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Microsoft word - insulin & type 2 for voice pdf.doc

Insulin has the most wonderful reputation among aggressive over time. Initially, many people with people with Type-2 diabetes. Many view it the Type-2 diabetes can control their blood sugar same way as moving to a nursing home (or through exercise (which improves insulin Florida retirement community)… just one short sensitivity) and a healthy diet with limited carbohydrates. Once this fails to achieve desired blood sugar levels, oral medications are often But nothing could be further from the truth. If added. Some medications reduce the amount of anything, taking insulin keeps you as far away sugar produced by the body; some improve from the mortician as possible. Despite recent sensitivity to insulin; and some stimulate the advances in medical therapy, insulin remains the pancreas to produce as much insulin as possible. most potent and effective treatment for elevated Eventually, the oral medications (combined with blood glucose. It is a more natural substance than diet and exercise) are unable to the job, and pills (chemically similar to the insulin produced by the body), and lacks many of the potential side-effects inherent to oral medications. Oral medications really do have their limits. Unlike insulin, which lowers blood sugar Today, there are more than 15 million people DIRECTLY by causing the body’s cells to absorb with Type-2 diabetes in the United States, and insulin from the bloodstream, oral medications more than 3 million take insulin. But many more work INDIRECTLY. They only work when the people should probably be taking insulin. Here is pancreas is able to produce sufficient amounts of insulin. Once the pancreas is unable to keep up with the workload, no amount of medication is Nature of the DiaBeast
going to solve the problem. And it really can be a problem. Elevated blood sugar levels cause Type-2 diabetes is a progressive condition. It gets worse over time. It usually starts out as a infection/impaired healing, diminished mental state of mild insulin resistance: the insulin and physical abilities, mood changes) as well as produced by the pancreas is not properly utilized long-term complications (blindness, kidney by the body’s cells. This result is a gradual failure, nerve disorders, heart disease). increase in the blood sugar level, which promotes increased insulin production by the pancreas. Insulin to the Rescue
Eventually, the pancreas is unable to make enough insulin to overcome the insulin resistance, Taking insulin is easier and safer than ever and glucose levels rise high enough to require before. Insulin syringes have short, super-thin needles that you can barely feel. Insulin can also be administered with an insulin pen: simply dial All this time, the pancreas is working harder and up and inject. Don’t forget… insulin is given into harder to secrete as much insulin as possible. Just FAT. Not muscle, not blood vessels, not into any like a machine that is strained and overworked, kind of sensitive tissue. Fat has no nerve endings, the insulin-producing cells eventually burn out so the injection procedure is virtually pain-free. and cease to function. This is why the treatment for type-2 diabetes tends to become more Voice of the Diabetic (Natl. Federation for the Blind): Winter, 2010 Copyright 2010, Gary Scheiner MS, CDE – Integrated Diabetes Services LLC In recent years, new insulin formulations have come to the forefront. “Basal” insulin, which works slowly and gradually over an extended period of time (like a time-release capsule), may be enough to get your diabetes in control. Glargine (brand name Lantus) and detemir (brand name Levemir) are two such insulins. They are usually taken once or twice daily, and do a good job of controlling blood sugar levels overnight and between meals. Having insulin working all the time helps to “rest” the pancreas so that it can generate extra insulin at mealtimes. And because Another effective option would be to use an basal insulin does not have a pronounced peak, it insulin PUMP. Insulin pumps are beeper-sized rarely causes hypoglycemia (low blood sugar). In and battery-operated. They deliver tiny pulses of many cases, basal insulin is all that is needed to rapid acting insulin throughout the day and night, control the blood sugar throughout the day and which effectively serves as the “basal” insulin. The user programs a larger dose, called a “bolus” dose, to be delivered at meal and snack times. In some instances, even with the addition of basal The insulin is delivered from the pump into a insulin, the pancreas is unable to make enough small plastic tube that sits just below the skin. insulin at mealtimes. This results in large blood sugar “spikes” after meals and snacks. Post-meal spikes have been shown to damage blood vessels and contribute to many of the complications of In order to cut down on the number of injections diabetes. To prevent the spikes, a number of required with MDI or the complexity of using an PREMIXED insulin. Premixed insulin usually Perhaps the most effective solution is to take consists intermediate insulin known as NPH (a rapid-acting insulin at each meal, in addition to cloudy mixture which peaks 4-10 hours after it is the usual injections of basal insulin. This is taken) combined with rapid insulin. Taken at called an MDI (multiple daily injection) program. breakfast and dinner, premixed insulin provides Rapid insulin, including lispro (brand name some basal insulin throughout the day and night Humalog), aspart (brand name Novolog) and (albeit with pronounced peaks and valleys), and glulisine (brand name Apidra) is usually taken at rapid insulin to offset breakfast and dinner. the onset of each meal or snack. Rapid insulin starts working in approximately 15 minutes, peaks (works hardest) in about an hour, and lasts for around 4 hours. The dose can be adjusted based on the amount of carbohydrate in the meal or snack. Rapid insulin, just like basal insulin, Insuin activity from twice daily premixed insulin Voice of the Diabetic (Natl. Federation for the Blind): Winter, 2010 Copyright 2010, Gary Scheiner MS, CDE – Integrated Diabetes Services LLC Some physicians also recommend a combination of insulin and oral medications. For example, basal insulin is often combined with medications called MEGLITINIDES (brand names Prandin and Starlix) or DPP-4 INHIBITORS (brand name Januvia). These medications help the pancreas to secrete extra insulin specifically at mealtimes. Granted, insulin is not ideal for everyone with Type-2 diabetes. It requires some dexterity to administer the injections. If the doses are incorrect, it can cause hypoglycemia (low blood sugar). And if not balanced with sufficient exercise and a healthy diet, insulin tends to cause weight gain. But don’t lose sight of the fact that diabetes is a disease that requires aggressive treatment. If your blood glucose level is frequently above target or your HbA1c is above 7%, talk to your doctor about intensifying your therapy. Starting insulin, or taking your insulin program to a higher level, may give you just the results you’re looking for. Editor’s note: Gary Scheiner is a Certified Diabetes Educator with a private practice specializing in intensive diabetes management. He and his team offer consultations and self-management education via phone and the internet. For questions or more information, you may contact him at, or call 877-735-3648. Voice of the Diabetic (Natl. Federation for the Blind): Winter, 2010 Copyright 2010, Gary Scheiner MS, CDE – Integrated Diabetes Services LLC


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MEDICAID FRAUD November 2006 Hidden Camera at New York Nursing Reveals Neglect . . . . . . 1 Cases . . . . . . . . . . . . . . . . . . . . . . 2 Case Updates . . . . . . . . . . . . . . . . 13 Hidden Camera at New York Nursing Home Reveals Neglect Attorney General Eliot Spitzer announced on November 22 the arrest of nine employees ofthe Hollis Park Manor Nursing Home in Queens, where

Chapter 8

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