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Hydraulic Fracturing & Health

Hydraulic fracturing, or fracking, is a method used to extract natural gas and oil from deep rock formations known as shale. Using this method, drilling operators force water, sand, and a mix of chemicals into horizontally drilled wells, causing the shale to crack and release natural gas or oil.

Hydraulic fracturing is one part of a broader process known as unconventional natural gas development, which refers to all operations associated with fracked wells, from well construction to the transport of gas and oil off the site.

Does hydraulic fracturing pose health risks to the people living near drilling sites?

Although research is underway, few studies to date have provided conclusive evidence about how unconventional natural gas development affects the health of nearby communities. Residents, environmental advocates, and some researchers have expressed concerns about potential health effects and environmental impacts on water and air in their communities.

More than two decades since the rapid expansion of unconventional natural gas extraction, researchers are now beginning to grasp the scope and extent of associated health effects and related costs. Mounting evidence related to environmental effects shows a need to analyze and quantify health and socioeconomic impacts using a common metric

Water quality

In some cases, it may be possible for natural gas and hydraulic fracturing-associated chemicals to travel through cracks in the rock into an underground drinking water source. Water contamination could also occur if a well is improperly installed, if chemicals are spilled from trucks or tanks, or if flowback is not effectively contained. Flowback is when water used in the hydraulic fracturing process flows out of the well. The extent of water contamination from these sources is currently unknown.

Air quality

Drilling sites can potentially affect local air quality in several ways. First, any process involving combustion can release toxic chemicals into the air. For example, the burning off, or flaring, of excess natural gas; the operation of heavy equipment at the well site; and the use of diesel trucks to transport materials to and from a site may all contribute to air pollution. In addition, the chemicals and sand used in the hydraulic fracturing process, as well as other chemicals that surface with the natural gas, may potentially become airborne and affect air quality.

Since operators are not always required to divulge the specific chemicals used, the extent of air pollution and the potential dangers to local communities are not well understood.

Community impacts

The changes associated with building and having a drilling site can have numerous impacts on community well-being. Some of these impacts may be positive. For example, a drilling operation can increase local employment rates, and result in greater access to health care. Drilling-associated activities, and a sudden influx of a large transient workforce, can also have negative impacts on a community. These may include increased noise, light, and traffic; heavier burdens on local infrastructure and resources, such as roads and hospitals; higher rates of crime and substance abuse; and changes to community character.

Are there health risks to the people who work at drilling sites?

Most of what is known about the health risks from unconventional natural gas development comes from studies of workers at these sites. While studies of worker exposures and health are limited, ongoing efforts continue to gather important insights. Currently, three hydraulic fracturing-specific health risks have been identified, in addition to risks, such as accidents, that are often associated with industrial occupations involving the use of heavy equipment.

1. Silica sand inhalation: Without proper protection, workers may inhale fine particles of silica sand, the type of sand used in the hydraulic fracturing process. Inhaling these particles can cause lung diseases.

2. Exposure to chemical spills: Accidental chemical spills may expose workers to compounds used in the hydraulic fracturing process, presenting a variety of health risks.

3. Exposure from flowback operations: Initial field studies suggest that workers performing certain operations may be exposed to high levels of volatile hydrocarbons, which can be acutely toxic. Exposures have resulted in the deaths of at least four workers involved in flowback operations, since 2010.

Indoor Air Quality

Indoor Air Quality

We tend to think of air pollution as a risk faced outside, but the air we breathe indoors can also be polluted. Smoke, vapors, mold, and chemicals used in certain paints, furnishings, and cleaners can all affect indoor air quality and our health.

Buildings affect overall well-being because most people spend most of their time inside. The U.S. Environmental Protection Agency estimates Americans are indoors 90% of their time –in built environments such as homes, schools, workplaces, places of worship, or gyms.

Environmental health researchers study how indoor air quality affects human health and well-being. Studies suggest that indoor concentrations of air pollutants are increasing, driven by factors such as the types of chemicals in home products, inadequate ventilation, hotter temperatures, and higher humidity.

Indoor air quality is a global issue. Both short- and long-term exposure to indoor air pollution can cause a range of health issues, including respiratory diseases, heart disease, cognitive deficits, and cancer. As one prominent example, the World Health Organization estimates 3.8 million people (https://www.who.int/health-topics/air-pollution#tab=tab_3) worldwide die every year from illnesses attributable to harmful indoor air from dirty cookstoves and fuel.

Certain populations may be affected more than others. Children, older adults, individuals with preexisting conditions, Native Americans, and households of low socioeconomic status are often exposed to higher levels of indoor pollutants

Types of Pollutants

Many factors contribute to poor indoor air quality. Indoor air includes pollutants that penetrate from the outdoors, as well as sources that are unique to the indoor environment. These sources involve:

  • Human activities within buildings, such as smoking, burning solid fuels, cooking, and cleaning.
  • Vapors from building and construction materials, equipment, and furniture.
  • Biological contaminants, such as mold, viruses, or allergens.

Some contaminants are described below:

  • Allergens (https://www.nih.gov/health/topics/agents/allergens/index.cfm) are substances that can trigger the immune system, causing an allergic reaction; they can circulate in air and remain on carpets and furniture for months.
  • Asbestos is a fibrous material formerly used for making incombustible or fireproof building materials, such as roof shingles, siding, and insulation.
  • Disturbing asbestos minerals or asbestos-containing materials can release fibers, often too small to see, into the air. Asbestos is known to be a human carcinogen.
  • Carbon monoxide is an odorless and toxic gas. It is found in fumes produced any time you burn fuel in cars or trucks, small engines, stoves, lanterns, grills, fireplaces, gas ranges, or furnaces. Proper venting or exhaust systems prevent build up in the air.
  • Formaldehyde (https://www.nih.gov/health/topics/agents/formaldehyde/index.cfm) is a strong-smelling chemical found in some pressed wood furniture, wood particle cabinets, flooring, carpets, and fabrics. It can also be a component of some glues, adhesives, paints, and coating products. Formaldehyde is known to be a human carcinogen.
  • Lead (https://www.nih.gov/health/topics/agents/lead/index.cfm) is a naturally occurring metal that has been used in a wide variety of products including gasoline, paint, plumbing pipes, ceramics, solders, batteries, and even cosmetics.
  • Mold (https://www.nih.gov/health/topics/agents/mold/index.cfm) is a microorganism and type of fungus that thrives in damp places; different molds are found everywhere, indoors and outside.
  • Pesticides (https://www.nih.gov/health/topics/agents/pesticides/index.cfm) are substances used to kill, repel, or control certain forms of plants or bugs that are considered to be pests.
  • Radon (https://www.nih.gov/health/topics/agents/radon/index.cfm) is a colorless, odorless, naturally occurring gas that comes from the decay of radioactive elements in soils. It can enter indoor spaces through cracks or gaps in buildings. Most exposures occur inside homes, schools, and workplaces. EPA estimates radon is responsible for about 21,000 U.S. deaths from lung cancer annually
  • Smoke (https://www.nih.gov/health/topics/agents/allergens/smoke/index.cfm) , a byproduct of combustion processes, such as from cigarettes, cookstoves, and wildfires, contains toxic chemicals like formaldehyde and lead.

Respiratory Disease

  • Actions to reduce mold exposure in early life may have long-term health benefits, potentially decreasing prevalence and severity of asthma.
  • Among inner-city children with asthma who live in homes with high levels of indoor air pollution, those children with sufficient vitamin D levels had fewer symptoms.
  • Household air pollution exposure likely affects lung development prenatally. Indoor air pollution exposure during pregnancy was associated with impaired lung function in infants. This altered infant lung function may then increase risk for pneumonia in the first year of life.
  • Outdoor air quality can affect indoor air. Air pollution levels have been trending downward over several decades in southern California, due to air quality-control policies. These improvements in air quality are associated with improved lung development in children.
  • The school environment contributes to childhood asthma illness. A study found that airborne mouse allergens in inner-city schools are linked to increased symptoms and decreased lung function in asthmatic children. School-based environmental interventions may be beneficial for curbing the public health problem of childhood asthma.

Cardiovascular Disease

A study partially supported by NIEHS found that markers of cardiovascular disease risk appear when ozone levels are even lower than current EPA air quality standards. In healthy adults, exposure to short-term indoor and outdoor ozone was linked to increased blood platelets, a risk factor for clotting, and increased blood pressure.

Cognitive Effects
  • Indoor exposures to air pollutants, including particulate matter, allergens, oxides of nitrogen, endotoxin, and mold, have been associated with impaired health and performance in children and adults
  • Characterization of indoor air pollution in schools is a public health concern for children, given the large amount of time spent there. Some inner-city schools exceeded WHO guidelines for interior air quality, particularly for nitric oxide, an indoor air pollutant that can affect cognitive outcomes, verbal abilities, and executive functioning. Physical defects and lack of proper ventilation contributed to the poor air quality in schools. The results suggest that improving building conditions and facilities, as well as consideration of the school’s outdoor surroundings, could create healthier environments.
  • Office workers scored higher on performance measures when working in “green” environments with low indoor pollutants and low carbon dioxide levels.
  • The air quality within an office can affect employees’ cognitive function, including response times and ability to focus, and it may also affect their productivity, according to NIEHS-funded research led by Harvard T.H. Chan School of Public Health.
  • Cancer Long-term exposure to radon and other indoor air substances that increase the chance of developing lung cancer include secondhand smoke, asbestos, arsenic, and some forms of silica and chromium.
  • Indoor air contaminants, such as the carcinogen formaldehyde, exceed acceptable levels in some early childhood learning centers

Symptoms & Causes of Diabetes

Diabetes occurs when your blood glucose, also called blood sugar, is too high. High blood glucose can cause health problems over time. The main types of diabetes are type 1, type 2, and gestational.

What are the symptoms of diabetes?

Symptoms of diabetes include

  • increased thirst and urination
  • increased hunger
  • fatigue
  • blurred vision
  • numbness or tingling in the feet or hands
  • sores that do not heal
  • unexplained weight loss

Symptoms of type 1 diabetes can start quickly, in a matter of weeks. Symptoms of type 2 diabetes often develop slowly—over the course of several years—and can be so mild that you might not even notice them. Many people with type 2 diabetes have no symptoms. Some people do not find out they have the disease until they have diabetes-related health problems, such as blurred vision or heart trouble.

What causes type 1 diabetes?

Type 1 diabetes occurs when your immune system, the body’s system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type 1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the disease. Studies such as TrialNet are working to pinpoint causes of type 1 diabetes and possible ways to prevent or slow the disease.

What causes type 2 diabetes?

Type 2 diabetes—the most common form of diabetes—is caused by several factors, including lifestyle factors and genes.

Overweight, obesity, and physical inactivity

You are more likely to develop type 2 diabetes if you are not physically active and are overweight or obese. Extra weight sometimes causes insulin resistance and is common in people with type 2 diabetes. The location of body fat also makes a difference. Extra belly fat is linked to insulin resistance, type 2 diabetes, and heart and blood vessel disease.

Insulin resistance

Type 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin well. As a result, your body needs more insulin to help glucose enter cells. At first, the pancreas makes more insulin to keep up with the added demand. Over time, the pancreas can’t make enough insulin, and blood glucose levels rise.

Genes and family history

As in type 1 diabetes, certain genes may make you more likely to develop type 2 diabetes. The disease tends to run in families and occurs more often in these racial/ethnic groups:

  • African Americans
  • Alaska Natives
  • American Indians
  • Asian Americans
  • Hispanics/Latinos
  • Native Hawaiians
  • Pacific Islanders

Genes also can increase the risk of type 2 diabetes by increasing a person’s tendency to become overweight or obese.

What causes gestational diabetes?

Scientists believe gestational diabetes, a type of diabetes that develops during pregnancy, is caused by the hormonal changes of pregnancy along with genetic and lifestyle factors.

Insulin resistance

Hormones produced by the placenta contribute to insulin resistance, which occurs in all women during late pregnancy. Most pregnant women can produce enough insulin to overcome insulin resistance, but some cannot. Gestational diabetes occurs when the pancreas can’t make enough insulin.

As with type 2 diabetes, extra weight is linked to gestational diabetes. Women who are overweight or obese may already have insulin resistance when they become pregnant. Gaining too much weight during pregnancy may also be a factor.

Genes and family history

Having a family history of diabetes makes it more likely that a woman will develop gestational diabetes, which suggests that genes play a role. Genes may also explain why the disorder occurs more often in African Americans, American Indians, Asians, and Hispanics/Latinas.

What else can cause diabetes?

Genetic mutations, other diseases, damage to the pancreas, and certain medicines may also cause diabetes.

Genetic mutations

  • Monogenic diabetes is caused by mutations, or changes, in a single gene. These changes are usually passed through families, but sometimes the gene mutation happens on its own. Most of these gene mutations cause diabetes by making the pancreas less able to make insulin. The most common types of monogenic diabetes are neonatal diabetes and maturity-onset diabetes of the young (MODY). Neonatal diabetes occurs in the first 6 months of life. Doctors usually diagnose MODY during adolescence or early adulthood, but sometimes the disease is not diagnosed until later in life.
  • Cystic fibrosis produces thick mucus that causes scarring in the pancreas. This scarring can prevent the pancreas from making enough insulin.
  • Hemochromatosis causes the body to store too much iron. If the disease is not treated, iron can build up in and damage the pancreas and other organs.

Hormonal diseases

Some hormonal diseases cause the body to produce too much of certain hormones, which sometimes cause insulin resistance and diabetes.

  • Cushing’s syndrome occurs when the body produces too much cortisol—often called the “stress hormone.”
  • Acromegaly occurs when the body produces too much growth hormone.
  • Hyperthyroidism occurs when the thyroid gland produces too much thyroid hormone.

Damage to or removal of the pancreas

Pancreatitis, pancreatic cancer, and trauma can all harm the beta cells or make them less able to produce insulin, resulting in diabetes. If the damaged pancreas is removed, diabetes will occur due to the loss of the beta cells occur due to the loss of the beta cells.

Medicines

Sometimes certain medicines can harm beta cells or disrupt the way insulin works. These include

  • niacin, a type of vitamin B3
  • certain types of diuretics, also called water pills
  • anti-seizure drugs
  • psychiatric drugs
  • drugs to treat human immunodeficiency virus (HIV )
  • pentamidine, a drug used to treat a type of pneumonia
  • glucocorticoids—medicines used to treat inflammatory illnesses such as rheumatoid arthritis, asthma, lupus, and ulcerative colitis
  • anti-rejection medicines, used to help stop the body from rejecting a transplanted organ

Statins, which are medicines to reduce LDL (“bad”) cholesterol levels, can slightly increase the chance that you’ll develop diabetes. However, statins help protect you from heart disease and stroke. For this reason, the strong benefits of taking statins outweigh the small chance that you could develop diabetes.

If you take any of these medicines and are concerned about their side effects, talk with your Doctor.

Source: https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes

What is Diabetes?

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

Over time, having too much glucose in your blood can cause health problems. Although diabetes has no cure, you can take steps to manage your diabetes and stay healthy.

Sometimes people call diabetes “a touch of sugar” or “borderline diabetes.” These terms suggest that someone doesn’t really have diabetes or has a less serious case, but every case of diabetes is serious.

What are the different types of diabetes?

The most common types of diabetes are type 1, type 2, and gestational diabetes.

Type 1 diabetes

If you have type 1 diabetes, your body does not make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive.

Type 2 diabetes

If you have type 2 diabetes, your body does not make or use insulin well. You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Type 2 is the most common type of diabetes.

Gestational diabetes

Gestational diabetes develops in some women when they are pregnant. Most of the time, this type of diabetes goes away after the baby is born. However, if you’ve had gestational diabetes, you have a greater chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes.

Other types of diabetes

Less common types include monogenic diabetes, which is an inherited form of diabetes, and cystic fibrosis-related diabetes

How common is diabetes?

As of 2015, 30.3 million people in the United States, or 9.4 percent of the population, had diabetes. More than 1 in 4 of them didn’t know they had the disease. Diabetes affects 1 in 4 people over the age of 65. About 90-95 percent of cases in adults are type 2 diabetes.

Who is more likely to develop type 2 diabetes?

You are more likely to develop type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight. Physical inactivity, race, and certain health problems such as high blood pressure also affect your chance of developing type 2 diabetes. You are also more likely to develop type 2 diabetes if you have prediabetes or had gestational diabetes when you were pregnant.

What health problems can people with diabetes develop?

Over time, high blood glucose leads to problems such as

  • heart disease
  • stroke
  • kidney disease
  • eye problems
  • dental disease
  • nerve damage
  • foot problems

Source: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes

Managing Diabetes

You can manage your diabetes and live a long and healthy life by taking care of yourself each day. Diabetes can affect almost every part of your body. Therefore, you will need to manage your blood glucose levels, also called blood sugar. Managing your blood glucose, as well as your blood pressure and cholesterol, can help prevent the health problems that can occur when you have diabetes.

Manage your diabetes ABCs

Knowing your diabetes ABCs will help you manage your blood glucose, blood pressure, and cholesterol. Stopping smoking if you smoke will also help you manage your diabetes. Working toward your ABC goals can help lower your chances of having a heart attack, stroke, or other diabetes problems.

A for the A1C test

The A1C test shows your average blood glucose level over the past 3 months. The A1C goal for many people with diabetes is below 7 percent. Ask your health care team what your goal should be.

B for Blood pressure

The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask what your goal should be.

C for Cholesterol

You have two kinds of cholesterol in your blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog your blood vessels. Too much bad cholesterol can cause a heart attack or stroke. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels.

Ask your health care team what your cholesterol numbers should be. If you are over 40 years of age, you may need to take a statin drug for heart health.

S for Stop smoking

Not smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Blood vessel narrowing makes your heart work harder. E-cigarettes aren’t a safe option either.

If you quit smoking

  • you will lower your risk for heart attack, stroke, nerve disease, kidney disease, diabetic eye disease, and amputation
  • your cholesterol and blood pressure levels may improve
  • your blood circulation will improve
  • you may have an easier time being physically active

Follow your diabetes meal plan

Make a diabetes meal plan with help from your health care team. Following a meal plan will help you manage your blood glucose, blood pressure, and cholesterol.

Choose fruits and vegetables, beans, whole grains, chicken or turkey without the skin, fish, lean meats, and nonfat or low-fat milk and cheese. Drink water instead of sugar-sweetened beverages. Choose foods that are lower in calories, saturated fat, trans fat, sugar, and salt.

Make physical activity part of your daily routine

Set a goal to be more physically active. Try to work up to 30 minutes or more of physical activity on most days of the week.

Brisk walking and swimming are good ways to move more. If you are not active now, ask your health care team about the types and amounts of physical activity that are right for you.

Following your meal plan and being more active can help you stay at or get to a healthy weight. If you are overweight or obese, work with your health care team to create a weight-loss plan that is right for you.

Take your medicine

Take your medicines for diabetes and any other health problems, even when you feel good or have reached your blood glucose, blood pressure, and cholesterol goals. These medicines help you manage your ABCs. Ask your doctor if you need to take aspirin to prevent a heart attack or stroke. Tell your health care professional if you cannot afford your medicines or if you have any side effects from your medicines.

Check your blood glucose levels

For many people with diabetes, checking their blood glucose level each day is an important way to manage their diabetes. Monitoring your blood glucose level is most important if you take insulin. The results of blood glucose monitoring can help you make decisions about food, physical activity, and medicines.

The most common way to check your blood glucose level at home is with a blood glucose meter. You get a drop of blood by pricking the side of your fingertip with a lancet. Then you apply the blood to a test strip. The meter will show you how much glucose is in your blood at the moment.

Ask your health care team how often you should check your blood glucose levels. Make sure to keep a record of your blood glucose self-checks.

What is continuous glucose monitoring?

Continuous glucose monitoring (CGM) is another way to check your glucose levels. Most CGM systems use a tiny sensor that you insert under your skin. The sensor measures glucose levels in the fluids between your body’s cells every few minutes and can show changes in your glucose level throughout the day and night. If the CGM system shows that your glucose is too high or too low, you should check your glucose with a blood glucose meter before making any changes to your eating plan, physical activity, or medicines. A CGM system is especially useful for people who use insulin and have problems with low blood glucose.

What are the recommended targets for blood glucose levels?

Many people with diabetes aim to keep their blood glucose at these normal levels:

  • Before a meal: 80 to 130 mg/dL
  • About 2 hours after a meal starts: less than 180 mg/dL

Talk with your health care team about the best target range for you. Be sure to tell your health care professional if your glucose levels often go above or below your target range.

What happens if my blood glucose level becomes too low?

Sometimes blood glucose levels drop below where they should be, which is called hypoglycemia. For most people with diabetes, the blood glucose level is too low when it is below 70 mg/dL.

Hypoglycemia can be life threatening and needs to be treated right away.

What happens if my blood glucose level becomes too high?

Doctors call high blood glucose hyperglycemia.

Symptoms that your blood glucose levels may be too high include:

  • feeling thirsty
  • feeling tired or weak
  • Headaches
  • urinating often
  • blurred vision

If you often have high blood glucose levels or symptoms of high blood glucose, talk with your health care team. You may need a change in your diabetes meal plan, physical activity plan, or medicines.

Know when to check for ketones

Your doctor may want you to check your urine for ketones if you have symptoms of diabetic ketoacidosis. When ketone levels get too high, you can develop this life-threatening condition. Symptoms include

  • trouble breathing
  • nausea or vomiting
  • pain in your abdomen
  • confusion
  • feeling very tired or sleepy

Ketoacidosis most often is a problem for people with type 1 diabetes.

Work with your health care team

Most people with diabetes get health care from a primary care professional. Primary care professionals include internists, family physicians, and pediatricians. Sometimes physician assistants and nurses with extra training, called nurse practitioners, provide primary care. You also will need to see other care professionals from time to time. A team of health care professionals can help you improve your diabetes self-care. Remember, you are the most important member of your health care team.

Besides a primary care professional, your health care team may include

  • an endocrinologist for more specialized diabetes care
  • a registered dietitian, also called a nutritionist
  • a nurse
  • a certified diabetes educator
  • a pharmacist
  • a dentist
  • an eye doctor
  • a podiatrist, or foot doctor, for foot care
  • a social worker, who can help you find financial aid for treatment and community resources
  • a counselor or other mental health care professional

When you see members of your health care team, ask questions. Write a list of questions you have before your visit so you don’t forget what you want to ask.

You should see your health care team at least twice a year, and more often if you are having problems or are having trouble reaching your blood glucose, blood pressure, or cholesterol goals. At each visit, be sure you have a blood pressure check, foot check, and weight check; and review your self-care plan. Talk with your health care team about your medicines and whether you need to adjust them. Routine health care will help you find and treat any health problems early, or may be able to help prevent them.

Talk with your doctor about what vaccines you should get  to keep from getting sick, such as a flu shot and pneumonia shot. Preventing illness is an important part of taking care of your diabetes. Your blood glucose levels are more likely to go up when you’re sick or have an infection.

Cope with your diabetes in healthy ways

Feeling stressed, sad, or angry is common when you live with diabetes. Stress can raise your blood glucose levels, but you can learn ways to lower your stress. Try deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music. Consider taking part in a diabetes education program or support group that teaches you techniques for managing stress.

Depression is common among people with a chronic, or long-term, illness. Depression can get in the way of your efforts to manage your diabetes. Ask for help if you feel down. A mental health counselor, support group, clergy member, friend, or family member who will listen to your feelings may help you feel better.

Try to get 7 to 8 hours of sleep each night. Getting enough sleep can help improve your mood and energy level. You can take steps to improve your sleep habits. If you often feel sleepy during the day, you may have obstructive sleep apnea, a condition in which your breathing briefly stops many times during the night. Sleep apnea is common in people who have diabetes. Talk with your health care team if you think you have a sleep problem.

Remember, managing diabetes isn’t easy, but it’s worth it.

Source: https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes

Insulin, Medicines, & Other Diabetes Treatments

Diabetes Treatments

The medicine you take will vary by your type of diabetes and how well the medicine controls your blood glucose levels, also called blood sugar. Other factors, such as your other health conditions, medication costs, and your daily schedule may play a role in what diabetes medicine you take.

Type 1 diabetes

If you have type 1 diabetes, you must take insulin because your body no longer makes this hormone. You will need to take insulin several times during the day, including with meals. You also could use an insulin pump, which gives you small, steady doses throughout the day.

Type 2 diabetes

Some people with type 2 diabetes can manage their disease by making healthy food choices and being more physically active. Many people with type 2 diabetes need diabetes medicines as well. These medicines may include diabetes pills or medicines you inject under your skin, such as insulin. In time, you may need more than one diabetes medicine to control your blood glucose. Even if you do not take insulin, you may need it at special times, such as during pregnancy or if you are in the hospital.

Gestational diabetes

If you have gestational diabetes, you should first try to control your blood glucose level by making healthy food choices and getting regular physical activity. If you can’t reach your blood glucose target, your health care team will talk with you about diabetes medicines, such as insulin or the diabetes pill metformin, that may be safe for you to take during pregnancy. Your health care team may start you on diabetes medicines right away if your blood glucose is very high.

What are the different types of insulin?

Several types of insulin are available. Each type starts to work at a different speed, known as “onset,” and its effects last a different length of time, known as “duration.” Most types of insulin reach a peak, which is when they have the strongest effect. Then the effects of the insulin wear off over the next few hours or so.

Types of Insulin and How They Work

Insulin typeHow fast it starts to work (onset)When it peaksHow long it lasts(duration)
Rapid-actingAbout 15 minutes afterinjection1 hour2 to 4 hours
Short-acting, alsocalled regularWithin 30 minutes afterinjection2 to 3 hours3 to 6 hours
Intermediate-acting2 to 4 hours afterinjection4 to 12 hours12 to 18 hours
Long-actingSeveral hours after injectionDoes not peak24 hours; some lastlonger

The chart above gives averages. Follow your doctor’s advice on when and how to take your insulin. Your doctor might also recommend premixed insulin, which is a mix of two types of insulin. Some types of insulin cost more than others, so talk with your doctor about your options if you’re concerned about cost. Read about financial help for diabetes care.

What are the different ways to take insulin?

The way you take insulin may depend on your lifestyle, insurance plan, and preferences. You may decide that needles are not for you and prefer a different method. Talk with your doctor about the options and which is best for you. Most people with diabetes use a needle and syringe, pen, or insulin pump. Inhalers, injection ports, and jet injectors are less common.

Insulin shots involve drawing insulin from a vial into a syringe and then injecting it under your skin.

Needle and syringe

You’ll give yourself insulin shots using a needle and syringe. You will draw up your dose of insulin from the vial, or bottle, into the syringe. Insulin works fastest when you inject it in your belly, but you should rotate spots where you inject insulin. Other injection spots include your thigh, buttocks, or upper arm. Some people with diabetes who take insulin need two to four shots a day to reach their blood glucose targets. Others can take a single shot.

Pen

An insulin pen looks like a pen but has a needle for its point. Some insulin pens come filled with insulin and are disposable. Others have room for an insulin cartridge that you insert and then replace after use. Insulin pens cost more than needles and syringes but many people find them easier to use. An insulin pen is a convenient way to take insulin

Pump

An insulin pump is a small machine that gives you small, steady doses of insulin throughout the day. You wear one type of pump outside your body on a belt or in a pocket or pouch. The insulin pump connects to a small plastic tube and a very small needle. You insert the needle under your skin and it stays in place for several days. Insulin then pumps from the machine through the tube into your body 24 hours a day. You also can give yourself doses of insulin through the pump at mealtimes. Another type of pump has no tubes and attaches directly to your skin, such as a self-adhesive pod. Insulin pumps deliver insulin 24 hours a day.

Inhaler

Another way to take insulin is by breathing powdered insulin from an inhaler device into your mouth. The insulin goes into your lungs and moves quickly into your blood. Inhaled insulin is only for adults with type 1 or type 2 diabetes.

Injection port

An injection port has a short tube that you insert into the tissue beneath your skin. On the skin’s surface, an adhesive patch or dressing holds the port in place. You inject insulin through the port with a needle and syringe or an insulin pen. The port stays in place for a few days, and then you replace the port. With an injection port, you no longer puncture your skin for each shot—only when you apply a new port.

Jet injector

This device sends a fine spray of insulin into the skin at high pressure instead of using a needle to deliver the insulin.

What oral medicines treat type 2 diabetes?

You may need medicines along with healthy eating and physical activity habits to manage your type 2 diabetes. You can take many diabetes medicines by mouth. These medicines are called oral medicines.

Most people with type 2 diabetes start medical treatment with metformin pills.

Metformin also comes as a liquid. Metformin lowers the amount of glucose that your liver makes and helps your body use insulin better. This drug may help you lose a small amount of weight.

Other oral medicines act in different ways to lower blood glucose levels. You may need to add another diabetes medicine after a while or use a combination treatment. Combining two or three kinds of diabetes medicines can lower blood glucose levels more than taking just one.

What other injectable medicines treat type 2 diabetes?

Besides insulin, other types of injected medicines are available. These medicines help keep your blood glucose level from going too high after you eat. They may make you feel less hungry and help you lose some weight. Other injectable medicines are not substitutes for insulin.

What should I know about side effects of diabetes medicines?

Side effects are problems that result from a medicine. Some diabetes medicines can cause hypoglycemia, also called low blood glucose, if you don’t balance your medicines with food and activity.

Ask your doctor whether your diabetes medicine can cause hypoglycemia or other side effects, such as upset stomach and weight gain. Take your diabetes medicines as your health care professional has instructed you, to help prevent side effects and diabetes problems.

Do I have other treatment options for my diabetes?

When medicines and lifestyle changes are not enough to manage your diabetes, a less common treatment may be an option. Other treatments include bariatric surgery for certain people with type 1 or type 2 diabetes, and an “artificial pancreas” and pancreatic islet transplantation for some people with type 1 diabetes.

Bariatric surgery

Also called weight-loss surgery or metabolic surgery, bariatric surgery may help some people with obesity and type 2 diabetes lose a large amount of weight and regain normal blood glucose levels. Some people with diabetes may no longer need their diabetes medicine after bariatric surgery. Whether and for how long blood glucose levels improve seems to vary by the patient, type of weight-loss surgery, and amount of weight the person loses. Other factors include how long someone has had diabetes and whether or not the person uses insulin.

Recent research suggests that weight-loss surgery also may help improve blood glucose control in people with type 1 diabetes who are obese.

Artificial Pancreas

The NIDDK has played an important role in developing “artificial pancreas” technology. An artificial pancreas replaces manual blood glucose testing and the use of insulin shots or a pump. A single system monitors blood glucose levels around the clock and provides insulin or a combination of insulin and a second hormone, glucagon, automatically. The system can also be monitored remotely, for example by parents or medical staff.

In 2016, the FDA approved a type of artificial pancreas system called a hybrid closed-loop system. This system tests your glucose level every 5 minutes throughout the day and night, and automatically gives you the right amount of insulin.

You still need to manually adjust the amount of insulin the pump delivers at mealtimes. But, the artificial pancreas may free you from some of the daily tasks needed to keep your blood glucose stable—or help you sleep through the night without the need to wake and test your glucose or take medicine.

The hybrid closed-loop system is expected to be available in the U.S. in 2017. Talk with your health care provider about whether this system might be right for you.

The NIDDK has funded several important studies on different types of artificial pancreas devices to better help people with type 1 diabetes manage their disease. The devices may also help people with type 2 diabetes and gestational diabetes.

Pancreatic islet transplantation

Pancreatic islet transplantation is an experimental treatment for poorly controlled type 1 diabetes. Pancreatic islets are clusters of cells in the pancreas that make the hormone insulin. In type 1 diabetes, the body’s immune system attacks these cells. A pancreatic islet transplant replaces destroyed islets with new ones that make and release insulin. This procedure takes islets from the pancreas of an organ donor and transfers them to a person with type 1 diabetes. Because researchers are still studying pancreatic islet transplantation, the procedure is only available to people enrolled in research studies.

Source: https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments

Mercury poisoning

Mercury

Mercury is a metal that is toxic to living organisms. It exists in several forms, some of which occur naturally in the environment.

Metallic or elemental mercury – an odorless, shiny, silver- white liquid – is commonly used in thermometers, barometers and fluorescent light bulbs. Metallic mercury is extremely dangerous. A few drops can generate enough fumes to contaminate the air in a room. Furthermore, skin contact with mercury can result in its absorption into the blood stream and potential health problems.

Mercury poisoning may include the following symptoms:

  • Impairment of coordinated movements such as walking or writing
  • Impaired speech, hearing and peripheral vision
  • Mood swings and memory loss
  • Muscle weakness
  • Numbness and a “pins and needles” feeling in the hands, feet and sometimes around the mouth
  • Skin rashes

Methylmercury, one of the metal’s forms, can attach to small particles in the soil or water. From there, methylmercury can enter and accumulate in the food chain. For example, small fish may eat food containing methylmercury particles, and some of those particles remain in their tissues. When larger fish eat those smaller fish, most of the methylmercury originally in the small fish is then stored in the larger fish. Methylmercury is found in both freshwater and saltwater fish and marine mammals.

Source: https://www.niehs.nih.gov/health/topics/agents/mercury/index.cfm