What is Diabetes

Diabetes is a disease in which levels of blood glucose, also called blood sugar, are above normal. People with diabetes have problems converting glucose to energy. Normally, after a meal, the body breaks food down into glucose, which the blood carries to cells throughout the body. Cells use insulin, a hormone made in the pancreas, to help them convert blood glucose into energy.

People develop diabetes because the pancreas does not make enough insulin or because the cells in the muscles, liver, and fat do not use insulin properly, or both. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over the years, high blood glucose, also called hyperglycemia, damages nerves and blood vessels, which can lead to complications such as heart disease, stroke, kidney disease, blindness, nerve problems, gum infections, and amputation.

What are the symptoms of diabetes?

Diabetes often goes undiagnosed because many of its symptoms seem so harmless. Often people with type 2 diabetes have no symptoms. The common symptoms of diabetes are:

-Excessive thirst and hunger (especially after eating)
-Dry mouth
-Frequent urination
-Unexplained weight loss (even though you are eating and feel hungry)
-Fatigue (weak, tired feeling)
-Blurred vision
-Numbness or tingling of the hands or feet
-Slow healing sores or cuts
-Itching of the skin (usually in the vaginal or groin area)
-Yeast infections

Type 1 diabetes, formerly called juvenile diabetes, is usually first diagnosed in children, teenagers, and young adults. In this form of diabetes, the pancreas no longer make insulin because the body’s immune system has attacked and destroyed the pancreatic cells specialized to make insulin. These insulin-producing cells are called beta cells.

Type 2 diabetes, formerly called adult-onset diabetes, is the most common form. People can develop type 2 diabetes at any age, even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin properly. As a result, the body needs more insulin to help glucose enter cells to be used for energy. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, the pancreas loses its ability to secrete enough insulin in response to meals.

Gestational diabetes is diabetes that first occurs during pregnancy. When women are pregnant, their need for insulin appears to increase, and many can develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life.

In pre-diabetes, blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes.  Many people with pre-diabetes develop type 2 diabetes within 10 years. The good news is that the recently completed Diabetes Prevention Program (DPP) study conclusively showed that people with prediabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range.

While the DPP also showed that some medications may delay the development of diabetes, diet and exercise worked better. Just 30 minutes a day of moderate physical activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in diabetes.

If you suddenly experience symptoms of increased thirst, frequent urination, or unexplained weight loss, diabetes may be the cause. To confirm the diagnosis, a fasting plasma glucose (FPG) test, a casual plasma glucose test, or an A1c test (glycated hemoglobin) will be performed.

The FPG measures your blood glucose level after you have fasted (not had anything to eat or drink) for at least 8 hours. Normal fasting blood glucose is between 70 and 100 mg/dl for people who do not have diabetes. The standard diagnosis of diabetes is made when two blood tests on different days show that your fasting blood glucose level is greater than or equal to 126 mg/dl. If the results are between 100 and 125 mg/dl, you are at risk.

In a casual plasma glucose test, blood glucose is tested without regard to the time since the person's last meal. A glucose level greater than 200 mg/dl may indicate diabetes, especially if the test is repeated at a later time and indicates similar results.

A major research study, the Diabetes Prevention Program (DPP), confirmed that people with pre-diabetes were able to sharply reduce their risk by losing 5 to 7 percent of their body weight through dietary changes and increased physical activity. Study participants followed a low-fat, low-calorie diet and engaged in regular physical activity, such as walking briskly for 30 minutes, five times a week. These strategies worked well for both men and women and were especially effective for participants aged 60 and older.

You can prevent or delay the onset of type 2 diabetes through a healthy lifestyle. Change your diet, increase your level of physical activity, maintain a healthy weight...with these positive steps, you can stay healthier longer and reduce your risk of diabetes.

What should you eat?

People with diabetes should follow the same general guidelines as everyone else. Eating the right kinds of foods in the right amounts can help you to control your diabetes. One way to ensure a healthy meal is the plate method:

For breakfast, fill two quarters of the plate but not the other half. For lunch and dinner, fill the entire plate.

When should you eat?

Eat three well-balanced meals per day. Meal times should be four to six hours apart. Try to avoid eating between meals unless a snack is included in your meal plan. DO NOT SKIP MEALS. Eating the same amount of food at the same time every day will prevent your blood glucose from going too high or too low.

• Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety.
• Eat non-starchy vegetables such as spinach, carrots, broccoli or green beans with meals.
• Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce.
• Include dried beans (like kidney or pinto beans) and lentils into your meals.
• Include fish in your meals 2-3 times a week.
• Choose lean meats like cuts of beef and pork that end in "loin" such as pork loin and sirloin. Remove the skin from chicken and turkey.
• Choose non-fat dairy such as skim milk, non-fat yogurt and non-fat cheese.
• Choose water and calorie-free "diet" drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks.
• Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats. Remember that fats are high in calories. If you're trying to lose weight, watch your portion sizes of added fats.
• Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and full-fat ice cream.
• Eating too much of even healthful foods can lead to weight gain. Watch your portion sizes.

Exercise regularly

Exercise is part of a healthy lifestyle for everyone, and it's especially important for people with diabetes. But exercise doesn't necessarily mean running a marathon or bench-pressing 300 pounds. The goal is to get active and stay active by doing things you enjoy. Exercise improves fitness, increases insulin sensitivity, maintains bone health, helps in weight management, and improves sleep patterns. Exercise can help lower blood glucose levels, which is why exercising in the morning or after a meal might naturally help to lower any higher blood glucose levels. Exercise includes many activities—walking, swimming, biking, tennis, gardening, lawn-mowing. Think of what you like to do, then get moving! Exercise should include 150 minutes/week of moderate intensity aerobic physical activity (50-70% of maximum heart rate). In addition, people with Type 2 diabetes should be encouraged to perform resistance training three times per week.

There are both genetic and environmental risk factors associated with diabetes. The following risk factors may increase your chance of developing diabetes:

• A family history of diabetes (if a parent or sibling in your family has diabetes)
• Race or ethnic background (the risk of diabetes is greater in Hispanics, African-Americans, Native Americans, and Asians)
• Being overweight (20 percent or more over your desired body weight)
• Hypertension (high blood pressure)
• Abnormal blood cholesterol or triglyceride levels: HDL or "good" cholesterol level under 45 mg/dl for men and 55 mg/dl for women, and/or a triglyceride level over 150 mg/dl.
• Age: Your risk of developing diabetes rises progressively as you get older.
• Use of certain drugs:
  • Blood pressure medications (such as thiazides)
  • Steroid medications (such as prednisone or Decadron [dexamethasone])
  • Hydantoin medications (such as Dilantin [phenytoin])
  • Medications for transplant recipients (such as cyclosporine)
• Alcohol, especially if you have been a heavy drinker for years
• Smoking
• History of gestational diabetes (developing diabetes during pregnancy) or delivery of babies who weigh more than 9 pound
• Autoimmune disease: Your body's defense system (immune system) attacks certain healthy cells in your pancreas that produce insulin (beta cells)
• Other factors, such as viruses, which may play a part in diabetes development

It is important to note that sugar itself does not cause diabetes. Eating a lot of sugar can lead to tooth decay, but it does not cause diabetes.

Total prevalence of diabetes

Total: 25.8 million children and adults in the United States—8.3% of the population—have diabetes.
Diagnosed: 18.8 million people
Undiagnosed: 7.0 million people
Prediabetes: 79 million people

• Age 20 years or older: 25.6 million, or 11.3% of all people in this age group, have diabetes.
• Age 65 years or older: 10.9 million, or 26.9% of all people in this age group, have diabetes.
• Men: 13.0 million, or 11.8% of all men aged 20 years or older, have diabetes.
• Women: 12.6 million, or 10.8% of all women aged 20 years or older, have diabetes.

Prevalence by race/ethnicity

• 7.1% of non-Hispanic whites
• 8.4% of Asian Americans
• 12.6% of non-Hispanic blacks
• 11.8% of Hispanics

Cost of Diabetes

• $174 billion: Total costs of diagnosed diabetes in the United States in 2007
• $116 billion for direct medical costs
• $58 billion for indirect costs (disability, work loss, premature mortality)

After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.