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Now That You Have Diabetes
1 Is diabetes a new disease?
No. Diabetes was identified 2,000 years ago by Aretaeus of Cappadocia, the Greek physician. However, very little progress was made in understanding or treating the disease until 1869 when Paul Langerhans described small islands (islets) in the pancreas. However, he did not know their function in regulating blood-sugar levels. In 1889, German scientist Oskar Minkowski discovered a critical link between the pancreas and diabetes when he removed a dog's pancreas and observed that it caused the dog to urinate frequently. He also found sugar in the dog's urine.
In 1909, the Belgian scientist Jean de Meyer used the term "insulin" to describe a hypothetical substance in the pancreas that controls blood sugar, even though insulin had not yet been discovered. Finally in 1921, after a series of experiments, J.J.R. Macleod, Charles Best, Frederick Banting, and James Collip succeeded in purifying insulin and successfully treating a diabetes patient with it. This discovery saved many people from dying in a coma due to high blood sugars. Although diabetes has been around a long time, we still need new and better therapies.
2 What does the term "diabetes mellitus" mean?
"Diabetes" and "mellitus" have two different histories and meanings. "Diabetes" is usually attributed to the Greek physician Aretaeus, who lived in 200 BC. He used the term "diabetes," meaning "to siphon or to flow through," for a disease in which the water that a person drinks runs rapidly through his or her body. It was not until the end of the 18th century that the term "mellitus" was added to "diabetes." An Englishman, John Rollo, and a German, Johann Peter Frank, first used the term "mellitus" (which means "sweet as honey") in the medical literature to describe the sweetness of the urine. So "diabetes mellitus" literally means a medical condition in which the patient drinks too much water and urinates frequently. The urine is sweet because it contains sugar.
3 Can I catch diabetes from someone else?
No. Diabetes is not like a cold or the flu. You cannot catch it from other people, even by kissing them. There are many causes of diabetes, but no form of diabetes has ever been shown to be infectious or contagious. Most diabetes develops from an inherited tendency to get it. If you have inherited this gene, you may develop type 1 diabetes when you are exposed to something in the environment. This unknown factor triggers the onset of diabetes. You may develop type 2 diabetes if (in addition to the gene) you gain weight and don't exercise regularly. There are also less common causes of diabetes, such as prolonged, excessive drinking of alcohol or having too much iron in your blood. So while there are many causes of diabetes, catching it from another person is not one of them.
4 Is there a time of year I am more likely to get diabetes?
Yes and no. Many studies have been done to determine when people get diabetes. Type 1 diabetes (previously called "insulin-dependent diabetes") usually occurs in thin individuals less than 30 years of age. It is more common to develop type 1 diabetes in the fall, the season in which many viral infections occur (for example, chicken pox, influenza, and the measles). Some experts think the higher rate of type 1 diabetes during the fall months suggests that type 1 diabetes may be started by a virus that causes an infection. However, this has never been proven. Type 2 diabetes generally appears gradually and has never been linked to a specific time of year.
5 Does eating sugar cause diabetes?
No. Although diabetes has been called "sugar diabetes" for many years, eating sugar does not cause it. Type 1 diabetes happens when your body's immune system destroys the insulin-producing beta-cells in the pancreas. Factors that may cause the immune system to do this are auto-antibodies, cow's milk, genetics, and oxygen-free radicals. Type 1 diabetes is probably triggered by one of these environmental factors in people who have the genes for developing the disease. Type 2 diabetes is often the result of a combination of factors, including genetics and lifestyle. However, eating sugar, while possibly contributing to weight gain, is not a cause.
6 Is diabetes a dangerous disease?
Yes. Statistics prove that diabetes causes much suffering and lost work time. For example, it is the leading cause of kidney failure in this country. Each year in the United States, between 15,000 and 30,000 people lose their eyesight because of diabetes, and 160,000 individuals die from diabetes-related causes. In fact, during the last 20 years, diabetes has caused more deaths than have all of the wars throughout the world in the 20th century. Unfortunately, the situation is getting worse, not better: the number of people developing diabetes is increasing. We all need to do our best to prevent and treat this disease in the United States and throughout the world.
7 Can I ignore the risks of diabetic complications since the thought of them scares me?
No, because taking action now can prevent the disabling complications of diabetes. Adjusting your food, physical activity, and medication (if any) to bring your blood-sugar levels to near normal ranges can help you avoid or delay complications. Research has proven that.
It's very common for people to fear aging or becoming disabled, whether or not they have diabetes. We all want to live well every day that we have, and be fully functional and independent. But choosing to ignore the effects of diabetes won't make them go away. Rather, taking charge to change the outcome can give you peace of mind, so you can live your life without fear. Knowing the effects of diabetic complications on your body is information that can give you power over the future!
8 How close are we to a cure for diabetes?
It depends on what you mean by a cure. Diabetes is not really one disease. It has many causes and, therefore, many cures. Recent years saw significant advances in diabetes prevention and treatment. These advances are important until cures become available. The ultimate cure for diabetes will likely involve replacing the cells in the pancreas that make insulin. This could be done artificially by inserting a remote-controlled insulin pump that is automatically regulated by a glucose sensor. The implantable pump has already been developed and tested in more than 400 people worldwide. Glucose sensors are under development and should be available soon.
9 How do I know whether I have type 1 or type 2 diabetes?
With type 1 diabetes, the body stops making insulin, often before, during, or shortly after adolescence (though there is no cut-off age). People with type 1 diabetes require insulin for life because insulin is essential for using and storing food. These people are usually lean and, without insulin, would go into a diabetic coma within a day or two. In the past, this disease was called "insulin-dependent diabetes mellitus" (IDDM). The proper name is now type 1 diabetes.
People with type 2 diabetes have enough insulin early in the disease, but their bodies are unable to use the insulin correctly to lower blood sugar. They are insulin resistant. Most people with type 2 diabetes are overweight and more than 30 years old when diagnosed. Often, people with type 2 diabetes can control their blood sugar with diet and exercise, though some take oral diabetes pills. After several years with type 2 diabetes, many people eventually need insulin as the disease progresses. In the past, this type of diabetes was called "non-insulin-dependent diabetes mellitus" (NIDDM). The correct term is now type 2 diabetes.
10 Should I tell my boss and coworkers that I have diabetes?
Whether or not to tell anyone is up to you. Your coworkers are not responsible for taking care of you, but you will probably find that they will be understanding and want to help you stay healthy. You do have a responsibility to yourself and your coworkers to keep the work environment safe. It is important to have a system in place for managing emergencies, such as severely low blood sugar or a sick day. Most people feel more comfortable dealing with emergencies when they have some preparation and understanding. You don't have to make diabetes the daily topic of conversation, and you may feel uncomfortable letting people at work become the "control patrol." This is a personal choice that requires consideration on your part, but you may find that your life is easier if you allow others to support you in managing your diabetes and staying healthy.
11 What is a health-care team, and how can I find one?
In addition to your family doctor, you need someone trained to help you with the day-today challenges of living with diabetes. Diabetes educator nurses and dietitians, plus your doctor, are the core members of your health-care team. A certified diabetes educator (CDE) is a health professional who has been trained and certified as an expert in diabetes education and management. The CDE may be a registered nurse (RN), registered dietician (RD), pharmacist, or another physician.
You can locate a CDE in your area by calling the American Association of Diabetes Educators (AADE) Awareness Hotline at 800 TEAM-UP-4. They will ask for your zip code and help you find a CDE near you. If you cannot find a CDE, you may find a nurse or RD who is interested in diabetes and willing to help you. Your doctor may also refer you to someone with experience in diabetes care.
You may also want to find a diabetes education program that offers individual or group classes. The ADA has a list of recognized diabetes programs in your area. Call 800 DIABETES for this information. If there isn't a recognized diabetes center near you, call your local hospital and ask about a diabetes education program or about diabetes educators on staff.
12 How often should I see my doctor to be as healthy as I can be?
The frequency of medical visits required to manage your diabetes varies according to numerous factors: (1) how long you've had diabetes, (2) your ability to adjust your treatment regimen effectively to maintain good blood-sugar control, and (3) whether you have diabetic complications or other medical problems that may interfere with your diabetes management.
At a minimum, all patients with diabetes should see a doctor twice a year. Recharging your motivation to achieve good blood-sugar control is an important part of every visit. You should also have an A1C test (see Glossary) at each semi-annual visit to test your average blood-sugar levels over a period of two or three months. Or if you are on insulin, you should take the test quarterly to monitor your blood-sugar control.
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 sugars 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.
13 Is there a list of tests and thins I am supposed to do to stay healthy?
Yes. The ADA publishes "Standards of Medical Care for Patients with Diabetes Mellitus" to provide guidelines for health professionals to manage diabetes and prevent complications. We recommend a checklist based on those standards to help diabetes patients keep track of all that needs to be done (see below and on page 33). Some tests come every three months and others yearly. For instance, you should have your eyes checked by an ophthalmologist and your urine checked for microalbuminuria (small amounts of protein) yearly. With these two tests, your doctor can detect eye and kidney problems early and start treatment. You may want to use your own flow sheet to be sure you get the tests done at the right time and to share these results with your health-care team. Talk with your team about which of these tests you need and when you should have each one done.
14 How can I tell if my diabetes program is successful?
Keep track of your diabetes the same way you do your checking account—by keeping tabs on the balance. With diabetes, the balance is the sum of:
Your blood sugar
Your daily weight
Your blood pressure
Your level of exercise
How you feel
If all of these items meet your goals, then you are doing fine.
Keep a daily record of your blood sugar and weight. You can check your blood pressure at home or have it done at shopping centers or pharmacies. Make daily exercise one of your goals. When you monitor your health daily, you help yourself succeed.CHAPTER 2
Blood-Sugar Highs and Lows
15 What are the symptoms of high blood sugar?
The symptoms of high blood sugar may vary from person to person or even in one person from day to day. But, in general, a person will:
1. Feel more hungry or thirsty than usual
2. Have to urinate more frequently than normal
3. Have to get up at night several times to go to the bathroom
4. Feel very tired or sleepy or have no energy
5. Be unable to see clearly or see "halos" when looking at a light
If you have any of these symptoms, check your glucose immediately. Do not treat these symptoms with additional insulin unless you are certain that they are due to high blood sugar. There are other conditions that cause similar symptoms.
16 What type of damage does high blood sugar do to my body?
Over time, high blood-sugar levels can damage both blood vessels and nerves in your body. This can result in poor blood flow to your hands, feet, legs, arms, and vital organs. Poor blood flow to these areas increases your risk of infections, heart problems, stroke, blindness, foot or leg amputation, and kidney disease. In addition, you can lose feeling in your feet or have increased pain in your feet and legs. Even mild injuries can damage your feet without your knowing it. Finally, damage to blood vessels and nerves can lead to sexual problems that are difficult to treat. For all these reasons, you should make a major effort to avoid high blood sugars in your body.
17 What are my blood-sugar goals if I have diabetes?
Try for nearly normal blood-sugar levels with few episodes of low blood sugar. The ADA's goals are shown in the chart below. They are determined from studies that examined the effects of near normal blood-sugar levels on the rates of diabetic complications. If you are persistently outside of these goals or have low blood sugar too often, discuss changing your diabetes therapy with your health-care team.
18 Should I be concerned about glucose control if I have type 2 diabetes?
Yes, but maybe not "tight" control. The older you were when you developed diabetes, the less benefit you get from achieving excellent glucose control. Because the benefits of tight control can differ depending on your age and situation, you and your health-care team need to determine your risk before you decide what your target A1C should be. (For more on A1C, see Glossary and chart on page 37 for target A1C levels.)
The Veterans Health Administration (VHA) has developed guidelines specific to the age at which you developed type 2 diabetes. These guidelines are now used in all Veterans Affairs (VA) clinics. For example, a patient who developed type 2 diabetes at an elderly age may have a target A1C of about 9%, whereas younger patients may benefit from a lower A1C of 7%. For details on these guidelines and what your target A1C should be, ask your health provider for information on this subject.
19 Why should I work so hard to improve my blood-sugar level?
You'll feel more energy and a greater sense of well-being when your blood sugar enters the normal range. In addition, you'll delay or prevent problems with your eyes, kidneys, and nerves as your blood sugar improves. Many doctors also believe that problems with heart disease, stroke, and hardening of the arteries may be delayed by good blood-sugar control. If you do not get these complications of diabetes, you'll live a longer, healthier life.
Excerpted from What to Expect When You Have Diabetes by Good Books. Copyright © 2008 Good Books. Excerpted by permission of Good Books.
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