Diabetes (diabetes mellitus) is a metabolic disorder that affects 23.6 million Americans. The trouble begins when blood glucose levels become elevated. This is due to a lack of sufficient insulin production, or the body failing to recognize and use the insulin properly. Serious organ damage can result from diabetes, especially if left untreated.
With proper care from your diabetes team and yourself, this disease, unlike many other diseases, may be managed and complications can be reduced, delayed or even prevented.
What causes diabetes?
Every time you eat, your body converts food into glucose (sugar) to fuel cells for energy. In order for this process to work, insulin, a hormone produced by the pancreas, must be present to transport glucose from the blood to the cells. In people who produce little or no insulin, glucose builds up in the blood instead. When blood sugar remains too high, headache, blurry vision, dull skin, and frequent urination are sure to follow. What is truly the worrisome issue is that consistently high blood sugar results in organ damage.
There are two major types of diabetes: type 1 and type 2. Type 1 is an autoimmune disorder in which the immune system attacks and destroys insulin-producing beta cells in the pancreas. It's not clear why this cellular genocide occurs, but it's believed that abnormal antibodies, and possibly viral infections, may be involved. Type 1 accounts for 5-10% of diagnosed diabetes, occurring most commonly in children and young adults, and requires daily insulin injections. Without this intervention, the body is forced to break down fats for energy, a process that produces ketones (waste products) in the blood, which can result in diabetic ketoacidosis (DKA), a highly toxic state that can lead to a life-threatening coma.
In Type 2, the pancreas may produce adequate insulin, but for some reason the body ignores it, setting up insulin resistance. In response, the pancreas pumps out even more insulin to force glucose into the cells since the glucose in accumulating in the bloodstream, resulting in elevated blood glucose. This form of diabetes is more common, occurring in up to 90-95% of diabetics and is associated with age, family history, obesity, and certain ethnic groups. The good news is that type 2 is largely preventable — even reversible — with proper care.
While having a sweet tooth isn't necessarily a precursor to diabetes for most people, a sensible diet low in fat and refined sugar does provide resistance. According to Ruchi Mathur, MD, Assistant Professor of Medicine at the Keck School of Medicine, University of Southern California, "It's a matter of smaller portion sizes more than anything else. Some people go to extremes by avoiding starches, but it doesn't work that way." Instead, she recommends limiting simple carbohydrates such as sodas, breads and pastas made from white flour and other highly processed foods. Most people don’t realize that 1 slice of bread or ⅓ cup of cooked rice breaks down into 4 teaspoons – over one tablespoon – of sugar in the bloodstream!
Double the Trouble – Diabetes Complications
More than half those living with diabetes can eventually expect to experience neuropathy, a tingling sensation (or lack of any feeling) in the extremities brought on by insufficient blood flow. In severe cases, especially when coupled with untreated ulceration, bone infection can occur and lead to the need for amputation.
Nephropathy, or kidney disease, is another complication of diabetes that is characterized by the presence of too much albumin (protein) in the urine. Unfortunately, this usually remains undetected until too much damage has occurred, possibly renal failure. However, elevated blood pressure and triglyceride levels are often early warning signs.
According to the American Diabetes Association, 12,000 to 24,000 annual cases of blindness are reported in diabetic patients ranging 20-74 years of age, primarily due to damage to eye vessels by high blood glucose levels. Eventually, lipid infiltration and deformed blood vessels attack and destroy the retina. Approximately 76% of eye damage can be prevented with good blood sugar control.
Awareness is key to the prevention of this disease, especially since the occurrence of diabetes in children and adults is rising on an epidemic scale. Over 3 million people have diabetes now than just two years ago. The American Diabetes Association estimates that by 2025, there will be 50.2 million people with diabetes in the United States (in 2008 there are 23.6 million – 17.9 million are diagnosed and 5.7 million don’t know they have the disease). The World Health Organization estimates that by 2030, there will be 366 million people worldwide with diabetes.
Did You Know?
In 2005, 46,739 people with diabetes began treatment for end-stage renal disease (ESRD) and in 2002, a total of 178,689 people were living on chronic dialysis or with a kidney transplant. With good blood sugar control people with diabetes can reduce damage to their kidneys by 35-56 percent.
Types of Diabetes
There are three main types of diabetes. Pre-diabetes is also a condition you may want to be aware of.
Approximately 21 million people in the United States have diabetes, and each year approximately one million new cases of diabetes are diagnosed. Nonetheless, many people who have diabetes remain undiagnosed. Diabetes is a disease of excess sugar (glucose) in the blood. Men and women of all ages and ethnic groups are affected by diabetes. If diabetes goes undiagnosed it could become life threatening.
Type 2 diabetes is more common than Type 1 diabetes. Approximately 90% of persons living with diabetes have Type 2 diabetes. Diabetes affects over 10% of Americans over the age of 65.
In Type 1 diabetes, symptoms of high blood glucose (sugar) appear suddenly or quickly, while in Type 2 diabetes, the symptoms appear more gradually over time.
Q. What are symptoms of diabetes?
A. Common diabetes symptoms include:
Q. How does diabetes occur?
A. Insulin hormone, made in the pancreas is necessary to regulate blood glucose levels. Insulin is a hormone that converts starches, sugars and other foods into energy for use by our body cells.
In the case of a person with diabetes, the body may not make enough insulin hormone in the beta cells of the pancreas, or the body may not use insulin properly (a condition called "insulin resistance"). When the body does not have enough insulin, the result is elevated blood glucose (blood sugar) levels.
When blood glucose (sugar) levels are too high, diabetes mellitus ("diabetes") is diagnosed.
Q. What is pre-diabetes?
A. This is a condition that often precedes diabetes when blood glucose levels are elevated, but the levels are not high enough to diagnose diabetes. With increased physical activity and modest weight loss, persons with pre-diabetes may prevent development of Type 2 diabetes.
Q. How is the diagnosis of diabetes made? What is the criteria for diagnosing diabetes?
A. Diabetes is diagnosed when the fasting blood glucose level is greater than 126 mg/dl on two separate testing dates, or if the blood glucose level is over 200 mg/dl with the presence of hyperglycemia (high blood sugar) symptoms. Also, some physicians will order an oral glucose tolerance test (OGTT) to confirm a diabetes diagnosis.
Being aware of the symptoms of diabetes is important. Discuss all laboratory results with your physician. The information provided in this article is intended to improve your general knowledge concerning diabetes and for educational purposes. The information in this article cannot substitute for professional medical advice, nor does it replace the medical judgment of a licensed healthcare professional.
Q. What are the different types of diabetes?
A. The major types of diabetes include:
Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes (GDM)
Although not an official type of diabetes, pre-diabetes is important to be aware of:
Q. Where can I learn more about the symptoms of diabetes?
A. Here are two helpful resources to learn more about diabetes symptoms:
How diabetes is treated depends on varying factors. The type of diabetes a person is diagnosed with, the progression of the disease prior to diagnosis and accompanying complications will factor into the treatment equation early on. Living with diabetes is a matter of learning to control blood sugar levels through lifestyle and medication. The basics of diabetes treatment are the same for all patients once baseline sugar levels are determined and target sugar levels are in control.
Two things are basic to treating type 1 diabetes and type 2 diabetes: 1) Maintaining a healthy diet and physical activity are key basic steps, and 2) Testing to monitor blood glucose levels, so adjustments can be made to diet and exercise when called for. In addition, insulin therapy may be required. Insulin injections are a necessity for type 1 diabetes patients, and may or may not be needed to treat patients with type 2 diabetes. Type 2 diabetes patients may take additional oral medications (with or without insulin) to help control blood glucose levels at target rates or they may control their blood sugar with meal planning and exercise only.
Diet
People with diabetes require no more special diet than the average person who eats healthy. Advancements in the understanding of diabetes have revealed that while a healthy diet is vastly beneficial to people living with diabetes, there are no special diet foods required by diabetics. What is healthy for anyone is healthy eating for people with diabetes.
The difference in diet for a person with diabetes is creating a consistent diet routine, balancing fats, proteins, and carbohydrates in particular. Carbohydrates turn to sugar in the blood, so limiting carbohydrates and being aware of carbohydrate intake is essential to good diabetes control.
Follow these tips for developing a healthy diet to aide in diabetes control.
Don’t know what to cook? Get healthy diabetic cooking tips and browse our diabetic recipes.
Exercise
The benefits of exercise for people with diabetes are many, and are not entirely different from the benefits enjoyed by those who do not have diabetes. It is beneficial in the short-term and the long-term. Short-term benefits are such that glucose is lowered due to the energy expended or used during the time of exercise. Long-term benefits are such that your insulin works more efficiently.
For diabetics, exercise helps improve the body's ability to use insulin. People with Type 2 diabetes with low or poorly functioning natural insulin can increase their body's ability to access the insulin they do have and improve overall blood sugar levels.
Additionally, physical activity and exercise decrease body fat. Lower amounts of body fat increase the body's sensitivity to insulin, improving the function of insulin whether natural or injected. Other benefits of exercise for diabetes patients include improved muscle strength, bone density, higher energy levels, and improved circulation. Coincidentally, cholesterol levels are positively affected, another complicating risk enhanced by diabetes. As many of the complications of diabetes are directly attributed to poor circulation and hardening blood vessels and arteries, exercising to improve these factors overall contributes to longevity and quality of life.
While exercise is an essential component in maintaining diabetes, it is important to get educated about how the body works and reacts to physical activity. Continuous moderate exercise improves sugar consumption and results in lowered glucose levels. Short, strenuous activity on the other hand, can trigger stress responses and increase glucose levels. There are also times when glucose levels may be high and exercising could contribute to the problem.
For these reasons, regular exercise regiments and limitations need to be discussed and planned with the help of a treating physician and diabetes educator. Staying well hydrated and monitoring sugar levels before and after exercise are important. Careful record keeping of sugar results help plan appropriate exercise routines, while predicting when a particular activity may necessitate meal or insulin adjustments.
Insulin
People living with diabetes may require daily insulin therapy. This will depend on the type of diabetes a person has and how well their body is able to process insulin .
There are different kinds of insulin , but all serve the same basic purpose. Insulin is a blood hormone that is needed to move blood sugar into cells where it is used as fuel energy. Without insulin, sugars remain in the bloodstream and cause a variety of physical complications. When a person with diabetes either does not produce insulin or cannot use their own, insulin must be injected to continue the job of sugar processing.
Insulin may be rapid-acting, short acting, intermediate, long-acting, or pre-mixed. Which insulin is taken is determined by factors such as how the individual patient's body reacts to insulin , how quickly the reaction is, the frequency and ability to take multiple injections, age, target glucose levels, and lifestyle and activity. Only a doctor can determine the right insulin to take, and adjustments are likely to be made to achieve maximum benefits. Insulin dosing schedules will vary similarly, and are also dependent upon the type of insulin being taken.
Diabetes research and development continues to strive towards easy living and disease maintenance. Alternative insulin delivery systems, like oral medications and insulin pump systems (continuously pumping insulin through a catheter in the abdomen) show promise towards lessening the burden of diabetes insulin therapy on patients. Open dialogue with treating physicians is recommended as a means of determining if the time is right for an individual diabetes patient to pursue new insulin options.
Oral Medications
Not all diabetes medications are insulin. In fact, oral medications are taken by a number of diabetes patients whose bodies still produce some natural insulin (majority of type 2 patients).
Oral diabetes medications may stimulate the pancreas to produce more insulin, or improve the ability of insulin to move sugar and function in the body. Oral diabetes medications may also help break down starch components and slow glucose levels. Other medications combine one or more medications.
As type 2 diabetes progresses, oral medications may be continued to support insulin injections if they become necessary.
Emerging Treatments
Diabetes treatments evolve rapidly. In addition to insulin pumps and painless testing procedures, Islet cell transplantation is showing promise in reducing insulin dependency (although unlikely to eliminate the need at this time). Alternative supplements and medications are being explored as well, but are less well regulated, so alternative options should only be pursued in collaboration with treating physicians.
Importance of Diabetes Treatments
Living with Diabetes
Living with diabetes is a balancing act of sorts. Learning to balance exercise, medication, testing, and diet can be overwhelming, but the result is well worth the effort. With good control of diabetes, the quality and longevity of life can soar to great heights. Complications are prevented and lessened with good continuous blood sugar control, maintaining health of body systems.
As living with diabetes becomes an accepted lifestyle choice, life for diabetes patients is close to normal as compared to those without the disease. In fact, the quality diet and lifestyle choices made may mean diabetes patients live better than many average people who pay no heed to good health practices. Diabetes is a lifestyle more than it is a disease when managed through good habits and effective treatments with the collaboration of well trained medical professionals.
How are diabetes and pre-diabetes diagnosed?
The following tests are used for diagnosis:
Positive test results should be confirmed by repeating the fasting plasma glucose test or the oral glucose tolerance test on a different day.
Fasting Plasma Glucose (FPG) Test
The FPG is the preferred test for diagnosing diabetes due to convenience and is most reliable when done in the morning. Results and their meaning are shown in table 1. If your fasting glucose level is 100 to 125 mg/dL, you have a form of pre-diabetes called impaired fasting glucose (IFG), meaning that you are more likely to develop type 2 diabetes but do not have it yet. A level of 126 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.
Table 1. Fasting Plasma Glucose Test
| Plasma Glucose Result (mg/dL) | Diagnosis |
|---|---|
| 99 and below | Normal |
| 100 to 125 | Pre-diabetes (impaired fasting glucose) |
| 126 and above | Diabetes* |
*Confirmed by repeating the test on a different day.
Oral Glucose Tolerance Test (OGTT)
Research has shown that the OGTT is more sensitive than the FPG test for diagnosing pre-diabetes, but it is less convenient to administer. The OGTT requires you to fast for at least 8 hours before the test. Your plasma glucose is measured immediately before and 2 hours after you drink a liquid containing 75 grams of glucose dissolved in water. Results and what they mean are shown in table 2. If your blood glucose level is between 140 and 199 mg/dL 2 hours after drinking the liquid, you have a form of pre-diabetes called impaired glucose tolerance or IGT, meaning that you are more likely to develop type 2 diabetes but do not have it yet. A 2-hour glucose level of 200 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.
Table 2. Oral Glucose Tolerance Test
| 2-Hour Plasma Glucose Result (mg/dL) | Diagnosis |
|---|---|
| 139 and below | Normal |
| 140 to 199 | Pre-diabetes (impaired glucose tolerance) |
| 200 and above | Diabetes* |
*Confirmed by repeating the test on a different day.
Gestational diabetes is also diagnosed based on plasma glucose values measured during the OGTT. Blood glucose levels are checked four times during the test. If your blood glucose levels are above normal at least twice during the test, you have gestational diabetes. Table 3 shows the above-normal results for the OGTT for gestational diabetes.
Table 3. Gestational Diabetes: Above-Normal
Results for the Oral Glucose Tolerance Test
| When | Plasma Glucose Result (mg/dL) |
|---|---|
| Fasting | 95 or higher |
| At 1 hour | 180 or higher |
| At 2 hours | 155 or higher |
| At 3 hours | 140 or higher |
Note: Some laboratories use other numbers for this test.
For additional information about the diagnosis and treatment of gestational diabetes, see the NIDDK booklet What I Need to Know About Gestational Diabetes.
Random Plasma Glucose Test
A random blood glucose level of 200 mg/dL or more, plus presence of the following symptoms, can mean that you have diabetes:
Other symptoms include fatigue, blurred vision, increased hunger, and sores that do not heal. Your doctor will check your blood glucose level on another day using the FPG or the OGTT to confirm the diagnosis.