Can people with diabetes

Contents

What is Diabetes?

In this section:

  • What are the different types of diabetes?
  • How common is diabetes?
  • Who is more likely to develop type 2 diabetes?
  • What health problems can people with diabetes develop?

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

Over time, having too much glucose in your blood can cause health problems. Although diabetes has no cure, you can take steps to manage your diabetes and stay healthy.

Sometimes people call diabetes “a touch of sugar” or “borderline diabetes.” These terms suggest that someone doesn’t really have diabetes or has a less serious case, but every case of diabetes is serious.

Diabetes affects just about everyone, from the over 110 million Americans with or at risk for the disease to the many more people who care for them.

What are the different types of diabetes?

The most common types of diabetes are type 1, type 2, and gestational diabetes.

Type 1 diabetes

If you have type 1 diabetes, your body does not make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive.

Type 2 diabetes

If you have type 2 diabetes, your body does not make or use insulin well. You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Type 2 is the most common type of diabetes.

Gestational diabetes

Gestational diabetes develops in some women when they are pregnant. Most of the time, this type of diabetes goes away after the baby is born. However, if you’ve had gestational diabetes, you have a greater chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes.

Other types of diabetes

Less common types include monogenic diabetes, which is an inherited form of diabetes, and cystic fibrosis-related diabetes.

How common is diabetes?

As of 2015, 30.3 million people in the United States, or 9.4 percent of the population, had diabetes. More than 1 in 4 of them didn’t know they had the disease. Diabetes affects 1 in 4 people over the age of 65. About 90-95 percent of cases in adults are type 2 diabetes.1

Who is more likely to develop type 2 diabetes?

You are more likely to develop type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight. Physical inactivity, race, and certain health problems such as high blood pressure also affect your chance of developing type 2 diabetes. You are also more likely to develop type 2 diabetes if you have prediabetes or had gestational diabetes when you were pregnant. Learn more about risk factors for type 2 diabetes.

What health problems can people with diabetes develop?

Over time, high blood glucose leads to problems such as

  • heart disease
  • stroke
  • kidney disease
  • eye problems
  • dental disease
  • nerve damage
  • foot problems

You can take steps to lower your chances of developing these diabetes-related health problems.

Diabetes Control: Why It’s Important

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People who have diabetes may hear or read a lot about controlling, or managing, the condition. But what is diabetes control and why is it so important?

What Is Diabetes Control?

When you hear your doctors or health care providers talk about “diabetes control,” they’re usually referring to how close your blood sugar, or

, is kept to the desired range. Having too much or too little sugar in your blood can make you feel sick now and cause health problems later.

Managing diabetes is like a three-way balancing act: The medicines you take (insulin or pills), the food you eat, and the amount of exercise you get all need to be in sync.

Diabetes can get out of control if you:

  • don’t take diabetes medicines as directed
  • don’t follow the meal plan (like eating too much or not enough food without adjusting diabetes medicines)
  • don’t get regular exercise or exercise more or less than usual without making changes to the diabetes plan
  • have an illness or too much stress
  • don’t check blood sugar levels enough

What Can Happen if Diabetes Is Not Under Control?

Out-of-control blood sugar levels can lead to short-term problems like hypoglycemia, hyperglycemia, or diabetic ketoacidosis. In the long run, not controlling diabetes can damage important organs, like the heart, kidneys, eyes, and nerves. This means that heart disease and stroke, kidney disease, vision problems, and nerve problems can happen to people with diabetes.

These problems don’t usually show up in kids or teens who have had the disease for only a few years, but they can happen to adults with diabetes. Kids and teens with diabetes who don’t control their blood sugar levels can be late going into puberty and might not end up as tall as they would have otherwise.

The good news is that keeping blood sugar levels under control can help keep you healthy and prevent health problems from happening later.

How Do I Know When My Diabetes Is Under Control?

If you have diabetes, your doctor or diabetes health care team will tell you what your blood sugar levels should be (usually called a target range). If you have diabetes, you’re trying to keep your blood sugar level as close to the target range as possible. As you get older, your target range may change.

The only way to know if your blood sugar level is close to your target range is to measure your blood sugar level several times a day with a

. Your diabetes health care team will help you determine when and how often to check your blood sugar level. Checking and keeping a record of the test results is very important — this helps you and your diabetes health care team make changes to your diabetes management plan as needed.

Some people with diabetes also use continuous glucose monitors (CGMs). These are wearable devices that measure blood sugar every few minutes throughout the day and night by using a sensor that is inserted under the skin. By providing a more detailed profile of blood sugar levels, these devices can help some people do an even better job of “fine-tuning” their blood sugar control.

The glucose meter and CGMs tell you what your blood sugar level is at the moment you test. But another type of blood sugar test, the glycosylated hemoglobin (pronounced: gly-KOH-sih-lay-tid HEE-muh-glo-bin and also known as the hemoglobin A1c or HbA1c) test, will help you and your doctor know how your blood sugar control was over the past 2 to 3 months. In general, the lower your HbA1C level, the better you’re doing at controlling your diabetes.

Getting Control

Keeping blood sugar levels close to normal will be challenging at times. But you can help keep your blood sugar levels in a healthy range with these steps:

  • Take your insulin or pills when you’re supposed to.
  • Follow your meal plan.
  • Get regular exercise.
  • Check your blood sugar levels often and make changes with the help of your diabetes health care team.
  • Visit your doctor and diabetes health care team regularly.
  • Learn as much as possible about diabetes.

Reviewed by: Steven Dowshen, MD Date reviewed: March 2018

7 Ways You Can Help Someone With Diabetes

There’s a good chance that someone you know has diabetes. It is a disease that affects more than 30 million people in the US—about 9% of the population. With those numbers, you’d think we would be more accustomed to hearing about and supporting people with diabetes. But in fact, they often face misunderstanding and stigma. People with diabetes are often exposed to mistaken notions that diabetes is not a serious illness and can be easily managed with lifestyle changes such as diet or activity changes. When told, explicitly or implicitly, that having diabetes is a sign of personal weakness and failure, people with diabetes may suffer from guilt, shame, embarrassment, and isolation. Such feelings are reported not only by adults but also by children living with diabetes and their parents.

The damage inflicted by stigma goes far beyond the emotional toll. People with diabetes who reported feeling stigmatized have been shown to have poorer diabetes control, including higher A1C levels, a higher body mass index (BMI), and a higher rate of self-reported uncontrolled diabetes.

Let’s do a better job of supporting our friends and family members living with this condition. Here are some ways you can combat stigma and support the people you know with diabetes.

  1. Don’t refer to people as “diabetics.” People with diabetes do not want to be defined by a diagnosis. Instead, say “a person with diabetes.”
  2. Don’t blame or judge. People often associate diabetes with poor lifestyle choices, such as inactivity and obesity. But the fact is, type 1 diabetes is an autoimmune disease and not caused by lifestyle choices. Type 2 diabetes is influenced by a combination of a person’s genetics; aging; social factors such as low income, employment issues, and low educational level; and lifestyle factors. Type 2 diabetes can also be caused by some hormonal diseases, certain diseases (such as hyperthyroidism and pancreas disorders), or by certain medicines.
  3. Participate in healthy choices. It’s important for people with diabetes to take steps to manage the disease—and you can help. For example, if you eat meals together, eat the same healthy foods that they do—specifically, items that are low in fat, cholesterol, salt, and added sugar. Don’t buy foods that they aren’t supposed to eat, because that can make them feel more self-conscious and isolated.
    You should also encourage the person to follow their healthcare provider’s advice for physical activity, and even better, you can even join them in the activities.
    Even if you mean well, avoid giving advice (when not asked for) about eating habits or other aspects of diabetes care. Leave it to the person’s healthcare provider to work with the person to manage their diabetes.
  4. Learn to recognize signs of a problem. For example, episodes of high blood sugar (called hyperglycemia) and low blood sugar (called hypoglycemia) can cause irritability.
    Other signs of high blood sugar that you may notice include being thirstier than usual and urinating frequently. Other signs of low blood sugar include nervousness, confusion, pale skin color, having little or no energy, and clumsiness.
  5. Accept blood sugar checks and medication regimens as normal and routine occurrences, anytime and anywhere. Some people with diabetes may be hesitant to check their blood sugar or take their medicine, such as insulin injections, in public. You can help by offering your support and showing your understanding that it’s a necessary part of their everyday diabetes management plan.
  6. Ask how you can help. Some people may need help with some parts of their diabetes management plan. Keep in mind that what they need may be different than what you think. Ask what you can do to help.
  7. Help with finding additional support. It can be helpful for a person with diabetes to talk with others who will understand his or her situation. This could include someone else with diabetes, a diabetes educator, or a local diabetes support group.

By understanding that diabetes is a disease that requires careful and lifelong monitoring and management, you can take steps to support the people in your life with diabetes while also helping to remove stigma and replace it with acceptance.

  • 1. Centers for Disease Control and Prevention. New CDC Report: More than 100 Million Americans Have Diabetes or Prediabetes. Accessed November 13, 2018.
  • 2. Liu NF, Brown AS, Folias AE, et al. Stigma in people with type 1 or type 2 diabetes. Clin Diabetes. 2017;35(1):27-34.
  • 3. Dickinson JK. The effect of words on health and diabetes. Spectrum.Diabetesjournals.org. 2017;30(1):11-16.
  • 4. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of Diabetes. Accessed November 16, 2018.
  • 5. DiaTribe.org. The Numbers of Shame and Blame: How Stigma Affects Patients and Diabetes Management. Accessed November 15, 2018.
  • 6. Heart.org. Living Healthy with Diabetes. Accessed November 20, 2018.
  • 7. Hill J, Nielsen M, Fox MH. Understanding the social factors that contribute to diabetes: A means to informing health care and social policies for the chronically ill. Perm J. 2013;17(2):67-72.
  • 8. FamilyDoctor.org. Helping a family member who has diabetes. Accessed September 9, 2018.
  • 9. Behavioral Diabetes Institute. Diabetes Etiquette. Accessed November 14, 2018.
  • 10. American Diabetes Association. Hyperglycemia (High Blood Glucose). Accessed October 24, 2018.
  • 11. American Diabetes Association. Hypoglycemia (Low Blood Glucose). Accessed October 24, 2018.
  • 12. American Association of Diabetes Educators. Diabetes Distress. Accessed November 14, 2018.
1. The risk factors for type 1 diabetes include all of the following except:
  1. Diet
  2. Genetic
  3. Autoimmune
  4. Environmental
2. Type 2 diabetes accounts for approximately what percentage of all cases of diabetes in adults?
  1. 55%-60%
  2. 35%-40%
  3. 90-95%
  4. 25-30%

3. Risk factors for type 2 diabetes include all of the following except:
  1. Advanced age
  2. Obesity
  3. Smoking
  4. Physical inactivity
4. What percentage of women with gestational diabetes is diagnosed with type 2 diabetes following pregnancy?
  1. 25%-30%
  2. 5%-10%
  3. <5%
  4. 20%-25%
5. Untreated diabetes may result in all of the following except:
  1. Blindness
  2. Cardiovascular disease
  3. Kidney disease
  4. Tinnitus
6. Prediabetes is associated with all of the following except:
  1. Increased risk of developing type 2 diabetes
  2. Impaired glucose tolerance
  3. Increased risk of heart disease and stroke
  4. Increased risk of developing type 1 diabetes
7. Diabetics are at increased risk of heart disease if they also:
  1. Smoke
  2. Have high HDL cholesterol levels
  3. Take aspirin
  4. Consume a high-fiber diet
8. Blood sugar is well controlled when Hemoglobin A1C is:
  1. Below 7%
  2. Between 12%-15%
  3. Less than 180 mg/dL
  4. Between 90 and 130 mg/dL
9. Excessive thirst and volume of very dilute urine may be symptoms of:
  1. Urinary tract infection
  2. Diabetes insipidus
  3. Viral gastroenteritis
  4. Hypoglycemia
10. Among female children and adolescents, the first sign of type 1 diabetes may be:
  1. Rapid weight gain
  2. Constipation
  3. Genital candidiasis
  4. Insomnia
11. Untreated hyperglycemia may lead to all of the following complications except:
  1. Hyperosmolar syndrome
  2. Vitiligo
  3. Diabetic ketoacidosis
  4. Coma
12. Hyperinsulinemia may be caused by all of the following except:
  1. An insulinoma
  2. Nesidioblastosis
  3. Insulin resistance
  4. Type 1 diabetes
13. Which statement about diabetes is false?
  1. The U.S. prevalence of diabetes is decreasing
  2. Diabetes is the seventh leading cause of death in the United States
  3. Diabetes is the leading cause of blindness among persons age 20 to 74
  4. Diabetes is the leading cause of kidney failure
14. The lifetime risk of developing diabetes for a male born in 2000 is:
  1. 1 in 5
  2. 1 in 3
  3. 2 in 5
  4. 1 in 2
15. Which of the following measures does not help to prevent diabetes complications?
  1. Controlling blood glucose
  2. Controlling blood pressure and blood lipids
  3. Eliminating all carbohydrates from the diet
  4. Prompt detection of diabetic eye and kidney disease
16. Proliferative retinopathy is often treated using:
  1. Tonometry
  2. Fluorescein angiogram
  3. Antibiotics
  4. Laser surgery
17. Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?
  1. Sulfonylureas
  2. Meglitinides
  3. Biguanides
  4. Alpha-glucosidase inhibitors
18. The benefits of using an insulin pump include all of the following except:
  1. By continuously providing insulin they eliminate the need for injections of insulin
  2. They simplify management of blood sugar and often improve A1C
  3. They enable exercise without compensatory carbohydrate consumption
  4. They help with weight loss
19. Which of the following regimens offers the best blood glucose control for persons with type 1 diabetes?
  1. A single anti-diabetes drugs
  2. Once daily insulin injections
  3. A combination of oral anti-diabetic medications
  4. Three or four injections per day of different types of insulin.
20. Diabetic neuropathies are diagnosed using all of the following except:

  1. Nerve conduction studies or electromyography
  2. Ultrasound
  3. Foot examinations
  4. Minnesota Mutiphasic Personality inventory (MMPI)
Answers and Explanations
1. A

Type 1 diabetes is a primary failure of pancreatic beta cells to produce insulin. It primarily affects children and young adults and is unrelated to diet.

2. C

Type 2 diabetes accounts for the overwhelming majority of cases diagnosed in adults. It develops gradually, beginning with insulin resistance and as the requirement for insulin increases, the pancreas becomes progressively less able to produce it.

3. C

Additional risk factors for type 2 diabetes are a family history of diabetes, impaired glucose metabolism, history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites.

4. B

African-American, Hispanic/Latina and Native American women are at greater risk of developing gestational diabetes than are white women. Women who experience gestational diabetes are at increased risk of developing diabetes during the decade following pregnancy.

5. D

Untreated diabetes also may result in loss of lower limbs to amputation and death.

6. D

Persons with elevated glucose levels that do not yet meet the criteria for diabetes are considered to have prediabetes and are at increased risk of developing type 2 diabetes. Weight loss and increasing physical activity can help people with prediabetes prevent or postpone the onset of type 2 diabetes.

7. A

Diabetics who smoke are at greater risk of developing heart disease because both diabetes and smoking act to narrow blood vessels. Smoking also is associated with increased risk of eye problems and may compromise circulation to the legs.

8. A

A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the two to three months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.

9. B

Diabetes insipidus is a condition in which the kidneys are unable to conserve water, often because there is insufficient antidiuretic hormone (ADH) or the kidneys are unable to respond to ADH. Although diabetes mellitus may present with similar symptoms, the disorders are different. Diabetes insipidus does not involve hyperglycemia.

10. C

The signs and symptoms that suggest type 1 diabetes include excessive thirst, hunger, urination, weight loss, fatigue, irritability, blurred vision, and infection with candida albicans (also known as yeast infections).

11. B

Excessively high blood sugar or prolonged hyperglycemia can cause diabetic ketoacidosis, the condition in which the body breaks down fat for energy and ketones spill into the urine. Diabetic hyperosmolar syndrome occurs when blood sugar is excessively high and available insulin is ineffective. In this case, the body cannot use glucose or fat for energy and glucose is excreted in the urine. Without immediate medical attention, both conditions may result in coma or death.

12. D

Hyperinsulinemia indicates a difficulty in blood sugar regulation; the pancreas is working to produce enough insulin to regulate blood sugar. Hyperinsulinemia may be cause by a tumor of insulin-producing cells (an insulinoma), excessive numbers of insulin producing cells (nesidioblastosis), or insulin resistance.

13. A

The prevalence of diabetes is increasing dramatically. The CDC reports an increase of more than three million cases in the two years from 2006 to 2008. By 2008, an estimated 8% of the U.S. population had diabetes.

14. B

The CDC reports that adults in the U.S. are at high risk of developing diabetes. Females are at higher risk than males and Hispanics/Latinos are at the greatest risk.

15. C

There is no evidence that eliminating all sugar from the diet benefits people with diabetes. It is more important for diabetics to manage and control total carbohydrate intake so that their blood glucose levels remain on target. Controlling blood glucose, blood pressure, and blood lipid levels can aid in the prevention of complications associated with diabetes.

16. D

Scatter laser treatment is used to shrink abnormal blood vessels in an effort to preserve vision. When there is significant bleeding in the eye, it is removed in a procedure known as vitrectomy. Tonometry is a diagnostic test that measures pressure inside the eye. A fluorescein angiogram is a diagnostic test that traces the flow of dye through the blood vessels in the retina; it is used to detect macular edema.

17. C

Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels

18. D

Using an insulin pump has many advantages, including fewer dramatic swings in blood glucose levels, increased flexibility about diet, and improved accuracy of insulin doses and delivery; however, the use of an insulin pump has been associated with weight gain.

19. D

Because persons with type 1 diabetes do not produce insulin, they require insulin and cannot be treated with oral anti-diabetic drugs. Several injections of insulin per day, calibrated to respond to measured blood glucose levels, offer the best blood glucose control and may prevent or postpone the retinal, renal, and neurological complications of diabetes.

20. D

Nerve conduction studies assess transmission of electrical signals through nerves and electromyography evaluates nerve transmission to muscles. Ultrasound can assess the responsivity and function of internal organs that may be compromised by neurological damage. Foot exams help to assess peripheral neuropathy and to ensure the integrity of skin. The MMPI is a psychological test and is not used to assess diabetic neuropathy.

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