An Overview of Diabetes - Continued

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Complications of Diabetes

Left untreated, diabetes can cause severe complications including heart disease, stroke, blindness, cataracts (Read about "Cataracts"), kidney disease and nerve damage that could lead to amputation.

• Diabetic neuropathy - This is the name given to the nerve damage caused by diabetes. NIDDK says symptoms of neuropathy include numbness and sometimes pain in the hands, feet or legs. Nerve damage can also cause problems with internal organs. (See Diabetic gastroparesis below) The symptoms of neuropathy depend on which nerves and what part of the body is affected. They can include numbness or insensitivity to pain or temperature; tingling, burning, or prickling; sharp pains or cramps; sensitivity to touch; loss of balance and coordination. Symptoms can get worse at night. In addition, neuropathy may be diffuse, affecting many parts of the body, or focal, affecting a single, specific nerve or part of the body. Peripheral neuropathy affects the feet and hands and autonomic neuropathy affects the internal organs.
  Treatment for neuropathy can include medications to treat the specific symptoms. In addition, careful monitoring of the feet, as well as control of blood glucose levels is essential. (Read about neuropathy in "Brain/Mental Health/Nervous System")
• Heart disease and stroke - The American Heart Association (AHA) says diabetes is also a major risk factor for stroke, coronary heart disease and heart attack. (Read about "Coronary Heart Disease" "Stroke") According to AHA, two-thirds of people with diabetes mellitus die of some form of heart or blood vessel disease, and adults with diabetes are two to four times more likely to have heart disease or suffer a stroke than adults without diabetes. Patients who have suffered from diabetes since childhood, especially if it has been poorly controlled, are at significant risk of developing one of these life threatening problems as early as their 20's or 30's.
  AHA says insulin resistance, a condition where the body cannot use the insulin it produces effectively and a key component of Type 2 diabetes, is associated with blood lipid imbalances. That can include things like an increased ratio of small low-density lipoprotein (LDL or so-called bad cholesterol), low levels of high-density lipoprotein (HDL or so-called good cholesterol), and increased levels of triglycerides, all of which are linked to higher risk of heart disease. (Read about "Cholesterol")
  AHA adds that people with diabetes may avoid or delay heart and blood vessel disease by controlling both their diabetes as well as the risk factors associated with heart disease. However, studies show many people with diabetes are unaware of their increased risk of heart disease and the importance of taking steps to reduce their risk by careful monitoring of blood sugar levels combined with weight loss, blood pressure and cholesterol control, and not smoking. (Read about "Hypertension: High Blood Pressure" "Quit Smoking")
• Diabetic retinopathy - Diabetic retinopathy is a potentially blinding complication of diabetes in which the eye's retina is damaged. ADA says it is more likely to develop the longer someone has had diabetes. Diabetic retinopathy occurs when diabetes damages the tiny blood vessels in the retina. At first, there may not be any changes in vision. Without treatment, eyesight progressively deteriorates. However, with treatment, the National Eye Institute says 90 percent of those with advanced diabetic retinopathy can be saved from going blind. The condition is usually treated with either surgery or laser surgery. It can be detected through regular eye exams. (Read about "Eye Exams")
• Kidney disease - Diabetes is the number one cause of chronic kidney failure, which is also called end stage renal disease (ESRD). Diabetes results in 35 percent of new ESRD cases each year. (Read about "Diabetes and Kidney Disease" "Kidney Disease" "Blood Pressure and Kidney Disease")
• Diabetic ketoacidosis - In this potential complication, impurities can build up rapidly in the body and cause a medical emergency. The impurities are the by-products of fat metabolism, called ketones. When ketones build-up, blood glucose levels rise. This can result in low blood pressure, rapid heart rate, and other symptoms. Diabetic ketoacidosis, as the condition is called, is treated with insulin and fluid replacement. In most, cases patients are admitted to the hospital, often to the intensive care unit.
• Diabetic gastroparesis - Diabetes can also affect the nerves that are part of the stomach. It can result in delayed emptying, abdominal distension and bloating and chronic pain. (Read more about gastroparesis in "Digestive Diseases & Conditions")

See also Monitoring and Treating, Types, Screenings, Symptoms, or Complications of Diabetes

Screening for Diabetes

During a screening, medical personnel will test to see if your blood glucose level is elevated. The fasting plasma glucose test is the preferred test for diagnosing type 1 or type 2 diabetes, according to NIDDK. It is most reliable when done in the morning. You may want to discuss the best time to take the test with your doctor. NIDDK says a diagnosis of diabetes can be made after positive results on any one of three tests, with confirmation from a second positive test on a different day:

• A random (taken any time of day) plasma glucose value of 200 mg/dL or more, along with the presence of diabetes symptoms.
• A plasma glucose value of 126 mg/dL or more after a person has fasted for 8 hours.
• An oral glucose tolerance test (OGTT) plasma glucose value of 200 mg/dL or more in a blood sample taken 2 hours after a person has consumed a drink containing 75 grams of glucose dissolved in water. This test, taken in a laboratory or the doctor's office, measures plasma glucose at timed intervals over a 3-hour period.

Gestational diabetes is diagnosed based on plasma glucose values measured during the OGTT, according to NIDDK. Glucose levels are normally lower during pregnancy, so the levels for diagnosis of diabetes in pregnancy are lower. If a woman has two plasma glucose values meeting or exceeding any of the following numbers, she is considered to have gestational diabetes:

• a fasting plasma glucose level of 95 mg/dL
• 1-hour level of 180 mg/dL
• a 2-hour level of 155 mg/dL
• a 3-hour level of 140 mg/dL

These tests measure whether or not your blood glucose level is higher than what's considered normal. If it's high and the cause is Type 2 diabetes, you may be able to restore your blood glucose level to a normal level through diet and exercise. Your doctor may also prescribe medication or insulin. As with any medication, talk with your doctor about possible side effects or interactions, especially if you're also on medication for high blood pressure. See also Monitoring and Treating, Types, Screenings, Symptoms, or Complications of Diabetes

Monitoring and Treating Diabetes

It's essential that someone with diabetes follow a healthy diet. (Read about "Dietary Guidelines") You should work with your doctor, registered dietician or healthcare provider to develop a meal plan. This is a guide that tells you how much and what kinds of food you can choose to eat at meals and snack times. By reading food labels (Read about "Food Labels"), buying healthy foods and following your food plan, you can help keep your diet on track.

It's also imperative for anyone with diabetes to monitor their blood sugar level carefully. Most methods of monitoring blood glucose require a blood sample, usually obtained by using an automatic lancing device on a finger. Some meters use a blood sample from a less sensitive area, such as the upper arm, forearm or thigh; though uncommon NIDDK says some devices use a beam of light instead of a lancet to pierce the skin. The drop of blood is then placed on the end of a specially coated strip, called a testing strip. The strip has a chemical on it that makes it change color according to how much glucose is in the blood.

In addition to daily monitoring of blood sugar, other tests can be used. One is the hemoglobin A1c test. According to the National Diabetes Education Program (NDEP), this test shows the average amount of sugar in your blood over the last 2-3 months. It is a simple lab test done by your health care provider. NDEP calls it the best test to find out if your blood sugar is under control and says diabetics should have a hemoglobin A1c test at least twice a year. The American Diabetes Association recommends an A1c target of less than 7 percent for optimal blood sugar control.

For someone with Type 1 diabetes, healthy eating, physical activity and insulin are the basic therapies for controlling their blood sugar levels. Insulin can be delivered via one of three methods - injection, an insulin pump or an inhaler. The amount of insulin must be balanced with food intake and daily activities. Insulin cannot be taken orally because it would be broken down during digestion. It must be injected or inhaled. ADA says, when injected, it must be injected into the fat under your skin for it to get into your blood and keep your blood sugar level as close to normal as possible. Insulin can be injected through a syringe, a pen or through a pump system that feeds the insulin into the body through a needle or catheter inserted just under the skin. There are also different types of insulin. They vary in how soon they start to work, when they reach their full strength, and how long they last in the body. ADA says insulin should never be stored in very hot or very cold locations. When using insulin, blood glucose levels must be closely monitored through frequent blood glucose checking. NIDDK says when blood glucose levels drop too low - a condition known as hypoglycemia - a person can become nervous, shaky and confused. Judgment can be impaired. If blood glucose falls too low, a person can faint. This is considered a medical emergency and emergency personnel should be called.

For someone with Type 2 diabetes, healthy eating, physical activity, and blood glucose testing are the basic management tools. In addition, many people with type 2 diabetes may require insulin or medication.

ADA says there are different classes of diabetes drugs. Some drugs work to help the body make more insulin. Others sensitize the body to the insulin that is already present. Others slow or block the breakdown of starches and some sugars. Still others enhance the body's own ability to lower blood sugar. The drugs may be used alone or in combination. It's important to ask your doctor about any side effects to be aware of, as well as any potential interactions. (Read about "Medicine Safety")

ADA says good control of blood glucose levels, a healthy diet and regular checkups are the keys to preventing diabetes-related eye and kidney problems:

• Patients with diabetes should see their eye care professional annually for a dilated eye examination, in order to detect a condition called retinopathy early, and possibly prevent blindness. (Read about "Eye Exams")
• They should have regular visits with their healthcare professional, and check-ups for cholesterol, blood pressure, etc.
• They should examine their feet regularly and see a doctor at once if they notice any sores that are not healing. (Read about "Wound Care") This is especially important because a person may have decreased sensation in their feet as a result of peripheral neuropathy. Infections may go undetected, leading potentially to gangrene and even the need for amputation.
• They should maintain a healthy weight, follow their prescribed diet carefully and exercise regularly.

As mentioned above, it is also essential that people with diabetes be aware of their risk of heart disease, stroke, and heart attack, and work to reduce their risk, both by monitoring their diabetes and by controlling their weight and blood cholesterol with a low-saturated-fat, low-cholesterol diet and regular exercise.

Ideally, everyone with diabetes should be monitored frequently by a health care team knowledgeable in the care of diabetes. The best way to reduce the risk of complications of diabetes is by staying educated about it and by mastering the skills necessary to control your blood glucose levels and keep them as close to the normal range as you can.

See also Monitoring and Treating, Types, Screenings, Symptoms, or Complications of Diabetes Related Information:
Blood Donation Guidelines
Pancreatitis
Primary Immunodeficiency
Coronary Heart Disease
Digestive Diseases and Conditions
Medicine Safety
Deep Vein Thrombosis
Losing Weight