Dear Friends,

 

Good Morning. This week let us discuss some FAQ's on Diabetes. Have a wonderful week ahead.

 

Rgds

 

Dr Rajesh Parekh

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Frequently Asked Questions about Diabetes

1. What is diabetes?

Diabetes is a chronic disease in which the body cannot make or properly use insulin. Insulin is a hormone that helps control the sugar, or glucose, in your blood. Glucose is the main source of fuel for your body.

When you have diabetes, the levels of blood glucose are too high, causing symptoms such as blurred vision, frequent urination, increased thirst, unintended weight loss, slow healing sores, and feelings of hunger and tiredness.

Diabetes is a serious disease. Over time, diabetes that is not well controlled causes serious damage to the eyes, kidneys, nerves, and heart.

2. How does diabetes develop?

Diabetes is a disease that prevents the body from properly converting foods into the energy needed for daily activity.

When you eat, your body changes most of the food into a form of sugar called glucose. Glucose travels through the blood stream to feed your cells. It is the main source of fuel for your body.

For glucose to get into cells, insulin must be present. Insulin is a hormone made by the pancreas, a large organ behind the stomach.

If your body does not make enough insulin or if the insulin doesn't work the way it should, glucose can't get into your cells. As a result, the amount of glucose in the blood increases, while the cells are starved of energy. The level of glucose in your blood then gets too high, causing diabetes.

3. How many people have diabetes?

About 18.2 million Americans, or 6.2 percent of the population, have diabetes. Thirteen million people have diagnosed diabetes, while an estimated 5.2 million people are undiagnosed. More than 8 million people 60 years or older have diabetes. This figure represents 18.3 percent of that age group.

4. What is the difference between type 1 and type 2 diabetes?

Type 1 diabetes usually arises in children, teenagers, or young adults. In this form of diabetes, the cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them.

Type 2 diabetes is the most common form of diabetes and the most common in adults over 40. However, people can develop type 2 diabetes at any age, even during childhood.

Type 2 diabetes usually begins with insulin resistance, a condition in which the body does not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to make enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes.

5. Is there a type of diabetes that is associated with pregnancy?

Yes, gestational diabetes. It typically occurs during the later stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had gestational diabetes is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin.

6. What causes diabetes?

At present, scientists do not know exactly what causes the body's immune system to attack the insulin-producing cells in the pancreas in people with type 1 diabetes. However, scientists believe that both genetic factors and environmental factors are involved.

Type 2 diabetes -- the most common form -- is linked to obesity, high blood pressure, and high cholesterol levels. Having any one of these conditions can keep your body from making and using insulin properly, thereby increasing your risk of developing type 2 diabetes.

7. Who is at risk for developing type 2 diabetes?

Being over 45 years of age and overweight or obese are key risk factors for developing type 2 diabetes. Other risk factors include

• having a first degree relative -- a parent, brother, or sister -- with diabetes
• being African American, American Indian, Alaska Native, Asian American, Pacific Islander, or Hispanic American/Latino.

Risk factors include

• having gestational diabetes, or giving birth to a baby weighing more than 9 pounds
• having blood pressure of 140/90 or higher, or having been told that you have high blood pressure.

Risk factors include

• having abnormal cholesterol levels, an HDL cholesterol or good cholesterol level of 35 or lower, or a triglyceride level of 250 or higher
• being inactive or exercising fewer than three times a week.

8. Can diabetes be prevented?

Yes, diabetes can be prevented in people who are at an increased risk for developing type 2 diabetes or have a condition called pre-diabetes.

In 2001, the National Institute of Diabetes and Digestive and Kidney Diseases concluded a clinical trial called the Diabetes Prevention Program. A clinical trial is a research study on people to learn if a new drug or treatment is both safe and effective.

This clinical trial found that type 2 diabetes can be prevented or delayed if you lose a small amount of weight by doing moderate physical activity. The study found that people with pre-diabetes can cut their risk of developing type 2 diabetes by more than half.

9. What is pre-diabetes?

Pre-diabetes is a condition where blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke.

If you have pre-diabetes, you can reduce your risk of getting diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes and even return to normal glucose levels.

10. Why does being overweight or obese put me at risk for developing diabetes?

Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. It can also cause high blood pressure. Overweight people are twice as likely to develop type 2 diabetes as people who are not overweight. You can reduce your risk of developing this type of diabetes by losing weight and by increasing your physical activity.

11. What steps can I take to lose weight to prevent type 2 diabetes?

If you are overweight or obese, choose sensible ways to get in shape

• Avoid crash diets. Instead, eat less of the foods you usually have. Limit the amount of fat you eat.
• Increase your physical activity. Aim for at least 30 minutes of exercise most days of the week.

• Set a reasonable weight-loss goal, such as losing 1 pound a week. Aim for a long-term goal of losing 5 to 7 percent of your total body weight.

12. Are diet and exercise beneficial even after diabetes develops?

Research has clearly shown that diet and exercise help people with type 2 diabetes control their blood glucose, blood pressure, and cholesterol in the short term. Although diet and exercise should lower the risk of developing heart disease and stroke and the other complications of diabetes, no long-term clinical trials have looked at this question.

A recently launched trial, the Look AHEAD study, will examine how diet and exercise affect heart attack, stroke, and cardiovascular-related death in overweight people with type 2 diabetes.

13. Can lifestyle changes help older people avoid diabetes?

The results of the Diabetes Prevention Program conducted by the National Institute on Diabetes, Digestive and Kidney Diseases showed that lifestyle changes that led to weight loss -- such as eating healthier and getting more exercise -- were effective in helping to reduce the development of diabetes in all age groups tested.

Lifestyle changes were especially effective in people aged 60 and older, reducing the development of diabetes by 71 percent. This is an important discovery because as many as 20 percent of people aged 60 and older develop diabetes.

14. What are the signs and symptoms of diabetes?

Many people have no signs or symptoms of diabetes. Symptoms can also be so mild that you might not notice them. Here is what to look for:

• increased thirst
• increased hunger
• fatigue

Symptoms of diabetes:

• increased urination, especially at night
• weight loss
• blurred vision
• sores that do not heal

Sometimes people have symptoms but do not suspect diabetes. They delay scheduling a checkup because they do not feel sick. Many people do not learn they have the disease until they have diabetes complications, such as blurry vision or heart trouble. Finding out early if you have diabetes is important because treatment can prevent damage to the body from diabetes.

15. How do doctors diagnose diabetes and pre-diabetes?

Doctors use the following tests to diagnose diabetes.

• A fasting plasma glucose, or FPG test measures your blood glucose after you have gone at least 8 hours without eating. Doctors use this test to detect diabetes or pre-diabetes.

• An oral glucose tolerance test, or OGTT measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a glucose-containing beverage. Doctors can use this test to diagnose diabetes or pre-diabetes.

• In a random plasma glucose test, the doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.

If any of these tests show that you might have diabetes, your doctor will need to repeat the fasting plasma glucose test or the oral glucose tolerance test on a different day to confirm the diagnosis.

16. When should I be tested for diabetes?

Anyone 45 years old or older should consider getting tested for diabetes. If you are 45 or older and you are overweight, it is strongly recommended that you get tested. If you are younger than 45, you should consider testing if you are overweight and have one or more of the other risk factors for diabetes.

Ask your doctor for a fasting plasma glucose, or FPG test or an oral glucose tolerance, or OGTT test. Your doctor will tell you if you have normal blood glucose, pre-diabetes, or diabetes. If your blood glucose is higher than normal but lower than the diabetes range, you have a condition called pre-diabetes. Have your blood glucose checked again in 1 to 2 years.

17. How do I take care of my diabetes every day?

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high.

People with diabetes should do four things every day to lower high blood glucose.

• Follow your meal plan.
• Get regular exercise.
• Take your diabetes medicine.
• Check your blood glucose.

Experts say most people with diabetes should try to keep their blood glucose level as close as possible to the level of someone who doesn't have diabetes. The closer to normal your blood glucose is, the lower your chances are of developing damage to your eyes, kidneys, and nerves.

Check with your doctor about the right range for you. Your health care team will help you learn how to reach your target blood glucose range. Your main health care providers are your doctor, nurse, diabetes educator, and dietitian.

A diabetes educator is a health care worker who teaches people how to manage their diabetes. Your educator may be a nurse, a dietitian, or another kind of health care worker. A dietitian is someone who's specially trained to help people plan their meals.

18. What kind of meal plan should a person with diabetes follow?

Healthy eating is very important to lowering blood glucose levels, and people with diabetes should have their own meal plan. Ask your doctor to give you the name of a dietitian who can work with you to develop a meal plan.

In designing a meal plan, the dietitian considers the person's weight and daily physical activity. For overweight people, a weight loss plan is a must for proper blood glucose control.

Your dietitian can help you plan meals to include foods that you and your family like to eat and that are good for you, too. Ask your dietitian to include foods that are heart healthy to reduce your risk of heart disease.

People with diabetes don't need to eat special foods. You can eat foods that are low in fat, salt, and sugar and high in fiber, such as beans, fruits, vegetables, and grains. Eating right will help you reach and stay at a weight that's good for your body, keep your blood glucose in a desirable range, and prevent heart and blood vessel disease.

19. If I have diabetes, should I avoid all sweets and sugars?

If you have diabetes you should limit the amount of fats and sweets you eat. These foods have calories, but not much nutrition. Some contain saturated fats and cholesterol that increase your risk of heart disease. Limiting these foods will help you lose weight and keep your blood glucose and blood fats under control.

It is okay to have sweets once in a while. Try having sugar-free popsicles, diet soda, fat-free ice cream or frozen yogurt, or sugar-free hot cocoa mix to satisfy a "sweet tooth."

Remember, fat-free and low sugar foods still have calories. Talk with your diabetes educator about how to fit sweets into your meal plan.

20. How important is exercise in controlling diabetes?

Exercise is very important for people with diabetes. Taking part in a regular fitness program has been shown to improve blood glucose levels in older people whose levels are high.

Exercise is especially good for people with diabetes because

• exercise helps keep weight down
• exercise helps insulin work better to lower blood glucose
• exercise is good for your heart and lungs
• exercise gives you more energy.

Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some exercises may not be safe. Your health care team can help you find safe exercises.

Walking, swimming, dancing, riding a bicycle, playing baseball, and bowling are all good ways to exercise. You can even get exercise when you clean house or work in your garden.

Try to exercise almost every day for a total of about 30 minutes. If you haven't exercised lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day.

21. What kinds of medication do people take for diabetes?

Strict control of blood glucose is the best defense against the serious complications of diabetes. Insulin and diabetes pills are the two kinds of medicines used to lower blood glucose.

You need insulin if your body has stopped making insulin or if it doesn't make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do, too. If your body makes insulin but the insulin doesn't lower your blood glucose, you may need diabetes pills.

22. How are insulin and diabetes pills taken?

Insulin can't be taken as a pill. You will give yourself shots every day or use an insulin pump. Insulin pumps are small machines that connect to narrow tubing, ending with a needle just under the skin near the abdomen. Insulin is delivered through the needle.

Some diabetes pills are taken once a day, and others are taken more often. Ask your health care team when you should take your pills.

Be sure to tell your doctor if your pills make you feel sick or if you have any other problems. Remember, diabetes pills don't lower blood glucose all by themselves. You will still want to follow a meal plan and exercise to help lower your blood glucose.

Sometimes, people who take diabetes pills may need insulin shots for a while. If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose.

Many people with type 2 diabetes do not need insulin or diabetes pills. They can take care of their diabetes by using a meal plan and exercising regularly.

23. What is an A1C test and why is it important in managing diabetes?

The A1C test, which used to be called hemoglobin A-1-C or H-b-A-1-C, is a simple lab test that measures your average blood glucose level over the last 3 months. Your health care provider takes a small blood sample to test your A1C.

The A1C is the best test for you and your health care team to know how well your treatment plan is working over time. The test shows if your blood glucose numbers have been close to normal or too high. The higher the amount of glucose in your blood, the higher your A1C result will be, increasing your chances for serious health problems.

You and your health care team should discuss the A1C goal that is right for you. For most people with diabetes, the A1C goal is less than 7. If your A1C number is less than 7, your care plan is probably working and your blood glucose is under good control. An A1C number higher than 8 means that you have a greater chance of eye disease, kidney disease, or nerve damage.

Lowering your A1C number -- by any amount -- can improve your chances of staying healthy. You should ask your health care provider for an A1C test at least twice a year.