Diabetes and Carb Counting For Dummies. Shafer Sherri

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and it caused allergic reactions, but people lived. In the 1970s genetically “human” insulin was produced in the lab and became widely available. Fast forward to today: There are numerous types of insulin and advanced technologies for administering them. Researchers around the globe continue to make progress in leaps and bounds, and they likely won’t stop until they find a cure.

      Type 2 diabetes is a state of “insulin resistance.” People with type 2 are able to make insulin, but the insulin isn’t fully effective. It’s similar to having a key made for your front door, but when you attempt to use it, you are frustrated to find out that it doesn’t work smoothly. The key is there, the lock is there, but it takes persistence and jiggling and coaxing until finally the door opens. That’s the case with type 2 diabetes. The insulin is there and the insulin receptor is there, but the cell isn’t responding properly. Glucose uptake is delayed due to insulin resistance, so blood-glucose levels rise.

      Insulin resistance precedes the onset of type 2 diabetes. Long before the diagnosis, the pancreas responds to rising blood-glucose levels by working harder to produce extra insulin. The pancreas works overtime because insulin levels have to rise higher than normal in order to manage glucose levels. Eventually the pancreas tires out and the beta-cells can no longer keep up the pace, so blood-glucose levels rise into diabetic ranges. (When glucose levels rise high enough, you may have symptoms, but not always. Symptoms are explained in the next section.)

       Noticing the symptoms of diabetes

      With insufficient amounts of insulin or insulin that doesn’t work properly, glucose can’t effectively get into the cells. Instead, the glucose accumulates in the bloodstream. Blood is filtered through the kidneys. Kidneys dispose of some of the excess glucose by removing it from the blood and dumping it into the urine. The bladder fills more quickly, which leads to frequent urination. Because the calories from glucose are flushed down the toilet, the cells aren’t fed as much and weight loss may occur.

      

There’s an interesting history behind the naming of the disease. The Greeks called it Diabetes Mellitus. Diabetes means “a siphon,” which refers to the excessive urination associated with the disease. Mellitus means “like honey,” which refers to the sweet smell and taste of the urine. Doctors in ancient Greece relied on their sense of taste and smell to make the diagnosis.

      

Symptoms are associated with uncontrolled diabetes. However, some people are asymptomatic, so diabetes can brew undetected for many years. In fact, some people are diagnosed with diabetes after developing a complication associated with uncontrolled, long-duration diabetes. It is important to have standard screening protocols for those at risk. Identifying risk factors and screening criteria are addressed later in this chapter.

      The common symptoms associated with elevated blood glucose include

      ❯❯ Increased urination: This occurs because the kidneys are dumping some of the excess glucose into the urine.

      ❯❯ Thirst: Frequent urination can lead to dehydration, which triggers thirst.

      ❯❯ Hunger: The result is hunger as glucose is lost in the urine instead of being available to feed the cells and tissues. Additionally, when cells aren’t fed, muscles and body fat break down to provide an alternate fuel source. The body can break itself down to feed itself, which can lead to weight loss.

      ❯❯ Additional symptoms: These may include fatigue, blurred vision, tingling or numbness in feet and hands, yeast and fungal infections, and wounds that are slow to heal.

      • When glucose isn’t used properly, the body lacks its main energy supply, which may result in fatigue or weakness.

      • Blurry vision is usually temporary. It’s caused by glucose accumulating in the lens of the eye, which in turn causes fluid retention and swelling of the lens. Once glucose levels are controlled, the lens goes back to its usual shape and vision should improve.

      

Do not buy a new pair of glasses when your blood glucose is out of control. The lens of the eye may be temporarily misshapen due to concentrated glucose levels, and that can alter vision. Your eye specialist should evaluate your baseline vision once your glucose levels have stabilized in the near normal range.

      • Uncontrolled diabetes can lead to nerve damage. Peripheral neuropathy, which refers to the nerves farthest from the brain and spinal cord, can cause tingling, burning, pain, or numbness in the feet or hands.

      • High blood glucose means more sugar is available for yeast and bacteria to thrive on, so infections can fester.

      • Healing may be impaired because the body’s immune system is compromised when glucose is out of control.

      

The symptoms associated with diabetes are not diagnostic and are sometimes related to other medical conditions. Discuss all medical concerns with your healthcare providers. Diabetes screening protocols are based on risk factors including weight and age and are clarified later in the chapter.

       Distinguishing the types of diabetes

      There are several types of diabetes. The suggested treatment depends upon the type. The vast majority of people have type 2 diabetes. Some people with type 2 diabetes can achieve control through diet and exercise modifications, while others need to add one or more oral medications. Everyone with type 1 diabetes and some people with type 2 diabetes require insulin.

       Type 1 diabetes

      Type 1 diabetes is an autoimmune disease. The body’s immune system, which is supposed to fight off bacteria, mistakenly destroys the insulin-producing beta-cells of the pancreas. People with type 1 diabetes no longer make insulin, so they must take insulin to live.

      In the past this form of diabetes was called juvenile diabetes, insulin-dependent diabetes, or IDDM (short for insulin-dependent diabetes mellitus). The preferred term is type 1 diabetes, which may be abbreviated T1DM or T1D. The old terms don’t hold true for all cases. Not all kids with diabetes have type 1; there are many adolescents with type 2 diabetes. Insulin is used to treat other forms of diabetes, not just type 1. While it is true that type 1 diabetes is most often diagnosed when a person is below the age of 20, some adults are diagnosed with type 1 diabetes in their 20s, 30s, 40s, and even later.

      Blood tests can determine whether the diagnosis is type 1 diabetes by detecting autoimmune markers in the blood. Another lab test called C-peptide estimates the amount of insulin being produced. (Find out more about diagnosing diabetes later in this chapter.)

       Type 2 diabetes

      Type 2 diabetes is due to insulin resistance. People with type 2 diabetes make insulin, but the insulin doesn’t work very well. Their own cells are resistant to the action of their insulin. Type 2 diabetes is due to a progressive insulin deficiency imposed on top of the initial insulin resistance.

      Previously it was called adult-onset, non-insulin-dependent diabetes, or NIDDM (non-insulin-dependent diabetes mellitus). The current standard is to call it type 2 diabetes, which can be abbreviated T2DM or T2D. Unfortunately, type 2 diabetes often occurs alongside of high blood pressure and dyslipidemia (abnormal blood fats). A major shift must take place in the lifestyle of Americans to turn this trend around.

       Prediabetes

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