What is Diabetes?

Diabetes is a disease in which the body is unable to produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy necessary for daily life. This means that your body cannot properly use and store glucose (a form of sugar). The glucose builds up in your bloodstream, causing a high blood glucose level. The cause of diabetes is still being researched, although both environmental and genetic factors such as family history and obesity appear to play roles.

Long-Term Complications

Diabetes can cause many long-term complications. The most common are:

• Blindness: Diabetes is the leading cause of new blindness for 20 to 74-year-olds.
• Kidney Disease: Diabetes is the leading cause of end-stage kidney disease.
• Nerve Disease and Amputation: 60-70% of diabetics have mild to severe forms of diabetic nerve damage. Extreme forms can lead to lower-limb amputation.
• Heart Disease and Stroke: Diabetics are two to four times more likely to have heart disease and two to four times more likely to have a stroke than non-diabetics.

Type 1 Diabetes

Type 1 diabetes accounts for five to 10 percent of diabetes cases. In Type 1, the body does not produce any insulin, which means that people with Type 1 diabetes must take daily insulin injections to stay alive. Although it can occur at any age, Type 1 most often occurs in children and young adults.

In Type 1 diabetes an immune process destroys the cells in the pancreas that produce insulin, a hormone, usually leaving your body unable to produce insulin. Without insulin your body cannot use glucose (a form of sugar) found in food for energy, so your body cannot control sugar levels in the blood. Therefore, people with Type 1 diabetes must take insulin injections daily.

Taking Insulin

Insulin cannot be taken in pill form, as a pill would not have time to work before the juices in your stomach destroy the insulin. Insulin must be injected under the skin — in the fat — for it to work. Scientists are working on new ways to give insulin. But today, shots are the only reliable method.

Signs & Symptoms

Type 1 diabetes often appears suddenly. Here are some signs and symptoms to look for:

• Frequent urination (and/or bed-wetting in children).
• Extreme hunger.
• Extreme thirst.
• Unplanned weight loss.
• Weakness and tiredness.
• Feeling edgy and having mood changes.
• Feeling sick to your stomach and vomiting.
• High levels of sugar in the blood.
• High levels of sugar in the urine.

Living With Diabetes

The key to living a healthy life with diabetes is to follow your diabetes treatment plan. The goal of this plan is to have good blood-sugar control, keeping your blood-sugar level as close to normal as possible. Your treatment plan will probably include:

• Insulin, to lower blood sugar. Your healthcare provider will prescribe how much and when to take which kinds of insulin.
• A registered dietitian, to help you design a meal plan that includes the amount, type and timing of meals. Most people have three meals and at least two snacks every day. Your meal plan can include foods you enjoy.
• Exercise to lower blood sugar. Along with insulin, exercise helps your body use blood sugar. Your healthcare provider can help you fit exercise safely into your daily routine.
• Blood testing. Testing your blood lets you know your blood-sugar level. The tests are simple. You prick your finger to get a drop of blood. A diabetes educator can teach you how to perform this test and use the test results.

You are at a greater risk for Type 1 diabetes if your siblings or parents have Type 1 diabetes. This is a very active area of research, with more information being discovered all the time.

Type 2 Diabetes

Type 2 diabetes accounts for 90-95% of diabetes cases and is the most common form of diabetes. In this case the body cannot make enough insulin, or is unable to use it properly. This most often occurs in adults over 40 or those who are overweight.

Type 2 diabetes used to be called non-insulin-dependent diabetes or adult-onset diabetes. With Type 2 diabetes, your body does not make enough insulin or cannot properly use the insulin it makes. Without enough insulin, your body cannot move blood sugar into the cells. Sugar builds up in the bloodstream and high blood levels of sugar can cause problems.

The most common type of diabetes — Type 2 — affects approximately 15 million Americans. Although it can occur at any age, it is most often found in people over age 45 and those who are overweight, among other factors.

Although the exact cause of Type 2 diabetes is unknown, family history plays a big role. A person can inherit a tendency to develop Type 2 diabetes, but it usually takes another factor, such as obesity, for the disease to materialize.

Risk Factors

You are at a greater risk for Type 2 diabetes if you:

• Are over age 40.
• Do not exercise regularly.
• Are overweight.
• Have a family history of diabetes.
• Have low HDL or high triglyceride level (blood fat levels).
• Are of a certain racial and ethnic group (e.g., African American, Hispanic American, Asian and Pacific Islander, or Native American).
• Are a woman who has had gestational diabetes, a form of diabetes occurring in four percent of all pregnancies, or who has had a baby weighing nine pounds or more at birth.

Signs & Symptoms

Type 2 diabetes often develops slowly. Some signs and symptoms include:

• Increased thirst.
• Increased need to urinate.
• Feeling edgy, tired or moody.
• Increased appetite, but losing weight.
• Having repeated or hard-to-heal infections of the skin, gums, vagina or bladder.
• Blurred vision.
• Tingling or loss of feeling in the hands or feet.
• Dry, itchy skin.

These symptoms can be so mild that they go unnoticed. Older people may confuse these symptoms with signs of aging and may not go to their healthcare practitioner. Half of all Americans who have diabetes may not know it.

Often, people with Type 2 diabetes have no symptoms.

Living With Diabetes

The key to living a healthy life with diabetes is to follow your diabetes treatment plan. The goal of this plan is to have good blood-sugar control, keeping your blood-sugar level as close to normal as possible.

• Your first step is to see your healthcare practitioner. You will be prescribed a daily treatment plan. The plan should include a healthy diet and regular exercise. You can often control type 2 diabetes with diet and exercise alone.
• Maintaining a healthy weight is important for people with type 2 diabetes.Losing weight can help some overweight people bring their blood sugars into the normal range.
• Your healthcare practitioner may also want you to test your blood-sugar levels regularly. Testing will let you know if your diabetes is in control. Be sure to ask how to do these tests.

Gestational Diabetes

Gestational diabetes develops in approximately 4 percent of all pregnant women, but disappears when the pregnancy is over. This affects approximately 135,000 women in the United States each year. Women who have had gestational diabetes have an increased risk for developing type 2 diabetes.

Gestational diabetes (GDM) occurs when a pregnant woman becomes diabetic during her pregnancy. The effects of poorly controlled gestational diabetes on the baby can include a large birth weight, possible injury to the baby during delivery and possible low blood sugar for a short while after delivery. Effects on the mother include difficult delivery (often necessitating Cesarean section or use of forceps) and an increased risk of developing type 2 diabetes later in life. Maintaining good blood sugar (glucose) levels during pregnancy can eliminate these risks for the baby and reduce the risk of a difficult delivery for the mother.

Assisting the pregnant woman and her family in achieving a healthy, safe pregnancy is a team effort including primary care and specialty physicians, nurses and other health professionals. When the diagnosis of gestational diabetes is made, the team expands to include other health professionals, a certified diabetes educator and a registered dietician. The goal of the certified diabetes educator and registered dietician is to equip women with the knowledge, skills and emotional support to manage gestational diabetes and deliver a healthy, normal-sized baby.

Monitoring

It is important that women with GDM learn to monitor their own blood-glucose levels at home. With appropriate blood glucose and urine ketone testing you receive immediate feedback about your condition and can positively impact it. Guidelines for safe glucose and ketone levels are provided. Technique and timing is critical for accurate monitoring, and this is taught in the first meeting with the certified diabetes educator.

Nutrition

Counseling by a registered dietitian is provided to ensure that you know how to choose foods which will support optimal blood-glucose readings and ideal pregnancy weight gain. Follow-up sessions after delivery address the need to return to a goal weight.

Exercise

While exercise is very important in increasing insulin sensitivity during pregnancy, it must be done with care. The diabetes educator will make a careful assessment of each woman's baseline activity level and suggest safe and appropriate activities.

Emotional Support

Women with GDM are often frightened by this diagnosis. The diabetes educator can take the time to listen to her concerns and provide information. They will stay in contact with each woman until delivery to provide encouragement and support.

Insulin Therapy

Insulin therapy is implemented when the combination of diet and activity are not adequate to maintain appropriate blood-glucose levels. Diabetes educators teach the necessary skills of insulin administration and more frequent monitoring.

Cost and Access

The charge for a visit with the certified diabetes educator and the registered dietician are often reimbursed by insurance. Checking with your insurance benefits counselor is the best way to determine this. For those who are uninsured or underinsured, financial assistance is available through our financial counselors in the Patient Access Department.

Pre-Diabetes

A condition that occurs when blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. It is estimated that approximately 54 million Americans have pre-diabetes. Research has shown that if action is taken to control blood glucose levels in the pre-diabetes stage development of Type 2 diabetes can be delayed or prevented.