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  Diabetes

 What Is Diabetes? Find out more

There are two main types of diabetes:
 Type 1 diabetes Find out more

 Type 2 diabetes Find out more

 Gestational diabetes Find out more
  • This type of diabetes by definition affects pregnant women
  • Treatment may involve diet alone or insulin injections to control blood glucose levels

  • This type of diabetes usually resolves once the pregnancy is over, but women who experience gestational diabetes have a greater risk for developing type 2 diabetes later in life.

 How common is type 2 Diabetes? Find out more
About 90% - 95% of all diabetic patients of Bangladesh belong to type 2 diabetes.

 What are the risk factors for type 2 diabetes? Find out more
  • Obesity. Many people with type 2 diabetes are obese, weighing at least 20% more than what is recommended for their height. Insulin resistance is known to increase when excess weight is added

  • Heredity. Unlike type 1 diabetes, type 2 diabetes tends to run in families

  • Age. The risk for developing type 2 diabetes increases with age. Half of all new cases of type 2 diabetes occur in persons age 55 or above

  • Race. Compared with Caucasians and Asians, type 2 diabetes is more common among Native Americans, African Americans, and Hispanics

  • Sedentary Lifestyle. Insulin resistance increases with lack of exercise

  • Women who have had gestational diabetes. Women who develop gestational diabetes during pregnancy have an increased risk of getting type 2 diabetes later on in life. Women who give birth to babies weighing 9 pounds or more at birth also have an increased risk of developing type 2 diabetes
  • Certain medications. The use of certain drugs, including thiazide diuretics and steroids may contribute to the development of type 2 diabetes

 What are the signs and symptoms of type 2 diabetes? Find out more
The symptoms of type 2 diabetes often develop gradually, may be vague in nature, and often go unnoticed. The most common symptoms associated with type 2 diabetes include:
  • Increased fatigue
  • Extreme hunger
  • Excessive thirst
  • Frequent urination (especially the need to get up during the night to pass urine); unusual thirst
  • Blurred vision
  • Irritability
  • Weight loss
  • Frequent infections (especially urinary tract infections, boils, and fungus infections)
  • Erectile dysfunction (impotence)
  • Slow healing of cuts and sores

Many people with type 2 diabetes are unaware that they have it. Others find out only by having a routine screening blood sugar performed. The American Diabetes Association (ADA) recommends that all adults should have routine diabetes screening beginning at age 45 or younger, if at risk.

 How is type 2 diabetes diagnosed? Find out more

 Random blood glucose Find out more
During a normal glucose test, a sample of blood can be obtained and tested at any time. Normal random glucose levels are 70 to 110 mg/dl. According to the ADA, a random glucose level of greater than 200 mg/dl is indicative of diabetes.

 Fasting plasma glucose test Find out more
During a fasting plasma glucose test, a sample of blood is obtained following a period of not eating or drinking (except water) for at least 8 hours. It is usually drawn early in the morning, before breakfast. According to the ADA, a fasting blood glucose level of greater than 126 mg/dl on two occasions is indicative of diabetes. The fasting blood glucose test is the most common test in use for diagnosing diabetes.

 Oral glucose tolerance test Find out more
During an oral glucose tolerance test, a fasting blood sugar is obtained initially. The person is then asked to drink a sweet sugary beverage. Blood glucose levels are then obtained every 30 minutes for the next 2 hours. A blood glucose level below 140 mg/dl at 2 hours is considered normal. A blood glucose level of greater than 200 mg/dl at 2 hours is indicative of diabetes. A blood glucose level of 140 to 199 mg/dl at 2 hours indicates impairment in glucose tolerance. These individuals should be monitored and screened for diabetes in the future.

 Urine glucose Find out more
Once the blood glucose level begins to rise above 180 mg/dl, glucose begins to spill over into the urine. This test is not diagnostic for diabetes, but if there is sugar in the urine, a blood glucose test should be performed.

 Urine ketones Find out more
Ketones are present in the urine when the body begins to breakdown fat for energy. Ketones indicate that there is not enough insulin present to prevent the mobilization of fat. The presence of ketones can indicate a serious and potentially lethal complication of type 1 diabetes

 Glycosylated hemoglobin Find out more
This blood test is not used to diagnose diabetes, but rather to give information about how well a blood glucose is being controlled. It is a simple blood test that can be taken at any time. It will give doctor important information that is needed to determine how much insulin is needed to take or how diet may need to be altered to keep diabetes under the best possible control.

 How is type 2 diabetes managed? Find out more

Although there is no cure for diabetes, there are several ways that type 2 diabetes can be well managed. The ultimate goal of any treatment for diabetes is to control blood glucose, to keep it within normal limits to minimize the risk of later complications. The following components are the cornerstone of successful type 2 diabetes management:

  • Diet modification

  • Exercise

  • Monitoring blood glucose levels

  • Medications as needed

  • Regular medical examinations by a doctor

 Diet management Find out more

The person with type 2 diabetes can enjoy the same foods as someone without diabetes as long as they control calories and stay active with exercise. If the persons are obese (weighing 20% more than the weight recommended for height), they will be advised to try to lose weight, since many people with type 2 diabetes can reduce their blood sugar by weight loss and exercise alone. A nutrition expert or dietitian can help to develop a personal nutrition plan that is aimed at improving the nutrition habits, while recognizing the need to enjoy food, too.

If a person is taking oral medications or insulin to control blood glucose level, the timing of meals becomes very important. Skipping or delaying meals can result in unhealthy fluctuations in blood sugar levels and can lead to serious diabetic reactions. In general, the aims of dietary advice are:

  • Achieve and maintain desirable body weight

  • Provide optimal nutrition

  • Achieve normal or near normal blood sugar and lipid levels

  • Avoid refined sugar, molasses, gur

  • Encourage high fiber diet- vegetable, legumes, whole gram, fruits

  • Minimum use of saturated fats e.g., animal fat, dairy products, butter, ghee, coconut products etc

  • Food intake must be distributed evenly throughout the day except during the days of fasting (ramazan)

  • Artificial sweetners containing sorbitol or fructose is discouraged, non-caloric sweetner e.g., aspartame, saccharine may be used

  • Reduce salt intake- if hypertension is present

 Exercise Find out more
Being overweight makes type 2 diabetes more difficult to control, so maintaining a healthy weight is an important part of treatment. Staying active and getting some form of regular exercise will help people with diabetes to not only manage their weight, but also to lower their blood sugar and thus reduce their overall risk of developing some of the long-term complications associated with diabetes.

The amount of exercise that is right for someone with type 2 diabetes will be based on many factors like age, weight, lifestyle, other existing health problems, and previous experience with exercise. All persons diagnosed with type 2 diabetes should have a complete physical examination by a doctor before starting any new exercise program.

Increasing the daily physical activity does not mean that the people will have to "work out" at a gym or health club. There are many activities that can be incorporated into daily routine that will go along way toward increasing physical activity. The examples that can be considered are: taking the stairs instead of the elevator, parking farther away from store entrances, enlisting a group of friends to take a daily walk, mowing the lawn or weeding the garden, going on bowling, or visiting a museum. Starting slowly, perhaps aiming for 15 minutes of increased physical activity per day is a realistic goal.

 Monitoring blood glucose levels Find out more
All people with type 2 diabetes need to have their blood glucose levels monitored, since the single most important factor in managing type 2 diabetes is achieving tight glucose control.

Many of those with type 2 diabetes learn how to monitor their blood glucose levels at home, while others have their glucose levels checked regularly by their doctor. Home glucose monitoring involves taking a small sample of blood from the fingertip, placing it on a special strip, and waiting for a machine to read the glucose levels. This can be as quick as 5 seconds. The doctor can advise about how often a person needs to check blood glucose levels.

Based on the results of blood glucose levels, the doctor will recommend changes to diet, exercise plan, and diabetic medications.

Medications
While some people with type 2 diabetes can manage their disease with diet and exercise alone, others will require medication. Oral medications prescribed alone or in combination, with or without insulin injections, are all possible ways that the doctor might treat type 2 diabetes.

Most oral medications used to treat type 2 diabetes work by increasing insulin production, decreasing glucose production, or enhancing the body's ability to use its own insulin more effectively. There are many different oral medications available to treat diabetes.

The individual with type 2 diabetes will need to inject insulin when their pancreas is no longer able to produce the insulin needed to regulate blood glucose levels. Insulin may be needed from the onset of type 2 diabetes, or it may become necessary later on, as the disease progresses.

Most patients with diabetes, who require insulin, learn to administer their own insulin after learning the proper techniques for insulin preparation and injection. The doctor will decide which type of insulin and how much is needed, based on theblood glucose levels.

 New insulin options Find out more
The 62nd Annual Scientific Session of the American Diabetes Association (ADA) stated that there would be new options for diabetic patients who take insulin injections. Some new options are pills, a transdermal skin patch, a mouth spray, and several types of pulmonary inhaled insulin. A pill, now in clinical trials, uses polymer technology to avoid degradation and make it more absorbent into the bloodstream.

The skin patch is battery-powered. When it is put on the skin it vaporizes cells on the skin's surface, creating "microscopic" openings through which insulin is absorbed during 12 hours of wear. Scientists are still testing the effectiveness of an oral spray for insulin which resembles a metered dose inhaler used by asthmatic patients. When perfected the insulin spray would be put directly into the lungs.

 Regular medical examinations by a doctor Find out more
An important part of the overall treatment plan with type 2 diabetes is regular medical examinations by a doctor who is experienced in treating diabetes type 2 patients. Maintaining tight blood glucose control and getting regular checkups and screenings can prevent many of the complications associated with diabetes.

 What is a diabetic reaction and how is it treated? Find out more
Hypoglycemia is a potentially serious side effect of diabetes management that can occur in diabetics when taking oral medications and/or insulin. It results when the level of glucose in the blood falls to an abnormally low level. More severe hypoglycemia can occur suddenly, causing unconsciousness or seizures. This type of hypoglycemia is a medical emergency.

The following signs and symptoms often accompany mild hypoglycemia:

  • Anxiety
  • Tremors or shaky feelings
  • Sweating or warm feeling inside
  • Hunger
  • Nausea
  • Rapidly beating heart
  • Mental confusion or difficulty concentrating
  • Dizziness
  • Headache
The following signs and symptoms often accompany more severe hypoglycemia:
  • Slurred speech
  • Disorientation
  • Confusion and irrational behavior
  • Loss of consciousness
  • Seizures

The treatment for hypoglycemia is glucose. Glucose is necessary to raise the blood sugar to a normal level. If the patient is awake and alert, he or she can ingest a food or drink that contains about 15 to 20 grams of carbohydrate. Good choices would include 6 ounces of fruit juice or cola product, about 7 lifesaver candies, or 14 ounces of milk. After ingesting one of these foods, it will take about 10 to 15 minutes for the blood glucose level to rise.

Severe hypoglycemia, that renders a diabetes patient unconscious, must be treated with an injectable form of glucose. Some people carry an injectable form of glucose called glucagon. Glucagon stimulates the liver to release glucose.

A family member or friend can give this injection at home, or wherever the reaction occurs. If glucagon is not available, or does not raise the blood sugar enough, emergency personnel will administer an intravenous injection of concentrated glucose. This will result in a rapid rise in blood sugar.

 How can the complications of type 2 diabetes be prevented? Find out more
The most important factors in reducing the risk of developing complications associated with diabetes include maintaining tight blood glucose control and having regular checkups with your doctor. It's no secret that a person with diabetes is at greater risk for other health problems; however, studies have shown that many of these problems can be prevented or successfully treated when they are identified early on.
Aggressive treatment of diabetes, beginning as soon as possible after diagnosis, reduces complications and prolongs health. The Diabetes Control and Complications Trial (DCCT), a clinical study conducted from 1983 to 1993 by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in United States showed that keeping blood glucose levels as close to normal as possible slows the onset and progression of eye, kidney, and nerve diseases caused by diabetes.

 Cardiovascular and cerebrovascular disorders Find out more
Heart disease is the number one cause of death in the United States, accounting for about one third of all deaths. It is even a greater threat since two thirds of people with diabetes die of heart or blood vessel disease. Those with diabetes are also about five times more likely to have a stroke than their nondiabetic counterparts.

In addition to controlling their blood glucose levels, people with diabetes must be aware of other factors that can play a role in preventing the cardiovascular and cerebrovascular complications of diabetes. These include not smoking, maintaining normal blood pressure and blood cholesterol levels, eating a low-fat diet, and getting regular exercise. These lifestyle factors are particularly important for people with type 2 diabetes.

 Eye disorders Find out more
People with diabetes are at increased risk for developing eye problems, the most common of which is a condition called diabetic retinopathy. Retinopathy is caused by damage to the blood vessels that nourish the nerves within the retina. Retinopathy is the leading cause of blindness in diabetes. All patients with type 2 diabetes are encouraged to have an annual eye exam to screen for this disorder.

Patients with diabetes also are at increased risk for developing cataracts, caused by clouding of the lens of the eye, and glaucoma, caused by an increase in fluid pressure within the eye that damages the optic nerve. Annual eye exams can detect both of these conditions. Cataracts can be corrected surgically and glaucoma can be treated with eye medication.

 Nervous system disorders Find out more
Diabetic nerve damage called neuropathy affects up to 65% of those with diabetes. Diabetic neuropathy can cause a variety of symptoms including pins and needles sensation in the hands and legs, or a loss of pain sensation in the extremities (which can contribute to foot problems). Neuropathy can also affect the bladder, bowel, stomach and skin, as well as cause sexual dysfunction for those with diabetes. The most common type of neuropathy is peripheral which can affect the arms and legs and result in amputation.

The best way to prevent diabetic neuropathy is to practice tight blood glucose control. Statistics show that a person can reduce the risk of neuropathy by 69% if he/she maintains tight control over blood sugars.

 Kidney disorders Find out more
Kidney damage called nephropathy occurs more commonly with diabetes and is the leading cause of end stage renal disease associated with diabetes. The earliest sign of kidney damage begins when protein begins to spill over into the urine. This can be detected by a simple urine test that should be performed regularly as part of a diabetes health screening.

Although heredity plays a role in the development of kidney problems for patients with diabetes, other factors like controlling blood pressure, reducing protein intake in the diet, and maintaining tight control of blood glucose levels can reduce the risk of kidney complications associated with diabetes.

 Infection Find out more
People with diabetes run an increased risk of developing many types of infections. This risk is directly related to increased glucose levels, which provide an ideal environment for many disease-causing organisms and also hamper the immune system's ability to fight off infections.

The best way for the person with diabetes to avoid infections is to practice tight control of blood glucose levels. Patients with diabetes should also closely examine their skin (especially their feet) for any evidence of breakdown or ulceration. Many diabetes patients have decreased sensation in their extremities, and it is possible for them to have foot ulcers without experiencing any pain.

Practicing good oral hygiene and visiting the dentist regularly can help some one with diabetes to avoid infections of the gums and mouth.

In diabetes, all cuts and open wounds deserve special attention. Be certain to wash any area of skin breakdown thoroughly with soap and water and monitor the area each day for evidence of infection (redness, warmth, pus, or other drainage and fever are all signs of infection).

 How often does a person need to see a doctor? Find out more
How often a person will need to visit a doctor will depend on various factors such as how close to normal the blood glucose levels are, what symptoms a person may be experiencing, what other health conditions are being treated for, and how comfortable the person is with current treatment plan for managing diabetes.

The American Diabetes Association recommends that all patients with type 2 diabetes should visit their doctor at least 2 to 4 times per year. If the patient is newly diagnosed or experiencing symptoms he/she may need to visit the doctor more often.

During each doctor visit the patient should be prepared to discuss about blood glucose readings. The doctor will record the weight and blood pressure at each visit. As part of routine physical examination the doctor will also check the eyes and feet to screen for diabetic complications. An annual examination by an eye doctor is also recommended. Several blood tests to check cholesterol, lipids, and glycosylated hemoglobin (a blood test that gives information about how well controlled the blood sugars have been during the last 2 to 3 months) may also be done. A urine test should also be performed to check for protein. During each office visit, the patient should have an opportunity to review treatment plan and set goals together with physician. It should be remembered that diabetes management is a joint effort that will only produce good results when both the patient and doctor work together cooperatively.
Very often it is. An example of the need for a patch test is when a skin rash has persisted for a long time. Many skin care products and medication would have been tried. It is necessary to identify the cause of contact allergy. A patch test will help to ascertain the cause.

Another situation whereby a patch test is important is when a dermatitis is suspected to be due to work. There are many substances in the workplace that may cause contact allergy.
 
     
 
 
 
 
 
     
 This Web site is intended for residents in Bangladesh and is not a substitute for independent professional advice. Information contained in  this Web site are for 'information purposes' only and are not intended to be used to diagnose, treat, cure or prevent any disease.
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Updated 29 August 2007
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