Diabetes mellitus, the most common disorder of the endocrine system, affects between 10 million and 20 million people in the United States alone. The disease is brought on by disorders in blood levels of insulin, a pancreatic hormone that helps your system convert blood glucose, or blood sugar, into energy. Type 1 diabetes-sometimes called insulin-dependent diabetes mellitus (IDDM) or juvenile or juvenile-onset diabetes-results from a shortage of insulin. Type 2 diabetes-also known as non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset or stable diabetes-results from the body's inability to process the hormone effectively. About 90 percent of all diabetics have this form.
Regardless of what type of diabetes you have, you need to work closely with your doctor to manage your diet, medication, and activity on a day-to-day basis. Your ability to oversee your own care will make a huge difference in whether you can control the condition and avoid its potentially serious effects.
The many short- and long-term complications of diabetes can demand as much attention as the disease itself. Most important, you need to watch your blood sugar levels every day to pre-vent an attack of hypoglycemia, in which avail-able levels of blood sugar are too low to fulfill your body's energy needs. Hypoglycemia can easily be remedied, however, once you recognize its symptoms.
Hyperglycemia, or high blood sugar, can bring on a serious diabetic condition known as ketoacidosis, in which the blood becomes in creasingly acidic from the accumulation of toxic by-products called ketones that are produced as the body breaks down fat for energy. Ketoacidosis occurs in Type 1 diabetics if they do not receive adequate supplementary insulin and their bodies are starved for energy sources. Ketoacidosis can also occur in diabetics if glucose and in-sulin levels are not properly balanced, or if the body comes under sudden physical stress, per-haps from an accident or illness. (Any sort of ill-ness increases the body's need for insulin to process blood glucose into the energy required to fight illness or infection.)
If you are diabetic, be especially alert for the warning signs of ketoacidosis: nausea, excessive thirst, frequent urination, extreme weakness, abdominal pain, and rapid deep breathing. Failure to respond immediately with injections of insulin and intravenous salt solutions (to replenish lost body fluids) can result in coma or death.
Long-term complications of diabetes can damage the eyes, nervous system, kidneys, and cardiovascular and circulatory systems, as well as hinder the body's overall resistance to infections. Cuts and sores heal more slowly for people with diabetes, and diabetics are also prone to gum problems, urinary tract infections, and mouth infections such as thrush, caused by an overgrowth of yeast organisms.
Complications from diabetes are the primary cause of adult blindness in the United States. Within 10 years after their condition is diagnosed, about half of all diabetics develop an eye disorder called diabetic retinopathy, which can weaken the capillaries that supply blood to the retina, and eventually affect vision. Almost all of those who have had the disease for at least 30 years experience some degree of diabetic retinopathy. Diabetics are also more likely to develop cataracts and glaucoma.
People with diabetes stand a higher than nor-mal chance of developing heart disease and circulatory problems such as high blood pressure, hardening of the arteries, heart attacks, and strokes. Poor circulation also makes diabetics more susceptible to skin ulcers, cramps, and gangrenous (tissue-destroying) infections. Damage to the blood vessels in the kidneys from diabetes may lead to kidney failure.
A number of people with diabetes suffer from a condition known as diabetic neuropathy, which causes a gradual deterioration of the nervous sys tem. The condition appears to begin early in both types of diabetes mellitus and affects motor nerves as well as sensory nerves. As a result, diabetics commonly experience a variety of aches and pains. Some develop slowed reflexes, loss of sensation, numbness and tingling in the legs, impotence, and circulatory problems.
In Type 1 diabetes, the pancreas secretes little or no insulin. Unable to use glucose in the blood, the body tries to produce energy by burning fat and muscle. Type 1 diabetes develops fairly quickly, usually striking people under age 30. Re-cent research suggests that many Type 1 diabetics may have had a genetic predisposition to the disease that was triggered by a viral infection.
Type 2 diabetes usually develops in people over age 40, and there appears to be a strong link between obesity and the development of Type 2 diabetes. Although this particular group of diabetics may have sufficient or even excessive amounts of insulin in their systems, their bodies are unable to use the hormone effectively. Excessive food intake boosts blood glucose levels, and the pancreas cannot produce enough insulin to convert the extra sugar into energy. Sometimes a similar form of this disease, called gestational diabetes, occurs as a temporary condition in women who are pregnant.
Diagnostic and Test Procedures
Your doctor may suspect that you have diabetes if a routine physical examination indicates that excess sugar in your body is being flushed out in your urine. Actual diagnosis begins with an examination of your glucose levels, which the doctor does by taking a blood sample in the morning before you have had anything to eat; if your pancreas is producing little or no insulin (Type 1), or if the body is not producing enough insulin to process blood sugar (Type 2), your glucose levels will be elevated. Additional tests for diabetes include a glucose tolerance test, which measures the body's ability to convert glucose into energy. After fasting for a period, you drink a very sweet beverage containing glucose, then have your blood glucose levels checked.
Treatment for both forms of diabetes mellitus re-quires adjustment of insulin levels in the body and strict management of diet and exercise. By paying close attention to the content and timing of your meals, you can minimize or avoid the "seesaw effect" of rapidly changing blood sugar levels, which can require quick changes in insulin dosages.
If you have Type 1 diabetes, it is essential that you receive supplementary insulin every day, at least twice a day, to promote your body's use of blood glucose. Since insulin is a protein and is destroyed by digestive enzymes, it cannot be taken orally. Rather, it must be injected directly into the body at set intervals. While some diabetics use a computerized pump that administers insulin on a set basis, most doctors advise direct injections. Learning to give injections to yourself or to your infant or child may at first seem the most daunting part of managing Type 1 diabetes, but the process quickly becomes routine.
Most insulin in use today is processed synthetically, although some is still derived from animal hormone. The medication comes in three varieties: short-acting (taking effect within 30 or 40 minutes and lasting for 6 hours); intermediate-acting (taking effect in 2 to 4 hours and lasting up to 24 hours); and long-acting (taking effect in 6 to 8 hours and lasting up to 32 hours). Each injection plan is tailored for the individual diabetic and adjusted to accommodate events such as periods of stress, adolescent growth, and the pre-menstrual period of a woman's monthly cycle.
By monitoring your own blood glucose levels, you can track your body's fluctuating insulin demand and help your doctor calculate the most appropriate insulin dosage. One self-monitoring technique involves a special meter that reads glucose levels in a sample of your blood dabbed on a strip of treated paper. Another method uses pa-per strips that change color when exposed to a drop of blood to indicate glucose levels.
For some Type 2 diabetics, diet and exercise are sufficient to keep the disease under control; others require drug therapy, which may include insulin or an oral hypoglycemia medication such as tolbutamide, acetohexamide, glipizide, glyburide, or chlorpropamide. If you take any of these drugs for Type 2 diabetes, ask your doctor about possible interactions with other prescription drugs, including chloramphenicol, phenyl-butazone, oxyphenbutazone, and clofibrate.
Maintaining a balanced diet is vital in both Type 1 and Type 2 diabetes, so work with your doctor to set up a menu plan. If you have Type 1 diabetes, and the timing of your insulin dosage is determined by activity and diet, when you eat and how much you eat are just as important as what you eat. Usually, doctors recommend three small meals and three to four snacks every day to maintain the proper balance between glucose and insulin in the blood. Carbohydrates-especially some starches and other complex carbohy-drates, which release glucose relatively slowly into the bloodstream-should make up 50 to 60 percent of your total caloric intake; proteins should compose from 20 to 25 percent; and fats, from 20 to 30 percent.
Recommended proportions of carbohy-drates, proteins, and fats for Type 2 diabetics are essentially the same, although patients who are overweight are encouraged to lower their intake of fat and eat more complex carbohydrates and fiber. Since Type 2 diabetics are usually not concerned with scheduled doses of insulin, they do not need to time their meals so carefully.
Another crucial element in a diabetic's daily program is exercise, which can help Type 2 diabetics in particular lose excess weight. For people with either type, exercise can also help mitigate cardiovascular complications of the disease, and it may offer stress relief as well. Type 1 diabetics need to remember, however, that exercise lowers blood glucose levels. To prevent an attack of hypoglycemia, plan to eat a carbohydrate snack approximately half an hour before you be-gin exercising, and make sure you have some-thing to eat or drink if you start to feel hypo-glycemic symptoms. With either type, check with your doctor before starting an exercise program.
It is also a good idea to wear a Medic Alert bracelet or tag indicating that you have diabetes; this will make others aware of your condition in case you have a severe hypoglycemic attack and are not able to make yourself understood, or if you are in an accident or another situation and need emergency medical care. Identifying your-self as a diabetic is important because hypo-glycemic attacks can be mistaken for drunken-ness, and victims often aren't able to care for themselves. Without prompt treatment, hypo-glycemia can result in a coma or seizures. And since your body is under increased stress when you are ill or injured, your glucose levels will need to be monitored by any medical personnel who give you emergency care.
Since diabetes that is incorrectly treated can be life-threatening, you should never try to treat the disease without the help of a doctor, and you should always discuss any possible treatments thoroughly. Some alternative remedies offer variations of diabetic diets. Others emphasize supplemental vitamins and minerals, prescribe herbs to restore blood sugar levels, or treat secondary effects. Stress-reduction practices may also help lower blood glucose levels.
Stimulation of certain points may relieve pain associated with diabetic neuropathy, boost the immune system, and minimize circulatory system complications. Consult a licensed practitioner.
Chinese herbal medicines, including ginseng root (Panax ginseng), are frequently used to alleviate some symptoms of diabetes; consult a practitioner for a comprehensive treatment plan.
Check with a practitioner to make sure herbs are appropriate for your condition. Remember: If you need insulin to manage your diabetes, there is no herbal substitute for the hormone.
Blueberry (Uaccinium myrtillus) leaves in a decoction may lower blood glucose levels and help maintain the vascular system. This remedy may also help to keep the blood vessels of the eye from hemorrhaging if you develop diabetic retinopathy. Diabetics in one study who ate crackers made from the powdered form of bur-dock (Arctium lappa) after a starchy meal had a lowered incidence of hyperglycemia. A cream made with cayenne (Capsicum frutescens) may relieve pain associated with peripheral neuropathy, a type of diabetic neuropathy.
Supplementing the diet with fenugreek (Trigonella foenum-graecum) seeds has been shown in clinical and experimental studies to re duce blood glucose and insulin levels while lowering blood cholesterol. Garlic (Allium sativum) may lower blood pressure as well as levels of blood sugar and cholesterol.
Ginkgo (Ginkgo biloba) extracts have been used to stem deteriorating vision in patients by maintaining adequate blood flow to the retina. Other reported benefits of ginkgo include reducing the risk of heart disease, hypertension, and elevated cholesterol levels.
Onion (Allium cepa) may free up insulin to help metabolize glucose in the blood, thus lowering blood glucose levels. Both raw and boiled onion extracts have been found to have this effect. Onion is also considered beneficial in maintaining a healthy cardiovascular system.
In laboratory tests, exercise has been shown to increase the tissue levels of chromium, which the body uses to regulate blood glucose and cholesterol levels. For Type 1 diabetics, exercise has also been found to increase the body's ability to use available insulin so that fewer insulin injections are needed. WARNING: If you have Type 1 diabetes, keep in mind that exercise lowers your blood glucose; eat a carbohydrate snack before exercising, and eat or drink again if you feel the warning symptoms of a hypoglycemic attack.
Type 2 diabetics who need to lose weight can benefit from moderate exercise. However, if you are a Type 2 diabetic, you should avoid weight-lifting or other forms of exertion that involve pushing or pulling heavy objects; these activities raise blood pressure and may aggravate any eye problems that stem from diabetes. If you are diabetic, be sure to take good care of your teeth and floss regularly; diabetes can ex-acerbate gum disease.
Any sort of practice that will lower your stress level, such as biofeedback, meditation, hypnotherapy, or other relaxation techniques, may help lessen your insulin requirements.
Nutrition and Diet
Some practitioners claim that diabetes is a disorder of Western lifestyles, pointing out that when people in other cultures abandon native foods for a diet of refined and processed foods, diabetes rates begin to rise. The high-carbohydrate high-plant-fiber diet (HCF diet) is an alternative to the conventional diet plan for diabetics.
The HCF diet calls for diabetics to follow these daily guidelines in planning their meals: Eat 70 to 75 percent complex carbohydrates, 15 to 20 percent proteins, and only 5 to 10 percent fats. The HCF diet is said to boost insulin's ability to promote blood glucose as an energy source, improve cholesterol levels, reduce the incidence of hyperglycemia and hypoglycemia, and help with weight loss for Type 2 diabetics.
A modified version of the HCF diet further restricts what foods may be eaten but increases the allowable amount of complex carbohydrates. One university study indicated that a high-carbohydrate, high-fiber diet could reduce the insulin demands of Type 1 diabetics by 30 to 40 per-cent, and of Type 2 diabetics by 75 to 100 percent.
Diabetics should avoid sugar, as it can lower the body's glucose tolerance and worsen circulatory problems. Nutritionists also emphasize the importance of certain foods, vitamins, and minerals, including the following:
Chromium supplements can be very helpful for people with diabetes. Chromium not only lowers blood glucose levels and improves glucose tolerance but it also lowers insulin levels and helps hold down blood cholesterol levels.
Inositol, a B-complex vitamin, has been shown to help protect diabetics from peripheral neuropathy by relieving numbness and tingling in the hands and feet. However, since inositol might alter blood sugar levels, make sure to check with your practitioner before starting supplements. Biotin, also called vitamin H, may improve glucose metabolism in diabetics.
Vitamin B6 may help decrease the severity of diabetic neuropathy and reduce insulin demands in Type 2 diabetics. Vitamin B12 may help treat diabetic neuropathy; injections may prove more beneficial than oral doses.
Diabetics may need supplements of vitamin C to make up for low blood levels of insulin, which normally works to help cells absorb the vitamin.
Proper amounts of vitamin C help the body maintain good cholesterol levels, fight off infection by bolstering the immune system, and prevent cataracts. Although some practitioners recommend supplementing your diet with up to 1 gram of vitamin C per day, you should consult your practitioner to make sure this is a safe dosage for you to take.
Vitamin E may help limit damage to the vascular system and improve blood cholesterol levels.
Manganese helps the body metabolize glucose; diabetics often have a serious manganese deficiency. Magnesium supplements may help control diabetic retinopathy and reduce the possibility of cardiovascular damage.
Zinc may help increase glucose tolerance, and potassium may improve a diabetic's ability to utilize insulin. Copper supplements may help improve cardiovascular fitness.
Okra and peas can help stabilize blood sugar levels and provide fiber in a high-complex-carbohydrate diet. Some research suggests that cinnamon can lower insulin requirements in Type 2 diabetics; seasoning your food with as much as ¼ tsp at every meal may help regulate blood sugar levels.
Because of the apparent link between obesity and Type 2 diabetes, you can do a great deal to help reduce your chances of developing the disease by slimming down if you are overweight. This is especially true if diabetes runs in your family. A good exercise program and a nutritionally balanced diet can greatly limit the effects of both Type 1 and Type 2 diabetes. If you smoke, quit; smoking can significantly increase the risk of heart disease, particularly for diabetics.
- excessive thirst and appetite.
- increased urination (sometimes as often as every hour).
- weight loss.
- fatigue. nausea, perhaps vomiting.
- blurred vision.
- in women, frequent vaginal infections and perhaps the cessation of menstruation.
- in men, impotence.
- in men and women, yeast infections.
Call Your Doctor If :
you feel nauseated, weak, and excessively thirsty; are urinating very frequently; have abdominal pain; and are breathing more deeply and rapidly than normal-perhaps with sweet breath that smells like nail polish re-mover. You may need immediate medical attention for ketoacidosis.
you feel weak or faint; are experiencing a rapid heartbeat, trembling, and excessive sweating; and feel irritable, hungry, or suddenly drowsy. You could be developing hypoglycemia, and may need to eat or drink some-thing quickly to avoid more serious complications.
L. Jovanovic, Md
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