What is Diabetes?
An excerpt from the book, “A Guide to Complimentary Treatments for Diabetes: Using Natural Supplements, Nutrition, and Alternative Therapies to Better Manage Your Diabetes” by Gene Bruno, MS, MHS. Read additional excerpts or buy the whole book.
WHAT IS DIABETES?
Since you are reading this book, it is likely that you or a loved one has already been diagnosed with diabetes. If this is the case, you probably understand the basics of what diabetes is about. Consequently, the purpose of this chapter is not to define the disease itself, but rather to explain some of the key things you should know about this high blood glucose (blood sugar) disorder. This is so that you can learn to live with diabetes, perhaps even thrive with the disease, and—most importantly—stay healthy.
SYMPTOMS OF DIABETES
Diabetes is characterized by a variety of symptoms. If you have not been diagnosed with diabetes but think you may have it, compare the symptoms you are experiencing to the symptoms on the following list. If two or more match up, it would be a good idea to see your doctor for a proper test and diagnosis.
Common Symptoms of Diabetes
- Blurred vision
- Increased appetite
- Increased infections
- Increased thirst
- Frequent urination
- Weight loss
Not everyone who suffers from diabetes will experience the same symptoms. Diabetes is a disease where the sufferer has higher-than-normal blood glucose levels. A normal range for fasting blood sugar is 60 to 109 milligrams per deciliter (mg/dL). When a person’s fasting blood glucose level is over 200 mg/dL, his or her kidneys lose their ability to reabsorb glucose back into the blood, causing some glucose to spill into the urine. In turn, these high glucose levels in the urine draw additional water from the blood, which increases the amount of urine produced. These people will likely experience frequent urination, dehydration, and an increased thirst. However, this is not the case for everyone. For some, constant fatigue is the only overt symptom.
Because diabetes is characterized by high glucose levels (which result from the body’s inability to make or use sufficient amounts of insulin), the diagnosis of diabetes is based primarily upon a measurement of blood glucose levels. Typically, this is done by means of a blood glucose test. A diagnosis of diabetes is made based upon the test results, which differ depending on the type of test used.
Table 1.1 shows the glucose levels that would be an indication of diabetes, depending on the blood test used. Please keep in mind that a non-diabetic person could possibly have glucose levels of 200 mg/dL after eating a meal, so these blood test results are just one factor in making a diabetes diagnosis. If someone has diabetes, symptoms of the disease will be present in addition to high glucose levels.
A diagnosis of diabetes is not as straightforward as simply having the disease or not having it. There are different types of diabetes and pre-diabetes, all of which will be discussed in the next section.
|Table 1.1 Glucose Levels Indicating Diabetes|
|Test Type||Glucose Levels|
|Eight-Hour Fast||126 mg/dL or greater|
|Fasting Blood Glucose Test||200 mg/dL or greater|
|Random Blood Glucose Test||200 mg/dL or greater|
TYPES OF DIABETES
There are three types of diabetes: type-1, type-2, and gestational. Type-1 diabetes, previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes, accounts for 5 to 10 percent of all diagnosed cases of adult diabetes. Although type-1 diabetes usually only affects children and young adults, it can occur at any age. This type of diabetes is primarily an autoimmune disease because with type-1, the body’s immune system destroys beta cells in the pancreas (beta cells make insulin).
To date, no specific ways to prevent type-1 diabetes have been established. Treatment typically involves having insulin delivered by an injection or a pump. A healthy meal plan and exercise program should also be part of the treatment strategy. See Chapter 2 for more information about this.
Type-2 diabetes, previously called non-insulin-dependent diabetes mellitus or adult-onset diabetes, accounts for about 90 to 95 percent of all diagnosed cases of diabetes. Type-2 usually starts as insulin resistance, a disorder in which the cells do not use insulin effectively. Unfortunately, as the body’s need for insulin increases, the pancreas gradually loses its ability to produce it.
People with type-2 diabetes can often control their blood glucose by following a healthy meal plan and exercise program, losing excess weight, and taking oral medication that helps lower glucose levels. However, some people with type-2 diabetes may also need insulin to control their blood glucose.
Gestational diabetes is a type of glucose intolerance that occurs during pregnancy. Women who suffer from this type of diabetes require treatment to normalize their maternal blood glucose levels. This is to avoid complications in the infant.
Immediately after the pregnancy, 5 to 10 percent of women who had gestational diabetes are found to have diabetes, usually type-2. The remaining 90 to 95 percent women who do not receive a diagnosis of diabetes immediately after delivery have a 40 to 60 percent chance of developing type-2 diabetes in the next five to ten years.
Before people develop type-2 diabetes, they almost always have “pre-diabetes,” a condition where blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. This may be verified with a glucose test after an overnight fast, or after a two-hour glucose tolerance test.
|Table 1.2 Glucose Levels Indicating Pre-Diabetes|
|Test Type||Glucose Levels|
|Overnight Fast||100 to 125 mg/dL|
|Two-Hour Glucose Tolerance Test||140 to 199 mg/dL|
There are approximately 57 million people in the United States who have pre-diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes. Research has also shown that if you take action to manage your blood glucose when you have pre-diabetes, you can delay or prevent type-2 diabetes from ever developing.
People with pre-diabetes are at increased risk of developing type-2 diabetes and heart disease, or of having a stroke.
COMPLICATIONS OF DIABETES
When blood glucose levels remain high and largely uncontrolled for a long period of time, the result can be a variety of serious complications. These complications include, but are not limited to, neuropathy (pain in the hands and feet); high blood pressure, cholesterol, and triglyceride levels; peripheral vascular disease (including pain when walking and foot ulcers); retinopathy (the leading cause of blindness worldwide); and weight gain or obesity. (Subsequent chapters are devoted to these complications, with a specific focus on which dietary supplements and complementary therapies can help treat each one.)
Many of these complications are the result of glycosylated protein (also known as glycated protein), which is protein that glucose has attached itself to. For example, glucose can attach itself to the protein in the hemoglobin in your red blood cells and form glycosylated hemoglobin, also called hemoglobin A1C, HbA1C, or just A1C for short. If this process continues, eventually you will end up with compounds called advanced glycosylation (or glycated) end products (AGEs). These AGEs become permanent fixtures in our cells.
AGEs are very reactive, frequently interacting with one anoth- er and other proteins. In the case of blood capillaries, this can result in the walls of the capillaries thickening, eventually block- ing off blood vessels. This is the underlying cause of kidney complications (nephropathy) and eye complications (retinopathy).
Having high levels of cellular sorbitol (a type of sugar alco- hol) may also result in diabetes complications. When you have high glucose levels, sorbitol is produced in high concentra- tions. Intracellular sorbitol (an accumulation of sorbitol within the cells) disrupts the pressure balance between the inside and outside of the cell, allowing water to enter the cell. The water causes the cell to swell. This process is what is believed to be—at least in part—responsible for the nerve damage (neuropathy) caused by diabetes. (Please note that this does not mean that consuming sorbitol in foods will have the same effect—it will not.)
The Importance of Blood Glucose Numbers
Research shows that keeping your blood glucose at normal levels reduces your chance of experiencing diabetic complications. To do this, you need to know your blood glucose numbers and your target goals.
There are two different tests to measure your blood glucose: the A1C test and the self-monitoring blood glucose (SMBG) test. The A1C test measures the amount of glucose that has attached to hemoglobin and measures your average blood glucose level over a period of three months. The SMBG test is self- administered. You do this test yourself using a drop of blood and a meter that measures the level of glucose in your blood at the time.
The A1C Test
You should have an A1C test done at least twice a year. The A1C test requires only a small blood sample, which can be taken at any time of the day. The A1C test is the best test to let you and your healthcare professional(s) know if your treat- ment plan is working over time. For most diabetics, the A1C goal is less than seven. An A1C result that is higher than seven means that you have a greater chance of diabetic complications. Conversely, lowering your A1C can improve your chances of staying healthy. If your number is seven or higher, you should talk to your healthcare professional about changing your treatment plan to bring your A1C number down. If you are pregnant, keeping your A1C at less than six will help ensure your baby is born healthy. If possible, women should plan ahead and work to get their A1C below six before getting pregnant. Although you typically have blood drawn at a lab or your doctor’s office for the A1C test, there are also A1C home testing devices. You and your doctor should decide if home testing is a good idea for you. If so, it is important to learn to do the test correctly and always discuss the results with your doctor.
The SMBG Test
Taking a SMBG test with a glucose meter helps determine how food, physical activity, and medicine affect your blood glucose levels. The readings can help you manage your diabetes day- by-day or even hour-by-hour. It’s a good idea to keep a record of your test results and review it each time you visit your healthcare professional. To do a SMBG test, you use a tiny drop of blood and a meter to measure your blood glucose level. Be sure you know how to do the test correctly. Most new meters give results as plasma glucose rather than whole blood glucose and come with a guide that shows desirable levels. Plasma does not include the red blood cells, so there is more room for glucose to occupy this space. Be sure to set your blood glucose goals with your healthcare professionals.
Usually, self tests are done before meals, after meals, and/or at bedtime—but diabetics who use insulin usually need to test more often than those who do not take insulin. However, you should talk to your healthcare professionals to determine the specifics of when and how often you should check your blood glucose. Most states have passed laws that require insurance to cover SMBG supplies and diabetes educa- tion. Check your coverage with your insurance plan. Medicare covers most of the cost of diabetes test strips, lancets (needles used to get a drop of blood), and blood glucose meters for people who have diabetes. If you are on Medicare, ask your doctor for details about coverage of the A1C test, diabetes supplies, diabetes education, and nutrition counseling.
Now that you have learned exactly what diabetes is and how a diagnosis is made, you will be able to make more informed decisions regarding your treatment. Although it may seem inconvenient and it may take awhile to get used to the regularity with which you must conduct the blood glucose tests (the SMBG in particular), it is vital that you do so. As previously stated, having the A1C test done at least twice a year is also important. Your healthcare professionals will need both the SMBG and A1C tests in order to get a complete picture of your blood glucose control. Without these tests, you won’t be able to tell if your dietary, medical, supplemental, and complementary therapy efforts are paying off.
Of course, your diet plays a large roll in the progression and treatment of diabetes. To make sure that you are making the right dietary efforts, read on to the next chapter, which provides plenty of information regarding the proper diet for a diabetic.
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