Stay on Top of It
Discover a world of resources brought to you by the Blue Cross and Blue Shield of North Carolina (BCBSNC) family to help you stay on top of your Diabetes treatment.
Diabetes: Learn more about the causes, symptoms and diagnoses
What is diabetes?1
Over 29 million people (more than 9% of the U.S. population) have diabetes.1 More than one quarter of these diabetics are undiagnosed. Diabetes is generally equally split between men and women. Here are the types of diabetes:
- Type 2 (the most common type)2
90% to 95% of all diagnosed cases of diabetes are Type 2. The pancreas of people with Type 2 diabetes keeps making insulin for some time, but the body can't use it very well. Most people with Type 2 find out about their diabetes between their 30s and 40s. Type 2 diabetes in children and adolescents, although uncommon, is being diagnosed more frequently among American Indians, African Americans, Hispanics/Latinos, Asians and Pacific Islanders.
- Type 1 diabetes
Five percent of people diagnosed with diabetes have Type 1.2 These people usually find out they have diabetes when they are children or young adults. People with Type 1 diabetes must inject insulin every day to live. The pancreas of a person with Type 1 makes little or no insulin. Scientists are learning more about the autoimmune process that causes the body to attack its own cells in the pancreas and stop making insulin (thereby causing Type 1 diabetes) in people with certain sets of genes.
- Gestational diabetes
Another type of diabetes, called gestational diabetes, appears during mid-pregnancy in some women. Doctors most often test for it between 24 and 28 weeks of pregnancy. Often gestational diabetes can be controlled through eating healthy foods and regular exercise. Sometimes a woman with gestational diabetes must also take insulin. For most women though, the diabetes goes away soon after delivery. When it does not go away, the diabetes is called Type 2 diabetes. Even if the diabetes does go away after the baby is born, half of all women who had gestational diabetes develop Type 2 diabetes later.
Certain risk factors make people more likely to get type 2 diabetes. Some of these are:
- A family history of diabetes.
- Lack of exercise.
- Weighing too much.
- Being of African American, American Indian, Alaska Native, Hispanic/Latino, or Asian/ Pacific Islander heritage.
You may recall having some of these signs before you found out you had diabetes:
- Being very thirsty (or always hungry).
- Urinating a lot–often at night.
- Having blurry vision from time to time.
- Feeling very tired much of the time.
- Losing weight without trying.
- Having very dry skin.
- Having sores that are slow to heal.
- Getting more infections than usual.
- Losing feeling or getting a tingling feeling in the feet.
A diagnosis of diabetes can happen when:
- Fasting blood sugar is 126 milligrams per deciliter (mg/dl) or greater
- Random blood sugar is 200 mg/dl or greater, with symptoms
- Two-hour glucose tolerance test is 200 mg/dl or greater
- Pre-diabetes fasting blood sugar is between 100-125 mg/dl
Please see a medical professional as soon as possible to have one or more of the tests above if you think you may have diabetes.
Treatment & management
List of screenings and tests to keep in mind
- Blood sugar test (A1c)6
An A1C test measures how much glucose has been sticking to your red blood cells. Since each red blood cell is replaced by a new one every 3 to 4 months, this test tells you how high the glucose levels have been during the life of the cells. If most of your recent blood glucose readings have been near normal (70 to 140 milligrams per deciliter or mg/dL, with the higher reading mainly after meals), the A1C test will be near normal (usually about 6%–7%). If you've had many readings above normal, the extra glucose sticking to your red blood cells will make your A1C test read higher. You should get an A1C test every 3 months if your test results are not yet at goal, or at least 2 times a year if your results are at goal. Ask your health care provider for the results and record them.
- Urine test (urine protein)
This test of your urine makes sure your kidneys are healthy. High protein levels in your urine are a sign you may be at risk for kidney problems. The American Diabetes Association recommends that you should get this test at least once a year.
- Eye exam (dilated retinal eye exam or DRE)
Ask for a full eye exam with dilated pupils each year. A dilated eye exam can show if you have, or are at risk for getting, an eye disease. If you don't take care of your eyes early, it can lead to serious problems or even blindness. The American Diabetes Association recommends that you get a retinal eye exam at least once a year.7
- Blood pressure screening
Blood pressure is the force of blood on the inside walls of blood vessels. Blood pressure that is too high makes the heart work harder and causes heart disease. The goal is less than 140/90 mmHg for most people.5 The American Diabetes Association recommends having your blood pressure checked at every doctor's visit and at least 2 times per year.
- Cholesterol test (lipids)8
It is important to maintain normal cholesterol levels. Bad cholesterol or LDL (Low Density Lipoprotein) builds up and clogs your arteries. Be sure to have your blood checked for total cholesterol, high-density 4424lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides.
Keeping track of your diabetes:9 The importance of staying on top of it
Good habits to follow10
Here are some tips for making healthy eating choices:
Eat regular meals. Eating every 4 to 5 hours can help control blood sugar.
Eat a variety of foods. Choose a variety of foods to eat so that your body gets the nutrition it needs.
Eat less fat. Foods that are baked, broiled, grilled, boiled or steamed are healthier to eat. Eat lean meats and low- or non-fat dairy products (cheese, milk, yogurt, etc).
Eat less sugar. You may find that eating less sugar helps you control your blood glucose level. When you do use sweeteners, choose those with a lower glycemic index like stevia, agave and fructose.
Eat more high-fiber foods like vegetables, dried beans, fruit and whole grain breads and cereals.
Drink water and other drinks that have no added sugar.
Eat fewer foods that have extra sugar, such as cookies, cakes, pastries, candy, brownies and sugared breakfast cereals.
Eat foods that have a lower glycemic index like proteins and vegetables.
Eat less salt. Use herbs and spices instead of salt to add flavor to your food.
Cut down on processed foods, such as foods you buy in cans and jars, pickled foods, lunch meats, and snack foods, such as chips.
Drinking alcohol can cause health problems, especially for people with diabetes. Alcohol may cause dangerous reactions with medicines you take. Your blood glucose can go down too low if you drink beer, wine, or liquor on an empty stomach. If you want to include a drink in your food plan once in a while, ask your health care team how to do so safely.
Physical activity:11 Learn how to stay healthy
It's important to be active. Physical activity can help you control your blood glucose and your weight and can also prevent heart and circulation problems.
Walking, working in the yard, and dancing are good ways to start. As you become stronger, you can add a few extra minutes to your physical activity. If you feel pain, slow down or stop and wait until it goes away.
Start by doing what you can do, and then look for ways to do more until you reach 150 minutes a week of activity. For example:
30 minutes at one time, five times a week
10 minutes at a time, 10 times a week
10 minutes at a time, several times a day
Do some physical activity every day. Choose an activity you enjoy. Walk, dance, swim or ride a bike. It's better to walk 10 or 20 minutes each day than one hour once a week. It's also okay to be active for 10 minutes at a time, three times a day.
Other tips to stay healthy:
- Lose weight if you are overweight or obese.
- Discontinue all tobacco use (cigarettes, cigars, pipes, smokeless tobacco). Tobacco use increases the risk of health problems from diabetes. To quit, call: 1-800-QUIT-NOW (1-800-784-8669).
- Ask your doctor or a diabetes educator how to take medications and use supplies to get the best results at the lowest cost.
- Always check your glucose before driving a vehicle, using heavy equipment, or being very physically active or being active for a long time.
- Always carry some type of quick fix food carbohydrate, sugar, food or drink with you, so you'll be ready at any time to treat a low glucose level.
- Always wear something (like an identification bracelet) that says you have diabetes. Carry a card in your wallet that says you have diabetes and shows if you use medicine to treat it.
- Get a flu shot each year (October to mid-November).
- Get a pneumonia shot every 5 years.
- Ask all your doctors to share exam results with other health care providers.
Hypoglycemia:12 Your low blood sugar and how to treat it
Signs and symptoms of hypoglycemia vary from person to person. People with diabetes should get to know their symptoms. Family members, friends, coworkers and care providers of very young or elderly diabetics should be told how to recognize a diabetic's signs and symptoms of hypoglycemia and how to treat it:
- Dizziness or light-headedness
- Sleepiness, weakness or feeling tired
- Difficulty speaking
- Double or blurry vision
- Fast or pounding heartbeat
Hypoglycemia can also happen during sleep. Signs of hypoglycemia during sleep include:
- Crying out or having nightmares
- Finding pajamas or sheets damp from perspiration
- Feeling tired, irritable, or confused after waking up
When people think their blood glucose is too low, they should check the blood glucose level of a blood sample using a meter. If the level is below 70 mg/dL, one of these quick fix foods (each item equals about 10 to 15 grams of carbohydrate) should be consumed right away to raise blood glucose:
- Glucose tablets–3 or 4 tablets (available at most pharmacies)
- Glucose gel–1 serving of glucose gel (available at most pharmacies)
- Soft drink or soda pop–1/2 cup, or 4 ounces, of a regular (including caffeinated)–not diet
- Sugar packets–2 to 3
- Fruit juice–1/2 cup (4 ounces)
- Hard candy–3 to 6 pieces
- Sugar or honey–4 teaspoons
- Milk–1 cup, or 8 ounces
The next step is to recheck blood glucose in 15 minutes to make sure it is 70 mg/dL or above. If it's still too low, another serving of a quick fix food should be eaten. These steps should be repeated until the blood glucose level is 70 mg/dL or above.
For people who take Acarbose (Precose) or Miglitol (Glyset), only pure glucose, also called dextrose which is available in tablet or gel form, will raise their blood glucose level during a low blood glucose episode. Other quick fix foods and drinks won't raise the level quickly enough.
People who use diabetes medications should learn what can trigger their low blood glucose levels and always have their blood glucose meter and several servings of quick fix foods available; wear a medical identification bracelet or necklace; always check their blood sugar before driving, and periodically during long trips; and carry an emergency glucagon pens at all times (if prescribed by their doctor).
Severe hypoglycemia (very low blood glucose) can cause a person to pass out and can even be life threatening. Another person can help someone who has passed out by giving an injection of glucagon. Glucagon will rapidly bring the blood glucose level back to normal and help the person regain consciousness. Family, friends, or coworkers–the people who will be around the person at risk of hypoglycemia–can learn how to give a glucagon injection and when to call 911 or get medical help.
Hyperglycemia/high blood sugar14
Hyperglycemia means high blood sugar or glucose. Glucose comes from the foods you eat. Insulin is the hormone that moves glucose into your cells to give them energy. Hyperglycemia happens when your body doesn't make enough insulin or can't use it the right way. People with diabetes can get hyperglycemia from not eating the right foods, from eating more than planned, severe dehydration, not getting enough insulin, not taking medicines correctly, not getting as much activity as planned. Other problems that can raise blood sugar include infections, acute illness, stress, surgery, certain medicines including steroids, eating disorders, or hormone imbalances.
- Blood glucose >250 (can be >600)
- Abnormally large amounts of urine and frequent urination (polyuria) with high levels of sugar in the urine (urine may even crystalize due to high sugar content)
- Extreme thirst (polydipsia) and dehydration (leading to dry skin and dry mouth)
- Weight loss without trying
- Nausea, vomiting and widespread abdominal pain
- Mental status change (can vary from being fully alert to extreme tiredness or coma)
- Poor skin turgor (skin with decreased turgor on the back of the hand will remain elevated after being pulled up and released)
- Deep and labored breathing
- Abnormally rapid heart rate (tachycardia) or abnormally low blood pressure (hypotension)
- Neurologic signs that include blindness over half of the field of vision (hemianopia), weakness on one side of the body (hemiparesis) and seizures
Hyperglycemia treatment15 requires:
- Frequent patient monitoring
- Understanding the importance of taking medications, especially during an illness, and never discontinuing medication without contacting the health care team
- Supplementing with short or rapid acting insulin if directed by your health care professional
- Reduction in hyperglycemia/high blood sugar (sometimes through IV insulin, if directed prescribed by medical professional)
- Consumption of an easily digestible liquid diet containing carbohydrates, salt and electrolytes when nauseated or ill
- Prevention of dehydration by drinking at least 1/2 cup (4 ounces) to 3/4 cup (6 ounces), every half-hour to hour, even if you have to do this in small sips. These liquids should not have calories. Water, diet soda, or tea without sugar are good choices
- Correction of dehydration if it occurs with intravenous (IV) fluids
- Correction of any electrolyte imbalances at home (drink electrolyte fluids like Gatorade or Pedialyte) or in a hospital setting (in hospital, may include IV potassium, bicarbonate therapy, and phosphate)
- Identification of the precipitating events that caused the high blood sugar
Failing to treat hyperglycemia can lead to diabetic ketoacidosis (DKA)
For most people, blood glucose levels that stay higher than 140 mg/dL long term are too high. Eating too much food, being less active than usual or taking too little diabetes medicine are some common reasons for high blood glucose. Your blood glucose can also go up when you're sick or under stress. Over time, high blood glucose can damage body organs. For this reason, many people with diabetes try to keep their blood glucose in control as much as they can.
- Heart/blood vessel problems16
Heart and blood vessel problems are the main causes of sickness and death among people with diabetes. These problems can lead to high blood pressure, heart attacks, and strokes. Heart and blood vessel problems can also cause poor circulation (blood flow) in the legs and feet. You're more likely to have heart and blood vessel problems if you smoke cigarettes, have high blood pressure or have too much cholesterol or other fats in your blood. Talk with your doctor about taking a daily aspirin to help prevent heart and blood vessel problems.
- Nerve damage17
Diabetic nerve damage (also called diabetic neuropathy) is a problem for many people with diabetes. Over time, high blood glucose levels damage the delicate coating of nerves. This damage can cause many problems, such as pain in your feet and loss of sensation (and inability to detect injury). Controlling your blood glucose can prevent or delay these symptoms, and may also help reduce the pain from some types of nerve damage.
- Foot and limb 18
Nerve damage, circulation problems, difficultly healing and infections caused by diabetes can cause serious foot problems for people with diabetes. As a result, about 60 percent of non-traumatic lower-limb amputations among people aged 20 years or older occur in people with diagnosed diabetes. Controlling your blood glucose, and not smoking or using tobacco, can help protect your feet. In fact, comprehensive foot care programs can reduce amputation rates by 45 to 85 percent. More than half of diabetes-related amputations can be prevented with regular exams and patient education. Check your feet and wash your feet every day. Trim your toenails very carefully after you have washed and dried your feet. Treat corns and calluses gently. Always wear shoes and socks, but before you put them on, always look and feel inside of them for anything that might injure your foot. Protect your feet from heat and cold, and ask your doctor to check your feet at least four times a year.
- Blindness and eye problems19
Diabetic eye disease (also called diabetic retinopathy) is a serious problem that can lead to loss of sight. Detecting disease through a dilated eye exam and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50 to 60 percent. Remember, finding and treating eye problems early can help save sight.
- Kidney disease and infection 20
In diabetic kidney disease (also called diabetic nephropathy), cells and blood vessels in the kidneys are damaged, affecting the organs' ability to filter out waste. Waste builds up in your blood instead of being excreted. In some cases, this can lead to kidney failure. When the kidneys fail, a person has to have his or her blood filtered through a machine (a treatment called dialysis) several times a week, or has to get a kidney transplant. Diabetic kidney disease happens slowly and silently, so you might not feel that anything is wrong until severe problems have developed. Therefore, it is important to get your blood and urine checked for kidney problems each year. A recent study shows that controlling your blood glucose can prevent or delay the onset of kidney disease. Keeping your blood pressure under control is also important.
- Dental problems 21
Because of high blood glucose, people with diabetes are more likely to have problems with their teeth and gums. Sore, swollen and red gums that bleed when you brush your teeth are a sign of a dental problem called gingivitis. Another problem, called periodontitis, happens when your gums shrink or pull away from your teeth. Like all infections, dental infections can make your blood glucose go up.
Caring for your teeth and gums every day can help keep them healthy. Learn the best way to brush teeth and use dental floss. Brush your teeth at least twice per day. Floss your teeth daily. Consider purchasing an electric toothbrush and discuss with your dentist the best toothpaste to use to help reduce the risk of periodontal gum disease. Be sure to get your teeth cleaned and checked at least every six months, and plan your dental visits so they don't interfere with the times you take your medication and eat meals. Regular, complete dental care helps prevent dental disease.
- Women's health complications22
Some women with diabetes may have special problems, such as bladder infections. If you have an infection, it needs to be treated right away. Some women get yeast infections in their vagina, especially when their blood glucose is high. A sign of a yeast infection may be itching in the vagina.
Some women with diabetes may have trouble with sexual function. Discomfort caused by vaginal itching or dryness can be treated. Regular Pap smears and mammograms help detect cervical and breast cancer early. All women, whether or not they have diabetes, need to have these tests regularly.
- Pregnancy and diabetes23
Women with diabetes can have healthy babies, but it takes planning ahead and effort. Pregnancy can make both high and low blood glucose levels happen more often. It can make diabetic eye disease and diabetic kidney disease worse. High glucose levels during pregnancy are dangerous for the baby, too.
https://www.niddk.nih.gov/health-information/health- communication-programs/ndep/health- care-professionals/school-guide/section6/Pages/default.aspx
- http://www.mayoclinic.org/diseases-conditions/hyperglycemia/basics/symptoms/con- 20034795