Understanding Diabetes Oxford Self-help Guide
Understanding diabetesOxford Self-help guide
Living with diabetesIf you have been recently diagnosed with diabetes, you are not alone.Over 14.6 million people in the United States have been diagnosedwith the disease, and this number continues to grow.Properly managing diabetes will most likely require some changesin your lifestyle. But with the help of modern treatments and carefulmonitoring, many people with diabetes are able to enjoy the sameactivities that they did before the diagnosis.In fact, you may have heard of a few of the people that have beenable to continue to excel at the things they love, even after beingdiagnosed with diabetes — actress Halle Berry, jazz great Miles Davis,even baseball legend Jackie Robinson. Throughout this book, you’lllearn how to keep your diabetes under control so that you too cancontinue to lead a healthy and fulfilling life.Diabetes can be different for everyone who has it and not everyonefollows the same course of treatment. With time, and with the helpof your doctor, you will learn what methods work best tohelp keep your blood sugar levels under control.Bring this book along to your next doctorvisit and review the questions onpage 32 together. Before long, youcan be on the road to successfullymanaging your diabetes.
2007 Oxford Health Plans, LLC.Designed and printed by Onward Publishing, Inc., Northport, NY 11768Understanding Diabetes is part of the Oxford Self-Help Library.SM
Contents1. What is diabetes?The pancreas is in charge. 3Insulin is the key . 3Types of diabetes. 4Symptoms and diagnosis. 52. Managing your diabetesMonitoring your blood glucose. 8Short-term complications of diabetes. 10Diet and meal planning. 11Feeling good: exercise for fun and fitness. 12Stop smoking . 14Take good care of your feet . 14Gum care. 15Periodic exams to schedule. 16Tips for changes in your daily routine. 173. MedicationOral medication. 21Types of insulin. 22Injecting insulin. 22Complementary therapies . 224. Preventing long-term complicationsEye problems: diabetic retinopathy . 24Kidney problems: diabetic nephropathy. 25Nerve problems: diabetic neuropathy. 26Heart problems: cardiovascular disease. 27Depression and diabetes. 275. Taking care of your child with diabetesQuestions children often ask. 29Informing school personnel. 30Reminders. 31Understanding diabetesOxford Self-help guide6. Questions for your doctorSuggested questions for your next doctor visit . 337. Getting additional helpMedical professionals . 34Organizations. 358. Glossary. 36
1. What is diabetes?Diabetes, also referred to as diabetes mellitus, is a disease in which the body is unable toproperly produce or use insulin, which is needed to process glucose. Glucose is a simple sugarthat gives the body’s cells the energy they need to do their work. It is released from many of thefoods we eat during the process of digestion.Approximately one millionnew cases of diabetes arediagnosed each year inthe United StatesThere are three major typesof diabetes: type 1, type 2and gestationalGood health depends on the cells’ ability to do their work. How well the cellsperform depends on the answers to the following questions:.Is there a normal level of glucose in the bloodstream?Are the cells able to draw in (absorb) glucose so it can be used as a sourceof energy?In diabetes, the answer to one or both questions is “No.”People are more likely todevelop diabetes after age 40Those who developdiabetes during middleage are often overweight
The pancreas is in chargeThe pancreas is the gland responsible for manufacturing and releasing chemicals, or hormones,that control the level of glucose in the blood. The pancreas lies behind the stomach and isshaped like a lamb chop. It contains many types of cells. Two of these cell types make proteinhormones that help control blood sugar.Beta cells produce the hormone insulin, which lowers the blood glucose levelAlpha cells produce the hormone glucagon, which raises the blood glucose levelInsulin is the keyInsulin normally balances the cells’ need for glucose by regulating the glucose level in thebloodstream. The carbohydrates we eat are the body’s main source of glucose. After thecarbohydrates are digested, they are stored by various organs, mainly the liver. Insulin helpsdetermine how much glucose is sent to the bloodstream from the liver and how much issent to the liver and muscles for storage.Even when there is a normal glucose level in the bloodstream, the cells cannot absorb itwithout the help of insulin. Insulin attaches to the surface of the cells, and just as a keyunlocks a door, insulin “unlocks” the cells’ surface, allowing glucose to enter.In people who have diabetes, either the pancreas stops producing insulin or the insulinthat is produced is less effective than normal. Each of these problems is linked to aspecific type of diabetes.3
Types of diabetesPre-diabetes is a condition that ismarked by blood glucose levels that arehigher than normal, but not high enoughfor a diagnosis of diabetes. Over 41million Americans have pre-diabetes,a number which continues to increaseas a result of rising obesity. Beingoverweight increases the risk of bothpre-diabetes and diabetes. Patients withpre-diabetes that do not improve theirdiet and exercise levels are more likelyto develop diabetes. Patients who takesteps to improve their risk factors maybe able to prevent pre-diabetes fromdeveloping into diabetes.In type 1 diabetes, which effects fiveto 10 percent of all Americans, thebeta cells stop producing insulin. Inthe past, this was also referred to asinsulin-dependent diabetes mellitus,or IDDM. About 15,000 to 20,000 newcases of type 1 diabetes are diagnosedeach year in the United States. Type 1diabetes is about 1.5 to 2.0 times morecommon among Caucasians thanAfrican Americans.Types of diabetesTypeKey pointsType 1.Type 2.Gestational.In type 2 diabetes, the beta cellsproduce insulin, but the insulin is at a.lower level or is less effective thannormal. As a result, the blood glucoselevel is frequently above normal range.In the past, this was referred to as4.Usually diagnosed in children oryoung adultsSymptoms may include unusualthirst, big appetite, frequent urination,blurred vision, tiredness, weightloss, non-healing infectionDiagnosis frequently based onhigh blood glucose andpresenting symptomsMust be treated with insulinUsually diagnosed in people overage 40; increasingly found in teensand youthOften associated with overweightand sedentary lifestyleMay cause no symptoms at all ormilder forms of the symptoms seenin individuals with type 1 diabetesMay be suspected when a routineblood test shows a high glucose levelDiagnosis often based on bloodglucose test or an oral glucosetolerance testTreatment includes diet, exercise,oral medication, and/or insulinOccurs during pregnancy, usuallyduring the 24th to 28th weeksOften causes no symptoms orjust tirednessDiagnosis usually based on anoral glucose tolerance testThe diabetes disappears afterthe pregnancy is completedSignals a risk for developing type 2diabetes within 10 years
noninsulin-dependent diabetes mellitus, or NIDDM.The incidence of new cases of type 2 diabetes each year in theUnited States is 500,000. Type 2 diabetes is thought to affect morethan 18 percent of the elderly population. At all ages, the incidenceis higher in African Americans, Hispanics, Asians, and NativeAmericans than in other groups.Gestational diabetes occurs during pregnancy, often during the 24thto 28th weeks. Unlike type 1 and type 2 diabetes, gestational diabetesis a temporary condition. It only lasts until the pregnancy is completed.However, women who have gestational diabetes are more likely than othersto develop type 2 diabetes within the following 10 years. Roughly 135,000pregnant women in the United States have gestational diabetes each year.Symptoms and diagnosisWhat are the key symptoms of the most common types of diabetes?Pre-diabetes is a diagnosis for people who have been tested and found to have elevated bloodglucose levels. Although the elevated levels are not high enough to be classified as diabetes,individuals are at increased risk for developing the condition in the future and are at increasedrisk of certain blood vessel damage such as heart disease. To prevent this progression, it isimportant to reach and/or maintain an ideal body weight, develop an exercise program andhealthy eating habits and follow recommendations from your doctor.Type 1 diabetes tends to cause symptoms rather suddenly, and it most often affects children oryoung adults. Unusual thirst, increased appetite, frequent urination, blurred vision, and tirednessare all common signs of type 1 diabetes.Type 2 diabetes usually evolves more slowly than type 1 — over months or sometimes years;it tends to be more common among overweight people over the age of 40. Some people withtype 2 diabetes have milder forms of the symptoms described for type 1 diabetes, but manyhave no symptoms at all. Instead, their disease is discovered during a routine blood test ormedical evaluation.5
Gestational diabetes is only rarely accompanied by symptoms. Therefore, periodic bloodglucose testing is very important during the 24th to 28th weeks of pregnancy.How is the diagnosis made?Type 1 diabetes is diagnosed by measuring your blood glucose level; a high bloodglucose reading, combined with the expected symptoms, is usually all that is neededto be sure of the diagnosis.Type 2 diabetes may not be suspected until a routine blood test finds an unusually highglucose level. If type 2 diabetes seems like a possibility, a “fasting” blood glucose test isusually done. The word “fasting” is used because the blood sample is taken first thing inthe morning or at least 10 hours after the person being tested has eaten. An oral glucosetolerance test is another choice; for this test, the person is given a drink that contains sugarand his or her blood glucose level is measured after 30 minutes, 60 minutes and 120 minutesto see how well the body handles sugar.Gestational diabetes is usually identified with oral glucose tolerance testing. The test is doneduring pregnancy. (This brochure does not provide further details about gestational diabetes.If you need additional information, please contact your doctor or log on to the American DiabetesAssociation web site at www.diabetes.org.)6
2. Managingyour diabetesWhile there is no cure for diabetes, a great deal is now known about howto keep it under control. Maintaining good control allows the body to useglucose efficiently. It also helps prevent the development of serious disease-.related complications.Monitoring your blood glucose, establishing a proper diet and exercise routine,and making other lifestyle commitments can help keep your diabetes under control.and reduce the risk of complications. You are the manager of your disease. Thefirst step is to always wear identification that states that you have diabetes. Thismay be on a chain you wear around your neck under your clothing, or on a bracelet.If something happens to you, even if it is unrelated to your disease, it is extremelyimportant that those who are providing care are aware that you have diabetes.Over time, you and your healthcare team will get to know your body’s responsesto various dietary changes, exercise, other illnesses, and, if necessary, medication.You will also learn which periodic examinations are important to schedule to helpyou manage your disease.Keeping the blood glucoselevel in control is the bestway to avoid diabetesrelated complicationsWhat you eat, when you eat,your level of physical activity,and stress all influence yourblood glucose levelEven moderately strenuousexercise, when done regularly,reduces the risk of heartdisease, lowers bloodpressure and helps maintaingood body weight
Blood glucose testingWhen you have diabetes, frequent blood testing isextremely important. There are several test kits anddevices available for getting reliable readings, and theyare easy to use. You and your doctor can decide whichone is best for you.Changes in blood glucose readingsOne of the reasons for frequent blood glucose testingis that test results are influenced by many things. Ananswer of “Yes” to any of the following questions mayaccount for unexpected test results: Did you eat within the last 90 minutes, or has it beenseveral hours since you’ve eaten? If you have eatenrecently, what did you eat? Has your eating been “off schedule” in the last24 hours?Monitoring yourblood glucoseChecking your blood glucose level regularlyand recording the readings is the best wayto know whether your diabetes is wellcontrolled. The finger-stick devices thatare now readily available allow you toobtain a small blood sample relativelypainlessly. The tiny needle on the end iseasily removed so that a fresh needle tipcan be inserted for each test. Dependingon the testing system being used, you Have you exercised today?simply place the blood sample directly Have you been under stress?onto a test strip, a meter test pad, or a Has your blood glucose been somewhat unstable? Other than your diabetes, are you ill? Do you have symptoms of possible hypoglycemia,hyperglycemia or ketoacidosis? Are you taking medication for your diabetes? If youare taking insulin, what type are you taking, when wasyour last dose and what injection site did you use? Ifyou are taking an oral hypoglycemic agent, which oneis it, what is the dose and when did you take it last?If you have questions about your blood glucose, callyour doctor.sensor that analyzes the blood for glucose.How often do I have toself-monitor my blood glucose?The frequency of daily blood glucosetesting varies. There may be periods oftime, such as when you are first diagnosedor if your blood glucose control worsens,when you will benefit from testing threeor more times per day. You may also needto test more frequently if you:.Take insulin or are starting anew medication.8Have problems with low blood glucoseHave problems with high blood glucose
.Are sickAre unable to eat as usualAre pregnantUse an insulin pumpIf your diabetes is well-controlled, you may test less frequently. Be sure to ask yourdiabetes care team to work with you to determine the right amount of testing for you.Importance of blood glucose controlStudies show that controlling your blood glucose helps prevent long-term complications affectingyour eyes, kidneys, nerves, and heart. That’s why keeping your blood glucose in the proper rangeis so important.Once diabetes develops, your blood glucose will rise and will attach to the hemoglobin foundin your red blood cells. Monitoring will help you control your blood glucose and should beperformed by your doctor and yourself.Self-monitoringSelf-monitoring, using a blood glucose meter, is performed several times a day or as directedby your doctor. You will be testing the amount of glucose in milligrams per deciliter (mg/dL)found in your blood. Your daily goal will be to keep your blood glucose below 160 mg/dLwithin two hours after eating and between 80-120 mg/dL after fasting.Physician monitoringYour doctor will perform an HbA1c test every three months in order to achieve an ongoingaverage of your blood glucose levels. This test gives your doctor an extremely accurateindication of how your diabetes is being controlled over time. The HbA1c test measures thepercentage of hemoglobin with attached glucose in your blood. For people who don’t havediabetes, levels fall between five to six percent. As an individual with diabetes, your goal willbe to achieve an HbA1c of seven percent or at the level recommended by your physician.9
Short-term complications of diabetesKetoacidosis and its preventionKetoacidosis occurs when the insulin level is so low that the body’s cells are unable to absorbglucose from the bloodstream. The cells then use body fat as their major source of energy.When fat is used consistently for this purpose, by-product chemicals called ketones areproduced. If the build-up of ketones in the blood goes unrecognized, ketoacidosis results.Ketoacidosis is a very serious complication because if it is left untreated, it can causecoma — even death. Some of the common signs of the condition include unusual thirst,nausea, vomiting, excessive urination, rapid breathing, abdominal pain, and a fruity smellingbreath. The risk of ketoacidosis increases if you stop following your usual meal plan forany reason, but particularly if you are ill or under stress. The best way to prevent ketoacidosisis to follow your basic daily plan for blood glucose testing, diet and exercise. If ketoacidosisis suspected, call for emergency help. An ambulance will bring you directly to the emergencyroom of your nearest hospital for treatment.Since the kidneys attempt to remove excess ketones from the blood, urine can be tested forketones. You’ll want to keep ketone test strips available so you can check for ketones any timeyour blood glucose reading is over 240 mg/dL. (Make sure that you replace the test stripswithin six months of opening a new package or when the expiration date has passed.) A ketonetest strip is placed into a urine sample, and color changes shown on the directions of the testkit will tell you whether ketones are present. A positive test means that your diabetes is notwell controlled, and you should report these findings by telephone to your doctor, especially ifthe result is moderate or severe. Blood ketone testing kits are also available for use at home.Hypoglycemia and hyperglycemia and their preventionHypoglycemia is the term used to describe a blood glucose level under 50 mg/dL. Thesymptoms are anxiety, sweating, hunger, and a sense of shakiness or lightheadedness.If you have some of these symptoms, test your blood level. If it is below 50 mg/dL, eator drink something sweet immediately to give your blood glucose a “quick” boost.Be sure to carry a source of “quick” sugar with you at all times. In addition to glucosetablets prescribed by your doctor, other choices include the following:.10Four or five sugar cubesA small box of raisins or five or six pieces of drie
pre-diabetes that do not improve their diet and exercise levels are more likely to develop diabetes. Patients who take steps to improve their risk factors may be able to prevent pre-diabetes from developing into diabetes. In type 1 diabetes , which effects five to 10 percent of all Americans, the beta cells stop producing insulin. In
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Bruce W. Bode, MD, FACE Atlanta Diabetes Associates Atlanta, Georgia American Diabetes Association. Facts and Figures. Available at: http://www.diabetes.org/ada/facts.asp. Accessed January 18, 2000. Diagnosed Type 1 Diabetes 0.5 - 1.0 Million Diagnosed Type 2 Diabetes 10.3 Million Undiagnosed Diabetes 5.4 Million Prevalence of Diabetes in the US 3
Diabetes Self-Management Education (DSME): The ongoing process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. Diabetes Self-Management Support (DSMS): Assist persons with diabetes in implementing and sustaining the behaviors to manage diabetes on an ongoing basis.
Diabetes in the United States More than 29 million people in the U.S. have diabetes 8.1 million people with diabetes are undiagnosed 9.3% of the U.S. population 1.7 million Americans aged 20 years or older were newly diagnosed with diabetes in 2010 Every 19 seconds, someone is diagnosed with diabetes
Clinical Diabetes. 2017 Jan; 35(1)51-54. Speight J, Conn J, Dunning T, Skinner TC, Diabetes Australia. Diabetes Australia position statement. A new language for diabetes: improving communications with and about people with diabetes. Diabetes Res Clin Pract 2012 Sep; 97(3): 425- 31.
Type 2 Diabetes Type 2 diabetes, which used to be called adult-onset diabetes, can affect people at any age, even children. However, type 2 diabetes develops most often in middle-aged and older people. People who are overweight and inactive are also more likely to develop type 2 diabetes. Type 2 diabetes usually begins with insulin resistance—a
TABLE 57-3. Proposed Classification System for Diabetes in Pregnancy Gestational diabetes: diabetes diagnosed during pregnancy that is not clearly overt (type 1 or type 2) diabetes Type 1 Diabetes: Diabetes resulting from β-cell destruction, usually leading to absolute insulin deficiency a. Without vascular complications b.
tulang dan untuk menilai efektivitas hasil pengobatan. Hasil pemeriksaan osteocalcin cukup akurat dan stabil dalam menilai proses pembentukan tulang. Metode pemeriksaan osteocalcin adalah enzyme-linked immunosorbent assay (ELISA). Nilai normalnya adalah: 10,1 9,4 ng/ml.8 Setelah disintesis, OC dilepaskan ke sirkulasi dan memiliki waktu paruh pendek hanya 5 menit setelah itu dibersihkan oleh .
