Diabetes Overview

What is diabetes?

Diabetes mellitus is a disease that prevents your body from properly using the energy from the food you eat. Diabetes occurs when either:

• The pancreas (an organ behind your stomach) produces little insulin or no insulin at all, or,
• The pancreas makes insulin, but the insulin made does not work as it should. This condition is called insulin resistance.

What is insulin?

Insulin is a naturally-occurring hormone, produced by the beta cells of the pancreas, that helps the body use glucose for energy.

Understanding metabolism

To understand diabetes better, it helps to know more about how the body uses food for energy (a process called metabolism). Your body is made up of millions of cells. To make energy, the cells need food in a very simple form. When you eat or drink, much of your food is broken down into a simple sugar called glucose. Glucose (sugar) provides the energy your body needs for daily activities.

The blood and blood vessels are the highways that transport glucose from where it is either taken in (the stomach) or manufactured (in the liver) to the cells where it is used (muscles) or where it is stored (fat). Glucose cannot go into the cells by itself. The pancreas releases a substance called insulin into the blood which serves as the helper, or the "key" that lets glucose into the cells for use as energy. When glucose leaves the bloodstream and enters the cells, the blood glucose level is lowered.

Compare the human body to a car. To start a car, you must turn the key to move the gas to the engine. Without insulin, or the "key," glucose cannot get into the body's cells for use as energy. This causes glucose to rise. Too much glucose in the blood is called "high blood sugar" or diabetes.

Types of diabetes

Type 1 diabetes

Type 1 diabetes occurs because the insulin-producing cells (called beta cells) of the pancreas are damaged. People with type 1 diabetes produce little or no insulin, so glucose cannot get into the body's cells for use as energy. This causes blood glucose to rise. People with type 1 diabetes MUST use insulin injections to control their blood glucose.

The damage to insulin-producing cells in type 1 diabetes occurs over a period of years. However, the symptoms of type 1 diabetes may occur over a period of days to weeks. Type 1 is the most common form of diabetes in people under age 20, but it can occur at any age.

Type 2 diabetes

Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin. However, the insulin produced is either not enough or doesn't work properly in the body. When there is not enough insulin or the insulin is not used as it should be, glucose cannot get into the body's cells for use as energy. This causes blood glucose to rise.

Type 2 diabetes is most common in people who are over age 40 and who are overweight. Some people with type 2 diabetes can manage it by controlling their weight, watching their diet, and exercising regularly. Others may also need to take an oral glucose-lowering medication or insulin injections.

Gestational diabetes

Gestational diabetes is a high blood glucose level that occurs during pregnancy. As pregnancy progresses, the developing baby has an increased need for glucose. Hormone changes during pregnancy also affect the action of insulin, resulting in high blood glucose levels.

Pregnant women who have an increased risk of developing gestational diabetes include those who:

• are over 25 years old
• are above their normal body weight
• have a family history of diabetes, and
• are Hispanic, African-American, Native American, or Asian.

Usually, blood glucose levels return to normal after childbirth. However, women who have had gestational diabetes have an increased risk of developing type 2 diabetes later in life.

What are the symptoms of diabetes?

The symptoms of type 1 diabetes are often sudden and severe. These symptoms include:

• Increased thirst
• Increased hunger (especially after eating)
• Dry mouth
• Frequent urination
• Unexplained weight loss (even though you are eating and feel hungry)
• Fatigue (weak, tired feeling)
• Blurred vision
• Numbness or tingling of the hands or feet
• Loss of consciousness (rare)

The symptoms of type 2 diabetes may be the same as those listed above. Most often, there are no symptoms or a very gradual development of the symptoms of type 1 diabetes.

Other symptoms include:

• Slow healing sores or cuts
• Itching of the skin (usually in the vaginal or groin area)
• Yeast infections
• Recent weight gain

Diabetes risk factors

Although the causes of diabetes are unknown, the following risk factors may increase your chance of developing diabetes:

• A family history of diabetes (if a parent or sibling in your family has diabetes)
• Race or ethnic background (the risk of diabetes is greater in Hispanics, African-Americans, Native Americans, and Asians)
• Being overweight (20 percent or more over your desired body weight)
• Hypertension (high blood pressure)
• Abnormal blood cholesterol or triglyceride levels: HDL or "good" cholesterol level under 45 mg/dl for men and 55 mg/dl for women, and/or a triglyceride level over 150 mg/dl.
• Age: Your risk of developing diabetes rises progressively as you get older.
• Use of certain drugs:
  • Blood pressure medications (such as thiazides)
  • Steroid medications (such as prednisone or Decadron [dexamethasone])
  • Hydantoin medications (such as Dilantin [phenytoin])
  • Medications for transplant recipients (such as cyclosporine)
• Alcohol, especially if you have been a heavy drinker for years
• Smoking
• History of gestational diabetes (developing diabetes during pregnancy) or delivery of babies who weigh more than 9 pounds
• Autoimmune disease: Your body's defense system (immune system) attacks certain healthy cells in your pancreas that produce insulin (beta cells).
• Other factors, such as viruses, which may play a part in diabetes development

It is important to note that sugar itself does not cause diabetes. Eating a lot of sugar can lead to tooth decay, but it does not cause diabetes.

How is diabetes diagnosed?

If you suddenly experience symptoms of increased thirst, frequent urination, or unexplained weight loss, diabetes may be the cause. To confirm the diagnosis, a fasting plasma glucose test or a casual plasma glucose test will be performed.

The preferred method of diagnosing diabetes is the fasting plasma glucose (FPG) test because it is easy to administer, convenient for patients, and less expensive than other tests (according to the American Diabetes Association). The FPG measures your blood glucose level after you have fasted or not eaten for 10 to 12 hours. Normal fasting blood glucose is between 70 and 100 mg/dl for people who do not have diabetes. The standard diagnosis of diabetes is made when two blood tests show that your fasting blood glucose level is greater than or equal to 126 mg/dl.

Some people have a normal fasting blood glucose reading, but their blood glucose rises rapidly as they eat. These people may have glucose intolerance. If their blood glucose levels are high enough, they may be considered to have diabetes.

In a casual plasma glucose test, blood glucose is tested without regard to the time since the person's last meal. A glucose level greater than 200 mg/dl may indicate diabetes, especially if the test is repeated at a later time and indicates similar results.

The oral glucose tolerance test is another method used to detect diabetes, but is not routinely performed except during pregnancy.

How is diabetes managed?

There is no cure for diabetes, but it can be treated and controlled. The goals of managing diabetes are to:

1. • Keep your blood glucose levels as near to normal as possible by balancing food intake with medication and activity.
   • Maintain your blood cholesterol and triglyceride (lipid) levels as near the normal ranges as possible by decreasing the total amount of fat to 30% or less of your total daily calories and by reducing saturated fat and cholesterol.
   • Control your blood pressure. (Your blood pressure should not go over 130/80.)
   • Decrease or possibly prevent the development of diabetes-related health problems.

You hold the keys to managing your diabetes by:

• Planning what you eat and following a balanced meal plan
• Exercising regularly
• Taking medication, if prescribed, and closely following the guidelines on how and when to take it
• Monitoring your blood glucose and blood pressure levels at home
• Keeping your appointments with your health care providers and having laboratory tests completed as ordered by your doctor.

What you do at home every day affects your blood glucose more than what your doctor can do every few months during your check-ups.