Definition of Diabetes

Diabetes mellitus is a chronic disease caused by the inability of the pancreas to produce insulin
or to use the insulin produced in the proper way. Diabetes is the 7th leading cause of death
among Americans; over 15 million Americans suffer from one form or another of this disease.

Description of Diabetes

After a meal, a portion of the food a person eats is broken down into sugar (glucose). The sugar
then passes into the bloodstream and to the body's cells via a hormone (called insulin) that is
produced by the pancreas.

Normally, the pancreas produces the right amount of insulin to accommodate the quantity of
sugar. However, if the person has diabetes, either the pancreas produces little or no insulin or
the cells do not respond normally to the insulin. Sugar builds up in the blood, overflows into the
urine and then passes from the body unused. Over time, high blood sugar levels can damage:

 eyes - leading to diabetic retinopathy and possible blindness

 blood vessels - increasing risk ofheart attack, stroke and peripheral artery obstruction
 nerves - leading to diabetic neuropathy, foot sores and possible amputation, possible
paralysis of the stomach, chronic diarrhea
 kidneys - leading to kidney failure

Diabetes has also been linked to impotence and digestive problems. It is important to note that
controlling blood pressure and blood glucose levels, plus regular screenings and check-ups, can
help reduce risks of these complications.

There are two main types of diabetes, Type I and Type II:

Type I diabetes or insulin-dependent diabetes (formerly called juvenile-onset diabetes,

because it tends to affect persons before the age of 20) affects about 10 percent of
people with diabetes. With this type of diabetes, the pancreas makes almost no insulin.

Type II diabetes or non-insulin-dependent diabetes. This was previously called "adult-

onset diabetes" because in the past it was usually discovered after age 40. However,
with increasing levels of obesity and sedentary lifestyle, this disease is now being found
more and more in adolescents - and sometimes even in children under 10 - and the
term "adult onset" is no longer used.

Type II diabetes comprises about 90 percent of all cases of diabetes. With this type of
diabetes, either the pancreas produces a reduced amount of insulin, the cells do not
respond to the insulin, or both.

There are three less common types of diabetes calledgestational diabetes, secondary diabetes
and impaired glucose tolerance (IGT):
 Gestational diabetes occurs during pregnancy and causes a higher than normal glucose
level reading.

Secondary diabetes is caused by damage to the pancreas from chemicals, certain

medications, diseases of the pancreas (such as cancer) or other glands.

Impaired glucose tolerance (IGT) is a condition in which the person's glucose levels are
higher than normal.

Causes and Risk Factors of Diabetes

The cause of Type I diabetes is genetically based, coupled with an abnormal immune response.

The cause of Type II diabetes is unknown. Medical experts believe that Type II diabetes has a
genetic component, but that other factors also put people at risk for the disease. These factors
include:

 sedentary lifestyle
 obesity (weighing 20 percent above a healthy body weight)
 advanced age
 unhealthy diet
 family history of diabetes
 improper functioning of the pancreas
 minority race (higher risk in Black, Hispanic, American Indian, westernized Asian and
native Hawaiian populations)
 medication (cortisone and some high blood pressure drugs)
 women having given birth to a baby weighing more than 9 lbs.
 previously diagnosed gestational diabetes
 previously diagnosed IGT

Symptoms of Diabetes

Usually, the symptoms of Type I diabetes are obvious. That is not true for Type II. Many people
with Type II do not discover they have diabetes until they are treated for a complication such
as heart disease, blood vessel disease (atherosclerosis), stroke, blindness, skin ulcers, kidney
problems, nerve trouble or impotence.

The warning signs and symptoms for both types are:

Type I: Frequent urination, increased thirst, extreme hunger, unexplained weight loss, extreme
fatigue, blurred vision, irritability, nausea and vomiting.

Type II: Any Type I symptom, plus: unexplained weight gain, pain, cramping, tingling or
numbness in your feet, unusual drowsiness, frequent vaginal or skin infections, dry, itchy skin
and slow healing sores.

Note: If a person is experiencing these symptoms, they should see a doctor immediately.
Diagnosis of Diabetes

Besides a complete history and physical examination, the doctors will perform a battery of
laboratory tests. There are numerous tests available to diagnose diabetes, such as a urine test,
blood test, glucose-tolerance test, fasting blood sugar and the glycohemoglobin (HbA1c) test.

A urine sample will be tested for glucose and ketones (acids that collect in the blood and urine
when the body uses fat instead of glucose for energy).

A blood test is used to measure the amount of glucose in the bloodstream.

A glucose-tolerance test checks the body's ability to process glucose. During this test, sugar
levels in the blood and urine are monitored for three hours after drinking a large dose of sugar
solution.

The fasting blood sugar test involves fasting overnight and blood being drawn the next morning.

The glycohemoglobin test reflects an average of all blood sugar levels for the preceding two
months.

Treatment of Diabetes

A landmark study, the 10-year, multi-center Diabetes Control and Complications Trial (DCCT),

has now shown that intensifying diabetes management with stricter control of blood sugar
levels can reduce long-term complications.

The results of DCCT are extraordinary in that they prove that tight control of glucose levels can
in fact dramatically slow the onset and progression of diabetic complications in both Type I and
Type II diabetes. Additionally, researchers have found strict attention to diet and exercise also
helps in the management of diabetes.

Management of Type I Diabetes

Virtually everyone with Type I diabetes (and more than one in three people with Type II)
must inject insulin to make up for their deficiency. Until recently, insulin came only from
the pancreases of cows and pigs (with pork insulin more closely duplicating human
insulin). While beef, pork and beef/pork combinations are still widely used, there are
now two types of "human" insulin available: semisynthetic (made by converting pork
insulin to a form identical to human) and recombinant (made by using genetic
engineering). All insulin helps glucose levels remain near normal (about 70 to 120
mg/dl).

Different types of insulin work for different periods of time. The numbers shown below
are only averages. The onset (how long it takes to reach the bloodstream to begin
lowering the blood sugar), peaking (how long it takes to reach maximum strength) and
duration (how long it continues to lower the blood sugar) of insulin activity can vary
from person to person and even from day to day in the same person.
Rapid or Regular Activity: Onset is within half an hour and activity peaks during a 2 to 5
hour period. It remains in the bloodstream for about 8 to 16 hours. These fast-acting,
short-lasting insulins are useful in special cases: accidents, minor surgery or illnesses,
which cause the diabetes to go out of control or whenever insulin requirements change
rapidly for any reason. These are also being used more and more in combination with a
long-acting insulin or alone (prior to meals and at bedtime).

Semilente: A special type of short-acting insulin that takes 1 to 2 hours for onset, peaks
3 to 8 hours after injection and lasts 10 to 16 hours.

Intermediate-Acting: Reaching the bloodstream 90 minutes after injection,

intermediate-acting insulin peaks 4 to 12 hours later and lasts in the blood for about 24
hours. There are two varieties of this type of insulin: Lente (called L) and NPH (called N).

Long-Acting: These insulins, which take 4 to 6 hours for onset, are at maximum strength
14 to 24 hours after injection, lasting 36 hours in the bloodstream. Long-acting insulin is
referred to as U (for Ultralente).

Please be aware of the following problems that exist with insulin intake:

o Hypoglycemia (low blood sugar) is sometimes called an insulin reaction or

insulin shock. It can occur suddenly in people using insulin if too little food is
eaten, if a meal is delayed or in the case of extreme exercise. Symptoms include
feeling cold, clammy, nervous, shaky, weak or hungry, and some people become
pale, have headaches or act strangely.
o Hyperglycemia (high blood sugar) occurs when too much food is eaten or not
enough insulin is taken. The warning signs are large amounts of sugar in the
urine and blood, frequent urination, great thirst and nausea.
o Ketoacidosis (in its most severe form - diabetic coma) develops when insulin
and blood sugar are so out of balance that ketones accumulate in the blood.
Symptoms include high blood sugar or ketones in the urine, dry mouth, great
thirst, loss of appetite, excessive urination, dry and flushed skin, labored
breathing, fruity-smelling breath and possible vomiting, abdominal pain and
unconsciousness.

In addition to daily injections of insulin, regular physical activity and a controlled diet are
essential. The American Diabetes Association (ADA) recommends the following daily
dietary guidelines:

o Up to 70 percent of all calories should be obtained from carbohydrates and

unsaturated fats. These carbohydrates should be mainly complex carbohydrates
and naturally occurring sugars (simular to those in milk and fruits). Examples of
unsaturated fats are vegetable oils and margarine.
o Between 10 and 20 percent of calories should be obtained from protein.
o Less than 10 percent of all calories should be obtained from fat. Saturated fats
are found in animal products and in some vegetable oils (such as coconut, palm,
and palm-kernel oils).
 o Eat 30 to 35 grams of fiber.
o Eat no more than 300 mg of cholesterol.

For Type I diabetes, the meal plan should be tailored to the person's individual needs
and is likely to include three meals and two or three snacks a day. A person with
diabetes must eat these meals and snacks at set times each day to properly balance
insulin.

Management of Type II Diabetes

The ADA recommends diet (see ADA guidelines stated above) and regular physical
activity as the first line of treatment for Type II diabetes. If normal glycemic levels are
not achieved within three (3) months, drug treatment is recommended.

Currently there are four (4) classes of prescription drugs available for the treatment of
Type II diabetes:

1. Sulfonylureas (Diabinese, Dymelor, PresTab, Orinase, Tolinase, Micronase,

DiaBeta, Glynase, Glucotrol, Glucotrol XL and Amaryl), which stimulate the
pancreas to release more insulin.
2. Biguanides (Glucophage and Metformin), which keep the liver from releasing
too much glucose.
3. Alpha-glucoside inhibitors (Precose), which slow the digestion of some
carbohydrates.
4. Thiazolidinediones, which control glucose levels by making muscles more
sensitive to insulin and reduce the amount of glucose that the liver produces.

Clinical trials suggest that oral antidiabetic agents - particularly the new noninsulin

secretagogues (including Troglitazone and Metformin, which act on the liver and
skeletal muscle) - may be useful in delaying or preventing development of Type II
diabetes. Both agents, acting primarily by different mechanisms of action, also have
demonstrated potential beneficial effects on serum lipid profiles.

Although these oral medications work in different ways, they can be combined to work
more effectively to manage Type II diabetes. When these combinations of oral
treatments are no longer effective (for about 60 percent of people with Type II
diabetes), the doctor will start a regimen of insulin alone or in combination with an oral
medication.

Prevention of Diabetes

There is no foolproof way to prevent diabetes, but steps can be taken to improve the chances of
avoiding it:

 Exercise. Studies of both men and women have shown that vigorous exercise, even if
done only once a week, has a protective effect against diabetes. Exercise not only
promotes weight loss but lowers blood sugar as well.
 Lose weight. There is evidence that both men and women who gain weight in adulthood
increase their risk of diabetes. A study conducted at Harvard showed that adult women
who gained 11 to 17 pounds since the age of 18 doubled their risk of diabetes; those
who gained between 18 and 24 pounds almost tripled their risk. Fact: 90 percent of
diabetics are overweight.
 Diet. The use of a diet low in calories and in saturated fat is an ideal strategy for
preventing Type II diabetes. (See the ADA guidelines stated in the TREATMENT section).
 Stop smoking. Smoking is especially dangerous for people with diabetes who are at risk
for heart and blood vessel diseases.
 Use alcohol in moderation. Moderation for men means no more than two drinks a day;
for women, one drink is the limit. Choose drinks that are low in alcohol and sugar such
as dry wines and light beers. If you use mixers, try to select one that is sugar free, such
as diet drinks, club soda, seltzer or water. If you take diabetic pills or insulin, alcohol can
drop blood glucose levels too far. Have the drink with a meal or snack.