The key to making the most of any doctor’s appointment is to be prepared. You need to ask yourself this series of questions and to write out a list of questions for your doctor.

If you are diabetic, this is especially true. There are many chronic diseases (associated with diabetes) that can be prevented or treated with the proper information.

The Questions

- Why are you visiting the doctor Answer this question - this is your presenting problem.

- When did the presenting problem start

- Do you know of anything that started this problem

- Have you had this problem before (If you have had this problem before, what did you do then )

- Is there any pain associated with this problem Have you taken anything or done anything to decrease the problem Is there any activity that increases the pain

Preparation

Be prepared. It is best if you write the answer to these questions down and take them with you (that way you will not forget important issues).

The Appointment

Arrive for the appointment at least 15 minutes early. Wear comfortable clothing.

Take with you:

1. All your prescription medications

2. All herbs, vitamins, and over the counter medications

3. If this is your first visit to this doctor - take any medical records that you have.

4. If you are female - know when you last had a period (could you be pregnant ). Know when you last had a pap smear and mammogram.

5. Take a book or magazine (this gives you something to do while waiting).

6. A list of any allergies (food, bee stings, and medications) and the type of allergy (rash, breathing difficulties, swelling)

7. A notebook to write down instructions and to take your questions for the doctor

8. Your insurance cards. If you have no insurance - be sure to share this with your doctor. They may know resources to help you if you should need follow-up tests, a specialist, or other medical care.

Conclusion

Visiting a doctor is not the most pleasant event in your life. It does not have to be stressful, if you are prepared.

If this is your first pregnancy then you are almost certainly having a wide range of emotions. Your emotions will change as the pregnancy goes on. When you first find you are pregnant you usually feel a huge outpouring of emotions, then as changes start within your body it can be a matter of many emotions in one day.

How will you know if the changes you are experiencing are just part of the pregnancy rather than gestational diabetes or something else that could be even more serious? Well if this is your first pregnancy then it can be difficult to know exactly what you should and should not be experiencing.

Morning Sickness

Most women get this to some degree during their pregnancy, it is often linked to a specific food. If you are having extensive sickness that goes on for long periods of time and it doesn’t stop no matter what you do then you should see your Dr. The constant loss of fluids can be harmful to both you and your unborn baby.

Never Ending Thirst

Being thirsty is known to be one of the signs of diabetes, this also applies to diabetes during pregnancy. This can be a difficult problem to balance. You are carrying a person inside you, that alone will mean that you have to increase your intake of fluids. However if you find that no matter what you do it is impossible to quench your thirst then you should make an appointment with your Dr.

If you think you have diabetes do not panic

Life is to live but only once. Diabetic is one among the deadliest which cannot be completely cured but can be controlled. Diabetic ketoacidosis (DKA) results due to the deficiency levels in insulin. Insulin is secreted to maintain the blood sugar levels. Diabetes mellitus is caused due to the inability of the body organs to maintain or react to the insulin levels in the body that are highly required for the proper functioning of the body.

It is an expensive affair even. So a proper diabetic weekly menu is the basic need of this disease. Treating oneself with proper diet in course of this disease can help the patient from many hurdles. These diets are available to you in weekly menu too. The weekly menu preferred for diabetic goes as follows:

It is good to have small meals in the due course of time rather than having 3 larger meals per day. Dairy products can be high in carbs as well, so try to limit you to one 8 oz serving at a time. Low-fat milk or unsweetened yogurt is good selection. Try to get at least 2-3 servings per day as a part of diabetic weekly menu.

Most contain carbohydrates as well as natural sugars, so watch your intake carefully. Combining them with protein at snack time or before exercise is a good idea. A small apple, banana or peach is a serving, or ? cup canned fruit (make sure canned fruits are packed in unsweetened fruit juice - not syrup). 2-4 servings a day are required.

Exercise is a basic need for this sickness. Regular workout for few hours is very much worth.

? Oil contains should be avoided to a large extend. Trim off visible fat before and after cooking.

? Vitamin D and calcium supplements can be used instead of sugar.

? Drink fluid that does not contain sugar.

? Consume much of leafy vegetables which are rich in vitamins and minerals that is one of the best of diabetic weekly menu items.

Prior to the development of insulin and other laboratory-manufactured medications, ancient healers prescribed natural remedies for the treatment of diabetes and lowering blood sugar. Please understand that while these examples should in no way replace conventional medical treatment, the following methods have been clinically shown to be effective in lowering? levels in adults suffering from Type II diabetes.

Cactus. Native Mexican Indians have used cactus leaves to lower blood-sugars for years. Recent studies have confirmed its effectiveness in reducing blood glucose due to the sticky pectin found in its mucilage. For this to be effective you only need to blend prepared and chopped cactus with some water to thin. Two tablespoons of cactus juice in the morning and two tablespoons at night have proven to be effective in lowering blood sugar.

Bitter melon and other green foods. Bitter melon is highly effective in lowering blood sugar. For centuries, cultures around the world have used bitter melon to lower levels naturally. Please beware however if you are pregnant or preparing this for a child as consuming the melon flesh, cooked or raw can cause hypoglycemia.

Vinegar. On-going trials are testing the efficacy of vinegar in lowering blood sugar levels and so far have promising results. Doctors theorize that properties in vinegar mimic the actions of diabetes medication such a Metformin. Participants in clinical trials took a tablespoon of apple cider vinegar before each meal.

Cinnamon. As little as 1 gram of cinnamon a day can have positive effects for diabetics. The beneficial component in cinnamon is not affected by heat which makes it a good additive to decaffeinated coffee or tea.

Coffee. Studies show that coffee drinkers have a 30 percent lower risk for developing diabetes. However you must only drink decaffeinated coffee as caffeine is known to cause spikes in blood sugar.

Tea. Both black and green teas boosts insulin activity while the polyphenols contained in the tea reduce the amount of the enzyme, amylase, that is necessary to convert starch into glucose. Decaffeinated teas are the way to go.

Water. Water was the first natural remedy prescribed by the human body itself. Diabetics experience excess thirst as a way for the body to flush out the excess glucose from the blood. Drink lots and lots of water.

While these are important in lowering blood sugar it is important to avoid things that cause high blood sugar as well. Avoid sugary drinks, refined wheat products, refined sugars, alcohol and aspirin.

In today’s fast paced world too few people are taking the time out to exercise and are relying heavily on convenient high-calorie/high-fat diets. Because of this there has been in meteoric rise in type 2 diabetes, striking people at younger and younger ages.

Many in the medical fields believe that type 2 diabetes is a more of a lifestyle disease rather than a medical one.?In the world we live in everything is super-sized and trying to find normal, healthy portions are next to impossible. Because of the lethargy involved after eating so much too few people are actually getting off the couch and taking part in even the most minor of exercise regimes. As you can imagine, over time the lack of exercise and poor dietary habits take its toll on our bodies.

The American Diabetes Association has said that about 16 million people in the United States have diabetes . People with? type 2 diabetes outnumber those with juvenile diabetes. Today, nearly 95 percent of all diabetics have type 2 diabetes.

Type 2 diabetes generally develops over time due to physical inactivity, heredity and poor diet. Because of these environmental and hereditary factors the body’s cells don’t recognize and properly use the insulin that the body produces. The term for this is insulin resistance.

When the cells cannot convert sugar or glucose into energy you risk damaging your heart, your nerve endings, your kidneys and your eyes. Complications of diabetes include an increased risk of stroke, high blood pressure, blindness, kidney disease and amputations of the limbs.

Risk factors for developing type 2 diabetes include the following:

• family history
• obesity
• lack of exercise
• glucose intolerance
• being over age 40
• being an African American, Native American, Latin American, Asian American or Pacific Islander

Fortunately despite the risk factors mentioned above, type 2 diabetes can be prevented in many cases. According to a recent National Institutes of Health study, the best defense against this disease is to have a healthy diet and engage in exercise for 30 minutes a day, five days a week. In fact, the study shows that it is possible to lower your risk for diabetes by 60 percent simply by incorporating some moderate daily exercise and cutting down on fat intake.

As I already mentioned, if you have these risk factors a diabetes diagnosis isn’t guaranteed. And, if you already have been diagnosed, the disease does not have to ruin your life. Diabetes is not a death sentence, with diet and exercise you can control this disease.

If you are suffering from diabetes you are aware of what the long-term complications of chronic high blood glucose levels are. You risk damage to your eyes, kidneys, nerves, blood vessels, and a variety of other organs. Persistent elevated blood sugar levels contribute to the damage but it can be avoided. If you have type II diabetics or are pre-diabetic you can avoid the damage by adding herbal supplements to your diet.

Prior to heading to your pharmacist it is recommended that you do some research regarding the product you choose as the strength and dosage of herbal products vary. It is always a good idea to purchase a quality name brand product as batches can often vary if you purchase a lesser known product. You will definitely want to have assurance that you are purchasing a product that will deliver consistent results.

If you have Type I diabetes and require insulin adding herbs with blood sugar lowering effects?is not recommended due to the serious potential for life -threatening hypoglycemia (extremely low blood sugar) or other medical complications.

While there are hundreds of herbal supplements that can assist in lowering your blood glucose levels I am only concentrating on those that can be easily purchased.

Aloe Vera (Aloe): Four species of this plant are recognized as having nutritional value with Aloe barbadensis leading the group. Early research shows that aloe gel might lower blood glucose levels. Recommended doseage is usually (15-30 ml (50 mg) per day.

American Ginseng: Recent studies have shown that Ginseng may be helpful in reducing blood glucose levels in Type II diabetic patients.

Bilberry (Huckleberry): Bilberry has been used in traditional European medicine for nearly a thousand years, primarily to treat diarrhea. Bilberry has antioxidant properties that help promote circulation in the eyes. Studies done on diabetic dogs indicate benefits in reducing blood sugar levels.

Bitter Melon: At least three different compounds in Bitter Melon have been reported to have sugar-regulating properties. Gurmarin, a polypeptide, is considered to be similar to bovine insulin.

Cinnamon Bark: Cinnamon is getting a lot of attention as a treatment for diabetes. Early studies show that it can lower blood glucose and cholesterol levels in people with type 2 diabetes. As little as ? to ? teaspoonfuls can have a powerful effect in lowering blood sugar.

Fenugreek: Fenugreek is effective for lowering blood sugar after meals. The recommended dose is 10-15 grams per day in divided doses with meals.

Ginger: Early research shows that ginger might increase insulin levels. It could also, theoretically, have an additive effect with medication used to treat diabetes and cause hypoglycemia.

Stevia: Stevia is a non-caloric herb, native to Paraguay, which has been used as a sweetener and flavor enhancer for centuries. Research suggests that stevioside, a constituent of Stevia, might reduce postprandial glucose levels by 18% in people with Type II diabetes.

Tumeric: Tumeric may decrease blood sugar levels (and cholesterol).

Curcumin supplementation could help prevent non-alcoholic steatohepatitis (NASH)-related hepatic fibrosis through suppression of low-density lipoprotein (LDL) oxidation, say researchers.

“NASH is characterized by fat accumulation and inflammation in the liver,” explain Anping Chen and Qiaohua Kang (Saint Louis University, Missouri, USA). It also quite commonly accompanies Type 2 diabetes.

Overall, about one-third of individuals with NASH develop the more serious symptoms of hepatic fibrosis and even cirrhosis.

Curcumin, the yellow pigment from the spice turmeric, has been shown to have anti-inflammatory, anti-oxidative, anti-viral, anti-hypercholesterolemic, anti-infective, and anticarcinogenic effects. It has also been suggested as a promising dietary supplement for liver protection.

Curcumin has previously been shown to inhibit the activation of hepatic stellate cells (HSCs), which are involved in progression of hepatic fibrosis.

In this study, Chen and Kang investigated the role of oxidized (ox)-LDL in HSC activation and the effects of curcumin on this process as well as other underlying mechanisms in cultured rat HSCs.

As reported in the journal Laboratory Investigation, they found that curcumin suppresses expression of the rat version of the human gene for lectin-like oxidized LDL receptor-1 (LOX-1), which results in reduced transport of oxLDL into cells.

The suppression of LOX-1 results from interruption of Wnt signaling and peroxisome proliferator-activated receptor-gamma (PPARg) activation.

“These results support our initial hypothesis and demonstrate that ox-LDL stimulates HSC activation, which is eliminated by curcumin by suppressing lox-1 expression by interrupting Wnt signaling and stimulating PPARg activity,” conclude the authors.

They add: “Our observations provide new insights into the molecular mechanisms of curcumin in inhibiting ox-LDL-induced HSC activation and offer a natural anti-fibrotic candidate for the therapeutic treatment and prevention of Type 2 diabetes and NASH-associated hepatic fibrosis.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Women with large abdominal and femoral adipocytes are at increased risk for developing Type 2 diabetes in later life, show results from a 25-year follow-up study.

“The results indicate that large fat cells contribute to the development of Type 2 diabetes,” commented lead author Malin Lonn (University of Gothenburg, Sweden).

“Increased knowledge about large fat cells and their effects may lead to new preventive and therapeutic alternatives,” he added.

Previous research demonstrated that enlarged subcutaneous abdominal adipocytes (AAs) were predictive for Type 2 diabetes in a population of Pima Indians living in Arizona in the USA.

In this study, Lonn and colleagues recruited 1302 women aged 38??”60 years who underwent a health examination in 1974??”1975. A subsample of 245 women from this group underwent assessment for body composition (total potassium and water content) and measurement of AA and femoral adipocytes (FA) size by adipose tissue needle biopsy.

These women were then followed up until 2001 for incidence of Type 2 diabetes. A total of 36 women from the original 245 had developed the condition.

Writing in The FASEB Journal, Lonn and colleagues report that women who developed Type 2 diabetes had significantly larger AA at baseline than women who remained healthy. More specifically, a 1 standard deviation increase in AA size was associated with a 91% increase in relative risk for Type 2 diabetes.

This association remained valid following adjustment for body fat percentage and waist-to-height ratio.

Similar associations were seen for larger FA size, but they were considerably weaker.

Of note, the team also found that waist-to-height ratio was a strong predictor for Type 2 diabetes risk independent of both AA and FA size.

“Taken together, the results show that adipocyte size, particularly in the abdominal region, was a predictor for Type 2 diabetes in middle-aged women,” conclude the authors.

“This adds valuable information to current knowledge in this research field and points to the importance of elucidating the underlying mechanism to increase our understanding of the pathogenesis of Type 2 diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Patients with Type 2 diabetes have an increased risk for relatively poor cognition if they experienced prediabetes hypertension 16 years earlier, research suggests.

When examining the relation between diabetes-associated cognitive function and metabolic and vascular risk factors it is important to consider that levels of certain risk factors may change over time.

Longitudinal studies that compare the risk factor profile over time between patients with good and poor cognitive functioning are therefore important.

These data have recently been provided by Esther van den Berg (University Medical Center Utrecht, The Netherlands) and co-workers in an analysis of 16-year data from the population-based Hoorn study, which examined glucose metabolism and vascular disease in Dutch men and women aged 50 “74 years.

The current analysis includes those individuals who did not have Type 2 diabetes when the study was initiated in 1989, but who had developed the disease by the 2000 “2001 examination.

Of these participants, 64 agreed to attend a further examination in 2005 “2007 and underwent an extensive neuropsychologic examination covering six cognitive domains (abstract reasoning, memory, information processing speed, attention and executive functions, visuoconstruction and language).

Patients were divided into tertiles according to a sum score for performance across cognitive domains, and the domain score for information-processing speed. Individuals in the lowest tertile were considered to have relatively poor cognition, and individuals in the highest tertile relatively good cognition.

The time course of vascular risk factors from 1989 to 2005 “2007 was compared between the tertiles adjusting for age, gender, and estimated IQ.

Reporting in the journal Diabetes/Metabolism Research and Reviews, the authors found that patients with relatively poor cognition had a 14 “18 mmHg higher systolic blood pressure in 1989 than patients with good cognition; levels of vascular risk factors were similar between cognitive function tertiles at the 2005 “2007 examination.

Interestingly, patients with relatively poor cognition did not have higher glycated hemoglobin levels at any point during the study, and had similar lipid profiles and body weight compared with Type 2 diabetes patients with good cognition. However, the authors note that the duration of Type 2 diabetes was relatively short, and the patients’ glucose levels were well-controlled.

“Patients with poor cognition had a higher systolic blood pressure than patients with good cognition over 16 years before. This suggests that diabetes-associated cognitive decline is related to the cumulative effects of long-term exposure to hypertension, even in pre-diabetes stages,” conclude the authors.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

People living with diabetes test their blood glucose anywhere from weekly to three to seven times daily or more. When performed properly, regular and frequent testing is an important diabetes management tool that can help people with diabetes avoid long-term risks and complications. However, even slight environmental variations can skew results and lead to problems including costly retesting and inaccurate adjustments to blood glucose levels.

Marc Wolf, a registered pharmacist with more than 28 years of experience helping patients with diabetes management and founder and CEO of Diabetic Care Services offers supply storage, usage and testing procedure tips to ensure accurate glucose readings for improved diabetes management.

Diabetes Testing Supply Storage

- Avoid storing meters and test strips in areas that experience varied temperatures, including heat, cold, sunlight or moisture. This can cause glucose meters to produce error messages or damage chemical reagents on test strips, which can cause inaccurate readings and disrupted diabetes management.

- Only use test strips within 30 days of the date you first open the vial. Write the expiration date in permanent marker on the outside of the vial to help remember the date.

- Always store strips in their original vial and replace the vial cap immediately after removing the strips to avoid damage to strips, exposure to airborne contaminants and inaccurate readings.

- Never use strips that are stored in cracked or damaged bottles.

Diabetes Testing Supply Usage

- For accurate diabetes management, always use the test strip that is specific to your blood glucose meter to ensure compatibility. Some strips are physically but not chemically compatible with other meters, and will produce inaccurate readings. Follow meter instructions carefully for proper coding. Also, check that your meter batteries are fully charged, as low batteries can skew results.

- Ensure the glucose meter is prepared to receive a blood droplet before drawing the sample.

- Avoid testing for diabetes management near rooms where there may be high levels of humidity-like the bathroom-as this can alter readings.

- Change lancets for every test, to avoid irritation from dull needles.

Blood Glucose Test Site

- While some new meters allow for alternate site testing, the fingertip is the most accurate test site for diabetes management because it registers changes in blood glucose more quickly than the rest of the body. To avoid calluses, soreness and infection, prick the finger on the sides-not the pads-, alternating between different sides and all ten fingers.

- Properly clean testing site with soap and water before drawing a sample. Even the smallest bits of food, sugar and glucose tablet residue can alter a reading. Make sure the site is entirely dry because even water can affect results.

- Try to test at approximately the same time each day, which will make it easier for you to identify patterns or sudden changes in your results.

Blood Glucose Sample

- Dehydration can cause false high glucose readings, so make sure you are properly hydrated before testing.

- Washing hands in warm water before testing can improve circulation and make it easier to obtain a sample. Pointing hands downward below heart level will also increase circulation.

- Gently squeezing and massaging your finger before pricking can increase blood flow, but do not squeeze finger immediately after prick, as this will actually decrease blood flow. Instead wait a moment and then gently milk the finger.

- When applying blood to the prepared test strip, avoid allowing your finger to touch the strip, as it may cause contamination. Make sure to fill the strip entirely; you may receive an error message if you do not.

After Blood Glucose Testing

- Record results to compare levels before and after meals and between days. If you have trouble remembering to record results, use a meter that stores results in its memory to assist with your diabetes management.

- If the test numbers do not coincide with how you are feeling, a personal indicator of where your general numbers should be, then test again. If you are still unsure, use an alternate meter. Do not ignore your intuition just to avoid retesting. It is important to check every detail for successful diabetes management.