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Last reviewed: May 10, 2010.
Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood.
Type 1 diabetes
Type 2 diabetes
Causes, incidence, and risk factors
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 fuel for 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 usually diagnosed in childhood. Many patients are diagnosed when they are older 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 autoimmune problems 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 with type 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 pre-diabetes (early type 2 diabetes).
There are many risk factors for 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
High blood cholesterol level
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)
High blood levels of glucose can cause several problems, including:
However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.
Symptoms of type 1 diabetes:
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:
DESTROYING BLOOD SUGAR
1. Not Knowing Your Disease
“You are your own doctor 99.9% of the time,” says Andrew Ahmann, MD, director of the Harold Schnitzer Diabetes Health Center at Oregon Health and Science University in Portland, Ore.
By that he means that you are the one watching your diet, making sure you exercise, and taking your medication on schedule. Understanding how diabetes works will help you make better decisions about how to monitor and manage it. Classes on coping with diabetes are an excellent but underused resource.
“Not enough patients seek them out, and not enough doctors send their patients to them,” Ahmann says.
That’s unfortunate, because not only do they offer essential information; they are often de facto support groups as well, bringing together people who are experiencing the same issues and difficulties and giving them a forum in which to meet and talk with each other.
2. Expecting Too Much Too Soon
One of the biggest hurdles in controlling your blood sugar is sticking to the necessary adjustments you must make to your eating and exercise habits. Many patients become frustrated and give up because they don’t see results right away, says endocrinologist Preethi Srikanthan, MD, assistant clinical professor of medicine at UCLA’s David Geffen School of Medicine.
“Most people expect something dramatic is going to happen right away,” she says. “But it has taken them a decade or two to get to this point, and it will take a while for them to even to get to that initial 5%-10% reduction in weight…These are challenges that must be taken in small steps.”
Expecting too much change right away is a mistake. So is doing too much before you are ready, especially when it comes to exercise, Ahmann says. He advises starting off slowly and easing into the habit.
“If they do more than they can tolerate, they will often quit,” he says. “Or they will do too much and hurt themselves.”
Be sure to talk with your health-care provider before starting a new exercise program, especially if you aren’t already active. He or she can help plan a routine that’s safe and effective, as well as set realistic goals.
3. Going it Alone
There are a lot of resources out there to help you manage your disease. Don’t ignore the fact that one of the most helpful might be right there at home. Spouses, partners, friends, and family members can all make excellent exercise buddies.
“One error that people make when it comes to exercise is that they try to do it on their own without help from other people,” Ahmann says.
There are other advantages to the buddy system. Enlist your spouse or significant other in your efforts to stick your medication schedule and to maintain a healthy diet.
“Eating alone can be a problem,” Ahmann says.
4. Neglecting Other Problems
In her practice, Srikanthan sees a lot of patients who are dealing with more than just their diabetes. Depression and stress are common among people with the disease, and both can have a negative impact on blood sugar levels.
Constant stress, for example, may produce hormones that hamper the ability of insulin to do its job. “Stress should be considered as a significant contributor to glycemic variation by both patients and physicians,” Srikanthan says.
“Anything to reduce stress will improve your blood sugar,” he says.
Exercise helps relieve stress and there’s evidence that meditation and massage will have benefits on blood sugar levels, says Ahmann.
People with diabetes are twice as likely to be depressed, and an estimated one of every three people with diabetes have symptoms of depression. The lethargy common to depression can be so discouraging that you might give up your efforts to take care of your diabetes. Not only will that make your diabetes worse, it may also intensify your depression, creating a vicious cycle.
There’s good news, though. According to a new study, treating depression in patients with type 2 diabetes improved their mental and physical health.
“You need to recognize depression and work with it,” Srikanthan says.
5. Misunderstanding and Misusing Medications
Ahmann says that many of his patients share a common misconception when it comes to the drugs used to control their disease.
“They think that medications are more powerful than diet and exercise,” he says.
That’s not necessarily true. In many cases, type 2 diabetes can be controlled by a combination of a healthy diet and regular exercise without the need for medication.
Among patients who do require medications, Ahmann says, one mistake stands out.
“It’s surprising how many people miss doses,” he says.
That’s a quick way to wreck your blood sugar level, so it’s a problem that needs to be recognized and addressed.
“You need to be honest with your [health care] provider that this is an issue,” says Ahmann, who points out that often the solution is for your doctor to change your dosing schedule to one that better suits you. “There are options.”
6. Making Poor Food Choices
When it comes to food and blood sugar, the big mistake is not the single candy bar that you couldn’t resist, Srikanthan says. The bigger picture matters more; unhealthy eating habits, in the long term, will have a worse effect on your blood sugar.
“People think it’s a one-time diversion, but no, it’s a consistent problem that affects your test results,” she says.
The two biggest hurdles, Srikanthan says, are calories and carbohydrates. You have to control both in order to keep your blood sugar level steady.
“Try to be aware of what’s going into your mouth,” she says.
That means keeping a diet diary to keep track of what you are eating and reading nutrition labels so that you can calculate the proper amounts of the foods you choose to eat.
Failing to eat on a regular schedule is another common mistake. Ahmann often sees patients who miss breakfast or who are too busy during the day to notice they are hungry.
“At home that evening, they tend to lose control, eating a large dinner and then snacking throughout the evening,” he says.