Diabetes

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Diabetes

With over 21 million Americans with type I or type II diabetes, and over 41 million with prediabetes, this disease is a rapidly evolving public health problem. Find out more about what causes diabetes as well as potential symptoms and signs to look for and other useful information about this serious disease.

Diabetes Overview

An estimated 21 million Americans have diabetes, a disease characterized by too much sugar in the bloodstream. Not all of them, however, have been diagnosed with the disease. If you have diabetes, you will want to learn as much as you can about how to take care of yourself. The better you eat and the more you exercise and keep your weight down, the more likely you will be able to lead a full and healthy life.

What causes diabetes? Both type I and type II diabetes occur when the pancreas, a gland behind the stomach, does not produce enough of the hormone called insulin. Insulin is the hormone necessary to carry sugar from the bloodstream into the cells. Once inside the cells, our body breaks down food, converting it into energy for immediate use, or storing it for the future. The body then uses that energy for all our bodily functions and to rid the body of waste products. This process is known as metabolism.

Here are the steps that happen during normal metabolism:

During and just after a meal, the body digests food into its Ïbasic building blocks.Ó This means the body breaks down carbohydrates (starches) into sugar. Glucose is the primary form of sugar the body needs for energy.
After the meal, glucose is absorbed into the blood.
The rise in blood glucose tells the pancreas to make insulin, which goes out into the bloodstream. About 10 minutes after a meal, insulin is at its highest level.
Insulin helps the glucose enter the body's cells. The glucose either is used right away for energy or stored in the liver and muscles for future use.
About two to four hours after eating a meal, the body returns to low levels of blood glucose, and the body starts using stored glucose as source of energy.
Here is what happens if a person has diabetes:

The pancreas is unable to produce enough insulin or the body is resistant to the action of insulin.
Without enough insulin to move sugar from the bloodstream and into the cells, the blood glucose level rises too high.
With increasing blood glucose concentration, extra glucose passes into the urine and out of the body before the body gets the energy it needs every day. 4. The body will react to a sugar imbalance and, eventually, the person may be at risk for major health problems. This is why it is important to get tested for diabetes and begin treatment as soon as possible.
There are two types of diabetes, type I diabetes and type II diabetes

Type 1 diabetes, an autoimmune disease, is the more severe form as far as glucose is concerned. People with type 1 diabetes must take insulin every day to treat their condition. Their bodies make very little or no insulin. Symptoms of type 1 diabetes can come on suddenly. This form of the disease is commonly seen in children and used to be called insulin-dependent diabetes or juvenile diabetes; however, type I diabetes may occur at any age.

Type 2 diabetes is the most common form of the disease, affecting 90 to 95 percent of all individuals with this disease. With type II diabetes, the body is resistant to the action of insulin, so it cannot carry sugar into the cells. Although the body makes some insulin, it is not enough to overcome this resistance. As more children and adults become overweight, many more are developing type II diabetes.

People with type II diabetes often can control the condition with a healthy lifestyle. Many may need medications, however. These medications can either improve insulin secretion by the pancreas or decrease insulin resistance. Some individuals may also need to take insulin. Type 2 diabetes is a progressive disorder because the ability of the pancreas to make insulin slowly gets worse over time. This is why lifestyle changes may be sufficient shortly after the onset of diabetes but as time goes on, more and more medications and even insulin may be required to keep the blood sugar under control.

If the disease is in the early stage, an individual may not experience any diabetes symptoms. If you suspect you may have diabetes, you should see a doctor. Symptoms of diabetes include fatigue, weight loss, blurred vision, excessive thirst, and excessive urination.

You may be at high risk of developing diabetes if you are overweight, have a family history of diabetes, or if you have a history of diabetes during pregnancy. If so, you should get tested for this condition. Other groups more likely to have diabetes are individuals over 45 years of age and non-Caucasians. Signs of diabetes should not be ignored.

A doctor will do various tests to measure a person's blood glucose level and that individualÌs ability to tolerate glucose. Getting blood glucose levels under control is necessary to prevent the complications of diabetes.

Both diabetes types can cause dangerous complications if it is not controlled. Specifically, if you have diabetes, you can go blind. You can also develop heart disease, and kidney failure. You are at risk of losing a limb one day, because of a decrease in circulation. In addition, you may experience life-threatening reactions to extremely low or high blood sugar levels.

Because of the possible serious consequences of diabetes, people with diabetes must manage their treatment carefully. Endocrinologists and internal medicine physicians who specialize in diabetes are trained to help patients manage this condition. People with diabetes may also need to see eye doctors (ophthalmologists), foot doctors (podiatrists), dietitians, and diabetes educators to round out their care. Only with proper attention can people with diabetes live the healthiest life possible.

Diabetes during Pregnancy

A temporary form of diabetes can occur when a woman is pregnant. This form is called gestational diabetes and often has no symptoms. Most women are tested for their ability to process glucose at some point in their pregnancy. If the test shows that a woman has a blood sugar problem, she will have to follow a special diet for the rest of the pregnancy. In some cases, she may also need to take insulin. Approximately 3 to 5 percent of pregnant women develop gestational diabetes.

Gestational diabetes occurs more often in African Americans, Native Americans, Hispanic Americans, Asian Americans, in people with a family history of diabetes and in those who are overweight. These populations are also the risk groups for type II diabetes, in general. Although this form of diabetes usually disappears after the baby is born, more than half of the women who have gestational diabetes eventually develop type II diabetes later in life.

If a woman has diabetes prior to the pregnancy, it is very important to get her diabetes under excellent control before becoming pregnant to reduce the risk for birth defects. A woman with diabetes who is planning a pregnancy should notify her physician.

Diabetes Symptoms

Type I Diabetes
People with Type 1 diabetes may have noticeable early symptoms that often come on suddenly. Potential symptoms of type I diabetes include:

Increased thirst

Increased urination

Constant hunger

Weight loss

Blurred vision

Fatigue, or a feeling of being tired

Type II Diabetes
Type 2 diabetes may occur without any symptoms or symptoms may develop gradually. This form has many different causes and symptoms. Type II diabetes symptoms may include:

Frequent yeast infections
Very slow healing of wounds or sores
Nausea
Fatigue, or a feeling of being tired
Increased urination
Increased thirst
Weight loss
Blurred vision

If you have these potential symptoms of diabetes, please see your doctor for testing.

Diabetes Treatment Options

All people with diabetes need to control their condition with proper diet and exercise. They also may need to measure their glucose regularly and to take oral medications or insulin injections to keep blood sugar level under control.

Type 1 Diabetes: People with type 1 diabetes must take insulin, which is the hormone they lack. Most people take several insulin injections every day or use an insulin pump. If you take insulin for type 1 diabetes, you should:

Take your insulin daily, as directed. Take your insulin, even if you do not feel well or are sick. If you have any questions, contact your doctor immediately.
Discuss the time you eat and the amount of food you eat with your physician and dietitian so that your insulin regimen can be adjusted appropriately.
Eat regularly scheduled meals. Never skip meals, especially if you have taken an insulin injection, because your blood sugar may drop too low.
Monitor your blood glucose levels regularly, as your doctor recommends.
Use your own needles at all times. Sharing needless can put you at risk for other diseases such as Hepatitis C and HIV.
Travel with your own needles and insulin.
Keep extra insulin in your refrigerator in case you break the bottle you are using.
Keep your insulin out of bright light, the freezer, and very hot places.
There are several types of insulin. They are classified by how fast they work and how long they work in the body. They include:

Mealtime (or ÏbolusÓ) insulin. Short-acting insulins given before meals to control the rise of blood glucose levels after eating. They are usually given in combination with basal (long-acting) insulin:

Ô Short-acting: Regular insulin

Ô Rapid-acting: Lispro, aspart, glulisine

Basal insulin. Controls blood sugar levels between meals and throughout the night. They are usually given once or twice daily and can be used alone or in combination with oral medications or rapid-acting insulins:

Ô Intermediate acting: NPH

Ô Long acting: Glargine and detemir

Pre-mixedÛCombination of bolus and basal insulins. Controls blood sugar levels after and between meals. They are usually given twice daily before breakfast and dinner. They can be used alone or in combination with oral medications.

Insulin pump. This is a device that is worn outside the body and pumps insulin through a flexible tube under the skin. The pump can be set to give a small amount continuously through the day as well as additional insulin doses before meals. Only short-acting insulins are used with insulin pumps.

The type of insulin your doctor prescribes will depend on which of the diabetes types you have, your lifestyle (e.g., foods you eat, how much you exercise), your age, your bodyÌs response to insulin,
and how often you are able or willing to check your blood sugar and to give yourself injections.

Type 2 Diabetes: Most people with type II diabetes can be treated with diet and exercise and oral antidiabetic agents. Some patients however, may require insulin injections once or several times per day to control their diabetes. If you take oral agents or insulin for diabetes, you should:

Know how often to take your medication and stick to the schedule.
Remember that your medication may not lower blood sugar if you do not eat correctly or do not do regular exercise.
You may need to start insulin if your other medication is unable to lower your blood sugar sufficiently.
Try to lose some weight if you are overweight. Even a small amount of weight loss can help to lower your blood sugar. You may even be able to stop taking medication if you are successful in losing weight.
There are several types of oral antidiabetic agents. They work in different ways. They can be used alone or in combination with other agents or insulin. The most common types of oral antidiabetic drugs are:

Sulfonylurea (glipizide, glyburide). They increase the amount of glucose produce by your body. They are effective in lowering blood sugar levels, but may cause the following side effects: hypoglycemia (low blood sugar), weight gain, skin rash (allergy), or flushing and nausea with alcohol consumption.

Metformin. Metformin is the most common antidiabetic agent use to treat diabetes. It allows the body and cells to respond better to insulin. It does not cause hypoglycemia if taken alone. However, it may cause upset stomach, nausea and loose stools. It cannot be used in patients with kidney or liver failure.

Thiazolidinediones (pioglitazone, rosiglitazone). They allow the body to respond better to insulin. Alone they do not cause hypoglycemia, but they could if mixed with insulin or other oral agents. They may also cause weight gain, fluid retention or swollen legs, and can worsen or lead to heart failure.

DPP-4 inhibitors (sitagliptin). A new drug that by preventing the inactivation of some gastrointestinal hormones (incretins) increases insulin secretion and lowers the release of glucagon by the pancreas.

Exenatide. An injectable diabetes medicine that helps control blood sugar levels. This medication helps your pancreas produce insulin more efficiently. In addition to improving glucose control, it may lead to a decrease in appetite and weight loss.

Keeping your glucose levels as close to normal will greatly lower your chances of developing long-term complications. If you have already developed complications, keeping your glucose levels as close to normal will greatly slow down the progression of these complications.
Even if you take very good care of yourself, sometimes you may have high blood sugar, which is called hyperglycemia, or low blood sugar, which is called hypoglycemia.

If your blood sugar is high (hyperglycemia):

High levels of blood sugar may make you need to urinate often and to have increased thirst.
Exercising may help to lower your blood sugar level, however, if your blood sugar is very high (over 250-300 mg/dl) it may not do so. Avoid exercise if your blood sugar is greater than 300 mg/dl. Do not take insulin to lower your blood sugar to allow you to exercise.
If you have type 1 diabetes or if you develop an illness that increases your blood glucose, you should check your blood or urine for ketones. High ketones in blood or urine can mean that there is not enough insulin for your body to control sugar levels in the blood. Ketones form in the body when it starts breaking down fat and you are dehydrated, and may indicate that you do not have enough water in your system. This can happen, for example, if you have the flu or another illness. You can keep a test kit for ketones in your home and workplace.
If eating and exercise do not help you control your high blood sugar, contact your doctor about a better way to manage your blood sugar. Often this means a change in the oral medication use, or you may need to start or to increase the insulin dose.
Low blood sugar usually occurs because of an imbalance between the amount of food you have eaten, the amount of exercise you have done, and the amount of medication (especially insulin) you have taken.

If your blood sugar is low (hypoglycemia):

You may have symptoms like shakiness, dizziness, confusion, inability to concentrate, hunger, paleness, or headache.
Raise your blood sugar immediately with a glass of juice, six pieces of hard candy, or three glucose tablets, available at drugstores.
Wait 15 minutes or so and then test yourself again. If your blood sugar is still low, repeat the sugar treatment again (juice, candy, etc.). If your blood glucose remains low so that you cannot help yourself and need someone else to assist you, that person should give you an injection of glucagon. If you do not have glucagon, someone should bring you to the nearest emergency room for help.
Glucagon is a prescribed injection drug that helps to raise blood sugar. If you take insulin and are prone to having hypoglycemic reactions, you should always have some on hand and train a relative or coworkers how or when to inject you with it, should you become unconscious.
If you are beginning to feel dizzy or weak, with the symptoms of low blood sugar while you are driving, pull to the side of the road immediately. Treat the reaction with sugar. Do not begin to drive again until you are completely back to normal.

Diabetes Lifestyle and Prevention

If you are living with diabetes, lifestyle is an important element of your care. It is extremely important that you eat a good balance of foods every day and exercise regularly. You will also have to learn to manage your disease by taking medicine, if necessary, and testing your blood sugar levels each day.

Diet:

Diabetes does not require special foods. A healthy, balanced diet can come from everyday foods. Certain foods are better than others, however, when managing diabetes. If you have diabetes, you should:

Choose foods that are low in fat and salt
Choose foods that are high in fiber (such as beans, vegetables and fruit)
Remember to eat foods from all food groups: milk and milk products; meat, chicken, turkey, fish, beans, cheese, and eggs; bread, cereal, rice, noodles, and potatoes; and fruits and vegetables.
Lose weight by reducing the amount of food you eat. Weight loss will make your diabetes easier to control if you have type II diabetes.
Your doctor can refer you to a dietitian who can help you plan meals that include the right foods, and recipes that taste great and are good for you.

Alcohol:

If your diabetes is under control and you do not have high blood pressure or nerve damage, your doctor may allow you to drink alcohol. You need to understand what happens when a person with diabetes drinks alcohol, however. If a person with diabetes drinks alcohol, while taking insulin or other diabetes medication, he or she risks low blood sugar. The liver will not release glucose until it first clears the alcohol, because the liver treats alcohol as a poison in the system.

If you drink alcohol, limit yourself to one drink a day if you are a woman and two drinks a day if you are a man. Remember, never drink alcohol on an empty stomach.

Smoking:

Smoking greatly increases your risk of heart disease and blood vessel disease Û two of the major complications of diabetes. Stopping smoking is the single best thing you can do to decrease your chances of developing heart disease and blood vessel disease.

Exercise and Activity:

Always see a doctor before starting an exercise program. Your doctor may have good ideas about types of exercise that would be best for you. Exercise is important for people with diabetes because it does the following:

Helps insulin work better to lower blood sugar
Helps keep weight down, which also improves the condition
Is good for the heart, blood vessels, and lungs
Gives you more energy
Be aware that exercise affects your body's need for sugar. When you exercise, be sure to do the following:

Have a snack with you in case you get low blood sugar
Wear a tag or carry a card that says you have diabetes
Eat a snack, such as milk or an apple, if it has been more than an hour since you have eaten
Avoid exercising if your blood sugar is over 240 mg/dL. Try to lower your blood sugar. Please see the section on Treatment Options, "If your blood sugar is high."
Do not take insulin to lower your blood sugar before exercising. This may result in severe low blood sugars.
If you have heart disease or risk factors for heart disease, such as advanced age, high cholesterol, increased protein in your urine, high blood pressure, or poor diabetes control, check with your doctor about whether or not you need a stress test before beginning an exercise regimen.
If you have nerve damage to your feet, be careful to wear well-fitting shoes and socks to avoid blisters. You should discuss your exercise regimen with your physician and/or podiatrist.

Managing your condition:

If you have diabetes, you have the responsibility of managing your condition.

If you need to take medicine, be sure to take it as directed. Do not change your own dosage or how often you take your medication unless you have been instructed to do so by your physician. Take it as prescribed and on time every day. Be careful not to skip doses of insulin or other medications.

Test your blood for sugar as directed by your doctor. Some people only test once a day. Those who take insulin or multiple medications may need to test four or more times a day. Talk to your doctor about how often you should test your blood sugar.

To test your blood, you will need test strips and a lancet to pierce your finger or forearm for a blood drop. You will simply prick your finger or forearm, get a drop of blood, and place it on the end of the strip. After a short time, place the strip in your glucose meter and get an exact number for your blood sugar.

People with type 1 diabetes may also want to buy urine test strips to measure ketone levels. These are substances that your body forms when you do not have enough insulin and your blood glucose levels are high. This usually happens when you are sick. You may need to test for ketones when you have a blood sugar reading of more than 240 mg/dL before you eat.

If you have a positive ketone test when you take a blood or urine test, call your doctor immediately. This may indicate a developing condition called diabetic ketoacidosis, a serious condition that can cause death if left untreated.

Finally, you should see your doctor for a hemoglobin A1c test every three to six months. This is a special blood test that gives your doctor a picture of your blood sugar over time. This test shows how much sugar is attached to the hemoglobin in your red blood cells. Ask your doctor if you have questions about your hemoglobin A1c test results. You should have a normal result if most of your blood sugar levels are near 100 mg/dL.

Managing your diabetes may take some planning. Ask your doctor how to best prepare for different situations, which may require extra insulin or even changes to your regular dose of medication:

When you are sick
If you are planning a pregnancy or become pregnant
When you are traveling
When you are at school or at work
When you are exercising
Associated Conditions

People with diabetes of both types commonly develop high blood pressure, or hypertension and high cholesterol levels. These conditions may also require specific medications that are necessary to achieve normal blood pressure and cholesterol levels.

When these levels are not controlled, they increase the risk for large blood vessel disease, which can cause heart attacks, strokes, and lead to amputations. It is critical to control these associated conditions, as well as the diabetes.

Many of the lifestyle changes you may make to control your diabetes, such as diet and exercise, will also be of benefit in controlling your blood pressure and cholesterol. Additional changes may also be needed, however, such as lowering the salt and fats in your diet.

If you are diagnosed with one of the diabetes types, the first thing you will want to do is to find a physician, specifically an endocrinologist, to help you manage your condition. Find a doctor who will listen to you and answer your questions. Make a commitment to yourself to get educated and to make the lifestyle changes you need to make to maintain good health despite the challenges of diabetes. A great doctor, the right medication, a good diet and exercise will go a long way in ensuring your well being for many years to come.