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Solo - Pharmacy Handout
Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Insulin is needed to transport glucose, the body’s unique form of energy, from the bloodstream into the cells. Without the presence or proper functioning of insulin, blood glucose levels become chronically elevated. An elevated level of blood glucose (hyperglycemia) is the hallmark symptom of diabetes.
Uncontrolled diabetes can cause serious health complications including eye damage which can lead to blindness, heart disease (including heart attacks), damage to the nerves, kidney failure, frequent infections, stroke, and foot problems. The total prevalence of diabetes in the United States (all ages) in 2005 was 20.8 million people, or 7% of the population. Of these, 14.6 million were diagnosed, with 6.2 million people being undiagnosed.
Insulin is a hormone produced by the pancreas and its role is to send glucose on its way for immediate use for energy, or for further processing and storage. The increase in glucose levels after eating prompts the body to release insulin, where the excess glucose is stored away as glycogen. Insulin is also used medically to treat some forms of diabetes mellitus. Insulin abnormalities are seen in both diabetes and obesity. They are also associated with inflammation and disordered blood coagulation that contribute to cardiovascular disease, especially heart attacks and strokes.
Types of diabetes
There are three major types of diabetes:
1. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes accounts for 5% to 10% of all diagnosed cases of diabetes.
2. Type 2 diabetes results when the body does not produce adequate insulin (insulin deficiency) and/or is unable to use insulin properly (insulin resistance). Type 2 diabetes is the most common form of diabetes and accounts for about 90% to 95% of all diagnosed cases of diabetes. Type 2 diabetes is increasing at an alarming rate due to poor diets and a sedentary lifestyle.
Type 2 diabetes is usually rooted early in life as insulin resistance or prediabetes, disorders in which the body does not produce enough insulin or the cells do not use insulin properly. Type 2 diabetes is also associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. Approximately 90 percent of individuals categorized as having type 2 diabetes are obese. Obesity greatly reduces the sensitivity of cells to the hormone insulin.
3. Gestational Diabetes results from insulin resistance due to pregnancy. Gestational diabetes is characterized as high blood sugar during pregnancy. The condition starts when the body is not able to make and use all the insulin it needs for pregnancy. It is not known exactly why this occurs but it is linked to the hormonal balance in the mother’s body. Hormones secreted by the placenta to help the baby develop cause the mother’s cells to become resistant to the effects of insulin and the problem is termed insulin resistance.
This insulin resistance prevents the mother from using the sugar in her blood as well as she should. Approximately 4% of American pregnant women have gestational diabetes and incur a 40-60% increased risk of developing type 2 diabetes later in life. Furthermore, gestational diabetes is found to predispose the child to type 2 diabetes later in life. Research has shown that the condition may be controlled with a low GI diet and exercise.
Risk Factors for Diabetes
1. Prediabetes is characterized in people with blood glucose levels that are higher than normal but not yet in the diabetic range. Risk factors for prediabetes include being overweight or obese, abdominal obesity, first-degree family history of diabetes (parent, brother or sister), history of diabetes during pregnancy (gestational diabetes), having polycystic ovary syndrome (PCOS), high blood pressure, and high cholesterol or triglyceride levels. People with prediabetes are at increased risk of developing type 2 diabetes and cardiovascular disease unless they adopt healthful lifestyle changes, specifically weight loss and increased physical activity. “Impaired fasting glucose” and “impaired glucose tolerance” are two other names for pre-diabetes. There are an estimated 54 million people in the United States over the age of 20 who have pre-diabetes.
2. Insulin Resistance, sometimes also referred to as the metabolic syndrome, happens when the cells of the body resist insulin. People with insulin resistance often have simultaneous health problems, including diabetes or prediabetes, obesity, high blood pressure, and high cholesterol and triglycerides. This cluster of disorders raises a serious risk for developing heart disease and type 2 diabetes. People with insulin resistance are three times as likely to have a heart attack or stroke as people without it, and they have five times more risk of developing type 2 diabetes.
3. Overweight and Obesity
Overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. The terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems. Body mass index (BMI) is a simple index of weight-for-height that is commonly used in classifying overweight and obesity in adult populations and individuals.
The World Health Organization (WHO) defines “overweight” as a BMI equal to or greater than 25, and “obesity” as a BMI equal to or greater than 30. It is important to remember that although BMI correlates with the amount of body fat, BMI does not directly measure body fat. As a result, some people, such as athletes, may have a BMI that identifies them as overweight even though they do not have excess body fat.
What happens when you have diabetes?
In type 1 diabetes, the body cannot make enough insulin and in type 2 diabetes, the cells cannot properly utilize the insulin that the body makes. In either case, insulin cannot “open” the cells to permit glucose entry and so glucose levels will build up in the blood. If not quickly corrected, symptoms of diabetes begin to appear and when left untreated can cause damage to the cells of the body.
It is important that people with diabetes test their blood sugar regularly to help adjust and monitor the strategies in their diabetes management program. Lifestyle changes including healthy eating, exercise and medication (if necessary) play an essential role in controlling diabetes and avoiding complications.
Symptoms of diabetes
People with diabetes frequently experience one or more of the following symptoms. However, since these symptoms may develop slowly over months or even years, the person may not realize that the body is experiencing abnormal characteristics.
   • Insatiable thirst
   • Frequent urination, especially at night
   • Increased hunger
   • Unexplained weight loss
   • Extreme fatigue
   • Blurred vision
   • Mood swings
   • Tingling or numbness in the hands or feet
   • Frequent skin, bladder or gum infections
   • Wounds that don’t heal
   • Dry, itchy skin
Screening for diabetes
A simple blood test in a clinical laboratory or doctor’s office can verify the diabetic status of a person’s blood. There are additional tests that can measure the amount of insulin being produced by the body (C-peptide) and also the presence of islet-cell antibodies (ICAs).
  Non-pregnant adults  

Random blood glucose =/> 200 mg/dl with classic and children symptoms 


Fasting plasma glucose =/> 126 mg/dl   OR

Plasma glucose =/> 200mg/dl 2 hours after an oral glucose tolerance test with a 75g
glucose load

Diagnosis Plasma Glucose Level
Impaired fasting glucose (IFT) 100 – 125 mg/dl after overnight fast
Impaired glucose tolerance (IGT)  140 – 199 mg/dl 2 hours after
glucose challenge
Menu planning for people with diabetes
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