Diabetes FAQ - Frequently Asked Questions File

This is a list of frequently asked questions (FAQ) about diabetes.  This should be used to give yourself a basic understanding of diabetes.  It should in no way take the place of getting competent medical care.  If you think you have diabetes get to a doctor as soon as possible so you can get treatment.  If you already have diabetes use this FAQ to reintroduce yourself to the basics of diabetes.  If there is a part of this FAQ you don't understand or if there's something you'd like to see added to this FAQ please let me know.  IF YOU DISTRIBUTE THIS FAQ PLEASE DO NOT MAKE ANY CHANGES OR CORRECTIONS.  If you believe an error is present or you'd like to see an addition made to this FAQ please send an e- mail to BELVE@AOL.COM
 

INDEX

*Symptoms
*The Pancreas
*Types Of Diabetes
*Complications
*Insulin & Oral Medications
*Diet
*Exercise
*Miscellaneous
 

SYMPTOMS

What are the symptoms of untreated diabetes?
The symptoms of diabetes include increased thirst, numbness or tingling in the arms or legs, frequent infections, drowsiness, diarrhea, weight loss, blurred vision, frequent urination, fatigue.

What is DKA?
DKA occurs when a person has an abnormally low insulin level in their body.  Excess fatty acids leak from the fat cells into the blood because there isn't enough insulin to keep them stored properly.  These fatty acids are carried to the liver and muscles which burn them as fuel.  In the liver these fatty acids are not completely burned up and the left over substance is ketones.  Eventually these ketones are spilled out in the urine or might even be breathed out through the
lungs (in severe cases)  This condition can poison the whole body and must be treated as soon as possible.

What are ketones?
Ketones are fragments of fatty acids that occur in the blood due to the breakdown of the body's fatty acids because there isn't enough insulin in the body.  When ketones are present a person MUST get treated for their diabetes immediately.

What are the symptoms of diabetic ketoacidosis?
The symptoms of diabetic ketoacidosis includes, abdominal pain, nausea, vomiting, thirst, weakness, increased heart rate, decreased blood pressure, dry skin and an increased respiratory rate.

What's a BG?
 is an abbreviation for blood glucose.

What is glucose?
Glucose is a form of sugar, usually blood sugar.

What is the normal range for blood glucose?
The normal range for blood glucose should be between 70-120.

What is hyperglycemia?
Hyperglycemia occurs when the blood glucose is higher than normal.

What is hypoglycemia?
Hypoglycemia occurs when the blood glucose is lower than normal.
 
 

THE PANCREAS

What is the pancreas?
The pancreas is an oblong organ located below and behind the stomach that is about one-tenth the size of the liver.  The pancreas secretes insulin into the blood.

What are the Isles of Langerhans?
The Isles of Langerhans are clusters of cells in the pancreas named for their discoverer Paul Langerhans.

What are beta cells?
Beta cells are located in the Islets of Langerhans and are responsible for the manufacturing and secreting of insulin into the blood stream.

What are alpha cells?
Alpha cells are also in the pancreas and are responsible for the manufacturing of glucagon.

What is glucagon?
Glucagon is a hormone produced by the alpha cells in the pancreas which raises blood sugar by breaking down glycogen.  Glucagon can also be injected if you experience a low blood sugar reaction.

What is glycogen?
Glycogen is the form in which you body stores glucose in your liver and muscles.  Glycogen is broken down by glucagon to help raise your blood sugar if you experience a low blood sugar reaction.
 
 

TYPES OF DIABETES

What are the types of diabetes?
Basically there are three types of diabetes: Type I, Type II. and Gestational diabetes.

What is Type I diabetes?
Type I diabetes is also known as "juvenile diabetes".  It is usually diagnosed in children and young adults, but it can occur at any age.  Type I diabetics produce little or no insulin and must inject insulin into their bodies.  Only 10-15 percent of all diabetics are Type I.

What is Type II diabetes?
Type II diabetes is also known as "adult onset diabetes".  Type II diabetics the beta cells are
producing insulin, or even too much insulin but their bodies do not use the insulin efficiently. Type II diabetics can be treated with oral medications, diet & exercise, or insulin.  85-90 percent of all diabetics are Type II.

What is Gestational diabetes?
Gestational diabetes occurs in non-diabetic pregnant women.  It is caused by hormonal changes and the increased nutritional intake she needs to support the baby.  The condition is usually temporary and goes away after the baby is born.

What is a honeymoon?
In most Type I diabetics all the beta cells are not destroyed all at once.  Shortly after a Type I diabetic begins insulin treatment he might go through a "honeymoon stage" when the diabetes becomes less severe.  The person might need little or no insulin during this time.  The person usually requires more insulin after awhile and the honeymoon period ends.
 

PREGNANCY & DIABETES (Gestational Diabetes)

What causes Gestational Diabetes?
Gestational diabetes occurs in pregnant women.

Can high blood sugars affect the fetus?
Yes, it's important that a woman have her blood glucose levels in control BEFORE she becomes pregnant.  Once the egg is fertilized and starts dividing specialized organs and tissues are formed and it's imperative that the mother's diabetes be in good control (as possible)

Can pregnant women take oral medications to control gestational diabetes?
Oral medications are NOT recommended for pregnant women.  Insulin therapy is recommended.

What can happen to the baby if the mother's blood glucose levels stay high during pregnancy?
If a mother's blood glucose levels stay high during pregnancy the baby's pancreas will overproduce insulin to bring it's own blood glucose levels down.  When the baby is born and the umbilical cord is cut the baby's pancreas cannot shut off the supply of insulin quickly enough and the baby can go into hypoglycemia (low blood sugar) very quickly.  The baby's brain must have glucose and the hypoglycemia can cut off the brains supply of glucose. Poorly controlled pregnant women can also have large (11 or 12 pound) babies whose lungs are not fully developed.
 
 

COMPLICATIONS

What are some complications of diabetes?
Some complications of diabetes can be neuropathy (nerve damage), retinopathy (eye damage), nephropathy (kidney damage), cardiovascular damage, and blindness.

Do only people with Type I diabetes get complications?
No, both Type I and Type II diabetics can get diabetic complications.  As a matter of fact, it's a diabetic complication that sometimes sends a Type II diabetic to the doctor where the diagnosis is made.
 
 

INSULIN & ORAL MEDICATIONS

What is insulin?
Insulin is a hormone produced by the pancreas which is secreted into the blood to help regulate blood glucose.

Are oral medications the same as insulin?
No, there are some oral medications that promote the release of the existing insulin reserves in a direct response to blood glucose levels.  Other medications increase the number of insulin
receptions on the muscle and fat cells in the body so the available insulin is more effective.  There is also another type of medication that works on the liver.  It interferes with the liver's production of glucose which keeps down the levels of sugar in the blood stream.  Oral medications used to control diabetes are not oral forms of insulin.

Can oral medications and insulin be taken at the same time?
Oral medications are sometimes used with insulin to treat diabetes.

Where does the insulin people inject come from?
The insulin diabetics inject can come from animals (cows or pigs) or it can be manufactured in the
laboratory to resemble human insulin.

Does using insulin cause side effects?
Insulin does cause side effects in some people.  The most common side effect is low blood sugar (also called an insulin reaction or hypoglycemia).  Another side effect is weight gain.

What are the symptoms of low blood sugar?
The symptoms of low blood sugar include shakiness, sweating, rapid heartbeat, restlessness, hunger, anxiety, fatigue, irritability, headache, loss of concentration, changes in vision, unconsciousness and seizure.

How do I treat an insulin reaction?
If the person can eat try to give them a quick source of sugar (juice, cake icing, soda, etc..)  If the
person is unconscious and has a glucagon kit you may be able to give them an injection of glucagon to help get their liver to release it's stored glucose.  If you don't know how to use a glucagon kit ask your doctor.

When can an insulin reaction occur?
An insulin reaction can occur when a person with diabetes, who is taking medication to help control their diabetes, skips a meal, exercises too much, eats too little food, or is under stress.

Can someone be allergic to insulin?
People can be allergic to insulin.  The allergy usually shows up as a rash at the injection site or over the entire body.

Besides being animal or human what else can be different about insulin?
Insulin are also categorized based on their action time: short-acting (Regular), intermediate-acting
(Lente, NPH), long-acting (Ultralente) and fixed combinations (70%, NPH/30% Regular or 50% NPH/50% Regular)

What is the action time of insulin?
The action time of insulin refers to the onset (how quickly the insulin starts to take effect, the peak
(the point at which the insulin works at it's maximum effect) and the duration (how long the insulin's effects last).

What is the strength of insulin?
The strength of insulin refers to the number of units of insulin per milliliter of fluid.  U-100 is the most commonly used insulin concentration in the United States.  U-100 means it has 100 units of insulin per milliliter.  The most commonly used concentration in other countries is U-40 which means it has 40 units of insulin per milliliter of fluid.  The syringe used to inject insulin must correspond with the concentration of the insulin.  If you used U-100 insulin with a U-40 syringe you'll inject more than double the insulin you need.

How should insulin be injected?
Your doctor or nurse will show you how to properly inject insulin but there are a few basics of the
injection procedure.

1. Wash your hands thoroughly with soap and water.

2. Roll the vial(s) of insulin between your hands to make sure the insulin is mixed thoroughly.  Look at the insulin.  Regular insulin should look clear and colorless, having a water-like consistency.  NPH, Lente and Ultralente insulin should have a cloudy or milky appearance.  Make sure the insulin doesn't swirl, appear frosted, gummy or have clumping or crystals.  If
you see any of these things in your insulin return the insulin to your pharmacy for a new one.

3.  Clean the top(s) of the insulin vials with an alcohol wipe.

4.  Draw up the amount of air equal to the amount of insulin you want to put into the syringe.  Inject that air into the vial.  If you will be mixing a combination of insulin in the syringe do this with each vial.

5. Draw up the insulin to the dose desired.  Make sure there are no air bubbles in the syringe.  When mixing insulin always draw up the Regular insulin first then draw up the longer-acting insulin second.

6. Choose the injection site and clean it thoroughly with soap and water.  Insulin should be injected into fatty tissue (found in the arms, thighs, abdomen, etc.)

7.  Stretch out or pinch up the skin.  Insert the needle at an angle (45 degrees in a child, 90 degrees
in an adult) and inject the insulin making sure the needle is all the way in and all of the insulin is
released from the syringe.

8. Release the skin and remove the needle.

9. Use a clean wipe and place mild pressure on the injection site.

10.  Safely dispose of the used needle and syringe.  Try to use a special disposal container you purchase or another kind of unbreakable container with tight-fitting cap.

Is a syringe the only way to take insulin?
No, there are also insulin pens, spray injectors and insulin pumps.

How should insulin be stored?
Insulin should be stored at room temperature.  Keep extra vials of insulin cool but not too cold (no colder than 40 degrees).  Never place insulin in a temperature hotter than 70 or 80 degrees.
 
 

DIET

Should diabetics drink alcohol?
If a diabetic has his diabetes under good control alcohol can be included in the diet IF it's worked into a menu plan.  A poorly controlled diabetic might have problems if they drink alcohol.  Alcohol affects metabolism and is soluble in lipids (fats).  Diabetics who drink may also be more susceptible to neuropathy.  Alcohol is a concentrated source of calories with no nutrients.  It's recommended that diabetics only consume one or two alcoholic beverages a week.

What is the Glycemic Index?
The Glycemic Index measures how quickly a carbohydrate food causes blood sugar to increase.

What is a carbohydrate?
A carbohydrate is a sugar, starch or fiber that is used by the body for fuel.

What is metabolism?
Metabolism are all the chemical and physical processes the body utilizes to turn food into fuel.
 
 

EXERCISE

(Don't start any exercise program unless you discuss it with your doctor BEFORE you begin)

Why is it important for people with diabetes to exercise?
It's important for people with diabetes to exercise because along with medication and/or diet exercise helps control blood glucose levels.

Can exercise take the place of medication?
Some Type II diabetics can control their diabetes with a change in diet and exercise.

How does insulin help the body control diabetes?
Exercise helps improve the body's insulin resistance.  Exercise also helps to control or lose weight.
Exercise helps your muscles increase their ability to transport glucose and to become more sensitive to the insulin in your body.

Is exercise good for a Type I diabetic?
Type I diabetics also benefit from regular exercise.  It can help improve their fitness level, stamina,
flexibility, and help keep unwanted pounds away.

How long does exercise affect blood glucose levels?
Exercise can affect blood glucose levels for up to 36 hours after the exercise is done.  It's important to pay close attention to the blood glucose level in case any adjustments have to be made to medication dosages.

How often should blood glucose levels be tested if a person is exercising?
If a diabetic is exercising blood glucose levels should be tested before, during, and after the exercise is done.  Frequent tests should be done if the person is exercising over a long period of time or if they feel like they're having an insulin reaction.

Why do blood glucose levels have to be tested more if a person is exercising?
Blood glucose levels have to be tested more often during exercise because exercise can make the blood glucose levels change without warning.  Self blood glucose monitoring plays a vital role in the exercise program for a diabetic taking medication (insulin or orals).  The test results are needed to obtain information to balance the food, medication and exercise (exercise and timing) to avoid abnormal and potentially dangerous blood glucose levels.
 

What should be done if the blood sugar drops too low during exercise?
If the blood sugar drops too low during exercise the person should eat a quick source of sugar (juice, cake icing, etc.) to help bring the blood sugar back up.  A drop in blood sugar (also called hypoglycemia or an insulin reaction) most likely will occur in a diabetic on medication.

Will exercise always lower blood glucose levels?
No, not all the time.  If a diabetic is in poor control or tries to exercise when his or her blood glucose level is 250 or higher before starting the exercise, the blood glucose level can go higher.  If your blood glucose is 250 or higher DON'T EXERCISE.  Wait until your get your blood glucose levels under control.

Can a person with neuropathy exercise?
A person with neuropathy can exercise but they will have to make certain adjustments.  They might try flexibility exercises or swimming to keep the pressure off their feet.

Are there any special items needed to start an exercise program?
If a person is taking medication to control their diabetes it's important they carry some fast-acting
carbohydrate (regular soda, glucose tablets, cake icing) with them at all times in case they suffer an insulin reaction.  You also need a meter so you can test your blood glucose levels.  If you're taking medication it's important t`o wear some type of medical identification in case you have low blood sugar and are unconscious.  Emergency personnel will need to know you have diabetes in order to give you the appropriate treatment.

Extra Tip: Let people around you know you have diabetes and try to make sure they know what to do in case you have an insulin reaction (low blood sugar)
 

DO NOT EXERCISE IF:

1. You are injured.

2. If you are experiencing symptoms of a minor illness (cold or flu).  Give yourself a break until the symptoms go away.

3. If your blood glucose levels are too low.  You may have to make adjustments to your pre-exercise food intake or insulin dosage to "normalize" your blood glucose level.  This should be done after you discuss it with your doctor.
 
 

MISCELLANEOUS

What is acidosis?
Acidosis is a condition where there are excessive ketones in the blood.

What is a Hemoglobin A1c?
A hemoglobin A1c is a laboratory test that measures a person's overall blood glucose control.  It can tell the average level of control over 3-4 months.  This is a good test to ask your doctor to do if you want to know how well you are controlling your diabetes.