Examining The Link Between Diabetes, Autoimmunity and Heart Disease for American Heart Month

February is National Heart Month. This article was written by Dr. Chad Larson, NMD, DC, CCN, CSCS. His aim is to help anyone who either has diabetes (or another autoimmune issue), or heart health issues understand the important connections between diabetes, autoimmunity and heart disease as a thorough understanding is vitally important for anyone with heart health issues. If you have Diabetes or heart disease, this post is for you! 

As medical science advances, we are learning more about the links between different individual diseases. In recognition of American Heart Month in February, I’d like to draw attention to some largely unknown facts about heart disease and its indirect link to autoimmune disease. In spite of pharmaceutical and technological medical advances, heart disease has continued to rank as the leading cause of death in the United States for several decades. Although we associate high cholesterol, obesity, high blood pressure and smoking as some of the most common factors leading to cardiovascular complications, there are actually hundreds of varying risk factors that can lead to heart disease, including an entirely different disease: diabetes.

Let’s first look at a brief but noteworthy chronological history of diabetes and its classification as an immune-mediated disease:

  • The term diabete was first recorded in an English medical text written around 1425.
  • It wasn’t until over 300 years later, in 1776, that it was confirmed diabetes was an issue of an excess amount of a certain kind of sugar (in the urine).
  • Just over 100 years later, in 1889, the role of the pancreas in diabetes was discovered.
  • Shortly after, in 1910, it was found that diabetes resulted from a lack of insulin.
  • In 1922, the first person received an insulin injection for the treatment of diabetes.
  • Types 1 and 2 diabetes were differentiated in 1936.
  • Autoimmunity was discovered in the 1950s.
  • Not until the mid 1970s was it recognized that diabetes can have an autoimmune basis.

Medical research has linked several diseases as being immune-mediated years after the original discovery of such diseases. Although this discovery was made almost 40 years ago, many people are still unaware that all types of diabetes can have an autoimmune component.

Now let’s look at how diabetes is linked to heart disease. Caused by a hardening of the arteries or a blocking of the blood vessels that go to your heart, people with diabetes are more than twice as likely to suffer a heart attack than those without (American Diabetes Association). In fact, two out of three people with diabetes die from heart disease or stroke, also classified as cardiovascular disease. Perhaps even more alarming is the threat that diabetes can cause nerve damage, sometimes making heart attacks painless or silent.

Autoimmune diabetes is caused when the body’s immune system begins attacking the beta cells that produce insulin in the pancreas. When insulin levels are down, the amount of glucose in the blood increases over time. High blood glucose levels can damage nerves and lead to increased deposits of fatty materials on the insides of the blood vessels. Complications such as poor blood flow, decreased oxygen in the blood stream, and the clogging and hardening of blood vessels can ultimately lead to two types of cardiovascular disease: coronary artery disease, responsible for heart attacks or failure, and cerebral vascular disease, leading to strokes.

And there you have it – a three-way link between Diabetes, Autoimmune Disease and Heart Disease. So, are there preventative measures that diabetics can take to prevent heart attacks and control autoimmune reactivity? Prevention of heart attacks for diabetics is parallel to that of non-diabetics, but with one very important additional measure – monitoring and regulating your blood sugar and insulin levels. Cyrex Laboratories, a clinical lab that specializes in functional immunology and autoimmunity, offers the “Array 6” – Diabetes Autoimmune Reactivity Screen. Array 6 assists in the early detection of autoimmune processes of Type 1 Diabetes, impaired blood sugar metabolism and Metabolic Syndrome, and also monitors the effectiveness of related treatment protocols.

A is always the case, it is recommended to schedule regular visits with your medical practitioner and specialists. Proper administration of medications can be vital to prevention of heart disease. In addition to insulin injections for diabetics, there are medications to aid in regulating blood glucose, blood pressure and cholesterol, which could all be vital to prevention of heart disease.

Dr. Chad Larson, NMD, DC, CCN, CSCS, Advisor and Consultant on Clinical Consulting Team for Cyrex Laboratories. Dr. Larson holds a Doctor of Naturopathic Medicine degree from Southwest College of Naturopathic Medicine and a Doctor of Chiropractic degree from Southern California University of Health Sciences. He is a Certified Clinical Nutritionist and a Certified Strength and Conditioning Specialist. He particularly pursues advanced developments in the fields of endocrinology, orthopedics, sports medicine, and environmentally-induced chronic disease.

Tomorrow We Get Our BiPap Machines

Back in November, I wrote about Fabgrandpa and I going for sleep studies.  That started a round of about a hundred doctor visits for us that included me going to a cardiologist. The cardiologist did a gazillion tests, and found nothing wrong with my heart. That is a relief, but it didn’t tell me why my feet and legs swelled up and were so painful. She referred me for a sleep study to check for sleep apnea

sleep study

All wired up for a sleep study for sleep apnea

After I went for the sleep study, I had an appointment with a lung doctor, Dr. Reid. He said my sleep study showed that I stopped breathing 29 times in an hour. That is enough to be labeled as “Severe Sleep Apnea”. The next step was to go back to the sleep center for another sleep study. This time, they put one less wire on me. This test was to determine the settings for my BIPAP machine. I still didn’t feel like I slept at all, but they were able to get the settings and send them to my doctor. Dr. Reid then sent a prescription order to a home health supply place in Carrollton. We finally got the call from them last week that our machines were ready to pick up. We go in the morning to get them. 

BIPAP

BIPAP Machine

In between times of the sleep studies, I also went to my endocrinologist, D. Vavrik. I showed him pictures of my legs and feet, and he said “I don’t do feet and legs, if it happens again, go to your primary care doctor.” Well, then. My A1C was too high, at 8.9. This is not a good trend for me. We talked about my blood sugar numbers when fasting, and how much insulin I was taking. He raised my insulin dosage to 35 units at meals for the short acting Novalin R, and 3o twice a day for the long acting Novalin N. So far, those increased dosages have been keeping my fasting blood sugar under 125, which I can live with for the moment. 

Fabgrandpa has also done the sleep studies, on the same nights as I went. His test results showed that he stopped breathing 66 times in an hour, which is more than once a minute. It made me wonder when he DID breathe. So Dr. Reid has also ordered him a BIPAP machine. I am really hoping that these machine make a difference in our sleeping, and therefore, in the way we feel during the day. Because, I am sleeping all day most days in my chair. I have no energy, no get up and go. If I do something like to to the grocery store, I wind up not being able to do anything for two or three days after. I still have to go and do it, though. 

On Tuesday, I am going to a pain management clinic. I went to my primary care doctor over a year ago, and asked to be referred to a pain management doctor, but none of the ones in our area would accept me as a patient because my pain does not originate in my back. They know how to treat back pain. They don’t, however, know how to treat chronic pain caused by a 12 inch surgical scar and lack of core muscle. My primary care doctor finally found a pain group that would accept me and I am hoping that they can at least prescribe a new pain reliever that will help me feel better. We’ll see. 

So, that is where we stand as far as health issues go. I have no heart disease, no congestive heart failure, no vascular disease. I DO have sleep apnea, chronic pain, and high blood sugar with type 2 diabetes. I hope that the coming year doesn’t bring any more issues for me. I also hope that whatever happens in Washington, D.C. doesn’t effect my health insurance. I have Medicare and a MAPD plan through Humana. It isn’t the best ever, but it is insurance. Have you been for your yearly checkups yet? What do you think is going to happen with the state of healthcare in the United States? Let’s get the discussion going. 

What Factors Affect How My Body Absorbs Insulin?

For individuals with type 1 diabetes and some individuals with type 2 diabetes, getting the correct amount of insulin your body needs is one of the most important ways to manage blood glucose levels. Monitoring blood glucose levels and administering insulin is a necessary routine.

insulin pen

New technologies, such as smartphone-like touchscreen insulin pumps, are simple to use and can make administering insulin more convenient. There are factors that affect the absorption and performance of your insulin that are important to understand as well.

Insulin Injection Site

The injection site can affect how quickly the body absorbs insulin. Continuously using the same injection site may cause the body to form scar tissue, which can cause slower absorption. Regardless of the method of injection, it is recommended that the injection site is regularly changed as to avoid the development of scar tissue.

Exercise

Exercise increases blood flow, which in turn increases the absorption rate of insulin. If the body absorbs insulin too quickly, it may lead to hypoglycemia. Individuals with diabetes should avoid doing exercise during the peak time of action for their insulin injection, since blood glucose levels may be lowered for up to twenty four hours after physical activity.

Individuals who plan to exercise after injecting insulin should also be sure to inject insulin in a part of the body that will not be affected by the exercise. For example, if you plan to go running after injecting insulin, do not administer insulin into the leg.

Skin Temperature

Heat causes blood vessels to dilate, or expand in size, and will increase blood flow. If the skin of the injection site is warm, insulin will be absorbed more quickly than if the injection site is cold. It is recommended that individuals with diabetes avoid extreme temperatures after administering insulin.

Extremely hot environments after insulin injection, such as may occur from taking a hot shower, may cause a reaction such as hypoglycemia. Alternatively, extremely cold environments, such as spending time outside in the winter without proper clothing, may lead to less absorption of insulin, and potentially high blood sugar levels, which can be very dangerous.

The State of the Insulin

The stability and state of the insulin can have an effect on how the body absorbs it. Insulin that has been open for too long or that has been exposed to extreme temperatures may perform very poorly.

For this reason, it is imperative to follow all storage instructions for insulin according to the package insert. Always inspect vials that are in use to ensure that they have not changed in color, translucency, or consistency.

 Communicate With Your Healthcare Provider

Always speak with your physician and your diabetes management team before making changes to your insulin administration routine. Healthcare professionals can help you better understand the factors that affect insulin absorption, and the methods that are best for you and your specific diagnosis.

 

 

 

Diabetes Supply Case: A New Sewing Project

I have been wanting to make a pretty bag for a diabetes supply case for quite some time. The problem has been that I could not find a pattern for what I wanted. So, after exhausting all the searches on Google, I decided to just try to make one. This version needs some work. It is NOT perfect, but it still looks better than the plain old drab black case that is standard issue for glucose meters.It is pretty close to my vision for what I wanted to make, but I am not satisfied with it. However, it is a good starting place. It just looks all wonky. 

diabetes supply case

My first draft for a diabetes suppy case

I wanted a bag that I could take with me when we go out to eat, or when we travel. I thought for a long time about what needed to be in it. 

  • a place to hold ice, to keep my insulin cool
  • a place to put the insulin
  • a place to hold the glucose meter, lancette device, a pen, test strips
  • a pocket for insulin syringes
  • a pocket for used supplies (so I can dispose of them when I get home)
diabetes supply case

The zipper part turned out pretty good, but need a longer oner.

Then I thought about what else I wanted to be in it:

  • Slots for debit card, insurance card, driver’s license 
  • A zippered pocket on the outside
  • A place to hold credit cards
  • A place for a food/blood sugar diary
  • A travel size Beano (I take them at every meal to reduce the amount of gas discharged into my colostomy bag.)
diabetes supply case

The inside of the bag.

When the case is opened up, the first thing you see on the left is the pocket with credit card slots. I have six slots. These are holding a debit card, some alcohol swabs, and some business cards. On the right is a see through (clear vinyl) pocket to hold used syringes until I can get home and put them in a Bio-Hazard container. 

diabetes supply case

Insulated, vinyl lined removable pouch for ice pack for insulin.

When you turn over the clear pocket, the removable insulated vinyl lined pouch for an ice pack is located under it. There are hook and loop strips on the case and pouch to help keep it in place. I can put my insulin vials inside the pouch and zip it shut, where they will stay cold all day. Then, if we are traveling, I can remove the pouch, put the insulin in the hotel refrigerator, and the pouch of ice in the freezer section. It will refreeze overnight and I will be ready for the next day of travel or sightseeing fun. 

The removable ice pack is easy to take out and put back in.

The removable ice pack is easy to take out and put back in.

Just another view of the removable ice pack. It stays in really well with the hook and loop strips. 

Credit card slots

Credit card slots

The pocket for credit card slots needs to be improved a bit. This one is divided into six slots. I can put my driver’s license and a debit card in there, and not have to take my purse with me everywhere. I think that is a big plus. 

diabetes supply case

The glucose meter and test strips.

Turn over the credit card slots, and there are the glucose meter, test strips, an empty test strip container to store used strips until I can get home and dispose of them in a bio-hazard container, my lancet device, and ink pen, and my Beano. These look a little wonky too, but remember, I did not have a pattern, and I was making this up as I went along. 

diabetes supply case

Pocket for new insulin syringes

On the underside of the credit card slot pocket, is another pocket for my new insulin syringes. This pocket is big enough to hold a bag of ten syringes. I can keep other syringes in my suitcase until they are needed. 

case 09

This is not really bad for a prototype.

This case is not finished. It needs to have some bias tape to cover the raw edges (I did not have any gray or pink on hand), and a couple of other little tweaks, but all in all, it is not bad for a first version. I am going to add a cross body strap to it too. When we get home from our vacation, I am going to make another one, and do a tutorial post on how to make it. I am also going to try to make a pattern for it. It will have some optional features, because not everyone needs the same supplies. 

So, what do you think of my Diabetes Supply Case? What would you want in yours that is not in this one? What would you leave out? 

Diabetes: My Three Month Follow Up With The Endocrinologist

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meds

Yes, it’s that time again, where I got to go and get stuck in poor veins that roll, and give up my blood for the lab tests that dictate my life. I was afraid the doctor was going to yell at me, which he has a reputation for doing if you aren’t following his instructions. Before you say I shouldn’t have to put up with that sort of behaviour, let me just say that he has never yelled at ME. And if he did, I would probably deserve it. 

I was afraid of the doctor’s wrath because I know I have been eating not quite right for a while for someone with diabetes. I don’t eat enough vegetables, and I eat too many sweets for someone who is diabetic. I just can’t give them up, though. I love sweets, and I get grumpy if I can’t have them. I just need to learn to be moderate with them. Because, you know, when I eat too many carbs, I pay for it with pain in my feet. That thing right there makes me try to do better. I don’t always achieve the level of moderation I am striving for, but I do try. 

cream horns

My nemesis

We quit buying ice cream, and most cookies. No donuts, and no chocolate cake. My nemesis lately has been cream horns. Who can walk away from those things? 

So, my lab results: 

A1C:  7.3  up. Not up by much, but still UP.Three months ago it was 6.1. I have to work on that. 

Cholesterol: 63  down. In January it was over 160, so it is down a lot. I started taking Atorvastatin 10 mg. I will continue to take it. My doctor was very pleased with this. So was I. 

Weight: UP by 3 pounds. Not telling you how much total. Ladies don’t. HA! Gotta get that down for sure. 

Exercise: None to speak of. I need to get back to doing something, even if it is only walking for five minutes. 

We discussed the pain in my feet, and decided that it is not bad enough to add another medication yet. We’ll just monitor it, and hope that I can get my sugar levels consistently low enough that I don’t have the pain. 

And last, the doctor increased my insulin dosage. Now, instead of 10 units before each meal, I am to take 10 units before breakfast; 14 units before lunch; and 18 units before dinner. We will see how my lab results reflect that increased dosage three months from now. 

Do you have diabetes? If so, how are your numbers? Do you have any complications, like neuropathy? Do you take insulin? What are you doing to get your numbers down?

I added this post to the Blogger Babes March Lifestyle Link Party

My Diabetes Update With Information About Less Expensive Insulin Options

meds

The last time I updated about my diabetes was in August. A lot has happened since then, so I decided to update y’all. I started taking Novolog using a prefilled pen type of injector after my August visit with the endocrinologist. It was easy enough to get used to, and it worked well in keeping my blood sugar under control. Then, in November, I entered into the “Medicare Gap”. For those of you who do not know what that is, I’ll try to explain. 

This is from Senior65.com

In 2015, if your Medicare Part D drug plan has a coverage gap once you and your insurance provider have paid $2,960 toward your covered drugs and you exit it at $4,700. Here is what you’ll owe for generics and your plan’s covered brand name drugs during the donut-hole:

Generic costs: 65%
Brand name costs: 45%

My insulin was going to cost me over $300 for each prescription for the month of December. I was panicking because I really didn’t know where almost $700 was going to come from to pay for my medications. I went to the Haralson County Department of Family and Children’s Services, which is the agency I needed to apply for the “Extra Help” that is available to some people who are having problems paying for their medications through Medicare. I did not qualify for that extra help. The next step was to apply for “financial assistance” from the manufacturers of the two forms of insulin I take. I did not qualify for that either, because I have insurance. Catch 22, eh?

Next, I asked my primary care doctor if she had any samples she could offer me so that I could make it to January, when I would be out of the gap purely because it was new year. She told me that she was no longer able to dispense medication samples due (I think, see note) to a provision of the Affordable Healthcare Act (Obamacare). This provision mandates that in order for rural healthcare providers to dispense samples of medications to their patients, they must keep a record of what medications they gave out, and they must call each patient who is using sample medications every day for five consecutive days to ask the patient if they are having any problems with those medications. In order to do the required patient contact and associated reporting, my doctor would have had to hire someone specifically to take care of making the calls, entering the data into the computer, and fill out out reports to comply with the mandate. Because hiring another person for her practice would be financially draining she opted to not give out medication samples.  (note: I googled my brains out trying to find information to back this up but was unable to find anything. Next time I talk to my doctor, I will ask where to find information about this.)

My endocrinologist is in another county and city that is not considered to be rural, so I went to his office next and requested samples that would be enough to get through December. Because so many of his patients are on medicare, and are all in “the donut hole”, they were completely out of samples. I understand that. I am not the only person who was floating in this boat. So, at this point, I had exhausted all of my options for getting any financial help or free samples of my medication. I ended up doing without one of my insulin prescriptions for three weeks simply because I could not afford it. 

I had a regular appointment with my endocrinologist the first week of January. Amazingly, my hbA1C was 6.1. The doctor remarked that I was the first patient he had seen that day with a normal A1C. I then had a discussion with him about the unaffordability of the medications he had prescribed for me, and I asked if there was a cheaper option I could take. That is when he told me that Wal-Mart has their own brand of insulin, both the long acting and the fast acting types, and that I could get them without a prescription at the Wal-Mart pharmacy for about $25 each. He told me which one of their brands was equivalent to the meds I take, and how to take each one. That was a real relief to me, because I would be going into the medicare gap this year in April, making my insulin just plain unaffordable for more than 7 months. 

The price of the two vials I need every  month of insulin, one of each type, plus the syringes I need to be able to give myself the injections, is $62.64. If I were to go through my insurance company and get to get the pre-filled pens that my doctor prescribed for me to begin with, the cost would be $90–two $45 co-pays. And, it would throw me into the “gap” starting in April, making all of my medications more expensive until November, when I would have paid enough out of pocket to come out of the gap. What I don’t understand is why I had to go through all of the steps I went through, and do without my medication for almost a month, before I got the information I needed. Why would my doctor not tell me about a less expensive brand of medication that works just as well? I already know the answer, but I still had to ask it here, just to provoke people to think about what they are doing. 

Now, my advice to any of you who have gotten this far reading about my medical hassles, is to 1) Tell your doctor you can’t afford the medication he has prescribed, and 2) ask your doctor if there is a more inexpensive medication that will work just as well for you. You are your own best advocate–open your mouth and speak up for yourself.