Living with diabetes

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VOL 109 / NO 5 / MAY 2001 / POSTGRADUATE MEDICINE

You have probably read frightening news reports about a possible epidemic of diabetes in the United States. The fact is that the incidence of diabetes has more than tripled over the past few decades, and the increase has been especially dramatic in recent years. Sedentary lifestyle and increasing body weight seem to be important causes. What does this mean for you and your family?

Diabetes is a condition in which too much glucose (sugar) is in the blood. Normally, the body's cells take glucose from the blood for use as energy. This requires the help of insulin, a hormone produced by the pancreas. If insulin-producing cells in the pancreas are destroyed, the body can't use glucose, and it builds up in the blood and overflows into the urine. This is known as insulin-dependent, or type 1, diabetes. It is seen mostly in people under 30 years of age and tends to run in families. People who have type 1 diabetes need insulin injections daily.

Another, much more common form of diabetes is called non-insulin-dependent, or type 2, diabetes. It occurs when the pancreas cannot make enough insulin or the insulin does not work effectively. This type is seen most often in people who are over 40 years of age, who are overweight, and who have a family history of the disease. About 90% of people who have diabetes have type 2. Many people have this disorder and do not know it.

How can you tell if you have diabetes?
The usual symptoms are thirst, frequent need to go to the bathroom, and weight loss despite eating more. Other symptoms, especially with type 2 diabetes, may be more subtle and can include fatigue, blurred vision, slow healing of sores, frequent infections, and tingling or loss of feeling in hands or feet. A simple office blood test can confirm the diagnosis.

How is diabetes treated?
The goal in treating either type 1 or type 2 diabetes is to bring the blood glucose level down within normal range. Regular exercise and a balanced diet low in concentrated sweets and fat are very important. Your doctor or a diabetes educator can help you plan an exercise and diet program tailored specifically to your needs.

If you have diabetes, you will also learn how to test your blood so you can keep track of highs and lows in blood glucose levels. Blood testing usually requires a finger prick. Then a drop of blood is placed on a test strip that is inserted into a special glucose meter. The meter shows the blood glucose level in just a few seconds.

People who have type 2 diabetes often can control blood glucose levels with diet, exercise, and weight loss alone. If not, oral medications that lower blood glucose may help. However, sometimes insulin is needed to control type 2 diabetes.

Why is it important to control blood glucose?
Too much glucose in the blood can damage blood vessels, especially those in the eyes and kidneys. Diabetes can also increase the risk of foot ulcers that don't heal normally. And, most important, the risk of heart disease is high for people who have diabetes. Complications may not appear until diabetes has been present for a number of years. However, many long-term complications can be prevented if diabetes is recognized and treated early. Therefore, it is extremely important to see your doctor regularly.

Take action early
Diabetes is likely to become even more common as the population ages and people become less active. You can do a number of things to prevent problems later on. Start today by watching your weight and getting enough exercise. Even small changes can have big payoffs.

Need more information?

Diabetes is a complex disorder that raises many questions. If you would like to learn more, the American Diabetes Association can provide a wealth of information. Its address is:

American Diabetes Association
1701 N Beauregard St
Alexandria, VA 22311
Telephone: 800-342-2383
Web: http://www.diabetes.org

When is diabetes an emergency?

It is a good idea to let people around you know that you have diabetes so they can help if necessary. A serious problem for people who have diabetes is hypoglycemia, or low blood sugar. It occurs when diabetes treatment lowers blood glucose too much.

Symptoms of low blood glucose include shaking, sweating, extreme fatigue, hunger, dizziness, mood changes, confusion, blurred vision, and headaches.

Low blood glucose is treated by eating or drinking something that contains sugar, such as a small glass of fruit juice or regular soda, sugar cubes, glucose tablets, or hard candy that won't cause choking. The sugar may take about 15 minutes to get into the blood and correct the reaction. If you or someone in your family has low blood glucose reactions, ask your doctor for help in correcting them.

In some cases, low blood glucose causes loss of consciousness. If this happens to someone near you, call 911 for help.

Lowering your risk of diabetes

Here are some of the things you can do now to lower your risk of diabetes and its complications.

• Get regular medical checkups.
• Lose weight if you need to and do everything you can to stay at a healthy weight. Ask your doctor for help.
• Maintain, or if necessary increase, your physical activity. This helps lower blood glucose. Your doctor can help you find the best and safest exercise for you.
• Have your blood cholesterol checked, and ask your doctor what you might do to lower levels that are too high.
• Make sure your blood pressure is in a healthy range.
• If you smoke, ask your doctor to help you quit.

This information is not a substitute for medical treatment.

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