Diabetes

Diabetes

Diabetes mellitus (MEL-ih-tus), often referred to as diabetes, is characterized by high blood glucose (sugar) levels that result from the body’s inability to produce enough insulin and/or effectively utilize the insulin. Diabetes is a serious, life-long condition and the sixth leading cause of death in the United States. Diabetes is a disorder of metabolism (the body's way of digesting food and converting it into energy). There are three forms of diabetes. Type 1 diabetes is an autoimmune disease that accounts for five- to 10-percent of all diagnosed cases of diabetes. Type 2 diabetes may account for 90- to 95-percent of all diagnosed cases. The third type of diabetes occurs in pregnancy and is referred to as gestational diabetes. Left untreated, gestational diabetes can cause health issues for pregnant women and their babies. People with diabetes can take preventive steps to control this disease and decrease the risk of further complications.

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  • 13 Answers
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    AStacy Wiegman, PharmD, Pharmacy, answered
    Eating sugar does not cause diabetes, although eating a diet high in sugar can lead to being overweight. Lifestyle factors such as being overweight, along with not exercising enough, plus genetics are the causes of type 2 diabetes. The cause of type 1 diabetes is not well understood, but it happens when the immune system attacks the cells that produce insulin in the pancreas. Sugar has nothing to do with this.
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    Random plasma glucose tests are the simplest way to detect diabetes. This test measures the amount of glucose in the blood at any given time and is done without fasting. If you have obvious symptoms of diabetes and the amount of glucose in your blood is 200 mg/dl or higher, you have diabetes. Symptoms of diabetes include frequent urination, intense thirst, blurred vision, unexplained weight loss, and extreme tiredness.

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    Although your health care provider may suspect that you have diabetes because of your symptoms, the only sure way to tell is with blood tests. Blood tests are used to diagnose both type 1 and type 2 diabetes, as well as gestational diabetes.

    The following blood tests are used for diagnosis:

    A1C Test

    • The A1C test can be used to diagnose diabetes.
    • A1C values represent average blood glucose levels over the past 2–3 months.
    • Test measures the concentration of hemoglobin molecules that have glucose attached to them. The measure is given as a percentage. An 8% level means that 8% of your molecules are glycated (sugar coated).
    • An A1C of 6.5% or higher is used to diagnose diabetes.

    Fasting Plasma Glucose Test

    • For this test, you will be asked not to eat or drink anything but water for at least 8–10 hours. Then, a sample of your blood is taken and the amount of glucose in the blood is measured.
    • For those without diabetes, the amount of glucose after fasting is usually less than 100 mg/dl.
    • However, when the amount of fasting plasma glucose is 126 mg/dl or higher, diabetes is suspected. A firm diagnosis of diabetes is made when two fasting plasma glucose tests, done on different days, are at least 126 mg/dl.

    Random Plasma Glucose Test

    • This test measures the amount of plasma glucose at any given time and is done without fasting.
    • You may be diagnosed with diabetes if your plasma glucose is 200 mg/dl or higher and you have obvious symptoms, such as frequent urination, intense thirst, blurred vision, unexplained weight loss, and extreme tiredness.

    Oral Glucose Tolerance Test

    • For this test, you will be asked not to eat or drink anything overnight. Then, in the morning, a sample of your blood is taken before and two hours after you have a drink that contains glucose.
    • If your fasting plasma glucose is 126 mg/dl or higher and/or your post-drink plasma glucose is 200 mg/dl or higher, then you will be diagnosed with diabetes regardless of your symptoms.
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    Type 2 diabetes tends to develop in people who have extra body fat.  Where you carry your excess fat may determine whether you get type 2 diabetes: extra fat above the hips (central body obesity) is riskier than fat in the hips and thighs for developing type 2 diabetes.  And leading an inactive “couch potato” lifestyle can also lead to diabetes.  This lifestyle also contributes to obesity.  Three-fourths of all people with type 2 diabetes are or have been obese—that is, they have a body mass index of 30 or above.  A BMI of 25 to 29.9 is considered overweight.
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    AToby Smithson, Nutrition & Dietetics, answered on behalf of Academy of Nutrition and Dietetics

    The best treatment for lowering your blood sugar is through diabetes self-management of diet, exercise, and medications. Consuming a balanced diet throughout the day and following a meal plan of carbohydrate distribution will help keep blood sugar readings in line. Your consumption of carbohydrate containing foods will also be managed through medications if necessary. Exercise can help lower blood sugar readings as well as aid in weight loss. Keep in mind there are other variables to add to the mix of managing blood sugar readings such as being sick with a cold, not getting adequate sleep, increased stress, and increase or decrease in physical activity.

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    AAmy Campbell, Endocrinology, Diabetes & Metabolism, answered

    Yes. In fact, you can pretty much eat any food if you have diabetes. But you need to know how much of that food you can eat and how often you can eat it. Dairy foods, such as milk and yogurt, contain carbohydrate, along with protein and maybe some fat. Carbohydrate has the most effect on blood glucose, compared to protein and fat. One cup of milk and six ounces of light-style yogurt each contain about 15 grams of carb, about as much as in a slice of bread or a piece of fruit. So if you want to drink milk or eat yogurt, you need to "count" them in your meal plan as one of your carb choices. Other dairy foods, like cheese, eggs and butter are mostly protein and/or fat, so they're counted differently in your meal plan. Cheese and butter tend to be high in saturated fat, a type of fat that can raise cholesterol levels, so it's wise to limit your intake of these foods, and choose lower fat cheeses and trans-fat free tub margarine, instead. Of course, if you have a lactose intolerance or a milk allergy, you may need to avoid some dairy foods. A dietitian can help you figure out how much of any food you can eat, as well as give you guidance on how much carbohydrate, protein and fat to aim for at your meals.

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    AAnkush K. Bansal, MD, Internal Medicine, answered on behalf of MDLIVE

    Not particularly but the fat in whole milk may contribute to obesity which will complicate diabetes. If you must drink milk, drink skim or 1%. By the way, whole (cow's) milk contains 4% fat so 2% is not that much better - it's not 2% of 4%. Low-fat cheeses and plain yogurt (with or without real fruit) is ok in moderation. 

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    AAmy Jones, Nutrition & Dietetics, answered
    Gluten is not bad for someone who has type 2 diabetes, unless that person also has Celiac disease or gluten intolerance. 
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    AWilliam Lee Dubois, Endocrinology, Diabetes & Metabolism, answered

    Call your doctor.

    Right.

    Now.

    You are in danger. If you’re dropping in your sleep you’re over medicated.

    Successful diabetes treatment is a balancing act between medications and therapies that lower blood sugar on one hand, and our intake of food on the other hand. Once balanced, it works pretty well, but sometimes getting that balance right is quite a trick. If you are going low in your sleep, we haven’t figured out that magic balance yet (or something has changed—maybe you lost weight or are eating less).

    Low blood sugar is always dangerous, but especially at night. You need to hook up with your medical team right away. In the meantime, eat a snack at bedtime as anti-low insurance. Half a peanut butter sandwich is a good choice. Unless you don’t like peanut butter. You want something that is somewhat high-carb, but also high in fat so that it lasts a long time. Chocolate is another good choice, except that your spouse will refuse to believe that it’s “medicine.”

    You want to avoid super-fast sugars in this case. A glass of juice would be a poor choice.

    But an evening snack is a patch. An emergency measure. It's unacceptable as part of your long-term therapy plan. You shouldn’t have to feed your medications.

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    AWilliam Lee Dubois, Endocrinology, Diabetes & Metabolism, answered

    Hello. I’d like to introduce you to your liver. Other than your skin, it’s the largest organ in your body.

    Your liver is a multi-tasking organ. It’s a filter. It’s a manufacturing plant for digestive juices. And it’s a giant sugar battery. Let’s talk about that last function.

    Every cell in your body, from a brain cell, to a cardiac muscle cell, to a cell in your little toe nail eats sugar. Sugar is the fuel they use to live and carry out their assorted specialized functions that keep you alive, healthy, and interesting.

    Your body’s primary source of sugar is from eating. Everything you eat, from Twinkies to t-bones, gets broken down into sugar by the body’s digestive system. Of course it isn’t practical to be eating all the time (even though some people try very hard to do just that), so the body has a storage system for extra sugar, and that’s your liver.

    When everything is working right, the liver dribbles sugar back into your blood stream as needed between meals and overnight while you sleep. When everything isn’t working right, like say, when you have diabetes, the liver may dribble too much sugar into the system overnight. This causes your morning blood sugar to be higher than your bedtime sugar even though all you have been doing is sleeping.

    Now, before you freak out on me, I want to make it clear that there’s nothing wrong with your liver. It isn’t broken, or failing. It’s just being a little over zealous in its duties.

    A very safe, effective, and cost-effective medication called metformin (a.k.a. Glucophage) will fix the problem.