Diabetes 101

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Diabetes overview

Diabetes is a condition in which blood glucose (sugar) is too high. The body uses glucose from food as a source of energy, much like a car uses gasoline for fuel. Insulin, a hormone that is made in the pancreas, moves glucose from the bloodstream into cells to be used for energy. When you have diabetes, your body either doesn’t make enough insulin (or stops making insulin altogether), or doesn’t use its own insulin as well as it should. As a result, glucose builds up in the blood and can’t get into cells to be used for energy.

Diabetes causes

There are many types of diabetes. Two of the main types of diabetes are Type 1 diabetes and Type 2 diabetes. Type 1 diabetes occurs when the immune system attacks and destroys the cells in the pancreas (called beta cells) that make insulin. The exact cause of Type 1 diabetes isn’t known, but scientists think that genes or environmental factors (such as viruses) could be responsible.

Type 2 diabetes is also caused by genes, as well as lifestyle factors, such as being overweight and not getting enough physical activity. The good news is that Type 2 diabetes can be prevented by losing between 5 and 10 percent of your body weight and aiming to get at least 15 minutes of moderate physical activity each week.

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Who gets diabetes?

About 30 million (9.4 percent) Americans have diabetes. Anyone at any age can get either Type 1 or Type 2 diabetes. Type 1 diabetes accounts for about 5 percent of cases of diabetes. However, Type 1 diabetes usually appears during childhood or adolescents. But again, adults get Type 1 diabetes, too. Risk factors for Type 1 diabetes include genes from both parents and environmental factors such as cold weather and viruses. Scientists think that people who are breastfed as infants and introduced to solid foods at a later age are less likely to get Type 1 diabetes.

There are more risk factors for Type 2 diabetes, and it’s more common than Type 1 diabetes, accounting for 90 to 95 percent of cases of diabetes. Type 2 diabetes risk factors include:

• older age
• being of certain ethnic and racial groups (African Americans, Native Americans, Hispanics, Asian Americans and Pacific Islanders)
• family history
• being overweight or obese
• having prediabetes
• having had gestational diabetes or a baby weighing more than 9 pounds at birth
• polycystic ovary syndrome
• inactivity

Diabetes symptoms

Symptoms of diabetes include:

• increased thirst and hunger
• frequent urination
• fatigue
• weakness
• blurred vision
• numbness or tingling in the hands or feet
• cuts or sores that don’t heal
• frequent yeast infections
• unexplained weight loss
• areas of darkened skin on the neck and in the armpits (called acanthosis nigricans)

Symptoms of Type 1 diabetes usually appear very quickly — often within a matter of weeks. Symptoms of Type 2 diabetes tend to develop more slowly — over many years, even — and for this reason, some people don’t notice any symptoms. In addition, many people who have Type 2 diabetes have no symptoms at all. They may find out if they have a diabetes-related health problem such as blurry vision or a heart attack.

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Diagnosing diabetes

Anyone with symptoms of diabetes should see their health-care provider for proper diagnosis. Using a home blood glucose meter or going to a health fair for a blood glucose check is not a valid way to diagnose this condition.

Your health-care provider will likely do one of the following blood tests to help diagnose diabetes:

• Fasting plasma glucose (FPG): This test is a blood test that measures the amount of glucose in your blood after fasting (not eating or drinking, other than water) for at least 8 hours. For this reason, it’s easiest for most people to have this test done first thing in the morning. A FPG of 126 mg/dl or higher can indicate diabetes.

• Random plasma glucose (RPG): This test is a glucose test that is performed at any time. It’s more likely to be used if you have symptoms of diabetes. A RPG result of 200 mg/dl or higher can indicate diabetes.

• A1C test (also called HbA1C or glycosylated hemoglobin): This is a blood test that measures your average blood glucose levels over the past 3 months. You can eat and drink before you have this test. An A1C result of 6.5 percent of higher can indicate diabetes.

These tests are usually repeated on a different day before a diabetes diagnosis is confirmed.

Sometimes, it’s not clear what type of diabetes a person has. In this instance, your health-care provider may order blood tests for autoantibodies and/or c-peptide; he or she may also check your urine for the presence of ketones.

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Getting checked for diabetes

Anyone with symptoms of diabetes should see their health-care provider right away. Because Type 1 diabetes runs in the family, relatives of people with Type 1 diabetes can be screened to detect the risk of developing Type 1 diabetes years before symptoms appear through a study called TrialNet.

Your health-care provider should screen you for Type 2 diabetes if you:

• are age 45 or older
• are between the ages of 19 and 44, are overweight or obese, and have one or more other diabetes risk factors
• are a woman who has had gestational diabetes

Children and teenagers can get Type 2 diabetes too. For this reason, your child’s health-care provider should screen for Type 2 diabetes if your child:

• is overweight or obese
• had a low birthweight
• has a mother who had diabetes while pregnant with them
• has any other risk factors for Type 2 diabetes

ABCs of diabetes

There’s a lot to know and do to manage your diabetes. Learning as much about your condition as possible and making sure you have support from your health-care team, family and friends will be helpful for you.

Knowing your diabetes ABC’s will help you to manage your blood glucose, blood pressure and smoking. Keeping your “numbers” at goal can lower your risk of having a heart attack, stroke, and eye, kidney and nerve damage. Stopping smoking is also very important.

• A is for A1C. The goal for most people with diabetes is less than 7 percent. The A1C is usually measured every three to 6 months.

• B is for blood pressure. The goal for most people is a below 140/90 mmHg. Your goal may be lower if you are younger or if you have kidney disease.

• C is for cholesterol. Your provider will measure HDL (good) and LDL (bad) cholesterol. Ask your provider what your goals are. If you are over 40 years of age, you may need to take a medicine called a statin.

• S is for stopping smoking. Smoking raises your risk of heart disease, nerve damage, kidney disease, eye disease and amputation. Ask your provider for help to quit smoking, or visit https://smokefree.gov for more information on ways to quit.

Talk with your health-care provider or a certified diabetes counselor about your “ABC” goals and how often you should have your numbers checked.

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Managing Diabetes: medications

While there is currently no cure for diabetes, it can be managed, and you can live a long and healthy life if you take care of yourself.

One way to manage diabetes is by taking medication. You may need medication to keep your blood glucose at a safe level; you may also need medication to help manage your blood pressure and cholesterol, since you have a higher risk of heart and kidney disease when you have diabetes.

There are several different types of diabetes medications, including:

• Insulin: People with type 1 diabetes must inject insulin to survive. Many people with type 2 diabetes need to take insulin, too. Insulin is injected using a syringe or a pen device; some people wear an insulin pump, instead.

• Diabetes pills: Diabetes pills are for people who have Type 2 diabetes.

• Non-insulin injectables: These are medications that have to be injected, but they are not insulin. They help your body use insulin better and may even help you lose weight.

Be sure to take your medication as prescribed, even if you feel well or your blood glucose levels are in your target range. Tell your provider if you have side effects or if you have trouble affording your medications.

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Checking your blood glucose

Checking your blood glucose with a meter is an important way to help you manage your diabetes. Without checking, you won’t know how your diabetes doing day to day. It’s especially helpful to check your blood sugar if you:

• Take insulin
• Are starting a new diabetes medication or are changing the dose of your medication
• Are pregnant
• Have frequent low blood sugars (hypoglycemia)
• Have low blood glucose but don’t feel symptoms

Ask your provider how often you should check your blood glucose and find out what your goals are. Common blood glucose goals for people with diabetes are:

• 80 to 130 before meals
• Less than 180 two hours after meals

You provider may be able to give you a blood glucose meter, or you can purchase one at your local pharmacy. A certified diabetes educator or your pharmacist can show you how to use your meter.

Keep a record of your blood glucose results or use a smart phone app to track them. Be sure to show your blood glucose results to your provider at your regular office visits.

Learn what to do if your blood glucose becomes too low (hypoglycemia) or too high (hyperglycemia). You may need a change in your diabetes medication, your eating plan, your physical activity plan, or all three.

Healthy eating

A healthy eating plan is important for everyone who has diabetes. You don’t need to follow a strict diet, but you will likely need to make some changes in order to keep your blood glucose levels in your target range. An eating plan can also help you lose weight and control your blood pressure and cholesterol, as well. Here are foods to include in your diabetes eating plan:

Healthy carbohydrate (carb) foods

• Fruits
• Vegetables
• Whole grains
• Legumes (beans and peas)
• Lower-fat dairy foods, such as milk and yogurt

Limit carbs that contain added sugar, like soda, candy, cake and cookies.

Protein foods

• Poultry without the skin
• Fish and seafood
• Lean red meat
• Eggs
• Tofu

Limit protein foods that are fried or high in saturated fat, such as sausage, hot dogs and fatty red meat.

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Fat foods

• Olive, canola and peanut oils
• Avocados
• Nuts and seeds

Limit fats that are solid at room temperature, such as butter, shortening, coconut oil and lard.

If you have high blood pressure, your provider may also recommend that you limit your sodium intake. Cut down on high sodium foods such as canned soups and vegetables, fast foods, and salty snacks like potato chips.

An easy way to get started with an eating plan is to use the plate method. Anyone with diabetes can use this approach. Here’s how it works:

• Fill half of your plate with low carb vegetables such as broccoli, spinach and tomatoes.
• Fill a quarter of your plate with a whole grain such as brown rice or a starchy vegetable such as peas.
• Fill the other quarter of you plate with a protein food, such as chicken breast, salmon or lean beef.
• Include a heart-healthy fat in small amounts such as avocado or almonds.
• Add a small piece of fruit or a cup of low fat milk or plain yogurt.

There are other meal-planning approaches that can work, too. Ask your doctor to refer you to a registered dietitian to help you develop an eating plan that will work best for you.

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Physical activity

Being active most days of the week will make it easier for you to manage your blood glucose. At the same time, it can help you lower your blood pressure and cholesterol, manage your weight, sleep better and deal with stress.

Aim to be active most days of the week for at least 30 minutes. If that sounds like too much, set a goal to do 10 minutes of activity, three times a day. It’s OK to start out slow and work your way up.

Choose one or two activities that you might enjoy doing. Walking is a great choice because you can walk just about anywhere, and you don’t need a gym membership or expensive equipment. However, swimming, dancing, tennis and bicycling are good options, too. Find something that you like to do so that you’re more likely to stick with it.

Always check with your health-care provider before starting a new physical activity program, especially if you have heart disease or other problems related to diabetes such as nerve or diabetic eye disease.

Coping with diabetes

Finding out that you have a chronic condition like diabetes is scary, and it’s normal for you to feel frightened, sad or stressed. It’s important to deal with stress because stress can raise your glucose levels. And when you’re under stress, you’re less likely to take care of yourself.

Stress may not go away, but there are ways to lower it. These include:

• Doing some type of physical activity
• Talking with a friend or loved one
• Gardening
• Watching a favorite movie
• Taking a nap
• Doing yoga or meditation

You might also find that joining a diabetes support group can be helpful, either in-person or online. Check with your local hospital for support group offerings, or ask your provider or diabetes educator. You can also call your local American Diabetes Association to find out about resources in your community.

If you can’t seem to shake feelings of sadness, you may be depressed. Depression is more common in people with diabetes than in people without diabetes. Taking care of diabetes is hard, and you may feel alone. Having complications of diabetes, such as heart disease can also lead to depression. Don’t be afraid to reach out for help if you feel down. Your provider can refer you to a mental health counselor, or you may find that a support group or talking with a clergy member is helpful. Therapy and even medication for depression can be effective treatments. Depression is treatable!

Do your best to make time to take care of yourself. That means getting 7 to 8 hours of sleep each night, eating regular meals, making time for physical activity and surrounding yourself with people who care about you.

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Your diabetes care team

You probably have a primary-care provider, such as a doctor, nurse practitioner or physician assistant. When you have diabetes, you will likely need other members as part of your health-care team. These may include:

• an endocrinologist for more specialized diabetes care
• a registered dietitian
• a nurse
• a certified diabetes educator
• a pharmacist
• a dentist
• an eye doctor
• a podiatrist, or foot doctor, for foot care
• a social worker, who can help you find financial aid for treatment and community resources
• a counselor or other mental health care professional

Remember that you are the most important member of your health-care team. Your team is there to help and support you, but you’re in charge of your health. Here’s how:

• Ask questions of your diabetes health-care team and make sure you’re involved in decision-making. Make a list of questions before your visits. Ask your spouse, a family member or a friend to go with you to your appointments.

• Keep all of your appointments, including annual physicals, annual dilated eye exams, and visits with your dietitian and diabetes educator.

• Make sure that your blood pressure, weight and feet are checked at every regular office visit. Ask the medical assistant or nurse to give your results.

• Ask your provider about your results and goals for your “ABCs.”

• Find out about options for medications, blood glucose monitoring and meal planning — be part of the decision making.

• Meet with a diabetes educator to learn what to do when you are sick or scheduled for a medical procedure.

• Find out what vaccinations you may need to keep from getting sick.

• Learn what to do and how to care for your diabetes when you are traveling

Managing diabetes is a lot of work, but your health-care team is there for you. With the right support and care, you can lead a healthy and fulfilling life with diabetes!

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Author: James Steinmetz

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