VOL-2

DIABETES
PREVENTION & CONTROL

BY

SOMA VISHWANATH

WHAT IS DIABETES?
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, or
early-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

of this type.

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.

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.

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.
Yessica Ramos, MD., said "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.

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.

Complications linked to 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
USA - 2011 National Diabetes Fact
Sheet
How many Americans have diabetes or pre-diabetes?

 8.5% of the US population have diabetes - 25.8 million

children and adults.

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 the disease.
 18.8 million people have been diagnosed with diabetes
 About 7 million people with diabetes have not been
diagnosed.
 Even though type 2 diabetes rates in the USA have risen
sharply, Timothy Lyons, MD, who is presently Director
of Research of the Harold Hamm Diabetes Center in
Oklahoma City says that the disease is still not being
detected promptly. He added that the lag in diagnosis
involves both patients and doctors.
 About 79 million people have pre-diabetes
 1.9 million people aged 20 years or more were newly
diagnosed with diabetes in 2010
 215,000 (0.26%) people younger than 20 years have
diabetes
 Approximately 1 in every 400 kids and teenagers has
diabetes
 11.3% of people aged 20+ years have diabetes; a total
of 25.6 million individuals
 26.9% of people aged 65+ years have diabetes; a total
of 10.9 million people
 11.8% of men have diabetes; a total of 13 million
people
 10.8% of women have diabetes; a total of 12.6 million
people

Diabetes In The United Kingdom

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 Regarding
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.
Here is a list of the most common diabetes symptoms:

 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.
Diagnosis of diabetes
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.

Type 1 diabetes
Type 1 diabetes is an autoimmune disease - the person's body
has destroyed his/her own insulin-producing beta cells in the
pancreas.

People with Diabetes Type 1 are unable to produce insulin.

Most patients with Diabetes Type 1 developed the condition
before the age of 40. Approximately 15% of all people with
diabetes have Type 1.

Type 1 diabetes is fatal unless the patient regularly takes

exogenous insulin. Some patients have had their beta cells
replaced through a pancreas transplant and have managed to
produce their own insulin again.

Type 1 diabetes is also known as juvenile diabetes or childhood

diabetes. Although a large number of diabetes Type 1 patients
become so during childhood, it can also develop after the age of
18. Developing Type 1 after the age of 40 is extremely rare.

Type 1, unlike Type 2, is not preventable. The majority of

people who develop Type 1 are of normal weight and are
otherwise healthy during onset. Exercise and diet cannot
reverse Type 1. Quite simply, the person has lost his/her
insulin-producing beta cells. Several clinical trials have
attempted to find ways of preventing or slowing down the
progress of Type 1, but so far with no proven success.

A C-peptide assay is a lab test that can tell whether somebody

has Type 1 or Type 2. As external insulin has no C-peptide a
lack of it would indicate Type 1. The test is only effective when
ALL the endogenous insulin has left the body - this can take
several months.

Diet for a person with type 1

A person with Type one will have to watch what he/she eats.
Foods that are low in fat, salt and have no or very little added
sugar are ideal. He/she should consume foods that have
complex carbohydrates, rather than fast carbohydrates, as well
as fruits and vegetables. A diet that controls the person's blood
sugar level as well as his/her blood pressure and cholesterol
levels will help achieve the best possible health. Portion size is
also important in order to maintain a healthy bodyweight.

Meal planning needs to be consistent so that the food and

insulin can work together to control blood glucose levels.
According to the Mayo Clinic there is no 'diabetes diet'.

The Clinic says you do not need to restrict yourself to boring

bland foods. Rather you should, as mentioned above, consume
plenty of fruits, vegetables and whole grains - foods that are
highly nutritious, low in fat, and low in calories. Even sugary
foods are acceptable now and again if you include them in your
food plan.

If you have Type 1 you should seek the help of a registered

dietitian. A dietitian can help you create a food plan that suits
you. Most dietitians agree that you should aim to consume the
same quantity of food, with equal portions of carbs, proteins
and fats at the same time each day.

Complications - the bad news and the

good news
A person with Type 1 has a two to four times higher risk of
developing heart disease, stroke, high blood pressure,
blindness, kidney failure, gum disease and nerve damage,
compared to a person who does not have any type of diabetes.

A person with Type 1 is more likely to have poor blood

circulation through his/her legs and feet. If left untreated the
problem may become such that a foot has to be amputated. A
person with Type 1 will likely go into a coma if untreated.

The good news is that treatment is available and it is effective

and can help prevent these complications from happening.

How to help prevent complications

 Keep your blood pressure under 130/85 mm Hg.
 Keep your cholesterol level below 200 mg.
 Check your feet every day for signs of infection.
 Get your eyes checked once a year.
 Get your dentist to check your teeth and gums twice a
year.

Physical activity helps regulate blood

sugar levels

Before starting exercise make sure your doctor tells you it is

OK. Try to make physical activity part of your daily life. You
should try to do at least 30 minutes of exercise or physical
activity each day. Physical activity or exercise means aerobic
exercise.

If you have not done any exercise for a while, start gently and
build up gradually. Physical activity helps lower your blood
sugar. Remember that exercise is good for everybody, not just
people with Type 1.

The benefits are enormous for your physical and mental health.
You will become stronger, fitter, your sleep will improve as
will your skin tone - and after some time you will look great!
Exercise will help your circulation - helping to make sure your
lower legs and feet are healthy.

Remember to check your blood sugar level more frequently

during your first few weeks of exercise so that you may adapt
your meal plans and/or insulin doses accordingly. Remember
that a person with Type 1 has to manually adjust his/her insulin
doses - the body will not respond automatically.

"Gary Hall won an Olympic gold medal in swimming.

He had Type 1 diabetes."

Possible cure for diabetes type 1 closer

with stem cells
Stem cells in the pancreas which can turn into insulin-
producing cells have been identified by researchers from the
Walter and Eliza Hall Institute of Medical Research, Parkville,
Victoria, Australia. They published their breakthrough in PLoS
One (November 9th, 2012).

The authors explain that their finding raises the hope that one
day soon patients with diabetes type 1 will be able to produce
their own insulin in their own regenerated beta cells in the
pancreas.

The scientists identified and isolated stem cells from the adult
pancreas. They then developed a method for making them
become insulin-producing cells that can secrete insulin in
response to glucose in the bloodstream.

Type 2 diabetes
A person with diabetes type 2 either:

1. Does not produce enough insulin. Or

2. Suffers from 'insulin resistance'. This means that the
insulin is not working properly.

The majority of people with Type 2 have developed the

condition because they are overweight. Type 2 generally
appears later on in life, compared to Type 1. Type 2 is the most
common form of diabetes.

In the case of insulin resistance, the body is producing the

insulin, but insulin sensitivity is reduced and it does not do the
job as well as it should do. The glucose is not entering the
body's cells properly, causing two problems:

1. A build-up of glucose in the blood.

2. The cells are not getting the glucose they need for
energy and growth.

In the early stages of Type 2 insulin sensitivity is the main

abnormality - also there are elevated levels of insulin in the
blood. There are medications which can improve insulin
sensitivity and reduce glucose production by the liver.

As the disease progresses the production of insulin is

undermined, and the patient will often need to be given
replacement insulin.
Excess abdominal fat is much more likely to bring on Type 2
Diabetes than excess fat under your skin

Many experts say that central obesity - fat concentrated around

the waist in relation to abdominal organs - may make
individuals more predisposed to develop Type 2 diabetes.

Central obesity does not include subcutaneous fat - fat under

the skin. The fat around your waist - abdominal fat - secretes a
group of hormones called adipokines. It is thought that
adipokines may impair glucose tolerance.

The majority of people who develop diabetes Type 2 were

overweight during the onset, while 55% of all Type 2 patients
were obese during onset.

Sometimes all the patient needs is to do more exercise,

lose weight and eat fewer carbs"

It is not uncommon for people to achieve long-term satisfactory

glucose control by doing more exercise, bringing down their
bodyweight and cutting down on their dietary intake of
carbohydrates.

However, despite these measures, the tendency towards insulin

resistance will continue, so the patient must persist with his/her
increased physical activity, monitored diet and bodyweight.

If the diabetes mellitus continues the patient will usually be

prescribed orally administered anti-diabetic drugs. As a person
with Type 2 does produce his/her own insulin, a combination of
oral medicines will usually improve insulin production,
regulate the release of glucose by the liver, and treat insulin
resistance to some extent.

If the beta cells become further impaired the patient will

eventually need insulin therapy in order to regulate glucose
levels.

The risk factors for type 2

Age and ethnicity. The older you are the higher your risk is,
especially if you are over 40 (for white people), and over 25
(for black, South Asian and some minority groups). It has been
found in the UK that black people and people of South Asian
origin have five times the risk of developing Type 2 compared
to white people.

Diabetes in the family. If you have a relative who has/had

diabetes your risk might be greater. The risk increases if the
relative is a close one - if your father or mother has/had
diabetes your risk might be greater than if your uncle has/had it.

Bodyweight (and inactivity combined with bodyweight).

Four-fifths of people who have Type 2 became so because they
were overweight. The more overweight a person is the higher
his/her risk will be. The highest risk is for a person who is
overweight and physically inactive. In other words, if you are
very overweight and do not do any exercise your risk is
greatest.

Cardiovascular problems and stroke. A person who has had

a stroke runs a higher risk of developing Type 2. This is also
the case for people who suffer from hypertension (high blood
pressure), or have had a heart attack. Any diagnosis of a
problem with circulation indicates a higher risk of developing
Type 2.

Gestational Diabetes. A woman who became temporarily

diabetic during pregnancy - gestational diabetes - runs a higher
risk of developing Type 2 later on. Women who give birth to a
large baby may run a higher risk, too.

Impaired fasting glycaemia (IFG) - Impaired glucose

tolerance (IGT). A person who has been diagnosed as having
impaired fasting glycaemia or impaired glucose tolerance and
does not have diabetes runs a significantly higher risk of
eventually developing Type 2. People with IFG or IGT have
higher than normal levels of glucose in their blood. In order to
prevent diabetes it is crucial that you eat healthily, keep an eye
on your weight and do exercise.
Severe mental health problems. It has been found that people
with severe mental health problems are more likely to develop
Type 2.

Diabetes and cardiovascular diseases

People with diabetes type 2 are much more likely to develop
cardiovascular diseases, such as coronary heart disease, stroke,
hypertension, inflammatory heart disease and other
cardiovascular conditions. Treatments tend to be similar to the
ones used on patients who do not have diabetes. Stents versus
bypass surgery for clogged artery - Patients with diabetes
who have one clogged artery tend to have better results from
heart bypass surgery than drug coated stents, researchers from
Saint Luke's Mid-America Heart Institute in Kansas City,
Missouri, explained at the American Heart Association's
(AHA's) Scientific Sessions 2012 in Los Angeles (4 November,
2012).

Although stents may be cheaper and appear initially to be a

better option, over the long term, bypass surgery patients in a
trial had fewer heard attacks and were less likely to die
prematurely, the investigators explained.

Senior author, Elizabeth A Magnuson, said "Our results

demonstrate that bypass surgery is not only beneficial from a
clinical standpoint, but also economically attractive from the
perspective of the US healthcare system. The economic data are
important because of the large number of people with diabetes
who are in need of procedures to unblock clogged arteries."

The findings confirm the American Heart Association’s

recommendations which have been in place since the 1990s
that diabetes patients with one clogged heart artery should
receive bypass surgery.
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.
Look at our page on Famous Diabetics - there are many of them
and they have achieved great things!

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

How is diabetes managed? -

physical activity, exercise
Physical activity Is crucial for a person
with diabetes
 it helps control your blood glucose
 it helps keep your weight down
 it helps keep your blood pressure down
 it helps raise your HDL (High-density lipoprotein),
good cholesterol levels
 it helps lower your LDL (Low-density lipoprotein), bad
cholesterol levels

These five benefits have a DIRECT bearing on how

successfully you manage your diabetes. Exercise also has other
general health benefits - you sleep better, your mental state
improves, etc.
How much exercise should you do?
Most experts say you should do exercise on at least five
days of each week. Each session should be of moderate-
intensity and should not last less than thirty minutes. The
following activities could be classed as of moderate-intensity:

 fast walking
 swimming
 cycling 5-9mph (level terrain, perhaps some slight hills)
 dancing
 rowing
 mowing the lawn

What is moderate-intensity physical

activity?
 You should experience some increase in your breathing
rate
 There should be an increase in your heart rate
 A Borg Scale perceived exertion of 11 to 14
 You should burn 3.5 to 7 calories per minute
 You should reach a METs of 3 to 6

What is MET?
MET stands for Metabolic Equivalent. An MET of 1 is when
you are sitting down doing nothing. If you walk slowly your
MET may rise to 2 or 2.5. If you walk normally it will go up to
3, while a brisk walk may bring it to 5. If a wild gorilla
suddenly appeared in the street and started chasing you your
desperate sprint would shoot your MET right up to about 8 or
even perhaps 9.

Beginners be careful!
If you have not done exercise for a long time you will need to
start with a little light exercise and build up slowly over time.
Each week add a little more time to each session and/or
increase the intensity.
Remember regular exercise is what matters. 5 days of 30
minutes each is great. One day per week at 150 minutes is not.

You must talk to your health care provider about an exercise

plan. He/she may want to check you over before you start.
Certain exercises are not ideal for patients who suffer from high
blood pressure, eye and/or foot problems.

Strength training is also good

The Centers for Disease Control and Prevention (CDC) says
that strength training exercises are good because they help you
build muscle. Strength training usually involves using weights.

Join a gym

There are many gyms today whose staff are experienced and
qualified to receive and train people for various illnesses and
conditions. In North America, Western Europe, Japan and
Australasia gyms receive doctors' referrals - doctors send them
to specific gyms as part of their therapy.

Having somebody there to help you along, occasionally to push

you along, can be a great motivator - especially for beginners
who may view the whole experience with apprehension.

Gyms are all-weather; they have equipment which gives you

immediate feedback on how well you are doing - your speed,
heart rate, calories burnt per minute/hour, your progress, etc.

Numerous people prefer gyms because it gives them a feeling

of doing something with others. Do not be afraid of joining
one. They are generally welcoming and members will not be
concerned about what you look like or how unfit you may be -
they are there for their health, just like you.

Diabetes treatment -
hypoglycemia
Hypoglycemia is sometimes called insulin reaction. It is when
your blood glucose is too low. Even though you may do all you
can to manage your diabetes, hypoglycemia can happen, and it
can and must be treated before it gets worse.

If you remember to check your blood glucose when your doctor

tells you to, your chances of experiencing hypoglycemia are
much lower. Also, a low blood glucose result will tell you that
you need to treat it.

If you feel the symptoms of hypoglycemia you should check

your blood glucose. If the reading tells you that your blood
glucose is low, you should treat it immediately.

The American Diabetes Association (ADA) says that if you

feel a hypoglycemic reaction but cannot check your blood
glucose it is better to treat the reaction than to wait till you can
check.

How do I treat hypoglycemia?

You need to raise your blood glucose. The fastest way to do
this is to eat some form of sugar. The ADA advises:

 Take 3 glucose tablets (easily bought)

 1/2 a cup of fruit juice
 5 to 6 pieces of hard candy (UK 'sweets')

You should ask your dietitian or health care professional for

more advice on what you could eat to treat hypoglycemia.
Make sure you always carry at least one type of sugar with you
so that you are prepared.

Check blood glucose, treat It and wait

20 minutes
After you have checked your blood glucose and treated the
hypoglycemia wait between 15 to 20 minutes and check your
blood glucose again. If your blood glucose is still low repeat
the whole process - eat some glucose, wait about 15-20 minutes
and check your blood glucose again.

Remember to stick to your eating times - your regular meals

and snacks are vital for keeping your blood glucose levels as
stable as possible. Hypoglycemia can affect all the organs in
your body, especially your brain.

Take hypoglycemia seriously

Hypoglycemia, if not treated quickly gets worse rapidly and the
patient will soon pass out.

A patient who passes out because of hypoglycemia will need

immediate treatment - probably a glucagon injection, or an
emergency visit to a hospital.

What does glucagon do?

Glucagon is injected, just like insulin is. However, glucagon
raises blood glucose.

You should ask your doctor to make sure you have some.

Hypoglycemia unawareness
It is possible, and not very unusual, for a person to pass out and
never have noticed they had been suffering from hypoglycemia.
This is known as hypoglycemia unawareness. The patient's
blood glucose drops and he/she is not aware of it.

Hypoglycemia unawareness is more common among patients

who have lived with diabetes for a long time, those with nerve
damage (neuropathy), patients on medication for hypertension
(high blood pressure) and those on tight glucose control.

Hypoglycemia symptoms
  Tingling sensation around the mouth
 Lightheadedness, dizziness
 Sweats
 Trembling, shakiness
 Headache
 Pallid skin (you go pale)
 Irritability, moodiness, you might become tearful
 Seizure (you have a fit, spasm)
 Absent mindedness
 Confusion
 Clumsiness
 Strong desire to eat

Diabetes treatment -
hyperglycemia
Hyperglycemia is when your blood glucose is too high; it is
the opposite of hypoglycemia. Hyperglycemia needs to be
treated immediately as it is a major cause of complications
among people with diabetes.

Hyperglycemia happens when there is no insulin in the blood,

not enough insulin in the blood, or the insulin in the blood is
not working properly.

The main reason for hyperglycemia for a patient who is being

treated for diabetes type 1 is that he/she has not given himself
enough insulin. For a type 2 diabetic it could be the same
reason, but also his/her insulin is less effective than it should
be.

For a patient with diabetes, overeating can bring on

hyperglycemia, as can too little exercise on a given day. Mental
stress can also bring it on. Remember that your body's supply
of insulin is determined by how much you give yourself, and
when. For a person who does not have diabetes his/her body
will respond automatically with appropriate quantities of
insulin.

Symptoms of hyperglycemia
 High blood glucose
 High levels of sugar in the urine
 Very hungry, hungry often (polyphagia)
 Excessive thirst, frequent thirst (polydipsia)
 Excessive and frequent urination (polyuria)
 Blurred vision - Weight loss
 Wounds and cuts heal poorly
  Dry mouth
 Cardiac arrhythmia
 Deep and rapid breathing (kussmaul hyperventilation)
 Impotence (erectile dysfunction)
 Itchy and/or dry skin
 Tiredness
 Stupor
 Coma

Good diabetes management is crucial

Your doctor will tell you what your glucose levels should be
and how often you should check it. If you stick to good
diabetes management practices your chances of experiencing
hyperglycemia are significantly reduced.

Ketoacidosis
As soon as you detect hyperglycemia, treat it immediately.
People who experience hyperglycemia and do not treat it run a
significantly high risk of going into diabetic coma
(ketoacidosis).

Ketoacidosis happens when there is not enough insulin in your

blood. Remember that without the insulin your cells cannot get
the vital fuel (energy) they need. Your body starts breaking
down fats to get its energy. This process of breaking down fats
produces ketones - waste products. Large amounts of ketones
are bad for you. Excess ketones in your blood will result in
frequent urination as your body tries to eliminate it. However, it
eventually becomes a losing battle, with the build up of ketones
happening faster than their elimination through urination.

Symptoms of ketoacidosis are:

 your breath smells fruity
 nausea and sometimes vomiting
 your mouth is extremely dry
 you are short of breath

Treating hyperglycemia
The American Diabetes Association says exercising can help
lower blood glucose levels. If your blood glucose is above
240mg/dl. Check your urine for ketones and do not exercise if
there are ketones present as this will raise your blood glucose
levels even more!
Reducing your food intake will also help lower your blood
glucose. It is important that you stick to your meal plan, which
should be worked out with a dietitian or health care
professional.

Ask your doctor for the best way to lower blood glucose levels.

If none of the measures mentioned above manages to lower

your blood glucose it is possible that your medication may have
to be re-scheduled. Your insulin and medication doses may
need to be altered, as might their timing (when you have them).

Remember that good diabetes management helps reduce the

incidence of hyperglycemia. Learn to detect hyperglycemia
quickly so that you can treat it early on.

Diabetes treatment - taking

insulin
You cannot take insulin as a pill. If you did, the moment it got
to your stomach it would be digested and would never get into
your bloodstream.

You have to inject insulin into the fat just under your skin -
from there it will get to your bloodstream.

There are many types of insulin. According to the American

Diabetes Association (ADA) there are over 20 types of insulin
in the American market. They work in different ways, they are
made differently, and they vary in price.

Insulin is most commonly made in laboratories today. It can

also come from animals, mainly pigs.

Rapid-acting insulin
This type of human insulin starts to work within five minutes of
being injected and peaks after about one hour. It continues to be
active for 2 to 4 hours. Examples of rapid-acting insulin are
lispro marketed by Eli Lilly, insulin aspart marketed by Novo
Nordisk, or insulin glulisine marketed by sanofi-aventis.

Short-acting insulin
Also known as Regular (acting) insulin. This type of human
insulin reaches your bloodstream approximately 30 minutes
after you inject it, and peaks from 2 to 3 hours after injection. It
is effective for 3 to 6 hours.

Intermediate-acting insulin
This human insulin takes from 2 to 4 hours to reach the
bloodstream after injection. It peaks at 4 to 12 hours. It is
effective for approximately 12 to 18 hours.

Long-acting insulin
This insulin gets into your bloodstream about 6 to 10 hours
after you inject it. It is effective for 20 to 24 hours. This type of
insulin is also known as ultralente.

Pre-mixed insulin
Some patients have to mix two different types of insulin. If they
find that difficult they can have the insulin pre-mixed. This is
especially useful for people who are visually impaired.

Allergic reaction to insulin additives

The insulin a diabetic takes has additives to keep it free of
bacteria and to tweak its time of action. Some patients may
have an allergic reaction to some additives found in
intermediate and long-acting insulins - however, this is very
rare.

Diabetes treatment - insulin

pump
Insulin pumps are mostly used by people with Diabetes Type 1.
However, more and more people with Type 2 are starting to use
them.

Users say that the pump allows them to get the treatment to
adapt to them, instead of the other way round as is the case with
insulin injections.

An Insulin Pump really can help you maintain your blood

glucose levels with specific parameters.

Delivers short acting insulin all day and

night
The pump delivers short (rapid) acting insulin, around the
clock, through a catheter placed under your skin. It separates
your insulin dosage into the basal rate and the bolus dose.

Basal insulin
This is your normal level of blood insulin when you have not
eaten or when you are asleep. Basal insulin is delivered
constantly throughout the day and night. It is possible to set the
pump so that amounts vary, depending on what time of day and
night it is.

Bolus (extra)
When you eat your blood will need more insulin. You press
buttons on the insulin pump which will give you a bolus -
additional insulin. The bolus covers your increased insulin
requirement because you have consumed carbohydrate.

If your blood glucose is too high you can take a bolus to bring
it back down again.

Where do you have (wear) it?

Most people simply attach the pump to their belt or waistband
using a clip or case. You can also keep it in your pocket.

If you are wearing a dress you could attach it to your arm or leg
under your clothes.

When sleeping many people place the pump next to them

on the bed, place it under the pillow or attach it to their
clothing.

Pump manufacturers say the pump is very rugged and will

withstand being dropped on the floor or the occasional soaking.
However, you should try to avoid that from happening.

Advantages of an insulin pump

 No more injections
 The pump is more accurate
 They improve A1C
 Blood glucose levels fluctuate less badly
 Easier diabetes management
 More leeway on your eating times
 More leeway on what you eat
 You can exercise without eating loads of carbs
THANK YOU