Islets of Hope for persons newly diagnosed with diabetes
Article by Lahle Wolfe. For reprint information e-mail: Editor@isletsofhope.com
Links to more comprehensive information about disorders sometimes associated with diabetes
Gary Scheiner, CDE
Newly Diagnosed (easier reading) Problems & Complaints with Diabetes
Comprehensive Information on Diabetes Problems & Complaints
Resource Links to
The Diabetes Monitor:
Resource Links to
Sheri L. Sanderson is the mother of three children, including one with gluten sensitivities. Her cookbook is the result of personal need---wanting to offer her family gluten-free meals that look and taste just as good as those she made before the change in diet. In addition to many years of... Read more
Mary J. Shoman
The American Fertility Association (Offers support and advocacy for those dealing with infertility and reproductive health.)
A Torah Infertility Medium of Exchange (A T.I.M.E. a non-profit organization devoted to the support and education of Jewish infertile couples.)
The Infertility Network (a registered Canadian charity which provides information & support to patients, parents & adult donor offspring)
Resource Links to
The Jewish Hospital Cholesterol Center (Dr. Glueck is a champion for women with PCOS)
Dr. Ronald Feinberg
Filled with indispensable advice on switching to the low-GI diet, incorporating exercise into your lifestyle, and preserving your overall health and well-being, as well as thirty delicious recipes, this book can help you beat your PCOS symptoms and take back control over your life
Important Medical Disclaimer
All information and material presented on the IOH's web site is intended for personal informational purposes only . No one should attempt to self-diagnose, self-treat, or alter a medical care plan without first consulting their physician
Information for those Newly Diagnosed with Diabetes
Disorders discussed on this page:
Addison's Disease, Asthma & Allergies, Celiac Disease (sprue), Cyclic Vomiting Syndrome (CVS), Cystic Fibrosis (CF), Eating Disorders (anorexia, bulimia, binge-eating disorder), Fibromyalgia Syndrome (FMS), Frozen Shoulder, Hashimoto's Thyroiditis, Hemochromatosis (iron overload or "bronze" diabetes), Infertility (primary & secondary), Irritable Bowel Syndrome (IBS), Polycystic Ovarian Syndrome (PCOS), Weight Gain, and Weight Loss
Click on any link below to read more in-depth information about each topic.
Addison's disease is an endocrine (hormonal) disorder in which a person does not make enough cortisol and other hormones in the adrenal glands. It can be difficult to diagnose in early stages but when cortisol levels become too low various symptoms occur; untreated Addison's can be fatal. Treatment includes oral medication to replace vital hormones. When pills cannot be swallowed injections are necessary.
The Type II form of Addison's disease (also called Schmidt's syndrome) usually afflicts young adults. Features of type II may include:
Addison's occurs in all age groups and afflicts men and women equally. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin in both exposed and unexposed parts of the body.
Asthma and allergies may be more commonly seen in persons with autoimmune disorders such as diabetes, polycystic ovarian syndrome (PCOS), and thyroid disorders.
Asthma is a disease of the human respiratory system in which the airways narrow, often in response to a “trigger” such as exposure to an allergen, cold air, exercise, or emotional stress. This narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing, which are the hallmarks of asthma. Between episodes, most patients feel fine.
Allergies are a hypersensitivity (over reaction) to a substance or environmental trigger. There are many causes and classifications of allergies.
For diabetics, allergic reaction to the older, animal insulins were not uncommon. However, allergic reaction to the newer synthetic insulins are rare. If someone has an allergic reaction to insulin it is more likely to be from an additive or buffering agent in the insulin. (IOH Founder's daughter Elizabeth is allergic to long-acting insulins but can take rapid acting without an allergic reaction).
A person with diabetes that has latex allergies will need to either inject via a pump, a latex-free syringe or pen, and if the allergy is extreme may need to use a type of insulin that does not contain a latex stopper. Be sure to report any reaction after taking insulin to your doctor.
Celiac disease is an incurable autoimmune intestinal disorder that has a genetic component to acquiring it. A person with celiac is intolerant to all forms of the food protein gluten. Gluten is a protein found in all forms of wheat and related rye grains. Persons with celiac must completely eliminate wheat and rye grains and barley from their diets, including: durum, semolina, spelt, kamut, einkorn, faro, rye, barley, triticale. Traditionally, oats have also been considered toxic to those with Celiac. New research may suggest otherwise but it is best to consult with your doctor about what is safe for you.
When a person with celiac eats gluten there is an immunologically toxic reaction to the gluten ingested. This causes many problems (and symptoms) including damage to the mucosal surface of the small intestine. The villi in the intestines become shorter and flatter when offending foods are eaten and the condition and symptoms worsen. It is imperative that persons with Celiac receive good medical care and stick to their gluten-free diet faithfully.
A change in diet can help control the sometimes debilitating symptoms of gluten intolerance which include diarrhea, constipation, bloating, gas, irritable bowel syndrome, weight loss, malnutrition and vitamin deficiency, unexplained anemia and fatigue, join pain, abdominal pain, and early onset of osteoporosis
A diet for celiac may prohibit:
For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within days of starting the diet. The small intestine is usually completely healed in 3 to 6 months in children and younger adults and within 2 years for older adults. Healed means a person now has villi that can absorb nutrients from food into the bloodstream.
Unfortunately, celiac is often associated with type 1 diabetes and anyone diagnosed with type 1 should be tested for celiac disease. A simple blood test can help determine if celiac antibodies are present, however, a blood test can come back negative and a person can still have celiac disease. Sometimes, a biopsy of the intestine is performed to diagnose celiac sprue if lab work is inconclusive.
Cyclic Vomiting Syndrome (CVS)
This disorder is not necessarily associated with diabetes but is sometimes mistaken for gastroparesis, which may occur in diabetes.
In CVS, people experience bouts or cycles of severe nausea and vomiting that last for hours or even days and alternate with longer periods of no symptoms. CVS occurs mostly in children, but the disorder can affect adults, too.
CVS has no known cause or cure and each episode is similar to the previous ones. The episodes tend to start at about the same time of day, last the same length of time, and present the same symptoms at the same level of intensity. Although CVS can begin at any age in children and adults, it usually starts between the ages of 3 and 7. In adults, episodes tend to occur less often than they do in children, but they last longer. Furthermore, the events or situations that trigger episodes in adults cannot always be pinpointed as easily as they can in children.
Episodes can be so severe that a person may have to stay in bed for days, unable to go to school or work. No one knows for sure how many people have CVS, but medical researchers believe that more people may have the disorder than is commonly thought (as many as 1 in 50 children in one study). Because other more common diseases and disorders also cause cycles of vomiting, many people with CVS are initially misdiagnosed until the other disorders can be ruled out. What is known is that CVS can be disruptive and frightening not just to people who have it, but to the entire family as well.
Cystic Fibrosis (CF)
A secondary form of diabetes can occur in those who have cystic fibrosis. Excess mucus can clog ducts in the pancreas creating diabetes-type problems. Cystic fibrosis related diabetes (CFRD) shares features of types 1 and 2 diabetes, but it is a unique and distinct form of diabetes that requires a special management approach.
CF is a chronic, genetic (hereditary), debilitating disease where the body over produces mucous. CF affects approximately 30,000 children and adults in the U.S. It can lead to serous life-threatening lung infections because the thick mucous clogs the lungs. This mucous can also block ducts in the pancreas causing permanent damage that can lead to the onset of type 1 diabetes.
Eating Disorders (EDs)
Why should you know about eating disorders? If you, your child, or loved one has one of the many metabolic disorders that carry a medical demand of closely monitoring eating habits, there is a significant increase in the risk of developing an eating disorder. Eating disorders (EDs) are not just a problem for young girls; an all too common belief. EDs can develop at any age and also affect boys and men. In Australian type 1 diabetic children as young as 11 years old purposely under bolus insulin with meals in order to lose weight.
In the United States studies suggest up to 25% of all females with diabetes – a prevalence of 2-6 times higher in women with diabetes than in the general population – have an eating disorder. The findings from a study by Flinders Medical Centre in Adelaide, also showed children in Australia with diabetes were markedly affected by disordered eating behavior:
While diabetes does not actually cause an eating disorder, having to pay close attention to weight management and food choices places an unnatural and unhealthy focus on eating and leads to distortion of self and body image. Once a person has ED issues, it is often easy for them to hide their problem under the guise of “it is part of my diabetes care plan.”
Restricting, the elimination of certain foods or entire food groups, is a common factor in ED behavior, as is developing “safe” and “unsafe” food lists. A person may become overly concerned or anxious when offered something from their “restricted or unsafe list.” The initial limitation and focus of a food may stem from legitimate management issues (eating high glycemic index carbohydrates causes a rapid rise in blood sugars, fat prolongs highs) that develop into compulsive avoidance. Fear may also stem from weight gain which can happen with all forms of diabetes, and for diabetics, the body conscious, ultra-thin-is-desirable- culture we live in, is made even worse because diabetics are weighed at every visit and constantly reminded from a health standpoint about excess body weight and diabetes. And those with metabolic challenges, especially type 2 and pre-diabetes, hear the “thin message” from culture, health professionals, parents, and even their own still voice from within. In fact, many believe that diabetics are to blame for their onset and readily point the finger at a lifestyle out of control.
Fibromyalgia Syndrome (FMS)
..."The American College of Rheumatology recognizes Fibromyalgia as a chronic condition with widespread and changing degrees of multifocal tenderness, involving the limbs and trunk. Many diabetics with nerve compression have symptoms in the arms and legs that could be confused with Fibromyalgia. Patients with diabetes may also suffer general tiredness, soreness, and muscle aches, associated with loss of energy..." Could this be Fibromyalgia?
FMS is a widespread musculoskeletal pain and fatigue disorder. FMS causes severe pain in muscles, ligaments, and tendons. The cause is still unknown, but it has become widely accepted as a true disorder. FMS is often associated with fatigue, chronic headaches, irritable bowel syndrome (IBS), and Temporomandibular Joint Dysfunction Syndrome (TMJ) and may be more commonly seen in persons with certain thyroid disorders (especially Hashimoto's thyroiditis) that are often associated with diabetes as well.
Symptoms include pain in the soft fibrous tissues including tendons, muscles, and ligaments and profound lack of energy (fatigue). Many persons with FMS feel pain throughout the body but pain can also be localized to a particular area(s). The pain can feel like a burning, stabbing, or shooting sensation, or like an overworked or pulled muscle. Sometimes the muscles themselves will twitch.
FMS has similar symptoms of chronic fatigue syndrome (CFS) and some researchers believe that they are the same syndrome or may have the same epidemiology (cause, or, origin). FMS also is very similar to the problems persons with Gulf War Syndrome may experience.
Frozen shoulder is a condition called "adhesive capsulitis." It may begin with shoulder pain from overuse or mild injury which causes a person to "favor" the shoulder, not moving or using it to avoid pain. But not using the shoulder makes this condition worse, not better.
While the reason is not known, diabetes is also a risk factor for frozen shoulder. Some scientists feel that it may be related to collagen, a substance in ligaments, that helps hold bones to joints. Because glucose molecules can attach to collagen, it is thought that people with diabetes may deposit abnormal amounts of collagen in cartilage and tendons of the shoulder.
About 20% of people with diabetes have frozen shoulder, a much higher percentage than is seen in the general population (about 5%).
Low thyroid is an "in" diagnosis for an entire host of problems. However, those with diabetes type 1 or type 2, and those with other metabolic disorders (including insulin resistance, metabolic syndrome X, pre-diabetes, PCOS) should be tested for antibodies for Hashimoto's. Antibodies for this disorder can appear years before symptoms occur so it is a simple, worthwhile blood test for anyone with a metabolic disorder.
Symptoms include weight gain, fatigue, hair loss, heavy or abnormal menstrual bleeding, dry skin, inability to concentrate, clumsiness, depression, change in sleep habits, and intolerance to temperature, especially the cold. Even in the presence of normal TSH levels, these symptoms (called subclinical) may exist and your physician may decide to being therapy with a low dose of a thyroid replacement drug.
Your doctor should run a specific test for Hashimoto's antibodies and not just a TSH (thyroid stimulating hormone) test since a person can have Hashimoto's (evidenced in an antibody test) years before thyroid levels fall. Your doctor may also take a sonogram of your thyroid. It is important for all persons diagnosed with diabetes, insulin resistance, or PCOS to have the specific antibody tests performed. There is a genetic component to Hashimoto's and it tends to run in families.
Treatment involves daily medication to replace certain hormones. There are several types of medications available and your doctor can help you decide which one is best for your needs. Medications available include both T4 (thyroxine) and T3 (liothyronine) replacement. Treatment often helps reduce the size of the enlarged thyroid gland (which can become large enough to make swallowing more difficult) but there is no cure for Hashimoto's Thyroiditis. Once a person starts taking thyroid medication they will usually be required to stay on it for life.
Hemochromatosis (Iron Overload)
Hemochromatosis is a disease in which a person stores excessive amounts of iron in the body. It is an inherited disorder that can lead to the onset of type 1 diabetes after years of iron "overload" which can damage the pancreas. About 40% of those diagnosed with hemochromatosis will also be diagnosed with type 1 diabetes at the same time. Diabetes did not cause hemochromatosis, but hemochromatosis causes diabetes. For this reason, this form of diabetes is considered a “secondary” diabetes because it is caused by damage to the pancreas from excessive levels of iron.
Symptoms of the disease include, joint pain, thyroid problems, hair loss, bronzing of the skin (hence the term "bronze diabetes), chronic fatigue, diabetes, menstrual irregularities, impotence, abdominal pain, liver disease, and liver or pancreatic cancer. Joint pain is the most common complaint of people with hemochromatosis. Other common symptoms include fatigue, lack of energy, abdominal pain, loss of sex drive, and heart problems. Symptoms tend to occur in men between the ages of 30 and 50 and in women over age 50. However, many people have no symptoms when they are diagnosed.
Hemochromatosis is usually treated by a specialist in liver disorders (hepatologist), digestive disorders (gastroenterologist), or blood disorders (hematologist). Because of the other problems associated with hemochromatosis, several other specialists may be on the treatment team, such as an endocrinologist, cardiologist, or rheumatologist. Internists or family practitioners can also treat the disease.*
Treatment involves removing excess iron from the body and to give supportive treatment to damaged organs. Excess iron is removed through phlebotomy (removal of blood). One-half liter of blood is removed from the body each week for 2 to 3 years until the iron stores are depleted. After that, less frequent phlebotomy is needed to maintain iron levels within normal limits. How often additional phlebotomy will be required depends on levels of hemoglobin, serum ferritin (iron), and patient symptoms. Persons with hemochromatosis must follow a special low-iron diet and there is cure for hemochromatosis.
Persons with hemochromatosis must follow a special diet to help maintain a lower serum ferritin. A low-iron diets does not substitute or replace the need for phlebotomy. A diet for hemochromatosis prohibits alcohol (especially for patients who have suffered liver damage.), avoidance of all iron supplements or vitamins containing iron, vitamin supplements, iron cookware, ingesting raw seafood or fortified processed foods such as 100% iron breakfast cereals.
Both primary and secondary infertility can be a concern to those with metabolic disorders. Infertility strikes both men and women. Read more...
Irritable Bowel Syndrome (IBS)
IBS manifests with alternating bouts of diarrhea, and/or constipation, abdominal gas and bloating can leave you feeling sluggish and interrupt normal activities in life. Many persons may have IBS, which is often diagnosed by ruling out other disorders first, without realizing it. This syndrome is treated with medication when necessary and through lifestyle changes including a fiber-rich diet.
Polycystic Ovarian Syndrome (PCOS)
As recently as 15 years ago few women were diagnosed with this serious syndrome when it was still known as "Stein-Levinthal Syndrome." Now, it is estimated that more than 15 million women in the United States have PCOS. PCOS is the most commonly diagnosed cause of infertility in women of child-bearing age. Once thought of as a cosmetic gynecological disorder brought upon from obesity, it is now known that PCOS can cause rapid, abnormal weight gain, infertility, is often associated with Hashimoto's thyroiditis, and can lead to cancer, heart disease, and diabetes and is not a gynecological disorder, but a complex endocrine disorder affecting many systems and functions of the body.
The symptoms and severity of the syndrome vary greatly between women. While the causes are unknown, insulin resistance (often secondary to obesity) is heavily associated with PCOS. Metabolic problems and symptoms include:
Treatment includes lifestyle changes; diet modifications, weight and stress management, and an exercise program. Medications are usually prescribed for insulin resistance (insulin sensitizing drugs such as Glucophage), to help restore the menstrual cycle (birth control pills and/or insulin sensitizing drugs), to address cosmetic issues (Aldactone and/or Vaniqa for hirsutism) and possible acne and/or weight loss drugs.
When infertility is an issue various courses of action may be necessary to achieve pregnancy. Infertility treatment needs to be tailored for each individual woman with PCOS but often begins with trying a combination of Glucophage and clomid, (a fertility drug) aimed at inducing ovulation, as the first step.
Weight gain can be the result of an unhealthy lifestyle including lack of physical activity and eating too much. But other factors can also contribute to weight gain including certain oral medications prescribed for diabetes, stress, insufficient sleep, and too much insulin. Hashimoto's thyroiditis, a hypothyroid (low) autoimmune disease can also cause weight gain and people with diabetes have a 4 times greater chance of having this thyroid disorder than non-diabetics.
Certain metabolic disorders, including type 2 diabetes, pre-diabetes, gestational diabetes, polycystic ovarian syndrome, metabolic syndrome, and insulin resistance can also lead to weight gain. Many people with these disorders may be insulin resistant and therefore overproduce insulin in response to eating. Insulin is not only a fat-storing hormone that instructs the body to store energy, but excess insulin cannot be excreted and can also be stored as fat.
When a person with insulin resistance eats certain foods (many types of carbohydrates, excessive protein, or high-fat foods) their body may over respond by producing too much insulin in order to maintain normal blood glucose levels. This is because cells in the body do not respond effectively to insulin so the body keeps on producing more until the cells finally "unlock" and move glucose into cells for nourishment.
Insulin resistance can be improved. Exercise, especially anaerobic (such as weight lifting and resistance training) activity can improve muscle sensitivity to insulin and increase insulin sensitivity by as much as 15% -- the same percentage of improvement as may be seen when taking oral insulin-sensitizing medications. Losing weight also improves insulin resistance, as does following a healthy, low-fat, moderate protein diet, rich in complex carbohydrates.
Many with insulin resistance find it easier to meet their weight loss goals by following low-glycemic index diets, or carbohydrate controlled plans. True, low-carbohydrate (40 grams of carbohydrate or less per day) that induce ketosis are somewhat controversial as to their long-term health risks and benefits. But many who are metabolically challenged and unable to lose weight on other plans find they can control their weight by more drastic carbohydrate reduction.
Sudden weight gain from fluid retention may indicate a serious underlying medical problem including heart disease, kidney disease, high blood pressure, a negative side effect to an oral antidiabetes medication, or even a condition such as irritable bowel syndrome or celiac disease. Be sure to discuss any sudden, unexplained, or significant weight loss with your physician.
Weight loss may be part of a healthy approach to managing diabetes, especially for those with type 2 diabetes. But when weight loss is either unintentional, or more than healthy, it could be part of an underlying medical condition or possibly due to an eating disorder.
Weight loss can occur in diabetes due to insufficient insulin present, from a wasting disease such as cystic fibrosis (CF), or from eating disorders, or difficulty in digestion food such as is the case with celiac sprue and irritable bowel syndrome.
Weight loss can occur when blood glucose levels are too high because not enough insulin is being taken in order to cover food eaten. One of the symptoms of type 1 diabetes prior to diagnosis is weight loss because when not enough insulin is present to properly metabolize and make use of food energy glucose (sugars) will build up in the blood stream.
To understand why weight loss occurs when not enough insulin is present it may help to think of insulin as a key that "unlocks" cells and allows glucose (from food energy) to enter into cells and nourish the body. Without sufficient insulin the body's cells, tissues, organs, and even the brain begin to starve. As a defense, the body turns to fat stores in an effort to find useable energy. When this happens, in addition to a buildup of glucose in the bloodstream, ketones (a byproduct of fat burning) may also build up in the body. This can lead to a serious, potentially life-threatening condition called diabetic ketoacidosis (DKA) and may require hospitalization.
You should always discuss unexpected weight loss, or moderate-high levels of urine ketones to your physician.
Page Updated 03/23/2006