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Understand and Prevent Diabetes

(29) Diabetes

Insulin, Glucose and you

Diabetes28

Driving and Alcohol

I drive a lot in my work and my lunch time varies from day to day. Does this matter? I am on two injections of insulin a day.

Yes, this can be a bit of a problem. The twice-daily insulin regimen is designed to provide a boost of insulin at midday to cope with the lunch time intake of food. Once the early morning injection of insulin has been given, there is no way of delaying the midday surge. It is very common for people who are well controlled on two injections a day to feel a little hypo before lunch.

There are two possible solutions to your problem.

• Eat some biscuits or fruit while you are driving – only do this in emergencies as you will not know how much to havefor lunch when you do get the chance to eat properly.

• Change your insulin regimen so that you have a small dose of short-acting insulin before each main meal and only have long-acting insulin in the evening to keep your diabetes under control during the night. You may have to eat snacks between meals but the three- or four-injection method should make the timing of meals more flexible. With an insulin pen an extra injection is really no hardship.

If I have diabetes, do I have to declare this when applying for a driving licence? If so, am I likely to be required to provide evidence as to fitness to drive?

Anyone whose diabetes is treated by diet alone does not need to inform the DVLA (Driving and Vehicle Licensing Agency). If your diabetes is treated by tablets or insulin, you must declare this when applying for a driving licence. If you already hold a driving licence, you must tell the DVLA as soon as you have been diagnosed. When you have notified the DVLA, you will receive a form asking for details about your diabetes and the names of any doctors whom you see regularly. They will also ask you to sign a declaration allowing your doctors to disclose medical details about your condition. There is usually no difficulty over someone with diabetes obtaining a licence to drive.

If you are treated by tablets, you will be able to obtain an unrestricted licence, provided that you undertake to inform the DVLA of any change in your treatment or if you develop any complications of diabetes.

If you are treated by insulin, the licence will be valid for only 3 years instead of up to the age of 70, which is normal in the UK. It is the risk of sudden and severe hypoglycaemia, which makes people liable to this form of discrimination. In general the only people who have difficulty in obtaining a licence are those on insulin with very erratic control and a history of hypos causing unconsciousness. Once their condition has been controlled and severe hypos abolished, they can reapply for a licence withconfidence. Diabetes UK has successfully campaigned for regulations on C1 licences to be changed. Previously, blanket restrictions were imposed on insulin users wishing to drive small vans and lorries between 3.5 and 7.5 tonnes. This now enables anyone on insulin, including those who have previously had their entitlement withdrawn, to be individually assessed on their fitness to drive. Restrictions on other Group 2 vehicles (heavier vehicles and passenger-carrying vehicles, such as mini-buses) remain.

When I was filling out a form for the DVLA, one of the questions asked whether I had had laser treatment in both eyes. Why do the DVLA need this information?

The DVLA may ask you to have a ‘visual fields test’ if you have had laser treatment in both eyes, and your licence will be revoked if you cannot pass this test. If you are having a visual fields test, we would recommend that you have the type in which both eyes are tested at the same time. This test, which examines both eyes together is the DVLA driving standard.

Do I have to inform my insurance company that I have diabetes?

When applying for motor insurance, you must declare that you have diabetes. Failure to disclose this can invalidate your cover if you need to put in a claim. The Disability Discrimination act 1996 has reduced the problems of insurers loading premiums surrounding motor insurance. The Act outlaws the charging of higher premiums for groups of people where no higher risk rate has been proven, as is the case with diabetes. Unfortunately, there are some companies that still discriminate, but Diabetes UK Services have arranged a car insurance scheme to help make life easier.

I have heard that a driver who had a motor accident while hypo was successfully prosecuted for driving under the influence of drugs and heavily fined. As someone who takes insulin I was horrified to hear this verdict.

Several people on insulin have been charged with this offence after a hypo at the wheel when the only ‘drug’ that they have used is insulin. It may seem very unfair but, for any victim of an accident, it is no consolation that the person responsible was hypo rather than being blind drunk. These cases emphasize the importance of taking driving seriously. Remember the rules:

• Always carry food/glucose in your car.

• If you feel at all hypo, stop your car (as soon as possible), take some glucose, and move into the passenger seat.

• Check that your blood glucose is above 5 mmol/litre before driving again.

• On a long journey, check blood glucose levels every few hours.

I have been a bus driver for 15 years and was found to have diabetes 5 years ago. Up until now I have been on tablets but may need to go on to insulin. Does this mean I will lose my job?

As a bus driver you will hold a PCV (Passenger Carrying Vehicle) licence. People on insulin are not allowed to drive a PCV. You are faced with a very difficult choice - either to continue on tablets feeling unwell but holding down your job, or else to start insulin and feel much better, but lose your source of employment. We would have to advise you to go onto insulin as you will come to this eventually anyway. Holders of a LGV (Large Goods Vehicle) licence will also lose their licence and thus their livelihood if insulin treatment is to be started. LGV drivers who have been on insulin since before 1991 and held their HGV licence since then may keep their licences provided that they can prove that their control of their diabetes is good and they are not subject to hypos.

I recently read a newspaper article that implied that people with diabetes who are breathalysed can produce a positive reading even though they have not been drinking alcohol. What does this mean?

Diabetes has no effect on breathalyser tests for alcohol even if acetone is present on the breath. However, the Lion Alcolmeter widely used by the police does also measure ketones, though this does not interfere with the alcohol measurement. Anyone breathalysed by the police may also be told that they have ketones and that they should consult their own doctor. These ketones may be caused either by diabetes that is out of control or by a long period of fasting.

 Alcohol

 My husband likes a pint of beer in the evening. He has now been found to have diabetes and has to stick to a diet. Does this mean he will have to give up drinking beer?

No. He can still drink beer but, if he is trying to lose weight, he will need to reduce his overall calorie intake and, unfortunately, all alcohol contains calories. There are about 180 calories in a pint of beer and this is equivalent to a large bread roll. Special ‘diabetic’ lager contains less carbohydrate but more alcohol so in the end it contains the same number of calories, with the draw-back of being more expensive and more potent. He should probably also avoid the ‘strong’ brews, which are often labeled as being low in carbohydrate, as these are higher in alcohol and calories than the ordinary types of beer and lager. Low-alcohol and alcohol-free beers and lagers often contain a lot of sugar, so,

if he decides to change to these, he should look for the ones also labelled as being low in sugar.So overall your husband is probably better off drinking ordinary beer, but if he is overweight he should restrict the amount he drinks.

My teenage son has had diabetes since the age of 7. He is now beginning to show interest in going out with his friends in the evening. What advice can you give him about alcohol?

Most people with diabetes drink alcohol and it is perfectly safe for them to do so. However, if your son is on insulin he must be aware of certain problems that alcohol can cause – in particular alcohol can make hypos more serious. When someone goes hypo a number of hormones are produced that make the liver release glucose into the bloodstream. If that person has drunk some alcohol, even as little as 2 pints of beer or a double measure of spirits, the liver will not be able to release glucose and hypos will be more sudden and more severe.

In practice alcoholic drinks that also contain carbohydrate tend to increase the glucose in the blood. So the overall effect of a particular alcoholic drink depends on the proportions of alcohol to carbohydrate. For instance, lemonade shandy (high carbohydrate/low alcohol) will have a different effect on blood glucose from vodka and slimline tonic (low carbohydrate/high alcohol). Your son may notice that ‘diabetic’ lager is more likely than ordinary beer to cause a hypo because it contains less carbohydrate but more alcohol.

If your son has been drinking in the evening, then his blood glucose may drop in the early hours of the morning. To counter act this it would be sensible for him to eat a sandwich or cereal and milk to provide extra carbohydrate before going to bed.

I am 18 and go out a lot with my friends. I am careful never to drink and drive but, when it is not my turn to drive, I do drink quite a lot. I am careful not to miss any meals and I am not increasing my insulin as I used to when I first started drinking, but I have had quite a few bad hypos recently. Why should this happen?

This is because alcohol blocks the release of glucose from the liver (see the previous question for more information about this). If your blood glucose is dropping because it is a while since youhave eaten or because you have been out and active longer than usual, then your body cannot come to the rescue as normal. Ideally it would be better if you could try not to have more than three or four units of alcohol in any one session. One unit of alcohol is half a pint of beer or lager or cider OR one glass of wine OR one single pub measure of spirits OR one measure of sherry or aperitif.

If you are going to have more than three or four units in one go, then make sure that you have your usual meal before you go out, have a snack while out and, very importantly, have a sandwich before you go to bed. Following this plan will help prevent you having hypos.

I believe that it is dangerous to drink alcohol if certain tablets are being taken. Does this apply to tablets used in diabetes?

In general the answer is no. Some people on chlorpropamide (Diabenese) experience an odd flushing sensation when they drink alcohol but those people can easily be changed on to an alternative tablet (e.g. gliclazide), which does not cause this problem.

The other consideration is that alcohol may alter the response to a hypo and most tablets used for diabetes can cause hypos. If you are on tablets and are going to drink any alcohol, then you must be extra careful not to go hypo.

I’ve heard that there is evidence that a moderate amount of alcohol is part of a healthy diet, and that it reduces the risk of heart disease and strokes.

My dietitian made me cut down my alcohol intake to one glass of wine a day, which is much less than I used to drink. What should I do?

Recent research shows that alcohol in moderation reduces the risk of heart attacks,  trokes and premature death in people with diabetes (or without); indeed the effects may be even more impressive in people with diabetes. Our view is that moderatealcohol intake (up to a maximum of half a bottle of wine a day, or equivalent) should be encouraged, but within a calorie-regulated diet, if the person is overweight.

 

 

 

 

 

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(30) Diabetes

How to Cure Type 2 Diabetes

Diabetes29

Drugs

My son was told that people with diabetes should not use Betnovate cream because it contains steroids. Is this true and why?

Most skin specialists avoid using powerful steroid creams such as Betnovate unless there is a serious skin condition. Very often a weak steroid preparation or some bland ointment is just as effective in clearing up mild patches of eczema and other rashes. Unfortunately too often the very strong steroids are often used first, instead of as a last resort. These strong steroids can be absorbed into the body through the skin and lead to a number of unwanted side effects. This advice applies to all people with skin problems and not just people with diabetes. One of the side effects of steroids is a rise in the blood glucose level. Thus, someone without diabetes may develop it while taking steroids and a person treated with diet only may need to go onto tablets or insulin. If there are good medical reasons for your son to take steroids, in whatever form, he should be prepared to test his blood for signs of poor control. If he is already taking insulin, the dose may need to be increased.

Can you tell me if any vaccinations including BCG are dangerous for people with diabetes?

There is no reason why a child should not have full immunization against the usual diseases. Sometimes inoculation is followed by a mild ’flu-like illness, which may lead to a slight upset of diabetes control. This is no reason to avoid protecting your child against measles, whooping cough, etc. In some areas school children are given BCG as a protection against tuberculosis. Children should also have the normal immunization procedures if they are travelling to exotic places.

My wife suffers from bad indigestion. She is afraid to take indigestion tablets in case they upset her diabetes. Can you advise what to do?

 Indigestion tablets and medicines do not upset diabetes. Is it safe to take water tablets (diuretics) with diabetes?

Diuretics are given to people who are retaining too much fluid in the body. This fluid retention may happen in heart failure and cause swelling of the ankles or shortness of breath. Diuretics are usually very effective but, as a side effect, they may cause a slight increase in the blood glucose. This is especially true of the milder diuretics such as Navidrex, which belong to the thiazide group. The increase in glucose is only slight but can sometimes mean that someone controlled on diet alone may need to take tablets.

People already on insulin are not affected by diuretics. The thiazide group of tablets is also used in the treatment of raised blood pressure.

Is there any special cough mixture for people with diabetes?

There are various sugar-free cough mixtures that can be bought from your chemist. However, there is only a tiny bit of sugar in a dose of ordinary cough mixture and this amount is not going to have any appreciable effect on the level of blood glucose. I have been on insulin for diabetes for 7 years.

I was recently found to have raised blood pressure and was given tablets, called beta-blockers, by my doctor. Since then I have had a bad hypo in which I collapsed without the normal warning signs of sweating, shaking, etc. Could the blood pressure tablets have caused this severe hypo?

Beta-blockers are widely used for the treatment of high blood pressure and certain heart conditions. They have an ‘anti-adrenaline’ effect, which theoretically could damp down the normal ‘adrenaline’ response to a hypo. However, research has shown that beta-blockers do not reduce the adrenaline warning of a hypo. Some beta-blockers have been designed to have their effect only in the heart without blocking the general adrenaline reaction. These selective beta-blockers are theoretically safer for people taking insulin.

Please could you give me a list of tablets or medicines that may interfere with my diabetes?

There are no medicines that must never be used but the following might increase the blood glucose and upset your control:

• Steroids (e.g. prednisolone, Betnovate ointment) and steroid inhalers (e.g. Becotide) – taken in tablet form may cause a rise in blood glucose level but inhalers or ointment will have this effect only in very large doses

• Thiazide diuretics (e.g. Navidrex, Neo-Naclex)

• The contraceptive pill

• Hormone replacement therapy (e.g. Harmogen, Prempac, Trisequens, Progynova)

• Certain bronchodilators (e.g. Ventolin) - might have a slight effect on raising the blood glucose

• Aspirin – in large doses might lower blood glucose

• Growth hormone treatment.

 

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(3) Diabetes

Smoking and Diabetes

Diabetes31

Smoking

 I am a 16-year-old on insulin. I would like to know whether smoking low tar cigarettes could interfere with my diabetes. Would it cause any restriction in my diet?

Smoking is unhealthy not only because it causes several cancers, particularly lung cancer, but because it leads to hardening of the arteries – affecting chiefly the heart, brain and legs. The proper advice to all people, especially teenagers, is not to smoke. Smoking will not directly affect your diabetes except, perhaps, by reducing your appetite.

When my doctor diagnosed diabetes, he told me to stop smoking. Could you tell me if there is a particular health hazard associated with smoking and diabetes?

The problem is made worse for me by the fact that I have to lose weight and, if I stop smoking, I will do just the opposite.

Smoking is a danger, both to the lungs and because of the risk of increased arterial disease affecting any smoker. Someone who has long-standing diabetes is also at risk of problems with poor blood circulation, and it is foolish to double this risk by continuing to smoke. If the discovery that you have diabetes has come as an unpleasant surprise, this is a good time to turn over a new leaf and alter your lifestyle, by eating less and giving up cigarettes. It may be a lot to ask, but many people manage to carry out this ‘double’. It will not kill you – on the contrary, you may live longer.

There is a lot of support available now for people who want to give up smoking and your doctor or practice nurse should be able to offer you advice on whom to contact. You may even find that they run an antismoking group or clinic. Some people find nicotine gum or patches useful, and we deal with these in a later question in this section.

Since my husband, who has had diabetes for 23 years, has stopped smoking, he has had high blood glucose tests. Why?

Your husband should be congratulated for giving up smoking. Most people who give up smoking put on weight, on average 4 kg (9 lb). This is because cigarettes suppress the appetite and make the body operating less efficiently, thus burning up more fuel (food). If your husband has put on weight, this explains his higher blood glucose levels. He should try to reduce weight to improve his diabetes. If he is already thin and his blood glucose levels are high then he will have to take tablets or insulin to get things under control.

My doctor has strongly advised me to give up smoking and suggested that I try nicotine patches. I was surprised to find that the information leaflet enclosed with the patches advised people with diabetes not to use the patches. Is this true?

It sounds as though the company is being overcautious. The main reason for giving up smoking is to reduce the damage that it does to the blood supply to the heart and legs. Each time someone has a cigarette, the nicotine that they inhale narrows the small blood vessels. This narrowing eventually becomes permanent, which explains why smoking increases the risk of such problems as heart attacks and gangrene. Nicotine patches have been shown to be a most effective way of helping people to stop smoking.

Nicotine has the same effect on the blood vessels whether from patches or from cigarettes. However, patches are no worse than cigarettes and, if they help you to give up smoking, the overall benefit will be enormous, especially with regard to your circulation. Don’t be afraid to try nicotine patches in the recommended dose. The same advice applies to nicotine chewing gum and the newer nicotine inhalerPrescription charges and Social

Security benefits

I believe that people with diabetes are entitled to free prescriptions. Please could you tell me how to apply?

One of the few definite advantages of having diabetes is exemption from payment on all prescription charges – even for treatment unconnected with the diabetes itself. People treated on diet alone are not exempt from prescription charges. You must obtain a form, called NHS prescriptions – how to get them free, from a chemist, hospital pharmacy or a Post Office.

Having filled in the form yourself, it must be signed by your family doctor or clinic doctor and sent to the local Family Practitioner Committee. The chemist should be able to give you the address. You will then receive an exemption certificate. Please remember to carry this certificate wherever you are likely to need a prescription, for example when going to the clinic or travelling in the UK. The certificate lasts for 5 years, and you will need to renew it at the end of that time.

To what Social Security benefits are I entitled now that I have diabetes?

There are no special benefits given automatically to people with diabetes. You may claim Disability Living Allowance if you have a child with diabetes who is under the age of 12, and it may be possible to obtain this allowance for a child up to the age of 16 if you can prove that the child needs extra supervision and care. Diabetes UK Careline can provide you with information to help you complete the necessary forms.

For more information about benefits, we suggest that you contact either Diabetes UK Careline, or the Disability Alliance, or the Benefits Agency. The Benefits Agency is the organization that deals with Social Security benefits on behalf of the Department of Social Security, and youcan make enquiries either at their offices or by phone. You will find their addresses and telephone numbers (they have several freephone enquiry lines) in your local phone book under ‘Benefits Agency’.

Since developing diabetes I have found that my food bills have risen alarmingly. Are there any special allowances that I can claim to offset the very high cost of the food?

Most people with diabetes are not entitled to any special allowance and, indeed, there is no real need for them to eat different food from others. Special diabetic products are not necessary. Now people are encouraged to eat food that is high rather than low in carbohydrate, they do not have to fall back on expensive protein as a source of calories.

My mother has had diabetes for 12 years and is subject to crashing hypos for no reason. She needs someone to be with her all the time. Would we be eligible for an Attendance Allowance as she needs watching 24 hours a day?

If you have to provide a continuous watch over your mother, then you would be able to apply for an Attendance Allowance. Before admitting defeat, however, it would be better to try every means to prevent the hypos. Presumably your mother is having insulin, though you do not mention the dose or type of insulin. It would be worth checking with the local diabetes service if anything could be done to reduce the frequency of hypos. Changing to more frequent but smaller doses of insulin might solve the problem. You may have to spend time and energy getting to grips with your mother’s diabetes. It would do more for her self-confidence to abolish the hypos than to get an attendance allowance.

Miscellaneous

Is there any objection to my donating blood? I am on two injections of soluble insulin a day and my general health is fine.

There is no obvious reason why a fit person with diabetes should not be a blood donor. However, the blood transfusion authorities do not accept blood from people on insulin. They suggest that the antibodies to insulin found in all people having injections may, in some mysterious way, harm the recipient of the blood.

Is it true that someone with diabetes should not use an electric blanket?

It is perfectly safe for you to use an electric blanket, although most underblankets should be used only to warm up the bed in advance. The manufacturers usually recommend that under-blankets should be switched off before you get into bed. However, there are now underblankets that can be left on all night on a very low heat and these would be safe to use, provided that you follow the manufacturer’s instructions. Overblankets can be left on all night, but again you should always check the manufacturer’s instructions.

Hot-water bottles are rather more dangerous as their temperature is not controlled. People with a slight degree of nerve damage can fail to realize that a bottle full of very hot water may be burning the skin of their feet. This is a recognized cause of foot ulcers. It is better to be safe than sorry and avoid the comfort of a hot-water bottle. Bedsocks are a possible alternative for cold feet, or you could try one of the small electric heating pads now on the market. Again you need to be careful how you use these and follow the manufacturer’s instructions – not all of them are suitable for use in bed

My 10-year-old daughter has had diabetes for 3 months. She has started to lose a lot of hair and now has a bald patch. Is this connected with her diabetes?

Yes, it could be. There are three ways in which diabetes and hair loss may be connected.

• If your child was very ill with ketoacidosis at the time of her diagnosis, this could lead to a heavy loss of hair. In this case, her hair will regrow over the next few months.

• Alopecia areata is a skin condition, which is slightly more common in people with diabetes. This is the likely diagnosis if your daughter has a well-defined bald patch with the rest of her hair remaining a normal thickness. If the patch is on the top of her head there is every chance that her hair will regrow over the next 6 months. There is no way of encouraging growth and steroid ointments may even cause permanent skin changes and make matters worse.

• Myxoedema or lack of thyroid hormones may occur with diabetes. If this is the cause of your daughter’s hair loss, you will notice other symptoms such as mental slowing, weight increase and an inability to keep warm. All these symptoms can be corrected by taking thyroid tablets. Shortage of body iron may also cause hair loss although this is not connected with diabetes.

I recently enquired about having electrolysis treatment for excess hair. I was told that, as I had diabetes, I would need a letter from my doctor stating that my diabetes did not encourage hair growth. Could I use wax hair removers instead?

There is no objection to you having electrolysis. Diabetes does not cause excessive hair growth. It sounds as though the firm doing the electrolysis is being overcautious.

Many women find wax hair removers useful for the less sensitive parts of the body. Make sure that the wax is not too hotIs it safe for people with diabetes to use sunbeds and saunas?

As safe as for those without diabetes. Exposure to ultraviolet radiation is known to increase the risk of skin cancer. Make sure that you can recognize a hypo when you are hot and sweaty. Keep some means of treating a hypo with you – not with your clothes in the changing room.

I have diabetes but would dearly love to have my ears pierced but, when I asked my doctor about this, he said there was a chance that my ears would swell. Please could you advise me if there is a great risk of this happening?

Anyone who has their ears pierced runs a small risk of infection until the wound heals completely. The risk in a well controlled person is no higher than normal. If your ears do become red, swollen, and painful, you may need an antibiotic.

Is there any connection between vertigo and diabetes? I have had diabetes for just over 2 years controlled on diet alone.

Vertigo, in the strict medical sense, describes that awful feeling when the whole world seems to be spinning round. It is usually due to disease of the inner ear or of the part of the brain that controls balance. This is not connected with diabetes in any way.

However, simple dizzy spells are a common problem with many possible causes, which may be difficult to diagnose. If dizziness occurs when you move from sitting down to the standing position, it may be the result of a sudden fall in blood pressure. This can sometimes be due to a loss of reflexes from diabetic neuropathy. There are no other connections between diabetes and vertigo.

My husband’s grandmother is 84 and has diabetes. Although she is fiercely independent, she cannot look after herself properly and will have to go into a residential home. Can you let me know of any homes that cater especially for people with diabetes?

Because diabetes becomes increasingly common in the elderly, most nurses in these homes are experienced in looking after diabetes. The staff of the home will probably be happy to do urine tests, ensure that diet is satisfactory and that she gets her tablets and, if necessary, insulin injections. If your grandmother-in-law is too fit and independent to accept a residential home, she may be a suitable candidate for a warden-controlled flat.

My wife, who developed diabetes a few weeks ago, is about to return to work. I feel that she should wear some sort of identity disc or bracelet showing that she has diabetes but she is reluctant to wear anything too eye-catching. Have you any suggestions?

It is very important that all people with diabetes, especially those on insulin, should wear some form of identification. Accidents can and do happen and it may be vital that any medical emergency team knows that your wife has diabetes.

Medic-Alert provide stainless steel bracelets or necklets which are functional if not very beautiful. They can also be obtained in silver, gold plate, and 9 carat gold.

SOS/Talisman produces a medallion, which can be unscrewed to reveal identification and medical details. These can be bought in most jewellers and come in a wide range of styles and prices, including some in 9-carat gold. Other products are always coming on to the market, and Balance, the magazine produced by Diabetes UK usually carries advertisements.

Could you tell me what ointment to use for skin irritation?

The most common cause of skin irritation in people with diabetes is itching around the genital region (pruritus vulvae). The most important treatment is to eliminate glucose from the urine by controlling diabetes. However, the itching can be relieved temporarily by cream containing a fungicide (e.g. Nystatin).

I have recently been given a foot spa and was surprised to see a caution on the side of the box that it is not suitable for people with diabetes. Is this true?

If you have neuropathy (nerve damage), you should check with your diabetes team before using the spa. If you don’t have neuropathy, make sure that you check the temperature of the water carefully and don’t soak your feet for too long!

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(31) Diabetes

 Smoking and Diabetes

Diabetes31

Smoking

I am a 16-year-old on insulin. I would like to know whether smoking low tar cigarettes could interfere with my diabetes. Would it cause any restriction in my diet?

Smoking is unhealthy not only because it causes several cancers, particularly lung cancer, but because it leads to hardening of the arteries – affecting chiefly the heart, brain and legs. The proper advice to all people, especially teenagers, is not to smoke. Smoking will not directly affect your diabetes except, perhaps, by reducing your appetite.

When my doctor diagnosed diabetes, he told me to stop smoking. Could you tell me if there is a particular health hazard associated with smoking and diabetes?

The problem is made worse for me by the fact that I have to lose weight and, if I stop smoking, I will do just the opposite.

Smoking is a danger, both to the lungs and because of the risk of increased arterial disease affecting any smoker. Someone who has long-standing diabetes is also at risk of problems with poor blood circulation, and it is foolish to double this risk by continuing to smoke. If the discovery that you have diabetes has come as an unpleasant surprise, this is a good time to turn over a new leaf and alter your lifestyle, by eating less and giving up cigarettes. It may be a lot to ask, but many people manage to carry out this ‘double’. It will not kill you – on the contrary, you may live longer.

There is a lot of support available now for people who want to give up smoking and your doctor or practice nurse should be able to offer you advice on whom to contact. You may even find that they run an antismoking group or clinic. Some people find nicotine gum or patches useful, and we deal with these in a later question in this section.

Since my husband, who has had diabetes for 23 years, has stopped smoking, he has had high blood glucose tests. Why?

Your husband should be congratulated for giving up smoking. Most people who give up smoking put on weight, on average 4 kg (9 lb). This is because cigarettes suppress the appetite and make the body operating less efficiently, thus burning up more fuel (food). If your husband has put on weight, this explains his higher blood glucose levels. He should try to reduce weight to improve his diabetes. If he is already thin and his blood glucose levels are high then he will have to take tablets or insulin to get things under control.

My doctor has strongly advised me to give up smoking and suggested that I try nicotine patches. I was surprised to find that the information leaflet enclosed with the patches advised people with diabetes not to use the patches. Is this true?

It sounds as though the company is being overcautious. The main reason for giving up smoking is to reduce the damage that it does to the blood supply to the heart and legs. Each time someone has a cigarette, the nicotine that they inhale narrows the small blood vessels. This narrowing eventually becomes permanent, which explains why smoking increases the risk of such problems as heart attacks and gangrene. Nicotine patches have been shown to be a most effective way of helping people to stop smoking.

Nicotine has the same effect on the blood vessels whether from patches or from cigarettes. However, patches are no worse than cigarettes and, if they help you to give up smoking, the overall benefit will be enormous, especially with regard to your circulation. Don’t be afraid to try nicotine patches in the recommended dose. The same advice applies to nicotine chewing gum and the newer nicotine inhalerPrescription charges and Social

Security benefits

I believe that people with diabetes are entitled to free prescriptions. Please could you tell me how to apply?

One of the few definite advantages of having diabetes is exemption from payment on all prescription charges – even for treatment unconnected with the diabetes itself. People treated on diet alone are not exempt from prescription charges. You must obtain a form, called NHS prescriptions – how to get them free, from a chemist, hospital pharmacy or a Post Office.

Having filled in the form yourself, it must be signed by your family doctor or clinic doctor and sent to the local Family Practitioner Committee. The chemist should be able to give you the address. You will then receive an exemption certificate. Please remember to carry this certificate wherever you are likely to need a prescription, for example when going to the clinic or travelling in the UK. The certificate lasts for 5 years, and you will need to renew it at the end of that time.

To what Social Security benefits are I entitled now that I have diabetes?

There are no special benefits given automatically to people with diabetes. You may claim Disability Living Allowance if you have a child with diabetes who is under the age of 12, and it may be possible to obtain this allowance for a child up to the age of 16 if you can prove that the child needs extra supervision and care. Diabetes UK Careline can provide you with information to help you complete the necessary forms.

For more information about benefits, we suggest that you contact either Diabetes UK Careline, or the Disability Alliance, or the Benefits Agency. The Benefits Agency is the organization that deals with Social Security benefits on behalf of the Department of Social Security, and youcan make enquiries either at their offices or by phone. You will find their addresses and telephone numbers (they have several freephone enquiry lines) in your local phone book under ‘Benefits Agency’.

Since developing diabetes I have found that my food bills have risen alarmingly. Are there any special allowances that I can claim to offset the very high cost of the food?

Most people with diabetes are not entitled to any special allowance and, indeed, there is no real need for them to eat different food from others. Special diabetic products are not necessary. Now people are encouraged to eat food that is high rather than low in carbohydrate, they do not have to fall back on expensive protein as a source of calories.

My mother has had diabetes for 12 years and is subject to crashing hypos for no reason. She needs someone to be with her all the time. Would we be eligible for an Attendance Allowance as she needs watching 24 hours a day?

If you have to provide a continuous watch over your mother, then you would be able to apply for an Attendance Allowance. Before admitting defeat, however, it would be better to try every means to prevent the hypos. Presumably your mother is having insulin, though you do not mention the dose or type of insulin. It would be worth checking with the local diabetes service if anything could be done to reduce the frequency of hypos. Changing to more frequent but smaller doses of insulin might solve the problem. You may have to spend time and energy getting to grips with your mother’s diabetes. It would do more for her self-confidence to abolish the hypos than to get an attendance allowance.

Miscellaneous

Is there any objection to my donating blood? I am on two injections of soluble insulin a day and my general health is fine.

There is no obvious reason why a fit person with diabetes should not be a blood donor. However, the blood transfusion authorities do not accept blood from people on insulin. They suggest that the antibodies to insulin found in all people having injections may, in some mysterious way, harm the recipient of the blood.

Is it true that someone with diabetes should not use an electric blanket?

It is perfectly safe for you to use an electric blanket, although most underblankets should be used only to warm up the bed in advance. The manufacturers usually recommend that under-blankets should be switched off before you get into bed. However, there are now underblankets that can be left on all night on a very low heat and these would be safe to use, provided that you follow the manufacturer’s instructions. Overblankets can be left on all night, but again you should always check the manufacturer’s instructions.

Hot-water bottles are rather more dangerous as their temperature is not controlled. People with a slight degree of nerve damage can fail to realize that a bottle full of very hot water may be burning the skin of their feet. This is a recognized cause of foot ulcers. It is better to be safe than sorry and avoid the comfort of a hot-water bottle. Bedsocks are a possible alternative for cold feet, or you could try one of the small electric heating pads now on the market. Again you need to be careful how you use these and follow the manufacturer’s instructions – not all of them are suitable for use in bed

My 10-year-old daughter has had diabetes for 3 months. She has started to lose a lot of hair and now has a bald patch. Is this connected with her diabetes?

Yes, it could be. There are three ways in which diabetes and hair loss may be connected.

• If your child was very ill with ketoacidosis at the time of her diagnosis, this could lead to a heavy loss of hair. In this case, her hair will regrow over the next few months.

• Alopecia areata is a skin condition, which is slightly more common in people with diabetes. This is the likely diagnosis if your daughter has a well-defined bald patch with the rest of her hair remaining a normal thickness. If the patch is on the top of her head there is every chance that her hair will regrow over the next 6 months. There is no way of encouraging growth and steroid ointments may even cause permanent skin changes and make matters worse.

• Myxoedema or lack of thyroid hormones may occur with diabetes. If this is the cause of your daughter’s hair loss, you will notice other symptoms such as mental slowing, weight increase and an inability to keep warm. All these symptoms can be corrected by taking thyroid tablets. Shortage of body iron may also cause hair loss although this is not connected with diabetes.

I recently enquired about having electrolysis treatment for excess hair. I was told that, as I had diabetes, I would need a letter from my doctor stating that my diabetes did not encourage hair growth. Could I use wax hair removers instead?

There is no objection to you having electrolysis. Diabetes does not cause excessive hair growth. It sounds as though the firm doing the electrolysis is being overcautious.

Many women find wax hair removers useful for the less sensitive parts of the body. Make sure that the wax is not too hotIs it safe for people with diabetes to use sunbeds and saunas?

As safe as for those without diabetes. Exposure to ultraviolet radiation is known to increase the risk of skin cancer. Make sure that you can recognize a hypo when you are hot and sweaty. Keep some means of treating a hypo with you – not with your clothes in the changing room.

I have diabetes but would dearly love to have my ears pierced but, when I asked my doctor about this, he said there was a chance that my ears would swell. Please could you advise me if there is a great risk of this happening?

Anyone who has their ears pierced runs a small risk of infection until the wound heals completely. The risk in a well controlled person is no higher than normal. If your ears do become red, swollen, and painful, you may need an antibiotic.

Is there any connection between vertigo and diabetes? I have had diabetes for just over 2 years controlled on diet alone.

Vertigo, in the strict medical sense, describes that awful feeling when the whole world seems to be spinning round. It is usually due to disease of the inner ear or of the part of the brain that controls balance. This is not connected with diabetes in any way.

However, simple dizzy spells are a common problem with many possible causes, which may be difficult to diagnose. If dizziness occurs when you move from sitting down to the standing position, it may be the result of a sudden fall in blood pressure. This can sometimes be due to a loss of reflexes from diabetic neuropathy. There are no other connections between diabetes and vertigo.

My husband’s grandmother is 84 and has diabetes. Although she is fiercely independent, she cannot look after herself properly and will have to go into a residential home. Can you let me know of any homes that cater especially for people with diabetes?

Because diabetes becomes increasingly common in the elderly, most nurses in these homes are experienced in looking after diabetes. The staff of the home will probably be happy to do urine tests, ensure that diet is satisfactory and that she gets her tablets and, if necessary, insulin injections. If your grandmother-in-law is too fit and independent to accept a residential home, she may be a suitable candidate for a warden-controlled flat.

My wife, who developed diabetes a few weeks ago, is about to return to work. I feel that she should wear some sort of identity disc or bracelet showing that she has diabetes but she is reluctant to wear anything too eye-catching. Have you any suggestions?

It is very important that all people with diabetes, especially those on insulin, should wear some form of identification. Accidents can and do happen and it may be vital that any medical emergency team knows that your wife has diabetes.

Medic-Alert provide stainless steel bracelets or necklets which are functional if not very beautiful. They can also be obtained in silver, gold plate, and 9 carat gold.

SOS/Talisman produces a medallion, which can be unscrewed to reveal identification and medical details. These can be bought in most jewellers and come in a wide range of styles and prices, including some in 9-carat gold. Other products are always coming on to the market, and Balance, the magazine produced by Diabetes UK usually carries advertisements.

Could you tell me what ointment to use for skin irritation?

The most common cause of skin irritation in people with diabetes is itching around the genital region (pruritus vulvae). The most important treatment is to eliminate glucose from the urine by controlling diabetes. However, the itching can be relieved temporarily by cream containing a fungicide (e.g. Nystatin).

I have recently been given a foot spa and was surprised to see a caution on the side of the box that it is not suitable for people with diabetes. Is this true?

If you have neuropathy (nerve damage), you should check with your diabetes team before using the spa. If you don’t have neuropathy, make sure that you check the temperature of the water carefully and don’t soak your feet for too long!

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(32) Diabetes

 Can Diabetes Cause Erectile Dysfunction?

Diabetes32

Sex, contraception and HRT

Although modern society has removed many of the taboos and inhibitions surrounding sex and contraception, many people still find it a difficult subject on which to ask personal questions.

There are very many old wives’ tales about diabetes and sex, and most of these are rubbish. Basically, people with diabetes are no different from people without diabetes in any aspect of sex, sexuality, fertility, infertility and contraception. There are, however, a  few exceptions, such as the undoubted risk of impotence in men who have had diabetes for many years. In such people, there is usually evidence of neuropathy (nerve damage), although in some cases this is only mild. Even this has to be considered in relationship to the fact that impotence is a common problem in people without diabetes. There is certainly good evidence that women with diabetes are totally without risk of developing any problem analogous to impotence. Frigidity, on the other hand, is not uncommon in women, just as impotence is not uncommon in men, with and without diabetes.

Various contraceptive devices have at times been claimed to be less effective in women with diabetes – the evidence to support this is poor and, in our opinion, people with diabetes should consider themselves entirely normal as far as contraceptive practice is concerned. There was, in the 1960s and 70s, much emphasis on the potential risk of precipitating diabetes when oral contraceptives were taken. It is now felt that the risks were grossly exaggerated in the media.

Impotence

I am male and have been diagnosed with diabetes. I have been told that diabetes could affect my sex life. Is this correct?

No. The vast majority of people, both male and female, are able to lead completely full and normal sex lives. This does not mean that problems do not occur but that most of these problems have nothing to do with diabetes. If, for any reason, diabetes control is lost with severe hyperglycaemia (high blood glucose), then this could affect your sex life. In a minority of people who have either severe nerve damage or arterial disease, a loss of sexual potency can be directly attributed to diabetes but this is uncommon. The majority of people, both male and female, can look forward to a completely normal sex life.

Is it normal for people with diabetes to suddenly find themselves totally uninterested in sexual intercourse?

My husband is really upset about my lack of desire! No more so than in people without diabetes. The feeling that you describe is more common in females than males, but no more common in those with diabetes than those without have had erratic blood glucose levels recently.

Would low blood glucose affect my ability to achieve or maintain an erection and more importantly, my ability to ejaculate?

No, not unless the blood glucose is very low (less than 2 mmol/litre), in which case many aspects of nerve function are impaired; this could affect both your potency and ability to ejaculate. These will return to normal when your blood glucose is stable.

Am I likely to become impotent? I have had diabetes for 5 years.

There is no doubt that many people with diabetes worry about possible complications that may lie ahead of them at some stage in the future, and many men have loss of potency at the top of their worry list. Our advice is to worry more about keeping your diabetes under control and balanced and less about what future skeletons there might be in the cupboard. By ensuring that you have good control of your diabetes, you are doing everything that you possibly can to avoid trouble in the future, and the chances are that you will steer clear of difficulties throughout your life.

My husband, who is middle-aged with Type 1 diabetes, has been impotent for the past 2 years. Please will you explain his condition as I am worried that my teenage son, who also has diabetes, may also discover that he is impotent.

Impotence (or the fear of it) worries many people and is certainly not so rare that we can ignore it. It has been claimed that as many as 20% of males with diabetes (though the figure is probably not as high as this) may at some stage become impotent. Most impotent men are not suffering from diabetes: anxiety, depression, overwork, tiredness, stress, guilt, alcohol excess and grief can contribute to impotence. Any man may find that he is temporarily impotent and there is no reason why men with diabetes should not also experience this. Fear of failure can perpetuate the condition. Overwork or worry is frequently the cause of lack ofinterest in sex and even of impotence. Excess alcohol can cause prolonged lack of potency.

Some men with diabetes do become impotent, owing to problems with the blood supply or the nerve supply to the penis. This usually develops slowly and in the younger person we believe it can be prevented by strict blood glucose control. In the older person the condition does not usually respond well to treatment. In this age group impotence is more commonly due to other factors and not to diabetes. We hope that you will be encouraged to discuss the matter further with your own doctor or with the doctor at the diabetes clinic.

My wife left me because I was impotent and the doctors say that there is nothing they can do for me – why was I not told about any treatments available?

We are surprised that the doctors said that there is nothing they can do for you, because, even for those who are completely impotent, there are now several treatments that can be tried.It must be very upsetting to think that your marriage broke up on account of your impotence. In our experience, most wives are sympathetic and understanding about impotence (whatever the cause) provided that both partners can talk about the matter in an open manner. We have known frank discussions leading to an increase of affection within marriage. Keeping things bottled up leads to the aggression and resentment that emerges from your question.

Recently, I have had trouble keeping an erection – has this anything to do with my diabetes? I also had a vasectomy a few years ago.

This is difficult to answer without knowing more about you and your medical history. Certainly it is unlikely that the vasectomy had anything to do with your current problem. Failure to maintain an adequate erection may occasionally be an early symptom of diabetic neuropathy. However and at least as commonly, it isoften a symptom of overwork or simply growing older and you would need detailed tests to be sure of the cause.

I suffered a stroke affecting the right side of my body 12 months ago at the age of 40 and now suffer from partial impotence. The onset seemed to coincide not with the stroke but with taking anticoagulants. Are these known to cause impotence? I have heard that blood pressure tablets can cause impotence and I have been taking these for 3 months and wonder whether this is a factor?

A severe stroke can sometimes be associated with impotence. A stroke is often due to narrowing of the arteries inside the head: the arteries elsewhere may also be narrowed and, if those supplying blood to the penis are affected, it could contribute to your impotence. You are also quite right about the question of drugs. Some blood pressure lowering drugs may cause impotence and can interfere with ejaculation. It would be unwise to stop taking the drugs since this would lead to loss of control of your blood pressure without first asking your doctor to try you on different tablets for your high blood pressure to see if this helps. Anticoagulant tablets are not known to cause impotence.

I have been impotent for months. Is there some drug or hormone that will help me?

It is extremely rare that impotence is due to a hormonal abnormality. Many cases of impotence are due to psychological causes and often respond to appropriate advice and occasionally drug treatment. If you have a hormonal defect, treatment with replacement hormones (testosterone) will cure that particular form of impotence. It is essential to get a correct diagnosis in order to ensure appropriate therapy. It has been shown that the injection of a drug called papaverine directly into the penis can sometimes be helpful. It leads to an erection and, in people who have become impotent; the result is often good enough to make this an acceptable and effective form of therapy.

Viagra (sildenafil) is the first oral treatment for impotence tobe licensed in the UK. It works by helping to relax the blood vessels in the penis, allowing blood to flow into the penis causing an erection. It will only help a man to get an erection if he is sexually stimulated. It is available to men with diabetes on the NHS, but officially the amount is limited to 4 tablets a month. It is important to use the full strength (100 mg) as lower amounts are less likely to have the desired effect.

I have used Viagra for 3 years for impotence. At first it worked very well but the effect now seems to be wearing off. Is there anything else I can try?

Recently another drug has come onto the market, which is designed to help people improve their erections. It is called apomorphine (or Uprima), and should be placed under the tongue about 20 minutes before you want sex. Apomorphine has about the same success rate as Viagra, but may help some people who do not respond to Viagra. The starting dose of apomorphine is 2 mg but, if this is no help, you can try a 3 mg dose. Apomorphine seems to be a safe drug, but you should avoid it if you have severe heart problems or if your blood pressure is low. You should wait 8 hours before repeating the dose of apomorphine.

Is there any other treatment for impotence apart from Viagra?

Yes. Depending on the cause, there are several effective forms of therapy. Counselling by a therapist trained in this subject can be helpful, particularly in cases where the stresses and conflicts of life are the root cause. Testosterone is effective in those with a hormone deficiency. Vacuum therapy, with a device that looks like a rigid condom, is also a (if expensive) form of therapy, which has been useful in many cases. Injections of papaverine or alprostadil into the penis, and penile implants (which require an operation) are also effective. The best choice for an individual requires a considerable amount of thought and discussion with your doctor. Many diabetes clinics hold special clinics for treatment of impotence.

After sexual intercourse I recently suffered quite a bad hypo. Is this likely to happen again and if so, what can be done to prevent it?

This form of physical activity can, like any other, lower the blood glucose level and lead to hypoglycaemia. When this happens, and it is not at all uncommon, then the usual remedies need to be taken – more food or sugar beforehand or immediately after-wards. You may find it useful to keep some quick-acting carbohydrate close at hand, perhaps on a bedside table.

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