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What is diabetes?

Diabetes is a condition that causes high blood glucose (blood sugar) levels. Over time, high blood glucose levels can damage the nerves, eyes, kidneys, heart and blood vessels. This damage can lead to other serious health problems such as heart disease or kidney disease.

Fortunately, the health problems caused by high blood glucose levels can be prevented or delayed. With proper treatment and education, people with diabetes can stay healthy and live well.

Everyone over age 45 needs to be tested for diabetes every three years. Earlier and more frequent testing is recommended for those at high risk.

What are the types of diabetes?

There are three types of diabetes. All three are caused by a breakdown in the ability of insulin to help the body use glucose for energy.

Type 1 diabetes
The immune system destroys the insulin-producing cells in the pancreas. The cells stop making insulin, and the body cannot use glucose for energy. People with type 1 diabetes need insulin injections every day to stay alive. Type 1 diabetes can begin at any age, but it usually occurs in children or in young adults under age 30.

Type 2 diabetes
Either the pancreas does not make enough insulin, or the body cannot use insulin properly. The body "resists" the action of insulin, and glucose does not get into the body's cells very well. Type 2 diabetes is more common after age 45, but even children can develop the disease.

Gestational diabetes
In some women, the hormonal changes of pregnancy demand more insulin than the body can make. Blood glucose levels return to normal after the birth of the baby and the diabetes goes away. However, women who have had gestational diabetes are at risk for developing type 2 diabetes later in life.

What are the symptoms of diabetes?

In type 1 diabetes, symptoms usually include extreme thirst, increased hunger, frequent urination, weight loss and fatigue. These symptoms can quickly lead to serious problems including coma and even death. If these symptoms occur, seek medical assistance immediately.

In type 2 diabetes, the symptoms can be vague, or there may be no symptoms. Vague symptoms include blurry vision, poor wound healing, numbness or tingling in the hands or feet and frequent infections. These vague symptoms can go unnoticed, and type 2 diabetes can sometimes be present for years without being detected.

In gestational diabetes, there are no symptoms. All pregnant women need to be tested for diabetes during the second trimester. This is especially important for women who are at risk.

Who is at risk for diabetes?

The risk factors for type 1 diabetes are uncertain, though family history seems to play a role. The risk factors for type 2 diabetes and gestational diabetes are:

• family history of diabetes
• over age 45
• overweight
• physically inactive
• high blood pressure
• abnormal blood cholesterol or triglycerides
• personal history of gestational diabetes
• African American, American Indian or Alaska Native, Hispanic, Asian American or Pacific Islander race or ethnicity

How is diabetes diagnosed?

Diabetes is diagnosed by measuring the level of glucose in the blood. Two abnormal blood tests done on different days are required to diagnose diabetes. The blood glucose levels required for diagnosis are:

• 126 mg/dL or higher for a fasting blood glucose test, which is done when a person has had nothing but water for 8 hours.
• 200 mg/dL or higher for a blood glucose test done at any time, without regard for food intake. Symptoms must also be present.

What is the treatment for diabetes?

The foundation of diabetes treatment is a healthful diet and regular exercise. Some people also need to take medication, which might include diabetes pills or insulin injections. The goal of diabetes treatment is to keep blood glucose levels as close to normal as possible.

People with diabetes are active participants in their own care every day. Their education is also an essential part of every diabetes treatment plan. Doctors, nurses, dietitians and psychologists with special training in diabetes provide the information, training and support needed for effective self care.

What to expect if you are diagnosed with diabetes

If you are diagnosed with diabetes, you need regular medical care to stay healthy and live well. Twice yearly medical visits will include:

• review of diabetes treatment plan and blood glucose records
• blood pressure check
• foot exam
• blood tests to measure cholesterol and triglycerides
• blood test to measure kidney function
• nutrition and diabetes self-care education

In addition, you will need to see an ophthalmologist every year for a complete eye exam and a dentist for regular dental check-ups.

Are you at risk for type 2 diabetes?

Take the first step now to help prevent diabetes from entering your life. Answer the following questions to determine your greatest areas of risk. The more "yes" answers, the greater your risk. Any "yes" answer means you should take preventive measures now.

Forty percent of the children or siblings of people diagnosed with type 2 diabetes will eventually develop diabetes unless they take steps to prevent it. Does your parent, brother or sister have type 2 diabetes?     Yes     No

People in some ethnic groups have two to three times the risk of developing diabetes compared to all people. Are you African American/Black, American Indian or Alaska Native, Hispanic, or Asian/Pacific Islander?     Yes    No

More than 40 percent of people with diabetes have abnormal blood fat levels. This increases their risk of heart disease up to four times that of the general population. Do you have abnormal cholesterol or blood fat?     Yes     No     Don't Know

The longer you are overweight and the more overweight you are, the greater your risk for diabetes. Is your weight more than or equal to the weight listed in the chart for your height? (The chart gives weights that are 20 percent over ideal weights.)    Yes     No

Weight Chart
(shows 20 percent over maximum ideal weights without shoes or clothing)

Low blood glucose (Hypoglycemia)

If you take diabetes pills or inject insulin, it is possible for your blood glucose level to get too low. You do not need to worry about low blood glucose levels if you are treating your diabetes with a food plan and exercise alone.

You need to treat for low blood glucose any time your blood glucose level is below 70 mg/dL (3.9 mmol/l). If you have symptoms of low blood glucose and your blood glucose is either below 80 mg/dL (4.4 mmol/l) or below your target range, you also should treat for low blood glucose. Early symptoms of low blood glucose are:

• paleness
• feeling shaky and weak
• sweating
• dizziness
• fast heartbeat
• hunger
• tingling or numb lips

These symptoms are a signal to you that your brain and nervous system are not getting enough glucose. If untreated, you might have a hard time walking or speaking, or you may get confused.

Know the symptoms of low blood glucose and be prepared to treat them. If you feel any of the symptoms, test your blood. Any time your blood glucose level is below 70 mg/dL (3.9 mmol/l), eat or drink something that contains 15 grams of carbohydrate (see list below). Liquid or soft foods are the best choices.

Foods and beverages for treating low blood glucose

• 3 glucose tablets
• 1/2 cup of fruit juice
• 1/2 cup regular soft drink (not diet)
• 1 cup skim milk
• 6-7 hard candies
• 6 small sugar cubes
• 8-10 jelly beans
• 1 tablespoon of honey
• 1 small tube of cake frosting

It's easy to overtreat low blood glucose. You may be feeling anxious and your body may be telling you to eat. However, if you eat too much, your blood glucose levels can get too high. The best thing to do when you feel symptoms of low blood glucose is to eat the suggested serving of food and wait for it to take effect. This takes about ten to fifteen minutes. Then test your blood again.

If your second test is above 70 mg/dL (3.9 mmol/l) and you feel better, you can go about what you were doing. If your test is still below 70 mg/dL, eat another carbohydrate food. After fifteen minutes, test again. If you still have low blood glucose after three tests, call your physician.

Guidelines for preventing low blood glucose

• Test your blood glucose level routinely.
• Follow your prescribed food plan.
• Do not delay meals or snacks.
• If you take insulin, measure it carefully and take the correct amounts.
• Take other medications exactly as prescribed.
• Plan for exercise.
• Eat food when you drink wine, beer or liquor.
• Test your blood glucose level before driving.