Diabetes Basics.

Prognosis and impacts

How serious is diabetes basics? Is diabetes basics chronic?

Diabetes needs to be considered a very serious condition. It is the 7th leading cause of death in the United States and over 15 million American have diabetes. It is a chronic condition for which we have no cure. About 2/3 of people with diabetes die of heart disease. It is the leading cause of adult blindness, the leading cause of kidney failure, and the leading cause of lower extremity amputation. It is also the second most common chronic condition seen by American doctors.

Although diabetes is a serious and chronic condition, early diagnosis and proper patient self-management can reduce and possibly eliminate the majority of the chronic complications. Meticulous control of blood glucose (HbA1c below 7% which would correlate to an average blood glucose below 150 mg/dL), good blood pressure control (below 130/80), low LDL (low density lipoprotein) cholesterol levels (below 100 mg/dL), one daily aspirin (either adult or children's), and daily foot inspection can make a major impact on improving one's risk for all diabetes-related problems.

Is diabetes basics deadly?

Will diabetes basics cause pain?

High blood glucose levels do not cause pain. However, having high glucose levels for many years can lead to nerve damage in the feet (called neuropathy), which can be painful. It is estimated that 25% of newly diagnosed patients with type 2 diabetes have pain or numbness in their feet from neuropathy.

Other complications related to many years of high blood glucose levels can cause pain. For example, people with diabetes are more at risk for carpel tunnel syndrome, which is a common condition in the general population. With this problem a large nerve going to the hand is squeezed causing pain in the hand. Often, surgery is required to fix this. People with diabetes are also more at risk for certain infections that may be painful. Some examples include infections of the skin (cellulitis and abscess) and even the kidney.

There is also an uncommon condition often referred to as "diabetic amyotrophy" which presents with muscle wasting of the thighs, weight loss, and severe pain. These patients often appear to have cancer. This condition is most common for men with type 2 diabetes in their 50s and 60s and usually resolves spontaneously in 12 to 18 months. There are no specific treatments for this.

Will diabetes basics be debilitating?

Diabetes can be debilitating, and there are many reasons for this.

It is not uncommon for people with diabetes to experience advanced neuropathy to the point that he or she cannot walk.

Diabetes can also be debilitating in that people with it have an increased risk of stroke.

Other complications such as heart disease, sight impairment, and the need for kidney dialysis would all be considered debilitating.

The good news is that all of these can be prevented if treatment is started early and aggressively. This treatment includes meticulous control of blood glucose (average glucose below 150 mg/dL), blood pressure (below 130/80), LDL cholesterol (bad cholesterol below 100 mg/dL), daily aspirin, and smoking cessation. Research also has shown that one particular type of blood pressure medication, called ACE (angiotensin converting enzyme) inhibitors, has an additional protective effect on complications besides lowering blood pressure. ACE inhibitors appear to stabilize or even reverse diabetic kidney disease if it is caught early enough. These drugs also have been found useful for people who have had heart attacks or have heart failure. One study even showed these drugs reduced the risk of heart attack or stroke by 25%! Finally, there is a growing body of research suggesting ACE inhibitors may protect against diabetic eye disease.

Will diabetes basics cause discomfort?

Is diabetes basics curable?

Will diabetes basics change the patient?s ability to have children or get pregnant?

Will diabetes basics change the patient's independence?

Will diabetes basics change the patient's ability to move about?

Will diabetes basics alter activities of daily living (e.g. work, sports, housework, etc.)?

For the vast majority of people with diabetes, there should be no alterations of daily living. For most people however, small amounts of time should be reserved for self-management. This would include time for home blood glucose monitoring (although our current meters take as little as 5 seconds!) and extra time to ensure the proper medication is received.

Exercise is encouraged for people with diabetes, although for those over the age of 40 years old it is recommended a stress test is performed to rule out early heart disease.

For people who take insulin, "shift work" (working different shifts including the "graveyard shift") can be a challenge. You should talk to your doctor about the best way to manage your insulin if this pertains to you.

Will diabetes basics cause fatigue or changes in metabolism?

Extremes in blood glucose levels can cause fatigue. Although it is difficult to give exact levels since it differs with the person, many people note fatigue when the blood glucose exceeds 400 mg/dL. Although hypoglycemia often presents with a tremor, fast heart rate, a sweating, it may be noted only as fatigue. This often occurs when the blood glucose drops below 60 mg/dL.

Unfortunately, many people have no symptoms or may note they were fatigued after they are diagnosed with diabetes and treated for it. The vast majority of people, once treated, note no problems with fatigue.

Will diabetes basics require a change in diet?

Over the years, there have been many changes to the proper diet for people with diabetes. It is first important to note that the diet for people with diabetes has to be individualized based on a variety of issues, such as:

• the type of diabetes,
• the ethnicity of the patient,
• the presence or absence of kidney disease,
• the presence or absence of obesity,
• the presence or absence of heart disease or high cholesterol levels,
• the amount of physical activity planned, and
• age.

If a pregnancy is planned or one is pregnant and has diabetes the diet will also need adjustment for this.

In general, it is recommended that one eats a low-fat diet with less than 10% of the calories coming from saturated fat. For people with high levels of LDL-cholesterol (the "bad" cholesterol) the January 2002 guidelines from the ADA suggest only 7% of total calories from saturated fat.

The most confusion about diet for people with diabetes has to do with carbohydrates, which are the types of foods most quickly broken down to glucose (such as breads, potatoes, pasta, fruit, and simple sugar). Research has clearly shown that table sugar (sucrose) does not increase blood sugar any more than breads, pasta or other carbohydrates AS LONG AS THE SAME NUMBER OF CALORIES ARE CONSUMED. For example, putting table sugar into coffee (about 15 grams of carbohydrate) would not change blood glucose any more than 1 piece of bread (about 15 grams of carbohydrate). Therefore, simple sugars ("sweets") do not need to be restricted by people with diabetes, but rather need to be substituted for other carbohydrate sources. For people using insulin, it is much easier since additional insulin can be administered to "cover" additional carbohydrate. This is where a nutritionist can be extremely helpful so that the exact amount of insulin needed to cover the carbohydrates can be determined. Typical ranges are one unit of insulin (lispro, aspart, or regular) may cover anywhere from 5 to 20 grams of carbohydrate.

Will diabetes basics have implications for relationships, social support, and interactions with family?

The interactions between relationships and diabetes are greatly underappreciated.

For children, relationships with friends and teachers can be profound. Adolescence is often a difficult time anyway, and diabetes can affect relationships with peers, members of the opposite sex, parents, and teachers. All of these relationships can be quite complicated. Many in this age group often try to hide their diabetes, which can also result in problems (for example, someone with diabetes gets hypoglycemic and no one in the group knows the person has diabetes).

Communication becomes particularly important for people in their early adult years, as issues pertaining to marriage and family planning are discussed. It is critical that concerns be discussed in the open with the assistance from a health care provider with understanding about the disease.

For older adults, the impact of both the daily living of diabetes and its complications becomes even more important. Again, one needs to talk to a healthcare provider knowledgeable about diabetes to explore its complications and how it affects everything from work performance to driving or sexual function.

Everyone living with an individual who has diabetes needs to have some knowledge about how to treat emergencies (hypoglycemia). Finally, psychological support can be extremely effective for many individuals due to the extreme challenges this condition presents for many individuals.

How useful was this page or article? This article is rated out of 5 stars (2552 ratings). Not useful at all Not very useful Useful Very useful Extremely useful