Diabetes - What Is Diabetes?

The word diabetes is common enough. Nearly everyone has heard it and may know someone who has it. But how many know what it is?

Diabetes is a medical condition identified by continual abnormally high levels of glucose in the blood. It is a disease that results when either the body fails to produce adequate insulin or the cells resist using the insulin produced.

In the first case (too low an amount of insulin produced) diabetes is called Type 1. In the second instance, the condition is known as Type 2 diabetes. Type 1 constitutes about 7% of cases, with Type 2 responsible for 90% or more. The disease affects about 7% of the population of the U.S., occurring more frequently among those age 60 or older.

There are other types, such as gestational diabetes that sometimes afflicts pregnant women, and others. But they are much less common and, in some cases, temporary.

Typical symptoms for either type are abnormally frequent urination, produced by the body's attempt to clear excess glucose by elimination. As a result, unusual thirst is common, compensated for by drinking higher than average amounts.

Type 1 has historically been known as juvenile onset diabetes, since it affected mostly younger people. Similarly, Type 2 was called adult onset diabetes, since it was found mostly in older adults. In Type 1 diabetes, it's believed that one of the primary factors causing the disease is an autoimmune system malfunction that affects the pancreas. Type 2 may be caused or worsened by obesity and other factors.

Both have genetic components as risk factors. But in either type, and regardless of the cause, the net effect is the same: an inability to clear glucose out of the bloodstream because of inadequate or faulty insulin production or use.

Insulin is the hormone chiefly responsible for regulating the level of glucose in the body. Many foods that contain carbohydrates are broken down by digestion and produce primarily glucose. That glucose is taken up by the body to supply the energy needed for cell repair, muscle movement and a thousand other functions. Insulin helps the glucose make its way into the cells.

When insulin is produced in too low an amount, or the body's cells resist the intake of glucose by interfering with insulin's function, diabetes is the result. Since the pancreas produces the overwhelming majority of the body's insulin, when some condition causes it to malfunction, diabetes can result.

The condition, whether Type 1 or Type 2, is usually chronic. But chronic doesn't mean that nothing can be done to minimize the effects. With proper diet and what are today relatively simple treatments, diabetes of either type is manageable. And the disease itself comes in a range of degrees. In some cases, the amount of insulin produced or used is only slightly under what's needed. In other cases, the pancreas produces almost none or the cells resist it strongly.

Since excess glucose left in the bloodstream can lead to a range of complications, diabetes can have a number of follow on effects. But how severe those effects are depends on the severity of the insulin deprivation or resistance.

Diabetes - Treatment Methods for Diabetes

Exactly how diabetes is treated depends on a number of factors: which type the patient has, how severe it is, the age of the patient and others.

Gestational diabetes, for example, that sometimes afflicts pregnant women at around 6-7 months into the pregnancy, may disappear after birth. Treatment may be as mild as doing nothing to additional diet management. Type 1 diabetes, on the other hand, is currently incurable and typically requires lifelong insulin shots.

But there are other forms of treatment, many of them amounting virtually or literally to self-care.

On the more extensive end of treatments there are a variety of drugs used apart from insulin.

Sulfonylureas, for example (such as Glucotrol® and Micronase®) help the body make insulin. That's helpful for Type 1 diabetes patients who produce too little. Biguanides, on the other hand (such as Glucophage®), aid in using insulin more efficiently, the common characteristic of Type 2 diabetes. Thiazolidinediones (like Avandia®) help make cells more sensitive to insulin, again useful in treating Type 2.

Other drugs work on glucose levels. Meglitinides (such as Prandin®) help control the blood sugar level after eating. Alpha-glucosidase inhibitors (like Precose®) slow down the absorption of sugars in the digestive tract.

All of these treatment options, and any others, will naturally involve careful monitoring of blood glucose level by use of one or more methods. Once that's known, the patient and his or her physician can focus on a particular category of treatment and/or self care.

In some cases, particularly those involving Type 2 diabetes, adjustment of the diet and an appropriate exercise regimen may be enough to control the disease without drugs. This is particularly true for those who suffer from elevated glucose levels with a condition called pre-diabetes.

There is a strong correlation between obesity and Type 2 diabetes, especially for those who tend to carry the excess weight mostly around the waist. For those, simply losing weight may be enough to bring the condition to the point that no drug treatments are necessary.

Many factors play into such a lifestyle adjustment and they tend to have other beneficial effects. Careful control of the amount and type of carbohydrates, adjustment of alcohol intake and other dietary changes aid in reducing cardiovascular problems of many types, including heart attack and stroke.

Physical exercise lowers blood sugar levels, having a direct effect on the condition. But exercise also helps the body's immune system along with having other positive benefits. That helps reduce the odds of subsidiary problems produced by diabetes. Stress, in particular, can produce changes that affect how hormones, including insulin, are used by the body. Exercise and an overall attitude adjustment can bring that under control.

If insulin becomes necessary, there are other forms apart from traditional injections. Oral insulin is now in widespread use. Insulin inhalers have recently been approved by the FDA for treatment of diabetes. An insulin pump, which injects the appropriate amount automatically as needed, may be appropriate for some patients.

The only way to know which treatment is best in a given circumstance is to be tested and diagnosed by a physician. Seek early diagnosis and treatment if you suspect you may have diabetes. That will provide the most, and the least objectionable, options for long term care.

Diabetes - Standard Diagnoses For Diabetes

Diabetes is characterized by abnormally elevated blood glucose levels over a period of time. Insulin is either produced in too low amount (Type 1) or not used properly (Type 2). Insulin is the principle hormone that helps the cells take up glucose. Since the amount is higher than normal, it's possible to take different tests that detect them.

One of the standard tests is called a 'Fasting Plasma Glucose' (FPG) test. The patient foregos eating for at least 8 hours (usually nothing after midnight). The test is administered by drawing blood and measuring the results. A normal fasting glucose level will be lower than about 99 mg/dL.

Levels between 100-125 mg/dL are an indication of a condition professionals call 'pre-diabetes'. In this case, the person doesn't have diabetes but is very likely to develop it within a few years unless management of glucose levels is undertaken by diet, exercise and possibly medication.

A level of 126 mg/dL or higher is a very strong indicator of full blown diabetes. When it's seen doctors will typically recommend other tests to aid in confirming the diagnosis. One of those is called an 'Oral Glucose Tolerance Test' (OGTT).

A patient who has fasted drinks a high glucose liquid (75 grams, not tasty but not harmful) and blood is drawn to test. The glucose levels are measured, then the test is repeated at intervals, usually two hours later, then three, then four. Sometimes the test interval is 30 min, 1 hour, 2 hours and so on.

A 2-hour glucose level of 139 mg/dL or below is considered normal. Insulin is released by the body in reaction to the high glucose and the cells take it up. But when the number is still 140-199 mg/dL two hours later, this is an indication that inadequate insulin is released or its normal action is being hindered. That suggests pre-diabetes. When the number is 200 mg/dL or higher, diabetes is indicated.

In the latter case, physicians will often recommend repeating the test at a later date to confirm the diagnosis. Many things can temporarily alter the body's blood glucose levels and its ability to regulate them. For example, taking steroids significantly alters blood glucose levels, as do certain diuretics. Pregnancy is one common example of a condition affecting glucose levels.

Another type of diabetes, one that occurs in about 3% of pregnancies (usually during 24-28 weeks gestation), is known as gestational diabetes. The OGTT is used to detect that as well. The test will be administered four times and the blood glucose level measured at each instance.

Another test commonly used is called the 'Random Plasma Glucose' (RPG) test. In this case a blood test is done without fasting. When the level is 200 mg/dL or higher it can indicate the presence of diabetes. Common symptoms are taken into account as well, such as unusually frequent urination, abnormal continued thirst even after drinking water and others.

No single test conclusively proves that a person has diabetes. Since the condition is potentially serious, though often managed with minimal lifestyle interruption, a battery of tests should be used before reaching a confirmed diagnosis.

Diabetes - Self-Treatment Devices for Diabetics

Most cases of diabetes treatment are primarily in the hands of the patient. While periodic testing by a professional lab is desirable, along with regular physician consultation, the treatments themselves are typically performed by the diabetic.

Fortunately, there are more convenient and relatively painless ways to do that than ever before. While no one wants to have diabetes, the treatment options provide safe, reliable methods of self-care.

Some cases of Type 2 diabetes can be treated almost entirely with diet and exercise. Many of these might actually be labeled pre-diabetes, a condition in which the blood glucose level is chronically elevated, but not to the degree of actual diabetes.

But most of those who suffer from Type 2 diabetes, and virtually all Type 1 diabetes patients, will require some form of glucose management. That usually means taking insulin.

In past decades, that was delivered by one method: a injection of insulin from a glass syringe. That required great care, since it involved the need to sterilize the needle and injection location, and give oneself regular shots. It was important to measure the dose accurately, as well. Not the worst possible problem, but far from pleasant, to be sure.

That option is still used in one form or another today, but there are also several other choices for contemporary self-care of diabetes.

Insulin Pens

Today, one can use pre-filled insulin pens. These are like a syringe in that they still inject insulin, but the cartridges and needle are sterile and the dosage is pre-measured. Insulin formulations vary and so the pens come in a variety. Most will deliver 300 units from an easy-to-use ink-cartridge style device, but they're also adjustable.

The user dials in the desired amount with a knob on one end. The amount to be injected shows up in a small window on the side. The tip of the 'pen' contains a needle. The needle is inserted just under the skin, the insulin delivered, then both needle and cartridge are disposed of. In some cases, a user can simply throw away the entire pen and start with a new one the next time.

Insulin Pumps

Another option is the insulin pump, a device about the size of a small cell phone. A relatively new device, it is usually attached outside the body, though some actually implant under the skin. In both cases, a computer-controlled device monitors the blood glucose level and releases the appropriate amount of insulin as needed. Insulin is delivered through a plastic tube tipped by a cannula (similar to a needle, but of soft plastic, not metal). The cannula is often implanted into the abdomen.

The proper amount is delivered discontinuously 24-hours per day whenever the monitor senses insulin is needed. This method results in a very accurate and timely management of blood glucose level.

Other delivery methods are still being tried, some of which work reasonably well.

Pills and Inhalers

Pills are convenient, but enzymes in the stomach tend to degrade the insulin so this method is still being perfected. Recently, new coatings have been devised that may make oral insulin delivery viable.

Nasal inhalers suffer from similar problems in delivering insulin to the bloodstream, and also tend to cause nasal irritation. Oral inhalers seem to work somewhat better, though there are still some possible side effects, such as coughing and mouth dryness. They're an option for some, nonetheless.

More advanced forms of treatment are still being researched, including repairing the basic problem by transplanting pancreas cells and gene therapy. But until those bear fruit, these options provide the diabetic with safe, convenient and generally painless choices.

Diabetes - Possible Complications From Diabetes

One of the possible tragic consequences of diabetes is the effects the disease has on various organs and body functions. They cover a wide range of systems and conditions. Fortunately, most are treatable and/or manageable.

Hypoglycemia

Hypoglycemia, for example, is a common side effect of diabetes medications. Since diabetes is characterized by too much glucose in the blood (hyperglycemia), treating it can produce too low a level (hypoglycemia). It can be mild and adjustable by changing diet or medications. But careful monitoring of blood glucose levels is essential to proper management.

Heart Disease and Stroke

Cardiovascular problems are more likely among those who suffer from diabetes. High glucose levels can gradually lead to increases of fatty deposits on blood vessels, constricting flow and possibly leading to atherosclerosis (clogging or hardening of the blood vessels). That increases the odds of heart attack or stroke. Those who have diabetes are twice as likely to have heart disease or a stroke, and often at a younger age than average.

Here again, though, the condition can be managed to minimize the odds of heart disease or stroke. An appropriate exercise regimen can help keep your cardiovascular in optimal condition. A heart healthy diet will reduce the odds of atherosclerosis. A good diet also reduces the chances of a stroke. In some cases, simple aspirin treatments may be helpful.

Eye Problems

A variety of eye problems are possible complications of diabetes. Indeed, one of the common symptoms is blurry vision. Excess glucose in the blood draws fluid out of tissues, including the lenses. That makes it more difficult to correctly focus. But there are other areas of the eye that can be affected, as well.

The retina (the lining on the back of the eye) may have its proper function impaired. As a side effect of elevated blood pressure caused by diabetes, small blood vessels in the eye can be damaged. That harms the retina. It may manifest itself in the form of blurry vision, but it can also appear as rings around lights or dark spots in your field of vision.

Careful monitoring of glucose levels and blood pressure can help minimize the odds of eye problems from diabetes. Here again, an appropriate diet, including lowering cholesterol and a good exercise routine will keep blood pressure under control.

Nervous System

One of the follow on effects of continual high blood pressure may be damage to the nervous system. When blood vessels are impaired they're less efficient at performing that essential function. Blood oxygenates the nerve cells. When deprived they will be impaired.

Controlling blood pressure will help reduce the odds of nervous system problems.

Kidney

Kidneys help filter the blood to eliminate waste products and remove toxins. Diabetes can impair that filtering function. That may lead to protein leaking out of the kidneys and into the urine where it's no longer available to the body for useful purposes. On the other hand, since the filtering function is less efficient, some waste products may go back into the bloodstream rather than being eliminated.

Keeping blood glucose level and blood pressure to the right level can help reduce the odds of kidney problems. In some cases, special medication (such as an ACE, angiotensin converting enzyme inhibitor or ARB, angiotensin receptor blocker) may be appropriate.

In all cases, the best course is to seek professional guidance for diagnosis and the appropriate treatments.

Diabetes - Monitoring Systems for Diabetics

Tracking the level of glucose in the blood is vital for proper diabetes management. Fortunately, the devices available to do that today are easy to use and provide many features.

One of the earliest self-test systems was developed in the mid-1970s. Then as now they used a sample of blood that is chemically analyzed by the device. Since then, they've gotten smaller, more accurate and require less blood.

Monitors now extrude a small test strip coated with chemicals used to perform the test. A small blood sample is provided, usually by pricking the finger with a lancet. The blood drop is smeared on the strip, then fed into a hand-held device. In a few seconds, it provides a readout of the current glucose level.

There are several pros and cons to all current devices.

They're convenient, but they do require a blood sample drawn from the body. That can be uncomfortable and is one of the main reasons that many people will only use them once per day, rather than the recommended three times daily.

They can give inaccurate readings if they're not calibrated and maintained properly. They need to be cleaned from time to time, in order to prevent old blood and chemicals from contaminating the device and throwing off the readings. But that's generally easy to do and the results are typically as accurate as a professional test from a lab, or nearly so.

Many contemporary devices far exceed the features available from their older cousins.

While having the convenience and timeliness of a home test is a great benefit, there are other desirable attributes for a good device. Many today will store numerous test results taken over time. That helps compare levels on an ongoing basis, providing better glucose level management. Some can download results to a PC where the data can be easily graphed, making the tracking process even more valuable.

Several models allow the user to draw blood from areas other than the finger. That gives the fingers a rest, since continual pricking can lead to excessive scarring and loss of sensitivity. It can also lead to running out of fingers to use and greater difficulty drawing blood, leading to additional discomfort. Alternative devices, if approved for use by your physician, can draw blood from the hands, arms and elsewhere.

But there are even better devices available on the market today.

Some use a laser to make a small, painless hole in the skin. A droplet of blood oozes out for smearing onto a test strip. It produces only a slight tingling sensation in the finger during the test. That eliminates the need for needles and is more sanitary and safer, as well as reducing discomfort.

Some work even while you sleep. No one wants to wake up in the middle of the night to prick a finger and run a test strip through the device for a readout. But the body continues to function twenty-four hours a day. Glucose levels can rise or fall at any time. Diabetics can buy a watch that monitors glucose level and alerts the wearer by an alarm if a threshold is exceeded.

Still more advanced devices require drawing no blood at all. It senses the glucose level through the skin by use of an infrared beam. In development since the mid 1990s, it was recently approved by the FDA for home use.

Diabetes - Minimizing Effects of Diabetes

Diabetes can present two main categories of problems, in the form of short term ill-effects and longer term harm. Minimizing both areas requires discipline.

Rapid spikes or dips in blood glucose level can result in several unpleasant effects: dizziness, disorientation, muscle weakness, nausea and others. For some diabetics, it's very difficult to prevent this from happening at some time. But there are practices that can improve the odds.

Regular and careful monitoring is a must. It's no picnic to endure a finger prick three times a day. For those who simply can't muster the will, it is worthwhile to look into some of the newer glucose monitoring devices that don't require it.

Some contain tiny, powerful lasers that create a hole through which blood oozes. They produce only a mild tingling sensation. One recent device senses glucose level through the skin using an infrared beam, requiring no blood sample at all.

The goal is to keep the glucose-insulin balance as close to normal levels as possible. Non-diabetics have a fasting glucose level under about 99 mg/dL. Even after a heavy meal, when glucose may rise to over 200 mg/dL, insulin is released which brings it back down within a couple of hours. That means that keeping the glucose level right isn't so much achieving a static number as maintaining the correct dynamic balance.

Part of a long-term glucose monitoring strategy should encompass regular physician visits with a quarterly A1C test. Several tests exist to measure blood glucose level at a given time. The A1C test provides a picture averaged over a period of months. The name comes from HbA1c, an abbreviation for glycated hemoglobin.

Hemoglobin molecules in the red blood cells carry oxygen to tissues. The extra glucose in the bloodstream of a diabetic causes that hemoglobin to get glycated. That effect persists and allows an A1C test to measure the accumulated result.

Long term the effects will accumulate, good or bad. Over 10-15 years or longer, many diabetes patients of the past would endure blindness, kidney damage, nerve damage and other ill health effects. That no longer has to be the case. With contemporary understanding of the disease and modern technology it's possible to reduce the odds of those effects nearly to those without the disease.

Exercise and diet are two key elements for the overwhelming majority of diabetes sufferers to help achieve the right glucose-insulin balance.

Keeping body fat low through proper diet and exercise will help. Body fat plays a role in how the body reacts to glucose levels, as well as affecting hormone production and release. While the mechanisms are still being investigated, many studies show there is a clear correlation between body fat and the severity of diabetes effects, as well.

Proper weight and body fat maintenance will also help keep blood pressure at the right level. Chronic high blood pressure is one of the major elements in increasing the risk of common diabetes problems: heart attack and stroke, eye and nerve damage, and others.

With diligence a diabetic can lead a normal life, one very much like those fortunate enough not to have the condition. A little attention a few times a day can lead to not having to pay too much attention at all.