How Diabetes Develops

[Guest guest]

How Diabetes Develops

Much of the food we eat is broken down by digestive juices into a simple

sugar called glucose, which is the body’s main source of energy. Glucose

passes into the bloodstream, where cells use it for energy.

Insulin is normally produced by beta cells in the pancreas (a large gland

located behind the stomach) and helps to move glucose from the blood into

cells. When we eat, the pancreas should automatically produce the right

amount of insulin for this process. When it doesn’t, diabetes occurs.

In people with diabetes, the pancreas produces little or no insulin, or

the body's cells do not respond to the insulin that is produced. As a

result, glucose builds up in the blood, overflows into the urine and

passes out of the body. Thus, the body loses its main source of fuel even

though the blood contains large amounts of glucose.

Types of Diabetes

There are several types of diabetes:

* In Type 1 (insulin-dependent) diabetes, the pancreas makes little or no

insulin because the insulin-producing beta cells have been destroyed.

Type 1 diabetes is less common than Type 2 diabetes, accounting for about

five to 10 percent of diabetes cases. It typically develops during

childhood or young adulthood. Though formerly known as “juvenile

diabetes,†the disorder can appear at any age.

Type 1 diabetes is classified as an autoimmune disease – a condition that

results when the immune system turns against a specific part or system of

the body. In diabetes, the immune system attacks the insulin-producing

beta cells in the pancreas and destroys them. At present, scientists do

not know exactly what causes the body's immune system to attack the beta

cells, but they believe that both genetic and environmental factors,

perhaps including viruses, are involved.

* In Type 2 (noninsulin-dependent) diabetes, the pancreas makes some

insulin, and sometimes produces too much. The insulin, however, is less

effective than normal. Type 2 diabetes most often occurs in overweight or

obese adults after the age of 30, but may also develop in children. It is

typically preceded by insulin resistance (when the body does not respond

to the action of insulin). Factors that contribute to insulin resistance

and Type 2 diabetes are genetics, obesity, physical inactivity and

advancing age.

Type 2 diabetes is on the rise in the U.S. and rates are expected to

continue increasing for several reasons, according to the CDC. The

increasing prevalence of obesity among Americans is a major contributor

to the rise in Type 2 diabetes. Over 100 million Americans – or about 61

percent of the adult population -- are overweight or obese and the number

of obese children in the U.S. is growing. Another reason is related to

the relatively low levels of physical activity among American adults

(approximately 25 percent of adult Americans engage in regular physical

activity of any intensity).

Other factors contributing to the rise of Type 2 diabetes are:

* the increasing age of the population

* the fast growth rate of certain ethnic populations at high risk for

developing the condition, including Latino and Hispanic Americans

* improved medical care that lengthens the lifespan, thus increasing the

risk for developing Type 2 diabetes

* A third type of diabetes, gestational diabetes mellitus, is one of the

most common problems of pregnancy and can be harmful for both the mother

and baby when not controlled.

Gestational diabetes results from the body’s resistance to insulin. This

resistance is caused by hormones produced by the placenta. It usually

disappears when the pregnancy is over, but women who have had gestational

diabetes have a greater risk of developing Type 2 diabetes later in life.

All pregnant women are routinely screened for gestational diabetes

between their 24th and 28th week.

* A new term " pre-diabetes " describes an increasingly common condition in

which blood glucose levels are higher than normal but not yet diabetic.

Those with pre-diabetes have impaired fasting glucose (between 110 and

125 mg/dL after an overnight fast) or they have impaired glucose

tolerance as indicated by one or more simple tests used to measure

glucose levels. Research supported by the U.S. Department of Health and

Human Services has shown that most people with this condition go on to

develop Type 2 diabetes within 10 years unless they make modest changes

in their diet and level of physical activity, which can help them reduce

their risks and avoid the debilitating disease.

Women and Diabetes: Special Concerns

Women with diabetes develop heart disease more often than other women,

and their heart disease is more severe. Women under age 50 with diabetes

are more vulnerable to heart attacks and strokes than those without

diabetes in their age group because diabetes seems to cancel estrogen’s

protective effects on women’s hearts prior to menopause. Women with

diabetes are at even greater risk for developing heart disease after

menopause.

According to the cholesterol management guidelines issued in May 2001 by

the National Cholesterol Education Program, National Heart, Lung, and

Blood Institute (NHLBI), diabetes poses as great a risk for having a

heart attack in 10 years as heart disease itself and should be managed as

aggressively as heart disease. A recent survey showed that most people

with diabetes don’t know that heart disease and stroke are the major

killers of people with diabetes. In fact, two-thirds of people with

diabetes die from cardiovascular disease and they die younger.

Although low-density lipoproteins (LDL) cholesterol (the type of

cholesterol that contributes to plaque buildup in your arteries) levels

are not higher in women with diabetes, studies have shown that lowering

LDL cholesterol levels to less than 100 mg/dl can help prevent heart

attacks and strokes for these women. Women with diabetes have lower

levels of high-density lipoproteins (HDL) cholesterol (the good

cholesterol) and higher levels of triglycerides, or fats, in the blood.

According to NHLBI’s cholesterol management guidelines, elevated LDL

cholesterol is a major cause of coronary heart disease and should be

treated aggressively. High cholesterol is typically treated with

specially designed diets low in saturated fat, weight loss, exercise and,

if necessary, medication.

For more information on the new guidelines, visit:

http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm.

Other health issues of concern to women with diabetes include:

* High blood pressure. Desired blood pressure for people with diabetes is

130/80, according to the American Diabetes Association.

* Urinary tract and vaginal infections. Urinary tract infections and

vaginal yeast infections are more common in women with diabetes. The

fungi and bacteria that cause these infections thrive in a high-sugar

environment and the body’s immune system can’t fight them as effectively

when blood glucose levels are too high.

* Menstrual problems. Irregular menstrual periods are common in women

with diabetes, especially if their blood sugar isn’t well controlled.

Blood sugar levels may rise and insulin needs may go up before a woman

with diabetes’ period starts, and fall once it begins.

* Adverse reactions to hormonal birth control methods. Contraceptives

containing hormones, such as birth control pills, IUDs that contain

progesterone, and long-lasting progestin implants and injections may

alter blood glucose levels. Birth control pills may increase insulin

resistance in some women with diabetes. Women with Type 2 diabetes may

find it harder to manage their blood glucose while taking birth control

pills. Though rare in healthy individuals, the risk of complications from

birth control pills such as high blood pressure and stroke are greater

for women with diabetes.

Management is Key to Living Well with Diabetes

Though a chronic and potentially a life-threatening condition, diabetes

can be effectively controlled and managed, once it’s accurately

diagnosed. The goal of diabetes management, according to the American

Association of Clinical Endocrinologists, is to prevent short-term and

long-term complications from developing. Without proper management,

individuals with either Type 1 or Type 2 diabetes can develop serious or

deadly complications from high glucose levels, including blindness,

kidney disease and nerve damage, as well as vascular disease that can

lead to amputations, heart disease and strokes. Uncontrolled diabetes can

complicate pregnancy; birth defects also are more common in babies born

to women with uncontrolled diabetes.

For those individuals with Type 1 diabetes, controlling blood sugar

levels means three to four daily shots of insulin and adjusting insulin

doses to food and exercise, testing blood glucose four to seven times a

day and adhering to a planned diet.

Type 2 diabetes may initially be controlled by a planned diet, exercise

and daily monitoring of glucose levels. Frequently, oral drugs that lower

blood glucose levels or insulin injections need to be added.

Treating diabetes comprehensively — that is, managing not only blood

glucose, but also blood pressure and cholesterol — is crucial to helping

prevent heart attack and stroke. The good news is that women with

diabetes who maintain lower blood glucose, blood pressure and cholesterol

levels can lower their risk of cardiovascular disease. To reduce your

risk, follow the ABCs approach recommended by the National Diabetes

Education Program, National Institute of Health and the American Diabetes

Association. The ABCs are easy to remember:

* The A stands for the A1C, or hemoglobin A1C test, which measures

average blood glucose over the previous three months

* B is for blood pressure, and

* C is for cholesterol

New Diabetes treatment guidelines have recently been issued by the

American College of Physicians (ACP) and published in the April 2003

edition of the ls of Internal Medicine. The guidelines emphasize the

importance of aggressive blood pressure control in lowering the risk for

heart disease, stroke and early death in Diabetes Type 2 patients. Up

until now, most of the focus in diabetes care has been on tightly

controlling blood sugar, but new evidence suggests that both variables

are very important in managing the disease.

The ACP recommends that patients with diabetes and high blood pressure

aim for blood pressure levels of less than 135/80 mm Hg and that both

thiazide diuretics and angiotensin-converting enzyme (ACE) inhibitors can

be used as first-line agents to control blood pressure in most diabetic

patients. The authors of the guidelines concluded that further studies

are needed to determine the relative contributions of glucose and blood

pressure control that lead to poor health outcomes in diabetes.

Marilyn

Moderator for

Diabetic_Recipes

dnevessr@...

Opinions expressed are solely

my own and should not be

mistaken for

Professional advice.