• What Does It Mean • To Have Diabetes? • Types Of Diabetes • Causes • Can It Be Cured? • Treatment • Diet • Carbohydrates • Protein • Fat • Exercise • Blood Glucose Testing • Urine Testing	• Oral Medication • Insulin • Types Of Insulin • Handling Insulin • Problems • Low Blood Glucose • (hypoglycemia) • Infections • Circulation • Dental Problems • Foot Problems • Conclusion
	THE INFORMATION PROVIDED HERE IS FOR GENERAL EDUCATIONAL PURPOSES ONLY AND SHOULD NOT BE CONSIDERED OR USED AS MEDICAL ADVICE. YOU MUST CONSULT YOUR DOCTOR PRIOR TO INITIATING ANY TREATMENT ROUTINE.
What does it mean to have diabetes?	If you have just been diagnosed with diabetes, you are not alone!  Over 17 million Americans have diabetes, and each day approximately 2,200 new individuals are diagnosed. Having diabetes means that your body's hormone, insulin, is not doing its job.  Insulin is needed to properly use the food that you eat for energy. Most of the food that you eat is broken down into glucose and other simple sugars. Normally, as newly arrived glucose enters the blood stream, your body  releases insulin from the pancreas, and puts the glucose into your cells to use as fuel. If you lack insulin, or your insulin is unable to function properly, the newly arrived glucose cannot be stored and will remain in your blood stream. Your blood glucose levels (also referred to as blood sugar levels) will then become elevated. These abnormally high levels, left untreated, can eventually cause damage to your eyes, heart, nerves and kidneys.
Types of Diabetes	There are several types of diabetes.  The most common are type 1 and type 2. In type 1, the pancreas makes little or no insulin.  Individuals with type 1 need insulin shots in order to stay alive. Type 1 can occur at any age, but is usually seen in children and young adults. With type 2 diabetes, the pancreas produces some insulin, but the amount is either not enough or is not effective, because the body's cells are resistant to it. Some individuals with type 2 diabetes need insulin to regulate their blood glucose, while others respond well to diet therapy and exercise alone, or a combination of diet, exercise and oral medication. Type 2 can occur at any age, but is most often seen after age 40.
Causes	The exact cause of diabetes is unknown.  Heredity may play a role in developing both types, but is most often associated with type 2.  Eating sweets does not cause diabetes, but must be limited to help control it. Being overweight, certain medications (ex: thyroid hormone, glucocorticoids, etc.) and emotional and physical stress related to medical conditions such as pregnancy, illness and surgery, can play a role in its development.  Also, for reasons not yet known, certain ethnic groups such as Native Americans, Hispanic Americans and African Americans tend to have a higher incidence of type 2. Symptoms The warning signs of diabetes include: Frequent urination    Blurred vision Unusual thirst            Numbness or tingling in hands and feet Intense hunger          Frequent infections Extreme fatigue        Irritability Slow healing cuts/bruises   If you have any of the above symptoms, contact your doctor immediately.
Can It Be Cured?	If treated properly, your blood glucose can go down to normal levels, but diabetes will always be part of your life.  Millions of individuals live healthy and active lives with diabetes, and you can too!  Make an effort to be involved in your treatment and learn all that you can about diabetes. Diabetic.com has educational articles and monthly newsletters that highlight a variety of diabetes related topics. The website also offers a bulletin board where you can exchange ideas, questions, answers and experiences with others who have diabetes.
Treatment	Diabetes is a serious condition. Although not curable, it is treatable. Those who do best are the individuals who take an active role in their own treatment. It is important to know how to manage your blood glucose levels. Treatment includes special diets, exercise, regular blood glucose testing and sometimes insulin injections and medication.
Diet	There are no bad foods. For many years, individuals with diabetes were told to avoid foods containing sugar.  Fortunately, we now know more about how diabetes works and today's diabetic diets are creative, healthy and allow for great variety. Many people can keep their blood glucose within a target range using diet alone. Even if you need to take oral medication and/or insulin to control your blood glucose levels, diet will always be an important part of your treatment.  What you eat, when you eat it, and how much food you eat, affects your blood glucose levels. The closer that you can keep your blood glucose levels to normal, the lower your risk of developing serious eye, kidney and nerve damage. Let's take a look at how different foods affect your diabetes:
Carbohydrates	Starches (pastas, rice, bread, cake, potatoes, corn, etc.), fruit and milk are high in carbohydrates. Once in your body, they break down into your cells' preferred form of energy--glucose.  Insulin is needed to help your cells take in the glucose. With diabetes, your insulin cannot do this task properly.  A diabetic diet helps you schedule your carbohydrate intake so  that your cells can get the glucose that they need. Consuming too many carbohydrate-containing foods can raise your blood glucose way above normal; eating too few, can hurt your body by denying it the high quality energy that it needs. Balancing your carbohydrate intake is an important part of your diabetes treatment.
Protein	Protein is found in milk, meats, cheeses, eggs and nuts and tofu. It builds and repairs muscles, skin and cells in your body.  During digestion, protein breaks down into amino acids which can, if necessary, be converted to glucose. Your body's cells, however, prefer using glucose from carbohydrates for energy.
Fat	Fat (oils, margarine, butter, lard, etc.) supplies needed energy, carries fat-soluble vitamins A, D, E and K in your body, and helps to maintain healthy skin. It adds to the flavor and texture of food, but should be limited. Fat is high in calories and too much fat in your diet can increase your risk of heart and blood vessel disease.
Eating Habits	The timing of your meals is also important. The more that you eat at one meal, the more insulin you will need to utilize the energy from the breakdown of those foods. If you eat smaller portions throughout your day, you will not need as much insulin to bring down your blood sugar. Here are some recommendations: 1.  Eat at least 3 times during your day. Many people enjoy 3 small meals and   two snacks. 2.  Eat each meal and snack at about the same time every day. 3.  Eat the same amount at every breakfast. All lunches should be similar in   size, and dinners should be similar in size to all other dinners. 4.  Do not skip meals. Carry some food with you if you think that you will be delayed. There are many types of diabetic diets. Some require a lot of measuring, some don't require any measuring at all. All are planned to provide you with the proper balance of carbohydrates, protein and fat, along with vitamins, minerals, fiber and other nutrients needed to keep you healthy. A registered dietitian (RD) is specially trained to design a diet that best suits your medical needs and lifestyle. The most popular diabetic diets, such as the Exchange Diet, Plate Method and Diabetic Food Pyramid, are reviewed in Diabetic.com's February newsletter.
Exercise	Exercise is a powerful tool for controlling your diabetes. It helps your cells take in glucose and aids in keeping your blood sugar at normal levels. Ask your doctor about the types of activity that meet your physical needs. It is recommended that you exercise for at least 20 minutes, 3-4 times each week.  Remember to begin slowly if you haven't exercised in a long time. Even 5 minutes each day can make a big difference in your health and your blood glucose levels.  For a thorough discussion of the topic of exercise, see Diabetic.com's January newsletter.
Blood Glucose Testing	Testing your own blood glucose levels help both you and your doctor see if your treatment plan is working for you.  It is very simple to do.  All you need is a drop of blood from your finger.  Place it on a special test strip and insert the strip into a glucose meter. The glucose meter will then measure your blood glucose levels. Your doctor will specify when and how often to do the blood testing. Most insurances cover the purchase of blood testing equipment, as will Medicare and Medicaid. For assistance with purchasing supplies for testing, check the "Free Supplies" and "Products"  sections of Diabetic.com. The normal range for blood glucose is 70 - 115 mg/dl (3.85 - 6 mmol/L). Blood glucose levels will go up immediately following a meal, but should return to normal levels within 2 hours. Blood glucose levels of 126 mg/dl (7mmol/L) or higher, are diagnosed as diabetes. See the section entitled "Problems" for ways to treat blood glucose levels that are not within the  normal range.
Urine Testing	With diabetes, your blood sugar can go way too high.  This can occur if you overeat, take too little insulin, become sick, or are under significant stress.  Under these conditions, your cells becomes starved for food and will begin breaking down fat for energy. The byproducts of fat breakdown are chemicals called ketones and can be extremely dangerous. They can make you throw up, have difficulty breathing, become extremely thirsty, and put you into a coma. To detect the presence of ketones, you should test your urine. Test strips for this purpose are available from diabetic.com.   Be sure to test your urine if you experience the symptoms listed above and/or have a blood glucose level of over 240 mg/dl (13 mmol/L). If you find that your urine tests positive for ketones, call your doctor immediately.
Oral Medications	You may need to take diabetes pills as part of your treatment plan. These pills work best when used with a healthy diet and regular exercise. There are many types of pills available and they work in a variety of ways. Some inhibit the release of glucose from your liver, slow the absorption of glucose in your gut and enhance the absorption of glucose in other parts of your body. Others stimulate your pancreas to produce additional insulin and help your cells respond better to available insulin.  Your doctor will prescribe the ones that are best suited to your needs.
Insulin	In certain types of diabetes, there is not enough insulin available. Insulin shots must then be taken which help glucose enter into the cells. The thought of giving yourself a shot can be a tough one, but know that millions of individuals are now giving themselves insulin shots with great ease.  Insulin attaches to the outside of most of your body cells and allows glucose to enter. Currently, it must be injected and cannot be put into pill form; your digestive enzymes would destroy it before it could begin to lower your blood glucose levels. Research, however, is ongoing regarding new ways to take insulin. Several companies have had some success with an inhaled form of insulin which the FDA has yet to approve. Check the "News" section of the Diabetic.com bulletin board for updates on diabetes medical breakthroughs.
Types of Insulin	There are several types of insulin. They are classified as rapid-acting, intermediate-acting, and long-acting.  You may be asked to combine these types depending on your needs.  Rapid-acting and short-acting insulin begin to act very quickly after you inject them and last a short time. They are usually taken to prevent an abnormal rise in glucose levels following meals. Intermediate and long-acting insulin have a gradual and longer lasting effect on blood glucose levels. There are two popular kinds of insulin--purified pork insulin and human insulin. Purified pork insulin acts much like the insulin made by the human body. Human insulin is not actually from humans, but is developed in a laboratory and is considered the most pure.
Handling Insulin	Insulin should be stored in a refrigerator, but once opened, can be stored at room temperature for easy access and comfort. Room temperature insulin usually feels more comfortable when injected and remains stable for 30 days after opening. When traveling, do not check your insulin with your bags. Luggage can be lost, and storage compartments are often extremely cold. Inspect the expiration date on your insulin. Do not use it beyond this date. Examine your insulin before using. Do not use it if the color appears abnormal or the insulin does not mix well. It is recommended that you dispose of your needles in a sharps container made especially for this purpose. Your doctor will decide which type of insulin is best for you and make sure that you learn the correct techniques for using it.
Problems	High blood glucose (hyperglycemia) There may be times when your blood sugar (glucose) levels go too high. This can happen when you are ill or under stress, eat too much, or have too little insulin in your blood. High blood glucose can cause headaches, blurry vision, frequent urination, increased thirst, and dry itchy skin. Test your urine for ketones if you experience a blood glucose reading of over 240 mg/dl (13 mmol/L) are sick, or have any of the symptoms listed above. Be sure to drink lots of water if you are urinating often.  It is very dangerous to become dehydrated. If your urine tests positive for ketones, contact your doctor immediately. (See urine testing)
Low Blood Glucose	There may also be times when your blood glucose will be too low. This can be caused by taking too much insulin, not eating enough, drinking alcohol on an empty stomach, or exercising for an extended period.  When your blood glucose is low, you may become shaky, feel tired, experience intense hunger, and become confused or nervous. It is important that you treat low blood glucose immediately. Test your blood glucose if you feel that it is too low. If it is less than 70mg/dl (less than 4 mmol/L) follow the 15/15 rule: eat or drink something with the equivalent of 15 grams of carbohydrate and then wait 15 minutes before  retesting your blood sugar. The following servings contain 15 grams of carbohydrate:     ½ cup apple or orange juice,  or     ½ - 3/4 cup regular (not diet) carbonated beverage, or     5 Lifesavers candies
Infections	Infections are common in people with diabetes. The first sign of an oncoming infection may be elevated blood glucose.  Other signs of infection include: pain, swelling, fever, redness, a feeling of warmth in a certain area, and a discharge. They can be very serious and can occur without any open cut or injury.  Call your doctor if you suspect that you have an infection.
Circulation	High blood glucose levels over an extended period of time can affect your blood vessels. This may lead to sexual problems such as impotence, cause kidney and vision problems and encourage the development of skin ulcers which, if left untreated, may lead to amputation. Individuals with diabetes are also at greater risk for heart attacks, strokes and other cardiovascular diseases. Be sure to see both your physician and eye doctor regularly.
Dental Problems	When your blood glucose is high, it is not unusual to get a mouth infection. High blood glucose levels encourage bacterial growth.  Brush your teeth at least two times each day. Be aware of any bleeding or gum soreness. Schedule regular dental exams and be sure to tell your dentist that you have diabetes. Try to schedule your dental appointments after mealtimes to lower your risk of low blood sugar caused by limiting your food intake following dental work. If you have difficulty eating due to a toothache or are unable to eat after having dental work done, follow the sick day recommendations found in Diabetic.com's March newsletter.
Foot Problems	Decreased feeling in your feet can make it difficult to know if your feet have been injured in any way. Early treatment of any foot injury can prevent serious complications, such as infection which can lead to amputation. To prevent foot problems, make certain that you wear shoes and socks that fit properly and change your shoes at least once during the day. Check your feet every time you remove your shoes. Look for redness, which can occur when shoes do not fit properly. Also look for cracks, cuts, bruises, etc. Discuss with your doctor or podiatrist the best way to care for your feet, cut your nails, and treat calluses.
Conclusion	Fortunately, many of the complications of diabetes can be reduced or avoided if you take good care of your health. Diabetic.com's newsletters and educational columns provide valuable updates on treatments and issues related  to diabetes.  The Diabetic.com bulletin board offers a terrific forum to share concerns with others who have diabetes.  Eating properly, exercising regularly, and following your prescribed treatment, can help you stay healthy and enjoy all that life has to offer.