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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    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 some other things that can cause your meter to give a poor reading:
    • Dirty meter
    • Meter or strip that's not at room temperature
    • Outdated test strip
    • Meter not calibrated (set up for) the current box of test strips
    • 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.
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    Although the A1C test is an important tool, it can't replace daily self-testing of blood glucose for those who need it. A1C tests don't measure your day-to-day control. You can't adjust your insulin on the basis of your A1C tests. That's why your blood sugar checks and your log of results are so important to staying in effective control.
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    Hemoglobin, a protein that links up with sugars such as glucose, is found inside red blood cells. Its job is to carry oxygen from the lungs to all the cells of the body. When diabetes is uncontrolled, you end up with too much glucose in the bloodstream. This extra glucose enters your red blood cells and links up (or glycates) with molecules of hemoglobin. The more excess glucose in your blood, the more hemoglobin gets glycated. By measuring the percentage of A1C in the blood, you get an overview of your average blood glucose control for the past few months.

    Suppose your blood sugar was high last week. What happened? More glucose hooked up (glycated) with your hemoglobin. This week, your blood glucose is back under control. Still, your red blood cells carry the "memory" of last week's high blood glucose in the form of more A1C.

    This record changes as old red blood cells in your body die and new red blood cells (with fresh hemoglobin) replace them. The amount of A1C in your blood reflects blood sugar control for the past 120 days, or the lifespan of a red blood cell.

    In a person who does not have diabetes, about 5% of all hemoglobin is glycated. For someone with diabetes and high blood glucose levels, the A1C level is higher than normal. How high the A1C level rises depends on what the average blood glucose level was during the past weeks and months. Levels can range from normal to as high as 25% if diabetes is badly out of control for a long time.
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    You aren't perfect -- and neither is your spouse or partner. Managing diabetes is a lot like juggling -- a careful balance of activity with food and medication. Even the best jugglers occasionally drop a ball. All you can do is pick it up and start juggling again.

    You and your spouse will do things differently. You are different people and you can't read each others' minds. Remind each other that you are a team and a team works together. Ultimately, your goal is the same -- to keep your child healthy and happy.

    Parent-to-Parent Communications Tips:
    • Ask questions and truly listen to each other's responses.
    • Share your honest feelings -- the everyday decisions on diabetes care and the deeper and darker emotions, such as guilt and fear.
    • Make decisions together. Be consistent in delivering your decisions. Your child will sense when you are not working together.
    • Set realistic expectations -- remember that no one is perfect.
    • Try to put yourself in the other person's shoes.
    • Stay calm and listen before you react.
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    The A1C test is a test that measures a person's average blood glucose level over the past 2 to 3 months. Hemoglobin is the part of a red blood cell that carries oxygen to the cells and sometimes joins with the glucose in the bloodstream. Also called hemoglobin A1C or glycosylated hemoglobin, the test shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood.
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    Consider these sobering statistics from the U.S. Department of Health and Human Services' Indian Health Service:
    • 2.2 times higher -- Likelihood of American Indians and Alaska Natives to have diabetes compared with non-Hispanic whites
    • 95% -- Percent of American Indians and Alaska Natives with diabetes who have type 2 diabetes (as opposed to type 1 diabetes)
    • 30% -- Estimated percent of American Indians and Alaska Natives who have prediabetes
    American Indians and Alaska Natives are clearly at greater risk. Educate yourself on how to prevent type 2 diabetes if you don't have it now, or how to effectively treat it if you've been diagnosed.
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    Poor control of diabetes can cause symptoms that look like depression. During the day, high or low blood sugar may make you feel tired or anxious. Low blood sugar levels can also lead to hunger and eating too much. If you have low blood sugar at night, it could disturb your sleep. If you have high blood sugar at night, you may get up often to urinate and then feel tired during the day.
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    When offered an alcoholic drink or cigarettes, here are some ways your teen can politely decline:
    • No thanks - I'm cool!
    • No thanks - I'm the designated driver!
    • No thanks - I have diabetes and if I drink or smoke, it can make me really sick. I'd rather be here the whole night and have a good time than have to leave early!
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    Here are some tips to help you and your child be prepared for situations where she's offered alcohol, cigarettes or drugs. These tips should also be helpful as your child transitions into adulthood when it becomes legal to drink (age 21) or is frequently around others who do (i.e., at college):

    • Ask your diabetes team (D-team) to discuss the affects of alcohol, cigarettes and drugs on diabetes with your teen.
    • Ask your teen about their conversation with the D-team. Be sure they understand what happens when a person with diabetes drinks alcohol, or uses tobacco or drugs.
    • Discuss peer pressure. Share ways you handled these kinds of issues as a teen.
    • Listen closely and try not to sound like you're nagging.
    • Remind your teen to always have her diabetes supplies (D-supplies) and wear a medical ID bracelet or necklace.
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    Questions to ask your child's doctor if your child has diabetes: 
    • When to get a flu shot?
    • Which symptoms should we look for?
    • When should we call the doctor?
    • Which doctor should we call? Pediatrician or endocrinologist? Or both?
    • How often should we test blood glucose (BG) levels and ketones during illness?
    • Which over-the-counter medicines are safe to take?
    • If needed, how much additional insulin should be given?