In Type II diabetes, the pancreas may produce enough insulin, however, cells have become resistant to the insulin produced and it may not work as effectively. Symptoms of Type II diabetes can begin so gradually that a person may not know that he or she has it. Early signs are lethargy, extreme thirst, and frequent urination. Other symptoms may include sudden weight loss, slow wound healing, urinary tract infections, gum disease, or blurred vision. It is not unusual for Type II diabetes to be detected while a patient is seeing a doctor about another health concern that is actually being caused by the yet undiagnosed diabetes.
Hypoglycemic reactions are promptly treated by giving carbohydrates (orange juice, hard candy, honey, or any sugary food); if necessary, subcutaneous or intramuscular glucagon or intravenous dextrose (if the patient is not conscious) is administered. Hyperglycemic crises are treated initially with prescribed intravenous fluids and insulin and later with potassium replacement based on laboratory values.
An article published in November 2012 in the journal Global Public Health found that countries with more access to HFCS tended to have higher rates of the disease. Though it’s likely that these countries’ overall eating habits play a role in their populations’ diabetes risk, a study published in February 2013 in the journal PLoS One found limiting access to HFCS in particular may help reduce rates of the diagnosis.
That said, some research does suggest that eating too many sweetened foods can affect type 2 diabetes risk, and with the Centers for Disease Control and Prevention (CDC) estimating that 30.3 million Americans have the disease — and that millions of more individuals are projected to develop it, too — understanding all the risk factors for the disease, including sugar consumption, is essential to help reverse the diabetes epidemic.
Patients with type 1 DM, unless they have had a pancreatic transplant, require insulin to live; intensive therapy with insulin to limit hyperglycemia (“tight control”) is more effective than conventional therapy in preventing the progression of serious microvascular complications such as kidney and retinal diseases. Intensive therapy consists of three or more doses of insulin injected or administered by infusion pump daily, with frequent self-monitoring of blood glucose levels as well as frequent changes in therapy as a result of contacts with health care professionals. Some negative aspects of intensive therapy include a three times more frequent occurrence of severe hypoglycemia, weight gain, and an adverse effect on serum lipid levels, i.e., a rise in total cholesterol, LDL cholesterol, and triglycerides and a fall in HDL cholesterol. Participation in an intensive therapy program requires a motivated patient, but it can dramatically reduce eye, nerve, and renal complications compared to conventional therapy. See: insulin pump for illus.
Education: People with diabetes should learn as much as possible about this condition and how to manage it. The more you know about your condition, the better prepared you are to manage it on a daily basis. Many hospitals offer diabetes education programs and many nurses and pharmacists have been certified to provide diabetes education. Contact a local hospital, doctor, or pharmacist to find out about programs and diabetes educators in your area.
About 84 million adults in the US (more than 1 out of 3) have prediabetes, and about 90% do not know they have it until a routine blood test is ordered, or symptoms of type 2 diabetes develop. For example, excessive thirst, frequent urination, and unexplained weight loss. If you have prediabetes also it puts you at risk for heart attack, stroke, and type 2 diabetes.
FIGURE 19-1 ■. This figure shows the hyperbolic relationship of insulin resistance and beta cell function. On the y-axis is beta cell function as reflected in the first-phase insulin response during intravenous (IV) glucose infusion; on the x-axis is insulin sensitivity and its mirror image resistance. In a subject with normal glucose tolerance (NGT) and beta-cell reserve, an increase in insulin resistance results in increased insulin release and normal glucose tolerance. In an individual for whom the capacity to increase insulin release is compromised, increasing insulin resistance with partial or no beta-cell compensation results in progression from normal glucose tolerance, to impaired glucose tolerance (IGT), and finally to diabetes (T2D). Differences between these categories are small at high insulin sensitivity, which may be maintained by weight reduction, exercise, and certain drugs. At a critical degree of insulin resistance, due to obesity or other listed factors, only a further small increment in resistance requires a large increase in insulin output. Those that can increase insulin secretion to this extent retain normal glucose tolerance; those who cannot achieve this degree of insulin secretion (e.g., due to a mild defect in genes regulating insulin synthesis, insulin secretion, insulin action, or an ongoing immune destruction of beta cells) now unmask varying degrees of carbohydrate intolerance. The product of insulin sensitivity (the reciprocal of insulin resistance) and acute insulin response (a measurement beta-cell function) has been called the “disposition index.” This index remains constant in an individual with normal beta cell compensation in response to changes in insulin resistance. IGT, impaired glucose tolerance; NGT, normal glucose tolerance; T2D, type 2 diabetes.
Higher levels of sugar in the urine and the vagina can become a breeding ground for the bacteria and yeast that cause these infections. Recurrent infections are particularly worrisome. “Usually when you keep getting infections, doctors will check for diabetes if you don’t already have it,” says Cypress. “Even women who go to the emergency room for urinary tract infections are often checked.” Don’t miss these other silent diabetes complications you need to know about.
“It’s not like you wake up one day and all of a sudden you’re thirsty, hungry, and [going to the bathroom] all the time,” says Melissa Joy Dobbins, RD, a certified diabetes educator in Illinois and a spokesperson for the American Association of Diabetes Educators. “It picks up gradually.” Indeed, “most people are unaware that they have diabetes in its early or even middle phases,” says Aaron Cypess, MD, assistant professor of medicine at Harvard Medical School and staff physician at Joslin Diabetes Center. Just because you’re not keyed in doesn’t mean you’re immune from problems associated with diabetes, he adds. The longer you go without controlling diabetes, the greater your risk for heart disease, kidney disease, amputation, blindness, and other serious complications. “We recommend that people with risk factors for diabetes, such as a family history or being overweight, get evaluated on a regular basis,” Dr. Cypess says. If you’ve been feeling off, talk to your doctor about getting a simple blood test that can diagnose the disease. And pay attention to these subtle signs and symptoms of diabetes.
Medications used to treat diabetes do so by lowering blood sugar levels. There is broad consensus that when people with diabetes maintain tight glucose control (also called "tight glycemic control") -- keeping the glucose levels in their blood within normal ranges - that they experience fewer complications like kidney problems and eye problems. There is however debate as to whether this is cost effective for people later in life.
Although some people with this type of diabetes are thin, the majority of people (90%) are overweight. Losing weight, even 2 kg to 5 kg (5 lbs to 10 lbs) can help lower blood glucose levels. For many people, following a healthy diet and an exercise program may be all that is needed to help control glucose levels. For others, healthy eating and exercise alone aren't enough to lower blood glucose levels.
If you are at increased risk of diabetes, have symptoms of diabetes, or have pre-diabetes (a major warning sign for diabetes), your doctor will check to see if you have diabetes. Your doctor may also check to see if you have diabetes if you are over the age of 45, have a family history of the disease, are overweight, or if you are at increased risk for another reason. The tests used to check for diabetes are the same tests used to check for pre-diabetes.
There is no known preventive measure for type 1 diabetes. Type 2 diabetes – which accounts for 85–90% of all cases – can often be prevented or delayed by maintaining a normal body weight, engaging in physical activity, and consuming a healthy diet. Higher levels of physical activity (more than 90 minutes per day) reduce the risk of diabetes by 28%. Dietary changes known to be effective in helping to prevent diabetes include maintaining a diet rich in whole grains and fiber, and choosing good fats, such as the polyunsaturated fats found in nuts, vegetable oils, and fish. Limiting sugary beverages and eating less red meat and other sources of saturated fat can also help prevent diabetes. Tobacco smoking is also associated with an increased risk of diabetes and its complications, so smoking cessation can be an important preventive measure as well.
Apart from severe DKA or hypoglycemia, type 1 diabetes mellitus has little immediate morbidity. The risk of complications relates to diabetic control. With good management, patients can expect to lead full, normal, and healthy lives. Nevertheless, the average life expectancy of a child diagnosed with type 1 diabetes mellitus has been variously suggested to be reduced by 13-19 years, compared with their nondiabetic peers. 
Diabetes also can cause heart disease and stroke, as well as other long-term complications, including eye problems, kidney disease, nerve damage, and gum disease. While these problems don't usually show up in kids or teens who've had type 2 diabetes for only a few years, they can affect them in adulthood, particularly if their diabetes isn't well controlled.
Those dark patches on your skin could be more serious than a blotchy tan. In fact, they might be the first sign of diabetes. This darkening of the skin, which usually occurs on the hands and feet, in folds of skin, along the neck, and in a person’s groin and armpits, called acanthosis nigricans, often occurs when insulin levels are high. The high insulin levels in your blood can increase your body’s production of skin cells, many of which have increased pigmentation, giving skin a darkened appearance.
Prediabetes is a condition in which blood glucose levels are too high to be considered normal but not high enough to be labeled diabetes. People have prediabetes if their fasting blood glucose level is between 100 mg/dL and 125 mg/dL or if their blood glucose level 2 hours after a glucose tolerance test is between 140 mg/dL and 199 mg/dL. Prediabetes carries a higher risk of future diabetes as well as heart disease. Decreasing body weight by 5 to 10% through diet and exercise can significantly reduce the risk of developing future diabetes.
Home blood glucose self-monitoring is indispensable in helping patients to adjust daily insulin doses according to test results and to achieve optimal long-term control of diabetes. Insulin or other hypoglycemic agents are administered as prescribed, and their action and use explained to the patient. With help from a dietitian, a diet is planned based on the recommended amount of calories, protein, carbohydrates, and fats. The amount of carbohydrates consumed is a dietary key to managing glycemic control in diabetes. For most men, 60 to 75 carbohydrate g per meal are a reasonable intake; for most women, 45 to 60 g are appropriate. Saturated fats should be limited to less than 7% of total caloric intake, and trans-fatty acids (unsaturated fats with hydrogen added) minimized. A steady, consistent level of daily exercise is prescribed, and participation in a supervised exercise program is recommended.
Type 2 diabetes is believed to have a strong genetic link, meaning that it tends to run in families. Several genes are being studied that may be related to the cause of type 2 diabetes. If you have any of the following type 2 diabetes risk factors, it’s important to ask your doctor about a diabetes test. With a proper diabetes diet and healthy lifestyle habits, along with diabetes medication, if necessary, you can manage type 2 diabetes just like you manage other areas of your life. Be sure to continue seeking the latest information on type 2 diabetes as you become your own health advocate.
Treatment of pituitary diabetes insipidus consists of administration of vasopressin. A synthetic analogue of vasopressin (DDAVP) can be administered as a nasal spray, providing antidiuretic activity for 8 to 20 hours, and is currently the drug of choice. Patient care includes instruction in self-administration of the drug, its expected action, symptoms that indicate a need to adjust the dosage, and the importance of follow-up visits. Patients with this condition should wear some form of medical identification at all times.
Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses, a lack of insulin may also develop. This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The most common cause is excessive body weight and insufficient exercise.
Your doctor will check your blood glucose levels, and if you are diagnosed with diabetes, your doctor will guide you on a plan to keep your blood sugar levels normal. If your diabetes is mild, your doctor will likely recommend a diet plan, exercise, and weight loss. Your doctor may prescribe medications that help reduce blood sugar levels. In some women, insulin may be necessary.
The causes of diabetes mellitus are unclear, however, there seem to be both hereditary (genetic factors passed on in families) and environmental factors involved. Research has shown that some people who develop diabetes have common genetic markers. In Type I diabetes, the immune system, the body's defense system against infection, is believed to be triggered by a virus or another microorganism that destroys cells in the pancreas that produce insulin. In Type II diabetes, age, obesity, and family history of diabetes play a role.
What you need to know about borderline diabetes Borderline diabetes, known as prediabetes, is a condition where blood sugar levels are higher than normal but not yet high enough to be type 2 diabetes. This MNT Knowledge Center article explains the signs to look out for, how to monitor the disease, and ways to prevent it becoming full diabetes. Read now