What
is diabetes?What
are the different types of diabetes?Who is
at risk for diabetes?What
are the signs and symptoms of diabetes?What
tests are used to diagnose diabetes?Who
should be tested for diabetes?How is
diabetes treated?Can
diabetes be prevented?What
is hypoglycemia? How is it related to diabetes?What
is new in diabetes research?
What is
diabetes?
Simply stated,
diabetes means the body has lost its main source of fuel, and the
body cannot survive without fuel. Diabetes is a condition in which
the pancreas, a little organ near the stomach that produces insulin
(a hormone), can't make enough insulin or the body can't use the
insulin properly. Insulin is important because it helps get glucose
(a sugar that comes from most of the foods we eat) into our cells
for energy. With diabetes, glucose builds up in the blood instead of
being used for energy. Diabetes is a serious and growing problem. An
estimated 17 million Americans have diabetes, but only 11.1million
cases are diagnosed. About nine million women have diabetes, and
about a third of these don't even know they have it! It is the 5th
leading cause of death in women.
Diabetes can lead to
serious, even life-threatening complications and serious damage to
many parts of the body: the heart, eyes, kidneys, blood vessels,
nerves, gums and teeth, feet and legs. Unfortunately, many people
first become aware that they have diabetes when they develop one of
these problems. Women with diabetes face special concerns, like an
increased risk of vaginal infections and complications during
pregnancy.
The three main types
of diabetes are:
-
Type 1
diabetes, also known as juvenile-onset or insulin-dependent
diabetes mellitus (IDDM)
-
Type 2
diabetes, also known as adult-onset or noninsulin-dependent
diabetes mellitus (NIDDM)
-
Gestational diabetes.
Type 1
diabetes usually occurs in children and young adults and is
considered an autoimmune disease. An autoimmune disease results when
the body's system for fighting infection (the immune system) turns
against a part of the body. In type 1 diabetes, the immune system
attacks the insulin-producing beta cells in the pancreas and
destroys them. The pancreas then produces little or no insulin,
thereby preventing cells from taking up sugar from blood. Someone
with type 1 diabetes needs daily injections of insulin to live. She
also needs to follow a strict diet and monitor her blood sugar
levels.
Symptoms include
increased thirst and urination, constant hunger, weight loss,
blurred vision, and extreme tiredness. If not diagnosed and treated
with insulin, a person can lapse into a life-threatening coma.
Type 2
diabetes is the most common form of diabetes. About 90 to
95 percent of people with diabetes have type 2 diabetes. This form
of diabetes usually develops in adults over the age of 40 and is
most common among adults over age 55. About 80 percent of people
with type 2 diabetes are overweight.
In type 2 diabetes,
the pancreas usually produces insulin, but for some reason, the body
cannot use the insulin effectively. The end result is the same as
for type 1 diabetes?an unhealthy buildup of glucose in the blood and
an inability of the body to make efficient use of its main source of
fuel.
The symptoms of type
2 diabetes develop gradually and are not as noticeable as in type 1
diabetes. Symptoms include feeling tired or ill, frequent urination
(especially at night), unusual thirst, weight loss, blurred vision,
frequent infections, and slow healing of sores.
Gestational
diabetes develops or is discovered during pregnancy. This
type usually disappears when the pregnancy is over, but women who
have had gestational diabetes have a greater risk of developing type
2 diabetes later in their lives. Gestational diabetes occurs in 2 to
5 percent of pregnancies and at higher rates among African
Americans, Hispanic Americans/Latinos, and Native Americans/Alaska
Natives.
Members of African
American, Native American/Alaska Native, Asian American, Hispanic
American/Latino, and Native Hawaiian/Pacific Islander ethnic groups
are at increased risk for diabetes.
Other things that can
put you at higher risk for developing diabetes include:
-
Being
more than 20 percent above your ideal body weight
-
Having a
mother, father, brother, or sister with diabetes
-
Giving
birth to a baby weighing more than 9 pounds or having diabetes
during pregnancy
-
Having
high blood pressure (140/90 or higher)
-
Having
abnormal blood lipid levels, such as low HDL (good) cholesterol
(less than 35 milligrams per deciliter (mg/dL)), or high
triglycerides (greater than 250 mg/dL)
-
Having
abnormal glucose tolerance in an earlier diabetes test.
People with type 2
diabetes often do not have symptoms, but you might have one or more
of these signs:
-
being
very thirsty or hungry
-
urinating often (especially at night)
-
feeling
very tired
-
losing
weight without trying
-
slow
healing sores
-
very
dry, itchy skin
-
tingling
or numbness in the feet or hands
-
sudden
vision changes
-
more
infections than usual (including frequent vaginal yeast and
bladder infections, among others, in women)
-
nausea,
vomiting, or stomach pain (might come with the sudden development
of juvenile diabetes)
A diagnosis of
diabetes can be confirmed by a series of tests that might include:
-
A blood test that measures the glucose in
your blood. A blood glucose level of 200 milligrams per
deciliter (mg/dL) or greater, with symptoms, means that you have
diabetes.
-
A blood test for glucose after you have
fasted, called fasting plasma glucose (FPG) value. An FPG
value of 126 mg/dL or greater means that you have diabetes.
-
A measurement of glucose in your blood
through an oral glucose tolerance test (OGTT). Although
this test is no longer recommended because it is cumbersome, some
health care providers may still use it. After fasting, you have to
drink a glucose syrup and have a blood sample taken 2 hours later.
An OGTT value of 200 mg/dL or greater means that you have
diabetes.
People with test
results between "normal" and "diabetes" levels have impaired glucose
metabolism and are at risk for developing diabetes, heart attacks,
and strokes.
If you are 45 years
old or older, you should be tested for diabetes. If your test result
is normal, you should then be tested every three years. People under
age 45 should be tested if they are at high risk for diabetes.
It is now recommended
that pregnant women who are at low risk for gestational diabetes do
not need to be tested. This low-risk group includes women who meet
all of the following criteria: are younger than 25
years old, are at normal body weight, without a family history of
diabetes, and not members of a high-risk ethnic group. Other women
should be tested for diabetes during the 24th to
28th weeks of pregnancy. You will be asked to drink a
glucose drink and have a blood test one hour later. If your blood
glucose value is 140 mg/dL or greater, your health care provider
will most likely want to do more tests before diagnosing you with
diabetes.
Diabetes treatment is
focused on keeping blood sugar in a normal range every day. A recent
major study showed that keeping blood glucose levels as close to
normal as safely possible reduces the risk of developing major
complications of type 1 diabetes.
If you have diabetes,
a good blood sugar range is from about 70 to 150 (before a meal) and
less than 200 about two hours after your last meal. Ask your health
care provider what the best range of blood sugar is for you, how to
test your blood sugar and how often. Careful meal planning and
exercise to control your weight are important to control your
diabetes. Your health care provider will evaluate if you need
diabetes pills or insulin shots.
Your health care
provider can also help you develop a plan for things you should do
every day to take care of your diabetes, including following a
healthy eating plan (eat your meals and snacks around the same time
each day) and being active for a total of 30 minutes most days. If
you do need diabetes medicine, take it at the same times every day.
Test your blood sugar and record it in a diary, then call your
health care provider if your numbers are too high or too low for two
to three days. If you have high blood pressure, take your medicine
exactly as prescribed. Check your bare feet for cuts, blisters,
sores, swelling, redness, or sore toenails (use a mirror if you have
trouble seeing the bottom of your feet). Brush and floss your teeth
twice a day. And, don't smoke!
Since diabetes can
cause serious problems for other parts of your body, you can help
detect these problems early by: having an eye exam once a year, even
if your eyes seem okay; having a dentist clean and check your teeth
and gums twice a year; and having your urine tested at least once a
year (to make sure your kidneys are healthy). See your health care
provider right away if you have signs of a urinary tract, bladder,
or kidney infection.
The Diabetes
Prevention Program (DPP) Clinical Trial conducted by the National
Institutes of Health showed that the onset of type 2 diabetes could
be prevented or delayed in people at high risk by losing 5 to 7
percent of body weight and getting 30 minutes of physical activity
such as brisk walking on most days. The good news is that these
lifestyle changes worked for men and women, for people of every
ethnic or racial group who participated in the study, and it was
especially successful for people over age 60. To help you lose
weight, eat a healthy diet that includes a balance of all the food
groups, with less fatty foods, foods lower in cholesterol, and more
foods rich in fiber. Too much fat or cholesterol and inactivity can
make you overweight and prevent your body from functioning
effectively. Not being able to regulate blood sugar correctly is one
effect. Cut down on fat and cholesterol by choosing low-fat dairy
products, lean cuts of meat, more fish and poultry without the skin,
and margarine instead of butter. Also, limit foods high in salt and
sugar.
To find out how
people can prevent or delay type 1 diabetes, the National Institute
of Diabetes and Digestive and Kidney Diseases (NIDDK) is sponsoring
a nationwide study called the Diabetes Prevention Trial-Type 1
(DPT-1). The study is recruiting people who have close relatives
with the disease, since they have an increased chance of developing
it. Animal research and small studies in people have shown that type
1 diabetes can be delayed in those at high risk with regular, small
doses of insulin. So, the DPT-1 study is testing whether type 1
diabetes can be prevented or delayed in humans with insulin
injections or insulin capsules. For more information about this
study, call 800-HALT-DM1 (800-425-8361).
Hypoglycemia, or low
blood sugar, is not diabetes but may occur as a complication of
diabetes, as a condition in itself, or in association with other
disorders. Hypoglycemia occurs when levels of glucose, the body's
main fuel, drop too low to fuel the body's activity. Carbohydrates
(sugars and starches) are the body's main dietary sources of
glucose. During digestion, the glucose is absorbed into the blood
stream (hence the term "blood sugar"), which carries it to every
cell in the body. Unused glucose is stored in the liver as glycogen.
In the case of hypoglycemia, the mechanism for converting stored
glucose (glycogen) back into usable glucose energy (glucose) by the
body is faulty. The process normally involves the liver and other
organs as well as various hormones.
A person with
hypoglycemia may feel weak, drowsy, confused, hungry, and dizzy.
Paleness, headache, irritability, trembling, sweating, rapid
heartbeat, and a cold, clammy feeling are also signs of low blood
sugar. In severe cases, a person can lose consciousness and even
lapse into a coma.
In recent years,
advances in diabetes research have led to better ways to manage
diabetes and treat its complications. For example, the insulin pump,
new oral medications, and better ways of monitoring blood glucose
have become available. In the future, it may be possible to
administer insulin through inhalers, a pill, or a patch. Islet
transplantation, a procedure that can restore insulin
production in patients with type 1 diabetes, is a highly promising
area of research. Scientists also have found several genes that
predispose people to both type 1 and type 2 diabetes. The National
Institutes of Health is funding a large effort to find all the genes
that influence getting diabetes. Once these genes are found,
scientists hope to find new therapies. Devices are also being
developed that can monitor blood glucose levels without having to
prick a finger to get a blood sample. Researchers continue to search
for the cause or causes of diabetes and ways to prevent and cure the
disorder.
