The Everything Guide to Managing Type 2 Diabetes

From Diagnosis to Diet, All You Need to Live a Healthy, Active Life with Type 2 Diabetes - Find Out What Type 2 Diabetes Is, Recognize the Signs and Symptoms, Learn How to Change Your Diet and Discover the Latest Treatments

Paula Ford-Martin, Jason Baker

• Editorial: Everything
• Año: 2012
• ISBN:
  9781440551970
• Categoría: Medicine
• Categoría: Diseases & Allergies

Diabetes is a complex disease--but learning about it shouldn't be! A Type 2 diabetes diagnosis can be daunting, but it is also manageable. With this all-in-one guide, you will get expert advice on establishing a healthier lifestyle and getting control of your diabetes. The Everything Guide to Managing Type 2 Diabetes provides easy-to-follow advice on all aspects of living with diabetes, and helps you:

• Recognize the symptoms of prediabetes and diabetes
• Monitor your blood glucose levels
• Learn about the types of insulin and insulin-delivery systems
• Understand the importance of nutrition and exercise
• Reduce the short- and long-term effects of diabetes

Filled with reliable advice and the latest information on medication, therapies, blood sugar monitoring, and more, this invaluable guide shows you how to take control of your diabetes and enjoy your life!

CHAPTER 1

What Is Diabetes?

Diabetes mellitus comes in many varieties—type 1, type 2, gestational, and variations such as maturity-onset diabetes of the young (MODY) and latent autoimmune diabetes in adults (LADA). Regardless of the name, people with diabetes share a common trait: Their bodies have an inherent inability to self-regulate the levels of blood glucose—or cellular fuel. In particular, type 2 diabetes accounts for 90 to 95 percent of U.S. diabetes cases and is one of the most serious and fastest growing health threats to Americans.

A Growing Problem

The U.S. Centers for Disease Control and Prevention (CDC) has called diabetes “an emerging epidemic.” The statistics say it all. As of 2011, the CDC put the number of U.S. residents living with diabetes at a staggering 25.8 million people, of which 7 million of these individuals don’t even know they have the disease. In other words, 8.3 percent of the entire U.S. population is living with diabetes. And another 79 million Americans over age twenty (35 percent of the population) have prediabetes, a condition that is a precursor to type 2 diabetes. Many lack important knowledge of the condition and the consequences.

Type 2 diabetes accounts for 90 to 95 percent of the total diabetes population in the United States and is the seventh leading cause of death in America. But moderate levels of regular physical activity and a healthy diet can cut a person’s chance of developing type 2 by 58 to 71 percent.

In addition to the physical and emotional toll it exacts, diabetes also comes with an enormous price tag. An American living with diabetes has health care costs that are three times higher than those without the disease. According to the American Diabetes Association (ADA), the disease costs Americans $174 billion annually in medical expenses and lost productivity. And it isn’t just diabetes that’s running up the tab. Nearly $58 billion of those costs were for direct expenses related to chronic diabetic complications, which translates to a cost of approximately $11,774 per patient.

The Endocrine System

Diabetes mellitus is a disease of the endocrine system. The endocrine system is composed of glands that secrete the hormones that travel through the circulatory and lymph systems. These hormones regulate metabolism, growth, sexual development, and reproduction. When one of these glands—the adrenals, the thyroid and parathyroids, the thymus, the pituitary, testes, ovaries, and the pancreas—secretes either too little or too much of a hormone, the entire body can be thrown off balance.

While the term diabetic is a useful adjective for describing things and conditions related to diabetes—diabetic supplies, diabetic kidney disease, and so on—some people with the disease bristle at being labeled “a diabetic.” People with diabetes should not have to be defined by the disease, nor be marginalized because of it.

The Pancreas and Liver

One of the endocrine glands—the pancreas—actually pulls double duty as a digestive organ. Sitting behind the stomach, the spongy pancreas secretes both digestive enzymes and endocrine hormones. It is long and tapered with a thicker bottom end (or head), which is cradled in the downward curve of the duodenum—the first portion of the small intestine or bowel. The long end (or tail) of the pancreas extends up behind the stomach toward the spleen. A main duct, or channel, connects the pancreas to the duodenum.

Anyone who takes insulin should have an emergency glucagon injection kit on hand. Glucagon is a hormone that prompts the liver to release glycogen and convert it into glucose. Glucagon is used to treat a severe hypoglycemic episode, or low blood sugar, in someone who has lost consciousness.

Pancreatic Tissues

In the pancreas, specialized cells known as exocrine tissue secrete digestive enzymes into a network of ducts that join the main pancreatic duct and end up in the duodenum. These enzymes are key in processing carbohydrates, proteins, and other nutrients.

The endocrine tissues of the pancreas contain cell clusters known as islets of Langerhans, named after Dr. Paul Langerhans, who first described them in medical literature. Islets (pronounced EYE-lets) are constructed of three cell types:

• Alpha cells manufacture and release glucagon (pronounced glue-co-gone), a hormone that raises blood glucose levels.
• Beta cells monitor blood sugar levels and produce glucose-lowering insulin in response.
• Delta cells produce the hormone somatostatin, which researchers believe is responsible for directing the action of both the beta and alpha cells.

Another Key Player: The Liver

Located toward the front of the abdomen near the stomach, the liver is the center of glucose storage. This important organ converts glucose—the fuel that the cells of the human body require for energy—into a substance called glycogen. Glycogen is warehoused in muscle and in the liver itself, where it can later be converted back to glucose for energy with the help of the hormone epinephrine (secreted by the adrenal glands) and glucagon from the pancreas. Together, the liver and pancreas preserve a delicate balance of blood glucose and insulin, which are produced in sufficient amounts to both fuel cells and maintain glycogen storage.

Insulin and Blood Sugar

While the liver is one source of glucose, most of the glucose the body uses is manufactured from food, primarily carbohydrates. Cells then metabolize, or convert, blood glucose for energy. And insulin is the hormone that makes it all happen.

How it works: the pancreas, glucose, and insulin. Normally, insulin enters the bloodstream to regulate the levels of glucose.

To visualize the role of insulin in the body and in diabetes, think of a flattened basketball. The ball needs air (or glucose) to supply the necessary energy to bounce. To fill a basketball, you insert an inflating needle into the ball valve to open it, and then pump air through the needle into the ball. Likewise, when a cell needs energy, insulin binds to an insulin receptor, or cell gateway, to “open” the cell and let glucose in for processing. You can blow pounds and pounds of compressed air at the ball valve, but without a needle to open it, the air will not enter. The same applies to your cells. Without insulin to bind to the receptors and open the cell for glucose, the glucose cannot enter. Instead, it builds up to damaging and toxic levels in the bloodstream.

What Goes Wrong in Diabetes

In people with type 2 diabetes, the inflating needle (the insulin) is the wrong size or shape for the valve (the insulin receptor), or the valve itself is too small or missing. This phenomenon, where there’s plenty of insulin but the body isn’t using it properly, is known as insulin resistance.

As the beta cells try to produce more and more insulin in an effort to compensate for the body’s growing inability to process glucose, another problem occurs. The pancreatic beta cells start to “burn out” and die, and insulin insufficiency (also known as insulin deficiency) is the result. The actual mechanics of how this occurs, and how early it happens in type 2, is not completely understood. But researchers have hypothesized that, at diagnosis, people with type 2 diabetes may have lost as much as 90 percent of their beta cell function.

Type 1 diabetes is different from type 2 diabetes. In type 1, the inflating needle is missing (no insulin production), or there are only one or two needles to fill an entire court full of basketballs (insufficient insulin production). This happens when the islets (specifically the insulin-producing beta cells) of the pancreas are destroyed.

Insulin resistance also occurs in gestational diabetes mellitus (GDM), a type of diabetes that first starts in pregnancy. Gestational diabetes usually resolves itself after childbirth, although women who develop GDM have a higher risk for another GDM diagnosis in future pregnancies. They also have an increased risk for developing type 2 diabetes later in life.

The Danger of High Blood Sugar

The human body needs glucose to function, but too much glucose circulating in the bloodstream has the potential to be toxic to all the tissues and organs of the body, including the insulin-producing beta cells of the pancreas. This is known as glucotoxicity. When insulin isn’t available, blood sugar levels rise higher and higher in the bloodstream. A person may experience fatigue, excessive thirst, and increased urination. These are the classic symptoms many people develop before receiving a diabetes diagnosis.

A severe rise in blood sugar can result in diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic coma (HHNC)—both are life-threatening medical emergencies. Timely diagnosis and treatment are important in preventing diabetes complications. Long-term, elevated blood sugars can damage virtually all the systems of the body. Blood vessel damage can result in cardiovascular disease, neuropathy (nerve damage), retinopathy (retinal eye disease), nephropathy (kidney disease), and more.

Managing Diabetes: A Balancing Act

While chronically high blood sugar levels cause diabetic complications over time, blood sugars that dip too low are also a problem. Hypoglycemia, or a low blood sugar level, is dangerous because, if left untreated, it can cause unconsciousness or even death. The most common triggers for a “hypo” include the following:

• An imbalance of food and insulin, such as when too much insulin is administered for the amount of carbohydrates eaten
• Certain type 2 oral medications
• Exercise without sufficient carbohydrate (carb) intake in individuals taking insulin and certain oral medications
• Excess alcohol intake without food in individuals taking insulin and certain oral medications

Some people who take insulin also experience overnight dips in blood glucose levels.

A normal, nonfasting blood glucose reading is between 60 and 140 mg/dl (or 3.3 to 7.8 mmol/l). By contrast, the following glucose readings may indicate diabetes: a casual (i.e., any time of day) plasma glucose reading of 200 mg/dl (11.1 mmol/l) or higher, accompanied by high blood sugar symptoms; an A1C of 6.5 percent or higher; a fasting plasma glucose reading of 126 mg/dl (7.0 mmol/l) or higher; or an oral glucose tolerance test with a two-hour postload value of 200 mg/dl (11.1 mmol/l) or higher.

Controlling Blood Sugar

The ultimate goal of management of any type of diabetes is to bring blood sugar to a level that is as close to normal as possible, as consistently as possible. The American Diabetes Association (ADA) suggests adults with diabetes try to achieve blood sugar levels of 70 to 130 mg/dl (milligrams per deciliter) or 3.9 to 7.2 mmol/l (millimoles per liter) before meals, and less than 180 mg/dl (10.0 mmol/l) one to two hours after eating (i.e., postprandial). The American Association of Clinical Endocrinologists ...