Cystic Fibrosis-Related Diabetes (CFRD)

The most common types of diabetes are type 1 and type 2 diabetes. CFRD has some features that are common in both. Type 1 diabetes used to be called insulin-dependent or juvenile-onset diabetes. It occurs most often in childhood. People with type diabetes can’t make any insulin, so they must take insulin to stay alive. This is why type diabetes is often called “insulin-dependent diabetes.” People with type diabetes who miss insulin doses get very sick and can get ketoacidosis (a life-threatening change in blood acidity). Type 2 diabetes used to be called non–insulin dependent or adult-onset diabetes. It is caused by the lack of a normal response to insulin in addition to not making enough insulin. This type of diabetes occurs most often in overweight people over the age of 0. People with type 2 diabetes don’t often get ketoacidosis, but they can get very sick when their blood sugars are too high. People with type 2 diabetes do not always need insulin to manage their diabetes. Some use insulin. Some take pills. Most are told to lose weight. Some manage type 2 diabetes through diet and exercise alone.

Diabetes

T1DM: The body cannot make insulin

T2DM: The body lacks normal responses to insulin and does not make enough insulin

CFRD: The body cannot make or use insulin

Causes of CFRD

CFRD is unique, though it shares features with both type and type 2 diabetes. As in type diabetes, the pancreas does not make enough insulin. Thus, people with CF have insulin deficiency. This is likely due to scars in the pancreas because of thick mucus. Most people with CF make less insulin than normal, though not all with CF get diabetes. Some people with CF get diabetes because they may have insulin resistance. This means that the cells in the body do not use insulin the right way so more insulin is needed to change food into fuel and keep blood sugars in the normal range. Because many with CF have both insulin deficiency and insulin resistance, more people with CF get diabetes than do people without CF. Even when people with CF are not acutely ill, their chronic underlying infections can cause insulin resistance. A third cause of insulin resistance is higher than normal cortisol levels. The hormone cortisol is a steroid. It is made in the adrenal glands. Our bodies make higher than normal cortisol levels in response to stress. High cortisol levels get in the way of insulin’s action. Steroid-containing drugs (called corticosteroids) can also increase cortisol levels. These drugs are sometimes needed to treat lung disease. When taken, they can, for a little while, worsen blood sugar control. In people with CF who do not have diabetes, using corticosteroids can give them diabetes for a little while during and after corticosteroid treatment. People can have CFRD only sometimes (intermittent CFRD) or always (chronic CFRD). If you have intermittent CFRD, you may only need to take insulin when sick or during steroid treatment. If you have chronic CFRD, you need insulin treatment at all times to prevent high blood sugar levels. Although CFRD is unique from type or type 2 diabetes, the problems caused by diabetes are the same for all. These include eye, kidney, and nerve problems. These problems are caused by many years of blood sugar levels that are too high. Every person’s goal for diabetes treatment, no matter what kind they have, is to keep blood sugar levels as normal as they can. This helps to prevent diabetes-caused problems.

Complications with Hyperglycemia:

          Vision Problems

          Kidney Problems

          Neurological Problems (Nerve Damage)

Goal: To Keep Blood Sugar Levels Normal

              A1C: 7%

              A1C may also be reported as eAG: 154 mg/dl

              Before a meal (preprandial plasma glucose): 70–130 mg/dl

              1-2 hours after beginning of the meal (Postprandial plasma glucose)*: Less than 180 mg/dl

ADA Normal Blood Sugar Levels

Managing Cystic Fibrosis-Related Diabetes

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Managing Diabetes- It’s App-tastic!

Currently, a steadily increasing amount of people are using their phone as a source of knowledge and information. Honestly, it makes sense though. Your phone is always with you, it’s convenient, and it fits in your pocket. But, more specifically it’s helping people manage diseases like diabetes. Diabetes can be a mountain to manage, unless you have the right tools: knowledge and organization. According to the American Diabetes Association, nearly 19 million Americans, or more than 8% of the population, have diabetes. An estimated 7 million more are living with diabetes and have no idea they have it.

As discussed, with the rapid rising rates of diabetes, managing the condition is more important than ever! By incorporating the digital age of electronic devices, Smartphones, and more importantly phone applications, managing your diabetes can become second nature. So, here is an app that I recently came across that has been generating a substantial amount of “buzz”. Allow me to further investigate the characteristics of the diabetes app….

1.     Diabetes Companion by mySugr

This is the #1 diabetes app in 6 countries. The Companion is a charming, sometimes outspoken diabetes manager. The app is a new-twist on a diabetes logbook. It gives you immediate feedback in a fun package and helps you stay motivated for the long haul. You win points for every entry made which helps tame your diabetes “monster”. The goal is to tame your monster every day. Challenges are available to help you set and attain personal goals. It’s all the diabetes management you’re used to, with a side-order of context to make it meaningful.

You can use photos of your food along with smart searches to help make educated decisions on the go, use tags, notes, and locations to describe the situations and circumstances around your data, and choose from a variety of ever changing challenges to push yourself and your therapy to the next level of diabetes management nirvana.

Cost: FREE

Key Features include:

          Quick and easy logging

          Smart search

          Convenient data analysis

          Neat and clear graphs

          Handy photo functions (multiple pictures per entry)

          Exciting challenges

          Snappy reports (PDF, Excel)

          Smile-inducing feedback

          Secure data backup

           Social sharing functions

          Fast multi-device sync

          Practical glucose reminders

          Registered medical device (which is very important when looking into apps that help manage/regulate health-related diseases/illnesses)

mySugr Diabetes Manager App: The Companion

MySugrdm appdm

Sixty Five Roses

Cystic fibrosis is the most common fatal genetic disorder in North America. The disorder produces thick, sticky mucus secretions that may seriously impair the function of multiple organs in the body. Most notably, these organs are the pancreas and lungs. Just a few decades ago, an infant born with CF seldom survived to adulthood. Today, the outlook is much brighter, with adults reaching their 30’s, 40’s, and some even into their 50’s.

Cystic fibrosis has three major consequences: chronic lung disease, pancreatic insufficiency, and abnormally high electrolyte concentrations in the sweat. Chronic lung disease develops because the airways in the lungs become congested with mucus, causing breathings to be strenuous. As the thick mucus stagnates in the bronchial tubes, bacteria multiply there. Lung infections are the usual cause of death in people with cystic fibrosis.

Cystic fibrosis causes some degree of pancreatic insufficiency in all cases, with about 90% of cases serious enough to require enzyme replacement therapy. With aging, damage to the pancreas deteriorates. The thick mucus obstructs the pancreatic ducts and interferes with the secretion of digestive enzymes, pancreatic juices, and pancreatic hormones. Eventually, the pancreatic cells are surrounded by mucus and are gradually replaced by fibrous tissues. Malabsorption of many nutrients including fat, protein, vitamins, and minerals often leads to malnutrition. Additionally, the secretion of insulin may be affected resulting in glucose intolerance and diabetes.

The therapy of cystic fibrosis aims to promote appropriate growth and development and prevent respiratory failure and complications. Treatment includes respiratory, diet, and drug therapy.

Nutrient losses through malabsorption, frequent infections, rapid turnover rate of protein and essential fatty acids, high protein catabolism, and high basal energy expenditures raise energy needs for people with cystic fibrosis to between 120%-150% of the RDA for gender and age. Extra energy is needed simply to breathe. RDs estimate individual energy requirements based on basal metabolic rate, activity level, pulmonary function, and degree of malabsorption.

Obtaining enough energy can be complicated, but because people with CF frequently experience a loss of appetite that is aggravated by repeated infections, emotional stress, and drug therapy. Coughing to clear the lungs may trigger vomiting or reflux of foods from the stomach. Thus the person with cystic fibrosis finds it difficult to take in enough food energy, protein, and other nutrients to meet needs.

NIH- Cystic Fibrosis

Cystic Fibrosis Foundation

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