What is diabetes?
Diabetes is a chronic condition in which glucose, often referred to as blood sugar, is too high. Glucose is made in the liver and muscle but also comes from the food you eat. In order to use this sugar, the pancreas makes a hormone called insulin. With type 1 diabetes, formally known as juvenile diabetes the pancreas produces no insulin or only a small amount.
In the case of type 2 diabetes, formally known as adult-onset diabetes, fat, muscle, and liver cells develop resistance to insulin, and eventually the pancreas cannot keep up with insulin production. When insulin does not work the way it should, glucose stays in the blood, increasing blood sugar levels.
Who is at risk for type 2 diabetes?
Being overweight is a major risk factor for type 2 diabetes. It is thought that abdominal fat in particular increases a person’s risk for diabetes.
Age is also a risk factor; anyone over 45 in considered to have a higher risk, although type 2 diabetes is being diagnosed in alarming numbers in teens and children, mostly due to inactivity and obesity.
Similarly, being sedentary increases your risk. Being active can help keep weight in check and any physical activity will use up glucose.
The National Institute of Health recommends at least 30 minutes a day to reduce your risk for heart disease and diabetes.
Certain races, including Alaska Native, American Indian, African American, Hispanic/Latino, Asian American, or Pacific Islander have an increased risk for type 2 diabetes, although the reasons why are unclear. Any family history of diabetes is also a risk factor.
High blood pressure, defined as over 140/90 mm Hg, or high triglyceride levels above 250 mg/dL, as well as low HDL “good” cholesterol levels below 35 mg/dL are also risk factors.
What are the symptoms?
Many diabetics have no symptoms at all. However, symptoms may include being thirsty, weight loss, being very hungry, blurred vision or sores that take a long time to heal or frequent infections. If you have these symptoms or if you are at an increased risk, you should speak with your doctor about being screened for diabetes.
What is pre-diabetes?
Pre-diabetes is when your blood sugar levels are above normal, but not high enough to be considered diabetic. Left unchecked, this can turn into diabetes. However, with vigilance, including moderate activity and weight loss, blood sugar levels can return to normal.
There are two tests to look for diabetes or pre-diabetes, the fasting plasma glucose test (FPG) and the oral glucose tolerance test (OGTT). FPG measures your blood sugar after at least eight hours of not eating, while OGTT also waits at least eight hours after your last meal, but a glucose beverage is given two hours before the test.
There is a third test called a random plasma glucose test that does not take into account the last time you ate.
Normal levels are below 100 mg/dL for FPG and below 140 mg/dL for OGTT.
Pre-diabetes levels are 100 to 125 mg/dL for FPG and 140 – 199 mg/dL for OGTT.
Diabetes is defined as at least two tests with levels of FPG above 126 mg/dL and OGTT levels above 200 mg/dL.
How is type 2 diabetes managed?
Eating right and losing weight are two of the most important components of managing diabetes and keeping blood sugar levels normal. Normal is defined as being 90 to 130 mg/dL before a meal and less than 180 mg/dL an hour or two after you have started a meal.
Everyone’s needs are different so you should speak to your doctor about the best meal and exercise plans to monitor and maintain your glucose levels.
Some people cannot manage their diabetes only through diet and exercise. For those people there is a range of oral and injected medications.
Some medications (like glimepiride, glyburide, and tolazamide) stimulate the pancreas to make more insulin while others (Metformin) stop the liver from making and releasing glucose. Other medications slow the breakdown of carbohydrates (such as acarbose) or make your tissue more sensitive to insulin (such as rosiglitazone), and injected insulin is also an option for some type 2 diabetics. Some doctors will prescribe aspirin therapy to help prevent heart disease.
What are common complications with diabetes?
The most common short-term complications are hyperglycemia (high blood sugar), hypoglycemia (low blood sugar) and diabetic ketoacidosis. Hyperglycemia and hypoglycemia can be caused by eating too much or too little, or by diabetes medications. Regular monitoring of blood sugar and speaking with your doctor can help you avoid these complications.
Ketoacidosis is an increase of toxic acids known as ketones in the urine. You should speak to your doctor right away if you think you have this problem, which may be accompanied by a loss of appetite, nausea, vomiting, stomach pain or a sweet smell on the breath.
There are even more long-term complications for diabetes. Keeping blood sugar at normal levels will help mitigate the risk of these complications, which all take years to develop.
Two out of three diabetics will die of heart disease or stroke. High blood sugar levels over the years can increase deposits of fatty material inside of blood vessels, slowing blood flow and increasing the chances for the hardening of blood vessels.
One of the most common complications is neuropathy, or nerve damage, especially in the legs and feet. This is the result of excess sugar in the capillaries that go to nerves. This may begin as tingling or burning at the tips of toes or fingers, but left untreated, this can lead to the loss of all feeling. Nerve damage can also affect your digestion system.
Diabetes can also damage the kidneys, eventually leading to kidney failure, which may require dialysis or a kidney transplant.
Diabetics are also at a higher risk for cataracts and glaucoma, as well as diabetic retinopathy where the blood vessels of the retina are damaged and may lead to blindness.
Skin conditions are also a problem with diabetes, including fungal and bacterial infections.
Urological problems, such as urinary tract infections, and sexual problems such as erectile dysfunction are also complications related to diabetes.
Many of these complications are not only caused by diabetes. Speak to your doctor about managing your type 2 diabetes to make sure you are minimizing your risk for any serious complications, and which problems you are most at risk for.
There are many trials being conducted for type 2 diabetes.