DETAILS OF DIABETES
DEFINITION
Diabetes is a life-long disease marked by high levels of sugar in the blood. It can be caused by too little insulin (a hormone produced by the pancreas to regulate blood sugar), resistance to insulin, or both.
CAUSES, INCIDENCE, AND RISK FACTORS
To understand diabetes, it is important to first understand the normal process of food metabolism. 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 glucose. This is because their pancreas does not make enough insulin or their muscle, fat, and liver cells do not respond to insulin normally, or both.
There are three major types of diabetes:
Type 1 diabetes is usually diagnosed in childhood. The body makes little or no insulin, and daily injections of insulin are required to sustain life. Without proper daily management, medical emergencies can arise.
Type 2 diabetes is far more common than type 1 and makes up 90% or more of all cases of diabetes. It usually occurs in adulthood. Here, the pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the 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 the growing number of older Americans, increasing obesity, and failure to exercise.
Gestational diabetes is high blood glucose that develops at any time during pregnancy in a person who does not have diabetes.
Diabetes affects about 18 million Americans. There are many risk factors for diabetes, including:
A parent, brother, or sister with diabetes
Obesity
Age greater than 45 years
Some ethnic groups (particularly African-Americans and Hispanic Americans)
Gestational diabetes or delivering a baby weighing more than 9 pounds
High blood pressure
High blood levels of triglycerides (a type of fat molecule)
High blood cholesterol level
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.
SYMPTOMS
High blood levels of glucose can cause several problems, including frequent urination, excessive thirst, hunger, fatigue, weight loss, and blurry vision. However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.
Symptoms of type 1 diabetes:
Increased thirst
Increased urination
Weight loss in spite of increased appetite
Fatigue
Nausea
Vomiting
Symptoms of type 2 diabetes:
Increased thirst
Increased urination
Increased appetite
Fatigue
Blurred vision
Slow-healing infections
Impotence in men
SIGNS AND TESTS
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 glucose 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 pre-diabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.
Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)
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.)
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.
TREATMENT
There is no cure for diabetes. The immediate goals are to stabilize your blood sugar and eliminate the symptoms of high blood sugar. The long-term goals of treatment are to prolong life, relieve symptoms, and prevent long-term complications such as heart disease and kidney failure.
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 and/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. People with diabetes need to review and update their knowledge, because new research and improved ways to treat diabetes are constantly being developed.
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. Your specific meal plans need to be tailored to your food habits and preferences. 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 follow a well-balanced and low-fat diet.
A registered dietician can be very helpful in planning dietary needs.
Weight management is important to achieving control of diabetes. Some people with type 2 diabetes can stop medications after losing excess weight, although the diabetes is still present.
HOW TO TAKE INSULIN OR ORAL MEDICATION
Medications to treat diabetes include insulin and glucose-lowering pills, called oral hypoglycemic agents. The bodies of people with type 1 diabetes cannot make their own insulin, so daily insulin injections are required. The bodies of people with type 2 diabetes make insulin but cannot use it effectively.
Insulin is not available in oral form. It is delivered by injections that are generally required one to four times per day. Some people use an insulin pump, which is worn at all times and delivers a steady flow of insulin throughout the day.
Insulin preparations differ in how quickly they start to work and how long they remain active. Sometimes different types of insulin are mixed together in a single injection. The types of insulin to use, the doses required, and the number of daily injections are chosen by a health care professional trained to provide diabetes care.
People who need insulin are taught to give themselves injections by their health care providers or diabetes educators.
Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and/or oral medications. There are several oral hypoglycemic agents that lower blood glucose in type 2 diabetes. They fall into one of three groups:
Medications that increase insulin production by the pancreas. These include Amaryl, Glucotrol, and Glucotrol XL, Micronase, Diabeta, Glynase, Prandin, and Starlix.
Medications that increase sensitivity to insulin. These include Glucophage, Avandia, and Actos.
Medications that delay absorption of glucose from the gut. These include Precose and Glyset.
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.
Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity, because when their ideal weight is reached, their own insulin and a careful diet can control their blood glucose levels.
Oral hypoglycemic agents are not known to be safe for use in pregnancy; women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy and while breast-feeding.
Gestational diabetes is treated with diet and insulin.
SELF-TESTING
Self-monitoring of blood glucose is done by checking the glucose content of a drop of blood. Regular testing tells you how well diet, medication, and exercise are working together to control your diabetes.
The results of the test can be used to adjust meals, activity, or medications to keep blood sugar levels in an appropriate range. Testing provides valuable information for the health care provider and identifies high and low blood sugar levels before serious problems develop.
The American Diabetes Association recommends that premeal blood sugar levels fall in the range of 80 to 120 mg/dL and bedtime blood levels fall in the range of 100 to 140 mg/dL. Your doctor may adjust this depending on your circumstances.
You should also ask your doctor how often to check your hemoglobin A1c (HbA1c) level. The HbA1c is a measure of average blood glucose during the previous two to three months. It is a very helpful way to monitor a patient's overall response to diabetes treatment over time. A person without diabetes has an HbA1c around 5%. People with diabetes should try to keep it below 7%.
Ketone testing is another test that is used in type 1 diabetes. Ketones build up in the blood when there is not enough insulin in people with type 1 diabetes, eventually "spilling 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 at the following times:
When the blood sugar is higher than 240 mg/dL
During acute illness (for example, pneumonia, heart attack, or stroke)
When nausea or vomiting occur
During pregnancy
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 diabetics who do not exercise regularly. You should be evaluated by your physician before starting an exercise program.
Here are some exercise considerations:
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 mobile phone or change for a payphone in case of emergency.
Drink extra fluids that do not contain sugar before, during, and after exercise.
Changes in exercise intensity or duration may require changes in diet or medication dose to keep blood sugar levels from going too high or low.
FOOT CARE
People with diabetes are prone to foot problems because of the likelihood of damage to blood vessels and nerves and a decreased ability to fight infection. Problems with blood flow and damage to nerves may cause an injury to the foot to go unnoticed until 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, people with diabetes should adopt a daily routine of checking and caring for the feet as follows:
Check your feet every day, and report sores or changes and signs of infection.
Wash your feet every day with lukewarm water and mild soap, and dry them thoroughly.
Soften dry skin with lotion or petroleum jelly.
Protect feet with comfortable, well-fitting shoes.
Exercise daily to promote good circulation.
See a podiatrist for foot problems or to have corns or calluses removed.
Remove shoes and socks during a visit to your health care provider and remind him or her to examine your feet.
Stop smoking, which hinders blood flow to the feet.
COMPLICATIONS
Emergency complications include diabetic hyperglycemic hyperosmolar coma.
Long-term complications include:
Diabetic retinopathy
Diabetic nephropathy
Diabetic neuropathy
Peripheral vascular disease
Hyperlipidemia, hypertension, atherosclerosis, and coronary artery disease
CALLING YOUR HEALTH CARE PROVIDER
Go to the emergency room or call the local emergency number (such as 911) if symptoms of ketoacidosis occur:
Increased thirst and urination
Nausea
Deep and rapid breathing
Abdominal pain
Sweet-smelling breath
Loss of consciousness
Go to the emergency room or call the local emergency number if symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction) occur:
Weakness
Drowsiness
Headache
Confusion
Dizziness
Double vision
Lack of coordination
Convulsions or unconsciousness
INSULIN
Background Information about Insulin
When we eat, our bodies break food down into organic compounds, one of which is glucose.
The cells of our bodies use glucose as a source of energy for movement, growth, repair, and other functions. But before the cells can use glucose, it must move from the bloodstream into the individual cells. This process requires insulin.
Insulin is produced by the beta cells in the islets of Langerhans in the pancreas. When glucose enters our blood, the pancreas should automatically produce the right amount of insulin to move glucose into our cells. People with type 1 diabetes produce no insulin. People with type 2 diabetes do not always produce enough insulin.
Types of Insulin
There are more than 20 types of insulin products available in four basic forms, each with a different time of onset and duration of action. The decision as to which insulin to choose is based on an individual's lifestyle, a physician's preference and experience, and the person's blood sugar levels. Among the criteria considered in choosing insulin are:
how soon it starts working (onset)
when it works the hardest (peak time)
how long it lasts in the body (duration)
The insulin products used by people with diabetes are either taken from animals (pigs or cows) or manufactured in labs to be identical to human insulin. Beef insulin is no longer available in the United States. Beginning in January 2006, pork insulin for human use will no longer be manufactured or marketed in the U.S.
INSULIN DELIVERY DEVICES
Types of Insulin Delivery Devices
All insulin delivery devices inject insulin through the skin and into the fatty tissue below.Most people inject the insulin with a syringe that delivers insulin just under the skin. Others use insulin pens, jet injectors, or insulin pumps. Several new approaches for taking insulin are under development.
Syringes Syringes are hypodermic needles attached to hollow barrels that people with diabetes use to inject insulin. Insulin syringes are small with very sharp points. Most have a special coating to help the needles enter the skin as painlessly as possible. Insulin syringes come in several different sizes to match insulin strength and dosage.
Insulin Pens
Insulin pens look like pens with cartridges - but the cartridges are filled with insulin rather than ink. They can be used instead of needles for giving insulin injections. Some pens use replaceable cartridges of insulin; other models are totally disposable after the pre-filled cartridge is empty. A fine short needle, like the needle on an insulin syringe, is on the tip of the pen. Users turn a dial to select the desired dose of insulin and press a plunger on the end to deliver the insulin just under the skin.
Jet Injectors
Insulin jet injectors may be an option for people who do not want to use needles. These devices use high pressure air to send a find spray of insulin through the skin. Jet injectors have no needles.
Insulin Pumps
Insulin pumps are small pumping devices worn outside of your body. They connect by flexible tubing to a catheter that is located under the skin of your abdomen. You program the pump to dispense the necessary amount of insulin. Usually, you set the pump to give a steady small dose of insulin, but you can give an additional amount in a short time if needed, such as after a meal. If adjusted properly, these pumps allow close control of your insulin levels without multiple injections. You should not use this type of pump during physical activities that may damage the pump or disrupt the pump's connection to the body. You still need to monitor your blood glucose levels regularly if you use this type of device.
Insulin Delivery Devices Under Development
Researchers are now developing several new methods for delivering insulin. These include the insulin patch and inhaled insulin. The insulin patch, when placed on the skin, will give a continuous, low dose of insulin. To adjust insulin doses before meals, users will pull off the tab on the patch to release insulin. Inhaled insulin delivery systems will give insulin as a dry power, inhaled through the mouth directly into the lungs where it passes into the bloodstream. This aerosol delivery system will likely be about the size of a flashlight and use rapid-acting insulin.
Food and Meal Planning
Because food intake affects the body's need for insulin and insulin's ability to lower blood sugar, diet is the cornerstone of diabetes treatment. Today, diabetes experts no longer recommend a single meal plan for all people with diabetes. Instead, they recommend meal plans that are flexible and take into account a person's lifestyle and particular health needs. The American Diabetes Association recommends that people with diabetes consult a registered dietician to design a meal plan.
Food and Meal Planning
Selecting Foods for a Healthy Meal Plan
The Food Guide Pyramid
Using the Food Label to Help with Food Choices
Overweight, Obesity and Weight-Loss
Dietary Supplements
FDA's Role in Regulating Food and Diet
Food and Meal Planning
Selecting Foods for a Healthy Meal Plan
By following the government's Dietary Guidelines for Americans, you can promote your health and reduce your risk for chronic diseases such as heart disease, certain types of cancer, diabetes, stroke, and osteoporosis. These diseases are leading causes of death and disability among Americans. Good diets can also reduce major risk factors for chronic disease-such as obesity, high blood pressure, and high blood cholesterol. Your food choices, your lifestyle, your environment, and your family history all affect your well-being. It is important for everyone to follow the 10 Dietary Guidelines listed below. If you are at higher risk of having a chronic disease, it is especially important.
The Dietary Guidelines for Americans include the following:
AIM FOR FITNESS . .
Aim for a healthy weight.
Be physically active each day.
BUILD A HEALTHY BASE . . .
Let the Pyramid guide your food choices.
Choose a variety of grains daily, especially whole grains.
Choose a variety of fruits and vegetables daily.
Keep food safe to eat.
CHOOSE SENSIBLY . . .
Choose a diet that is low in saturated fat and cholesterol and moderate in total fat.
Choose beverages and foods to moderate your intake of sugars.
Choose and prepare foods with less salt.
If you drink alcoholic beverages, do so in moderation.
Some people with diabetes use the Exchange Lists for Meal Planning. This system, established by the American Dietetic and American Diabetes associations, separates foods into six categories based on their nutritional makeup. People following this plan choose a set number of servings from each category daily, depending on their nutritional needs.
The Food Guide Pyramid
The Food Guide Pyramid can help you put the Dietary Guidelines into action. The pyramid illustrates the research-based food guidance developed by the U.S. Department of Agriculture and supported by the Department of Health and Human Services. It is based on USDA's research on what foods Americans eat, what nutrients are in these foods, and how to make the best food choices to promote good health. It outlines what to eat each day, but it is not a rigid prescription. You can use it as a general guide in choosing a healthful diet that is right for you. The pyramid calls for eating a variety of foods to get the nutrients you need, and, at the same time, the right amount of calories to maintain a healthy weight.
Using the food label to help with food choices
Under regulations from the Food and Drug Administration of the Department of Health and Human Services and the Food Safety and Inspection Service of the U.S. Department of Agriculture, the food label offers more complete, useful and accurate nutrition information than ever before.
With today's food labels, consumers get
nutrition information about almost every food in the grocery store
distinctive, easy-to-read formats that enable consumers to more quickly find the information they need to make healthful food choices
information on the amount per serving of saturated fat, cholesterol, dietary fiber, and other nutrients of major health concern
nutrient reference values, expressed as % Daily Values, that help consumers see how a food fits into an overall daily diet
uniform definitions for terms that describe a food's nutrient content--such as "light," "low-fat," and "high-fiber"--to ensure that such terms mean the same for any product on which they appear
claims about the relationship between a nutrient or food and a disease or health-related condition, such as calcium and osteoporosis, and fat and cancer. These are helpful for people who are concerned about eating foods that may help keep them healthier longer.
standardized serving sizes that make nutritional comparisons of similar products easier
declaration of total percentage of juice in juice drinks. This enables consumers to know exactly how much juice is in a product.
A diet low in saturated fat and cholesterol may help reduce the risk of coronary heart disease.
A diet rich in fruits, vegetables and grain products that contain fiber, particularly soluble fiber, and are low in saturated fat and cholesterol may help reduce the risk of coronary heart disease.
Soluble fiber from whole oats, as part of a diet low in saturated fat and cholesterol, may help reduce the risk of coronary heart disease.
Overweight, Obesity, and Weight-Loss
More than 60 percent of U.S. adults are either overweight or obese, according to the Centers for Disease Control and Prevention (CDC). While the number of overweight people has been slowly climbing since the 1980s, the number of obese adults has nearly doubled since then.
Excess weight and physical inactivity account for more than 300,000 premature deaths each year in the United States, second only to deaths related to smoking, says the CDC. People who are overweight or obese are more likely to develop heart disease, stroke, high blood pressure, diabetes, gallbladder disease and joint pain caused by excess uric acid (gout). Excess weight can also cause interrupted breathing during sleep (sleep apnea) and wearing away of the joints (osteoarthritis).
To address the public health epidemic of being overweight or obese, former Surgeon General David Satcher issued a "call to action" in December 2001. Satcher's report, The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity, outlined strategies that communities can use in helping to address the problems. Those options included requiring physical education at all school grades, providing more healthy food options on school campuses, and providing safe and accessible recreational facilities for residents of all ages.
COMPLICATIONS OF DIABETES
Heart and Blood Vessel Disease
Heart disease is the leading cause of death for people with diabetes.
Three out of four diabetes-related deaths are caused by heart and blood vessel (cardiovascular) disease. People with diabetes are 2-4 times more likely to have heart disease than persons without diabetes. Even people with type 2 diabetes who do not have heart disease have an increased risk of having a heart attack. People with diabetes also tend to have other risk factors for heart disease including obesity, high blood pressure, and hardening of the arteries (atherosclerosis).
In recent years, FDA has approved drugs that lower blood pressure and reduce the risk of heart attacks and strokes. It has also approved lipid-altering drugs that target abnormalities of cholesterol and triglycerides.
BLINDNESS
Adults with diabetes should have yearly eye exams to ensure the health of their eyes and to protect their vision.
Over time, high blood sugar levels can damage the blood vessels that feed the retina of the eye. In nonproliferative diabetic retinopathy (NPDR), an early stage of diabetic eye disease, the blood vessels may leak fluid. This may cause the retina to swell and vision to blur, a condition called diabetic macular edema. In advanced or proliferative diabetic retinopathy (PDR), abnormal new blood vessels grow on the surface of the retina. The abnormal blood vessels don't supply the retina with normal blood flow. In addition, they may eventually pull on the retina and cause it to detach.
Some cases of diabetic retinopathy can be treated with laser surgery. In this procedure, doctors aim a strong beam of light onto the patient's retina to shrink or seal leaking or abnormal vessels. Laser surgery can't restore vision already lost, so early detection is important. In some advanced cases of PDR, a surgeon may remove the vitreous portion of the eye and replace it with a clear solution (called a vitrectomy).
KIDNEY FAILURE
Over time, high blood sugar levels can damage the kidneys. Even when drugs and diet are able to control diabetes, the disease can lead to kidney disease (diabetic nephropathy) and kidney failure.
Healthy kidneys act like filters to clean the blood of waste products and extra fluid. Damaged kidneys do not clean the blood well. Instead, waste products and fluid build up in the blood.
People with kidney failure must either have dialysis treatment (to substitute for some of the filtering functions of the kidneys) or receive a kidney transplant.
Foot Ulcers
Adults with diabetes need to take special care of their feet.
People with diabetes are at risk for foot injuries due to numbness caused by nerve damage (diabetic neuropathy) 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 people with diabetes. Patients with foot ulcers may use wound dressings, skin substitutes, or other treatments to protect and heal their skin.
Wound dressings are medical devices that are used to protect ulcerated skin and assist in its healing. They can range from simple bandages that you can buy in the drug store to complex materials that contain antibacterial and antiviral substances.
Skin substitutes are products that help in closing the wounds of slow healing ulcers in patients with diabetes. They are made from human cells known as fibroblasts that are placed on a dissolvable mesh material. When the mesh material is placed on the ulcer, it is gradually absorbed and the human cells grow and replace the damaged tissue in the ulcer.
FDA has cleared one gel product (becaplermin) that is used as a treatment for diabetic foot ulcers. This product contains genetically engineered platelet-derived growth factor, one of the proteins the body produces to encourage new tissue growth. Clinical studies of the product indicated that the likelihood of complete ulcer closure, after up to 20 weeks of treatment, was greater when becaplermin is used.
The classic symptoms of diabetes are:
excessive urination, including frequent trips to the bathroom in the middle of the night
intense thirst and hunger
severe fatigue.
Other symptoms of diabetes may include:
dry skin
blurred vision
unexplained weight loss
thin, malnourished appearance.
While the presence of these symptoms alone is not diagnostic for diabetes, if you have any of the symptoms listed above you should contact your doctor to test for diabetes. Several tests are available to assess your risk of diabetes. Find out about diabetic products for less painful testing.
Diagnosing Diabetes: The Glucose Tolerance Test and Others
When diabetes symptoms are present your doctor may perform one of more procedures used to test for diabetes. Most of them are blood tests that seek to confirm high blood glucose levels when compared to normal blood glucose levels. Urine tests are often used as a screening test for diabetes since high blood glucose often results in glucose spilling into the urine. The amount of glucose in your blood is measured in milligrams per deciliter (mg/dl). Below you'll find descriptions of the more common diabetes tests, and what their results mean.Fasting Plasma Glucose Test
One of the more common tests for diabetes, the fasting plasma glucose test, measures blood glucose after a 12- to 14-hour fast. Fasting prompts the body to release glucagon, a hormone that acts to raise normal blood glucose levels. In the non-diabetic, insulin is released to bring the high blood glucose back down to a normal level. This doesn't occur in the body of a person with diabetes. Normal blood glucose levels after a fast should be in the range of 70–100 mg/dl. A blood glucose reading of 126 mg/dl or higher suggests diabetes; with high results the test will often be repeated. If the blood glucose results of a second test measure 126 mg/dl or higher, a diagnosis of diabetes is usually confirmed.
Oral Glucose Tolerance Test
Like the fasting plasma glucose test, an oral glucose tolerance test is performed after fasting. The patient drinks a glucose solution, and blood tests are taken several times over the course of a three-hour period. If insulin production is within normal limits, blood glucose should rise over the first hour to 160-180 mg/dl, and then drop back to normal. If diabetes is present, the high blood glucose level will take much longer to drop.
Here's what the test results of the blood drawn two hours after drinking the glucose solution indicate:
A reading below 140 mg/dl is normal.
A reading between 140 and 199 mg/dl indicates glucose intolerance.
A reading of 200 mg/dl or more reveals diabetes.
INSULIN HUMAN
VASCULAR HEALTH AND DIABETES
DIABETES
What is diabetes?
If there is not enough insulin activity, or the body does not use the insulin effectively, the body's blood glucose rises. This condition with high blood glucose levels is called diabetes.
Glucose - The body requires a certain amount of sugar (glucose) in the blood. Too much causes damage to the body proteins. Too little prevents body cells from working properly. The amount of glucose is controlled by insulin.
Pancreas - Insulin comes from the pancreas, a gland lying just below the stomach. Insulin goes straight through the blood stream to the tissues where it acts.
Insulin - The starch in food is broken down into glucose. This glucose makes the pancreas release insulin. The insulin allows tissues to use the glucose.
Complications - High blood glucose levels can affect the heart, brain, limbs, eyes, kidneys and nerves.
THERE ARE TWO MAIN
types of diabetes
Type 1 - This form of diabetes is insulin dependent - that is regular insulin injections are needed. This type of diabetes usually affects younger people.
Type 2 - This form of diabetes is non-insulin dependent and usually affects older people. It can often be treated effectively with a diet and regular exercise, though medication may be necessary. Paradoxically, a few people with Type 2 diabetes may eventually need a small amount of insulin, as well as their tablets.
This section will concentrate on Type 2 Diabetes, previously known as maturity-onset diabetes.
Your risk of diabetes can be easily assessed today - make an appointment with your doctor.
Are you at risk of developing Type 2 diabetes?
Your risk of developing diabetes during your life time is at least 1 in 10.
Risk factor test
Try this quick risk tick test - if you tick 3 or over you should consult your doctor.
[___] Over 40 years old
[___] Have a blood relative with diabetes
[___] Do not exercise regularly
[___] Your waist measurement is over 90cm (men), or over 80cm (women)
[___] Your blood pressure is above 140/90 or you use medication for blood pressure
[___] Your are Aboriginal or Torres Strait Islander
[ ___] You are from Southern Europe, the Middle East, South East Asia, or are Polynesian or Indian.
Total Score - If you have ticked 3 or more risk factors you are at high risk and should see your doctor for a check-up.
Symptoms for diabetes Type 2
It is important to be aware that you could have diabetes and diabetes related problems without symptoms.
Symptoms test
Place a tick in the box if you:
[___] Urinate excessively
[___] Always thirsty
[___] Lost weight for no reason
[___] Experience numbness or tingling in the feet or legs
[___] Have blurred vision
[___] Always feel tired
[___] Itching skin or skin infections
Total Score - If you have ticked 2 or more symptoms you are at high risk and should see your doctor for a check-up.
Diagnosis
There are two levels of testing your blood glucose level (BGL). The first level is the finger prick blood glucose test - people who have been diagnosed as having diabetes use this test daily to monitor their control of their diabetes.
If you have symptoms of diabetes then your doctor will arrange for you to have a fasting blood glucose level test. You need to fast for 12 hours (it is OK to have a drink of water, or black tea or coffee without sugar) before the blood test is conducted. Only if your glucose levels are borderline, may your doctor want you to have a Glucose Tolerance Test. This tests your body's ability to handle a glucose load over a two hour period after being given a glucose drink.
DIABETES MEDICATION
Tablets
There are many different types of tablets to treat Type 2 diabetes. Some are short acting and need to be taken twice or three times a day. Others have a longer duration of action but this may increase the chance of becoming hypoglycaemic, particularly in older people. One class of medication is often used early on, particularly in people who are overweight, as it mildly suppresses the appetite as well as helping the body use its own insulin more effectively.
If your doctor prescribes tablets, make sure you know what you are taking, why you are on that particular medication, what are the side effects, and what are the interactions.
Insulin
Even with Type 2 diabetes, which is commonly known as non-insulin dependent diabetes (NIDDM), patients may paradoxically need insulin later in the course of the illness. This is because the pancreas may finally exhaust its capacity to produce enough insulin even with the help of diabetic tablets. Patients with Type 2 diabetes commonly need lower doses of insulin than Type 1 diabetics, and insulin treatment may be combined with tablets. Finally insulin may be used in the short term when you are unwell or hospitalised, and your diabetes is temporarily more difficult to control than usual.
Be sure to carry identification with you (for example one of the commercially available bracelet systems) so that in the event of an emergency it is easy to establish that you are diabetic and what medication you are taking.
Summary
The bad news is that diabetes is Australia's fastest growing chronic illness and it is the seventh highest cause of death in Australia. The good news is that today the control of diabetes is simpler and more effective than ever before.
Make sure that you consider your own risk factors, and see your doctor to have your blood glucose checked.
If you already have diabetes, careful control of blood glucose, maintaining a healthy lifestyle, and working with your diabetic team to regularly check for complications will ensure that you remain as healthy as possible for as long as possible.
Diagram showing the main features of diabetes mellitus
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Early exposure to cows milk and lack of breast feeding
Date
Authors
Subjects
Results
1997
Gimeno et al
346 Brazilian diabetic children <18 years of age
Short duration of exclusive breast feeding is a risk factor for Type 1. Introduction of cow's milk before 8 days is a risk factor
1998
Jones et al
160 boys & 150 girls with Type 1
Increased risks associated with not breast feeding but these were not statistically significant
2001
Samuelsson & Ludvigsson
297 Swedish diabetic children diagnosed <15 years of age & seasonal variation with disease
Seasonality was most pronounced in children who developed diabetes between the ages of 10 and 15 years. Indicated increased risk in those who had been exclusively breastfed for a shorter time
2001
Monetini et al
28 Italian non-diabetic children, 16 exclusively breast fed & 12 bottle fed with cow's milk
Breastfeeding within the first 4 months of life prevents the generation of antibody response to bovine beta-casein
1997
Pettitt et al
720 Pima Indians
Exclusive breast feeding for first 2/12 of life is associated with lower rate of T2
2002
Young et al
46 native Canadian type 2 patients <18 years of age
Breastfeeding reduces the risk of Type 2 diabetes
CHILDHOOD DIABETES
Diabetes is an evolving disease with changing patterns seen in both type 1 and type 2 diabetes. A wide variation exists in worldwide incidence rates of type 1 with the highest occurring in Finland (over 45% per 100,000 under the age of 15 years) and the lowest in parts of China. In Europe the incidence of type 1 diabetes in children has risen by 2-5%. Diabetes is the most common endocrine disease of childhood.
In some countries, such as Japan, there are 4 times as many adolescents with type 2 diabetes as with type 1. The Japanese health authorities were among the first to realize the importance of type 2 diabetes in schoolchildren following the start of urinary glucose screening in schools in 1974. Their data now show the seriousness of type 2 diabetes in adolescence. Obesity, a high energy, high fat diet, reduced exercise, urbanization and other lifestyle changes seem to be the major aetiological factors in the type 2 diabetes epidemic. There is so much readily available food available to so many populations.
There is also suggestive evidence that poor maternal nutrition sufficient to cause intrauterine growth retardation may leave a legacy of reprogrammed fetal cells and an increased risk of future type 2 diabetes when nutrition becomes abundant in later life.
Why vegans may be at reduced risk
· Vegans have less obesity.
· Lower intakes of saturated fat
· High intake of fibre, especially soluble fibre
· High intakes of unrefined foods
OBESITY
The vegan diet generally promotes healthful weights. It is less calorie dense and more nutrient dense than the western diet. The advantages are well recognised. Obesity is fast moving to the top of the health agenda and Britain has overtaken Germany to become the fattest nation in Europe with 1 in 4 of our children now overweight. Treating obesity related illnesses such as diabetes costs the NHS around £1.7 billion a year - £200 million more than smoking related diseases. Obesity is the single most obvious risk factor for type 2 diabetes. Lifestyle modification programmes starting in childhood are urgently needed and society needs to change its attitude to childhood nutrition, play and exercise.
FATS
There is no physiological requirement for dietary fat, only for essential fatty acids which are the polyunsaturated fats - linoleic and alpha-linolenic which are principally from plant sources. Humans and other mammals lack the enzyme to synthesize them therefore they are essential in the diet. The two types of fat I will be exploring in relation to diabetes are saturated fats and trans fatty acids.
TYPE 1 DIABETES
In people with type 1 diabetes, glucose isn't moved into the cells because insulin is not available. When glucose builds up in the blood instead of going into cells, the body's cells starve for nutrients and other systems in the body must provide energy for many important bodily functions. As a result, high blood glucose develops and can cause:
Dehydration. The build up of sugar in the blood can cause an increase in urination (to try to clear the sugar from the body). When the kidneys lose the glucose through the urine, a large amount of water is also lost, causing dehydration.
Weight loss. The loss of sugar in the urine means a loss of calories which provide energy and therefore many people with high sugars lose weight. (Dehydration also contributes to weight loss.)
Diabetic ketoacidosis (DKA). Without insulin and because the cells are starved of energy, the body breaks down fat cells. One of the products of fat break down is a specific type of acid that can be used by the brain for energy. Unfortunately none of the body's other cells can use this acid for energy, and thus continue to starve without insulin. So, the liver releases the sugar it stores to help out. Since the body cannot use these sugars without insulin, more sugars piles into the blood stream. The combination of high excess sugars, dehydration and acid build up is known as "ketoacidosis" and can be life-threatening if not treated immediately.
Damage to the body. Over time, the high glucose levels in the blood may damage the nerves and small blood vessels of the eyes, kidneys, and heart and predispose a person to atherosclerosis (hardening) of the large arteries that can cause heart attack and stroke.
Who Gets Type 1 Diabetes?
Although the disease usually starts in people under the age of 20, type 1 diabetes may occur at any age.
The disease is relatively uncommon, affecting 1 in 250 Americans. The condition is more common in whites than in blacks and occurs equally in men and women.
What Causes Type 1 Diabetes?
Doctors don't know all the factors that lead to type 1 diabetes. Clearly, the susceptibility to the condition can be inherited.
Doctors have identified that an environmental trigger plays a role in causing the disease. Type 1 diabetes appears to occur when something in the environment -- a toxin or a virus (but doctors aren't sure) -- triggers the immune system to mistakenly attack the pancreas and destroy the beta cells of the pancreas to the point where they can no longer produce sufficient insulin. Markers of this destruction -- called autoantibodies -- can be seen in most people with type 1 diabetes. In fact, they are present in 85% to 90% of people with the condition when the blood sugars are high.
Because it's an autoimmune disease, type 1 diabetes can occur along with other autoimmune diseases such as hyperthyroidism from Grave's disease or the patchy decrease in skin pigmentation that occurs with vitiligo.
What Are the Symptoms?
The symptoms of type 1 diabetes are often subtle, but they can become severe. They include:
Increased thirst
Increased hunger (especially after eating)
Dry mouth
Nausea and occasionally vomiting
Abdominal pain
Frequent urination
Unexplained weight loss (even though you are eating and feel hungry)
Fatigue (weak, tired feeling)
Blurred vision
Heavy, labored breathing (Kussmaul respiration)
Frequent infections of the skin, urinary tract or vagina
COFFEE DRINKERS SHOW LOWER DIABETES RISK
It might be better to start your morning with a cup of coffee than a sugar-sweetened juice, at least where risk for type 2 diabetes is concerned, a new study suggests.
Researchers found that among more than 12,000 middle-aged adults, those who drank four or more cups of coffee each day had a lower risk of developing type 2 diabetes than those who rarely had a cup.
The findings, reported in the American Journal of Epidemiology, agree with those of several past studies.
The reason is not fully clear, but one possibility is that certain coffee components - such as magnesium or chlorogenic acid - improve the body's regulation of blood sugar. Some research also suggests that caffeinated coffee spurs a prolonged spike in metabolism that may help control body weight.
Type 2 diabetes arises when the body loses sensitivity to the hormone insulin, which shuttles sugar from the blood into cells to be used for energy. The disorder is closely associated with obesity.
Obesity link
In contrast to the case with coffee, sugar-filled soft drinks and juices have been linked to obesity and higher diabetes risk in certain studies. In the current one, however, a taste for sweet drinks was not a risk factor for diabetes.
Still, the findings are not a green light to fill up on coffee and sugary drinks, according to the researchers, led by Nina P. Paynter, a doctoral candidate at the Johns Hopkins School of Public Health in Baltimore.
Moderation, as always, is in order, the study's senior author, Dr. W.H. Linda Kao, said. "We feel it is definitely premature to recommend coffee consumption," she advised.
The Hopkins researchers based their findings on data from 12,204 middle-aged US adults who were followed from 1987 to 1999 - all of who were free of diabetes at the outset.
While the coffee-diabetes connection is "intriguing," Kao said, more research is needed to determine whether the beverage itself has a true effect on diabetes risk.
MEDICAL ENCYCLOPEDIA
BLOOD TEST
To monitor the amount of glucose within the blood a person with diabetes should test their blood regularly. The procedure is quite simple and can often be done at home.
MEDICAL ENCYCLOPEDIA
PANCREAS
T
he pancreas is located behind the liver and is where the hormone insulin is produced. Insulin is used by the body to store and utilize glucose.
MEDICAL ENCYCLOPEDIA
GLUCOSE TEST
A person with diabetes constantly manages their blood's sugar (glucose) levels. After a blood sample is taken and tested, it is determined whether the glucose levels are low or high. If glucose levels are too low carbohydrates are ingested. If glucose in the blood is too high, the appropriate amount of insulin is administered into the body such as through an insulin pump
MEDICAL ENCYCLOPEDIA
DIABETIC BLOOD CIRCULATION IN FOOT
People with diabetes are at risk for blood vessel injury, which may be severe enough to cause tissue damage in the legs and feet.
MEDICAL ENCYCLOPEDIA
DIABETIC RETINOPATHY
Diabetes causes an excessive amount of glucose to remain in the blood stream which may cause damage to the blood vessels. Within the eye the damaged vessels may leak blood and fluid into the surrounding tissues and cause vision problems
MEDICAL ENCYCLOPEDIA
ISLETS OF LANGERHANS
Islets of Langerhans contain beta cells and are located within the pancreas. Beta cells produce insulin which is needed to metabolize glucose within the body.
MEDICAL ENCYCLOPEDIA
INSULIN PUMP
Various styles of insulin pumps may be utilized by people with diabetes to inject insulin into the body in a controlled, more convenient and discrete manner.
MEDICAL ENCYCLOPEDIA
TYPE I DIABETES
In response to high levels of glucose in the blood, the insulin-producing cells in the pancreas secrete the hormone insulin. Type I diabetes occurs when these cells are destroyed by the body’s own immune system.
MEDICAL ENCYCLOPEDIA
FOOD AND INSULIN RELEASE
Insulin is a hormone secreted by the pancreas in response to increased glucose levels in the blood.
MEDICAL ENCYCLOPEDIA
INSULIN PRODUCTION AND DIABETES
Insulin is a hormone produced by the pancreas that is necessary for cells to be able to use blood sugar.
MEDICAL ENCYCLOPEDIA
MONITOR BLOOD GLUCOSE - SERIES: PART 1
Set up the meter according to the specific directions that come with your meter. Get the supplies ready, including a new test strip and disposable lancet. Place the lancet into the lancing device.
Morning
6 O’ Clock
Coffee or Tea with Sugar.
8 O’ Clock
4 Idaly or 3 Dosai or 4 Chappathi
11 O’ Clock
Lemon Juice with Salt, Tomato Juice.
After Noon
1 O’ Clock
Rice 2 ½ Cups (250 grms)
Non Veg : Fish, Chicken – 200 gram
Mutton – 100 gram, Egg Daily.
Evening
4 O’ Clock
Coffee or tea with Sugar.
8 O’ Clock
4 Chappatti with Vegetable.
Night
10 O’ Clock
Milk 1 Cup.
