Friday, 25 November 2011

Diabetes – Basic Things You Must Know About Diabetes.





 DEFINITION


Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood.

Causes, incidence, and risk factors

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.
To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:
  • A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
  • An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.
People with diabetes have high blood sugar. This is because:
  • Their pancreas does not make enough insulin
  • Their muscle, fat, and liver cells do not respond to insulin normally
  • Both of the above
There are three major types of diabetes:
  • Type 1 diabetes is usually diagnosed in childhood. Many patients are diagnosed when they are older than age 20. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown. Genetics, viruses, and autoimmune problems may play a role.
  • Type 2 diabetes is far more common than type 1. It makes up most of diabetes cases. It usually occurs in adulthood, but young people are increasingly being diagnosed with this disease. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to increasing obesity and failure to exercise.
  • Gestational diabetes is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes. Women who have gestational diabetes are at high risk of type 2 diabetes and cardiovascular disease later in life.
Diabetes affects more than 20 million Americans. Over 40 million Americans have prediabetes (early type 2 diabetes).
There are many risk factors for type 2 diabetes, including:
  • Age over 45 years
  • A parent, brother, or sister with diabetes
  • Gestational diabetes or delivering a baby weighing more than 9 pounds
  • Heart disease
  • High blood cholesterol level
  • Obesity
  • Not getting enough exercise
  • Polycystic ovary disease (in women)
  • Previous impaired glucose tolerance
  • Some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans)

Symptoms

High blood levels of glucose can cause several problems, including:
  • Blurry vision
  • Excessive thirst
  • Fatigue
  • Frequent urination
  • Hunger
  • Weight loss
However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.
Symptoms of type 1 diabetes:
  • Fatigue
  • Increased thirst
  • Increased urination
  • Nausea
  • Vomiting
  • Weight loss in spite of increased appetite
Patients with type 1 diabetes usually develop symptoms over a short period of time. The condition is often diagnosed in an emergency setting.
Symptoms of type 2 diabetes:
  • Blurred vision
  • Fatigue
  • Increased appetite
  • Increased thirst
  • Increased urination

Signs and tests

A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes.
The following blood tests are used to diagnose diabetes:
  • Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions. Levels between 100 and 126 mg/dL are referred to as impaired fasting glucose or prediabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.
  • Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours. (This test is used more for type 2 diabetes.)
  • Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic diabetes symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)
Persons with diabetes need to have their hemoglobin A1c (HbA1c) level checked every 3 - 6 months. The HbA1c is a measure of average blood glucose during the previous 2 - 3 months. It is a very helpful way to determine how well treatment is working.

Treatment

The immediate goals are to treat diabetic ketoacidosis and high blood glucose levels. Because type 1 diabetes can start suddenly and have severe symptoms, people who are newly diagnosed may need to go to the hospital.
The long-term goals of treatment are to:
These goals are accomplished through:
  • Blood pressure and cholesterol control
  • Careful self testing of blood glucose levels
  • Education
  • Exercise
  • Foot care
  • Meal planning and weight control
  • Medication or insulin use
There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms.
LEARN THESE SKILLS
Basic diabetes management skills will help prevent the need for emergency care. These skills include:
  • How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
  • What to eat and when
  • How to take insulin or oral medication
  • How to test and record blood glucose
  • How to test urine for ketones (type 1 diabetes only)
  • How to adjust insulin or food intake when changing exercise and eating habits
  • How to handle sick days
  • Where to buy diabetes supplies and how to store them
After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. Review and update your knowledge, because new research and improved ways to treat diabetes are constantly being developed.
SELF-TESTING
If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes. It can help your doctor prevent complications.
The American Diabetes Association recommends keeping blood sugar levels in the range of:
  • 80 - 120 mg/dL before meals
  • 100 - 140 mg/dL at bedtime
Your doctor may adjust this depending on your circumstances.
WHAT TO EAT
You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can help you plan your dietary needs.
People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low.
People with type 2 diabetes should follow a well-balanced and low-fat diet.
HOW TO TAKE MEDICATION
Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.
People with type 1 diabetes cannot make their own insulin. They need daily insulin injections. Insulin does not come in pill form. Injections are generally needed one to four times per day. Some people use an insulin pump. It is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use inhaled insulin. See also: Type 1 diabetes
Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes. See also: Type 2 diabetes
Medications may be switched to insulin during pregnancy and while breastfeeding.
Gestational diabetes may be treated with exercise and changes in diet.
EXERCISE
Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than those who do not exercise regularly.
Here are some exercise considerations:
  • Always check with your doctor before starting a new exercise program.
  • Ask your doctor or nurse if you have the right footwear.
  • Choose an enjoyable physical activity that is appropriate for your current fitness level.
  • Exercise every day, and at the same time of day, if possible.
  • Monitor blood glucose levels before and after exercise.
  • Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
  • Carry a diabetes identification card and a cell phone in case of emergency.
  • Drink extra fluids that do not contain sugar before, during, and after exercise.
You may need to change your diet or medication dose if you change your exercise intensity or duration to keep blood sugar levels from going too high or low.
FOOT CARE
People with diabetes are more likely to have foot problems. Diabetes can damage blood vessels and nerves and decrease the body's ability to fight infection. You may not notice a foot injury until an infection develops. Death of skin and other tissue can occur.
If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.
To prevent injury to the feet, check and care for your feet every day.

Support Groups

For additional information, see diabetes resources.

Expectations (prognosis)

With good blood glucose and blood pressure control, many of the complications of diabetes can be prevented.
Studies have shown that strict control of blood sugar, cholesterol, and blood pressure levels in persons with diabetes helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.

Complications

Emergency complications include:
Long-term complications include:

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of ketoacidosis:
  • Abdominal pain
  • Deep and rapid breathing
  • Increased thirst and urination
  • Loss of consciousness
  • Nausea
  • Sweet-smelling breath
Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction):

Prevention

Maintaining an ideal body weight and an active lifestyle may prevent type 2 diabetes.
Currently there is no way to prevent type 1 diabetes.
There is no effective screening test for type 1 diabetes in people who don't have symptoms.
Screening for type 2 diabetes and people with no symptoms is recommended for:
  • Overweight children who have other risk factors for diabetes starting at age 10 and repeating every 2 years
  • Overweight adults (BMI greater than 25) who have other risk factors
  • Adults over 45, repeated every 3 years
To prevent complications of diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having.
Regularly have the following tests:
  • Have your blood pressure checked every year (blood pressure goals should be 130/80 mm/Hg or lower).
  • Have your glycosylated hemoglobin (HbA1c) checked every 6 months if your diabetes is well controlled, otherwise every 3 months.
  • Have your cholesterol and triglyceride levels checked yearly (aim for LDL levels below 100 mg/dL).
  • Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine).
  • Visit your ophthalmologist (preferably one who specializes in diabetic retinopathy) at least once a year, or more often if you have signs of diabetic retinopathy.
  • See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.
  • Make sure your health care provider inspects your feet at each visit.

 

Diabetes Mellitus, Type 2-Definition

Type 2 diabetes is a chronic (lifelong) disease marked by high levels of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes.

Symptoms

Often, people with type 2 diabetes have no symptoms at all. If you do have symptoms, they may include:

Causes & Risk Factors

Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is needed to move blood sugar (glucose) into cells, where it is stored and later used for energy.
When you have type 2 diabetes, the body does not respond correctly to insulin. This is called insulin resistance. Insulin resistance means that fat, liver, and muscle cells do not \respond normally to insulin. As a result blood sugar does not get into cells to be stored for energy.
When sugar cannot enter cells, abnormally high levels of sugar build up in the blood. This is called hyperglycemia. High levels of blood sugar often trigger the pancreas to produce more and more insulin, but it not enough to keep up with the body's demand.
People who are overweight are more likely to have insulin resistance, because fat interferes with the body's ability to use insulin.
Type 2 diabetes usually occurs gradually. Most people with the disease are overweight at the time of diagnosis. However, type 2 diabetes can also develop in those who are thin, especially the elderly.
Family history and genetics play a large role in type 2 diabetes. Low activity level, poor diet, and excess body weight (especially around the waist) significantly increase your risk for type 2 diabetes.
Other risk factors include:
  • Age greater than 45 years
  • HDL cholesterol of less than 35 mg/dL or triglyceride level of greater than 250 mg/dL
  • High blood pressure
  • History of gestational diabetes
  • Previously identified impaired glucose tolerance by your doctor
  • Race/ethnicity (African Americans, Hispanic Americans, and Native Americans all have high rates of diabetes)

Tests & Diagnostics

Type 2 diabetes is diagnosed with the following blood tests:
  • Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions.
  • Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours.
  • Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue (this test must be confirmed with a fasting blood glucose test).
You should see your health care provider every 3 months. At these visits, you can expect your health care provider to::
  • Check your blood pressure
  • Check the skin and bones on your feet and legs
  • Check the sensation on your feet
  • Exam the back part of the eye with a special lighted instrument called an ophthalmoscope
The following tests will help you and your doctor monitor your diabetes and prevent complications:
  • Have your blood pressure checked at least every year (blood pressure goals should be 130/80 mm/Hg or lower).
  • Have your glycosulated hemoglobin (HbA1c) checked every 6 months if your diabetes is well controlled; otherwise every 3 months.
  • Have your cholesterol and triglyceride levels checked yearly (aim for LDL levels below 100 mg/dL).
  • Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine).
  • Visit your ophthalmologist) at least once a year, or more often if you have signs of diabetic retinopathy.
  • See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.

Treatments

The immediate goal of treatment is to lower high blood glucose levels. The long-term goals of treatment are to prevent diabetes-related complications.
The primary treatment for type 2 diabetes is exercise and diet.
LEARN THESE SKILLS
You should learn basic diabetes management skills. They will help prevent complications and the need for medical care. These skills include:
  • How to test and record your blood glucose (See: Blood glucose monitoring)
  • What to eat and when
  • How to take medications, if needed
  • How to recognize and treat low and high blood sugar
  • How to handle sick days
  • Where to buy diabetes supplies and how to store them
It may take several months to learn the basic skills. Always continue to educate yourself about the disease and its complications. Learn how to control and live with diabetes. Over time, stay current on new research and treatment.
SELF-TESTING
Self testing refers to being able to check your blood sugar at home yourself. It is also called self-monitoring of blood glucose (SMBG). Regular self-testing of your blood sugar tells you and your health care provider how well your diet, exercise, and diabetes medications are working.
A device called a glucometer can provide an exact blood sugar reading. There are different types of devices. Usually, you prick your finger with a small needle called a lancet. This gives you a tiny drop of blood. You place the blood on a test strip and put the strip into the device. Results are available in 30 - 45 seconds.
A health care provider or diabetes educator will help set up an at-home testing schedule for you. Your doctor will help you set your blood sugar goals.
  • Most people with type 2 diabetes only need to check their blood sugar once or twice a day.
  • If your blood sugar levels are under control, you may only need to check them a few times a week.
  • Tests may be done when you wake up, before meals, and at bedtime.
  • More frequent testing may be needed when you are sick or under stress.
The results of the test can be used to adjust meals, activity, or medications to keep your blood sugar levels in an appropriate range. Testing can identify high and low blood sugar levels before serious problems develop.
Keeping a record for yourself and your health care provider. This will be a big help if you are having trouble managing your diabetes.
DIET AND WEIGHT CONTROL
People with type 2 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low. Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. You should work closely with your doctor, nurse, and registered dietitian to learn how much fat, protein, and carbohydrates you need in your diet. Your meal plans should fit your daily lifestyle and habits, and should try to include foods that you like.
Managing your weight and eating a well-balanced diet are important. Some people with type 2 diabetes can stop taking medications after losing weight (although they still have diabetes). See: Diabetes diet
Bariatric (weight loss) surgery may be considered for very overweight patients who are not well managed with diet and medications. See:
REGULAR PHYSICAL ACTIVITY
Regular exercise is important for everyone, but especially if you have diabetes. Regular aerobic exercise lowers your blood sugar level without medication and helps burn excess calories and fat so you can manage your weight.
Exercise can help your overall health by improving blood flow and blood pressure. It decreases insulin resistance even without weight loss. Exercise also increases the body's energy level, lowers tension, and improves your ability to handle stress.
Consider the following when starting an exercise routine:
  • Always check with your health care provider before starting an exercise program.
  • Ask your health care provider whether you have the right footwear.
  • Choose an enjoyable physical activity that is appropriate for your current fitness level.
  • Exercise every day, and at the same time of day, if possible.
  • Monitor blood glucose levels at home before and after exercise.
  • Carry food that contains a fast-acting carbohydrate in case blood glucose levels get too low during or after exercise.
  • Wear a diabetes identification bracelet and carry a cell phone in case of emergency.
  • Drink extra fluids that do not contain sugar before, during, and after exercise.
  • You may need to modify your diet or medication if you exercise longer or more intensely, to keep blood glucose levels in the correct range.
MEDICATIONS TO TREAT DIABETES
If diet and exercise do not help maintain normal or near-normal blood glucose levels, your doctor may prescribe medication. Since these drugs help lower your blood sugar levels in different ways, your doctor may have you take more than one. These drugs may also be given along with insulin, if needed.
Some of the most common types of medication are listed below. They are taken by mouth or injection.
  • Biguanides (Metformin) tell the liver to produce less glucose and help muscle and fat cells and the liver absorb more glucose from the bloodstream. This lowers blood sugar levels.
  • Sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pancreas to make more insulin. They are taken by mouth.
  • Thiazolidinediones (such as rosiglitazone) help muscle and fat cells and the liver absorb more blood sugar when insulin is present. Rosiglitazone may increase the risk of heart problems. Talk to your doctor.
  • Injectible medications (including exenatide and pramlintide) can lower blood sugar.
  • Meglitinides (including repaglinide and nateglinide) trigger the pancreas to make more insulin in response to the level of glucose in the blood.
  • Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract to lower after-meal glucose levels.
If you continue to have poor blood glucose control despite lifestyle changes and taking medicines by mouth, your doctor will prescribe insulin. Insulin may also be prescribed if you have had a bad reaction to other medicines. Insulin must be injected under the skin using a syringe or insulin pen device. It cannot be taken by mouth.
Insulin preparations differ in how fast they start to work and how long they work. Your healthcare provider will determine the appropriate type of insulin to use and will tell you what time of day to use it.
More than one type may be mixed together in an injection to achieve the best blood glucose control. Usually injections are needed one to four times a day. Your doctor or diabetes educator will show you how to give yourself an injection.
Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity. When they reach their ideal weight, their own insulin and a careful diet can control their blood glucose levels.
It is not known whether hypoglycemia medications taken by mouth are safe for use in pregnancy. Women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy and while breastfeeding.
MEDICATIONS TO PREVENT COMPLICATIONS
Since those with diabetes have a much higher chance of developing heart disease, kidney disease, and other medical problems, they may need to take certain medicines to treat these problems or prevent them from happening.
An ACE inhibitor (or ARB) is often recommended:
  • As the first choice medicine for treating high blood pressure in persons with diabetes
  • For those who have signs of early kidney disease
Statin drugs are usually the first choice to treat an abnormal cholesterol level. Aim for LDL cholesterol level less than 100 mg/dL.
Aspirin to prevent heart disease is most often recommended for persons with diabetes who:
  • Are 40 or older
  • Have a history of heart problems
  • Have a family history of heart disease
  • Have high blood pressure or high cholesterol
  • Smoke
FOOT CARE
People with diabetes are more likely to have foot problems. Diabetes can damage nerves, which means you may not feel an injury to the foot until a large sore or infection develops. Diabetes can also damage blood vessels.
In addition, diabetes affects the body's immune system. This decreases the body's ability to fight infection. Small infections can quickly get worse and cause the death of skin and other tissues. Amputation may be needed.
To prevent injury to the feet, check and care for your feet every day.

Drugs

Children with type 1 diabetes need daily injections of insulin to help their bodies use glucose. The amount and type of insulin required depends on the height, weight, age, food intake, and activity level of the individual diabetic patient. Some patients with type 2 diabetes may also need to use insulin injections if their diabetes cannot be controlled with diet, exercise, and oral medication. Injections are given subcutaneously, that is, just under the skin, using a small needle and syringe, an insulin pen injector, an insulin infusion pump, or a jet injector device. Injection sites can be anywhere on the body where there is a layer of fat available, including the upper arm, abdomen, or upper thigh.
Insulin may be given as an injection of a single dose of one type of insulin once a day, or different types of insulin can be mixed and given in one dose or split into two or more doses during a day. Patients who require multiple injections over the course of a day may be able to use an insulin pump that administers small doses of insulin on demand. The small battery-operated pump is worn outside the body and is connected to a cannula (a thin, flexible plastic tube) that is inserted into the abdomen called an insertion set. Pumps are programmed to infuse a small, steady infusion of insulin (called a basal dose) throughout the day, and larger doses (called boluses) before meals. Because of the basal infusion, pumps can offer many children much tighter control over their blood glucose levels and more flexibility with their diet than insulin shots afford them.
Regular insulin is fast-acting and starts to work within 15 to 30 minutes, with its peak glucose-lowering effect about two hours after it is injected. Its effects last for about four to six hours. NPH (neutral protamine Hagedorn) and Lente insulin are intermediate-acting, starting to work within one to three hours and lasting up to 18 to 26 hours. Ultra-lente is a long-acting form of insulin that starts to work within four to eight hours and lasts 28 to 36 hours. Peakless, or basal-action insulin (insulin glargine, or Lantus) starts working in 15 minutes and has a duration of between 18 and 26 hours.

Complications

After many years, diabetes can lead to serious problems with your eyes, kidneys, nerves, heart, blood vessels, and other areas in your body.
If you have diabetes, your risk of a heart attack is the same as someone who has already had a heart attack. Both women and men with diabetes are at risk. You may not even have the typical signs of a heart attack.
In general, complications include:

Prevention

Diabetes screening is recommended for:
  • Overweight children who have other risk factors for diabetes, starting at age 10 and repeating every 2 years
  • Overweight adults (BMI greater than 25) who have other risk factors
  • Adults over 45 every 3 years
You can help prevent type 2 diabetes by keeping a healthy body weight and an active lifestyle.
To prevent complications of diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having.
Stay up-to-date with all your vaccinations and get a flu shot every year.
To prevent diabetes-related foot problems, you should:
  • Stop smoking if you smoke.
  • Improve control of your blood sugar
  • Get a foot exam by your health care provider at least twice a year and learn whether you have nerve damage.
  • Check and care for your feet EVERY DAY, especially if you already have known nerve or blood vessel damage or current foot problems. Follow the instructions below.
  • Make sure you are wearing the right kind of shoes.

 

Diabetes Mellitus, Type 1-Definition

Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas does not produce enough insulin to properly control blood sugar levels.

 

Definition

Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas does not produce enough insulin to properly control blood sugar levels.
See also:

Symptoms

Some people will have no symptoms before they are diagnosed with diabetes.
Others may notice these symptoms as the first signs of type 1 diabetes, or when the blood sugar is high:
  • Feeling tired or fatigued
  • Feeling hungry
  • Being very thirsty
  • Urinating more often
  • Losing weight without trying
  • Having blurry eyesight
  • Losing the feeling or feeling tingling in your feet
For others, warning symptoms that they are becoming very sick may be the first signs of type 1 diabetes, or may happen when the blood sugar is very high (see: diabetic ketoacidosis):
  • Deep, rapid breathing
  • Dry skin and mouth
  • Flushed face
  • Fruity breath odor
  • Nausea or vomiting, unable to keep down fluids
  • Stomach pain
Low blood sugar (hypoglycemia) can develop quickly in people with diabetes who are taking insulin. Symptoms typically appear when the blood sugar level falls below 70. Watch for:
  • Headache
  • Hunger
  • Nervousness
  • Rapid heartbeat (palpitations)
  • Shaking
  • Sweating
  • Weakness

Causes & Risk Factors

There are several forms of diabetes. Type 1 diabetes used to be called juvenile or insulin-dependent diabetes. Type 1 diabetes can occur at any age, but it is most often diagnosed in children, adolescents, or young adults.
Insulin is a hormone produced by special cells, called beta cells, in the pancreas, an organ located in the area behind your stomach. Insulin is needed to move blood sugar (glucose) into cells, where it is stored and later used for energy. In type 1 diabetes, these cells produce little or no insulin.
Without enough insulin, glucose builds up in the bloodstream instead of going into the cells. The body is unable to use this glucose for energy. This leads to the symptoms of type 1 diabetes.
Within 5 - 10 years, the insulin-producing beta cells of the pancreas are completely destroyed and the body can no longer produce insulin.
The exact cause is unknown, but most likely there is a viral or environmental trigger in genetically susceptible people that causes an immune reaction. The body's white blood cells mistakenly attack the insulin-producing pancreatic beta cells.

Tests & Diagnostics

Diabetes is diagnosed with the following blood tests:
  • Fasting blood glucose level -- diabetes is diagnosed if it is higher than 126 mg/dL on two occasions
  • Random (nonfasting) blood glucose level -- diabetes is suspected if it is higher than 200 mg/dL, and the patient has symptoms such as increased thirst, urination, and fatigue (this must be confirmed with a fasting test)
  • Oral glucose tolerance test -- diabetes is diagnosed if the glucose level is higher than 200 mg/dL after 2 hours.
Ketone testing is also used in type 1 diabetes. Ketones are produced by the breakdown of fat and muscle. They are harmful at high levels. The ketone test is done using a urine sample. Ketone testing is usually done at the following times:
The following tests will help you and your doctor monitor your diabetes and prevent complications of diabetes:
  • Check the skin and bones on your feet and legs.
  • Check the sensation in your feet.
  • Have your blood pressure checked at least every year (blood pressure goal should be 130/80 mm/Hg or lower).
  • Have your glycosulated hemoglobin (HbA1c) checked every 6 months if your diabetes is well controlled; otherwise, every 3 months.
  • Have your cholesterol and triglyceride levels checked yearly (aim for LDL cholesterol levels below 100 mg/dL).
  • Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine).
  • Visit your ophthalmologist at least once a year, or more often if you have signs of diabetic retinopathy.
  • See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.

Treatments

The immediate goals of treatment are to treat diabetic ketoacidosis and high blood glucose levels. Because type 1 diabetes can come on suddenly and the symptoms can be severe, newly diagnosed people may need to stay in the hospital.
The long-term goals of treatment are to:
You are the most important person in managing your diabetes. You should know the basic steps to diabetes management:
  • How to recognize and treat low blood sugar (hypoglycemia)
  • How to recognize and treat high blood sugar (hyperglycemia)
  • Diabetes meal planning
  • How to give insulin
  • How to monitor blood glucose and urine ketones
  • How to adjust insulin and food intake during exercise
  • How to handle sick days
  • Where to buy diabetes supplies and how to store them
INSULIN
Insulin lowers blood sugar by allowing it to leave the bloodstream and enter cells. Everyone needs insulin. People with type 1 diabetes can't make their own insulin. They must take insulin every day.
Insulin is usually injected under the skin. In some cases, a pump delivers the insulin continuously. Insulin does not come in pill form.
Insulin preparations differ in how fast they start to work and how long they last. The health care professional will review your blood glucose levels to determine the appropriate type of insulin you should use. More than one type of insulin may be mixed together in an injection to achieve the best blood glucose control.
The injections are needed, in general, from one to four times a day. People are taught how to give insulin injections by their health care provider or a diabetes nurse educator. At first, a child's injections may be given by a parent or other adult. By age 14, most children can be expected (but should not be required) to give their own injections.
People with diabetes need to know how to adjust the amount of insulin they are taking in the following situations:
  • When they exercise
  • When they are sick
  • When they will be eating more or less food and calories
  • When they are traveling
DIET
People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low. (See: Diabetes diet)
The American Diabetes Association and the American Dietetic Association have information for planning healthy, balanced meals. It can help to talk with a registered dietitian or nutrition counselor.
PHYSICAL ACTIVITY
Regular exercise helps control the amount of sugar in the blood. It also helps burn excess calories and fat to achieve a healthy weight.
Ask your health care provider before starting any exercise program. Those with type 1 diabetes must take special precautions before, during, and after intense physical activity or exercise.
  • Always check with your doctor before starting a new exercise program.
  • Ask your doctor or nurse if you have the right footwear.
  • Choose an enjoyable physical activity that is appropriate for your current fitness level.
  • Exercise every day and at the same time of day, if possible.
  • Monitor your blood glucose levels at home before and after exercising.
  • Carry food that contains a fast-acting carbohydrate in case your blood glucose levels get too low during or after exercise.
  • Wear a diabetes identification bracelet and carry a cell phone to use in case of emergency.
  • Drink extra fluids that do not contain sugar before, during, and after exercise.
  • As you change the intensity or duration of your exercise, you may need to modify your diet or medication to keep your blood glucose levels in an appropriate range.
SELF-TESTING
Self-testing refers to being able to check your blood sugar at home yourself. Regular self-testing of your blood sugar tells you and your health care provider how well your diet, exercise, and diabetes medications are working. This is also called self-monitoring of blood glucose, or SMBG.
A health care provider or diabetes educator will help set up a testing schedule for you at home.
  • Your doctor will help you set a goal for what level your blood sugar should be during the day.
  • The results can be used to adjust meals, activity, or medications to keep blood sugar levels within an appropriate range. Tests are usually done before meals and at bedtime. More frequent testing may be needed when you are sick, under stress, or adjusting your insulin dosing.
Testing will provide valuable information so the health care provider can suggest improvements to your care and treatment. Testing will identify high and low blood sugar levels before serious problems develop.
A device called a glucometer can provide a blood sugar reading. There are different types of devices. Usually, you prick your finger with a small needle called a lancet to get a tiny drop of blood. You place the blood on a test strip and put the strip into the device. You should have results within 30 - 45 seconds.
Keeping accurate records of your test results will help you and your health care provider plan how to best control your diabetes.
The American Diabetes Association recommends keeping blood sugar levels in the range of:
  • 80 - 120 mg/dL before meals
  • 100 - 140 mg/dL at bedtime
FOOT CARE
Diabetes causes damage to the blood vessels and nerves. This can reduce your ability to feel injury to or pressure on the foot. You may not notice a foot injury until severe infection develops. Diabetes can also damage blood vessels. Small sores or breaks in the skin may progress to deeper skin ulcers. Amputation of the affected limb may be needed when these skin ulcers do not improve or become larger or deeper.
To prevent problems with your feet, you should:
  • Stop smoking if you smoke.
  • Improve control of your blood sugar.
  • Get a foot exam by your health care provider at least twice a year and learn whether you have nerve damage.
  • Check and care for your feet EVERY DAY, especially if you already have known nerve or blood vessel damage or current foot problems.
  • Make sure you are wearing the right kind of shoes.
See: Diabetes foot care.
TREATING LOW BLOOD SUGAR
Hypoglycemia can develop quickly in people with diabetes. Symptoms typically appear when the blood sugar level falls below 70. If you have symptoms:
  • Do a blood sugar check.
  • If the level is low or you have symptoms of hypoglycemia, eat something with sugar: 4 ounces of fruit juice, 3 - 4 Lifesavers candies, or 4 ounces of regular soda. Overtreating a mild low blood sugar reaction can lead to problems with high blood sugar and difficult blood sugar control overall.
  • Symptoms should go away within 15 minutes. If the symptoms don't go away, repeat the sugar-containing food as above, and test the sugar level again. When your blood sugar is in a safer range (over 70 mg/dL), you may need to eat a snack with carbohydrates and protein, such as cheese and crackers or a glass of milk.
Ask your doctor if you need a glucagon injection kit to raise blood sugar quickly in an emergency.
MEDICATIONS TO PREVENT COMPLICATIONS
Your doctor may prescribe medications to reduce your chances of developing eye disease, kidney disease, and other conditions that are more common in people with diabetes.
An ACE inhibitor (or ARB) is often recommended as the first choice for those with high blood pressure and those with signs of kidney disease. ACE inhibitors include:
Statin drugs are usually the first choice to treat an abnormal cholesterol level. Aim for an LDL cholesterol level of less than 100 mg/dL.
Aspirin to prevent heart disease is most often recommended for people with diabetes who:
  • Are older than 40
  • Have a personal or family history of heart problems
  • Have high blood pressure or high cholesterol
  • Smoke

Complications

After many years, diabetes can lead to serious problems with your eyes, kidneys, nerves, heart, blood vessels, and other areas in your body.
If you have diabetes, your risk of a heart attack is the same as someone who has already had a heart attack. Both women and men with diabetes are at risk. You may not even have the typical signs of a heart attack.
In general, complications include:
Other complications include:
  • Erection problems
  • Infections of the skin, female genital tract, and urinary tract

Prevention

Currently, there is no way to prevent type 1 diabetes. There is no effective screening test for type 1 diabetes in people with no symptoms.
To prevent complications of diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having.
Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.





Gestational Diabetes

Definition

Gestational diabetes is high blood sugar (diabetes) that starts or is first diagnosed during pregnancy.

Symptoms

Usually there are no symptoms, or the symptoms are mild and not life threatening to the pregnant woman. Often, the blood sugar (glucose) level returns to normal after delivery.
Symptoms may include:

Causes & Risk Factors

Risk factors for gestational diabetes include:
  • African or Hispanic ancestry
  • Being older than 25 when pregnant
  • Family history of diabetes
  • Giving birth to a previous baby that weighed more than 9 pounds
  • Obesity
  • Recurrent infections
  • Unexplained miscarriage or death of a newborn

Tests & Diagnostics

Gestational diabetes may not cause symptoms. All pregnant women should receive an oral glucose tolerance test between the 24th and 28th week of pregnancy to screen for the condition.

Treatments

The goals of treatment are to keep blood sugar (glucose) levels within normal limits during the pregnancy, and to make sure that the fetus is healthy.
WATCHING YOUR BABY
Your health care provider should closely check both you and your fetus throughout the pregnancy. Fetal monitoring to check the size and health of the fetus often includes ultrasound and nonstress tests.
  • A nonstress test is a very simple, painless test for you and your baby. A machine that hears and displays your baby's heartbeat (electronic fetal monitor) is placed on your abdomen. When the baby moves, its heart rate normally increases 15 - 20 beats above its regular rate.
  • Your health care provider can look at the pattern of your baby's heartbeat compared to its movements and find out whether the baby is doing well. The health care provider will look for increases in the baby's normal heart rate, occurring within a certain period of time.
DIET AND EXERCISE
Managing your diet can give you the calories and nutrients you need for your pregnancy, control your blood sugar (glucose) levels, and avoid the need to take medications. Regular exercise also can help keep your blood sugar under better control.
Eating a balanced diet is a key part of any pregnancy. The food you eat helps your baby grow and develop inside of you. Because every pregnancy is different, your doctor and dietitian will create a diet just for you.
  • The best way to improve your diet is by eating a variety of healthy foods. Your doctor or nurse will prescribe a daily prenatal vitamin. They may suggest that you take extra iron or calcium. Talk to your doctor or nurse if you're a vegetarian or are on some other special diet.
  • Remember that "eating for two" does not mean you need to eat twice as many calories. You usually need just 300 extra calories a day (such as a glass of milk, a banana, and 10 crackers).

Complications

  • Delivery-related complications due to the infant's large size
  • Development of diabetes later in life
  • Increased risk of newborn death
  • Low blood sugar (glucose) or illness in the newborn

Prevention

Beginning prenatal care early and regular prenatal visits helps improve the health of you and your baby. Knowing the risk factors for gestational diabetes and having prenatal screening at 24 - 28 weeks into the pregnancy will help detect gestational diabetes early.






Diabetic Ketoacidosis

Definition

Diabetic ketoacidosis is a complication of diabetes that occurs when the body cannot use sugar (glucose) as a fuel source because the body has no insulin or not enough insulin, and fat is used instead. Byproducts of fat breakdown, called ketones, build up in the body.

Symptoms

The warning signs that you are becoming very sick might include:
Other symptoms that can occur include:

Causes & Risk Factors

People with type 1 diabetes lack enough insulin, a hormone the body uses to process glucose (blood sugar) for energy. When glucose is not available, body fat is broken down instead.
As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis
Blood glucose levels rise (usually higher than 300 mg/dL) because the liver produces glucose to try to combat the problem. However the cells cannot pull in that glucose without insulin.
Diabetic ketoacidosis may lead to a diagnosis of type 1 diabetes, because it is often the first symptom that causes a person to see a doctor. It can also be the result of increased insulin needs in someone already diagnosed with type 1 diabetes. Infection, trauma, heart attack, or surgery can lead to diabetic ketoacidosis in such cases. Missing doses of insulin can also lead to ketoacidosis in people with diabetes.
People with type 2 diabetes can develop ketoacidosis, but it is rare. It is usually triggered by a severe illness. People of Hispanic and African-American ethnicity seem to be more likely to have ketoacidosis as a complication of type 2 diabetes.

Tests & Diagnostics

Ketone testing may be used in type 1 diabetes to screen for early ketoacidosis. The ketones test is done using a urine sample. Ketone testing is usually done at the following times:
Other tests that may be done to diagnose ketoacidosis include:
This disease may also affect the results of the following tests:

Treatments

The goal of treatment is to correct the high blood glucose level by giving more insulin. Another goal is to replace fluids lost through excessive urination and vomiting. You may be able to recognize the early warning signs and make appropriate corrections at home before the condition gets worse.
If ketoacidosis is severe, you will need to go to the hospital. The following will be done at the hospital:
  • Insulin replacement will be given.
  • Fluids and electrolytes will be replaced.
  • The cause of the condition (such as infection) will be found and treated.

Complications

Prevention

People with diabetes should learn to recognize the early warning signs and symptoms of ketoacidosis. In people with infections or who are on insulin pump therapy, measuring urine ketones can give more information than glucose measurements alone.
Insulin pump users need to check often to see that insulin is still flowing through the tubing, and that there are no blockages, kinks, or disconnections.

 

 

 

 

 

 

 


 

Diabetes Mellitus with Hyperosmolar Coma

Definition

Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes that involves extremely high blood sugar (glucose) levels without the presence of ketones. Ketones are byproducts of fat breakdown.

Symptoms

Symptoms may get worse over a period of days or weeks.
Other symptoms that may occur with this disease:

Causes & Risk Factors

Diabetic hyperglycemic hyperosmolar syndrome is a condition of:
  • Extremely high blood sugar (glucose) levels
  • Extreme lack of water (dehydration)
  • Decreased consciousness
The buildup of ketones in the body (ketoacidosis) may also occur.
This condition is usually seen in people with type 2 diabetes. It may occur in those who have not been diagnosed with diabetes, or in people who have not been able to control their diabetes. The condition may be brought on by:
  • Infection
  • Other illness
  • Medications that lower glucose tolerance or increase fluid loss (in people who are losing or not getting enough fluid)
Normally, the kidneys try to make up for high glucose levels in the blood by allowing the extra glucose to leave the body in the urine. If you do not drink enough fluids, or you drink fluids that contain sugar, the kidneys can no longer get rid of the extra glucose. Glucose levels in the blood can become very high as a result. The blood then becomes much more concentrated than normal (hyperosmolarity).
Hyperosmolarity is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances that normally cause water to move into the bloodstream. This draws the water out of the body's other organs, including the brain. Hyperosmolarity creates a cycle of increasing blood-glucose levels and dehydration.
Risk factors include:
  • A stressful event such as infection, heart attack, stroke, or recent surgery
  • Congestive heart failure
  • Impaired thirst
  • Limited access to water (especially in patients with dementia or who are bedbound)
  • Older age
  • Poor kidney function
  • Poor management of diabetes -- not following the treatment plan as directed
  • Stopping insulin or other medications that lower glucose levels

Tests & Diagnostics

Signs may include:
Test results include:
Evaluation for possible causes may include:

Treatments

The goal of treatment is to correct the dehydration. This will improve the blood pressure, urine output, and circulation.
Fluids and potassium will be given through a vein (intravenously). High glucose levels are treated with intravenous insulin.

Complications

Prevention

Controlling type 2 diabetes and recognizing the early signs of dehydration and infection can help prevent this condition.

 

 

 

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