Learn About Diabetes

• National Diabetes Statistics
• Diabetes 101
• Frequently Asked Questions About Diabetes

Frequently Asked Questions About Diabetes

Question: What is Diabetes?

• Answer: Diabetes means that your blood glucose (GLOO-kos), also called blood sugar, is too high. Glucose comes from the food you eat and is needed to fuel our bodies. Glucose is also stored in our liver and muscles. Your blood always has some glucose in it because your body needs glucose for energy. But having too much glucose in your blood is not healthy.An organ called the pancreas (PAN-kree-as) makes insulin (IN-suh-lin). Insulin helps glucose get from your blood into your cells. Cells take the glucose and turn it into energy.If you have diabetes, the pancreas makes little or no insulin or your cells cannot use insulin very well. Glucose builds up in your blood and cannot get into your cells. If your blood glucose stays too high, it can damage many parts of the body such as the heart, eyes, kidneys, and nerves.

Question: Are there different types of Diabetes?

Answer:
• In type 1 diabetes, the cells in the pancreas that make insulin are destroyed. If you have type 1 diabetes, you need to get insulin from shots or a pump everyday. Most teens can learn to adjust the amount of insulin they take according to their physical activity and eating patterns. This makes it easier to manage your diabetes when you have a busy schedule. Type 1 used to be called “insulin dependent” or “juvenile” diabetes. 
• In type 2 diabetes, the pancreas still makes some insulin but cells cannot use it very well. If you have type 2 diabetes, you may need to take insulin or pills to help your body’s supply of insulin work better. Type 2 used to be called “adult onset diabetes.” Now more teens are getting type 2, especially if they are overweight. 
• Gestational (jes-TAY-shon-al) diabetes is a type of diabetes that occurs when women are pregnant. Having it raises their risk for getting diabetes, mostly type 2, for the rest of their lives. It also raises their child’s risk for being overweight and for getting type 2 diabetes.

Question: How do I take care of my Diabetes?

• Answer: The key to taking care of your diabetes is to keep your blood glucose as close to normal as possible. The best way to do this is to:
• Make healthy food choices
• Eat the right amounts of food
• Be active everyday
• Stay at a healthy weight
• Take your medicines and check your blood glucose as planned with your health care team

Your doctor will tell you what blood glucose level is right for you. Your goal is to keep your blood glucose as close to this level as you can. Your doctor or diabetes educator will teach you how to check your blood glucose with a glucose meter.

It helps to know what affects your blood glucose level. Food, illness, and stress raise your blood glucose. Insulin or pills and being physically active lower your blood glucose. Talk with your doctor or diabetes educator about how these things change your blood glucose levels and how you can make changes in your diabetes plan.

Carbohydrates (CAR-boh-HY-drates), or carbs for short, are a good source of energy for our bodies.But if you eat too many carbs at one time, your blood glucose can get too high. Many foods contain carbs. Great carb choices include whole grain foods, nonfat or low-fat milk, and fresh fruits and vegetables. Eat more of them rather than white bread, whole milk, sweetened fruit drinks, regular soda, potato chips, sweets, and desserts.

Question: Why do I need to take care of my Diabetes?

• Answer: If you take care of your diabetes you can lower your risk for other health problems. High blood glucose can harm blood vessels and cause heart attacks or strokes. It can also damage organs in the body and cause blindness, kidney failure, loss of toes or feet, gum problems, or loss of teeth.The good news is that when you take care of your diabetes, you can reduce or avoid these problems.
• Do not let diabetes stop you! You can do all the things your friends do and live a long and healthy life.

Question: What are Diabetes problems?

• Answer: Too much glucose in the blood for a long time can cause diabetes problems. This high blood glucose, also called blood sugar, can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes, the leading causes of death for people with diabetes. You can do a lot to prevent or slow down diabetes problems.

Question: What should my blood glucose levels be?

• Answer: Keeping your blood glucose on target can prevent or delay diabetes problems. The chart below shows target blood glucose levels for most people with diabetes.



Target Blood Glucose Levels for People With Diabetes
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 when you need to check your blood glucose using a blood glucose meter. You will do the checks yourself. Your health care provider can teach you how to use your meter.

Question: What should I do each day to stay healthy with Diabetes?

Answer:
• Check your blood glucose every day. Each time you check your blood glucose, write the number in your record book. 
• Follow the healthy eating plan that you and your doctor or dietitian have worked out.
• Be active a total of 30 minutes most days. Ask your doctor what activities are best for you.
• Take your medicines as directed.
• Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.
• Brush and floss your teeth every day. 
• Control your blood pressure and cholesterol.  
• Don't smoke.

Question: What can I do to prevent heart disease and stroke?

Answer:
• Keep your blood glucose under control. You can see if it is under control by having an A1C test at least twice a year. The A1C test tells you your average blood glucose for the past 2 to 3 months. The target for most people is below 7.
• Keep your blood pressure under control. Have it checked at every doctor visit. The target for most people is below 130/80.
• Keep your cholesterol under control. Have it checked at least once a year. The targets for most people are
  • LDL (bad) cholesterol: below 100
  • HDL (good) cholesterol: above 40 in men and above 50 in women
  • triglycerides (another type of fat in the blood): below 150  
• Make physical activity a part of your daily routine. Aim for at least 30 minutes of exercise most days of the week. Check with your doctor to learn what activities are best for you. Take a half-hour walk every day. Or walk for 10 minutes after each meal. Use the stairs instead of the elevator. Park at the far end of the lot. Choose an activity you like and stay active.
• Make sure that the foods you eat are "heart-healthy." Include foods high in fiber, such as oat bran, oatmeal, whole-grain breads and cereals, fruits, and vegetables. Cut back on foods high in saturated fat or cholesterol, such as meats, butter, dairy products with fat, eggs, shortening, lard, and foods with palm oil or coconut oil. Limit foods with trans fat, such as snack foods and commercial baked goods.
• Lose weight if you need to. If you are overweight, try to exercise most days of the week. See a registered dietitian for help in planning meals and lowering the fat and calorie content of your diet to reach and maintain a healthy weight.
• If you smoke, quit. Your doctor can tell you about ways to help you quit smoking.
• Ask your doctor whether you should take an aspirin every day. Studies have shown that taking a low dose of aspirin every day can help reduce your risk of heart disease and stroke.
• Take your medicines as directed.

Question: What is Diabetic eye disease?

Answer: Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss or even blindness. Diabetic eye disease may include:
• Diabetic retinopathy—damage to the blood vessels in the retina.
• Cataract—clouding of the eye's lens. Cataracts develop at an earlier age in people with diabetes.
• Glaucoma—increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults.

Question: What is Diabetic retinopathy?

Answer: Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina.  In some people with diabetic retinopathy, blood vessels may swell and leak fluid.

In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision. 

If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

Question: What are the stages of Diabetic retinopathy?

Answer:
• Diabetic retinopathy has four stages:
1. Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.
2. Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.
3. Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
4. Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

Question: Who is at risk for Diabetic retinopathy?

Answer: All people with diabetes--both type 1 and type 2--are at risk. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression.During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.

Question: What can I do to protect my vision?

Answer: If you have diabetes get a comprehensive dilated eye exam at least once a year and remember:
• Proliferative retinopathy can develop without symptoms. At this advanced stage, you are at high risk for vision loss.
• Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.
• You can develop both proliferative retinopathy and macular edema and still see fine. However, you are at high risk for vision loss.
• Your eye care professional can tell if you have macular edema or any stage of diabetic retinopathy. Whether or not you have symptoms, early detection and timely treatment can prevent vision loss.

If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care.

The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight-saving laser surgery.

This level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease. Be sure to ask your doctor if such a control program is right for you.

Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health as well as help protect your vision.

Question: What are Diabetic Neuropathies (Nerve Disorders)?

Answer: Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness—loss of feeling—in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs.

About 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat and blood pressure and those who are overweight.

Question: What causes Diabetic Neuropathies?

Answer: The causes are probably different for different types of diabetic neuropathy. Researchers are studying how prolonged exposure to high blood glucose causes nerve damage. Nerve damage is likely due to a combination of factors:
• metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin
• neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves
• autoimmune factors that cause inflammation in nerves
• mechanical injury to nerves, such as carpal tunnel syndrome
• inherited traits that increase susceptibility to nerve disease
• lifestyle factors, such as smoking or alcohol use

Question: What are the symptoms of Diabetic Neuropathies?

• Answer: Symptoms depend on the type of neuropathy and which nerves are affected. Some people with nerve damage have no symptoms at all. For others, the first symptom is often numbness, tingling, or pain in the feet. Symptoms are often minor at first, and because most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Symptoms can involve the sensory, motor, and autonomic—or involuntary—nervous systems. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe.
• Symptoms of nerve damage may include:
• numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
• wasting of the muscles of the feet or hands
• indigestion, nausea, or vomiting
• diarrhea or constipation
• dizziness or faintness due to a drop in blood pressure after standing or sitting up
• problems with urination
• erectile dysfunction in men or vaginal dryness in women
• weakness

Symptoms that are not due to neuropathy, but often accompany it, include weight loss and depression.

Question: What are the types of Diabetic Neuropathy?

Answer: Diabetic neuropathy can be classified as peripheral, autonomic, proximal, or focal. Each affects different parts of the body in various ways.
• Peripheral neuropathy, the most common type of diabetic neuropathy, causes pain or loss of feeling in the toes, feet, legs, hands, and arms.
• Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes. Autonomic neuropathy can also cause hypoglycemia unawareness, a condition in which people no longer experience the warning symptoms of low blood glucose levels.
• Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs.
• Focal neuropathy results in the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain. Any nerve in the body can be affected.

Question: What is Hypoglycemia?

Answer: Hypoglycemia, also called low blood sugar, occurs when your blood glucose (blood sugar) level drops too low to provide enough energy for your body's activities. In adults or children older than 10 years, hypoglycemia is uncommon except as a side effect of diabetes treatment, but it can result from other medications or diseases, hormone or enzyme deficiencies, or tumors.

Glucose, a form of sugar, is an important fuel for your body. Carbohydrates are the main dietary sources of glucose. Rice, potatoes, bread, tortillas, cereal, milk, fruit, and sweets are all carbohydrate-rich foods.

After a meal, glucose molecules are absorbed into your bloodstream and carried to the cells, where they are used for energy. Insulin, a hormone produced by your pancreas, helps glucose enter cells. If you take in more glucose than your body needs at the time, your body stores the extra glucose in your liver and muscles in a form called glycogen. Your body can use the stored glucose whenever it is needed for energy between meals. Extra glucose can also be converted to fat and stored in fat cells.

When blood glucose begins to fall, glucagon, another hormone produced by the pancreas, signals the liver to break down glycogen and release glucose, causing blood glucose levels to rise toward a normal level. If you have diabetes, this glucagon response to hypoglycemia may be impaired, making it harder for your glucose levels to return to the normal range.

Symptoms of hypoglycemia include

• hunger
• nervousness and shakiness
• perspiration
• dizziness or light-headedness
• sleepiness
• confusion
• difficulty speaking
• feeling anxious or weak

Hypoglycemia can also happen while you are sleeping. You might

• cry out or have nightmares
• find that your pajamas or sheets are damp from perspiration
• feel tired, irritable, or confused when you wake up

Question: What is pre-diabetes?

Answer: Pre-diabetes means you have blood glucose levels that are higher than normal but not high enough to be called diabetes. Glucose is a form of sugar your body uses for energy. Too much glucose in your blood can damage your body over time. Pre-diabetes is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).

If you have pre-diabetes, you are more likely to develop type 2 diabetes, heart disease, and stroke. Being overweight and physically inactive contributes to pre-diabetes. You can sometimes reverse pre-diabetes with weight loss that comes from healthy eating and physical activity.

Question: Who should be tested for pre-diabetes?

Answer: If you are 45 years old or older, your doctor may recommend that you be tested for pre-diabetes, especially if you are overweight. Being overweight means your body mass index (BMI) is over 25. BMI is a measure of your weight relative to your height. If you’re not sure, ask your doctor if you are overweight.

Even if you are younger than 45, consider getting tested if you are overweight and

• are physically active less than three times a week
• have a parent, brother, or sister with diabetes
• have high blood pressure
• have abnormal levels of HDL cholesterol or triglycerides, two types of blood fats
• had gestational diabetes—diabetes during pregnancy—or gave birth to a baby weighing more than 9 pounds
• are African American, American Indian, Hispanic/Latino, Asian American, or Pacific Islander
• have polycystic ovary syndrome
• have dark, thick, velvety skin around your neck or in your armpits
• have blood vessel problems affecting your heart, brain, or legs

If the results are normal, you should be retested in 3 years. If you have pre-diabetes, you should be tested for type 2 diabetes every year or two.