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DIABETES
INFORMATION
What is diabetes?
Diabetes is a group of diseases
characterized by high levels of
blood glucose resulting from
defects in insulin production,
insulin action, or both. Diabetes
can be associated with serious
complications and premature
death, but people with diabetes
can take steps to control the
disease and lower the risk of
complications. The main types of
diabetes are simply referred to as
“type 1” and “type 2”.
Type 1 Diabetes
Previously called insulin-dependent diabetes
mellitus (IDDM) or juvenile-onset diabetes. Type
1 diabetes develops when the body's immune
system destroys pancreatic beta cells, the only
cells in the body that make the hormone insulin
that regulates blood glucose. This form of
diabetes usually strikes children and young
adults, although disease onset can occur at any
age. Type 1 diabetes may account for 5% to 10%
of all diagnosed cases of diabetes. Type 1 is more
common in white Americans.
Symptoms of Type 1 Diabetes
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Frequent urination
Unusual increased thirst
Extreme hunger
Unusual weight loss in spite of
increased appetite
Extreme fatigue and irritability
Those with type 1 diabetes
usually develop symptoms over
a short period of time.
THE CONDITION IS
OFTEN DIAGNOSED IN
AN EMERGENCY
SETTING.
Type 2 Diabetes
Type 2 diabetes may account for about 90% to 95% of all
diagnosed cases of diabetes.
Type 2 diabetes is associated with older age, obesity, family
history of diabetes, history of gestational diabetes, impaired
glucose metabolism, physical inactivity, and race/ethnicityAfrican Americans, Hispanic/Latino Americans, and
American Indians.
Type 2 diabetes is increasingly being diagnosed in children
and adolescents.
Symptoms of Type 2 Diabetes
Any of the Type 1 symptoms
 Frequent infections
 Blurred vision
 Cuts/bruises that are slow to heal
 Tingling/numbness in the hands/feet
 Recurring skin, gum, or bladder infections
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However, because type 2 develops slowly, some people
with high blood sugar experience no symptoms at all.
Hyperglycemia and Hypoglycemia
Hyperglycemia and hypoglycemia are diseases of the body's
blood sugar levels. However, they have the opposite issues.
 Hyperglycemia (hi"per-gli-SE'me-ah) is an increase in
plasma glucose (blood sugar). It can turn into a complex
medical condition - diabetic ketoacidosis (ke"to-as"id-O'sis)
and coma - if it's not treated on time and adequately.
Hyperglycemia is usually the first sign of diabetes mellitus.
Symptoms can include high levels of sugar in urine,
frequent urination, excessive thirst and/or hunger, and
high blood glucose.
Ketones are substances that are made when the
body breaks down fat for energy. Normally, your
body gets the energy it needs from carbohydrates
in your diet. But stored fat is broken down and
ketones are made if your diet does not contain
enough carbohydrates to supply the body with
sugar (glucose) for energy or if your body cannot
use blood sugar (glucose) properly.
You can often lower your blood glucose level by
exercising. However, if your blood glucose is
above 240 mg/dl, check your urine for ketones.
If you have ketones, do not exercise. (You
can check ketones trough blood or urine test.)
Exercising when ketones are present may make
your blood glucose level go even higher. You'll
need to work with your doctor to find the safest
way for you to lower your blood glucose level.
Cutting down on the amount of food you eat
might also help.
Work with your dietitian to make changes in your
meal plan. If exercise and changes in your diet
don't work, your doctor may change the amount
of your medication or insulin or possibly the
timing of when you take it.
 Hypoglycemia (hi"po-gli-SE'me-ah) is a low level
of plasma glucose (blood sugar). It's a dangerous
condition because glucose is the major source of
energy for the brain. Lack of glucose, like lack of
oxygen, produces brain damage or even death if
the deficit is prolonged.
 Hypoglycemia can occur after insulin excess
and/or inadequate glucose intake, among other
causes. These situations are common in people
with diabetes who receive too much insulin or
who don't eat enough.
Hypoglycemia starts to cause these symptoms when glucose
levels fall below
50 milligrams per deciliter (mg/dL):
- sweating
- tremors
- anxiety
- hunger
- dizziness
- headache
-cloudy vision
-confusion
-abnormal behavior
-convulsions
-loss of consciousness
What should you do if hypoglycemia occurs?
If you're suspected of hypoglycemia, you must eat or drink
something with sugar in it immediately.
Other Types of Diabetes
 Gestational diabetes (which resembles type 2 in
several aspects) occurs in about 2%-5% of pregnancies,
usually at around 28 weeks or later, and may improve or
disappear after delivery. It is fully treatable but requires
careful medical supervision throughout the pregnancy.
About 20%-50% of affected women develop type 2
diabetes later in life.
 Congenital nephrogenic diabetes insipidus is a
condition in which the kidneys can't conserve water,
leading to excessive water loss. This condition is present
from birth.
 Cystic fibrosis-related diabetes (CFRD)- Diabetes in
people with cystic fibrosis combines the characteristics of
both type 1 and type 2 diabetes. Build up of thick
secretions in the pancreas eventually damages the
hormone-producing cells, causing insulin deficiency. This
sounds like type 1 diabetes, but it is not quite the same
thing because it does not start in childhood, but in
adulthood, and is caused by damage to a pancreas that
used to produce insulin normally.
 Steroid diabetes is not an autoimmune disease and yet
it can sometimes have total beta cell failure. It comes
about from the taking of (medically prescribed) steroids
over a long period of time.
 Monogenic diabetes is rare, but results from mutations
in a single gene, such as Permanent neonatal diabetes
mellitus (PND), transient neonatal diabetes (TND), and
maturity-onset diabetes of the young (MODY). All of these
are the main forms of monogenic diabetes.
Complications of Diabetes
 Heart disease and stroke
 High blood pressure
 Blindness
 Kidney disease (nephropathy)
 Nervous system disease (neuropathy)
 Amputations
 Dental disease
 Complications of pregnancy
 Biochemical imbalances
 Increased susceptibility to many other illnesses (which can
lead to worse prognoses)
 Diabetic neuropathy is a common complication
of diabetes, in which nerves are damaged as a result
of high blood sugar levels (hyperglycemia).
 Diabetic nephropathy is kidney disease or
damage that results as a complication of diabetes.
Diabetic Retinopathy
Diabetic retinopathy is damage to the eye's retina
that occurs with long-term diabetes (both 1 and 2). It
is caused by damage to blood vessels of the retina.
Many people with early diabetic retinopathy have no
symptoms before major bleeding occurs in the eye.
This is why everyone with diabetes should have
regular eye exams.
Diabetic retinopathy
Chronic generalized periodontitis in a diabetic
patient. Note the heavy deposits of materia alba in the
mandibular anterior teeth and the spacing of teeth, in
this 52 year-old male with poor oral hygiene.
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
them every day.
Currently, there are approximately 100,000 limb amputations
performed on diabetic patients in the United States each year.
Diabetic foot complications
Most lead to amputation
People with diabetes are far more likely to have a
foot or leg amputated than other people. The
problem? Many people with diabetes have artery
disease, which reduces blood flow to the feet. Also,
many people with diabetes have nerve disease,
which reduces sensation.
Together, these problems make it easy to get ulcers
and infections that may lead to amputation. Most
amputations are preventable with regular care and
proper footwear.
One of the biggest threats to your feet is smoking. Smoking
affects small blood vessels. It can cause decreased blood flow
to the feet and make wounds heal slowly. A lot of people with
diabetes who need amputations are smokers.
Cardiovascular disease is the leading cause of
death in people with diabetes.
When untreated or poorly controlled,
diabetes has serious consequences.
Diabetes increases a person’s risk of
developing hypertension and
atherosclerosis (hardening/narrowing of
the arteries), which eventually lead to heart
disease.
Assistance
People with diabetes may need
assistance to help them manage their
disease and keep track of their diabetes
care.
Treating diabetes
 To survive, people with type 1 diabetes must have insulin
delivered by injections or a pump.
 Many people with type 2 diabetes can control their blood
glucose by following a careful diet and exercise program,
losing excess weight, and taking oral medication.
 Diabetes self-management education is an integral
component of medical care.
 Among adults with diagnosed diabetes, 12% take both
insulin and oral medications, 19% take insulin only, 53%
take oral medications only, and 15% do not take either
insulin or oral medications.
Diabetes Care Checklist
Daily diabetes care activities:
 Exercise
 Follow meal plan
 Take diabetes medicine
 Check blood glucose as recommended by a health care
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provider
Check feet for sores that are not healing properly
Get feet checked
Brush teeth and floss
Check blood pressure at least twice per year
Manage their disease and keep track of their
diabetes care
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Plan walks or other activities with clients with
diabetes to help them get regular exercise. Help them
follow the advice of their health care provider about
ways to exercise safely.
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Prepare healthy meals that fit into meal plans for
people with diabetes and pre-diabetes.
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Offer to help check their feet for sores or calluses.
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Provide transportation to the heath care provider's
office so that clients do not miss important medical
visits.
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Become aware of the signs and symptoms of
hypoglycemia and hyperglycemia and how to
appropriately treat them.
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Provide assistance when client is sick. Being sick can
raise blood glucose and may make it difficult to eat
properly or monitor blood glucose as needed.