Diabetes

Diabetes affects how the body processes the sugar found in food. Insulin is the hormone responsible for using sugar as an energy source in the body. People who have diabetes either can’t produce enough insulin or they can’t use it properly (i.e. insulin resistance). As a result, sugar accumulates in the blood. Note: Diabetes insipidus is a disease that is completely different from diabetes mellitus. It is characterized by the inability of the kidneys to concentrate urine, which causes abundant urination and intense thirst. Diabetes insipidus is caused by a vasopressin deficiency or a kidney’s insensitivity to this hormone. Vasopressin is released by the pituitary gland and, normally, acts on the kidneys in order to cause the resorption of water in the blood.

Types of diabetes

Most people with diabetes (90 percent) have type 2 diabetes. Although sometimes referred to as adult-onset diabetes, it can develop at any age. People with type 1 diabetes, also known as juvenile diabetes, can’t make enough insulin and so are dependent on taking insulin by injection. A third type of diabetes, gestational diabetes, can develop during pregnancy when a woman’s insulin needs increase. In most cases, pregnant women with this kind of diabetes can control their blood sugar levels by modifying their diet and the condition resolves itself soon after the birth.

Symptoms

Most people who develop diabetes are over 40 years of age and are overweight. Often, other members of their family also have diabetes. The condition develops gradually… People with diabetes might:

• be more thirsty and need to urinate more
• be more tired and irritable than usual
• lose weight, even though they might be more hungry
• have frequent infections (skin, bladder, or vaginal infections, etc.)
• develop blurred vision
• experience a tingling sensation in their hands and feet or feel like they’ve lost some sensitivity there

Some diabetics are unaware that they have the disease because their symptoms are mild and easily overlooked. Thus it can take a long time before a diagnosis is made. Over time, diabetes causes hardening of the blood vessels and injury to the heart, kidneys, and eyes. Diabetes is the first cause of blindness in North America. It is also a factor in many cases of heart disease. All of this because diabetics have too much sugar in their blood.

Diagnosis

Diabetes is diagnosed by measuring blood sugar levels at a time when a person’s blood sugar level is normally at it’s lowest point: in the morning (on waking). In addition, blood sugar level measured at any time of the day, without regard to the interval since the last meal is a good indicator for diabetes… (Blood sugar levels are expressed in millimoles of sugar per liter of blood (mmol/L).) Blood sugar levels higher than those found in the following chart are usually indicative of diabetes.

Blood sugar levels

Upon arising in the morning	> 7.0 mmol/L
At any time of the day	> 11.1 mmol/L

Management

If you are diagnosed with type 2 diabetes, then your goal is to bring your blood sugar levels to within the healthy range and keep them there as much as possible. To do this, you’ll need to:

• make wise food choices (if you are overweight then you must lose weight as well);
• exercise regularly (at least 5 days a week, for a minimum of half an hour);
• control your blood pressure and cholesterol.

Blood sugar levels	Normal range	Target for most patients	Target for pregnant women
Upon arising in the morning, before meals, and at bedtime	4.0 to 6.0 mmol/L	4.0 to 7.0 mmol/L	less then 5.3 mmol/L
1 hour after a meal			less then 7.8 mmol/L
2 hours after a meal	5.0 to 8.0 mmol/L	5.0 to 10.0 mmol/L	less then 6.7 mmol/L

Your doctor may also decide to put you on diabetes medicine to help with your blood sugar levels. Medications include oral diabetes medications (e.g., sulfonylureas, biguanides, acarbose, and thiazolidinediones) and insulin injections. Insulin injections are given from one to four times per day according to the individuals, by means of a single-use syringe, or with a reloadable insulin pen. They may also be given automatically and continuously using an insulin pump, a device worn at the waist and equipped with a catheter fixed under the skin. Insulin injections must be given in the subcutaneous tissue (hypodermis). An intra-muscular injection would cause the insulin to act too quickly, risking hypoglycemia, while too superficial an injection would cause the insulin to act too slowly, resulting in hyperglycemia. If you are prescribed medications to help control your diabetes, talk to your pharmacist, who will advise you on any side effects. Your pharmacist can also suggest the best blood glucose meter for you to use for testing your blood sugar levels at home.

Living with type 2 diabetes

If you – or someone you love – have diabetes, then you need to learn as much as you can about the disease and how to manage it on a daily basis. Exercise and eating a well-balanced diet should be at the top of your list. If medications have been prescribed, make sure they are taken as ordered. In addition:

• stay informed: Ask your doctor or pharmacist about local diabetes education programs; see a nutritionist for a personalized meeting.
• take care of your feet: Because diabetes causes poor circulation and nerve damage, feet aren’t as sensitive as they should be. Keep feet clean and dry and treat any blisters, cuts, or sores immediately.
• have regular eye checkups: Because diabetes can lead to retinopathy (a disease of the retinas), even blindness, visit an ophthalmologist at least once a year.
• look after your skin: Because diabetes involves high blood sugar and poor circulation, skin doesn’t heal as well and is subject to frequent infections. Be sure to wash with mild soap, use sunscreen, and cleanse and bandage all skin abrasions carefully.

For more information

Canadian Diabetes Association www.diabetes.ca