diabetes FAQ

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FAQ

What are the symptoms of diabetes?

People who think they might have diabetes must visit a physician for diagnosis.

Below is a list of the common symptoms of diabetes. However, people with

diabetes may have only some of these complaints; other people may not have any.

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.

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.

What is the difference between type 1 and type 2 diabetes mellitus?

Type 1 and type 2 diabetes mellitus are both conditions in which hyperglycemia

(high blood sugar) occurs, but the cause of the hyperglycemia is different in

the two diseases. In both, the underlying problem involves the hormone insulin,

which is produced by beta cells in the pancreas. Insulin helps cells take up

glucose (sugar), removing it from the blood. In type 1 diabetes, insulin is in

short supply because the beta cells are destroyed by an unknown process (that is

thought to involve an attack by the immune system). Type 1 diabetes occurs most

often in children and is not related to obesity.

In type 2 diabetes, the pancreas is still able to secrete insulin. However, the

tissues in the body, especially the muscles, do not take up glucose in response

to the insulin. This causes the pancreas to secrete more insulin, which forces

the tissues to take up the glucose in the blood. As the body becomes more and

more resistant to the effects of insulin, however, the pancreas can not keep up.

The net result is high blood sugar levels. Type 2 diabetes tends to occur in

adults, especially those who are overweight.

What causes type 2 diabetes? Sedentary lifestyle, obesity, smoking, high

cholesterol levels, high blood pressure and age accelerate development of the

disease in susceptible individuals. The factors that determine whether an

individual develops type 2 diabetes or not are mainly genetic (i.e., in the

family).

Can diabetes be prevented?

Most physicians believe that maintaining a normal body weight can help reduce

the risk of this condition in predisposed individuals. A number of studies have

shown that regular physical activity can significantly reduce the risk of

developing type 2 diabetes.

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.

What kinds of complications are associated with diabetes?

The complications of diabetes fall into two major categories, microvascular

(involving small blood vessels) and macrovascular (involving large blood

vessels).

Microvascular complications include eye damage (retinopathy), nerve damage

(neuropathy), and kidney damage (nephropathy). These conditions can range in

severity from those that cause no symptoms (such as protein in the urine) to

moderate (impotence, digestive difficulty, foot ulcers) to devastating

(blindness, dialysis, amputation). The best way to prevent microvascular

complications is to maintain blood glucose levels as close to normal as

possible. In addition, diabetics should obtain routine eye exams, and consult a

physician when they notice any symptoms linked to diabetic complications, such

as numbness or tingling in the feet, nausea, vomiting, or abdominal discomfort.

Macrovascular complications include atherosclerosis of large blood vessels,

which can predispose to angina and heart attack, as well as stroke. It is not

clear if blood glucose levels have much of an effect on these problems, but high

cholesterol levels and blood pressure definitely do, and should be treated

aggressively in people with diabetes.

The above complications apply to people with both type 1 and type 2 diabetes,

and usually take years to develop. People with type 1 diabetes can also develop

ketoacidosis, an acute condition in which the absence of insulin causes

extremely high blood sugar levels and the accumulation of ketones (which often

give the breath a fruity smell) in the blood. This constitutes a medical

emergency that usually requires hospitalization.

Is there a cure for diabetes?

In general, there is currently no easy way to cure diabetes. Insulin and other

medications treat the condition, but they do not provide a cure. Some patients

with type 2 diabetes can avoid having to take any medications through diet and

exercise, and to the extent that their blood sugar levels remain normal, they

can be considered cured. If they regain weight, however, they will almost

certainly re-develop high blood sugar.

In type 1 diabetes, a pancreas transplantation can " cure " the diabetes, but

there is still a lifelong requirement to take powerful anti-rejection

medications that have dangerous side effects of their own. This problem,

combined with the shortage of suitable organ donors, makes transplantation an

unsuitable option for most people.

There are several exciting new therapies in development, ranging from islet cell

transplantation to gene therapy, that may hold promise of a cure in the future.

Will I need insulin?

All people with type 1 diabetes need insulin because they do not produce any

insulin. In contrast, many people with type 2 diabetes can be treated with diet

and exercise alone or in combination with pills. Insulin therapy is only started

if pills do not work effectively or if patients request insulin. One exception

is that pregnant women with diabetes of any type are always advised to take

insulin.

How often should I see my doctor?

In general, patients with type 1 diabetes should see their doctor every 3-4

months, while patients with type 2 diabetes can have checkups every 6 months.

When a patient with diabetes is first diagnosed, or when a new therapy like

insulin is started, more frequent visits may be necessary for awhile until it is

clear that blood sugar levels are consistently well-controlled. Pregnant women

with diabetes should see their doctor on a monthly or bi-monthly basis, with

frequent phone contact to ensure good control during this critical period. Most

people with diabetes should see an eye doctor yearly, although pregnant women

should go once each trimester.

How often do I need to check my blood sugar?

Patients with type 1 diabetes need to check their blood sugars 3-4 times a day

and may need to adjust their insulin doses based on the results. Most people

with type 2 diabetes check their blood sugars less frequently, such as 1-2 times

a day. Recording blood sugar levels and bringing them to appointments with

doctors is very important so that medications can be adjusted appropriately.

Is diabetes hereditary?

Both type 1 and type 2 diabetes tend to run in families, but no specific mode of

inheritance is known. If your family members have diabetes, it is not certain

that you will, too, although you are more likely than the average person to be

diagnosed with the condition. Both type 1 and type 2 diabetes probably result

from a combination of an inherited predisposition to diabetes and some

environmental factors (e.g., being overweight may contribute to type 2

diabetes).

What is a hemoglobin A1c level?

Hemoglobin is the protein in red blood cells that carries oxygen. Glucose can

attach to hemoglobin, creating a molecule called hemoglobin A1c. This process is

dependent upon the amount of sugar in the blood, so that the higher the blood

sugar, the higher the percentage of hemoglobin A1c. Since red blood cells

survive for approximately 120 days, the hemoglobin A1c level gives your doctor a

good idea of your average blood sugar control over the previous 3 months. A

normal hemoglobin A1c level varies a little depending upon which lab does the

testing, but most people agree that anything over 6.5% is too high.

How often do I need to get my eyes checked?

People with diabetes are at risk for many complications involving the eyes,

including blindness. Therefore, they should see an eye doctor regularly.

Specifically, patients with type 1 diabetes should start seeing an eye doctor

yearly after they've been diagnosed for five years, while people with type 2

diabetes should start going yearly from the time they are diagnosed. Any

diabetic with eye symptoms, such as blurry vision, should see an eye doctor

immediately. Pregnant women often need to go once per trimester.

How can I prevent foot sores that might lead to amputation?

People with diabetes often have reduced sensation in their feet, which means

that they can step on something sharp or otherwise hurt themselves without

realizing it. This puts them at risk of developing sores on their feet. If not

caught in time, these lesions can become infected, and in extreme cases may

require limb amputation. Thus, proper foot care is essential for diabetics.

It is very important for diabetics to clean and dry their feet every day. While

doing this, they should look for sores or breaks in the skin on their feet.

Toenails should be filed and the corners should not be cut. Diabetics should be

careful to wear low-heeled shoes that fit well, and should never go barefoot. If

sores, redness, blisters, pain or breaks in the skin develop, a doctor should be

consulted immediately. Many diabetics see podiatrists regularly for help with

foot care.

Will diabetes shorten my life?

The average lifespan for people with diabetes is shorter than for nondiabetics.

Most of the increased risk of death comes from the complications of diabetes,

including heart, kidney, and nerve damage. Fortunately, we now know that careful

control of blood sugar levels can greatly reduce the risk of most of these

devastating complications. Additionally, careful attention to keeping blood

pressure and cholesterol levels in the normal range also improves lifespan for

people with diabetes. As more and better therapies and strategies for monitoring

blood sugar levels are brought into use in the next few years, we can expect

that the situation will improve even more.

I have high blood sugar, but I don't eat anything with sugar in it--how can that

be?

Many different foods, especially carbohydrates and fats, can be broken down into

glucose. In addition, glucose is made by the liver. Both of these sources, in

the setting of insulin deficiency or insulin resistance, can contribute to high

blood sugar.

If my problem is high blood sugar, why do I have to eat a low fat diet?

People with type 2 diabetes are often overweight, and patients with this

condition should make every effort to lose excess pounds. A low-fat diet can be

very useful in this regard. Additionally, people with all forms of diabetes are

prone to heart disease and stroke, and a low-fat diet can help improve blood

lipid levels.

What are the symptoms of hypoglycemia (low blood sugar)?

Hypoglycemia (low blood sugar) is a frequent side effect of insulin,

sulfonylurea, or repaglinide therapy. Hypoglycemia often feels different to

different people, but commonly noted symptoms include sweating, nervousness,

trembling or shakiness, rapid heart beat, headache, vision problems, slurred

speech, irritability, and weakness. In severe cases, it can lead to loss of

consciousness, seizures, or even coma. The vast majority of hypoglycemic

episodes are caught early, and can be treated with oral sugar, such as orange

juice or candy. In cases where the patient is unconscious, sugar has to be given

intravenously. Alternatively, a family member can inject glucagon, a hormonal

antidote to insulin, into the patient's skin. All patients taking insulin or

sulfonylureas should have such a glucagon kit at home, and someone in the house

should be trained to use it. All patients should also wear a medical alert

bracelet identifying themselves as diabetic.

Will diabetes affect my sex life?

In men, diabetes can lead to impotence, the inability to maintain an erection.

This occurs as a result of the nerve and blood vessel damage that occur in

longstanding diabetes. Fortunately, there are new medicines available to help

treat impotence. The best option, though, is prevention of nerve damage in the

first place by tight control of blood sugars.

How much exercise do I need?

People with diabetes need exercise as much, if not more than people without

diabetes. Exercise helps to lower blood glucose directly by pushing sugar into

working muscles, and it also helps patients to lose weight. Additional benefits

of exercise include reductions in blood pressure and cholesterol levels, both of

which contribute significantly to the complications of diabetes. While there is

no specific amount of exercise required for all diabetics, most physicians

recommend 20-30 minutes of moderate exercise several times each week. Patients

should talk to their doctors before initiating an exercise program, as testing

for hidden nerve damage or cardiac disease might be necessary.