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    Learning About Your Health

    Diabetes: Introduction to Living with Diabetes

    What is Diabetes?

    Diabetes is a condition where the body is unable to use sugar (also called glucose) normally. Your body is made of millions of cells that need glucose for energy. Glucose comes from the foods you eat. Your blood carries glucose to the cells in your body. A hormone called insulin helps glucose enter the cells where it can be used or stored for energy. If the glucose can not get into the cells, it builds up in the blood.

    When you have diabetes the amount of glucose in your blood becomes higher than normal. Your blood always has some glucose in it to provide your body with energy. However, too much glucose in the blood is not healthy.

    Diabetes occurs for one of the following reasons:

    • The body does not make enough insulin (called insulin deficiency).

    • The body can not use insulin properly (called insulin resistance).

    • The body does not make enough insulin and can not use insulin properly.

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    Different Hormones Affect Blood Glucose Levels

    The body relies on many different hormones to keep blood glucose levels in balance.

    Hormones that lower blood glucose include insulin, amylin and glucagon-like peptide-1 (GLP-1). Insulin and amylin are both made in the pancreas, a gland located behind the stomach. GLP-1 is made by the small intestine.

    Hormones that increase blood glucose include glucagon, cortisol and epinephrine. Glucagon is made by the pancreas, while cortisol and epinephrine are both made by the adrenal glands (located above the kidneys). These hormones are often referred to as the “stress” hormones.
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    Signs and Symptoms of Diabetes

    Before being diagnosed with diabetes, you may or may not experience some of the signs and symptoms of high blood glucose. Symptoms may include:

    • Frequent urination

    • Increased thirst

    • Increased appetite

    • Unexplained weight loss

    • Dry, itchy skin

    • Tiredness

    • Poor wound healing

    • Tingling of the hands or feet

    • Blurry vision

    • Frequent infections

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    Different Types of Diabetes

    • Type 1 diabetes develops when the body’s immune system destroys the cells of the pancreas where insulin is made, causing insulin deficiency. People diagnosed with type 1 diabetes need insulin (shots) in order to live.

    • Type 2 diabetes is the most common form of diabetes. About 90% of people with diabetes have type 2. It usually starts with the cells not being able to use insulin properly. Eventually, the cells of the pancreas get tired and start to make less insulin. People diagnosed with type 2 diabetes may need medications (pills) and/or insulin.

    • Gestational diabetes occurs in about 4% of all pregnancies. During pregnancy, the mother’s blood carries glucose to the baby through the placenta. Hormones released by the placenta can increase insulin resistance which causes high blood glucose. Some women’s bodies do not make enough insulin to control higher glucose levels. While it is the mother who has diabetes and not the baby, pills or insulin may be necessary to help control the glucose levels of the mother and fetus. Gestational diabetes usually goes away after birth when these hormones are no longer present. However, the risk is higher for these women to get diagnosed with type 2 diabetes within 10 years. For more information about diabetes and pregnancy, you can contact the CPMC Diabetes and Pregnancy Program (DAPP) at 415-600-6388.

    • Pre-Diabetes occurs when the blood glucose is higher than normal but not high enough to be considered diabetes. A person with pre-diabetes is more at risk for developing type 2 diabetes. Increasing physical activity, losing weight, and eating a healthy diet may delay or prevent the onset of type 2 diabetes.

    • Other forms of diabetes are less common. They may include medical conditions of the pancreas or be caused by medications that prevent the body from using insulin properly (for example, steroid use). Pills or insulin may also be required to control blood glucose levels.

      Steroids (for example, Prednisone®, Solumedrol® and Decadron®) treat certain conditions, like asthma, skin conditions and inflammatory bowel disease, and are used with some surgeries (for example, to prevent rejection of transplanted organs). Steroids also increase insulin resistance and prevent the body’s insulin from working properly. Over time, your doctor may decrease the amount of steroid medications you need. Therefore, it is important to be in close contact with your doctor to report your glucose levels so medications may be adjusted.

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    Risk Factors for Type 2 Diabetes

    It is not always clear why people get diabetes. Some things that may put you at greater risk for developing diabetes are:

    • Not exercising / physical inactivity

    • Having a close relative with diabetes (family history)

    • Being overweight

    • Being a member of a high-risk ethnic group — Hispanic/Latino, African American, Asian, Pacific Islander or Native American

    • Having diabetes during pregnancy and/or giving birth to a baby weighing more than nine pounds

    • Having high blood pressure, greater than 140/90 mmHg

    • Having high blood levels of triglycerides, 250 mg/dL or more

    • Having low blood levels of high density lipoproteins (HDL), under 35 mg/dL

    • Being diagnosed with pre-diabetes

    • Being older than 45 years

    • Taking certain medications (such as steroids, or those used for psychiatric conditions)

    • Having cystic fibrosis

    • Receiving an organ transplants

    • Being a lesbian, gay, bisexual, transgender individual (due to certain hormones and lifestyle risk factors associated with this community)

    • Smoking

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    Diagnosing Diabetes

    Diabetes is diagnosed by measuring how much glucose is in your blood in one of three following ways:

    1. A fasting test measures the glucose in your blood first thing in the morning after no food or calorie-containing drinks for at least 8 hours.

    2. A non-fasting (or random) test measures the glucose in your blood at any time during the day, regardless of what you eat or drink.

    3. An A1C or estimated glucose average, a laboratory test that measures your average blood glucose levels over the last 2-3 months.

    Diagnostic fasting, non-fasting and A1C blood test results fall into one of three groups:
    • Normal (no diabetes):

      • Fasting glucose less than 100 mg/dL

      • Non-fasting glucose less than 140 mg/dL

      • A1C of 5.6% or less

    • Pre-diabetes:

      • Fasting glucose between 100 - 125 mg/dL

      • Non-fasting glucose between 140 - 199 mg/dL

      • A1C between 5.7 to 6.4%

    • Diabetes:

      • Fasting glucose of 126 mg/dL or more

      • Fasting glucose of 200 mg/dL or more, with symptoms

      • A1C 6.5% or more

    Note: values used for diagnosing diabetes are different from those used to manage diabetes. Once diagnosed, refer to the glucose and A1C values for managing diabetes.

    As of 2011, about 26 million Americans have diabetes and 79 million people have pre-diabetes. Talk to your health care provider about the type of diabetes you have.

    Produced by the staff and physicians at California Pacific Medical Center in association with the Center for Patient and Community Education. Last updated: 12/11

    Funded by: A generous donation from the Mr. and Mrs. Arthur A. Ciocca Foundation.

    Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).

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