February 6, 2012
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February 6, 2012
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Overview
Once it develops, diabetes is a lifelong condition that affects an estimated 23.6 million people in the United States—that’s almost 8 percent of the population. It’s considered a disorder of the metabolism, meaning that diabetes affects how the body uses food for growth and energy.
Glucose, Insulin, and Diabetes
In people with diabetes, the body is not able to use glucose normally and blood glucose levels are above normal. Glucose is important because it’s the body’s main source of fuel. Glucose is a form of sugar in the blood; when food is eaten, it’s broken down into glucose and passes into the bloodstream, where it provides energy.
Insulin, a hormone produced by the pancreas, is essential for the body’s process of using fuel, or glucose: blood cells need insulin to take up glucose. In people with diabetes, however, the pancreas produces too little or no insulin or their blood cells do not respond effectively to insulin.
As a result of insufficient insulin production or ineffective use, glucose builds up in the blood and, instead of being used as fuel, is passed out of the body in urine. In other words, the body loses its main source of fuel.
There are three main types of diabetes:
What Is Type 1 Diabetes?
Type 1 diabetes is an autoimmune disease. It’s also known as insulin-dependent diabetes. Five to 10 percent of diagnosed diabetes in the United States is type 1.
In autoimmune diseases, the body’s immune system (which normally fights infection) functions abnormally and attacks a part of the body. In type 1 diabetes, the immune system attacks the cells in the pancreas (beta cells) that produce insulin. As a result, a person with type 1 diabetes produces little or no insulin. He or she must take insulin daily to live.
Causes of Type 1 Diabetes
The exact causes of type 1 diabetes are still not known. Researchers suspect that causes include autoimmune, genetic, and environmental factors; viruses may also be involved. Though type 1 diabetes can develop at any age, it most often appears in children and young adults.
Risks for Type 1 Diabetes
Men and women have equal incidence of type 1 diabetes. It can occur at any age, though it most often develops in children. The disease is more common among Whites than among other races.
These risk factors increase the likelihood of developing both type 1 and type 2 diabetes:
What Is Type 2 Diabetes?
Type 2 diabetes is the more-common form of the disease; among people with diabetes, nine out of 10 have type 2. In type 2 diabetes, the pancreas makes insulin for some time, but the body can’t use it effectively. Insulin production eventually decreases, at which time glucose builds up in the blood and the body cannot use it for fuel.
Causes of Type 2 Diabetes
Type 2 diabetes most often affects people who are overweight, older, have a family history of diabetes, are physically inactive, or have had gestational diabetes. Certain ethnicities—such as African American, Mexican American, and Pacific Islander—also have a high incidence of type 2 diabetes.
Risks for Type 2 Diabetes
Pre-diabetes. Pre-diabetes refers to a condition where people have blood glucose levels that are higher than normal but not high enough to be considered diabetes. Pre-diabetes can still be a health concern—it raises the risk of developing type 2 diabetes, heart disease, and stroke. Without prevention, a person with pre-diabetes is likely to develop type 2 diabetes within 10 years. Preventive steps include weight loss of 5 to 7 percent through healthy diet and increased physical activity.
Type 2 diabetes is more common among older people, and many who develop it are overweight; in fact, being overweight or obese is the leading risk factor for type 2 diabetes because excess weight can keep the body from using insulin properly. African Americans, American Indians, Native Hawaiians and other Pacific Islanders and Hispanics have a higher incidence than Whites. Older age, impaired glucose tolerance, physical inactivity, a family history of diabetes or a personal history of gestational diabetes are risk factors for type 2 diabetes.
Diabetes Testing and Diagnosis
Diabetes is most often diagnosed in children and adults using a fasting blood glucose test. This test is performed when the patient hasn’t eaten for eight hours (in other words, after “fasting”) and measures levels of glucose in the blood. Diabetes may be diagnosed with a fasting blood glucose level of 126 milligrams per deciliter (mg/dL) or higher.
Other tests for diabetes include: 1) the oral glucose tolerance test, where blood glucose levels are measured two hours after drinking 75 grams of glucose dissolved in water; a blood glucose level of 200 me/dL indicates diabetes and 2) a blood glucose level of 200 mg/dL or higher taken at any time of day when other symptoms of diabetes are present.
Who should get tested? People who may want to consider testing include those over 45 years of age, especially if they are overweight, and people younger than 45 who are overweight and have one or more additional risk factors. Find a list of risk factors under “Risks.”
Symptoms of Diabetes
Symptoms may develop quickly, but damage to the insulin-producing beta cells in the pancreas may have been going on for some time.
It’s important to know and recognize these symptoms because a person who develops diabetes and is not diagnosed and treated can lapse into a life-threatening diabetic coma. This coma is known as diabetic ketoacidosis.
Treatments
There is no cure for diabetes, but it can be treated, or managed. The main goal in diabetes management is to keep blood glucose levels, cholesterol, and blood pressure as close to normal range as possible. A combination of insulin, physical activity, and healthy diet are the basic tools for treating type 1 diabetes. Type 2 diabetes is managed by healthful eating, regular physical activity, and blood glucose testing to keep track of blood glucose levels. Some people with type 2 diabetes also take medicines (pills, insulin, or other injectable medicine) to help control glucose levels.
Management of diabetes has improved in recent decades. Innovations include quick-acting and long-acting insulins for insulin-dependent (type 1) diabetes, more oral drugs for type 2 diabetes, improved blood glucose monitors, and external insulin pumps to replace daily injections. As well, care for diabetes-related conditions has improved; for example, laser surgery can treat eye disease, and kidney and pancreas transplantation is a possibility for people with organ failure.
Treatment of diabetes is often handled by primary care physicians, though other specialists may be part of the healthcare team. Additional specialists may include an endocrinologist who specializes in diabetes care, a dietician to help with sound food choices, educators certified in diabetes, and a podiatrist and/or ophthalmologist (eye and foot issues are possible complications of diabetes). And, depending on an individual’s overall health, the healthcare team may extend to other specialists—cardiologists for those with heart concerns and obstetricians for pregnant women, for example.
A regular visit to the doctor for someone with diabetes should include:
Complications
Diabetes has a large impact in the United States: it’s been widely recognized as one of the leading causes of death and disability. Cardiovascular disease is a serious risk for people with diabetes, which contributes to the high rate of death among people with diabetes from heart disease or stroke (at least 65 percent). As a result, people with diabetes need to manage their blood glucose levels as well as their blood pressure and cholesterol levels. Healthy diet, physical activity, and medicines prescribed by a doctor can help protect cardiovascular health. Some healthcare providers also recommend regular Aspirin use. Avoiding or quitting smoking is another important part of cardiovascular health.
Serious Health Complications of Diabetes
There are other complications related to diabetes that, while not always immediately life-threatening, can become long-term problems. Fortunately, by controlling your blood glucose levels, maintaining a healthy weight, exercising regularly, and managing your blood pressure and cholesterol levels, many of the potential complications of diabetes can be prevented or managed or their onset may be delayed. Learn more about these complications and how to manage them in the next section, “Living with Diabetes and Caring for Yourself.”
Living with Diabetes and Caring for Yourself
If you have diabetes, your healthcare team is important, but you make a big difference in your health by the steps you personally take to manage diabetes. Daily management involves keeping blood glucose at target levels (avoiding levels that are too low or too high), knowing how to respond if blood glucose rises or drops, and making healthy choices about diet and exercise. As well, understanding potential common complications of diabetes and how to manage or prevent them will help you stay healthy.
What You Can Do
Maintain healthy blood pressure. Normal blood pressure (less than 130/80) can help prevent damage to eyes, kidneys, and blood vessels among people with diabetes. High blood pressure is common among people with diabetes. Keep blood pressure within a healthy range through healthy diet and physical activity, and in some cases, with medicines prescribed by your doctor.
Maintain healthy cholesterol. High blood cholesterol levels are a potential complication of diabetes and, due to resulting narrowing or clogging of blood vessels, can raise risk for heart disease and stroke (two particularly significant health concerns among people with diabetes) and cause circulation problems. Try to keep blood cholesterol at healthy levels (a total cholesterol of under 200, LDL under 100, HDL above 40 in men and 50 in women, and triglycerides under 150) with a healthy diet, exercise, and possibly medications.
Don’t smoke. Smoking is a health risk for the general population and can be particularly dangerous for people with diabetes. Ill effects include raising blood glucose, blood pressure, and cholesterol levels. As well, tobacco further increases the risk of heart and blood vessel complications among people with diabetes. If you do smoke, quitting has significant health benefits—risk for heart attack and stroke and nerve, kidney, and oral diseases are all lowered.
Get an annual flu shot. Because diabetes can make your immune system more vulnerable to severe cases of the flu, it’s important to protect yourself by getting a flu shot every year, preferably in the fall before flu season begins. Talk your doctor about other vaccinations, like one for pneumonia.
Keep your blood glucose as close to normal as possible. Test your blood glucose regularly (several times a day, as indicated by your healthcare team); doing so can prevent or delay the onset of certain diabetes-related complications. Watch for both low blood glucose and high blood glucose. By keeping track, you’ll better understand how food, physical activity, and diabetes medicines affect blood glucose and, as a result, how to better manage these levels.
Recognize what triggers low blood glucose readings (lower than 70 mg/dL). Eating less than usual, getting more exercise, or taking too much diabetes medicine can cause a drop, and so can drinking beer, wine, or liquor. Your doctor can tell you about ways to treat low blood glucose, including which foods to eat and the right amounts. Examples include fruit juice (1/2 cup), hard candy (three to five pieces), and glucose tablets (three to four).
It’s also important that you tell people around you (friends, family, and coworkers) that you have diabetes and how to respond if your blood glucose falls too low. They should know about foods and medications to give you, including timing and amount or dosage.
High blood glucose (higher than 140 mg/dL) before a meal can damage body organs over time. Blood glucose can be high as a result of too much food, less physical activity than usual, or too little diabetes medicine. You can help prevent levels from becoming too high by maintaining a consistent food and exercise program, drinking enough water, taking diabetes medicine at regular times, and maintaining a healthy weight.
Be prepared for work, school, and travel. When you leave home, plan to follow your regular schedule as closely as possible, including when you eat, test blood glucose, take medicine, and exercise. Take along all necessary supplies, including snacks, water, medicines, and blood glucose testing supplies and wear a form of identification (like a bracelet) to indicate that you have diabetes.
Take proper care of your feet, eyes, and oral health. Get routine exams with appropriate specialists (a podiatrist for feet, and an ophthalmologist for eyes, and a dentist). Prevent injury to your feet by checking them regularly and wearing properly-fitting shoes and cotton socks. Practice good oral hygiene—brush your teeth at least twice a day and floss at least once.
Weight Loss and Exercise
Maintaining a healthy weight (including losing weight, if necessary) and exercising regularly are important factors in all aspects of diabetes-related health.
How does exercise benefit people with diabetes? Exercise can have many good effects among people with diabetes. Being active can help control blood glucose and blood cholesterol (raising “good” HDL and lowering “bad” LDL), keep weight within a healthy range, and help prevent heart and blood flow problems, which reduces risk of heart disease and nerve damage.
How much exercise is needed? For diabetes-related health, and general health, the recommended about of exercise is 30 minutes per day, at least five days per week. Recommended intensity is moderate; walking briskly, mowing the lawn, dancing, swimming, or bicycling are examples of moderate-intensity activities.
What precautions should people with diabetes take when planning an exercise program? Speak with your doctor about the types of activities that are safe for you and the appropriate intensity. Special exercise-related considerations among people with diabetes include heart, foot, and eye problems and high blood pressure. If necessary, your doctor will help you choose activities that accommodate any limitations you may have.
How does exercise affect blood glucose levels? Your doctor can also help you understand how exercise may affect your blood glucose levels and how to take precautions to keep levels in a safe range. For example, exercise may lower blood glucose levels too much, causing hypoglycemia (a condition where symptoms include shakiness, weakness, confusion, irritability, and hunger). The risk of hypoglycemia may be higher in people who take insulin or other oral medications. Hypoglycemia can be prevented by checking blood glucose before exercise—if it’s below 100, eat a small snack.
Your doctor can also talk with you about precautions like bringing food and glucose tablets with you when you exercise and eating properly prior to exercise. He or she can discuss insulin use and exercise, as dosage may need to be changed before beginning an exercise program.
Exercise can also raise blood glucose levels, so it’s important to avoid exercise when levels are high (above 300, or a fasting blood glucose above 250).
Other precautions include wearing cotton socks and properly fitting shoes; checking your feet for sores, blisters, cuts, or other injuries; and drinking enough fluids, as dehydration can affect blood glucose.
Healthy Diet
To make healthy food choices, consider these guidelines:
Replace less-healthful choices with the following types of foods:
Cut back on high-sugar foods like:
Cut back on salt (in cooking and at the table) and in foods like:
Gestational Diabetes
Gestational diabetes can occur in pregnant women. It develops late in pregnancy and usually goes away after the baby is born. Gestational diabetes remains a health concern, however, because it raises a woman’s risk of developing type 2 diabetes within five to 10 years by 40 to 60 percent. Women who have had gestational diabetes may be able to help prevent type 2 diabetes by maintaining a healthy body weight and staying physically active.
Other Types of Diabetes
In addition to type 1, type 2, and gestational diabetes, there are other types of diabetes. And sometimes a person exhibits characteristics of more than one type; in type 1.5 diabetes (latent autoimmune diabetes in adults), for example, a person will show signs of both type 1 and type 2. Additional types of diabetes include those caused by genetic defects of the insulin-producing cells in the pancreas, genetic defects of insulin action, damage to the pancreas, excess amounts of certain hormones, and medications that reduce insulin action.
Prevalence
Incidence of diabetes appears to on the rise. The Centers for Disease Control and Prevention (CDC) estimates that one in three people in the United States born in 2000 will be affected by diabetes. And by 2050 the CDC projects that diagnosis of diabetes will have increased by 165 percent.
Diabetes Among Women
In addition to gestational diabetes, there are several ways in which diabetes affects women differently from men. Women with diabetes tend to have a more-serious risk of heart disease, and in the event of a heart attack, women have lower survival rates and those who survive have a poorer quality of life. As well, risk of blindness is greater for women with diabetes than men.
Women with diabetes who wish to become pregnant need to make special considerations, as pregnancy can affect insulin levels and diabetes-related eye and kidney problems. Pregnant women need to be especially careful about keeping blood glucose levels as close to normal as possible in order to protect themselves and the baby.
National Diabetes Education Program
The Centers for Disease Control and Prevention
National Diabetes Information Clearinghouse
National Diabetes Information Clearinghouse. www.diabetes.niddk.nih.gov. Accessed May, 2010.
Diabetes Public Health Resource. The Centers for Disease Control and Prevention Web site. http://www.cdc.gov/diabetes/. Accessed May, 2010.
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