Diabetes is a serious disease with potentially dangerous complications, but with proper management and a healthful lifestyle, its worst effects may be avoided.
Diabetes is the leading cause of adult blindness in the United States. It is the single leading cause of kidney failure and non-traumatic amputations. This year alone, 160,000 Americans will die from diabetes-more than from breast cancer, AIDS and other chronic diseases. Diabetes costs the U.S. more than $92 billion in health care costs and lost productivity annually.
It is estimated that although about 16 million Americans have diabetes, only half of them have been diagnosed with the disease. Furthermore, many people who are aware of their condition do not take it seriously enough and develop severe complications.
What’s most tragic about all this is that diabetics can live long, healthy lives. Many of the health problems associated with the condition can be prevented or moderated by maintaining a normal body weight, engaging in regular physical activity, eating well, and taking medication if advised to do so by a physician. In certain instances, diabetes can be avoided altogether by following these life-style recommendations.
Who Gets Diabetes?
Anyone can get diabetes, but the following factors may put you at higher risk of developing it:
- Being overweight (see weight chart)
- Having a family history of diabetes
- Being of African-American, Hispanic or Native American origins ups the risk of developing diabetes two to six times as that of the general population. In addition, African Americans experience higher rates of blindness, amputation and kidney failure due to diabetes.
- Not exercising regularly (see All the Right Moves)
- Being over age 45
- Delivering a baby over nine pounds
What Is Diabetes?
When we eat, our body turns food into glucose (the sugar that cells use for fuel), and a hormone called insulin helps the glucose get into body cells. In diabetes, however, too much glucose stays in the blood. As a result, two problems occur: body cells become starved for energy, and, over time, the high glucose levels can damage the nerves, eyes, kidneys, heart and blood vessels.
There are two main kinds of diabetes:
1) The most common form of diabetes, accounting for 90 to 95 percent of all diabetes cases, is noninsulin-dependent diabetes (type II diabetes). People with this condition either don’t produce enough insulin to control glucose levels or their cells simply do not respond to the insulin.
2) Insulin-dependent diabetes (type I diabetes) is less common but much more severe. This condition is caused by damage to the pancreas, an organ near your stomach that contains beta cells, which produce insulin. Many things can destroy beta cells, but in most people with insulin-dependent diabetes, a glitch in the immune system causes it to attack the beta cells. Without insulin-producing beta cells, glucose builds up in the blood.
Can I Tell If I Have Diabetes?
That depends. Most people with Type II diabetes cannot tell they have it, which is one of the reasons only half of all the people with the condition have been diagnosed. However, if their blood glucose levels get way too high (most likely when the person is sick or under a lot of stress), signs may include: headache, blurry vision, excessive thirst, frequent urination, or dry, itchy skin.
Type I, on the other hand, is more likely to be apparent. People with this form of diabetes can experience one or more of the following: an inexplicable weight loss, very frequent urination, constant hunger and thirst, trouble seeing, fatigue, lapsing into a coma. A simple blood test that detects how much glucose is in the blood can reveal whether a person has diabetes. Then a doctor must consider various factors to determine if it’s type I or II. Generally, people with type I are diagnosed when they’re under 30 years old, lean, and have high levels of ketones (toxins your body produces when it breaks down fat for energy) in their urine. People with type II are most often diagnosed when they’re obese and over 30. They usually do not have urine ketones.
How Is Diabetes Treated?
Diabetes is a chronic disease that can be managed, but not cured. The goal of treatment for both types of diabetes is to lower blood glucose levels and improve the body’s use of insulin. The recommended ways to do this include:
- Eating a healthy diet. Since your body changes food into glucose, what you eat is very important when trying to control glucose levels. In the past, people with diabetes were told to stay away from sweets, but diet recommendations have changed. Experts now believe the best dietary recommendations for diabetics are the same as they are for everyone: minimize fat intake, consume moderate amounts of protein, and plenty of complex carbohydrates. Consistency and moderation are also very important dietary factors for diabetics. It’s best to eat about the same number of calories each day, keep track of how much carbohydrate is eaten, have meals and snacks at the same time each day, and never skip meals.
Since each person is different, it’s important for people with diabetes to see a dietitian who can work out a unique eating plan. To create such a plan, the dietitian needs to know details about preferred foods, daily activities, other health problems, and exercise habits.
- Exercise. Being active plays an important role in the treatment of diabetes because it helps cells take in glucose and lowers glucose levels in your blood. Ideally, it’s best to exercise three or four times a week for at least 20 minutes. People who are not used to exercising, should start slowly. Even a five-minute walk is a step in the right direction.
- Glucose Testing. Home glucose tests can help keep track of how well you are controlling glucose levels. To test blood, a special device called a glucose meter is available in most drug stores. To perform the test, you prick your finger and put a drop of blood on a special test strip that the meter analyzes and then displays how much glucose it contains. Your doctor will tell you how often to test your blood. You should keep a diary of the results.
How Does Treatment For Type I and II Differ?
The strategies mentioned above can help control both types of diabetes. But there are a few ways in which treatment varies depending on which form of the disease a person has. These are:
Type II Diabetes
People with noninsulin-dependent diabetes are often advised to lose weight if they are 20 percent over the recommended weight for their sex and height (see weight chart). Losing weight helps your body use insulin better. In fact, sometimes losing 10 or 20 pounds is all that’s needed to bring type II diabetes under control.
Still, sometimes healthful habits like eating well, losing weight and exercising are not enough. In that case, people with type II diabetes may have to take one or both of the following:
Diabetes pills do not contain insulin, but they help the body better use the insulin it produces. There are two kinds of diabetes pills: sulfonylureas and biguanides. There are many kinds of sulfonylureas, but metformin is the only type of biguanide. According to the American Diabetes Association, no one pill is better than any other. What differs is how often they need to be taken, how long they take to act and their side effects. The main side effects of metformin are upset stomach and diarrhea. The sulfonylurea drugs can cause low blood sugar reactions. Both kinds of drugs may interact with other medicines.
It is very important to keep in mind that taking pills does not replace healthful habits. You still need to eat a good diet or the pills won’t work.
Sometimes diabetes pills do not help. In some people they help at first and then stop working. When this happens, a combination of both sulfonylurea and metformin may be effective.
Insulin Shots. If all else fails, insulin supplements may be necessary either alone or along with the pills.
There are various sources and types of insulin from which to choose. The hormone may come from pigs or cows, or it may be made in a lab (the latter has the fewest side effects). Insulin also comes in three speeds, or the time it takes for the insulin to enter the bloodstream and reach its peak action, and the duration of time it stays in the blood. Doctors can use these differences to tailor treatment to a particular patient’s schedule and lifestyle.
Most people take regular insulin at least twice a day, before breakfast and dinner, since it acts quickly on the glucose produced by their meals. The longer acting insulins are helpful because they control glucose levels during the late part of the day or overnight. Usually the two speeds of insulin are mixed together and given at breakfast and dinner, but different combinations can be used to suit individual needs.
Type I Diabetes
Type I diabetes is known as insulin-dependent diabetes because people with this form of the disease don’t produce the vital hormone and take insulin every day to get glucose out of their blood and into their cells for fuel. Without insulin, a type I diabetic can die. Insulin shots must be taken every day. Doctors teach their patients how to give themselves shots and to smoothly incorporate this critical treatment into their lives.
Type I diabetics can also get insulin by using a pump. The small computerized device can be hooked on to a belt or pocket. A plastic tube leads from the pump to a needle inserted under the skin and provides a constant supply of insulin. It can deliver a bigger dose before meals. The benefit of a pump is that it gives precise, accurate doses and releases insulin in much the same way the body does. Some people are able to get their glucose under better control with pumps, but they cost more than shots and take some time to learn to use. If you want to find out more about the pump, discuss it with your doctor. glucose testing. Most insulin-dependent diabetics monitor their glucose levels at least four times a day.
1) Ketoacidosis. Sometimes blood glucose levels can get too high. This may happen if a person eats too much or doesn’t take enough insulin. Stress can also make blood glucose levels rise. Without enough insulin, the body is starved for energy and starts breaking down fat for fuel. As a result, the body produces toxic chemicals called ketones, which can cause vomiting, difficulty breathing, thirst, dry, itchy skin, or coma. Diabetics who feel any of these symptoms must test both their glucose level and their urine for ketones, using test strips that can be bought at the drugstore. Diabetics should also check their urine when glucose levels are over 240 mg/dL and when they are sick. Immediate medical attention is necessary when ketones are persistently found in the urine.
2) Hypoglycemia. Sometimes, insulin or sulfonylurea pills lower glucose levels too much and cause a person to feel tired, confused, shaky, sweaty and/or hungry. When this happens, glucose levels should be tested at once. Diabetics are urged to do the same thing whenever they feel “odd” or “funny.” A low glucose reading (less than 70 mg/dL) can be remedied by eating 15 grams of a fast-acting sugar right away. For example, 1/2 cup of fruit juice, 2 tablespoons of raisins, 1 cup of skim milk, 3 hard candies, 4 teaspoons of sugar or 4 ounces of non-diet soft drink.
What Can Go Wrong?
Too much glucose in the blood over many years can damage the eyes, kidneys, and nerves. It also increases the risk for heart and blood vessel disease. The best defense against diabetes complications is to keep glucose levels under control.
The damage diabetes causes to nerves is called diabetic neuropathy and there are several types, depending on which part of the body is affected. The symptoms of nerve damage can include:
- Feelings of prickling, tingling, burning or jabbing
- Loss of feeling
- Weak muscles
- Bladder infections
- Sexual problems
To prevent nerve damage, diabetics are encouraged to keep glucose levels well under control, eat a healthy diet, exercise regularly, avoid smoking, and drink alcohol in moderation-if at all.
If nerve damage does develop, improving glucose control can help. Also, pain caused by the damage can be treated with certain drugs, exercises or special skin creams. Surgery may sometimes help. Other treatments are available depending on where the nerve damage occurs.
The kidneys are essential to filter wastes from the blood. But diabetes may cause the kidneys to lose their ability to filter properly. As a result, protein that the body needs is lost in the urine, and wastes that the body doesn’t need build up in the blood. Ten to 21 percent of all people with diabetes develop kidney disease (diabetic nephropathy). This type of disease causes no symptoms until the kidneys are severely damaged. Therefore, people with diabetes should have their urine tested for protein each year. Blood tests can also be performed.
Kidney disease may be prevented by controlling glucose levels, keeping blood pressure down, and eating a healthful diet. This is critical because once kidney damage occurs, it cannot be reversed. Two treatments are available for kidneys that are severely compromised. One is dialysis, in which a patient is hooked up to a machine that filters the blood. Dialysis must be performed frequently and for long periods of time, often three times a week for over four hours each time. The other option is a kidney transplant.
Diabetes can lead to diabetic retinopathy, or eye disease. There are two types of eye damage that can occur from diabetes. In the milder form, nonproliferative retinopathy, blood vessels leak blood and fluid into the eye. The more severe-and luckily less common-type of eye damage is proliferative retinopathy, in which new blood vessels sprout and grow out of control. Both types cause eye damage by putting pressure on the retina (the lining at the back of the eye that senses light and acts like the film in a camera). If left unchecked, this damage can cause blindness. Like kidney disease, retinopathy may not cause any symptoms, so diabetics should see an ophthalmologist each year after the age of 30. Those under 30, are also advised to see an eye doctor every year after they’ve had diabetes for five years. A trip to the eye doctor is in order if there are warning signs like blurry or double vision, spots or floaters, pain or pressure in the eyes, difficulty reading, or loss of peripheral vision (the ability to see things from the outer corners of the eyes).
The best way to prevent eye damage is to keep glucose levels normal. However, if damage occurs, the earlier it’s caught, the better treatment works. The two main treatments are: Photocoagulation (sealing leaky blood vessels with a laser), and Vitrectomy (surgically removing blood and scar tissue from the eye).
Heart and Blood Vessel Damage
Diabetes increases the risk for hardening of the arteries, stroke, and peripheral vascular disease, in which an insufficient amount of blood reaches the areas farthest from the heart. This occurs because diabetes changes body chemistry. As a result, blood may clot too easily, blood vessels may narrow, and fat may build up in the blood vessels faster. Symptoms include poor circulation, frequent infections, itchy skin, shiny legs that lose their hair, calves that hurt excessively during exercise and, for men, difficulty having an erection. High blood pressure and cholesterol levels signal that a person has a higher risk for heart or blood vessel damage (see our Special Report In Tune with the Beat of Your Heart). Preventive measures for these problems include:
- Keeping blood glucose levels under control
- Not smoking
- Eating a low-fat, low-salt diet
- Keeping blood pressure normal
- Keeping your blood cholesterol level below 200 mg/dL
- Exercising regularly
- Losing weight if needed
Poor lifestyle habits are linked to 50 to 80 percent of all cases of type II diabetes-the most common form of the disease. That means you can significantly reduce your risk of developing diabetes by maintaining a healthy body weight, engaging in regular physical activity and eating well. Other Problems
Often, damage to one organ will affect other parts of the body. Common problems of this type include:
- Skin. Damaged nerves and narrowed blood vessels can both lead to dry, itchy skin. Poor circulation makes infections more likely and longer lasting, and can cause spots, blisters, yellow bumps and rashes. Skin on the hands and toes may become waxy and tight. Moisturizing skin (except between toes and other places where skin touches skin) can help. Cuts should be washed carefully, but avoid harsh cleaners like alcohol.
- Mouth. High glucose levels provide an inviting home for germs, so people with diabetes are more likely to get gum infections. In addition, poor circulation can slow down the healing process. Professional cleaning every six months can help protect teeth, as can brushing with a soft brush at least twice a day, and flossing every day.
- Impotence. One out of every four impotent men has diabetes. Both nerve damage and poor circulation can make it difficult to have an erection. If the doctor determines that impotence is caused by diabetes, getting glucose levels under control can help. Also, quitting smoking will improve circulation.
- Feet. People with diabetes often have problems with their feet. Nerve damage and reduced circulation can affect feeling in the feet, making it difficult to detect if they’ve been scraped or injured. Poor blood flow can keep any sores from healing, which can lead to gangrene (when the tissue dies because of inadequate circulation in the area). That is why diabetes is the most frequent cause of non-traumatic lower limb amputations. Each year 54,000 people lose their foot or leg to diabetes.
To protect their feet, diabetics should: Wash them and dry them carefully; check for injuries; have shoes fit by a trained fitter; wear only comfortable, supportive shoes with low heels and plenty of wiggle room for the toes; check for pebbles or other irritating objects before slipping shoes on; wear socks without seams or mended areas; avoid going barefoot-even to walk to the bathroom during the night.
Our thanks to Seth N. Braunstein, M.D., Associate Professor of Medicine, Division of Endocrinology, University of Pennsylvania, Philadelphia, PA, for reviewing this article.
Good News for Diabetics with a Sweet Tooth
In the past, people with diabetes were prohibited from eating sugar. But now sweets are no longer off limits. Since sugars are simple carbohydrates, it was assumed that they would be digested and changed into glucose faster than other foods, thereby causing a faster rise in blood glucose levels. New research shows, however, that all carbohydrates are digested and converted to glucose at about the same rate. Whether the carbohydrate is simple (like sugar) or complex (like bread) doesn’t seem to matter. That’s why the American Diabetes Association has changed it’s dietary guidelines. Instead of eliminating simple sugar altogether, diabetics are advised to work them into their food plan in place of other carbohydrates. Meaning they can have that ice cream sundae, as long as they compensate for it by cutting back on an equivalent amount of other carbohydrates. A typical diet for diabetics allows for three to four carbohydrate choices at each meal (approximately 12 to 15 grams of carbohydrates are considered one carbohydrate choice). So a person with diabetes might have one to two choices in the morning; one to two in the afternoon for those on insulin; and one to three at bedtime. Food labels tell you the total number of carbohydrate grams per serving. And the following list indicates what are considered single carbohydrate choices among some common foods:
Grains, Starches and Sweets:
- 1 slice of bread, English muffin, hamburger bun, or small roll
- 1/2 bagel
- 3/4 cup of dry cereal (most types)
- 1/2 cup cooked cereal
- 1/4 cup granola
- 1/2 cup pasta, potatoes, winter squash, peas or corn
- 1 small potato
- 1/3 cup cooked rice, beans or lentils
- 2 small pancakes or 1 medium-size pancake
- 4 to 5 snack crackers or 6 soda crackers
- 3 cups popcorn
- 1 ounce pretzels
- 3 graham cracker squares
- 1 3-inch cookie or 2 1 3/4-inch cookies
- 1 tablespoon sugar or maple syrup
Vegetables and Fruits:
- 1 1/2 cups cooked vegetables
- 3 cups raw vegetables
- 1 1/2 cups tomato or other vegetable juice
- 1 medium-size fresh fruit
- 1/2 cup fresh or frozen fruit
- 1/2 cup fruit canned in natural juice or water
- 1/2 grapefruit or banana
- 1/4 cup dried fruit
- 1 cup berries or melon
- 12 to 15 grapes
- 1/3 to 1/2 cup fruit juice
- 1 cup (8 ounces) skim or low-fat milk
- 1 cup plain or artificially sweetened yogurt
- 1/2 cup ice cream
- 1/3 cup frozen yogurt
All the Right Moves
Exercise helps people with diabetes in many ways. It can help alleviate stress, which could raise glucose levels, and it lowers blood cholesterol and blood pressure, cutting the risk for heart disease. Blood glucose levels fall for several hours after the exercise, reducing how much medication is needed. Working out can also help keep weight down (excess weight makes it harder to control glucose levels).
There are two types of exercises: one makes your muscles stronger (anaerobic or weight-bearing) and the other gives you more stamina (aerobic). Both are good for people with diabetes, but most doctors emphasize aerobic exercise because it strengthens the heart and lungs and helps keep weight down.
To improve fitness, you should participate in aerobic exercise that increases your heart rate for 20 to 40 minutes, three to five times a week. Good aerobic activities include jogging, biking, walking, swimming, dancing, and skating.
Talk to your doctor before beginning an exercise program to find out how to adjust food and medications. Also, depending on your age, your physician may want to run some tests before you start.
To avoid injury, it’s best to ease into any type of exercise routine. Initially, a short walk once a week may suffice. Once that becomes second nature, the number of walks per week can be increased and so can the distance. Anything that gets you up and moving is good, so physical activity should be incorporated into everyday tasks. Take the stairs instead of the elevator, rake leaves or sweep the floors with vigor, park further away from destinations to get more walking in, stretch or do some jumping jacks while watching TV. Diabetics should, however, take a little extra care while exercising:
Keep alert for warning signs. Since exercise lowers blood glucose levels, be prepared in case they drop too low. Learn the signs of low blood sugar (see Hypoglycemia, and have some form of sugar with you.
Protect your feet. Make sure you use good exercise shoes that fit well, are designed for the type of activity you are doing, and have smooth insides with no seams, gaps or areas that rub. Wear clean socks without lumpy seams. Check your shoes and socks before exercising to make sure they are smooth and free of stones or bumps. Check your feet after exercising for blisters, cuts, or scrapes.
Warm up and cool down. Stretch or walk slowly for 5 to 10 minutes before and after exercise.
Stick to a routine. Try to exercise at the same time each day. That way the effect on your blood glucose level will be more predictable. An hour after a meal or a snack is a good time.
Wear a medical identification bracelet. Keep something with you that lets people know you have diabetes.
Test your blood glucose level before you exercise. If it’s higher than 250 mg/dL and there are chemicals called ketones in your urine, don’t exercise. If you have type I diabetes and your glucose level is less than 100 mg/dL, have a snack high in carbohydrates before exercising. Your doctor may also want you to test your glucose both during and after your exercise session.
Drink lots of fluids. Avoid getting dehydrated by drinking a lot of fluids (skip drinks with caffeine).
Don’t exercise if your feet or legs hurt, if you are out of breath, if the weather is very hot or cold or if your blood pressure is high. Also, stop working out if you start feeling sick, dizzy or winded, or if exercising becomes painful.
Watch Your Weight
This chart shows weights that are 20 percent heavier than what is recommended for medium-framed men and women. If your weight is at or above the amount listed for your height, you may be at risk for diabetes, or your diabetes may be harder to control.
|Height||Women/ Weight (lbs.)||Men/ Weight (lbs.)|
Source: American Diabetes Association
For More Information
American Diabetes Association
This non-profit organization funds diabetes research and provides educational materials for patients, including cookbooks and meal planning guides for diabetics.
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892–3560
A service of the National Institute of Diabetes and Digestive and Kidney Diseases (the government’s leading agency for diabetes research), it functions as an information, educational, and referral resource for diabetics and the general public.
National Eye Institute
Supports basic and clinical research into treatments for diabetic eye disease. The institute’s National Eye Health Education Program promotes public and professional awareness of the importance of early diagnosis and treatment of diabetic eye disease.