Healthy food choices are a critical component of diabetes care. Choosing the correct foods and avoiding others will help patients keep their blood sugar in check and reduce the side effects that occur with wide fluctuations in blood sugar. Diet is also important for keeping other factors such as weight, cholesterol, and blood pressure within healthy ranges. Diabetic Diet Recommendations Snack between meals (every 3-4 hours) to avoid overeating at meal time Increase fiber intake, which improves blood sugar control and helps lower cholesterol Use plate method 1/2 plate vegetables 1/4 plate bread, pasta, rice, potato 1/4 plate meat, poultry, fish Foods for Diabetes Lean meats Fish Vegetables Beans Whole grains Non-fat dairy Fruits (in moderation due to high sugar content) Nuts (in moderation due to high fat content) Foods to Avoid with Diabetes High in sugar (high glycemic load) Simple carbohydrates (high glycemic index) High saturated fat foods Highly processed foods

What should I do on days I’m sick? Many people think they should stop taking their insulin on days they are sick and not eating as much. DO NOT stop taking insulin; increased dosing is often required because the body is stressed. Steps to take when sick Monitor blood sugar every 2-4 hrs Do not exercise Increase fluids Check urine for ketones if blood sugar >240 Notify clinican if moderate or large ketones Make appointment with doctor What is proper foot care for diabetic patients? Foot care is extremely important for diabetic patients because improper care can lead to foot ulcers, infection, and even amputation.  Many patients with diabetes have decreased sensation in the feet, therefore they may not notice if they have a cut on their foot, which increases risk for infection. In addition patients with diabetes are at risk for slow wound healing. Guidelines suggest you should check feet at least once daily always wear socks and well fitting shoes avoid walking barefoot when soaking feet, check temperature first lotion to prevent dryness and cracking, but not between toes cut toenails straight across, file edges notify health care provider immediately if any foot problems occur Why am I waking up with high blood sugar?

Fibromyalgia (FM) formerly known as Fibrositis, is a chronic disorder characterized by widespread pain that is accompanied by other symptoms such as fatigue, sleep disturbances, headaches, and cognitive dysfunction. FM is caused by a dysfunction in the central nervous systems detection of and response to pain. As a result, the patient experiences an amplification of pain. Sleep disturbance in FM is a consequence of HPA axis dysfunction. The peripheral nervous system also appears to play a role in this condition. Global prevalence of FM is estimated to be about 2.7% of the population. FM is more common in women with a female to male ratio of 3:1. While FM can develop at any age, in women it is most commonly diagnosed in middle age. According to CDC, the annual cost of healthcare for FM patients is $9573 per patient. FM is the second most common rheumatic disorder after osteoarthritis. FM can have detrimental effects on patient’s lives and interfere with their work and personal relationships. According to a study, 35% of FM patients report difficulties in performing daily activities. Fibromyalgia is a common and complex condition characterized by widespread musculoskeletal pain, accompanied by mood, memory, sleep, and fatigue issues. Studies show that fibromyalgia intensifies pain sensations by altering the way your brain processes pain signals.

The exact cause of FM is unclear but both genetics and environment appear to play a role in the development of this condition. Genetic Support of genetic association comes from several studies that show first degree relatives of FM patients are 9 times more likely to get the disorder as compared to general population. In addition, genetic studies reveal an association with dysfunction in the serotonergic, dopaminergic, and catecholaminergic pathways involved in pain transmission and modulation. Catecholaminergic pathways include neurotransmitters dopamine, epinephrine and norepinephrine. Dopamine and serotonin are neurotransmitters that affect the way the body interprets pain. Gene association studies found single nucleotide polymorphism in three genes: gamma-aminobutyric acid receptor subunit- β 3 (GABRB3), trace amine receptors (TAAR1) and guanylate binding protein 1 (GBP1) that differed in FM patients and healthy controls. Environmental factors and infection These factors may include stress, trauma, and certain infections like Epstein Barr virus and Lyme disease. Studies have also implicated early sexual abuse in development of FM. Evidence suggests the role of cytokines, which are linked to the immune inflammatory process, in the pathogenesis of FM. Pro-inflammatory cytokine such as IL-1RA, IL-6, and IL-8 have been found to be increased in FM patients.

Diagnosis of fibromyalgia can be a challenging task since its symptoms can mimic or be associated with many other health conditions. Nevertheless, fibromyalgia diagnosis is carried out purely on clinical grounds, depending on the patient’s physical examination and doctor’s history. To be diagnosed with fibromyalgia, you must have had at least three months of persistent pain as well as pain and tenderness in at least 11 out of 18 tender points. These tender points may include:    Thighs    Shoulders    Ribcage    Neck    Lower back    Knees    Chest    Buttocks    Elbows(arms) Also, before you are diagnosed with this syndrome, the tender points must be analyzed through a digital palpation with about 4 kg of pressure. During this analysis, the pain points are pressed and the patient has to state whether the sensation is “painful” or “irritating.” If the patient feels an unbearable pain rather than a mere irritation in most tender points, then he/she may be suffering from fibromyalgia disorder. Your doctor may also inquire about your stress levels, sleep disturbances and fatigue. No definite x-rays or blood tests are used during the diagnosis of fibromyalgia.  Other tests such as thyroid functionality, rheumatoid factor, cyclic citrullinated peptide test, erythrocyte sedimentation rate and a complete blood count may be conducted to rule out other possible medical conditions.