Diabetes Mellitus Symptoms

(Signs of Diabetes)
Diabetes News: Finding the Causes of Diabetes, Medicinal Herbs Used in China Are
Shown to Lower Glucose Levels. Please also read Yu Xiao San 8805 on Type I and
Type II Diabetes and Hypoglycemic Effects of Selected Ingredients
It's not unusual to have diabetes mellitus and yet have no symptoms. Type 2 diab
etes, in particular, develops slowly. Many people have type 2 diabetes for as lo
ng as eight years before it's diagnosed. When symptoms do develop, they often va
ry. But two symptoms that occur in many people with the disease are increased th
irst and frequent urination.
That's because excess glucose circulating in your body draws water from your tis
sues, making you feel dehydrated. To quench your thirst, you drink a lot of wate
r and other beverages, and that leads to more frequent urination.
Another condition, diabetes insipidus, also causes increased thirst and urinatio
n, but despite the similar name and symptoms, it's not related to diabetes melli
tus. Diabetes insipidus isn't caused by a problem with blood sugar, but rather b
y a hormone disorder originating in the pituitary gland in your brain that makes
your kidneys unable to conserve water.
Other warning signs of diabetes mellitus include:
Flu-like symptoms. Diabetes can sometimes feel like a viral illness, with fatigu
e, weakness and loss of appetite. Sugar is your body's main fuel, and when it do
esn't reach your cells you may feel tired and weak.

Weight gain or loss. Because your body is trying to compensate for lost fluids a
nd sugar, you may eat more than usual and gain weight. But the opposite also can
occur. You may eat more than normal, but still lose weight because your muscle
tissues don't get enough glucose to generate growth and energy. This is especial
ly true if you have type 1 diabetes, in which very little sugar gets into your c
ells. In fact, most people with type 1 diabetes are at or below their normal wei
ght.

Blurred vision. High levels of blood sugar pull fluid out of the tissues in your
body ? including the lenses of your eyes. This affects your ability to focus. O
nce your diabetes is treated and your blood sugar levels drop, your vision shoul
d improve. Over a period of years, however, diabetes can also cause new blood ve
ssels to form in your retina ? the back part of your eye ? as well as damage old
vessels. For most people this causes only mild vision problems. But for others,
the effects may be much more serious. In some cases, diabetes can lead to blind
ness.

Slow-healing sores or frequent infections. Diabetes affects your body's ability

to heal and fight infection. Bladder and vaginal infections can be a particular
problem for women.

Nerve damage (neuropathy). Excess sugar in your blood can damage the small blood
vessels to your nerves, leading to a number of symptoms. The most common are ti
ngling and loss of sensation in your hands and especially your feet. You may als
o experience burning pain in your legs, feet, arms and hands. In addition, more
than half the men age 50 and older with diabetes may experience some degree of s
exual dysfunction from damage to the nerves that help produce an erection.
Red, swollen, tender gums. Diabetes increases the risk of infection in your gums
and in the bones that hold your teeth in place. As a result, your gums may pull
away from your teeth, your teeth may become loose, or you may develop sores or
pockets of pus in your gums. This is especially true if you have a gum infection
before the onset of diabetes.
(From Mayo Clinic)

Diabetes Facts
What is diabetes?
Diabetes is a disease in which the body either fails to produce any insulin (typ
e 1, also called insulin-dependent or juvenile-onset), or the insulin that it do
es produce is unable to adequately trigger the conversion of food into energy (t
ype 2, also called non-insulin-dependent or adult-onset).
Who has diabetes?
Federal statistics estimate that 18.2 million children and adults in the United
States ? 6.3 percent of the population ? have diabetes. While an estimated 13 mi
llion of these have been diagnosed with diabetes, 5.2 million are estimated to h
ave type 2 diabetes and not know it. Most people with diabetes have type 2; an e
stimated 800,000 have type 1. About 1 million people age 20 or older will be d
iagnosed with diabetes this year. Diabetes is more prevalent among Native Americ
ans, African Americans, Hispanic Americans and Asian Americans/Pacific Islanders
. An estimated 20 million people in the U.S have pre-diabetes, a condition that
occurs when one has higher than normal blood glucose levels, but not high enough
to be diagnosed as having type 2 diabetes. (Research shows that if action is
taken to control glucose levels, those with pre-diabetes can prevent or delay th
e onset of diabetes.)
What are the symptoms of diabetes?
Excessive thirst
Frequent urination
Weight loss
Blurred vision
Increased hunger
Frequent skin, bladder or gum infections
Irritability
Tingling or numbness in hands or feet
Slow to heal wounds
Extreme unexplained fatigue
Sometimes there are no symptoms (type 2 diabetes)Who is at greatest risk for dev
eloping diabetes?
People who:
are 45 or over
are overweight
are habitually physically inactive
have previously been identified as having IFG (impaired fasting glucose) or IGT
(impaired glucose tolerance)
have a family history of diabetes
have members of certain ethnic groups (including Asian American, African-America
n, Hispanic American, and Native American)
have had gestational diabetes or have given birth to a child weighing more than
9 pounds
have elevated blood pressure
have an HDL cholesterol level (the ?good? cholesterol) of 35 mg/dl or lower and/
or a triglyceride level of 250 mg/dl or higher
have polycystic ovary syndrome
have a history of vascular disease
What are the long-term complications of diabetes?
People with diabetes are two to four more times more likely to develop heart dis
ease or have a stroke than those who don't have diabetes
Diabetes is the leading cause of new blindness among adults between 20 and 74 ye
ars old.
Diabetes is the leading cause of treated end-stage kidney disease in the U.S.
More than 60 percent of the limb amputations in the U.S. occur among people with
diabetes
About 60-70 percent of the people with diabetes have mild to severe nerve damage
Diabetes is the sixth-leading cause of death by disease in the United States. Di
abetes leads to the death of an estimated 213,000 people in the U.S. each year.
Diabetes and its complications cost an estimated $132 billion annually in the Un
ited States alone in terms of healthcare costs and lost productivity

Diabetes Symptoms
Often diabetes goes undiagnosed because many of its symptoms (often misspelled a
s "symtoms") seem so harmless. Recent studies indicate that the early detection
of diabetes symptoms and treatment can decrease the chance of developing the co
mplications of diabetes.
Some diabetes symptoms include:
Frequent urination
Excessive thirst
Extreme hunger
Unusual weight loss
Increased fatigue
Irritability
Blurry vision

Causes of Diabetes
Diabetes mellitus occurs when the pancreas doesn't make enough or any of the hor
mone insulin, or when the insulin produced doesn't work effectively. In diabetes
, this causes the level of glucose in the blood to be too high.
In Type 1 diabetes the cells in the pancreas that make insulin are destroyed, ca
using a severe lack of insulin. This is thought to be the result of the body att
acking and destroying its own cells in the pancreas - known as an autoimmune rea
ction.
It's not clear why this happens, but a number of explanations and possible trigg
ers of this reaction have been proposed. These include:
infection with a specific virus or bacteria;
exposure to food-borne chemical toxins; and
exposure as a very young infant to cow's milk, where an as yet unidentified comp
onent of this triggers the autoimmune reaction in the body.
However, these are only hypotheses and are by no means proven causes.
Type 2 diabetes is believed to develop when:
the receptors on cells in the body that normally respond to the action of insuli
n fail to be stimulated by it - this is known as insulin resistance. In response
to this more insulin may be produced, and this over-production exhausts the ins
ulin-manufacturing cells in the pancreas;
there is simply insufficient insulin available; and
the insulin that is available may be abnormal and therefore doesn't work properl
y.
The following risk factors increase the chances of someone developing Type 2 dia
betes:
Increasing age;
obesity; and
physical inactivity.
Rarer causes of diabetes include:
Certain medicines;
pregnancy (gestational diabetes); and
any illness or disease that damages the pancreas and affects its ability to prod
uce insulin e.g. pancreatitis.
What doesn't cause diabetes
It's important to also be aware of the different myths that over the years have
arisen about the causes of diabetes.
Eating sweets or the wrong kind of food does not cause diabetes. However, it may
cause obesity and this is associated with people developing Type 2 diabetes.
Stress does not cause diabetes, although it may be a trigger for the body turnin
g on itself as in the case of Type 1 diabetes. It does, however, make the sympto
ms worse for those who already have diabetes.
Diabetes is not contagious. Someone with diabetes cannot pass it on to anyone el
se.
(by Dr. Rob Hicks)
Diabetes News: Finding the Causes of Diabetes, Medicinal Herbs Used in China Are
Shown to Lower Glucose Levels. Please also read Yu Xiao San 8805 on Type I and
Type II Diabetes and Hypoglycemic Effects of Selected Ingredients
Causes of Diabetes
Drugs such as steroids, Dilantin, and others may elevate the blood sugar through
a variety of mechanisms. Certain other drugs, such as alloxan, streptozocin, an
d thiazide diuretics, are toxic to the beta cells of the pancreas and can cause
diabetes. Certain syndromes (for example, Prader-Willi, Down's, Progeria, and Tu
rner's) may result in a hyperglycemic state; if this state is prolonged, the res
ult can be permanent diabetes.
Diabetes resulting in an insulin-dependent state is classified as Type 1 diabete
s. While Type 1 diabetes affects only between 5 to10 percent of the diabetic pop
ulation, its effects on the body can be worse than other forms of diabetes. In t
he past, Type 1 has been known as juvenile or juvenile-onset diabetes (because i
t is usually diagnosed in those under thirty), brittle diabetes, unstable diabet
es, and ketosis-prone diabetes. People in this classification more frequently ex
hibit the classic symptoms, usually with ketones present in blood and urine. A b
lood-sugar level of 800 mg/dl (44 mmol) or more, especially if ketones are not p
resent, indicates a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome
(a state in which the body is extremely dry (dehydrated), the chemicals in the b
ody are concentrated, and the blood sugar is high).
As stated before, diabetes is a syndrome or group of diseases (rather than one d
isease), leading to the prolonged hyperglycemic state. Type 1 is most associated
with the killing of the beta cells, most likely by the body's own immune system
. Either the immune system cannot kill an infecting agent, which then kills the
beta cells, or the immune system itself goes "wild," attacking the body's own ti
ssue and destroying the beta cells. The cells of the islets of Langerhans are in
flamed, resulting from an infectious-disease process (for example, mumps) or, mo
re commonly, from an autoimmune (allergic to self) response.
The autoimmune process results in the circulation of antibodies that may either
cause or be caused by beta-cell death. If it is found that the antibodies cause
beta-cell destruction (the body fighting what it now considers foreign to itself
), the body's response to the Type 1 diabetes is much less severe (i.e., easier
to control) with treatment. Until then, the outcome is a lack of available insul
in. While the onset is said to be sudden, changes resulting in decreased insulin
availability may have occurred over a longer period of time. In short, insulin-
dependent diabetes mellitus is an inherited defect of the body's immune system,
resulting in destruction of the insulin-producing beta cells of the pancreas.
Heredity is a major cause of diabetes. If both parents have Type 2 diabetes, the
re is a chance that nearly all of their children will have diabetes. If both par
ents have Type 1 diabetes, fewer than 20 percent of their children will develop
Type 1 diabetes. In identical twins, if one twin develops Type 2 diabetes, the c
hance is nearly 100 percent that the other twin will also develop it. In Type 1
diabetes, however, only 40 to 50 percent of the second twins will develop the di
sease, indicating that while inheritance is important, environmental factors (fo
r example, too much food, too much stress, viral infection, and so forth) are al
so involved in the development of Type 1 diabetes

Type 1 Diabetes Mellitus

Alternative names
Insulin-dependent diabetes mellitus; Juvenile onset diabetes; Diabetes - Type 1
Definition
Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas pr
oduces too little insulin to regulate blood sugar levels appropriately.
Causes, incidence, and risk factors
Diabetes is a life-long disease for which there is not yet a cure. There are sev
eral forms of diabetes, including:
Type 1 diabetes, often called juvenile or insulin-dependent diabetes
Type 2 diabetes, often called adult or non-insulin-dependent diabetes
Gestational diabetes, which occurs during pregnancy.
For all types of diabetes, the metabolism of carbohydrates (including sugars suc
h as glucose), proteins, and fats is altered.
In type 1 diabetes, the beta cells of the pancreas produce little or no insulin,
the hormone that allows glucose to enter body cells. Once glucose enters a cell
, it is used as fuel.
Without adequate insulin, glucose builds up in the bloodstream instead of going
into the cells. The body is unable to use this glucose for energy despite high l
evels in the bloodstream, leading to increased hunger. In addition, the high lev
els of glucose in the blood causes the patient to urinate more, which in turn ca
uses excessive thirst. Within 5 to 10 years after diagnosis, the insulin-produci
ng beta cells of the pancreas are completely destroyed, and no more insulin is p
roduced.
Type 1 diabetes can occur at any age, but it usually starts in people younger th
an 30. Symptoms are usually severe and occur rapidly.
The exact cause of type 1 diabetes is not known. Type 1 diabetes accounts for 3%
of all new cases of diabetes each year. There is 1 new case per every 7,000 chi
ldren per year. New cases are less common among adults older than 20.
Symptoms
increased thirst
increased urination
weight loss despite increased appetite
nausea
vomiting
abdominal pain
fatigue
absence of menstruation
Signs and tests
The following tests can be used to diagnose diabetes:
urinalysis shows glucose and ketone bodies in the urine, but a blood test is req
uired for diagnosis
fasting blood glucose is 126 mg/dL or higher
random (nonfasting) blood glucose exceeds 200 mg/dL (this must be confimed with
a fasting test)
insulin test (low or undetectable level of insulin)
C-peptide test (low or undetectable level of the protein C-peptide, a by-product
of insulin production)
Treatment
At diagnosis, the immediate goals of treatment are to treat diabetic ketoacidosi
s (also called DKA) and high blood glucose levels. Because of the sudden onset a
nd severity of symptoms in type 1 diabetes, treatment for newly diagnosed people
may involve hospitalization.
The long-term goals of treatment are to prolong life, reduce symptoms, and preve
nt diabetes-related complications such as blindness, kidney failure, and amputat
ion of limbs.
These goals are accomplished through education, insulin use, meal planning and w
eight control, exercise, foot care, and careful self-testing of blood glucose le
vels.
INSULIN
Insulin lowers blood sugar by allowing it to leave the blood stream and enter ce
lls. Everyone needs insulin. People with type I diabetes can't make their own in
sulin, and they must take insulin every day.
Insulin is injected under the skin using a syringe, or in some cases, an infusio
n pump delivers the insulin continuously. It is not available in an oral form.
Insulin preparations differ in how fast they start to work and how long they las
t. The health care professional reviews blood glucose levels to determine the ap
propriate type of insulin the person should use. More than one type of insulin m
ay be mixed together in an injection to achieve the best control of blood glucos
e.
The injections are needed, in general, from 1 to 4 times a day. People are taugh
t how to give insulin injections by their health care provider or a diabetes nur
se educator. Initially, a child's injections may be given by a parent or other a
dult. By age 14, most children can be expected (but should not be required) to g
ive their own injections.
DIET
Meal planning for type 1 diabetes requires consistency to allow food and insulin
to work together to regulate blood glucose levels. If meals and insulin are out
of balance, extreme variations in blood glucose can occur.
The American Diabetes Association and the American Dietetic Association has info
rmation for planning healthy, balanced meals. Consultation with a registered die
titian or nutrition counselor is an invaluable tool for meal planning and dietar
y control for diabetics.
PHYSICAL ACTIVITY
Regular exercise is especially important for the person with diabetes, as it hel
ps control the amount of sugar in the blood and helps burn excess calories and f
at to achieve optimal weight.
Before people with diabetes begin any exercise program, they should obtain medic
al approval. Type 1 diabetics must take special precautions before, during and a
fter participation in intense physical activity or exercise.
SELF-TESTING
Blood glucose monitoring is done by checking the glucose content of a small drop
of blood. The testing is done on a regular basis and will inform the person wit
h diabetes how well diet, medication, and exercise are working together to contr
ol diabetes.
The results can be used to adjust meals, activity, or medications to keep blood-
sugar levels within an appropriate range. It will provide valuable information f
or the health care provider to suggest changes to improve care and treatment. Te
sting will identify high and low blood-sugar levels before serious problems deve
lop.
FOOT CARE
People with diabetes are prone to foot problems because of complications related
to the illness. Diabetes causes damage to the blood vessels and nerves, which c
an result in a decreased ability to sense trauma or pressure on the foot. A foot
injury could go unnoticed until severe infection develops.
Additionally, diabetes alters the bodies immune system, decreasing the body's ab
ility to fight infection. Small infections can rapidly progress to death of the
skin and other tissues, necessitating amputation of the affected limb.
To prevent injury to the feet, diabetics should adopt a daily foot care routine.
TREATING LOW BLOOD SUGAR
Low blood sugar, known as hypoglycemia, can occur in diabetics when they use too
much insulin, exercise too much, or have not eaten enough food. Hypoglycemia ca
n develop quickly in people with diabetes. Symptoms of low blood sugar typically
appear when the sugar level falls below 70. Watch for weakness, shaking, sweati
ng, headache, nervousness, and hunger.
If these symptoms occur and you have a blood sugar test kit available, do a bloo
d sugar check. If the level is low, the person with diabetes should eat somethin
g with sugar: fruit juice, several teaspoons of sugar, a cup of skim milk, or re
gular soda. If you don't have a test kit handy, sugar should be eaten anyway - i
t can't hurt. Symptoms should subside within 15 minutes. If the symptoms don't s
ubside, more sugar should be eaten and the sugar level tested again.
AFTER the symptoms subside, more substantial food can be eaten. Eat simple sugar
FIRST to get the situation under control. Even if you or your child is hungry,
"real" food should not be eaten until the sugar level comes up - real food won't
produce enough sugar and takes too long to digest.
If you are a parent, relative, or friend of someone experiencing these symptoms,
monitor the person closely. If symptoms become worse -- confusion, seizures, or
unconsciousness -- give the person a shot of glucagon. If you don't have glucag
on, call 911 immediately.
You should have some glucagon stored for emergencies. Make sure everyone in your
home, as well as babysitters and caregivers, knows how to use it. Periodically
remind everyone how to use it, and check the expiration date.
Don't panic. Glucagon works very fast -- usually within 15 minutes. While you ar
e waiting for the person to revive, keep him on his side to prevent choking. If
the person is not better in 15 minutes, call 911.
TREATING HIGH KETONES
When there is not enough insulin to move glucose into cells, glucose can build u
p in the blood. The body then looks for other forms of energy and uses fat as a
fuel source. As fats are broken down, acids called ketones build up in the blood
and urine. In high levels, ketones are poisonous to body tissue. This condition
is known as ketoacidosis.
You can check for ketones using a simple urine test available at pharmacies. Thi
s test should be performed every 4-6 hours anytime a person with diabetes is reg
istering blood sugar above 240; sick; unusually thirsty or has a dry mouth; urin
ating frequently; or vomited
The warning signs that ketoacidosis is getting serious might include flushed fac
e, dry skin and mouth, nausea or vomiting, stomach pain, deep, rapid breathing,
or fruity breath odor.
If these symptoms occur, call the doctor or go to the emergency room right away.
If left untreated, this condition will lead to coma and even death.
MONITORING
Visit your physician and/or diabetes educator at least 4 times a year.
Have your glycosylated hemoglobin (HbA1c) measured 2-4 times a year to evaluate
your overall glucose control. (Ask your doctor how often you should be tested.)
Have your cholesterol and triglyceride levels and kidney function evaluated year
ly.
Visit your ophthalmologist (preferably one that specializes in diabetic retinopa
thy) at least once a year, more frequently if signs of diabetic retinopathy deve
lop.
Every 6 months have a thorough dental cleaning and examination. Inform your dent
ist and hygienist that you have diabetes.
Monitor your feet every day for early signs of injury or infection. Make sure yo
ur health care provider inspects your feet at each visit.
Stay up-to-date with all of your vaccinations (including pneumococcal), and get
a flu shot every year in the fall.
EDUCATION
You are the most important person in managing your diabetes. Diabetes education
is a crucial part of the treatment plan. Diabetes education basically involves l
earning how to live with your diabetes.
Knowledge of disease management is imperative to avoid developing short-term com
plications such as hypoglycemia and hyperglycemia and to delay or slow the onset
of long-term complications of the disease such as diabetic retinopathy (eye dis
ease) or nephropathy (kidney disease).
You should be knowledgeable about the basic principles of diabetes management. B
asic "survival skills" include:
how to recognize and treat low blood sugar (hypoglycemia)
how to recognize and treat high blood sugar (hyperglycemia)
diabetes meal planning
how to administer insulin
how to monitor blood glucose and urine ketones
how to adjust insulin and/or food intake during exercise
how to handle sick days
where to buy diabetic supplies and how to store them
Expectations (prognosis)
The outcome for people with diabetes varies. Recent studies show that tight cont
rol of blood glucose can prevent or delay the progression of eye disease, kidney
disease and nervous system disease that is caused by diabetes. However, complic
ations may occur even when good diabetes control is achieved with insulin and di
et.
Complications
EMERGENCY COMPLICATIONS:
DIABETIC KETOACIDOSIS
In a person with type 1 diabetes, the body will use fat as a fuel if insulin is
not present. The by-products of fat metabolism are ketones. Ketones build up in
the blood and "spill" over into the urine.
A condition called ketoacidosis develops when the blood is made acidic by the ke
tones.
HYPOGLYCEMIA
Hypoglycemia (low blood glucose) occurs when the balance between insulin, food i
ntake, and exercise is disturbed. Symptoms of mild hypoglycemia include hunger,
nervousness, and fast heart rate. More serious hypoglycemia can lead to confusio
n and even loss of consciousness. Loss of consciousness due to low blood sugar i
s called hypoglycemic coma.
LONG-TERM COMPLICATIONS:
People who have had diabetes for several years are likely to develop long-term c
omplications, which can be minimized but not entirely eliminated by proper diabe
tic management:
VASCULAR DISEASE
By age 55, about 35% of men and women with type 1 diabetes have died from a hear
t attack compared to 8% of nondiabetic men and 4% of nondiabetic women.
People with type 1 diabetes are also at higher risk to develop blockages in the
major arteries of the legs than nondiabetics. Lower the risk of vascular disease
by aggressively treating cholesterol and blood pressure, exercising regularly,
and avoiding or quitting tobacco products.
MICROVASCULAR DISEASE
Microvascular (small vessel) changes occur in capillaries of every organ of the
body. There is a thickening of the wall of the small blood vessels. These change
s are responsible for many of the diabetes complications.
EYE COMPLICATIONS
Changes in the small blood vessels of the retina (also known as diabetic retinop
athy) predispose the diabetic to several eye disorders. After 15 years of diabet
es, 80% of diabetics will have some diabetic retinopathy.
If bleeding and scarring has developed, a retinal detachment may occur, causing
blindness. Vascular changes in the iris may cause obstruction of the flow of ocu
lar fluid and cause glaucoma. Diabetics are also more likely than nondiabetics t
o develop cataracts.
DIABETIC NEPHROPATHY (kidney disease)
Kidney abnormalities may be noted early in the disease. Poorly controlled diabet
es may accelerate the development of kidney failure. Urinary tract infections in
diabetics tend to be more severe and may result in kidney damage.
Diabetics are more vulnerable to kidney damage from high blood pressure than non
diabetics.
DIABETIC NEUROPATHY(nerve damage)
People with diabetes may develop temporary or permanent damage to nerve tissue.
Diabetic neuropathy is more likely to develop if blood glucose is poorly control
led. Some diabetics will not develop neuropathy, while others may develop this c
ondition relatively early.
On average, symptoms such as numbness and tingling occur 10 to 20 years after di
abetes has been diagnosed.
DIABETIC FOOT PROBLEMS
The feet of people with diabetes are very susceptible to infection and injury. M
any diabetes-related hospital admissions are for foot problems, and a significan
t number of non-accident-related leg amputations are performed on diabetics.
Several foot problems are common in people with diabetes, including skin changes
(loss of hair; loss of ability to sweat; and dry, cracked skin), arterial insuf
ficiency (impaired blood supply to feet), neuropathy, and specific foot deformit
ies (hallux valgus, bunion, hammertoe, and calluses).
SKIN AND MUCUS MEMBRANE PROBLEMS
People with diabetes are more likely than nondiabetics to develop infections. Hy
perglycemia (high blood sugar) predisposes diabetics to fungal infections of the
skin, nails, and female genital tract and to urinary tract infection.
Calling your health care provider
Medical follow-up for a person newly diagnosed with type 1 diabetes should proba
bly occur weekly until good control of blood glucose is achieved. The health car
e provider will want to review results of home glucose monitoring and urine test
ing, and a diary of meals, snacks, and insulin injections.
As the disease becomes more stable, follow-up visits will be less frequent. Peri
odic evaluation is very important for the evaluation of long-term complications
associated with diabetes.
Call your health care provider or go to the emergency room if symptoms of ketoac
idosis are present:
increased thirst and urination
nausea
deep and rapid breathing
abdominal pain
sweet-smelling breath
loss of consciousness (This may occur in insulin dependent diabetics when a dose
of insulin is missed, or if illness or infection is present.)
Go to the emergency room or call the local emergency number (such as 911) if sym
ptoms of severe hypoglycemia or insulin reaction are present:
trembling
weakness
drowsiness
headache
confusion
dizziness
double vision
lack of coordination
convulsions or unconsciousness
Early signs of hypoglycemia may be treated at home by eating sugar or candy or i
njecting glucagon. If the signs of hypoglycemia are not relieved by the above ac
tion or if blood glucose levels remain below 60 mg/dL go to the emergency room.

Type 2 Diabetes Mellitus

Alternative names
Noninsulin-dependent diabetes mellitus; Diabetes - Type 2
Definition
Type 2 diabetes is a chronic, life-long disease that results when the body's ins
ulin does not work effectively. Insulin is a hormone released by the pancreas in
response to increased levels of blood sugar (glucose) in the blood.
Causes, incidence, and risk factors
Diabetes is caused by a problem in the way your body makes or uses insulin. Insu
lin is necessary for glucose to move from the blood to the inside of the cells.
Unless glucose gets into cells, the body cannot use it for energy. Excess glucos
e remains in the blood, and is then removed by the kidneys. The symptoms inlcude
excessive thirst, frequent urination, hunger, and fatigue.
There are several types of diabetes:
Type 1 diabetes, which requires total insulin replacement in order to live becau
se the body does not make adequate amounts
Type 2 diabetes, which is related to insulin resistance (lack of the ability of
the body to respond to insulin appropriately) and is often accompanied by obesit
y and high cholesterol
Gestational diabetes, which occurs during pregnancy
Diabetes affects up to 6% of the population in the U.S. Type 2 diabetes accounts
for 90% of all cases.
A main component of type 2 diabetes is "insulin resistance". This means that the
insulin produced by your pancreas cannot connect with fat and muscle cells to l
et glucose inside and produce energy. This causes hyperglycemia (high blood gluc
ose).
To compensate, the pancreas produces more insulin. The cells sense this flood of
insulin and become even more resistant, resulting in a vicious cycle of high gl
ucose levels and often high insulin levels.
Type 2 diabetes usually occurs gradually. Most people with type 2 diabetes are o
verweight at the time of diagnosis. However, the disease can also develop in lea
n people, especially if elderly.
Genetics play a large role in type 2 diabetes and family history is a risk facto
r. However, low activity level, poor diet, and excess body weight (especially ar
ound the waist) significantly increase your risk for type 2 diabetes.
Other risk factors include:
Race/ethnicity; African-Americans, Hispanic-Americans, and Native Americans all
have high rates of diabetes
Age greater than 45 years
Previously identified impaired glucose tolerance by your doctor
High blood pressure
HDL cholesterol of less than 35 and/or triglyceride level of greater than 250
History of gestational diabetes
Symptoms
Often, people with type 2 diabetes have no symptoms at all. If you do have sympt
oms, they may include:
increased thirst
increased urination
increased appetite
fatigue
blurred vision
frequent and/or slow-healing infections (including bladder, vaginal, skin)
erectile dysfunction in men
Signs and tests
Type 2 diabetes is diagnosed with the following blood tests:
Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on
two occasions.
Random (non-fasting) blood glucose level -- diabetes is suspected if higher than
200 mg/dL and accompanied by the classic symptoms of increased thirst, urinatio
n, and fatigue. (This test must be confirmed with a fasting blood glucose test.)
Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher
than 200 mg/dL after 2 hours.
Treatment
The first goals are to eliminate the symptoms and stabilize your blood glucose l
evels. The ongoing goals are to prevent long-term complications and prolong your
life. The primary treatment for type 2 diabetes is exercise and diet.
LEARN THESE SKILLS
You should learn basic diabetes management skills. They will help prevent compli
cations and the need for medical care. These skills include:
How to test and record your blood glucose (see blood glucose monitoring).
What to eat and when.
How to take medications, if indicated.
How to recognize and treat low and high blood sugar.
How to handle sick days.
Where to buy diabetes supplies and how to store them.
It may take several months to learn the basic skills. Once your condition has st
abilized, continue to educate yourself about the disease process, how to control
and live with diabetes, and long-term complications of the disease. Over time,
stay current on new research and treatment.
SELF-TESTING
Blood sugar testing, or self-monitoring of blood glucose, is done by checking th
e glucose content of a small drop of blood. Regular testing tells you how well d
iet, exercise, and medication are working together to control diabetes.
The results of the test can be used to adjust meals, activity, or medications to
keep blood sugar levels in an appropriate range. Testing provides valuable info
rmation for the health care provider and identifies high and low blood sugar lev
els before serious problems develop.
When testing blood sugars yourself, a glucometer is used. A glucometer is a smal
l device that provides an exact reading of blood glucose. A test strip is used t
o collect a small drop of blood, obtained by pricking the finger with a small, s
pecially-designed needle (called a lancet).
The strip is then placed in the meter. Results are available within 30 to 45 sec
onds. A health care provider or diabetes educator will help set up an appropriat
e testing schedule for you. You will also be taught how to respond to different
ranges of glucose values obtained when you self-test.
Tests are usually done before meals and at bedtime. More frequent testing may be
indicated during illness or stress. Accurate record keeping of test results wil
l make them more useful for planning how to best control your diabetes.
DIET AND WEIGHT CONTROL
Meal planning includes choosing healthy foods, eating the right amount of food,
and eating meals at the right time. You should work closely with your health car
e provider to learn how much fat, protein, and carbohydrates you need in your di
et. Your specific meal plans need to be tailored to your food habits and prefere
nces. A registered dietitian can be helpful in determining your specific, indivi
dual dietary needs.
In type 2 diabetes, weight management and a well-balanced diet are important. So
me people with type 2 diabetes can stop medications after intentional weight los
s, although the diabetes is still present. Consultation with a registered dietit
ian is an invaluable planning tool.
REGULAR PHYSICAL ACTIVITY
Regular exercise is important for everyone, but especially if you have diabetes.
Regular exercise helps control the amount of glucose in the blood. It also help
s burn excess calories and fat to achieve optimal weight.
Exercise improves overall health by improving blood flow and blood pressure. It
naturally decreases insulin resistance even without weight loss. Exercise also i
ncreases the body's energy level, lowers tension, and improves your ability to h
andle stress. Everyone should obtain medical approval before starting an exercis
e program, but this is especially important if you have diabetes.
The following should be considered:
Choose an enjoyable physical activity that is appropriate for the current fitnes
s level.
Exercise every day, and at the same time of day, if possible.
Monitor blood glucose levels by home testing before and after exercise.
Carry food that contains a fast-acting carbohydrate in case blood glucose levels
get too low during or after exercise.
Wear a diabetes identification bracelet and carry change for a phone call in cas
e of emergency.
Drink extra fluids that do not contain sugar before, during and after exercise.
Changes in exercise intensity or duration may require modification of your diet
or medication to keep blood glucose levels in an appropriate range.
MEDICATION
When you cannot achieve normal or near-normal blood glucose levels with diet and
exercise, medication is added to the treatment plan. Your doctor will start you
on oral (by mouth) medicines, such as:
Oral sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pan
creas to make more insulin.
Biguanides (Metformin) tell the liver to decrease its production of glucose, whi
ch increases glucose levels in the blood stream.
Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbo
hydrates from the digestive tract, thereby lowering the after-meal glucose level
s.
Thiazolidinediones (such as rosiglitazone) help insulin work better at the cell
site. In essence, they increase the cell's sensitivity (responsiveness) to insul
in.
Meglitinides (including repaglinide and nateglinide) trigger the pancreas to mak
e more insulin in response to how much glucose is in the blood.
If you continue to have poor blood glucose control despite lifestyle changes and
using oral medicines, your doctor will prescribe insulin. Insulin may also be p
rescribed if you have had a bad reaction to oral medicines. Insulin must be inje
cted under the skin using a syringe and cannot be taken by mouth.
Insulin preparations differ in how fast they start to work and how long they wor
k. The health-care professional will determine the appropriate type of insulin t
o use and will counsel you on what time of day to use it.
More than one type may be mixed together in an injection to achieve the best con
trol of blood glucose. The injections are needed, in general, from one to four t
imes a day. You will be taught how to give yourself injections by your doctor or
a diabetes educator referred by your doctor.
FOOT CARE
People with diabetes are prone to foot problems because of complications caused
by damage to blood vessels and nerves and decreased ability to fight infection.
Blood flow to the feet may become compromised and damage to the nerves may cause
an injury to the foot to go unnoticed until infection develops. Death of skin a
nd other tissue can occur. If left untreated, amputation of the affected foot ma
y ultimately be necessary.
To prevent injury to the feet, diabetics should adopt a daily routine of checkin
g and caring for the feet as follows:
Check your feet every day, and report sores or changes and signs of infection.
Wash feet every day with lukewarm water and mild soap, and dry them thoroughly.
Soften dry skin with lotion or petroleum jelly.
Protect feet with comfortable, well-fitting shoes.
Exercise daily to promote good circulation.
See a podiatrist for foot problems, or to have corns or calluses removed.
Remove shoes and socks during a visit to the health care provider to remind them
to examine your feet.
Discontinue smoking because it worsens blood flow to the feet.
CONTINUING CARE
A person with type 2 diabetes should have a visit with a diabetes care provider
every three months. A thorough three-month evaluation includes:
Glycosylated hemoglobin (HbA1c) is a weighted three-month average of what your b
lood glucose has been. This test measures how much glucose has been sticking to
the red blood cells. It also indicates how much glucose has been sticking to oth
er cells. A high HbA1c is an indicator of risk for long-term complications. Curr
ently, the ADA recommends an HbA1c of less than 7% to protect oneself from compl
ications. This test should be done every three months.
Blood pressure check.
Foot and skin examination.
Ophthalmoscopy examination.
Neurological examination.
The following evaluations should be done at least annually:
Random microalbumin (urine test for protein).
BUN and serum creatinine.
Serum cholesterol, HDL, and triglycerides.
ECG.
Dilated retinal exam.
Expectations (prognosis)
The risks of long-term complications from diabetes can be reduced. Those with th
e best control of blood glucose and blood pressure significantly reduce their ri
sk of death, stroke, heart failure, and other complications. Reduction of HbA1c
by even one percentage point can decrease your risk for complicatons by 25%.
Complications
Emergency complications include diabetic coma.
Long-term complications include:
diabetic retinopathy (eye disease)
diabetic nephropathy (kidney disease)
diabetic neuropathy (nerve damage)
peripheral vascular disease (damage to blood vessels/circulation)
high cholesterol, high blood pressure, atherosclerosis, and coronary artery dise
ase
Calling your health care provider
Call your health care provider immediately if you have:
trembling
weakness
drowsiness
headache
confusion
dizziness
double vision
lack of coordination
These symptoms can rapidly progress to emergency conditions (such as convulsions
, unconsciousness, or hypoglycemic coma).
Prevention
Everyone over 45 should have their blood glucose checked at least every three ye
ars. Regular testing of random blood glucose should begin at a younger age and b
e performed more often if you are at particular risk for diabetes.
Maintain a healthy body weight and keep an active lifestyle to help prevent the
onset of type 2 diabetes.