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Type 1 Diabetes • Type 1 diabetes occurs when the body's own immune system destroys the insulinproducing cells of the pancreas (called beta cells). • Normally, the body's immune system fights off foreign invaders like viruses or bacteria. But for unknown reasons, in people with type 1 diabetes, the immune system attacks various cells in the body. This results in a complete deficiency of the insulin hormone.

Understanding Insulin and Type 1 Diabetes • Normally the hormone insulin is secreted by the pancreas in low amounts. When you eat a meal, sugar (glucose) from food stimulates the pancreas to release insulin. The amount that is released is proportional to the amount that is required by the size of that particular meal. • Insulin's main role is to help move certain nutrients -- especially glucose -- into the cells of the body's tissues. Cells use sugars and other nutrients from meals as a source of energy to function. The amount of sugar in the blood decreases once it enters the cells. Normally that signals the beta cells in the pancreas to lower the amount of insulin secreted so that you don't develop low blood sugar levels (hypoglycemia). But the destruction of the beta cells that occurs with type 1 diabetes throws the entire process into disarray.

In people with type 1 diabetes, sugar isn't moved into the cells because insulin is not available. When sugar builds up in the blood instead of going into cells, the body's cells starve for nutrients and other systems in the body must provide energy for many important bodily functions. As a result, high blood sugar develops and can cause: Dehydration. The build up of sugar in the blood can cause an increase in urination (to try to clear the sugar from the body). When the kidneys lose the glucose through the urine, a large amount of water is also lost, causing dehydration. Weight loss. The loss of sugar in the urine means a loss of calories which provide energy and therefore many people with high sugars lose weight. (Dehydration also contributes to weight loss.) Diabetic ketoacidosis (DKA). Without insulin and because the cells are starved of energy, the body breaks down fat cells. Products of this fat breakdown include acidic

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chemicals called ketones that can be used for energy. Levels of these ketones begin to build up in the blood, causing an increased acidity. The liver continues to release the sugar it stores to help out. Since the body cannot use these sugars without insulin, more sugars piles into the blood stream. The combination of high excess sugars, dehydration and acid build up is known as "ketoacidosis" and can be life-threatening if not treated immediately. Damage to the body. Over time, the high sugar levels in the blood may damage the nerves and small blood vessels of the eyes, kidneys, and heart and predispose a person to atherosclerosis (hardening) of the large arteries that can cause heart attack and stroke.

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Who Gets Type 1 Diabetes? • Although the disease usually starts in people under the age of 20, type 1 diabetes may occur at any age. • The disease is relatively uncommon, affecting 1 in 250 Americans. The condition is more common in whites than in blacks and occurs equally in men and women.

What Causes Type 1 Diabetes? • Doctors don't know all the factors that lead to type 1 diabetes. Clearly, the susceptibility to the condition can be inherited. • Doctors have identified that an environmental trigger plays a role in causing the disease. Type 1 diabetes appears to occur when something in the environment -- a toxin or a virus (but doctors aren't sure) -- triggers the immune system to mistakenly attack the pancreas and destroy the beta cells of the pancreas to the point where they can no longer produce sufficient insulin. Markers of this destruction -- called autoantibodies -- can be seen in most people with type 1 diabetes. In fact, they are present in 85% to 90% of people with the condition when the blood sugars are high. Because it's an autoimmune disease, type 1 diabetes can occur along with other autoimmune diseases such as hyperthyroidism from Grave's disease or the patchy decrease in skin pigmentation that occurs with vitiligo.

What Are the Symptoms of Type 1 Diabetes? The symptoms of type 1 diabetes are often subtle, but they can become severe. They include: • • • • • • Increased thirst Increased hunger (especially after eating) Dry mouth Nausea and occasionally vomiting Abdominal pain Frequent urination • • • • • Unexplained weight loss (even though you are eating and feel hungry) Fatigue (weak, tired feeling) Blurred vision Heavy, labored breathing (Kussmaul respiration) Frequent infections of the skin, urinary tract, or vagina

Signs of an emergency with type 1 diabetes include: • • • Shaking and confusion Rapid breathing Fruity smell to the breath • • Abdominal pain Loss of consciousness (rare)

How Is Type 1 Diabetes Diagnosed?

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• If your health care provider suspects diabetes, he will first check for abnormalities in your blood (high blood sugar level). In addition, he may look for glucose or ketone bodies in the urine. There is currently no way to screen for or prevent the development of type 1 diabetes. Many people with type 1 diabetes live long, healthy lives. The key to good health is keeping your blood sugar levels within your target range, which can be done with meal planning, exercise and intensive insulin therapy. All people with type 1 diabetes must use insulin injections to control their blood sugar. You will also need to check your blood sugar levels regularly and make adjustment of insulin, food and activities to maintain a normal sugar.

How Is Type 1 Diabetes Managed?

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Type 2 Diabetes Overview

Type 2 diabetes, often called non-insulin dependent diabetes, is the most common form of diabetes, affecting 90% - 95% of the 21 million people with diabetes. What Is Type 2 Diabetes? Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin; however, the insulin their pancreas secretes is either not enough or the body is unable to recognize the insulin and use it properly. This is called insulin-resistance. When there isn't enough insulin or the insulin is not used as it should be, glucose (sugar) can't get into the body's cells. When glucose builds up in the blood instead of going into cells, the body's cells are not able to function properly. Other problems associated with the buildup of glucose in the blood include: Diabetic Coma (Hyperosmolar nonketotic diabetic coma). When a person with type 2 diabetes becomes severely dehydrated and is not able to drink enough fluids to make up for the fluid losses, they may develop this life-threatening complication.

Who Gets Type 2 Diabetes?

Anyone can get type 2 diabetes. However, those at highest risk for the disease are those who are obese or overweight, women who have had gestational diabetes, people with family members who have type 2 diabetes and people who have metabolic syndrome (a cluster of problems that include high cholesterol, high triglycerides, low good 'HDL' cholesterol and a high bad 'LDL' cholesterol, and high blood pressure). In addition, older people are more susceptible to developing the disease since aging makes the body less tolerant of sugars. Although it is more common than type 1 diabetes, the causes of type 2 diabetes are less well understood. It is likely caused by multiple factors and not a single problem. Type 2 diabetes can run in families, but the exact nature of how it's inherited or the identity of a single genetic factor is not known.

What Causes Type 2 Diabetes?


What Are the Symptoms of Type 2 Diabetes? The symptoms of type 2 diabetes vary from person to person but may include: • Increased thirst.

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• • • • Increased hunger (especially after eating). Dry mouth. Nausea and occasionally vomiting. Frequent urination. • • • Fatigue (weak, tired feeling). Blurred vision. Numbness or tingling of the hands or feet. Frequent infections of the skin, urinary tract or vagina.

How Is Type 2 Diabetes Diagnosed?

To diagnose type 2 diabetes, your health care provider will first check for abnormalities in your blood (high blood glucose level). In addition, he or she may look for glucose or ketone bodies in your urine. Type 2 diabetes testing includes a fasting plasma glucose test or a casual plasma glucose test. You will also need to check your blood sugar levels regularly.

Complications Associated With Type 1 and Type 2 Diabetes If your type 1 or Type 2 diabetes isn't well controlled, there are a number of serious or lifethreatening problems you may experience, including:

Retinopathy. People with type 2 diabetes may already have abnormalities in the eyes related to the development of diabetes. Over time more and more people who initially do not have eye problems related to the disease will develop some form of eye problem. It is important to control not only sugars but blood pressure and cholesterol to prevent progression of eye disease. Fortunately, the vision loss isn't significant in most. Kidney damage. The risk of kidney disease increases over time, meaning the longer you have diabetes the greater your risk. This complication carries significant risk of serious illness -- such as kidney failure and heart disease. Poor blood circulation and nerve damage. Damage to nerves and hardening of the arteries leads to decreased sensation and poor blood circulation in the feet. This can lead to increased infections and an increased risk of ulcers which heal poorly and can in turn significantly raises the risk of amputation. Damage to nerves may also lead to digestive problems, such as nausea, vomiting, and diarrhea.