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Diabetes
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Diabetes



Related terms
Background
Treatment
Author information
Bibliography
Types and causes of diabetes
Managing and preventing diabetes

Related Terms
  • Acanthosis nigricans, Alzheimer's disease, angina, autoimmune disease, beta cells, capillaries, carbohydrate, cortisol, Coxsackie B, c-reactive protein, depression, DI, diabetes insipidus, diabetes mellitus, diabetes type 1, diabetes type 2, diabetic complications, diabetic ketoacidosis, diabetic nephropathy, diabetic neuropathy, diabetic retinopathy, DM, enterovirus, fasting blood glucose test, fructosamines, gastroparesis, gestational diabetes, glucagon, glucose, glycemic, hemolysis, hyperglycemia, hyperglycemic hyperosmolar non-ketotic syndrome, hyperinsulinemia, hyperlipidemia, hypertension, hypoglycemia, IFG, IGT, impaired fasting glucose, impaired glucose tolerance, insulin, insulin resistance syndrome (IRS), insulinoma, islet cells, ketoacidosis, ketones, lipemia, metabolic syndrome, microangiopathy, nesidioblastosis, OGTT, oral glucose tolerance test, pancreas, peripheral neuropathy, polydipsia, polyphagia, polyuria, prediabetes, random blood glucose test, stroke, subcutaneously, syndrome X.

Background
  • Diabetes, also known as diabetes mellitus, is a chronic health condition where the body is unable to produce enough insulin and properly break down sugar (glucose) in the blood. Glucose comes from food and is used by the cells for energy. Glucose is also made in the liver. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. Insulin is needed to move sugar into the cells where it can be used for energy needed for body processes.
  • After digestion of food, glucose passes into the bloodstream. For glucose to get into cells, insulin must be present. Throughout the pancreas are clusters of cells called the islets of Langerhans. Islets are made up of several types of cells, including beta cells that make insulin. When normal individuals eat, beta cells in the pancreas automatically produce the right amount of insulin to move glucose from blood into the cells of the body. In individuals with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose. Glucose may also interact with cells, especially those in very narrow blood vessels. This process may lead to neuropathies and decreased immune function.
  • With Type 1 diabetes, the body does not make any insulin. With Type 2 diabetes, the more common type, the body does not make or use insulin properly. Without enough insulin, glucose stays in the blood and causes a condition called hyperglycemia, or high blood sugar levels.
  • Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes. Pregnant women can temporarily develop gestational diabetes, a type of diabetes that begins late in pregnancy.
  • In 2007, an estimated 20.8 million children and adults in the United States, or 7% of the population, had diabetes mellitus. An estimated 14.6 million have been diagnosed with diabetes (both type 1 and type 2), while 6.2 million people (or nearly one-third) are unaware that they have type 2 diabetes.
  • Diabetes is widely recognized as one of the leading causes of death and disability in the United States. The U.S. Centers for Disease Control (CDC) recognizes diabetes as the 6th leading cause of death in the United States, with over 72,000 deaths in 2004.

Treatment
  • Treatment for diabetes is a lifelong commitment of monitoring blood sugar, taking insulin if prescribed, maintaining a healthy weight, eating healthy foods, and exercising regularly. The goal is to keep your blood sugar level as close to normal as possible to delay or prevent complications. In fact, tight control of blood sugar levels can reduce the risk of diabetes-related heart attacks and strokes by more than 50%.
  • Lifestyle choices:
  • If an individual has been diagnosed with diabetes, healthy lifestyle choices, including diet and exercise, are necessary. These healthy choices will help to improve glycemic (blood sugar) control and prevent or minimize complications of diabetes.
  • Diet: A healthy diet is important in controlling blood sugar levels and preventing diabetes complications. Eat a consistent, well-balanced diet that is high in fiber, low in saturated fat, and low in concentrated sweets. A consistent diet that includes roughly the same number of calories at about the same times of day helps a healthcare provider prescribe the correct dose of medication or insulin.
  • What and how much an individual eats will affect their blood sugar level. Blood sugar is typically highest one to two hours after a meal. One way individuals with diabetes can manage their food intake to keep their blood glucose as close to normal as possible is by calculating how many grams of carbohydrate they eat. Carbohydrates tend to have the greatest effect on blood glucose. The balance between the amount of carbohydrate eaten and the available insulin determines how much the blood glucose level goes up after meals or snacks. To help control your blood glucose, individuals should know which foods contain carbohydrates, the size of a "serving" of different foods, and how many carbohydrate servings to eat each day. A dietician can help individuals work out a dietary plan that is right for them.
  • Foods that contain carbohydrates include grains, pasta, and rice; breads, crackers, and cereals; starchy vegetables, including potatoes, corn, peas, and winter squash; legumes such as beans, peas, and lentils; fruits and fruit juices; milk and yogurt; and sweets and desserts. Non-starchy vegetables such as spinach, kale, broccoli, salad greens, and green beans are very low in carbohydrates. Carbohydrate counting can ensure that the right amount of carbohydrate is eaten at each meal and snack.
  • The amount of food an individual eats is also closely related to blood glucose control. If an individual eats more food than is recommended on a meal plan, their blood glucose goes up. Although foods containing carbohydrates have the most impact on blood glucose, most foods will have some effect.
  • Exercise and weight control: Regular exercise, in any form, can help reduce the risk of developing diabetes. Physical activity moves sugar from the blood into the cells. The more active an individual is, the lower the blood sugar level. Activity can also reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure, blindness, and leg ulcers. Exercise will also help to keep blood sugar at a relatively even level and avoid excessively low or high blood sugar levels, which can be dangerous and even life threatening. As little as 20 minutes of walking, three times a week, has a proven beneficial effect. No matter how light or how long, some exercise is better than no exercise. If the individual has complications of diabetes, such as eye, kidney, or nerve problems, they may be limited both in type of exercise and amount of exercise that can safely be performed without worsening the condition. Individuals taking insulin may need to lower the insulin dose before unusual physical activity and exercise. A doctor will help in determining these changes.
  • If the individual is overweight, losing even ten pounds can reduce the risk of diabetes. To keep weight in a healthy range, it is recommended by healthcare professionals to focus on permanent changes to eating and exercise habits. A dietitian or a weight modification program can help an individual reach their goal.
  • Self-monitoring blood glucose: Checking blood sugar levels frequently, at least before meals and at bedtime, is important in controlling diabetes. Even if the individual takes insulin and eats on a rigid schedule, the amount of sugar in the blood can change unpredictably. Depending on what type of insulin therapy the individual is prescribed, such as single dose injections, multiple dose injections, or an insulin pump, the individual may need to check and record blood sugar levels up to four or more times a day. Careful monitoring is the only way to make sure that the blood sugar level remains within target range. A range of 90-130 milligrams/deciliter before meals is suggested for most individuals with diabetes. A doctor will tell the individual what their target range should be.
  • Also, results should be recorded in a logbook that should include insulin or oral medication doses and times, when and what was eaten, when and for how long exercise occurred, and any significant events of the day such as high or low blood sugar levels and how the problem was treated. A daily blood sugar logbook or diary is invaluable to the healthcare team in seeing how the individual is responding to medications, diet, and exercise in the treatment of their diabetes.
  • Better equipment now available makes testing blood sugar levels less painful and less complicated. Medicare now pays for diabetic testing supplies, as do many private insurers and Medicaid.
  • A doctor or healthcare team will help the individual decide what type of meter to buy. There are more than 20 types ofmeters available on the market. Examples include Accu-check®, Lifescan®, and OneTouch®. Meters vary in size, weight,test time, blood sample requirements, memory capabilities, and other special features. Most meterscan measure blood glucose with only a one- or two-step process.Most also incorporate no-wipe technology, which means usersdo not have to wipe off excess blood after applying a blooddrop to the reagent strip. In addition, many meters now requireonly a very small amount of blood, thus decreasing the problems with bleeding often seen in advanced diabetics and the elderly and the fear and painof wounds from the lancet.
  • A few of the newer meters offer the option of obtaining bloodsamples from alternate sites, such as a forearm instead of afingertip. This can benefit patients who find constant lancetwounds on their fingers difficult to tolerate. The fingers have many nerve endings and are a very painful site for testing, although they are the most reliable. More complex meters have features to aid in identifying trendsand to graph reports for more comprehensive data tracking, particularlyfor patients who test several times a day.
  • In order to get an accurate blood glucose result, the individual needs to make sure that the meter is clean, that its code matches the test strips, that their finger is clean, and that an adequate-size drop of blood is being tested. Before pricking the finger, it is recommended by healthcare professionals to wash the hands with warm water, shake the hands below the waist, and squeeze the finger a few times.
  • GlucoWatch®: In 2001, the U.S. Food and Drug Administration (FDA) approved the GlucoWatch®, a watch-like device that helps individuals with diabetes measure their blood glucose via tiny electric currents. It draws small amounts of fluid from the skin and measures blood glucose levels three times per hour for up to 12 hours. The GlucoWatch® is considered a first step toward noninvasive, continuous glucose monitoring, but it does have some shortfalls. GlucoWatch® is not considered as accurate as a blood test, so any measurements that fall outside of normal ranges will need to be re-tested with a finger stick test.
  • Medications:
  • Insulin and oral medications: Many individuals with diabetes can manage their blood sugar with diet and exercise alone, but some need diabetes medications or insulin therapy. In addition to diabetes medications, a doctor might prescribe low-dose aspirin therapy to help prevent heart and blood vessel disease. Aspirin prevents blood from clotting by blocking the production of thromboxane A-2, a chemical that platelets produce that causes them to clump. Aspirin accomplishes this by inhibiting the enzyme cyclo-oxygenase-1 (COX-1) that produces thromboxane A-2.
  • Many oral or injected medications can be used to treat type 2 diabetes. Some diabetes medications stimulate the pancreas to produce and release more insulin. Others inhibit the production and release of glucose from the liver, which means the individual needs less insulin to transport sugar into the cells. Still others block the action of stomach enzymes that break down carbohydrates or make tissues more sensitive to insulin.
  • The decision about which medications are best depends on many factors, including blood sugar levels and the presence of any other health problems. Medications taken by mouth for diabetes and blood sugar regulation include:
  • Sulfonylureas: Sulfonylureas help the pancreas make more insulin, which then lowers blood glucose. They also help the body use the insulin it makes to better lower blood glucose. For these medications to work, the pancreas has to make some insulin. Possible side effects include hypoglycemia (low blood sugar levels), an upset stomach, a skin rash or itching, and weight gain. Examples of sulfonylurea medications include glimepiride (Amaryl®), glyburide (DiaBeta®), chlorpropamide (Diabinese®), acetohexamide (Dymelor®), glipizide (Glucotrol®, Glucotrol XL®), glyburide (Glynase®, Micronase®), tolbutamide (Orinase®), and tolazamide (Tolinase®).
  • Biguanides: Biguanides helps lower blood glucose by making sure the liver does not make too much glucose. Biguanides also lowers the amount of insulin in the body. Metformin (Glucophage®) is currently the only biguanide available. Individuals may lose a few pounds when starting metformin. This weight loss can help control blood glucose. Metformin can also improve blood fat and cholesterol levels, which are often not normal if the individual has type 2 diabetes. Metformin does not generally cause blood glucose to get too low (hypoglycemia), unless it is combined with other medications that increase insulin. Metformin may cause nausea and vomiting if more than about two to four alcoholic drinks a week are consumed while on the medication. Other side effects include nausea, diarrhea, headache, and weakness. A metallic taste in the mouth may be noticed.
  • Alpha-glucosidase inhibitors: Alpha-glucosidase inhibitors are a class of oral medications for type 2 diabetes that decrease the absorption of carbohydrates from the intestine, resulting in a slower and lower rise in blood glucose throughout the day, especially right after meals. Before carbohydrates are absorbed from food, they must be broken down into smaller sugar particles like glucose by enzymes in the small intestine. One of the enzymes involved in breaking down carbohydrates is called alpha glucosidase. By inhibiting this enzyme, carbohydrates are not broken down as efficiently and glucose absorption is delayed. The alpha-glucosidase inhibitors include acarbose (Precose®) and miglitol (Glyset®).
  • Thiazolidinediones: Thiazolidinediones help make the cells more sensitive to insulin. The insulin can then move glucose more efficiently from the blood into the cells for energy. Side effects of these medications may include weight gain, anemia (less red blood cells which causes the blood to carry less oxygen than normal), and edema (fluid accumulation). More serious side effects include liver damage and chronic heart failure. A doctor will monitor the individual's liver function while taking thiazolidinediones. Examples of thiazolidinediones includes pioglitazone (Actos®) and rosiglitazone (Avandia®).
  • Meglitinides: Meglitinides helps the pancreas make more insulin right after meals, which lowers blood glucose. A doctor might prescribe a meglitinide medication by itself or with metformin (Glucophage®) if one medicine alone does not control blood glucose levels. Possible side effects of meglitinides include hypoglycemia (low blood sugar) and weight gain. Examples include repaglinide (Prandin®).
  • D-phenylalanine derivative: D-phenylalanine derivatives helps the pancreas make more insulin quickly and for a short time. Then the insulin helps lower blood glucose after eating a meal. These medications may cause blood glucose levels to drop too low. Doctors will check liver function while taking d-phenylalanine derivatives. An example of a d-phenylalanine derivative is nateglinide (Starlix®).
  • DPP-4 inhibitor: DPP-4 (dipeptidyl-peptidase 4) inhibitors enhance the body's own ability to control blood sugar levels, increase insulin when blood sugar is high, especially after eating, and reduce the amount of sugar made by the liver after eating. Sitagliptin (Januvia®) is currently the only DPP-4 inhibitor available. Side effects of DPP-4 inhibitors include a runny or stuffy nose, sore throat, headache, nausea, stomach pain, or diarrhea.
  • Exenatide (Byetta®): Exenatide (Byetta®) is an injectable drug that reduces the level of sugar (glucose) in the blood. It is used for treating type 2 diabetes. Exenatide belongs in a class of drugs called incretin mimetics because these drugs mimic the effects of incretins. Incretins, such as human-glucagon-like peptide-1 (GLP-1), are hormones that are produced and released into the blood by the intestine in response to food. GLP-1 increases the secretion of insulin from the pancreas, slows absorption of glucose from the gut, and reduces the action of glucagon. Glucagon is a hormone that increases glucose production by the liver. All three of these actions reduce levels of glucose in the blood. In addition, GLP-1 reduces appetite. Exenatide is a synthetic (man-made) hormone that resembles and acts like GLP-1. In studies, exenatide-treated patients achieved lower blood glucose levels and experienced weight loss. Exenatide was approved by the U.S. Food and Drug Administration (FDA) in May 2005.
  • Combination medications: Some anti-diabetic medications may be combined to provide glucose and insulin control. An example of a combination drug is glyburide combined with metformin (Glucovance®). Side effects of combination drugs are similar to those associated with the individual drugs in the product.
  • Insulin: Insulin is a naturally-occurring hormone secreted by the pancreas. Insulin is required by the cells of the body in order for them to remove and use glucose from the blood. Insulin may need to be taken by type 1 and type 2 diabetics. Because stomach enzymes interfere with insulin taken by mouth, insulin must be injected or inhaled. Often, insulin is injected using a fine needle and syringe or an insulin pen injector (a device that looks like an ink pen, except the cartridge is filled with insulin).
  • Individuals with diabetes mellitus have an inability to take up and use glucose from the blood and, as a result, the glucose level in the blood rises. In type 1 diabetes, the pancreas cannot produce insulin. Therefore, insulin therapy is needed. In type 2 diabetes, individuals produce insulin, but cells throughout the body do not respond normally to the insulin. Nevertheless, insulin also may be used in type 2 diabetes to overcome the resistance of the cells to insulin. By increasing the uptake of glucose by cells and reducing the concentration of glucose in the blood, insulin prevents or reduces the long-term complications of diabetes, including damage to the blood vessels, eyes, kidneys, and nerves. Insulin is administered by injection under the skin (subcutaneously). The subcutaneous tissue of the abdomen is preferred because absorption of the insulin is more consistent from this location than subcutaneous tissues in other locations.
  • There are several types of insulin, classified by how soon and how long they act. It is helpful to know when the insulin starts to work, its peak (when the insulin is working its hardest), and the duration (how long the insulin works). Premixed combinations of slower- and fast-acting insulin are also available. Depending on the individual's needs, a doctor may prescribe a mixture of insulin types to use throughout the day and night. Insulin medications can be made from bovine, porcine, and recombinant human insulin sources. However, in the United States, bovine-tissue derived insulin is no longer available as of 1999, due to U.S. Food and Drug Administration (FDA) concerns over the possible transmission of bovine spongiform encephalopathy (also known as mad-cow disease), and most porcine derived formulations have been discontinued as well. Nearly all insulin on the market today is now produced from bacteria and is identical to human insulin.
  • Regular (rapid onset of action, short duration of action) and NPH (slower onset of action, longer duration of action) human insulin are the most commonly-used preparations. Regular insulin has an onset of action (begins to reduce blood sugar) within 30 minutes of injection, reaches a peak effect at one to three hours, and has effects that last six to eight hours. NPH insulin is insulin with an intermediate duration of action. It has an onset of action starting about two hours following injection. It has a peak effect 4-12 hours after injection and aduration of action of 18-26 hours.
  • Lente insulin is also insulin with an intermediate duration of action. It has an onset of action two to four hours after injection, a peak activity 6-12 hours after injection, and aduration of action of 18-26 hours. Ultralente insulin is long-acting insulin with an onset of action four to eight hours after injection, a peak effect 10-30 hours after injection, and aduration of action of more than 36 hours.
  • An ultra rapid-acting insulin, insulin lispro (Humalog®), is a chemically-modified, natural insulin. When compared to regular insulin, insulin lispro has a more rapid onset of action, an earlier peak effect, and a shorter duration of action. It reaches peak activity 0.5-2.5 hours after injection. Therefore, insulin lispro should be injected 15 minutes before a meal as compared to regular insulin, which is injected 30-60 minutes before a meal.
  • Insulin aspart (Novolog®) and insulin glargine (Lantus®) are both human insulins that have had their chemical composition slightly altered. The chemical changes provide insulin aspart with a faster onset of action (20 minutes) and a shorter duration of action (three to five hours) than regular human insulin. It reaches peak activity one to three hours after injection. Insulin glargine has a slower onset of action (70 minutes) and a longer duration of action (24 hours) than regular human insulin. Its activity does not peak.
  • Premixed insulins are a combination of specific proportions of intermediate-acting and short-acting insulin in one bottle or insulin pen (the numbers following the brand name indicate the percentage of each type of insulin). Examples of premixed insulins include Humalog mix 75/25, Novolog 70/30, Novolin 70/30, and Humulin 70/30.
  • Healthcare professionals recommend storing unopened bottles of insulin in the refrigerator; also, insulin should not be used after the expiration date. Insulin should not be frozen. Store bottles that are being used at room temperature (59-86 degrees Fahrenheit) for 28-30 days. Discard after 30 days. Avoid exposing the bottles to temperature extremes (less than 36 degrees Fahrenheit or more than 86 degrees Fahrenheit). Regular insulin should not be used if it becomes cloudy in appearance. NPH insulin should not be used if it becomes clumped or crystallized or if the bottle becomes frosted. Make sure that dosages are rechecked whenever changing insulin. Get guidance from a healthcare professional before mixing insulins.
  • Insulin pump: An insulin pump also may be an option. The pump is a device about the size of a cell phone worn on the outside of the body. A tube connects the reservoir of insulin to a catheter that is inserted under the skin of the abdomen. The pump is programmed to dispense specific amounts of insulin automatically. It can be adjusted to deliver more or less insulin depending on meals, activity level, and blood sugar level.
  • Inhaled insulin: Inhaled insulin (Exubera®) is also available. Inhaled insulin is a powdered form of insulin that is rapid acting, usually taken before a meal. It replaces only short-acting forms of injectable insulin, not the longer acting (basal) insulin that may be required as part of a diabetes treatment plan. Inhaled insulin is not approved for anyone younger than 18 and should not be used by individuals who smoke or who have given up cigarettes within the past six months. However, it is considered safe for individuals who live with smokers. Exubera® is not recommended for individuals with asthma, bronchitis, emphysema, or any form of active lung disease. Baseline tests for lung function are recommended by healthcare providers before starting treatment, after the first six months of treatment, and every year thereafter, even if no pulmonary symptoms such as lung or breathing problems exist.
  • Surgery:
  • Pancreas transplant: Many individuals with type 1 diabetes can manage their disease by following a diet and exercise plan, monitoring blood glucose levels, and using insulin injections. But for some individuals, this is a difficult task, resulting in a number of serious short- and long-term complications. A pancreas transplant is the closest thing to restoring normal pancreas function. A pancreas transplant is not the best option for all people with type 1 diabetes, however, and is primarily recommended for individuals with kidney failure.
  • Pancreas transplants pose serious health risks and are not always successful. The individual will need to take immune-suppressing drugs, such as cyclosporine (Sandimmune®), to prevent organ rejection. These drugs can have serious side effects, including a high risk of infection and organ injury. Because the side effects can be more dangerous than the diabetes, pancreas transplants are usually reserved for individuals whose diabetes cannot be controlled or those who have serious complications.
  • Other surgeries: Islet transplantation is an experimental procedure where islets (special cells in the pancreas that make insulin) are taken from the pancreas of a deceased healthy organ donor. The islets are purified, processed, and transferred into the individual with type 1 diabetes. Once implanted, the beta cells in these islets begin to make and release insulin. Researchers hope that islet transplantation will help people with type 1 diabetes live without daily injections of insulin. Stem cell transplants may also offer help to those suffering from type 1 diabetes, but the benefits are controversial in the United States.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
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  3. Catalan V, Gomez-Ambrosi J, Rotellar F, et al. Validation of Endogenous Control Genes in Human Adipose Tissue: Relevance to Obesity and Obesity-associated Type 2 Diabetes Mellitus. Horm Metab Res. 2007;39(7):495-500. .
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Types and causes of diabetes
  • Pre-diabetes: Individuals with pre-diabetes have blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes. This condition raises the risk of developing type 2 diabetes, heart disease, and stroke.
  • Pre-diabetes is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. Some individuals have both IFG and IGT. In IFG, glucose levels are a little high when it has been several hours after eating. In IGT, glucose levels are a little higher than normal right after eating.
  • Pre-diabetes is becoming more common in the United States, according to estimates provided by the U.S. Department of Health and Human Services (DHHS). Many individuals with pre-diabetes go on to develop type 2 diabetes within 10 years.
  • Type 1 diabetes: Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body's immune system that fights infection begins to attack a part of the body. In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas. The pancreas then produces no insulin. An individual with type 1 diabetes must take insulin daily for proper blood sugar control.
  • It is not known exactly what causes the body's immune system to attack the beta cells, but researchers believe that autoimmune, genetic, viral, and environmental factors may be involved. Type 1 diabetes accounts for about 5-10% of cases of diagnosed diabetes in the United States. Type 1 diabetes develops most often in children and young adults but can appear at any age.
  • Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can develop a condition called diabetic ketoacidosis or a low blood pH due to the accumulation of ketones in the blood. Diabetic ketoacidosis may lead to a coma if not treated appropriately.
  • Type 2 diabetes: The most common form of diabetes is type 2 diabetes. About 90-95% of individuals with diabetes have type 2. This form of diabetes is most often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes (diabetes developed during pregnancy), physical inactivity, and certain ethnicities. About 80% of individuals with type 2 diabetes are overweight.
  • Type 2 diabetes is increasingly being diagnosed in children and adolescents. When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively. This is a condition called insulin resistance. After several years of making extra insulin because the body cannot use it efficiently, insulin production decreases. The result is the same as for type 1 diabetes - glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.
  • Insulin also normally shuts down the ability of the liver to produce glucose. In individuals with type 2 diabetes, however, insulin is unable to inhibit sugar production in the liver, either because the pancreas is not producing enough insulin or because insulin's signal cannot be detected.
  • The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores. Some individuals have no symptoms.
  • Type 2 diabetes can be treated with diet,exercise, and oral prescription medications but may requireinsulin shots.
  • Hyperinsulinemia: Hyperinsulinemia is when an individual has too much insulin in the blood. Hyperinsulinemia is not diabetes, but may lead to type 2 diabetes if not managed appropriately. Hyperinsulinemia is a sign of an underlying problem that is causing the pancreas to secrete excessive amounts of insulin. The most common cause of hyperinsulinemia is insulin resistance, a condition in which the body is resistant to the effects of insulin and the pancreas tries to compensate by making more insulin. Rarely, hyperinsulinemia is caused by a tumor of the insulin-producing cells of the pancreas (insulinoma) or excessive numbers of insulin-producing cells in the pancreas (nesidioblastosis). Hyperinsulinemia may not have signs or symptoms unless it causes low blood sugar (hypoglycemia).
  • Metabolic syndrome: Metabolic syndrome, also known as syndrome X or insulin resistance syndrome (IRS), is a set of abnormalities in which type 2 diabetes (insulin resistant) or hyperinsulinemia is almost always present. Insulin resistance causes the tissues to stop responding to insulin. If an individual has insulin resistance, the body will make more and more insulin, but because the tissues do not respond to it, the body will not be able to use glucose (sugar) properly. Insulin resistance often occurs with other health problems, such as diabetes, high cholesterol, high blood pressure and heart attack. When a person has many of these problems together, doctors call it insulin resistance syndrome. Metabolic syndrome includes hypertension (high blood pressure), hyperlipidemia (high cholesterol), large waist size, an increase in cortisol (stress hormone), abnormalities in blood clotting, and an increase in inflammatory responses. A high rate of cardiovascular disease is associated with the metabolic syndrome.
  • Diabetes insipidus: Diabetes insipidus (DI) is a rare disease, not widely diagnosed, in which the kidneys produce abnormally large volumes of dilute urine. DI is caused by a deficiency of the antidiuretic hormone (ADH), also known as vasopressin. DI can also be caused by insensitivity of the kidneys to ADH. DI is different from diabetes mellitus (DM), which involves insulin problems and high blood sugar. The symptoms can be similar, such as extreme thirst and frequent urination. However, DI is related to how the kidneys handle fluids. Urine and blood tests can determine which is present.
  • Gestational diabetes: Some women develop gestational diabetes late in pregnancy. Although this form of diabetes usually disappears after the birth of the baby, women who have had gestational diabetes have a 20-50% chance of developing type 2 diabetes within 5-10 years. Maintaining a reasonable body weight and being physically active may help prevent development of gestational diabetes turning into type 2 diabetes.
  • As with type 2 diabetes, gestational diabetes occurs more often in some ethnic groups and among women with a family history of diabetes. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Women with gestational diabetes may not experience any symptoms. When a woman has diabetes and her blood sugar is poorly controlled and too high, excess amounts of sugar are transported to the baby. Since the baby does not have diabetes, the fetus is able to increase the production of insulin substantially in order to use this extra sugar. This abnormal cycle of events can result in several complications including macrosomia (large baby, over 8.8 pounds), neonatal hypoglycemia (low blood sugar), stillbirth, and birth defects (such as brain, spinal cord, or heart conditions).
  • The only treatment for gestational diabetes is insulin, as oral anti-diabetic medications can not be used in pregnancy due to the possible risks.
  • Maturity-onset diabetes of the young (MODY): Maturity-onset diabetes of the young (MODY) is a type of diabetes that is caused by genetic mutations. MODY may occur during childhood or adolescence, but may be misdiagnosed as Type 1 or Type 2 diabetes, or may be unidentified until the patient is an adult. Research indicates that the genetic mutations responsible for MODY interfere with normal pancreatic secretion of insulin. Currently, six gene mutations have been identified as causative factors for MODY, each of which produce several different forms of MODY, named MODY 1-MODY 6. Each type of MODY has different signs and symptoms, clinical manifestations, complications, and treatments.
  • It has been estimated that 1- 5% of diabetes cases in the United States are MODY. MODY typically presents during a patients 20s, usually before the age of 25. Patients at risk for MODY have a strong family history of diabetes, and/or have developed diabetes before middle age. In contrast to clinical manifestations in other forms of diabetes, MODY patients are typically not overweight, and are sometimes able to be treated with meal planning, oral diabetes medications, or low doses of insulin. It is recommended for the patient to work closely with their healthcare provider to determine the best treatment, based on the specific type of MODY diagnosed.

Managing and preventing diabetes
  • Healthy lifestyle choices can help prevent type 2 diabetes and manage type 1 diabetes. Even if diabetes runs in the individual's family, diet and exercise can help prevent the disease. Healthy lifestyle choices can help individuals prevent potentially serious complications of diabetes, such as stroke, nerve damage, and heart disease.
  • Dental health: Diabetes may leave individuals prone to gum infections. Healthcare professionals recommend brushing the teeth at least twice daily, flossing the teeth once a day, and schedule dental exams at least twice a year. Contacting a dentist right away if the gums bleed or look red or swollen is recommended.
  • Diet: It is important to choose foods low in fat and calories. Fresh fruits, vegetables, and whole grains. It is best to eliminate all refined carbohydrates (sugars and white flour) and hydrogenated oils. Limiting the amount of high-sugarbeverages, such assoft drinks and fruit punches, is recommended by healthcare professionals.Avoid high-fat foods like ice cream, butter, and high-fatmeats.Decreasing the consumption of milk and dairy products may also help with blood sugar control. Lean poultry and fish should be eaten more often than red meat. It is best not to cook with butter, margarine, lard, and hydrogenated oils. Olive oil or vegetable oils such as safflower are recommended by healthcare professionals.
  • Eating healthy foods and exercising regularly can also help control high blood pressure and high cholesterol levels.
  • Alcohol consumption should be limited to no more than one drink per day for women,two perday for men, and none if there is difficulty controllingalcohol intake (addiction) or uncontrolled blood sugar levels.
  • Foot health: Healthcare professionals recommend to wash the feet daily in lukewarm water and top dry them gently, especially between the toes. It is important to moisturize the feet with lotion. Checking the feet every day for blisters, cuts, sores, redness, or swelling is important. It is recommended to consult a doctor if a sore or other foot problem that does not heal within a few days exists.
  • Glucagon kit: Keeping a glucagon kit nearby in case of a low blood sugar emergency is important. Glucagon is an important hormone involved in carbohydrate metabolism. Produced by the pancreas, it is released when the glucose level in the blood is low (hypoglycemia), causing the liver to convert stored glycogen into glucose and release it into the bloodstream. The action of glucagon is thus opposite to that of insulin, which instructs the body's cells to take in glucose from the blood in times of satiation. An injection of glucagon will raise blood sugar levels.
  • Identification tags: Healthcare professionals recommend that individuals with diabetes wear a tag or bracelet identifying the condition.
  • Ketones: Individuals can test to see if the body is making ketones by doing a simple urine test. There are several products available for ketone testing that can be purchased without a prescription. Common product names include Ketostix®, Chemstrip K®, and Acetest®. The test result can be negative or show small, moderate, or large quantities of ketones. Healthcare professionals recommend testing for ketones during the following situations: anytime the blood glucose is over 250 milograms/deciliter for two checks in a row; when the individual is ill - often illness, infections, or injuries will cause sudden high blood glucose and this is an especially important time to check for ketones; when the individual is planning to exercise and the blood glucose is over 250 milligrams/deciliter; and when pregnant, individuals should test for ketones each morning before breakfast and anytime the blood glucose is over 250 miligrams/deciliter. As long as blood glucose levels are not too high, the presence of ketones is not a problem. Untreated high blood glucose with ketones can lead to a life-threatening condition called diabetic ketoacidosis (DKA). If the ketone test is positive, healthcare providers recommend calling a doctor immediately.
  • Physical activity and weight control: Healthcare professionals recommend 30 minutes of moderate physical activity a day, where tolerated. Taking a brisk daily walk, riding a bike, or swimming laps are good exercises for individuals with diabetes. Losing weight is very important in maintaining healthy blood sugar levels.
  • Studies have reported that individuals can lower the risk of developing diabetes by losing 5-7% of body weight through diet and increased physical activity. Diet and exercise resulting in a 5-7% weight loss (approximately 10-14 pounds in an individual weighing 200 pounds) can lower the incidence of type 2 diabetes by nearly 60%.
  • Proper glucose control: The single best thing an individual can do is to keep their blood sugar level within the suggested range every day. The only way to do this is through a combination of regular blood sugar checks (self blood glucose monitoring), a balanced diet low in simple sugars and fat and high in complex carbohydrates and fiber, and appropriate medical treatment. A nutritionist, a doctor, and others on the healthcare team will help set up appropriate diabetes treatment strategies for the individual.
  • Regular doctor visits: Scheduling regular health check-ups is important. However, regular diabetes checkups are not meant to replace yearly physicals or routine eye exams. Doctors will look for any diabetes-related complications, such as neuropathy, as well as screen for other medical problems. An eye care specialist will check for signs of retinal damage, cataracts, and glaucoma.
  • Smoking cessation: Smoking cigarettes or use of any other form of tobacco raises the risks for developing complications from diabetes, such as heart attack, stroke, nerve damage, and kidney disease. Smoking damages blood vessels and contributes to heart disease, stroke, and poor circulation in the limbs. Smokers who have diabetes are three times more likely to die of cardiovascular disease than are nonsmokers who have diabetes, according to the American Diabetes Association (ADA). A doctor can help plan a strategy to stop smoking or to stop using other types of tobacco.
  • Stress reduction: Chronic stress can lead to the adrenal glands releasing the stress hormone cortisol. Chronic release of cortisol can lead to health problems such as blood sugar regulation problems such as hyperinsulinemia, high cholesterol levels, inflammation, poor immunity, and obesity. Stress can be controlled through integrative therapies, such as meditation, breathing, yoga, and certain herbs and vitamins. Getting plenty of rest may also help with decreasing stress and improving immunity. High blood sugar levels can weaken the immune system.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.



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