Diabetes Questions and Answers

Question. What is diabetes?

A. Diabetes mellitus is a chronic disease in which blood glucose (sugar) levels are too high. Cells in the body break down glucose in order to provide energy for movement, growth, and repair. The hormone insulin is responsible for regulating glucose levels in the blood. Abnormally high levels of glucose can damage the small and large blood vessels, leading to diabetic blindness, kidney disease, amputations of limbs, stroke, and heart disease.

There are three common types of diabetes. Type 1 diabetes is usually (but not always) diagnosed in children and young adults. Persons with type 1 diabetes make no insulin and must take insulin every day. Type 2 diabetes is usually (but not always) diagnosed in adults over the age of 45. In type 2 diabetes, either the person is not making enough insulin, or the body is resistant to insulin and cannot use it properly. Gestational diabetes occurs during pregnancy: 2-4 percent of all pregnant women have gestational diabetes. If a woman has gestational diabetes, she has about a 40 percent chance of having type 2 diabetes later in her life.

About 17 million persons in America have Diabetes mellitus, but five million of them don't even know it. Nearly 1 million new cases are diagnosed each year. The disease affects men and women of all ages and ethnic groups. African Americans, Latinos, American Indians, Alaskan Natives, Asian Americans, and Pacific Islanders are more greatly affected than other groups.

For more information about diabetes, use the following links:

National Institute of Child Health and Development: Understanding Gestational Diabetes

MedlinePlus Health Information on Type 1 Diabetes

MedlinePlus Health Information on Type 2 Diabetes

HealthFinder: Diabetes

These sites will help answer your diabetes questions.

Question. How do I know if I have diabetes?

A. As many as 50 percent (one-half) of persons with type 2 diabetes are unaware that they have the disease. For this reason, it is particularly important to pay attention to the signs and symptoms of diabetes and its risk factors.

Some of the signs of either type 1 or type 2 diabetes are:

• being very thirsty
  
• urinating often
  
• feeling very hungry or tired
  
• losing or gaining weight without trying
  
• having sores that heal slowly
  
• having dry, itchy skin
  
• losing the feeling in your feet or having tingling in your feet
  
• having blurry eyesight

Symptoms of type 1 diabetes often develop over a short period of time. In type 2 diabetes, symptoms develop more slowly, and some persons never have any symptoms of the disease. If you are regularly having any of these signs and symptoms, you should tell your doctor.

Question. What factors increase my risk of getting diabetes?

A. Although researchers don't fully understand why some persons get diabetes and others don't, it is clear that certain factors increase your risk. You are at risk for having diabetes if:

• Your mother, father, sister, or brother has diabetes;
  
• You are African American, Hispanic American/Latino, American Indian, Native Alaskan, Asian American, or Pacific Islander;
  
• You have high blood pressure (at or above 130/80);
  
• You have a history of diabetes during pregnancy (gestational diabetes) or gave birth to a baby weighing more than nine pounds at birth;
  
• You are overweight or obese;
  
• You are inactive or have a sedentary lifestyle; or
  
• You are older than 45 years of age.

If you have one or more of these risk factors, even if you are experiencing no symptoms, your doctor may want to test you for diabetes.

Question. How will my doctor test me for diabetes?

A. Although the amount of glucose in your blood varies depending on when and what you eat, the range should be relatively narrow. In general, your blood sugar is highest after you eat and lowest after you have not eaten for 8-10 hours. After fasting all night, most persons have blood glucose levels between 70 and 110 milligrams of glucose per deciliter of blood (mg/dL). After eating a large meal, a person's blood sugar will rise, but generally not above 140 mg/dL. People with untreated diabetes will have higher blood sugars after fasting and after eating.

To check if you have diabetes, your doctor will test your blood sugar levels. The results of these tests and other clinical findings will be used to decide if you have diabetes and what type. Doctors cannot diagnose diabetes on the basis of one single test. Instead, they will perform two or more glucose tests before confirming your diagnosis. The most common tests to measure glucose are the fasting plasma glucose test, the random blood sugar test, and the oral glucose tolerance test.

• Fasting plasma glucose test. Most experts recommend using a fasting plasma glucose test to diagnose diabetes. Before taking this test, you cannot eat anything for 8 to 10 hours. Blood will be drawn from a vein in your arm and sent to a laboratory for testing. If your fasting blood glucose is 126 mg/dL or higher, your doctor will probably diagnose you with diabetes.
   
• Random blood sugar test. Many cases of diabetes are found during routine physical exams when blood is drawn for other tests. Since you don't necessarily fast before these physical exams, you may have just eaten and your blood sugar may be high. Even so, it shouldn't be higher than 200 mg/dL. If your random blood glucose is higher than 200 mg/dL, your doctor will probably suspect diabetes and may want to give you a fasting plasma glucose test.
   
• Oral glucose tolerance test. In this test, a person consumes a drink containing glucose dissolved in water. Blood is then drawn in timed intervals over a three-hour period. If plasma glucose levels rise more than expected, the person is diagnosed with diabetes. This test is often used to check pregnant women for gestational diabetes. It is rarely used to diagnose diabetes in other patients, because it is cumbersome and time-consuming.

Question. How can I reduce my chance of getting diabetes?

A. A recent study funded by the Federal government of 3,234 persons at high risk for diabetes showed that diet and exercise can sharply lower the risk of getting type 2 diabetes.

The Diabetes Prevention Program (DPP) was a major clinical study of ways to prevent or delay diabetes in persons at high risk for type 2 diabetes. Patients were overweight and had higher than normal levels of blood glucose, called impaired glucose tolerance. Both conditions are strong risk factors for type 2 diabetes. Because of the high risk among some minority groups, about half of the DPP participants were African American, American Indian, Asian American, Pacific Islander, or Hispanic.

The DPP compared two methods for preventing diabetes: (1) an intensive program of healthy eating and exercise and (2) the use of metformin, a diabetes drug. Persons who engaged in moderate physical activity for about 30 minutes a day, followed a low-fat and low-calorie diet, and lost 5 to 7 percent of their body weight (or about 12 pounds for someone who weighs 200 pounds) cut their risk of getting type 2 diabetes by about one half (58%). Those persons receiving metformin reduced their risk by one third (31%).

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I hope the answers to these diabetes questions have been helpful. If you have any other questions about diabetes, or if you suspect you may have the disease, be sure to consult with a doctor. Diabetes is a serious disease, so be sure to take it seriously.