This page contains a Flash digital edition of a book.



iabetes mellitus (DM) is a medical and endocrine disorder where the blood glucose level is high. There may be a lack of insulin, insulin resistance or both. Insulin

is a hormone made in the pancreas that helps to lower the blood glucose levels. Diabetes mellitus is commonly referred to as “sugar” in some cultures. It can occur in young people, commonly referred to as Type I, or adult onset, which is commonly referred to as Type II. Pregnant women can also sometimes develop diabetes. This is referred to as gestational diabetes.

Sugar, sugar, honey, honey…

When diabetes is inadequately controlled, it can lead to serious multiple medical problems. Diabetic ketoacidosis (DKA) and hyperosmolar nonketotic coma are amongst the most serious complications. DKA can occur in patients with insulin dependent diabetes with very elevated glucose levels. Symptoms of DKA include fruity smelling breath, frequent urination with ketones, confusion and very high glucose levels. Hyperosmolar nonketotic coma can occur if excess glucose is released into the urine. Many urine strips can test for glucose and ketones. You normally should not have either in urine. DKA and hyperosmolar nonketotic coma are extremely dangerous and requires hospital admission for proper management.

Other potential complications: • Neuropathy (the nerves’ function is reduced)- symptoms include numbness, tingling in the feet • Nephropathy (reduced kidney function, sometimes this can lead to kidney failure) • Retinopathy (the retina in the eyes may develop abnormalities or even detach) • Atherosclerosis- hardening of the blood vessels • Cardiomyopathy- the heart muscles weaken leading to reduced function of the heart • Erectile dysfunction • Poor healing after surgery or injury • Bladder dysfunction • Intestinal problems including constipation, diarrhea, delayed gastric (stomach) emptying

When silence is not golden…

Diabetes can also lead to silent myocardial

When sweet becomes sour

Many of us grew up in an environment where we had to eat our vegetables (including those Brussel sprouts - yuck!) and dessert and candy were occasional treats. Once again, our mothers were smarter than we gave them credit for. Moms are always right, aren’t they?

infarction (heart attack). Therefore, the usual symptoms of a heart attack such as chest pain, left arm and jaw pain may not be felt when a diabetic patient is having a heart attack.

Put your foot down…

Foot care is extremely important. People with nerve damage or reduced nerve function in their feet may not feel when an injury occurs. It is important to wear well-fitting shoes and examine the feet. Cuts and other injuries may take longer to heal and may need medical attention and care.

Take control

We can’t escape it. Diet and exercise are a must. A balanced, low glycemic index (less than 55), reduced carbohydrate diet and exercise helps to reduce the blood sugar levels. Low glycemic index foods break down slower in your body than high glycemic index foods and will leave you feeling a little more full.

There are multiple medications that are available with a prescription that can reduce the glucose levels. The list includes but is not limited to Metformin, Glyburide, Januvia. The supplement chromium may also help.

For those who require insulin, the pump and injections are amongst the options. Type I and some Type II patients will require insulin.

Hemoglobin A1C is a blood test that can measure how well the glucose has been controlled over the past 2-3 months.

How low can you go? While the goal of diabetic treatment is to reduce the blood sugar levels, too low of a glucose level (hypoglycemia) can be detrimental as well. Levels under 50 mg/dL can give symptoms of fainting, dizziness, trembling and sweating. To combat this, drink orange juice or have a carbohydrate snack or other drink.

The sweet taste of victory Diabetes mellitus can not be cured, but it is manageable. In general, the American Diabetic Association recommends maintaining your glucose levels at 80-120 mg/dL before meals, and 100-140 mg/dL at bedtime. Tight control of the glucose levels do help to reduce and prevent

by Dr. Camille Graham

many of the unwanted complications of diabetes. If you or a loved one has diabetes, keep a close eye on the glucose levels. Surgery, infection and some medications may also increase the glucose level, so the diabetic medications and/or insulin may need adjustments when these conditions occur.

If you have any questions or concerns, please seek medical attention. Diabetes should never be taken lightly. There are many organizations, including the American Diabetes Association, that provide compelling information on diabetes.



Dr. Graham has a degree in economics from Hunter College in NYC where she graduated summa cum laude, She received her medical degree from Harvard University where she also earned a masters in public health. She has been in private practice in Dallas since 2001 and is board certified by the American Academy of Otolaryngology – Head and Neck Surgery. Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84
Produced with Yudu -