Recently I recieved my latest lab work.  To my horror, but not surprised it was not good.  One item that stood out was the Anion Gap levels.  I thought it was interesting enough to make an article about this and inform other people.

The Anion Gap is an approximate measurement of ions, that is molecules with a charge, either negative or positive. Sodium and potassium are positively charged and therefore called cations; this is why they are often represented as Na⁺ and K⁺ respectively. These two are the main cations measured in the blood. Negatively charged molecules are called anions, and the major anions measured in the blood are chloride (Cl^-) and bicarbonate (HCO₃^-). You can tell those electrolytes in the blood because they are measured as mEq/L rather than in milligrams/dL. Because your body must remain neutral, or in other words having the same amount of positive ions as negative ions, the equation (Na⁺ + K⁺ + unmeasured cations) must = (Cl^- + HCO₃^- + unmeasured anions). Some of the unmeasured cations (~7Mmol/L) include calcium, magnesium, and most other minerals. Unmeasured anions (~24 Mmol/L) include proteins like albumin, and phosphates, sulfates, etc. There are always more unmeasured anions than cations, and thus the “anion gap” equation, (Na⁺ + K⁺) – (Cl^- + HCO₃^-), is always greater than zero.

If your lab report does not include an anion gap, you can calculate it yourself by converting the CO₂ result to HCO₃^- by subtracting 1 mEq/l from the CO₂ content…

Optimum Value: 10 to 12 MMol/L depending on the method of calculation.

The Anion Gap is increased when there are excessive anions/acids in the blood. This is either from too much acid production or insufficient removal of acids (either through the lungs, stomach, or kidneys). Excess acids lead to a rapid respiratory rate (the body wants to blow off the extra CO₂), an inability to hold your breath (the acid build up forces you to exhale), low blood pressure (due to vasodilation), fatigue, poor appetite, etc. The high anion gap indicates that the electrical charge of the fluids are too negative compared to the inside of the cell. Because the charge across cell membranes is required for many enzymes and energy production, a reduced charge may result in less energy production (oxidative phosphorylation and ATP). A high anion gap may also indicate a functional need for alkaline minerals.

The electrical potential between the inside of the cell and the outside of the cell is basis for nearly all transactions that occur with in the cell. Within the cell the chief cation is potassium and the chief anion is phosphorus. Outside the cell the sodium is balanced by chloride. The balance between the inside and the outside of the cell is maintained by a pump that sends potassium in and sends sodium out. When there is an insufficiency of these electrolytes, electricity can’t be generated – as a result energy production and cellular function is compromised.

Common causes of an elevated Anion Gap include:

• Ketoacid overproduction due to fat metabolism (diabetes, alcohol, starvation)
• Lactic Acid overproduction due to respiratory failure (the tissue has inadequate oxygen), genetic defects of enzymes of carbohydrate metabolism, nutritional deficiencies that impair the bodies ability to metabolize lactic acid (B vitamins, especially vitamin B₁)
• Inability to excrete acids (sulfate and phosphate) due to renal disease (usually with an elevated BUN and creatinine).
• Dehydration.
• Medications such as salicylates causing a metabolic block.
• Toxins such as ethylene glycol, methanol, paraldehyde, propyl alcohol

The Anion Gap is decreased by free radical pathology due to overproduction of alkaloids. Other causes that have been reported associated with a reduced anion gap are

• Alkalosis for any reason
• Lithium toxicity (can be due to effects on sodium)
• Primary hypothyroidism
• Kidney disease (due to the loss of the cations sodium and or potassium)
• Polymyxin B

• Hyperchloremic acidosis (excess chloride)
• Multiple Myeloma
• Hyponatremia (low blood sodium level; see appropriate lab finding webpage)
• Hypoalbuminemia  (see albumin; can increase the amount of free blood calcium)
• Bromide Ingestion (displaces chloride)
• Uncalculated blood cations (calcium, magnesium)

Gluten is a composite formed from several different proteins. It is found most commonly inwheat and other related grains, such as barley and rye. Adding texture and a characteristic chewiness to baked goods, gluten is used in a wide variety of other foods as a thickener and binder, flavor enhancer, and protein supplement.

Some people can develop an intolerance to these proteins, however; a gluten-free diet often helps to alleviate symptoms caused by this intolerance and prevents further damage to the body.

Foods Containing Gluten

Along with wheat, other cereal grains that contain gluten are durum, spelt, and einkorn, as well as farro, graham, kamut, and semolina. Many are also used to enhance the flavor and protein of foods, as well as to bind and thicken their consistency. While the grains are often found in breakfast cereals and various baked goods, they can also be included in a variety of other foods that are not as obvious.

Used as a thickener, gluten can be found in soups and broths, as well as gravies and sauces such as ketchup, salad dressings, or marinades. Since it enhances flavor, it is used in bouillon, spice blends, and other foods such as coffees, dairy products, vinegars, and liquors. It can also be found in the substance used to seal envelopes since it acts as a stabilizer.

Gluten is also used on its own as a protein supplement, particularly for people who do not have access to other protein sources. The protein it contains also makes it useful in meat substitutes, especially those used in vegan and vegetarian diets. Imitation meats or wheat meats, such as seitan, are often made of concentrated gluten.

Gluten Proteins

Within gluten, there are actually four main proteins: albumins, glutelins, globulins, and prolamins. Glutelins and prolamins are found in higher concentrations in wheat, while albumins and globulins are more plentiful in corn and rice. Many people associate wheat with the term “gluten,” however, as it is those proteins that are most directly related to health issues such as celiac disease. Glutelins, in particular, are dangerous for those susceptible to gluten intolerance because of the way that acids in the body break them down.

Most of the protein in wheat — 80% — is made up of the prolamin called gliadin and the glutelin called glutenin. When these molecules are joined together due to a chemical reaction, they stretch and harden, allowing dough to form a light, airy loaf with a chewy texture. As a result, these proteins are commonly found in flour and other baking products.

Function in Bread

Kneading dough creates the strands that help the gliadin and glutenin molecules to join or cross-link. The more the dough is kneaded, the more links are developed and the chewier the final product becomes. In addition, the proteins thicken when heated, trapping the carbondioxide produced by yeast. This enables baked goods to rise more and retain their shape instead of crumbling.

The amount of gluten added to the flour can have an impact on the texture of the final product. Bread flour needs more of these proteins to produce a loaf that isn’t too dense or crumbly, while pastry flour — which should be flaky instead of chewy — has less. The flour industry measures its concentration with a farinograph, an instrument used to indicate density and elasticity among other elements in flour.

Gluten Intolerance

Gluten intolerance is a term that is used to describe three conditions: wheat allergy, non-celiac gluten sensitivity, and celiac disease. According to research, between 5 and 10 percent of all people may suffer from some form of sensitivity. All three conditions are difficult to diagnose, however, so it is thought that many people are not aware that this intolerance may be the source of other health issues.

Most forms of gluten intolerance cause the body to produce an abnormal immune response in the presence of wheat or its proteins. An allergy to wheat can produce symptoms such as hives, difficulty breathing, and digestive problems; in serious cases, a person with this allergy can experience anaphylaxis, a sudden and severe reaction that can be life-threatening. People with celiac disease, which causes damage and inflammation in the small intestine, can suffer from bloating, weight loss, fatigue, and headaches as the body has difficulty obtaining all the nutrients it needs from food.

Gluten-Free Diet

Avoiding gluten altogether is the only way to prevent the damage caused by an intolerance, though this can be difficult to do. A gluten-free diet requires a complete understanding of what it is and where it can be found. Gluten is found in many products, so it’s necessary for someone following this diet to read labels carefully and know what products might contain it. In general, “gluten-free” means that the product contains less than the minimum standard that is considered to be harmful, though this number varies worldwide. Because so many foods contain these proteins, finding alternative sources for all of the vitamins, minerals, and fiber required for a healthy diet can be a challenge.

Recently, there have been a plethora of articles about the occurrence of Type 2 diabetes in tweens and teens.  The article focused on the difficulty of blood glucose control in this age group.  One thing that is noticeably absent in these articles is the differences or similarities of care between Type 1 diabetics of the same ages.  My question is are the younger Type 2 diabetics being offered the same care as Type 1 diabetics.  After reading the article I don’t believe so.

I think the reason why it is harder to treat adolescent Type 2 Diabetes because they are being treated like adults diabetics. This is why at the drugstore we have medications at adult strength and children’s strength.  Even though some of the adolescents may look adult they are still in essence—children.  Their bodies should be treated as such.  I find it utterly in poor judgment to treat children with adult medications.  Will the Type 2 diabetic epidemic spark pharmaceutical companies into researching children diabetic medication……perhaps if there is mounting public demand.  Then that will be several years away.

Medical community is using cookie cutter science theory to cure all that ails a adolescent T2 Diabetic.  Basically if it works for another group it should would on this group despite age and biological difference.  Children and adolescences are still growing.   It just makes me wonder what all these so called medical professionals are doing with their time.  It is very interesting none of the articles that I read mention any comparison to insulin therapy or the therapies that have worked with Type 1 adolescents.

If the newly diagnosed adolescent diabetic is not responding to oral meds, if and when insulin therapy and a pump will be introduced?  Why delay this therapy?  Are the same silly rules that keep adult Type 2 Diabetics from getting a pump being applied to these adolescents? It is understandable that trying to get adolescents to be receptive to insulin therapy will be hard.  But the alternatives have not proven to have much success.   I am an adult insulin dependent diabetic and I am having a horrible time controlling my glucose levels. My doctor is still reluctant to have me go on pump therapy.  I can only image the resistance from doctors to issue a pump to a diabetic adolescent that wasn’t a Type 1.  

 I hope things change and I get some answers to some of my questions.

]]> http://sexydiabetic.com/equal-treatment-for-t2-kids/feed/ 0 http://sexydiabetic.com/type-2-diabetes-is-harder-to-treat-in-kids/ http://sexydiabetic.com/type-2-diabetes-is-harder-to-treat-in-kids/#comments Sat, 05 May 2012 19:34:30 +0000 chrystal http://sexydiabetic.com/?p=4031

Type 2 diabetes is harder to treat in kids, study finds

Obesity and the form of diabetes linked to it are taking an even worse toll on America’s youth than medical experts had realized. As obesity rates in children have climbed, so has the incidence of type 2 diabetes, and a new study adds another worry: The disease progresses more rapidly in children than in adults, and is harder to treat.

“It’s frightening how severe this metabolic disease is in children,” said David Nathan, an author of the study and director of the diabetes center at the Massachusetts General Hospital. “It’s really got a hold on them and it’s hard to turn around.”

Before the 1990s, this form of diabetes was hardly ever seen in children. It is still uncommon, but experts say any increase in such a serious disease is troubling. There were about 3,600 new cases a year from 2002 to 2005 (the latest available data)

The research is the first large study of type 2 diabetes in children, “because this didn’t used to exist,” said Robin Goland, a member of the research team and co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York City. She added, “These are people who are struggling with something that shouldn’t happen in kids who are this young.”

Why the disease is so hard to control in children and teenagers is not known. The researchers said that rapid growth and the intense hormonal changes at puberty may play a part.

The study followed 699 children ages 10 to 17 at medical centers around the country for about four years. It found that the usual oral medicine for type 2 diabetes stopped working in about half of the patients within a few years, and they had to add daily shots of insulin to control their blood sugar.

Researchers said they were shocked by how poorly the oral drugs performed, because they work much better in adults. The results and an editorial are being published online on Sunday by The New England Journal of Medicine.

The findings could signal trouble ahead, because poorly controlled diabetes significantly increases the risk of heart disease, eye problems, nerve damage, amputations and kidney failure. The longer a person has the disease, the greater the risk. So in theory, people who develop diabetes as children may suffer its complications much earlier in life than did previous generations who became diabetic as adults.

“I fear that these children are going to become sick earlier in their lives than we’ve ever seen before,” Dr. Nathan said.

But aggressive treatment can lower the risks.

“You really have to be on top of these kids and individualize therapy for each person,” said Barbara Linder, a senior adviser for childhood diabetes research at the National Institute of Diabetes and Digestive and Kidney Diseases, which sponsored the new study.

Most of the participants in the study came from low-income families: 42 percent had yearly incomes under $25,000, and 34 percent below $50,000. About 40 percent were Hispanic, 33 percent black, 20 percent white, 6 percent American Indian and less than 2 percent Asian. Poor people and minority groups have some of the highest rates of obesity and diabetes in both adults and children.

Type 2 diabetes used to be so rare in children that it was called adult-onset diabetes. Type 1, a much less common form, was most likely to strike children and teenagers, and was called juvenile diabetes. Both forms of the disease cause high blood sugar, but their underlying causes are different.

Type 1 occurs because the patient’s own immune system mistakenly destroys the cells in the pancreas that make insulin, a hormone needed to control blood sugar levels. Patients have to take insulin.

Type 2 is thought to be brought on by obesity and inactivity in people who have a genetic predisposition to develop the disease when they gain weight. And they may also have an inborn tendency to put on weight. The pancreas still makes insulin, though not enough, and the body does not use insulin properly — a condition called insulin resistance. High blood pressure and cholesterol often come with the disease. Initial treatments include diet, exercise and oral medicines, but many people eventually need insulin.

Hey folks!!!

I know I don’t write as often as I should for my blog.  What I do try to do is to keep my faithful visitors updated with currently news and revelations concerning diabetic issues.   I don’t want my blog to be a “whiner’s” corner always complaining about my diabetes and how it has broken me down.  I never felt this way and I don’t want anybody else feeling this way if I can help it.  I do understand that this is the only way some people can communicate about their diabetes.  This is sad because there is always something positive about every so called bad situation.  This is one reason why I don’t write something personal very often.

I have read long personal blogs by other people and I can only wonder would they sit down and read there own writing themselves.  It is hard enough to practice what you may preach but then to have to read it would be just at strenuous if not harder.

On a personally note, I am quite focused on several projects that demand most of my attention because they could be monetarily satisfying.  Of course anything else that is monetarily satisfying, I normally will put it into my diabetic efforts.  In addition to doing this blog, I am also focused on another diabetic event for the summer months and for the fall during November.  I don’t want to spill the beans on the November event but only in Los Angeles could this event be attempted.  I know if I am able to do this it will be spectacular.  I can ask is to be patient with me so I can work my magic.  I like to include everything and everybody in my events.  This does take time

Vitamin D is a steroid vitamin, a group of fat-soluble prohormones, which encourages the absorption and metabolism of calcium and phosphorous. People who are exposed to normal quantities of sunlight do not need vitamin D supplements because sunlight promotes sufficient vitamin D synthesis in the skin.

Five forms of vitamin D have been discovered, vitamin D₁, D₂, D₃, D₄, D₅. The two forms that seem to matter to humans the most are vitamins D₂ (ergocalciferol) and D₃(cholecalciferol).

Researchers at the University of Minnesota found that Vitamin D levels in the body at the start of a low-calorie diet predict weight loss success, suggesting a possible role for vitamin D in weight loss.

Vitamin D for humans is obtained from sun exposure, food and supplements. It is biologically inert and has to undergo two hydroxylation reactions to become active in the body. The active form of vitamin D in the body is called Calcitriol (1,25-Dihydroxycholecalciferol).

What do we need vitamin D for?

• It is crucial for the absorption and metabolism of calcium and phosphorous, which have various functions, especially the maintenance of healthy bones.

• It is an immune system regulator.

• It may be an important way to arm the immune system against disorders like the common cold, say scientists from the University of Colorado Denver School of Medicine, Massachusetts General Hospital and Children’s Hospital Boston.

• It may reduce the risk of developing multiple sclerosis. Multiple sclerosis is much less common the nearer you get to the tropics, where there is much more sunlight, according to Dennis Bourdette, chairman of the Department of Neurology and director of the Multiple Sclerosis and Neuroimmunology Center at Oregon Health and Science University, USA.

• Vitamin D may have a key role in helping the brain to keep working well in later life, according to a study of 3000 European men between the ages of 40 and 79.

• Vitamin D is probably linked to maintaining a healthy body weight, according to research carried out at the Medical College of Georgia, USA.

• It can reduce the severity and frequency of asthma symptoms, and also the likelihood of hospitalizations due to asthma, researchers from Harvard Medical School found after monitoring 616 children in Costa Rica.

• It has been shown to reduce the risk of developing rheumatoid arthritis in women.

• A form of vitamin D could be one of our body’s main protections against damage from low levels of radiation, say radiological experts from the New York City Department of Health and Mental Hygiene.

• Various studies have shown that people with adequate levels of vitamin D have a significantly lower risk of developing cancer, compared to people with lower levels. Vitamin D deficiency was found to be prevalent in cancer patients regardless of nutritional status, in a study carried out by Cancer Treatment Centers of America.

People underestimate the amount of sugar in drinks which are perceived to be “healthy”, research suggests.

The Glasgow University study asked more than 2,000 people in the UK to estimate how much sugar was in a range of drinks.

While many overestimated the amount in fizzy beverages, they underestimated levels in smoothies and fruit juices.

The research also found soft drinks could be accounting for a large chunk of their recommended calorie intake.

The British Soft Drinks Association says the sugar in soft drinks is not hidden because beverages carry clear labelling of nutritional content, including calorie and sugar content.

Risk factor

The reasearchers asked participants to assess their weekly drinking habits.

Their answers suggested 450 calories a day were being consumed – a quarter of the daily limit for women and a fifth for men.

But it was the lack of awareness about the sugar content of drinks that caused concern.

The participants were asked to guess the number of teaspoons of sugar in a range of popular drinks.

They underestimated it for pure apple juice and orange juice, a caffeinated energy drink and a smoothie by between two and four teaspoons.

And for a pomegranate-based drink, they underestimated the sugar content by nearly 18 teaspoons.

Unsurprisingly, many participants were not taking the calorie content of their soft drinks into account when thinking about their diet.

The team warned that the over-consumption of soft drinks was contributing to obesity and was a major risk factor for conditions such as diabetes, high blood pressure, heart disease and stroke. Lead researcher Prof Naveed Sattar said: “What you drink can be as damaging to the body as what you eat.”There is no question that consuming too many sugar-sweetened drinks can greatly contribute to obesity. ”Some varieties of drinks such as pure fruit juices and smoothies, which are perceived as ‘healthy’ options, are also very high in sugar.

“For many people struggling with their weight, reducing their intake of such drinks and replacing with water or diet drinks would be a sensible first target to help them lessen their calorie intake.”

Ambulances are the latest vehicles to face up to one inarguable fact – as a nation, we are getting bigger and that poses a huge design headache. You can’t move nowadays for warnings about rising obesity levels – as a result of which, ironically, the advice suggests we need to be moving more and eating less. As experts continue to warn of increased health risks including heart disease, diabetes and some cancers, the world around us is having to change shape to accommodate our changing shapes.

It emerged this week that ambulance services across the country are having to revamp their fleets to cope with heavier patients.

“A few years ago, probably only 10 years ago, your average patient was 12 to 13 stone – now that’s probably 17 to 18 stone. And we quite regularly see patients around 30 stone in weight and even bigger than that,” says Nigel Wells of West Midlands Ambulance Service.

The specialist equipment being stocked includes heavy-duty wheelchairs and stretchers, inflatable cushions for lifting patients, while ambulance tail-lifts are being reinforced.

Many services are also buying specialist “bariatric” ambulances, at a cost of up to £90,000 each, equipped with double-width trolley stretchers and capable of carrying patients weighing up to 50 stone.

Many hospitals have had to take similar steps, investing in stronger beds and chairs, wider body scanners, and longer surgical instruments for use on obese patients. One NHS board in Scotland has spent more than £20,000 on three beds that can support people weighing up to 78 stone.

And there are other examples of the way our environment is adapting to handle a growing load.

Airlines

Just as the US has infamously led the way in the world in terms of obesity, its airlines have pioneered tough policies toward bulky passengers.

Several US airlines charge passengers for a second seat if they cannot fit into one.

This has been a longstanding policy at Southwest Airlines, which imposes the charge if a passenger cannot comfortably lower the armrests on their seat.

The airline generated headlines last year when it barred from a flight American film director Kevin Smith, who used his Twitter account to complain about being branded a “safety risk”.

As well as the issue of their own and neighbouring passengers’ comfort, there are concerns over overweight people’s swift evacuation and possible hindrance of others in an emergency.

Gary Davis, Fellow of the Institute of Ergonomics & Human Factors, has been working on cabin design with airlines for about 15 years.

“He says that research into seating materials had allowed seat backs to be made thinner, increasing the space a passenger has up to the back of the seat in front.”

“So you effectively increase cabin space without losing any seats, so you get the same number of seats in the aircraft but give the customer a better experience – it’s a win-win situation if you can achieve that.”

The more pressing problem – literally – of overweight passengers encroaching on neighbours’ seats, was far harder to tackle, he says.

“In terms of the width of economy-class seats on commercial airliners, there’s not much you can do without going to the extreme of taking out whole lines of seats – and I can’t see airlines doing that very willingly.”

In 2009, Irish budget carrier Ryanair announced it was considering a “fat tax” on its largest customers. The idea, widely seen as a publicity stunt, was never implemented.

Theatres

When London’s Royal Festival Hall went through a £71m refit in 2004, more than 100 seats were removed to give audience members extra room.

This is typical of space problems now being experienced by a generation of theatres built about a century ago, when, according to the Theatres Trust, people were not just lighter on average but also about four inches shorter.

“Old theatres are probably one of the worst places where seat width and seat pitch are really tight,” says Mr Davis.

Last year, a US report suggested that between 1900 and 1990 the average width of an American theatre seat expanded from 19 to 21 inches – then had increased another inch in the 20 years after.

Modern auditoriums held half the number of people as similar-sized spaces around 1900, the report added. And the bottom-line is all about those bums on seats for theatres.

On top of the costs of renovating venues for the 21st Century, they face the possibility of reduced revenue from fewer seats – while the public bears some of the burden with higher ticket prices.

Sports stadia

Facing similar pressures of cramming high numbers of people on closely-packed seating for prolonged periods are sports stadia.

The new Wembley stadium, which opened in 2007, offers seats that are 50cm wide and 80cm deep – 9cm wider and 16cm deeper than at the old Wembley.

“There is more leg room in every seat in the new Wembley stadium than there was in the royal box of the old stadium,” the website declares.

Crematoria

Children can be set on the path to a lifetime of obesity before the age of two, a US study suggested last year, making this genuinely a cradle-to-grave problem.

And the challenge of larger and larger corpses is one that has had to be addressed by crematoria in recent years.

Some councils have spent thousands on wider furnaces, according to the Local Government Association. Grieving relatives have sometimes had to travel hundreds of miles to the few venues that can handle over-sized coffins.

The Institute of Cemetery and Crematorium Management has predicted that a large number of facilities will have to be upgraded because of this growing trend.

A fat tax could raise money and help get people eating more healthily, says a director at the University of Oxford.

Health promotion research group director Mike Rayner said at least a quarter of British adults are obese, and that is costing the health services billions of pounds of year every year.

He called for a 12p tax on soft drinks, even bigger than the 2 cents tax introduced in France, claiming it would prevent several thousand deaths a year as people switched to healthier drinks.

But Labour MP Angela Eagle and Liberal Democrat minister Steve Webb suggested better packaging and education were likely to be more practical options.

Mr Rayner said taxes were already used to discourage people from drinking or smoking and a fat tax plan would raise money for the Treasury and prevent people dying.

He said: “There’s evidence to show that manipulating food prices can encourage healthy eating. So why are we so reluctant to change the way we tax food?

“We’re in the grip of an obesity crisis. As a nation we’re consuming too many calories and eating too much cheap, energy-dense food, like crisps, chocolate bars or fizzy drinks.”

Chips or doughnuts

He explained how Denmark introduced a ‘fat tax’ on foods containing saturated fats, which raise cholesterol.

He said: “They’ve got the right idea, but a lot of the low-fat foods in Britain are high in salt, so we might be tackling one problem only to create another.

“Instead we need to rethink the way we apply VAT to food. At the moment we have a muddled system: you do pay tax on some relatively-healthy things like smoothies, but you don’t pay it on a lot of junk food like chips or doughnuts.

“I don’t care whether it’s hot or cold, whether you got it from a takeaway or a shop – I’d like us to tax all unhealthy foods from butter to biscuits. And in doing so we can tackle a problem that will only keep expanding.”

His film was shown to two MPs to gauge what support there might be from politicians.

Mr Webb, a Liberal Democrat pensions minister, called on manufacturers to put “put less junk into the food” and said of the fat tax: “It should certainly be looked at, but not as a tax-raising measure.”

He added: “We should look at Denmark and other countries who have tried it and see what the evidence is, so we need to do it based on the evidence. But it is worth looking at, I agree.”

Ms Eagle, the shadow leader of the House of Commons, called for better food labelling and education and said a fat tax was a “lot easier said than done”.

She said: “My instinct is that VAT or tax may have a role to play but education, assistance, and regulation of some of the salt content in food is all equally important.”

Feeling down? Or so irritable you could scream? Chances are that your blood sugar’s too high or too low. And not surprisingly, it affects your mood.

“When diabetics have low blood sugar, they may not even act like themselves,” says Olga Calof, MD, a board-certified endocrinologist in the Los Angeles area. “They may have behavioral changes that they don’t even notice. It’s different for every individual. And high blood sugars can also cause symptoms, too.”

When your blood sugar drops too low, your brain is simply not getting enough of the sugar it needs to function. And when this happens, irritability is often an early symptom, explains Howard Shapiro, D.O, author of the forthcoming Eat and Beat Diabetes with Picture Perfect Weight Loss. This irritability is often accompanied by sweating, a feeling of weakness, shakiness, and difficulty concentrating. And if the blood sugar isn’t brought back up to speed, the diabetic can suffer headaches and mental confusion.

“It could even look like the person is on drugs,” Shapiro says. “They could have slurred speech.”

It’s not unheard of during an episode of hypoglycemia for a person to feel dizzy and even to have a rapid heartbeat, says Calof.  While some symptoms may not be obvious to the diabetic, those around him see mood changes right away.

“Your spouse may notice that you are moody and cranky,” Calof says. “Some people say they can see that a spouse’s sugar is low just by their facial expression.”

When your blood sugar is high, it can be mood-altering, too. It’s typical to feel irritated, explains Kenneth Gorfinkle, Ph.D., assistant clinical professor of psychology at the Naomi Berrie Diabetes Center at NewYork-Presbyterian/Columbia in New York City. It’s also possible to suffer from poor concentration and to be a little fatigued or short tempered. All of which can quickly put a person into a bad mood.

But one’s mood can also be affected simply because of the diabetes and the worry over blood sugar levels. If you blood sugar shoots up too high, or if it is so low you need to treat it, you can feel guilty and afraid. There’s fear over what complications could ensue over time, and fear of a loss of control during an episode of hypoglycemia. “You can have feelings of self-chastisement and self-pity,” Gorfinkle explains. “And this leads to a very unhappy mood.”

Occasionally, the subtle mood changes in someone with a high blood sugar may not even be apparent to those around him, says Calof. The person may feel just slightly sleepy and dehydrated, but nothing else. The problem, though, is that high blood sugar over time can cause devastating complications.

Rx for Low Blood Sugar

Recognize that hypoglycemia (low blood sugar) can be dangerous and must be treated promptly. It also can be prevented if you spread your carbohydrate intake throughout the day, and eat small meals rather than just three large ones, says Shapiro. Since both caffeine (and alcohol, on an empty stomach) can cause the blood sugar to drop, be vigilant about your intake of coffee as well as alcoholic beverages, Shapiro recommends. Keep fruit juice, sugar tablets, and hard candy around for episodes of hypoglycemia.

Rx for High Blood Sugar

Frequent blood sugar testing, intensive medication therapy and paying close attention to what you eat can help you to avoid high blood sugars. Remember, the feeling of a high blood sugar may not be as disconcerting as the feeling of a low blood sugar, but the long term health consequences can be debilitating.