Note: My guide for diabetes is very long as diabetes is a huge subject itself. But for everybody's convenience, I've divided everything up into separate sections so the information is easier to read and access, especially if you're only curious about specific parts.
Livewire Guide to Disability: Diabetes
What is Diabetes?
Diabetes is a chronic disease which affects an estimated 20.8 million Americans - about 7% of all Americans (comparatively, about the entire population of Australia!). It is difficult to define diabetes under one broad definition. It is very important to understand that there are two types of diabetes: Type 1 Diabetes (also known as insulin dependent diabetes) and Type 2 Diabetes (also known as non-insulin dependent diabetes). There is also a third type of diabetes which occurs in pregnant women and only lasts during the pregnancy. Type 3 Diabetes (also known as gestational diabetes) is rarer than the other two and normally is not referred to when diabetes is taught, and as such, I will not talk about it as I know very little about it. All three types are in every way a different "disease" where each has same effect.
Type 1 Diabetes:
Type 1 Diabetes occurs when one's body does not produce enough insulin, thus making it impossible to absorb glucose (sugar) in the bloodstream. This leads to high blood sugars.
What Causes Type 1 Diabetes?
There is no clear cause for Type 1 Diabetes, other than the fact that it is onset by the body's lack of producing insulin. There may be a wide variety of reasons for one to have Type 1 Diabetes, but from observations, it is not directly genetic like Type 2 Diabetes is (although there has been recently discovered evidence of certain cell types which Type 1 Diabetics are more likely to have, which means that it could be genetic, but isn't always).
The most commonly speculated and widely accepted cause of Type 1 Diabetes is by an autoimmune system, which means that one's immune system labels parts of its own body as invaders and destroys it. In a Type 1 Diabetics' case suffering from an autoimmune system, their immune system attacked the islet cells which produce insulin in their pancreas, thus destroying the islet cells and source of insulin. While Type 1 Diabetes is not directly genetic, an autoimmune system is, which would make Type 1 Diabetes indirectly genetic, although having an autoimmune system doesn't necessarily mean one will become Type 1 Diabetic. Factors such as viral, chemical, and other agents, as well as general stress, can increase the risk of a person with an autoimmune system of having their islet cells attacked. There is no ways of preventing Type 1 Diabetes available to the common person (all preventions of Type 1 Diabetes focuses on dealing with autoimmunity issues - for example, there has been research on different ways to make one's islet cells immune to one's immune system (this is called "immune tolerance"), but nothing of which has been conclusive enough to make such immunizations available to the public yet).
It is important to remember that Type 1 Diabetes does not develop right away. It is not as if the immune system attacks the islet cells in a person and all of the sudden they have Type 1 Diabetes. Type 1 Diabetes develops very gradually, over many attacks by the immune system, over periods of months or even years. Below is a diagram and short explanation of the onset of Type 1 Diabetes.
(Source: http://www.uchsc.edu/misc/diabetes/ud03.pdf)
Who Does Type 1 Diabetes Occur In?
Generally, Type 1 Diabetes develops in young children, although it's been known to develop in those up to 20 years old (myself included at age 16), rarely older than that. Type 1 Diabetes is the most common form of diabetes in those younger than 40 years old, although Type 1 Diabetics make up only about 5 - 10% of all diabetics - meaning, for the United States, an estimated total of 1 to 2 million Americans have Type 1 Diabetes, about 1 or 2 in every 300 Americans. Because Type 1 Diabetes is not directly genetic, its frequency is more or less equal among all races and societies around the world, although those without access to insulin will die from the condition, meaning that its frequency among adult populations in nations with inadequate healthcare is smaller than in nations with better healthcare.
How Is Type 1 Diabetes Treated?
All Type 1 Diabetics are treated by giving themselves artificial insulin. This is usually done through injecting insulin into their bodies (usually through sticking a syringe in one's belly, thighs, or the underside of their arms - although from personal experience, I can tell you that just about all Type 1 Diabetics, myself included, inject our syringes in our bellies as that's the easiest to reach area which also has the most fat, meaning it's less painful). Most Type 1 Diabetics give themselves shots of insulin about five times a day.
As recently as five years ago, a new technology came out for Type 1 Diabetics called an "insulin pump." These pumps look like little pagers that Type 1 Diabetics carry around in their pockets which connect into the Type 1 Diabetic's body through what's called an infusion set. The infusion set only has to be replaced every three days or so, meaning that insulin pumps are much more convenient in that the Type 1 Diabetic does not need to give themself a shot every time they need to take insulin. As a result, Type 1 Diabetics with insulin pumps do not need to structure everything they need to eat in a meal, meaning that these pumps allow for much more flexibility. Moreover, they also improve blood sugar control in that they're able to give little bits of insulin each hour to counteract the liver producing glucose for one's own body (thus gradually raising blood sugars). I'll explain more on how exactly insulin works later.
While insulin pumps sound great, there are drawbacks to them. The biggest drawback, which is more of a psychological one, is that insulin pumps work so well that the Type 1 Diabetic doesn't even feel as if they have the disease. This can lead one who is not careful into neglecting their blood sugar readings and can consequently lead to more high or, more often, low blood sugars. Type 1 Diabetics with insulin pumps tend to be three times more likely to have a low blood sugar, which can create immediate problems. Another big drawback is the fact that insulin pumps cost about $5000 and most American health insurances only cover a portion of that - mine, for example, covered only $1000 of it. They are very expensive and still very new technology, which means that insurance companies are less likely to cover them (although how receptive insurance companies are to new technologies varies state from state).
Type 2 Diabetes:
Type 2 Diabetes occurs when one's cells in their body does not respond to its own insulin, thus making it impossible to absorb glucose (sugar) in the bloodstream. This leads to high blood sugars.
What Causes Type 2 Diabetes?
Genetic factors are the single largest cause of one developing Type 2 Diabetes. In just about all cases, Type 2 Diabetics have some parent, grandparent, or other family member who also has the disease. In studies of twins, if one's twin develops Type 2 Diabetes, they have an 80% chance of developing it themselves (whereas with Type 1 Diabetes, they only have a 50% chance).
Another major factor, and a very widely known one, in developing Type 2 Diabetes is obesity. About 80% of all Type 2 Diabetics are overweight, and Type 2 Diabetes has been known to occur in those who are as young as 15 years old that are obese, which all suggests a correlation (though do be reminded that correlation does not equal causation, meaning that one who is overweight may not necessarily develop Type 2 Diabetes, but is at a much higher risk of developing it). "Insulin resistance," which is the phenomenon where one's cells gradually stop responding to insulin, usually occurs with excess weight and a lack of physical fitness (and the same goes for artificial insulin for insulin dependent diabetics - heavier people tend to require more insulin than lighter people).
Type 2 Diabetes develops far more gradually than Type 1 Diabetes does. It's important to think of diabetes in terms of blood sugars rather than just focusing on whether one is diabetic or not. One can go from having a normal blood sugar to having a borderline diabetic blood sugar for a long time until having a diabetic level blood sugar - and even then, people often go for a long time without noticing that they have a diabetic level blood sugar until it is severe enough (remember that not all insulin is resisted by the cells in Type 2 Diabetics, just as not all islet cells stop producing insulin in Type 1 Diabetics). As a result, there are a much larger estimated number of people who have Type 2 Diabetes than Type 1 Diabetes - the number in the United States totals at about 6 million Americans, or 2% of the US population.
Who Does Type 2 Diabetes Occur In?
Type 2 Diabetes most commonly occurs in people over the age of 40 years old and who are overweight, although those as young as 15 years old who are very overweight have also developed Type 2 Diabetes. Type 2 Diabetes is the most common form of diabetes at about 90 - 95% of all diabetics, and is usually the form of diabetes most people refer to when they talk about diabetes. While Type 2 Diabetes occurs in all ethnic groups, it is most frequent among those of Latino, Asian, Native American, and Sub-Saharan African (or black) heritages. An estimated 18 to 19 million people in the United States have Type 2 Diabetes, or about 6 to 6.5% of the US population, of which an estimated 6 million, or about one third of all Type 2 Diabetics do not know they even have the disease.
How Is Type 2 Diabetes Treated?
Type 2 Diabetics are usually treated by taking oral drugs on a daily basis which help the cells in their bodies respond to the insulin that they produce. As a result, Type 2 Diabetics have to live by a much more strict diet than Type 1 Diabetics because they cannot give themselves more or less of their drugs to control their blood sugars like Type 1 Diabetics can with insulin.
Some Type 2 Diabetics have stopped producing insulin just like Type 1 Diabetics. As a result, the treatment for these people are the exact same as the treatment for Type 1 Diabetes as artificial insulin is not resisted by the cells in one's body the same way the insulin they produce is. Because of this, referring to Type 1 Diabetes as insulin dependent diabetes and Type 2 Diabetes as non-insulin dependent diabetes is inaccurate, though common because this was how the two types of diabetes were differentiated in the past before more research proved this notion to be false.
How Does Insulin Work?
In order to really understand diabetes, it is imperative that one understands insulin. Insulin is a hormone, and a hormone is a chemical released in one's body which transmits a command to another part of the body. For example, the pituitary gland in your brain produces growth hormones and these hormones travel all through your body telling each part of it to expand and grow. Insulin works in the same exact way, only it tells each cell of your body to absorb glucose from your bloodstream. Without insulin or your cells not responding to the insulin your body produces, your cells will not absorb glucose, leading to high blood sugars.
Besides High Blood Sugars, What Happens If No Insulin Is Produced or Not Responded To?
Without glucose for one's cells, they'll usually turn to other means for energy before starving, of course. One's body will start cannibalizing their muscles first and using that protein for energy. After the reserve of muscles has been depleted, one's body will turn to consuming their own fat for energy, creating a rapid weight loss - which is also the goal of the Atkins Diet (and why it says to not consume any carbohydrates - from which it is broken up by one's stomach into glucose). After the reserve of fat has been depleted, then the person will essentially starve to death if they do not receive artificial insulin.
What Are the Effects of High Blood Sugars?
The effects of high blood sugars have mainly long-term effects, compared to low blood sugars which have solely short-term effects, although there are a few short-term effects of high blood sugars provided that they are high enough. Below is a table of how blood sugars are classified, as well as some of their associated symptoms:
(Source: http://www.uchsc.edu/misc/diabetes/ud07.pdf)
This table shows that blood sugars that are below 60 are critically low blood sugars, blood sugars between 70 and 150 are normal blood sugars (the kind non-diabetics have), high blood sugars are between 200 and 400, and that very high blood sugars are above 400 (they can go above 800, though it's rare - when I went to the hospital to be diagnosed with diabetes, my blood sugar was at 984).
The long-term effects of diabetes are as listed:
- Heart disease and stroke.
- Nerve damage.
- Blood vessel damage in the hands and feet, and gangrene.
- Kidney disease.
- Eye problems and blindness.
- Gum disease.
- Urinary tract infections.
- Respiratory infections.
- Scaly and hardened skin.
- Celiac disease.
- Increased risk of colon and rectal cancer.
- Impotence (the inability to sustain an erection).
There aren't too many short-term effects of blood sugars in the high range - mainly long term ones. The more short-term effects of blood sugars in this range include excessive thirst (which starts to develop around blood sugars of 240 or so) and frequent and prolonged urination (which really start to develop around blood sugars of 300 or so). After blood sugars of 300 is when most people begin to recognize diabetic symptoms.
The very high range of blood sugars is where most of the short-term effects of high blood sugars begin to occur. In this range, a complication known as acidosis begins to occur.
What Is Acidosis?
A chemical compound known as ketones is produced in one's bloodstream and is found in their urine when one's cells absorb more energy from fat than from glucose. Essentially, ketones are a byproduct of fat breakdown and testing ketones in one's urine was how diabetics in the past tested their blood sugars before blood sugar meters were created. This also creates fruity smelling breath, which is why the people who use the Atkins Diet have fruity smelling breath - they undergo the same exact thing I have described and their bodies have large amounts of ketones built up in them as a result.
As ketone production spirals out of control, they build up in one's body tissues. When ketones are built up so high, the acidity of their blood increases, and with diabetics being so thirsty as their kidneys use the water in their body to clean the blood in order to flush out the high glucose levels in the blood (which is why kidneys are often damaged in diabetics, from being so overworked, as well as eyes being damaged as the kidneys clean the eyes and if there's too much glucose in the blood, it damages that), diabetics become dehydrated, making the acidity in their blood even stronger. When the acidity becomes strong enough, this creates a complication known as acidosis. Those suffering from acidosis often feel very sick and nauseous (many wind up throwing up if it becomes bad enough), and they also begin to have trouble breathing as the acidosis hurts one's respiratory system. When most diabetics go to the hospital for high blood sugars, they go primarily for this reason. I, personally, was lucky enough to avoid acidosis as I drank well over 30 cups of water per day at my worst point, keeping my body not too dehydrated.
What Are the Effects of a Low Blood Sugar?
I briefly touched on low blood sugars by mentioning that all effects of low blood sugars are short-term. Having a low blood sugar will not result in any long-term effects, aside from death (which is simultaneously a short-term effect).
Low blood sugars tend to occur primarily in Type 1 Diabetics, the type most teenage diabetics tend to be. Moreover, not everybody who suffers from low blood sugars is diabetic - those who are not diabetic but have low blood sugars are called hypoglycemic, and the state of having a low blood sugar is called hypoglycemia.
Having a blood sugar lower than 70 is considered low, but it's generally not considered worrisome until it dips below 60. There are a few noticeable effects (which are also symptoms), which include:
- Trembling.
- Irritability.
- Palpitations.
- Anxiety.
- Sweating.
- Hunger.
If the blood sugar dips below 50 for long enough (note: one can have a blood sugar in the 20s and still not have these effects / symptoms that I'm about to list, but if it stays there long enough, they will occur), the following effects / symptoms will occur:
- Difficulty in thinking.
- Incoherency.
- Difficulty in walking / balancing.
- Headache.
- Seizure.
- Coma.
- Ultimately, death.
If you have any friends who are diabetic or hypoglycemic, it is absolutely imperative that you recognize these symptoms / effects. They are not always the same for each low blood sugar and are different among everyone. For example, I've been more incoherent during some low blood sugars but still able to walk okay, whereas I've had no balance during some while I was still fully coherent. If you have any friends like this and you see them acting strangely like that, it is important that you make sure that they're okay and that they get something to eat, like some candy, juice, or pop and followed by something with more protein and complex carbohydrates, like some meat or whole wheat bread. Your actions regarding this could potentially mean their life.
What Are the Symptoms of Diabetes?
Some symptoms of diabetes include:
- Frequent and prolonged urination (major symptom).
- Excessive thirst (major symptom).
- Extreme hunger.
- Unusual weight loss (major symptom).
- Increased fatigue (major symptom).
- Irritability.
- Blurry vision.
- Fruity smelling breath.
The ones I marked as a major symptom are the ones which all diabetics would agree on and experienced themselves. When diabetes was noted in the past - specifically by the ancient Greeks - these were the symptoms they referred to. The origin of the word "diabetes" comes from the ancient Greek prefix dia (across, apart) and verb bainein (to walk, stand), forming the word diabainein (to stride, walk, or stand with legs asunder), which then formed the derivative diabetes ("one that straddles," or specifically in this context, "a siphon"). The ancient Greeks and Egyptians defined diabetes as a disease where one's body organs melted and are urinated out of the body (hence the excessive urination), which is where the siphon makes sense - as one's organs are siphoned out of the body through urination. While not entirely accurate, it does highlight the symptoms of diabetes very well. As you might imagine from this, frequent and prolonged urination (and by prolonged, I mean urinating quite strongly for longer than two or three minutes) is the single most important symptom of diabetes, which is very true.
But do bear in mind that just because you may have quite a few symptoms does not necessarily mean that you are diabetic. It is absolutely vital that you go to a doctor for a diagnosis if you think you might have diabetes, but I will explain to you how exactly you can see for yourself whether you have diabetes or not.
How Can I Test Myself To See If I Have Diabetes?
Being one who does his best to avoid going to the doctor (after all, I didn't go to a doctor for my diagnosis of diabetes until I was about ready to pass out from starvation as my cells were not getting nearly enough glucose and my muscle and fat reserves for energy were all depleted), I will explain to you how you can test yourself to see if you have diabetes or not. Pay very close attention to what I say here if you ever intend to do this, and if you do actually do this and think you may have diabetes, be sure to see a doctor at some point for a proper diagnosis.
First of all, you will need a blood sugar monitor / meter. Diabetes is a common enough disease where you probably know someone who is diabetic and can use theirs.
Secondly, you will need to take your blood sugar at two separate times. You need to take a "fasting" blood sugar, meaning one where you haven't eaten in awhile (at least more than four hours). And then you will need to take another blood sugar reading two hours after you drink some kind of sugary drink, such as apple juice, orange juice, or Pepsi. The table below will explain what the corresponding blood sugar reading means (note that the glucola is a special sugary drink the doctors would give you to test this. It's similar to the drinks I listed, but it doesn't taste as good):
(Source: http://www.uchsc.edu/misc/diabetes/ud04.pdf)
A normal blood sugar during fasting should be below 100. If it's between 100 and 126, then you are borderline diabetic. This doesn't mean that you are diabetic, but it means that you are at risk and should seek a doctor just in case. If your blood sugar is over 126, then you have passed the line used to define diabetes and are diabetic. Although don't be mistaken - if you do pass this line, you are not diagnose with diabetes (remember, there could be errors, such as you having sugar on your fingers when you pricked yourself to get a blood sugar reading). You can only be diagnosed by a medical professional and if your blood sugar is really over 126, you should immediately go to the doctor.
These same things apply for the 2 hours after having a sugary drink, only at different blood sugar levels. If you're below 140, you're normal. If you're between 140 and 200, you are borderline diabetic. And if you are over 200, then you have diabetes and it's urgent that you see a doctor if that's the case.
Myths of Diabetes:
Here I would like to dispel some common myths I've heard circulated about diabetes. If you have read everything I have written, they will already have been dispelled, but I'd like to make things clear.
Diabetes is caused by eating too much sugar.
Of all diabetic myths, this has to be the most insulting of them, as well as one of the most common. While eating too much (and generally not sugar, but usually fats) can make somebody overweight and that can lead that person to developing Type 2 Diabetes, it is not always the case, and moreover for the Type 1 Diabetics, it is never the case. Type 1 Diabetes is not preventable at the moment, and Type 2 Diabetes isn't always either.
Diabetics can't eat any sugar.
While it is more important for diabetics to maintain a healthier diet than non-diabetics (especially Type 2 Diabetics who cannot compensate for eating more carbohydrates than they should like a Type 1 Diabetic can), diabetics can still have many of the things that non-diabetics have. It's funny how often people question me when I'm eating a muffin, a cookie, or some kind of junk food. I eat about as normally as I did before I was diagnosed with Type 1 Diabetes. The only difference is that I now compensate for what I eat with insulin, as well as the fact that I have switched from regular Pepsi to Diet Pepsi.
You can "catch" diabetes.
Simply untrue. I have never personally heard this myth circulated before, but you cannot catch diabetes from being around a diabetic or even from sharing a syringe with that diabetic (although I do not recommend sharing syringes at all for other health concerns). The only way a non-diabetic could acquire diabetes is by giving themselves injections of insulin. One's body over time would then become addicted to that insulin and stop producing insulin for themselves, essentially making that person a Type 1 Diabetic. Why anybody would do this, though, is beyond me.
People with high blood sugars are hyper.
While this isn't necessarily related to diabetes, this is one of the dumber myths I hear a lot. High blood sugars make people sleepy. Ever felt really tired after a big meal? That's because your blood sugar spiked way up. Your body will have a lot of glucose to consume and that enables one to be hyper (which is why you feel hyper when you eat a lot of candy with your friends - because you're already very active), although generally if one is sleepy after a large meal, they will not be doing any kind of strenuous activity, and all that extra sugar will go straight to fat. It is often recommended that you do things like go out for a jog or something after dinner to counterbalance that.
Any high blood sugar reading means that you're diabetic.
This isn't always the case, though it usually is. Blood sugars skyrocket in normal people after meals, too. The difference is that their bodies quickly adjust for that skyrocketing blood sugar by detecting the amount of glucose entering the bloodstream and compensate for it by bring the person's blood sugar back to normal - diabetics try to mimic that, but manually. So if you're not diabetic and ever take your blood sugar 30 minutes or so after a meal, don't panic when you see a blood sugar reading in the upper 100s. That's normal.
Insulin cures diabetes.
Insulin treats diabetes, but it certainly does not cure it. There is a major difference between the two. In order to be cured, one must be completely over the disease, meaning that taking insulin would no longer be required.
Low carbohydrate diets like the Atkins Diet are good for diabetics.
Low carbohydrate diets such as the Atkins Diet are good for nobody, period. All they result in are high levels of ketones and acidity in one's blood, as I described in the Acidosis section of this guide. It is far healthier for a diabetic to eat a well balanced and normal diet like everybody else.
Insulin causes impotence (the inability to sustain an erection).
This has to be one of the more lulz myths out there. It's just simply not true as there is nothing in artificial insulin which would cause this (artificial insulin is actually produced in the same way natural insulin is, but under artificial conditions). If anything, it's the opposite - insulin helps prevent impotence as high blood sugars make it more difficult for the penis to sustain its erection.
Resources:
While I've touched on just about everything one needs to know about diabetes, there are still many things I have not covered, such as the different types of oral drugs for Type 2 diabetics and what exactly they do, the different types of insulin and what exactly they do specifically to one's blood sugar, how blood sugars rise and fall and what they should look like, the costs of everything for diabetics in the United States, etc. There is one resource in particular that I have used and where I have obtained my tables and graphs from: http://www.uchsc.edu/misc/diabetes/ud11.html.
This is an online version of the textbook I was given about diabetes in the hospital when I was diagnosed. This book is mainly geared toward those who had just recently developed diabetes and those under 18. It is written at an 8th grade level so it's very easy to read and it has funky pictures and diagrams which make it easier for younger children to visualize what exactly diabetes is. Regardless of it being geared toward newly diabetics, I think it's an excellent resource for anybody who wishes to learn more about diabetes in greater depth.
Post edited at 5:22 am on June 11, 2008 by Bud2400
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This is a really great idea. Frankly, I'm a little sad I didn't come up with it. That fact aside, you can expect an entry here soon. 
