Overview
Diabetes mellitus refers to a group of
diseases that affect how your body uses blood sugar (glucose). Glucose is vital
to your health because it's an important source of energy for the cells that
make up your muscles and tissues. It's also your brain's main source of fuel.
The underlying cause of diabetes varies
by type. But, no matter what type of diabetes you have, it can lead to excess
sugar in your blood. Too much sugar in your blood can lead to serious health
problems.
Chronic diabetes conditions include
type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions
include prediabetes and gestational diabetes. Prediabetes occurs when your
blood sugar levels are higher than normal, but not high enough to be classified
as diabetes. And prediabetes is often the precursor of diabetes unless
appropriate measures are taken to prevent progression. Gestational diabetes
occurs during pregnancy but may resolve after the baby is delivered.
Symptoms
Diabetes symptoms vary depending on how
much your blood sugar is elevated. Some people, especially those with
prediabetes or type 2 diabetes, may sometimes not experience symptoms. In type
1 diabetes, symptoms tend to come on quickly and be more severe.
Some of the signs and symptoms of type
1 diabetes and type 2 diabetes are:
- Increased
thirst
- Frequent
urination
- Extreme
hunger
- Unexplained
weight loss
- Presence
of ketones in the urine (ketones are a byproduct of the breakdown of
muscle and fat that happens when there's not enough available insulin)
- Fatigue
- Irritability
- Blurred
vision
- Slow-healing
sores
- Frequent
infections, such as gums or skin infections and vaginal infections
Type 1 diabetes can develop at any age,
though it often appears during childhood or adolescence. Type 2 diabetes, the
more common type, can develop at any age, though it's more common in people
older than 40.
When to see a doctor
- If you
suspect you or your child may have diabetes. If you
notice any possible diabetes symptoms, contact your doctor. The earlier
the condition is diagnosed, the sooner treatment can begin.
- If
you've already been diagnosed with diabetes. After
you receive your diagnosis, you'll need close medical follow-up until your
blood sugar levels stabilize.
Causes
To understand diabetes, first, you must
understand how glucose is normally processed in the body.
How insulin works
Insulin is a hormone that comes from a gland
situated behind and below the stomach (pancreas).
·
The pancreas secretes insulin into the bloodstream.
·
The insulin circulates, enabling sugar to enter your cells.
·
Insulin lowers the amount of sugar in your bloodstream.
·
As your blood sugar level drops, so does the secretion of
insulin from your pancreas.
The role of glucose
Glucose — a sugar — is a source of
energy for the cells that make up muscles and other tissues.
- Glucose
comes from two major sources: food and your liver.
- Sugar
is absorbed into the bloodstream, where it enters cells with the help of
insulin.
- Your
liver stores and makes glucose.
- When
your glucose levels are low, such as when you haven't eaten in a while,
the liver breaks down stored glycogen into glucose to keep your glucose
level within a normal range.
Causes of type 1 diabetes
The exact cause of type 1 diabetes is
unknown. What is known is that your immune system — which normally fights
harmful bacteria or viruses — attacks and destroys your insulin-producing cells
in the pancreas. This leaves you with little or no insulin. Instead of being
transported into your cells, sugar builds up in your bloodstream.
Type 1 is thought to be caused by a
combination of genetic susceptibility and environmental factors, though exactly
what those factors are is still unclear. Weight is not believed to be a factor
in type 1 diabetes.
Causes of prediabetes and type 2
diabetes
In prediabetes — which can lead to type
2 diabetes — and in type 2 diabetes, your cells become resistant to the action
of insulin, and your pancreas is unable to make enough insulin to overcome this
resistance. Instead of moving into your cells where it's needed for energy,
sugar builds up in your bloodstream.
Exactly why this happens is uncertain,
although it's believed that genetic and environmental factors play a role in
the development of type 2 diabetes too. Being overweight is strongly linked to
the development of type 2 diabetes, but not everyone with type 2 is overweight.
Causes of gestational diabetes
During pregnancy, the placenta produces
hormones to sustain your pregnancy. These hormones make your cells more
resistant to insulin.
Normally, your pancreas responds by
producing enough extra insulin to overcome this resistance. But sometimes your
pancreas can't keep up. When this happens, too little glucose gets into your
cells and too much stays in your blood, resulting in gestational diabetes.
Risk factors
Risk factors for diabetes depend on the
type of diabetes.
Risk factors for type 1 diabetes
Although the exact cause of type 1
diabetes is unknown, factors that may signal an increased risk include:
- Family
history. You are risk increases if a parent or sibling has type 1 diabetes.
- Environmental
factors. Circumstances
such as exposure to a viral illness likely play some role in type 1
diabetes.
- The
presence of damaging immune system cells (autoantibodies). Sometimes
family members of people with type 1 diabetes are tested for the presence
of diabetes autoantibodies. If you have these autoantibodies, you have an
increased risk of developing type 1 diabetes. But not everyone who has
these autoantibodies develops diabetes.
- Geography. Certain
countries, such as Finland and Sweden, have higher rates of type 1
diabetes.
Risk factors for prediabetes and type 2
diabetes
Researchers don't fully understand why
some people develop prediabetes and type 2 diabetes and others don't. It's
clear that certain factors increase the risk, however, including:
- Weight. The
more fatty tissue you have, the more resistant your cells become to
insulin.
- Inactivity. The
less active you are, the greater your risk. Physical activity helps you
control your weight, uses up glucose as energy, and makes your cells more
sensitive to insulin.
- Family
history. You are risk increases if a parent or sibling has type 2 diabetes.
- Race
or ethnicity. Although
it's unclear why, certain people — including Black, Hispanic, American
Indian, and Asian American people — are at higher risk.
- Age. Your
risk increases as you get older. This may be because you tend to exercise
less, lose muscle mass and gain weight as you age. But type 2 diabetes is
also increasing among children, adolescents, and younger adults.
- Gestational
diabetes. If
you developed gestational diabetes when you were pregnant, your risk of
developing prediabetes and type 2 diabetes increases. If you gave birth to
a baby weighing more than 9 pounds (4 kilograms), you're also at risk of
type 2 diabetes.
- Polycystic
ovary syndrome. For
women, having polycystic ovary syndrome — a common condition characterized
by irregular menstrual periods, excess hair growth, and obesity — increases
the risk of diabetes.
- High
blood pressure. Having
blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an
increased risk of type 2 diabetes.
- Abnormal
cholesterol and triglyceride levels. If you have low levels of high-density
lipoprotein (HDL), or "good," cholesterol, your risk of type 2
diabetes is higher. Triglycerides are another type of fat carried in the
blood. People with high levels of triglycerides have an increased risk of
type 2 diabetes. Your doctor can let you know what your cholesterol and
triglyceride levels are.
Risk factors for gestational diabetes
Pregnant women can develop gestational
diabetes. Some women are at greater risk than others. Risk factors for
gestational diabetes include:
- Age. Women
older than age 25 are at increased risk.
- Family
or personal history. Your risk increases if you have
prediabetes — a precursor to type 2 diabetes — or if a close family
member, such as a parent or sibling, has type 2 diabetes. You're also at
greater risk if you had gestational diabetes during a previous pregnancy,
if you delivered a very large baby or if you had an unexplained
stillbirth.
- Weight. Being
overweight before pregnancy increases your risk.
- Race
or ethnicity. For
reasons that aren't clear, women who are Black, Hispanic, American Indian, or Asian American are more likely to develop gestational diabetes.
Complications
Long-term complications of diabetes
develop gradually. The longer you have diabetes — and the less controlled your
blood sugar — the higher the risk of complications. Eventually, diabetes
complications may be disabling or even life-threatening. Possible complications
include:
- Cardiovascular
disease. Diabetes
dramatically increases the risk of various cardiovascular problems,
including coronary artery disease with chest pain (angina), heart attack,
stroke, and narrowing of arteries (atherosclerosis). If you have diabetes,
you're more likely to have heart disease or stroke.
- Nerve
damage (neuropathy). Excess sugar can injure the walls of the
tiny blood vessels (capillaries) that nourish your nerves, especially in
your legs. This can cause tingling, numbness, burning, or pain that usually
begins at the tips of the toes or fingers and gradually spreads upward.
Left untreated, you could lose all
sense of feeling in the affected limbs. Damage to the nerves related to
digestion can cause problems with nausea, vomiting, diarrhea, or constipation.
For men, it may lead to erectile dysfunction.
- Kidney
damage (nephropathy). The kidneys contain millions of tiny
blood vessel clusters (glomeruli) that filter waste from your blood.
Diabetes can damage this delicate filtering system. Severe damage can lead
to kidney failure or irreversible end-stage kidney disease, which may
require dialysis or a kidney transplant.
- Eye
damage (retinopathy). Diabetes can damage the blood vessels of
the retina (diabetic retinopathy), potentially leading to blindness.
Diabetes also increases the risk of other serious vision conditions, such
as cataracts and glaucoma.
- Foot
damage. Nerve
damage in the feet or poor blood flow to the feet increases the risk of
various foot complications. Left untreated, cuts and blisters can develop
serious infections, which often heal poorly. These infections may
ultimately require toe, foot, or leg amputation.
- Skin
conditions. Diabetes
may leave you more susceptible to skin problems, including bacterial and
fungal infections.
- Hearing
impairment. Hearing
problems are more common in people with diabetes.
- Alzheimer's
disease. Type
2 diabetes may increase the risk of dementia, such as Alzheimer's disease.
The poorer your blood sugar control, the greater the risk appears to be.
Although there are theories as to how these disorders might be connected,
none has yet been proved.
- Depression. Depression
symptoms are common in people with type 1 and type 2 diabetes. Depression
can affect diabetes management.
Complications of gestational diabetes
Most women who have gestational
diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar
levels can cause problems for you and your baby.
Complications in your baby can occur as a result of
gestational diabetes, including:
- Excess
growth. Extra
glucose can cross the placenta, which triggers your baby's pancreas to
make extra insulin. This can cause your baby to grow too large
(macrosomia). Very large babies are more likely to require a C-section
birth.
- Low
blood sugar. Sometimes
babies of mothers with gestational diabetes develop low blood sugar
(hypoglycemia) shortly after birth because their own insulin production is
high. Prompt feedings and sometimes an intravenous glucose solution can
return the baby's blood sugar level to normal.
- Type 2
diabetes later in life. Babies of mothers who have gestational
diabetes have a higher risk of developing obesity and type 2 diabetes
later in life.
- Death. Untreated
gestational diabetes can result in a baby's death either before or shortly
after birth.
Complications in the mother also can occur as a result of
gestational diabetes, including:
- Preeclampsia. This
condition is characterized by high blood pressure, excess protein in the
urine, and swelling in the legs and feet. Preeclampsia can lead to serious
or even life-threatening complications for both mother and baby.
- Subsequent
gestational diabetes. Once you've had gestational diabetes in
one pregnancy, you're more likely to have it again with the next
pregnancy. You're also more likely to develop diabetes — typically type 2
diabetes — as you get older.
Complications of prediabetes
Prediabetes may develop into type 2
diabetes.
Prevention
Type 1 diabetes can't be prevented.
However, the same healthy lifestyle choices that help treat prediabetes, type 2
diabetes and gestational diabetes can also help prevent them:
- Eat
healthy foods. Choose
foods lower in fat and calories and higher in fiber. Focus on fruits,
vegetables, and whole grains. Strive for variety to prevent boredom.
- Get
more physical activity. Aim for about 30 minutes of moderate
aerobic activity on most days of the week, or at least 150 minutes of
moderate aerobic activity a week.
- Lose
excess pounds. If
you're overweight, losing even 7% of your body weight — for example, 14
pounds (6.4 kilograms) if you weigh 200 pounds (90.7 kilograms) — can
reduce the risk of diabetes.
Don't try to lose weight during
pregnancy, however. Talk to your doctor about how much weight is healthy for
you to gain during pregnancy.
To keep your weight in a healthy range,
focus on permanent changes to your eating and exercise habits. Motivate
yourself by remembering the benefits of losing weight, such as a healthier
heart, more energy, and improved self-esteem.
Sometimes medication is an option as
well. Oral diabetes drugs such as metformin (Glumetza, Fortamet, others) may
reduce the risk of type 2 diabetes — but healthy lifestyle choices remain
essential. Have your blood sugar checked at least once a year to check that you
haven't developed type 2 diabetes.
Diagnosis
Symptoms of type 1 diabetes often
appear suddenly and are often the reason for checking blood sugar levels.
Because symptoms of other types of diabetes and prediabetes come on more
gradually or may not be evident, the American Diabetes Association (ADA) has
recommended screening guidelines. The ADA recommends that the
following people be screened for diabetes:
- Anyone
with a body mass index higher than 25 (23 for Asian Americans), regardless
of age, who
has additional risk factors, such as high blood pressure, abnormal cholesterol
levels, a sedentary lifestyle, a history of polycystic ovary syndrome, or
heart disease, and who has a close relative with diabetes.
- Anyone
older than age 45 is advised to receive an initial blood
sugar screening, and then, if the results are normal, to be screened every
three years thereafter.
- Women
who have had gestational diabetes are advised to be screened for diabetes
every three years.
- Anyone
who has been diagnosed with prediabetes is advised to be tested every year.
Tests for type 1 and type 2 diabetes
and prediabetes
- Glycated
hemoglobin (A1C) test. This blood test, which doesn't require
fasting, indicates your average blood sugar level for the past two to
three months. It measures the percentage of blood sugar attached to
hemoglobin, the oxygen-carrying protein in red blood cells.
The higher your blood sugar levels, the
more hemoglobin you'll have with sugar attached. An A1C level of 6.5% or higher
on two separate tests indicates that you have diabetes. An A1C between 5.7 and
6.4 % indicates prediabetes. Below 5.7 is considered normal.
If the A1C test results aren't
consistent, the test isn't available, or you have certain conditions that can
make the A1C test inaccurate — such as if you are pregnant or have an uncommon
form of hemoglobin (known as a hemoglobin variant) — your doctor may use the
following tests to diagnose diabetes:
- Random
blood sugar test. A blood sample will be taken at a random
time. Regardless of when you last ate, a blood sugar level of 200
milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or
higher suggests diabetes.
- Fasting
blood sugar test. A blood sample will be taken after an
overnight fast. A fasting blood sugar level of less than 100 mg/dL (5.6
mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6
to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or
higher on two separate tests, you have diabetes.
- Oral
glucose tolerance test. For this test, you fast overnight, and
the fasting blood sugar level is measured. Then you drink a sugary liquid,
and blood sugar levels are tested periodically for the next two hours.
A blood sugar level less than 140 mg/dL
(7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after
two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L
and 11.0 mmol/L) indicates prediabetes.
If type 1 diabetes is suspected, your
urine will be tested to look for the presence of a byproduct produced when
muscle and fat tissue are used for energy because the body doesn't have enough
insulin to use the available glucose (ketones). Your doctor will also likely
run a test to see if you have the destructive immune system cells associated
with type 1 diabetes called autoantibodies.
Tests for gestational diabetes
Your doctor will likely evaluate your
risk factors for gestational diabetes early in your pregnancy:
- If
you're at high risk of gestational diabetes — for
example, if you were obese at the start of your pregnancy; you had
gestational diabetes during a previous pregnancy; or you have a mother,
father, sibling, or child with diabetes — your doctor may test for diabetes
at your first prenatal visit.
- If
you're at average risk of gestational diabetes, you'll
likely have a screening test for gestational diabetes sometime during your
second trimester — typically between 24 and 28 weeks of pregnancy.
Your doctor may use the following
screening tests:
- Initial
glucose challenge test. You'll begin the glucose challenge test
by drinking a syrupy glucose solution. One hour later, you'll have a blood
test to measure your blood sugar level. A blood sugar level below 140
mg/dL (7.8 mmol/L) is usually considered normal on a glucose challenge
test, although this may vary at specific clinics or labs.
If your blood sugar level is higher
than normal, it only means you have a higher risk of gestational diabetes. Your
doctor will order a follow-up test to determine if you have gestational
diabetes.
- Follow-up
glucose tolerance testing. For the follow-up test, you'll be asked
to fast overnight and then have your fasting blood sugar level measured.
Then you'll drink another sweet solution — this one containing a higher
concentration of glucose — and your blood sugar level will be checked
every hour for a period of three hours.
If at least two of the blood sugar
readings are higher than the normal values established for each of the three
hours of the test, you'll be diagnosed with gestational diabetes.
Treatment
Depending on what type of diabetes you
have, blood sugar monitoring, insulin, and oral medications may play a role in
your treatment. Eating a healthy diet, maintaining a healthy weight, and
participating in regular activity also are important factors in managing
diabetes.
Treatments for all types of diabetes
An important part of managing diabetes
— as well as your overall health — is maintaining a healthy weight through a
healthy diet and exercise plan:
- Healthy
eating. Contrary
to popular perception, there's no specific diabetes diet. You'll need to
center your diet on more fruits, vegetables, lean proteins, and whole
grains — foods that are high in nutrition and fiber and low in fat and
calories — and cut down on saturated fats, refined carbohydrates, and
sweets. In fact, it's the best eating plan for the entire family. Sugary
foods are OK once in a while, as long as they're counted as part of your
meal plan.
Yet, understanding what and how much to
eat can be a challenge. A registered dietitian can help you create a meal plan
that fits your health goals, food preferences, and lifestyle. This will likely
include carbohydrate counting, especially if you have type 1 diabetes or use
insulin as part of your treatment.
- Physical
activity. Everyone
needs regular aerobic exercise, and people who have diabetes are no
exception. Exercise lowers your blood sugar level by moving sugar into
your cells, where it's used for energy. Exercise also increases your
sensitivity to insulin, which means your body needs less insulin to
transport sugar to your cells.
Get your doctor's OK to exercise. Then
choose activities you enjoy, such as walking, swimming or biking. What's most
important is making physical activity part of your daily routine.
Aim for at least 30 minutes or more of
aerobic exercise most days of the week, or at least 150 minutes of moderate
physical activity a week. Bouts of activity can be as brief as 10 minutes,
three times a day. If you haven't been active for a while, start slowly and
build up gradually. It's also a good idea to avoid sitting for too long — aim
to get up and move if you've been sitting for more than 30 minutes.
Treatments for type 1 and type 2
diabetes
Treatment for type 1 diabetes involves
insulin injections or the use of an insulin pump, frequent blood sugar checks,
and carbohydrate counting. Treatment of type 2 diabetes primarily involves
lifestyle changes, monitoring of your blood sugar, diabetes
medications, insulin, or both.
- Monitoring
your blood sugar. Depending on your treatment plan, you
may check and record your blood sugar as many as four times a day or more
often if you're taking insulin. Careful monitoring is the only way to make
sure that your blood sugar level remains within your target range. People
with type 2 diabetes who aren't taking insulin generally check their blood
sugar much less frequently.
People who receive insulin therapy also
may choose to monitor their blood sugar levels with a continuous glucose
monitor. Although this technology hasn't yet completely replaced the glucose
meter, it can significantly reduce the number of fingersticks necessary to
check blood sugar and provide important information about trends in blood sugar
levels.
Even with careful management, blood
sugar levels can sometimes change unpredictably. With help from your diabetes
treatment team, you'll learn how your blood sugar level changes in response to
food, physical activity, medications, illness, alcohol, stress — and for women,
fluctuations in hormone levels.
In addition to daily blood sugar
monitoring, your doctor will likely recommend regular A1C testing to measure
your average blood sugar level for the past two to three months.
Compared with repeated daily blood
sugar tests, A1C testing better indicates how well your diabetes treatment plan
is working overall. An elevated A1C level may signal the need for a change in
your oral medication, insulin regimen, or meal plan.
Your target A1C goal may vary depending
on your age and various other factors, such as other medical conditions you may
have. However, for most people with diabetes, the American Diabetes Association
recommends an A1C of below 7%. Ask your doctor what your A1C target is.
- Insulin. People
with type 1 diabetes need insulin therapy to survive. Many people with
type 2 diabetes or gestational diabetes also need insulin therapy.
Many types of insulin are available,
including short-acting (regular insulin), rapid-acting insulin, long-acting
insulin, and intermediate options. Depending on your needs, your doctor may
prescribe a mixture of insulin types to use throughout the day and night.
Insulin can't be taken orally to lower
blood sugar because stomach enzymes interfere with insulin's action. Often
insulin is injected using a fine needle and syringe or an insulin pen — a
device that looks like a large ink pen.
An insulin pump also may be an option.
The pump is a device about the size of a small cellphone worn on the outside of
your body. A tube connects the reservoir of insulin to a catheter that's
inserted under the skin of your abdomen.
A tubeless pump that works wirelessly
is also now available. You program an insulin pump to dispense specific amounts
of insulin. It can be adjusted to deliver more or less insulin depending on
meals, activity level, and blood sugar level.
In September 2016, the Food and Drug
Administration approved the first artificial pancreas for people with type 1
diabetes who are aged 14 and older. A second artificial pancreas was approved in
December 2019. Since then systems have been approved for children older than 2
years old.
An artificial pancreas is also called
closed-loop insulin delivery. The implanted device links a continuous glucose
monitor, which checks blood sugar levels every five minutes, to an insulin
pump. The device automatically delivers the correct amount of insulin when the
monitor indicates it's needed.
There are more artificial pancreas
(closed-loop) systems currently in clinical trials.
- Oral
or other medications. Sometimes other oral or injected
medications are prescribed as well. Some diabetes medications stimulate
your pancreas to produce and release more insulin. Others inhibit the
production and release of glucose from your liver, which means you need
less insulin to transport sugar into your cells.
Still, others block the action of
stomach or intestinal enzymes that break down carbohydrates or make your
tissues more sensitive to insulin. Metformin (Glumetza, Fortamet, others) is
generally the first medication prescribed for type 2 diabetes.
Another class of medication called
SGLT2 inhibitors may be used. They work by preventing the kidneys from
reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine.
- Transplantation. In some
people who have type 1 diabetes, a pancreas transplant may be an option.
Islet transplants are being studied as well. With a successful pancreas
transplant, you would no longer need insulin therapy.
But transplants aren't always
successful — and these procedures pose serious risks. You need a lifetime of
immune-suppressing drugs to prevent organ rejection. These drugs can have
serious side effects, which is why transplants are usually reserved for people
whose diabetes can't be controlled or those who also need a kidney transplant.
- Bariatric
surgery. Although
it is not specifically considered a treatment for type 2 diabetes, people
with type 2 diabetes who are obese and have a body mass index higher than
35 may benefit from this type of surgery. People who've undergone gastric
bypass have seen significant improvements in their blood sugar levels.
However, this procedure's long-term risks and benefits for type 2 diabetes
aren't yet known.
Treatment for gestational diabetes
Controlling your blood sugar level is
essential to keeping your baby healthy and avoiding complications during
delivery. In addition to maintaining a healthy diet and exercising, your
treatment plan may include monitoring your blood sugar and, in some cases,
using insulin or oral medications.
Your doctor also will monitor your
blood sugar level during labor. If your blood sugar rises, your baby may
release high levels of insulin — which can lead to low blood sugar right after
birth.
Treatment for prediabetes
If you have prediabetes, healthy
lifestyle choices can help you bring your blood sugar level back to normal or
at least keep it from rising toward the levels seen in type 2 diabetes.
Maintaining a healthy weight through exercise and healthy eating can help.
Exercising at least 150 minutes a week and losing about 7% of your body weight
may prevent or delay type 2 diabetes.
Sometimes medications — such as
metformin (Glucophage, Glumetza, others) — also are an option if you're at high
risk of diabetes, including when your prediabetes is worsening or if you have
cardiovascular disease, fatty liver disease, or polycystic ovary syndrome.
In other cases, medications to control
cholesterol — statins, in particular — and high blood pressure medications are
needed. Your doctor might prescribe low-dose aspirin therapy to help prevent
cardiovascular disease if you're at high risk. However, healthy lifestyle
choices remain key.
Signs of trouble in any type of
diabetes
Because so many factors can affect your
blood sugar, problems may sometimes arise that require immediate care, such as:
- High
blood sugar (hyperglycemia). Your blood sugar level can rise for many
reasons, including eating too much, being sick, or not taking enough
glucose-lowering medication. Check your blood sugar level as directed by
your doctor, and watch for signs and symptoms of high blood sugar —
frequent urination, increased thirst, dry mouth, blurred vision, fatigue, and nausea. If you have hyperglycemia, you'll need to adjust your meal
plan, medications, or both.
- Increased
ketones in your urine (diabetic ketoacidosis). If your
cells are starved for energy, your body may begin to break down fat. This
produces toxic acids known as ketones. Watch for loss of appetite,
weakness, vomiting, fever, stomach pain, and a sweet, fruity breath.
You can check your urine for excess
ketones with an over-the-counter ketones test kit. If you have excess ketones
in your urine, consult your doctor right away or seek emergency care. This
condition is more common in people with type 1 diabetes.
- Hyperglycemic
hyperosmolar nonketotic syndrome. Signs and symptoms of this
life-threatening condition include a blood sugar reading over 600 mg/dL
(33.3 mmol/L), dry mouth, extreme thirst, fever, drowsiness, confusion,
vision loss, and hallucinations. Hyperosmolar syndrome is caused by
sky-high blood sugar that turns blood thick and syrupy.
It is seen in people with type 2
diabetes, and it's often preceded by an illness. Call your doctor or seek
immediate medical care if you have signs or symptoms of this condition.
- Low
blood sugar (hypoglycemia). If your blood sugar level drops below
your target range, it's known as low blood sugar (hypoglycemia). If you're
taking medication that lowers your blood sugar, including insulin, your
blood sugar level can drop for many reasons, including skipping a meal and
getting more physical activity than normal. Low blood sugar also occurs if
you take too much insulin or an excess of a glucose-lowering medication
that promotes the secretion of insulin by your pancreas.
Check your blood sugar level regularly,
and watch for signs and symptoms of low blood sugar — sweating, shakiness,
weakness, hunger, dizziness, headache, blurred vision, heart palpitations,
irritability, slurred speech, drowsiness, confusion, fainting, and seizures. Low
blood sugar is treated with quickly absorbed carbohydrates, such as fruit juice
or glucose tablets.
Lifestyle and home remedies
Diabetes is a serious disease.
Following your diabetes treatment plan takes a round-the-clock commitment.
Careful management of diabetes can reduce your risk of serious — even
life-threatening — complications.
- Make a
commitment to managing your diabetes. Learn all you can about diabetes.
Establish a relationship with a diabetes educator, and ask your diabetes
treatment team for help when you need it.
- Choose
healthy foods and maintain a healthy weight. If
you're overweight, losing just 5% of your body weight can make a
difference in your blood sugar control if you have prediabetes or type 2
diabetes. A healthy diet is one with plenty of fruits, vegetables, lean
proteins, whole grains, and legumes, with a limited amount of saturated
fat.
- Make
physical activity part of your daily routine. Regular
exercise can help prevent prediabetes and type 2 diabetes, and it can help
those who already have diabetes to maintain better blood sugar control. A
minimum of 30 minutes of moderate exercises — such as brisk walking — most
days of the week is recommended. Aim for at least 150 minutes of moderate
aerobic activity a week.
It's also a good idea to spend less
time sitting still. Try to get up and move around for a few minutes at least
every 30 minutes or so when you're awake.
Lifestyle for type 1 and type 2
diabetes
In addition, if you have type 1 or type
2 diabetes:
- Identify
yourself. Wear
a tag or bracelet that says you have diabetes. Keep a glucagon kit nearby
in case of a low blood sugar emergency — and make sure your friends and
loved ones know how to use it.
- Schedule
a yearly physical and regular eye exam. Your regular diabetes checkups aren't
meant to replace yearly physicals or routine eye exams. During the
physical, your doctor will look for any diabetes-related complications and
screen for other medical problems. Your eye care specialist will check for
signs of retinal damage, cataracts, and glaucoma.
- Keep
your vaccinations up to date. High blood sugar can weaken your immune
system. Get a flu shot every year, and your doctor may recommend the
pneumonia vaccine, as well. The Centers for Disease Control and Prevention
(CDC) also currently recommends hepatitis B vaccination if you haven't
previously been vaccinated against hepatitis B and you're an adult aged 19
to 59 with type 1 or type 2 diabetes.
The most recent CDC guidelines advise
vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes.
If you are age 60 or older, have diabetes, and haven't previously received the
vaccine, talk to your doctor about whether it's right for you.
- Pay
attention to your feet. Wash your feet daily in lukewarm water.
Dry them gently, especially between the toes. Moisturize with lotion, but
not between the toes. Check your feet every day for blisters, cuts, sores,
redness, or swelling. Consult your doctor if you have a sore or other foot
problem that doesn't heal promptly on its own.
- Keep
your blood pressure and cholesterol under control. Eating
healthy foods and exercising regularly can go a long way toward
controlling high blood pressure and cholesterol. Medication may be needed,
too.
- Take
care of your teeth. Diabetes may leave you prone to
more-serious gum infections. Brush and floss your teeth at least twice a
day. And if you have type 1 or type 2 diabetes, schedule regular dental
exams. Consult your dentist right away if your gums bleed or look red or
swollen.
- If you
smoke or use other types of tobacco, ask your doctor to help you quit. Smoking
increases your risk of various diabetes complications. Smokers who have
diabetes are more likely to die of cardiovascular disease than nonsmokers who have diabetes, according to the American Diabetes
Association. Talk to your doctor about ways to stop smoking or to stop
using other types of tobacco.
- If you
drink alcohol, do so responsibly. Alcohol can cause either high or low
blood sugar, depending on how much you drink and if you eat at the same
time. If you choose to drink, do so only in moderation — one drink a day
for women and two drinks a day for men — and always with food.
Remember to include the carbohydrates
from any alcohol you drink in your daily carbohydrate count. And check your
blood sugar levels before going to bed.
- Take
stress seriously. The hormones your body may produce in
response to prolonged stress may prevent insulin from working properly,
which will raise your blood sugar and stress you even more. Set limits for
yourself and prioritize your tasks. Learn relaxation techniques. And get
plenty of sleep.
Alternative medicine
Numerous substances have been shown to
improve insulin sensitivity in some studies, while other studies fail to find
any benefit for blood sugar control or in lowering A1C levels. Because of the
conflicting findings, there aren't any alternative therapies that are currently
recommended to help everyone with blood sugar management.
If you decide to try any type of
alternative therapy, don't stop taking the medications that your doctor has
prescribed. Be sure to discuss the use of any of these therapies with your
doctor to make sure that they won't cause adverse reactions or interact with
your current therapy.
Additionally, there are no treatments —
alternative or conventional — that can cure diabetes, so it's critical that
people who are receiving insulin therapy for diabetes don't stop using insulin
unless directed to do so by their physicians.
de-->
Post a Comment