American Diabetes Association Complete Guide to Diabetes by American Diabetes Association

• Table of Contents
• Read an Excerpt

Table of Contents

Read an Excerpt

What Is Diabetes?
When you or someone you love has diabetes, you discover that you must think about a part of life that others take for granted. Your never-changing goal becomes reaching a subtle balance between glucose and insulin. The more you learn about diabetes, the better you can be at your balancing act, and the richer your life shared with this chronic disease can be.

TYPES OF DIABETES

Diabetes refers to a set of several different diseases. The most common types of diabetes are type 1, or immune-mediated diabetes mellitus, and type 2, or insulin-resistant di- abetes mellitus. A third type of diabetes, gestational diabetes mellitus, occurs during some pregnancies.
All types of diabetes have similar symptoms, because all forms of the disease result in too much sugar, or glucose, in the blood. This is because your body is unable to remove glucose from your blood and deliver it to the cells in your body. Your cells use glucose as a source of energy in order to stay alive. But the reasons why your body cannot use glucose from the blood are different for type 1 and type 2 diabetes.
People with type 1 diabetes do not make enough insulin. Insulin is a small protein made by the pancreas that helps the body use or store glucose from food. People with type 1 diabetes can be treated with injections of insulin. In contrast, people with type 2 diabetes, like women with gestational diabetes, do make insulin, but for some reason, the cells in their bodies are resistant to insulin’s action or they don’t make enough insulin. In all types of diabetes, if glucose does not get into the cells and tissues that need it, it accumulates in theblood.
About half of all cases of type 1 diabetes appear in childhood or in the early teenage years. For this reason, it used to be called juvenile-onset diabetes. If your symptoms first appeared during the early teenage years, your doctor probably suspected diabetes right away. If you were a young child when the disease developed, it might have occurred so fast that you went into a coma, before anyone suspected diabetes. Type 2 diabetes most often develops in adulthood and used to be called adult-onset diabetes. Usually, it does not appear suddenly. Instead, you may have no noticeable symptoms or only mild symptoms for years before diabetes is detected, perhaps during a routine exam or blood test. Gestational diabetes only appears during pregnancy in women with no previous history of type 1 or type 2 diabetes and goes away after pregnancy. Pregnant women are tested for gestational diabetes.
All people with diabetes have one thing in common. They have too much sugar, or glucose, in their blood. People with very high or poorly controlled blood glucose levels share many similar symptoms:
• an unusual thirst
• a frequent desire to urinate
• blurred vision
• a feeling of being tired most of the time for no apparent reason
People with type 2 diabetes may also experience leg pain that may indicate nerve damage or poor circulation. Many people with type 1 diabetes and some people with type 2 diabetes also find that they lose weight even though they are hungrier than usual and are eating more.
Even if they have lost weight, people with type 2 diabetes still tend to be overweight. Three-fourths of all people with type 2 diabetes are or have been obese — that is, they are at least 20 percent over their desirable body weight (see the chart of suggested body weights for adults). Type 2 diabetes tends to develop in people who have extra body fat. Where you carry your excess fat may determine whether you get type 2 diabetes: Extra fat above the hips (central body obesity) is riskier than fat in the hips and thighs for developing type 2 diabetes. And leading an inactive “couch potato” lifestyle can also lead to diabetes. It also contributes to obesity.
If you have recently been diagnosed with diabetes, you are not alone. Nearly 16 million Americans — about one of every 17 people — have the disease. About 1,800 new cases of diabetes are diagnosed each day, with about 655,000 new cases each year. Ninety to ninety-five percent of all cases of diabetes in people over age 20 are type 2 diabetes. And half of all people with type 2 diabetes are unaware they even have the disease. Because of the nature of type 2 diabetes, it is possible to have mild symptoms (what you feel) or signs (what the doctor can detect) of type 2 diabetes for years before diabetes worsens. In contrast, few cases of type 1 diabetes go undetected for long. The symptoms of type 1 diabetes are severe enough that the person goes to the doctor for help.
SUGGESTED BODY WEIGHT FOR ADULTS

Height (in feet/inches),________________________Weight (in pounds)
without shoes_______________________________without clothes
______________________Age 19 to 34__________Age 35 and over
5’0” _____________________97-128 _________________108-138
5’1”_____________________101-132 _________________111-143
5’2”_____________________104-137 _________________115-148
5’3”_____________________107-141 _________________119-152
5’4”_____________________111-146 _________________122-157
5’5”_____________________114-150 _________________126-162
5’6”_____________________118-155 _________________130-167
5’7”_____________________121-160 _________________134-172
5’8”_____________________125-164 _________________138-178
5’9”_____________________129-169 _________________142-183
5’10”____________________132-174 _________________146-188
5’11”____________________136-179 _________________151-194
6’0”_____________________140-184 _________________155-199
6’1”_____________________144-189 _________________159-205
6’2”_____________________148-195 _________________164-210
6’3”_____________________152-200 _________________168-216
6’4”_____________________156-205 _________________173-222
6’5”_____________________160-211 _________________177-228
6’6”_____________________164-216 _________________182-234
From The Dietary Guidelines for Americans, U.S. Department of Agriculture, U.S. Department of Health and Human Services, 3rd edition, 1990.
WHO HAS DIABETES?

Almost 16 million Americans have diabetes. This is about 6 percent of the people in the country. In 1999, it was estimated that 500,000 to 1 million people had type 1 diabetes. It is hard to get an exact count of the number of people with diabetes because we have no nationwide diabetes registry. Slightly under half of the people with type 1 diabetes are children and teenagers aged 20 and younger. Type 1 diabetes is more common in whites than in African Americans, Hispanic Americans, Asian Americans, and Native Americans.
In 1999, it was estimated that about 9.5 million people had diagnosed type 2 diabetes. Another 5 to 6 million people are undiagnosed. It is common in older people. Nearly 11 percent of Americans age 65 to 74 have type 2 diabetes. It is more common in some ethnic groups than others. In Americans age 45 to 74, over 14 percent of Mexican Americans and Puerto Rican Americans have type 2 diabetes, over 10 percent of African Americans have type 2 diabetes, and about 6 percent of Cuban Americans and whites have type 2 diabetes. Type 2 diabetes is even more common in Native Americans: In some groups, almost half of adults age 30 to 64 have type 2 diabetes.
About 135,000 women develop gestational diabetes each year. Of these, about 40 percent get type 2 diabetes within 15 years.
TESTS FOR DIABETES

Although your physician may suspect that you have diabetes because of your symptoms, the only sure way to tell is with blood tests. Blood tests are used to diagnose both type 1 and type 2 diabetes, as well as gestational diabetes. Your doctor may repeat your blood tests to be sure of the diagnosis.
The blood tests are based on the fact that diabetes keeps your blood glucose, or sugar, levels above normal some or all of the time. Your blood glucose levels may be high even though you haven’t eaten recently. In addition, your body cannot get rid of the extra glucose that appears in the blood after eating.
Random plasma glucose tests are the simplest way to detect diabetes. This test measures the amount of glucose in the blood at any given time and is done without fasting. If you have obvious symptoms of diabetes and the amount of glucose in your blood is 200 mg/dl or higher, your doctor will diagnose diabetes. Symptoms of diabetes include frequent urination, intense thirst, blurred vision, unexplained weight loss, and extreme tiredness.
The preferred method for diagnosing diabetes is the fasting plasma glucose test. For this test, your doctor will ask you not to eat for at least 8 to 10 hours. Then, a sample of your blood is taken, and the amount of glucose present in the blood is measured. Normally after fasting, the amount of glucose is less than 110 mg/dl. But when the amount of blood glucose is greater than 126 mg/dl, the doctor will suspect diabetes. In diabetes, extra glucose remains in the blood, even after fasting, because it cannot enter the body’s cells. This is due to a lack of insulin or resistance to the action of insulin. Doctors usually make a firm diagnosis of diabetes when two fasting plasma glucose tests, done on different days, are over 126 mg/dl.
If your test results are greater than 110 mg/dl but less than 126 mg/dl, you may be diagnosed with impaired fasting glucose. This is not diabetes, but sometimes occurs before diabetes, usually type 2 diabetes, develops. Some people with impaired glucose tolerance never get diabetes. However, some of the same problems that result from having diabetes also occur in people with impaired glucose tolerance. If you have been diagnosed with impaired glucose tolerance, your physician will want to watch carefully for diabetes. Also, you need to talk with your doctor about reducing your risk of heart disease, keeping your weight in the healthy range, and exercising regularly to lower your chances of developing diabetes.
Certain pregnant women with no history of diabetes are at high risk for developing gestational diabetes. These are women who are 25 years of age or older, are overweight, have a parent or sibling with diabetes, or are Hispanic, Native American, Asian, or African-American.
If you have any of these characteristics, your obstetrician will screen you for gestational diabetes with a glucose challenge. This is done between the 24th and 28th weeks of pregnancy. At this time, the hormones of pregnancy naturally begin to cause temporary insulin resistance that lasts until the baby is born. The glucose challenge helps your doctor determine whether your body is able to overcome the insulin resistance on its own. You are given a glucose drink to finish at a certain time, without regard to eating. If the glucose in your blood 1 hour later is 140 mg/dl or above, you may have gestational diabetes. Your doctor will need to give you another test, for which you may need to fast, for a firm diagnosis.
NOT SURE WHICH TYPE OF DIABETES YOU HAVE?

Your characteristics................Type 1?........................Type 2?

Age 10 at diagnosis...................Probably........................Not likely
Age 20 at diagnosis...................Probably........................Not likely
Age 30 at diagnosis...................Probably........................Not likely
Age 40 at diagnosis...................Maybe...........................Maybe
Age 50 at diagnosis..................Not likely.......................Probably
Age 60 at diagnosis..................Not likely.......................Probably
Age 70 at diagnosis..................Not likely.......................Probably
Underweight at diagnosis.........Probably........................Not likely
Normal weight at diagnosis......Maybe...........................Maybe
Overweight at diagnosis...........Not likely......................Probably
Frequent urination,...................Yes................................Maybe
hunger, and thirst
before diagnosis
Large amount of ketones...........Yes...............................No
in urine from time
to time
Family history of......................Yes...............................Maybe
type 1 diabetes
Family history of......................Maybe.........................Yes
type 2 diabetes
Previous gestational..................No...............................Yes
diabetes
Use insulin................................Yes..............................Yes
Use oral diabetes.........Maybe for a few months..........Yes
medication
Use no diabetes medication......No...............................Yes
TYPE 1 OR TYPE 2?

If tests reveal that you have diabetes (and you’re not pregnant), your doctor must then decide whether you have type 1 or type 2 diabetes. Although the symptoms and blood test results are similar for both type 1 and type 2 diabetes, the causes are very different.
It will help your doctor to know whether there has been type 1 or type 2 diabetes in your family. Your age is not the only clue about what type of diabetes you have. It’s true that most people younger than age 20 who show signs of diabetes have type 1 diabetes and that most people diagnosed with diabetes when they’re over age 30 have type 2 diabetes. But there are exceptions. In some cases, families carry a genetic trait for developing type 2 diabetes as young people. And in some Native American families, obesity is so prevalent that children as young as 10 years old have type 2 diabetes.
• If you are overweight or obese, it is more likely that you have type 2 diabetes.
• If you suddenly developed signs of diabetes, such as frequent urination, unusual thirst and hunger, and weight loss, perhaps after an illness, and are a young adult or child, it is more likely that you have type 1 diabetes.
• If you are not overweight and there are ketones in your urine, it is more likely that you have type 1 diabetes (see Chapter 5 on ketone testing).
• If you are African American or Hispanic American, are older than 50, are overweight, and haven’t been feeling quite “right” for a long time, it is more likely that you have type
2 diabetes.
• If your doctor treats you with insulin injections, you could have either type 1 or type 2 diabetes.
DIABETES: FACT OR MYTH?

“I used to have type 2 diabetes, but now I have type 1 diabetes. My doctor put me on insulin last year.”

Lots of people, over 40 percent of adults with diabetes, use insulin. But because there are about 90 adults with type 2 diabetes to every 5 adults with type 1 diabetes, this means there are a lot of people with type 2 diabetes taking insulin. People with type 1 diabetes must use insulin to make up for their pancreas no longer making it. You don’t necessarily have type 1 diabetes just because you have to take insulin. Many people with type 2 diabetes need extra insulin to overcome their body’s resistance to the insulin already being made by the pancreas.
Type 1 diabetes and type 2 diabetes, while having a lot in common, are two different diseases. They have different causes. The type of diabetes you have does not change as you age or if you lose or gain weight or change treatment.

Copyright© 2000 by American Diabetes Association. Foreword by Bruce R. Zimmerman, MD and Elizabeth A. Walker, DNSc, RN, CDE