Diabetes

Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. You can also have prediabetes. This means that your blood sugar is higher than normal but not high enough to be called diabetes. Having prediabetes puts you at a higher risk of getting type 2 diabetes.

Over time, having too much glucose in your blood can cause serious problems. It can damage youreyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes.

Blood tests can show if you have diabetes. One type of test, the A1C, can also check on how you are managing your diabetes. Exercise, weight control and sticking to your meal plan can help control your diabetes. You should also monitor your blood glucose level and take medicine if prescribed.

Prevention

Risk Factors

Causes

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.

To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:

• A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
• An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be stored or used as fuel.

People with diabetes have high blood sugar because their body cannot move sugar from the blood into muscle and fat cells to be burned or stored for energy, and because their liver makes too much glucose and releases it into the blood. This is because either:

• Their pancreas does not make enough insulin
• Their cells do not respond to insulin normally
• Both of the above

There are two major types of diabetes. The causes and risk factors are different for each type:

• Type 1 diabetes can occur at any age, but it is most often diagnosed in children, teens, or young adults. In this disease, the body makes little or no insulin. This is because the pancreas cells that make insulin stop working. Daily injections of insulin are needed. The exact cause is unknown.
• Type 2 diabetes is much more common. It most often occurs in adulthood, but because of high obesity rates, teens and young adults are now being diagnosed with this disease. Some people with type 2 diabetes do not know they have it.
• There are other causes of diabetes, and some patients cannot be classified as type 1 or type 2.

Gestational diabetes is high blood sugar that develops at any time during pregnancy in a woman who does not have diabetes.

If your parent, brother, or sister has diabetes, you may be more likely to develop the disease.

Symptoms

Symptoms vary from person to person. The early stages of diabetes have very few symptoms, so you may not know you have the disease. But damage may already be happening to your eyes, your kidneys and your cardiovascular system even before you notice symptoms. Common symptoms include the following:

• Extreme hunger
• Extreme thirst
• Frequent urination
• Unexplained weight loss
• Fatigue or drowsiness
• Blurry vision
• Slow-healing wounds, sores or bruises
• Dry, itchy skin
• Tingling or numbness in the hands or feet
• Frequent or recurring skin, gum, bladder or vaginal yeast infections

People who have diabetes type 2 may also show signs of insulin resistance, such as darkening skin around the neck or in the armpits, high blood pressure, cholesterol problems, yeast infections and skipped or absent periods in teen girls and women.

After many years, diabetes can lead to other serious problems. These problems are known as diabetes complications, and include:

• Eye problems, including trouble seeing (especially at night), light sensitivity, and blindness
• Sores and infections of the leg or foot, which untreated can lead to amputation of the leg or foot
• Damage to nerves in the body, causing pain, tingling, a loss of feeling, problems digesting food, and erectile dysfunction
• Kidney problems, which can lead to kidney failure
• Weakened immune system, which can lead to more frequent infections
• Increased chance of having a heart attack or stroke

Diagnosis

WHY IS IT IMPORTANT TO PREVENT, DIAGNOSE AND TREAT DIABETES?

Untreated diabetes causes blood sugar levels to rise. This can lead to a number of serious problems, including:

• Eye damage that can cause blindness
• Kidney failure
• Heart attacks
• Nerve and blood vessel damage that can lead to the loss of toes or feet
• Problems with gums, including tooth loss

The longer the body is exposed to high blood sugar levels, the greater the risk that problems will occur. That’s why treatment is important at any age. Keeping blood sugar levels very close to the ideal can minimize, delay and, in some cases, even prevent the problems that diabetes can cause.

HOW IS DIABETES DIAGNOSED?

Your doctor may test for diabetes if he or she suspects you are at risk. To check for diabetes, your doctor may request the following tests:

• Fasting blood sugar test. This test is usually done in the morning, after an 8-hour fast. This means that you shouldn’t eat any foods or drink any liquids except for water for 8 hours before the test. At the end of the fast, a doctor or nurse measure the amount of glucose in your blood. If your blood sugar level is 126 milligrams per deciliter (mg/dL) or higher, your doctor will probably want to repeat the test. A blood sugar level of 126 milligrams per deciliter (mg/dL) or higher on 2 occasions indicates diabetes. Test results from 100 mg per dL to 125 mg per dL suggest prediabetes.
• Oral glucose tolerance test. During this test, you will drink a beverage containing 75 grams of glucose dissolved in water. Two hours later, a doctor or nurse will measure the amount of glucose in your blood. A blood sugar level of 200 mg/dL or higher indicates diabetes.
• Random blood sugar test. This test measures the level of glucose in your blood at any time of day, regardless of when you last ate. Combined with symptoms of diabetes, a blood glucose level of 200 mg/dL or higher indicates

Treatment

How can I help myself stay healthy if I have diabetes?

Although diabetes can’t be cured, you can still live a long and healthy life. The single most important thing you can do is control your blood sugar level. You can do this by eating right, exercising, maintaining a healthy weight and, if needed, taking oral medicines or insulin.

EAT A HEALTHY DIET.

The recommended diet for many people who have diabetes is very similar to that suggested for everyone: low in fat, low in cholesterol, low in salt and low in added sugar. Your diet should include lots of complex carbohydrates (such as whole-grain breads, cereals and pasta), fruits and vegetables. This type of diet will help you control your blood sugar level, as well as your blood pressure and cholesterol levels. It’s also important to watch your portion size so you can control your blood sugar and maintain a healthy weight. In order to help keep your blood sugar at a healthy level, it’s important to eat at least 3 meals per day and never skip a meal. For more information, read Diabetes and Nutrition.

Tips on eating right

• Eat at about the same time every day. This helps keep your insulin or medicine and sugar levels steady.
• Try to eat 3 times a day. Have a snack at bedtime if you’re taking medicine or insulin. Avoid other snacking unless you’re exercising or treating hypoglycemia.
• If you’re overweight, lose weight. Even losing just a little weight, such as 5 to 15 pounds, can lower your blood sugar levels.
• Eat plenty of fiber. Green leafy vegetables, whole grains and fruits are good choices. Fiber helps you feel full and helps with digestion.
• Eat fewer empty calories, such as foods high in sugar and fat, and alcohol.

EXERCISE.

Exercising will help your body use insulin and lower your blood sugar level. It also helps control your weight, gives you more energy and is good for your overall health. Exercise is also good for your heart, your cholesterol levels, your blood pressure and your weight–all factors that can affect your risk of heart attack and stroke. Exercise also seems to make people feel better about themselves and feel less anxious. Talk with your doctor about starting an exercise program. He or she can help you make a plan. For more information, read Diabetes and Exercise.

MAINTAIN A HEALTHY WEIGHT.

Losing excess weight and maintaining a healthy body weight will help you in 2 ways. First, it helps insulin work better in your body. Second, it will lower your blood pressure and decrease your risk for heart disease.

TAKE YOUR MEDICINE.

If your diabetes can’t be controlled with diet, exercise and weight control, your doctor may recommend medicine or insulin. Oral medicines (taken by mouth) can make your body produce more insulin or help your body use the insulin it makes more efficiently. Some people need to add insulin to their bodies with insulin injections, insulin pens or insulin pumps. Always take medicines exactly as your doctor prescribes.

WHAT MEDICINES ARE AVAILABLE TO TREAT DIABETES?

Several kinds of medicine can help you control your blood sugar level. Some medicines are pills that you take by mouth (orally). Most people who have diabetes type 2 start with an oral medicine. Oral medicine doesn’t work for everyone, though. It is not effective in the treatment of type 1 diabetes. Insulin therapy is necessary for all people who have diabetes type 1 and for some people who have diabetes type 2. If you need insulin, you’ll have to give yourself a shot (either with a syringe or with an insulin pen). Your doctor will tell you which kind of medicine you should take and why.

WHAT TESTS CAN I USE TO CHECK MY BLOOD SUGAR LEVEL?

There are 2 blood tests that can help you manage your diabetes. One of these tests is called an A1C test, which reflects your blood sugar (or blood glucose) control over the past 2-3 months. Testing your A1C level every 3 months is the best way for you and your doctor to understand how well your blood sugar levels are controlled. The other test is called SMBG, or self-monitoring of blood glucose. Using a blood glucose monitor to do SMBG testing can help you improve control of your blood sugar levels.

WHAT IF MY BLOOD SUGAR GETS TOO LOW?

People who have diabetes may have times when their blood sugar level is too low. Low blood sugar is called hypoglycemia. Signs of hypoglycemia include the following:

• Feeling very tired
• Frequent yawning
• Being unable to speak or think clearly
• Loss of muscle coordination
• Sweating
• Twitching
• Seizures
• Suddenly feeling like you’re going to pass out
• Becoming very pale
• Loss of consciousness

People who have diabetes should carry at least 15 grams of a fast-acting carbohydrate with them at all times in case of hypoglycemia or an insulin reaction. The following are examples of quick sources of energy that can relieve the symptoms:

• Nondiet soda- ½ to ¾ cup
• Fruit juice- ½ cup
• Fruit- 2 tablespoons of raisins
• Milk- 1 cup
• Candy- 5 Lifesavers
• Glucose tablets- 3 tablets (5 grams each)

If you don’t feel better 15 minutes after having a fast-acting carbohydrate, or if monitoring shows that your blood sugar level is still too low, have another 15 grams of a fast-acting carbohydrate.

Teach your friends, work colleagues and family members how to treat hypoglycemia, because sometimes you may need their help. Also, keep a supply of glucagon on hand. Glucagon comes in a kit with a powder and a liquid that must be mixed together and then injected (given as a shot). It will raise your blood sugar level. If you are unconscious, or you can’t eat or drink, another person can give you a shot of glucagon. This will bring your blood sugar level back to normal.

WHAT ABOUT SMOKING AND ALCOHOL?

You should stop smoking as soon as possible. It’s probably okay to drink some alcohol with a meal, but you should only have 1 serving each day. A serving is 4 ounces of wine, 12 ounces of beer or 1.5 ounces of hard liquor. If you drink on an empty stomach, you risk causing a drop in your blood sugar. Talk with your doctor about how much alcohol is safe for you to consume with your diabetes.

HOW WILL I KNOW IF MY BLOOD SUGAR LEVEL IS TOO HIGH?

High blood sugar (also called hyperglycemia) can occur even if you are eating properly and taking your insulin correctly. Eating too much food at a meal, getting sick, having hormonal changes and feeling stressed out can affect your blood sugar.

Symptoms of hyperglycemia include the following:

• Frequent urination
• Extreme thirst
• Blurry vision
• Feeling very tired

WHAT SHOULD I DO IF MY BLOOD SUGAR LEVEL IS TOO HIGH?

If your blood sugar level goes higher than it should, you may need to take an extra dose of rapid- or short-acting insulin to return your blood sugar to the normal range. Your doctor can tell you how much insulin you need to take to lower your blood sugar level.