Tag: diabetes

YOUR DIAGNOSIS IS SERIOUS … WHAT NOW?

You just got the news that you’re very sick. To ensure your quickest, safest, and best outcome you must be actively engaged and lead you own care. As soon as you can balance your emotions, you will have to make important decisions about your doctors, treatment, care, and finances.

Click here for an even more detailed step-by-step explanation of each step.

LEARN

During the next few days, weeks, and months you must learn enough about your choices to make informed decisions. Likely, your doctor or health insurance provider has provided or will provide information specific to your diagnosis. This might be a pamphlet, web page, video, support group, app., or something else.

IT TAKES TIME

It will take time before you have processed your new diagnosis and balanced your emotions. It may take just a few days or several months. There are a wide range of emotions that people feel after getting a serious diagnosis. It’s important to realize that these feelings are all natural. It’s common to feel grief shock, anger, frustration, worry, and other emotions. It’s also common for people of any age to experience short-term changes in behavior after hearing such serious news.  Be reassured that in most cases your emotions and any physical changes like loss of sleep or diet are temporary. They typically start returning normal within weeks when there is support.  

KEY TIP: Science shows that you increase your chances for positive outcomes when you find at least one person, or a support group, you trust to talk to.

When you walk this journey alone, you increase the risk of things not working out for the best for many reasons. If there is no one in your life that you trust enough, consider finding comfort and support by seeking out and communicating with others who have experienced a similar diagnosis, and often recovery.

Shyness doesn’t matter in these groups. You can stay anonymous and just listen and learn from other posts and replies. Sometimes the comfort of being anonymous also lets you express your feelings to others who you hardly know, because you have shared a common experience.

You may also connect with care givers and family members as well as patients, both current and past. Support groups are often available in-person in most urban areas and online for anyone with a smart phone and/or Internet access. Here’s a link to hundreds of local and online support communities organized alphabetically by diagnosis.

KEY TIP: Trust, but research and verify everything you learn in chat rooms with your physicians and through published, peer-reviewed research and patient use cases.

If you’re emotions have not begun to balance within 30 to 60 days engage the support of your doctor. You’ll make better decisions once your emotions settle. It also is not advisable to make any immediate decisions regarding your health unless your doctor tells you that you must act quickly. If you must make a quick decision, seriously consider a second opinion from another clinician or experienced provider in as short a time as possible. You can stay within your network for the lowest cost or seek out world renowned clinicians at providers like the Cleveland Clinic, Stanford Health Care, and other major health centers for virtual second opinions within days.

KEY TIP: It’s a best practice to always contact your health insurance provider and ask questions until you understand any cost to you, and what you can do to get the lowest cost, highest quality care.

If your reactions to your diagnosis do not get better within a few weeks or if they get worse, ask your doctor about mental health counselors and support that is available. Click here for an even more detailed step-by-step explanation of each step.

Last revision: 08132022

Blood Glucose Accurately Predicts COVID-19 Severity

The Nov. 23 issue of Annals of Internal Medicine published an observational study that concluded that hyperglycemia (blood sugar level) independently predicted progression from noncritical to critical condition and death, regardless of prior Diabetes history,  among more than 11,000 patients with confirmed COVID-19, from 109 hospitals in Spain. This study informs how people admitted to a hospital even with mild hyperglycemia should be treated. Since it examines outcome by admission blood sugar level it eliminates the effect of any inpatient treatment.

Overview: Diabetic Self-management and Emergencies During Coronavirus

In most cases people can take steps on their own to correct when blood sugar is too low or high. Those steps are outlined later in this article. Sometimes, people need help. If you are close with someone who has diabetes, consider having a discussion with them about what they want in case of an emergency.

Diabetes and Illness

People with diabetes who get sick with the flu or common cold should stay home and limit contact with others. Other recommendations from the Centers for Disease Control (CDC) include:

  1. Continue taking diabetes medication and insulin.
  2. Test blood glucose every four hours.
  3. Drink extra (calorie-free) liquids.
  4. Eat as normally as possible.
  5. Weigh yourself daily
  6. Check your temperature daily.

The CDC recommends that you contact a health care professional or go to the nearest hospital emergency department if any of the following occur:

  1. Your too sick to eat.
  2. You are not able to keep food down for 6 hours or more.
  3. You are having severe diarrhea.
  4. You have lost 5 pound or more.
  5. You have a fever over 101 degrees F.
  6. Your blood sugar level is < 60 mg/dl or > 300 mg/dl.
  7. You have ketones in your urine.
  8. You have trouble breathing.
  9. You feel sleepy or are not thinking clearly.

Diabetes and Coronavirus

We are learning more about Coronavirus every day. People with Type 2 diabetes are at increased risk of severe illness from COVID-19, and people with Type 1 diabetes may be at greater risk as well.  You can not ensure you have no risk of infection from Coronavirus. When protective measures and strict social distancing can not be maintained, people with diabetes should seriously consider avoiding activities.[i]

High blood sugar (over 250 mg/dl) and low blood sugar (under 70 mg/dl) can be dangerous, and symptoms can turn into an emergency quickly. Knowing the symptoms and what to do when your blood sugars are high or low may save your life.

High Blood Sugar; ( > 250 mg/dl )

The problem with high blood sugar is that your body can start burning fat instead of blood glucose and/or you blood can become acidic in a way that damages vital organs. This can cause medical emergencies that can be fatal.

When your blood sugars regularly exceed 180 mg/dl you should work with your health insurance provider and doctor to find and schedule an appointment with an Endocrinologist.  An Endocrinologist specializes in Diabetes and get help you develop a treatment and management.  You can find one in your area by searching The American Association of Clinical Endocrinologists website.

There is also an uncommon and very serious problem called Hyperosmolar Hyperglycemic Syndrome (HHS) when blood sugar is extremely elevated ; > 600 mg/dl. According to WebMD, HHS happens mostly in older people with uncontrolled diabetes who are sick or have an infection, and often occurs over days or weeks.[ii]

Symptoms

Frequent urination, a fruity smell on your breath, extreme thirst, nausea, vomiting, and stomach pain. Any sudden or unexplained symptom is a signal to contact a doctor. At a minimum you should use a home test or dipstick test to check your urine for ketones. If ketones are present, you should contact your doctor for next steps

Treatments for High Blood Sugar

Drink water – to help your body release urine. You should discuss this method with your health care providers because you can drink too much water; specially if you have heart or kidney issues.

Administer Insulin – discuss with your doctor how much rapid acting insulin to inject when your blood sugar level is too high and check your blood sugar again after 30 minutes to ensure your blood sugar is going down.

Exercise – your body will burn sugar when your heart pumps faster than usual. Any exercise should be discussed before-hand with your health care providers, especially if you are a Type 1 Diabetic.

Low Blood Sugar; ( < 70 mg/dl )

Blood sugar can also be too low. This is called hypoglycemia. Without treatment, low blood sugar can also become life threatening. Blood sugar most often drops too low because a person takes too much insulin, consumes too much alcohol, misses meals, or does too much exercise.

Many times people with diabetes can feel when their blood sugar is too low. However, that’s not always the case. Even for people who have had diabetes for a long time. Symptoms of low blood sugar to be aware of include confusion, dizziness, nausea, hunger, nervousness, sweating, weakness, tiredness, tingling in extremities, and headache. More sever symptoms include seizures and a loss of consciousness.

Treatment for Low Blood Sugar

If at any time a person loses consciousness someone should call 911.

If a person is experiencing mild symptoms or knows that they have low blood sugar they should eat a high carb snack like a glucose tablet, candy, sweet juice, sugar. The American Diabetes Association recommends that you take 15 grams of a carbohydrate and test yourself after 15 minutes. If levels are still below 70 mg/dl take another 15 grams of carbs and test yourself again after 15 minutes.  Once blood sugar levels rise above 70 mg/dl eat a meal. If symptoms continue after eating 30 grams of carbohydrates seek medica help.

In an Emergency

Signs of a possible emergency include the persistence of any of the symptoms outlined above for a prolonged time. Symptoms indicating that the problem is overwhelming the body include chest pain, difficulty breathing, a sudden fever, a severe headache, weakness in a part of the body, seizures, and loss of consciousness.

When any of these symptoms are experienced a call to 911 or trip to the hospital emergency department is needed.  WebMD states that you should give them a glucagon shot to raise their blood levels. aPatientsPlace.com does not support untrained people giving medications to people unless there are no other options.

Diabetes also makes people 2 to 4 times more likely to have a heart attack. Know the common signs of a heart attack and call 911 immediately or go to a hospital emergency department when needed. Stroke risk is also increased with diabetes. Know the symptoms and how to seek emergency care.

In the Emergency Department the primary goals are rapid evaluation and stabilization.[iii] Once the person is stabilized their primary care doctor and Endocrinologist, if they have one, should be contacted for post-discharge follow up and diabetes management care planning.

References

[i] Centers for Disease Control and Prevention. July 30, 2020. People with Certain Medical Conditions. Accessible at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

[ii] WebMD Medical Reference. Nov. 19, 2018. Diabetes Emergencies: How You Can Help. Accessible at https://www.webmd.com/diabetes/diabetes-emergencies-what-to-do

[iii] Ford W, Self WH, Slovis C, McH=Naughton CD. Diabetes in the Emergency Department and Hospital: Acute Care of Diabetes Patients. Current Emergency and Hospital Medicine reports. 2013; 1(1):1-9. Doi:10.1007/s40138-012-0007-x

 

Checklist – Next Steps After a Serious Diagnosis

Last Revised:04/03/2022

By Warren Kolber, MHA

If you’ve just been told that you have a serious illness or life-threatening condition you do not need to take the journey back to health alone. In fact, this will happen to most people if they live long enough, and it happens millions of times in America every week.

Use the following steps to insure the highest quality care and best outcomes for yourself…, or click the Step-by-Step Patient Guidelines for more information;

1- Understand and balance your emotions.

2- Take control.

3- Learn about your condition.

4- Learn about your health insurance. 

5- Schedule and prepare for follow up appointment.

6- Find Support.

7- Ask questions of your doctor, specialists, other patients, and your insurance company.

8- Confirm your diagnosis.

9- Keep as many routines as possible.

10- Get and file copies of all your medical records; including doctor’s notes.

11. Consult an experienced specialist.

12. Schedule a second follow-up with your primary care to discuss treatment and care options.

13. Get second and even third opinions.

Schedule a phone chat, video chat, or via email to discuss your personal circumstances.

Reducing Cardiovascular Risk in People w/Type 2 Diabetes

If you’ve recently been diagnosed with Type 2 Diabetes and a significant cardiovascular risk you may want to review the 2017 guidelines on reducing cardiovascular risk  from the American Diabetes Association.

You may also want to review some of the evidence on Statin use and the development of Type 2 Diabetes from the British Journal of Clinical Pharmacology, with comments by the study author, Fariba Ahmadizar and Robert Eckel, MD professor of medicine and director of the Lipid Clinic at the University of Colorado Hospital. One of the items of note from that study was that overweight and obese people had  ah igher risk of developing Type 2 Diabetes associated with Statin use.

It’s important to understand that Statins lower cholesterol by blocking the production an enzyme in the liver that helps make cholesterol. A Patients Place also recommends reading the 2019 article by D. Schade, MD, on the common misconceptions of prescribing Statins to reduce cardiovascular disease in The American Journal of Medicine.