DIABETES
Definition
Diabetes is
a life-long disease of high blood sugar caused by too little insulin,
resistance to insulin, or both.
Causes and risks
To
understand diabetes, first consider the normal process of food metabolism.
Several things happen when food is digested:
- A sugar called glucose enters the bloodstream. Glucose
is a source of fuel for the body.
- An organ called the pancreas makes insulin. The role of
insulin is to move glucose from the bloodstream into muscle, fat, and liver
cells, where it can be used as fuel.
People with diabetes have high blood glucose. This is because their pancreas
does not make enough insulin, or their muscle, fat and liver do not respond to
insulin normally, or both.
There are three major types of diabetes:
- Type 1
diabetes, which is usually diagnosed in childhood. The body
makes little or no insulin, and daily injections of insulin are required
to live. Without proper daily management, medical emergencies can arise.
- Type 2
diabetes, which is far more common (about 90% of all diabetes
cases) and usually occurs in adulthood. The pancreas does not make enough
insulin to keep blood glucose levels normal, often because the body does
not respond well to the insulin. Many people with Type 2 diabetes do not
even know they have it, although it is a serious condition. Type 2
diabetes is becoming more common due to the growing number of older
Americans, increasing obesity, and a lack of exercise. Without proper
management, long-term health risks such as heart disease, stroke, and
kidney failure can occur.
- Gestational
diabetes, which is high blood glucose at any time during
pregnancy.
Diabetes affects 16 million Americans. There are many risk factors for
diabetes, including:
- Family history of diabetes (parent or sibling)
- Obesity
- Age greater than 45 years
- Certain ethnic groups (African-Americans,
Hispanic-Americans)
- Diabetes during pregnancy or baby weighing more than 9
pounds
- High blood pressure
- High blood levels of triglycerides (a type of fat
molecule)
- High blood cholesterol level
The American Diabetes Association recommends that all adults be screened for
diabetes at least every three years. A person at high risk should be screened
more often.
Prevention
Maintaining
an ideal body weight and an active lifestyle may prevent the onset of type 2
diabetes. Currently there is no way to prevent type 1 diabetes.
Symptoms
High blood levels of glucose can cause several problems, including frequent
urination, excessive thirst, hunger, fatigue, weight loss and blurry vision.
However, some people with high blood sugar experience no symptoms at all. About
40% of Type 2 diabetics have no symptoms of their condition.
Symptoms of Type 1 diabetes:
Symptoms of Type 2 diabetes:
Signs and tests
- Analysis of urine (urinalysis) showing glucose and
ketones (products of the breakdown of fat)
- Blood
glucose level
- Glucose
tolerance test (blood glucose is measured after drinking 75
grams of glucose)
- Hemoglobin A1c (HbA1c) level
Patients with Type 1 diabetes usually develop symptoms over a short period
of time, and the condition is often diagnosed in an emergency setting. In
addition to having high glucose levels, acutely ill Type 1 diabetics have high
levels of ketones. Ketones are produced by the breakdown of fat and muscle, and
they are toxic at high levels. Ketones in the blood cause a condition called
"acidosis" (low blood pH). Urine testing detects both glucose and
ketones in the urine. Blood glucose levels are also high.
Type 2 diabetes is diagnosed when:
- The blood glucose is 126 milligrams per deciliter
(mg/dl) or higher on two occasions after fasting (abstaining from food)
for 8 or more hours; or
- The blood
glucose level is 200 milligrams per deciliter or higher at any
time between meals with symptoms of diabetes, such as increased thirst,
urination, and fatigue; or
- A blood glucose level drawn two hours after drinking a
75-gram glucose solution is 200 milligrams per deciliter or higher.
The hemoglobin A1c (HbA1c) level is a measure of average blood glucose
during the previous two to three months. It is used to monitor a patient’s
response to diabetes treatment.
Treatment
There is no cure for diabetes.
The immediate goals of treatment are to stabilize the blood sugar and to
eliminate the symptoms of high blood sugar. The long-term goals of treatment
are to prolong life, improve the quality of life, relieve symptoms, and prevent
long-term complications such as heart disease and kidney failure.
The American Diabetes Association recommends that pre-meal blood sugars fall
in the range of 80 to 120 milligrams per deciliter, bedtime blood sugars fall
in the range of 100 to 140 milligrams per deciliter, and HbA1c levels are at or
below 7 percent. Education, diet, exercise, weight
control, medication, blood glucose self-testing, and foot care are vital
for good control of diabetes and prevention of its complications.