Complications

Good blood sugar control can reduce your risk of serious health problems, like:

• Heart disease and stroke. Adults with diabetes are more likely to have heart disease or a stroke. Heart disease is the leading cause of death in people with diabetes.
  
• High blood pressure. Many adults with diabetes have high blood pressure or take prescription medicine(s) for high blood pressure.
  
• Eye problems. People with diabetes are at risk for cataracts, glaucoma, and problems with the retina (retinopathy), which can reduce vision or cause blindness. Diabetes is the leading cause of new cases of blindness in adults ages 20 to 74.
  
• Kidney damage. Diabetes is the leading cause of severe kidney disease.
  
• Nerve damage. Many people with diabetes have some nerve damage. This shows up as numbness or tingling in the feet or hands. You may not feel pain well, so sores can get worse and get infected. Severe nerve damage in people with diabetes is a major cause of leg and foot amputations.
  
• Infections. People with diabetes may be at greater risk for infection and death from infections. High blood sugar may make it harder for your body to fight infections. People with diabetes may be at a greater risk for getting many other illnesses. Once they get these illnesses, they have more trouble getting better.
  
• Gum disease. Because infections are harder to fight, you’re more likely to develop gum disease.
  
• Problems in pregnancy. Diabetes that isn’t managed well, before pregnancy and during pregnancy, can cause birth defects and miscarriages. During the later parts of pregnancy, poorly controlled diabetes can lead to very large babies, which is risky for both mother and child.
  

There’s good news, though. When you manage your diabetes well, you can reduce the risk of these health problems.

Who Gets Diabetes?

Millions of Americans have been diagnosed with type 2 diabetes. Many others have it and don’t know it. Millions more have a condition called pre-diabetes, which means that they are at risk for developing type 2 diabetes.

Several things put you at risk for type 2 diabetes. You can control some of these factors, such as:

• Your weight. Too much body fat is a main risk factor for type 2 diabetes.
  
• Smoking. This makes it harder for you to control your blood sugar.
  
• Lack of being active. Being inactive can lead to excess body fat, high blood sugar, and high blood pressure.
  
• High blood pressure and/or high cholesterol. These conditions are linked to type 2 diabetes and heart disease.
  

Risk factors you can’t control:

• Family history. Your risk is higher, if you have a close relative (parent, brother, sister) with diabetes.
  
• Gestational diabetes, or having a baby who weighs more than 9 pounds. Women who have diabetes during pregnancy or have a large baby are at greater risk for diabetes later in life, usually type 2 diabetes.
  
• Age. Type 2 diabetes is more common in people age 40 and older, but it is rising among young people who are overweight and inactive.
  
• Ethnic group. African Americans, Latinos, Hispanics, Native Americans, Asian Americans, and Pacific Islanders are more likely to develop diabetes.
  

The more risk factors you have, the more likely you will get type 2 diabetes.

Make An Action Plan

Managing diabetes

Good health begins with your personal plan to manage diabetes. You and your doctor will come up with a plan, possibly with the help of a diabetes teacher or a dietitian.

The goal of treatment is to keep your blood sugar level as close to normal as you can. Changing your eating habits and being more active are very important first steps. But healthy eating and exercise don’t always lower blood sugar enough. You may need to take one or more medicines to keep your blood sugar under control. Many people with type 2 diabetes take medicines. Some take a combination of medicines that work in different ways to help control blood sugar.

Managing type 2 diabetes can be hard work. With support, information, and the help of your doctor, you can do it!

Download the Diabetes.com Type 2 Diabetes Action Plan (PDF Format).

Hang in There

Don’t be surprised if you sometimes feel like there’s lots to do to manage type 2 diabetes. Here are some tips to help you keep on track:

Stay motivated

• If you’re having trouble staying with your diabetes plan, think about what the problem may be.
  
• Ask yourself what you need to do to get on track. Find one step that could get you started. Choose something fairly easy.
  
• Find things you can do to keep the problem from happening again.
  
• Focus on your successes, not your slip-ups. Don’t beat yourself up for backsliding.
  
• It’s normal to feel overwhelmed with the demands of managing diabetes. Accepting that you have diabetes doesn’t mean that you have to like it.
  
• The more you know about diabetes, the easier it is to manage. Visit this program, whenever you need a refresher. Read books and visit respected Web sites about diabetes. Or, take a class in your community. See a diabetes educator at least once a year for more tips on living with diabetes.
  

Get diabetes support

• Decide what type of support you need from your family, friends, co-workers, or healthcare team. Then tell them. Odds are, they’ll be happy to help and flattered that you asked them.
  
• Some of the areas you might need help with are setting goals, getting through hard times, and solving problems.
  
• Teach your family and friends about type 2 diabetes. Ask them to listen to what you think and feel, and support you in making some healthy changes. For instance, they may want to exercise with you.
  
• Stay in touch with your doctors between appointments. You may want to talk on the phone or fax your blood sugar records. This will help you and your doctor spot any problems early.
  
• Join a support group for people with type 2 diabetes. It always helps to talk with people who’ve been there.
  

Ways To Help Yourself

Maintain a Healthy Blood Sugar Level

There’s a secret to keeping your blood sugar in check: Be prepared.

Diabetes on the job

Talk with your doctor about how to manage diabetes at work. Be sure to:

• Eat meals at about the same time every day. Try not to skip meals or snacks.
  
• Take your medicines and test your blood sugar as directed by your doctor.
  
• Describe the signs of low blood sugar to close co-workers. You may need their help if your blood sugar drops.
  
• Keep sugar snacks or glucose pills in your desk, in case your blood sugar gets too low. Carry some with you.
  
• Tell the company nurse that you have diabetes.
  
• Keep tabs on your stress. Try deep breathing, relaxation, or take a short break from the office.
  

Dealing with sick days

A cold or the flu can make it harder to keep your blood sugar in check. It is recommended that people with diabetes get a flu shot every year. Also, you and your healthcare provider should make a “sick-day” plan. When you’re sick:

• Check your blood sugar four times a day. If it’s higher than 300 mg/dL, use a home test to check your urine for ketones.
  
• Keep taking your diabetes medicines.
  
• Drink plenty of water or sugar-free drinks to stay hydrated.
  
• Try to eat as usual. If your stomach can’t handle it, try clear soups or gelatin.
  
• Check any over-the-counter medicines for sugar. Ask your pharmacist for sugar-free options.
  

Call your doctor if your blood sugar is lower than 70 mg/dL several times a week, or if it stays higher than 240 mg/dL. Also, call if you’ve been vomiting or had diarrhea for several hours, or if your urine has high ketone levels.

Diabetes on the road

To prepare for your vacation, follow these steps:

• See your healthcare provider before your trip to go over your plans.
  
• Plan for changes in meal patterns, time zones, and activity levels.
  
• Take along twice as many medicines and supplies as you think you’ll need.
  
• Always carry medicines and snacks with you, and wear a medical ID bracelet or necklace.
  
• Wear comfortable, closed shoes, change them often, and never go barefoot. Check your feet every day for calluses, bunions, sores, or discolored skin.
  
• Find out how to get healthcare where you’re going. Locate the nearest hospital or Red Cross center in advance.
  
• Get any travel shots you need at least one month before you go.
  
• Tell the airline and cruise-ship staff that you have diabetes. They can give you special meals.
  
• If you’re traveling by car, test your blood sugar before you leave. Stick as close to your regular routine as you can.
  
• Learn important phrases in the local language, such as “I need help” or “I have diabetes.” And words, like “sugar” or “orange juice.”
  

Diabetes Resources

For online diabetes information, news, and community features:

Note: The Diabetes.com Web site contains links to third-party Web sites on the Internet. These links are provided as a service to individuals interested in more information. These sites are not part of the Diabetes.com Web site, a GlaxoSmithKline (GSK) Web site. The content and materials in these third-party Web sites are not produced or endorsed by GSK and may refer to uses of our products that are not recommended by GSK. You should always consult with your doctor before using any GSK prescription product.

The following nonprofit and professional groups can provide you with more information on type 2 diabetes:

American Association of Clinical Endocrinologists (AACE)
1000 Riverside Ave., Suite 205
Jacksonville, FL 32204
Phone: (904) 353-7878
E-mail: info@aace.com
www.aace.com
www.powerofprevention.com

American Association of Diabetes Educators
100 W. Monroe Street, Suite 400
Chicago, Illinois 60603
Phone: (800) 338-3633
www.aadenet.org

American College of Cardiology
Heart House
9111 Old Georgetown Road
Bethesda, MD 20814-1699
Phone: (301) 897-5400
Toll-Free: (800) 253-4636, ext. 694
www.acc.org

American Diabetes Association (ADA)
ATTN: National Call Center
1701 North Beauregard Street
Alexandria, VA 22311
Toll-free: (800) DIABETES (342-2383)
Phone: (703) 549-1500
www.diabetes.org

American Heart Assocation
National Center
7272 Greenville Avenue
Dallas, TX 75231
Toll-Free: (800) AHA-USA (242-8721)
www.americanheart.org

American Kidney Fund
6110 Executive Blvd., Suite 1010
Rockville, MD 20852
Toll-Free: (800) 638-8299
www.akfinc.org/

Association of Black Cardiologists
6849 B2 Peachtree Dunwoody Road, NE
Atlanta, GA 30328
Phone: (678) 302-4ABC (4222)
Toll-Free: (800) 753-9222
www.abcardio.org

Centers for Disease Control and Prevention: Diabetes
1600 Clifton Rd.
Atlanta, GA 30333
Tel: (404) 639-3311
Toll-Free: (800) 311-3435
www.cdc.gov/doc.do/id/0900f3ec802723eb

Joslin Diabetes Center
One Joslin Place
Boston, MA 02215
Phone: (617) 732-2400
www.joslin.org

National Diabetes Education Program
One Diabetes Way
Bethesda, MD 20814-9692
Phone: (301) 496-3583
Email: ndep@info.nih.gov
www.ndep.nih.gov/diabetes/diabetes.htm

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Phone: (301) 654-3327
diabetes.niddk.nih.gov

Taking Control of Your Diabetes
1110 Camino Del Mar, Suite B
Del Mar, CA 92014
Phone: or 1-800-99-TCOYD
www.tcoyd.org

The Diabetic Gourmet
diabeticgourmet.com

Plan Your Meals for diabetes

There’s no such thing as a “diabetic diet.”

Still, you may be confused about what to eat. Here’s the low-down on some things that might be confusing:

• Carbohydrates. Some meal plans want you to count grams of carbohydrates (sugar and starch). Your dietitian can help you learn to count carbohydrates.
  
• Sugar. Most experts say small amounts of sugar are fine, as long as they are part of your meal plan. Sugar is just one type of carbohydrate.
  
• Alcohol. Discuss the use of alcohol with your doctor. Many people with diabetes can have an alcoholic drink now and then—as long as you account for it in your food plan. Be sure to drink alcohol only with food.
  
• Artificial sweeteners. These can replace sugar, but beware of high-calorie, processed foods made with sugar substitutes. Foods that claim to be “sugar-free” or have “no sugar added” may have a lot of carbohydrates. So, read food labels carefully.
  

Tips for planning healthy meals

• Make sure your dietitian knows which foods you like to eat when making your meal plan. If the plan includes foods that you dislike, or if something you love is left out, you’re less likely to stick with it.
  
• Eat a variety of foods. A plateful of different-colored foods will help you get items from all the food groups. Include high-fiber choices, such as fruits, vegetables, and whole grains.
  
• Limit your salt, which can affect blood pressure. Avoid packaged snack foods. Replace table salt with other spices.
  
• Read food labels, so you know what you’re really eating.
  
• Avoid saturated fats, like butter, fatty meats, and cheese. These boost “bad” (LDL) cholesterol. Instead, look for good fats, like omega-3 fats in fish and oils made from plants.
  
• Eat fiber. Good sources are whole wheat breads, high-fiber cereals, vegetables, and fiber supplements. Foods with fiber may help you manage your blood sugar level.
  
• Watch portions. Eat only the amount of food in your meal plan. Eat about the same amount of food each day.
  
• Eat meals about every four to five hours. Do not skip meals.
  
• Eat meals and snacks at regular times every day. If you take a diabetes medicine, eat your meals and take your medicine about the same time each day.
  

Eating healthy on the run

Your life is probably hectic. That can mean dining out a lot. Here are some tips that can help you eat healthier on the run:

• Avoid items called “jumbo,” “giant,” “deluxe,” or “super-sized.” They tend to have more calories.
  
• Choose grilled or broiled sandwiches with lean meats, like turkey or chicken. Avoid creamy toppings, like mayonnaise. Add flavor with lettuce, tomato, and onion.
  
• A salad can be a good choice. But, watch out for high-fat toppings, like dressings, bacon bits, cheeses, and croutons.
  
• Stick to soft tacos and other non-fried foods when you eat Mexican foods. Choose chicken over beef. Pile on lettuce, tomatoes, and salsa. Go easy on cheese, sour cream, and refried beans.
  
• Choose thin-crust pizza with vegetable toppings. Limit yourself to one or two slices. Leave off the meat and extra cheese, which add calories, fat, and sodium.

Juvenile Diabetes

Juvenile diabetes is an autoimmune disorder which can be due to environmental trigger or virus, which hampers the function of beta cell. Once the beta cells are destroyed the body is unable to produce insulin. It is also believed that Type 1 diabetes results from an infectious or toxic insult to a child, whose immune system is predisposed to develop an aggressive autoimmune response either against molecules of the B cell or against altered pancreatic B antigens, resembling a viral protein. A child with diabetic siblings is more prone to develop juvenile diabetes than the child from a totally unaffected family. It is considered to be a more hereditary problem than excess eating or being obese. Pancreas produces the exact amount of insulin, to breakdown the sugar produced in the body. The juvenile diabetic lack the production of insulin so, sugar builds up high in the blood, overflows into the urine and passes from the body unused. It is estimated that about 10-15% in United States are suffering with juvenile diabetes. Approximately 35 American children are diagnosed with juvenile diabetes every day.

Symptoms of Juvenile Diabetes

Juvenile Diabetes Cure

Diagnosis of Juvenile Diabetes

Obesity and Diabetes

Diabetes is spreading worldwide as an epidemic. Diabetes is a disorder in which the body cells fail to take up glucose from the blood. Wasting of tissues is seen as glucose-starved cells are forced to consume their own proteins. Diabetes is the cause of blindness, kidney failure and amputation in adults. Individuals with diabetes lack the ability to use the hormone insulin.

As we start eating food, our body starts producing insulin. The insulin signal attaches to a special receptor on the cell surface, to make the cell turn-on its own glucose transporting machinery. It had been observed that type 2 diabetics have normal or even elevated levels of insulin in their body with normal insulin receptor, but due to some unknown reason the binding of insulin to the cell receptors does not starts the glucose transporting machinery, which it is supposed to do. Special proteins called IRS (insulin receptor substrate) are inside the cell. In type 2 diabetes something is interfering with the action of the IRS protein and it is also estimated that about 80% of those who develop type 2 diabetes are obese. When insulin attaches to the receptor protein, the receptor responds by adding a chemical called a phosphate group onto the IRS molecules by which the IRS molecules turn into action. Once activated, they start variety of processes, including an enzyme that turns on the glucose transporter machinery.

Overweight and obesity are both labels for series of weight, greater than what is generally considered healthy for an individual. BMI ranges for children and teens above a normal weight have different labels (at risk of overweight and overweight). Excess body weight is implicated as a risk factor for many disorders including heart disease, cancer, diabetes, female infertility, prostate enlargement, uterine fibroids, gallstone and gestational diabetes etc. The location of fat deposits in the body leads to different risks associated with it. Increased abdominal fat can be estimated by waist size.

Dozens of controlled clinical trials had been carried out to determine the fasting insulin levels and effect of weight loss on fasting blood glucose. They found:

• Weight loss produced by lifestyle modification declines blood glucose levels and HbA1c in type 2 diabetics.
• Glucose tolerance in overweight individuals will improve due to decrease in abdominal fat with impaired glucose tolerance.
• Glucose tolerance improves in overweight individuals due to increased cardio respiratory fitness with impaired glucose tolerance or diabetes.

Diabetic Weight Loss

Hypoglycemia

Glucose is an important fuel for the body to produce energy. The glucose used by the body as a fuel is released from the metabolism of carbohydrates. After meal, glucose starts producing and it is circulated to different body cells through the circulating blood. The cells require insulin to take up glucose inside the membrane and generate energy. When there is inadequate production of insulin, glucose metabolism is slowed down and less glucose is circulated in the blood. This condition is termed as Hypoglycemia. It happens to every diabetic patient from time to time and the severity differs from case to case. Although you are taking good care of diabetes, hypoglycemia may result as it is mostly an insulin reaction which in turn depends on number of factors at a time. As blood sugar begins to fall the counter regulatory hormone like glucagon, another hormone stimulates break down of glycogen and releases glucose, causing blood glucose level to rise. For diabetes, glucagon response to hypoglycemia is impaired, which makes it tough for the body to revert back the normal blood glucose level. Hypoglycemia can occur in people with diabetes who take certain medications to keep their blood glucose levels in control. Hypoglycemia is mild and it can be easily treated by drinking or eating something with carbohydrate. But left untreated, hypoglycemia can lead to loss of consciousness. Although it can happen suddenly, hypoglycemia can usually be treated quickly, bringing your blood glucose level back to normal. Hypoglycemia is a problem for every diabetic so it is important to learn its causes, signs, symptoms, diagnosis and prevention in order to cope up with it as soon as possible.

Hypoglycemia Symptoms

Causes of Hypoglycemia

Treating Hypoglycemia

Diabetic Ketoacidosis

Diabetic Ketoacidosis is a condition in which the body cells are unable to get glucose for producing energy. It is a state of absolute or relative insulin deficiency aggravated by hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism. Due to insufficiency of insulin, the cells cannot use glucose. To avoid starvation the body begins to break down fat, for energy. The constant break down of fat, releases fatty acids and ketone bodies causing chemical imbalance (metabolic imbalance) called Diabetic Ketoacidosis. Diabetic Ketoacidosis (DKA) and its Pathophysiology In the absence of insulin, an anabolic hormone the cells of muscle, liver and other body parts are unable to take up glucose. Counter regulatory hormones, such as glucagon, growth hormone, and catecholamine; boosts triglyceride breakdown into free fatty acids and gluconeogenesis. Beta-oxidation of these free fatty acids leads production of ketone bodies. Metabolism in DKA shifts from carbohydrate metabolism to fat breakdown. Diabetic Ketoacidosis include a metabolic acidosis as the ketone bodies, produced by beta-oxidation of free fatty acids to deplete extra cellular and cellular acid buffers. The hyperglycemia-induced osmotic diuresis depletes sodium, potassium, phosphates, and water (i.e.10% of total body fluids). Moderate or large amounts of ketones in your urine are dangerous. They upset the chemical balance of the blood. Following are the reasons for moderate or large amounts of ketones in the body: Insufficiency of insulin (inborn error) Due to improper injection Body does not produce insulin (flu or any infection) Body needs more insulin No enough food or skipping of meals When blood glucose levels fall too low

Diabetic Ketoacidosis Symptoms

Diabetic Ketoacidosis Causes

Diagnosis of Ketoacidosis

Diabetic Ketoacidosis Treatment

Prevention

Glycosuria

Clinical diagnosis of the diabetes require some of the laboratory tests, glycosuria (finding glucose in the urine) is one of the significant test for detecting frank diabetes. Those who are non diabetic, for them glycosuria can occur for the short term due to emotional stress, pain, hyperthyroidism, alimentary hyperglycemia or meningitis. It can also occur when there is insufficiency of insulin and if a substantial amount of food with high sugar is consumed.

Glycosuria is a condition in which glucose or simple sugar is detected in the urine despite of normal blood sugar level. The normally functioning kidneys absorb and reabsorb the extra blood sugar till renal threshold, with the help of millions of micro tubules – Nephron (filtering unit of kidney). The renal threshold is a concentration level above which all simple sugar is not absorbed in the blood, hence extra glucose is excreted by the kidneys in the urine. Renal threshold of normal kidney is around 10mmol/L. In few cases, when drugs are being used for a longer span of time, it may alter the threshold level of kidney. The amount of glucose not reabsorbed by the kidneys is usually less than 0.1%. Adults excrete about 65 mg of glucose per day. The relationship between glycosuria and the renal threshold are explained in the diagram given below.

In renal glycosuria glucose is abnormally eliminated in the urine due to improper action of the nephron.

The renal glycosuria occurs only when there are abnormally functioning kidneys, due some dent in the kidneys or as an autosomal recessive trait.

Glycosuria Causes

Diabetes and Insulin

The failure to make insulin or insufficiency of insulin is termed as Diabetes mellitus. Insulin is a natural hormone which controls the level of the sugar glucose in the blood. Insulin allows cells to use glucose for energy. Cells cannot utilize glucose without insulin. Excess glucose builds up in the bloodstream, increasing the risk of diabetes. Glucose is the body's primary source of fuel. Insulin enables the body cells to take glucose from the bloodstream. The cells might use glucose for production of energy if required, or it is sent to the liver to preserve it, in the form of glycogen. Functions of Insulin In addition to its role of regulating glucose metabolism, insulin also Stimulates lipogenesis Diminishes lipolysis Increases amino acid transport into cells Modulates transcription Altering the cell content of numerous mRNAs Stimulates growth DNA synthesis Cell replication

Structure of Insulin

Insulin Synthesis

Types of Insulin

Insulin Regimens

Diabetes Insulin Classification

Diabetes and Insulin Analogs

Insulin Injection Devices

Diabetes Treatment and Insulin Problems

Diabetes Diet

Diet plays a significant role in controlling the diabetes. The diabetic diet may be used alone or else in combination with insulin doses or with oral hypoglycemic drugs. Main objective of diabetic diet is to maintain ideal body weight, by providing adequate nutrition along with normal blood sugar levels in blood. The diet plan for a diabetic is based on height, weight, age, sex, physical activity and nature of diabetes. While planning diet, the dietician has to consider complications such as high blood pressure, high cholesterol levels. With respect to the above factors, a dietician will assess calories to be given, like scheming the carbohydrates, proteins, fats, type of carbohydrate, amount of fiber and so on. Exchange meal plan is a diet program which balances the amount of carbohydrate that we intake per day. Glucose is a sugar released from carbohydrate so if we want to control blood sugar we have to limit the consumption of simple carbohydrate. Carbohydrate foods are given as value per portion, known as the exchange. This plan helps us to decide on the type of food to be taken, the amount of food and also the time to eat. You can plan for more flexible meal as you get more knowledge about the diet of a diabetic, may be like the counting carbohydrate meal plan or constant carbohydrate. But there is no common diet that works for everyone. Nor is there any particular diet that works perfectly for any diabetic over a long period. While planning diabetes diet we should adhere to certain important factors, they are as follows: Fiber should be at least 40 gm / day Instead of 3 heavy meals, we should go for 4-5 small mid intervals Replace bakery products and fast foods by simple whole cooked cereals, and don't eat carbohydrates 2 hours before bedtime Consume fresh fruit and vegetables at least 5 exchange/ day Diabetics must always need to take care of thier diet and also about the food they eat. Care has to be taken because all foods contain not only carbohydrate, but also some energy value. Protein and fat available in the food are converted to glucose in the body. This glucose has some effect on the blood sugar level which has to be taken care. Furthermore there is no need that you have to eat only bland boring diet. Instead you have to eat more fruits, vegetables and whole grains. It means that to select foods that are high in nutrition and low in calories and fat.

Diabetes Care

Diabetic Diet Dos

Diabetic Diet Donts

Diabetes Complications

Once we have crossed the reversible stage of prediabetes and enter diabetes stage certain changes start developing in our body. These changes occur due to high blood sugar with instability in the hormones as well as blood vessels and nerves. When these changes become permanent in the body it develops into serious Diabetes Complications and body indicates these changes by steady symptoms. Symptoms of the Diabetes Complications Diabetic retinopathy shows symptoms of pain in your eyes and may even result in loss of vision. Renal (kidney) disease shows symptoms of swelling (edema) in the feet and legs. It then passes over total body and as the disease progresses, blood pressure also increases. Tingling, burning, numbness, tightness, shooting or stabbing pain in the hands, feet or other parts of your body, especially at night. Digestive problems also occur if, the nerves controlling internal organs gets damaged (autonomic neuropathy). You may have scanty or profuse sweating, difficulty of sensing when your bladder is full, when there is a low blood sugar, increased sexual problems, weakness, dizziness, and fainting. Chest pain (angina) or shortness of breath dizziness or light headache, shoulder or stomach pain, fast heartbeat. You might not show any symptoms until having a heart attack or stroke. When alarming symptoms given by the body are ignored and the same status is maintained, it starts damaging body organs, such as heart, kidney, eye, feet, and skin. The physiology for each and every affected organ is explained one by one.

Diabetic Retinopathy

Diabetic Neuropathy

Diabetes Skin Care

Diabetic Nephropathy

Heart Disease and Stroke

Outlook

Diabetes is a leading cause of death in all industrialized nations. Overall, the risk of premature death of people with diabetes is twice that of people who do not have diabetes. Prognosis depends on the type of diabetes, degree of blood sugar control, and development of complications.

Type 1 diabetes

About 15% of people with type 1 diabetes die before age 40 years, which is about 20 times the rate of that age group in the general population.

• The most common causes of death in type 1 diabetes are diabetic ketoacidosis, kidney failure, and heart disease.
  
  
• The good news is that prognosis can be improved with good blood sugar control. Maintaining tight blood sugar control has been proven to prevent, slow the progression of, and even improve established complications of type 1 diabetes.

Type 2 diabetes

The life expectancy of people who are diagnosed with type 2 diabetes in their 40s decreases by 5-10 years because of the disease.

• Heart disease is the leading cause of death for people with type 2 diabetes.
  
  
• Excellent glycemic control, tight blood pressure control, and keeping the bad cholesterol level at the recommended level of 100 mg/dL or lower and the good cholesterol as high as possible. Use of aspirin when indicated can prevent, slow the progression of, and improve established complications in diabetes.

Prevention

We do not yet know of a way to prevent type 1 diabetes. Type 2 diabetes, however, can be prevented in some cases.

• Control weight to normal or near-normal levels by eating a healthy low-fat, high-fiber diet.
  
  
• Regular exercise is crucial to the prevention of type 2 diabetes.
  
  
• Keep alcohol consumption low.
  
  
• Quit smoking.
  
  
• If you have high blood fat levels (such as high cholesterol) or high blood pressure, take your medication as directed.
  
  
• Lifestyle modification and/or certain medications can be used in people with prediabetes to prevent progression to diabetes. Prediabetes can be diagnosed by checking fasting glucose and 2 hours after ingesting 75 grams of glucose.

If you already have diabetes, your focus should be on preventing the complications, which can cause serious disabilities such as blindness, kidney failure requiring dialysis, amputation, or even death.

• Tight glucose control: The single best thing you can do is to keep your blood sugar level within the suggested range every day. The only way to do this is through a combination of regular blood sugar checks, a balanced diet low in simple sugars and fat and high in complex carbohydrates and fiber, and appropriate medical treatment. Please consult a nutritionist or check with your doctor about questions that you may have regarding diet.
  
  
• Quit smoking
  
  
• Maintain a healthy weight
  
  
• Increase your physical activity. Aim for moderately vigorous physical activity for at least 30 minutes every day.
  
  
• Drink an adequate amount of water and avoid taking too much salt.
  
  
• Take care of your skin. Keep it supple and hydrated to avoid sores and cracks that can become severely infected.
  
  
• Brush and floss your teeth every day. See your dentist regularly to prevent gum disease.
  
  
• Wash and examine your feet every day, looking for small cuts, sores, or blisters that may cause problems later. You should file rather than cut your toenails to avoid damaging the surrounding skin. You may need to see a specialist in foot care (podiatrist) to help you care for your feet.

Next Steps

Follow-up

Treatment: Follow your health care provider's treatment recommendations. Keep daily records of your blood sugar levels, the times you checked the levels, when and how much insulin or medication you took, when and what you ate, and when and for how long you exercised. Call your health care provider if you have any problems with your treatment or symptoms that suggest poor glucose control.

Education: Attend diabetes education classes at your local hospital. The more educated you are about your disease, the better you are likely to do.

Regular visits to your primary care provider: If you are on insulin, you should see your health care provider about every 3 months or more often. For other diabetics, every 3-6 months is generally adequate, unless you are having problems.

Recognize low blood sugar levels and know how to treat them: You and your family should be taught how to recognize the signs and symptoms of low blood sugar levels. You should have a clear plan for treating low blood sugar levels and when to call 911. Mild symptoms include confusion and sweating. These symptoms progress to lethargy, agitation (sometimes with violent, jerking motions), or even seizures.

Medications

Many different types of medications are available to help lower blood sugar levels in type 2 diabetes. Each type works in a different way. It is very common to combine 2 or more types to get the best effect with fewest side effects.

• Sulfonylureas: These drugs stimulate your pancreas to make more insulin.
  
  
• Biguanides: These agents decrease the amount of glucose produced by your liver.
  
  
• Alpha-glucosidase inhibitors: These agents slow absorption of the starches you eat. This slows down glucose production.
  
  
• Thiazolidinediones: These agents increase your sensitivity to insulin.
  
  
• Meglitinides: These agents stimulated the pancreas to make more insulin.
  
  
• D-phenylalanine derivatives: These agents stimulate your pancreas to produce more insulin more quickly.
  
  
• Amylin synthetic derivatives: Amylin is a naturally occurring hormone secreted by the pancreas along with insulin. An amylin derivative, such as pramlintide (Symlin), is indicated when blood sugar control is not achieved despite optimal insulin therapy. Pramlintide is administered as a subcutaneous injection along with insulin and helps achieve lower blood sugar levels after meals, helps reduce fluctuation of blood sugar levels throughout the day, and improves hemoglobin A1C levels.
  
  
• Incretin mimetics: Incretin mimetics promote insulin secretion by the pancreas and mimic other blood sugar level lowering actions that naturally occur in the body. Exenatide (Byetta) is the first incretin mimetic agent approved in the United States. It is indicated for diabetes mellitus type 2 in addition to metformin or a sulfonylurea when these agents have not attained blood sugar level control alone.
  
  
• Insulins: Human insulin is the only type of insulin available in the United States; it is less likely to cause allergic reactions than animal-derived varieties of insulin. The type of insulin chosen to customize treatment for an individual is based on the goal of providing optimal blood sugar control. Different types of insulin are available and categorized according to their times of action onset and duration. Commercially prepared mixtures of some insulins may also be used to provide constant (basal) control and immediate control.
  • Rapid-acting insulins
    • Regular insulin (Humulin R, Novolin R)
      
      
    • Insulin lispro (Humalog)
      
      
    • Insulin aspart (Novolog)
      
      
    • Insulin glulisine (Apidra)
      
      
    • Prompt insulin zinc (Semilente, slightly slower acting)
      
      
    • Inhaled insulin (Exubera)
      
  • Intermediate-acting insulins
    • Isophane insulin, neutral protamine Hagedorn (NPH) (Humulin N, Novolin N)
      
      
    • Insulin zinc (Lente)
      
  • Long-acting insulins
    • Extended insulin zinc insulin (Ultralente)
      
      
    • Insulin glargine (Lantus)
      
      
    • Insulin detemir (Levemir)

Medical Treatment

The treatment of diabetes is highly individualized, depending on the type of diabetes, whether you have other active medical problems, whether you have complications of diabetes, and your age and general health at time of diagnosis.

• Your health care provider will set goals for lifestyle changes, blood sugar control, and treatment.
  
  
• Together, you will devise a plan to help you meet those goals.

Education about diabetes and its treatment is essential in all types of diabetes.

• When you are first diagnosed with diabetes, your diabetes care team will spend a lot of time with you, teaching you about your condition, your treatment, and everything you need to know to care for yourself on a daily basis.
  
  
• Your diabetes care team includes your health care provider and his or her staff. It may include specialists in foot care, neurology, kidney diseases, and eye diseases. A professional dietitian and a diabetes educator also may be part of the team.

Your care team will see you at appropriate intervals to monitor your progress with your goals.

Type 1 diabetes

Treatment of diabetes almost always involves the daily injection of insulin, usually a combination of short-acting insulin such as regular or Lispro or Aspart insulin and a longer acting insulin such as NPH, lente, glargine, detemir, or ultralente insulins.

• Insulin must be given as an injection. If taken by mouth, insulin would be destroyed in the stomach before it could get into the blood where it is needed.
  
  
• Most people with type 1 diabetes give these injections to themselves. Even if someone else usually gives you your injections, it is important that you know how to do it in case the other person is not available.
  
  
• A trained professional will show you how to store and inject the insulin. Usually this is a nurse who works with the health care provider or a diabetes educator.
  
  
• Insulin is usually given in 2 or 3 injections per day, generally around mealtimes. Dosage is individual and is tailored by the health care provider. Longer acting insulins are typically administered 1 or 2 times per day.
  
  
• Some people have their insulin administered by continuous infusion pumps to provide adequate blood glucose control. Supplemental mealtime insulin is programed into the pump by the individual as recommended by his or her health care provider.
  
• It is very important to eat if you have taken insulin, as the insulin will lower your blood sugar regardless of whether you have eaten. If you take insulin without eating, you could have hypoglycemia. This is called an insulin reaction.
  
  
• There is an adjustment period while you learn how insulin affects you and how to time your mealtimes and exercise times with your insulin injections to keep your blood sugar level as even as possible.
  
  
• Keeping accurate records of your blood sugar levels and insulin dosages is crucial in helping your health care provider take care of your diabetes.
  
  
• Eating a consistent, healthy diet appropriate for your size and weight is essential in controlling your blood sugar level.

Type 2 diabetes

Depending on how elevated your blood sugar and glycosylated hemoglobin are at the time of your diagnosis, you may be given a chance to lower your blood sugar level without medication.

• The best way to do this is to lose weight if you are obese and begin an exercise program.
  
  
• This will generally be tried for 3-6 months, and then your blood sugar and glycosylated hemoglobin will be rechecked. If they remain high, you will be started on an oral medication, usually a sulfonylurea or biguanide (Metformin), to help control your blood sugar level.
  
  
• Even if you are on medication, it is still important to eat a healthy diet, lose weight if you are overweight, and engage in moderate physical activity as often as possible.
  
  
• Your health care provider will monitor your progress on medication very carefully at first. It is important to get just the right dose of the right medication to get your blood sugar level in the recommended range with the fewest side effects.
  
  
• Your doctor may decide to combine two types of medications to get your blood sugar level under control.
  
  
• Gradually, even people with type 2 diabetes may require insulin injections to control their blood sugar levels.
  
  
• It is becoming more common for people with type 2 diabetes to take a combination of oral medication and insulin injections to control blood sugar levels.