Diabetes: The Basics

1. Diabetes: The Basics Cornell Wellness Program 5.9% of the US population has diabetes. Approximately 15.1 million people. Each day 2,200 people are diagnosed. 798,000 will be diagnosed this year. It is the 7th leading cause of death. Currently, there is no cure for diabetes only methods to treat its symptoms.5.9% of the US population has diabetes. Approximately 15.1 million people. Each day 2,200 people are diagnosed. 798,000 will be diagnosed this year. It is the 7th leading cause of death. Currently, there is no cure for diabetes only methods to treat its symptoms.

2. Diabetes- What Is It? Body is not producing or has lost sensitivity to insulin. Insulin is a hormone that allows sugars (glucose) to enter into each cell in your body. Insulin is produced in the body by the pancreas. Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

3. Quick Review-Anatomy Of The Pancreas A gland that lies behind the stomach Produces three hormones. It�s on the left side! In a healthy body, the pancreas secretes a hormone called insulin.� Insulin acts as a key, unlocking cells and allowing glucose to enter and fuel them. In a body with diabetes, the pancreas either stops making insulin entirely, can't make enough insulin, or can't use the insulin it makes. Lack of insulin leads to a build up of glucose in the bloodstream (or "hyperglycemia," high blood glucose).� Without a functioning pancreas, insulin must be obtained from another source -- insulin injections. If the pancreas is still functioning at some level (as in type 2 diabetes), other medications may be taken instead of or in addition to insulin. In a healthy body, the pancreas secretes a hormone called insulin.� Insulin acts as a key, unlocking cells and allowing glucose to enter and fuel them. In a body with diabetes, the pancreas either stops making insulin entirely, can't make enough insulin, or can't use the insulin it makes. Lack of insulin leads to a build up of glucose in the bloodstream (or "hyperglycemia," high blood glucose).� Without a functioning pancreas, insulin must be obtained from another source -- insulin injections. If the pancreas is still functioning at some level (as in type 2 diabetes), other medications may be taken instead of or in addition to insulin.

4. Insulin And The Other Hormones Insulin- Hormone that lowers blood glucose. Glucagon - Hormone that increases the amount of glucose in the blood when it is needed. Somatostatin - Hormone that can suppress both glucagon and insulin when needed.

5. How Does Insulin Work? A person normally secretes insulin in response to an elevated blood sugar level. Insulin helps sugar move out of the blood and into the cells. Cells will not allow blood sugar in without insulin. - this can cause a problem. Insulin is a vital part of the body�s food use. In a healthy body, the stomach and digestive system break down much of the food we eat into glucose, a type of sugar. This glucose is released into the bloodstream. All the cells of the body use glucose for energy. Insulin acts as a key, unlocking the cells and enabling glucose to enter and provide fuel and energy. In people with diabetes, that key is gone. Without insulin, there is no way for the glucose to travel from the blood into individual cells. Then two things happen: the cells begin to starve, and the level of glucose in the blood rises to unhealthy levels. Insulin is a vital part of the body�s food use. In a healthy body, the stomach and digestive system break down much of the food we eat into glucose, a type of sugar. This glucose is released into the bloodstream. All the cells of the body use glucose for energy. Insulin acts as a key, unlocking the cells and enabling glucose to enter and provide fuel and energy. In people with diabetes, that key is gone. Without insulin, there is no way for the glucose to travel from the blood into individual cells. Then two things happen: the cells begin to starve, and the level of glucose in the blood rises to unhealthy levels.

6. Types Of Diabetes Type I - body does not produce any insulin. Type II- body is not making enough or is losing sensitivity to insulin made. Secondary - a consequence from another disease. For example, pancreatitis or cystic fibrosis. Gestational Diabetes- diabetes during pregnancy. Impaired Glucose Tolerance- an intermediate between normal and diabetes. Type 1 diabetesResults from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes. Type 2 diabetes Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes. Gestational diabetes Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually, type 2. Pre-diabetes Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes. Type 1 diabetesResults from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes. Type 2 diabetes Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes. Gestational diabetes Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually, type 2. Pre-diabetes Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes.

7. Why Isn�t The Body Making Insulin? In people with Type I, the immune system has made a big mistake. It attacks the beta cells and destroys them. In people with Type II, the pancreas is still making insulin, just not enough to keep up, or their bodies have become insulin resistant. Type 1 diabetes (formerly known as "juvenile diabetes") occurs when the pancreas stops making insulin all together. Type 1 diabetes is usually diagnosed in youth, although sometimes people develop type 1 well into their 30's.  Type 2 diabetes occurs when the pancreas makes some insulin, but either it can't make enough or the insulin it does make doesn�t work very well. Type 2 diabetes is traditionally associated with older people but these days, more and more youth are being diagnosed with type 2 diabetes. Type 1 diabetes (formerly known as "juvenile diabetes") occurs when the pancreas stops making insulin all together. Type 1 diabetes is usually diagnosed in youth, although sometimes people develop type 1 well into their 30's. Type 2 diabetes occurs when the pancreas makes some insulin, but either it can't make enough or the insulin it does make doesn�t work very well. Type 2 diabetes is traditionally associated with older people but these days, more and more youth are being diagnosed with type 2 diabetes.

8. Type I Usually diagnosed in children and young adults. Must take daily insulin shots to stay alive. Type I accounts for 5-10% of the population with diabetes. Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar (glucose), starches and other food into energy needed for daily life. Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar (glucose), starches and other food into energy needed for daily life.

9. Type II The most common form of the disease. Approximately 50% of men and 70% of women are obese when diagnosed. Nearing epidemic proportions increased number of older Americans greater occurrence of obesity sedentary lifestyles Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems: Right away, your cells may be starved for energy. Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart. While diabetes occurs in people of all ages and races, some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population. Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems: Right away, your cells may be starved for energy. Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart. While diabetes occurs in people of all ages and races, some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population.

10. What Are The Symptoms? Polyphasia - excessive eating Polyurea - excessive urination Polydypsia - excessive fluid intake Blurred vision Poor wound healing Irritability Diabetes often goes undiagnosed because many of it�s symptoms seem so harmless. Early detection and treatment can lower the incidence of complications.Diabetes often goes undiagnosed because many of it�s symptoms seem so harmless. Early detection and treatment can lower the incidence of complications.

11. How Are You Diagnosed With Diabetes? In June 1997, the ADA redefined it�s criteria for diagnosing diabetes. <110 mg/dl is normal fasting blood glucose. 110 � 126 mg/dl is impaired fasting glucose. >126 mg/dl (fasting blood glucose) is used to diagnose diabetes. Doctors diagnose on the basis of high levels of glucose in the blood. There are 2 types of blood tests used for screening and diagnostic. Screening is done on people with no symptoms of diabetes. You have probably seen these done at health fairs where blood is taken by pricking your finger. For a diagnostic tests, the physician draws blood from a vein. Two of the diagnostic tests are: Fasting Plasma Glucose Test � fasted for at least 8 hours. Oral Glucose Tolerance Test: Must fast overnight, then your fasting blood sugar is tested. You then receive 75 grams of glucose and blood samples are taken four times to measure blood glucose levels. Diabetes is actually diagnosed when two diagnostic test completed at different times/days show that your blood sugar is high.Doctors diagnose on the basis of high levels of glucose in the blood. There are 2 types of blood tests used for screening and diagnostic. Screening is done on people with no symptoms of diabetes. You have probably seen these done at health fairs where blood is taken by pricking your finger. For a diagnostic tests, the physician draws blood from a vein. Two of the diagnostic tests are: Fasting Plasma Glucose Test � fasted for at least 8 hours. Oral Glucose Tolerance Test: Must fast overnight, then your fasting blood sugar is tested. You then receive 75 grams of glucose and blood samples are taken four times to measure blood glucose levels. Diabetes is actually diagnosed when two diagnostic test completed at different times/days show that your blood sugar is high.

12. In Order To Be Diagnosed With Diabetes: Person must have symptoms of diabetes Plasma glucose >200 Fasting blood glucose of >126 mg/dl FBS, FBG, FPG, FG, FS 2-hour plasma glucose >200 mg/dl on oral glucose tolerance test OGTT, GTT OGTT is a single 2-hour post challenge glucose level after drinking or ingesting a 75 gm glucose solution after an overnight fast of 8-12 hours. Impaired Fasting Glucose When a person has a fasting glucose equal to or greater than 110 and less than 126 mg/dl, they are said to have impaired fasting glucose. This is considered a risk factor for future diabetes, and will likely trigger another test in the future, but by itself, does not make the diagnosis of diabetes. Impaired Glucose Tolerance A person is said to have impaired glucose tolerance when the 2-hour glucose results from the oral glucose tolerance test are greater than or equal to 140 but less than 200 mg/dl.� This is also considered a risk factor for future diabetes. There has recently been discussion about lowering the upper value to 180 mg/dl to diagnose more mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications. Diabetes A person has diabetes when oral glucose tolerance tests show that the blood glucose level at 2 hours is equal to or more than 200 mg/dl.� This must be confirmed by a second test (any of the three) on another day. There has recently been discussion about lowering the upper value to 180 mg/dl to diagnose more people with mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications.OGTT is a single 2-hour post challenge glucose level after drinking or ingesting a 75 gm glucose solution after an overnight fast of 8-12 hours. Impaired Fasting Glucose When a person has a fasting glucose equal to or greater than 110 and less than 126 mg/dl, they are said to have impaired fasting glucose. This is considered a risk factor for future diabetes, and will likely trigger another test in the future, but by itself, does not make the diagnosis of diabetes. Impaired Glucose Tolerance A person is said to have impaired glucose tolerance when the 2-hour glucose results from the oral glucose tolerance test are greater than or equal to 140 but less than 200 mg/dl.� This is also considered a risk factor for future diabetes. There has recently been discussion about lowering the upper value to 180 mg/dl to diagnose more mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications. Diabetes A person has diabetes when oral glucose tolerance tests show that the blood glucose level at 2 hours is equal to or more than 200 mg/dl.� This must be confirmed by a second test (any of the three) on another day. There has recently been discussion about lowering the upper value to 180 mg/dl to diagnose more people with mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications.

13. Screening All patients at age 45 and older If the results are normal, repeat every 3 years Screen at a younger age if patient meets following risk factors Obesity Inactive lifestyle First degree relative with diabetes High-risk ethnic group (African Americans, Native Americans, Asian Americans, Hispanics/Latinos and Pacific Islander heritage) Was diagnosed with gestational diabetes or delivered a baby whose birth weight >9 lbs. Hypertension HDL level <40(men) <50(women) or triglycerides >250 Found to have impaired glucose tolerance or impaired fasting on a previous test.

14. I�ve Got Diabetes, Now What? After diagnosis, there is a great need for education. A diabetic diet is no different from the basic healthy eating plan. An activity goal is no different than a basic healthy activity plan. So why bother? The Good News About Diabetes You might be wondering: What�s the �good� news about diabetes, the seventh leading cause of death that has reached epidemic proportions in the United States in the past 10 years? The good news is that we now have definitive proof that type 2 diabetes can be delayed or prevented in persons at risk for the disease. How� through moderate changes in lifestyle. The Diabetes Prevention Program (DPP) was a large, multi-site clinical trial that proved that type 2 diabetes can be prevented or delayed through modest weight loss (5 to 7 percent of initial body weight) and regular physical activity. In fact, these modest changes resulted in a 58 percent reduction in the development of diabetes in persons at increased risk for the disease. Moreover, these impressive results were obtained in all ethnic and age groups and especially in those over age 60. You�re probably saying to yourself � �Every time I try to get my overweight patients to lose weight, I fail.�We recognize how difficult it is to get patients to lose weight. Aggressive (and sometimes unrealistic) goals often lead to failure and frustration for both patient and health care provider. Again, the good news is that significant risk reduction can be achieved through modest weight loss. In the DPP, a man who weighed 290 pounds and lost 7 percent of his body weight would still weigh 270 pounds, but have the potential for significant risk reduction for developing diabetes. The Good News About Diabetes You might be wondering: What�s the �good� news about diabetes, the seventh leading cause of death that has reached epidemic proportions in the United States in the past 10 years? The good news is that we now have definitive proof that type 2 diabetes can be delayed or prevented in persons at risk for the disease. How� through moderate changes in lifestyle. The Diabetes Prevention Program (DPP) was a large, multi-site clinical trial that proved that type 2 diabetes can be prevented or delayed through modest weight loss (5 to 7 percent of initial body weight) and regular physical activity. In fact, these modest changes resulted in a 58 percent reduction in the development of diabetes in persons at increased risk for the disease. Moreover, these impressive results were obtained in all ethnic and age groups and especially in those over age 60. You�re probably saying to yourself � �Every time I try to get my overweight patients to lose weight, I fail.�We recognize how difficult it is to get patients to lose weight. Aggressive (and sometimes unrealistic) goals often lead to failure and frustration for both patient and health care provider. Again, the good news is that significant risk reduction can be achieved through modest weight loss. In the DPP, a man who weighed 290 pounds and lost 7 percent of his body weight would still weigh 270 pounds, but have the potential for significant risk reduction for developing diabetes.

15. Diabetes Complications Kidney Heart Nerve damage Feet/skin Eye/Vision Teeth/Gums Each year 190,000 people die as a result of diabetic complications. Diabetes complications are the seventh leading cause of death. They are all strongly related to high blood sugar. They include: Blindness- this is the leading cause of blindness in people 20 to 74 years of age. Kidney Disease � 10 �21% develop kidney disease, it is the most common cause of end-stage renal disease requiring the need of dialysis to live. Heart Disease and Stroke � diabetes are 2 �4 times more likely to have heart disease. Early testing is good.Each year 190,000 people die as a result of diabetic complications. Diabetes complications are the seventh leading cause of death. They are all strongly related to high blood sugar. They include: Blindness- this is the leading cause of blindness in people 20 to 74 years of age. Kidney Disease � 10 �21% develop kidney disease, it is the most common cause of end-stage renal disease requiring the need of dialysis to live. Heart Disease and Stroke � diabetes are 2 �4 times more likely to have heart disease. Early testing is good.

16. Treatment Goals For Type II Achieve normal or near-normal blood glucose levels. Prevent, delay or treat complications. Improve health through optimal monitoring, nutrition and activity. ConsistencyConsistency

17. Blood Glucose Monitoring All diabetics must keep track of blood glucose levels. This is the only way to know if the treatment is effective. Gives the diabetic a good indication of what affects their blood sugar level. Must check at least 2 times a day and four times a day for at least 3 days a week. This is the only way to give feedback to your doctor. Especially if your goal is to eliminate meds.This is the only way to give feedback to your doctor. Especially if your goal is to eliminate meds.

18. Oral Medications � 4 Types Sulfonylurea-stimulates the body to make more insulin. Metformin-lowers blood sugar by helping the insulin work better Thiazolidinediones- increases muscle sensitivity to insulin. Alpha-glucosidase inhibitors- slow the process of carbohydrate digestion. All diabetes pills sold today in the United States are members of five classes of drugs: sulfonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. These five classes of drugs work in different ways to lower blood glucose levels. Sulfonylureas Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. Sulfonylurea drugs have been in use since the 1950s. Chlorpropamide (brand name Diabinese) is the only first-generation sulfonylurea still in use today. The second generation sulfonylureas are used in smaller doses than the first-generation drugs. There are three second-generation drugs: glipizide (brand names Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl). These drugs are generally taken one to two times a day, before meals. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs. Meglitinides Meglitinides are drugs that also stimulate the beta cells to release insulin. Repaglinide (brand name Prandin) and nateglinide (Starlix) are meglitinides. They are taken before each of three meals. Because sulfonylureas and meglitinides stimulate the release of insulin, it is possible to have hypoglycemia (low blood glucose levels). You should know that alcohol and some diabetes pills may not mix. Occasionally, chlorpropamide, and other sulfonylureas, can interact with alcohol to cause vomiting, flushing, or sickness. Ask your doctor if you are concerned about any of these side effects. Biguanides Metformin (brand name Glucophage) is a biguanide. Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. It is usually taken two times a day. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food. Thiazolidinediones Rosiglitazone (Avandia) and pioglitazone (ACTOS)�are in�a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver.�The first drug in this group, troglitazone (Rezulin), was removed from the market because�it caused serious liver problems in a small number of people. So far rosiglitazone and pioglitazone have not shown the same problems, but users are still monitored closely for liver problems as a precaution. Both drugs appear to increase the risk for�heart failure in some individuals, and there is debate about whether rosiglitazone may contribute to an increased risk for heart attacks. Both drugs are effective at reducing A1C and generally have few side effects. DPP-4 Inhibitors A new class of medications called DPP-4 inhibitors help improve�A1C without causing hypoglycemia. They work by by preventing the breakdown of a naturally occuring compound in the body, GLP-1. GLP-1 reduces blood glucose levels in the body, but is broken down very quickly so it does not work well when injected as a drug itself.� By interfering in the process that breaks down GLP-1, DPP-4 inhibitors allow it to remain active in the body longer, lowering blood glucose levels only when they are elevated. DPP-4 inhibitors�do not tend to cause weight gain and tend�to have a neutral or positive effect on cholesterol�levels. Sitagliptin (Januvia) is currently the only DPP-4 inhibitor on the market. Alpha-glucosidase inhibitors Acarbose (brand name Precose) and meglitol (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea. Oral combination therapy Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects. Switching from one single pill to another is not as effective as adding another type of diabetes medicine. Can diabetes pills help me? Only people with type 2 diabetes can use pills to manage their diabetes. These pills work best when used with meal planning and exercise. This way you have three therapies working together to lower your blood glucose levels. Diabetes pills don't work for everyone. Although most people find that their blood glucose levels go down when they begin taking pills, their blood glucose levels may not go near the normal range. What are the chances that diabetes pills will work for you? Your chances are low if you have had diabetes for more than 10 years or already take more than 20 units of insulin each day. On the other hand, your chances are good if you developed diabetes recently or have needed little or no insulin to keep your blood glucose levels near normal. Diabetes pills sometimes stop working after a few months or years. The cause is often unknown. This doesn't mean your diabetes is worse. When this happens, oral combination therapy can help. Even if diabetes pills do bring your blood glucose levels near the normal range, you may still need to take insulin if you have a severe infection or need surgery. Pills may not be able to control blood glucose levels during these stressful times when blood glucose levels shoot up. Also, if you plan to become pregnant, you will need to control your diabetes with diet and exercise or with insulin. It is not safe for pregnant women to take oral diabetes medications. There is no "best" pill or treatment for type 2 diabetes. You may need to try more than one type of pill, combination of pills, or pills plus insulin.All diabetes pills sold today in the United States are members of five classes of drugs: sulfonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. These five classes of drugs work in different ways to lower blood glucose levels. Sulfonylureas Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. Sulfonylurea drugs have been in use since the 1950s. Chlorpropamide (brand name Diabinese) is the only first-generation sulfonylurea still in use today. The second generation sulfonylureas are used in smaller doses than the first-generation drugs. There are three second-generation drugs: glipizide (brand names Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl). These drugs are generally taken one to two times a day, before meals. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs. Meglitinides Meglitinides are drugs that also stimulate the beta cells to release insulin. Repaglinide (brand name Prandin) and nateglinide (Starlix) are meglitinides. They are taken before each of three meals. Because sulfonylureas and meglitinides stimulate the release of insulin, it is possible to have hypoglycemia (low blood glucose levels). You should know that alcohol and some diabetes pills may not mix. Occasionally, chlorpropamide, and other sulfonylureas, can interact with alcohol to cause vomiting, flushing, or sickness. Ask your doctor if you are concerned about any of these side effects. Biguanides Metformin (brand name Glucophage) is a biguanide. Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. It is usually taken two times a day. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food. Thiazolidinediones Rosiglitazone (Avandia) and pioglitazone (ACTOS)�are in�a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver.�The first drug in this group, troglitazone (Rezulin), was removed from the market because�it caused serious liver problems in a small number of people. So far rosiglitazone and pioglitazone have not shown the same problems, but users are still monitored closely for liver problems as a precaution. Both drugs appear to increase the risk for�heart failure in some individuals, and there is debate about whether rosiglitazone may contribute to an increased risk for heart attacks. Both drugs are effective at reducing A1C and generally have few side effects. DPP-4 Inhibitors A new class of medications called DPP-4 inhibitors help improve�A1C without causing hypoglycemia. They work by by preventing the breakdown of a naturally occuring compound in the body, GLP-1. GLP-1 reduces blood glucose levels in the body, but is broken down very quickly so it does not work well when injected as a drug itself.� By interfering in the process that breaks down GLP-1, DPP-4 inhibitors allow it to remain active in the body longer, lowering blood glucose levels only when they are elevated. DPP-4 inhibitors�do not tend to cause weight gain and tend�to have a neutral or positive effect on cholesterol�levels. Sitagliptin (Januvia) is currently the only DPP-4 inhibitor on the market. Alpha-glucosidase inhibitors Acarbose (brand name Precose) and meglitol (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea. Oral combination therapy Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects. Switching from one single pill to another is not as effective as adding another type of diabetes medicine. Can diabetes pills help me? Only people with type 2 diabetes can use pills to manage their diabetes. These pills work best when used with meal planning and exercise. This way you have three therapies working together to lower your blood glucose levels. Diabetes pills don't work for everyone. Although most people find that their blood glucose levels go down when they begin taking pills, their blood glucose levels may not go near the normal range. What are the chances that diabetes pills will work for you? Your chances are low if you have had diabetes for more than 10 years or already take more than 20 units of insulin each day. On the other hand, your chances are good if you developed diabetes recently or have needed little or no insulin to keep your blood glucose levels near normal. Diabetes pills sometimes stop working after a few months or years. The cause is often unknown. This doesn't mean your diabetes is worse. When this happens, oral combination therapy can help. Even if diabetes pills do bring your blood glucose levels near the normal range, you may still need to take insulin if you have a severe infection or need surgery. Pills may not be able to control blood glucose levels during these stressful times when blood glucose levels shoot up. Also, if you plan to become pregnant, you will need to control your diabetes with diet and exercise or with insulin. It is not safe for pregnant women to take oral diabetes medications. There is no "best" pill or treatment for type 2 diabetes. You may need to try more than one type of pill, combination of pills, or pills plus insulin.

19. Insulin Type I and sometimes Type II patients need to be treated with insulin. There are more than 20 types. They differ in how they are made, how they work in the body and their cost. What about insulin? Although it is a common practice to try pills before insulin, you may start on insulin based on several factors. These factors include: how long you have had diabetes how high your blood glucose level is what other medicines you take your overall health Because diabetes pills seem to help the body use insulin better, some people take them along with insulin shots. The idea behind this "combination" therapy is to try to help insulin work better. Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from food. In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots to use glucose from meals. People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with type 2 diabetes need diabetes pills or insulin shots to help their bodies use glucose for energy. Insulin cannot be taken as a pill. The insulin would be broken down during digestion just like the protein in food. Insulin must be injected into the fat under your skin for it to get into your blood. There are many different insulins for many different situations and lifestyles and there are more than 20 types of insulin sold in the United States. These insulins differ in how they are made, how they work in the body, and price. Insulin is made in labs to be identical to human insulin or it comes from animals (pigs). Future availability of animal insulin is uncertain.What about insulin? Although it is a common practice to try pills before insulin, you may start on insulin based on several factors. These factors include: how long you have had diabetes how high your blood glucose level is what other medicines you take your overall health Because diabetes pills seem to help the body use insulin better, some people take them along with insulin shots. The idea behind this "combination" therapy is to try to help insulin work better. Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from food. In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots to use glucose from meals. People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with type 2 diabetes need diabetes pills or insulin shots to help their bodies use glucose for energy. Insulin cannot be taken as a pill. The insulin would be broken down during digestion just like the protein in food. Insulin must be injected into the fat under your skin for it to get into your blood. There are many different insulins for many different situations and lifestyles and there are more than 20 types of insulin sold in the United States. These insulins differ in how they are made, how they work in the body, and price. Insulin is made in labs to be identical to human insulin or it comes from animals (pigs). Future availability of animal insulin is uncertain.

20. Hypoglycemia Hypoglycemia- low blood sugar Happens to everyone with diabetes Symptoms include shakiness, dizziness, sweating, hunger, headache, pale skin, sudden moodiness, clumsy or jerky movements, difficulty paying attention, and tingling sensations around mouth. Also known as low blood sugar. Part of living with diabetes is learning to cope with some of the problems that go along with having the disease. Hypoglycemia or low blood glucose (sugar) is one of those problems. Hypoglycemia happens from time to time to everyone who has diabetes. Hypoglycemia, sometimes called an insulin reaction, can happen even during those times when you're doing all you can to manage your diabetes. So, although many times you can't prevent it from happening, hypoglycemia (low blood glucose) can be treated before it gets worse. For this reason, it's important to know what hypoglycemia is, what symptoms of hypoglycemia are, and how to treat hypoglycemia. What are the symptoms of hypoglycemia? Shakiness Dizziness Sweating Hunger Headache Pale skin color Sudden moodiness or behavior changes, such as crying for no apparent reason Clumsy or jerky movements Seizure Difficulty paying attention, or confusion Tingling sensations around the mouth How do you know when your blood glucose is low? Part of managing diabetes is checking blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. The results from checking your blood will tell you when your blood glucose is low and that you need to treat it. You should check your blood glucose level according to the schedule you work out with your doctor. More importantly though, you should check your blood whenever you feel low blood glucose coming on. After you check and see that your blood glucose level is low, you should treat hypoglycemia quickly. If you feel a reaction coming on but cannot check, it's best to treat the reaction rather than wait. Remember this simple rule: When in doubt, treat.Also known as low blood sugar. Part of living with diabetes is learning to cope with some of the problems that go along with having the disease. Hypoglycemia or low blood glucose (sugar) is one of those problems. Hypoglycemia happens from time to time to everyone who has diabetes. Hypoglycemia, sometimes called an insulin reaction, can happen even during those times when you're doing all you can to manage your diabetes. So, although many times you can't prevent it from happening, hypoglycemia (low blood glucose) can be treated before it gets worse. For this reason, it's important to know what hypoglycemia is, what symptoms of hypoglycemia are, and how to treat hypoglycemia. What are the symptoms of hypoglycemia? Shakiness Dizziness Sweating Hunger Headache Pale skin color Sudden moodiness or behavior changes, such as crying for no apparent reason Clumsy or jerky movements Seizure Difficulty paying attention, or confusion Tingling sensations around the mouth How do you know when your blood glucose is low? Part of managing diabetes is checking blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. The results from checking your blood will tell you when your blood glucose is low and that you need to treat it. You should check your blood glucose level according to the schedule you work out with your doctor. More importantly though, you should check your blood whenever you feel low blood glucose coming on. After you check and see that your blood glucose level is low, you should treat hypoglycemia quickly. If you feel a reaction coming on but cannot check, it's best to treat the reaction rather than wait. Remember this simple rule: When in doubt, treat.

21. How To Treat Hypoglycemia Quickest way to raise blood glucose is with some form of sugar. 3 glucose tablets, 1/2 cup of fruit juice, 5-6 pieces of candy. Wait 15-20 minutes and test blood sugar again. If hypoglycemia goes untreated, patient could get worse and pass out. How do you treat hypoglycemia? The quickest way to raise your blood glucose and treat hypoglycemia is with some form of sugar, such as 3 glucose tablets (you can buy these at the drug store), 1/2 cup of fruit juice, or 5-6 pieces of hard candy. Ask your health care professional or dietitian to list foods that you can use to treat low blood glucose.�And then, be sure you always have at least one type of sugar with you. Once you've checked your blood glucose and treated your hypoglycemia, wait 15 or 20 minutes and check your blood again.� If your blood glucose is still low and your symptoms of hypoglycemia don't go away, repeat the treatment.� After you feel better, be sure to eat your regular meals and snacks as planned to keep your blood glucose level up. It's important to treat hypoglycemia quickly because hypoglycemia can get worse and you could pass out.� If you pass out, you will need IMMEDIATE treatment, such as an injection of glucagon or emergency treatment in a hospital. Glucagon raises blood glucose. It is injected like insulin. Ask your doctor to prescribe it for you and tell you how to use it.� You need to tell people around you (such as family members and co-workers) how and when to inject glucagon should you ever need it. If glucagon is not available, you should be taken to the nearest emergency room for treatment for low blood glucose.� If you need immediate medical assistance or an ambulance, someone should call the emergency number in your area (such as 911) for help.� It's a good idea to post emergency numbers by the telephone. If you pass out from hypoglycemia, people should: NOT inject insulin. NOT give you food or fluids. NOT put their hands in your mouth. Inject glucagon. Call for emergency help. How do you prevent low blood glucose? Good diabetes control is the best way we know to prevent hypoglycemia.� The trick is to learn to recognize the symptoms of hypoglycemia.� This way, you can treat hypoglycemia before it gets worse. How do you treat hypoglycemia? The quickest way to raise your blood glucose and treat hypoglycemia is with some form of sugar, such as 3 glucose tablets (you can buy these at the drug store), 1/2 cup of fruit juice, or 5-6 pieces of hard candy. Ask your health care professional or dietitian to list foods that you can use to treat low blood glucose.�And then, be sure you always have at least one type of sugar with you. Once you've checked your blood glucose and treated your hypoglycemia, wait 15 or 20 minutes and check your blood again.� If your blood glucose is still low and your symptoms of hypoglycemia don't go away, repeat the treatment.� After you feel better, be sure to eat your regular meals and snacks as planned to keep your blood glucose level up. It's important to treat hypoglycemia quickly because hypoglycemia can get worse and you could pass out.� If you pass out, you will need IMMEDIATE treatment, such as an injection of glucagon or emergency treatment in a hospital. Glucagon raises blood glucose. It is injected like insulin. Ask your doctor to prescribe it for you and tell you how to use it.� You need to tell people around you (such as family members and co-workers) how and when to inject glucagon should you ever need it. If glucagon is not available, you should be taken to the nearest emergency room for treatment for low blood glucose.� If you need immediate medical assistance or an ambulance, someone should call the emergency number in your area (such as 911) for help.� It's a good idea to post emergency numbers by the telephone. If you pass out from hypoglycemia, people should: NOT inject insulin. NOT give you food or fluids. NOT put their hands in your mouth. Inject glucagon. Call for emergency help. How do you prevent low blood glucose? Good diabetes control is the best way we know to prevent hypoglycemia.� The trick is to learn to recognize the symptoms of hypoglycemia.� This way, you can treat hypoglycemia before it gets worse.

22. Hyperglycemia High blood sugar Not enough insulin Too much food Too little exercise Hyperglycemia happens from time to time to all people who have diabetes. It is the technical term for high blood sugar. Other stresses can also cause it. What are the symptoms of hyperglycemia? The signs and symptoms include: high blood glucose, high levels of sugar in the urine, frequent urination, and increased thirst. Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. Checking your blood and then treating high blood glucose early will help you avoid the other symptoms of hyperglycemia. It's important to treat hyperglycemia as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel. So, your body breaks down fats to use for energy. When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood. This can lead to ketoacidosis. Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include: shortness of breath breath that smells fruity nausea and vomiting a very dry mouth  Hyperglycemia happens from time to time to all people who have diabetes. It is the technical term for high blood sugar. Other stresses can also cause it. What are the symptoms of hyperglycemia? The signs and symptoms include: high blood glucose, high levels of sugar in the urine, frequent urination, and increased thirst. Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. Checking your blood and then treating high blood glucose early will help you avoid the other symptoms of hyperglycemia. It's important to treat hyperglycemia as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel. So, your body breaks down fats to use for energy. When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood. This can lead to ketoacidosis. Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include: shortness of breath breath that smells fruity nausea and vomiting a very dry mouth

23. Hemoglobin A1c A good indicator of blood glucose control. Gives a % that indicates control over the preceding 2-3 months. Performed 2 times a year. A hemoglobin of 6% indicates good control and level >8% indicates action is needed. Hemoglobin A1C is the blood test with a memory. Hemoglobin is the protein in red blood cells that carries oxygen. These blood cells stay in circulation for 2-3 months. It is not used to diagnose just to monitor blood sugar control. It is performed two times a year. A hemoglobin of 6% indicates good control and level>8% indicates action is needed. A1C��a test that measures a person's average blood glucose level over the past 2 to 3 months. Hemoglobin (HEE-mo-glo-bin) is the part of a red blood cell that carries oxygen to the cells and sometimes joins with the glucose in the bloodstream. Also called hemoglobin A1C or glycosylated (gly-KOH-sih-lay-ted) hemoglobin, the test shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood. Hemoglobin A1C is the blood test with a memory. Hemoglobin is the protein in red blood cells that carries oxygen. These blood cells stay in circulation for 2-3 months. It is not used to diagnose just to monitor blood sugar control. It is performed two times a year. A hemoglobin of 6% indicates good control and level>8% indicates action is needed. A1C��a test that measures a person's average blood glucose level over the past 2 to 3 months. Hemoglobin (HEE-mo-glo-bin) is the part of a red blood cell that carries oxygen to the cells and sometimes joins with the glucose in the bloodstream. Also called hemoglobin A1C or glycosylated (gly-KOH-sih-lay-ted) hemoglobin, the test shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood.

24. Treatment Goals The main goal is to normalize blood sugar. Realistic goals for diabetics are 70-140 mg/dl before meals, <180 mg/dl after and a glycosolated hemoglobin (HgA1C) within 1% of normal. Need good blood glucose control to avoid complications.

25. Physical Activity And Diabetes Especially beneficial in type II diabetes. Possible improvement in blood glucose control. Improved insulin sensitivity/lower medication requirement. Reduction in body fat. Cardiovascular benefits. Stress reduction. Prevention of Type II diabetes (IGT). Diabetics also must be pay close attention to their feet, this may be an issue with exercise. 1 in 5 people with diabetes enter the hospital due to foot problems. Usually due to poor wound healing which is caused by poor circulation. Diabetics also must be pay close attention to their feet, this may be an issue with exercise. 1 in 5 people with diabetes enter the hospital due to foot problems. Usually due to poor wound healing which is caused by poor circulation.

26. Things To Consider Medication timing. Food intake timing. Recent illness or infection. Postpone exercise if glucose reading is below 100 mg/dl or above 250 mg/dl Consume 15g of carbs. per 60 min. of exercise. Keep a snack handy. Practice proper foot care. Carry medical identification.

27. How To Avoid Complications Control weight Eat a healthy well-balanced diet. Get regular exercise Have regular checkups Check feet everyday for cuts and blisters Do not smoke! Keep blood sugars normal Avoid the 2 common diabetic problems, hypoglycemia and hyperglycemia

28. Conclusion For more information:www.diabetes.org Diabetes is a very complicated disease. It is the cause of great discomfort and death in this country alone. The best defense is to make everyone aware of the risk factors and symptoms to prevent and detect.Diabetes is a very complicated disease. It is the cause of great discomfort and death in this country alone. The best defense is to make everyone aware of the risk factors and symptoms to prevent and detect.

29. Questions? Contact the Wellness Program 255-3886 wellness@cornell.edu 303 Helen Newman Hall

30. Sources American Diabetes Association Diabetes.org