Diabetes
______________
Contents
1. National Diabetes StatisticsWhat Is Diabetes?
Types of Diabetes
Treatment of Diabetes
Impaired Glucose Tolerance and Impaired Fasting Glucose
Prevention of Diabetes
Prevention of Diabetes Complications
Glucose Control
Blood Pressure Control
Control of Blood Lipids
Preventive Care Practices For Eyes, Kidneys, and Feet
Methods
Prevalence of Diabetes
Prevalence of Diabetes Among People Under 20 Years of Age
Prevalence of Diabetes Among People 20 Years or Older
Prevalence of Diabetes by Race/Ethnicity Among People 20 Years or Older
Incidence of Diabetes
Deaths Among People With Diabetes
Complications of Diabetes
Stroke
High Blood Pressure
Blindness
Kidney Disease
Nervous System Disease
Amputations
Dental Disease
Complications of Pregnancy
Other Complications
Cost of Diabetes in the United States
Heart Disease
Acknowledgments
2. Diabetes in African Americans
How Many African Americans Have Diabetes?
What Risk Factors Increase the Chance of Developing Type 2 Diabetes?
Genetic Risk Factors
Medical Risk Factors
Figure 1. Prevalence of diagnosed and undiagnosed diabetes in African Americans, U.S., 1988-94.
Gestational Diabetes (GDM)
Hyperinsulinemia and Insulin Resistance
Obesity
Physical Activity
How Does Diabetes Affect African American Children?
How Does Diabetes Affect African American Women During Pregnancy?
Figure 2. Time trends in the percentage of adolescents and adults in the U.S. who are overweight, U.S., 1988-94
How Do Diabetes Complications Affect African Americans?
Eye Disease
Kidney Failure
Amputations
Does Diabetes Cause Excess Deaths in African Americans?
How Is NIDDK Addressing the Problem of Diabetes in African Americans?
Prevention
Figure 3. Mortality rates in African American and white diabetic men and women in a sample of the U.S. population, 1971-1993.
National Diabetes Education Program
Points to Remember
References
3. Diabetes in Hispanic Americans
Major Studies of Diabetes in Hispanic Americans
How Many Hispanic Americans Have Diabetes?
Table 1. Hispanic American Populations in the United States and Percentage With Diabetes
Figure 1. Prevalence of diagnosed and undiagnosed diabetes in Mexican Americans, U.S., 1988-94
What Factors Increase the Chance of Developing Type 2 Diabetes?
Genetic Risk Factors
Figure 2. Genetic origins of the major Hispanic subgroups in the United States
Medical and Lifestyle Risk Factors
Prediabetes (Impaired Glucose Tolerance and Impaired Fasting Glucose)
Gestational Diabetes
Hyperinsulinemia and Insulin Resistance
Obesity
Physical Activity
Figure 3. Prevalence of overweight individuals among whites, blacks, and Mexican Americans in the population, 1988-91
How Does Diabetes Affect Hispanic Young People?
How Does Diabetes Affect Hispanic Women During Pregnancy?
How Do Diabetes Complications Affect Hispanic Americans?
Eye Disease
Kidney Disease
Nerve Disease
Peripheral Vascular Disease
Heart Disease
How Is NIDDK Addressing the Problem of Diabetes in Hispanic Americans?
Diabetes Prevention Program
National Diabetes Education Program
Points to Remember
References
4. Diabetes in American Indians and Alaska Natives
How Many American Indians and Alaska Natives Have Diabetes?
Type 2 Diabetes
Table 1. Age-adjusted prevalence of diagnosed diabetes among American Indians/Alaska Natives, age 20 and older, by group of tribes–United States, 1997
Table 2. Prevalence of diagnosed diabetes among American Indians/Alaska Natives and non-Hispanic whites, age 20 and older, by age and sex– United States, 1997.
Type 1 Diabetes
What Risk Factors Increase the Chance?
Genetic Risk Factors
Medical and Lifestyle Risk Factors
Obesity
Diet and Physical Inactivity
Prediabetes (Impaired Glucose Tolerance and
Impaired Fasting Glucose)
Hyperinsulinemia and Insulin Resistance
How Does Diabetes Affect American Indian and Alaska Native Women During Pregnancy?
How Does Diabetes Affect Cardiovascular Health in American Indians and Alaska Natives?
Ischemic Heart Disease
Stroke
Hypertension
How Do Diabetes Complications Affect American Indians and Alaska Natives
Diabetic Retinopathy
Cataracts
Diabetic Nephropathy
Lower Extremity Amputation
Periodontal Disease
Infections
Does Diabetes Cause an Inordinate Number of Deaths in American Indians and Alaska Natives?
How Is NIDDK Addressing the Problem of Diabetes in American Indians?
Diabetes Prevention Program
Points to Remember
References
5. Diabetes in Asian and Pacific Islander Americans
Table 1. Asian and Pacific Islander ethnicities in the United States
How Many Asian and Pacific Islander Americans Have Diabetes?
Type 2 Diabetes
Table 2. Prevalence of diabetes in the United States in non-Hispanic white people, Asian Americans, and Native Hawaiians.
Type 1 Diabetes
What Risk Factors Increase the Chance That Asian and Pacific Islander Americans Will Develop Type 2 Diabetes?
Genetic Risk Factors
Lifestyle and Medical Risk Factors
Obesity
Diet and Physical Inactivity
Prediabetes (Impaired Glucose Tolerance and Impaired Fasting Glucose)
Hyperinsulinemia and Insulin Resistance
How Does Diabetes Affect Asian and Pacific Islander American Women During Pregnancy?
How Does Diabetes Affect Cardiovascular Health in Asian and Pacific Islander Americans?
How Do Diabetes Complications Affect Asian and Pacific Islander Americans?
Diabetic Retinopathy
Diabetic Nephropathy
Lower Extremity Amputation
Does Diabetes Cause an Inordinate Number of Deaths in Asian and Pacific Islander Americans?
How Is NIDDK Addressing the Problem of Diabetes in Asian and Pacific Islander Americans?
Diabetes Prevention Program
Points to Remember
References
6. Diabetes Diagnosis
Questions to Ask Your Doctor About Blood Sugar
7. About Pre-Diabetes
How Do You Tell If You Have Pre-Diabetes?
What You Can Do
Frequently Asked Questions
Q: What is pre-diabetes and how is it different from diabetes?
Q: Is pre-diabetes the same as Impaired Glucose Tolerance or Impaired Fasting Glucose?
Q: Why do we need to give it a new name? Has the condition changed?
Q: How do I know if I have pre-diabetes?
Q: How does the FPG test define diabetes and pre-diabetes?
Q: How does the OGTT define diabetes and pre-diabetes?
Q: Which test is better?
Q: Why do I need to know if I have pre-diabetes?
Q: Will my insurance cover testing and treatment?
Q: What is the treatment for pre-diabetes?
Q: Who should get tested for pre-diabetes?
Q: How often should I be tested?
Q: Could I have pre-diabetes and not know it?
Q: Should children be screened for pre-diabetes?
8. Am I At Risk For Type 2 Diabetes?
What Is Type 2 Diabetes?
How Can Type 2 Diabetes Be Prevented?
What Are the Signs and Symptoms of Type 2 Diabetes?
Types of Diabetes
Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes
Should I Be Tested For Diabetes?
What Does It Mean to Have Pre-Diabetes?
Besides Age and Overweight, What Other Factors Increase My Risk For Type 2 Diabetes?
What Can I Do About My Risk?
Doing My Part: Getting Started
Reach and Maintain a Reasonable Body Weight
Make Wise Food Choices Most of the Time
Be Physically Active Every Day
Take Your Prescribed Medications
9. Hypoglycemia
How Does the Body Control Glucose?
What Are the Symptoms of Hypoglycemia?
Hypoglycemia in Diabetes
Managing Hypoglycemia in Diabetes
Other Causes of Hypoglycemia
Diagnosis
Reactive Hypoglycemia
Rare Causes of Hypoglycemia
Resources on Hypoglycemia
Additional Readings
10. What I Need to Know About Eating and Diabetes
How Food Affects Your Blood Glucose
Blood-glucose Levels
Noninvasive Blood Glucose Monitors
How Can I Keep My Blood Glucose at a Health Level?
Why Should I Eat About the Same Amount at the Same Times Each Day?
Your Diabetes Medicines
Your Exercise Plan
Hypoglycemia
The Food Pyramid
Starches
Vegetables
Fruit
Milk and Yogurt
Meat and Meat Substitutes
Fats and Sweets
Alcohol
Your Meal Plan
Measuring Your Food
When You Are Sick
Points to Remember
How to Find More Help
11. Kidney Disease of Diabetes
Prevent Diabetes Problems: Keep Your Kidneys Healthy
The Course of Kidney Disease
Five Stages
Effects of High Blood Pressure
Preventing and Slowing Kidney Disease
Blood Pressure Medicines
Low-Protein Diets
Intensive Management of Blood Glucose
Dialysis and Transplantation
Good Care Makes a Difference
Looking to the Future
References
12. Prevent Diabetes Problems: Keep Your Kidneys Healthy
What are diabetes problems?
What should I do each day to stay healthy with diabetes?
What do my kidneys do?
How can I prevent diabetes kidney problems?
Is there a medicine to slow down kidney damage?
How can my doctor protect my kidneys during special x-ray tests?
How can diabetes hurt my kidneys?
What can I do if I have diabetes kidney problems?
How will I know if my kidneys fail?
What happens if my kidneys fail?
Will I know if I start to have kidney problems?
How can I find out if I have kidney problems?
Will my doctor do other kidney tests?
13. End-Stage Renal Disease: Choosing a Treatment That’s Right For You
When Your Kidneys Fail
Treatment Choice: Hemodialysis
Purpose
How It Works
Getting Ready
Who Performs It
The Time it Takes
Possible Complications
Your Diet
Pros and Cons
Working With Your Health-Care Team
Treatment Choice: Peritoneal Dialysis
Purpose
How It Works
Getting Ready
Types of Peritoneal Dialysis
Possible Complications
Your Diet
Pros and Cons
Working With Your Health-Care Team
Dialysis Is Not a Cure
Treatment Choice: Kidney Transplantation
Purpose
How It Works
Getting Ready
The Time It Takes
Possible Complications
Your Diet
Pros and Cons
Working With Your Health-Care Team
Conclusion
Paying for Treatment
Medicare
Private Insurance
Medicaid
Veterans Administration (VA) Benefits
Social Security Income (SSI) and Social Security Disability Income (SSDI)
Organizations That Can Help
Additional Reading
14. Diabetic Neuropathies: The Nerve Damage of Diabetes
Causes
Symptoms
Types of Diabetic Neuropathy
Neuropathy Affects Nerves Throughout the Body
Peripheral Neuropathy
Autonomic Neuropathy
Proximal Neuropathy
Focal Neuropathy
Peripheral Neuropathy
Autonomic Neuropathy
Unawareness of Hypoglycemia
Heart and Circulatory System
Digestive System
Urinary Tract and Sex Organs
Sweat Glands
Eyes
Proximal Neuropathy
Focal Neuropathy
Preventing Diabetic Neuropathy
Diagnosis
Treatment
Foot Care
Pain Relief
Gastrointestinal Problems
Dizziness and Weakness
Urinary and Sexual Problems
Points to Remember
Hope Through Research
For More Information
15. Gastroparesis and Diabetes
What Is Gastroparesis?
Symptoms
Complications of Gastroparesis
Major Causes of Gastroparesis
Diagnosis
Treatment
Insulin For Blood Glucose Control in People With Diabetes
Medication
Meal and Food Changes
Feeding Tube
Parenteral Nutrition
Points to Remember
16. Impotence
How Does an Erection Occur?
What Causes Impotence?
How Is Impotence Diagnosed?
Patient History
Physical Examination
Laboratory Tests
Other Tests
Psychosocial Examination
How Is Impotence Treated?
Psychotherapy
Drug Therapy
Vacuum Devices
Surgery
What Will the Future Bring?
Points to Remember
Resources for More Information
17. Keep Your Nervous System Healthy
What Are Diabetes Problems?
What Can I Do Each Day to Stay Healthy With Diabetes?
What Can I Do to Prevent Diabetes From Damaging My Nervous System?
What Can I Do to Take Care of My Feet?
What Does My Nervous System Do?
How Can Diabetes Hurt My Nervous System?
How Can Diabetes Damage to The Peripheral Nerves Affect Me?
How Can Diabetes Damage to the Autonomic Nerves Affect Me?
How Can Diabetes Damage to the Cranial Nerves Affect Me?
How Do I Know if I Have Nerve Damage?
For More Information
18. Keep Your Heart and Blood Vessels Healthy
What Are Diabetes Problems?
What Should I Do Each Day to Stay Healthy With Diabetes?
What Do My Heart and Blood Vessels Do?
What Damages My Heart and Blood Vessels?
What Can I Do to Prevent Heart and Blood Vessel Problems?
How Do My Blood Vessels Get Clogged?
What Heart Problems Can Unhealthy Blood Vessels Cause?
How Does Heart Disease Cause High Blood Pressure?
What Are the Warning Signs of a Stroke?
How Can Clogged Blood Vessels Hurt My Legs and Feet?
What Can I Do to Prevent or Control Peripheral Vascular Disease?
Which Medical Tests Will Help Me Keep Track of Any Heart or Blood Vessel Problems?
For More Information
19. Keep Your Feet and Skin Healthy
What Are Diabetes Problems?
What Should I Do Each Day to Stay Healthy With Diabetes?
How Can Diabetes Hurt My Feet?
What Can I Do To Take Care of My Feet?
How Can I Get My Doctor to Help Me Take Care of My Feet?
What Are Common Diabetes Foot Problems?
How Can Special Shoes Help My Feet?
How Can Diabetes Hurt My Skin?
What Can I Do to Take Care of My Skin?
Take Care of Your Feet for a Lifetime
Tips For Proper Footwear
Steps For Preventing Foot Problems
Annual Comprehensive Diabetes Foot Exam
20. Keep Your Teeth and Gums Healthy
What Are Diabetes Problems?
What Should I Do Each Day to Stay Healthy With Diabetes?
How Can Diabetes Hurt My Teeth and Gums?
How Do I Know If I Have Damage to My Teeth and Gums?
How Can I Keep My Teeth and Gums Healthy?
How Can My Dentist Take Care of My Teeth and Gums?
For More Information
21. Keep Your Diabetes Under Control
What Are Diabetes Problems?
Will I Have Diabetes Problems?
What Should My Blood Sugar Numbers Be?
How Can I Find Out What My Average Blood Sugar Is?
Check Your Hemoglobin Alc I.Q.
Answers to the Hemoglobin A1c I.Q. Quiz
What Should I Do About Blood Pressure?
What Should I Know and Do About Smoking?
What Else Can I Do to Prevent Diabetes Problems?
Things to Check For Good Diabetes Care
How to Use the Daily Diabetes Record Page
Blood sugar checks
Medicines
Notes
22. Guiding Principles for Diabetes Care: For Health-Care Providers
Introduction
Principle 1: Screening High-Risk People and Diagnosing Diabetes
Principle 2: On-Going Care
Principle 3: Diabetes Education
Principle 4: Treating Hyperglycemia
Principle 5: Self-Monitoring of Blood Glucose Control and Hemoglobin A1c (HbA1c)
Principle 6: Preventing and Diagnosing Long-Term Diabetes Problems
Principle 7: Screening For and Treating Long-Term Diabetes Problems
23. Medicines for People With Diabetes
Do I Need to Take Diabetes Medicine?
What if I have type 1 diabetes?
What if I have type 2 diabetes?
Why do I need medicines for type 1 diabetes?
Specific insulin
Why Do I Need Medicines for Type 2 Diabetes?
What Do I Need to Know About Diabetes Pills?
Specific Pills
Oral Drugs
What Do I Need to Know About Insulin?
Can insulin be taken as a pill?
How does insulin work?
How often should I take insulin?
When should I take insulin?
Are there several types of insulin?
Does insulin work the same all the time?
Where on my body should I inject insulin?
How should I store insulin?
What are possible side effects of insulin?
Might I Take More Than One Diabetes Medicine at a Time?
What Should I Know About Hypoglycemia (low blood sugar)?
How Do I Know If My Diabetes Medicines Are Working?
24. Alternative Therapies for Diabetes
Acupuncture
Biofeedback
Chromium
Magnesium
Vanadium
Additional Information on Alternative Therapies for Diabetes
25. Diabetes Control and Complications Trial (DCCT)
What Is the DCCT?
DCCT Study Findings
How Did Intensive Treatment Affect Diabetic Eye Disease?
How Did Intensive Treatment Affect Diabetic Kidney Disease?
How Did Intensive Treatment Affect Diabetic Nerve Disease?
How Did Intensive Treatment Affect Diabetes-Related Cardiovascular Disease?
Elements of Intensive Management in the DCCT
What Are the Risks of Intensive Treatment?
26. The Prevention or Delay of Type 2 Diabetes
Introduction
Should We Attempt To Prevent Diabetes?
Who Are Potential Candidates For Screening and Intervention?
Choice of Screening Test
Age Considerations and Screening Frequency
How Should Diabetes Prevention Be Performed?
How Should Diabetes Prevention Be Performed?
Lifestyle Modification
Pharmacological Interventions
Lifestyle or Medication?
How Do Strategies to Prevent Diabetes Differ From Those to Treat Diabetes?
What Additional Research Is Needed?
Conclusions
References
27. Diet and Exercise Delay Diabetes and Normalize Blood Glucose
28. Diabetes Prevention Program: Questions & Answers
What Is Impaired Glucose Tolerance (IGT)?
How does the fasting blood glucose test differ from the oral glucose tolerance test?
For a person with IGT, what is the risk of developing type 2 diabetes?
How many people in the U.S. have IGT? Would the DPP interventions benefit all of them?
How do the DPP results compare to the findings of other type 2 diabetes prevention studies?
How do diet and physical activity work to prevent diabetes?
What were the goals of DPP’s lifestyle intervention arm?
What dietary advice did participants receive?
Lifestyle intervention more effectively reduced diabetes risk than metformin.
Within each arm, did certain groups of DPP participants benefit more from the intervention than other groups?Did the DPP volunteers in the lifestyle group benefit more from one lifestyle change than the other, e.g., more from exercise than from diet or vice versa?
Lifestyle changes with diet and exercise reduced diabetes risk, as did treatment with metformin. By combining these interventions, could diabetes risk be reduced even further?
Would the new formulation of metformin, Glucophage XR, be helpful to people with IGT?
Do the DPP interventions affect the risk of cardiovascular disease, an important cause of mortality in people with type 2 diabetes?
Are there any plans to get information about the DPP to the public and health- care professionals?
What is the estimated cost of the DPP interventions?
Were there any deaths or serious injuries in the study resulting from metformin treatment or the lifestyle changes?
Were there adverse effects associated with the interventions?
What will happen to the volunteers who took part in the DPP?
What happened to the DPP volunteers who developed diabetes?
Are diet and exercise beneficial even after diabetes develops?
29. Understanding Gestational Diabetes A Practical Guide to a Healthy Pregnancy
What is gestational diabetes and what causes it?
How does gestational diabetes differ from other types of diabetes?
Who is at risk for developing gestational diabetes and how is it detected?
How does gestational diabetes affect pregnancy and will it hurt my baby?
What can be done to reduce problems associated with gestational diabetes?
Diet and Weight Gain
Why is a special diet recommended?
How much weight should I gain?
How should I eat during my pregnancy?
Other Nutritional and Nonnutritional Considerations
Alcohol
Salt
Caffeine
Megavitamins
Smoking
What food patterns help keep blood sugar levels normal?
How do I plan meals?
What can be done to slow weight gain during pregnancy?
Is breast-feeding recommended?
Glucose Monitoring
What is self-blood glucose monitoring?
How often and when should I test?
How should I record my test results?
Are there any other tests I should know about?
How do I test for ketones?
When do I test for ketones?
Is it ever necessary to take insulin?
Will my baby be healthy?
Does gestational diabetes affect labor and delivery?
Should I expect my baby to have any problems?
Will I develop diabetes in the future?
Exercise
Should I exercise?
What happens if diet and exercise fail to control my blood sugars?
Can my blood sugar level go too low, and if so, what do I do?
Glossary
30. Consequences of Alcohol Use in Diabetics
Pathophysiology of Diabetes Mellitus
The Pancreas and Its Hormones
Alcohol’s Effects on Blood Sugar Levels of Diabetics
Effects of Alcohol Consumption in the Fed State
Effects of Alcohol Consumption in the Fasting State
Alcohol’s Effects on Complications of Diabetes
Diabetic Ketoacidosis
Alterations of Lipid Metabolism
Elevated Triglyceride Levels.
Reduced LDL Cholesterol Levels.
Elevated HDL Cholesterol Levels.
Cardiovascular Disease
Peripheral Neuropathy
Retinopathy
Medication Interactions
Summary
References