DIABETES - Part 1

Diabetes means your blood glucose, also called blood sugar, is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn't good for your health.

How do you get high blood glucose?

Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all the cells in your body. Insulin is a chemical, also called a hormone, made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body doesn't make enough insulin, or if the insulin doesn't work the way it should, glucose can't get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing pre-diabetes or diabetes.

What is pre-diabetes?

Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is, if you have pre-diabetes, you can reduce your risk of getting diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes and even return to normal glucose levels.

What are the signs of diabetes?

The signs of diabetes are

• being very thirsty
• urinating often
• feeling very hungry or tired
• losing weight without trying
• having wounds that heal slowly
• having dry, itchy skin
• losing the feeling in your feet or having tingling in your feet
• having blurry eyesight

You may have had one or more of these signs before you found out you had diabetes. Or you may have had no signs at all. A blood test to check your glucose levels will show if you have pre-diabetes or diabetes.

What kind of diabetes do you have?

People can get diabetes at any age. Type 1, type 2, and gestational diabetes are the three main kinds.  

Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. With this form of diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them. Treatment for type 1 diabetes includes taking insulin and possibly another injectable medicine, making wise food choices, being physically active, taking aspirin daily-for some-and controlling blood pressure and cholesterol.

Type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age-even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes. Treatment includes using diabetes medicines, making wise food choices, being physically active, taking aspirin daily-for some-and controlling blood pressure and cholesterol.

Some women develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin.

Why do you need to take care of your diabetes?

After many years, diabetes can lead to serious problems with your eyes, kidneys, nerves, and gums and teeth. But the most serious problem caused by diabetes is heart disease. When you have diabetes, you are more than twice as likely as people without diabetes to have heart disease or a stroke.
If you have diabetes, your risk of a heart attack is the same as someone who has already had a heart attack. Both women and men with diabetes are at risk. You may not even have the typical signs of a heart attack.
You can reduce your risk of developing heart disease by controlling your blood pressure and blood fat levels. If you smoke, talk with your doctor about quitting. Remember that every step toward your goals helps!

What's a desirable blood glucose level?

Everyone's blood has some glucose in it. In people who don't have diabetes, the normal range is about 70 to 120. Blood glucose goes up after eating but 1 or 2 hours later returns to the normal range.
Ask your health care team when you should check your blood glucose with a meter. Talk about whether the blood glucose targets listed below are best for you. Then write in your own targets.

Blood Glucose Targets for Most People with Diabetes
When	Target levels	My target levels
Before meals	70 to 130	______ to _____
1 to 2 hours after the start of a meal	below 180	below ______

It may be hard to reach your target range all of the time. But the closer you get to your goal, the more you will reduce your risk of diabetes-related problems and the better you will feel. Every step helps.

Taking Care of Your Diabetes Every Day

 
Do four things every day to take care of your diabetes:

• Follow your meal plan.
• Be physically active.
• Take your diabetes medicines every day.
• Check your blood glucose as recommended.
• Take other tests for your diabetes.
• Keep daily records.

Experts say most people with diabetes should try to keep their blood glucose level as close as possible to the level of someone who doesn't have diabetes. The closer to normal your blood glucose is, the lower your chances are of developing serious health problems.
Check with your doctor about the right range for you. The Blood Glucose Targets table shows target blood glucose ranges.
Your health care team will help you learn how to reach your target blood glucose range. Your team may include a doctor, a nurse, a dietitian, and others.

When you see your doctor, ask lots of questions. Before you leave, be sure you understand everything you need to know about taking care of your diabetes.
A diabetes educator is a health worker who teaches people how to manage their diabetes. Your educator may also be a nurse, a dietitian, or other kind of health care worker.
A dietitian is someone who's specially trained to help people plan their meals. 

Follow your meal plan

You should have your own meal plan. Ask your doctor to give you the name of a dietitian who can work with you to develop a meal plan. Your dietitian can help you plan meals that include foods that you and your family like to eat and that are good for you too. Ask your dietitian to include foods that are heart-healthy to reduce your risk of heart disease.
Your diabetes meal plan will include breads, cereals, rice, and grains; fruits and vegetables; meat and meat substitutes; dairy products; and fats. People with diabetes don't need to eat special foods. The foods on your meal plan are good for everyone in your family! Making wise food choices will help you

• reach and stay at a weight that's good for your body
• keep your blood glucose, blood pressure, and cholesterol under control
• prevent heart and blood vessel disease

 

Action Steps
If You Use Insulin

• Follow your meal plan.
• Don't skip meals, especially if you've already taken your insulin, because your blood glucose may go too low. Email us for information about how to handle low blood glucose, also called hypoglycemia.

Action Steps
If You Don't Use Insulin

 

• Follow your meal plan.

Don't skip meals, especially if you take diabetes medicines, because your blood glucose may go too low. Eat several small meals during the day instead of one or two big meals.

Be Physically Active

Physical activity helps you stay healthy. Try walking, swimming, dancing, riding a bicycle, playing baseball, or bowling. You can even get exercise when you clean your house or work in your yard. Physical activity is especially good for people with diabetes because it

• helps keep weight down
• helps insulin work better to lower blood glucose
• is good for your heart and lungs
• gives you more energy

You may be able to stop taking diabetes pills if you lose weight. Always check with your doctor before you stop taking your diabetes pills. Losing 5 or 10 Kgs can help you reach your target blood glucose levels.
 Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some exercises like weightlifting may not be safe. Your health care team can help you find safe exercises.

Being active helps you stay healthy. Try to be active almost every day for a total of about 30 minutes. If you haven't been very active lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day. If you use insulin or take diabetes pills that help your body make insulin, you may need to eat a snack before you exercise. Check your blood glucose before you exercise. If your blood glucose is below 100, have a snack before you exercise.

Action Steps
If You Use Insulin

• See your doctor before starting a physical activity program.
• Check your blood glucose before, during, and after exercising. Don't exercise when your blood glucose is high and you have ketones in your blood or urine. Email us for information about ketones.
• Don't exercise right before you go to sleep because it could cause low blood glucose during the night.

Action Steps
If You Don't Use Insulin

 

• See your doctor before starting a physical activity program. 
• Ask your doctor whether you need to eat before you exercise.

 
When you exercise, carry glucose  or a carbohydrate snack with you in case you have low blood glucose. Wear or carry an identification tag or card that says you have diabetes.

Take Your Diabetes Medicines Every Day

Three kinds of diabetes medicines can help you reach your blood glucose targets: pills, insulin, and other injections. Many people with type 2 diabetes take pills to help keep blood glucose in their target range.

If You Take Diabetes Pills

If your body makes insulin but the insulin doesn't lower your blood glucose enough, you may need diabetes pills. Some pills are taken once a day, and others are taken more often. Ask your health care team when you should take your pills. Be sure to tell your doctor if your pills make you feel sick or if you have any other problems.
Sometimes, people who take diabetes pills may need insulin for a while. If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose.

If You Use Insulin

You need insulin if your body has stopped making insulin or if it doesn't make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do too. Some women with gestational diabetes also need to take insulin.


You may need insulin to control your blood glucose.
Your doctor can tell you which of these ways to take insulin is best for you.

·        Taking injections. You'll use a needle attached to a syringe-a hollow tube with a plunger-that you fill with a dose of insulin. Some people use an insulin pen, a pen-like device with a needle and a cartridge of insulin.

·        Using an insulin pump. A pump is a small device, worn on a belt or in a pocket, that holds insulin. The pump connects to a small plastic tube and a very small needle. The needle is inserted under the skin and stays in for several days.

·        Using an insulin jet injector. This device sends a fine spray of insulin through the skin with high-pressure air instead of a needle.

·        Using an insulin infuser. A small tube is inserted just beneath the skin and remains in place for several days. Insulin is injected into the end of the tube instead of through the skin.

If You Use Other Injectable Medicines

Some people with diabetes use other injectable medicines to reach their blood glucose targets. These medicines are not substitutes for insulin.

If You Don't Use Pills, Insulin, or Other Injectable Medicines

Many people with type 2 diabetes don't need diabetes medicines. They can take care of their diabetes by using a meal plan and exercising regularly.