A - Z Encyclopedia
Understanding Diabetes
the Basics | Symptoms | Detection and Treatment | Prevention
Detection and Treatment
Your doctor may suspect you have diabetes if a routine physical examination indicates that excess sugar in your body is being flushed out in your urine. Actual diagnosis begins with an examination of your glucose levels, which the doctor does by taking a blood sample in the morning before you have had anything to eat €” levels of 126 or greater indicate diabetes. If your pancreas is producing little or no insulin (type 1), or if the body is not responding normally to insulin (type 2), your glucose levels will be elevated.
What Are the Treatments?
Since diabetes can be life threatening when treated incorrectly, you should never try to treat the disease without the help of a doctor, and you should always discuss any possible treatments thoroughly.
Treatment for both forms of diabetes requires keeping close watch over your blood sugar levels and keeping them in line with a combination of medications, exercise, and diet. By paying close attention to what and when you eat, you can minimize or avoid the "seesaw effect" of rapidly changing blood sugar levels, which can require quick changes in medication, especially insulin, dosages.
Medications
If you have type 1 diabetes, you can be treated with insulin injections every day, at least twice a day, to allow your body to use blood sugar for energy. Learning to give injections to yourself or to your infant or child may at first seem the most daunting part of managing diabetes, but the process quickly becomes routine.
Some people with diabetes use a computerized pump €” called an insulin pump €” that administers insulin on a set basis. You and your doctor program the pump to deliver a certain amount of insulin throughout the day. In addition, you program the pump to deliver a certain amount of insulin based on your blood sugar level before you eat.
In January 2006 Exubera became the first inhaled insulin to get FDA approval. Exubera delivers short-acting insulin via an inhaler. Other alternatives to insulin injection are under development, including mouth sprays, insulin patches, and insulin that can be swallowed.
Some people with diabetes use a computerized pump €” called an insulin pump €” that administers insulin on a set basis. You and your doctor program the pump to deliver a certain amount of insulin throughout the day. In addition, you program the pump to deliver a certain amount of insulin based on your blood sugar level before you eat.
Most insulin in use today is produced synthetically. The medication comes in five types: very rapid (taking effect within 15 minutes and lasting three to five hours); rapid-acting (taking effect within 30 to 60 minutes and lasting for five to seven hours); intermediate-acting (taking effect in one to two hours and lasting up to 24 hours); long-acting (taking effect in four to eight hours and lasting up to 36 hours); and premixed (taking effect within 30 minutes and lasting up to 24 hours). Each injection plan is tailored for the individual and adjusted to accommodate events such as periods of stress, adolescent growth, and the premenstrual period of a woman's monthly cycle.
By monitoring your own blood sugar levels, you can track your body's fluctuating insulin demand and help your doctor calculate the most appropriate insulin dosage. People with diabetes check their blood sugar up to four times a day with an instrument called a glucometer. The glucometer detects glucose levels in a sample of your blood dabbed on a strip of treated paper. To determine your blood glucose control, glycated hemoglobin (glycosolated hemoglobin or HbA1c) may be checked, which shows your average blood sugar over the past three months.
For some people with type 2 diabetes, diet and exercise are sufficient to keep the disease under control; others require medication, which may include insulin or an oral medication.
Oral medications for type 2 diabetes work in different ways to bring blood sugar levels back to normal €” drugs that increases insulin production by the pancreas (including Amaryl, Glucotrol, Diabeta, Prandin, and Starlix); drugs that decrease sugar absorption by the intestines (Precose and Glyset); drugs that improve how the body uses insulin (Avandia and Actos), and drugs that decrease sugar production by the liver and improve insulin resistance (Glucophage). Some pills contain more than one type of diabetes medication.
Nutrition and Meal Timing
Maintaining a balanced diet is vital in both types 1 and 2 diabetes, so work with your doctor or dietitian to set up a menu plan. If you have type 1 diabetes, the timing of your insulin dosage is determined by activity and diet. When you eat and how much you eat are just as important as what you eat. Usually, doctors recommend three small meals and three to four snacks every day to maintain the proper balance between sugar and insulin in the blood.
Carbohydrates should make up 50% of your total caloric intake; proteins should make up 20%; and fats, from 30%. Carbohydrates are broken down into glucose early during digestion and have the most immediate effect on blood sugar, so it's better to eat starches and other complex carbohydrates rather than fruit juice and other simple sugars that have a rapid effect on blood sugar.
Recommended proportions of carbohydrates, proteins, and fats for people with type 2 diabetes are essentially the same, although patients who are overweight are encouraged to lower their intake of fat and eat more complex carbohydrates and fiber. A low-fat vegetarian diet may control type 2 diabetes, while a menu loaded with plant-based, water-soluble fiber, which slows glucose absorption, helps stabilize blood sugar.
Exercise
Another crucial element in a treatment program for diabetes is exercise. With either type of diabetes, check with your doctor before starting an exercise program. Exercise improves your body's use of insulin and may lower blood sugar levels. To prevent your blood sugar from falling to dangerously low levels, check your blood sugar and, if necessary, eat a carbohydrate snack approximately half an hour before exercising. If you start to feel symptoms of low blood sugar (called hypoglycemia), have a carbohydrate snack or drink.
In laboratory tests, exercise has been shown to increase the tissue levels of chromium, which the body uses to regulate blood sugar and cholesterol levels. Exercise helps some people with type 2 diabetes lower their blood glucose levels and may eliminate the need for medication.
For people with either type of diabetes, exercise can decrease the chance of having a heart attack or stroke and can improve circulation. It may offer stress relief as well. People with type 2 diabetes who need to lose weight can benefit from moderate exercise. Be particularly careful when starting a weightlifting program as this can affect blood pressure and may aggravate any eye problems that stem from diabetes. Talk to your doctor about what type of exercise is right for you.
Lifestyle
It is a good idea to wear a Medic Alert bracelet or tag indicating that you have diabetes. This will make others aware of your condition in case you have a severe hypoglycemic attack and are not able to make yourself understood, or if you are in an accident and need emergency medical care. Identifying yourself as having diabetes is important because hypoglycemic attacks can be mistaken for drunkenness, and victims often aren't able to care for themselves. Without prompt treatment, hypoglycemia can result in a coma or seizures. And, since your body is under increased stress when you are ill or injured, your blood sugar levels will need to be monitored by any medical personnel who give you emergency care. Be sure to take good care of your teeth and floss regularly. Diabetes can worsen gum disease.
Alternative Medecine
Vitamins and Minerals
Alternative medicine should never be used alone to treat diabetes. However, there are things you can do €” in addition to medication, proper diet, and exercise €” that may help control your blood sugar and prevent complications of diabetes.
Chromium supplements may help people with diabetes. Chromium not only lowers blood glucose levels and improves glucose tolerance, but it also lowers insulin levels and helps hold down blood cholesterol levels.
Inositol, a B-complex vitamin, has been shown to help protect people with diabetes from peripheral neuropathy by relieving numbness and tingling in the hands and feet. However, since inositol might alter blood sugar levels, make sure to check with your doctor before starting supplements. Biotin, also called vitamin H, may improve glucose metabolism in people with diabetes.
Vitamin B-6 may help decrease the severity of diabetic neuropathy and reduce insulin demands in people with type 2 diabetes. Vitamin B-12 may help treat diabetic neuropathy; injections may prove more beneficial than oral doses if warranted.
People with diabetes may need supplements of vitamin C to make up for low blood levels of insulin, which normally works to help cells absorb the vitamin. Proper amounts of vitamin C help the body maintain good cholesterol levels, fight off infection by bolstering the immune system, and prevent cataracts. Although some practitioners recommend supplementing your diet with up to 1 gram of vitamin C per day, you should check with your doctor to make sure this is a safe dosage for you.
Vitamin E may help limit damage to the vascular system and improve blood cholesterol levels.
Manganese helps the body metabolize glucose. Some people with diabetes have a serious manganese deficiency. Magnesium supplements may help control diabetic retinopathy and reduce the possibility of cardiovascular damage.
Zinc may help increase glucose tolerance, and potassium may improve a diabetic's ability to utilize insulin. Copper supplements may help improve cardiovascular fitness.
Okra and peas can help stabilize blood sugar levels and provide fiber in a high-complex-carbohydrate diet.
Mind/Body Medicine
Guided imagery, biofeedback, meditation, hypnotherapy, and yoga reduce stress hormones, which in turn can help stabilize blood sugar levels and lessen insulin requirements. Biofeedback also increases circulation, which improves the blood flow to the hands and feet and may decrease the likelihood of amputation.
Acupuncture or magnetic field therapy often relieves the discomfort of neuropathy, a nerve problem sometimes experienced with diabetes.
Herbal Remedies
Capsaicin cream, a topical ointment made with cayenne, is also helpful in reducing pain in the hands and feet. People with severe loss of sensation in the hands or feet should use caution when using capsaicin, as they may not be able to fully feel any burning sensation.
The diet and herbal compounds of Ayurvedic medicine may be successful at lowering glucose levels. Ayurvedic treatments may strengthen glucose tolerance levels while keeping cholesterol levels in check. It is also helpful for treating the obesity and infertility that are often associated with diabetes.
Ginkgo, garlic, holy basil leaves, fenugreek seeds, ginseng, and hawthorn have been promoted as remedies for diabetic symptoms. Though some small studies have shown them to be effective, more research is needed before they can be generally recommended. Check with your doctor before trying any herbal product.
the Basics | Symptoms | Detection and Treatment | Prevention
