, a condition known as gt;insulin resistancegt;. gt;gt;The pancreas, which contains the insulin-making beta cells, responds to the body's insulin resistance by churning out even more of the hormone. Even though insulin levels may increase to a degree, even the increased amount is not sufficient to prevent blood sugar from becoming too high. (In contrast, type 1 diabetes is a less-common autoimmune disease that destroys the insulin-producing cells, although some people don't fit neatly into either category.)gt;gt;The excess blood sugar in diabetes can wreak havoc on blood vessels all over the body and cause complications. It can severely damage the eyes, kidneys, nerves, and other body parts; cause sexual problems; and double the risk of heart attack and stroke. gt;gt;Eventually, insulin-producing cells can shut down and stop producing the hormone completely. Some people with type 2 diabetes gt;need insulingt;, but most don't. (It's type 1 diabetes that requires insulin shots to survive; about one-third of people with type 2 use insulin.) You may need to inject insulin to help replace or supplement your own natural production of the hormone and to help your body overcome insulin resistance. gt;gt;gt;Good news about managing type 2 diabetesgt; gt;The good news is that if you eat gt;healthier carbohydratesgt; and gt;more fibergt;, blood sugar drops. And exercise can increase the insulin sensitivity of muscles, which will then absorb more blood sugar. If diet and exercise alone won't do it, there are drugs that boost the muscle's sensitivity to insulin and curb blood sugar. gt;gt;In the past 10 years a slew of new drugs have come on the market that control blood sugar in new and innovative ways. Blood-sugar testing has made huge strides too—some gt;monitorsgt; now require only tiny amounts of blood and give results in seconds.gt;gt;So much of this illness is under the patient's control. But having that much control over a disease isn't a cakewalk. You may need to battle psychological demons to remain motivated over the long haul and learn how to live with diabetes and still feel alive.gt;gt;"The good news is that with diabetes, 90% is up to the patient," says Yvonne Thigpen, the diabetes program coordinator at Mount Clemens Regional Medical Center in Michigan. "The bad news is that 90% of diabetes management is up to them." gt;gt;]]> Diabetes is the leading cause of kidney failure in the U.S. (ISTOKEPHOTO)