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What is Diabetes?

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What is Diabetes?

STATISTICS
TYPES OF DIABETES
PRE-DIABETES
WARNING SIGNS OF DIABETES
ALL ABOUT INSULIN RESISTANCE
GETTING THE MOST FROM YOUR DOCTORS VISIT
METABOLIC SYNDROME


UNDERSTANDING DIABETES

Diabetes is an insufficient or total lack in the body, of a hormone called insulin. Insulin is produced in the pancreas, which is located near the stomach. What insulin does is it allows the glucose or sugar from the food you eat to enter the cells of the body to give you energy. The body’s ability to produce or respond to insulin is affected by diabetes due to this lack of insulin or insulin resistance.
A person without diabetes eats and the right amount of insulin enters the bloodstream and opens up the cells of the body for the glucose to enter and give them energy. 
For a person with diabetes that process is affected and the glucose isn’t getting into the cells as it should, and remains in the bloodstream adding up. This build up happens for several different reasons: (Too little insulin, cells cannot use the insulin made or the liver releases too much glucose.) This high amount of glucose is called hyperglycemia. (Hyper-high Glycemia-glucose or sugar). Over time this high blood sugar if left untreated, travels throughout the body and can cause damage to both large and small blood vessels. (eyes ,kidneys, heart, circulatory system etc.).
Diabetes is a serious, complex, chronic and age old disease. There is no cure, but it can be controlled.


STATISTICS

In 2015: 30.3 million Americans, or 9.4% of the population, had diabetes. Approximately 1.25 million American children and adults have type 1 diabetes. Of the 30.3 million adults with diabetes, 23.1 million were diagnosed and 7.2 million have diabetes and don't know it. There are approximately 1.5 million Americans diagnosed with diabetes every year. Michigan has a higher than average amount of diabetes and Muskegon an even higher average than Michigan.


TYPES OF DIABETES

TYPE 1 DIABETES:
Used to be called Juvenile Diabetes. About 10% of the people with diabetes have Type 1. It is seen mostly in persons 20 years of age or younger. The pancreas stops producing insulin. The body actually destroys its own beta cells that produce insulin. The person with Type1 diabetes needs to replace the insulin with insulin injections daily. They also need to balance these injections with the right amount of food and exercise.

TYPE 2 DIABETES:
Used to be called Adult Onset diabetes. Approximately 90% of the people with diabetes have Type2. Usually they are diagnosed after the age of 40 years, but many children are being diagnosed at an increased rate.
With Type 2 diabetes, the person has some insulin, just not enough to keep their blood sugars in the normal range. Or, they could have something called insulin resistance where the insulin is just not getting into the cells of the body. Symptoms might not be as noticeable right away. 
When first diagnosed with Type 2 diabetes, you often are put on a regime of diet and exercise to control you blood sugars. If that doesn’t work you can be put on oral medications or combination of medications along with diet and exercise. The pancreas is working overtime to produce enough insulin for you and can wear itself out. 
Diabetes is a progressive disease and treatment can change over a lifetime. So sometimes a person with Type 2 diabetes needs to go on insulin, or insulin and oral medications. Type 2 diabetes is often accompanied by hypertension (high blood pressure), high cholesterol and obesity.
Diabetes is the leading cause of heart disease. A person with diabetes is 2-4 times more likely to develop heart disease or stroke. Other complications associated with diabetes are blindness, kidney failure, neuropathy (nerve damage) and amputations. Studies have shown that keeping your blood sugars in good control can lessen the severity, delay or stop complications from developing.

TYPE 1.5 or LADA (Latent Autoimmune Diabetes of Adulthood) OR SLOW ONSET TYPE 1 DIABETES:
This applies to person 25 years or older diagnosed with diabetes as adults, but who do not immediately require insulin for treatment and are often not overweight and have little or no resistance to insulin. They often do not have other signs of Type 2 diabetes such as high cholesterol and high blood pressure. It is estimated that 15-20% of persons diagnosed with Type 2 might actually have LADA or Slow Onset Type 1 Diabetes.
There are special lab tests that can be done to help with the diagnoses. One of them is (Insulin C-Peptide). This test measures residual beta cell function by determining the level of insulin production.

GESTATIONAL DIABETES:
Usually a temporary condition of elevated blood sugars during pregnancy. Women are usually tested for diabetes during their pregnancy if they have any risk factors ( family history, obesity, glycosuria-sugar in the urine, or history of gestational diabetes).
If testing shows that the women doesn’t have diabetes at that time, they are usually retested at 24-28 weeks. Women who have just average risk factors are usually tested at the 24-28 week time period. Once diagnosed, treatment includes medical nutritional therapy, exercise and if needed to control blood sugars, insulin therapy. It usually corrects itself after the baby is born. It is possible though, that the women will develop diabetes later in life.
Uncontrolled diabetes of all types results in high blood glucose levels which over time can cause long term complications.


PRE-DIABETES

What is pre-diabetes? 
Pre-diabetes is a condition that can lead to type 2 diabetes and heart disease. When you have pre-diabetes, your blood glucose (sugar) levels are higher than normal but are not high enough to be called diabetes. Diabetes can lead to many health problems, so it’s better to prevent it in the first place. You can take steps to prevent or delay type 2 diabetes and heart disease. The long term damage of elevated blood sugars can already be starting. Intervention is necessary to get your blood sugars down to normal to help prevent or delay the development of Type 2 diabetes. Talking with your doctor about proper diet, becoming more physically active, and needed weight loss can all be part of this plan.

Why do I have pre-diabetes? 
You are likely to develop pre-diabetes when you have certain risk factors. Your chances of having pre-diabetes go up if you
  • are age 45 or older
  • are African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander
  • have a parent, brother, or sister with diabetes
  • are overweight
  • are physically inactive
  • have high blood pressure or if you take medicine for high blood pressure
  • have low HDL cholesterol and/or high triglycerides
  • are a woman who had diabetes during pregnancy
  • have been diagnosed with Polycystic Ovary Syndrome (PCOS)

How can I prevent or delay diabetes? 
You can prevent or delay type 2 diabetes from developing by: 
  • cutting back on calories and saturated fat
  • losing weight
  • increasing your daily physical activity
If you’re overweight, losing 7% of your total weight can help you a lot. For example, if you weigh 200 pounds, your goal would be to lose 15 pounds. 

How do I decide what to do? 
You don’t have to make big changes. Small steps can add up to big results. Check out the ideas for eating less and moving more. 
  • Your health care team can help you make a plan. Talk about ways to be active, such as
  • walking briskly for at least 30 minutes a day, 5 days a week
  • being more active throughout the day by parking further from the store, or taking the stairs.
  • Make a plan to eat less fat and calories. You can meet with a dietitian to talk about what to eat and how to lose weight. You might try starting each dinner with a salad of leafy greens. Salad provides nutrients and fills you up. Then you might eat less of any high-calorie foods that might come later.
  • switching from regular soda and juice to no-calorie water.


Are there any medicines to treat pre-diabetes?
If you’re at very high risk for diabetes, your health care provider might give you a medicine to help prevent or delay diabetes. For most people, eating less, being more active, and losing weight work better than taking medicines. 

How often should I be checked for pre-diabetes?
If you have been told you have pre-diabetes, have your blood glucose levels checked every year. Your health care provider may want to check your glucose levels more often, especially if you’re taking a medicine for pre-diabetes.

What else should my health care provider check?
When you have pre-diabetes, your health care provider should also check for signs of heart disease and blood vessel problems. For example, your health care provider might check your blood pressure and your cholesterol. Talk with your health care team about what to do if your blood pressure or cholesterol levels are too high. Making wise food choices, staying active, and taking medicines (if needed) can help you stay healthy.
What does having pre-diabetes mean for my health in the future? Having pre-diabetes is your early warning system. Take action now and avoid the problems that diabetes and heart disease could bring. Small steps can make a big difference in your health. Choose 2 or 3 small steps today.


WARNING SIGNS OF DIABETES

Type 1 Diabetes
Most frequent in adolescents and young adults. Characterized by the sudden appearance of some or many of these symptoms:
  • Frequent Urination
  • Excessive Thirst
  • Unusual Hunger
  • Rapid or Unexplained Weight Loss
  • Obvious fatigue
  • Nausea & Vomiting
Type 2 Diabetes
Seen in adults and children. Symptoms may include any of the signs of Type 1, and/or:
  • Itching Skin
  • Blurred Vision
  • Excessive Weight
  • Drowsiness
  • Tingling, Numbness, Pain in the Extremities
  • Skin Infections and Slow Healing of Cuts. Frequent Gum or Bladder Infections.
High Risk Characteristics for Diabetes:
  • Obesity (20% or more over desired body weight)
  • Parent or sibling with diabetes
  • Women who have had a baby over 9# at birth
  • Physically inactive
  • Member of high risk ethnic population (African-American, Hispanic-American, Native American, Asian-American, or Pacific Islanders)
Symptoms of type1 diabetes can start quickly, in a matter of weeks. Symptoms of type 2 diabetes often develop slowly---over the course of several years---and can be so mild that you might not even notice them. Many people with type 2 diabetes have no symptoms. Some people do not find out they have the disease until they have diabetes-related health problems, such as blurred vision or heart trouble.
Getting checked annually, especially if you have a history of diabetes in your family, is important. Don't hesitate to call a doctor if you are experiencing any of these symptoms. Diabetes left untreated can lead to unwanted complications.


ALL ABOUT INSULIN RESISTANCE

Insulin resistance is a condition that increases your chances of developing type 2 diabetes and heart disease. When you have insulin resistance, your body has problems using insulin. Over time, this makes your blood glucose (sugars) levels go up. The good news is that cutting calories, being active, and losing weight can reverse insulin resistance and lower your chances of developing type 2 diabetes and heart disease.

What does insulin do? 
Insulin helps your body use glucose for energy. Insulin is a hormone made by the pancreas. Your body needs insulin to turn glucose into energy. Insulin works like a key at the entrance to your body’s cells. Food arrives at the door of a cell in the form of blood glucose. Insulin opens the door, just like a key. Then blood glucose enters the cell where it’s used for energy.
When you have insulin resistance, your cells don’t respond to insulin. Blood glucose still arrives at the cell door, but your cell resists opening the door for insulin. Your pancreas tries to keep blood glucose levels normal by making extra insulin. At first, the extra insulin helps. But after a while, even extra insulin can’t open the cell doors and the glucose builds up in your blood. If your blood glucose gets too high, you may have either pre-diabetes or diabetes.

What raises your risk for insulin resistance, pre-diabetes, and diabetes? 
You are at risk is you are overweight, or physically inactive. Also if you are a women with a waist measurement at your belly button over 35 inches or a man with a waist size over 40 inches. You are at risk is you have a parent, brother, or sister with type2 diabetes. If you are of African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander you are at risk. Other things that make you at risk are if you have polycystic ovary syndrome, have had gestational diabetes, have given birth to a baby weighing more than 9 pounds, are age 45 or older, have had above normal blood glucose levels, or have blood pressure levels of 140/90 or higher. More things that make you at risk include, a low HDL cholesterol level (below 35mg/dl, or high triglycerides ( higher than 250mg/dl). If you have had heart disease, a stroke, or disease of the blood vessels in your neck or legs, or have a darkening of the skin under your armpits or around your neck. Some of these risks factors also raise your risk of heart disease.

How is insulin resistance diagnosed? At this time, there is no commonly used test to diagnose insulin resistance. People with insulin resistance usually have no symptoms. Your health care provider can review your risk factors and then consider whether you’re likely to have insulin resistance. If you’re at risk, your health care provider should check your blood glucose levels to see whether you might have pre-diabetes or diabetes.

How can you prevent or reverse insulin resistance? 
You can eat less calories and be physically active. If you do, it’s more likely you’ll lose weight. Even a loss of 5-10% (about 10-20lbs) can help. Ways to eat less include: Eating smaller serving sizes, share a main dish when eating out, try calorie free drinks or water instead of regular soft drinks and juice, choose baked, grilled and steamed foods instead of fried. Other ideas for eating less are to use a smaller plate, eat more vegetables, whole grains, and fruit, ask for salad dressings and sauces “on the side”, cut back on high-fat toppings, such as butter, sour cream, regular salad dressings, mayonnaise, and gravy. Instead, season foods with barbeque sauce, salsa, lemon juice or other low-fat options. 

How to add more physical activity to your day: 
Take the stairs instead of the elevator; walk around while you talk on the phone or during TV commercials. Find an activity you enjoy, such as dancing, gardening, playing with the kids or get up to change the TV channel. Take the dog for a walk, park at the far end of the shopping center lot and walk to the store, walk every day after lunch, working up to 30 minutes of brisk walking. You can split the walking to two 15 minute walks or even three, 10 minute ones. What is your favorite activity? Find what works for you and do it. You’ll be glad you did.

Does insulin resistance affect people who already have type 2 diabetes? 
Yes, insulin resistance usually starts before type 2 diabetes is diagnosed. Then it continues, making it harder for you to reach your blood glucose targets. If you have type 2 diabetes, fight insulin resistance by eating less calories, being more active, and losing weight if you need to. Talk with your health care team about ways to achieve your goals using meal planning, physical activity and medicines.


GETTING THE MOST FROM YOUR DOCTORS VISIT

Are you getting the most from your doctor visits? 
First and foremost you have to select a doctor that is board certified. It doesn’t hurt to get opinions from others who like their doctors. Make sure your doctor is someone you are comfortable talking with. If you have a chronic condition, it is best to have a physician that deals with that condition on a regular basis. Don’t feel obligated to stay with a doctor if you are not happy or don’t feel you are getting the time you need. 

Prepare: 

  • Always arrive to your appointment a little early in case there is any paperwork that is needed. Always have you insurance card with you and let them know if the insurance or number has changed.
  • Make sure the doctor has your complete medical history and knows any allergies that you have.
  • sometimes with routine physicals you can have your blood work done ahead of time so that you can discuss the results with the doctor at the time of your visit.
  • Make sure your take your shoes and socks off in the exam room, so that the doctor will be sure to check your feet, especially if you have issues with neuropathy.
  • Bring a list of all the medications you are taking. This includes prescriptions, over the counter medications, & vitamins too. List the dosage and when and for how long you have been on the medication. You should carry this list with you at all times in case of an emergency. During the stress of an emergency, our thoughts are not always clear. So it is best to have an updated list with you.
  • Write down a list, you’re most troubling first, of all your questions you wish to ask the doctor or any health issues you are having before your appointment. That way you won’t forget anything while you are there. Include all your symptoms and how long you’ve been having them as well.
Share:
  • Make sure you are honest about your health habits when talking with your doctor.
  • Make sure you get all your questions answered and let the doctor know about all your symptoms that you are concerned about.
  • Let the doctor know if you need any refills on your prescriptions.
  • Don’t forget to bring your blood sugar log book for the doctor to see
Ask:
  • If prescribed a medication, ask if any side effects, how it should be taken (with or without food), and when. Ask if symptoms don’t improve how long you should wait to call and/or return.
  • Report problems with medications right away to your doctor.
  • Ask about any blood work or test results. Know your numbers. You should know what your blood pressure is or your cholesterol numbers are. If high you need to ask where your doctor would like to see them at.
  • Don’t hesitate to ask the doctor to repeat anything he has told you, if you don’t understand.
  • Before you leave the office you need to know when the doctor wants to see you again and what tests that you may need to get.
  • It is ok to call back after your appointment if a question arises after you get home.
So prepare ahead of time, because your time is precious as well as your doctor’s. You want to get the most from your visit.


METABOLIC SYNDROME


Even though one in four adults in the U.S. have something known as metabolic syndrome or syndrome X, many don’t know it. It is the name of a group of risk factors that raises your risk for heart disease (CHD), diabetes, and stroke. These risk factors are mentioned below:
  • A large waistline. Also known as abdominal obesity. Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as hips.
  • High triglyceride level. Triglycerides are a type of fat found in the blood.
  • Low HDL (good cholesterol). HDL helps remove cholesterol from your arteries. So, a low HDL raises your risk for heart disease.
  • High blood pressure. Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.
  • High fasting blood sugar. High blood sugars in uncontrolled diabetes can lead to damage of both small and large blood vessels in the body.
Your risk for heart disease, diabetes, and stroke increases with the number of metabolic risk factors you have. You must have at least three of the five metabolic risk factors to be diagnosed with metabolic syndrome. Having even one risk factor though still raises you risk for heart disease. You should try and control every risk factor you can to reduce your risk. 
The risk of having metabolic syndrome is closely linked to being overweight or obese, lack of physical activity, insulin resistance, sleep issues like snoring, and even genetics and age. Insulin resistance is a condition in which the body can’t use its insulin properly. This resistance can lead to high bold sugar levels, and it’s closely linked to overweight and obesity.
Metabolic syndrome is becoming more common due to a rise in obesity rates among adults. In the future, it may overtake smoking as the leading risk factor for heart disease.
Healthy lifestyle changes are the first line of treatment for metabolic syndrome. These changes include:
  • Losing weight – Your doctor will likely recommend a weight loss plan with a long term goal of lowering your body mass index to less than 25. A BMI of 25-29 is considered overweight, and a BMI of 30 or more is obese.
  • Being physically active-- Even modest amounts of physical activity are good for your health. Many Americans are not active enough. The more active you are, the more you’ll benefit. Talk with your doctor about the type and amounts of exercise that are right for you. Four main types of exercise are aerobic, muscle strengthening, bone strengthening and stretching. People with metabolic syndrome are usually urged to keep up a moderate level of activity.
  • Eating right—Means eating more fruits, vegetables and whole grains, nuts, seeds and beans, fat free or low fat dairy products, lean meats and poultry without the skin.
  • Quitting smoking— Smoking causes vasoconstriction or narrowing of the blood vessels. This is major risk factor for heart related problems. If you smoke, stop. If you have trouble stopping on your own get some help. Talk with your doctor for the best method for you.
  • Limit alcohol intake.
If lifestyle changes are not enough, your doctor may prescribe medication to control blood pressure, lipids (fats), and blood sugar. Blood –thinning medicines, such as aspirin, may also be used to reduce the risk of blood clots which often occurs with metabolic syndrome. Talk with your doctor if this is something for you. It is possible to prevent or delay metabolic syndrome, mainly with a healthy lifestyle and a lifelong commitment to change. Successfully controlling it requires this commitment, plus teamwork and support with family, friends and your health care provider.