Diabetes

Type 2 Diabetes and Pre-Diabetes

Diabetes is a disorder that affects the way your body uses digested food for growth and energy. Normally, the food you eat is broken down into glucose. The glucose then passes into your bloodstream, where it is used by your cells for growth and energy. For glucose to reach your cells, however, insulin must be present. Insulin is a hormone produced by your pancreas, a hand-sized gland behind your stomach.

Most people with type 2 diabetes have two problems: the pancreas may not produce enough insulin, and fat, muscle, and liver cells cannot use it effectively. This means that glucose builds up in the blood, overflows into the urine, and passes out of the body - without fulfilling its role as the body's main source of fuel.

About 17 million people in the United States have diabetes. Ninety to 95 percent of them have type 2 diabetes. Diabetes is the main cause of kidney failure, limb amputation, and new-onset blindness in American adults. People with diabetes are also two to four times more likely than people without diabetes to develop heart disease.

Pre-diabetes, also called impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), is a condition in which your blood glucose (blood sugar) levels are higher than normal but not high enough for a diagnosis of diabetes. Having pre-diabetes puts you at higher risk for developing type 2 diabetes. If you have pre-diabetes, you are also at increased risk for developing heart disease.

You are more likely to develop type 2 diabetes if

• you are overweight
• you are 45 years old or older
• you have a parent, brother, or sister with diabetes
• your family background is African American, American Indian, Asian American, Hispanic American/Latino, or Pacific Islander
• you have had gestational diabetes or gave birth to at least one baby weighing more than 9 pounds
• your blood pressure is 140/90 or higher, or you have been told that you have high blood pressure
• your HDL cholesterol is 35 or lower, or your triglyceride level is 250 or higher
• you are fairly inactive, or you exercise fewer than three times a week

Blood Glucose Levels

What should my blood glucose levels be?

For most people, target blood glucose levels are

Before meals: 90 to 130
1 to 2 hours after the start of a meal: less than 180

Ask your doctor how often you should check your blood glucose. The results from your blood glucose checks will tell you if your diabetes care plan is working. Also ask your doctor for an A1C test at least twice a year. Your A1C number gives your average blood glucose for the past 3 months.

Keeping Your Blood Glucose Levels Healthy!

• Eat about the same amount of food each day.
• Eat your meals and snacks at about the same times each day.
• Do not skip meals or snacks.
• Take your medicines at the same times each day.
• Exercise at about the same times each day.

Exercise Plan

What you eat and when also depend on how much you exercise. Exercise is an important part of staying healthy and controlling your blood glucose. Physical activity should be safe and enjoyable, so talk with your doctor about what types of exercise are right for you. Whatever kind of exercise you do, here are some special things that people with diabetes need to remember:

• Take care of your feet. Make sure your shoes fit properly and your socks stay clean and dry. Check your feet for redness or sores after exercising. Call your doctor if you have sores that do not heal.

• Drink about 2 cups of water before you exercise, about every 20 minutes during exercise, and after you finish, even if you don't feel thirsty.

• Warm up and cool down for 5 to 10 minutes before and after exercising. For example, walk slowly at first, then walk faster. Finish up by walking slowly again.

• Test your blood glucose before and after exercising. Do not exercise if your fasting blood glucose level is above 300. Eat a small snack if your blood glucose is below 100.

• Know the signs of low blood glucose (hypoglycemia) and how to treat it.

Low Blood Sugars (Hypoglycemia)

You should know the signs of hypoglycemia (low blood sugar) such as feeling weak or dizzy, sweating more, noticing sudden changes in your heartbeat, or feeling hungry. If you experience these symptoms, stop exercising and test your blood glucose. If it is 70 or less, eat one of the following right away:

• 2 or 3 glucose tablets
• 1/2 cup (4 ounces) of any fruit juice
• 1/2 cup (4 ounces) of a regular (not diet) soft drink
• 1 cup (8 ounces) of milk
• 5 or 6 pieces of hard candy
• 1 or 2 teaspoons of sugar or honey

After 15 minutes, test your blood glucose again to find out whether it has returned to a healthier level. Once blood glucose is stable, if it will be at least an hour before your next meal, it's a good idea to eat a snack.

To be safe when you exercise, carry something to treat hypoglycemia, such as glucose tablets or hard candy. Another good idea is to wear a medical identification bracelet or necklace (in case of emergency). Teach your exercise partners the signs of hypoglycemia and what to do about it.

When You Are Sick

It's important to take care of your diabetes even when you're ill. Here are some tips on what to do:

• Even if you can't keep food down, keep taking your diabetes medicine.
• Drink at least one cup (8 ounces) of water or other calorie-free, caffeine-free liquid every hour while you're awake.
• If you can't eat your usual food, try drinking juice or eating crackers, popsicles, or soup.
• If you can't eat at all, drink clear liquids such as ginger ale. Eat or drink something with sugar in it if you have trouble keeping food down, because you still need calories. If you don't have enough calories, you increase your risk of hypoglycemia (low blood sugar).
• Make sure that you check your blood glucose. Your blood glucose level may be high even if you're not eating.
• Call your doctor right away if you throw up more than once or have diarrhea for more than 6 hours.

Points to Remember

What, when, and how much you eat all affect your blood glucose level.

You can keep your blood glucose at a healthy level if you

• Eat about the same amount of food each day.
• Eat at about the same times each day.
• Take your medicines at the same times each day.
• Exercise at the same times each day.

Every day, choose foods from these food groups: starches, vegetables, fruit, meat and meat substitutes, and milk and yogurt. How much of each depends on how many calories you need a day.

Limit the amounts of fats and sweets you eat each day.

The information contained on this site is not intended to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Web Resources

The American Diabetes Association website, www.diabetes.org/home.jsp provides information on prevention, nutrition, and exercise. It inlcudes a special section for those who have recently been diagnosed with diabetes and a section on diabetes and women.

The website BDDiabetes.com has a special section on Diabetes Care for Older Adults. All of the menu items on the left are related to this topic. and it includes instructions for caregivers. Under "Special Topics" is information diabetes as a risk factor for falling. Click here to visit the falls page.