What is diabetes?

Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is converted into glucose, or sugar, for our bodies to use for energy and growth. The pancreas, an organ near your stomach, creates a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugar to build up in your blood.

Diabetes can cause serious health complications including heart disease, blindness, kidney failure and lower-extremity amputations. Diabetes is the sixth leading cause of death in the United States and a leading cause of disability, impacting approximately 7% of the U.S. population.

What are the types of diabetes?

Type 1 diabetes, previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes, is estimated to account for 5% to 10% of all diagnosed cases of diabetes. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin, which regulates blood glucose. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age.

Type 2 diabetes, previously called non-insulin-dependent diabetes mellitus or adult-onset diabetes, is estimated to account for about 90% to 95% of all diagnosed cases of diabetes. Type 2 diabetes usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity and race/ethnicity. Type 2 diabetes is increasingly being diagnosed in children and adolescents.

Gestational diabetes is a type of diabetes that only pregnant women get. If not treated, it can cause problems for mothers and babies. Gestational diabetes develops in 2% to 5% of all pregnancies but usually disappears when a pregnancy is over. Other specific types of diabetes resulting from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses may account for 1% to 2% of all diagnosed cases of diabetes.

What are the symptoms of diabetes?

People who think they might have diabetes must visit a physician for diagnosis. They may have some or none of the following symptoms:

• » Frequent urination
• » Excessive thirst
• » Unexplained weight loss
• » Extreme hunger
• » Sudden vision changes
• » Tingling or numbness in hands or feet
• » Feeling very tired much of the time
• » Very dry skin
• » Sores that are slow to heal
• » More infections than usual

Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes, now called type 1 diabetes.

What is pre-diabetes?

Pre-diabetes is the state that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Before people develop type 2 diabetes, they almost always have "pre-diabetes" - blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. There are 54 million people in the United States who have pre-diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes. Other studies show that many people with pre-diabetes develop type 2 diabetes in 10 years. Research has also shown that if you take action to manage your blood glucose when you have pre-diabetes, you can delay or prevent type 2 diabetes from ever developing.

While diabetes and pre-diabetes occur in people of all ages and races, some groups have a higher risk for developing the disease than others. Diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population. This means they are also at increased risk for developing pre-diabetes.

There are two different tests your doctor can use to determine whether you have pre-diabetes: the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT). The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have pre-diabetes or diabetes. If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT).

Pre-diabetes is a serious medical condition that can be treated. The good news is that recent studies conclusively showed that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range. While some medications may delay the development of diabetes, diet and exercise worked better. Just 30 minutes a day of moderate physical activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in diabetes.

Who gets diabetes?

• » People of any age
• » People with a family history of diabetes
• » Others at high risk for type 2 diabetes: older people,
     overweight and sedentary people, African Americans,
     Alaska Natives, American Indians, Asian Americans, Native
     Hawaiians,some Pacific Islander Americans and
     Hispanics/Latinos
• » Type 2 diabetes is also being increasingly diagnosed in
     children and adolescents

Will my diabetes ever go away?

There is no cure for diabetes. Neither type 1 (juvenile onset or insulin-requiring) diabetes or type 2 (adult-onset) diabetes ever goes away. Overweight patients diagnosed with type 2 diabetes may discover that their blood glucose returns to normal if they lose weight and begin regular physical activity. Does this mean their diabetes has disappeared? No. The development of type 2 diabetes is a gradual process in which the body becomes unable to produce enough insulin for its needs and/or the body's cells become resistant to insulin's effects. Gradually the patient goes from having "impaired glucose tolerance," a decreased but still adequate ability to convert food into energy, to having "diabetes."

If the patient were to gain weight back or scale back on their physical activity program, high blood glucose would return. If they were to overeat at a meal, their blood glucose probably would continue to go higher than someone without diabetes. Also, the decreased insulin production and/or increased insulin resistance that led to the initial diabetes diagnosis will gradually intensify over the years and during periods of stress. In time, the patient who could maintain normal blood glucose with diet and exercise alone may discover that he or she needs to add oral diabetes medications - or perhaps even insulin injections - to keep blood glucose in a healthy range.

The good news for a type 1 and type 2 patient: if insulin, medication, weight loss, physical activity and changes in eating result in normal blood glucose, it means their diabetes is well-controlled and their risk of developing diabetes complications is much lower. But it doesn't mean that their diabetes has gone away.

Why should I self test?

Many people think they can tell what their blood sugar is by how they feel. Self testing is very important to controlling your blood sugar. It's the only way to know for sure how your body reacts to medications, insulin, food and exercise. Regular testing will help you develop a pattern management system to keep your blood sugar within target range. It will help your doctor in providing or changing your treatment plan and will also help you avoid High and Low Sugar reactions. These reactions can cause serious health concerns, including fainting, convulsions, coma and death.

What is high blood sugar?

Hyperglycemia (High Blood Sugar). Hyperglycemia is a serious health problem for those with diabetes - and develops when there is too much sugar in the blood. When a person with diabetes has hyperglycemia frequently or for long periods of time, damage to nerves, blood vessels and other body organs can occur. You can help prevent Hyperglycemic reactions by making sure you are following your meal plan, exercise program and medicine schedule. Know your diet, and keep track of the total amounts of carbohydrate that you are consuming. Test your blood glucose regularly and keep track of the results. Know when to contact your health care provider if you have repeated abnormal blood glucose readings. Make sure you always wear medical identification that states you have diabetes so you can receive proper treatment in the event of an emergency.

Symptoms of Hyperglycemia include:

• » Increased thirst
• » Headaches
• » Difficulty concentrating
• » Blurred vision
• » Frequent urination
• » Fatigue (weak, tired feeling)
• » Weight loss
• » Blood glucose more than 180 mg/dL

What is low blood sugar?

Hypoglycemia (Low Blood Sugar). The symptoms of hypoglycemia can vary from person to person, as can the severity. Classically, hypoglycemia is diagnosed by a low blood sugar with symptoms that resolve when the sugar level returns to the normal range. While patients who do not have any metabolic problems can complain of symptoms suggestive of low blood sugar, true hypoglycemia usually occurs in patients being treated for diabetes (type 1 and type 2).

Symptoms of Hypoglycemia include:

• » Nervousness
• » Sweating
• » Intense hunger
• » Trembling
• » Weakness
• » Palpitations
• » Trouble speaking

Symptoms can progress to confusion, drowsiness, changes in behavior, coma and death.

What are the risk factors for diabetes?

Risk factors for type 2 diabetes include:

• » Older age
• » Obesity
• » Family history of diabetes
• » Prior history of gestational diabetes
• » Impaired glucose tolerance
• » Physical inactivity
• » Race/ethnicity

African Americans, Alaska Natives, American Indians, Asian Americans, Native Hawaiians, some Pacific Islander Americans and Hispanics/Latinos are at particularly high risk for type 2 diabetes.

What is the treatment for diabetes?

Healthy eating, physical activity and insulin injections/pumps are the basic therapies for type 1 diabetes. The amount of insulin taken must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose testing.

Healthy eating, physical activity and blood glucose testing are the basic therapies for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels. Many people with type 2 diabetes can control their blood glucose by following a careful diet and exercise program, losing excess weight and taking oral medication.

People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from going too low or too high. People with diabetes should see a health care provider who will monitor their diabetes control and help them learn to manage their diabetes. In addition, people with diabetes may see endocrinologists, who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management. Many people with diabetes also need to take medications to control their cholesterol and blood pressure.

Glucose control
Research studies have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, for every 1% reduction in results of A1C blood tests (e.g., from 8.0% to 7.0%), the risk of developing microvascular diabetic complications (eye, kidney, and nerve disease) is reduced by 40%.

Blood pressure control
Blood pressure control can reduce cardiovascular disease (heart disease and stroke) by approximately 33% to 50% and can reduce microvascular disease (eye, kidney, and nerve disease) by approximately 33%. In general, for every 10 millimeters of mercury (mm Hg) reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12%.

Control of blood lipids
Improved control of cholesterol or blood lipids (for example, HDL, LDL, and triglycerides) can reduce cardio-vascular complications by 20% to 50%.

Preventive care practices for eyes, kidneys and feet
Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%. Comprehensive foot care programs can reduce amputation rates by 45% to 85%.

Diabetes self-management education is an integral component of medical care. Among adults with diagnosed diabetes, 12% take both insulin and oral medications, 19% take insulin only, 53% take oral medications only and 15% do not take either insulin or oral medications.

What are some other sources of information on diabetes?