Diabetes 101

The Diabetic Angels do not provide medical advice, diagnosis, or treatment…the material contained in DIABETES 101 or anywhere on this website, is not intended to be a substitute for professional medical advice, treatment or diagnosis. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The contents of Diabetes 101 contained on this website are for informational purposes only.

WHAT IS DIABETES?

Diabetes is a chronic (continual) disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Insulin is needed to move glucose (blood sugar) into cells, where it is used for energy. If glucose does not get into the cells, the body cannot use it for energy. Too much glucose will then remain in the blood, causing the symptoms of diabetes. Insulin is a hormone that regulates blood sugar. There Are Two Main Types of Diabetes. People with Type 1 diabetes are completely unable to produce insulin. People with Type 2 diabetes can produce insulin, but their cells don’t respond to it. In either case, the glucose can’t move into the cells and blood glucose levels can become high. Over time, these high glucose levels can cause serious complications. TYPE 1 DIABETES Previously known as insulin-dependent or childhood-onset, is characterized by a lack of insulin production. Without daily administration of insulin, Type 1 diabetes is rapidly fatal.

Symptoms of type 1 Diabetes?

Extreme thirst
Frequent urination
Fatigue, lethargy
Sugar in urine
Sudden vision changes
Increased appetite – constant hunger
Sudden weight loss
Fruity, sweet, or wine-like odor on breath
Heavy, labored breathing
Stupor, unconsciousness
If you think you have diabetes, call a doctor immediately, and drink fluids WITHOUT SUGAR to prevent dehydration. These symptoms may occur suddenly.

TYPE 2 DIABETES

Formerly called non-insulin-dependent or adult-onset results from the body’s ineffective use of insulin. Type 2 diabetes usually occurs gradually. Most people with the disease are overweight at the time of diagnosis. However, type 2 diabetes can also develop in those who are thin, especially the elderly. Although no one knows for certain what causes type 2 diabetes, there seems to be a genetic component to developing it. In fact, it’s estimated that 45% to 80% of children with type 2 diabetes have at least one parent with diabetes and may have a significant family history of the disease. In some cases, a parent may be diagnosed with type 2 diabetes at the same time as his or her child. Most children and adults who develop type 2 diabetes are overweight. Excess fat makes it harder for the cells to respond to insulin. And being inactive further reduces the body’s ability to respond to insulin. In the past, doctors called this type of diabetes adult-onset diabetes because it almost exclusively affected overweight adults. Today, that description is no longer accurate. More kids and teens are being diagnosed with type 2 diabetes, probably because more kids and teens are overweight. Family history and genetics play a large role in type 2 diabetes. Low activity level, poor diet, and excess body weight (especially around the waist) significantly increase your risk for type 2 diabetes.

Other risk factors include:

Race/ethnicity: Certain ethnic groups also tend to be more prone to developing type 2 diabetes, including people of Native American – African American – Hispanic-Latino and Asian-Pacific Island descent.
Age greater than 45 years High blood pressure History of gestational diabetes

Symptoms of type 2 diabetes?

Often, people with type 2 diabetes have no symptoms at all. If you do have symptoms, they may include:

Increased thirst
Increased urination
Increased appetite
Fatigue
Blurred vision
Frequent or slow-healing infections

NORMAL BLOOD SUGAR LEVELS are between 70 and 120 mg/dL. Keeping blood sugar levels within this range may be difficult, especially in children with type 1 diabetes. Therefore, an individual’s doctor may adjust the target range (for example, 80-180 mg/dL). People with diabetes can’t always maintain blood sugar levels within the target range; no matter how hard they try. A person’s varying schedules and eating habits, as well as the physical changes that occur as they grow, can send blood sugar levels out of range for no apparent reason. A person with type 1 diabetes should never be made to feel that it is their fault if their blood sugar levels are out of range.

HIGH BLOOD SUGAR or HYPERGLYCEMIA: Hyperglycemia occurs when the blood sugar level becomes too high…(greater than 160), and should be treated immediately. High blood sugar may be a warning that this individual is getting sick.

High Blood Sugar in type 1 Diabetics: Follow doctor’s orders for correcting high blood sugar. CAUSE of High Blood Sugar:

Too much food
Too little exercise or physical activity
Skipped or not enough oral diabetes pills or insulin
Insulin that has spoiled after being exposed to extreme heat or freezing cold
Stress from illness, infection injury or surgery
A blood glucose meter that is not reading accurately

*High blood sugar generally develops over a longer period of time.

Symptoms of High Blood Sugar include:

Rapid, heavy breathing
Vomiting
Increased Thirst
Drowsiness
Abdominal pain
Nausea
Sweet-smelling breath
Frequent urination
Confusion
Blurry Vision
More frequent infections
Slow healing cuts and sores
Unexplained weight loss
Unconsciousness.

WHAT TO DO FOR HIGH BLOOD SUGAR: If blood sugar is over 240 mg/dl, it is suggested that the diabetic check for ketones. When a diabetic experiences high blood sugar drink water (It is recommended to drink a minimum of 8 glasses each day), Or sugar-free drinks, 1-2 cups per hour, but no regular soda or juice. If your blood glucose is 250 or greater and you are on insulin, check your urine for ketones. If you have ketones, follow your sick day rules or call your healthcare team if you are not sure what to do. Ask yourself what may have caused the high blood sugar, and take action to correct it. Ask your health care team if you are not sure what to do. Try to determine if there is a pattern to your blood glucose levels. Check your blood glucose before meals 3 days in a row. If greater than your target level for 3 days, a change in medication may be needed. Call your healthcare team or adjust your insulin dose following well day rules. Call your healthcare team if you are currently using diabetes pills.

LOW BLOOD SUGAR or HYPOGLYCEMIA: A low blood sugar, also called hypoglycemia or an insulin reaction, is defined as a blood glucose level below 60 to 70 mg/dl. NOTE: People with type 1 diabetes have symptoms of low blood sugar at various readings. Some people with type 1 diabetes feel perfectly fine at readings below 70. Others begin to show low blood sugar symptoms at readings somewhat above 70. Remember: When you correct for a low blood sugar do not over eat, or you can begin a blood sugar rollercoaster.

CAUSE of Low Blood Sugar or Hypoglycemia: Low blood sugars or insulin reactions can occur whenever insulin is used. Although less frequent, it can also occur with use of drugs that stimulate insulin production in Type 2 diabetes, such as Diabenese, Glyburide, Glipizide, and Starlix.

*Other causes include:*

Skipping meals and snacks
Not eating enough food at a meal or snack time
Exercising longer or harder than usual without eating some extra food
Getting too much insulin
Not timing the insulin doses properly with meals, snacks, and exercise.

Symptoms of Low Blood Sugar or Hypoglycemia:

Shaking
Blurred vision
Seizures
Sweating
Dizziness
Confusion
Pale appearance or complexion
Numbness of the lip Irritability,
mood swings, or personality change
Frequent sighing
Hunger
Headache
Tingling
Fast heart rate
Sudden tiredness
Poor concentration
Nausea or vomiting
Loss of consciousness

Nighttime lows can be particularly hard to recognize. If you wake up during the night with any of the symptoms below, check your blood sugar immediately. (Or eat quick carbs and then check – it may be helpful to keep snacks at your bedside, i.e. juice, crackers).

Nighttime Symptoms:

Nightmares – waking up with a fast heart rate
Waking up very alert
Damp night clothes or sheets
Restlessness and inability to go back to sleep

People often sleep through nighttime reactions and have symptoms the next morning that they may not recognize as resulting from a nighttime reaction. If you have any of these symptoms, suspect an insulin reaction during the night. It is strongly recommended that you test your blood sugar at 2 a.m. for a few nights. This can do wonders to identify and correct this potentially dangerous situation.

Symptoms of Next Morning Low Blood Sugar Reaction:

An unusually high blood sugar after breakfast or before lunch
Waking up with a headache
Waking up “foggy headed”
Loss of short-term memory

*Having one insulin reaction increases the risk for another. In one study, 46% of the people who had a reaction had another reaction the same day and another 24% had a reaction on the second day. Unfortunately, the second reaction is harder to recognize because stress hormones, which create symptoms like sweating and shaking, are largely depleted by the first reaction for the next 2 to 3 days!

HOW TO TREAT LOW BLOOD SUGAR – HYPOGLYCEMIA

If blood sugar levels are slightly low and the person is alert and lucid, he or she: SHOULD NOT EXERCISE, but they should EAT…After eating; check blood sugar level again to make sure it is within the target range. The person may require another snack later in the day and continue to check blood sugar levels regularly.
If blood sugar levels are low and individual is showing signs of low blood sugar but is still able to eat, he or she should immediately eat or drink a fast-acting source of glucose (i.e., juice, glucose gel, or tablets). He or she may need to eat more food after that (i.e., crackers or other complex carbohydrate). Continue to check blood sugar levels regularly.

If blood sugar levels are low and individual is showing signs of low blood sugar and is unconscious, convulsing, and/or an unable to swallow:

REMAIN CALM – DO NOT administer food or drink to an unconscious person, as it may obstruct the airway.
Position the individual on the floor on his/her side to prevent falling, injury, or choking.
Call 911.
Administer emergency glucagon shot (unconsciousness may last up to ten minutes post-glucagon).
Continue to check blood sugar levels regularly.
Give additional food (i.e., crackers or other complex carbohydrate) when able to eat and if needed, in order to keep blood sugar levels in target range.

Blood Glucose Levels Before Meals: Levels should be between 90 and 130 mg of glucose per deciliter of blood.

Blood Glucose Two hours After Meals: Levels should be less than 180 mg/dl.

Blood Glucose Levels At Bedtime: Levels should be between 100 and 140 mg/dL.

How To Use Mini-Dose Glucagon for Preventing Hypoglycemia Exercise

EXERCISE AND DIABETES
According to the Juvenile Diabetes Research Foundation Physical exercise is especially important for people with diabetes. The steps a person with diabetes takes to improve overall fitness can be greatly beneficial, because regular exercise helps lower blood sugar levels and keep them in target range. Exercise makes insulin work more effectively because it takes less insulin to balance the carbohydrates consumed. Therefore, children who begin to exercise more may find that taking their typical doses of insulin before eating a typical amount of food may result in lower blood sugar levels.

REMEMBER: Do NOT exercise if blood sugar is low.

Do NOT exercise if blood sugar is high > 250 mg/dl and ketones are present.

Do NOT exercise if blood sugar is >350 mg/dL with or without keytones.

Diabetes Myths and Misconceptions For Type 1 Diabetes

Diabetes can be difficult to understand and even though people care, it is common for them to ask questions that reflect a lack of knowledge about Type 1, here are some myths.

Myth: You can catch diabetes from someone else.
FACT: No! Although we don’t know exactly why some people develop diabetes, we know diabetes is not contagious. It can’t be caught like a cold or flu. There seems to be some genetic link in diabetes, particularly type 2 diabetes. Lifestyle factors also play a part.

Myth: Taking insulin cures diabetes.
FACT: Taking insulin keeps people with type 1 diabetes alive, but does not cure the disease. While progress toward finding a cure has been substantial, there is still no cure for diabetes.

Myth: Insulin causes weight gain, and because obesity is bad for you, insulin should not be taken.
FACT: Both the UKPDS (United Kingdom Prospective Diabetes Study) and the CCT (Diabetes Control and Complications Trial) have shown that the benefit of glucose management with insulin far outweighs (no pun intended) the risk of weight gain.

Myth: Diabetes is caused by obesity, or eating too much sugar.
FACT: While obesity has been identified as one of the “triggers” for type 2 diabetes, it has no relation to the cause of type 1 diabetes. Scientists do not yet know exactly what causes type 1 diabetes, but the belief that both genetic and environmental factors are involved. Eating too much sugar is not a factor.

Myth: People with diabetes are more likely to get colds and other illnesses.
FACT: No! you are no more likely to get a cold or another illness if you have diabetes. However, people with diabetes are advised to get flu shots. This is because any infection interferes with your blood glucose management, putting you at risk of high blood glucose levels and, for those with type 1 diabetes, an increased risk of ketoacidosis.

Myth: People with diabetes should never eat sweets.
FACT: Limiting sweets will helps people with type 1 diabetes keep their blood sugar under control, but, with advice from their doctor or nutritionist, sweets can fit into their meal plan, just as they would for people without diabetes. And there are times when sweets are a must: if the blood sugar level drops too low, sweets (or juice, or soda) can be the surest to raise it, and prevent the onset of hypoglycemia (Low Blood sugar).

Myth: People with diabetes can’t engage in athletics.
FACT: Physical exercise is important for everyone’s health, and is especially important for people with diabetes. Regular exercise helps lower blood sugar levels and keep them in the target range. There are countless examples of athletes who have had great success, from Olympic Gold Medalist swimmer Gary Hall to baseball great Ron Santo to hockey great Bobby Clarke.

Myth: Only kids get Type 1 Diabetes.
FACT: Type 1 diabetes, also known as “juvenile” or “juvenile onset” diabetes, is usually first diagnosed in children, teenagers, or young adults. However, people may develop type 1 diabetes at any age.

Myth: Insulin is addictive
FACT: You cannot become addicted to insulin. It is a natural substance that the body requires. It is understandable that using a needle to inject insulin might provoke thoughts of drug use and addiction, so if using syringe needles in public causes you concern, talk to your doctor about other methods you can use to administer your insulin.

Myth: It does not matter where insulin is injected.
FACT: Where you inject your insulin determines the rate of absorption. Injection around the abdomen has the fastest rate of absorption, while thighs and buttocks are the slowest. Injecting in the arms fall somewhere in between. Wherever you inject your insulin, be sure to inject into a fatty area of your body. Also, it is a good idea to rotate injection sites. Multiple injections in the same place can cause fat deposits to build up under the skin, which can delay insulin absorbtion.

Myth: Insulin injections hurt.
FACT: A fear of needles is a common complaint for many people taking injections. However, today’s insulin syringes and pens are virtually painless. The best way to overcome this fear is to try insulin injections yourself. Your primary care physician can show you how to administer the injection. If you try it yourself and still feel pain, discuss this with your doctor. Your injection method and even the temperature of the insulin could be a factor.

Myth: Women with diabetes shouldn’t get pregnant.
FACT: Thanks to advances in diabetes research, the outlook for pregnant women with diabetes is significantly better today than it was a generation ago. However, diabetic pregnancy requires extra effort and commitment, excellent blood sugar control, and education in all areas of diabetes management.

Myth: No matter what you do, a person with diabetes for years will eventually get complications.
FACT: Complications are not inevitable. The mechanisms that cause complications are not yet fully understood, and the extent to which they develop varies from person to person. Tight blood sugar control is the only method demonstrated to reduce the risk of developing complications, but their occurrence remains unpredictable in any individual. Some individuals with Type 1 diabetes may be genetically predisposed to develop complications (one of the critical issues being addressed by JDRF’s Research).

Diabetes Myths and Conceptions For Type 2 Diabetes

Myth: Kids don’t get type 2 diabetes.
FACT: Though type 2 diabetes is usually diagnosed in adulthood, increased obesity and other factors have led to a recent “epidemic” of this form of diabetes in young adults and children under the age of 10. Still, most children diagnosed with diabetes, get type 1.

Myth: Diabetes is rare in the United States.
FACT: Diabetes mellitus affects 13 million people (6% of the population) in the United States. Over 5 million of these people have the disease but do not know it. The direct and indirect cost of diabetes mellitus is $98 Billion per year in the United States alone. It is the third leading cause of death in the United States.

Myth: The only form of treatment for diabetes is insulin.
FACT: Type 1 diabetes mellitus is treated with insulin, exercise, and a diabetic diet. Type 2 diabetes mellitus is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, insulin medications are considered.

Myth: You can have a little bit of diabetes.
FACT: There is no such thing as a “touch of sugar” or being “borderline diabetic.” Either someone has diabetes or they don’t.

Myth: Insulin injections will disrupt my life.
FACT: If your doctor prescribes insulin, don’t panic. You will not be confined to home, destined to never travel again. Instead, you will find a time that insulin injections will simply become a part of your daily routine. Your doctor can design a dosing schedule that will fit your lifestyle and various types of insulins are available for different needs. Convenience devices like insulin pens or pumps may provide even more flexibility in your daily life.

Myth: Taking insulin means I have failed at managing my diabetes.
FACT: Using insulin is not a sign of failure to control your diabetes. Nor is it an indication of severe health problems or proof that your risk of diabetes complications has increased. Try as you might, the beta cells in your pancreas are not under your control. After years of successful management, it is not uncommon for people with type 2 diabetes to reach a point where improved glucose control can only be obtained by using insulin. This is not your fault. It is a natural progression of diabetes.

Myth: It does not matter where insulin is injected.
FACT: Where you inject your insulin determines rate of absorbtion. Injection around the abdomen has the fastest rate of absorbtion, while thighs and buttocks are the slowest. Injecting in the arms fall somewhere in between. Wherever you inject your insulin, be sure to inject into a fatty area of your body. Also, it is a good idea to rotat injection sites. Multiple injections in the same place can cause fat deposits to build up under the skin, which can delay insulin absorbtion.

Myth: Once you start insulin you cannot stop.
FACT: Type 1 diabetes is defined as such because insulin-producing beta cells within the pancreas are gradually destroyed and eventually fail to produce insulin. Therefore, people with type 1 diabetes require insulin. The treatment for type 1 diabetes also includes a proper diet and exercise. People with type 2, however, are still able to produce insulin at diagnosis but over time, the overworked beta cells of the pancreas can wear out completely and lose the ability to secrete insulin. People with Type 2 may be treated with insulin at one time and then be switched to oral medications. Some people may even be able to decrease their medications as their blood glucose improves and others still may find they are able to stop taking medications altogether once they lose weight.

Myth: Using insulin means I can eat the way I want.
FACT: Great theory, but actually a poor diet means your insulin has to work even harder to lower your blood glucose. Insulin, like oral medications, are only a part of the diabetes treatment plan. The most effective way to use insulin is in combination with a healthy diet and exercise. However, insulin or any other diabetes medication cannot take the place of your taking care of yourself.

SOURCES: JDRF Diabetes.niddk.nih.gov Joslin dLife Diabetes.org Diabetesnet.com/diabetes-control Diabetesnet.com/diabetes-control/low-blood-sugars/hypoglycemia-unawareness Kidshealth.org Medicinenet.com Health24