GUIDE TO DIABETES.

1}.TREATMENT TO YOUR HEALTH-
Being diagnosed with diabetes means that looking after your health has become even more important. This section of the Guide to diabetes includes information about medications, your lifestyle, monitoring your health and complementary therapies.
2}.EATING WELL-
Balancing your diet when you are diagnosed with diabetes can be challenging. Although the food choices you make and your eating habits are important in helping you manage your diabetes, you should be able to continue enjoying a wide variety of foods as part of healthy eating.

Eating a balanced diet, managing your weight, and following a healthy lifestyle, together with taking any prescribed medication and monitoring where appropriate will benefit your health enormously.

Remember, in the long run it is better to make small changes that you feel you can stick to rather than completely altering your diet and not sticking to it.

Taking steps to balance your diet will help you control your:

A}.blood glucose levels
B}.blood fats – cholesterol and triglycerides
C}.blood pressure
It will also help regulate your weight. If you are overweight losing weight will help you control your diabetes and will also reduce your risk of heart disease, high blood pressure and stroke.

You are sure to have lots of questions about your diet. A registered dietitian will be able to answer your questions. Diabetes UK recommends that everyone with diabetes should see a registered dietitian at diagnosis, and then have regular reviews for specific advice on their eating habits
3}.



KEEPING ACTIVE-Being active is good for all of us but is especially important for people with diabetes. Physical activity, combined with healthy eating and any diabetes medication that you might be taking, will help you to manage your diabetes and prevent long-term diabetes complications.

Everyday fitness
Activity made easy...
Being more physically active often conjures up images of gym memberships, long distance runs and aerobics in a leotard, yet this need not be the case. The great news is that you can become more active by making small changes to your lifestyle.

This section of the website offers you a chance to think about what:

makes being more active important to you
might be getting in the way of you taking the plunge
changes you can make to your daily routine.
It lays out the long-term aim for activity levels, providing you with lots of ideas and top tips for being more active.

... Plus info for the seriously sporty
There is also information for the more serious sports people amongst you.

Don't be afraid to ask
If you have any concerns at all about becoming more active, never be afraid to ask for advice – your diabetes team is there to help.
4}.SMOKING-
If you have been diagnosed with diabetes, giving up smoking is one of the most positive things you can do to both improve your health and reduce your risks of the long-term complications associated with the condition.

This section of the website explains about the damage smoking does to people with diabetes, the benefits of giving up and ideas on how to get the support you need to stop smoking
SMOKING AND DIABETES-
Almost everybody is aware of the dangerous link that smoking has with diseases such as cancer, but are you conscious of its connection with diabetes?

Cigarettes contain more than 4000 chemical compounds and at least 400 toxic substances.

Everyone risks damaging their health through smoking a cigarette, pipe or cigar, but for people with diabetes the risk may be even greater. If you have diabetes you already have an increased chance of developing cardiovascular disease, such as a heart attack, stroke or circulatory problems in the legs. Combine this with smoking (which can also double your risk of complications) and you make the chances of developing these diseases even higher.

Smoking ...

... when you have diabetes can make it more likely that you will develop neuropathy (nerve damage), nephropathy (kidney damage) and retinopathy (eye damage).
... decreases the amount of oxygen reaching the tissues of the body, which can lead to a heart attack or stroke.
... increases your LDL (low density ‘bad’ lipids) cholesterol level and lowers HDL (high density ‘good’ lipoproteins). This can make blood cells stick together, which can attract cholesterol and fats to stick to the artery walls making it more difficult for blood to circulate. This can damage and constrict (narrow) the blood vessels of the body (known as atherosclerosis) or cause a clot to form and possibly break away to travel round the body leading to a heart attack, stroke, peripheral vascular disease or worsening of foot and leg ulcers.
... increases your blood pressure by releasing adrenaline which causes blood vessels to constrict and the heart to beat faster.
... raises blood glucose levels. This is probably due to the nicotine and other products involved in smoking which may cause insulin resistance (whereby insulin doesn’t work properly) and stimulate stress hormones that can increase glucose levels.
So, like maintaining good blood glucose control, eating well, taking regular exercise and keeping to a healthy weight, giving up smoking is one of the most beneficial things you can do for your future health.
SUPPORT TO QUIT-
Giving up can be hard, but you don’t have to carry the burden of quitting on your own. It has been shown that you are more likely to quit if you get the right support. Whichever method you choose, there are clear benefits from quitting and plenty of support to help you. So what’s stopping you from stopping?

Stop Smoking Services
One way to get support is to use a Stop Smoking Service. These can offer you free advice specific to your individual needs together with meetings, which may be on a one-to-one basis or group sessions.

NHS Smoking Helpline
Tel: 0800 169 0 169
www.givingupsmoking.co.uk

QUIT
0800 00 22 00
www.quit.org.uk

There are also treatments available that can help you to stop smoking.

Nicotine replacement therapies
Nicotine replacement therapies (NRTs) are available on prescription as well as over the counter.

Nicotine is a drug that affects the areas of the brain which produce ‘feel good’ chemicals. NRTs help you to withdraw from this addiction without all the other harmful chemicals in a cigarette.

NRTs are available in a number of different forms, such as patches, gum, nasal spray, lozenges, microtabs and inhalators. A trained healthcare professional will help you to choose the one which suits best your smoking habits and lifestyle and will keep in close touch with you as you slowly decrease the amount you use (usually over a period of 12 weeks).

NRT is not licensed for use in children but individual clinicians may use it for a young person over the age of 12.

Prescription drugs
Prescription drugs are usually offered to smokers who have tried other methods.
There are two options at present but it must be remembered that your doctor may know of medical reasons why you could not be prescribed it.

Zyban
Zyban (Buproprion) which is taken for a maximum of 8 weeks. It works by reducing the craving for nicotine. The dosage has to be carefully followed and if the attempt to stop smoking is unsuccessful, further treatment will not be funded for 6 months.

Champix
Champix (Varenicline) which is taken for 12 weeks. It works by mimicking the effect of nicotine in the body and blocking the feel-good effect if a smoker does have a cigarette. The dosage must be carefully followed. A maintenance dose may be given for a further 12 weeks after completing the initial course.

Neither of these tablets can be used for people under 18 years old.

Other therapies
Other therapies that may work for some people but don’t have clinical tests to prove their effectiveness include acupuncture, hypnotherapy and laser treatment.
5}.MANAGING YOUR WEIGHT-
A healthy lifestyle is something everyone is recommended to follow but sometimes seems difficult to achieve. Being overweight can seriously affect your health but often people have their own reasons for losing weight. Making realistic long term changes to your lifestyle can bring huge rewards. Whether you want to be able to fit in to last summer’s clothes, play in the park with your grandchildren or to run for the bus without feeling out of puff, losing weight and keeping it off is well worth the effort.

But why is losing weight important?


One of the reasons for the increase in diabetes over the years is the increase in the number of people who are overweight. In fact more than four out of five people diagnosed with diabetes are overweight. We can’t ignore this fact that people who are overweight are at greater risk of developing Type 2 diabetes.
For people with diabetes there are major health benefits from losing weight. Being overweight makes diabetes control more difficult as excess weight makes it hard for the body to use insulin properly (insulin resistance), whether the insulin is being injected or being made by the body. Insulin resistance is especially associated with excess fat around the waist and people from South Asian communities have a greater health risk associated with being overweight.

If you are overweight, losing weight will help to control

-blood glucose levels
-blood fats – cholesterol and triglycerides
-blood pressure.
-Losing weight will also:


-reduce your risk of heart disease,
-improve your mobility
-reduce joint damage
-reduce tiredness
-help relieve stress
-help improve your self-esteem.

CAN TOO MUCH SUGAR CAUSE DIABETES FOR YOU?

Diabetes is one of those diseases we all 'sort of' know about — something to do with sugar, right?
Well, if you 'sort of' know that much, here are some facts you should know for sure: diabetes can lead to blindness, heart attack, stroke and its incidence has tripled in the last ten years — there's a new case diagnosed every seven minutes.

So it affects millions of us.

But the good news is, for most people, it's largely preventable. But how?

Our reporter, Dr Andrew Rochford, is going to put a commonly held belief about diabetes to the test. Andrew is going to over indulge his sweet tooth — and it's all in the name of medical research.


test
Sugar is often associated with Australia's fastest growing chronic disease — diabetes. But what we want to know is can too much sugar in your diet actually cause diabetes?

Essentially, diabetes is related to elevated blood sugar levels, so the logic goes, eat more sugar, get diabetes.
Associate Professor Maarten Kamp is a diabetes expert at the Gold Coast hospital: "Currently more than 1.2 million Aussies have diabetes and only half of those are diagnosed, so half the people with diabetes are unaware of it. There's a further two million or so people who are at risk of developing diabetes, having a condition we call pre-diabetes."


It's forecast that by 2010, 1.8 million Australians will have diabetes. That will put them at risk of heart disease, strokes, kidney failure, blindness, nerve damage and a whole host of other nasties.
Here's how diabetes happens:

To get the energy we need to survive, our body converts some of the food we eat into sugars, also known as glucose. At the same time, our pancreas is creating a hormone called insulin, which acts like a key, binding to cells and allowing them to absorb that glucose. But people with diabetes don't produce enough insulin, or that insulin doesn't work properly, so it's like they've lost the key — the cell door stays locked and the glucose stays in your blood.

"And that means that whilst there is plenty of glucose in the blood, too much glucose, and that's what's damaging, and isn't getting into the cells properly where it's needed to provide energy for the body," says Professor Kamp.

Andrew also needs to declare a personal interest: "My dad has diabetes and we've had some scary times with this illness. Diabetics have to keep a careful balance between insulin and glucose in his body. So my dad has to inject insulin four times a day. If he gets the balance wrong, then he can fall into a coma — called a hypo."


"Unfortunately the diabetes has put a lot of strain on my wife and children particularly when I have hypos in the middle of the night and four and five-year-old kids see their father being carted down the stairs by ambulance men. Andrew unfortunately has seen that on a couple of occasions and I'm sure he's not too happy about it," says Michael Rochford.
Fortunately those attacks, which can be fatal, are rare.


There are two types of diabetes, Andrew's dad is a Type 1:
"Type 1 diabetes is predominantly caused by being at risk with having inherited genes that place people at risk and we think it's then set off by particular types of infections. It's not absolutely clear what causes Type 1 diabetes," says Professor Kamp.

But most people with diabetes, nearly 90 percent of sufferers are Type 2.

"Type 2 diabetes again people have a predisposition to it, genetic predisposition, but it largely develops as a result of overweight, inactivity, over-nutrition that we see in our society nowadays," says the Professor.

Type 2 diabetes usually starts around age 45, but a recent report showed children in Australia are now suffering from the disease.

Which brings us back to our test…

First Andrew has his normal insulin and glucose levels recorded through a blood test. Then comes the good part — a pig-out in a lolly shop.

Andrew: "It's a tough gig, but I'm up to the challenge … If a sugar overdose can cause diabetes, all this lot ought to do the trick … Finally a test I can enjoy — guilt-free."



It sounds logical — the more you eat, the higher the levels, so after Andrew has binged for 24 hours he heads off to have his blood sugar levels tested again. Remember, the body absorbs sugar, by producing insulin, which unlocks the cell doors. A non-diabetic person produces enough insulin to cope with as much glucose as we throw at it, and keep the blood sugar normal.

So what do Andrew's results say?
"Now on the day when I had the high sugar diet — the diet we should all avoid — my blood sugar stayed the same, which you'd expect from someone without diabetes. But my insulin level was through the roof, my pancreas was working overtime to try and maintain my blood sugar at that level," says Andrew.

But his system did cope — despite the binge, his blood sugar level stayed normal, and that means eating sugar is not a direct cause of diabetes.



But if Andrew kept that high-sugar diet up, he could develop insulin resistance and he'd certainly put on weight, which is a major problem.
"Obesity is a very important factor in contributing to diabetes it's certainly the main factor that's contributing to the epidemic of diabetes that we have," says Professor Kamp.

So how do you know if you have diabetes?

Some of the symptoms include:


Fatigue
Passing urine frequently
Constant thirst
Infections that are slow to heal
If you are diabetic or at risk of it, diet is one area you can really take control of to improve your situation.


Chef Peter Howard has done just that. Food is Peter's passion, but as he himself admits, he loved it just a bit too much: "Always eating, always drinking, not really caring what I was eating and not really caring what I was drinking just as long it was a lot of both."
But all that's changed since he was diagnosed with Type 2 diabetes.


Diabetes can't be cured but Peter is controlling his condition with diet and exercise — so far he doesn't need insulin shots. He now walks every day and does weights and crunches and he's lost 15 kilos.
What did Peter have to cut out of his diet?

"Mostly fats, I loved deep fried things so the fats had to go. Sugars … I loved sweet things, absolutely loved sweet things, just adored them so they just had to go and I think actually the amount was the thing as well, and the constancy. So now I do eat very, very well and I eat a lot, but I eat a lot of really good food and what I'm always looking for is food that's high in fibre."

He's so passionate about living better, Peter's even brought out his own cookbook with recipes for good health.

The plain truth is we're sitting on an obesity time bomb that could explode into a massive diabetes epidemic. But we can change the future by changing how we eat right now.

So there are many causes of diabetes but we're happy to report that sugar isn't one of them. But does that mean you can stay in a lolly shop and gorge yourself? No, because if you eat too much sugar then you'll put on weight and obesity is a risk factor.

So all the fun aside, diabetes isn't a laughing matter — you can protect yourself with a healthy diet and regular exercise and if diabetes runs in the family or you have any concerns go and see your doctor.



Why do people normally inject insulin instead of taking a pill? Because if they swallowed it, digestive enzymes would destroy it before the body could use it.

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It sounds logical — the more you eat, the higher the levels, so after Andrew has binged for 24 hours he heads off to have his blood sugar levels tested again. Remember, the body absorbs sugar, by producing insulin, which unlocks the cell doors. A non-diabetic person produces enough insulin to cope with as much glucose as we throw at it, and keep the blood sugar normal.

So what do Andrew's results say?
"Now on the day when I had the high sugar diet — the diet we should all avoid — my blood sugar stayed the same, which you'd expect from someone without diabetes. But my insulin level was through the roof, my pancreas was working overtime to try and maintain my blood sugar at that level," says Andrew.

But his system did cope — despite the binge, his blood sugar level stayed normal, and that means eating sugar is not a direct cause of diabetes.

EFFECT OF SUGAR TO YOUR HEALTH.

The average American consumes an astounding 2-3 pounds of sugar each week, which is not surprising considering that highly refined sugars in the forms of sucrose (table sugar), dextrose (corn sugar), and high-fructose corn syrup are being processed into so many foods such as bread, breakfast cereal, mayonnaise, peanut butter, ketchup, spaghetti sauce, and a plethora of microwave meals.

In the last 20 years, we have increased sugar consumption in the U.S. 26 pounds to 135 lbs. of sugar per person per year! Prior to the turn of this century (1887-1890), the average consumption was only 5 lbs. per person per year! Cardiovascular disease and cancer was virtually unknown in the early 1900's.

The "glycemic index" is a measure of how a given food affects blood-glucose levels, with each food being assigned a numbered rating. The lower the rating, the slower the absorption and digestion process, which provides a more gradual, healthier infusion of sugars into the bloodstream. On the other hand, a high rating means that blood-glucose levels are increased quickly, which stimulates the pancreas to secrete insulin to drop blood-sugar levels. These rapid fluctuations of blood-sugar levels are not healthy because of the stress they place on the body.

One of sugar's major drawbacks is that it raises the insulin level, which inhibits the release of growth hormones, which in turn depresses the immune system. This is not something you want to take place if you want to avoid disease.

An influx of sugar into the bloodstream upsets the body's blood-sugar balance, triggering the release of insulin, which the body uses to keep blood-sugar at a constant and safe level. Insulin also promotes the storage of fat, so that when you eat sweets high in sugar, you're making way for rapid weight gain and elevated triglyceride levels, both of which have been linked to cardiovascular disease. Complex carbohydrates tend to be absorbed more slowly, lessening the impact on blood-sugar levels.

Sugar depresses the immune system.
We have known this for decades. It was only in the 1970's that researchers found out that vitamin C was needed by white blood cells so that they could phagocytize viruses and bacteria. White blood cells require a 50 times higher concentration inside the cell as outside so they have to accumulate vitamin C.

There is something called a "phagocytic index" which tells you how rapidly a particular macrophage or lymphocyte can gobble up a virus, bacteria, or cancer cell. It was in the 1970's that Linus Pauling realized that white blood cells need a high dose of vitamin C and that is when he came up with his theory that you need high doses of vitamin C to combat the common cold.

We know that glucose and vitamin C have similar chemical structures, so what happens when the sugar levels go up? They compete for one another upon entering the cells. And the thing that mediates the entry of glucose into the cells is the same thing that mediates the entry of vitamin C into the cells. If there is more glucose around, there is going to be less vitamin C allowed into the cell. It doesn't take much: a blood sugar value of 120 reduces the phagocytic index by 75%. So when you eat sugar, think of your immune system slowing down to a crawl.

Here we are getting a little bit closer to the roots of disease. It doesn't matter what disease we are talking about, whether we are talking about a common cold or about cardiovascular disease, or cancer or osteoporosis, the root is always going to be at the cellular and molecular level, and more often than not insulin is going to have its hand in it, if not totally controlling it.

The health dangers which ingesting sugar on an habitual basis creates are certain. Simple sugars have been observed to aggravate asthma, move mood swings, provoke personality changes, muster mental illness, nourish nervous disorders, deliver diabetes, hurry heart disease, grow gallstones, hasten hypertension, and add arthritis.

Because refined dietary sugars lack minerals and vitamins, they must draw upon the body's micro-nutrient stores in order to be metabolized into the system. When these storehouses are depleted, metabolization of cholesterol and fatty acid is impeded, contributing to higher blood serum triglycerides, cholesterol, promoting obesity due to higher fatty acid storage around organs and in sub-cutaneous tissue folds.

Because sugar is devoid of minerals, vitamins, fiber, and has such a deteriorating effect on the endocrine system, major researchers and major health organizations (American Dietetic Association and American Diabetic Association) agree that sugar consumption in America is one of the 3 major causes of degenerative disease.

A good source of supplies for diabetics is diabeticdrugstore.com. They offer healthy eating diabetic food, hard to find sugar free candy and medical alert jewelry for diabetes care.

Honey is a simple sugar
There are 4 classes of simple sugars which are regarded by most nutritionists as "harmful" to optimal health when prolonged consumption in amounts above 15% of the carbohydrate calories are ingested: Sucrose, fructose, honey, and malts.

Some of you may be surprised to find honey here. Although honey is a natural sweetener, it is considered a refined sugar because 96% of dry matter are simple sugars: fructose, glucose and sucrose. It is little wonder that the honey bear is the only animal found in nature with a problem with tooth-decay (honey decays teeth faster than table sugar). Honey has the highest calorie content of all sugars with 65 calories/tablespoon, compared to the 48 calories/tablespoon found in table sugar. The increased calories are bound to cause increased blood serum fatty acids, as well as weight gain, on top of the risk of more cavities.

Pesticides used on farm crops and residential flowers have been found in commercial honey. Honey can be fatal to an infant whose immature digestive tracts are unable to deal effectively with Botulinum Spore growth. What nutrients or enzymes raw honey does contain are destroyed by manufacturers who heat it in order to give it a clear appearance to enhance sales. If you are going to consume honey, make sure it is raw, unheated honey. Good to use in special cures, but not as an every day food. It is not much better than white or brown sugar.

IMPORTANCE OF EXERCISE AGAINST DIABETES.

Regular exercise is good for your general health as well as for your diabetes. Exercise makes your heart stronger and improves your circulation. Exercise improves your muscle tone and strength. Exercise helps you manage stress and helps you feel better about yourself. All of these help to make you more fit.

Exercise helps to reduce your risk of developing heart disease. Exercise helps lower the level of triglycerides and raise the level of HDL or "good cholesterol" in your blood. Exercise also helps lower your blood pressure. High blood pressure contributes to many of the chronic complications that can occur with diabetes.

Exercise helps you lose weight or maintain your weight by burning calories. By following a meal plan and exercising regularly, you can lose weight and maintain it at a desirable level. Exercise over time will increase the amount of muscle and decrease the amount of fat stored in your body. Muscle cells use more sugar and improve your blood sugar levels.

During exercise your body uses more sugar for energy than when your body is at rest. This can result in a rapid lowering of your blood sugar if you are taking insulin or an oral sulfonylurea (such as glipizide, glyburide, or glimepiride). You may have hypoglycemia (low blood sugar) during or after exercise. It is important that you keep your blood sugar in a safe range while you exercise. In order to do this, there must be a balance between the sugar used for energy while you exercise, the sugar available from food, and the medication you are on to lower your blood sugar. Testing your blood sugar is the best way to check this balance.

If you are at risk for hypoglycemia (low blood sugar) when you exercise, always be prepared. Sometimes hypoglycemia is harder to recognize when you are exercising because the exercise may make you sweaty or light-headed. Testing your blood sugar if you suspect an hypoglycemia is very important. If possible, exercise with a family member or friend who could help you if needed. Always carry some form of identification that says you have diabetes. Be sure to take some quick-acting form of sugar with you when you exercise such as glucose tablets or gel, Life Savers® or fruit juice.

If you have Type 1 diabetes, exercise is always balanced with your meal plan and insulin to control your diabetes. Changes may have to made in your insulin or food intake or both before and after exercise to prevent you from having hypoglycemia (low blood sugar).

If you have Type 2 diabetes, exercise helps to increase the sensitivity of your body cells to insulin. With this increased sensitivity, your own insulin works better and your blood sugar levels get better. When exercise is done at least every other day it is more likely to have this effect. Exercising regularly and following a meal plan may get your blood sugars in the target range without medication. In many people with Type 2 diabetes, medication is needed. Exercise is then used with a meal plan and the medication to control your diabetes.

Getting Started With Exercise.

You should talk over any plans you have for starting an exercise program with your doctor. Your doctor will assess the state of your health and decide whether you have heart disease or diabetes complications before advising you about exercise. Your doctor will give you information about exercise and your diabetes therapy. When you start an exercise program, you should start slowly and gradually build up your strength.

Choose an exercise you will enjoy and one which will fit with your lifestyle and physical abilities. The best type of exercise is aerobic exercise. This is exercise which is continuous over an extended period of time and uses large amounts of energy. Examples of this type of exercise are walking, running, bicycling, and swimming. These forms of exercise are more likely to help control your blood sugar than activities that require only short bursts of energy like many team sports and calisthenics. Exercises that are static and involve heavy lifting and total body straining should be avoided. These kinds of exercise do very little to benefit your heart or make your body's cells sensitive to insulin.

Walking is a very good form of exercise. Almost anyone can start a walking program. You can start out slowly and go a short distance and then gradually build up how fast and how far you walk. Walking is easily fit into your lifestyle and requires only a good pair of shoes and comfortable clothing. You can walk outdoors or indoors, alone or with others, and in all forms of weather. Enclosed malls have become an excellent and popular place to walk when the weather is bad.

Whatever exercise you choose should be done regularly and about the same time of day. It is best if you exercise daily but that may not be possible in your life. If daily exercise is impossible, a minimum of every other day (3-4 times per week) is the key to having exercise being of help in managing your diabetes. You should identify which days and times you will be able to exercise and then follow this schedule. This will help you plan for any change that you may need to make in your diabetes therapy because of exercise.

Self-Care for Exercise

If you have Type 1 diabetes, you may need less insulin or more food or both when you exercise. Trial and error over time will help you determine what insulin or food changes your body will need for safe blood sugar levels during exercise. The extra food you eat to provide sugar for exercise should not be subtracted from your meal plan. Blood sugar testing before and after exercise helps you know if the changes you make in your insulin or your food intake or both were right for you. If you are starting a new exercise, and especially if the exercise is done for a long time, you will need to also do blood sugars during exercise. Keeping careful records will help you establish the pattern of your blood sugar response to exercise.

You may prefer to adjust your insulin for exercise. This would be the best action to take if you are trying to lose weight and are doing planned exercise. Reduction in the amount of rapid or short acting insulin prior to exercise will reduce the amount of extra food you might have to eat to prevent or treat hypoglycemia. If you have certain days of the week when you are very active and other days when you get very little exercise, your insulin regimen may be adjusted to match these changes in your exercise pattern. If you notice a pattern of decreased blood sugar levels after you begin exercising, your intermediate or long-acting insulin doses may need to be decreased. Your doctor or nurse should be asked about adjusting you insulin for exercise.

Often you will need to eat extra food before you exercise. Whether you will need extra food before exercise and how much food you will need depends on several factors. The factors you will need to consider are when your insulin is peaking, when you last ate a meal or snack, how long and how hard you plan to exercise, and your blood sugar level. If your blood sugar is less than 80 mg/dl, you will always need a snack prior to exercise. The amount will depend on how long and how hard you plan to exercise. If your blood sugar is 80-180 mg/dl, you will need a snack if you plan exercise that is of moderate intensity and for 30 minutes or more. If your blood sugar is 180-240 mg/dl, you will not need a snack prior to exercise, but may need one later if the exercise is for 30 minutes or more. The longer and harder you exercise, the more extra food you will need to eat.

Trial and error over time will help you figure out what food your body will need for safe blood sugar levels during exercise. The extra food you eat to provide sugar for exercise should not be subtracted from your meal plan. Blood sugar testing should be done before and after exercise to help you figure out how exercise affects your blood sugar levels and whether you ate the right amount of food. If you are starting a new exercise, and especially if the exercise is done for a long time, you will need to also do blood sugars during exercise (approximately every 30 minutes). Keeping careful records will help you establish the pattern of your blood sugar response to exercise.

Exercise should be avoided if your blood sugar is consistently 300 mg/dl or more or you have ketones in your urine. Your diabetes should be brought under better control with adequate amounts of insulin before you exercise.

Exercise can increase how fast your insulin gets absorbed from the injection site. This could cause a rapid drop in your blood sugar level and may result in an insulin reaction. Because of this you should consider the type of exercise you will be doing when you choose an injection site. Insulin will be absorbed more rapidly if it is injected in fatty tissue over a muscle you will be exercising within an hour.

Your blood sugar level often continues to decrease after exercise. This occurs most often after exercise that is strenuous and of long duration. During exercise of this type, your muscles use sugar from your bloodstream and sugar that has been stored in your liver and muscles in the form of glycogen. During the hours after exercise, your body restores this glycogen by taking sugar out of the blood. This may take up to 24 hours and can result in hypoglycemia (low blood sugar). To prevent hypoglycemia after strenuous and prolonged exercise, your should eat extra food after you have quit exercising. It is very important to do a blood sugar test at bedtime when you have exercised vigorously and increase your bedtime snack to prevent a nighttime insulin reaction.

If you have Type 2 diabetes and are overweight your goal should be to exercise without increasing your food intake. If you are using a meal plan only for management of your diabetes, you are not at risk for your blood sugar dropping too low during exercise so extra food will not be needed. If extra food is needed to keep your blood sugar normal when you exercise, you will not be successful in losing weight. It is important that you not view exercise as a reason to eat extra food. Keep in mind that exercise may make you feel hungry. If this happens to you, try doing exercise just after you have eaten the biggest meal of the day.

Your blood sugar levels will probably be stable during and after exercise but it is possible that you may have hypoglycemia (low blood sugar) if you are taking insulin or an oral sulfonylurea (such as glipizide, glyburide, or glimepiride) especially if your exercise is strenuous or prolonged. You will need to follow the self-care guidelines for exercise and Type 1 diabetes. Hypoglycemia must be treated with extra food immediately. Hypoglycemia during or after exercise may mean that your medication dose needs to be reduced. Call your doctor or nurse about the hypoglycemia. Blood sugar testing helps you find out about the effect exercise is having on your diabetes control.

Foot Care for Exercise

When you have diabetes you are at greater risk for foot injury when you exercise. Nerve damage may decrease your ability to feel an injury to your feet. Impaired circulation can mean slow or poor healing when injuries do occur. Prevention of injury to your feet is very important. When you talk to your doctor about starting an exercise program, you will be advised about whether your legs and feet can safely tolerate the type of exercise your are planning.

Check your feet before and after exercise. Look for breaks in the skin, redness, blisters, or unusual swelling. If any of these problems occur, contact your doctor immediately. Wear shoes that fit properly and that are appropriate for the type of exercise you will be doing. Wear cotton socks, preferably white, and change them during exercise if they become damp.

Diabetes Complications and Exercise

Long-term complications such as eye or nerve damage may be worsened by inappropriate or strenuous exercise. This is why it is so important to check with your doctor before you begin an exercise program. If you have eye problems, exercises that require straining, such as weight lifting, can cause further eye damage. If you have nerve damage or poor circulation to your feet, exercises that produce a lot of impact on your feet, like running, can cause foot sores that you do not feel, possibly leading to serious damage before you notice the problem. The goal is to prevent worsening of any problems you have by selecting the proper exercise for you.www.diabetespreventions.blogspot.com

WEIGHT LOSS AND EXERCISE.

WEIGHT LOSS
Losing weight and keeping it off is a real challenge for most people. That's why it's important to begin a weight loss program with the help of your health care team, including, if possible, a dietitian. They can help you find ways to decrease calories but still consume the foods you enjoy. And they can suggest strategies to help you change old habits for new ones. It's important to remember that losing even a relatively small amount of weight can make a real improvement in reducing your risk for diabetes and other serious conditions.

EXERCISE
Exercise is also known as physical activity and includes anything that gets you moving, such as walking, dancing, or working in the yard. You can earn the benefits of being physically active without going to a gym, playing sports, or using fancy equipment. When you're physically fit, you have the strength, flexibility, and endurance needed for your daily activities. Being physically active helps you feel better physically and mentally.
CLUBPED
ClubPed is the Association's new online feature. You already walk every day. Now all you have to do is track your walking steps. Set a goal and start walking. Walk alone, with a friend, or in a group. ClubPed can help you get started and maintain your walking program, while offering some cool rewards.

DIABETES STATISTICS

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There are 23.6 million people in the United States, or 8% of the population, who have diabetes. The total prevalence of diabetes increased 13.5% from 2005-2007. Only 24% of diabetes is undiagnosed, down from 30% in 2005 and from 50% ten years ago.

With so many people affected by diabetes, the American Diabetes Association has compiled diabetes statistics on the impact of the disease and its complications.

Further Reading . . .
Diabetes 4-1-1: Facts, Figures, and Statistics at a Glance offers media professionals, government employees, and students access to up-to-date accurate numbers and solid facts about diabetes from the preeminent diabetes source.

Total Prevalence of Diabetes & Pre-diabetes
Read more detailed information on the prevalence of diabetes, and how it affects different races/ethnicities.

Complications of Diabetes in the United States
Diabetes is associated with an increased risk for a number of serious, sometimes life-threatening complications and certain populations experience an even greater threat. Good diabetes control can help reduce your risk, however many people are not even aware that they have diabetes until they develop one of its complications.

The Dangerous Toll of Diabetes
Based on death certificate data, diabetes contributed to 224,092 deaths in 2002. Studies indicate that diabetes in generally under-reported on death certificates, particularly in the cases of older persons with multiples chronic conditions such as heart disease and hypertension. Because of this, the toll of diabetes is believed to be much higher than officially reported.

Direct and Indirect Costs of Diabetes in the United States
The total annual economic cost of diabetes in 2007 was estimated to be $174 billion. Medical expenditures totaled $116 billion and were comprised of $27 billion for diabetes care, $58 billion for chronic diabetes-related complications, and $31 billion for excess general medical costs.

National Diabetes Fact Sheet (PDF)
This is the official Fact Sheet developed jointly by the Centers for Disease Control and Prevention, the National Institutes of Health, the American Diabetes Association, and other partners. The Fact Sheet is the authoritative source of information, statistics, and national estimates on diabetes in the United States.

The National Diabetes Fact Sheet was compiled using these methods and resources. (PDF)

Economic Costs of Diabetes in the U.S. for 2007 (PDF)
An authoritative study of the direct and indirect costs of diabetes conducted by the American Diabetes Association and endorsed by the National Institutes of Health and the Centers for Disease Control and Prevention.

The World Health Organization's Report -- Preventing Chronic Diseases: A Vital Investment (PDF)
The report makes the case for urgent action in countries all over the world to halt and turn back the growing threat of chronic diseases, and dispels the long-held misunderstandings about heart disease, stroke, cancer and other chronic diseases.

ALL ABOUT DIABETES

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

There are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately, 5.7 million people (or nearly one quarter) are unaware that they have the disease.

In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes. The American Diabetes Association recommends the FPG because it is easier, faster, and less expensive to perform.

With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.

In the OGTT test, a person's blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes

MAJOR TYPES OF DIABETES
TYPE 1 DIABETES
Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.

TYPE 2 DIABETES
Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes.

GESTATIONAL DIABETES
Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually, type 2.

PRE-DIABETES
Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes.




ADDITIONAL INFORMATION
Recently Diagnosed
You or someone you love has just been diagnosed with diabetes -- chances are you have a million questions running through your head. This area of our Web site can help ease your fears and teach you more about living with diabetes or caring for someone with diabetes, and connect you with others affected by diabetes who will listen and share their own experiences.

Diabetes Learning Center
Take the first steps toward better diabetes care by visiting the Diabetes Learning Center -- an area for people who have been recently diagnosed with diabetes, or those needing basic information.

Diabetes Symptoms
Often diabetes goes undiagnosed because many of its symptoms seem so harmless. Learn what they are in this section.

Diabetes Risk Test
23.6 million Americans have diabetes -- nearly one in four does not know it! Take our diabetes risk test to see if you are at risk for having diabetes. Diabetes is more common in African Americans, Latinos, Native Americans, Asian Americans and Pacific Islanders.

Diabetes Myths
Find the truth about some of the most common myths about diabetes.

Diabetes Statistics
With so many people affected by diabetes, the American Diabetes Association has compiled statistics on the impact of diabetes and its complications. We have statistics listed by population, complication, and economic impact.

The Genetics of Diabetes
You've probably wondered how you got diabetes. You may worry that your children will get it too. Unlike some traits, diabetes does not seem to be inherited in a simple pattern. Yet clearly, some people are born more likely to get diabetes than others.

THE ACUTE COMPLICATIONS OF DIABETES

Severely elevated blood sugar levels due to an actual lack of insulin or a relative deficiency of insulin.
levels due to too much insulin or other glucose-lowering medications.
Insulin is vital to patients with type 1 diabetes - they cannot live with out a source of exogenous insulin. Without insulin, patients with type 1 diabetes develop severely elevated blood sugar levels. This leads to increased urine glucose, which in turn leads to excessive loss of fluid and in the urine. Lack of insulin also causes the inability to store fat and protein along with breakdown of existing fat and protein stores. This dysregulation, results in the process of ketosis and the release of ketones into the blood. Ketones turn the blood acidic,Without prompt medical treatment, patients with diabetic ketoacidosis can rapidly go into and even death.
Diabetic ketoacidosis can be caused by infections trauma all which may increase insulin requirements. In addition, missing doses of insulin is also an obvious risk factor for developing diabetic ketoacidosis. Urgent treatment of diabetic ketoacidosis involves the intravenous administration of fluid, electrolytes, and insulin, usually in a hospital intensive care unit. Dehydration can be very severe, and it is not unusual to need to replace 6-7 liters of fluid when a person presents in diabetic ketoacidosis. Antibiotics are given for infections. With treatment, abnormal blood sugar levels, and dehydration can be reversed rapidly, and patients can recover remarkably well.
In patients with type 2 diabetes, stress, infection, and medications (such as corticosteroids) can also lead to severely elevated blood sugar levels. Accompanied by dehydration, severe blood sugar elevation in patients with type 2 diabetes can lead to an increase in blood osmolality.This condition can lead to coma (hyperosmolar coma). A hyperosmolar coma usually occurs in elderly patients with type 2 diabetes. Like diabetic ketoacidosis, a hyperosmolar coma is a medical emergency. Immediate treatment with intravenous fluid and insulin is important in reversing the hyperosmolar state. Unlike patients with type 1 diabetes, patients with type 2 diabetes do not generally develop ketoacidosis solely on the basis of their diabetes. Since in general, type 2 diabetes occurs in an older population, concomitant medical conditions are more likely to exist, and these patients may actually be sicker overall. The complication and death rates from hyperosmolar coma is thus higher than in DKA.
In patients with diabetes, the most common cause of low blood sugar is excessive use of insulin or other glucose-lowering medications, to lower the blood sugar level in diabetic patients in the presence of a delayed or absent meal. When low blood sugar levels occur because of too much insulin, it is called an insulin reaction. Sometimes, low blood sugar can be the result of an insufficient caloric intake or sudden excessive physical exertion.
Blood glucose is essential for the proper functioning of brain cells. The actual level of blood sugar at which these symptoms occur varies with each person, but usually it occurs when blood sugars are less than 65 mg/dl. Untreated, severely low blood sugar levels can lead to coma, seizures, and, in the worse case scenario, irreversible brain death. At this point, the brain is suffering from a lack of sugar, and this usually occurs somewhere around levels of <40 mg/dl.
The treatment of low blood sugar consists of administering a quickly absorbed glucose source. These include glucose containing drinks, such as orange juice, soft drinks (not sugar-free), or glucose tablets in doses of 15-20 grams at a time (for example, the equivalent of half a glass of juice). Even cake frosting applied inside the cheeks can work in a pinch if patient cooperation is difficult. If the individual becomes glucagon can be given by intramuscular injection.
Glucagon causes the release of glucose from the liver (for example, it promotes gluconeogenesis). Glucagon can be lifesaving and every patient with diabetes who has a history of hypoglycemia (particularly those on insulin) should have a glucagon kit. Families and friends of those with diabetes need to be taught how to administer glucagon, since obviously the patients will not be able to do it themselves in an emergency situation. Another lifesaving device that should be mentioned is very simple; a medic alert bracelet should be worn by all patients with diabetes.

WHAT CAUSES DIABETES?

Insufficient production of insulin (either absolutely or relative to the body's needs), production of defective insulin (which is uncommon), or the inability of cells to use insulin properly and efficiently leads to hyperglycemia and diabetes. This latter condition affects mostly the cells of muscle and fat tissues, and results in a condition known as "insulin resistance." This is the primary problem in type 2 diabetes. The absolute lack of insulin, usually secondary to a destructive process affecting the insulin producing beta cells in the pancreas, is the main disorder in type 1 diabetes. In type 2 diabetes, there also is a steady decline of beta cells that adds to the process of elevated blood sugars. Essentially, if someone is resistant to insulin, the body can, to some degree, increase production of insulin and overcome the level of resistance. After time, if production decreases and insulin cannot be released as vigorously, hyperglycemia develops.
Glucose is a simple sugar found in food. Glucose is an essential nutrient that provides energy for the proper functioning of the body cells. Carbohydrates are broken down in the small intestine and the glucose in digested food is then absorbed by the intestinal cells into the bloodstream, and is carried by the bloodstream to all the cells in the body where it is utilized. However, glucose cannot enter the cells alone and needs insulin to aid in its transport into the cells. Without insulin, the cells become starved of glucose energy despite the presence of abundant glucose in the bloodstream. In certain types of diabetes, the cells' inability to utilize glucose gives rise to the ironic situation of "starvation in the midst of plenty". The abundant, unutilized glucose is wastefully excreted in the urine.
Insulin is a hormone that is produced by specialized cells (beta cells) of the pancreas. (The pancreas is a deep-seated organ in the abdomen located behind the stomach.) In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood. After a meal, the blood glucose level rises. In response to the increased glucose level, the pancreas normally releases more insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels after a meal. When the blood glucose levels are lowered, the insulin release from the pancreas is turned down. It is important to note that even in the fasting state there is a low steady release of insulin than fluctuates a bit and helps to maintain a steady blood sugar level during fasting. In normal individuals, such a regulatory system helps to keep blood glucose levels in a tightly controlled range. As outlined above, in patients with diabetes, the insulin is either absent, relatively insufficient for the body's needs, or not used properly by the body. All of these factors cause elevated levels of blood glucose (hyperglycemia).

WHAT IS A DIABETES?

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels, that result from defects in insulin secretion, or action, or both. Diabetes mellitus, commonly referred to as diabetes (as it will be in this article) was first identified as a disease associated with "sweet urine," and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine.
Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime.

What is the impact of diabetes?
Over time, diabetes can lead to blindness, kidney failure, and nerve damage. These types of damage are the result of damage to small vessels, referred to as microvascular disease. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart disease, and other large blood vessel diseases. This is referred to as macrovascular disease. Diabetes affects approximately 17 million people (about 8% of the population) in the United States. In addition, an estimated additional 12 million people in the United States have diabetes and don't even know it.
From an economic perspective, the total annual cost of diabetes in 1997 was estimated to be 98 billion dollars in the United States. The per capita cost resulting from diabetes in 1997 amounted to $10,071.00; while healthcare costs for people without diabetes incurred a per capita cost of $2,699.00. During this same year, 13.9 million days of hospital stay were attributed to diabetes, while 30.3 million physician office visits were diabetes related. Remember, these numbers reflect only the population in the United States. Globally, the statistics are staggering.
Diabetes is the third leading cause of death in the United States after heart disease and cancer.

Home blood sugar (glucose) testing is an important part of controlling blood sugar. One important goal of diabetes treatment is to keep the blood glucose levels near the normal range of 70 to 120 mg/dl before meals and under 140 mg/dl at two hours after eating. Blood glucose levels are usually tested before and after meals, and at bedtime. The blood sugar level is typically determined by pricking a fingertip with a lancing device and applying the blood to a glucose meter, which reads the value. There are many meters on the market, for example, Accu-Check Advantage, One Touch Ultra, Sure Step and Freestyle. Each meter has its own advantages and disadvantages (some use less blood, some have a larger digital readout, some take a shorter time to give you results, etc). The test results are then used to help patients make adjustments in medications, diets, and physical activities.
There are some interesting developments in blood glucose monitoring. Currently, at least three continuous glucose sensors are approved in the United States (Dexcom, Medtronic and Navigator). The new continuous glucose sensor systems involve an implantable cannula placed just under the skin in the abdomen or in the arm. This cannula allows for frequent sampling of blood glucose levels. Attached to this is a transmitter that sends the data to a pager-like device. This device has a visual screen that allows the wearer to see, not only the current glucose reading, but also the graphic trends. In some devices, the rate of change of blood sugar is also shown. There are alarms for low and high sugar levels. Certain models will alarm if the rate of change indicates the wearer is at risk for dropping or rising blood glucose too rapidly. The Medtronic version is specifically designed to interface with their insulin pumps. However, at this time the patient still must manually approve any insulin dose (the pump cannot blindly respond to the glucose information it receives, it can only give a calculated suggestion as to whether the wearer should give insulin, and if so, how much). All of these devices need to be correlated to fingersticks for a few hours before they can function independently. The devices can then provide readings for 3-5 days.
Diabetes experts feel that these blood glucose monitoring devices give patients a significant amount of independence to manage their disease process; and they are a great tool for education as well. It is also important to remember that these devices can be used intermittently with fingersticks. For example, a well-controlled patient with diabetes can rely on fingerstick glucose checks a few times a day and do well. If they become ill, if they decide to embark on a new exercise regimen, if they change their diet and so on, they can use the sensor to supplement their fingerstick regimen, providing more information on how they are responding to new lifestyle changes or stressors. This kind of system takes us one step closer to closing the loop, and to the development of an artifical pancreas that senses insulin requirements based on glucose levels and the body's needs and releases insulin accordingly - the ultimate goal.
Hemoglobin A1c (A1c)
To explain what an hemoglobin A1c is, think in simple terms. Sugar sticks, and when it's around for a long time, it's harder to get it off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die off. When sugar sticks to these cells, it gives us an idea of how much sugar is around for the preceding three months. 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% (optimal is <6.5%). The benefits of measuring A1c is that is gives a more reasonable and stable view of what's happening over the course of time (three months), and the value does not bounce as much as finger stick blood sugar measurements. There is a direct correlation between A1c levels and average blood sugar levels as follows.
While there are no guidelines to use A1c as a screening tool, it gives a physician a good idea that someone is diabetic if the value is elevated. Right now, it is used as a standard tool to determine blood sugar control in patients known to have diabetes.
A1c(%) Mean blood sugar(mg/dl)
6 135
7 170
8 205
9 240
10 275
11 310
12 345
The American Diabetes Association currently recommends an A1c goal of less than 7.0%. Other Groups such as the American Association of Clinical Endocrinologists feel that an A1c of <6.5% should be the goal.
Of interest, studies have shown that there is about a 10% decrease in relative risk for microvascular disease for every 1% reduction in A1c. So, if a patient starts off with an A1c of 10.7 and drops to 8.2, though there are not yet at goal, they have managed to decrease their risk of microvascular complications by about 20%. The closer to normal the A1c, the lower the absolute risk for microvascular complications. Data also suggests that the risk of macrovascular disease decreases by about 24% for every 1% reduction in A1c values.
It should be mentioned here that there are a number of conditions in which an A1c value may not be accurate. For example, with significant anemia, the red blood cell count is low, and thus the A1c is altered. This may also be the case in sickle cell disease and other hemoglobinopathies.

HOW IS DIABETES DIAGNOSED?

The fasting blood glucose (sugar) test is the preferred way to diagnose diabetes. It is easy to perform and convenient. After the person has fasted overnight (at least 8 hours), a single sample of blood is drawn and sent to the laboratory for analysis. This can also be done accurately in a doctor's office using a glucose meter.
Normal fasting plasma glucose levels are less than 100 milligrams per deciliter (mg/dl).
Fasting plasma glucose levels of more than 126 mg/dl on two or more tests on different days indicate diabetes.
A random blood glucose test can also be used to diagnose diabetes. A blood glucose level of 200 mg/dl or higher indicates diabetes.
When fasting blood glucose stays above 100mg/dl, but in the range of 100-126mg/dl, this is known as impaired fasting glucose (IFG). While patients with IFG do not have the diagnosis of diabetes, this condition carries with it its own risks and concerns, and is addressed elsewhere.
The oral glucose tolerance test
Though not routinely used anymore, the oral glucose tolerance test (OGTT) is a gold standard for making the diagnosis of type 2 diabetes. It is still commonly used for diagnosing gestational diabetes and in conditions of pre-diabetes, such as polycystic ovary syndrome. With an oral glucose tolerance test, the person fasts overnight (at least eight but not more than 16 hours). Then first, the fasting plasma glucose is tested. After this test, the person receives 75 grams of glucose (100 grams for pregnant women). There are several methods employed by obstetricians to do this test, but the one described here is standard. Usually, the glucose is in a sweet-tasting liquid that the person drinks. Blood samples are taken at specific intervals to measure the blood glucose.
For the test to give reliable results:
the person must be in good health (not have any other illnesses, not even a cold).
the person should be normally active (not lying down, for example, as an inpatient in a hospital), and
the person should not be taking medicines that could affect the blood glucose.
For three days before the test, the person should have eaten a diet high in carbohydrates (200-300 grams per day).
The morning of the test, the person should not smoke or drink coffee.
The classic oral glucose tolerance test measures blood glucose levels five times over a period of three hours. Some physicians simply get a baseline blood sample followed by a sample two hours after drinking the glucose solution. In a person without diabetes, the glucose levels rise and then fall quickly. In someone with diabetes, glucose levels rise higher than normal and fail to come back down as fast.
People with glucose levels between normal and diabetic have impaired glucose tolerance (IGT). People with impaired glucose tolerance do not have diabetes, but are at high risk for progressing to diabetes. Each year, 1%-5% of people whose test results show impaired glucose tolerance actually eventually develop diabetes. Weight loss and exercise may help people with impaired glucose tolerance return their glucose levels to normal. In addition, some physicians advocate the use of medications, such as metformin (Glucophage), to help prevent/delay the onset of overt diabetes.
Recent studies have shown that impaired glucose tolerance itself may be a risk factor for the development of heart disease. In the medical community, most physicians are now understanding that impaired glucose tolerance is nor simply a precursor of diabetes, but is its own clinical disease entity that requires treatment and monitoring.
Evaluating the results of the oral glucose tolerance test
Glucose tolerance tests may lead to one of the following diagnoses:
Normal response: A person is said to have a normal response when the 2-hour glucose level is less than 140 mg/dl, and all values between 0 and 2 hours are less than 200 mg/dl.
Impaired glucose tolerance: A person is said to have impaired glucose tolerance when the fasting plasma glucose is less than 126 mg/dl and the 2-hour glucose level is between 140 and 199 mg/dl.
Diabetes: A person has diabetes when two diagnostic tests done on different days show that the blood glucose level is high.
Gestational diabetes: A woman has gestational diabetes when she has any two of the following: a 100g OGTT, a fasting plasma glucose of more than 95 mg/dl, a 1-hour glucose level of more than 180 mg/dl, a 2-hour glucose level of more than 155 mg/dl, or a 3-hour glucose level of more than 140 mg/dl.

SYMPTOMS OF DIABETES

Many of the signs of Type 1 and Type 2 diabetes are similar. In both, there is too much glucose in the blood and not enough in the cells of your body. High glucose levels in Type I are due to a lack of insulin because the insulin producing cells have been destroyed. Type 2 diabetes occurs when the body's cells become resistant to insulin that is being produced. Either way, your cells aren't getting the glucose that they need, and your body lets you know by giving you these signs and symptoms.
Frequent trips to the bathroom:
Are you visiting the bathroom much more lately? Does it seem like you urinate all day long? Urination becomes more frequent when there is too much glucose in the blood. If insulin is nonexistent or ineffective, the kidneys can't filter glucose back to the blood. They become overwhelmed and try to draw extra water out of the blood to dilute the glucose. This keeps your bladder full and it keeps you running to the bathroom.
Unquenchable Thirst:
If it feels like you can't get enough water and you're drinking much more than usual, it could be a sign of diabetes, especially if it seems to go hand in hand with frequent urination. If your body is pulling extra water out of your blood and you're running to the bathroom more, you will become dehydrated and feel the need to drink more to replace the water that you are losing.
Losing Weight Without Trying:
This symptom is more noticeable with Type 1 diabetes. In Type 1, the pancreas stops making insulin, possibly due to a viral attack on pancreas cells or because an autoimmune response makes the body attack the insulin producing cells. The body desperately looks for an energy source because the cells aren't getting glucose. It starts to break down muscle tissue and fat for energy. Type 2 happens gradually with increasing insulin resistance so weight loss is not as noticeable.
Weakness and Fatigue:
It's that bad boy glucose again. Glucose from the food we eat travels into the bloodstream where insulin is supposed to help it transition into the cells of our body. The cells use it to produce the energy we need to live. When the insulin isn't there or if the cells don't react to it anymore, then the glucose stays outside the cells in the bloodstream. The cells become energy starved and you feel tired and run down.
Tingling or Numbness in Your Hands, Legs or Feet:
This symptom is called neuropathy. It occurs gradually over time as consistently high glucose in the blood damages the nervous system, particularly in the extremities. Type 2 diabetes is a gradual onset, and people are often not aware that they have it. Therefore, blood sugar might have been high for more than a few years before a diagnosis is made. Nerve damage can creep up without our knowledge. Neuropathy can very often improve when tighter blood glucose control is achieved.
Other Signs and Symptoms That Can Occur:
Blurred vision, skin that is dry or itchy, frequent infections or cuts and bruises that take a long time to heal are also signs that something is amiss. Again, when these signs are associated with diabetes, they are the result of high glucose levels in the body. If you notice any of the above signs, schedule an appointment with your doctor. He or she will be able to tell you if you have reason to be concerned about a diagnosis of diabetes