DIABETES

INFORMATION

Tender Loving Family, Inc.

What is diabetes?

Diabetes is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes can be associated with serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications. The main types of diabetes are simply referred to as “type 1” and “type 2”.

Type 1 Diabetes

Previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes may account for 5% to 10% of all diagnosed cases of diabetes. Type 1 is more common in white Americans.

Symptoms of Type 1 Diabetes

Frequent urination Unusual increased thirst Extreme hunger Unusual weight loss in spite of

increased appetite Extreme fatigue and irritability

THE CONDITION IS OFTEN DIAGNOSED IN AN

EMERGENCY SETTING.

Those with type 1 diabetes usually develop symptoms over a short period of time.

Type 2 Diabetes

Type 2 diabetes may account for about 90% to 95% of all diagnosed cases of diabetes.

Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity- African Americans, Hispanic/Latino Americans, and American Indians.

Type 2 diabetes is increasingly being diagnosed in children and adolescents.

Symptoms of Type 2 Diabetes

Any of the Type 1 symptoms Frequent infections Blurred vision Cuts/bruises that are slow to heal Tingling/numbness in the hands/feet Recurring skin, gum, or bladder infections

However, because type 2 develops slowly, some people with high blood sugar experience no symptoms at all.

Hyperglycemia and Hypoglycemia

Hyperglycemia and hypoglycemia are diseases of the body's blood sugar levels. However, they have the opposite issues.

Hyperglycemia (hi"per-gli-SE'me-ah) is an increase in plasma glucose (blood sugar). It can turn into a complex medical condition - diabetic ketoacidosis (ke"to-as"id-O'sis) and coma - if it's not treated on time and adequately. Hyperglycemia is usually the first sign of diabetes mellitus. Symptoms can include high levels of sugar in urine, frequent urination, excessive thirst and/or hunger, and high blood glucose.

Ketones are substances that are made when the body breaks down fat for energy. Normally, your body gets the energy it needs from carbohydrates in your diet. But stored fat is broken down and ketones are made if your diet does not contain enough carbohydrates to supply the body with sugar (glucose) for energy or if your body cannot use blood sugar (glucose) properly.

You can often lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl, check your urine for ketones. If you have ketones, do not exercise. (You can check ketones trough blood or urine test.)

Exercising when ketones are present may make your blood glucose level go even higher. You'll need to work with your doctor to find the safest way for you to lower your blood glucose level.

Cutting down on the amount of food you eat might also help.

Work with your dietitian to make changes in your meal plan. If exercise and changes in your diet don't work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it.

Hypoglycemia (hi"po-gli-SE'me-ah) is a low level of plasma glucose (blood sugar). It's a dangerous condition because glucose is the major source of energy for the brain. Lack of glucose, like lack of oxygen, produces brain damage or even death if the deficit is prolonged.

Hypoglycemia can occur after insulin excess and/or inadequate glucose intake, among other causes. These situations are common in people with diabetes who receive too much insulin or who don't eat enough.

Hypoglycemia starts to cause these symptoms when glucose levels fall below

50 milligrams per deciliter (mg/dL):

- sweating -cloudy vision - tremors -confusion - anxiety -abnormal behavior - hunger -convulsions - dizziness -loss of consciousness - headache

What should you do if hypoglycemia occurs?If you're suspected of hypoglycemia, you must eat or drink something with sugar in it immediately.

Other Types of Diabetes

Gestational diabetes (which resembles type 2 in several aspects) occurs in about 2%-5% of pregnancies, usually at around 28 weeks or later, and may improve or disappear after delivery. It is fully treatable but requires careful medical supervision throughout the pregnancy. About 20%-50% of affected women develop type 2 diabetes later in life.

Congenital nephrogenic diabetes insipidus is a condition in which the kidneys can't conserve water, leading to excessive water loss. This condition is present from birth.

Cystic fibrosis-related diabetes (CFRD)- Diabetes in people with cystic fibrosis combines the characteristics of both type 1 and type 2 diabetes. Build up of thick secretions in the pancreas eventually damages the hormone-producing cells, causing insulin deficiency. This sounds like type 1 diabetes, but it is not quite the same thing because it does not start in childhood, but in adulthood, and is caused by damage to a pancreas that used to produce insulin normally.

Steroid diabetes is not an autoimmune disease and yet it can sometimes have total beta cell failure. It comes about from the taking of (medically prescribed) steroids over a long period of time.

Monogenic diabetes is rare, but results from mutations in a single gene, such as Permanent neonatal diabetes mellitus (PND), transient neonatal diabetes (TND), and maturity-onset diabetes of the young (MODY). All of these are the main forms of monogenic diabetes.

Complications of Diabetes

Heart disease and strokeHigh blood pressureBlindnessKidney disease (nephropathy)Nervous system disease (neuropathy)AmputationsDental diseaseComplications of pregnancyBiochemical imbalancesIncreased susceptibility to many other illnesses

(which can lead to worse prognoses)

Diabetic neuropathy is a common complication of diabetes, in which nerves are damaged as a result of high blood sugar levels (hyperglycemia).

Diabetic nephropathy is kidney disease or damage that results as a complication of diabetes.

Diabetic Retinopathy

Diabetic retinopathy is damage to the eye's retina that occurs with long-term diabetes (both 1 and 2). It is caused by damage to blood vessels of the retina.

Many people with early diabetic retinopathy have no symptoms before major bleeding occurs in the eye. This is why everyone with diabetes should have regular eye exams.

Diabetic retinopathy

Chronic generalized periodontitis in a diabetic patient. Note the heavy deposits of

materia alba in the mandibular anterior teeth and the spacing of teeth, in this 52 year-old

male with poor oral hygiene.

People with diabetes are more likely to have foot problems. Diabetes can damage blood vessels and nerves and decrease the body's ability to fight infection. You may not notice a foot injury until an infection develops. Death of skin and other tissue can occur.

If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.

To prevent injury to the feet, check and care for them every day.

Currently, there are approximately 100,000 limb amputations performed on diabetic patients in the

United States each year.

Diabetic foot complications

Most lead to amputation

People with diabetes are far more likely to have a foot or leg amputated than other people. The problem? Many people with diabetes have artery disease, which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation.

Together, these problems make it easy to get ulcers and infections that may lead to amputation. Most amputations are preventable with regular care and proper footwear.

One of the biggest threats to your feet is smoking. Smoking affects small blood vessels. It can cause

decreased blood flow to the feet and make wounds heal slowly. A lot of people with diabetes who need

amputations are smokers.

Cardiovascular disease is the leading cause of death in people with diabetes.

When untreated or poorly controlled, diabetes has serious consequences.

Diabetes increases a person’s risk of developing hypertension and atherosclerosis (hardening/narrowing of the arteries), which eventually lead to heart disease.

Assistance

People with diabetes may need assistance to help them manage their disease and keep track of their diabetes care.

Treating diabetes

To survive, people with type 1 diabetes must have insulin delivered by injections or a pump.

Many people with type 2 diabetes can control their blood glucose by following a careful diet and exercise program, losing excess weight, and taking oral medication.

Diabetes self-management education is an integral component of medical care.

Among adults with diagnosed diabetes, 12% take both insulin and oral medications, 19% take insulin only, 53% take oral medications only, and 15% do not take either insulin or oral medications.

Diabetes Care Checklist

Daily diabetes care activities:

Exercise Follow meal plan Take diabetes medicine Check blood glucose as recommended by a health

care provider Check feet for sores that are not healing properly Get feet checkedBrush teeth and floss Check blood pressure at least twice per year

Manage their disease and keep track of their diabetes care

Plan walks or other activities with clients with diabetes to help them get regular exercise. Help them follow the advice of their health care provider about ways to exercise safely.

Prepare healthy meals that fit into meal plans for

people with diabetes and pre-diabetes.

Offer to help check their feet for sores or calluses.

Provide transportation to the heath care provider's office so that clients do not miss important medical visits.

Become aware of the signs and symptoms of hypoglycemia and hyperglycemia and how to appropriately treat them.

Provide assistance when client is sick. Being sick can raise blood glucose and may make it difficult to eat properly or monitor blood glucose as needed.