#YesSalud Diabetes Education Campaign

The #YesSalud bilingual campaign, a collaboration between the Diabetes Hands Foundation online communities and USAGov, aims to raise awareness about diabetes; different types, prevention and how to help loved-ones with diabetes. Every week in November we will be presenting a different theme, with the goal to provide as much information and as many resources to our community as possible.
As part of this campaign, we collected questions about diabetes from members of the general public and then recorded an interview with two professionals working with people with diabetes, answering those questions.  Here is that interview:

What is diabetes?

There are several types of diabetes, and the distinctions between them can be confusing!  Here’s a quick explanation:

Type 1 diabetes is an autoimmune condition, which means that it is caused by the body’s own immune system.  There are many different autoimmune conditions, including rheumatoid arthritis (RA), Crohn’s disease, and vitiligo.  In the case of type 1 diabetes, the immune system attacks and kills the cells in the pancreas that secrete insulin, leaving the person unable to properly integrate the energy from digested food into the cells of the body, and leaving that energy – in the form of glucose – circulating in the blood stream.  This is why people with type 1 diabetes usually have very high blood glucose levels when they are diagnosed.  Learn more about type 1 diabetes in our type 1 forum!

Type 2 diabetes is a complex metabolic condition that is strongly linked to the person’s genetic make-up, and also affected by several other factors like diet and physical activity.  In people with type 2 diabetes insulin is often still produced in the pancreas, but not in sufficient quantities to effectively maintain blood glucose levels in a healthy range.  In addition to this, many people who have type 2 are not able to process insulin well, which means that even if it is present in sufficient quantities it still does not work well.  Unlike type 1 diabetes, type 2 is a progressive condition.  This means that insulin production and efficiency decline over time, making blood glucose levels increase gradually, and necessitating more and more “intervention” (medication, dietary restriction, physical exercise) in order to keep blood glucose levels within a healthy range.  Learn more about type 2 diabetes in our type 2 forum!

Pre-diabetes is the very beginning stages of type 2 diabetes.  Recall that, as a progressive condition, type 2 diabetes causes blood glucose levels to rise gradually over time.  People diagnosed with pre-diabetes are at the beginning of that process, and their blood glucose levels are not yet high enough to qualify as type 2 diabetes.  There is evidence that the progress from pre-diabetes to type 2 diabetes can be slowed (some say even halted, but this is controversial) by changes in diet and physical activity in some cases.

What are the symptoms of diabetes?

Despite having different causes, types 1 and 2 diabetes can have the same symptoms, because ultimately the same thing is causing them: elevated blood glucose levels.  The difference is that in type 1 diabetes the symptoms usually present much faster and are more extreme, whereas in type 2 these symptoms can develop so gradually (due to the progressive nature of the condition) that the person who has them may not even notice them until the condition has progressed fairly far.  These symptoms include:  unintended weight loss, excessive hunger and thirst, frequent urination, fatigue, blurry vision, tingling or numbness in hands and/or feet, very slow-healing wounds, vomiting (type 1), body aches (type 1).

What are the risk factors for developing diabetes?

As stated in the explanation of what diabetes is, type 1 diabetes is an autoimmune condition caused by the body’s own immune system attacking and killing the cells in the pancreas that produce insulin.  Why this happens is not yet known, but current science points to a collection of factors which include genetics and environment.  There is evidence that those with a parent or sibling with type 1 diabetes may have a higher risk of developing it themselves than those who do not, but there are also many people with type 1 diabetes who do not have close family members with the condition.

Type 2 diabetes has a much clearer list of risk factors than type 1.  They include:

• race – African Americans, Native Americans, Hispanics and Pacific Islanders are at higher risk than other racial groups
• weight – 80% of people with type 2 diabetes are over-weight
• high blood pressure (hypertension)
• high cholesterol
• family history – those with family members who have type 2 are at much higher risk than those without
• physical inactivity
• age – risk of type 2 diabetes increases with age

Can diabetes be prevented or cured?

There is currently no known way to prevent or cure type 1 diabetes, although much research is going into both efforts.  If you or someone you love has a parent or sibling with type 1, you can contact the researchers at Pathway to Prevention for information about participating in their studies about prevention in people at elevated risk.

Most cases of type 2 diabetes are not preventable, and none are curable.  However, many people are able to slow progress through changing their diet and increasing their physical activity.  Some people with type 2 diabetes are able to temporarily reduce, or even cease, medication for the condition by eating differently and exercising more, but those people still have diabetes, and usually require medication again at some point.

Learn about research toward a cure for diabetes in our “Research/Cure” forum section.

What is…

Insulin?  Insulin is a hormone produced in the pancreas, which transports glucose from the blood stream into cells for nourishment.   Without insulin, the food we eat is broken down in the digestive process and converted to glucose for energy, but that glucose is not able to get into the cells, and instead amasses in the blood.  This is why people with diabetes (all types) exhibit higher than normal levels of glucose in the blood.  All people with type 1 diabetes and many with type 2 require insulin therapy (injected or administered using an insulin pump) in order to live.

A1c test?  This is a blood test that indicates average blood glucose level over the past 90 days.  The test is used to diagnose diabetes (any type) because people with diabetes have higher A1c levels than those without (except in cases where blood glucose levels are managed in a way that keeps them very close to “normal”).  The A1c level of a person without diabetes is 4.0-5.6%.  An A1c of 5.7-6.4% indicates high risk of developing diabetes, and above 6.4% indicates diabetes.

Metformin?  Metformin is the most commonly prescribed medication for people with type 2 diabetes, and is an effective treatment for many people.   It is an oral medication which lowers blood glucose levels by reducing the amount of glucose secreted into the blood stream by the liver, and also helping the cells of the body utilize the insulin that is present more effectively.  It does not increase actual levels of insulin in the body.  Some people experience weight loss and/or gastrointestinal distress as side effects of metformin.  Learn more about metformin and other non-insulin medications for diabetes here.

What should people with diabetes EAT?

There is no one diet that works well for all people with diabetes, or even for all people with the same type of diabetes.  Some people with diabetes find that they can manage their blood sugar best by reducing or restricting the amount of carbohydrate they eat (as in fruit, grains, beans, starchy vegetables, bread, and milk.  Others are successful in managing blood glucose levels using a diet that balances amounts of protein, fat and carbohydrate in particular proportions.

100% of the carbohydrate consumed converts directly into glucose in the blood stream when it is digested, so people with diabetes do need to know what foods contain carbohydrate, and consume those in moderation.  People who take insulin also need to know how much carbohydrate they are consuming in any given meal, so that they can calculate the amount of insulin they need to properly balance the glucose that will enter their blood stream.

Nutritionists and dieticians are invaluable resources for people with diabetes, to help each individual figure out what nutrition plan works best for them in relation to blood sugar management and sustainability.  Learn more about nutrition for people with diabetes in this video interview with a registered dietician.  See other nutrition-related videos on TuDiabetes, and recipes shared by members in our forum.

Many people with diabetes are told that losing weight could improve their blood glucose control and reduce their risk of developing diabetes-related complications.  Losing weight usually requires making changes in diet and exercise habits, which is hard to do!  If you struggle with this you are not alone.  Take a look at our forum section called Healthy Living for conversations about weight management through diet and exercise.

It can be really hard to manage blood glucose levels!  What factors affect blood glucose?

Managing blood sugar can be really difficult to do, and it is different for every person with diabetes.  Because we are often told that blood sugar is determined by what we eat and how much we exercise, many people with diabetes experience frustration when they do the same things on different days, and see different results in our blood sugars.  The reason for this is that there are many factors that affect blood glucose, in addition to diet, exercise and diabetes medications!  A few of these factors are:

• stress (tends to raise BG)
• sleep (lack of sleep tends to raise BG)
• menstrual cycle
• illness (tends to raise BG)
• hormonal changes
• some (non-diabetes) medications
• variable insulin sensitivity (this can be different at different times of day!)

TuDiabetes has hosted a series of live interviews with well-known Certified Diabetes Educator Gary Scheiner, who work focuses on managing blood glucose.  For more information about BG management, watch the archived videos here.

A note about morning blood glucose levels: many people with diabetes experience higher BG levels in the mornings.  This can be caused by something called the “dawn phenomenon”, and is due to the release of a variety of hormones during the night, which cause “insulin resistance”.  People who experience the dawn phenomenon require more insulin in the morning (or other medication, for those not taking insulin) in order to keep BG stable at that time of day.  Always work with a health care provider to adjust dosages of insulin and other diabetes medications.

What are diabetes complications, and can they be reversed?

Diabetes complications are caused by having elevated blood glucose levels, over time.  They normally develop very gradually, and regular screening can pinpoint them early so that steps can be taken to stop their progression, and even reverse the damage.  The primary way to stop complications is to bring blood glucose levels down to a healthy range, using the variety of tools we have to do that.   Diabetes complications include*:

• cardiovascular disease
• peripheral neuropathy (nerve damage in hands and feet)
• gastropareses (nerve damage in the digestive system)
• kidney damage
• retinopathy (eye damage)
• skin infections
• hearing impairment
• Alzheimer’s disease

Visit the TuDiabetes forum section about complications to see what our members are sharing about this topic, and get support if you need it!  Learn more about diabetes complications of the eyes (“diabetic retinopathy”), and how to avoid them, in our videos section.

*This list comes from the Mayo Clinic