What is Diabetes?
Diabetes is a disorder of metabolism. Diabetes affects the way our body uses blood sugar (glucose), which is a vital source to our health. Most of the food we eat is broken down into glucose. Normally, glucose is able to enter the cells because of the action of insulin (a hormone produced and secreted by the pancreas).
In people with diabetes, this process is not effective because instead of being transport into your cells, glucose accumulates in your bloodstream and eventually is excreted in your urine. This occurs either because your body does not produce enough insulin, or because the cells don't respond to insulin properly.
Diabetes generally occurs in two forms:
- Type 1 diabetes - This type is an autoimmune disease where the pancreas makes little or no insulin. It affects between 5 and 10% of people with the disease. People with type 1 diabetes must take insulin daily to live.
- Type 2 diabetes - this is the most common form of diabetes. About 90 - 95% of people with diabetes have type 2. This form of diabetes is associated with old age, obesity, family history, previous history of gestational diabetes, physical inactivity, and ethnicity. About 80% of people with type 2 diabetes are overweight.
Both types of diabetes are serious. The build up of glucose in your blood can damage almost every organ in your body. Eventually, diabetes can be fatal.
But the good news is that eating right, maintaining a healthy weight and getting plenty of exercise can help prevent the disease. If you have diabetes, diet and exercise along with medications that control blood sugar can help you continue to live a healthy and active life.
Screening for Diabetes
If you experience symptoms of severe increased thirst, frequent urination, unexplained weight loss, increased hunger, tingling of your hands or feet, your doctor may need to run a test for diabetes.
Many people first learn that they have diabetes through blood tests. In some cases, diabetes might not be detected before damage to your eyes, kidneys, or other organs has occurred. The American diabetes Association suggests that all adults have a fasting blood glucose test at the age of 45. If the test results are normal, repeat the test every few years. If your results are borderline, have a fasting blood sugar test every year. Your doctor can also test for diabetes based on your symptoms and risk factors. Usually doctors don't screen for diabetes during routine visits.
The amount of sugar in your blood fluctuates but the range is relatively narrow. After fasting all night, most people have levels between 70 and 100 milligrams of glucose per deciliter of blood. Thats the equvalent of about 1 teaspoon of sugar in a gallon of water. If you consistently have fasting glucose levels in your blood, you likely have diabetes.
Tests that can detect diabetes are:
- Fasting Plasma Glucose Test - The FPG is the preferred method for diagnosing diabetes because it is easy to do, convenient, and less expensive than other tests. In general, your blood sugar is highest right after you eat and lowest after an overnight fast. That's why the preferred way to test blood sugar is after you have fasted overnight. In this test, blood is drawn from a vein in your arm and send to a laboratory for tests.
- Finger- Prick Blood Sugar Screening - This test is fast, easy, inexpensive, and requires only a single drop o blood from a prick of the finger. Your blood is placed on a chemically treated strip that's inserted into a machine that shows your blood sugar level. If the level is high, you are to have a formal diagnostic test such as the FPG.
- Casual Blood Sugar Test - This test is part of a routine blood test done during a physical exam. Your blood is drawn through a needle inserted into your arm and send to a lab for testing. During this test, blood sugar is tested without regarding the time since the persons last meal. A glucose level greater than 200mg/dL may indicate diabetes, especially if the test is repeated at a later time and shows similar results.
- Oral Glucose Tolerance Test - This is another method used to detect diabetes, but is usually done during pregnancy to diagnose gestational diabetes, or for someone who is suspected of having type 2 diabetes yet has a normal fasting glucose level. This test requires that you drink 8 ounces of an extremely sweet liquid after fasting for 6 hours. Your blood sugar is measured before you drink the liquid, then every hour for three hours. If your blood sugar rises more than expected and doesn't return to normal by the third hour, you are likely to have diabetes.
- Glycated Hemoglobin Test - After you've received a diagnosis of diabetes, your doctor may order this test to measure your average blood glucose level for the previous two to three months. The test, also known as a hemoglobin A1C test, measures the amount of blood sugar attached to hemoglobin molecules — the iron-rich molecules in red blood cells that deliver oxygen to your body. The higher your blood sugar levels, the more hemoglobin molecules you will have with sugar attached. In general, the life cycle of a red blood cell is 75 to 90 days, which is why the A1C test shows your average blood glucose levels for the past two to three months.
How is Diabetes treated?
In order for you to feel healthy and to avoid diabetes, controlling your blood sugar is essential. Some people can control their blood sugar levels with diet and exercise alone. Others might need help from insulin or other medications in addition to changes in lifestyle. In any case, monitoring your blood sugar is the key part of your treatment program. For those whose kidneys are failing or who aren't responding to treatments, pancreas or islet cell transplantation may be an option.
Diabetes pills are grouped in categories based on type. There are several categories of diabetes pills -- each works differently. Talk to your doctor about pills for diabetes. However, the signs and symptoms of diabetes must be recognized first before understanding what treatment is available.
Pancrease transplantation - These transplants have been performed since the late 1960s. Most are done in conjunction with or after a kidney transplant. Kidney failure is one of the most common complications of diabetes. Receiving a new pancreas when you receive a new kidney may actually improve your kidney's survival. After a successful pancreas transplant, many people with diabetes no longer need to use insulin. There are risks associated with pancreas transplants. Your body may reject the new organ after the transplant, which means you will have to take immunosupressive drugs for the rest of your life. These drugs can be costly and have serious side effects. Talk to your doctor about pancreas transplantation, an option for those under the age of 45 with type 1 diabetes and need to, or have had a kidney transplant, where insulin medications are unsuccessful
Islet cell transplantation - There are about 1 million islet cells in the pancreas; 75-80% of these cells produce insulin. The beta cells that produce insulin reside in the islets. Although islet cell transplantation is still considered experimental, transplanting these cells offers a less invasive, less expensive and less risky option to a pancreas transplant. In this transplant, doctors infuse fresh pancreas cells into the liver of the person with diabetes. The cells spread through the liver and begin to produce insulin. The liver is the site of the transplant because it is easier to access the large portal vein in your liver. Cells that grow in the liver secrete insulin much like the cells in the pancreas do.
Monitoring your blood sugar may seem like an overwhelming task if you just recieved a diagnosis of diabetes. Learning how to measure your blood sugar is an important part of caring for your diabetes. After some time you will find that understanding how to monitor your blood sugar becomes a simple everyday task.
If you take insulin, you will need to test your blood at least twice a day. If you have type two diabetes and don't use insulin, you may need to test your blood sugar levels once a day or as little as twice a week. Remember than the amount of sugar in your blood is always changing. Self-monitoring helps you learn what makes your blood sugar levels rise and fall. This way you can make adjustments in your treatment.
Factors that affect your blood sugar levels include:
- Food - Food raises your blood sugar level making it higher after one to two hours after a meal. What you eat, and how much you eat also affect your blood sugar level.
- Exercise - The more active you are, the lower your blood sugar will be. Physical activity causes sugar to be transported to your cells, where it is used for energy. Aerobic exercises like brisk walking, jogging, or biking are great. Even gardening and housework can lower your blood sugar.
- Medications - insulin or oral diabetes medications work to lower your blood sugar. Make sure you tell your doctor about any medications that you take before taking medication for diabetes. Some medications can affect your glucose levels.
- Alcohol - Small amounts of alcohol — about 2 ounces — can cause your sugar levels to fall. Sometimes alcohol can cause sugar levels to rise. If you choose to drink, do so only in moderation. Monitor your blood sugar before and after consuming alcohol to see how it affects you. Keep in mind that alcohol counts as carbohydrate calories in your diet. Fluctuations in hormone levels -The female hormone estrogen usually makes cells more responsive to insulin, and progesterone makes cells more resistant. Although these two hormones fluctuate throughout the menstrual cycle, the majority of women don't notice a corresponding change in blood sugar levels. Those who do are more likely to experience changes in blood sugar during the third week of their menstrual cycle, when estrogen and progesterone levels are highest.
- Healthy weight - Being overweight is the greatest risk factor for type 2 diabetes. That's because fat makes your cells more resistant to insulin. When you lose weight, the process reverses and your cells become more receptive to insulin. For some people with type 2 diabetes, weight loss is all that's needed to restore blood sugar to normal. A modest weight loss of 10 to 20 pounds is often enough.
Medication for Dealing with Diabetes
When diet, exercise and maintaining a healthy weight aren't enough, you may need the help of medication. Insulin is a medication used to treat diabetes. Everyone with type 1 diabetes and some people with type 2 diabetes must take insulin every day to replace what their pancreas is unable to produce.
Unfortunately, insulin can't be taken in pill form because enzymes in your stomach break it down so that it becomes ineffective. For that reason, many people inject themselves with insulin using a syringe or an insulin pen injector — a device that looks like a pen, except the cartridge is filled with insulin. Others may use an insulin pump, which provides a continuous supply of insulin, eliminating the need for daily shots.
The most commonly used form of insulin is synthetic human insulin. This is chemically identical to human insulin but manufactured in a laboratory. Synthetic human insulin isn't perfect. One of its chief failings is that it doesn't mimic the way natural insulin is secreted. But newer types of insulin, known as insulin analogs, more closely resemble the way natural insulin acts in your body. Among these are lispro (Humalog), insulin aspart (NovoLog) and glargine (Lantus).
A number of drug options exist for treating type 2 diabetes, including:
- Sulfonylurea drugs - These medications stimulate your pancreas to produce and release more insulin. For them to be effective, your pancreas must produce some insulin on its own. Second-generation sulfonylureas such as glipizide (Glucotrol), glyburide (DiaBeta, Glynase PresTab, Micronase) and glimepiride (Amaryl) are prescribed most often. The most common side effect of sulfonylureas is low blood sugar, especially during the first four months of therapy. You're at much greater risk of low blood sugar if you have impaired liver or kidney function.
- Meglitinides - These medications, such as repaglinide (Prandin), have effects similar to sulfonylureas, but you're not as likely to develop low blood sugar. Meglitinides work quickly, and the results fade rapidly.
- Biguanides - Metformin (Glucophage, Glucophage XR) is the only drug in this class available in the United States. It works by preventing the production and release of glucose from your liver, which means you need less insulin to transport blood sugar into your cells. One benefit of metformin is that is tends to cause less weight gain than do other diabetes medications.
- Alpha-glucosidase inhibitors - These drugs block the action of enzymes in your digestive tract that break down carbohydrates. That means sugar is absorbed into your bloodstream more slowly, which helps inhibit the rapid rise in blood sugar that usually occurs right after a meal. Drugs in this class include acarbose (Precose) and miglitol (Glyset). Although safe and effective, alpha-glucosidase inhibitors can cause abdominal bloating, gas and diarrhea. If taken in high doses, they may also cause reversible liver damage.
- Thiazolidinediones - These drugs make your body tissues more sensitive to insulin and keep your liver from overproducing glucose. Side effects of thiazolidinediones, such as rosiglitazone (Avandia) and pioglitazone hydrochloride (Actos), include swelling, weight gain and fatigue. A far more serious potential side effect is liver damage. The thiazolidinedione troglitzeone (Rezulin) was taken off the market in March 2000 because it caused liver failure. If your doctor prescribes these drugs, it's important to have your liver checked every two months during the first year of therapy. Contact your doctor immediately if you experience any of the signs and symptoms of liver damage, such as nausea and vomiting, abdominal pain, loss of appetite, dark urine, or yellowing of your skin and the whites of your eyes (jaundice).
- Drug combinations - Combining drugs from different classes may allow you to be able to control your blood sugar in several different ways. Each class of oral medication can be combined with drugs from any other class. Most doctors prescribe two drugs in combination, although sometimes three drugs may be prescribed. Newer medications, such as Glucovance, which contains both glyburide and metformin, combine different oral drugs in a single tablet.