Diabetes

According to the latest figures from the Centers for Disease Control and Prevention (CDC), nearly 24 million Americans have diabetes mellitus, which is commonly referred to as diabetes. That's about 8 percent of the American population. About 6 million of those people have no idea they have diabetes and millions more are at risk of developing it. If you have diabetes, your body has problems converting the food you eat into energy. The danger of this lies in the fact that if untreated, diabetes can damage the eyes, kidneys, nerves, heart and blood vessels. (Read about "The Eye" "Diabetes and Kidney Disease" "Nervous System" "The Heart & Cardiovascular System") Therefore, whenever present, it's essential to diagnose, monitor and treat diabetes correctly.

Diabetes mellitus should not be confused with diabetes insipidus (DI). Diabetes insipidus and diabetes mellitus are unrelated, although they can have similar signs and symptoms, like excessive thirst and excessive urination. (Read about "Diabetes Insipidus")

Below find information to help you learn more about diabetes, its causes, complications and how to live with it.

Insulin and blood sugar

Normally, the food we eat is broken down into glucose, which is a form of sugar. The glucose passes into the bloodstream, where it is used by cells for growth and energy. For cells to use glucose, however, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. (Read about "Endocrine System") If the insulin isn't present, or if the cells don't respond to it, the glucose stays in the bloodstream, causing a rise in the blood sugar or blood glucose level. When blood sugar levels are too high it's called hyperglycemia; when blood sugar levels fall too low it's called hypoglycemia. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says conditions that can lead to hypoglycemia in people with diabetes include taking too much medication, missing or delaying a meal, eating too little food for the amount of insulin taken, exercising too strenuously, drinking too much alcohol, or any combination of these factors.

Types of diabetes

The American Diabetes Association (ADA) and NIDDK say there are different types of diabetes and insulin-resistance:

• Type 1 diabetes (which has also been called insulin-dependent or immune-mediated diabetes) occurs when your body can't produce insulin. This is the kind of diabetes that often appears before the age of 18, although it can also strike at any age. Type 1 diabetes is considered an autoimmune disease. An autoimmune disease results when the body's system for fighting infection, the immune system, turns against a part of the body. (Read about "The Immune System") In Type 1 diabetes, according to NIDDK, the immune system attacks the insulin-producing cells in the pancreas and destroys them. The pancreas then produces little or no insulin. An individual with Type 1 diabetes requires daily doses of insulin. The insulin can be delivered by injection, or through a pump system, which feeds the insulin into the body through a needle or catheter inserted just under the skin. Healthy meal planning and regular exercise are also a part of treatment for type 1 diabetes.
• Type 2 diabetes (which has also been called non-insulin-dependent diabetes) is much more common than Type 1 diabetes, affecting some 90% of people with diabetes. In this type, your body can produce insulin, but it either doesn't produce enough or it isn't using it properly. Someone with Type 2 diabetes uses exercise, healthy meal planning and, in many cases, oral medications or insulin to control blood sugar levels. Type 2 diabetes has been linked with obesity (Read about "Obesity"), and the number of people in the U.S. with Type 2 diabetes is growing.
• Gestational diabetes develops during pregnancy and usually disappears once the baby is born. This condition requires careful monitoring throughout the pregnancy and can put a woman at higher risk of developing diabetes later in life. The ADA says about four percent of pregnant women develop gestational diabetes during pregnancy, and women who were overweight before becoming pregnant are at a higher risk. (Read about "Healthy Pregnancy") Women who have had gestational diabetes are at increased risk for developing type 2 diabetes. The Centers for Disease Control and Prevention say women who have had gestational diabetes have a 20 to 50 percent chance of developing diabetes in the next 5-10 years. Therefore, any woman who developed gestational diabetes during pregnancy should be sure she is monitored throughout her life. It is very important that she maintain a normal weight and exercise regularly.

• Pre-diabetes/Insulin Resistance The U.S. Department of Health and Human Services (HHS) says there is also a condition called "pre-diabetes" which may affect as many as 54 million Americans. The term "pre-diabetes" is being used to describe an increasingly common condition in which blood glucose levels are higher than normal but not yet diabetic. This is also known as impaired glucose tolerance or impaired fasting glucose. Someone with impaired glucose tolerance may also be described as "insulin resistant," that is, their body produces insulin but isn't utilizing it correctly, causing blood sugar levels to rise.

  Insulin resistance is also a factor in metabolic syndrome or syndrome X. (Read about "Metabolic Syndrome") Other risk factors for metabolic syndrome include a body mass index of over 25 (Read about "Body Mass Index"), high triglyceride levels, family history of diabetes (Read about "Family Health History"), polycystic ovary syndrome (Read about "Polycystic Ovary Syndrome"), sedentary lifestyle, age and ethnicity. The American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) say metabolic syndrome is an epidemic condition that dramatically increases risk for type 2 diabetes, heart disease and stroke. They estimate that it affects one in three Americans.

  HHS says most people with pre-diabetes will likely develop diabetes within a decade unless they make changes in their diet and level of physical activity, which can help them reduce their risks. Even before they develop diabetes, their health is still at risk, since they are much more likely to develop high blood pressure, abnormal blood lipids and coronary heart disease. (Read about "Hypertension: High Blood Pressure" "Cholesterol") Studies have linked obesity to impaired glucose tolerance/pre-diabetes.

• Latent Autoimmune Diabetes in Adults (LADA) goes by a number of names, according to the ADA. It can also be called type 1.5 or slow onset type 1. NIDDK says that LADA usually shows up after the age of 35 and with signs that the immune system (Read about "The Immune System") is attacking the cells in the pancreas that make insulin. ADA says people with LADA may not need insulin in the beginning, and they generally are not insulin resistant. However, they most likely will eventually need insulin to control blood sugar. Diet and exercise is also crucial to controlling blood sugar levels. ADA also says people with LADA tend to be physically fit in the way they look, not overweight.

Symptoms of diabetes

Symptoms of diabetes can vary, but the American Academy of Family Physicians says typical symptoms, especially for Type 1 diabetes, include:

• frequent urination (Read about "Urinary System")
• excessive thirst
• blurry vision
• tingling or numbness in the hands and feet (Read about "Paresthesia")
• unexplained weight loss despite eating more than usual
• extreme tiredness or irritability

In Type 2 diabetes there may not be any symptoms, especially initially. This is why screening is so important, especially if you have any of the risk factors for diabetes. Type 2 diabetes occurs most often after the age of 40 (although the American Diabetes Association says there is an alarming - potentially lifestyle-related - increase in the number of people under age 40 now developing this kind of diabetes). It's estimated that millions of people have type 2 diabetes and do not know it. Talk to your doctor about being tested for diabetes, especially if any of the following risk factors apply to you:

• you have a family history of diabetes
• you are more than twenty percent over your ideal weight (Read about "Body Mass Index")
• you have high blood pressure or high blood cholesterol (Read about "Hypertension: High Blood Pressure" "Cholesterol")
• you belong to a racial or ethnic group at higher risk, including Hispanic, African-American or Native American
• you developed diabetes during pregnancy or delivered a large baby (9 pounds or heavier)

Complications of diabetes

Left untreated, diabetes can cause severe complications including heart disease, stroke, blindness, cataracts (Read about "Cataracts"), kidney disease and nerve damage that could lead to amputation.

• Diabetic neuropathy - This is the name given to the nerve damage caused by diabetes. NIDDK says symptoms of neuropathy include numbness and sometimes pain in the hands, feet or legs. (Read about "Feet, Ankles and Legs") Nerve damage can also cause problems with internal organs. The symptoms of neuropathy depend on which nerves and what part of the body is affected. They can include numbness or insensitivity to pain or temperature; tingling, burning, or prickling; sharp pains or cramps; sensitivity to touch; loss of balance and coordination. Symptoms can get worse at night. In addition, neuropathy may be diffuse, affecting many parts of the body, or focal, affecting a single, specific nerve or part of the body. Peripheral neuropathy affects the feet and hands and autonomic neuropathy affects the internal organs.

  Treatment for neuropathy can include medications to treat the specific symptoms. In addition, careful monitoring of the feet, as well as control of blood glucose levels is essential. (Read about "Peripheral Neuropathy")

• Heart disease and stroke - The American Heart Association (AHA) says diabetes is also a major risk factor for stroke, coronary heart disease and heart attack. (Read about "Coronary Heart Disease" "Stroke") According to AHA, two-thirds of people with diabetes mellitus die of some form of heart or blood vessel disease, and adults with diabetes are two to four times more likely to have heart disease or suffer a stroke than adults without diabetes. Patients who have suffered from diabetes since childhood, especially if it has been poorly controlled, are at significant risk of developing one of these life threatening problems as early as their 20's or 30's.

  AHA says insulin resistance, a condition where the body cannot use the insulin it produces effectively and a key component of Type 2 diabetes, is associated with blood lipid imbalances. These can include things like an increase in low-density lipoprotein (LDL or so-called bad cholesterol), low levels of high-density lipoprotein (HDL or so-called good cholesterol), and increased levels of triglycerides, all of which are linked to higher risk of heart disease. (Read about "Cholesterol")

  AHA adds that people with diabetes may avoid or delay heart and blood vessel disease by controlling both their diabetes as well as the risk factors associated with heart disease. However, studies show many people with diabetes are unaware of their increased risk of heart disease and the importance of taking steps to reduce their risk by careful monitoring and control of blood sugar levels combined with weight loss, blood pressure and cholesterol control, and not smoking. (Read about "Hypertension: High Blood Pressure" "Quit Smoking")

• Diabetic retinopathy - Diabetic retinopathy is a potentially blinding complication of diabetes in which the eye's retina is damaged. ADA says it is more likely to develop the longer someone has had diabetes. Diabetic retinopathy occurs when diabetes damages the tiny blood vessels in the retina. At first, there may not be any changes in vision. Without treatment, eyesight progressively deteriorates. However, with treatment, the National Eye Institute says 90 percent of those with advanced diabetic retinopathy can be saved from going blind. The condition is usually treated with either surgery or laser surgery. It can be detected through regular eye exams. (Read about "Eye Exams")
• Kidney disease - Diabetes is the number one cause of chronic kidney failure, which is also called end stage renal disease (ESRD). Diabetes results in 35 percent of new ESRD cases each year. (Read about "Diabetes and Kidney Disease" "Kidney Disease" "Blood Pressure and Kidney Disease")
• Diabetic ketoacidosis - In this potential complication, impurities can build up rapidly in the body and cause a medical emergency. The impurities are the by-products of fat metabolism, called ketones. Ketones build up in the blood because not enough insulin is available to burn glucose for energy, and fat is burned rapidly instead. The high level of ketones that results causes acid in the blood, which is dangerous, and the high level of glucose leads to severe dehydration. (Read about "Dehydration") This can result in low blood pressure, rapid heart rate, and other symptoms. Diabetic ketoacidosis, as the condition is called, is treated with insulin and fluid replacement. In most cases patients are admitted to the hospital, often to the intensive care unit. This is most likely to occur in type 1 diabetes. A similar condition, known as hyperglycemic hyperosmolar state (HHS), can occur in type 2 diabetes, and is also a medical emergency.
• Diabetic gastroparesis - Diabetes can also affect the nerves that are part of the stomach. It can result in delayed emptying, abdominal distension and bloating and chronic pain. (Read about "Gastroparesis")
• Yeast infections - Yeast infections are more common in people with diabetes, especially if the diabetes is not well controlled. Women with diabetes are more likely to have recurrent vaginal yeast infections, according to the National Women's Health Information Center. (Read about "Vaginal Yeast Infections") Uncontrolled diabetes also increases the risk of thrush. (Read about "Thrush")

Screening for diabetes

During a screening, medical personnel will test to see if your blood glucose level is elevated. The fasting plasma glucose test is the preferred test for diagnosing type 1 or type 2 diabetes, according to NIDDK. It is most reliable when done in the morning. You may want to discuss the best time to take the test with your doctor. NIDDK says a diagnosis of diabetes can be made after positive results on any one of three tests, with confirmation from a second positive test on a different day:

• A random (taken any time of day) plasma glucose value of 200 mg/dL or more, along with the presence of diabetes symptoms.
• A plasma glucose value of 126 mg/dL or more after a person has fasted for 8 hours.
• An oral glucose tolerance test (OGTT) plasma glucose value of 200 mg/dL or more in a blood sample taken 2 hours after a person has consumed a drink containing 75 grams of glucose dissolved in water. This test, taken in a laboratory or the doctor's office, measures plasma glucose at timed intervals over a 3-hour period.

These tests measure whether or not your blood glucose level is higher than what's considered normal. If it's high you may be able to restore your blood glucose level to a normal level through diet and exercise. Your doctor may also prescribe medication or insulin. As with any medication, talk with your doctor about possible side effects or interactions, especially if you're also on medication for high blood pressure.

Gestational diabetes is diagnosed based on plasma glucose values measured during the OGTT, according to NIDDK. Glucose levels are normally lower during pregnancy, so the levels for diagnosis of diabetes in pregnancy are lower. If a woman has two plasma glucose values meeting or exceeding any of the following numbers, she is considered to have gestational diabetes:

• a fasting plasma glucose level of 95 mg/dL
• 1-hour level of 180 mg/dL
• a 2-hour level of 155 mg/dL
• a 3-hour level of 140 mg/dL

Monitoring and treating diabetes

It's essential that someone with diabetes follow a healthy diet. (Read about "Dietary Guidelines") You should work with your doctor, registered dietician or healthcare provider to develop a meal plan. This is a guide that tells you how much and what kinds of food you can choose to eat at meals and snack times. By reading food labels (Read about "Food Labels"), buying healthy foods and following your food plan, you can help keep your diet on track.

It's also imperative for anyone with diabetes to monitor their blood sugar level carefully. Most methods of monitoring blood glucose require a blood sample, usually obtained by using an automatic lancing device on a finger. Some meters use a blood sample from a less sensitive area, such as the upper arm, forearm or thigh. NIDDK says some devices use a beam of light instead of a lancet to pierce the skin, but these are not commonly available. The drop of blood is then placed on the end of a specially coated strip, called a testing strip. The strip has a chemical on it that makes it change color according to how much glucose is in the blood. ADA says that it is vital that you compare your test results to the goals you and your healthcare provider established. If you are not meeting your goals at least 75 percent of the time, you need to discuss this with your healthcare provider. Changes may be needed in your medication, insulin, diet or exercise.

There are also continuous monitoring systems. A sensor can be inserted under the skin to provide glucose values every few minutes. Continuous measurements must be used in conjunction with fingerstick measurements.

In addition to daily monitoring of blood sugar, other tests can be used. One is the hemoglobin A1c test. According to the National Diabetes Education Program (NDEP), this test shows the average amount of sugar in your blood over the last 2-3 months. It is a simple lab test done by your health care provider. NDEP calls it the best test to find out if your blood sugar is under control and says diabetics should have a hemoglobin A1c test at least twice a year. The American Diabetes Association recommends an A1c target of less than 7 percent for optimal blood sugar control.

For someone with diabetes, healthy eating, physical activity, oral medications and/or insulin are the basic therapies for controlling blood sugar levels. Insulin can be delivered via one of two methods - injections or an insulin pump. The amount of insulin must be balanced with food intake and daily activities. Insulin cannot be taken orally because it would be broken down during digestion. It must be injected. ADA says, when injected, it must be injected into the fat under your skin for it to get into your blood and keep your blood sugar level as close to normal as possible. Insulin can be injected through a syringe, a pen or through a pump system that feeds the insulin into the body through a needle or catheter inserted just under the skin. There are also different types of insulin. They vary in how soon they start to work, when they reach their full strength, and how long they last in the body. ADA says insulin should never be stored in very hot or very cold locations. When using insulin, blood glucose levels must be closely monitored through frequent blood glucose checking. NIDDK says when blood glucose levels drop too low - a condition known as hypoglycemia - a person can become nervous, shaky and confused. Judgment can be impaired. If blood glucose falls too low, a person can faint. This is considered a medical emergency and emergency personnel should be called. Your healthcare provider can give you instructions on how to deal with milder episodes, and on ways to prevent or minimize them.

In addition to insulin, there are also medications. ADA says there are different classes of diabetes drugs. Some drugs work to help the body make more insulin. Others sensitize the body to the insulin that is already present. Others slow or block the breakdown of starches and some sugars. Still others enhance the body's own ability to lower blood sugar. The drugs may be used alone or in combination. It's important to ask your doctor about any side effects to be aware of, as well as any potential interactions. (Read about "Medicine Safety") Some newer classes of drugs support the actions of hormones - called incretins - produced in the small intestine during digestion. Incretins are hormones that work to increase insulin secretion.

ADA says good control of blood glucose levels, a healthy diet and regular checkups are the keys to preventing diabetes-related eye and kidney problems:

• Patients with diabetes should see their eye care professional annually for a dilated eye examination, in order to detect a condition called retinopathy early, and possibly prevent blindness. (Read about "Eye Exams")
• They should have regular visits with their healthcare professional, and check-ups for cholesterol, blood pressure, etc.
• They should examine their feet regularly and see a doctor at once if they notice any sores that are not healing. (Read about "Wound Care") This is especially important because they may have decreased sensation in their feet as a result of peripheral neuropathy. Infections (Read about "Microorganisms") may go undetected, leading potentially to gangrene and even the need for amputation.
• They should maintain a healthy weight, follow their prescribed diet carefully and exercise regularly.
• They should compare their self-testing blood sugar results daily with their goals of blood-glucose control. If they are not meeting these goals, at least 75 percent of the time, they should notify their healthcare provider. Patients should ask their healthcare provider for their goals if they don't already know them.

As mentioned above, it is also essential that people with diabetes be aware of their risk of heart disease, stroke, and heart attack, and work to reduce their risk, both by monitoring their diabetes and goals, and by controlling their weight and blood cholesterol with a low-saturated-fat, low-cholesterol diet and regular exercise.

In some cases, where there are severe complications of type 1 diabetes, a pancreas transplant can be considered. (Read about "Transplants") However this is a serious, life changing operation, and potential benefits and risks must be weighed carefully.

Ideally, everyone with diabetes should be monitored frequently by a health care team knowledgeable in the care of diabetes. The best way to reduce the risk of complications of diabetes is by staying educated about it and by mastering the skills necessary to control your blood glucose levels and keep them as close to the normal range as you can.

Related Information:

    Blood Donation Guidelines

    Pancreatitis

    Primary Immunodeficiency

    Coronary Heart Disease

    Digestive System

    Medicine Safety

    Deep Vein Thrombosis

    Losing Weight