Federation of Chinese American and Chinese Canadian Medical Societies

Friday May 08, 2009

Understanding Diabetes

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WHAT IS DIABETES?

Diabetes is a common metabolic disorder due to lack of insulin action, resulting in high blood sugar (glucose) levels. Diabetes affects about 5% of the population and is a major cause of heart attacks, strokes, blindness, kidney failure, and amputations. Proper control of diabetes can reduce the risk of these complications.

Type 1 - Insulin-Dependent Diabetes

the pancreas, a gland in the body, produces little or no insulin - usually occurs before age 40 - requires insulin injections to maintain life

Type 2 - Non-insulin Dependent Diabetes

the pancreas produces some insulin, but insulin does not work as effectively in the body - most common (more than 90% of diabetes) - usually occurs above age 40 - is often hereditary

Risk Factors

obesity (especially central or abdominal fat)
family history of diabetes
in women, history of diabetes in pregnancy, or delivery of babies over 9lb (4 kg)

WHAT ARE SYMPTOMS OF DIABETES?

Typical symptoms are thirst, frequent urination, chronic tiredness, blurred vision, and weight loss. However, there are often no symptoms until blood sugar levels are very high or the disease is advanced, so a periodic blood test to check for diabetes is recommended particularly for those over age 45 with risk factors.

LONGTERM COMPLICATIONS

Poorly controlled diabetes over many years increases the rate of atherosclerosis (blockage in the arteries caused by fatty deposits) and causes small blood vessel disease, resulting in damage to many different organs in the body.

The organs most affected by diabetes are the eyes, kidneys, circulation system, and peripheral nervous system.

Cardiovascular disease: People with diabetes have a much higher risk of having heart attack and strokes.
Retinopathy: Diabetes is the number one cause of new blindness in the adult. Impaired vision is common in diabetes due to vascular damage.
Nephropathy: Gradual decrease in kidney function occurs and can result in kidney failure.
Neuropathy: Poorly controlled diabetes for many years can result in numbness and loss of sensation in the legs.
Arterial disease in the legs: Impaired circulation results in diabetic foot problems such as non healing ulcers, with risk of infection, gangrene and amputation.

There is evidence that good blood sugar control, when started early, can prevent or slow the progression of these serious longterm complications.

WHAT YOU CAN DO:

Diet: For every person with diabetes, following a proper diet is essential in controlling blood sugar levels. Taking insulin or tablets does not mean that diet can be ignored. Careful meal planning with the help of a dietician is recommended for a nutritious well-balanced diet.

Some useful tips:
- Eat regular meals, with snacks if taking insulin
- Try to avoid sweet-tasting foods, sugar, sweet sauces
- Avoid fatty, greasy, or fried foods; eat leaner meats
- Limit the amount of rice, choose whole-grain breads over white bread
- Restrict fruit juice, choose fresh fruit instead, but limit to small portions, e.g. half an orange, apple, or banana for dessert
- Eat plenty of dark green and orange vegetables
Exercise: Regular exercise is important in improving blood sugar control and in weight reduction. In general, exercise should be moderate and continuous (e.g. walking, swimming, cycling, dancing, tennis, low-impact aerobics, Tai-Chi)
- Exercise regularly, at least 4 times a week and preferably daily. A simple program that most people can follow is walking for 30 minutes daily.
- Snacks are necessary for people taking insulin, or if the exercise is vigorous or prolonged (beware of low blood sugar symptoms after exercise).
- Start exercise slowly and increase gradually. (It is important to talk to your doctor before you start any exercise program).
Self-Monitoring of Blood Sugar: Check your blood sugars (blood glucose) regularly with a blood glucose meter, using glucose teststrips. This useful information, recorded in a diary, tells you how various foods and activities affect your blood sugars day-to-day and helps you and your doctor to best manage your diabetes.
Attend Diabetes Education: Learning more about diabetes is recommended, since how well your diabetes is managed depends on how you live with diabetes.
Medication: In most cases diet is not sufficient to normalize blood sugars, and your doctor may add diabetes medication (pills) or insulin to improve control. It is important not to skip meals to avoid possible hypoglycemia (low blood sugar). Dosages may need to be adjusted during illness, especially if one is vomiting or unable to eat.
Beware of Hypoglycemia: It is important to recognize symptoms of excessively low blood sugar levels, which can be dangerous. Symptoms are severe hunger, weakness, trembling, sweating, and must be corrected by immediately taking sugar, candy, or juice.
- Testing your blood glucose using your glucose meter should prove if it is too low (<3.4nmmol/I or <65mg/dl).
- People with diabetes taking insulin or bloodsugar lowering medication are more susceptible to hypoglycemic episodes, which may be caused by skipping meals, unusual increase in physical activity without eating to compensate, or inappropriate dose of medication or insulin. Any symptoms should be reported to your doctor.
See Your Doctor Regularly
- Monitor control of your diabetes:
  
  Optimal target for fasting blood glucose is 7mmol/l or 120mg/dl or lower
  
  The blood test Hemoglobin AIC(HbAC) is a measure of the average blood sugar control for the past 3 months, and should be checked regularly, with the optimal target being under 0.08(8%) to lower the risk of longterm complications of diabetes.
- Screen for complications
  
  Complications of diabetes develop gradually and can be detected years before symptoms appear. Regular examinations should include:
  - annual eye examination (by an ophthalmologist)
  - blood tests for kidney function
  - urine tests for protein and microalbumin (which is an early indicator of kidney malfunction)
- Control co-existing conditions:
  
  People with diabetes often have high blood pressure or high cholesterol and triglyceride levels. These conditions must be well-controlled, if present.
  - check cholesterol, triglycerides, LDL, HDL.