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The Type 2 Diabetes Handbook
Six Rules for Staying Healthy with Type 2 Diabetes
By Rod Colvin, James T. Lane, Jack Kusler
Addicus Books, Inc.Copyright © 2011 Rod Colvin
All rights reserved.
Learn the Basics about Type 2 Diabetes
Type 2 diabetes is an epidemic in the United States. The American Diabetes Association estimates 18 million Americans have been diagnosed with the disease and another 6 million others have it, but have not been diagnosed.
Type 2 diabetes develops most often in adults over the age of forty, but can develop in young people, too. If not kept under control, diabetes can cause serious complications. People with type 2 diabetes are two to three times more likely to have a heart attack or stroke. Diabetes is also the most common cause of kidney failure and blindness in adults under age sixty. Other potential complications include nerve damage, which may lead to pain and numbness in the hands and feet, and damage to blood vessels, which may result in amputation of limbs. Nerve damage can also affect many other bodily functions.
It's never easy to hear from your doctor that you have a chronic disease such as type 2 diabetes. It's not uncommon to feel depressed after being told you have diabetes, and depression may have a negative effect on your health. When you're depressed, you may not feel motivated to take the best care of yourself. Consequently, you may not eat right or take medications as directed. These actions can cause blood sugars to rise even higher.
If you're like many people, you may at first go into denial about having type 2 diabetes. You may tell yourself things such as "This can't happen to me" or "My case will be different — I won't have problems like some other people do. After all, I don't really feel sick."
Denial is a common response to a diagnosis of diabetes. Perhaps initial denial allows our minds to accept the news more gradually. However, ongoing denial is a dangerous thing. It will prevent you from getting the care you need to manage the disease. Some people deny having the disease for years before taking action to control it; this lack of action over time significantly increases the risks for complications.
One way to break through denial is to talk with people you trust about having type 2 diabetes. Keeping it a secret feeds the denial. Discuss your thoughts and feelings openly. If you feel you would benefit from more emotional support, consider finding a therapist, a certified diabetes educator, or a support group. Once you accept the diagnosis, you'll be better prepared to start a treatment plan.
Defining Type 2 Diabetes
Type 2 diabetes is a metabolic disorder caused by the combination of the body's resistance to the effect of insulin (not using its own insulin efficiently) and the pancreas not producing enough insulin. As a result, there is an increase in the level of sugar, also known as glucose, in the blood. This causes a condition known as insulin resistance, which is at the root of type 2 diabetes. If you learn that you have high blood sugars, you may have been gradually becoming insulin resistant for several years.
In order to understand the concept of insulin resistance, let's review briefly how our food is digested and turned into energy. When food enters your body, it is broken down into small components, including glucose, an important sugar that comes from carbohydrates. Glucose is a major source of energy for the body. When you eat carbohydrates, your body detects a rise in glucose and signals the pancreas to produce insulin. Together, glucose and insulin enter the bloodstream. The insulin allows the glucose to enter the cells of the muscles and liver to be used for energy.
If your body is not producing enough insulin, or if your body is not using the insulin efficiently, the glucose doesn't reach the cells. This causes a rise in glucose. Your body will counter with increased insulin production and secretion, which also causes an increase in the levels of insulin in the blood. There are multiple causes of insulin resistance.
Causes of Insulin Resistance
Obesity. Many people become insulin resistant when they are 35 to 40 percent above their ideal body weight. The extra weight overloads tissues with excess fatty acids in the blood and promotes insulin resistance. Obesity is a leading cause of insulin resistance. Nearly three-fourths of the people with type 2 diabetes are overweight; however, thin people, especially the elderly, can also develop diabetes.
Genetics. Your family history is a key factor in insulin levels. Genetics help to determine whether or not you will develop insulin resistance.
Physical inactivity. When muscle is not used regularly, it is less efficient at receiving and using glucose in response to insulin.
Stress. When the body is under stress, it releases a hormone called cortisol. Too much of this hormone is thought to play a role in the development of insulin resistance. Cortisol can also stimulate appetite and weight gain.
Infection or illness. An illness or infection raises the level of stress hormones critical for the body's ability to recover from the illness. The stress hormones actually work against the effect of insulin and cause further insulin resistance. In addition, high blood sugars inhibit the ability of the white blood cells to kill bacteria and may result in a greater risk of infection.
Pregnancy. The fluctuation of hormones during pregnancy may increase insulin resistance. For those women with an increased risk of type 2 diabetes later on, blood sugars may rise during pregnancy and result in a form of diabetes called gestational diabetes.
Ethnicity. The chances of having insulin resistance and being diagnosed with type 2 diabetes increase if your heritage is African American, American Indian, Alaska Native, Hispanic/Latino, Asian, or Pacific Islander.
Symptoms of Diabetes
The symptoms of diabetes may develop so gradually that you don't readily notice them. Many people have diabetes for several years before it's diagnosed. You may have some of the symptoms of type 2 diabetes, but you may not have all of them. The following list describes symptoms and why they occur.
Frequent urination and excessive thirst. When blood is filtered into the kidneys and blood sugars are high, you start excreting glucose into your urine. This causes the urine to pull more water out of your blood. As a result, you need to urinate more frequently. Frequent urination can cause dehydration, prompting you to feel excessive thirst.
Fatigue. When your body is not delivering glucose to the cells efficiently, your body is experiencing a form of starvation. It cannot use the energy from the food you eat. Energy production by many of the tissues in the body goes down. Consequently, you feel tired and lack energy.
Excessive hunger. When the body's cells are not receiving the glucose they need for energy, it can produce the sensation of hunger. The cells send a message to the brain that they need glucose; the brain interprets this signal as hunger.
Occasional blurry vision. When blood sugars are high, the glucose draws excess fluid into the eyeballs. This expansion of volume changes the focal point on the eye, causing occasional blurry vision.
Weight loss. This may not seem like a likely symptom since most people with type 2 diabetes are overweight. However, when your body does not use insulin adequately, body tissues, including muscle and fat, can break down as your body looks for alternative sources of fuel. Calories are excreted in the urine, and you experience a weight loss.
Sores or wounds that heal slowly. When you have a wound, the body uses proteins to repair tissues. When you have high blood sugars, your body does not produce structurally normal proteins. This slows healing.
Infections. With type 2 diabetes, you may have more infections than usual. Just as a high level of glucose affects other components in the blood, it also affects the white blood cells, which fight infection. Consequently, the white blood cells do not stave off infections normally.
Numbness or tingling sensations in the feet or hands. High glucose levels can damage nerves. Since the nerves in the feet and hands are the longest nerves in the body, they are the ones most commonly affected. You may experience a sensation of tingling or numbness.
Tests for Diagnosing Diabetes
The most commonly used test to diagnose type 2 diabetes is the fasting blood glucose test. Two other tests may also be used; they are the random plasma glucose test] and the oral glucose tolerance test.
Fasting Blood Glucose Test
The fasting blood glucose test is the screening test favored by the American Diabetes Association. For this test, you must fast for six to eight hours. Then, blood is drawn from a vein in your arm and your blood sugar levels are tested.
If the test shows that you have a fasting blood sugar level above 126 mg/dl, you are usually diagnosed with type 2 diabetes. However, your doctor will likely perform the test a second time on another day to confirm the diagnosis.
Fasting Blood Glucose Classifications
Normal: less than 100 mg/dl
Impaired fasting glucose:100 to 125 mg/dl
Diabetes: greater than 126 mg/dl
An impaired fasting glucose level means that your blood sugars are high, but not high enough to be classified as type 2 diabetes.
You will notice that the standard medical measurement used in blood tests is listed as "mg/dl," which refers to "milligrams per deciliter." A deciliter is one-tenth of a liter — a little less than half a cup. The body contains about 5.6 liters (six quarts), of blood.
Random Plasma Glucose Test
This test can be performed at any time without fasting. Blood is drawn and tested. For this test, a normal blood sugar level is below 140 mg/dl. If your test results are 200 mg/dl or above, and you have symptoms of diabetes, you can be diagnosed with type 2 diabetes.
Oral Glucose Tolerance Test
Although the oral glucose tolerance test is considered the most sensitive test for diagnosing type 2 diabetes, it's not considered the most convenient by patients. It takes longer than other tests and blood is drawn several times. For this test, you are asked to fast overnight, and a sample of your blood is drawn. Then, you are asked to drink a cup of liquid glucose. After drinking the glucose, your blood is drawn and tested again at two hours.
If you don't have type 2 diabetes, the blood glucose will rise and then return to normal because adequate insulin is produced in response to the sugary drink. However, if you do have diabetes, the blood glucose will rise higher than normal and come down at a much slower rate because not enough insulin is produced or the cells of the muscles and liver are not properly responding to the insulin.
If your oral glucose tolerance test result is 110 mg/dl or less, you have a normal glucose response and do not have diabetes. Your body is handling sugars normally.
If, at the two-hour mark during the test, your blood glucose is 140 mg/dl or higher but less than 200 mg/dl, you have impaired glucose tolerance. This means you are not processing glucose normally and are at increased risk for type 2 diabetes. If your blood glucose level at two hours is 200 mg/dl or greater, you will be diagnosed with type 2 diabetes.
Hemoglobin A1c Test
The Hemoglobin A1c test is another important means for measuring sugar levels in the blood. This test is different from others in that it tells what the blood sugar levels have been on average over a three-month period.
How is this test able to produce such a result? Hemoglobin A1c is a protein in red blood cells that bonds with blood sugars. Since red blood cells can live from 90 to 120 days, the hemoglobin A1c stays in the blood for that length of time. Accordingly, it is effective in measuring blood sugars over a period of time.
According to the American Diabetes Association, a normal A1c level is between 4 and 6 percent. A person with a level of 6.5 percent or higher is considered to have type 2 diabetes. This test is also used to assess blood sugar control as part of an ongoing monitoring strategy.
Disorders that Affect Type 2 Diabetes
As mentioned earlier, type 2 diabetes is a metabolic disorder. Other metabolic disorders, including abnormal blood fat (cholesterol and triglycerides) levels and high blood pressure, can be aggravated by type 2 diabetes. Similarly, high blood sugar levels can have a negative affect on cholesterol levels and blood pressure. In fact, if you a have a cluster of these metabolic disorders, you may have a condition known as metabolic syndrome.
Metabolic syndrome has also been called Syndrome X and insulin resistance syndrome. It's important to be aware of the disorders that make up this syndrome since they can affect your overall health. If you have metabolic syndrome, your risk of heart attack and stroke increases significantly. You are considered to have metabolic syndrome if you have three or more of the syndrome's five criteria.
1. High fasting blood glucose. This means blood glucose levels are higher than 110 (mg/dl) when tested after fasting, but are not yet high enough to be classified as diabetes.
2. Abdominal obesity. The fat around the belly, or "central obesity," is a key risk factor because it affects the body's metabolism. Men have central obesity if they have a waist circumference of 40 inches; for women, it is 35 inches.
3. Low HDL cholesterol. The high-density lipoprotein cholesterol (HDL) is known as the "good" cholesterol. For men, HDL levels of less than 45 mg/dl fit the criteria for metabolic syndrome; for women, the criteria is an HDL level of less than 55 mg/dl.
4. High triglycerides. Triglycerides are a form of fat the body uses for energy. Levels of more than 150 mg/dl are considered high for both men and women.
5. High blood pressure. High blood pressure, or hypertension, occurs when the force of blood flowing through the artery walls is too high. A blood pressure of 130/80 or more is considered high.
We've already discussed fasting blood glucose, so let's take a closer look at the other disorders in metabolic syndrome.
Medical experts believe that belly fat releases fatty acids and other hormones into the bloodstream, causing an increase in insulin resistance. It's also believed that abdominal fat cells produce toxic chemicals that disrupt the normal production of insulin and may promote chronic inflammation of tissues and the lining of blood vessels. These actions may also increase insulin resistance, which may promote high blood pressure and abnormal cholesterol levels.
Low HDL Cholesterol
Cholesterol is carried through the bloodstream by proteins. High-density lipoproteins, HDL, the "good cholesterol," acts as a scavenger in the bloodstream, carrying away harmful cholesterol to the liver for excretion from the body. This helps prevent the formation of clogged arteries, a condition known as atherosclerosis. When HDL cholesterol levels are too low, the good cholesterol is not able to function normally, and contributes to atherosclerosis, the buildup of cholesterol in the arteries.
HDL (Good) Cholesterol Levels
For women: 55 mg/dl or greater
For men: 45 mg/dl or greater
Low HDL cholesterol can be caused by a variety of factors, which include: high blood sugars, being overweight, lack of physical activity, cigarette smoking, high triglycerides, genetics, and some medications such as anabolic steroids.
Most of the stored fat in your body is made up of triglycerides. They come from fats in the food we eat; the body makes them from carbohydrates. When we eat, the calories we don't need immediately for energy are converted to triglycerides and transported to fat cells to be stored.
When the body needs energy, the fat tissue breaks down the triglycerides and releases them into the bloodstream as fatty acids. If you are overweight, too much fatty acid is released, and tissues become overloaded with fat. This contributes to insulin resistance and to the development of cardiovascular disease.
Excerpted from The Type 2 Diabetes Handbook by Rod Colvin, James T. Lane, Jack Kusler. Copyright © 2011 Rod Colvin. Excerpted by permission of Addicus Books, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Rule 1 Learn the Basics about Type 2 Diabetes,
Rule 2 Eat Right and Control Your Weight,
Rule 3 Exercise Regularly,
Rule 4 Monitor Blood Sugar Levels,
Rule 5 Take Medications as Directed,
Rule 6 Avoid Complications by Practicing Good Self-Care,
About the Authors,