Whether or not you have diabetes, you have probably heard of it since it now affects more than 25.8 million Americans, or 8.3% of our population. Diabetes, called “high sugar” by some and “diabetes mellitus” by doctors, occurs when there is too much sugar, or glucose, in a person’s blood. There are two major types of this disease: type 1 and type 2 diabetes mellitus. Type 1 diabetes usually occurs only in the young (children, teenagers) while type 2 can occur at any age, but is most often diagnosed after a person turns 40 years old. One of the key body chemicals involved in diabetes, besides glucose, is insulin. Your pancreas (which sits right behind your stomach) makes insulin. This insulin then travels through the blood stream and helps glucose enter cells to be used as fuel. Diabetes occurs when either the insulin is not produced, there is not enough insulin made, the cells stop responding to insulin, or a combination of the three.
Diabetes has been present in people as long as diseases have been recorded; however, before Europe and America began to cultivate cane sugar, type 2 diabetes was only seen in the very rich. The rich in Eastern kingdoms ate only sweet, fattening food, while the rich in England and the Americas got their sugar from whole grains, fruits, and vegetables. Once cane sugar became popular and readily available to everyone, diabetes became much more common. This shows the strong link between diet and diabetes, but more recent research has shown that there is far more to the story.
High blood sugar can cause several symptoms, including the following:
Although most of these symptoms may apply to either Type 1 or Type 2 diabetes, there are some clear differences between the two.
Type 1 diabetes typically develops quickly, which means a person may be quite ill at the time of diagnosis. The symptoms above will be quite severe, especially weight loss despite eating more than usual, markedly increased urination (including nighttime urination), and extreme thirst. In fact, the disease got its name from some of these symptoms; in Greek, diabetes means “siphon” and mellitus means “sweet.” It refers to the excess urination found in diabetics and the fact that glucose, instead of being used as fuel, is lost in the urine, leading to sugary, “sweet” urine.
Type 2 diabetics, on the other hand, most often develop the condition slowly, with a gradual onset of more subtle symptoms. Type 2 diabetics almost never lose weight without trying and some will even gain weight. Since they can still use some insulin, their body still has fuel and therefore, they usually will not suffer from being hungry all the time like type 1 diabetics. If left untreated, though, the symptoms of type 2 diabetes will get more and more severe.
Both types of diabetes are what medical professionals call “multifactorial.” This means that they are caused by many factors interacting with each other. An example of a non-multifactorial condition is colorblindness. If one identical twin is colorblind, the other twin will be too, since one genetic defect causes this disorder. Diabetes is different. It is possible that one identical twin may have diabetes and the other may not, since more things than genetics cause diabetes.
Risk Factors for Type 1 Diabetes Mellitus
Doctors and scientists have not yet found the exact cause of type 1 diabetes, but they know that the following can be contributors to the cause of the condition:
The bottom line is that in type 1 diabetes, the body cannot produce insulin, which means the sugar in the bloodstream can’t enter the cells, which leads to very high concentrations of sugar in the blood and very low fuel for the body.
Risk Factors for Type 2 Diabetes
So far, scientists have found many conditions that put you at risk of developing type 2 diabetes (risk factors), but they know that there are still more to be discovered. Since type 2 diabetes is a multifactorial disease, a person must have more than just one of the “causes” below to develop diabetes.
Prevention of type 2 diabetes relies on knowing the risk factors for actually developing the condition. By focusing on areas within these risk factors that you know could use improvement will decrease your chance of getting diabetes. For example, two of the most important risk factors are diet and exercise. If you decrease the calories you eat and also increase your activity level, you will significantly lower your chances of developing type 2 diabetes.
African Americans, Hispanic and Latino Americans, Native Americans and Alaska Natives, Asian Americans and Pacific Islanders, women with a history of gestational diabetes and older adults.
The major risk factors for developing diabetes (from here on, we will only discuss type 2 diabetes) are
The extremely high prevalence of type 2 diabetes (from now on, “diabetes”) may lead you to think that there is nothing you can do to prevent getting it, or to reverse the process once you begin to show signs of the disease. Fortunately, there is a very effective strategy for preventing this condition. In general, what you want to do is look at the risk factors of diabetes and reverse them. Let’s take a look at those risk factors again:
Now, there are several risk factors that you can’t do anything about, such as age, family history, ethnicity, and of course, any part of your personal medical history. Things you can change, though, can make up for the unchangeable. Lowering your blood pressure and cholesterol can decrease your chance of being diagnosed as diabetic; what is even more amazing is that controlling these things can even improve your sugar readings if you are already a diabetic! Believe it or not, there’s more: changing your diet and increasing your activity level make an even bigger difference than lowering cholesterol and blood pressure.
A group funded by the National Institutes for Health (NIH) carried out a large study beginning in 2002 called the Diabetes Prevention Program, or DPP. The DPP looked at over 3,000 patients in 27 different clinics who were considered “high risk” for developing diabetes. They then split this group into a group that received support for an “intensive” diet and exercise program, but with no diabetes medication; a group that received metformin and only standard diet and exercise training; and, finally, a group that received a placebo along with only standard diet and exercise training. (A placebo is a “fake” medication: it looks like a certain medicine, but all it contains is a small amount of sugar or starch.) The results were very surprising.
In the group that changed their diet and exercise patterns to low fat, low calorie diet plus 30 minutes per day of exercise, the study detected a 58% reduction in development of diabetes! These people only lost approximately 5-7% of their original weight (if they started at 200 pounds, they lost from 10 – 14 pounds), but the effect was enormous. Over half of these people who were already well on their way to developing diabetes at the start of the study never developed it, compared to the rest who did. The study lasted five years, so this was considered a lasting effect, as long as the diet and exercise were continued as well.
The bottom line is that the best way to prevent developing diabetes is to start (or continue) a low fat, low calorie diet and work up to exercising 30 minutes per day, 6 to 7 days per week. Try to lose at least 5% of your body weight. The NIH has shown that the people that are most successful at losing weight have several things in common. They know their own risk of developing diabetes. They include their friends and family in their lifestyle changes as well as keeping their medical team in the loop. They set a weight loss goal at the start of making these changes and they then keep track of their weight by writing it down at least weekly. Lastly, these people keep a daily record of their food intake and physical activity. By training yourself to follow these standards, you to can reduce your risk for diabetes, even if your doctor has told you that you are already “pre-diabetic.” Even you who already have diabetes can control your condition much more easily by following the above plan; you may even be able to take less medication.
There is no single cure for diabetes, but there is treatment to decrease the health risks of having this condition. Type 1 diabetics will always need insulin.
Type 2 diabetics, on the other hand, rarely begin insulin at the time of diagnosis. In fact, if type 2 diabetics follow their doctor’s medication and diet plan, as well as make some important lifestyle changes, they may never have to take insulin. Appropriate treatment specifically for type 2 diabetics includes the following:
For type 1 diabetics, treatment is more straightforward. Type 1 diabetics are not able to produce any insulin, so they must take insulin from the beginning of their disease and onward to take the place of natural insulin. Type 1 diabetics must also keep a strictly modified diet so that they not only keep their blood sugar from being too high (too little insulin, too much food), but also so they don’t drop their blood sugar too low (too much insulin, too little food).
Exercise is one of the best things you can do for your diabetes. Studies show that you can lower your hemoglobin A1C levels by doing exercise. You should know that more intense exercise has a greater effect on your glucose levels and A1C, even if you do much less of it than you might do at a low or moderate intensity. It is important to exercise, but you should talk to your doctor before beginning a program.
This doesn’t mean working out in the gym or running a marathon. It can be things you enjoy, from gardening to playing tennis to walking with friends. Exercising for ten minutes after each meal will add up to thirty minutes of exercise each day.
This type of exercise will increase your heart rate and your breathing. Cardiovascular exercise also helps treat diabetes. It will lower your A1C and make your own insulin as well as your medications work much better.
It is important you consult your doctor before beginning a new exercise plan. He/She will check your heart and lungs to make sure they are healthy enough for exercise. Your feet will also be checked for nerve damage. If you have numbness in your feet from diabetes, you will need to be very careful while exercising.
If your doctor gives you permission to exercise, you will have to choose between vigorous exercise and lighter exercise. If you do vigorous (60 – 80% of your maximum heart rate) exercise, try to do this at least 90 minutes per week. If you prefer lighter (40 – 60% of your maximum heart rate) exercise, such as walking or gardening, do this at least 150 minutes per week. Maximum heart rate is, roughly, 220 – your age in years
Resistance, or strength, training makes most people think of lifting heavy weights. This can be what you do, but you can also lift lighter weights more times or do several other types of activities. Yoga improves flexibility, but it also increases muscle strength. You can also do push-ups, sit-ups or use resistance bands. Strength training is important for everyone in order to stay healthy and injury-free. It also has positive effects on your diabetes.
Recent studies have shown that exercise that involves only stretching does not help control diabetes. It also was shown not to help in injury prevention either. If stretching helps you feel better, continue doing so, but know that you should also include another type of exercise in your life as well.
Getting regular restful sleep is important to being healthy for everyone, not simply for diabetics. It is more important to you, though, because being rested will help your diabetes. Some studies suggest that most people require approximately eight hours of sleep nightly; however, the number of hours varies from person to person. Since the quality of sleep is much more important, a person may feel fresh after only six hours of sleep. It is also possible for an individual to sleep eight or more hours and still feel tired. A person who is not sleeping enough will have higher levels of a “stress chemical” in the body called cortisol. This chemical can make your blood sugar higher and harder to manage. See the following list for helpful tips to improve your sleep.
Only after you have tried the sleep hygiene habits above should you consider taking medication to help you sleep. Many of the sleeping medications are addictive and all of them have side effects. If you have tried sleep hygiene techniques and still are having trouble sleeping, it may be beneficial to your health to take a sleeping pill for a short time. Ask your primary doctor about which medicine is right for you.
Everybody has some stress in their lives, but what you may not know is that too much psychological stress can actually make your diabetes worse. In non-diabetic person, stress can be a good thing in the short term. Stress helps you get through certain high-pressure things, like giving a presentation, running a marathon or taking a test. When stress becomes chronic, though, your body overproduces certain chemicals that cause damage to your body. If you are diabetic, stress will make your blood sugar go up and make your insulin less effective. In a person who has “pre-diabetes” (someone with borderline high blood sugar), high stress might push them into full diabetes. Thankfully, there are steps you can take to minimize your stress.
Evaluate your job as a source of stress
If you have a high-stress job, consider ways to make it less stressful, such as taking a short break in the morning and afternoon to do something restful, like stretching or meditation or even just to take a few sips of water.
This applies to many parts of your life, but has a big impact on appointments, shopping, and cooking. If your mornings are rushed and stressful, consider laying out your clothes and packing your bag the night before. If being with family is stressful, take some time each week to do something alone or with friends that you enjoy. Each Sunday, make a rough plan of what you will eat and what you need from the store for the following week. Not only will this lower your stress, it will help your budget as well!
You may hear this word meditate and think, “That’s not for me,” but recent medical studies have shown that even brief, daily meditation has a large influence on reducing stress levels. Try setting aside five minutes in the morning and before bed to just sit comfortably and try to clear your mind completely. This takes practice, but it will pay off. There are also many apps out there that can help guide meditation and add deep-breathing techniques as well.
Avoid Excess Caffeine and Alcohol
If you suffer from high stress, try avoiding or simply reducing your caffeine and alcohol intake. Caffeine helps with sleepiness and fatigue, but it can also disturb your sleep and cause anxiety. This can make your diabetes worse. Alcohol in moderation (one glass/day for women, two/day for men) is not unhealthy, but for you, it can actually increase stress in the long run and will also decrease the quality of your sleep.
Everyone knows that a bad night of sleep can lead to a hard and stressful day. See the sleep section for tips on lowering your stress by improving your sleep.
Many stressed people add to their stress by putting off important tasks, like work projects or paying the bills. Even though this means you do not deal with the problem at that moment, you will experience increased stress right away that will last until you take care of the problem. Fixing chronic procrastination is difficult, but by making small changes at a time, you can lower your stress in a major way.
Cardiovascular exercise (“cardio”) has shown a huge effect in lowering stress. It can also help your diabetes in multiple other ways too. . Another exercise that helps decrease stress in many people is yoga. If you feel intimidated by this activity, know that there are many levels of classes. You will be able to find a class that lets you practice yoga at your own level and speed. There are some risks that you have because of your diabetes, though, so see the section exercise for more detailed information.
There are two main types of diabetes medications: oral medications and insulin, which is injected.
These medications work in several different ways, including improving the effectiveness of the body’s natural insulin, reducing glucose production, increasing insulin production and inhibiting sugar absorption.
For a specific description of each medication, click on one of the categories below.
Insulin is an injectable medication that acts as a supplement or a replacement for the body’s own insulin. Insulin is the first-line treatment for type 1 diabetics since they lack the ability to make their own. Type 2 diabetics usually begin treatment with oral medications and lifestyle modifications, but if a person presents to the doctor with extremely out of control type 2 diabetes, insulin may be given as a first medicine. Also many type 2 diabetics will go on to require insulin at some point in their lives. It is a fact of diabetes that the pancreas will eventually lose more and more ability to make its own insulin. There are four types of exogenous (not from the body) insulin. They are classified based on how fast they work and how long their effects last.
Medications that improve the use of the body’s own insulin
Metformin (Glucophage) is usually the first choice for oral treatment of type 2 diabetes. It acts by increasing the sensitivity of liver, muscle, fat, and other tissues to the uptake and effects of insulin. These actions lower the level of sugar in the blood. The side effects of metformin include gastrointestinal distress and lactic acidosis (too much acid in the body). Metformin should not be administered in patients with impaired renal function, concurrent liver disease or alcohol abuse and heart failure. Patients who are about to undergo a surgical procedure and/or CT scan with contrast material should not take their metformin
Thiazolidinediones (rosiglitazone and pioglitazone) lower blood glucose by increasing insulin sensitivity. These drugs may take a few weeks before they have an effect on blood sugar. Drugs in this class are not recommended for patients with symptomatic heart failure. These drugs are not chosen for initial therapy and are reserved for second-line treatment in combination with other diabetes medications.
Medications that reduce glucose production
DPP-IV inhibitors (sitaglipin and saxaglitptin) act by increasing insulin secretion from pancreas and reducing sugar production from the liver. They are commonly used as a second agent in those who do not respond to a single agent; they are often used in combination with metformin or sulfonylureas.
Medications that increase the body’s production of insulin
Sulfonylureas (first generation: diabinese, orinase, second generation: glipizide, gliclazide, glyburide, glimepiride) are the oldest class of oral hypoglycemic drugs. They act by stimulating the pancreas to release more insulin. The major adverse effect of sulfonylureas is hypoglycemia. Before beginning a sulfonylurea, the patient should be instructed about the symptoms of hypoglycemia. Risk factors for hypoglycemia include increasing age, alcohol abuse, poor nutrition, and kidney problems. Some patients may experience weight gain with sulfonylureas.
Meglitinides (repaglinide and nateglinide) are short-acting glucose-lowering drugs that act similarly to the sulfonylureas (they stimulate the pancreas to release more insulin). Meglitinides may be used in patients who have allergy to sulfonylurea medications. They have a similar risk for weight gain as sulfonylureas, but less risk of hypoglycemia.
Medications that inhibit sugar absorption from food
Alpha-glucosidase inhibitors (acarbose and miglitol) act by blocking enzymes that help digest starches to slow the rise in blood glucose from the stomach and intestines. The main side effects are flatulence (gas) and diarrhea. These drugs are not recommended for initial therapy.
Managing your other medical conditions
Many diabetics also have other conditions as well. The most common of these are high blood pressure and high cholesterol. These conditions increase your risk of heart attack, kidney failure, and stroke. The reason for this is that they damage the inside of your arteries, which can lead to blockage of the very small blood vessels in your heart, kidneys, and brain. When this blockage happens, it cuts off blood flow (and thus, oxygen flow) to that area, which will cause that part to die. In the heart, this is called a heart attack, whereas in the brain, it is called a stroke. High blood pressure and high cholesterol can damage your blood vessels on their own, but together they cause even more damage.
High blood pressure, or hypertension, affects 10 – 15% of Caucasian adults and up to 30% of black adults in the U.S. High blood pressure is named so because it refers to a consistently elevated pressure of the blood on the inner walls of the arteries. High blood pressure is dangerous because it damages the inner walls of an artery; the body responds to this damage the same way as it fixes a cut: it clots. These clots can dislodge and float in the blood until that blood vessel narrows and the clot gets stuck – just like a clog in your pipes. The area of your body past that clot will lose blood and oxygen supply and can even die. If this happens in the heart, it is a heart attack. In the brain, it is a stroke. Diabetics especially should have their blood pressure taken at every doctor’s visit. See the following table for which numbers you should aim for.
Blood Pressure Values and Hypertension Diagnosis
Top number (systolic) in mm Hg
Bottom number (diastolic) in mm Hg
Normal blood pressure
Stage 1 hypertension
160 or more
100 or more
Stage 2 hypertension
Goal for diabetic patients
Having high cholesterol puts you at higher risk for heart attack and stroke. As a diabetic, there’s an even higher risk, so you should get your cholesterol checked regularly and treat it if your doctor says you should. Even though most people only refer to cholesterol as “too high,” there are actually many different types of cholesterol. The two that most people focus on are called high density lipoprotein (HDL – “good cholesterol”) and low density lipoprotein (LDL – “bad cholesterol”). When people get their cholesterol checked, they also will get checked for a triglyceride level. These are small fatty molecules that float around in your blood along with cholesterol. You want your LDL to be as low as possible. HDL acts as a small vacuum cleaner in your blood, cleaning up dangerous fat molecules. A very high HDL can even counteract the bad effects of a mildly high LDL. The best way to increase HDL is by exercising regularly.
Below 200 mg/dL
240mg/dL and above
Below 70 mg/dL
Best for people with diabetes and high risk for heart disease
Below 100 mg/dL
Best for people at rish for heart disease
190 mg/dL and above
Below 40 mg/dL (men)
Below 50 mg/dL (women)
190 mg/dL and above
Below 150 mg/dL
500 mg/dL and above
If you are overweight, try to reduce your weight through diet and exercise. Focus on making gradual lifestyle changes that result in lifelong maintenance of a healthy weight.
Many people who have Type II diabetes struggle with achieving a healthy weight. Your diabetes is very closely affected by your weight. If you lose weight, you may be able to reduce the number of medications you take and improve high cholesterol and high blood pressure as well. This means that losing weight will greatly decrease your risk for heart disease and stroke. Set small, achievable goals. Not everyone will do well with the same recommendations, so look around and ask friends and coworkers what they do to lose weight.
One tricky thing you should know about your diabetes risk and your weight is that it not only matters how much you weigh, but what shape you are. Doctors have designated two types of obesity: apple-shaped and pear-shaped, apple-shaped people (people who carry their weight around their middle, not their hips or legs) are at much greater risk of developing diabetes, as well as other diseases, like heart disease and stroke. Doctors have discovered that the fat surrounding a person’s internal organs (liver, pancreas, bladder, etc) is different than fat found right under the skin. Internal fat produces harmful chemicals that will greatly increase your risk of disease. This is why it is important not to have a large waistline, even if you are not actually overweight or obese. The best way to make sure fat deposits in the right place and doesn’t surround your organs is to do intense exercise.
Pear-shaped people (people who carry their weight around their hips, butt and thighs) are at a greater risk of developing osteoporosis, varicose veins and cellulite. The best exercise for Pear-shaped people is resistance exercise.
The American Diabetes Association and the American Dietetic Association have developed specific dietary guidelines for people with diabetes. By eating well-balanced meals in the correct amounts, you can learn to thrive despite your diabetes. These guidelines recommend lowering carbohydrate consumption and including more fruits and vegetables in the diet. Balancing your carbohydrates with fiber, protein, and unsaturated fat will help keep your blood sugar, weight and other health conditions under control.
Diet is the most important behavioral aspect of diabetes treatment. Dietary compliance is a major factor in achieving optimal blood glucose control in both type 1 and type 2 diabetes. Meal content, portion size and timing of meals are particularly important for diabetics who are taking diabetes medication. The four components in food that affect your blood sugar level are:
Diabetic Nerve Damage
Diabetes can cause many serious problems in the feet. The small nerves and blood vessels in the feet become damaged from high blood sugar levels. Careful and regular attention to the feet should be a daily part of every diabetic’s life. There are several levels of care that you should be aware of: routine home foot care, including proper footwear, regular visits with your primary doctor, visits to the podiatrist, and how to know what is a footcare emergency.
Home Foot Care
It is very important to wash and dry your feet every day. Use mild soap and lukewarm water to avoid irritation or burns that you may not feel. After washing, pat your feet dry – it is important that they are completely dry, even between the toes. Next apply lotion to feet, but do not put any between the toes to avoid increasing your risk of a fungal infection. Make sure that you look at your feet every day, morning and night. Use a hand mirror in order to see the whole foot. Due to poor circulation, every cut, corn, or callus is a potential problem. Never try to fix these problems at home. A professional should always be the one who removes corns and calluses and treats other problems, such as ingrown toenails. If you are ever unsure of whether a foot problem requires medical care, call your primary doctor for an appointment.
One of the most important steps a diabetic can take to protect their legs from surgery or amputation is to wear proper footwear, all of the time. You should never go barefoot, even at home. Some specialty shoe stores sell shoes made for diabetics. The best thing to do is to consult a podiatrist (foot doctor) about what shoes and socks to wear and the possibility of having special inserts made for your shoes. If you do not see a podiatrist right away, make sure your shoes fit well, with no areas that rub or cause blisters. Also, make sure your socks are made out cotton or wool and that they don’t have any bands or seams that may cause sore spots.
Regular Doctor’s Appointments, Including the Podiatrist
Because you have diabetes, you will be seeing the doctor more often now. You should plan on visiting your primary doctor at least every three months. You will have your hemoglobin A1C tested, blood pressure and weight measured, and you will have a foot check. This foot check can detect new areas of numbness or weakness, which you can then take care of at home so that you do not develop any complications such as infections, ulcers, or amputation. You should also have a comprehensive foot check every year, usually at the podiatrist’s office. There they will determine if any prescription socks, inserts, or shoes are necessary for you.
While most foot problems in diabetics can be treated by a primary care physician, there are some things to look out for that signal a more serious condition, for which you should seek immediate care, either in an urgent care facility or an emergency room. These things include the following:
Additional Diabetes Care
Routine Eye Examination
As a diabetic, you are at increased risk for visual loss from both correctable vision changes and from retinopathy (eye disease caused by diabetes). You should begin having screening exams soon after the time of your diagnosis with diabetes. This exam will include a dilation of your eyes (the doctor will use drops to dilate your pupils, allowing them to see the retina). If there are no abnormalities of the retina, dilation may only need to be done every 2-3 years, but you should still go to the eye doctor once a year to have regular screenings done.
Other Screening for Diabetics
There are other screening tests that you should have because you have diabetes. It is very important to ask your doctor about a urine test for protein. Albumin is a small protein that circulates in your blood. Normally, your kidneys will filter this protein back into the blood and none will make it to the urine. With damage, the kidney is not working as well and some albumin leaks out into the urine. Your doctor should check your urine for this protein as well as for blood and glucose at every visit. It is important to catch minor kidney damage early to prevent kidney failure.