Filed under: Diabetes
The term "diabetes mellitus" refers to a group of diseases that affect how your body uses blood glucose, commonly called blood sugar. Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's your brain's main source of fuel.
If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the reasons may differ. Too much glucose can lead to serious health problems.
Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes — when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes — and gestational diabetes, which occurs during pregnancy.
Diabetes symptoms vary depending on how high your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, however, symptoms tend to come on quickly and be more severe. Some of the signs and symptoms of type 1 and type 2 diabetes include:
Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the most common type, can develop at any age and is often preventable.
When to see a doctor
To understand diabetes, first you must understand how glucose is normally processed in the body.
How glucose normally works
Glucose is a main source of energy for the cells that make up your muscles and other tissues. Glucose comes from two major sources: the food you eat and your liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells, with the help of insulin.
The hormone insulin comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key, unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.
Your liver acts as a glucose storage and manufacturing center. When you haven't eaten in a while your liver releases stored glucose to keep your glucose level within a normal range.
Causes of type 1 diabetes
In type 1 diabetes, your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream. Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what those factors are is still unclear.
Causes of prediabetes and type 2 diabetes
In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells, sugar builds up in your bloodstream. Exactly why this happens is uncertain, although as in type 1 diabetes, it's believed that genetic and environmental factors play a role in the development of type 2. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.
Causes of gestational diabetes
During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin. As your placenta grows larger in the second and third trimesters, it secretes more of these hormones — making it even harder for insulin to do its job.
Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can't keep up. When this happens, too little glucose gets into your cells and too much stays in your blood. This is gestational diabetes.
Risk factors for diabetes depend on the type of diabetes.
Risk factors for type 1 diabetes
Although the exact cause of type 1 diabetes is unknown, genetic factors likely play a role. Your risk of developing type 1 diabetes increases if you have a parent or sibling who has type 1 diabetes. Environmental factors, such as exposure to a viral illness, also likely play some role in type 1 diabetes. Other factors that may increase your risk include:
Risk factors for prediabetes and type 2 diabetes
Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including:
Risk factors for gestational diabetes
Any pregnant woman can develop gestational diabetes, but some women are at greater risk than are others. Risk factors for gestational diabetes include:
Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:
Complications of gestational diabetes
Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.
Complications in your baby can occur as a result of gestational diabetes:
Complications in you can also occur as a result of gestational diabetes:
Complications of prediabetes
Prediabetes may develop into type 2 diabetes.
You're likely to start by seeing your primary care doctor if you are experiencing symptoms of diabetes. If your child is experiencing symptoms of diabetes, you might see your child's pediatrician. If blood sugar levels are extremely high, you'll likely be sent to the emergency room. If blood sugar levels aren't so high as to put you or your child immediately at risk, you may be referred to an endocrinologist, a doctor who specializes in diabetes, among other disorders.
Because appointments can be brief, and because there's often a lot of ground to cover, it's good to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Preparing a list of questions can help you make the most of your time together. List your questions from most important to least important, in case time runs out. For diabetes, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
Symptoms of type 1 diabetes often appear suddenly and are usually the reason that blood sugar levels are checked. Because symptoms of other types of diabetes and prediabetes come on more gradually, the American Diabetes Association (ADA) has recommended screening guidelines. The ADA recommends that the following people be screened for diabetes:
Tests for type 1 and type 2 diabetes
If the A1C test results aren't consistent, the test isn't available, or if you have certain conditions that can make the A1C test inaccurate — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to diagnose diabetes:
If type 1 diabetes is suspected, you'll also likely have a blood test to look for diabetes antibodies. In addition, your urine will be tested to look for the presence of ketones, a byproduct produced when muscle and fat tissue are used for energy when the body doesn't have enough insulin to use the available glucose.
Tests for gestational diabetes
Medical experts haven't established a single set of screening guidelines for gestational diabetes. Some question whether gestational diabetes screening is needed if you're younger than 25 and have no risk factors. Others say that screening all pregnant women — no matter their age — is the best way to catch all cases of gestational diabetes.
Your doctor will likely evaluate your risk factors for gestational diabetes early in your pregnancy.
Your doctor may use the following screening tests:
Tests for prediabetes
The primary test to screen for prediabetes is:
If the A1C test isn't available, or if you have certain conditions that can make the A1C test inaccurate — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to diagnose diabetes:
Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral medications may play a role in your treatment. A pancreas transplant may be an option for people with diabetes that is difficult to control.
But no matter what type of diabetes you have, eating a healthy diet, maintaining a healthy weight and keeping an eye on your blood sugar levels are all keys to managing your diabetes.
Treatments for all types of diabetes
An important part of managing all types of diabetes is maintaining a healthy weight through a healthy diet and exercise plan:
Healthy eating. Contrary to popular perception, there's no diabetes diet. You won't be restricted to boring, bland foods. Instead, you'll need plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — and fewer animal products and sweets. In fact, it's the best eating plan for the entire family. Even sugary foods are OK once in a while, as long as they're included in your meal plan.
Yet understanding what and how much to eat can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. This may include carbohydrate counting, especially if you have type 1 diabetes.
Treatments for type 1 and type 2 diabetes
Treatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent blood sugar checks and carbohydrate counting. Treatment of type 2 diabetes primarily involves monitoring of your blood sugar, along with diabetes medications, insulin or both.
Monitoring your blood sugar. Depending on your treatment plan, you may check and record your blood sugar level several times a week to three or more times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. People who receive insulin therapy may also choose to monitor their blood sugar levels with a continuous glucose monitor. Although this technology doesn't yet replace the glucose meter, it can provide important information about trends in blood sugar levels.
Even if you eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to things like food, physical activity, medications, illness, alcohol, stress and — for women — fluctuations in hormone levels.
In addition to daily blood sugar monitoring, your doctor may recommend regular A1C testing to measure your average blood sugar level for the past two to three months. Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working overall. An elevated A1C level may signal the need for a change in your insulin regimen or meal plan. Your target A1C goal may vary depending on your age and various other factors. However, for most people, the American Diabetes Association recommends an A1C of below 7 percent. Ask your doctor what your A1C target is.
Insulin. Anyone who has type 1 diabetes needs insulin therapy to survive. Some people with type 2 diabetes also need insulin therapy. Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar. Often insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin.
An insulin pump also may be an option. The pump is a device about the size of a cell phone worn on the outside of your body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of your abdomen. A tubeless pump that works wirelessly is also now available. You program an insulin pump to dispense specific amounts of insulin. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.
Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.
Treatment for gestational diabetes
Controlling your blood sugar level is essential to keeping your baby healthy and avoiding complications during delivery. In addition to maintaining a healthy diet and exercising, your treatment plan may include monitoring your blood sugar and, in some cases, using insulin.
Your health care provider will also monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin — which can lead to low blood sugar right after birth.
Treatment for prediabetes
If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes. Maintaining a healthy weight through exercise and healthy eating can help. Exercising at least 150 minutes a week and losing 5 to 10 percent of your body weight may prevent or delay type 2 diabetes.
Sometimes medications — such as the oral diabetes drugs metformin (Glucophage) and acarbose (Precose) — also are an option if you're at high risk of diabetes, including when your prediabetes is worsening or you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.
In other cases, medications to control cholesterol — statins, in particular — and high blood pressure medications are needed. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease if you are at high risk. Healthy lifestyle choices remain key, however.
Signs of trouble in any type of diabetes
Because so many factors can affect your blood sugar, problems sometimes arise. These conditions require immediate care, because if left untreated, seizures and loss of consciousness (coma) can occur.
Diabetes is a serious disease. Following your diabetes treatment plan takes round-the-clock commitment. But your efforts are worthwhile. Careful management of diabetes can reduce your risk of serious — even life-threatening — complications.
No matter what type of diabetes you have:
Lifestyle for type 1 and type 2 diabetes
In addition, if you have type 1 or type 2 diabetes:
Above all, stay positive. The good habits you adopt today can help you enjoy an active, healthy life with diabetes.
Numerous substances have been shown in some studies to improve insulin sensitivity, yet other studies have failed to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, no alternative therapies are currently recommended for diabetes control. Some of the substances that have shown promise in helping to control blood sugar include:
If you decide that you'd like to try an alternative therapy, don't stop taking the medications that your doctor has prescribed, and discuss the use of any of these therapies with your doctor to be sure that they won't cause adverse reactions with your current therapy.
Additionally, there are no treatments — alternative or conventional — that can cure diabetes, so it's critical that people who are on insulin therapy for diabetes don't stop using insulin unless directed to do so by their physician.
Living with diabetes day in, day out can be difficult and frustrating. Sometimes, even when you've done everything right, your blood sugar levels may rise. But stick with your diabetes management plan, and you'll likely see a positive difference in your A1C when you visit your doctor.
Because good diabetes management can be time-consuming, and sometimes overwhelming, some people find it helps to talk to someone. Your doctor can probably recommend a mental health professional for you to speak with, or you may want to try a support group. Sharing your frustrations and your triumphs with people who understand what you're going through can be very helpful. And you may find that others have great tips to share about diabetes management. Your doctor may know of a local support group, or you can call the American Diabetes Association at 800-DIABETES (800-342-2383) or the Juvenile Diabetes Research Foundation at 800-533-CURE (800-533-2873).
Type 1 diabetes can't be prevented. However, the same healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can help prevent them.
Sometimes medication is an option as well. Oral diabetes drugs such as metformin (Glucophage) may reduce the risk of type 2 diabetes — but healthy lifestyle choices remain essential.
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