HEREDITY, STRESS, ILLNESS

Is Diabetes Hereditary?

Scientists estimate that the child of a parent with noninsulin-dependent diabetes has approximately a 10 to 15 percent chance of developing noninsulin-dependent diabetes. If both parents have diabetes, the child's risk of having the disease increases. The child's health habits throughout his or her life will affect the risk of developing diabetes. Obesity, for example, may increase the risk of diabetes or cause it to occur earlier in life.

Noninsulin-dependent diabetes in a parent has no effect on the chances that his or her child will have insulin-dependent diabetes, the more severe form of diabetes.

Stress and Illness

One way the body responds to stress is to increase the level of blood glucose. In a person with diabetes, stress may increase the need for treatment to lower blood glucose levels. Illnesses such as colds and flu are forms of physical stress that a doctor can treat. The doctor will advise the person to drink plenty of fluids. When blood glucose is high, the body gets rid of glucose through urine, and this fluid needs to be replaced.

If nausea makes eating or taking oral diabetes drugs a problem, a doctor should be consulted. Not eating can increase the risk of low blood glucose, while stopping oral medications or insulin during illness can lead to very high blood glucose. A doctor may prescribe insulin temporarily for someone with diabetes who can't take medicine by mouth.

Great thirst, rapid weight loss, high fever, or very high urine or blood glucose are signs that blood sugar is out of control. If a person has these symptoms, a doctor should be called immediately.

Like illness, stress that results from losses or conflicts at home or on the job can affect diabetes control. Urine and blood glucose checks can be clues to the effects of stress. If someone finds that stress is making diabetes control difficult, a doctor can advise treatment and suggest sources of help.

SPECIAL SITUATIONS

Surgery

Surgery is stressful, both physically and mentally. It can raise blood glucose levels even in someone who is careful about control.

To make sure that surgery and recovery are successful for someone with diabetes, a doctor will test blood glucose and keep it under careful control, usually with insulin. Careful control makes it possible for someone with diabetes to have surgery with little or no more risk than someone without diabetes.

To plan a safe and successful surgery, the surgeon and attending physicians must know that the person they're treating has diabetes. While tests done before surgery can detect diabetes, the patient should inform the doctor of his or her condition. A surgical team also will evaluate the possible effect of complications of diabetes, such as heart or kidney problems.

Pregnancy

Bearing a child places extra demands on a woman's body. Diabetes makes it more difficult for her body to adjust to these demands and it can cause problems for both mother and baby. Some woman may develop a form of diabetes during pregnancy called gestational diabetes. Gestational diabetes develops most frequently in the middle and later months of pregnancy, after the time of greatest risk for birth defects. Although this kind of diabetes often disappears after the baby's birth, treatment is necessary during pregnancy to make sure the diabetes doesn't harm the mother or fetus.

A woman who knows she has diabetes should keep her condition under control before she becomes pregnant, so that her diabetes won't increase the risk of birth defects. A woman whose diabetes isn't well controlled may have an unusually large baby. Diabetes also increases the risk of premature birth and problems in the baby, such as breathing difficulties, low blood sugar and occasionally, death.

Blood glucose monitoring and treatment with insulin can ensure that a baby born to a mother with diabetes will be healthy. Oral diabetes drugs aren't given during pregnancy because the effects of these drugs on the unborn baby aren't known. By following the advice of a doctor trained to treat gestational diabetes, the mother can make sure her blood glucose is normal and her baby is well nourished.

Approximately half of women with gestational diabetes will no longer have abnormal blood glucose tests shortly after giving birth. However, many women with gestational diabetes will develop noninsulin-dependent diabetes later in their lives. Regular check-ups can ensure that if a woman does develop diabetes later, it will be diagnosed and treated early.

ALCOHOL BEVERAGES

Most people with diabetes can drink alcohol safely if they drink in moderation (one or two drinks occasionally), because in higher quantities alcohol can cause health problems:

• Alcohol has calories without the vitamins, minerals, and other nutrients that are essential for maintaining good health. A doctor can discuss whether it's safe for an individual with diabetes to drink. People who are trying to lose weight need to account for the calories in alcohol in diet planning. A dietitian also can provide information about the sugar and alcohol content of various alcoholic drinks.
• Alcohol on an empty stomach can cause low blood glucose or hypoglycemia. Hypoglycemia is a particular risk in people who use oral medications or insulin for diabetes. It can cause shaking, dizziness, and collapse. People who don't know someone has diabetes may mistake these symptoms for drunkenness and neglect to seek medical help.
• Oral diabetes medications--tolbutamide and chlorpropamide--can cause dizziness, flushing, and nausea when combined with alcohol. A doctor can advise patients on the safety of drinking when taking these and other diabetes medications.
• Frequent, heavy drinking can cause liver damage over time. Because the liver stores and releases glucose, blood glucose levels may be more difficult to control in a person with liver damage from alcohol.
• Frequent heavy drinking also can raise the levels of fats in blood, increasing the risk of heart disease.
  

EXERCISE

Exercise has many benefits, and for someone with diabetes regular exercise combined with a good diet can help control diabetes. Exercise not only burns calories, which can help with weight reduction, but it also can improve the body's response to the hormone insulin. As a result, following a regular exercise program can make oral diabetes medications and insulin more effective and can help control blood glucose levels.

Exercise also reduces some risk factors for heart disease. For example, exercise can lower fat and cholesterol levels in bloods which increase heart disease risk. It also can lower blood pressure and increase production of a cholesterol, called HDL, that protects against heart disease.

However, infrequent, strenuous exercise can strain muscles and the circulatory system and can increase the risk of a heart attack during exercise. A doctor can decide how much exercise is safe for an individual. The doctor will consider how well controlled a person's diabetes is, the condition of the heart and circulatory system, and whether complications require that the person avoid certain types of activity.

Walking is great exercise, especially for an inactive person, and it's easy to do. A person can start off walking for 15 or 20 minutes, three or four times a week, and gradually increase the speed or distance of the walks. The purpose of a good exercise program is to find an enjoyable activity and do it regularly. Doing strenuous exercise for six months and then stopping isn't as effective. People taking oral drugs or insulin need to remember that strenuous exercise can cause dangerously low blood glucose and they should carry a food or drink high in sugar for medical emergencies. Signs of hypoglycemia include hunger, nervousness, shakiness, weakness, sweating, headache, and blurred vision. As a precaution, a person with diabetes should wear an identification bracelet or necklace to alert a stranger that the wearer has diabetes and may need special medical help in an emergency.

A doctor may advise someone with high blood pressure or other complications to avoid exercises that raise blood pressure. For example, lifting heavy objects and exercises that strain the upper body raise blood pressure.

People with diabetes who have lost sensitivity in their feet also can enjoy exercise. They should choose shoes carefully and check their feet regularly for breaks in skin that could lead to infection. Swimming or bicycling can be easier on the feet than running.

Points to Remember

Exercise has three major benefits; it burns calories, improves the body's response to insulin, and reduces risk factors for heart disease.

An exercise program should be started slowly and with the advice of a doctor.

CHECKING BLOOD GLUCOSE LEVELS

When a person's body is operating normally, it automatically checks the level of glucose in blood. If the level is too high or too low, the body will adjust the sugar level to return it to normal. This system operates in much the same way that cruise control adjusts the speed of a car. With diabetes, the body doesn't do the job of controlling blood glucose automatically. To make up for this, someone with diabetes has to check blood sugar regularly and adjust treatment accordingly.

A doctor can measure blood glucose during an office visit. However, levels change from hour to hour and someone who visits the doctor only every few weeks won't know what his or her blood glucose is daily. Do-it-yourself tests enable people with diabetes to check their blood sugar daily.

The easiest test someone can do at home is a urine test. When the level of glucose in blood rises above normal, the kidneys eliminate the excess glucose in urine. Glucose in urine, therefore, reflects an excess of glucose in blood.

Urine testing is easy. Tablets or paper strips are dipped in urine. The color change that occurs indicates whether blood glucose is too high. However, urine testing is not completely accurate because the reading reflects the level of blood glucose a few hours earlier. In addition, not everyone's kidneys are the same. Even when the amount of glucose in two people's urine is the same, their sugar levels may be different. Certain drugs and vitamin C also can affect the accuracy of urine tests.

It's more accurate to measure blood glucose directly. Kits are available that allow people with diabetes to test their blood glucose at home. The test involves pricking a finger to draw a drop of blood. A spring-operated "lancet" does this automatically. The drop of blood is placed on a strip of specially coated plastic or into a small machine that "reads" how much glucose is in the blood. A doctor may suggest that someone test his or her blood glucose several times a day. Self blood glucose monitoring can show how the body responds to meals, exercise, stress, and diabetes treatment.

Another test that measures the effectiveness of treatment is a "glycosylated hemoglobin" test. It measures the glucose that has become attached to hemoglobin, the molecule in red blood cells that gives blood its red color. Over time, hemoglobin absorbs glucose, according to its concentration in blood. Once glucose is absorbed by hemoglobin it remains there until the blood cells die and new ones replace them. With the "glycosylated hemoglobin" test, a doctor can tell whether blood glucose has been very high over the last few months.

Points to Remember

Testing blood glucose levels regularly can show whether treatment is working.

DIABETES DIET

The proper diet is critical to diabetes treatment. It can help someone with diabetes:

• Achieve and maintain desirable weight. Many people with diabetes can control their blood glucose by losing weight and keeping it off.
• Maintain normal blood glucose levels.
• Prevent heart and blood vessel diseases, conditions that tend to occur in people with diabetes.
  

A doctor will usually prescribe diet as part of diabetes treatment. A dietitian or nutritionist can recommend a diet that is healthy, but also interesting and easy to follow. No one has to be limited to a preprinted, standard diet. Someone with diabetes can get assistance in the following ways:

• A doctor can recommend a local nutritionist or dietitian.
• Local diabetes centers at large medical clinics, hospitals, or medical universities usually have dietitians and nutritionists on staff.
  

The guidelines for diabetes diet planning include the following:

• Many experts recommend that 50 to 60 percent of daily calories come from carbohydrates, 12 to 20 percent from protein, and no more than 30 percent from fat.
• Spacing meals throughout the day, instead of eating heavy meals once or twice a day, can help a person avoid extremely high or low blood glucose levels.
• With few exceptions, the best way to lose weight is gradually: one or two pounds a week. Strict diets must never be undertaken without the supervision of a doctor.
• People with diabetes have twice the risk of developing heart disease as those without diabetes, and high blood cholesterol levels raise the risk of heart disease. Losing weight and reducing intake of saturated fats and cholesterol, in favor of unsaturated and monounsaturated fats, can help lower blood cholesterol.
  

For example, meats and dairy products are major sources of saturated fats, which should be avoided; most vegetable oils are high in unsaturated fats, which are fine in limited amounts; and olive oil is a good source of monounsaturated fat, the healthiest type of fat. Liver and other organ meats and egg yolks are particularly high in cholesterol. A doctor or nutritionist can advise someone on this aspect of diet.

• Studies show that foods with fiber, such as fruits, vegetables, peas, beans, and whole-grain breads and cereals may help lower blood glucose. However, it seems that a person must eat much more fiber to get this benefit. A doctor or nutritionist can advise someone about adding fiber to a diet.

• Exchange lists are useful in planning a diabetes diet. They place foods with similar nutrients and calories into groups. With the help of a nutritionist, the person plans the number of servings from each exchange list that he or she should eat throughout the day. Diets that use exchange lists offer more choices than preprinted diets.
  

Continuing research may lead to new approaches to diabetes diets. Because one goal of a diabetes diet is to maintain normal blood glucose levels, it would be helpful to have reliable information on the effects of foods on blood glucose. For example, foods that are rich in carbohydrates, like breads, cereals, fruits, and vegetables break down into glucose during digestion, causing blood glucose to rise. However, scientists don't know how each of these carbohydrates affect blood glucose levels. Research is also under way to learn whether foods with sugar raise blood glucose higher than foods with starch. Experts do know that cooked foods raise blood glucose higher than raw, unpeeled foods. A person with diabetes can ask a doctor or nutritionist about using this kind of information in diet planning.

Points to Remember

A diabetes diet should do three things; achieve ideal weight, maintain normal blood glucose levels, and limit foods that contribute to hear disease.

A nutritionist or dietitian can help plan a diabetes diet.

TREATING DIABETES

The goals of diabetes treatment are to keep blood glucose within normal range and to prevent long-term complications. Why control blood glucose? In the first place, diabetes can cause short-term effects: some are unpleasant and some are dangerous. These include thirst, frequent urination, weakness, lack of ability to concentrate, loss of coordination, and blurred vision. Loss of consciousness is possible with very high or low blood sugar levels, but is more of a danger in insulin-dependent than in noninsulin-dependent diabetes.

In the second place, the long-term complications of diabetes may result from many years of high blood glucose. Research is under way to find out if this is true and to learn if careful control can help prevent complications. Meanwhile, most doctors feel that if people with diabetes keep their blood glucose levels under control, they will reduce the risk of complications.

The best treatment for noninsulin-dependent diabetes is a diet that helps the person maintain normal weight. In people who are overweight, losing weight is the one treatment that is clearly effective in controlling diabetes.

In some people, exercise can help keep weight and diabetes under control. However, when diet and exercise alone can't control diabetes, two other kinds of treatment are available: oral diabetes medications and insulin. The treatment a doctor suggests depends on the person's age, lifestyle, and the severity of the diabetes.

Points to Remember

Diabetes treatment can reduce symptoms, like thirst and weakness, and the chances of long-term problems, like heart and eye disease.

If treatment with diet and exercise isn't effective, a doctor may prescribe oral medications or insulin.

There is no known cure for diabetes; daily treatment must continue throughout a person's lifetime.

DIAGNOSING DIABETES

A doctor can diagnose diabetes by checking for symptoms such as excessive thirst and frequent urination and by testing for glucose in blood or urine. When blood glucose rises above a certain point, the kidneys pass the extra glucose in the urine. However, a urine test alone is not sufficient to diagnose diabetes.

A second method for testing glucose is a blood test usually done in the morning before breakfast (fasting glucose test) or after a meal (postprandial glucose test).

The oral glucose tolerance test is a second type of blood test used to check for diabetes. Sometimes it can detect diabetes when a simple blood test does not. In this test, blood glucose is measured before and after a person has consumed a thick, sweet drink of glucose and other sugars. Normally, the glucose in a person's blood rises quickly after the drink and then falls gradually again as insulin signals the body to metabolize the glucose. In someone with diabetes, blood glucose rises and remains high after consumption of the liquid.

A doctor can decide, based on these tests and a physical exam, whether someone has diabetes. If a blood test is borderline abnormal, the doctor may want to monitor the person's blood glucose regularly. If a person is overweight, he or she probably will be advised to lose weight. The doctor also may monitor the patient's heart, since diabetes increases the risk of heart disease.

Points to Remember

A doctor will diagnose diabetes by looking for four kinds of evidence.

• risk factors like exercise weight and a family history of diabetes .
• symptoms such as thirst and frequent urination.
• complications like heart trouble .
• signs of excess glucose or sugar in blood and urine tests.

NONINSULIN-DEPENDENT DIABETES

Who Develops Noninsulin-Dependent Diabetes?

Age, sex, weight, physical activity, diet, lifestyle, and family health history all affect someone's chances of developing diabetes. The chances that someone will develop diabetes increase if the person's parents or siblings have the disease.

While the chances of developing diabetes increase with age, gender isn't a risk factor, although African American women are more likely to develop diabetes than African American men.

While people can't change family history, age, or race, it is possible to control weight and physical fitness. A doctor can decide if someone is at risk for developing diabetes and offer advice on reducing that risk.

Points to Remember

The following factors increase someone's chances of developing diabetes.

• obesity
• family history of diabetes
• advancing age

What Causes Noninsulin-Dependent Diabetes?

While eating sugar, for example, doesn't cause diabetes, eating large amounts of sugar and other rich, fatty foods, can cause weight gain. Most people who develop diabetes are overweight.
Obesity is a major factor leading to noninsulin-dependentdiabetes.

Points to Remember

• In people with noninsulin-dependent diabetes, insulin doesn't lower blood sugar, a condition called insulin resistance.
• Obesity is a risk factor for diabetes.

TYPES

There are THREE main Types of the Diabetes

Type 1 diabetes

Type 2 diabetes

Gestational diabetes

Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. With this form of diabetes, the beta cells of the pancreas no longer make insulin because the body’s immune system has attacked and destroyed them. These types of diabetics are dependent upon insulin. Some common symptoms of type 1 diabetes mellitus are excessive thirst and urination, distorted vision, sudden weight loss, and severe exhaustion. The symptoms of type 1 usually develop over a short period of time.

Treatment for type 1 diabetes includes taking insulin, making wise food choices, being physically active, taking aspirin daily (for some), and controlling blood pressure and cholesterol.

Type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age—even during childhood. Type 2 diabetes, the most common form, is often related to obesity, old-age, a sedentary lifestyle, genetic history of the disease, ethnicity, and a history of gestational diabetes. Those with type 2 usually have a pancreas that produces enough insulin, but the body, for an unidentified reason, does not use it properly. This improper use of insulin is commonly referred to as insulin resistance. Throughout time the pancreas will begin to fail in producing insulin and sugar will build up in the body, making this main fuel source unattainable. Being the most common form of the debility, type 2 accounts for 90 - 95% of the diabetic population, and is on the increase. Though this ailment is mostly widespread among obese adults it is also being diagnosed in children and adolescents. Some of the most common symptoms of type 2 diabetes mellitus are severe exhaustion, excessive urination, distorted vision, and enhanced hunger. Compared to type 1, these symptoms develop at a more gradual pace.

Treatment includes using diabetes medicines, making wise food choices, being physically active, taking aspirin daily, and controlling blood pressure and cholesterol.

Gestational diabetes is a form of the epidemic that can be acquired by women who are pregnant. This form of the condition usually disappears after the pregnancy is over, but leaves the mother with a 20 - 50% possibility of developing type 2 diabetes. Women who have a family history of developing the disease are, of course, the more likely candidates for diabetes. The disorder is primarily caused by hormones that are generated by the placenta and amplify the mothers’ resistance to insulin.

SIGNS OF DIABETES

The signs of diabetes are


* being very thirsty.

* urinating often.

* feeling very hungry or tired.

* losing weight without trying.

* having sores that heal slowly.

* having dry, itchy skin.

* losing the feeling in your feet or having tingling in your feet.

* having blurry eyesight.


You may have had one or more of these signs before you found out you had diabetes. Or you may have had no signs at all. A blood test to check your glucose levels will show if you have pre-diabetes or diabetes.

WHAT IS DIABETES?

Diabetes

Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugar to build up in your blood.
Did you know that diabetes, if unchecked, can lead to very serious conditions such as kidney problems, blindness, and amputations.

How do you get high blood glucose?

Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all the cells in your body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body doesn’t make enough insulin, or if the insulin doesn’t work the way it should, glucose can’t get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing pre-diabetes or diabetes.

What is pre-diabetes?

Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is, if you have pre-diabetes, you can reduce your risk of getting diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes and even return to normal glucose levels.