Wednesday, December 9, 2009

Insulin Pump For Diabetes Mellitus


What is an insulin pump?

The most recently available advance in insulin delivery is the insulin pump. In the United States, MiniMed and Disetronic market the insulin pump. An insulin pump is composed of a pump reservoir similar to that of an insulin cartridge, a battery-operated pump, and a computer chip that allows the user to control the exact amount of insulin being delivered.


How big is an insulin pump?

Currently, pumps on the market are about the size of a standard communications beeper.


How does an insulin pump work?

The pump is attached to a thin plastic tube (an infusion set) that has a soft cannula (or plastic needle) at the end through which insulin passes. This cannula is inserted under the skin, usually on the abdomen. The cannula is changed every two days. The tubing can be disconnected from the pump while showering or swimming. The pump is used for continuous insulin delivery, 24 hours a day. The amount of insulin is programmed and is administered at a constant rate (basal rate). Often, the amount of insulin needed over the course of 24 hours varies depending on factors like exercise, activity level, and sleep.

The insulin pump allows the user to program many different basal rates to allow for variation in lifestyle. In addition, the user can program the pump to deliver a bolus (large dose of insulin) during meals to cover the excess demands of carbohydrate ingestion.


How common is an insulin pump?

Over 50,000 people worldwide are using an insulin pump. This number is growing dramatically as these devices become smaller and more user-friendly. Insulin pumps allow for tight blood sugar control and lifestyle flexibility while minimizing the effects of low blood sugar (hypoglycemia). At present, the pump is the closest device on the market to an artificial pancreas. More recently, newer models of the pump have been developed that do not require a tubing, in fact - the insulin delivery device is placed directly on the skin and any adjustments needed for insulin delivery are made through a PDA like device that must be kept within a 6 foot range of the insulin delivery device, and can be worn in a pocket, kept in a purse, or on a tabletop when working.

Probably the most exciting innovation in pump technology is the ability to use the pump in tandem with newer glucose sensing technology. Glucose sensors have improved dramatically in the last few years, and are an option for patients to gain further insight into their patterns of glucose response to tailor a more individual treatment regimen. The newest generation of sensors allows for a real time glucose value to be given to the patient. The implantable sensor communicates wirelessly with a pager-sized device that has a screen. The device is kept in proximity to the sensor to allow for transfer of data, however, it can be a few feet away and still receive transmitted information. Depending on the model, the screen displays the blood glucose reading, a thread of readings over time, and a potential rate of change in the glucose values. The sensors can be programmed to produce a "beep" if blood sugars are in a range that is selected as too high or too low. Some can provide a warning beep if the drop in blood sugar is occurring too quickly.

To take things one step further, there is one particular sensor that is new to the market that is designed to communicate directly with the insulin pump. While the pump does not yet respond directly to information from the sensor, it does "request" a response from the patient if there is a need for adjustments according to the patterns it is programmed to detect. The ultimate goal of this technology is to "close the loop" by continuously sensing what the body needs, and then responding by providing the appropriate dose of insulin. While this technology is a few more years in the making, the strides in this direction continue to grow.

Wednesday, November 11, 2009

Gestational Diabetes Treatment

Overview

Treatment of gestational diabetes involves eating a balanced diet and getting regular exercise to keep your blood sugar (glucose) levels within an acceptable range.

The goal is to reduce the risk of complications for you and your baby during pregnancy and after birth. If your blood sugar level and the fetus's weight remain normal, the risk of complications is no greater than if you did not have gestational diabetes.

During pregnancy

Treatment for gestational diabetes during pregnancy includes:

Eating a balanced diet. Controlling the amount of carbohydrates in your diet allows your body's naturally produced insulin to keep blood glucose levels within the acceptable range. Nutritional counseling by a registered dietitian is an important part of treatment for gestational diabetes.

Getting regular exercise. Following a balanced diet and getting regular exercise may prevent the need for insulin injections.

Monitoring blood glucose levels. Take a home blood sugar test 1 hour after the first bite of each meal. Some experts recommend that women who take insulin should also test their blood sugar before meals. Keeping blood sugar levels within the acceptable range reduces the risk that the fetus will gain excessive weight, leading to possible complications.

Monitoring fetal growth and well-being. You may be asked to monitor fetal movements and report any significant decrease. Fetal ultrasound is used to evaluate fetal growth during pregnancy. If the fetus is growing larger than expected, you may need to take insulin injections. If you take insulin, a nonstress test may be done to evaluate the fetus's heart rate. A nonstress test may also be done near the expected delivery date for all women with gestational diabetes.

Having regular medical checkups. Women with gestational diabetes are twice as likely to develop high blood pressure as other pregnant women. Therefore, you need regular medical visits to monitor your blood pressure and to check your urine for protein. Your health professional may ask you to keep daily food records. They may be reviewed along with your weight to make sure you are getting adequate nutrition.

Taking insulin injections. If blood sugar levels are not remaining within an acceptable range after at least 2 weeks of eating a balanced diet and exercising regularly, insulin injections will be needed. Insulin may be started after 1 week of diet and exercise if your blood sugar level is not within an acceptable range. Usually, when the baby is delivered, a woman's blood sugar level returns to normal and she no longer needs to take insulin.

Most obstetricians generally advise pregnant women not to diet, and a total weight gain during pregnancy of about 25 lb (11.3 kg) to 35 lb (15.9 kg) is expected. However, if you were very overweight before becoming pregnant, a weight gain of less than 15 lb (6.8 kg) is acceptable. If you are obese, your doctor will probably ask you to restrict your caloric intake, even during your pregnancy.

During labor and delivery

Once your pregnancy has reached its 38th week, your doctor may want to deliver your baby to reduce the chance that the baby will be abnormally large (macrosomia). At this point, your obstetrician may try to induce labor or perform a cesarean section (C-section) to deliver the baby. Unless your fetus is not as developed as it should be, this delivery should not harm it. If allowed to become too large, it may be too difficult to deliver your fetus safely. Periodic ultrasound measurements help determine the size of the fetus and the need for early delivery. However, since treatment of gestational diabetes is very successful in preventing large babies, many obstetricians will increase fetal monitoring rather than deliver early.

During labor and delivery, you and the baby are monitored closely. Monitoring includes:

--Your blood glucose levels, which will be tested at least every 1?2 hours. If your level rises too high, you may be given small amounts of insulin through a vein (intravenous, or IV). If your level drops too low, you may be given IV fluid that contains glucose.

--The fetal heart rate, which provides an indication of how well the baby is tolerating the birth. Internal or external fetal heart monitoring may be used. If the baby is large or does not seem to be tolerating labor, surgery (cesarean section, or C-section) may be needed to deliver the baby. However, most women with gestational diabetes are able to deliver their babies naturally.

After delivery

After delivery, you and the baby need to be monitored closely.

--Your blood glucose levels may be tested as often as hourly for the first few hours. In most cases, women do not need to have insulin injections after delivery.

--The baby's blood glucose levels will be monitored. If your blood glucose levels were above the acceptable range during pregnancy, the baby's body will continue to produce extra insulin for several hours after birth. The extra insulin may cause the baby's blood glucose to drop too low (hypoglycemia). For babies who are able to take feedings by mouth, breast-feeding seems to help protect against low blood sugar.12 If the baby's blood glucose level drops below the acceptable range, he or she may need extra sugar, such as a sugar water drink or glucose given intravenously.

--The baby's blood may be checked for low calcium, high bilirubin, and extra red blood cells.

What to Think About

The blood glucose levels of most women with gestational diabetes return to normal within a few hours after delivery. However, women who have had gestational diabetes in a previous pregnancy are at risk for developing type 2 diabetes later in life. In addition, between 30% and 69% of women who have gestational diabetes develop the condition again in future pregnancies.

Gestational Diabetes Diet Plan

What is it? Gestational (jes-ta-shun-ull) diabetes is when your blood sugar (glucose) is too high while you are pregnant. Gestational diabetes often goes away after the baby is born. But, you may get diabetes later if you have diabetes during pregnancy.

In diabetes, your body does not make enough insulin or the insulin it makes does not work right. This causes your blood sugar levels to be too high. This can be harmful to you and your unborn child. Controlling your blood sugar is important for the health of your unborn baby.

The carbohydrates (kar-bo-hi-drates) in your food become glucose in your body. Glucose is a major energy source for your body. Carbohydrates come from starchy foods such as breads, pasta, potatoes, rice, and other grains. Carbohydrates are also found in fruits, dairy foods, vegetables, sugar, and sweets.

You need to eat the right amount of carbohydrates, protein, and fat while you are pregnant. This requires more planning if you are taking insulin to control your blood sugar while you are pregnant.

What is carbohydrate counting? Carbohydrate counting means keeping track of the amount of carbohydrates you eat every day. You should eat the same amount of carbohydrates at the same times each day. This will help keep your blood sugar within the normal range.

One serving of a carbohydrate food contains 12 to 15 grams of carbohydrate. A serving is equal to one of the portions listed below. You can exchange or trade one carbohydrate food for another from the same food group. For example, you can choose 1 slice of bread instead of 1/2 cup cooked cereal.

Vegetables contain only 5 grams of carbohydrate per serving. Do not count vegetables as carbohydrates unless you eat more than 2 servings per meal. Meat, meat substitutes, and fats are not counted as carbohydrates.

Care:

Calorie Intake:

Most pregnant women need about 300 extra calories per day in the second and third trimesters to gain enough weight. This equals about 16 to 17 calories per pound of ideal body weight.

An extra 10 to 12 grams of protein per day is also needed to help your baby grow normally. It is also helpful to get 45 to 60% of your calories from carbohydrates, 15 to 25% from protein, and 20 to 30% from fat.

Eating Plans:

Your dietitian (di-uh-tih-shun) will show you how to meet the guidelines above. You may use the sample menu below or the Diabetes Meal Planning Guide to do this. Ask for the CareNotes?handout about the diabetic exchange diet to find the serving sizes of foods not on the lists below.

Some people with gestational diabetes can control their blood sugar with diet alone. They do this by eating 3 meals and 1 to 3 snacks each day.

You will need a snack at bedtime to prevent your blood sugar levels from being too low overnight. Your dietitian will tell you if you need snacks in the morning or afternoon.

Eat at the same times each day, whenever possible, and never skip meals or snacks. Spread your food out evenly over the day so that you eat about every 2 to 3 hours. Eat only the amount that is on the food list. Or the amount your dietitian tells you to eat for each type of carbohydrate food.

Avoid foods and beverages with added sugar, corn syrup, honey, molasses, or maple syrup, or jams and jellies.

Read the labels of packaged foods to find the grams of carbohydrate a serving has in it.

Other Factors:

Choosing high fiber foods will help control your blood sugar and have regular bowel movements. High fiber foods are fresh fruits and vegetables, whole grain breads, cooked dried beans, and bran cereals.

Check with your doctor before exercising during pregnancy. Tell your dietitian about your exercise plan so your diet can be changed if needed. You may need extra carbohydrates before exercise to keep your blood sugar from dropping too low.

Talk with your caregiver if your blood sugar levels are too low or too high. Make sure your cholesterol and other blood lipids (fats) are checked at least once a year. You may need to follow a lowfat diet if they are too high.

Serving Sizes: Use the list below to measure foods and serving sizes. A serving size means the size of food after it is cooked or prepared.

1 pint or 2 cups (16 fluid ounces) of liquid is the size of 1-1/3 soda-pop cans.

1-1/2 cup (12 fluid ounces) of liquid is the size of a soda-pop can.

1 cup of food is the size of a large handful, or 8 fluid ounces of liquid.

?cup of food is about half of a large handful, or 4 fluid ounces of liquid.

2 tablespoons (Tbsp) is about the size of a large walnut.

1 tablespoon (Tbsp) is about the size of the tip of your thumb (from the last crease).

1 teaspoon (tsp) is about the size of the tip of your little finger (from the last crease).

3 ounces of cooked meat, fish, or poultry is about the size of a deck of cards.

1 ounce of cooked meat, fish, or poultry is about ?cup.

One ounce of hard cheese is about a 1 inch cube.

A serving of vegetables is ?cup (1/2 handful) cooked, or 1 cup (1 handful) raw.

CARBOHYDRATE FOODS AND SERVING SIZES

Breads and Starches: Each serving contains 15 grams carbohydrate. Eat ____ servings per day from this list. Most people need 6-10 servings per day.

1 slice bread (1 ounce)

1/2cup cooked pasta, corn, cooked cereal, mashed potato, or green peas

1/3 cup cooked rice, dried beans, or dried peas

3/4 cup flake cereal

1/2 hamburger or hot dog bun, English muffin, or frozen bagel

3 cups air-popped popcorn

1 small (3 inch) potato

2 rice cakes

6 saltines or three (2-1/2 inch squares) graham crackers

Fruits: Each serving contains 15 grams carbohydrate. Eat ____ servings per day from this list. Most people need 2-4 servings per day. Avoid juice or limit to 1/2 cup per day if your blood sugar levels are too high.

1/2 cup apple, orange, or grapefruit juice

1 small (2-1/2 inch) apple, peach, or orange

1/2 cup applesauce or canned fruit

3/4 cup fresh blueberries

15 small grapes or 12 large grapes

1 kiwi fruit

1/2 large pear or fresh grapefruit

2 Tbsp raisins or 1/4 cup dried fruit

1-1/4 cup fresh strawberries or melon cubes

Dairy: Each serving contains 12 grams carbohydrate. Eat or drink____ servings per day from this list. Most people need 2-3 servings per day.

1/2 cup sugar free custard, pudding, or evaporated milk

1 cup fresh milk or sugar-free yogurt

1/3 cup nonfat milk powder

Vegetables: Each serving contains 5 grams carbohydrate. Only count a vegetable as carbohydrate if you have more than 2 servings per meal. Eat ____ servings per day from this list. Most people need 2-4 servings per day.

2 Tbsp tomato sauce

1 cup vegetable or tomato juice

1/2 cup cooked vegetables or 1 cup raw vegetables

Combination Foods: Each serving contains about 15 grams carbohydrate. Eat ____ servings per day from this list. Most people need 1-2 servings per day.

1/2 cup of any casserole, like tuna or chicken noodle, macaroni and cheese, chili with meat, or spaghetti and meat sauce

1 cup cream, bean, tomato, or vegetable soup

1/8 of a 10-inch pizza

1/2 of a store-bought pot pie, like chicken, turkey, or beef

One 3 ounce taco

NON-CARBOHYDRATE FOODS TO INCLUDE IN YOUR DIET

Meat / Meat Substitutes: The foods on this list do not count as carbohydrates. Eat ____ servings per day from this list. Most people need 3-5 servings per day.

1/2 cup cottage cheese

1/2 cup cooked dried beans

1 to 2 oz low fat cheese

1 large egg (Limit eggs to 2 or 3 per week.)

2 to 3 oz cooked meat, fish, poultry

2 Tbsp peanut butter

Fats: The foods on this list do not count as carbohydrates. Eat ____ servings per day from this list. Most people need 1-3 servings per day.

6 almonds or 10 small peanuts

1/8 avocado

1 teaspoon oil or margarine

6 small olives

2 Tbsp low calorie salad dressing

1Tbsp regular salad dressing

2200 CALORIE SAMPLE MENU A sample of a 2200 calorie gestational diabetic diet is listed below. A dietitian can help you decide how many snacks you need each day.

Breakfast: 42 grams carbohydrate

3 carbohydrate choices such as.

2 breads or starches, like 1 cup bran cereal or 1 cup cooked oatmeal

1 milk, like 1 cup skim milk, 1% milk, or nonfat sugar-free yogurt

1 ounce meat or protein, like ?cup scrambled egg substitute or lowfat cottage cheese

2 fats, like 2 tsp margarine

Morning Snack: 15 grams carbohydrate

1 fruit, such as 1/2 large banana

1 oz. meat substitute, such as 2 Tbsp peanut butter

Lunch: 67 grams carbohydrate

The following foods can be combined to make a sandwich:

2 carbohydrate choices like 2 slices whole wheat bread

2 ounces meat or protein, like 2 ounces lean roast beef or ?cup water-packed tuna

1 vegetable, like 2 lettuce leaves with 2 slices of tomato

1 fat, like 1 tsp mayonnaise or 1 Tbsp salad dressing

1 fruit, like 1-1/4 cups fresh strawberries

1 vegetable, like 1/2 cup vegetable soup or 1 cup carrot sticks

1 free food, like 12 ounces sugar-free soft drink

1 milk, like 1 cup sugar-free nonfat yogurt

Afternoon snack: 15 grams carbohydrate

1 starch, like 3 squares (2-1/2 inch) graham crackers

Dinner: 82 grams carbohydrate

5 carbohydrate choices such as:

2 starches, like 1 large baked potato or 1 cup cooked pasta

1 starch, like 1 small dinner roll (1 ounce)

1 fruit, like 1 cup melon cubes or 4 fresh apricots

1 milk, like 1 cup skim milk or nonfat sugar-free yogurt

2 vegetables, like 1 cup steamed asparagus and 2 cups tossed salad

3 ounces meat or protein, like grilled chicken breast or salmon

2 fats, like 1 tsp margarine and 2 Tbsp lowfat salad dressing

Evening Snack: 27 grams carbohydrate

1 carbohydrate choice such as 1 bread, 6 whole wheat crackers, or 1 slice whole wheat bread

1 meat or protein, like 1 ounce lowfat cheese or 1 ounce lowfat ham

1 milk, like 1 cup skim milk or nonfat sugar-free yogurt

Totals For The Day: About 2180 calories.

About 248 grams carbohydrate, or 47% of calories.

About 123 grams protein, or 23% of calories.

About 72 grams fat, or 30% of calories.

CALL YOUR CAREGIVER IF:

You have questions about the serving sizes in this diabetic diet.

You have questions about how to prepare or cook foods on this diet.

You have questions about how or where to buy foods on this diet.

You have questions or concerns about your illness, medicine, or this diet.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Gestational Diabetes Test - Detection and Diagnosis

Detection and Diagnosis

Risk assessment for gestational diabetes mellitus should be undertaken at the first prenatal visit. Women with clinical characteristics consistent with a high risk of gestational diabetes mellitus (marked obesity, personal history of gestational diabetes mellitus, glycosuria, or a strong family history of diabetes) should undergo glucose testing (see below) as soon as feasible. If they are found not to have gestational diabetes mellitus at that initial screening, they should be retested between 24 and 28 weeks of gestation. Women of average risk should have testing undertaken at 24 to 28 weeks of gestation. Low-risk status requires no glucose testing, but this category is limited to those women meeting all of the following characteristics:

Age <25 years
Weight normal before pregnancy
Member of an ethnic group with a low prevalence of gestational diabetes mellitus
No known diabetes in first-degree relatives
No history of abnormal glucose tolerance
No history of poor obstetric outcome
A fasting plasma glucose level >126 mg/dL (7.0 mmol/L) or a casual plasma glucose >200 mg/dL (11.1 mmol/L) meets the threshold for the diagnosis of diabetes, if confirmed on a subsequent day, and precludes the need for any glucose challenge. In the absence of this degree of hyperglycemia, evaluation for gestational diabetes mellitus in women with average or high-risk characteristics should follow one of two approaches:

One-step approach: Perform a diagnostic oral glucose tolerance test (OGTT) without prior plasma or serum glucose screening. The one-step approach may be cost-effective in high-risk patients or populations (e.g., some Native-American groups).

Two-step approach: Perform an initial screening by measuring the plasma or serum glucose concentration 1 hour after a 50-g oral glucose load (glucose challenge test [GCT]) and perform a diagnostic oral glucose tolerance test on that subset of women exceeding the glucose threshold value on the glucose challenge test. When the two-step approach is employed, a glucose threshold value >140 mg/dL (7.8 mmol/L) identifies approximately 80% of women with gestational diabetes mellitus, and the yield is further increased to 90% by using a cutoff of >130 mg/dL (7.2 mmol/L).

With either approach, the diagnosis of gestational diabetes mellitus is based on an oral glucose tolerance test. Diagnostic criteria for the 100-g oral glucose tolerance test are shown in Table 1, below. Alternatively, the diagnosis can be made using a 75-g glucose load and the glucose threshold values listed for fasting, 1 hour, and 2 hours (Table 2, below); however, this test is not as well validated for detection of at-risk infants or mothers as the 100-g oral glucose tolerance test.

Gestational Diabetes Symptoms

Symptoms

Increased thirst
Increased urination
Weight loss in spite of increased appetite
Fatigue
Nausea and vomiting
Frequent infections including those of the bladder, vagina, and skin
Blurred vision
Note: Usually there are no symptoms.

Signs and tests

An oral glucose tolerance test between the 24th and 28th weeks of pregnancy is the main test for gestational diabetes.

Diabetes Prevention

If you look at the statistics for sugar consumption in the USA and the percentage of the population with Type II (Adult Onset) diabetes, you'll see they track pretty much one-for-one. A friend of mine has "the other kind" of diabetes--the kind you get through no fault of your own. He is amazed that non-diabetic people live a lifestyle that puts them at such high risk for a disease that complicates his life so much.

Type II (Adult Onset) diabetes is a sugar disease. You can control it, even prevent it. The keys are these:

Managing your insulin (controlling sugar sources)
Eating small portions instead of "filling up" at meals
Keeping your bodyfat percentage down (obesity is a high risk factor)

Let's take a closer look:

Diet

There is no one magic diet that works for everyone. Nor is there a single diet that works best for one individual over a long time. Pay attention to your genetics, and to your ethnic group's traditional foods. If you are African American, that does not mean overcooked vegetables or pork rinds. Such garbage came on the nutritional scene only recently, and is not a true ethnic food. The same is true for Italians who overdose on pepperoni pizza. Being Italian myself as, well as having enjoyed fantastic African cuisine, I can tell you there is a lot more to these diets than the recent introductions often associated with these cultural groups.

Except for Eskimos and a few other highly specialized ethnic groups, all diets must adhere to the same few macronutrient rules. For example:
Eliminate as many processed carbohydrates as possible.
Don't eat carbohydrates 2 hours before bedtime.
Balance your fat/carbos/protein in a roughly 30/40/30 ratio (this is a guideline, not a hard and fast rule--it doesn't work for everyone).
Eat at least 5 or 6 small meals a day.
Always eat a high-protein breakfast.
Did you know that the peanuts offered on airlines are LESS fattening than the fat-free pretzels? It's true. Stay away from fat-free foods--they make your insulin levels do a yo-yo, and that makes you put on fat. Yuck. Worse, it sets the stage for adult-onset diabetes.

Do NOT eat white flour, bleached flour, enriched flour, or any other kind of wheat flour that is not whole wheat. The glycemic effects of such flours will work against you. Eat whole grain flours, and try to get a variety. Amaranth and soy are two good flours. Eat oat groats instead of oatmeal. In short, get your grains in the least-processed form you can. This holds true for everyone, regardless of genetics (unless you have a malabsorption problem). This one "trick" will help you keep your insulin level on an even keel, and that is paramount to diabetes prevention and management.

What also holds true for everyone is: drink lots of water! Fill a gallon jug twice a day, and make sure you drink all of it. Once you get as lean as you want to be, cut back to a single gallon if you want to. For added fat loss, drink chilled (but not super cold) water. Sodas do not count. Such beverages are extremely unhealthy, for reasons I won't cover here. However, I will say that if you want to get osteoporosis, soft drinks are for you. Soft drinks make for soft bones.

Learn about insulin management. Make a trip to your library and get a book on the glycemic index. Also, look for Ann Louise Gittleman's book,"Your Body Knows Best." She has other books that are good, too. If you can't find it at your library, you can order it via this hyperlink: Your Body Knows Best, $5.59. Be careful on these diet books: most of them are completely wrong.

Make sure to eat at least 5 or 6 small meals a day, rather than one big one. Doing so levels out your insulin and your blood sugar. Forget about that full feeling. If you find yourself overeating out of anxiety or boredom, fix the underlying problem--don't add to it by poor eating!

Exercise

You need to build muscle and burn fat. How many lean, muscular people do you know with diabetes? OK, so listen! Live the lean lifestyle, and you will be way ahead in the diabetes game.

Walking is a great exercise. Do it every day, and you'll raise your metabolic rate, as well as level out your blood sugar. This means you will burn extra calories even while you are sitting in front of your computer or sleeping in your bed! Look at the ways you save calories, and then spend them instead. Take the stairs instead of the elevator. Park away from the door, instead of up close. Use a pushmower instead of a riding mower. Pay attention to what you do and think of how you can burn more calories while doing it.

Source: Article written by Mark Lamendola, Mindconnection.com - who is genetically at risk for developing diabetes.

Type 2 Diabetes Symptoms

Up to two-thirds of people with type 2 diabetes have no symptoms. If present, the most common ones are:

increased production of urine (the body is trying to get rid of the excess glucose in the urine)
unusual thirst
tiredness (because the glucose is "going to waste" and not being converted into energy)
loss of weight
increased appetite
feeling sick
blurred vision
infections such as thrush or irritation of the genitals
Some people simply feel a bit unwell or assume they are just ageing.

Signs and tests

Type 2 diabetes is diagnosed with the following blood tests:

Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions.
Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)
Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours.

Type 1 Diabetes Symptoms

Type 1 diabetes takes only a few weeks to develop. The initial symptoms are:

increased production of urine (because the body tries to get rid of the excess glucose in the urine, diluting it with water),
excessive thirst,
fatigue (because the glucose is not being converted into energy),
loss of weight,
increased appetite,
feeling sick,
blurred vision,
infections such as thrush or irritation of the genitals.
If type 1 diabetes is not treated at this stage, the body begins to produce chemicals called ketones that build up in the blood. This condition ? diabetic ketoacidosis ? causes additional symptoms:

vomiting,
stomach pain,
rapid breathing,
increased pulse rate,
sleepiness.
Without treatment, diabetic ketoacidosis can lead to coma or death.

Signs and tests

The following tests can be used to diagnose diabetes:

urinalysis shows glucose and ketone bodies in the urine, but a blood test is required for diagnosis
fasting blood glucose is 126 mg/dL or higher
random (nonfasting) blood glucose exceeds 200 mg/dL (this must be confimed with a fasting test)
insulin test (low or undetectable level of insulin)
C-peptide test (low or undetectable level of the protein C-peptide, a by-product of insulin production)

Tuesday, November 10, 2009

Types of Diabetes

The three main types of diabetes are

Type 1 diabetes
Type 2 diabetes
Gestational diabetes


Type 1 Diabetes

Type 1 diabetes is 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 diabetes, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live.

At present, scientists do not know exactly what causes the body's immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved. Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States. It 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 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 lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.

Type 2 Diabetes

The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. About 80 percent of people with type 2 diabetes are overweight.

Type 2 diabetes is increasingly being diagnosed in children and adolescents. However, nationally representative data on prevalence of type 2 diabetes in youth are not available.

When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons, the body cannot use the insulin effectively, a condition called insulin resistance. After several years, 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.

The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue or nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of wounds or sores. Some people have no symptoms.

Gestational Diabetes

Gestational diabetes develops only during pregnancy. Like type 2 diabetes, it occurs more often in African Americans, American Indians, Hispanic Americans, and among women with a family history of diabetes. Women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years.

Type 2 Diabetes Mellitus

Alternative names

Noninsulin-dependent diabetes mellitus; Diabetes - Type 2

Definition

Type 2 diabetes is a chronic, life-long disease that results when the body's insulin does not work effectively. Insulin is a hormone released by the pancreas in response to increased levels of blood sugar (glucose) in the blood.

Causes, incidence, and risk factors

Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is necessary for glucose to move from the blood to the inside of the cells.

Unless glucose gets into cells, the body cannot use it for energy. Excess glucose remains in the blood, and is then removed by the kidneys. The symptoms inlcude excessive thirst, frequent urination, hunger, and fatigue.

There are several types of diabetes:

Type 1 diabetes, which requires total insulin replacement in order to live because the body does not make adequate amounts
Type 2 diabetes, which is related to insulin resistance (lack of the ability of the body to respond to insulin appropriately) and is often accompanied by obesity and high cholesterol
Gestational diabetes, which occurs during pregnancy
Diabetes affects up to 6% of the population in the U.S. Type 2 diabetes accounts for 90% of all cases.

A main component of type 2 diabetes is "insulin resistance". This means that the insulin produced by your pancreas cannot connect with fat and muscle cells to let glucose inside and produce energy. This causes hyperglycemia (high blood glucose).

To compensate, the pancreas produces more insulin. The cells sense this flood of insulin and become even more resistant, resulting in a vicious cycle of high glucose levels and often high insulin levels.

Type 2 diabetes usually occurs gradually. Most people with type 2 diabetes are overweight at the time of diagnosis. However, the disease can also develop in lean people, especially if elderly.

Genetics play a large role in type 2 diabetes and family history is a risk factor. However, low activity level, poor diet, and excess body weight (especially around the waist) significantly increase your risk for type 2 diabetes.

Other risk factors include:

Race/ethnicity; African-Americans, Hispanic-Americans, and Native Americans all have high rates of diabetes
Age greater than 45 years
Previously identified impaired glucose tolerance by your doctor
High blood pressure
HDL cholesterol of less than 35 and/or triglyceride level of greater than 250
History of gestational diabetes
Symptoms

Often, people with type 2 diabetes have no symptoms at all. If you do have symptoms, they may include:

increased thirst
increased urination
increased appetite
fatigue
blurred vision
frequent and/or slow-healing infections (including bladder, vaginal, skin)
erectile dysfunction in men
Signs and tests

Type 2 diabetes is diagnosed with the following blood tests:

Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions.
Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)
Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours.
Treatment

The first goals are to eliminate the symptoms and stabilize your blood glucose levels. The ongoing goals are to prevent long-term complications and prolong your life. The primary treatment for type 2 diabetes is exercise and diet.

LEARN THESE SKILLS

You should learn basic diabetes management skills. They will help prevent complications and the need for medical care. These skills include:

How to test and record your blood glucose (see blood glucose monitoring).
What to eat and when.
How to take medications, if indicated.
How to recognize and treat low and high blood sugar.
How to handle sick days.
Where to buy diabetes supplies and how to store them.
It may take several months to learn the basic skills. Once your condition has stabilized, continue to educate yourself about the disease process, how to control and live with diabetes, and long-term complications of the disease. Over time, stay current on new research and treatment.

SELF-TESTING

Blood sugar testing, or self-monitoring of blood glucose, is done by checking the glucose content of a small drop of blood. Regular testing tells you how well diet, exercise, and medication are working together to control diabetes.

The results of the test can be used to adjust meals, activity, or medications to keep blood sugar levels in an appropriate range. Testing provides valuable information for the health care provider and identifies high and low blood sugar levels before serious problems develop.

When testing blood sugars yourself, a glucometer is used. A glucometer is a small device that provides an exact reading of blood glucose. A test strip is used to collect a small drop of blood, obtained by pricking the finger with a small, specially-designed needle (called a lancet).

The strip is then placed in the meter. Results are available within 30 to 45 seconds. A health care provider or diabetes educator will help set up an appropriate testing schedule for you. You will also be taught how to respond to different ranges of glucose values obtained when you self-test.

Tests are usually done before meals and at bedtime. More frequent testing may be indicated during illness or stress. Accurate record keeping of test results will make them more useful for planning how to best control your diabetes.

DIET AND WEIGHT CONTROL

Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. Your specific meal plans need to be tailored to your food habits and preferences. A registered dietitian can be helpful in determining your specific, individual dietary needs.

In type 2 diabetes, weight management and a well-balanced diet are important. Some people with type 2 diabetes can stop medications after intentional weight loss, although the diabetes is still present. Consultation with a registered dietitian is an invaluable planning tool.

REGULAR PHYSICAL ACTIVITY

Regular exercise is important for everyone, but especially if you have diabetes. Regular exercise helps control the amount of glucose in the blood. It also helps burn excess calories and fat to achieve optimal weight.

Exercise improves overall health by improving blood flow and blood pressure. It naturally decreases insulin resistance even without weight loss. Exercise also increases the body's energy level, lowers tension, and improves your ability to handle stress. Everyone should obtain medical approval before starting an exercise program, but this is especially important if you have diabetes.

The following should be considered:

Choose an enjoyable physical activity that is appropriate for the current fitness level.
Exercise every day, and at the same time of day, if possible.
Monitor blood glucose levels by home testing before and after exercise.
Carry food that contains a fast-acting carbohydrate in case blood glucose levels get too low during or after exercise.
Wear a diabetes identification bracelet and carry change for a phone call in case of emergency.
Drink extra fluids that do not contain sugar before, during and after exercise.
Changes in exercise intensity or duration may require modification of your diet or medication to keep blood glucose levels in an appropriate range.

MEDICATION

When you cannot achieve normal or near-normal blood glucose levels with diet and exercise, medication is added to the treatment plan. Your doctor will start you on oral (by mouth) medicines, such as:

Oral sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pancreas to make more insulin.
Biguanides (Metformin) tell the liver to decrease its production of glucose, which increases glucose levels in the blood stream.
Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract, thereby lowering the after-meal glucose levels.
Thiazolidinediones (such as rosiglitazone) help insulin work better at the cell site. In essence, they increase the cell's sensitivity (responsiveness) to insulin.
Meglitinides (including repaglinide and nateglinide) trigger the pancreas to make more insulin in response to how much glucose is in the blood.
If you continue to have poor blood glucose control despite lifestyle changes and using oral medicines, your doctor will prescribe insulin. Insulin may also be prescribed if you have had a bad reaction to oral medicines. Insulin must be injected under the skin using a syringe and cannot be taken by mouth.

Insulin preparations differ in how fast they start to work and how long they work. The health-care professional will determine the appropriate type of insulin to use and will counsel you on what time of day to use it.

More than one type may be mixed together in an injection to achieve the best control of blood glucose. The injections are needed, in general, from one to four times a day. You will be taught how to give yourself injections by your doctor or a diabetes educator referred by your doctor.

FOOT CARE

People with diabetes are prone to foot problems because of complications caused by damage to blood vessels and nerves and decreased ability to fight infection. Blood flow to the feet may become compromised and damage to the nerves may cause an injury to the foot to go unnoticed until infection develops. Death of skin and other tissue can occur. If left untreated, amputation of the affected foot may ultimately be necessary.

To prevent injury to the feet, diabetics should adopt a daily routine of checking and caring for the feet as follows:

Check your feet every day, and report sores or changes and signs of infection.
Wash feet every day with lukewarm water and mild soap, and dry them thoroughly.
Soften dry skin with lotion or petroleum jelly.
Protect feet with comfortable, well-fitting shoes.
Exercise daily to promote good circulation.
See a podiatrist for foot problems, or to have corns or calluses removed.
Remove shoes and socks during a visit to the health care provider to remind them to examine your feet.
Discontinue smoking because it worsens blood flow to the feet.

CONTINUING CARE

A person with type 2 diabetes should have a visit with a diabetes care provider every three months. A thorough three-month evaluation includes:

Glycosylated hemoglobin (HbA1c) is a weighted three-month average of what your blood glucose has been. This test measures how much glucose has been sticking to the red blood cells. It also indicates how much glucose has been sticking to other cells. A high HbA1c is an indicator of risk for long-term complications. Currently, the ADA recommends an HbA1c of less than 7% to protect oneself from complications. This test should be done every three months.
Blood pressure check.
Foot and skin examination.
Ophthalmoscopy examination.
Neurological examination.
The following evaluations should be done at least annually:

Random microalbumin (urine test for protein).
BUN and serum creatinine.
Serum cholesterol, HDL, and triglycerides.
ECG.
Dilated retinal exam.
Expectations (prognosis)

The risks of long-term complications from diabetes can be reduced. Those with the best control of blood glucose and blood pressure significantly reduce their risk of death, stroke, heart failure, and other complications. Reduction of HbA1c by even one percentage point can decrease your risk for complicatons by 25%.

Complications

Emergency complications include diabetic coma.

Long-term complications include:

diabetic retinopathy (eye disease)
diabetic nephropathy (kidney disease)
diabetic neuropathy (nerve damage)
peripheral vascular disease (damage to blood vessels/circulation)
high cholesterol, high blood pressure, atherosclerosis, and coronary artery disease
Calling your health care provider

Call your health care provider immediately if you have:

trembling
weakness
drowsiness
headache
confusion
dizziness
double vision
lack of coordination
These symptoms can rapidly progress to emergency conditions (such as convulsions, unconsciousness, or hypoglycemic coma).

Prevention

Everyone over 45 should have their blood glucose checked at least every three years. Regular testing of random blood glucose should begin at a younger age and be performed more often if you are at particular risk for diabetes.

Maintain a healthy body weight and keep an active lifestyle to help prevent the onset of type 2 diabetes.

Type 1 Diabetes Mellitus

Alternative names

Insulin-dependent diabetes mellitus; Juvenile onset diabetes; Diabetes - Type 1

Definition

Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas produces too little insulin to regulate blood sugar levels appropriately.

Causes, incidence, and risk factors

Diabetes is a life-long disease for which there is not yet a cure. There are several forms of diabetes, including:

Type 1 diabetes, often called juvenile or insulin-dependent diabetes
Type 2 diabetes, often called adult or non-insulin-dependent diabetes
Gestational diabetes, which occurs during pregnancy.
For all types of diabetes, the metabolism of carbohydrates (including sugars such as glucose), proteins, and fats is altered.

In type 1 diabetes, the beta cells of the pancreas produce little or no insulin, the hormone that allows glucose to enter body cells. Once glucose enters a cell, it is used as fuel.

Without adequate insulin, glucose builds up in the bloodstream instead of going into the cells. The body is unable to use this glucose for energy despite high levels in the bloodstream, leading to increased hunger. In addition, the high levels of glucose in the blood causes the patient to urinate more, which in turn causes excessive thirst. Within 5 to 10 years after diagnosis, the insulin-producing beta cells of the pancreas are completely destroyed, and no more insulin is produced.

Type 1 diabetes can occur at any age, but it usually starts in people younger than 30. Symptoms are usually severe and occur rapidly.

The exact cause of type 1 diabetes is not known. Type 1 diabetes accounts for 3% of all new cases of diabetes each year. There is 1 new case per every 7,000 children per year. New cases are less common among adults older than 20.

Symptoms

increased thirst
increased urination
weight loss despite increased appetite
nausea
vomiting
abdominal pain
fatigue
absence of menstruation
Signs and tests

The following tests can be used to diagnose diabetes:

urinalysis shows glucose and ketone bodies in the urine, but a blood test is required for diagnosis
fasting blood glucose is 126 mg/dL or higher
random (nonfasting) blood glucose exceeds 200 mg/dL (this must be confimed with a fasting test)
insulin test (low or undetectable level of insulin)
C-peptide test (low or undetectable level of the protein C-peptide, a by-product of insulin production)
Treatment

At diagnosis, the immediate goals of treatment are to treat diabetic ketoacidosis (also called DKA) and high blood glucose levels. Because of the sudden onset and severity of symptoms in type 1 diabetes, treatment for newly diagnosed people may involve hospitalization.

The long-term goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs.

These goals are accomplished through education, insulin use, meal planning and weight control, exercise, foot care, and careful self-testing of blood glucose levels.

INSULIN

Insulin lowers blood sugar by allowing it to leave the blood stream and enter cells. Everyone needs insulin. People with type I diabetes can't make their own insulin, and they must take insulin every day.

Insulin is injected under the skin using a syringe, or in some cases, an infusion pump delivers the insulin continuously. It is not available in an oral form.

Insulin preparations differ in how fast they start to work and how long they last. The health care professional reviews blood glucose levels to determine the appropriate type of insulin the person should use. More than one type of insulin may be mixed together in an injection to achieve the best control of blood glucose.

The injections are needed, in general, from 1 to 4 times a day. People are taught how to give insulin injections by their health care provider or a diabetes nurse educator. Initially, a child's injections may be given by a parent or other adult. By age 14, most children can be expected (but should not be required) to give their own injections.

DIET

Meal planning for type 1 diabetes requires consistency to allow food and insulin to work together to regulate blood glucose levels. If meals and insulin are out of balance, extreme variations in blood glucose can occur.

The American Diabetes Association and the American Dietetic Association has information for planning healthy, balanced meals. Consultation with a registered dietitian or nutrition counselor is an invaluable tool for meal planning and dietary control for diabetics.

PHYSICAL ACTIVITY

Regular exercise is especially important for the person with diabetes, as it helps control the amount of sugar in the blood and helps burn excess calories and fat to achieve optimal weight.

Before people with diabetes begin any exercise program, they should obtain medical approval. Type 1 diabetics must take special precautions before, during and after participation in intense physical activity or exercise.

SELF-TESTING

Blood glucose monitoring is done by checking the glucose content of a small drop of blood. The testing is done on a regular basis and will inform the person with diabetes how well diet, medication, and exercise are working together to control diabetes.

The results can be used to adjust meals, activity, or medications to keep blood-sugar levels within an appropriate range. It will provide valuable information for the health care provider to suggest changes to improve care and treatment. Testing will identify high and low blood-sugar levels before serious problems develop.

FOOT CARE

People with diabetes are prone to foot problems because of complications related to the illness. Diabetes causes damage to the blood vessels and nerves, which can result in a decreased ability to sense trauma or pressure on the foot. A foot injury could go unnoticed until severe infection develops.

Additionally, diabetes alters the bodies immune system, decreasing the body's ability to fight infection. Small infections can rapidly progress to death of the skin and other tissues, necessitating amputation of the affected limb.

To prevent injury to the feet, diabetics should adopt a daily foot care routine.

TREATING LOW BLOOD SUGAR

Low blood sugar, known as hypoglycemia, can occur in diabetics when they use too much insulin, exercise too much, or have not eaten enough food. Hypoglycemia can develop quickly in people with diabetes. Symptoms of low blood sugar typically appear when the sugar level falls below 70. Watch for weakness, shaking, sweating, headache, nervousness, and hunger.

If these symptoms occur and you have a blood sugar test kit available, do a blood sugar check. If the level is low, the person with diabetes should eat something with sugar: fruit juice, several teaspoons of sugar, a cup of skim milk, or regular soda. If you don't have a test kit handy, sugar should be eaten anyway - it can't hurt. Symptoms should subside within 15 minutes. If the symptoms don't subside, more sugar should be eaten and the sugar level tested again.

AFTER the symptoms subside, more substantial food can be eaten. Eat simple sugar FIRST to get the situation under control. Even if you or your child is hungry, "real" food should not be eaten until the sugar level comes up - real food won't produce enough sugar and takes too long to digest.

If you are a parent, relative, or friend of someone experiencing these symptoms, monitor the person closely. If symptoms become worse -- confusion, seizures, or unconsciousness -- give the person a shot of glucagon. If you don't have glucagon, call 911 immediately.

You should have some glucagon stored for emergencies. Make sure everyone in your home, as well as babysitters and caregivers, knows how to use it. Periodically remind everyone how to use it, and check the expiration date.

Don't panic. Glucagon works very fast -- usually within 15 minutes. While you are waiting for the person to revive, keep him on his side to prevent choking. If the person is not better in 15 minutes, call 911.

TREATING HIGH KETONES

When there is not enough insulin to move glucose into cells, glucose can build up in the blood. The body then looks for other forms of energy and uses fat as a fuel source. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous to body tissue. This condition is known as ketoacidosis.

You can check for ketones using a simple urine test available at pharmacies. This test should be performed every 4-6 hours anytime a person with diabetes is registering blood sugar above 240; sick; unusually thirsty or has a dry mouth; urinating frequently; or vomited

The warning signs that ketoacidosis is getting serious might include flushed face, dry skin and mouth, nausea or vomiting, stomach pain, deep, rapid breathing, or fruity breath odor.

If these symptoms occur, call the doctor or go to the emergency room right away. If left untreated, this condition will lead to coma and even death.

MONITORING

Visit your physician and/or diabetes educator at least 4 times a year.
Have your glycosylated hemoglobin (HbA1c) measured 2-4 times a year to evaluate your overall glucose control. (Ask your doctor how often you should be tested.)
Have your cholesterol and triglyceride levels and kidney function evaluated yearly.
Visit your ophthalmologist (preferably one that specializes in diabetic retinopathy) at least once a year, more frequently if signs of diabetic retinopathy develop.
Every 6 months have a thorough dental cleaning and examination. Inform your dentist and hygienist that you have diabetes.
Monitor your feet every day for early signs of injury or infection. Make sure your health care provider inspects your feet at each visit.
Stay up-to-date with all of your vaccinations (including pneumococcal), and get a flu shot every year in the fall.
EDUCATION

You are the most important person in managing your diabetes. Diabetes education is a crucial part of the treatment plan. Diabetes education basically involves learning how to live with your diabetes.

Knowledge of disease management is imperative to avoid developing short-term complications such as hypoglycemia and hyperglycemia and to delay or slow the onset of long-term complications of the disease such as diabetic retinopathy (eye disease) or nephropathy (kidney disease).

You should be knowledgeable about the basic principles of diabetes management. Basic "survival skills" include:

how to recognize and treat low blood sugar (hypoglycemia)
how to recognize and treat high blood sugar (hyperglycemia)
diabetes meal planning
how to administer insulin
how to monitor blood glucose and urine ketones
how to adjust insulin and/or food intake during exercise
how to handle sick days
where to buy diabetic supplies and how to store them
Expectations (prognosis)

The outcome for people with diabetes varies. Recent studies show that tight control of blood glucose can prevent or delay the progression of eye disease, kidney disease and nervous system disease that is caused by diabetes. However, complications may occur even when good diabetes control is achieved with insulin and diet.

Complications

EMERGENCY COMPLICATIONS:

DIABETIC KETOACIDOSIS
In a person with type 1 diabetes, the body will use fat as a fuel if insulin is not present. The by-products of fat metabolism are ketones. Ketones build up in the blood and "spill" over into the urine.

A condition called ketoacidosis develops when the blood is made acidic by the ketones.

HYPOGLYCEMIA
Hypoglycemia (low blood glucose) occurs when the balance between insulin, food intake, and exercise is disturbed. Symptoms of mild hypoglycemia include hunger, nervousness, and fast heart rate. More serious hypoglycemia can lead to confusion and even loss of consciousness. Loss of consciousness due to low blood sugar is called hypoglycemic coma.

LONG-TERM COMPLICATIONS:

People who have had diabetes for several years are likely to develop long-term complications, which can be minimized but not entirely eliminated by proper diabetic management:
VASCULAR DISEASE
By age 55, about 35% of men and women with type 1 diabetes have died from a heart attack compared to 8% of nondiabetic men and 4% of nondiabetic women.

People with type 1 diabetes are also at higher risk to develop blockages in the major arteries of the legs than nondiabetics. Lower the risk of vascular disease by aggressively treating cholesterol and blood pressure, exercising regularly, and avoiding or quitting tobacco products.

MICROVASCULAR DISEASE
Microvascular (small vessel) changes occur in capillaries of every organ of the body. There is a thickening of the wall of the small blood vessels. These changes are responsible for many of the diabetes complications.

EYE COMPLICATIONS
Changes in the small blood vessels of the retina (also known as diabetic retinopathy) predispose the diabetic to several eye disorders. After 15 years of diabetes, 80% of diabetics will have some diabetic retinopathy.

If bleeding and scarring has developed, a retinal detachment may occur, causing blindness. Vascular changes in the iris may cause obstruction of the flow of ocular fluid and cause glaucoma. Diabetics are also more likely than nondiabetics to develop cataracts.

DIABETIC NEPHROPATHY (kidney disease)
Kidney abnormalities may be noted early in the disease. Poorly controlled diabetes may accelerate the development of kidney failure. Urinary tract infections in diabetics tend to be more severe and may result in kidney damage.

Diabetics are more vulnerable to kidney damage from high blood pressure than nondiabetics.

DIABETIC NEUROPATHY(nerve damage)
People with diabetes may develop temporary or permanent damage to nerve tissue. Diabetic neuropathy is more likely to develop if blood glucose is poorly controlled. Some diabetics will not develop neuropathy, while others may develop this condition relatively early.

On average, symptoms such as numbness and tingling occur 10 to 20 years after diabetes has been diagnosed.

DIABETIC FOOT PROBLEMS
The feet of people with diabetes are very susceptible to infection and injury. Many diabetes-related hospital admissions are for foot problems, and a significant number of non-accident-related leg amputations are performed on diabetics.

Several foot problems are common in people with diabetes, including skin changes (loss of hair; loss of ability to sweat; and dry, cracked skin), arterial insufficiency (impaired blood supply to feet), neuropathy, and specific foot deformities (hallux valgus, bunion, hammertoe, and calluses).

SKIN AND MUCUS MEMBRANE PROBLEMS
People with diabetes are more likely than nondiabetics to develop infections. Hyperglycemia (high blood sugar) predisposes diabetics to fungal infections of the skin, nails, and female genital tract and to urinary tract infection.

Calling your health care provider

Medical follow-up for a person newly diagnosed with type 1 diabetes should probably occur weekly until good control of blood glucose is achieved. The health care provider will want to review results of home glucose monitoring and urine testing, and a diary of meals, snacks, and insulin injections.

As the disease becomes more stable, follow-up visits will be less frequent. Periodic evaluation is very important for the evaluation of long-term complications associated with diabetes.

Call your health care provider or go to the emergency room if symptoms of ketoacidosis are present:

increased thirst and urination
nausea
deep and rapid breathing
abdominal pain
sweet-smelling breath
loss of consciousness (This may occur in insulin dependent diabetics when a dose of insulin is missed, or if illness or infection is present.)
Go to the emergency room or call the local emergency number (such as 911) if symptoms of severe hypoglycemia or insulin reaction are present:

trembling
weakness
drowsiness
headache
confusion
dizziness
double vision
lack of coordination
convulsions or unconsciousness
Early signs of hypoglycemia may be treated at home by eating sugar or candy or injecting glucagon. If the signs of hypoglycemia are not relieved by the above action or if blood glucose levels remain below 60 mg/dL go to the emergency room.

Type 2 Diabetes Diet

We are all advised to live healthier lifestyles ? eat more healthily, lose weight, exercise more, stop smoking? and so on. For people who have Type 2 diabetes this advice forms an important part of the management plan. You may be surprised to learn that you actually have the potential to reduce the harmful effects of diabetes, purely by making some changes to your lifestyle.

Here, we focus on the role of diet and exercise in the management of Type 2 diabetes. In particular, we will take a look at the way in which diet and exercise can improve:

Blood glucose levels
Blood fats
Blood pressure
Blood glucose levels
Blood glucose levels are mainly kept in check by insulin. Type 2 diabetes usually occurs as the result of a combination of problems with insulin activity (insulin resistance) and insulin secretion. Diet and exercise can help to combat both of these problems.

Insulin resistance
The majority of people with Type 2 diabetes are ?insulin resistant?. This means that the insulin that is produced does not work very efficiently and large amounts are needed to keep blood glucose levels down. If the beta cells are under too much strain they may not be able to produce these large amounts of insulin; the blood glucose levels rise and diabetes results. People who are overweight and/or inactive tend to be more insulin resistant than lean people who exercise regularly.

The opposite of insulin resistance is insulin sensitivity. The more sensitive the body is to insulin, the less insulin is needed to control blood glucose levels.

The body can be made more sensitive to its insulin in a number of ways:

By increasing the level of daily activity
By reducing the number of calories that are eaten and losing weight
With drugs
A few simple changes to your eating and exercise habits can make all the difference.

If insulin sensitivity is increased through weight loss and an increase in activity level then less insulin is needed to keep blood glucose levels controlled. If less insulin is needed, then less strain is put on the beta cells.

Food, blood glucose and insulin
Carbohydrate foods have the greatest direct effect on blood glucose levels. Carbohydrates are broken down into glucose by digestive enzymes. The glucose is then absorbed from the intestine into the bloodstream (usually 1 ? 2 hours after eating) and this causes the blood glucose level to rise after a meal. Insulin is needed so that the body?s cells can take this glucose from the bloodstream and either use it for energy or store it for later. People who do not have diabetes will produce just the right amount of insulin to cope with the rise in blood glucose that occurs after a meal. Insulin on demand allows the person without diabetes to keep blood glucose levels within the normal range, even after a meal rich in carbohydrates.

If you have Type 2 diabetes then your body no longer produces enough insulin on demand to keep blood glucose levels within the normal range. Many people with Type 2 diabetes do not produce enough insulin to cope with the sharp rise in blood glucose that happens after a meal.

Choosing food types that are more slowly digested can reduce the ?post-meal spike? in blood glucose, which in turn reduces the demand on the beta cells for insulin.

So, a three-pronged attack on the situation can help you to control your blood glucose levels:

Increase your daily level of activity ? this helps to reduce insulin resistance
Reduce you daily calorie intake and try to lose some weight ? this helps to reduce insulin resistance
Choose carbohydrate foods that are digested more slowly ? this takes the strain off the beta cells after a meal.
Blood fats
Many people with Type 2 diabetes have unhealthy levels of blood fats ? this is commonly referred to as an unhealthy ?lipid profile?. Too much of the wrong types of fat in the blood increases the risk of heart disease and circulation problems. Another important aim of diet and exercise in the management of your diabetes will therefore be to help keep your blood lipid levels normal.

Reducing your intake of saturated fat and not drinking too much alcohol can help to bring down levels of cholesterol and triglycerides in the blood.

Do note that, in addition to healthy eating, regular exercise can also help to improve your blood lipid profile.

Blood pressure
Type 2 diabetes is often accompanied by high blood pressure and this increases the risk of diabetic eye and kidney damage, as well as heart disease and circulation problems. Regular exercise, eating a low-fat and low-salt diet, and reducing alcohol intake can all help to lower blood pressure.

Different food types
You will need to learn about different food types so that you can make healthy choices when it comes to meal planning.

The overall effect of a meal on the blood glucose level will depend on the different types of foods making up the meal. Carbohydrate foods have the greatest effects on blood glucose levels because they are mostly digested to glucose, which is absorbed from the intestine straight into the bloodstream. However, proteins and fats in the diet do affect blood glucose levels too.

You will need to pay attention to the amount and type of fat that you eat. Fatty foods tend to be high in calories and eating too much of some types of fat can raise your blood fat levels, increasing the risk of heart disease and circulation problems.

Glycaemic Index
Different types of carbohydrate foods are digested at different rates and therefore have different effects in terms of raising the blood glucose level after a meal. Some foods are quite rapidly digested to glucose (e.g. cornflakes), whilst others take longer for the glucose to hit the bloodstream (e.g. All-BranTM). The effect of different carbohydrate foods on blood glucose levels has been quantified by the Glycaemic Index (GI). Foods with a low GI cause less of a spike in post-meal blood glucose than those with a high GI.

Sugar
It is still widely believed amongst the general population that people with diabetes should avoid eating sugar because it causes a rapid increase in blood glucose levels. This is not true! Table sugar, which we sprinkle on our cornflakes, actually causes less of a spike in blood glucose than the cornflakes themselves. Sucrose*, surprisingly, has a lower GI than cornflakes.

As part of healthy eating, we are all advised to cut down on sugar ? this is because it has little nutritional value, it does little to satisfy the appetite and it?s a source of ?empty calories?.

*Important note:

Table sugar is not the same as glucose. Table sugar is called sucrose and is a disaccharide ? it contains two sugar molecules: one fructose and one glucose. Table sugar needs to be broken down by digestive enzymes before the fructose and glucose can be absorbed. Glucose is absorbed quickly because it does not need to be broken down (digested) first.

Fats
The most significant effect of fat on blood glucose levels is probably to slow down the rise in blood glucose after a meal. Fat delays the rate at which the stomach empties ? this has the knock-on effect of slowing down the absorption of glucose from digested carbohydrate foods. You might think that this is a good thing, but remember that a high-fat diet is not necessarily a healthy diet.

There are different types of fats ? some can be beneficial to our health, but others can increase the risk of high blood pressure and heart disease. Too much saturated fat and cholesterol in the diet can result in unhealthy levels of blood fats. However, monounsaturated fats may improve your lipid profile.

Protein
Excess protein in the diet that is not needed by the body is converted to glucose by the liver. This means that consuming large amounts of protein can result in an increase in blood glucose levels several hours after eating.

Currently there is no strong evidence that a high protein diet is particularly beneficial for people with diabetes. Remember that animal sources of protein - meat and dairy products - are high in saturated fat.

Putting the theory into practice
So far, we have looked at the different ways in which diet and exercise can help you to manage your diabetes. This is all well and good ? but how do you actually go about using this information? There is a lot to consider and you may well be feeling totally overwhelmed by it all. So where do you start?

Talk to your dietitian. Together you should be able to work out a food plan that is suitable for you and takes into account your tastes and lifestyle, in addition to financial and cultural considerations.

Look at your usual eating and exercising patterns and see where you could make small changes for the better. Set yourself achievable targets.

Use blood glucose monitoring to find out whether your diet and exercise approach is working; make a note in your diary of the changes you made and learn from experience. The most informative times to test are first thing in the morning, before eating and 1 ? 2 hours after your meal.

If you are taking tablets to help control your blood glucose level then you will need to eat regular meals and make sure that you take your tablets at the times prescribed. Remember, your tablets will only be successful in controlling your diabetes if you pay attention to your diet and engage in regular exercise.

If you are injecting insulin to help control your blood glucose levels then you should also look at the principles of dietary management in Type 1 diabetes ? this will help you to understand more about the relationship between your blood glucose levels and the food that you eat, and the insulin that you inject.

Summary
Learn about different food types and eat a healthy, nutritious diet
Consider what you eat and how it might affect your blood glucose level ? learn about the effects of different types and amounts of food on YOUR blood glucose level using blood glucose monitoring
Use a calorie counter, or similar book, to assess the carbohydrate, fat and protein content of foods
Use food labels
Use the Glycaemic Index
Cut down on saturated fats
Cut down on alcohol and salt, particularly if you have high blood pressure
Increase your level of activity
Important:

If you take certain tablets or have insulin injections?

An additional role of diet in managing diabetes is preventing low blood glucose levels (hypoglycaemia). This is particularly important if you take tablets that increase your insulin production, or if you have insulin injections.

Some insulin and tablet regimens require you to have snacks in between meals in order to prevent hypoglycaemia. Snacks are not always necessary though, so check with your doctor and/or dietitian to see if you need to snack between meals.

Delayed or missed meals are probably the most common cause of hypoglycaemia. Take steps to avoid low blood glucose levels if you know that you are not going to be able to eat your usual meal. Have an extra snack to keep you going and keep an eye on your blood glucose level.

A bedtime snack is, however, essential for all people who have insulin injections. This ensures that blood glucose levels don?t fall too low during the night.

Snacks are also very important before exercising, especially if the activity does not form part of your regular daily routine. This is to prevent exercise-induced hypoglycaemia.

Diabetes Diet

Definition

Specific diabetic dietary guidelines have been developed by the American Diabetes Association and the American Dietetic Association to improve the management of diabetes.

Key principles are to:

Achieve weight control through reducing calories
Reduce intake of dietary fat (specifically saturated fat)
Individualize guidelines for carbohydrates based on the type of diabetes you have and the control of your blood sugar levels.
Function

There are two primary types of diabetes and the nutritional goals for each are different.

With type 1 diabetes, studies show that total carbohydrate has the most effect on the amount of insulin needed and maintaining blood sugar control. There is a delicate balance of carbohydrate intake, insulin, and physical activity that is necessary for optimal blood levels of a sugar called glucose. If these components are not in balance, there can be wide fluctuations, from too high to too low, in blood glucose levels. For those with type 1 diabetes, on a fixed dose of insulin, the carbohydrate content of meals and snacks should be consistent from day to day.

For children with type 1 diabetes, weight and growth patterns are a useful way to determine if the child's intake is adequate. Try not to withhold food or give food when a child is not hungry. Insulin dosing and scheduling should be based on a child's usual eating and exercise habits.

With type 2 diabetes, the main focus is on weight control, because 80% to 90% of people with this disease are overweight. A meal plan, with reduced calories, even distribution of carbohydrates, and replacement of some carbohydrate with healthier monounsaturated fats helps improve blood glucose levels. Examples of foods high in monounsaturated fat include peanut or almond butter, almonds, walnuts, and other nuts. These can be substituted for carbohydrates, but portions should be small because these foods are high in calories.

In many cases, moderate weight loss and increased physical activity can control type 2 diabetes. Some people will need to take oral medications or insulin in addition to lifestyle changes.

Children with type 2 diabetes present special challenges. Meal plans should be recalculated often to account for the child's change in calorie requirements as he or she grows. Three smaller meals and 3 snacks are often required to meet calorie needs. Changes in eating habits and increased physical activity help reduce insulin resistance and improve blood sugar control. When at parties or during holidays, sugar-containing foods can still be eaten, but your child should have fewer carbohydrates on that day. For example, if birthday cake, Halloween candy, or other sweets are eaten, the usual daily amount of potatoes, pasta, or rice should be eliminated. This substitution helps keep calories and carbohydrates in better balance.

For children with either type of diabetes, special occasions (like birthdays or Halloween) require additional planning because of the sweets that abound.

Recommendations

Reduce the amount of dietary fat. The current American Diabetes association guidelines advise that less than 7-10% of calories should come from saturated fat. These are the fats that raise LDL ("bad") cholesterol. Dietary cholesterol should be less than 200-300 mg per day. Additionally, intake of trans-unsaturated fats should be minimized. These are better known as partially hydrogenated oils. Reducing fat intake may help contribute to modest weight loss.

Keep protein intake in the range of 15-20% of total calories. Choices low in fat are recommended such as nonfat dairy products, legumes, skinless poultry, fish and lean meats. To keep the cholesterol content in range, approximately 6 ounces of protein per day is recommended. This is about the size of 2 decks of cards.

Carbohydrate choices should come from whole grains breads, cereals, pasta, brown rice, beans, fruits and vegetables. Increasing dietary fiber is a general guideline for the entire population rather than specifically for people with diabetes. Portions and type of carbohydrate affect calories and is reflected by weight and blood glucose control. Learning to read labels for total carbohydrate rather than sugar provides the best information for blood sugar control.

Limit sources of high calorie and low nutritional value foods, including those with a high content of sugars. Sugar-containing foods should be substituted for other carbohydrate sources (such as potatoes) instead of just adding them on to the meal.

A registered dietitian can help you best decide how to balance your diet with carbohydrates, protein and fat.

Diabetes Food and Meal Planning

Because food intake affects the body's need for insulin and insulin's ability to lower blood sugar, diet is the cornerstone of diabetes treatment. Today, diabetes experts no longer recommend a single meal plan for all people with diabetes. Instead, they recommend meal plans that are flexible and take into account a person's lifestyle and particular health needs. The American Diabetes Association recommends that people with diabetes consult a registered dietician to design a meal plan.

Food and Meal Planning

Selecting Foods for a Healthy Meal Plan

By following the government's Dietary Guidelines for Americans, you can promote your health and reduce your risk for chronic diseases such as heart disease, certain types of cancer, diabetes, stroke, and osteoporosis. These diseases are leading causes of death and disability among Americans. Good diets can also reduce major risk factors for chronic disease-such as obesity, high blood pressure, and high blood cholesterol. Your food choices, your lifestyle, your environment, and your family history all affect your well-being. It is important for everyone to follow the 10 Dietary Guidelines listed below. If you are at higher risk of having a chronic disease, it is especially important.

The Dietary Guidelines for Americans include the following:

AIM FOR FITNESS . . .

--Aim for a healthy weight.
--Be physically active each day.

BUILD A HEALTHY BASE . . .

--Let the Pyramid guide your food choices.
--Choose a variety of grains daily, especially whole grains.
--Choose a variety of fruits and vegetables daily.
--Keep food safe to eat.

CHOOSE SENSIBLY . . .

--Choose a diet that is low in saturated fat and cholesterol and moderate in total fat.
--Choose beverages and foods to moderate your intake of sugars.
--Choose and prepare foods with less salt.
--If you drink alcoholic beverages, do so in moderation.

Some people with diabetes use the Exchange Lists for Meal Planning. This system, established by the American Dietetic and American Diabetes associations, separates foods into six categories based on their nutritional makeup. People following this plan choose a set number of servings from each category daily, depending on their nutritional needs.

The Food Guide Pyramid

The Food Guide Pyramid can help you put the Dietary Guidelines into action. The pyramid illustrates the research-based food guidance developed by the U.S. Department of Agriculture and supported by the Department of Health and Human Services. It is based on USDA's research on what foods Americans eat, what nutrients are in these foods, and how to make the best food choices to promote good health. It outlines what to eat each day, but it is not a rigid prescription. You can use it as a general guide in choosing a healthful diet that is right for you. The pyramid calls for eating a variety of foods to get the nutrients you need, and, at the same time, the right amount of calories to maintain a healthy weight.

Using the food label to help with food choices

Under regulations from the Food and Drug Administration of the Department of Health and Human Services and the Food Safety and Inspection Service of the U.S. Department of Agriculture, the food label offers more complete, useful and accurate nutrition information than ever before.

With today's food labels, consumers get

--nutrition information about almost every food in the grocery store
--distinctive, easy-to-read formats that enable consumers to more quickly find the information they need to make healthful food choices
--information on the amount per serving of saturated fat, cholesterol, dietary fiber, and other nutrients of major health concern
--nutrient reference values, expressed as % Daily Values, that help consumers see how a food fits into an overall daily diet
--uniform definitions for terms that describe a food's nutrient content--such as "light," "low-fat," and "high-fiber"--to ensure that such terms mean the same for any product on which they appear
--claims about the relationship between a nutrient or food and a disease or health-related condition, such as calcium and osteoporosis, and fat and cancer. These are helpful for people who are concerned about eating foods that may help keep them healthier longer.
--standardized serving sizes that make nutritional comparisons of similar products easier
--declaration of total percentage of juice in juice drinks. This enables consumers to know exactly how much juice is in a product.

Begin with the Nutrition Facts panel, usually on the side or back of the package. The Nutrition Facts panel has two parts: The main or top section, which contains product-specific information (serving size, calories, and nutrient information) that varies with each food product; and the bottom part, which contains a footnote. This footnote is only on larger packages and provides general dietary information about important nutrients.

Several features of the Nutrition Panel help people with diabetes manage their diets. First of all, serving sizes now are more uniform among similar products and reflect the amounts people actually eat. The similarity makes it easier to compare the nutritional qualities of related foods. People who use the Exchange Lists should be aware that the serving size on the label may not be the same as that in the Exchange Lists. For example, the label serving size for orange juice is 8 fluid ounces (240 milliliters). In the exchange lists, the serving size is 4 ounces (one-half cup) or 120 mL. So, a person who drinks one cup of orange juice has used two fruit exchanges.

The label also gives grams of total carbohydrate, protein and fat, which can be used for carbohydrate counting. The values listed for total carbohydrates include all carbohydrates, including dietary fiber and sugars listed below it. Not singled out is complex carbohydrates, such as starches. The sugars include naturally present sugars, such as lactose in milk and fructose in fruits, and those added to the food, such as table sugar, corn syrup, and dextrose. The listing of grams of protein also is helpful for those restricting their protein intake, either to reduce their risk of kidney disease or to manage the kidney disease they have developed.

Elsewhere on the label, consumers may find claims about the food's nutritional benefits. These claims signal that the food contains desirable levels of certain nutrients. Some claims, such as "low fat," "no saturated fat," and "high fiber," describe nutrient levels. Some of these are particularly interesting to people with diabetes because they highlight foods containing nutrients at beneficial levels.

Other claims, called health claims, show a relationship between a nutrient or food and a disease or health condition. FDA has authorized a number of claims, which are based on significant scientific agreement. Three claims that relate to heart disease are of particular interest to people with diabetes:

--A diet low in saturated fat and cholesterol may help reduce the risk of coronary heart disease.
--A diet rich in fruits, vegetables and grain products that contain fiber, particularly soluble fiber, and are low in saturated fat and cholesterol may help reduce the risk of coronary heart disease.
--Soluble fiber from whole oats, as part of a diet low in saturated fat and cholesterol, may help reduce the risk of coronary heart disease.

Nutrient and health claims can be used only under certain circumstances, such as when the food contains appropriate levels of the stated nutrients.

Overweight, Obesity, and Weight-Loss

More than 60 percent of U.S. adults are either overweight or obese, according to the Centers for Disease Control and Prevention (CDC). While the number of overweight people has been slowly climbing since the 1980s, the number of obese adults has nearly doubled since then.

Excess weight and physical inactivity account for more than 300,000 premature deaths each year in the United States, second only to deaths related to smoking, says the CDC. People who are overweight or obese are more likely to develop heart disease, stroke, high blood pressure, diabetes, gallbladder disease and joint pain caused by excess uric acid (gout). Excess weight can also cause interrupted breathing during sleep (sleep apnea) and wearing away of the joints (osteoarthritis).

To address the public health epidemic of being overweight or obese, former Surgeon General David Satcher issued a "call to action" in December 2001. Satcher's report, The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity, outlined strategies that communities can use in helping to address the problems. Those options included requiring physical education at all school grades, providing more healthy food options on school campuses, and providing safe and accessible recreational facilities for residents of all ages.

Dietary Supplements

Congress defined the term "dietary supplement" in the Dietary Supplement Health and Education Act (DSHEA) of 1994. A dietary supplement is a product taken by mouth that contains a "dietary ingredient" intended to supplement the diet. The "dietary ingredients" in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. Dietary supplements can also be extracts or concentrates, and may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders. They can also be in other forms, such as a bar, but if they are, information on their label must not represent the product as a conventional food or a sole item of a meal or diet. Whatever their form may be, DSHEA places dietary supplements in a special category under the general umbrella of "foods," not drugs, and requires that every supplement be labeled a dietary supplement.

In October 1994, the Dietary Supplement Health and Education Act (DSHEA) was signed into law by President Clinton. Before this time, dietary supplements were subject to the same regulatory requirements as were other foods. This new law, which amended the Federal Food, Drug, and Cosmetic Act, created a new regulatory framework for the safety and labeling of dietary supplements.

Under DSHEA, a firm is responsible for determining that the dietary supplements it manufactures or distributes are safe and that any representations or claims made about them are substantiated by adequate evidence to show that they are not false or misleading. This means that dietary supplements do not need approval from FDA before they are marketed. Except in the case of a new dietary ingredient, where pre-market review for safety data and other information is required by law, a firm does not have to provide FDA with the evidence it relies on to substantiate safety or effectiveness before or after it markets its products.

Also, manufacturers do not need to register themselves nor their dietary supplement products with FDA before producing or selling them. Currently, there are no FDA regulations that are specific to dietary supplements that establish a minimum standard of practice for manufacturing dietary supplements. However, FDA intends to issue regulations on good manufacturing practices that will focus on practices that ensure the identity, purity, quality, strength and composition of dietary supplements. At present, the manufacturer is responsible for establishing its own manufacturing practice guidelines to ensure that the dietary supplements it produces are safe and contain the ingredients listed on the label.

People with diabetes should be sure to consult a doctor or pharmacist before purchasing or taking any supplement. Many supplements contain active ingredients that have strong biological effects and their safety is not always assured in all users. Other supplements may interact with prescription and over-the-counter medicines. By taking these products, you may be placing yourself at risk.

Tuesday, August 18, 2009

DIABETES





What Is Diabetes.

Diabetes is the critical mildew caused by the genetic people: the luck of building the mildew of the pancreas. If your family is unprotected to the disease, review this essay to acknowledge symptoms of diabetes as shortly as possible.

The sort we diabetes

Type we is great well known as insulin-dependent diabetes mellitus (IDDM). It is rebate usual to the USA yet is the most critical as great as customarily develops inside of the couple of days or weeks. In DID, miss of insulin ensuing from the drop of beta cells. Symptoms compared with DID have been so graphic which they frequency leave any disbelief of diagnosis. They have been as follows:

Polyurie: urinate mostly as great as in vast quantities is the classical pointer of diabetes, as the physique liquid rushes by the kidney to intermix the tall levels of sugarine in the urine.

Polydipsie: An surprising lust is the full of illness outcome of as great revisit urination: the body, it shows the detriment of fluids to be replaced. Dehydration in the destiny begin if the condition is not taken sooner.

Polyphagia: This feeling of impassioned craving stems from the idea which the physique dies of craving since glucose is not reaching the cells to yield desperately indispensable energy.

A quick weight loss: Most Type we patients have been during or subsequent their preferred weight. When starts DID, May unexpected they remove some-more weight up to fifteen pounds in the singular week even if they May some-more than sufficient to eat as great as have the great appetite. The miss of insulin equates to which the calories in the form of glucose, have been sent by the urine as great as the physique starts to bake fat reserves.

FASTING PLASMA GLUCOSE (FPG) TEST:- The FPG exam has turn the singular of the most renouned diabetes tests. The categorical obstacle with the FPG exam is which it is not befitting to exam for gestational diabetes (a form of diabetes which develops during pregnancy). However, if we have been not profound the chances have been which your alloy will have use of this exam to have their diagnosis.
To proceed we will be scheduled in for the FPG test. Your alloy will need we to eat zero for during slightest 8 hours before to the test. During the exam they will take the red blood representation as great as magnitude your red blood glucose levels. They will afterwards break down in to parts the red blood representation as great as diagnose we formed upon the following rules:

- A red blood sugarine spin of 99 milligrams per decilitre (mg/dL) or rebate = Normal.
- A red blood sugarine spin of in between 100 mg/dL as great as 125 mg/dL = Impaired Fasting Glucose (a form of pre-diabetes which if left untreated can climb in to sort 2 diabetes).
- A red blood sugarine spin of 126 mg/dL or larger = Type 1 or sort 2 diabetes. In this e.g. we will be since an additional FPG for accuracy. If both FPGs indicate which we have diabetes your alloy will examine serve as great as diagnose we with sort 1 or sort 2 diabetes

The doubts of diabetes approach down upon their list of dreaded diseases with Cancer commanding the list as great as Heart mildew entrance in the tighten next. The fears of the people were utterly impractical with the lot of them fearing craft crashes as great as shark bites blissfully unknowingly of the threats they run when it cones to diabetes.

49% of the people fright cancer some-more than they do any additional disease. Only 6% feared or unequivocally were wakeful of the threats of diabetes. This is notwithstanding 10% of the race being diagnose with the small spin of red blood sugarine troubles during their lives as great as being insist the risk of the mildew perceptible itself.

Among the people polled 4% feared shark attacks some-more than something else, 13% feared lizard bites as great as 8% were aroused of spider attacks. When ask about diabetes they were during the detriment for difference as great as never knew anything about the disease. They were subsequent the feeling which diabetes is the mildew the singular is innate with genetic they believe. So if they do not have it they will not get it. Nothing is additional from the reality. Diabetes is the unequivocally genuine risk with outcome which operation from kidney failure, heart disaster as great as the lot of some-more complications which embody corner as great as haughtiness pains.

Health check experts around the universe have been of the unanimous perspective which if the singular leads the full of illness lifestyle with plenty practice they can equivocate diabetes the most glorious approach advice.

Diabetes Basics - What is Diabetes?

Diabetes is a chronic disease that affects as many as 16 million Americans. For reasons that are not yet clear, diabetes is increasing in our population to the point where public health authorities are calling diabetes an "epidemic" that requires urgent attention.

Of the 16 million people with diabetes, about one-third of them don't even know they have it. Every year, 800,000 additional cases are diagnosed. It affects over six percent of the population now, and it is projected that nearly nine percent of all Americans will have diabetes by the year 2025. Health care costs for diabetes are estimated to be nearly $100 billion per year in the US.

People with diabetes are unable to use the glucose in their food for energy. The glucose accumulates in the bloodstream, where it can damage the heart, kidneys, eyes and nerves. Left untreated, diabetes can develop devastating complications. It is one of the leading causes of death and disability in the United States.

However, the good news is that with proper care, people with diabetes can lead normal, satisfying lives. Much of this care is "self-managed," meaning that if you have this condition, you must take day-to-day responsibility for your own care.

Most important to managing the disease is to know as much about it as you can. The first thing to know is what kind of diabetes you have. There are three types:

•Type 1 diabetes
•Type 2 diabetes
•Gestational diabetes


Diabetes Basics - Diabetes Symptoms

Type 1 Diabetes Symptoms

The symptoms of Type I diabetes often come on suddenly and very severely. They include:

•being exceptionally thirsty
•dry mouth
•the need to urinate often
•weight loss (even though you may be hungry and eating well)
•feeling weak and tired
•blurry vision


Type 2 Diabetes Symptoms

Sometimes, people with Type II diabetes don't notice any symptoms or the symptoms are experienced gradually. They include:

•blurry vision
•cuts or sores that are slow to heal
•itchy skin, yeast infections
•increased thirst
•dry mouth
•need to urinate often
•leg pain


Diabetes Basics - Diagnosis

The only way you can be sure you have diabetes is by getting a test. The American Diabetes Association (ADA) now recommends that everyone over age 45 should have a fasting plasma glucose test. If test results are normal, the test should be repeated every three years. If you have risk factors for diabetes, you should be tested at a younger age and more often. The high risk factors include:


•Being more than 20 percent above your ideal body weight or having a body mass index (BMI) of greater than or equal to 27. The BMI is the ratio of weight in kilograms to height in meters squared. Your doctor can give you information on your BMI.

•Calculate Your Body Mass Index.

•Having a mother, father, brother or sister with diabetes.

•Being African American, Alaska Native, Pacific Islander American, Hispanic, Native or Asian American.

•Giving birth to a baby weighing more than 9 lbs or having diabetes during pregnancy (gestational diabetes).

•Having an HDL cholesterol level less than 35 mg/dL (HDL is the 'good' cholesterol) or trigylcerides (certain kinds of body fat) greater than 250 mg/dL.

•Having blood pressure at or above 140/90 millimeters of mercury (mmHg).

•Having abnormal glucose levels when previously tested for diabetes.

Fasting Plasma Glucose

This is the preferred test for diabetes. To have this test, you have to fast at least eight hours or overnight. You will have a blood sample drawn and examined for glucose. Most people have a level between 70 and 110 milligrams of glucose per deciliter of blood. A level of 126 mg/dl or higher on two tests given on two different days confirms a diagnosis of diabetes. (Previously a level of 140 mg/dl or higher was used to diagnose diabetes, but in 1997, the guidelines were revised because by the time a person got a diagnoses of diabetes with a level of 140 mg/dl, serious damage to the body had often already occurred. By lowering the diagnostic levels to 126 mg/dl, early control of the disease can begin and risk of complications is lower.)


Random Blood Glucose Test

You don't have to fast to have this test, which is sometimes used if symptoms are present. Blood samples are taken shortly after eating or drinking. A blood glucose level of 200 mg/dl or higher points to diabetes, but it must be confirmed on another day with a fasting plasma glucose, an oral glucose tolerance test or another random blood glucose of over 200.


Oral Glucose Tolerance Test

For this test you have to fast at least eight hours and not have smoked or drank coffee. Your fasting plasma glucose is tested from a blood sample. After the test you will be asked to drink a sweet glucose syrup and then your glucose level will be measured from a blood sample taken two hours after you drink the liquid. There can be up to four blood samples taken to measure the blood glucose level. The American Diabetes Association expert committee recommends that this test be eliminated because it is a difficult and time-consuming test.


Glucose Challenge

This is a test your doctor may give you to see if you have gestational diabetes, diabetes developed during pregnancy. You may be given this test if you are age 25 or older, are overweight, have a close relative with diabetes or if you are Hispanic, Native American, Asian or African American or a Pacific Islander. This test is given between the 24th and 28th weeks of pregnancy. You will be given a glucose drink and if an hour later, your glucose is 140 mg/dl or higher, your doctor may suspect gestational diabetes. You may then be given an oral glucose tolerance test.

Impaired Fasting Glucose

Impaired fasting glucose is a new diagnostic category. If your blood sugar is measured between 110 and 125 mg/dL, it means you have impaired fasting glucose. This means your blood sugar is greater than normal, but less than the level of a person diagnosed with diabetes. It's thought that around 13.4 million adults, about 7 percent of the US population, have impaired fasting glucose. It's suspected that some people with impaired fasting glucose go on to develop diabetes. Talk to your doctor to see if exercise and eating a healthy diet will bring your blood sugar closer to normal.


Diabetes Basics - Complications of Diabetes

Heart Disease and Stroke Diabetic Kidney Disease Hypertension and Diabetic Kidney Disease Diabetic Eye Disease Diabetic Neuropathy Gastroparesis Diffuse Neuropathy
Both Type 1 and Type 2 diabetes are associated with long-term complications that threaten life and the quality of life. The disease is the leading cause of adult blindness, end-stage kidney disease(ESRD) and amputations (as a result of nerve disease).

People with diabetes are two to four times more likely to have coronary heart disease and stroke than people who don't have it. Diabetes complicates pregnancy and results in more birth defects than babies born to women without the disease.

•Heart disease is the leading cause of diabetes-related deaths. Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes.

•The risk of stroke is two to four times higher.

•An estimated 60 to 65 percent of people with diabetes have high blood pressure.

•Diabetes is the leading cause of new cases of blindness in adults 20 to 24 years old.

•More than half the limb amputations in the United States occur among people with diabetes.

It's important to know how serious the complications of diabetes can be. If you have diabetes, you will be the person most responsible for working to avoid the worst effects of the disease. You will want to know about these problems so that you can be alert to detecting them and preventing them. Diabetes care is a 24-hour-a-day effort, and preventing complications is worth establishing good self-care routines. The most effective way to avoid complications from either type of diabetes is to keep your blood sugar levels as close to normal as you can. Click on Benefits of Tight Control.


Symptoms of Diabetes

The list of signs and symptoms mentioned in various sources for Diabetes includes the 64 symptoms listed below:

No early symptoms - many people have Type 2 diabetes without knowing it

Early mild symptoms - from moderate blood sugars (which are still dangerous and lead to serious complications):

Abscess
Skin rashes
Skin infections
Athlete's foot
Poor skin healing
Urinary tract infections
Candida
Thrush
Dry itchy skin
Flaky skin
Skin ulcers
Skin boils
Peripheral neuropathy
Paresthesias
Foot tingling
Foot numbness
Hand tingling
Hand numbness
Blurred vision
Sexual problems
Erectile failure
Unusual vaginal dryness
Premature menopause
Absent periods
Poor healing - any type of difficulty healing of minor infections, injury or after surgery.
Weight loss
Weight gain
Drowsiness
Malaise

Later more extreme symptoms when blood sugars get higher:

Excessive thirst
Excessive urination
Dehydration
Bed wetting - in children
Excessive hunger
Tiredness
Weight loss
Severe blurred vision
Muscle cramps
Muscle aches
Headaches
Irritability
Tiredness
Fatigue
Muscle weakness
Acne - often worsens from diabetes and improves once sugars controlled
Sexual problems
Erectile failure
Unusual vaginal dryness
Absent menstrual periods
Persistent fungal skin infections
Athlete's foot
Tinea
Thrush (Candida)
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) - a very severe life-threatening complication of high blood sugars.

Diabetic Ketoacidosis (DKA) - a very severe life-threatening complication of high blood sugars, requiring emergency treatment, which has very severe symptoms:

Nausea
Vomiting
Sweet-smelling fruity acetone breath
Breathing difficulty
Rapid Pulse
Abdominal pain - usually in children


Diabetes Diet

Diet plays a significant role in controlling the diabetes. The diabetic diet may be used alone or else in combination with insulin doses or with oral hypoglycemic drugs. Main objective of diabetic diet is to maintain ideal body weight, by providing adequate nutrition along with normal blood sugar levels in blood. The diet plan for a diabetic is based on height, weight, age, sex, physical activity and nature of diabetes. While planning diet, the dietician has to consider complications such as high blood pressure, high cholesterol levels.

With respect to the above factors, a dietician will assess calories to be given, like scheming the carbohydrates, proteins, fats, type of carbohydrate, amount of fiber and so on.

Exchange meal plan is a diet program which balances the amount of carbohydrate that we intake per day. Glucose is a sugar released from carbohydrate so, if we want to control blood sugar we have to limit the consumption of simple carbohydrate. Carbohydrate foods are given as value per portion, known as the exchange. This plan helps us to decide on the type of food to be taken, the amount of food and also the time to eat. You can plan for more flexible meals as you get more knowledge about the diet for a diabetic, may be like the counting carbohydrate meal plan or constant carbohydrate. But there is no common diet that works for everyone. Nor is there any particular diet that works perfectly for any diabetic over a long period. While planning diabetes diet we should adhere to certain important factors, they are as follows:

Fiber should be at least 1.4 oz / day
Instead of 3 heavy meals, we should go for 4-5 small mid intervals
Replace bakery products and fast foods by simple whole cooked cereals, and don't eat carbohydrates 2 hours before bedtime
Consume fresh fruit and vegetables at least 5 exchange/ day
Diabetics always need to take care of their diet and also about the food they eat. Care has to be taken because all foods contain not only carbohydrate, but also some energy value. Protein and fat available in the food are converted to glucose in the body. This glucose has some effect on the blood sugar level, which has to be taken care of. Furthermore, you needn’t have to eat only the bland boring diet. Instead, you can eat more fruits, vegetables and whole grains. All it means is that you need to select foods that are high in nutrition and low in calories.


Fats (Limit to 1 serving per meal) A serving can be:-

10 Peanuts.
1 Tbsp Salad Dresssing
2 Tbsp light salad dressing or saur cream.
1 Tsp margarine, Oil or mayonnaise.
1/8 Avocado.
Sweets (Substitute for starch or fruit serving occasionally) A serving can be:-

2 Small Cookies.
1 Small Cupcake or Muffin
½ Cup Ice cream.
1/3 Cup Frozen Yoghurt.
¼ Cup Sherbet.
1 tsp Syrup or Honey.
Milk (2-3 Servings per day) A serving can be:

1 cup Milk.
1 Cup Low Fat.
1 Cup Artificially Sweetened yogurt (No sugar)
Meat / Fish/Chicken (2-3 Serving per day) A serving can be:

2 oz Cooked Lean Meat/Poultry/Fish.
½ - ¾ Cup Tuna or Cottage Cheese.
1 Egg or 4 oz Tofu or 1 oz cheese.
2 Tbsp peanut Butter.
Vegetables (3-5 Serving Per day) A Serving can be:

1 Cup Raw Vegetables.
½ Cup Cooked Vegetables.
½ Cup Tomato or Vegetable Juice.
Fruits (3 Serving per Day) A Serving Can be:

70 gm small fruit.
½ Cup canned fruit.
¼ cup Dried Fruit.
½ Cup Fruit Juice. (No sugar)
Grains, Starchy Vegetables and Beans. (6 plus Servings Per Day) A Serving Can be:-

1 Slice of 1 oz bread or ½ (1 oz) Bagel or 5 Crackers or 1 Granola bar.
½ Hamburger or Hot dog Bun or a tortilla of 6 inch or 2 tacos.
½ Cup Cooked Cereal, Cooked beans, Lentils, Corn, Peas, S. Potato, Potato or Pasta.
1 Cup winter Squash, 1 Cup Soup.
1/3 Cup Rice or 3 Cup Plain Popcorn (Fat free)









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