If you have diabetes, even a minor cut or scrape can turn into a serious problem. Here’s how to treat a wound properly to protect your health.
For most people, a nick or a scrape is no big deal. But for someone with diabetes, even a minor cut or scrape can turn into a very serious problem if not treated properly.
“Diabetes impacts white blood cell function, which obstructs the body’s ability to fight bacteria and close wounds,” says Asaad H. Samra, M.D., director of the Centre for Wound Healing at Bayshore Medical Centre. In addition, people with uncontrolled diabetes may develop poor circulation, making it difficult for the body to deliver nutrients to injured areas, which hinders the healing process.
That’s why it’s crucial for people with diabetes to correctly treat any wound, no matter how minor it seems. Here’s some advice from Dr. Samra:
Wash the wound thoroughly. Use an antibacterial soap and warm water to clean out the wound. Then pat dry with a clean cloth and apply over-the-counter antibacterial ointment.
Cover the wound. Use a bandage to keep the wound clean, moist and protected. “It’s now considered old, inaccurate information to let a wound dry out,” says Dr Samra.
Redress it daily. Take off the bandage and make sure nothing has significantly changed since the last time you saw the wound. Use soap and water to wash away the old ointment, then pat dry and apply a fresh coat. If, after a few days, you feel the wound is healing well, you can stretch the redressing to every other day.
Inspect it every time you change the bandage. If you don’t see improvement over the course of a week, or if any redness or foul smell develops, call your doctor. Also contact your doctor if the wound fails to heal within four to six weeks.
Check your feet daily. Diabetes can lead to neuropathy, which limits sensation in the extremities. “So someone with diabetes could have an injury on their foot and not even know it,” says Dr. Samra. This, plus poor blood flow, puts you at risk for developing an infection from a foot sore. Be on the lookout for any cuts, sores, blisters, swelling or any changes to the skin or nails. Don’t forget to check the bottom of your feet (use a mirror). And never go barefoot, even inside your house.
Diabetes as we know it is typically organised into two neat categories: type 1 and type 2. In reality, diabetes is much more complicated
Diabetes as we know it is typically organized into two neat categories: type 1 and type 2. In type 1 diabetes, antibodies from your own immune system destroy the cells which produce insulin. The disease starts suddenly and is usually diagnosed in children. Type 2 diabetes most often develops in adults as a result of insulin resistance (your cells don't use the insulin well), not insulin production.
In reality, diabetes is much more complicated, and it can manifest in at least one other form, often referred to as type 1.5. This type of diabetes, explains Ping H. Wang, MD, chair of the department of diabetes, endocrinology, and metabolism at City of Hope in Duarte, California, has features of both type 1 and type 2.
What is type 1.5 diabetes?
Like Type 1 diabetes, type 1.5 has an autoimmune component, which means antibodies from your immune system mistakenly destroy the pancreatic beta cells which produce insulin. Insulin is the hormone needed to get blood sugar out of the bloodstream and into the cells. Without it, glucose accumulates in the blood, leading to potentially life-threatening complications.
Unlike type 1, though, type 1.5 does not have to be treated with insulin right away, and is generally diagnosed in younger adults, not kids. This makes it more like type 2, as does the fact that it progresses much more gradually than type 1, says John B. Buse, MD, PhD, chief of endocrinology at the University of North Carolina School of Medicine in Chapel Hill.
While type 1 diabetes is primarily a problem of insulin production and type 2 one of insulin resistance, type 1.5 seems to include both of those issues. "It's a term used to describe patients who have some level of decreased insulin production due to decreased functioning of the beta cells of the pancreas," explains Deena Adimoolam, MD, a specialist in endocrinology and preventative medicine in New Jersey. "Patients with Type 1.5 diabetes are able to produce some insulin, but not enough insulin, and over time they may not produce any insulin at all."
To be clear, type 1.5 is not a medical term and some experts object to its use. The term can describe Maturity Onset Diabetes of the Young (MODY), a genetic condition which occupies another grey area between type 1 and type 2. But it's perhaps most commonly associated with latent autoimmune diabetes in adults (LADA) and is often used synonymously with that condition.
Causes of type 1.5 diabetes
No one knows exactly why antibodies which normally guard against foreign invaders decide instead to destroy the body's own insulin-producing cells. Genetics plays a role in all forms of diabetes. The first genome-wide association study of type 1.5 diabetes found that the genetic signature overlapped both type 1 and type 2 diabetes but had more in common with type 1 than with type 2.
Even when genes are involved, an environmental trigger usually sets the process in motion, regardless of what the disease is. "You have to have the right genetic predisposition, but something has to set your immune system off on a course to destroy the cells that make insulin," explains Dr. Buse. "It's unclear what those are."
Researchers have discovered links with weight gain, viral infections and stress but nothing is certain. It's also possible that type 2 diabetes morphs into type 1.5. "Some patients with type 2 diabetes who are not well-controlled for. Years may develop 'beta cell burnout' over time where their pancreas produces less insulin," says Deena Adimoolam, MD, a specialist in endocrinology and preventative medicine in New Jersey.
Symptoms of type 1.5 diabetes
There are usually no symptoms in the beginning of type 1.5. That's because the beta cells are destroyed so gradually, life seems to continue as normal. Adults diagnosed with autoimmune diabetes usually develop symptoms when they're down to about 10% of the normal number of beta cells, says Dr. Buse.
Once symptoms do appear, they are similar to those for other forms of diabetes. "They're all related to high levels of blood glucose—blurred vision, increased urination, increased thirst, increased yeast infections (mainly in women), weight loss, feeling hungry and feeling tired," says Dr. Adimoolam.
The first symptom of type 1.5 and type 1 can be diabetic ketoacidosis (DKA), when stratospherically high blood sugar levels lead to dangerously high levels of acid in your bloodstream.
Long-term complications of diabetes are also similar for all forms of diabetes and include heart disease. People with type 1.5 or adult autoimmune diabetes are more likely to develop microvascular complications (problems in the small blood vessels) such as neuropathy. Diabetes complications in general, says Dr. Buse, "generally develop over decades."
Type 1.5 diabetes diagnoses
Part of diagnosing so-called type 1.5 or any other form of diabetes is to check for abnormally high blood sugar levels. But this test alone won't tell you what type of diabetes you have. To help pinpoint type 1.5, doctors will also test for the presence of glutamic acid decarboxylase antibodies (GAD). These are the most common antibodies to destroy insulin-producing pancreatic cells in people with type 1.5
"Antibody tests are positive in about 70% of cases but there are antibody negative patients," says Dr. Buse.
When investigating LADA, doctors also look for traits of "atypical diabetes," says Dr. Buse. "If everything aligns—if someone has a strong family history of type 2 and they're overweight, they have high blood pressure and high triglycerides and a lot of features of metabolic syndrome—they likely have type 2." Being diagnosed in younger adulthood suggests type 1.5, as does weight loss, being under the age of 30 or so and having a family history of autoimmune disease.
Another tip-off is that people with LADA typically don't respond as well to oral diabetes medications, but they do respond well to insulin, says Dr. Buse.
The differences can be subtle and, as a result, LADA or type 1.5 is often mistaken for type 2 diabetes. As many as 3%-12% of all diabetes in adults may be LADA, according to one estimate. This means that many folks with so-called type 1.5 are funnelled into the wrong kind of treatment.
Treatment and prevention options for type 1.5 diabetes
Like everything else about type 1.5, treatment has settled on a halfway mark between type 1 and type 2 diabetes. People with type 1.5 will eventually need insulin but usually not right away. This may seem strange given that diagnosis usually takes place when patients have only had one-tenth the number of original beta cells. But, says Dr. Buse, "the pace at which those remaining cells die is much slower [than type 1] so you can get away with diet modification at the beginning." A carbohydrate-restricted diet often works well, as it does in type 2, he adds.
Oral medications can also help in those early days, but most will need insulin eventually, says Dr. Adimoolam.
While there's no known way to prevent type 1 diabetes, you may be able to stave off 1.5 with lifestyle factors like maintaining a normal weight, sticking to healthy foods and exercising.
Australian researchers hope low-cost saliva test will replace current needle-based test for diabetes sufferers
Australian scientists say they have developed pain-free blood sugar testing for diabetics, a non-invasive strip that checks glucose levels via saliva.
For diabetics, managing their blood sugar levels typically means pricking their fingers multiple times a day with a lancet and then placing a drop of blood on a testing strip. Understandably, some diabetes sufferers avoid the painful process by minimising their tests.
However, this latest test works by embedding an enzyme that detects glucose into a transistor that can then transmit the presence of glucose, according to Paul Dastoor, professor of physics at the University of Newcastle in Australia, who led the team that created it.
He said the tests create the prospect of pain-free, low-cost glucose testing which should lead to much better outcomes for diabetes sufferers.
“Your saliva has glucose in it and that glucose concentration follows your blood glucose. But it is a concentration about 100 times lower which means that we had to develop a test that is low cost, easy to manufacture, but that has sensitivity about 100 times higher than standard glucose blood test,” Dastoor told Al Jazeera.
Professor of Physics Paul Dastoor holds up a non-invasive, printable saliva test strip for diabetics at the University of Newcastle, New South Wales, Australia [Courtesy of University of Newcastle via Reuters]
Since the electronic materials in the transistor are inks, the test can be made through low-cost printing.
“The materials that we work with are remarkable, they are electronic inks that can act as electronic material, but the difference is that we can print them at massive scale using a reel-to-reel printer, the same that you use to make newspapers,” Dastoor said.
The project secured A$6.3 million ($4.7m) in funding from the Australian government to establish a facility to produce the test kits should clinical trials be passed.
Dastoor says the technology could also be transferred to COVID-19 testing and allergen, hormone and cancer testing.
The university is already working with Harvard University on a test for COVID-19 using the same technology.
When NFL offensive lineman Ryan Jensen was waking up more than 13 times a night, he developed mood swings, fatigue and lost weight — jeopardizing his career. Once he was diagnosed and treated for sleep apnoea, he was back on track. But he’s not alone; it’s estimated that 33% to 50% of elite athletes are poor sleepers. That’s about the same number of folks with Type 2 diabetes who have sleep problems and that threaten to derail their life too.
Diabetes is associated with sleep issues because out-of-whack blood sugar levels can cause frequent urination (when they’re too high), anxiety, even nightmares (when they’re too low). Then poor sleep, especially less-restorative slow-wave sleep, interferes with insulin regulation and blood sugar levels — and it goes round and round.
A study in the Journal of Sleep Research lays out the consequences: Participants who had diabetes and also experienced frequent sleep disturbances were 87% more likely to die of any cause (car accident, heart attack, etc.) during the nine-year study follow-up than people who didn’t have diabetes and slept well, and were 12% more likely to die than those who had diabetes but no sleep issues.
If you have diabetes and sleep issues: Get your glucose levels under control 24/7. Consider using a continuous glucose monitor to keep track and ask your doctor for a referral to a diabetes educator. Talk to your doctor about the new diabetes-control medications that are available. And then ... get evaluated for sleep disturbances. You can turn this around!
To mark National Diabetes Week, the Australian Government is announcing a new three-year $140 million agreement with Diabetes Australia to continue delivering the National Diabetes Services Scheme (NDSS)
Diabetes directly affects approximately 5 per cent of Australia’s population. Sadly, 80 per cent of people report feeling shame or blame because they have the disease.
This year’s National Diabetes Week – from 11 to 17 July – seeks to address this, by changing the conversation and reducing diabetes-related stigma.
Diabetes Australia is spearheading the campaign, which asks people “Would you mind?” if you were made to feel ashamed because of a health condition.
The NDSS helps people understand and self-manage their life with diabetes. It also gives them access to services, support, and subsidised diabetes products like blood glucose testing strips, insulin syringes, insulin pump consumables, and continuous glucose monitoring (CGM) products.
The NDSS currently supports nearly 1.4 million Australians with diabetes. It delivered more than 5.7 million diabetes products in 2019–20, at a cost of more than $188 million.
In addition to the NDSS, the Government subsidises essential medicines, like insulin, under the Pharmaceutical Benefits Scheme (PBS). In 2019–20, PBS expenditure on medicines for diabetes was over $632 million.
Since 2017, the scheme has also provided fully subsidised CGM products to eligible people. The Government has expanded the eligibility criteria to allow more people to benefit, and now provides fully subsidised CGM products to:
children and young people, under 21 years of age, with type 1 diabetes
children and young people with conditions very similar to type 1 diabetes, such as cystic fibrosis-related diabetes and neonatal diabetes, who require insulin
women with type 1 diabetes who are planning for pregnancy, pregnant or immediately post-pregnancy
people with type 1 diabetes aged 21 years or older who have concessional status.
These changes mean more than 58,000 Australians with type 1 diabetes are eligible to access CGM products, with funding of more than $300 million over four years.
The new agreement with Diabetes Australia also secures the future of successful programs which are making a real difference for people with diabetes, including:
KeepSight, a program to help prevent diabetes-related blindness by making it easier for people with diabetes to get their eyes checked
Diabetes in Schools, which provides nationally consistent information and training for parents and families, principals, school staff and health professionals, so students with type 1 diabetes can be supported to manage their condition at school, and
FootForward, a new program to help people with diabetes understand the importance of getting their feet checked, to avoid foot problems that can lead to amputation.
The Government’s commitment to supporting Australians with diabetes extends well beyond the NDSS.
We recognise the importance of clinical research and how it provides an important opportunity to identify better ways to prevent, treat and manage diabetes.
Since 2010, the National Health and Medical Research Council has provided $626 million for diabetes research. Since its inception, the Medical Research Future Fund has invested $78 million in diabetes research. This includes $25 million to JDRF Australia (formerly known as the Juvenile Diabetes Research Foundation) for the Australian Type 1 Diabetes Clinical Research Network.
Work is also under way on an updated Australian National Diabetes Strategy to outline the national response to diabetes and better coordinate and target existing resources across all levels of government. The strategy will span 2021–2030 and is expected later this year.
Both can be treated, but only one can be prevented
Type 1 and type 2 diabetes may share a name, but there are as many things different about them as there are similar.
At their core, both diseases involve abnormally high levels of sugar in the bloodstream, which is a dangerous, if not life-threatening situation. That occurs as the result of deficiencies in the hormone insulin. In a healthy body, insulin, which is produced by your pancreas, heads to the bloodstream after you eat to break down the sugars from food before escorting them into your cells where they wait to be used as energy.
In type 1 diabetes, the body no longer makes any insulin at all, which means that blood sugar levels rise to sometimes stratospheric levels in the blood. Type 2 is a completely different physiology, with the insulin getting less and less effective over time, rather than shutting down abruptly, Mary Vouyiouklis Kellis, MD, an endocrinologist at the Cleveland Clinic, tells Health. This is called insulin resistance.
Type 1 diabetes represents less than 5% of diabetes cases, and type 2 diabetes 90 to 95%. Other, rarer forms of the condition, make up the rest.
The Differences and Similarities Between Type 1 and Type 2 Diabetes
Credit: Getty Images
The causes of type 1 and type 2 are different
Type 1 diabetes is an autoimmune condition, which means that your immune system mistakenly attacks your body. In the case of type 1 diabetes, immune-system cells go after the insulin-producing beta cells in the pancreas, which causes insulin production to suddenly turn off.
No one knows exactly why your body goes on the offensive, but there are probably many contributing factors. "We don't completely understand why this happens but there is some data that a viral infection can trigger the process if you already have a predisposition," says Dr. Vouyiouklis Kellis. "You may already have antibodies [the immune-system cells that attack the pancreas] but the second hit is a viral infection." That predisposition could also be genetic.
With type 2 diabetes, genetics, including family history, can also play a role, but here the main risk comes from being obese or overweight, as well as other lifestyle factors, such as not being active and eating unhealthy foods, Jasmine D. Gonzalvo, PharmD, director of the Centre for Health Equity and Innovation at Purdue University in West Lafayette, Indiana, tells Health. "The body still has some ability to produce insulin, but the body has a resistance to the insulin." In type 2 diabetes, the cells may also have difficulty using the insulin effectively, called insulin resistance.
Type 1 and type 2 affect different groups of people
Type 1 diabetes used to be called "Juvenile Onset Diabetes" because, although it can affect anyone, it most often strikes kids aged four to six and those aged 10 to 14.
Type 2 diabetes, originally called adult-onset diabetes, mostly affects adults, but the age at diagnosis is getting younger.
"There's been more of a grey area within the last decade or so, where you see an older onset of what actually is type 1 and a younger onset of type 2 diabetes," says Gonzalvo. "There has been more of a merging rather than a separation."
Other distinctions remain. "Type 1 diabetes tends to be diagnosed in younger individuals of normal weight, though they may have a personal or family history of autoimmune disease," Deena Adimoolam, MD, a specialist in endocrinology and preventative medicine, who practices in New Jersey, tells Health. "Type 2 diabetes tends to be diagnosed in older individuals who are overweight or obese."
The symptoms and complications are similar
Consistently high levels of blood sugar cause the symptoms of both types of diabetes and many of those symptoms are the same. "Presenting symptoms are similar in all forms of diabetes—increased thirst, increased urination, blurred vision, worsening fatigue, weight loss," says Dr. Adimoolam. "Since patients with type 1 diabetes produce very little or no insulin at the time of diagnosis, they are more likely to present to the hospital with a life-threatening condition called diabetic ketoacidosis (DKA)." People with type 1 may also lose weight.
One unique symptom of type 2 diabetes is a condition called acamphotisi nigricans, says Vouyiouklis Kellis. That's when you see a darkening of the skin at the back of the neck or back of the arm, places where there are folds under the skin. This is a sign of insulin resistance, which is a hallmark of type 2 diabetes but not type 1 diabetes.
Chronically high levels of blood glucose can lead to serious complications which, says Dr. Adimoolam, are similar for both types of diabetes. These include heart disease, kidney problems, nerve damage, amputation, and eye damage that can result in blindness.
Diagnosis is the same
Diagnosing type 1 and type 2 diabetes is based on tests to determine how high your blood sugar is. There are several different types of tests, including the A1C test, a blood test which looks at your average blood-sugar levels over the past two to three months, and a fasting plasma glucose test, a blood test which measures levels after you've been fasting for at least eight hours.
If your doctor thinks you have type 1 diabetes, he or she may also order certain antibody tests.
The treatments are different
There's only one treatment for type 1 diabetes: insulin replacement. "Without insulin, people with type 1 diabetes may die from complications like diabetic ketoacidosis," says Dr. Adimoolam.
There are a wide range of treatment options for type 2 diabetes, starting with oral and injectable medications to control blood sugar, then moving on to insulin when those things stop working. "Many people with type 2 diabetes are on a combination of these treatments," says Dr. Adimoolam.
A healthy diet and regular exercise are a cornerstone of managing both forms of diabetes.
Only type 2 diabetes can be prevented
There's no way to prevent type 1 diabetes, but you can help prevent type 2 with lifestyle modifications. "We're talking about making healthier food choices, engaging in physical activity, and taking medication," says Dr. Gonzalvo.
Great advice — and yummy ideas — for snacks that help lower blood sugar or keep pounds off
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When the stay-at-home orders began back in March, plenty of people predicted that it would affect people's eating habits, and no surprise, it has. Results of an online survey conducted in April and published last month in the medical journal Obesityfound that 70 percent of nearly 8,000 respondents admitted to snacking more.
They say that like it's a bad thing.
While snacking often gets maligned as an unhealthy habit, it can have an upside, particularly if you're one of the more than 34 million Americans with type 2 diabetes. For many people, snacking can help prevent overeating at meals and keep energy levels steady throughout the day, says Erin Palinski-Wade, a registered dietitian and author of 2 Day Diabetes Diet. “For people with diabetes specifically,” she says, “snacking can be a great way to help manage appetite and space carbohydrates out during the day. Eating frequently may also help prevent the blood sugar lows that can occur when you haven't eaten for an extended period of time."
Most people have experienced some of the effects of wonky blood sugar levels: sudden lethargy, mood swings or ravenous hunger. People with type 2 diabetes are more sensitive to these effects, as well as long-term risks including vision problems, nerve damage, and heart and kidney issues. That's because a diabetic pancreas fails to release insulin, or at least enough of it to deal with the aftermath of eating. Normally, your body breaks food down into glucose, a sugar and the main energy source for your cells. Insulin helps deliver that energy to cells; without that hormone, or enough of it, the sugar stays in your blood. Chronically elevated blood sugar can cause organ and tissue damage over time.
Previously, when a short-acting injectable insulin was the only option for people with type 2 diabetes, experts pushed a three-meal, two-snack-a-day regimen, says Amy Kimberlain, a registered dietician and spokesperson for the Academy of Nutrition and Dietetics. But now that there are other injectables and oral medications that work differently, those restrictions have loosened up. Still, she says, timing and consistency are key when it comes to managing blood sugar, and therefore when eating.
Eating at regular intervals throughout the day is one key — Palinski-Wade recommends her clients with type 2 diabetes have some food every three to four hours. And, ideally, roughly the same amount of food. Big meals are a no-no when you have diabetes because they dump far too much glucose in your system at once. Skipping meals is ill-advised for similar reasons — your blood sugar will plummet. Sensible snacking can help in both scenarios. Palinski-Wade's helpful guide for “sensible": Make sure your snacks are no more than one-third to one-half the calories of your meals. So if you typically eat 500 calories at a meal, your snacks should be between 160 and 250 calories each.
Of course, what you eat matters, too. Your body digests carbohydrates, proteins and fats at different rates. Simple carbs — things like refined white bread and processed sugary snacks — turn into glucose the fastest, flooding your system with more sugar than it can handle. Ideally, you want a steady drip of carbs throughout your day, says Kimberlain. “We overeat carbs in general,” she says. “Strive to make half of them whole grains, which have fiber to slow digestion, and pair them with proteins and healthy fats.” For instance, try adding peanut butter to oatmeal, or beans to rice. And remember, you don't get to double up on carbs at one meal because you skipped them at a previous meal. Your goal is balance and consistency.
It may seem tough not to stress-eat carbs right now, but that Obesity study did have some encouraging data: While 44 percent of respondents were snacking on junk food, 26 percent had increased their intake of healthful snacks while quarantining. You can, too. Need more inspiration? Check out these expert-recommended suggestions for whatever you're craving:
Savoury:
Hummus (we like Sabra singles, which are pre-portioned in 150 calorie containers) with veggies (sliced cucumber, bell pepper, celery or carrots). There's some evidence that fiber from plant-based sources may help with insulin sensitivity in as little as three weeks.
Avocado toast or crackers. “One-third of a medium avocado contains just 4 grams of carbs, 79 percent from fiber, which slows down food digestion and prevents rapid rises in blood glucose following a meal,” says Palinski-Wade. They also have 6 grams of heart-healthy fats per serving. Try spreading avocado on crisp whole grain crackers or a slice of whole grain toast for a tasty midday fiber and nutrient boost. Sprinkle with a little garlic salt, cumin or red pepper flakes.
Salty:
Cheese crisps. Reach for these crunchy protein treats instead of potato chips. You can make them easily yourself by baking small piles of grated cheese (cheddar and Parmesan both work well) on a parchment-lined baking sheet in a 400-degree oven until golden and crisp, about 5 minutes. Whisps also makes a variety of flavors.
DIY snack mix. Mix some low-calorie whole-grain popcorn (sugar-free Pop Zero, SkinnyPop, and heirloom Pipcorn are among our fav brands) with 1 ounce of nuts, such as Wonderful Pistachios No Shells Roasted & Salted or Diamond of California's first-ever ready-to-eat Snack Walnuts line. You can season with spices like cinnamon or cayenne if you prefer. The protein-fiber-fat trio will help keep you fuller longer.
Sweet:
Ricotta cheese with dark chocolate chips. Stir some dark chocolate (it has less sugar and antioxidants) into some part-skim ricotta for a creamy, protein-packed, low-carb way to satisfy a sweet tooth.
Prunes. Naturally occurring sugar is typically bound with fibre, so it won't spike blood sugar levels, says Palinski-Wade. Prunes (or dried plums, as they've been rebranded) are one of the lowest-sugar dried fruits, and, she says, eating five to six prunes per day may help prevent bone loss — a great benefit especially as people with diabetes are at a greater risk of developing osteoporosis. She even uses them as a sugar substitute in baked goods, such as her chocolate chip prune cookies.
![Professor of Physics Paul Dastoor holds up a non-invasive, printable saliva test strip for diabetics at the University of Newcastle, New South Wales, Australia [Courtesy of University of Newcastle via Reuters]](https://www.aljazeera.com/wp-content/uploads/2021/07/2021-07-13T010507Z_1903186655_RC2TJ59UYJ3P_RTRMADP_3_HEALTH-AUSTRALIA-DIABETES.jpg?resize=770%2C513)
