What id Diabetes

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in

which the person has high blood glucose (blood sugar), either because insulin production is inadequate,

or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar

will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia)

and hungry (polyphagia).

There are three types of diabetes:

1) Type 1 Diabetes

The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes,

juvenile diabetes, or early-onset diabetes. People usually develop type 1 diabetes before their 40th year,

often in early adulthood or teenage years.

Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 10% of all diabetes cases

are type 1.

Patients with type 1 diabetes will need to take insulin injections for the rest of their life. They must also

ensure proper blood-glucose levels by carrying out regular blood tests and following a special diet.

Between 2001 and 2009, the prevalence of type 1 diabetes among the under 20s in the USA rose 23%,

according to SEARCH for Diabetes in Youth data issued by the CDC (Centers for Disease Control and

Prevention). (Link to article)

2) Type 2 Diabetes

The body does not produce enough insulin for proper function, or the cells in the body do not react to

insulin (insulin resistance).

Approximately 90% of all cases of diabetes worldwide are of this type.

Some people may be able to control their type 2 diabetes symptoms by losing weight, following a

healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. However, type 2

diabetes is typically a progressive disease - it gradually gets worse - and the patient will probably end up

have to take insulin, usually in tablet form.

Overweight and obese people have a much higher risk of developing type 2 diabetes compared to those

with a healthy body weight. People with a lot of visceral fat, also known as central obesity, belly fat, or

abdominal obesity, are especially at risk. Being overweight/obese causes the body to release chemicals

that can destabilize the body's cardiovascular and metabolic systems.

The risk of developing type 2 diabetes is also greater as we get older. Experts are not completely sure

why, but say that as we age we tend to put on weight and become less physically active. Those with a

close relative who had/had type 2 diabetes, people of Middle Eastern, African, or South Asian descent

also have a higher risk of developing the disease.

Men whose testosterone levels are low have been found to have a higher risk of developing type 2

diabetes. Researchers from the University of Edinburgh, Scotland, say that low testosterone levels are

linked to insulin resistance. (Link to article)

Measuring the glucose level in blood

3) Gestational Diabetes

This type affects females during pregnancy. Some women have very high levels of glucose in their blood,

and their bodies are unable to produce enough insulin to transport all of the glucose into their cells,

resulting in progressively rising levels of glucose.

Diagnosis of gestational diabetes is made during pregnancy.

The majority of gestational diabetes patients can control their diabetes with exercise and diet. Between

10% to 20% of them will need to take some kind of blood-glucose-controlling medications. Undiagnosed

or uncontrolled gestational diabetes can raise the risk of complications during childbirth. The baby may

be bigger than he/she should be.

Scientists from the National Institutes of Health and Harvard University found that women whose diets

before becoming pregnant were high in animal fat and cholesterol had a higher risk for gestational

diabetes, compared to their counterparts whose diets were low in cholesterol and animal fats. (Link to

article)

What Is Prediabetes?

The vast majority of patients with type 2 diabetes initially had prediabetes. Their blood glucose levels

where higher than normal, but not high enough to merit a diabetes diagnosis. The cells in the body are

becoming resistant to insulin.

Studies have indicated that even at the prediabetes stage, some damage to the circulatory system and

the heart may already have occurred.

Diabetes Is A Metabolism Disorder

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our

bodies use digested food for energy and growth. Most of what we eat is broken down into glucose.

Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies.

When our food is digested, the glucose makes its way into our bloodstream. Our cells use the glucose

for energy and growth. However, glucose cannot enter our cells without insulin being present - insulin

makes it possible for our cells to take in the glucose.

Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases

an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as

glucose enters the cells blood-glucose levels drop.

A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated

(hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin,

or has cells that do not respond properly to the insulin the pancreas produces. This results in too much

glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine.

So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and

growth requirements.

How To Determine Whether You Have Diabetes, Prediabetes or Neither

Doctors can determine whether a patient has a normal metabolism, prediabetes or diabetes in one of

three different ways - there are three possible tests:

The A1C test

- at least 6.5% means diabetes

- between 5.7% and 5.99% means prediabetes

- less than 5.7% means normal

The FPG (fasting plasma glucose) test

- at least 126 mg/dl means diabetes

- between 100 mg/dl and 125.99 mg/dl means prediabetes

- less than 100 mg/dl means normal

An abnormal reading following the FPG means the patient has impaired fasting glucose (IFG)

The OGTT (oral glucose tolerance test)

- at least 200 mg/dl means diabetes

- between 140 and 199.9 mg/dl means prediabetes

- less than 140 mg/dl means normal

An abnormal reading following the OGTT means the patient has impaired glucose tolerance (IGT)

Why Is It Called Diabetes Mellitus?

Diabetes comes from Greek, and it means a "siphon". Aretus the Cappadocian, a Greek physician during

the second century A.D., named the condition diabainein. He described patients who were passing too

much water (polyuria) - like a siphon. The word became "diabetes" from the English adoption of the

Medieval Latin diabetes.

In 1675, Thomas Willis added mellitus to the term, although it is commonly referred to simply as

diabetes. Mel in Latin means "honey"; the urine and blood of people with diabetes has excess glucose,

and glucose is sweet like honey. Diabetes mellitus could literally mean "siphoning off sweet water".

In ancient China people observed that ants would be attracted to some people's urine, because it was

sweet. The term "Sweet Urine Disease" was coined.

Controlling Diabetes - Treatment Is Effective And Important

All types of diabetes are treatable. Diabetes type 1 lasts a lifetime, there is no known cure. Type 2

usually lasts a lifetime, however, some people have managed, through a lot of exercise, diet and

excellent body weight control to get rid of their symptoms without medication.

Researchers from the Mayo Clinic Arizona in Scottsdale showed that gastric bypass surgery can reverse

type 2 diabetes in a high proportion of patients. They added that within three to five years the disease

recurs in approximately 21% of them. Yessica Ramos, MD., said "The recurrence rate was mainly

influenced by a longstanding history of Type 2 diabetes before the surgery. This suggests that early

surgical intervention in the obese, diabetic population will improve the durability of remission of Type 2

diabetes." (Link to article)

Patients with type 1 are treated with regular insulin injections, as well as a special diet and exercise.

Patients with Type 2 diabetes are usually treated with tablets, exercise and a special diet, but sometimes

insulin injections are also required.

If diabetes is not adequately controlled the patient has a significantly higher risk of developing

complications.

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Complications linked to badly controlled diabetes:

Eye complications - glaucoma, cataracts, diabetic retinopathy, and some others.

Foot complications - neuropathy, ulcers, and sometimes gangrene which may require that the foot be

amputated

Skin complications - people with diabetes are more susceptible to skin infections and skin disorders

Heart problems - such as ischemic heart disease, when the blood supply to the heart muscle is

diminished

Hypertension - common in people with diabetes, which can raise the risk of kidney disease, eye

problems, heart attack and stroke

Mental health - uncontrolled diabetes raises the risk of suffering from depression, anxiety and some

other mental disorders

Hearing loss - diabetes patients have a higher risk of developing hearing problems

Gum disease - there is a much higher prevalence of gum disease among diabetes patients

Gastroparesis - the muscles of the stomach stop working properly

Ketoacidosis - a combination of ketosis and acidosis; accumulation of ketone bodies and acidity in the

blood.

Neuropathy - diabetic neuropathy is a type of nerve damage which can lead to several different

problems.

HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome) - blood glucose levels shoot up too high, and

there are no ketones present in the blood or urine. It is an emergency condition.

Nephropathy - uncontrolled blood pressure can lead to kidney disease

PAD (peripheral arterial disease) - symptoms may include pain in the leg, tingling and sometimes

problems walking properly

Stroke - if blood pressure, cholesterol levels, and blood glucose levels are not controlled, the risk of

stroke increases significantly

Erectile dysfunction - male impotence.

Infections - people with badly controlled diabetes are much more susceptible to infections

Healing of wounds - cuts and lesions take much longer to heal

USA - 2011 National Diabetes Fact Sheet

How many Americans have diabetes or pre-diabetes?

8.5% of the US population have diabetes - 25.8 million children and adults.

Researchers from the Jefferson School of Population Health (Philadelphia, PA) published a study which

estimates that by 2025 there could be 53.1 million people with the disease. (Link to article)

18.8 million people have been diagnosed with diabetes

About 7 million people with diabetes have not been diagnosed.

Even though type 2 diabetes rates in the USA have risen sharply, Timothy Lyons, MD, who is presently

Director of Research of the Harold Hamm Diabetes Center in Oklahoma City says that the disease is still

not being detected promptly. He added that the lag in diagnosis involves both patients and doctors.

(Link to article)

About 79 million people have pre-diabetes

1.9 million people aged 20 years or more were newly diagnosed with diabetes in 2010

215,000 (0.26%) people younger than 20 years have diabetes

Approximately 1 in every 400 kids and teenagers has diabetes

11.3% of people aged 20+ years have diabetes; a total of 25.6 million individuals

26.9% of people aged 65+ years have diabetes; a total of 10.9 million people

11.8% of men have diabetes; a total of 13 million people

10.8% of women have diabetes; a total of 12.6 million people

Diabetes In The United Kingdom

In the United Kingdom there are about 3.8 million people with diabetes, according to the National

Health Service. Diabetes UK, a charity, believes this number will jump to 6.2 million by 2035, and the

National Health Service will be spending as much as 17% of its health care budget on diabetes by then.

Diabetes Spreads In Southeast Asia

Diabetes is rapidly spreading in Southeast Asia as people embrace American fast foods, such as

hamburgers, hot dogs, French fries and pizza. More Chinese adults who live in Singapore are dying of

heart disease and developing type 2 diabetes than ever before, researchers from the University of

Minnesota School of Public Health and the National University of Singapore reported in the journal

Circulation.

The authors found that Chinese adults in Singapore who eat American-style junk foods twice a week had

a 56% greater risk of dying prematurely form heart disease, while their risk of developing type 2

diabetes rose 27%, compared to their counterparts who "never touched the stuff". There was a 80%

higher likelihood of dying from coronary heart disease for those eating fast foods four times per week.

(Link to article)

Some Facts And Myths Regarding Diabetes

Many presumed "facts" are thrown about in the paper press, magazines and on the internet regarding

diabetes; some of them are, in fact, myths. It is important that people with diabetes, pre-diabetes, their

loved ones, employers and schools have an accurate picture of the disease. Below are some diabetes

myths:

People with diabetes should not exercise - NOT TRUE!! Exercise is important for people with diabetes, as

it is for everybody else. Exercise helps manage body weight, improves cardiovascular health, improves

mood, helps blood sugar control, and relieves stress. Patients should discuss exercise with their doctor

first.

Fat people always develop type 2 diabetes eventually - this is not true. Being overweight or obese raises

the risk of becoming diabetic, they are risk factors, but do not mean that an obese person will definitely

become diabetic. Many people with type 2 diabetes were never overweight. The majority of overweight

people do not develop type 2 diabetes.

Diabetes is a nuisance, but not serious - two thirds of diabetes patients die prematurely from stroke or

heart disease. The life expectancy of a person with diabetes is from five to ten years shorter than other

people's. Diabetes is a serious disease.

Children can outgrow diabetes - this is not true. Nearly all children with diabetes have type 1; insulin-

producing beta cells in the pancreas have been destroyed. These never come back. Children with type 1

diabetes will need to take insulin for the rest of their lives, unless a cure is found one day.

Don't eat too much sugar, you will become diabetic - this is not true. A person with diabetes type 1

developed the disease because their immune system destroyed the insulin-producing beta cells. A diet

high in calories, which can make people overweight/obese, raises the risk of developing type 2 diabetes,

especially if there is a history of this disease in the family.

I know when my blood sugar levels are high or low - very high or low blood sugar levels may cause some

symptoms, such as weakness, fatigue and extreme thirst. However, levels need to be fluctuating a lot for

symptoms to be felt. The only way to be sure about your blood sugar levels is to test them regularly.

Researchers from the University of Copenhagen, Denmark showed that even very slight rises in blood-

glucose levels significantly raise the risk of ischemic heart disease. (Link to article)

Diabetes diets are different from other people's - the diet doctors and specialized nutritionists

recommend for diabetes patients are healthy ones; healthy for everybody, including people without the

disease. Meals should contain plenty of vegetables, fruit, whole grains, and they should be low in salt

and sugar, and saturated or trans fat. Experts say that there is no need to buy special diabetic foods

because they offer no special benefit, compared to the healthy things we can buy in most shops.

High blood sugar levels are fine for some, while for others they are a sign of diabetes - high blood-sugar

levels are never normal for anybody. Some illnesses, mental stress and steroids can cause temporary

hikes in blood sugar levels in people without diabetes. Anybody with higher-than-normal blood sugar

levels or sugar in their urine should be checked for diabetes by a health care professional.

Diabetics cannot eat bread, potatoes or pasta - people with diabetes can eat starchy foods. However,

they must keep an eye on the size of the portions. Whole grain starchy foods are better, as is the case

for people without diabetes.

One person can transmit diabetes to another person - NOT TRUE. Just like a broken leg is not infectious

or contagious. A parent may pass on, through their genes to their offspring, a higher susceptibility to

developing the disease.

Only older people develop type 2 diabetes - things are changing. A growing number of children and

teenagers are developing type 2 diabetes. Experts say that this is linked to the explosion in childhood

obesity rates, poor diet, and physical inactivity.

I have to go on insulin, this must mean my diabetes is severe - people take insulin when diet alone or

diet with oral or non-insulin injectable diabetes drugs do not provide good-enough diabetes control,

that's all. Insulin helps diabetes control. It does not usually have anything to do with the severity of the

disease.

If you have diabetes you cannot eat chocolates or sweets - people with diabetes can eat chocolates and

sweets if they combine them with exercise or eat them as part of a healthy meal.

Diabetes patients are more susceptible to colds and illnesses in general - a person with diabetes with

good diabetes control is no more likely to become ill with a cold or something else than other people.

However, when a diabetic catches a cold, their diabetes becomes harder to control, so they have a

higher risk of complications.

People can often have diabetes and be completely unaware. The main reason for this is that the

symptoms, when seen on their own, seem harmless. However, the earlier diabetes is diagnosed the

greater the chances are that serious complications, which can result from having diabetes, can be

avoided.

Here is a list of the most common diabetes symptoms:

Frequent urination

Have you been going to the bathroom to urinate more often recently? Do you notice that you spend

most of the day going to the toilet? When there is too much glucose (sugar) in your blood you will

urinate more often. If your insulin is ineffective, or not there at all, your kidneys cannot filter the glucose

back into the blood. The kidneys will take water from your blood in order to dilute the glucose - which in

turn fills up your bladder.

Disproportionate thirst

If you are urinating more than usual, you will need to replace that lost liquid. You will be drinking more

than usual. Have you been drinking more than usual lately?

Intense hunger

As the insulin in your blood is not working properly, or is not there at all, and your cells are not getting

their energy, your body may react by trying to find more energy - food. You will become hungry.

Weight gain

This might be the result of the above symptom (intense hunger).

Unusual weight loss

This is more common among people with Diabetes Type 1. As your body is not making insulin it will seek

out another energy source (the cells aren't getting glucose). Muscle tissue and fat will be broken down

for energy. As Type 1 is of a more sudden onset and Type 2 is much more gradual, weight loss is more

noticeable with Type 1.

Increased fatigue

If your insulin is not working properly, or is not there at all, glucose will not be entering your cells and

providing them with energy. This will make you feel tired and listless.

Irritability

Irritability can be due to your lack of energy.

Blurred vision

This can be caused by tissue being pulled from your eye lenses. This affects your eyes' ability to focus.

With proper treatment this can be treated. There are severe cases where blindness or prolonged vision

problems can occur.

Cuts and bruises don't heal properly or quickly

Do you find cuts and bruises take a much longer time than usual to heal? When there is more sugar

(glucose) in your body, its ability to heal can be undermined.

More skin and/or yeast infections

When there is more sugar in your body, its ability to recover from infections is affected. Women with

diabetes find it especially difficult to recover from bladder and vaginal infections.

Itchy skin

A feeling of itchiness on your skin is sometimes a symptom of diabetes.

Gums are red and/or swollen - Gums pull away from teeth

If your gums are tender, red and/or swollen this could be a sign of diabetes. Your teeth could become

loose as the gums pull away from them.

Frequent gum disease/infection

As well as the previous gum symptoms, you may experience more frequent gum disease and/or gum

infections.

Sexual dysfunction among men

If you are over 50 and experience frequent or constant sexual dysfunction (erectile dysfunction), it could

be a symptom of diabetes.

Numbness or tingling, especially in your feet and hands

If there is too much sugar in your body your nerves could become damaged, as could the tiny blood

vessels that feed those nerves. You may experience tingling and/or numbness in your hands and feet.

Diagnosis of diabetes

Diabetes can often be detected by carrying out a urine test, which finds out whether excess glucose is

present. This is normally backed up by a blood test, which measures blood glucose levels and can

confirm if the cause of your symptoms is diabetes.

If you are worried that you may have some of the above symptoms, you are recommended to talk to

your Doctor or a qualified health professional.

What is insulin?

Insulin is a hormone. It makes our body's cells absorb glucose from the blood. The glucose is stored in

the liver and muscle as glycogen and stops the body from using fat as a source of energy.

When there is very little insulin in the blood, or none at all, glucose is not taken up by most body cells.

When this happens our body uses fat as a source of energy. Insulin is also a control signal to other body

systems, such as amino acid uptake by body cells. Insulin is not identical in all animals - their levels of

strength vary.

Porcine insulin, insulin from a pig, is the most similar to human insulin. Humans can receive animal

insulin. However, genetic engineering has allowed us to synthetically produce 'human' insulin.

The pancreas

(1. click for large diagram) - © 3d Medical RF

The pancreas is part of the digestive system. It is located high up in your abdomen and lies across your

body where the ribs meet at the bottom. It is shaped like a leaf and is about six inches long. The wide

end is called the head while the narrower end is called the tail, the mid-part is called the body.

The pancreas has two principal functions:

It produces pancreatic digestive juices.

It produces insulin and other digestive hormones.

The endocrine pancreas is the part of the pancreas that produces insulin and other hormones.

The exocrine pancreas is the part of the pancreas that produces digestive juices.

Insulin is produced in the pancreas. When protein is ingested insulin is released.

Insulin is also released when glucose is present in the blood. After eating carbohydrates, blood glucose

levels rise.

Insulin makes it possible for glucose to enter our body's cells - without glucose in our cells they would

not be able to function. Without insulin the glucose cannot enter our cells.

Within the pancreas, the Islets of Langerhans contain Beta cells, which synthesize (make) the insulin.

Approximately 1 to 3 million Islets of Langerhans make up the endocrine part of the pancreas (mainly

the exocrine gland), representing just one fiftieth of the pancreas' total mass.

Etymology (history) of the word pancreas

It is said that the pancreas was described first by Herophilus of Chalcedon in about 300B.C. and the

organ was named by Rufus of Ephesus in about 100A.D

However, it is an established fact that the word pancreas had been used by Aristotle (384-322B.C.)

before Herophilus.

In Aristotle's HistoriaAnimalium, there is a line saying "another to the so-called pancreas". It is

considered that the words "so-called pancreas" imply that the word pancreas had been popular at the

time of Aristotle, but it had not been authorized yet as an anatomical term.

However, the word pancreas presumably has been accepted as an anatomical term since Herophilus.

The word pancreas comes from the Greek pankreas, meaning sweetbread.

Discovery of insulin

In 1920, Dr. Frederick Banting wanted to make a pancreatic extract,

which he hoped would have anti-diabetic qualities. In 1921, at the

University of Toronto, Canada, along with medical student Charles Best,

they managed to make the pancreatic extract.

Their method involved tying a string around the pancrease duct. When

examined several weeks later, the pancreatic digestive cells had died

and been absorbed by the immune system. The process left behind

thousands of islets. They isolated the extracts from the islets and

produced isletin. What they called isletin became known as insulin.

Banting and Best managed to test this extract on dogs that had diabetes.

They discovered insulin. In fact, they managed to keep a dog, that had

had its pancreas taken out, alive throughout the whole summer by

administering it the extract (which was, in fact, insulin). The extract

regulated the dogs blood sugar levels.

At this point, Professor J. MacLeod, who had placed the laboratory at their disposal, said he wanted

to see a re-run of the whole trial. After doing so he decided to get his whole research team to work

on the production and purification of insulin.

J.B. Collip joined the scientific team, which now consisted of Banting, Best, Collip and MecLeod.

They managed to produce enough insulin, in a pure enough form, to be able to test it on patients.

In 1922 the insulin was tested on Leonard Thompson, a 14-year-old diabetes patient who lay dying

at the Toronto General Hospital. He was given an insulin injection. At first he suffered a severe

allergic reaction and further injections were cancelled. The scientists worked hard on improving the

extract and then a second dose of injections were administered on Thompson. The results were

spectacular.

The scientists went to the other wards with diabetic children, most of them comatose and dying from

diabetic keto-acidosis. They went from bed-to-bed and injected them with the new purified extract -

insulin. This is known as one of medicines most dramatic moments. Before injecting the last

comatose children, the first started to awaken from their comas. A joyous moment for family

members and hospital staff!!

Collip did not get on too well with Banting and Best apparently - and he soon left the project. Best

continued trying to improve the extract and managed eventually to produce enough for the hospital's

demand. Their work was privately published. The Eli Lilly Company soon got to hear about it and

offered to assist. It was not long before the Eli Lilly Company managed to produce large quantities of

refined pure insulin.

In 1923 Banting and Macleod were awarded the Nobel Prize in Physiology or Medicine. Banting

shared his prize with Best and Macleod shared his with Collip. The patent for insulin was sold to the

University of Toronto for one dollar.

Type 1 diabetes

Type 1 diabetes is an autoimmune disease - the

person's body has destroyed his/her own insulin-

producing beta cells in the pancreas.

People with Diabetes Type 1 are unable to produce insulin. Most patients with

Diabetes Type 1 developed the condition before the age of 40. Approximately

15% of all people with diabetes have Type 1.

Type 1 diabetes is fatal unless the patient regularly takes exogenous insulin. Some patients have had

their beta cells replaced through a pancreas transplant and have managed to produce their own insulin

again.

Type 1 diabetes is also known as juvenile diabetes or childhood diabetes. Although a large number of

diabetes Type 1 patients become so during childhood, it can also develop after the age of 18. Developing

Type 1 after the age of 40 is extremely rare.

Type 1, unlike Type 2, is not preventable. The majority of people who develop Type 1 are of normal

weight and are otherwise healthy during onset. Exercise and diet cannot reverse Type 1. Quite simply,

the person has lost his/her insulin-producing beta cells. Several clinical trials have attempted to find

ways of preventing or slowing down the progress of Type 1, but so far with no proven success.

A C-peptide assay is a lab test that can tell whether somebody has Type 1 or Type 2. As external insulin

has no C-peptide a lack of it would indicate Type 1. The test is only effective when ALL the endogenous

insulin has left the body - this can take several months.

Diet for a person with type 1

A person with Type one will have to watch what he/she eats. Foods that are low in fat, salt and have no

or very little added sugar are ideal. He/she should consume foods that have complex carbohydrates,

rather than fast carbohydrates, as well as fruits and vegetables. A diet that controls the person's blood

sugar level as well as his/her blood pressure and cholesterol levels will help achieve the best possible

health. Portion size is also important in order to maintain a healthy bodyweight.

Meal planning needs to be consistent so that the food and insulin can work together to control blood

glucose levels. According to the Mayo Clinic there is no 'diabetes diet'.

The Clinic says you do not need to restrict yourself to boring bland foods. Rather you should, as

mentioned above, consume plenty of fruits, vegetables and whole grains - foods that are highly

nutritious, low in fat, and low in calories. Even sugary foods are acceptable now and again if you include

them in your food plan.

If you have Type 1 you should seek the help of a registered dietitian. A dietitian can help you create a

food plan that suits you. Most dietitians agree that you should aim to consume the same quantity of

food, with equal portions of carbs, proteins and fats at the same time each day.

Complications - the bad news and the good news

A person with Type 1 has a two to four times higher risk of developing heart disease, stroke, high blood

pressure, blindness, kidney failure, gum disease and nerve damage, compared to a person who does not

have any type of diabetes.

A person with Type 1 is more likely to have poor blood circulation through his/her legs and feet. If left

untreated the problem may become such that a foot has to be amputated. A person with Type 1 will

likely go into a coma if untreated.

The good news is that treatment is available and it is effective and can help prevent these complications

from happening.

How to help prevent complications

Keep your blood pressure under 130/85 mm Hg.

Keep your cholesterol level below 200 mg.

Check your feet every day for signs of infection.

Get your eyes checked once a year.

Get your dentist to check your teeth and gums twice a year.

Physical activity helps regulate blood sugar levels

Before starting exercise make sure your doctor tells you it is OK. Try to make physical activity part of

your daily life. You should try to do at least 30 minutes of exercise or physical activity each day. Physical

activity or exercise means aerobic exercise.

If you have not done any exercise for a while, start gently and build up gradually. Physical activity helps

lower your blood sugar. Remember that exercise is good for everybody, not just people with Type 1.

The benefits are enormous for your physical and mental health. You will become stronger, fitter, your

sleep will improve as will your skin tone - and after some time you will look great!

Exercise will help your circulation - helping to make sure your lower legs and feet are healthy.

Remember to check your blood sugar level more frequently during your first few weeks of exercise so

that you may adapt your meal plans and/or insulin doses accordingly. Remember that a person with

Type 1 has to manually adjust his/her insulin doses - the body will not respond automatically.

"Gary Hall won an Olympic gold medal in swimming.

He had Type 1 diabetes."

Possible cure for diabetes type 1 closer with stem cells

Stem cells in the pancreas which can turn into insulin-producing cells have been identified by

researchers from the Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.

They published their breakthrough in PLoS One (November 9th, 2012).

The authors explain that their finding raises the hope that one day soon patients with diabetes type 1

will be able to produce their own insulin in their own regenerated beta cells in the pancreas.

The scientists identified and isolated stem cells from the adult pancreas. They then developed a method

for making them become insulin-producing cells that can secrete insulin in response to glucose in the

bloodstream.

Type 2 diabetes

A person with diabetes type 2 either:

Does not produce enough insulin. Or

Suffers from 'insulin resistance'. This means that the insulin is not working properly.

The majority of people with Type 2 have developed the condition because they are overweight. Type 2

generally appears later on in life, compared to Type 1. Type 2 is the most common form of diabetes.

In the case of insulin resistance, the body is producing the insulin, but insulin sensitivity is reduced and it

does not do the job as well as it should do. The glucose is not entering the body's cells properly, causing

two problems:

A build-up of glucose in the blood.

The cells are not getting the glucose they need for energy and growth.

In the early stages of Type 2 insulin sensitivity is the main abnormality - also there are elevated levels of

insulin in the blood. There are medications which can improve insulin sensitivity and reduce glucose

production by the liver.

As the disease progresses the production of insulin is undermined, and the patient will often need to be

given replacement insulin.

"Excess abdominal fat is much more likely to bring on Type 2 Diabetes than excess fat under your skin"

Many experts say that central obesity - fat concentrated around the waist in relation to abdominal

organs - may make individuals more predisposed to develop Type 2 diabetes.

Central obesity does not include subcutaneous fat - fat under the skin. The fat around your waist -

abdominal fat - secretes a group of hormones called adipokines. It is thought that adipokines may impair

glucose tolerance.

The majority of people who develop diabetes Type 2 were overweight during the onset, while 55% of all

Type 2 patients were obese during onset.

"Sometimes all the patient needs is to do more exercise,

lose weight and eat fewer carbs"

It is not uncommon for people to achieve long-term satisfactory glucose control by doing more exercise,

bringing down their bodyweight and cutting down on their dietary intake of carbohydrates.

However, despite these measures, the tendency towards insulin resistance will continue, so the patient

must persist with his/her increased physical activity, monitored diet and bodyweight.

If the diabetes mellitus continues the patient will usually be prescribed orally administered anti-diabetic

drugs. As a person with Type 2 does produce his/her own insulin, a combination of oral medicines will

usually improve insulin production, regulate the release of glucose by the liver, and treat insulin

resistance to some extent.

If the beta cells become further impaired the patient will eventually need insulin therapy in order to

regulate glucose levels.

The risk factors for type 2

Age and ethnicity. The older you are the higher your risk is, especially if you are over 40 (for white

people), and over 25 (for black, South Asian and some minority groups). It has been found in the UK that

black people and people of South Asian origin have five times the risk of developing Type 2 compared to

white people.

Diabetes in the family. If you have a relative who has/had diabetes your risk might be greater. The risk

increases if the relative is a close one - if your father or mother has/had diabetes your risk might be

greater than if your uncle has/had it.

Bodyweight (and inactivity combined with bodyweight). Four-fifths of people who have Type 2 became

so because they were overweight. The more overweight a person is the higher his/her risk will be. The

highest risk is for a person who is overweight and physically inactive. In other words, if you are very

overweight and do not do any exercise your risk is greatest.

Cardiovascular problems and stroke. A person who has had a stroke runs a higher risk of developing

Type 2. This is also the case for people who suffer from hypertension (high blood pressure), or have had

a heart attack. Any diagnosis of a problem with circulation indicates a higher risk of developing Type 2.

Gestational Diabetes. A woman who became temporarily diabetic during pregnancy - gestational

diabetes - runs a higher risk of developing Type 2 later on. Women who give birth to a large baby may

run a higher risk, too.

Impaired fasting glycaemia (IFG) - Impaired glucose tolerance (IGT). A person who has been diagnosed

as having impaired fasting glycaemia or impaired glucose tolerance and does not have diabetes runs a

significantly higher risk of eventually developing Type 2. People with IFG or IGT have higher than normal

levels of glucose in their blood. In order to prevent diabetes it is crucial that you eat healthily, keep an

eye on your weight and do exercise.

Severe mental health problems. It has been found that people with severe mental health problems are

more likely to develop Type 2.

Diabetes and cardiovascular diseases

People with diabetes type 2 are much more likely to develop cardiovascular diseases, such as coronary

heart disease, stroke, hypertension, inflammatory heart disease and other cardiovascular conditions.

Treatments tend to be similar to the ones used on patients who do not have diabetes. Stents versus

bypass surgery for clogged artery - Patients with diabetes who have one clogged artery tend to have

better results from heart bypass surgery than drug coated stents, researchers from Saint Luke's Mid-

America Heart Institute in Kansas City, Missouri, explained at the American Heart Association's (AHA's)

Scientific Sessions 2012 in Los Angeles (4 November, 2012).

Although stents may be cheaper and appear initially to be a better option, over the long term, bypass

surgery patients in a trial had fewer heard attacks and were less likely to die prematurely, the

investigators explained.

Senior author, Elizabeth A Magnuson, said "Our results demonstrate that bypass surgery is not only

beneficial from a clinical standpoint, but also economically attractive from the perspective of the US

healthcare system. The economic data are important because of the large number of people with

diabetes who are in need of procedures to unblock clogged arteries."

The findings confirm the American Heart Association’s recommendations which have been in place since

the 1990s that diabetes patients with one clogged heart artery should receive bypass surgery.

Famous diabetics

Diabetes does not stop you from pursuing your ambitions

Being diabetic might mean a change in lifestyle. It does not mean you will not be able to pursue your

career effectively, run a business, practice a sport or realize your ambition.

Here is a sample list of people who have achieved great things. They all have something in common -

they all have (had) diabetes. Some managed to win Olympic Gold Medals.

Diabetes will not stop you from becoming a top sportsman or sportswoman, politician, actor/actress,

musician, or journalist. If your eating is well planned, if you do plenty of exercise, and adhere to any

medication plan your doctor gives you, there is no reason AT ALL why you cannot carry on trying to

pursue your lifetime ambitions.

An inspiration!

Sir Steven Redgrave won 5 Olympic Gold medals for rowing and has suffered from Diabetes Type 1 since

1997. Despite being diagnosed with diabetes he continued training hard and won his fifth Olympic Gold

in Sydney in 2000. He won the five medals in five consecutive Olympic games:

2000 Olympic Gold, Coxless Four (with Matthew Pinsent, Tim Foster, James Cracknell)

1996 Olympic Gold, Coxless Pair (with Matthew Pinsent)

1992 Olympic Gold, Coxless Pair (with Matthew Pinsent)

1988 Olympic Gold, Coxless Pair (with Andy Holmes)

1988 Olympic Bronze, Coxed Pair (with Andy Holmes and Patrick Sweeney)

1984 Olympic Gold, Coxed Four (with Martin Cross, Adrian Ellison, Andy Holmes, Richard Budgett).

Redgrave was diagnosed with ulcerative colitis in 1992. He also suffers from dyslexia.

Treatment for diabetes - how is diabetes managed?

A long time ago

Before insulin was discovered in 1921 Diabetes Type 1 was a fatal disease - most patients would die

within a few years of onset. Things have changed a great deal since then.

You can lead a normal life

If you have Type 1 and follow a healthy eating plan, do adequate exercise, and take insulin, you can lead

a normal life. Look at our page on Famous Diabetics - there are many of them and they have achieved

great things!

Balance insulin intake with food and lifestyle

The quantity of insulin intake must be closely linked to how much food you consume, as well as when

you eat. Your daily activities will also have a bearing on when and how much insulin you take.

Checking your blood glucose levels

A person with diabetes has to have his/her blood glucose levels checked periodically. There is a blood

test called the A1C which tells you what your average blood glucose levels were over a two-to-three

month period.

Type 2 patients need to eat healthily, be physically active, and test their blood glucose. They may also

need to take oral medication, and/or insulin to control blood glucose levels.

Prevent developing cardiovascular disease

As the risk of cardiovascular disease is much higher for a diabetic, it is crucial that blood pressure and

cholesterol levels are monitored regularly.

Healthy eating, doing exercise, keeping your weight down will all contribute towards good

cardiovascular health - some patients will need oral medication for this.

Stop smoking!

As smoking might have a serious effect on the cardiovascular health the patient should stop smoking.

A health care provider

A health care professional (HCP) will help the patient learn how to manage his/her diabetes. The HCP

will also monitor the diabetes control. It is important that you know what to do and that a professional

is helping and monitoring the management of your diabetes.

In most countries the GP (general practitioner, primary care physician, family doctor) provides this

regular care. There are also diabetitians, endocrinologists, cardiologists, nurses, internists, pediatricians,

dietitians, podiatrists, ophthalmologists, optometrists, sports specialists and many others.

If a diabetes patient is pregnant she should see an obstetrician who specializes in diabetes (gestational

diabetes). There are pediatricians who specialize in caring for the infants of diabetic mothers.

The aim of diabetes management

The main aim of diabetes management is to keep the following under control:

Blood glucose levels

Blood pressure

Cholesterol levels

High and low blood glucose

The patient will need to make sure his/her blood glucose levels do not fluctuate too much.

Hypoglycemia - low blood glucose - can have a bad effect on the patient. Hypoglycemia can cause:

Shakiness

Anxiety

Palpitations, Tachycardia

Feeling hot, sweating

Clamminess

Feeling cold

Hunger

Nausea

Abdominal discomfort

Headache

Numbness, pins and needles

Depression, moodiness

Apathy, Tiredness, Fatigue, Daydreaming

Confusion

Dizziness

Bad coordination, slurred speech

Seizures

Coma

More information on Hypoglycemia is available on our Hypoglycemia page.

Hyperglycemia - when blood glucose is too high - can also have a bad effect on the patient.

Hyperglycemia can cause:

Polyphagia - frequently hungry

Polydipsia - frequently very thirsty

Polyuria - frequent urination

Blurred vision

Extreme tiredness

Weight loss

Cuts and scrapes will heal slowly and badly

Dry mouth

Dry or itchy skin

Erectile dysfunction (impotence)

Recurrent infections

Kussmaul hyperventilation: deep and rapid breathing

Cardiac arrhythmia

Stupor

Coma

More information on Hyperglycemia is available on our Hyperglycemia page.

How is diabetes managed? - Self-monitoring of blood glucose

Monitoring your own glucose is done with a Glucose Meter. Self-monitoring is often called SMBG (self-

monitoring of blood glucose). Glucose meters today are small, battery-operated devices.

A sample of blood

When you want to test for glucose with a glucose meter you need to place a small sample of your blood

on a test strip. Your skin is pricked with a lancet - like a very fast pin-prick.

These test strips are disposable. You then place the strip in the monitor. The strips are coated with

glucose dehydrogenase or hexokinase that combines with glucose in blood.

The blood is usually taken from a finger, but some meters allow the use of other parts of the body to

supply the blood sample.

How the meter works

The meter tells you how much glucose is present in your blood. How meters do this may vary. With

some meters a measurement of the amount of electricity that passes through your blood sample is

measured, while others measure the degree of reflection of light. The glucose level is displayed as a

number. In the case of this picture (below right) the person's glucose level is low. Many of the new

meters can store a series of test results, while others can be connected to your personal computer to

store results, which you can also print out.

How to choose a glucose meter

According to the FDA there are 25 different meters on the market. They are not all the same. You should

bear the following in mind when choosing one:

Testing speed

Size

Memory (ability to store results)

Price

The newer models have automatic timing, error codes and signals, barcode readers to help with

calibration. Some have spoken instructions for people who are visually impaired.

Using your meter

Frequency of meter usage varies significantly from patient-to-patient. It is important that you adhere to

the instructions given to you from your health care provider. Every person with diabetes should be self-

monitoring his/her blood glucose - this is especially so for people who are taking insulin.

According to the American Diabetes Association (ADA), patients with Type 1 should self-monitor blood

glucose at least three times per day.

The ADA says that women with gestational diabetes (diabetes during pregnancy) should self-test twice a

day.

There is no general recommendation from the ADA regarding frequency of self-testing for Type 2

patients.

Most patients who do have to self-test will generally have to do so before meals, a couple of hours after

meals, at bedtime, 3.a.m., and whenever signs or symptoms are felt.

When a patient changes medication testing should be carried out more frequently.

If you have an unusual illness or sudden stress, you should test more frequently.

Knowing how to use your meter

As meters work in different ways you should get training from a diabetes educator.

Using a glucose meter - instructions

Wash your hands with warm water and soap. Dry completely. You could also dab or wipe the area with

alcohol and then dry completely.

Use the lancet to prick your fingertip.

Hold your hand down. Hold your finger at the same time until you see a small droplet of blood appear.

Place the blood on the test strip.

Follow the instructions for placing the test strip and using your meter.

Keep a record of your result.

Many regulatory authorities, such as the FDA, require that meters and test strips come with instructions.

It is important that you become familiar with these instructions, which should be included in the User

Manual. Some meters give out an error code if something is wrong. Checking the User Manual will tell

you what the error code means.

In many countries the User Manual will have a toll free number. If you call and cannot get through call

your health care provider or your local emergency room. Check out the website of the manufacturer.

The FDA advises patients to visit the manufacturer's website regularly for any updates or issues.

How is diabetes managed? Planning your food consumption

Three things will have a major impact on your blood glucose and blood lipids (cholesterol, triglycerides)

levels

What you eat

How much you eat

When you eat

By selecting the right types of foods, as well as appropriate quantities you can significantly improve your

ability to control your blood glucose and blood lipids.

What does healthy eating mean?

Healthy eating most certainly does not mean you will go hungry and have to spend much of your life

desperately trying to resist temptation. You can still consume the food you like. All it means is that you

will have to be much more aware of how much carbohydrate, fat and protein you consume each time

you eat. You just have to get the balance right.

Carbohydrates

Carbohydrates are most abundantly found in fruit, vegetables, yoghurt, sweets, pasta and bread.

Our body needs carbohydrates; we cannot live without them. When consumed, our bodies turn the

carbohydrate into blood glucose - glucose is needed by our cells for energy and growth.

If you consume the same amount of carbohydrates each time you eat - especially if those times are at

the same time each day - you will be well on your way towards controlling your blood glucose.

It is important that you do not skip meals, no matter what your blood glucose readings indicate. All you

will achieve by skipping meals is a more aggressive fluctuation in your blood glucose levels - something

you want to try to avoid.

If your consumption of glucose can follow a regular pattern, it will be easier for you to balance food with

your medicine(s) and physical activity with optimum blood glucose control.

Variety and moderation

A varied and moderated diet is ideal if you want to enjoy good health. Your carbohydrate intake should

consist of a variety of grains, fruits and vegetables. They have plenty of fiber - fiber helps control blood

glucose.

Remember that brown rice has more fiber than white rice; whole-grain breads have the most fiber. If

you are cooking or baking, opt for whole-wheat or whole grain flours. Include pulses, such as beans;

they are a great source of fiber. Dark green leafy vegetables and dark yellow ones have a slower release

of carbohydrates than most other vegetables.

Carb, protein and fat mix

According to the Mayo Clinic, your daily intake of calories should consist of:

Carbohydrates 45% to 65%

Proteins 15% to 20%

Fats 20% to 35%

If you adhere to your meal plan for portion sizes and eating times you should eat the same mix of

carbohydrates, proteins and fats each day. Your blood sugar control will be ideal, as will your weight.

The more you vary from your food plan, the Mayo Clinic informs, the more your blood glucose will

fluctuate.

The rewards will be worth it

The ideal eating pattern for a person with diabetes is not really any different from what a non-diabetic

person would do if he/she aimed for optimum health and fitness. However, the diabetes patient has the

added incentive of trying to prevent complications from developing, such as cardiovascular disease,

kidney problems, vision problems and leg and feet sores.

Foods on offer for a diabetes patient are extensive and varied. You will be able to plan a wide range of

tasty and interesting meals.

The food pyramid

When you talk to your health care professional, diabetes educator or dietician, they will probably

mention the Food Pyramid.

At the base there are foods rich in carbohydrates, such as grains, then there are fruit and vegetables.

Above are meat, fish, milk and cheese; which are rich in protein. At the top are the fatty foods.

Almost all diabetes and medical associations say that you should eat more from the groups at the

bottom of the pyramid, and less from those at the top.

It is vital that you talk to an expert about your eating plan. It needs to be tailored according to your

weight, age, which medications you are taking and how physically active you are (and, if so, when during

the day you are likely to be the most active).

Glycemic index

Not all carbohydrates are the same. The Glycemic Index (GI) describes what effect certain foods can

have on our blood glucose levels. A high GI tends to cause more blood glucose fluctuations than a low

one. Ask your dietician.

- Information on the Glycemic Index from the Canadian Diabetes Association

How is diabetes managed? - physical activity, exercise

Physical activity Is crucial for a person with diabetes

it helps control your blood glucose

it helps keep your weight down

it helps keep your blood pressure down

it helps raise your HDL (High-density lipoprotein), good cholesterol levels

it helps lower your LDL (Low-density lipoprotein), bad cholesterol levels

These five benefits have a DIRECT bearing on how successfully you manage your diabetes. Exercise also

has other general health benefits - you sleep better, your mental state improves, etc.

How much exercise should you do?

Most experts say you should do exercise on at least five days of each week. Each session should be of

moderate-intensity and should not last less than thirty minutes. The following activities could be classed

as of moderate-intensity:

fast walking

swimming

cycling 5-9mph (level terrain, perhaps some slight hills)

dancing

rowing

mowing the lawn

What is moderate-intensity physical activity?

You should experience some increase in your breathing rate

There should be an increase in your heart rate

A Borg Scale perceived exertion of 11 to 14

You should burn 3.5 to 7 calories per minute

You should reach a METs of 3 to 6

What is MET?

MET stands for Metabolic Equivalent. An MET of 1 is when you are sitting down doing nothing. If you

walk slowly your MET may rise to 2 or 2.5. If you walk normally it will go up to 3, while a brisk walk may

bring it to 5. If a wild gorilla suddenly appeared in the street and started chasing you your desperate

sprint would shoot your MET right up to about 8 or even perhaps 9.

Beginners be careful!

If you have not done exercise for a long time you will need to start with a little light exercise and build

up slowly over time. Each week add a little more time to each session and/or increase the intensity.

Remember regular exercise is what matters. 5 days of 30 minutes each is great. One day per week at

150 minutes is not.

You must talk to your health care provider about an exercise plan. He/she may want to check you over

before you start. Certain exercises are not ideal for patients who suffer from high blood pressure, eye

and/or foot problems.

Strength training is also good

The Centers for Disease Control and Prevention (CDC) says that strength training exercises are good

because they help you build muscle. Strength training usually involves using weights.

Join a gym

There are many gyms today whose staff are experienced and qualified to receive and train people for

various illnesses and conditions. In North America, Western Europe, Japan and Australasia gyms receive

doctors' referrals - doctors send them to specific gyms as part of their therapy.

Having somebody there to help you along, occasionally to push you along, can be a great motivator -

especially for beginners who may view the whole experience with apprehension.

Gyms are all-weather; they have equipment which gives you immediate feedback on how well you are

doing - your speed, heart rate, calories burnt per minute/hour, your progress, etc.

Numerous people prefer gyms because it gives them a feeling of doing something with others. Do not be

afraid of joining one. They are generally welcoming and members will not be concerned about what you

look like or how unfit you may be - they are there for their health, just like you.

Diabetes treatment - hypoglycemia

Hypoglycemia is sometimes called insulin reaction. It is when your blood glucose is too low. Even though

you may do all you can to manage your diabetes, hypoglycemia can happen, and it can and must be

treated before it gets worse.

If you remember to check your blood glucose when your doctor tells you to, your chances of

experiencing hypoglycemia are much lower. Also, a low blood glucose result will tell you that you need

to treat it.

If you feel the symptoms of hypoglycemia you should check your blood glucose. If the reading tells you

that your blood glucose is low, you should treat it immediately.

The American Diabetes Association (ADA) says that if you feel a hypoglycemic reaction but cannot check

your blood glucose it is better to treat the reaction than to wait till you can check.

How do I treat hypoglycemia?

You need to raise your blood glucose. The fastest way to do this is to eat some form of sugar. The ADA

advises:

Take 3 glucose tablets (easily bought)

1/2 a cup of fruit juice

5 to 6 pieces of hard candy (UK 'sweets')

You should ask your dietitian or health care professional for more advice on what you could eat to treat

hypoglycemia.

Make sure you always carry at least one type of sugar with you so that you are prepared.

Check blood glucose, treat It and wait 20 minutes

After you have checked your blood glucose and treated the hypoglycemia wait between 15 to 20

minutes and check your blood glucose again. If your blood glucose is still low repeat the whole process -

eat some glucose, wait about 15-20 minutes and check your blood glucose again.

Remember to stick to your eating times - your regular meals and snacks are vital for keeping your blood

glucose levels as stable as possible. Hypoglycemia can affect all the organs in your body, especially your

brain.

Take hypoglycemia seriously

Hypoglycemia, if not treated quickly gets worse rapidly and the patient will soon pass out.

A patient who passes out because of hypoglycemia will need immediate treatment - probably a

glucagon injection, or an emergency visit to a hospital.

What does glucagon do?

Glucagon is injected, just like insulin is. However, glucagon raises blood glucose.

You should ask your doctor to make sure you have some.

Hypoglycemia unawareness

It is possible, and not very unusual, for a person to pass out and never have noticed they had been

suffering from hypoglycemia. This is known as hypoglycemia unawareness. The patient's blood glucose

drops and he/she is not aware of it.

Hypoglycemia unawareness is more common among patients who have lived with diabetes for a long

time, those with nerve damage (neuropathy), patients on medication for hypertension (high blood

pressure) and those on tight glucose control.

Hypoglycemia symptoms

Tingling sensation around the mouth

Lightheadedness, dizziness

Sweats

Trembling, shakiness

Headache

Pallid skin (you go pale)

Irritability, moodiness, you might become tearful

Seizure (you have a fit, spasm)

Absent mindedness

Confusion

Clumsiness

Strong desire to eat

Diabetes treatment - hyperglycemia

Hyperglycemia is when your blood glucose is too high; it is the opposite of hypoglycemia. Hyperglycemia

needs to be treated immediately as it is a major cause of complications among people with diabetes.

Hyperglycemia happens when there is no insulin in the blood, not enough insulin in the blood, or the

insulin in the blood is not working properly.

The main reason for hyperglycemia for a patient who is being treated for diabetes type 1 is that he/she

has not given himself enough insulin. For a type 2 diabetic it could be the same reason, but also his/her

insulin is less effective than it should be.

For a patient with diabetes, overeating can bring on hyperglycemia, as can too little exercise on a given

day. Mental stress can also bring it on. Remember that your body's supply of insulin is determined by

how much you give yourself, and when. For a person who does not have diabetes his/her body will

respond automatically with appropriate quantities of insulin.

Symptoms of hyperglycemia

High blood glucose

High levels of sugar in the urine

Very hungry, hungry often (polyphagia)

Excessive thirst, frequent thirst (polydipsia)

Excessive and frequent urination (polyuria)

Blurred vision - Weight loss

Wounds and cuts heal poorly

Dry mouth

Cardiac arrhythmia

Deep and rapid breathing (kussmaul hyperventilation)

Impotence (erectile dysfunction)

Itchy and/or dry skin

Tiredness

Stupor

Coma

Good diabetes management is crucial

Your doctor will tell you what your glucose levels should be and how often you should check it. If you

stick to good diabetes management practices your chances of experiencing hyperglycemia are

significantly reduced.

Ketoacidosis

As soon as you detect hyperglycemia, treat it immediately. People who experience hyperglycemia and

do not treat it run a significantly high risk of going into diabetic coma (ketoacidosis).

Ketoacidosis happens when there is not enough insulin in your blood. Remember that without the

insulin your cells cannot get the vital fuel (energy) they need. Your body starts breaking down fats to get

its energy. This process of breaking down fats produces ketones - waste products. Large amounts of

ketones are bad for you. Excess ketones in your blood will result in frequent urination as your body tries

to eliminate it. However, it eventually becomes a losing battle, with the build up of ketones happening

faster than their elimination through urination.

Symptoms of ketoacidosis are:

your breath smells fruity

nausea and sometimes vomiting

your mouth is extremely dry

you are short of breath

Treating hyperglycemia

The American Diabetes Association says exercising can help lower blood glucose levels. If your blood

glucose is above 240mg/dl. Check your urine for ketones and do not exercise if there are ketones

present as this will raise your blood glucose levels even more!

Reducing your food intake will also help lower your blood glucose. It is important that you stick to your

meal plan, which should be worked out with a dietitian or health care professional.

Ask your doctor for the best way to lower blood glucose levels.

If none of the measures mentioned above manages to lower your blood glucose it is possible that your

medication may have to be re-scheduled. Your insulin and medication doses may need to be altered, as

might their timing (when you have them).

Remember that good diabetes management helps reduce the incidence of hyperglycemia. Learn to

detect hyperglycemia quickly so that you can treat it early on.

Diabetes treatment - taking insulin

You cannot take insulin as a pill. If you did, the moment it got to your stomach it would be digested and

would never get into your bloodstream.

You have to inject insulin into the fat just under your skin - from there it will get to your bloodstream.

There are many types of insulin. According to the American Diabetes Association (ADA) there are over

20 types of insulin in the American market. They work in different ways, they are made differently, and

they vary in price.

Insulin is most commonly made in laboratories today. It can also come from animals, mainly pigs.

Rapid-acting insulin

This type of human insulin starts to work within five minutes of being injected and peaks after about one

hour. It continues to be active for 2 to 4 hours. Examples of rapid-acting insulin are lispro marketed by

Eli Lilly, insulin aspart marketed by Novo Nordisk, or insulin glulisine marketed by sanofi-aventis.

Short-acting insulin

Also known as Regular (acting) insulin. This type of human insulin reaches your bloodstream

approximately 30 minutes after you inject it, and peaks from 2 to 3 hours after injection. It is effective

for 3 to 6 hours.

Intermediate-acting insulin

This human insulin takes from 2 to 4 hours to reach the bloodstream after injection. It peaks at 4 to 12

hours. It is effective for approximately 12 to 18 hours.

Long-acting insulin

This insulin gets into your bloodstream about 6 to 10 hours after you inject it. It is effective for 20 to 24

hours. This type of insulin is also known as ultralente.

Pre-mixed insulin

Some patients have to mix two different types of insulin. If they find that difficult they can have the

insulin pre-mixed. This is especially useful for people who are visually impaired.

Allergic reaction to insulin additives

The insulin a diabetic takes has additives to keep it free of bacteria and to tweak its time of action. Some

patients may have an allergic reaction to some additives found in intermediate and long-acting insulins -

however, this is very rare.

Diabetes treatment - insulin pump

Insulin pumps are mostly used by people with Diabetes Type 1. However, more and more people with

Type 2 are starting to use them.

Users say that the pump allows them to get the treatment to adapt to them, instead of the other way

round as is the case with insulin injections.

An Insulin Pump really can help you maintain your blood glucose levels with specific parameters.

Delivers short acting insulin all day and night

The pump delivers short (rapid) acting insulin, around the clock, through a catheter placed under your

skin. It separates your insulin dosage into the basal rate and the bolus dose.

Basal insulin

This is your normal level of blood insulin when you have not eaten or when you are asleep. Basal insulin

is delivered constantly throughout the day and night. It is possible to set the pump so that amounts vary,

depending on what time of day and night it is.

Bolus (extra)

When you eat your blood will need more insulin. You press buttons on the insulin pump which will give

you a bolus - additional insulin. The bolus covers your increased insulin requirement because you have

consumed carbohydrate.

If your blood glucose is too high you can take a bolus to bring it back down again.

Where do you have (wear) it?

Most people simply attach the pump to their belt or waistband using a clip or case. You can also keep it

in your pocket.

If you are wearing a dress you could attach it to your arm or leg under your clothes.

When sleeping many people place the pump next to them on the bed, place it under the pillow or attach

it to their clothing.

Pump manufacturers say the pump is very rugged and will withstand being dropped on the floor or the

occasional soaking. However, you should try to avoid that from happening.

Advantages of an insulin pump

No more injections

The pump is more accurate

They improve A1C

Blood glucose levels fluctuate less badly

Easier diabetes management

More leeway on your eating times

More leeway on what you eat

You can exercise without eating loads of carbs