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 the main source of energy for the cells that make up your muscles and tissues. It's your body'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 somewhat, depending on what type of diabetes you have. If you have prediabetes or gestational diabetes, you may not experience symptoms. Or you might experience some or all of the symptoms of type 1 and type 2 diabetes:
� Increased thirst
� Frequent urination
� Extreme hunger
� Unexplained weight loss
� Fatigue
� Blurred vision
� Slow-healing sores
� 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 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 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 by 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, for example, your liver releases stored glucose to keep your glucose level within a normal range.
How diabetes affects your blood sugar :
Causes of type 1 diabetes
In type 1 diabetes, your immune system � which normally fights harmful bacteria or viruses � attacks and destroys the 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.
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 excess fat � especially abdominal fat � and inactivity seem to be important factors.
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, family history may play a role. Your risk of developing type 1 diabetes increases if you have a parent or sibling who has type 1 diabetes. Other factors have been proposed, as well, such as exposure to a viral illness.
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.
� 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 Asian-Americans � are at higher risk.
� Age. Your risk increases as you get older, especially after age 45. Often, that's 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.
Other conditions associated with diabetes include:
� High blood pressure
� High levels of low-density lipoprotein (LDL), or "bad," cholesterol
� Low levels of high-density lipoprotein (HDL), or "good," cholesterol
� High levels of triglycerides, another fat in the blood
When these conditions � high blood pressure, high blood sugar and abnormal blood fats � occur together with obesity, they are associated with resistance to insulin.
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
Diabetes complications vary depending on the type of diabetes you have.
Complications of type 1 and type 2 diabetes
Short-term complications of type 1 and type 2 diabetes require immediate care. Left untreated, these conditions can cause seizures and a state of unconsciousness (coma).
� 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.
� Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces potentially toxic acids known as ketones.
� 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.
Long-term complications of diabetes develop gradually. The earlier you develop diabetes � and the less controlled your blood sugar � the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening.
� 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 twice as 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 over a period of months or years 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 problems with 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.
� Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness.
� 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 infections, fungal infections and itching. Gum infections also may be a concern, especially if you have a history of poor dental hygiene.
� Bone and joint problems. Diabetes may put you at risk of bone and joint problems such as osteoporosis.
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 become wedged in the birth canal, sustain birth injuries or 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. Rarely, untreated gestational diabetes results 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. Left untreated, 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.
Prediabetes may develop into type 2 diabetes.
Tests and diagnosis
Tests for type 1 and type 2 diabetes
In June 2009, an international committee composed of experts from the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation recommended that type 1 and type 2 diabetes testing include 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 of 6.5 percent or higher on two separate tests indicates you have diabetes.
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:
� 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 70 and 99 mg/dL (3.9 and 5.5 mmol/L) is normal. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you'll be diagnosed with diabetes.
Tests for gestational diabetes
Screening for gestational diabetes is a routine part of prenatal care. Most health care providers recommend a blood test known as a glucose challenge test between the 24th and 28th weeks of pregnancy � or earlier if you're at particularly high risk of gestational diabetes.
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 above 140 mg/dL (7.8 mmol/L) usually indicates gestational diabetes, but you'll likely need a second test to confirm the diagnosis.
For the follow-up test, you'll be asked to fast overnight. 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.
Tests for prediabetes
The American College of Endocrinology suggests prediabetes testing for anyone who has a family history of type 2 diabetes and for those who are obese or have metabolic syndrome. Women with a personal history of gestational diabetes also should be tested.
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 6 and 6.5 percent suggests you have prediabetes.
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.
� 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). A blood sugar level of 200 mg/dL (11.1 mmol/L) or higher may indicate diabetes.
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 select people.
But no matter what type of diabetes you have, maintaining a healthy diet, exercising and keeping a healthy weight are all keys to managing your diabetes.
Treatments for all types of diabetes
An important part of managing all types of diabetes includes 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. Once you've covered the basics, remember the importance of consistency. To keep your blood sugar on an even keel, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.
� 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 and type 2 diabetes primarily involves monitoring of your blood sugar along with insulin, other diabetes medications 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 several times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.
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 need insulin, as well. 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. The pump is programmed to dispense specific amounts of insulin automatically. 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. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease.
� Transplantation. In some people who have type 1 diabetes, a pancreas transplant may be an option. Other types of transplants are being studied as well. With a successful pancreas transplant, you would no longer need insulin therapy. But pancreas transplants aren't always successful � and the procedure poses serious risks. You'd need a lifetime of potent 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, pancreas transplants are usually reserved for people whose diabetes can't be controlled or those who have serious complications.
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.
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. This includes if 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 to achieve desired goals. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease. Healthy lifestyle choices remain key, however.
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.
Lifestyle for all diabetes
No matter what type of diabetes you have:
� Make a commitment to managing your diabetes. Learn all you can about diabetes. Make healthy eating and physical activity part of your daily routine. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it.
� 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 twice a year. Consult your dentist right away if your gums bleed or look red or swollen.
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, as well as 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 may recommend the pneumonia vaccine or other immunizations as well.
� 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 within a few days.
� 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.
� 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. In fact, smokers who have diabetes are three times 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.
� 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.
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) and rosiglitazone (Avandia) may reduce the risk of type 2 diabetes � but healthy lifestyle choices remain essential.
Blood sugar testing
Gather your tools
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Touch test strip to blood
View your results
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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 the main source of energy for the cells that make up your muscles and tissues. It's your body'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 somewhat, depending on what type of diabetes you have. If you have prediabetes or gestational diabetes, you may not experience symptoms. Or you might experience some or all of the symptoms of type 1 and type 2 diabetes:
� Increased thirst
� Frequent urination
� Extreme hunger
� Unexplained weight loss
� Fatigue
� Blurred vision
� Slow-healing sores
� 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 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 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 by 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, for example, your liver releases stored glucose to keep your glucose level within a normal range.
How diabetes affects your blood sugar :
Causes of type 1 diabetes
In type 1 diabetes, your immune system � which normally fights harmful bacteria or viruses � attacks and destroys the 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.
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 excess fat � especially abdominal fat � and inactivity seem to be important factors.
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, family history may play a role. Your risk of developing type 1 diabetes increases if you have a parent or sibling who has type 1 diabetes. Other factors have been proposed, as well, such as exposure to a viral illness.
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.
� 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 Asian-Americans � are at higher risk.
� Age. Your risk increases as you get older, especially after age 45. Often, that's 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.
Other conditions associated with diabetes include:
� High blood pressure
� High levels of low-density lipoprotein (LDL), or "bad," cholesterol
� Low levels of high-density lipoprotein (HDL), or "good," cholesterol
� High levels of triglycerides, another fat in the blood
When these conditions � high blood pressure, high blood sugar and abnormal blood fats � occur together with obesity, they are associated with resistance to insulin.
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
Diabetes complications vary depending on the type of diabetes you have.
Complications of type 1 and type 2 diabetes
Short-term complications of type 1 and type 2 diabetes require immediate care. Left untreated, these conditions can cause seizures and a state of unconsciousness (coma).
� 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.
� Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces potentially toxic acids known as ketones.
� 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.
Long-term complications of diabetes develop gradually. The earlier you develop diabetes � and the less controlled your blood sugar � the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening.
� 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 twice as 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 over a period of months or years 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 problems with 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.
� Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness.
� 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 infections, fungal infections and itching. Gum infections also may be a concern, especially if you have a history of poor dental hygiene.
� Bone and joint problems. Diabetes may put you at risk of bone and joint problems such as osteoporosis.
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 become wedged in the birth canal, sustain birth injuries or 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. Rarely, untreated gestational diabetes results 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. Left untreated, 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.
Prediabetes may develop into type 2 diabetes.
Tests and diagnosis
Tests for type 1 and type 2 diabetes
In June 2009, an international committee composed of experts from the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation recommended that type 1 and type 2 diabetes testing include 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 of 6.5 percent or higher on two separate tests indicates you have diabetes.
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:
� 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 70 and 99 mg/dL (3.9 and 5.5 mmol/L) is normal. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you'll be diagnosed with diabetes.
Tests for gestational diabetes
Screening for gestational diabetes is a routine part of prenatal care. Most health care providers recommend a blood test known as a glucose challenge test between the 24th and 28th weeks of pregnancy � or earlier if you're at particularly high risk of gestational diabetes.
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 above 140 mg/dL (7.8 mmol/L) usually indicates gestational diabetes, but you'll likely need a second test to confirm the diagnosis.
For the follow-up test, you'll be asked to fast overnight. 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.
Tests for prediabetes
The American College of Endocrinology suggests prediabetes testing for anyone who has a family history of type 2 diabetes and for those who are obese or have metabolic syndrome. Women with a personal history of gestational diabetes also should be tested.
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 6 and 6.5 percent suggests you have prediabetes.
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.
� 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). A blood sugar level of 200 mg/dL (11.1 mmol/L) or higher may indicate diabetes.
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 select people.
But no matter what type of diabetes you have, maintaining a healthy diet, exercising and keeping a healthy weight are all keys to managing your diabetes.
Treatments for all types of diabetes
An important part of managing all types of diabetes includes 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. Once you've covered the basics, remember the importance of consistency. To keep your blood sugar on an even keel, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.
� 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 and type 2 diabetes primarily involves monitoring of your blood sugar along with insulin, other diabetes medications 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 several times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.
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 need insulin, as well. 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. The pump is programmed to dispense specific amounts of insulin automatically. 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. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease.
� Transplantation. In some people who have type 1 diabetes, a pancreas transplant may be an option. Other types of transplants are being studied as well. With a successful pancreas transplant, you would no longer need insulin therapy. But pancreas transplants aren't always successful � and the procedure poses serious risks. You'd need a lifetime of potent 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, pancreas transplants are usually reserved for people whose diabetes can't be controlled or those who have serious complications.
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.
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. This includes if 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 to achieve desired goals. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease. Healthy lifestyle choices remain key, however.
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.
Lifestyle for all diabetes
No matter what type of diabetes you have:
� Make a commitment to managing your diabetes. Learn all you can about diabetes. Make healthy eating and physical activity part of your daily routine. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it.
� 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 twice a year. Consult your dentist right away if your gums bleed or look red or swollen.
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, as well as 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 may recommend the pneumonia vaccine or other immunizations as well.
� 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 within a few days.
� 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.
� 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. In fact, smokers who have diabetes are three times 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.
� 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.
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) and rosiglitazone (Avandia) may reduce the risk of type 2 diabetes � but healthy lifestyle choices remain essential.
Blood sugar testing
Gather your tools
Blood sugar testing is usually done with a special needle called a lancet and an electronic glucose monitor. Start by gathering your supplies:
- Computer connecting cord (available with some glucose monitors)
- Lancet
- Glucose monitor carrying case
- Glucose monitor
- Lancing device
- Lancing device cap with dial to set depth of skin puncture
- Test strip
- Vial containing test strips
Wash your hands
Wash your hands with soap and warm water. Dry them completely. If you don't have access to soap and warm water, use an alcohol pad to clean the area you plan to stick. Dry the area completely before pricking your skin.
Insert test strip
Remove a test strip from its container and fully insert the test strip into the monitor.
Some glucose monitors must be coded every time you open a new vial of test strips. If your monitor needs coding, follow the manufacturer's instructions.
Prick your fingertip
Attach the lancing device cap onto the lancing device if it isn't already attached. Use the depth dial on the top of the lancing device to select the penetration depth of your lancing tip. Place the tip covering the lancet on the side of your fingertip, which is less sensitive than is the flat side of the tip of your finger. Press the button to discharge the lancet.
Depending on your glucose monitor, you may be able to test your blood glucose from other sites, such as your forearm or thigh. But check with your doctor or diabetes educator first to find out if alternative site testing is appropriate in your case.
Touch test strip to blood
Hold your hand down to encourage a drop of blood to emerge. If the blood doesn't come out easily, gently squeeze the end of your finger. Touch the drop of blood with the test strip. The blood will be absorbed by the wicking action of the test strip.
View your results
Within a few seconds, the monitor displays your blood glucose level on a screen. If you think something's not right, do a quality control test according to the manufacturer's instructions and check the owner's manual for other troubleshooting issues.
Discard your lancet
Place the used lancet in a safe container � one that prevents people from sticking themselves. Also, safely discard needles and syringes that are used to inject insulin or diabetes medications. Safe disposal boxes are available at health care supply stores and many pharmacies. Alternatively, you could use a heavy-duty plastic container, such as an empty laundry detergent bottle. When the container is full, ask your waste management company about proper disposal. Containers with used lancets and needles are considered hazardous waste.
Record your results
Each time you perform a blood test, log your results. Record the date, time, test results, medication and dosage, and diet and exercise information. Some people use a notebook, record book or journal. Or, depending on your blood glucose monitor, you may be able to download the information to your computer or transfer the information to a mobile device or an online tracking program. The more complete your records are, the more useful they'll be.
You'll need this record when you visit your doctor or other members of your diabetes health care team for checkups.
Store your equipment
You may want to keep your diabetes supplies in a small carrying case for easy access when you're on the go. Take special care to keep your equipment out of hot or cold places, such as the glove compartment in your car in summer or winter. When you travel, place your medication prescription with your glucose testing kit. Carry these items with you, rather than stowing them in your luggage. Diabetes-related medication, equipment and supplies are permitted through airport security checkpoints.
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