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Diabetes

The Diabetes UK Careline is a dedicated diabetes helpline for all people with diabetes, their friends, family, carers and healthcare professionals.

Please click here to access the link to their website

What are the symptoms of diabetes?

People who think they might have diabetes must visit a physician for diagnosis. Below is a list of the common symptoms of diabetes. However, people with diabetes may have only some of these complaints; other people may not have any.

Frequent urination

Excessive thirst

Unexplained weight loss

Extreme hunger

Sudden vision changes

Tingling or numbness in hands or feet

Feeling very tired much of the time

Very dry skin Sores that are slow to heal

More infections than usual.

What causes type 1 diabetes?

The causes of type 1 diabetes appear to be much different than those for type 2 diabetes, though the exact mechanisms for development of both diseases are unknown. The appearance of type 1 diabetes is suspected to follow exposure to an "environmental trigger," such as an unidentified virus, stimulating an immune attack against the beta cells of the pancreas (that produce insulin) in some genetically predisposed people.

What is the difference between type 1 and type 2 diabetes mellitus?

Type 1 and type 2 diabetes mellitus are both conditions in which hyperglycemia (high blood sugar) occurs, but the cause of the hyperglycemia is different in the two diseases. In both, the underlying problem involves the hormone insulin, which is produced by beta cells in the pancreas. Insulin helps cells take up glucose (sugar), removing it from the blood. In type 1 diabetes, insulin is in short supply because the beta cells are destroyed by an unknown process (that is thought to involve an attack by the immune system). Type 1 diabetes occurs most often in children and is not related to obesity.

In type 2 diabetes, the pancreas is still able to secrete insulin. However, the tissues in the body, especially the muscles, do not take up glucose in response to the insulin. This causes the pancreas to secrete more insulin, which forces the tissues to take up the glucose in the blood. As the body becomes more and more resistant to the effects of insulin, however, the pancreas can not keep up. The net result is high blood sugar levels. Type 2 diabetes tends to occur in adults, especially those who are overweight.

What causes type 2 diabetes? Sedentary lifestyle, obesity, smoking, high cholesterol levels, high blood pressure and age accelerate development of the disease in susceptible individuals. The factors that determine whether an individual develops type 2 diabetes or not are mainly genetic (i.e., in the family).

Can diabetes be prevented?

Most physicians believe that maintaining a normal body weight can help reduce the risk of this condition in predisposed individuals. A number of studies have shown that regular physical activity can significantly reduce the risk of developing type 2 diabetes.

Researchers are making progress in identifying the exact genetics and "triggers" that predispose some individuals to develop type 1 diabetes, but prevention, as well as a cure, remains elusive.

What kinds of complications are associated with diabetes?

The complications of diabetes fall into two major categories, microvascular (involving small blood vessels) and macrovascular (involving large blood vessels).

Microvascular complications include eye damage (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy). These conditions can range in severity from those that cause no symptoms (such as protein in the urine) to moderate (impotence, digestive difficulty, foot ulcers) to devastating (blindness, dialysis, amputation). The best way to prevent microvascular complications is to maintain blood glucose levels as close to normal as possible. In addition, diabetics should obtain routine eye exams, and consult a physician when they notice any symptoms linked to diabetic complications, such as numbness or tingling in the feet, nausea, vomiting, or abdominal discomfort.

Macrovascular complications include atherosclerosis of large blood vessels, which can predispose to angina and heart attack, as well as stroke. It is not clear if blood glucose levels have much of an effect on these problems, but high cholesterol levels and blood pressure definitely do, and should be treated aggressively in people with diabetes.

The above complications apply to people with both type 1 and type 2 diabetes, and usually take years to develop. People with type 1 diabetes can also develop ketoacidosis, an acute condition in which the absence of insulin causes extremely high blood sugar levels and the accumulation of ketones (which often give the breath a fruity smell) in the blood. This constitutes a medical emergency that usually requires hospitalization.

Is there a cure for diabetes?

In general, there is currently no easy way to cure diabetes. Insulin and other medications treat the condition, but they do not provide a cure. Some patients with type 2 diabetes can avoid having to take any medications through diet and exercise, and to the extent that their blood sugar levels remain normal, they can be considered cured. If they regain weight, however, they will almost certainly re-develop high blood sugar.

In type 1 diabetes, a pancreas transplantation can "cure" the diabetes, but there is still a lifelong requirement to take powerful anti-rejection medications that have dangerous side effects of their own. This problem, combined with the shortage of suitable organ donors, makes transplantation an unsuitable option for most people.

There are several exciting new therapies in development, ranging from islet cell transplantation to gene therapy, that may hold promise of a cure in the future.

Will I need insulin?

All people with type 1 diabetes need insulin because they do not produce any insulin. In contrast, many people with type 2 diabetes can be treated with diet and exercise alone or in combination with pills. Insulin therapy is only started if pills do not work effectively or if patients request insulin. One exception is that pregnant women with diabetes of any type are always advised to take insulin.

How often should I see my doctor?

In general, patients with type 1 diabetes should see their doctor every 6 months, while patients with type 2 diabetes can have checkups every 12 months, although most patients with type 2 diabetes are seen more frequently due to other associated problems. When a patient with diabetes is first diagnosed, or when a new therapy like insulin is started, more frequent visits may be necessary for awhile until it is clear that blood sugar levels are consistently well-controlled. Pregnant women with diabetes should see their doctor on a monthly or bi-monthly basis, with frequent phone contact to ensure good control during this critical period. Most people with diabetes should see an eye doctor yearly, although pregnant women should go once each trimester.

How often do I need to check my blood sugar?

Patients with type 1 diabetes need to check their blood sugars 3-4 times a day and may need to adjust their insulin doses based on the results. Most people with type 2 diabetes check their blood sugars less frequently, such as 1-2 times a day. Recording blood sugar levels and bringing them to appointments with doctors is very important so that medications can be adjusted appropriately.

Is diabetes hereditary?

Both type 1 and type 2 diabetes tend to run in families, but no specific mode of inheritance is known. If your family members have diabetes, it is not certain that you will, too, although you are more likely than the average person to be diagnosed with the condition. Both type 1 and type 2 diabetes probably result from a combination of an inherited predisposition to diabetes and some environmental factors (e.g., being overweight may contribute to type 2 diabetes).

What is a hemoglobin A1c level?

Hemoglobin is the protein in red blood cells that carries oxygen. Glucose can attach to hemoglobin, creating a molecule called hemoglobin A1c. This process is dependent upon the amount of sugar in the blood, so that the higher the blood sugar, the higher the percentage of hemoglobin A1c. Since red blood cells survive for approximately 120 days, the hemoglobin A1c level gives your doctor a good idea of your average blood sugar control over the previous 3 months. A normal hemoglobin A1c level varies a little depending upon which lab does the testing, but most people agree that anything over 6.5% is too high.

How often do I need to get my eyes checked?

People with diabetes are at risk for many complications involving the eyes, including blindness. Therefore, they should see an eye doctor regularly. Specifically, patients with type 1 diabetes should start seeing an eye doctor yearly after they've been diagnosed for five years, while people with type 2 diabetes should start going yearly from the time they are diagnosed. Any diabetic with eye symptoms, such as blurry vision, should see an eye doctor immediately. Pregnant women often need to go once per trimester.

How can I prevent foot sores that might lead to amputation?

People with diabetes often have reduced sensation in their feet, which means that they can step on something sharp or otherwise hurt themselves without realizing it. This puts them at risk of developing sores on their feet. If not caught in time, these lesions can become infected, and in extreme cases may require limb amputation. Thus, proper foot care is essential for diabetics.

It is very important for diabetics to clean and dry their feet every day. While doing this, they should look for sores or breaks in the skin on their feet. Toenails should be filed and the corners should not be cut. Diabetics should be careful to wear low-heeled shoes that fit well, and should never go barefoot. If sores, redness, blisters, pain or breaks in the skin develop, a doctor should be consulted immediately. Many diabetics see podiatrists regularly for help with foot care.

Will diabetes shorten my life?

The average lifespan for people with diabetes is shorter than for nondiabetics. Most of the increased risk of death comes from the complications of diabetes, including heart, kidney, and nerve damage. Fortunately, we now know that careful control of blood sugar levels can greatly reduce the risk of most of these devastating complications. Additionally, careful attention to keeping blood pressure and cholesterol levels in the normal range also improves lifespan for people with diabetes. As more and better therapies and strategies for monitoring blood sugar levels are brought into use in the next few years, we can expect that the situation will improve even more.

I have high blood sugar, but I don't eat anything with sugar in it--how can that be?

Many different foods, especially carbohydrates and fats, can be broken down into glucose. In addition, glucose is made by the liver. Both of these sources, in the setting of insulin deficiency or insulin resistance, can contribute to high blood sugar.

If my problem is high blood sugar, why do I have to eat a low fat diet?

People with type 2 diabetes are often overweight, and patients with this condition should make every effort to lose excess pounds. A low-fat diet can be very useful in this regard. Additionally, people with all forms of diabetes are prone to heart disease and stroke, and a low-fat diet can help improve blood lipid levels.

What are the symptoms of hypoglycemia (low blood sugar)?

Hypoglycemia (low blood sugar) is a frequent side effect of insulin, sulfonylurea, or repaglinide therapy. Hypoglycemia often feels different to different people, but commonly noted symptoms include sweating, nervousness, trembling or shakiness, rapid heart beat, headache, vision problems, slurred speech, irritability, and weakness. In severe cases, it can lead to loss of consciousness, seizures, or even coma. The vast majority of hypoglycemic episodes are caught early, and can be treated with oral sugar, such as orange juice or candy. In cases where the patient is unconscious, sugar has to be given intravenously. Alternatively, a family member can inject glucagon, a hormonal antidote to insulin, into the patient's skin. All patients taking insulin or sulfonylureas should have such a glucagon kit at home, and someone in the house should be trained to use it. All patients should also wear a medical alert bracelet identifying themselves as diabetic.

Will diabetes affect my sex life?

In men, diabetes can lead to impotence, the inability to maintain an erection. This occurs as a result of the nerve and blood vessel damage that occur in longstanding diabetes. Fortunately, there are new medicines available to help treat impotence. The best option, though, is prevention of nerve damage in the first place by tight control of blood sugars.

How much exercise do I need?

People with diabetes need exercise as much, if not more than people without diabetes. Exercise helps to lower blood glucose directly by pushing sugar into working muscles, and it also helps patients to lose weight. Additional benefits of exercise include reductions in blood pressure and cholesterol levels, both of which contribute significantly to the complications of diabetes. While there is no specific amount of exercise required for all diabetics, most physicians recommend 20-30 minutes of moderate exercise several times each week. Patients should talk to their doctors before initiating an exercise program, as testing for hidden nerve damage or cardiac disease might be necessary.

 

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