Diabetes and Carb Counting For Dummies. Shafer Sherri

Your eye specialist should evaluate your baseline vision once your glucose levels have stabilized in the near normal range.

      • Uncontrolled diabetes can lead to nerve damage. Peripheral neuropathy, which refers to the nerves farthest from the brain and spinal cord, can cause tingling, burning, pain, or numbness in the feet or hands.

      • High blood glucose means more sugar is available for yeast and bacteria to thrive on, so infections can fester.

      • Healing may be impaired because the body’s immune system is compromised when glucose is out of control.

      

The symptoms associated with diabetes are not diagnostic and are sometimes related to other medical conditions. Discuss all medical concerns with your healthcare providers. Diabetes screening protocols are based on risk factors including weight and age and are clarified later in the chapter.

       Distinguishing the types of diabetes

      There are several types of diabetes. The suggested treatment depends upon the type. The vast majority of people have type 2 diabetes. Some people with type 2 diabetes can achieve control through diet and exercise modifications, while others need to add one or more oral medications. Everyone with type 1 diabetes and some people with type 2 diabetes require insulin.

       Type 1 diabetes

      Type 1 diabetes is an autoimmune disease. The body’s immune system, which is supposed to fight off bacteria, mistakenly destroys the insulin-producing beta-cells of the pancreas. People with type 1 diabetes no longer make insulin, so they must take insulin to live.

      In the past this form of diabetes was called juvenile diabetes, insulin-dependent diabetes, or IDDM (short for insulin-dependent diabetes mellitus). The preferred term is type 1 diabetes, which may be abbreviated T1DM or T1D. The old terms don’t hold true for all cases. Not all kids with diabetes have type 1; there are many adolescents with type 2 diabetes. Insulin is used to treat other forms of diabetes, not just type 1. While it is true that type 1 diabetes is most often diagnosed when a person is below the age of 20, some adults are diagnosed with type 1 diabetes in their 20s, 30s, 40s, and even later.

      Blood tests can determine whether the diagnosis is type 1 diabetes by detecting autoimmune markers in the blood. Another lab test called C-peptide estimates the amount of insulin being produced. (Find out more about diagnosing diabetes later in this chapter.)

       Type 2 diabetes

      Type 2 diabetes is due to insulin resistance. People with type 2 diabetes make insulin, but the insulin doesn’t work very well. Their own cells are resistant to the action of their insulin. Type 2 diabetes is due to a progressive insulin deficiency imposed on top of the initial insulin resistance.

      Previously it was called adult-onset, non-insulin-dependent diabetes, or NIDDM (non-insulin-dependent diabetes mellitus). The current standard is to call it type 2 diabetes, which can be abbreviated T2DM or T2D. Unfortunately, type 2 diabetes often occurs alongside of high blood pressure and dyslipidemia (abnormal blood fats). A major shift must take place in the lifestyle of Americans to turn this trend around.

       Prediabetes

      Prediabetes is when blood-glucose levels are above normal but not yet in the range of diabetes. One in three American adults has blood-glucose levels in the prediabetes range. Up to 90 percent of them don’t know it. Prediabetes can lead to type 2 diabetes within five to ten years. The good news is that studies clearly show that progressing to type 2 diabetes isn’t inevitable. Weight loss of roughly 5–10 percent of starting weight coupled with moderate exercise of at least 150 minutes per week reduces the risk by up to 58 percent. Early detection and intervention may return blood-glucose levels to near normal ranges.

       Gestational diabetes

      Gestational diabetes is typically diagnosed in the second or third trimester of pregnancy. Pregnancy hormones interfere with the way insulin works by inducing a state of insulin resistance. As the pregnancy progresses, the mother’s pancreas has to work harder to make enough insulin to keep blood-glucose levels controlled. Some women simply can’t keep up with the demand, and they get diabetes during pregnancy, which resolves after delivery. Gestational diabetes is abbreviated as GDM (gestational diabetes mellitus). Women should be screened for GDM at 24 to 28 weeks of pregnancy. GDM also indicates a risk for developing type 2 diabetes in the future. (See Chapter 17 and the nearby sidebar “Diabetes and pregnancy” for more information.)

       Other forms of diabetes

      Other forms of diabetes make up only a small fraction of the cases of diabetes. These forms include the following:

      ❯❯ Neonatal diabetes occurs within the first six months of life and can be transient or permanent. Genetic testing is needed to clarify the defect, because some babies are best treated with oral medications while others require insulin.

      ❯❯ Cystic fibrosis–related diabetes (CFRD) can affect as many as half of the adults and 20 percent of the children who have cystic fibrosis. Insulin is the therapy of choice for CFRD.

      ❯❯ Maturity-onset diabetes of the young (MODY) is inherited and caused by any number of different chromosomal mutations. Treatment depends upon the specific genetic defect, so testing is required to clarify the diagnosis.

DIABETES AND PREGNANCY

      Diabetes during pregnancy is considered a high-risk pregnancy. It is imperative for women with type 1 and type 2 diabetes to have tightly controlled blood-glucose levels prior to becoming pregnant. Uncontrolled diabetes can have devastating consequences. When maternal glucose levels are elevated, the extra glucose readily passes to the baby and that can cause big problems. High blood glucose in the first trimester increases the risk of birth defects and miscarriage. Gestational diabetes doesn’t develop until later in the pregnancy, so birth defects aren’t a concern with GDM.

      There are late-pregnancy risks that apply to women with type 1, type 2, and gestational diabetes. High glucose in the second half of the pregnancy can cause the baby to grow too big, which makes for a riskier delivery for both baby and mom. Uncontrolled glucose levels also increase the risk of preeclampsia and stillbirth. Stringent glucose control throughout the entire pregnancy is critical. Women with diabetes who are of childbearing age should have preconception counseling. Some medications are not safe for the baby and thus must be discontinued prior to conception, including meds used to treat hypertension and cholesterol. Have a discussion with your healthcare provider. For more information on managing diabetes during pregnancy, see Chapter 17.

Recognizing Diabetes Risk Factors and Getting Diagnosed

      The onset of type 1 diabetes tends to be sudden and come as a complete surprise. Prediabetes and type 2 diabetes can go undetected for years. Early diagnosis and intervention improve outcomes. I address screening protocols and diagnostic testing in the following sections.