Diabetes

Definition
The term "diabetes mellitus" refers to a group of diseases that affect how your body uses blood glucose, commonly called blood sugar. Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's your brain's main source of fuel.
If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the reasons may differ. Too much glucose can lead to serious health problems.
Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes — when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes — and gestational diabetes, which occurs during pregnancy.
Symptoms
Diabetes symptoms vary depending on how high your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, however, symptoms tend to come on quickly and be more severe. Some of the signs and symptoms of type 1 and type 2 diabetes include:

• Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough insulin)
• Fatigue
• Blurred vision
• Slow-healing sores
• Mild high blood pressure
• Frequent infections, such as gum or skin infections and vaginal or bladder infections

Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the most common type, can develop at any age and is often preventable.
When to see a doctor

• If you suspect you or your child may have diabetes. If you notice any possible diabetes symptoms, contact your doctor. The earlier the condition is diagnosed, the sooner treatment can begin.
• If you've already been diagnosed with diabetes. If you've been diagnosed with diabetes, you'll initially need close medical follow-up until your blood sugar levels stabilize.

Causes
To understand diabetes, first you must understand how glucose is normally processed in the body.
How glucose normally works
Glucose is a main source of energy for the cells that make up your muscles and other tissues. Glucose comes from two major sources: the food you eat and your liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells, with the help of insulin.
The hormone insulin comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key, unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.
Your liver acts as a glucose storage and manufacturing center. When you haven't eaten in a while your liver releases stored glucose to keep your glucose level within a normal range.
Causes of type 1 diabetes
In type 1 diabetes, your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream. Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what those factors are is still unclear.
Causes of prediabetes and type 2 diabetes
In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells, sugar builds up in your bloodstream. Exactly why this happens is uncertain, although as in type 1 diabetes, it's believed that genetic and environmental factors play a role in the development of type 2. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.
Causes of gestational diabetes
During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin. As your placenta grows larger in the second and third trimesters, it secretes more of these hormones — making it even harder for insulin to do its job.
Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can't keep up. When this happens, too little glucose gets into your cells and too much stays in your blood. This is gestational diabetes.
Risk factors
Risk factors for diabetes depend on the type of diabetes.
Risk factors for type 1 diabetes
Although the exact cause of type 1 diabetes is unknown, genetic factors likely play a role. Your risk of developing type 1 diabetes increases if you have a parent or sibling who has type 1 diabetes. Environmental factors, such as exposure to a viral illness, also likely play some role in type 1 diabetes. Other factors that may increase your risk include:

• The presence of damaging immune system cells (autoantibodies). Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes autoantibodies. If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But, not everyone who has these autoantibodies develops type 1.
• Dietary factors. A number of dietary factors have been linked to an increased risk of type 1 diabetes, such as low vitamin D consumption; early exposure to cow's milk or cow's milk formula; or exposure to cereals before 4 months of age or after 7 months of age. However, none of these factors has been shown to cause type 1 diabetes.
• Race. Type 1 diabetes is more common in whites than in other races.
• Geography. Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes.

Risk factors for prediabetes and type 2 diabetes
Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including:

• Weight. The more fatty tissue you have, the more resistant your cells become to insulin.
• Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin. Exercising less than three times a week may increase your risk of type 2 diabetes.
• Family history. Your risk increases if a parent or sibling has type 2 diabetes.
• Race. Although it's unclear why, people of certain races — including blacks, Hispanics, American Indians and Asians — are at higher risk.
• Age. Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is increasing dramatically among children, adolescents and younger adults.
• Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes.
• Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
• High blood pressure. Having blood pressure over 140/90mm Hg is linked to an increased risk of type 2 diabetes.
• Abnormal cholesterol levels. If you have low levels of high-density lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is higher. Low levels of HDL are defined as below 35 mg/dL.
• High levels of triglycerides. Triglycerides are a fat carried in the blood. If your triglyceride levels are above 250 mg/dL, your risk of diabetes increases.

Risk factors for gestational diabetes
Any pregnant woman can develop gestational diabetes, but some women are at greater risk than are others. Risk factors for gestational diabetes include:

• Age. Women older than age 25 are at increased risk.
• Family or personal history. Your risk increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.
• Weight. Being overweight before pregnancy increases your risk.
• Race. For reasons that aren't clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

Complications
Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:

• Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you are more likely to have heart disease or stroke.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
• Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant. The rates of serious kidney disease have dropped significantly in recent years, likely due to improvements in diabetes management.
• Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. As many 25 percent of people with diabetes have some form of diabetic retinopathy. And, about 4 percent of people with diabetes have diabetic retinopathy that's so advanced that it may affect their ability to see.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections. Severe damage might require toe, foot or even leg amputation.
• Skin and mouth conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections. Gum infections also may be a concern, especially if you have a history of poor dental hygiene.
• Brain problems. Recent research suggests that high blood sugar levels may increase the risk of Alzheimer's disease in people who have type 2 diabetes and a certain gene linked to the development of Alzheimer's disease. Further research is needed to confirm this link.
• Cancer. People with diabetes have a higher risk of some cancers. But the reasons aren't clear. It may be that the factors that increase the risk of type 2 diabetes also increase the risk of type 2 diabetes, or it may be a factor of the disease or its treatment. This is an active area of research, but in the meantime, no changes in treatment are recommended.

Complications of gestational diabetes
Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.
Complications in your baby can occur as a result of gestational diabetes:

• Excess growth. Extra glucose can cross the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to require a C-section birth.
• Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal.
• Respiratory distress syndrome. If your baby is delivered early, respiratory distress syndrome — a condition that makes breathing difficult — is possible. Babies who have respiratory distress syndrome may need help breathing until their lungs become stronger.
• Jaundice. This yellowish discoloration of the skin and the whites of the eyes may occur if a baby's liver isn't mature enough to break down a substance called bilirubin, which normally forms when the body recycles old or damaged red blood cells. Although jaundice usually isn't a cause for concern, careful monitoring is important.
• Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
• Death. Untreated gestational diabetes can result in a baby's death either before or shortly after birth.

Complications in you can also occur as a result of gestational diabetes:

• Preeclampsia.This condition is characterized by high blood pressure and excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.
• Subsequent gestational diabetes. Once you've had gestational diabetes in one pregnancy, you're more likely to have it again with the next pregnancy. You're also more likely to develop diabetes — typically type 2 diabetes — as you get older.

Complications of prediabetes
Prediabetes may develop into type 2 diabetes.
Preparing for your appointment
You're likely to start by seeing your primary care doctor if you are experiencing symptoms of diabetes. If your child is experiencing symptoms of diabetes, you might see your child's pediatrician. If blood sugar levels are extremely high, you'll likely be sent to the emergency room. If blood sugar levels aren't so high as to put you or your child immediately at risk, you may be referred to an endocrinologist, a doctor who specializes in diabetes, among other disorders.
Because appointments can be brief, and because there's often a lot of ground to cover, it's good to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. This will likely include restricting your diet, such as for a fasting blood sugar test.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes. If you're monitoring your glucose values at home, bring a record of the glucose results, detailing the dates and times of testing.
• Make a list of any allergies you have and all medications, as well as any vitamins or supplements, that you're taking.
• Record your family medical history. In particular, note any relatives who have had diabetes, heart attacks or strokes.
• Take along a family member or friend, if possible. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor. Be clear about aspects of your diabetes management that need clarification.
• Be aware if you need any prescription refills. Your doctor can renew your prescriptions while you're there.

Preparing a list of questions can help you make the most of your time together. List your questions from most important to least important, in case time runs out. For diabetes, some basic questions to ask your doctor include:

• Are the symptoms I'm experiencing now related to my diabetes or another condition?
• What kinds of tests do I need to best manage my diabetes?
• What else can I do to protect my health?
• What are other options to manage my diabetes?
• I have other health conditions. How can I best manage these conditions together?
• Are there any restrictions that I need to follow?
• Should I see another specialist, such as a dietitian or diabetes educator?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms that concerned you about the possibility that you have diabetes?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• Is there a family history of preeclampsia or diabetes?

Tests and diagnosis
Symptoms of type 1 diabetes often appear suddenly and are usually the reason that blood sugar levels are checked. Because symptoms of other types of diabetes and prediabetes come on more gradually, the American Diabetes Association (ADA) has recommended screening guidelines. The ADA recommends that the following people be screened for diabetes:

• Anyone with a body mass index over 25, regardless of age, who has additional risk factors, such as high blood pressure, a sedentary lifestyle, a history of polycystic ovary syndrome, having delivered a baby who weighed more than 9 pounds, a history of diabetes in pregnancy, high cholesterol levels, a history of heart disease, or having a close relative with diabetes.
• Anyone over the age of 45 is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter.

Tests for type 1 and type 2 diabetes

• Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes.

If the A1C test results aren't consistent, the test isn't available, or if you have certain conditions that can make the A1C test inaccurate — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to diagnose diabetes:

• Random blood sugar test. A blood sample will be taken at a random time. Regardless of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes.
• Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level between 100 and 125 mg/dL (5.6 and 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you'll be diagnosed with diabetes.

If type 1 diabetes is suspected, you'll also likely have a blood test to look for diabetes antibodies. In addition, your urine will be tested to look for the presence of ketones, a byproduct produced when muscle and fat tissue are used for energy when the body doesn't have enough insulin to use the available glucose.
Tests for gestational diabetes
Medical experts haven't established a single set of screening guidelines for gestational diabetes. Some question whether gestational diabetes screening is needed if you're younger than 25 and have no risk factors. Others say that screening all pregnant women — no matter their age — is the best way to catch all cases of gestational diabetes.
Your doctor will likely evaluate your risk factors for gestational diabetes early in your pregnancy.

• If you're at high risk of gestational diabetes — for example, your body mass index (BMI) before pregnancy was 30 or higher or you have a mother, father, sibling or child with diabetes — your doctor may test for diabetes at your first prenatal visit.
• If you're at average risk of gestational diabetes, you'll likely have a screening test for gestational diabetes sometime during your second trimester — between 24 and 28 weeks of pregnancy.

Your doctor may use the following screening tests:

• Initial glucose challenge test. You'll begin the glucose challenge test by drinking a syrupy glucose solution. One hour later, you'll have a blood test to measure your blood sugar level. A blood sugar level below 130 to 140 milligrams per deciliter (mg/dL), or 7.2 to 7.8 millimoles per liter (mmol/L), is usually considered normal on a glucose challenge test, although this may vary at specific clinics or labs. If your blood sugar level is higher than normal, it only means you have a higher risk of gestational diabetes. Your doctor will diagnose you after giving you a follow-up test.
• Follow-up glucose tolerance testing. For the follow-up test, you'll be asked to fast overnight and then have your fasting blood sugar level measured. Then you'll drink another sweet solution — this one containing a higher concentration of glucose — and your blood sugar level will be checked every hour for a period of three hours. If at least two of the blood sugar readings are higher than normal, you'll be diagnosed with gestational diabetes.

Tests for prediabetes
The primary test to screen for prediabetes is:

• The glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level between 5.7 and 6.4 percent suggests you have prediabetes. Normal levels are below 5.7 percent.

If the A1C test isn't available, or if you have certain conditions that can make the A1C test inaccurate — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to diagnose diabetes:

• Fasting blood sugar test. A blood sample will be taken after an overnight fast. A blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. Normal is below 100 mg/dL.
• Oral glucose tolerance test. A blood sample will be taken after you fast for at least eight hours or overnight. Then you'll drink a sugary solution, and your blood sugar level will be measured again after two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A blood sugar level from 140 to 199 mg/dL (7.8 to 11 mmol/L) is considered prediabetes. This is sometimes referred to as impaired glucose tolerance (IGT).

Treatments and drugs
Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral medications may play a role in your treatment. A pancreas transplant may be an option for people with diabetes that is difficult to control.
But no matter what type of diabetes you have, eating a healthy diet, maintaining a healthy weight and keeping an eye on your blood sugar levels are all keys to managing your diabetes.
Treatments for all types of diabetes
An important part of managing all types of diabetes is maintaining a healthy weight through a healthy diet and exercise plan:

• Healthy eating. Contrary to popular perception, there's no diabetes diet. You won't be restricted to boring, bland foods. Instead, you'll need plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — and fewer animal products and sweets. In fact, it's the best eating plan for the entire family. Even sugary foods are OK once in a while, as long as they're included in your meal plan.
  Yet understanding what and how much to eat can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. This may include carbohydrate counting, especially if you have type 1 diabetes.
• Physical activity. Everyone needs regular aerobic exercise, and people who have diabetes are no exception. Exercise lowers your blood sugar level by transporting sugar to your cells, where it's used for energy. Exercise also increases your sensitivity to insulin, which means your body needs less insulin to transport sugar to your cells. Get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes or more of aerobic exercise most days of the week. If you haven't been active for a while, start slowly and build up gradually.

Treatments for type 1 and type 2 diabetes
Treatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent blood sugar checks and carbohydrate counting. Treatment of type 2 diabetes primarily involves monitoring of your blood sugar, along with diabetes medications, insulin or both.

• Monitoring your blood sugar. Depending on your treatment plan, you may check and record your blood sugar level several times a week to three or more times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. People who receive insulin therapy may also choose to monitor their blood sugar levels with a continuous glucose monitor. Although this technology doesn't yet replace the glucose meter, it can provide important information about trends in blood sugar levels.
  Even if you eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to things like food, physical activity, medications, illness, alcohol, stress and — for women — fluctuations in hormone levels.
  In addition to daily blood sugar monitoring, your doctor may recommend regular A1C testing to measure your average blood sugar level for the past two to three months. Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working overall. An elevated A1C level may signal the need for a change in your insulin regimen or meal plan. Your target A1C goal may vary depending on your age and various other factors. However, for most people, the American Diabetes Association recommends an A1C of below 7 percent. Ask your doctor what your A1C target is.
• Insulin. Anyone who has type 1 diabetes needs insulin therapy to survive. Some people with type 2 diabetes also need insulin therapy. Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar. Often insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin.
  An insulin pump also may be an option. The pump is a device about the size of a cell phone worn on the outside of your body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of your abdomen. A tubeless pump that works wirelessly is also now available. You program an insulin pump to dispense specific amounts of insulin. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.
  Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.
• Oral or other medications. Sometimes other oral or injected medications are prescribed as well. Some diabetes medications stimulate your pancreas to produce and release more insulin. Others inhibit the production and release of glucose from your liver, which means you need less insulin to transport sugar into your cells. Still others block the action of stomach enzymes that break down carbohydrates or make your tissues more sensitive to insulin.
• Transplantation. In some people who have type 1 diabetes, a pancreas transplant may be an option. Islet transplants are being studied as well. With a successful pancreas transplant, you would no longer need insulin therapy. But transplants aren't always successful — and these procedures pose serious risks. You need a lifetime of immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects, including a high risk of infection, organ injury and cancer. Because the side effects can be more dangerous than the diabetes, transplants are usually reserved for people whose diabetes can't be controlled or those who have serious complications.
• Bariatric surgery. Although it is not specifically considered a treatment for type 2 diabetes, people with type 2 who also have a body mass index over 35 may benefit from this type of surgery. People who've undergone gastric bypass have seen significant improvements in their blood sugar levels. However, this procedure's long-terms risks and benefits for type 2 diabetes aren't yet known.

Treatment for gestational diabetes
Controlling your blood sugar level is essential to keeping your baby healthy and avoiding complications during delivery. In addition to maintaining a healthy diet and exercising, your treatment plan may include monitoring your blood sugar and, in some cases, using insulin.
Your health care provider will also monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin — which can lead to low blood sugar right after birth.
Treatment for prediabetes
If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes. Maintaining a healthy weight through exercise and healthy eating can help. Exercising at least 150 minutes a week and losing 5 to 10 percent of your body weight may prevent or delay type 2 diabetes.
Sometimes medications — such as the oral diabetes drugs metformin (Glucophage) and acarbose (Precose) — also are an option if you're at high risk of diabetes, including when your prediabetes is worsening or you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.
In other cases, medications to control cholesterol — statins, in particular — and high blood pressure medications are needed. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease if you are at high risk. Healthy lifestyle choices remain key, however.
Signs of trouble in any type of diabetes
Because so many factors can affect your blood sugar, problems sometimes arise. These conditions require immediate care, because if left untreated, seizures and loss of consciousness (coma) can occur.

• High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication. Check your blood sugar level often, and watch for signs and symptoms of high blood sugar — frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you'll need to adjust your meal plan, medications or both.
• Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces toxic acids known as ketones. Watch for loss of appetite, weakness, vomiting, fever, stomach pain and a sweet, fruity smell on your breath. You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, consult your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes.
• Hyperosmolar hyperglycemic nonketotic syndrome. Signs and symptoms of this life-threatening condition include a blood sugar reading over 600 mg/dL, dry mouth, extreme thirst, fever, drowsiness, confusion, vision loss and hallucinations. Hyperosmolar syndrome is caused by sky-high blood sugar that turns blood thick and syrupy. It tends to be more common in people with type 2 diabetes, and it's often preceded by an illness. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition.
• Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar. Your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal. However, low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin or if you're receiving insulin therapy. Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar — sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, irritability, slurred speech, drowsiness, confusion, fainting and seizures. Low blood sugar is treated with quickly absorbed carbohydrates, such as fruit juice or glucose tablets.

Lifestyle and home remedies
Diabetes is a serious disease. Following your diabetes treatment plan takes round-the-clock commitment. But your efforts are worthwhile. Careful management of diabetes can reduce your risk of serious — even life-threatening — complications.
No matter what type of diabetes you have:

• Make a commitment to managing your diabetes. Learn all you can about diabetes. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it.
• Choose healthy foods and maintain a healthy weight. Losing just 5 to 10 percent of your body weight if you're overweight can make a significant difference in your blood sugar control. A healthy diet is one full of fruits, vegetables, whole grains and legumes, with a limited amount of saturated fat.
• Make physical activity part of your daily routine. Regular exercise can help prevent prediabetes and type 2 diabetes, and it can help those who already have diabetes to maintain better blood sugar control. Thirty minutes of moderate exercise -such as brisk walking — most days of the week is recommended. A recent study found that a combination of exercises — aerobic exercises, such as walking or dancing, most days, combined with resistance training, such as weight lifting or yoga twice a week — helps control blood sugar more effectively than either type of exercise alone.

Lifestyle for type 1 and type 2 diabetes
In addition, if you have type 1 or type 2 diabetes:

• Identify yourself. Wear a tag or bracelet that says you have diabetes. Keep a glucagon kit nearby in case of a low blood sugar emergency — and make sure your friends and loved ones know how to use it.
• Schedule a yearly physical and regular eye exams. Your regular diabetes checkups aren't meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications and screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.
• Keep your immunizations up-to-date. High blood sugar can weaken your immune system. Get a flu shot every year, and get a tetanus booster shot every 10 years. Your doctor will likely recommend the pneumonia vaccine, as well. The Centers for Disease Control and Prevention (CDC) also currently recommends hepatitis B vaccination if you haven't previously been vaccinated against hepatitis B and you're an adult aged 19 to 59 with type 1 or type 2 diabetes. The most recent CDC guidelines advise vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you're age 60 or older and have diabetes and haven't previously received the vaccine, talk to your doctor about the whether it's right for you.
• Pay attention to your feet. Wash your feet daily in lukewarm water. Dry them gently, especially between the toes. Moisturize with lotion, but not between the toes. Check your feet every day for blisters, cuts, sores, redness or swelling. Consult your doctor if you have a sore or other foot problem that doesn't start to heal on its own.
• Keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medication may be needed, too.
• Take care of your teeth. Diabetes may leave you prone to gum infections. Brush and floss your teeth at least twice a day. And if you have type 1 or type 2 diabetes, schedule dental exams at least once a year. Consult your dentist right away if your gums bleed or look red or swollen.
• If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including heart attack, stroke, nerve damage and kidney disease. Smokers who have diabetes are more likely to die of cardiovascular disease than are nonsmokers who have diabetes, according to the American Diabetes Association. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco.
• If you drink alcohol, do so responsibly. Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so only in moderation — one drink a day for women and two drinks a day for men — and always with food. Remember to include the carbohydrates from any alcohol you drink in your daily carbohydrate count.
• Take stress seriously. If you're stressed, it's easy to abandon your usual diabetes management routine. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly, which only makes matters worse. To take control, set limits. Prioritize your tasks. Learn relaxation techniques. Get plenty of sleep.

Above all, stay positive. The good habits you adopt today can help you enjoy an active, healthy life with diabetes.
Alternative medicine
Numerous substances have been shown in some studies to improve insulin sensitivity, yet other studies have failed to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, no alternative therapies are currently recommended for diabetes control. Some of the substances that have shown promise in helping to control blood sugar include:

• Alpha-lipoic acid
• Caffeine
• Cinnamon
• Chromium
• Flaxseed
• Ginseng
• Glucomannan
• Guar gum
• Magnesium

If you decide that you'd like to try an alternative therapy, don't stop taking the medications that your doctor has prescribed, and discuss the use of any of these therapies with your doctor to be sure that they won't cause adverse reactions with your current therapy.
Additionally, there are no treatments — alternative or conventional — that can cure diabetes, so it's critical that people who are on insulin therapy for diabetes don't stop using insulin unless directed to do so by their physician.
Coping and support
Living with diabetes day in, day out can be difficult and frustrating. Sometimes, even when you've done everything right, your blood sugar levels may rise. But stick with your diabetes management plan, and you'll likely see a positive difference in your A1C when you visit your doctor.
Because good diabetes management can be time-consuming, and sometimes overwhelming, some people find it helps to talk to someone. Your doctor can probably recommend a mental health professional for you to speak with, or you may want to try a support group. Sharing your frustrations and your triumphs with people who understand what you're going through can be very helpful. And you may find that others have great tips to share about diabetes management. Your doctor may know of a local support group, or you can call the American Diabetes Association at 800-DIABETES (800-342-2383) or the Juvenile Diabetes Research Foundation at 800-533-CURE (800-533-2873).
Prevention
Type 1 diabetes can't be prevented. However, the same healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can help prevent them.

• Eat healthy foods. Choose foods low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.
• Get more physical activity. Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day.
• Lose excess pounds. If you're overweight, losing even 5 percent of your body weight — for example, 10 pounds (4.5 kilograms) if you weigh 200 pounds (90.7 kilograms) — can reduce the risk of diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

Sometimes medication is an option as well. Oral diabetes drugs such as metformin (Glucophage) may reduce the risk of type 2 diabetes — but healthy lifestyle choices remain essential.

DAFTAR PUSTAKA

http://healthyliving.msn.com/diseases/diabetes/diabetes-8

Bahaya lemak jenuh

PENDAHULUAN

Minyak goreng merupakan salah satu bahan pangan yang sangat dibutuhkan oleh masyarakat, misalnya untuk menggoreng dan menumis. Masyarakat sering menggunakan berkali-kali untuk menggoreng. Secara ilmiah perlakuan ini tidak sehat, karena asam lemak bebas mengandung ikatan rangkap yang dapat membentuk peroksida, keton maupun aldehid (Winarni et al., 2010).

Di Indonesia makanan yang digoreng sangat disukai dan dikonsumsi secara luas oleh berbagai lapisan masyarakat dari segala tingkat usia. Bahan makanan yang digoreng menempati porsi yang cukup besar dari menu makanan sehari-hari. Dalam proses penggorengan, minyak berfungsi sebagai medium penghantar panas, menambah rasa gurih, dan menambah nilai gizi serta kalori dalam bahan pangan. Menggoreng merupakan suatu cara memasak bahan pangan yang banyak dilakukan di Indonesia yang menggunakan minyak goreng yang berfungsi sebagai penghantar panas yang mematangkan makanan (Oeij  et al., 2007).

Menurut Notoatmodjo (2003), pengetahuan atau kognitif merupakan domain yang sangat penting dalam membentuk tindakan seseorang (over behavior). Pengetahuan memiliki hubungan dengan kesehatan. Pengetahuan akan kesehatan, penyakit, serta pemeliharaan kesehatan sangat luas cakupannya. Secara otomatis, pengetahuan akan diet atau pola makan yang sehat merupakan bagian dari pengetahuan kesehatan tersebut. Pengetahuan akan pola makan juga erat hubungannya dengan pola konsumsi seseorang (Marks et al., 2005).

Keluarga merupakan unit pelayanan kesehatan yang terdepan dalam meningkatkan derajat  kesehatan komunitas. Apabila keluarga sehat, akan tercapai komunitas yang sehat pula. Budaya keluarga dan makanan memiliki hubungan yang sangat erat. Makanan berfungsi untuk mempertahankan, meningkatkan, dan mengendalikan kesehatan yang optimal (Sudiharto, 2007). Menurut Dinas Kesehatan Kota Banjarmasin tahun 2011, untuk mendapatkan status gizi keluarga yang baik diperlukan pengetahuan, kemampuan dan perilaku gizi yang baik dan benar bagi setiap anggota keluarga. Perilaku gizi yang baik dan benar adalah perilaku untuk mengkonsumsi makanan dalam jumlah yang cukup sesuai kebutuhan, baik macam maupun kualitasnya.

Beragamnya peran dalam keluarga mengarah pada peran ibu yang besar pada pekerjaan domestik, mencari nafkah menambah penghasilan keluarga. Meskipun demikian ibu tetap bertugas menyediakan makanan bagi keluarga (Puspita, 2004). Memasak, mencuci dan membersihkan rumah merupakan sebagian dari sekian banyak tugas dari ibu rumah tangga. Masakan yang sehat dan lingkungan tempat tinggal yang bersih tentunya menjadi kunci kesehatan bagi siapa saja (Ahira, 2011).

Menggoreng dengan deep frying dengan suhu penggorengan tinggi akan menyebabkan banyak asam lemak tidak jenuh berubah menjadi asam lemak jenuh. Di samping itu, apabila bahan baku yang digoreng berasal dari produk hewani, kolestrol akan masuk kedalam minyak goreng jelantah dan akan menambah risiko penyakit degenerative (Sitepoe, 2008). Penggunaan minyak sebagai media penggorengan akan menyebabkan kerusakan minyak akibat pemanasan berulang-ulang pada suhu tinggi (Ketaren cit. Kusmanto et al, 2005). Menurut Oeij et al (2007), jika minyak dipanaskan berulang-ulang, maka proses destruksi minyak akan bertambah cepat, hal ini disebabkan meningkatnya kadar peroksida pada tahap pendinginan yang akan mengalami dekomposisi jika minyak tersebut dipanaskan kembali. Minyak yang sudah digunakan berulang-ulang apabila diberikan pada ternak atau disuntikkan ke dalam darah, akan timbul gejala diare, kelambatan pertumbuhan, pembesaran organ, deposit lemak yang tidak normal, kanker, kontrol tidak sempurna pada pusat saraf, dan mempersingkat umur. Peroksida lipid dalam aliran darah mengakibatkan denaturasi lipoprotein yang mempunyai kerapatan rendah. Lipoprotein dalam keadaan normal berfungsi sebagai alat transportasi trigliserida, sehingga bila mengalami denaturasi akan mengakibatkan deposisi lemak dalam pembuluh darah dan menimbulkan gejala aterosklerosis.

Lemak adalah substansi yang tampak seperti lilin dan tidak larut dalam air. Lemak yang terdapat dalam bahan makanan umumnya terdiri dari tiga gugus asam lemak dengan gliserol yang dikenal sebagai trigliserida. Lemak dalam bahan makanan dapat dibagi menjadi tiga golongan, yaitu  lemak jenuh (saturated fatty acid), lemak tidak jenuh tunggal (mono saturated fatty acid), lemak tidak jenuh ganda (poly-unsaturated fatty acid) (Soeharto, 2004).

Lemak jenuh dari bahan nabati dapat ditemukan pada minyak kelapa, minyak sawit, dan beberapa minyak dari tumbuhan yang berasal dari daerah tropis lainnya. Lemak jenuh juga dikenal dengan sebutan lemak tidak baik karena mempunyai sifat yang dapat mengganggu tubuh, yaitu menyebabkan darah lengket dengan dinding pembuluh darah sehingga darah mudah menggumpal. Selain itu pula lemak jenuh ini mudah menumpuk pada dinding pembuluh darah dan mengakibatkan pergeseran dinding pembuluh darah dan mengganggu peredaran darah. Akibatnya beberapa penyakit seperti jantung, darah tinggi, stroke sering diderita oleh orang-orang yang mengkonsumsi makanan dengan kadar lemak jenuh yang tinggi. Makanan yang mengandung lemak jenuh biasanya terdapat pada makanan yang digoreng, yang memang  memiliki rasa yang khas dengan gurihnya, tetapi dalam makanan gorengan itu ternyata memiliki lemak jenuh yang tinggi pula (Graha, 2010).

Kolesterol dan lemak (trigliserida) merupakan faktor resiko fundamental dalam proses penyumbatan pembuluh arteri. Untuk mencegahnya perlu dijaga agar dua substansi tersebut dalam darah berada dalam batas normal. Dilihat asalnya, kolesterol dan lemak datang dari zat makanan dan yang diproduksi oleh liver. Karena itu, kadarnya dalam darah tergantung dari diit, penyerapan di usus serta kemampuan liver memproduksi dan mengendalikannya (Soeharto, 2002).

IUD

KONTRASEPSI IUD

IUD singkatan dari Intra Uterine Device  digunakan untuk alat kontrasepsi pada wanita. IUD diletakan didalam rahim dengan tujuan mencegah/ menghambat pertemuan antara sel telur dengan sel sperma,sehingga tidak terjadi pembuahan dan kehamilan.

Komposisi
Batang plastik berbentuk T berukuran 3 cm dengan balutan tembaga seluas kurang lebih 380 mm2

Mekanisme Kerja
IUD Andalan akan mencegah pelepasan sel telur sehingga tidak akan terjadi pembuahan. Selain itu mengurangi mobilitas sperma agar tidak dapat membuahi sel telur serta mencegah sel telur yang telah dibuahi menempel pada dinding rahim

Kualitas
IUD Andalan efektif mencegah kehamilan hingga 99,4% apabila dipasang sesuai dengan prosedur oleh bidan atau dokter terlatih.

Keunikan

• Sangat murah dan efisien karena cukup sekali pemakaian yang dibantu oleh tenaga medis
• Pilihan kontrasepsi non hormonal jangka panjang yang minim efek samping
• Efektif mencegah kehamilan selama 10 tahun
• Cepat mengembalikan kesuburan, sehingga dapat segera hamil jika diinginkan
• Tidak mempengaruhi produksi dan kualitas ASI
• Efektif mencegah kehamilan ektopik

Efek Samping
Secara umum, efek samping yang timbul tidak akan bersifat permanen. Efek samping hanya akan bersifat sementara tergantung dari penerimaan tubuh terhadap IUD. Efek samping yang bersifat sementara tersebut antara lain:

• Perubahan siklus haid pada 3 bulan pertama pemakaian
• Pembengkakan panggul bisa terjadi setelah terkena infeksi penyakit kelamin
• Tidak memberikan perlindungan terhadap IMS dan HIV dan AIDS

Penting untuk diperhatikan

• Anda hanya perlu sekali dalam setahun untuk datang ke dokter atau bidan untuk memeriksakan keberadaan IUD Anda
• Pemasangan IUD harus dilakukan oleh tenaga medis yang telah dilatih
• IUD dapat dipasang segera setelah melahirkan, setelah plasenta keluar
• Kapan saja bisa dipasang tidak harus sedang haid asalkan Anda tidak sedang hamil.