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Diabetes: What's the deal Type 1 vs Type 2? My risk?

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Wednesday, November 3, 2010

Diabetes: What's the deal Type 1 vs Type 2? My risk?

There are always things on the news "linking" various foods or behaviors to Type 2 Diabetes, and in honor of national diabetes month, I wanted to talk about the different types, and risk factors that are totally preventable!  It is estimated that 24 million people have diabetes an 57 million are at risk for developing the disease, in the US, and 171 million people are affected worldwide; let's make sure that we aren't on that list of 'at risk'!!

Just as a background, Diabetes Mellitus is a metabolic disorder in which you have high blood sugar due to either decreased production of insulin or because your cells don't respond to the insulin your body creates.  Diabetes can also be mimicked my taking corticosteroids for various disease processes or simply gestational that will be reversed once you have your baby or stop taking steroids!  As well, type 2 diabetes can be "reversible" on!

Type 1 Diabetes:
Type 1 was originally dubbed "juvenile onset diabetes" or "Insulin dependent diabetes" and really the body fails to produce insulin from the pancreas because the body attacks itself (an autoimmune disorder), therefore people affected need to give themselves insulin injections to level their blood sugars.

Type 2 Diabetes:
It is a result of poor diet and lifestyle, usually, and is characterized by insulin resistance; your body makes insulin but the insulin receptor cells reject it, and usually there is a lower insulin release baseline.  This is the most common type of diabetes and affects 90% of Americans that are classified with diabetes.  Early on when insulin levels are just decreased, there are oral medications that can be taken to improve insulin sensitivity (basically make the most out of what your body is already producing) and/or reduce glucose production by the liver.

A term that has been dubbed for people who have elevated blood glucose levels as a baseline, but not high enough to diagnose as Type 2 Diabetes.  At this stage, with lifestyle changes, you can usually prevent it from turning into a diabetes diagnosis.

What are warning signs?
Polyuria (frequent urination), Polydipsia (increased thirst), and polyphagia (increased hunger)which can be sudden in Type 1 Diabetes and may occur over a slower period of time with Type 2 Diabetes.  Prolonged elevated glucose levels can cause changes to the retina which can lead to blurry or changed vision, slow healing cuts/bruises, tingling/numbness in hands and feet, and/or recurring skin/gum/bladder infections.

What should glucose levels be?

After eating
2-3 hours after eating
Impaired Glucose

How do I know if I have it?
If you have any of these warning signs, or are concerned, go to your HCP who will test your glucose in the office, and check a fasting glucose or perform a glucose tolerance test: check a fasting blood sugar which should be less than 126mg/dl, with a glucose tolerance test the should be glucose level less than 200 two hours after ingesting 75g of glucose, and they will check an Hb A1C (a sample of hemoglobin from the blood which helps to determine an average of glucose levels over time) which should be less than or equal to 6.5%

Why is it such a big deal?
There are TONS of complications that can occur from diabetes taht can occur in both the long and short-term of having the disease, which is why it is crucial to check your blood sugar frequently throughout the day AND treat your elevated blood sugars with your prescribed insulin (or other treatment).  Some of the more acute and life threatening are:
hypoglycemia: Severely low blood glucose levels and can be characterized by shakiness, hunger, sweating, confusion, pale skin, jerky movements, clumsiness, etc and the treatment is drinking 4oz (1/2 glass) of juice or soda, 1 tablespoon of honey, 2 tablespoons of raisins.  Then, re-check your glucose levels in 20 minutes.
diabetic ketoacidosis:  from extremely elevated blood glucose levels, the breath becomes fruity (or smells like acetone), breathing can change to rapid deep breaths, abdominal pain with nausea and vomiting, and can lead to altered mental states and coma (it can happen quickly and I'v seen it hundreds of times!)It is VERY SERIOUS and a medical EMERGENCY!!  You need to be treated in the hospital.
hyperosmolar hyperglycemic nonketotic syndrome: Usually in type 2 diabetes and is usually brought on by illness or infection; your blood sugars to rise to a severe level (>600) then your body attempts to get rid of excess sugar through getting rid of body water, you will rid your body of all its free fluids, your urine will be very dark and concentrated and once you get severely dehydrated you are at risk for seizures, coma, and death.  It can happen over days or weeks.  You need to be treated with IV fluids if it goes to far, it is also a medical EMERGENCY!  It can also occur after a diabetic drinks to much be aware with diabetic younger adults!!!

Long-term complications can be:
peripheral vascular disease
cardiovascular diseases
retinal damage
chronic renal failure

What can I do to prevent Type 2 Diabetes?
Lifestyle changes!!! Eat a healthy, sensible diet full of fruits and veggies, lay off processed foods and foods high in sugars. Exercise moderately 4-5 days a week of 20-30 minutes of moderate exercise (you are short of breath and work up a good sweat!)  See your HCP regularly to have your sugars checked.  If you are overweight, use a dietician to lose weight in a healthy way and get to a healthy weight, find a exercise buddy, or better yet, go for a long walk on your lunch break for the days you can't go for a heavier workout.

Treatments Type 1: 
Injectable insulins (regular, NPH) and/or synthetic long acting insulin.  They can be injected into the fatty tissue of the skin, and can be injected a few times daily (after checking blood sugars) OR administered through an insulin pump which is a continuous ow rate of insulin (much like our body secretes) and you can increase rates based on your blood sugars to treat when you are going to ingest high amounts of glucose.

Treatments Type 2:
Make those aforementioned lifestyle changes to help and reverse the diabetes!  The medications prescribed can stimulate the pancreas to produce and secrete more insulin, inhibit the production and release of glucose from the liver, and/or block the actions of the stomach enzymes that break down carbohydrates and make cells more sensitive to insulin.
Medications that increase Insulin production:
Saxagliptin (onglyza)
Sitagliptin (Januvia)
Glyburide (DiaBeta)
Glipizide (Glucotrol)
Glimepiride (Amaryl)
Medications that improve effectiveness of insulin: (all oral)
Metformin (glucophage, Avandia)
Pioglitazone (Actos)
Medications that alter food absorption: (oral)
Acarbose (Precose)
Miglotol (Glyset)
All of these medications have varying side effects, and your HCP will decide which will work best for you.  it may be some trial an error regarding which works best and it is totally dependent upon your body and why you have diabetes.

Please go see your HCP if you have any of the warning signs, and take control of your (pre)diabetes if you have it.  Also, remember that just because Type 1 isn't reversible, you should still live a healthy lifestyle with fresh foods, exercise, and frequently check your blood sugars!!  If you have signs or symptoms of hyperosmolar hyperglycemic nonketotic syndrome or diabetic ketoacidosis please seek medical treatment immediately!!

Yours in Good Health


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