Diabetes: Causes, Symptoms and Treatments

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. 

Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).

Fast facts on diabetes

Here are some key points about diabetes. More detail and supporting information is in the main article.

• Diabetes is a long-term condition that causes high blood sugar levels.
• In 2013 it was estimated that over 382 million people throughout the world had diabetes (Williams textbook of endocrinology).
• Type 1 Diabetes - the body does not produce insulin. Approximately 10% of all diabetes cases are type 1.
• Type 2 Diabetes - the body does not produce enough insulin for proper function. Approximately 90% of all cases of diabetes worldwide are of this type.
• Gestational Diabetes - this type affects females during pregnancy.
• The most common diabetes symptoms include frequent urination, intense thirst and hunger, weight gain, unusual weight loss, fatigue, cuts and bruises that do not heal, male sexual dysfunction, numbness and tingling in hands and feet.
• If you have Type 1 and follow a healthy eating plan, do adequate exercise, and take insulin, you can lead a normal life.
• Type 2 patients need to eat healthily, be physically active, and test their blood glucose. They may also need to take oral medication, and/or insulin to control blood glucose levels.
• As the risk of cardiovascular disease is much higher for a diabetic, it is crucial that blood pressure and cholesterol levels are monitored regularly.
• As smoking might have a serious effect on cardiovascular health, diabetics should stop smoking.
• Hypoglycemia - low blood glucose - can have a bad effect on the patient. Hyperglycemia - when blood glucose is too high - can also have a bad effect on the patient.

There are three types of diabetes:

1) Type 1 diabetes

The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, orearly-onset diabetes. People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years.

Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 10% of all diabetes cases are type 1.

Patients with type 1 diabetes will need to take insulin injections for the rest of their life. They must also ensure proper blood-glucose levels by carrying out regular blood tests and following a special diet.

Between 2001 and 2009, the prevalence of type 1 diabetes among the under 20s in the USA rose 23%, according to SEARCH for Diabetes in Youth data issued by the CDC (Centers for Disease Control and Prevention). 

2) Type 2 diabetes

The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance).

Approximately 90% of all cases of diabetes worldwide are type 2.

Measuring the glucose level in blood

Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. 

However, type 2 diabetes is typically a progressive disease - it gradually gets worse - and the patient will probably end up have to take insulin, usually in tablet form.

Overweight and obese people have a much higher risk of developing type 2 diabetes compared to those with a healthy body weight. People with a lot of visceral fat, also known as central obesity, belly fat, or abdominal obesity, are especially at risk. Being overweight/obese causes the body to release chemicals that can destabilize the body's cardiovascular and metabolic systems.

Being overweight, physically inactive and eating the wrong foods all contribute to our risk of developing type 2 diabetes. 

Drinking just one can of (non-diet) soda per day can raise our risk of developing type 2 diabetes by 22%, researchers from Imperial College London reported in the journal Diabetologia. The scientists believe that the impact of sugary soft drinks on diabetes risk may be a direct one, rather than simply an influence on body weight.

The risk of developing type 2 diabetes is also greater as we get older. Experts are not completely sure why, but say that as we age we tend to put on weight and become less physically active. 

Those with a close relative who had/had type 2 diabetes, people of Middle Eastern, African, or South Asian descent also have a higher risk of developing the disease.

Men whose testosterone levels are low have been found to have a higher risk of developing type 2 diabetes. Researchers from the University of Edinburgh, Scotland, say that low testosterone levels are linked to insulin resistance. 

For more information on how type 1 and type 2 diabetes compare, see our article: the difference between type 1 and type 2 diabetes.

3) Gestational diabetes

This type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose.

Diagnosis of gestational diabetes is made during pregnancy.

The majority of gestational diabetes patients can control their diabetes with exercise and diet. Between 10% to 20% of them will need to take some kind of blood-glucose-controlling medications. Undiagnosed or uncontrolled gestational diabetes can raise the risk of complications during childbirth. The baby may be bigger than he/she should be.

Scientists from the National Institutes of Health and Harvard University found that women whose diets before becoming pregnant were high in animal fat and cholesterol had a higher risk for gestational diabetes, compared to their counterparts whose diets were low in cholesterol and animal fats. 

Diabetes symptoms

Symptoms of diabetes - by Mikael Häggström

What is prediabetes?

The vast majority of patients with type 2 diabetes initially had prediabetes. Their blood glucose levels where higher than normal, but not high enough to merit a diabetes diagnosis. The cells in the body are becoming resistant to insulin.

Studies have indicated that even at the prediabetes stage, some damage to the circulatory system and the heart may already have occurred.

Diabetes is a metabolism disorder

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies.

When our food is digested, the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present - insulin makes it possible for our cells to take in the glucose.

Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as glucose enters the cells blood-glucose levels drop.

A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. 

This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.

How to determine whether you have diabetes, prediabetes or neither

Doctors can determine whether a patient has a normal metabolism, prediabetes or diabetes in one of three different ways - there are three possible tests:

• The A1C test
  - at least 6.5% means diabetes
  - between 5.7% and 5.99% means prediabetes
  - less than 5.7% means normal
• The FPG (fasting plasma glucose) test
  - at least 126 mg/dl means diabetes
  - between 100 mg/dl and 125.99 mg/dl means prediabetes
  - less than 100 mg/dl means normal
  An abnormal reading following the FPG means the patient has impaired fasting glucose (IFG)
• The OGTT (oral glucose tolerance test) 
  - at least 200 mg/dl means diabetes
  - between 140 and 199.9 mg/dl means prediabetes
  - less than 140 mg/dl means normal
  An abnormal reading following the OGTT means the patient has impaired glucose tolerance (IGT)

Why is it called diabetes mellitus?

Diabetes comes from Greek, and it means a "siphon". Aretus the Cappadocian, a Greek physician during the second century A.D., named the condition diabainein. He described patients who were passing too much water (polyuria) - like a siphon. The word became "diabetes" from the English adoption of the Medieval Latin diabetes.

In 1675, Thomas Willis added mellitus to the term, although it is commonly referred to simply as diabetes. Mel in Latin means "honey"; the urine and blood of people with diabetes has excess glucose, and glucose is sweet like honey. Diabetes mellitus could literally mean "siphoning off sweet water".

In ancient China people observed that ants would be attracted to some people's urine, because it was sweet. The term "Sweet Urine Disease" was coined.

Controlling diabetes - treatment is effective and important

All types of diabetes are treatable. Diabetes type 1 lasts a lifetime, there is no known cure. Type 2 usually lasts a lifetime, however, some people have managed to get rid of their symptoms without medication, through a combination of exercise, diet and body weight control.

Special diets can help sufferers of type 2 diabetes control the condition.

Researchers from the Mayo Clinic Arizona in Scottsdale showed that gastric bypass surgery can reverse type 2 diabetes in a high proportion of patients. 

They added that within three to five years the disease recurs in approximately 21% of them. "The recurrence rate was mainly influenced by a longstanding history of Type 2 diabetes before the surgery. 

This suggests that early surgical intervention in the obese, diabetic population will improve the durability of remission of Type 2 diabetes." 

Patients with type 1 are treated with regular insulin injections, as well as a special diet and exercise.

Patients with Type 2 diabetes are usually treated with tablets, exercise and a special diet, but sometimes insulin injections are also required.

If diabetes is not adequately controlled the patient has a significantly higher risk of developing complications.

Complications linked to badly controlled diabetes:

Below is a list of possible complications that can be caused by badly controlled diabetes:

• Eye complications - glaucoma, cataracts, diabetic retinopathy, and some others.
• Foot complications - neuropathy, ulcers, and sometimes gangrene which may require that the foot be amputated
• Skin complications - people with diabetes are more susceptible to skin infections and skin disorders
• Heart problems - such as ischemic heart disease, when the blood supply to the heart muscle is diminished
• Hypertension - common in people with diabetes, which can raise the risk of kidney disease, eye problems, heart attack and stroke
• Mental health - uncontrolled diabetes raises the risk of suffering from depression, anxiety and some other mental disorders
• Hearing loss - diabetes patients have a higher risk of developing hearing problems
• Gum disease - there is a much higher prevalence of gum disease among diabetes patients
• Gastroparesis - the muscles of the stomach stop working properly
• Ketoacidosis - a combination of ketosis and acidosis; accumulation of ketone bodies and acidity in the blood.
• Neuropathy - diabetic neuropathy is a type of nerve damage which can lead to several different problems.
• HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome) - blood glucose levels shoot up too high, and there are no ketones present in the blood or urine. It is an emergency condition.
• Nephropathy - uncontrolled blood pressure can lead to kidney disease
• PAD (peripheral arterial disease) - symptoms may include pain in the leg, tingling and sometimes problems walking properly
• Stroke - if blood pressure, cholesterol levels, and blood glucose levels are not controlled, the risk of stroke increases significantly
• Erectile dysfunction - male impotence.
• Infections - people with badly controlled diabetes are much more susceptible to infections
• Healing of wounds - cuts and lesions take much longer to heal

How many Americans have diabetes and prediabetes?

Statistics from the 2014 USA national diabetes fact sheet from the CDC's National Diabetes Report.

• 29.1 million US children and adults (9.3% of the population) have diabetes. This is a rise from 25.8 million (8.5%) in 2011.
  Researchers from the Jefferson School of Population Health (Philadelphia, PA) published a study which estimates that by 2025 there could be 53.1 million people with diabetes.
• 21 million people have been diagnosed with diabetes (a rise from 18.8 million in 2011).
• About 8.1 million people with diabetes have not been diagnosed (a rise from 7 million in 2011). This equates to 27.8% of people with diabetes currently being undiagnosed.

Diagnosed and undiagnosed diabetes among people aged 20 years or older, US, 2012

• About 86 million Americans aged 20 years or older have prediabetes.
• 1.7 million people aged 20 years or more were newly diagnosed with diabetes in 2012.
• 208,000 (0.25%) people younger than 20 years have diabetes.
• Approximately 1 in every 400 kids and teenagers has diabetes.
• 12.3% of people aged 20+ years have diabetes; a total of 28.9 million individuals.
• 25.9% of people aged 65+ years have diabetes; a total of 11.2 million people.
• 13.6% of men have diabetes; a total of 15.5 million people (a rise from 11.8% in 2010).
• 11.2% of women have diabetes; a total of 13.4 million people (a rise from 10.8 in 2010).

Diabetes in the UK

In the United Kingdom there are about 3.8 million people with diabetes, according to the National Health Service. Diabetes UK, a charity, believes this number will jump to 6.2 million by 2035, and the National Health Service will be spending as much as 17% of its health care budget on diabetes by then.

Diabetes spreads in southeast Asia

Diabetes is rapidly spreading in Southeast Asia as people embrace American fast foods, such as hamburgers, hot dogs, French fries and pizza. More Chinese adults who live in Singapore are dying of heart disease and developing type 2 diabetes than ever before, researchers from the University of Minnesota School of Public Health and the National University of Singapore reported in the journal Circulation.

The authors found that Chinese adults in Singapore who eat American-style junk foods twice a week had a 56% greater risk of dying prematurely form heart disease, while their risk of developing type 2 diabetes rose 27%, compared to their counterparts who "never touched the stuff". There was a 80% higher likelihood of dying from coronary heart disease for those eating fast foods four times per week. 

Some facts and myths about diabetes

Many presumed "facts" are thrown about in the paper press, magazines and on the internet regarding diabetes; some of them are, in fact, myths. It is important that people with diabetes, pre-diabetes, their loved ones, employers and schools have an accurate picture of the disease. Below are some diabetes myths:

• People with diabetes should not exercise - NOT TRUE!! Exercise is important for people with diabetes, as it is for everybody else. Exercise helps manage body weight, improves cardiovascular health, improves mood, helps blood sugar control, and relieves stress. Patients should discuss exercise with their doctor first.
• Fat people always develop type 2 diabetes eventually - this is not true. Being overweight or obese raises the risk of becoming diabetic, they are risk factors, but do not mean that an obese person will definitely become diabetic. Many people with type 2 diabetes were never overweight. The majority of overweight people do not develop type 2 diabetes.
• Diabetes is a nuisance, but not serious - two thirds of diabetes patients die prematurely from stroke or heart disease. The life expectancy of a person with diabetes is from five to ten years shorter than other people's. Diabetes is a serious disease.
• Children can outgrow diabetes - this is not true. Nearly all children with diabetes have type 1; insulin-producing beta cells in the pancreas have been destroyed. These never come back. Children with type 1 diabetes will need to take insulin for the rest of their lives, unless a cure is found one day.
• Don't eat too much sugar, you will become diabetic - this is not true. A person with diabetes type 1 developed the disease because their immune system destroyed the insulin-producing beta cells. A diet high in calories, which can make people overweight/obese, raises the risk of developing type 2 diabetes, especially if there is a history of this disease in the family.
• I know when my blood sugar levels are high or low - very high or low blood sugar levels may cause some symptoms, such as weakness, fatigue and extreme thirst. However, levels need to be fluctuating a lot for symptoms to be felt. The only way to be sure about your blood sugar levels is to test them regularly. Researchers from the University of Copenhagen, Denmark showed that even very slight rises in blood-glucose levels significantly raise the risk of ischemic heart disease. 
• Diabetes diets are different from other people's - the diet doctors and specialized nutritionists recommend for diabetes patients are healthy ones; healthy for everybody, including people without the disease. Meals should contain plenty of vegetables, fruit, whole grains, and they should be low in salt and sugar, and saturated or trans fat. Experts say that there is no need to buy special diabetic foods because they offer no special benefit, compared to the healthy things we can buy in most shops.
• High blood sugar levels are fine for some, while for others they are a sign of diabetes - high blood-sugar levels are never normal for anybody. Some illnesses, mental stress and steroids can cause temporary hikes in blood sugar levels in people without diabetes. Anybody with higher-than-normal blood sugar levels or sugar in their urine should be checked for diabetes by a health care professional.
• Diabetics cannot eat bread, potatoes or pasta - people with diabetes can eat starchy foods. However, they must keep an eye on the size of the portions. Whole grain starchy foods are better, as is the case for people without diabetes.
• One person can transmit diabetes to another person - NOT TRUE. Just like a broken leg is not infectious or contagious. A parent may pass on, through their genes to their offspring, a higher susceptibility to developing the disease.
• Only older people develop type 2 diabetes - things are changing. A growing number of children and teenagers are developing type 2 diabetes. Experts say that this is linked to the explosion in childhood obesity rates, poor diet, and physical inactivity.
• I have to go on insulin, this must mean my diabetes is severe - people take insulin when diet alone or diet with oral or non-insulin injectable diabetes drugs do not provide good-enough diabetes control, that's all. Insulin helps diabetes control. It does not usually have anything to do with the severity of the disease.
• If you have diabetes you cannot eat chocolates or sweets - people with diabetes can eat chocolates and sweets if they combine them with exercise or eat them as part of a healthy meal.
• Diabetes patients are more susceptible to colds and illnesses in general - a person with diabetes with good diabetes control is no more likely to become ill with a cold or something else than other people. However, when a diabetic catches a cold, their diabetes becomes harder to control, so they have a higher risk of complications.

Diabetes Symptoms

People can often have diabetes and be completely unaware. The main reason for this is that the symptoms, when seen on their own, seem harmless. However, the earlier diabetes is diagnosed the greater the chances are that serious complications, which can result from having diabetes, can be avoided.

The most common symptoms of diabetes

Here is a list of the most common signs and symptoms of diabetes:

Frequent urination

Have you been going to the bathroom to urinate more often recently? Do you notice that you spend most of the day going to the toilet? When there is too much glucose (sugar) in your blood you will urinate more often. If your insulin is ineffective, or not there at all, your kidneys cannot filter the glucose back into the blood. The kidneys will take water from your blood in order to dilute the glucose - which in turn fills up your bladder.

Disproportionate thirst

If you are urinating more than usual, you will need to replace that lost liquid. You will be drinking more than usual. Have you been drinking more than usual lately?

Intense hunger

As the insulin in your blood is not working properly, or is not there at all, and your cells are not getting their energy, your body may react by trying to find more energy - food. You will become hungry.

Weight gain

This might be the result of the above symptom (intense hunger).

Unusual weight loss

This is more common among people with Diabetes Type 1. As your body is not making insulin it will seek out another energy source (the cells aren't getting glucose). Muscle tissue and fat will be broken down for energy. As Type 1 is of a more sudden onset and Type 2 is much more gradual, weight loss is more noticeable with Type 1.

Increased fatigue

If your insulin is not working properly, or is not there at all, glucose will not be entering your cells and providing them with energy. This will make you feel tired and listless.

Irritability

Irritability can be due to your lack of energy.

Blurred vision

This can be caused by tissue being pulled from your eye lenses. This affects your eyes' ability to focus. With proper treatment this can be treated. There are severe cases where blindness or prolonged vision problems can occur.

Cuts and bruises don't heal properly or quickly

Do you find cuts and bruises take a much longer time than usual to heal? When there is more sugar (glucose) in your body, its ability to heal can be undermined.

More skin and/or yeast infections

When there is more sugar in your body, its ability to recover from infections is affected. Women with diabetes find it especially difficult to recover from bladder and vaginal infections.

Itchy skin

A feeling of itchiness on your skin is sometimes a symptom of diabetes.

Gums are red and/or swollen - Gums pull away from teeth

If your gums are tender, red and/or swollen this could be a sign of diabetes. Your teeth could become loose as the gums pull away from them.

Frequent gum disease/infection

As well as the previous gum symptoms, you may experience more frequent gum disease and/or gum infections.

Sexual dysfunction among men

If you are over 50 and experience frequent or constant sexual dysfunction (erectile dysfunction), it could be a symptom of diabetes.

Numbness or tingling, especially in your feet and hands

If there is too much sugar in your body your nerves could become damaged, as could the tiny blood vessels that feed those nerves. You may experience tingling and/or numbness in your hands and feet.

Symptoms of diabetes - by Mikael Häggström

Diabetes diagnosis

Diabetes can often be detected by carrying out a urine test, which finds out whether excess glucose is present. This is normally backed up by a blood test, which measures blood glucose levels and can confirm if the cause of your symptoms is diabetes.

If you are worried that you may have some of the above symptoms, you are recommended to talk to your Doctor or a qualified health professional.

What is insulin?

Insulin is a hormone. It makes our body's cells absorb glucose from the blood. The glucose is stored in the liver and muscle as glycogen and stops the body from using fat as a source of energy.

When there is very little insulin in the blood, or none at all, glucose is not taken up by most body cells. When this happens our body uses fat as a source of energy. Insulin is also a control signal to other body systems, such as amino acid uptake by body cells. Insulin is not identical in all animals - their levels of strength vary.

Porcine insulin, insulin from a pig, is the most similar to human insulin. Humans can receive animal insulin. However, genetic engineering has allowed us to synthetically produce 'human' insulin.

The pancreas

The pancreas is part of the digestive system. It is located high up in your abdomen and lies across your body where the ribs meet at the bottom. It is shaped like a leaf and is about six inches long. The wide end is called the head while the narrower end is called the tail, the mid-part is called the body.

The pancreas has two principal functions:

1. It produces pancreatic digestive juices.
2. It produces insulin and other digestive hormones.

The endocrine pancreas is the part of the pancreas that produces insulin and other hormones.

The exocrine pancreas is the part of the pancreas that produces digestive juices.

Insulin is produced in the pancreas. When protein is ingested insulin is released.

Insulin is also released when glucose is present in the blood. After eating carbohydrates, blood glucose levels rise.

Insulin makes it possible for glucose to enter our body's cells - without glucose in our cells they would not be able to function. Without insulin the glucose cannot enter our cells.

Within the pancreas, the Islets of Langerhans contain Beta cells, which synthesize (make) the insulin. Approximately 1 to 3 million Islets of Langerhans make up the endocrine part of the pancreas (mainly the exocrine gland), representing just one fiftieth of the pancreas' total mass.

Etymology (history) of the word pancreas

It is said that the pancreas was described first by Herophilus of Chalcedon in about 300B.C. and the organ was named by Rufus of Ephesus in about 100A.D

However, it is an established fact that the word pancreas had been used by Aristotle (384-322B.C.) before Herophilus.

In Aristotle's Historia Animalium, there is a line saying "another to the so-called pancreas". It is considered that the words "so-called pancreas" imply that the word pancreas had been popular at the time of Aristotle, but it had not been authorized yet as an anatomical term.

However, the word pancreas presumably has been accepted as an anatomical term since Herophilus.

The word pancreas comes from the Greek pankreas, meaning sweetbread.

How the Body Works: The Pancreas (by dizzo95)

Treatment for diabetes - how is diabetes managed?

A long time ago

Before insulin was discovered in 1921 Diabetes Type 1 was a fatal disease - most patients would die within a few years of onset. Things have changed a great deal since then.

You can lead a normal life

If you have Type 1 and follow a healthy eating plan, do adequate exercise, and take insulin, you can lead a normal life. 

Balance insulin intake with food and lifestyle

The quantity of insulin intake must be closely linked to how much food you consume, as well as when you eat. Your daily activities will also have a bearing on when and how much insulin you take.

Checking your blood glucose levels

A person with diabetes has to have his/her blood glucose levels checked periodically. There is a blood test called the A1C which tells you what your average blood glucose levels were over a two-to-three month period.

Type 2 patients need to eat healthily, be physically active, and test their blood glucose. They may also need to take oral medication, and/or insulin to control blood glucose levels.

Prevent developing cardiovascular disease

As the risk of cardiovascular disease is much higher for a diabetic, it is crucial that blood pressure and cholesterol levels are monitored regularly.

Healthy eating, doing exercise, keeping your weight down will all contribute towards good cardiovascular health - some patients will need oral medication for this.

Stop smoking!

As smoking might have a serious effect on the cardiovascular health the patient should stop smoking.

A health care provider

A health care professional (HCP) will help the patient learn how to manage his/her diabetes. The HCP will also monitor the diabetes control. It is important that you know what to do and that a professional is helping and monitoring the management of your diabetes.

In most countries the GP (general practitioner, primary care physician, family doctor) provides this regular care. There are also diabetitians, endocrinologists, cardiologists, nurses, internists, pediatricians, dietitians, podiatrists, ophthalmologists, optometrists, sports specialists and many others.

If a diabetes patient is pregnant she should see an obstetrician who specializes in diabetes (gestational diabetes). There are pediatricians who specialize in caring for the infants of diabetic mothers.

The aim of diabetes management

The main aim of diabetes management is to keep the following under control:

• Blood glucose levels
• Blood pressure
• Cholesterol levels

High and low blood glucose

The patient will need to make sure his/her blood glucose levels do not fluctuate too much.

Hypoglycemia - low blood glucose - can have a bad effect on the patient. Hypoglycemia can cause:

• Shakiness
• Anxiety
• Palpitations, Tachycardia
• Feeling hot, sweating
• Clamminess
• Feeling cold
• Hunger
• Nausea
• Abdominal discomfort
• Headache
• Numbness, pins and needles
• Depression, moodiness
• Apathy, Tiredness, Fatigue, Daydreaming
• Confusion
• Dizziness
• Bad coordination, slurred speech
• Seizures
• Coma

Hyperglycemia - when blood glucose is too high - can also have a bad effect on the patient. Hyperglycemia can cause:

• Polyphagia - frequently hungry
• Polydipsia - frequently very thirsty
• Polyuria - frequent urination
• Blurred vision
• Extreme tiredness
• Weight loss
• Cuts and scrapes will heal slowly and badly
• Dry mouth
• Dry or itchy skin
• Erectile dysfunction (impotence)
• Recurrent infections
• Kussmaul hyperventilation: deep and rapid breathing 
• Cardiac arrhythmia
• Stupor
• Coma

How is diabetes managed? - Self-monitoring of blood glucose

Monitoring your own glucose is done with a Glucose Meter. Self-monitoring is often called SMBG (self-monitoring of blood glucose). Glucose meters today are small, battery-operated devices.

A sample of blood

When you want to test for glucose with a glucose meter you need to place a small sample of your blood on a test strip. Your skin is pricked with a lancet - like a very fast pin-prick.

These test strips are disposable. You then place the strip in the monitor. The strips are coated with glucose dehydrogenase or hexokinase that combines with glucose in blood.

The blood is usually taken from a finger, but some meters allow the use of other parts of the body to supply the blood sample.

How the meter works

The meter tells you how much glucose is present in your blood. How meters do this may vary. With some meters a measurement of the amount of electricity that passes through your blood sample is measured, while others measure the degree of reflection of light. The glucose level is displayed as a number. In the case of this picture (below right) the person's glucose level is low. Many of the new meters can store a series of test results, while others can be connected to your personal computer to store results, which you can also print out.

How to choose a glucose meter

According to the FDA there are 25 different meters on the market. They are not all the same. You should bear the following in mind when choosing one:

• Testing speed
• Size
• Memory (ability to store results)
• Price

The newer models have automatic timing, error codes and signals, barcode readers to help with calibration. Some have spoken instructions for people who are visually impaired.

Using your meter

Frequency of meter usage varies significantly from patient-to-patient. It is important that you adhere to the instructions given to you from your health care provider. Every person with diabetes should be self-monitoring his/her blood glucose - this is especially so for people who are taking insulin.

According to the American Diabetes Association (ADA), patients with Type 1 should self-monitor blood glucose at least three times per day.

The ADA says that women with gestational diabetes (diabetes during pregnancy) should self-test twice a day.

There is no general recommendation from the ADA regarding frequency of self-testing for Type 2 patients.

Most patients who do have to self-test will generally have to do so before meals, a couple of hours after meals, at bedtime, 3.a.m., and whenever signs or symptoms are felt.

When a patient changes medication testing should be carried out more frequently.

If you have an unusual illness or sudden stress, you should test more frequently.

Knowing how to use your meter

As meters work in different ways you should get training from a diabetes educator.

Using a glucose meter - instructions

1. Wash your hands with warm water and soap. Dry completely. You could also dab or wipe the area with alcohol and then dry completely.
2. Use the lancet to prick your fingertip.
3. Hold your hand down. Hold your finger at the same time until you see a small droplet of blood appear.
4. Place the blood on the test strip.
5.  Follow the instructions for placing the test strip and using your meter.
6.  Keep a record of your result.

Many regulatory authorities, such as the FDA, require that meters and test strips come with instructions. It is important that you become familiar with these instructions, which should be included in the User Manual. Some meters give out an error code if something is wrong. Checking the User Manual will tell you what the error code means.

In many countries the User Manual will have a toll free number. If you call and cannot get through call your health care provider or your local emergency room. Check out the website of the manufacturer. The FDA advises patients to visit the manufacturer's website regularly for any updates or issues.

How is diabetes managed? Planning your food consumption

Three things will have a major impact on your blood glucose and blood lipids (cholesterol, triglycerides) levels

• What you eat
• How much you eat
• When you eat

By selecting the right types of foods, as well as appropriate quantities you can significantly improve your ability to control your blood glucose and blood lipids.

Researchers from UT Southwestern Medical Center reported in the journal Diabetes Care (April 2013 issue) that patients with type 2 diabetes who adhere to the same strict diet required by those who undergo bariatric surgery have similar reductions in blood glucose levels as those who had the surgery. In other words, if you have type 2 diabetes and do not undergo bariatric surgery, you will have similar blood glucose control as those who had the surgery if you stick to their diet.

What does healthy eating mean?

Healthy eating most certainly does not mean you will go hungry and have to spend much of your life desperately trying to resist temptation. You can still consume the food you like. All it means is that you will have to be much more aware of how much carbohydrate, fat and protein you consume each time you eat. You just have to get the balance right.

Carbohydrates

Carbohydrates are most abundantly found in fruit, vegetables, yoghurt, sweets, pasta and bread.

Our body needs carbohydrates; we cannot live without them. When consumed, our bodies turn the carbohydrate into blood glucose - glucose is needed by our cells for energy and growth.

If you consume the same amount of carbohydrates each time you eat - especially if those times are at the same time each day - you will be well on your way towards controlling your blood glucose.

It is important that you do not skip meals, no matter what your blood glucose readings indicate. All you will achieve by skipping meals is a more aggressive fluctuation in your blood glucose levels - something you want to try to avoid.

If your consumption of glucose can follow a regular pattern, it will be easier for you to balance food with your medicine(s) and physical activity with optimum blood glucose control.

Variety and moderation

A varied and moderated diet is ideal if you want to enjoy good health. Your carbohydrate intake should consist of a variety of grains, fruits and vegetables. They have plenty of fiber - fiber helps control blood glucose.

Remember that brown rice has more fiber than white rice; whole-grain breads have the most fiber. If you are cooking or baking, opt for whole-wheat or whole grain flours. Include pulses, such as beans; they are a great source of fiber. Dark green leafy vegetables and dark yellow ones have a slower release of carbohydrates than most other vegetables.

Carb, protein and fat mix

According to the Mayo Clinic, your daily intake of calories should consist of:

• Carbohydrates 45% to 65%
• Proteins 15% to 20%
• Fats 20% to 35%

If you adhere to your meal plan for portion sizes and eating times you should eat the same mix of carbohydrates, proteins and fats each day. Your blood sugar control will be ideal, as will your weight. The more you vary from your food plan, the Mayo Clinic informs, the more your blood glucose will fluctuate.

The rewards will be worth it

The ideal eating pattern for a person with diabetes is not really any different from what a non-diabetic person would do if he/she aimed for optimum health and fitness. However, the diabetes patient has the added incentive of trying to prevent complications from developing, such as cardiovascular disease, kidney problems, vision problems and leg and feet sores.

Foods on offer for a diabetes patient are extensive and varied. You will be able to plan a wide range of tasty and interesting meals.

The food pyramid

When you talk to your health care professional, diabetes educator or dietician, they will probably mention the Food Pyramid.

At the base there are foods rich in carbohydrates, such as grains, then there are fruit and vegetables.

Above are meat, fish, milk and cheese; which are rich in protein. At the top are the fatty foods.

Almost all diabetes and medical associations say that you should eat more from the groups at the bottom of the pyramid, and less from those at the top.

It is vital that you talk to an expert about your eating plan. It needs to be tailored according to your weight, age, which medications you are taking and how physically active you are (and, if so, when during the day you are likely to be the most active).

Glycemic index

Not all carbohydrates are the same. The Glycemic Index (GI) describes what effect certain foods can have on our blood glucose levels. A high GI tends to cause more blood glucose fluctuations than a low one. Ask your dietician.

- Information on the Glycemic Index from the Canadian Diabetes Association.

EXERCISE 

What's the best exercise for type 2 diabetes?