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Defining Diabetes
What is Diabetes?
Diabetes is a lifelong disease that is a problem with the way the body uses
food. Most of the food people eat is broken down into glucose. Glucose is the name
for sugar in the blood. Glucose (sugar) is the main source of fuel for the body. After
eating, glucose (sugar) passes into the bloodstream, where cells use it for growth
and energy. Insulin must be present for the body to use glucose (sugar).
What is insulin?
Insulin is a hormone produced by the pancreas, a large gland behind the
stomach. When people eat, the pancreas makes just enough insulin to move glucose
from the blood into the cells. In people with diabetes, the pancreas makes too little
or no insulin, or the cells do not respond to the insulin that the pancreas makes.
Glucose builds up in the blood, overflows into the urine, and passes out of the body
in the urine. The cells of the body can’t get the glucose from the blood. The body
loses its main source of fuel even though the blood contains large amounts of
glucose.
Types of Diabetes:
I. Type I Diabetes
What is type I diabetes?
Type I diabetes (also called Juvenile Diabetes) is a condition where the
pancreas does not secrete insulin, the hormone needed to carry sugar from our
bloodstream into our cells. This results in increased levels of sugar in our
bloodstream.
Why do people get type I Diabetes?
Type I diabetes may occur because of heredity and also environmental
factors such as exposure to certain viruses. The reason type I diabetics cannot
produce and secrete insulin is because the cells in the pancreas that produce insulin
(called beta cells) become damaged. The body actually attacks its own beta cells,
causing them to stop working. Conditions where the body attacks itself, like type I
diabetes, are called autoimmune conditions. Type I diabetes is an autoimmune
condition, and we cannot control whether we get type I diabetes through diet or
exercise.
How common is type I diabetes and who gets it?
Far less common than type II diabetes, type I diabetes occurs in about 15 out
of 100,000 people every year. It most often occurs in children between the ages of
eight and twelve, and is more common in Caucasians.
How is type I diabetes treated?
The only treatment for type I diabetes is insulin. Insulin is an injection that
directly gives the body the ability to carry blood sugar into the cells. While some
medications for diabetes help pre existing insulin work more efficiently, type I
diabetics cannot use these types of medications because they have no insulin to
begin with.
II. Type II Diabetes
What is type II diabetes?
Type II diabetes is a disease which the pancreas is unable to effectively create
insulin. With an excessive lack of insulin, your body becomes unable to put sugar from
your blood into the rest of your body. When the sugar can’t get out of your blood, it
builds up to dangerous levels. Once this happens your pancreas will get overworked and
eventually stop making insulin. This is what makes type 2 diabetes occur.
Why do people get type II diabetes?
The body's tissues have lost the ability to respond to insulin, making it more
difficult for your body to get sugar from the blood to make energy. This is called
insulin resistance. Inevitably, your pancreas makes less and less insulin to help
move sugar out of your blood. Blood sugar levels may rise gradually over years.
This results in type II diabetes if not treated.
What is the treatment for type II diabetes?
The treatment for type II diabetes is going to depend on two things:
1. How severe your diabetes is at the time of diagnosis?
2. How much effort are you willing to put into changing your life
style?
The answers to the preceding questions will direct you treatment to one of the
following forms.
1. Begin exercising more/differently. In the early onset of type II
diabetes, this lifestyle change and commitment can be a very
effective treatment alone.
2. In other cases of type II diabetes, you may be asked to take a pill
once or twice a day to effectively treat your diabetes. This pill will
be taken in combination with changes in your lifestyle.
3. Another very effective treatment is the use of insulin. As stated
previously, insulin production is decreased significantly with type
II diabetes. Insulin is used to treat by injecting small amounts of it
into your body. This is achieved by creating a very specific
regimen with your healthcare provider. This regimen will be
based on how much more insulin you require as a diabetic. This
treatment is also done in conjunction with lifestyle modification.
These three forms of treatment are used alone at times or in conjunction depending
on the patients needs.
Will my children get type II diabetes?
There is an increased risk of developing type II diabetes for people that have
a first degree relative with type II diabetes. This does not mean that your children
will definitely develop type II diabetes, but it is good reason to include your children
in your new healthier lifestyle to help decrease the probability of having diabetes
when they are older.
III. Pre-Diabetes
What makes me be a borderline diabetic?
If your blood sugar is consistently higher than normal, but not high enough to
be diagnosed with diabetes
Why does it matter, it isn’t diabetes?
By the time the diagnosis of diabetes is made, several body systems have
already been damaged, especially the heart and circulatory system. Also if we can
catch people at the pre-diabetic stage, we can delay or stop the progression to full
blown Diabetes, through lifestyle changes.
Experts say that having pre-diabetes makes you 5-15 times more likely to
develop type II diabetes than people with normal sugar levels.
Monday 8 am – 11 am
Tuesday 8 am – 4:30 pm
Wednesday 8 am – 4:30 pm
Thursday 8 am – 4:30 pm
Friday 8 am – 4:30 pm
What family doctors and clinics are close by where I can be treated for medical
problems and diabetes?
Please call each clinic to find out more about fees, hours, appointments. Most provide care for
uninsured, underinsured, and insured.
Cascade Clinic
590 Cascade Ave. S.W.
Atlanta, GA 30310
404-752-1400
Located just south of I-20 from City of Refuge.
Call for payment information and hours. See broad range of patients from uninsured
to insured to Medicare/Medicaid.
Gateway 24/7 Homeless Services Center
275 Pryor St.
Atlanta, GA 30318
404-880-3559
Located close to the Capital.
Provides general medical care for uninsured.
The Good Samaritan Health Center
239 Ivan Allen Jr. Blvd. NW
Atlanta, GA 30313
404-523-6571
Provide general medical care for uninsured. Payment is sliding scale. Location close
to City of Refuge.
West Lake Clinic
319 W. Lake Ave. N.W.
Atlanta, GA 30318
404-752-1400
Located close to corner of W. Lake Ave and Simpson Rd, very close to City of Refuge.
Provide general medical care.
Where else can I look for help with diabetes?
The above clinics may be able to help assist in getting necessary medications. Visit:
http://www.needymeds.org/index.shtml to learn more about ways to get medications
for less money. This website is a non-profit organization assisting uninsured or
underinsured patients.
Resources:
1.
CDC Website:
a. http://www.cdc.gov/diabetes/faq/basics.htm#4
3.
CDC Wonder Website
a. http://wonder.cdc.gov/wonder/sci_data/misc/type_txt/diab.asp
Henry J. Kaiser Family Foundation Website
a. http://www.statehealthfacts.kff.org/profileind.jsp?sub=22&rgn=12&cat=
2.
4.
National Medical Association Diabetes Website
a. http://www.nmadiabetesnet.org/index.php/aboutdiabetes/about_diabetes
5.
6.
Epocrates
10.
11.
12.
13.
14.
http://www.cdc.gov/diabetes/faq/basics.htm#2
http://www.cdc.gov/diabetes/faq/prediabetes.htm
http://www.mayoclinic.com/health/prediabetes/DS00624
http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/
http://www.mayoclinic.com/health/type-1-diabetes/DS00329
http://www.needymeds.org/index.shtml
7. http://www.gradyhealthsystem.org/Specialties/specialties_diabetes.asp
8. www.choa.org
9. http://www.piedmont.org/oth/Page.asp?PageID=OTH000158
15. Ref: National Diabetes Information Clearinghouse. A Service of National Institute of
Diabetes and Digestive and Kidney Diseases. National Institutes of Health.
Available at: http://diabetes.niddk.nih.gov/dm/pubs/overview/#what.
What test will the doctor do to determine whether or not you have prediabetes?
FGP
OGTT
Source: http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/
Fasting Plasma Glucose (FPG) is a test that measures the amount of sugar in
your blood while you are fasting. The other is a Oral Glucose Tolerance Test (OGTT),
normally if you eat sugar your body starts to break it down, if you break it down
slower than normal, you then have impaired glucose tolerance. Glucose is the
smallest thing you can break down sugar into. Both of these tests are looking at your
body’s ability to breakdown sugar, the way non-diabetics break it down. In the
diagram above you can see, regardless of the test, normal sugar breakdown will lead
to having the sugar in the green area. If you are a pre-diabetic your sugar may fall
between the yellow areas. Diabetes would be diagnosed if in either of the tests the
sugar numbered around the red areas.
Who should get tested for pre-diabetes?
People who are overweight and 45 years or older, otherwise consult your
physician or medical provider. But, remember that the same things that pre-dispose
you to developing diabetes make you also susceptible to pre-diabetes.
What will the doctor tell me I need to do?
The doctor will encourage you to lose weight, at least 10-15 lbs. He will also
recommend 30 minutes a day of physical activity like a brisk walk or jogging, and
moderate changes to your daily diet. These three things could reduce your risk of
developing diabetes by 50%.
Will I need medication?
If you are diagnosed as a pre-diabetic your doctor might want to put you on a
medication called metformin, also known as a glucophage. Another medication he
might choose is Precose also known as acarbose. Also if you have some of the risk
factors for developing diabetes, your doctor might want to start you on these
medications.
Signs and Symptoms of Diabetes
What are the signs and symptoms of Diabetes?
Signs and symptoms of diabetes may include any or none of the following:
• Urinating more often, especially having to get up at night to urinate
• Being very thirsty, especially so thirsty that it makes you get up at night to drink
water
• Losing weight that you cannot explain or have not been trying to lose
• Being more hungry than you normally are
• Vision suddenly becoming blurry
• Tingling or numbness in hands or feet
• Feeling very tired much of the time
• Very dry skin
• Sores that heal very slowly (For example tender, red, and/or pus-filled sores)
• More infections than usual including yeast infections of the vagina, penis or folds
of the skin. Also infections of the urinary tract.
If you have any of these symptoms in addition to nausea, vomiting, stomach pains,
rapid breathing, and fruity breath odor (like juicy fruit gum) this may be an
emergency that leads to coma or death if not quickly treated
You are more likely to have diabetes if you are overweight or obese, are black or
Latino, your doctor has told you that you have high blood pressure and high
cholesterol, or you have members of your family with diabetes.
Complications of Diabetes
What Problems Are Caused by Diabetes?
If blood glucose levels remain high, over time fatty materials will build up on
the walls of blood vessels. These fatty deposits can harden the walls of blood
vessels (atherosclerosis) taking away elasticity and making the wall more likely to
rupture under increased pressure. The increase in pressure is caused by the same
fatty build up and will cause narrowing of the inside of the blood vessel, much like a
clogged pipe in your house. As the vessel narrows, flow through the vessel is
restricted which puts pressure on the walls of the blood vessels. As the passageway
for blood narrows and pressure builds, people with diabetes start to experience
problems and may ask the following questions:
•
•
•
•
•
How does diabetes cause blindness? –
o (Retinopathy) Increased blood sugar levels cause small blood vessels
(capillaries) in the eye to become fragile and leak into the eye
(macular edema) causing spots of vision loss. As more blood vessels
become damage and blocked off, blood flow to the retina is restricted
and vision fails.
Can diabetes cause a heart attack? – (Myocardial infarction)
o Similar results occur in the vessels of the heart. As the vessels become
damaged (ischemia) blood cannot flow to the heart that results in a
heart attack.
How does diabetes cause kidney damage? – (Nephropathy)
o Filtering blood vessels (glomerular capillaries) within the kidneys
become scarred and leaky, decreasing the filtering ability and waste
removal of the kidneys. This leads to illness and eventually death.
How does diabetes cause strokes? –
o Weakened, blocked and broken blood vessels provide the brain with a
poor blood supply (ischemia). Without oxygen supplied by the blood,
cell death occurs with a loss of brain function to the affected area.
Why are some infections worse for diabetics? –
o Reduced blood flow inhibits the body’s healing response allowing
infections opportunity to grow and worsen. The feet are often
affected. People with diabetes should have regular foot exams by
their doctor as well as self -examination.
Who is at risk?
Who is at risk for getting diabetes?
People who:
• Are age 45 or older
• Are African-American, Latino, Native-American or Asian
• Have a parent, brother or sister who has diabetes
• Have or had diabetes while pregnant
• Gave birth to a baby that weighed more than nine pounds
• Have high blood pressure
• Do not have an active lifestyle
• Are overweight or obese
•
•
Have high cholesterol or fat in their blood
Live in Georgia
Diabetes in African-Americans:
How many African-Americans have diabetes?
3.7 million African-Americans age 20 years or older have diabetes. That is
14.7% of all African-Americans.
How many African Americans have diabetes and do not know it?
One third
How much more likely is it for African-Americans to get diabetes than white
people?
1.8 times more likely.
How much more likely is it for African-Americans do die from diabetes than
white people?
There is a 27% higher death rate for African-Americans.
Do African-Americans have more complications of diabetes than white
people?
Yes. African-Americans have higher rates of problems like kidney disease,
amputations and blindness than white people.
Diabetes in Georgia:
How many adults in Georgia have diabetes?
51,100
For every 100 people in Georgia, how many have diabetes?
Almost eight.
Is diabetes more common in Georgia than the rest of the U.S.?
Yes, diabetes is over 40% more common in Georgia than in the rest of the
country.
How many people in Georgia die each year from diabetes?
3,176
How many people in Georgia get hospitalized from diabetes each year?
10,071
Another Perspective…
Analogy to aid in the understanding of Diabetic complications:
It is important to first ask the patient about their own understanding of
diabetes and what causes the complications, for example:
“I’d like to hear your understanding of what Diabetes is? And why do you
have to treat diabetes? What’s the point?”
“Diabetes can be a complicated disease, but it doesn’t have to be. We all may
not know the biochemistry behind human life but we all know the basics of how a
car runs, right? So let’s think about it, you’ve got the car, the gas tank and the
gasoline.
“What happens when you pour the gas in the gas tank?”
“The car runs well! But if you pour the gasoline on the car, not only will your
car not run (and smell bad!), but, slowly over time, damage will occur. The paint
will begin to peel, the seats will fade, then the upholstery will begin to degrade and
form holes. Eventually the gasoline will destroy the paint, upholstery and seats.
Diabetes is a disease in which your body is not able to take the sugar from
your blood and put it into your cells. That’s why your doctors are always worrying
about your “high blood sugar.”
Sugar needs to be in the cells because sugar is fuel or rather the gasoline that
the cells need to make your body run! Now, let’s say that the car is a human body,
the gas tank will be a human cell and the gasoline is sugar.
If you don’t take the sugar (gasoline) out of the blood and put it in the
cells (gas tank) not only will the body not work well, over time the sugar will
cause damage to the body (car). It will damage the blood vessels and nerves.
“Where do we have blood vessels?”
Everywhere! We have blood vessels in the eyes, this is why uncontrolled
diabetes is the number one cause of blindness in adults in the US. It causes damage
to nerves, like the nerves in your fingers and toes. This is why diabetics often lose
feeling in their feet from nerve damage and then a small cut in their foot, that they
may not feel, can turn into a serious infection. When you combine an infection in the
foot with poor circulation from the damaged blood vessels you get ulcers that don’t
heal well. This is why diabetic foot infections are the leading cause of amputations
in the US.
“Where else do we find important blood vessels?”
“The heart and brain. Elevated blood sugars over time will damage those
blood vessels too, increasing your risk of heart attack and stroke.”
Where can I get help?
Where can children go if they need a specialist for their diabetes?
Endocrinology
Children's at Egleston 404-250-5437
Children’s at Egleston Diabetes Education Program 404-785-1724
Children's at Scottish Rite 404-250-5437
Children’s at Scottish Rite Diabetes Education Program 404-785-4841
Endocrinology/Diabetes
Children's at Hughes Spalding
404-785-9850
Children's at Hughes Spalding Primary Care Clinic
35 Jesse Hill Jr. Drive SE
Atlanta, GA 30303
404-785-9850
8 a.m. to 8 p.m., Monday to Friday
After Hours: 5 p.m. to 8 p.m., Monday to Friday
Where else can I get specialist treatment for diabetes?
Piedmont Hospital – Diabetes Resource Center
404-605-3823
An endowment through this center from the Wilbur and Hilda Glenn Family
Foundation provides 30 scholarships annually for people with limited financial
resources. Call the above number or access an application for the scholarship
online at:
http://www.piedmont.org/oth/Page.asp?PageID=OTH000158
Grady’s Diabetes Center: (404) 616-3731
96 Armstrong St.
Atlanta, GA 30303
http://www.gradyhealthsystem.org/Specialties/specialties_diabetes.asp
Clinic has educational programs that include meeting with a diabetes certified
educator, classes on sugar, diet, and videos.
Must have a written referral from a primary care physician either from a
neighborhood doctor’s office or from the Grady Primary Care clinic.
Fax the referral to Central Scheduling (404) 616-0787
Bring insurance information to your appointment: Grady, Medicaid, private
Hours: