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Types and causes of diabetes
Managing and preventing diabetes

Types and causes of diabetes
  • Pre-diabetes: Individuals with pre-diabetes have blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes. This condition raises the risk of developing type 2 diabetes, heart disease, and stroke.
  • Pre-diabetes is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. Some individuals have both IFG and IGT. In IFG, glucose levels are a little high when it has been several hours after eating. In IGT, glucose levels are a little higher than normal right after eating.
  • Pre-diabetes is becoming more common in the United States, according to estimates provided by the U.S. Department of Health and Human Services (DHHS). Many individuals with pre-diabetes go on to develop type 2 diabetes within 10 years.
  • Type 1 diabetes: Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body's immune system that fights infection begins to attack a part of the body. In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas. The pancreas then produces no insulin. An individual with type 1 diabetes must take insulin daily for proper blood sugar control.
  • It is not known exactly what causes the body's immune system to attack the beta cells, but researchers believe that autoimmune, genetic, viral, and environmental factors may be involved. Type 1 diabetes accounts for about 5-10% of cases of diagnosed diabetes in the United States. Type 1 diabetes develops most often in children and young adults but can appear at any age.
  • Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can develop a condition called diabetic ketoacidosis or a low blood pH due to the accumulation of ketones in the blood. Diabetic ketoacidosis may lead to a coma if not treated appropriately.
  • Type 2 diabetes: The most common form of diabetes is type 2 diabetes. About 90-95% of individuals with diabetes have type 2. This form of diabetes is most often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes (diabetes developed during pregnancy), physical inactivity, and certain ethnicities. About 80% of individuals with type 2 diabetes are overweight.
  • Type 2 diabetes is increasingly being diagnosed in children and adolescents. When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively. This is a condition called insulin resistance. After several years of making extra insulin because the body cannot use it efficiently, insulin production decreases. The result is the same as for type 1 diabetes - glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.
  • Insulin also normally shuts down the ability of the liver to produce glucose. In individuals with type 2 diabetes, however, insulin is unable to inhibit sugar production in the liver, either because the pancreas is not producing enough insulin or because insulin's signal cannot be detected.
  • The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores. Some individuals have no symptoms.
  • Type 2 diabetes can be treated with diet,exercise, and oral prescription medications but may requireinsulin shots.
  • Hyperinsulinemia: Hyperinsulinemia is when an individual has too much insulin in the blood. Hyperinsulinemia is not diabetes, but may lead to type 2 diabetes if not managed appropriately. Hyperinsulinemia is a sign of an underlying problem that is causing the pancreas to secrete excessive amounts of insulin. The most common cause of hyperinsulinemia is insulin resistance, a condition in which the body is resistant to the effects of insulin and the pancreas tries to compensate by making more insulin. Rarely, hyperinsulinemia is caused by a tumor of the insulin-producing cells of the pancreas (insulinoma) or excessive numbers of insulin-producing cells in the pancreas (nesidioblastosis). Hyperinsulinemia may not have signs or symptoms unless it causes low blood sugar (hypoglycemia).
  • Metabolic syndrome: Metabolic syndrome, also known as syndrome X or insulin resistance syndrome (IRS), is a set of abnormalities in which type 2 diabetes (insulin resistant) or hyperinsulinemia is almost always present. Insulin resistance causes the tissues to stop responding to insulin. If an individual has insulin resistance, the body will make more and more insulin, but because the tissues do not respond to it, the body will not be able to use glucose (sugar) properly. Insulin resistance often occurs with other health problems, such as diabetes, high cholesterol, high blood pressure and heart attack. When a person has many of these problems together, doctors call it insulin resistance syndrome. Metabolic syndrome includes hypertension (high blood pressure), hyperlipidemia (high cholesterol), large waist size, an increase in cortisol (stress hormone), abnormalities in blood clotting, and an increase in inflammatory responses. A high rate of cardiovascular disease is associated with the metabolic syndrome.
  • Diabetes insipidus: Diabetes insipidus (DI) is a rare disease, not widely diagnosed, in which the kidneys produce abnormally large volumes of dilute urine. DI is caused by a deficiency of the antidiuretic hormone (ADH), also known as vasopressin. DI can also be caused by insensitivity of the kidneys to ADH. DI is different from diabetes mellitus (DM), which involves insulin problems and high blood sugar. The symptoms can be similar, such as extreme thirst and frequent urination. However, DI is related to how the kidneys handle fluids. Urine and blood tests can determine which is present.
  • Gestational diabetes: Some women develop gestational diabetes late in pregnancy. Although this form of diabetes usually disappears after the birth of the baby, women who have had gestational diabetes have a 20-50% chance of developing type 2 diabetes within 5-10 years. Maintaining a reasonable body weight and being physically active may help prevent development of gestational diabetes turning into type 2 diabetes.
  • As with type 2 diabetes, gestational diabetes occurs more often in some ethnic groups and among women with a family history of diabetes. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Women with gestational diabetes may not experience any symptoms. When a woman has diabetes and her blood sugar is poorly controlled and too high, excess amounts of sugar are transported to the baby. Since the baby does not have diabetes, the fetus is able to increase the production of insulin substantially in order to use this extra sugar. This abnormal cycle of events can result in several complications including macrosomia (large baby, over 8.8 pounds), neonatal hypoglycemia (low blood sugar), stillbirth, and birth defects (such as brain, spinal cord, or heart conditions).
  • The only treatment for gestational diabetes is insulin, as oral anti-diabetic medications can not be used in pregnancy due to the possible risks.
  • Maturity-onset diabetes of the young (MODY): Maturity-onset diabetes of the young (MODY) is a type of diabetes that is caused by genetic mutations. MODY may occur during childhood or adolescence, but may be misdiagnosed as Type 1 or Type 2 diabetes, or may be unidentified until the patient is an adult. Research indicates that the genetic mutations responsible for MODY interfere with normal pancreatic secretion of insulin. Currently, six gene mutations have been identified as causative factors for MODY, each of which produce several different forms of MODY, named MODY 1-MODY 6. Each type of MODY has different signs and symptoms, clinical manifestations, complications, and treatments.
  • It has been estimated that 1- 5% of diabetes cases in the United States are MODY. MODY typically presents during a patients 20s, usually before the age of 25. Patients at risk for MODY have a strong family history of diabetes, and/or have developed diabetes before middle age. In contrast to clinical manifestations in other forms of diabetes, MODY patients are typically not overweight, and are sometimes able to be treated with meal planning, oral diabetes medications, or low doses of insulin. It is recommended for the patient to work closely with their healthcare provider to determine the best treatment, based on the specific type of MODY diagnosed.

Managing and preventing diabetes
  • Healthy lifestyle choices can help prevent type 2 diabetes and manage type 1 diabetes. Even if diabetes runs in the individual's family, diet and exercise can help prevent the disease. Healthy lifestyle choices can help individuals prevent potentially serious complications of diabetes, such as stroke, nerve damage, and heart disease.
  • Dental health: Diabetes may leave individuals prone to gum infections. Healthcare professionals recommend brushing the teeth at least twice daily, flossing the teeth once a day, and schedule dental exams at least twice a year. Contacting a dentist right away if the gums bleed or look red or swollen is recommended.
  • Diet: It is important to choose foods low in fat and calories. Fresh fruits, vegetables, and whole grains. It is best to eliminate all refined carbohydrates (sugars and white flour) and hydrogenated oils. Limiting the amount of high-sugarbeverages, such assoft drinks and fruit punches, is recommended by healthcare professionals.Avoid high-fat foods like ice cream, butter, and high-fatmeats.Decreasing the consumption of milk and dairy products may also help with blood sugar control. Lean poultry and fish should be eaten more often than red meat. It is best not to cook with butter, margarine, lard, and hydrogenated oils. Olive oil or vegetable oils such as safflower are recommended by healthcare professionals.
  • Eating healthy foods and exercising regularly can also help control high blood pressure and high cholesterol levels.
  • Alcohol consumption should be limited to no more than one drink per day for women,two perday for men, and none if there is difficulty controllingalcohol intake (addiction) or uncontrolled blood sugar levels.
  • Foot health: Healthcare professionals recommend to wash the feet daily in lukewarm water and top dry them gently, especially between the toes. It is important to moisturize the feet with lotion. Checking the feet every day for blisters, cuts, sores, redness, or swelling is important. It is recommended to consult a doctor if a sore or other foot problem that does not heal within a few days exists.
  • Glucagon kit: Keeping a glucagon kit nearby in case of a low blood sugar emergency is important. Glucagon is an important hormone involved in carbohydrate metabolism. Produced by the pancreas, it is released when the glucose level in the blood is low (hypoglycemia), causing the liver to convert stored glycogen into glucose and release it into the bloodstream. The action of glucagon is thus opposite to that of insulin, which instructs the body's cells to take in glucose from the blood in times of satiation. An injection of glucagon will raise blood sugar levels.
  • Identification tags: Healthcare professionals recommend that individuals with diabetes wear a tag or bracelet identifying the condition.
  • Ketones: Individuals can test to see if the body is making ketones by doing a simple urine test. There are several products available for ketone testing that can be purchased without a prescription. Common product names include Ketostix®, Chemstrip K®, and Acetest®. The test result can be negative or show small, moderate, or large quantities of ketones. Healthcare professionals recommend testing for ketones during the following situations: anytime the blood glucose is over 250 milograms/deciliter for two checks in a row; when the individual is ill - often illness, infections, or injuries will cause sudden high blood glucose and this is an especially important time to check for ketones; when the individual is planning to exercise and the blood glucose is over 250 milligrams/deciliter; and when pregnant, individuals should test for ketones each morning before breakfast and anytime the blood glucose is over 250 miligrams/deciliter. As long as blood glucose levels are not too high, the presence of ketones is not a problem. Untreated high blood glucose with ketones can lead to a life-threatening condition called diabetic ketoacidosis (DKA). If the ketone test is positive, healthcare providers recommend calling a doctor immediately.
  • Physical activity and weight control: Healthcare professionals recommend 30 minutes of moderate physical activity a day, where tolerated. Taking a brisk daily walk, riding a bike, or swimming laps are good exercises for individuals with diabetes. Losing weight is very important in maintaining healthy blood sugar levels.
  • Studies have reported that individuals can lower the risk of developing diabetes by losing 5-7% of body weight through diet and increased physical activity. Diet and exercise resulting in a 5-7% weight loss (approximately 10-14 pounds in an individual weighing 200 pounds) can lower the incidence of type 2 diabetes by nearly 60%.
  • Proper glucose control: The single best thing an individual 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 (self blood glucose monitoring), a balanced diet low in simple sugars and fat and high in complex carbohydrates and fiber, and appropriate medical treatment. A nutritionist, a doctor, and others on the healthcare team will help set up appropriate diabetes treatment strategies for the individual.
  • Regular doctor visits: Scheduling regular health check-ups is important. However, regular diabetes checkups are not meant to replace yearly physicals or routine eye exams. Doctors will look for any diabetes-related complications, such as neuropathy, as well as screen for other medical problems. An eye care specialist will check for signs of retinal damage, cataracts, and glaucoma.
  • Smoking cessation: Smoking cigarettes or use of any other form of tobacco raises the risks for developing complications from diabetes, such as heart attack, stroke, nerve damage, and kidney disease. Smoking damages blood vessels and contributes to heart disease, stroke, and poor circulation in the limbs. Smokers who have diabetes are three times more likely to die of cardiovascular disease than are nonsmokers who have diabetes, according to the American Diabetes Association (ADA). A doctor can help plan a strategy to stop smoking or to stop using other types of tobacco.
  • Stress reduction: Chronic stress can lead to the adrenal glands releasing the stress hormone cortisol. Chronic release of cortisol can lead to health problems such as blood sugar regulation problems such as hyperinsulinemia, high cholesterol levels, inflammation, poor immunity, and obesity. Stress can be controlled through integrative therapies, such as meditation, breathing, yoga, and certain herbs and vitamins. Getting plenty of rest may also help with decreasing stress and improving immunity. High blood sugar levels can weaken the immune system.

Copyright © 2011 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.