Diabetes is a complex disease that can be life-threatening. It is also one of the diseases that we can now manage and treat well. There are two main types of diabetes, I and II. Over 95% of those with diabetes have Type II. Here is an in-depth look at what diabetes is and the different types; as well as treatments and lifestyle changes that can help you live a better life.
What is Diabetes?
Diabetes occurs when the body is incapable of managing blood sugar levels due to several factors that involve the hormone insulin. The person may make too much insulin or not enough, they may also develop insulin resistance which means the cells won’t use the insulin properly.
It is a life threatening illness that left untreated can result in death. Common complications of un-managed diabetes are blindness, loss of extremities to gangrene, obesity, and coma. There are two main types of diabetes, Type I and Type II. Type I is usually hereditary and diagnosed at a young age. Type II is commonly called a lifestyle disease, although there are many other risk factors involved. Other types of diabetes, such as gestational diabetes, are considered related but are not classed with the other two types.
Diabetes has a complex set of symptoms that can be frequently mistaken for other disorders. If you have any of the symptom on this list, you should talk to your doctor about doing a risk evaluation and monitoring your blood sugar levels. The common symptoms are:
- Frequent need to urinate ( not a feeling, but actual urination)
- Constant thirst
- Constant hunger
- Gaining weight
- Losing weight (for no identifiable reason)
- Tingling or stinging in limbs, feet and hands
- Numbness in extremities
- Mood swings
- Blurred vision
- Muscle aches/wasting
- Slow healing cuts and bruises
Being tested for diabetes should be a part of the elimination process in diagnosing any disease with the shared symptoms.
Does being pre-diabetic or having gestational diabetes mean I will get diabetes?
You may have been told you are pre-diabetic by a doctor, or found out you have developed gestational diabetes while pregnant. Neither of these conditions included in this discussion of diabetes for two reasons. The classification of being pre-diabetic simply means you have the warning markers for developing Type II diabetes.
Pre-diabetic conditions can be managed with proper diet and exercise to avoid the onset of developed diabetes. Gestational diabetes is a temporary condition that is not related to an increased risk of diabetes, but is related to an increased risk of having gestational diabetes during your next pregnancy. Gestational diabetes is a complex topic on its own. This article deals primarily with the diagnosed conditions of Type I and Type II diabetes.
Who is at risk for diabetes?
The prime risk group for Type I diabetes are those with a family history of the disease. The risk group for Type II diabetes is much larger. It should be noted that there are specific forms of Type II diabetes that are commonly associated with certain races and ethnicities. African American women are in one of the highest risk groups for both types of diabetes, as are women of Latin ancestry.
Type I Diabetes
As mentioned earlier, heredity is a huge risk marker for Type I diabetes. It used to be called “juvenile diabetes” as it is most commonly diagnosed in children. Now, there is evidence that hereditary diabetes may not appear until later in life, which led to it being renamed Type I. It is estimated that only 5% of those diagnosed with diabetes have Type I. It is incurable and irreversible, but can be successfully managed with insulin.
Type II Diabetes
The prevalent form of diabetes is Type II. It is often referred to as a lifestyle disease as many factors of unhealthy living contribute to its development. There are cases in which Type II is diagnosed without lifestyle factors being involved. The most common risk factors for Type II include:
- Being overweight
- Fat distribution
- Sedentary lifestyle
- Family history
- Being pre-diabetic
- Gestational diabetes
It is important to note that some of these risk factors include things you cannot control, but that don’t guarantee you will develop Type II diabetes. Being sedentary and overweight are considered to be the highest risk factor, which reinforces the designation of the disease as one from lifestyle. It is possible in many cases to reverse the Type II with lifestyle changes.
Known general risk factors
New evidence is showing that there are many other risk factors at play in the development of diabetes. The two that have been identified as strong contributing factors are stress, and working 2nd or 3rd shift. The hormone cortisol, and the diurnal and nocturnal cycle of hormones in the body, can contribute to diabetes when their natural balance is thrown off. The correlation between Type II diabetes and second shift work for African American women is particular strong. As science begins to understand the interrelation of hormones to metabolism better, you can expect to see more risk factors identified.
What is Insulin?
Insulin is present in the body naturally. It is a hormone that is released to help control blood glucose levels and it is produced by the pancreas. Insulin is released in the blood stream when glucose is detected. Glucose can come from carbohydrates that you eat, and from stored glucose in the body that have been released. The insulin hormone attaches to the blood glucose. This then allows the cells to “recognize” glucose and absorb it through the cellular walls. The cells then use this glucose as energy for repair, growth and maintenance of cellular life.
Persons with diabetes may make too much insulin, which then forces a dangerously low blood glucose amount and prohibits storage of insulin – both of which can lead to a state of cellular starvation after glutting the cells with glucose. They may also have a problem where they make too little insulin, or their body makes the hormone and it is not released into the blood stream. This creates too much blood glucose that the cells cannot recognize and use. Insulin as a medication helps the body to use blood glucose properly. It does not provide the glucose itself – that is accomplished through diet and glucose supplementation. Insulin cannot be taken in a pill form, it must be in a liquid form which requires injections for the person to use it.
Discovery of Insulin
The discovery of Insulin occurred during the 20s. Dr. Frederick Banting, then of the University of Toronto, was trying to isolate a pancreatic extract that would help those who were diabetic. With the help of his student, Charles Best, they isolated a cell compound form the pancreas that then became known as insulin.
Treatment for Diabetes
Treatment for diabetes involves a combination of medication, diet, exercise and lifestyle changes. There is no form of diabetes that does not require some type of medication, but many people who have diabetes can control it enough so they don’t need to take insulin shots. For those with very difficult diabetes to manage, there are now insulin pumps that can help stabilize blood sugar levels throughout the day. Diabetes is a life threatening condition, but one that can be managed.
Self monitoring refers to the process of staying aware of your blood sugar levels, and other associated measurable levels of ketones and symptoms. Measuring your blood sugar is a part of the insulin routine. It is done using a pinprick test strip device. It is an essential daily practice for many to make sure their insulin routine matches the needs of their body. There are 3 basic types of self-monitoring you will need to learn and do.
Testing your blood sugar – this is a very fast and virtually painless test now thanks to innovations in pinprick devices. The basic concept is that a drop of blood is taken from your fingertip and placed on a test strip. The test strip is then measured for a level of blood sugar in the drop of blood. Small devices have made this an automated process that is easy to incorporate into your day. Some people have to test several times a day, but if your blood sugar is well managed, you may be allowed to test less often.
Testing for ketones in the urine – The ketone test is a simple strip that is dipped in a small amount of urine that tests for ketones. Ketones are the chemical byproduct of the metabolism of fat into fuel in the body. You want that to happen when you exercise, but a diabetic very much doesn’t want that to happen if they are not exercising – it is a sign that insulin is not doing the job in the body. Your doctor will recommend this testing procedure to you if they feel it is necessary.
Being aware of your associated symptoms – One of the best self-monitoring habits you can get into is to keep a diary of symptoms and monitoring results. You want to be able to see all of your results together so you can begin to detect patterns. These patterns can be very helpful in food planning. You also want to keep a record of all of your other symptoms that are pre-cursors to a measurable level of low or high blood sugar. As time goes by, you will begin to recognize these pre-symptoms more easily and be proactive in taking care of your diabetes.
Food planning is an essential skill you have to learn in order to manage your diabetes. The basics of food planning are:
- What you need to eat in a meal
- When you should eat
- What you can have as a snack
- When you should snack
There are three basic styles of creating a food plan.
- The plate method.
- Using the glycemic index.
- Carbohydrate tracking.
Using the plate method is one of the simplest to master. It can be an excellent way to start your new diet plan. The plate method focuses on learning to visually divide a plate into sections that are reserved for different types of food. Then you learn a food list of things you can eat and make sure they are in the right ratio on your plate.
Both the glycemic index (GI) and the carbohydrate method are more complex, but you should learn them as well. The glycemic index is a list of the glycemic content of different foods. This helps you understand how your body converts them into glucose so you can achieve a better balance. The carbohydrate tracking method is slightly easier than the GI method, carbs are related to the GI of a food but more foods have their carbs listed than have the GI.
The importance of the food diary
One thing that is essential in food planning for diabetes is keeping a food diary. This can help show you how your body interacts with different foods and mealtimes. In many ways it acts as a symptom tracker. If you keep a record of what you ate, when you ate it, and how it made you feel – you will learn more about what type of eating routine works for you. You should also pay attention to what types of activities make you hungry, or push your blood sugar low. One of the biggest problems with food planning is that there are so many myths about diets and food for the diabetic.
Top 3 Diabetes Diet Myths
People’s first reaction to what they should do with food when they find out they are diabetic is to cut out all sugar and take on a strict diet. That isn’t going to help you, but it is understandable why that is the first assumption about what to do. There are some very strong myths about the diabetes diet. Here are just the top 3 most common diabetes diet myths.
Medication can counter-balance diet – False. Many people believe that they can still eat what they want, or indulge when they want and just rely on an insulin shot to keep them safe. That is not how the body works. Your insulin is designed to help you keep your body in safe balance. If you eat the wrong foods, the insulin will not help and you could set up a severe rise or crash in your blood sugar level that can result in hypo- or hyperglycemia. Both of those states are potentially deadly.
You have to follow a special “diabetic diet” – False. There is really no such thing as a diabetic diet; the diet that is recommended is one that all people should be eating. It is a basic, nutritionally balanced diet plan that features all the foods you love in moderation. It doesn’t include foods that are high in sugars, fats or empty calories because they are unhealthy. You don’t need to follow a special diet plan if you are eating a good and balanced diet.
Eating too much sugar causes diabetes – False. Diabetes doesn’t have anything to do with dietary sugar, it has to do with how your body can use the glucose in the body. Glucose is made from the conversion of dietary carbohydrates -which can come from many different sources. Diabetes is about how insulin and glucose act in your body. Eating sugary foods is not good for a diabetic because they cannot use their insulin effectively (or have too little) to use the sugar when it becomes glucose. Too much sugar and too little insulin can lead to hyperglycemia.
There are many more myths about diet and diabetes that you should familiarize yourself with when planning your meals. Another important one is to be aware that just because a food is labeled “diet,” that doesn’t mean that it is good for you. Your best bet is to meet with a nutritionist and have an expert help you form your diet plan.
Daily exercise is exceedingly important in managing Type I and Type II diabetes. Even if you are using insulin to manage your diabetes you want to commit to daily exercise as it will help to mitigate the stress diabetes puts on your body. There are some precautions you have to take when exercising, especially if you have Type I diabetes. It is easy for intense workouts to trigger the release of the stress hormone cortisol, which can radically lower your blood glucose levels.
A good habit to get into is to check your blood sugar before you start to exercise, during and after. Once you know how exercise effects your blood sugar levels you can plan for additional drinks or snacks during the exercise to help maintain your glucose balance. Exercise can also push you into hyperglycemia, if you have a pump this can be easily managed by adjusting your daily rate of dose on the days you exercise.
Always talk to your doctor before starting any program so they can explain to you how your ketone levels may change so you know when that is OK, and when it should be a concern.
Hypoglycemia is the state when there is too little glucose in the bloodstream. You may be producing enough insulin, but there is nothing for the insulin to attach to so the cells have fuel. Hypoglycemia is a life-threatening condition. The most common symptoms are nervousness, shakiness, confusion, being unsteady on your feet and headache. Severe symptoms include nausea, vomiting, seizures and unconsciousness. Hypoglycemia is best handled as soon as it starts by giving the person a small amount of simple carbohydrate such as a small glass of juice, fruit or hard candy. Many diabetics will carry glucose tabs as well.
If you are hypoglycemic you should never take insulin. Insulin will lower the blood sugar level even further and force you into a diabetic coma. If the person does not respond to simple carbohydrates, or they are unconscious or seizing, they will need an injection of glucagon. This will push glucose directly into the blood stream via an injection into fatty tissue.
Hyperglycemia is when there is too much blood sugar in the body. This is a result of your body being unable to produce or use insulin. People with either type of diabetes can become hyperglycemic. The common symptoms for hyperglycemia include frequent urination and thirst. If you are diabetic and experience these symptoms, you can test your urine for the presence of ketones. If ketones are present you are in state of hyperglycemia.
What are ketones?
Ketones are a byproduct chemical that is made as a result of the body using fat as energy. This is very much the goal of many fitness programs, but when it occurs during times that you are not working out it can be a sign that there is not enough insulin being used, or that your body has become unable to use it and is burning fat for fuel.
This doesn’t mean that hyperglycemia is a great way to lose weight, the burning of fat and the increasing levels of blood glucose can quickly lead to a diabetic coma. It is important to note that this is a state you can reach without having a proper diagnosis of diabetes. You can develop hyperglycemia for many reasons, including stress and illness. For a diabetic, it can be deadly. For someone who is not diabetic, it can also be deadly and the first sign that they have now developed diabetes.
If you have been diagnosed with diabetes you may have to take insulin. Whether or not you do depends on the type of diabetes you have, the length of time you have had diabetes, and the amount of insulin you need that your body cannot manage on its own. If your doctor tells you that you need to take insulin you must take it. Diabetes is a life-threatening condition. If it is left untreated or un-managed, it can lead to loss of sight, limbs and life.
There are many alternative and complementary treatments available that can help your diabetic medication to work better. For those with Type II diabetes, a change in lifestyle habits may be enough to correct the body’s own blood sugar management system. Always discuss your treatments, medications and lifestyle changes with your doctor before beginning them.
This way then can outline any precautions you should take, and they can measure how well your changes are working for you. Type II diabetes can be reversed in many cases, and for some it cannot. Almost all pre-diabetic conditions can be reversed as well. Type I diabetes cannot be reversed and must be managed carefully.
Depending on your health, and the progression of your diabetes your doctor may try you on any one of a number of brand name diabetes pills. These pills do not provide additional insulin to the body. What they do is enable the body to manage its insulin better by doing one of three things:
- Blocking the release of stored sugar in the liver
- Increasing the receptivity of cells to insulin to allow it to be passed through the cell barrier more efficiently
- Blocking the re-absorption of glucose by the kidney
- Increasing excretion of glucose by the body
Diabetes pills are for those with a Type II diagnosis only, they are not an option if you have Type I diabetes. With Type II they are only prescribed if the patient has had diabetes for less than 10 years, and/or takes less than 20 units of insulin daily. They may also be helpful to people who are not yet diabetic, but who have blood glucose related issues that may lead to diabetes. Unfortunately, diabetes pills will often stop working suddenly. Science isn’t sure why this happens, but for many people, the use of diabetes pills is only effective for a limited time.
One reason that a doctor will prescribe diabetes pills when they know there is a high chance of them not working, or suddenly stopping to work, is that they can buy the patient crucial time. Studies have shown that the combination of diabetes pills and lifestyle changes can often manage, and even reverse, Type II diabetes in some people. The most critical part of this equation lies in the commitment to lifestyle changes. It is also important to remember that heredity may also have a great influence upon whether the path of Type II diabetes can be interrupted.
Insulin cannot be given in a pill form. The hormone has to be suspended in a liquid making injections the only way to deliver insulin to the body. Most diabetic patients inject themselves on a regular routine and in cases of emergency need.
Some people do well with an insulin pump which can eliminate the need for injection by using a catheter for delivery. Insulin is measured in units. It can come in bottles that you draw the dose into the syringe each time, pre-measured doses in bottles, and syringes that are packaged with a pre-measured amount. There is no pill form for insulin, diabetes pills are very different and are made to promote insulin use, production or release.
4 Types of Insulin
There are 4 types of insulin available. You can choose to fill the injecting needle yourself, but there are also pre-mixed and pre-measured dosing syringes available. Not everyone takes the same amount of insulin in an injection, the amount will depend on the level of insulin in your body, and the ability you have to use insulin. The 4 types are:
- Fast acting
- Long acting
Each type of insulin has an action that follows a defined arc of processing in the body. Fast-acting can begin to work in 15 minutes, Regular (or short-acting) works in 30 minutes, Intermediate may take 2 to 4 hours before beginning to work, and long-acting is designed to have a slow 24 hour release in the body to manage blood sugar levels all day. Insulin is measured in units. The maximum dose is 500 units for those with extreme insulin resistance in the body.
The insulin arc of action
Insulin follows an arc of action. When it is released (or taken via injection), it hits the blood stream in a specific range of time to begin working. Within 1 to 3 hours, insulin will achieve its peak presence in the blood stream, and then the level diminishes after that. One way to visualize this is to think of the act of eating. When you eat and your body begins to digest the food and the first carbohydrates are converted to glucose is the start of the action.
It can take your body up to 2 hours to complete digesting food and metabolizing the glucose to provide the peak levels of blood sugar from meal. Then, the cells absorb the glucose from the blood stream, lowering the levels until the blood glucose level is back to its normal amount. Ideally, there is always enough blood glucose available to handle the constant need of cells for sustenance.
The release of insulin is triggered and controlled by hormones such as cortisol, the hormone we release in times of stress. If the trigger hormone doesn’t call for the release, then any excess blood sugar is stored and some always remains in the blood stream.
Storing Insulin Properly
As insulin is only delivered in an injection format, it is liquid. One thing you never want to do is store your insulin in a cool or refrigerated environment. While this can make it last longer, cold insulin can be very painful to inject. Insulin is to be kept at room temperature. It can be stored for 30 days at a time before it must be discarded.
The syringes used with insulin are mostly disposable. There are reusable syringes but it can be very difficult to maintain sterility outside of a clinical environment. Being injected with a contaminated needle can lead to serious and life threatening infection. Most insurance covers the cost of the disposable needles, and there are many programs that will help with the cost of insulin and injections as well.
One option you have for insulin management is to have an insulin pump. This is not a replacement for your pancreas and it does not automatically release insulin in response to your body’s needs. An insulin pump can be set to either release insulin throughout the day on a predetermined schedule, and/or it can be used to release “blast” amounts of insulin when you eat.
The pump is attached to your body with tape, and a catheter is inserted into fatty tissue and taped in place as well. Many people prefer the insulin pump as they find it easier to manage their insulin needs, and it allows them to avoid injections. There are also some drawbacks to using the pump. Not all insurance companies will cover and insulin pump, and should the pump disconnect or the catheter get dislodged you could miss important doses of insulin and become gravely ill. To have an insulin pump you usually have to spend a night to a few days in a hospital while you learn how to use it in a safe environment.
It is less common for someone who has Type II diabetes and who needs less than 20 units of insulin a day to be given the suggestion of an insulin pump. That is changing as the pumps and catheter styles are getting more reliable. It is most common to see an insulin pump on someone who has Type I, or who has had Type II for over 20 years. For someone with Type I, which is often diagnosed at an early age, an insulin pump can let them manage their blood glucose levels more effectively with a process that is least disruptive to their daily life.
Effective complementary supplements, medications & techniques
There are few complementary medicines and techniques that can help manage diabetes, but there are many complementary and alternative methods that can help manage the cluster of symptoms that can occur with diabetes. When it comes to directly interacting with the diabetic condition, the only two other treatments that are recommended (under advice from your doctor) are:
- Bariatric Surgery
There is significant clinical evidence that taking a low dose of aspirin daily can help those with diabetes avoid heart attacks. There is also a lot of data supporting that bariatric surgery can help those with Type II diabetes and a BMI of 35 or above. In some instances, the resulting weight loss from the surgery can move someone out of diabetes – however, they must manage their diet and lifestyle habits rigorously to avoid putting the weight back on because they are now in a much higher risk category for developing Type II diabetes again.
A cautionary word about supplements, herbal remedies and alternative medicine
While there is more evidence supporting the effectiveness of many supplements, herbal remedies and alternative medicines for a variety of disorders, it is not recommended that you use them for the management of diabetes in place of insulin medications. Diabetes is a life threatening condition. Many of the herbal treatments have not been studied enough to truly understand how they affect the body’s management of blood glucose levels, but it is known that some of them do effect the levels.
As for dietary supplements, it is recommended that you get the majority of your nutrition from whole food sources. While supplements can be effective in some cases, the real caution lies in the fact that there is no established way to test the effectiveness of a supplement. Be careful of products that promise to reverse or eliminate diabetes – there is no approved medication to do that and no evidence to support those claims.
You can benefit from using general supplements to augment your nutrition, and by taking advantage of many of the physical and spiritual practices promoted in alternative treatments as they are effective in helping to reduce stress and manage blood pressure. Before you take any supplement or remedy, check with your pharmacist about potential interactions with other medications as well.
What you should always remember about diabetes?
Diabetes is a life threatening condition that can start at any age. Some people with Type II diabetes may reverse their condition with diet, exercise and healthy weight loss management programs. There is no reason for diabetes to limit your enjoyment in life as it can be managed with medications and lifestyle changes.
Researchers are constantly working to identify risk factors and to examine the effectiveness of new treatments, including holistic and alternative treatments. It is very important that you follow your doctor’s orders and take the prescription medication and insulin as needed. It is only after your blood sugar levels are in control that you can talk to your doctor about changes and options. There is no cure for diabetes; reversing Type II diabetes does not mean that the person cannot develop it again. We are only just beginning to understand the role of heredity and stress as a risk factor for Type I and Type II.
The latest innovations in design for insulin pumps are making it easier to manage injecting insulin, and the advances in diabetes pills are enabling more people to make the changes that we know help so that they can avoid having to inject insulin for longer.
It is important that you make your doctor aware of any family history of diabetes, seek to maintain a healthy diet and body weight, as well as call to your doctor’s attention any symptoms you may notice. The sooner diabetes is detected the easier it is to manage. The better your diabetes is managed, the less you will suffer. Managing diabetes is a joint effort that requires your doctor and their prescriptions, as well as your commitment to living a healthy lifestyle for management of diabetes to be successful in your life.
Oral Diabetes Medications:
Diabetes Basics: http://www.diabetes.org/diabetes-basics/
What is Diabetes? What causes Diabetes?