Diabetes

Are You at Risk?

Complete the diabetes awareness quiz, Could You Have Diabetes and Not Know It? Add your score and check your risk. Available on the Internet.

What You Will Learn

This information will help you better understand what diabetes is, the problems associated with it and the type of diet, medication and exercise recommended for treatment.

Introduction: 

According to the American Diabetes Association, 18.2 million Americans have diabetes and about 151,000 young people less than 20 years of age have diabetes. 

Some people are more likely to get diabetes. They include (1) people who have family members with diabetes, (2) certain ethnic groups, including native Americans, African Americans, Hispanic and Asian/Pacific Islanders and (3) people with some other health problems, such as being overweight.

There is no cure for diabetes yet, so people with diabetes must learn to manage the disease and take care of themselves properly.

What is Diabetes?

Diabetes is a serious chronic (lifelong) disease. People with diabetes either can’t make or properly use a hormone called insulin. This causes high levels of glucose (sugar) in the blood. Without insulin, glucose (sugar) levels in the blood get very high because the body can’t use the sugar from digested food for energy.

Most people now use the common term “diabetes” rather than the full term “diabetes mellitus” (di-uh-bee-tess mell–le–tus). Diabetes mellitus means "sweet urine." (Latin terms:  diabetes – to pass through and mellitus - sweet). When blood glucose levels get too high, glucose spills into the urine. Testing the urine for excess sugar was used to diagnose diabetes in the past.

Glucose is a simple sugar that is the body’s main source of energy. (A simple sugar does not break down into other sugars.) Much of the food we eat is broken down into glucose during digestion. Glucose is carried through the bloodstream to the body’s cells to be used for energy for all the things we do.
 

Our blood always has some glucose in it because the body needs glucose for energy. Our bodies keep the amount of glucose in the blood from being too high or too low.  

Insulin is the hormone the body needs to move glucose (sugar) from the blood into body cells to be used for energy. Insulin is produced by the beta cells of the Islets (Eye-lets) of Langerhans located in the pancreas (pan-kree-us). Insulin has three important functions:

a. Allows glucose to pass into cells to be used for energy.

b. Suppresses excess production of sugar in the liver.

c. Suppresses breakdown of fat for energy.

Without insulin, blood sugar levels rise because muscle and fat cells aren't able to use glucose for energy. The cells tell the body that they're "hungry" and the liver releases glycogen, a form of stored glucose. This further increases the blood sugar level. Hyperglycemia (hi-per-gli-ce-me-uh) means high blood sugar.  Hyperglcemia occurs when the body doesn’t make insulin or cannot use insulin properly to turn glucose into energy. Hyperglycemia occurs in diabetes.

Insulin is produced by the beta (bay-tah) cells in the (Islets/Islands (eye-lets) of Langerhans (lang-er-hans) located in the pancreas.
 

Normally after eating, many foods break down into glucose during digestion and move from the small intestine into the blood. The blood carries the glucose to the body cells.  The cells need insulin to move glucose from the blood into the cells where it can be used for energy. In other word, insulin acts as a key to open cells to let glucose in to be changed into energy for the body’s needs.

For the person who has diabetes, the food breaks down into glucose during digestion and then moves from the intestinal tract through the bloodstream to the cells; however, since the body either doesn’t make or use insulin properly, glucose can’t get into the cells and sugar builds up in the blood. Remember, insulin is the key that opens cell doors to let glucose (sugar) in to be used for energy.

Blood tests are used to find the amount of sugar in the blood. They show the normal blood glucose level and the blood glucose level for diagnosing diabetes. 

Normal - less than 110 mg/dl    (mg/dl = milligrams per deciliter)

Diabetes - 126 mg/dl or higher   (mg/dl = milligrams per deciliter)

(To diagnose diabetes, two tests with results of 126 mg/dl or more are needed. The blood tests should be done after an overnight fast, without food or beverage.)

Pre-diabetes is a new term that is being used for those people whose blood sugar is between 110 and 125 mg/dl. These people are likely to develop diabetes.

Think and review: 
What is diabetes? What is insulin? Why does blood sugar get high with diabetes?  

Two types of diabetes:

There are two major types of diabetes:  type 1 and type 2.  

Type 1 diabetes used to be called “juvenile diabetes” and insulin-dependent diabetes. Type 1 diabetes is a disease that occurs because the body can’t make insulin and sugar levels in blood get too high.

Five percent to 10 percent of all diabetes cases are type 1. Most children with diabetes have type 1 diabetes. Type 1 diabetes usually develops in youth but it can develop at any age. Each year, more than 13,000 youth are diagnosed with type 1 diabetes. Approximately one in every 400 to 500 children and adolescents has type 1 diabetes. The peak incidence of type 1 occurs during puberty, around 10 to 12 years of age in girls and 12 to 14 years of age in boys. More Caucasians have type 1 diabetes than other ethnic groups.

Type 1 diabetes is one of the most common chronic diseases in school-aged children. About 159,000 young people in the U.S. under age 18 have type 1 diabetes. The risk of developing type 1 diabetes is higher than almost all other severe chronic childhood diseases. Only asthma is more common.

Type 1 is an autoimmune disease in which the immune system makes a mistake and destroys good cells. In type 1 diabetes, the cells that normally protect from germs or viruses attack and destroy the beta cells of the pancreas instead. Without beta cells, the body can’t make insulin. Without insulin, sugar builds up in the blood, causing type 1 diabetes. Type 1 diabetes often occurs after flu-like symptoms.

Type 1 diabetes tends to run in families. Brothers and sisters of children with type 1 diabetes have about a 10% chance of developing the disease by age 50. The identical twin of a person with type 1 diabetes has a 25 percent to 50 percent higher chance of developing type 1 diabetes than a child in an unaffected family.

Type 1 can’t be prevented or cured yet. People with type 1 diabetes must treat their diabetes by taking insulin every day by injections (shots), insulin pen or insulin pump. Type 1 diabetes is not contagious.

Type 2 diabetes was previously known as “adult onset” and “non-insulin dependent diabetes.” Ninety percent to 95 percent of diabetes cases are type 2.  Most people with Type 2 diabetes have a close family member with Type 2.

The risk of type 2 diabetes increases as people grow older. Most cases begin after age 30 or 40 but the number of children and teens with type 2 is increasing. About 20 percent of new cases of childhood diabetes are type 2.

Type 2 diabetes runs in families. Having a first or second-degree relative increases the risk for type 2. Ethnic groups at increased risk of type 2 diabetes are native Americans, African Americans, Hispanic and Asian/Pacific Islanders.

Type 2 diabetes occurs because the body either can’t make enough insulin or can’t use insulin properly, causing sugar to build up in the blood. When the body can’t use the insulin it produces effectively, this is called insulin resistance. When the cells resist insulin, glucose can’t get into cells and builds up in the blood, causing type 2 diabetes. Because the body cells are resistant to insulin, the pancreas works harder to produce more insulin. For a while, the body may have high levels of insulin. Eventually, the pancreas produces only a little or no insulin. Being overweight, having poor eating habits and being inactive may lead to insulin resistance.

The risk of developing type 2 diabetes can be reduced by having a healthy lifestyle, including eating healthfully, being physically active and not gaining too much weight. Poor dietary habits, inactivity and overweight may keep the body from using insulin properly (insulin resistance) and lead to type 2 diabetes. Type 2 diabetes is increasing in all age groups because of inactivity, poor eating habits and overweight. About 85 percent of type 2 cases in kids are linked to excessive weight.

Eating healthy meals and adding more physical activity have been shown to help control blood sugar levels. If diet and exercise are not enough, oral medications (pills) or insulin are prescribed. Treatments for children usually begin with changing their diet and exercise habits.

Another type of diabetes is gestational (jess-tae-shun-al) diabetes. Gestational diabetes occurs during pregnancy. All pregnant women are tested for high blood glucose to find out if they have gestational diabetes and receive treatment if they have the condition. Many women who have gestational diabetes develop diabetes later. 

Women who have gestational diabetes often give birth to babies weighing 9 pounds or more. Gestational diabetes causes babies to gain weight because the sugar in the mother’s blood passes through the placenta to the baby and causes the baby to gain extra weight. The mother’s blood may also carry other substances, such as ketones, which can pass through the placenta and cause developmental problems for the baby.

These large babies face health problems, including damage to their shoulders during birth and higher risk for breathing problems. Because the baby’s pancreas has to make extra insulin to take care of the extra glucose from the mother, newborns may have very low blood glucose levels at birth. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes. 

Think and review:

What are the two main types of diabetes?

Which type of diabetes used to be called “adult onset diabetes” but is now increasing in children and teens?

Symptoms of Diabetes:

Type 1 symptoms:  High blood glucose levels cause the symptoms of diabetes.  The symptoms of type 1 diabetes include: 

• Thirst – When sugar levels are high, extra water is needed to dissolve and flush out the sugar. This causes extreme thirst (polydipsia {polly-dip-see-uh). Even though the person drinks lots of water or fluids, he may become dehydrated.
• Frequent urination - The kidneys are working overtime to remove the excess sugar from the blood and large amounts of urine are produced. The person has to urinate very often. Frequent urination is called polyuria {polly-your-ee-uh).
• Hunger – Because body cells are starved for energy, the person feels very hungry and may eat a lot of food but still loses weight. Increased appetite is called (polyphagia {polly-fay-gee-uh).
• Weight loss - Because body cells are starved for energy, the person often loses weight even though eating often.
• Tired – A person with high blood glucose levels may feel tired, drowsy, weak or irritable.
• Blurry vision - Some people may have vision problems.
• Stomachache or nausea may occur also.

The symptoms of type 1 diabetes can become severe. A dangerous condition called diabetic ketoacidosis {kee-toe-as-eh-doe-see-us} (DKA) can occur if diabetes symptoms aren’t recognized and treated to bring down very high blood sugar levels.

The symptoms of DKA include a fruity breath odor, nausea and vomiting, stomach pain, lethargy, sleepiness and difficulty breathing. Without treatment, the person may go into a coma and die. DKA requires immediate emergency treatment! 

(Explanation of DKA:  Without insulin to move glucose into cells for energy, the body begins to metabolize protein and fat. When the body uses stored fat for energy, ketones (acids) produced in the liver build up in the blood. Ketones are excreted in the urine along with sodium bicarbonate, which results in a decrease in the pH of the blood. This condition is called diabetic ketoacidosis (DKA). To correct the acidosis, the body begins a deep, labored respiration, called Kussmaul’s respiration. The person may have nausea and vomiting, which can lead to loss of water from the body, stomach pain, a flushed face, dry skin and mouth, a rapid and weak pulse, and low blood pressure. If the person is not given fluids and insulin right away, ketoacidosis can lead to coma and even death.)

Type 2 symptoms: Many of the symptoms of type 2 and type 1 diabetes are the same.  A person may have all or some of the symptoms. It’s also possible not to have any signs or to be aware of them. The major signs are:

• Frequent urination
• Thirst
• Hunger
• Fatigue
• Irritability
• Slow healing of wounds or sores
• Tingling or numbness in hands or feet
• Dry skin
• Itching
• Blurry vision
• Acanthosis nigricans (A-can-toe-sis nie-greh-cans) – dark, thick velvety patches on the skin around the neck or in the armpits
• High blood pressure