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The Truth About Diabetes

Diabetes is a complex and complicated disease.  The evidence on new technologies and therapeutic treatments is rapidly expanding our knowledge and ability to manage diabetes and its complications, which is the first step in taking control. Must of this care is “Self-managed,” meaning you must take day-to-day responsibility for your own care. The information we have provided on this website is for you to learn as much as you can about diabetes including care information for your convenience and to help improve your quality of life with diabetes.

About Diabetes

Diabetes is a chronic disease that results from the body’s inability to sufficiently produce or properly use insulin. Insulin is a hormone that is secreted from beta cells in the pancreas and needed to convert sugar, starches and other food into energy needed for daily life.  Without insulin, the cells of the body cannot absorb sufficient glucose from the bloodstream. Diabetes occurs in several forms, but Type 1 and Type 2 are the two most common forms and represent about 10% and 90% respectively of the total diabetic population in Finland.

Prevalence and Impact

In Finland there are about 300 000 people diagnosed with diabetes. There are, however, numerous people whose diabetes is yet to be diagnosed. Diabetes is more common within male population. An average of 15 000 new cases of diabetes are diagnosed every year and diabetes is spreading in alarming numbers, for example, the current number of people with type 2 diabetes is tenfold to the one of mid 1900’s.

Type I and Type II Diabetes

Type I Diabetes

Type 1 diabetes is when your body does not produce insulin at all and may account for 5 to 10% of all diagnosed cases of diabetes. A person with Type 1 diabetes needs insulin shots to use glucose from the food they eat. Without insulin, your body can't use sugar and fat broken down from the food you eat. When sugar can't get into your cells, your blood glucose rises and it's this high blood glucose level that damages your body.

Type 1 diabetes develops most often in children or young adults but can occur at any age. It can come on suddenly, often after an illness. There is no cure for Type 1 diabetes, but because of new knowledge about the disease and new medical advances, good self-care is now possible. A person with diabetes can live a healthy life and avoid or experience few complications from the disease.

Characteristics of Type 1 diabetes

  • Most common in children
  • Quick onset with thirst, frequent urination, weight loss developing and worsening over days to weeks
  • Usually no known family history
  • No major risk factors; risk is increased if there is a strong family history
  • Insulin shots required to control diabetes
  • Blood glucose levels are sensitive to small changes in diet, exercise, and insulin dose

Type II Diabetes

Type 2 diabetes, previously known as non-insulin dependent diabetes, is when your body does not produce enough insulin and it doesn’t use insulin properly, typically begins after age 40.  People with Type 2 need diabetes pills or insulin shots to help their bodies use glucose for energy. Type 2 diabetes is the most common type of diabetes, accounting for 90 to 95 percent of all diabetes.

Type 2 diabetes is a progressive disease that can cause significant, severe complications such as heart disease, kidney disease, blindness and loss of limbs through amputation. Treatment differs at various stages of the condition. In its early stages, many people with Type 2 diabetes can control their blood glucose levels by losing weight, eating properly and exercising. Many may subsequently need oral medication, and some people with Type 2 diabetes may eventually need insulin shots to control their diabetes and avoid the disease's serious complications.

The onset of Type 2 diabetes is a two-stage process: (1) resistance to insulin's action, often exacerbated by obesity, followed by (2) the pancreas failing to increase insulin enough to compensate adequately. Life expectancy is reduced by 5 to 10 years in middle-aged people with Type 2 diabetes.

Characteristics of Type 2 Diabetes

  • Most common in adults, although more younger people are developing this type
  • Usually slow onset with thirst, frequent urination, weight loss developing over weeks to months
  • Usually runs in families
  • Most people who get this type are overweight or obese
  • Treatment usually begins with diet and exercise, progressing to use of oral medications and later to insulin as the disease advances
  • Blood glucose levels may improve with weight loss, change in diet and increased exercise
  • May be prevented or delayed in high-risk individuals by moderate weight loss and exercise

Pregnancy and Diabetes

Some women, about 3 to 5 percent of all pregnant women, get this form of diabetes during pregnancy, which is also known as gestational diabetes. It is defined as hyperglycemia with onset or first recognition during pregnancy.

Gestational Diabetes happens when the body doesn't make enough insulin and resists the action of insulin because of hormones.  The condition develops about midway through the pregnancy. It usually ends when the baby is born, but some women who have gestational diabetes go on to develop diabetes when they get older. Some studies have reported that almost 40 percent of women who have gestational diabetes will go on to develop Type 2 diabetes. Although most women with this condition are treated with diet, some women may need insulin. The problem can't be treated with pills because the medication can harm the baby.

Gestational diabetes usually doesn't cause birth defects, but one of the problems is the possibility of having a baby that is considerably larger than normal. There is also the risk that the baby might have low blood glucose right after it's born.

Children and Teens with Diabetes

Diabetes mellitus is the most common endocrine disease and one of the most common chronic conditions in children. Type 2 diabetes and other types of diabetes, including genetic defects of beta cell function such as maturity-onset diabetes of the young, also known as MODY, are increasing in frequency and should be considered when clinical presentation is atypical for Type 1 diabetes. Fortunately today, advances in treatment and monitoring of blood glucose levels have made diabetes far less difficult to deal with than it used to be. Still, it is a serious condition with potentially critical complications and requires lifelong monitoring and treatment.

While the majority of children with diabetes have Type 1 (a.k.a. juvenile diabetes), a growing number of kids and teens are being diagnosed with Type 2 diabetes, which was once considered an “adults only” disease.

A major modifiable risk factor for the development of Type 2 diabetes for children is obesity. As parent, it’s important to give them the autonomy they need to own their own diabetes, while simultaneously staying close enough to their treatment to ensure their safety. It can be a difficult balance, and one that constantly shifts along with developmental changes in your child.

It’s important to remember that children mature at different rates; what one child can handle at age seven another may be ready for at age four. In addition, each child’s individual emotional and physical development can also progress at varying speeds. For example, you preschool-aged child may have the mental capacity to test her own blood glucose levels, but lack the fine motor skills to do the job. However, even the smallest child can be empowered to take part in her diabetes care by reading a blood glucose monitor screen, unzipping a supply case, or choose an injection or testing site.

Here are some basic diabetes management skill sets, and general guidelines on when your child may be ready to take them on:

  • Self-testing blood glucose levels. Somewhere between ages 5 and 7 children may start expressing an interest in testing their own blood glucose levels. As long as their testing method is correct, there’s no reason not to pass along this task to your child. By age 8, most children should have this task mastered (unless they’re newly diagnosed). Parents should remind children to test at the appropriate times and should help interpret blood glucose readings.
  • Counting carbohydrates. Between ages 7 and 9 children may begin asking about carbohydrates and engaging in simple carb counting. Child-geared systems that use visual aids such as flashcards and refrigerator magnets may help your child understanding carb counting earlier.
  • Taking insulin. Between the ages 8 and 12 most children should be able to administer injections; parents should oversee dose calculation and drawing up of the insulin, although doing so in a hands-off manner will help your child build the skills and confidence she needs to take over the task permanently. The same goes for regulating insulin pump therapy.

At Risk

Type I Diabetes

Type I diabetes is more common among whites than Asian, Hispanic, Native and African Americans. If you have a close relative with the disease, you are more likely to develop Type I.

Type II Diabetes

Type II diabetes also tends to run in families. In fact there seems to be even stronger evidence for some kind of genetic cause for Type II than for Type I diabetes. Type II is more common among Asian, Hispanic, Native and African Americans.

Although Type II diabetes usually develops after age 40, about half of all people diagnosed with the disease are older than 55. This may be because as people age, they tend to become more sedentary and to gain weight. Eating too much food and being inactive can make you obese and you are more likely to develop Type II diabetes if you are obese. Obesity is, by far, the greatest risk factor for this kind of diabetes.

Where the weight is distributed seems to be a factor, too. If you tend to have an apple-shaped body in which you store fat around the tummy, you are more at risk for Type II diabetes. Those with a pear shape in which fat is stored in the hips are somewhat less at risk.

Gestational Diabetes

Any woman can develop gestational diabetes during pregnancy, but some women are more at risk than others. Some risk factors include obesity, a family history of diabetes, having previously given birth to a very large baby, a stillbirth, a child with a birth defect or having too much amniotic fluid. Women who are older than 25 are at higher risk than younger women.

  • Obesity – with Body Mass Index (BMI) of 30 or over
  • Family history of Type II diabetes
  • If you are an older mom – age 35 or over
  • If you previously delivered larger babies (between 3,8 kg and 4,5kg)
  • If you have high blood pressure
  • You are Hispanic, African American, Native American, South or East Asian, or of Pacific Island descent.

Diabetes Symptoms

Type 1 Diabetes Symptoms

Symptoms of Type 1 diabetes usually appear suddenly and require immediate medical attention.  They include:

  • being exceptionally thirsty
  • dry mouth
  • the need to urinate often
  • weight loss (even though you may be hungry and eating well)
  • feeling weak and tired
  • blurry vision

Type 2 Diabetes Symptoms

Sometimes, people with Type 2 diabetes don't notice any symptoms or the symptoms are experienced gradually. They include:

  • blurry vision
  • cuts or sores that are slow to heal
  • itchy skin, yeast infections
  • increased thirst
  • dry mouth
  • need to urinate often
  • leg pain

Complications

Diabetes is a serious condition with potentially devastating complications that affects all age groups worldwide. Both Type 1 and Type 2 diabetes are associated with long-term complications that threaten life and the quality of life. The disease is the leading cause of adult blindness, end-stage kidney disease (ESRD) and amputations (as a result of nerve disease). People with diabetes are two to four times more likely to have coronary heart disease and stroke than people who don't have it. Diabetes complicates pregnancy and results in more birth defects than babies born to women without the disease.

Heart Disease and Stroke
Having diabetes puts you at increased risk for heart disease and stroke. This is the biggest cause of death for people with diabetes. The disease process changes your body and can make you prone to fatty deposits in your arteries. These deposits can cause a heart attack. Diabetes can also make your blood more likely to clot and this can result in heart attack and stroke. The disease also puts you at risk for high blood pressure, which is a major cause of both heart disease and stroke.

Diabetic Kidney Disease and Hypertension
Diabetes is the most common cause of kidney failure. However, it's also true that most people with diabetes don't go on to have end-stage kidney disease (ESRD). Early in diabetes, the blood-filtering units of the kidneys are damaged. This means important proteins are lost in the urine. A urine test that measures protein can show beginning diseases. Later in the disease, the kidneys can't remove waste products from the blood.
Hypertension is not just a cause of kidney disease, but it's also a result of damage created by the kidney disease. Physical changes in the kidneys contribute to high blood pressure creating a dangerous spiral.

Diabetic Eye Disease
Diabetic eye disease refers to a group of eye problems that people with diabetes may have as a complication of the disease. All of these diseases can cause vision loss or even blindness. They include diabetic retinopathy, damage to the vessels of the retina; cataract, clouding of the eye's lens and glaucoma, an increase in fluid pressure inside the eye that leads to optic nerve damage and vision loss. Diabetic retinopathy is the most common eye disease associated with diabetes and it's the leading cause of blindness in American adults.

Diabetic Neuropathy
Diabetic neuropathy is a nerve disorder caused by diabetes. Sometimes it involves numbness and pain in hands, feet or legs, but nerve damage can also affect other systems in your body. Neuropathy can come on suddenly and cause problems with digestion, gastroparesis, heart problems, bladder infections, impotence, weight loss and weakness.

Gastroparesis
About 20 percent of the people with Type 1 diabetes develop this disorder in which the stomach takes too long to empty. People with Type 2 diabetes get it also, but less often. Diabetes damages the vagus nerve, which is the nerve that keeps food moving through the digestive tract. Gastroparesis can cause food to harden into solid masses and can cause blockages and bacteria problems. The fact that the stomach isn't working properly can also disturb the absorption of glucose and make it harder to control blood glucose.

Diffuse Neuropathy
Diffuse neuropathy is a kind of nerve problem that affects many parts of the body. There are two types of diffuse neuropathy. Peripheral neuropathy affects the feet and hands and autonomic neuropathy affects the internal organs. Autonomic neuropathy can affect a lot of body processes and systems, everything from sexual response in both women and men, digestive problems that cause weight loss, even regulation of body temperature and sweat.

Focal Neuropathy
This kind of diabetic neuropathy appears suddenly and affects specific nerves, most often in the torso, leg or head. Symptoms can include severe pain in an area of the body, eye and hearing problems or even paralysis on one side of the face called Bell's palsy. Carpel tunnel syndrome is a common symptom of focal neuropathy. This type of neuropathy is unpredictable and most often occurs in older people who have mild diabetes. Although it's painful, it tends to improve by itself without causing long-term damage.

Hypoglycemia

If your blood glucose drops below about 3,3 mmol/l, you can have a low blood glucose reaction called hypoglycemia. It may occur once or twice a week if you have Type 1 diabetes. Hypoglycemia is much less common with Type 2 diabetes, but it can happen especially with certain oral medications, missed meals, and exercise without proper precautions. The typical threshold for hypoglycemia is 3,9 mmol/l, although it may be higher or lower depending on a patient’s individual blood glucose target range.

Symptoms include erratic heartbeat, sweating, dizziness, confusion, unexplained fatigue, shakiness, hunger, and potential loss of consciousness. People who have tight control of their diabetes are more at risk for low blood glucose and so are the elderly. Once a low is recognized, it should be treated immediately with a fast-acting carbohydrate such as glucose tablets or juice.

Hyperglycemia

Too much sugar in the blood is called hyperglycemia. This is a problem that, left uncontrolled, can damage eyes, kidneys, heart, nerves and blood vessels. Causes include eating too much food, too little insulin or other medication, forgetting to take insulin or medication, skipping normal exercise, feeling sick or stressed. If your blood glucose is over 18,3 mmol/l, you may test your urine for ketones, which are made when your body burns fat instead of glucose for energy. You should drink lots of fluids, check your glucose frequently and call a doctor or nurse. If your blood glucose is more than 27,8 mmol/l and there are signs of ketones in your urine, get to a hospital immediately.

Often there are no signs with hyperglycemia. But if the blood glucose is extremely high, you may experience headache, blurry vision, thirst, hunger, frequent urination, dry skin, upset tummy or a fruity smell on the breath.

Ketoacidosis

Extremely high blood glucose levels can lead to one of two conditions — diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS; also called hyperglycemic hyperosmolar nonketotic coma). Although both syndromes can occur in either Type 1 or Type 2 diabetes, DKA is more common in Type 1 and HHNS is more common in Type 2.

This is a severe complication associated with hyperglycemia. When your body lacks insulin, two things happen. Blood glucose levels rise, which causes excess urination as the body excretes water in order to try to dissolve the glucose. This can lead to increased urination and dehydration, and ketosis starts slowly and gradually builds up. Common symptoms include loss of appetite, stomach pain, nausea and vomiting, and deep and rapid breathing. Others signs are a flushed face, dry skin and mouth, fruity breath odor, a rapid and weak pulse, and low blood pressure. You may test for ketones in your urine with special test strips that are available in drugstores.

Second, because the body cannot metabolize glucose, it begins to burn fat for energy. Normal byproducts of fat metabolism are acidic substances called ketones. When fats are the main source of energy, ketones accumulate in the blood and in urine. They change the body’s chemical balance to the acidic range, a condition known as ketoacidosis. It is life threatening but reversible with prompt treatment.  You should drink fluids and inject insulin right away. If you are unable to keep fluids down because of nausea or vomiting, it can become a critical medical emergency. Patients who do not get fluids and insulin right away may lapse into a coma.

Monitoring and Testing    

Home blood glucose testing is an important part of controlling blood glucose for diabetics. One important goal of diabetes treatment is to keep the blood glucose levels near the normal range of 3,9 to 6,7 mmol/l before meals and under 7,8 mmol/l at 2 hours after eating. Blood glucose (BG) levels are usually tested before and after meals, and at bedtime. The blood glucose level is typically determined by pricking a fingertip with a lancing device and applying the blood to a glucose meter, which reads the value. Since blood glucose levels can fluctuate widely, even frequent home glucose testing may not accurately reflect the degree of success in controlling blood glucose.

Self Monitoring Blood Glucose Test

Self-monitoring of blood glucose (SMBG) levels through home testing is a fundamental tool of diabetes management which most people with diabetes can benefit from. Potential benefits, including A1C improvement, avoidance and identification of hypoglycemia and increased lifestyle flexibility, are enhanced when individuals receive self-management education that enables them to adjust their dietary choices, physical activity and medication in response to SMBG values.

The frequency of SMBG should be determined individually, based on the type of diabetes, the treatment prescribed, the need for information about BG levels and the individual’s capacity to use the information from testing to modify behaviors or adjust medication. Your diabetes health care professional will help you to set the target range fro your glucose levels. They will also help you determine when and how often to test your blood glucose. Some suggested times are:

  • When you wake up (fasting level)
  • Before breakfast
  • 1-2 hours after breakfast
  • Before lunch
  • 1-2 hours after lunch
  • Before or after exercise
  • Before dinner
  • 1-2 hours after dinner
  • Before bedtime
  • After a snack
  • At 2 or 3 AM, if taking insulin

People with Type 1 diabetes and pregnant women taking insulin are recommended to test their blood glucose levels at least 3 times a day. People with Type 2 diabetes who take multiple injections of insulin daily should also test 3 or more times a day. Testing before and after meals is associated with improved glycemic control compared to testing before meals alone.

Testing should be frequent enough to achieve blood glucose goals, and both Type 1 and Type 2 patients should test more often when:

  • You add or adjust your medication for diabetes
  • You think your blood glucose levels may be too low or too high
  • You are ill, or feeling uncomfortable over long periods of time

Meters are available that allow SMBG using blood samples from sites other than the fingertip, such as the forearm, palm of the hand or thigh. Accuracy of results is variable across sites. During periods of rapid change in BG levels such as, after meals, after exercise and during hypoglycemia, fingertip testing has been shown more accurate glycemic status than other sites. In comparison, blood samples taken from the palm near the base of the thumb demonstrate a closer correlation to fingertip samples at all times of day, and during periods of rapid change in BG levels.

Hemoglobin A1c (HbA1c) test

The hemoglobin A1c test - also called HbA1c, glycated hemoglobin test, or glycohemoglobin - is an important blood test used to determine how well your diabetes is being controlled. Hemoglobin A1c provides an average of your blood glucose control over a six to 12 week period and is used in conjunction with home blood glucose monitoring to make adjustments in your diabetes medicines.

Hemoglobin is a substance within red blood cells that carries oxygen throughout your body. When your diabetes is not controlled, sugar builds up in your blood and combines with your hemoglobin, becoming "glycated." Therefore, the average amount of sugar in your blood can be determined by measuring a hemoglobin A1c level. If your glucose levels have been high over recent weeks, your hemoglobin A1c test will be higher. The amount of hemoglobin A1c will reflect the last several weeks of blood glucose levels, typically encompassing a period of 120 days.

In most labs, the normal range is 4-5.9 %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patients it's less than 7.0%.

Level of Control A1C Number
Normal Range 4 – 5.9%
Well Controlled 7% or Lower
Take Action Higher than 8%

The benefits of measuring A1c is that it gives a more reasonable view of what's happening over the course of time, generally the last 3 months, and the value does not bounce as much as finger stick blood glucose measurements.

People with diabetes should have this test every three months to determine whether their blood glucose levels have reached the target level of control. Those who have their diabetes under good control may be able to wait longer between the blood tests, but experts recommend checking at least 2 times a year.

Ketone Testing

A ketone test checks for ketones in your blood or urine. Ketones are substances that are made when the body breaks down fat for energy. Normally, your body gets the energy it needs from carbohydrate in your diet. However, stored fat is broken down and ketones are made if your diet does not contain enough carbohydrate to supply the body with glucose for energy or if your body cannot use blood glucose properly.

Ketone testing is recommended for all individuals with Type 1 diabetes during periods of acute illness accompanied by elevated blood glucose level.  If blood glucose levels remain elevated (> 14.0 mmol/L) or when symptoms such as nausea, vomiting or abdominal pain are present, ketone testing should be considered because it may mean you have diabetic ketoacidosis, a potentially life-threatening condition.

The level of ketones, and not just the presence of ketones, may be important to your doctor as well. Many conditions can change ketone levels. Fasting usually causes only mild increases in the level, but ketone levels in diabetic ketoacidosis are much higher. Your health professional will discuss any significant abnormal results with you in relation to your symptoms and medical history.

A urine test is the most commonly used method of measuring ketones, but blood test may be preferred over urine test, as they have been associated with earlier detection of ketosis and response to treatment.

Other Laboratory Glucose Tests

Fasting Plasma Glucose Test

This is the test that screens for diabetes by measuring the level of glucose in a person's blood plasma after a period of fasting (not eating). The fasting plasma glucose test is given to nonpregnant adults who are at high risk for diabetes. It is a carbohydrate metabolism test which measures plasma, or blood glucose levels after you have gone at least 8 hours without eating.  Fasting stimulates the release of the hormone glucagon, which in turn raises plasma glucose levels. In people without diabetes, the body will produce and process insulin to counteract the rise in glucose levels. In people with diabetes this does not happen, and the tested glucose levels will remain high. Most people have a level between 3,9 and 6,1 millimoless of glucose per liter of blood. A level of 7,3 mmol/l or higher on two tests given on two different days confirms a diagnosis of diabetes. Individuals with a fasting plasma glucose level less than 7,3 mmol/l but greater than or equal to 6,1 mmol/l are classified as having impaired fasting glucose.

Random Plasma Glucose Test

This is the test generally as a screening for diabetes when a patient has had food or drink and therefore cannot do a fasting plasma glucose test or oral glucose tolerance test. It is performed with a small blood draw taken at any time of the day, which is sent to the lab for analysis. In general, the glucose level under 11,1 mmol/l is considered normal for this test.  Levels higher than 11,1 mmol/l, along with the presence of symptoms of diabetes, indicate a diagnosis of diabetes. It is recommended that the diagnosis be confirmed with a subsequent retest on a different day. The retest should be an oral glucose tolerance test or the fasting plasma glucose test if possible.

Oral Glucose Tolerance Test

This is the test for diabetes that occurs with pregnancy, and it is usually done during the 24th to the 28th week of pregnancy. It measures your blood glucose levels four or five times over a 3-hour period after you have gone at least 8 hours without eating, smoking or drinking coffee. You will be asked to drink a sweet glucose syrup of about 75 to 100 grams, which should cause glucose levels to rise in the first hour, and then fall back to normal within three hours as the body produces insulin to normalize glucose levels.  On average, normal glucose levels typically peak at 8,89 – 10 mmol/l from 30 minutes to 1 hour after administration of the oral glucose dose, and should then return to fasting levels of 7,78 mmol/l or less within a 2- to 3-hour period.  Because the OGTT is a more sensitive test than the fasting plasma glucose test, and involves multiple blood draws to monitor insulin production, it can often detect cases of diabetes that may be missed by the fasting test.

Diabetes Treatment

If you have Type 1 diabetes, your body doesn't make insulin which helps sugar from food be turned into energy. If you have Type 2 diabetes, your pancreas does not make enough insulin and your body can't use it properly. Sometimes, eating a healthy diet and getting enough exercise will control Type 2 Diabetes. Sometimes, your doctor will give you medication. However, diabetes medications that lower blood glucose level never take the place of healthy eating and exercise. Some people, after a few years of taking oral medication, will need to begin taking insulin.

Insulin

Insulin lowers blood glucose by moving sugar from the blood into the cells of your body. Once inside the cells, sugar provides energy. If you take insulin, you'll need to eat on time and match your insulin injections to your meals. Your insulin should peak at the same time blood glucose levels from meals are also peaking.

Most people with diabetes need at least two insulin shots a day for good blood glucose control. Some people take three or four shots a day to have a more flexible plan. You should take insulin 30 minutes before a meal if you take regular insulin alone or with a longer-acting insulin. If you take lispro (Humalog), or insulin aspart (Novolog), two insulins that works really fast, you should take your shot just before you eat.

A rough guideline to remember is that one unit of insulin lowers blood glucose by 50 mg/dL and covers about 10 to 15 grams of carbohydrate.

Oral Medications

Usually, people with Type 1 diabetes don't use oral medications. These medications work best in people with Type 2 diabetes who have had high blood glucose for less than ten years and who have normal weight or obesity. It's not uncommon for oral medication to control blood glucose well for years and then stop working. Some people who begin treatment with oral medications eventually need to take insulin. You should also pay closer attention to possible side effects that these oral medications may have.

Sulfonylureas
Sulfonylureas act to force your pancreas to make more insulin, which then lowers your blood glucose.
For this medication to work, your pancreas has to make some insulin. The correct time to take these medications varies.

Biguanides
The generic name of this drug is metformin. It helps lower blood glucose by making sure your liver doesn't make too much sugar. Metformin also lowers the amount of insulin in your body. You may lose a few pounds when you start to take metformin. This weight loss can help you control your blood glucose. Metformin can also improve blood fat and cholesterol levels, which are often high if you have Type 2 diabetes. It is normally taken two to three times each day with a meal.

Alpha-glucosidase inhibitors
There are now two alpha-glucosidase inhibitors, acarbose and miglitol. Both medications block the enzymes that digest the starches you eat. This action causes a slower and lower rise of blood glucose through the day, but mainly right after meals.
Acarbose and Miglitol are taken three times daily, at meals, although your doctor might ask you to take the medication less often at first. It should be taken with the first bite of a meal.

Thiazolidinediones
The generic names for these medications are pioglitazone and troglitazone. The medication works by helping make your cells more sensitive to insulin. The insulin can then move glucose from your blood into your cells for energy.
Pioglitazone is usually taken once a day at the same time, with or without a meal. Trosiglitazone is taken either once or twice a day, at the same time each day, with or without a meal.

Meglitinides
This is a new type of diabetes medication. Repaglinide is a generic name for one of the meglitinides. This medication helps your pancreas make more insulin right after meals, which lowers blood glucose. Your doctor might prescribe repaglinide by itself or with metformin if one medication alone doesn't control your blood glucose. A good thing about repaglinide is that it works fast and your body uses it quickly. This fast action means you can vary the times you eat and the number of meals you eat more easily than you can with other diabetes medications. These work like short acting sulfonylureas.

Your doctor will tell you to take repaglinide before you eat a meal. If you skip a meal, you shouldn't take the dose. Repaglinide is taken from 30 minutes before to just before a meal. It lowers blood glucose the most one hour after it's taken, and it is out of the bloodstream in three to four hours.

Diet and Exercise

Diabetes and exercise go hand in hand. Whether you’re scaling mountains, working out with a trainer at the gym, or taking long walks around your neighborhood, making exercise a part of your daily routine can help you enjoy a healthier diabetes life.

A Healthier Weight and Lifestyle
Reaching and maintaining a healthy weight is important for everyone with diabetes. Weight control is extremely important in treating Type 2 diabetes because extra body fat makes it difficult for people with Type 2 diabetes to make and use their own insulin. If you are overweight, losing just 5-10Kg may improve your blood glucose control so much that you can stop taking or reduce your medication.

Moderating Sugar, Fat and Carbohydrates
The body breaks down different types of foods at different rates. Carbohydrates typically take from five minutes to three hours to digest, whereas protein takes three to six hours and fat can take eight or more hours. That's why different foods have different effects on blood glucose, such as why ice cream raises blood glucose levels more slowly than potatoes. But people with diabetes don’t always have to forgo desserts and sweets. They just have to be sure not to eat moderate amounts more than once or twice a week.

Diabetes Management

Physical Acitivity

Sometimes, it may seem easier to pop a pill or even take a shot than to put on your walking shoes and hit the trail. But the truth is that exercise, in combination with a healthy diet, is one of the best things you can do to take care of yourself if you have diabetes.

  • Exercise burns calories, which will help you lose weight or maintain a healthy weight.
  • Regular exercise can help your body respond to insulin and is known to be effective in managing blood glucose. Exercise can lower blood glucose and possibly reduce the amount of medication you need to treat diabetes, or even eliminate the need for medication.
  • Exercise can improve your circulation, especially in your arms and legs, where people with diabetes can have problems.
  • Exercise can help reduce your cholesterol and high blood pressure. High cholesterol and high blood pressure can lead to a heart attack or stroke.
  • Exercise helps reduce stress, which can raise your glucose level.
  • It can lower your risk for heart disease, reduce your cholesterol levels and your blood pressure.

In some people, exercise combined with a meal plan, can control Type 2 Diabetes without the need for medications.

Tips for start exercising

  • If you're planning to walk or jog, be sure your shoes fit well and are designed for the activity you have in mind. Be alert for blisters. Wear new shoes for a bit each day until they're comfortable and not as likely to cause blisters. Remember, always wear socks.
  • Start slowly with a low-impact exercise such as walking, swimming, or biking.
  • Build up the time you spend exercising gradually. If you have to, start with five minutes and add a bit of time each day.
  • Always wear an ID tag indicating that you have diabetes to insure proper treatment in case there's a problem when you're exercising or you have an injury.
  • Avoid lifting very heavy weights as a precaution against sudden high blood pressure.
  • If you have foot problems, consider swimming or biking, which is easier on the feet than jogging.
  • Stretch for five minutes before and after your workout regardless of how intense you plan to exercise.

 Try to exercise at the same time every day for the same duration. This will help control your blood glucose. Exercise at least three times a week for about 30 to 45 minutes.

If your blood glucose level is over 16,7 mmol/l, if you are sick, short of breath, have ketones in your urine or are experiencing any tingling, pain or numbness in your legs, don't exercise. Also if your medication is peaking, it's better not to exercise.

Nutrition

What you eat is one of the most important aspects of managing diabetes. Don't fight against good nutrition. Find tips and ideas to make healthful eating a part of your busy lifestyle.

People with diabetes should pay careful attention to nutrition and diet as part of your treatment program. Nutrition experts say that there is no one diet for diabetes, but people with diabetes should follow the nutrition guidelines, while paying special attention to carbohydrate intake. People with diabetes should also eat about the same amount of food at the same time each day to keep blood glucose levels stable.

If you've never attempted to eat a healthy, well-balanced diet before your diabetes diagnosis, it can be difficult to know where to get started. Some tips include:

  • Eat more starches such as bread, cereal, and starchy vegetables. Aim for six servings a day or more. For example, have cold cereal with nonfat milk or a bagel with a teaspoon of jelly for breakfast. Another starch-adding strategy is to add cooked black beans, corn or garbanzo beans to salads or casseroles.
  • Eat five fruits and vegetables every day. Have a piece of fruit or two as a snack, or add vegetables to chili, stir-fried dishes or stews. You can also pack raw vegetables for lunch or snacks.
  • Eat sugars and sweets in moderation. Include your favorite sweets in your diet once or twice a week at most. Split a dessert to satisfy your sweet tooth while reducing the sugar, fat and calories.

Smoking

If you smoke and have been diagnosed with diabetes, your doctor will recommend that you quit because smoking makes problems caused by diabetes worse. People with diabetes can experience blood flow problems in the legs and feet, which can sometimes lead to amputation, and smoking can decrease blood flow even more. Smoking can also worsen sexual impotence in men, cause high levels of LDL cholesterol, and can raise the risk of heart attack and stroke. (lifeclinic) Each year, 45,000 Canadians die of smoking-related illnesses.

Smoking is a habit that hurts everyone, smokers and non-smokers alike. Smokers are insulin resistant, show signs of insulin resistance syndrome, and are at an increased risk – 50% in men and women – for developing Type 2 diabetes. Those who smoke second-hand, even if they don’t mean to, are at risk of developing cancer, breathing problems, and heart disease. These people are more susceptible to colds and flu, and may even die younger than those who don’t breathe second-hand smoke.

Smoking can also aggravate many problems that people with diabetes already face, such as heart and blood vessel disease. Smoking can:

  • cut the amount of oxygen reaching tissues, which can lead to a heart attack, stroke, miscarriage, or stillbirth.
  • increase your cholesterol and other fat levels and the levels, raising your risk of a heart attack.
  • damage and constrict the blood vessels, which worsen foot ulcers and lead to blood vessel disease and leg and foot infections.
  • increase your risk for limited joint mobility.
  • cause cancer of the mouth, throat, lung, and bladder.
  • increase your blood pressure.
  • raise your blood glucose level, making it harder to control your diabetes.

People with diabetes who smoke are three times as likely to die of cardiovascular disease than other people with diabetes. Those with Type 1 and Type 2 diabetes who smoke are at risk for micro- and macrovascular complications, as well as diabetic nephropathy, retinopathy, and neuropathy.

Whether you’ve been smoking for a lifetime or have just started, quitting smoking is the best thing you can do to decrease your risk of diabetic complications. It is never too late to get on the road to good health.

Travel

Trips often hold surprises, delays and changes that can affect what you eat, when you eat, when you monitor your blood glucose levels, and the amount of physical activity you engage in. Think about your regular daily schedule, and try to stick to it as closely as possible. This is especially important if you are traveling to a different time zone. So, before your trip, talk to your doctor and diabetes educator to plan your timing for medication, testing, food, and activity.

A few common-sense preparations can help make a heart patient's travel both safe and enjoyable. Discuss your travel plans with your doctor ahead of time, including:

  • What medical equipment or devices you need to take with you
  • Physical exertion
  • Trips to high altitudes
  • Exposure to very cold or very hot climates

Other tips to help assure a smooth trip:

  • If you have frequent or severe symptoms, don't travel alone.
  • Include frequent breaks to avoid fatigue, especially when traveling by car.
  • Take an adequate supply of your prescription drugs; if you will run out of one during the trip, get an extra supply before you go, since you may not be able to get your prescription refilled in another state or country.
  • Carry your prescription drugs in your carry-on luggage so they won't get separated from you.
  • Arrange for special meals or a wheelchair (if needed) with your travel agent or airline representative when you make a reservation.

When flying or riding in a car, reduce the risk of blood clots in the legs by doing "ankle pumps" while you're seated: point your toes out as far as possible and then pull them as far toward your skin as you can.

In general:

    • Move around every one to two hours to increase comfort and reduce risk for blood clots.
    • Tell at least one person traveling with you about your diabetes.
    • Never go barefoot, even in the shower or pool.
    • Be careful about food safety when traveling in some countries.
    • Use bottled water to brush your teeth.
    • Drink bottled water with no ice.
    • Eat only cooked vegetables and fresh fruit that can be peeled.
    • Only consume pasteurized dairy foods.
    • Don’t eat food from street vendors.