Why is the risk of blood vessel diseases increased so much in diabetes? Basic Information
There are several reasons why the risk of vascular diseases, such as heart attack, stroke, and diseases of the vessels in the limbs (peripheral vascular disease), is increased in both types of diabetes. The weight gain and lack of exercise common in people with type 2 diabetes lead to other conditions such as abnormal cholesterol levels and high blood pressure, which are potent causes of vascular disease.
WHAT IS DIABETIC NEPHROPATHY ? QUESTION 34
What is diabetic nephropathy? Basic Information
DIABETIC NEPHROPATHY - WHAT WE NEED TO KNOW
Diabetic nephropathy is the term used to describe kidney damage that occurs in diabetes, usually of longstanding. The damage to the kidney in diabetes can result from the high blood sugar itself, which leads to an expansion of certain types of material in the filtering mechanism of the kidney.
This expansion damages the delicate cells responsible for filtering waste materials through the kidney. Eventually, there are abnormal pressures and changes in the important electrical balance in this complex structure.
DIABETIC NEPHROPATHY - WHAT WE NEED TO KNOW
Diabetic nephropathy is the term used to describe kidney damage that occurs in diabetes, usually of longstanding. The damage to the kidney in diabetes can result from the high blood sugar itself, which leads to an expansion of certain types of material in the filtering mechanism of the kidney.
This expansion damages the delicate cells responsible for filtering waste materials through the kidney. Eventually, there are abnormal pressures and changes in the important electrical balance in this complex structure.
WHAT IS DIABETIC RETINOPATHY? QUESTION 33
What is diabetic retinopathy? Basic Information
DIABETIC RETINOPATHY - WHAT WE SHOULD KNOW
Diabetic retinopathy is damage to the eye that results from chronically untreated or inadequately treated high blood sugar. In its more advanced form, it can result in severe visual loss or blindness if untreated, and this can occur suddenly without warning.
DIABETIC RETINOPATHY - WHAT WE SHOULD KNOW
Diabetic retinopathy is damage to the eye that results from chronically untreated or inadequately treated high blood sugar. In its more advanced form, it can result in severe visual loss or blindness if untreated, and this can occur suddenly without warning.
WHAT IS DIABETIC NEUROPATHY? QUESTION 32
What is diabetic neuropathy? Basic Information
DIABETIC NEUROPATHY - WHAT WE SHOULD KNOW
Diabetic neuropathy is the term used to describe the usually chronic damage to nerves that occurs as a result of untreated, or inadequately treated, high blood sugar. It results from a complex sequence of events that leads to damage and destruction of the minute blood vessels that nourish nerves along their course to the region of the body they serve after leaving the spinal canal.
DIABETIC NEUROPATHY - WHAT WE SHOULD KNOW
Diabetic neuropathy is the term used to describe the usually chronic damage to nerves that occurs as a result of untreated, or inadequately treated, high blood sugar. It results from a complex sequence of events that leads to damage and destruction of the minute blood vessels that nourish nerves along their course to the region of the body they serve after leaving the spinal canal.
WHAT IS DIABETIC COMA? QUESTION 31
What is diabetic coma? Basic Information
DIABETIC COMA - WHAT WE SHOULD KNOW
Diabetic coma is loss of consciousness occurring as a result of very high blood sugar. Its causes are similar in both type 1 and type 2 diabetes, but with the important difference that other abnormalities of the blood chemistry may contribute to the coma in type 1 diabetes.
DIABETIC COMA - WHAT WE SHOULD KNOW
Diabetic coma is loss of consciousness occurring as a result of very high blood sugar. Its causes are similar in both type 1 and type 2 diabetes, but with the important difference that other abnormalities of the blood chemistry may contribute to the coma in type 1 diabetes.
DOES DIABETES PUT ME AT RISK OF ANY OTHER DISEASES OR ILLNESSES? QUESTION 30
30. Does diabetes put me at risk of any other diseases or illnesses?
Aside from the direct consequences of high blood sugar itself, which are discussed in Question 29, people with diabetes are at risk of suffering from other associated diseases. In the case of type 1 diabetes, the diseases either result from the high blood sugar or from the root cause of the diabetes, which is a predisposition to destroy the hormone-producing tissues (called autoimmunity).
Thus, a person with type 1 diabetes is more likely to suffer from adrenal gland damage (Addison’s disease), thyroid gland damage (Graves’ or, much more commonly, Hashimoto’s disease), and several other disorders.
Aside from the direct consequences of high blood sugar itself, which are discussed in Question 29, people with diabetes are at risk of suffering from other associated diseases. In the case of type 1 diabetes, the diseases either result from the high blood sugar or from the root cause of the diabetes, which is a predisposition to destroy the hormone-producing tissues (called autoimmunity).
Thus, a person with type 1 diabetes is more likely to suffer from adrenal gland damage (Addison’s disease), thyroid gland damage (Graves’ or, much more commonly, Hashimoto’s disease), and several other disorders.
WHAT CAN HAPPEN IF MY DIABETES IS NOT PROPERLY TREATED AND CONTROLLED? QUESTION 29
29.What can happen if my diabetes is not properly treated and controlled?
Uncontrolled diabetes, which generally refers to glucose levels that are higher rather than lower than the target range, can lead to immediate short-term and longer term consequences. The short-term consequences result from the very high blood glucose itself, which is described in Question 4.
If severe enough or untreated for long enough, markedly high blood glucose levels can result in coma and ultimately death, due to the severe abnormalities of blood chemistry that occur. It is important to note that only a very small minority of patients with either form of diabetes will die in this way.
Uncontrolled diabetes, which generally refers to glucose levels that are higher rather than lower than the target range, can lead to immediate short-term and longer term consequences. The short-term consequences result from the very high blood glucose itself, which is described in Question 4.
If severe enough or untreated for long enough, markedly high blood glucose levels can result in coma and ultimately death, due to the severe abnormalities of blood chemistry that occur. It is important to note that only a very small minority of patients with either form of diabetes will die in this way.
CAN DIABETES SOMETIMES BE TEMPORARY AND GO AWAY? QUESTION 28
28. Can diabetes sometimes be temporary and go away again?
Yes, this can and does occur, in the case of both types of diabetes. However, in the case of type 1 diabetes,
the disappearance is very predictably temporary and the diabetes will almost inevitably return within
months or a year or two.
The reasons for it are complex and relate to the fact that type 1 diabetes is often diagnosed under conditions of physical stress. When the diabetes is treated and the stress to the body has resolved, there may be sufficient remaining insulin producing capability in the pancreas to keep the blood sugar normal under most circumstances.
Yes, this can and does occur, in the case of both types of diabetes. However, in the case of type 1 diabetes,
the disappearance is very predictably temporary and the diabetes will almost inevitably return within
months or a year or two.
The reasons for it are complex and relate to the fact that type 1 diabetes is often diagnosed under conditions of physical stress. When the diabetes is treated and the stress to the body has resolved, there may be sufficient remaining insulin producing capability in the pancreas to keep the blood sugar normal under most circumstances.
I HAD DIABETES DURING MY LAST PREGNANCY. AM I AT RISK OF DIABETES IN THE FUTURE? QUESTION 27
27. I had diabetes during my last pregnancy. Am I at risk of diabetes in the future?
Yes, you are at high risk both of having type 2 diabetes in the future and of having diabetes again with your next pregnancy. The reason for this is that women destined to get type 2 diabetes in middle age or beyond
tend to be the same women who will develop diabetes in pregnancy.
Therefore, the presence of diabetes in pregnancy is an indicator of future risk for type 2 diabetes.
Yes, you are at high risk both of having type 2 diabetes in the future and of having diabetes again with your next pregnancy. The reason for this is that women destined to get type 2 diabetes in middle age or beyond
tend to be the same women who will develop diabetes in pregnancy.
Therefore, the presence of diabetes in pregnancy is an indicator of future risk for type 2 diabetes.
I HAVE A STRONG FAMILY HISTORY OF DIABETES. HOW OFTEN SHOULD I BE CHECKED FOR IT? QUESTION 26
26. I have a strong family history of diabetes. How often should I be checked for it?
The frequency with which you should be checked for diabetes depends upon your degree of risk, your age, and lifestyle factors. Even if you have a strong family history of type 1 diabetes, your risk of developing it is still only about 5% and is much lower after the age of 35.
Furthermore, type 1 diabetes usually presents with obvious symptoms, such as those described in Question 21, and is unlikely to be missed. Since there is presently little that can be done to prevent type 1 diabetes, screening is usually not performed.
The frequency with which you should be checked for diabetes depends upon your degree of risk, your age, and lifestyle factors. Even if you have a strong family history of type 1 diabetes, your risk of developing it is still only about 5% and is much lower after the age of 35.
Furthermore, type 1 diabetes usually presents with obvious symptoms, such as those described in Question 21, and is unlikely to be missed. Since there is presently little that can be done to prevent type 1 diabetes, screening is usually not performed.
COULD I HAVE DIABETES FOR A LONG TIME AND NOT KNOWN IT? QUESTION 25
25. Could I have had diabetes for a long time and not known it?
Yes, indeed, you could have had diabetes for a considerable period of time, months or even years, and been unaware of it. However, it is unlikely that you could have had severe diabetes with very high blood sugars for a long time without having to seek medical attention, as you would have experienced complications.
However, milder degrees of diabetes are often without obvious symptoms, although in retrospect patients will realize that all was not well when they start to feel the benefits of treatment. Studies have shown that, on average, type 2 diabetes has been present for several years by the time it is diagnosed.
Yes, indeed, you could have had diabetes for a considerable period of time, months or even years, and been unaware of it. However, it is unlikely that you could have had severe diabetes with very high blood sugars for a long time without having to seek medical attention, as you would have experienced complications.
However, milder degrees of diabetes are often without obvious symptoms, although in retrospect patients will realize that all was not well when they start to feel the benefits of treatment. Studies have shown that, on average, type 2 diabetes has been present for several years by the time it is diagnosed.
IS HYPOGLYCEMIA OPPOSITE OF DIABETES? QUESTION 24
24. My doctor says I have hypoglycemia. Isn’t that the opposite of diabetes?
Yes, hypoglycemia (low blood sugar) is the opposite of the hyperglycemia (high blood sugar) that characterizes diabetes. Certain treatments for diabetes and several conditions unrelated to diabetes can cause hypoglycemia.
The most common form of hypoglycemia occurs in otherwise healthy young individuals, more commonly in women than men, and is quite benign, although it can be associated with distressing symptoms. Fortunately, it is usually treatable by adjustment of the composition and timing of meals.
Yes, hypoglycemia (low blood sugar) is the opposite of the hyperglycemia (high blood sugar) that characterizes diabetes. Certain treatments for diabetes and several conditions unrelated to diabetes can cause hypoglycemia.
The most common form of hypoglycemia occurs in otherwise healthy young individuals, more commonly in women than men, and is quite benign, although it can be associated with distressing symptoms. Fortunately, it is usually treatable by adjustment of the composition and timing of meals.
CAN I FEEL MY HIGH AND LOW BLOOD SUGAR RELIABLY? QUESTION 23
23. Can I “feel” my high and low blood sugars reliably?
Although many people with diabetes confidently state that they can reliably detect both their high and low blood sugars without actual measurement, studies have shown that these beliefs are not usually accurate. It is generally easier to be aware of hypoglycemia (“low sugars”) than high blood sugars.
This is because the margin of safety between blood sugars in the lower part of the normal range and dangerously low blood sugars is quite narrow—only about 25 mg/dl—and the body has a vigorous and rapid response system, designed to ensure that a source of energy is rapidly found and consumed.
Although many people with diabetes confidently state that they can reliably detect both their high and low blood sugars without actual measurement, studies have shown that these beliefs are not usually accurate. It is generally easier to be aware of hypoglycemia (“low sugars”) than high blood sugars.
This is because the margin of safety between blood sugars in the lower part of the normal range and dangerously low blood sugars is quite narrow—only about 25 mg/dl—and the body has a vigorous and rapid response system, designed to ensure that a source of energy is rapidly found and consumed.
HOW DOES MY DOCTOR CONFIRMS THE DIAGNOSIS OF DIABETES? QUESTION 22
22.How does my doctor confirm the diagnosis of diabetes?
Your doctor will perform one of the standard measurements for the diagnosis of diabetes approved by the accepted authoritative body in whichever part of the world you live. In the United States, this is generally set by the American Diabetes Association (ADA) and is accepted by most practitioners, insurers, and health providers as valid.
The most current ADA criteria for the diagnosis of diabetes are shown in Table 1 (see Question 9). Your doctor may or may not ask you to fast prior to measuring the blood glucose or he or she may perform a standard 2-hour test known as the oral glucose tolerance test.
Your doctor will perform one of the standard measurements for the diagnosis of diabetes approved by the accepted authoritative body in whichever part of the world you live. In the United States, this is generally set by the American Diabetes Association (ADA) and is accepted by most practitioners, insurers, and health providers as valid.
The most current ADA criteria for the diagnosis of diabetes are shown in Table 1 (see Question 9). Your doctor may or may not ask you to fast prior to measuring the blood glucose or he or she may perform a standard 2-hour test known as the oral glucose tolerance test.
WHAT ARE THE MOST COMMON SYMPTOMS OF DIABETES? QUESTION 21
21.What are the most common symptoms of diabetes?
The common and early symptoms of diabetes result from the effect of the high blood sugar entering the urine and drawing fluid from the body’s tissues along with it. This leads to excess urine production with frequent urination.
The loss of body fluid leads to thirst, in order to replace the fluid loss. As long as the person with diabetes is able to keep pace with his or her thirst by regular fluid intake, he or she will remain relatively well.
The common and early symptoms of diabetes result from the effect of the high blood sugar entering the urine and drawing fluid from the body’s tissues along with it. This leads to excess urine production with frequent urination.
The loss of body fluid leads to thirst, in order to replace the fluid loss. As long as the person with diabetes is able to keep pace with his or her thirst by regular fluid intake, he or she will remain relatively well.
SEVERAL MEMBERS OF MY CLOSE FAMILY HAVE DIABETES. WILL ATTEMPTS AT PREVENTION STILL WORK FOR ME? QUESTION 20
20. Several members of my close family have diabetes.Will attempts at prevention still work for me?
Please refer to Question 19 regarding type 1 diabetes. Regarding type 2 diabetes, your success in preventing diabetes depends upon a combination of how successful you are at attaining the necessary goals and how susceptible your family is.
Inherited susceptibility can range from modest to very high. The risk also depends very much on whether both sides of a person’s family have a hereditary pattern of diabetes.
Please refer to Question 19 regarding type 1 diabetes. Regarding type 2 diabetes, your success in preventing diabetes depends upon a combination of how successful you are at attaining the necessary goals and how susceptible your family is.
Inherited susceptibility can range from modest to very high. The risk also depends very much on whether both sides of a person’s family have a hereditary pattern of diabetes.
CAN TYPE 1 DIABETES ALSO BE PREVENTED? QUESTION 19
19. Can type 1 diabetes also be prevented?
At the present time, we do not think that type 1 diabetes can effectively be prevented. Part of the problem is that we do not know the exact environmental trigger(s), although there is provocative evidence for a number of factors, such as early exposure to cow’s milk, certain viral strains, and lack of stimulation of the immune system at an early age by natural exposure to infective agents.
The evidence is insufficient to make specific recommendations for avoidance of, or immunization against, specific potential triggering agents. A number of clinical trials of agents that modify the immune system attack on the insulinproducing cells of the pancreas (see Question 2) are under way.
At the present time, we do not think that type 1 diabetes can effectively be prevented. Part of the problem is that we do not know the exact environmental trigger(s), although there is provocative evidence for a number of factors, such as early exposure to cow’s milk, certain viral strains, and lack of stimulation of the immune system at an early age by natural exposure to infective agents.
The evidence is insufficient to make specific recommendations for avoidance of, or immunization against, specific potential triggering agents. A number of clinical trials of agents that modify the immune system attack on the insulinproducing cells of the pancreas (see Question 2) are under way.
ARE THERE ANY NATURAL HERBS, MINERALS, OR OTHER REMEDIES THAT PREVENT DIABETES? QUESTION 18
18. Are there any natural herbs, minerals, or other remedies that prevent diabetes?
While it would be premature to answer yes to this question, it does appear that certain compounds can favorably impact the blood sugar and may have the potential to delay or prevent diabetes. Those for whom there is at least some evidence include uncooked walnuts, gymnema sylvestre (also known as gurmarbooti or
gurmar), green tea, and certain compounds of chromium, zinc, and vanadium.
While it is not known how most of these compounds work, the metallic compounds may work by facilitating the body’s mechanisms for releasing insulin, or responding to insulin. Overall, the effect of most of these items is quite mild, and they may influence the blood sugar by a few points.
While it would be premature to answer yes to this question, it does appear that certain compounds can favorably impact the blood sugar and may have the potential to delay or prevent diabetes. Those for whom there is at least some evidence include uncooked walnuts, gymnema sylvestre (also known as gurmarbooti or
gurmar), green tea, and certain compounds of chromium, zinc, and vanadium.
While it is not known how most of these compounds work, the metallic compounds may work by facilitating the body’s mechanisms for releasing insulin, or responding to insulin. Overall, the effect of most of these items is quite mild, and they may influence the blood sugar by a few points.
IS THERE ANYTHING I CAN DO TO REDUCE MY CHILDREN'S RISK OF GETTING DIABETES? QUESTION 17
17. Is there anything I can do to reduce my children’s risk of getting diabetes?
There is presently little that can reliably be done to reduce a person’s risk of type 1 diabetes, as discussed in Question 19. However, type 2 diabetes has undergone a dramatic increase in children and adolescents in recent years, and it is clear that this is driven, in the most part, by childhood and adolescent overweight and obesity as well as lack of regular exercise.
Therefore, establishment of a healthy pattern of eating in childhood, without excess calorie intake, and encouragement of regular exercise can be the most effective means of preventing the development of diabetes.
There is presently little that can reliably be done to reduce a person’s risk of type 1 diabetes, as discussed in Question 19. However, type 2 diabetes has undergone a dramatic increase in children and adolescents in recent years, and it is clear that this is driven, in the most part, by childhood and adolescent overweight and obesity as well as lack of regular exercise.
Therefore, establishment of a healthy pattern of eating in childhood, without excess calorie intake, and encouragement of regular exercise can be the most effective means of preventing the development of diabetes.
WHAT OTHER FACTORS INCREASE MY RISK OF GETTING DIABETES? QUESTION 16
16.What other factors increase my risk of getting diabetes?
Besides excess weight, hereditary risk, and lack of exercise, another factor that can increase the risk of developing diabetes is the use of certain medications. Among these medications, the type associated most strongly with increased risk are the steroids (also called glucocorticoids), whose members include prednisone, methylprednisolone, hydrocortisone, and dexamethasone.
The steroids belong to a class of naturally occurring stress hormones known as counterregulatory hormones, which prepare the body to combat stress. They tend to raise blood sugar.
Besides excess weight, hereditary risk, and lack of exercise, another factor that can increase the risk of developing diabetes is the use of certain medications. Among these medications, the type associated most strongly with increased risk are the steroids (also called glucocorticoids), whose members include prednisone, methylprednisolone, hydrocortisone, and dexamethasone.
The steroids belong to a class of naturally occurring stress hormones known as counterregulatory hormones, which prepare the body to combat stress. They tend to raise blood sugar.
DOES STRESS AFFECT MY RISK OF GETTING DIABETES? QUESTION 15
15.Does stress affect my risk of getting diabetes?
The perception of stress differs greatly among individuals. What one person may perceive as stressful, another may not. For this reason, stress is quite hard to measure in real-life situations.
Artificial measures of accepted stress, such as electric shocks or deprivation of sleep, are very hard to apply to day-to-day life. However, people who report that they are more stressed, regardless of the actual nature of the stress itself, are more likely to suffer from diabetes.
The perception of stress differs greatly among individuals. What one person may perceive as stressful, another may not. For this reason, stress is quite hard to measure in real-life situations.
Artificial measures of accepted stress, such as electric shocks or deprivation of sleep, are very hard to apply to day-to-day life. However, people who report that they are more stressed, regardless of the actual nature of the stress itself, are more likely to suffer from diabetes.
IS THERE A PARTICULAR DIET THAT WILL REDUCE MY CHANCE OF TYPE 2 DIABETES? QUESTION 14
14. Is there a particular type of diet that will reduce my chance of type 2 diabetes?
The most important aspect of any diet to prevent type 2 diabetes is its calorie (i.e., energy) content. If calorie
intake exceeds calorie usage, then the excess calories will, in the absence of other modifying factors, be directed toward the body’s energy storage compartment, which is, of course, the fat tissue.
Therefore, a diet that matches calorie consumption with output is the key to prevention of overweight and obesity and therefore diabetes. If one is already overweight, then the diet should provide fewer calories than are required, so that energy will be drawn from the body fat stores and gradual weight loss will occur.
The most important aspect of any diet to prevent type 2 diabetes is its calorie (i.e., energy) content. If calorie
intake exceeds calorie usage, then the excess calories will, in the absence of other modifying factors, be directed toward the body’s energy storage compartment, which is, of course, the fat tissue.
Therefore, a diet that matches calorie consumption with output is the key to prevention of overweight and obesity and therefore diabetes. If one is already overweight, then the diet should provide fewer calories than are required, so that energy will be drawn from the body fat stores and gradual weight loss will occur.
ARE THERE ANY MEDICATIONS I CAN TAKE TO HELP PREVENT DIABETES? QUESTION 13
13. Are there any medications I can take to help prevent diabetes?
Yes, there are a number of medications that will help to reduce the likelihood of a person developing type 2 diabetes, but not type 1 diabetes. These are shown in Table 2.
None are labeled by the Food and Drug Administration for this indication. Our use of them is mainly confined to choosing a drug that will tend to slow progression to type 2 diabetes when the drug is needed for another condition.
Yes, there are a number of medications that will help to reduce the likelihood of a person developing type 2 diabetes, but not type 1 diabetes. These are shown in Table 2.
None are labeled by the Food and Drug Administration for this indication. Our use of them is mainly confined to choosing a drug that will tend to slow progression to type 2 diabetes when the drug is needed for another condition.
DOES REGULAR EXERCISE HELP TO PREVENT TYPE 2 DIABETES? QUESTION 12
12.Does regular exercise help to prevent type 2 diabetes?
Yes, regular exercise of at least moderate intensity provides some protection against the onset of type 2 diabetes. Exercise improves insulin resistance and thereby makes insulin more effective at removing glucose from the blood.
In patients with prediabetes (see Question 9), exercise can prevent the progression of elevated glucose values toward the frankly diabetic range, or even restore them to normal. Exercise also consumes calories from those stored in the exercising muscle as starch (glycogen) and the need to replenish these stores draws glucose out of the bloodstream and thereby reduces the circulating levels.
Yes, regular exercise of at least moderate intensity provides some protection against the onset of type 2 diabetes. Exercise improves insulin resistance and thereby makes insulin more effective at removing glucose from the blood.
In patients with prediabetes (see Question 9), exercise can prevent the progression of elevated glucose values toward the frankly diabetic range, or even restore them to normal. Exercise also consumes calories from those stored in the exercising muscle as starch (glycogen) and the need to replenish these stores draws glucose out of the bloodstream and thereby reduces the circulating levels.
HOW DOES MY WEIGHT AFFECT MY RISK OF TYPE 2 DIABETES? QUESTION 11
11.How does my weight affect my risk of type 2 diabetes?
Weight and risk of type 2 diabetes are clearly linked. Figure 3 shows the risk of development of type 2 diabetes, as it relates to body weight.
For clinical purposes, weight is related to height by a formula known as body mass index or BMI. In our society, a BMI of 18 to almost 25 is considered to be healthy and from 25 to almost 30 is considered overweight.
Weight and risk of type 2 diabetes are clearly linked. Figure 3 shows the risk of development of type 2 diabetes, as it relates to body weight.
For clinical purposes, weight is related to height by a formula known as body mass index or BMI. In our society, a BMI of 18 to almost 25 is considered to be healthy and from 25 to almost 30 is considered overweight.
WHY DO WOMEN GET DIABETES WHEN THEY ARE PREGNANT? IS IT DANGEROUS FOR THEM OR THEIR BABY? QUESTION 10
10.Why do some women get diabetes when they are pregnant? Is this dangerous for them or their baby?
Pregnancy is a situation in which insulin resistance (see Question 2) is a normal feature. This is because it is beneficial for the nutrients absorbed from a pregnant woman’s meals to be channeled first to the growing fetus.
The development of maternal insulin resistance in the second half of pregnancy assures that this will occur. At least part of the reason for the development of maternal insulin resistance is that the placenta produces substances that lead to insulin resistance and as the placenta grows, the insulin resistance increases.
Pregnancy is a situation in which insulin resistance (see Question 2) is a normal feature. This is because it is beneficial for the nutrients absorbed from a pregnant woman’s meals to be channeled first to the growing fetus.
The development of maternal insulin resistance in the second half of pregnancy assures that this will occur. At least part of the reason for the development of maternal insulin resistance is that the placenta produces substances that lead to insulin resistance and as the placenta grows, the insulin resistance increases.
IS THERE SUCH THING AS BORDERLINE DIABETES? QUESTION 9
9. Is there such a thing as borderline diabetes? What is it?
The term borderline diabetes has now been replaced by the term prediabetes. Both terms indicate that a person has abnormalities in his or her plasma glucose levels that fall short of standard accepted definitions for frank diabetes.
Table 1 shows the normal ranges for both fasting plasma glucose and for plasma glucose after a glucose load by mouth. The reason that a standardized 75 gram (a little under 3 ounces) glucose load is used is to allow a direct comparison between different individuals under the same conditions.
The term borderline diabetes has now been replaced by the term prediabetes. Both terms indicate that a person has abnormalities in his or her plasma glucose levels that fall short of standard accepted definitions for frank diabetes.
Table 1 shows the normal ranges for both fasting plasma glucose and for plasma glucose after a glucose load by mouth. The reason that a standardized 75 gram (a little under 3 ounces) glucose load is used is to allow a direct comparison between different individuals under the same conditions.
CAN A PERSON HAVE BOTH TYPE 1 AND TYPE 2 DIABETES AT THE SAME TIME? QUESTION 8
8. Can a person have both type 1 and type 2 diabetes at the same time?
Generally speaking, we do not diagnose both disorders in the same individual. If people have type 1 diabetes, they are completely lacking effective circulating insulin.
By definition, this is not the case in people with type 2 diabetes, so having the one disorder effectively rules
out the other. However, people with type 1 diabetes may be prone to the same metabolic problems as those with type 2 diabetes.
Generally speaking, we do not diagnose both disorders in the same individual. If people have type 1 diabetes, they are completely lacking effective circulating insulin.
By definition, this is not the case in people with type 2 diabetes, so having the one disorder effectively rules
out the other. However, people with type 1 diabetes may be prone to the same metabolic problems as those with type 2 diabetes.
ARE MY BROTHERS AND SISTERS AND MY CHILDREN AT RISK OF DIABETES? QUESTION 7
7. Are my brothers and sisters and my children at risk of diabetes?
If you have type 1 diabetes, your first-degree relatives (i.e. mother, father, brother, sister, and your children) are about ten times more likely than the general population to get type 1 diabetes. The frequency of type 1 diabetes in the general population is about half a percent (i.e., one in two hundred), so the risk in your first-degree relatives is about 10 1/2, or 5%.
Fortunately, this is not particularly high. Also, it is related to age. About 90% of cases of type 1 diabetes occur before age 35. Therefore, the parents of a person with type 1 diabetes are at considerably less, and ever decreasing, risk compared to his or her siblings and children.
If you have type 1 diabetes, your first-degree relatives (i.e. mother, father, brother, sister, and your children) are about ten times more likely than the general population to get type 1 diabetes. The frequency of type 1 diabetes in the general population is about half a percent (i.e., one in two hundred), so the risk in your first-degree relatives is about 10 1/2, or 5%.
Fortunately, this is not particularly high. Also, it is related to age. About 90% of cases of type 1 diabetes occur before age 35. Therefore, the parents of a person with type 1 diabetes are at considerably less, and ever decreasing, risk compared to his or her siblings and children.
DOES DIABETES AFFECT ALL RACIAL GROUPS? QUESTION 6
6. Does diabetes affect all racial groups equally?
No, there are significant differences in the hereditary tendency to acquire diabetes. In general Caucasians (non-Hispanic whites) have a lower tendency to develop type 2 diabetes than other ethnic groups. The situation with regard to type 1 diabetes is the opposite, with the highest prevalence currently being in the regions in and near Finland, Sardinia, and Kuwait.
Lifestyle does not appear to be more important than the hereditary tendency in determining the chance of a person to develop type 1 diabetes. However, in the case of type 2 diabetes it is an important factor.
No, there are significant differences in the hereditary tendency to acquire diabetes. In general Caucasians (non-Hispanic whites) have a lower tendency to develop type 2 diabetes than other ethnic groups. The situation with regard to type 1 diabetes is the opposite, with the highest prevalence currently being in the regions in and near Finland, Sardinia, and Kuwait.
Lifestyle does not appear to be more important than the hereditary tendency in determining the chance of a person to develop type 1 diabetes. However, in the case of type 2 diabetes it is an important factor.
CAN DIABETES BE CURED? QUESTION 5
5. Can diabetes be cured?
In general, we do not consider that diabetes can be cured once it has been diagnosed. People with type 2 diabetes can reverse the detectable abnormalities of diabetes by lifestyle adjustment without the use of medications (discussed in Question 28).
However, the tendency to manifest high blood sugar again is always present if the patient is under significant metabolic stress, such as that caused by medications, severe illness, injury, regaining lost weight, cessation of exercise, aging, etc. Therefore we consider that diabetes can be under excellent control or in remission, but we do not usually use the word cured.
In general, we do not consider that diabetes can be cured once it has been diagnosed. People with type 2 diabetes can reverse the detectable abnormalities of diabetes by lifestyle adjustment without the use of medications (discussed in Question 28).
However, the tendency to manifest high blood sugar again is always present if the patient is under significant metabolic stress, such as that caused by medications, severe illness, injury, regaining lost weight, cessation of exercise, aging, etc. Therefore we consider that diabetes can be under excellent control or in remission, but we do not usually use the word cured.
WHAT ARE THE SYMPTOMS OF DIABETES? QUESTION 4
4.What are the symptoms of diabetes?
The typical symptoms of diabetes occur as a result of the high levels of glucose in the bloodstream and its passage into the urine and other tissues. These are frequent urination and thirst. Thirst arises as a result of the dehydration caused by the frequent urination.
Dehydration and loss of nutrient calories in the urine lead to weight loss and hunger. Passage of glucose into the tissues of the eye can cause fluctuating degrees of blurred vision. When these symptoms are prolonged and severe, as is typical with type 1 diabetes, serious changes occur in our blood chemistry due to the deficiency of insulin.
The typical symptoms of diabetes occur as a result of the high levels of glucose in the bloodstream and its passage into the urine and other tissues. These are frequent urination and thirst. Thirst arises as a result of the dehydration caused by the frequent urination.
Dehydration and loss of nutrient calories in the urine lead to weight loss and hunger. Passage of glucose into the tissues of the eye can cause fluctuating degrees of blurred vision. When these symptoms are prolonged and severe, as is typical with type 1 diabetes, serious changes occur in our blood chemistry due to the deficiency of insulin.
WHAT IS THE DIFFERENCE BETWEEN DIABETES MELLITUS AND DIABETES INSIPIDUS? - QUESTION 3
3.What is the difference between diabetes mellitus and diabetes insipidus?
The word diabetes is an interesting one. Its origin is in the Greek language where it is derived from the word for a siphon or, more simply, a pipe or hose. This word was used to describe the disorder in ancient times (and diabetes was recognized in great antiquity) because those suffering from it produced such plentiful amounts of urine that they were reminiscent of a water pipe.
The reason for the plentiful amounts of urine lies in the fact that when the sugar glucose reaches excessively high levels in our bloodstream, it is filtered into the kidney and enters the urine in large quantities. Due to its chemical and physical properties, when large amounts of glucose are filtered by our kidneys into the urine, it cannot be fully reabsorbed and retains a large amount of water with it, thus creating very large volumes of urine.
The word diabetes is an interesting one. Its origin is in the Greek language where it is derived from the word for a siphon or, more simply, a pipe or hose. This word was used to describe the disorder in ancient times (and diabetes was recognized in great antiquity) because those suffering from it produced such plentiful amounts of urine that they were reminiscent of a water pipe.
The reason for the plentiful amounts of urine lies in the fact that when the sugar glucose reaches excessively high levels in our bloodstream, it is filtered into the kidney and enters the urine in large quantities. Due to its chemical and physical properties, when large amounts of glucose are filtered by our kidneys into the urine, it cannot be fully reabsorbed and retains a large amount of water with it, thus creating very large volumes of urine.
WHAT IS THE DIFFERENCE BETWEEM TYPE 1 AND TYPE 2 DIABETES? - QUESTION 2 AND WE ANSWER
2.What is the difference between type 1 and type 2 diabetes?
Type 1 diabetes is entirely due to an almost complete deficiency of insulin. The deficiency is the result of the immune system erroneously attacking and destroying the insulin-producing cells in the pancreas.
For the proper functioning of our bodies, it is necessary for insulin to be present at all times in the bloodstream and tissues, not only after we have eaten. Insulin is essential to maintain the structure of our tissues and prevent them from being broken down in an uncontrolled manner.
Type 1 diabetes is entirely due to an almost complete deficiency of insulin. The deficiency is the result of the immune system erroneously attacking and destroying the insulin-producing cells in the pancreas.
For the proper functioning of our bodies, it is necessary for insulin to be present at all times in the bloodstream and tissues, not only after we have eaten. Insulin is essential to maintain the structure of our tissues and prevent them from being broken down in an uncontrolled manner.
WHY AND HOW DID I GET DIABETES? - QUESTION 1 AND WE ANSWER
1.Why and how did I get diabetes?
Diabetes occurs for a number of reasons, but the ultimate cause of the high blood sugar that characterizes the disorder is either deficiency of the hormone insulin or a combination of insulin deficiency and resistance of the body tissues to its actions.
In response to food intake, insulin is released by specialized cells in the pancreas and is necessary for adequate amounts of glucose and other nutrients from food to be absorbed into certain tissues of the body.When insulin is lacking or the body resists its actions, the level of glucose in the blood becomes excessively high and diabetes is diagnosed.
Diabetes occurs for a number of reasons, but the ultimate cause of the high blood sugar that characterizes the disorder is either deficiency of the hormone insulin or a combination of insulin deficiency and resistance of the body tissues to its actions.
In response to food intake, insulin is released by specialized cells in the pancreas and is necessary for adequate amounts of glucose and other nutrients from food to be absorbed into certain tissues of the body.When insulin is lacking or the body resists its actions, the level of glucose in the blood becomes excessively high and diabetes is diagnosed.
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