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.

Recently Answered

  • 1 Answer
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    Once you know how your body handles a given amount of insulin, you and your dietitian or nurse educator will meet and fine-tune your plan. Take into account any physical activities and how they affect your blood glucose levels, too.

    However you decide to go about fine-tuning your insulin doses, remember that you still need to pay attention to your food choices. It’s easy to get in the habit of eating fries and a shake and just taking more insulin. But even though you are counting carbohydrates, calories still count, too.

    It will take a while before you feel like you’ve mastered these food and insulin adjustments, but they can buy you greater flexibility in your activities and meals while keeping your blood glucose level where you want it.

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    If you have type 1 diabetes, you’ll be using insulin and other injectable medication to intensively manage your diabetes. You’ll probably be taking more and different types of insulin in intensive diabetes management. Keep in mind that you’ll also need to monitor your blood glucose much more frequently with intensive diabetes management

    • You’ll probably want to check your blood glucose often, at least as often as you inject insulin or other injectables and sometimes more.

    • You could be monitoring seven times a day depending on how often you eat: before your three meals, after each meal, and before bedtime.

    • You may even check at 3 a.m. once or twice a week. For instance, you will not want your blood glucose level to become too low during the night. So if you’ve experienced several severe hypoglycemic episodes, you may want to aim for a higher overnight blood glucose level.

    • Every bit of checking gives you more knowledge of how your body reacts to food, exercise, insulin, stress, and illness. Once you’ve settled into a comfortable routine, you may be able to do fewer checks. Remember that monitoring gives you the information you need to make wise decisions in managing your diabetes.

    • You may want to wear a continuous glucose monitor that records your glucose level throughout the day and night.

  • 1 Answer
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    There are many factors to consider in setting your personal glucose goals:

    • your age

    • how long you’ve had diabetes

    • the type of diabetes you have

    • frequency and severity of hypoglycemia 

    • your lifestyle and occupation

    • other medical conditions

    • how much support you get from family and friends 

    • your personal motivation for diabetes self-management

  • 2 Answers
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    A reasonable goal for most people with diabetes is an A1C of less than 7%, as the risk for kidney disease, eye disease, and other complications increases as A1C goes up. Researchers took patients’ A1C measurements in the Diabetes Control and Complications Trial to see how well they were doing with overall control. The study subjects on intensive management lowered their A1C values dramatically -- even though they did not often reach their daily blood glucose goals. This improvement was seen after about 3-6 months of intensive management.
    In addition to A1C, patients may also hear the term estimated average glucose (eAG). Estimated average glucose is a new way to report A1C results using the same units as your blood glucose meter (mg/dl). The American Diabetes Association’s target for results reported as eAG is 154 mg/dl.
    See All 2 Answers
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    The American Diabetes Association has established recommended targets for glucose levels. These recommendations are based on the findings from research about preventing complications.

    Before meals: 70-130 mg/dl

    Two hours after the first bite of a meal: less than 180 mg/dl

    However, the ADA’s goals may not be easy for you to reach. Or they may not be right for you. Why not see what your blood glucose levels are before and after meals and compare them to the goals listed above? Then choose a realistic goal for the short term. Perhaps you can make a few, small changes to slowly lower your blood glucose levels. 

  • 1 Answer
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    One piece of information that came out of the Diabetes Control and Complications Trial (DCCT) is that even if you set goals that seem reasonable, they can be hard to reach. The DCCT goals for people in the intensive management group were to have near-normal blood glucose levels before and after meals and at bedtime. Most people just couldn’t consistently reach these goals. No matter how hard you and your health care team work, it is difficult to keep blood glucose levels close to those found in people without diabetes.
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    The idea behind intensive diabetes management is to keep your blood glucose levels as close to normal as possible. If you decide that intensive management is for you, you will want to choose blood glucose goals as close to those of people without diabetes as is reasonable and safe for you. It’s a group decision that you, your family, and your health care team need to make together.
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    There are some people for whom intensive diabetes management is not safe. For instance, because tighter blood glucose levels bring a higher risk of severe hypoglycemia, intensive insulin therapy in children is risky. Severe hypoglycemia can interfere with normal brain development, particularly in young children. Intensive diabetes management in children requires close supervision, usually from a diabetes specialist.
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    The Diabetes Control and Complications Trial, a recent major research study, showed that by tightly managing blood glucose levels, people with type 1 diabetes could delay or even prevent many of the complications of diabetes. 
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    If you take an intermediate-acting insulin, you will need to eat when
    your insulin is peaking, whether it is convenient or not. If you take one shot of long- or intermediate-acting insulin, there are several ways to get the bolus of insulin you need for meals. Some people with type 2 diabetes may be able to make enough insulin to cover the post-meal increase in blood glucose. For these people, providing the basal insulin helps their pancreas to do its job better. Another option is to take oral diabetes medications. These medications can provide the coverage needed for meals. Still another possibility is to take a combination of insulins. You can take a rapid- or short-acting insulin along with your morning shot of long acting insulin. This gives you a bolus of insulin to cover your breakfast meal. You can either use premixed insulins or mix two types of insulin in one injection.