Patient Education

Diabetes Mellitus is defined as a chronic illness associated with decreased or absent insulin production and/or improper action of insulin. This causes disturbance in food breakdown resulting in high blood sugar levels.

Insulin (produced in the pancreas) is a hormone that lowers the sugar level in the bloodstream.

Diabetes is diagnosed through a blood test performed by a physician. Diagnosis will occur by either of two methods, which are:

• A Fasting (no food or drink for at least 8 hours) Blood Sugar greater than or equal to 126 mg/dL on 2 or more occasions
• A Random (no reference to time of last meal consumed) Blood Sugar greater than or equal to 200 mg/dL on 2 or more occasions

Once the physician has determined that the blood sugar levels are elevated, then he or she will determine the type of diabetes and the proper treatment. There are three main types of diabetes.

Types of Diabetes
Type 1: In this type of diabetes, the pancreas produces absolutely no insulin. Medication therapy will only include insulin by injections or an insulin pump.

Type 2: In this type of diabetes, the pancreas continues to produce some insulin, but not enough to compensate for increased food intake or continued weight gain. Treatment includes a meal plan, pills and/or insulin by injections or an insulin pump.

Gestational Diabetes: This type of diabetes occurs during pregnancy, which usually is diagnosed during the second trimester. Treatment involves a strict meal plan and exercise.

Signs and Symptoms
Depending on personal blood sugar levels, one may not experience diabetic signs or symptoms. In many cases, diabetes has no symptoms. Are you at risk? When symptoms do arise, people do not necessarily connect them to diabetes. The most common symptoms of diabetes are:

• Being very thirsty
• Frequent urination (especially during the night)
• Unexplained weight loss or gain
• Increased hunger, especially after meals
• Blurred vision
• Skin infections
• Wounds that don't heal
• Extreme, unexplained fatigue

If you have any of the above symptoms, tell your physician immediately. To find out if you are at risk, take the Risk Factor Test provided by the American Heart Association.

The following are the diagnostic tests for diabetes:

• Fasting Plasma Glucose ³ 126 mg/dL on 2 or more occasions
• Random Plasma Glucose ³ 200 mg/dL on 2 or more occasions
• Oral Glucose Tolerance Test ³ 200 mg/dL at the 2-hour mark

Early diagnosis, treatment and control of diabetes is imperative to decrease any risk of long-term complications.

Are You at Risk?
Could you have diabetes and not know it? Take the test below, brought to you by the American Diabetes Association, to see how many risk factors you have for diabetes. Even if you do not test high, please see the list of common signs and symptoms of diabetes.

Sixteen million Americans have diabetes and one-third of them don't even know it! Take this test to see if you are at risk for having diabetes. Diabetes is more common in African-Americans, Hispanics, American Indians, Asian Americans and Pacific Islanders. If you are a member of one of these ethnic groups, you need to pay special attention to this test. To find out if you are at risk, calculate 5 points if the statement is true for you and 0 points if the statement is false. Finally, add your total score and see the results below.

• My weight is equal to or above that listed in the chart below. (yes = 5 points)
• I am under 65 years of age and I get little or no exercise. (yes = 5 points)
• I am between 45 and 65 years of age. (yes = 5 points)
• I am 65 years old or older. (yes = 9 points)
• I am a woman who has had a baby weighing more than nine pounds at birth. (yes = 1 point)
• I have a sister or brother with diabetes. (yes = 1 point)
  I have a parent with diabetes. (yes = 1 point)

Scoring

3 to 9 points
You are probably at low risk for having diabetes now. But don't forget about it - especially if you are Hispanic, American Indian, Asian American or Pacific Islander. You may be at a higher risk in the future. The new guidelines recommend that everyone 45 and older consider being tested for the disease every three years. However, people at high risk should consider being tested at a younger age.

10 or more points
You are at high risk for having diabetes. Only your health care provider can determine for sure if you have diabetes.

At-Risk Weight Chart

If you weigh the same or more than the amount listed for your height, you may be at risk for diabetes. This chart is based on Body Mass Index (BMI). The chart shows unhealthy weights for men and women age 35 or older at the listed heights. At-risk weights are lower for individuals under age 35.

Treatment
Treatment for diabetes can vary depending on each person's individual needs.

Nutrition: All people with diabetes should be using nutrition as part of their diabetes treatment. A meal plan containing the correct amount of carbohydrate, protein and fat can be figured in order to aid in controlling blood sugar levels and maintain a healthy weight. A registered dietitian is part of the diabetes care team here at Harris Methodist H•E•B Hospital.

Exercise: After receiving clearance from a physician, exercise should be a major component in diabetes treatment. Exercise can lower blood sugar levels as well as improve blood pressure, cholesterol, heart fitness and lower stress. Exercising and maintaining a healthy weight can reduce or eliminate the need for diabetes medication.

Blood Sugar Monitoring: Monitoring blood sugar levels at home is essential to good diabetes care. The American Diabetes Association recommends every person with diabetes test blood sugar levels two times per day unless on insulin, then the recommendation is four times per day. A physician or diabetes educator can recommend a blood glucose monitor that is appropriate.

Oral Medication: If blood sugar levels cannot be controlled through meal planning and exercise alone, oral medication may need to be added. There are many types of diabetes medications available; a physician can determine which type may be appropriate.

Insulin: Insulin is a medication taken by injection that aids in lowering sugar levels in the blood stream. For people diagnosed with Type 1 diabetes, as well as people with Type 2 diabetes who are unable to achieve blood sugar control with oral medication, insulin is the medication therapy of choice. There are several types of insulin; a physician can determine which type to prescribe.

Routine Care: It is very important for any person with diabetes to have routine diabetes care. A diabetes care team includes certified diabetes educators, which may include registered nurses or registered dietitians. The care team should also include a primary care physician, an opthamologist and a podiatrist. A yearly consultation with your care team is recommended for optimal health benefits.

Learn more about managing your diabetes at www.nutrition.gov.