What You Should Know About Diabetes

• What is Diabetes?
• Types of Diabetes
• Symptoms of Diabetes
• Who Is at Risk for Diabetes?
• Treatment of Diabetes
• Low Blood Sugar (Hypoglycemia, Insulin Reaction)
• Importance of Monitoring Blood Sugar
• Treatment for Type I
• About Supervising Children with Diabetes
• Treatment for Type II Diabetes
• Employment
• A Word About Complications
• Hope for the Future

What is Diabetes?

Diabetes is a chronic disease that impairs the body's ability to use food properly.

Normally, glucose, a form of sugar produced when starches and sugars are digested, is burned as fuel to supply the body with energy. This process--turning food into energy--is called metabolism.

But in order to metabolize glucose properly, the body requires another substance: Insulin. Insulin is a hormone produced by the pancreas, a gland located just beneath the stomach; its job is to regulate the body's use of glucose. Insulin is essential to the metabolic process.

Trying to burn glucose without insulin is like trying to set fire to a pile of logs without a match. It can't be done. And that's the problem for people with diabetes: they either don't produce enough insulin to properly metabolize glucose, or the insulin they have works inefficiently.

Without insulin to turn glucose into energy the glucose piles up in the bloodstream and spills into the urine showing as "sugar in the urine." Excessively high levels of sugar in the blood and the urine are the hallmarks of untreated diabetes.

While there is no cure for diabetes as yet, it can be controlled. The main goal of diabetes treatment is to control blood sugar levels and keep them in the normal range. The specific kind of treatment used to control blood sugars depends on the type of diabetes a person has.

Types of Diabetes

• Type I (Insulin-Dependent or Juvenile) Diabetes.
  In this form of diabetes, a person's pancreas produces little or no insulin. Although the causes for this are not entirely known, scientists believe that the body's own defense system (the immune system) attacks and destroys the insulin-producing cells in the pancreas. Because insulin is necessary for life, people with Type I diabetes must take one or more injections of insulin every day in order to metabolize their food.

  Before the discovery of insulin in 1921, people with Type I diabetes would fall into a diabetic coma and die, usually within a few weeks of onset.

  This form of diabetes used to be known as juvenile diabetes because it usually starts in children or young adults.

• Type II (Non-Insulin-Dependent or Adult-Onset) Diabetes.
  In this form of diabetes, the pancreas still produces insulin, but for some reason the body is not able to use it effectively. So, in spite of the presence of adequate amounts of insulin, blood glucose levels are not normal.

  Fortunately, Type II diabetes can be treated in a variety of ways, including weight loss (many Type II's are overweight), proper diet, reduced sugar intake and exercise. More severe cases may be treated with oral drugs or insulin injections.

  Type Il, which is also known as adult-onset diabetes, occurs most often in people over 40. Other less common forms of diabetes include:

• Gestational Diabetes
  Diabetes can suddenly appear in pregnant women who have never exhibited any signs of high blood glucose -- this is called gestational diabetes. The hormonal changes of pregnancy stress the mother's system and, in some cases, the pancreas is unable to produce sufficient insulin. Treatment for gestational diabetes ranges from diet management to insulin therapy. While this type of diabetes usually disappears after the birth of the baby, 30 to 40 percent of these women develop diabetes within 5 to 10 years.
• Glucose Intolerance
  This condition used to be called latent or borderline diabetes, but it is no longer considered a form of diabetes. People with glucose intolerance have an abnormal response when large amounts of carbohydrates are consumed. They are unable to metabolize it normally. Such people are at increased risk for developing diabetes, but most do not.

Symptoms of Diabetes

If you notice one or more of these symptoms on a recurring basis, you should see a doctor. He or she can find out, through a simple series of tests, if you have diabetes.

Type I

These symptoms may occur suddenly:

• Frequent urination, in large quantities
• Excessive thirst
• Extreme hunger all the time
• Sudden weight loss, for no apparent reason
• Weakness, drowsiness or exhaustion
• Sudden vision changes or blurred vision
• Nausea and vomiting

Type II

These symptoms usually occur gradually:

• Any of the symptoms listed for Type I
• Recurring or hard-to-heal skin, gum or urinary tract infections
• Drowsiness
• Tingling or numbness in hands or feet
• Itching of the skin and genitals

Who Is at Risk for Diabetes?

Nearly one in every 20 North Americans has diabetes. Out of about eight million diagnosed with diabetes, one million are Type I and seven million are Type II. Another eight million are Type II and have not yet been diagnosed. High risk categories include the following:

• People with diabetic relatives: Diabetes appears to have an inherited genetic tendency.
• People who are overweight: The chance of developing Type II diabetes doubles with every 20 percent excess weight. It is believed that excess body fat prevents insulin from working properly.
• People over forty: Type II diabetes is most common in middle and old age.

Treatment of Diabetes

Treatment of diabetes aims to do what a normal body does naturally--maintain a proper balance of insulin and glucose.

How Diabetes is Controlled

Diabetes "control" means keeping the level of sugar (glucose) in the blood as close to normal as possible. The three elements of diabetes "control" are:

1. Food
2. Exercise
3. Insulin

The rule of thumb is: food makes the glucose level rise; exercise and insulin make the glucose level fall.

Diabetes control is a constant balancing act of these three factors. If the balance is thrown off, there is the danger of either of two diabetic emergencies: hypoglycemia (low blood sugar--insulin reaction) or hyperglycemia (high blood sugar). Hyperglycemia will be encountered much less frequently as a problem than hypoglycemia.

Low Blood Sugar (Hypoglycemia, Insulin Reaction)

Sometimes called "insulin shock," this happens suddenly if a person using insulin eats too little food, doesn't eat soon enough, takes too much insulin, or exercises too much. This condition must be treated quickly with sugar or sugary foods because hypoglycemia can lead to unconsciousness. If a person becomes unconscious, honey or syrup should be rubbed inside the person's cheek, where it can be absorbed without risk of choking. If the person still does not respond in 10 to 15 minutes, glucagon, a hormone that raises blood sugar, may need to be injected.

• Symptoms appear rapidly: One or more of these symptoms may suddenly occur. Each person has a particular set of personal symptoms and you will come to recognize them. (Note: Some patients show no preliminary symptoms and therefore need to monitor their blood sugar levels more frequently.)
  • Inappropriate responses
  • Crankiness
  • Confusion and inattention
  • Lack of coordination
  • Drowsiness
  • Pale complexion
  • Perspiration
  • Headache
  • Trembling
  • Sudden hunger
  • Dizziness

Ketoacidosis

If a diabetic gets into a state of hyperglycemia--too much sugar and not enough insulin to use it--and the condition isn't treated, a dangerous biological process occurs. Since the body can't use the sugar to supply its energy needs, it starts to "steal" energy from the fats stored in the body. When fats are broken down, acids called "ketones" are formed in the body. Too many ketones in the system become poisonous. Without proper treatment, the diabetic may fall into a coma requiring hospitalization. This condition can be fatal.

Fortunately, this condition develops gradually--over several hours or days. Prompt attention to the warning signs can avert a serious problem. Usually a diabetic coma occurs only in Type I diabetes.

• Symptoms occur gradually:
  • Extreme thirst
  • Drowsiness, lethargy
  • Sugar in urine
  • Dry, hot skin
  • Lack of appetite
  • High levels of sugar and ketones in the blood
  • Fruity, sweet or wine-like odor on breath
  • Heavy, labored breathing
  • Eventual stupor or unconsciousness

Monitoring Your Blood Sugar

One of the most important advances in diabetes treatment and control has been the ability to measure and monitor one's own blood sugar levels at home.

Whether insulin-dependent or non-insulin-dependent, people with diabetes must understand how the disease works and learn how to manage their blood sugar levels. They must take very good care of themselves, paying attention to diet, eating habits and exercise. They should test their blood at specified times of the day in order to keep a watch on blood sugar levels.

Importance of Monitoring Blood Sugar

• To help prevent diabetic emergencies.
• To possibly reduce and even reverse some of the long-term complications of diabetes.
• To feel good. The closer to normal the blood sugar is kept, the better a person with diabetes feels.
• To enjoy greater freedom to participate in any activity.

There are two types of tests used to monitor blood sugar levels: blood tests and urine tests. See JDF brochure "Monitoring Your Blood Sugar."

Blood Tests

Blood sugar levels can be measured at home with a blood glucose monitoring system. It involves placing a drop of blood on a chemically treated strip which is then put into a meter for a blood sugar reading. Another method relies on a visual comparison of the strip with a color-coded chart. It is believed that with more precise monitoring and better "control," the complications of diabetes can be reduced, even reversed.

Urine Tests

Although a urine test using tablets or strips will indicate if sugar has spilled into the urine at some point, this method does not measure the actual level of blood sugar. Urine tests are useful, however, for monitoring ketones, whose presence are a warning sign of ketoacidosis, which can lead to diabetic coma.

Frequency of Testing

People with insulin-dependent diabetes are advised to test their blood sugar levels frequently, before meals and at bedtime.

Keep Records of Tests

It is recommended that people with diabetes keep records of the self-tests. Not only should they share this information with their physician (who may make appropriate adjustments in insulin dosages), they can also learn how to adjust their own intake of food or medication according to their physical activities.

Treatment for Type I

Type I diabetic patients must take insulin injections every day to make up for the hormone their bodies do not supply. But how do you determine what amount of insulin your body needs at any given time?

Balancing Blood Sugar and Insulin Levels

An insulin injection is only a rough estimate of what is really needed. If you take a shot in the morning, and then suddenly decide to do some vigorous exercise without taking into account the extra sugar that will be burned--your body will be left with too little sugar and too much insulin. This may produce hypoglycemia, described above. Any person with Type I diabetes learns that before engaging in strenuous activity, you must take some extra carbohydrates to make up for the sugar that will be burned, or take less insulin that day. This regimen should be discussed with your doctor.

• Factors that can upset the balance
  • Physical activity
  • Illness
  • Infection
  • Periods of growth
  • Fatigue
  • Excitement
  • Anxiety
  • Hormonal changes

Be Prepared

You must be prepared to treat an insulin reaction by carrying a fast-acting sugar at all times, and making sure it is available at home, at school or in the workplace. It can be in the form of orange juice, non-diet soda, candy, or sugar itself.

You should carry identification stating that you have diabetes. ID bracelets and cards are available through Medic Alert. You should carry enough money to summon help in case of emergency.

About Supervising Children with Diabetes

If you are supervising a child with diabetes, you should realize that:

• Children with diabetes can lead a normal life.
• Children with diabetes have the same needs for guidance, support and understanding as other children.
• Diabetes is not contagious.

With some simple guidelines, no one should be worried about taking care of a child with diabetes, either at camp, in school or on a "sleepover" date.

General Guidelines

• Watch the child's behavior before meals and snacks.
• Try not to assign strenuous physical exercise just before a meal when the child may be in need of sugar.
• Arrange an inconspicuous means of taking the mid-morning and/or afternoon snacks if they are part of the child's diet. This same consideration should be used for insulin injections and monitoring blood sugar levels
• Keep sugar readily available.
• Encourage the child to carry some form of sugar.
• Make sure all necessary personnel are aware and informed.
• The child should take a snack before bedtime.
• Keep any child suspected of having a "reaction" with an adult.
• DO NOT send the child home alone. You must make sure the reaction has been taken care of before the child is left alone or allowed to go home.

Treatment for Type II Diabetes

Most cases of Type II diabetes can be controlled by diet and exercise alone. The specific diet and exercise plan a doctor or dietitian suggests depends on the person's age, lifestyle and overall condition. In some cases, oral drugs or insulin injections may be necessary, too. The key is to determine the right balance of these elements.

Diet

• Concentrated sugars should not be eaten because insulin can’t be produced fast enough to burn them.
• A personal meal plan should aim for a fixed number of calories each day.
• Cholesterol and saturated fats should be restricted because people with diabetes are at a higher risk of heart attack.
• Weight loss through diet is a must for the overweight person with diabetes. Often, once the desired weight is maintained, no other treatment is necessary.

Exercise

• Exercise is important both because it helps to control weight and because it burns food, reducing demand on the pancreas to produce insulin.
• Check with your physician before starting an exercise program to determine what activities will be best for you.

Scheduling

Maintain a regular pattern of eating, exercising, and resting. Changes of schedule require adapting the diet or insulin dosages appropriately. For instance, if you have Type II diabetes and you're going to a very late dinner, you should work in a little snack at your normal dinner hour.

Employment

People with diabetes can work and work well. The discipline demanded in order to control the diabetes often makes for a better employee. They must eat at regular times, but other than that, they can do even a very physically demanding job. People with diabetes work in nearly every walk of life.

• Insurance Rates: Hiring people with diabetes usually does NOT affect a firm's insurance rates. Employees are often covered automatically under most group plans upon completion of a short waiting period after hiring.

A Word About Complications

As time goes on, diabetes can cause complications in organs and systems throughout the body.

• Diabetes affects the blood vessels and the heart, increasing the risk of heart disease, stroke, and other problems caused by poor circulation, such as gangrene.
• Diabetes is the leading cause of adult blindness in North America. Some damage to the blood vessels in the retina is evident in 90 percent of all persons who have had diabetes for 15 years or longer.
• Kidney disease is a major complication of diabetes. About 30 percent of new dialysis patients have diabetes-caused kidney failure.
• The incidence of stroke is two to six times higher in people with diabetes.

Simply put, diabetes is a chronic, complicated and destructive disease.

Hope for the Future

There is increasing hope that diabetes and its problems can be cured. Significant progress has been made, and JDF funding has been involved in all of these areas:

• Transplanting insulin-producing cells and pancreases in human subjects.
• Understanding how the body's own immune system destroys insulin-producing cells.
• Identifying the genes involved in diabetes to define who is at risk.
• Establishing how viruses may work as a "trigger" mechanism in diabetes.
• Improving laser techniques to treat eye problems.
• Developing insulin pumps and other experimental insulin-delivery systems.
• Developing new ways to monitor blood glucose.
• Developing drugs that may reduce diabetic complications.

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