Understanding Diabetes -- Diagnosis and Treatment

How Do I Know if I Have Diabetes?

Your doctor may suspect you have diabetes if you have some risk factors for diabetes, or if you have high levels of blood sugar in your urine. Your blood sugar (also called blood glucose) levels may be high if your pancreas is producing little or no insulin (type 1 diabetes), or if the body is not responding normally to insulin (type 2 diabetes).

Getting diagnosed begins with one of three tests. In most cases, your doctor will want to repeat a test that is high in order to confirm the diagnosis:

• A fasting glucose test is a test of your blood sugar levels taken in the morning before you have eaten. A level of 126 mg/dL or higher may mean that you have diabetes.
• An oral glucose tolerance test (OGTT) entails drinking a beverage containing glucose and then having your blood glucose levels checked every 30 to 60 minutes for up to 3 hours. If the glucose level is 200 mg/dL or higher at 2 hours, then you might have diabetes.
• The A1c test is a simple blood test that shows your average blood sugar levels for the past 2-3 months. An A1c level of 6.5% or higher may mean you have diabetes.

Your doctor may also suggest a zinc transporter 8 autoantibody (ZnT8Ab) test. This blood test -- along with other information and test results -- can help determine if a person has type 1 diabetes instead of another type. The goal of having the ZnT8Ab test is a prompt and accurate diagnosis, and that can lead to timely treatment.

What Are the Treatments for Diabetes?

Diabetes is a serious disease that you cannot treat on your own. Your doctor will help you make a diabetes treatment plan that is right for you -- and that you can understand. You may also need other health care professionals on your diabetes treatment team, including a foot doctor, nutritionist, eye doctor, and a diabetes specialist (called an endocrinologist).

Treatment for diabetes requires keeping close watch over your blood sugar levels (and keeping them at a goal set by your doctor) with a combination of medications, exercise, and diet. By paying close attention to what and when you eat, you can minimize or avoid the "seesaw effect" of rapidly changing blood sugar levels, which can require quick changes in medication dosages, especially insulin. Find out how to choose the right diabetes treatment for you.

Diabetes Drugs

If you have type 1 diabetes, your pancreas no longer makes the insulin your body needs to use blood sugar for energy. You will need insulin in the form of injections or through use of a continuous pump. Learning to give injections to yourself or to your infant or child may at first seem the most daunting part of managing diabetes, but it is much easier than you think.

Some people with diabetes use a computerized pump -- called an insulin pump -- that gives insulin on a set basis. You and your doctor program the pump to deliver a certain amount of insulin throughout the day (the basal dose). Plus, you program the pump to deliver a certain amount of insulin based on your blood sugar level before you eat (bolus dose).

Injectable insulin comes in five types:

• Rapid-acting (taking effect within a few minutes and lasting 2-4 hours)
• Regular or short-acting (taking effect within 30 minutes and lasting 3-6 hours)
• Intermediate-acting (taking effect in 1-2 hours and lasting up to 18 hours)
• Long-acting (taking effect in 1-2 hours and lasting beyond 24 hours)
• Ultra- long-acting (taking effect in 1-2 hours and lasting 42 hours)

A rapid-acting inhaled insulin (Afrezza) is also FDA-approved for use before meals. It must be used in combination with long-acting insulin in patients with type 1 diabetes and should not be used by those who smoke or have chronic lung disease. It comes as a single dose cartridge. Premixed insulin is also available for people who need to use more than one type of insulin.

Insulin degludec (Tresiba) is a once-daily, long-acting insulin, providing a basal dose of insulin lasting beyond 42 hours. (It's the only basal insulin approved for both type 1 and type 2 diabetes in patients as young as 1 year old.) It is also available in combination with rapid-acting insulin (Ryzodeg 70/30).

Each treatment plan is tailored for the person and can be adjusted based on what you eat and how much you exercise, as well as for times of stress and illness.

By checking your own blood sugar levels, you can track your body's changing needs for insulin and work with your doctor to figure out the best insulin dosage. People with diabetes check their blood sugar up to several times a day with an instrument called a glucometer. The glucometer measures glucose levels in a sample of your blood dabbed on a strip of treated paper. Also, there are now devices, called continuous glucose monitoring systems (CGMS), that can be attached to your body to measure your blood sugars every few minutes for up to a week at a time. But these machines check glucose levels from skin rather than blood, and they are less accurate than a traditional glucometer.

For some people with type 2 diabetes, diet and exercise are enough to keep the disease under control. Other people need medication, which may include insulin and an oral drug.

Drugs for type 2 diabetes work in different ways to bring blood sugar levels back to normal. They include:

• Drugs that increases insulin production by the pancreas, including chlorpropamide (Diabinese), glimepiride, (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta, Glynase), nateglinide (Starlix), and repaglinide (Prandin)
• Drugs that decrease sugar absorption by the intestines, such as acarbose (Precose) and miglitol (Glyset)
• Drugs that improve how the body uses insulin, such as pioglitazone (Actos) and rosiglitazone (Avandia)
• Drugs that decrease sugar production by the liver and improve insulin resistance, like metformin (Glucophage). Metformin causes weight loss and this is one of the ways it helps bring blood sugars back to normal.
• Drugs that increase insulin production by the pancreas or its blood levels and/or reduce sugar production from the liver, includingalogliptin (Nesina), dulaglutide (Trulicity), exenatide (Byetta, Bydureon), linagliptin (Tradjenta), liraglutide (Victoza), lixisenatide (Adlyxin), saxagliptin (Onglyza), semaglutide (Ozempic), andsitagliptin (Januvia).
• Drugs that block the reabsorption of glucose by the kidney and increase glucose excretions in urine, called sodium-glucose co-transporter 2 (SGLT2) inhibitors. They also trigger weight loss which helps bring blood sugars back to normal. They are canaglifozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), and ertugliflozin (Steglatro). These drugs can also help reduce the risk of hospitalization for heart failure and cardiovascular death in patients with heart failure.
• Pramlinitide (Symlin) is an injectable synthetic hormone. It helps lower blood sugar after meals in people with diabetes who use insulin.

Some pills contain more than one type of diabetes medication. They include the recently approved empagliflozin/linagliptin (Glyxambi). It combines a SGLT2 inhibitor that blocks reabsorption of glucose into the kidneys with a DPP-4 inhibitor which increases hormones to help the pancreas produce more insulin and the liver produce less glucose.

Nutrition and Meal Timing for Diabetes

Eating a balanced diet is vital for people who have diabetes, so work with your doctor or dietitian to set up a menu plan. If you have type 1 diabetes, the timing of your insulin dosage is determined by activity and diet. When you eat and how much you eat are just as important as what you eat. Usually, doctors recommend three small meals and three to four snacks every day to maintain the proper balance between sugar and insulin in the blood.

A healthy balance of carbohydrates, proteins, and fats in your diet will help keep your blood glucose on target. How much of each will depend on many factors, including your weight and your personal preferences. Watching your carbohydrates -- knowing how much you need and how many you are eating -- is key to blood sugar control. If you are overweight, either a low-carbohydrate, low-fat/low calorie, or Mediterranean diet may help you get your weight to goal. No more than 7% of your diet should come from saturated fat, and you should try to avoid trans fats altogether.

Try to fill half your plate with nonstarchy vegetables such as:

• Asparagus
• Broccoli
• Carrot
• Cucumber
• Salad greens
• Squash
• Tomato

Also, make sure to get some of these:

• Beans
• Berries
• Citrus fruits
• Lean meat
• Low-fat or nonfat dairy products
Nuts
• Poultry or fish
• Sweet potatoes

You can also get protein from vegetarian options like tofu.

Stick to whole-grain foods. If you eat cereals, check the ingredients and make sure whole grain is first on the list.

Examples of whole grains include:

• Brown rice
• Bulgur (cracked wheat)
• Millet
• Popcorn
• Quinoa
• Sorghum
• Whole oats oatmeal
• Whole wheat

In general, less-processed food is better. It has a lower glycemic index, which means it may have less of an effect on your blood sugar. For example, oatmeal from whole oats has a lower glycemic index than instant oatmeal.

If you have type 2 diabetes and follow a healthy diet and exercise routine, you could lose weight and improve your diabetes. One study found long-term weight loss through diet and exercise could lower your chances of having a stroke and dementia.

Exercise for Diabetes

Another crucial element in a treatment program for diabetes is exercise. With either type of diabetes, check with your doctor before starting an exercise program. Exercise improves your body's use of insulin and may lower blood sugar levels. To prevent your blood sugar from falling to dangerously low levels, check your blood sugar and, if necessary, eat a carbohydrate snack about half an hour before exercising. If you start to feel symptoms of low blood sugar (called hypoglycemia), stop exercising and have a carbohydrate snack or drink. Wait 15 minutes and check again. Have another snack again if it is still too low.

Exercise helps some people with type 2 diabetes lower their blood glucose levels and may help prevent the disease in those at risk.

For people with either type of diabetes, exercise can lower the chance of having a heart attack or stroke and can improve circulation. It may offer stress relief, as well. People with type 2 diabetes who need to lose weight can benefit from moderate exercise. Most people with diabetes are encouraged to get at least 150 minutes each week of moderate-intensity aerobic physical activity, like walking. Strength training is often recommended at least twice a week. Talk to your doctor about what type of exercise is right for you. Learn how to start (and stick with) a workout routine when you have diabetes.

If you aren't active now, start slow. Then build up how much exercise you get over time. Shoot for four to seven periods of activity each week. Try to make each period last at least 30 minutes. And you don't have to work out at the gym to be active. Take the stairs instead of an elevator, or park at the far end of the lot. Both add exercise to your daily routine.

Have a realistic goal and make a plan. What exercises will you do, and when will you do them? For example, you might plan to walk 30 minutes most days on your lunch break.

Change your activities often enough so you don't get bored. You can do aerobic activities like walking or jogging. And resistance exercises like working out with weights offer another option. Whatever you do, don't forget to stretch before and after each workout session.

It's important to realize that exercise lowers your blood sugar. Talk to your doctor about whether you need to adjust your meds or insulin dose to keep your levels high enough.

Lifestyle Changes for Diabetes

Wear a medical ID tag

It is a good idea to wear a MedicAlert bracelet or tag that says you have diabetes. This will make others aware of your condition in case you have a severe hypoglycemic attack and are not able to make yourself understood, or if you are in an accident and need emergency medical care. Identifying yourself as having diabetes is important because hypoglycemic attacks can be mistaken for drunkenness, and victims often aren't able to care for themselves. Without prompt treatment, hypoglycemia can result in a coma or seizures. And, because your body is under increased stress when you are ill or injured, your blood sugar levels will need to be checked by the medical personnel who give you emergency care.

Take care of your teeth

Be sure to take good care of your teeth and floss regularly. Diabetes can worsen gum disease.

Reduce stress

If you're stressed, you may exercise less, drink more, and not watch your diabetes as closely.

Stress can also raise your blood sugar and make you less sensitive to insulin. When you're stressed, your body adopts a "fight or flight" response. That means it will make sure you have enough sugar and fat available for energy.

Studies of people with type 1 diabetes found blood sugar levels go up for most people under mental stress and down for others. If you have type 2 diabetes and you're feeling pressure, your glucose will go up.

If something has you bothered, try to make changes that can help you relax. You might exercise, spend time with friends, meditate, or replace negative thoughts with positive ones. Do whatever works for you.

Support groups, counseling, or therapy can help, too.

Quit smoking

Kick the habit. It'll give you better control of your blood sugar levels.

If you smoke, you're also more likely to have serious health problems as well as a higher chance for complications from diabetes. Those can include:

• Heart and kidney disease
• Poor blood flow to the legs and feet, which could lead to infections, ulcers, and amputation of your toes or feet
• Retinopathy, an eye disease that causes blindness
• Peripheral neuropathy, nerve damage in the arms and legs that causes weakness, numbness, pain, and poor coordination

Cut back on alcohol

If you're on insulin or oral diabetes meds like sulfonylureas or meglitinides, drinking alcohol can drop blood sugar to dangerous levels. When you drink, your liver has to work to remove the alcohol from your blood instead of regulating your blood sugar.

Drunkenness and low blood sugar can also cause dizziness, disorientation, and sleepiness. You could confuse the symptoms of too much alcohol and low blood sugar. A woman should have no more than one drink a day. For men, the limit is two drinks per day. One drink is 12 ounces of beer, a 5-ounce glass of wine, or an ounce and a half of liquor like vodka. With mixed drinks, choose no-calorie mixers like club soda or diet soda.

Try switching to a light beer or wine spritzer. You can also sip more slowly or switch to water or another calorie-free drink.

If you cut back on the drinks, you may eat better. Alcohol can lower your willpower to resist overeating.

Take notes

Keeping a detailed daily log can help you track what affects your glucose levels. That log can include:

• Insulin and other medications
• Food, especially carbs
• Physical activity
• Stress
• Illnesses

After a week or so, see if you notice any patterns.

If you're trying to lose weight, write down everything you eat or drink for a week or two, including portion size. That'll give you a clear picture of where you stand and what changes you can make.

If you drink alcohol, check your blood sugar before you drink, while you drink, before you go to bed, and the following day. Alcohol lowers blood sugar for up to 24 hours after you finish your last drink.

Alternative Medicine for Diabetes

Vitamins and minerals

Alternative medicine should never be used alone to treat diabetes. But there are things you can do -- in addition to medication, proper diet, and exercise -- that may help control your blood sugar and prevent complications of diabetes.

Although chromium does have an effect on insulin as well as on glucose metabolism, there is no evidence that taking chromium supplements can help in the treatment of diabetes. But chromium is found in many healthy foods, such as green vegetables, nuts, and grains. Studies have suggested that biotin, also called vitamin H, when used with chromium, may improve glucose metabolism in people with diabetes. But no studies have shown that biotin by itself is helpful.

Vitamins B6 and B12 may help treat diabetic nerve pain if you have low levels of these vitamins and that is contributing to the nerve pain. But otherwise, there is no proof that taking these vitamins will help.

Vitamin C may make up for low blood levels of insulin, which normally works to help cells absorb the vitamin. Proper amounts of vitamin C may help the body maintain a good cholesterol level and keep blood sugar levels under control. But too much can cause kidney stones and other problems. Check with your doctor to see if a vitamin C supplement is right for you.

Vitamin E may help limit damage to the blood vessels and help protect against kidney and eye disease. But too much can lead to serious problems, such as a higher risk of stroke. Talk to your doctor before adding this supplement.

Magnesium helps control blood sugar levels. Some people with diabetes have a serious magnesium deficiency. Magnesium supplements, in this case, may improve the action of insulin.

Mind/body medicine

Guided imagery, biofeedback, meditation, hypnotherapy, and yoga reduce stress hormones, which in turn may help stabilize blood sugar levels. Biofeedback may also help lower blood pressure, but more research is needed to discover its role in the treatment of diabetes and high blood pressure.

Herbal remedies

Capsaicin cream, a topical ointment made with cayenne, has been reported by some patients to help lower pain in the hands and feet from diabetic neuropathy. But people with loss of sensation in the hands or feet should use caution when using capsaicin, as they may not be able to fully feel any burning sensation. Check with your doctor if you are thinking of trying this product.

Evening primrose oil is thought to help diabetic nerve pain, but no conclusive evidence has yet been found.

Ginkgo, garlic, holy basil leaves, fenugreek seeds, ginseng, and hawthorn are other herbals that have been promoted by some as remedies for diabetic symptoms. More research is needed to see what, if any, role these herbals may play. Check with your doctor before trying any herbal product.

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