Stress

Stress and Diabetes
How the Body Handles Stress
Stress and Blood Glucose Levels
Personality, Stress and Blood Glucose Levels
What is Stress and How Does it Affect us?
Research – Stress

 

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Research – Stress

Aggressive diabetes treatment can be stressful
Research carried out in the Netherlands [Diabetes Care, Oct 2006] has shown that when people are identified as having Type 2 diabetes as a result of screening, they usually experience little anxiety in the first years after the diagnosis. However, the research shows that early and intensive treatment appears to lead to higher anxiety and less ability to cope.

The article states that there is an ongoing debate on screening for Type 2 diabetes with one side emphasising the advantages of detecting diabetes at an early stage of the disease because early and intensive management may reduce diabetes-related illness and death. But opponents to this view say while the psychological consequences of early detection and treatment are unclear that this approach is not certain.

The researchers studied 196 patients diagnosed with diabetes 3 to 33 months previously who were receiving usual care or intensive treatment. The majority of patients reported little distress and low levels of perceived seriousness and vulnerability, and felt confident coping with the disease but those who received intensive treatment reported more distress and less self-confidence in the first year. The authors emphasised:

• the importance of taking variations between patients into account in the development and implementation of self care programmes for patients with a recent diagnosis of type 2 diabetes during a screening trial.
• that doctors should be more attuned to patients’ psychological needs when they first prescribe intensive treatments.

Should we ask similar questions about the treatment for Type 1 diabetes?
‘Intensive treatment’ means multi-daily doses of insulin [MDI] and ‘usual care’ usually means twice daily injections both aiming to achieve blood glucose levels as near normal as possible. It was recognised that ‘intensive treatment’ involved more daily injections, more daily blood glucose testing, better education and of course, a greater risk of more episodes of severe hypoglycaemia and weight increase. Importantly, when MDI was introduced it was recognised that this regime was not suitable for everyone, not everyone wanted or could manage this more complex regime.

But now we have an increasing use of insulin analogues and one pharmaceutical company has stated that in future they will only supply insulin analogues. The use of insulin analogues means that people with Type 1 diabetes, and many with Type 2, will HAVE to use a regime of at least 4 injections a day – intensive treatment. Yet the above research showed that people on intensive treatment reported more distress and less self-confidence! So the increasing use of insulin analogues could well increase number of people with low self-esteem, anxiety and stress. Even if doctors are attuned to patients’ psychological needs, the reduction in types of insulin reduces their options to help patients.

Yes, there are pre-mixed analogue insulins which may be OK given twice daily, but we all know that they remove flexibility of dose and injection timing. Twice daily injections of separate short- and longer-acting animal or human insulins can still be geared to suit the activities and meals and for some people are a much easier to manage blood sugars. Do we really want to be left with little choice of insulin and the resulting effect of complicated regimes that could increase stress and reduce the quality of life of some people?

Related Health Issues

Hypoglycaemia
The Eyes and Diabetes
The Kidneys and Diabetes
Weight and Diet
Exercise Your Heart
Diabetic Neuropathy
Diabetes and Coeliac Disease
Stress, Anxiety and Depression
The Prostate and Diabetes
Polycystic Ovarian Syndrome
Joint and Muscle Problems Associated With Diabetes
Impotence
Women, Sex and Diabetes
Osteoporosis – Is There A Link with Diabetes?
An experience of the menopause

The Prostate and Diabetes

The prostate is a walnut-sized gland underneath the bladder in men that encircles the urethra [the tube that carries urine out of the body]. In adults the prostate often begins a new growth and tests have to be carried out to find out if this is benign or cancerous. If benign, it s called benign prostatic hyperplasia or BPH and if not, it is localised prostate cancer but to date no tests have been found to entirely reliable.
The pressure of the enlarged prostate may partially close the urethra causing various urinary problems, especially in older men.

A study published in the Journal of Urology, June 2000, shows that in men with diabetes the symptoms of BPH are worse than in men without diabetes. The research looked at the records of 1,290 men with diabetes and 8,566 men without diabetes all of whom were having drug treatment for BPH. They compared BPH symptoms before and after drug treatment and found that men with diabetes had more symptoms and slower urine flow rate than those without diabetes. It showed that men with diabetes have symptoms as severe as non-diabetic men eleven years older and a urine flow rate the same as non-diabetic men seven years older.

Facts about prostate cancer to put it in perspective

• Prostate cancer is slow growing so most men will die of something else before the cancer becomes a problem.
• It seems to occur in the majority of men as they get older but is not life threatening and remains localised in the prostate gland. Autopies have shown that 40% of men over the age of 50 have prostate cancer [and never knew] and the risk rises steadily with age so that by the age of 80 so that by 80, 70% of men have it.
• Surveys show that for the average 50year old man with a reasonable life expectancy of a further 25years, there is a 10% chance that he will develop clinically significant prostate cancer but only a 3% chance that he will die of it.

Symptoms of BPH and prostate cancer

• A weak or interrupted urine flow.
• Frequent urination during the night.
• Burning or painful urination.
• Urgent need to urinateUrine leakage.
• Feeling that the bladder is not empty even after urinating.

Ways to help the symptoms:

• Limit the amount of fluids before bed.
• Drink less alcohol and caffeine.
• Completely empty your bladder.
• Check with your GP that any other medicines you are taking are not aggravating the problems.

Treatment

Consult your doctor -It may be that if the symptoms don’t cause any problems, then there may be no need for treatment other than regular check ups.

Drug treatment – There are two different kinds of tablets that can help, all with side effects. One type of drug relaxes the prostrate muscles and lets the urine flow more easily and the other shrinks the prostate over several months.

Radiotherapy – Treatment is applied externally by Xrays or internally by using radioactive implants but a study has shown that it has limited efficacy [Int Joun of Radiat Oncol Bio Phys 2002, 53]. It also causes a range of unpleasant side effects.

Surgery – This is often recommended for men with serious BPH problems and prostate cancer. Surgery can have both severe and debilitating side effects that can include incontinence and impotence with a risk that both BPH and prostate cancer can return. A statement from the US National Cancer Institute in July 2001 says that the rate of recurrence rises to 40% 10 years after surgery.

Watchful waiting
Doing nothing does not sound like a treatment option but it is and it may be the best option and one that certainly should be discussed with your doctor. If BPH or prostate cancer is not causing effects or symptoms that markedly affect quality of life, then doing nothing may be the right choice. All the above treatments cause side effects that may be worse than the symptoms.

Screening for prostate cancer
Research to demonstrate whether or not screening for prostate cancer beneficial is far from conclusive. In 2000 the US National Cancer Institute stated ‘It is not known if the benefits of prostate cancer screening outweigh the risks, if surgery is a better option than radiation or if treatment is better than no treatment’.

The PSA screening test
This is the test used to screen for prostate and cancer and it measures the levels of prostate-specific antigen [PSA] in the blood. PSA is a protein produced by the prostate and when the prostate is enlarged the PSA blood levels tend to rise. However this tests produces a lot of false positives, suggesting that cancer is present when it is not, and false negatives giving the all clear when cancer is actually present
[Urologe A, 2000;39:22-6]

There is also disagreement about what level of PSA is significant and ‘normal’ levels can vary according to different factors.

If a PSA is positive, then further tests have to be carried out and these can have adverse effects that are worse than the condition itself as most prostate cancers are slow growing and may be present for years before they cause symptoms.

When considering being screened for prostate cancer, it is essential that the risks and benefits of the PSA and any subsequent procedures are carefully considered.

Related Health Issues

Hypoglycaemia
The Eyes and Diabetes
The Kidneys and Diabetes
Weight and Diet
Exercise Your Heart
Diabetic Neuropathy
Diabetes and Coeliac Disease
Stress, Anxiety and Depression
The Prostate and Diabetes
Polycystic Ovarian Syndrome
Joint and Muscle Problems Associated With Diabetes
Impotence
Women, Sex and Diabetes
Osteoporosis – Is There A Link with Diabetes?
An experience of the menopause

Polycystic Ovarian Syndrome

What is polycystic ovarian syndrome?

Polycystic ovarian syndrome, or PCOS, is a hormonal disorder affecting 5% to 10% of women of childbearing age. There are higher than normal male hormones, called androgens in the bloodstream and fluid-filled cysts inside one or both of the ovaries which can produce unpleasant symptoms. Usually 15 to 20 follicles inside of the ovaries begin to mature for ovulation every month and one follicle matures and is released by the ovaries while the rest die off but women with PCOS never have one follicle mature fully. This results in the 15 to 20 follicles staying inside the ovaries and they become cysts and it is these cysts that produce androgens.

PCOS can greatly interrupt the menstrual cycle, causing irregular or even a complete lack of ovulation and so women with PCOS often have difficulties becoming pregnant.

Symptoms
Many women never have any symptoms but others have a wide variety of them including:

• irregular menstruation or loss of menstruation [amenorrhea].
• Difficulty getting pregnant.
• Weight gain, particularly around the waist line.
• Hirstism which causes excessive hair growth, especially on the face and body.
• Acne and oily skin.
• Decreased breast size.

Who is at risk of PCOS?
Any woman can develop PCOS but it does seem that some women are at an increased risk:

• having a family history of PCOS [especially mother or sister]
• having diabetes or insulin resistance
• being overweight or obese
• being between the ages of 20 and 30

What causes PCOS?
Researchers are unsure about the causes but there are some factors that seem to play a role:

• Low levels of follicle-stimulating hormone [FHS] which is hormone released by the pituitary gland. It helps follicles inside of the ovaries to mature so that ovulation can take place.
• High levels of androgens, male sex hormones – most women suffering from polycystic ovarian syndrome have extremely high levels of androgens which could interfere with ovulation and contribute to PCOS.
• Insulin resistance – A large number of women with PCOS are insulin resistant which means that the body does not manage insulin properly. Insulin is essential to proper ovarian function so resistance to insulin may contribute to PCOS. This seems a little complicated because PCOS itself can cause weight gain and weight gain can cause insulin resistance but it seems that insulin resistance can also play a part in the development of PCOS.

The connection with diabetes
In recent years, it has become clear that PCOS is closely related to a problem with insulin. However, experts have been unable to find out whether insulin is the cause of PCOS in some women or if PCOS leads to problems with insulin. But it is certain that women with PCOS often have problems with insulin resistance and one study found that as many as 30% of PCOS patients suffer from insulin resistance.

Treatment of PCOS
At present there is no cure for PCOS but there some treatments that can help regulate the menstrual cycle or increase the chances of getting pregnant. These include:

Weight loss – To regulate insulin levels and restore ovulation and menstruation.

Birth Control Pills – They contain both oestrogen and progesterone which can help to regulate the menstrual cycle and decrease the appearance of hair growth and acne.

Diabetes Medications – It has been thought that metformin, a Type 2 diabetes medication may be useful to decrease testosterone levels, restore ovulation and lessen hair growth but a recent study described below suggests otherwise.

Fertility medications – The fertility medication, Clomiphene or injections of gonadotropins may help to stimulate ovulation and increase your chances of getting pregnant.

Surgery – Ovarian drilling can be an effective procedure to help to stimulate ovulation. Small holes are punctured through the ovaries to allow a decrease in testosterone levels and an increase in ovulation.

Complications of PCOS
There are a number of health problems that can develop as a result of PCOS including infertility, thickening of the endometrium and obesity related illnesses such as heart disease and Type 2 diabetes.

PCOS can also have a significant emotional effect on women because of the changes in appearance and many women can feel isolated, and depressed.

Recent research
A large study [New England Journal of Medicine, Feb 8 2007] compared the effects of metformin and standard fertility treatment drug, clomiphene in helping women with PCOS to have a successful pregnancy.

According to the study, women who took metformin alone, ovulated more than women on standard treatment. Women taking a combination of metformin and clomiphene also ovulated more frequently than women taking clomiphene alone or metformin alone. However, the increase in ovulation did not result in an increase in the number of successful pregnancies and deliveries for with either metformin alone or the combination of metformin and clomiphene. The results were as follows:

• Metformin only group, 15 out of 208 women gave birth – 7.2%
• Clomiphene only group, 47 out of 209 women gave birth – 22.5 percent
• Combined clomiphene-metformin group, 56 out of 209 women gave birth – 26.8% and not a statistically significant difference from the clomiphene only group
• Obese women were less likely to conceive and less likely to ovulate in response to metformin.
• So the researchers recommend the use of clomiphene alone and not in combination with metformin.

For more information on polycystic ovarian syndrome, please visit the NHS Choices website:

NHS Choices: PCOS

Joint and Muscle Problems Associated with Diabetes

Introduction
Connective Tissue Disorders
Tests Your Doctor May Carry Out
Myopathy
Cheiroarthropathy
Frozen Shoulder
Trigger Finger
Dupuytren’s Contracture
Carpel Tunnel
Stiff Man’s Syndrome [SMS] Also Known as Stiff Person’s Syndome
Diffuse idiopathic Skeletal Hyperostosis [DISH]

 

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Introduction

Joint and skeletal disorders, known as connective tissue disorders, are recognised as complications of diabetes but they tend to receive less attention than the other complications and the progress of these conditions is often not monitored. This could be because they are not life-threatening but they can be distressing and painful conditions that may adversely affect lifestyles for many people. One thing that seems clear, is that no one seems to know the causes of these conditions or if there are certain people who are more susceptible to them. It seems unacceptable to simply put them down to ‘long-term diabetes’.

In the IDDT Newsletter April 2003, Rae Price described how she had developed pains in her hands and feet and was diagnosed with cheiroarthropathy but no one seemed to have heard of it! But she changed to animal insulin and not only felt better but the general stiffness and pain had disappeared. Rae’s diary resulted in many phone calls and letters from people with various joint and muscle problems, so we decided to take a look!

Joint and Muscle Problems Associated with Diabetes

Introduction
Connective Tissue Disorders
Tests Your Doctor May Carry Out
Myopathy
Cheiroarthropathy
Frozen Shoulder
Trigger Finger
Dupuytren’s Contracture
Carpel Tunnel
Stiff Man’s Syndrome [SMS] Also Known as Stiff Person’s Syndome
Diffuse idiopathic Skeletal Hyperostosis [DISH]

 

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Connective Tissue Disorders

Connective tissue is the material between the cells of the body that gives tissues form and strength. It also is involved in delivering nutrients to the cells around the body. It is made up of a dozens of proteins including collagens. These proteins vary in quantity to provide different structures with varying functions: bone, cartilage, tendons and ligaments as well as fatty and elastic tissues.

Many connective tissue disorders are caused by mutations [alterations] in genes for building tissues and these mutations may change the structure and development of skin, bones, joints, heart, blood vessels, lungs, eyes and ears. Some connective tissue disorders are not directly linked to these mutations but some people may be genetically predisposed to becoming affected. Inherited connective tissue disorders may not be evident at birth but may appear after a certain age or after exposure to a particular environmental stress.

Joint and Muscle Problems Associated with Diabetes

Introduction
Connective Tissue Disorders
Tests Your Doctor May Carry Out
Myopathy
Cheiroarthropathy
Frozen Shoulder
Trigger Finger
Dupuytren’s Contracture
Carpel Tunnel
Stiff Man’s Syndrome [SMS] Also Known as Stiff Person’s Syndome
Diffuse idiopathic Skeletal Hyperostosis [DISH]

 

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Tests That Your Doctor May Carry Out

In connective tissue disorders there may be inflammation or infection present and/or there may be damage to muscles. There are two tests that the doctor may carry out:

• ESR Test [erythrocyte sedimentation rate] – this is the ‘standard’ blood test that GPs often carry out for many conditions to find out if there is any infection present in the body. A high result means that there is an infection and this can then be treated.
• Creatine Kinase Test – this is carried out to diagnose and monitor the progress of neuromuscular disorders. Creatine kinase [CK] is a protein found mainly in muscle and it is an enzyme that encourages a biochemical reaction to occur to provide a quick source of energy for the cells. If muscle is damaged, then during the muscle regeneration muscle cells break open and their contents go into the bloodstream. This means that the amount of CK in the blood will rise indicating that muscle damage has occurred and this can caused by chronic disease or by acute muscle injury.

Joint and Muscle Problems Associated with Diabetes

Introduction
Connective Tissue Disorders
Tests Your Doctor May Carry Out
Myopathy
Cheiroarthropathy
Frozen Shoulder
Trigger Finger
Dupuytren’s Contracture
Carpel Tunnel
Stiff Man’s Syndrome [SMS] Also Known as Stiff Person’s Syndome
Diffuse idiopathic Skeletal Hyperostosis [DISH]

 

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Myopathy

Myopathy is a general term used to describe any disease of muscles, such as the muscular dystrophies and myopathies associated with thyroid disease. It can be caused by endocrine disorders, including diabetes, metabolic disorders, infection or inflammation of the muscle, certain drugs and mutations in genes. Diabetes myopathy is thought to be caused by neuropathy, a complication of diabetes. General symptoms of myopathies include muscle weakness of limbs sometimes occurring during exercise although in some cases the symptoms diminish as exercise increases. Depending on the type of myopathy, one muscle group may be more affected than others.

Treatment – This varies according to the type of myopathy but may include drug therapy such as immuno-suppressants, physiotherapy, bracing or surgery.

Joint and Muscle Problems Associated with Diabetes

Introduction
Connective Tissue Disorders
Tests Your Doctor May Carry Out
Myopathy
Cheiroarthropathy
Frozen Shoulder
Trigger Finger
Dupuytren’s Contracture
Carpel Tunnel
Stiff Man’s Syndrome [SMS] Also Known as Stiff Person’s Syndome
Diffuse idiopathic Skeletal Hyperostosis [DISH]

 

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Cheiroarthropathy

[diabetic prayer]

This is often called limited joint mobility and in people with diabetes it generally involves the small joints of the hands, although it can affect larger joints such as wrist, shoulder, knees, hips. It is usually painless but numbness and pain may be present if there is also neuropathy or angiopathy of the hand. Most people do not report the problem until there is some deformity or loss of movement of the fingers. The affected fingers are swollen with a thick, tight and waxy skin and there is an inability to press both hands together hence the term, diabetic prayer. Other disorders of the hand, such as carpel tunnel syndrome and Dupuytren’s contracture, have different and distinct clinical features. Cheiroarthropathy is linked with more serious microvascular complications of diabetes eg retinopathy, nephropathy and neuropathy, so diagnosis is important. The causes of cheiroarthropathy are not really understood.

Treatment – because of the relationship with the microvascular complications of diabetes, improved diabetic control is advised but there is no well established treatment. Physiotherapy is important to maintain movement and prevent further deterioration. Surgery and corticosteriod injections may help in severe cases.

Prevalence:

• 4-14% of the non-diabetic population
• 8.4- 55% of people with Type 1 diabetes
• 4.2 -77% of people with Type 2 diabetes

Studies show a wide variation which could be due to genetic or racial factors or incorrect diagnosis. However, it does increase with the duration of diabetes

Joint and Muscle Problems Associated with Diabetes

Introduction
Connective Tissue Disorders
Tests Your Doctor May Carry Out
Myopathy
Cheiroarthropathy
Frozen Shoulder
Trigger Finger
Dupuytren’s Contracture
Carpel Tunnel
Stiff Man’s Syndrome [SMS] Also Known as Stiff Person’s Syndome
Diffuse idiopathic Skeletal Hyperostosis [DISH]

 

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Frozen Shoulder [adhesive capsulitis]

An early sign of frozen shoulder is when lifting the arm above the head, reaching across the body or behind the back is difficult. This is followed by pain, often worse at night, the pain then reduces but the range of movement is more limited which may last for 4-12months. In the final stage, the condition begins to resolve although surgery may be needed to restore movement. The cause is unknown but thought to involve an underlying inflammatory problem. The capsule around the shoulder joint thickens and contracts leaving less space for the upper arm bone to move around. It can also occur after long periods of immobilisation eg after injury or surgery.

Treatment – Drugs such as aspirin or ibuprofen to reduce the inflammation and pain, muscle relaxants, physiotherapy, exercises, heat or ice therapies, corticosteroid injections but surgery is only used if there is no improvement after several months. Some people have reported a positive response from acupuncture. Frozen shoulder affects more women than men, usually starts between ages 40 and 65 and affects 10-20% of people with diabetes.

Joint and Muscle Problems Associated with Diabetes

Introduction
Connective Tissue Disorders
Tests Your Doctor May Carry Out
Myopathy
Cheiroarthropathy
Frozen Shoulder
Trigger Finger
Dupuytren’s Contracture
Carpel Tunnel
Stiff Man’s Syndrome [SMS] Also Known as Stiff Person’s Syndome
Diffuse idiopathic Skeletal Hyperostosis [DISH]

 

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Trigger Finger

This is a common condition which results in a bent finger, as if pulling a trigger on a gun. The finger may be swollen, stiff and painful and there may be a bump over the joint in the palm of the hand. It involves the tendons and pulleys in the hand that bend the finger. The tendons connect the muscles to the forearm with the bones of the finger and each tendon is covered by a sheath. As the fingers are bent, the tendons glide backwards and forwards guided by a restraining pulley. If the tendon sheath becomes inflamed it swells and may develop a nodule or thickening of the tendon. The nodule passes through the pulley as the finger bends but gets stuck as the finger straightens which causes further irritation and swelling until eventually the finger locks in this bent position. The exact cause is unknown. It affects people over 40 and people with a history of diabetes or rheumatoid arthritis are particularly at risk of developing it.

Treatment – Aims to reduce the swelling and cycle of irritation so initially treatment is rest, splintering of the finger and taking aspirin or ibuprofen to reduce the swelling and pain. If the problem persists a steroid injection in the tendon sheath can relieve the pain and locking for several months. People with diabetes may require surgery to release the tendon and this can restore movement immediately.

Joint and Muscle Problems Associated with Diabetes

Introduction
Connective Tissue Disorders
Tests Your Doctor May Carry Out
Myopathy
Cheiroarthropathy
Frozen Shoulder
Trigger Finger
Dupuytren’s Contracture
Carpel Tunnel
Stiff Man’s Syndrome [SMS] Also Known as Stiff Person’s Syndome
Diffuse idiopathic Skeletal Hyperostosis [DISH]

 

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Dupuytren’s Contracture

This is a fairly common condition in the palm of the hand that can cause the fingers to contract. It occurs when the connective tissue under the skin in the palm of the hand begins to thicken and shorten and as the tissue tightens it may pull the fingers down towards the palm of the hand. The first sign is a nodule near the base of the little finger and the ring finger. Gradually other nodules may appear across the first joint of the fingers, the skin puckers and the finger is pulled towards the palm. It usually affects the ring finger first followed by the little, the long and the index fingers but there is evidence that in diabetes, different fingers are affected. The problem is not pain but the restriction of movement. Although again the cause is unknown, there is a genetic link because it affects people of northern European decent. It is seven times more common in men than women and usually does not show up until after 40 years of age. People with diabetes, alcoholics and those taking anticonvulsant drugs have a higher risk of Dupuytren’s contracture.

Treatment – The only treatment is surgery but this is usually only if the contracture has developed into a deformity. The outcome is usually good.

Joint and Muscle Problems Associated with Diabetes

Introduction
Connective Tissue Disorders
Tests Your Doctor May Carry Out
Myopathy
Cheiroarthropathy
Frozen Shoulder
Trigger Finger
Dupuytren’s Contracture
Carpel Tunnel
Stiff Man’s Syndrome [SMS] Also Known as Stiff Person’s Syndome
Diffuse idiopathic Skeletal Hyperostosis [DISH]

 

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Carpel Tunnel Syndrome

The carpel tunnel is a narrow, rigid passage of ligament and bones at the base of the hand that contains the median nerve [runs from the forearm to the hand] and tendons. If there is thickening of irritated tendons or other swelling the tunnel narrows and the median nerve is compressed. The symptoms often start gradually at night during sleep with burning, tingling or itching in the palm of the hand and fingers, especially the thumb and first two fingers and this can progress to daytime pain, weakness or numbness in the hand and wrist that may extend up the arm.

It is thought to be a combination of factors that put pressure on the nerve and tendons, rather than a problem with the median nerve itself. The most likely cause is congenital with some people just having a narrower tunnel but other common factors are injury to the wrist that causes swelling, over-activity of the pituitary gland, rheumatoid arthritis, and fluid retention.

Carpel tunnel problems affect three times as many women as men. People with diabetes or other metabolic disorders that can directly affect nerves are more susceptible to compression so have a higher risk of developing carpel tunnel problems.

Treatment – Obviously underlying causes such as diabetes or arthritis should be looked at first but treatment generally is resting the affected hand for two weeks, avoidance of anything that may worsen the symptoms and if necessary applying a splint to immobilise the wrist. In more severe cases drugs physiotherapy and/or surgery may be needed.

Research has found that genetics, rather than repetitive hand use, is responsible for carpal tunnel syndrome.
[American Academy of Orthopaedic Surgeons annual meeting: February 20, 2007]

However, according to the researchers genetics do not provide the whole answer. Age, genetics, obesity, diabetes, thyroid, various types of hormonal conditions, even pregnancy are predisposing factors but there are external factors that will bring on the symptoms. So the researchers suggest that a person may have a genetic or multi-factorial predisposition to carpel tunnel syndrome but something may cause the symptoms to develop. In other words, people who use their hands continuously and laboriously don’t get carpel tunnel more frequently than those who don’t.

The study authors suggest that these findings may affect disability, workers’ compensation and personal-injury claims.

Joint and Muscle Problems Associated with Diabetes

Introduction
Connective Tissue Disorders
Tests Your Doctor May Carry Out
Myopathy
Cheiroarthropathy
Frozen Shoulder
Trigger Finger
Dupuytren’s Contracture
Carpel Tunnel
Stiff Man’s Syndrome [SMS] Also Known as Stiff Person’s Syndome
Diffuse idiopathic Skeletal Hyperostosis [DISH]

 

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Stiff Man’s Syndrome [SMS] Now Also Known as Stiff Person’s Syndrome

This is a rare slow progressive neurological disorder and the symptoms are painful contractions and spasms of voluntary muscles, particularly those of the back and upper legs. It is caused by rogue antibodies in the blood causing muscles to lock unexpectedly leaving the person with this condition paralysed for minutes or hours at a time. The symptoms may worsen when the person is exposed to anxiety or sudden motion or noise. Sleep usually suppresses the frequency of the contractions.

Researchers think that stiff person’s syndrome may be an autoimmune disorder. How rare is rare? This is difficult to estimate because doctors often think that the symptoms are psychological or due to depression. 50% of people with SMS also have Type 1 diabetes although the link between the two conditions has not been proved scientifically.

It is interesting to note that the information on the National Institute of Health website says that other autoimmune diseases such as diabetes may occur more frequently in people with Stiff Man’s Syndrome. Interesting because if we look at the diabetes literature it is described the other way around as a ‘rare complication of diabetes’!

Treatment – The drug diazepam, a muscle relaxant, provides improvement in most cases, as do some other drugs. Physiotherapy may also be helpful in some people.

Joint and Muscle Problems Associated with Diabetes

Introduction
Connective Tissue Disorders
Tests Your Doctor May Carry Out
Myopathy
Cheiroarthropathy
Frozen Shoulder
Trigger Finger
Dupuytren’s Contracture
Carpel Tunnel
Stiff Man’s Syndrome [SMS] Also Known as Stiff Person’s Syndome
Diffuse idiopathic Skeletal Hyperostosis [DISH]

 

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Diffuse Idiopathic Skeletal Hyperostosis [DISH]

This is where there is calcification of the spinal ligaments and the most common part to be affected is the thoracic [chest] spine. It may also be accompanied by general calcification of other ligaments and tendons. The symptoms are stiffness of the neck and back with decreased movement but pain is not the most marked symptom. The cause is not known but the prevalence of DISH is higher in people diabetes than the general population, especially in people with Type 2 diabetes who are obese.

Treatment – There is no evidence that good diabetic control delays the onset or improves the condition. Treatment is physiotherapy, aspirin or ibuprofen

General Information
Erectile Dysfunction and Diabetes
What to do if Erectile Dysfunction Develops
Treatment Options
Cochrane Review of Erectile Dysfunction Drugs For Men With Diabetes
Further Information

 

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General Information

Erectile dysfunction, more frequently referred to as impotence, is the persistent or recurrent inability to attain or maintain an erection. It is still something that is difficult or embarrassing to talk about, even within a relationship and so in many men it goes unreported. However, it is important to remember that over the last few years there have been major advances in the treatment of erectile dysfunction and the majority of men can now be treated effectively for intercourse to take place.

Facts

• All men, with or without diabetes, experience difficulties in achieving an erection at some time in their lives.
• It affects at least one man in every 10.
• Overall 35% of men with diabetes have erectile dysfunction but this rises to 50% in men with diabetes over the age of 50.

Causes of erectile dysfunction?
Until about 20 years ago erectile dysfunction was thought to be almost entirely caused by psychological factors but it is now known that physical conditions are present in about 75% of men and that in many men it may be caused by a combination of both.

Physical causes
If erectile dysfunction is of a physical cause then the onset is often gradual. These may be:

• Damage or diseases that affect the nerves which go to or from the penis.
• Vascular disease.
• Side effects of medications, such as anti-hypertensive drugs. Sedatives, tranquillisers and anti-depressants may also be a cause.
• High cholesterol levels.
• Too much alcohol, some recreational drugs and heavy smoking.
• Neurological disease, eg stroke.
• Chronic disease such as diabetes, kidney failure and liver failure.

Psychological causes
If erectile dysfunction is of sudden onset, this suggests a psychological cause such as:

• Stress and anxiety either at work or at home
• Marital conflicts
• Depression

For more information on erectile dysfunction, please visit the NHS Choices website:

NHS Choices: Impotence

Impotence and Diabetes

General Information
Erectile Dysfunction and Diabetes
What to do if Erectile Dysfunction Develops
Treatment Options
Cochrane Review of Erectile Dysfunction Drugs For Men With Diabetes
Further Information

 

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Erectile Dysfunction and Diabetes

In the majority of cases of erectile dysfunction in men with diabetes the cause is physical rather than psychological and the most common cause is neuropathy – damage to the nerves that go to and from the penis. Physical causes themselves can also cause psychological difficulties, so general counselling and discussion may be helpful.

Research has shown that there is not only a problem about being open about these issues but there is also a lot of misunderstanding. It showed:

• 9% defined erectile dysfunction incorrectly
• 30% were unaware that it is a complication of diabetes
• 42% thought it was inevitable with age,

The study concluded that not sufficient emphasis is placed on impotence by health care professionals and they do not see it as important as other complications of diabetes. Healthcare professionals should raise this issue at diabetes annual check ups in order to provide people with the opportunity to raise what for them may be an embarrassing topic but also because erectile dysfunction can be a sign of diabetes control problems or other underlying health conditions. It can lead to a significant reduction in quality of life and relationship difficulties.
Ref 1 Pract Diab 1997, Vol 4, No 4 The diabeteic males perception of erectile dysfunction, Cummings et al

Impotence and Diabetes

General Information
Erectile Dysfunction and Diabetes
What to do if Erectile Dysfunction Develops
Treatment Options
Cochrane Review of Erectile Dysfunction Drugs For Men With Diabetes
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What to do if Erectile Dysfunction Develops

Important to remember that over the last few years there have been major advances in the treatment of erectile dysfunction and the majority of can now be treated effectively for intercourse to take place.

However, it is first necessary to identify the problem and this means discussing the problem with your GP or diabetic clinic doctor. You may well be referred to a specialist or your GP practice may have a clinic within the surgery. Once referred to the specialist, there will be a general assessment of your health and any medications you might be taking. Blood tests will also be carried out to check your diabetes control, hormone levels, blood pressure and general fitness. There may also be discussions about your previous sexual function and your relationship with your partner.

Impotence and Diabetes

General Information
Erectile Dysfunction and Diabetes
What to do if Erectile Dysfunction Develops
Treatment Options
Cochrane Review of Erectile Dysfunction Drugs For Men With Diabetes
Further Information

 

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Treatment Options

Psycho-sexual therapy
This may be recommended where psychological factors are considered to be an important part of the causes of erectile dysfunction. It may be recommended in combination with other treatments.

Cochrane Review of psychosocial interventions for erectile dysfunction
A meta-analysis was carried out looking at all the research for erectile dysfunction to compare the effectiveness of psychological treatment [therapy] and treatment with oral drugs, vacuum devices or other psychological interventions. The reviewers searched for randomised controlled trials carried out between 1966 and 2007 and found 11 trials involving 398 men. Their conclusions were:

• Group psychotherapy therapy improves erectile dysfunction in selected patients.
• Focused sex group therapy was more effective than no treatment.
• Men who received group therapy and Viagra [sildenafil] showed significant improvement of erectile dysfunction and were less likely than those receiving only Viagra to drop out.
• No difference was found when comparing the effectiveness of psychological interventions with local injection and vacuum devices.

Ref: Melnik T, Soares BGO, Nasselo AG. Psychosocial interventions for erectile dysfunction. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004825. DOI: 10.1002/14651858.CD004825.pub2

Hormone treatments
Only a small number of cases of erectile dysfunction are caused by hormonal imbalance – most often reduced levels of testosterone. If this is the case, testosterone replacement can then be used.

Oral medications
There are now three drugs in tablet form on the market used to treat erectile dysfunction

• Viagra [Sildenafil, Pfzer]
• Cialis [Tadafil, Lilly]
• Vardenfil or Levitra [Bayer/GlaxoSmithKline]

They all act in the same way by helping the smooth muscles in the penis to relax so increasing the blood flow to the penis causing an erection. They will only work if the man is sexually stimulated. None of them should be taken in combination with each other.

Viagra – This was the first drug of its type on the market. It should be taken about an hour before sexual activity and on average takes 20 to 60 minutes to work and within a 4 to 6 hour period after taking the tablet, an erection should occur.

Side effects are usually mild and transient with the most common being headache and flushing. It should not be taken with other medicines unless the doctor says it is safe to do so.

Not to be taken by people who are taking medicines that contain nitrates, these are commonly prescribed for angina sufferers. Also people with the following conditions:

• Severe heart or liver problems
• Recent heart attack, stroke or low blood pressure
• Certain rare eye diseases eg retinitis pigmentosa.

Cialis – This is a new drug and within 30 minutes of taking it, 50% of men can get an erection if sexually stimulated and its effects last for 24 hours. So the manufacturers say that it will allow men with erectile dysfunction to choose when they want to have sex and will allow couples greater spontaneity. The publicity material says that in clinical trials Cialis worked in four out of five men.

Side effects are usually mild and transient, the most common being headache and indigestion. Less common side effects include stuffy nose, flushing, myalgia, dizziness and backache.

It should not to be taken by people who are taking medicines that contain nitrates. It should also not be taken by men with the following:

• Severe cardiac disease where sexual activity is inadvisable
• Heart attack in the last 90 days or significant heart failure in the last 6 months
• Stroke within the last 6 months
• Unstable angina
• Uncontrolled arrhythmias [irregular heart beat], low or untreated high blood pressure

Vardenafil or Levitra – The latest drug where clinical trials have shown that is effective and reliable in a wide range of men with erectile dysfunction. It normally works within 25-60 minutes and within a 5 hour period after taking.

Side effects are usually mild and transient with the most common being headache and flushing.

Not to be taken by people who are taking medicines that contain nitrates. It should also not be taken by men with the following:

• Severe cardiac disease where sexual activity is inadvisable
• Recent stroke, heart attack or low blood pressure
• Unstable angina

Research among men with diabetes 73% taking 20mg Vardenfil/Levitra showed a significant improvement in erections. Most adverse events were mild to moderate and transient – headache, flushing, rhinitis dyspepsia, nausea and dizziness.

Impotence and Diabetes

General Information
Erectile Dysfunction and Diabetes
What to do if Erectile Dysfunction Develops
Treatment Options
Cochrane Review of Erectile Dysfunction Drugs For Men With Diabetes
Further Information

 

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Cochrane Review of Erectile Dysfunction Drugs For Men With Diabetes

There are three popular drugs to treat erectile dysfunction – sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), known as PDE-5 inhibitors. They have been found to be quite effective in the general population and now a Cochrane Review investigated whether these drugs are a safe and effective option for men with diabetes. The Review showed that although diabetes can cause a number of other chronic complications, such as heart disease and high blood pressure, these erectile dysfunction drugs were shown not to cause many adverse reactions in men with diabetes. The most common side effects were headache, flushing and upper respiratory tract complaints and flu-like symptoms.

The Cochrane Collaboration is an international organisation which evaluates research and draws evidence-based conclusions to inform medical practice. In this case the Cochrane reviewers analysed eight studies that compared the effectiveness of the three PDE-5 medications to placebo. 1,759 men were involved with about half randomised to receive PDE-5 inhibitor therapy for 12 weeks in most studies and the rest to the placebo group. Overall, 80 percent of the participants had type 2 diabetes and the others had type 1 diabetes.

At the end of the studies men who took PDE-5 inhibitors showed improvements on all measures of erectile function, with an average difference of 26.7% more “successful intercourse attempts” compared to placebo groups. However, the Cochrane reviewers caution that men should use PDE-5 inhibitors only as directed by their physicians and should discuss interactions with other drugs that may be being taken and specific contraindications. The reviewers also warn that there is no concrete evidence that these medications are safe for the long term.

NHS Availabilty
All three are available on NHS prescription to men with diabetes but this is limited to four tables per month.

Other forms of treatment

Transurethral therapy
This is a needle-free form of treatment where a small pellet of a drug is introduced into the urethra [the tube that urine passes through] with a special applicator. The drug is absorbed through the urethra walls into the erectile tissue giving an erection in 5-10 minutes.

Intercavernosal injection therapy
The man and/or his partner are taught how to inject a drug directly into the penis. An erection usually occurs within 15 minutes.

Vacuum devices
These devices produce an erection using a hand or battery operated vacuum pump attached to a plastic cylinder.

Penile prosthesis
These are like splints that are surgically inserted into the penis. This causes destruction of the erectile tissue and should not be considered until other treatments have been tried.

Impotence and Diabetes

General Information
Erectile Dysfunction and Diabetes
What to do if Erectile Dysfunction Develops
Treatment Options
Cochrane Review of Erectile Dysfunction Drugs For Men With Diabetes
Further Information

 

Back to Related Health Issues

Further Information

The Sexual Dysfunction Association
Suite 301, Emblem House,
London Bridge Hospital
27 Tooley Street
London
SE1 2PR

helpline: 0870 7743571
website: www.sda.uk.net or www.impotence.org.uk

Relate
To find your local Relate call 0300 100 1234
website: www.relate.org.uk

Healthline
A wealth of useful information can be found by visiting:
website: www.healthline.com