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“It Feels Like Home When You Eat Rice and Beans”: Perspectives of Urban Latinos Living With Diabetes. Diabetes Spectrum. 21(2):120-127. Spring 2008.
This article reports on a qualitative study that explored psychosocial issues that affect diabetes self-management for Hispanic/Latino men and women of primarily Caribbean ancestry. The study included 37 adults with diabetes in Bronx, NY, who were recruited to seven focus groups. The focus groups were conducted in Spanish and English, audiotaped, transcribed, and subjected to qualitative analysis. The authors report on the themes that emerged from these groups: the effect of diabetes on sexual health problems, perceptions about the link between depression and diabetes, intergenerational issues and their impact on participants’ beliefs about diabetes, and perceptions of discrimination and discontinuity in health care. The article includes numerous direct quotes from the focus group participants. The authors conclude that perspectives among Hispanic/Latino populations about living with diabetes are diverse, and more research is needed. 2 tables. 38 references.
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Genitourinary Complications. IN: Veves, A.; Malik, R.A., eds. Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. pp 453-472.
This chapter on genitourinary complications is from a textbook on diabetic neuropathy. The authors note that disturbances in bladder emptying or storage are often asymptomatic to the patient, particularly in the beginning of this diabetes complication. However, sexual dysfunctions are readily perceived by the patient. Topics covered include the physiology of micturition, the pathophysiology and clinical symptomatology of the diabetic bladder, a diagnostic approach and treatment options for micturition disturbances, the epidemiology of erectile dysfunction (ED), the physiology and pathophysiology of erection, treatment strategies for ED, other sexual problems in men with diabetes, and female sexual dysfunction. The authors stress that impairment of bladder storage and emptying as well as sexual dysfunction may have severe organic and psychosocial consequences, so their existence should be systematically screened for in the routine diabetes clinic. 3 figures. 3 tables. 74 references.
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Sex And Diabetes: For Him And for Her. Alexandria, VA: American Diabetes Association. 2007. 211 p.
This book helps readers diagnosed with diabetes, and their partners, understand how diabetes can complicate even the most loving and open relationships. The authors review common physical and emotional complications of diabetes and treatments for both men and women, then provide tips about how to talk with one's health care provider about the sexually related complications of diabetes. The book includes practical information about losing weight, exercising, and keeping physically healthy; ideas and tips for building sexual intimacy through music, movies, romantic foods, and more; information about how to avoid dangerous or money-wasting sexual health scams; and detailed suggestions to help spice up one's romantic life. Nearly all the pages in the book have sidebars noting specific tips, readers' suggestions and experiences, and summaries of the concepts presented in the text. One chapter offers a variety of healthy, diabetes-friendly recipes using ingredients purported to be aphrodisiacs. A final chapter lists resources that may prove helpful for readers seeking additional, reliable information about diabetes and diabetes-related sexual complications. A detailed subject index concludes the volume.
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Treatment of Erectile Dysfunction in Diabetic Men: Management of Nonresponders to Phosphodiesterase Type 5 Inhibitors. Practical Diabetology. 26(4): 18-21. December 2007.
This article considers the treatment of erectile dysfunction (ED) in men with diabetes, focusing on those patients who do not respond to phosphodiesterase type 5 (PDE-5) inhibitors, including Cialis, Levitra, and Viagra. The authors note that men with diabetes have a lower response rate to these agents than do other men. The article uses a case report of a 53-year-old man who presented to his primary care physician with the chief complaint of ED. He was treated with oral hypoglycemic agents and was able to significantly reduce his serum glucose level; sildenafil (Viagra) given to treat the ED was subsequently unsuccessful so he was referred to a urologist. Increased dosage of sildenafil, some lifestyle changes, and transdermal testosterone gel were prescribed successfully for this patient to achieve adequate erections for sexual intimacy and an improved libido and energy level. The authors go on to discuss the etiology of ED, the use of PDE-5 inhibitors in men with diabetes, a definition of nonresponders, and the suggested management of nonresponders, including ruling out other causes, changing the dosage of the PDE-5, and considering injections or surgery. 18 references.
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Diabetes in Clinical Practice: Questions And Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. 467 p.
This book deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. The book offers 30 chapters, beginning with an introduction to diabetes and followed by topics including the pathophysiology of type 1 and type 2 diabetes, glycemic control, hypoglycemic, diabetic coma, surgery in diabetes, acute illness in diabetes, diabetes and exercise, diabetes and pregnancy, diabetes and the young, diabetes and old age, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, microangiopathy in diabetes, diabetic foot, skin disorders in diabetes, sexual function in diabetes, musculoskeletal system and diabetes, infections in diabetes, hypertension and diabetes, lipids and diabetes, diabetes and driving, diabetes and travel, nutrition, oral medications, insulin, new therapies, and the prevention of diabetes. Each chapter presents three to six case studies, which are individually discussed, and relevant questions are posed and answered. Each chapter concludes with a list of references for further reading. Some chapters are illustrated with black-and-white photographs. A detailed subject index concludes the text.
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Diabetes in the Bedroom. Diabetes Forecast. 59(9): 54-57. September 2006.
This article helps readers with Type 1 diabetes learn how to enjoy a healthy and satisfying sex life by considering any diabetes-related concerns before heading into the bedroom. Written in a question and answer format, the article discusses the impact of sexual activity on blood glucose levels, how to know when to snack before or after sexual activity, how to manage an insulin pump (and its tubing) during sex, birth control issues, the carbohydrate content of bodily fluids, diabetes as a cause of erectile dysfunction and ejaculation problems, diabetes as a cause of female sexual problems (including susceptibility to yeast infections and lack of lubrication), and the impact of diabetes on one’s libido. The author cautions that depression can also play a role in lack of interest in sexual activities and there is a common link between diabetes and depression. One side bar offers suggestions for readers who want to keep their own sexuality alive: control blood glucose levels, exercise, have hormone levels check, check other medications, take plenty of time, and communicate with one’s partner. Readers are also encourage to talk with their health care provider about any sexual concerns they may have.
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Diabetic Neuropathies. IN: Mensing, C., ed. Art and Science of Diabetes Self-Management Education. Chicago, IL: American Association of Diabetes Educators. pp. 550-572.
Diabetic neuropathy (DN) is not a single entity, but rather a number of different syndromes, each with a range of clinical and subclinical manifestations. This chapter on diabetic neuropathies is from a comprehensive text that serves as a resource for all health professionals, community professionals, and individuals who provide education to individuals with diabetes. Topics covered include diagnostic strategies, neuropathic pain, subclinical neuropathies, generalized symmetrical polyneuropathy, autonomic neuropathy, gastrointestinal disorders related to autonomic neuropathy, sexual dysfunction, bladder dysfunction, sweating disturbances, focal and multifocal neuropathies, treatment of diabetic neuropathies based on pathogenetic mechanisms, and controversies in neuropathy management. A thorough history and detailed physical examination, together with the aid of simple clinical tests, are essential for the diagnosis. Small-fiber neuropathy may lead to foot ulceration and subsequent gangrene and amputation. Large-fiber neuropathy produces numbness, ataxia, and impairment of quality of life and may lead to falls and fractures. Recent studies on new agents that target the pathophysiological mechanisms have led to a better understanding of the pathogenesis of diabetic neuropathy as well as the pain mechanisms for the different types of pain syndromes. The chapter includes a list of key points, a summary of teaching strategies, case studies, suggested Internet resources, a glossary of key terms, and a list of references. 6 tables. 90 references.
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Erectile Dysfunction. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 363-376.
This chapter on erectile dysfunction (ED) is from a comprehensive text on obesity and diabetes. ED is defined as the consistent or recurrent inability to attain or maintain a penile erection sufficient for sexual intercourse. ED is a common sexual dysfunction, especially among men with diabetes. Diabetes mellitus, hypertension, hyperlipidemia, and coronary artery disease are known to increase the likelihood of having ED. The author discusses a definition and epidemiology of ED, its pathophysiology, the diagnostic evaluation, treatment options, and the costs of various treatments. Vascular impairment in diabetes will lead to ED from large-vessel disease, but more important, from problems with intrapenile blood flow. Diagnostic components should include the patient's history, a physical examination, and diagnostic testing, including tests that measure nocturnal penile activity and patient symptom surveys. Treatment options include optimizing glycemic control, oral medications, injectable therapy, transurethral therapy, vacuum assistance devices, constriction rings, and penile implants. 1 figure. 5 tables. 35 references.
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Sexual Dysfunction and Diabetes. Today's Dietitian. 8(9): 25-26. September 2006.
This article helps dietitians understand the impact of diabetes on sexual function. The author notes that sexual dysfunction potentially affects a rather large number of people, yet, due to its private and subacute nature, it is a problem that may often be overlooked or ignored by patients and providers alike. Research suggests that men with diabetes commonly struggle with erectile dysfunction (ED) but generally experience no impact on levels of sexual desire. Women may have decreased sexual desire and can also experience difficulties with arousal, vaginal lubrication, and painful intercourse. The author reviews these problems and the role of diabetes complications (such as neuropathy) in their development. The author notes that while most dietitians probably will not be directly addressing issues of sexuality with their clients, recognition of the impact that diabetes has on various aspects of the client’s life is an important part of providing quality, holistic health care. References are available through references@gvpub.com.
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Sexual Function And Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 251-260.
This chapter on sexual function and diabetes is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include the repercussions of diabetes mellitus (DM) in sexual life, including erectile dysfunction and its management, and ejaculation disturbances; the role of vascular disease risk factors; sexual problems in women with diabetes; and the use of oral contraceptive pills in women with diabetes, including the risk of complications such as thrombophlebitis and pulmonary embolism. The chapter presents three detailed case studies, with relevant questions posed and answered. Readers are walked through the diagnostic and patient care management process for the case studies presented. 6 references.
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Sexual Wellness. Diabetes Self-Management. 23(2): 19-22. March April 2006.
This article explores sexual dysfunction and sexual wellness, focusing on people with diabetes. The author cautions that up to 50 percent of people with diabetes will experience some sort of sexual dysfunction at some point. In addition, other diabetes-related health issues can influence one’s sexual disease and can be a threat to intimacy within a relationship. The article covers specific problems, including desire disorders (decreased libido), hormonal changes, arousal disorders (including erectile dysfunction), orgasm disorders, and pain disorders. The author outlines the complications of diabetes that may have an impact on sexuality, including high blood glucose levels, impaired circulation, and neuropathy; encourages readers to try preventive and proactive strategies to any sexual concerns; and advises readers to consult their diabetes or other health care provider for assistance. The article concludes with a section reminding readers of the importance of healthy and open communication between sexual partners, particularly as they deal with any sexual concerns that may arise. 3 references.
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Care of Children and Adolescents With Type 1 Diabetes: A Statement of the American Diabetes Association. Diabetes Care. 28(1): 186-212. January 2005.
In caring for children with diabetes, professionals need to understand the importance of involving adults in the child's diabetes management. The education about how to care for a child or adolescent with diabetes must be provided to the entire family unit, emphasizing age and developmentally appropriate self-care and integrating same into the child's diabetes management. This American Diabetes Association Statement provides a single resource on current standards of care pertaining specifically to children and adolescents with type 1 diabetes. It is not meant to be an exhaustive compendium on all aspects of the management of pediatric diabetes. However, relevant references are provided and current works in progress are indicated as such. The information provided is based on evidence from published studies whenever possible and, when not, supported by expert opinion or consensus. The Statement discusses and provides recommendations in the areas of diagnosis, initial care, diabetes education, identification (medical tags), appropriate self-management by age, glycemic control, insulin management of diabetes, blood glucose monitoring, nutrition, medical nutrition therapy (MNT), exercise, assessment of child and family risk factors at diagnosis, psychosocial issues, acute complications, immunization, chronic complications, associated autoimmune conditions, adjustment and psychiatric disorders, adolescence, adherence to self-management, and special situations, including sick day management, and diabetes care at school and day care. A final section considers risk behaviors, including use of tobacco and recreational drugs and unprotected sexual intercourse. 4 tables. 237 references.
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Conversation About Your Sex Life: Is It Time to Talk?. Diabetes Vital. 1(3): 4. Fall 2005.
Sexual dysfunction is a common occurrence in diabetes, yet is not often talked about when discussing complications of the disease. This brief article describes how poorly controlled diabetes, blood glucose fluctuations, and medication side effects can affect sexual function and libido (desire). The author provides five simple tips to remember when talking with one's partner about sexual dysfunction. These are: choose the right moment, be open and honest, share responsibility, stay connected, and prepare together for any visits to health care providers to get help with sexual dysfunction. The author encourages readers to communicate openly with their partners as well as with their health care providers in addressing any concerns about sexual dysfunction.
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Urinary Incontinence and Diabetes in Postmenopausal Women. Diabetes Care. 28(7): 1730-1738. July 2005.
This article reports on a study that evaluated diabetes characteristics and other risk factors for urinary incontinence among community-dwelling post-menopausal women. The cross-sectional analysis included 1,017 postmenopausal women (218 with diabetes) aged 55 to 75 years, enrolled from a health maintenance organization. Overall, 60 percent of the women had any incontinence in the prior month and 8 percent had severe incontinence. Parity (the number of pregnancies a woman has had) and post void residual bladder volume were not associated with incontinence). Oral estrogen and vaginal estrogen use were positively associated with a report of any incontinence but not severe incontinence. A history of urinary tract infection (UTI) and measures of general health were associated with both outcomes. Women with diabetes reported disproportionately more severe incontinence, difficulty controlling urination, mixed (stress and urge) incontinence, use of pads, inability to completely empty the bladder, being unaware of leakage, and discomfort with urination. Multiple regression analyses showed that diabetes duration, treatment type, peripheral neuropathy, and retinopathy (eye disease) were significantly associated with severe incontinence; However additional adjustment for body mass index (BMI) diminished the strength of the relationship. 3 tables. 35 references.
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Urologic Complications of Diabetes. Diabetes Care. 28(1): 177-185. January 2005.
Diabetes mellitus is associated with an earlier onset and increased severity of urologic diseases, resulting in costly and debilitating urologic complications. Urologic complications, including bladder dysfunction, sexual and erectile dysfunction, as well as symptomatic and asymptomatic urinary tract infections (UTIs), have a profound effect on the quality of life of men and women with diabetes. This review article presents an overview of the current understanding of clinical and basic research on urologic complications of diabetes and recommendations for future directions for research and clinical care. The authors note that research studies that define expected prevalence, incidence, and risk factors, as well as interventions to reduce the risk of developing these complications, are limited. However, intensive glycemic control delays the onset and progression of microvascular complications of diabetes in both type 1 and type 2 diabetes. If microvascular complications also damage the vascular and neurologic innervation of the urethral sphincter, bladder, and corpora cavernosa, then intensive glycemic control may prevent or improve the severity of urologic complications. The authors conclude by reiterating the need for new research initiatives to better understand the disease mechanisms and burden of urologic complications in men and women with diabetes. 118 references.
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Diabetic Neuropathy: Early Clues, Effective Management. Consultant. 44(12): 1549-1556. October 2004.
This article guides physicians in a structured approach to the diagnosis and treatment of diabetic neuropathy (nerve disease associated with diabetes mellitus). The author stresses that the early signs of diabetic neuropathy can be detected during a routine clinical examination and annual surveillance for evidence of neuropathy and intensive diabetes management can reduce the incidence of complications. Physicians should inspect patients' feet for deformities and for sensory loss, which indicate risk of ulceration. Prolonged poor glycemic (blood glucose) control, alcohol abuse, and obesity increase the risk of amputation. Autonomic dysfunction, which can lead to sexual dysfunction and gastropathy (gastrointestinal problems), can be detected by measurement of heart rate and blood pressure. Electromyography and nerve conduction studies can be used to confirm a diagnosis of diabetic neuropathy. Improved metabolic control is the main goal of treatment. Analgesics, neuromodulators, and tricyclic antidepressants are effective for managing pain. 1 figure. 3 tables.
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Erectile Dysfunction Treatments. Diabetes Spectrum. 17(4): 232. 2004.
This patient education fact sheet discusses erectile dysfunction (ED), formerly called impotence. Defined as an inability to achieve or maintain an erection long enough for sexual intercourse, ED is a common problem for men with diabetes. The fact sheet focuses on the treatments available, including ED medications such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis); other drugs used for ED, including alprostadil, which is injected into the penis, and testosterone patches; counseling; vacuum devices; and surgery. Readers are encouraged to learn more about ED and its treatments by meeting with their health care provider.
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Learn the Risks: You Have the Power to Prevent Kidney Disease. Bethesda, MD: National Kidney Disease Education Program. 2004. 4 p.
People with diabetes, high blood pressure, or a family member with kidney failure are more likely to develop kidney disease. This brochure helps African Americans understand the risk factors for kidney disease, a problem that is more prevalent in this community than in white Americans. The brochure outlines the basic physiology of the healthy kidneys, reminds readers that kidney disease often strikes without warning symptoms, and reviews the impact of hypertension and diabetes on the incidence of kidney disease. Diabetes is the most common cause and hypertension is the second leading cause of kidney failure, thus strategies to control these conditions may prevent kidney disease as well. A tear-away card is included that lists questions for readers to ask their health care providers, as well as tips for talking with members of their health care team. Readers are also referred to the National Kidney and Urologic Diseases Information Clearinghouse (www.kidney.niddk.nih.gov) and the National Kidney Disease Education Program (www.nkdep.nih.gov) for more information. The brochure is illustrated with photographs of African Americans.
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Sexual and Urologic Problems of Diabetes. Bethesda, MD: National Diabetes Information Clearinghouse. 2004. 8 p.
This fact sheet provides information about the sexual and urologic problems that can be experienced by people with diabetes. Sexual and urologic complications of diabetes are related to the nerve damage that diabetes can cause. The fact sheet first describes sexual problems in men with diabetes, including erectile dysfunction (ED), and retrograde ejaculation. The next section discusses sexual problems in women with diabetes, which can include decreased vaginal lubrication and decreased or absent sexual response. The fact sheet then discusses urologic problems, including neurogenic bladder and urinary infections. A final section considers whether or not these complications are inevitable and how people with diabetes can lower their risk of sexual and urologic problems, primarily by controlling their diabetes through diet and exercise. Readers are referred to other publications available from the National Kidney and Urologic Diseases Information Clearinghouse. The contact information for four resource organizations is provided, as is a brief description of the goals and activities of the National Diabetes Information Clearinghouse. 1 figure.
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Prevalence and Predictors of Sexual Dysfunction in Patients With Type 1 Diabetes. Diabetes Care. 26(2): 409-414. February 2003.
This article reports on a study aimed to measure the prevalence of sexual dysfunction in patients with diabetes; describe how descriptive variables, psychological variables, diabetic complications, and sexual dysfunction relate in patients with diabetes; and describe the predictors of sexual dysfunction in patients with diabetes. A total of 240 adults type 1 diabetes patients visiting the outpatient diabetes clinic of an university hospital completed questionnaires evaluating psychological adjustment to diabetes and sexual functioning. Medical records were used to obtain HbA1c (glycosylated hemoglobin, a measure of blood glucose over time) values as well as information on microvascular diabetes complications. Sexual dysfunction was reported by 27 percent of women and 22 percent of men. No differences were found between sexes in type of reported sexual dysfunction. In men, but not in women, sexual dysfunction was related to age, body mass index (BMI), duration of diabetes, and diabetes complications. No correlation with HbA1c was found in either sex. In women, but not in men, sexual dysfunction was related to depression and the quality of the partner relationship. Analyses demonstrated that, in men, the significant predictors of sexual dysfunction were higher age and presence of complications, whereas, in women, sexual dysfunction was related to depression. The authors conclude that both women and men with diabetes are at increased risk for sexual dysfunction. 4 tables. 30 references.
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Sildenafil Citrate for Treatment of Erectile Dysfunction in Men With Type 1 Diabetes. Diabetes Care. 26(2): 279-284. February 2003.
In 5 to 10 percent of men with type 1 diabetes, erectile dysfunction (ED) may be a particularly common and unwanted complication. This study focuses on the effects of sildenafil (Viagra) in men with type 1 diabetes and ED. A total of 188 patients were entered into a double-blind, placebo-controlled, parallel-group, flexible-dose study and were randomized to received sildenafil (n = 95) or placebo (n = 93) for 12 weeks. Efficacy was evaluated using questions three (Q3; achieving an erection) and four (Q4; maintaining an erection) from the International Index of Erectile Function (IIEF), a global efficacy question (GEQ) and a patient event log of sexual activity. Improvements in mean scores from baseline to end of treatment for IIEF Q3 (35.7 percent versus 19.9 percent) and Q4 (68.4 percent versus 26.5 percent) were significant in patients receiving sildenafil compared with those receiving placebo. Moreover, the percent of improved erections (GEQ, 66.6 versus 28.6 percent) and successful intercourse attempts (63 percent versus 33 percent) was significantly increased with sildenafil compared with placebo. Improvements in sexual function were seen irrespective of the degree of ED severity. Adverse events were generally mild to moderate in severity, with headache (20 percent versus 8 percent), flushing (18 percent versus 3 percent), and dyspepsia (8 percent versus 1 percent) reported more often in the sildenafil than in placebo-treated patients. The authors conclude that treatment with sildenafil for ED was effective, resulting in an increased percentage of successful attempts at intercourse, and was well tolerated among men with type 1 diabetes. 2 figures. 2 tables. 32 references.
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Williams Textbook of Endocrinology. 10th ed. St. Louis, MO: Elsevier, Health Sciences Division. 2003. (CD-ROM)
This textbook of endocrinology serves as a bridge between basic science and clinical endocrinology. Forty-one chapters are provided in ten sections: hormones and hormone action, hypothalamus and pituitary, thyroid, adrenal, reproduction, endocrinology and the life span, mineral metabolism, disorders of carbohydrate and lipid metabolism, polyendocrine disorders, and paraendocrine and neoplastic syndromes. Specific topics include: principles of endocrinology; the endocrine patient; genetic control of peptide hormone formation; mechanism of action of hormones that act as nuclear hormone receptors; mechanism of action of hormones that act at the cell surface; laboratory techniques for recognition of endocrine disorders; neuroendocrinology; the anterior pituitary; the posterior pituitary; thyroid physiology and diagnostic evaluation of patients with thyroid disorders; thyrotoxicosis; hypothyroidism and thyroiditis; nontoxic goiter and thyroid neoplasia; the adrenal cortex; endocrine hypertension; the physiology and pathology of the female reproductive axis; fertility control: current approaches and global aspects; disorders of the testes and the male reproductive tract; sexual dysfunction in men and women; endocrine changes of pregnancy; endocrinology of fetal development; disorders of sex differentiation; normal and aberrant growth; puberty: ontogeny, neuroendocrinology, physiology, and disorders; endocrinology and aging; hormones and disorders of mineral metabolism; metabolic bone disease; kidney stones; type 2 diabetes mellitus; type 1 diabetes mellitus; complications of diabetes mellitus; glucose homeostasis and hypoglycemia; obesity; disorders of lipid metabolism; pathogenesis of endocrine tumors; multiple endocrine neoplasias; the immunoendocrinopathy syndromes; gastrointestinal hormones and gut endocrine tumors; endocrine-responsive cancer; humoral manifestations of malignancy; carcinoid tumors, carcinoid syndrome, and related disorders. Each chapter is written by experts in the field and concludes with extensive references; a subject index concludes the textbook. The CD-ROM format enables powerful search capabilities, as well as links to MEDLINE abstracts for many of the references.
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2002 Day-by-Day Diabetes Calendar: Daily Words of Diabetes Wisdom. McLean, VA: International Medical Publishing. 2002. [338 p.].
This spiral bound calendar offers daily words of diabetes wisdom, as well as space to record one's diabetes management goals and monitoring figures. The calendar encourages readers to set daily attainable goals and to take each day as a new diabetes beginning. The daily calendar pages (Saturday and Sunday share a page) offer a fact about diabetes, or a recipe, or a motivational quotation; space for notes; space for daily blood glucose scores; and related medical facts. Specific topics include historical markers in the understanding and care of diabetes, psychosocial factors associated with diabetes, foot care, skin care, hemoglobin A1C, risk factors for certain ethnic groups, weight loss, the benefits of tight blood glucose control, sugar in medicines, dietary fiber, diagnostic tests, exercise, self monitoring of blood glucose (SMBG), camping, blood pressure and its control, preventing kidney diseases, eye care, pregnancy, oral health and dental care, sexual dysfunction, drugs used to treat type 2 diabetes, obesity in children, nutrition and working with a dietitian, insulin injections, diabetes in pets, baking hints, smoking cessation, parenting, cholesterol, gestational diabetes, patient education, and celebrating holidays. Recipes include barbeque chicken Thai, spicy black bean soup, rosemary roasted red potatoes, peach angel food cake, Southwestern chicken and black bean stew, grits, baked potato salad with dill, Cuban rice and beans, roasted vegetable stew, cheese ravioli, chicken marinade, apple pie, hot cross buns, spring rolls, tangy baked chicken, broccoli spaghetti, tabbouleh (bulgur salad), summer pasta salad, turkey loaf, Italian vegetable sandwich, apple muffins, chili with rice, teriyaki tuna, chicken kabobs, gazpacho, cucumber salad with tofu, chicken and broccoli pasta, fried butternut squash, flounder fillets with spinach, Chinese chicken salad, artichoke pasta, basmati rice, Greek chicken pasta, zucchini patties, apple chicken, veggie fajitas, fruit pudding, eggplant and tomato pie, pesto, hummus, chicken chowder, baked spaghetti, fruit salad, granola, barley salad with almonds and apricots, dirty rice, vegetarian chili, sugar free Christmas cutouts, Waldorf salad, stuffed potatoes, and quesadillas. The calendar concludes with a list of resource organizations, with their telephone numbers and websites noted.
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Diabetes and the Risk of Acute Urinary Tract Infection Among Postmenopausal Women. Diabetes Care. 25(10): 1778-1783. October 2002.
This article reports on a study that examined whether the presence of diabetes alters the risk of acute urinary tract infection (UTI) in postmenopausal women. The authors conducted a case-control study of the Group Health Cooperative of Puget Sound (GHC), a staff-model nonprofit health maintenance organization in Washington State. Subjects were women aged 55 to 75 years who had been members of GHC for at least 1 year and who had had an acute symptomatic UTI within the preceding month. Of the 901 case and 913 control subjects, diabetes was reported in 13.1 and 6.8 percent, respectively. The health plan diabetes registry confirmed the diagnosis in 92 percent of women who self-reported the condition. The age-adjusted odds ratio for UTI in relation to self-reported clinician-diagnosed diabetes was 2.2. Adjustment for frequency of sexual intercourse and history of UTI had little effect on this estimate. Compared with nondiabetic women, higher UTI odds were seen in subjects who used oral hypoglycemic agents and insulin, but not in subjects with untreated diabetes or diabetes treated by lifestyle changes. The authors conclude that diabetes under pharmacologic treatment is associated with increased risk of clinically apparent UTI in postmenopausal women. 3 tables. 28 references.
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Long-Term Complications. In: Edelman, S.V. and Henry, R.R. Diagnosis and Management of Type 2 Diabetes. Caddo, OK: Professional Communications, Inc. 2002. p. 211-254.
This chapter on the long term complications of type 2 diabetes is from a handbook for primary care providers that offers a concise overview of the diagnosis and management of type 2 diabetes. Patients with type 2 diabetes are prone to long term complications including macrovascular disease; microvascular disease, including diabetic retinopathy (eye disease), diabetic neuropathy (nerve disease), diabetic nephropathy (kidney disease), and diabetic foot disorders. Diabetic neuropathy can encompass complications including gastroparesis (delayed stomach emptying), diabetic diarrhea, neurogenic bladder, impaired cardiovascular reflexes, and sexual dysfunction. The authors describe each of these complications and outline steps (focusing primarily on drug therapies) that can be taken to prevent or treat each problem. They stress that the long term, chronic complications of diabetes have the greatest impact on the health of individuals with diabetes as well as on the health care system. Consequently, early detection and aggressive treatment of these complications are essential to reduce associated morbidity and mortality. 3 figures. 10 tables. 38 references.
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Sexual Dysfunction in Women with Type 1 Diabetes: a Controlled Study. Diabetes Care. 25(4): 672-677. April 2002.
This article reports on a study undertaken to examine the prevalence of sexual problems in women with type 1 diabetes, to compare this prevalence rate with that of an age-matched control group, to study the influence of diabetes-related somatic factors on female sexuality, and to study the influence of psychological variables on the sexual functioning of both groups. A total of 120 women with diabetes visiting an outpatient diabetes clinic completed questionnaires evaluating psychological adjustment to diabetes, marital satisfaction, depression, and sexual functioning. Medical records were used to obtain data on HbA1c (glycosylated hemoglobin, a measure of blood glucose levels over time), use of medication, body mass index (BMI), and early onset microvascular (blood vessel) complications. An age-matched control group of 180 healthy women attending an outpatient gynecological clinic for preventive routine gynecological assessment also completed the non-diabetes-related questionnaires. More women with diabetes than control subjects reported sexual dysfunction (27 percent versus 15 percent), but a significant difference was found only for decreased lubrication. No association was found between sexual dysfunction and age, BMI, duration of diabetes, HbA1c, use of medication, menopausal status, or complications. Women with more complications, however, reported significantly more sexual dysfunctions, and the presence of complications altered treatment satisfaction. Both diabetic and control women with sexual dysfunction mentioned lower quality of the marital relation and more depressive symptoms than their respective counterparts without sexual problems. Depression was a significant predictor for sexual dysfunction in both women with diabetes and in control subjects. The authors conclude that sexual problems are frequent in women with diabetes. They affect the overall quality of life and deserve more attention in clinical practice and research. 2 tables. 27 references.
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Uncomplicated Guide to Diabetes Complications. 2nd ed. Alexandria, VA: American Diabetes Association. 2002. 294 p.
Diabetes mellitus can result in many complications, but many of them can be prevented. This book explains to patients how early testing, new medical treatments, and improvements in diabetes control can prevent or slow the development of complications. Each complication is discussed, including symptoms, medical treatments, and self care approaches, in nontechnical language. Twenty chapters cover acute complications (diabetic ketoacidosis or DKA, and hyperosmolar hyperglycemic state or HHS), hypoglycemia (low blood glucose levels), foot problems, eye disease (diabetic retinopathy), heart disease, cholesterol and other blood fats, stroke, hypertension (high blood pressure), nephropathy (kidney disease), peripheral vascular disease, peripheral neuropathy (nerve disease), autonomic neuropathies, gastrointestinal complications, infection and diabetes, diabetes and skin, psychosocial complications, men's sexual health, women's sexual health, oral health, and prevention strategies. This edition includes information on the discoveries and recommendations from the recently completed Diabetes Prevention Program, which linked improved diet and exercise with a slow-down in the development of diabetes and of its complications. One appendix lists medical tests, including recommended scheduling for those tests. A brief description of the activities and resources of the American Diabetes Association is included. A subject index concludes the book.
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UTIs: Prevention and Treatment. Diabetes Forecast. 55(8): 28-30. August 2002.
Urinary tract infections (UTIs) are more common in women than in men and more prevalent in women with diabetes. This article reviews the prevention and treatment of UTIs in women with diabetes. Topics include the anatomy and physiology of the female urogenital tract, blood glucose levels as a risk factor for UTIs, the diagnosis of a UTI, treatment strategies, the symptoms of UTIs, prevention methods, and risk factors (including age, frequent sexual activity, poor hygiene, pregnancy). The author concludes that good bladder health practices can help all women to reduce their changes of getting UTIs. Frequent and recurring infections put a woman at risk for kidney infections. High blood glucose provides a rich environment for bacteria to grow; by maintaining good blood glucose control, women can reduce their risk of bladder infections.
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Celebrate Your Sexuality. Diabetes Forecast. 54(5): 73-74, 76. May 2001.
This article reviews steps women who have diabetes can take to rekindle sexual intimacy regardless of their age. First, women should ask themselves whether the sexual difficulties they are experiencing pose a real problem. Women who feel that they are missing out on something they once enjoyed should talk with their health care provider. A thorough examination will rule out any physical problems that could be interfering with libido. Women should also discuss any emotional problems they may be having in their relationship and should inform their doctor if they are feeling depressed. Women may experience sexual desire, but may still have problems feeling aroused. Vaginal dryness may indicate a problem with arousal. This problem can be caused by certain medicines, vaginal infections, neuropathy, or poor circulation. Nonprescription vaginal lubricants may help. Some women may feel sexual desire and be able to become aroused, but they may still have trouble achieving orgasm. Many conditions contribute to this problem, including obesity, vaginal dryness, vaginal infections, and other vaginal conditions. Poor blood glucose control can also affect sexual pleasure.
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Celebrating Your Sexuality. Diabetes Forecast. 54(5): 39-41. May 2001.
This article uses a question and answer format to review ways women who have diabetes can have healthy and sexually fulfilling lives. The article begins by explaining how women define sexuality. This is followed by a discussion of the relationship between diabetes and physical health. Sexual activity involves physical exertion and can cause low blood glucose. Women should not ignore the symptoms of hypoglycemia. They should treat them as soon as possible. Women need to talk with their partner about the potential for low blood glucose, its symptoms, and how to treat it. Diabetes can also affect the nerves and blood vessels of the female sexual organs. In addition, high blood glucose can increase the chance of vaginitis, yeast infections, and urinary tract infections, which can interfere with enjoyment of sexual activity. Hyperglycemia can also reduce energy levels and vitality. Some medications can interfere with a woman's desire for sex, affect the circulation of blood, or affect the function of muscles and nerves involved in the sexual response. Emotional problems caused by diabetes may also interfere with a woman's sexual relationships. The article advises readers to seek counseling if they are having difficulty with physical and emotional intimacy.
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Diabetes and Erectile Dysfunction. Clinical Diabetes. 19(1): 45-48. February 2001.
This article provides clinicians with information on the etiology, diagnosis, and treatment of erectile dysfunction (ED). Awareness of ED as a significant and common complication of diabetes has increased in recent years. Studies suggest that the prevalence of ED in men with diabetes ranges from 35 to 75 percent versus 26 percent in the general population. Although the causes of ED are numerous, they generally fall into the categories of organic and psychogenic. The organic causes can be subdivided into the categories of vascular, traumatic/postsurgical, neurological, endocrine induced, and drug induced. Examples of psychogenic causes include depression, performance anxiety, and relationship problems. The natural history of ED in men who have diabetes is normally gradual. Both vascular and neurological mechanisms are commonly involved. Autonomic neuropathy is a major contributor to the high incidence of ED in men who have diabetes. The first step in evaluating ED is a thorough sexual and medical history and physical examination. Although few simple laboratory tests can help identify obvious causes of organic ED, initial tests should include glycosylated hemoglobin, free testosterone, thyroid function tests, and prolactin levels. Preventive measures such as improving glycemic control and hypertension, quitting smoking, reducing excessive alcohol intake, and avoiding medications that may contribute to ED may help reduce the risk of developing ED. However, once ED has developed, oral agents such as sildenafil and yohimbine are considered first line therapy. Intracavernosal injections are an acceptable alternative for men who are not candidates for oral therapy. Mechanical therapy with vacuum assisted erection devices is also effective, and penile prosthesis is a viable option. The article is accompanied by a patient information sheet.
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Diabetic Autonomic Neuropathy. Practical Diabetology. 20(2): 48-49. June 2001.
Autonomic neuropathy affects the nerves that regulate involuntary body functions and systems such as the digestive system, the sexual organs, the urinary tract, the heart, and the sweat glands. Symptoms include sexual dysfunction, delayed emptying of the stomach (gastroparesis), diarrhea, and difficulty urinating. This patient education fact sheet describes diabetic autonomic neuropathy (DAN), the reasons to get tested for this condition, diagnostic tests used to confirm DAN, and how to prevent and modify the complications that can occur from DAN. DAN is usually diagnosed using heart rate variability (HRV) testing. This easy, noninvasive test looks at how one of the organs controlled by the nervous system (the heart) responds to simple exercises. Three exercises are performed: breathing deeply for one minute, blowing with force (as if filling a balloon) for 15 seconds, and standing up from a lying down position. Each exercise should normally cause one's heart rate to change. By carefully measuring how much the heart rate changes, along with other factors, a physician can diagnose DAN. Keeping one's diabetes well controlled is the best preventive strategy. Physicians can treat DAN aggressively through medicines, treatments, or simply by helping the patient to gain better control of their blood glucose (sugar) levels. One figure illustrates the different body systems that can be affected by diabetic autonomic neuropathy. 1 figure.
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Diabetic Autonomic Neuropathy: Part 2: Treatment. Practical Diabetology. 20(2): 30, 32-33, 36. June 2001.
Autonomic neuropathy affects the nerves that regulate involuntary body functions and systems such as the digestive system, the sexual organs, the urinary tract, the heart, and the sweat glands. Symptoms include sexual dysfunction, delayed emptying of the stomach (gastroparesis), diarrhea, and difficulty urinating. This article, the second in a two part series on autonomic neuropathy of diabetes (DAN), reviews the treatments for early autonomic neuropathy and strategies to prevent possible complications. The author discusses the systematic treatment of DAN, including glycemic control, the use of an insulin pump, pancreas transplantation, the use of alpha lipoic acid (thioctic acid), and the use of other antioxidants. The author then outlines the prevention strategies, first in the area of the cardiovascular system. Extra precautions should be taken to guard against the development of heart disease and to catch and treat disease at the earliest possible time. The diagnosis of DAN should prompt a stronger bias toward the treatment of blood pressure, dyslipidemia (abnormal levels of fats, including cholesterol, in the blood), and other related conditions. Exercise stress testing should be considered for patients with DAN to identify and treat those with silent myocardial infarctions (heart attack). Other preventive approaches include the use of exercise, ACE inhibitors to preserve kidney function, increased perioperative vigilance, and increased vigilance for other end organ dysfunction (including foot conditions, eye disease, and kidney disease, or nephropathy). The author reiterates the importance of physicians and patients working together to identify and try to modify risk factors associated with DAN. 16 references.
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Endocrinology. 4th ed. Philadelphia, PA: Harcourt Health Sciences. 2001. 3 v., 3048 p.
This three volume set of books provides a complete, authoritative, up to date analysis of endocrine disease and basic endocrine physiology. This edition consists of 194 chapters that cover every aspect of endocrinology in detail by an authority in the field. About one third of the chapters are new, and the remainder have been rewritten and updated. Topics covered in volume one include the principles of hormone action; neuroendocrinology and the pituitary gland; growth and maturation; immunology and endocrinology; obesity, anorexia nervosa, and nutrition in endocrinology; and diabetes mellitus, carbohydrate metabolism, and lipid disorders. Chapters on diabetes mellitus focus on anatomy and physiology, classification, etiology, diagnosis, and treatment. Specific clinical disorders discussed include syndromes of insulin resistance, oculopathy, neuropathy, nephropathy, diabetic foot complications, ketoacidosis, hyperosmolar coma, lactic acidosis, hypoglycemia, atherosclerosis, syndrome X, and hyperglycemia. Volume two includes information on the parathyroid gland, calciotropic hormones, bone metabolism, the thyroid gland, the adrenal gland, and glucocorticoids. Topics covered in volume three include endocrine hypertension and mineralocorticoids, reproductive endocrinology and sexual development, female reproduction, endocrinology of the breast, male reproduction, endocrinology and pregnancy, endocrine tumor syndromes, and endocrine testing and treatment. Numerous figures. Numerous tables. Numerous references.
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Guide for Men with Diabetes. Alexandria, VA: American Diabetes Association. 2001. [4 p.].
This brochure helps readers understand the impact that diabetes can have on a man's sexual health. Topics include the sexual problems that might accompany diabetes, notably erectile dysfunction (ED, formerly called impotence); the importance of working closely in tandem with one's health care providers; the emotions of coping with sexual dysfunction; treatment options for ED; fertility considerations; and the impact of depression and anxiety on sexuality. One sidebar reports a mock interview between a certified diabetes educator and a male patient discussing these issues. The brochure includes space for readers to record their health care provider's contact information. The brochure is copiously illustrated with brightly colored graphics.
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Guide for Women with Diabetes. Alexandria, VA: American Diabetes Association. 2001. [4 p.].
This brochure helps readers understand the impact that diabetes can have on a woman's sexual health. Some women with diabetes have less interest in sex because of depression or frequent yeast infections; high blood glucose levels (hyperglycemia) can make a woman feel tired all the time; and sometimes intercourse is painful because of vaginal dryness. Topics include the sexual problems that might accompany diabetes; the importance of working closely in tandem with one's health care providers; the emotions of coping with sexual dysfunction; preconception and fertility considerations; the interplay between blood glucose levels and menstrual hormones; the impact of depression and anxiety on sexuality; and menopause. One sidebar reports a mock interview between a certified diabetes educator and a female patient discussing these issues. The brochure includes space for readers to record their health care provider's contact information and a checklist of female health-related issues that readers may want to discuss with their health care provider. The brochure is copiously illustrated with brightly colored graphics.
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Keeping On Top of Neuropathy. Diabetes Self-Management. 18(5): 63-66. September-October 2001.
Most people with diabetes have heard of the nerve damage associated with diabetes called diabetic neuropathy, though many are not fully aware of its dangers which can include erectile dysfunction, heart rhythm abnormalities, and amputations. Neuropathy affects 90 percent of people who have had either type 1 or type 2 diabetes for more than 10 years, although the symptoms can be subtle or even absent. This article helps people with diabetes understand the two general forms of neuropathy (peripheral and autonomic) and some of the tests used to diagnose them. Peripheral neuropathy, which affects the feet, legs, and the hands (less commonly), is dangerous because its symptoms can be so subtle. The damage and the danger from peripheral neuropathy come from loss of nerve function and loss of blood supply, both of which are caused by hyperglycemia (too much glucose, or sugar, in the blood). Foot disease caused by neuropathy is the most common complication leading to hospitalization of people with diabetes. Tests used to diagnose peripheral neuropathy include the simple monofilament test, vibration testing, visual examination, checking pulses in the foot (to test the blood supply to the feet), and electrophysiology. Autonomic neuropathy affects the nerves that regulate involuntary body functions and systems such as the digestive system, the sexual organs, the urinary tract, the heart, and the sweat glands. Symptoms include sexual dysfunction, delayed emptying of the stomach (gastroparesis), diarrhea, and difficulty urinating. Autonomic neuropathy can be diagnosed and monitored by the measurement of heart rate variability (for cardiac problems) and by electrogastrogram to measure the rhythm disturbances in the stomach. The author emphasizes the crucial role of prevention in both peripheral and autonomic neuropathy. One sidebar reviews the recommended steps for daily foot care.
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Mayo Clinic on Managing Diabetes. Rochester, MN: Mayo Clinic. 2001. 194 p.
This book provides practical and easy to understand information on controlling diabetes and preventing complications of the disease. Part one provides facts about diabetes. Topics include types of diabetes, the signs and symptoms of diabetes, the risk factors for diabetes, and the criteria and tests for diagnosing diabetes. In addition, the issue of diabetic complications is addressed, focusing on hypoglycemia, diabetic hyperosmolar syndrome, diabetic ketoacidosis, neuropathy, nephropathy, retinopathy, heart and blood vessel disease, and increased risk of infection. Part two deals with the components involved in controlling the disease. Chapters discuss monitoring blood glucose, eating a healthy diet, getting daily exercise, and maintaining a healthy weight. Part three examines medical therapies for managing diabetes. Chapters provide information on the use of insulin to manage type 1 and type 2 diabetes; the use of sulfonylureas, meglinitides, biguanides, alpha glucosidase inhibitors, thiazolidinediones, and drug combinations to manage type 2 diabetes; and pancreas and islet cell transplantation as possible cures for diabetes. Part four addresses issues related to living well with diabetes. One chapter focuses on important tests every person who has diabetes should be getting, including the glycosylated hemoglobin test, lipid tests, the serum creatinine test, and the urine microalbumin test. Another chapter discusses self care issues, including having annual physical examinations, visiting a dentist regularly, caring for feet, avoiding smoking, monitoring blood pressure, and managing stress. A third chapter explores sexual health issues for both men and women. Topics include the affect of the menstrual cycle and menopause on blood glucose, hormone replacement therapy, pregnancy, and impotence. Each chapter concludes with a question and answer section. The book also includes a list of additional resources. 17 figures. 1 table.
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Ramadan Fasting: Impact on Diabetes Mellitus and Guidelines for Care. Practical Diabetology. 20(3): 7-11, 14. September 2001.
Ramadan is the ninth lunar month in the Islamic calendar. During this month, all healthy adult Muslims, male or female, are expected to abstain from foods, fluids, oral medications, intravenous fluids and nutrients, smoking, and sexual intercourse from dawn to sunset. This article discusses the impact of this cultural and religious requirement on people who have diabetes. The classic Islamic point of view is that Ramadan fasting is good for the health and is also good for the spiritual cleanliness of Muslims. Ramadan fasting is a type of intermediate or partial fasting because individuals can eat again after 12 to 14 hours. The physiologic aspects of Ramadan are influenced by the combination of food and water deprivation, the periodic nature of fasting, and the modification of physical activities during the daytime hours. In people with diabetes, the blood glucose response to fasting is individual and variable. It has been suggested that the fasting blood glucose of such patients can be influenced by dietary noncompliance as a result of eating high carbohydrate meals (a tradition during Ramadan). This dietary factor may outweigh factors such as age, sex, and weight in influencing blood glucose in fasting patients with diabetes. The author notes that Ramadan fasting per se does not impair glycemic control in patients with diabetes. The glycemic control strategy in such patients should be considered individually in light of the control level before Ramadan, presence of complications, and course of the diabetes. The author discusses the impact of fasting on insulin, lipids (fats), renal (kidney) physiology, and body weight. Specific guidelines for diabetes care during Ramadan are outlined. A patient education handout about fasting for religious purposes and its impact on diabetes control is offered in the same journal issue. 26 references.
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Sex, Pregnancy, and Hypoglycemia. In: Lincoln, T.A.; Eaddy, J.A. Beating the Blood Sugar Blues. Alexandria, VA: American Diabetes Association. 2001. p.86-90.
Diabetes can have an effect on a person's sexual health, both in their ability to physically enjoy sexual relations and in feeling like enjoying it. Good glucose control prevents the nerve and circulation damage that can interfere with a man's ability to have an erection and a woman's ability to have an orgasm. Good glucose control also can improve one's health and emotional state. This chapter on sex, pregnancy, and hypoglycemia (low blood glucose levels) is from a book that offers first hand knowledge from two doctors who have more than 100 years of combined experienced with the day-to-day balancing act of blood glucose (sugar) and diabetes. The authors, both of whom have type 1 diabetes, share their own stories as well as those of over 40 of their patients. In this chapter, the authors discuss the physiology of health sexuality, the impact of sexual activity on blood glucose levels (which is similar to other physical activities), the reluctance of patients to discuss sexuality with their physicians, the importance of preventing hypoglycemia during pregnancy (even before conception), the role of self-monitoring of blood glucose (SMBG) during pregnancy, post childbirth considerations for mothers with diabetes, and the importance of careful planning, before and after the baby is born. 1 table.
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Teenagers and the Blood Sugar Blues. In: Lincoln, T.A.; Eaddy, J.A. Beating the Blood Sugar Blues. Alexandria, VA: American Diabetes Association. 2001. p.79-85.
Type 1 diabetes most frequently appears during adolescence, a time when a child has to make many adjustments to deal with puberty and the responsibilities that come with growing up. Diabetes further complicates this situation. This chapter on teenagers and hypoglycemia (low blood glucose levels) is from a book that offers first hand knowledge from two doctors who have more than 100 years of combined experienced with the day-to-day balancing act of blood glucose (sugar) and diabetes. The authors, both of whom have type 1 diabetes, share their own stories as well as those of over 40 of their patients. In this chapter, the authors discuss special situations (the classroom setting was covered in a previous chapter) such as traveling and sports, sexual development, and gaining independence (which may be played out in the diabetes management arena). The authors conclude with a brief section of 'straight talk to teens' in which they stress the importance of being open about diabetes and taking charge of one's own health.
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Treating Neuropathy While Waiting for a Cure. Diabetes Self-Management. 18(1): 61, 63-65. January-February 2001.
This article provides an overview of diabetic neuropathy. This complication of diabetes, which is caused by hyperglycemia, affects both people who have type 1 and type 2 diabetes. The most common form of diabetic neuropathy is peripheral diabetic polyneuropathy. This form of neuropathy can affect the feet, legs, arms, and hands. Another form of neuropathy, autonomic neuropathy, may affect the digestive system, the sexual organs, the urinary tract, the heart, and the sweat glands. Focal neuropathies affect specific nerves or areas. The article explains how high blood glucose levels damage the nerves and discusses the use of insulin or oral hypoglycemic agents to treat the cause of neuropathy. The article then presents approaches to treating painful neuropathy, including drugs such as gabapentin and other anticonvulsant drugs, antidepressants, narcotics, capsaicin cream and nonpharmacological methods such as transcutaneous electrical nerve stimulation. Autonomic neuropathies can be treated symptomatically with drugs. In addition, the article discusses the prevention of complications and reports on progress in treating and preventing diabetic neuropathy. The article includes a list of resources on neuropathy and its potential treatments.
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As Your Child Grows Up. In: Siminerio, L.M. and Betschart, J. American Diabetes Association Guide to Raising a Child with Diabetes. 2nd ed. Alexandria, VA: American Diabetes Association. 2000. p. 98-132.
This chapter, part of a book on raising a child with diabetes, deals with diabetes care during various stages of development, focusing on the care of infants, preschoolers, school age children, and adolescents. Issues addressed with regard to infants include determining whether a baby has low blood glucose, coping with illnesses, and handling a refusal to eat. Topics discussed with regard to preschoolers include helping a child accept fingersticks and injections, getting a child to eat regularly, dealing with a hospitalization, and making the decision to send a child to daycare or preschool. Issues examined that are relevant to the school age years include handling troublesome periods; helping a child develop a positive attitude about diabetes; communicating with a child's school and teachers; understanding the school's legal responsibilities regarding the child with diabetes; checking blood glucose at school; coping with hypoglycemia and hyperglycemia at school; and dealing with snacks, lunches, and parties. Topics explored with regard to adolescents include dealing with problems related to diabetes care; experimenting with alcohol, tobacco, and illegal drug use; driving; dating; recognizing eating disorders; understanding the impact of diabetes on puberty and sexual development; making career choices; and marrying and having children. Other topics include deciding whether to send a child to diabetes camp, understanding the impact of diabetes on body height and weight, dealing with sibling relationships and the impact of diabetes on siblings, and planning meals for the family. The chapter also provides guidelines for testing a wet diaper for urine glucose and treating a baby for low blood glucose, presents a sample diabetes care plan for a child, and offers guidelines for alcohol use by people who have diabetes. 26 figures.
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Coping and Psychosocial Adjustment of Women with Diabetes. Diabetes Educator. 26(1): 105-112. January-February 2000.
This article describes a study that investigated the relationships between coping styles and psychosocial adjustment for women with diabetes. The sample consisted of 115 community residing women who had diabetes. Coping was measured by the Revised Jalowiec Coping Scale and psychosocial adjustment by the Psychosocial Adjustment to Illness Scale. Pearson's product movement correlation was used to assess relationships between coping and adjustment. The most frequently and effectively used coping styles were optimistic, confrontive, self-reliant, and supportant. The psychological, social, and health care domains showed the most problems. The fewest problems were in the extended family, sexual, and vocational domains. Relationships were found between women's coping styles and psychosocial adjustment, with better adjustment associated with effective use of confrontive, supportant, optimistic, self-reliant, and palliative coping styles. The article concludes that important relationships exist between the ways women cope with diabetes and their level of psychosocial adjustment to the illness. Knowledge of these relationships can help diabetes educators assist clients in making lifestyle changes. 4 tables. 29 references. (AA-M).
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Diabetes Home Video Guide: Skills for Self-Care. Timonium, MD: Milner-Fenwick. 2000. (videocassette).
This videotape provides people who have diabetes with information on the basic skills needed to keep blood glucose in the target range and offers tips for incorporating these skills into daily life. Part one focuses on diabetes and related health concerns. One chapter in this segment of the tape explains how diabetes affects the body, what the long term complications are, and how to determine an appropriate blood glucose range. Another chapter examines related health concerns such as smoking, high blood cholesterol, high blood pressure, and excess body weight. Part two deals with blood glucose management, focusing on education, diet, exercise, monitoring, and medications. The chapter on education discusses the importance of education, the diabetes care team, and other resources. The chapter on nutrition provides nutrition guidelines and discusses other aspects of healthy eating. The chapter on exercise explains how to create an exercise plan. Other topics include doing aerobic and weight bearing exercises, keeping exercise fun and safe, and maintaining physical activity. The chapter on blood glucose monitoring focuses on laboratory testing, blood glucose self testing, and self testing techniques. Other topics include blood glucose records, medical emergencies, and equipment and supplies. The chapter on medications focuses on oral medications and insulin. Topics include insulin care, injection, and supplies; hypoglycemia; and medication tracking systems. Part three addresses the challenges of self management and offers strategies to help the viewer balance diabetes management with living. One chapter in this segment focuses on understanding the importance of pattern management, recognizing patterns, and adjusting a treatment plan. Another chapter deals with solving problems associated with sick days, dining out, unusual schedules, travel, special occasions, and holidays. A third chapter discusses lifestyle changes and emotions, focusing on incorporating change into daily life, managing emotions, handling sexual dysfunction and stress, dealing with close relationships, and finding support. The final chapter of the segment offers suggestions on maintaining good health, focusing on foot, skin, eye, and dental care; immunizations; and medical appointment and test scheduling. The video is accompanied by a foldout guide that provides an overview of diabetes self care skills.
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Diabetes Patient Education Manual. Gaithersburg, MD: Aspen Publishers. 2000. 378 p.
This manual serves as a comprehensive source of patient education materials for the diabetes patient. Chapter one, created especially for the professional, addresses the issue of effective patient education. Topics include conducting an educational needs assessment, using various teaching plans and strategies, and creating effective materials. The topics in the following chapters are presented in the form of a collection of large print, easy to read handouts. Each topic is presented at third and sixth grade literacy levels and in both English and Spanish. In addition to these low literacy materials, the manual includes patient education materials created by diabetes professionals from around the United States. Chapter two provides an overview of diabetes and its treatment. Chapter three discusses blood sugar control, focusing on self monitoring of blood glucose, hypoglycemia, hyperglycemia, and ketones. Chapter four presents meal planning guidelines and provides worksheets and planning forms. Chapter five explains the use of insulin; oral diabetes medications such as sulfonylureas, biguanides, alpha glucosidase inhibitors, thiazolidinediones, and meglitinides; and other medications that may increase or decrease blood glucose levels. Chapter six discusses the importance of exercise in diabetes management and offers guidelines for creating an individualized exercise program. Chapter seven describes diabetes related complications, including heart and circulation, foot, skin, eye, nerve, dental, and kidney problems. Other topics include stress management, women's sexual health, and the prevention and treatment of constipation. Chapter eight addresses issues related to special situations, including sick days, pregnancy, travel, surgery, and driving. Many chapters also include practitioner reference materials.
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Erectile Dysfunction in Diabetes Mellitus. In: Leahy, J.L.; Clark, N.G.; Cefalu, W.T. Medical Management of Diabetes Mellitus. Monticello, NY: Marcel Dekker, Inc. 2000. p. 427-442.
Erectile dysfunction is defined as the inability to achieve or maintain an erection long enough to permit satisfactory sexual intercourse. This chapter on ED in diabetes mellitus is from a textbook for practicing providers and for physicians in training that offers a comprehensive, up-to-date overview of diabetes mellitus. The text outlines the most effective diagnostic and therapeutic approaches to clinical problems, rather than try to be encyclopedic in coverage. In this chapter, the authors discuss prevalence, etiology (causes), normal aging changes in erectile function, normal penile physiology, the impact of diabetes on erectile function, diagnostic tests, first-line treatment strategies (sex therapy, hormone treatments), and medical therapies for ED, including nonpharmacological therapy and drug therapy, including self injection and sildenafil (Viagra). 1 figure. 5 tables. 10 references.
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Impotence Treatment Update. Diabetes Self-Management. 17(4): 110-111. July-August 2000.
This article provides updated information on treatments for erectile dysfunction. Many different factors can disrupt the process of male sexual arousal, including psychological barriers, heart disease, excess alcohol consumption, and diabetes. The latter contributes to erectile dysfunction because men who have diabetes are more likely to develop atherosclerosis, which makes it harder for blood to flow into the penis, and to have nerve damage, which can prevent normal transmission of nerve signals from the brain to the penis. When the drug sildenafil, commonly known as Viagra, was introduced to the United States in 1998, it was an immediate hit because it was the first impotence treatment to come in pill form. Despite its popularity, sildenafil can have dangerous and even fatal side effects, mainly when it interacts with nitrate-containing heart drugs. A second oral impotence treatment, apomorphine, may soon receive Food and Drug Administration approval. This drug, marketed under the brand name Uprima, is placed under the tongue and allowed to dissolve. The drug works by stimulating a chemical in the brain called dopamine that helps initiate erections. However, this drug also has side effects, including nausea and vomiting, dizziness, and fainting.
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Keep Yourself Healthy at Home: A Guide for Adults with Diabetes. South Deerfield, MA: Channing L. Bete Co., Inc. 2000. 60 p.
This illustrated handbook provides adults who have diabetes with information on health care. Section one provides general information about health care, the prevention of health problems, and the use of diabetes and general medications. Section two discusses specific problems and their treatment, focusing on allergies, appendicitis, asthma; back pain; bites and stings; bronchitis; bruises, cuts, and scrapes; burns and sunburns; chest pain; colds, flu, and cough; constipation; diarrhea; dizziness and fainting; fever; foot and leg problems; headaches; heartburn; mouth problems; nausea and vomiting; sexual concerns; sexually transmitted diseases; skin problems; sprains and strains; urinary tract infections; and vaginitis. Section three focuses on conditions of special concern for people who have diabetes, including heart disease and stroke and eye, kidney, and nerve diseases. Section four explains how to deal with hypoglycemia and hyperglycemia and provides space for writing down emergency numbers and other emergency information.
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Life with Diabetes: A Series of Teaching Outlines by the Michigan Diabetes Research and Training Center. 2nd ed. Alexandria, VA: American Diabetes Association. 2000. 676 p.
This teaching guide presents outlines on many diabetes related topics. The primary purpose of the outlines is to guide health professionals in the education of patients who have diabetes mellitus. Although the content is generally for adults who have type 1 or type 2 diabetes, the information can be adapted for use with younger patients or those with special learning needs. The first section consists of core outlines that present basic information generally taught to people who have diabetes. Topics focus on living with diabetes; understanding the impact of food on diabetes; planning meals; exercising; taking oral medications or insulin; monitoring diabetes; regulating blood glucose; coping; caring for skin, feet, and teeth; understanding long term complications; and changing behavior. The second section presents supplementary outlines that focus on specific situations. Topics include food and weight, dietary cardiovascular risk factors, carbohydrate counting, diabetes exchanges, sexual health, pregnancy, intensive insulin therapy, and insulin pump therapy. Each outline in these two sections includes a statement of purpose; prerequisites that participants should know before attending a particular session; objectives; materials needed for teaching a session; a recommended teaching method; a content outline that includes the general concepts to be covered, specific details, and instructor's notes or teaching tips; a skills checklist; an evaluation and documentation plan; suggested readings related to each topic; and visuals and handouts. The third section provides support materials, including resources for health professionals and people who have diabetes, supplemental reading, and sample educational objectives.
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Sex and Diabetes. In: American Diabetes Association. Diabetes A to Z: What You Need to Know About Diabetes, Simply Put. 4th ed. Alexandria, VA: American Diabetes Association. 2000. p. 148-151.
This chapter provides people who have diabetes with information on sexual problems caused by diabetes. Physical causes of sexual problems include being too tired to have sex, having a urinary tract infection, lacking bladder control, and having damaged limbs or joints. In women, nerve damage to the sex organs can cause a loss of sensation and vaginal dryness. Women who have diabetes tend to get more vaginal infections than women who do not have diabetes, and the pain or discomfort from vaginal infections or vaginal dryness can make women more likely to have vaginismus. Men who have diabetes may be affected by impotence as a result of damage to the nerves in the penis, damage to blood vessels in the penis, or poor blood glucose control. Sexual problems may also have psychological causes.
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Sexual Function in Men with Diabetes Type 2: Association with Glycemic Control. Journal of Urology. 163(2): 788-791. March 2000.
This article describes a study that evaluated the association of glycemic control with erectile dysfunction in men with type 2 diabetes. The study population consisted of a convenience sample of 78 sexually active male outpatients who had diabetes. Participants completed questions one to five of the International Index of Erectile Function. Details of disease duration, complications, medication use, patient age, and level of glycosylated hemoglobin (HbA1c) were obtained by reviewing the medical record. Mean subject age plus or minus standard deviation was 62.0 plus or minus 12.3 years, mean HbA1c was 8.1 percent plus or minus 1.9 percent, and mean erectile function score decreased as HbA1c increased. The test for linearity was also significant. There were no statistically significant associations of levels of glycemic control with alpha blocker, beta blocker, or diuretic use. However, insulin use was more frequent in men with poor control, in that 70 percent of those with HbA1c greater than 9 percent received insulin. Bivariate analysis showed a significant correlation of HbA1c with neuropathy but not with patient age, duration of diabetes, alpha blockers, beta blockers, or diuretics. Multivariate analysis demonstrated that HbA1c was an independent predictor of erectile function score, even after adjusting for peripheral neuropathy, which was also an independent predictor. When subject age and duration of diabetes were included in multivariate models, only HbA1c and neuropathy were significant independent predictors of erectile function score. The article concludes that the data add to the growing body of literature suggesting that erectile dysfunction correlates with the level of glycemic control. 3 tables. 24 references. (AA-M).
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Sexual Health and Diabetes. In: Michigan Diabetes Research and Training Center; Funnell, M.M., et al. Life with Diabetes: A Series of Teaching Outlines by the Michigan Diabetes Research and Training Center. 2nd ed. Alexandria, VA: American Diabetes Association. 2000. p. 533-555
This teaching outline, part of a series of teaching outlines on living with diabetes, provides information about the effect of diabetes on sexual health and sexual function. The outline includes a statement of purpose; prerequisites that participants should know before attending a particular session; objectives; materials needed for teaching a session; a recommended teaching method; a content outline that includes the general concepts to be covered, specific details, and instructor's notes or teaching tips; an evaluation and documentation plan; and suggested readings. Concepts covered in the outline include the components of sexual health; the impact of diabetes on sexual health; the female sexual health issues of menstruation, pregnancy, contraception, menopause, vaginitis, and sexual dysfunction; the male sexual health issues of sexual maturation, fertility, and sexual dysfunction. Other topics include the treatment of female and male sexual dysfunction and treatment resources for men and women. In addition, visuals are provided.
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Tools of the Trade 2000. Diabetes Self-Management. 17(6): 8-10, 12, 14-15, 18-19. November-December 2000.
This article describes products that have either come on the market in late 1999 or 2000 or products that are expected to be approved for marketing soon. The article begins by explaining the approval process for new products or new drugs. This is followed by a description of new products or drugs in the categories of insulin analogs, insulin delivery, diabetes drugs, sexual dysfunction treatments, diabetic gastroparesis devices, diabetic foot ulcer treatments, aids for the visually impaired, and blood glucose and other health indicator monitoring devices. Information provided about each product or drug includes its name; the name, telephone number, and website address of its manufacturer; its status; and what it does. During 2000, a rapid acting and a long acting insulin analog were approved and lispro received two new indications and had a slight label change. In 2000, two companies continued working on devices and forms of insulin that allow it to be inhaled through the lungs rather than injected, and insulin pump manufacturers enlarged their product lines. A diabetes drug that was approved in 2000 was a combination glyburide and metformin pill, and promising drugs undergoing clinical trials included nateglinide, pramlintide acetate, and amylin. A new product for sexual dysfunction currently available in the United States is the clitoral therapy device. Other promising sexual dysfunction products or drugs undergoing trials include the urethral suppository, apomorphine, phentolamine, and topiglan gel. A diabetic gastroparesis device approved in 2000 was the enterra implant, and a foot ulcer treatment also approved was the apligraf skin substitute. A new tool on the way for the visually impaired is a device that reads drug labels out loud. Products under development in the blood glucose monitoring category are devices that allow a person to obtain a blood sample from another part of the body, do not require a blood sample at all, or monitor blood glucose on a continuous basis. In addition, several manufacturers are developing more convenient ways of checking other health indicators. Drugs that were removed from the market during 2000 included troglitazone, cisapride, and pork insulins.
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What Everyone Should Know About STD's. Diabetes Self-Management. 17(1): 30, 32-34, 36. January-February 2000.
This article provides people who have diabetes with information on sexually transmitted diseases (STDs). People who have diabetes are not believed to be at a higher risk for STDs than the general population. The infectious agents that cause STDs are typically passed from one person to another during sexual contact. Although STDs are most prevalent among adolescents and young adults, they can affect people of all backgrounds and economic levels. Many STDs initially cause no symptoms, so a person who is infected may be able to pass the disease on to a sex partner without realizing he or she is doing so. Therefore, safe sex practices must be used at all times. Some of the most common STDs in North America are gonorrhea, chlamydia, syphilis, genital herpes, viral hepatitis, genital warts, and molluscum contagiosum. Acquired immune deficiency syndrome (AIDS), which is caused by the human immunodeficiency virus (HIV), is perhaps the most feared STD. Although many people live for some time with the virus, it is ultimately fatal. HIV is carried in body fluid, and the primary mode of transmission is through unprotected sexual contact with someone who has the virus. The article discusses the symptoms, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, genital herpes, viral hepatitis, genital warts, and molluscum contagiosum. In addition, the article outlines ways people can reduce the risk of developing an STD and identifies sources of information about STDs.
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