Diabetes Information from Drugs.com

Diabetes is a life-long disease marked by high levels of sugar in the blood. It can be caused by too little insulin (a hormone produced by the pancreas to regulate blood sugar), resistance to insulin (when cells in the body cannot effectively use insulin), or both. Diabetes can lead to serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations, such as a foot or lower leg.

In their Standards of Medical Care in Diabetes (2014), the American Diabetes Association (ADA) recommends routine screening for type 2 diabetes beginning at age 45, especially in the overweight or obese, and the test should be repeated every three years if the results are normal. Screening is also recommended for all people who are under 45 and overweight or obese and with:

Diabetes is the seventh leading cause of death in the United States. As of 2010, 25.8 million people -- 8.3% of the population -- have diabetes; 1.9 million new cases of diabetes were diagnosed in people aged 20 years or older in 2010. The prevalence of diabetes is greater among older people. Among Americans aged 65 years or older, 26.9% (10.9 million people) have diabetes. Over 7 million people remain undiagnosed with diabetes, and roughly 79 million people have prediabetes, when blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. Long-term damage to the heart and circulatory system can still occur with prediabetes.

Among adults with diagnosed type 1 or type 2 diabetes, 12% take insulin only, 14% take both insulin and oral medication, 58% take oral medication only, and 16% do not take either insulin or oral medication.

The American Diabetes Association states that the total costs of diagnosed diabetes have risen from $174 billion in 2007 to $245 billion in 2012. This figure represents a 41 percent increase over a five year period.

To understand diabetes, it is important to first understand the normal process of food metabolism. Several things happen when food is digested:

People with diabetes have high blood glucose because their pancreas does not make enough insulin or their muscle, fat, and liver cells do not respond to insulin normally (insulin resistance), or both.

There are three major types of diabetes:

Type 1 Diabetes Risk Factors

Type 2 Diabetes Risk Factors (How Do You Get Type 2 Diabetes?)

Gestational Diabetes Risk Factors

As previously mentioned, the American Diabetes Association recommends that all adults be screened for diabetes at least every three years. A person at high risk should be screened more often.

Research shows that you can lower your risk for type 2 diabetes by 58% by:

High blood levels of glucose can cause several symptoms, including frequent urination, excessive thirst, hunger, fatigue, weight loss, and blurry vision. However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.

Symptoms of Type 1 Diabetes:

Symptoms of Type 2 Diabetes:

Symptoms of Gestational Diabetes

A urinalysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes. The following blood glucose tests are used to diagnose diabetes:

Patients with type 1 diabetes usually develop symptoms over a short period of time, and the condition is often diagnosed in an emergency setting. In addition to having high glucose levels, acutely ill type 1 diabetics have high levels of ketones.

There is no cure for diabetes. The immediate goals are to stabilize your blood sugar and eliminate the symptoms of high blood sugar. The long-term goals of treatment are to prolong life, relieve symptoms, and prevent long-term complications such as heart disease, amputations, and kidney failure.

Lifestyle changes are the cornerstone of diabetes management for all patients. In addition to medication, achieving goals for weight management and diet, physical activity, smoking cessation, and moderate alcohol use is imperative for diabetes control.

Bariatic weight loss surgery may be an option for patients with a BMI over 35 kg/m2 and type 2 diabetes. After surgery, patients will need lifelong lifestyle support and medical monitoring.

After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. People with diabetes need to review and update their knowledge, because new research and improved ways to treat diabetes are constantly being developed.

You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. Your specific meal plans need to be tailored to your food habits and preferences. People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugars from becoming extremely high or low. Type 2 diabetics should follow a well-balanced and low-fat diet.

A registered dietician can be very helpful in planning dietary needs.

Weight management is important to achieving control of diabetes. Some people with type 2 diabetes can stop medications after losing excess weight, although the diabetes is still present.

Medications to treat diabetes include insulin and glucose-lowering pills, called oral hypoglycemic agents. People with type 1 diabetes cannot make their own insulin, so daily insulin injections or inhalations are required. People with type 2 diabetes make insulin but cannot use it effectively.

Insulin is not available in oral tablet form, although a new inhaled insulin product called Afrezza was approved in 2014. Afrezza is an ultra rapid-acting inhaled insulin that is administered with meals to improve blood sugar control in adult diabetics. Insulin is usually is delivered by injections that are required one to four times per day. Some people use an insulin pump, which is worn at all times and delivers a steady flow of insulin throughout the day.

Insulin preparations differ in how quickly they start to work and how long they remain active. Sometimes different types of insulin are mixed together in a single injection. The types of insulin to use, the doses required, and the number of daily injections are chosen by a health care professional trained to provide diabetes care.

People who need insulin are taught to give themselves injections by their health care providers or diabetes educators. Special insulin pens are also available for some insulins that prevent the need for pulling up insulin with a needle into a syringe. The insulin is stored in the pen and needles can be attached to the pens prior to injection.

Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and/or oral medications. There are several oral hypoglycemic agents that lower blood glucose in type 2 diabetes. Selection of an oral diabetes treatment may follow this general guideline:

Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity, because when their ideal weight is reached, their own insulin and a careful diet can control their blood glucose levels. Even a 10-15 percent weight loss in some diabetic patients can drastically lower blood sugar.

Oral hypoglycemic agents are not known to be safe for use in pregnancy; women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy and while breast-feeding.

Gestational diabetes is treated with diet and insulin.

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

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

The American Diabetes Association recommends that premeal blood sugar levels fall in the range of 80 to 120 mg/dL and bedtime blood levels fall in the range of 100 to 140 mg/dL. Your doctor may adjust this depending on your circumstances.

You should also ask your doctor how often you need to have your hemoglobin A1c (HbA1c) level checked. The HbA1c is a measure of average blood glucose during the previous two to three months. It is a very helpful way to monitor a patient's overall response to diabetes treatment over time. A person without diabetes has an HbA1c around 5%. People with diabetes should try to keep it below 7%. Usually HbA1c is checked every three months.

Ketone testing is another test that is used in type 1 diabetes. Ketones build up in the blood when there is not enough insulin in people with type 1 diabetes, eventually "spilling over" into the urine. The ketone test is done on a urine sample. High levels of blood ketones may result in a serious condition called ketoacidosis. Ketone testing is usually done at the following times:

Another complication that can be avoided by checking the blood sugar level is Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS). HHNS is a serious condition usually seen in older persons with type 2 diabetes, although it can occur in type 1 patients also. HHNS is usually brought on by an illness or infection. HHNS only occurs when diabetes is uncontrolled. HHNS may occur gradually, and take days or even weeks to develop. The best way to avoid HHNS is to check your blood sugar regularly. Be aware of the symptoms of HHNS that include:

Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than diabetics who do not exercise regularly. You should be evaluated by your physician before starting an exercise program.

Here are some exercise considerations:

Changes in exercise intensity or duration may require changes in diet or medication dose to keep blood sugar levels from going too high or low.

If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.

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

For additional information, see diabetes resources.

The risks of long-term complications from diabetes can be reduced.

The Diabetes Control and Complications Trial (DCCT) studied the effects of tight blood sugar control on complications in type 1 diabetes. Patients treated for tight blood glucose control had an average HbA1c of approximately 7%, while patients treated less aggressively had an average HbA1c of about 9%. At the end of the study, the tight blood glucose group had dramatically fewer cases of kidney disease, eye disease, and nervous system disease than the less-aggressively treated patients.

In the United Kingdom Prospective Diabetes Study (UKPDS), researchers followed nearly 4,000 people with type 2 diabetes for 10 years. The study monitored how tight control of blood glucose (HbA1c of 7% or less) and blood pressure (less than 144 over less than 82) could protect a person from the long-term complications of diabetes.

This study found dramatically lower rates of kidney, eye, and nervous system complications in patients with tight control of blood glucose. In addition, there was a significant drop in all diabetes-related deaths, including lower risks of heart attack and stroke. Tight control of blood pressure was also found to lower the risks of heart disease and stroke.

The results of the DCCT and the UKPDS dramatically demonstrate that good blood glucose and blood pressure control, many of the complications of diabetes can be prevented.

Emergency complications include diabetic hyperglycemic hyperosmolar coma.

Long-term complications include:

Go to the emergency room or call the local emergency number (such as 911) if symptoms of ketoacidosis occur:

Go to the emergency room or call the local emergency number if symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction) occur:

Maintaining an ideal body weight and an active lifestyle may prevent the onset of type 2 diabetes. Currently there is no way to prevent type 1 diabetes.

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Diabetes Information from Drugs.com