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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    A Stacy Wiegman, PharmD, Pharmacy, answered
    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 Stacy Wiegman, PharmD, 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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    A William Lee Dubois, Endocrinology Diabetes & Metabolism, answered

    Diabetes isn’t the problem; it's high blood sugar that's the killer. High sugar turns your blood into battery acid that can rob you of sight, kidneys, limbs, and ultimately of life itself. So all treatments have the goal of reducing blood sugar so that it won’t harm you.

    There are three categories of treatment:

    • Lifestyle

    • Oral meds.

    • Injectable meds.

    In times past doctors focused on lifestyle first, trying to get newly diagnosed diabetics to eat better and exercise more. While lifestyle change works, I’m actually not a fan of the approach, at least not as frontline therapy.

    Frankly put, it’s easier to change your gender than your diet. And that’s if you live in a vacuum. But diabetics have families too, and often families create barriers to significant change.

    I don’t like letting diabetes win. Period. So I prefer to break out the big guns from the get-go. I believe in medicating diabetes into submission first, and then looking at lifestyle changes. Once diabetes is controlled, people generally feel better. That’s a good time to talk about how you could feel even better. Lifestyle changes are best taken on in small bites (pardon the pun). Dramatic, radical changes are hard to maintain. Small, incremental changes are more likely to last for the long haul. Maybe that’s why I feel the need to dip into the medicine cabinet first thing, slow and steady change will take too long if someone’s blood sugar is dangerously high. But we can always back-off of the meds as time goes by and lifestyle improves.

    Oral meds are pills to help reduce blood sugar. There are a wide variety to choose from and they go about lowering blood sugar in different ways. Some increase insulin production. Some reduce insulin resistance. Some affect hormones that control digestion. Many of the pills can be used together to attack the blood sugar from several sides at once.

    Injectable meds include insulin and an array of newer high-tech hormone therapies that are pretty marvelous. Now, I know everyone freaks out at the thought of using a needle. Yikes! But, I gotta tell you from experience, it isn’t as bad as you think it. Really, these new needles we have don’t hurt a bit.

    The last thing I want to cover is the fact that diabetes is progressive. It marches forward all the time. Over time, you move from lifestyle, to pills, to shots.  I just want you to know that it’s normal. No fear. Shots are an evolution, not a failure.
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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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    Urine testing is not an accurate way to measure blood glucose. It is the way to check for ketones when you cannot eat or are ill. A buildup of ketones tells you that you are developing ketoacidosis. Ketones are breakdown products of fat that produce acid in the body. Too much acid can result in you being hospitalized. Therefore, when you are sick with a cold or the flu, you should test your urine for ketones and call your health care team if you detect any. You can buy urine ketone testing strips at the drugstore.
    The information about blood glucose that you get from urine testing for glucose is not precise enough to make decisions for treatment. Your kidney does not spill glucose into your urine until your blood glucose is higher than 200 mg/dl. The ADA does not recommend that you use urine glucose testing (especially if you're taking insulin) if you can perform fingerstick blood glucose testing.
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    A Elaine Koontz, Nutrition & Dietetics, answered

    The following guidelines might help you to better plan your appointments and tests:

    • A1c test (if your blood glucose is not stable), blood pressure check, weight check, and foot check every three months
    • A1c test (if your blood glucose is stable) and dental exam every six months
    • Physical exam, comprehensive foot exam, blood cholesterol and blood fat tests, kidney tests, dilated eye exam, and flu shot annually

     

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