You can’t find activities that interest or amuse you.
✔ You feel worthless.
✔ You have frequent thoughts of suicide.
✔ You have no appetite.
✔ You find no humor in anything.
If you recognize several of these symptoms in your daily life, you need to get some help. Your sense of hopelessness may include the feeling that no one else can help you – but that’s simply not true. First, go to your primary physician or endocrinologist (diabetes specialist) for advice. He or she may help you to see the need for some short-term or long-term therapy. Well-trained therapists – especially therapists trained to take care of people with diabetes – can see solutions that you can’t see in your current state. You need to find a therapist whom you can trust so that when you’re feeling low you can talk to this person and feel assured that he or she is very interested in your welfare.
Your therapist may decide that you would benefit from medication to treat the anxiety or depression. Currently, many drugs are available that are proven safe and free of side effects. Sometimes a brief period of medication is enough to help you adjust to your diabetes.
You can also find help in a support group. The huge and continually growing number of support groups shows that positive things are happening in these groups. In most support groups, participants share their stories and problems, helping everyone involved cope with their own feelings of isolation, futility, or depression.
Chapter 2
Making the Diagnosis with Glucose and Hemoglobin A1c
In This Chapter
▶ Seeing how glucose works in the body
▶ Identifying chronic high blood glucose with the hemoglobin A1c
▶ Reviewing the warning signs of prediabetes
▶ Testing for diabetes
▶ Getting to know actual patients and their stories
The Greeks and Romans knew about diabetes. The way they tested for the condition was – prepare yourself – by tasting people’s urine. In this way, the Romans discovered that the urine of certain people was mellitus, the Latin word for sweet. (They got their honey from the island of Malta, which they called Mellita.) In addition, the Greeks noticed that when people with sweet urine drank, the fluids came out in the urine almost as fast as they went in the mouth, like a siphon. The Greek word for siphon is diabetes. Thus we have the origins of the modern name for the disease, diabetes mellitus.
In this chapter, I cover some not-so-fun stuff about diabetes – the big words, the definitions, and so on. If you really want to understand what’s happening to your body when you have diabetes – and I know I would – then you won’t want to skip this chapter.
Realizing the Role of Glucose
The body has three sources of energy: protein, fat, and carbohydrates. I discuss the first two sources in greater detail in Chapter 8, but I tackle the third one now. Sugar is a carbohydrate. Many different kinds of sugars exist in nature, but glucose, the sugar that has the starring role in the body, provides a source of instant energy so that muscles can move and important chemical reactions can take place. Table sugar, or sucrose, is actually two different kinds of sugar – glucose and fructose – linked together. Fructose is the type of sugar found in fruits and vegetables. Because fructose is sweeter than glucose, sucrose (the combination of fructose and glucose) is sweeter than glucose alone as well. Therefore, your taste buds don’t need as much sucrose or fructose to get the same sweet taste of glucose.
In order to understand the symptoms of diabetes, you need to know a little about the way the body normally handles glucose and what happens when things go wrong. A hormone called insulin finely controls the level of glucose in your blood. A hormone is a chemical substance made in one part of the body that travels (usually through the bloodstream) to a distant part of the body where it performs its work. In the case of insulin, that work is to act like a key to open a cell (such as a muscle, fat, or liver cell) so that glucose can enter. If glucose can’t enter the cell, it can provide no energy to the body.
With this fine-tuning, your body keeps the level of glucose pretty steady at about 60 to 100 mg/dl (3.3 to 6.4 mmol/L) all the time.
Your glucose starts to rise in your blood when you don’t have a sufficient amount of insulin or when your insulin is not working effectively (see Chapter 3). When your glucose rises above 180 mg/dl (10.0 mmol/L), glucose begins to spill into the urine and make it sweet. Up to that point, the kidneys, the filters for the blood, are able to extract the glucose before it enters your urine. The loss of glucose into the urine leads to many of the short-term complications of diabetes. (See Chapter 4 for more on short-term complications.)
Understanding the Hemoglobin A1c
Your blood glucose level is the level of sugar in your blood, a key measure of diabetes. Individual blood glucose tests are great for deciding how you’re doing at that moment and what to do to make it better, but they do not give the big picture. They are just a moment in time. Glucose can change a great deal even in 30 minutes. What you need is a test that gives an integrated picture of many days, weeks, or even months of blood glucose levels. The test that accomplishes this important task is called the hemoglobin A1c.
Hemoglobin is a protein that carries oxygen around the body and drops it off wherever it’s needed to help in all the chemical reactions that are constantly taking place. The hemoglobin is packaged within red blood cells that live in the bloodstream for 60 to 90 days. As the blood circulates, glucose in the blood attaches to the hemoglobin and stays attached. It attaches in several different ways to the hemoglobin, and the total of all the hemoglobin attached to glucose is called glycohemoglobin. Glycohemoglobin normally makes up about 6 percent of the hemoglobin in the blood. The largest fraction, two-thirds of the glycohemoglobin, is in the form called hemoglobin A1c, making it easiest to measure. The rest of the hemoglobin is made up of hemoglobin A1a and A1b.
The
