Diabetes also known medically as diabetes mellitus is a group of diseases that affect the way your body uses blood sugar (glucose). This sugar is vital to your health because it’s your body’s main source of fuel.
Normally, glucose is able to enter your cells because of the action of insulin a hormone secreted by your pancreas. Insulin acts like a key to unlock microscopic doors that allow glucose into your cells. But in diabetes mellitus, this process goes awry. Instead of being transported into your cells, glucose accumulates in your bloodstream and eventually is excreted in your urine. This usually occurs either because your body doesn’t produce enough insulin or because the cells don’t respond to insulin properly.
Diabetes mainly occurs in two forms:
This type develops when your pancreas makes little or no insulin. It affects between 5 percent and 10 percent of people with the disease.
This type is far more common than type 1, affecting between 90 percent and 95 percent of people with diabetes over age 20. It occurs when your body is resistant to the effects of insulin or your pancreas produces some, but not enough, insulin to maintain a normal glucose level.
More Americans have diabetes than ever before. The disease affects 17 million adults and children, yet close to a third of them may not know they have it. That’s because diabetes can develop gradually over many years, often with no symptoms. Both types of diabetes are serious. The accumulation of glucose in your blood can damage almost every major organ in your body. Eventually, diabetes can be fatal. It’s the sixth leading cause of death in the United States.
No one has yet found a cure for diabetes mellitus. But the good news is that eating right, maintaining a healthy weight and getting plenty of exercise can help prevent the disease. And if you have diabetes, diet and exercise along with medications that control blood sugar can help you continue to live a healthy and active life.
Many people first learn they have diabetes through blood tests done for another condition or as part of a routine physical exam. But in some cases, diabetes may not be detected before damage to your eyes, kidneys or other organs has occurred. That’s why the American Diabetes Association recommends that all adults have a fasting blood glucose test at age 45. If the test results are normal, repeat the test every three years. If your results are borderline, have a fasting blood sugar test every year. Your doctor also may test for diabetes based on your symptoms or risk factors. Otherwise, doctors usually don’t screen for diabetes during routine visits.
Although the amount of sugar in your blood fluctuates, the range is relatively narrow. After fasting all night, most people have levels between 70 and 100 milligrams of glucose per deciliter of blood (mg/dL). That’s the equivalent of about 1 teaspoon of sugar in a gallon of water. If you consistently have fasting glucose levels above 126 mg/dL, you likely have diabetes.
Tests that can detect diabetes include:
Controlling your blood sugar is essential to feeling healthy and avoiding long-term complications of diabetes. Some people are able to control their blood sugar with diet and exercise alone. Others may need to use insulin or other medications in addition to lifestyle changes. In either case, monitoring your blood sugar is a key part of your treatment program.
Pancreas or islet cell transplantation may be an option for people whose kidneys are failing or who aren’t responding to other treatments.
In recent years, researchers have focused increasing attention on transplantation for people with type 1 diabetes. Current procedures include:
If you’ve just received a diagnosis of diabetes, monitoring your blood sugar may seem like an overwhelming task. But once you learn to measure your blood sugar and understand how important it is, you’ll feel more comfortable with the procedure and more in control of your disease. Testing is crucial because it tells you whether you’re keeping your glucose levels in the range you and your doctor have agreed on.
The best range for you depends on your age and the type of diabetes you have. For younger adults who don’t have complications of diabetes, a typical target range might be 80 to 120 mg/dL before meals, and below 180 mg/dL after eating. Older adults who have complications from their disease may have a fasting target goal of 100 to 140 mg/dL and below 200 mg/dL after meals. That’s because blood sugar that falls too low in older adults can be more dangerous than in younger people.
How often you test your blood sugar depends on the type of diabetes you have. If you take insulin, test your blood sugar at least twice a day, and preferably three or four times a day. But if you have type 2 diabetes and don’t use insulin, you may need to test your blood sugar levels only once a day or as little as twice a week.
Keep in mind that the amount of sugar in your blood is constantly changing. Self-monitoring helps you learn what makes your blood sugar levels rise and fall, so you can make adjustments in your treatment. Factors that affect your blood sugar include:
Hormone levels also fluctuate during perimenopause the time before menopause. How this affects blood sugar varies, but most women can control any symptoms with additional exercise and changes in their diet. If your symptoms are more severe, your doctor may recommend oral contraceptives or hormone replacement therapy (HRT). After menopause, many women with diabetes require about 20 percent less medication because their cells are more sensitive to insulin.
A healthy diet
Contrary to popular myth, there’s no “diabetes diet.” Furthermore, having diabetes doesn’t mean you have to eat only bland, boring foods. Instead, it means you’ll eat more fruits, vegetables and whole grains foods that are high in nutrition and low in fat and calories and fewer animal products and sweets. Actually, it’s the same eating plan all Americans should follow.
Yet understanding what and how much to eat can be a challenging task. Fortunately, a registered dietitian can help you put together a meal plan that fits your health goals, food preferences and lifestyle. Once you’ve decided on a meal plan, keep in mind that consistency is extremely important. To keep your blood sugar at a consistent level, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.
But even with all the information you need and the best intentions, sticking to your diet can be one of the most challenging parts of living with diabetes. The key is to find ways to stay motivated. Don’t let others undermine your determination to eat in the healthiest way possible. You have to believe that what you’re doing matters and that you’re worth it.
Exercise
Everyone needs regular aerobic exercise, and people with diabetes are no exception. The good news is that the same exercises that are good for your heart and lungs also help lower your blood sugar levels.
See your doctor before beginning any exercise program. Once you have the go-ahead, take some time to think about which activities you enjoy and are likely to stick with. Walking, hiking, jogging, biking, tennis, cross-country skiing and swimming are all good choices.
Aim for at least 30 minutes of aerobic exercise most days. But if you haven’t been active for a while, start slowly and build up gradually. For the best results, combine your aerobic activity with stretching and strength-training exercises.
Healthy weight
Being overweight is the greatest risk factor for type 2 diabetes. That’s because fat makes your cells more resistant to insulin. But when you lose weight, the process reverses and your cells become more receptive to insulin. For some people with type 2 diabetes, weight loss is all that’s needed to restore blood sugar to normal. Furthermore, a modest weight loss of 10 to 20 pounds is often enough.
Yet losing even 10 pounds can be a challenge for most people. Fortunately, you don’t have to do it alone. A registered dietitian can help you develop a weight-loss plan that takes into account your current weight, activity level, age and overall health. Ultimately, however, the motivation has to come from you.
Medications
When diet, exercise and maintaining a healthy weight aren’t enough, you may need the help of medication. Medications used to treat diabetes include insulin. Everyone with type 1 diabetes and some people with type 2 diabetes must take insulin every day to replace what their pancreas is unable to produce. Unfortunately, insulin can’t be taken in pill form because enzymes in your stomach break it down so that it becomes ineffective. For that reason, many people inject themselves with insulin using a syringe or an insulin pen injector a device that looks like a pen, except the cartridge is filled with insulin. Others may use an insulin pump, which provides a continuous supply of insulin, eliminating the need for daily shots.
An insulin pump is a pumping device about the size of a deck of cards. You wear it outside your body. A small tube connects the reservoir of insulin to a catheter that’s inserted under the skin of your abdomen. The pump dispenses the desired amount of insulin into your body and can be adjusted to infuse more or less insulin depending on meals, activity and glucose level. Insulin pumps aren’t for everyone. But for some people they provide improved blood sugar control and a more flexible lifestyle.
The most widely used form of insulin is synthetic human insulin, which is chemically identical to human insulin but manufactured in a laboratory. Unfortunately, synthetic human insulin isn’t perfect. One of its chief failings is that it doesn’t mimic the way natural insulin is secreted. But newer types of insulin, known as insulin analogs, more closely resemble the way natural insulin acts in your body. Among these are lispro (Humalog), insulin aspart (NovoLog) and glargine (Lantus).
A number of drug options exist for treating type 2 diabetes, including:
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