Diabetes is a group of metabolic diseases where a person has high blood sugar, either because the body doesn’t produce enough insulin, or because cells don’t respond to the insulin that is produced.
High blood sugar produces the classic symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).
There are three main types of diabetes:
- Type 1 diabetes: results from the body’s failure to produce insulin, and requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenilediabetes.)
- Type 2 diabetes: results from insulin resistance, a condition where cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.
- Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.
Other forms of diabetes include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.
All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications.
Both type 1 and 2 are chronic conditions that usually cannot be cured.
Pancreas transplants have been tried with limited success in type 1 DM; gastric bypass surgeryhas been successful in many with morbid obesity and type 2 DM. Gestational diabetes usually resolves after delivery. Diabetes without proper treatments can cause many complications.
Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease,chronic renal failure, retinal damage.
Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessation and maintaining a healthy body weight.
As of 2000 at least 171 million people worldwide suffer from diabetes, or 2.8% of the population. Type 2 diabetes is by far the most common, affecting 90 to 95% of the U.S. diabetes population.
Insulin is a hormone. It makes our body’s cells absorb glucose from the blood. The glucose is stored in the liver and muscle as glycogen and stops the body from using fat as a source of energy. When there is very little insulin in the blood, or none at all, glucose is not taken up by most body cells.
When this happens our body uses fat as a source of energy. Insulin is also a control signal to other body systems, such as amino acid uptake by body cells. Insulin is not identical in all animals – their levels of strength vary.
Porcine insulin, insulin from a pig, is the most similar to human insulin. Humans can receive animal insulin. However, genetic engineering has allowed us to synthetically produce ‘human’ insulin.
The pancreas is part of the digestive system. It is located high up in your abdomen and lies across your body where the ribs meet at the bottom. It is shaped like a leaf and is about six inches long. The wide end is called the head while the narrower end is called the tail, the mid-part is called the body.
The pancreas has two principal functions:
- It produces pancreatic digestive juices.
- It produces insulin and other digestive hormones.
The endocrine pancreas is the part of the pancreas that produces insulin and other hormones.
The exocrine pancreas is the part of the pancreas that produces digestive juices. Insulin is produced in the pancreas. When protein is ingested insulin is released.
Insulin is also released when glucose is present in the blood. After eating carbohydrates, blood glucose levels rise.
Insulin makes it possible for glucose to enter our body’s cells – without glucose in our cells they would not be able to function. Without insulin the glucose cannot enter our cells.
Within the pancreas, the Islets of Langerhans contain Beta cells, which synthesize (make) the insulin. Approximately 1 to 3 million Islets of Langerhans make up the endocrine part of the pancreas (mainly the exocrine gland), representing just one fiftieth of the pancreas’ total mass.
Causes of Diabetes
Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.
To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:
- A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
- An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.
People with diabetes have high blood sugar. This is because:
- Their pancreas does not make enough insulin
- Their muscle, fat, and liver cells don’t respond to insulin normally
- Both of the above
Diabetes affects more than 20 million Americans. Over 40 million Americans have pre-diabetes (early type 2 diabetes).
There are many risk factors for type 2 diabetes, including:
- Age over 45 years
- A parent, brother, or sister with diabetes
- Gestational diabetes or delivering a baby weighing more than 9 pounds
- Heart disease
- High blood cholesterol level
- Not getting enough exercise
- Polycystic ovary disease (in women)
- Previous impaired glucose tolerance
- Some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans)
High blood levels of glucose can cause several problems, including:
- Blurry vision
- Excessive thirst
- Frequent urination
- Weight loss
However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.
Symptoms of type 1 diabetes:
- Increased thirst
- Increased urination
- Weight loss in spite of increased appetite
Patients with type 1 diabetes usually develop symptoms over a short period of time. The condition is often diagnosed in an emergency setting.
Symptoms of type 2 diabetes:
- Blurred vision
- Increased appetite
- Increased thirst
- Increased urination
The immediate goals are to treat diabetic ketoacidosis and high blood glucose levels. Because type 1 diabetes can start suddenly and have severe symptoms, people who are newly diagnosed may need to go to the hospital.
The long-term goals of treatment are to:
- Prolong life
- Reduce symptoms
- Prevent diabetes-related complications such as blindness, heart disease, kidney failure, and amputation of limbs
These goals are accomplished through:
- Blood pressure and cholesterol control
- Careful self testing of blood glucose levels
- Foot care
- Meal planning and weight control
- Medication or insulin use
There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms.
Learn These Skills
Basic diabetes management skills will help prevent the need for emergency care. These skills include:
- How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
- What to eat and when
- How to take insulin or oral medication
- How to test and record blood glucose
- How to test urine for ketones (type 1 diabetes only)
- How to adjust insulin or food intake when changing exercise and eating habits
- How to handle sick days
- Where to buy diabetes supplies and how to store them
After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. Review and update your knowledge, because new research and improved ways to treat diabetes are constantly being developed.
If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood.
Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes. It can help your doctor prevent complications.
The American Diabetes Association recommends keeping blood sugar levels in a range based on your age. Discuss these goals with your doctor and diabetes educator.
- 70 – 130 mg/dL for adults
- 100 – 180 mg/dL for children under age 6
- 90 – 180 mg/dL for children 6 – 12 years old
- 90 – 130 mg/dL for children 13 – 19 years old
- Less than 180 mg/dL for adults
- 110 – 200 mg/dL for children under age 6
- 100 – 180 mg/dL for children 6 – 12 years old
- 90 – 150 mg/dL for children 13 – 19 years old
What to Eat
Contrary to what you may have heard, there is no “diabetes diet,” per se — and that’s good news!
The foods recommended for a diabetes diet to control blood glucose (or blood sugar) are good for those with diabetes — and everyone else. This means that you and your family can eat the same healthy foods at mealtime.
However, for people with diabetes, the total amounts of carbohydrates consumed each day must be monitored carefully. Of the different components of nutrition — carbohydrates, fats, and proteins — carbohydrates have the greatest influence on blood sugar levels. Most people with diabetes also have to monitor total fat consumption and protein intake, too.
To keep your blood sugar levels in check, you need to make healthy food choices,exercise regularly, and take the medicines your health care provider prescribes. A dietitian can provide in-depth nutrition education to help you develop a personalized meal plan that fits your lifestyle and activity level, and meets your medical needs.
You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can help you plan your dietary needs.
People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low.
People with type 2 diabetes should follow a well-balanced and low-fat diet.
The goal of nutrition for people with diabetes is to attain the ABCs of diabetes. The A stands for the A1c or hemoglobin A1c test, which measures average blood sugar over the previous three months. B is for blood pressure, and C is for cholesterol. People with diabetes should attain as near as normal blood sugar control (HbA1c), blood pressure, and healthy cholesterol levels.
Alcohol and Diabetes
Use discretion when drinking alcohol if you have diabetes. Alcohol is processed in the body very similarly to the way fat is processed, and alcohol provides almost as many calories as fat. If you choose to drink alcohol, only drink it occasionally and when your blood sugar level is well-controlled. It’s a good idea to check with your doctor to be sure drinking alcohol is acceptable.
Diabetes and Glycemic Index
For years, researchers have tried to determine what causes blood sugar levels after meals to soar too high in those with diabetes. Potential culprits have included sugar, carbohydrates, and starches, among other foods. The glycemic index is a ranking that attempts to measure the influence that each particular food has on blood sugar levels. It takes into account the type of carbohydrates in a meal and its effect on blood sugar.
Foods that are low on the glycemic index appear to have less of an impact on blood sugar levels after meals. People who eat a lot of low glycemic index foods tend to have lower total body fat levels. High glycemic index foods generally make blood sugar levels higher. People who eat a lot of high glycemic index foods often have higher levels of body fat, as measured by the body mass index (BMI).
Talk to your doctor, a registered dietitian, or a diabetes educator and ask if the glycemic index might work to help gain better control of your blood sugar levels.
The glycemic load takes into account the effect of the amount of carbohydrates in a meal. Both the type of carbohydrate and the amount have an effect on blood sugar.
If you have diabetes, it’s important to eat right every day to keep your blood sugar levels even and stay healthy. Here’s some easy tips:
- Be sure to eat a wide variety of foods. Having a colorful plate is the best way to ensure that you are eating plenty of fruits, vegetables, meats, and other forms of protein such as nuts, dairy products, and grains/cereals.
- Eat the right amount of calories to maintain a healthy weight.
- Choose foods high in fiber such as whole grain breads, fruit, and cereal. They contain important vitamins and minerals. You need 25 to 35 grams of fiber per day. Studies suggest that people with type 2 diabetes who eat a high fiber diet can improve their blood sugar and cholesterol levels. Similar results have been suggested in some studies in people with type 1 diabetes.
Serving Sizes and Diabetes
Be sure to eat only the amount of food in your diabetes meal plan. Excess calories result in excess fat and excess weight. In people with type 2 diabetes, excess body fat means less sensitivity to insulin.
Weight loss in overweight and obese people with type 2 diabetes helps improve blood sugars and reduces those risk factors which lead to heart disease. Your dietitian can help you determine the appropriate serving sizes you need, depending on if you need to maintain your weight, gain weight, or lose weight, and if you have high or low blood sugar levels.
- In women with gestational diabetes, it’s important to eat multiple meals and snacks per day as recommended.
- don’t skip meals.
- Eat meals and snacks at regular times every day. If you are taking a diabetes medicine, eat your meals and take your medicine at the same times each day.
You might have heard that, as a person with diabetes, you shouldn’t have any table sugar. While some health care providers continue to promote this, many — realizing that the average person lives in the real world and will probably indulge in a bit of sugar every now and then — have adopted a more forgiving view.
Most experts now say that small amounts of sugar are fine, as long as they are part of an overall healthy meal plan. Table sugars don’t raise your blood sugar any more than similar amounts of calories from starches, which is found in many foods that we consume. It is important to remember that sugar is just one type of carbohydrate.
When eating sugar, keep these tips in mind:
- Read food labels. Learn how to determine how much sugar or carbohydrates are in the foods that you eat.
- Substitute, don’t add. When you eat a sugary food, such as cookies, cakes, or candies, substitute them for another carbohydrate or starch (for example, potatoes) that you would have eaten that day. Make sure that you account for this in your carbohydrate budget for the day. If it is added to your meal for the day, then remember to adjust your insulin dose for the added carbohydrates so you can continue to maintain glucose control as much as possible. In other words, readjust your medications if you do add sugars to you meals.
- Sugary foods can be fattening. Many foods that have a lot of table sugar are very high in calories and fat. If you are watching your weight (and many people with diabetes must), you need to eat these foods in moderation!
- Check your blood sugar after eating sugary foods and talk to your health care provider about how to adjust your insulin if needed when eating sugars.
- Ultimately, the total grams of carbohydrates — rather than what the source of the sugar is — is what needs to be accounted for in the nutritional management of the person with diabetes.
Diabetes Diet Myths
Before you start a diabetes diet, get the facts. So many people believe that having diabetes means you must avoid sugar and carbohydrates at all cost, load up on protein, and prepare “special” diabetic meals apart from the family’s meals.
Wrong! Most individuals with diabetes can continue to enjoy their favorite foods, including desserts, as long as they monitor the calories, carbs, and other key dietary components and keep a regular check on their blood glucose levels.
Get the facts and start enjoying the foods you love on a diabetes diet.
What Is the TLC Diet for Diabetes?
People with diabetes who have abnormal cholesterol levels will likely be placed on a diet known as a “TLC” diet. The TLC diet will help reduce the intake of cholesterol-raising nutrients.
As part of this diet you may be asked to lose weight and increase physical activity levels — all of these are components that will help lower bad LDL cholesterol. Looking at food labels will help you become more knowledgeable about your intake of fats and cholesterol.
Specifically, the TLC diet calls for the following:
- Total fat consumption should be 25%-35% or less of total calories eaten per day.
- Saturated fats should be less than 7% of total calories eaten in a day.
- Polyunsaturated fats (from liquid vegetable oils and margarines low in trans fats) should be up to 10% of the total calories per day consumed.
- Monounsaturated fats (derived from vegetable sources like plant oils and nuts) should be up to 20% of total calories per day eaten.
- Carbohydrates should be 50%-60% of total calories per day eaten
- We should eat 20-30 grams of fiber per day. These can be derived from oats, barley, psyllium, and beans.
- The amounts of protein in the diet should equal about 15%-20% of total calories eaten per day.
- Cholesterol content of the diet should be less than 200 milligrams per day.
How Much Fat Is Acceptable on a Diabetes Diet?
People with diabetes have higher than normal risk for heart disease, stroke, and disease of the small blood vessels in the body. Controlling blood pressure and limiting the amount of fats in the diet will help reduce the risk of these complications.
Limiting the amounts of saturated fats, increasing the amount of regular exercise, and receiving medical treatment can lower bad LDL cholesterol. This has been repeatedly shown in medical studies to help people with diabetes reduce their risk of heart disease and reduce the risk of death if a heart attack does occurs in a diabetic person.
Artificial sweeteners can be added to a variety of foods and beverages without adding more carbohydrates to your diabetes diet. Using non-caloric artificial sweeteners instead of sugar also greatly reduces calories in your favorite foods.
Keep in mind that foods with artificial sweeteners are not necessarily zero carbohydrates foods. Many have carbohydrates; therefore, you must read the food labels to determine the gram amounts per serving that these have in order to take into account the effect that these carbohydrates have on your glycemic control. Foods labeled with artificial sweeteners can affect your blood sugar.
As long as you are aware of the content of carbohydrates you can adjust your meal or medication to maintain blood sugar control. “Sugar free” means no sugar has been added, but you must remember these foods still contain carbohydrates which does affect your blood sugars.
Examples of artificial sweeteners you can use include:
- Other non-nutritive sweeteners
Pregnant or breastfeeding women should avoid saccharine, and people who suffer from phenylketonuria shouldn’t use aspartame. People with phenylketonuria are unable to metabolize phenylalanine, an amino acid that’s a common part of many proteins.
Some artificial sweeteners — such as xylitol, mannitol, and sorbitol — have some calories and do slightly increase blood sugar levels.
The American Diabetes Association cautions that eating too much of any artificial sweetener can cause gas and diarrhea.
How to Take Medication
Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.
People with type 1 diabetes cannot make their own insulin. They need daily insulin injections. Insulin does not come in pill form. Injections are generally needed one to four times per day. Some people use an insulin pump. It is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use inhaled insulin. See also: Type 1 diabetes
Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes.
Medications may be switched to insulin during pregnancy and while breastfeeding.
Gestational diabetes may be treated with exercise and changes in diet.
Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than those who don’t exercise regularly.
Here are some exercise considerations:
- Always check with your doctor before starting a new exercise program.
- Ask your doctor or nurse if you have the right footwear.
- Choose an enjoyable physical activity that is appropriate for your current fitness level.
- Exercise every day, and at the same time of day, if possible.
- Monitor blood glucose levels before and after exercise.
- Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
- Carry a diabetes identification card and a cell phone in case of emergency.
- Drink extra fluids that don’t contain sugar before, during, and after exercise.
You may need to change your diet or medication dose if you change your exercise intensity or duration to keep blood sugar levels from going too high or low.
Physical activity Is crucial for a person with diabetes
- it helps control your blood glucose
- it helps keep your weight down
- it helps keep your blood pressure down
- it helps raise your HDL (High-density lipoprotein), good cholesterol levels
- it helps lower your LDL (Low-density lipoprotein), bad cholesterol levels
These five benefits have a DIRECT bearing on how successfully you manage your diabetes. Exercise also has other general health benefits – you sleep better, your mental state improves, etc.
Most experts say you should do exercise on at least five days of each week. Each session should be of moderate-intensity and shouldn’t last less than thirty minutes. The following activities could be classed as of moderate-intensity:
- fast walking
- cycling 5-9mph (level terrain, perhaps some slight hills)
- mowing the lawn
What is moderate-intensity physical activity?
- You should experience some increase in your breathing rate
- There should be an increase in your heart rate
- A Borg Scale perceived exertion of 11 to 14
- You should burn 3.5 to 7 calories per minute
- You should reach a METs of 3 to 6
What is MET?
MET stands for Metabolic Equivalent. An MET of 1 is when you are sitting down doing nothing. If you walk slowly your MET may rise to 2 or 2.5. If you walk normally it will go up to 3, while a brisk walk may bring it to 5. If a wild gorilla suddenly appeared in the street and started chasing you your desperate sprint would shoot your MET right up to about 8 or even perhaps 9.
Beginners be careful!
If you have not done exercise for a long time you will need to start with a little light exercise and build up slowly over time. Each week add a little more time to each session and/or increase the intensity.
Remember regular exercise is what matters. 5 days of 30 minutes each is great. One day per week at 150 minutes is not.
You must talk to your health care provider about an exercise plan. He/she may want to check you over before you start. Certain exercises are not ideal for patients who suffer from high blood pressure, eye and/or foot problems.
Strength training is also good
The Centers for Disease Control and Prevention (CDC) says that strength training exercises are good because they help you build muscle. Strength training usually involves using weights.
Join a gym
There are many gyms today whose staff are experienced and qualified to receive and train people for various illnesses and conditions. In North America, Western Europe, Japan and Australasia gyms receive doctors’ referrals – doctors send them to specific gyms as part of their therapy.
Having somebody there to help you along, occasionally to push you along, can be a great motivator – especially for beginners who may view the whole experience with apprehension. Gyms are all-weather and have equipment that provides immediate feedback on how well you are doing – your speed, heart rate, calories burnt per minute/hour, your progress, etc.
Many people prefer gyms because it gives them a feeling of doing something with others. Don’t be afraid of joining one. They are generally welcoming and members won’t be concerned about what you look like or how unfit you may be – they are there for their health, just like you.
People with diabetes are more likely to have foot problems. Diabetes can damage blood vessels and nerves and decrease the body’s ability to fight infection. You may not notice a foot injury until an infection develops. Death of skin and other tissue can occur.
If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.
To prevent injury to the feet, check and care for your feet every day.
For more information, see:
- Diabetes foot care
- Type 1 diabetes
- Type 2 diabetes
Diabetes Links and Resources
American Diabetes Association
Detailed site with information about prevention and managing the different types of Diabetes
Changing Life With Diabetes
A site operated by Novo Nordisk, containing detailed information on Diabetes. (You are asked to sign in to access some of the tools on the site and by giving your information you may be sent special offers from Novo Nordisk and their business partners.)
An informative site for people who want to know more about controlling and managing diabetes.