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Diabetes 101

By Nina Nazor

What is Diabetes?

Diabetes mellitus is a group of diseases sharing the common characteristic of high blood sugar levels. Diabetes happens when the pancreas cannot produce enough insulin or when the insulin that is produced in the pancreas cannot work adequately. When diabetes is not well controlled, it can cause serious complications and premature death.

The continued rise in the number of people with diabetes in the United States is alarming. Nearly 21 million Americans have diabetes; most of them type 2. This represents about 7 percent of the population and more than 6 million of these people do not know they have the condition, according to the Centers for Disease Control and Prevention (CDC).

The CDC also reports that another 41 million people are estimated to have pre-diabetes, a condition that is developed before type 2 diabetes.

Diabetes is a leading cause of adult blindness, lower-limb amputation, kidney disease and nerve damage. Also, two-thirds of people with diabetes die from heart disease.

However, the good news is that you can control diabetes, and we are here to help you.

What is Insulin?

Insulin is a hormone secreted by your pancreas and its function is to regulate blood glucose levels. Insulin works like a key to open the door of the cells so glucose – the fuel you get from food - can come inside and be converted into energy.

Think of a corridor full of doors. You need a key to unlock each door so you can put glucose in each room. Well, insulin is that key and if it is not produced in the right amounts or if it cannot open the doors because it is cracked, then glucose builds up in the blood causing your blood sugar to go up. This is called hyperglycemia (high levels of blood glucose) and is the common manifestation of diabetes.

What are the Symptoms of Diabetes?

The most common symptoms of diabetes are the following:

  • Frequent urination
  • Excessive thirst
  • Excessive hunger
  • Feeling tired or ill
  • Sudden weight loss
  • Blurred vision
  • Slow healing of infections

Why do these symptoms appear when blood glucose is high?

When you have hyperglycemia, insulin cannot open the doors of the cells and glucose cannot enter the cells to be converted into energy. Your body then detects that the levels of blood glucose are too high and, since high glucose can be very toxic, your body tries to get rid of the extra glucose through your kidneys, which are the filters for your blood.

Then the kidneys pour as much glucose as possible into your urine, causing you to urinate more frequently and thus lose a lot of fluids. This makes you excessively thirsty.

Now, when your blood glucose levels are high due to your glucose not entering the cells to be used for energy, the lack of fuel makes you feel hungry and tired.

So, since your body can't get energy from the food you eat, you might also start losing weight.

The blurred vision, the slow healing of infections and other symptoms like dry skin and genital itching, are all consequences of the high levels of glucose in the blood.

How is Diabetes Diagnosed?

There are 3 ways to know if you have diabetes:

  1. If you have symptoms of diabetes and a plasma glucose level equal or greater than 200 mg/dl (11.1 mmol/l) in a sample taken at any time of day.
  2. If the measurement of your blood glucose levels after an overnight fast (12 hours), which is called Fasting Blood Glucose Test shows a value equal or greater than 126 mg/dl (7.0 mmol/l). Normal fasting glucose levels range between 70-110 mg/dL.
  3. If the measurement of the ability of your body to handle excess sugar properly after drinking a drink with glucose shows a 2-hour plasma glucose value equal or greater than 200 mg/dl (11.1 mmol/l).

In this test, know as the Oral Glucose Tolerance Test a blood sample is taken and you will be given a beverage containing 75 grams of glucose or 100 grams for pregnant women. Then, your blood glucose levels will be tested again at 30 minutes, 1 hour, 2 hours and, for pregnant women, 3 hours after drinking the beverage with glucose.

Diagnosis of Gestational Diabetes

A woman has gestational diabetes when she has any two of the following values after the Glucose Tolerance Test:

·  A fasting glucose level higher than 105 mg/dl,

·  A 1-hour glucose level higher than 190 mg/dl,

·  A 2-hour glucose level higher than 165 mg/dl, or

·  A 3-hour glucose level higher than 145 mg/dl.

What is Type 1 Diabetes?

Type 1 diabetes was previously called insulin dependent diabetes mellitus or juvenile diabetes because it usually strikes children, adolescents and young adults.

Type 1 diabetes develops quickly, usually over a few weeks, and symptoms are normally very obvious and dramatic.

Type 1 diabetes happens when the immune system of the person, usually a child, destroys the beta cells in the pancreas, which are responsible for making insulin.

Type 1 diabetes is believed to account for 5% to 10% of all diagnosed cases of diabetes. Risk factors for type 1 diabetes may include autoimmune, genetic, and environmental factors.

What is Type 2 Diabetes?

Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus or adult-onset diabetes because it used to affect adults. However, nowadays it is increasingly being diagnosed in children and adolescents due to the obesity epidemic we experience today.

Type 2 diabetes develops slowly and the symptoms are usually less severe than in people with type 1 diabetes. Some people may not notice any symptoms at all and are only diagnosed after a routine medical check up.

Type 2 diabetes affects about 90% to 95% of all diagnosed people with diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly and cause hyperinsulinemia, that is, a higher production of insulin to keep blood glucose levels controlled. But even though there is much insulin in the blood, it cannot work correctly on the surface of the cells to allow glucose to enter and be used or stored. This causes high blood glucose levels.

Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or Other Pacific Islanders are at high risk.

What is Gestational Diabetes?

Gestational diabetes develops when a woman is diagnosed with diabetes during pregnancy.

Gestational diabetes affects about 4% of all pregnant women in the United States each year and strikes more frequently African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes.

Gestational diabetes usually develops between week 24 and 28 of gestation. If you have gestational diabetes, your baby does not have diabetes, however, you must keep your blood glucose levels under control to avoid health problems for you or your baby.

Several studies have reported that after pregnancy, 5% to 10% of women with gestational diabetes are found to have type 2 diabetes. In addition, women who have had gestational diabetes have a 20% to 50% chance of developing diabetes in the next 5-10 years.

How Dangerous is Diabetes?

Diabetes is a serious condition. Diabetes is the sixth leading cause of death in the United States. If diabetes is not controlled properly, it can cause vision loss, kidney disease, amputations and heart disease, among other problems.

We don't know for certain the cause of these complications, but it seems that high glucose levels affect the large and small arteries.

Diabetes is a leading cause of adult blindness, lower-limb amputation, kidney disease and nerve damage. Also, two-thirds of people with diabetes die from heart disease.

How Do I get Diabetes?

Diabetes is not contagious; you don't catch diabetes. Diabetes is a chronic disease. We still don't know the causes, but type 1 diabetes is related to an autoimmune problem where defenses attack the insulin producer cells. Type 2 diabetes is related to family history of diabetes, obesity, and ethnicity as well as gestational diabetes.

Can Diabetes be Prevented?

The answer is type 2 diabetes yes. Several studies report that if you are at high risk for developing type 2 diabetes, just a modest weight loss and regular physical activity, such as brisk walking for al least 30 min/day will delay or prevent type 2 diabetes.

In case you have fasting glucose intolerance, which is also called pre-diabetes, it is even more important that you engage in a weight loss program and start exercising every day. You also should monitor your glucose levels every year.

High blood pressure control, reducing cholesterol levels and quitting smoking are also key factors in reducing the risk for developing diabetes.

Researchers are working hard to find out what else we could do to prevent the development of type 2 diabetes. Meanwhile, focus on following a healthy and active lifestyle and you will improve the quality of your life, while reducing your risk for developing diabetes.

Is There a Cure for Diabetes?

Public health authorities in the USA are working on three basic issues: prevention, looking for the cure and improvement of the the quality of care for people with diabetes to delay or prevent complications.

There is not a cure available yet, but recently the transplantation of islet cells, the ones that produce insulin, has been successful, although with some of the side effects of medications to avoid rejection of the transplanted tissues in the recipients body.

Pancreas transplantation is not recommended unless there is a need for a kidney transplant too, since the effects can be a lot worse than having to inject insulin and keeping a healthy lifestyle.

Artificial pancreases are in development but not ready yet.

Another approach under study is genetic manipulation, where cells that are not insulin producers have insulin gene inserted to order them produce human insulin.

These approaches are just promises now, but progress keeps being made every day.

The best thing you can do so far is to keep the best control possible, and when the cure is here, you will always have a better chance if you are a healthy person with diabetes.

Sources:

American Diabetes Association. Standards of Medical Care in Diabetes–2006. Position Statement. Diabetes Care 29:S4-S42, 2006.

National Center for Chronic Disease Prevention and Health Promotion CDC's, Basics About Diabetes.

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