Reviewed By: Dr. Kurt Kloss, MD
Last Reviewed Date: Dec 14, 2020
Last Modified Date: Dec 14, 2020
Published Date: Nov 26, 2018
TABLE OF CONTENTS
Chapter 1: Introduction to Diabetes: The Basics Chapter 2: What You Should Know About Diabetes Chapter 3: Juvenile Diabetes: A Parent's Guide to Understanding Juvenile Diabetes Chapter 4: Eight main facts about Diabetes Chapter 5: Causes of Diabetes Explained Chapter 6: Common Questions about Diabetes Chapter 7: Newest Trends in the World of Diabetes Chapter 8: Diagnosis and Treatments
Diabetes is a set of numerous diseases that are related to one single factor: the insulin hormone. When you are healthy, your pancreas produces enough insulin to help manage the sugar found in your blood. This organ hiding behind your stomach will produce the necessary amount of the insulin hormone. As a result, your body will be able to properly store and use both the sugar and fat found in the food you are eating. When your pancreas is underworking, a small amount of insulin is released, or none at all. Also, your body might not have the capacity to appropriately use this insulin. This will result in diabetes. This condition can be messy for many; and, up till now, there is still no cure from it. All you have is a good management plan and your treatment.
Healthy People 2020 is a program that was developed to lower the risks associated with diabetes mellitus (DM) as well as improving the quality of life. When people get diagnosed on time, they can seek the right medical and lifestyle changes that will prevent the disease from progressing and causing permanent damages to the body. So, diabetes awareness and education are of major importance. This guide will help overview the different types, risk factors, as well as management and treatment options to help you cope if you get a diagnosis.
Chapter 1- Introduction to Diabetes: The Basics
What are the different types of Diabetes?
This metabolic disorder is linked to how our body manages the breakdown of food. There are four different types. Whatever the type of diabetes is, there is one simple common factor for all. It all starts when you decide to eat, food is broken down into small particles called Glucose. This is the result of eating anything containing sugar or carbs in it. This glucose is a source of energy to our cells and body. But, for your cells to utilize the glucose for energy, they need insulin to be released in your bloodstream. When you have diabetes mellitus, your body is either not producing enough insulin, or it is not capable of using the insulin. Sometimes, it is both together. In this case, glucose will start building up in your bloodstream and your health will be at jeopardy.
- Type 1: this is an insulin-dependent diabetes that normally surfaces during childhood. It is an autoimmune condition that is due to the body attacking the pancreas. This will lead to a damaged pancreas that will not be able to produce insulin. This disease is not life threatening as long as it is well managed. You will have to follow a strict treatment course accompanied by lifestyle changes.
- Type 2: this is the most common type of diabetes that normally occurs later on in life. More than 95% of diabetic people have type-2. It is an adult set condition and is a non-insulin-dependent diabetes. It can also affect teenagers. This type is a less invasive type of diabetes; but, would still need to be managed to prevent any associated health complications. With this type, your pancreas can produce insulin; but the amount is either not enough or your cells are resisting it. For obese people, type-2 diabetes is insulin dependent. For this type, the pancreas work really hard to produce insulin; and, it is not enough. This resistance can happen in your fat cells, muscle cells or liver. Many type-2 diabetic can manage their condition by losing weight, eating a well-balanced appropriate diet and exercising. But, for others, type-2 tend to progress bringing health risks and complications. In that case, a treatment is imminent.
- Gestational Diabetes: This is the kind of diabetes that occurs in pregnant women, only during the pregnancy. It normally resolves on its own after delivery. During the nine months of pregnancy, the cells act differently with the sugar. This type of diabetes can be worrisome for some as it could lead to complications for the mother and the baby. This type does not necessarily cause any alarming sign or symptoms. The routine blood tests normally depict any abnormal glucose level. The good news is that it simply requires a good management of the expectant mother’s lifestyle like food habits, and exercising. In some cases, medications could be prescribed. After delivery, the doctor will test your blood glucose levels to double check if it is back to normal. He will also recheck it after six weeks. Some women who develop gestational diabetes are at higher risk to developing type-2 diabetes than others. So, if you were obese when you got pregnant or you had gestational diabetes in your previous pregnancy; then your doctor will have to screen you. He will test you during your first visit. However, if you have lower risks; then, you will be tested during the second trimester (between weeks 24 and 28). You need to be aware that when you have GDM, you have to know how to control your blood glucose levels for your and your baby’s sake. You do not want to end up facing complications during your delivery. So, even if you are following the right management plan, it is essential for you to keep getting tested. In some cases, you will need to start taking oral medications or even insulin. Some women witness a rise in their blood glucose levels during delivery, this will entice the baby to release high levels of insulin, which will lead to a hypoglycemia after birth. So, proper care during pregnancy, delivery and post-delivery are of major importance for this type of DM.
- Pre-diabetes: This is the kind of diabetes that can be reversed with proper management and care. It is not the disease itself; but, rather, a wake-up call that shakes you off a little so you can prevent any official launch of the chronic disease. If left untreated, it will probably lead to diabetes type-2. So, being prediabetic means that your blood glucose levels are higher than normal, but are not there quite yet to label you as a diabetic. Prediabetes is also referred to as IGT (Impaired glucose tolerance), IFG (Impaired fasting glucose), and a hemoglobin A1c level of 5.7-6.4%. There are no clear-cut symptoms for being prediabetic; but you might end up having polycystic ovaries, as well as having dark thick skin patches especially around the elbows, knees, neck and knuckles. If you are obese or overweight; then, you are at higher risk of developing prediabetes.
If you think that Diabetes Insipidus is another common form of diabetes, you do not need to worry. Despite its name, this is a very rare condition occurring to less than 20,000 people in the USA; and, that can be cured. It occurs when you experience intense thirst and urination due to an imbalance of salts and water in your system. It is a metabolic problem that needs to be diagnosed, and is chronic. One thing for sure is that it is not related to the diabetes we know.
Diabetes is a serious public health concern, occurring in the American population at rates that many experts describe as epidemic in proportion. It is not just a condition shadowing Americans; but it is epidemic everywhere in the world.
To really understand the impact and effect of this chronic condition on the USA, one has to look at the numbers.
- In 2015, 30.3 million Americans had diabetes. Among these, bout 1.25 million have type-1 diabetes and 7.2 million were undiagnosed. Also, out of the 30.3, 12 million were senior citizens.
- Every year, in the USA, 1.5 million individuals get diagnosed.
- Diabetes, up till now, is the 7th cause of death among Americans.
- About 200,000 Americans below the age of 20 years are diagnosed.
- Diabetes affect races differently: 15.1% are Americans Indians, 12.7% black non-Hispanics, 12.1% Hispanics, 8% Asian Americans, 7.4% white non-Hispanics.
- As far costs of this chronic disease: 327 billion dollars were spent in 2017 on diagnosed cases, 237 billion dollars for direct medical costs and 90 billion dollars were associated with reduced productivity.
(American Diabetes Association, 2018)
Does your Blood have Too Much Sugar?
High blood sugar levels, or hyperglycemia, is a condition in which there are excessive amounts of sugar, or glucose, circulating in your bloodstream. While your body requires some glucose in the bloodstream in order to provide its cells with the energy they need to function; higher than normal sugar levels can be harmful to major organs and systems in your body. Here, we'll discuss what can cause hyperglycemia, the potential dangers of high blood sugar and how the condition can be detected, diagnosed and managed.
What are the Main causes of Hyperglycemia?
A number of conditions and disorders can cause blood glucose levels to rise. Among the most common are several forms of diabetes. Undiagnosed and untreated diabetes can cause chronic high blood sugar levels; and, episodes of hyperglycemia can occur under some circumstances in people who are already being treated for the disease.
- Type 1 diabetes
- Type 2 diabetes
- Gestational diabetes
- In people undergoing treatment for diabetes, spikes in blood sugar levels can happen for a number of reasons. Most common is eating the wrong types of foods – and not just sugary ones. Fatty foods can cause blood glucose to rise, as can over-indulging in carbohydrates, such as bread, pasta and potatoes. Sugar free foods can also raise blood sugar, since many of them contain starches – which are converted into sugars by digestion.
- Pancreatitis – This is the inflammation or infection in the pancreas, which can cause insulin producing cells in this vital gland to malfunction, impairing insulin production and causing blood glucose to rise.
- Use of corticosteroids – These drugs can cause high glucose levels that will, in most cases, return to normal when the medication is stopped.
- Common illnesses – Colds, flu and other common illnesses can cause temporary blood sugar elevations.
- Stress – High levels of stress hormones can increase your blood glucose levels. Both the pituitary and adrenal glands play a role in the production of the stress hormone, cortisol.
The Dangers of High Sugar Levels
Blood sugar levels that are chronically high or spike frequently can cause a number of problems, both short and long term. Immediate consequences of high blood glucose can include:
- Increased thirst
- Frequent urination
- Blurred vision
- Trouble concentrating
- Among the long-term dangers of high blood sugar are:
- Poor healing of sores or skin infections
- Vision impairment or blindness
- Nerve damage throughout the body
- Digestion problems
- Damage to blood vessels and poor circulation
- Heart disease
- Kidney disease or failure
- Diabetic ketoacidosis, a metabolic disturbance that can lead to coma or death. Symptoms of the condition can include vomiting, weakness, fever, dry mouth, shortness of breath and confusion.
Diagnosis and Treatment of Hight Blood Glucose levels
High blood glucose levels can be detected via numerous screening tests that can measure the level of sugar in urine. However, measuring the blood glucose levels is a more accurate means of detecting the existing problem. This is generally done with a blood test called a fasting plasma glucose test. If results of these common tests indicate a need for further investigation, a blood test called the hemoglobin A1C test may be done, which measures the average blood sugar levels over the past 90 days. You might even try to do the oral glucose tolerance test, which measures the effects of a sugary drink on blood glucose levels over a period of 2 or 3 hours.
Treatment is necessary to help manage hyperglycemia and diabetes and depends on the underlying causes, as well as the time of onset of the condition. In some cases, minor dietary changes and exercises can help reduce your blood sugar levels; and, in other cases insulin or glucose-lowering medications may be necessary for adequate glucose control.
Chapter 2- What You Should Know About Diabetes
Progression of Diabetes
Type 1 occurs when there is an absence of insulin production and usually appears during childhood or adolescence (though it can occur at older age). It requires insulin dosages for survival and to prevent any progress of the disease. About five to 10 percent of diabetics have type 1. Type 2 tends to evolve slowly over time and can often be reversed with dietary changes, plus a healthy lifestyle. It is by far the most common type of diabetes, but is now being seen in much younger ages. With both types of diabetes, high levels of glucose in the bloodstream can damage major organs and lead to serious complications. The symptoms can be similar in both types: frequent urination and thirst, fatigue, headaches, sores that are slow to heal, and finally numbness in hands and feet.
The long-term outcome of diabetes type 1 or 2 depends upon what type of management is instigated and the intimate association the disease has with food, particularly carbohydrates, which get broken down as glucose. Blood glucose rises when digestion frees the glucose from the food.
Pasta, potatoes, grains and cereal are usually what crosses our mid when we think of carbohydrates. But, the truth is that the building blocks of any carbohydrate are sugar molecules, including the glucose and fructose found in fruit, candy and even milk. Simple sugars give food its sweet taste and are easily digestible, while complex carbohydrates (non-sweet starches) must be digested in the stomach and intestine before they are absorbed. In simple terms, carbs are comprised of starch, sugar and fiber.
How Do Carbohydrates and Diabetes Work Together?
In non-diabetics, the hormone insulin, released from the pancreas, stimulates the cells to allow the entry of excess glucose leading to the blood glucose to return back to normal levels. But, in diabetics, these cells don’t respond naturally. So, the glucose levels are not naturally diminished. In other words, insulin resistance becomes the norm. That’s the definition of diabetes – blood glucose levels don’t return to lower levels as they should.
The body needs insulin, either from the pancreas or by injection, to utilize the carbohydrates. Therefore, carbohydrate counting is important for most diabetics, especially those with type 1, because they can measure the precise amount of carb intake per day along with the amount of insulin they need.
Carbohydrates have received a bad reputation among some dietary experts, but they are not and they should not be forbidden. They should, however, be controlled as part of any healthy diet. While a few specialists recommend that about 35 percent of food intake per day come from carbohydrates, others prefer 50 percent, unless high triglyceride levels indicate otherwise. (Check with your healthcare provider or nutritionist for your recommended percentage).
What are the Main Benefits of Counting Carbs to Control Diabetes?
The primary benefit in counting carbohydrates is recognizing that more than any other food content, it is carbs which determine how much your blood sugar will increase following a meal. That’s because carbs are composed of small sugar molecules which are broken down by the digestive system and then absorbed into the bloodstream. As a result of this absorption, sugar level rises.
All carbs, from pastas to apples and orange juice, end up as sugar when absorbed into the bloodstream. By recognizing portions, counting carbohydrate intake and controlling calories you will know what amount of insulin to take if you’re insulin-dependent, and how to self-manage your diabetes through diet if you’re not. Eat more carbs and you need more insulin; less carbs means less insulin.
How Do I Get Started?
First, remember it’s the amount of carbohydrates you consume that you need to focus on and not the type. Seek the help of a dietician to determine your recommended daily carbohydrate allowance in either grams or percentages. Certified nutritionists and general diabetes education classes are both valuable resources to learn more about your condition in general. In particular, You need to know about how to properly count your carbohydrates and educate yourself on the nuances of diet, nutrition, portion control, serving size and something called “carb counts.”
Here are some general tips to get started:
Know what counts as a carb. All plant-based foods, including pasta, rice, bread, potatoes, beans, fruits, vegetables, nuts and seeds contain carbohydrates. So do all refined sugars, undigested fiber, milk and dairy products and most snacks and desserts.
Read food labels. Labels are now required on most food packaging. The numbers will be listed per serving in both grams and percentages of daily values, depending upon your calorie needs.
Recognize that a “serving” is a common measurement, while a “portion” is what you choose to eat. For example, one “serving” may equal 15 grams of carbohydrates while the portion you chose to eat may contain only 10 grams.
Make a list of foods you like and see if their total carbohydrate grams fall within your budgeted daily amount.
Consistent timing and content are important at first, but once you know the gram amounts you are allowed daily, you can mix and match foods as long as you stay within your designated range. This “exchange system” lets you to vary your diet.
Blood sugars reflect the carb intake more than it reflects anything else such as fat and protein, so be especially careful to measure starch, fruit and milk exchanges.
What Do I Need to Maintain a Carbohydrate “Budget”
Once you’ve figured out how many grams of carbs you can safely consume per day, or the overall daily percentage that should be in your diet, think of your maintenance program as you would if you were on a per diem allowance.
Let’s say you have a 150 -180 carb per day allowance as determined by your dietician or healthcare provider. That’s about 10 carb choices (carbs are often measured and spent in 15-gram packages called a “carb choice.”) These choices can be distributed among your daily meals and/or a snack.
Next, keep portions in mind because a carb choice in a serving may differ from one food portion to another. It’s likely you’ll need website or other resources to help provide you with what portions sizes equal a carb choice, but here are some common examples:
½ cup cooked, starchy vegetables = a carb choice (15 grams)
1 slice bread = a carb choice (15 grams)
2 tablespoons of dried fruit = a carb choice (15 grams)
Some non-starchy foods still have carbohydrates; but you would have to eat three cups to equate it to one exchange of carbs. That’s why even experts often need a little help in learning how to reach and maintain your carbohydrate intake within the recommended limits.
But don’t get discouraged. Attitude is everything when you are taking control of your life and your health. While there are no magic bullets or secret cures when it comes to diabetes, there are plenty of resources available, and lots of support from professionals who want to improve your diet and your welfare for the long haul. The good news is, diabetes can be controlled by adopting a few changes that can quickly become life-enhancing habits. A good place to try to get the right kinds of information is the American Diabetes Association at www.diabetes.org where you can find recommendations and evidence-based research studies.
Chapter 3- Juvenile Diabetes: A Parent's Guide to Understanding Juvenile Diabetes
A new case of diabetes is diagnosed every hour. Approximately 13,000 children receive such a diagnosis every year, and over one million people are currently living with it across the world. As the parent of a child that has been diagnosed with juvenile diabetes, you may be frightened, confused, and anxious about the future. This diagnosis is life-changing for both you and your child. However, with a loving, positive attitude, you can help your child lead a happy, normal life.
What is Juvenile Diabetes?
Juvenile diabetes is a medical condition that typically emerges during an individual's childhood or adolescence. It is an immune disorder that causes the child's immune system to attack the beta cells in the child's pancreas and destroy them. Because the beta cells are responsible for producing insulin, your child's insulin levels drop to unhealthy lows. This causes glucose to build up in the child's bloodstream, thus causing significant damage to all of the organs in the body.
Typical symptoms of diabetes include frequent urination, extreme thirst, a fruity or sugary breath odor, drowsiness, sudden and significant weight loss, constant hunger, vision changes, difficulty breathing, vomiting, and sugar in the urine. Scientists are not yet sure what the exact cause of juvenile diabetes is, but it is likely that both environmental and genetic factors play a role in its development. Most cases of diabetes in children are caused by type I diabetes, but type I diabetes is responsible for only 5 percent to 10 percent of all diabetes cases.
If juvenile diabetes is not properly controlled, it may cause severe health complications. Some of the most serious complications that may arise if your child's diabetes is out of control include coma, heart disease, kidney damage, stroke, skin conditions, and vascular disorders. If appropriate medical attention is not received, diabetes could eventually result in your child developing a vision disorder and eventually losing his or her sight.
Dealing with the Diagnosis
Children are usually diagnosed with juvenile diabetes based on the results of several different chemical tests, including tests performed on the urine and the blood. If there are ketones and glucose present in your child's urine, the doctor will suspect that he or she has juvenile diabetes, and he will likely order further testing. A random non-fasting blood glucose test will then be performed. If the result exceeds 200 mg/dl, the doctor will have a stronger suspicion of juvenile diabetes. Finally, the doctor will order a fasting glucose test. Juvenile diabetes is confirmed if your child's fasting blood glucose test comes back with a result of 126 mg/dl or more.
Most children with juvenile diabetes must take insulin several times each day to manage their sugar levels. Insulin may be administered by injection or, in more serious cases, the child may receive insulin through a pump placed surgically in his or her body. To help your child manage this condition, you should remind him or her to take the medicine prescribed by the doctor exactly as directed. Missing a dose of insulin can be very dangerous for a child with juvenile diabetes. You must also make sure that your child eats frequently enough to keep his or her blood sugar from dropping too low, which can also be dangerous.
Another way to help your child manage juvenile diabetes is to make sure that he or she understands why it is important to take medication and monitor eating habits. You should teach him or her about proper nutrition management so that he or she understands how to make good eating choices. You should also help your child to monitor his or her blood glucose levels throughout the day to ensure that it remains within healthy ranges. Finally, encourage your child to engage in physical activity. Doing so will help control both weight gain and blood glucose levels.
Other Resources for Parents
Managing juvenile diabetes is a difficult task. As a parent, you need as much help as you can get. Education is also very helpful in managing this condition. To find more information about juvenile diabetes, how to cope, and how to get involved with other parents, consult the following links.
Chapter 4- Eight main facts about Diabetes
There are eight key points about diabetes that everyone should know, with a focus on the preventable type 2:
1. The Role that Genes Play
To date, about 45 genes have been identified that are linked to type 2 diabetes. Insulin resistance is the hallmark of type 2 diabetes, and could have evolved as part of a genetic bundle, helping the body store energy for times of famine. In today’s westernized world, famine is highly unlikely, so this genetic role takes a back seat to obesity and poor glucose control, which runs in families. If you have close relatives that have the disease, you are at higher risk. Men are more likely than women to develop type 2 diabetes.
Take-home lesson: know and understand that genes are only part of the risk factors involved, not the whole story. So, make the right lifestyle choices and eat well to grow into a healthy adult.
2. Heart Disease Risk
The three most common risk factors for heart disease are high blood pressure, high cholesterol and elevated triglycerides. All are closely related to type 2 diabetes. If you are overweight and sedentary, you are then at an increased risk for both heart disease and diabetes. New research is trying to uncover the link between low-level inflammations in the lining of the blood vessels that lead to increased risk in heart disease. Elevated levels of C-reactive protein, for example, are markers for inflammation. Diabetes-related damage to the blood vessels in the kidneys may prove a leading cause of diabetes, and may also explain why diabetes and high blood pressure are often found together.
Take-home lesson: know your risks for heart disease because if you have cardiovascular disease, you’re at higher risk for diabetes.
3. What Weight Has to Do with It
First of all, not everyone who is overweight or obese will develop diabetes. Nor is everyone with type 2 diabetes obese. While a body mass index that falls within a higher than a normal range raises your risks, being overweight or obese is not the cause of diabetes.
Take-home lesson: Even if you’re at a normal weight, you can still be at risk. But if you are overweight or obese, that’s even more reason to be tested.
4. Food Choices and Nutrition
Experts recommend a heart-healthy diet to prevent or delay type 2 diabetes. That’s because the more you do to protect your heart, the better for overall health and the lower your risk for diabetes. Avoid processed foods when possible, limit sugar and salt, eat more whole foods and consume lots of fruits and vegetables. Follow a “less of everything plan” to reduce calories and if overweight, strive for obtainable goals. Even a seven percent reduction in body weight can reap huge benefits.
Take-home lesson: preventing diabetes doesn’t come with food labels so you’ll have to put thought and effort into making better choices.
5. How Stress Can Raise Your Risk of Diabetes
Several studies have found that chronic stress, along with a high fat/high sugar diet, can lead to more abdominal fat and increase the risk of insulin resistance. That’s because stress hormones can bind to muscle and fat cells, altering the way they respond. When you’re stressed, your levels of stress hormone rise and the chance of insulin-resistance reactions also rise. If you are already at risk for developing diabetes, managing your stress level is critical to keeping diabetes at bay.
Take-home lesson: Explore stress reduction steps, including a physical activity you enjoy, mediation, yoga and breathing exercises. Resources on managing stress are readily available online and at local colleges, learning facilities and community centers.
6. Let’s Move
Inactivity causes glucose levels in the blood to rise, which can then cause damage throughout the body. Exercise, by contrast, trains the muscles to respond better to insulin. Those who engage in some type of regular physical activity find that insulin sensitivity improves, sometimes over a short period of time. If you’ve been inactive for a long time, best to start small, a 10-minute walk or a few minutes on an exercise bike. The ultimate goal is 30 minutes daily, or a minimum of 3-4 days a week. New research says its best to work out in a colder environment, 62 to 65 degrees, because the body has to generate more energy and can create the more desirable “brown fat,” which keeps organs warm and promotes lean muscle tissue, plus burns more calories.
Take-home lesson: It doesn’t take much, and it doesn’t take long for the body to respond to healthier choices. If your healthcare provider says you’re clear to start an exercise program, make a commitment to get moving.
7. How Age Affects Risk and Latest Stats
After middle age, the risk of diabetes rises each year. Most new cases of type 2 diabetes are diagnosed in people 45 to 64. But things are quickly changing It’s now estimated that up to 5,000 people under the age of 20 are newly diagnosed with the disease each year, due primarily to poor eating habits and too little exercise. We live in a “toxic environment,” say experts, in which bad nutrition and a sedentary lifestyle are making our children prone to develop this chronic disease.
Take-home lesson: Making even a few changes within your family can make a big difference. A lower calorie diet and about 150 minutes of exercise a week (less than 22 minutes per day) could prevent or delay the onset of type 2 diabetes.
8. Making the Choice
If you think you’re at risk, get tested. If you find you have prediabetes or type 2 diabetes, get to work on a treatment plan that involves a healthy diet, exercise and possibly medication. Don’t rely on supplements, get six to eight hours sleep a night and if you’ve already been diagnosed, ask about the latest class of medications that rid the body of excess glucose.
Take-home lesson: Even small changes can fend off type 2 diabetes or improve your health if you have it. Healthcare providers can counsel, coach and treat your disease only to a point. The rest is up to you.
So How Can I Reduce My Risk for Diabetes?
Here’s a quick and easy recap for changes you can make that could keep diabetes out of your future:
Move more, especially after meals. Aim for 150 minutes of physical activity a week, which is less than 22 minutes a day. This can be simply achieved. You do not have to go the gym to exercise. You can decide to take the stairs instead of the elevator. You can also look for a parking spot that is far from the entrance of your destination, this will oblige you to walk more, more steps mean more activity.
Give up the sugared drinks and watch what you eat, especially sugars and carbs. Forget about sodas and juices. Try to go for kinds of breads that are low in sugar or do not contain any. Cut the fat and increase the fiber in your diet.
Manage your stress. You can resort to stress-managing techniques such as breathing, meditation and yoga.
Aim to be in charge of your own health and take responsibility for your choices. You are the only one that can make a difference in your body. When you make the right choices, you are evaluating your life is more important than bad food or bad habits.
Know your numbers – get tested if you are at risk for diabetes through genetics or lifestyle factors. Optimal blood sugar rates are: 70 mg/dL to 130 mg/dL before meals, and less than 180 mg/dL two hours after meals. Sugar levels should be around seven percent.
Chapter 5- Causes of Diabetes Explained
Do you know what causes diabetes? If not, here is what you need to know: the incidence of type 2 diabetes is increasing at epidemic rates and the disease is, in many cases, preventable. According to a report released by the CDC in November, 2012, rates of diabetes mellitus rose exponentially between 1995 and 2010. During the 15-year period, rates doubled in 18 states. While only three states had rates of diabetes exceeding 6 percent in 1995, all 50 did by 2010, and in six states and Puerto Rico, one of every 10 adults have the disease. Additionally, CDC estimates suggest that of the 25.8 million people with diabetes in 2011, 7.0 million were undiagnosed and unaware that they had the disease.
Type 2 Diabetes
Type 2 diabetes is among the most common and harmful metabolic diseases. It affects the way the body metabolizes sugar (glucose), which is the body's main source of fuel. In an individual with this disorder, the body cannot use insulin properly, which is the hormone that regulates glucose absorption by the cells, a condition called insulin resistance. In the early phases of the disease, often referred to as prediabetes, the body compensates for insulin resistance by producing more of the hormone. However, as insulin resistance grows, the body will struggle to keep up and blood glucose will rise to dangerous levels.
What Causes Diabetes?
Diabetes occurs as the pancreas becomes less efficient or completely unable to produce insulin – the hormone that regulates glucose absorption into the cells – or the body becomes unable to use insulin appropriately. While the underlying causes of diabetes remain unknown, a number of factors are known to contribute to the development of the disease, including:
Genetics – Both type 1 and type 2 diabetes have genetic components, meaning that if there is a history of the disease in your family, you may be genetically susceptible to developing diabetes. Additionally, certain ethnic groups are at higher risk than others of developing diabetes, including African Americans, Asian Americans, Hispanics/Latinos, American Indians, Alaska Natives and Pacific Islanders.
Overweight or obesity – Considered primary causes of diabetes, overweight and obesity are known to contribute to the development of type 2 diabetes by changing the way the body responds to insulin. According to the CDC, the prevalence of overweight or obesity in individuals diagnosed with diabetes is more than 85 percent, with just over 54 percent falling into the obese category.
Inactivity – Also listed among the top causes of diabetes, a lack of regular physical activity has been associated with a higher risk of developing type 2 diabetes. According to the National Diabetes Information Clearinghouse, studies have proven that regular physical activity can sharply lower risk of developing type 2 diabetes.
Poor dietary habits – Eating too much of the wrong types of foods contributes to the development of type 2 diabetes. A body of evidence has accumulated over the past several decades showing that eating a diet that primarily consists of calorie-dense processed foods and beverages and lacks enough raw fruits, vegetables and whole grains can significantly increase diabetes risk. According to a study published in the Journal of the European Association for the Study of Diabetes (Diabetologia), habitual soda drinkers are at particular risk, with just one soda daily increasing diabetes risk by 22 percent.
Pregnancy – A type of diabetes that occurs in 18 percent of pregnancies, gestational diabetes is caused by hormones and genetics. During pregnancy, the placenta produces hormones that interfere with insulin function, causing insulin resistance. In most women, the pancreas is able to compensate by increasing insulin production. However, in women with a genetic predisposition to diabetes, the pancreas often cannot produce enough insulin to control blood sugar levels, resulting in diabetes. Gestational diabetes is typically temporary, disappearing after delivery, but women who experience it are at increased risk of developing type 2 diabetes.
Autoimmune reactions – A primary cause of type 1 diabetes, autoimmune reactions are a condition in which the immune system malfunctions, attacking the body. In type 1 diabetes, as well as a small percentage of type 2 diabetes cases, the immune system destroys insulin producing cells in the pancreas, decreasing or eliminating insulin production.
Abnormal Glucose Production – The liver produces glucose and releases it into the blood stream in response to a hormonal signal from the pancreas. In some individuals, the liver – for reasons not entirely understood by medical science – produces excessive amounts of glucose, contributing to diabetes.
Too Much TV – According to researchers at the Harvard School of Public Health there is a link between too much TV and increased diabetes risk. Dr. Frank Hu and his team of researchers found that for every two hours of TV watching, risk of type 2 diabetes rose by 20 percent.
Sleep Habits – According to the Cleveland Clinic Journal of Medicine, sleep loss and sleep disturbances have been shown to increase diabetes risk, causing measurable changes in glucose metabolism, hormone levels, and autonomic nervous system activity, all mechanisms that can contribute to diabetes development.
Environmental toxins/medications – Certain chemicals and toxins have been associated with increased diabetes risk, including dioxin, arsenic and chemicals used in older rat poisons. Medications that have been linked to higher diabetes risk include some seizure medications, psychiatric drugs, diuretics, HIV medications and glucocorticoids.
While these factors do increase diabetes’ risk, none of them alone means that a person will definitely develop diabetes. The important thing to remember is that many of these risk factors can be controlled, reducing the heightened risk they cause. Another important point is that if an individual has several of these risk factors, diabetes testing is in order. Not everyone with diabetes displays obvious symptoms, which contributes to the estimated 7 million undiagnosed diabetes sufferers.
How Diabetes Affects the Body
Uncontrolled diabetes causes gradual damage to virtually all cells in the body, which can lead to a wide range of complications. Among the most serious of these are:
Cardiovascular disease – According to the American Heart Association, adults with diabetes are two to four times more likely to die of some form of heart disease or stroke than the average person, and are also at high risk for developing other cardiovascular disorders, such as hypertension, and peripheral artery disease.
Diabetic dyslipidemia (unhealthy lipid profiles) – Diabetes frequently lowers levels of HDL (good) cholesterol in the body and elevates levels of LDL (bad) cholesterol and triglycerides, increasing arterial sclerosis and heart disease risk.
Kidney disease – High blood glucose levels overwork the kidneys and cause vascular abnormalities, factors that contribute to kidney disease.
Diabetic neuropathy – High blood sugar causes damage to nerve fibers in 60 to 70 percent of people with diabetes. Depending upon the nerves affected, diabetic neuropathy can have effects that include numbness and tingling in the extremities, digestive problems, urinary tract issues, and problems with the heart and blood vessels.
Other potential complications of diabetes include eye disorders, skin disorders and pregnancy complications. Evidence suggests that diabetes may also increase risk of hearing loss, Alzheimer's disease and dementia.
Screening and Prevention
Since millions of Americans have diabetes and don't know it, the first step in protecting your health is diabetes screening, especially if you have risk factors for the disorder or symptoms of diabetes, such as:
- Unusual thirst
- Frequent urination
- Delayed healing
- Vision changes
A variety of screening tests are used to detect diabetes, including urine and blood tests to detect current high glucose levels and more complex screening tests that measure average blood sugar levels over two to three months.
Even if your screening tests show you're already in the prediabetes phase, diabetes can be prevented by changing some of those controllable risk factors. Losing as little as 15-20 pounds can dramatically decrease risk, as can 30 minutes of exercise daily. A healthy diet can also significantly reduce risk, so stay away from fatty, sugary and highly-processed foods, replacing them with whole grains, lean proteins, low-fat dairy and lots of colorful fruits and vegetables. You can pick celeries, tomatoes, green leaves, bell peppers, spinach among others,
Chapter 6- Common Questions about Diabetes
What causes diabetes?
Much remains to be understood about what causes diabetes. But it begins in the pancreas, the organ that produces insulin, or sugar, that fuels the body and is essential for growth. Insulin-making cells in the pancreas sometimes lose their ability to sense and respond to glucose levels in the blood. Glucose levels start to rise in the blood when the amount of insulin is insufficient or doesn’t work properly.
What are my POSSIBLE risks for having diabetes?
Certainly, your genes have something to do with becoming diabetic – a family history of the disease is a major risk factor in both type 1 and type 2. With type 2, getting older, being overweight and being tested as pre-diabetic are additional red flags.
Other risk factors:
- Certain racial and ethnic groups including African-American, Hispanic, Asian and Native American are at higher risk than non-Hispanic whites for diabetes.
- A history of high blood pressure.
- Low HDL (good) cholesterol.
- A high level of triglycerides.
- Gestational diabetes (during pregnancy) or having a larger-than-normal weight baby.
What are the symptoms?
Symptoms of the disease can begin early in the progression of diabetes and include:
- Unusual thirst
- Frequent urination
- Extreme hunger
- Blurry vision or changes in vision
- Weight loss that is unexplained
- Extremely dry skin
- Sores that don’t heal normally or more frequent infections
However, many people with type 2 diabetes do not exhibit “typical” symptoms. A blood test can help determine whether a person has diabetes or pre-diabetes.
How do I understand my lab results?
Having diabetes means having a number of lab tests administered, some more specialized than others. Diabetic symptoms may not even appear until blood glucose levels are quite high. A blood glucose level test (BG) can help diagnose and monitor diabetes. It is usually measured following an 8-10 hour fast and is called a fasting level test.
Fasting glucose levels above a certain level are considered an indicator that diabetes is present. Other tests include but are not limited to:
If a non-fasting blood glucose test was performed and the result was above a certain level, most healthcare providers would then order a fasting test to confirm the diagnosis.
Hemoglobin A1c – also simplified to “A1c.” This blood test shows the amount of glucose attached to the hemoglobin in your blood. Most people with elevated levels of BG also have higher levels of glycated (glucose-containing) hemoglobin.
Glucose tolerance test – often used to diagnose gestational diabetes during pregnancy.
C-peptide test – helps determine what type of diabetes might be present – type 1 or type 2 by means of how much insulin your body produces.
Some healthcare providers also recommend cholesterol and lipid level testing, because people with diabetes are at increased risk for heart disease.
What are some of the more serious complications from the disease?
Left untreated or poorly managed, diabetes can create long-term complications that reduce quality of life and even lifespan, including:
- Heart disease
- Vision problems that can lead to blindness
- Kidney failure
- Amputation of the lower limbs or extremities, due to poor circulation
While diabetes is not always preventable, it can be delayed or prevented in many cases. Learn about primary risk factors for diabetes to better understand how to lower your risk. For more information and additional resources, check out the website of the American Diabetes Association or the National Diabetes Education Program at http://ndep.nih.gov.
Chapter 7- Newest Trends in the World of Diabetes
Little Progress in U.S. Obesity Rates:
According to a Washington Bureau article (10/07/14) kids have us beat when it comes to winning the bulge battle. In a study published by a health advocacy group, childhood obesity rates in America are stabilizing but adults remain stubbornly overweight. The two states that topped the list in heaviest population: West Virginia and Mississippi, with adult obesity rates at 35.1 percent, or more than a third of the overall number of residents. Obesity is defined as having a body mass index (BMI) of 30 or more. The bottom line: more American adults now face a higher risk for diabetes and other major diseases.
Can Sunshine Slow Weight Gain and Reduce type 2 Diabetes Symptoms?
After treatment with ultraviolet light, mice in a research study displayed fewer warning signs for type 2 diabetes, including high glucose levels and insulin resistance. But while we know the sun is generally good for us, it’s too soon to tell (and more research is needed) before we can determine if what works in mice works on humans. It does, however, raise some interesting questions. (Source: BBC News Health, “Sunshine Can Slow Weight Gain and Diabetes Symptoms,” 10/23/14)
Stem Cells Raise Hope for Type 1 Diabetes Cure
Finally, the good news is that there has been promising research indicating that stem cells raise hope for a type 1 diabetes cure. An autoimmune disorder that causes the pancreas to stop producing insulin, type 1 diabetes is usually found in children and young adults. Now researchers are focusing on cell therapy. Harvard University researchers have successfully used stem cell technology to grow insulin-secreting cells. If the procedure proves successful in humans, those with type 1 diabetes could theoretically be cured with a transplant. Experts say they are “one pre-clinical step away from the finish line.” But, like for any new discovery, studies needs to be done in order to solidly prove the link.
Best Diet to Follow According to Experts Is Heart-Healthy, To Prevent or Delay Diabetes
Such a diet means you will need to eat fewer processed foods, which contain salt and sugar. From another angle, you will have to lea towards eating more fruits and vegetables as well as more whole wheat and unprocessed grains, nuts, seeds and beans. Portion control is also critical with a “less-of-everything” approach. Even small changes can help. For example, you may want to give up any kind of sugary sodas; and, instead of having some dessert, you may choose to take a 15-minute walk.
Reducing or better managing stress can help. Chronic stress can lead to overeating (or poor food choices) and stress hormones like cortisol can change the way other cells respond, including muscle and fat cells. (Source: www.aarp.org/bulletin 10/14/14) Know the numbers that indicate normal levels of blood sugar: 70 mg/dl to 130 mg/dl before meals and 180 mg/dl two hours after a meal. Your A1C hemoglobin (average blood sugar over 2-3 months) should be around 7 percent.
Vitamin D and it effect on Diabetic people
A new study links Vitamin D deficiency to Diabetes. As vitamin D levels decreased the participants diabetes control also decreased. Other recent research has identified vitamin D deficiency as a significant factor in many varieties of cancer as well as hypertension, stroke, heart disease, autoimmune diseases, depression, chronic pain, osteoarthritis, osteoporosis, muscle weakness, birth defects, and even periodontal disease.
The main criticism of this study, and similar ones, is that it does not show cause and effect. In other words, is the Vitamin D deficiency that is causing the problem, in this case diabetes; or is it a symptom of the problem itself. Regardless of the answer maintaining healthy levels of vitamin D is important for many reasons including keeping your bones in good shape.
Fortunately, this type of research is bringing vitamin D to the forefront of requirements for health and well-being. To ensure good health Vitamin D levels should be monitored periodically through a Vitamin D, 25-hydroxy blood test. Vitamin blood testing has long been ignored by the health care industry but studies such as this are showing the importance of maintaining healthy vitamin levels and monitoring those levels with blood tests. Low Vitamin D is linked to Poor Diabetes Control.
Chapter 8- Diagnosis and Treatments
Now that you know the risk factors and consequences of living with diabetes, it would make sense to know more about how it is diagnosed, what kinds of tests you would need and how to treat/manage such a condition. It is all in the numbers that you get. Never try to self-diagnose a condition based on something you read; furthermore, never try to self-medicate yourself. You do need your doctor and you do need to have blood tests, regularly!
Because patients who have diabetes type 1 usually have the condition appear suddenly; and, because the type-2 is usually progressive leading to many health conditions, the ADA (American Dietetics Association) advises certain people to get screened:
- If you are someone who has a Body Mass Index (BMI) higher than 25 and have any other condition like high blood pressure, high cholesterol levels and others; then, it would be wise for you to get screened to stay on the safe side.
- If you have a BMI higher than 25 and lead a sedentary lifestyle or have an immediate relative who is diabetic; then, you are at high risks of becoming diabetic.
- If you are older than 45, it is recommended for you to get screened. In case your results were negative the first time; it would make sense to repeat them every three years.
- If you are a woman who developed gestational diabetes, you are recommended to get screened every three years.
- If you have prediabetes; then, it is recommended to get screened once a year.
The Tests for all kinds of diabetes (types 1 and 2 as well as prediabetes)
The A1C test: It does not require any fasting and averages your blood glucose levels over the past three months. If your levels are higher than 6.5% two times in a row; then, you are diabetic. If the A1C is between 5.7 and 6.4%; then, you are prediabetic. If the percentage is below than 5.7; then, you are not diabetic.
Random Blood Glucose level: This is recommended when the A1C test is not available for you. No matter what and when you ate when the numbers are higher than 200 mg/dl then you are most probably diabetic.
Fasting Blood Sugar Levels: This test can be performed after an overnight of fasting. In that case, and if the numbers were consistent two times in a row; when the levels are between 100 and 125 mg/dl, you are prediabetic. When the numbers are higher than 126, you are diabetic.
Oral Glucose test: This test is a two-steps method. You will need to fast overnight. The following morning, you need to take your glucose levels. Then, you are required to drink something sugary and redo the test after two hours. If you have your blood glucose levels less than 140mg/dl; then, you are healthy. In case the blood glucose level was higher than 200 mg/dl after two hours wait; then, you are diabetic. You are prediabetic if your reading is between 140 and 199 mg/dl.
Following the blood test, you would need to test your urine for any byproducts.
For women at risk of developing gestational diabetes, there will be two different tests to be screened. The Initial Glucose challenge test where you drink a syrup solution and get your blood glucose tested one hour after your drink. If your levels are higher than 140mg/dl; then your results are positive for gestational diabetes. The second test is the follow-up glucose tolerance testing when you are required to fast overnight and you will get tested for your glucose levels; then, you drink the sugar drink (higher concentration of sugar then the first test), and get tested once every hour for a period of three hours. If two tests out of three are higher than normal; then you are positive for this type of diabetes.
It is essential for anyone who might be at risk of developing this chronic disease to get tested. When you get tested, you get rid of any possibility of having a disease progressing and leading to life threatening consequences.
In case you were diagnosed with diabetes; then, it is essential for you to follow the necessary treatment. The treatment starts with the right lifestyle changes. So, think of working out, eating healthy and coordinating with your primary care giver regarding the best treatment possible.
Part of your treatment, you will have to monitor your blood glucose levels on a daily basis, at least four times a day or more if you are prescribed insulin. Even if you are following a treatment, your blood glucose might change for no apparent reason. This is very normal as your levels might be affected by change in the food you are eating, your stress levels, how often you are exercising, a possible illness, some new medications, alcohol or changes in hormonal levels for women. Also, and even if your blood glucose levels are regulated, you still need to perform routine A1C testing that will overview how well your treatment and lifestyle changes are working. If the levels are still above normal ranges, this means that your management plan is not effective and needs to be changed.
The different treatments
In order for your blood glucose levels to get regulated, a treatment plan is imminent. Never make a decision on your own. You always have to consult with your doctor and decide together on the best solution for your case. Normally, he will prescribe either one of these four solutions.
- Insulin: Insulin is a necessity for the those who are diabetic type-1. Also, it is considered an effective treatment for some who have the type-2. There are many kinds of insulin: the rapid-acting insulin, the long acting one and the intermediate acting one. What you will end up taking depends on your case. Sometimes, a mix of these three is prescribed. When you talk about insulin, you are talking about a treatment that is not taken orally; but, rather, it is injected using a very thin needle or a pen. Some might even use a pump. But, a pump is rather an invasive method where a device as big as a cellphone is worn by the patient that is connected to a catheter inserted under the skin in your abdomen. Some pumps are wireless and can be programed according to your needs. More studies and alterations are still needed to perfect the pump.
- Oral Medication: this is an alternative to those who can walk around insulin. Not everyone can take this treatment route. These oral medications stimulate the pancreas to produce more insulin. They also help the better release of insulin. Some other oral medications help by inhibiting the function of the liver in releasing glucose, this way you will need less insulin to transport the available glucose. Metformin is one of the most common oral meds for diabetes. These include Glucophage or glumetza. These are normally the first line of medications you get prescribed when you get diagnosed with diabetes type-2.
- Transplant: this is the last resort of people who have type-1 diabetes. A pancreas transplant might be necessary for them despite the major health concerns that such an operation poses on the patient. When a person undergoes an organ transplant, he or she will be obliged to stay on a lifetime of immune suppressants drugs so the body will not reject the new organ. These drugs have serious consequences. That’s why this solution is a last resort.
- Bariatric Surgery: this is not specifically a solution for treating diabetic people; however, when these are obese, then losing some weight might help them regulate their blood glucose levels. For example, patients who have a BMI of more than 35 might find it very beneficial to lose weight by means of surgery.
As a conclusion, when you have the predisposition and possible symptoms of a diabetic condition, you need to seek medical help and get a possible diagnosis. If your results turn positive; then, it is time for you to change your lifestyle and preferences accordingly. Changing your food choices, embracing a more active lifestyle, losing the excess weight; all these will help you embrace this chronic condition that as been affecting so many people worldwide. Sometimes, a treatment would be necessary to manage the glucose levels. But whatever the treatment route is, getting tested regularly is of major importance. The blood glucose levels fluctuate due to many unforeseen reasons and you have to be on top of the game. So, take a deep breath, and be positive that when you do the right choices, you will be ok.
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