Diabetes

Diabetes Defined

If you have diabetes, your body cannot make or properly use insulin. Insulin is a hormone that helps control the sugar, or glucose, in your blood. Glucose is the main source of fuel for your body.

When you have diabetes, the levels of blood glucose are too high. High blood glucose can cause symptoms such as blurred vision, frequent urination, increased thirst, unintended weight loss, slow healing sores, and feelings of hunger and tiredness. However, some people with diabetes do not have symptoms.

Diabetes is a serious disease. Over time, diabetes that is not well controlled causes serious damage to the eyes, kidneys, nerves, and heart.

About 18.2 million Americans, or 6.2 percent of the population, have diabetes. Thirteen million people have diagnosed diabetes, while an estimated 5.2 million people are undiagnosed. More than 8 million people 60 years or older have diabetes. This figure represents 18.3 percent of that age group.

About 5 to 10 percent of people with diabetes have type 1 diabetes. Type 1 diabetes usually occurs in children, teenagers, or adults under age 30. In people with type 1 diabetes, the body can no longer produce insulin.

About 90 percent of people in the United States with diabetes have type 2 diabetes. It is most common in adults over age 40, and the risk of getting type 2 diabetes increases with age. With this form of diabetes, the body does not always produce enough insulin or does not use insulin efficiently. Being overweight and inactive increases the chances of developing type 2 diabetes.

Type 2 diabetes is also more common in people with a family history of diabetes and in African Americans, Hispanic Americans, American Indians and Alaska Natives, and Asian and Pacific Islanders.

Some women develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life.

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too high or too low. About two-thirds of people with diabetes die of heart disease, so it is also important to control blood pressure and cholesterol. This may require taking medications prescribed by a doctor.

When blood glucose levels drop too low, a condition known as hypoglycemia, a person can become nervous, shaky, and confused. Judgment can be impaired. If blood glucose falls too low, a person can faint.

A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia. Diabetics may go into a coma if their blood sugar levels rise too high.

Strict control of blood glucose as well as blood pressure and cholesterol is the best defense against the serious complications of diabetes. People who take steps to control their diabetes can make a big difference in their health. If you have diabetes, stick to a diet plan, monitor your blood sugar, exercise regularly, take prescribed medication, and make healthy lifestyle choices.

Causes and Prevention

Diabetes is a serious, life-long disease. It cannot be cured, but careful control of blood sugar can prevent or delay the complications of this disease. A great deal of research is underway to find out exactly what causes diabetes and how to prevent it.

Causes

Diabetes is a disease that prevents the body from properly converting foods into the energy needed for daily activity. Understanding how diabetes develops starts with knowing what happens when the body digests food.

When you eat, your body changes most of the food into a form of sugar called glucose. Glucose travels through the blood stream to “fuel,” or feed your cells. It is the main source of fuel for your body.

For glucose to get into cells, insulin must be present. Insulin is a hormone made by the pancreas, a large organ behind the stomach.

If your body does not make enough insulin or if the insulin doesn’t work the way it should, glucose can’t get into your cells. It remains in your blood, while the cells are starved of energy. The level of glucose in your blood then gets too high, causing diabetes.

Over the years, high levels of glucose in the blood damage nerves and blood vessels. This can lead to complications such as heart disease and stroke, kidney disease, blindness, nerve damage, gum infections, and lower limb amputation.

There are three main forms of diabetes: type 1, type 2 and gestational diabetes. Type 1 diabetes is an autoimmune disease. An autoimmune disease occurs when the body’s system for fighting infection — the immune system — turns against a part of the body.

In type 1 diabetes, the immune system attacks the insulin-producing cells in the pancreas and destroys them. The pancreas then produces little or no insulin.

At present, scientists do not know exactly what causes the body’s immune system to attack the cells, but they believe that both genetic factors and environmental factors, such as viruses, are involved. Studies have begun to try to identify these factors and prevent type 1 diabetes in people at risk.

Type 2 diabetes — the most common form — is linked to obesity, high blood pressure, and high levels of bad cholesterol called triglycerides, and low levels of good cholesterol called high density lipoprotein or HDL. About 80 percent of people with type 2 diabetes are overweight. Being overweight can keep your body from using insulin properly.

When type 2 diabetes is diagnosed, the pancreas is usually producing some insulin, but not as much as needed. After several years, insulin production tends to decrease in people with type 2 diabetes.

Being over 45 years of age and overweight or obese raises the risk of developing type 2 diabetes. Other risk factors include:

having a first-degree relative — a parent, brother, or sister — with diabetes
being African American, American Indian or Alaska Native, Asian American or Pacific Islander, or Hispanic American/Latino.

Risk factors include:

having gestational diabetes, or giving birth to at least one baby weighing more than 9 pounds
having blood pressure of 140/90 or higher, or having been told that you have high blood pressure.

Risk factors include:

having abnormal cholesterol levels — an HDL cholesterol level of 35 or lower, or a triglyceride level of 250 or higher
being inactive or exercising fewer than three times a week.

Before people develop type 2 diabetes, they usually have pre-diabetes — a condition in which blood glucose levels are higher than normal, but not yet high enough for a diagnosis of diabetes.

People with pre-diabetes are more likely to develop diabetes within 10 years and also are more likely to have a heart attack or stroke. Pre-diabetes is common in America, according to new estimates. About 41 million people, or 40 percent of U.S. adults ages 40 to 74, have pre-diabetes.

Prevention

Diabetes tends to run in families, but other factors add to the risk of getting diabetes. For example, being overweight and under-active triggers diabetes in people who are at risk.

The two most common forms of diabetes are type 1 and type 2. In people with type 1 diabetes the body stops making insulin. Currently, there is no way to delay or prevent this form of diabetes.

Type 2 diabetes can be prevented in people who are at an increased risk for developing type 2 diabetes or have a condition called pre-diabetes. Pre-diabetes is a condition in which blood glucose levels are higher than normal but not yet high enough for a diagnosis of diabetes. People with pre-diabetes are more likely to develop diabetes within 10 years and are also more likely to have a heart attack or stroke.

A recent study by the National Institute of Diabetes and Digestive and Kidney Diseases, called the Diabetes Prevention Program, showed that people with pre-diabetes can sharply lower their chances of developing the disease through modest weight loss with diet and exercise.

That same study showed that changes in diet and exercise were especially effective in curbing the development of diabetes in older people. In fact, the development of diabetes dropped by 71 percent in adults 60 and older who were enrolled in the study.

Making modest lifestyle changes can often prevent or delay type 2 diabetes in people who are at risk. Here are some tips that may help.

Reach and maintain a reasonable body weight. Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. It can also cause high blood pressure. Recent studies have shown that losing even a few pounds can help reduce your risk of developing type 2 diabetes.

In the Diabetes Prevention Program, people who lost 5 to 7 percent of their body weight significantly reduced their risk of type 2 diabetes. So if you weigh 200 pounds, losing only 10 pounds can make a difference.

Make wise food choices most of the time. What you eat has a big impact on your health. By making wise food choices, you can help control your body weight, blood pressure, and cholesterol.

Be physically active every day. Regular exercise tackles several risk factors at once. It helps you lose weight, control your cholesterol and blood pressure, and improve your body’s use insulin. People in the Diabetes Prevention Program study who were physically active 30 minutes a day 5 days a week reduced their weight and risk of type 2 diabetes. Many chose walking for exercise.

Take your prescribed medications. Some people need medication to help control their blood pressure or cholesterol levels. If you do, take your medicines as directed. Ask your doctor whether there are any medicines you can take to help you prevent type 2 diabetes.

Researchers are working hard to uncover the genetic and environmental factors that may put people at risk for obesity, pre-diabetes, and diabetes. As they learn more about the changes in the body that lead to diabetes, researchers will develop ways to prevent and cure the different stages of this disease.

Symptoms and Diagnosis

Diabetes is often called a “silent” disease because many people have no signs or symptoms before they are diagnosed. Symptoms can also be so mild that you might not notice them. More than 5 million people in the United States have type 2 diabetes and do not know it.

The signs of diabetes are

being very thirsty
urinating often
feeling very hungry or tired
losing weight without trying.

The signs of diabetes are

having sores that heal slowly
having dry, itchy skin
losing the feeling in your feet or having tingling in your feet
having blurry eyesight.

Symptoms of type 1 diabetes, which occurs most often in children and young adults, usually develop over a short period of time. The symptoms for type 2 diabetes develop more gradually.

Gestational diabetes develops only during pregnancy and usually disappears after delivery. However, the mother is at increased risk of getting type 2 diabetes later in life.

Doctors use the following tests to diagnose diabetes.

A fasting plasma glucose, or FPG test, measures your blood glucose after you have gone at least 8 hours without eating. Doctors use this test to detect diabetes or pre-diabetes.

An oral glucose tolerance test, or OGTT, measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a sweet beverage. Doctors use this test to diagnose diabetes or pre-diabetes. Doctors also use the oral glucose tolerance test to diagnose gestational diabetes in pregnant women

In a random plasma glucose test, your doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.

If any of these tests show that you might have diabetes, your doctor will need to repeat the fasting plasma glucose test or the oral glucose tolerance test on a different day to confirm the diagnosis.

The fasting plasma glucose or FPG test is the preferred test for diagnosing diabetes and is most reliable when done in the morning.

Because type 2 diabetes is more common in older people, especially in people who are overweight, doctors recommend that anyone 45 years of age or older be tested for diabetes. If you are 45 or older and overweight, getting tested is strongly recommended.

Diabetes is a serious disease that can lead to pain, disability, and death. Sometimes people have symptoms but do not suspect diabetes. They delay scheduling a checkup because they do not feel sick.

Many people do not find out they have the disease until they have diabetes complications, such as blurry vision or heart trouble. Finding out early if you have diabetes is important because treatment can prevent damage to the body from diabetes.

Treatment and Research

Diabetes cannot be cured, but it can be controlled. Strict control of blood glucose, or blood sugar, as well as blood pressure and cholesterol is the best defense against the serious complications of diabetes.

People with type 1 diabetes control their blood sugar with insulin injections and frequent self-monitoring of blood glucose. People with type 2 diabetes generally control their blood sugar with oral medications and, in some cases, insulin. Sometimes a person with type 2 diabetes can control blood glucose levels with diet and exercise alone.

Good control of blood glucose requires

following a meal plan
getting regular physical activity
taking diabetes medicine every day
checking blood glucose as recommended
monitoring your diabetes ABCs. (A1C or blood glucose average, Blood pressure, and Cholesterol)

Diet and Exercise

Follow a Meal Plan

Healthy eating is very important to lowering blood glucose levels, and people with diabetes should have their own meal plan. Ask your doctor to give you the name of a dietitian or a diabetes educator who can work with you to develop a meal plan.

In designing a meal plan, the dietitian considers the patient’s weight and daily physical activity. For overweight patients, a weight loss plan is a must for proper blood glucose control. Your dietitian can help you plan meals to include foods that you and your family like to eat and that are good for you. Ask your dietitian to include foods that are heart healthy to reduce your risk of heart disease.

People with diabetes don’t need to eat special foods. You can eat foods that are low in fat, salt, and sugar and high in fiber, such as beans, fruits, vegetables, and grains. Eating right will help you reach and stay at a weight that’s good for your body, keep your blood glucose in a desirable range, and prevent heart and blood vessel disease.

Get Regular Physical Activity

Regular physical activity is important for people with diabetes. Taking part in a regular fitness program has been shown to improve blood glucose levels in older people whose levels are high.

Exercise is especially good for people with diabetes because

exercise helps keep weight down
exercise helps insulin work better to lower blood glucose
exercise is good for your heart and lungs
exercise gives you more energy.

Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some exercises like weightlifting may not be safe. Your health care team can help you find safe exercises.

Walking, swimming, dancing, riding a bicycle, playing baseball, and bowling are all good ways to exercise. You can even get exercise when you clean house or work in your garden.

Try to exercise almost every day for a total of about 30 minutes. If you haven’t exercised lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day.

Medications

Take Your Diabetes Medicine Every Day

Insulin and diabetes pills are the two kinds of medicines used to lower blood glucose.

You need insulin if your body has stopped making insulin or if your body doesn’t make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do, too.

Insulin can’t be taken as a pill. You will give yourself shots every day or use an insulin pump. Insulin pumps are small machines that connect to narrow tubing, ending with a needle just under the skin near the abdomen. Insulin is delivered through the needle.

If your body makes insulin, but the insulin doesn’t lower your blood glucose, you may need diabetes pills. Some pills are taken once a day, and others are taken more often. Ask your health care team when you should take your pills.

Be sure to tell your doctor if your pills make you feel sick or if you have any other problems. Remember, diabetes pills don’t lower blood glucose all by themselves. You will still want to follow a meal plan and exercise to help lower your blood glucose.

Sometimes, people who take diabetes pills may need insulin shots for a while. If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose.

Many people with type 2 diabetes do not need insulin or diabetes pills. They can take care of their diabetes by using a meal plan and exercising regularly.

Self-monitoring

Check Your Blood Glucose as Recommended

The best way to find out how well you are taking care of your diabetes is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, exercise plan, or medicine.

Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three or four times a day. You may check before eating, before bed, and sometimes in the middle of the night.

Your doctor or diabetes educator will show you how to check your blood using a blood glucose meter. Your health insurance or Medicare may pay for the supplies and equipment you need.

Monitor Your Diabetes ABC’s

Heart disease and stroke are the leading causes of death for people with diabetes. If you have diabetes, heart disease is more likely to strike you and at an earlier age than someone without diabetes. Therefore, people with diabetes need to control their A1C or blood glucose average, their Blood pressure, and their Cholesterol — the ABCs of diabetes.

The A1C test, also called the hemoglobin A1C test, shows overall blood glucose for the past 3 months. It shows how much glucose is sticking to your red blood cells. The doctor does this test to see what your blood glucose is most of the time. This test should be done at least twice a year.

An A1C test result of under 7 usually means that your diabetes treatment is working well and your blood glucose is under control. If your A1C is above 7 your blood glucose is too high and you have a greater chance of getting diabetes complications.

If your A1C is 8 or above, take action. You need a change in your meal plan, exercise plan, or diabetes medicine to lower your chance of getting diabetes problems like kidney damage. Talk with your health care provider about your A1C goal.

High blood pressure makes your heart work too hard. This leads to strokes and other problems such as kidney disease. Your blood pressure should be checked at every doctor visit. The target blood pressure for most people with diabetes is less than 130/80. Talk with your health care provider about your blood pressure goal.

Low density lipoprotein, or LDL, is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year. The target LDL cholesterol for most people with diabetes is less than 100. Talk with your health care provider about your cholesterol goal.

Foot Care

Foot care is very important for people with diabetes. High blood glucose levels and a reduced blood supply to the limbs cause nerve damage that reduces feeling in the feet. Someone with nerve damage may not feel a pebble inside his sock that is causing a sore. One may not feel a blister caused by poorly fitting shoes. Foot injuries such as these can cause ulcers, which may lead to amputation.

People with diabetes should check their feet every day and watch for any cuts, sores, red spots, swelling, and infected toenails. Sores, blisters, breaks in the skin, infections, or buildup of calluses should be reported right away to a podiatrist or a family doctor.

Skin Care

Skin care is very important because people with diabetes may have more injuries and infections, they should protect their skin by keeping it clean, using skin softeners to treat dryness, and taking care of minor cuts and bruises.

Diabetes FAQ’s

1. What is diabetes?
Diabetes is a chronic disease in which the body cannot make or properly use insulin. Insulin is a hormone that helps control the sugar, or glucose, in your blood. Glucose is the main source of fuel for your body.

When you have diabetes, the levels of blood glucose are too high, causing symptoms such as blurred vision, frequent urination, increased thirst, unintended weight loss, slow healing sores, and feelings of hunger and tiredness.

Diabetes is a serious disease. Over time, diabetes that is not well controlled causes serious damage to the eyes, kidneys, nerves, and heart.

2. How does diabetes develop?
Diabetes is a disease that prevents the body from properly converting foods into the energy needed for daily activity.

When you eat, your body changes most of the food into a form of sugar called glucose. Glucose travels through the blood stream to feed your cells. It is the main source of fuel for your body.

For glucose to get into cells, insulin must be present. Insulin is a hormone made by the pancreas, a large organ behind the stomach.

If your body does not make enough insulin or if the insulin doesn’t work the way it should, glucose can’t get into your cells. As a result, the amount of glucose in the blood increases, while the cells are starved of energy. The level of glucose in your blood then gets too high, causing diabetes.

3. How many people have diabetes?
About 18.2 million Americans, or 6.2 percent of the population, have diabetes. Thirteen million people have diagnosed diabetes, while an estimated 5.2 million people are undiagnosed. More than 8 million people 60 years or older have diabetes. This figure represents 18.3 percent of that age group.

4. What is the difference between type 1 and type 2 diabetes?
Type 1 diabetes usually arises in children, teenagers, or young adults. In this form of diabetes, the cells of the pancreas no longer make insulin because the body’s immune system has attacked and destroyed them.

Type 2 diabetes is the most common form of diabetes and the most common in adults over 40. However, people can develop type 2 diabetes at any age, even during childhood.

Type 2 diabetes usually begins with insulin resistance, a condition in which the body does not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to make enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes.

5. Is there a type of diabetes that is associated with pregnancy?
Yes, gestational diabetes. It typically occurs during the later stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had gestational diabetes is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin.

6. What causes diabetes?
At present, scientists do not know exactly what causes the body’s immune system to attack the insulin-producing cells in the pancreas in people with type 1 diabetes. However, scientists believe that both genetic factors and environmental factors are involved.

Type 2 diabetes — the most common form — is linked to obesity, high blood pressure, and high cholesterol levels. Having any one of these conditions can keep your body from making and using insulin properly, thereby increasing your risk of developing type 2 diabetes.

7. Who is at risk for developing type 2 diabetes?
Being over 45 years of age and overweight or obese are key risk factors for developing type 2 diabetes. Other risk factors include

having a first degree relative — a parent, brother, or sister — with diabetes
being African American, American Indian, Alaska Native, Asian American, Pacific Islander, or Hispanic American/Latino.

Risk factors include

having gestational diabetes, or giving birth to a baby weighing more than 9 pounds
having blood pressure of 140/90 or higher, or having been told that you have high blood pressure.

Risk factors include

having abnormal cholesterol levels, an HDL cholesterol or good cholesterol level of 35 or lower, or a triglyceride level of 250 or higher
being inactive or exercising fewer than three times a week.

8. Can diabetes be prevented?
Yes, diabetes can be prevented in people who are at an increased risk for developing type 2 diabetes or have a condition called pre-diabetes.

In 2001, the National Institute of Diabetes and Digestive and Kidney Diseases concluded a clinical trial called the Diabetes Prevention Program. A clinical trial is a research study on people to learn if a new drug or treatment is both safe and effective.

This clinical trial found that type 2 diabetes can be prevented or delayed if you lose a small amount of weight by doing moderate physical activity. The study found that people with pre-diabetes can cut their risk of developing type 2 diabetes by more than half.

9. What is pre-diabetes?
Pre-diabetes is a condition where blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke.

If you have pre-diabetes, you can reduce your risk of getting diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes and even return to normal glucose levels.

10. Why does being overweight or obese put me at risk for developing diabetes?
Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. It can also cause high blood pressure. Overweight people are twice as likely to develop type 2 diabetes as people who are not overweight. You can reduce your risk of developing this type of diabetes by losing weight and by increasing your physical activity.

11. What steps can I take to lose weight to prevent type 2 diabetes?
If you are overweight or obese, choose sensible ways to get in shape

Avoid crash diets. Instead, eat less of the foods you usually have. Limit the amount of fat you eat.
Increase your physical activity. Aim for at least 30 minutes of exercise most days of the week.
Set a reasonable weight-loss goal, such as losing 1 pound a week. Aim for a long-term goal of losing 5 to 7 percent of your total body weight.

12. Are diet and exercise beneficial even after diabetes develops?
Research has clearly shown that diet and exercise help people with type 2 diabetes control their blood glucose, blood pressure, and cholesterol in the short term. Although diet and exercise should lower the risk of developing heart disease and stroke and the other complications of diabetes, no long-term clinical trials have looked at this question.

A recently launched trial, the Look AHEAD study, will examine how diet and exercise affect heart attack, stroke, and cardiovascular-related death in overweight people with type 2 diabetes.

13. Can lifestyle changes help older people avoid diabetes?
The results of the Diabetes Prevention Program conducted by the National Institute on Diabetes, Digestive and Kidney Diseases showed that lifestyle changes that led to weight loss — such as eating healthier and getting more exercise — were effective in helping to reduce the development of diabetes in all age groups tested.

Lifestyle changes were especially effective in people aged 60 and older, reducing the development of diabetes by 71 percent. This is an important discovery because as many as 20 percent of people aged 60 and older develop diabetes.

14. What are the signs and symptoms of diabetes?
Many people have no signs or symptoms of diabetes. Symptoms can also be so mild that you might not notice them. Here is what to look for:

increased thirst
increased hunger
fatigue

Symptoms of diabetes:

increased urination, especially at night
weight loss
blurred vision
sores that do not heal

Sometimes people have symptoms but do not suspect diabetes. They delay scheduling a checkup because they do not feel sick. Many people do not learn they have the disease until they have diabetes complications, such as blurry vision or heart trouble. Finding out early if you have diabetes is important because treatment can prevent damage to the body from diabetes.

15. How do doctors diagnose diabetes and pre-diabetes?
Doctors use the following tests to diagnose diabetes.

A fasting plasma glucose, or FPG test measures your blood glucose after you have gone at least 8 hours without eating. Doctors use this test to detect diabetes or pre-diabetes.

An oral glucose tolerance test, or OGTT measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a glucose-containing beverage. Doctors can use this test to diagnose diabetes or pre-diabetes.

In a random plasma glucose test, the doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.

16. When should I be tested for diabetes?
Anyone 45 years old or older should consider getting tested for diabetes. If you are 45 or older and you are overweight, it is strongly recommended that you get tested. If you are younger than 45, you should consider testing if you are overweight and have one or more of the other risk factors for diabetes.

Ask your doctor for a fasting plasma glucose, or FPG test or an oral glucose tolerance, or OGTT test. Your doctor will tell you if you have normal blood glucose, pre-diabetes, or diabetes. If your blood glucose is higher than normal but lower than the diabetes range, you have a condition called pre-diabetes. Have your blood glucose checked again in 1 to 2 years.

17. How do I take care of my diabetes every day?
People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high.

People with diabetes should do four things every day to lower high blood glucose.

Follow your meal plan.
Get regular exercise.
Take your diabetes medicine.
Check your blood glucose.

Experts say most people with diabetes should try to keep their blood glucose level as close as possible to the level of someone who doesn’t have diabetes. The closer to normal your blood glucose is, the lower your chances are of developing damage to your eyes, kidneys, and nerves.

Check with your doctor about the right range for you. Your health care team will help you learn how to reach your target blood glucose range. Your main health care providers are your doctor, nurse, diabetes educator, and dietitian.

A diabetes educator is a health care worker who teaches people how to manage their diabetes. Your educator may be a nurse, a dietitian, or another kind of health care worker. A dietitian is someone who’s specially trained to help people plan their meals.

18. What kind of meal plan should a person with diabetes follow?
Healthy eating is very important to lowering blood glucose levels, and people with diabetes should have their own meal plan. Ask your doctor to give you the name of a dietitian who can work with you to develop a meal plan.

In designing a meal plan, the dietitian considers the person’s weight and daily physical activity. For overweight people, a weight loss plan is a must for proper blood glucose control.

Your dietitian can help you plan meals to include foods that you and your family like to eat and that are good for you, too. Ask your dietitian to include foods that are heart healthy to reduce your risk of heart disease.

19. If I have diabetes, should I avoid all sweets and sugars?
If you have diabetes you should limit the amount of fats and sweets you eat. These foods have calories, but not much nutrition. Some contain saturated fats and cholesterol that increase your risk of heart disease. Limiting these foods will help you lose weight and keep your blood glucose and blood fats under control.

It is okay to have sweets once in a while. Try having sugar-free popsicles, diet soda, fat-free ice cream or frozen yogurt, or sugar-free hot cocoa mix to satisfy a “sweet tooth.”

Remember, fat-free and low sugar foods still have calories. Talk with your diabetes educator about how to fit sweets into your meal plan.

20. How important is exercise in controlling diabetes?
Exercise is very important for people with diabetes. Taking part in a regular fitness program has been shown to improve blood glucose levels in older people whose levels are high.

Exercise is especially good for people with diabetes because

exercise helps keep weight down
exercise helps insulin work better to lower blood glucose
exercise is good for your heart and lungs
exercise gives you more energy.

21. What types of exercise should I do?
Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some exercises may not be safe. Your health care team can help you find safe exercises.

Walking, swimming, dancing, riding a bicycle, playing baseball, and bowling are all good ways to exercise. You can even get exercise when you clean house or work in your garden.

22. What kinds of medication do people take for diabetes?
Strict control of blood glucose is the best defense against the serious complications of diabetes. Insulin and diabetes pills are the two kinds of medicines used to lower blood glucose.

You need insulin if your body has stopped making insulin or if it doesn’t make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do, too. If your body makes insulin but the insulin doesn’t lower your blood glucose, you may need diabetes pills.

23. How are insulin and diabetes pills taken?
Insulin can’t be taken as a pill. You will give yourself shots every day or use an insulin pump. Insulin pumps are small machines that connect to narrow tubing, ending with a needle just under the skin near the abdomen. Insulin is delivered through the needle.

Some diabetes pills are taken once a day, and others are taken more often. Ask your health care team when you should take your pills.

Sometimes, people who take diabetes pills may need insulin shots for a while. If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose.

Many people with type 2 diabetes do not need insulin or diabetes pills. They can take care of their diabetes by using a meal plan and exercising regularly.

24. What is an A1C test and why is it important in managing diabetes?
The A1C test, which used to be called hemoglobin A-1-C or H-b-A-1-C, is a simple lab test that measures your average blood glucose level over the last 3 months. Your health care provider takes a small blood sample to test your A1C.

The A1C is the best test for you and your health care team to know how well your treatment plan is working over time. The test shows if your blood glucose numbers have been close to normal or too high. The higher the amount of glucose in your blood, the higher your A1C result will be, increasing your chances for serious health problems.

You and your health care team should discuss the A1C goal that is right for you. For most people with diabetes, the A1C goal is less than 7. If your A1C number is less than 7, your care plan is probably working and your blood glucose is under good control. An A1C number higher than 8 means that you have a greater chance of eye disease, kidney disease, or nerve damage.

Lowering your A1C number — by any amount — can improve your chances of staying healthy. You should ask your health care provider for an A1C test at least twice a year.

25. Does Medicare help pay for services and supplies for people with diabetes?
Medicare helps pay for certain services and supplies for people with diabetes who have Medicare Part B. All require a doctor’s prescription. The diabetes-related services and supplies that are covered include

blood sugar monitor and supplies
an A1C test, which is a lab test that measures how well your blood glucose has been controlled over the past 3 months.

Medicare covers

dilated eye examinations to check for diabetic eye diseases
glaucoma screening
flu and pneumonia shots
diabetes self-management training
medical nutrition therapy services.

For more information about what Medicare covers, contact the Centers for Medicare and Medicaid Services at 1-800-MEDICARE, or 1-800-633-4227. TTY users dial 1-877-486-2048.

26. What are clinical trials?
Clinical trials are research studies conducted with human volunteers to find out if a new drug or treatment is both safe and effective. New therapies are tested on people only after laboratory and animals studies have shown promising results. The Food and Drug Administration sets strict rules to make sure that people who agree to be in the studies are treated as safely as possible.

27. Why do people participate in clinical trials?
Well-conducted clinical trials are the fastest and safest way to find improved treatments and preventions for diseases. NIH-funded studies are carefully designed to answer specific medical questions while protecting participants’ safety.

Also, participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research.

28. How do I find more information about participating in an NIH diabetes-related clinical trial?
The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials at ClinicalTrials.gov. Click here to see a list of the current clinical trials on diabetes. A separate window will open. Click the “x” in the upper right hand corner of the “Clinical Trials” window to return here.

According to the American Diabetes Association, there are 20.8 million children and adults in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease.