Chapter 1

Diabetes 101: Discovering the Basics

In This Chapter

Getting to know the types of diabetes

Diagnosing diabetes

Seeing the highs and lows of blood glucose levels

Managing diabetes through nutrition

Staying healthy with exercise

Investigating the important role of medication in diabetes management

This is a cookbook with a twist.

This book begins not with recipes or a discussion on food handling or food shopping or the like, but rather starts right here, in Chapter 1, with a discussion on diabetes.

Beginning this book by talking about the basics of diabetes - Diabetes 101, if you will - is in keeping with the very special nature of diabetes. Diabetes is special in many ways, but none more so than this: If you're living with diabetes, the more you know about your diabetes and the more actively you are involved in your own health care, the more you can do to ensure you stay healthy.

Your diabetes therapy begins anew every day when you first get up and decide what you're going to eat. And your therapy continues all day with every morsel you put in your mouth. If you have diabetes it's not your doctor or nurse or dietitian or any other person who ultimately makes your nutrition choices; it is you.

Healthy eating affects diabetes in many different and crucial ways: The food choices you make will influence your blood glucose ("blood sugar"), your weight, your blood pressure, your cholesterol, your bowel habits, your sense of well-being, and much more. Indeed, we are routinely, absolutely, blown away by the dramatic improvement in the health of our patients with diabetes who carefully practise healthy eating.

In this chapter, we look at the different types of diabetes and we explore how to manage them. Because diabetes is (as we look at in a moment) a condition characterized by high blood glucose, we look in detail at blood glucose, how high (and low) levels can make you feel, and how you can control your blood glucose through nutrition, exercise, and medication. For most people with diabetes, a combination of these therapies works best in achieving and maintaining both good blood glucose control and good health in general.

This chapter is an overview of key elements of diabetes. For detailed information on the material we cover here, we unabashedly refer you to another book that Ian co-wrote: Diabetes For Canadians For Dummies (Wiley).

Examining the Types of Diabetes

Diabetes is a condition in which you have elevated blood glucose (blood sugar) either because you don't make enough insulin, or you make enough insulin but it doesn't work well, or, in some cases, both. Glucose is the type of sugar that the body uses as fuel to provide energy for metabolism, muscle action, and brain function. Insulin, a hormone made by the pancreas, works by acting on muscle and fat cells to allow them to extract glucose from the blood, and by acting on the liver to suppress its production of glucose. You could think of it as insulin grabbing onto the glucose and opening the door to take the glucose into the cells to be used for energy.

There are three main types of diabetes:

• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes

All three types of diabetes are, by definition, characterized by a tendency for having high blood glucose levels. With proper therapy, however, you can (and indeed, must) bring high blood glucose levels under control.

Type 1 diabetes used to go by two other names that, although outdated, you still may come across: juvenile diabetes and insulin-dependent diabetes mellitus (IDDM). Type 2 diabetes also used to go by two other names: adult onset diabetes and non-insulin dependent diabetes mellitus (NIDDM). These older names were abandoned because they led to confusion. For example, type 1 diabetes frequently begins in adults (so it's not actually a "juvenile" condition) and people with non-insulin dependent diabetes frequently depend on insulin treatment. No wonder these old terms were abandoned!

Diabetes insipidus: The "other" form of diabetes

Although most people (including us in this book) talk about diabetes as if there were only one form, in fact there are actually two. Diabetes mellitus refers to the form of diabetes we discuss in this book: that is, the form of diabetes characterized by elevated blood glucose. The other form, called diabetes insipidus, is an entirely different condition: an uncommon disease in which a problem with antidiuretic hormone puts you at risk of excess urine production and, as a result, dehydration.

Type 1 diabetes

Type 1 diabetes is an autoimmune disease, meaning that the body's immune system malfunctions and creates antibodies that target its own tissues. In the case of type 1 diabetes, the body makes antibodies that attack and destroy the insulin-producing islet cells in the pancreas. (More specifically, they attack one type of islet cell called a beta cell.)

These are some important things to know about type 1 diabetes:

• It most commonly develops in adolescents, but also often occurs in young children and young adults. (Increasing scientific evidence suggests that, in fact, in most cases the first onset is in adults.)
• Symptoms typically appear soon after the condition first develops. (We discuss these symptoms later in this chapter.)
• It is far less common than type 2 diabetes. Type 1 diabetes accounts for between 5 and 10 percent of all cases of diabetes.
• Urgent treatment with insulin is required as soon as this condition is discovered; delaying therapy can be life-threatening.

Type 2 diabetes

Type 2 diabetes is caused by a combination of the body's insulin not working as effectively as it should (a condition called insulin resistance) and the pancreas making insufficient quantities of insulin.

These are some important things to know about type 2 diabetes:

• It most commonly occurs in middle-aged or older individuals, most of whom are overweight and sedentary. (However, many people with type 2 diabetes don't fit this mould.)
• It is often preceded by years of prediabetes, a condition in which blood glucose levels are higher than normal but not high enough to make a diagnosis of diabetes.
• It is far more common than type 1 diabetes. Type 2 diabetes accounts for between 90 and 95 percent of all cases of diabetes.
• The most important component of therapy is lifestyle, including healthy eating, exercise, and weight control.

Gestational diabetes

Gestational diabetes (GDM) is a temporary form of diabetes that, by definition, occurs only during pregnancy. It develops in anywhere from 4 to 18 percent of pregnancies depending on what criteria are used to make the diagnosis (there are two different sets of criteria in use, each with its pros and cons), and is routinely tested for at about the midway point of a pregnancy. As in the other types of diabetes, women with gestational diabetes have a tendency toward elevated blood glucose levels that, with proper therapy, can be kept under control.

Gestational diabetes does not harm or risk harming the affected woman, per se. Its importance lies in its potential impact on the developing fetus. If the diabetes is insufficiently treated, the fetus can become overly large, which can make delivery difficult. Also, after delivery, the newborn often has low blood glucose. (Medical staff routinely test for this in a baby born to a woman with gestational diabetes.) Low blood glucose in the newborn is not serious and is easy to treat by giving the baby sugar water to drink. Other complications from gestational diabetes seldom occur.

Gestational diabetes is treated by following a special nutrition program (as we discuss in Chapter 4). Regular exercise also helps. If despite these measures the woman's blood glucose levels remain elevated, insulin therapy is typically used. Because of limited scientific evidence regarding their use in pregnancy, oral hypoglycemic agents (see "Taking Oral Medications to Help Control Your Blood Glucose" later in this chapter) are seldom used. This may change in the future.

If you've had gestational diabetes, it means you're at high risk of later developing type 2 diabetes so it's essential that you follow a very healthy lifestyle after the delivery and that your doctor test your blood glucose levels from time to time thereafter. This testing includes both a glucose tolerance test within a few months of your delivery and a measurement of your fasting blood glucose from time to time.

If you've had gestational diabetes, get your blood glucose level checked before trying to conceive again; that way, if you've developed type 2 diabetes it can be brought under control before you get pregnant. Uncontrolled diabetes present at the time of conception and during early pregnancy is very dangerous as it can damage the fetus's developing organs.

Investigating How Diabetes Is Diagnosed

Diabetes - in any form - is a serious disease and, befitting this, is diagnosed according to strict criteria. According to the Canadian Diabetes...