• Diabetes


    Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood.

    Symptoms

    High blood levels of glucose can cause several problems, including:

    Blurry vision
    Excessive thirst
    Fatigue
    Frequent urination
    Hunger
    Weight loss

    However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.

    Symptoms of type 1 diabetes:
    Fatigue
    Increased thirst
    Increased urination
    Nausea
    Vomiting
    Weight loss in spite of increased appetite

    Patients with type 1 diabetes usually develop symptoms over a short period of time. The condition is often diagnosed in an emergency setting.

    Symptoms of type 2 diabetes:

    Blurred vision
    Fatigue
    Increased appetite
    Increased thirst
    Increased urination

    Treatment

    The immediate goals are to treat diabetic ketoacidosis and high blood glucose levels. Because type 1 diabetes can start suddenly and have severe symptoms, people who are newly diagnosed may need to go to the hospital.

    The long-term goals of treatment are to:

    Prolong life
    Reduce symptoms
    Prevent diabetes-related complications such as blindness, heart disease, kidney failure, and amputation of limbs

    These goals are accomplished through:
    Blood pressure and cholesterol control
    Careful self testing of blood glucose levels
    Education
    Exercise
    Foot care
    Meal planning and weight control
    Medication or insulin use

    There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms.

    LEARN THESE SKILLS

    Basic diabetes management skills will help prevent the need for emergency care. These skills include:
    How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
    What to eat and when
    How to take insulin or oral medication
    How to test and record blood glucose
    How to test urine for ketones (type 1 diabetes only)
    How to adjust insulin or food intake when changing exercise and eating habits
    How to handle sick days
    Where to buy diabetes supplies and how to store them

    After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. Review and update your knowledge, because new research and improved ways to treat diabetes are constantly being developed.

    SELF-TESTING

    If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes. It can help your doctor prevent complications.

    The American Diabetes Association recommends keeping blood sugar levels in the range of:

    80 – 120 mg/dL before meals
    100 – 140 mg/dL at bedtime

    Your doctor may adjust this depending on your circumstances.

    WHAT TO EAT

    You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can help you plan your dietary needs.

    People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low.

    People with type 2 diabetes should follow a well-balanced and low-fat diet.

    HOW TO TAKE MEDICATION

    Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.

    People with type 1 diabetes cannot make their own insulin. They need daily insulin injections. Insulin does not come in pill form. Injections are generally needed one to four times per day. Some people use an insulin pump. It is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use inhaled insulin.

    Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes.

    Medications may be switched to insulin during pregnancy and while breastfeeding.

    Gestational diabetes may be treated with exercise and changes in diet.

    EXERCISE

    Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than those who do not exercise regularly.

    Here are some exercise considerations:

    Always check with your doctor before starting a new exercise program.
    Ask your doctor or nurse if you have the right footwear.
    Choose an enjoyable physical activity that is appropriate for your current fitness level.
    Exercise every day, and at the same time of day, if possible.
    Monitor blood glucose levels before and after exercise.
    Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
    Carry a diabetes identification card and a cell phone in case of emergency.
    Drink extra fluids that do not contain sugar before, during, and after exercise.

    You may need to change your diet or medication dose if you change your exercise intensity or duration to keep blood sugar levels from going too high or low.

    FOOT CARE

    People with diabetes are more likely to have foot problems. Diabetes can damage blood vessels and nerves and decrease the body’s ability to fight infection. You may not notice a foot injury until an infection develops. Death of skin and other tissue can occur.

    If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.

    To prevent injury to the feet, check and care for your feet every day.

    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 used as fuel.

    People with diabetes have high blood sugar. This is because:

    Their pancreas does not make enough insulin
    Their muscle, fat, and liver cells do not respond to insulin normally
    Both of the above

    There are three major types of diabetes:

    Type 1 diabetes is usually diagnosed in childhood. Many patients are diagnosed when they are older than age 20. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown. Genetics, viruses, and autoimmune problems may play a role.
    Type 2 diabetes is far more common than type 1. It makes up most of diabetes cases. It usually occurs in adulthood, but young people are increasingly being diagnosed with this disease. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to increasing obesity and failure to exercise.
    Gestational diabetes is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes. Women who have gestational diabetes are at high risk of type 2 diabetes and cardiovascular disease later in life.

    Diabetes affects more than 20 million Americans. Over 40 million Americans have prediabetes (early type 2 diabetes).

    There are many risk factors for type 2 diabetes, including:

    Age over 45 years
    A parent, brother, or sister with diabetes
    Gestational diabetes or delivering a baby weighing more than 9 pounds
    Heart disease
    High blood cholesterol level
    Obesity
    Not getting enough exercise
    Polycystic ovary disease (in women)
    Previous impaired glucose tolerance
    Some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans)

    Tests & diagnosis

    A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes.

    The following blood tests are used to diagnose diabetes:

    Fasting blood glucose level — diabetes is diagnosed if higher than 126 mg/dL on two occasions. Levels between 100 and 126 mg/dL are referred to as impaired fasting glucose or prediabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.
    Oral glucose tolerance test — diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours. (This test is used more for type 2 diabetes.)
    Random (non-fasting) blood glucose level — diabetes is suspected if higher than 200 mg/dL and accompanied by the classic diabetes symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)

    Persons with diabetes need to have their hemoglobin A1c (HbA1c) level checked every 3 – 6 months. The HbA1c is a measure of average blood glucose during the previous 2 – 3 months. It is a very helpful way to determine how well treatment is working.

    Prognosis

    With good blood glucose and blood pressure control, many of the complications of diabetes can be prevented.
    Studies have shown that strict control of blood sugar, cholesterol, and blood pressure levels in persons with diabetes helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.

    Prevention

    Maintaining an ideal body weight and an active lifestyle may prevent type 2 diabetes.

    Currently there is no way to prevent type 1 diabetes.

    There is no effective screening test for type 1 diabetes in people who don’t have symptoms.

    Screening for type 2 diabetes and people with no symptoms is recommended for:

    Overweight children who have other risk factors for diabetes starting at age 10 and repeating every 2 years
    Overweight adults (BMI greater than 25) who have other risk factors
    Adults over 45, repeated every 3 years

    To prevent complications of diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having.

    Regularly have the following tests:
    Have your blood pressure checked every year (blood pressure goals should be 130/80 mm/Hg or lower).
    Have your glycosylated hemoglobin (HbA1c) checked every 6 months if your diabetes is well controlled, otherwise every 3 months.
    Have your cholesterol and triglyceride levels checked yearly (aim for LDL levels below 100 mg/dL).
    Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine).
    Visit your ophthalmologist (preferably one who specializes in diabetic retinopathy) at least once a year, or more often if you have signs of diabetic retinopathy.
    See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.
    Make sure your health care provider inspects your feet at each visit.

    Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.

    Complications

    Emergency complications include:

    Diabetic hyperglycemic hyperosmolar coma
    Diabetic ketoacidosis

    Long-term complications include:

    Atherosclerosis
    Coronary artery disease
    Diabetic nephropathy
    Diabetic neuropathy
    Diabetic retinopathy
    Erection problems
    Hyperlipidemia
    Hypertension
    Infections of the skin, female urinary tract, and urinary tract
    Peripheral vascular disease
    Stroke

    When to contact a doctorGo to the emergency room or call the local emergency number (such as 911) if you have symptoms of ketoacidosis:

    Abdominal pain
    Deep and rapid breathing
    Increased thirst and urination
    Loss of consciousness
    Nausea
    Sweet-smelling breath

    Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction):

    Confusion
    Convulsions or unconsciousness
    Dizziness
    Double vision
    Drowsiness
    Headache
    Lack of coordination
    Weakness

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