Diabetes comes in several varieties:
usually diagnosed in childhood or early adulthood but can occur at any age, people with Type 1 diabetes lose their ability to produce insulin, a pancreatic hormone that is required to metabolize glucose, which feeds the body. The absence of insulin leads to high blood glucose levels and diabetic ketoacidosis (DKA), a state which can be very serious and is fatal if untreated. Continual high blood glucose levels (higher than normal but not high enough to induce DKA) lead to what are known as the complications of diabetes: neuropathy, kidney disease and retinopathy, as well as other things, which vary from annoying to serious. The task of the person with any form of diabetes is to try and maintain normal or close to normal blood glucose levels.
usually diagnosed in adulthood, people with Type 2 sometimes use just diet and exercise to control blood sugars, sometimes also use oral medications and occasionally use insulin. This is the most common form of diabetes, affecting approximately 90% of those with diabetes.
which comes with pregnancy and generally goes away after birth. Insulin is required because the body is unable to produce enough to serve the mother and the fetus.
I was diagnosed with Type 1 diabetes in 1979, when I was thirteen. At that time, the only options for attempting control of diabetes were one shot of insulin a day and urine tests. Since then, many advances have been made in managing diabetes more effectively. A major step was the blood glucose testing machine. It is much more accurate than urine tests, although it does involve making holes in your fingers frequently. These machines, not surprisingly, determine the level of glucose in the blood. High or low glucose levels indicate that insulin/oral medication and/or food intake and/or exercise levels need to be adjusted.
The price of the machines has come down but the strips that are required for each test are expensive (the strips I use cost 93 cents each - I use 6 a day, more if I am sick. Over a year, that adds up to over $2,000). If a person with diabetes can test their blood often and adjusts insulin accordingly, eat a nutritious diet and get enough exercise, the chances of complications may decrease significantly. Unfortunately, some people with IDDM experience complications no matter how good their control.
Blood glucose levels can be affected by many things other than insulin/food/exercise, like stress, excitement, hormones or medications like antihistamines and decongestants. Keeping it level takes a lot of work and can be overwhelming, especially since there is no guarantee all that work will pay off in the long term. The DCCT results support the theory that normal blood glucose levels do lead to decreased complications, but also does not discount the unknown role genes may play in the development of complications.
The Diabetes Control and Complications Trial was a ten year landmark study that looked at whether or not high blood glucose levels are related to long term complications in people with IDDM. It found that good control and intensive management prevented or delayed complications by at least 50%. Intensive control was defined as keeping blood sugars and Hemoglobin A1C's in normal ranges, and included a team approach, 3-4 injections per day or use of an insulin pump and 4-5 blood glucose tests per day. This was the proof needed to get some people doing blood sugars and doctors and other medical professionals more focused on getting and providing much needed education about the risks of uncontrolled diabetes.
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