DMDSP

Diabetes Causes
Type 1 diabetes is believed to be an autoimmune disease. The body's immune system attacks the cells in the pancreas that produce insulin.

A predisposition to develop type 1 diabetes may run in families but much less so than for type 2.
Environmental factors, such as certain types of viral infections, may also contribute.
Type 1 diabetes is most common in people of non-Hispanic white persons of Northern European descent, followed by African Americans and Hispanic Americans. It is relatively rare in those of Asian descent.
Type 1 diabetes is slightly more common in men than in women.

Type 2 diabetes: Type 2 diabetes is believed to have a strong genetic link, meaning that it tends to run in families. Several genes are being studied that may be related to the cause of type 2 diabetes. Risk factors for developing type 2 diabetes include the following:

High blood pressure
High blood triglyceride (fat) levels
Gestational diabetes or giving birth to a baby weighing more than 9 pounds
High-fat diet
High alcohol intake
Sedentary lifestyle
Obesity or being overweight
Ethnicity: Certain groups, such as African Americans, Native Americans, Hispanic Americans, and Japanese Americans, have a greater risk of developing type 2 diabetes than non-Hispanic whites.
Aging: Increasing age is a significant risk factor for type 2 diabetes. Risk begins to rise significantly at about age 45 years, and rises considerably after age 65 years
Diabetes Treatment
Self-Care at Home
If you have diabetes, you would be wise to make healthful lifestyle choices in diet, exercise, and other health habits. These will help to improve glycemic (blood sugar) control and prevent or minimize complications of diabetes.
Diet: A healthy diet is key to controlling blood sugar levels and preventing diabetes complications.
- If you are obese and have had difficulty losing weight on your own, talk to your health care provider. He or she can recommend a dietitian or a weight modification program to help you reach your goal.
- Eat a consistent, well-balanced diet that is high in fiber, low in saturated fat, and low in concentrated sweets.
- A consistent diet that includes roughly the same number of calories at about the same times of day helps your health care provider prescribe the correct dose of medication or insulin.
- It will also help to keep your blood sugar at a relatively even level and avoid excessively low or high blood sugar levels, which can be dangerous and even life threatening.
Exercise: Regular exercise, in any form, can help reduce the risk of developing diabetes. Activity can also reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure, blindness, and leg ulcers.
- As little as 20 minutes of walking 3 times a week has a proven beneficial effect. Any exercise is beneficial; no matter how light or how long, some exercise is better than no exercise.
- If you have complications of diabetes (eye, kidney, or nerve problems), you may be limited both in type of exercise and amount of exercise you can safely do without worsening your condition. Consult with your health care provider before starting any exercise program.
Alcohol use: Moderate or eliminate your consumption of alcohol. Try to have no more than 7 alcoholic drinks in a week and never more than 2-3 in an evening. One drink is considered 1.5 ounces of liquor, 6 ounces of wine, or 12 ounces of beer. Excessive alcohol use is a known risk factor for type 2 diabetes. Alcohol consumption can cause low or high blood sugar levels, nerve pain called neuritis, and increase in triglycerides, which is a type of fat in our blood.
Smoking: If you have diabetes, and you smoke cigarettes or use any other form of tobacco, you are raising your risks markedly for nearly all of the complications of diabetes. Smoking damages blood vessels and contributes to heart disease, stroke, and poor circulation in the limbs. If you need help quitting, talk to your health care provider.
Self-monitored blood glucose: Check your blood sugar levels frequently, at least before meals and at bedtime, and record the results in a logbook.
- This log should also include your insulin or oral medication doses and times, when and what you ate, when and for how long you exercised, and any significant events of the day such as high or low blood sugar levels and how you treated the problem.
- Better equipment now available makes testing your blood sugar levels less painful and less complicated than ever. Your daily blood sugar diary is invaluable to your health care provider in seeing how you are responding to medications, diet, and exercise in the treatment of your diabetes.
- Medicare now pays for diabetic testing supplies, as do many private insurers and Medicaid.
Medical Treatment
The treatment of diabetes is highly individualized, depending on the type of diabetes, whether you have other active medical problems, whether you have complications of diabetes, and your age and general health at time of diagnosis.
- Your health care provider will set goals for lifestyle changes, blood sugar control, and treatment.
- Together, you will devise a plan to help you meet those goals.
Education about diabetes and its treatment is essential in all types of diabetes.
- When you are first diagnosed with diabetes, your diabetes care team will spend a lot of time with you, teaching you about your condition, your treatment, and everything you need to know to care for yourself on a daily basis.
- Your diabetes care team includes your health care provider and his or her staff. It may include specialists in foot care, neurology, kidney diseases, and eye diseases. A professional dietitian and a diabetes educator also may be part of the team.
Your care team will see you at appropriate intervals to monitor your progress with your goals.
Type 1 diabetes
Treatment of diabetes almost always involves the daily injection of insulin, usually a combination of short-acting insulin such as regular or Lispro or Aspart insulin and a longer acting insulin such as NPH, lente, glargine, detemir, or ultralente insulins.
- Insulin must be given as an injection. If taken by mouth, insulin would be destroyed in the stomach before it could get into the blood where it is needed.
- Most people with type 1 diabetes give these injections to themselves. Even if someone else usually gives you your injections, it is important that you know how to do it in case the other person is not available.
- A trained professional will show you how to store and inject the insulin. Usually this is a nurse who works with the health care provider or a diabetes educator.
- Insulin is usually given in 2 or 3 injections per day, generally around mealtimes. Dosage is individual and is tailored by the health care provider. Longer acting insulins are typically administered 1 or 2 times per day.
- Some people have their insulin administered by continuous infusion pumps to provide adequate blood glucose control. Supplemental mealtime insulin is programed into the pump by the individual as recommended by his or her health care provider.
- It is very important to eat if you have taken insulin, as the insulin will lower your blood sugar regardless of whether you have eaten. If you take insulin without eating, you could have hypoglycemia. This is called an insulin reaction.
- There is an adjustment period while you learn how insulin affects you and how to time your mealtimes and exercise times with your insulin injections to keep your blood sugar level as even as possible.
- Keeping accurate records of your blood sugar levels and insulin dosages is crucial in helping your health care provider take care of your diabetes.
- Eating a consistent, healthy diet appropriate for your size and weight is essential in controlling your blood sugar level.
Type 2 diabetes
Depending on how elevated your blood sugar and glycosylated hemoglobin are at the time of your diagnosis, you may be given a chance to lower your blood sugar level without medication.
- The best way to do this is to lose weight if you are obese and begin an exercise program.
- This will generally be tried for 3-6 months, and then your blood sugar and glycosylated hemoglobin will be rechecked. If they remain high, you will be started on an oral medication, usually a sulfonylurea or biguanide (Metformin), to help control your blood sugar level.
- Even if you are on medication, it is still important to eat a healthy diet, lose weight if you are overweight, and engage in moderate physical activity as often as possible.
- Your health care provider will monitor your progress on medication very carefully at first. It is important to get just the right dose of the right medication to get your blood sugar level in the recommended range with the fewest side effects.
- Your doctor may decide to combine two types of medications to get your blood sugar level under control.
- Gradually, even people with type 2 diabetes may require insulin injections to control their blood sugar levels.
- It is becoming more common for people with type 2 diabetes to take a combination of oral medication and insulin injections to control blood sugar levels.
Medications
Many different types of medications are available to help lower blood sugar levels in type 2 diabetes. Each type works in a different way. It is very common to combine 2 or more types to get the best effect with fewest side effects.
- Sulfonylureas: These drugs stimulate your pancreas to make more insulin.
- Biguanides: These agents decrease the amount of glucose produced by your liver.
- Alpha-glucosidase inhibitors: These agents slow absorption of the starches you eat. This slows down glucose production.
- Thiazolidinediones: These agents increase your sensitivity to insulin.
- Meglitinides: These agents stimulated the pancreas to make more insulin.
- D-phenylalanine derivatives: These agents stimulate your pancreas to produce more insulin more quickly.
- Amylin synthetic derivatives: Amylin is a naturally occurring hormone secreted by the pancreas along with insulin. An amylin derivative, such as pramlintide (Symlin), is indicated when blood sugar control is not achieved despite optimal insulin therapy. Pramlintide is administered as a subcutaneous injection along with insulin and helps achieve lower blood sugar levels after meals, helps reduce fluctuation of blood sugar levels throughout the day, and improves hemoglobin A1C levels.
- Incretin mimetics: Incretin mimetics promote insulin secretion by the pancreas and mimic other blood sugar level lowering actions that naturally occur in the body. Exenatide (Byetta) is the first incretin mimetic agent approved in the United States. It is indicated for diabetes mellitus type 2 in addition to metformin or a sulfonylurea when these agents have not attained blood sugar level control alone.
- Insulins: Human insulin is the only type of insulin available in the United States; it is less likely to cause allergic reactions than animal-derived varieties of insulin. The type of insulin chosen to customize treatment for an individual is based on the goal of providing optimal blood sugar control. Different types of insulin are available and categorized according to their times of action onset and duration. Commercially prepared mixtures of some insulins may also be used to provide constant (basal) control and immediate control.