Understanding Diabetes

Having diabetes means you have too much sugar—called glucose—in your blood. If untreated, diabetes can harm the body, particularly the heart and vascular system. In fact, people with diabetes are two-to-four times more likely to have heart disease or suffer a stroke than those who don’t have the disease. Experts say this risk is even greater for women with diabetes. 

Diabetes can lead to heart attacks, strokes, kidney disease, blindness, dental disease, amputations, and other serious health problems. And the longer you have high levels of blood glucose traveling around your body, the more likely you are to have problems. 

If you have diabetes, the best thing you can do is learn about how to manage your condition and prevent problems. 

About diabetes 

Diabetes develops when the body either:

• Does not make enough insulin or
• Is unable to use insulin properly (called insulin resistance, generally the result of being overweight, not exercising and eating a poor diet, which can lead to metabolic syndrome) or
• Both 

Insulin is a hormone that is usually made in the pancreas. It helps your body use the sugars that are in the foods we eat. Glucose gives your body energy, and insulin helps carry glucose to your cells. 

If the body doesn’t make or use insulin well, glucose builds up in the blood instead of being absorbed by cells in the body. The body’s cells are then starved of energy, despite high blood glucose levels.

There are three types of diabetes:

• Type 1 diabetes, also known as juvenile diabetes, is usually found in childhood, though not always.
• Type 2 diabetes is the most common form of diabetes—accounting for up to 95% of all cases. It most often occurs in adults; however, more and more children are being diagnosed. This may be because more youth are overweight or less physically active.
• Gestational diabetes occurs during pregnancy. 

There is also growing concern over prediabetes. People with prediabetes are more likely to develop type 2 diabetes, as well as heart disease and stroke. The good news is that you can take steps to prevent or delay the onset of full-blown diabetes. Some studies find that losing weight—just 5-to-10% of your starting weight—can delay or even reverse prediabetes.

Diabetes is a lifelong condition that needs to be managed to stay healthy. Over time, too much glucose in the blood can cause serious problems including:

• heart disease
• stroke
• damage to the blood vessels in your eyes, kidneys and nerves
• damage to the arteries of the legs that, in some cases, can lead to loss of a limb
• ulcers on the feet or legs that don’t heal well
• gum disease 

Am I at risk?

There are a number of things that can make someone more likely to develop type 2 diabetes. For example: 

• Being overweight/obese—the more weight you carry, especially around your midsection, typically the more resistant your body is to insulin
• Having high blood pressure generally or during pregnancy (called preeclampsia)
• Eating an unhealthy diet that is high in fat, calories, cholesterol and processed food
• Not exercising regularly
• Being older than 45, although it can occur in younger people
• Having a parent, brother or sister who has diabetes
• Being diagnosed with gestational diabetes
  • Up to 3 out of 5 women who had this during pregnancy will go on to develop diabetes within 15 years
• Giving birth to a baby that weighed more than 9 pounds
• Having polycystic ovarian syndrome (PCOS)

Type 2 diabetes is also more common among certain ethnic/racial groups including African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders. 

It’s important to talk with your doctor about all of your personal risk factors.

What are the signs and symptoms?

According to the American Diabetes Association, about 7 million people in the U.S. have undiagnosed diabetes; but symptoms are often present. Still, some people have no signs. 

Common signs and symptoms include:

• extreme thirst
• urinating more than usual
• unexplained weight loss/losing weight without trying
• blurry vision
• wounds or blisters that don’t heal well
• tingling or numbness in your hands and/or feet
• feeling very tired
• dry, itchy skin
• red, swollen, tender gums
• frequent infections

How it’s diagnosed 

Diabetes is diagnosed by taking a detailed medical history, including a report of symptoms, and blood tests that measure the amount of glucose in the blood or how your body handles it.

There are several types of blood tests to check your sugar level:

• Hemoglobin A1c (HbA1c or A1c), or simple A1c gives an overall picture of your blood sugar level over the last 2-3 months
• Fasting glucose test measures the amount of glucose in your blood after you haven’t had anything to eat or drink for 8 hours
• Oral glucose tolerance test checks your blood glucose levels before and 2 hours after you drink a special sweet drink and shows how well your body processes glucose

Managing Diabetes 

There are a number of things you can do to help manage your diabetes and live a healthier life. It’s very important to take steps that will help you to keep your blood sugar level low. This is most often achieved through a combination of:

• healthy eating
• exercise
• insulin therapy and/or diabetes medication, and
• routine blood sugar monitoring

The American Diabetes Association has set the following blood glucose targets for people with diabetes. Your health care team will work with you to set your personal blood glucose goals and map out a course of treatment that’s best for you.

Target Blood Glucose Levels for Most People with Diabetes
Before Meals:	70 to 130 mg/dL
1 to 2 Hours After the Start of a Meal:	Less than 180 mg/dL

HbA1c/A1c is also used to give an average blood glucose level over the past three months. Target A1c for people with diabetes should be less than 7%.

American Diabetes Association Guidelines
RESULT	A1c
Normal	Less than 5.7%
Prediabetes	5.7% to 6.4%
Diabetes	6.5% or higher

Your treatment plan will likely include: 

• Making healthier choices overall. That means:
   
  • Getting regular exercise
  • Maintaining a healthy weight
  • Eating a healthy diet that is lower in salt, fat and refined carbohydrates; it’s also helpful to meal plan, read labels and to learn how to substitute saturated and trans fats for healthier fats
  • Avoiding cigarettes and alcohol


• Taking medications 

Several medications are used to help control your blood sugar levels. The type of medicine you take—insulin therapy and/or oral diabetes medications—will depend on your type of diabetes, as well as other health conditions. 

Some medications are given by mouth; others may be given by injection or by using an insulin pen or pump. Many people with diabetes take multiple medications.

• Ongoing care and monitoring 

Taking care of yourself, going to necessary medical appointments, getting lab tests, including a yearly urine test, and knowing your blood glucose number are all important to managing diabetes. 

As mentioned, maintaining a healthy weight, staying physically active and eating a healthy diet are also key to controlling blood sugar levels. 

Talk with your doctor about:

• Checking your blood sugar level – ask your care team how often you need to check and record your blood glucose, and if you should use a glucose meter at home. Knowing your glucose levels can help you and your doctor make decisions about your medicines, meals and exercise regimen. If your glucose level is not where it should be, changes can be made to your treatment plan. Random blood sugar testing may also be done or recommended when you have symptoms.
   
• Controlling your blood pressure and cholesterol levels, if needed
   
• Knowing what to look for – ask your doctor about possible complications from diabetes and what to watch for. For example:
  
  
  • Nerve damage (called diabetic neuropathy), which most often shows as a numbness, tingling or burning in your hands or feet
  • Eye problems such as blurry vision
  • Kidney issues
  • Cuts, blisters or sores on your feet
  • Heart disease and stroke 

Call 9-1-1 if you have chest pain, fainting or shortness of breath. 

• Getting immunizations – ask your doctor about getting vaccinated to help prevent illnesses such as influenza, pneumococcal disease and shingles.

Talking to your care team

Managing diabetes is a team effort. 

You will likely be seen by a number of health professionals including your primary care doctor, an endocrinologist, nurse, dietician/certified diabetes educator, dentist, eye doctor, foot doctor, pharmacist, and cardiologist if you also have cardiovascular disease or are at high risk. 

Make sure to write down questions before each appointment. For example, you might want to ask: 

• How often should I be checking my blood sugar?
• What is my target blood glucose level and HbA1c/A1c? How am I doing?
• What is the best thing I can do to help control my diabetes?
• What kind of exercise is best for me? How often should I be exercising?
• What dietary guidelines should I follow?
• Do I need medication?
• What should my blood pressure be?
• Should I be taking a low-dose aspirin?
• What should I do if my blood sugar gets too low? How do I prevent this from happening?
• What symptoms should I watch for and when should I call you? How do I know when my blood sugar is too low or too high, and what do I do?
• Would it help to see a dietitian or nutritionist?
• Should I be seeing a doctor to get my eyes or feet checked?

Helpful resources 

American Diabetes Association
www.diabetes.org 

American Heart Association
www.heart.org 

Centers for Disease Control and Prevention
http://www.cdc.gov/diabetes/prevention/index.htm

National Diabetes Information Clearinghouse
1–800–860–8747
www.diabetes.niddk.nih.gov

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_{Published: Nov. 2015
Medical Reviewer: Alison Bailey, MD, FACC, Director, Preventive Cardiology and Cardiac Rehabilitation, Erlanger Health System, Chattanooga, TN}