Diabetes

Overview

If you just found out you have diabetes, you probably have a lot of questions and you may feel a little uncertain. But you're not alone. In the United States, 23.6 million people have diabetes. Most of these people lead full, healthy lives. One of the best things you can do for yourself is to learn all you can about diabetes. This article will tell you some of the basics about diabetes.

What is diabetes?

Diabetes is a disease that occurs when a person's body doesn't make enough of the hormone insulin or can't use insulin properly. There are 2 types of diabetes. Type 1 diabetes occurs when your body's pancreas doesn't produce any insulin. Type 2 diabetes occurs when the pancreas either doesn't produce enough insulin or your body's cells ignore the insulin. Between 90% and 95% of people who are diagnosed with diabetes have type 2 diabetes.

What is type 1 diabetes?

Type 1 diabetes is also called insulin-dependent diabetes. It is sometimes called juvenile diabetes because it is usually discovered in children and teenagers, but adults may also have it.

What is type 2 diabetes?

Type 2 diabetes occurs when the body doesn't produce enough insulin or the body's cells ignore the insulin.

Can children get type 2 diabetes?

Yes. In the past, doctors thought that only adults were at risk of developing type 2 diabetes. However, an increasing number of children in the United States are now being diagnosed with the disease. Doctors think this increase is mostly because more children are overweight or obese and are less physically active.

What is pre-diabetes?

Pre-diabetes occurs when blood sugar levels are higher than they should be, but not so high that your doctor can say you have diabetes. Pre-diabetes is becoming more common in the United States. It greatly increases the risk of developing type 2 diabetes.

The good news is that you can take steps to prevent or delay the onset of full-blown type 2 diabetes by making lifestyle changes, such as eating a healthy diet, reaching and maintaining a healthy weight, and exercising regularly.

Can I live a normal life with diabetes?

Yes, you can live a normal life. You can stay healthy if you do what it takes to control your diabetes.

Symptoms

What are the symptoms of diabetes?

Symptoms vary from person to person. The early stages of diabetes have very few symptoms, so you may not know you have the disease. But damage may already be happening to your eyes, your kidneys and your cardiovascular system even before you notice symptoms. Common symptoms include the following:

Extreme hunger
Extreme thirst
Frequent urination
Unexplained weight loss
Fatigue or drowsiness
Blurry vision
Slow-healing wounds, sores or bruises
Dry, itchy skin
Tingling or numbness in the hands or feet
Frequent or recurring skin, gum, bladder or vaginal yeast infections

People who have type 2 diabetes may also show signs of insulin resistance, such as darkening skin around the neck or in the armpits, high blood pressure, cholesterol problems, yeast infections and skipped or absent periods in teen girls and women.

Call your doctor if:

You start feeling very thirsty and are urinating more often than usual.
You are nauseous or vomit more than once.
You lose a significant amount of weight.
You start breathing deeper and faster.
Your breath smells like nail polish remover.
You start to tremble, feel weak and drowsy, and then feel confused or dizzy, or your vision becomes blurred.
You feel uncoordinated.
You have a sore, blister or wound (especially on your feet) that won't heal.

If blood sugar levels become very high without treatment, a condition called diabetic ketoacidosis may develop. If this happens, symptoms may include shortness of breath, pain in the abdomen, vomiting, dehydration, and even coma and death if left untreated.

Causes & Risk Factors

What causes diabetes?

When you digest food, your body changes most of the food you eat into glucose (a form of sugar). A hormone called insulin allows this glucose to enter all the cells of your body and be used as energy. Insulin is produced by the pancreas. In someone who has type 2 diabetes, the pancreas doesn't make enough insulin or the body's cells can't use insulin properly (called insulin resistance). This causes glucose to build up in your blood instead of moving into the cells. Too much glucose in the blood can lead to serious health problems that may damage the blood vessels, nerves, heart, eyes and kidneys.

Am I at risk? What can I do to reduce my risk?

Talk to your doctor about your risk factors for diabetes. Although you may not be able to change all of them, you can make changes to significantly lower your risk.

What are the risk factors for type 2 diabetes?

Weight

Obesity is the single most important risk factor for type 2 diabetes. The more overweight you are, the more resistant your body is to insulin. To figure out if you're overweight, check the chart and talk to your doctor. A healthy, low-fat diet and regular exercise can help you lose weight gradually and keep it off.

Weight and Risk

Find your height in the left column, then look to the right to find the corresponding weight. If you weigh the amount shown (or more), you may be at risk for diabetes.

	Weight (in pounds)
Height	Women	Men
4'9	134
4'10	137
4'11	140
5'0	143
5'1	146	157
5'2	150	160
5'3	154	162
5'4	157	165
5'5	161	168
5'6	164	172
5'7	168	175
5'8	172	179
5'9	175	182
5'10	178	186
5'11	182	190
6'0		194
6'1		199
6'2		203
6'3		209

Age

The risk for type 2 diabetes increases with age, especially after 45 years of age. Although you can't change your age, you can work on other risk factors to reduce your risk.

Family history

Although you can't change your family history, it is important for you and your doctor to know if diabetes runs in your family. Your risk for diabetes is higher if your mother, father or sibling has diabetes. Tell your doctor if anyone in your family has diabetes.

Race/ethnic background

For reasons still unclear to doctors, some ethnic groups have a higher risk of diabetes than others. You are at greater risk if you belong to one of these groups:

Native American
Hispanic American
African American
Pacific Islander

Exercise

Exercising and maintaining a healthy weight can reduce your risk of diabetes. Any amount of activity is better than none, but try to exercise for 30 to 60 minutes most days of the week. If you haven't exercised in a while or you have health problems, talk with your doctor before starting an exercise program.

Diet

A diet high in fat, calories and cholesterol increases your risk of diabetes. In addition, a poor diet can lead to obesity (another risk factor for diabetes) and other health problems. A healthy diet is high in fiber and low in fat, cholesterol, salt and sugar. Also, remember to watch your portion size--how much you eat is just as important as what you eat.

Gestational diabetes

Gestational diabetes is a kind of diabetes that happens only during pregnancy. It occurs in about 4% of pregnant women. Although gestational diabetes goes away after pregnancy, 40% to 60% of women who had gestational diabetes are diagnosed with type 2 diabetes within 15 years.

Even if they don't have gestational diabetes, women who give birth to babies who weigh 9 pounds or more are more likely to develop type 2 diabetes later in life.

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a condition that occurs when an imbalance of hormone levels in a women's body causes cysts to form on the ovaries. Women who have PCOS are at an increased risk of developing type 2 diabetes.

Multiple risk factors

The risk of developing type 2 diabetes increases with the number of risk factors you have. If you have 2 or more risk factors, talk to your doctor about how to delay or prevent type 2 diabetes.

Diagnosis & Tests

Why is it important to prevent, diagnose and treat diabetes?

Untreated diabetes causes blood sugar levels to rise. This can lead to a number of serious problems, including:

Eye damage that can cause blindness
Kidney failure
Heart attacks
Nerve and blood vessel damage that can lead to the loss of toes or feet
Problems with gums, including tooth loss

The longer the body is exposed to high blood sugar levels, the greater the risk that problems will occur. That's why treatment is important at any age. Keeping blood sugar levels very close to the ideal can minimize, delay and, in some cases, even prevent the problems that diabetes can cause.

How is diabetes diagnosed?

Your doctor may test for diabetes if he or she suspects you are at risk. To check for diabetes, your doctor may request the following tests:

Fasting blood sugar test. This test is usually done in the morning, after an 8-hour fast. This means that you shouldn't eat any foods or drink any liquids except for water for 8 hours before the test. At the end of the fast, a doctor or nurse measure the amount of glucose in your blood. If your blood sugar level is 126 milligrams per deciliter (mg/dL) or higher, your doctor will probably want to repeat the test. A blood sugar level of 126 milligrams per deciliter (mg/dL) or higher on 2 occasions indicates diabetes. Test results from 100 mg per dL to 125 mg per dL suggest prediabetes.
Oral glucose tolerance test. During this test, you will drink a beverage containing 75 grams of glucose dissolved in water. Two hours later, a doctor or nurse will measure the amount of glucose in your blood. A blood sugar level of 200 mg/dL or higher indicates diabetes.
Random blood sugar test. This test measures the level of glucose in your blood at any time of day, regardless of when you last ate. Combined with symptoms of diabetes, a blood glucose level of 200 mg/dL or higher indicates diabetes.

Treatment

How can I help myself stay healthy if I have diabetes?

Although diabetes can't be cured, you can still live a long and healthy life. The single most important thing you can do is control your blood sugar level. You can do this by eating right, exercising, maintaining a healthy weight and, if needed, taking oral medicines or insulin.

Eat a healthy diet. The recommended diet for many people who have diabetes is very similar to that suggested for everyone: low in fat, low in cholesterol, low in salt and low in added sugar. Your diet should include lots of complex carbohydrates (such as whole-grain breads, cereals and pasta), fruits and vegetables. This type of diet will help you control your blood sugar level, as well as your blood pressure and cholesterol levels. It's also important to watch your portion size so you can control your blood sugar and maintain a healthy weight. In order to help keep your blood sugar at a healthy level, it's important to eat at least 3 meals per day and never skip a meal. For more information, read Diabetes and Nutrition.

Tips on eating right

Eat at about the same time every day. This helps keep your insulin or medicine and sugar levels steady.
Try to eat 3 times a day. Have a snack at bedtime if you're taking medicine or insulin. Avoid other snacking unless you're exercising or treating hypoglycemia.
If you're overweight, lose weight. Even losing just a little weight, such as 5 to 15 pounds, can lower your blood sugar levels.
Eat plenty of fiber. Green leafy vegetables, whole grains and fruits are good choices. Fiber helps you feel full and helps with digestion.
Eat fewer empty calories, such as foods high in sugar and fat, and alcohol.

Exercise. Exercising will help your body use insulin and lower your blood sugar level. It also helps control your weight, gives you more energy and is good for your overall health. Exercise is also good for your heart, your cholesterol levels, your blood pressure and your weight--all factors that can affect your risk of heart attack and stroke. Exercise also seems to make people feel better about themselves and feel less anxious. Talk with your doctor about starting an exercise program. He or she can help you make a plan. For more information, read Diabetes and Exercise.

Maintain a healthy weight. Losing excess weight and maintaining a healthy body weight will help you in 2 ways. First, it helps insulin work better in your body. Second, it will lower your blood pressure and decrease your risk for heart disease.

Take your medicine. If your diabetes can't be controlled with diet, exercise and weight control, your doctor may recommend medicine or insulin. Oral medicines(taken by mouth) can make your body produce more insulin or help your body use the insulin it makes more efficiently. Some people need to add insulin to their bodies with insulin injections, insulin pens or insulin pumps. Always take medicines exactly as your doctor prescribes.

What medicines are available to treat diabetes?

Several kinds of medicine can help you control your blood sugar level. Some medicines are pills that you take by mouth (orally). Most people who have type 2 diabetes start with an oral medicine. Oral medicine doesn't work for everyone, though. It is not effective in the treatment of type 1 diabetes. Insulin therapy is necessary for all people who have type 1 diabetes and for some people who have type 2 diabetes. If you need insulin, you'll have to give yourself a shot (either with a syringe or with an insulin pen). Your doctor will tell you which kind of medicine you should take and why.

What tests can I use to check my blood sugar level?

There are 2 blood tests that can help you manage your diabetes. One of these tests is called an A1C test, which reflects your blood sugar (or blood glucose) control over the past 2-3 months. Testing your A1C level every 3 months is the best way for you and your doctor to understand how well your blood sugar levels are controlled. The other test is called SMBG, or self-monitoring of blood glucose. Using a blood glucose monitor to do SMBG testing can help you improve control of your blood sugar levels.

What if my blood sugar gets too low?

People who have diabetes may have times when their blood sugar level is too low. Low blood sugar is called hypoglycemia. Signs of hypoglycemia include the following:

Feeling very tired
Frequent yawning
Being unable to speak or think clearly
Loss of muscle coordination
Sweating
Twitching
Seizures
Suddenly feeling like you're going to pass out
Becoming very pale
Loss of consciousness

People who have diabetes should carry at least 15 grams of a fast-acting carbohydrate with them at all times in case of hypoglycemia or an insulin reaction. The following are examples of quick sources of energy that can relieve the symptoms:

Nondiet soda- ½ to ¾ cup
Fruit juice- ½ cup
Fruit- 2 tablespoons of raisins
Milk- 1 cup
Candy- 5 Lifesavers
Glucose tablets- 3 tablets (5 grams each)

If you don't feel better 15 minutes after having a fast-acting carbohydrate, or if monitoring shows that your blood sugar level is still too low, have another 15 grams of a fast-acting carbohydrate.

Teach your friends, work colleagues and family members how to treat hypoglycemia, because sometimes you may need their help. Also, keep a supply of glucagon on hand. Glucagon comes in a kit with a powder and a liquid that must be mixed together and then injected (given as a shot). It will raise your blood sugar level. If you are unconscious, or you can't eat or drink, another person can give you a shot of glucagon. This will bring your blood sugar level back to normal.

What about smoking and alcohol?

You should stop smoking as soon as possible. It's probably okay to drink some alcohol with a meal, but you should only have 1 serving each day. A serving is 4 ounces of wine, 12 ounces of beer or 1.5 ounces of hard liquor. If you drink on an empty stomach, you risk causing a drop in your blood sugar. Talk with your doctor about how much alcohol is safe for you to consume with your diabetes.

How will I know if my blood sugar level is too high?

High blood sugar (also called hyperglycemia) can occur even if you are eating properly and taking your insulin correctly. Eating too much food at a meal, getting sick, having hormonal changes and feeling stressed out can affect your blood sugar.

Symptoms of hyperglycemia include the following:

Frequent urination
Extreme thirst
Blurry vision
Feeling very tired

What should I do if my blood sugar level is too high?

If your blood sugar level goes higher than it should, you may need to take an extra dose of rapid- or short-acting insulin to return your blood sugar to the normal range. Your doctor can tell you how much insulin you need to take to lower your blood sugar level.

Complications

What are diabetic complications?

Too much glucose in the blood can lead to serious health problems, including heart disease and damage to the nerves and kidneys. These are known as diabetic complications.

Diabetic Neuropathy (nerve damage)

Diabetic neuropathy makes it hard for your nerves to send messages to the brain and other parts of the body. If you have nerve damage, you may lose feeling in parts of your body or have a painful, tingling or burning feeling.

Neuropathy most often affects the feet and legs. If you have neuropathy, you may not be able to feel a sore on your foot. The sore can become infected and, in serious cases, the foot may have to be amputated (removed). People who have neuropathy may continue walking on a foot that has damaged joints or bones. This can lead to a condition called Charcot foot that causes swelling and instability in the injured foot. It can also cause the foot to become deformed. However, this problem can often be avoided.

If you have diabetes, check your feet every day. If you see swelling, redness and feel warmth in your foot, see your doctor immediately. These can be signs of Charcot foot. Your doctor should also check your feet frequently.

Warning signs of nerve damage

Call your doctor if you have:

Numbness, tingling or burning feelings in your fingers, toes, hands and/or feet
Sharp pain that is worse at night
Cuts, sores or blisters on your feet that don't hurt as much as you would expect, and that also heal very slowly
Muscle weakness and difficulty walking

Erectile dysfunction (in men) and vaginal dryness (in women)

Diabetic Retinopathy (eye problems)

The retina is the part of the eye that is sensitive to light and sends messages to your brain about what you see. Diabetes can damage and weaken the small blood vessels in the retina. This damage is called diabetic retinopathy.

When the blood vessels of your retina are damaged, fluid can leak from them and cause swelling in your macula. The macula is the central part of the retina and give you sharp, clear vision. The swelling and fluid can cause blurry vision and make it hard for you to see. If retinopathy gets worse, it may lead to blindness.

Laser surgery can often be used to treat or slow down retinopathy, especially if the problem is found early. People who have diabetes should have an eye exam once a year.

Warning signs of eye problems

Call your doctor if you have:

Blurry vision for more than 2 days
Sudden loss of vision in 1 or both eyes
Black or gray spots, cobwebs or strings that move or drift when you move your eyes (called floaters)
Flashing lights in your vision that aren't really there
Pain or pressure in your eye(s)

Diabetic Nephropathy (kidney damage)

Diabetes can also damage the blood vessels in your kidneys so they can't filter out waste. This damage is called diabetic nephropathy. Some people who have nephropathy will eventually need dialysis (a treatment that eliminates waste from the blood) or kidney transplant.

The risk for nephropathy is increased if you have both diabetes and high blood pressure, so it is important to control both of these conditions.

Protein in the urine is usually the first sign of nephropathy. This should be checked yearly.

Heart Disease and Stroke

People who have diabetes are at greater risk for heart disease and stroke. The risk is even greater for people who have diabetes and smoke, have high blood pressure, have a family history of heart disease or are overweight.

Heart disease is easiest to treat when it is caught early. It is very important to see your doctor on a regular basis. He or she can test for early signs of heart disease.

The recommended cholesterol level for a person who has diabetes is the same as for someone who has heart disease. If your cholesterol is higher than the recommended level, your doctor will talk to you about lifestyle changes and medication to help get your cholesterol under control.

What can I do to prevent or delay diabetic complications?

To prevent problems, keep your blood sugar level as close to normal as possible and follow your doctor's instructions. The following are some other tips:

Carefully follow your doctor's instructions for taking your insulin.
Eat a variety of healthy foods. Avoid foods that are high in fat, cholesterol, salt and added sugar.
Maintain a healthy weight. If you're overweight, your doctor can give you advice on how to lose weight safely.
Keep your blood pressure at a healthy level (below 130/80 mm Hg).
Maintain a healthy cholesterol level (under 200 mg).
Be physically active on a regular basis.
Quit smoking.
Take care of your feet and check them every day for signs of injury and infection.
Have an eye exam every year to check your vision.
See your dentist twice a year to check your teeth and gums.
Stay up-to-date on your immunizations. Get a flu shot each year and a tetanus booster every 10 years.
Manage your stress.
See your doctor regularly, even when you feel fine. Your doctor will check for early signs of complications.
Call your doctor right away if you have any of the warning signs listed.

Other Organizations

Questions to Ask Your Doctor

My mother has diabetes. Should I be tested?
I've been diagnosed with type 2 diabetes. If I lose weight and eat better, will it go away?
What is the best thing I can do to control my diabetes?
Am I at risk for any complications from diabetes?
Which glucose meter is best for me?
Will I need to take insulin?
Are there any other medicines I can take to help control diabetes?
Are my children at higher risk for diabetes?
What exercise program is right for me?
When should I call my doctor?

Bibliography

Portions of this article were developed by the American Academy of Family Physicians in cooperation with the American Diabetes Association.

Portions of this article were developed as part of an educational program made possible by an unrestricted educational grant from LifeScan, Inc., makers of OneTouch Blood Glucose Meters.

Portions of this article were developed with general underwriting support from The Coca-Cola Company.

Educational Guidelines for Achieving Tight Control and Minimizing Complications of Type 1 Diabetes by Stephen Havas, M.D., M.P.H., M.S. (American Family Physician November 01, 1999, http://www.aafp.org/afp/991101ap/1985.html)

The Merck Manual for Healthcare Professionals. Diabetes Mellitus (DM). Accessed January 01, 2011

National Diabetes Information Clearinghouse. Diabetes Overview. Accessed January 01, 2011

National Diabetes Education Program. Overview of Diabetes in Children and Adolescents. Accessed January 01, 2011

National Institutes of Health. Type 1 Diabetes Fact Sheet. Accessed January 01, 2011

Diagnosis and Classification of Diabetes Mellitus: New Criteria by Jennifer Mayfield, M.D., M.P.H. (American Family Physician October 08, 1998, http://www.aafp.org/afp/981015ap/mayfield.html)

Attenuating Cardiovascular Risk Factors in Patients with Type 2 Diabetes by Alan J. Garber, M.D., Ph.D. (American Family Physician December 15, 2000, http://www.aafp.org/afp/20001215/2633.html)

Treatment of Type 2 Diabetes Mellitus by Joe A. Florence, M.D., and Bryan F. Yeager, Pharm.D. (American Family Physician May 15, 1999, http://www.aafp.org/afp/990515ap/2835.html)

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