COPING WITH DIABETES | Added: 12, August 2017



DIABETES AND EMOTIONAL HEALTH

Can stress cause diabetes?

No, contrary to some reports, there is no evidence that stress can cause diabetes. But it can affect a person with diabetes, as stress does raise blood glucose levels.

How does diabetes cause stress?

Experts often say that stress can affect diabetes (mainly by raising blood glucose levels), and diabetes can cause stress. Most people with diabetes do not realize this double connection, especially when they are first diagnosed with the disease. In particular, having diabetes puts a burden on the person because it requires many lifestyle changes, not only for that person, but also for those around him or her (and especially when a child is diagnosed with diabetes). There is the stress of making sure the person’s blood glucose stabilizes to a level that is good for that person. And there is the stress of making sure that he or she eats, exercises, and works comfortably while maintaining a healthy blood glucose level. Many people without the disease do not understand the challenges of the disease-and such a lack of understanding can also cause stress in the person with diabetes.

How do the many stresses in life affect a person’s blood glucose levels?

The double whammy, as it is often called, is that stressful events are tough on the body (mentally and physically) and, in turn, affect blood glucose levels, whether a person has diabetes or not. With or without diabetes, the stress hormones (usually cortisol and catecholamines) can counteract the effects of the body’s insulin (stress can even affect injected insulin for a person with type 1 diabetes). This stress effect makes blood glucose levels rise, sometimes to dangerous levels.

What problems may people with diabetes face in relation to others who do not have the disease?

If you talk with people who have diabetes, they’ll often say that communication or “people problems” can lead to stress or bad feelings. For example, many people will tell a person with diabetes what he or she should eat (even though they themselves do not have the disease) or treat the person differently when a diagnosis is made. Most people with diabetes want practical and emotional help, but they also want others to understand the many difficult challenges they face with diabetes.

What study indicated that people with diabetes may be more prone to depression and vice versa?

It is well established that diabetes and depression often occur together. It is unknown why this link exists, but according to a study of 55,000 women conducted by researchers at Harvard School of Public Health, the link appears to be bidirectional, meaning either condition can cause the onset of the other. The study showed that over a ten-year period, there was a 29 percent higher risk of developing depression for women who had diabetes than for those who did not. Contrarily, women who had depression were 17 percent more likely to develop diabetes than those who were not depressed. Both results took into account risk factors for both conditions, such as excess body fat and inactivity.

The researchers speculated that depression may result from biochemical changes that occur if a person develops diabetes. It could also be that diabetes occurs as a result of the treatment for the depression, as antidepressant drugs may affect a person’s glucose levels or cause weight gain that puts the person at risk for diabetes. They also suggest that depression may develop after someone develops diabetes because the person has to live with the stresses of the chronic disease. These suggestions are all speculation so far, and more studies need to be done.

DIABETES AND VACCINATIONS

What is the purpose of a vaccination?

The purpose of vaccination, or immunization, is to artificially induce active immunity, so there will be resistance to the pathogen upon natural exposure in the future. Vaccinations are prepared under laboratory conditions from either dead or severely weakened antigens.

Should people with diabetes obtain a flu and/or pneumonia shot each year?

Most health care professionals suggest that a person with diabetes obtain a flu shot each year, usually in the fall. According to the CDC, people with diabetes (types 1 or 2), even when the disease is well managed, are at higher risk of developing serious flu complications than most other people. These can include such conditions as pneumonia, bronchitis, and sinus and ear infections, which may lead to hospitalization. Such susceptibility occurs because the immune system of a person with diabetes is less able to fight off infections, and an illness makes it more difficult to control blood glucose levels. For example, when people are sick, they may not feel like eating, and if they have diabetes, lack of food can cause blood glucose levels to become unbalanced.

In addition, people with type 1 or type 2 diabetes should ask their health care professional if they need a pneumonia shot-also called pneumococcal vaccination-as they are at increased risk of developing pneumonia if they do contract the flu. Overall, a person with diabetes should contact his or her health care provider to understand what shots are needed and the best way to obtain them.

Because diabetics are at higher risk of getting the flu or pneumonia, it is recommended they get a flu shot every year without fail.

Why does a new flu vaccine have to be prepared each year?

A new flu vaccine is prepared every year because the strains of flu viruses change from year to year. Nine to ten months before the flu season begins, scientists prepare a new vaccine made from inactivated (killed) flu viruses. The vaccine preparation is based on the strains of the flu viruses that are in circulation at the time. It includes those A and B viruses expected to circulate the following winter. Another reason to get vaccinated for the flu every year is that immunity after a flu shot declines and may be too low to provide protection after one year.

ENJOYING THE OUTDOORS

Can sunburn affect a person with diabetes?

Yes, sunburn can affect a person with diabetes, whether the individual gets burned while hiking, walking in the sunshine, or skiing at a ski resort. Sunburn can stress the body, and for a person with diabetes, such stress can raise blood glucose levels. Sunshine can also put stress on the eyes, causing eye strain. The best way to counteract these problems is not to quit going outside but to use a broad-spectrum sunscreen and to wear protective eye gear.

What SPF (sun protection factor) is best?

For people with or without diabetes, it is best to use sunscreen lotion to protect against the sun’s ultraviolet rays. When it comes to sunscreen, the SPF number located on a lotion’s container is the most important. Most experts generally recommend that a sunscreen with an SPF of at least 30 is usually sufficient, since it blocks out around 97 percent of the sun’s ultraviolet rays. For those with fairer skin or who have a history of skin cancer, dermatologists often recommend an SPF closer to 60. In addition, those who are outside for more than two to three hours-especially from 10 A.M. to 2 P.M., the peak sun-exposure hours-can often benefit from a higher SPF number.

Of course, the use of sunscreen is often debated, especially in association with vitamin D. Although the seasonal change in sunlight is one of the major reasons for fluctuations in a person’s vitamin D levels, another culprit is clothing that covers the arms and legs, limiting the sunlight that helps the body produce vitamin D. In addition, using sunscreen may affect vitamin D levels to a certain extent, although in reality, few people use enough sunscreen to block all of the UV rays.

Is there a connection between skin cancer and diabetes?

Although more studies are needed, a study from 2013 indicated there may be an association between skin cancer and diabetes, especially if a person has had diabetes for 15 years or longer. But the study raised many questions, and no one truly knows whether there is a higher risk of skin cancer for people with diabetes or whether it is just that the older a person becomes, the more he or she is exposed to environmental conditions that cause skin cancer. Overall, health care professionals suggest that people with diabetes follow the same guidelines as those without diabetes, such as using sunscreen, wearing light clothing to cover the arms and legs, and being aware of how much time they are exposed to sunlight.

Checking regularly for melanoma or other forms of skin cancer is important for everyone, so take precautions and schedule an appointment with a dermatologist to be safe.

What is Lyme disease?

Lyme disease is caused by a bacterium transmitted to humans through the bite of various types of infected ticks. The smaller, immature tick nymphs usually spread the disease because they are so small and difficult to see. In most cases, the tick must be attached for 36 to 48 hours or more before the Lyme disease bacterium can be transmitted. If infected, a person can experience flulike symptoms, such as fever, headache, and fatigue, and in about 80 percent of the cases, a “bull’s-eye” skin rash can be seen around the bite area. The typical treatment is a few weeks of antibiotics. If the infection is not treated, it can eventually affect joints, the heart, and the nervous system. According to the Centers for Disease Control and Prevention, it is estimated that children ages five to nine face the greatest risk of contracting Lyme disease, with about 75,000 children diagnosed annually. It is also considered the most common tick-borne disease in the country, with about 300,000 new cases (all ages) per year. But the numbers may be higher as many cases mimic other illnesses and are not diagnosed.

What happens if a person with diabetes contracts Lyme disease?

Few studies have been conducted on how a person with diabetes can cope with Lyme disease. In addition, if there is no telltale rash, the symptoms often mimic other diseases. Some of the symptoms, if the infection is not treated, seem as if they would exacerbate diabetic conditions, as the infection often involves inflammation (from the infection) and neuropathy-type symptoms-both of which are not only symptoms of diabetes but also conditions that worsen if a person has diabetes.

What is the West Nile virus?

According to the Centers for Disease Control and Prevention, the West Nile virus is a seasonal problem that is commonly transmitted by infected mosquitoes. It is found widely on other continents, including Africa, Europe, and Asia, and was first detected in the United States in 1999. The insects become infected with the virus when they feed on other contaminated animals, especially birds. From there, the insects spread the virus to humans and other animals. The virus has an incubation period of about three to 14 days (which means that the symptoms will not start until three to 14 days after a bite). But most people-around 70 to 80 percent-do not develop any symptoms. Others who are infected can develop a fever, along with a headache, body aches, joint pains, vomiting, diarrhea, or rash. Most people recover completely. It is estimated that less than 1 percent of people infected develop serious neurological illness, such as encephalitis (inflammation of the brain) or meningitis (inflammation of the lining of the brain and spinal cord). As of this writing, there is no treatment or vaccine for the virus.

What happens if a person with diabetes contracts West Nile virus?

For people with diabetes, there is a known risk factor for contracting a severe case of West Nile virus. In addition, it appears that people who also had high blood pressure were more likely to develop a serious case of West Nile virus in comparison with healthier individuals who contracted the virus. It is estimated that people with diabetes were four times more likely to have serious complications from the virus, while people with high blood pressure were twice as likely to have serious complications. This is why health care professionals suggest that people with diabetes use insect repellent while outdoors in the summer, especially in areas in which West Nile virus has been reported (or when traveling to mosquito-infested areas, including some overseas spots). Because mosquitoes are most active at dusk and dawn, people should wear long sleeves and pants if they go outdoors during these times. Finally, anyone with diabetes who experiences any hyperglycemia or symptoms noted above should seek medical attention.

Are people with diabetes sensitive to temperature?

Yes, a person with diabetes can be temperature-sensitive, especially when it is hot. In fact, people with diabetes have to be extra cautious when the temperatures go up as extreme heat can affect their blood glucose levels, depending on what they have eaten, whether they are well-hydrated, and their level of physical activity. For example, studies have shown that older people with type 2 diabetes have a more difficult time cooling down in hot temperatures. One study also found that exercise and a subsequent rise in body temperature could be a difficult challenge to those with diabetes-indicating that people without diabetes were able to cool down twice as well as people with diabetes. The researchers believe this is because diabetes damages blood vessels, including those involved in regulating body temperature. (For more about diabetes and exercise in hot and cold conditions, see the chapter “Diabetes and Exercise.”)

How can extremely high temperatures affect diabetes medications and equipment?

Not only do extreme temperatures affect a person with diabetes, but they can also cause a problem with a person’s medications and testing equipment. Heat-especially combined with high humidity-can affect certain medications, especially long-term exposure to high temperatures. For example, many types of insulin are fine in temperatures ranging from 93–95° Fahrenheit (34–35° Celsius), but any higher, and the medication rapidly degrades. When temperatures are about 80° Fahrenheit (27° Celsius), with humidity higher than about 40 percent, not only are diabetes medications affected, but so also is diabetes-testing equipment, causing the equipment (including insulin pumps) to malfunction or batteries to stop functioning. In addition, a disconnected pump or supplies should not be left in a hot car, by a pool, in direct sunlight, or on the beach. According to the American Diabetes Association, it is best, in these conditions-or in any climate and temperature-to protect and take precautions to maintain medications, supplies, and equipment.

Because of the circulation problems diabetics suffer, frostbite is of special concern.

Can cold weather affect a person with diabetes?

Yes. In particular, people with diabetes often have problems with slower blood flow (vascular problems), especially to the extremities. For a person with diabetes who already has “sluggish” blood flow, cold weather can cause major problems, especially with staying warm. Because the blood flow in their extremities is less, the cold may further cause problems with feet and hands. Thus, people with diabetes who attend outdoor events or enjoy cold-weather activities should be aware of frostbite.

The cold can also affect the monitoring of a person’s blood glucose levels. For instance, if diabetes test strips are used to monitor glucose, the strips need a certain level of oxygen and blood flow to calculate the level accurately. Thus, a person who is too cold may obtain an incorrect blood glucose reading. And if the person attempts to get blood from his or her fingertip to test blood glucose levels, cold fingers make it more difficult to obtain a good blood sample. In such cases, warming the hands-many suggest holding the hands under their armpits-becomes necessary for a good reading.

What is Raynaud’s phenomenon or syndrome?

Raynaud’s phenomenon or syndrome is an autoimmune condition that causes a person’s hands and feet to become extremely cold. It is usually brought on by cold weather and/or stress, with symptoms ranging from extreme cold in the feet, toes, and/or hands to numbness. It is mostly due to the constriction of blood vessels in the extremities. If a person also has diabetes, the blood flow to the extremities is slower, thus creating an even colder (or numb) feeling in the hands and feet. This can also cause problems with blood glucose readings. Raynaud’s can cause a false reading if blood is taken from the hands or feet and will not represent the person’s blood glucose levels throughout the body. Thus, efforts to “correct” a blood-sugar level may be in error.

How can extremely cold temperatures affect diabetes medications and equipment?

Like extremely hot temperatures, cold temperatures can affect the medications and testing equipment (such as glucose monitors and test strips) of a person with diabetes. As in extreme heat, diabetes medications are affected by cold, especially liquids such as insulin. Diabetes-testing equipment can also be damaged by extreme cold, causing it to malfunction (especially insulin pumps and glucose monitors) or batteries to stop functioning. As with extreme heat, it is best to protect all diabetes medications and equipment from the cold if at all possible. If possible, take the medicines and equipment inside, as even leaving them in a car could cause problems in freezing temperatures.

How are variations in temperature detected by the body?

Temperature sensations are detected by specialized free nerve endings called cold receptors and warm receptors. Cold receptors respond to decreasing temperatures, and warm receptors respond to increasing temperatures. Cold receptors are most sensitive to temperatures between 50°F (10°C) and 68°F (20°C). Temperatures below 50°F (10°C) stimulate pain receptors, producing a freezing sensation. Warm receptors are most sensitive to temperatures above 77°F (25°C) and become unresponsive at temperatures above 113°F (45°C). Temperatures near and above 113°F (45°C) stimulate pain receptors, producing a burning sensation. Both warm and cold receptors rapidly adapt. Within about a minute of continuous stimulation, the sensation of warmth or cold begins to fade.

Is there any seasonal variation in diabetes?

It is truly unknown whether there is any seasonal variation in diabetes. But there are some interesting observations. For example, according to several studies, it appears that type 1 diabetes develops more often in the winter than in the summer. In addition, it is thought that type 1 diabetes is more common in cold climates. This fact is often thought to be why Northern Europeans have more type 1 diabetes than Southern Europeans. But more research needs to be done. After all, one of the warmest islands in the Mediterranean is Sardinia, where people have a high risk of developing diabetes.

DIABETES AND TRAVELING

What should a person with diabetes think about before driving a vehicle?

One of the major things a person with diabetes can do when driving is to make sure his or her blood glucose level is stable. This means the driver’s glucose levels are in a safe target range-not too low, causing a possible hypoglycemic episode, or too high, possibly causing a hyperglycemic episode. In addition, most people with diabetes carry certain items in their car, including snacks and supplies in case they are delayed in traffic. Some also carry a blood glucose meter and/or a glucagon kit in case of an emergency. (For details about glucagon kits, see the chapter “Taking Charge of Diabetes.”)

How can a person let local law officials know he or she has diabetes?

People with diabetes often experience episodes of hypoglycemia or low blood glucose. When that happens, the person seems to slur his or her words, may be irritable and pale, and may stagger and sweat-much like someone intoxicated or on drugs. If the person with diabetes is stopped by police during such an episode, officers may not know the difference. And although many communities have trained or are training first responders (police, firefighters, and emergency medical technicians) to spot and care for people with diabetes, there are things a person with diabetes can do to help.

It might be a good idea to have a snack available in the car in case you get stuck in traffic and need something edible to control your sugar levels.

Although wearing a medic-alert bracelet, necklace, or tattoo is good for identifying a diabetic in an emergency, many police officers suggest also carrying a card that identifies a person as diabetic (one in a wallet with the driver’s license and one with the car registration in case the other gets misplaced). There are several medic-alert cards that a diabetic-types 1 and 2, and gestational-can use, including those offered by the American Diabetes Association. Not only should the identification include information about the signs of low and high blood glucose (hypo- and hyperglycemia, respectively), but it also should carry a list of suggestions as to how the first responder can help treat both conditions.

Is it better for a person with diabetes to bring his or her own food when traveling?

This is a matter of personal preference. Some conditions do not warrant bringing foods, and there are even certain airlines-especially those from overseas-that do not allow certain foods to be carried on board owing to contamination risks.

What items should a person with diabetes carry on a trip?

Most people don’t leave behind their medicine when they embark on a trip, and a person with diabetes will need to remember not only medicine but also several items that may be vital to keep his or her blood glucose at a safe level. Bringing the proper supplies takes some planning, especially for people on insulin. On an extended trip, most people with diabetes carry snacks and supplies. They also have their blood glucose meter available and often a glucagon kit in case of a hypoglycemic episode.

How can a person with diabetes handle eating on a long trip?

For most diabetics, eating is often a trial when traveling long or short distances, and longer distances are the most challenging. Thus, most health care professionals suggest that a person with diabetes should stop frequently for meals if possible in order to keep his or her blood sugar levels balanced or should carry enough food to keep levels even. For insulin-dependent diabetics, knowing how their glucose levels respond to insulin and meals is necessary. And for those on oral medication, how much and what can be consumed in terms of food is necessary to know. This does not mean people with diabetes cannot celebrate on a trip, but it is important that they know how certain foods affect them. (For more about eating out, see the chapter “Shopping for Food and Eating Out.”)

Will the temperature in various places visited during a trip affect a diabetic’s insulin and/or diabetic medications?

Yes, temperature can affect some of the medications taken by a diabetic. In particular, insulin should be kept cool, but not frozen, as freezing destroys the insulin. In fact, if insulin is stored beyond 30 days, it should be refrigerated. (For more about taking care of diabetic medications, see the chapter “Taking Charge of Diabetes.”) There are even special coolers for diabetics who are traveling.

What are some conversion tables for blood glucose monitoring during travel outside the United States?

Not all glucose monitors are created equal. Therefore, it is necessary when traveling outside the United States (or for people coming into the United States) for diabetics to understand the differences in glucose monitoring. In the United States, monitors use milligrams per deciliter; in other countries, it is thousandths of a mole (mmol; a mole is the amount of any chemical substance that equals the number of atoms in 12 grams of carbon–2) per liter. The following chart gives some of those conversions:

Converting Moles per Liter to Milligrams per Deciliter

Mmol/l

mg/dl

0.06

1

0.07

0.28

5

0.29

0.55

10

0.56

2.2

40

2.3

2.8

50

2.9

3.3

60

3.4

3.9

70

3.10

1.4

80

1.5

5.5

100

5.6

6.1

110

6.2

7.2

130

7.3

8.3

150

8.4

9.4

170

9.5

11.1

200

11.2

13.9

250

13.10

16.6

300

16.7

20.0

360

21.0

22.2

400

22.3

27.7

500

27.8

40.0

720

41.0

50.0

900

Is there a cruise line that caters to people who need dialysis?

Yes, as of this writing, there is a cruise line that offers dialysis (link to http://www.dialysisatsea.com). But it does take planning. In addition, the services are usually not covered by insurance, and the times of travel vary widely. Another option for people who need dialysis may be to arrange for dialysis ahead of time at the cruise ship’s ports of call-something that a person’s home dialysis center may be able to help set up.

Do cruise lines cater to people with diabetes?

For many people, going on a cruise is a lifetime dream. But for a person with diabetes, it’s vital to understand what the cruise line of choice has to offer in terms of accommodations, foods and beverages, and medical facilities. For example, some cruise lines provide nutritional information, especially carbohydrate counts, that is important to a person with diabetes to maintain blood glucose levels. Thus, according to many diabetes organizations, the best way for a person with diabetes to approach a cruise is to ask questions and be prepared.

Cruise ships will make arrangements for the dietary needs of vacationers.

PREPARING FOR DISASTERS AND EMERGENCIES

Why should a person with diabetes prepare for possible disasters?

Disasters force people to leave their homes or offices quickly. Such emergencies can include train derailments or gas explosions or natural disasters, such as hurricanes, earthquakes, or tornadoes. Because a person with diabetes needs certain foods and medicine, diabetes organizations recommend that a diabetic have an emergency package to grab in times of emergency or disasters. Also, in temporary shelters, people with diabetes should identify themselves as such so they can get proper care if it’s available.

What are some tips to help people with diabetes plan for emergencies?

According to the Centers for Disease Control and Prevention, there are ways for a person with diabetes to prepare for a possible emergency or disaster. This is particularly important if the person lives in an area with the potential for natural emergencies (such as floods, snowstorms, tornadoes, hurricanes, or earthquakes). The following lists some of these suggestions, which can apply not only to an adult with diabetes but also to a family who has a child with diabetes (for more about websites that help a person with diabetes plan for an emergency, see the chapter “Resources, Websites, and Apps”):

Prepare an emergency supply of food and water, along with an adequate supply of medicine and medical supplies in an emergency kit. This should be a three-day supply for most areas, but amounts depend on the needs of the person. For more disaster-prone areas, it is probably best to have at least a week’s supply or more. (The person with diabetes should ask a pharmacist or health care provider-if the medications come from them-how to properly store the prescription medicines during an emergency.)

Keep a list of all the medicines (and any other medical information that may be important) handy. Most people keep such information on the refrigerator or on a kitchen or bathroom cabinet door. In case the person with diabetes cannot communicate during an emergency, a list is especially helpful to emergency personnel or others assisting the person with diabetes.

Keep a copy of all prescriptions and other important medical information in the emergency kit, along with the name and phone number of the health care provider(s) of the person with diabetes.

Keep a list of the types, model numbers, and number of medical devices used by the person who has diabetes.

Before an emergency happens, the person with diabetes, especially if he or she needs insulin, should plan how to handle medicine that normally requires refrigeration.

Periodically check the expiration dates on the medicines and supplies in the emergency kit, so there is not a problem if there is an emergency.

The person with diabetes-or a person who is providing him or her health care-should keep the emergency kit in easy reach in case of an emergency. The last thing a person wants in an emergency is to be unable to find necessary medications and equipment.

If a person with diabetes needs certain medical treatments-for example, kidney dialysis-it is best to ask the health care provider (or the person who administers the treatment) about emergency plans to care for the patient.

A person with diabetes should always wear identification that says he or she has diabetes. In addition, a person with diabetes should carry an emergency identification card at all times, especially when traveling-whether close to or far away from home.

A person with diabetes who takes insulin should find out from the health care provider what to do if the insulin (or any other necessary medication) runs out during an emergency.

How can parents protect their child with diabetes at school before an emergency happens?

If a parent has a child with diabetes at school, there are additional preparations that can be made in case of an emergency. According to the Centers for Disease Control and Prevention, parents can add several items to the adult emergency preparedness list (above) in order to help their child:

If a child has diabetes, and is in school or day care, understand the school’s emergency plans, so there will be no added confusion in an already-confusing emergency situation.

Make sure the school or day care has the supplies needed for the child with diabetes before an emergency happens.

Ask the school or day care whether anyone there could help the child with diabetes in case medications or injections are needed during an emergency.

What is geoenvironmental diabetology?

Geoenvironmental diabetology is the name for studies of how environmental stressors have negative effects on people with diabetes. It also includes studies of the interaction between the environment and people with diabetes. An even more specific definition of the research in this field is the study of how geophysical phenomena affect people with diabetes, including effects on metabolism; equipment, medications, supplies, access to care, and how people with diabetes cope with extreme natural circumstances. Researchers in this field examine such events as natural disasters (for example, earthquakes) and extreme weather (hurricanes, extreme cold, and heat waves). The study does not include how events in the physical world might trigger the disease but how environmental factors affect people with the disease.

For example, geoenvironmental diabetology studies of the Kobe and Mid-Niigata earthquakes in Japan (January 17, 1995, and October 2004, respectively) indicated a significant worsening of HbA1c levels in people with diabetes for up to six months following the disasters. In these cases, people with diabetes could not get to their medications and supplies, and medical care was disrupted. Most people lost insulin vials, needles, and other diabetes equipment because of the destruction. Such studies help officials and nongovernmental organizations determine and anticipate the best way to provide people with diabetes relief after natural disasters. These studies do not apply only to one area of the world but to many places that experience natural disasters. This field is in its infancy; many researchers believe it has a place in the modern world, especially with an expanding population exposed to extreme geologic and weather events. In addition, in many places, there is the threat of global climate change that many people-and many with diabetes-face.

How can a person with diabetes help prevent falls in the home?

According to many diabetes organizations and studies, falls, especially in the home, are the number-one cause of injury for people age 60 and older, as well as the second-likeliest cause of injury for people ages 40 to 59. According to a recent study, older adults with diabetes-especially those using insulin-are more likely to fall, causing injury and possible hospitalization. The researchers stressed that those people with diabetes were more likely to experience falls because of poor standing balance, a history of falling, and often an A1c of 8 percent or higher (for more about the A1c test, see the chapter “Taking Charge of Diabetes”).

Because of this risk of falling, health care professionals offer several suggestions to people with diabetes. These include controlling blood glucose levels; practicing balance and strength exercises (ask your doctor for suggestions as to the type of exercises needed); and keeping hallways, stairs, and major pathways in the home clear of boxes, cords, and sundry other items that are easy to trip over. If possible, have grab bars, railings, and nonslip rugs throughout the house (especially in the bathroom) to make navigation easier. Finally, see an eye care professional at least once a year. (Diabetics have more problems with vision loss than people without diabetes.)

Older adults with diabetes are even more likely to suffer injury from falls than those without the disease.

How can a person with diabetes help family and friends understand what to do in a diabetic emergency?

The best thing people with diabetes can do for themselves and their friends, families, and neighbors who check on them periodically is to leave a note of instructions on their refrigerator in case of a diabetic emergency. (Be sure to tell others where the list is located!) On the note, the person with diabetes should legibly list the emergency number (911 in most places), the hospital he or she would like to be taken to in an emergency, the location of the glucagon kit (with quick, visual instructions inside the kit), the primary-care physician’s name and telephone number, the insurance company (perhaps even a copy of the insurance card), and emergency contact numbers (family, friends, caregivers, etc.).

DIABETES AND BLOOD AND ORGAN DONATIONS

Can a person with diabetes give blood?

Yes, a person with diabetes can donate blood, platelets, and plasma. According to the American Red Cross (an organization that controls about 45 percent of the blood supply in the United States), people with type 1 or type 2 diabetes that is well controlled by insulin or oral medications are eligible to donate. Of course, other qualifications have to be met, such as being in good health, weighing over 110 pounds, and being over age 17. Some states also have their own specific restrictions, such as different age requirements, or, for example in California, refusing blood donation from a person who has diabetes and uses bovine-derived insulin.

Why are some people with bronze diabetes often not allowed to donate blood?

According to the American Red Cross, people with bronze diabetes, a form of diabetes caused by hemochromatosis (excess iron in the blood), are currently prohibited from giving blood donations. It is not necessarily the bronze diabetes that stops a person from donating but the overall hemochromatosis disease, which usually begins before bronze diabetes develops. (For more information about hemochromatosis and bronze diabetes, see the chapter “Other Types of Diabetes.”)

Not everyone agrees. Although there is no risk of passing on this genetic disease to other people through blood transfusions, the Red Cross still does not allow such donations. Yet the Food and Drug Administration does permit people with hemochromatosis to donate blood, as long as the blood is specially marked and there are certain restrictions and rules about how blood banks can use this blood. Because of such regulations, most blood banks in the United States currently do not accept donations by people with hemochromatosis. Most other countries do not have such rules and have no restrictions on people with hemochromatosis that keep them from donating blood.

Can a person with diabetes donate an organ-such as a kidney-to a relative?

No, in most cases, a person with diabetes cannot donate an organ to a relative. This is because the disease-whether type 1, type 2, or other type of diabetes-affects the kidneys, pancreas, and other organs to a certain extent depending on the person’s condition. In addition, the surgery for such operations often puts the person with diabetes at risk, mainly owing to a weakened immune system.

Can a person with diabetes donate an organ (or organs) upon death?

Yes, according to the National Kidney Foundation, if a person who had diabetes had normally functioning organs, then he or she can donate those organ(s) after death. But there is an exception: An insulin-dependent diabetic cannot donate the pancreas after death.

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