Peptic ulcer disease (also known as PUD) occurs when the strong acids and digestive juices normally present in the stomach damage the inside of the stomach or small intestine. This can happen when the protective mucus layer wears away in certain areas, causing ulcers (sores or lesions). There are two main types of peptic ulcers, named according to their location:
Gastric ulcers are sores in the stomach. This type of ulcer occurs equally among men and women and develops most commonly between the ages of 55 and 65. Pain from gastric ulcers is usually worst after eating a meal. Antacids can relieve the pain of gastric ulcers.
Duodenal ulcers occur in the upper part of the small intestine, called the duodenum. This type of ulcer was once more common in men, but is now equally prevalent in both genders. It is more common with age. Pain from duodenal ulcers typically occurs when the stomach is empty (e.g., at night or between meals). It may last a number of weeks and then temporarily go away. Food and antacids can often relieve this kind of pain.
The most common symptom of PUD is a gnawing or burning pain in the abdomen, between the breastbone and navel, sometimes passed off as "heartburn." An ulcer can also feel like a dull ache or strong hunger pangs with belching and bloating. The pain may be worse when you are hungry and may improve with a small meal. More serious PUD (typically poorly treated or untreated PUD) can lead to nausea, vomiting, lack of appetite, weight loss, bloody vomit, or black, tarry stools. Some people, especially the elderly, may not feel any pain from an ulcer. Other medical conditions, including gastroesophageal reflux disease (GERD) and cancers of the stomach or esophagus, can also cause similar symptoms.
Over 3 million Canadians have diabetes. It is the leading cause of blindness in North Americans under 65 years of age. Diabetes is a condition where the body either cannot produce enough insulin (type 1 diabetes) or cannot respond properly to insulin (type 2 diabetes). Insulin is important because it moves glucose, a simple sugar, into the body's cells from the blood. Glucose, which is used by the cells as a source of energy, comes from the food people eat . If insulin isn't available or doesn't work correctly to move glucose from the blood into cells, glucose will stay in the blood, leading to high blood sugar levels.
High blood sugar levels damage the blood vessels, including the tiny blood vessels in the eye. This leads to an eye disease known as diabetic retinopathy. The retina is an area at the back of the eye that changes light into nerve signals. With diabetic retinopathy, some blood vessels in the retina are lost, and some of the other blood vessels begin to "leak" blood. This causes the retina to swell, and gradually cuts off its supply of oxygen and nutrients. Eventually, the retina starts to grow new blood vessels to replace the damaged ones. Unfortunately, these new vessels are not as strong as the old ones and are more likely to break, causing bleeding in the eye.
At first, people with diabetic retinopathy will not notice any symptoms. As the disease gets worse, they may notice blurred vision, black spots or flashing lights. Eventually, it can progress to blindness. Everyone with diabetes is at risk for diabetic retinopathy, and the risk increases the longer you've had diabetes.
Fortunately, you can reduce your risk. If you do not have diabetes, but think you may be at risk for this condition, visit your doctor to be screened for diabetes. If you do have diabetes:
Have frequent eye check-ups:
People with type 1 diabetes who are 15 years of age and older should have an eye check-up every year, starting 5 years after they are diagnosed with diabetes.
People with type 2 diabetes should have an eye check-up every 1 to 2 years, starting as soon as they are diagnosed.
Pregnant women with diabetes are especially at risk. They should have an eye check-up while they are planning a pregnancy, during the first trimester, as needed during pregnancy, and within the first year after the baby is born.
Make sure you monitor your blood sugar frequently and use your medications as recommended by your doctor. There is evidence that keeping your blood sugar under tight control can slow down eye damage.
If you have high blood pressure, follow your recommended diet and medications to keep it under control. If you are not sure whether you have high blood pressure, or whether your blood pressure is under control, discuss this with your doctor.
If you begin to develop diabetic retinopathy, there are treatments that can slow down the damage, although they do not cure the condition. Laser surgery is used to seal "leaky" blood vessels in the eye and prevent new ones from forming. Vitrectomy is used for people who have a lot of bleeding in the eye. The cloudy eye fluid is replaced by a salt solution to improve the sight.
The Canadian Diabetes Association (CDA) recommends that people with diabetes who are using insulin more than once a day should self-monitor their blood glucose levels at least 3 times a day. The CDA also recommends that people with type 2 diabetes who use insulin once a day should test their blood glucose levels once a day at different times of day. People with type 2 diabetes who are not using insulin should speak to their physician or primary health care provider about how often they should test. The frequency of monitoring depends on your treatments and how well your blood sugar is controlled.
A blood glucose meter is used to test blood glucose at home and to determine whether blood glucose levels are in the target range. Meters can be obtained at most pharmacies. Testing glucose levels helps put the person with diabetes in control and be more active in managing their condition. Using blood glucose meters to determine the effects of certain foods on blood glucose levels can also help a person with diabetes to choose appropriate foods more carefully.
A person with diabetes should talk with their diabetes educator or pharmacist about which model of glucose meter is appropriate for them. Anyone using a glucose meter should receive proper training so that they can test their blood glucose levels properly.
Ask a diabetes educator about:
the size of the drop of blood needed
the type of blood glucose strips to use
how to check if the meter is accurate (the meter should be checked at least once a year)
how to code the meter
how to clean the meter
If a person with diabetes experiences symptoms of hypoglycemia (i.e., low blood glucose), they should check their blood glucose immediately. If a meter is not immediately available, the symptoms should still be treated with the following guidelines:
Eat or drink a fast-acting carbohydrate (15 g):
3 to 5 glucose tablets (the exact amount will depend on the glucose content per tablet of the brand you have; check to make sure you are aware of this amount and take enough to make up 15 g of glucose)
¾ cup (175 mL) of orange juice or regular soft drink
6 Life Savers®
1 tablespoon (15 mL) of honey
3 teaspoons (15 mL) or 3 packets of table sugar dissolved in water
Wait 15 minutes, then check blood glucose again. If it is still low, treat again (repeat step 1).
Once the hypoglycemia has been reversed, if the next meal is more than one hour away, or if the person is going to be active, they should eat a snack, such as a half-sandwich or cheese and unsalted crackers (something with 15 g of carbohydrate and a protein source).
Certain people at risk of hypoglycemia may be advised by their doctor to carry a prefilled 1 mg glucagon injection and make it readily available for emergency situations. This medication is intended to increase blood glucose levels rapidly.
Do-it-yourself tests for ketones are useful during times of illness. Ketones are potentially dangerous acids that build up in your blood when you lack insulin. Ketone buildup is much more common if you have type 1 diabetes. Talk to your doctor or primary health care provider about how to test for ketones.