Comprehensive catalog of types of diabetes, symptoms, treatments, and complications

[Guest guest]

I came across this article on the Mayo Clinic site. Much of it is common

knowledge to those on the list who are veterans, but it might be helpful for

some who aren't. It reads quickly, even though it is fairly long. It's

concise and accurate, and covers everything.

Dave

From:

http://www.mayoclinic.com/health/type-1-diabetes/DS00329/DSECTION=treatments-and\

-drugs

Treatments and drugs

By Mayo Clinic staff

CLICK TO ENLARGE

Insulin pump

Treatment for type 1 diabetes is a lifelong commitment to:

a.. Taking insulin

b.. Exercising regularly and maintaining a healthy weight

c.. Eating healthy foods

d.. Monitoring blood sugar

The goal is to keep your blood sugar level as close to normal as possible to

delay or prevent complications. Although there are exceptions, generally,

the goal is to keep your daytime blood sugar levels between 80 and 120 mg/dL

(4.4 to 6.7 mmol/L) and your bedtime numbers between 100 and 140 mg/dL (5.6

to 7.8 mmol/L).

If managing your diabetes seems overwhelming, take it one day at a time. And

remember that you're not in it alone. You'll work closely with your diabetes

treatment team — doctor, diabetes educator and registered dietitian — to

keep your blood sugar level as close to normal as possible.

Insulin and other medications

Anyone who has type 1 diabetes needs insulin therapy to survive.

Types of insulin are many and include:

a.. Rapid-acting insulin

b.. Long-acting insulin

c.. Intermediate options

Examples are regular insulin (Humulin R, Novolin R, others), insulin

isophane (Humulin N, Novolin N), insulin lispro (Humalog), insulin aspart

(NovoLog), insulin glargine (Lantus) and insulin detemir (Levemir).

Depending on your needs, your doctor may prescribe a mixture of insulin

types to use throughout the day and night.

An inhaled insulin (Exubera) was previously available, but the manufacturer

stopped selling the drug because too few people were using it. Since it was

taken off the market, this drug has been linked to an increased number of

lung cancers in people with a history of smoking. However, because the

additional number of lung cancer cases is so small, it's not clear if

there's a link to the medication. If you used Exubera and have a history of

smoking, discuss these concerns with your doctor.

Injection options to get insulin into your body currently include injection

and insulin pump infusion. Insulin can't be taken orally to lower blood

sugar because stomach enzymes interfere with insulin's action.

Insulin injections can be done using:

a.. A fine needle and syringe

b.. An insulin pen — a device that looks like an ink pen, except the

cartridge is filled with insulin

c.. An insulin pump — a device about the size of a cell phone worn on the

outside of your body. A tube connects a reservoir of insulin to a catheter

that's inserted under the skin of your abdomen. There's also a wireless pump

option that's available in most areas. You wear a pod filled with insulin on

your body that has a tiny catheter that's inserted under your skin. The

insulin pod can be worn on your abdomen, lower back, or on a leg or an arm.

The programming is done with a wireless device that communicates with the

pod.

Whichever pump you use, it's programmed to dispense specific amounts of

rapid-acting insulin automatically. This steady dose of insulin is known as

your basal rate, and it replaces whatever long-acting insulin you were

using. When you eat, you program the pump with the amount of carbohydrates

you're eating and your current blood sugar, and it will give you what's

called a " bolus " dose of insulin to cover your meal and to correct your

blood sugar if it's elevated. Some research has found an insulin pump to be

more effective at controlling blood sugar levels than injections are.

Oral medications are sometimes prescribed as well, such as:

a.. Pramlintide (Symlin). An injection of this medication before you eat

can slow the movement of food through your stomach to curb the sharp

increase in blood sugar that occurs after meals.

b.. High blood pressure medications. Even if you don't have high blood

pressure, your doctor may prescribe medications known as

angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor

blockers (ARBs), because these medications can help keep your kidneys

healthy in addition to lowering blood pressure. It's recommended that people

with diabetes have blood pressures less than 130/80 millimeters of mercury

(mm Hg).

c.. Cholesterol-lowering drugs. As with high blood pressure drugs, your

doctor may not wait until your cholesterol is elevated before he or she

prescribes cholesterol-lowering agents known as statins. Cholesterol

guidelines are more aggressive for people with diabetes because of the

elevated heart disease risk. The American Diabetes Association recommends

that low-density lipoprotein (LDL, or " bad " ) cholesterol be below 100 mg/dL

(2.6 mmol/L) and that high-density lipoprotein (HDL, or " good " ) cholesterol

be over 50 mg/dL (1.3 mmol/L). Triglycerides, another type of blood fat, are

ideal when they're less than 150 mg/dL (1.7 mmol/L).

Healthy eating and counting carbohydrates

Contrary to popular perception, there's no such thing as a diabetes diet.

You won't be restricted to a lifetime of boring, bland foods. Instead,

you'll need plenty of:

a.. Fruits

b.. Vegetables

c.. Whole grains

These foods are high in nutrition and low in fat and calories. And they mean

fewer animal products and sweets. This is actually the best eating plan,

even for people without diabetes.

You'll need to learn how to count the carbohydrates in the foods you eat so

that you can give yourself enough insulin to properly metabolize those

carbohydrates. A registered dietitian can help you create a meal plan that

fits your health goals, food preferences and lifestyle.

Physical activity

Everyone needs regular aerobic exercise, and people who have type 1 diabetes

are no exception. Get your doctor's OK to exercise. Then choose activities

you enjoy, such as walking, swimming or biking. What's most important is

making physical activity part of your daily routine. Aim for at least 30

minutes of aerobic exercise most days of the week. Stretching and strength

training exercises are important, too. If you haven't been active for a

while, start slowly and build up gradually.

Remember that physical activity lowers blood sugar, often for long after

you're done working out. If you begin a new activity, check your blood sugar

level more often than usual until you know how that activity affects your

blood sugar levels. You might need to adjust your meal plan or insulin doses

to compensate for the increased activity. If you use an insulin pump, you

can set a temporary basal rate to keep your blood sugar from dropping. Ask

your doctor or diabetes educator to show you how.

Blood sugar monitoring

Depending on what type of insulin therapy you select or require —

single-dose injections, multiple-dose injections or insulin pump — you may

need to check and record your blood sugar level at least four times a day,

and probably more. Careful monitoring is the only way to make sure that your

blood sugar level remains within your target range. Be sure to wash your

hands before checking your blood sugar levels to get the most accurate

reading.

Even if you take insulin and eat on a rigid schedule, the amount of sugar in

your blood can change unpredictably. With help from your diabetes treatment

team, you'll learn how your blood sugar level changes in response to:

a.. Food. What and how much you eat will affect your blood sugar level.

Blood sugar is typically highest one to two hours after a meal.

b.. Physical activity. Physical activity moves sugar from your blood into

your cells. The more active you are, the lower your blood sugar level. To

compensate, you might need to lower your insulin dose before unusual

physical activity.

c.. Medication. You need insulin to lower your blood sugar level. But

other medications you take may affect your blood sugar level as well,

sometimes requiring changes in your diabetes treatment plan.

d.. Illness. During a cold or other illness, your body will produce

hormones that raise your blood sugar level. This might require changes in

your diabetes treatment plan.

e.. Alcohol. Alcohol can cause either high or low blood sugar, depending

on how much you drink and if you eat at the same time. If you choose to

drink, do so in moderation, which means no more than one drink a day for

women and two drinks or fewer daily for men.

f.. Stress. The hormones your body may produce in response to prolonged

stress may prevent insulin from working properly.

g.. For women, fluctuations in hormone levels. As your hormone levels

fluctuate during your menstrual cycle, so can your blood sugar level —

particularly in the week before your period. Menopause may trigger

fluctuations in your blood sugar level as well.

Continuous glucose monitoring (CGM) is the newest way to monitor blood sugar

levels, and may be most helpful for people who have developed hypoglycemia

unawareness. Continuous glucose monitors attach to the body using a fine

needle just under the skin that checks blood glucose level every few

minutes. CGM isn't yet considered as accurate as standard blood sugar

monitoring, so it's not considered a replacement method for keeping track of

blood sugar, but an additional measure.

Situational concerns

Certain life circumstances call for different considerations.

a.. Driving. Hypoglycemia can occur at any time, even when you're driving.

It's a good idea to check your blood sugar anytime you're getting behind the

wheel. If it's below 70 mg/dL (3.9 mmol/L), have a snack and then retest

again in 15 minutes to make sure it's risen to a safe level. Low blood sugar

makes it hard to concentrate or to react as rapidly as you might need to

when you're driving.

b.. Working. In the past, people with type 1 diabetes were often refused

certain jobs just because they had diabetes. Fortunately, advances in

diabetes management and anti-discrimination laws have made such blanket bans

largely a thing of the past. However, type 1 diabetes can pose some

challenges in the workplace. For example, if you work in a job that involves

driving or operating heavy machinery, hypoglycemia could pose a serious risk

to you and those around you. You may need to work with your doctor and your

employer to ensure that certain accommodations are made, such as your having

a quick break for blood sugar testing and fast access to food and drink any

time so you can properly manage your diabetes and prevent low blood sugar

levels. There are federal and state laws in place that require employers to

make reasonable accommodations for people with diabetes.

c.. Being pregnant. Because the risk of pregnancy complications is higher

for women with type 1 diabetes, experts recommend that women have a

preconception evaluation and that A1C readings should be less than 7 percent

before you attempt to get pregnant. Some drugs, such as high blood pressure

medications and cholesterol-lowering medications, may need to be stopped

before pregnancy. The risk of birth defects is increased for women with type

1 diabetes, particularly when diabetes is poorly controlled during the first

six to eight weeks of pregnancy, so planning your pregnancy is key. Careful

management of your diabetes during pregnancy can decrease your risk of

complications.

d.. Being older. As long as you're still active and have normal cognitive

abilities, your diabetes management goals will likely be the same as they

were when you were younger. But, for those who are frail, sick or have

cognitive deficits, tight control of blood sugar may not be practical. If

you're caring for a loved one with type 1 diabetes, ask his or her doctor

what the new diabetes goals should be.

Investigational treatments

a.. Pancreas transplant. With a successful pancreas transplant, you would

no longer need insulin. But pancreas transplants aren't always successful —

and the procedure poses serious risks. You would need a lifetime of potent

immune-suppressing drugs to prevent organ rejection. These drugs can have

serious side effects, including a high risk of infection and organ injury.

Because the side effects can be more dangerous than is the diabetes,

pancreas transplants are generally reserved for those with very

difficult-to-control diabetes.

b.. Islet cell transplantation. Researchers are experimenting with islet

cell transplantation, which provides new insulin-producing cells from a

donor pancreas. Although this experimental procedure has met with problems

in the past, new techniques and better drugs to prevent islet cell rejection

may improve its future chance for success. However, islet cell

transplantation still requires the use of immune-suppressing medications,

and just as it did with its own natural islet cells, the body often destroys

transplanted islet cells, making the time off insulin short-lived.

Additionally, a sufficient supply of islet cells isn't available for this

treatment to become more widespread.

c.. Stem cell transplant. In a 2007 Brazilian study, a small number of

people newly diagnosed with type 1 diabetes were able to stop using insulin

after being treated with stem cells made from their own blood. Although stem

cell transplants — which involve shutting down the immune system and then

building it up again — can be risky, the technique may one day provide an

additional treatment option for type 1 diabetes.

Signs of trouble

Despite your best efforts, sometimes problems will arise. Certain short-term

complications of type 1 diabetes require immediate care. Left untreated,

these conditions can cause seizures and loss of consciousness (coma).

Low blood sugar (hypoglycemia). This occurs when your blood sugar level

drops below your target range. Ask your doctor what's considered a low blood

sugar level for you. Blood sugar levels can drop for many reasons, including

skipping a meal, getting more physical activity than normal or injecting too

much insulin.

Learn the symptoms of low blood sugar, and test your blood sugar if you

think your blood sugar levels are dropping. When in doubt, always do a blood

sugar test. Early signs and symptoms of low blood sugar include:

a.. Sweating

b.. Shakiness

c.. Hunger

d.. Weakness

e.. Anxiety

f.. Dizziness or lightheadedness

g.. Pale skin

h.. Rapid or irregular heart rate

i.. Fatigue

j.. Headaches

k.. Blurred vision

l.. Irritability

Later signs and symptoms of low blood sugar, which can sometimes be mistaken

for alcohol intoxication in teens and adults include:

a.. Lethargy

b.. Confusion

c.. Behavior changes, sometimes dramatic

d.. Poor coordination

e.. Convulsions

If you develop hypoglycemia during the night, you might wake with

sweat-soaked pajamas or a headache. Thanks to a natural rebound effect,

nighttime hypoglycemia might cause an unusually high blood sugar reading

first thing in the morning.

If you have a low blood sugar reading, have some fruit juice, glucose

tablets, hard candy, regular (not diet) soda or another source of sugar.

Then retest your blood sugar in about 15 minutes to make sure it has gone up

into the normal range. If it's not in the normal range, re-treat with more

sugar (juice, candy, glucose tablets or another source of sugar) and then

retest in another 15 minutes. Keep doing this until you get a normal

reading. It's a good idea to eat a meal or snack once you've gotten a normal

reading. A mixed food source, such as peanut butter and crackers, can help

stabilize the blood sugar.

If a blood glucose meter isn't readily available, treat for low blood sugar

anyway if you have symptoms of hypoglycemia, and then test as soon as

possible.

Always carry a source of fast-acting sugar with you. Left untreated, low

blood sugar will cause you to lose consciousness. If this occurs, you may

need an emergency injection of glucagon — a hormone that stimulates the

release of sugar into the blood. Be sure you always have a glucagon

emergency kit available — at home, at work, when you're out — and make sure

it hasn't expired.

Hypoglycemia unawareness. Some people may lose the ability to sense that

their blood sugar levels are coming down, because they've developed a

condition known as hypoglycemia unawareness. With hypoglycemia unawareness,

the body no longer reacts to a low blood sugar with symptoms such as

lightheadedness or headaches. The more you experience low blood sugars, the

more likely you are to develop hypoglycemia unawareness. The good news is

that if you can avoid having a hypoglycemic episode for several weeks, you

may start to become more aware of impending lows.

High blood sugar (hyperglycemia). Your blood sugar can rise for many

reasons, including eating too much, eating the wrong types of foods, not

taking enough insulin, or illness.

Watch for:

a.. Frequent urination

b.. Increased thirst

c.. Blurred vision

d.. Fatigue

e.. Nausea

f.. Irritability

g.. Hunger

h.. Difficulty concentrating

If you suspect hyperglycemia, check your blood sugar. You might need to

adjust your meal plan or medications. If your blood sugar is higher than

your target range, you'll likely need to administer a " correction " using an

insulin shot or through an insulin pump. A correction is an additional dose

of insulin that should bring your blood sugar back into the normal range.

High blood sugar levels don't come down as quickly as they go up. Ask your

doctor how long to wait until you recheck. If you use an insulin pump,

random high blood sugar readings may mean you need to change the pump site.

If you have two consecutive blood sugar readings above 250 mg/dL (13.9

mmol/L), test for ketones using a urine test stick. Don't exercise if your

blood sugar level is high or if ketones are present. If only a trace or

small amounts of ketones are present, drink extra fluids to flush out the

ketones.

If your blood sugar is persistently above 300 mg/dL (16.7 mmol/L), call your

doctor or seek emergency care.

Increased ketones in your urine (diabetic ketoacidosis). If your cells are

starved for energy, your body may begin to break down fat — producing toxic

acids known as ketones.

Signs and symptoms of this serious condition include:

a.. Nausea

b.. Vomiting

c.. Abdominal pain

d.. A sweet, fruity smell on your breath

e.. Weight loss

If you suspect ketoacidosis, check your urine for excess ketones with an

over-the-counter ketones test kit. If you have large amounts of ketones in

your urine, call your doctor right away or seek emergency care. Also, call

your doctor if you have vomited more than once and you have ketones in your

urine.