What is diabetes? What causes diabetes?

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, and lowers the blood sugar level.

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.

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.

There are three main types of diabetes:

Diabetes Type 1 - You produce no insulin at all.

Diabetes Type 2 - You don't produce enough insulin, or your insulin is not working
properly.

Gestational Diabetes - You develop diabetes just during your pregnancy.

(World Health Organization)

Diabetes Types 1 & 2 are chronic medical conditions - this means that they are
persistent and perpetual. Gestational Diabetes usually resolves itself after the birth
of the child.

Treatment is effective and important

All types of diabetes are treatable, but Type 1 and Type 2 diabetes last a lifetime;
there is no known cure. The patient receives regular insulin, which became
medically available in 1921. The treatment for a patient with Type 1 is mainly
injected insulin, plus some dietary and exercise adherence.

Patients with Type 2 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, such as hypoglycemia, ketoacidosis, and nonketotic
hypersosmolar coma. Longer term complications could be cardiovascular disease,
retinal damage, chronic kidney failure, nerve damage, poor healing of wounds,
gangrene on the feet which may lead to amputation, and erectile dysfunction.
DIABETES STATISTICS:

In the USA - 2007

17.9m people are diagnosed with diabetes

5.7m people are undiagnosed with diabetes

57m people have pre-diabetes

186,300 (0.22%) people under 20 have diabetes

1 in every 400 to 600 under 20-year olds have Type 1 diabetes

2m adolescents have pre-diabetes

23.5m (10.7%) of those over 20 have diabetes

12.2m of those over 60 have diabetes

12m men (11.2%) have diabetes

11.5m women (10.2%) have diabetes

American Diabetes Association

Symptoms of Diabetes

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.

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

(1. click for large diagram) - © 3d Medical RF

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:

It produces pancreatic digestive juices.

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.

Etymology (history) of the word pancreas

It is said that the pancreas was described first by Herophilus of Chalcedon in about
300B.C. and the organ was named by Rufus of Ephesus in about 100A.D
However, it is an established fact that the word pancreas had been used by
Aristotle (384-322B.C.) before Herophilus.

In Aristotle's Historia Animalium, there is a line saying "another to the so-called

pancreas". It is considered that the words "so-called pancreas" imply that the word
pancreas had been popular at the time of Aristotle, but it had not been authorized
yet as an anatomical term.

However, the word pancreas presumably has been accepted as an anatomical term
since Herophilus.

The word pancreas comes from the Greek pankreas, meaning sweetbread.

Discovery of insulin

In 1920, Dr. Frederick Banting wanted to make a pancreatic extract, which he

hoped would have anti-diabetic qualities. In 1921, at the University of Toronto,
Canada, along with medical student Charles Best, they managed to make the
pancreatic extract.

Their method involved tying a string around the pancrease duct. When examined
several weeks later, the pancreatic digestive cells had died and been absorbed by
the immune system. The process left behind thousands of islets. They isolated the
extracts from the islets and produced isletin. What they called isletin became known
as insulin.

Banting and Best managed to test this extract on dogs that had diabetes. They
discovered insulin. In fact, they managed to keep a dog, that had had its pancreas
taken out, alive throughout the whole summer by administering it the extract
(which was, in fact, insulin). The extract regulated the dogs blood sugar levels.

At this point, Professor J. MacLeod, who had placed the laboratory at their disposal,
said he wanted to see a re-run of the whole trial. After doing so he decided to get
his whole research team to work on the production and purification of insulin.
 J.B. Collip joined the scientific team, which now consisted of Banting, Best, Collip
and MecLeod. They managed to produce enough insulin, in a pure enough form, to
be able to test it on patients.

In 1922 the insulin was tested on Leonard Thompson, a 14-year-old diabetes

patient who lay dying at the Toronto General Hospital. He was given an insulin
injection. At first he suffered a severe allergic reaction and further injections were
cancelled. The scientists worked hard on improving the extract and then a second
dose of injections were administered on Thompson. The results were spectacular.

The scientists went to the other wards with diabetic children, most of them
comatose and dying from diabetic keto-acidosis. They went from bed-to-bed and
injected them with the new purified extract - insulin. This is known as one of
medicines most dramatic moments. Before injecting the last comatose children, the
first started to awaken from their comas. A joyous moment for family members and
hospital staff!!

Collip did not get on too well with Banting and Best apparently - and he soon left
the project. Best continued trying to improve the extract and managed eventually
to produce enough for the hospital's demand. Their work was privately published.
The Eli Lilly Company soon got to hear about it and offered to assist. It was not long
before the Eli Lilly Company managed to produce large quantities of refined pure
insulin.

In 1923 Banting and Macleod were awarded the Nobel Prize in Physiology or
Medicine. Banting shared his prize with Best and Macleod shared his with Collip. The
patent for insulin was sold to the University of Toronto for one dollar.

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 automiticaly.

Type 2 diabetes
A person with diabetes type 2 either:

Does not produce enough insulin. Or

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

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:

1. Shakiness

2. Anxiety

3. Palpitations, Tachycardia

4. Feeling hot, sweating

5. Clamminess

6. Feeling cold

7. Hunger

8. Nausea

9. Abdominal discomfort

10.Headache

11.Numbness, pins and needles

12.Depression, moodiness

13.Apathy, Tiredness, Fatigue, Daydreaming

14.Confusion

15.Dizziness

16.Bad coordination, slurred speech

17.Seizures

18.Coma

Hyperglycemia - when blood glucose is too high - can also have a bad effect on the
patient. Hyperglycemia can cause:

1. Polyphagia - frequently hungry

2. Polydipsia - frequently very thirsty

3. Polyuria - frequent urination

4. Blurred vision

5. Extreme tiredness

6. Weight loss

7. Cuts and scrapes will heal slowly and badly

8. Dry mouth

9. Dry or itchy skin

10.Erectile dysfunction (impotence)

11.Recurrent infections

12.Kussmaul hyperventilation: deep and rapid breathing

13.Cardiac arrhythmia

14.Stupor

15.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

• Wash your hands with warm water and soap. Dry completely. You could
also dab or wipe the area with alcohol and then dry completely.

• Use the lancet to prick your fingertip.

• Hold your hand down. Hold your finger at the same time until you see a
small droplet of blood appear.

• Place the blood on the test strip.

• Follow the instructions for placing the test strip and using your meter.

• 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.

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.

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

Useful Diabetes Links and Resources

• American Diabetes Association

Detailed site with information about prevention and managing the different
types of Diabetes

http://www.diabetes.org/home.jsp

• American Diabetes Association

Detailed site with information about prevention and managing the different
types of Diabetes.

http://www.diabetes.org/

• Changing Life With Diabetes

A site operated by Novo Nordisk, containing detailed information on Diabetes.

(You are asked to sign in to access some of the tools on the site and by giving
your information you may be sent special offers from Novo Nordisk and their
business partners.)

http://www.changingdiabetes-us.com

• Diabetes Self-Management

An informative site for people who want to know more about controlling and
managing diabetes.

http://www.diabetesselfmanagement.com