An estimated 23.6 million people in the United States have diabetes, a serious and lifelong condition. Of those 23.6 million, 17.9 million have been diagnosed and 5.7 million have not. The number of individuals diagnosed with diabetes has risen from 1.5 million in 1958 to 18.8 million in 2010. It is estimated that 79 million adults in America 20 years and older have prediabetes. Prediabetes is a condition where blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes.

Diabetes is a disorder of the body's metabolism — the way the body turns food into energy. Most of the food people eat gets broken down into glucose, which is a form of sugar in the blood. Glucose is one of the body's main sources for fuel. After our bodies digest our food, glucose passes into the bloodstream where it is absorbed by cells for growth and energy. However, for glucose to get into the cells, the hormone insulin must be present. Insulin is made by a large gland behind the stomach called the pancreas.

When we eat, our pancreas automatically creates the right amount of insulin in order to move glucose from blood into the cells. In those with diabetes, however, the pancreas makes little or no insulin or the cells do not respond correctly to the insulin which is produced. Glucose then builds up in the blood and overflows into the urine. Thereby, the body loses its primary source of fuel.

The three main types of diabetes are type 1 diabetes, type 2 diabetes and gestational diabetes. In type 1 diabetes, the pancreas no longer produces insulin because the body's own immune system has attacked and destroyed the pancreatic cells that specialize in insulin production. In type 2 diabetes, the most common form of the condition, muscle, liver and fat cells in the body do not use insulin properly. As a result, the body needs more insulin to help glucose enter the cells to be converted to energy. In time, the pancreas loses its ability to make enough insulin. Gestational diabetes is a form of diabetes that first develops during pregnancy.

Initial signs that the blood sugar is high can include the following:

  • being very thirsty
  • feeling hungry
  • fatigue
  • blurry eyesight
  • losing feeling or feeling tingling in your feet
  • losing weight without trying
  • frequent urination

Additional signs that blood sugar is very high may include the following:

  • deep, rapid breathing
  • dry skin and mouth
  • flushed face
  • fruity breath odor
  • nausea or vomiting, inability to keep down fluids
  • stomach pain

Both patients with type 1 diabetes and those with type 2 diabetes may experience these symptoms. People with type 2 diabetes often have no symptoms at first. They may not experience symptoms for many years.

Other symptoms of diabetes may include the following:

  • bladder, kidney, skin or other infections that are more frequent or heal slowly
  • erectile dysfunction
  • pain or numbness in feet or hands

The fasting plasma glucose (FPG) test measures blood sugar levels in an individual who has not eaten anything for at least eight full hours. This is the preferred and most common test for diagnosing diabetes because of its convenience and low cost.

An oral glucose tolerance test (OGTT) measures blood sugar levels after an individual fasts for at least eight hours and two hours after the patient drinks a glucose-containing beverage.

A random plasma glucose test, also known as a casual plasma glucose test, measures blood sugar without regard to when the person being tested last ate. This test is often used with an assessment of symptoms for a proper diagnosis.

If you suspect you are at risk for diabetes or diabetes runs in your family, schedule an appointment with your doctor or healthcare professional in order to receive proper testing for diabetes.

Diabetes has no cure, but the condition can be managed. Before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years following their diagnosis. While insulin is not a cure, it is considered the first major breakthrough in diabetes treatment.

Insulin can be administered directly into body either by injection, an insulin pump, an insulin jet injector or an insulin infuser. Talk to your doctor about these options and work out a strategy that is easiest for you to fit into your daily regimen.

Today, a healthy diet, physical activity and insulin therapy are the basic treatments for diabetes. Blood sugar levels must be closely monitored.

People with type 2 diabetes may need one or more diabetes medications to control their insulin levels.

There are multiple medications for those with diabetes. Diabetes medication helps not only to keep blood sugar levels in a target range, but also to prevent further complications of the condition such as heart disease, heart attack, kidney disease, nerve damage, digestive problems, eye disease and tooth and gum problems.

Metformin is the first choice diabetes medication recommended by the American Diabetes Association for those with type 2 diabetes. This medication lowers the amount of glucose (sugar) made by your liver, thereby preventing blood sugar levels from getting too high.

Alpha-glucosidase inhibitors (Miglitol, Acarbose) help to keep blood sugar from going too high following a meal, a common problem for those with diabetes. These medications work by slowing down the digestion of foods that are high in carbohydrates such as rice, potatoes, bread, milk and fruit.

Starlix (nateglinide) helps the body to make more insulin for a short period of time directly after eating. The insulin helps to keep blood sugar levels from rising too high after eating. Prandin (repaglinide) is a similar medication, helping to make more insulin for a short period of time right after meals so that blood sugar levels don't rise too high after eating.

Januvia (sitagliptin) helps to lower blood sugar by helping your body make more insulin when needed while keeping the liver from putting stored glucose into the blood.

Sulfonylureas also help the body to create more insulin to help lower blood glucose.

Actos (pioglitazone) and Avandia (rosiglitazone) are used to treat insulin resistance — the cause of type 2 diabetes. Insulin resistance means that the body doesn't use insulin properly and that insulin is not absorbed effectively by the body's cells.

Symlin (pramlintide) is another medication that helps to keep blood sugar levels from rising too high after eating. It works by making food move more slowly through the stomach and keeping the liver from storing glucose. This medicine may prevent hunger, leading patients to eat less and perhaps lose weight.

Byetta (exenatide) helps your body make more insulin than is needed and functions in a way similar to Symlin, slowing digestion and preventing glucose storage. 

Managing diabetes is more than simply keeping blood sugar levels under control — it is also essential to manage blood pressure and cholesterol levels through healthy eating, physical activity and proper medication in order to lower risk for cardiovascular disease. At least 65 percent of those with diabetes die from heart disease or stroke. Aspirin therapy, if recommended by a doctor or health care professional, as well as quitting smoking, can help lower the risk of cardiovascular disease.

Those with diabetes must take responsibility and initiative for their day-to-day care. Much of their daily care involves keeping blood sugar levels from going too low or too high. If you have diabetes, you and your doctor should work together, or employ the assistance of a dietician, to design a meal plan for yourself in order to stay healthy and lower your risks of heart disease. You will need to begin to fit physical activity into your daily routine. Exercise can help keep weight down, may help insulin work better and is good for your heart and lungs.

Type 1 diabetes is an autoimmune disease, meaning it is a disease that happens when the body's immune system mistakenly attacks healthy body tissues. In type 1 diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas, which results in the pancreas then producing little or no insulin. The exact cause of type 1 diabetes is not known, but researchers believe that autoimmune, genetic and environmental factors are involved in the body's immune system attacks on pancreatic beta cells.

Type 2 diabetes is insulin resistance, or the body's inability to use insulin effectively. When type 2 diabetes is diagnosed, the pancreas is typically producing enough insulin, but the body does not absorb it properly and therefore cannot convert the glucose to energy. After several years, insulin production decreases. Glucose then builds up in the blood, in a manner similar to that of type 1 diabetes, and the body cannot make fuel or convert nutrients to energy.

Gestational diabetes is caused by an influx of hormones that often accompanies a typical pregnancy. A pregnant body may also require more insulin than the body is able to make, thereby creating an insulin shortage and causing diabetes. 

Diabetes is not a contagious condition, therefore people cannot "catch" it from each other. However, certain factors do increase one's risk of developing diabetes.

Ninety to 95 percent of all diagnosed cases of diabetes in adults are cases of type 2 diabetes. Only 5 percent of diagnosed cases are type 1, while 2 to 10 percent of cases are gestational diabetes.

Type 1 diabetes is more prevalent in whites than in nonwhites, although it does occur equally in both women and men. Type 1 diabetes is rare in most African, American Indian and Asian populations. This condition often develops in children but can occur at any age.

Type 2 diabetes is more common in older individuals, although that statistic is changing rapidly. Type 2 diabetes is often seen in overweight individuals and occurs most in African Americans, American Indians and some Asian Americans, Native Hawaiians, Pacific Islanders and Hispanics.

Diabetes rates in the United States are likely to continue increasing for several reasons, including the fact that as a nation, America is seeing much more obesity, even in young individuals. According to recent estimates from the CDC, diabetes will affect one in three people born in 2000 in the United States. The CDC also predicts that the prevalence of diagnosed diabetes in the United States will increase 165 percent by 2050.

Diabetes is a serious condition, no matter what type you have. It takes caution, commitment and vigilance in order to properly manage the condition. Once you receive a diagnosis, make sure to speak to your doctor at length and get all of your questions answered. Find out what lifestyle and dietary changes will be required as well as any medications you may need.

Involve the people around you (i.e., friends and family) in your new lifestyle. This may make sticking to healthy habits easier and longer lasting. These healthy, proactive steps are necessary to reduce the risk of cardiovascular disease and other diabetes-related complications.

Ask your doctor to show you how to administer insulin, and pay close attention. You will be solely responsible for managing your insulin and blood sugar levels, and you will need to fully understand how to do so in order to stay healthy.

When starting any new condition, be cautious and keep your eyes open for any new symptoms. Call your doctor right away if you notice sores that are not healing or anything else out of the ordinary.

How much of an impact does diabetes have on the nation?

  • In 2006, diabetes was the seventh leading cause of death listed on US death certificates. Cardiovascular disease is the leading cause of death among individuals with diabetes. About 68 percent of people with diabetes die of heart disease or stroke. Overall, total health care and related costs for the treatment of diabetes run about $174 billion annually. Indirect costs, including disability payments, time lost from work and reduced productivity, totaled $58 billion. Direct medical costs for diabetes care, including hospitalizations, medical care and treatment supplies, totaled $116 billion.

When should I be checked for diabetes?

  • You can ask your doctor at any time to be checked for diabetes. A physical examination may alert your doctor to abnormal blood pressure, which may lead to further testing. People 45 years of age and older should consider getting tested for prediabetes or diabetes. Those younger than 45 who are overweight, obese or extremely obese should consider being tested for the condition. If you have a family history of diabetes, it is good measure to be tested.

If you have diabetes, remember that the condition is manageable, and it may be easier to stick to your medications and lifestyle plan if you have the help of others.

It is recommended that diabetes patients get 30 to 60 minutes of exercise every day when time permits — even activities such as brisk walking can help your heart health. Diabetes patients are also encouraged to eat healthy foods such as fruits, vegetables, fish, lean meats, chicken or turkey without skin, dry peas or beans, whole grains and low-fat dairy products such as skim milk or cheese. Fish and lean meat should be kept at about 3 ounces (or the size of a deck of cards). Diabets patients should eat foods that have less fat and sodium (salt), as well as foods with more fiber, such as whole grain cereals and whole grain breads.

Diabetes patients should maintain a healthy weight, stop smoking and learn to cope with stress, as stress can raise blood sugar levels. Stress can be difficult to eliminate fully, so you may wish to ask your doctor what you can do to more actively manage stress.

If your doctor has prescribed medication to control your diabetes, take that medication even when you are feeling good. Ask your doctor if you need aspirin to reduce the risk for heart attack or stroke. Get into the habit of receiving routine and regular care.

Review Date: 
August 13, 2012
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