Diabetes Basics.
Last updated Thursday, February 10, 2005
ConclusionWhat are the five most important facts about diabetes basics? The five most important facts about diabetes are as follows:
Diabetes is not one disease, but rather is at least two
diseases grouped as type 1 and type 2 diabetes. In actuality, there are
many other types of diabetes but the vast majority can be classified
into these two types. Type 1 diabetes, which usually presents in
children or teens, can present at any age. It is caused by the body
destroying the cells in the pancreas that make insulin (the B-cells of
the islets) and therefore insulin is required for survival. In type 2
diabetes, which affects Hispanics, Blacks, Asians, and American Indians
more frequently, one must have both a resistance to the effects of
insulin (so more insulin is required to maintain a normal glucose) and
some degree of insulin deficiency. People with type 2 diabetes are
usually (but not always) overweight and often have other risk factors
for a heart attack or stroke including high blood pressure and
dyslipidemia (high triglycerides, low HDL cholesterol). People with
type 2 diabetes often have their disease for years before they are
diagnosed, which is why the American Diabetes Association
recommends screening for all high-risk individuals, which would include
everyone over 45 years of age, people with a strong family history of
type 2 diabetes, and women who had diabetes during a pregnancy
(gestational diabetes). Control of blood glucose for both type 1 and type 2 diabetes
can reduce the risks of complications, especially those involving the
eyes (retinopathy), the kidney (nephropathy) and the nerves
(neuropathy). The American Diabetes Association recommends maintaining the HbA1c below 7%, which would be an average blood glucose of 150 mg/dL. Treatment of blood pressure below 130/80 and LDL-cholesterol
("bad cholesterol") below 100 mg/dL has been shown to prolong life in
people with diabetes. For the blood pressure, there are advantages to
using the class of drugs called ACE inhibitors. For cholesterol, the
class of drugs called statins has been shown to decrease death rates.
Also, a daily aspirin has been shown to reduce risks of a heart attack. People with diabetes should have the following tests performed on a regular basis by their doctor:
- a dilated eye exam each year to assess for diabetic retinopathy (the leading cause of adult blindness in the U.S.)
- a yearly assessment for urine albumin or urine protein, which is
the first sign of diabetic kidney disease (nephropathy, which is the
leading cause of kidney dialysis or transplant in the U.S.)
- a yearly measurement of cholesterol levels
- Two HbA1c levels measured each year if you are well controlled, not
receiving insulin, and four per year if you are receiving insulin.
- have a yearly comprehensive foot exam by your doctor assessing for
the presence of neuropathy and vascular disease (the leading cause of
lower extremity amputation in the U.S.).
- consider some type of heart stress testing if you have diabetes and
any other risk factors for a heart attack. Although 2/3 of people with
diabetes die from heart disease, it often presents without any symptoms
and testing for it early may lead to finding a problem before it leads
to a heart attack.
If, despite following the physician's advice, a person with
diabetes still cannot meet the specific HbA1c, blood pressure, or
cholesterol goals noted above, or the physician refuses to perform the
standards of care from the ADA outlined above (they can also be read at
www.diabetes.org),
he or she might consider getting a second opinion or finding another
physician. Doctors specializing in diabetes are called endocrinologists
and it may be wise to consider seeing an endocrinologist if this
situation occurs.
Disclaimer
This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.
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