Diabetes Basics.
Last updated Thursday, February 10, 2005
AboutBasics of diabetes basics Diabetes is a condition caused by lack of a chemical in the body (a
hormone) called insulin. There are two major forms of diabetes. In type
1 diabetes, eventually no insulin is produced and individuals require
insulin injections for survival. It used to be thought this only
presented in children but it is now clear this can occur at any age.
The other, more common form of diabetes, called type 2 diabetes,
occurs due to the body's resistance to the effects of insulin in
addition to an insufficient quantity of insulin. However, in this type
of diabetes there is usually some insulin produced.
For both types of diabetes blood glucose levels are elevated.
Furthermore, people with diabetes are prone to certain complications
not seen in those without diabetes. These complications involve the eye
(retinopathy), kidney (nephropathy), and nerves (neuropathy). People
with diabetes also get early hardening of the arteries
(atherosclerosis), leading to early heart attacks and strokes. The good
news for people with diabetes is that with proper care, all of these
problems can be avoided. Immediate medical attention Uncontrolled diabetes presents with frequent thirst and urination.
Over time patients will become dehydrated as the glucose is "spilling"
over into the urine. If insulin deficiency is severe enough, fat stores
are used for energy as glucose cannot get into cells. This problem is
much more common with type 1 diabetes and is called "ketoacidosis". It
can be diagnosed at home with a simple urine test. When significant
ketones are found in the urine it is important to be in touch with a
physician immediately.
There are other conditions that require immediate attention. Blurry
vision in someone with known diabetic eye disease or someone with a
long history of diabetes may mean there was bleeding in the back of the
eye. This may require treatment by an eye doctor. An infection on the
bottom of the foot is a common problem that needs immediate attention
too. When people with long-standing diabetes experience heart disease,
they often do not get the typical chest pain (angina) that occurs in
those people without diabetes. Often their symptoms of heart disease
presents with shortness of breath with minimal exertion. This should
also prompt a call to a physician.
Swelling (edema) of the ankles is another common symptom that may be
a sign of a serious problem. For example, new swelling in the ankles
may suggest that large quantities of protein are being lost in the
urine--the first problem noted with kidney disease. Swelling may also
be seen with early heart failure, a common problem in people with
diabetes. Alternatively, swelling may be due to a non-serious
condition, such as a side effect of a new medication or even a clue
that the veins which take blood back to the heart are not working as
well as they could be. Therefore, anytime new swelling is noted it
should be reported to your physician. Facts and myths
Diabetes does not "skip" generations. However, we don't understand
the exact reasons why some people get diabetes and others don't.
A common misconception is that if children eat too much candy they
will "catch" diabetes. Although we are seeing more type 2 diabetes in
young people, this misconception refers to type 1 diabetes and is not
true.
For people with diabetes, many feel that occasional blood glucose
levels over 200 mg/dL will have long-term consequences. This is not
true at all as it is common for glucose levels to rise above this level
in almost everyone with diabetes.
There are also many misconceptions regarding food. One common one is
that fresh fruit is "healthy" because it is "natural". While this may
be true, fruit is also very effective at causing the blood glucose to
rise quickly. Fruit juices are the most common problem here. Many
people also don't realize how much milk causes blood glucose to rise.
Finally, there are many misunderstandings regarding the glucose effects
of alcohol. Depending on the type of alcohol consumed and the amount of
food consumed, blood glucose can actually go DOWN when drinking so this
needs to be done with caution.
There is also a common misunderstanding about exercise. While it is
true that exercise usually results in lower blood glucose levels, if a
person with type 1 diabetes exercises without sufficient insulin in the
bloodstream (for example, more than 12 hours after the last shot of NPH
insulin) the blood glucose can actually go UP! In fact exercise at this
time period can actually lead to ketoacidosis. Therefore, for people
with type 1 diabetes great attention is required balancing blood
glucose levels and exercise. Since high blood glucose often occurs when
insulin levels in the blood are low, the usual recommendation is to
wait until the blood sugar is below 250 mg/dL before participating in
strenuous exercise.
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