What is diabetes?
Diabetes is a chronic incurable disease in which persistent high blood sugar levels (hyperglycemia) are due to the body’s inability to produce enough insulin, or effectively use insulin already present in the body. Insulin is a hormone produced by the pancreas and is necessary to break down sugar and other foods into glucose. A lack of insulin makes it impossible for glucose to enter cells where it is used for energy. Therefore, the glucose remains in the bloodstream. When blood sugar levels become too high, the blood sugar “spills” over into the urine. This spilling forces the kidneys to work overtime in an effort to flush out the sugar.
Nearly sixteen million people in the United States have diabetes. Five hundred thousand to one million are insulin dependent. The peak incidence of new onset diabetes in adolescents occurs during puberty (approximately ages 10 to 12 for girls and 12 to 14 in boys). There are two main types of diabetes:
- Type 1 Diabetes or Insulin Dependent Diabetes – the pancreas does not produce enough insulin; blood sugar must be closely monitored and insulin injections are needed daily; usually occurs during childhood or early adult years.
- Type 2 Diabetes or Non-insulin Dependent Diabetes – the pancreas produces enough insulin but it is not effectively used; usually occurs after 40 years of age.
The demands of a complex diabetes treatment plan are complicated by the many physical, psychological and social changes which take place during adolescence. It is of utmost importance that you establish a good relationship with the health care team that will assist you with your treatment plan and understand all aspects of the plan including the signs and symptoms of both hypo and hyperglycemia, diet and exercise, glucose monitoring, and insulin administration. Your primary care physician will refer you to other members of the health care team in order to meet all of your learning needs( i.e. a dietitian for your special diet and a nurse to learn about blood glucose monitoring and insulin injections).
Diagnosis and symptoms of diabetes
If you visited your doctor with the following symptoms the diagnosis of diabetes would be considered and could be confirmed with a simple blood test.
- Constant hunger
- Excessive thirst
- Frequent urination
- Weight loss (without dieting)
- Difficulty seeing
Diabetic treatment plan
Keeping your blood sugar levels under control is the number one goal of your diabetic treatment plan. Your treatment plan will include:
- Blood sugar monitoring
- Insulin injections or oral medication
Blood sugar monitoring
Accurate blood sugar monitoring is critical in order to maintain your glucose levels within a normal and consistent range. A glucose monitor is used to determine your blood sugar levels throughout the day. There are various types of glucose monitors available. Your physician will recommend the monitor that is best for you.
Your doctor will refer you to a specially trained nurse to assist you with becoming familiar with your glucose monitor. This learning session is an opportunity to ask questions about all aspects of blood glucose monitoring as well as learning to operate and troubleshoot your monitor. A hands-on demonstration will help you in remembering the steps on how to obtain an accurate glucose reading. Your physician will set a “glucose range” for you so you can take the necessary actions if your blood sugar gets too high or too low.
Monitoring your glucose levels will help you detect and treat high or low blood sugar. It will also assist you in determining which foods and activities make your blood sugar go up or down. This process is simply done by placing a drop of blood from your finger onto a special test strip.The strip is then inserted into the monitor and the amount of glucose in your blood will appear on the screen. There are certain times you will need to monitor your blood sugar more often such as when you are ill or taking over-the-counter medications approved by your doctor or if you have made any changes in your lifestyle which affect your activity, diet or sleep pattern (such as traveling).
Reading your blood glucose level
Typically done with a finger prick blood glucose test.
Blood Glucose Test Reading
Ideal Target Range
|Average glucose* (before meals)||80-120||under 80||over 140|
|Average glucose* (bedtime meals)||100-140||under 100||over 160|
*(blood glucose measured by: mg/dl)
Hypoglycemia or low blood sugar occurs when blood levels get near 70 mg/dl. Eating meals and snacks as scheduled will help prevent the risk of hypoglycemia.
Hypoglycemia can be caused by:
- Not eating at the appropriate time
- Not eating enough at meal time
- Skipping a meal or snack
- Strenuous or prolonged exercise
- Taking too much insulin
Early symptoms of hypoglycemia include:
- Heart pounding
Later symptoms of hypoglycemia may include:
- Blurred vision
If hypoglycemia is ignored or not treated quickly enough a person may lapse into a coma. Early detection and treatment are necessary in order to prevent a severe hypoglycemic reaction.
Early detection & treatment of hypoglycemia
- First, and most important, do not panic.
- Always wear your medical identification .
- If possible test your blood sugar as soon as you feel your symptoms coming on.
- Always carry a carbohydrate drink, hard candy or piece of fruit “just in case”.
- Keep some glucose tablets with you at all times.
- Wait 10 – 15 minutes for the ingested carbohydrate to begin raising your blood sugar.
- Seek immediate medical attention if you are not feeling better soon after you have taken in some carbohydrates.
Diabetic Ketoacidosis (DKA)
DKA occurs when blood sugar levels are too high. The occurrence of diabetic ketoacidosis may be the first indication of Type I Diabetes (insulin-dependent) or the result of increased insulin needs for a previously diagnosed diabetic. Insulin may need to be increased during times when the body is stressed( i.e. infection).
Poor compliance with the treatment plan may also lead to DKA. The starving body begins to break down fat for energy and this leads to the production of ketones or acid in the blood.
It is important to check urine for ketones when your blood glucose level is elevated above the range your physician has prescribed. You can easily check for ketones in your urine by using a test strip available at your local pharmacy. Symptoms of Diabetic Ketoacidosis:
- Frequent urination
- Difficulty breathing
- Flushed skin
- Fruity breath
Call your health care provider immediately if:
- Your blood sugar is near 240 mg/dl.
- You are experiencing any of the above symptoms.
- You are ill or experiencing a stressful situation(s).
- Have changed your diet, exercise pattern, or insulin dosage.
Complying with your prescribed diet, that is taking in the correct amount of calories, eating meals and snacks at the appropriate times, and having a carbohydrate snack readily available in the event of a hypoglycemic reaction, is of utmost importance in maintaining normal glucose levels.
A visit with a registered dietician can put you on the right track with your specific dietary needs. Based on your weight, activity level, and the amount of insulin prescribed for you, your dietician can assist you with planning healthful meals while maintaining your prescribed daily caloric intake.
Together you will need to review the American Diabetic Association Food Exchange List in order to ensure that you are eating the correct amount of carbohydrates, proteins and fats. Once you become comfortable with food trading or substituting, and reading food labels, meal and snack planning will be simple.
Discuss the following with your dietician:
- What your daily schedule is like (usual meal times).
- Foods that you especially like or dislike.
- Activity / exercise level.
Together a workable plan can be accomplished. Keep in mind that as your schedule changes (travel, holidays, sporting events, or if you are ill) you will need to adjust your food intake as well.
Exercise can be especially helpful for diabetic teens. Being active helps glucose to go into your cells to be used for energy, therefore lowering the amount of glucose in your bloodstream and the amount of insulin you will need. Sounds great.But remember to discuss your normal activities, whether it be bike riding or soccer, with your healthcare team in order to regulate your diet and insulin doses appropriately.
Insulin, the hormone normally released by the cells of the pancreas, is necessary to help the body use glucose for energy or store it to be used at a later time.
There are many different types of insulin. Insulin is categorized by:
- Onset – how soon the insulin starts to work
- Peak time – when the insulin is working the hardest
- Duration – how long the insulin lasts in your body
Onset, peak time and duration time of insulin are all very important in maintaining a normal blood glucose range. It is not possible to take insulin orally because it will breakdown in your stomach and therefore cannot be used effectively to control blood sugar levels. Insulin must be given by injection into your fatty tissue. You will be instructed by a health care professional, specially trained in caring for diabetic patients, on how to give yourself shots. This will be scary at first but soon after you will become comfortable with the routine.
See All About Insulin for proper insulin storage, dosage, timing, administration, self-monitoring, injection technique, site rotation, insulin syringes, pens and pump therapy, and safe needle disposal.
Even the perfect treatment plan will not work to keep blood glucose levels under control if you are not compliant. Family, friends, teachers and coaches must all be aware of your diabetes, the symptoms of hypoglycemia, and the immediate interventions necessary to assist you in the event of a hypoglycemic reaction.
Use Daily Record Keeping to Manage your Diabetes
Accurate daily record keeping of the following is useful for both your health care team and family to assist you with managing your diabetes.
- Food intake
- Blood and urine monitoring
- Insulin administration (times, type, dose)
- Marked variation in exercise
- Illness and/or stress
Years of uncontrolled diabetes can cause damage to your eyes and kidneys, as well as your heart and blood vessels. Taking care of your skin, especially of your legs and feet, is critical in preventing serious problems. Keeping glucose levels under control will allow you to feel your best as well as minimize diabetes -related complications later in life.
Click here for more information on how to watch out for and deal with foot problems that are associated with diabetes.