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According to the latest figures from the Centers for Disease Control and Prevention (CDC), over 26 million Americans have diabetes mellitus, which is commonly referred to as diabetes. That's about 8 percent of the American population. About 7 million of those people have no idea they have diabetes and millions more are at risk of developing it.
Our TYPE 2 DIABETES RISK ASSESSMENT can help you learn more about your own risk factors for the most common type of diabetes, type 2 diabetes.
Simply click on the link for the form. Fill it out online to learn more about how specific things affect the risk of developing type 2 diabetes. When you're done, you may want to print it out and share it with your doctor. Any information you enter will NOT be saved once you close the window. This is to protect your privacy. When you're done, simply close the form window, and continue reading.
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.
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 (commonly referred to as insulin-resistance), 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.
The American Diabetes Association (ADA) and NIDDK say there are different types of diabetes and insulin-resistance:
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.
Diabetes can also result from specific genetic conditions, as well as from surgery, medications, infections, pancreatic disease, and other illnesses.
Symptoms of diabetes can vary, but the American Academy of Family Physicians says typical symptoms, especially for Type 1 diabetes, include:
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:
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 and care of the feet, as well as control of blood glucose levels are 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")
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:
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 pregnant woman has two plasma glucose values meeting or exceeding any of the following numbers, she is considered to have gestational diabetes:
For someone with diabetes, healthy eating, physical activity, oral medications and/or insulin are the basic therapies for controlling blood sugar levels.
Diet - It's essential that someone with any type of 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.
Monitoring blood sugar - It's also imperative for anyone with diabetes to monitor their blood sugar level carefully. Options include:
Glucose monitors - 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.
Insulin - Insulin is essential for anyone with Type 1 diabetes. People with Type 2 diabetes may need to take insulin as well. 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.
Medications - 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 check-ups are the keys to preventing diabetes-related eye and kidney problems:
Dental care is also important, including regular check-ups. CDC says that people with diabetes are more likely to have problems with their teeth and gums. (Read about "Oral Health")
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 risks, 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.
All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.
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