PREFACE
As a matter of fact that Diabetes is one of many common diseases around us in life which needs some attentions. Each of us in our own family or community may have stories about this disease but not all of us aware about it. Very often that Diabetes will become a hot topic in our life only where there is one in our family or community who has affected by the disease. The discussion is becoming more intensive since ourselves affected by the disease or starts to recognize the symptom of affecting it.
Some of us may learn from the story of who has the Diabetes that closed to our family or community and from there we know how about the treatment and to avoid the risks for getting survive. Again not all of us is getting aware and taking action to prevent it earlier. Action has only been taken after we affected by the disease. Whatever our status of Diabetes, it is wise to know what Diabetes is.
Since Diabetes is a disease that attacks the body with several risks of complication, the basic knowledge on Diabetes is very important to know especially the mechanism how the body convert sugars and starches into energy needed for daily life. How come the sugars are getting in our blood, what is the normal glucose content in our blood, how to diagnose it, the energy needed for daily life and the foods that we are eating are important knowledge that may improve our habit in life. The knowledge is also important to avoid guessing to the disease and taking improper action on that.
Other important issue regarding Diabetes is the medicines. The lack of knowledge on Diabetes may leads us to take wrong medicine or medical treatment that can make the situation even worst. Of course we maybe know from our friends or publications on the traditional medicines like plants, roots, seeds, leafs and special fruits that have efficacies against the disease but still we needs knowledge of using it.
In order to provide a basic knowledge on Diabetes, I here try to compile the most important knowledge in practice from various sources for hoping that it will be useful for one who would like to know better about Diabetes.
I need to thank you and appreciate to my wife, Ambar Purwani and colleagues, especially Mr. Soenarto HM, Mr. Herman Achmad, Mr. Suprayitno and Mr. Prayoga DP for their helps, supports and advices so that I can feel better and still have a sprit to fight against the high glucose level in my blood. I dedicate this compiled knowledge to my families and colleagues for a better awareness on Diabetes.
Ir. Bambang Yudho Utomo
TABLE OF CONTENTS
PREFACE
ALL ABOUT DIABETES
GENERAL INFORMATION
DIABETES OVERVIEW
What is diabetes?
What are the types of diabetes?
What tests are recommended for diagnosing diabetes?
What are the other forms of impaired glucose metabolism, also called pre-diabetes?
What are the scope and impact of diabetes?
Who gets diabetes?
How is diabetes managed?
What is the status of diabetes research?
What will the future bring?
Points to remember
For More Information
WHAT IS DIABETES?
How do you get high blood glucose?
What is pre-diabetes?
What are the signs of diabetes?
What kind of diabetes do you have?
Why do you need to take care of your diabetes?
What's a desirable blood glucose level?
TAKING CARE OF YOUR DIABETES EVERY DAY
Follow Your Meal Plan
Get Regular Exercise
Take Your Diabetes Medicine Every Day
Check Your Blood Glucose as Recommended
Take Other Tests for Your Diabetes
WHEN YOUR BLOOD GLUCOSE IS TOO HIGH OR TO LOW
What You Need to Know About High Blood Glucose
What You Need to Know About Low Blood Glucose (Hypoglycemia)
WHY IT’S IMPORTANT TO CARE OF YOUR DIABETES
Diabetes and Your Heart and Blood Vessels
Diabetes and Your Eyes
Diabetes and Your Kidneys
Diabetes and Your Nerves
Diabetes and Your Gums and Teeth
TAKING CARE OF YOUR DIABETES AT SPECIAL TIMES
When You're Sick
When You're at School or Work
When You're Away From Home
When You're Planning a Pregnancy
WHERE TO GET MORE HELP WITH YOUR DIABETES
People Who Can Help You
Organizations That Can Help You
MEDICINES FOR PEOPLE WITH DIABETES
Do I need to take diabetes medicine?
Why do I need medicines for type 1 diabetes?
Why do I need medicines for type 2 diabetes?
What do I need to know about diabetes pills?
What do I need to know about insulin?
Might I take more than one diabetes medicine at a time?
What should I know about hypoglycemia (low blood sugar)?
How do I know if my diabetes medicines are working?
For More Information
Acknowledgments
Diabetes Pills
Insulins
DIAGNOSIS OF DIABETES
What is diabetes?
What is pre-diabetes?
How are diabetes and pre-diabetes diagnosed?
What factors increase my risk for type 2 diabetes?
When should I be tested for diabetes?
What steps can delay or prevent type 2 diabetes?
How is diabetes managed?
Points to Remember
For More Information
WHAT I NEED TO KNOW ABOUT EATING AND DIABETES
How Food Affects Your Blood Glucose
Blood Glucose Levels
Your Diabetes Medicines
Your Exercise Plan
Hypoglycemia
The Food Pyramid
Starches
Vegetables
Fruit
Milk and Yogurt
Meat and Meat Substitutes
Fats and Sweets
Alcohol
Your Meal Plan
Measuring Your Food
When You Are Sick
Points to Remember
How to Find More Help
FREQUENTLY ASK QUESTIONS
DIABETES DICTIONARY
REFERENCES
ALL ABOUT DIABETES
Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.
There are 18.2 million people in the United States, or 6.3% of the population, who have diabetes. While an estimated 13 million have been diagnosed with diabetes, unfortunately, 5.2 million people (or nearly one-third) are unaware that they have the disease.
In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes. The American Diabetes Association recommends the FPG because it is easier, faster, and less expensive to perform.
With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.
In the OGTT test, a person's blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.
Major Types of Diabetes
Type 1 diabetes
Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.
Type 2 diabetes
Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Approximately 90-95% (17 million) of Americans who are diagnosed with diabetes have type 2 diabetes.
Gestational diabetes
Gestational diabetes affects about 4% of all pregnant women - about 135,000 cases in the United States each year.
Pre-diabetes
Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. It is estimated that at least 20.1 million Americans have pre-diabetes, in addition to the 18.2 million with diabetes.
Additional Information
Diabetes Symptoms
Often diabetes goes undiagnosed because many of its symptoms seem so harmless. Learn what they are in this section.
Diabetes Risk Test
More than 18 million Americans have diabetes - one in three does not know it! Take our diabetes risk test to see if you are at risk for having diabetes. Diabetes is more common in African Americans, Latinos, Native Americans, Asian Americans and Pacific Islanders.
Diabetes Statistics
With so many people affected by diabetes, the American Diabetes Association has compiled statistics on the impact of diabetes and its complications. We have statistics listed by population, complication, and economic impact.
The Genetics of Diabetes
You've probably wondered how you got diabetes. You may worry that your children will get it too. Unlike some traits, diabetes does not seem to be inherited in a simple pattern. Yet clearly, some people are born more likely to get diabetes than others.
Who's on your health care team?
No matter what kind of diabetes you have, it affects many parts of your life. You can get help from health professionals trained to focus on different areas, from head to toe. A health care team helps you use the health care system to its fullest. So whom do you need on your team? Find out here.
GENERAL INFORMATION
What is diabetes?
Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes can be associated with serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications.
Types of diabetes
Type 1 diabetes
Type 1 diabetes 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. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes may account for 5% to 10% of all diagnosed cases of diabetes. Risk factors for type 1 diabetes may include autoimmune, genetic, and environmental factors.
Type 2 diabetes
Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account 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 insulin. 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. Type 2 diabetes is increasingly being diagnosed in children and adolescents.
Gestational diabetes
Gestational diabetes is a form of glucose intolerance that is diagnosed in some women during pregnancy. Gestational diabetes 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 specific types
Other specific 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 may account for 1% to 5% of all diagnosed cases of diabetes.
Treating diabetes
To survive, people with type 1 diabetes must have insulin delivered by injections or a pump.
Many people with type 2 diabetes can control their blood glucose by following a careful diet and exercise program, losing excess weight, and taking oral medication.
Many people with diabetes also need to take medications to control their cholesterol and blood pressure.
Diabetes self-management education is an integral component of medical care.
Among adults with diagnosed diabetes, 12% take both insulin and oral medications, 19% take insulin only, 53% take oral medications only, and 15% do not take either insulin or oral medications.
Treatment with insulin or oral medications—United States, 1999-2001
Source: 1999–2001 National Health Interview Survey
Detailed information about this graph is available.
Prediabetes:
Impaired glucose tolerance and impaired fasting glucose
Prediabetes is a term used to distinguish people who are at increased risk of developing diabetes. People with prediabetes have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Some people may have both IFG and IGT.
IFG is a condition in which the fasting blood sugar level is elevated (110 to 125 milligrams per deciliter or mg/dL) after an overnight fast, but is not high enough to be classified as diabetes.
IGT is a condition in which the blood sugar level is elevated (140 to 199 mg/dL) after a 2-hour oral glucose tolerance test, but is not high enough to be classified as diabetes.
In a cross-section of U.S. adults aged 40-74 years tested from 1988 to 1994, 20.1 million (21.1%) had prediabetes (IGT or IFG or both). Among these adults with prediabetes, 9.6 million (10.1%) adults had IFG and 14.2 million (14.9%) had IGT.
Progression to diabetes among those with prediabetes is not inevitable. Studies suggest that weight loss and increased physical activity among people with prediabetes prevent or delay diabetes and may return blood glucose levels to normal.
People with prediabetes are already at increased risk for other adverse health outcomes such as heart disease and stroke.
Prevention or delay of diabetes
Research studies have found that lifestyle changes can prevent or delay the onset of type 2 diabetes among high-risk adults. These studies included people with IGT and other high-risk characteristics for developing diabetes. Lifestyle interventions included diet and moderate-intensity physical activity (such as walking for 2 1/2 hours each week). In the Diabetes Prevention Program, a large prevention study of people at high risk for diabetes, the development of diabetes was reduced 58% over 3 years.
Studies have also shown that medications have been successful in preventing diabetes in some population groups. In the Diabetes Prevention Program, people treated with the drug metformin reduced their risk of developing diabetes by 31% over 3 years. Treatment with metformin was most effective among younger, heavier people (those 25-40 years of age who were 50 to 80 pounds overweight) and less effective among older people and people who were not as overweight. Similarly, in the STOP-NIDDM Trial, treatment of people with IGT with the drug acarbose reduced the risk of developing diabetes by 25% over 3 years. Other medication studies are ongoing. In addition to preventing progression from IGT to diabetes, both lifestyle changes and medication have also been shown to increase the probability of reverting from IGT to normal glucose tolerance
There are no known methods to prevent type 1 diabetes. Several clinical trials are currently in progress or being planned.
Prevention of diabetes complications
Diabetes can affect many parts of the body and can lead to serious complications such as blindness, kidney damage, and lower-limb amputations. Working together, people with diabetes and their health care providers can reduce the occurrence of these and other diabetes complications by controlling the levels of blood glucose, blood pressure, and blood lipids and by receiving other preventive care practices in a timely manner.
Glucose control
· Research studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, for every 1% reduction in results of A1C blood tests (e.g., from 8.0% to 7.0%), the risk of developing microvascular diabetic complications (eye, kidney, and nerve disease) is reduced by 40%.
Blood pressure control
Blood pressure control can reduce cardiovascular disease (heart disease and stroke) by approximately 33% to 50% and can reduce microvascular disease (eye, kidney, and nerve disease) by approximately 33%.
In general, for every 10 millimeters of mercury (mm Hg) reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12%.
· Control of blood lipids
Improved control of cholesterol or blood lipids (for example, HDL, LDL, and triglycerides) can reduce cardiovascular complications by 20% to 50%.
Preventive care practices for eyes, kidneys, and feet
Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%.
Comprehensive foot care programs can reduce amputation rates by 45% to 85%.
Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30% to 70%. Treatment with ACE inhibitors and angiotensin receptor blockers (ARBs) are more effective in reducing the decline in kidney function than other blood pressure lowering drugs.
Complications of diabetes in the United States
Heart disease and stroke
Heart disease is the leading cause of diabetes-related deaths. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
The risk for stroke is 2 to 4 times higher among people with diabetes.
About 65% of deaths among people with diabetes are due to heart disease and stroke.
High blood pressure
About 73% of adults with diabetes have blood pressure greater than or equal to 130/80 mm Hg or use prescription medications for hypertension.
· Blindness
Diabetes is the leading cause of new cases of blindness among adults aged 20-74 years.
Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.
Kidney disease
Diabetes is the leading cause of end-stage renal disease, accounting for 44 percent of new cases.
In 2001, 42,813 people with diabetes began treatment for end-stage renal disease.
In 2001, a total of 142,963 people with end-stage renal disease due to diabetes were living on chronic dialysis or with a kidney transplant.
· Nervous system disease
About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems.
Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.
Amputations
More than 60% of nontraumatic lower-limb amputations occur among people with diabetes.
In 2000-2001, about 82,000 nontraumatic lower-limb amputations were performed annually among people with diabetes.
Dental disease
Periodontal (gum) disease is more common among people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes.
Almost one-third of people with diabetes have severe periodontal diseases with loss of attachment of the gums to the teeth measuring 5 millimeters or more.
Complications of pregnancy
Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies.
Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to the mother and the child.
Other complications
Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma.
People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.
DIABETES OVERVIEW
On this page:
What is diabetes?
What are the types of diabetes?
What tests are recommended for diagnosing diabetes?
What are the other forms of impaired glucose metabolism, also called pre-diabetes?
What are the scope and impact of diabetes?
Who gets diabetes?
How is diabetes managed?
What is the status of diabetes research?
What will the future bring?
Points to remember
For More Information
Almost everyone knows someone who has diabetes. An estimated 18.2 million people--6.3 percent of the population--in the United States have diabetes--a serious, lifelong condition. Of those, 13 million have been diagnosed. About 5.2 million people have not yet been diagnosed. Each year, about 1.3 million people age 20 or older are diagnosed with diabetes.
What is diabetes?
Diabetes is a disorder of metabolism--the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body.
After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.
When we eat, the pancreas is supposed to automatically produce the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.
What are the types of diabetes?
The three main types of diabetes are
type 1 diabetes
type 2 diabetes
gestational diabetes
Type 1 Diabetes
Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body's system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. Someone with type 1 diabetes needs to take insulin daily to live.
At present, scientists do not know exactly what causes the body's immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved. Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States.
Type 1 diabetes develops most often in children and young adults, but the disorder can appear at any age. Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier.
Symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.
Type 2 Diabetes
The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. About 80 percent of people with type 2 diabetes are overweight. Type 2 diabetes is increasingly being diagnosed in children and adolescents. However, nationally representative data on prevalence of type 2 diabetes in youth are not available.
When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but, for unknown reasons, the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes--glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.
The symptoms of type 2 diabetes develop gradually. They are not as sudden in onset as in type 1 diabetes. Some people have no symptoms. Symptoms may include fatigue or nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of wounds or sores.
Gestational Diabetes
Gestational diabetes develops only during pregnancy. Like type 2 diabetes, it occurs more often in African Americans, American Indians, Hispanic Americans, and among women with a family history of diabetes. Women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years.
What tests are recommended for diagnosing diabetes?
The fasting plasma glucose test is the preferred test for diagnosing type 1 or type 2 diabetes and is most reliable when done in the morning. However, a diagnosis of diabetes is made for any one of three positive tests, with a second positive test on a different day:
A random plasma glucose value (taken any time of day) of 200 mg/dL or more, along with the presence of diabetes symptoms.
A plasma glucose value of 126 mg/dL or more, after a person has fasted for 8 hours.
An oral glucose tolerance test (OGTT) plasma glucose value of 200 mg/dL or more in the blood sample, taken 2 hours after a person has consumed a drink containing 75 grams of glucose dissolved in water. This test, taken in a laboratory or the doctor's office, measures plasma glucose at timed intervals over a 3-hour period.
Gestational diabetes is diagnosed based on plasma glucose values measured during the OGTT. Glucose levels are normally lower during pregnancy, so the threshold values for diagnosis of diabetes in pregnancy are lower. If a woman has two plasma glucose values meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting plasma glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.
What are the other forms of impaired glucose metabolism, also called pre-diabetes?
People with pre-diabetes, a state between "normal" and "diabetes," are at risk for developing diabetes, heart attacks, and strokes. However, studies suggest that weight loss and increased physical activity can prevent or delay diabetes. There are two forms of pre-diabetes.
Impaired Fasting Glucose
A person has impaired fasting glucose (IFG) when fasting plasma glucose is 100 to 125 mg/dL. This level is higher than normal but less than the level indicating a diagnosis of diabetes.
Impaired Glucose Tolerance
Impaired glucose tolerance (IGT) means that blood glucose during the oral glucose tolerance test is higher than normal but not high enough for a diagnosis of diabetes. IGT is diagnosed when the glucose level is 140 to 199 mg/dL 2 hours after a person is given a drink containing 75 grams of glucose.
In a cross-section of American adults age 40 to 74, tested during the period 1988 to 1994, 20.1 million (21.1 percent) had pre-diabetes. Of those, 9.6 million (10.1 percent) had IFG and 14.2 million (14.9 percent) had IGT.
What are the scope and impact of diabetes?
Diabetes is widely recognized as one of the leading causes of death and disability in the United States. In 2000, it was the sixth leading cause of death. However, diabetes is likely to be underreported as the underlying cause of death on death certificates. About 65 percent of deaths among those with diabetes are attributed to heart disease and stroke.
Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, strokes, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.
In 2002, diabetes cost the United States $132 billion. Indirect costs, including disability payments, time lost from work, and premature death, totaled $40 billion; direct medical costs for diabetes care, including hospitalizations, medical care, and treatment supplies, totaled $92 billion.
Who gets diabetes?
Diabetes is not contagious. People cannot "catch" it from each other. However, certain factors can increase the risk of developing diabetes.
Type 1 diabetes occurs equally among males and females, but is more common in whites than in nonwhites. Data from the World Health Organization's Multinational Project for Childhood Diabetes indicate that type 1 diabetes is rare in most African, American Indian, and Asian populations. However, some northern European countries, including Finland and Sweden, have high rates of type 1 diabetes. The reasons for these differences are not known.
Type 2 diabetes is more common in older people, especially in people who are overweight, and occurs more often in African Americans, American Indians, some Asian Americans, Native Hawaiians and other Pacific Islander Americans, and Hispanic Americans. On average, non-Hispanic African Americans are 1.6 times as likely to have diabetes as non-Hispanic whites of the same age. Hispanic Americans are 1.5 times as likely to have diabetes as non-Hispanic whites of similar age. American Indians have one of the highest rates of diabetes in the world. On average, American Indians and Alaska Natives are 2.3 times as likely to have diabetes as non-Hispanic whites of similar age. Although prevalence data for diabetes among Asian Americans and Pacific Islanders are limited, some groups, such as Native Hawaiians and Japanese and Filipino residents of Hawaii age 20 or older, are about twice as likely to have diabetes as white residents of Hawaii of similar age.
The prevalence of diabetes in the United States is likely to increase for several reasons. First, a large segment of the population is aging. Also, Hispanic Americans and other minority groups make up the fastest-growing segment of the U.S. population. Finally, Americans are increasingly overweight and sedentary. According to recent estimates, the prevalence of diabetes in the United States is predicted to be 8.9 percent of the population by 2025.
How is diabetes managed?
Before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment.
Today, healthy eating, physical activity, and insulin via injection or an insulin pump are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking.
Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.
People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high. When blood glucose levels drop too low--a condition known as hypoglycemia--a person can become nervous, shaky, and confused. Judgment can be impaired. If blood glucose falls too low, a person can faint.
A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia.
People with diabetes should see a health care provider who helps them learn to manage their diabetes and monitors their diabetes control. An endocrinologist is one type of doctor who may specialize in diabetes care. In addition, people with diabetes often see ophthalmologists for eye examinations, podiatrists for routine foot care, and dietitians and diabetes educators to help teach the skills of day-to-day diabetes management.
The goal of diabetes management is to keep blood glucose levels as close to the normal range as safely possible. A major study, the Diabetes Control and Complications Trial (DCCT), sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), showed that keeping blood glucose levels as close to normal as safely possible reduces the risk of developing major complications of type 1 diabetes.
The 10-year study, completed in 1993, included 1,441 people with type 1 diabetes. The study compared the effect of two treatment approaches--intensive management and standard management--on the development and progression of eye, kidney, and nerve complications of diabetes. Intensive treatment aims to keep hemoglobin A1C as close to normal (6 percent) as possible. Hemoglobin A1C reflects average blood sugar over a 2- to 3-month period. Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications. More recently, a followup study of DCCT participants showed that the ability of intensive control to lower the complications of diabetes has persisted 8 years after the trial ended.
The United Kingdom Prospective Diabetes Study, a European study completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes.
Hope through research
NIDDK conducts research in its own laboratories and supports a great deal of basic and clinical research in medical centers and hospitals throughout the United States. It also gathers and analyzes statistics about diabetes. Other Institutes at the National Institutes of Health (NIH) conduct and support research on diabetes-related eye diseases, heart and vascular complications, pregnancy, and dental problems.
Other Government agencies that sponsor diabetes programs are the Centers for Disease Control and Prevention, the Indian Health Service, the Health Resources and Services Administration, the Department of Veterans Affairs, and the Department of Defense.
Many organizations outside of the Government support diabetes research and education activities. These organizations include the American Diabetes Association, the Juvenile Diabetes Research Foundation International, and the American Association of Diabetes Educators.
In recent years, advances in diabetes research have led to better ways to manage diabetes and treat its complications. Major advances include
the development of quick-acting and long-acting insulin analogues
better ways to monitor blood glucose and for people with diabetes to check their own blood glucose levels
research advances in noninvasive blood glucose monitoring
development of external insulin pumps that deliver insulin, replacing daily injections
laser treatment for diabetic eye disease, reducing the risk of blindness
successful transplantation of kidneys and pancreas in people whose own kidneys fail because of diabetes
better ways of managing diabetes in pregnant women, improving chances of successful outcomes
new drugs to treat type 2 diabetes and better ways to manage this form of diabetes through weight control
evidence that intensive management of blood glucose reduces and may prevent development of diabetes complications
demonstration that two types of antihypertensive drugs, ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers), are more effective in reducing a decline in kidney function than other antihypertensive drugs in people with diabetes
promising results with islet transplantation for type 1 diabetes reported by the University of Alberta in Canada
evidence that people at high risk for type 2 diabetes can lower their chances of developing the disease through diet, weight loss, and physical activity
What will the future bring?
Prevention of Diabetes
Researchers continue to search for the cause or causes of diabetes and ways to prevent and cure the disorder. Scientists are looking for genes that may be involved in type 1 or type 2 diabetes. Some genetic markers for type 1 diabetes have been identified, and it is now possible to screen relatives of people with type 1 diabetes to see if they are at risk.
Type 1 Diabetes
The Diabetes Prevention Trial--Type 1 (DPT-1) identified relatives at risk for developing type 1 diabetes and investigated two ways to delay or prevent type 1 diabetes. Neither low-dose insulin injections nor an oral form of insulin were successful in delaying or preventing type 1 diabetes in people at risk.
The DPT-1 was funded by the NIDDK, the National Institute of Allergy and Infectious Diseases, the National Institute of Child Health and Human Development, and the National Center for Research Resources within the National Institutes of Health as well as the American Diabetes Association and the Juvenile Diabetes Research Foundation International.
Researchers are working on a way to help people with type 1 diabetes live without daily injections of insulin. In an experimental procedure called islet transplantation, islets are taken from a donor pancreas and transferred into another person. Once implanted, the beta cells in these islets begin to make and release insulin.
Scientists have made many advances in islet transplantation in recent years. Since reporting their findings in the June 2000 issue of the New England Journal of Medicine, researchers at the University of Alberta in Edmonton, Canada, have continued to use a procedure called the Edmonton protocol to transplant pancreatic islets into people with type 1 diabetes. A multicenter clinical trial of the Edmonton protocol for islet transplantation is currently under way, and results will be announced in several years. According to the International Islet Transplant Registry, as of June 2003, about 50 percent of the patients have remained insulin-free for up to 1 year after receiving a transplant. A clinical trial of the Edmonton protocol is also being conducted by the Immune Tolerance Network, funded by the National Institutes of Health and the Juvenile Diabetes Research Foundation International.
The goal of islet transplantation is to infuse enough islets to control the blood glucose level without insulin injections. For an average-sized person (70 kg), a typical transplant requires about 1 million islets, extracted from two donor pancreases. Because good control of blood glucose can slow or prevent the progression of complications associated with diabetes, such as nerve or eye damage, a successful transplant may reduce the risk of these complications. But a transplant recipient will need to take immunosuppressive drugs that stop the immune system from rejecting the transplanted islets.
Researchers are trying to find new approaches that will allow successful transplantation without the use of immunosuppressive drugs, thus eliminating the side effects that may accompany their long-term use. These drugs have significant side effects and their long-term effects are still not known. Immediate side effects of immunosuppressive drugs may include mouth sores and gastrointestinal problems, such as stomach upset or diarrhea. Patients may also have increased blood cholesterol levels, decreased white blood cell counts, decreased kidney function, and increased susceptibility to bacterial and viral infections. Taking immunosuppressive drugs increases the risk of tumors and cancer as well.
Researchers do not fully know what long-term effects this procedure may have. Also, although the early results of the Edmonton protocol are very encouraging, more research is needed to answer questions about how long the islets will survive and how often the transplantation procedure will be successful.
A major obstacle to widespread use of islet transplantation will be the shortage of islet cells. The supply available from deceased donors will be enough for only a small percentage of those with type 1 diabetes. However, researchers are pursuing avenues for alternative sources, such as creating islet cells from other types of cells. New technologies could then be employed to grow islet cells in the laboratory.
Type 2 Diabetes
In 1996, NIDDK launched its Diabetes Prevention Program (DPP). The goal of this research effort was to learn how to prevent or delay type 2 diabetes in people with impaired glucose tolerance (IGT), a strong risk factor for type 2 diabetes.
The findings of the DPP, which were released in August 2001, showed that people at high risk for type 2 diabetes could sharply lower their chances of developing the disease through diet and exercise. In addition, treatment with the oral diabetes drug metformin also reduced diabetes risk, though less dramatically.
Participants randomly assigned to intensive lifestyle intervention reduced their risk of getting type 2 diabetes by 58 percent. On average, this group maintained their physical activity at 30 minutes per day, usually with walking or other moderate intensity exercise, and lost 5 to 7 percent of their body weight. Participants randomized to treatment with metformin reduced their risk of getting type 2 diabetes by 31 percent.
Of the 3,234 participants enrolled in the DPP, 45 percent were from minority groups that suffer disproportionately from type 2 diabetes: African Americans, Hispanic Americans, Asian Americans and Pacific Islanders, and American Indians. The trial also recruited other groups known to be at higher risk for type 2 diabetes, including individuals age 60 and older, women with a history of gestational diabetes, and people with a first-degree relative with type 2 diabetes.
Prevention and Treatment of Cardiovascular Disease
The National Institutes of Health is studying the best strategies to prevent and treat cardiovascular disease (CVD) in people with diabetes in three trials: Look AHEAD, ACCORD, and BARI 2D. These studies are all joint efforts of the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute.
The Look AHEAD: Action for Health in Diabetes study will be the largest clinical trial to date to examine the long-term health effects of voluntary weight loss. This multi-center, randomized clinical trial will examine the consequences of a lifestyle intervention designed to achieve and maintain weight loss over the long term through decreased caloric intake and increased exercise. Look AHEAD will focus on the disease most associated with overweight and obesity, type 2 diabetes, and on the outcome that causes the greatest morbidity and mortality, cardiovascular disease.
The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, a randomized multi-center trial, is being undertaken by the NIH to study three key approaches to preventing major cardiovascular events in individuals with type 2 diabetes. The primary outcome that ACCORD will measure is the first occurrence of a major cardiovascular disease event, specifically heart attack, stroke, or cardiovascular death. In addition, the study will investigate the impact of the treatment strategies on other cardiovascular outcomes; total mortality; limb amputation; eye, kidney, or nerve disease; health-related quality of life; and cost-effectiveness.
The Bypass Angioplasty Revascularization Investigation in Type 2 Diabetics Trial (BARI 2D), a 5-year, multi-center clinical trial, will compare medical versus early surgical management of patients with type 2 diabetes who also have coronary artery disease and stable angina or ischemia. At the same time, BARI 2D is studying the effect of two different strategies to control blood glucose--providing insulin versus increasing the sensitivity of the body to insulin--on risk of cardiovascular mortality and morbidity.
A complete listing of clinical research studies can be found at http://ClinicalTrials.gov.
Several new drugs have been developed to treat type 2 diabetes. By using the oral diabetes medications now available, many people can control blood glucose levels without insulin injections. Studies are under way to determine how best to use these drugs to manage type 2 diabetes.
Points to Remember
What is diabetes?
a disorder of metabolism--the way the body digests food for energy and growth
What are the main types of diabetes?
type 1 diabetes
type 2 diabetes
gestational diabetes
What is the impact of diabetes?
It affects 18.2 million people--6.3 percent of the population.
It is a leading cause of death and disability.
It costs $132 billion per year.
Who gets diabetes?
people of any age
those with a family history of diabetes
most common in older people, overweight and sedentary people, African Americans, Alaska Natives, American Indians, Asian Americans, Native Hawaiians, some Pacific Islander Americans, and Hispanic Americans
For More Information
For more information about type 1, type 2, and gestational diabetes, as well as diabetes research, statistics, and education, contact
National Diabetes Education Program
American Diabetes Association
Juvenile Diabetes Research Foundation International
What Diabetes Is
Diabetes means that your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn't good for your health.
How do you get high blood glucose?
Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all the cells in your body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body doesn't make enough insulin or if the insulin doesn't work the way it should, glucose can't get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing pre-diabetes or diabetes.
What is pre-diabetes?
Pre-diabetes is a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is if you have pre-diabetes, you can reduce your risk of getting diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes and even return to normal glucose levels.
What are the signs of diabetes?
The signs of diabetes are
being very thirsty
urinating often
feeling very hungry or tired
losing weight without trying
having sores that heal slowly
having dry, itchy skin
losing the feeling in your feet or having tingling in your feet
having blurry eyesight
You may have had one or more of these signs before you found out you had diabetes. Or you may have had no signs at all. A blood test to check your glucose levels will show if you have pre-diabetes or diabetes.
What kind of diabetes do you have?
People can get diabetes at any age. There are three main kinds.
Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. In this form of diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them. Treatment for type 1 diabetes includes taking insulin shots or using an insulin pump, making wise food choices, exercising regularly, taking aspirin daily (for some), and controlling blood pressure and cholesterol.
Type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age--even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes. Treatment includes using diabetes medicines, making wise food choices, exercising regularly, taking aspirin daily, and controlling blood pressure and cholesterol.
Some women develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin.
Diabetes can start at any age.
This guide is for people who have either type 1 diabetes or type 2 diabetes.
If you use insulin, look at the white boxes for "Action Steps."
If you don't use insulin, look at the gray boxes for "Action Steps."
Why do you need to take care of your diabetes?
After many years, diabetes can lead to serious problems in your eyes, kidneys, nerves, and gums and teeth. But the most serious problem caused by diabetes is heart disease. When you have diabetes, you are more than twice as likely as people without diabetes to have heart disease or a stroke.
If you have diabetes, your risk of a heart attack is the same as someone who has already had a heart attack. Both women and men with diabetes are at risk. You may not even have the typical signs of a heart attack.
You can reduce your risk of developing heart disease by controlling your blood pressure and blood fat levels. If you smoke, talk with your doctor about quitting. Remember that every step toward your goals helps!
Later in this guide, we'll tell you how you can try to prevent or delay long-term problems. The best way to take care of your health is to work with your health care team to keep your blood glucose, blood pressure, and cholesterol in your target range.
What's a desirable blood glucose level?
Everyone's blood has some glucose in it. In people who don't have diabetes, the normal range is about 70 to 120. Blood glucose goes up after eating, but returns to the normal range 1 or 2 hours later.
Ask your health care team when you should check your blood glucose with a meter. Talk about whether the blood glucose targets listed below are best for you. Then write in your own targets.
Blood Glucose Targets for Most People
When
Target levels
My target levels
Before meals
90 to 130
_____________
1 to 2 hours after the start of a meal
Less than 180
_____________
Printer-friendly version of Glucose Targets form
It may be hard to reach your target range all of the time. But the closer you get to your goal, the more you will reduce your risk of diabetes-related problems and the better you will feel. Every step helps.
TAKING CARE OF YOUR DIABETES EVERY DAY
Do four things every day to lower high blood glucose:
Follow your meal plan.
Get regular exercise.
Take your diabetes medicine.
Check your blood glucose.
Experts say most people with diabetes should try to keep their blood glucose level as close as possible to the level of someone who doesn't have diabetes. The closer to normal your blood glucose is, the lower your chances are of developing damage to your eyes, kidneys, and nerves.
Check with your doctor about the right range for you. The chart in chapter one shows target blood glucose ranges.
Your health care team will help you learn how to reach your target blood glucose range. Your main health care providers are your doctor, nurse, diabetes educator, and dietitian.
When you see your health care provider, ask lots of questions. Before you leave, be sure you understand everything you need to know about taking care of your diabetes.
A diabetes educator is a health care worker who teaches people how to manage their diabetes. Your educator may be a nurse, a dietitian, or another kind of health care worker.
A dietitian is someone who's specially trained to help people plan their meals. For more information about these health care providers and for help in finding them, see chapter six.
The next sections of this guide will tell you more about the four main ways you take care of your diabetes: Follow your meal plan, get regular exercise, take your diabetes medicine, and check your blood glucose.
Follow Your Meal Plan
People with diabetes don't need to eat special foods. The foods on your meal plan are good for everyone in your family! Try to eat foods that are low in fat, salt, and sugar and high in fiber such as beans, fruits, vegetables, and grains. Eating right will help you
Reach and stay at a weight that's good for your body.
Keep your blood glucose in a desirable range.
Prevent heart and blood vessel disease.
Your daily meal plan should include foods from these groups:
Source: U.S. Department of Agriculture/U.S. Department of Health and Human Services
People with diabetes should have their own meal plan. Ask your doctor to give you the name of a dietitian who can work with you to develop a meal plan. Your dietitian can help you plan meals to include foods that you and your family like to eat and that are good for you too. Ask your dietitian to include foods that are heart-healthy to reduce your risk of heart disease.
ACTION STEPS
If you use insulin
Follow your meal plan.
Don't skip meals, especially if you've already taken your insulin, because your blood glucose may go too low. (See chapter 3 for information on how to handle hypoglycemia, also called low blood sugar.)
Printer-friendly version of the "Action Steps" if you use insulin
ACTION STEPS
If you DON'T use insulin
Follow your meal plan.
Don't skip meals, especially if you take diabetes medicine, because your blood glucose may go too low. It may be better to eat several small meals during the day instead of one or two big meals.
Printer-friendly version of the "Action Steps" if you DON'T use insulin
Get Regular Exercise
Exercise is good for your diabetes. Walking, swimming, dancing, riding a bicycle, playing baseball, and bowling are all good ways to exercise. You can even get exercise when you clean house or work in your garden. Exercise is especially good for people with diabetes because
Exercise helps keep weight down.
Exercise helps insulin work better to lower blood glucose.
Exercise is good for your heart and lungs.
Exercise gives you more energy.
Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some exercises like weightlifting may not be safe. Your health care team can help you find safe exercises.
Try to exercise almost every day for a total of about 30 minutes. If you haven't exercised lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day.
If you haven't eaten for more than an hour or if your blood glucose is less than 100 to 120, have a snack before you exercise. (See chapter 3 for snack ideas.)
Being active helps you feel better.
When you exercise, carry glucose tablets or a carbohydrate snack with you in case you get hypoglycemia (low blood sugar). Wear or carry an identification tag or card saying that you have diabetes.
The groups listed in chapter six have more information about diabetes and exercise.
ACTION STEPS
If you use insulin
See your doctor before starting an exercise program.
Check your blood glucose before, during, and after exercising. Don't exercise when your blood glucose is over 240 or if you have ketones in your urine (see below).
Don't exercise right before you go to sleep, because it could cause hypoglycemia (low blood sugar) during the night.
Printer-friendly version of the "Action Steps" if you use insulin
ACTION STEPS
If you don't use insulin
See your doctor before starting an exercise program.
Printer-friendly version of the "Action Steps" if you DON'T use insulin
Take Your Diabetes Medicine Every Day
Insulin and diabetes pills are the two kinds of medicines used to lower blood glucose.
If You Use Insulin
You need insulin if your body has stopped making insulin or if it doesn't make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do too.
Insulin can't be taken as a pill. You'll give yourself shots every day or use an insulin pump. Insulin pumps are small machines that connect to narrow tubing, ending with a needle just under the skin near the abdomen. Insulin is delivered through the needle.
Keep extra insulin in your refrigerator in case you break the bottle you're using. Don't keep insulin in the freezer or in hot places like the glove compartment of your car. Also, keep it away from bright light. Too much heat, cold, and bright light can damage insulin.
If you use a whole bottle of insulin within 30 days, you can keep that bottle at room temperature. If you don't use a whole bottle of insulin within 30 days, then store it in the refrigerator.
You may need insulin to control your blood glucose.
If You Take Diabetes Pills
If your body makes insulin, but the insulin doesn't lower your blood glucose, you may need diabetes pills. Some pills are taken once a day, and others are taken more often. Ask your health care team when you should take your pills.
Be sure to tell your doctor if your pills make you feel sick or if you have any other problems. Remember, diabetes pills don't lower blood glucose all by themselves. You'll still want to follow a meal plan and exercise to help lower your blood glucose.
Sometimes, people who take diabetes pills may need insulin shots for a while. If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose.
You may be able to stop taking diabetes pills if you lose weight. (Always check with your doctor before you stop taking your diabetes pills.) Losing 10 or 15 pounds can sometimes help you reach your target blood glucose level.
Many people with type 2 diabetes take pills to help keep blood glucose in their target range.
If You Don't Use Insulin or Take Diabetes Pills
Many people with type 2 diabetes don't need insulin or diabetes pills. They can take care of their diabetes by using a meal plan and exercising regularly.
Check Your Blood Glucose as Recommended
You'll want to know how well you're taking care of your diabetes. The best way to find out is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, exercise plan, or medicine.
Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three or four times a day. You may check before eating, before bed, and sometimes in the middle of the night.
Your doctor or diabetes educator will show you how to check your blood using a blood glucose meter. Your health insurance or Medicare may pay for the supplies and equipment you need.
Checking your blood glucose will help you see if your diabetes treatment plan is working.
Take Other Tests for Your Diabetes
Urine Tests
You may need to check your urine if you're sick or if your blood glucose is over 240. A urine test will tell you if you have ketones in your urine. Your body makes ketones when there isn't enough insulin in your blood. Ketones can make you very sick. Call your doctor right away if you find ketones when you do a urine test. You may have a serious condition called ketoacidosis. If it isn't treated, it can cause death. Signs of ketoacidosis are vomiting, weakness, fast breathing, and a sweet smell on the breath. Ketoacidosis is more likely to develop in people with type 1 diabetes.
You can buy strips for testing ketones at a drug store. Your doctor or diabetes educator will show you how to use them.
The A1C Test
Another test for blood glucose, the A1C, also called the hemoglobin A1C test, shows what your overall blood glucose was for the past 3 months. It shows how much glucose is sticking to your red blood cells. The doctor does this test to see what your blood glucose is most of the time. Have this test done at least twice a year.
Ask your doctor what your A1C test showed. A result of under 7 usually means that your diabetes treatment is working well and your blood glucose is under control. If your A1C is 8 or above, it means that your blood glucose may be too high. You'll then have a greater chance of getting diabetes problems, like kidney damage. You may need a change in your meal plan, exercise plan, or diabetes medicine.
A1C Results
Target for most people with diabetes
under 7
Time to change my diabetes care plan
8 or above
My last result
__________
My target
__________
printer-friendly version of A1C Results form
Talk with your doctor about what your target should be. Even if your A1C is higher than your target, remember that every step toward your goal helps reduce your risk of diabetes problems.
Keep Daily Records
Print and make copies of the daily diabetes record page. Then write down the results of your blood glucose checks every day. You may also want to write down what you ate, how you felt, and whether you exercised.
By keeping daily records of your blood glucose checks, you can tell how well you're taking care of your diabetes. Show your blood glucose records to your health care team. They can use your records to see whether you need changes in your diabetes medicines or in your meal plan. If you don't know what your results mean, ask your health care team.
Things to write down every day in your record book are
results of your blood glucose checks
your diabetes medicines: times and amounts taken
if your blood glucose was very low (see chapter three)
if you ate more or less food than you usually do
if you were sick
if you found ketones in your urine
what kind of exercise you did and for how long
ACTION STEPS
If you use insulin
Keep a daily record of
Your blood glucose numbers.
The times of the day you took your insulin.
The amount and type of insulin you took.
Whether you had ketones in your urine.
Printer-friendly version of the "Action Steps" if you use insulin
ACTION STEPS
If you DON'T use insulin
Keep a daily record of
Your blood glucose numbers.
The times of the day you took your diabetes pills.
Printer-friendly version of the "Action Steps" if you DON'T use insulin
Sample of a record page for a person who doesn't use insulin or diabetes pills.
Print a blank version of the daily diabetes record page to keep track of your blood glucose level.
WHEN YOUR BLOOD GLUCOSE IS TOO HIGH OR TOO LOW
Sometimes, no matter how hard you try to keep your blood glucose in your target range, it's too high or too low. Blood glucose that's too high or too low can make you very sick. Here's how to handle these emergencies.
What You Need to Know About High Blood Glucose
If your blood glucose stays over 180, it may be too high. (Go back to the chart.) It means you don't have enough insulin in your body. High blood glucose can happen if you miss taking your diabetes medicine, eat too much, or don't get enough exercise. Sometimes, the medicines you take for other problems cause high blood glucose. Be sure to tell your doctor about other medicines you take.
Having an infection or being sick or under stress can also make your blood glucose too high. That's why it's very important to check your blood glucose and keep taking your insulin or diabetes pills when you're sick. (For more about how to take care of yourself when you're sick, see chapter five.)
If you're very thirsty and tired, have blurry vision, and have to go to the bathroom often, your blood glucose may be too high. Very high blood glucose may also make you feel sick to your stomach.
If your blood glucose is high much of the time or if you have symptoms of high blood glucose, call your doctor. You may need a change in your insulin or diabetes pills, or a change in your meal plan.
What You Need to Know About Low Blood Glucose (Hypoglycemia)
Hypoglycemia happens if your blood glucose drops too low. It can come on fast. It's caused by taking too much diabetes medicine, missing a meal, delaying a meal, exercising more than usual, or drinking too much alcohol. Sometimes, medicines you take for other health problems can cause blood glucose to drop.
Hypoglycemia can make you feel weak, confused, irritable, hungry, or tired. You may sweat a lot or get a headache. You may feel shaky. If your blood glucose drops lower, you could pass out or have a seizure.
If you have any of these symptoms, check your blood glucose. If the level is 70 or below, have one of the following right away:
2 or 3 glucose tablets
1/2 cup (4 oz.) of any fruit juice
a piece of fruit or a small box of raisins
1/2 cup (4 oz.) of a regular (not diet) soft drink
5 or 6 pieces of hard candy
1 or 2 teaspoons of sugar or honey
Have one of these "quick fix" foods when your blood glucose is low.
After 15 minutes, check your blood glucose again to make sure that it's no longer too low. Once your blood glucose is stable, if it will be at least an hour before your next meal, have a snack.
If you take insulin or a diabetes pill that can cause hypoglycemia, always carry food for emergencies. It's a good idea also to wear a medical identification bracelet or necklace.
If you take insulin, keep a glucagon kit at home and also at a few other places where you go often. Glucagon is given as an injection with a syringe and quickly raises blood glucose. Show your family, friends, and co-workers how to give you a glucagon injection if you pass out because of hypoglycemia.
You can prevent hypoglycemia by eating regular meals, taking your diabetes medicine, and checking your blood glucose often. Checking will tell you whether your glucose level is going down. You can then take steps, like eating some fruit, crackers, or other snacks, to raise your blood glucose.
When you have hypoglycemia, have a snack to bring your blood glucose back to normal.
ACTION STEPS
If you use insulin
Tell your doctor if you have hypoglycemia often, especially at the same time of the day or night several times in a row.
Tell your doctor if you've passed out from hypoglycemia.
Ask your doctor about glucagon. Glucagon is a medicine that raises blood glucose. If you pass out from hypoglycemia, someone should call 911 and give you a glucagon shot.
Printer-friendly version of the "Action Steps" if you use insulin
ACTION STEPS
If you DON'T use insulin
Tell your doctor if you have hypoglycemia often, especially at the same time of the day or night several times in a row.
Be sure to tell your doctor about other medicines you are taking.
Some diabetes pills can cause hypoglycemia. Ask your doctor whether your pills can cause hypoglycemia.
Printer-friendly version of the "Action Steps" if you DON'T use insulin
WHY IT’S IMPORTANT TO TAKE CARE OF YOUR DIABETES
Taking care of your diabetes every day will help keep your blood glucose in your target range and help prevent other health problems that diabetes can cause over the years. This part of the guide describes those problems. We tell you about them not to scare you, but to help you understand what you can do to keep them from happening.
Do what you can every day to keep your blood glucose in the range that's best for you.
Follow your meal plan every day.
Get regular exercise every day.
Take your diabetes medicine every day.
Check your blood glucose as recommended.
Diabetes and Your Heart and Blood Vessels
The biggest problem for people with diabetes is heart and blood vessel disease. Heart and blood vessel disease can lead to heart attacks and strokes. It also causes poor blood flow (circulation) in the legs and feet.
To check for heart and blood vessel disease, your health care team will do some tests. At least once a year, have a blood test to see how much cholesterol is in your blood. Your health care provider should take your blood pressure at every visit. He or she may also check the circulation in your legs, feet, and neck.
The best way to prevent heart and blood vessel disease is to take good care of yourself and your diabetes.
Eat foods that are low in fat and salt.
Keep your blood glucose on track. Know your A1C. The target for most people is under 7.
If you smoke, quit.
Exercise regularly.
Lose weight if you need to.
Ask your health care team whether you should take an aspirin every day.
Keep your blood pressure on track. The target for most people is under 130/80. If needed, take medicine to control your blood pressure.
Keep your cholesterol level on track. The target for LDL cholesterol for most people is under 100. If needed, take medicine to control your blood fat levels.
What's a desirable blood pressure level?
Blood pressure levels tell how much your blood is pushing against the walls of your blood vessels. Your pressure is given as two numbers: The first is the pressure as your heart beats and the second is the pressure as your heart relaxes. If your blood pressure is higher than your target, talk with your health care team about changing your meal plan, adding exercise, or taking medicine.
Blood Pressure Results
Target for most people with diabetes
under 130/80
My last result
____________
My target
____________
printer-friendly version of Blood Pressure Results form
What are desirable blood fat levels?
Cholesterol, a fat found in the body, appears in different forms. If your LDL cholesterol ("bad" cholesterol) is 100 or above, you are at increased risk of heart disease and may need treatment. A high level of total cholesterol also means a greater risk of heart disease. But HDL cholesterol ("good" cholesterol) protects you from heart disease, so the higher it is, the better. It's best to keep triglyceride (another type of fat) levels under 150. All of these target numbers are important for preventing heart disease.
Target Blood Fat Levels for People With Diabetes
Total cholesterol
under 200
My last result_____
My target_____
LDL cholesterol
under 100
My last result_____
My target_____
HDL cholesterol
above 40 (men)
My last result_____
My target_____
above 50 (women)
My last result_____
My target_____
Triglycerides
under 150
My last result_____
My target_____
printer-friendly version of Target Blood Fat Levels form
Rose is 55 years old and teaches at a junior high school on an American Indian reservation in New Mexico. Rose has had type 2 diabetes for almost 10 years. When she first found out she had diabetes, she weighed too much and didn't get much exercise. After talking it over with her doctor, Rose began an exercise program. She lost weight, and her blood glucose began to come down. She felt better too. Now Rose teaches an exercise class in her spare time.
Diabetes and Your Eyes
Have your eyes checked once a year. You could have eye problems that you haven't noticed yet. It is important to catch eye problems early when they can be treated. Treating eye problems early can help prevent blindness.
High blood glucose can make the blood vessels in the eyes bleed. This bleeding can lead to blindness. You can help prevent eye damage by keeping your blood glucose as close to normal as possible. If your eyes are already damaged, an eye doctor may be able to save your sight with laser treatments or surgery.
The best way to prevent eye disease is to have a yearly eye exam. In this exam, the eye doctor puts drops in your eyes to make your pupils get bigger (dilate). When the pupils are big, the doctor can see into the back of the eye. This is called a dilated eye exam, and it doesn't hurt. If you've never had this kind of eye exam before, you should have one now, even if you haven't had any trouble with your eyes. Be sure to tell your eye doctor that you have diabetes.
Here are some tips for taking care of your eyes:
For people with type 1 diabetes: Have your eyes examined when you have had diabetes for 5 years and every year after that first exam. (Children should have an eye exam in their early teens.)
For people with type 2 diabetes: Have an eye exam every year.
For women planning to have a baby: Have an eye exam before becoming pregnant.
If you smoke, quit.
Keep your blood glucose and blood pressure as close to normal as possible.
Tell your eye doctor right away if you have any problems like blurry vision or seeing dark spots, flashing lights, or rings around lights.
See your eye doctor for an eye exam with dilated pupils every year. Early treatment of eye problems can help save your sight.
Diabetes and Your Kidneys
Your kidneys help clean waste products from your blood. They also work to keep the right balance of salt and fluid in your body.
Too much glucose in your blood is very hard on your kidneys. After a number of years, high blood glucose can cause the kidneys to stop working. This condition is called kidney failure. If your kidneys stop working, you'll need dialysis (using a machine or special fluids to clean your blood) or a kidney transplant.
Have a urine test once a year for signs of kidney damage. The test measures how much protein is in your urine. A blood pressure medicine (called an ACE inhibitor) can help prevent kidney damage. Ask your doctor whether this medicine could help you. Other ways to help prevent kidney problems are to
Take your medicine if you have high blood pressure.
Ask your doctor or your dietitian whether you should eat less meat, cheese, milk, and fish or fewer eggs.
See your doctor right away if you get a bladder or kidney infection. Signs of bladder or kidney infections are cloudy or bloody urine, pain or burning when you urinate, and having to urinate often or in a hurry. Back pain, chills, and fever are also signs of kidney infection.
Keep your blood glucose and blood pressure as close to normal as possible.
If you smoke, quit.
Mike is a migrant farm worker with type 2 diabetes and high blood pressure. Mike, 47, is married, and he and his wife have three children. The family is often on the move, depending on where the work is. Mike has his blood pressure and kidneys checked at clinics in migrant worker camps. Some of the clinics also offer diabetes classes. Whenever they can, Mike and his wife attend these classes. They especially like the cooking classes because they learn how to prepare low-cost, healthy meals for the whole family.
Diabetes and Your Nerves
Over time, high blood glucose can harm the nerves in your body. Nerve damage can cause you to lose the feeling in your feet or to have painful, burning feet. It can also cause pain in your legs, arms, or hands or cause problems with eating, going to the bathroom, or having sex.
Nerve damage can happen slowly. You may not even realize you have nerve problems. Your doctor should check your nerves at least once a year. Part of this exam should include tests to check your sense of feeling and the pulse in your feet.
Tell the doctor about any problems with your feet, legs, hands, or arms. Also, tell the doctor if you have trouble eating, going to the bathroom, or having sex, or if you feel dizzy sometimes.
Nerve damage to the feet can lead to amputations. You may not feel pain from injuries or sore spots on your feet. If you have poor circulation because of blood vessel problems in your legs, the sores on your feet can't heal and might become infected. If the infection isn't treated, it could lead to amputation.
Ask your doctor whether you already have nerve damage in your feet. If you do, it is especially important to take good care of your feet. To help prevent complications from nerve damage, check your feet every day (see Foot care tips below).
Joe is a 65-year-old retired letter carrier with type 2 diabetes. Every time he visits his doctor, he takes his shoes and socks off so the doctor can check his feet for sores, ulcers, and wounds. The doctor also checks the sense of feeling in Joe's feet. Joe and his doctor talk about ways to prevent foot and nerve problems. Since Joe has lost some feeling in his toes, the doctor also talks to him about the importance of good foot care and keeping his blood glucose in a good range.
Here are some ways to take care of your nerves:
Keep your blood glucose and blood pressure as close to normal as possible.
Limit the amount of alcohol you drink.
Check your feet every day.
If you smoke, quit.
Foot Care Tips
You can do a lot to prevent problems with your feet. Keeping your blood glucose in your target range and taking care of your feet can help protect them.
Check your bare feet every day. Look for cuts, sores, bumps, or red spots. Use a mirror or ask a family member for help if you have trouble seeing the bottoms of your feet.
Wash your feet in warm--not hot--water every day, but don't soak them. Use mild soap. Dry your feet with a soft towel, and dry carefully between your toes.
After washing your feet, cover them with lotion before putting your shoes and socks on. Don't put lotion or cream between your toes.
File your toenails straight across with an emery board. Don't leave sharp edges that could cut the next toe.
Don't try to cut calluses or corns off with a razor blade or knife, and don't use wart removers on your feet. If you have warts or painful corns or calluses, see a podiatrist, a doctor who treats foot problems.
Wear thick, soft socks. Don't wear mended stockings or stockings with holes or seams that might rub against your feet.
Check your shoes before you put them on to be sure they have no sharp edges or objects in them.
Wear shoes that fit well and let your toes move. Break new shoes in slowly. Don't wear flip-flops, shoes with pointed toes, or plastic shoes. Never go barefoot.
Wear socks if your feet get cold at night. Don't use heating pads or hot water bottles on your feet.
Have your doctor check your feet at every visit. Take your shoes and socks off when you go into the examining room. This will remind the doctor to check your feet.
See a podiatrist for help if you can't take care of your feet yourself.
Diabetes and Your Gums and Teeth
Diabetes can lead to infections in your gums and the bones that hold your teeth in place. Like all infections, gum infections can cause blood glucose to rise. Without treatment, teeth may become loose and fall out.
To help prevent damage to your gums and teeth,
See your dentist twice a year. Tell your dentist that you have diabetes.
Brush and floss your teeth at least twice a day.
If you smoke, quit.
Keep your blood glucose as close to normal as possible.
Keeping your blood glucose in your target range, brushing and flossing your teeth every day, and having regular dental checkups are the best ways to prevent gum and teeth problems when you have diabetes.
James runs a bookstore in California. He's 35 years old and has had type 1 diabetes for 15 years. James takes good care of his teeth and sees his dentist twice a year. He makes his appointments in the morning, after breakfast, so he won't get hypoglycemia while at the dentist. He also carries glucose tablets and wears an identification bracelet that has the name and the telephone number of his doctor on it.
TAKING CARE OF YOUR DIABETES AT SPECIAL TIMES
Diabetes is part of your life. It's very important to take care of it when you're sick, when you're at school or work, when you travel, or when you're pregnant or thinking about having a baby. Here are some tips to help you take care of your diabetes at these times.
When You're Sick
Take good care of yourself when you have a cold, the flu, an infection, or other illness. Being sick can raise your blood glucose. When you're sick,
Check your blood glucose every 4 hours. Write down the results.
Keep taking your insulin and your diabetes pills. Even if you can't keep food down, you still need your diabetes medicine. Ask your doctor or diabetes educator whether to change the amount of insulin or pills you take.
Drink at least a cup (8 ounces) of water or other calorie-free, caffeine-free liquid every hour while you're awake.
If you can't eat your usual food, try drinking juice or eating crackers, popsicles, or soup.
If you can't eat at all, drink clear liquids such as ginger ale. Eat or drink something with sugar in it if you have trouble keeping food down.
Test your urine for ketones if
your blood glucose is over 240
you can't keep food or liquids down
Call your health care provider right away if
your blood glucose has been over 240 for longer than a day
you have moderate to large amounts of ketones in your urine
you feel sleepier than usual
you have trouble breathing
you can't think clearly
you throw up more than once
you've had diarrhea for more than 6 hours
ACTION STEPS
If you use insulin
Take your insulin, even if you've been throwing up. Ask your doctor about how to adjust your insulin dose, based on your blood glucose test results.
Printer-friendly version of the "Action Steps" if you use insulin
ACTION STEPS
If you DON'T use insulin
Take your diabetes pills, even if you've been throwing up.
Printer-friendly version of the "Action Steps" if you DON'T use insulin
When You're at School or Work
Take care of your diabetes when you're at school or at work:
Follow your meal plan.
Take your medicine and check your blood glucose as usual.
Tell your teachers, friends, or close co-workers about the signs of hypoglycemia. You may need their help if your blood glucose drops too low.
Keep snacks nearby and carry some with you at all times to treat hypoglycemia.
Tell your company nurse or school nurse that you have diabetes.
Sally, a 12-year-old with type 1 diabetes, loves her gymnastics class. She practices every day for an hour. Before Sally exercises, she checks her blood glucose to make sure it's okay to start her workout. If her blood glucose is too low, she eats a snack before beginning to practice. Sally has told her coach that she has diabetes. She knows that if she has a problem with hypoglycemia, her coach will be there to help her.
When You're Away From Home
Taking care of your diabetes, even on vacation, is very important.
Here are some tips:
Follow your meal plan as much as possible when you eat out. Always carry a snack with you in case you have to wait to be served.
Limit your drinking of beer, wine, or other alcoholic beverages. Ask your diabetes educator how much alcohol you can safely drink. Eat something when you drink.
If you're taking a long trip by car, check your blood glucose before driving. Stop and check your blood glucose every 2 hours. Always carry snacks like fruit, crackers, juice, or soda in the car in case your blood glucose drops too low.
Ask ahead of time for a diabetes meal if you're traveling by plane. Most airlines serve special meals for people with health needs. Carry food (like crackers or fruit) with you in case meals are late.
Carry your medicines (insulin, insulin needles, and diabetes pills) and your blood testing supplies with you. Never put them in the suitcase you don't carry with you on the plane or train.
Ask your health care team how to adjust your medicines, especially your insulin, if you're traveling across time zones.
Take comfortable, well-fitting shoes on vacation. You'll probably be walking more than usual, so you should take extra care of your feet.
If you're going to be away for a long time, ask your doctor for a written prescription for your diabetes medicine and the name of a doctor in the place you're going to visit.
Don't count on buying extra supplies when you're traveling, especially if you're going to another country. Different countries use different kinds of insulin, needles, and pills.
When traveling by plane, find out if and when a meal will be served. Then decide when to take your insulin shot or diabetes pills. You may need to bring healthy snacks for the trip.
ACTION STEPS
If you use insulin
When you travel,
Buy special insulated bags to carry your insulin and to keep it from freezing or getting too hot.
Take extra needles, insulin, and blood glucose test strips in case of loss or breakage.
If you're going to another country, ask your doctor for a letter saying that you have diabetes and need insulin shots. If asked, show the letter to the customs people.
Printer-friendly version of the "Action Steps" if you use insulin
When You're Planning a Pregnancy
Planning ahead is very important if you want to have a baby. High blood glucose can be harmful to both a mother and her unborn baby. Even before you become pregnant, your blood glucose should be close to the normal range. Keeping blood glucose near normal before and during pregnancy helps protect both mother and baby.
Your insulin needs may change when you're pregnant. Your doctor may want you to take more insulin and check your blood glucose more often. If you take diabetes pills, your doctor will switch you to insulin when you're pregnant.
If you plan to have a baby:
Work with your health care team to get your blood glucose as close to the normal range as possible.
See a doctor who has experience in taking care of pregnant women with diabetes.
Have your eyes and kidneys checked. Pregnancy can make eye and kidney problems worse.
Don't smoke, drink alcohol, or use harmful drugs.
Follow the meal plan you get from your dietitian or diabetes educator to make sure you and your unborn baby have a healthy diet.
If you're already pregnant, see your doctor right away. It's not too late to bring your blood glucose close to normal so that you'll stay healthy during the rest of your pregnancy.
Maria, a 25-year-old woman with type 1 diabetes, wanted children. Her doctor told Maria and her husband that before she got pregnant, her blood glucose should be close to normal and her kidneys, eyes, and blood pressure should be checked. Maria began to watch her diabetes very carefully. She checked her blood glucose four times a day, ate healthy meals, began to walk a lot, and checked her blood and urine often to make sure that her body was healthy enough to carry a baby.
Once Maria became pregnant, she spent a lot of time taking care of her diabetes. Her hard work paid off. After 9 months, she gave birth to a healthy baby boy.
WHERE TO GET MORE HELP WITH YOUR DIABETES
People Who Can Help You
Your doctor. He or she may be your doctor at the clinic where you go for health care, your family doctor, or someone who has special training in caring for people with diabetes. A doctor with that kind of special training is called an endocrinologist or diabetologist.
You'll talk with your doctor about what kind of medicine you need and how much you should take. You'll also agree on a target blood glucose range and blood pressure and cholesterol targets. Your doctor will do tests to be sure that your blood glucose, blood pressure, and cholesterol are staying on track and that you're staying healthy. Ask your doctor if you should take aspirin every day to help prevent heart disease.
Your diabetes educator. A diabetes educator may be a nurse, a dietitian, or another kind of health care worker. Diabetes educators teach you about meal planning, diabetes medicines, exercise, how to check your blood glucose, and how to fit diabetes care into your everyday life. Don't be shy about asking your doctor or diabetes educator about the information in this guide. Ask questions if you don't understand something. After all, it's your health!
Your family and friends. Keeping your blood glucose at your target level is a daily job. You may need help or support from your family or friends. You may want to bring a family member or close friend with you when you visit your doctor or diabetes educator. Taking good care of your diabetes can sometimes be a family affair!
A counselor or mental health worker. You might feel sad about having diabetes or get tired of taking care of yourself. Or you might be having problems because of work, school, or family. If diabetes makes you feel sad or angry or if you have other problems that make you feel bad, you can talk to a counselor or mental health worker. Your doctor or diabetes educator can help you find a counselor if you need one.
Organizations That Can Help You
How to find a diabetes educator
To find a diabetes educator near you, call the American Association of Diabetes Educators toll-free at 1-800-832-6874, or look on the Internet at www.diabeteseducator.org and click on "Find a Diabetes Educator."
How to find a dietitian
To find a dietitian near you, call the American Dietetic Association toll-free at 1-800-366-1655, or look on the Internet at www.eatright.org and click on "Find a Dietitian."
How to find programs about diabetes
To find programs about diabetes or for additional information, contact
American Diabetes AssociationJuvenile Diabetes Research Foundation International
Both these organizations have magazines and other information for people with diabetes.
They also have local groups in many places where you can meet other people who have diabetes.
MEDICICES FOR PEOPLE WITH DIABETES
General Information
Do I need to take diabetes medicine?
Why do I need medicines for type 1 diabetes?
Why do I need medicines for type 2 diabetes?
What do I need to know about diabetes pills?
What do I need to know about insulin?
Might I take more than one diabetes medicine at a time?
What should I know about hypoglycemia (low blood sugar)?
How do I know if my diabetes medicines are working?
For More Information
Acknowledgments
Specific Medications
Diabetes Pills
Insulins
Do I need to take diabetes medicine?
What if I have type 1 diabetes?
Type 1 is the type of diabetes that people most often get before 30 years of age. All people with type 1 diabetes need to take insulin (IN-suh-lin) because their bodies do not make enough of it. Insulin helps turn food into energy for the body to work.
What if I have type 2 diabetes?
Healthy eating may help you loweryour blood glucose.
Type 2 is the type of diabetes most people get as adults after the age of 40. But you can also get this kind of diabetes at a younger age.
Healthy eating, exercise, and losing weight may help you lower your blood glucose (also called blood sugar) when you find out you have type 2 diabetes. If these treatments do not work, you may need one or more types of diabetes pills to lower your blood glucose. After a few more years, you may need to take insulin shots because your body is not making enough insulin.
You, your doctor, and your diabetes teacher should always find the best diabetes plan for you.
The pancreas is where your body makes insulin.
Why do I need medicines for type 1 diabetes?
Most people make insulin in their pancreas. If you have type 1 diabetes, your body does not make insulin. Insulin helps glucose from the foods you eat get to all parts of your body and be used for energy.
Because your body no longer makes insulin, you need to take insulin in shots. Take your insulin as your doctor tells you. The section What do I need to know about insulin? provides more information on insulin.
Also see: Specific Insulins
Why do I need medicines for type 2 diabetes?
If you have type 2 diabetes, your pancreas usually makes plenty of insulin. But your body cannot correctly use the insulin you make. You might get this type of diabetes if members of your family have or had diabetes. You might also get type 2 diabetes if you weigh too much or do not exercise enough.
After you have had type 2 diabetes for a few years, your body may stop making enough insulin. Then you will need to take diabetes pills or insulin.
You need to know:
Diabetes medicines that lower blood glucose never take the place of healthy eating and exercise.
If your blood glucose gets too low more than a few times in a few days, call your doctor.
Take your diabetes pills or insulin even if you are sick. If you cannot eat much, call your doctor.
What do I need to know about diabetes pills?
Many types of diabetes pills can help people with type 2 diabetes lower their blood glucose. Each type of pill helps lower blood glucose in a different way. The diabetes pill (or pills) you take is from one of these groups. You might know your pill (or pills) by a different name.
Sulfonylureas (SUL-fah-nil-YOO-ree-ahs) stimulate your pancreas to make more insulin.
Biguanides (by-GWAN-ides) decrease the amount of glucose made by your liver.
Alpha-glucosidase inhibitors (AL-fa gloo-KOS-ih-dayss in-HIB-it-ers) slow the absorption of the starches you eat.
Thiazolidinediones (THIGH-ah-ZO-li-deen-DYE-owns) make you more sensitive to insulin.
Meglitinides (meh-GLIT-in-ides) stimulate your pancreas to make more insulin.
D-phenylalanine (dee-fen-nel-AL-ah-neen) derivatives help your pancreas make more insulin quickly.
Combination oral medicines put together different kinds of pills.
Also see: Specific Pills
Your doctor might prescribe one pill. If the pill does not lower your blood glucose, your doctor may
ask you to take more of the same pills, or
add a new pill or insulin, or
ask you to change to another pill or insulin.
Tell your doctor about the side effects you feel.
What are side effects?
Side effects are changes that may happen in your body when you take a medicine. When your doctor gives you a new medicine, ask what the side effects might be.
Some side effects happen just when you start to take the medicine. Then they go away.
Some side effects happen only once in a while. You may get used to them or learn how to manage them.
Some side effects will cause you to stop taking the medicine. Your doctor may try another one that doesn't cause you side effects.
What do I need to know about insulin?
If your pancreas no longer makes enough insulin, then you need to take insulin as a shot. You inject the insulin just under the skin with a small, short needle.
Can insulin be taken as a pill?
Insulin is a protein. If you took insulin as a pill, your body would break it down and digest it before it got into your blood to lower your blood glucose.
How does insulin work?
Insulin lowers blood glucose by moving glucose from the blood into the cells of your body. Once inside the cells, glucose provides energy. Insulin lowers your blood glucose whether you eat or not. You should eat on time if you take insulin.
How often should I take insulin?
Most people with diabetes need at least two insulin shots a day for good blood glucose control. Some people take three or four shots a day to have a more flexible diabetes plan.
When should I take insulin?
You should take insulin 30 minutes before a meal if you take regular insulin alone or with a longer-acting insulin. If you take a rapid-acting insulin, you should take your shot just before you eat.
Are there several types of insulin?
Yes. There are six main types of insulin. They each work at different speeds. Many people take two types of insulin.
Does insulin work the same all the time?
After a short time, you will get to know when your insulin starts to work, when it works its hardest to lower blood glucose, and when it finishes working.
You will learn to match your mealtimes and exercise times to the time when each insulin dose you take works in your body.
How quickly or slowly insulin works in your body depends on
your own response
the place on your body where you inject insulin
the type and amount of exercise you do and the length of time between your shot and exercise
Where on my body should I inject insulin?
You can inject insulin into several places on your body. Insulin injected near the stomach works fastest. Insulin injected into the thigh works slowest. Insulin injected into the arm works at medium speed. Ask your doctor or diabetes teacher to show you the right way to take insulin and in which parts of the body to inject it.
These are good places to give yourself insulin shots.
How should I store insulin?
Keep the bottles of insulin you are using at room temperature.
If you use a whole bottle of insulin within 30 days, keep that bottle of insulin at room temperature. On the label, write the date that is 30 days away. That is when you should throw out the bottle with any insulin left in it.
If you do not use a whole bottle of insulin within 30 days, then store it in the refrigerator all the time.
If insulin gets too hot or cold, it breaks down and does not work. So, do not keep insulin in very cold places such as the freezer, or in hot places, such as by a window or in the car's glove compartment during warm weather.
Keep at least one extra bottle of each type of insulin you use in your house. Store extra insulin in the refrigerator.
What are possible side effects of insulin?
hypoglycemia
weight gain
Also see: Specific Insulins
Might I take more than one diabetes medicine at a time?
Yes. Your doctor may ask you to take more than one diabetes medicine at a time. Some diabetes medicines that lower blood glucose work well together. Here are examples:
Two Diabetes Pills
If one type of pill alone does not control your blood glucose, then your doctor might ask you to take two kinds of pills. You may take two separate pills or one pill that combines two medicines. Each type of pill has its own way of acting to lower blood glucose. Here are pills used together:
a sulfonylurea and metformin
a sulfonylurea and acarbose
metformin and acarbose
repaglinide and metformin
nateglinide and metformin
pioglitazone and a sulfonylurea
pioglitazone and metformin
rosiglitazone and metformin
rosiglitazone and a sulfonylurea
Diabetes Pills and Insulin
Your doctor might ask you to take insulin and one of these diabetes pills:
a sulfonylurea
metformin
pioglitazone
What should I know about hypoglycemia (low blood sugar)?
Sulfonylureas, meglitinides, D-phenylalanine derivatives, combination oral medicines, and insulin are the types of diabetes medicines that can make blood glucose go too low. Hypoglycemia can happen for many reasons:
delaying or skipping a meal
eating too little food at a meal
getting more exercise than usual
taking too much diabetes medicine
drinking alcohol
You know your blood glucose may be low when you feel one or more of the following:
dizzy or light-headed
hungry
nervous and shaky
sleepy or confused
sweaty
You may feel dizzy or shaky when your blood glucose gets too low.
If you think your blood glucose is low, test it to see for sure. If your blood glucose is at or below 70 mg/dL, have one of these items to get 15 grams of carbohydrate:
1/2 cup (4 oz.) of any fruit juice
1 cup (8 oz.) of milk
1 or 2 teaspoons of sugar or honey
1/2 cup (4 oz.) of regular soda
5 or 6 pieces of hard candy
glucose gel or tablets (take the amount noted on the package to add up to 15 grams of carbohydrate)
Test your blood glucose again 15 minutes later. If it is still below 70 mg/dL, then eat another 15 grams of carbohydrate. Then test your blood glucose again in 15 minutes.
If you cannot test your blood glucose right away but you feel symptoms of hypoglycemia, eat one of the items listed above.
If your blood glucose is not low, but you will not eat your next meal for at least an hour, then have a snack with starch and protein. Here are some examples:
crackers and peanut butter or cheese
half of a ham or turkey sandwich
a cup of milk and crackers or cereal
How do I know if my diabetes medicines are working?
Learn to test your blood glucose. Ask your doctor or diabetes teacher about the best testing tools for you and how often to test. After you test your blood glucose, write down your blood glucose test results. Then ask your doctor or diabetes teacher if your diabetes medicines are working. A good blood glucose reading before meals is between 70 and 140 mg/dL.
Ask your doctor or diabetes teacher about how low or how high your blood glucose should get before you take action. For many people, blood glucose is too low below 70 mg/dL and too high above 240 mg/dL.
One other number to know is the result of a blood test your doctor does called the A1C. It shows your blood glucose control during the past 2 to 3 months. For most people, the target for A1C is less than 7 percent.
For More Information
Diabetes Teachers (nurses, dietitians, pharmacists, and other health professionals)
To find a diabetes teacher near you, call the American Association of Diabetes Educators toll-free at 1-800-832-6874.
Recognized Diabetes Education Programs (teaching programs approved by the American Diabetes Association)
To find a program near you, call 1-800-DIABETES (1-800-342-2383) or look at its Internet home page at www.diabetes.org and click on "Diabetes Info."
Dietitians
To find a dietitian near you, call The American Dietetic Association's National Center for Nutrition and Dietetics at 1-800-366-1655 or look at its Internet home page at www.eatright.org and click on "Find a Dietitian."
Acknowledgments
The National Diabetes Information Clearinghouse thanks the people who helped review or field-test this booklet.
DIAGNOSIS OF DIABETES
What is diabetes?
Diabetes is a disease in which blood glucose levels are above normal. People with diabetes have problems converting food to energy. After a meal, food is broken down into a sugar called glucose, which is carried by the blood to cells throughout the body. Cells use insulin, a hormone made in the pancreas, to help them convert blood glucose into energy.
People develop diabetes because the pancreas does not make enough insulin or because the cells in the muscles, liver, and fat do not use insulin properly, or both. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over the years, high blood glucose, also called hyperglycemia, damages nerves and blood vessels, which can lead to complications such as heart disease and stroke, kidney disease, blindness, nerve problems, gum infections, and amputation.
Types of Diabetes
The three main types of diabetes are type 1, type 2, and gestational diabetes.
Type 1 diabetes, formerly called juvenile diabetes, is usually first diagnosed in children, teenagers, or young adults. In this form of diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them.
Type 2 diabetes, formerly called adult-onset diabetes, is the most common form. People can develop it at any age, even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals.
Gestational diabetes develops in some women during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or by a shortage of insulin.
Type 1 Diabetes and Type 2 Diabetes
To move away from basing the names of the two main types of diabetes on treatment or age at onset, an American Diabetes Association expert committee recommended in 1997 universal adoption of simplified terminology. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) agrees.
Former Names
Preferred Names
Type Ijuvenile diabetesinsulin-dependent diabetes mellitusIDDM
type 1 diabetes
Type IIadult-onset diabetesnoninsulin-dependent diabetes mellitusNIDDM
type 2 diabetes
What is pre-diabetes?
In pre-diabetes, blood glucose levels are higher than normal but not high enough to be characterized as diabetes. However, many people with pre-diabetes develop type 2 diabetes within 10 years. Pre-diabetes also increases the risk of heart disease and stroke. With modest weight loss and moderate physical activity, people with pre-diabetes can delay or prevent type 2 diabetes.
How are diabetes and pre-diabetes diagnosed?
The following tests are used for diagnosis:
A fasting plasma glucose test measures your blood glucose after you have gone at least 8 hours without eating. This test is used to detect diabetes or pre-diabetes.
An oral glucose tolerance test measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a glucose-containing beverage. This test can be used to diagnose diabetes or pre-diabetes.
In a random plasma glucose test, your doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.
Positive test results should be confirmed by repeating the fasting plasma glucose test or the oral glucose tolerance test on a different day.
Fasting Plasma Glucose (FPG) Test
The FPG is the preferred test for diagnosing diabetes and is most reliable when done in the morning. Results and their meaning are shown in table 1. If your fasting glucose level is 100 to 125 mg/dL, you have a form of pre-diabetes called impaired fasting glucose (IFG), meaning that you are more likely to develop type 2 diabetes but do not have it yet. A level of 126 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.
Table 1. Fasting Plasma Glucose Test
Plasma Glucose Result (mg/dL)
Diagnosis
99 and below
Normal
100 to 125
Pre-diabetes(impaired fasting glucose)
126 and above
Diabetes*
*Confirmed by repeating the test on a different day.
Oral Glucose Tolerance Test (OGTT)
Research has shown that the OGTT is more sensitive than the FPG test for diagnosing pre-diabetes, but it is less convenient to administer. The OGTT requires you to fast for at least 8 hours before the test. Your plasma glucose is measured immediately before and 2 hours after you drink a liquid containing 75 grams of glucose dissolved in water. Results and what they mean are shown in table 2. If your blood glucose level is between 140 and 199 mg/dL 2 hours after drinking the liquid, you have a form of pre-diabetes called impaired glucose tolerance or IGT, meaning that you are more likely to develop type 2 diabetes but do not have it yet. A 2-hour glucose level of 200 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.
Table 2. Oral Glucose Tolerance Test
2-Hour Plasma Glucose Result (mg/dL)
Diagnosis
139 and below
Normal
140 to 199
Pre-diabetes(impaired fasting glucose)
200 and above
Diabetes*
*Confirmed by repeating the test on a different day.
Gestational diabetes is also diagnosed based on plasma glucose values measured during the OGTT. Blood glucose levels are checked four times during the test. If your blood glucose levels are above normal at least twice during the test, you have gestational diabetes. Table 3 shows the above-normal results for the OGTT for gestational diabetes.
Table 3. Gestational Diabetes: Above-Normal Results for the Oral Glucose Tolerance Test
When
Plasma Glucose Result (mg/dL)
Fasting
95 or higher
At 1 hour
180 or higher
At 2 hours
155 or higher
At 3 hours
140 or higher
Note: Some laboratories use other numbers for this test.
For additional information about the diagnosis and treatment of gestational diabetes, call the National Diabetes Information Clearinghouse (NDIC) at 1-800-860-8747.
Random Plasma Glucose Test
A random blood glucose level of 200 mg/dL or more, plus presence of the following symptoms, can mean that you have diabetes:
increased urination
increased thirst
unexplained weight loss
Other symptoms include fatigue, blurred vision, increased hunger, and sores that do not heal. Your doctor will check your blood glucose level on another day using the FPG or the OGTT to confirm the diagnosis.
What factors increase my risk for type 2 diabetes?
To find out your risk, check each item that applies to you.
I am 45 or older.
I am overweight or obese (see the body mass index [BMI] in table 4).
I have a parent, brother, or sister with diabetes.
My family background is African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino.
I have had gestational diabetes, or I gave birth to at least one baby weighing more than 9 pounds.
My blood pressure is 140/90 or higher, or I have been told that I have high blood pressure.
My cholesterol levels are not normal. My HDL cholesterol ("good" cholesterol) is 35 or lower, or my triglyceride level is 250 or higher.
I am fairly inactive. I exercise fewer than three times a week.
Checking My Weight
BMI is a measure used to evaluate body weight relative to height. You can use BMI to find out whether you are underweight, normal weight, overweight, or obese. Use table 4 to find your BMI.
Find your height in the left-hand column.
Move across in the same row to the number closest to your weight.
The number at the top of that column is your BMI. Check the word above your BMI to see whether you are normal weight, overweight, or obese. If you are overweight or obese, talk with your doctor about ways to lose weight to reduce your risk of diabetes or pre-diabetes.
Table 4. Body Mass Index
For a printer-friendly version of this table, use the pdf. *
Normal
Overweight
Obese
BMI
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
Height(inches)
Body Weight (pounds)
58
91
96
100
105
110
115
119
124
129
134
138
143
148
153
158
162
167
172
59
94
99
104
109
114
119
124
128
133
138
143
148
153
158
163
168
173
178
60
97
102
107
112
118
123
128
133
138
143
148
153
158
163
168
174
179
184
61
100
106
111
116
122
127
132
137
143
148
153
158
164
169
174
180
185
190
62
104
109
115
120
126
131
136
142
147
153
158
164
169
175
180
186
191
196
63
107
113
118
124
130
135
141
146
152
158
163
169
175
180
186
191
197
203
64
110
116
122
128
134
140
145
151
157
163
169
174
180
186
192
197
204
209
65
114
120
126
132
138
144
150
156
162
168
174
180
186
192
198
204
210
216
66
118
124
130
136
142
148
155
161
167
173
179
186
192
198
204
210
216
223
67
121
127
134
140
146
153
159
166
172
178
185
191
198
204
211
217
223
230
68
125
131
138
144
151
158
164
171
177
184
190
197
203
210
216
223
230
236
69
128
135
142
149
155
162
169
176
182
189
196
203
209
216
223
230
236
243
70
132
139
146
153
160
167
174
181
188
195
202
209
216
222
229
236
243
250
71
136
143
150
157
165
172
179
186
193
200
208
215
222
229
236
243
250
257
72
140
147
154
162
169
177
184
191
199
206
213
221
228
235
242
250
258
265
73
144
151
159
166
174
182
189
197
204
212
219
227
235
242
250
257
265
272
74
148
155
163
171
179
186
194
202
210
218
225
233
241
249
256
264
272
280
75
152
160
168
176
184
192
200
208
216
224
232
240
248
256
264
272
279
287
76
156
164
172
180
189
197
205
213
221
230
238
246
254
263
271
279
287
295
Obese
Extreme Obesity
BMI
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
Height(inches)
Body Weight (pounds)
58
177
181
186
191
196
201
205
210
215
220
224
229
234
239
244
248
253
258
59
183
188
193
198
203
208
212
217
222
227
232
237
242
247
252
257
262
267
60
189
194
199
204
209
215
220
225
230
235
240
245
250
255
261
266
271
276
61
195
201
206
211
217
222
227
232
238
243
248
254
259
264
269
275
280
285
62
202
207
213
218
224
229
235
240
246
251
256
262
267
273
278
284
289
295
63
208
214
220
225
231
237
242
248
254
259
265
270
278
282
287
293
299
304
64
215
221
227
232
238
244
250
256
262
267
273
279
285
291
296
302
308
314
65
222
228
234
240
246
252
258
264
270
276
282
288
294
300
306
312
318
324
66
229
235
241
247
253
260
266
272
278
284
291
297
303
309
315
322
328
334
67
236
242
249
255
261
268
274
280
287
293
299
306
312
319
325
331
338
344
68
243
249
256
262
269
276
282
289
295
302
308
315
322
328
335
341
348
354
69
250
257
263
270
277
284
291
297
304
311
318
324
331
338
345
351
358
365
70
257
264
271
278
285
292
299
306
313
320
327
334
341
348
355
362
369
376
71
265
272
279
286
293
301
308
315
322
329
338
343
351
358
365
372
379
386
72
272
279
287
294
302
309
316
324
331
338
346
353
361
368
375
383
390
397
73
280
288
295
302
310
318
325
333
340
348
355
363
371
378
386
393
401
408
74
287
295
303
311
319
326
334
342
350
358
365
373
381
389
396
404
412
420
75
295
303
311
319
327
335
343
351
359
367
375
383
391
399
407
415
423
431
76
304
312
320
328
336
344
353
361
369
377
385
394
402
410
418
426
435
443
When should I be tested for diabetes?
Anyone 45 years old or older should consider getting tested for diabetes. If you are 45 or older and your BMI indicates that you are overweight (see table 4), it is strongly recommended that you get tested. If you are younger than 45, are overweight, and have one or more of the risk factors, you should consider testing. Ask your doctor for a FPG or an OGTT. Your doctor will tell you if you have normal blood glucose, pre-diabetes, or diabetes. If your blood glucose is higher than normal but lower than the diabetes range (called pre-diabetes), have your blood glucose checked in 1 to 2 years.
What steps can delay or prevent type 2 diabetes?
A major research study, the Diabetes Prevention Program, confirmed that people who followed a low-fat, low-calorie diet, lost a modest amount of weight, and engaged in regular physical activity (walking briskly for 30 minutes, five times a week, for example) sharply reduced their chances of developing diabetes. These strategies worked well for both men and women and were especially effective for participants aged 60 and older.
For additional information about how you can lower your risk for type 2 diabetes, see the NIDDK booklet Am I at Risk for Type 2 Diabetes? Also, the National Diabetes Education Program (NDEP) offers several booklets as part of its "Small Steps, Big Rewards" campaign on preventing type 2 diabetes, including information on setting goals, tracking progress, implementing a walking program, and finding additional resources.
How is diabetes managed?
If you are diagnosed with diabetes, you can manage it with meal planning, physical activity, and, if needed, medications. For additional information about taking care of type 1 or type 2 diabetes, see the NIDDK booklet Your Guide to Diabetes: Type 1 and Type 2.
Points to Remember
Diabetes and pre-diabetes are diagnosed by checking blood glucose levels.
Many people with pre-diabetes develop type 2 diabetes within 10 years.
If you have pre-diabetes, you can delay or prevent type 2 diabetes with a low-fat, low-calorie diet, modest weight loss, and regular physical activity.
If you are 45 or older, you should consider getting tested for diabetes. If you are 45 or older and overweight, it is strongly recommended that you get tested.
If you are younger than 45, are overweight, and have one or more of the risk factors, you should consider testing.
WHAT I NEED TO KNOW ABOUT EATING AND DIABETES
On this page:
How Food Affects Your Blood Glucose
Blood Glucose Levels
Your Diabetes Medicines
Your Exercise Plan
Hypoglycemia
The Food Pyramid
Starches
Vegetables
Fruit
Milk and Yogurt
Meat and Meat Substitutes
Fats and Sweets
Alcohol
Your Meal Plan
Measuring Your Food
When You Are Sick
Points to Remember
How to Find More Help
How Food Affects Your Blood Glucose
Whether you have type 1 or type 2 diabetes, what, when, and how much you eat all affect your blood glucose. Blood glucose is the main sugar found in the blood and the body's main source of energy.
If you have diabetes (or impaired glucose tolerance), your blood glucose can go too high if you eat too much. If your blood glucose goes too high, you can get sick.
Your blood glucose can also go too high or drop too low if you don't take the right amount of diabetes medicine.
If your blood glucose stays high too much of the time, you can get heart, eye, foot, kidney, and other problems. You can also have problems if your blood glucose gets too low (hypoglycemia).
Keeping your blood glucose at a healthy level will prevent or slow down diabetes problems. Ask your doctor or diabetes teacher what a healthy blood glucose level is for you.
Blood Glucose Levels
What should my blood glucose levels be?
For most people, target blood glucose levels are
Before meals
90 to 130
1 to 2 hours after the start of a meal
less than 180
Talk with your health care provider about your blood glucose target levels. Print out this chart and write them in.
Before meals
______ to ______
1 to 2 hours after the start of a meal
less than ______
Ask your doctor how often you should check your blood glucose. The results from your blood glucose checks will tell you if your diabetes care plan is working. Also ask your doctor for an A1C test at least twice a year. Your A1C number gives your average blood glucose for the past 3 months.
How can I keep my blood glucose at a healthy level?
Eat about the same amount of food each day.
Eat your meals and snacks at about the same times each day.
Do not skip meals or snacks.
Take your medicines at the same times each day.
Exercise at about the same times each day.
Why should I eat about the same amount at the same times each day?
Your blood glucose goes up after you eat. If you eat a big lunch one day and a small lunch the next day, your blood glucose levels will change too much.
Keep your blood glucose at a healthy level by eating about the same amount of carbohydrate foods at about the same times each day. Carbohydrate foods, also called carbs, provide glucose for energy. Starches, fruits, milk, starchy vegetables such as corn, and sweets are all carbohydrate foods.
Talk with your doctor or diabetes teacher about how many meals and snacks to eat each day. Print out these clock faces and draw hands on the clocks to show when to have your meals and, if necessary, snacks.
Your Diabetes Medicines
What you eat and when affects how your diabetes medicines work. Talk with your doctor or diabetes teacher about the best times to take your diabetes medicines based on your meal plan.
Print out this chart. Fill in the names of your medicines, when to take them, and how much to take. If you take your medicine with a meal, write down the name of the meal. Draw hands on the clocks to show when to take your medicines.
Name of medicine: __________________ Time: ________ Meal: _______________ How much: ________________________
Name of medicine: __________________ Time: ________ Meal: _______________ How much: ________________________
Name of medicine: __________________ Time: ________ Meal: _______________ How much: ________________________
Name of medicine: __________________ Time: ________ Meal: _______________ How much: ________________________
Your Exercise Plan
What you eat and when also depend on how much you exercise. Exercise is an important part of staying healthy and controlling your blood glucose. Physical activity should be safe and enjoyable, so talk with your doctor about what types of exercise are right for you. Whatever kind of exercise you do, here are some special things that people with diabetes need to remember:
Take care of your feet. Make sure your shoes fit properly and your socks stay clean and dry. Check your feet for redness or sores after exercising. Call your doctor if you have sores that do not heal.
Drink about 2 cups of water before you exercise, about every 20 minutes during exercise, and after you finish, even if you don't feel thirsty.
Warm up and cool down for 5 to 10 minutes before and after exercising. For example, walk slowly at first, then walk faster. Finish up by walking slowly again.
Test your blood glucose before and after exercising. Do not exercise if your fasting blood glucose level is above 300. Eat a small snack if your blood glucose is below 100.
Know the signs of low blood glucose (hypoglycemia) and how to treat it.
Hypoglycemia
You should know the signs of hypoglycemia (low blood sugar) such as feeling weak or dizzy, sweating more, noticing sudden changes in your heartbeat, or feeling hungry. If you experience these symptoms, stop exercising and test your blood glucose. If it is 70 or less, eat one of the following right away:
2 or 3 glucose tablets
1/2 cup (4 ounces) of any fruit juice
1/2 cup (4 ounces) of a regular (not diet) soft drink
1 cup (8 ounces) of milk
5 or 6 pieces of hard candy
1 or 2 teaspoons of sugar or honey
After 15 minutes, test your blood glucose again to find out whether it has returned to a healthier level. Once blood glucose is stable, if it will be at least an hour before your next meal, it's a good idea to eat a snack.
To be safe when you exercise, carry something to treat hypoglycemia, such as glucose tablets or hard candy. Another good idea is to wear a medical identification bracelet or necklace (in case of emergency). Teach your exercise partners the signs of hypoglycemia and what to do about it.
The Food Pyramid
Eat a variety of food to get the vitamins and minerals you need. Eat more from the groups at the bottom of the pyramid, and less from the groups at the top.
How much should I eat each day?
Have about 1,200 to 1,600 calories a day if you are
a small woman who exercises
a small or medium woman who wants to lose weight
a medium woman who does not exercise much
Choose this many servings from these food groups to have 1,200 to 1,600 calories a day:
6 starches
2 milk and yogurt
3 vegetables
2 meat or meat substitute
2 fruit
up to 3 fats
Talk with your diabetes teacher to make a meal plan that fits the way you usually eat, your daily routine, and your diabetes medicines. Then make your own plan.
Have about 1,600 to 2,000 calories a day if you are
a large woman who wants to lose weight
a small man at a healthy weight
a medium man who does not exercise much
a medium to large man who wants to lose weight
Choose this many servings from these food groups to have 1,600 to 2,000 calories a day:
8 starches
2 milk and yogurt
4 vegetables
2 meat or meat substitute
3 fruit
up to 4 fats
Talk with your diabetes teacher to make a meal plan that fits the way you usually eat, your daily routine, and your diabetes medicines. Then make your own plan.
Have about 2,000 to 2,400 calories a day if you are
a medium to large man who does a lot of exercise or has a physically active job
a large man at a healthy weight
a large woman who exercises a lot or has a physically active job
Choose this many servings from these food groups to have 2,000 to 2,400 calories a day:
11 starches
2 milk and yogurt
4 vegetables
2 meat or meat substitute
3 fruit
up to 5 fats
Talk with your diabetes teacher to make a meal plan that fits the way you usually eat, your daily routine, and your diabetes medicines. Then make your own plan.
Make Your Own Food Pyramid
Print out this pyramid and fill in the numbers of servings next to the name of each food group.
Each day, I need
Starches
Starches are bread, grains, cereal, pasta, or starchy vegetables like corn and potatoes. They give your body energy, vitamins, minerals, and fiber. Whole grain starches are healthier because they have more vitamins, minerals, and fiber.
Eat some starches at each meal. People might tell you not to eat starches, but that is not correct. Eating starches is healthy for everyone, including people with diabetes.
Examples of starches include
bread
pasta
corn
potatoes
rice
crackers
tortillas
beans
yams
How much is a serving of starch?
If you have more than one serving at a meal, you can choose several different starches or have two or three servings of one starch.
Print out this chart. Then fill in the blanks with how many servings of starch to have at meals and snacks.
1. How many servings of grains, cereals, pasta, and starchy vegetables (starches) do you now eat each day?I eat _____ starch servings each day.
2. Check how many servings of starches to have each day in the section on How much should I eat each day. I will eat _____ starch servings each day.
3. To control your blood glucose, spread the servings you eat throughout the day. I will eat this many servings of starches at
Breakfast______
Snack ______
Lunch______
Snack ______
Dinner______
Snack ______
A diabetes teacher can help you with your meal plan.
What are healthy ways to eat starches?
Buy whole grain breads and cereals.
Eat fewer fried and high-fat starches such as regular tortilla chips and potato chips, french fries, pastries, or biscuits. Try pretzels, fat-free popcorn, baked tortilla or potato chips, baked potatoes, or low-fat muffins.
Use low-fat or fat-free yogurt or fat-free sour cream instead of regular sour cream on a baked potato.
Use mustard instead of mayonnaise on a sandwich.
Use the low-fat or fat-free substitutes such as low-fat mayonnaise or light margarine on bread, rolls, or toast.
Eat cereal with fat-free (skim) or low-fat (1%) milk.
Vegetables
Vegetables give you vitamins, minerals, and fiber, with very few calories.
Examples of vegetables include
lettuce
broccoli
vegetable juice
peppers
carrots
green beans
salsa
chilies
greens
How much is a serving of vegetables?
If you have more than one serving at a meal, you can choose a few different types of vegetables or have two or three servings of one vegetable.
Print out this chart. Then fill in the blanks with how many servings of vegetables to have at meals and snacks.
1. How many servings of vegetables do you now eat each day?I eat _____ vegetable servings each day.
2. Check how many servings of vegetables to have each day in the section on How much should I eat each day. I will eat___________vegetable servings each day.
3. To control your blood glucose, spread the servings you eat throughout the day. I will eat this many servings of vegetables at
Breakfast______
Snack ______
Lunch______
Snack ______
Dinner______
Snack ______
A diabetes teacher can help you with your meal plan.
What are healthy ways to eat vegetables?
Eat raw and cooked vegetables with little or no fat, sauces, or dressings.
Try low-fat or fat-free salad dressing on raw vegetables or salads.
Steam vegetables using a small amount of water or low-fat broth.
Mix in some chopped onion or garlic.
Use a little vinegar or some lemon or lime juice.
Add a small piece of lean ham or smoked turkey instead of fat to vegetables when cooking.
Sprinkle with herbs and spices. These flavorings add almost no fat or calories.
If you do use a small amount of fat, use canola oil, olive oil, or soft margarines (liquid or tub types) instead of fat from meat, butter, or shortening.
Fruit
Fruit gives you energy, vitamins, minerals, and fiber.
Examples of fruit include
apples
fruit juice
strawberries
bananas
raisins
oranges
mango
guava
papaya
How much is a serving of fruit?
If you have more than one serving at a meal, you can choose different types of fruit or have two servings of one fruit.
Print out this chart. Then fill in the blanks with how many servings of fruit to have at meals and snacks.
1. How many servings of fruit do you now eat each day?I eat _____ fruit servings each day.
2. Check how many servings of fruit to have each day in the section on How much should I eat each day.I will eat _____ fruit servings each day.
3. To control your blood glucose, spread the servings you eat throughout the day. I will eat this many servings of fruit at
Breakfast______
Snack ______
Lunch______
Snack ______
Dinner______
Snack ______
A diabetes teacher can help you with your meal plan.
What are healthy ways to eat fruit?
Eat fruits raw or cooked, as juice with no sugar added, canned in their own juice, or dried.
Buy smaller pieces of fruit.
Eat pieces of fruit rather than drinking fruit juice. Pieces of fruit are more filling.
Drink fruit juice in small amounts.
Save high-sugar and high-fat fruit desserts such as peach cobbler or cherry pie for special occasions.
Milk and Yogurt
Milk and yogurt give you energy, protein, fat, calcium, vitamin A, and other vitamins and minerals.
How much is a serving of milk and yogurt?
Note: If you are pregnant or breastfeeding, have four to five servings of milk and yogurt each day.
Print out this chart. Then fill in the blanks with how many servings of milk and yogurt to have at meals and snacks.
1. How many servings of milk and yogurt do you now have each day?I have _____ milk and yogurt servings each day.
2. Check how many servings of milk and yogurt to have each day in the section on How much should I eat each day. I will have ___________ milk and yogurt servings each day.
3. To control your blood glucose, spread the servings you have throughout the day.I will have this many servings of milk and yogurt at
Breakfast______
Snack ______
Lunch______
Snack ______
Dinner______
Snack ______
A diabetes teacher can help you with your meal plan.
What are healthy ways to have milk and yogurt?
Drink fat-free (skim or nonfat) or low-fat (1%) milk.
Eat low-fat or fat-free fruit yogurt sweetened with a low-calorie sweetener.
Use low-fat plain yogurt as a substitute for sour cream.
Meat and Meat Substitutes
The meat and meat substitutes group includes meat, poultry, eggs, cheese, fish, and tofu. Eat small amounts of some of these foods each day.
Meat and meat substitutes help your body build tissue and muscles. They also give your body energy and vitamins and minerals.
Examples of meat and meat substitutes include
chicken
fish
beef
eggs
peanut butter
tofu
cheese
ham
pork
How much is a serving of meat or meat substitute?
*Two to three ounces of meat (after cooking) is about the size of a deck of cards.
Print out this chart. Then fill in the blanks with how many servings of meat and meat substitutes to have at meals and snacks.
1. How many servings of meat or meat substitutes do you now eat each day? I eat _____ servings of meat or meat substitutes each day.
2. Check how many servings of meat or meat substitutes to have each day in the section on How much should I eat each day.I will eat _____ servings of meat or meat substitutes each day.
3. To control your blood glucose, spread the servings you eat throughout the day. I will eat this many servings of meat or meat substitutes at
Breakfast______
Snack ______
Lunch______
Snack ______
Dinner______
Snack ______
A diabetes teacher can help you with your meal plan.
What are healthy ways to eat meat or meat substitutes?
Buy cuts of beef, pork, ham, and lamb that have only a little fat on them. Trim off extra fat.
Eat chicken or turkey without the skin.
Cook meat or meat substitutes in low-fat ways:
broil
grill
stir-fry
roast
steam
stew
To add more flavor, use vinegars, lemon juice, soy or teriyaki sauce, salsa, ketchup, barbecue sauce, and herbs and spices.
Cook eggs with a small amount of fat or use cooking spray.
Limit the amounts of nuts, peanut butter, and fried chicken that you eat. They are high in fat.
Choose low-fat or fat-free cheese.
Fats and Sweets
Limit the amounts of fats and sweets you eat. They have calories, but not much nutrition. Some contain saturated fats and cholesterol that increase your risk of heart disease. Limiting these foods will help you lose weight and keep your blood glucose and blood fats under control.
Examples of fats include
Salad dressing
oil
butter
margarine
avocado
olives
Examples of sweets include
regular soda
ice cream
cake
cookies
pie
candy
How much is a serving of sweets?
How much is a serving of fat?
How can I satisfy my sweet tooth?
It's okay to have sweets once in a while. Try having sugar-free popsicles, diet soda, fat-free ice cream or frozen yogurt, or sugar-free hot cocoa mix.
Other tips:
Share desserts in restaurants.
Order small or child-size servings of ice cream or frozen yogurt.
Divide homemade desserts into small servings and wrap each individually. Freeze extra servings.
Don't keep dishes of candy in the house or at work.
Remember, fat-free and low-sugar foods still have calories. Talk with your diabetes teacher about how to fit sweets into your meal plan.
Alcohol
Alcohol has calories but no nutrients. If you drink alcohol on an empty stomach, it can make your blood glucose level too low. Alcohol also can raise your blood fats. If you want to drink alcohol, talk with your doctor or diabetes teacher about how it fits into your meal plan.
Your Meal Plan
Print out this chart to plan your meals and snacks for one day. (Work with your diabetes teacher if you need help.)
Breakfast
Food Group
Food
How Much
Snack
Food Group
Food
How Much
Lunch
Food Group
Food
How Much
Snack
Food Group
Food
How Much
Dinner
Food Group
Food
How Much
Snack
Food Group
Food
How Much
Measuring Your Food
To make sure your food servings are the right size, use
measuring cups
measuring spoons
a food scale
Also, the Nutrition Facts label on food packages tells you how much of that food is in one serving.
Weigh or measure foods to make sure you eat the right amounts.
These tips will help you choose the right serving sizes.
Measure a serving size of dry cereal or hot cereal, pasta, or rice and pour it into a bowl or plate. The next time you eat that food, use the same bowl or plate and fill it to the same level.
For one serving of milk, measure 1 cup and pour it into a glass. See how high it fills the glass. Always drink milk out of that size glass.
Meat weighs more before it's cooked. For example, 4 ounces of raw meat will weigh about 3 ounces after cooking. For meat with a bone, like a pork chop or chicken leg, cook 5 ounces raw to get 3 ounces cooked.
One serving of meat or meat substitute is about the size and thickness of the palm of your hand or a deck of cards.
A small fist is equal to about 1/2 cup of fruit, vegetables, or starches like rice.
A small fist is equal to 1 small piece of fresh fruit.
A thumb is equal to about 1 ounce of meat or cheese.
The tip of a thumb is equal to about 1 teaspoon.
When You Are Sick
It's important to take care of your diabetes even when you're ill. Here are some tips on what to do:
Even if you can't keep food down, keep taking your diabetes medicine.
Drink at least one cup (8 ounces) of water or other calorie-free, caffeine-free liquid every hour while you're awake.
If you can't eat your usual food, try drinking juice or eating crackers, popsicles, or soup.
If you can't eat at all, drink clear liquids such as ginger ale. Eat or drink something with sugar in it if you have trouble keeping food down, because you still need calories. If you don't have enough calories, you increase your risk of hypoglycemia (low blood sugar).
Make sure that you check your blood glucose. Your blood glucose level may be high even if you're not eating.
Call your doctor right away if you throw up more than once or have diarrhea for more than 6 hours.
Points to Remember
What, when, and how much you eat all affect your blood glucose level.
You can keep your blood glucose at a healthy level if you
Eat about the same amount of food each day.
Eat at about the same times each day.
Take your medicines at the same times each day.
Exercise at the same times each day.
Every day, choose foods from these food groups: starches, vegetables, fruit, meat and meat substitutes, and milk and yogurt. How much of each depends on how many calories you need a day.
Limit the amounts of fats and sweets you eat each day.
How to Find More Help
Diabetes Teachers (nurses, dietitians, pharmacists, and other health professionals)
To find a diabetes teacher near you, call the American Association of Diabetes Educators toll-free at 1-800-TEAMUP4 (1-800-832-6874) or see www.diabeteseducator.org and click on "Find a Diabetes Educator."
Recognized Diabetes Education Programs (teaching programs approved by the American Diabetes Association)
To find a program near you, call toll-free 1-800-DIABETES (1-800-342-2383) or see www.diabetes.org/education/edustate2.asp?loc=x.
Dietitians
To find a dietitian near you, call the American Dietetic Association's National Center for Nutrition and Dietetics toll-free at 1-800-366-1655 or see www.eatright.org and click on "Find a Nutrition Professional."
FREQUENTLY ASKED QUESTIONS
It is very important for people who think they might have diabetes to visit a personal health care practitioner. The following simplified questions and answers can’t take the place of a personal consultation.
What is diabetes?
Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugars to build up in your blood.
Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the seventh leading cause of death in the United States.
What are the symptoms of diabetes?
People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following symptoms:
Frequent urination
Excessive thirst
Unexplained weight loss
Extreme hunger
Sudden vision changes
Tingling or numbness in hands or feet
Feeling very tired much of the time
Very dry skin
Sores that are slow to heal
More infections than usual.
Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes, now called type 1 diabetes.
What are the types and risk factors of diabetes?
The following types of diabetes and some of their risk factors are quoted from the National Diabetes Fact Sheet: National estimates and general information on diabetes in the United States (Centers for Disease Control and Prevention. Atlanta, GA: US Department of Health and Human Services, 1997):
Type 1 diabetes
Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes may account for 5% to 10% of all diagnosed cases of diabetes. Risk factors are less well defined for type 1 diabetes than for type 2 diabetes, but autoimmune, genetic, and environmental factors are involved in the development of this type of diabetes.
Type 2 diabetes
Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90% to 95% of all diagnosed cases of diabetes. Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes.
Gestational diabetes
Gestational diabetes develops in 2% to 5% of all pregnancies but usually disappears when a pregnancy is over. Gestational diabetes occurs more frequently in African Americans, Hispanic/Latino Americans, American Indians, and people with a family history of diabetes than in other groups. Obesity is also associated with higher risk. Women who have had gestational diabetes are at increased risk for later developing type 2 diabetes. In some studies, nearly 40% of women with a history of gestational diabetes developed diabetes in the future.
Other specific types of diabetes
Other specific types of diabetes result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses. Such types of diabetes may account for 1% to 2% of all diagnosed cases of diabetes.
What is the treatment for diabetes?
Management strategies should be planned along with a qualified health care team.
The following information on treatments for diabetes is from the National Diabetes Fact Sheet: National estimates and general information on diabetes in the United States (Centers for Disease Control and Prevention. Atlanta, GA: US Department of Health and Human Services, 1997):
Diabetes knowledge, treatment, and prevention strategies advance daily. Treatment is aimed at keeping blood glucose near normal levels at all times. Training in self-management is integral to the treatment of diabetes. Treatment must be individualized and must address medical, psychosocial, and lifestyle issues.
Treatment of type 1 diabetes:
Lack of insulin production by the pancreas makes type 1 diabetes particularly difficult to control. Treatment requires a strict regimen that typically includes a carefully calculated diet, planned physical activity, home blood glucose testing several times a day, and multiple daily insulin injections.
Treatment of type 2 diabetes:
Treatment typically includes diet control, exercise, home blood glucose testing, and in some cases, oral medication and/or insulin. Approximately 40% of people with type 2 diabetes require insulin injections.
What causes type 1 diabetes?
The causes of type 1 diabetes appear to be much different than those for type 2 diabetes, though the exact mechanisms for development of both diseases are unknown. The appearance of type 1 diabetes is suspected to follow exposure to an "environmental trigger," such as an unidentified virus, stimulating an immune attack against the beta cells of the pancreas (that produce insulin) in some genetically predisposed people.
Can diabetes be prevented?
A number of studies have shown that regular physical activity can significantly reduce the risk of developing type 2 diabetes. It also appears to be associated with obesity. Researchers are making progress in identifying the exact genetics and "triggers" that predispose some individuals to develop type 1 diabetes, but prevention, as well as a cure, remains elusive.
Is there a cure for diabetes?
In response to the growing health burden of diabetes mellitus (diabetes), the diabetes community has three choices: prevent diabetes; cure diabetes; and take better care of people with diabetes to prevent devastating complications. All three approaches are actively being pursued by the US Department of Health and Human Services.
Both the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) are involved in prevention activities. The NIH is involved in research to cure both type 1 and type 2 diabetes, especially type 1. CDC focuses most of its programs on being sure that the proven science is put into daily practice for people with diabetes. The basic idea is that if all the important research and science are not made meaningful in the daily lives of people with diabetes, then the research is, in essence, wasted.
Several approaches to "cure" diabetes are being pursued:
Pancreas transplantation
Islet cell transplantation (islet cells produce insulin)
Artificial pancreas development
Genetic manipulation (fat or muscle cells that don’t normally make insulin have a human insulin gene inserted — then these "pseudo" islet cells are transplanted into people with type 1 diabetes).
Each of these approaches still has a lot of challenges, such as preventing immune rejection; finding an adequate number of insulin cells; keeping cells alive; and others. But progress is being made in all areas.
What are some other sources for information on diabetes?
The following organizations may help in your search for more information on diabetes:
Federal Government Organizations
Non-Federal Government Organizations
http://www.cdc.gov/diabetes/faqs.htm
DIABETES DICTIONARY
A
acanthosis (uh-kan-THO-sis) nigricans (NIH-grih-kans):
a skin condition characterized by darkened skin patches; common in people whose body is not responding correctly to the insulin that they make in their pancreas (insulin resistance). This skin condition is also seen in people who have pre-diabetes or type 2 diabetes.
acarbose (AK-er-bose):
an oral medicine used to treat type 2 diabetes. It blocks the enzymes that digest starches in food. The result is a slower and lower rise in blood glucose throughout the day, especially right after meals. Belongs to the class of medicines called alpha-glucosidase inhibitors. (Brand name: Precose.)
ACE inhibitor:
an oral medicine that lowers blood pressure; ACE stands for angiotensin (an-gee-oh-TEN-sin) converting enzyme. For people with diabetes, especially those who have protein (albumin) in the urine, it also helps slow down kidney damage.
acesulfame (a-see-SUL-fame) potassium (puh-TAS-ee-um):
a dietary sweetener with no calories and no nutritional value. Also known as acesulfame-K. (Brand name: Sunett.)
acetohexamide (a-see-toh-HEX-uh-myde):
an oral medicine used to treat type 2 diabetes. It lowers blood glucose by helping the pancreas make more insulin and by helping the body better use the insulin it makes. Belongs to the class of medicines called sulfonylureas. (Brand name: Dymelor.)
Actos:
see pioglitazone.
acute:
bes something that happens suddenly and for a short time. Opposite of chronic.
adhesive capsulitis (cap-soo-LITE-is):
a condition of the shoulder associated with diabetes that results in pain and loss of the ability to move the shoulder in all directions.
adult-onset diabetes:
former term for type 2 diabetes.
AGEs (A-G-EEZ):
stands for advanced glycosylation (gly-KOH-sih-LAY-shun) endproducts. AGEs are produced in the body when glucose links with protein. They play a role in damaging blood vessels, which can lead to diabetes complications.
albuminuria (al-BYOO-mih-NOO-ree-uh):
a condition in which the urine has more than normal amounts of a protein called albumin. Albuminuria may be a sign of nephropathy (kidney disease).
alpha (AL-fa) cell:
a type of cell in the pancreas. Alpha cells make and release a hormone called glucagon. The body sends a signal to the alpha cells to make glucagon when blood glucose falls too low. Then glucagon reaches the liver where it tells it to release glucose into the blood for energy.
alpha-glucosidase (AL-fa-gloo-KOH-sih-days) inhibitor:
a class of oral medicine for type 2 diabetes that blocks enzymes that digest starches in food. The result is a slower and lower rise in blood glucose throughout the day, especially right after meals. (Generic names: acarbose and miglitol.)
Amaryl:
see glimepiride.
amylin (AM-ih-lin):
a hormone formed by beta cells in the pancreas. Amylin regulates the timing of glucose release into the bloodstream after eating by slowing the emptying of the stomach.
amyotrophy (a-my-AH-truh-fee):
neuropathy resulting in pain, weakness, and/or wasting in the muscles.
anemia (uh-NEE-mee-uh):
a condition in which the number of red blood cells is less than normal, resulting in less oxygen being carried to the body's cells.
angiopathy (an-gee-AH-puh-thee):
of the blood vessels (veins, arteries, capillaries) or lymphatic vessels.
antibodies (AN-ti-bod-eez):
proteins made by the body to protect itself from "foreign" substances such as bacteria or viruses. People get type 1 diabetes when their bodies make antibodies that destroy the body's own insulin-making beta cells.
A1C:
a test that measures a person's average blood glucose level over the past 2 to 3 months. Hemoglobin (HEE-mo-glo-bin) is the part of a red blood cell that carries oxygen to the cells and sometimes joins with the glucose in the bloodstream. Also called hemoglobin A1C or glycosylated (gly-KOH-sih-lay-ted) hemoglobin, the test shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood.
ARB:
an oral medicine that lowers blood pressure; ARB stands for angiotensin (an-gee-oh-TEN-sin) receptor blocker.
arteriosclerosis (ar-TEER-ee-oh-skluh-RO-sis):
hardening of the arteries.
artery:
a large blood vessel that carries blood with oxygen from the heart to all parts of the body.
aspart (ASS-part) insulin:
a rapid-acting insulin. On average, aspart insulin starts to lower blood glucose within 10 to 20 minutes after injection. It has its strongest effect 1 to 3 hours after injection but keeps working for 3 to 5 hours after injection.
aspartame (ASS-per-tame):
a dietary sweetener with almost no calories and no nutritional value. (Brand names: Equal, NutraSweet.)
atherosclerosis (ATH-uh-row-skluh-RO-sis):
clogging, narrowing, and hardening of the body's large arteries and medium-sized blood vessels. Atherosclerosis can lead to stroke, heart attack, eye problems, and kidney problems.
autoimmune (AW-toh-ih-MYOON) disease:
disorder of the body's immune system in which the immune system mistakenly attacks and destroys body tissue that it believes to be foreign.
autonomic (aw-toh-NOM-ik) neuropathy (ne-ROP-uh-thee):
a type of neuropathy affecting the lungs, heart, stomach, intestines, bladder, or genitals.
Avandia:
see rosiglitazone.
B
background retinopathy (REH-tih-NOP-uh-thee):
a type of damage to the retina of the eye marked by bleeding, fluid accumulation, and abnormal dilation of the blood vessels. Background retinopathy is an early stage of diabetic retinopathy. Also called simple or nonproliferative (non-pro-LIF-er-uh-tiv) retinopathy.
basal rate:
a steady trickle of low levels of longer-acting insulin, such as that used in insulin pumps.
beta cell:
Beta cells are located in the islets of the pancreas.
biguanide (by-GWAH-nide):
a class of oral medicine used to treat type 2 diabetes that lowers blood glucose by reducing the amount of glucose produced by the liver and by helping the body respond better to insulin. (Generic name: metformin.)
blood glucose:
the main sugar found in the blood and the body's main source of energy. Also called blood sugar.
blood glucose level:
the amount of glucose in a given amount of blood. It is noted in milligrams in a deciliter, or mg/dL.
blood glucose meter:
a small, portable machine used by people with diabetes to check their blood glucose levels. After pricking the skin with a lancet, one places a drop of blood on a test strip in the machine. The meter (or monitor) soon displays the blood glucose level as a number on the meter's digital display.
Blood glucose meter
blood glucose monitoring:
checking blood glucose level on a regular basis in order to manage diabetes. A blood glucose meter (or blood glucose test strips that change color when touched by a blood sample) is needed for frequent blood glucose monitoring.
blood pressure:
the force of blood exerted on the inside walls of blood vessels. Blood pressure is expressed as a ratio (example: 120/80, read as "120 over 80"). The first number is the systolic (sis-TAH-lik) pressure, or the pressure when the heart pushes blood out into the arteries. The second number is the diastolic (DY-uh-STAH-lik) pressure, or the pressure when the heart rests.
blood sugar:
see blood glucose.
blood sugar level:
see blood glucose level.
blood urea (yoo-REE-uh) nitrogen (NY-truh-jen) (BUN):
a waste product in the blood from the breakdown of protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN levels increase.
blood vessels:
tubes that carry blood to and from all parts of the body. The three main types of blood vessels are arteries, veins, and capillaries.
BMI:
see body mass index.
body mass index (BMI):
a measure used to evaluate body weight relative to a person's height. BMI is used to find out if a person is underweight, normal weight, overweight, or obese.
To find BMI: Multiply body weight in pounds by 703. Divide that number by height in inches. Divide that number by height in inches again. Find the resulting numberin the chart below.
Below 18.5 is underweight.
18.5-24.9 is normal.
25.0-29.9 is overweight.
30.0 and above is obese.
bolus (BOH-lus):
an extra amount of insulin taken to cover an expected rise in blood glucose, often related to a meal or snack.
borderline diabetes:
for type 2 diabetes or impaired glucose tolerance.
brittle diabetes:
a term used when a person's blood glucose level moves often from low to high and from high to low.
BUN:
See blood urea nitrogen.
bunion (BUN-yun):
a bulge on the first joint of the big toe, caused by the swelling of a fluid sac under the skin. This spot can become red, sore, and infected.
C
callus:
a small area of skin, usually on the foot, that has become thick and hard from rubbing or pressure.
calorie:
a unit representing the energy provided by food. Carbohydrate, protein, fat, and alcohol provide calories in the diet. Carbohydrate and protein have 4 calories per gram, fat has 9 calories per gram, and alcohol has 7 calories per gram.
capillary (KAP-ih-lair-ee):
the smallest of the body's blood vessels. Oxygen and glucose pass through capillary walls and enter the cells. Waste products such as carbon dioxide pass back from the cells into the blood through capillaries.
capsaicin (kap-SAY-ih-sin):
an ingredient in hot peppers that can be found in ointment form for use on the skin to relieve pain from diabetic neuropathy.
carbohydrate (kar-boh-HY-drate):
one of the three main nutrients in food. Foods that provide carbohydrate are starches, vegetables, fruits, dairy products, and sugars.
Sources of carbohydrate
carbohydrate counting:
a method of meal planning for people with diabetes based on counting the number of grams of carbohydrate in food.
cardiologist (kar-dee-AH-luh-jist):
a doctor who treats people who have heart problems.
cardiovascular (KAR-dee-oh-VASK-yoo-ler) disease:
heart and blood vessels (arteries, veins, and capillaries).
cataract (KA-ter-act):
clouding of the lens of the eye.
CDE: see certified diabetes educator.
cerebrovascular (seh-REE-broh-VASK-yoo-ler) disease:
damage to blood vessels in the brain. Vessels can burst and bleed or become clogged with fatty deposits. When blood flow is interrupted, brain cells die or are damaged, resulting in a stroke.
certified diabetes educator (CDE):
a health care professional with expertise in diabetes education who has met eligibility requirements and successfully completed a certification exam.See diabetes educator.
Charcot's (shar-KOHZ) foot:
a condition in which the joints and soft tissue in the foot are destroyed; it results from damage to the nerves.
cheiroarthropathy (KY-roh-ar-THRAHP-uh-thee):
see limited joint mobility.
cheiropathy (ky-RAH-puh-thee): see limited joint mobility.
chlorpropamide (klor-PROH-pah-mide):
an oral medicine used to treat type 2 diabetes. It lowers blood glucose levels by helping the pancreas make more insulin and by helping the body better use the insulin it makes. Belongs to the class of medicines called sulfonylureas. (Brand name: Diabinese.)
cholesterol (koh-LES-ter-all):
a type of fat produced by the liver and found in the blood; it is also found in some foods. Cholesterol is used by the body to make hormones and build cell walls.
chronic:
describes something that is long-lasting. Opposite of acute.
circulation:
the flow of blood through the body's blood vessels and heart.
coma:
a sleep-like state in which a person is not conscious. May be caused by hyperglycemia (high blood glucose) or hypoglycemia (low blood glucose) in people with diabetes.
combination oral medicines:
a pill that includes two or more different medicines. See Glucovance.
combination therapy:
the use of different medicines together (oral hypoglycemic agents or an oral hypoglycemic agent and insulin) to manage the blood glucose levels of people with type 2 diabetes.
complications:
harmful effects of diabetes such as damage to the eyes, heart, blood vessels, nervous system, teeth and gums, feet and skin, or kidneys. Studies show that keeping blood glucose, blood pressure, and low-density lipoprotein cholesterol levels close to normal can help prevent or delay these problems.
congenital (kun-JEN-ih-tul) defects:
problems or conditions that are present at birth.
congestive heart failure:
loss of the heart's pumping power, which causes fluids to collect in the body, especially in the feet and lungs.
conventional therapy:
a term used in clinical trials where one group receives treatment for diabetes in which A1C and blood glucose levels are kept at levels based on current practice guidelines. However, the goal is not to keep blood glucose levels as close to normal as possible, as is done in intensive therapy. Conventional therapy includes use of medication, meal planning, and exercise, along with regular visits to health care providers.
coronary artery disease: see coronary heart disease.
coronary (KOR-uh-ner-ee) heart disease:
heart disease caused by narrowing of the arteries that supply blood to the heart. If the blood supply is cut off the result is a heart attack.
C-peptide (see-peptide):
"Connecting peptide," a substance the pancreas releases into the bloodstream in equal amounts to insulin. A test of C-peptide levels shows how much insulin the body is making.
creatinine (kree-AT-ih-nin):
a waste product from protein in the diet and from the muscles of the body. Creatinine is removed from the body by the kidneys; as kidney disease progresses, the level of creatinine in the blood increases.
D
dawn phenomenon (feh-NAH-meh-nun):
the early-morning (4 a.m. to 8 a.m.) rise in blood glucose level.
DCCT:
see Diabetes Control and Complications Trial.
dehydration (dee-hy-DRAY-shun):
the loss of too much body fluid through frequent urinating, sweating, diarrhea, or vomiting.
dermopathy (dur-MAH-puh-thee):
disease of the skin.
desensitization (dee-sens-ih-tiz-A-shun):
a way to reduce or stop a response such as an allergic reaction to something. For example, if someone has an allergic reaction to something, the doctor gives the person a very small amount of the substance at first to increase one's tolerance. Over a period of time, larger doses are given until the person is taking the full dose. This is one way to help the body get used to the full dose and to prevent the allergic reaction.
dextrose (DECKS-trohss), also called glucose:
simple sugar found in blood that serves as the body's main source of energy.
DiaBeta:
see glyburide.
diabetes:
see diabetes mellitus.
Diabetes Control and Complications Trial (DCCT):
a study by the National Institute of Diabetes and Digestive and Kidney Diseases, conducted from 1983 to 1993 in people with type 1 diabetes. The study showed that intensive therapy compared to conventional therapy significantly helped prevent or delay diabetes complications. Intensive therapy included multiple daily insulin injections or the use of an insulin pump with multiple blood glucose readings each day. Complications followed in the study included diabetic retinopathy, neuropathy, and nephropathy.
diabetes educator:
a health care professional who teaches people who have diabetes how to manage their diabetes. Some diabetes educators are certified diabetes educators (CDEs). Diabetes educators are found in hospitals, physician offices, managed care organizations, home health care, and other settings.
diabetes insipidus (in-SIP-ih-dus):
a condition characterized by frequent and heavy urination, excessive thirst, and an overall feeling of weakness. This condition may be caused by a defect in the pituitary gland or in the kidney. In diabetes insipidus, blood glucose levels are normal.
diabetes mellitus (MELL-ih-tus):
a condition characterized by hyperglycemia resulting from the body's inability to use blood glucose for energy. In type 1 diabetes, the pancreas no longer makes insulin and therefore blood glucose cannot enter the cells to be used for energy. In type 2 diabetes, either the pancreas does not make enough insulin or the body is unable to use insulin correctly.
Diabetes Prevention Program (DPP):
a study by the National Institute of Diabetes and Digestive and Kidney Diseases conducted from 1998 to 2001 in people at high risk for type 2 diabetes. All study participants had impaired glucose tolerance, also called pre-diabetes, and were overweight. The study showed that people who lost 5 to 7 percent of their body weight through a low-fat, low-calorie diet and moderate exercise (usually walking for 30 minutes 5 days a week) reduced their risk of getting type 2 diabetes by 58 percent. Participants who received treatment with the oral diabetes drug metformin reduced their risk of getting type 2 diabetes by 31 percent.
diabetic diarrhea (dy-uh-REE-uh):
loose stools, fecal incontinence, or both that result from an overgrowth of bacteria in the small intestine and diabetic neuropathy in the intestines. This nerve damage can also result in constipation.
diabetic eye disease:
see diabetic retinopathy.
diabetic ketoacidosis (KEY-toe-ass-ih-DOH-sis) (DKA):
an emergency condition in which extremely high blood glucose levels, along with a severe lack of insulin, result in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. Signs of DKA are nausea and vomiting, stomach pain, fruity breath odor, and rapid breathing. Untreated DKA can lead to coma and death.
diabetic myelopathy (my-eh-LAH-puh-thee):
damage to the spinal cord found in some people with diabetes.
diabetic nephropathy:
see nephropathy.
Diabetic neuropathy:
see neuropathy.
diabetic retinopathy (REH-tih-NOP-uh-thee):
diabetic eye disease; damage to the small blood vessels in the retina. Loss of vision may result.
diabetogenic (DY-uh-beh-toh-JEN-ic):
causing diabetes. For example, some drugs cause blood glucose levels to rise, resulting in diabetes.
diabetologist (DY-uh-beh-TAH-luh-jist):
a doctor who specializes in treating people who have diabetes.
Diabinese:
see chlorpropamide.
Diagnosis (DY-ug-NO-sis):
the determination of a disease from its signs and symptoms.
dialysis (dy-AL-ih-sis):
the process of cleaning wastes from the blood artificially. This job is normally done by the kidneys. If the kidneys fail, the blood must be cleaned artificially with special equipment. The two major forms of dialysis are hemodialysis and peritoneal dialysis.
· hemodialysis (HE-mo-dy-AL-ih-sis): the use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer (DY-uh-LY-zur), a machine that removes wastes and extra fluid. The cleaned blood then goes back into the body.
Hemodialysis
· peritoneal (PEH-rih-tuh-NEE-ul) dialysis: cleaning the blood by using the lining of the abdomen as a filter. A cleansing solution called dialysate (dy-AL-ih-sate) is infused from a bag into the abdomen. Fluids and wastes flow through the lining of the belly and remain "trapped" in the dialysate. The dialysate is then drained from the belly, removing the extra fluids and wastes from the body.
dietitian (DY-eh-TIH-shun):
a health care professional who advises people about meal planning, weight control, and diabetes management. A registered dietitian (RD) has more training.
dilated (DY-lay-ted) eye exam:
a test done by an eye care specialist in which the pupil (the black center) of the eye is temporarily enlarged with eyedrops to allow the specialist to see the inside of the eye more easily.
Dilated eye
Undilated eye
DKA:
see diabetic ketoacidosis.
D-phenylalanine (dee-fen-nel-AL-ah-neen) derivative:
a class of oral medicine for type 2 diabetes that lowers blood glucose levels by helping the pancreas make more insulin right after meals. (Generic name: nateglinide.)
DPP:
see Diabetes Prevention Program.
Dupuytren's (doo-PWEE-trenz) contracture (kon-TRACK-chur):
a condition associated with diabetes in which the fingers and the palm of the hand thicken and shorten, causing the fingers to curve inward.
Dymelor:
see acetohexamide.
E
edema (eh-DEE-muh):
swelling caused by excess fluid in the body.
electromyography (ee-LEK-troh-my-AH-gruh-fee) (EMG):
a test used to detect nerve function. It measures the electrical activity generated by muscles.
EMG:
see electromyography.
endocrine (EN-doh-krin) gland:
a group of specialized cells that release hormones into the blood. For example, the islets in the pancreas, which secrete insulin, are endocrine glands.
endocrinologist (EN-doh-krih-NAH-luh-jist):
a doctor who treats people who have endocrine gland problems such as diabetes.
end-stage renal disease (ESRD):
see kidney failure.
enzyme (EN-zime):
protein made by the body that brings about a chemical reaction, for example, the enzymes produced by the gut to aid digestion.
erectile dysfunction:
see impotence.
euglycemia (you-gly-SEEM-ee-uh):
a normal level of glucose in the blood.
exchange lists:
one of several approaches for diabetes meal planning. Foods are categorized into three groups based on their nutritional content. Lists provide the serving sizes for carbohydrates, meat and meat alternatives, and fats. These lists allow for substitution for different groups to keep the nutritional content fixed.
F
fasting blood glucose test:
a check of a person's blood glucose level after the person has not eaten for 8 to 12 hours (usually overnight). This test is used to diagnose pre-diabetes and diabetes. It is also used to monitor people with diabetes.
fat:
1. One of the three main nutrients in food. Foods that provide fat are butter, margarine, salad dressing, oil, nuts, meat, poultry, fish, and some dairy products.
2. Excess calories are stored as body fat, providing the body with a reserve supply of energy and other functions.
Sources of fat
50/50 insulin:
premixed insulin that is 50 percent intermediate-acting (NPH) insulin and 50 percent short-acting (regular) insulin.
fluorescein (fluh-RESS-ee-in) angiography (an-gee-AH-grah-fee):
a test to examine blood vessels in the eye; done by injecting dye into an arm vein and then taking photos as the dye goes through the eye's blood vessels.
fructosamine (frook-TOH-sah-meen) test:
measures the number of blood glucose molecules (MAH-leh-kyools) linked to protein molecules in the blood. The test provides information on the average blood glucose level for the past 3 weeks.
fructose (FROOK-tohss):
a sugar that occurs naturally in fruits and honey. Fructose has 4 calories per gram.
G
gangrene (GANG-green):
the death of body tissue, most often caused by a lack of blood flow and infection. It can lead to amputation.
gastroparesis (gas-tro-puh-REE-sis):
a form of neuropathy that affects the stomach. Digestion of food may be incomplete or delayed, resulting in nausea, vomiting, or bloating, making blood glucose control difficult.
gestational (jes-TAY-shun-ul) diabetes mellitus (MELL-ih-tus) (GDM):
a type of diabetes mellitus that develops only during pregnancy and usually disappears upon delivery, but increases the risk that the mother will develop diabetes later. GDM is managed with meal planning, activity, and, in some cases, insulin.
gingivitis (JIN-jih-VY-tis):
a condition of the gums characterized by inflammation and bleeding.
gland:
a group of cells that secrete substances. Endocrine glands secrete hormones. Exocrine glands secrete salt, enzymes, and water.
glargine (GLAR-jeen) insulin:
very-long-acting insulin. On average, glargine insulin starts to lower blood glucose levels within 1 hour after injection and keeps working evenly for 24 hours after injection.
glaucoma (glaw-KOH-muh):
an increase in fluid pressure inside the eye that may lead to loss of vision.
glimepiride (gly-MEH-per-ide):
an oral medicine used to treat type 2 diabetes. It lowers blood glucose by helping the pancreas make more insulin and by helping the body better use the insulin it makes. Belongs to the class of medicines called sulfonylureas. (Brand name: Amaryl.)
glipizide (GLIH-pih-zide):
an oral medicine used to treat type 2 diabetes. It lowers blood glucose by helping the pancreas make more insulin and by helping the body better use the insulin it makes. Belongs to the class of medicines called sulfonylureas. (Brand names: Glucotrol, Glucotrol XL.)
glomerular (glo-MEHR-yoo-lur) filtration rate:
measure of the kidney's ability to filter and remove waste products.
glomeruli (glo-MEHR-yoo-lie):
plural of glomerulus.
glomerulus (glo-MEHR-yoo-lus):
a tiny set of looping blood vessels in the kidney where the blood is filtered and waste products are removed.
glucagon (GLOO-kah-gahn):
a hormone produced by the alpha cells in the pancreas. It raises blood glucose. An injectable form of glucagon, available by prescription, may be used to treat severe hypoglycemia.
Glucophage, Glucophage XR:
see metformin.
glucose:
one of the simplest forms of sugar.
glucose tablets:
chewable tablets made of pure glucose used for treating hypoglycemia.
Glucose tablets
glucose tolerance test:
see oral glucose tolerance test.
Glucotrol, Glucotrol XL:
see glipizide.
Glucovance:
an oral medicine used to treat type 2 diabetes. It is a combination of glyburide and metformin.
glyburide (GLY-buh-ride):
an oral medicine used to treat type 2 diabetes. It lowers blood glucose by helping the pancreas make more insulin and by helping the body better use the insulin it makes. Belongs to the class of medicines called sulfonylureas. (Brand names: DiaBeta, Glynase PresTab, Micronase; ingredient in Glucovance.)
glycemic (gly-SEE-mik) index:
a ranking of carbohydrate-containing foods, based on the food's effect on blood glucose compared with a standard reference food.
glycogen (GLY-koh-jen):
the form of glucose found in the liver and muscles.
glycosuria (gly-koh-SOOR-ee-ah):
the presence of glucose in the urine.
glycosylated hemoglobin:
see A1C.
Glynase PresTab:
see glyburide.
Glyset:
see miglitol.
gram:
a unit of weight in the metric system. An ounce equals 28 grams. In some meal plans for people with diabetes, the suggested amounts of food are given in grams.
One slice of bread has 15 grams of carbohydrate.
H
HDL cholesterol (kuh-LESS-tuh-rawl),
stands for high-density-lipoprotein (LIP-oh-PRO-teen) cholesterol:
a fat found in the blood that takes extra cholesterol from the blood to the liver for removal. Sometimes called "good" cholesterol.
hemodialysis:
see dialysis.
hemoglobin A1C test:
see A1C.
heredity:
the passing of a trait from parent to child.
HHNS:
see hyperosmolar hyperglycemic nonketotic syndrome.
high blood glucose:
see hyperglycemia.
high blood pressure:
see hypertension.
high-density lipoprotein cholesterol:
see HDL cholesterol.
HLA:
see human leukocyte antigens.
home glucose monitor:
see blood glucose meter.
honeymoon phase:
temporary remission of hyperglycemia that occurs in some people newly diagnosed with type 1 diabetes, when some insulin secretion resumes for a short time, usually a few months, before stopping again.
hormone:
a chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. For example, insulin is a hormone made in the pancreas that tells other cells when to use glucose for energy. Synthetic hormones, made for use as medicines, can be the same or different from those made in the body.
human leukocyte antigens (HLA):
proteins located on the surface of the cell that help the immune system identify the cell either as one belonging to the body or as one from outside the body. Some patterns of these proteins may mean increased risk of developing type 1 diabetes.
hyperglycemia (HY-per-gly-SEE-mee-uh):
excessive blood glucose. Fasting hyperglycemia is blood glucose above a desirable level after a person has fasted for at least 8 hours. Postprandial hyperglycemia is blood glucose above a desirable level 1 to 2 hours after a person has eaten.
hyperinsulinemia (HY-per-IN-suh-lih-NEE-mee-uh):
a condition in which the level of insulin in the blood is higher than normal. Caused by overproduction of insulin by the body. Related to insulin resistance.
hyperlipidemia (HY-per-li-pih-DEE-mee-uh):
higher than normal fat and cholesterol levels in the blood.
hyperosmolar (HY-per-oz-MOH-lur) hyperglycemic (HY-per-gly-SEE-mik) nonketotic (non-kee-TAH-tik) syndrome (HHNS):
an emergency condition in which one's blood glucose level is very high and ketones are not present in the blood or urine. If HHNS is not treated, it can lead to coma or death.
hypertension (HY-per-TEN-shun):
a condition present when blood flows through the blood vessels with a force greater than normal. Also called high blood pressure. Hypertension can strain the heart, damage blood vessels, and increase the risk of heart attack, stroke, kidney problems, and death.
Checking blood pressure
hypoglycemia (hy-po-gly-SEE-mee-uh):
a condition that occurs when one's blood glucose is lower than normal, usually less than 70 mg/dL. Signs include hunger, nervousness, shakiness, perspiration, dizziness or light-headedness, sleepiness, and confusion. If left untreated, hypoglycemia may lead to unconsciousness. Hypoglycemia is treated by consuming a carbohydrate-rich food such as a glucose tablet or juice. It may also be treated with an injection of glucagon if the person is unconscious or unable to swallow. Also called an insulin reaction.
hypoglycemia unawareness (un-uh-WARE-ness):
a state in which a person does not feel or recognize the symptoms of hypoglycemia. People who have frequent episodes of hypoglycemia may no longer experience the warning signs of it.
hypotension (hy-poh-TEN-shun):
low blood pressure or a sudden drop in blood pressure. Hypotension may occur when a person rises quickly from a sitting or reclining position, causing dizziness or fainting.
I
IDDM (insulin-dependent diabetes mellitus):
former term for type 1 diabetes.
immune (ih-MYOON) system:
the body's system for protecting itself from viruses and bacteria or any "foreign" substances.
immunosuppressant (ih-MYOON-oh-suh-PRESS-unt):
a drug that suppresses the natural immune responses. Immunosuppressants are given to transplant patients to prevent organ rejection or to patients with autoimmune diseases.
impaired fasting glucose (IFG):
a condition in which a blood glucose test, taken after an 8- to 12-hour fast, shows a level of glucose higher than normal but not high enough for a diagnosis of diabetes. IFG, also called pre-diabetes, is a level of 100 mg/dL to 125 mg/dL. Most people with pre-diabetes are at increased risk for developing type 2 diabetes.
impaired glucose tolerance (IGT):
a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. IGT, also called pre-diabetes, is a level of 140 mg/dL to 199 mg/dL 2 hours after the start of an oral glucose tolerance test. Most people with pre-diabetes are at increased risk for developing type 2 diabetes. Other names for IGT that are no longer used are "borderline," "subclinical," "chemical," or "latent" diabetes.
implantable (im-PLAN-tuh-bull) insulin pump:
a small pump placed inside the body to deliver insulin in response to remote-control commands from the user.
impotence (IM-po-tents):
the inability to get or maintain an erection for sexual activity. Also called erectile (ee-REK-tile) dysfunction (dis-FUNK-shun).
incidence (IN-sih-dints):
a measure of how often a disease occurs; the number of new cases of a disease among a certain group of people for a certain period of time.
incontinence (in-KON-tih-nents):
loss of bladder or bowel control; the accidental loss of urine or feces.
inhaled insulin:
an experimental treatment for taking insulin using a portable device that allows a person to breathe in insulin.
injection (in-JEK-shun):
inserting liquid medication or nutrients into the body with a syringe. A person with diabetes may use short needles or pinch the skin and inject at an angle to avoid an intramuscular injection of insulin.
injection site rotation:
changing the places on the body where insulin is injected. Rotation prevents the formation of lipodystrophies.
injection sites:
places on the body where insulin is usually injected.
insulin:
a hormone that helps the body use glucose for energy. The beta cells of the pancreas make insulin. When the body cannot make enough insulin, insulin is taken by injection or through use of an insulin pump.
insulin adjustment:
a change in the amount of insulin a person with diabetes takes based on factors such as meal planning, activity, and blood glucose levels.
insulin-dependent diabetes mellitus (IDDM):
former term for type 1 diabetes.
insulinoma (IN-suh-lih-NOH-mah):
a tumor of the beta cells in the pancreas. An insulinoma may cause the body to make extra insulin, leading to hypoglycemia.
insulin pen:
a device for injecting insulin that looks like a fountain pen and holds replaceable cartridges of insulin. Also available in disposable form.
insulin pump:
an insulin-delivering device about the size of a deck of cards that can be worn on a belt or kept in a pocket. An insulin pump connects to narrow, flexible plastic tubing that ends with a needle inserted just under the skin. Users set the pump to give a steady trickle or basal amount of insulin continuously throughout the day. Pumps release bolus doses of insulin (several units at a time) at meals and at times when blood glucose is too high, based on programming done by the user.
Insulin pump
insulin reaction:
when the level of glucose in the blood is too low (at or below 70 mg/dL). Also known as hypoglycemia.
insulin receptors:
areas on the outer part of a cell that allow the cell to bind with insulin in the blood. When the cell and insulin bind, the cell can take glucose from the blood and use it for energy.
insulin resistance:
the body's inability to respond to and use the insulin it produces. Insulin resistance may be linked to obesity, hypertension, and high levels of fat in the blood.
insulin shock:
see hypoglycemia.
intensive therapy:
a treatment for diabetes in which blood glucose is kept as close to normal as possible through frequent injections or use of an insulin pump; meal planning; adjustment of medicines; and exercise based on blood glucose test results and frequent contact with a person's health care team.
intermediate-acting insulin:
a type of insulin that starts to lower blood glucose within 1 to 2 hours after injection and has its strongest effect 6 to 12 hours after injection, depending on the type used. See lente insulin and NPH insulin.
intermittent (IN-ter-MIT-ent) claudication (CLAW-dih-KAY-shun):
pain that comes and goes in the muscles of the leg. This pain results from a lack of blood supply to the legs and usually happens when walking or exercising.
intramuscular (in-trah-MUS-kyoo-lar) injection:
inserting liquid medication into a muscle with a syringe. Glucagon may be given by subcutaneous or intramuscular injection for hypoglycemia.
islet (EYE-let) cell autoantibodies (aw-toe-AN-ti-bod-eez) (ICA):
proteins found in the blood of people newly diagnosed with type 1 diabetes. They are also found in people who may be developing type 1 diabetes. The presence of ICA indicates that the body's immune system has been damaging beta cells in the pancreas.
islet transplantation:
moving the islets from a donor pancreas into a person whose pancreas has stopped producing insulin. Beta cells in the islets make the insulin that the body needs for using blood glucose.
islets:
groups of cells located in the pancreas that make hormones that help the body break down and use food. For example, alpha cells make glucagon and beta cells make insulin. Also called islets of Langerhans (LANG-er-hahns).
islets of Langerhans:
see islets.
J
jet injector (in-JEK-tur):
a device that uses high pressure instead of a needle to propel insulin through the skin and into the body.
juvenile diabetes:
former term for insulin-dependent diabetes mellitus (IDDM), or type 1 diabetes.
K
ketoacidosis:
see diabetic ketoacidosis.
ketone:
a chemical produced when there is a shortage of insulin in the blood and the body breaks down body fat for energy. High levels of ketones can lead to diabetic ketoacidosis and coma. Sometimes referred to as ketone bodies.
ketonuria (key-toe-NUH-ree-ah):
a condition occurring when ketones are present in the urine, a warning sign of diabetic ketoacidosis.
ketosis (ke-TOE-sis):
a ketone buildup in the body that may lead to diabetic ketoacidosis. Signs of ketosis are nausea, vomiting, and stomach pain.
kidney disease:
see nephropathy.
kidney failure:
a chronic condition in which the body retains fluid and harmful wastes build up because the kidneys no longer work properly. A person with kidney failure needs dialysis or a kidney transplant. Also called end-stage renal (REE-nul) disease or ESRD.
kidneys:
the two bean-shaped organs that filter wastes from the blood and form urine. The kidneys are located near the middle of the back. They send urine to the bladder.
Kidneys
Kussmaul (KOOS-mall) breathing:
the rapid, deep, and labored breathing of people who have diabetic ketoacidosis.
L
LADA:
see latent autoimmune diabetes in adults.
lancet:
a spring-loaded device used to prick the skin with a small needle to obtain a drop of blood for blood glucose monitoring.
laser surgery treatment:
a type of therapy that uses a strong beam of light to treat a damaged area. The beam of light is called a laser. A laser is sometimes used to seal blood vessels in the eye of a person with diabetes. See photocoagulation.
latent autoimmune diabetes in adults (LADA):
a condition in which type 1 diabetes develops in adults.
LDL cholesterol (kuh-LESS-tuh-rawl),
stands for low-density lipoprotein (LIP-oh-PRO-teen) cholesterol:
a fat found in the blood that takes cholesterol around the body to where it is needed for cell repair and also deposits it on the inside of artery walls. Sometimes called "bad" cholesterol.
lente (LEN-tay) insulin:
an intermediate-acting insulin. On average, lente insulin starts to lower blood glucose levels within 1 to 2 hours after injection. It has its strongest effect 8 to 12 hours after injection but keeps working for 18 to 24 hours after injection. Also called L insulin.
limited joint mobility:
a condition in which the joints swell and the skin of the hand becomes thick, tight, and waxy, making the joints less able to move. It may affect the fingers and arms as well as other joints in the body.
lipid (LIP-id):
a term for fat in the body. Lipids can be broken down by the body and used for energy.
lipid profile:
a blood test that measures total cholesterol, triglycerides, and HDL cholesterol. LDL cholesterol is then calculated from the results. A lipid profile is one measure of a person's risk of cardiovascular disease.
lipoatrophy (LIP-oh-AT-ruh-fee):
loss of fat under the skin resulting in small dents. Lipoatrophy may be caused by repeated injections of insulin in the same spot.
lipodystrophy (LIP-oh-DIH-struh-fee):
defect in the breaking down or building up of fat below the surface of the skin, resulting in lumps or small dents in the skin surface. (See lipohypertrophy or lipoatrophy.) Lipodystrophy may be caused by repeated injections of insulin in the same spot.
lipohypertrophy (LIP-oh-hy-PER-truh-fee):
buildup of fat below the surface of the skin, causing lumps. Lipohypertrophy may be caused by repeated injections of insulin in the same spot.
lispro (LYZ-proh) insulin:
a rapid-acting insulin. On average, lispro insulin starts to lower blood glucose within 5 minutes after injection. It has its strongest effect 30 minutes to 1 hour after injection but keeps working for 3 hours after injection.
liver:
an organ in the body that changes food into energy, removes alcohol and poisons from the blood, and makes bile, a substance that breaks down fats and helps rid the body of wastes.
Liver
long-acting insulin:
a type of insulin that starts to lower blood glucose within 4 to 6 hours after injection and has its strongest effect 10 to 18 hours after injection. See ultralente insulin.
low blood sugar:
see hypoglycemia.
low-density lipoprotein cholesterol:
see LDL cholesterol.
M
macrosomia (mack-roh-SOH-mee-ah):
abnormally large; in diabetes, refers to abnormally large babies that may be born to women with diabetes.
Macrosomia
macrovascular (mack-roh-VASK-yoo-ler) disease:
disease of the large blood vessels, such as those found in the heart. Lipids and blood clots build up in the large blood vessels and can cause atherosclerosis, coronary heart disease, stroke, and peripheral vascular disease.
macula (MACK-yoo-la):
the part of the retina in the eye used for reading and seeing fine detail.
macular (MACK-yoo-lur) edema (eh-DEE-mah):
swelling of the macula.
maturity-onset diabetes of the young (MODY):
a kind of type 2 diabetes that accounts for 1 to 5 percent of people with diabetes. Of the six forms identified, each is caused by a defect in a single gene.
meglitinide (meh-GLIH-tin-ide):
a class of oral medicine for type 2 diabetes that lowers blood glucose by helping the pancreas make more insulin right after meals. (Generic name: repaglinide.)
metabolic syndrome:
the tendency of several conditions to occur together, including obesity, insulin resistance, diabetes or pre-diabetes, hypertension, and high lipids.
metabolism:
the term for the way cells chemically change food so that it can be used to store or use energy and make the proteins, fats, and sugars needed by the body.
metformin (met-FOR-min):
an oral medicine used to treat type 2 diabetes. It lowers blood glucose by reducing the amount of glucose produced by the liver and helping the body respond better to the insulin made in the pancreas. Belongs to the class of medicines called biguanides. (Brand names: Glucophage, Glucophage XR; an ingredient in Glucovance.)
mg/dL:
milligrams (MILL-ih-grams) per deciliter (DESS-ih-lee-tur), a unit of measure that shows the concentration of a substance in a specific amount of fluid. In the United States, blood glucose test results are reported as mg/dL. Medical journals and other countries use millimoles per liter (mmol/L). To convert to mg/dL from mmol/L, multiply mmol/L by 18. Example: 10 mmol/L × 18 = 180 mg/dL.
microalbumin (MY-kro-al-BYOO-min):
small amounts of the protein called albumin in the urine detectable with a special lab test.
microaneurysm (MY-kro-AN-yeh-rizm):
a small swelling that forms on the side of tiny blood vessels. These small swellings may break and allow blood to leak into nearby tissue. People with diabetes may get microaneurysms in the retina of the eye.
Micronase:
see glyburide.
microvascular (MY-kro-VASK-yoo-ler) disease:
disease of the smallest blood vessels, such as those found in the eyes, nerves, and kidneys. The walls of the vessels become abnormally thick but weak. Then they bleed, leak protein, and slow the flow of blood to the cells.
miglitol (MIG-lih-tall):
an oral medicine used to treat type 2 diabetes. It blocks the enzymes that digest starches in food. The result is a slower and lower rise in blood glucose throughout the day, especially right after meals. Belongs to the class of medicines called alpha-glucosidase inhibitors. (Brand name: Glyset.)
mixed dose:
a combination of two types of insulin in one injection. Usually a rapid- or short-acting insulin is combined with a longer acting insulin (such as NPH insulin) to provide both short-term and long-term control of blood glucose levels.
mmol/L:
millimoles per liter, a unit of measure that shows the concentration of a substance in a specific amount of fluid. In most of the world, except for the United States, blood glucose test results are reported as mmol/L. In the United States, milligrams per deciliter (mg/dL) is used. To convert to mmol/L from mg/dL, divide mg/dL by 18. Example: 180 mg/dL ÷ 18 = 10 mmol/L.
MODY:
see maturity-onset diabetes of the young.
monitor:
see blood glucose meter.
monofilament:
a short piece of nylon, like a hairbrush bristle, mounted on a wand. To check sensitivity of the nerves in the foot, the doctor touches the filament to the bottom of the foot.
mononeuropathy (MAH-noh-ne-ROP-uh-thee):
neuropathy affecting a single nerve.
myocardial (my-oh-KAR-dee-ul) infarction (in-FARK-shun):
an interruption in the blood supply to the heart because of narrowed or blocked blood vessels. Also called a heart attack.
N
nateglinide (neh-TEH-glin-ide):
an oral medicine used to treat type 2 diabetes. It lowers blood glucose levels by helping the pancreas make more insulin right after meals. Belongs to the class of medicines called D-phenylalanine derivatives. (Brand name: Starlix.)
necrobiosis (NEK-roh-by-OH-sis) lipoidica (lih-POY-dik-ah) diabeticorum (DY-uh-bet-ih-KOR-um):
a skin condition usually on the lower part of the legs. Lesions can be small or extend over a large area. They are usually raised, yellow, and waxy in appearance and often have a purple border.
neovascularization (NEE-oh-VASK-yoo-ler-ih-ZAY-shun):
the growth of new, small blood vessels. In the retina, this may lead to loss of vision or blindness.
nephrologist (neh-FRAH-luh-jist):
a doctor who treats people who have kidney problems.
nephropathy (neh-FROP-uh-thee):
disease of the kidneys. Hyperglycemia and hypertension can damage the kidneys' glomeruli. When the kidneys are damaged, protein leaks out of the kidneys into the urine. Damaged kidneys can no longer remove waste and extra fluids from the bloodstream.
nerve conduction studies:
tests used to measure for nerve damage; one way to diagnose neuropathy.
nerve disease:
see neuropathy.
neurologist (ne-RAH-luh-jist):
a doctor who specializes in problems of the nervous system, such as neuropathy.
neuropathy (ne-ROP-uh-thee):
disease of the nervous system. The three major forms in people with diabetes are peripheral neuropathy, autonomic neuropathy, and mononeuropathy. The most common form is peripheral neuropathy, which affects mainly the legs and feet.
NIDDM:
see noninsulin-dependent diabetes mellitus.
noninsulin-dependent diabetes mellitus (NIDDM):
former term for type 2 diabetes.
noninvasive (NON-in-VAY-siv) blood glucose monitoring:
measuring blood glucose without pricking the finger to obtain a blood sample.
NPH insulin:
an intermediate-acting insulin; NPH stands for neutral protamine Hagedorn. On average, NPH insulin starts to lower blood glucose within 1 to 2 hours after injection. It has its strongest effect 6 to 10 hours after injection but keeps working about 10 hours after injection. Also called N insulin.
nutritionist (noo-TRIH-shuh-nist):
a person with training in nutrition; may or may not have specialized training and qualifications. See dietitian.
O
obesity:
a condition in which a greater than normal amount of fat is in the body; more severe than overweight; having a body mass index of 30 or more.
obstetrician (ob-steh-TRIH-shun):
a doctor who treats pregnant women and delivers babies.
OGTT:
see oral glucose tolerance test.
ophthalmologist (AHF-thal-MAH-luh-jist):
a medical doctor who diagnoses and treats all eye diseases and eye disorders. Opthalmologists can also prescribe glasses and contact lenses.
Ophthalmologist
optician (ahp-TI-shun):
a health care professional who dispenses glasses and lenses. An optician also makes and fits contact lenses.
optometrist (ahp-TAH-meh-trist):
a primary eye care provider who prescribes glasses and contact lenses. Optometrists can diagnose and treat certain eye conditions and diseases.
oral glucose tolerance test (OGTT):
a test to diagnose pre-diabetes and diabetes. The oral glucose tolerance test is given by a health care professional after an overnight fast. A blood sample is taken, then the patient drinks a high-glucose beverage. Blood samples are taken at intervals for 2 to 3 hours. Test results are compared with a standard and show how the body uses glucose over time.
oral hypoglycemic (hy-po-gly-SEE-mik) agents:
medicines taken by mouth by people with type 2 diabetes to keep blood glucose levels as close to normal as possible. Classes of oral hypoglycemic agents are alpha-glucosidase inhibitors, biguanides, D-phenylalanine derivatives, meglitinides, sulfonylureas, and thiazolidinediones.
Orinase:
see tolbutamide.
overweight:
an above-normal body weight; having a body mass index of 25 to 29.9.
P
pancreas (PAN-kree-us):
an organ that makes insulin and enzymes for digestion. The pancreas is located behind the lower part of the stomach and is about the size of a hand.
Pancreas
pancreas transplantation:
a surgical procedure to take a healthy whole or partial pancreas from a donor and place it into a person with diabetes.
pediatric (pee-dee-AT-rik) endocrinologist (en-doh-krih-NAH-luh-jist):
a doctor who treats children who have endocrine gland problems such as diabetes.
pedorthist (ped-OR-thist):
a health care professional who specializes in fitting shoes for people with disabilities or deformities. A pedorthist can custom-make shoes or orthotics (special inserts for shoes).
periodontal (PER-ee-oh-DON-tul) disease:
disease of the gums.
periodontist (PER-ee-oh-DON-tist):
a dentist who specializes in treating people who have gum diseases.
peripheral (puh-RIF-uh-rul) neuropathy (ne-ROP-uh-thee):
nerve damage that affects the feet, legs, or hands. Peripheral neuropathy causes pain, numbness, or a tingling feeling.
peripheral (puh-RIF-uh-rul) vascular (VAS-kyoo-ler) disease (PVD):
a disease of the large blood vessels of the arms, legs, and feet. PVD may occur when major blood vessels in these areas are blocked and do not receive enough blood. The signs of PVD are aching pains and slow-healing foot sores.
peritoneal dialysis:
see dialysis.
pharmacist (FAR-mah-sist):
a health care professional who prepares and distributes medicine to people. Pharmacists also give information on medicines.
Pharmacist
photocoagulation (FOH-toh-koh-ag-yoo-LAY-shun):
a treatment for diabetic retinopathy. A strong beam of light (laser) is used to seal off bleeding blood vessels in the eye and to burn away extra blood vessels that should not have grown there.
pioglitazone (py-oh-GLIT-uh-zone):
an oral medicine used to treat type 2 diabetes. It helps insulin take glucose from the blood into the cells for energy by making cells more sensitive to insulin. Belongs to the class of medicines called thiazolidinediones. (Brand name: Actos.)
podiatrist (puh-DY-uh-trist):
a doctor who treats people who have foot problems. Podiatrists also help people keep their feet healthy by providing regular foot examinations and treatment.
podiatry (puh-DY-uh-tree):
the care and treatment of feet.
point system:
a meal planning system that uses points to rate the caloric content of foods.
polydipsia (pah-lee-DIP-see-uh):
excessive thirst; may be a sign of diabetes.
polyphagia (pah-lee-FAY-jee-ah):
excessive hunger; may be a sign of diabetes.
polyuria (pah-lee-YOOR-ee-ah):
excessive urination; may be a sign of diabetes.
postprandial (post-PRAN-dee-ul) blood glucose:
the blood glucose level taken 1 to 2 hours after eating.
Prandin:
see repaglinide.
Precose:
see acarbose.
pre-diabetes:
a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke. Other names for pre-diabetes are impaired glucose tolerance and impaired fasting glucose.
premixed insulin:
a commercially produced combination of two different types of insulin. See 50/50 insulin and 70/30 insulin.
preprandial (pree-PRAN-dee-ul) blood glucose:
the blood glucose level taken before eating.
prevalence:
the number of people in a given group or population who are reported to have a disease.
proinsulin (proh-IN-suh-lin):
the substance made first in the pancreas and then broken into several pieces to become insulin.
proliferative (pro-LIH-fur-ah-tiv) retinopathy (REH-tih-NOP-uh-thee):
a condition in which fragile new blood vessels grow along the retina and in the vitreous humor of the eye.
prosthesis (prahs-THEE-sis):
a man-made substitute for a missing body part such as an arm or a leg.
protein (PRO-teen):
1. One of the three main nutrients in food. Foods that provide protein include meat, poultry, fish, cheese, milk, dairy products, eggs, and dried beans.
2. Proteins are also used in the body for cell structure, hormones such as insulin, and other functions.
Sources of protein
proteinuria (PRO-tee-NOOR-ee-uh):
the presence of protein in the urine, indicating that the kidneys are not working properly.
pump:
see insulin pump.
R
rapid-acting insulin:
a type of insulin that starts to lower blood glucose within 5 to 10 minutes after injection and has its strongest effect 30 minutes to 3 hours after injection, depending on the type used. See aspart insulin and lispro insulin.
rebound hyperglycemia (HY-per-gly-SEE-mee-ah):
a swing to a high level of glucose in the blood after a low level. See Somogyi effect.
receptors:
see insulin receptors.
Recognized Diabetes Education Programs:
diabetes self-management education programs that are approved by the American Diabetes Association.
regular insulin:
short-acting insulin. On average, regular insulin starts to lower blood glucose within 30 minutes after injection. It has its strongest effect 2 to 5 hours after injection but keeps working 5 to 8 hours after injection. Also called R insulin.
renal (REE-nal):
having to do with the kidneys. A renal disease is a disease of the kidneys. Renal failure means the kidneys have stopped working.
renal threshold (THRESH-hold) of glucose:
the blood glucose concentration at which the kidneys start to excrete glucose into the urine.
repaglinide (reh-PAG-lih-nide):
an oral medicine used to treat type 2 diabetes. It lowers blood glucose by helping the pancreas make more insulin right after meals. Belongs to the class of medicines called meglitinides. (Brand name: Prandin.)
retina (REH-ti-nuh):
the light-sensitive layer of tissue that lines the back of the eye.
retinopathy:
see background retinopathy, proliferative retinopathy, and diabetic retinopathy.
risk factor:
anything that raises the chances of a person developing a disease.
rosiglitazone (rose-ee-GLIH-tuh-zone):
an oral medicine used to treat type 2 diabetes. It helps insulin take glucose from the blood into the cells for energy by making cells more sensitive to insulin. Belongs to the class of medicines called thiazolidinediones. (Brand name: Avandia.)
S
saccharin (SAK-ah-rin):
a sweetener with no calories and no nutritional value.
secondary diabetes:
a type of diabetes caused by another disease or certain drugs or chemicals.
self-management:
in diabetes, the ongoing process of managing diabetes. Includes meal planning, planned physical activity, blood glucose monitoring, taking diabetes medicines, handling episodes of illness and of low and high blood glucose, managing diabetes when traveling, and more. The person with diabetes designs his or her own self-management treatment plan in consultation with a variety of health care professionals such as doctors, nurses, dietitians, pharmacists, and others.
70/30 insulin:
premixed insulin that is 70 percent intermediate-acting (NPH) insulin and 30 percent short-acting (regular) insulin.
sharps container:
a container for disposal of used needles and syringes; often made of hard plastic so that needles cannot poke through.
short-acting insulin:
a type of insulin that starts to lower blood glucose within 30 minutes after injection and has its strongest effect 2 to 5 hours after injection. See regular insulin.
side effects:
the unintended action(s) of a drug.
sliding scale:
a set of instructions for adjusting insulin on the basis of blood glucose test results, meals, or activity levels.
Somogyi (suh-MOH-jee) effect, also called rebound hyperglycemia:
when the blood glucose level swings high following hypoglycemia. The Somogyi effect may follow an untreated hypoglycemic episode during the night and is caused by the release of stress hormones.
sorbitol (SORE-bih-tall):
1. A sugar alcohol (sweetener) with 4 calories per gram.
2. A substance produced by the body in people with diabetes that can cause damage to the eyes and nerves.
split mixed dose:
division of a prescribed daily dose of insulin into two or more injections given over the course of the day.
starch:
another name for carbohydrate, one of the three main nutrients in food.
Starlix:
see nateglinide.
stroke:
condition caused by damage to blood vessels in the brain; may cause loss of ability to speak or to move parts of the body.
subcutaneous (sub-kyoo-TAY-nee-us) injection:
putting a fluid into the tissue under the skin with a needle and syringe.
sucralose:
a sweetener made from sugar but with no calories and no nutritional value.
sucrose:
a two-part sugar made of glucose and fructose. Known as table sugar or white sugar, it is found naturally in sugar cane and in beets.
sugar:
1. A class of carbohydrates with a sweet taste; includes glucose, fructose, and sucrose.
2. A term used to refer to blood glucose.
sugar alcohols:
sweeteners that produce a smaller rise in blood glucose than other carbohydrates. Their calorie content is about 2 calories per gram. Includes erythritol, hydrogenated starch hydrolysates, isomalt, lactitol, maltitol, mannitol, sorbitol, and xylitol. Also known as polyols (PAH-lee-alls.)
sugar diabetes:
former term for diabetes mellitus.
sulfonylurea (sul-fah-nil-yoo-REE-ah):
a class of oral medicine for type 2 diabetes that lowers blood glucose by helping the pancreas make more insulin and by helping the body better use the insulin it makes. (Generic names: acetohexamide, chlorpropamide, glimepiride, glipizide, glyburide, tolazamide, tolbutamide.)
syndrome x:
see insulin resistance and metabolic syndrome.
syringe (suh-RINJ):
a device used to inject medications or other liquids into body tissues. The syringe for insulin has a hollow plastic tube with a plunger inside and a needle on the end.
Syringe
T
team management:
a diabetes treatment approach in which medical care is provided by a team of health care professionals including a doctor, a dietitian, a nurse, a diabetes educator, and others. The team act as advisers to the person with diabetes.
thiazolidinedione (THIGH-uh-ZOH-lih-deen-DYE-own):
a class of oral medicine for type 2 diabetes that helps insulin take glucose from the blood into the cells for energy by making cells more sensitive to insulin. (Generic names: pioglitazone and rosiglitazone.)
tight control:
see intensive therapy.
tolazamide (tohl-AH-zah-mide):
an oral medicine used to treat type 2 diabetes. It lowers blood glucose by helping the pancreas make more insulin and by helping the body better use the insulin it makes. Belongs to the class of medicines called sulfonylureas. (Brand name: Tolinase.)
tolbutamide (tohl-BYOO-tah-mide):
an oral medicine used to treat type 2 diabetes. It lowers blood glucose by helping the pancreas make more insulin and by helping the body better use the insulin it makes. Belongs to the class of medicines called sulfonylureas. (Brand name: Orinase.)
Tolinase:
see tolazamide.
triglyceride (try-GLISS-er-ide):
the storage form of fat in the body. High triglyceride levels may occur when diabetes is out of control.
type 1 diabetes:
a condition characterized by high blood glucose levels caused by a total lack of insulin. Occurs when the body's immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. Type 1 diabetes develops most often in young people but can appear in adults.
type 2 diabetes:
a condition characterized by high blood glucose levels caused by either a lack of insulin or the body's inability to use insulin efficiently. Type 2 diabetes develops most often in middle-aged and older adults but can appear in young people.
type I diabetes:
former term for type 1 diabetes.
type II diabetes:
former term for type 2 diabetes.
U
UKPDS:
see United Kingdom Prospective Diabetes Study.
ulcer (UL-sur):
a deep open sore or break in the skin.
ultralente (UL-truh-LEN-tay) insulin:
long-acting insulin. On average, ultralente insulin starts to lower blood glucose within 4 to 6 hours after injection. It has its strongest effect 10 to 18 hours after injection but keeps working 24 to 28 hours after injection. Also called U insulin.
unit of insulin:
the basic measure of insulin. U-100 insulin means 100 units of insulin per milliliter (mL) or cubic centimeter (cc) of solution. Most insulin made today in the United States is U-100.
United Kingdom Prospective Diabetes Study (UKPDS):
a study in England, conducted from 1977 to 1997 in people with type 2 diabetes. The study showed that if people lowered their blood glucose, they lowered their risk of eye disease and kidney damage. In addition, those with type 2 diabetes and hypertension who lowered their blood pressure also reduced their risk of stroke, eye damage, and death from long-term complications.
U-100:
see unit of insulin.
urea (yoo-REE-uh):
a waste product found in the blood that results from the normal breakdown of protein in the liver. Urea is normally removed from the blood by the kidneys and then excreted in the urine.
uremia (yoo-REE-mee-ah):
the illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion.
urine:
the liquid waste product filtered from the blood by the kidneys, stored in the bladder, and expelled from the body by the act of urinating.
urine testing:
also called urinalysis; a test of a urine sample to diagnose diseases of the urinary system and other body systems. In people with diabetes, a doctor may check for
1. Glucose, a sign of diabetes or other diseases.2. Protein, a sign of kidney damage, or nephropathy. (Also see albuminuria.) 3. White blood cells, a sign of urinary tract infection. 4. Ketones, a sign of diabetic ketoacidosis or other conditions.
Urine may also be checked for signs of bleeding. Some tests use a single urine sample. For others, 24-hour collection may be needed. And sometimes a sample is "cultured" to see exactly what type of bacteria grows.
urologist (yoo-RAH-luh-jist):
a doctor who treats people who have urinary tract problems. A urologist also cares for men who have problems with their genital organs, such as impotence.
V
vascular (VAS-kyoo-ler):
relating to the body's blood vessels.
Vascular system
vein:
a blood vessel that carries blood to the heart.
very-long-acting insulin:
a type of insulin that starts to lower blood glucose within 1 hour after injection and keeps working evenly for 24 hours after injection. See glargine insulin.
very-low-density lipoprotein (VLDL) cholesterol:
a form of cholesterol in the blood; high levels may be related to cardiovascular disease.
vitrectomy (vih-TREK-tuh-mee):
surgery to restore sight in which the surgeon removes the cloudy vitreous humor in the eye and replaces it with a salt solution.
vitreous (VIH-tree-us) humor:
the clear gel that lies behind the eye's lens and in front of the retina.
VLDL cholesterol:
see very-low-density lipoprotein cholesterol.
void:
to urinate; to empty the bladder.
W
wound care:
steps taken to ensure that a wound such as a foot ulcer heals correctly. People with diabetes need to take special precautions so wounds do not become infected.
X
xylitol (ZY-lih-tall):
a carbohydrate-based sweetener found in plants and used as a substitute for sugar; provides calories. Found in some mints and chewing gum.
REFERENCES
National Diabetes Education Program1 Diabetes WayBethesda, MD 20892-3600Phone: 1-800-438-5383Internet: http://ndep.nih.gov
The following organizations also distribute materials and support programs for people with diabetes and their families and friends:
American Diabetes Association National Service Center1701 North Beauregard Street Alexandria, VA 22311 Phone: 1-800-342-2383 or (703) 549-1500 Internet: www.diabetes.org
Juvenile Diabetes Research Foundation International120 Wall Street, 19th Floor New York, NY 10005 Phone: 1-800-533-2873 or (212) 785-9500 Internet: www.jdrf.org
National Diabetes Education Program1 Diabetes WayBethesda, MD 20892-3600Phone: 1-800-438-5383Fax: (301) 907-8906Internet: http://ndep.nih.gov
National Diabetes Information Clearinghouse
1 Information Way Bethesda, MD 20892-3560 Email: ndic@info.niddk.nih.gov
The National Diabetes Information Clearinghouse (NDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1978, the clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public. NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes.
Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts.
This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired.
NIH Publication No. 03-4016April 2003
http://diabetes.niddk.nih.gov/dm/pubs/type1and2/help.htm
Instructions
This resource is designed to be used with forms that you can print out and personalize to meet your individual needs. If you do not have a printer, you can contact the National Diabetes Information Clearinghouse at ndic@info.niddk.nih.gov to request a copy of the booklet Medicines for People With Diabetes.
American Associationof Diabetes EducatorsChicago, IL
Shelly Amos, L.R.D.Nez Percé NutritionLapwai, ID
Noreen Cohen, M.S., R.D., L.D.Humana Health Care PlansSan Antonio, TX
Paula Dubcak, R.N., C.D.E.Humana Health Care PlansSan Antonio, TX
Lois Exelbert, R.N., M.S., C.D.E., A.C.C.E.Joslin Center for DiabetesBaptist Hospital of MiamiMiami, FL
Ruth Farkas-Hirsch, R.N., M.S., C.D.E.(on behalf of American Diabetes Association)University of Washington,Diabetes Care CenterSeattle, WA
Lawana Geren, R.N., C.D.E.Humana Health Care PlansSan Antonio, TX
Gwen Hosey, M.S., A.N.P., C.D.E.IHS Portland Area Diabetes Program at WashingtonBellingham, WA
Joslin Center for DiabetesCommunity Medical CenterToms River, NJ
Melinda Maryniuk, M.Ed., R.D., C.D.E.Joslin Diabetes CenterBoston, MA
Pat Mathis, M.S., R.N., C.D.E.Marianne Sack, R.N., C.D.E.So Others Might EatWashington, DC
Kathy O'Keeffe, M.S., R.D., L.D., C.D.E.Carolina Diabetes and Kidney CenterSumter, SC
Carolyn Ross, R.D., M.S., C.D.E.PHS Indian HospitalCass Lake, MN
Lisa Spence, M.S.Purdue UniversityWest Lafayette, IN
Judy Tomassene, M.P.H., M.S., R.D.Seattle Indian Health BoardSeattle, WA
Madelyn L. Wheeler, M.S., R.D., F.A.D.A., C.D.E.Indiana University School of MedicineDiabetes Research and Training CenterIndianapolis, IN
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