Diabetes in Adults

What Is Diabetes?

Diabetes is a condition in which the glucose (sugar) level in the blood is too high. Glucose is a simple type of sugar that supplies the body with energy. The body is unable to keep the glucose level within the normal range and so the amount of glucose in the blood becomes too high. 

The problem occurs because there is a lack of insulin in the body.

Insulin is a hormone that is needed to metabolize the sugar (glucose) we eat. When the sugar (glucose) we eat passes into the bloodstream, insulin moves the glucose from the blood into the cells, where the glucose  supplies the energy the cells need to function.

Insulin is made in the pancreas.  

There are two kinds of diabetes:

• Type 1 diabetes – The pancreas stops making insulin completely or does not make enough of it. 
• Type 2 diabetes – The pancreas still makes some insulin, but the body is not able to use it properly.

In either case the glucose does not get into the cells as normal and accumulates in the blood.

Type 1 diabetes usually starts in children but can also start in adults.

Type 2 diabetes  commonly starts in adults and is also called adult-onset diabetes, 

Most adults with diabetes have type 2 diabetes; Type 2 diabetes accounts for 90 percent of all diabetes cases. In recent years, however, more and more adolescents, and even some children, have developed type 2 diabetes because of increasing amounts of obesity in our country.

What is insulin? How does insulin Work?

Insulin is a hormone made in the pancreas. It controls the level of glucose in the blood. When food is digested the stomach and intestinse the carbohydrates in the food are broken down into sugar molecules, or glucose. Glucose is then absorbed from the intestine into the bloodstream and so the level of glucose in the blood rises. This rise in blood glucose (sugar) normally signals the special cells in the pancreas, called beta cells, to release the right amount of insulin.

Insulin allows glucose and other nutrients (such as amino acids from proteins) to enter muscle cells. There, they can be stored for later or burned for energy.

When the body has a problem making insulin or the muscle cells do not respond to insulin in the right way, diabetes results

Diabetes in Adults: What Are The Symptoms?

Diabetes in adults may start slowly. In fact, millions of people don’t even know they have it before it is diagnosed by measuring blood glucose. Others may just feel very tired at first, then later may have these symptoms:

• Urinating more than usual, as the body tries to get rid of the extra sugar in the blood
• Feeling unusually thirsty, because the body needs to replace the lost fluid
• Nausea
• Blurred vision
• Losing weight even though eating more than usual
• Frequent infections
• Skin sores that won’t heal

It’s important to remember that diabetes symptoms may not be the same for everyone:

• The symptoms of type 2 diabetes may come on gradually.
• Some people may have no symptoms at all.
• Many people have type 2 diabetes and don’t know it.

Untreated diabetes can cause serious health problems, such as blindness, heart and blood vessel damage, and permanent nerve damage. Seeing your doctor regularly for checkups and a discussion of your risk for diabetes is key to staying healthy.

Who Gets Diabetes?

Type 2 diabetes – the type that mostly affects adults – affects all types of people. However, there are factors that can put you at higher risk for developing the condition:

• Being overweight (body mass index of 25+)
• Carrying fat around the waist and stomach
• Being sedentary
• Being more than 45 years old (being over 65 increases risk even further)
• Having a family history of type 2 diabetes
• Having had gestational diabetes (a mild glucose abnormality first noted in pregnancy which can cause difficulties with delivery and in the newborn after birth) or having a baby that weighed 9 lbs or more
• Being of African-American, Latino, Asian-American, or Native American descent
• Having a low high-density lipoprotein (HDL) cholesterol level (less than 35)
• Having a high triglyceride level (250 or above)
• Having high blood pressure (140/90 mm/Hg or higher)

Type 2 diabetes used to be quite rare before middle age, but now affects more and more young people who are overweight. Being overweight, even as a child or teenager, is a significant risk factor for developing diabetes as an adult.

About Impaired Glucose Tolerance

A condition called impaired glucose tolerance, a state between “normal” and “diabetes,” could indicate that a person may get diabetes later. Impaired glucose tolerance also may put people at higher risk for heart disease and stroke.

Impaired glucose tolerance shows up on tests as a slightly elevated blood sugar level that is not high enough to be called diabetes. A doctor checks for this condition using an oral glucose tolerance test.

It is estimated that 20 million people in the U.S. have impaired glucose tolerance, including many children. Finding out about impaired glucose tolerance early might allow a person to make healthy lifestyle changes that will help them avoid getting diabetes or having other health problems later in life.

Another situation that puts a person at increased risk for getting diabetes later and for heart disease and stroke is impaired fasting glucose. In this condition, the fasting glucose level is higher than normal but less than necessary to diagnose diabetes.

How Is Diabetes Diagnosed?

Diabetes is often diagnosed by measuring fasting glucose levels. If that value is lower than the value necessary to diagnose diabetes but your doctor suspects you still may have diabetes, an oral glucose tolerance test may be done. This is a special test that shows how well the body uses glucose.

Talk to your doctor about how often you should be tested. How frequently you are tested for diabetes depends on your age and risk factors for the condition.

• If you are 45 years old or older, you need to get tested for diabetes, even if you do not have any risk factors.
• If you are younger than 45 and have one or more risk factors, you should also get tested.
• After the age of 45, people should be tested for diabetes every three years.

How Is Diabetes Treated?

Diabetes can’t be cured, but it can be controlled. The treatment varies according to how much insulin the body makes, and how well the body is able to use available insulin.

• Many people with type 2 diabetes can control their diabetes at first by losing weight, eating a healthy diet, and exercising regularly.
• Others also need pills that help boost their natural insulin, or help the body use insulin more efficiently.
• Many adults with type 2 diabetes eventually need insulin shots.
• People with type 1 diabetes always need insulin shots.

Treatment for diabetes helps keep blood sugar levels steady and alleviates symptoms. Controlling blood sugar will also help reduce the risk of complications, such as problems with the kidneys, eyes, heart, skin, mouth and feet.

Who Treats Diabetes?

Treating diabetes is a team effort. Your diabetes team may include:

• A doctor. This may be a regular doctor or a diabetes specialist (an endocrinologist)
• A diabetes educator, who may also be a registered nurse
• A dietitian, who can help with planning meals and snacks, and can answer questions about food

People with diabetes need to have regular check-ups from a dentist and an eye doctor, and may need help from a podiatrist (foot specialist). People with diabetes may also need expert help getting started on an exercise program.

The diabetes team can help you:

• Eat in a way that keeps blood sugar as steady as possible
• Lose weight if necessary
• Test your blood sugar correctly
• Learn to take insulin shots
• Start a fitness program
• Watch for and treat symptoms of low blood sugar, which may be a medication side effect
• Watch out for early signs of complications such as problems with eyes, feet, skin and kidneys

Can Diabetes Be Controlled?

In the early stages, you may be able to control your diabetes without medication, by looking after yourself carefully. But if you are taking medication, taking care of yourself is just as important. It will help the medication work much better.

Things you can do to control your diabetes include:

Control your weight. For many people with diabetes, reducing weight is the single most important thing they can do.

• Don’t try quick weight loss diets. They won’t work for long, and can be dangerous.
• Do follow your diabetes team’s advice, and lose weight slowly and steadily.
• Don’t get discouraged. Losing as little as 10 to 15 pounds may make a big difference in how you feel and how well your diabetes is controlled.

Eat on time, and eat well. Keep track of what you eat, when you eat, and how much you eat. Small, regular meals work best for most people who have diabetes.

Exercise three to four times a week. Exercise does three good things.

• It helps control weight
• It helps the cells use blood sugar
• It helps prevent heart disease

Medication For Diabetes

There are now several medications available to treat diabetes. Most are taken in pill form. Different diabetes pills do different things:

• Help the pancreas make more insulin
• Help the body’s cells use insulin more efficiently
• Work with both the pancreas and the cells to control blood sugar levels
• Slows down the digestion of carbohydrates in the food we eat causing the rise of glucose in the blood following a meal to be less.

In order to help your diabetes medication work well, remember these points:

• You may start off with one type of medication and change or add others later.
• Keep taking your medication as directed by your doctor even if you feel better.
• Tell your doctor or pharmacist if you experience side effects or a change in your condition.

Side Effects

Diabetes medications may cause side effects, including

• Stomach upset
• Gas
• Bloating
• Diarrhea
• Metallic tast
• Less appetite

These side effects usually go away on their own in a week or two. If they don’t go away, tell your doctor. He or she can probably switch you to a different medication or change your dose.

There’s plenty you can do to help diabetes medication work correctly:

• Follow the directions for taking medication.
• Follow your treatment team’s advice about when to eat meals and what to eat to help control your blood sugar.
• Carry emergency snacks in case the medication causes your blood sugar to drop too low. Low blood sugar can be dangerous.
• Get regular liver tests if required for your type of medication.

Types Of Medication

There are several types of medication commonly used to treat type 2 diabetes:

• Sulfonylureas Stimulate your pancreas to make more insulin.
• Biguanides Decrease the amount of glucose made by your liver.
• Alpha-glucosidase inhibitors Slow the absorption of the starches you eat.
• Thiazolidinediones Make you more sensitive to insulin.
• Meglitinides Stimulate your pancreas to make more insulin.
• D-phenylalanine Help your pancreas make more insulin quickly.
• Combination oral medicines. A combination of different types of pills.

Do You Need Insulin?

If you have type 1 diabetes, when the body no longer produces insulin, you probably need to take insulin shots every day. With type 2 diabetes, sometimes the pancreas can’t make enough insulin, even with the help of pills. If that happens, you will need to take insulin as well.

You can store insulin at room temperature for up to a month. It can also be kept in the refrigerator, but be sure to let it warm up before the shot. Insulin that’s too cold may be uncomfortable to inject.

Insulin won’t work if it goes below 36 degrees or above 86 degrees. It can also be damaged by sunlight.

• Don’t leave bottles in a car on a hot or cold day.
• Keep them out of direct sunlight.
• If you are traveling by plane, keep the bottles with you. Bags you check may get too hot or too cold.

Your doctor or nurse will show you how to draw up insulin into the syringe. Sometimes you may use a single type; sometimes you need to mix two types in the syringe, so they can be given together in one shot. Or you may use an insulin pen, which comes pre-loaded with insulin and ready to use.

Where to Give an Insulin Shot

Insulin is injected into the fat just beneath the skin. Ask your health care team about a good spot, because the injection site may affect how well the insulin is absorbed. The best places are:

• The abdomen
• The upper arms
• The thighs
• The hips (not the buttocks)

Choose an injection site about half an inch (one finger-width) from the place where the previous shot was given.

Care of Syringes

Syringes can be used more than once, but must never be shared. When the needle starts to get blunt after three or four shots, throw it out. Many states require you to use a special “sharps” container for the disposal of used needles. You can get one from your pharmacy.

How Is Blood Sugar Monitored?

Keeping track of your blood sugar levels makes your diabetes easier to manage and helps you keep an eye on your condition.

• Blood sugar that is too high (hyperglycemia) can make you feel sick. You may urinate frequently, become thirsty, have blurring of vision and may get skin infections, eg, boils. And if it stays high for long, it can cause problems with your eyes, feet and kidneys.
• Blood sugar that is too low (hypoglycemia) can make you feel sick too. You may sweat, feel very hungry, weak and anxious, feel your heart pounding in your chest. You may not be able to think clearly and even pass out.

If you are taking insulin,you should test your blood at least twice a day, usually before a meal. Some people take only one injection of insulin a day before going to bed. In that case, testing your blood only once a day before breakfast is necessary.

• When you are sick.
• When you are starting a new medicine, and need to see how well it is working.
• If you get symptoms of low blood sugar.

About Glucose Meters

You can buy inexpensive meters that tell you how much sugar is in your blood. With most, after you prick your finger with a special lancet, you put a drop of blood on a test strip for the meter to read. Glucose meters also store the results of tests, with the date.

There are more than 25 different types of meters on the market. They differ in these ways:

• Amount of blood needed for test
• Testing speed
• Overall size
• Ability to store test results in memory
• Cost

Newer types of meters are generally easier to use and have more features, such as the ability to store results or print them out. “Noninvasive” models are also available that don’t require a finger stick.

Even if you have a meter that stores numbers, note the time and the blood sugar number in a logbook. Then you won’t lose your data if the meter goes wrong or its battery dies. Also,it will be easier for your doctor to analyze the results written in a log book than to have to scroll through the results that are stored in the meter. Be sure to have spare batteries on hand, just in case.

The Hemoglobin A1C Test

About once every three months, you will need a blood test that shows how well you have been controlling your blood sugar over the long term. The hemoglobin A1C test measures the amount of sugar that has stuck to the red blood cells. It reflects the average blood sugar over the past two to three months.

How Does Diet Affect Diabetes?

A healthy diet is a crucial part of managing diabetes. People who have diabetes should watch:

• What time they eat (meals and snacks should be about the same time every day)
• How much they eat (meals and snacks should be about the same size every day)
• The balance of what they eat at each meal (not too much of one type of food).

In the beginning, you will probably work with a dietitian to plan meals and snacks. You may follow a plan called “carbohydrate counting.” Carbohydrate counting is keeping track of starchy foods and sugar, which have the most effect on blood sugar.

The Balanced Diet

Meals and snacks can be based on the food pyramid. Your dietitian may tell you just how many servings you need of each food, and how large a serving should be.

• The largest part of each meal should be the foods at the bottom of the pyramid, such as whole grain breads, pasta and rice, and starchy vegetables like potatoes, corn, peas and beans.
• Every day, you should have several servings of vegetables and fruit.
• Protein should come from lean meats, chicken, turkey, or fish, or meat substitutes like beans, eggs or low-fat cheese.
• Dairy foods should be either non-fat or low-fat.
• Eat fats and sugars only in small amounts.

The Food Pyramid

This pyramid shows approximately where food should come from, with much more from the wide parts than the narrow.

Fat and sugar: Use sparingly

Dairy foods (two to three servings): Choose non-fat or low-fat

Protein (two to three servings): Meat, poultry, fish, eggs, beans: Choose lean protein sources, such as skinless chicken and fish. Limit egg yolks to 3-4 per week, 1/2 cup of beans can be substituted for 1 serving of meat or fish

Vegetables (three to five servings): Eat all different types and colors

Fruit (two to four servings): Eat whole fruit rather than drinking fruit juice so you get enough fiber

Grains and starchy vegetables (six to 11 servings): Choose whole grain breads, and a wide variety of other starches

Salt

High blood pressure often goes along with diabetes. High sodium intake has been linked to high blood pressure.

• Cut down gradually on salt used in cooking and at the table.
• Avoid high-sodium foods such as chips, snack crackers, processed meats, and canned soups.

Sugar

There is no need to avoid all sugar. However, use sugar sparingly and try not to add additional sugar to foods.

• Eat sugar as part of a meal (for example, in fruit pies, frozen yogurt, or pudding).
• Avoid too much sugar between meals. Drink diet soft drinks, not regular.
• Don’t waste your money on “diabetic” foods. They are often high in fat to make up for lack of sugar.
• Avoid processed foods, which are often high in sugar and fat and low in nutrients.

Fats

Fats may not cause blood sugar to fluctuate in people with diabetes, but they still should be reduced, especially if you are trying to lose weight.

People with diabetes have a much higher than average risk of heart disease. You can reduce that risk if you cut down on saturated fat, which is found in meat, dairy foods, and solid vegetable fats.

• Choose lean meats; take the skin off chicken.
• Instead of butter or hard margarine, eat “good” fats from oils such as canola or olive, or from nuts. Choose margarine that lists a liquid oil as the first ingredient.
• Buy skim or low-fat milk, and non-fat or low-fat yogurt. Limit the amount of regular cheese: choose a low-fat type.
• Avoid fried foods. Grill, broil, boil or bake instead.
• Limit egg yolks to three to four per week.

Alcohol

Ask your diabetes team how much alcohol (if any) you can have with meals.

Don’t drink alcohol on an empty stomach. Have it with a meal and sip it slowly.

Research shows that if your diabetes is under control, a moderate amount of alcohol has only a minimal effect on blood sugar. A moderate amount is defined as:

• No more than two alcoholic drinks daily for men
• One alcoholic drink daily for women

One drink equals:

• One 12-ounce can of beer
• One 5-ounce glass of wine
• One 1-ounce shot glass of whiskey.

If your blood sugar is not under control or you have diabetes complications, avoid large amounts of alcohol. It can worsen some complications, including nerve damage, coronary artery disease and high blood pressure.

Also keep in mind that alcohol is high in calories. If you’re trying to lose weight, alcohol can make that more difficult.

Snacks

Snacks can help keep blood sugar from dipping too low between meals. These should not be high in sugar and fat, like candy or chips, but foods such as:

• Peanut butter and crackers
• Cheese and crackers
• Low-fat sugar-free yogurt
• Fresh fruit
• Bran muffins
• Graham crackers

Always carry a source of carbohydrate, eg, glucose tablets, in case yor blood sugar gets too low. This may occur if you are taking either insulin, or to a much less extent, a sulfonylurea agent. It is much more likely to occur if you skip meals, eat less than usual or exercise more than usual.

Eating Out

When you eat out, stick to the same plan you follow at home.

• Eat servings about the same size as you have at home. If there is food left over, ask for a doggy bag.
• Avoid food high in fat. Order foods that are broiled, boiled, steamed, grilled, or baked, not fried.
• If you order salad, ask for the dressing on the side, and use only a little.
• Have fruit for dessert or, as a treat, split one dessert with a friend or two.
• If your doctor has asked you to limit salt, ask for low-sodium dishes.

What Is Low Blood Sugar?

Hypoglycemia – low blood sugar – can be very unpleasant and sometimes dangerous. It can be caused by:

• Taking certain diabetes pills (sulfonylureas) without enough food
• Overexercising if taking insulin or a sulfonylurea
• Alcohol on an empty stomach
• Too much insulin

The Signs of Hypoglycemia

You may feel:

• Shaky, sweaty, hungry, faint or weak
• Palpitations, or a rapid heart beat
• Irritable and impatient

If you don’t raise your blood sugar, you may get blurred vision and headache. You may get drowsy and confused, and even pass out.

What To Do About Low Blood Sugar

You should immediately take about 15 grams of sugar. Good sources are:

If possible, test your blood sugar 15 minutes after eating some sugar. If it is still low (below 70) or if you can’t test but still feel weak and shaky, take more sugar.

As soon as you feel better, you should eat some solid food. If it’s nearly mealtime, have your next meal early. If it’s an hour or more before mealtime, have a snack, such as:

• Half a ham or turkey sandwich
• Peanut butter with crackers

Even if you can bring up your blood sugar quite easily, make a note in your log each time you have hypoglycemia, so you can tell your doctor what seemed to cause it. Write down:

• The time
• When you last ate
• When you last had a pill or an insulin shot.

If you have hypoglycemia frequently, you may need changes in your medication, or in your mealtimes. If your blood sugar level dips low after exercise, plan to eat a snack or small meal before your exercise session.

How Does Illness Affect Diabetes?

Even “normal” illnesses like colds and flu can cause special problems when you have diabetes.

• If you can’t eat, or are vomiting, it may be hard to keep blood sugar up.
• Some illnesses interfere with the way insulin works. If you are taking insulin, youo may need more while you are ill. If you are ill for a long period and the pills are not controlling your diabetes, your doctor may want you to start insulin.

Get an action plan from your diabetes team that tells you exactly what to do when you get sick. For example, you should know:

• Whether you will need insulin (or extra insulin);
• When to call the doctor;
• What soft food and drink you should have on hand in case you can’t eat normally;
• What extra medicine you may need (for example, to settle your stomach).

Some General Rules For When You Are Ill

• Call the doctor if your blood sugar is over 300.
• Drink plenty of fluids. Drink at least one 8-ounce cup of water every hour (people with diabetes can get sick if they are dehydrated).
• If your blood sugar is low and you can’t eat, drink juice or regular (not diet) soda to keep your blood sugar up.
• If you can’t keep anything down, suck on ice chips, then sip clear soda, such as regular ginger ale.
• Keep taking your medicine.
• Have someone look in on you or call you every few hours.
• Call the diabetes team if you have any questions, or if you start to feel worse.

How Do You Avoid Complications From Diabetes?

People with diabetes have a high risk of many serious health problems. That’s because when you have more sugar than normal in your blood, it can damage blood vessels and nerves. This can lead to:

• Problems with eyes
• Problems with kidneys
• Problems with nerves, especially in the feet
• Problems with teeth and skin

People who control their blood sugar have fewer diabetes complications. The best thing you can do for your health is to:

• Keep testing your blood regularly.
• Keep eating healthy food, and eating regularly.
• Keep exercising.
• Keep taking your medication.
• Make sure that your blood pressure and levels of fat in your blood are normal to avoid heard disease and strokes.

You can also catch any problems early, and treat them before they become too serious.

If You Smoke – Quit!

Smoking can make the problems of diabetes far, far worse. Smokers are likely to get complications much sooner than others.

If you smoke, quit! Ask your doctor about new methods of quitting. There are now pills that can help (bupropion), as well as nicotine replacement systems such as patches or gum.

Cut Your Risk For Heart Disease

You can keep your risk of heart disease low by taking care of your health:

• Control your weight.
• Exercise regularly.
• Eat a low-fat diet, with plenty of vegetables.

If you have pills to control blood pressure, or cholesterol, take them every day, even if you feel fine.

Care For Your Kidneys

Your doctor will check your kidneys regularly. In addition, it’s important to tell the doctor any time you get symptoms of a bladder infection-having to urinate more often than usual, and feeling pain or a burning sensation when you urinate. Then the infection can be treated before it causes damage.

Care For Your Eyes

See the eye doctor at least every year. Diabetes can cause damage to the retina in the back of the eye. You may not get any symptoms, but the doctor can see if damage is starting. Early care can prevent blindness.

Care For Your Mouth

You have a higher risk of gum disease than average, and may get mouth sores that don’t heal.

• See your dentist regularly (every three to six months).
• Brush and floss your teeth regularly.
• See the dentist if you get any sores in the mouth.

Care for Your Feet

Your feet may not get a good blood supply, which means that sores won’t heal. In addition, damage to your nerves may mean you can’t feel sores, cuts, and other injuries to your feet.

• Calluses indicate that areas of the feet are receiving too much pressure. If the increased pressure continues, the skin may break down and you may get a foot ulcer.
• If your feet start to feel numb, tell the diabetes team, and show them your feet on every visit.
• Check your feet every day yourself. If you have any cuts or sores that don’t heal in a couple of days, tell the doctor.
• Avoid shoes that pinch or cause blisters.
• Always wear shoes, even in the house.
• Wash your feet at least once a day. Dry carefully and rub with a lanolin skin cream (except between the toes).
• Cut or file toenails straight across. If that is hard for you, have the nurse do it.
• Don’t try to treat corns or calluses yourself. Show calluses to your doctor or health care team at each visit. He or she may refer you to a podiatrist (a foot specialist).
• Make sure bathwater won’t burn your feet. Test it with your hand or elbow first.
• If your feet are cold at night, wear socks. Don’t warm them with hot water bottles or electric blankets, which may burn the feet.

Other Problems with Nerves

Tell your doctor if you start to feel other problems with your nerves. These may show up in many parts of the body. For example:

• You may have trouble with digestion
• Men may start to have erectile dysfunction (inability to achieve or maintain an erection).
• You may feel dizzy when you stand up.
• You may notice long periods of time between urinating and emptying your bladder.

Your doctor may be able to help stop the damage to the nerves before it worsens.

Depression

People with diabetes may get depressed. Keep in mind that depression can be treated. Symptoms of depression include:

• Persistent sad mood
• Feelings of hopelessness and pessimism
• Feelings of guilt, worthlessness, and helplessness
• Loss of interest or pleasure in activities that were once enjoyed
• Feeling tired or low-energy all the time
• Difficulty concentrating, remembering, making decisions
• Changes in sleep habits
• Loss of appetite and weight loss, or overeating and weight gain
• Thoughts of death or suicide
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Tell your health care team if you experience any of these symptoms for days at a time. You may need medication or counseling.

There are support groups available for people with diabetes. Sometimes talking with others who share your condition can help you cope and feel less alone. Talk to your doctor about finding a support group in your area.

When in doubt, talk to health care team.

Diabetes in Adults: Frequently Asked Questions

Here are some frequently asked questions related to diabetes.

Q: I know several people who have type 2 diabetes, and I’m concerned about my own risk. Should I get tested for the condition?

A: If you are over 45 years old, have a family history of diabetes, are significantly overweight, or are sedentary, you should get tested for diabetes during your regular physical. If your doctor suspects diabetes, you may need to have an oral glucose tolerance test.

Q: My nutritionist told me that one key to losing weight and controlling my blood sugar is portion size. How big should food servings be?

A: When you have diabetes, it’s important to keep track of not only what you eat, but how much. Serving sizes for the different foods in the food pyramid are listed below:One serving of fruit equals:

• 1 medium piece of fresh fruit
• 3/4 cup (6 ounces) of pure fruit juice
• 1/2 cup of berries
• 1/4 cup of dried fruit

One serving of grain equals:

• 1 slice of bread
• 1/2 a bagel, pita, or English muffin
• 1 6-inch tortilla
• 1/2 cup of cooked rice, pasta, oatmeal, or other grains
• 1 cup cold cereal

One serving of vegetables equals:

• 1/2 cup cooked or chopped, raw, nonleafy vegetables (green beans, broccoli, carrots, peppers, etc.)
• 1 cup chopped, raw, leafy greens (lettuce, spinach, kale, etc.)
• 1 cup vegetable juice

One serving of protein equals:

• 3 ounces lean meat, poultry, or fish (about the size of a deck of cards)
• 1 cup tofu
• 2 veggie burgers
• 1 cup cooked dried beans or peas
• 2 eggs
• 1/2 cup of tuna
• 2 slices of sandwich meat
• 4 tablespoons peanut butter

One serving of dairy equals:

• 1 cup (8 ounces) milk, yogurt, or frozen yogurt
• 1/2 ounce of cheese (about the size of your thumb)

When eating packaged foods, make sure you read the food label to see how many servings the package contains.

Q: What types of exercise are best for people with diabetes?

A: Any type of exercise that is aerobic, that is, activities that work your heart and lungs, are good. These include walking, biking, swimming, aerobics, rowing, in-line skating-anything that gets the large muscles of your body working, gets your heart pumping and makes blood flow through your body. If you have been sedentary for a long time, talk to your doctor before starting to exercise, and perhaps start out with short, easy walks at first until you build yourself up.

Q: Are foods or beverages made with artificial sweeteners OK for people with diabetes?

A: Most foods and beverages made with artificial sweeteners are low in calories and are fine for people with diabetes. However, read labels to find out the fat and calorie content of the item and make sure it fits into your overall eating plan. Artificial sweeteners include:

• Saccharin (Sugar Twin, Sweet’n Low)
• Aspartame (NutraSweet, Equal)
• Acesulfame potassium (Sweet One)

Diabetes in Adults: Putting It All Together

Here is a summary of the important facts and information related to diabetes.

• Diabetes is caused by lack of insulin, a hormone that is essential for getting energy from food.
• There are two types of diabetes. In type 1 diabetes, which often starts in children, the body stops making insulin completely. In type 2 diabetes, the body still makes some insulin, but cannot use it properly.
• Diabetes is at epidemic proportions in the United States. About 17 million people in the U.S. have type 2 diabetes. One third of those people are unaware that they have the condition.
• Several factors put people at higher risk for diabetes, including obesity, a family history of the condition, and a sedentary lifestyle.
• A doctor diagnoses diabetes using a blood test to measure glucose levels in the blood. A special test called an oral glucose tolerance test may also be necessary.
• Diabetes usually requires a team of treatment specialists, including a regular doctor, a diabetes educator who may be a registered nurse, a nutritionist, and an endocrinologist.
• Diabetes can often be initially controlled through lifestyle changes, such as losing weight, eating a healthy diet and following a diabetes meal plan, and getting regular exercise.
• Several medications are available to help treat diabetes. These are usually taken in pill form and either help the body make more insulin or help the body’s cells use insulin more efficiently.
• The key to diabetes management is controlling blood sugar and avoiding hyperglycemia and hypoglycemia. People with diabetes must monitor their blood sugar regularly using a glucose meter.
• People whose bodies don’t make any insulin, or who are not helped adequately by medication, may need to take daily insulin shots.
• Diabetes can cause complications, including heart disease, nerve damage, and blindness. Proper management of the condition through diet, exercise, and medication can help prevent complications.
• Diabetes has emotional and mental implications as well as physical ones. People who have diabetes should know the symptoms of depression, talk to their treatment team about how they are feeling, and perhaps join a support group.

Diabetes in Adults: Glossary

Here are definitions of medical terms related to diabetes.

Amino acids: Building blocks of proteins

Beta cells: Insulin-producing cells of the islets of Langerhans in the pancreas.

Body mass index: A measurement of the percentage of fat to muscle in the human body. To determine body mass index, weight in kilograms is divided by height in meters. A body mass index higher than 25 indicates overweight.

Endocrinologist: A physician who specializes in the endocrine system, which is the network of glands and other structures that secrete hormones and affect the function of certain organs.

Finger stick: The act of puncturing the tip of the finger to get a small sample of blood.

Glucagon: A hormone made in the pancreas that raises blood sugar levels. It can be given by injection to treat severe hypoglycemia.

Glucose: Commonly referred to as “sugar,” it is the major source of energy used by the body’s cells. It is taken from foods we eat and can be made from protein.

Glucose meter: A special device used to measure blood sugar levels.

Hemoglobin A1c test (HB A1c): This test indicates the average level of blood sugar over the previous three ot four months. It shows how well blood sugar levels are being controlled.

High-density lipoprotein (HDL) cholesterol: “Good” cholesterol. High HDL cholesterollevels are associated with a decreased risk of heart disease.

Hormone: A chemical messenger secreted by a gland that then travels in the blood to act on other parts of the body.

Hypertension: Higher than normal blood pressure. Hypertension can cause heart disease, strokes, kidney and eye damage.

Hyperglycemia: High levels of sugar in the blood. In diabetes, this can happen if there is not enough insulin or because of unusual food intake, less activity, illness, or other stress.

Impaired fasting glucose: A blood glucose level before breakfast that is higher than normal but lower than the value to diagnose diabetes. It is one of the risk factors that is associated with developing diabetes or heart disease in the future.

Hypoglycemia: Not enough sugar in the blood for those tissues that depend mainly on sugar for energy, such as the brain. This can happen after exercise, taking more insulin than usual, or skipping eating.

Impaired glucose tolerance: High blood glucose level that develops after a carbohydrate-rich meal or test dosage of glucose. Does not necessarily indicate diabetes, but may be a sign that the condition could develop later in life.

Insulin: A hormone made in the pancreas. It regulates the way sugar, fat, and protein are moved into the cells, and the way they are stored or used for energy.

Ketoacidosis: A condition caused by lack of insulin that could result in severe dehydration and a high-acid condition in the body.

Ketones: Acids created by the process within the body of burning fat; if the body produces too many ketones, they are excreted in the urine.

Lancet: A short pointed blade used to obtain a drop of blood; it has a guard above the blade that prevents a deep incision.

Low density lipoprotein (LDL) cholesterol: “Bad” cholesterol. High LDL cholesterol levels are associated with an increased risk of heart disease.

Neuropathy: A disease or condition of the nervous system; nerve damage.

Oral glucose tolerance test: A special test used to diagnose diabetes and determine how well the body metabolizes glucose.

Pancreas: The organ inside the abdomen that secretes various substances, including enzymes needed for digestion, insulin, and glucagon.

Triglyceride: The chief ingredient in fats and oils. High levels in the blood are associated with heart disease.

Diabetes in Adults: Additional Sources of Information

Here are some reliable sources that can provide more information on diabetes.

American Diabetes Association 
Phone: 1-800-DIABETES (1-800-832-6874)
http://www.diabetes.org

National Diabetes Information Clearinghouse 
Phone: 1-301-654-3327
http://www.niddk.nih.gov

MedicAlert Foundation International 
Phone: 1-800-432-5378 
http://www.medicalert.org