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Encyclopedia -> Disease -> D -> Diabetes Alternate Names: Diabetes mellitus Causes and Risks: To understand diabetes, first consider the normal process of food metabolism. Several things happen when food is digested:
People with diabetes have high blood glucose. This is because their pancreas does not make enough insulin, or their muscle, fat and liver do not respond to insulin normally, or both. There are three major types of diabetes:
Diabetes affects 16 million Americans. There are many risk factors for diabetes, including:
The American Diabetes Association recommends that all adults be screened for diabetes at least every three years. A person at high risk should be screened more often. Prevention: Maintaining an ideal body weight and an active lifestyle may prevent the onset of type 2 diabetes. Currently there is no way to prevent type 1 diabetes. Symptoms: High blood levels of glucose can cause several problems, including frequent urination, excessive thirst, hunger, fatigue, weight loss and blurry vision. However, some people with high blood sugar experience no symptoms at all. About 40% of Type 2 diabetics have no symptoms of their condition. Symptoms of Type 1 diabetes:
Symptoms of Type 2 diabetes:
Signs and Tests:
Patients with Type 1 diabetes usually develop symptoms over a short period of time, and the condition is often diagnosed in an emergency setting. In addition to having high glucose levels, acutely ill Type 1 diabetics have high levels of ketones. Ketones are produced by the breakdown of fat and muscle, and they are toxic at high levels. Ketones in the blood cause a condition called "acidosis" (low blood pH). Urine testing detects both glucose and ketones in the urine. Blood glucose levels are also high. Type 2 diabetes is diagnosed when:
The hemoglobin A1c (HbA1c) level is a measure of average blood glucose during the previous two to three months. It is used to monitor a patient’s response to diabetes treatment. Treatment: There is no cure for diabetes. The immediate goals of treatment are to stabilize the blood sugar and to eliminate the symptoms of high blood sugar. The long-term goals of treatment are to prolong life, improve the quality of life, relieve symptoms, and prevent long-term complications such as heart disease and kidney failure. The American Diabetes Association recommends that pre-meal blood sugars fall in the range of 80 to 120 milligrams per deciliter, bedtime blood sugars fall in the range of 100 to 140 milligrams per deciliter, and HbA1c levels are at or below 7 percent. Education, diet, exercise, weight control, medication, blood glucose self-testing, and foot care are vital for good control of diabetes and prevention of its complications. EDUCATION: Diabetes education is an important part of a treatment plan. People can learn many skills, including:
After patients learn the basics of diabetes care, many go on to learn how their diabetes started and how it can cause long-term health problems. People with diabetes need to review and update their knowledge, because new research and improved ways to treat diabetes are constantly being developed. DIET: The American Diabetes Association (ADA) currently recommends that 50-60% of a person’s diet should come from carbohydrates (starches and sugars), 10-20% from protein, and less than 30% from fats. The ADA no longer recommends a specific number of calories per day. Specific meal plans are based on an individual’s usual food intake. 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 sugars from becoming extremely high or low. Type 2 diabetics should eat diets that are well-balanced and low fat. A registered dietician can be very helpful in planning a diabetic’s dietary needs. EXERCISE: Regular exercise is especially important for the person with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. The Nurses Health Study has shown that diabetics who exercise are less likely to experience a heart attack or stroke than diabetics who do not exercise regularly. A diabetic should be evaluated by his or her physician before starting an exercise program. Here are some exercise considerations:
MEDICATION: Medications to treat diabetes include insulin and glucose-lowering pills. People with Type 1 diabetes cannot make their own insulin, so they must take insulin injections every day to survive. People with Type 2 diabetes make insulin, but they do not use it effectively. They can survive without insulin injections, but many take insulin shots to achieve control of their blood sugar levels. Insulin must be injected under the skin using a needle and syringe, or in some cases, an insulin pump. Insulin is not available in oral form. There are several types of insulin preparations. They differ in how fast they start to work and how long they work. Insulin injections may be required only once a day or several times a day. Sometimes different types of insulin are mixed together in a single injection. The types of insulin to use, insulin doses, and number of daily injections are chosen by a healthcare professional trained to provide diabetes care. People needing insulin are taught to give themselves their injections by their healthcare providers or diabetes educators. Unlike Type 1 diabetes, Type 2 diabetes may respond to treatment with exercise, diet, or oral medications. There are several oral medications that lower blood glucose in Type 2 diabetes. They fall into one of three groups:
Occasionally, people with Type 2 diabetes no longer need medication if they exercise, restrict their diet, and lose weight. However, most Type 2 diabetics will require more than one medication for good blood sugar control within three years of starting their first medication. Different groups of oral medications may be combined, or insulin and oral medications may be used together. Presently, oral medications are not used to treat diabetes occurring in pregnancy. Gestational diabetes is treated with diet and insulin. SELF-TESTING: Blood sugar testing, also called "self-monitoring," is done using a special meter called a glucometer to check the amount of glucose in a drop of blood. Testing is usually done before meals and at bedtime, though more frequent testing may be needed during times of illness or stress. If it is done on a regular basis, testing informs the diabetic patient and their healthcare provider how well diet, exercise, and medication are working together to control their diabetes. Blood sugar testing results can be used to adjust meals, activity, or medications to keep blood sugar levels within an appropriate range. They allow healthcare providers to recommend changes in diabetes treatment. Testing will identify high blood sugar and low blood sugar levels before serious problems develop. Ketone testing is a second test that is used in Type 1 diabetes. Ketones build up in the blood when there is not enough insulin in Type 1diabetes and eventually "spill over" into the urine. The ketone test is done on a urine sample. High levels of blood ketones may result in a serious condition called ketoacidosis. Ketone testing is usually done:
FOOT CARE: People with diabetes are at risk for foot injuries due to numbness caused by nerve damage and low blood flow to the legs and feet. The most serious injury is a foot ulcer. Diabetic foot ulcers are at very high risk of becoming infected, and sometimes they cannot be healed. Non-healing foot ulcers are a frequent cause of amputation in diabetics. To prevent foot injury, diabetics should adopt a daily routine of checking and caring for their feet as follows:
Support Groups: The stress of illness can often be helped by joining a support group where members share common experiences and problems. See diabetes – support group. Prognosis: For many years, it was thought that the long-term complications of diabetes were inevitable. We now know that this does not have to be true for most people. Diabetes is frequently complicated by heart disease, stroke, kidney failure, impaired vision or blindness, diseases of the nervous system, and foot and leg amputations. Recent studies show that good blood sugar control can prevent these complications. The Diabetes Control and Complications Trial (DCCT) studied the effects of tight blood sugar control on complications in Type 1 diabetes. Patients treated for tight blood glucose control had an average HbA1c of approximately 7 percent, while patients treated less aggressively had an average HbA1c of about 9 percent. At the end of the study, the tight blood glucose group had dramatically less kidney disease, eye disease, and nervous system disease than the less aggressively treated patients. The United Kingdom Prospective Diabetes Study (UKPDS) studied the effects of tight blood glucose control in patients with Type 2 diabetes. This study also found dramatically lower rates of kidney, eye, and nervous system complications in patients with tight control of blood glucose (meaning an average HbA1c of 7%). In addition, there was a significant drop in all diabetes-related deaths, including lower risks of heart attack and stroke. Tight control of blood pressure was also found to lower the risks of heart disease and stroke. The results of the DCCT and UKPDS studies confirm that good blood sugar control reduces the risk of long-term complications in both Type 1 and Type 2 diabetics. Complications: Possible complications include:
Go to the emergency room or call the local emergency number (such as 911) if symptoms of ketoacidosis are present:
Go to the emergency room or call the local emergency number if symptoms of extremely low blood sugar (";hypoglycemic coma"; or ";insulin reaction";) are present:
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