General Information About Diabetes

• General Information About Diabetes
• Understanding blood glucose and insulin
• Main Types of Diabetes
• Risk Factors
• Symptoms
• Diabetes diagnosis
• Medical Treatment
• Self-Care at Home
• Prevention

1.General Information About Diabetes

Diabetes is a disorder of metabolism – the way human’s bodies use digested food for growth and energy. Most of the food we eat is broken down by the digestive juices into a simple sugar called glucose. And glucose is the main source of fuel for the body.

After digestion, the glucose passes into our bloodstream where it is available for body cells to use for growth and energy. For the glucose to get into the cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

When we eat, the pancreas is supposed to automatically produce the right amount of insulin to move the glucose from our blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the body cells do not respond to the insulin that is produced. As a result, glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

2. Understanding blood glucose and insulin

After we eat, various foods are broken down in our gut into sugars. The main sugar is called glucose which passes through our gut wall into our bloodstream. However, to remain healthy, our blood glucose level should not go too high or too low.

insulin and pancreasSo, when our blood glucose level begins to rise (after we eat), the level of a hormone called insulin should also rise. Insulin works on the cells of our body and makes them take in glucose from the bloodstream. Some of the glucose is used by the cells for energy, and some is converted into glycogen or fat (which are stores of energy). When the blood glucose level begins to fall (between meals), the level of insulin falls. Some glycogen or fat is then converted back into glucose which is released from the cells into the bloodstream.

Insulin is a hormone that is made by cells called beta cells. These are part of little ‘islands’ of cells (islets) within the pancreas. Hormones are chemicals that are released into the bloodstream and work on various parts of the body.

3. Main Types of Diabetes

The two main types of diabetes are called type 1 and type 2. A third form of diabetes is called gestational diabetes.

• Type 1 diabetes, the beta cells in the pancreas stop making insulin. The illness and symptoms develop quickly (over days or weeks) because the level of insulin in the bloodstream becomes very low. Type 1 diabetes used to be known as juvenile, early onset, or Insulin Dependent Diabetes. It usually first develops in children or in young adults. Type 1 diabetes is treated with insulin injections and diet.
• Type 2 diabetes, formerly called adult-onset diabetes, is the most common form. People can develop type 2 diabetes at any age, even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin properly. As a result, the body needs more insulin to help glucose enter cells to be used for energy. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, the pancreas loses its ability to secrete enough insulin in response to meals.
• Gestational diabetes is diabetes that first occurs during pregnancy. When women are pregnant, their need for insulin appears to increase, and many can develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life.4. Risk Factors

4. Risk Factors

Several factors contribute to a person’s risk of developing diabetes. People do not know exactly what causes diabetes, but they believe that both genetic factors and exposure to viruses are involved.

Risk factors that contribute to developing diabetes include:

• being overweight or obese;
• pre-diabetes;
• advanced age;
• physical inactivity;
• having high blood pressure and/or high cholesterol;
• having a family history of diabetes;
• belonging to certain high-risk ethnic populations (e.g. Aboriginal, African, Hispanic, Asian);
• having a history of gestational diabetes; and
• having other conditions which may include vascular disease, polycycstic ovary syndrome, acanthosis nigricans and schizophrenia

5. Symptoms

Symptoms of type 1 diabetes are often dramatic and come on very suddenly.

• Type 1 diabetes is usually recognized in childhood or early adolescence, often in association with an illness (such as a virus or urinary tract infection) or injury.
• The extra stress can cause diabetic ketoacidosis.
• Symptoms of ketoacidosis include nausea and vomiting. Dehydration and often-serious disturbances in blood levels of potassium follow.
• Without treatment, ketoacidosis can lead to coma and death.

Symptoms of type 2 diabetes are often subtle and may be attributed to aging or obesity.

• A person may have type 2 diabetes for many years without knowing it.
• People with type 2 diabetes can develop hyperglycemic hyperosmolar nonketotic syndrome.
• Type 2 diabetes can be precipitated by steroids and stress.
• If not properly treated, type 2 diabetes can lead to complications like blindness, kidney failure, heart disease, and nerve damage.

Common symptoms of both major types of diabetes:

• Fatigue:
  In diabetes, the body is inefficient and sometimes unable to use glucose for fuel. The body switches over to metabolizing fat, partially or completely, as a fuel source. This process requires the body to use more energy. The end result is feeling fatigued or constantly tired.
• Excessive urination (polyuria)
  Another way the body tries to get rid of the extra sugar in the blood is to excrete it in the urine. This can also lead to dehydration because excreting the sugar carries a large amount of water out of the body along with it.
• Excessive eating (polyphagia)
  If the body is able, it will secrete more insulin in order to try to deal with the excessive blood sugar levels. Moreover, the body is resistant to the action of insulin in type 2 diabetes. One of the functions of insulin is to stimulate hunger. Therefore, higher insulin levels lead to increased hunger and eating.
• Poor wound healing
  High blood sugar levels prevent white blood cells, which are important in defending the body against bacteria and also in cleaning up dead tissue and cells, from functioning normally. When these cells do not function properly, wounds take much longer to heal and become infected more frequently. Also, long-standing diabetes is associated with thickening of blood vessels, which prevents good circulation including the delivery of enough oxygen and other nutrients to body tissues.
• Unexplained weight loss:
  People with diabetes may lose weight even though they eat an apparently appropriate or even excessive amount of food.
• Excessive thirst (polydipsia)
  A person with diabetes develops high blood sugar levels, which overwhelms the kidney’s ability to reabsorb the sugar as the blood is filtered to make urine. Excessive urine is made as the kidney spills the excess sugar. The body tries to counteract this by sending a signal to the brain to dilute the blood, which translates into thirst. The body encourages more water consumption to dilute the high blood sugar back to normal levels and to compensate for the water lost by excessive urination.
• Infections
  Certain infection syndromes, such as frequent yeast infections of the genitals, skin infections, and frequent urinary tract infections, may result from suppression of the immune system by diabetes and by the presence of glucose in the tissues, which allows bacteria to grow well. They can also be an indicator of poor blood sugar control in a person known to have diabetes.
• Altered mental status
  Agitation, unexplained irritability, inattention, extreme lethargy, or confusion can all be signs of very high blood sugar, ketoacidosis, hyperosmolar hyperglycemia nonketotic syndrome, or hypoglycemia (low sugar). Thus, any of these merit the immediate attention of a medical professional.
• Blurry vision
  Blurry vision is not specific for diabetes but is frequently present with high blood sugar levels

6. Diabetes diagnosis

The fasting blood glucose test is the preferred test for diagnosing diabetes in children and nonpregnant adults. The test is most reliable when done in the morning. However, a diagnosis of diabetes can be made based on any of the following test results, confirmed by retesting on a different day:

1. A blood glucose level of 126 milli grams per deciliter (mg/dL) or higher after an 8-hour fast. This test is called the fasting blood glucose test.
2. A blood glucose level of 200 mg/dL or higher 2 hours after drinking a beverage containing 75 grams of glucose dissolved in water. This test is called the oral glucose tolerance test (OGTT).
3. A random—taken at any time of day—blood glucose level of 200 mg/dL or higher, along with the presence of diabetes symptoms.
Gestational diabetes is diagnosed based on blood glucose levels measured during the OGTT. Glucose levels are normally lower during pregnancy, so the cutoff levels for diagnosis of diabetes in pregnancy are lower. Blood glucose levels are measured before a woman drinks a beverage containing glucose. Then levels are checked 1, 2, and 3 hours afterward. If a woman has two blood glucose levels meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting blood glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.

7. Medical Treatment

The treatment of diabetes is highly individualized, depending on the type of diabetes, whether the patient has other active medical problems, whether the patient has complications of diabetes, and age and general health of the patient at time of diagnosis.

A healthcare provider will set goals for lifestyle changes, blood sugar control, and treatment.

• Together, the patient and the healthcare provider will devise a plan to help meet those goals.
• Education about diabetes and its treatment is essential in all types of diabetes.
• When the patient is first diagnosed with diabetes, the diabetes care team will spend a lot of time with the patient, teaching them about their condition, treatment, and everything they need to know to care for themselves on a daily basis.
• The diabetes care team includes the healthcare provider and his or her staff. It may include specialists in foot care, neurology, kidney diseases, and eye diseases. A professional dietitian and a diabetes educator also may be part of the team. The healthcare team will see you at appropriate intervals to monitor your progress with your goals.

Type 1 diabetes
Treatment of diabetes almost always involves the daily injection of insulin, usually a combination of short-acting insulin [for example, lispro (Humalog) or aspart (NovoLog)] and a longer acting insulin [for example, NPH, Lente, glargine (Lantus), detemir, or ultralente].

• Insulin must be given as an injection. If taken by mouth, insulin would be destroyed in the stomach before it could get into the blood where it is needed.
• Insulin is usually given in two or three injections per day, generally around mealtimes. Dosage is individualized and is tailored to the patient’s specific needs by the healthcare provider. Longer acting insulins are typically administered one or two times per day.
• Most people with type 1 diabetes give these injections to themselves. Even if someone else usually gives the patient injections, it is important that the patient knows how to do it in case the other person is unavailable.
• A trained professional will show the patient how to store and inject the insulin. Usually this is a nurse who works with the healthcare provider or a diabetes educator.
• Some people have their insulin administered by continuous infusion pumps to provide adequate blood glucose control. Supplemental mealtime insulin is programmed into the pump by the individual as recommended by his or her healthcare provider.
• It is very important to eat if the patient has taken insulin, as the insulin will lower blood sugar regardless of whether they have eaten. If insulin is taken without eating, the result may be hypoglycemia. This is called an insulin reaction.
• There is an adjustment period while the patient learns how insulin affects them, and how to time meals and exercise with insulin injections to keep blood sugar level as even as possible.
• Keeping accurate records of blood sugar levels and insulin dosages is crucial for the patient’s diabetes management.
• Eating a consistent, healthy diet appropriate for the patient’s size and weight is essential in controlling blood sugar level.

Type 2 diabetes

Depending on how elevated the patient’s blood sugar and glycosylated hemoglobin (HbA1c) are at the time of diagnosis, they may be given a chance to lower blood sugar level without medication.

• The best way to do this is to lose weight if obese and begin an exercise program.
• This will generally be tried for three to six months, then blood sugar and glycosylated hemoglobin will be rechecked. If they remain high, the patient will be started on an oral medication, usually a sulfonylurea or biguanide [metformin Glucophage)], to help control blood sugar level.
• Even if the patient is on medication, it is still important to eat a healthy diet, lose weight if they are overweight, and engage in moderate physical activity as often as possible.
• The healthcare provider will monitor the patient’s progress on medication very carefully at first. It is important to get just the right dose of the right medication to get the blood sugar level in the recommended range with the fewest side effects.
• The doctor may decide to combine two types of medications to get blood sugar level under control.
• Gradually, even people with type 2 diabetes may require insulin injections to control their blood sugar levels.
• It is becoming more common for people with type 2 diabetes to take a combination of oral medication and insulin injections to control blood sugar levels.

8. Self-Care at Home

If you or someone you know has diabetes, they would be wise to make healthful lifestyle choices in diet, exercise, and other health habits. These will help to improve glycemic (blood sugar) control and prevent or minimize complications of diabetes.

8-1. Diet:

A healthy diet is key to controlling blood sugar levels and preventing diabetes complications.

• If the patient is obese and has had difficulty losing weight on their own, talk to a healthcare provider. He or she can recommend a dietitian or a weight modification program to help the patient reach a goal.
• A consistent diet that includes roughly the same number of calories at about the same times of day helps the healthcare provider prescribe the correct dose of medication or insulin.
• Eat a consistent, well-balanced diet that is high in fiber, low in saturated fat, and low in concentrated sweets.
• It will also help to keep blood sugar at a relatively even level and avoid excessively low or high blood sugar levels, which can be dangerous and even life-threatening.

8-2. Exercise:

Regular exercise, in any form, can help reduce the risk of developing diabetes. Activity can also reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure, blindness, and leg ulcers.

• As little as 20 minutes of walking three times a week has a proven beneficial effect. Any exercise is beneficial; no matter how light or how long, some exercise is better than no exercise.
• If the patient has complications of diabetes (eye, kidney, or nerve problems), they may be limited both in type of exercise and amount of exercise they can safely do without worsening their condition. Consult with your health care provider before starting any exercise program.

8-3. Alcohol use:

Moderate or eliminate consumption of alcohol. Try to have no more than seven alcoholic drinks in a week and never more than two or three in an evening. One drink is considered 1.5 ounces of liquor, 6 ounces of wine, or 12 ounces of beer. Excessive alcohol use is a known risk factor for type 2 diabetes. Alcohol consumption can cause low or high blood sugar levels, nerve pain called neuritis, and increase in triglycerides, which is a type of fat in our blood.

8-4. Smoking:

If the patient has diabetes, and you smoke cigarettes or use any other form of tobacco, they are raising the risks markedly for nearly all of the complications of diabetes. Smoking damages blood vessels and contributes to heart disease, stroke, and poor circulation in the limbs. If someone needs help quitting, talk to a healthcare provider.

8-5. Self-monitored blood glucose:

Check blood sugar levels frequently, at least before meals and at bedtime, and record the results in a logbook.

• This log should also include insulin or oral medication doses and times, when and what the patient ate, when and for how long they exercised, and any significant events of the day such as high or low blood sugar levels and how they treated the problem.
• Better equipment now available makes testing blood sugar levels less painful and less complicated than ever. A daily blood sugar diary is invaluable to the healthcare provider in seeing how the patient is responding to medications, diet, and exercise in the treatment of diabetes.
• Medicare now pays for diabetic testing supplies, as do many private insurers and Medicaid.

9. Prevention

People do not yet know of a way to prevent type 1 diabetes. Type 2 diabetes, however, can be prevented in some cases.

• Control weight to normal or near-normal levels by eating a healthy low-fat, high-fiber diet.
• Regular exercise is crucial to the prevention of type 2 diabetes.
• Keep alcohol consumption low.
• Quit smoking.
• If you have high blood fat levels (such as high cholesterol) or high blood pressure, take your medication as directed.
• Lifestyle modification and/or certain medications can be used in people with prediabetes to prevent progression to diabetes. Pre-diabetes can be diagnosed by checking fasting glucose and two hours after ingesting 75 grams of glucose.
• If you or someone you know already have diabetes, your focus should be on preventing the complications, which can cause serious disabilities such as blindness, kidney failure requiring dialysis, amputation, or even death.
• Tight glucose control: The single best thing the patient can do is to keep their blood sugar level within the suggested range every day. The only way to do this is through a combination of regular blood sugar checks, a balanced diet low in simple sugars and fat and high in complex carbohydrates and fiber, and appropriate medical treatment. Please consult a nutritionist or check with the doctor with questions in regard to diet.
• The skin should be taken care of; keep it supple and hydrated to avoid sores and cracks that can become severely infected.
• Quit smoking
• Maintain a healthy weight
• Increase physical activity levels. Aim for moderately vigorous physical activity for at least 30 minutes every day.
• Drink an adequate amount of water and avoid taking too much salt.
• Brush and floss the teeth every day. See a dentist regularly to prevent gum disease.
• The feet should be washed and examined daily, looking for small cuts, sores, or blisters that may cause problems later. The toenails should be filed rather than cut to avoid damaging the surrounding skin. A specialist in foot care (podiatrist) may be necessary to help care for the feet.