Diabetes and Nutrition Center

What is diabetes?

Diabetes is a metabolic disorder that means your body does not make enough insulin. Or it means that your body is not able to use the insulin it makes. Your body needs the hormone insulin to change blood sugar (glucose) into energy. Without insulin, too much glucose collects in your blood. Diabetes may also be a result of other conditions. These include genetic syndromes, chemicals, medicines, pancreatitis, infections, and viruses.

Diabetes can be one of three types: type 1, type 2, or gestational. All three are metabolic disorders that affect the way the body uses (metabolizes) food to make glucose. Glucose is the main source of fuel for the body.

What is prediabetes?

Type 2 diabetes is often preceded by prediabetes. In prediabetes, blood glucose levels are higher than normal but not high enough to be defined as diabetes. But many people with prediabetes develop type 2 diabetes within 10 years, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Prediabetes also raises the risk for heart disease and stroke.

You can delay or even prevent type 2 diabetes by making lifestyle changes. These include losing extra weight if you are overweight and getting more exercise. If you are overweight, losing 5% to 10% of your weight can make a difference. For exercise, aim for at least 150 minutes a week of physical activity. Don’t let more than two days go by without being active.

Experts recommend that all adults spend less time sitting and being inactive. This is especially important if you have type 2 diabetes. When sitting for long periods of time, get up for short sessions of light activity every 30 minutes.

How does diabetes affect blood glucose?

Insulin must be present for glucose to be able to move into the cells of the body. Insulin is made by your pancreas. Normally it is readily available to help move glucose into the cells.

When you have diabetes, your pancreas makes too little or no insulin. Or the cells in your body don’t respond to the insulin that’s made. This causes a buildup of glucose in the blood. The cells in your body, meanwhile, are starving for glucose and do not have enough fuel to work as they should.

The three main types of diabetes are similar in the buildup of blood glucose because of problems with insulin. But each has a different cause and treatment:

• Type 1 diabetes is an autoimmune disease. The body's immune system destroys the cells in the pancreas that make insulin. This means that your body has no or only a small amount of insulin. People with type 1 diabetes must take insulin every day in order to live.
• Type 2 diabetes develops when the body cannot make enough insulin or is not able to use it properly. Type 2 diabetes may be controlled with diet, exercise, and weight loss, or may need oral medicines or insulin injections.
• Gestational diabetes mellitus (GDM) occurs in pregnant women who have not been diagnosed with diabetes in the past. In a woman with gestational diabetes, her body cannot effectively use the insulin that is present. This type of diabetes goes away after delivery. If it does not go away, it was not gestational diabetes but type 1 or 2 diabetes that started during pregnancy. Gestational diabetes may be controlled with diet, exercise, and attention to weight gain. Women with this type of diabetes may need to take medicines to control their glucose. They may be at higher risk for type 2 diabetes later in life.

Complications of diabetes

Diabetes is the seventh leading cause of death among Americans. Experts think that many cases of diabetes are not reported as a condition leading to or causing death. But each year, more than 200,000 deaths are reported as being caused by diabetes or its complications. Complications of diabetes include eye problems and blindness, heart disease, stroke, neurological problems, amputation, kidney disease, and impotence.

Except for gestational diabetes, diabetes is a chronic, incurable disease that affects nearly every part of the body. It contributes to other serious diseases and can be life-threatening. Diabetes must be managed under the care of a healthcare provider throughout a person's life. The serious complications of diabetes can be prevented or stopped from progressing with proper care.

What is the treatment for diabetes?

Specific treatment for diabetes will be discussed with you by your healthcare provider based on:

• Type of diabetes
• Your age, overall health, and medical history
• Extent of the disease
• Your tolerance for specific medicines, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference
• Cost

Type 1 diabetes

People with type 1 diabetes no longer produce insulin, and they must have insulin injections to use the glucose, or sugar, they obtain from eating.

People with type 1 diabetes must give themselves insulin several times per day. Insulin can either be injected, which involves the use of a needle and syringe, or it can be given by an insulin pump, insulin pen, or jet injector, or inhaler. Extra amounts of insulin may be taken before meals, depending on the blood glucose level and food to be eaten.

Insulin currently can't be taken as a pill. Because it's a protein, it would be broken down during digestion just like the protein in food. It must be injected into the fat under the skin for insulin to get into the blood.

New pharmaceutical materials and techniques have been developed, however, that can protect insulin from being broken down in the digestive tract. The first human trials of oral insulin were reported in 2006. Phase I clinical trials have shown insulin given in a gel capsule to be safe and effective. Clinical trials will continue over the next several years as the medicine moves through the federal approval process.

The amount of insulin needed depends on height, weight, age, food intake, and activity level. Insulin doses must be balanced with mealtimes and activities, and dosage levels can be affected by illness, stress, or unexpected events.

Type 2 diabetes

Although people with type 2 diabetes may continue to produce some insulin for some time, their bodies can't efficiently use it. This is known as insulin resistance, and may indicate the need for oral medicines or injections that can help stimulate the pancreas to release insulin or optimize the body's ability to use the insulin secreted. People with type 2 diabetes need insulin during illness and later when they are not able to control diabetes with noninsulin therapies.

Diet and exercise

Diet and exercise can often bring blood glucose levels down to normal. When these measures are no longer enough, the next step is the addition of medicines that lower blood glucose levels.

The job of controlling your blood sugar is mostly up to you. But your diabetes healthcare team is there to help. These experts will teach you how to manage diabetes and the health risks it brings. With practice, controlling your blood sugar will become a habit.

Working with your healthcare team

Your diabetes healthcare team will work closely with you to create a management plan. The goal is to keep your blood sugar controlled to delay or prevent other health problems. Your healthcare team is likely to include:

• Primary care provider: Your regular healthcare provider may be the first person to tell you about diabetes.
• Endocrinologist: A healthcare provider specialized in treating people with diabetes, though most people with diabetes may not need to see an endocrinologist.
• Registered dietitian: Teaches you how food and healthy eating can help you control blood sugar.
• Certified Diabetes Care and Education Specialist (CDCES): A nurse, dietitian, physician assistant, or pharmacist that teaches you all about managing diabetes.
• Health psychologist or social worker: Helps you cope with the feelings and stresses that diabetes may bring.
• Other healthcare team members can include an eye healthcare provider, dentist, podiatrist, pharmacist, occupational therapist, and exercise physiologist.

Who else can help?

Daily diabetes management can be a lot to handle. It might affect your routine, at home and on the job. Don’t be afraid to let your family, friends, and work supervisor know about your condition. These people can support your need to stick to a schedule that meets your treatment plan.

Reach out to your family and friends

Family and friends can support your efforts to take care of yourself. So don’t feel bad asking for help when you need it. If they have questions or aren’t taking your diagnosis seriously, ask them to learn along with you. At first, it might be hard for them to understand some of the changes you are making. Tell them that your health is your priority. Their support can help keep you focused and confident as you learn to control your blood sugar.