Diabetes

What is Diabetes?

Diabetes Mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels that develop when your body does not produce enough insulin, or when your body does not effectively use the insulin that it does produce.

Your body needs insulin to break down sugar for energy. Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin is used to allow the absorption of sugar into cells from the blood stream. When the blood glucose level elevates after eating, insulin is released from the pancreas to allow sugars to be transferred from the blood to the cells and then return the blood glucose level to normal. In patients with diabetes, the absence of, or insufficient production of insulin causes hyperglycemia, or high blood sugar. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime.

Diabetes can lead to significant health risks, including:

  • increased risk of developing high blood pressure
  • atherosclerosis (narrowing of the arteries)
  • coronary artery disease
  • stroke
  • damaged blood vessels and circulatory problems
  • blindness
  • kidney failure
  • nerve damage

Women with diabetes are much more likely to have heart attacks, angina (chest pain) or require heart surgery than men with diabetes. Although the cause is not fully understood, it is believed to be connected with the interaction between female hormones, blood sugar and insulin.

Common Types of Diabetes

Type 1 Diabetes is an autoimmune disorder, and usually develops in children, teenagers, young adults and even people in their 30s. It occurs when the pancreas no longer produces insulin, which the body needs to break down sugar for energy. It is believed that a combination of genetic predisposition and other unknown factors provoke the immune system into attacking and killing the insulin-producing cells in the pancreas. Symptoms are often dramatic and come on very suddenly. It is treated with insulin. 10% of people with diabetes have Type 1, also known as Insulin Dependent Diabetes Mellitus (IDDM).

Type 2 Diabetes often develops in overweight adults and is primarily caused by insulin resistance. It occurs when the pancreas does not produce enough insulin, or when the body does not effectively use the insulin that is produced. This means no matter how much insulin is made, the body cannot use it as well as it should. As a result, glucose cannot be moved from the blood into cells. Over time, the excess sugar in the blood gradually poisons the pancreas causing it to make less insulin and making it even more difficult to keep blood glucose under control.

Symptoms are often subtle and may be attributed to aging or obesity. A person may have type 2 diabetes for many years without knowing it. It can be precipitated by steroids and stress. People with type 2 diabetes can develop hyper-glycemic hyperosmolar non-ketotic syndrome. If not properly treated, type 2 diabetes can lead to complications like blindness, kidney failure, heart disease, and nerve damage.

90% of people with diabetes have Type 2, also known as Non-Insulin Dependent Diabetes Mellitus (NIDDM) or adult onset diabetes mellitus (AODM). Obesity is a leading cause of insulin resistance – 90% of people with type 2 diabetes are overweight. Genetic factors are also likely to be involved in the cause of type 2 diabetes. A family history of the disease has been shown to increase the chances of getting it.

Other risk factors for the development of type 2 diabetes include:

  • A history of gestational diabetes
  • Being 40 years of age or older
  • Blood vessel disease
  • First Nation, Hispanic, South Asian, Asian, or African descent
  • Giving birth to a large baby
  • High blood pressure
  • High cholesterol
  • Polycystic Ovary Syndrome (PCOS)
  • Schizophrenia
  • Pre-diabetes or impaired fasting glucose

Gestational Diabetes occurs in 2 to 4% of women during pregnancy. Significant hormonal changes during pregnancy can lead to blood sugar elevation in genetically predisposed individuals. Gestational diabetes usually resolves once the baby is born. However, 25% – 50% of women with gestational diabetes will eventually develop type 2 diabetes later in life, especially in those who require insulin during pregnancy and those who remain overweight after their delivery.

Signs & Symptoms of Type 1 and 2 Diabetes

  • Fatigue: With diabetes, the body has difficulty using glucose for energy, so it switches over to metabolizing fat, partially or completely, as a fuel source. This process requires more energy and can result in feeling fatigued or constantly tired.
  • Excessive thirst (polydipsia): The inability to process sugar leaves high levels of sugar in the blood which overwhelms the kidneys as the blood is filtered to make urine. More water is required to dilute the blood, which results in constant thirst.
  • Excessive urination (polyuria): Increased thirst results in increased urination as the body tries to remove the excess sugar from the blood. The excessive urination can also lead to dehydration.
  • Unexplained weight loss: People with diabetes are unable to process many of the calories in the foods they eat. Thus, they may lose weight even though they eat an apparently appropriate or even excessive amount of food. Losing sugar and water in the urine and the accompanying dehydration also contributes to weight loss.
  • Excessive eating (polyphagia): If the body is able, it will secrete more insulin in order to try to process the excessive blood sugar levels, even though the body is resistant to the action of insulin in type 2 diabetes. The higher insulin levels in the blood stream lead to increased hunger and eating. Despite increased caloric intake, the person may gain very little weight and may even lose weight.
  • Poor wound healing: High blood sugar levels prevent white blood cells from functioning normally. Also, long-standing diabetes is associated with thickening of blood vessels, which impairs circulation and the delivery of enough oxygen and other nutrients to body tissues. Under these conditions, wounds take much longer to heal and become infected more frequently.
  • Frequent Infections: A suppressed immune system and the presence of glucose in the blood stream create ideal conditions for bacteria to grow. Certain infection syndromes, such as frequent yeast infections of the genitals, skin infections, and urinary tract infections, may result.
  • Mental Instability: Agitation, unexplained irritability, inattention, extreme lethargy, or confusion can all be signs of very high blood sugar, ketoacidosis, hyperosmolar hyperglycemia non-ketotic syndrome, or hypoglycemia (low sugar).
  • Blurred vision: Blurry vision is frequently present with high blood sugar levels.

Complications

Diabetes is a chronic, life-long condition that requires careful control. Without proper management it can lead to serious health complications such as cardiovascular disease, kidney failure, blindness and nerve damage. However, with the correct treatment and recommended lifestyle changes, complications can be delayed or prevented.

Short-Term Complications

  • Low blood sugar (hypoglycemia) – A person who takes insulin is going to face the problem of their blood sugar falling too low at some point because they have overestimated the insulin they need, have exercised more than anticipated or have not eaten enough. Hypoglycemia can be corrected rapidly by eating some sugar. If it is not corrected it can lead to loss of consciousness. It is important that the person with diabetes recognizes the signs of hypoglycemia so they can react quickly.
  • Ketoacidosis – When the body breaks down fats, acidic waste products called ketones are produced. The body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. However, the body cannot release all the ketones and they build up in your blood, causing ketoacidosis. Ketoacidosis is a severe condition caused by lack of insulin. It mainly affects people with type 1 diabetes.
  • Lactic acidosis – Lactic acidosis is the build-up of lactic acid in the body. Cells make lactic acid when they use glucose for energy. If too much lactic acid stays in the body, the person begins to feel ill. Lactic acidosis is rare and mainly affects people with type 2 diabetes.
  • Bacterial/fungal infections – People with diabetes are more prone to bacterial and fungal infections. Bacterial infections include sties and boils. Fungal infections include athlete’s foot, ringworm and vaginal infections.

Long-Term Complications

  • Eye disease (retinopathy) – Eye disease, or retinopathy, is the leading cause of blindness and visual impairment in adults in developed societies. About 2% of all people who have had diabetes for 15 years become blind, while about 10% develop a severe visual impairment.
  • Kidney disease (nephropathy) – Diabetes is the leading cause of kidney disease (nephropathy). About one third of all people with diabetes develop kidney disease and approximately 20% of people with type 1 diabetes develop kidney failure.
  • Nerve disease (neuropathy) – Diabetic nerve disease or neuropathy affects at least half of all people with diabetes. There are different types of nerve disease which can result in a loss of sensation in the feet or hands, pain in the foot and problems with the functioning of different parts of the body including the heart, the eye, the stomach, the bladder and the penis. A lack of sensation in the feet can lead to people with diabetes injuring their feet without realizing it. These injuries can lead to ulcers and possibly amputation.
  • Diseases of the circulatory system – Disease of the circulatory system, or cardiovascular disease, accounts for 75% of all deaths among people with diabetes of European origin. In the USA, coronary heart disease is present in between 8% and 20% of people with diabetes over 45 years of age. Their risk of heart disease is 2 to 4 times higher than those who do not have diabetes. It is the main cause of disability and death for people with type 2 diabetes in industrialized countries.
  • Amputation – Diabetes is the most common cause of amputation that is not the result of an accident. People with diabetes are 15 to 40 times more likely to require lower-limb amputation compared to the general population.

Prevention

The onset of type 2 diabetes can be delayed or prevented through a healthy lifestyle. Change your diet, increase your level of physical activity, and maintain a healthy weight. With these positive steps, you can stay healthier longer and reduce your risk of developing diabetes and its related health complications.

If you already have diabetes, losing weight and maintaining a healthy weight can help you control your blood glucose levels and can lower your risk of developing complications.

Diabetes Health Goals

People with diabetes or pre-diabetes are responsible for much of their care, which can be complicated and difficult. However, self-care can be made easier by working with the patient’s healthcare team to set goals for blood sugar levels, weight loss, and control of other health risks. Goals may vary depending on other risk factors, such as age, and the presence of cardiac disease and other complications.

Diabetes Blood Sugar Goals
The major goal in treating diabetes is to minimize any elevation of blood sugar (glucose) without causing abnormally low levels of blood sugar. Careful control of blood sugars can help prevent the long-term effects of poorly controlled blood.

Diabetes Weight Goals
Being overweight is itself a risk for diabetes as excess weight can make it harder for the body to use insulin. Most healthcare professionals suggest that diabetics aim to maintain a healthy weight for their height and body type. This weight is often based on a person’s;

  • Body Mass Index or BMI (between 18.5 and 24.9 is considered healthy)
  • Waist circumference (less than 40 inches for men; less than 35 for women
  • Frame

If a woman is pregnant, her healthcare provider may set guidelines for how much weight she should aim to gain during her pregnancy, depending on her pre-pregnancy weight and whether she has gestational diabetes.
The Body Mass Index (BMI) is a measure of body fat based on a formula that calculates the ratio of your height and weight. Your BMI is an indicator of your appropriate weight for your height and is a more reliable indicator of body fat than just weight alone.
A BMI of less than 25 is the goal for keeping your blood sugar under control. If your BMI is above the normal range then you are at greater risk for developing type 2 diabetes.

Use our convenient BMI and Healthy Weight calculator below:






  • BMI
    Weight Level
    Health Risk
  • - 25
    Normal
    Minimal Health Risk
  • 25 - 27
    Overweight
    Moderate Health Risk
  • 27 - 30
    Very Overweight
    High Health Risk
  • 30 - 35
    Moderately Obese
    Very High Health Risk
  • 35 - 40
    Severely Obese
    Extremely High Health Risk
  • 40 +
    Severely Obese
    Very Dangerous

Diabetes Cardiac Goals

The National Institutes of Health has set recommended target ranges for blood pressure and lipid levels, since each of those can contribute to the risk of heart disease:

  • Blood pressure: Less than 130/80
  • Low-density lipoprotein (LDL or “bad” cholesterol): Less than 100 mg/dL;
  • High-density lipoprotein (HDL or “good” cholesterol): Greater than 40 mg/dL for men and greater than 50 for women
  • Triglycerides: Less than 150 mg/dL

Treatment & Management

Management of the patient with diabetes requires a multidisciplinary team approach where the primary care provider must take a systematic approach to the evaluation and management of the patient. The goals of therapy are to correct the metabolic abnormalities of diabetes and to prevent the development of micro-vascular and macro-vascular complications. Whether a new patient is being evaluated or an established patient is being followed-up, recognized treatment guidelines and recommendations for ensuring good diabetes care should be kept in mind.

Type 1 Diabetes is treated with insulin, exercise, and a diabetic diet.

Type 2 Diabetes is treated first with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, treatment with insulin is considered.

Weight reduction and exercise are important treatments for diabetes because they increase the body’s sensitivity to insulin, making it more effective, and thus helping to control blood sugar elevations and minimize the need for medications and insulin.

The Dr. Bernstein diet program is a medically supervised weight loss program which is a safe and effective method for diabetic patients to reduce fat and maintain a healthy weight. With this diet program, over 90% of our patients stop the use of all diabetic medication when they reach their healthy goal weight. The Dr. Bernstein Diet program includes a restricted diet along with vitamin and mineral supplementation and behavioural and life style modification.

At Dr. Bernstein Diet & Health Clinics, we have been able to help many patients at pre-diabetic stage and those diagnosed with diabetes (both Type 1 & Type 2) with medically supervised weight loss. Our expertly-trained doctors and nurses monitor you throughout the program and can help you achieve better control of your blood sugars and reduce or eliminate your need for diabetic medications, including insulin, and prevent the very serious complications of diabetes as you lose weight. Blood tests may even show that your diabetes no longer exists. Imagine no longer needing to do finger-prick blood sugar tests!

*Individual weight loss may vary. Call for details. Compliance with our program is required.