woman working out

Diabetes touches almost every part of your life. It is a serious, lifelong condition, but there is a lot you can do to protect your health. You can take charge of your health—not only for today, but also for the coming years.

Diabetes can cause health problems over time. It can hurt all of your organs including your eyes, your kidneys, and your nerves. It can lead to problems with the blood flow in your body. Even your teeth and gums can be harmed. And diabetes in pregnancy can cause special problems. Many of these problems don’t have to happen. You can do a lot to prevent them, and there are people in your community who can help.

Today and every day, strive to balance your food, physical activity, stress and medicine. Test your own blood glucose (also called blood sugar) to learn how these affect your diabetes. Being informed will help you make choices that protect your health and help you to feel well every day.

Feeling healthy can allow you to play a big part in the life of your family and  community. You may even want to join a community group in which people share their stories and help others deal with their diabetes.

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Everyone has glucose (sugar) in their blood.  It is the fuel for the body’s cells. Glucose comes from the food you eat as well as what your body produces. A hormone produced in the pancreas, called insulin, moves sugar from the blood stream to the cells where it is used for energy.  In diabetes, sugar cannot travel from the blood steam into the body cells so it stays in the blood. This is caused when either the body does not produce enough insulin or it does not use insulin correctly. Over time, high blood sugar, called hyperglycemia, can lead to serious health problems such as heart attacks, strokes, and blindness. Finding out you have diabetes is scary, but don't panic. People with diabetes can live long, healthy, happy lives when they learn how to manage the disease.

Type 1 diabetes

Type 1 was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump.

This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes accounts for 5% to 10% of all diagnosed cases of diabetes. Risk factors for type 1 diabetes may be autoimmune, genetic, or environmental. There is no known way to prevent type 1 diabetes. Several clinical trials of methods of the prevention of type 1 diabetes are currently in progress or are being planned.

Type 2 diabetes

Type 2 was previously called non insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it.

Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or other Pacific Islanders are at particularly high risk for type 2 diabetes and its complications. Clinically-based reports and regional studies suggest that Type 2 diabetes in children and adolescents, although still rare, is being diagnosed more frequently, particularly in American Indians, African Americans, and Hispanic/Latino Americans.

Gestational diabetes

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Gestational diabetes is a form of glucose intolerance diagnosed in some women during pregnancy. It occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes. During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant. After pregnancy, 5% to 10% of women with gestational diabetes are found to have type 2 diabetes. Women who have had gestational diabetes have a 20% to 50% chance of developing diabetes in the next 5 -10 years.

Other Types of Diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, drugs, malnutrition, infections, and other illnesses. Such types of diabetes account for 1% to 5% of all diagnosed cases. 

 

Several treatments are available for diabetes: pills, insulin, diet, exercise, and/or weight loss.  You may need one of these treatments or you may need all of them.  Talk with your diabetes care team to learn about your treatment options and to determine which treatment(s) is best for you. 

Type 1 diabetes:

insulin injectionWith this type of diabetes, the beta cells in the pancreas produce no insulin or too little insulin to regulate blood glucose levels, so insulin injections are required.  Insulin cannot be taken as a pill. The insulin would be broken down during digestion just like the protein in food. Insulin must be injected into the fat under your skin for it to get into your blood.  There are several types of insulin all of which work differently. In addition to insulin, Type 1 diabetes management also includes healthy eating and regular activity.

Type 2 diabetes:

PillsIn type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. When the body is unable to use the insulin properly it is referred to as insulin resistance. Your role in managing insulin resistance is eating properly, being active and maintaining a healthy body weight.  Pills are also commonly used to help control blood sugar. Over time, insulin may be added to your treatment plan.

 

Gestational diabetes:

Due to the hormones of pregnancy, insulin resistance causes high blood sugars. Common treatment plans include a personalized carbohydrate-controlled diet, regular physical activity and, at times, insulin injections, until the baby is born.

Diabetes is a chronic progressive condition. Depending on how long one has been treated for diabetes, oral medications (pills) sometimes lose their ability to control blood sugar. Insulin is very effective at reducing blood sugars and there is a large amount of research that has made it clear that well controlled blood sugars reduce the risk of long term diabetes complications such as kidney, vision, nerve and heart disease. There are multiple types of insulin available so that each patient is able to have a customized regimen that will be effective in improving their blood sugar control.

Insulin Myths

1. Insulin causes complications.  This is not true. Often patients start insulin later than is ideal and unfortunately complications are already underway.

2. If you need insulin your diabetes is really serious! Insulin is simply another tool to manage your condition. Any high blood sugar is serious and insulin is available for control.

3. My doctor told me if I ate a healthy diet, lost weight and exercised I would stay off insulin. What happened? Sometimes weight loss and healthy behaviors can improve diabetes control. However, diabetes is a progressive condition and often despite the best self-management, insulin is required to improve control. 

4. Once I start insulin I will be on it forever. Not necessarily. Diabetes control is dynamic and sometimes insulin is no longer needed. However, very often patients choose to stay on insulin because they feel better and it is the most effective way to keep blood sugars controlled.

5. Insulin causes weight gain.  It is true that sometimes patients who begin insulin gain weight. Insulin helps your body use food more efficiently. Following a meal plan, an exercise program and working with your health care team can help keep you from gaining excess weight.

6. Taking insulin injections will be painful. Many patients are surprised when they finally see how small and thin the needle actually is. In addition, many insulins come in insulin pens that make taking insulin simpler and more convenient.

How insulin works

  • Supplements insulin when the body is unable to make insulin (Type 1) or, when more insulin is needed than the body can produce (Type 2)
  • Helps our bodies to use the glucose that comes from the foods we eat
  • Helps to control high blood sugar

Guidelines for use

  • Inject once or multiple times each day; it varies based on the type of insulin you are using
  • Your doctor or diabetes educator can coach you on the specific times for the insulin that is right for you
  • Consume alcohol with caution; drinking alcohol while taking insulin may cause low blood sugar
  • Dosage adjustments may be necessary for people who take insulin

What to do if a dose is forgotten

  • Depending on the type of insulin you are taking you may be able to take the injection within an hour (long acting insulins) or you may need to skip the dose (short acting insulins)
  • Do not take 2 doses the next time

Side effects

  • Hypoglycemia
  • Infection at injection site (rare)
  • Allergic reaction (rare)

Who should NOT take this medication

  • Caution should be taken if you have any health issues which make it difficult to recognize or treat hypoglycemia
  • Very rarely there is an allergy to newer insulins.

Insulin action times

Insulin Action Times 

Insulin delivery systems

Syringes

Insulin SyringesSyringes are hollow barrels that have hypodermic needles attached. They are used to inject insulin. Insulin syringes are small with very small needles. Most have a special coating to help the needles enter the skin as painlessly as possible. Insulin syringes come in several different sizes to match insulin strength and dosage.

Insulin pens

Insulin pens look like pens with cartridges - but the cartridges are filled with insulin rather than ink. They can be used instead of syringes for giving insulin injections. Some pens use replaceable cartridges of insulin; other models are totally disposable after the pre-filled cartridge is empty. A fine short needle, like the needle on an insulin syringe, is screwed on to the tip of the pen. Users turn a dial to select the desired dose of insulin and press a plunger on the end to deliver the insulin just under the skin.

Insulin Pens 

Insulin pumps

Insulin pumps are small pumping devices worn outside of your body. They connect by flexible tubing to a catheter that is located under the skin of your abdomen. You program the pump to dispense the necessary amount of insulin. Usually, you set the pump to give a steady small dose of insulin, but you can give an additional amount in a short time if needed, such as before or after a meal. If adjusted properly, these pumps allow close control of your insulin levels without multiple injections. You still need to monitor your blood glucose levels regularly if you use this type of device.

 

 

Pramlintide (Symlin)

Drug Name  Brand Name  Doses Available (mcg) 
Pramlintide Symlin 15-120

This medication is a member of the synthetic amylin (neuroendocrine hormone) class.

How it works

  • This medication is used with insulin to lower blood sugar, especially after meals by slowing down the rate in which food is digested
  • Decreases glucose secretion by the liver
  • Works to decrease appetite, some people may lose weight as a result

Guidelines for useSymlin pens

  • In people with Type 1 diabetes using insulin
  • In people with Type 2 diabetes who are taking insulin, Sulfonylurea and/or Metformin

What to do if a dose is forgotten

  • Resume usual dose at next scheduled injection time
  • Do not “double up” on Symlin

Side effects

Side effects may occur when starting this medication but will often lessen once your body is used to the medication

  • Nausea, vomiting, diarrhea, headache
  • May cause severe low blood sugars if pre-meal insulin dose not adjusted

Who should NOT take this medication

  • People with Type 2 diabetes who are on not insulin
  • People with digestive issues (gastroporesis)

 

Exenatide (Byetta)

 

Drug Name  Brand Name  Doses Available (mcg) 
Exenatide Byetta 5, 10

This medication is the member of incretin mimetic class.

How it worksByetta pens

  • Increases glucose dependent insulin secretion
  • Decreases output of sugar by the liver
  • Decreases the rate sugar enters blood by delaying how the food is digested in the gut
  • Decreases food intake by appetite suppression, some people may lose weight as a result

Guidelines for use

  • Byetta is indicated as add-on therapy to improve blood sugar control in people with Type 2 diabetes who are taking Metformin, a Sulfonylurea, a Thiazolidinedione, or a combination of these medications
  • Inject 30-60 minutes before breakfast and dinner

What to do if a dose is forgotten

  • Resume usual dose at next scheduled injection time
  • Do not “double up” on Byetta

Side effects

Side effects may occur when starting this medication but will often lessen once your body is used to the medication

  • Nausea, vomiting, diarrhea, jitters, dizziness, headache
  • If you arte taking a Sulfonylurea with Byetta, you may experience a low blood sugar

Who should NOT take this medication

  • People with Type 1 diabetes or people with severe kidney problems or digestive issues (gastroporesis)

 

 

 Targets for diabetes control

Fasting Blood Sugar Between 80-130 mg/dL
2 hours after Meal Blood Sugar Less than 180 mg/dL
HgbA1C Less than 7%
Blood Pressure Less than 140/90 mmHg
LDLC *
HDL Men: Greater than 40 mg/dL; Women: Greater than 50 mg/dL
Triglyceride Less than 150 mg/dL

*Cholestrol levels are individualized. Most people with diabetes require a statin medication. Discuss your cholesterol treatment with your provider.

-Guidelines of the American Diabetes Association's Clinical Practice Recommendations

Note: Improved body weight can help you reach your target goals. As little as 10-15 pounds weight loss can improve your diabetes control.

 

Before the appointment:

Since you are in charge of your diabetes, it is important that you are prepared when you visit your diabetes care team. Make the most of the appointment by preparing a list of questions and current medications (with dosages) ahead of time. The Medication Profile (pdf) is available for your use.

At the appointment: 

While you are waiting in the exam room, remove your shoes and stockings so your provider may examine your feet during the appointment. Also, set your list of questions and medications on the desk along with your blood sugar log and glucometer. Be sure to talk to your provider about your normal eating habits and exercise routine – these are important factors in glucose control.  Write down the goals that you and your diabetes care team create. Discuss with your provider any diabetes classes you might want to attend. Update your Diabetes Health Record (pdf) and schedule your follow up appointment before you leave.

After the appointment: 

Review the information and goals discussed during your appointment. Post your new health goals in a place you can see everyday such as on your bathroom mirror or computer. Use the tool My Experiment (pdf) to help you more effectively design your health goal.

 

 

Journals / Newsletters

Diabetes Forecast (monthly magazine)
American Diabetes Association; subscription included with ADA membership
(800) 806-7801
http://www.diabetes.org

Voice of the Diabetic (magazine)
Published quarterly; targets people experiencing diabetes complications
(573) 875-8911
www.nfb.org/nfb/voice_of_the_diabetic.asp
Diabetes Health (monthly magazine)
(800) 488-8468
www.diabeteshealth.com
Diabetic Gourmet (magazine)
Free monthly electronic magazine and newsletter
http://diabeticgourmet.com/

Diabetes Self-Management (bimonthly magazine)
(800) 234-0923
www.diabetesselfmanagement.com

 Make sure to visit our Diabetes Resource page for a complete list of diabetes resources.

 

Diabetes class schedules