Within the setting of diabetes, the target blood pressure is <130/80. The topic of target blood pressures has been well-researched, and several large studies have consistently shown that significant improvements in lengthy term cardiovascular and kidney health do not become apparent until blood stress is reduced to this level. For this reason, doctors tend to be very aggressive when devising treatment plans for diabetic sufferers.

Some studies have suggested that certain groups of diabetic sufferers — like those with preexisting kidney problems — benefit most from blood pressures less than 120/80. Data has shown that the risk of cardiovascular problems and further kidney damage approach their lowest measurable values within this range. Because it is difficult to reduce blood pressure to this level, it is a recommendation usually reserved only for specific patients.
Non-Drug Therapy

The official guidelines of both the American Heart Association and the American Diabetes Association state that blood pressures within the range of 130-139/80-89 should first be treated with “non-pharmacologic” (no medicine) options. These options include:

• Weight loss
• Salt restriction
• Dietary changes
• Quitting smoking
• Limiting alcohol intake

In sufferers without diabetes, strict adherence to these rules very often leads to significant drops in blood pressure, enough so that drug therapy may not be needed. While the same can occur in diabetic patients, it is less common, and drug therapy is usually needed. These changes are still worthwhile, though, because they increase the effectiveness of the drug therapy and ultimately lead to better blood pressure manage.

Drug Therapy

Drug therapy is a necessary step for most sufferers at some point during treatment. Vast amounts of research have been done in an effort to determine which drug or drug combination is the “best” for treating high blood pressure in patients with diabetes. Though study results vary slightly, there is a near universal consensus that the best drugs to use within the setting of diabetes are:

• ACE Inhibitors
• Angiotensin Receptor Blockers (ARBs)
• Diuretics (Thiazides)

These drugs specifically address several concerns associated with higher blood pressure within the setting of diabetes including volume expansion, blood vessel stiffness, and kidney damage. Though some doctors initially begin therapy by trying a diuretic on its own, it is more common to begin with an ACE Inhibitor. Ultimately, some ACE Inhibitor / ARB combination is usually the treatment of choice, with a diuretic added if needed. Though this is the most common type of drug treatment, other drugs may be included depending on specific patient factors.

If your doctor chooses to start therapy with a diuretic, be aware that this is not a bad choice, and there is evidence to support this decision in certain types of sufferers. It will be clear very quickly whether the treatment is working or not, and adjustments will be made if necessary.
Follow-Up Care

Whatever the specific treatment being administered, proper follow up care is important to managing the lengthy term success of your therapy. Within the beginning, you’ll likely see your doctor monthly, or even bi-weekly, until an effective plan is in place. Then, many doctors will ask you to come back every three months for the first year. This close follow up is used to track changes in blood pressure and establish a baseline for certain physical parameters like electrolyte levels (potassium and sodium within the blood) and kidney function.

After the first year, your doctor may choose to switch to six month appointments, or might want you to continue on the three-month schedule. If you are asked to continue the three month schedule, this is not a cause for alarm, it just means that much more time is needed to ensure that everything is going as planned. A growing number of doctors are asking all diabetic patients with higher blood stress to come in every three months. Keeping these appointments is important. Treatment is most effective when paired with a schedule of proper follow-up care.

Pineapple contains a proteolytic enzyme bromelain, which breaks down protein. Pineapple juice can thus be used as a marinade and tenderizer for meat. The enzymes in raw pineapples can interfere with the preparation of some foods, such as jelly or other gelatin-based desserts.

The bromelain breaks down in cooking or the canning process, thus canned pineapple can generally be used with gelatin. These enzymes can be hazardous to someone suffering from certain protein deficiencies or disorders, such as Ehlers-Danlos syndrome.

Raw pineapples also should not be consumed by those with hemophilia or by those with kidney or liver disease, as it may reduce the time taken to coagulate a consumer’s blood

Consumers of pineapple have claimed that pineapple has benefits for some intestinal disorders and others believe it serves as a pain reliever; others claim that it helps to induce childbirth when a baby is overdue.

Pineapple is a good source of manganese (91 %DV in a 1 cup serving), as well as containing significant amounts of Vitamin C (94 %DV in a 1 cup serving) and Vitamin B1 (8 %DV in a 1 cup serving).

Therefore, dDiabetic can eat a certain amount of pineapple within blood sugar levels as stable circumstances.

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Diabetic peripheral neuropathy can also cause sharp pain in your feet. You may become excruciatingly sensitive to the lightest touch, like the sheets on your bed.If you don’t notice or treat the sores, they can become deeply infected, and lead to amputation. A sad reality: having a toe, foot, or lower leg surgically removed is 10 times more likely in people with diabetes.

10 Tips to Protect Diabetic Feet

Foot Care Tip 1. Check both feet daily.
Look over both feet carefully every day, and be sure you check between all of your toes. Blisters and infections can start between your toes, and with diabetic neuropathy, you may not feel them until they’ve become irritated or infected. If a physical challenge keeps you from checking your own feet, ask a family member to help.

Foot Care Tip 2. Wash with warm – not hot – water.
Wash both of your feet briefly each day with warm – not hot – water. You may not be able to feel heat with your feet, so test the water with your hands first. Avoid soaking too long in water, since waterlogged sores have a harder time healing. Dry your feet right away, and remember to dry gently between all of your toes.

Foot Care Tip 3. Make sure your shoes fit well.
It’s an investment worth making. Even the slightest rubbing or misfit shoe can cause a blister that turns into a sore that becomes infected and never heals. Buy better-fitting shoes, or try different socks, even at the most minor signs of redness or irritation, since you may not be able to feel when it’s getting worse. Before buying or putting on the shoes check your shoes for rough seams, sharp edges or other objects that could hurt your feet. And break your shoes in gradually.

Foot Care Tip 4. Skip the barefoot look.
Always wear shoes or slippers. Always wear socks with your shoes, since leather, plastics, and manmade shoe materials can irritate your skin and quickly bring on blisters. While you might prefer the look of hose, nylon knee-highs, or thin socks, you may find that these don’t give your toes or heels enough protection. Wear thicker socks to pad your feet and cushion any calluses or sore spots.

Foot Care Tip 5. Speak up.
Nerve damage can be unpredictable. Tell your doctor about any changes in sensation in your toes, feet, or legs. Speak up if you notice pain, tingling, a pins-and-needles feeling, numbness, or any other unusual signs – even if it seems trivial to you. There’s nothing small-potatoes about a potential foot amputation.

Foot Care Tip 6. Stay soft – but dry.
Your skin may be dry and cracked because of high glucose levels, and cracked skin means it’s easier for bacteria to get under your skin and harder for infections to heal. Use a small amount of skin lotion daily, but be sure your feet feel dry – not damp or sticky – afterwards. Try not to get the lotion in between your toes. Keep your toenails trimmed and filed smooth to avoid ingrown toenails. You may find it easier to trim your nails after using lotion, when your cuticles are softer. Use a pumice stone after showering or bathing to softly file corns or calluses.

Foot Care Tip 7. Try non-impact exercise.
Swimming, cycling, yoga, and tai chi are increasingly popular ways to exercise – with minimal impact on your feet. Talk with your doctor before starting an exercise program.

Foot Care Tip 8. Fix bunions, corns, and hammertoes.
If your big toe slants sharply in toward your other toes, with a big bump on the knuckle of your big toe, you’ve got a classic bunion. Corns are spots of thick, rough skin, where the tissue builds up on toes constantly barraged by too much rubbing or pressure. A buckled-under toe, called a hammertoe, can result from muscle weakness caused by diabetic nerve damage. All of these make it hard to fit shoes comfortably. But a good podiatrist can help you fix these problems and take better care of your feet.

Foot Care Tip 9. Consider fitted orthotics.
A podiatrist can also fit you with shoe inserts called orthotics to support your feet if your have diabetic nerve pain or the muscles have become weak from nerve damage. If pain or weakness is so severe that it’s too painful or even impossible to walk, a foot brace or orthopedic shoes might help. A podiatrist is your best source for these devices.

Foot Care Tip 10. Control your blood sugar.
The best treatment for nerve pain, ultimately, is to manage your diabetes well. In fact, a major study by the American Diabetes Association in 2006 showed that strict blood glucose control with intensive insulin therapy lowered the chances of having symptoms of peripheral neuropathy – tingling, burning, and pain – by 64%. While you can’t control whether or not you get diabetic nerve pain, you can help control your glucose levels with diet, exercise, and mediations if you need them.

Your feet are your source of independence – or at least its foundation. Give your feet a little tenderness, a little loving care, each day. And be sure to have your doctor take a good look at your feet during each of your diabetes checkups, in case you missed anything.

As many as 54 million Americans have prediabetes — a condition where blood sugar levels are abnormally high, but not high enough to qualify as diabetes — says the American Diabetes Association (ADA). Add to that the nearly 21 million Americans already coping with full diabetes, and you can see how common nerve pain may be.

A healthy lifestyle helps lower your risk of heart disease, stroke, and other diabetes complications, as well. So know your risk for complications, and work to control the ones you can control.

1. You’ve Had Diabetes for Many Years.

The risk: Nerve pain and damage is more common in people who have had diabetes for more than 25 years.

What you can do: Do your best to monitor your blood sugar at home as often as advised by your doctor. The NDIC also advises having the A1c test, a blood test that measures your average amount of blood glucose over the previous 2 to 3 months, at least twice a year.

2. You Have High Blood Sugar.

The risk: Who are the people at highest risk of nerve pain and damage from diabetes? Those who have trouble controlling their blood sugar.

What you can do: Sometimes glucose control is about mind over matter: you may simply need a little help staying motivated, sticking to your exercise program, or learning how to prepare more varied, tasty, healthy meals. But if you’re “doing everything right” and still have high glucose levels, you may need to change your plan and start medications to help better manage your blood sugars.

3. You’re Over 40.

The risk: Diabetic nerve damage is more common in people over 40.

What you can do: While you can’t turn back the clock, you can recommit to a healthy lifestyle each year. You might try one, fun new thing to help manage your diabetes each year, like finding a new diabetes cookbook or joining a walking or swimming group, to keep yourself motivated. If you’re in a relationship, tell your partner or spouse that your diabetes-friendly lifestyle can help your sweetheart feel young, healthy, and energized, too. Every little bit helps when it comes to diet, exercise, and other lifestyle changes.

4. You’re Overweight.

The risk: Being overweight is double trouble for people with diabetes. It puts you at higher risk of diabetic nerve damage — and higher risk of deadly diabetes complications like heart attack and stroke.

What you can do: Losing weight is hard for everyone, since meals are loaded with emotional meaning, well-being, satisfaction — or frustration. So if you’re overweight, be patient — but consistent — with yourself. Losing even a few extra pounds can be a big boost to your health, says the ADA. You really can control this risk with a balanced diet and exercise plan designed for slow, safe weight loss. And losing weight means less pressure on those tender feet if you already have diabetic nerve pain.

5. You Smoke.

The risk: Smokers are at greater risk of nerve damage from diabetes. And as you no doubt know, smoking has been linked to heart disease for years.

What you can do: You really can quit, even if you’ve been a longtime smoker. And it’s never too late: Even if you’ve smoked for years, you’ll do yourself a world a good if you quit. These days, you’ll find smoking cessation classes, groups, and resources everywhere. Set a quit date, commit yourself, and ask your friends, family, colleagues, and your doctor for support.

6. You Drink a Lot of Alcohol.

The risk: Alcohol goes right into your bloodstream and can “spike” your blood sugar the same way high-sugar foods like desserts do. Drinking can also make you swerve off your meal plan and eat foods you know will wreck your blood sugars. Even more sobering? Alcohol blocks how well your liver clears fat from your blood and can raise your level of unhealthy blood fats called triglycerides – even with as little as two 4-ounce glasses a wine a week, says the ADA.

What you can do: The ADA and NDIC both advise cutting down on drinking to help prevent — or at least try to control — diabetic nerve damage. If you already have nerve pain, ask your doctor whether you should have any alcohol at all. There isn’t any proven, “safe” amount to drink, so if you’re living with diabetes, you may decide to cut out drinking entirely.

7. You’re Off-Target With Your Blood Fats.

The risk: The wrong levels of fats in your blood put you at higher risk of diabetic neuropathy. Often, people with diabetes have too-low levels of HDL (“good cholesterol”) and too-high levels of the blood fat called triglycerides, says the ADA. To make matters worse, their LDL (“bad cholesterol”) makes them more likely to have a heart attack. A grim truth: 66% of people with diabetes will die of a heart attack or stroke, according the ADA.
What you can do: Find out your numbers, if you’re not sure. Have your cholesterol checked at least once a year, and aim for these target levels, advises the ADA:
LDL cholesterol:    below 100 mg/dL
HDL cholesterol:    above 40 mg/dL for men
above 50 for women
Triglycerides:    below 150 mg/dL
Keep in mind that these are general guidelines; check with your doctor to see if your target levels are different, given your medical condition.

8. You Have High Blood Pressure.

The risk: High blood pressure, or hypertension, increases your risk of diabetic neuropathy. As many as two out of three adults with diabetes have high blood pressure, increasing their risk of heart disease and stroke.

What you can do: Some people can manage high blood pressure with diet and exercise alone; others need medication. For everyone with diabetes, the ADA advises keeping your blood pressure lower than 130/80 (“130 over 80″). This goal is lower than for the general population, since diabetic people have a higher risk of heart disease and stroke. If you can’t keep your blood pressure at this target with exercise and healthy eating, talk to your doctor about taking medications for better blood pressure control.

Quick review: Your blood sugar, weight, blood fats like cholesterol, blood pressure, smoking, and drinking. That’s six of the eight risk factors for diabetic neuropathy that are under your control. Not bad. Now if medicine can just come up with a “cure” for aging …

In six weeks of study, the 76-year-old female and male high cholesterol, aged25 79, complete 73 low-fat diet before the baseline. In the beginning of the trial, participants were randomly assigned to the test results of the treatment group and control group of blood and other or cardiovascular disease markers. During the study, the test group gives three and five grams of low molecular weight (LMW) or high molecular weight (HMW) barley glucan (twice daily, then in cereal and juice.

Posttreatment assessment of blood lipids and other CVD biomarkers revealed improvements in low-density lipoprotein (LDL) cholesterol, triglycerides, markers of glycemic control

(glycosylated hemoglobin, HOMA model) and a key marker of inflammation(hs-CRP).

The researchers concluded both doses of LMW and HMW barley beta-glucan improved blood lipids over a six-week treatment period.

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