Diabetes


Bad Breath – Episode 114

A cartoon of two guys. One with black hair and blue shirt is laughing with a green cloud of bad breath. The green cloud of bad breath has surrounded the second guy with brown hair, goatee, and brown shirt. The second guy is grimacing with crossed eyes at the smell.

Bad Breath Basics

Halitosis, aka bad breath, can have many causes.  Some bad breath you can prevent with the choices you make, but some bad breath can be a sign of a more serious issue or disease.

Oral Health

You should brush your teeth for at least 2 minutes twice a day, including the surface of your tongue, then rinse your mouth with an antibacterial mouthwash.  Follow one of your brushing sessions with a good flossing.  This allows you to get any food debris and bacteria build-up out of the way on a daily basis.

You should see your dentist twice a year for a deep cleaning and a check-up on your overall oral health.  Your dentist will be able to help you with bad breath issues that may stem from more complicated issues like cavities, gum disease, poorly-fitting dentures, or thrush.

Dry mouth, whether due to your natural biology, medication side effects, or mouth-breathing, can lead to bad breath due to the imbalance of bacteria growth.

Your Choices

Smoking and other tobacco products can make your breath smell bad even when you are not actively using it.

The foods you eat also affect the status of your breath.  The compounds that cause eaten and digested foods to smell contain sulfur-based compounds.  These include broccoli, cabbage, brussel sprouts, onions and garlic, coffee, and fish.  The funny thing about these smelly compounds is that they can actually make your WHOLE BODY smell (including your breath as well as other exiting air) until they have passed all the way out of your body!

Diseases

Infections, such as bronchitis, pneumonia, and sinusitis, can lead to distinctive bad breath.  Postnasal drip can lead to bad breath as well.  Pharyngeal diverticula that trap old food bits can make your breath smell, as well as tonsil stones that are calcified debris trapped by the tonsils.  Bad breath can also be indicative of acid reflux or GERD.

Certain diseases that have telltale breath smells include diabetes, liver disease, and kidney disease.

People with diabetes are at risk of a medical emergency known as Diabetic Ketoacidosis, in which a lack of insulin renders the body’s cells unable to use the available sugar.  The body starts burning fatty acids for energy and the waste product is ketones.  Ketones cause the body to become very acidic.  This leads to a rapid transfer of water (extracellular fluid rushes into the blood to try and neutralize and dilute the ketones and then the kidneys rapidly try to flush out the acidic fluid through the urine) which can lead to fatal dehydration.  Clinicians are taught that people experiencing ketoacidosis may have fruity-smelling breath or breath that smells like acetone or nail polish remover.

People with liver disease may have breath that smells musty or like a mildewing basement.  And people with kidney disease may have breath that smells fishy or like urine or ammonia.  Ammonia is a typical by-product that is released in urine.  Someone with kidney disease may not be able to filter out the ammonia compounds effectively.  Therefore, the ammonia compounds will circulate in the blood.

Call Back

Brush your tongue – Tastebuds
Tonsil stones – Tonsils
Pharyngeal diverticula – Dysphagia

Connect with me

Support us on Patreon

Give us your Feedback

Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlayTuneIn Radio

Like the Facebook page

Music Credits: Up In My Jam (All Of A Sudden) by – Kubbi https://soundcloud.com/kubbiCreative Commons — Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 http://creativecommons.org/licenses/b…Music provided by Audio Library https://youtu.be/tDexBj46oNI


Diabetes Madlib #2

Clueless About Diabetes Madlib

[source: diabetesduo.com]

With November being National Diabetes Awareness Month, here is another version of the Diabetes Madlibs.  How many of these misconceptions have you held?  Have you ever thought that all types of diabetes are the same?  It may be time to get to know someone with diabetes, they can teach you a lot.

(Answers provided by Ronei, but they are not representative of her knowledge and support of people with diabetes, this is for comic value only.)

“Oh, you have Diahbeedees? So your stomach doesn’t work, right? Well, at least you don’t have emphysema. My Grandmother has it and got it because she ate too much fruit. Last year, she had her toe cut off! I hear you can cure it by drinking water? I feel joyful for you because those fuzzy needles would make me pant. And I could never have someone burp one of those pump things in my knee. My cousin had juvenile diabetes but outgrew it when she turned 54. I was reading in the Enquirer that Helen Mirren had it but reversed it by eating only sushi. And Jimmy Fallon has it and he’s lived a long time with no problems. I also read where lots of people who have it bad travel to Ireland because they have a cure for it there. Don’t get excited, Dr. Who said there will be a cure here in America in 9 years. Then you can start eating kale again!” 

Connect with me

Support us on Patreon

Give us your Feedback

Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunesStitcherGooglePlayTuneIn Radio

Like the Facebook page


Diabetes Madlib #1

Clueless About Diabetes Madlib

[source: diabetesduo.com]

While science understands many of the aspects of diabetes, and it still continues to learn more, society as a whole doesn’t have a clue.  If you have diabetes, I’m sure you’ve had some of the following statements said to you.  If you don’t, read this as a list of things to never say to someone with diabetes.

(Answers provided by Ronei, but they are not representative of her knowledge and support of people with diabetes, this is for comic value only.)

“Oh, you have dyebabeetees? So your lungs don’t work, right? Well, at least you don’t have cancer. My sister has it and got it because she ate too much sushi. Last year, she had her legs cuff off! I hear you can cure it by drinking water? I feel joy for you because those fuzzy needles would make me cook. And I could never have someone skate one of those pump things in my eyeball. My cousin had juvenile diabetes but outgrew it when she turned 102. I was reading in National Enquirer that Meryl Streep had it but reversed it by eating only enchiladas. And Olivia Davis has it and she’s lived a long time with no problems. I also read where lots of people who have it bad travel to England because they have a cure for it there. Don’t be sad, Dr. Paschall said there will be a cure here in America in 9 years. Then you can start eating chocolate chip cookies again!”

Connect with me

Give us your Feedback

Join the Pharmacist Answers Podcast Community on Facebook


Special Episode #4: Life & Blood Sugar [Show Notes]

For someone with diabetes, everything they do in life affects their blood sugar.  They could be eating 100% right and taking their medicine 100% right, and something would cause the blood sugar to be off.

Exercise

It is well-accepted that exercise is good for you.  Your body will store extra sugar as a large molecule called Glycogen.  Imagine a line of kindergarteners hold hands trying to make it through the museum, Glycogen is just a bunch of glucoses holding hands.  When you’re not eating, your body will snip off a glucose at a time as it needs it.  The liver stores and directs the glycogen most of the time.  Your skeletal muscles also store some glycogen, because when they do work (i.e. exercise), it takes too long for the liver to snip off glucose from glycogen and send it to them.  

After exercise, the body replenishes the muscles’ glycogen stores.  This can cause the blood sugar level to drop, for someone with diabetes, this can be dangerous because they can’t “untake” medicine.  When protein and carbohydrates are eaten together, before or after exercise, the blood sugar changes can happen more slowly – the nutrient absorption in the gut causes a “traffic jam” of sorts.

Sleep

Certain metabolism processes happen only when you sleep.    Some people with diabetes wake up with really high blood sugar, others wake up with really low blood sugar.  Sleep is not restful and restorative if the blood sugar is out of balance, but also if sleep is not restful, then blood sugar levels can be jacked up – not just in the morning, but for the rest of the day.

Stress

The hormones that are triggered by stress – even something as basic as adrenaline, can cause the body to respond to insulin and glucose differently.  

Sickness

Your body is going to responds things differently when the immune system is in high gear – that includes insulin, glucose, the food you eat.  An infection requires an antibiotic because you are infected with a bacteria.  Bacteria are living organisms.  Living organisms consume energy sources and produce waste.  This can affect the sugar levels in your bloodstream.  You’re immune system doing work also burns sugar.

Allergies

Works about the same as sickness.  Your immune system is actively trying to protect you from something (allergens) and so it responds differently.

Smoking

If you smoke, STOP!  The nicotine and other chemicals make you more resistant to insulin.  This is most troublesome in Type 2 Diabetes.

Hormones

Especially for women, hormone cycles can affect sensitivity to insulin differently during different times of the month.  Adrenaline can override almost any response to any previous hormone response.

Life is hard

Life with diabetes is super hard.  Diabetes and other chronic diseases are silent and it doesn’t show on the outside at first sight.  Extend grace, extend compassion.

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute!

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunesStitcherGooglePlayTuneIn Radio

Like the Facebook page

Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/


Special Episode #3: Meds & Blood Sugar

People with chronic diseases don’t get holidays or vacations from their medication.

4 ways medication can affect blood sugar

Type of medication

The goal of the medication that people with diabetes take is to lower blood sugar – either by increasing insulin sensitivity, encouraging the pancreas to make more insulin, or to replace insulin that’s not naturally made anymore.  Metformin is like insulin’s wingman; it helps make the cells ready for insulin when it comes by.  So usually these medications (including insulin) will lower blood glucose no matter if you eat or not.

Timing of medication

Most of the medications should not be taken if a meal is going to be skipped.

Dose of medication

The more sugar you eat, the more insulin you need.  The higher the blood sugar level, the higher the dose is needed.  It needs to stay proportional.  Any form of sugar you eat gets turns into glucose, the complexity of the sugar determines how fast it raises your blood sugar.  Even diabetics are at risk for hypoglycemia.  If one little thing gets out of whack, it can cause a drop in blood sugar and require a “rescue”.  Favorite hypoglycemia rescue “go to” is orange juice (lots of simple sugars).  Regular soda can be used, as well as hard candy or glucose tablets.  NO DIET SODA – artificial sweeteners do not affect sugar enough.  High blood sugar can cause coma, lower blood sugar can cause coma.  Bottom line: Coma is bad.

Interaction with medication

Fluoroquinolones can causes changes in blood sugar control and require a person to check their levels and adjust their medicines more often.  Steroids can also cause blood sugar to be more uncontrolled – this is true for acute (short term) use or chronic (long term – like autoimmune diseases) use.  Beta blockers used for blood pressure control can mask the symptoms of low blood sugar because the symptoms are very similar.  Symptoms of low blood pressure:  tiredness, weakness, dizziness, shakiness, inability to focus.  The only way to know which one you’re experiencing is to check your blood sugar and your blood pressure.

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute!

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunesStitcherGooglePlayTuneIn Radio

Like the Facebook page

Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/


Special Episode #2: Food & Blood Sugar

Blood Sugar Basics

Your blood sugar affects how tired you are, your productivity, and your moods.  This is 1000x more true for those with diabetes.

Hypoglycemia = Low blood sugar

3 main energy sources in your food

Carbohydrates are some complex form of sugar that your body can turn into glucose very quickly.  Glucose is the main form of sugar that your body uses for energy.  Because your liver is very efficient in this process, you can get a blood sugar spike (sugar high) and then you crash after it’s over.  Insulin is the key to the door to let the glucose in your cells.

Fats can be turned into sugar by your liver is your glucose stores are depleted.  So, this can affect your blood sugar levels, although it’s less of an impact that carbohydrates.  Insulin has another job – fat storage.  If there’s a lot of fat, the insulin is being used up storing fat rather than allowing glucose into cells.

Proteins are promoted as a counterbalance to the carbs.  It causes a traffic jam in the absorption and metabolism processes that allows the sugars into the blood stream much slower.  The liver does have a process called gluconeogenesis (the creation of new sugar) where it can make sugar out of protein, but it’s a last resort.

Other things in your food

There is some evidence that shows caffeine causes temporary insulin resistance while it’s in the body.  You still get an “energized” feeling b/c caffeine increases the heart rate but the energy usage is not very efficient because the glucose is not being used well.

Alcohol can drop your blood sugar initially, especially if it’s consumed on an empty stomach.  When the liver is steadily detoxing the alcohol out of your bloodstream, the replenishment of the glucose supply slows down.  This contributes to what make you feel sleepy after drinking alcohol.  On the flip side, it will increase your blood sugar because 1) alcohol is usually mixed in a sugary drink (i.e. cocktails) and 2) alcohol is distilled from “high carb” sources (grapes, wheat, barley, rye, corn, etc).

Any changes to eating habits need to be exactly that – new habits.  It can’t just be a program that you do once without permanent change.  If you’re cutting out all or most of one of the 3 main energy sources, you have to make sure you keep up with your caloric needs.

Calorie Math

1 g of Fat = 9 calories

1 g of Carb = 4 calories

1 g of Protein = 3 calories

Calories are calories when it comes it energy, so the other nutrients from your foods are a more important to consider when choosing what to eat.

There are lots of things your body would have to adjust to when changing eating habits (digestion adjustments, for one) and 30 days may not be enough to get it “normalized”.

JDRF

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute!

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunesStitcherGooglePlayTuneIn Radio

Like the Facebook page

Music Credit: “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/


Special Episode #1: Interview with Rachel Mayo

Hemoglobin A1C

This test measures the percentage of your hemoglobin (the protein in your red blood cells that carry oxygen) has been coated in glucose. When there’s a lot of extra sugar floating around, it tends to stick to the other things floating around with it.  Red blood cells live for 120 days*, so that’s a lot of time to let sugar hitch a ride.  And while a blood glucose measurement gives a snapshot of what the blood sugar level is right now, the A1c measurements gives us an idea of what the blood sugar level has been during all the times you’re not pricking your finger to measure over the last 3 months*.

*I do realize that 120 days equals 4 months and not 3 months, but the really old and decrepit RBC’s that are close to their expiration are exactly that – decrepit, so they’re not in good enough shape to give us a trustworthy measurement.

Goal

For those with diabetes, the goal is to have an A1c >7%.  For the average non-diabetic, A1c is ~ 5% (though with the American lifestyle, that “normal” number is creeping up – but that has more to do with Type 2 Diabetes).

Rachel received lots of support through the people she met through the Juvenile Diabetes Research Foundation (JDRF) and continues to support their cause and actively helps other T1D’s get connected.  She also participates in her local chapter of JDRF and participates in the Annual One Walk in Nashville (that’s where I got to hang out with Rachel for this interview!) You can find out what JDRF is all about by visiting JDRF.org and walk.JDRF.com.

++Time Sensitive ++ —> Follow Rachel on social media during the month of November to catch her Diabetes education Periscopes.

Meme of Rachel's "Type 1 Diabetic" tattoo, @rachelcmayo on instagram, periscope, pinterest, and twitter

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/


Insulin is not bad [Show Notes]

An image of a hand underling the word "DIABETES" in red marker. All Type 1 diabetics and many Type 2 diabetics depend on insulin to stay alive.

The Bottom Line

Without insulin, you would die!

Some Basics

Sugar scrub = sugar + water (+/- essential oils)
– a good exfoliant to remove dead skin

Your tiniest capillaries are so small that red blood cells can barely squeeze through one at a time.  So, if the fluid around the red blood cell is full of sugar, it’s like that sugar scrub on your skin.

And that extra sugar can damage the capillaries in your eyes, finger tips, toes, and organs.

The cells in your body require glucose to do their jobs.  

Insulin

Insulin is the only key that will let the glucose in.  No key means no glucose.  No glucose means no energy.  And no energy eventually means death.

Insulin is also responsible for fat storage.

If you don’t eat the sugars, the body will use the fat stores on your body for energy.  But if you don’t consume energy sources (by being on a specific diet) AND your energy stores are depleted, your body will break down the proteins (aka muscles of your body) to make energy.  Your brain (and other organs in your body don’t want you to die).

Sugars and fats you eat gets turned into glucose.  Insulin opens the doors to allow the cells to use the glucose.  If there’s extra glucose around, insulin tells the liver to link it together to form glycogen and store it for later.  If the glycogen storage is full, insulin tells the liver to turn the glucose into triglycerides (think clogged arteries and growing fat deposits).

Free glucose is the easiest and fastest to use.  But during times that you’re not actively consuming sugars (like when you’re sleeping), your body is still working and that’s when glycogen can be used to provide glucose.

How much sugar in a day?  

It’s always different for different people.  The goal is having a level blood sugar as much of the day as possible.  The rule of complex carbs being better than simple carbs is true, because it takes your body longer to break down and use complex carbs.  While simple carbs usually dump a whole log of glucose in your blood stream at one time.  And natural sugars are better than processed sugars because processed sugars tend to be more concentrated.

Your body has an easier time utilizing nutrients and supplements that look more like itself over ones that are synthesized in lab.

Holla!

Rachel Mayo is my diabetes hero!

Find her at:

Callback

T1D vs T2D

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page


Liver Lesson #2: Metabolism [Show Notes]

Review

Liver – have one.

Lobule – yep!

A colored sketch of a liver lobule with labeled parts.

Liver makes bile, helps digest fat in the intestines. Gallbladder? Holds bile until your intestines need bile.

3 main energy sources:  Carbohydrates, Fats, Proteins

Intestines absorb them into the blood and send them to the liver.

Basics of Metabolism

Metabolism = change

This type of change happens for 2 reasons:

  1. To make something useful
  2. To make something safe

What’s water got to do with it?

  • Your blood is made of water
  • Liver preforms hydrolysis on carbohydrates (using water to dissolve it into tiny bits of sugar = glucose)

Carbohydrate Metabolism

Glucose is the main form of sugar that your body uses for energy.

Sugars are the easiest to turn into energy so that gets used first.  So low carb diets force the body to go after fats, which are the next easiest.  If you’re eating low fat as well, then the body will burn the fat deposits on the body.  Weight loss!

Fat Metabolism

The liver breaks down the fatty acids to make cholesterol (which is not always bad).  Cholesterol is used in your cells walls to keep them fluid and slippery.  Cholesterol is also used to make bile (think “like dissolves like”).  If there’s any extra fatty acids the liver performs gluconeogenesis (gluco = glucose, neo = new, genesis = creation). It basically creating glucose out of anything that contains Carbon.

This is why fats are bad for Type 2 Diabetics as well as sugar.

Protein Metabolism

Protein is the hardest, but can still provide energy.  Proteins are made up of amino acids.  Amino = Nitrogen, acid = carbon.  The nitrogen is relatively useless, so the liver turns it into urea, that gets sent out and filtered by the kidneys.  The part with the carbon can be turned into glucose (gluconeogenesis again).

One of the intermediate steps of the urea production is ammonia.  There is actually a blood test that can be done to test the ammonia-urea balance (BUN = Blood Urea Nitrogen), and if this is out of balance, it indicates a problem.  This test may indicate that your body is metabolizing your own muscles.  This can also be a sign of starvation or other nutritional imbalance.  You need your muscles, you don’t want to metabolize your muscles.

Your body generally needs fully intact amino acids to build, rebuild, and heal muscles.  Proteins and amino acids have a life span, so your body is constantly rebuilding and replacing with fresh supply.  Athletes require higher protein diets than most because of this process.

Take Away

Glucose and fats aren’t inherently bad, it’s more about the amounts of each that get consumed and float around your body.

Your liver can be very efficient and metabolizing the foods you eat.

Your body gets fat deposits because the body is saturated with enough fatty acids that it needs, so any extra gets packed up and shipped around the body to be stored until later.

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

 


Type 1 Diabetes vs Type 2 Diabetes

An image of a hand underling the word "DIABETES" in red marker

Diabetes Facts

All of the cells in your body depend on different forms of sugars to make energy (mostly glucose though).

Insulin works like a key to unlock the doors of the cells and let the sugar in to be used.

Adults get newly diagnosed with Type 1 Diabetes too, it’s not just a childhood disease like a lot of marking will make you think.

Diabetes: Type 1 vs Type 2

Type 1 Diabetes: The pancreas (insulin factory) quits working or becomes dysfunctional.

Type 2 Diabetes: The key holes and the doors are broken or jammed and the insulin “key” won’t fit in them as well or at all.  This is known as insulin resistance.

In Type 1, you have to import insulin (aka injections), because you can’t make your own insulin anymore, ever.

Insulin pumps (outside pancreas) give a continuous flow of insulin and can sense sugar levels. It tries to operate as much like a natural pancreas would.

In Type 2, the medications are being developed to encourage your body to use your natural insulin as best and as long as possible.

There are lots of ways to get in a door if they key won’t work, thus there are lots of different medications to help in Type 2.

Holla!

Shout out to Rachel Mayo (@rachelcmayo) for her inspiration for this topic and for her strength and courage to not be scared of #T1D.

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page