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This article was compiled by Dr. G. M. Siddiqui M.D,
CEO, Medical Services, Lifeline Healthcare.
(Guidelines of American Diabetic Association was followed.)
Diabetes – Frequently asked Questions (FAQs)
Diabetes means your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn't good for your health.
Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all of 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 does not 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.
Types of Diabetes
There are three main kinds of diabetes: type 1, type 2, and gestational diabetes. The result of type 1 and type 2 diabetes is the same: glucose builds up in the blood, while the cells are starved of energy. Over the years, high blood glucose damages nerves and blood vessels, oftentimes leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation.
Type 1 Diabetes
Type 1 diabetes, which used to be called juvenile diabetes or insulin-dependent diabetes, develops most often in young people. However, type 1 diabetes can also develop in adults. With this form of diabetes, your body no longer makes insulin or doesn’t make enough insulin because your immune system has attacked and destroyed the insulin-producing cells. About 5 to 10 percent of people with diabetes have type 1 diabetes.
To survive, people with type 1 diabetes must have insulin delivered by injection or a pump.
Type 2 Diabetes
Type 2 diabetes, which used to be called adult-onset diabetes or non insulin-dependent diabetes, is the most common form of diabetes. Although people can develop type 2 diabetes at any age -- even during childhood -- type 2 diabetes develops most often in middle-aged and older people.
Type 2 diabetes usually begins with insulin resistance—a condition that occurs when fat, muscle, and liver cells do not use insulin to carry glucose into the body’s cells to use for energy. As a result, the body needs more insulin to help glucose enter cells. At first, the pancreas keeps up with the added demand by making more insulin. Over time, the pancreas doesn’t make enough insulin when blood sugar levels increase, such as after meals. If your pancreas can no longer make enough insulin, you will need to treat your type 2 diabetes.
Gestational Diabetes
Some women develop gestational diabetes during the late stages of pregnancy. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Although this form of diabetes usually goes away after the baby is born, a woman who has had it and her child are more likely to develop diabetes later in life.
Prediabetes
Prediabetes means your blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. People with prediabetes are at an increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is that if you have prediabetes, you can reduce your risk of getting type 2 diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes.
2. What are the Signs and Symptoms of Diabetes?
Individuals can experience different signs and symptoms of diabetes, and sometimes there may be no signs. Some of the signs commonly experienced include:
| a. | Frequent urination | |
| b. | Excessive thirst | |
| c. | Increased hunger | |
| d. | Weight loss | |
| e. | Tiredness | |
| f. | Lack of interest and concentration | |
| g. | A tingling sensation or numbness in the hands or feet | |
| h. | Blurred vision | |
| k. | Frequent infections | |
| l. | Slow-healing wounds | |
| m. | Vomiting and stomach pain (often mistaken as the flu) |
The development of type 1 diabetes is usually sudden and dramatic while the symptoms can often be mild or absent in people with type 2 diabetes, making this type of diabetes hard to detect.
If you show these signs and symptoms, consult a health professional.
3. What causes Diabetes?
Type 1 diabetes is an autoimmune disease. In an autoimmune reaction, antibodies, or immune cells, attach to the body's own healthy tissues by mistake, signaling the body to attack them.
At present, scientists do not know exactly what causes the body's immune system to attack the insulin-producing cells in the pancreas in people with type 1 diabetes. However, many believe that both genetic factors and environmental factors are involved. Studies now are underway to identify these factors and prevent type 1 diabetes in people at risk.
Type 2 diabetes—the most common form of diabetes—is caused by a combination of factors, including insulin resistance, a condition in which the body’s muscle, fat, and liver cells do not use insulin effectively. Type 2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin.
4. Who is at risk for developing type 2 Diabetes?
Here are the risk factors for type 2 diabetes:
a. Being over 45 years of age.
b. Being overweight or obese.
c. Having a first-degree relative - a parent, brother, or sister - with diabetes.
d. Being African American, American Indian or Alaska Native, Asian American or Pacific Islander, or Hispanic American/Latino.
e. Having gestational diabetes, or giving birth to at least one baby weighing more than 9 pounds.
f. Having blood pressure of 140/90 or higher, or having been told that you have high blood pressure.
g. Having abnormal cholesterol levels -- an HDL cholesterol level of 35 or lower, or a triglyceride level of 250 or higher.
h. Being inactive or exercising fewer than three times a week.
k. Having polycystic ovary syndrome, also called PCOS (women only).
l. on previous testing, having prediabetes (an HA1c level of 5.7 to 6.4 percent), impaired glucose tolerance (IGT) or impaired fasting glucose (IFG).
m. history of cardiovascular disease (disease affecting the heart and blood vessels).
5. How Can I prevent Diabetes from developing?
Diabetes is a serious disease. It increases your chance of blindness, heart disease, stroke, kidney failure, and amputations. But you can protect yourself by making some simple changes. Recent studies show that people at high risk for type2 diabetes could prevent or delay it by doing the following:
Weight loss improves insulin resistance and reduces hypertension. People who are overweight or obese should therefore be encouraged to achieve and maintain a healthy body weight. Lose 5 to 7 percent of their weight, if they are overweight—that’s 10 to 14 pounds (4.5 to 6.3 kg) for a 200 pound (90.6 kg) person.
Physical activity is one of the main pillars in the prevention of diabetes. Increased physical activity is important in maintaining weight loss and is linked to reduced blood pressure, reduced resting heart rate, increased insulin sensitivity, improved body composition and psychological well-being. Get at least 30 minutes of moderate-intensity physical activity five days a week. This could be brisk walking, yard work, and actively playing with children, for example, riding bicycles or playing soccer.
A balanced and nutritious diet is essential for health. A healthy diet reduces risk factors for cardiovascular diseases. Lose and maintain the weight loss by making healthy food choices by eating a variety of foods that are low in fat and reducing the number of calories they eat per day.
Other behaviors to consider include:
Smoking: a well-established risk factor for many chronic diseases, including diabetes and its complications. As well as other harmful effects, smoking increases abdominal fat accumulation and insulin resistance. All smokers should be encouraged to quit smoking. However, weight gain is common when quitting smoking and therefore dietary advice on avoiding weight gain should also be given (e.g. managing cravings and withdrawal symptoms by using short bouts of physical activity as a stress-relief activity, rather than eating snacks).
Stress and depression: There is evidence of a link between depression and both diabetes and cardiovascular disease.
Sleeping patterns: Both short (9h) sleep durations may be associated with a higher risk of developing type 2 diabetes. Sleep deprivation may impair the balance of hormones regulating food intake and energy balance. Long sleep durations may be a sign of sleep-disordered breathing or depression and should be treated appropriately. There is also a close association between obesity and obstructive sleep apnoea syndrome (OSA), the most common form of sleep disordered breathing.
6. What happens if Diabetes is not controlled?
a. Diabetes is a very serious disease. Over time, diabetes that is not well managed causes serious damage to the eyes, kidneys, nerves, and heart, gums and teeth. If you have diabetes, you are more likely than someone who does not have diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or stroke at an earlier age than others.
b. The best way to protect yourself from the serious complications of diabetes is to manage your blood glucose, blood pressure, and cholesterol and avoid smoking. It is not always easy, but people who make an ongoing effort to manage their diabetes can greatly improve their overall health.
Early Detection of Diabetes is very important because sometimes people have symptoms but do not suspect diabetes. They delay scheduling a checkup because they do not feel sick. Therefore, many people do not find out they have the disease until they have diabetes complications, such as a heart attack or stroke. Finding out early if you have diabetes is important because treatment can prevent or delay the complications of the disease.
Who Should Get Tested?
Because type 2 diabetes is more common in older people, anyone who is 45 or older should consider getting tested. If you are 45 or older and overweight, getting tested is strongly recommended. If you are younger than 45, overweight, and have one or more risk factors, you also should talk with your doctor about being tested. See risk factors for type 2 diabetes.
Tests for Diabetes
The following tests are used to diagnose diabetes or prediabetes.
a. A HA1c test measures your average blood glucose levels over the past 3 months. It can be used to diagnose type 2 diabetes and prediabetes. It does not require fasting and blood can be drawn for the test any time of the day.
b. A fasting plasma glucose, or FPG test, measures your blood glucose after you have gone at least 8 hours without eating. Doctors use this test to detect diabetes or prediabetes.
c. In a random plasma glucose test, your doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not prediabetes.
d. An oral glucose tolerance test, or OGTT, measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a sweet beverage. Doctors also use the oral glucose tolerance test to diagnose gestational diabetes in pregnant women.
If any of these tests show that you might have diabetes, your doctor will need to repeat the test with a second measurement unless there are clear symptoms of diabetes. Get more details about tests for diabetes.
7. How do I manage my diabetes every day?
Manage Your Diabetes Every Day
Diabetes cannot be cured, but it can be managed. Managing blood glucose (blood sugar) as well as blood pressure and cholesterol is the best defense against the serious complications of diabetes.
Know What to Do Every Day
To manage your diabetes, here are things to do every day.
| a. | Take your medicines. | |
| b. | Keep track of your blood glucose (blood sugar). | |
| c. | Check your blood pressure if your doctor advises. | |
| d. | Check your feet. | |
| e. | Brush your teeth and floss. | |
| f. | Stop smoking. | |
| g. | Eat well. | |
| h. | Be active. |
A.Take Your Diabetes Medicines
People with type 1 diabetes control their blood sugar with insulin -- delivered either by injection or with a pump. Many people with type 2 diabetes can control blood glucose levels with diet and exercise alone. Others require oral medications or insulin, and some may need both, as well as lifestyle modification.
Ask your doctor if you need to take aspirin every day to prevent a heart attack or stroke.
B. Keep Track of Your Blood Glucose
One of the best ways to find out how well you are taking care of your diabetes is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, exercise plan, or medication.
Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three a day or even more. You may be told to check before eating, before bed, and sometimes in the middle of the night.
Your doctor or diabetes educator will show you how to check your blood using a blood glucose meter.
C. Check Your Blood Pressure
Check your blood pressure if your doctor advises and keep a record of it. You can check your pressure at home with a home blood pressure measurement device or monitor. Check with your health care provider to make sure you are using the monitor correctly.
D. Check Your Feet
Foot care is very important for people with diabetes. High blood glucose levels and a reduced blood supply to the limbs cause nerve damage that reduces feeling in the feet. Someone with nerve damage may not feel a pebble inside his or her sock that is causing a sore. Or a blister caused by poorly fitting shoes may go unnoticed. Foot injuries such as these can cause ulcers, which may, if not cared for, ultimately lead to the need for amputation.
If you have diabetes,
a. Check your feet every day and watch for any cuts, sores, red spots, swelling, and infected toenails.
b. Report sores, blisters, breaks in the skin, infections, or buildup of calluses to a podiatrist or a family doctor.
c. Never walk barefoot.
d. Have your feet checked at every doctor visit.
e. Take your shoes and socks off when you go into the examining room. This will remind the doctor to check your feet.
E. Brush Your Teeth and Floss
People with diabetes can have tooth and gum problems more often if their blood glucose stays high. High blood glucose also can make tooth and gum problems worse. You can even lose your teeth.
Here are ways to protect your teeth and gums.
a. Keep your blood glucose as close to normal as possible.
b. Use dental floss at least once a day. Flossing helps prevent the buildup of plaque on your teeth. Plaque can harden and grow under your gums and cause problems. Using a sawing motion, gently bring the floss between the teeth, scraping from bottom to top several times.
c. Brush your teeth after each meal and snack. Use a soft toothbrush. Turn the bristles against the gum line and brush gently. Use small, circular motions. Brush the front, back, and top of each tooth.
d. If you wear false teeth, keep them clean.
e. Call your dentist right away if you have problems with your teeth and gums.
F. Stop Smoking
If you smoke, stop. Smoking raises your risk for many diabetes problems, including heart attack and stroke. Ask for help to quit.
G. Eat Well
People with diabetes don't need to buy or prepare special foods. The foods that are best for someone with diabetes are excellent choices for everyone: foods that are low in fat, salt, and sugar, and high in fiber, such as beans, fruits, vegetables, and whole grains. These foods help you reach and stay at a weight that's good for your body, keep your blood pressure, glucose and cholesterol in a desirable range, and prevent or delay heart and blood vessel disease.
H. Be Active
Try to exercise almost every day for a total of about 30 to 60 minutes. If you haven't exercised lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day. (Tip: you don’t need to get your exercise in all at one time.)
Be sure to check with your doctor before starting an exercise program.
I. Other Areas to Manage
Here are other areas to manage if you have diabetes.
a. Take care of your eyes.
b. Protect your kidneys.
c. Protect your skin.
d. Learn how to cope with stress.
High blood glucose and high blood pressure from diabetes can hurt your eyes. It can even cause blindness, or other painful eye problems
Here are ways to prevent diabetes eye problems.
a. Keep your blood glucose and blood pressure as close to normal as you can.
b. Have an eye care professional examine your eyes once a year. Have this exam even if your vision is okay.
J. Protect Your Kidneys
High blood glucose and high blood pressure may damage the kidneys. Damaged kidneys do not do a good job of filtering out wastes and extra fluid.
Here are ways to prevent diabetes kidney problems.
a. Keep your blood glucose and blood pressure as close to your target goal as you can.
b. Get tested at least once a year for kidney disease. Ask your doctor if you should be tested.
c. Follow the healthy eating plan you work out with your doctor or dietitian. If you already have kidney problems, your dietitian may suggest you cut back on protein.
K. Protect Your Skin
Skin care is very important, too. Because people with diabetes may have more injuries and infections, they should protect their skin by keeping it clean and taking care of minor cuts and bruises.
L. Learn How to Cope With Stress
Stress can raise your blood glucose (blood sugar). While it is hard to remove stress from your life, you can learn to handle it. Try deep breathing, gardening, taking a walk, meditating, working on your hobby, or listening to your favorite music.
People with type 1 diabetes control their blood sugar with insulin -- either with shots or an insulin pen. Many people with type 2 diabetes can control blood glucose levels with sugar with diet and exercise alone. Others require oral medications or insulin, and some people may need to take both, along with lifestyle modification.
8. What kinds of medication do people take for Diabetes?
Medications:
Diabetes cannot be cured, but it can be managed. Managing blood glucose (blood sugar) as well as blood pressure and cholesterol is the best defense against the serious complications of diabetes.
Diabetes pills and insulin are the two kinds of medicines used to lower blood glucose.
People with type 1 diabetes control their blood sugar with insulin -- either delivered by injection or a pump. Many people with type 2 diabetes can control blood glucose levels with diet and exercise alone. Others require oral medications or insulin, and some may need both, as well as lifestyle modification.
A. Taking Diabetes Pills
If your body is still making some insulin, but not enough to keep your blood glucose levels under control, you may need diabetes pills. Some medications are taken once a day; others must be taken more often. Ask your health care team when you should take your pills. Remember to take your medicines every day, even when you feel well.
Be sure to tell your doctor if your pills make you feel sick or if you have any other problems. Remember, diabetes pills don't lower blood glucose all by themselves. You will still want to follow a meal plan and exercise to help lower your blood glucose.
You need insulin if your body has stopped making insulin or if your body doesn't make enough. Everyone with type 1 diabetes needs Insulin, and many people with type 2 diabetes do, too.
Insulin can't be taken as a pill. It is usually taken by shots or with an insulin pump or insulin pen. Insulin pumps are small machines, usually worn on the hip, that contain insulin and deliver small steady doses of insulin throughout the day, Some pumps are attached directly to the skin. Other people use an insulin pen, which holds a cartridge of insulin that is dialed to the prescribed dose of insulin and then injected.
Sometimes, people who take diabetes pills may need insulin shots for a while. If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose.
9. What Kind a meal plan should a person with diabetes follow?
Ask your doctor to give you the name of someone trained to help you create a healthy eating plan, such as a dietitian. This plan, often called medical nutrition therapy, will include regular monitoring by your dietitian and education about how to adjust your eating habits as the need occurs. Your dietitian can help you plan meals that include foods that you and your family like and that are good for you.
Your healthy eating plan will include:
a. |
Breads, cereals, rice, and whole grains. |
|
b. |
Fruits and vegetables. |
|
c. |
Meat and meat substitutes. |
|
d. |
Dairy products. |
|
| e. | Healthy fats, like fish oil, vegetable oil etc. |
My Diabetes Care Record
| Date | Result | Date | Result | Date | Result | Date | Result | |
| Each visit |
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| Blood pressure My target is: |
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|
Review |
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| Weight check My target is: |
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At least twice |
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| A1C My target is: |
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| Once a year |
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| Cholesterol-LDL My target is: |
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| Complete foot exam |
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| Dental exam |
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| Eye exam (with drops in your eyes) |
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| Kidney check |
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| At least once |
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| Hepatitis B shot |