Insulin is a hormone produced by the pancreas to control blood sugar.
Diabetes can be caused by too little insulin, resistance to insulin,
or both.
To understand diabetes, it is important to first understand the normal
process by which food is broken down and used by the body for energy.
Several things happen when food is digested:
*. A sugar called glucose enters the bloodstream. Glucose is a source
of fuelfor the body.
*. An organ called the pancreas makes insulin. The role of insulin is
to move glucose from the bloodstream into muscle,fat, and liver cells,
where it can be used as fuel.
People with diabetes have high blood sugar. This is because:
*. Their pancreas does not make enough insulin
*. Their muscle, fat, and liver cells do not respond to insulin normally
*. Both of the above
There are three major types of diabetes:
*. Type 1 diabetes is usuallydiagnosed in childhood. Many patients are
diagnosed when they areolder than age 20. In this disease, the body
makes little or no insulin. Daily injections of insulin are needed.
The exact cause is unknown. Genetics, viruses , and autoimmuneproblems
may play a role.
*. Type 2 diabetes is far more common than type 1. It makes up most of
diabetes cases. It usually occurs in adulthood, but young people are
increasingly being diagnosed with this disease. The pancreas does not
make enough insulin to keep blood glucose levels normal, often because
the body does not respond well to insulin. Many people withtype 2
diabetes do not know they have it, although it is a serious condition.
Type 2 diabetes is becoming more common due to increasing obesity and
failure to exercise .
*. Gestational diabetes is high blood glucose that develops at any
time during pregnancy in a woman who does not have diabetes. Women who
have gestational diabetes are at high risk of type 2 diabetes and
cardiovascular disease later in life.
Diabetes affects more than 20 million Americans. Over 40 million
Americans have prediabetes (early type 2 diabetes).
There are many risk factorsfor type 2 diabetes, including:
*. Age over 45 years
*. A parent, brother, or sister with diabetes
*. Gestational diabetes or delivering a baby weighing more than 9 pounds
*. Heart disease
*. High blood cholesterol level
*. Obesity
*. Not getting enough exercise
*. Polycystic ovary disease (in women)
*. Previous impaired glucose tolerance
*. Some ethnic groups (particularly African Americans, Native
Americans, Asians, Pacific Islanders, and Hispanic Americans)
Symptoms
High blood levels of glucose can cause several problems, including:
*. Blurry vision
*. Excessive thirst
*. Fatigue
*. Frequent urination
*. Hunger
*. Weight loss
However, because type 2 diabetes develops slowly, some people with
high blood sugar experience no symptoms at all.
Symptoms of type 1 diabetes :
*. Fatigue
*. Increased thirst
*. Increased urination
*. Nausea
*. Vomiting
*. Weight loss in spite of increased appetite
Patients with type 1 diabetes usually develop symptoms over a short
period of time. The condition is often diagnosed in an emergency
setting.
Symptoms of type 2 diabetes:
*. Blurred vision
*. Fatigue
*. Increased appetite
*. Increased thirst
*. Increased urination
Signs and tests
A urine analysis may be used to look for glucose and ketones from the
breakdown of fat. However, a urine test alonedoes not diagnose
diabetes.
The following blood tests are used to diagnose diabetes:
*. Fasting blood glucose level -- diabetes is diagnosed if higher than
126 mg/dL on two occasions. Levels between 100 and 126 mg/dL are
referred to as impaired fasting glucose or prediabetes. These levels
are considered to be risk factors for type 2 diabetes and its
complications.
*. Oral glucose tolerance test -- diabetes is diagnosed if glucose
levelis higher than 200 mg/dLafter 2 hours. (This test is used more
for type 2 diabetes.)
*. Random (non-fasting) blood glucose level -- diabetes is suspected
if higher than 200 mg/dL and accompanied by the classic diabetes
symptoms of increased thirst, urination, and fatigue. (This test must
be confirmed with a fasting blood glucose test .)
Persons with diabetes need to have their hemoglobin A1c ( HbA1c )
level checked every 3 - 6 months. The HbA1c is a measure of average
blood glucose during the previous 2 - 3 months. It is a very helpful
way to determine how well treatment is working.
Treatment
The immediate goals are totreat diabetic ketoacidosis and high blood
glucose levels. Because type 1 diabetes can start suddenlyand have
severe symptoms, people who arenewly diagnosed may need to go to the
hospital.