Cold weather can increase the risk of heart attacks and strokes, as well as flu, colds and coronavirus.

We’ve teamed up with the British Heart Foundation’s (BHF) to identify some simple tips to help keep yourself healthy while the weather is cold.

Manage your condition

Your heart needs to work much harder in colder temperatures to keep blood pumping around your body.

If your heart health and underlying conditions such as diabetes are well managed, you’re less likely to have problems if you do get a cold. An important way to support your heart health is by taking your medication on time.

Keeping to a schedule, setting reminders, and getting your repeat prescription ordered before you run out of medications can help you to keep on top of your routine.

If you have questions about heart and circulatory diseases, BHF’s experienced cardiac nurses are available to help answer your questions or concerns.

Call 0808 802 1234 for free, Monday to Friday 9am to 5pm (excluding bank holidays) or get in touch via this link, email or online chat.

Fuel your body with tasty, healthy food

It’s common to crave comfort food during the colder months – but it’s all about balance when it comes to your diet. This is just as true around this time of year.

While heavy, stodgy dishes might be tempting during the chilly weather, it’s important to fuel your body with the food it needs to stay healthy.

Fruit and veggies are packed full of essential vitamins and minerals that can help support your immune system as part of a healthy, balanced diet, helping you to fight off colds.

• Find healthy recipes and nutritional information from BHF

Keep moving

Living with obesity puts strain on your body, heart and immune system and may make it less effective at fighting infections.

Exercising can be harder in the winter as the dark evenings and rainy weather can make us feel less motivated. However, there are lots of activities you can do indoors instead.

• See BHF’s range of ideas for keeping active indoors or outside

Look after your mental health and wellbeing

Looking after your mental health is important all year round. However, shorter days, darker nights and more time indoors can make us feel especially low. The lack of sunlight also means that many of us aren’t getting the right amount of Vitamin D.

It’s recommended that we all consider taking a 10 microgram Vitamin D supplement in autumn and winter to help protect our bone and muscle health. You might also need to take this year-round if you don’t go outside very much or if you cover most of your skin when you do.

Being active and keeping in touch with friends and family can also help improve your mood.

Many people also find practicing mindfulness or meditation useful – why not try putting 10 minutes a day in your diary?

Managing stress is also particularly important in the colder months, as too much can affect how our immune system works.

Hormones from stress may suppress immune function and increase blood pressure.

It might also lead to us reaching for sugary snacks and drinking too much alcohol which will impact your overall mood.

• BHF has lots of information on how to look after your wellbeing this winter and beyond.

Discover more heart health support

Living with diabetes and a heart condition can leave you searching for answers.  That’s why having easy access to information from a trusted source is important.

British Heart Foundation is here to help.

Visit bhf.org.uk/questions to find out more.

Any illness can cause glucose levels to rise, including:

• Cold
• Influenza
• Diarrhoea
• Urinary tract infection
• Pneumonia
• Injury

It’s crucial for people with diabetes to understand how to adjust their management strategies during these times to maintain stability and prevent complications.

The essential mantra for diabetes management during these times revolves around the “SICK” day rules:

• S: Sugar
• I: Insulin
• C: Carbohydrates
• K: Ketones

Sugar (glucose) monitoring

During sick days, blood glucose levels can be unpredictable. It’s crucial for individuals with diabetes to monitor these levels more frequently to adapt their management plan accordingly.

Testing should be done every 4 hours to ensure that any significant changes are promptly addressed.

Keeping a detailed log of these readings, along with symptoms and any adjustments made to medication or dietary intake, can provide valuable insights for both the individual and their healthcare provider.

Diligent monitoring is the cornerstone of effective diabetes management during illness, ensuring that decisions are data-driven and responsive to the body’s needs.

Insulin and medication

Continuing insulin and diabetes medications during illness is critical as your body’s need for insulin might actually increase, despite eating less.

There are some medication classes that may need to be temporarily stopped if at risk of dehydration (SADMAN rules).

These are:

• S SGLT2 inhibitors: If taken during an acute illness that can lead to dehydration, there is an increased risk of developing euglycaemic DKA.
• A ACE inhibitors: If taken during an acute illness that can lead to dehydration, there is an increased risk of developing AKI due to reduced renal efferent vasoconstriction.
• D Diuretics: If taken during an acute illness that can lead to dehydration, there is an increased risk of developing AKI.
• M Metformin: If taken during an acute illness that can lead to dehydration, there is an increased risk of developing lactic acidosis.
• A ARBs: If taken during an acute illness that can lead to dehydration, there is an increased risk of developing AKI.
• N NSAIDs: If taken during an acute illness that can lead to dehydration, there is an increased risk of developing AKI due to reduced renal afferent vasodilation.

Once the unwell person is feeling better and able to eat and drink for 24–48 hours, these medications can be restarted.

Never skip your doses without consulting a healthcare professional.

• Missing insulin injections

If you’re experiencing higher than usual blood glucose levels, you might need to adjust your medication dosage.

Adjustment should be based on a plan previously discussed with your healthcare provider, tailored to your specific needs during illness.

Carbohydrates

Maintaining stable blood glucose levels can be challenging when you’re sick.

However, nutrition and hydration is paramount during sick days.

If you find it hard to eat your regular meals, focus on consuming small amounts of carbohydrates regularly to keep blood sugar levels stable.

Hydration is equally important, especially to help lower high blood sugar levels and prevent dehydration.

Consider easy-to-eat options like broth or low-sugar fruits such as blueberries or strawberries.

The goal is to manage glucose levels and stay hydrated, even when your usual diet is disrupted by illness.

Ketones

Monitoring for ketones is essential during sickness, especially for people with type 1 diabetes, as the risk of ketoacidosis increases.

Use a ketone test strip to check your urine for ketones if your blood glucose is consistently high or if you feel sicker than expected.

A positive ketone test indicates that your body is using fat for energy due to insufficient insulin which requires immediate action.

This may include adjusting your insulin dosage and consuming more fluids.

Consult with your healthcare provider promptly if ketones are present.

When to get medical assistance

It’s vital to know when an illness with diabetes necessitates medical intervention.

Immediate healthcare attention is required if you experience:

• Severe dehydration
• Persistent high blood sugar levels
• Significant ketones in urine
• Symptoms of ketoacidosis, like nausea, vomiting, and abdominal pain
• Difficulty breathing, chest pain, or altered consciousness

Preparing a sick day plan in consultation with your healthcare team, including when to seek help, can make managing these situations more straightforward and less stressful.

What is inflammation?

Inflammation refers to the immune system’s defence mechanism against harm or infections. Whenever the human body recognises threats such as pathogens, cell damage or irritants, it activates a protective biological response which involves widening blood vessels to enhance blood flow and summoning immune cells to the scene for healing.

Inflammation is classified as either acute or chronic.

Acute inflammation

Acute inflammation is the body’s immediate reaction to harm or infection which manifests with symptoms including redness, warmth, swelling, pain, and sometimes temporary loss of function. Once the root cause of acute inflammation is addressed, inflammation typically subsides.

Common instances of acute inflammation include:

• Inflammation in the airways due to acute bronchitis
• Sore throat caused by a flu
• A bee sting
• Physical injuries such as a broken toe
• Minor skin wounds

Chronic inflammation

Chornic inflammation refers to the prolonged inflammatory response that can last from months to years which arises when the body can’t remove the root cause of inflammation or when a subtle response persists without a clear reason.

Chronic inflammatory conditions include:

• Rheumatoid arthritis
• Asthma which can cause inflamed air passages
• Periodontitis
• Crohn’s disease
• Eczema

What causes inflammation?

Inflammation can be triggered by a number of things – from external injuries to internal autoimmune disorders.

Chronic inflammation is also often a byproduct of lifestyle choices such as:

• An unhealthy diet
• Sedentary habits
• Smoking
• Chronic stress

Obesity can also induce persistent mild inflammation.

What are the symptoms of inflammation?

Recognising the signs of inflammation can enable treatment and/or intervention.

Common signs of inflammation include:

• Redness: An inflamed area often appears redder than the surrounding skin due to increased blood flow.
• Heat: The inflamed region may feel warm to the touch, again due to enhanced blood circulation.
• Swelling: Fluids and immune cells accumulate in the inflamed area, leading to noticeable swelling.
• Pain: Inflammation often causes discomfort or pain, especially when the inflamed area is touched or moved.
• Loss of function: In some cases, the inflamed part may not function optimally. For instance, an inflamed joint might restrict movement.

Consult a healthcare professional if you notice persistent signs of inflammation, especially if they’re accompanied by other symptoms like fatigue, fever, or unexplained weight loss.

What are the risks of inflammation?

Short-term inflammation is protective but long-term, chronic inflammation can be hazardous to the body.

Over time, it can harm healthy cells and tissues and is linked to several conditions associated with diabetes including cardiovascular disease, neuropathy, retinopathy and nephropathy.

What’s the link between diabetes and inflammation?

Both type 1 diabetes and type 2 diabetes have inflammatory components.

Type 1 diabetes occurs when the body mistakenly attacks the body’s beta cells which produce insulin after an inflammatory process in people with a genetic disposition for the condition.

In type 2 diabetes, the body becomes resistant to insulin, meaning it can’t use insulin effectively and over time, the pancreas can’t produce enough insulin to keep blood sugar levels in control.

While the exact cause of insulin resistance isn’t fully understood, inflammation plays a significant role.

Fat cells, especially in people who are overweight or obese, release pro-inflammatory chemicals called cytokines which can disrupt the action of insulin in cells.

In people with type 2 diabetes, inflammatory markers such as C-reactive protein (CRP) may be elevated even in the absence of an infection or injury.

Persistent inflammation can damage tissues over time and contribute to the complications of long-term high blood glucose levels.

How can I minimise inflammation?

Research has shown that chronic inflammation can be improved through:

• Eating a healthy diet: A diet rich in low-carbohydrate fruits, veggies, lean meats, healthy fats, and grains have anti-inflammatory components like omega-3s, antioxidants, and fibre.
• Keep blood sugar levels in range: High blood sugar levels can lead to the oxidation of free fatty acids in your fat cells, further promoting inflammation.
• Being active: Aerobic exercise can help combat chronic inflammation.
• Stress: Research shows stress can cause inflammation. Try mindfulness, meditation, and yoga to reduce stress levels.
• Getting sleep: Lack of sleep is associated with inflammation.
• Limit smoking: Nicotine activates white blood cells called neutrophils which cause increased inflammation.
• Limit alcohol: Alcohol can promote intestinal inflammation.

People with diabetes can be more prone to get dandruff due to a compromised immune system caused by persistent high blood glucose levels.

What is dandruff?

Dandruff is a condition caused by the scalp shedding dead skin cells. Everyone sheds skin cells, but some people can shed them more regularly than others which results in dandruff.

Itchiness, redness, and flaking of the scalp are common symptoms of the illness.

What causes dandruff?

Researchers think that dandruff is caused by a number of causes including:

• Dry skin/scalp
• Oily scalp: the Malassezia globosa fungi feeds on oils on the scalp which some people’s body’s can be be irritated by causing a red, itchy and inflamed scalp and dandruff.
• Poor hygiene
• Stress
• Seborrheic dermatitis: a form of eczema that affects areas of the body that secrete oil.

Your age, hormones and immune system status can also affect your susceptibility to dandruff.

Conditions such as Alzheimer’s disease, epilepsy, Parkinson’s disease, and traumatic brain injury can elevate a person’s risk of Seborrheic dermatitis

People with uncontrolled diabetes, or chronically high blood glucose levels are more likely to get dandruff due to their immune systems being weaker. This makes the body more susceptible to fungal and bacterial infections. Spend as much time in range to minimise this risk.

• How to Bring Down High Blood Sugar Levels

Symptoms of dandruff

As obvious as it sounds, the flaking of the scalp is the most prevalent sign of dandruff.

You may notice flakes on clothes or in the hair can range in size from little and white to huge and yellowish.

If you have eczema or dry skin already, it can sometimes be hard to distinguis. Other dandruff symptoms include:

• Itchiness
• Dry scalp
• Redness
• Burning feeling on the scalp

Treatment for dandruff

To minimise dandruff, try washing your hair with a medicated shampoo or topical treatments which contain chemicals such as zinc pyrithione, ketoconazole, and selenium sulphide that help to inhibit yeast and fungal development on the scalp.

Corticosteroid topical creams can be used to relieve scalp irritation and itching.

Home treatments including tea tree oil, aloe vera, and apple cider vinegar can be used to soothe and moisturise the scalp.

Dandruff is a common scalp condition and usually not something to be overly concerned about. However, it is essential to understand the cause and seek treatment to avoid future consequences.

People who are more prone to dandruff should take extra care to maintain good hygiene and maintain good blood glucose control.

Cardiovascular diseases can range from mild to life-threatening and can lead to serious health complications if left untreated.

Awareness of cardiovascular disease is especially important for people with diabetes since they are at a higher risk of getting it than people without diabetes. Cardiovascular disease is a leading cause of mortality and morbidity for people with diabetes.

What is cardiovascular disease?

Cardiovascular disease is a leading cause of death worldwide. Annually, it causes 17.9 million deaths according to the World Health Organization.

Types of cardiovascular disease

There are several different types of cardiovascular diseases. Each condition has its own individual symptoms and treatments.

The most common types of cardiovascular disease include:

• Arrhythmia: occurs when the heart beats too fast or irregularly which can cause heart palpitations, dizziness, and fainting.
• Coronary Artery Disease (CAD): occurs when the arteries that supply blood to the heart narrow or become blocked, which can lead to chest pain or a heart attack.
• Heart failure: occurs when the heart is unable to pump enough blood to meet the body’s needs and can cause fatigue and breathlessness.
• Peripheral Arterial Disease (PAD): occurs when the arteries that supply blood to the legs and feet narrow or become blocked and can cause pain, numbness, and tingling.
• Stroke: occurs when the blood supply to the brain is disrupted and can cause numbness, weakness and difficulty speaking.

Each particular cardiovascular disease can be caused by a variety of risk factors, including genetics, lifestyle choices, and underlying health conditions.

Symptoms of cardiovascular disease

The symptoms of cardiovascular disease can vary depending on the type of condition a person has.

Some of the most common symptoms include:

• Chest pain
• Shortness of breath
• Fatigue
• Dizziness
• Nausea
• Sweating

Symptoms can be mild or severe and can occur gradually over time or happen suddenly.

Causes of cardiovascular disease

There are many potential causes of cardiovascular disease.

Some of the most common causes include:

• High blood pressure
• High cholesterol levels
• Smoking
• Uncontrolled diabetes
• Obesity and
• Sedentary lifestyle

Other risk factors can include age, gender, family history, and underlying health conditions such as kidney disease or sleep apnea.

It is important to address these risk factors to prevent and/or manage cardiovascular disease.

Why should people with diabetes be aware of cardiovascular disease?

Uncontrolled blood glucose levels puts people with diabetes at a higher risk of cardiovascular disease for a variety of reasons:

• Persistently high blood glucose levels can damage blood vessels over time. This increases the chance of developing atherosclerosis, a disease in which the arteries constrict and stiffen owing to plaque formation.
• People with diabetes are more likely to have additional cardiovascular disease risk factors including high blood pressure, high cholesterol, and obesity.
• People with diabetes may have other complications that can contribute to the development of cardiovascular disease such as kidney disease or peripheral neuropathy.

Managing your blood glucose levels, blood pressure and cholesterol levels is key for people with diabetes to reduce their risk of developing cardiovascular disease.

Treatment for cardiovascular disease

The treatment for cardiovascular disease will depend on the type and severity of the condition:

• Medications can be used to manage symptoms or prevent further damage, such as blood thinners, statins, or beta-blockers.
• Lifestyle changes, such as exercise, behavioural change therapy, healthy eating, and quitting smoking, can also help to improve symptoms and prevent further complications.
• In severe cases, surgery may be required – such as bypass surgery, angioplasty, or heart transplant.

Prevention of cardiovascular diseases

Preventing cardiovascular disease involves addressing the underlying risk factors that can lead to the condition. This includes:

• Maintaining a healthy weight
• Exercising regularly
• Eating a healthy diet
• Not smoking
• Managing stress and
• Managing any underlying health conditions such as diabetes or high blood pressure

Regular check-ups with a healthcare provider can also help to monitor and manage these risk factors.

Conclusion

Cardiovascular disease is a serious health condition that can lead to life-threatening complications.

Understanding the symptoms, causes, types, treatment, and prevention of cardiovascular diseases is essential to managing this condition and reducing the risk of complications.

A cardiac arrest is a life-threatening emergency which differs from a heart attack.

A cardiac arrest occurs when the heart experiences an abrupt stop to blood pumping throughout your body due to an electrical issue.

When the heart stops pumping blood, the brain does not receive any oxygen and causes the sufferer to become unconscious and stop breathing.

A 2023 survey showed that almost half of British adults don’t know how to perform CPR.

Learning CPR is very important as without CPR, a person in this position can die in minutes.

When do I need to perform CPR?

CPR should be performed only if someone is:

• Unconscious and not breathing
• Unconscious and not breathing correctly

What should I do if someone if unconscious but breathing properly?

Call 999 and place the person in the recovery position if they are unconscious but breathing properly.

What is the recovery position?

The recovery position is a first-aid method used to keep an open airway in a person who is asleep but breathing properly.

The recovery position entails carefully positioning the individual on their side with their head slightly inclined backwards and their upper arm supporting their head to keep the individual from choking on their own saliva or vomit.

How do I perform CPR?

The following are the five steps of doing CPR on an adult person who is not breathing or breathing incorrectly:

Step 1. Shake and shout

• Check for response by shaking and shouting
• If there is no response, call 999 and ask for an ambulance.

Step 2. Call 999

• Call, or ask someone else, to call 999 for an ambulance
• Ask for a public access defibrillator (PAD).

Step 3. Give chest compressions

• Kneel down beside the person
• Place the palm of one hand on the centre of the person’s chest and your other hand on top. Lock your fingers together.
• Keeping your arms straight, use the palm/heel of your hand to push the breastbone down, pressing down 5-6 cm at a rate of 100-120 times per minute.
• According to the British Heart Foundation, you should push to the beat of the Bee Gees’ song Stayin’ Alive: that’s around 2 compressions per second.
• Continue giving chest compressions until help arrives or the person starts to regain consciousness.

Step 4. Persist

• Keep going until the emergency services arrive, or if the person shows signs of consciousness such as coughing, speaking or breathing correctly. If someone else is available, switch turns giving CPR to avoid exhaustion.

Step 5. Use a defibrillator

• If a defibrillator is available, use it by following its instructions, but do not touch the person while they are being shocked.

CPR is different for a baby.

Is a heart attack the same as cardiac arrest?

A heart attack is not the same as a cardiac arrest.

A heart attack occurs when an artery that supplies blood to the heart muscle becomes clogged. A clogged artery deprives a portion of the heart muscle of oxygen which results in chest pain or discomfort.

A person who is having a heart attack is normally conscious and breathing.

You should call the emergency services in either case as both are medical emergencies.

Conclusion

CPR is a life-saving method that can be done when a person’s heart has stopped beating or they are not breathing regularly.

Knowing CPR can give you the confidence and ability to respond quickly and successfully in an emergency, enhancing a person in distress’s chances of survival.

Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin.

DKA is most commonly associated with

type 1 diabetes

, however, people with

type 2 diabetes

that produce very little of their own insulin may also be affected.

Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly.

• Read about
  
  Diabetes and Ketones
  

What is diabetic ketoacidosis?

DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe

illness

Symptoms of DKA

Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes.

Typical symptoms of diabetic ketoacidosis include:

• Vomiting
• Dehydration
• An unusual smell on the breath – sometimes compared to the smell of pear drops
• Deep laboured breathing (called kussmaul breathing) or hyperventilation
• Rapid heartbeat
• Confusion and disorientation
• 
  Coma
  

Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (

hyperglycemia

).

Causes and risk factors for diabetic ketoacidosis

As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy.

This may happen for a number of reasons including:

• Having blood glucose levels consistently over 15 mmol/l
• Missing insulin injections
• If a fault has developed in your
  
  insulin pen
  
  or
  
  insulin pump
  
• 
  As a result of illness or infections
  
• 
  High or prolonged levels of stress
  
• 
  Excessive alcohol consumption
  
  
• 
  Illegal drug use
  

DKA may also occur prior to a diagnosis of type 1 diabetes.

Ketoacidosis can occasionally occur in pregnancy and this can be very dangerous for both the mother to be and the child.

Euglycemic diabetic ketoacidosis

In most cases, ketoacidosis in people with diabetes will be accompanied by high sugar levels. However, ketoacidosis can also occur at low or normal blood glucose levels. This is referred to as euglycemic diabetic ketoacidosis and may occur if someone who is insulin dependent neither eats nor takes sufficient insulin for a prolonged period of time.

People on insulin pumps

should be aware that euglycemic diabetic ketoacidosis could occur during or following exercise if insulin delivery is suspended for too long. Healthcare professionals recommend that insulin delivery is not suspended for more than 1 hour.

How common is ketoacidosis?

Ketoacidosis is most common in children with type 1 diabetes. Diabetes UK notes that in 2009-2010, 9% of children experienced at least one episode of diabetic ketoacidosis.

How is diabetic ketoacidosis diagnosed?

Diabetic ketoacidosis is usually diagnosed using blood and urine tests which measure the concentration of ketones in the blood or urine.

In addition to

testing ketone levels

, levels of potassium may also be measured as part of the treatment to check for signs of hypokalemia (low potassium levels). Potassium may be depleted as a result of excessive urination.

How serious is diabetic ketoacidosis?

DKA is a serious medical emergency. Without urgent treatment, this diabetes complication can lead to death. With adequate and rapid intervention and treatment, mortality rates are lowered to around 5%.

If someone with diabetes displays the signs of ketoacidosis, the situation should be

treated as an emergency

How is diabetic ketoacidosis treated?

Treatment of diabetic ketoacidosis involves administering intravenous fluids to correct dehydration and to replace any salts that may be lost from the body during ketoacidosis through passing excessive quantities of urine.

Insulin is also required to instantly suppress the ketone bodies that the body manufactures.

If an infection has been the underlying causes of DKA, you will be given a sick day plan to help you take the
right amount of insulin. Close observation of the patient to quickly identify and prevent complications is essential and therefore you will usually be treated in hospital until your ketone levels have stabilised and you have returned to eating normally.

How do I avoid diabetic ketoacidosis?

The best way to prevent diabetic ketoacidosis is to keep good blood glucose control at all times. Regularly testing your blood sugar levels at home will help you to manage your glucose levels.

If you experience difficulty in controlling your diabetes, speak to your GP or consultant who can advise you or may refer you to go on a structured

diabetes education

course.

If you ever feel unwell or abnormal, you should test your

blood sugar levels

at once.

In people with hay fever, the immune system overreacts, producing antibodies that attack the allergenic substance. While pollen isn’t harmful, the symptoms of allergic rhinitis can include sneezing, a blocked nose (nasal congestion) and irritated eyes (allergic conjunctivitis).

Hay fever

While hay fever will not directly affect your diabetes, allergy symptoms can leave you unwell and make it harder to manage your condition.

Tiredness caused by congestion or disrupted sleep means it can be challenging to keep track of your blood glucose levels, and you may not notice the signs of low blood sugar (hypoglycaemia) or high blood sugar (hyperglycaemia).

Prescription and over-the-counter medications can be taken to treat hay fever, including nasal sprays, eye drops and oral medications. However, most medicines available have side effects that impact blood glucose levels.

Symptoms of seasonal allergies

Common symptoms of hay fever include:

• Sneezing
• Runny or blocked nose
• Itchy and watery eyes
• Congested ears
• Postnasal drip
• Itchiness in the roof of your mouth or throat

Less common symptoms can also include:

• Headache
• Shortness of breath
• Coughing

Symptoms range in severity and are often worse when there is a higher pollen count.

Treatments for allergies

Antihistamines

These medications can stop allergy symptoms such as sneezing and allergic conjunctivitis and are typically available on prescription and over-the-counter.

While antihistamines will not directly affect your diabetes, some can cause drowsiness, making it harder to spot the symptoms of high and low blood glucose levels.

Some antihistamines are non-drowsy and might be a better option if you are concerned about monitoring your blood sugar.

Before taking any new medication, you should consult with your healthcare professional.

Decongestants

Available as oral medicines and nasal sprays, decongestants help to relieve a blocked nose by drying up the secretions in your nasal passages.

If you have diabetes, you should avoid decongestants containing phenylephrine and pseudoephedrine, as these can raise blood sugar levels and cause hyperglycaemia.

Decongestants can also raise heart rate and blood pressure, and you should discuss your options with your GP or pharmacist before taking them.

Steroids (Corticosteroids)

Corticosteroids are used to reduce and treat inflammation caused by hay fever. The most common type of steroid available to treat allergies is a nasal spray, but they can also come in the form of oral medications and eye drops.

Steroids can make the liver release more glucose and block the effect of insulin, causing insulin resistance. Both of these can be particularly dangerous for people with diabetes, causing hyperglycaemia due to the excess glucose in the blood.

If you are required to take any steroid treatments, you should regularly check your blood glucose levels, informing your doctor of any changes.

Due to its impact on blood glucose levels, long-term use of corticosteroids has also been known to trigger the development of type 2 diabetes, also known as drug-induced diabetes.

Avoiding allergies

Although it is not always possible to avoid the causes of seasonal allergic rhinitis, there are some preventative measures you can take, including:

• Wearing sunglasses to keep pollen away from your eyes.
• Wash off pollen from your skin and hair by taking a shower after being inside.
• Remove excess moisture out of your home by using a dehumidifier, keeping it well-ventilated when possible.
• Avoid going outside when the pollen forecast is predicted to be high.
• Wash your bedding regularly, and consider using hypoallergenic bedding that is resistant to allergens.

How can I tell if I have a cold or hay fever?

Colds are caused by a virus and are contagious, while hay fever is an allergic reaction to pollen and is not contagious.

Cold symptoms can occur any time although they are more common in colder months.

Whereas hay fever symptoms align with pollen seasons and worsen when outdoors during high pollen counts.

Symptoms may be different too.

Colds symptoms include:

• Sneezing
• Coughing
• Sore throat
• Headaches
• Possible fever
• Loss of taste or smell

Symptoms typically last 1-2 weeks.

For hay fever, symptoms can last for weeks or even months during pollen seasons.

Observing patterns with when your symptoms occur can help indicate whether it’s hay fever or a cold.

If in doubt, consult your healthcare team.

Although typically found in central and western Africa, there are now reports of multiple monkeypox outbreaks across the UK.

While monkeypox is not very contagious and is less dangerous than other viruses, it is always important to be able to identify the signs of a disease and the risks it may pose to you.

Transmission of monkeypox

Monkeypox is a viral zoonosis, which means it is a type of virus transmissible to humans from animals. The first instance of the virus was identified in laboratory monkeys in 1958, hence the name monkeypox.  However, it is thought that people catch the virus from infected wild animals, specifically rodents like rats and squirrels.

Between people, monkeypox is transmitted through bodily fluids, close contact with lesions (touching monkeypox blisters or scabs), respiratory droplets (if someone with the rash coughs or sneezes) and contaminated materials like clothing, bedding and towels.

Those living in the UK are unlikely to contract monkeypox, although certain people are more at risk.

If you have recently travelled to west or central Africa, where the disease is endemic, there is a higher chance you could get the virus.

Being in close contact, including sexual contact, with someone who has monkeypox or is symptomatic also puts you at a higher risk of getting monkeypox. Even touching another person’s skin or sharing their bedding counts as close contact.

While anyone can become infected with monkeypox, there have been a higher amount of cases in people who are gay or bisexual and in men who have sex with men.

Symptoms of monkeypox

Symptoms of monkeypox usually appear between 5 and 21 days after infection. These include:

• A high temperature
• A headache
• Muscle aches
• Backache
• Swollen glands
• Shivering
• Exhaustion

A rash will often develop between days 1 to 5. Beginning on the face, the rash can spread to other parts of the body, including the genitals.

Sometimes a monkeypox rash can look similar to chickenpox. The rash will typically look like raised spots to start with, which will turn into small blisters filled with fluid. Eventually, these blisters will form scabs and peel off.

What to do if you think you have monkeypox

The NHS recommends contacting a sexual health clinic if you have symptoms of monkeypox and have been in close contact with anyone who has or may have the virus in the past three weeks.

You should also contact a clinic if you have visited west or central Africa in the past three weeks and are exhibiting symptoms.

Find your nearest sexual health clinic here.

Ring ahead before visiting the clinic and explain your concerns. It is important that you stay at home and avoid close contact with others until you’ve been given further advice.

Treating monkeypox

In most cases, monkeypox is mild with most people usually recovering within a few weeks without the need for treatment.

As with other viral infections, those diagnosed with monkeypox should isolate themselves to help prevent the further spread of the disease.

A person with more severe symptoms, or a higher risk of developing serious secondary complications, may have to stay in a specialist hospital until they fully recover.

People may also be offered a vaccine to help fight off the virus. Previously, vaccination against smallpox has been found to be 85% effective in treating monkeypox.[1]

Who is at risk: monkeypox and diabetes

Although monkeypox is not usually fatal, with most people recovering within a few weeks of contracting the disease, it may be more severe in certain individuals, including children, pregnant women, or those considered immunosuppressed.

Having diabetes does mean you are considered immunosuppressed. However, those who do not have their condition under control can be more susceptible to infection as high blood sugar (also called hyperglycaemia) can negatively affect the body’s immune system. There are many ways you can take control of your blood sugar levels, such as eating a healthy diet and keeping fit

Dyslipidemia is the term for unbalanced or unhealthy cholesterol levels. Whilst the term ‘cholesterol levels’ is used; a more accurate term is ‘lipid levels’.

There are different forms of dyslipidemia which includes too high cholesterol but can also refer to too low cholesterol or when the balance of total and HDL cholesterol is unhealthy.

Cholesterol and lipoproteins

Cholesterol
serves an important role in the body and is used in the membranes of all our body’s cells.

When we have our cholesterol levels measured, what are actually being measured are tiny proteins in the blood which carry the cholesterol.

These lipoproteins include:

• LDL – sometimes known as ‘bad’ cholesterol
• HDL – sometimes known as ‘good’ cholesterol

High cholesterol

Having too high cholesterol (hypercholesterolemia) can signify a higher risk of heart problems.

Too high cholesterol can include one or more of the following:

• Too high total cholesterol
• Too high LDL cholesterol
• 
  Too high triglyceride levels

Many people with type 2 diabetes will often find they have high cholesterol either when diagnosed or before finding out they have type 2 diabetes.

Some people may have high cholesterol because they have a condition called familial hypercholesterolaemia. This is a genetic condition that affects about one in 250 people.

People with this condition will have had higher cholesterol levels than normal from birth. However, as high cholesterol rarely presents symptoms, the condition may not be diagnosed until adulthood.


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Other factors can also cause higher cholesterol levels include certain medications such as:

• 
  Steroids
• Beta blockers
• Diuretics

Unbalanced cholesterol

High cholesterol can indicate poor health but it is possible to high total cholesterol and still have healthy cholesterol levels, as long as your HDL cholesterol levels are sufficiently high.

A more reliable measure of heart risk is how unbalanced your cholesterol levels are.

If you’ve been given cholesterol levels that include your total cholesterol and your HDL levels, you can estimate how healthy your cholesterol levels are.

Take your total cholesterol number and divide it by your HDL number. If the result is less than four, your cholesterol levels are probably healthy.


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Note: this health estimate only applies if your cholesterol results are given in mmol/l and can only be a guide of heart health.

This check is known as the

ratio of total cholesterol to HDL

If you don’t have both your total and HDL levels for your latest cholesterol result, ask your health team as they should be able to provide this figure if you have diabetes.

Too low cholesterol

The body needs to keep many things in balance. Just as you can have

too high and too low blood sugar
and

too high and too low blood pressure, you can also have too high and too low cholesterol.

Having cholesterol levels below 3 mmol/l is linked with higher risks of cancers and mortality (death).

Advanced cholesterol tests

Doctors are able to carry out more advanced cholesterol checks that measure other small particles such as apolipoprotein A-I (apoA-I) and apolipoprotein B (apoB).

This test can provide a more accurate estimate of heart health than the ratio of total cholesterol to HDL.

However, this is not a standard test and most doctors will not use this test unless there is a specific need for it.

Achieving healthy cholesterol levels

Low-fat diets
can help to lower cholesterol but

low-carbohydrate
and

ketogenic diets
typically lead to a healthier balance of cholesterol as they help to raise the level of HDL (good) cholesterol.

A low-carb

Mediterranean diet
is regarded as one of the best diets for heart health.

Low-cab Mediterranean diets are rich in healthy fats from oily fish, fresh, unprocessed meat, full-fat dairy, avocados, nuts, seeds, olives and olive oil.

A ketogenic diet has been shown to be effective for improving blood glucose control and helping towards weight loss in people with diabetes. It has also been shown to significantly benefit a number of other conditions.

Whilst the benefits are clear in some conditions, such as epilepsy, in which the ketogenic diet has been extensively studied.

In other conditions, the ketogenic diet shows promise but there is a lack of robust clinical trials to give strong evidence.

Epilepsy and seizure disorders

The ketogenic diet is one of the medically accepted treatment for chronic seizures in epilepsy and other epileptic disorders, including Lennox-Gastaut syndrome and Dravet syndrome.


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Research has shown that it helps reduce the frequency of seizures in children.

About half the children whose seizures don’t respond to any medications almost immediately stop seizure activity once they are in ketosis.


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The reason for the effectiveness of ketogenic diets in treating children is not entirely clear. Researchers are investigating this approach in adults.

Scientists don’t know whether the seizure activity is improved by the presence of the ketone B-OHB (beta-hydroxyburyrate) or the stark reduction in

blood glucose
or insulin in the body. It could that this results from a combination of these factors or something altogether different.

Cancer

By producing a state of ketosis, the ketogenic diet may have a role in helping to treat aggressive metastatic cancers and brain tumours that are not treated effectively with standard care alone.

Sugar is a fuel source which can feed cancer and insulin is essentially a growth hormone. The ketogenic diet can dramatically reduce carbohydrate, which helps reduce blood sugar and the amount of insulin in the body.

The theory states that this cuts down on the amount of sugar and insulin that certain cancers rely on and that malignant tumours can’t adapt readily to using ketones instead of sugar like normal tissue can. This is part of the Warburg effect.


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Whilst this is the theory, no significant studies have been run that have shown whether or not this effect occurs in practice and there is some evidence to suggest that cancers may adapt to using ketones.


^[223]

As a result, the benefits of a ketogenic diet on cancer is still an unknown area.

Alzheimer’s disease

Alzheimer’s disease
(AD) often manifests itself as the inability of certain regions of the brain to use sugar as a fuel. Thus, researchers are investigating whether uncontrolled type 2 diabetes, where too much sugar remains in the blood, could damage the brain and contribute to the development of AD.


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There is evidence that changing the body’s energy fuel from mainly sugar towards ketones may have a significant role in brain health and perhaps even Alzheimer’s treatment.


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Ketones, which the brain can use for over half of its fuel requirements, once carbohydrate intake is lowered, essentially boost the energy levels of

brain
cells by increasing the number of energy powerhouses (mitochondria) in these cells.

A higher number of mitochondria in brain cells is thought to help improve learning and memory abilities, leading to a better quality of life for people with AD.


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Parkinson’s disease

There’s evidence that a ketogenic diet could potentially help in preventing or combatting Parkinson’s disease.

In a very small, uncontrolled study, Parkinson’s disease patients experienced a mean of 43% reduction in Parkinson’s disease symptoms after following a ketogenic diet for 28 days. However, because the study was only seven participants, the researchers could not rule out the fact that the improvement may have been a placebo effect.


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Other research studies have suggested that

ketones
produced on a ketogenic diet may have beneficial effects on how the brain responds to dopamine, which could reduce the symptoms of the condition.


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More research will be needed though before we can say with any certainty whether the diet can indeed help.

Traumatic brain injury

Research suggest that a severe head trauma is often followed by the person having very-high blood sugars. There is some evidence that elevated

blood sugar levels
may worsen the injury and impair recovery from the trauma.


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Several compelling studies, in animal models and small clinical trials, tend to support that a ketogenic diet could protect against further damage from the injury by

bringing blood sugar levels down

<sup>[230]



[231]</sup>

Researchers who have tried to attenuate the effects of brain injury with ketones supplements have found that the brain’s uptake of ketones increases significantly following an injury, suggesting that the brain preferentially changes its fuel source during recovery.


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The mechanisms of action of ketones after an injury are unclear, but it is thought that they may lower inflammation in the brain and prevent brain cell death. It has been suggested that high ketone levels could also increase blood flow.

ADHD

Recent research and controlled studies suggest that diet plays an important part in the management of attention-deficit/hyperactivity disorder (ADHD).

One of the diets that helps reduce symptoms associated with ADHD include the ketogenic diet.

The diet is especially thought to help with a symptom of ADHD overlapping with epilepsy called epileptiform discharges.


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In one study involving 37

children, treatment with the ketogenic diet resulted in a reduction of epileptiform discharges by 13.6 per cent in more than half of these children after only one month.

Further research needs to be done on the relationship between improvement of ADHD symptoms and eating ketogenic, but the diet can provide an alternative to stimulant medications, which can come with side effects.

Chronic Lyme disease symptoms

Lyme disease is a chronic autoimmune condition that can affect the joints,

memory
and heart in the long-term.


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Lyme disease damages the brain by producing profound inflammation. Ketones may help alleviate some of the post-Lyme symptoms thanks to their significant anti-inflammatory effects.

Ketones bring down inflammation by reducing levels of cytokines – a commonly elevated inflammatory marker found in the brain of people affected by Lyme.

Providing ketones as a fuel source for the brain of people who have had Lyme may help speed up their recovery by lifting brain fog as well as improving memory and concentration.

Exocrine pancreatic insufficiency (EPI) is a condition that occurs then the pancreas starts to lose its ability to aid digestion.

What is the pancreas?

The

pancreas

is well known amongst people with diabetes as the gland that produces and releases insulin. However, this is not its only function.

The pancreas releases hormones into the blood (endocrine), but also sends some through tube like ducts (exocrine) to certain organs,

mainly in the digestive system

The exocrine enzymes it releases – elastase, lipase, protease and amylase – are used in the intestines to help with digestion. It also releases bicarbonate to neutralise stomach acid.

What is exocrine pancreatic insufficiency?

Exocrine pancreatic insufficiency (EPI) is when the pancreatic functions start to falter and there are not enough exocrine enzymes released to digest food properly. As a result, the body struggles to absorb a lot of vital nutrients.

This usually happens due to tissue damage of the pancreas, or as a blockage of the ducts that transfer the enzymes into the intestines, and can lead to several symptoms and complications.

What causes EPI?

One of the most common causes of EPI is cystic fibrosis. About 90% of

cystic fibrosis patients

have EPI, and many will have it from birth.

However, EPI can also be caused by

chronic pancreatitis

(CP).

CP is an inflammation of the pancreas, caused, among other things, by

alcohol

or gallstones. It can stop the pancreas from producing and releasing the hormones or enzymes that it is supposed to. For this reason, it can also cause

secondary diabetes

Symptoms of EPI

Because of how it affects the digestive system, the symptoms of EPI have to do with not absorbing enough nutrients from food or digesting it properly. They can include:

• 
  Diarrhoea
  
• Loss of appetite
• 
  Weight loss
  
• Steatorrhea (foul smelling feces caused by undigested fat)
• Flatulence
• Stomach pain

Diabetes and EPI

It is unknown exactly what causes certain cases of EPI, but it does occur often in people with insulin dependent diabetes.

Among other theories such as it being caused by a virus, EPI has been hypothesised to be as a result of an autoimmune disease attacking the pancreas, just as

type 1 diabetes

is.

In 2003, a study of over 1,000 diabetic patients found that insulin dependent diabetics were more likely to produce abnormally low levels of exocrine pancreatic enzymes.

Between 25% and 50% of insulin dependent diabetics were found to have developed exocrine pancreatic insufficiency.

Furthermore, another study published in 2011 found that obese women produced less elastase, one of the exocrine enzymes. A person’s development of type 2 diabetes may be related to obesity, and so they could well suffer with a form of EPI.

People with diabetes are prone to heart problems. It’s one of the most common diabetic complications.

Prolonged exposure to high blood glucose levels weakens the arteries, among other things, which increases the chances of blockage.

Keeping a healthy heart, therefore, is essential. There are a number of ways to do it.

Heart care

There are several things you can do to prevent heart disease:

• 
  Exercise:
  
  Physical activity keeps your
  
  metabolism
  
  active
• 
  Maintaining a healthy weight:
  
  What constitutes a healthy weight depends on the person. Your doctor can advise you
• 
  Eating plenty of vegetables and low-GI foods:
  
  
  Non-starchy vegetables
  
  are a great source of fibre, which helps prevent the build-up of cholesterol. Low-GI foods – that is, foods that have a low rating on the glycemic index, a measure of a food’s effect on blood glucose levels – prevent high blood glucose levels. This, in turn, reduces the risk of artery damage
• 
  Drink less:
  
  Unless your
  
  alcohol intake
  
  it already low, reducing the amount of alcohol you drink can help protect your heart. Heavy alcohol consumption increases the risk of high blood pressure and weakens the heart muscle.
• 
  Eat less processed foods:
  
  A number of studies have suggested that processed food increases the risk of heart failure by causing chronic inflammation that blocks blood vessels.
• 
  Eat less salt:
  
  Like alcohol, consuming too much salt raises your blood pressure.
• 
  Stop smoking:
  
  smoking damages the lining of the arteries, which leads to the build-up of fat.

The importance of heart care can’t be overstated. 80 per cent of people with diabetes die from coronary heart disease.

NHS checks

There are a number of tests that can be conducted to determine heart disease.

Cholesterol test

The

cholesterol

test is simple. All you need to do is provide a little sample of blood. If your cholesterol levels are high, you won’t be left to it. Expect advice and support.

Blood pressure test

High blood pressure

is a common health problem, affecting around 30 per cent of adults in the United Kingdom. Most people don’t know they have it, because it doesn’t present symptoms.

You’ve probably had a blood pressure test before. It involves a cuff being placed around your upper arm and tightened.

HbA1c test

The

HbA1c test

provides a longer term indication of your blood glucose control than a finger-prick test. Several studies have linked healthy HbA1c levels to a reduced risk of heart disease.

To prevent heart disease, make sure you get as close as possible to the HbA1c target of 6.5%.

If you have type 1 diabetes, that target is 7.5%, because a lower target would increase the risk of

hypoglycemia

If you can comfortably manage 6.5% as someone with type 1 diabetes, this is ideal. Note that these targets are generalised; healthy HbA1c levels vary from person to person.

Speak to your healthcare team to get a more personalised figure.

Spotting heart problems

If you can’t prevent heart disease, it’s important to know when it’s happening. Familiarise yourself with the symptoms:

• Tightness in the chest
• Breathlessness
• Pain in your arm or leg
• Palpitations
• Faster heartbeat
• Weakness or dizziness
• Nausea
• Sweating

If you experience these symptoms, contact your doctor immediately. A timely diagnosis and quick treatment can prevent things from getting worse.

Perhaps you’ve already been diagnosed with a heart condition. If so, be sure to contact your doctor if you experience new symptoms, or if your existing symptoms get worse.

Spotting a stroke

Stroke can be life-threatening

It occurs when the brain isn’t receiving a proper supply of blood. If stroke is treated quickly, the damage can be reduced.

So you need to know the signs and symptoms. If you or anyone else experience the following, call 999 immediately:

• Facial muscles drooping
• Unable to lift both arms due to weakness or numbness
• Speech impairment: your speech might be garbled or slurred, or you may not be able to speak at all

Research indicates that people with diabetes have a higher risk of oral health problems, including

gum disease

, thrush and dry mouth.

It is important for people living with diabetes to maintain excellent plaque removal every day through brushing regularly and using floss or small brushes for cleaning in-between the teeth. Good oral health can contribute to good general health.

Keeping good control of blood glucose levels, eating a healthy diet and quitting smoking can all help reduce your risk of

dental health

problems. You should also ensure your dentist knows about your diabetes and that you attend regular dental appointments.

In this section we will look at the recommended teeth cleaning techniques that can help you maintain healthy teeth and gums and lower the chance of oral and general health complications developing.

Recommended brushing and interdental cleaning techniques

You should always brush your teeth last thing at night and at one other time in the day. A timer can be useful to ensure you brush for a full two minutes each time.

Once you have brushed your teeth, spit out but don’t rinse your mouth with water. Toothpaste has an active ingredient called fluoride, which prevents dental decay. The excess toothpaste on your teeth will continue working, if it is not rinsed off, to keep your teeth strong. Some toothpastes are designed to also reduce tooth sensitivity, these toothpastes should be used in the same way.

The mechanical aspect of tooth brushing removes dental plaque; this is the most important way to maintain healthy gums rather than a mouthwash.

A good quality small headed toothbrush can make all the difference to plaque removal. Toothbrushes should have soft nylon bristles with rounded ends. They should be used gently and feel comfortable in the hand. A dentist or hygienist can advise you about the best type of toothbrush to use.

Once a day you should use small brushes or floss to remove the plaque from in-between your teeth to improve and maintain the health of your gums. Be sure to use a small brush which is a snug fit in the gaps between your teeth to remove as much plaque as possible.

Once a day you should use small brushes or floss to remove the plaque from in-between your teeth to improve and maintain the health of your gums. Be sure to use a small brush which is a snug fit in the gaps between your teeth to remove as much plaque as possible.

How to floss video guide

How clean are your teeth?

An easy way to assess how well you are brushing your teeth is by using a plaque-disclosing tablet. These tablets show up the plaque deposits on your teeth, and can be bought online, at your dental surgery, in a pharmacy or at the supermarket.

Steps of use:

1. Wear an old T-shirt/top as splashes of dye may discolour your clothes
2. Brush your teeth as normal
3. Apply Vaseline to your lips
4. Chew a disclosing tablet on both sides of your mouth and role your tongue around the outer edges of your teeth
5. Rinse your mouth out with water
6. Plaque deposits will show as pink marks on your teeth
7. Look at your teeth in the mirror with good light, to see if any plaque deposits remain on your teeth
8. Any plaque missed can be brushed away
9. Repeat the process once a week, to check how well you have been brushing.

You may want to take a picture on your phone of the plaque deposits to remind you of any areas you have missed and where to concentrate on brushing in future.

How clean are your teeth?

Common areas for plaque to build up and be missed when tooth brushing include:

• In-between your teeth
• At the levels where the teeth meet the gums
• Around the edges of crowns and fillings
• On the tongue side and palate sides of your teeth

How to prevent gum disease

High triglyceride levels, also known as hypertriglyceridemia, are often the result of either an additional medical condition or having a

high calorie diet

High triglyceride levels tend to be particularly common in patients with uncontrolled

type 2 diabetes

If you have triglyceride levels that are too high, it is important to take steps to bring your triglyceride levels down. Lifestyle changes can help with reducing high triglyceride levels. Your doctor will be able to advise you on how to address the problem.

What are triglycerides?

Triglycerides are blood fats that are a flexible source of energy.

The body can convert triglycerides into glucose and triglycerides can also be stored in adipose tissue (fat cells).

The process of converting triglycerides into glucose is known as gluconeogenesis and is performed by the

liver

Are there symptoms of raised triglyceride levels?

High triglyceride levels will not usually result in symptoms but, if you have diabetes and live in the UK, you should be given a cholesterol test at least once each year which will test your triglycerides in addition to

cholesterol

Whilst it is less common, some people may develop fat deposits under the skin called xanthomas.

These are yellow lumps that can develop anywhere on the body but are more commonly found around the eyelids and around joints such as the knees, elbows and knuckles.

Diagnosis – testing triglyceride levels

Your health team can

test your serum triglyceride levels

(amount of triglycerides in the blood) through a blood test and this will usually be done as part of a cholesterol test.

Recently eaten food and drink, within the last few hours, can raise triglyceride levels so to get a fair result, you need to fast before the test.

If you have type 1 diabetes or are otherwise on insulin, your health team may ask you not to fast, however, to prevent raising the risk of

hypoglycemia

occurring.

People with diabetes should be given a cholesterol test at least once per year. If you are not sure whether you have had a cholesterol test in the past 12 months, ask your doctor whether you have had one.

Triglyceride targets

The NICE guidelines do not state a target for triglyceride levels. Treatment for high triglyceride levels should take into account other cholesterol levels and whether triglyceride levels are consistently too high.

Diabetes UK advises fasting triglyceride levels to be

under 1.7 mmol/l

Causes of high triglyceride levels

A high level of triglycerides in the blood, when fasting, can be caused by any of the following:

• 
  Obesity
  
• A high calorie diet
• Poorly controlled diabetes
• 
  Excessive alcohol consumption
  
• Cirrhosis of the liver
• 
  Kidney disease
  
• Hypothyroidism – an underactive thyroid
• Familial hypertriglyceridemia – a genetic disorder
• 
  Certain medications
  
  – including steroids, beta-blockers and diuretics

Treating high triglyceride levels

High triglyceride levels can be treated by following a

lower calorie diet

and taking regular exercise. Cutting down on alcohol is also recommended. Using a

lifestyle based method

in this way is the ideal way to lower triglyceride levels.

If you have high triglyceride levels, you may be prescribed medication to help lower your triglyceride levels.

You may also be prescribed medication, such as statins, fibrates or niaci, if you also have high levels of LDL cholesterol.

Taking omega 3 fish oils may also help to

reduce triglyceride levels

Complications of hypertriglyceridemia

Having high triglyceride levels over a long period of time raises the risk of conditions such as

heart disease

and

stroke

Higher than recommended triglyceride levels have also been linked with higher incidence of

diabetic neuropathy

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Having very high triglyceride levels is associated with increased risks of

pancreatitis

and

fatty liver disease

Frozen shoulder, also known as adhesive capsulitis, occurs when ligaments around the shoulder joint swell and become stiff.

The inflammation of this tissue can make normal healing hard and result in your shoulder being so stiff that everyday activities can be troublesomen, such as buttoning your shirt.

Frozen shoulder can be very painful for sufferers, which is normally followed by increasing stiffness after around nine months. Symptoms can get worse over a number of months and years and greatly affect movement.

Patients with frozen shoulder can ease their symptoms, but this can sometimes take several years.

Connection with diabetes

Research has shown that people with diabetes are up to

twice as likely

to suffer from frozen shoulder. Dr. Richard Bernstein reports this is due to effects on collagen in the shoulder, which holds the bones together in a joint.

Collagen can become sticky if

sugar

molecules become attached, resulting in movement being restricted and the shoulder beginning to stiffen. This process is known as glycosylation.

Poorly controlled diabetes has long been linked to muscular and skeletal problems, with consistently high blood sugars likely to increase the risk of

complications

such as frozen shoulder.

Symptoms of frozen shoulder

Pain and stiffness are the two main symptoms of frozen shoulder, which can vary from being mild to severe enough that you may not be able to move your shoulder.

Symptoms typically affect patients across three different stages:

• 
  Stage one: Freezing
  
  (lasts between six weeks to nine months) – your shoulder will become very painful and can result in range of motion being lost
• 
  Stage two: Frozen
  
  (lasts between four to 12 months) – your pain may ease, but your shoulder could become increasingly stiff
• 
  Stage three: Thawing
  
  (lasts between six months to many years) – ability to move your shoulder will improve and you may be able to resume doing more everyday tasks

Individuals can experience great differences in symptoms, but early diagnosis and treatment can reduce their severity. In a minority of cases, symptoms can last for a number of years.

Causes of frozen shoulder

It is not fully understood why frozen shoulder occurs. As one person’s symptoms can be different to another’s, it can be hard to categorically say what causes the condition.

There are a number of causes that are believed to increase the risk of developing frozen shoulder, including:

• 
  Other health conditions
  
  – such as diabetes,
  
  heart disease
  
  ,
  
  stroke
  
  , overactive and underactive thyroid
• 
  Recent surgery or injury
  
  – frozen shoulder can develop after a shoulder or arm injury or surgery – this may be partly due to keeping your shoulder still for prolonged periods during your recovery
• 
  Age and gender
  
  – frozen shoulder most affects people aged between 40 and 60, while women are more likely to develop the condition than men
• 
  Altered arm mobility
  
  – not moving your shoulder for long periods, such as during a stay in hospital, or participating in an activity that involves arm rotatio, overweight weight lifting and sudden stress via injury can cause frozen shoulder
• 
  Other shoulder conditions
  
  – such as calcific tendonitis and rotator cuff tear

Diagnosis of frozen shoulder

You should see your doctor if you feel any persistent pain in your shoulder, especially if this is limiting your shoulder movement. Early diagnosis of frozen shoulder can help prevent long-term symptoms and get you on treatment for stiffness and pain as soon as possible.

A physical examination will be conducted by

your doctor

to evaluate your pain and range of motion.  You will be asked to perform tasks such as raising your hands up, touching your opposite shoulder and scratching your back.

You will also be asked about your symptoms, including their severity, when they started and if you have any other health conditions. A blood test may be conducted to rule out other possible health conditions.

If frozen shoulder cannot be identified from symptoms alone, imaging tests such as X-rays, ultrasound scan and an MRI (magnetic resonance imaging) scan may be conducted to rule out physical problems with your shoulder.

Treatment for frozen shoulder

Treatment for frozen shoulder focuses on controlling the pain and helping restore some movement. This can vary across levels of severity.

Shoulder exercises and stretching is commonly advised to keep the shoulder from further stiffening.

Your doctor or physiotherapist will run through this with you, as well as the prospect of deep massage of the affected tendons and trigger points.

Anti-inflammatory painkillers may be advised to ease the pain, as well as ordinary painkillers such as codeine.

A steroid injection to reduce inflammation can provide relief from symptoms, while surgery may be considered when all other treatments are not helping.

Whilst most, if not all, of us will experience some degree of

memory loss

from time to time, if lapses in memory become common, severe or begin to cause difficulties in day to day life, it’s important to find out why.

In this guide we look at some of the factors that can be commonly associated with memory loss specifically in people with diabetes.

Causes of memory loss

Memory loss can be brought on by a number of factors associated with diabetes, including:

• Low blood glucose levels (hypoglycemia)
• Persistent high blood glucose levels (hyperglycemia)
• Dementia and Alzheimer’s disease
• Stroke
• Anxiety, stress and depression
• Poor sleep
• Statins

Note that these factors can vary widely in terms of their effects with some factors only linked with temporary memory problems whereas others may lead to lengthy or even permanent memory trouble.

The following part of this guide will look into each of these factors in more detail in terms of how they affect memory and how memory problems can be minimised or prevented.

Low blood sugar (hypoyglycemia)

One of the ways in which

low blood sugar

can affect the body is that it can lead to temporary impairment in memory. In most cases, memory should improve back to normal soon after your levels return to normal.

A 2007 study, of 1,144 patients with type 1 diabetes, that reviewed hypoglycemia as a potential factor in cognitive decline (including memory loss) found no evidence of a link between episodes of

severe hypoglycemia

and substantial long-term decline in cognitive function.

Whilst the study found no link, it is important to note that hypoglycemia, and particularly severe hypoglycemia, should be minimised where possible to reduce the risks of other health problems such as heart disease.


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High blood sugar (hyperglycemia)

By contrast to the effects of low blood sugar,

high blood sugar

has been linked with longer term effects on memory.

A 2012 study showed that higher HbA1c levels in elderly adults to be linked with a decline in cognitive function (including memory) over a nine-year period compared to those with lower

HbA1c levels

High blood glucose levels over a number of years is linked with reduced size of the hippocampus; an important part of the brain that is responsible for memory.

The message is therefore that keeping blood glucose levels well controlled is likely to reduce the risk of memory problems in the longer term.


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Dementia and Alzheimer’s disease

Memory impairment is one of the key signs of Alzheimer’s disease and other forms of dementia. As noted by Alzheimer’s Disease International, there are particularly strong links between dementia and type 2 diabetes.

High blood pressure (hypertension) and dyslipidemia (high total cholesterol) in midlife are also linked with pronounced increase in risk of dementia.

The lifestyle changes suggested for treating type 2 diabetes, such as regular exercise, having a balanced diet and aiming to lose weight if overweight, are recommended by the NHS to reduce the risk of dementia.


^[184]

Stroke

Memory loss can occur following

stroke

and the best way to reduce the risk of memory loss is to take steps to reduce the likelihood of stroke occurring or repeating.

As with dementia, the same lifestyle changes are also suggested for reducing the risk of stroke.

Anxiety, stress and depression

Anxiety, stress and

depression

are frequently linked with difficulties with memory in the short-term, with memory improving again once a period of stress, anxiety or depression is over.

If you have depression or are going through long periods of anxiety or stress, speak to your doctor. There are number of effective treatments available aside from medication, which include talking therapies

and mindfulness

Poor sleep

Having poor sleep may lead to memory and cognitive (brain) problems the next day. The effect may become worse if you are going through a period in which you are consistently getting too little sleep or interrupted sleep. Having too low or very high blood sugar overnight can also reduce quality of sleep.

There are a number of things you can try to get a better night’s sleep. If you continue to have

problems sleeping
, speak to your doctor about it.

Statins

Statins are cholesterol lowering drugs which are commonly prescribed to people with diabetes. Memory loss is noted as a less common short term side effect. If memory loss occurs whilst on statins, notify your doctor. In this case, your memory should return to normal after

statins

are discontinued.

Research suggests that, in the long term, statins may have a protective effect against Alzheimer’s disease, however, this has yet to be shown conclusively.

Norovirus is a form of stomach bug that can cause severe vomiting, diarrhoea and dehydration.

As with other forms of viral infections, Norovirus can make

diabetes control
more difficult.

Norovirus has been called the winter vomiting bug because it is more prevalent in the winter months.

Symptoms

The most prominent signs that you may have caught Norovirus are:

• Nausea
• Vomiting
• 
  Dehydration
• 
  Diarrhoea

Other symptoms which may accompany the above, include:

• Headache
• Stomach ache
• Aching muscles in the arms or legs
• Having a high temperature (over 38C/100.4F)

How long does the Norovirus infection last?

Symptoms of the infection will usually pass after a couple of days but it is possible the symptoms may persist longer in some people.

What are the causes of Norovirus?

Norovirus is a stomach bug which can be passed through contact with someone who has the infection or via contaminated food, objects or surfaces.

Regularly washing hands, cleaning surfaces and practising good food hygiene can help to prevent the virus from spreading.

How is Norovirus treated?

There is no specific treatment to rid the body of Norovirus but

your body’s immune system
should be able to fight off the virus.

It is important though to treat and prevent dehydration by drinking fluid regularly.

The NHS advises we drink more than the 6 to 8 glasses of fluid that is usually recommended for fluid intake per day.

This is because vomiting and

diarrhoea depletes the fluid available
within our body.

Norovirus and diabetes control

Viral infections usually make diabetes  more difficult to control. If you catch the Norovirus it is likely that your blood glucose levels will rise higher than usual as the body attempts to fight off the virus.

Preventing dehydration

Vomiting and diarrhoea both involve a loss of fluids from the body which can make dehydration more likely to occur. In addition, infections can raise blood glucose levels which can result in passing more urine than usual which could also raise the chance of dehydration.

It is therefore important to take fluids regularly and look out for the

symptoms of dehydration
such as having a dry mouth, darker than normal urine or headaches.

Testing blood glucose levels and ketone levels

It is important, for people on insulin in particular, to regularly

check your blood glucose levels
to prevent your sugar levels going too high or low.

If you have type 1 diabetes, Diabetes UK recommends performing a test for ketones if you have blood glucose levels above 15 mmol/l. If you have higher levels of ketones, this could develop into a

dangerous condition called ketoacidosis, so contact your health team for advice.

• Read more on
  
  testing ketone levels

In late 2009 through to 2010 swine flu was declared to be a pandemic by the WHO. In August 2010, the WHO de-classified the virus as a pandemic but advised that swine flu should not be ignored.

Coupled with the media hype around swine flu and the fact that the virus is predominantly killing those with underlying illnesses, people with diabetes were understandably alarmed.

In 2010, swine flu is still present and the Health Protection Agency are urging people in higher risk groups, such as those with diabetes, book themselves in for a free flu jab.

Am I more likely to get swine flu if I have diabetes?

Diabetes and swine flu are not associated. If you have diabetes,

there is no greater likelihood of you developing swine flu

However, those people with diabetes that develop swine flu may find

blood sugar levels
become affected, and diabetes management and treated must be adjusted accordingly.

If you are diagnosed with swine flu and you have diabetes, your doctor or

healthcare professional
will provide you with guidance.

What are the symptoms of swine flu?

Swine flu (H1N1) symptoms are similar to common flu.

They include:

• Body aches
• Headache
• Coughs
• Sore throat
• Tiredness
• Fever

If you have diabetes and fear you have swine flu, you should contact your healthcare professional immediately.

Swine flu

can be dangerous

for people with diabetes because it can worsen blood glucose treatment and require more active treatment.

Swine flu prevention

There are a number of prevention mechanisms people with diabetes can take to avoid swine flu. For instance, learning about the condition and the hygiene techniques is important.

If the pandemic develops, experts advise purchasing face masks and minimising contact with other people.

• Learn more about the disease and how to prevent it
• Cover the mouth and nose when you cough and sneeze
• Use a tissue and quickly and carefully dispose of it afterwards
• Wash your hands regularly using soap and water
• Clean all hard surfaces with standard disinfectant

Swine flu treatment

If you do contract swine flu, you will likely be treated either by paracetamol, anti-viral medications such as

Tamiflu, Relenza or if complications develop, by antibiotics. In the majority of cases, swine flu is

not fatal

Sleep Apnea, also called sleep apnea, is a common breathing disorder that affects many people whilst they sleep, could be an early warning that diabetes development is underway.

Numerous medical studies have linked obstructive sleep apnea with greater risk of developing

type 2 diabetes

According to experts, side effects directly related to sleep apnea could influence the metabolism of people as they sleep.

The condition is surprisingly common, to the extent that sleep apnea has been termed: ‘the silent epidemic’.

Sleep apnea affects as many as one-tenth of middle-aged men, and manifests itself as an interruption of breathing during the hours of sleep.

The correlation between sleep and diabetes is well-prove, with interruptions to deep sleep a key part of diabetes risk.

Obesity
makes both diabetes and sleep apnea more likely.

Why does sleep apnea damage the body and lead to greater risk of diabetes?

Sleep apnea is thought to be dangerous because it affects the concentration of oxygen within the bloodstream.

It also plays havoc with sleep patterns, and can lead to daytime fatigue in more serious cases.

The actual mechanism that causes sleep apnea to influence oxygen.

If I have sleep apnea, am I a diabetic?

Not necessarily, but having sleep apnea does mean an increased risk of

developing diabetes

Is OSAS the same as sleep apnea?

OSAS stands for Obstructive Sleep Apnea Syndrome.

What are the symptoms of Sleep Apnea?

Sleep Apnea occurs when an obstruction gets in the way of air entering the lungs.

These short periods of stopping breathing are generally limited to a less than 10 seconds, and can occur often during the night.

Generally, the brain works the sleeping person up when apnea occurs, often with a snore or snort.

How serious is Sleep Apnea?

Experts advice all people with sleep apnea, however mild or severe, to seek a diabetes test. Sleep apnea can range from very mild to serious, and is measured by the number of apneas and hypoapneas per night.