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Diabetes Tip SheetOverviewDiabetes is a metabolic disease in which a person experiences high blood sugar levels over a period of time. There are two kinds of diabetes, Type 1 and Type 2 as well as Gestational diabetes, which occurs during pregnancy. While the onset of Type 1 diabetes can be sudden with symptoms developing in childhood over several weeks or months, the onset of Type 2 diabetes is often much more gradual and can occur at any age. Untreated diabetes can lead to complications stemming from damaged blood vessels. These complications typically appear 10-20 years after illness onset and can impact several parts of the body. According to the World Health Organization (WHO), damage to blood vessels in the eye is known as diabetic retinopathy and can result in loss of vision and blindness. Damage to blood vessels in the kidneys, known as diabetic nephropathy can lead to kidney disease leading to a need for dialysis or kidney transplant. However, damage to the nerves of the body is the most common diabetic complication and can result in numbness, tingling and pain in the skin. Neuropathy can also result in diabetic foot ulcers which can be difficult to treat. Ultimately foot amputation may be required. Diabetes is also associated with a 1.2-1.5 rate of cognitive decline compared to those without diabetes (Cukierman, Gerstein & Williamson, 2005).Type 1 Diabetes-Lack of insulin production.In type 1 diabetes, the body does not produce insulin. The body breaks down the sugars and starches you eat into a simple sugar called glucose, which it uses for energy. Insulin is a hormone that the body needs to get glucose from the bloodstream into the cells of the body. With the help of insulin therapy and other treatments, even young children can learn to manage their condition and live long, healthy lives. Type 2 Diabetes-Body’s ineffective use of insulin (accounts for 90% of diabetes cases).-Often does not have any symptoms.-Approximately one third of people who have Type 2 diabetes do not know it. In?type 2 diabetes, your body does not use insulin properly. This is called?insulin resistance. At first, the pancreas makes extra insulin to make up for it. But, over time your?pancreas?isn’t able to keep up and can’t make enough insulin to keep your?blood glucose?levels normal. Type 2 is treated with lifestyle changes, oral medications (pills), and?insulin. Gestational Diabetes-Diabetes that occurs during pregnancy.During pregnancy – usually around the 24th week – many women develop gestational diabetes. A?diagnosis?of gestational diabetes doesn't mean that you had diabetes before you conceived, or that you will have diabetes after giving birth. But it's important to follow your doctor's advice regarding?blood glucose?(blood?sugar) levels while you're planning your pregnancy, so you and your baby both remain healthy. Common Symptoms of DiabetesUrinating often Feeling very thirsty Feeling very hungry - even though you are eating Extreme fatigue Blurry vision Cuts/bruises that are slow to heal Weight loss - even though you are eating more (type 1) Tingling, pain, or numbness in the hands/feet (type 2)Diagnosis and ManagementA diagnosis of diabetes is made by a physician based on blood test results, and once diabetes is diagnosed, there is no cure for diabetes. However, implementing a series of lifestyle changes can help patients manage the effects of their diabetes. Patients may benefit from the services of dieticians, counselors, physicians, clinical pharmacists and weight loss coaches. The goal of diabetes management is for the patient to maintain blood sugar levels that are within normal limits. Those suffering from diabetes may benefit from education about diabetes as well as education about nutrition, exercise and maintaining normal body weight. Patients with diabetes may also be prescribed medication to help control their blood sugar levels. Metformin is a common first line medication for diabetes and works by decreasing the amount of glucose produced by the liver (Krentz & Bailey, 2005). In many cases, patients with diabetes may need to monitor their blood glucose by using a small machine that pricks their finger so that a drop of blood can be taken and analyzed for blood sugar content. Because there is physical pain and blood involved, this can be a very difficult health behavior change for people to make. Additionally, if their blood glucose levels are too high, they may need to self-administer an insulin injection to bring their levels down. Injecting oneself with a needle to administer insulin can also be very difficult and patients will benefit from a great deal of support and education until they become proficient in monitoring their sugars and administering their insulin injections. PreventionWhile there are no known preventative measures for Type 1 diabetes, Type 2 diabetes can be prevented. Maintaining a normal body weight and engaging in moderate exercise at least 4 times per week has been shown to minimize the risk of diabetes. Likewise, maintaining healthy eating habits with a diet rich in whole grains, fiber, nuts and fish (AlEssa, et al. (2015). Active smoking as also been associated with an increased risk for diabetes (Willi, et al. 2007). It should be noted that low income individuals are the most likely to present with untreated diabetes. This is likely due in large part to the lack of nutritional food available to those with limited financial means. ResourcesAlessa, H., Bupathiraju, S., Malik, V., Wedick, N., Campos, H., Rosner, B., Willett, W., Hu, F.B. (2015). Carbohydrate quality measured using multiple quality metrics is negatively associated with type 2 diabetes. HYPERLINK "" \t "_blank" Circulation, 1-31:A:20.Cukierman, T., Gerstein, H.C. & Williamson, J. D. 2005. Cognitive decline and dementia in diabetes-systematic overview of prospective observational studies. Diabetologia, 48(12), 2460-2469.Krentz, A.J. & Bailey, C.J. (2005). Oral antidiabetic agents. Drugs, 65(3), 385-411.Willi, C., Bodenmann, P., Ghali, W.A., Faris, P.D., Cornuz, J.(2007). Active Smoking and the Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA. 298(22):2654-2664. doi:10.1001/jama.298.22.2654.World Health Organization. Retrieved April 25, 2016American Diabetes Association. (2015). Backholer, K., Chen, L., & Shaw, J. (2012). Screening for diabetes. Pathology,?44(2), 110-4.Hanas, R., & NetLibrary, Inc. (2004). Type 1 Diabetes in Children, Adolescents and Young Adults How to Become an Expert on Your Own Diabetes.National Diabetes Education Program. (2009). Guiding Principles for Diabetes Care for Health Care Professionals.National Diabetes Education Program. (2004). Tips for helping a person with diabetes : How you can help your loved one with diabetes. (NIH publication ; no. 04-5485). Bethesda, Md.]: National Diabetes Education Program.National Diabetes Information Clearinghouse. (2003). Your guide to diabetes type 1 and type 2. (NIH publication ; no. 03-4016). Bethesda, MD]: NIDDK, National Diabetes Information Clearinghouse.United States. Indian Health Service. Division of Diabetes Treatment Prevention. (2008). Promoting a Healthy Weight in Children and Youth : Clinical Strategies : Recommendations and Best Practices.Vitry, A., Roughead, E., Preiss, A., Ryan, P., Ramsay, E., Gilbert, A., . . . Fadini, G. (2010). Influence of Comorbidities on Therapeutic Progression of Diabetes Treatment in Australian Veterans: A Cohort Study. PLoS ONE, 5(11), PLoS ONE, 2010, Vol.5(11). ................
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