Click Here for Integrative Medicine Diabetes Management
Highly Recommended: CDC National Diabetes Education Program resource: 4 Steps to Manage Your Diabetes For Life
History of Diabetes
The American Diabetes Association reports that the number of people who suffer from diabetes continues to grow each year. (1) Today, 5% of the world’s population has diabetes, a metabolic disorder that affects the control of blood glucose. Are there really more people developing the disorder or more people diagnosed? This question is difficult to answer.
Type 2 diabetes is a lifestyle illness that is often brought on by environmental factors that trigger genetic predispositions. Nutrition, environment and genetics all play a role in the development and treatment of the disease. But diabetes is not a disease of just the 20th century. In fact, written history exists as far back as 1552 B.C. when physician Hesy-ra, an Egyptian, first wrote about polyuria as a symptom.
This history dates back to centuries before Christ and continues to play a role today. In the early days doctors did not have sophisticated methods of testing people so they employed the help of people called ‘water tasters’. Up through the 11th century these people would taste the urine of those suspected to have diabetes, or sugar in their urine, to see if there was a sweet taste to it. When the blood sugar increased sugar spilled out of the blood and into the urine. As a result the word ‘mellitus’ was added to the diagnosis (Latin word for honey, referring to the sweet taste of the urine). (2)
It was the early 19th century before scientists were able to develop the first chemical tests that would indicate if there was glucose in the urine, eliminating the need for ‘tasters’. This was an important breakthrough in the diagnosis and treatment of diabetes. Now doctors could more consistently diagnose and monitor a condition that causes long-term health effects for the sufferer.
Treatment at this time wasn’t focused on diet until the 1870’s when French physician Bouchardat noticed that the gycosuria (sugar in the urine) was more common in his diabetic patients and decreased significantly during food rationing. The French were forced to ration their food during a siege by Germany during the Franco-Prussian war. After discerning this difference Bouchardat theorized that it was the diet that played an important role in treatment. (3)
Following the end of the war another French researcher, Claude Bernard, studied the function of the pancreas and liver. He made important discoveries in the metabolism of glycogen. At the same time in history Czech researcher, Pavlov, discovered the link between the nervous system and secretion of gastric acid. The combination of these discoveries later helped researchers to understand the physiology of the digestive system, ultimately important in the treatment of diabetes.
In 1869 Paul Langerhans, a German medical student, announced the discovery of two systems of cells in the pancreas. One of these cells, Cells of Langerhans, was named after him. But it wasn’t until 1920 that Dr. Banting conceived of the possibility of the hormone insulin and began a quest to discover the chemical using dogs. (4)
It was 20 years later that the link between high blood glucose and damage to the kidneys and eyes was discovered and published. This led the way for more standardized insulin treatment using a standard syringe. In 1959, physicians recognized the difference between Type 1 and Type 2 diabetes. This recognition helped to individualize the treatment of diabetics and lengthen their lifespan. This helped to decrease the risk for the development of complications. (5)
With the advent of laser surgery in 1970 researchers learned how to slow the development of progressive damage to the eyes. Other researchers began to manufacture glucometers to make testing of blood glucose more accessible and easier.
Synthetic insulin was introduced in 1983. Until that time standard insulin was supplied from cows or bovine insulin. Today synthetic insulin can be delivered through insulin pumps to significantly cut down on the number of complications that an individual suffers later in life. By delivering insulin in doses more in line with how the pancreas would deliver it to the body the individual doesn’t have the highs and lows they once experienced.
Because using an insulin pump reduces the number of complications, insurance companies recognize they are saving money in the long run. This has led them to decide to cover the cost of an insulin pump at earlier ages. Research is currently being conducted on the transplantation of pancreatic cells, without using immune suppressants, which will supply an individual with Type 1 diabetes with a natural source of insulin.
The diagnosis, treatment and complications of diabetes has come a long way from when ‘tasters’ were employed to diagnose diabetes through tasting sweet urine!
Types of Diabetes
There are three different types of diabetes which can affect individuals. Two of these are what are commonly called sugar diabetes. The medical terms for these are Type 1 diabetes and type 2 diabetes. The third type of diabetes is water diabetes or diabetes insipidus.
Type 2 diabetes is a complex medical condition that results in increased blood sugar from the body’s resistance to insulin. In other words, there is not a depletion of insulin in the body but rather a problem with the insulin being used at the cellular level. This results in an increased amount of blood sugar in the blood stream which significantly damages the eyes, heart, kidneys and brain. (1)
The medical terminology that describes high blood sugar is hyperglycemia. It is estimated that over 15 million people in the United States out of the 17 million who suffer from diabetes experienced Type 2 diabetes. Type 2 diabetes is also sometimes called non-insulin-dependent diabetes because it changes the metabolism of carbohydrates, lipids and protein without shutting off the production of insulin. (2)
The resistance to insulin is the major reason that complications occur. This condition can go under diagnosed, especially when it does not cause extremely high blood sugar and symptoms can be attributed to any other underlying medical condition. Treatment for Type 2 diabetes is also different from Type 1 diabetes because many people are able to control their condition with weight loss, diet, exercise and lifestyle changes.
In the past decade there is that an introduction of new oral medications that can also delay the use of injectable insulin once lifestyle changes are no longer effective. Researchers have found that diabetics who have been experiencing symptoms less than 10 years and you are able to incorporate lifestyle changes can use oral hypoglycemic options for years before requiring insulin. (3)
Type 1 diabetes is also called juvenile diabetes or insulin-dependent diabetes. Treatment of this condition should be best addressed by a team of specialists which can include the child, the parents, a nutritionist, and an endocrinologist as well as others who are well-versed in treating youngsters with diabetes.
Type 1 diabetes results when the islet cells which produce insulin in the pancreas completely shut down in the body no longer has insulin available. Insulin is responsible for moving blood sugar into the cells so that energy can be produced. This is the powerhouse of the cellular system and what feeds the body and allows it to work correctly. (4)
Without insulin the sugar builds up in the bloodstream and eventually spills over into the kidneys. The buildup of sugar results in complications which include loss of eyesight, heart disease, stroke, kidney failure and nerve damage. Blood sugar will often be higher in individuals who have Type 1 diabetes then individuals who suffer from Type 2 diabetes.
The American Diabetes Association estimates that approximately 1.5 million people have Type 1 diabetes in the United States today. The exact cause of this condition is not known but many believe that it is the result of an infectious agent or a toxic insult to the immune system. It is not caused by obesity, diet or lack of exercise, which is what may trigger Type 2 diabetes.
More frequently the symptoms of Type-1 diabetes will occur suddenly and must be addressed as an emergency situation to prevent tragic results. Children will prevent with frequent urination, unexplained weight loss, extreme weakness or fatigue, numbness or tingling in the hands and feet, lethargy and drowsiness and a fruity odor to the breath.
New treatment protocols developed in Alberta Canada involve transplantation of islet cells without the use of steroids to prevent rejection. This new technique has resulted in seven out of seven patients who have functioning islet cells without rejection or medications to prevent rejection for over one year! (5)
Diabetes insipidus is another form of diabetes that is not as well publicized and does not involve the metabolism of sugar. Instead it is a metabolic medical condition that involves a large excretion of urine because the kidneys lose their ability to concentrate the urine and returned fluid to the body. It is caused by a lack of anti-diuretic hormone that controls the ability of the kidney to concentrate urine. (6)
There are actually four different types of diabetes insipidus and all need to be treated differently. The most common cause is a lack of vasopressin, which is produced by the pituitary gland. The goal is to treat the diabetes insipidus to prevent dehydration and then find the reason for the destruction of the pituitary gland so that it can also be addressed.
About half of the time diabetes insipidus is caused by reasons that aren’t known or cannot be identified. The condition is permanent but there are medications which can easily control the symptoms. Individuals will continue to have several restrictions even though medication will help them stay under control. They must make good efforts to prevent dehydration and must always take their medication in order to be able to live a normal lifestyle.
Symptoms of Diabetes
Diabetes is a complex metabolic condition that results in the individual experiencing high blood glucose levels when left untreated. Unfortunately, in the past years the symptoms of diabetes were often overlooked because they seemed rather harmless. However, in the past years with increased media attention, more people understand the effects that diabetes can have on the body and the symptoms that they should look for.
Diabetes can actually take two different forms, should be treated two different ways and can have two different outcomes. Type 1 diabetes develops when an autoimmune response damages the ability of the pancreas to produce any insulin. This particular type of diabetes used to be called juvenile diabetes or insulin-dependent diabetes because the majority of individuals who developed it were less than 20 years of age. Type 2 Diabetes develops when the person’s body becomes resistant to the insulin being produced by the pancreas. The long-term effects of both are the same but in the second case the body has enough insulin but the cells do not allow it to do the assigned job of ushering in glucose to provide energy. (1,2)
In either case, too much glucose is floating around in the bloodstream which ultimately causes the symptoms and individual experiences in the long-term damage to the body’s organs. Because of the difference in causative factors both types of diabetes will have different treatment protocols.
Often these symptoms appear to be so harmless that an individual may not seek medical help or the advice of their primary care physician. Researchers are finding that people who seek medical advice sooner have less damage done to their hearts, kidneys and peripheral vascular system than individuals who put off seeing their doctor.
Symptoms of diabetes include frequent urination, especially at night. This means that individuals get up to go to the bathroom frequently and often drink more water during the day. As the kidneys recognize that there is too much glucose in the blood system they try to pull more water out of the blood dragging the glucose with it. This keeps the bladder full and causes the individual to become dehydrated leading to excessive thirst.
The increased thirst is really a response to the kidneys getting rid of the glucose. It isn’t that the glucose causes the thirst but rather dehydration that the body experiences.
People who suffer from type 1 diabetes will often experience unusual weight loss. Because the body isn’t able to get rid of the glucose from the bloodstream it begins to break down muscle and fat to provide the energy which results in weight loss.
People with diabetes also suffer from increased fatigue as a result of a lack of energy because glucose does not make it into the cellular structure. This lack of energy leaves people feeling drained and fatigued.
Other symptoms can include blurred vision, dry mouth, male impotence, female yeast infections or unusual infections. Many of these symptoms can be associated with allergies or a cold, such as thirst which leads to the urination, weight loss, fatigue and irritability. (3)
Any individual who has one or more of these symptoms without suffering from a cold or other underlying medical condition should see their physician immediately so that a simple blood tests can be performed to determine if the individual have high blood sugar. This test is simple, can be done in the physician’s office and does not require hospitalization.
Causes of Diabetes
Diabetes is a group of diseases that is marked by high levels of glucose, or sugar, in the blood. The increased amount sugar in the blood is a result of either defects in the production of insulin or the way in which insulin is used by the body. Complications from diabetes can result in further medical conditions that make it difficult to treat the diabetes, such as kidney failure, peripheral vascular disease or heart disease.
Type 1 diabetes is the result of a lack of insulin production because of the destruction of beta cells in the pancreas. These beta cells are responsible for the production of insulin that regulates blood glucose. Researchers have found that there is a combination of genetic and environmental factors that increase a person’s risk for developing Type 1 diabetes. (1)
If these factors can be identified through further research then it is feasible that scientists will be able to make recommendations for the prevention of this disease. Researchers do know that the body attacks the beta cells in the pancreas because of a mistake made by the immune system. The theory is that Type 1 diabetes happens when an environmental toxin or pathogen triggers the immune system to attack itself.
Type 1 diabetes can happen at any age but most often happens in children and young adults. Because of the causative factors it has an acute onset. Most individuals are able to pinpoint when their symptoms began. In some instances the resulting problems from an acute onset of symptoms leads to the need for emergency services.
Type 2 diabetes is also called non-insulin-dependent diabetes mellitus or adult onset diabetes. This condition happens when the body still produces enough insulin but the body has become resistant to the effects of the hormone. This type of diabetes usually develops in middle age and in overweight individuals. It is most common in people who are older, obese, have a family history of diabetes or have had gestational diabetes. (2)
Individuals who go on to experienced Type 2 diabetes find that there are specific risk factors that place them in a higher risk category. These risk factors include sedentary lifestyle, stress, infection, hereditary or inherited traits, age, poor diet, obesity, hypertension and high triglyceride and cholesterol levels. These are factors that place individuals at a higher risk for developing Type 2 diabetes but are not necessarily causative factors. (3)
The exact causative factor for an individual who develops Type 2 diabetes is not known or understood. Some individuals may have most of the risk factors but never develop the disease while others may have only one or two factors and develop the disease. Researchers and scientists are continuing to work towards a better understanding of the causes of this illness.
What scientists do know is that diabetes is not contagious which means that one individual with diabetes cannot pass it to another individual. It is not caused by eating sweets or the wrong kinds of foods. However, the wrong kinds of foods and eating sweets can cause of obesity which is associated with a higher risk of developing Type 2 diabetes. Stress itself is not a cause of diabetes but rather a trigger for the development of the symptoms and it does make the symptoms worse in those who already have the disease.
The third type of diabetes which affects the glucose system is gestational diabetes. This is a diabetic situation that occurs in a pregnant woman and is believed to be caused by hormonal changes in weight gain. When found early, it is easily treated so that it does not affect the growth and development of the infant. Most women who develop gestational diabetes find that the condition disappears after the delivery of the baby. However, having suffered from gestational diabetes puts a woman at greater risk for developing type 2 diabetes later in life. (4)
Although researchers and scientists continue to search for a viable causative factor for diabetes there are reasonable treatment options available for individuals at this time. These treatment options are not cures but rather methods for individuals to better manage their disease condition in order to reduce the possibility of long-term medical complications.
Tests for Diabetes
Diabetes is a metabolic disorder that afflicts 5% of the world’s population. People who suffer from diabetes face significant long-term disabilities and complications if they don’t keep their blood glucose under control. Because early diagnosis, treatment and tight control of this chronic condition yeilds good results for the sufferer, researchers have searched for and discovered several short term and long term methods of monitoring blood sugar as well as testing for the condition. (1)
Some physicians follow specific recommendations to test for diabetes in their general patient population. Those who are over 45 and obese should be tested and those younger than 45 and obese should be considered.
Doctors will use several different tests, combine the results of those tests, and determine if a person has diabetes. The first, and simplest, test is the fasting blood sugar test. A small blood sample will be taken at the lab after the patient has had nothing to eat or drink after midnight. Normal blood sugar is between 70-110; considered borderline to 135 and high over 140. (2)
Fasting blood sugar can be affected by factors other than diabetes. If a person is taking a diuretic or steroid it may alter the test. Also, some people who may be considered ‘pre-diabetic’ will also test with high blood sugar when they are ill but their values will return to normal after the illness has subsided.
Most physicians will also request a 2 or 4 hour oral glucose tolerance test (OGTT). During this test the patient arrives at the lab having fasted since midnight. They then drink a high concentration glucose drink. During the next 2 or 4 hours their blood sugar is measured every hour and urine tested every 30 minutes. During a normal test the blood sugar will not go above 110 even though the body has been stressed with a high dose of sugar. If there is diabetes the numbers will be elevated during the test. (3)
Physicians will combine the results of a fasting blood sugar, OGTT, and physical examination and history to make a definitive diagnosis of diabetes.
Once a person has been diagnosed with diabetes it is important to continue to monitor their disease process. This is done through the use of several different blood tests. All diabetics learn to self monitor blood glucose through the use of a glucometer at home. These small machines measure the amount of glucose in the blood by using a small blood sample obtained through a finger stick.
Then once every 3 – 6 months your doctor should order an A1C test to give you and the doctor an overall view of how well the glucose has been controlled in the past three months. The A1C is also called a glycosylated hemoglobin test. The American Diabetes Association recommends that this test is done twice a year for people who are well controlled and more often when blood sugars are not well controlled, if diabetics have other illness (illness affects control of the blood sugar) or when the treatment of the condition is changed. (4)
A serum creatinine test is recommended once a year. This is a simple blood test that helps the doctor to determine how well your kidneys are performing. Serum creatinine is excreted through the kidneys and is a by-product of muscle metabolism. So if your kidneys aren’t working well they won’t excrete as much of the chemical.
A urine microalbumin test also evaluates the health of your kidneys by measuring the amount of protein that leaks through the kidneys into the urine. If your kidneys become damaged the waste products that kidneys normally filter remain in your blood and the protein that normally is in your blood leaks to your kidneys. The test is usually done on a one time fresh urine sample, although your physician may do a quantitative 24 hour study and ask you to collect 24 hours worth of urine.
The last diabetes test that is commonly done are lipid tests to evaluate your low density lipoproteins (LDL) and high density lipoproteins (HDL). Diabetes and heart disease are linked because of the damage that is done to the body from the diabetes and because those with diabetes have a higher risk of developing heart disease.
Doctors use the results of these tests to help determine how much vessel damage may be happening. The American Heart Association and the American Diabetes Association recommend that these tests are done once a year, more often if you are on lipid lowering drugs.
Diabetes tests have improved the way in which diabetes is monitored and treated. Now with vigilant monitoring and treatment patients have a lower risk of high blood pressure, stroke, heart disease and peripheral vascular disease then they once had even 10 years ago.
Pre-Diabetes
Diabetes is a metabolic disorder that affects the regulation of glucose in the blood stream and the use of glucose in the cells for energy. Without glucose the metabolic process of providing energy changes and the body begins to burn fat and protein for which insulin, the primary hormone regulating glucose metabolism, is not required. (1)
There are two types of Diabetes – Type 1 and Type 2 – but it is only in Type 2 diabetes that there is some warning, or pre-diabetes, that the condition is imminent. In Type 2 diabetes the individual often has some pre-disposing factors and possibly some genetic factors. The process is generally gradual and occurs when the cells of the body become resistant to the insulin that is being produced. In other words, the body continues to produce insulin, in greater and greater amounts, but the cells no longer are able to utilize it.
Before developing Type 2 diabetes, most people have a condition referred to as “pre-diabetes” where the blood glucose is at higher than normal levels but not yet high enough to cause severe symptoms or be diagnosed as diabetes. The American Diabetes Association estimates that there are over 18 million people in the U.S. who have diabetes and 57 million who have pre-diabetes. (2) More importantly, recent research has identified specific changes in the body that begin to cause long-term damage to the heart and circulatory system. (3)
Because people with diabetes often fall into risk groups, or those individuals who have a higher probability of developing diabetes, those who have pre-diabetes have the same risk factors. Diabetes is more common among those who are overweight, have diabetes in their immediate family or belong to certain populations, such as African Americans, Latinos, Native Americans and Asian Americans.
There are two different tests that can be used to determine if high blood sugar is a problem that should be addressed. These tests should be ordered if the individual has underlying risk factors. The first test is a fasting plasma glucose test. This measures the amount of glucose or sugar in the blood stream after not having eaten for at least 12 hours. If the glucose is high after fasting then the doctor determines that you have impaired fasting glucose. (4)
The second test is an oral glucose tolerance test (OGTT). This test requires a bit more cooperation from the patient since they must drink a high sugar drink that is between 8 and 16 ounces after having fasted for 12 hours. If the physician wants the oral GTT they will draw a fasting glucose prior to starting the test. Once the individual drinks the fluid a lab technician will draw blood and request urine every 30 to 60 minutes. This test measures the body’s response to a high load of glucose and how well the pancreas can respond with insulin as well as how quickly the body can move the glucose into the cells. (5)
Doctors will evaluate the numbers that are reported back from these two tests and make a determination that an individual has pre-diabetes if their glucose in their blood is between 140 and 200 after a gtt or between 100 and 126 after a fasting glucose test. These numbers have been revised downward over the years as researchers are better able to determine the impact they have on long-term health.
Today, treatment for pre-diabetes includes dietary changes, lifestyle changes and exercise. All of these things will help the body to more fully utilize the insulin that the body is producing and possibly delay further treatment for diabetes with oral hypoglycemic agents or insulin injections.
Blood sugar values that range over 126 for fasting or 140 for oral glucose challenge represents diabetes that must be treated and monitored more closely. In a study by the American Diabetes Association researchers found that approximately 11% of patients with pre-diabetes go on to develop diabetes in one year. (6)
Usually pre-diabetes doesn’t have symptoms. It is the high blood glucose levels that cause the classic symptoms of diabetes and in individuals who have pre-diabetes their blood glucose isn’t high enough to cause symptoms such as excessive thirst, multiple trips to the bathroom, unexplained weight loss, blurred vision and extreme hunger.
In new research published July 2009 researchers found that the increased risk to heart disease and stroke found in individuals who smoked was most likely caused because nicotine builds an insulin resistance in the body. This resistance causes pre-diabetes which leads to a greater risk of cardiovascular disease. Their results suggested that by working to decrease the insulin resistance found in smokers they could effectively decrease the increased risk to cardiovascular disease in the same population. (7)
The 7 Basics of Diabetes Prevention
1) If you are overweight you risk developing diabetes. Reduce the amount of food on your plate so you gradually eat less and start to lose weight. Drink a glass of plain water or a sugar-free drink before your meal to take the edge of any hunger pains.
2) Reduce the amount of fat you are eating. Grill or bake foods instead of frying; use low-fat spreads and reduced fat meals. Eat smaller meals to the point of satisfaction, but not fullness. Never eat a large meal or a lot of the same type of food at one time.
3) Check the Glycemic Index of the food you are eating – knowing what each food contains helps maintain your blood-sugars, which in turn can prevent the full onset of diabetes.
4) Drink at least 8 glasses of water every day. If you keep a bottle of water with you and sip frequently you’ll be surprised how much you do drink throughout the day.
5) When hunger occurs between meals, choose a healthy snack rather than a chocolate bar.
6) Use skim milk or soy milk rather than full-fat milk in hot drinks.
7) Exercise is good for health, but if you are not use to exercise then start in moderation. In order to start, 15 minutes gentle walking each day will ease you into a regular exercising pattern. Make exercise part of the daily routine. The greatest benefit is seen in those who exercise consistently most days of the week.
Diabetes and Hypertension
Diabetes and hypertension are two major health threats to people throughout the world. Data from the National Diabetes 2011 Fact Sheet indicate that there are 7 million people in the US with diabetes who are undiagnosed. At this time there are over 25 million individuals who have diabetes in the United States alone. Screening for these two particular disorders are large factors in the early prevention and treatment of illnesses that often results in significant negative medical complications. (1)
In some cases diabetes is not found until the sufferer experiences a complication or it is found during a routine screening blood test. However, because of recent media attention and increased education of the middle-aged population, more individuals recognize the signs and symptoms of this progressive disease. If the disease is not recognized until the latter stages, then significant damage can have been done to the eyes, kidneys, nerves and heart muscle. These complications are costly financially, emotionally and relationally.
Early detection and treatment for diabetes will help improve the control of blood glucose and improve the control of lipids and blood pressure. Researchers have found that individuals who suffer from diabetes have a greater risk of also experiencing hypertension. (2)
Hypertension, or high blood pressure, is another of the major health threats to individuals. Hypertension is the medical term used for high blood pressure which can result from damage to the kidneys, heart, liver and also increases the risk of stroke to the individual.
Individuals who have diagnosis of diabetes or hypertension should be routinely screened for the other condition. Unfortunately people who suffer from hypertension are more likely to experience diabetes than those people who don’t experienced hypertension at all.
Screening tests should also be done on individuals who have a family history of diabetes, those who are overweight, those over 45 and those who have known hyperlipidemia, or increased lipids in the blood stream, such as cholesterol.
Women who have had a history of gestational diabetes, or the delivery of an infant over 9 pounds, are also at higher risk for diabetes and subsequently hypertension. The screening tests used are a quick dip stick evaluating protein in the urine or a blood pressure measurement. Patients who are spilling protein in their urine have a greater chance of having renal damage which can have resulted from either diabetes or hypertension.
A fasting blood sugar is the standard test for diabetes. This is a simple blood test which is taken after eight hours of complete fasting. Most individuals are told to stop eating after midnight in the blood tests is taken sometime after 8 a.m. the next morning, prior to breakfast, coffee or any other intake. This test is reliable but it does require a follow-up test if the test indicates that there is a problem with elevated blood sugar. (3)
A more extensive test to evaluate the diagnosis of diabetes is called the oral glucose tolerance test. During this test the patient is asked to drink a product that contains 75 g of glucose after having fasted for eight hours. Patients should be cautious when drinking this material since many find themselves vomiting after introducing something with this high sugar content into their stomachs after having eaten nothing else. (4)
Blood samples are then taken every half-hour and the urine is also tested every hour. This test is a measurement of the body’s response to a high load of glucose. The results of this test will help the physician determine a diagnosis of diabetes as well as give a good indication of how much insulin or oral hypoglycemic the individual should start with.
If an individual already has the diagnosis of diabetes then a glycosylated hemoglobin, or hemoglobin A1 C, is drawn to determine the severity of the diabetes over a period of time. This test is usually drawn every six months to get an accurate picture of the previous six months of glucose control. (5)
Screening for hypertension is much simpler and involves only doing a blood pressure test while sitting or standing. At the same time the individual may be screened for heart disease that can include a blood test for cholesterol, an EKG and chest x-ray.
These screenings for diabetes and hypertension can successfully be done at health fairs and doctors offices. It is especially important for individuals who have risk factors to understand those factors and how lifestyle choices may help prevent illness.
Effect of Low Blood Sugar
One of the side effects of diabetes suffered by many individuals is low blood sugar. In the case of diabetes the body is not able to process blood sugar or glucose which subsequently damages bodily systems and organs. The treatment for this is to use oral hypoglycemic or injectable insulin which assists the body in producing energy by drawing glucose into the cellular system. The insulin or oral hypoglycemic medications require that the individual have a enough blood sugar upon which it will work.
In some cases an individual will also have a condition that is known as “brittle” or hard to control diabetes. These individuals find that they have problems with low blood sugar and high blood sugar which happened during both the daytime and nighttime.
Low blood sugar, or hypoglycemia, is the medical term used to describe when blood sugar falls below what the body requires to stay alive. Low blood sugar is defined when the number falls below 65. When the level falls very low, such as below 20, individuals can get confused, drowsy and even lose consciousness. The blood sugar levels are necessary in order to maintain significant brain activity. If this blood sugar drops during pregnancy it can permanently harmed the baby.
Individuals who do not suffer from brittle diabetes can produce low blood sugar by taking too much insulin, not eating enough food, exercise when it wasn’t planned for, drinking too much alcohol or exercising and not eating. Each of these situations causes an environment in the body in which the amount of blood sugar drops and there continues to be insulin present that works on the remaining blood sugar.
Low blood sugar is usually referred to as an “insulin reaction”. People who are suffering from any insulin reaction will present with shaking, sweating, blurred vision, headache, tingling, hunger, numbness, fast heart rate, sudden tiredness, pale appearance, personality changes, confusion, poor concentration and potentially loss of consciousness. (1)
The physician, diabetes educator or endocrinologists should discuss how to treat low blood sugar symptoms with the sufferer. These treatment protocols should also be reviewed with family members and friends as well as carried on the diabetic’s person in case they are unable to communicate.
People who are having a low blood sugar reaction, and are also exhibiting personality changes or confusion, may have a difficult time accepting treatments. Individuals who suffer from brittle diabetes should also carry injectable sugar for instances when they are unable to take in nutrition by mouth or are unwilling because of confusion.
For the most part, you should be able to correct low blood sugar by drinking small amounts of fluid that are highly concentrated in sugar, such as orange juice, followed by nutrition that is high in protein to maintain blood sugar levels. The initial high glucose fluid, such as orange juice with no added sugar, will enter the bloodstream quickly through the stomach lining and the follow-up of protein will give the body a consistent supply of nutrition. (2)
Low blood sugar can also occur at night. Unfortunately it is harder to recognize because individuals are most likely asleep! Diabetics who suffer the effects of low blood sugar at night can experience nightmares, waking up very alert, sweating at night and awakening with damp bed sheets, waking up with a fast heart rate or restlessness and an inability to go back to sleep. (3)
It is very important for individuals to check their blood sugar during the night if they awaken with any of these symptoms. If you feel certain you are a low then eat a few quick carbohydrates before testing your level in order to ensure that your blood sugar will not continue to drop.
Some individuals will sleep through night reactions but have symptoms the next morning. If you awaken in the morning with a very high blood sugar level after breakfast or before lunch, headache first thing in the morning, ketones in the urine but no glucose and/or foggy thinking first thing in the morning, you should wake yourself up during the night at 2 a.m. for the next few nights in order to test blood sugar. This will help to identify and correct the situation that can have potentially damaging results.
Researchers have found that a diabetic who has one insulin reaction increases their risk of having another. In one study researchers found that 22% of people who suffered a hypoglycemia episode which required ambulance attendance suffered another within the next 24 hours. (4) Unfortunately, the longer a person has diabetes and suffers from low blood sugar reaction, the more difficult it is for them to recognize the symptoms of a hypoglycemic attack because the body acclimates to the stress of low blood sugar. These individuals only recognize low blood sugar levels when they’re sugar drops significantly.
It is very important for individuals who suffer from diabetes to continue to monitor their blood sugar levels even when they believe that they are stable and under control. Blood sugar levels are significantly affected by exercise, stress, lack of sleep and hydration. By a closely monitoring blood sugar an individual is taking big steps towards improving their long-term health.
Effects of Diabetes
Diabetes is a complex metabolic disorder that causes damage to the body systems and organs through an increase in blood sugar levels well above normal. This increase in blood sugar can be the result of two different types of diabetes. In type-1 diabetes the pancreas shuts down and no longer produces insulin. While in type-2 diabetes insulin continues to be produced but the body becomes resistant to the hormone and can no longer use it.
Changes to your health happens over years and can sometimes be attributed to the aging process as well. Unfortunately, kidney damage, heart damage and stroke happen at a time when an individual is already facing a decline in eyesight, memory, hearing and energy levels that accompany the process of aging when you may not have made the best lifestyle choices.
Diabetes will also have an effect on the eyesight, heart disease, kidney disease and peripheral vascular disease. The effect of diabetes ends with devastation that leaves an individual debilitated at the end of their life.
These changes can be delayed when you make several lifestyle changes and choices that improve your health. But these changes potentially require major differences in the way that you live, eat and enjoy a social life. In either case the person who suffers from diabetes will go through a grieving process because of both the lifestyle choices that are forced upon them and the potential future they are now facing.
The symptoms of diabetes are sometimes so subtle that people will ignore them and put off diagnosis for weeks and even months. Researchers are now finding that the earlier a diagnosis is made, the longer medical repercussions of diabetes can be delayed. These symptoms are caused by high blood glucose level, or blood sugar level, that affects the way in which the kidney filters urine. (1,2)
The extra glucose that is in the blood will cause significant and cumulative damage to the eyes and retina; the long term effects of which are blindness. Damage is also done to the heart muscle which can potentiate the effects of heart disease, stroke and increase the risk of heart attacks.
The damage done to the vascular system in the heart also affects the vascular system in the hands and feet, more prominently the feet. This is called the peripheral vascular system that feeds your feet and hands with oxygen and nutrition. The increased blood sugar will cause the vascular system to work poorly and allows fluid to build up in the extremities. This causes swelling in the feet and can lead to open sores, gangrene and amputation. All of this is the result of the increase fluid builds up in the cellular structures of the feet which increases the risk of infection and decreases the ability of the body to repair itself. (3)
The increased amount of blood glucose also increases the work of the kidneys which takes an incredible toll over the years. The kidneys accurately attempt to filter the extra glucose out of the bloodstream. In order to do this more water must be extracted from the blood which leads to dehydration and thirst in the individual. It also leads to an increased amount of urination. This increased workload will lead to kidney failure if the diabetes is not well controlled. The added strained to the vascular system in the kidneys will also contribute to kidney failure. (4)
The long-term effect of diabetes has the potential to be devastating. Individuals face the future with potential loss of legs to amputation, kidney dialysis because of a failed kidney or stroke or heart attack from vascular damage. However, with care, lifestyle changes and strictly following the recommendations of the endocrinologist, most individuals are able to significantly delay and potentially alleviate these effects completely.
Monitoring Diabetes
Diabetes is a metabolic disorder in which the body is unable to adequately use or adequately produce insulin. This inability to use insulin, whether because of body resistance or decrease production, results in a high level of glucose in the blood stream. This excess sugar is the reason behind the long-term complications, such as loss of a eyesight, kidney damage, sexual dysfunction and nerve damage. By adequately monitoring glucose levels an individual who is diabetic can often decrease the number of complications and the severity of those complications.
Blood glucose monitoring happens in two different ways. In the first case, an individual should monitor their blood glucose levels at least daily, if not three times daily, at home using a glucometer. In the second case the endocrinologist will order a blood test every three to six months to monitor other blood indicators that give the physician an adequate reading of how well-controlled the individual’s glucose levels have been.
Decades ago these methods of monitoring blood glucose were not available. In fact, history has recorded the use of “urine testers”, or individuals who tasted urine in order to determine whether or not sugar was spilling into the urine. (1) Today, manufacturers have produced technologically advanced monitors that are small, inconspicuous and often need no more than a drop of blood in order to get an accurate reading.
By monitoring blood sugar over the entire day the individual helps to reduce the numbers of peaks and valleys in the glucose readings, which also helps to decrease the long-term complications. Monitoring blood sugar also helps in individual to learn how food, activity levels, stress, medicine and insulin all play a role together in the control of blood glucose. Using this information the patient can stay healthy, prevent or delay complications and prevent infections.
This monitoring at home is done with a glucose meter or glucometer. Your insurance plan will indicate which model of glucometer they are willing to pay for. The individual should also check with their endocrinologist to see which one the physician recommends. Consider the different features and which are important to you. For instance, those who have poor eyesight may want to spend a little bit more money for a meter that reads in large print. Others may want a meter that will store results over several days.
The second way of monitoring blood glucose levels is called the hemoglobin A1C. test. This is a simple lab test, often drawn in the doctor’s office that shows the average amount of sugar that has been in the person’s blood over the past three months. This is the best test a health care provider can use to determine if the blood sugar is under good control. (2)
Glucose in the blood stream can become attached to hemoglobin. This is the part of the red blood cell that carries oxygen. The process of sugar becoming attached to hemoglobin is called glycosylation. Once the sugar is attached it stays for the life of the red blood cell, which is approximately 120 days. Researchers have determined the ratio of sugar in the blood to the amount of glycosylated hemoglobin. This means that the higher the level of blood sugar, the more sugar attaches to red blood cells.
Using the hemoglobin A1c test physicians can determine how stable glucose levels have been in the past 120 days. Results on the blood work are given in percentages. The lower the percentage the better control the individual has maintained.
In a major study of individuals who suffer from diabetes, the Diabetes Control and Complications Trial, researchers found how important this test really is. This study indicated that by lowering the hemoglobin A1C percentage the individual can delay or completely prevent serious complications of blindness, kidney failure and nerve disease. The study also indicated that lowering the level by any amount would improve a person’s chances of staying healthy longer. (3)
Most endocrinologist or physicians will order this test at least twice a year. If the person has not been in good control or has a new diagnosis or has recently undergone surgery the tests may be ordered more often. Any changes to the treatment plan, differences in exercise routines for changes in diet would also be an indication for a hemoglobin A1c blood test to be ordered more frequently.
An individual with diabetes should have a test results that is less than 7%. Those who keep their levels close to 7% have a much better chance of delaying or preventing long-term complications. Studies have shown that people whose levels remained at 8% or higher have an increased chance of long-term complications. Any individual whose test result is greater than 8% should have their treatment protocols changed and diet reevaluated.
Gestational Diabetes
Gestational diabetes is the medical term used to describe diabetes mellitus that presents during pregnancy and disappears after the baby has been delivered. The American Diabetes Association estimates that approximately 4% of women who are pregnant will develop gestational diabetes. This condition requires very specialized care for the remainder of the pregnancy in order to protect the health of both the mother and child. (1)
During pregnancy some women develop a resistance to insulin that results in gestational diabetes. Insulin is the hormone that draws sugar from the bloodstream into the cells where it is burned to supply energy at the cellular level. Without the sugar the body is forced to burn fat for fuel. This has a significant negative effect on both the mother and baby. The extra sugar in the bloodstream also causes complications in the health of the mother and child.
Because of the significant negative effects for both mother and child current standard treatment in pregnancy calls for a screening test after the 1st trimester. Women who are greater risk for gestational diabetes will undergo a 5 hour glucose tolerance test. The screening test is a simple blood test that is drawn to look for the presence of too much sugar in the blood. The five hour glucose tolerance test (GTT) is a much more complex test. (2)
During a five hour GTT the woman is given between 8-16 ounce of a high sugar drink and then urine and blood is tested at 30 minute intervals for the next 5 hours. This test looks at how the woman’s body handles the extra sugar load, how much insulin is secreted and how much sugar is left in the blood stream and spills into the urine.
It is important for women to understand and recognize the symptoms of gestational diabetes for those whose condition develops after the screening test has happened. These symptoms can be very subtle, such as an increased amount of thirst, more trips to the bathroom, hungrier and blurred vision. All of these symptoms are caused by increased blood sugar but can also be attributed to other underlying medical conditions. (3)
Because the sugar isn’t absorbed into the cells the mother also experiences greater fatigue than she would have just being pregnant. As the kidneys try to filter out the excess sugar, take out more water the woman also gets dehydrated. She becomes thirsty from the dehydration and visits the bathroom more frequently because of the increased water intake.
Some of these symptoms are also those of pregnancy. Some women may believe that they are going to the bathroom more frequently because of the weight of the baby over the bladder. However, thirst isn’t a symptom of pregnancy. Between the 20th and 24th week the woman’s energy level also returns so she shouldn’t feel fatigued at this point. When the woman is suffering from gestational diabetes she may feel some relief from the fatigue but then it returns in full force as she doesn’t have energy because of the insulin resistance.
Researchers have found that babies who suffer from gestational diabetes have negative effects in later years. Left untreated the condition causes complications during the delivery and for the mother. For these reasons it is very important to identify and treat gestational diabetes as early as possible. A simple fasting blood sugar is enough to rule out the condition. (4)
Women who have higher risk factors, such as family history of diabetes, obesity, lack of exercise or a previous pregnancy with gestational diabetes should have a five hour glucose tolerance test to rule out the possibility and prevent medical complications.
Weight Loss and Diabetes
Did you know that nine out of 10 people who are newly diagnosed with type 2 diabetes are overweight? The American Diabetic Association estimates that 80% of the 15 million individuals who suffer from Type 2 diabetes are significantly overweight and that the obesity contributes greatly to the development of the disease.
It is no secret that a slow, intentional weight loss will decrease the risk of health problems and diabetes is included in that list. This weight loss will also reduce the need for insulin, improve cardiovascular health and improve lipid profiles. By achieving these goals you also reduce your risk factors for developing stroke, heart attack, retinal damage and kidney failure. (1)
However, losing weight and keeping it off is as much of a challenge for those who have diabetes as it is for those who don’t. If it were not a challenge then the thousands of weight loss programs that are currently making billions of dollars every year would be out of business. The weight loss industry has become a multibillion dollar industry due to the difficulty that people find in removing excess baggage. As a diabetic it is important that you engage the help of other professionals to help you lose weight that you require in order to decrease your need for external insulin and medication.
Losing weight as a diabetic is accomplished the same way that weight loss is achieved under any other circumstance. Weight gain or weight loss is simply a mathematical equation of how many calories are eaten versus how many are spent. In other words, if an individual burns off 1500 calories per day but eats 2000 calories per day they will gain weight. If the reverse is true they will lose weight.
Each pound of body weight is equal to 3500 calories. If there is a negative caloric intake of 500 calories per day and individual should be able to lose 1 pound of body weight each week.
While weight loss of 1 pound a week is a realistic goal, too many times we want our results to happen today. When an individual decides to lose weight they often want to lose 10 pounds this week. If you really lost 10 pounds in one week you would have to have a negative calorie intake of 35,000 calories! This is not possible. To achieve this it would require that metabolism was increased through some external chemical response, such as chemotherapy or cancer, and you had stopped eating altogether.
The goal of any weight loss program is to achieve a gradual loss that can be maintained. This results in a healthy body and mind and can also result in the elimination of medication required to control Type 2 diabetes. (2)
On the quest to lose weight individuals who suffer from diabetes will find that exercise is their friend. The American diabetes Association recommends that individuals engaged in exercise for two reasons. In the first place, exercise reduces the body’s need for insulin while still controlling blood glucose levels. In the second place, it increases metabolism and enables an individual to lose weight with greater ease. (3)
Another product that diabetics have at their disposal for weight loss is the drug, Byetta. This medication and was originally designed to assist in the control type 2 diabetes but was found to have a side effect of weight loss. It was approved by the FDA for treatment as an injectable medication. It is not insulin but improves the control of blood glucose by mimicking the action of another hormone and helps the body to use insulin most effectively. (4)
Studies have also found that individuals who use Byetta have experienced weight loss. The theory is that the drugs slows the movement of food from the stomach through the intestines which helps individuals to feel full or longer and results in an individual who eats less. At this point the drug is approved only for those who have diabetes and not as a weight-loss drug.
While individuals who have diabetes may find it useful to use Byetta it should not be the only factor used to achieve weight loss. Weight control is incredibly important in the long term management of diabetes in the prevention of long-term health complications.
Individuals who are overweight and suffer from Type 2 diabetes find their overall health improves with weight loss and the management of their disease improves as well. Unfortunately, researchers also found that those who lose weight, put it back on, take it off again and continue to go through a roller coaster ride of weight loss and weight gain actually do more harm to their overall long-term health than those who just remain several pounds overweight.
But, before giving up and deciding not to attempt weight loss it is important to recognize the significant health benefits that you achieve even through the loss of five or 10 pounds. If five or 10 pounds is all that can be achieved initially it is enough that you do it, maintain the loss and attempt to lose more later.
Sexual Dysfunction and Diabetes
Individuals who suffer from diabetes often suffer long-term consequences complications from a high level of glucose in the blood stream. This high level of glucose is a result of the metabolic condition called diabetes. Over the long term one of these significant medical conditions which results is erectile dysfunction or sexual dysfunction.
Erectile dysfunction is a common problem in men who have diabetes but, thanks to recent advancements in treatment protocols, it is not inevitable. Physicians now have strategies to prevent this condition as well as treatment options for men who all ready have difficulties with sexual dysfunction.
Men who have diabetes are three times more likely to have erectile dysfunction than are other men, according to the National Institute of Diabetes and Digestive and Kidney Diseases. In fact, it is estimated that up to 85% of men who have diabetes will experience some degree of erectile dysfunction. And, the longer an individual has had diabetes and the more severe the condition, the more likely they are to have trouble with erections. (1)
When this condition is left untreated it results in frustration, discouragement and often depression. Unfortunately, it is also a condition which men are unwilling to speak about with ease. For this reason physicians who are treating a man with diabetes should take an active role in seeking information about their sexual health in order to assist in any way possible.
Basically, erectile dysfunction is the inability to achieve or maintain an adequate erection for satisfying sexual activity. In some instances the penis does not become hard at all and in other instances it does not become hard enough to have sex. (2) Many people are aware of the medications available to treat men who have erectile dysfunction as they grow older. The advertising for Viagra and Cialis, to name just two medications, is so widespread that most individuals who live within earshot of a television or who have picked up a magazine will have some knowledge of these option.
However, men who have diabetes can suffer from this condition for other reasons. A person who has diabetes which is not strictly controlled will have excess sugar in the blood stream that will damage nerves and blood vessels that are responsible for erections. This means that while the brain may be ready, the information is not relayed adequately to the sexual organ which does not respond at all. This means that the recent advancements in drug therapy are not as successful in men who have erectile dysfunction as a result of diabetes.
This lack of response should not be misinterpreted as a lack of interest. In fact, the opposite is quite often true. The man is often very interested but because of nerve damage or vascular damage, the body is unable to respond.
Men who have diabetes which is poorly controlled can also have difficulty with the inhibition of the release of nitric oxide. If there is too little nitric oxide in the blood system it can hamper the flow to the penis which again makes it difficult to achieve or maintain an erection. Other underlying medical conditions can also affect the situation, such as cardiovascular disease or hardening of the arteries.
However, although men are more likely to be identified as having sexual problems with their diabetes, both men and women can develop problems because of the damage to nerves and small blood vessels. The reason for the sexual dysfunction is the same, the damage to the nerve endings and blood vessels because of the high levels of glucose in the blood system.
Research into sexual problems in women with diabetes is very limited at this point. Some estimate that between 18 and 27% of women will experience some type of sexual dysfunction, such as decreased lubrication, painful intercourse, lack of sexual desire and decreased or absent response. (3)
Decreased or absent sexual response can include the inability to become or remain aroused. It can also mean that the woman has reduced or no sensation in the genital area with the constant or occasional inability to reach orgasm.
Women who have difficulty with lubrication can purchase prescription or over-the-counter vaginal lubricants. There are also techniques used to treat decreased sexual responses which can include changes in position and a variety of different stimulation during sexual relations. Some women also find that using Kegel exercises to strengthen pelvic floor muscles can improve sexual response. Currently, there are studies underway for drug treatment specifically designed for women who are suffering from sexual dysfunction as a result of diabetes.
Cure for Diabetes
Is a cure for diabetes mellitus now a reality?
Diabetes is a metabolic disease that affects over 17 million people in the United States alone. The condition creates complications that range from blindness to kidney failure and cardiovascular disease and stroke.
Researchers, scammers, holistic medicine physicians and well meaning doctors have all claimed to find a cure for diabetes at one time or another. The reality is that with good lifestyle choices, nutritional intake and exercise most people who experience pre-diabetic symptoms may go through the rest of their lives without ever suffering diabetes. However, many who have Type 2 diabetes are not able to make the necessary changes and choices that negate their life-long poor choices.
Those who suffer from Type 1 diabetes experience the condition because the cells that produce insulin have completely shut down. Some theorize that the lace of insulin production is a result of an immune response in the body to an environmental trigger, such as a toxin or virus. However, no definitive cause for Type-1 diabetes has been identified.
Finding a cure for diabetes requires that the cure also addresses the reason behind the diabetes. So, the jury is now out on whether some of the promising research has indeed found a cure. A cure would mean less of a financial burden on both families and insurance companies as well as better health for millions of Americans and people around the world.
Sixty five percent of people with Type 2 diabetes do not understand their blood test readings and do not know what having their blood sugar under control really means to their long-term health. For some, they believe that once their sugar is ‘under control’ they have achieved a cure and no longer require medication, lifestyle changes, or changes to their nutritional intake.
These assumptions are absolutely not true and result in people who suffer from long-term affect that negatively impact their lives for years. It is perfectly reasonable to assume that a person who has their blood sugar at normal levels one day can find their sugar level too high the next.
It is also perfectly reasonable for an individual with Type 2 diabetes to eliminate partially hydrogenated oils and trans-fats from the diet and replace them with natural oils, add vitamin C and a health diet to find that their need for medication is reduced significantly or totally eliminated after 3 months to a year.
Having blood sugar control is a daily struggle that involves insulin, diet, exercise and lifestyle changes. Diabetics have two choices – cure or better control. At this time there are several avenues being pursued for cure for diabetes mellitus now a reality:
- Pancreatic transplantation
- Islet cell transplantation
- Artificial pancreas
- Genetic manipulation
Each has its own challenges, including prevention of immune rejection. But only one has had significant results in initial trials of Diabetics with type 1 diabetes. (1,2)
To date there have been seven out of seven successful islet cell transplantations done that have been producing insulin for greater than 1 year. And to date this has been nothing short of a miracle. This new procedure was designed by Dr. James Shapiro at the University of Alberta and is known as the Edmonton procedure. It is a non-steroid combination of three drugs to prevent rejection of the transplanted cells – which also appears to prevent the autoimmune diabetes from returning.
Seven patients were surgically implanted with the islet cells and given the combination of medications and seven have remained successfully producing insulin with indication that the original autoimmune problem with the pancreas is returning.
Dr. Ray Rajotte, a veteran islet cell transplant research member, and his team are teaching the Edmonton procedure around the world. Clinical trials are beginning in the US and Europe. If you are interested in the clinical trials being planned in the U.S. contact the Immune Tolerance Network through their website (immunetolerance.org). A cure for diabetes mellitus now a reality appears to be just around the corner for type 1 diabetics.
Read more here about how to eliminate Diabetes Mellitus:
Diabetes Mellitus Management
References:
History of Diabetes:
(1) American Diabetes Associations: Diabetes Basics Statistics
http://www.diabetes.org/diabetes-basics/diabetes-statistics/
(2) Saudi Medical Journal: History of Diabetes Mellitus
http://www.ncbi.nlm.nih.gov/pubmed/11953758
(3) Google Books: Transplantation of the Pancreas
By Rainer W. G. Gruessner, David E. R. Sutherland
http://books.google.com/books?id=2-lo9GE3aUEC&pg=PA41&lpg=PA41&dq=French+physician+Bouchardat+discovers+diabetes&source=bl&ots=QjRYsYgr7x&sig=RFU3v9lBynRyC9XjCJkZjqJWX5k&hl=en&sa=X&ei=EdISUL_JJ8KS0QG20ICQCg&ved=0CEMQ6AEwAjgK#v=onepage&q=French%20physician%20Bouchardat%20discovers%20diabetes&f=false
(4) Nobelprize.org: The Discovery of Insulin
http://www.nobelprize.org/educational/medicine/insulin/discovery-insulin.html
Types of Diabetes
(1) University of Maryland Medical Center: Diabetes
http://www.umm.edu/altmed/articles/diabetes-000049.htm
(2) American Diabetes Associations: Diabetes Statistics
http://www.diabetes.org/diabetes-basics/diabetes-statistics/
(3) Diabetes Journal: Trends in Use of Oral Hypoglycemic Agents
http://care.diabetesjournals.org/content/11/7/558.full.pdf
(4) American Diabetes Association: Diabetes Basics
http://www.diabetes.org/diabetes-basics/type-1/
(5) University of Illinois At Chicago :Promising Advances in Islet Cell Transplants for Diabetics
http://www.sciencedaily.com/releases/2008/06/080609141225.htm
(6) U.S. National Library of Medicine: Diabetes Insipidus
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001415/
Symptoms of Diabetes:
(1) American Diabetes Association: Type 1
http://www.diabetes.org/diabetes-basics/type-1/
(2) American diabetes Association: Type 2
http://www.diabetes.org/diabetes-basics/type-2/
(3) University of Maryland Medical Center: Diabetes
http://www.umm.edu/altmed/articles/diabetes-000049.htm
Causes of Diabetes:
(1) University of Maryland Medical Center: Type 1 Diabetes
http://www.umm.edu/patiented/articles/what_causes_type_1_diabetes_000009_2.htm/
(2) American Diabetes Association: Type 2 Diabetes
http://www.diabetes.org/diabetes-basics/type-2/
(3) PubMed Health: Type 2 Diabetes
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001356/
(4) American Pregnancy Association: Gestational Diabetes
http://www.americanpregnancy.org/pregnancycomplications/gestationaldiabetes.html
Tests for Diabetes:
(1) National Diabetes Information Clearinghouse:
Diagnosis of diabetes
http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/
(2) MayoClinic.com: Diabetes
http://www.mayoclinic.com/health/diabetes/ds01121/dsection=tests-and-diagnosis
(3) MedlinePlus: Glucose Tolerance Test
http://www.nlm.nih.gov/medlineplus/ency/article/003466.htm
(4) American Diabetes Association: Living with Diabetes
http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/
Pre-Diabetes:
(1) Diabetes UK: What is Diabetes?
http://www.diabetes.org.uk/Guide-to-diabetes/Introduction-to-diabetes/What_is_diabetes/
(2) American Diabetes Association: Diabetes Statistics
http://www.diabetes.org/diabetes-basics/diabetes-statistics/
(3) Kids Health: Long-Term Complications of Diabetes
http://kidshealth.org/teen/diabetes_center/basics/complications.html
(4) The New England Journal of Medicine: Normal Fasting Plasma Glucose Levels and Type 2 Diabetes in Young Men
http://www.nejm.org/doi/full/10.1056/NEJMoa050080
(5) MedlinePlus: Glucose Tolerance Test
http://www.nlm.nih.gov/medlineplus/ency/article/003466.htm
(6) American Diabetes Association: Prediabetes FAQ
http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/pre-diabetes-faqs.html
(7) Charles Drew University of Medicine and Science: Why Smoking Increased the Risk of Heart Disease and Stroke
http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/pre-diabetes-faqs.html
Diabetes and Hypertension:
(1) American Diabetes Association: Diabetes Basics
http://www.diabetes.org/diabetes-basics/diabetes-statistics/
(2) American Family Physician: Controlling Hypertension in Patients with Diabetes
http://www.aafp.org/afp/2002/1001/p1209.html
(3) Medline Plus: Glucose Test- Blood
http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm
(4) MayoClinic.com: Glucose Tolerance Test
http://www.mayoclinic.com/health/glucose-tolerance-test/MY00145
(5) American Diabetes Association: Living with Diabetes: A1C
http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/
Effect of Low Blood Sugar:
(1) National Diabetes Information Clearinghouse: Hypoglycemia
http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/#treatment
(2) Mayoclinic.com: Hypoglycemia
http://www.mayoclinic.com/health/hypoglycemia/DS00198/DSECTION=treatments-and-drugs
(3) Medscape General Medicine: Nocturnal Hypoglycemia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994862/
(4) Prehospital Emergency Care: Prehospital Hypoglycemia
http://www.ncbi.nlm.nih.gov/pubmed/14582099
Effects of Diabetes:
(1) PennState Hershey Milton S. Hershey Medical Center: Diabetes Type-1
http://pennstatehershey.adam.com/content.aspx?productId=10&pid=10&gid=000009
(2) American Diabetes Association: Tight Diabetes Control
http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/tight-diabetes-control.html
(3) Kids Health: Long-Term Complications of Diabetes
http://kidshealth.org/teen/diabetes_center/basics/complications.html
(4) Medline Plus: Long-term Complications of diabetes
http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000327.htm
Monitoring Diabetes:
(1) The Health Fitness Project: History of Diabetes
http://www.thehealthfitnessproject.com/special-populations/diabetes/
(2) American Diabetes Association: A1C
http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/
(3) National Diabetes Information Clearinghouse: DCCT and EDIC: The Diabetes Control and Complications Trial and Follow up Study
http://diabetes.niddk.nih.gov/dm/pubs/control/
Gestational Diabetes:
(1) American diabetes Association: Gestational diabetes
http://www.diabetes.org/diabetes-basics/gestational/
(2) Beaumont Health system: Glucose Tolerance Test
http://beaunet.beaumont.edu/portal/pls/portal/lab.lab_pkg.lab_test_info_content?xid=1570
(3) Mayoclinic.com: Gestational Diabetes
http://www.mayoclinic.com/health/gestational-diabetes/ds00316/dsection=symptoms
(4) American Pregnancy Association: Gestational Diabetes
http://www.americanpregnancy.org/pregnancycomplications/gestationaldiabetes.html
Weight Loss and Diabetes:
(1) Journal of Epidemiology and Community Health: Relation of Weight gain and Weigh Loss on Subsequent Diabetes Risk in Overweight Adults
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1731720/
(2) American Diabetes Association: Food and Fitness Weight Loss
http://www.diabetes.org/food-and-fitness/fitness/weight-loss/
(3) American Diabetes Association: Food and Fitness Physical Activity
http://www.diabetes.org/food-and-fitness/fitness/weight-loss/physical-activity/
(4) Drugs.com: Byetta
http://www.drugs.com/byetta.html
Sexual Dysfunction and Diabetes:
(1) National Diabetes Information Clearinghouse: Sexual and Urologic Problems of Diabetes
http://diabetes.niddk.nih.gov/dm/pubs/sup/index.aspx
(2) National Kidney and Urologic Diseases Information Clearinghouse: Erectile Dysfunction
http://kidney.niddk.nih.gov/kudiseases/pubs/ED/index.aspx
(3) National Diabetes Information Clearinghouse: Sexual and Urologic Problems of Diabetes
http://diabetes.niddk.nih.gov/dm/pubs/sup/
Cure for Diabetes:
(1) National Diabetes Information Clearinghouse: Pancreatic Islet Transplantation
http://diabetes.niddk.nih.gov/dm/pubs/pancreaticislet/
(2)University of IL at Chicago: Promising Advances in Islet Cell Transplants for Diabetes
http://www.sciencedaily.com/releases/2008/06/080609141225.htm
