Diabetes Overview:

What is diabetes mellitus?

Diabetes mellitus is a disease that prevents your body from properly using the sugar from the food you eat. Diabetes occurs in one of the following situations:

• The pancreas produces too little insulin or no insulin at all

-Or-

• The pancreas makes insulin, but it does not work correctly (insulin resistance)

What are the types of diabetes?

There are two main types of diabetes, Type 1 and Type 2:

• Type 1 diabetes occurs because the insulin-producing cells of the pancreas (beta cells) are damaged. In Type 1 diabetes, the pancreas makes little or no insulin so sugar cannot get into the body’s cells. People with Type 1 diabetes must use insulin to control their blood glucose levels. Type 1 diabetes is the most common form of diabetes in people under the age 30, however, it can occur at any age. Only 10% of people with diabetes are diagnosed with Type 1.
• In Type 2 diabetes, the pancreas makes insulin, but it either doesn’t produce enough or the insulin made does not work correctly. 90% of people with diabetes have Type 2 and it occurs most often in people over the age of 40 and who are overweight. Type 2 diabetes may sometimes be controlled through the combination of diet, weight management, and exercise, however, treatment also may include glucose-lowering medications (taken by mouth) or insulin injections.

Other types of diabetes can result from pregnancy (gestational diabetes), surgery, use of certain medicines, and various other illnesses.

What are the symptoms of diabetes?

Symptoms include:

• Increased thirst
• Increased hunger (especially after eating)
• Dry mouth
• Frequent urination
• Unexplained weight loss
• Weak, tired feeling
• Blurred vision
• Numbness or tingling in the hands or feet
• Slow-healing sores or cuts
• Dry and itchy skin (usually in the groin area)

What are the symptoms of low blood sugar?

Most people have symptoms of low blood sugar (hypoglycemia) when their blood sugar level gets below 60 mg/dl (your physician can advise you on how to test your blood sugar level).

When your blood sugar is low, your body will react and provide signs that you need to eat. Different people have different symptoms but some of the early signs of low blood sugar include:

• Weakness
• Dizziness
• Feeling hungry
• Trembling and feeling shaky
• Sweating
• Pounding heart
• Pale skin
• Feeling frightened or anxious

Late symptoms of low blood sugar include:

• Confusion
• Headaches
• Crankiness or irritability
• Poor coordination
• Bad dreams or nightmares
• Inability to focus
• Numbness in your mouth and tongue
• Passing out

Diagnosis and Tests:

How is diabetes diagnosed?

Diabetes is typically diagnosed with fasting blood sugar tests or with an A1c blood test, also known as glycated hemoglobin tests.

A fasting blood sugar test is performed after you have had nothing to eat or drink for at least 8 hours. Under these conditions, normal blood sugar is less than 100 mg/dl (5.6 mmol/l).

For an A1c blood test, you do not need to be fasting and it should be performed in a laboratory using a method that is certified by the National Glycohemoglobin Standardization Program (NGSP) and standardized to the Diabetes Control and Complications Trial (DCCT) assay.

• Fasting Glucose Test
• Normal: Less than 100
• Pre-diabetes: 100-125
• Diabetes: 126 or higher
• Random Glucose Test
• Normal: Less than 140
• Pre-diabetes: 140-199
• Diabetes: 200 or higher
• A1c Test
• Normal: Less than 5.7%
• Pre-diabetes: 5.7 – 6.4%
• Diabetes: 6.5% or higher

Management and Treatment:

How is diabetes managed?

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

• Keep blood sugar levels as close 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 fat consumption to 30% or less of your total daily calories
• Control your blood pressure (It should not go over 130/80)
• Decrease or prevent the development of diabetes-related health problems

You can improve your success at managing diabetes by:

• Planning and following a balanced meal plan
• Exercising regularly
• Taking medication, if prescribed, and following the guidelines closely
• Regularly monitoring your blood glucose and blood pressure levels
• Keeping your appointments with your health care providers and having laboratory tests completed as ordered

IMPORTANT: What you do daily at home affects your blood glucose more than what your doctor can do every few months during your check-up.

What are insulin pumps?

Insulin pumps are small devices about the size of a beeper that you wear on your belt or put in your pocket. They have a thin, flexible tube with a fine needle on the end that is inserted under the skin of your abdomen and taped in place. The pump releases a carefully measured, steady flow of insulin. Insulin pumps can cost $6,000 – $10,000 for the pump, with additional costs for supplies. Using a pump requires you to monitor your blood sugar level at least four times a day. Based on your levels you program appropriate doses and make necessary adjustments to your insulin depending on your food intake and exercise program. Some health care providers prefer insulin pumps over injections because it slowly releases insulin much like the pancreas.

Living With:

Can diabetes be cured?

No. A cure for diabetes has not yet been found, however, diabetes can be treated and controlled. Most people with diabetes manage their disease and lead normal lives.

What are some of the long-term complications of diabetes?

• Retinopathy (eye disease): Everyone with diabetes should see an ophthalmologist (eye specialist) annually for a dilated eye examination.
• Nephropathy (kidney disease): Urine testing should be performed every year. Regular blood pressure checks are important to control high blood pressure and slowing kidney disease. Generally, blood pressure should be less than 130/80 in adults.
• Neuropathy (nerve disease): Numbness or tingling in your feet should be reported to your doctor. Check your feet for redness, calluses, cracks, or breakdown in the skin tissue.

Other, long-term complications may include:

• Eye problems, including glaucoma and cataracts
• Dental problems
• High blood pressure
• Heart disease

References:

• American Diabetes Association: Diabetes Basics
• The National Institute of Diabetes and Digestive and Kidney Diseases: What is Diabetes?
• American Diabetes Association: A1C and eAG