Diabetes
Insulin is a hormone produced by the pancreas to control blood sugar.
Diabetes can be caused by too little insulin, resistance to insulin, or both.
To understand diabetes, it is important to first understand the normal process
by which food is broken down and used by the body for energy. Several
things happen when food is digested:
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A sugar called glucose enters the bloodstream. Glucose is a source of
fuel for the body.
An organ called the pancreas makes insulin. The role of insulin is to
move glucose from the bloodstream into muscle, fat, and liver cells,
where it can be used as fuel.
People with diabetes have high blood sugar because their body cannot move
sugar into fat, liver, and muscle cells to be stored for energy. This is because
either:
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Their pancreas does not make enough insulin
Their cells do not respond to insulin normally
Both of the above
There are three major types of diabetes. The causes and risk factors are
different for each type:
 Type 1 diabetes can occur at any age, but it is most often diagnosed
in children, teens, or young adults. Insulin is a hormone produced by
special cells, called beta cells, in the pancreas. The pancreas is found
behind your stomach. Insulin is needed to move blood sugar (glucose)
into cells, where it is stored and later used for energy. In type 1
diabetes, beta cells produce little or no insulin. Without enough
insulin, glucose builds up in the bloodstream instead of going into the
cells. The body is unable to use this glucose for energy. This leads to
the symptoms of type 1 diabetes. The exact cause of type 1 diabetes is
unknown.
 Type 2 diabetes makes up most of diabetes cases. It most often
occurs in adulthood, but teens and young adults are now being
diagnosed with it because of high obesity rates. Many people with
type 2 diabetes do not know they have it. It is a noninsulin-dependent
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diabetes; Diabetes - type 2; Adult-onset diabetes. Diabetes is caused
by a problem in the way your body makes or uses insulin. Insulin is
needed to move blood sugar (glucose) into cells, where it is stored and
later used for energy. When you have type 2 diabetes, your fat, liver,
and muscle cells do not respond correctly to insulin. This is called
insulin resistance. As a result, blood sugar does not get into these cells
to be stored for energy. When sugar cannot enter cells, high levels of
sugar build up in the blood. This is called hyperglycemia. Type 2
diabetes usually occurs slowly over time. Most people with the
disease are overweight when they are diagnosed. Increased fat makes
it harder for your body to use insulin the correct way. Type 2 diabetes
can also develop in people who are thin. This is more common in the
elderly. Family history and genes play a large role in type 2 diabetes.
Low activity level, poor diet, and excess body weight around the waist
increase your risk
 Gestational diabetes is high blood sugar that develops at any time
during pregnancy in a woman who does not have diabetes. Pregnancy
hormones can block insulin from doing its job. When this happens,
glucose levels may increase in a pregnant woman's blood.
You are at greater risk for gestational diabetes if you:
 Are older than 25 when you are pregnant
 Have a family history of diabetes
 Gave birth to a baby that weighed more than 9 pounds or had a birth
defect
 Have high blood pressure
 Have too much amniotic fluid
 Have had an unexplained miscarriage or stillbirth
 Were overweight before your pregnancy
Symptoms
High blood sugar levels can cause several symptoms, including:
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Blurry vision
Excess thirst
Fatigue
Frequent urination
Hunger
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Weight loss
Because type 2 diabetes develops slowly, some people with high blood sugar
have no symptoms.
Symptoms of type 1 diabetes develop over a short period of time. People
may be very sick by the time they are diagnosed.
Signs and tests
A urine analysis may be used to look for high blood sugar. However, a urine
test alone does not diagnose diabetes.
Your health care provider may suspect that you have diabetes if your blood
sugar level is higher than 200 mg/dL. To confirm the diagnosis, one or more
of the following tests must be done.
Blood tests:
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Fasting blood glucose level -- diabetes is diagnosed if it is higher than
126 mg/dL twice. Levels between 100 and 126 mg/dL are called
impaired fasting glucose or pre-diabetes. These levels are risk factors
for type 2 diabetes.
Hemoglobin A1c test -o Normal: Less than 5.7%
o Pre-diabetes: 5.7% - 6.4%
o Diabetes: 6.5% or higher
Oral glucose tolerance test-- diabetes is diagnosed if glucose level is
higher than 200 mg/dL after 2 hours. (This test is used more often for
type 2 diabetes.)
Screening for type 2 diabetes in people who have no symptoms is
recommended for:
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Overweight children who have other risk factors for diabetes, starting
at age 10 and repeated every 2 years
Overweight adults (BMI greater than 25) who have other risk factors
Adults over age 45, repeated every 3 years
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Treatment
There is no cure for diabetes. Treatment involves medicines, diet, and
exercise to control blood sugar and prevent symptoms and problems.
Studies have shown that better control of blood sugar, cholesterol, and blood
pressure levels in persons with diabetes helps reduce the risk of kidney
disease, eye disease, nervous system disease, heart attack, and stroke.
Complications
Emergency complications include:
 Diabetic hyperglycemic hyperosmolar coma (Diabetic
hyperglycemic hyperosmolar syndrome (HHS) is a complication of
type 2 diabetes that involves extremely high blood sugar (glucose)
levels without the presence of ketones. Ketones are byproducts of fat
breakdown.)
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Diabetic ketoacidosis (The buildup of ketones in the body)
After many years, diabetes can lead to other serious problems:
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You could have eye problems, including trouble seeing (especially at
night) and light sensitivity. You could become blind.
Your feet and skin can develop sores and infections. After a long time,
your foot or leg may need to be removed. Infection can also cause
pain and itching in other parts of the body.
Diabetes may make it harder to control your blood pressure and
cholesterol. This can lead to a heart attack, stroke, or other problems.
It can become harder for blood to flow to your legs and feet.
Nerves in the body can become damaged, causing pain, tingling, and a
loss of feeling.
Because of nerve damage, you could have problems digesting the
food you eat. You could feel weakness or have trouble going to the
bathroom. Nerve damage can also make it harder for men to have an
erection.
High blood sugar and other problems can lead to kidney damage. The
kidneys might not work as well, and they may even stop working.
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Prevention
Keeping an ideal body weight and an active lifestyle may prevent type 2
diabetes.
There is no way to prevent type 1 diabetes.
To prevent complications of diabetes, visit your health care provider or
diabetes educator at least four times a year. Talk about any problems you are
having.
SELF-TESTING
If you have diabetes, your doctor may tell you to regularly check your
blood sugar levels at home. There are a number of devices available,
and they use only a drop of blood. Self-monitoring tells you how well
diet, medication, and exercise are working together to control your
diabetes. It can help your doctor prevent complications.
Keeping blood sugar levels in a range based on your age. Discuss
these goals with your doctor and diabetes educator.
Before meals:
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70 - 130 mg/dL for adults
100 - 180 mg/dL for children under age 6
90 - 180 mg/dL for children 6 - 12 years old
90 - 130 mg/dL for children 13 - 19 years old
At bedtime:
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Less than 180 mg/dL for adults
110 - 200 mg/dL for children under age 6
100 - 180 mg/dL for children 6 - 12 years old
90 - 150 mg/dL for children 13 - 19 years old
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