Health ProMed Nursing Director Angel Rodriguez, Ruben Bras of the Puerto Rico Primary Care Association and other ProMed staffers quickly load Humulin R insulin into cold storage at the ProMed San Juan clinic. Humulin R is used to stabilize a patient’s blood sugar. The medicines from Direct Relief were critical after Hurricane Maria, with many patients battling stress and limited access to nutritious food. (Lara Cooper/Direct Relief)
This deluge of products alternately offered to fill attendees with energy or to calm us down, but almost never to keep us as we were. The implicit allure of such products was that we were not okay, or at least could be better. Given all the ways in which most people believe we could be improved, “wellness” has become an all-encompassing concept and industry that not only eats into the territory of mainstream medicine, but that has subsumed what used to be called “alternative medicine”—that which alludes to scientific claims when convenient and also defines itself in opposition to the scientific establishment.
Antidepressants most commonly treat depression. However, they can be prescribed for diabetic nerve pain because they interfere with chemicals in your brain that cause you to feel pain. Your doctor may recommend tricyclic antidepressants, such as amitriptyline, imipramine (Tofranil), and desipramine (Norpramin). These can cause unpleasant side effects like dry mouth, fatigue, and sweating.

The classic oral glucose tolerance test measures blood glucose levels five times over a period of three hours. Some physicians simply get a baseline blood sample followed by a sample two hours after drinking the glucose solution. In a person without diabetes, the glucose levels rise and then fall quickly. In someone with diabetes, glucose levels rise higher than normal and fail to come back down as fast.
Exposure to certain viral infections (mumps and Coxsackie viruses) or other environmental toxins may serve to trigger abnormal antibody responses that cause damage to the pancreas cells where insulin is made. Some of the antibodies seen in type 1 diabetes include anti-islet cell antibodies, anti-insulin antibodies and anti-glutamic decarboxylase antibodies. These antibodies can be detected in the majority of patients, and may help determine which individuals are at risk for developing type 1 diabetes.
Most universities and colleges have health centers that offer counseling services to enrolled students. You can take advantage of counseling services and/or medical services for stress and other areas of mental wellness. It’s in your best interest – and that of your patients – if you are the healthiest version of yourself. Find information on the health center at your dental school.

Electrical stimulation can sometimes block pain signals from traveling up the nerves. The most commonly used system is called TENS, which stands for transcutaneous electrical nerve stimulation. TENS works by sending electrical pulses across the surface of the skin into the nerves. The stimulating pulses help prevent pain signals from reaching the brain. They also help stimulate your body to produce higher levels of its own natural painkillers, called endorphins.


For over a decade, Cummings and others have tried to reframe the very concept of bariatric surgery (they prefer “metabolic surgery”). Their work has shown these procedures just don’t change how much food the stomach can fit; they trigger a cascade of metabolic and bodily changes, many of which help people with type 2 diabetes naturally get their blood sugar under control. Some changes even start happening before a patient loses weight, such as higher levels of peptide production in the gut that seem to restore a patient’s sensitivity to insulin.

For now, I manage my diabetes through a combination of technologies. I use a blood test meter to measure my glucose levels at least five times a day. I use a pump that is attached to my abdomen to deliver frequent doses of insulin throughout the day. And now I also use a continuous monitoring device that measures my subcutaneous blood sugar levels to help the insulin pump work more effectively.
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Nerve damage from diabetes is called diabetic neuropathy and is also caused by disease of small blood vessels. In essence, the blood flow to the nerves is limited, leaving the nerves without blood flow, and they get damaged or die as a result (a term known as ischemia). Symptoms of diabetic nerve damage include numbness, burning, and aching of the feet and lower extremities. When the nerve disease causes a complete loss of sensation in the feet, patients may not be aware of injuries to the feet, and fail to properly protect them. Shoes or other protection should be worn as much as possible. Seemingly minor skin injuries should be attended to promptly to avoid serious infections. Because of poor blood circulation, diabetic foot injuries may not heal. Sometimes, minor foot injuries can lead to serious infection, ulcers, and even gangrene, necessitating surgical amputation of toes, feet, and other infected parts.
Abnormal cholesterol and triglyceride levels. If you have low levels of high-density lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is higher. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know what your cholesterol and triglyceride levels are.
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