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Answers to Your Diabetes Questions

What is diabetes? It's not an illness you can catch like a cold or cure like an infection. It's a condition in which your body can't maintain the right level of blood sugar, or glucose -- the source of energy that powers muscles, organs and other body systems. There are three types of diabetes.

Type 1 diabetes occurs when the body is unable to produce insulin. This illness is believed to be a type of autoimmune disease. A person with this type of diabetes has certain genes that make it likely to develop this illness. The disease may be triggered by certain viral infections or other environmental factors. Insulin is a hormone that allows energy in the form of glucose to enter the cells of the body. Type 1 diabetes is most likely found in children and adolescents. About 5 to 10 percent of all people with diabetes have this type, according to 2007 statistics from the American Diabetes Association (ADA).

Type 2 diabetes occurs when the body makes too little insulin or is unable to properly use the insulin it produces. This is called insulin resistance and is more common in adults. About 90 to 95 percent of people with diabetes have this type.

Gestational diabetes occurs in pregnancy and usually goes away after a woman gives birth. About 4 percent of all pregnant women develop gestational diabetes. Women who have had gestational diabetes have a 20 to 50 percent risk for developing type 2 diabetes 5 to 10 years after a pregnancy.

Prediabetes is a condition that often precedes the development of type 2 diabetes. It occurs when a person's blood glucose levels are higher than normal (this is called abnormal glucose tolerance), but not high enough to be called type 2 diabetes, the ADA says. Prediabetes is often associated with being overweight or obese, higher than normal levels of total cholesterol, LDL, HDL and triglycerides and high blood pressure (hypertension). About 57 million Americans have prediabetes, and nearly 24 million Americans have type 2 diabetes, according to 2007 statistics from the Centers for Disease Control and Prevention. If people with prediabetes make changes in their weight, eating habits and exercise, they may be able to avoid developing type 2 diabetes.

Can it be treated?

Yes. The main goal of diabetes treatment for both type 1 and type 2 is to keep blood sugar levels as close to normal as safely possible, the ADA says. Treatment usually involves changes in diet, weight loss (if needed) and regular exercise. Medication such as insulin shots, inhaled insulin, injected medicines that improve the release or use of insulin, or oral medication also may be necessary. A person with diabetes needs to get regular screening tests for possible complications.

So why is blood glucose control difficult?

Glucose levels rise and fall as you eat, sleep and go about your day. Exercise, stress, emotions and common illness such as colds or flu can affect blood sugar control. If you have diabetes, you must monitor your blood sugar closely, especially if you are taking insulin or medication to keep the glucose within normal range. You must balance meals with periods of activity, and you may need to test your blood several times a day.

What happens if glucose levels get out of control?

Low blood sugar

In the short term, hypoglycemia (low blood sugar) can occur when there is an imbalance between the calories you are eating and the calories you are burning during exercise and/or the medication you are taking to control your blood sugar. For example, these imbalances can occur if you eat less than planned or exercise more than planned. Hypoglycemia can be serious if not treated quickly.

High blood sugar

Occasional hyperglycemia (high blood sugar) can happen if you eat more than planned or exercise less than planned; if you have an illness, such as a cold or flu, or extreme emotional stress; or if you don't take your medications correctly. Hyperglycemia can be corrected with the help of your health care provider by adjusting your meal plan or medication, or by exercising more.

Complication of prolonged high blood sugar

Hyperglycemia that continues for years can cause serious complications. It can cause:

  • A markedly increased risk for heart attacks.

  • Increased risk for stroke.

  • Diabetic retinopathy, which can lead to central visual loss and eventually functional blindness.

  • Kidney failure. Diabetes is the leading cause for kidney transplants.

  • Circulatory problems. Erectile dysfunction is related to poor blood flow. Decreased blood flow to the extremities, particularly the legs, can lead to amputation. Diabetes is the leading cause of below-the-knee amputations in the United States.

  • Damage to nerves (neuropathy), which can cause tingling, pain or changes in sensation in the skin. Damage to the autonomic nerves may cause abnormal sweating (typically when eating or even with mild exercise), slowed digestion, attacks of sudden onset diarrhea, poor control of heart rate and other problems.

People with diabetes also are prone to skin disorders, gum disease and other problems. Most long-term complications take 10 years or more to develop, says Alan L. Rubin, M.D., an endocrinologist and author of Diabetes for Dummies.

However, he adds, "many people with type 2 diabetes have it for five or more years before a doctor diagnoses it." So, they may already have the beginnings of complications when they are diagnosed.

This is overwhelming; what can help?

Learn all you can about diabetes. Share your concerns with loved ones. Join a support group. See specialists. And follow a healthful lifestyle and diet.

How can exercise help?

If you weigh too much, find a form of fitness you enjoy and work at it until, through diet and exercise, you have lost weight. A study with 3,000 participants, published in the New England Journal of Medicine in February 2002, found that exercise and weight loss worked twice as well as medication in preventing diabetes in those at high risk. "A change of 5 to 7 percent in body weight, or just 10 pounds for a 200-pound person, is enough to delay the disease," says Larry Ballonoff, M.D., an endocrinologist in Denver. Walking 30 minutes a day, five days a week, can do the trick.

Has glucose monitoring improved?

Yes. You can measure your blood sugar readings at home and work with a meter that screens a drop of blood from a pricked finger. Another advance is the hemoglobin A1c blood test, which tracks average glucose levels over a period of three months. This yields a broader picture of how treatment is working.

What's my best plan?

You should take steps to keep your glucose levels as normal as possible, make exercise part of your daily routine and maintain a positive attitude. As Dr. Rubin puts it, "He who laughs, lasts."