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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    Results of an A1C test and a blood glucose check don't always match up. The A1C test measures your average blood sugar levels over a 120-day period (the lifespan of a red blood cell). But a blood glucose check measures your blood sugar at a single moment. If your blood sugar levels were high last week, and you adjusted your diabetes treatment plan so that your blood sugar returned to normal, the A1C result may still be high, because it includes the high blood sugar levels from the previous week.

    The A1C test measures the percentage of glycated hemoglobin in your blood. Glycated hemoglobin is created when molecules of hemoglobin (the oxygen-carrying protein in your blood) attach to molecules of glucose (the sugar in your blood). The more sugar you have in your blood, the higher your percentage of glycated hemoglobin.
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    A , Pharmacy, answered
    Work with your doctor to come up with a schedule for testing your blood sugar. Factors for you and your doctor to consider in developing your schedule include the medicines you take, when you eat and how well-controlled your blood sugar is. Many people with diabetes find that it works well for them to check blood sugar first thing in the morning, but talk with your doctor to find out what's best for you.
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    High blood glucose before a meal tells you that your liver is making too much glucose and needs to be told to slow down! The signal it needs is insulin. Because it takes time for insulin to be absorbed from the skin and additional time to reduce the liver's glucose production, we suggest that you take your usual dose of insulin and wait 60–90 minutes (instead of the usual 30–45 minutes) to eat. This will allow your blood glucose level to fall toward the normal range before you eat, giving the insulin a "head start." The goal is not to become low before eating but to regain control over high blood glucose. An alternative is to take lispro insulin 15–30 minutes before your meal, which should lower your blood glucose more rapidly than regular insulin.

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    Most health care professionals recommend that a woman with pre-existing diabetes (both type 1 & type 2) who becomes pregnant monitor her blood glucose levels up to 8 times daily. In terms of your day-to-day routine, you should probably monitor: before each meal, 1 or 2 hours after each meal, at bedtime, occasionally at 2 or 3 a.m.

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    The oral medications classified as thiazolidinediones (TZDs), which are often prescribed for type 2 diabetes, may cause women who are not ovulating and haven't gone through menopause to begin ovulating again, enabling them to conceive. Also, oral contraceptives may be less effective when you are taking TZDs.

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    Treatment options for diabetes vary, depending on the type of diabetes involved. However, the four primary factors in any diabetes treatment are weight management, a healthy diet, exercise, and blood glucose monitoring. Everyone diagnosed with Type 1 diabetes will need to take some form of insulin. But, if you have been diagnosed with other types of diabetes, you will only need to take medications such as insulin if diet and exercise are insufficient.

    If you manage your diabetes effectively, you can have a long, healthy life. The primary goal of diabetes treatment is to stabilize blood glucose levels. The better your blood glucose is managed, the more positive your treatment outcomes.
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    There is about a 30% chance that your kidney function will worsen during pregnancy, but these changes often improve after delivery of the infant. Many women with diabetes will first show signs of abnormal kidney function (spilling protein into the urine) during pregnancy. If you have kidney disease before getting pregnant, then there is a chance that it will get worse during pregnancy.
    Moreover, babies born to mothers with diabetic kidney disease have a higher risk of stillbirth, respiratory distress, jaundice, and abnormally small body size compared to babies of mothers with diabetes without kidney problems. Also, about 30% of these babies are born prematurely. You will need to have tight blood glucose control and careful control of blood pressure before and during the pregnancy. Thus, it can be done, but you should know the risk before you get pregnant.
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    When you have diabetes and you’re sick, your body is also stressed. To deal with this stress, your body releases hormones that help you fight the illness. But these hormones also counteract the effect of insulin in lowering blood glucose and cause blood glucose levels to go up. Sickness can cause your diabetes to go out of control. Extremely high blood glucose levels caused by illness can also lead to diabetic ketoacidosis in people with type 1 diabetes, so you may need to test your urine for ketones.  In people with type 2 diabetes illness can lead to hyperosmolar hyperglycemic syndrome (HHS).
    Blood glucose monitoring is especially important during any bout of sickness. Even if you have type 2 diabetes and only monitor once a day, you may want to keep a closer check during times of illness. Be sure to talk to your health care team before you get ill about what you should do in the event of illness. You and your health care team can work together to come up with a plan to help you handle common illnesses such as colds or the flu.
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    Diabetes experts don't recommend testing your urine for glucose because this method is not as accurate as checking your blood. But testing your urine for ketones can be very important in managing your diabetes. Check with your doctor to see if you need to monitor your ketone levels. You may need to do ketone urine checks if your blood glucose is more than 300 milligrams per deciliter (mg/dL) or if you're sick with the flu, a cold or a stomach bug. If you are having symptoms of high ketones -- feeling tired all the time, thirst or dry mouth, flushed skin, mental confusion, difficulty breathing or a fruity smell on your breath -- it can be a good idea to check your ketone levels.
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    The frequency of medical visits required for your diabetes will vary according to how long you've had diabetes, your ability to adjust your treatment regimen effectively to maintain good blood glucose control, and whether you have diabetic complications or other medical problems that may interfere with your diabetes management.

    At a minimum, all patients with diabetes should plan on seeing a doctor twice a year. Recharging your motivation to achieve good blood glucose control is an important part of every visit. You should have an A1C test done then, or if you are on insulin, you should have the test done quarterly to see how your blood glucose control is doing.

    In addition, every patient with diabetes should have someone he or she can contact on short notice to discuss problems as they arise, such as unexplained high blood glucose or sudden illness. This person need not be a physician but may be a certified diabetes educator (CDE), registered dietitian (RD), nurse practitioner, or nurse case manager.

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