Everything You Need To Know About Diabetes My Baba 14 November, 2017 Expert November brings a change in seasons and weather for many. It also is a start to many of the celebrations we will enjoy with others in the coming months. For many, this is also an important month to celebrate something a bit deeper and more personal. November is National Diabetes Awareness Month, which is an effort put forth by the American Diabetes association. The organisation hopes to bring attention to the condition that so many live with, and educate on the differences in type of diabetes as well as the warning signs for those who may be at risk and encourage people to make healthy lifestyle changes. As a world wide effort to educate and empower we also celebrate World Diabetes Day on November 14th. As of 2015, per several surveys conducted by the CDC, the statistics on prevalence of diabetes show that about 9.4% of the US population have diabetes (about 30 million people). The amazing thing is that while 23 million noted knowledge of having diabetes, 7 million were not yet diagnosed. It is also estimated that about 1.5 million are diagnosed with diabetes every year in those who are older than 18 with greater than 50% in adults in mid-40’s to mid-60’s age. And, the incidence is also higher for those of African American and Hispanic heritage. This fact makes the effort this month towards awareness of what diabetes is, risk factors and warning signs to watch for, and lifestyle changes for prevention very important indeed! There are several types of diabetes we commonly hear about. They are: Pre-diabetes, type 2 diabetes – affecting about 90-95% of the population with diabetes, type 1 diabetes – affecting about 5% of those with diabetes and Gestational Diabetes – diabetes that occurs during pregnancy. With so many types, it is important to know the basic differences, risk factors and the warning signs. Prediabetes is a condition in which blood glucose (sugar) levels are higher than normal but not yet high enough to diagnose diabetes. Often lifestyle changes such as weight loss and an increase in activity level are a good way to prevent a future diagnosis of type 2 diabetes. Are you at risk? Adults older than 45 years and who are overweight Adults younger than 45 years who are overweight, inactive, have a family history of diabetes and high blood pressure What can you do to prevent? Lifestyle changes such as weight loss and an increase in activity can give a greater than 50% reduction in progression to type 2 Diabetes. Type 2 diabetes is the most common form of diabetes. The hallmark of type 2 diabetes is that your body does not use insulin the right way which causes blood glucose (sugar) to increase in the body to levels higher than normal. Insulin is the hormone made by the pancreas that is released into the blood when glucose levels go up, most often after eating. Insulin helps glucose get into the body cells where it is either used as energy or stored to use later. In the early stage of development, the pancreas tries to compensate for the body not using insulin the right way and it pumps out extra, but over time it can’t keep up to keep blood glucose levels normal. Type 2 diabetes is often managed with lifestyle changes such as healthy eating and a change in activity level. If this is not enough or if blood glucose levels are too high upon diagnosis then oral medication, insulin or other injectable medication may be used to help bring blood glucose down along with the lifestyle changes. Are you at risk? Higher risk for those of African American, Latino, Native American or Asian/Pacific Islander descent. Those older than 65 are at higher risk. Family history/genetics Sedentary lifestyle/overweight Previous history of impaired fasting glucose (blood sugar that is higher than normal upon waking in the morning) High blood pressure and cholesterol Polycystic ovarian syndrome (specific for women) Previous history of Gestational diabetes during pregnancy or having a baby larger than 9 lbs. at birth. What are the warning signs? (These typically develop slowly over time) Increased thirst and a dry mouth Increase in going to the bathroom, and having to go overnight Weight loss despite not trying and with a possible increase in appetite Feeling very weak and tired Change in vision – blurred or issues with headaches Dry skin Type 1 Diabetes is an autoimmune disease that causes the body to attack the insulin producing cells in the pancreas and destroys them. Someone with type 1 diabetes will always have to use insulin to help regulate blood glucose levels since their body no longer makes it. Lifestyle changes make a difference for those with type 1 as well. Attention to food and activity aid with management considerably. Are you at risk? Family history of type 1 in parents or siblings Ethnic background – more common in Caucasians Geography – more commonly diagnosed in colder times of the year or colder climates Exposure to some viruses – such as the coxsackie viruses Age – most commonly diagnosed in childhood or adolescence but can also occur in adults of any age What are the warning signs? (These typically develop suddenly over a few days or weeks) Significant quick weight loss (despite an increase in appetite) Thirst that is not satisfied Change in vision – often blurry. Low energy levels – frequent naps in usually active kids Increase in going to the bathroom Bedwetting in children who were previously potty trained Breath that smells fruity or like nail polish remover Excessive wet diapers in babies and toddlers Gestational Diabetes is a condition specific to pregnant women. In the second trimester all women are given a test called a glucose tolerance test. The test is done at this point as the placenta is making large amounts of pregnancy hormones that can cause resistance to insulin. This test shows how well the body responds to sugar. If blood glucose levels are elevated during this test gestational diabetes is diagnosed. This type of diabetes happens later in pregnancy (2nd trimester), so it doesn’t cause the type of birth defects that are seen in babies of mothers who have diabetes prior to pregnancy. It can, however, cause harm to the developing baby by supplying more glucose to the developing child. This excess of sugar causes the baby’s pancreas to have to make more than the normal amount of insulin to keep its blood glucose normal which is then stored as fat. A big baby (called macrosomia) and the mother can face problems during or after delivery such as breathing problems, damage to the babies shoulders, possibility of c-section due to inability to birth vaginally, and a risk of very low blood glucose in the infant after delivery. Children of mothers who had poorly managed gestational diabetes are also at higher risk of being overweight and developing type 2 diabetes later in life. For most women, this form of diabetes goes away after delivery. Who is at risk? Women who are overweight and sedentary High blood pressure and cholesterol levels Women who smoke Unhealthy diet Family history of type 2 diabetes Women who have had gestational diabetes previously are at a greater risk for developing in future pregnancy What are the warning signs? (Talk to your OB team if you experience any of these symptoms even before or after the glucose tolerance test) High levels of sugar in urine (seen in a urine sample at your OB office) Thirst that is unusual Increase in urination (more than normal increase in pregnancy) Recurrence of vaginal or bladder infections Recurrence of nausea or development of nausea in 2nd trimester Change in vision – blurry Can I have a healthy pregnancy with diabetes? Women with gestational, type 1 or type 2 diabetes can all have healthy and successful pregnancies. Tight management of blood glucose is the key. Aim to get exercise daily, eat a healthy diet, use medication as prescribed and work closely with your health care team to make sure your glucose levels are optimal during pregnancy. Working with a Certified Diabetes Educator can make a big difference in management and help you and the baby stay healthy as well. A diagnosis with diabetes can be overwhelming, but there is a lot of good support. If you feel you may have any of the listed symptoms, the best option is to check in with your primary care doctor. They can do a few simple tests to evaluate your blood glucose level and let you know if the symptoms are related to diabetes. If so, ask for a visit with a Certified Diabetes Educator or attend a group class so you can get started managing your diabetes optimally from the beginning. Jennifer Smith, RD, LD, CDE is the Director of Lifestyle and Nutrition at Integrated Diabetes Services (http://integrateddiabetes.com/what-we-do/) . She works with people who live with all types of diabetes around the world to provide skills for successful management of diabetes. She has lived with type 1 diabetes for 29 years herself, so she has first-hand knowledge of the day-to-day events that affect diabetes management. As a talented dietitian, diabetes educator, athlete, mother and person with diabetes, Jennifer is in a unique position to assist Integrated Diabetes Services’ intensively managed clients.