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Diabetes or Diabetes Mellitus (m?li't?s), is a chronic disorder of glucose (sugar) metabolism caused by inadequate production or use of insulin, a hormone produced in specialized cells (beta cells in the islets of Langerhans) in the pancreas that allows the body to use and store glucose.
It is a leading cause of death in the United States and is especially prevalent among African Americans. The treatment of diabetes was revolutionized when F. G. Banting and C. H. Best isolated insulin in 1921.
Last Updated - 2nd November 2005
The lack of insulin results in an inability to metabolize glucose, and the capacity to store glycogen (a form of glucose) in the liver and the active transport of glucose across cell membranes are impaired. The symptoms are elevated sugar levels in the urine and blood, increased urination, thirst, hunger, weakness, weight loss, and itching. Prolonged hyperglycemia (excess blood glucose) leads to increased protein and fat catabolism, a condition that can cause premature vascular degeneration and atherosclerosis. Uncontrolled diabetes leads to diabetic acidosis, in which ketones build up in the blood. Patients have sweet-smelling breath, and may suffer confusion, unconsciousness, and death. There are two distinct types of diabetes mellitus: insulin-dependent and noninsulin-dependent.
Insulin-dependent diabetes (Type I), also called juvenile-onset diabetes, is the more serious form of the disease; about 10% of diabetics have this form. It is caused by destruction of pancreatic cells that make insulin and usually develops before age 30. Type I diabetics have a genetic predisposition to the disease. There is some evidence that it is triggered by a virus that changes the pancreatic cells in a way that prompts the immune system to attack them. The symptoms are the same as in the non-insulin-dependent variant, but they develop more rapidly and with more severity. Treatment includes a diet limited in carbohydrates and saturated fat, exercise to burn glucose, and regular insulin injections, sometimes administered via a portable insulin pump. Transplantation of islet cells has also proved successful since 1999, after new transplant procedures were developed, but the number of pancreases available for extraction of the islet cells is far smaller than the number of Type I diabetics. Patients receiving a transplant must take immunosuppressive drugs to prevent rejection of the cells.
Noninsulin-dependent diabetes (Type 2), also called adult-onset diabetes, results from the inability of the cells in the body to respond to insulin. About 90% of diabetics have this form, which is more prevalent in minorities and usually occurs after age 40. Although the cause is not completely understood, there is a genetic factor and 90% of those affected are obese. As in Type I diabetes, treatment includes exercise and weight loss and a diet low in total carbohydrates and saturated fat. Some individuals require insulin injections; many rely on oral drugs, such as sulphonylureas, metformin, or acarbose.
Diabetes affects the way the body handles fats, leading to fat accumulation in the arteries and potential damage to the kidneys, eyes, heart, and brain, and statins (cholesterol-lowering drugs) may be prescribed to prevent heart disease. It is the leading cause of kidney disease. Many patients require dialysis or kidney transplants. Most cases of acquired blindness in the United States are caused by diabetes. Diabetes can also affect the nerves, causing numbness or pain in the face and extremities. A complication of insulin therapy is insulin shock, a hypoglycemic condition that results from an oversupply of insulin in relation to the glucose level in the blood.
RISK FACTORS for TYPE 2 DIABETES
- Family history
- Being age 40 or over
- Being overweight (20 percent more than ideal weight)
- Inactive lifestyle
- African-American, Hispanic, Pacific Island or Native American descent
- Having a history of gestational diabetes (diabetes during pregnancy)
- Dry mouth.
- Increased thirst
- Frequent urination
- Increased appetite (Type 1 only)
- Unexplained weight loss (Type 1 only)
- Feeling week, tired and dizzy
- Frequent skin infections
- Slow healing wounds
- Recurrent vaginal infections
- Blurry vision
- Tingling or numbness in the hands or feet
- Fast, shallow breathing
- Fruity-smelling breath
- Take insulin or medications as prescribed
- Eat a healthy diet to keep your blood sugar in control and pay special attention to eating low-fat foods
- Exercise regularly to help regulate your blood sugar level, reduce your risk for heart disease and control weight
- Track the food you eat and the kind and amount of exercise you get
- Take good care of your feet as diabetes may damage nerves and reduce the blood flow to your feet
- Get regular eye exams. Diabetic retinopathy can cause blindness. Early detection and treatment can slow the process and save your sight
- Have regular medical checkups. If you are diabetic or know someone who is, call a health professional if signs of low blood sugar last more than 15 minutes
SIGNS of LOW BLOOD SUGAR
- Confusion, irritability
- Slurred speech
- Fatigue, weakness
- Extreme hunger
- Rapid heartbeat
- Blurry vision
- Dizziness, headache.
How to Prevent Diabetes
Pre-diabetes is a serious medical condition that can be treated. Diabetes Prevention studies conclusively showed that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range.
While studies also showed that some medications may delay the development of diabetes, diet and exercise worked better. Just 30 minutes a day of moderate physical activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in diabetes.
Diabetes and Diet
How Does Diabetes Affect Diet?
Normally, the body produces a hormone called insulin. With diabetes, the ability to make or utilize insulin is impaired. Without insulin, the body can't properly use glucose, the simple sugar the body produces from the food we eat. Insulin is the key that unlocks cells and lets the glucose enter, thus providing energy for critical cell metabolism.
The regulation of blood sugar in the non-diabetic is automatic, adjusting to whatever foods are eaten. For the diabetic, however, extra care must be taken to balance food intake (and the resultant impact on blood sugar levels) with insulin injections, exercise and any other glucose altering activity.
Type 1 or Type 2 Diabetes?
- Some recommendations for a diabetic diet depend on the type of diabetes you have. In Type 1 diabetes the focus is mostly on matching food intake to insulin. You'll need to know when your insulin peaks and how quickly you metabolize different foods. In Type 2 diabetes the concern may be more oriented to weight loss in order to improve the body's ability to utilize the insulin it does produce.
- In both Type 1 and Type 2 diabetes, as well as in gestational diabetes, the overall goal is to gather enough nutritional information to maintain a healthful diet and avoid large fluctuations in your blood sugar levels.
What Is the Glycemic Index?
Not all carbohydrates are created equal, nor will they all affect your blood sugar in the same way. Researchers have created a glycemic index that ranks foods according to their ability to raise blood sugar.
The glycemic index is a ranking of carbohydrates based on their immediate effect on blood glucose (blood sugar) levels. It compares foods gram for gram of carbohydrate. Carbohydrates that breakdown quickly during digestion have the highest glycemic indexes. The blood glucose response is fast and high. Carbohydrates that break down slowly, releasing glucose gradually into the blood stream, have low glycemic indexes.
Lowering insulin levels is not only a key ingredient in weight loss, but also the secret to long-term health. Low GI Diet makes weightloss achievable and sustainable.
What is the Significance of Glycemic Index?
- Low GI means a smaller rise in blood glucose levels after meals
- Low GI diets can help people lose weight
- Low GI diets can improve the body's sensitivity to insulin
- High GI foods help re-fuel carbohydrate stores after exercise
- Low GI can improve diabetes control
- Low GI foods keep you fuller for longer
- Low GI can prolong physical endurance
What is Glycemic Load?
- Glycemic load builds on the GI to provide a measure of total glycemic response to a food or meal
- Glycemic load = GI (%) x grams of carbohydrate per serving
- One unit of GL ~ glycemic effect of 1 gram glucose
- You can sum the GL of all the foods in a meal, for the whole day or even longer
- A typical diet has ~ 100 GL units per day (range 60 - 180)
- The GI database gives both GI & GL values
How to Switch to a Low GI Diet
- Use breakfast cereals based on oats, barley and bran
- Use "grainy" breads made with whole seeds
- Reduce the amount of potatoes you eat
- Enjoy all types of fruit and vegetables (except potatoes)
- Eat plenty of salad vegetables with vinaigrette dressing
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