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About Diabetes

A Few Facts About Diabetes
What is diabetes?

Diabetes is a disease in which your body is unable to properly use and store glucose (a form of sugar). Glucose backs up in the bloodstream -- causing your blood glucose or "sugar" to rise too high.

There are two major types of diabetes. In Type 1 (also called juvenile-onset or insulin-dependent) diabetes, your body completely stops producing any insulin, a hormone that enables your body to use glucose found in foods for energy. People with Type 1 diabetes must take daily insulin injections to survive. This form of diabetes usually develops in children or young adults, but can occur at any age. In Type 2 (also called adult-onset or non insulin-dependent) diabetes, the body produces insulin, but not enough to properly convert food into energy. This form of diabetes usually occurs in people who are over 40, overweight, and have a family history of diabetes.

The Four Types of Diabetes

Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes may account for 5% to 10% of all diagnosed cases of diabetes. Risk factors are less well defined for type 1 diabetes than for type 2 diabetes, but autoimmune, genetic, and environmental factors are involved in the development of this type of diabetes.

Type 2 diabetes was previously called non-insulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90% to 95% of all diagnosed cases of diabetes. Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes.

Gestational diabetes develops in 2% to 5% of all pregnancies but disappears when a pregnancy is over. Gestational diabetes occurs more frequently in African Americans, Hispanic/Latino Americans, American Indians, and persons with a family history of diabetes. Obesity is also associated with higher risk. Women who are having gestational diabetes are at increased risk for later developing type 2 diabetes. In some studies, nearly 40% of women with a history of gestational diabetes developed diabetes in the future.

"Other specific types" of diabetes result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses. Such types of diabetes may account for 1% to 2% of all diagnosed cases of diabetes.

How do people know if they have diabetes?

People with diabetes frequently experience certain symptoms. These include:

being very thirsty

having to go to the bathroom very frequently to urinate

weight loss

increased hunger

blurry vision

skin infections

wounds that don't heal

and/or extreme unexplained fatigue

If you or a loved one are one of the millions of people diagnosed with Type 1 or 2 diabetes, you may have wondered how your medication interacts with a particular herb or vitaminŠor what happens to your blood glucose levels when you perspire profusely in a JacuzziŠor if too little fat in your diet is as bad for your health as too much fat.

In some cases, there are no Symptoms -- this happens at times with type 2 diabetes. In this case, people can live for months, even years without knowing they have the disease. This form of diabetes comes on so gradually that symptoms may not even be recognized.

Who gets diabetes?

Diabetes can occur in anyone. However, people who have close relatives with the disease are somewhat more likely to develop it. The risk of developing diabetes also increases as people grow older. People who are over 40 and overweight are more likely to develop diabetes. So are people of African-American, Hispanic or Asian heritage. Also, people who develop diabetes while pregnant (a condition called gestational diabetes) are more likely to develop full-blown diabetes later in life.

How is diabetes treated?

There are certain things that everyone who has diabetes, whether type 1 or type 2, needs to do to be healthy. You need to have a meal (eating) plan. You need to pay attention to how much you exercise, because exercise can help your body use insulin better to convert glucose into energy for cells. Everyone with type 1 diabetes, and some people with type 2 diabetes, also need to take insulin injections. Some people with type 2 diabetes take pills called "oral agents" which help their bodies produce more insulin and/or use the insulin it is producing better. Some people with type 2 diabetes can manage their disease with weight loss, diet and exercise alone and don't need any medication.

Everyone who has diabetes should be seen at least once every six months by a diabetes specialist ( an endocrinologist). You should also be seen periodically by other members of a diabetes treatment team, including a diabetes nurse educator, and a diabetes dietitian educator who helps you develop a meal plan that works best for you. Ideally you should also see an exercise physiologist for help in developing an exercise plan, and if you think you need it, a social worker, psychologist or other mental health professional for help with the stresses and challenges of living with a chronic disease. Everyone who has diabetes should have regular eye exams (once a year) by an ophthalmologist to make sure that any eye problems associated with diabetes are caught early, and treated before they become serious.

Also, people with diabetes need to learn how to monitor their blood sugars day-to-day at home using home blood sugar monitoring. This daily testing, which your diabetes educator can explain to you, will help you see how well your meal plan, exercise, and medication are working to keep your blood sugars in a normal range.

What other problems can diabetes cause?

Your health care team will encourage you to follow your meal plan and exercise program, use your medications and monitor your blood sugars regularly to keep your blood sugars in as normal a range as possible as much of the time as possible. Why is this so important? Because poorly managed diabetes can lead to a host of long-term complications -- among them are heart attacks, strokes, blindness, kidney failure, blood vessel disease that requires an amputation, nerve damage, and impotence in men.

But happily, a recent nationwide study completed over a 10-year period showed that if people keep their blood sugars as close to normal as possible, they can reduce their risk of developing some of these complications by 50 percent or more.

Can diabetes be prevented?

Maybe someday. A study being conducted at Joslin Diabetes Center and several other sites nationwide is screening the immediate relatives of someone with type 1 diabetes because we can now identify those who will develop this form of the disease as much as five or more years in advance.

Type 2 diabetes is the most common type of diabetes, yet we still do not understand it very well. But recent research does suggest that there are some things you can do to prevent this form of diabetes, particularly if it runs in your family, or if you have had gestational diabetes, or if you are a member of an ethnic group (African-Americans, Native Americans, Hispanic-Americans), that is more prone to this disease.

A research study is now underway to see if this form of diabetes can be prevented as well. Changes in lifestyle, (more exercise and weight loss), and certain medications are being tested to see if type 2 diabetes can be prevented.

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