Threshold for diagnosis of diabetes is based on the relationship between results of glucose tolerance tests, fasting glucose or HbA1c and complications such as retinal problems. A fasting or random blood sugar is preferred over the glucose tolerance test, as they are more convenient for people. HbA1c has the advantages that fasting is not required and results are more stable but has the disadvantage that the test is more costly than measurement of blood glucose. It is estimated that 20% of people with diabetes in the United States do not realize that they have the disease.
Although there are dozens of known type 1 genes, about half of the risk attributable to heredity comes from a handful that coordinate a part of the immune system called HLA, which helps the body recognize nefarious foreign invaders, such as viruses, bacteria, and parasites. Type 1 diabetes is an autoimmune disease, in which the body's own immune system destroys the cells in the pancreas that produce insulin, so perhaps it is no surprise that immunity genes are involved. Other autoimmune diseases share the HLA gene link, which may be why people with type 1 are more likely to develop additional autoimmune disorders.
Doctors can monitor treatment using a blood test called hemoglobin A1C. When the blood glucose levels are high, changes occur in hemoglobin, the protein that carries oxygen in the blood. These changes are in direct proportion to the blood glucose levels over an extended period. The higher the hemoglobin A1C level, the higher the person's glucose levels have been. Thus, unlike the blood glucose measurement, which reveals the level at a particular moment, the hemoglobin A1Cmeasurement demonstrates whether the blood glucose levels have been controlled over the previous few months.
Hyperglycemia or high blood sugar is a serious health problem for diabetics. There are two types of hyperglycemia, 1) fasting, and 2)postprandial or after meal hyperglycemia. Hyperglycemia can also lead to ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome (HHNS). There are a variety of causes of hyperglycemia in people with diabetes. Symptoms of high blood sugar may include increased thirst, headaches, blurred vision, and frequent urination.Treatment can be achieved through lifestyle changes or medications changes. Carefully monitoring blood glucose levels is key to prevention.
Diabetes mellitus (DM) comprises a group of disorders characterized by hyperglycemia. It is the sixth leading cause of death in the United States and results in $132 billion in total direct and indirect costs. Although the incidence of Type 1 diabetes has doubled over the past 30 years, the increase in Type 2 diabetes has been even more dramatic. An estimated 20–40% of cases in large pediatric diabetes centers are now Type 2, and the rates are expected to rise along with the epidemic of childhood and adolescent obesity (Chapter 11).
Doctors and people with diabetes have observed that infections seem more common if you have diabetes. Research in this area, however, has not proved whether this is entirely true, nor why. It may be that high levels of blood sugar impair your body's natural healing process and your ability to fight infections. For women, bladder and vaginal infections are especially common.
The term brittle diabetes has been used to refer to people who have dramatic recurrent swings in blood glucose levels, often for no apparent reason. However, this term is no longer used. People with type 1 diabetes may have more frequent swings in blood glucose levels because insulin production is completely absent. Infection, delayed movement of food through the stomach, and other hormonal disorders may also contribute to blood glucose swings. In all people who have difficulty controlling blood glucose, doctors look for other disorders that might be causing the problem and also give people additional education on how to monitor diabetes and take their drugs.
Although the signs of diabetes can begin to show early, sometimes it takes a person a while to recognize the symptoms. This often makes it seem like signs and symptoms of diabetes appear suddenly. That’s why it’s important to pay attention to your body, rather than simply brushing them off. To that end, here are some type 1 and type 2 diabetes symptoms that you may want to watch out for:
Pay attention if you find yourself feeling drowsy or lethargic; pain or numbness in your extremities; vision changes; fruity or sweet-smelling breath which is one of the symptoms of high ketones; and experiencing nausea or vomiting—as these are additional signs that something is not right. If there’s any question, see your doctor immediately to ensure that your blood sugar levels are safe and rule out diabetes.
^ Jump up to: a b Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, Clegg AJ (September 2009). "The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation". Health Technology Assessment. 13 (41): 1–190, 215–357, iii–iv. doi:10.3310/hta13410. PMID 19726018.
Type 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin well. As a result, your body needs more insulin to help glucose enter cells. At first, the pancreas makes more insulin to keep up with the added demand. Over time, the pancreas can’t make enough insulin, and blood glucose levels rise.
Hyperglycemia (ie, random blood glucose concentration of more than 200 mg/dL or 11 mmol/L) results when insulin deficiency leads to uninhibited gluconeogenesis and prevents the use and storage of circulating glucose. The kidneys cannot reabsorb the excess glucose load, causing glycosuria, osmotic diuresis, thirst, and dehydration. Increased fat and protein breakdown leads to ketone production and weight loss. Without insulin, a child with type 1 diabetes mellitus wastes away and eventually dies due to DKA. The effects of insulin deficiency are shown in the image below.
Home blood glucose monitoring kits are available so patients with diabetes can monitor their own levels. A small needle or lancet is used to prick the finger and a drop of blood is collected and analyzed by a monitoring device. Some patients may test their blood glucose levels several times during a day and use this information to adjust their doses of insulin.
The patient, physician, nurse, and dietician must carefully evaluate the patient's life style, nutritional needs, and ability to comply with the proposed dietary prescription. There are a variety of meal planning systems that can be used by the patient with diabetes; each has benefits and drawbacks that need to be evaluated in order to maximize compliance. Two of the most frequently used ones are the exchange system (see accompanying table) and the carbohydrate counting system.
Retinopathy: If blood sugar levels are too high, they can damage the eyes and cause vision loss and blindness. Retinopathy causes the development and leaking of new blood vessels behind the eye. Other effects of diabetes, such as high blood pressure and high cholesterol, can make this worse. According to the CDC, early treatment can prevent or reduce the risk of blindness in an estimated 90 percent of people with diabetes.