DIABETES: WHAT YOU NEED TO KNOW.

                                      What is diabetes?

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels that result from defects in insulin secretion, or its action, or both. Diabetes mellitus, commonly referred to as diabetes (as it will be in this article) was first identified as a disease associated with "sweet urine," and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine.
Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes, the absence of insufficient production of, or lack of response to insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime.

                                    What causes diabetes?

Reader Stories
  • Insufficient production of insulin (either absolutely or relative to the body's needs), production of defective insulin (which is uncommon), or the inability of cells to use insulin properly and efficiently leads to hyperglycemia and diabetes. This latter condition affects mostly the cells of muscle and fat tissues, and results in a condition known as insulin resistance. This is the primary problem in type 2 diabetes. The absolute lack of insulin, usually secondary to a destructive process affecting the insulin-producing beta cells in the pancreas, is the main disorder in type 1 diabetes. In type 2 diabetes, there also is a steady decline of beta cells that adds to the process of elevated blood sugars. Essentially, if someone is resistant to insulin, the body can, to some degree, increase production of insulin and overcome the level of resistance. After time, if production decreases and insulin cannot be released as vigorously, hyperglycemia develops.
Glucose is a simple sugar found in food. Glucose is an essential nutrient that provides energy for the proper functioning of the body cells. Carbohydrates are broken down in the small intestine and the glucose in digested food is then absorbed by the intestinal cells into the bloodstream, and is carried by the bloodstream to all the cells in the body where it is utilized. However, glucose cannot enter the cells alone and needs insulin to aid in its transport into the cells. Without insulin, the cells become starved of glucose energy despite the presence of abundant glucose in the bloodstream. In certain types of diabetes, the cells' inability to utilize glucose gives rise to the ironic situation of "starvation in the midst of plenty". The abundant, unutilized glucose is wastefully excreted in the urine.
Insulin is a hormone that is produced by specialized cells (beta cells) of the pancreas. (The pancreas is a deep-seated organ in the abdomen located behind the stomach.) In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood. After a meal, the blood glucose level rises. In response to the increased glucose level, the pancreas normally releases more insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels after a meal. When the blood glucose levels are lowered, the insulin release from the pancreas is turned down. It is important to note that even in the fasting state there is a low steady release of insulin than fluctuates a bit and helps to maintain a steady blood sugar level during fasting. In normal individuals, such a regulatory system helps to keep blood glucose levels in a tightly controlled range. As outlined above, in patients with diabetes, the insulin is either absent, relatively insufficient for the body's needs, or not used properly by the body. All of these factors cause elevated levels of blood glucose (hyperglycemia).

                                      What is the impact of diabetes?

Over time, diabetes can lead to blindness,kidney failure, and nerve damage. These types of damage are the result of damage to small vessels, referred to as microvascular disease. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart disease, and other large blood vessel diseases. This is referred to as macrovascular disease. Diabetes affects approximately 26 million people in the United States, while another 79 million have prediabetes. An estimated 7 million people in the United States have diabetes and don't even know it.

From an economic perspective, the total annual cost of diabetes in 2012 was estimated to be 245 billion dollars in the United States. This included 116 billion in direct medical costs (healthcare costs) for people with diabetes and another 69 billion in other costs due to disability, premature death, or work loss. Medical expenses for people with diabetes are over two times higher than those for people who do not have diabetes. Remember, these numbers reflect only the population in the United States. Globally, the statistics are staggering. 



                                       Diabetes facts

  • Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood.
  • Insulin produced by the pancreas lowers blood glucose.
  • Absence or insufficient production of insulin causes diabetes.
  • The two types of diabetes are referred to as type 1 and type 2. Former names for these conditions were insulin-dependent and non-insulin-dependent diabetes, or juvenile onset and adult onset diabetes.
  • Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue.
  • Diabetes is diagnosed by blood sugar (glucose) testing.
  • The major complications of diabetes are both acute and chronic.
    • Acute complications: dangerously elevated blood sugar (hyperglycemia) or abnormally low blood sugar (hypoglycemia) due to diabetes medications
    • Chronic complications: disease of the blood vessels (both small and large) that can damage the feet, eyes, kidneys, nerves, and heart

    •                         What are diabetes symptoms?

      Reader Stories

      • The inability of insulin to perform normally has effects on protein, fat and carbohydrate metabolism. Insulin is an anabolic hormone, that is, one that encourages storage of fat and protein.
      • A relative or absolute insulin deficiency eventually leads to weight loss despite an increase in appetite.
      • Some untreated diabetes patients also complain of fatigue, nausea andvomiting.
      • Patients with diabetes are prone to developing infections of the bladder, skin, and vaginal areas.
      • Fluctuations in blood glucose levels can lead to blurred vision. Extremely elevated glucose levels can lead to lethargy and coma.

                          How is diabetes diagnosed?

      The fasting blood glucose (sugar) test is the preferred way to diagnose diabetes. It is easy to perform and convenient. After the person has fasted overnight (at least 8 hours), a single sample of blood is drawn and sent to the laboratory for analysis. This can also be done accurately in a doctor's office using a glucose meter.
      • Normal fasting plasma glucose levels are less than 100 milligrams per deciliter (mg/dl).
      • Fasting plasma glucose levels of more than 126 mg/dl on two or more tests on different days indicate diabetes.
      • A random blood glucose test can also be used to diagnose diabetes. A blood glucose level of 200 mg/dl or higher indicates diabetes.
      When fasting blood glucose stays above 100mg/dl, but in the range of 100-126mg/dl, this is known as impaired fasting glucose (IFG). While patients with IFG or prediabetes do not have the diagnosis of diabetes, this condition carries with it its own risks and concerns, and is addressed elsewhere.

      The oral glucose tolerance test

      Though not routinely used anymore, the oral glucose tolerance test (OGTT) is a gold standard for making the diagnosis of type 2 diabetes. It is still commonly used for diagnosing gestational diabetes and in conditions of pre-diabetes, such as polycystic ovary syndrome. With an oral glucose tolerance test, the person fasts overnight (at least eight but not more than 16 hours). Then first, the fasting plasma glucose is tested. After this test, the person receives 75 grams of glucose. There are several methods employed by obstetricians to do this test, but the one described here is standard. Usually, the glucose is in a sweet-tasting liquid that the person drinks. Blood samples are taken at specific intervals to measure the blood glucose.
      For the test to give reliable results:
      • The person must be in good health (not have any other illnesses, not even a cold).
      • The person should be normally active (not lying down, for example, as an inpatient in a hospital), and
      • The person should not be taking medicines that could affect the blood glucose.
      • The morning of the test, the person should not smoke or drink coffee.
      The classic oral glucose tolerance test measures blood glucose levels five times over a period of three hours. Some physicians simply get a baseline blood sample followed by a sample two hours after drinking the glucose solution. In a person without diabetes, the glucose levels rise and then fall quickly. In someone with diabetes, glucose levels rise higher than normal and fail to come back down as fast.
      People with glucose levels between normal and diabetic have impaired glucose tolerance (IGT) or insulin resistance. People with impaired glucose tolerance do not have diabetes, but are at high risk for progressing to diabetes. Each year, 1% to 5% of people whose test results show impaired glucose tolerance actually eventually develop diabetes. Weight loss and exercise may help people with impaired glucose tolerance return their glucose levels to normal. In addition, some physicians advocate the use of medications, such as metformin (Glucophage), to help prevent/delay the onset of overt diabetes.
      Research has shown that impaired glucose tolerance itself may be a risk factor for the development of heart disease. In the medical community, most physicians are now understanding that impaired glucose tolerance is nor simply a precursor of diabetes, but is its own clinical disease entity that requires treatment and monitoring.

      Evaluating the results of the oral glucose tolerance test

      Glucose tolerance tests may lead to one of the following diagnoses:
      • Normal response: A person is said to have a normal response when the 2-hour glucose level is less than 140 mg/dl, and all values between 0 and 2 hours are less than 200 mg/dl.
      • Impaired glucose tolerance (prediabetes): A person is said to have impaired glucose tolerance when the fasting plasma glucose is less than 126 mg/dl and the 2-hour glucose level is between 140 and 199 mg/dl.
      • Diabetes: A person has diabetes when two diagnostic tests done on different days show that the blood glucose level is high.
      • Gestational diabetes: A pregnant woman has gestational diabetes when she has any two of the following:, a fasting plasma glucose of 92 mg/dl or more, a 1-hour glucose level of 180 mg/dl or more, or a 2-hour glucose level of 153 mg/dl, or more.
  • Diabetes treatment depends on the type and severity of the diabetes. Type 1 diabetes is treated with insulin, exercise, and a diabetic diet. Type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, insulin and other injectable medications are considered.
                       

  Treatment Options for Diabetes

Managing your glucose levels is the key to leading a healthy life that’s free of complications from diabetes. Depending on your specific diagnosis and overall health, you can control your diabetes with diet, exercise, careful monitoring, and treatment that may include a Medtronic insulin pump.
The main goal of diabetes management is to control your glucose levels. By taking care of your blood sugar levels, you increase your chances of living a healthy, complication-free life. Depending on you and your health, you can control your diabetes through a combination of diet and exercise, diabetes treatment, and, in some cases, insulin therapy.

Diet and Exercise

Whether you have type 1 or type 2 diabetes, diet and exercise will be the key to your diabetes management. You’ll want to eat a diet that includes lots of fruits and vegetables and is low in fats. If you’re overweight, you’ll want to lose weight. And you’ll want to increase the amount of exercise that you do each day.

Medications

If diet and exercise are not enough to control your diabetes, your doctor will probably prescribe one or more diabetes medications. There are many types of diabetes treatments. Your doctor will probably have you try several until you find the one that’s right for managing your diabetes.

Insulin Therapy

If you have type 1 diabetes, you’ll need to take insulin because your body does not produce this important hormone. If you have type 2 diabetes, you may one day need to take insulin. There are many options for taking insulin, including the traditional vial and syringe, insulin pens, inhaled insulin, and insulin pump therapy.

Insulin Pumps

Insulin pumps are small, portable devices that deliver insulin continuously to patients with diabetes. The insulin pump can be worn in many locations, including on a belt or in a pouch inside clothing. The pump delivers insulin through a small tube placed under the skin. Adult and paediatric studies1,2 show that insulin pump therapy can achieve better glucose control than conventional multiple daily insulin injection regimens.

Continuous Glucose Monitors

Because the main goal of diabetes management is controlling your glucose levels, many individuals are finding that 24-hour glucose monitoring can help them lead healthy lives. Continuous glucose monitors are small, portable devices that measure glucose levels and provide blood glucose trend information every 5 minutes. This information can help you improve your diabetes management, and lower your risk of diabetes complications.

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