The Basics
- What is diabetes?
- What causes diabetes?
- What are the different types of diabetes?
- Diabetes and Women: The Statistics
- How does diabetes affect women differently?
Diagnosis and Treatment
Empower Yourself
Diabetes
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Diabetes Resources
The Basics
What is diabetes?
Diabetes is a life-long disease in which there are high levels of sugar in the blood. People with diabetes have high blood glucose (sugar) because their pancreas does not make enough insulin, or because their muscle, fat, and liver cells do not respond to insulin normally. Some people with diabetes experience both of these problems.
Insulin
The role of insulin is to transport glucose from the bloodstream to the muscle, fat, and liver cells, where it is used as fuel. When there is not enough insulin or the insulin is not functioning properly, these muscle, fat, and liver cells are not getting the fuel they need. Insulin is made in the pancreas. People with Type 2 Diabetes have to take their insulin through injections. There is no pill, because if you ingested insulin, it would be broken down like any protein.
Signs and Symptoms
High levels of glucose in the blood cause several problems. If you are experiencing these symptoms, it is possible that you have one of the three types of diabetes, which will be explained later.
- Increased thirst
- Increased urination
- Weight loss despite increased appetite
- Fatigue
- Nausea
- Vomiting
- Blurry vision
- Slow-healing infections
- Impotence in men
In some cases, symptoms will not appear at all because the disease develops so slowly. Therefore, if you have a history of diabetes in the family, you should consult a doctor even if you are not experiencing symptoms.
Hypoglycemia and Hyperglycemia
Part of living with diabetes is learning how to deal with the problems that come with the disease. Since the insulin is not functioning properly in your body, often a problem that results is abnormal levels of sugar. When the blood sugar level is too low, it is called hypoglycemia. When it is too high, it is called hyperglycemia. You always need to remain vigilant of your blood sugar levels.
When your blood sugar levels are too low, the quickest way to treat it is by having five or six pieces of hard candy or a glass of juice. When your blood sugar levels are too high, exercise can often bring them down.
Ketones
Ketones are acids that build up in the blood. They are produced by the breakdown of fat and muscle, and they are toxic at high levels. People with diabetes are at risk of having high levels of ketones. Ketones in the blood cause a condition called "acidosis" (low blood pH). Urine testing detects both glucose and ketones in the urine.
What causes diabetes?
There is not a single known cause of diabetes. However, studies have suggested that genetics plays a role. Also, environmental factors like obesity and lack of exercise seem to play a part in the development of diabetes. Some of the specific risk factors for developing diabetes include:
- A parent or sibling with diabetes
- Obesity
- Age greater than 45 years
- Some ethnic groups (particularly African-Americans and Hispanic Americans)
- Gestational diabetes or delivering a baby weighing more than 9 pounds
- high blood pressure
- High blood levels of triglycerides (a type of fat molecule)
- High blood cholesterol level
There are ways to prevent the development of certain types of diabetes. Before people develop Type 2 Diabetes, they almost always develop "pre-diabetes". At this point, blood-glucose levels are higher than normal but not high enough that the person is considered diabetic. If you take control when you are still in the pre-diabetes stage, you can prevent Type 2 Diabetes from ever developing. Lifestyle modification is the best method to prevent diabetes. This includes:
- Talking to a nutritionist about modifying your diet with a goal of reducing body weight by between 5 and 7%.
- Implementing a regular exercise plan of about 150 minutes of exercise per week.
What are the different types of diabetes?
- Type 1 diabetes is usually diagnosed in childhood or adolescence. The body makes little or no insulin, and the patient requires daily injections of insulin to survive. If this form of diabetes is not managed carefully and on a daily basis, it can be fatal.
- Type 2 diabetes is much more common than type 1. 90% or more diabetes cases are Type 2. The onset usually occurs in adulthood. In Type 2, the pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the insulin. Glucose will remain in the blood instead of going into the cells. This means the cells may be starving for energy
- High blood glucose levels can cause damage to the eyes, kidneys, nerves, and heart
- Many people with type 2 diabetes do not know they have it, but it is a serious condition that needs to be treated. The increasing levels of obesity and the lack of exercise in America, as well as the growing number of older people, have all contributed to rising instances of Type 2 diabetes.
- Gestational diabetes is high blood glucose that develops at any time during pregnancy in a person who does not have diabetes. Women who get gestational diabetes during pregnancy are more likely to get Type 2 diabetes later in life.
- Pre-Diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 54 million Americans who have pre-diabetes, in addition to the 20.8 million with diabetes.
Diabetes and Women: The Statistics
- Almost 21 million Americans suffer from some form of diabetes, including 9.7 million women.
- One-third of people with diabetes do not know they have it.
- Pregnancy brings about the risk of gestational diabetes, which only occurs during pregnancy. 2-5% of pregnancies cause gestational diabetes.
- The prevalence of diabetes is 2-4 times as high among African America, Latina, American Indian, and Asian women than among white women.
- The risk of diabetes increases with age.
- Because of the aging population of women in the US, as well as the increasing percentage of minority women, the rates of diabetes among women is rising.
How does diabetes affect women differently?
Because of the hormonal fluctuations that are unique to women, there are many ways in which your diabetes may affect you that are different from how it would affect men.
Yeast infections
Because of the unbalanced blood sugar levels in the blood, women are more likely to develop yeast infections. Sugar is a trigger for yeast growth.
Birth Control
Birth control pills may raise your blood glucose levels. Using them for longer than a year or 2 may also increase your risk of complications with diabetes or diabetic-related problems. For example, if you develop high blood pressure while on the pill, you increase the chance that eye or kidney disease will worsen.
Pregnancy
Pregnancy presents the risk of developing gestational diabetes. However, healthcare providers no longer discourage women with diabetes or women at risk for developing diabetes from becoming pregnant. There are serious risks to both mother and child, though, if the diabetes is not controlled before and during the pregnancy:
- Mismanaged diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies.
- Mismanaged diabetes during the second and third trimesters of pregnancy can result in excessively large babies, which presents a risk to both mother and child.
The most important thing for pregnant women with diabetes is making sure blood glucose levels remain in the target range. This means developing a treatment plan with your doctor that keeps meals, exercise, and insulin in balance. The plan needs to change as your pregnancy develops and your hormone levels change. You will need to check levels often (as much as 8 times a day) and keep a record of the results.
Motherhood
Unless otherwise advised by your physician, women with diabetes can still breastfeed their babies. While your child is more likely to eventually develop diabetes if it runs in the family, this is not a result of breast-feeding.
Menopause
The fluctuations in hormonal levels and balance that occur during menopause may lead to abnormal blood glucose levels. Women with diabetes are also at risk of early onset of menopause, which increases the risk of cardiovascular disease.
Osteoporosis
This condition, through which your bones become brittle, is a major health problem for aging women. This disease affects one in three women after menopause. Studies have found that women who suffer from Type 1 diabetes are slightly more likely to get osteoporosis. This may explain the higher incidence of fractured and broken hips among post-menopausal women with Type 1 diabetes.
Women with Type 1 diabetes should be exceptionally careful to reduce their risk of osteoporosis. You can do this in a number of ways.
- Ensure that your diet has sufficient calcium by eating foods like yogurt, cheese, and milk. Tinned fish with bones, tofu, and leafy greens also contain a high dose of calcium.
- Take regular weight-bearing exercise at least three times a week. Walking, dancing, weight-training, and running are all examples of weight-bearing exercise.
- Do not smoke. Smoking can bring on premature menopause, and smoking lowers your bone-mineral density.
- Drink only moderate amounts of alcohol.
Diagnosis and Treatment
Diagnosis
If you are experiencing the aforementioned diabetes symptoms, it is possible that you have either diabetes or pre-diabetes. If you discover that your blood sugar is still at pre-diabetes levels, you can prevent Type 2 diabetes from ever developing. This is just one reason why it is vital that you see your doctor if you think you ay have diabetes.
In order to diagnose whether a patient has pre-diabetes or diabetes, your doctor will conduct one of two diagnostic tests (Note: mg/dL = milligrams per deciliter):
Fasting Plasma Glucose Test (FPG): For this test, adults should not eat for six hours prior to administration. Blood is drawn from a vein, usually on the inside of the elbow or the back of the hand. This test is used to measure blood glucose levels. If these levels are unusually high in the blood, this probably means that there is not enough insulin being produced. A fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. Fasting blood glucose levels of 126 mg/dl or higher signals diabetes.
Oral Glucose Tolerance Test (OGTT): During this test, adults should not eat or drink for twelve hours prior to administration. They should be sure that they were eating normally in the days prior to the test. The oral glucose tolerance test is used to screen pregnant women for gestational diabetes between 24 and 28 weeks of pregnancy. It may also be used to in cases where the disease is suspected, despite a normal fasting blood glucose. For the test, you will be asked to drink a liquid containing a certain amount of glucose. Your blood will be taken before you do this, and again every 30 to 60 minutes after you drink the solution. The test takes up to 3 hours. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.
Treatment
There is no cure for diabetes, but the treatments are such that people can maintain long, healthy lives with diabetes. The immediate goals are to stabilize the blood sugar levels and to eliminate symptoms of abnormal blood sugar levels. The long-term goals of treatment are to prolong life, alleviate symptoms, and prevent long-term complications associated with diabetes, like kidney failure and heart disease.
Some people who suffer from Type 2 Diabetes may find that when they lose weight and increase activity, they no longer need medication. A careful diet and an ideal weight can be enough to bring blood glucose levels under control.
The medications to treat diabetes include insulin and glucose-lowering pills. If you need insulin, there is no avoiding the need for injections. Insulin is not available in oral form.
Insulin: Insulin injections are generally required one to four times per day. Some people use an insulin pump, which is worn at all times and delivers a steady flow of insulin throughout the day. People who need insulin are taught to give themselves injections by their health care providers or diabetes educators. The types of insulin to use, the doses required, and the number of daily injections are chosen by a health care professional trained to provide diabetes care.
Oral medications: These medications may help lower glucose levels in Type 2 Diabetes patients. Most type 2 diabetics require more than one medication for effective control of blood sugar levels within three years of starting their first medication. Different groups of oral medications may be combined, or insulin and oral medications may be used together.
- Medications that increase insulin production by the pancreas include Amaryl, Glucotrol, and Glucotrol XL, Micronase, Diabeta, Glynase, Prandin, and Starlix.
- Medications that increase sensitivity to insulin include Glucophage, Avandia, and Actos.
- Medications that delay absorption of glucose from the gut. include Precose and Glyset.
Oral hypoglycemic agents are not proven safe for pregnant women. Women with type 2 diabetes who take these medications may be switched to insulin during pregnancy and while breast-feeding.
Empower Yourself
Dealing with diabetes
It is overwhelming to learn that you or a loved one has been diagnosed with diabetes. Nonetheless, it is vital that you take control as soon as you learn of your condition. Patients play an exceptionally important role in managing their own diabetes. Unlike many other diseases, daily self-management is the primary treatment. Basic management skills will help prevent emergencies from arising. Therefore, when speaking with your doctor, you need to learn:
- How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
- What to eat and when: People with Type 1 Diabetes should eat at about the same times everyday, and should try to eat the same types of food. This will help keep blood sugars from going too high or too low. People with Type 2 Diabetes should follow a well-balanced, low-fat diet. Talk to your doctor about what exactly is right for you.
- How to take insulin or oral medication
- How to test and record blood glucose levels: Blood glucose levels can be checked by looking at the glucose levels in a single drop of blood. Regular testing will tell you how your diet, exercise, and medication are working for you.
- How to test urine for ketones (Type 1 only)
- How to adjust insulin and food when eating habits, exercise, or hormonal levels change
There are also extra measures you can take to help manage not only your physical health, but your mental and emotional health.
- Create a Daily Management Plan with your doctor. This should help you organize your treatment, diet, and exercise.
- Join a support group. It is important that you realize that you are not alone! It is shocking to discover that you have this disease, but there are others going through it who can help support you. There are also walks, community events, and fundraisers to participate in.
Frequently Asked Questions
What is diabetes?
Diabetes mellitus is a chronic disease in which blood glucose (sugar) levels are too high. Cells in the body break down glucose in order to provide energy for movement, growth, and repair. The hormone insulin is responsible for regulating glucose levels in the blood. Abnormally high levels of glucose can damage the small and large blood vessels, leading to diabetic blindness, kidney disease, amputations of limbs, stroke, and heart disease.There are three common types of diabetes. Type 1 diabetes is usually (but not always) diagnosed in children and young adults. Persons with type 1 diabetes make no insulin and must take insulin every day. Type 2 diabetes is usually (but not always) diagnosed in adults over the age of 45. In type 2 diabetes, either the person is not making enough insulin, or the body is resistant to insulin and cannot use it properly. Gestational diabetes occurs during pregnancy: 2-4 percent of all pregnant women have gestational diabetes. If a woman has gestational diabetes, she has about a 40 percent chance of having type 2 diabetes later in her life. About 17 million persons in America have Diabetes mellitus, but five million of them don't even know it. Nearly 1 million new cases are diagnosed each year.
How do I know if I have diabetes?
As many as 50 percent (one-half) of persons with type 2 diabetes are unaware that they have the disease. For this reason, it is particularly important to pay attention to the signs and symptoms of diabetes and its risk factors. Some of the signs of either type 1 or type 2 diabetes are:
- being very thirsty
- urinating often
- feeling very hungry or tired
- losing or gaining weight without trying
- having sores that heal slowly
- having dry, itchy skin
- losing the feeling in your feet or having tingling in your feet
- having blurry eyesight
Symptoms of type 1 diabetes often develop over a short period of time. In type 2 diabetes, symptoms develop more slowly, and some persons never have any symptoms of the disease. If you are regularly having any of these signs and symptoms, you should tell your doctor.
How are different age groups affected by diabetes?
Among Americans under age 20, just one quarter of one percent (about 206,000 people) have diabetes. Among Americans aged 20 years and older, 8.7 percent (18.2 million people) have diabetes. The prevalence of diabetes increases among older people. Among Americans aged 60 years and older, 18.3 percent (8.6 million people) have diabetes.
What is the economic cost of diabetes in the United States?
The estimated economic cost of diabetes in 2002 was $132 billion. Of this amount, $92 billion was due to direct medical costs and $40 billion due to indirect costs such as lost workdays, restricted activity, and disability due to diabetes. The average medical expenditure for a person with diabetes was $13,243, or 5.2 times greater than the cost for a person without diabetes. In addition, 11 percent of national health care expenditures went to diabetes care.
What are some research studies that have provided important evidence about diabetes prevention and treatment?
The Diabetes Prevention Program (DPP) was a federally funded study of over 3,000 people at high risk for diabetes. The DPP showed that a 5 to 7 percent weight loss from exercise and decreased dietary fat and calories can delay and possibly prevent type 2 diabetes.
The 10-year Diabetes Control and Complications Trial (DCCT) showed that keeping blood glucose levels close to normal helps prevent type 1 diabetes-related complications. Among the 1,441 people participants, all of whom had type 1 diabetes, those who kept their hemoglobin A1C as close to normal as possible had considerably lower incidence of diabetic eye, kidney, and nerve complications. A follow-up study showed that, 8 years after the trial ended, participants who were continuing to maintain intensive blood glucose control continued to have lower rates of complications.
The Diabetes Prevention Trial - Type 1 (DPT-1) researched two methods to delay or prevent type 1 diabetes. Nine medical centers and more than 350 U.S. and Canadian clinics took part in the DPT-1. One DPT-1 trial tested whether low-dose insulin injections could prevent or delay the development of type 1 diabetes in people at high risk for developing type 1 diabetes within 5 years. The other tested whether oral insulin would prevent type 1 diabetes in people with a moderate risk for developing diabetes. However, neither trial was successful at preventing or delaying type 1 diabetes.
Where can I learn more about current clinical trials for diabetes research?
Log onto www.ClinicalTrials.gov to read regularly updated information about federally and privately supported clinical research in human volunteers. www.ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and telephone numbers for more details.
What are some recent improvements in diabetes care?
Technology has given new solutions to diabetes care. Quick-acting and long-acting insulins provide more options for managing insulin-dependent diabetes. A wider range of oral drugs are available to treat type 2 diabetes. New monitors make it easier and more comfortable for people to test and track their blood glucose. External insulin pumps can replace the discomfort of daily injections. Laser surgery can treat diabetic eye disease and prevent blindness. Successful kidney and pancreas transplantation procedures bring hope to people with organ failure.
In addition, we have learned more about how to manage diabetes and prevent complications through weight reduction, blood glucose control, and exercise. We have more successful methods of managing diabetes during pregnancy. We have also identified lifestyle changes that can help prevent diabetes.
Can diabetes be prevented?
A number of studies have shown that regular physical activity can significantly reduce the risk of developing type 2 diabetes. Type 2 diabetes also appears to be associated with obesity.
Researchers are making progress in identifying the exact genetics and "triggers" that predispose some individuals to develop type 1 diabetes, but prevention remains elusive.
Is there a cure for diabetes?
In response to the growing health burden of diabetes, the diabetes community has three choices: prevent diabetes; cure diabetes; and improve the quality of care of people with diabetes to prevent devastating complications. All three approaches are actively being pursued by the US Department of Health and Human Services.
Both the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) are involved in prevention activities. The NIH is involved in research to cure both type 1 and type 2 diabetes, especially type 1. CDC focuses most of its programs on being sure that the proven science is put into daily practice for people with diabetes. The basic idea is that if all the important research and science are not applied meaningfully in the daily lives of people with diabetes, then the research is, in essence, wasted.
Several approaches to "cure" diabetes are being pursued:
- Pancreas transplantation
- Islet cell transplantation (islet cells produce insulin)
- Artificial pancreas development
- Genetic manipulation (fat or muscle cells that don't normally make insulin have a human insulin gene inserted — then these "pseudo" islet cells are transplanted into people with type 1 diabetes).
Each of these approaches still has a lot of challenges, such as preventing immune rejection; finding an adequate number of insulin cells; keeping cells alive; and others. But progress is being made in all areas.
How can diabetes affect cardiovascular health?
cardiovascular disease is the leading cause of early death among people with diabetes. Adults with diabetes are two to four times more likely than people without diabetes to have heart disease or experience a stroke. At least 65% of people with diabetes die from heart disease or stroke. About 70% of people with diabetes also have high blood pressure.
How can diabetes affect the eyes?
In diabetic eye disease, high blood glucose and high blood pressure cause small blood vessels to swell and leak liquid into the retina of the eye, blurring the vision and sometimes leading to blindness. People with diabetes are also more likely to develop cataracts - a clouding of the eye's lens, and glaucoma - optic nerve damage. Laser surgery can help these conditions.
How can I keep my eyes healthy if I have diabetes?
There's a lot you can do to prevent eye problems. A recent study shows that keeping your blood glucose level closer to normal can prevent or delay the onset of diabetic eye disease. Keeping your blood pressure under control is also important. Finding and treating eye problems early can help save sight.
It is best to have an eye doctor give you a dilated eye exam at least once a year. The doctor will use eye drops to enlarge (dilate) your pupils to examine the backs of your eyes. Your eyes will be checked for signs of cataracts or glaucoma, problems that people with diabetes are more likely to get.
Because diabetic eye disease may develop without symptoms, regular eye exams are important for finding problems early. Some people may notice signs of vision changes. If you're having trouble reading, if your vision is blurred, or if you're seeing rings around lights, dark spots, or flashing lights, you may have eye problems. Be sure to tell your health care team or eye doctor about any eye problems you may have.
How can diabetes affect the kidneys?
In diabetic kidney disease (also called diabetic nephropathy), cells and blood vessels in the kidneys are damaged, affecting the organs' ability to filter out waste. Waste builds up in your blood instead of being excreted. In some cases this can lead to kidney failure. When the kidneys fail, a person has to have his or her blood filtered through a machine (a treatment called dialysis) several times a week, or has to get a kidney transplant.
Why is it especially important to take care of my feet if I have diabetes?
Nerve damage, circulation problems, and infections can cause serious foot problems for people with diabetes. Sometimes nerve damage can deform or misshape your feet, causing pressure points that can turn into blisters, sores, or ulcers. Poor circulation can make these injuries slow to heal. Sometimes this can lead to amputation of a toe, foot, or leg.
What should I do on a regular basis to take care of my feet?
- Look for cuts, cracks, sores, red spots, swelling, infected toenails, splinters, blisters, and calluses on the feet each day. Call your doctor if such wounds do not heal after one day.
- If you have corns and calluses, ask your doctor or podiatrist about the best way to care for them.
- Wash your feet in warm—not hot—water and dry them well.
- Cut your toenails once a week or when needed. Cut toenails when they are soft from washing. Cut them to the shape of the toe and not too short. File the edges with an emery board.
- Rub lotion on the tops and bottoms of feet—but not between the toes—to prevent cracking and drying.
- Wear shoes that fit well. Break in new shoes slowly, by wearing them 1 to 2 hours each day for the first 1 to 2 weeks.
- Wear stockings or socks to avoid blisters and sores.
- Wear clean, lightly padded socks that fit well; seamless socks are best.
- Always wear shoes or slippers, because when you are barefoot it is easy to step on something and hurt your feet.
- Protect your feet from extreme heat and cold.
- When sitting, keep the blood flowing to your lower limbs by propping your feet up and moving your toes and ankles for a few minutes at a time.
- Avoid smoking, which reduces blood flow to the feet.
- Keep your blood sugar, blood pressure, and cholesterol under control by eating healthy foods, staying active, and taking your diabetes medicines.
How can diabetes affect the digestion?
Gastroparesis, otherwise known as delayed gastric emptying, is a disorder where, due to nerve damage, the stomach takes too long to empty itself. It frequently occurs in people with either type 1 or type 2 diabetes.
Symptoms of gastroparesis include heartburn, nausea, vomiting of undigested food, an early feeling of fullness when eating, weight loss, abdominal bloating, erratic blood glucose levels, lack of appetite, gastroesophageal reflux, and spasms of the stomach wall.
How can diabetes affect my mood?
Several studies suggest that diabetes doubles the risk of depression, although it's still unclear why. The psychological stress of having diabetes may contribute to depression, but diabetes' metabolic effect on brain function may also play a role. At the same time, people with depression may be more likely to develop diabetes.
The risk of depression increases as more diabetes complications develop. When you are depressed, you do not function as well, physically or mentally; this makes you less likely to eat properly, exercise, and take your medication regularly.
Psychotherapy, medication, or a combination of both can treat depression effectively. In addition, studies show that successful treatment for depression also helps improve blood glucose control.
Glossary of Diabetes Terms
AADE: American Association of Diabetes Educators. A national voluntary organization of professionals interested in education of the person and/or family with diabetes.
acetoacetic acid: An acid that also contains a ketone group in its molecule.
acetone: A ketone formed in greater abundance in the liver from fatty acids when glucose is not available to the cells for energy. Acetone, one of three ketones, is found in the blood and urine of people with uncontrolled diabetes and causes the breath to have a fruity odor.
acidosis: An acid condition of the body resulting from abnormal amounts of acid, such as acetoacetic and beta hydroxybutyric acids. Acidosis occurs in people who are not producing insulin or who do not receive enough insulin.
ADA: American Diabetes Association, Incorporated, is a national voluntary health organization of professional and lay people interested in research, service, and education in the field of diabetes.
adrenal glands: Two tent-shaped organs that secrete epinephrine (see epinephrine) and glucocorticoids (see glucocorticoids) and aldosterone.
adult diabetes: Now called Type 2 or non-insulin-dependent diabetes mellitus. (See Type 2 diabetes.)
alpha cells: Cells that produce glucagon; found in the islets of Langerhans of the pancreas.
atrophy: The shrinking of a body part due to lack of nutrition. In diabetes, this may mean a decrease in the amount of fat under the skin. This sometimes occurs at the sites of insulin injection and results in hollowed-out areas that are cosmetically undesirable.
beta cells: Cells that produce insulin; found in the islet of Langerhans of the pancreas.
biguanides: Drugs, such as phenformin (DBI and DBI-TD), have also been used in treating diabetes. They do not stimulate the pancreas to produce more insulin but prevent glucose uptake from the intestine, prevent gluconeogenesis, and promote the breakdown of glucose, among other actions. Although these drugs are not now available in the United States, a new phenformin called metformin is being tested. It is found to be less of a cause of lactic acidosis, a side effect seen in the use of the earlier drugs.
blood-glucose level: The concentration of glucose in the blood. It is commonly called blood sugar and is usually measured in milligrams per deciliter (mg/dl) or in millimoles (mmol).
blood-glucose meter: A hand-held machine that tests blood-glucose levels. A drop of blood, obtained by pricking a finger, is placed on a small strip that is inserted in the meter which calculates and displays the blood-glucose level.
brittle diabetes: A type of Type 1 diabetes in which the blood-glucose level fluctuates widely from high to low. Brittle diabetes can be caused by the complete loss of ability to produce any insulin, by too high an insulin dose, or by other factors. It can often be improved through a good treatment program. Also called unstable diabetes.
calorie: A unit for the measurement of heat. The heat-producing, or energy-producing, value of foods is measured in calories. A true calorie is such a small unit that 1,000 calories—a kilocalorie—is usually referred to as a calorie when discussing caloric values of food.
calorie content: The amount of heat released on the burning of one gram of food, most correctly called a kilocalorie (k).
carbohydrate: One of the three main constituents of foods. Carbohydrates are composed mainly of sugars and starches.
cardiovascular disease: Disease of the heart and large blood vessels; tends to occur more often and at a younger age in people with diabetes and may be related to how well the diabetes is controlled.
cell membrane: The material that surrounds all cells and acts to retain helpful substances, exclude harmful substances, and allow glucose to pass into the cells (with the help of insulin).
cesarean section: An operation in which an infant is delivered by being removed from the mother's womb through an incision in the abdomen. Infants of diabetic mothers (IDM) are frequently delivered before term by this means.
Charcot's joint: Chronic progressive degeneration of the stress-bearing action of a joint (i.e., ankles).
cholesterol: A mixture of lipoproteins found in blood, consisting of HDL (high-density lipoproteins), LDL (low-density lipoproteins), and VLDL (very-low-density lipoproteins). Present recommendations are to keep cholesterol levels below 200 mg/dl.
closed-loop system: A self-controlled blood-glucose control system (artificial pancreas or artificial beta cell).
conventional control: One or two doses of insulin with blood sugars higher than normal 50 percent or more of the time.
DCCT: Diabetes Control and Complications Trial—A 10-year research study sponsored by the National Institutes of Health (NIH) involving more than 1,400 people with Type I diabetes. The study proved that tight blood-glucose control can prevent or delay diabetic complications related to hyperglycemia.
dawn phenomenon: An early-morning rise in blood-glucose levels, believed to be due to a delayed response in growth-hormone release.
diabetes mellitus: A disease in which the body is unable to use and store glucose normally because of a decrease or lack of insulin production. Diabetes mellitus is usually inherited, but it may be caused by any process that destroys the pancreas (usually the beta cells) or alters the effectiveness of the receptor site on the cell membrane.
diabetic coma: Unconsciousness occurring during ketoacidosis. Associated symptoms include dry skin and mouth, fruity odor of the breath, very deep and rapid respirations, rapid pulse, and low blood pressure. Diabetic coma is caused by a deficiency of insulin.
diabetic ketoacidosis (DKA): The most severe state of diabetes, in which there are markedly elevated glucose levels in blood and urine, elevated ketones in blood and urine, dehydration, and electrolyte imbalance. (See ketoacidosis.)
diabetic ketosis: A serious state of diabetes in which there is glucose in blood and urine, ketones in blood and urine, and possibly some dehydration. (See ketosis.)
dialysis: A method of washing the toxins out of the blood. Peritoneal dialysis is done at home (usually 4 hours in, 4 hours out); hemodialysis is done at home (usually 12 hours in, 12 hours out) or at a center.
double-void technique: The procedure of collecting a urine specimen 30 minutes after first voiding of all the urine. The double-voiding technique is often used in collecting urine to test for glucose and acetone levels. It is a rough measure of diabetes control at that particular time.
epinephrine: A hormone released from the adrenal glands. Its main function in diabetes is to release glucose from the liver, increase the circulation rate, and prevent release of secreted insulin.
exchange: A serving of food that contains known and relatively constant amounts of carbohydrate, fat, and/or protein. The food used in an exchange is usually weighed or measured. The exchanges are divided into several groups: milk, fruit, meat, fat, bread, and vegetables.
fasting blood glucose: Blood-glucose concentration in the morning before breakfast. Commonly called fasting blood sugar (FBS).
fat: One of the three main constituents of foods. Fats occur in nearly pure form as liquids or solids, such as oils and margarines, or they may be a component of other foods. Fats may be of animal or vegetable origin. They have a higher energy content than any other food (9 calories per gram).
fatty acids: Constituents of fat. When there is an insulin deficiency, as in diabetes, fatty acids increase in the blood and are used by the liver to produce ketones.
fiber: Aids in the normal functioning of the digestive system, specifically the intestinal tract.
flocculation: A "snowy" look to insulin that may occur when the insulin has been exposed to too high or too low a temperature or when it is out of date.
fluorescein angiopathy: Procedure in which photographs of the retina are taken after a water-soluble dye has been injected into the vein.
fractional urine: Urine collected over a period of time and used to test for glucose and acetone levels. Fractions of urine are usually collected over 24 hours: from breakfast to lunchtime, from lunchtime to suppertime, from suppertime to bedtime, and from bedtime to rising. Also called block urine.
gangrene: The death of tissue caused by a very poor blood supply, as sometimes occurs in the feet and legs of persons with diabetes. Infection may be a contributing cause.
genes: Basic units of hereditary characteristics passed on through reproduction (part of chromosomes).
gestational diabetes: A period of abnormal glucose tolerance that occurs during pregnancy, usually controlled by diet and possibly insulin.
globin insulin: Modified form of insulin produced by attaching a globin molecule to Regular insulin, slowing absorption and extending the peak and duration of action. Globin insulin is a clear insulin with acidic pH and intermediate action. It is no longer on the market.
glucagon: A hormone produced by the alpha cells in the islet of Langerhans of the pancreas. Glucagon causes a rise in the blood-glucose level by releasing glucose from liver and muscle cells. It is used by injection for the treatment of severe insulin reactions at home, school, or work.
glucocorticoids: Hormones released from the cortex of the adrenal gland; in relation to diabetes, they cause amino acids to be changed into new glucose (gluconeogenesis).
gluconeogenesis: The process of converting amino acids and glycerol to new glucose. This process takes place in the liver and muscle cells of the body.
glucose: The simple sugar, also known as dextrose, that is found in the blood and is used by the body for energy.
glucose tolerance: The ability of the body to use and store glucose. Glucose tolerance is zero in persons with diabetes mellitus.
glucose-tolerance test: A test for diabetes mellitus. The person being tested is given a measured amount of glucose to drink; blood-glucose levels are measured before ingestion and 1/2, 1 1/2, 2, 3, and sometimes 4 to 6 hours after ingestion. Also called oral glucose tolerance test (OGTT).
glucose toxicity: A state in which the lack of insulin, due to a decreased availability and/or function of the cell receptor site to receive insulin, results in an increase of glucose in the body, which is toxic to the beta cells in the islet of Langerhans. This toxicity is such that it may even lead to beta cell death.
glycogen: Glycogen is glucose in storage form in the liver. It may be broken down to form blood glucose during an insulin reaction or during a fast.
glycogenesis: The process whereby the liver converts a portion of glucose to glycogen.
glycogenolysis: The breakdown of glycogen to glucose.
glycohemoglobin: A test that reflects average blood-glucose control for about 3 to 4 months before the test. One test is the hemoglobin A1c.
glycolysis: The breakdown of glucose to carbon dioxide and water.
glycosuria: The presence of glucose in the urine (glyco refers to sugar, uria to urine).
gram: A small unit of weight in the metric system. Used in weighing food to determine a specific amount to eat or to burn in calories (1 pound [16 ounces] equals 453 grams).
healthcare team: The group of professionals who help manage diabetes and which may include a physician, registered dietitian, and certified diabetes educator, ophthalmologist, podiatrist, or other specialists.
heart disease: A cardiovascular condition in which the heart does not efficiently pump blood. People with diabetes are at greater risk for developing heart disease than is the general population.
heredity: The transmission of a trait, such as blue eyes, from parents to offspring.
hormone: A chemical substance produced by one gland or tissue and carried by the blood to other tissues or organs, where it stimulates action and causes a specific effect. Insulin and glucagon are hormones.
hyperbilirubinemia: Condition in which a person has greater-than-normal value (+12.50 mg/dl in the infant) of bilirubin in the blood. Signs: jaundiced look to skin and whites of eyes.
hyperglycemia: A greater-than-normal level of glucose in the blood (high blood glucose). Fasting blood-glucose values greater than 105 mg/dl (5.8 mmol) are suspect; greater than 140 mg/dl (7.8 mmol) are diagnostic.
hyperinsulinism: An excessive amount of insulin, which may be caused by overproduction of insulin by the beta cells of the islets of Langerhans in the pancreas or by an excessive dose of insulin. Hyperinsulinism may cause hypoglycemia (low blood-glucose levels).
hypertension: high blood pressure. Found to aggravate diabetes control or the complications already developed.
hypocalcemia: Less-than-normal value (10-12 mg/dl in the infant) of calcium in the blood. Signs: convulsive seizure and irritability of the neuromuscular system.
hypoglycemia: A less-than-normal level of glucose in the blood (low blood-glucose level). Fasting blood-glucose value less than 60 mg/dl (3.3 mmol).
hypoglycemic agent: A drug or substance, such as sulfonylureas (e.g., Tolbutamide) and glipizide, used to reduce blood-glucose levels.
impaired glucose tolerance: Condition that exists when blood-glucose values are elevated above normal but are inconclusive for diabetes. Sometimes mistakenly called borderline diabetes.
insulin: A hormone secreted by the beta cells of the islets of Langerhans in the pancreas. Promotes the utilization of glucose.
insulin-dependent diabetes mellitus (IDDM): Also called Type 1 diabetes or juvenile diabetes.
insulin reaction: A condition with rapidly occurring onset that is the result of low blood-glucose levels. It may be caused by too much insulin, too little food, or an increase in exercise without a corresponding increase in food or decrease in insulin. Symptoms may vary from nervousness, shakiness, headaches, and drowsiness to confusion and convulsions, and even to coma.
insulin resistance: A condition in which the body does not properly respond to insulin. It is the most common cause of Type 2 diabetes.
intensive control: Three or more doses of insulin per day or use of the insulin infusion pump with blood sugars in the normal or near normal range 80 percent or more of the time.
islets of Langerhans: The small groups of cells in the pancreas that contain alpha, beta, and delta cells and produce glucagon, insulin, and somatostatin.
isophane insulin: NPH (neutral protamine Hagedorn) insulin, a neutral pH, intermediate-acting insulin.
juvenile diabetes: Now called Type 1 or insulin-dependent diabetes mellitus (IDDM).
ketoacidosis: A condition of the body in which there is not enough insulin. Free fatty acids are released from fat cells and produce ketones in the liver. These ketones or acids result in an imbalance of the blood (acidosis). In the more acute state, the result is ketoacidosis. Large amounts of sugar and ketones are found in urine, electrolytes are imbalanced, and dehydration is present. The onset is usually slow. The condition leads to loss of appetite, abdominal pain, nausea and vomiting, rapid and deep respiration, and coma. Death may occur.
ketone bodies: A name given by some to a mixture of ketones and other metabolism products that may break down into ketones. These other metabolism products are usually acetoacetic acid (which has a ketone group within the molecule) and beta hydroxybutyric acid (a molecule very similar to acetoacetic acid).
ketonemia: The presence of ketones in the blood.
ketones: Substances formed in the blood when a fat is broken down because of insufficient insulin. Fats are broken down into fatty acids, which are then chemically changed into ketones. Ketones (usually acetone) are often found in the blood and urine of persons with uncontrolled diabetes. Ketones may produce a fruity odor in the breath and urine of a person.
ketonuria: The presence of ketones in the urine.
ketosis: The presence of large amounts of ketones in the body, secondary to excessive breakdown of fat caused by insufficient insulin in a person with diabetes mellitus. Acidosis precedes and causes ketosis; the combination (ketosis and acidosis) is called ketoacidosis. Ketosis can also result from starvation or illness in nondiabetic individuals.
kidney threshold: The level of a substance (such as glucose) in the blood in the kidney, above which it will be spilled into the urine. Also called renal threshold.
Kimmelstiel-Wilson syndrome: Lesions of the filtered tubules of the kidney, caused by blood-vessel degeneration related to poorly controlled diabetes, as described by doctors Kimmelstiel and Wilson.
Kussmaul's inspiration: The rapid, deep, and labored respiration observed in patients with diabetic ketoacidosis; an involuntary mechanism to excrete carbon dioxide in order to reduce carbonic-acid level.
labile diabetes: A term used for unstable diabetes control. (See brittle diabetes.)
Lente insulin: An intermediate-acting insulin that is a mixture of 30 percent Semilente and 70 percent Ultralente insulin.
lipolysis: The increased fat breakdown in the body tissues that occurs in ketosis (lysis of fat).
Liver Activation Treatment: (Pulsatile IntraVenous Insulin Treatment) insulin given by vein in a pulselike fashion (insulin based on total body needs given in short spurts every few seconds while the person sips a high glucose-loaded drink).
macroangiopathy: Disease related to the large blood vessels of the body.
maturity-onset diabetes: Another name for Type 2 diabetes (also called adult diabetes, non-insulin-dependent diabetes, mild diabetes, ketone-resistant diabetes).
Mauriac syndrome: A condition observed before puberty in children with prolonged, poorly controlled diabetes. It involves an enlarged, fatty liver, pitting edema, and short stature. The Mauriac syndrome is seldom seen today due to proper treatment, with adequate food and insulin provided for growth.
meal plan: An arrangement whereby the total food allowed daily is expressed in terms of a certain number of points or exchanges, with the foods to be eaten at specific times.
metabolism: All the chemical processes in the body, including those by which foods are broken down and used for tissue or energy production.
mg/dl (milligrams per deciliter): The unit of measure used to describe blood-glucose levels.
microaneurysms: Small ballooned-out areas on the capillary blood vessels, such as might be found on the retina of the eye. They may burst and bleed.
microangiopathy: Disease related to the small blood vessels of the body.
monounsaturated fat: Has effect similar to that of polyunsaturated fat but does not lower HDL cholesterol. Found in olive oil and other oils.
nephropathy: Disease of the kidneys which can be life-threatening.
neuritis: Inflammation of the nerves.
neuropathy: Any disease of the nervous system. Neuropathy may occur in persons with diabetes and be related to poor control. Symptoms such as pain, loss of sensation, loss of reflexes, and/or weakness may occur.
non-insulin-dependent diabetes (NIDDM): Also called Type 2 diabetes.
NPH: Neutral Protamine Hagedorn, an intermediate-acting insulin that initially received its slower action through the addition of a protein to short-acting insulin.
obesity: An abnormal and excessive amount of body fat. Obesity is a risk factor for Type 2 diabetes.
omega: Three fatty acids that are useful in lowering triglycerides and cholesterol. They also slow blood clotting. Found in salmon, tuna, and certain other fish.
open-loop system: A mechanical system of insulin injection that is not self-controlled but must be controlled or programmed externally.
oral agents (oral hypoglycemic agents): Medications taken orally to lower blood glucose. They are used by people with Type 2 diabetes and should not be confused with insulin.
oral glucose-tolerance test (OGGT): See glucose-tolerance test.
oral hypoglycemia agent: Another name for a blood-glucose-lowering agent. (See hypoglycemic agent.)
pancreas: A gland that is positioned near the stomach and that secretes at least two hormones—insulin and glucagon—and many digestive enzymes.
pancreas, artificial: A mechanical device that stimulates the functions of the beta cells. It withdraws blood continuously, measures the glucose level, and injects an appropriate dose of insulin or glucose to reestablish a normal blood-glucose level.
points system: A method of quantitating food intake by assigning points to various food components (carbohydrate, fat, protein, calories, sodium, etc.) and determining the number of each component point needed for a meal or for a day's intake. This system may either substitute for or accompany the less precise exchange system for diet calculation (75k = 1 point).
polydipsia: Excessive thirst, with increased drinking of water.
polyphagia: Excessive hunger or appetite, resulting in increased food intake.
polyunsaturated fat: The type of fat that is liquid at room temperature, unless hydrogenated. Includes corn and certain other vegetable oils.
polyuria: Excessive output of urine.
postprandial: Occurring after a meal.
potential abnormality of glucose tolerance: The time during the life of a diabetic person before any abnormality in glucose tolerance can be demonstrated. The identical twin of a person with diabetes is thought to have potential abnormality of glucose tolerance.
precipitate: Particles that settle out of solution. This may occur in insulin that is kept beyond the expiration date, is contaminated, or is improperly mixed.
previous abnormality of glucose tolerance: A classification used for the person who has been documented to have hyperglycemia during pregnancy, illness, or other crisis but who currently has relatively normal blood-glucose levels without any treatment.
protamine zinc insulin (PZI): A long-acting insulin, prepared with large amounts of protamine combined with Regular insulin in the presence of zinc.
protein: One of the three main constituents of foods. Proteins are made up of amino acids and are found in foods such as milk, meat, fish, and eggs. Proteins are essential constituents of all living cells and are the nitrogen-containing nutrient. The calorie content of protein is four calories per gram.
Regular insulin: Short-acting insulin crystallized from the pancreas of animals or synthetically made. This insulin is neutralized and can be premixed with NPH insulin. Also known as clear insulin or crystalline insulin.
renal: Pertaining to the kidneys.
renal threshold: Another name for kidney threshold.
respiratory distress syndrome (RDS): Difficulty in breathing, noted by grunting, respiratory or expiratory wheezing or both, labored respiration, cyanosis (a blueness of the lips, face, fingers, and toes that can expand to involve the total body), and abnormal rate of respiration.
retina: The light-sensitive layer at the back of the inner surface of the eyeball.
retinopathy: Disease of the retina. Retinopathy occurs in persons with prolonged, poorly controlled diabetes and involves abnormal growth of and bleeding from the capillary blood vessels in the eye.
saturated fat: The type of fat, such as butter, that is usually solid at room temperature. Saturated fats are usually derived from animal sources.
self-monitoring of blood glucose (SMBG): A technique of testing a person's blood-glucose level in order to determine the body response to activity, food, and medication.
Semilente: Insulin prepared through special crystallizing techniques to produce small insulin crystals with large absorptive surfaces and rapid action. Semilente is slower in action than Regular insulin but more rapid than the intermediate-acting insulin.
serum glucose: The concentration of glucose in the liquid part of the blood after the cells have been removed (clotted blood).
single-void technique: The procedure of collecting a urine specimen four times a day, before meals and at bedtime. The bladder is not emptied for 30 minutes before the specimen is collected.
Somogyi effect: A phenomenon (described by the biochemist Somogyi) in which hypoglycemia causes activation of the internal counterregulatory hormones (for example, glucagon, growth hormone, and epinephrine), causing a rebound in the blood-glucose level to hyperglycemic levels. Also called post-hypoglycemia hyperglycemia.
spot test: A urine test performed on a sample collected using the single-void technique.
sugar: A form of carbohydrate that provides calories and raises blood glucose levels.
sugar substitutes: Sweeteners, such as saccharin, acesulfame K, and aspartame, that are used as a substitute for sugar.
sulfonylureas: Chemical compounds that stimulate production or release of insulin by the beta cells in the pancreas and/or prevent release of glucose from the liver. They are used in the treatment of Type 2 diabetes.
time-action curve: A curve that shows the effect of a medicine at various times after it is taken.
twenty-four-hour urine: Used to measure quantitative glucose levels in urine from a pooled, twenty-four-hour specimen.
Type I diabetes: Results from inability to make insulin due to a combination of genetics or inheritance and environmentalstressors. Insulin-dependent diabetes mellitus is associated with insulin's lack of availability, its action on the receptor sites, and/or its function with the glycolytic pathway. Also called insulin-dependent diabetes or juvenile diabetes.
Type II diabetes: A type of diabetes that is usually found in adults over 30 years of age. The onset is gradual, and the symptoms are often minimal. Patients are often overweight. Those with Type 2 are less prone to acute complications, such as acidosis and coma, than are patients with Type 1. Type 2 diabetes is treated through diet alone or through diet plus oral hypoglycemic agents. Insulin injections may or may not be required. Also called non-insulin-dependent diabetes, non-ketosis-prone diabetes, or maturity-onset diabetes. (Previously called adult diabetes or maturity-onset diabetes in the young [MODY].)
Ultralente: A long-acting insulin that is prepared using special crystallizing techniques that produce large crystals with small absorptive surfaces. Similar in action to PZI.
unsaturated fats: The type of fat, such as vegetable oil, that is usually liquid at room temperature. (See monounsaturated fat and polyunsaturated fat.)
unstable diabetes: Another name for brittle diabetes.
urine tests: Tests that measure substances in the urine. They provide a general idea of a patient's blood-glucose level several hours before the test. Urine tests for ketones are important for preventing ketoacidosis.
Diabetes Resources and Tools
Government Agencies
*Accepts Spanish calls
National Diabetes Education Program
One Diabetes Way?
Bethesda, MD 20814-9692
Phone: (301) 496-3583
http://ndep.nih.gov
Department of Health and Human Services
Food and Drug Administration?
5600 Fishers Lane?
Rockville, Maryland 20857
Phone: (888) INFO-FDA
http://www.fda.gov/diabetes/
National Center for Chronic Disease Prevention
4770 Buford Highway NE, Mailstop K-10
Atlanta, GA 30341-3717?
Phone: (770) 488-5000
Fax: (770) 488-5966
http://www.cdc.gov/diabetes/index.htm
* National Center for Complementary and Alternative Medicine, NIH, HHS
PO Box 7923
Gaithersburg, MD 20898
Phone: (888) 644-6226
TTY: (866) 464-3615
FAX: (866) 464-3616
http://nccam.nih.gov/health/diabetes/
Private Organizations
American Diabetes Association
ATTN: National Call Center
1701 North Beauregard Street
Alexandria, VA 22311
Phone: (800) DIABETES
http://www.diabetes.org
*National Osteoporosis Foundation (NOF)
1232 22nd Street, NW
Washington, DC 20037-1292
Phone: (800) 223-9994 (English) and (800) 624-2663 (Spanish)
http://www.nof.org
Newsletters, Magazines, Reports
Healthy Women Today
The National Women's Health Information Center
http://www.womenshealth.gov/newsletter
Diabetes Forecast
Sign up for this popular magazine that will keep you up-to-date on diabetes news.
http://www.diabetes.org/diabetes-forecast.jsp?WTLPromo=home1st_forecast_freefeb07
Diabetes Studies
Read the latest studies online.
http://diabetes.diabetesjournals.org/current.shtml
Tools
National Diabetes Education Program
View this educational slideshow.
http://ndep.nih.gov/resources/presentations/diabetesthenumber0107/slide01.htm
Fact Sheet
Read this fact sheet, distributed by the Office on Minority Health
http://www.cdc.gov/omhd/AMH/factsheets/diabetes.htm
Professional: