Diabetes Overview

Diabetes mellitus (DM) is a set of related diseases in which the body cannot regulate the amount of
sugar (specifically, glucose) in the blood.
The blood delivers glucose to provide the body with energy to perform all of a person's daily activities.
 The liver converts the food a person eats into glucose. The glucose is then released into the
bloodstream.
 In a healthy person, the blood glucose level is regulated by several hormones, primarliy insulin.
Insulin is produced by the pancreas, a small organ between the stomach and liver. The pancreas
also makes other important enzymes released directly into the gut that helps digest food.
 Insulin allows glucose to move out of the blood into cells throughout the body where it is used
for fuel.
 People with diabetes either do not produce enough insulin (type 1 diabetes) or cannot use
insulin properly (type 2 diabetes), or both (which occurs with several forms of diabetes).
 In diabetes, glucose in the blood cannot move efficiently into cells, so blood glucose levels
remain high. This not only starves all the cells that need the glucose for fuel, but also harms
certain organs and tissues exposed to the high glucose levels.
Type 1 diabetes (T1D): The body stops producing insulin or produces too little insulin to regulate blood
glucose level.
 Type 1 diabetes involves about 10% of all people with diabetes in the United States.
 Type 1 diabetes is typically diagnosed during childhood or adolescence. It used to be referred to
as juvenile-onset diabetes or insulin-dependent diabetes mellitus.
 Type 1 diabetes can occur in an older individual due to destruction of the pancreas by alcohol,
disease, or removal by surgery. It also results from progressive failure of the pancreatic beta
cells, the only cell type that produces significant amounts of insulin.
 People with type 1 diabetes require insulin treatment daily to sustain life.
Type 2 diabetes (T2D): Although the pancreas still secretes insulin, the body of someone with type 2
diabetes is partially or completely unable to use this insulin. This is sometimes referred to as insulin
resistance. The pancreas tries to overcome this resistance by secreting more and more insulin. People
with insulin resistance develop type 2 diabetes when they fail to secrete enough insulin to cope with
their higher demands.
 At least 90% of adult individuals with diabetes have type 2 diabetes.
 Type 2 diabetes is typically diagnosed in adulthood, usually after age 45 years. It used to be
called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus. These names
are no longer used because type 2 diabetes does occur in younger people, and some people
with type 2 diabetes require insulin therapy.
 Type 2 diabetes is usually controlled with diet, weight loss, exercise, and oral medications.
However, more than half of all people with type 2 diabetes require insulin to control their blood
sugar levels at some point in the course of their illness.
Gestational diabetes (GDM) is a form of diabetes that occurs during the second half of pregnancy.
 Although gestational diabetes typically resolves after delivery of the baby, a woman who
develop gestational diabetes is more likely than other women to develop type 2 diabetes later in
life.
 Women with gestational diabetes are more likely to have large babies.
Metabolic syndrome (also referred to as syndrome X) is a set of abnormalities in which insulin-resistant
diabetes (type 2 diabetes) is almost always present along with hypertension (high blood pressure), high
fat levels in the blood (increased serum lipids, predominant elevation of LDL cholesterol, decreased HDL
cholesterol, and elevated triglycerides), central obesity, and abnormalities in blood clotting and
inflammatory responses. A high rate of cardiovascular disease is associated with metabolic syndrome.
Prediabetes is a common condition related to diabetes. In people with prediabetes, the blood sugar
level is higher than normal but not yet high enough to be considered diagnostic of diabetes.
 Prediabetes increases a person's risk of developing type 2 diabetes, heart disease, or stroke.
 Prediabetes can typically be reversed (without insulin or medication) with lifestyle changes such
as losing a modest amount of weight and increasing physical activity levels. Weight loss can
prevent, or at least delay, the onset of type 2 diabetes.
 An international expert committee of the American Diabetes Association redefined the criteria
for prediabetes, lowering the blood sugar level cut-off point for prediabetes. Approximately 20%
more adults are now believed to have this condition and may develop diabetes within 10 years if
they do make lifestyle changes such as exercising more and maintaining a healthy weight.
About 17 million Americans (6.2% of adults in North America) are believed to have diabetes. AIt has
been estimated that about one third of adults with diabetes do not know they have diabetes.
 About 1 million new cases of diabetes is diagnosed occur each year, and diabetes is the direct or
indirect cause of at least 200,000 deaths each year.
 The incidence of diabetes is increasing rapidly. This increase is due to many factors, but the most
significant are the increasing incidence of obesity associated with the prevalence of a sedentary
lifestyle.
Complications of diabetes
Both type 1 and type 2 diabetes ultimately lead to high blood sugar levels, a condition called
hyperglycemia. Over a long period of time, hyperglycemia damages the retina of the eye, the blood
vessels of the kidneys, the nerves, and other blood vessels.
 Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness.
 Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of kidney failure.
 Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot wounds
and ulcers, which frequently lead to foot and leg amputations.
 Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach
(gastroparesis), chronic diarrhea, and an inability to control heart rate and blood pressure
during postural changes.
 Diabetes accelerates atherosclerosis, (the formation of fatty plaques inside the arteries), which
can lead to blockages or a clot (thrombus). Such changes can then lead to heart attack, stroke,
and decreased circulation in the arms and legs (peripheral vascular disease).
 Diabetes predisposes people to elevated blood pressure, high levels of cholesterol and
triglycerides. These conditions both independently and together with hyperglycemia, increase
the risk of heart disease, kidney disease, and other blood vessel complications.
Diabetes can contribute to a number of acute (short-lived) medical problems.
 Many infections are associated with diabetes, and infections are frequently more dangerous in
someone with diabetes because the body's normal ability to fight infections is impaired. To
compound the problem, infections may worsen glucose control, which further delays recovery
from infection.
 Hypoglycemia or low blood sugar, occurs intermittently in most people with diabetes. It can
result from taking too much diabetes medication or insulin (sometimes called an insulin
reaction), missing a meal, exercising more than usual, drinking too much alcohol, or taking
certain medications for other conditions. It is very important to recognize hypoglycemia and be
prepared to treat it at all times. Headache, feeling dizzy, poor concentration, tremor of the
hands, and sweating are common symptoms of hypoglycemia. A person can faint or have a
seizure if blood sugar level become too low.
 Diabetic ketoacidosis (DKA) is a serious condition in which uncontrolled hyperglycemia (usually
due to complete lack of insulin or a relative deficiency of insulin) over time creates a buildup of
 ketones (acidic waste products ) in the blood. High levels of ketones can be very harmful. This
typically happens to people with type 1 diabetes who do not have good blood glucose control.
Diabetic ketoacidosis can be precipitated by infection, stress, trauma, missing medications like
insulin, or medical emergencies such as a stroke and heart attack.
 Hyperosmolar hyperglycemic nonketotic syndrome is a serious condition in which the blood
sugar level gets very high. The body tries to get rid of the excess blood sugar by eliminating it in
the urine. This increases the amount of urine significantly, and often leads to dehydration so
severe that it can cause seizures, coma, and even death. This syndrome typically occurs in
people with type 2 diabetes who are not controlling their blood sugar levels, who have become
dehydrated, or who have stress, injury, stroke, or are taking certain medications, like steroids.

Diabetes Causes
Type 1 diabetes: Type 1 diabetes is believed to be an autoimmune disease. The body's immune system
specifically attacks the cells in the pancreas that produce insulin.
A predisposition to develop type 1 diabetes may run in families, but genetic causes (a postitive
family history) are much more common for type 2 diabetes.
Environmental factors, including common unavoidable viral infections, may also contribute to type
1 diabetes.
Type 1 diabetes is most common in people of non-Hispanic, Northern European descent (especially
Finland and Sardinia), followed by African Americans, and Hispanic Americans. It is relatively rare in
those of Asian descent.
Type 1 diabetes is slightly more common in men than in women.
Type 2 diabetes: Type 2 diabetes has strong genetic links, meaning that type 2 diabetes tends to run in
families. Several genes have been identified, and more are under study which may relate to the causes
of type 2 diabetes. Risk factors for developing type 2 diabetes include the following:
High blood pressure
High blood triglyceride (fat) levels
Gestational diabetes or giving birth to a baby weighing more than 9 pounds
High-fat diet
High alcohol intake
Sedentary lifestyle
Obesity or being overweight
Ethnicity, particularly when a close relative had type 2 diabetes or gestational diabetes: certain
groups, such as African Americans, Native Americans, Hispanic Americans, and Japanese Americans,
have a greater risk of developing type 2 diabetes than non-Hispanic whites.
Aging: Increasing age is a significant risk factor for type 2 diabetes. Risk begins to rise significantly at
about age 45 years, and rises considerably after age 65 years.
Diabetes Symptoms
Symptoms of type 1 diabetes are often dramatic and come on very suddenly.
Type 1 diabetes is usually recognized in childhood or early adolescence, often in association with an
illness (such as a virus or urinary tract infection) or injury.
The extra stress can cause diabetic ketoacidosis.
o Symptoms of ketoacidosis include nausea and vomiting. Dehydration and often-serious
disturbances in blood levels of potassium follow.
o Without treatment, ketoacidosis can lead to coma and death.
Symptoms of type 2 diabetes are often subtle and may be attributed to aging or obesity.
A person may have type 2 diabetes for many years without knowing it.
People with type 2 diabetes can develop hyperglycemic hyperosmolar nonketotic syndrome.
 Type 2 diabetes can be precipitated by steroids and stress.
If not properly treated, type 2 diabetes can lead to complications such as blindness, kidney failure,
heart disease, and nerve damage.
Common symptoms of both type 1 and type 2 diabetes include:
Fatigue, constantly tired: In diabetes, the body is inefficient and sometimes unable to use glucose
for fuel. The body switches over to metabolizing fat, partially or completely, as a fuel source. This
process requires the body to use more energy. The end result is feeling fatigued or constantly tired.
Unexplained weight loss: People with diabetes are unable to process many of the calories in the
foods they eat. Thus, they may lose weight even though they eat an apparently appropriate or even
an excessive amount of food. Losing sugar and water in the urine and the accompanying
dehydration also contributes to weight loss.
Excessive thirst (polydipsia): A person with diabetes develops high blood sugar levels, which
overwhelms the kidney's ability to reabsorb the sugar as the blood is filtered to make urine.
Excessive urine is made as the kidney spills the excess sugar. The body tries to counteract this by
sending a signal to the brain to dilute the blood, which translates into thirst. The body encourages
more water consumption to dilute the high blood sugar back to normal levels and to compensate
for the water lost by excessive urination.
Excessive urination (polyuria): Another way the body tries to rid the body of the extra sugar in the
blood is to excrete it in the urine. This can also lead to dehydration because a large amount of water
is necessary to excrete the sugar.
Excessive eating (polyphagia): If the body is able, it will secrete more insulin in order to try to
manage the excessive blood sugar levels. Moreover, the body is resistant to the action of insulin in
type 2 diabetes. One of the functions of insulin is to stimulate hunger. Therefore, higher insulin
levels lead to increased hunger. Despite increased caloric intake, the person may gain very little
weight and may even lose weight.
Poor wound healing: High blood sugar levels prevent white blood cells, which are important in
defending the body against bacteria and also in cleaning up dead tissue and cells, from functioning
normally. When these cells do not function properly, wounds take much longer to heal and become
infected more frequently. Long-standing diabetes also is associated with thickening of blood
vessels, which prevents good circulation, including the delivery of enough oxygen and other
nutrients to body tissues.
Infections: Certain infections, such as frequent yeast infections of the genitals, skin infections, and
frequent urinary tract infections, may result from suppression of the immune system by diabetes
and by the presence of glucose in the tissues, which allows bacteria to grow. These infections can
also be an indicator of poor blood sugar control in a person known to have diabetes.
Altered mental status: Agitation, unexplained irritability, inattention, extreme lethargy, or
confusion can all be signs of very high blood sugar, ketoacidosis, hyperosmolar hyperglycemia
nonketotic syndrome, or hypoglycemia (low sugar). Thus, any of these merit the immediate
attention of a medical professional. Call your health care professional or 911.
Blurry vision: Blurry vision is not specific for diabetes but is frequently present with high blood
sugar levels.

When to Seek Medical Care

If a person has diabetes and experiences any of the following, call a health care professional:
Experiencing diabetes symptoms: this may mean that the person's blood sugar level is not being
controlled despite treatment
Blood sugar levels, when tested, are consistently high (more than 200 mg/dL): Persistently high
blood sugar levels are the root cause of all of the complications of diabetes.
 The patient's blood sugar level is often low (less than 70 mg/dL): this may mean that the diabetes
management strategy is too aggressive. It also may be a sign of infection or other stress on the
body's organs such as kidney failure, liver failure, adrenal gland failure, or the concomitant use of
certain medications.
An injury to the foot or leg, no matter how minor: even the tiniest cut or blister can become very
serious in a person with diabetes. Early diagnosis and treatment of problems with the feet and
lower extremities, along with regular diabetic foot care, are critical in preserving the function of the
legs and preventing amputation.
Low-grade fever (less than 101.5 F or 38.6 C): Fever is a sign of infection. In patients with diabetes,
many common infections can potentially be more dangerous for them than for other people. Note
any symptoms, such as painful urination, redness or swelling of the skin, abdominal pain, chest
pain, or cough, that may indicate where the infection is located.
Nausea or vomiting, but can keep liquids down: The health care professional may adjust
medications while the patient is sick, and will probably recommend an urgent office visit or a visit to
the emergency department. Persistent nausea and vomiting can be a sign of diabetic ketoacidosis, a
potentially life-threatening condition, as well as several other serious illnesses.
Small sore(s) (ulcer) on the foot or le:. Any non-healing sore or ulcer on the feet or legs of someone
with diabetes needs to be seen by a medical professional right away. A sore less than 1 inch across,
not draining pus, and not exposing deep tissue or bone, can safely be evaluated by a health care
professional, as long as the patient does not have fever and their blood sugar levels are under
control.
When you call a health care professional, tell them that you or someone you know has diabetes and are
concerned.
The patient will probably be referred to a nurse who will ask questions and make a
recommendation about what to do.
Be prepared for this conversation. Have a list of medications, medical problems, allergies to
medicines, and a blood sugar diary handy by the phone.
The nurse may need any or all of this information to decide both the urgency of the patient's
condition and how best to recommend treatment for the problem.
Diabetic emergencies
The following situations can become 911 medical emergencies and warrant an immediate visit to a
hospital emergency department.
The person with a severe diabetic complication may travel to the emergency department by car or
ambulance.
A companion should go along to speak for the person if the person is not able to speak for himself
or herself with the emergency care professional.
Bring a list of medical problems, medications, allergies to medications, and the person's blood sugar
diary to the emergency department. This information will help the emergency care professional
diagnose the problem and treat it appropriately.
The following are signs and symptoms of diabetic complications that warrant emergency care.
Altered mental status: Lethargy, agitation, forgetfulness, or just strange behavior can be a sign of
very low or very high blood sugar levels. If a person has diabetes with an altered mental status:
o Try giving them some fruit juice (about 6 ounces) or cake icing if the person is awake enough to
swallow normally without choking. Avoid giving things such as hard candy that can lodge in the
throat. The health care provider can prescribe glucose wafers or gels that melt under the
tongue.
o Does not wake up and behave normally within about 15 minutes, call 911.
 o Is not a known diabetic, these symptoms can be signs of stroke, drug intoxication, alcohol
intoxication, oxygen starvation, and other serious medical conditions. Call 911 immediately.
Nausea or vomiting: If the patient is known to have diabetes and cannot keep food, medications, or
fluids down at all, they may have diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic
syndrome, or another complication of diabetes. If the person:
o Has not already taken the latest insulin dose or oral diabetes medicine, do not take it without
talking to a medical professional.
o Already has low blood sugar levels, taking additional insulin or medication will drive the blood
sugar level down even further, possibly to dangerous levels.
Fever above 101.5 F (38.6 C): If the primary health care professional cannot see the patient right
away, seek emergency care for a person with diabetes with a high fever. Note any other symptoms
such as cough, painful urination, abdominal pain, or chest pain.
High blood sugar level: If the patient's blood sugar level is above 400 mg/dL, and the primary health
care professional cannot see them right away, go to the closest emergency department. Very high
blood sugar levels can be a sign of diabetic ketoacidosis or hyperosmolar hyperglycemic nonketotic
syndrome, depending on the type of diabetes the person has. Both of these conditions can be fatal
if not treated promptly.
Large sores or ulcers on the feet or legs: If the person has diabetes, a non-healing sore larger than 1
inch in diameter can be a sign of a potentially limb-threatening infection.
o Other signs and symptoms that merit immediate care are exposed bone or deep tissue in the
wound, large areas of surrounding redness and warmth, swelling, and severe pain in the foot or
leg.
o If left untreated, such a sore may ultimately require amputation of the limb.
Cuts or lacerations: Any cut penetrating all the layers of skin, especially on the legs, is a potential
danger to a person with diabetes. Proper wound care, although important to anyone's recovery, is
especially important in diabetics to assure proper wound healing.
Chest pain: If the person has diabetes, take very seriously any pain in the chest, particularly in the
middle or on the left side, and seek medical attention immediately.
o People with diabetes are more likely than non-diabetic people to have a heart attack, with or
without experiencing chest pain.
o Irregular heartbeats and unexplained shortness of breath may also be signs of heart attack.
Severe abdominal pain: Depending on the location, this can be a sign of heart attack, abdominal
aortic aneurysm (widening of the large artery in the abdomen), diabetic ketoacidosis, or interrupted
blood flow to the bowels.
o All of these are more common in people with diabetes than in the general population, and are
potentially life-threatening.
o People with diabetes also get other common causes of severe abdominal pain such as
appendicitis, perforated ulcer, inflammation and infection of the gallbladder, kidney stones,
and bowel obstruction.
o Severe pain anywhere in the body is a signal for timely medical attention.

Diabetes Diagnosis
Doctors use special tests in diagnosing diabetes and also in monitoring blood sugar level control in
known diabetics.
The health care professional will take a history including information about the patient's symptoms, risk
factors for diabetes, past medical problems, current medications, allergies to medications, family history
of diabetes, or other medical problems such as high cholesterol or heart disease, and personal habits
and lifestyle.
A number of laboratory tests are available to confirm the diagnosis of diabetes.
Finger stick blood glucose: This is a rapid screening test that may be performed anywhere, including
community-based screening programs.
Although a not as accurate as testing the patient's blood in the hospital laboratory, a fingerstick
blood glucose test but is easy to perform, and the result is available right away.
The test involves sticking the patient's finger for a blood sample, which is then placed on a strip. The
strip goes into a machine that reads the blood sugar level. These machines are only accurate to
within about 10%-20% of true laboratory values.
Fingerstick blood glucose values tend to be most inaccurate at very high or very low levels, so this
test is only a preliminary screening study. Fingerstick is the way most people with diabetes monitor
their blood sugar levels at home.
Fasting plasma glucose: The patient will be asked to eat or drink nothing for 8 hours before having
blood drawn (usually first thing in the morning). If the blood glucose level is greater than or equal to 126
mg/dL (without eating anything), they probably have diabetes.
If the result is abnormal, the fasting plasma glucose test may be repeated on a different day to
confirm the result, or the patient may undergo an oral glucose tolerance test or a glycosylated
hemoglobin test (often called "hemoglobin A1c") as a confirmatory test.
If fasting plasma glucose level is greater than 100 but less than 126 mg/dL, then the patient has
what is called impaired fasting glucose, or IFG. This is considered to be prediabetes. These patients
do not have diabetes, but they are at high risk of developing diabetes in the near future.
Oral glucose tolerance test: This test involves drawing blood for a fasting plasma glucose test, then
drawing blood for a second test at two hours after drinking a very sweet drink containing up to 75 grams
of sugar.
If the blood sugar level after the sugar drink is greater than or equal to 200 mg/dL, the patient has
diabetes.
If the blood glucose level is between 140 and 199, then the patient has impaired glucose tolerance
(IGT), which is also a prediabetic condition.
Glycosylated hemoglobin or hemoglobin A1c: This test is a measurement of how high the blood sugar
levels have been over approximately the last 120 days (the average life-span of the red blood cells on
which the test is based).
Excess blood glucose hooks itself on to the hemoglobin in red blood cells and stays there for the life
of the red blood cell.
The percentage of hemoglobin that has had excess blood sugar attached to it can be measured in
the blood. The test involves having a small amount of blood drawn.
A hemoglobin A1c test is the best measurement of blood sugar control in people known to have
diabetes. A hemoglobin A1c result of 7% or less indicates good glucose control. A result of 8% or
greater indicates that blood sugar levels are too high, too much of the time.
The hemoglobin A1c test is the best test for diabetes follow-up care, than to diagnose diabetes. Still,
a hemoglobin A1c result greater than 6.1% is highly suggestive of diabetes. Generally, a
confirmatory test would be needed before diagnosing diabetes.
The hemoglobin A1c test is generally measured about every 3 to 6 months for people with known
diabetes, although it may be done more frequently for people who are having difficulty achieving
and maintaining good blood sugar control.
This test is not used for people who do not have diabetes or are not at increased risk of diabetes.
Normal values may vary from laboratory to laboratory, although an effort is under way to
standardize how measurements are performed.
Diagnosing complications of diabetes
A person with diabetes should be checked regularly for early signs of diabetic complications. A health
care professional can order some of these tests; for others, the patient should be referred to a specialist.
The patient should have their eyes checked at least once a year by an eye specialist
(ophthalmologist) to screen for diabetic retinopathy, a leading cause of blindness.
The patient's urine should be checked for protein (microalbumin) on a regular basis, at least one to
two times per year. Protein in the urine is an early sign of diabetic nephropathy, a leading cause of
kidney failure.
Sensation in the legs should be checked regularly using a tuning fork or a monofilament device.
Diabetic neuropathy is a leading cause of lower extremity ulcers in individuals with diabetes, which
frequently lead to amputation of the feet or legs.
The health care professional should check the feet and lower legs of the patient at every visit for
cuts, scrapes, blisters, or other lesions that could become infected. Adults with diabetes should
check the soles of their feet and their legs daily with a hand-held mirror, either by themselves or
with the assistance of a relative or caretaker.
The patient should be screened regularly for conditions that may contribute to heart disease, such
as high blood pressure and high cholesterol.
Diabetes Treatment
Diabetes Self-Care at Home (Lifestyle Changes and Glucose Monitoring)
If a person has diabetes, healthful lifestyle choices in diet, exercise, and other health habits will help to
improve glycemic (blood sugar) control and prevent or minimize complications of diabetes.
Diabetes Diet: A healthy diet is key to controlling blood sugar levels and preventing diabetes
complications.
If the patient is obese and has had difficulty losing weight on their own, talk to a health care
professional. He or she can recommend a dietitian or a weight modification program to help the
patient reach a goal.
Eat a consistent, well-balanced diet that is high in fiber, low in saturated fat, and low in
concentrated sweets.
A consistent diet that includes roughly the same number of calories at about the same times of
day helps the health care professional prescribe the correct dose of medication or insulin.
A healthy diet also helps to keep blood sugar at a relatively even level and avoids excessively low
or high blood sugar levels, which can be dangerous and even life-threatening.
Exercise: Regular exercise, in any form, can help reduce the risk of developing diabetes. Activity can also
reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure,
blindness, and leg ulcers.
As little as 20 minutes of walking three times a week has a proven beneficial effect. Any exercise
is beneficial; no matter how easy or how long, some exercise is better than no exercise.
If the patient has complications of diabetes (such as eye, kidney, or nerve problems), they may
be limited both in type of exercise, and amount of exercise they can safely do without
worsening their condition. Consult with your health care professional before starting any
exercise program.
Alcohol use: Moderate or eliminate consumption of alcohol. Try to have no more than seven alcoholic
drinks in a week, and never more than one or two drinks in an evening. One drink is considered 1.5
ounces of liquor, 6 ounces of wine, or 12 ounces of beer. Excessive alcohol use is a known risk factor for
type 2 diabetes. Alcohol consumption can cause low or high blood sugar levels, nerve pain (neuritis), and
an increase in triglycerides.
Smoking: If the patient has diabetes, and smokes cigarettes or use any other form of tobacco, they are
raising the risks markedly for nearly all of the complications of diabetes. Smoking damages blood vessels
and contributes to heart disease, stroke, and poor circulation in the limbs. If a person needs help to quit
tobacco use, talk to a health care professional.
Self-monitored blood glucose: Check blood sugar levels frequently, at least before meals and at
bedtime, then record the results in a logbook.
This log should also include insulin or oral medication doses and times, when and what the
patient ate, when and for how long they exercised, and any significant events of the day such as
high or low blood sugar levels and how they treated the problem.
Better equipment now available makes testing blood sugar levels less painful and less
complicated than ever. A daily blood sugar diary is invaluable to the health care professional in
evaluating how the patient is responding to medications, diet, and exercise in the treatment of
diabetes.
Medicare now pays for diabetic testing supplies, as do many private insurers and Medicaid.

Diabetes Medical Treatment

The treatment of diabetes is highly individualized, depending on the type of diabetes, whether the
patient has other active medical problems, whether the patient has complications of diabetes, and age
and general health of the patient at time of diagnosis.
A health care professional will set goals for lifestyle changes, blood sugar control, and
treatment.
Together, the patient and the health care professional will formulate a plan to help meet those
goals.
Education about diabetes and its treatment is essential in all types of diabetes.
When the patient is first diagnosed with diabetes, the diabetes care team will spend a lot of
time with the patient, teaching them about their condition, treatment, and everything they
need to know to care for themselves on a daily basis.
The diabetes care team includes the health care professional and his or her staff. It may include
specialists in foot care, neurology, kidney diseases, and eye diseases. A professional dietitian
and a diabetes educator also may be part of the team.
The health care team will see the patient at appropriate intervals to monitor their progress and evaluate
goals.
Type 1 diabetes
Treatment of diabetes almost always involves the daily injection of insulin, usually a combination of
short-acting insulin (for example, lispro [Humalog] or aspart [NovoLog]) and a longer acting insulin (for
example, NPH, Lente, glargine [Lantus], detemir [Levemir]).
Insulin must be given as an injection just under the skin. If taken by mouth, insulin would be
destroyed in the stomach before it could get into the blood where it is needed.
Most people with type 1 diabetes give these injections to themselves. Even if someone else
usually gives the patient injections, it is important that the patient knows how to do it in case
the other person is unavailable.
A trained professional will show the patient how to store and inject the insulin. Usually this is a
nurse who works with the health care professional or a diabetes educator.
Insulin is usually given in two or three injections per day, generally around mealtimes. Dosage is
individualized and is tailored to the patient's specific needs by the health care professional.
Longer acting insulins are typically administered one or two times per day.
Some people have their insulin administered by continuous infusion pumps to provide adequate
blood glucose control. Supplemental mealtime insulin is programmed into the pump by the
individual as recommended by his or her health care professionals.
 It is very important to eat after the taking insulin, as the insulin will lower blood sugar regardless
of whether the person has eaten. If insulin is taken without eating, the result may be
hypoglycemia. This is called an insulin reaction.
There is an adjustment period while the patient learns how insulin affects them, and how to
time meals and exercise with insulin injections to keep blood sugar levels as even as possible.
Keeping accurate records of blood sugar levels and insulin dosages is crucial for the patient's
diabetes management.
Eating a consistent, healthy diet appropriate for the patient's size and weight is essential in
controlling blood sugar level.
Type 2 diabetes
Depending on how elevated the patient's blood sugar and glycosylated hemoglobin (HbA1c) are at the
time of diagnosis, they may be given a chance to lower blood sugar levels through lifestyle changes,
without medication.
The best way to do this is to lose weight if the patient is obese, and begin an exercise program.
This will generally be tried for 3 to 6 months, then blood sugar and glycosylated hemoglobin will
be rechecked. If they remain high, the patient will be started on an oral medication, usually a
sulfonylurea or biguanide (metformin [Glucophage]), to help control blood sugar levels.
Even if the patient is on medication, it is still important to eat a healthy diet, lose weight if they
are overweight, and engage in moderate physical activity as often as possible.
The health care professional will initially monitor the patient's progress on medication very
carefully. It is important to receive just the right dose of the right medication, to regulate blood
sugar levels in the recommended range with the fewest side effects.
The doctor may decide to combine two types of medications to achieve blood sugar levels
control.
Gradually, even people with type 2 diabetes may require insulin injections to control their blood
sugar levels.
It is becoming more common for people with type 2 diabetes to take a combination of oral
medication and insulin injections to control blood sugar levels.
Diabetes Medications
Many different types of medications are available to help lower blood sugar levels in people with type 2
diabetes. Each type works in a different way. It is very common to combine two or more types to get the
best effect with fewest side effects.
Sulfonylureas: These drugs stimulate the pancreas to make more insulin.
Biguanides: These agents decrease the amount of glucose produced by the liver.
Alpha-glucosidase inhibitors: These agents slow absorption of the starches a person eats. This
slows down glucose production.
Thiazolidinediones: These agents increase sensitivity to insulin.
Meglitinides: These agents stimulate the pancreas to make more insulin.
D-phenylalanine derivatives: These agents stimulate the pancreas to produce more insulin
more quickly.
Amylin synthetic derivatives: Amylin is a naturally occurring hormone secreted by the pancreas
along with insulin. An amylin derivative, such as pramlintide (Symlin), is indicated when blood
sugar control is not achieved despite optimal insulin therapy. Pramlintide is administered as a
subcutaneous injection along with insulin and helps achieve lower blood sugar levels after
meals, helps reduce fluctuation of blood sugar levels throughout the day, and improves
hemoglobin A1C levels.
Incretin mimetics: Incretin mimetics promote insulin secretion by the pancreas and mimics
other blood sugar level lowering actions that naturally occur in the body. Exenatide (Byetta) was
 the first incretin mimetic agent approved in the United States. It is indicated for diabetes
mellitus type 2 in addition to metformin or a sulfonylurea when these agents have not attained
blood sugar level control alone.
Insulins: Synthetic hyuman insulin is now the only type of insulin available in the United States;
it is less likely to cause allergic reactions than animal-derived varieties of insulin used in the past.
The type of insulin chosen to customize treatment for an individual is based on the goal of
providing optimal blood sugar control. Different types of insulin are available and categorized
according to their times of action onset and duration. Commercially prepared mixtures of insulin
may also be used to provide constant (basal) control and immediate control.
o Examples of rapid-acting insulins
Regular insulin (Humulin R, Novolin R)
Insulin lispro (Humalog)
Insulin aspart (Novolog)
Insulin glulisine (Apidra)
Prompt insulin zinc (Semilente, slightly slower acting)
o Examples of intermediate-acting insulins
Isophane insulin, neutral protamine Hagedorn (NPH) (Humulin N, Novolin N)
Insulin zinc (Lente)
o Examples of long-acting insulins
Extended insulin zinc insulin (Ultralente)
Insulin glargine (Lantus)
Insulin detemir (Levemir)
Diabetes Follow-up
Treatment:
Follow the health care professional's treatment recommendations.
Keep records of blood sugar levels as often as recommended by the health care professional and
the diabetes care team, including the times the levels were checked, when and how much
insulin or medication was taken, when and what was eaten, and when and for how long the
patient exercised.
Call the health care professional if the patient has any problems with their treatment or
symptoms that suggest poor glucose control.
Education:
Attend diabetes education classes at the local hospital. The more educated the patient and their
family are about the disease, the better they are likely to do.
If the patient takes insulin, they should see the health care professional about every 3 months or
more often. For other people with diabetes, every 3 to 6 months is generally adequate, unless
they are having complications.
Recognize low blood sugar levels and know how to treat them
The patient and their family should be taught how to recognize the signs and symptoms of low
blood sugar levels. The patient should have a clear plan for treating low blood sugar levels and
know when to call 911. Mild symptoms include confusion and sweating. Moreover, these
symptoms can progress to lethargy, agitation (sometimes with violent, jerking motions), or even
seizures.
Diabetes Prevention
It is not yet known how to prevent type 1 diabetes. Type 2 diabetes, however, can be prevented in some
cases.
Control weight to normal or near-normal levels by eating a healthy low-fat, high-fiber diet.
Regular exercise is crucial to the prevention of type 2 diabetes.
 Keep alcohol consumption low.
Quit smoking.
If a person has high blood fat levels (such as high cholesterol) or high blood pressure, take all
medications as directed.
Lifestyle modifications and/or certain medications can be used in people with prediabetes to
prevent progression to diabetes. Prediabetes can be diagnosed by checking fasting glucose and 2
hours after ingesting up to 75 grams of glucose (dosing is based on the weight of the patient).
If you or someone you know already has diabetes, the focus should be on preventing the complications,
which can cause serious disabilities such as blindness, kidney failure requiring dialysis, amputation, or
even death.
Tight glucose control: The single best thing a person with diabetes can do is to keep their blood
sugar level within the suggested range every day. The only way to do this is through a combination
of regular blood sugar checks; a balanced diet low in simple sugars and fat, and high in complex
carbohydrates and fiber; a high degree of personal motivation; and appropriate medical treatment.
Consult a nutritionist or check with a doctor with questions in regard to diet.
Quit smoking
Maintain a healthy weight
Increase physical activity levels. Aim for moderately vigorous physical activity for at least 30 minutes
every day.
Drink an adequate amount of water and avoid consuming too much salt.
The skin should be taken care of; keep it supple and hydrated to avoid sores and cracks that can
become severely infected.
Brush and floss the teeth every day. See a dentist regularly to prevent gum disease.
The feet should be washed and examined daily, looking for small cuts, sores, or blisters that may
cause problems later. The toenails should be filed rather than cut to avoid damaging the
surrounding skin. A specialist in foot care (podiatrist) may be necessary to help care for the feet.
Diabetes Prognosis
Diabetes is a leading cause of death in all industrialized nations. Overall, the risk of premature death of
people with diabetes is twice that of people who do not have diabetes. Prognosis depends on the type
of diabetes, degree of blood sugar control, and development of complications.
Type 1 diabetes
About 15% of people with type 1 diabetes die before age 40 years, which is about 20 times the rate of
that age group in the general population.
The most common causes of death in type 1 diabetes are diabetic ketoacidosis, kidney failure,
and heart disease.
The good news is that prognosis can be improved with good blood sugar control. Maintaining
tight blood sugar control has been proven to prevent, slow the progression of, and even
improve established complications of type 1 diabetes.
Type 2 diabetes
The life-expectancy of people who are diagnosed with type 2 diabetes in their 40s decreases by 5-10
years because of the disease.
Heart disease is the leading cause of death for people with type 2 diabetes.
Excellent glycemic control, tight blood pressure control, and keeping the "bad" cholesterol (LDL)
level at the recommended level of <100 mg/dL (or lower, particularly if other risk factors for
cardiovascular disease are present) and the "good" (HDL) cholesterol as high as possible. Use of
aspirin when indicated can prevent, slow the progression of, and improve established
complications in diabetes.
If you have diabetes you are more likely to have foot problems. Diabetes can damage your nerves (See:
Diabetic neuropathy). This, in turn, may make you less able to feel an injury or pressure on the skin of
your foot. You may not notice a foot injury until severe damage or infection develops.
Diabetes changes your body's ability to fight infections. Damage to blood vessels because of diabetes
results in less blood and oxygen getting to your feet. Because of this, small sores or breaks in the skin
may become deeper skin ulcers. The affected limb may need to be amputated if these skin ulcers do not
improve, get larger, or go deeper into the skin.
If you have diabetes, you should:
 Improve control of your blood sugar
 Stop smoking
 Get a foot exam by your health care provider at least once a year and learn whether you have
nerve damage.
 Check and care for your feet every day, especially if you already have known nerve or blood
vessel damage or current foot problems. Follow the instructions below.
DAILY CARE ROUTINE
Check your feet and toes every day. Look carefully at the top, sides, soles, heels, and between the toes.
Wash your feet and toes every day with lukewarm water and mild soap. Strong soaps may damage the
skin.
 Test the temperature of the water with your fingers or elbows before putting your feet in warm
or hot water. Because of your diabetes, you may not be able to sense if the water is too hot.
Burns can easily occur.
 Gently and thoroughly dry your feet, especially between your toes. Infections can develop in
moist areas.
 Your feet may become very dry and may crack, possibly causing an infection. After bathing your
feet, soften dry skin with lotion, petroleum jelly, lanolin, or oil. Do not put lotion between your
toes if you have sores there.
Ask your health care provider if it is okay for you to trim your nails. If it is, ask your health care provider
to show you the safest way. If your toenails are not trimmed correctly, you may get a foot sore or ulcer.
 Soak your feet in lukewarm water to soften your nails before trimming.
 Cut the nail straight across, because curved nails are more likely to become ingrown.
Avoid sitting with your legs crossed or standing in one position for long periods of time.
If you smoke, stop. It decreases blood flow to the feet.
TIPS ON SHOES AND SOCKS
Wear shoes at all times to protect your feet from injury. Otherwise, if you have poor vision and less
ability to feel pain, you may not notice minor cuts or bumps.
 Check the inside of your shoes for rough areas or torn pieces that can cause excess pressure or
irritation.
 If you have nerve damage to your feet, change or temporarily remove your shoes after 5 hours
of wearing them during the day. This changes the pressure points during the course of the day.
The type of shoes you wear when you have diabetes is important:
 Wear comfortable, well-fitting shoes that have plenty of room in them. Never buy shoes that do
not fit properly, hoping the shoes will stretch with time. Nerve damage may prevent you from
being able to sense pressure from poorly fitting shoes. You may need a special shoe made to fit
your foot.
 Wear shoes made of canvas, leather, or suede. Do not wear shoes made out of plastic, or
another material that does not breathe. Do not wear thong sandals.
 Wear shoes you can easily adjust. They should have laces, Velcro, or buckles.
 Do not wear shoes with pointed or open toes, such as high heels, flip-flops, or sandals.
Socks may provide an extra layer of protection between your shoe and your foot.
 Wear clean, dry socks or nonbinding panty hose every day.
 Do NOT wear stockings with seams that can cause pressure points.
 Wear socks to bed if your feet are cold. In cold weather, wear warm socks and limit your
exposure to the cold to prevent frostbite.
MORE HELPFUL TIPS
 Do NOT use antiseptic solutions on your feet because these can burn and injure skin.
 Do NOT apply a heating pad or hot water bottle to your feet. Avoid hot pavement or hot sandy
beaches.
 Remove shoes and socks during visits to your health care provider. This is a reminder that you
may need a foot exam.
 Do NOT treat corns or calluses yourself using over-the-counter remedies. Make an appointment
with a podiatrist to treat foot problems.
 If obesity prevents you from being physically able to inspect your feet, ask a family member,
neighbor, or visiting nurse to perform this important check.
Report sores or other changes to your doctor immediately. Report all blisters, bruises, cuts, sores, or
areas of redness.
Function
If you have type 2 diabetes, your main focus is often on weight control. Most people with this disease
are overweight.
You can improve blood sugar (glucose) levels by following a meal plan that has:
 Fewer calories
 An even amount of carbohydrates (30 - 45 grams per meal)
 Healthy monounsaturated fats
Examples of foods that are high in monounsaturated fats include peanut or almond butter, almonds,
and walnuts. You can substitute these foods for carbohydrates, but keep portions small because these
foods are high in calories. Learn how to read nutrition labels to help you make better food choices.
Often, you can improve type 2 diabetes control by losing weight (about 10 pounds) and increasing
physical activity (for example, 30 minutes of walking per day). In addition to making lifestyle changes,
some people will need to take pills or insulin injections to control their blood sugar.
CHILDREN AND TYPE 2 DIABETES
Children with type 2 diabetes present special challenges. Meal plans should consider the amount of
calories children need to grow. Kids often need three smaller meals and three snacks to meet their
calorie needs. The goal should be a healthy weight (most children with type 2 diabetes are obese) and
increased physical activity.
Changes in eating habits and increased exercise help improve blood sugar control. When at parties or
during holidays, your child may still eat sugary foods. But during other times of the day, the child should
have fewer carbohydrates. Children who eat birthday cake, Halloween candy, or other sweets should
NOT have the usual daily amount of potatoes, pasta, or rice. This substitution helps keep calories and
carbohydrates in better balance.
MEAL PLANNING
One of the most challenging aspects of managing diabetes is meal planning. Work closely with the
doctor and dietitian to design a meal plan that keeps the blood sugar (glucose) levels near normal. The
meal plan should give you or your child the proper amount of calories to maintain a healthy body
weight.
Having diabetes does not mean you or your child must completely give up any food, but it does change
the kinds of foods your child should eat routinely. Choose foods with moderate amounts of
carbohydrates (about 30 - 45 grams per meal) to help keep blood sugar levels under good control. Foods
should also provide enough calories to maintain a healthy weight. Regular monitoring of blood sugar
(glucose) at home will help you learn how different foods affect blood sugar (glucose) levels.
Back to TopRecommendations
A registered dietitian can help you decide how to balance the carbohydrates, protein, and fat in your
diet. Here are some general guidelines:
The amount of each type of food you eat depends on:
 Your diet
 Your weight
 How often you exercise
 Your other health risks
Everyone has individual needs. Work with your doctor, and possibly a dietitian, to develop a meal plan
that works for you.
The Diabetes Food Pyramid, which resembles the old USDA food guide pyramid, splits foods into six
groups in a range of serving sizes. In the Diabetes Food Pyramid, food groups are based on carbohydrate
and protein content instead of their food type. A person with diabetes should eat more of the foods in
the bottom of the pyramid (grains, beans, vegetables) than those on the top (fats and sweets). This diet
will help keep your heart and body systems healthy.
Another method, similar to the new "plate" USDA food guide, encourages larger portions of vegetables
(half the plate) and moderate portions of protein (one-quarter of the plate) and starch (one-quarter of
the plate).
GRAINS, BEANS, AND STARCHY VEGETABLES
(6 or more servings a day)
Foods like bread, grains, beans, rice, pasta, and starchy vegetables are at the bottom of the pyramid
because they should serve as the foundation of your diet. As a group, these foods are loaded with
vitamins, minerals, fiber, and healthy carbohydrates.
It is important, however, to eat foods with plenty of fiber. Choose whole-grain foods such as whole-grain
bread or crackers, tortillas, bran cereal, brown rice, or beans. Use whole-wheat or other whole-grain
flours in cooking and baking. Choose low-fat breads, such as bagels, tortillas, English muffins, and pita
bread.
VEGETABLES
(3 - 5 servings a day)
Choose fresh or frozen vegetables without added sauces, fats, or salt. Opt for more dark green and deep
yellow vegetables, such as spinach, broccoli, romaine lettuce, carrots, and peppers.
FRUITS
(2 - 4 servings a day)
Choose whole fruits more often than juices. Whole fruits have more fiber. Citrus fruits, such as oranges,
grapefruits, and tangerines, are best. Drink fruit juices that do NOT have added sweeteners or syrups.
MILK
(2 - 3 servings a day)
Choose low-fat or nonfat milk or yogurt. Yogurt has natural sugar in it, but it can also contain added
sugar or artificial sweeteners. Yogurt with artificial sweeteners has fewer calories than yogurt with
added sugar.
MEAT AND FISH
(2 - 3 servings a day)
Eat fish and poultry more often. Remove the skin from chicken and turkey. Select lean cuts of beef, veal,
pork, or wild game. Trim all visible fat from meat. Bake, roast, broil, grill, or boil instead of frying.
FATS, ALCOHOL, AND SWEETS
In general, you should limit your intake of fatty foods, especially those high in saturated fat, such as
hamburgers, cheese, bacon, and butter.
If you choose to drink alcohol, limit the amount and have it with a meal. Check with your health care
provider about how alcohol will affect your blood sugar, and to determine a safe amount for you.
Sweets are high in fat and sugar, so keep portion sizes small. Here are some tips to help avoid eating too
many sweets:
 Ask for extra spoons and forks and split your dessert with others.
 Eat sweets that are sugar-free.
 Always ask for the small serving size.
Learn how to read food labels, and consult them when making food decisions.

Essential Tips on Diabetes

Whether you are newly diagnosed or due for a re-cap on the basics, these 5 essentials of diabetes
management help you take a step back and ask yourself whether the basics are being met.
Read up on diabetes
Knowledge is one of the best ways to beat diabetes. Diabetes is able to affect our whole body so there
can be a lot to take in and sometimes when we absorb the information in small occasional chunks, it can
leave us quite confused.
Thankfully, there are some great books available which break down what we need to know in a really
well structured way.
As well as providing a solid foundation for understanding diabetes, books can be a cost effective way to
improve our diabetes management.
A quality book on diabetes will often cost no more than a tub of test strips. Every one with diabetes
should aim to get hold of at least one really good book on the subject.
 Diabetes book reviews
Test and record your blood sugars
Once you have read up on diabetes, the next stage is to take your understanding forward on a personal
level – how diabetes affects you.
Testing will not only let you see how you’re doing on a regular basis, but it should also help you
understand your diabetes and inform your decision making.
This could include helping to choose a suitable diet, knowing how activity affects you and how stressful
days and illness need to be managed. Furthermore, the more detail you record, the better prepared you
will be for doctor’s appointments.
 Blood glucose levels
 Free blood glucose diary
Some people, particularly those with type 2 diabetes, have experienced difficulty with being prescribed
blood glucose testing strips. Read more on availability of test strips.
Pick a good diet for your diabetes
A good diet will help in a myriad of ways. It can help improve blood sugar levels, improve blood pressure
and cholesterol, reduce tiredness, improve digestion and can significantly improve clarity of thought.
Diet can be one of the most confusing aspects for people with diabetes as so much information is
contradictory. Even with the conflicting information out there, there are some common themes that run
through, such as eating foods with plenty of fibre and a low glycaemic index.
Vegetables and unsalted nuts fit the criteria well. Fish is a good pick and good quality lean meats are
generally well regarded.
 Which foods help diabetes?
Include some activity each day
Just a little activity each day can help to improve our health and it can also help us to feel more
energetic through the day.
Activity needn’t mean taking out a gym subscription, a 20 minute walk or even 15 minutes of press ups
and/or aerobics in your own living room will get the heart pumping.
The effect of regular activity is also known to help increase insulin sensitivity, which can be useful for all
types of diabetes, particularly type 2 diabetes.

How to Bring Down High Blood Sugar Levels

Having high blood sugar levels can be discomforting and many people wish to
know what they can do to help to bring down high blood glucose levels.

We look at some of the options for lowering blood glucose in the short term.

High blood sugar is commonly known as hyperglycemia.

What are the signs of high blood sugar?

The classic symptoms of high blood glucose levels are:

 Feeling very thirsty

 Needing to go the toilet often
 Having a dry mouth
 Feeling tired/lethargic
 Feeling uncomfortable and irritable

Check your blood sugar

If you have take medication that may cause low blood sugar (hypoglycemia),
it’s highly advisable to check your blood sugar levels before you try to bring
your sugar levels down, just in case your blood sugar is normal or low, which
can be the case in some situations.

Testing of blood sugar before bringing your levels down is particularly

important if you take insulin.

Correcting high blood sugar levels with insulin

If you take insulin, one way to reduce blood sugar is to inject insulin.

However, be careful as insulin can take 4 hours or longer to be fully absorbed,

so you need to make sure you take into account how much insulin you may
already have in your body that is yet to be absorbed by the blood. Insulin that
is yet to be absorbed by the blood is called ‘active insulin’.

If you decide to correct with insulin, watch you don’t over correct as this can
lead to hypoglycemia and can be dangerous, particularly so before bed.

Walking
Exercise can help to lower blood sugar and walking is a good way of achieving
this.

It might make sense that exercising harder would have a better effect on
lowering blood sugar therefore but this is not always the case as strenuous
exercise can produce a stress response which causes the body to raise blood
glucose levels. This response does tend to vary from person.

Drinking more water

When your blood sugar levels are running high, your body will try to flush
excess sugar out of your blood through the urine. As a result, your body will
need more fluids to rehydrate itself. Drinking water can help the body with
flushing out some of the glucose in the blood.

Just a word of caution to be sensible with drinking water; water intoxication

(which can result in death) is possible if a number of litres water are drunk in a
short space of time. This is rare and quite difficult to manage but it pays to be
aware of this.

How Does Diabetes Affect The Body?

Diabetes has a substantial affect on the body

Knowing how diabetes affects your body can help you look after your body
and prevent diabetic complications from developing.

Many of effects of diabetes stem from the same guilty parties, namely high
blood pressure, high cholesterol levels and a lack of blood glucose control.

Signs of diabetes

When undiagnosed or uncontrolled, the effects of diabetes on the body can be

noticed by the classic symptoms of diabetes, namely:

 Increased thirst
 Frequent need to urinate
 Fatigue
 Blurred vision and
 Tingling or pain in the hands, feet and/or legs.

Long term effects of diabetes on the body

In addition to the symptoms, diabetes can cause long term damage to our
body. The long term damage is commonly referred to as diabetic
complications. Diabetes affects our blood vessels and nerves and therefore
can affect any part of the body.

However, certain parts of our body are affected more than other parts.

Diabetic complications will usually take a number of years of poorly controlled

diabetes to develop. Complications are not a certainty and can be kept at bay
and prevented by maintaining a strong level of control on your diabetes, your
blood pressure and cholesterol.

These can all be helped by keeping to a healthy diet, avoiding cigarettes and
alcohol, and incorporating regular activity into your daily regime in order to
keep blood sugar levels within recommended blood glucose level guidelines.

The effect of diabetes on the heart

Diabetes and coronary heart disease are closely related.

Diabetes contributes to high blood pressure and is linked with high cholesterol
which significantly increases the risk of heart attacks and cardiovascular
disease.

Diabetes and strokes

Similar to how diabetes affects the heart, high blood pressure and cholesterol
raises the risk of strokes.

How diabetes effects the eyes

A relatively common complication of diabetes is diabetic retinopathy. As with

all complications, this condition is brought on by a number of years of poorly
controlled or uncontrolled diabetes. Diabetic retinopathy has a number of
symptoms.
Retinopathy is caused by blood vessels in the back of the eye (the retina)
swelling and leaking. High blood pressure is also a contributing factor for
diabetic retinopathy.

Diabetic retinopathy can be treated so it’s best to catch it as early as you can.
The best way to do this is to attend a retinopathy screening appointment,
provided free on the NHS, once each year.

Effect of diabetes on the kidneys

The kidneys are another organ that is at particular risk of damage as a result
of diabetes and the risk is again increased by poorly controlled diabetes, high
blood pressure and cholesterol.

Diabetic nephropathy is the term for kidney disease as a result of diabetes.

Damage to the kidneys takes place over a period of years and can picked up
by nephropathy screening before it gets too serious. Treatment includes
lifestyle changes and may include medicine to treat high blood pressure and
cholesterol.

Diabetes and its effects on the nerves

The effects of diabetes on the nerves can be serious as the nerves are
involved in so many of our bodily functions, from movement and digestion
through to sex and reproduction.

The presence of nerve damage (neuropathy) is commonly noticed by:

 Numbness or tingling in the hands or feet

 Lack of arousal in the penis or clitoris
 Excessive sweating or
 Diagnosis of delayed stomach emptying

Treatments for neuropathy concentrates on reducing pain but medication such

blood pressure lowering drugs may also be prescribed to help prevent
development of the condition.

Diabetes and its effect on digestion

Diabetes can affect digestion in a number of ways. If diabetes has caused

nerve damage, this can lead to nausea, constipation or diarrhoea.
An alternative cause of disturbed digestion can be the result of diabetes
medication. Some type 2 diabetes medications for instance are prone to
causing digestive issues, although these tend to settle down after the body
gets used to them.

How diabetes affects the skin

Diabetes affect on the skin is usually a result of its affect on the nerves and
circulation which can lead to dry skin, slow healing of cuts, burns and wounds,
fungal and bacterial infections and loss of feeling in the foot.

People with diabetes are recommended to have their feet checked at least
once a year. The effect of diabetes on the feet is often referred to as diabetic
foot.

Which food help dabetes?

One of the first questions for people newly diagnosed with diabetes is 'what
can I eat'.

Information can be very confusing with many news and healthy living
magazines suggesting foods that can help diabetes.

To help make some kind of sense, we present our guide on which foods can
help diabetes.

Picking a sensible diabetic diet

The following guidelines provide a good basis for a diabetic diet.

 Foods with a low GI (glycaemic index)

 Include lean meats, fish or other sources of protein
 Include plenty of fibre
 Try to take in a relatively low amounts of saturated fat and salt

Fruit and vegetables

Vegetables are a very good choice.

They contain a good quantity of vitamins and minerals and are a great source
of fibre. Some vegetables have more effect on blood sugar than others so you
may need to pick vegetables with a lower GI.

Fruits are also a good source of fibre and vitamins but people with diabetes
will often find that some fruits are better than others for their blood sugar
levels.

Protein

Protein can be very useful as it is more slowly broken down by the body than
carbohydrates.

As a result, it has less of an effect on blood sugar and can help you to feel
fuller for longer. Good protein sources include oily fish and lean meats, such
as grilled skinless chicken.

Whole grains

Whole grain foods are those containing oats, barley, wheat where the full
grain is used.

Foods made from grains have quite a high concentration of carbohydrate so

people with diabetes will benefit by testing their blood sugar before and after
eating grain based foods to see whether their blood sugar is being raised too
high.
Much modern food is made from over processed grains, such as plain flour,
many breads, white rice and pastries. However, whole grain varieties do exist.
Breads with a higher amount of fibre, for instance, are generally better than
those with a low amount of fibre. Similarly, brown rice is a better choice than
white rice.

Nuts, herbs and spices

Nuts can be a good food choice.

Avoid salted nuts and try to limit the quantity of nuts you eat as they have a
high calorific value. Don’t let the calories put you off completely though, nuts
are a great source of fibre and vitamins and can be beneficial for cholesterol.

Walnuts, almonds, brazil nuts and macadamia nuts are good choices.

Herbs and spices are not only a great way to add flavour to food, they’re also
another good source of vitamins. Adding herbs and spices to food can help to
replace adding extra salt.

Which foods should people with diabetes avoid?

Try to limit all of the following:

 White bread, white pasta and pastries

 Ready meals
 Take away food

Some people may be comfortable completely ruling these foods out of their
diet whereas others may want to occasionally include some of these foods
every now and again. The key is to be able to pick a sensible limit and be able
to stick to it.

Many people also suggest staying away from so-called Diabetic Food.

Eat according to your blood glucose meter

Everyone is different, so what works for one person is no guarantee it will

work for another. It’s worth knowing and being aware of general guidelines
and then testing to see how different foods affect your sugar levels.
One tried and tested method is to try different foods and meals by testing your
blood sugar before eating (taking any medication as you usually would) and
then testing your blood at two hour intervals.

A blood test before eating, 2 hours after and 4 hours after will be a good test
for most meals, however, some low GI foods (such as whole meal pasta) may
need a test 6 hours after to see the effect of the food.

Keeping Active with Diabetes

Keeping active is important for people who have or are at risk of diabetes

Keeping active is an important part of one's lifestyle, and particularly for those
who either have or are at risk of diabetes.

Even a little extra activity can have a lot of benefits, such as improving insulin
sensitivity, improving your feeling of well being, controlling your weight,
reducing risks of cancer and heart problems and helping strengthen bones as
well as muscles.

How much activity should I be doing?

Any extra activity you can fit into your day is a plus. The minimum
recommended level of activity is 30 minutes at least 5 days a week.

Children should aim for at least an hour a day. The British Heart Foundation
recommends that we take 10,000 steps per day to promote a healthy heart;
this is equivalent to about 5 miles.
What counts as activity?

Activity counts as anything that will up your heart rate a little.

This could include any of the following:

 a brisk walk
 climbing flights of stairs
 shopping (not internet shopping though!)
 gardening
 housework
 DIY
 dancing
 yoga, pilates, tai chi
 active sports

Motivation towards being more active

Some people find it difficult to commit to being more active citing not having
enough time as one of the reasons. Whilst activity does involve some
investment of time, in the longer run, a little activity or exercise can help to
free up time as well as providing you with more vitality.

Activity allows the brain to function better and can help to compulsive
behaviours which can lead to your time being better spent. The term healthy
body, healthy mind rings true.
Activity and heart problems

People with existing heart problems may need to avoid particularly strenuous
activities such as press ups, lifting weights and strenuous aerobic exercise
such as running.

Any activity that involves getting up quickly may also need to be avoided. If
you have cardiovascular problems, your healthcare team can offer advice as
to which activities will be most suitable.

Diabetes and Vegetarianism

A standard vegetarian diet could help diabetes sufferers, particularly those

type 2 patients seeking to avoid insulin injections, and pre-diabetics worried
about developing the disease.

The BDA (British Diabetic Association) recommends a diet that closely

matches a vegetarian diet, due to the fact that eating this type of food is
loaded with fibre and complex carbohydrates. In the body, this translates to a
better metabolism and perhaps lower blood sugar levels.

Vegetarians are typically thinner, with a better proportion of muscle to fat, and
not suffering from high bad cholesterol levels (unless their lifestyle external to
diet contradicts this).

Diabetic Food
Diabetic food is considered a gimmick to push food to people with diabetes

Diabetic food forum threads

 Should 'diabetic' food be better regulated?
 Diabetic Food - why is it sold?
 Sweets
 Hartley's sugar-free jellies
 No sugar chocolate

Diabetic food is fast becoming an obsolete term. Yet, this doesn't stop
thousands of diabetics believing they have to buy this food and countless
manufacturers selling diabetic food products.

The situation has reached the point at which Diabetes UK and the Food
Standards Agency have issued a joint statement calling for an end to ‘diabetic
food’ and ‘suitable for diabetics’ on food labels.

Dietary policy

This shift in dietary policy is largely down to changing diet advice, which
recommends that any food is suitable for people with diabetes in sensible
moderation.

Concern has existed for some time that labelling a food as ‘diabetic’ could
mislead people with diabetes into thinking that the food was essential or at the
least especially suitable.

Often, diabetic foods are more expensive than standard products, with sugar-
free and low-sugar versions also often misleading.

Often, ‘diabetic’ food labelling is applied to sweet food such as biscuits and
chocolate. According to the joint statement - people who eat sugary food
should do so sparingly, and only as part of a healthy and balanced diet.
Effectively, healthy eating advice provided by the authorities is the same for
people with diabetes as it is for those without; specially designated ‘diabetic’
foods should now become a thing of the past.

I am diabetic, should I eat diabetic food?

No, people with diabetes don’t need to eat special diabetic food.

Health authorities and Diabetes UK advise a healthy, balanced diet with no

need to seek out specially labelled food.

Because a manufacturer labels a food as ‘suitable for diabetics’ doesn’t mean

that other food is necessarily unsuitable for diabetics.

Why should I avoid diabetic food?

Firstly, ‘diabetic’ food is often much more expensive than other types of food.

Secondly, this type of food may offer no additional health benefits for the
buyer. Because of this, it is recommended that diabetics don’t need to focus
their food buying on diabetic food.

Will diabetic food hurt me?

Choosing diabetic food over healthy, natural products may damage your blood
glucose control more than eating a balanced diet.
However, ‘diabetic’ foods of themselves may also synthetic sugars which can
send blood glucose levels up. Remember, always read labels carefully and
don’t be drawn in by a food which is ‘suitable for diabetics.’

Diet for Type 1 Diabetes

Different foods impact your blood sugars differently

The dietary advice generally given to people with type 1 diabetes is not much
different to the dietary advice for people without diabetes.

The main issues to consider are how sharply different foods are likely to
impact on your blood glucose levels and how to balance the quantity of
carbohydrate with the right amount of insulin.

Carbohydrate counting

Carbohydrate counting plays a key role in helping to balance insulin intake

with the food you eat.

A number of carbohydrate counting courses are available including the

DAFNE course (dose adjustment for normal eating) which is widely
recommended by people who have been on it.

Another carbohydrate counting resource which is quickly growing in popularity

is the Carbs and Cals book which shows, in pictorial form, how many
carbohydrates are in a huge variety of different meals and portion sizes.
Healthy eating for type 1 diabetes

Eating healthily comes highly recommended and can play a part in helping to
prevent the development of complications.

Eating a balanced diet, containing a variety of different vegetables, will help to

provide many nutrients that the body needs.

Try to include foods containing unsaturated fats such as nuts, avocados and
oily fish.

We recommend limiting the amount of processed foods you eat and try to
include home prepared or freshly prepared food wherever possible.

 Read more on healthy eating for diabetes

Low carb diets and type 1 diabetes

Some people with type 1 diabetes may wish to adopt a reduced carbohydrate
diet. Low carb diets can be helpful for people who are struggling to keep
control on a carb centered diet or for those who are otherwise looking to
tighten their control.

One of the benefits of reducing your intake of carbohydrate is in reducing the

extent of post meal high blood sugar levels.
Lower carb diets will require a reduction in insulin and could result in
hypoglycemia if doses are not changed correctly. It is recommended to speak
to your doctor before going onto a significantly different diet.

Diet for Type 2 Diabetes

Type 2 diabetes diet should focus on not spiking blood glucose levels

Diets for type 2 diabetes should be built around the principles of healthy
eating with a focus on foods that do not adversely affect blood glucose levels.

As a general guide, a diet that includes a good variety of vegetables, a good

source of unsaturated fats such as in nuts, avocados and oily fish and focuses
on unprocessed foods is a good start.

Type 2 diabetes and the NHS diet

The diet advice that is generally given out by the NHS is to include starchy
carbohydrates with each meal, eat more fruit and vegetables, to eat at least 2
portions of oily fish a week and to cut down on saturated fat, salt and sugars.

The most disputed part of the advice is over the recommendation to eat
starchy carbohydrates at each meal.

Many people with type 2 diabetes find that even low GI sources of starchy
carbohydrate (such as basmati rice and whole grain bread) tend to
significantly increase blood glucose levels.

People should do blood glucose tests before and 2 hours after meals to see
which foods, and in what quantities, are appropriate for them.
Low carb diets and type 2 diabetes

Low carbohydrate diets tend to be popular with people with type 2 diabetes,
with many people reporting improved blood glucose levels on a low carb diet,
and it can help to reduce dependency on medication.

Low carbohydrate diets, despite their popularity and apparent effectiveness,

have yet to be endorsed by the NHS. Read more about low carb diets and
NHS recommendations.

People who are taking medication for type 2 diabetes should be aware that
low carb diets could raise the likelihood of hypoglycemia so it’s recommended
to speak with your doctor before starting such a diet.

Raw food diets and type 2 diabetes

Raw food diets can be viewed as effective detox diets. Some of the health
advantages of raw food diets are a result of the reliance on freshly prepared
food and the high amount of fruit and vegetables involved.

Raw food diets are quite restrictive and it’s recommended that you check with
your doctor before starting a raw food diet to ensure you get a good balance
of nutrients.
Very low calorie diets and the Newcastle study diet

A study published in 2011 known as ‘the Newcastle study diet’ showed that a
very low calorie diet could be particularly effective at reversing the symptoms
of type 2 diabetes.

Since the results were published, a significant number of people with type 2
diabetes have been keen to give the 8 week long diet a try.

Very low calorie diets, such as the Newcastle diet, are viewed as quite
extreme diets and not recommended to be started without supervision from a
doctor.

People with diabetes are often advised to eat a good selection of whole grain
food. However, people are often confused as to what counts as whole grain.

Much of the produce which many of us have grown up with consists of refined
wheat products lacking very much of the nutrition within better whole grain
equivalents.

If you have wheat or grain based foods, try to find whole grain varieties. They
will be better for your sugar levels as well as your health in general.

What are whole grain foods?

Whole grain foods are found in cereals such as wheat, oats, barley, maize,
rye and brown rice, amongst others.

The grain is made up of three constituent parts:

 Germ: the germ is the reproductive part of the grain and is packed with
nutrients
 Endosperm: accounts for about 80% of the grain, this is the starchy part
 Bran: the fibre rich outside (shell) of the grain

Much food sold these days is made from highly refined flour and wheat
products. The more refined the food is, the less nutrition it carries. White
bread for example is made from highly refined flour which has very little
nutritional value as the refining process strips out much of the vitamins.
Furthermore, products that are highly refined, such as white bread, are very
quickly turned into glucose by the body and therefore they are best avoided by
those with diabetes.

Which foods count as whole grain?

For food to count as whole grain, it should include each of the three parts
(germ, endosperm and bran). However, shop produce can make it very
difficult to tell what is actually whole grain.

Be wary of terms like wholemeal, granary and multigrain as these offer no

guarantee that the bread is made from whole grains. Look instead for use of
the term ‘whole grain’ or ‘wholegrain’.

As a general guide, look for items such as the following:

 Brown rice
 Products with bran
 Whole grain or buckwheat flour
 Whole grain bread

Truly whole grain foods are difficult to find in supermarkets and so sometimes
a ‘wholemeal loaf’ may be the best on offer.

As a good general rule of thumb, the more fibre present in a grain product, the
healthier it is likely to be.
What are the benefits of eating wholegrain foods?

Whole grain foods include more nutrition than their non-whole grain
equivalents. The nutritional benefits of whole grain foods are:

 More fibre – great for digestion

 Reduced impact on blood sugar – compared with more refined
equivalents
 Good source of minerals; magnesium and zinc
 Good source of vitamins B and E

Does all brown bread count as whole grain?

A lot of brown bread, particularly the cheaper supermarket loaves, is not

whole grain because a lot of these breads don’t include either the bran or the
germ. As a result the bread is starchy but lacks the extra fibre and nutrients it
would have if it were whole grain. Sadly some brown bread is simply white
bread coloured with sugar (molasses or caramel)!

Also, some bread may be called ‘whole grain topped’ which means whilst the
topping is whole grain, the bread itself is likely not. One way to help with
picking a healthy loaf is to pick one that has a good concentration of fibre.

Look for breads that contain over 3g of fibre per slice (about 8g of fibre per
100g of bread).

Manage your diabetes.

Many people avoid the long-term problems of diabetes by taking good care of
themselves. Work with your health care team to reach your ABC target. Use this self-
care plan.
 Follow your diabetes meal plan. If you do not have one, ask your health care team to help
you develop a meal plan.

o Eat healthy foods such as fruits and vegetables, fish, lean meats, chicken or turkey
without the skin, dry peas or beans, whole grains, and low-fat or skim milk and
cheese.

o Keep fish and lean meat and poultry portions to about 3 ounces (or the size of a deck
of cards). Bake, broil, or grill it.

o Eat foods that have less fat and salt.

o Eat foods with more fiber such as whole grain cereals, breads, crackers, rice, or
pasta.

 Get 30 to 60 minutes of physical activity on most days of the week. Brisk walking is a great
way to move more.

 Stay at a healthy weight by using your meal plan and moving more.

 Ask for help if you feel down. A mental health counselor, support group, member of the
clergy, friend, or family member who will listen to your concerns may help you feel better.

 Learn to cope with stress. Stress can raise your blood glucose. While it is hard to remove
stress from your life, you can learn to handle it. NDEP's Diabetes HealthSense provides
online access to resources that support people with diabetes in making changes to live
well. For more information visit www.YourDiabetesInfo.org/HealthSense.

 Stop smoking. Ask for help to quit. Call 1-800-QUITNOW (1-800-784-8669)

 Take medicines even when you feel good. Ask your doctor if you need aspirin to prevent a
heart attack or stroke. Tell your doctor if you cannot afford your medicines or if you have
any side effects.

 Check your feet every day for cuts, blisters, red spots, and swelling. Call your health care
team right away about any sores that do not go away.

 Brush your teeth and floss every day to avoid problems with your mouth, teeth, or gums

 Check your blood glucose. You may want to test it one or more times a day. Use the card
at the back of this booklet to keep a record of your blood glucose numbers. Be sure to
show it to your health care team.

 Check your blood pressure if your doctor advises.

 Report any changes in your eyesight to your health care team.

 Talk with your health care team about your blood glucose targets. Ask how and
when to test your blood glucose and how to use the results to manage your diabetes.

 Use this plan as a guide to your self-care.

 Discuss how your self-care plan is working for you each time you visit your health
care team.