What is diabetes? What causes diabetes?

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia). Types of diabetes 1) Type 1 Diabetes The body does not produce insulin. Some people may refer to this type as insulindependent diabetes, juvenile diabetes, or early-onset diabetes. People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years. Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 10% of all diabetes cases are type 1. Patients with type 1 diabetes will need to take insulin injections for the rest of their life. They must also ensure proper blood-glucose levels by carrying out regular blood tests and following a special diet. Between 2001 and 2009, the prevalence of type 1 diabetes among the under 20s in the USA rose 23%, according to SEARCH for Diabetes in Youth data issued by the CDC (Centers for Disease Control and Prevention). (Link to article) 2) Type 2 Diabetes The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance). Approximately 90% of all cases of diabetes worldwide are of this type. Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. However, type 2 diabetes is typically a progressive disease - it gradually gets worse - and the patient will probably end up have to take insulin, usually in tablet form. Overweight and obese people have a much higher risk of developing type 2 diabetes compared to those with a healthy body weight. People with a lot of visceral fat, also known as central obesity, belly fat, or abdominal obesity, are especially at risk. Being overweight/obese causes the body to release chemicals that can destabilize the body's cardiovascular and metabolic systems. The risk of developing type 2 diabetes is also greater as we get older. Experts are not completely sure why, but say that as we age we tend to put on weight and become less physically active. Those with a close relative who had/had type 2 diabetes, people of Middle Eastern, African, or South Asian descent also have a higher risk of developing the disease. Men whose testosterone levels are low have been found to have a higher risk of developing type 2 diabetes. Researchers from the University of Edinburgh, Scotland, say that low testosterone levels are linked to insulin resistance. 3) Gestational diabetes This type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the

glucose into their cells, resulting in progressively rising levels of glucose. Diagnosis of gestational diabetes is made during pregnancy. The majority of gestational diabetes patients can control their diabetes with exercise and diet. Between 10% to 20% of them will need to take some kind of blood-glucosecontrolling medications. Undiagnosed or uncontrolled gestational diabetes can raise the risk of complications during childbirth. The baby may be bigger than he/she should be. Scientists from the National Institutes of Health and Harvard University found that women whose diets before becoming pregnant were high in animal fat and cholesterol had a higher risk for gestational diabetes, compared to their counterparts whose diets were low in cholesterol and animal fats. (Link to article)

What is Prediabetes?
The vast majority of patients with type 2 diabetes initially had prediabetes. Their blood glucose levels where higher than normal, but not high enough to merit a diabetes diagnosis. The cells in the body are becoming resistant to insulin. Studies have indicated that even at the prediabetes stage, some damage to the circulatory system and the heart may already have occurred.

Diabetes - A Metabolism Disorder

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies. When our food is digested, the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present - insulin makes it possible for our cells to take in the glucose. Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as glucose enters the cells blood-glucose levels drop. A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.

How to determine whether you have diabetes, prediabetes or neither

Doctors can determine whether a patient has a normal metabolism, prediabetes or diabetes in one of three different ways - there are three possible tests:

The A1C test - at least 6.5% means diabetes - between 5.7% and 5.99% means prediabetes - less than 5.7% means normal The FPG (fasting plasma glucose) test - at least 126 mg/dl means diabetes - between 100 mg/dl and 125.99 mg/dl means prediabetes - less than 100 mg/dl means normal An abnormal reading following the FPG means the patient has impaired fasting glucose (IFG) The OGTT (oral glucose tolerance test) - at least 200 mg/dl means diabetes - between 140 and 199.9 mg/dl means prediabetes - less than 140 mg/dl means normal An abnormal reading following the OGTT means the patient has impaired glucose tolerance (IGT)

Why is it called Diabetes Mellitus?

Diabetes comes from Greek, and it means a "siphon". Aretus the Cappadocian, a Greek physician during the second century A.D., named the condition diabainein. He described patients who were passing too much water (polyuria) - like a siphon. The word became "diabetes" from the English adoption of the Medieval Latin diabetes. In 1675, Thomas Willis added mellitus to the term, although it is commonly referred to simply as diabetes. Mel in Latin means "honey"; the urine and blood of people with diabetes has excess glucose, and glucose is sweet like honey. Diabetes mellitus could literally mean "siphoning off sweet water". In ancient China people observed that ants would be attracted to some people's urine, because it was sweet. The term "Sweet Urine Disease" was coined.

Some facts and myths regarding diabetes

Many presumed "facts" are thrown about in the paper press, magazines and on the internet regarding diabetes; some of them are, in fact, myths. It is important that people with diabetes, pre-diabetes, their loved ones, employers and schools have an accurate picture of the disease. Below are some diabetes myths:

People with diabetes should not exercise - NOT TRUE!! Exercise is important for people with diabetes, as it is for everybody else. Exercise helps manage body weight, improves cardiovascular health, improves mood, helps blood sugar control, and relieves stress. Patients should discuss exercise with their doctor first.

Fat people always develop type 2 diabetes eventually - this is not true. Being overweight or obese raises the risk of becoming diabetic, they are risk factors, but do not mean that an obese person will definitely become diabetic. Many people with type 2 diabetes were never overweight. The majority of overweight people do not develop type 2 diabetes.

Diabetes is a nuisance, but not serious - two thirds of diabetes patients die prematurely from stroke or heart disease. The life expectancy of a person with diabetes is from five to ten years shorter than other people's. Diabetes is a serious disease.

Children can outgrow diabetes - this is not true. Nearly all children with diabetes have type 1; insulin-producing beta cells in the pancreas have been destroyed. These never come back. Children with type 1 diabetes will need to take insulin for the rest of their lives, unless a cure is found one day.

Don't eat too much sugar, you will become diabetic - this is not true. A person with diabetes type 1 developed the disease because their immune system destroyed the insulin-producing beta cells. A diet high in calories, which can make people overweight/obese, raises the risk of developing type 2 diabetes, especially if there is a history of this disease in the family.

I know when my blood sugar levels are high or low - very high or low blood sugar levels may cause some symptoms, such as weakness, fatigue and extreme thirst. However, levels need to be fluctuating a lot for symptoms to be felt. The only way to be sure about your blood sugar levels is to test them regularly. Researchers from the University of Copenhagen, Denmark showed that even very slight rises in blood-glucose levels significantly raise the risk of ischemic heart disease. (Link to article)

Diabetes diets are different from other people's - the diet doctors and specialized nutritionists recommend for diabetes patients are healthy ones; healthy for everybody, including people without the disease. Meals should contain plenty of vegetables, fruit, whole grains, and they should be low in salt and sugar, and

saturated or trans fat. Experts say that there is no need to buy special diabetic foods because they offer no special benefit, compared to the healthy things we can buy in most shops.

High blood sugar levels are fine for some, while for others they are a sign of diabetes - high blood-sugar levels are never normal for anybody. Some illnesses, mental stress and steroids can cause temporary hikes in blood sugar levels in people without diabetes. Anybody with higher-than-normal blood sugar levels or sugar in their urine should be checked for diabetes by a health care professional. Diabetics cannot eat bread, potatoes or pasta - people with diabetes can eat starchy foods. However, they must keep an eye on the size of the portions. Whole grain starchy foods are better, as is the case for people without diabetes.

One person can transmit diabetes to another person - NOT TRUE. Just like a broken leg is not infectious or contagious. A parent may pass on, through their genes to their offspring, a higher susceptibility to developing the disease.

Only older people develop type 2 diabetes - things are changing. A growing number of children and teenagers are developing type 2 diabetes. Experts say that this is linked to the explosion in childhood obesity rates, poor diet, and physical inactivity.

I have to go on insulin, this must mean my diabetes is severe - people take insulin when diet alone or diet with oral or non-insulin injectable diabetes drugs do not provide good-enough diabetes control, that's all. Insulin helps diabetes control. It does not usually have anything to do with the severity of the disease.

If you have diabetes you cannot eat chocolates or sweets - people with diabetes can eat chocolates and sweets if they combine them with exercise or eat them as part of a healthy meal.

Diabetes patients are more susceptible to colds and illnesses in general - a person with diabetes with good diabetes control is no more likely to become ill with a cold or something else than other people. However, when a diabetic catches a

cold, their diabetes becomes harder to control, so they have a higher risk of complications. CONTROL

Step 1: Learn about diabetes.

Diabetes means that your blood glucose (blood sugar) is too high. There are two main types of diabetes. Type 1 diabetes - the body does not make insulin. Insulin helps the body use glucose from food for energy. People with type 1 need to take insulin every day. Type 2 diabetes - the body does not make or use insulin well. People with type 2 often need to take pills or insulin. Type 2 is the most common form of diabetes. Gestational (jes-TAY-shon-al) diabetes - occurs in some women when they become pregnant. It raises her future risk of developing diabetes, mostly type 2. It may raise her child's risk of being overweight and developing type 2 diabetes.

Diabetes is serious.
You may have heard people say they have a touch of diabetes or that their sugar is a little high. These words suggest that diabetes is not a serious disease. That is not correct. Diabetes is serious, but you can learn to manage it! Its not easy, but its worth it! All people with diabetes need to make healthy food choices, stay at a healthy weight, and move more every day. Taking good care of yourself and your diabetes can help you feel better. It may help you avoid health problems caused by diabetes such as:

heart attack and stroke eye problems that can lead to trouble seeing or going blind nerve damage that can cause your hands and feet to hurt, tingle, or feel numb. Some people may even lose a foot or a leg. kidney problems that can cause your kidneys to stop working gum disease and loss of teeth

When your blood glucose is close to normal you are likely to:

have more energy. be less tired and thirsty and urinate less often. heal better and have fewer skin, or bladder infections.

have fewer problems with your eyesight, feet, and gums. Ask your health care team what type of diabetes you have. Learn why diabetes is serious. Learn how caring for your diabetes helps you feel better today and in the future.

Step 3: Manage your diabetes.

Many people avoid the long-term problems of diabetes by taking good care of themselves. Work with your health care team to reach your ABC target. Use this self-care plan.

Follow your diabetes meal plan. If you do not have one, ask your health care team to help you develop a meal plan. o Eat healthy foods such as fruits and vegetables, fish, lean meats, chicken or turkey without the skin, dry peas or beans, whole grains, and low-fat or skim milk and cheese. o Keep fish and lean meat and poultry portions to about 3 ounces (or the size of a deck of cards). Bake, broil, or grill it. o Eat foods that have less fat and salt. o Eat foods with more fiber such as whole grain cereals, breads, crackers, rice, or pasta. Get 30 to 60 minutes of physical activity on most days of the week. Brisk walking is a great way to move more. Stay at a healthy weight by using your meal plan and moving more. Ask for help if you feel down. A mental health counselor, support group, member of the clergy, friend, or family member who will listen to your concerns may help you feel better. Learn to cope with stress. Stress can raise your blood glucose. While it is hard to remove stress from your life, you can learn to handle it. NDEP's Diabetes HealthSense provides online access to resources that support people with diabetes in making changes to live well. For more information visit www.YourDiabetesInfo.org/HealthSense. Stop smoking. Ask for help to quit. Call 1-800-QUITNOW (1-800-784-8669) Take medicines even when you feel good. Ask your doctor if you need aspirin to prevent a heart attack or stroke. Tell your doctor if you cannot afford your medicines or if you have any side effects. Check your feet every day for cuts, blisters, red spots, and swelling. Call your health care team right away about any sores that do not go away. Brush your teeth and floss every day to avoid problems with your mouth, teeth, or gums Check your blood glucose. You may want to test it one or more times a day. Use the card at the back of this booklet to keep a record of your blood glucose numbers. Be sure to show it to your health care team.

Check your blood pressure if your doctor advises. Report any changes in your eyesight to your health care team. Talk with your health care team about your blood glucose targets. Ask how and when to test your blood glucose and how to use the results to manage your diabetes. Use this plan as a guide to your self-care. Discuss how your self-care plan is working for you each time you visit your health care team.

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Step 4: Get routine care.

See your health care team at least twice a year to find and treat any problems early.

At each visit be sure you have a:

blood pressure check foot check weight check review of your self-care plan shown in Step 3

Two times each year have an:

A1C test - it may be checked more often if it is over 7

Once each year be sure you have a:

cholesterol test triglyceride (try-GLISS-er-ide) test - a type of blood fat complete foot exam dental exam to check teeth and gums - tell your dentist you have diabetes dilated eye exam to check for eye problems flu shot urine and a blood test to check for kidney problems

At least once get a:

pneumonia (nu-mo-nya) shot Ask your health care team about these and other tests you may need. Ask what yours results mean.

Write down the date and time of your next visit. Use the card at the back of this booklet to keep a record of your diabetes care. If you have Medicare, ask your health care team if Medicare will cover some of the costs for o learning about healthy eating and diabetes self-care o special shoes, if you need them o medical supplies o diabetes medicines

Fibres role in preventing and controlling diabetes 1. Improves your blood sugar control and thus may reduce the risk of diabetes. 2. Fibre intake is associated with a lower risk of heart disease. 3. Fibre helps you keep full, so may even promote weight loss. Tip 2: Establish regular eating habits: A regular eating habit is specially important for diabetics. Your body is better able to regulate blood sugar levels and your weight when you maintain a regular meal schedule. Aim for moderate and consistent portion sizes for each meal or snack. Dont skip breakfast: start your day off with a good breakfast. Eating breakfast everyday will help you have energy as well as steady blood sugar levels. Eat small meals at regular times: It is helpful to eat three small meals at regular times plus three snacks spread out through the day. People tend to eat larger portion when they are overly hungry. So eating regularly will help you keep your portion in check. Keep calories intake the same: Regulating the amount of calories you eat on a day-to-day basis has an impact on the regularity of your blood sugar levels. Try to eat roughly the same amount of calories every day, rather than overeating one day or at one meal and then skimping on the next. Tip 3: Choose fats wisely: fats can either be helpful or harmful in your diet. People with diabetes are at higher risk for heart disease. So its even more important to be smart about fats. Some fats are unhealthy and others have sound health benefits. But all fats are high in calories so you should always watch your portion sizes. Unhealthy fats: The two most damaging fats are saturated fats and trans fats. Saturated fats are found mainly in animal products such as red meat, whole milk dairy products and eggs. Trans fats, also called partially hydrogenated, are created by adding hydrogen to liquid

vegetable oils to make them more solid and less likely to spoil which is very good for food manufacturers and very bad for you. Healthy fats: The best fats are saturated fats which come from plant sources and are liquid at room temperature. Primary sources include olive oil, canona oil, nuts and avocadoes. Also focus on omega-3 fatty acids which fight inflammation and support brain and heart health. Good sources include salmon tuna sesame seed. Tip 4: Stock up unhealthy appetising foods: Fruits: Keep a large fruit bowl filled and in sight on a table or on your fridge. Fruits are high in fibre and vitamins plus they are colourful and pretty to look at. Nuts and seeds: Keep a variety of nuts and seeds on hand. Peanut butter is very satisfying and full of healthy fats. Grains: It is best to keep only slow release carbohydrates around. This means grain such as millet and brown rice. Also stock up on whole grain high fibre cereals and breads, in your kitchen. Cut back on soft drinks that contain sugar. That is the conclusion drawn by a study that appeared in the journal of the American Medical Association. Women who drink more than one sugar sweetened soft drink a day were found to be twice as likely to develop diabetes than those who did not. People with type two diabetes are less able than most people to perceive sweet taste, and this may make it more difficult for them to lose weight. Because they do not recognise the sweet taste of substances, they often consume sugary products that they do not appreciate as sweet. Research at the University of Colorado Health Sciences centre found that smokers who have diabetes are two to three times more likely than their non-smoking counterparts to develop kidney damage, often leading to the need for dialysis or a transplant. Smoking constricts blood vessels. In people with diabetes, this helps to push large protein molecules out of the vessels and into the kidneys.

Symptoms of Diabetes
People can often have diabetes and be completely unaware. The main reason for this is that the symptoms, when seen on their own, seem harmless. However, the earlier diabetes is diagnosed the greater the chances are that serious complications, which can result from having diabetes, can be avoided.

Here is a list of the most common diabetes symptoms:

Frequent urination Have you been going to the bathroom to urinate more often recently? Do you notice that you spend most of the day going to the toilet? When there is too much glucose (sugar) in your blood you will urinate more often. If your insulin is ineffective, or not there at all, your kidneys cannot filter the glucose back into the blood. The kidneys will take water from your blood in order to dilute the glucose - which in turn fills up your bladder. Disproportionate thirst If you are urinating more than usual, you will need to replace that lost liquid. You will be drinking more than usual. Have you been drinking more than usual lately? Intense hunger As the insulin in your blood is not working properly, or is not there at all, and your cells are not getting their energy, your body may react by trying to find more energy - food. You will become hungry. Weight gain This might be the result of the above symptom (intense hunger). Unusual weight loss This is more common among people with Diabetes Type 1. As your body is not making insulin it will seek out another energy source (the cells aren't getting glucose). Muscle tissue and fat will be broken down for energy. As Type 1 is of a more sudden onset and Type 2 is much more gradual, weight loss is more noticeable with Type 1. Increased fatigue If your insulin is not working properly, or is not there at all, glucose will not be entering your cells and providing them with energy. This will make you feel tired and listless. Irritability Irritability can be due to your lack of energy. Blurred vision This can be caused by tissue being pulled from your eye lenses. This affects your eyes' ability to focus. With proper treatment this can be treated. There are severe cases where blindness or prolonged vision problems can occur. Cuts and bruises don't heal properly or quickly Do you find cuts and bruises take a much longer time than usual to heal? When there is more sugar (glucose) in your body, its ability to heal can be undermined. More skin and/or yeast infections When there is more sugar in your body, its ability to recover from infections is affected. Women with diabetes find it especially difficult to recover from bladder and vaginal infections. Itchy skin A feeling of itchiness on your skin is sometimes a symptom of diabetes. Gums are red and/or swollen - Gums pull away from teeth If your gums are tender, red and/or swollen this could be a sign of diabetes. Your teeth could become loose as the gums pull away from them.

Frequent gum disease/infection As well as the previous gum symptoms, you may experience more frequent gum disease and/or gum infections. Sexual dysfunction among men If you are over 50 and experience frequent or constant sexual dysfunction (erectile dysfunction), it could be a symptom of diabetes. Numbness or tingling, especially in your feet and hands If there is too much sugar in your body your nerves could become damaged, as could the tiny blood vessels that feed those nerves. You may experience tingling and/or numbness in your hands and feet.

Diagnosis of diabetes
Diabetes can often be detected by carrying out a urine test, which finds out whether excess glucose is present. This is normally backed up by a blood test, which measures blood glucose levels and can confirm if the cause of your symptoms is diabetes. If you are worried that you may have some of the above symptoms, you are recommended to talk to your Doctor or a qualified health professional.