Diabetes

Some people who have diabetes think it's not a very serious disease. They may believe that their diabetes is not serious because they got it late in life or because they don't take insulin. There are people who believe that they only have a "touch" of sugar or "borderline" diabetes. These ideas are not correct – diabetes is always a serious disease. Whether you take insulin or not, your diabetes puts you at risk for the following serious complications:

• Eye Disease – Diabetes is a major cause of blindness: 12,000 to 24,000 people lose their sight because of diabetes every year.
• Foot Amputations – Diabetes is the cause of more than 80,000 foot amputations in the U.S. every year.
• Kidney Failure – Each year, almost 44,000 people suffer kidney failure because of diabetes. These people must get a kidney transplant or use an artificial kidney machine (dialysis).
• Heart and Blood Vessel Disease – People with diabetes are two to four times as likely as people without diabetes to have heart disease, high blood pressure, and strokes.

Symptoms of diabetes:

1. Being very thirsty
2. Being very hungry
3. Too much urine
4. Fatigue
5. Losing weight without trying
6. Having sores that heal slowly
7. Having dry, itchy skin
8. Losing feeling in the feet or having tingling in the feet
9. Having blurry eyesight

Types Of Diabetes

There are three common types of diabetes: type 1, type 2, and gestational. Gestational diabetes occurs during pregnancy. It usually goes away after the baby is born, but diabetes may return later.

Type 1 Diabetes

Occurs most often in children and young adults. In type 1 diabetes the immune system attacks and destroys insulin producing cells in the pancreas, which results in high blood glucose levels. Insulin injections are required to treat type 1 diabetes.

Type 2 Diabetes

Accounts for 90% of all diagnosed cases of diabetes. In type 2 diabetes “insulin resistance” occurs. This happens when the pancreas produces insulin but the body’s cells cannot read the signal to let glucose into the cells. Being overweight or obese is a leading risk factor for developing type 2 diabetes.  Other risk factors include:  physical inactivity, aging (type 2 diabetes is more prevalent in middle age and older adults), family history of diabetes, prior history of gestational diabetes, and certain racial groups.

There are two other conditions that pose risk for developing diabetes, including prediabetes and the metabolic syndrome.

Prediabetes: Blood glucose levels are higher than normal but not high enough to have a diagnosis of diabetes. Prediabetes raises the risk of developing type 2 diabetes and increases the risk of heart disease by 50 percent. Most people with prediabetes develop type 2 diabetes within ten years. Lifestyle modification involving weight loss and physical exercise helps to prevent or delay the onset of diabetes.

The metabolic syndrome: Is another commonly used term in discussing diabetes. Metabolic syndrome, which is sometimes referred to as “insulin resistance syndrome” or “syndrome X” is a cluster of conditions including obesity, high blood pressure, high cholesterol, and high triglycerides, that may indicate a tendency to develop diabetes, hypertension and heart disease.

Diabetes and your heart:

Longterm (chronic) health problems don’t happen overnight. They develop over months and years. Often, these problems are not reversible. In most cases, you don’t even know that diabetes complications are occurring until they cause a serious problem. Cardiovascular disease (CVD) includes those conditions that affect the proper functioning of the heart and blood vessels. It is the most common complication of diabetes, and can lead to heart attacks, strokes, and other serious problems. Examples of cardiovascular disease include heart attack, angina, heart failure, and peripheral vascular diseases, which can cause gangrene or ulceration of the feet and leg, requiring amputation. People with diabetes are two to four times more likely to suffer from heart disease. Risk factors for cardiovascular disease include high blood pressure, high blood fat (lipid) levels, high blood sugar, obesity, inactivity, heredity, sex (males), and advancing age. By controlling your lipids (total “good” and “bad” cholesterol and triglycerides) and blood pressure and diabetes you can help reduce the risk of cardiovascular complications.

Blood pressure and lipids goals for people with diabetes:

• Blood pressure should be less than 130/80 millimeters of mercury (mm/Hg)
• LDL (bad) Cholesterol should be less than 100 mg/dl
• Triglycerides should be less than 150 mg/dl
• HDL (good) Cholesterol should be greater than 40 mg/dl

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Management of diabetes:

Goal of treatment: The goal of treatment for diabetes is to keep blood sugar levels close to normal to prevent complications. The American Diabetes Association’s guidelines for blood glucose levels for people with diabetes are 80 - 120mg/dL before meals and 100 – 140 mg/dL before bedtime.

Lifestyle Modification:

Eating Healthy:

Having diabetes does not mean you need special foods, or that you will never be able to eat sweets again. You can eat the same healthy foods that everyone else can! Your meal  plan should include foods that are low in saturated fat, salt, and sugar, and high in fiber (such as beans, fruits, vegetables, and whole grains). Eating properly will help you:

• Reach and stay at a weight that is good for you
• Keep your blood sugar in a healthy range
• Prevent heart and blood vessel diseases

Your key to success is a meal plan. A meal plan is a daily eating plan. There are many different types of meal plans. Some focus on controlling calories or portion size, while others count fat or carbohydrates. Still others combine both of these methods. The exchange meal plan is an example.  With this meal plan, you can choose a specific number of servings each day from these six food groups: starch/bread, meat (or fish, poultry, or meat alternative such as soy products) vegetable, fruit, milk, and fat. The number of servings is based on how many calories you can have each day. Using Exchange Lists for Meal Planning, developed by the American Diabetes Association and American Dietetic Association, you can choose the foods you would like to eat for each meal. A defined serving or “exchange” of each food item in one of these categories has the same calories, grams of fat, protein and carbohydrate in it as every other food item in that category. So, under the “fruit choices” in the exchange system, for example, 1/ 2 cup of apple sauce and a small banana each equals one “fruit exchange” that has 60 calories, 15 grams of carbohydrate, and no protein or fat. In the exchange meal planning system, your healthcare team works with you to develop a meal plan that distributes a number of exchanges from each of the six food categories through each of three meals and two or three snacks each day. The meal plan is developed based on the patient's diabetes treatment plan and goals. If weight loss is a goal, for example, the patient will have fewer exchanges to spend at each meal, so that total calories are kept at a level to enable the patient to lose weight. Patients then use food lists to figure out how to “spend” those exchanges at each meal. The following are some tips for a meal plan:

• Choose a variety of foods from each food group.
• Eat foods high in complex carbohydrates and fiber.
• Reduce cholesterol and saturated fats.
• Use only the amount of fat recommended in your meal plan. When you do use fat, use olive oil or canola oil instead of butter, lard, margarine, and other oils.
• Avoid trans fats.
• Use sugar in moderation

Exercise and Fitness

• Helps your body use sugar faster and better
• Improves your blood flow and blood pressure and strengthens your heart and lungs
• Lowers the amount of fat (cholesterol and triglycerides) in your blood. This is important since fat plays a big part in heart and blood vessel diseases
• Makes insulin work better. People with diabetes who exercise daily often don’t need as much insulin
• Increases your energy level and improves your strength and muscle tone
• Helps you lose or maintain weight. If you lose weight, you may reduce your need for diabetes medicines and your risk of complications from diabetes
• Lowers tension and stress
• Improves your overall mental and physical health

Quit Smoking

There is no safe way to smoke, and diabetes and smoking are a bad combination. Smoking puts you at greater risk for heart and blood vessel problems, like heart attack and stroke. It also increases your risk for lung cancer and other cancers, chronic lung disease (e.g., emphysema, chronic bronchitis) diabetic eye disease and kidney problems.

Medication Therapy

Diabetes Pills

If you have type 2 diabetes, you may have tried to control your blood sugar through exercise and diet. If diet and exercise alone have not worked, you may need to take diabetes pills. Diabetes pills, also called oral diabetes medicine or oral hypoglycemic agents, only work in people whose bodies make some insulin of their own. There are many different kinds of diabetes pills. Each works differently in the body, and you may need to take more than one type of pill. Some pills, like glyburide and glipizide, increase your insulin output. Others, like metformin, Actos ® , help enhance the work of insulin. Diabetes pills are safe and easy to take. Keep in mind that diabetes pills may not lower blood sugar enough by themselves. You will still have to follow an eating and exercise plan to help lower your blood sugar. Losing even a little bit of weight can sometimes help lower your blood sugar, and you may be able to stop taking diabetes pills if you lose weight. Sometimes people who take diabetes pills need insulin shots for a short period of time.

Insulin

is a hormone made in the pancreas, and everyone needs it to stay alive. Insulin works like a gatekeeper, allowing the sugar in your bloodstream to enter the cells, which is where the sugar is used as fuel for your body. People with type 1 diabetes do not make any or enough insulin. People with type 2 diabetes cannot use insulin properly, so they need more of it. In both types of diabetes there is not enough insulin to let the sugar into your cells. As a result, sugar builds up in your bloodstream. This leads to high blood sugar. Insulin cannot be taken as a pill. You need to inject it into your body. There are three ways to do this:

• Needle and syringe
• Insulin pen
• Insulin pump

Monitoring Blood Sugar Control

Self Testing: To test your blood sugar, you need a small needle called a lancet (used with a fingerstick device), special blood testing strips, and a blood sugar testing machine called a glucometer.

Ketone Testing: While urine testing is not very accurate for checking your blood sugar, but it can show if you have ketones in your urine. Ketones are a chemical your body makes when it burns fat, instead of sugar, for energy. Your body makes ketones when there is not enough insulin in your blood. This occurs more often in type 1 diabetes. You probably will only have to do a urine test when you are sick or if your blood sugar is unusually high (over 240–300 mg) before eating a meal.

Hemoglobin A1c (three Month Sugar Test): Blood sugar levels vary a lot from day to day, especially if you have diabetes. Any time you check your blood sugar you get important information, but you are only getting the level for that one time. The glycosylated hemoglobin test (often called the hemoglobin A1c test or HbA1c test) shows your average blood sugar levels over a three month period.

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