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Diabetes is a disorder of metabolism--the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood which is the main source of fuel for the body. After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells and be used, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

When we eat, the pancreas is supposed to automatically produce the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. The body is unable to correctly use its main source of fuel even though the blood contains large amounts of glucose.

The three main types of diabetes are

• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes

Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body's system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks the insulin-producing cells in the pancreas and destroys them. The pancreas then produces little or no insulin. Someone with type 1 diabetes needs to take injections of insulin daily to live.

At present, scientists do not know exactly what causes the body's immune system to attack the beta cells, but they believe that both genetic factors and environmental factors, possibly viruses, are involved. Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States.

Type 1 diabetes develops most often in children and young adults, but the disorder can appear at any age. Symptoms of type 1 diabetes usually develop over a short period, although destruction of insulin producing pancreatic cells can begin years earlier. Symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.

The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes usually develops after age 40 and is most common in adults over age 55. About 80 percent of people with type 2 diabetes are overweight. Type 2 diabetes is often part of a metabolic syndrome that includes obesity, high blood pressure, and high cholesterol. Unfortunately, as more children become overweight, type 2 diabetes is becoming more common in young people.

When type 2 diabetes is diagnosed the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively. This condition is called insulin resistance and after several years insulin production also decreases. The result is the same as for type 1 diabetes--glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.

The symptoms of type 2 diabetes develop gradually. They are not as sudden in onset as in type 1 diabetes. Some people have no symptoms. Symptoms may include fatigue or nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of wounds or sores.

Gestational diabetes develops only during pregnancy. Though it usually disappears after delivery, the mother is at increased risk of getting type 2 diabetes later in life.

People with diabetes frequently experience certain symptoms.
These may include:

• increased thirst
• frequent urination
• weight loss
• increased hunger
• feeling very tired
• blurry vision
• frequent infections, slow-healing cuts or sores
• problems with sexual function in males
• dry, itchy skin; numbness or tingling in hands or feet

In some cases, there are no symptoms with type 2 diabetes or they may come on so gradually that they are not recognized . Therefore, people can live for months, even years without knowing they have the disease.

Nutrition and exercise, along with medications, are the cornerstones of controlling diabetes. Good nutrition, meaning a well balanced diet, improves overall health and helps keep your weight under control and blood sugar levels closer to their normal levels. Your physician or dietitian can help design a diet that works for you. Exercise can lower your blood sugar by helping your body use its food supply more efficiently. Exercise also increases blood flow to small blood vessels to help improve overall circulation. Before starting an exercise regimen talk to your physician to see what type of exercise and how much are best suited for you.

Diabetics are at risk for many long term health complications such as heart disease, stroke, poor blood flow which can lead to infection or amputation, kidney disease, blindness, and impotence in men. Keeping your blood sugar as close to normal as possible can delay or prevent the onset of some complications. Maintaining good oral health by seeing your dentist regularly along with good skin and foot care is also important for diabetics. Other lifestyle changes such as smoking cessation and limited alcohol consumption will improve overall health and glucose control.

work by delaying the digestion of carbohydrates and slow the absorption of sugars to prevent the sharp rise in blood sugar that can occur after meals

Examples include:
acarbose (Precose®) miglitol (Glyset®)

Important reminders when taking these medications:

• gastrointestinal symptoms (abdominal pain, flatulence, and diarrhea) are common when taking these medications, but usually decrease over time
• take your dose with the first bite of meals as directed by your physician

work by stimulating insulin release from the pancreas when increased glucose levels are present

Examples include:
repaglinide (Prandin®)
nateglinide (Starlix®)

Important reminders when taking these medications:

• take 15 to 30 minutes before a meal
• if you add or skip a meal, you may be instructed by your physician to add or skip the dose associated with that meal

work by decreasing glucose production by the liver, decreasing the absorption of glucose in the intestines, and increasing insulin sensitivity

Examples include:
metformin (Glucophage® / Glucophage XR®)

Important reminders when taking these medications:

• gastrointestinal symptoms (nausea, diarrhea, anorexia, and cramping) are common when taking these medications
• avoid or limit use of alcohol
• take medication with food

work by decreasing insulin resistance, decreasing production of glucose by the liver, and increasing insulin receptor numbers

Examples include: pioglitazone (Actos®)
rosiglitazone (Avandia®)

Important reminders when taking these medications:

• important to have your liver function monitored while on these medications
• report any chest pain, rapid heartbeat, abdominal pain, fever, rash, yellowing of the skin or eyes, dark urine, light stools, unusual fatigue, or nausea and vomiting to your physician
• may be taken without regards to meals
• avoid alcohol

work by stimulating the pancreas to release insulin in response to increased blood sugar

Examples include:
glimepiride (Amaryl®)
glyburide (DiaBeta / Micronase / Glynase®)
chlorpropamide (Diabinese®)
acetohexamide (Dymelor®)
glipizide (Glucotrol / Glucotrol XL®)
tolbutamide (Orinase®) tolazamide (Tolinase®)

Important reminders when taking these medications:

• take 30 minutes before breakfast or the first main meal

Combination Examples include: Glucovance®contains both glyburide and metformin

Insulin is the principal hormone required for proper glucose use. It lowers blood glucose by stimulating glucose uptake by skeletal muscle and fat and by inhibiting hepatic glucose production

Examples include:
Humalog, Humalog Mix, Humulin 50/50, Humulin 70/30, Humulin L, Humulin N, Humulin R, Humulin U, Iletin II NPH Pork, Iletin II Regular Pork, Iletin Lente, Iletin NPH, Iletin Regular, Lantus, Novolin 70/30, Novolin L, Novolin N, Novolin R, Novolog

• wear a medical identification bracelet or carry something that identifies you as a diabetic
• be aware of the signs and symptoms of hypoglycemia (low blood sugar), which can be any of the following:
  -feel shaky
  -become sweaty
  -feel tired
  -become hungry
  -feel crabby or confused
  -have rapid heartbeat
  -have blurred vision
  -have headaches
  -pass out
• carry glucose tabs or candy with you at all times in case of hypoglycemia
• ensure those around you are familiar with the signs and symptoms of hypoglycemia and what to do in case it occurs
• have an eye exam annually
• have a dental exam twice a year
• check your feet daily for problems (sores, blisters, cracks)
• ask your provider about enrolling in a diabetic education course
• maintain regular office visits with your physician
• checking your blood glucose at home allows you to better control your diabetes
• consult physician or pharmacist before starting any new prescription or over-the-counter drugs