Diabetes

      Type 1 diabetes

      Type 2 diabetes

      Diabetic Neuropathy

      Blood Glucose Monitoring

      How to Eat Well

:: DIABETES

Diabetes

Diabetes is a long-term (chronic) condition caused by too much glucose (sugar) in the blood. It is also known as diabetes mellitus.

In the UK, diabetes affects approximately 2.3 million people, and it's thought there are at least half a million more people who have the condition but are not aware of it.

  How does diabetes occur?

Normally, the amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach). When food is digested and enters your bloodstream, insulin moves any glucose out of the blood and into cells, where it is broken down to produce energy.

However, in those with diabetes, the body is unable to break down glucose into energy. This is because there is either not enough insulin to move the glucose, or because the insulin that is there does not work properly.

There are two types of diabetes - type 1 and type 2. This article focuses on type 1 diabetes (go to 'useful links' for information about type 2 diabetes).

Type 1 diabetes

Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them.

Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar (glucose), starches and other food into energy needed for daily life.

Finding out you have diabetes is scary. But don't panic. Type 1 diabetes is serious, but people with diabetes can live long, healthy, happy lives.

Type 2 diabetes

Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency.

Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems:

• Right away, your cells may be starved for energy.

• Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart.

Finding out you have diabetes is scary. But don't panic. Type 2 diabetes is serious, but people with diabetes can live long, healthy, happy lives.

While diabetes occurs in people of all ages and races, some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in Asians, African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population.

Diabetic Neuropathy

Gestational diabetes
Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually, type 2.

Pre-diabetes
Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes.

Conditions and Treatment

In type 2 diabetes, the body fails to properly use insulin, which is needed to take sugar from the blood to the cells.  You can learn more about some conditions (including hyperglycemia and hypoglycemia) and how to prevent them in this section. You will also find helpful information about insulin, diagnostic tests and tips on what to expect from your health care provider.

Hypoglycemia
Hypoglycemia, or low blood sugar, can happen even during those times when you're doing all you can to control your diabetes. 

Hyperglycemia
Hyperglycemia is a major cause of many of the complications that happen to people who have diabetes.  For this reason, it's important to know what hyperglycemia is, what its symptoms are, and how to treat it.

Checking Your Blood Glucose 

People with diabetes work to keep their blood sugar (glucose) as near to normal as possible. Keeping your blood glucose in your target range can help prevent or delay the start of diabetes complications such as nerve, eye, kidney, and blood vessel damage.When you learned you had diabetes, you and your health care team worked out a diabetes care plan. The plan aims to balance the foods you eat with your exercise and, possibly, diabetes pills or insulin. You can do two types of checks to help keep track of how your plan is working. These are blood glucose checks and urine ketone checks.

Blood Glucose Monitoring Checks

Blood glucose monitoring is the main tool you have to check your diabetes control. This check tells you your blood glucose level at any one time. Keeping a log of your results is vital. When you bring this record to your health care provider, you have a good picture of your body's response to your diabetes care plan. Blood glucose checks let you see what works and what doesn't. This allows you and your doctor, dietitian, or nurse educator to make needed changes.

Here is a table that lists blood glucose ranges for adults with diabetes:

Who Should Check?

Experts feel that anyone with diabetes can benefit from checking their blood glucose. The American Diabetes Association recommends blood glucose checks if you have diabetes and are:

• taking insulin or diabetes pills

• on intensive insulin therapy

• pregnant

• having a hard time controlling your blood glucose levels

• having severe low blood glucose levels or ketones from high blood glucose levels

• having low blood glucose levels without the usual warning signs

Urine Checks

Urine checks for glucose are not as accurate as blood glucose checks. Urine testing for glucose should not be done unless blood testing is impossible.

A urine check for ketones is another matter. This check is important when your diabetes is out of control or when you are sick. You can find moderate or large amounts of ketones in urine when your body is burning fat instead of glucose for fuel. This happens when there is too little insulin at work. Everyone with diabetes needs to know how to check their urine for ketones.

How Blood Checks Work

You stick your finger with a special needle, called a lancet, to get a drop of blood. With some meters, you can also use your forearm, thigh or fleshy part of your hand. There are spring-loaded lancing devices that make sticking yourself less painful. Before using the lancing device, wash your hands or site you chose with soap and water. If you use your fingertip, stick the side of your fingertip by your fingernail to avoid having sore spots on the frequently used part of your finger.

Checking With a Blood Glucose Meter

Blood glucose meters are small computerized machines that "read" your blood glucose. In all types of meters, your blood glucose level shows up as a number on a screen (like that on your pocket calculator). Be sure your doctor or nurse educator shows you the correct way to use your meter. With all the advances in blood glucose meters, use of a meter is better than visual checking.

How to Pick a Meter

There are many meters to choose from. Some meters are made for those with poor eyesight. Others come with memory so you can store your results in the meter itself. The American Diabetes Association does not endorse any products or recommend one meter over another. If you plan to buy a meter, here are some questions to think about:

• What meter does your doctor or diabetes educator suggest? They may have meters that they use often and know best.

• What will it cost? Some insurance companies will only pay for a certain meter. Call your insurance company before you purchase a meter and ask how to get a meter and supplies. If your insurance company does not pay for blood glucose checking supplies, rebates are often available toward the purchase of your meter. You still have to consider the cost of the matching strips and lancets. Shop around.

• How easy is the meter to use? Methods vary. Some have fewer steps than others.

• How simple is the meter to maintain? Is it easy to clean? How is the meter calibrated (set correctly for the batch of strips you are using)?

Are meters accurate?

Experts testing meters in the lab setting found them accurate and precise. That's the good news. The bad: meter mistakes most often come from the person doing the blood checks. For good results you need to do each step correctly. Here are other things that can cause your meter to give a poor reading:

• a dirty meter

• a meter or strip that's not at room temperature

• an outdated test strip

• a meter not calibrated (set up for) the current box of test strips

• a blood drop that is too small

Ask your health care team to check your skills at least once a year. Error can creep in over time.

Logging Your Results

When you finish the blood glucose check, write down your results and use them to see how food, activity and stress affect your blood glucose. Take a close look at your blood glucose record to see if your level is too high or too low several days in a row at about the same time. If the same thing keeps happening, it might be time to change your plan. Work with your doctor or diabetes educator to learn what your results mean for you. This takes time. Ask your doctor or nurse if you should report results out of a certain range at once by phone.

Keep in mind that blood glucose results often trigger strong feelings. Blood glucose numbers can leave you upset, confused, frustrated, angry, or down. It's easy to use the numbers to judge yourself. Remind yourself that your blood glucose level is a way to track how well your diabetes care plan is working. It is not a judgment of you as a person. The results may show you need a change in your diabetes plan.

Checking for Ketones

You may need to check your urine for ketones once in a while. Ketones in the urine is a sign that your body is using fat for energy instead of using glucose because not enough insulin is available to use glucose for energy. Ketones in the urine is more common in type 1 diabetes.

Urine tests are simple, but to get good results, you have to follow directions carefully. Check to be sure that the strip is not outdated. Read the insert that comes with your strips. Go over the correct way to check with your doctor or nurse.

Here's how most urine tests go:

• Get a sample of your urine in a clean container.

• Place the strip in the sample (you can also pass the strip through the urine stream).

• Gently shake excess urine off the strip.

• Wait for the strip pad to change color. The directions will tell you how long to wait.

• Compare the strip pad to the color chart on the strip bottle. This gives you a range of the amount of ketones in your urine.

• Record your results.

What do your results mean? Small or trace amounts of ketones may mean that ketone buildup is starting. You should test again in a few hours. Moderate or large amounts are a danger sign. They upset the chemical balance of your blood and can poison the body. Never exercise when your urine checks show moderate or large amounts of ketones and your blood glucoser is high. These are signs that your diabetes is out of control. Talk to your doctor at once if your urine results show moderate or large amounts of ketones.

Keeping track of your results and related events is important. Your log gives you the data you and your doctor and diabetes educator need to adjust your diabetes care plan.

When to Test

Ask your doctor or nurse when to check for ketones. You may be advised to check for ketones when:

• your blood glucose is more than 300 mg/dl

• you feel nauseated, are vomiting, or have abdominal pain

• you are sick (for example, with a cold or flu)

• you feel tired all the time

• you are thirsty or have a very dry mouth

• your skin is flushed

• you have a hard time breathing your breath smells "fruity"

• you feel confused or "in a fog"

These can be signs of high ketone levels that need your doctor's help.

How to Eat Well

Balancing your diet when you have Type 2 diabetes can be challenging but it is important. Making sensible food choices and adapting your eating habits will help you manage your diabetes and help protect your long-term health.

 The good news is that you should still be able to enjoy a wide variety of food. It is better to make small changes that you feel you can stick to rather than completely altering your diet and not sticking to it.

1. Eat three meals a day

 Avoid skipping meals and space out your breakfast, lunch and evening meal over the day. This will not only help control your appetite but will also help control your blood glucose levels.

2. At each meal include starchy carbohydrate foods

 Examples include bread, pasta, chapatis, potatoes, yam, noodles, rice and cereals. The amount of carbohydrate you eat is important to control your blood glucose levels. Especially try to include those that are more slowly absorbed (have a lower glycaemic index) as these won’t affect your blood glucose levels as much. Better choices include: pasta, basmati or easy cook rice, grainy breads such as granary, pumpernickel and rye, new potatoes, sweet potato and yam, porridge oats, All-Bran and natural muesli. The high fibre varieties of starchy foods will also help to maintain the health of your digestive system and prevent problems such as constipation.

3. Cut down on the fat you eat, particularly saturated fats

 A low fat diet benefits health. Choose unsaturated fats or oils, especially monounsaturated fat (eg olive oil and rapeseed oil) as these types of fats are better for your heart. As fat is the greatest source of calories, eating less fat will help you to lose weight if you need to. To cut down on the fat you eat, here are some tips:

    * Use less saturated fat by having less butter, margarine and cheese.

    * Choose lean meat and fish as low fat alternatives to fatty meats.

    * Choose lower fat dairy foods such as skimmed or semiskimmed milk, low fat or diet yogurts, reduced fat cheese and lower fat spreads.

    * Grill steam or oven bake instead of frying or cooking with oil or other fats.

    * Watch out for creamy sauces and dressings and swap for tomato-based sauces instead.

4. Eat more fruit and vegetables

 Aim for at least five portions a day to provide you with vitamins, minerals and fibre to help you to balance your overall diet. One portion is, for example, a banana or apple, a handful of grapes, a tablespoon of dried fruit, a small glass of fruit juice or fruit smoothie, three heaped tablespoons of vegetables or a cereal bowl of salad.

5. Include more beans and lentils

 Examples include kidney beans, butter beans, chickpeas or red and green lentils. These have less of an effect on your blood glucose levels and may help to control your blood fats. Try adding them to stews, casseroles and soups, or to a salad.

6. Aim for at least two portions of oily fish a week

 Examples include mackerel, sardines, salmon and pilchards. Oily fish contains a type of polyunsaturated fat called omega 3 which helps protect against heart disease.

7. Limit sugar and sugary foods

 This does not mean you need to eat a sugar-free diet. Sugar can be used in foods and in baking as part of a healthy diet. Using sugar-free, no added sugar or diet fizzy drinks/squashes, instead of sugary versions can be an easy way to reduce the sugar in your diet.

8. Reduce salt in your diet to 6g or less a day

 More than this can raise your blood pressure, which can lead to stroke and heart disease. Limit the amount of processed foods you eat (as these are usually high in salt) and try flavouring foods with herbs and spices instead of salt.

9. Drink alcohol in moderation only

 That’s a maximum of 2 units of alcohol per day for a woman and 3 units per day for a man. For example, a single pub measure (25ml) of spirit is about 1 unit or half a pint of lager, ale, bitter or cider has 1-1 1/2 units. Over the years the alcohol content of most drinks has gone up. A drink can now contain more units than you think – a small glass of wine (175ml) could contain as much as 2 units. Remember, alcohol contains empty calories so think about cutting back further if you are trying to lose weight. Never drink on an empty stomach, as alcohol can make hypoglycaemia (low blood glucose levels) more likely to occur when taking certain diabetes medication.