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ОглавлениеWriter, Kate Ruder; Director, Book Publishing, Robert Anthony; Managing Editor, Abe Ogden; Acquisitions Editor, Victor Van Beuren; Production Manager, Melissa Sprott; Editor, Greg Guthrie; Composition, Naylor Design, Inc.; Cover Design, Jody Billert; Illustrations, Pam Little, CMI.
©2011 by the American Diabetes Association, Inc.® All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including duplication, recording, or any information storage and retrieval system, without the prior written permission of the American Diabetes Association.
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The suggestions and information contained in this publication are generally consistent with the Clinical Practice Recommendations and other policies of the American Diabetes Association, but they do not represent the policy or position of the Association or any of its boards or committees. Reasonable steps have been taken to ensure the accuracy of the information presented. However, the American Diabetes Association cannot ensure the safety or efficacy of any product or service described in this publication. Individuals are advised to consult a physician or other appropriate health care professional before undertaking any diet or exercise program or taking any medication referred to in this publication. Professionals must use and apply their own professional judgment, experience, and training and should not rely solely on the information contained in this publication before prescribing any diet, exercise, or medication. The American Diabetes Association—its officers, directors, employees, volunteers, and members—assumes no responsibility or liability for personal or other injury, loss, or damage that may result from the suggestions or information in this publication.
The paper in this publication meets the requirements of the ANSI Standard Z39.48-1992 (permanence of paper).
ADA titles may be purchased for business or promotional use or for special sales. To purchase more than 50 copies of this book at a discount, or for custom editions of this book with your logo, contact the American Diabetes Association at the address below, at booksales@diabetes.org, or by calling 703-299-2046.
American Diabetes Association
1701 North Beauregard Street
Alexandria, Virginia 22311
DOI: 10.2337/9781580403306
Library of Congress Cataloging-in-Publication Data
American Diabetes Association complete guide to diabetes / American Diabetes Association. —5th ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-58040-330-6 (alk. paper)
1. Diabetes—Popular works. I. American Diabetes Association. II. Title: Complete guide to diabetes.
RC660.4.A485 2011
616.4’62—dc22
2010041272
eISBN: 9781580403689
Contents
Chapter 5: Gestational Diabetes
Chapter 6: Basics of Blood Glucose Monitoring
Chapter 7: Self-Monitoring Tools
Chapter 8: Blood Glucose Emergencies
Part IV: Managing Your Diabetes
Chapter 9: Setting Blood Glucose Goals
Chapter 11: Physical Activity and Exercise
Chapter 12: Medications for Type 2 Diabetes
Part V: Complications of Diabetes
Chapter 14: Diabetes Complications and Prevention
Part VI: Diabetes and Health Care
Chapter 17: Your Health Care Team
Chapter 18: Health Care System
Chapter 19: Coping with Diabetes
Chapter 20: Family Life and Children with Diabetes
Chapter 21: Work, School, and Travel
Foreword
It is with both pride and a great sense of service to the diabetes community that all of us at the American Diabetes Association provide this all-new, fully revised 5th edition of the Complete Guide to Diabetes. As recently reported, the diabetes epidemic now reaches both across the country and around the globe. Even more individuals are affected by diabetes and many more can be identified as “at risk” for diabetes—particularly for type 2 diabetes.
The tools available for diabetes care continue to improve, and knowing exactly what tools are available to treat your diabetes is more important than ever. In this 5th edition, we have updated the entire contents and provided even more insight into the use of the many tools available to those affected by diabetes.
This edition emphasizes the important role the diabetes patient plays in his or her own care. In this era of patient-centered care, we trust that this will help you become an ever more important resource for improving your diabetes control. The Guide offers insights and advice, reviews all of the new and old tools for management, and gives a personal perspective on how to live well with diabetes. This edition includes updated discussions of:
• The many important components of managing diabetes—including treatment goals, eating healthy, remaining active, and understanding the medications used for treating both type 1 and type 2 diabetes
• Information on new and improved technology for monitoring and controlling diabetes
• Helpful ways to stay on track—and track blood sugar/glucose control, maintaining a healthy weight, and keeping blood pressure and cholesterol under control
• The role of the health care team—and living a happy, healthy life with diabetes
We are grateful for all of the effort the contributors have put into this Guide and extend our sincere thanks to the many patients and health professionals who treat, research, and teach about diabetes for their help in making this book possible. The American Diabetes Association is leading the fight to Stop Diabetes and its complications—and we know that you have in your hands an incredibly valuable toolbox that provides you with the information you need to work with your health care team to achieve the best care possible.
David Kendall
Chief Scientific and Medical Officer American Diabetes Association January 2011
Introduction
It’s a time of empowerment for people living with diabetes. Patients have never had so many tools and choices at their disposal. Every year, we see new technology for monitoring and treating diabetes. We also see more choices for people to manage diabetes on their own terms—whether it’s an application on a mobile phone that tracks readings or a better insulin pump for swimming laps in the pool.
At the same time, scientists and health care providers are finding that tried-and-true methods in diabetes care—such as keeping your blood glucose on target and maintaining a healthy weight—will help you live a long life.
This is all great news for people with diabetes. After all, you are the person most responsible for keeping yourself healthy day to day and into your nineties.
What’s New
This newest edition of the American Diabetes Association Complete Guide to Diabetes explains the latest advancements in managing and treating diabetes. More importantly, perhaps, the book provides the kind of trusted, in-depth, and essential information that you’d expect from the American Diabetes Association.
Here’s what’s new: You’ll find a new chapter on women’s health that describes what to keep on your radar if you’re a woman with diabetes. And you’ll find a similar chapter for men with diabetes. A more comprehensive discussion of mental health and how it affects people with diabetes is also included.
There are updates on health insurance: how to make it work for you and your diabetes and the impact of health care reform. A few changes to workplace laws and airport security are also tucked inside.
The book provides updates on the latest blood glucose technology, including features to consider when buying a new meter. New to the book also is a section on continuous blood glucose monitors—how they work and who is using them.
How to Read This Book
Of course, how you read this book depends on your goals and time. If you’ve just been diagnosed with diabetes, you may want to start with chapter 1 to get the most comprehensive picture. However, if you’ve been living with diabetes for a while, you may want to skip to a topic that interests you, such as medications for type 2 diabetes or carbohydrate counting.
Keep in mind that this book is meant to be a resource for educating yourself as a patient. You should always discuss any changes to your routine or medications with your health care provider. Together, you can come up with the best plan for handling your day-to-day care and emergency situations.
At the beginning of each chapter, you’ll find a list of the topics that are covered. Use these lists to quickly determine the content of specific chapters and to prepare yourself for what will be covered.
Definitions are linked from the text to give you concise descriptions of technical terms so that you won’t have to look them up in the dictionary. There are more facts and tips on living with diabetes than ever before.
Improved Organization
We’ve revised and improved the organization of the ADA Complete Guide to Diabetes. You’ll find shorter chapters that discuss specific topics in diabetes care rather than longer chapters on broad issues. You’ll also see the chapters organized into eight distinct parts.
Of course—just like in the last edition—you’ll find basic information about diabetes and blood glucose up front. And you’ll find the more specific issues of work, school, and travel in the back.
Dive In
Now that you know what’s new and how things are laid out, it’s time to dive in. Turn to the first chapter, “Diabetes Facts,” to find out what diabetes is, who has it, and how it’s affecting people worldwide.
Part I
Diabetes 101
CHAPTER 1
Diabetes Facts
When you were first diagnosed with diabetes, your doctor probably sent you home with a lot of information. That’s a great place to start. Even if you’ve been living with diabetes for years, you may still have very basic questions about what diabetes is. Or who else has diabetes.
This chapter will work to answer some of your initial questions, helping you brush up on the facts about diabetes. In the following chapters we’ll discuss more about how diabetes works and, most importantly, how it affects you.
What Is Diabetes?
In a nutshell, diabetes is a disorder in which the body does not make or correctly use insulin. But what is insulin? Insulin is a hormone. Your body needs insulin to help turn the food you eat into the energy and energy reserves that your body needs to function properly. When your insulin is out of balance, your whole body is out of balance.
Sounds simple enough, right? Well, not everyone with diabetes has the same type of problem using insulin. Some people don’t make any insulin at all; other people make too little insulin or don’t use that insulin efficiently.
This is why diabetes is broken down into different types, with the most common forms being type 1 and type 2 diabetes. Some women also get diabetes when they become pregnant; this is called gestational diabetes. Most cases of diabetes fall within these three types, which will be explained in more detail in chapters 3, 4, and 5.
There are some other types of diabetes, which can be caused by genetic defects, diseases such as cystic fibrosis, organ transplantation, or AIDS treatment. Still other people don’t fit neatly into the categories of type 1 or type 2 diabetes. In fact, there are more than ten different forms of diabetes!
Who Has Diabetes?
Although you may feel like you’re the only one dealing with diabetes—you’re definitely not alone. Millions of Americans and hundreds of millions of people worldwide have diabetes. In the United States, eight out of every 100 people aged 20 years or older have diabetes. That works out to nearly 26 million adults and children with diabetes, according to recent statistics from the Centers for Disease Control and Prevention.
So, it’s very likely that you know someone else with diabetes. It could be someone at your school or in your yoga class or in your apartment building. Diabetes affects children and adults, people who are fit or out-of-shape, and people of all races and ethnicities.
However, not everyone with diabetes is wearing a big neon sign screaming: “I have diabetes too!” Each person with diabetes has different symptoms and treatments. The people you know with diabetes are probably managing it in personal and discreet ways.
Famous People with Diabetes
However, some people are quite outspoken about their diabetes—celebrities. There are hundreds of famous people with diabetes, many juggling the demands of entertainment, sports, or politics while keeping on top of a serious disorder.
Famous People with Diabetes
• Halle Berry, actress
• Nicole Johnson, Miss America 1999
• Jay Cutler, NFL quarterback
• Aretha Franklin, singer
• Larry King, talk show host
• Mike Huckabee, former governor of Arkansas
• Nick Jonas, singer
• Gary Hall, Jr., Olympic gold medalist swimmer
• Chris Matthews, news anchor
• Billie Jean King, tennis player
• Anne Rice, author
• Neil Young, singer
• Elizabeth Taylor, actress
• B.B. King, musician
• Bret Michaels, singer
It may sound corny, but this list makes you realize how much you can accomplish with diabetes. It’s nice to know that diabetes won’t keep you from winning a gold medal in the Olympics like Gary Hall or headlining an ’80s glam rock band like Bret Michaels.
Undiagnosed Diabetes
Nearly 26 million people have diabetes in the United States. Yet, there are only 18.8 million diagnosed cases of diabetes. That means that nearly one-quarter of the people with diabetes do not even know they have diabetes. How could all these people go undiagnosed? Unlike many diseases, diabetes doesn’t always have obvious symptoms in the beginning.
Over 7 million people have diabetes but don’t know it. They are walking around with signs and perhaps mild symptoms of diabetes, but they have not been to a health care provider for the proper tests and diagnosis because few realize that anything is wrong.
Most undiagnosed people have type 2 diabetes. In contrast, few cases of type 1 diabetes go undetected for long. As you’ll see in later chapters, the symptoms of type 1 diabetes are so severe that the person goes to a doctor for help.
Rise in Diabetes
You may have heard that more and more people are getting diabetes. Unfortunately, this is absolutely true. The number of people with diabetes in the United States increased by 3 million over two years, according to recent statistics from the Centers for Disease Control and Prevention.
However, children are increasingly getting type 1 and type 2 diabetes. Certain ethnic groups are also seeing an increase in diabetes. Native Americans have the highest rate of diabetes at 16.1%, followed by African Americans at 12.6% and Hispanics at 11.8%. In contrast, 8.4% of Asian Americans and 7.1% of whites have diabetes in the United States.
Diabetes More Common in Elderly People
Older people are still affected most by diabetes. For example, 26.9% of people aged 65 years and older have diabetes, as opposed to 11.3% of people aged 20 years and older.
A Global Epidemic
The rise in diabetes is happening beyond our borders. In 2010, the International Diabetes Federation estimated that 285 million people worldwide have diabetes and more than 430 million people will have diabetes by 2030. Diabetes deaths are likely to double between 2005 and 2030, according to the World Health Organization (WHO). As you may expect, the United States has some of the highest rates of diabetes. But it’s still not at the top of the list.
Five Countries with the Highest Rates of Diabetes in 2000
• India
• China
• United States
• Indonesia
• Japan
The WHO and other groups, such as the International Diabetes Federation, are working to raise awareness and help prevent and control diabetes worldwide. For example, the International Diabetes Federation’s Life for a Child Program helps supply children with diabetes with insulin and other equipment throughout the world. The Federation also supplies grants to fund research on diabetes prevention and treatment.
World Diabetes Day
The United Nations passed a Diabetes Resolution in 2006 declaring November 14th as World Diabetes Day and encouraging member states to develop policies to prevent and treat diabetes.
Early History of Diabetes
As much as diabetes is widespread, it is also age old. Diabetes is one of the oldest known diseases in the world. In fact, people wrote down early descriptions of the disorder before they really understood what it was. References to diabetes can be found in some of the oldest surviving medical writings in the world.
Early References to Diabetes
• An early Egyptian medical text written around 1550 BCE describes a condition of “passing too much urine.”
• The Greek physician Aretaeus, who lived in the second century CE, gave diabetes its name from a Greek word meaning “siphon” or “pass through.” Aretaeus observed that his patients’ bodies appeared to “melt down” into urine.
• People observed early on that the urine from people with diabetes was very sweet. In fact, one way to diagnose diabetes was to pour urine near an anthill. If the ants were attracted to the urine, it meant that the urine contained sugar.
• By the 18th century, physicians added the Latin term mellitus (honey-sweet) to diabetes, which describes its sugary taste.
Up Next
In the next few chapters, you’ll find out a lot more about the science of diabetes. We’ve come a long way from pouring urine on anthills! One of the most important scientific discoveries in diabetes was glucose. Chapter 2 gets down to the basics of glucose and its role in diabetes.
CHAPTER 2
Glucose Facts
It sounds like a technical term, but glucose is just a fancy name for sugar. Your health care provider tested the glucose in your blood when he or she diagnosed you with diabetes. Perhaps it was the first time you heard the term. In any case, you’ll probably hear it a lot more.
Glucose is probably the most important term you’ll need to understand for managing your diabetes. In this chapter, we’ll discuss what it is and how it affects your diabetes. We’ll also cover the tests that measure glucose in your blood.
What Is Glucose?
Glucose is a simple sugar in your blood and your body’s main source of energy. It is called blood glucose or sometimes blood sugar. It comes primarily from carbohydrates in many of the foods that you eat, including sugary treats like cupcakes, starchy things like vegetables, and grains like breakfast cereal.
How Glucose Works
The purpose of glucose is to provide energy. The key to providing energy is eating food. Yes, food!
When people eat certain foods, their bodies break them down into simple sugars called glucose. Glucose goes into their bloodstream, where it travels to all of the cells in their body. Cells use this glucose for energy to do all the big and small jobs that keep the body humming. To operate at peak performance, your body needs to keep blood glucose levels within a normal range. If you have too little glucose, you run out of energy; too much, and the extra glucose will be stored and cause weight gain. In people with diabetes, excess glucose stays in the blood and may also damage different parts of the body, such as blood vessels and nerves.
The optimal, “normal” range of blood glucose is measured using a plasma glucose test. A normal fasting glucose level is 70–99 milligrams per 1 deciliter of blood, which is abbreviated as 70–99 mg/dl. Fasting means that you haven’t eaten for at least eight hours before the test.
But how does the human body regulate glucose levels? This feat requires a delicate balance of hormones and stored glucose.
Pancreas
The pancreas is an organ that does not get much attention—unless it stops doing its job. It is an important player in your digestive system, and it sits right behind your stomach.
The pancreas secretes many hormones, including two very important hormones for regulating glucose: insulin and glucagon. These hormones are made by cells in the pancreas known as the islets of Langerhans. Within the islets of Langerhans, alpha cells produce glucagon and beta cells produce insulin.
Islets of Langerhans
The islets of Langerhans are named for the German physician Paul Langerhans, who first described them in 1869 while still a medical student. He presented a thesis that described these cells as looking different than other cells in the pancreas. However, Langerhans could not determine what these cells did.
Insulin and Glucagon
Insulin and glucagon are two important hormones that help keep your blood glucose on target. Insulin helps move glucose (energy) to your cells and glucagon helps raise blood glucose.
Insulin is the “special key” to make sure glucose effectively gets to cells. Insulin also prevents the liver from making too much glucose when you are not eating. The pancreas needs to produce the right amount of insulin to move glucose from the bloodstream to cells. It releases insulin in response to rising blood glucose levels during snacks and meals. It also releases a small, steady stream of insulin throughout the day. This keeps your liver from making too much glucose between meals or overnight.
Conversely, the pancreas produces glucagon to raise blood glucose levels between meals or during exercise when your body uses a lot of energy. Glucagon raises blood glucose by stimulating the liver to release stored glucose.
We’ve only just recently begun to understand the delicate and complicated process of insulin and glucagon secretion. Together, these processes work to maintain a steady level of glucose in the blood all the time. This process is central to understanding how diabetes develops and how to treat it.
People have known about diabetes since antiquity. Unfortunately, for thousands of years, they didn’t know how it worked or how to treat it. Beginning in the Enlightenment (17th and 18th centuries), this began to change.
Early Glucose Discoveries
• In 1776, scientists discovered that glucose was in the blood of both people with and people without diabetes. That led them to suspect that people with diabetes pass glucose from blood into urine. But they didn’t know how.
• Over one hundred years later, in 1889, two German physiologists, Oskar Minkowski and Joseph von Mering, accidently discovered that the pancreas is involved in diabetes. As part of their experiments on how the body uses fat, they removed the pancreas of a laboratory dog. Much to their astonishment, the dog urinated again and again. Luckily, the scientists tested the dog’s urine for glucose. Sure enough, the dog had developed diabetes when its pancreas was removed. This led the scientists to suspect that some substance in the pancreas somehow prevented diabetes.
• It would take another 30 years for scientists to find this magic pancreatic substance—insulin. This discovery, one of the greatest of modern medical history, is discussed in chapter 13.
Too Much Glucose
People with diabetes don’t produce enough or don’t produce any insulin. Or they don’t use insulin effectively. This results in a buildup of too much glucose in their blood.
In all types of diabetes, glucose does not get into the cells that need it and instead builds up in the bloodstream. In addition, cells don’t have the energy they need to do their work.
The buildup of glucose in blood can have various effects, depending on its severity. For one thing, the body may try to flush out excess glucose by filtering it through the kidneys and expelling it from the body in urine. Therefore, people with high levels of glucose in their blood may urinate a lot or feel thirsty because of dehydration.
In other cases, the body may try to “grab” energy from muscle and stored fat cells because it can’t get energy from glucose in the blood. This can cause muscle deterioration and weight loss.
Symptoms of High Blood Glucose
People with very high blood glucose levels share many similar symptoms. You may have had some of these symptoms before you were diagnosed with diabetes.
Some Early Symptoms of Diabetes
• Extreme thirst
• A frequent need to urinate
• Blurred vision
• A feeling of being tired most of the time for no apparent reason
However, some people do not have any symptoms of high blood glucose. Because the signs of diabetes can be so mild, many people walk around for years with dangerously high glucose levels, which can lead to long-term damage. In fact, many people don’t realize they have diabetes until they begin to suffer from complications of the disease.
Of course, only a health care provider can make an accurate diagnosis of diabetes. A trip to the doctor is the next logical step if you or someone you love has symptoms of diabetes or you run a risk of developing diabetes.
Glucose Tests
Although you or your health care provider may suspect that you have diabetes because of your symptoms, the only sure way to tell is with glucose tests.
Diabetes causes your blood glucose levels to be above normal some or all of the time. Your blood glucose levels may be high even though you haven’t eaten recently. So, checking the amount of glucose in your blood can determine whether you have diabetes or not. There are four types of tests used to diagnose diabetes: A1C test, fasting plasma glucose test, random plasma glucose test, and two-hour oral glucose tolerance test.
Plasma glucose tests measure the amount of glucose in the plasma of your blood to determine whether the level is higher than normal. Plasma glucose is different from whole-blood glucose, which contains blood cells. In the laboratory, your blood sample is spun in a machine to remove blood cells, platelets, and cell debris. Only the plasma is left. Scientists measure the amount of glucose in the plasma, and these numbers can be 15% higher than whole-blood readings.
A1C Test
• The A1C test can be used to diagnose diabetes.
• Blood is collected from a fingerstick or vein.
• A1C values represent average blood glucose levels over the past 2–3 months.
• The test measures the concentration of hemoglobin molecules that have glucose attached to them. The measure is given as a percentage. An 8% level means that 8% of your molecules are glycated (sugar coated).
• An A1C of 6.5% or higher is used to diagnose diabetes.
Fasting Plasma Glucose Test
• In diabetes, extra glucose remains in the blood, even after fasting.
• For this test, you will be asked not to eat or drink anything but water for at least 8–10 hours. Then, a sample of your blood is taken and the amount of glucose in the blood is measured.
• For those without diabetes, the amount of glucose after fasting is usually less than 100 mg/dl.
• However, when the amount of fasting plasma glucose is 126 mg/dl or higher, diabetes is suspected. A firm diagnosis of diabetes is made when two fasting plasma glucose tests, done on different days, are at least 126 mg/dl.
Random Plasma Glucose Test
• The simplest way to detect diabetes.
• This test measures the amount of plasma glucose at any given time and is done without fasting.
• You may be diagnosed with diabetes if your plasma glucose is 200 mg/dl or higher and you have obvious symptoms, such as frequent urination, intense thirst, blurred vision, unexplained weight loss, and extreme tiredness.
Oral Glucose Tolerance Test
• This test can also be used to diagnose diabetes.
• For this test, you will be asked not to eat or drink anything overnight. Then, in the morning, a sample of your blood is taken before and two hours after you have a drink that contains glucose.
• If your fasting plasma glucose is 126 mg/dl or higher and/or your post-drink plasma glucose is 200 mg/dl or higher, then you will be diagnosed with diabetes regardless of your symptoms.
Categories of Increased Risk for Diabetes
Sometimes increased risk for diabetes is apparent before diabetes develops. If your fasting plasma glucose test is greater than 100 mg/dl but less than 126 mg/dl, you may have impaired fasting glucose. Some people also have impaired glucose tolerance, a condition in which blood plasma glucose levels are higher than normal (140 mg/dl to 199 mg/dl) 2 hours after the start of an oral glucose tolerance test. If your A1C is 5.7–6.4%, you may be at similar risk.
If you have impaired fasting glucose and/or impaired glucose tolerance, you may be diagnosed with prediabetes. This is not the same as having diabetes, but it sometimes occurs before diabetes develops.
If you have been diagnosed with prediabetes, you will want to have your blood glucose tested routinely and watch for symptoms of diabetes. Also, you need to talk with your health care provider about reducing your risk of heart disease. Keeping your weight in the healthy range and exercising regularly will lower your chances of developing diabetes.
Prediabetes
Some people with prediabetes never get diabetes, especially if they make lifestyle changes that help improve their health, such as exercising more, making healthier food choices, and losing some unwanted weight. However, some of the same problems that result from having diabetes also occur in people with prediabetes.
Which Type of Diabetes?
If tests reveal that you have diabetes (and you’re not pregnant), the next question is whether you have type 1, type 2, or another type of diabetes. Although the symptoms and blood test results can be similar for both type 1 and type 2 diabetes, the causes are very different.
