Our bodies change the foods we eat into glucose. Glucose travels through the bloodstream to “fuel” or feed our cells. Insulin is a hormone that helps our bodies use glucose for energy. People with diabetes either do not make insulin, do not use insulin properly, or both. This means they have too much glucose (sugar) in their blood. As a result, they often feel tired, hungry, or thirsty; they may lose weight, urinate often, or have trouble with their eyes. In time, the high levels of this form of sugar in the blood (glucose) can hurt their eyes, kidneys, and nerves. It can also cause heart disease, strokes and even the need to remove all or part of a limb (amputation).

Diabetes tends to run in families, but other factors add to the risk of getting diabetes. For example, being overweight and underactive can sometimes trigger diabetes in people who are at risk. There is a lot of research underway looking at what causes diabetes and how best to manage it. But there is a lot we do know. For example, we know that careful control of blood glucose, blood pressure, and cholesterol can help prevent or delay diabetes and its complications. For more, please read the Diabetes article.

Types of Diabetes

There are two types of diabetes. In one kind, people must take insulin every day. This is called type 1 diabetes, formerly known as juvenile-onset diabetes. Type 1 diabetes is often first seen in children, teenagers, or adults under age 30.

The second kind of diabetes happens when the body produces insulin but doesn’t use it in the right way. This is called type 2 diabetes, formerly called adult-onset diabetes. It is most common in people over age 40. Type 2 diabetes is linked to obesity, lack of activity, family history of diabetes, and family background. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at very high risk for type 2 diabetes.

There is also a condition called pre-diabetes in which blood glucose (a form of sugar) levels are higher than normal but not high enough to be called diabetes. This condition raises the risk of type 2 diabetes, heart disease, and stroke. People with pre-diabetes can delay or prevent type 2 diabetes by losing weight and being more active.

Related Health Concerns
Blood glucose levels that are either very high or very low can lead to serious medical problems, even emergencies. In addition to the health problems noted above, people with diabetes could go into a coma (become unconscious) if their blood glucose levels get very high. Low blood glucose (called hypoglycemia) can also cause problems if it’s untreated. Usually hypoglycemia is mild and can easily be treated by eating or drinking something with carbohydrates such as bread, fruit, potatoes, or milk. But, left untreated, hypoglycemia can lead to loss of consciousness. Although hypoglycemia can happen suddenly, it can usually be treated quickly, bringing your blood glucose level back to normal.

Researchers recently have found that people with diabetes also have an increased risk for Alzheimer’s disease. Studies are underway to understand this connection and to see whether strict control of glucose can delay or prevent this problem.

Symptoms
Often, people with type 2 diabetes have few or no symptoms. Many people with type 2 diabetes don’t even know they have it. For some people, feeling run, down is their only symptom. Other people may feel thirsty, urinate often, lose weight, have blurred vision, get skin infections, or heal slowly from cuts and bruises. It is very important to tell the doctor right away about any of these problems.

Tests
Medical tests will show if diabetes is causing your problems. A doctor can diagnose diabetes by reviewing your symptoms and checking your blood glucose levels. One test (fasting plasma glucose test) measures your blood glucose level after eating or drinking nothing (fasting) for at least 8 hours, usually overnight. In another test, called the oral glucose tolerance test, your blood glucose is checked and then you drink a sugary beverage. Your blood glucose (sugar) levels are then checked 1 hour, 2 hours, and 3 hours later. Diagnosis is confirmed after a repeat test on a different day.

Research shows that some increase in blood glucose levels often comes with age. This may be caused by weight gain, especially when fat builds up around the waist.

Managing Diabetes
There are things you can do to take control of your diabetes.
• Meal planning and eating correctly are key to managing blood glucose, blood pressure, and cholesterol levels. To plan meals and eat right, you need to understand how different foods affect your glucose levels. A good meal plan will take into account your food likes and dislikes, goals for weight control, and daily physical activity. Health care professionals can work with you to create a personalized meal plan.
• Physical activity is very important in dealing with diabetes. Taking part in a regular fitness program can improve blood glucose levels in older people with diabetes. A health care professional can help plan a physical activity program just right for you.
• Medications are also central to controlling diabetes for many people. Doctors may prescribe oral medicines (those taken by mouth), insulin, or a combination of both as needed. People with type 2 diabetes may not need to take diabetes medications if they can reach glucose, blood pressure, and cholesterol goals through meal planning, eating the right foods, and physical activity.
• Keeping track of how well your diabetes care plan is working is important. Check blood glucose levels and monitor your blood pressure and cholesterol levels.

What else can you do?
Eye Exams. People with diabetes should have an eye exam every year. Finding and treating eye problems early can help prevent more serious conditions later on.

Kidney Check. A yearly urine test for a protein called albumin will show whether your kidneys are affected by diabetes.

Foot Care. Diabetes can reduce blood supply to arms and legs and cause numbness in the feet. People with diabetes should check their feet every day and watch for any redness or patches of heat. Sores, blisters, breaks in the skin, infections, or build-up of calluses should be checked right away by a doctor specializing in foot care (podiatrist) or a family doctor.

Skin Care. People with diabetes can protect their skin by keeping it clean, using skin softeners to treat dryness, and taking care of minor cuts and bruises to prevent infections and other problems.

Care of Teeth and Gums. Working closely with a dentist is very important. Teeth and gums need special attention to avoid serious infections.

Flu Shots and Pneumonia Vaccine. Getting a yearly flu shot and a pneumonia vaccine at least once will help keep people with diabetes healthy. If 5 years or more have passed since your pneumonia shot, ask your doctor if you should be revaccinated.

The body’s cells need two energy requirements to function. The blood stream delivers both oxygen and glucose to the front door of the cell. The the oxygen is invited in, but the glucose needs a key to open the door. The insulin molecule is that key. When we eat, the body senses the levels of glucose in the blood stream and secretes just the right amount of insulin from the pancreas so that cells and the body can function.

People with diabetes don’t have the luxury of that auto-sensing. They need to balance the amount of glucose intake with the amount of insulin that needs to be injected. Not enough insulin and the glucose levels in the blood stream start to rise; too much insulin, and they plummet.

The consequences of hypoglycemia (hypo=low, glycemia=glucose in the blood) are easy to understand. No energy source, no function – and the first organ to go is the brain. It needs power to function, and without glucose, the brain shuts down quickly. Confusion, lethargy, and coma occur in short order. It’s interesting that brain cells don’t need insulin to open their doors to glucose, so when people develop coma from low blood sugar, they waken almost instantaneously upon treatment. Blood sugar is one of the first things checked on scene of a comatose patient, because it’s so easy to fix and very embarrassing for an EMT to miss.

And sometimes, too much – is too much. High blood glucose levels, or hyperglycemia, cause a cascade of effects that are damaging to the body in the short and long-term. In the long-term, abnormally high blood sugar causes damage to blood vessels leading to a variety of potential catastrophes; including but not limited to any system that has a blood supply, potentially leading to heart attack, stroke, kidney failure, blindness, and amputations. Add the increased risk of infection associated with hyperglycemia and there is great incentive to keep blood sugars tightly under control.

A rise in glucose because of the lack of insulin has short term consequences as well. Cells can’t get at the sugar floating in the blood stream, so they turn to alternative fuel sources to function, but the waste products of this form of metabolism, ketones, make the body more acidic. At the same time, the kidneys sense too much glucose and start spilling it into the urine. Unfortunately, water follows and dehydration quickly occurs. The body tells itself to drink more, but the kidneys rid the body of the water faster. The downward spiral begins. The body becomes more acidic and dehydrated, electrolytes become imbalanced, and a medical emergency is eminent.
• The technical term: diabetic ketoacidosis.

• The treatment: fluids, insulin, and education for prevention.

People with diabetes live in a very narrow range of normal. Tight blood sugar control is achieved by taking multiple daily glucose tests and using insulin more frequently during the day, which mimics normal body function allows those with diabetes to live “normal” lives. Autopilot treatments are getting better. How good should diabetic therapy be? When we no longer marvel at elite athletes who have diabetes, and when they don’t become a story.