WHAT IS DIABETES?
Diabetes (medically known as diabetes mellitus) is a disorder of the metabolism where the body has trouble using glucose, or blood sugar, for energy. When we eat, our body breaks down foods known as carbohydrates (fruits, vegetables, bread, pasta, dairy, and sweets) into glucose, which is sent to our cells through the bloodstream.
When our body’s systems detect glucose in the blood (particularly during meal or snack times), an organ called the pancreas releases an appropriate amount of a hormone called insulin. Insulin makes it possible for our cells to absorb glucose and provide the energy our body and brain need to function.
Types of Diabetes
Type 1 Diabetes
Type 1 diabetes (previously called juvenile diabetes or insulin-dependent diabetes) is a disorder of the body’s immune system that results from the pancreas not producing any insulin. Type 1 diabetes represents only 5%–10% of all diagnosed cases. It is currently incurable, but it is treatable with a rigid therapy of artificial insulin.
Type 2 Diabetes
Type 2 diabetes (previously called adult-onset diabetes) results when the body doesn’t respond appropriately to insulin, a condition called “insulin resistance.” This more common (90%–95% of all cases) variety of diabetes often runs in families or racial groups, but can also be caused by poor diet and an inactive lifestyle.
If caught in its early stages, this type of diabetes is often treatable with modifications in diet and an exercise program. If left untreated, a person with type 2 diabetes could eventually develop extreme insulin resistance and require the addition of artificial insulin. Insulin resistance is a condition where your body requires unusually high amounts of insulin to maintain normal glucose levels, and your pancreas just can’t keep up.
Type 2 diabetes is the most common form of diabetes.
In type 2 diabetes, your body does not use insulin properly. This is called insulin resistance. At first, the pancreas makes extra insulin to make up for it. But, over time your pancreas isn’t able to keep up and can’t make enough insulin to keep your blood glucose levels normal. Type 2 is treated it with lifestyle changes, oral medications (pills), and insulin.
When glucose builds up in the blood instead of going into cells, it can cause two problems:
Right away, your cells may be starved for energy.
Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart.
Some people with type 2 can control their blood glucose with healthy eating and being active. But, your doctor may need to also prescribe oral medications or insulin to help you meet your target blood glucose levels. Type 2 usually gets worse over time – even if you don’t need medications at first, you may need to later on.
Some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population.
Gestational diabetes affects about 4% of all pregnant women in the late stages of pregnancy. Pregnant women who have never had diabetes before, but who have high blood glucose levels are said to have gestational diabetes. The condition usually goes away after pregnancy, but if left untreated can harm the baby.
What is Gestational Diabetes?
Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes. According to a 2014 analysis by the Centers for Disease Control and Prevention, the prevalence of gestational diabetes is as high as 9.2%.
We don’t know what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother’s insulin in her body. This problem is called insulin resistance. Insulin resistance makes it hard for the mother’s body to use insulin. She may need up to three times as much insulin.
Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose builds up in the blood to high levels. This is called hyperglycemia. You may also be interested in our book, Diabetes & Pregnancy: A Guide to a Healthy Pregnancy.
How Gestational Diabetes Can Affect Your Baby
Gestational diabetes affects the mother in late pregnancy, after the baby’s body has been formed, but while the baby is busy growing. Because of this, gestational diabetes does not cause the kinds of birth defects sometimes seen in babies whose mothers had diabetes before pregnancy.
However, untreated or poorly controlled gestational diabetes can hurt your baby. When you have gestational diabetes, your pancreas works overtime to produce insulin, but the insulin does not lower your blood glucose levels. Although insulin does not cross the placenta, glucose and other nutrients do. So extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the baby’s pancreas to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat.
This can lead to macrosomia or a “fat” baby. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. Because of the extra insulin made by the baby’s pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.
How to Treat Gestational Diabetes
Because gestational diabetes can hurt you and your baby, you need to start treatment quickly.
Treatment for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don’t have gestational diabetes. Treatment for gestational diabetes always includes special meal plans and scheduled physical activity. It may also include daily blood glucose testing and insulin injections.
If you’re testing your blood glucose, the American Diabetes Association suggests the following targets for women who develop gestational diabetes during pregnancy. More or less stringent glycemic goals may be appropriate for each individual.
Before a meal (preprandial): 95 mg/dl or less
1-hour after a meal (postprandial): 140 mg/dl or less
2-hours after a meal (postprandial): 120 mg/dl or less
You will need help from your doctor, nurse educator, and other members of your health care team so that your treatment for gestational diabetes can be changed as needed. For you as the mother-to-be, treatment for gestational diabetes helps lower the risk of a cesarean section birth that very large babies may require.
Sticking with your treatment for gestational diabetes will give you a healthy pregnancy and birth, and may help your baby avoid future poor health.
Keeping Worry in Perspective
While gestational diabetes is a cause for concern, the good news is that you and your health care team — your doctor, obstetrician, nurse educator, and dietitian — work together to lower your high blood glucose levels. And with this help, you can turn your concern into a healthy pregnancy for you, and a healthy start for your baby.
Gestational Diabetes – Looking Ahead
Gestational diabetes usually goes away after pregnancy. But once you’ve had gestational diabetes, your chances are 2 in 3 that it will return in future pregnancies. In a few women, however, pregnancy uncovers type 1 or type 2 diabetes. It is hard to tell whether these women have gestational diabetes or have just started showing their diabetes during pregnancy. These women will need to continue diabetes treatment after pregnancy.
Many women who have gestational diabetes go on to develop type 2 diabetes years later. There seems to be a link between the tendency to have gestational diabetes and type 2 diabetes. Gestational diabetes and type 2 diabetes both involve insulin resistance. Certain basic lifestyle changes may help prevent diabetes after gestational diabetes.
Lower Your Risk for Diabetes by Losing Weight
Are you more than 20% over your ideal body weight? Losing even a few pounds can help you avoid developing type 2 diabetes.
Making healthy food choices Follow simple daily guidelines, like eating a variety of foods including fresh fruits and vegetables, limiting fat intake to 30% or less of daily calories, and watching your portion size. Healthy eating habits can go a long way in preventing diabetes and other health problems.
Exercising Regular exercise allows your body to use glucose without extra insulin. This helps combat insulin resistance and is what makes exercise helpful to people with diabetes. Never start an exercise program without checking with your doctor first.
SYMPTOMS OF DIABETES
Early Detection Is A Good Thing
Diabetes often goes undiagnosed because many of its symptoms may seem subtle at first. Recent studies indicate that the early detection of diabetes symptoms and treatment can decrease the chance of developing diabetes complications.
Symptoms of Type 1 Diabetes
Unusual weight loss
Extreme fatigue and irritability
Symptoms of Type 2 Diabetes
Any of the type 1 symptoms
Cuts/bruises that are slow to heal
Tingling/numbness in the hands/feet
Recurring skin, gum, or bladder infections
SEVEN STEPS, COUNTLESS BENEFITS
Better blood glucose control has gained significant attention since the release of the landmark Diabetes Control and Complications Trials (DCCT). The study emphasized the importance of good control in helping patients feel better, and ultimately enjoy a better lifestyle. Here are seven steps that will help you gain greater control of your diabetes management.
1. Blood Glucose and Hemoglobin A1C Testing
Blood glucose testing gives you important feedback for making immediate and day-to-day adjustments in your diabetes management. The haemoglobin A1C (HbA1c) test shows you your average blood glucose over the last 60 to 90 days. Both types of testing are necessary with insulin pump therapy.
2. Treating Hypoglycemia (Low Blood Glucose)
Hypoglycemia, or low blood glucose (BG) levels, cannot be completely avoided on insulin pump therapy, however, most people find that they occur less often and are less severe than with insulin injections. In fact, clinical studies show that BG lows can be reduced by as much as 75%1 when using insulin pump therapy.
It is important to establish a routine for when your blood glucose is low. Have something available to treat a low and you are less likely to overtreat and raise your glucose levels too much.
3. Treating Hyperglycemia (High Blood Glucose)
High blood glucose can occur while using the pump for the same reasons it did when you were not on the pump, including some situations that are unique to insulin pump therapy:
Too much food
Not enough insulin
Loss of insulin potency
Not receiving insulin from the pump
The goal of treating hyperglycemia is to prevent Diabetic Ketoacidosis (DKA) and delay or prevent diabetes complications due to high blood glucose over an extended period of time.
4. Sick Day Management
Managing diabetes during an illness or infection requires frequent blood glucose and urine ketone testing. Illness and infection put extra stress on the body and often raise blood glucose. An insulin pump allows you to make adjustments to quickly and easily respond to illness and infection.
When you are sick, it is difficult to take care of your diabetes, but, unfortunately, you must. If you are too sick to monitor your diabetes carefully, ask a friend or family member to help. If there is no one to help you, ask your healthcare provider for assistance.
5. Nutrition and Carbohydrate Counting
Insulin pump therapy allows you to be flexible with your food choices. Since there is no long-acting insulin dictating when what or how much you eat, there is no reason to be rigid concerning your diet. By understanding the nutritional content of the food you eat, you will be able to take insulin accordingly to maintain blood glucose control.
Carbohydrates have the greatest effect on blood glucose, especially within a few hours of being eaten. Counting carbohydrates allows you to match your insulin dose to the food you are eating. Although fat and protein can affect your blood glucose when eaten in large amounts, it is the carbohydrates that affect blood glucose the most.
Using an insulin pump during exercise allows you to reduce your basal rate instead of eating carbohydrates to compensate for the lowering effect exercise often has on blood glucose. Your body needs insulin and carbohydrates to use glucose for energy during exercise. How much you need to reduce your insulin and how many carbohydrates you need to eat varies with different types of exercise and with how often you exercise. It takes trial and error to get the balance right.
It is important to keep in mind that the body needs insulin during exercise; therefore, it is not recommended that you discontinue using the pump unless the exercise is of short duration (1 hour or less).
7. Managing Infusion Sites
It is important to be proactive about keeping your infusion set healthy and your insulin, reservoir, and infusion set fresh. With a little care, you can take full advantage of the benefits of insulin pump therapy and avoid serious problems.
A few simple principles can significantly improve your results:
Change the infusion site regularly
Rotate infusion site regularly
Follow the recommended rotation methods
Inspect infusion site frequently
Use appropriate sites
Keep adequate supplies on hand
Find The Right Balance For You
Real Alternatives to Conventional Injection Therapy
Real Alternatives to Conventional Injection Therapy
When it comes to managing your diabetes, there are a few therapy options available for treatment. Here are some advantages and disadvantages of each.
Additionally, new technologies like Continuous Glucose Monitoring (CGM) provide valuable glucose trend information, making it easier to know how food, insulin, and activity are affecting your glucose readings—all day and all night—by displaying the information on the device screen. It can alert you to dangerously high or low glucose levels, allowing you to take action and potentially prevent complications. The newest devices provide real-time trending information that will allow you to understand how your everyday activities affect your glucose levels.
Nutrition and Eating
Proper nutrition and eating will help you control your diabetes so you can feel better and live life on your terms. This section shows you how to count carbs, as well as provide you with food lists, high carb meals, recipes, and guidelines for drinking alcohol.
Lows, Highs, and Sick Days
Get information on how to treat low BG levels, high BG levels, and what to do if you wake up with high glucose levels. This section also covers guidelines for sick days