Diabetes information

What Is It?
Diabetes is a chronic condition in which the body loses its ability to process glucose, the raw sugar that serves as the source of energy to your cells. The formal name for the condition is Diabetes Mellitus from the Greek "diabetes", meaning "siphon" or "flowing through" and "mellitus" referring to the sweetness of honey. If untreated, diabetes causes a buildup of glucose in the bloodstream. As a response, the body tries to rid itself of the glucose through frequent urination. This is the reason for the elevated glucose levels in the urine. High glucose levels can lead to long-term health problems. There are three types of diabetes: Type 1, Type 2 and Gestational Diabetes.

Type 1 Diabetes
Type 1 diabetes was once called "juvenile diabetes" because it most often occurred in children or young adults. With this type, the pancreas, a small organ near the stomach, stops producing insulin, usually after a bout of some kind of illness. Insulin is the hormone that cells use to convert glucose to energy. Without insulin, a person could, in effect, starve to death on a full stomach.

A person with Type 1 diabetes will often show the symptoms quickly and some may even blackout due to a condition called "ketoacidosis". Once diagnosed, Type 1 diabetes can be treated successfully with injected insulin (it must be injected because it breaks down in the stomach if taken in tablet form).

Type 2 Diabetes
By far the most common form, 90 percent of all people with diabetes have Type 2; this was once called "adult onset" diabetes. In this condition, the pancreas continues to produce insulin, sometimes at a reduced rate, but the cells in the body lose their sensitivity, so the insulin fails to work properly. However, because some insulin is still available, the symptoms of Type 2 are not always immediately obvious and many people go for years, risking the dangers of continuing high blood-glucose levels, without knowing they have the condition.

Roughly 40 percent of people with Type 2 diabetes can manage their condition through changes in diet and increased exercise, which improves the body's sensitivity to insulin. The rest must take oral medication or, in some cases, injected insulin.

Gestational Diabetes
Four percent of pregnant women develop Gestational Diabetes Mellitus (GDM); they then have a 40-percent chance of developing Type 2 diabetes within the next 10 years. Women with gestational diabetes are twice as likely to give birth to a very large baby and three to four times as likely to give birth by Cesarean section.

Complications

• Diabetes is the leading cause of new blindness in adults.
• 40 to 50 percent of people with diabetes have nerve damage; it is the leading cause of amputations in adults.
• The risk of cardiac problems increases by two-fold for men with diabetes, three-fold for women.
• Hypertension is twice as common among seniors with diabetes.
• 50 to 60 percent of men with diabetes experience erection dysfunction (impotence).

A New Epidemic
The World Health Organization estimates that the prevalence of diabetes will jump from the current 1 person in 20 to 1 in 10 over the next 10 years, and the increase will be worse in the developed world, where the high incidence of obesity and the aging population increases the risk factors. In Canada, diabetes will affect 1 in 11 adults over the age of 20.

This could be a public health catastrophe, but if those at risk recognize the warning signals and act accordingly, the savings will be counted in thousands of lives and millions of dollars.

Diabetes: Are you at risk?*
The risk factors are different for Type 1 diabetes and Type 2 diabetes. If you are of Aboriginal, Hispanic, Asian or African decent, your chances of developing Type 1 diabetes are higher than those who are not. A family history of diabetes is another risk factor for Type 1 diabetes. In the cases of Type 2 diabetes, the risk factors are:

• Age over 45.
• Overweight.
• Previous problems with glucose tolerance.
• Having given birth to a baby over 9 lbs/4 kg.

Symptoms*
For Type 1 diabetes, the symptoms include:

• Excessive appetite.
• Excessive thirst.
• Excessive urination.
• Fatigue.
• Weight loss.

Those with Type 2 diabetes may also experience some of the same symptoms as those with Type 1 diabetes. There are also other symptoms that may be evident in Type 2 diabetes, which include:

• Slow healing of cuts.
• Skin infections.
• Bladder infections.
• Blurred vision.
• Numbness or tingling in the hands and feet.

It is also important to note that Type 2 diabetes, the most common type, can occur with little or no symptoms. Fully half of the Canadians who have diabetes don't yet know it. Getting a diagnosis is the first step toward managing your diabetes. If you are over 45 years of age, you should be getting your blood sugar levels tested every 3 years. If you have known risk factors, you should be checked every year.

*Information has been provided by the Canadian Diabetes Association.

Diabetes Management
There are a number of steps in managing your condition, each to help you lead a full and active life. These steps include:

· Educate yourself. Diabetes education is very important and plays a big role in helping you manage your condition as well as making lifestyle choices.

· Make a dietary plan. Work with a dietician to design the best meal plan for you. If you have Type 1 diabetes, your plan will aim to provide you with a healthy diet and a steady level of carbohydrates. If you have Type 2 diabetes, your plan will aim to reduce your blood sugar levels and your weight (if applicable).

· Exercise regularly. Exercise and diet work hand in hand. Exercise can help you lose excess weight, lower your blood sugar level and improve insulin sensitivity³. You should consult your doctor before beginning any exercise program.

· Monitor your own blood sugar. You can test your own blood sugar levels at home with a blood glucose meter. There are a variety of blood glucose monitors on the market, and your pharmacist can help you pick out the one that's most suited to your needs. You should keep your own record of your blood sugar levels, because it can help you determine your need for adjusting your medication, food or exercise⁵. When to test and the number of tests vary from person to person, so you and your doctor will determine the best schedule for you.

Drug Therapy
Type 1 diabetes
All those with Type 1 diabetes need to be treated with injected insulin. Insulin comes in many forms varying in how fast they start working, how long it takes for them to reach maximum efficiency and how long they last. There are rapid acting, short acting, intermediate acting, long acting and premixed combinations of short and intermediate acting insulin on the market⁴. Your doctor will work with you to formulate a regimen that is best for you. For those of you who find using syringes and vials inconvenient, insulin pens offer a more portable and convenient way of giving your insulin.

Type 2 diabetes
When blood sugar levels cannot be controlled through diet and exercise, oral medications can help. These include: sulfonyureas, biguanides, Alpha glucosidase, thiazolidinediones and meglitinide.

Sulfonylureas stimulate your pancreas to make more insulin, and may also lower the blood sugar production in your liver and help your body use insulin better. Glyburide and Gliclazide are examples of this class.

Biguanides help your muscle take in more blood sugar and reduce blood sugar production by your liver. An example is Metformin.

Alpha Glucosidase inhibitors slow down the absorption of carbohydrates in your small intestines, hence, lowering your blood sugar. Acarbose is an example of this class of medication.

Thiazolidinediones help your muscle and fat tissues take up and use more blood sugar and lower the amount of blood sugar produced. An example of this class is Rosiglitazone.

Meglitinide is a new chemical class of medications that reduce blood glucose by stimulating the release of insulin from the pancreas. This mechanism is the same as that of the sulfonylureas. Repaglinide is an example of this class.

A combination of these pills or a combination of a pill and insulin may be prescribed if just one medicine doesn't lower the blood sugar levels to an adequate level.

Crisis Management
Some people with diabetes could be in danger if their blood-glucose level drops below a critical point, a condition called hypoglycemia. The symptoms are sweating, tremors, fatigue, confusion and weakness. Untreated, this condition can lead to death. If someone you know has diabetes, or if you come upon someone wearing a diabetes Medic Alert® bracelet while in this condition, you should immediately call for medical assistance and then administer sugar in the form of a sweet drink (soft drink containing sugar or a fruit juice) or a sugar syrup or candy.

Seeking Information
If you have any questions about diabetes or about your treatment, talk to your doctor or Save-On-Foods pharmacist.

Our pharmacists can also introduce you to the benefits of the Health computer kiosk - an easily accessible, user-friendly and authoritative source of the latest knowledge on health and medicines at the touch of your fingertips. Health kiosks are located in all of our pharmacies. And when you have found the information you're looking for, you can print it and take it with you.