The Diabetic Male's Essential Guide to Living Well

by Joseph Juliano M.D.

Overview

An up-beat, take-charge daily health care manual for the diabetic

Dr. Juliano's book pulls no punches about the seriousness of diabetes; he has been blind for fifteen years due to his disease and he draws on his own experience to offer hard-won day-to-day advice. He discusses insulin and other medications and stresses the importance of self-home blood-glucose monitoring, exercise, and good nutrition. He is honest about possible long-term complications to the diabetic eye, kidney, and vascular systems, and problems such as male pattern baldness and erectile dysfunction. Above all, he believes in positive thinking to help the diabetic live well. There are a resource guide, bibliography, and selected readings.

Product Details

ISBN-13:	9781627799232
Publisher:	Holt, Henry & Company, Inc.
Publication date:	10/27/2015
Sold by:	Macmillan
Format:	eBook
Pages:	224
File size:	429 KB

About the Author

An insulin-depent diabetic for thirty-six years, Dr. Joseph Juliano is also the co-author of The Diabetic's Innovative Cookbook (Owl Books, 0-8050-3785-3). He lives in central Texas.
An insulin-depent diabetic for thirty-six years, Dr. Joseph Juliano is also the co-author of The Diabetic's Innovative Cookbook (Owl Books, 0-8050-3785-3). He lives in central Texas.

Read an Excerpt

The Diabetic Male's Essential Guide to Living Well

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By Joseph Juliano

Henry Holt and Company

Copyright © 1998 Joseph Juliano
All rights reserved.
ISBN: 978-1-62779-923-2

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CHAPTER 1

Gaining a Perspective on Diabetes

Okay, let's go for it. We will examine the differences between Type I and Type II diabetes mellitus and then explore the history of this very ancient disease. We will briefly look at the role insulin plays for the insulin-dependent diabetic and at the different types of insulin used in today's modern therapy. Then, we will plunge into a study of oral antidiabetic agents used to control the blood sugar of a non-insulin-dependent diabetic. A clear understanding will be gained as to why a Type I diabetic cannot take pills to control his diabetes and why a Type II diabetic may not have to take pills at all, or may have to take pills and insulin injections together.

A General Discussion of Diabetes Mellitus, Type I and Type II

In 1979 the National Diabetes Data Group, NDDG, part of the National Institutes of Health, determined a new classification of diabetes and other categories of glucose intolerance. If you are insulin-dependent, and therefore must administer your daily insulin dose or doses with a syringe or other insulin delivery device, then you have what is referred to as Type I insulin-dependent diabetes mellitus, IDDM. At one time this type of diabetes was referred to as juvenile-onset diabetes or simply juvenile diabetes. This type of diabetes encompasses about 20 percent of all diabetic cases. It is characterized by severe reduction of available insulin in children and young adults. In these cases overt symptoms are present, including polyuria (frequent urination), polydipsia (excessive thirst), weight loss, and, many times, ketoacidosis. Diabetic ketoacidosis, DKA, is a serious condition of prolonged high blood sugar, increased acid concentration, and decreased bicarbonate along with an accumulation of ketone bodies (see Chapter 9, here).

If you are able to control your diabetes with diet, exercise, and/or oral medication, then you have Type II non-insulin-dependent diabetes mellitus, NIDDM. This type of diabetes was once referred to as adult-onset diabetes. Making up 80 percent of the diabetic population, it is characterized by insulin resistance and usually occurs in patients over the age of forty, with decreased tissue response to their own, endogenous, insulin and/or decreased tissue response to insulin given by injection, an exogenous source.

Onset of Type II diabetes is difficult to determine, and many cases will be asymptomatic for years. Obesity is a problem in 60 to 90 percent of Type II cases. Today, the classifications of Type I and Type II are used so as not to confuse an adult who has been diagnosed with insulin-dependent diabetes. Certainly juvenile-onset diabetes would not be the appropriate designation for this type of diabetes.

There are three key components to managing your diabetes, whether you have Type I or Type II: proper diet, the right amount of exercise, and careful administration of insulin or the oral antidiabetic agent your doctor has prescribed.

One key point you need to understand very clearly: every single case of diabetes is an individual case and thus represents issues, treatments, and particular challenges that are part of that individual's own genetic makeup. My case of diabetes will be different from yours, and although there may be broad generalizations we can make concerning my diabetes and yours, there will be many differences. Because of this fact, it is imperative that you discuss your case of diabetes with your doctor on a regular basis, to allow him or her to become familiar with your own individual case.

If you have been diagnosed with Type II non-insulin-dependent diabetes, you may find it intriguing that some individuals who have been formally diagnosed with this type of diabetes have been able to regulate their diets so carefully that they no longer have diabetes. A dear friend of mine, Don, was diagnosed with Type II diabetes several years ago, when he was in his mid-fifties. After the initial shock and consequent depression, my extremely disciplined friend did a complete lifestyle about-face when he found he was diabetic. At six feet two inches tall and 190 pounds, cholesterol at 350 mg/dl, triglycerides (blood fats) at 400 plus, he lost fifty pounds and reduced his cholesterol and triglycerides to near-normal levels. He dieted himself out of diabetes and greatly improved his health. The end result of his extremely disciplined dieting was that he lost fifty pounds, yet he was not overweight to begin with. He looked like he was only skin and bones, but more important to him was that he did not have to take any oral medication for his diabetes because his blood sugars were and are now running at normal levels. Some mutual friends and I had a rather frank talk with him and we told him it was time to increase his caloric intake on his diabetic diet so that he would not dry up and blow away. He took our advice and gained some weight and is in great shape today. The moral of this story is that it can be done no matter what, understanding that real dedication and discipline in confronting the challenge of diabetes can result in making the entire process easier to live with and manage.

Diabetes from a Historical Perspective

Let us define diabetes mellitus. Literally translated, mellitus means honey (or sugar), and diabetes means siphon (or tube). When translated freely, diabetes mellitus means a running through of sugar, which certainly describes the condition in its uncontrolled state.

Maturity-onset or adult-onset Type II diabetes mellitus is defined as an often milder form of diabetes of gradual onset in obese individuals over the age of thirty-five. These definitions cover the term diabetes in the broadest sense.

Diabetes is a disease going back to ancient times, believed to date to at least 1550 B.C., due to the mention of the term polyuria in the ancient writings of the Egyptian Ebers Papyrus. Frequent urination is indeed a symptom of diabetes, and thus medical historians believe that this is the first mention of the disease in recorded history. There are medical writings from India that may precede the Egyptian writings. In these ancient writings, it was noted that honey was present in the urine of some people, and other symptoms of diabetes were reported, including thirst, fatigue, and skin eruptions. These writings from India also proclaimed that this disease was found among the wealthy and immoderate. In this context, immoderate most probably denotes those who ate and drank too much. Additionally, some possibilities of hereditary effects of this disorder were noted during this time. Physicians proclaimed this disease incurable. Other medical writings from this same period include the Chinese, who reported polyuria and the sweet taste of an affected person's urine that would attract dogs. Persons affected were also found to possess the skin eruptions or boils reported in other ancient writings.

However, in the medical writings of the ancient Greeks, most notably Hippocrates, there is no mention of diabetes. This is thought to be due to the fact that the ancient Greeks lived severe and austere lives with little obsessive consumption. As time moved forward and the lifestyle improved for the Greeks, excessive behavior (excessive in this context meaning eating and drinking too much) became evident in their writings of a kidney disease known to them as diarrhea of the urine. Medical historians believe this to be an early description of another symptom of diabetes.

In the fourth century Arab physicians reported honey in the urine, and during the Renaissance physicians reported that diabetics drank less than they excreted; they were amazed at the tremendous quantity of urine diabetics produced. During the sixteenth and seventeenth centuries in England, more knowledge was gained concerning diabetes and an important finding was made that sweetness in the urine was determined to be caused by the presence of sugar.

In the nineteenth century the German physician, Johann Franz, developed a yeast test to determine the presence of sugar in the urine. Up until this time, the only way to detect the presence of sugar in a suspected diabetic's urine was to taste it.

Diabetes has been suspected to be a disease of the stomach, the kidneys, the liver, and the blood. It was thought to be a central nervous system disease until about 1857. Minkowski and von Mering conducted experiments in 1889 in Strassburg, Germany, to prove that diabetes is a disease associated with the pancreas. This was an important finding and one that is often forgotten in the history of diabetes.

Eugene L. Opie, in 1901, and Leonid Sobelev, in 1902, determined that diabetes is a disease of the endocrine system. Their experiments discovered that a group of special cells in the pancreas were part of the endocrine system. These cells were named the islets of Langerhans after the man who first described these cells, Paul Langerhans, a German anatomist and physician who had discovered them in 1869. These islet cells deposit their hormones directly into the bloodstream. Unfortunately, Langerhans did not have an understanding of the function of the cells that carry his name.

It was later discovered by Opie and Sobelev that the hormonal secretions were affected by beta cells whose function was changed, resulting in diabetes. At this point, it was understood that a specific antidiabetic hormone existed, and the investigative race was on to isolate this specific hormone that would be usable in the treatment of diabetes. By isolating the hormone from dog pancreas, two Canadian physicians, Frederick G. Banting and Charles H. Best, discovered insulin in 1921 and later won the Nobel Prize in Physiology and Medicine. According to the Encyclopedia of Medical History, "the Nobel Prize committee botched the award. Herbert Best, who worked with Frederick Banting throughout the project's life, received no prize. McLeod [the proprietor of the laboratory where Banting and Best did their research] was named discoverer of insulin despite the fact that he was away throughout the discovery period, and played no part in the actual research of insulin. The vagaries of the prize committee were partially redressed when Banting shared his prize with Best."

CHAPTER 2

Insulin

Insulin is a very complex and large protein molecule. It is also a special hormone, which is produced by the pancreas, a gland of internal secretion found in the endocrine system. Insulin is produced by specialized cells called beta cells found within the islets of Langerhans within the pancreas gland. The pancreas serves many more purposes than just to secrete insulin. It is a complex organ with many functions and plays a crucial role in the secretion of digestive enzymes, the chemicals used in the breakdown of food in the metabolic process.

You may well be aware of the importance of insulin in controlling blood sugar, but I would like to mention a few more facts concerning the importance of insulin as it relates to the biochemistry of metabolism. If you want to read further into the molecular biology of diabetes, there are many excellent technical works on the biochemistry of diabetes. In my opinion, the best medical textbook covering this subject is Diabetes Mellitus Theory and Practice, Third Edition, edited by Max Ellenberg, M.D., and Harold Rifkin, M.D., and published in 1988 (here).

We have seen that insulin is manufactured, stored, secreted, and placed directly into the bloodstream by the beta cells located on the islets of Langerhans. Insulin plays a vital role in metabolism, the myriad complex phenomena associated with the derivation of energy from the acquisition of various materials required to sustain life and promote further growth. Thus, ingested food is broken down into various components through this complex process, known as metabolism. This derived energy is then utilized and stored to sustain vital functions. The metabolic process continues even though there may be no ingestion of food as the complex biochemical interactions continue in order to make and repair cells and tissues. Without insulin, a vital component to the metabolic process is missing, thus causing a negative domino effect to occur during metabolism. Because the human body is an absolute miracle in its ability to biochemically interplay one process with another, insulin plays an important role in augmenting certain processes that remove sugar from the blood and inhibiting other processes that act to raise the blood sugar.

An example of the stimulatory effect of insulin is its effect on the liver to make and store an important animal starch called glycogen. Insulin is also the necessary regulatory hormone in the process by which sugar is removed from the blood and allowed to enter into muscle and fat cells. These few examples are part of insulin's ability to lower the blood sugar and thus keep homeostasis, or the normal balanced condition within the body. As insulin augments and stimulates, conversely insulin is an inhibitory substance also. It inhibits the breakdown of glycogen within the liver by inhibiting the process of glycogenolysis (breakdown of animal starch), which would turn animal starch back into sugar. Another important role of insulin is the inhibition of new sugar formation, or gluconeogenesis, from within the liver. By inhibiting these two processes, insulin lowers the blood sugar via alternative pathways.

Insulin also plays a vital role in causing the entrance of sugar, and thus energy, into fat and protein cells. Without insulin, amino acids, the body's basic building blocks, would not be stimulated into delivery to the muscle cells, and thus would not promote the buildup of muscle tissue.

Without insulin, the above important pathways would not happen. Thus the uncontrolled diabetic, or the diabetic in need of insulin therapy, tends to deteriorate due to the lack of these important cell- and tissue-building pathways. This is a very basic overview of insulin and its affect on biochemical pathways. Its action within the human body is crucial to our understanding of the human condition.

Types of Insulin

There are four basic categories of insulin defined by its onset and duration. The onset refers to the time the insulin takes to begin exerting its effect. The duration refers to the total time of action in terms of its effect.

Super-quick-acting Insulin

Eli Lilly's new super-quick-acting insulin is, at the present time, in a class by itself. This insulin begins its action within fifteen minutes after injection and peaks in one hour. This insulin is for high blood sugar situations where immediate control is necessary. For now, this insulin is available only with your doctor's prescription, and consultation with your doctor is mandatory before using this new insulin preparation.

Short-acting Insulin

Short-acting insulin, usually referred to as regular insulin, or Humulin R, has an onset of between twenty and thirty minutes. Its action will peak, that is, deliver its highest level of performance, in three to five hours. Its duration, or its total time of effect, is from five to seven hours. This insulin type is clear and requires no rolling action to insure its proper mixing within the vial. Regular insulin has been traditionally used in conjunction with other insulin types. Today, a new therapy is to use regular insulin alone, but in four to six injections spread throughout a twenty-four-hour period.

Intermediate-acting Insulin

Intermediate-acting insulin, called N when composed of human insulin or NPH or Lente when it is a mixture of pork and beef insulin, has an onset of sixty to ninety minutes. The peak action of intermediate-acting insulin is from eight to twelve hours. The duration of this insulin is from twenty-four to forty-eight hours. This insulin type is cloudy and must be carefully rolled in the palms of the hands to insure good mixing. Never shake this type of insulin to mix it. Insulin is a delicate protein and should never be vigorously agitated. Shaking also will produce frothing or bubbles, which will make it more difficult to withdraw.

Long-acting Insulin

Long-acting insulin, known as Ultralente, has an onset of five to eight hours. This insulin peaks in sixteen to eighteen hours, while the duration is thirty-two or more hours. Ultralente supplies a basal level of insulin and must be used with multiple doses of regular insulin. This insulin is also cloudy in appearance and should always be carefully rolled in the palms of the hands to insure proper mixing, just as in the case of intermediate-acting insulin.

First introduced by a pharmaceutical company in Denmark, single-vial preparation of premixed insulin is now available composed of NPH intermediate-acting insulin and regular insulin in a two-to-one ratio. That is, the ratio of the two components of insulin is two parts of NPH intermediate-acting insulin to one part of regular, short-acting insulin. If you were to take thirty units of this insulin, using the two-to-one ratio, you would be taking ten units of regular insulin with twenty units of NPH intermediate-acting insulin, for a total dose of thirty units. I would carefully evaluate the convenience of the single-vial approach against the additional versatility of mixing regular and NPH insulin using two separate vials. The Danish preparation is difficult for the beginner to maneuver, and even for the veteran diabetic it can be a very complicated insulin to use. By all means check with your doctor and be sure you understand this insulin well before you and your doctor agree that it is the correct insulin for your needs. It is a cloudy-appearing insulin due to the presence of NPH intermediate-acting insulin. The same care in mixing before use is indicated as in the case of the other cloudy-appearing insulins. Remember that regular insulin is always clear in the vial. If it looks slightly cloudy, it must be discarded.

(Continues...)

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Excerpted from The Diabetic Male's Essential Guide to Living Well by Joseph Juliano. Copyright © 1998 Joseph Juliano. Excerpted by permission of Henry Holt and Company.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Contents

Title Page,
Copyright Notice,
Dedication,
Acknowledgments,
Foreword by Hank Belopavlovich,
Introduction,
Take a Walk with Me,
1. Gaining a Perspective on Diabetes,
2. Insulin,
3. Oral Antidiabetic Medications,
4. Self Home Blood Glucose Monitoring,
5. Clinical Blood Tests,
6. New Treatment Modalities,
7. Long-term Diabetic Complications: An Overview,
8. Long-term Complications to the Diabetic Eye,
9. Long-term Complications to the Diabetic Kidney,
10. Long-term Complications to the Diabetic Vascular and Nervous Systems,
11. Implications of Hypertension for the Diabetic,
12. Taking a Positive Approach,
13. Exercise Physiology and Diabetes,
14. Acupuncture and Diabetes,
15. The Diabetic Diet,
16. Vitamins,
17. Care of the Diabetic Foot,
18. Dental Hygiene,
19. Male Baldness,
20. Erectile Dysfunction in the Diabetic Male,
21. How to Avoid Stress,
22. Reflections on a Lifetime with Insulin-dependent Diabetes,
Appendix A: Comments by Kenneth A. Goldberg, M.D. on Male Impotence and Diabetes,
Appendix B: The Symptoms of Low Blood Sugar,
Appendix C: Selected Newsletters and Journals on Diabetes,
Appendix D: Other Resources,
Appendix E: Resource Guide to Aids and Appliances Published by the Diabetes Action Network of the National Federation of the Blind,
Selected Readings,
Bibliography,
Supplemental Bibliography on Hypertension from John Raia, Pharm D., Bristol-Myers Squibb Pharmaceutical,
Index,
About the Author,
Also by Joseph Juliano,
Copyright,

Editorial Reviews

"Dr. Juliano's book is a 'must read' for both female and male diabetics. [It] gives a great sense of empathy and encouragement far above the usual text book approach."—Irene E. Ralske, Senior R & DChemist, Health Care Products, High Tech Pharmacal

From the Publisher