1. What id Diabetes
Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in
which the person has high blood glucose (blood sugar), either because insulin production is inadequate,
or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar
will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia)
and hungry (polyphagia).
There are three types of diabetes:
1) Type 1 Diabetes
The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes,
juvenile diabetes, or early-onset diabetes. People usually develop type 1 diabetes before their 40th year,
often in early adulthood or teenage years.
Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 10% of all diabetes cases
are type 1.
Patients with type 1 diabetes will need to take insulin injections for the rest of their life. They must also
ensure proper blood-glucose levels by carrying out regular blood tests and following a special diet.
Between 2001 and 2009, the prevalence of type 1 diabetes among the under 20s in the USA rose 23%,
according to SEARCH for Diabetes in Youth data issued by the CDC (Centers for Disease Control and
Prevention). (Link to article)
2) Type 2 Diabetes
The body does not produce enough insulin for proper function, or the cells in the body do not react to
insulin (insulin resistance).

2. Approximately 90% of all cases of diabetes worldwide are of this type.
Some people may be able to control their type 2 diabetes symptoms by losing weight, following a
healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. However, type 2
diabetes is typically a progressive disease - it gradually gets worse - and the patient will probably end up
have to take insulin, usually in tablet form.
Overweight and obese people have a much higher risk of developing type 2 diabetes compared to those
with a healthy body weight. People with a lot of visceral fat, also known as central obesity, belly fat, or
abdominal obesity, are especially at risk. Being overweight/obese causes the body to release chemicals
that can destabilize the body's cardiovascular and metabolic systems.
The risk of developing type 2 diabetes is also greater as we get older. Experts are not completely sure
why, but say that as we age we tend to put on weight and become less physically active. Those with a
close relative who had/had type 2 diabetes, people of Middle Eastern, African, or South Asian descent
also have a higher risk of developing the disease.
Men whose testosterone levels are low have been found to have a higher risk of developing type 2
diabetes. Researchers from the University of Edinburgh, Scotland, say that low testosterone levels are
linked to insulin resistance. (Link to article)
Measuring the glucose level in blood
3) Gestational Diabetes
This type affects females during pregnancy. Some women have very high levels of glucose in their blood,
and their bodies are unable to produce enough insulin to transport all of the glucose into their cells,
resulting in progressively rising levels of glucose.

3. Diagnosis of gestational diabetes is made during pregnancy.
The majority of gestational diabetes patients can control their diabetes with exercise and diet. Between
10% to 20% of them will need to take some kind of blood-glucose-controlling medications. Undiagnosed
or uncontrolled gestational diabetes can raise the risk of complications during childbirth. The baby may
be bigger than he/she should be.
Scientists from the National Institutes of Health and Harvard University found that women whose diets
before becoming pregnant were high in animal fat and cholesterol had a higher risk for gestational
diabetes, compared to their counterparts whose diets were low in cholesterol and animal fats. (Link to
article)

4. What Is Prediabetes?
The vast majority of patients with type 2 diabetes initially had prediabetes. Their blood glucose levels
where higher than normal, but not high enough to merit a diabetes diagnosis. The cells in the body are
becoming resistant to insulin.
Studies have indicated that even at the prediabetes stage, some damage to the circulatory system and
the heart may already have occurred.
Diabetes Is A Metabolism Disorder
Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our
bodies use digested food for energy and growth. Most of what we eat is broken down into glucose.
Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies.
When our food is digested, the glucose makes its way into our bloodstream. Our cells use the glucose
for energy and growth. However, glucose cannot enter our cells without insulin being present - insulin
makes it possible for our cells to take in the glucose.
Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases
an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as
glucose enters the cells blood-glucose levels drop.
A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated
(hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin,
or has cells that do not respond properly to the insulin the pancreas produces. This results in too much
glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine.
So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and
growth requirements.
How To Determine Whether You Have Diabetes, Prediabetes or Neither

5. Doctors can determine whether a patient has a normal metabolism, prediabetes or diabetes in one of
three different ways - there are three possible tests:
The A1C test
- at least 6.5% means diabetes
- between 5.7% and 5.99% means prediabetes
- less than 5.7% means normal
The FPG (fasting plasma glucose) test
- at least 126 mg/dl means diabetes
- between 100 mg/dl and 125.99 mg/dl means prediabetes
- less than 100 mg/dl means normal
An abnormal reading following the FPG means the patient has impaired fasting glucose (IFG)
The OGTT (oral glucose tolerance test)
- at least 200 mg/dl means diabetes
- between 140 and 199.9 mg/dl means prediabetes
- less than 140 mg/dl means normal
An abnormal reading following the OGTT means the patient has impaired glucose tolerance (IGT)
Why Is It Called Diabetes Mellitus?
Diabetes comes from Greek, and it means a "siphon". Aretus the Cappadocian, a Greek physician during
the second century A.D., named the condition diabainein. He described patients who were passing too
much water (polyuria) - like a siphon. The word became "diabetes" from the English adoption of the
Medieval Latin diabetes.
In 1675, Thomas Willis added mellitus to the term, although it is commonly referred to simply as
diabetes. Mel in Latin means "honey"; the urine and blood of people with diabetes has excess glucose,
and glucose is sweet like honey. Diabetes mellitus could literally mean "siphoning off sweet water".

6. In ancient China people observed that ants would be attracted to some people's urine, because it was
sweet. The term "Sweet Urine Disease" was coined.
Controlling Diabetes - Treatment Is Effective And Important
All types of diabetes are treatable. Diabetes type 1 lasts a lifetime, there is no known cure. Type 2
usually lasts a lifetime, however, some people have managed, through a lot of exercise, diet and
excellent body weight control to get rid of their symptoms without medication.
Researchers from the Mayo Clinic Arizona in Scottsdale showed that gastric bypass surgery can reverse
type 2 diabetes in a high proportion of patients. They added that within three to five years the disease
recurs in approximately 21% of them. Yessica Ramos, MD., said "The recurrence rate was mainly
influenced by a longstanding history of Type 2 diabetes before the surgery. This suggests that early
surgical intervention in the obese, diabetic population will improve the durability of remission of Type 2
diabetes." (Link to article)
Patients with type 1 are treated with regular insulin injections, as well as a special diet and exercise.
Patients with Type 2 diabetes are usually treated with tablets, exercise and a special diet, but sometimes
insulin injections are also required.
If diabetes is not adequately controlled the patient has a significantly higher risk of developing
complications.
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Complications linked to badly controlled diabetes:
Eye complications - glaucoma, cataracts, diabetic retinopathy, and some others.
Foot complications - neuropathy, ulcers, and sometimes gangrene which may require that the foot be
amputated
Skin complications - people with diabetes are more susceptible to skin infections and skin disorders
Heart problems - such as ischemic heart disease, when the blood supply to the heart muscle is
diminished
Hypertension - common in people with diabetes, which can raise the risk of kidney disease, eye
problems, heart attack and stroke
Mental health - uncontrolled diabetes raises the risk of suffering from depression, anxiety and some
other mental disorders
Hearing loss - diabetes patients have a higher risk of developing hearing problems
Gum disease - there is a much higher prevalence of gum disease among diabetes patients
Gastroparesis - the muscles of the stomach stop working properly
Ketoacidosis - a combination of ketosis and acidosis; accumulation of ketone bodies and acidity in the
blood.
Neuropathy - diabetic neuropathy is a type of nerve damage which can lead to several different
problems.
HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome) - blood glucose levels shoot up too high, and
there are no ketones present in the blood or urine. It is an emergency condition.
Nephropathy - uncontrolled blood pressure can lead to kidney disease
PAD (peripheral arterial disease) - symptoms may include pain in the leg, tingling and sometimes
problems walking properly

8. Stroke - if blood pressure, cholesterol levels, and blood glucose levels are not controlled, the risk of
stroke increases significantly
Erectile dysfunction - male impotence.
Infections - people with badly controlled diabetes are much more susceptible to infections
Healing of wounds - cuts and lesions take much longer to heal
USA - 2011 National Diabetes Fact Sheet
How many Americans have diabetes or pre-diabetes?
8.5% of the US population have diabetes - 25.8 million children and adults.
Researchers from the Jefferson School of Population Health (Philadelphia, PA) published a study which
estimates that by 2025 there could be 53.1 million people with the disease. (Link to article)
18.8 million people have been diagnosed with diabetes
About 7 million people with diabetes have not been diagnosed.
Even though type 2 diabetes rates in the USA have risen sharply, Timothy Lyons, MD, who is presently
Director of Research of the Harold Hamm Diabetes Center in Oklahoma City says that the disease is still
not being detected promptly. He added that the lag in diagnosis involves both patients and doctors.
(Link to article)
About 79 million people have pre-diabetes
1.9 million people aged 20 years or more were newly diagnosed with diabetes in 2010
215,000 (0.26%) people younger than 20 years have diabetes

9. Approximately 1 in every 400 kids and teenagers has diabetes
11.3% of people aged 20+ years have diabetes; a total of 25.6 million individuals
26.9% of people aged 65+ years have diabetes; a total of 10.9 million people
11.8% of men have diabetes; a total of 13 million people
10.8% of women have diabetes; a total of 12.6 million people
Diabetes In The United Kingdom
In the United Kingdom there are about 3.8 million people with diabetes, according to the National
Health Service. Diabetes UK, a charity, believes this number will jump to 6.2 million by 2035, and the
National Health Service will be spending as much as 17% of its health care budget on diabetes by then.
Diabetes Spreads In Southeast Asia
Diabetes is rapidly spreading in Southeast Asia as people embrace American fast foods, such as
hamburgers, hot dogs, French fries and pizza. More Chinese adults who live in Singapore are dying of
heart disease and developing type 2 diabetes than ever before, researchers from the University of
Minnesota School of Public Health and the National University of Singapore reported in the journal
Circulation.
The authors found that Chinese adults in Singapore who eat American-style junk foods twice a week had
a 56% greater risk of dying prematurely form heart disease, while their risk of developing type 2
diabetes rose 27%, compared to their counterparts who "never touched the stuff". There was a 80%
higher likelihood of dying from coronary heart disease for those eating fast foods four times per week.
(Link to article)
Some Facts And Myths Regarding Diabetes

10. Many presumed "facts" are thrown about in the paper press, magazines and on the internet regarding
diabetes; some of them are, in fact, myths. It is important that people with diabetes, pre-diabetes, their
loved ones, employers and schools have an accurate picture of the disease. Below are some diabetes
myths:
People with diabetes should not exercise - NOT TRUE!! Exercise is important for people with diabetes, as
it is for everybody else. Exercise helps manage body weight, improves cardiovascular health, improves
mood, helps blood sugar control, and relieves stress. Patients should discuss exercise with their doctor
first.
Fat people always develop type 2 diabetes eventually - this is not true. Being overweight or obese raises
the risk of becoming diabetic, they are risk factors, but do not mean that an obese person will definitely
become diabetic. Many people with type 2 diabetes were never overweight. The majority of overweight
people do not develop type 2 diabetes.
Diabetes is a nuisance, but not serious - two thirds of diabetes patients die prematurely from stroke or
heart disease. The life expectancy of a person with diabetes is from five to ten years shorter than other
people's. Diabetes is a serious disease.
Children can outgrow diabetes - this is not true. Nearly all children with diabetes have type 1; insulin-
producing beta cells in the pancreas have been destroyed. These never come back. Children with type 1
diabetes will need to take insulin for the rest of their lives, unless a cure is found one day.
Don't eat too much sugar, you will become diabetic - this is not true. A person with diabetes type 1
developed the disease because their immune system destroyed the insulin-producing beta cells. A diet
high in calories, which can make people overweight/obese, raises the risk of developing type 2 diabetes,
especially if there is a history of this disease in the family.
I know when my blood sugar levels are high or low - very high or low blood sugar levels may cause some
symptoms, such as weakness, fatigue and extreme thirst. However, levels need to be fluctuating a lot for
symptoms to be felt. The only way to be sure about your blood sugar levels is to test them regularly.
Researchers from the University of Copenhagen, Denmark showed that even very slight rises in blood-
glucose levels significantly raise the risk of ischemic heart disease. (Link to article)

11. Diabetes diets are different from other people's - the diet doctors and specialized nutritionists
recommend for diabetes patients are healthy ones; healthy for everybody, including people without the
disease. Meals should contain plenty of vegetables, fruit, whole grains, and they should be low in salt
and sugar, and saturated or trans fat. Experts say that there is no need to buy special diabetic foods
because they offer no special benefit, compared to the healthy things we can buy in most shops.
High blood sugar levels are fine for some, while for others they are a sign of diabetes - high blood-sugar
levels are never normal for anybody. Some illnesses, mental stress and steroids can cause temporary
hikes in blood sugar levels in people without diabetes. Anybody with higher-than-normal blood sugar
levels or sugar in their urine should be checked for diabetes by a health care professional.
Diabetics cannot eat bread, potatoes or pasta - people with diabetes can eat starchy foods. However,
they must keep an eye on the size of the portions. Whole grain starchy foods are better, as is the case
for people without diabetes.
One person can transmit diabetes to another person - NOT TRUE. Just like a broken leg is not infectious
or contagious. A parent may pass on, through their genes to their offspring, a higher susceptibility to
developing the disease.
Only older people develop type 2 diabetes - things are changing. A growing number of children and
teenagers are developing type 2 diabetes. Experts say that this is linked to the explosion in childhood
obesity rates, poor diet, and physical inactivity.
I have to go on insulin, this must mean my diabetes is severe - people take insulin when diet alone or
diet with oral or non-insulin injectable diabetes drugs do not provide good-enough diabetes control,
that's all. Insulin helps diabetes control. It does not usually have anything to do with the severity of the
disease.
If you have diabetes you cannot eat chocolates or sweets - people with diabetes can eat chocolates and
sweets if they combine them with exercise or eat them as part of a healthy meal.
Diabetes patients are more susceptible to colds and illnesses in general - a person with diabetes with
good diabetes control is no more likely to become ill with a cold or something else than other people.

12. However, when a diabetic catches a cold, their diabetes becomes harder to control, so they have a
higher risk of complications.
People can often have diabetes and be completely unaware. The main reason for this is that the
symptoms, when seen on their own, seem harmless. However, the earlier diabetes is diagnosed the
greater the chances are that serious complications, which can result from having diabetes, can be
avoided.
Here is a list of the most common diabetes symptoms:
Frequent urination
Have you been going to the bathroom to urinate more often recently? Do you notice that you spend
most of the day going to the toilet? When there is too much glucose (sugar) in your blood you will
urinate more often. If your insulin is ineffective, or not there at all, your kidneys cannot filter the glucose
back into the blood. The kidneys will take water from your blood in order to dilute the glucose - which in
turn fills up your bladder.
Disproportionate thirst
If you are urinating more than usual, you will need to replace that lost liquid. You will be drinking more
than usual. Have you been drinking more than usual lately?
Intense hunger
As the insulin in your blood is not working properly, or is not there at all, and your cells are not getting
their energy, your body may react by trying to find more energy - food. You will become hungry.
Weight gain
This might be the result of the above symptom (intense hunger).
Unusual weight loss
This is more common among people with Diabetes Type 1. As your body is not making insulin it will seek
out another energy source (the cells aren't getting glucose). Muscle tissue and fat will be broken down
for energy. As Type 1 is of a more sudden onset and Type 2 is much more gradual, weight loss is more
noticeable with Type 1.
Increased fatigue

13. If your insulin is not working properly, or is not there at all, glucose will not be entering your cells and
providing them with energy. This will make you feel tired and listless.
Irritability
Irritability can be due to your lack of energy.
Blurred vision
This can be caused by tissue being pulled from your eye lenses. This affects your eyes' ability to focus.
With proper treatment this can be treated. There are severe cases where blindness or prolonged vision
problems can occur.
Cuts and bruises don't heal properly or quickly
Do you find cuts and bruises take a much longer time than usual to heal? When there is more sugar
(glucose) in your body, its ability to heal can be undermined.
More skin and/or yeast infections
When there is more sugar in your body, its ability to recover from infections is affected. Women with
diabetes find it especially difficult to recover from bladder and vaginal infections.
Itchy skin
A feeling of itchiness on your skin is sometimes a symptom of diabetes.
Gums are red and/or swollen - Gums pull away from teeth
If your gums are tender, red and/or swollen this could be a sign of diabetes. Your teeth could become
loose as the gums pull away from them.
Frequent gum disease/infection
As well as the previous gum symptoms, you may experience more frequent gum disease and/or gum
infections.
Sexual dysfunction among men
If you are over 50 and experience frequent or constant sexual dysfunction (erectile dysfunction), it could
be a symptom of diabetes.
Numbness or tingling, especially in your feet and hands
If there is too much sugar in your body your nerves could become damaged, as could the tiny blood
vessels that feed those nerves. You may experience tingling and/or numbness in your hands and feet.

14. Diagnosis of diabetes
Diabetes can often be detected by carrying out a urine test, which finds out whether excess glucose is
present. This is normally backed up by a blood test, which measures blood glucose levels and can
confirm if the cause of your symptoms is diabetes.
If you are worried that you may have some of the above symptoms, you are recommended to talk to
your Doctor or a qualified health professional.
What is insulin?
Insulin is a hormone. It makes our body's cells absorb glucose from the blood. The glucose is stored in
the liver and muscle as glycogen and stops the body from using fat as a source of energy.
When there is very little insulin in the blood, or none at all, glucose is not taken up by most body cells.
When this happens our body uses fat as a source of energy. Insulin is also a control signal to other body
systems, such as amino acid uptake by body cells. Insulin is not identical in all animals - their levels of
strength vary.
Porcine insulin, insulin from a pig, is the most similar to human insulin. Humans can receive animal
insulin. However, genetic engineering has allowed us to synthetically produce 'human' insulin.
The pancreas
(1. click for large diagram) - © 3d Medical RF

15. The pancreas is part of the digestive system. It is located high up in your abdomen and lies across your
body where the ribs meet at the bottom. It is shaped like a leaf and is about six inches long. The wide
end is called the head while the narrower end is called the tail, the mid-part is called the body.
The pancreas has two principal functions:
It produces pancreatic digestive juices.
It produces insulin and other digestive hormones.
The endocrine pancreas is the part of the pancreas that produces insulin and other hormones.
The exocrine pancreas is the part of the pancreas that produces digestive juices.
Insulin is produced in the pancreas. When protein is ingested insulin is released.
Insulin is also released when glucose is present in the blood. After eating carbohydrates, blood glucose
levels rise.
Insulin makes it possible for glucose to enter our body's cells - without glucose in our cells they would
not be able to function. Without insulin the glucose cannot enter our cells.
Within the pancreas, the Islets of Langerhans contain Beta cells, which synthesize (make) the insulin.
Approximately 1 to 3 million Islets of Langerhans make up the endocrine part of the pancreas (mainly
the exocrine gland), representing just one fiftieth of the pancreas' total mass.
Etymology (history) of the word pancreas
It is said that the pancreas was described first by Herophilus of Chalcedon in about 300B.C. and the
organ was named by Rufus of Ephesus in about 100A.D

16. However, it is an established fact that the word pancreas had been used by Aristotle (384-322B.C.)
before Herophilus.
In Aristotle's HistoriaAnimalium, there is a line saying "another to the so-called pancreas". It is
considered that the words "so-called pancreas" imply that the word pancreas had been popular at the
time of Aristotle, but it had not been authorized yet as an anatomical term.
However, the word pancreas presumably has been accepted as an anatomical term since Herophilus.
The word pancreas comes from the Greek pankreas, meaning sweetbread.
Discovery of insulin
In 1920, Dr. Frederick Banting wanted to make a pancreatic extract,
which he hoped would have anti-diabetic qualities. In 1921, at the
University of Toronto, Canada, along with medical student Charles Best,
they managed to make the pancreatic extract.
Their method involved tying a string around the pancrease duct. When
examined several weeks later, the pancreatic digestive cells had died
and been absorbed by the immune system. The process left behind
thousands of islets. They isolated the extracts from the islets and
produced isletin. What they called isletin became known as insulin.
Banting and Best managed to test this extract on dogs that had diabetes.
They discovered insulin. In fact, they managed to keep a dog, that had
had its pancreas taken out, alive throughout the whole summer by
administering it the extract (which was, in fact, insulin). The extract
regulated the dogs blood sugar levels.
At this point, Professor J. MacLeod, who had placed the laboratory at their disposal, said he wanted
to see a re-run of the whole trial. After doing so he decided to get his whole research team to work
on the production and purification of insulin.
J.B. Collip joined the scientific team, which now consisted of Banting, Best, Collip and MecLeod.
They managed to produce enough insulin, in a pure enough form, to be able to test it on patients.
In 1922 the insulin was tested on Leonard Thompson, a 14-year-old diabetes patient who lay dying

17. at the Toronto General Hospital. He was given an insulin injection. At first he suffered a severe
allergic reaction and further injections were cancelled. The scientists worked hard on improving the
extract and then a second dose of injections were administered on Thompson. The results were
spectacular.
The scientists went to the other wards with diabetic children, most of them comatose and dying from
diabetic keto-acidosis. They went from bed-to-bed and injected them with the new purified extract -
insulin. This is known as one of medicines most dramatic moments. Before injecting the last
comatose children, the first started to awaken from their comas. A joyous moment for family
members and hospital staff!!
Collip did not get on too well with Banting and Best apparently - and he soon left the project. Best
continued trying to improve the extract and managed eventually to produce enough for the hospital's
demand. Their work was privately published. The Eli Lilly Company soon got to hear about it and
offered to assist. It was not long before the Eli Lilly Company managed to produce large quantities of
refined pure insulin.
In 1923 Banting and Macleod were awarded the Nobel Prize in Physiology or Medicine. Banting
shared his prize with Best and Macleod shared his with Collip. The patent for insulin was sold to the
University of Toronto for one dollar.
Type 1 diabetes
Type 1 diabetes is an autoimmune disease - the
person's body has destroyed his/her own insulin-
producing beta cells in the pancreas.
People with Diabetes Type 1 are unable to produce insulin. Most patients with
Diabetes Type 1 developed the condition before the age of 40. Approximately
15% of all people with diabetes have Type 1.

18. Type 1 diabetes is fatal unless the patient regularly takes exogenous insulin. Some patients have had
their beta cells replaced through a pancreas transplant and have managed to produce their own insulin
again.
Type 1 diabetes is also known as juvenile diabetes or childhood diabetes. Although a large number of
diabetes Type 1 patients become so during childhood, it can also develop after the age of 18. Developing
Type 1 after the age of 40 is extremely rare.
Type 1, unlike Type 2, is not preventable. The majority of people who develop Type 1 are of normal
weight and are otherwise healthy during onset. Exercise and diet cannot reverse Type 1. Quite simply,
the person has lost his/her insulin-producing beta cells. Several clinical trials have attempted to find
ways of preventing or slowing down the progress of Type 1, but so far with no proven success.
A C-peptide assay is a lab test that can tell whether somebody has Type 1 or Type 2. As external insulin
has no C-peptide a lack of it would indicate Type 1. The test is only effective when ALL the endogenous
insulin has left the body - this can take several months.
Diet for a person with type 1
A person with Type one will have to watch what he/she eats. Foods that are low in fat, salt and have no
or very little added sugar are ideal. He/she should consume foods that have complex carbohydrates,
rather than fast carbohydrates, as well as fruits and vegetables. A diet that controls the person's blood
sugar level as well as his/her blood pressure and cholesterol levels will help achieve the best possible
health. Portion size is also important in order to maintain a healthy bodyweight.
Meal planning needs to be consistent so that the food and insulin can work together to control blood
glucose levels. According to the Mayo Clinic there is no 'diabetes diet'.
The Clinic says you do not need to restrict yourself to boring bland foods. Rather you should, as
mentioned above, consume plenty of fruits, vegetables and whole grains - foods that are highly

19. nutritious, low in fat, and low in calories. Even sugary foods are acceptable now and again if you include
them in your food plan.
If you have Type 1 you should seek the help of a registered dietitian. A dietitian can help you create a
food plan that suits you. Most dietitians agree that you should aim to consume the same quantity of
food, with equal portions of carbs, proteins and fats at the same time each day.
Complications - the bad news and the good news
A person with Type 1 has a two to four times higher risk of developing heart disease, stroke, high blood
pressure, blindness, kidney failure, gum disease and nerve damage, compared to a person who does not
have any type of diabetes.
A person with Type 1 is more likely to have poor blood circulation through his/her legs and feet. If left
untreated the problem may become such that a foot has to be amputated. A person with Type 1 will
likely go into a coma if untreated.
The good news is that treatment is available and it is effective and can help prevent these complications
from happening.
How to help prevent complications
Keep your blood pressure under 130/85 mm Hg.
Keep your cholesterol level below 200 mg.
Check your feet every day for signs of infection.
Get your eyes checked once a year.
Get your dentist to check your teeth and gums twice a year.
Physical activity helps regulate blood sugar levels

20. Before starting exercise make sure your doctor tells you it is OK. Try to make physical activity part of
your daily life. You should try to do at least 30 minutes of exercise or physical activity each day. Physical
activity or exercise means aerobic exercise.
If you have not done any exercise for a while, start gently and build up gradually. Physical activity helps
lower your blood sugar. Remember that exercise is good for everybody, not just people with Type 1.
The benefits are enormous for your physical and mental health. You will become stronger, fitter, your
sleep will improve as will your skin tone - and after some time you will look great!
Exercise will help your circulation - helping to make sure your lower legs and feet are healthy.
Remember to check your blood sugar level more frequently during your first few weeks of exercise so
that you may adapt your meal plans and/or insulin doses accordingly. Remember that a person with
Type 1 has to manually adjust his/her insulin doses - the body will not respond automatically.
"Gary Hall won an Olympic gold medal in swimming.
He had Type 1 diabetes."
Possible cure for diabetes type 1 closer with stem cells
Stem cells in the pancreas which can turn into insulin-producing cells have been identified by
researchers from the Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.
They published their breakthrough in PLoS One (November 9th, 2012).
The authors explain that their finding raises the hope that one day soon patients with diabetes type 1
will be able to produce their own insulin in their own regenerated beta cells in the pancreas.

21. The scientists identified and isolated stem cells from the adult pancreas. They then developed a method
for making them become insulin-producing cells that can secrete insulin in response to glucose in the
bloodstream.
Type 2 diabetes
A person with diabetes type 2 either:
Does not produce enough insulin. Or
Suffers from 'insulin resistance'. This means that the insulin is not working properly.
The majority of people with Type 2 have developed the condition because they are overweight. Type 2
generally appears later on in life, compared to Type 1. Type 2 is the most common form of diabetes.
In the case of insulin resistance, the body is producing the insulin, but insulin sensitivity is reduced and it
does not do the job as well as it should do. The glucose is not entering the body's cells properly, causing
two problems:
A build-up of glucose in the blood.
The cells are not getting the glucose they need for energy and growth.
In the early stages of Type 2 insulin sensitivity is the main abnormality - also there are elevated levels of
insulin in the blood. There are medications which can improve insulin sensitivity and reduce glucose
production by the liver.
As the disease progresses the production of insulin is undermined, and the patient will often need to be
given replacement insulin.
"Excess abdominal fat is much more likely to bring on Type 2 Diabetes than excess fat under your skin"
Many experts say that central obesity - fat concentrated around the waist in relation to abdominal
organs - may make individuals more predisposed to develop Type 2 diabetes.

22. Central obesity does not include subcutaneous fat - fat under the skin. The fat around your waist -
abdominal fat - secretes a group of hormones called adipokines. It is thought that adipokines may impair
glucose tolerance.
The majority of people who develop diabetes Type 2 were overweight during the onset, while 55% of all
Type 2 patients were obese during onset.
"Sometimes all the patient needs is to do more exercise,
lose weight and eat fewer carbs"
It is not uncommon for people to achieve long-term satisfactory glucose control by doing more exercise,
bringing down their bodyweight and cutting down on their dietary intake of carbohydrates.
However, despite these measures, the tendency towards insulin resistance will continue, so the patient
must persist with his/her increased physical activity, monitored diet and bodyweight.
If the diabetes mellitus continues the patient will usually be prescribed orally administered anti-diabetic
drugs. As a person with Type 2 does produce his/her own insulin, a combination of oral medicines will
usually improve insulin production, regulate the release of glucose by the liver, and treat insulin
resistance to some extent.
If the beta cells become further impaired the patient will eventually need insulin therapy in order to
regulate glucose levels.
The risk factors for type 2
Age and ethnicity. The older you are the higher your risk is, especially if you are over 40 (for white
people), and over 25 (for black, South Asian and some minority groups). It has been found in the UK that
black people and people of South Asian origin have five times the risk of developing Type 2 compared to
white people.

23. Diabetes in the family. If you have a relative who has/had diabetes your risk might be greater. The risk
increases if the relative is a close one - if your father or mother has/had diabetes your risk might be
greater than if your uncle has/had it.
Bodyweight (and inactivity combined with bodyweight). Four-fifths of people who have Type 2 became
so because they were overweight. The more overweight a person is the higher his/her risk will be. The
highest risk is for a person who is overweight and physically inactive. In other words, if you are very
overweight and do not do any exercise your risk is greatest.
Cardiovascular problems and stroke. A person who has had a stroke runs a higher risk of developing
Type 2. This is also the case for people who suffer from hypertension (high blood pressure), or have had
a heart attack. Any diagnosis of a problem with circulation indicates a higher risk of developing Type 2.
Gestational Diabetes. A woman who became temporarily diabetic during pregnancy - gestational
diabetes - runs a higher risk of developing Type 2 later on. Women who give birth to a large baby may
run a higher risk, too.
Impaired fasting glycaemia (IFG) - Impaired glucose tolerance (IGT). A person who has been diagnosed
as having impaired fasting glycaemia or impaired glucose tolerance and does not have diabetes runs a
significantly higher risk of eventually developing Type 2. People with IFG or IGT have higher than normal
levels of glucose in their blood. In order to prevent diabetes it is crucial that you eat healthily, keep an
eye on your weight and do exercise.
Severe mental health problems. It has been found that people with severe mental health problems are
more likely to develop Type 2.
Diabetes and cardiovascular diseases
People with diabetes type 2 are much more likely to develop cardiovascular diseases, such as coronary
heart disease, stroke, hypertension, inflammatory heart disease and other cardiovascular conditions.
Treatments tend to be similar to the ones used on patients who do not have diabetes. Stents versus

24. bypass surgery for clogged artery - Patients with diabetes who have one clogged artery tend to have
better results from heart bypass surgery than drug coated stents, researchers from Saint Luke's Mid-
America Heart Institute in Kansas City, Missouri, explained at the American Heart Association's (AHA's)
Scientific Sessions 2012 in Los Angeles (4 November, 2012).
Although stents may be cheaper and appear initially to be a better option, over the long term, bypass
surgery patients in a trial had fewer heard attacks and were less likely to die prematurely, the
investigators explained.
Senior author, Elizabeth A Magnuson, said "Our results demonstrate that bypass surgery is not only
beneficial from a clinical standpoint, but also economically attractive from the perspective of the US
healthcare system. The economic data are important because of the large number of people with
diabetes who are in need of procedures to unblock clogged arteries."
The findings confirm the American Heart Association’s recommendations which have been in place since
the 1990s that diabetes patients with one clogged heart artery should receive bypass surgery.
Famous diabetics
Diabetes does not stop you from pursuing your ambitions
Being diabetic might mean a change in lifestyle. It does not mean you will not be able to pursue your
career effectively, run a business, practice a sport or realize your ambition.
Here is a sample list of people who have achieved great things. They all have something in common -
they all have (had) diabetes. Some managed to win Olympic Gold Medals.
Diabetes will not stop you from becoming a top sportsman or sportswoman, politician, actor/actress,
musician, or journalist. If your eating is well planned, if you do plenty of exercise, and adhere to any
medication plan your doctor gives you, there is no reason AT ALL why you cannot carry on trying to
pursue your lifetime ambitions.

25. An inspiration!
Sir Steven Redgrave won 5 Olympic Gold medals for rowing and has suffered from Diabetes Type 1 since
1997. Despite being diagnosed with diabetes he continued training hard and won his fifth Olympic Gold
in Sydney in 2000. He won the five medals in five consecutive Olympic games:
2000 Olympic Gold, Coxless Four (with Matthew Pinsent, Tim Foster, James Cracknell)
1996 Olympic Gold, Coxless Pair (with Matthew Pinsent)
1992 Olympic Gold, Coxless Pair (with Matthew Pinsent)
1988 Olympic Gold, Coxless Pair (with Andy Holmes)
1988 Olympic Bronze, Coxed Pair (with Andy Holmes and Patrick Sweeney)
1984 Olympic Gold, Coxed Four (with Martin Cross, Adrian Ellison, Andy Holmes, Richard Budgett).
Redgrave was diagnosed with ulcerative colitis in 1992. He also suffers from dyslexia.
Treatment for diabetes - how is diabetes managed?
A long time ago
Before insulin was discovered in 1921 Diabetes Type 1 was a fatal disease - most patients would die
within a few years of onset. Things have changed a great deal since then.
You can lead a normal life

26. If you have Type 1 and follow a healthy eating plan, do adequate exercise, and take insulin, you can lead
a normal life. Look at our page on Famous Diabetics - there are many of them and they have achieved
great things!
Balance insulin intake with food and lifestyle
The quantity of insulin intake must be closely linked to how much food you consume, as well as when
you eat. Your daily activities will also have a bearing on when and how much insulin you take.
Checking your blood glucose levels
A person with diabetes has to have his/her blood glucose levels checked periodically. There is a blood
test called the A1C which tells you what your average blood glucose levels were over a two-to-three
month period.
Type 2 patients need to eat healthily, be physically active, and test their blood glucose. They may also
need to take oral medication, and/or insulin to control blood glucose levels.
Prevent developing cardiovascular disease
As the risk of cardiovascular disease is much higher for a diabetic, it is crucial that blood pressure and
cholesterol levels are monitored regularly.
Healthy eating, doing exercise, keeping your weight down will all contribute towards good
cardiovascular health - some patients will need oral medication for this.
Stop smoking!
As smoking might have a serious effect on the cardiovascular health the patient should stop smoking.

27. A health care provider
A health care professional (HCP) will help the patient learn how to manage his/her diabetes. The HCP
will also monitor the diabetes control. It is important that you know what to do and that a professional
is helping and monitoring the management of your diabetes.
In most countries the GP (general practitioner, primary care physician, family doctor) provides this
regular care. There are also diabetitians, endocrinologists, cardiologists, nurses, internists, pediatricians,
dietitians, podiatrists, ophthalmologists, optometrists, sports specialists and many others.
If a diabetes patient is pregnant she should see an obstetrician who specializes in diabetes (gestational
diabetes). There are pediatricians who specialize in caring for the infants of diabetic mothers.
The aim of diabetes management
The main aim of diabetes management is to keep the following under control:
Blood glucose levels
Blood pressure
Cholesterol levels
High and low blood glucose
The patient will need to make sure his/her blood glucose levels do not fluctuate too much.
Hypoglycemia - low blood glucose - can have a bad effect on the patient. Hypoglycemia can cause:

28. Shakiness
Anxiety
Palpitations, Tachycardia
Feeling hot, sweating
Clamminess
Feeling cold
Hunger
Nausea
Abdominal discomfort
Headache
Numbness, pins and needles
Depression, moodiness
Apathy, Tiredness, Fatigue, Daydreaming
Confusion
Dizziness
Bad coordination, slurred speech
Seizures
Coma
More information on Hypoglycemia is available on our Hypoglycemia page.
Hyperglycemia - when blood glucose is too high - can also have a bad effect on the patient.
Hyperglycemia can cause:
Polyphagia - frequently hungry
Polydipsia - frequently very thirsty

29. Polyuria - frequent urination
Blurred vision
Extreme tiredness
Weight loss
Cuts and scrapes will heal slowly and badly
Dry mouth
Dry or itchy skin
Erectile dysfunction (impotence)
Recurrent infections
Kussmaul hyperventilation: deep and rapid breathing
Cardiac arrhythmia
Stupor
Coma
More information on Hyperglycemia is available on our Hyperglycemia page.
How is diabetes managed? - Self-monitoring of blood glucose
Monitoring your own glucose is done with a Glucose Meter. Self-monitoring is often called SMBG (self-
monitoring of blood glucose). Glucose meters today are small, battery-operated devices.
A sample of blood
When you want to test for glucose with a glucose meter you need to place a small sample of your blood
on a test strip. Your skin is pricked with a lancet - like a very fast pin-prick.
These test strips are disposable. You then place the strip in the monitor. The strips are coated with
glucose dehydrogenase or hexokinase that combines with glucose in blood.

30. The blood is usually taken from a finger, but some meters allow the use of other parts of the body to
supply the blood sample.
How the meter works
The meter tells you how much glucose is present in your blood. How meters do this may vary. With
some meters a measurement of the amount of electricity that passes through your blood sample is
measured, while others measure the degree of reflection of light. The glucose level is displayed as a
number. In the case of this picture (below right) the person's glucose level is low. Many of the new
meters can store a series of test results, while others can be connected to your personal computer to
store results, which you can also print out.
How to choose a glucose meter
According to the FDA there are 25 different meters on the market. They are not all the same. You should
bear the following in mind when choosing one:
Testing speed
Size
Memory (ability to store results)
Price
The newer models have automatic timing, error codes and signals, barcode readers to help with
calibration. Some have spoken instructions for people who are visually impaired.
Using your meter

31. Frequency of meter usage varies significantly from patient-to-patient. It is important that you adhere to
the instructions given to you from your health care provider. Every person with diabetes should be self-
monitoring his/her blood glucose - this is especially so for people who are taking insulin.
According to the American Diabetes Association (ADA), patients with Type 1 should self-monitor blood
glucose at least three times per day.
The ADA says that women with gestational diabetes (diabetes during pregnancy) should self-test twice a
day.
There is no general recommendation from the ADA regarding frequency of self-testing for Type 2
patients.
Most patients who do have to self-test will generally have to do so before meals, a couple of hours after
meals, at bedtime, 3.a.m., and whenever signs or symptoms are felt.
When a patient changes medication testing should be carried out more frequently.
If you have an unusual illness or sudden stress, you should test more frequently.
Knowing how to use your meter
As meters work in different ways you should get training from a diabetes educator.
Using a glucose meter - instructions
Wash your hands with warm water and soap. Dry completely. You could also dab or wipe the area with
alcohol and then dry completely.

32. Use the lancet to prick your fingertip.
Hold your hand down. Hold your finger at the same time until you see a small droplet of blood appear.
Place the blood on the test strip.
Follow the instructions for placing the test strip and using your meter.
Keep a record of your result.
Many regulatory authorities, such as the FDA, require that meters and test strips come with instructions.
It is important that you become familiar with these instructions, which should be included in the User
Manual. Some meters give out an error code if something is wrong. Checking the User Manual will tell
you what the error code means.
In many countries the User Manual will have a toll free number. If you call and cannot get through call
your health care provider or your local emergency room. Check out the website of the manufacturer.
The FDA advises patients to visit the manufacturer's website regularly for any updates or issues.
How is diabetes managed? Planning your food consumption
Three things will have a major impact on your blood glucose and blood lipids (cholesterol, triglycerides)
levels
What you eat
How much you eat
When you eat
By selecting the right types of foods, as well as appropriate quantities you can significantly improve your
ability to control your blood glucose and blood lipids.
What does healthy eating mean?

33. Healthy eating most certainly does not mean you will go hungry and have to spend much of your life
desperately trying to resist temptation. You can still consume the food you like. All it means is that you
will have to be much more aware of how much carbohydrate, fat and protein you consume each time
you eat. You just have to get the balance right.
Carbohydrates
Carbohydrates are most abundantly found in fruit, vegetables, yoghurt, sweets, pasta and bread.
Our body needs carbohydrates; we cannot live without them. When consumed, our bodies turn the
carbohydrate into blood glucose - glucose is needed by our cells for energy and growth.
If you consume the same amount of carbohydrates each time you eat - especially if those times are at
the same time each day - you will be well on your way towards controlling your blood glucose.
It is important that you do not skip meals, no matter what your blood glucose readings indicate. All you
will achieve by skipping meals is a more aggressive fluctuation in your blood glucose levels - something
you want to try to avoid.
If your consumption of glucose can follow a regular pattern, it will be easier for you to balance food with
your medicine(s) and physical activity with optimum blood glucose control.
Variety and moderation
A varied and moderated diet is ideal if you want to enjoy good health. Your carbohydrate intake should
consist of a variety of grains, fruits and vegetables. They have plenty of fiber - fiber helps control blood
glucose.
Remember that brown rice has more fiber than white rice; whole-grain breads have the most fiber. If
you are cooking or baking, opt for whole-wheat or whole grain flours. Include pulses, such as beans;

34. they are a great source of fiber. Dark green leafy vegetables and dark yellow ones have a slower release
of carbohydrates than most other vegetables.
Carb, protein and fat mix
According to the Mayo Clinic, your daily intake of calories should consist of:
Carbohydrates 45% to 65%
Proteins 15% to 20%
Fats 20% to 35%
If you adhere to your meal plan for portion sizes and eating times you should eat the same mix of
carbohydrates, proteins and fats each day. Your blood sugar control will be ideal, as will your weight.
The more you vary from your food plan, the Mayo Clinic informs, the more your blood glucose will
fluctuate.
The rewards will be worth it
The ideal eating pattern for a person with diabetes is not really any different from what a non-diabetic
person would do if he/she aimed for optimum health and fitness. However, the diabetes patient has the
added incentive of trying to prevent complications from developing, such as cardiovascular disease,
kidney problems, vision problems and leg and feet sores.
Foods on offer for a diabetes patient are extensive and varied. You will be able to plan a wide range of
tasty and interesting meals.
The food pyramid

35. When you talk to your health care professional, diabetes educator or dietician, they will probably
mention the Food Pyramid.
At the base there are foods rich in carbohydrates, such as grains, then there are fruit and vegetables.
Above are meat, fish, milk and cheese; which are rich in protein. At the top are the fatty foods.
Almost all diabetes and medical associations say that you should eat more from the groups at the
bottom of the pyramid, and less from those at the top.
It is vital that you talk to an expert about your eating plan. It needs to be tailored according to your
weight, age, which medications you are taking and how physically active you are (and, if so, when during
the day you are likely to be the most active).
Glycemic index
Not all carbohydrates are the same. The Glycemic Index (GI) describes what effect certain foods can
have on our blood glucose levels. A high GI tends to cause more blood glucose fluctuations than a low
one. Ask your dietician.
- Information on the Glycemic Index from the Canadian Diabetes Association
How is diabetes managed? - physical activity, exercise

36. Physical activity Is crucial for a person with diabetes
it helps control your blood glucose
it helps keep your weight down
it helps keep your blood pressure down
it helps raise your HDL (High-density lipoprotein), good cholesterol levels
it helps lower your LDL (Low-density lipoprotein), bad cholesterol levels
These five benefits have a DIRECT bearing on how successfully you manage your diabetes. Exercise also
has other general health benefits - you sleep better, your mental state improves, etc.
How much exercise should you do?
Most experts say you should do exercise on at least five days of each week. Each session should be of
moderate-intensity and should not last less than thirty minutes. The following activities could be classed
as of moderate-intensity:
fast walking
swimming
cycling 5-9mph (level terrain, perhaps some slight hills)
dancing
rowing
mowing the lawn
What is moderate-intensity physical activity?
You should experience some increase in your breathing rate
There should be an increase in your heart rate

37. A Borg Scale perceived exertion of 11 to 14
You should burn 3.5 to 7 calories per minute
You should reach a METs of 3 to 6
What is MET?
MET stands for Metabolic Equivalent. An MET of 1 is when you are sitting down doing nothing. If you
walk slowly your MET may rise to 2 or 2.5. If you walk normally it will go up to 3, while a brisk walk may
bring it to 5. If a wild gorilla suddenly appeared in the street and started chasing you your desperate
sprint would shoot your MET right up to about 8 or even perhaps 9.
Beginners be careful!
If you have not done exercise for a long time you will need to start with a little light exercise and build
up slowly over time. Each week add a little more time to each session and/or increase the intensity.
Remember regular exercise is what matters. 5 days of 30 minutes each is great. One day per week at
150 minutes is not.
You must talk to your health care provider about an exercise plan. He/she may want to check you over
before you start. Certain exercises are not ideal for patients who suffer from high blood pressure, eye
and/or foot problems.
Strength training is also good
The Centers for Disease Control and Prevention (CDC) says that strength training exercises are good
because they help you build muscle. Strength training usually involves using weights.

38. Join a gym
There are many gyms today whose staff are experienced and qualified to receive and train people for
various illnesses and conditions. In North America, Western Europe, Japan and Australasia gyms receive
doctors' referrals - doctors send them to specific gyms as part of their therapy.
Having somebody there to help you along, occasionally to push you along, can be a great motivator -
especially for beginners who may view the whole experience with apprehension.
Gyms are all-weather; they have equipment which gives you immediate feedback on how well you are
doing - your speed, heart rate, calories burnt per minute/hour, your progress, etc.
Numerous people prefer gyms because it gives them a feeling of doing something with others. Do not be
afraid of joining one. They are generally welcoming and members will not be concerned about what you
look like or how unfit you may be - they are there for their health, just like you.
Diabetes treatment - hypoglycemia
Hypoglycemia is sometimes called insulin reaction. It is when your blood glucose is too low. Even though
you may do all you can to manage your diabetes, hypoglycemia can happen, and it can and must be
treated before it gets worse.
If you remember to check your blood glucose when your doctor tells you to, your chances of
experiencing hypoglycemia are much lower. Also, a low blood glucose result will tell you that you need
to treat it.
If you feel the symptoms of hypoglycemia you should check your blood glucose. If the reading tells you
that your blood glucose is low, you should treat it immediately.

39. The American Diabetes Association (ADA) says that if you feel a hypoglycemic reaction but cannot check
your blood glucose it is better to treat the reaction than to wait till you can check.
How do I treat hypoglycemia?
You need to raise your blood glucose. The fastest way to do this is to eat some form of sugar. The ADA
advises:
Take 3 glucose tablets (easily bought)
1/2 a cup of fruit juice
5 to 6 pieces of hard candy (UK 'sweets')
You should ask your dietitian or health care professional for more advice on what you could eat to treat
hypoglycemia.
Make sure you always carry at least one type of sugar with you so that you are prepared.
Check blood glucose, treat It and wait 20 minutes
After you have checked your blood glucose and treated the hypoglycemia wait between 15 to 20
minutes and check your blood glucose again. If your blood glucose is still low repeat the whole process -
eat some glucose, wait about 15-20 minutes and check your blood glucose again.
Remember to stick to your eating times - your regular meals and snacks are vital for keeping your blood
glucose levels as stable as possible. Hypoglycemia can affect all the organs in your body, especially your
brain.
Take hypoglycemia seriously

40. Hypoglycemia, if not treated quickly gets worse rapidly and the patient will soon pass out.
A patient who passes out because of hypoglycemia will need immediate treatment - probably a
glucagon injection, or an emergency visit to a hospital.
What does glucagon do?
Glucagon is injected, just like insulin is. However, glucagon raises blood glucose.
You should ask your doctor to make sure you have some.
Hypoglycemia unawareness
It is possible, and not very unusual, for a person to pass out and never have noticed they had been
suffering from hypoglycemia. This is known as hypoglycemia unawareness. The patient's blood glucose
drops and he/she is not aware of it.
Hypoglycemia unawareness is more common among patients who have lived with diabetes for a long
time, those with nerve damage (neuropathy), patients on medication for hypertension (high blood
pressure) and those on tight glucose control.
Hypoglycemia symptoms
Tingling sensation around the mouth
Lightheadedness, dizziness
Sweats
Trembling, shakiness

41. Headache
Pallid skin (you go pale)
Irritability, moodiness, you might become tearful
Seizure (you have a fit, spasm)
Absent mindedness
Confusion
Clumsiness
Strong desire to eat
Diabetes treatment - hyperglycemia
Hyperglycemia is when your blood glucose is too high; it is the opposite of hypoglycemia. Hyperglycemia
needs to be treated immediately as it is a major cause of complications among people with diabetes.
Hyperglycemia happens when there is no insulin in the blood, not enough insulin in the blood, or the
insulin in the blood is not working properly.
The main reason for hyperglycemia for a patient who is being treated for diabetes type 1 is that he/she
has not given himself enough insulin. For a type 2 diabetic it could be the same reason, but also his/her
insulin is less effective than it should be.

42. For a patient with diabetes, overeating can bring on hyperglycemia, as can too little exercise on a given
day. Mental stress can also bring it on. Remember that your body's supply of insulin is determined by
how much you give yourself, and when. For a person who does not have diabetes his/her body will
respond automatically with appropriate quantities of insulin.
Symptoms of hyperglycemia
High blood glucose
High levels of sugar in the urine
Very hungry, hungry often (polyphagia)
Excessive thirst, frequent thirst (polydipsia)
Excessive and frequent urination (polyuria)
Blurred vision - Weight loss
Wounds and cuts heal poorly
Dry mouth
Cardiac arrhythmia
Deep and rapid breathing (kussmaul hyperventilation)
Impotence (erectile dysfunction)
Itchy and/or dry skin
Tiredness
Stupor
Coma
Good diabetes management is crucial

43. Your doctor will tell you what your glucose levels should be and how often you should check it. If you
stick to good diabetes management practices your chances of experiencing hyperglycemia are
significantly reduced.
Ketoacidosis
As soon as you detect hyperglycemia, treat it immediately. People who experience hyperglycemia and
do not treat it run a significantly high risk of going into diabetic coma (ketoacidosis).
Ketoacidosis happens when there is not enough insulin in your blood. Remember that without the
insulin your cells cannot get the vital fuel (energy) they need. Your body starts breaking down fats to get
its energy. This process of breaking down fats produces ketones - waste products. Large amounts of
ketones are bad for you. Excess ketones in your blood will result in frequent urination as your body tries
to eliminate it. However, it eventually becomes a losing battle, with the build up of ketones happening
faster than their elimination through urination.
Symptoms of ketoacidosis are:
your breath smells fruity
nausea and sometimes vomiting
your mouth is extremely dry
you are short of breath
Treating hyperglycemia
The American Diabetes Association says exercising can help lower blood glucose levels. If your blood
glucose is above 240mg/dl. Check your urine for ketones and do not exercise if there are ketones
present as this will raise your blood glucose levels even more!
Reducing your food intake will also help lower your blood glucose. It is important that you stick to your
meal plan, which should be worked out with a dietitian or health care professional.

44. Ask your doctor for the best way to lower blood glucose levels.
If none of the measures mentioned above manages to lower your blood glucose it is possible that your
medication may have to be re-scheduled. Your insulin and medication doses may need to be altered, as
might their timing (when you have them).
Remember that good diabetes management helps reduce the incidence of hyperglycemia. Learn to
detect hyperglycemia quickly so that you can treat it early on.
Diabetes treatment - taking insulin
You cannot take insulin as a pill. If you did, the moment it got to your stomach it would be digested and
would never get into your bloodstream.
You have to inject insulin into the fat just under your skin - from there it will get to your bloodstream.
There are many types of insulin. According to the American Diabetes Association (ADA) there are over
20 types of insulin in the American market. They work in different ways, they are made differently, and
they vary in price.
Insulin is most commonly made in laboratories today. It can also come from animals, mainly pigs.
Rapid-acting insulin
This type of human insulin starts to work within five minutes of being injected and peaks after about one
hour. It continues to be active for 2 to 4 hours. Examples of rapid-acting insulin are lispro marketed by
Eli Lilly, insulin aspart marketed by Novo Nordisk, or insulin glulisine marketed by sanofi-aventis.

45. Short-acting insulin
Also known as Regular (acting) insulin. This type of human insulin reaches your bloodstream
approximately 30 minutes after you inject it, and peaks from 2 to 3 hours after injection. It is effective
for 3 to 6 hours.
Intermediate-acting insulin
This human insulin takes from 2 to 4 hours to reach the bloodstream after injection. It peaks at 4 to 12
hours. It is effective for approximately 12 to 18 hours.
Long-acting insulin
This insulin gets into your bloodstream about 6 to 10 hours after you inject it. It is effective for 20 to 24
hours. This type of insulin is also known as ultralente.
Pre-mixed insulin
Some patients have to mix two different types of insulin. If they find that difficult they can have the
insulin pre-mixed. This is especially useful for people who are visually impaired.
Allergic reaction to insulin additives
The insulin a diabetic takes has additives to keep it free of bacteria and to tweak its time of action. Some
patients may have an allergic reaction to some additives found in intermediate and long-acting insulins -
however, this is very rare.

46. Diabetes treatment - insulin pump
Insulin pumps are mostly used by people with Diabetes Type 1. However, more and more people with
Type 2 are starting to use them.
Users say that the pump allows them to get the treatment to adapt to them, instead of the other way
round as is the case with insulin injections.
An Insulin Pump really can help you maintain your blood glucose levels with specific parameters.
Delivers short acting insulin all day and night
The pump delivers short (rapid) acting insulin, around the clock, through a catheter placed under your
skin. It separates your insulin dosage into the basal rate and the bolus dose.
Basal insulin
This is your normal level of blood insulin when you have not eaten or when you are asleep. Basal insulin
is delivered constantly throughout the day and night. It is possible to set the pump so that amounts vary,
depending on what time of day and night it is.
Bolus (extra)
When you eat your blood will need more insulin. You press buttons on the insulin pump which will give
you a bolus - additional insulin. The bolus covers your increased insulin requirement because you have
consumed carbohydrate.

47. If your blood glucose is too high you can take a bolus to bring it back down again.
Where do you have (wear) it?
Most people simply attach the pump to their belt or waistband using a clip or case. You can also keep it
in your pocket.
If you are wearing a dress you could attach it to your arm or leg under your clothes.
When sleeping many people place the pump next to them on the bed, place it under the pillow or attach
it to their clothing.
Pump manufacturers say the pump is very rugged and will withstand being dropped on the floor or the
occasional soaking. However, you should try to avoid that from happening.
Advantages of an insulin pump
No more injections
The pump is more accurate
They improve A1C
Blood glucose levels fluctuate less badly
Easier diabetes management
More leeway on your eating times
More leeway on what you eat
You can exercise without eating loads of carbs