Diabetes — also known medically as diabetes mellitus — is a group of diseases that affect the way your body uses blood sugar (glucose). This sugar is vital to your health because it's your body's main source of fuel.
Normally, glucose is able to enter your cells because of the action of insulin — a hormone secreted by your pancreas. Insulin acts like a key to unlock microscopic doors that allow glucose into your cells. But in diabetes mellitus, this process goes awry. Instead of being transported into your cells, glucose accumulates in your bloodstream and eventually is excreted in your urine. This usually occurs either because your body doesn't produce enough insulin or because the cells don't respond to insulin properly.
Diabetes mainly occurs in two forms:
- Type 1 diabetes. This type develops when your pancreas makes little or no insulin. It affects between 5 percent and 10 percent of people with the disease.
- Type 2 diabetes. This type is far more common than type 1, affecting between 90 percent and 95 percent of people with diabetes over age 20. It occurs when your body is resistant to the effects of insulin or your pancreas produces some, but not enough, insulin to maintain a normal glucose level.
More Americans have diabetes than ever before. The disease affects 17 million adults and children, yet close to a third of them may not know they have it. That's because diabetes can develop gradually over many years, often with no symptoms. Both types of diabetes are serious. The accumulation of glucose in your blood can damage almost every major organ in your body. Eventually, diabetes can be fatal. It's the sixth leading cause of death in the United States.
No one has yet found a cure for diabetes mellitus. But the good news is that eating right, maintaining a healthy weight and getting plenty of exercise can help prevent the disease. And if you have diabetes, diet and exercise along with medications that control blood sugar can help you continue to live a healthy and active life.
It's not unusual to have diabetes mellitus and yet have no symptoms. Type 2 diabetes, in particular, develops slowly. Many people have type 2 diabetes for as long as eight years before it's diagnosed. When symptoms do develop, they often vary. But two symptoms that occur in many people with the disease are increased thirst and frequent urination.
That's because excess glucose circulating in your body draws water from your tissues, making you feel dehydrated. To quench your thirst, you drink a lot of water and other beverages, and that leads to more frequent urination.
Another condition, diabetes insipidus, also causes increased thirst and urination, but despite the similar name and symptoms, it's not related to diabetes mellitus. Diabetes insipidus isn't caused by a problem with blood sugar, but rather by a hormone disorder originating in the pituitary gland in your brain that makes your kidneys unable to conserve water.
Other warning signs of diabetes mellitus include:
- Flu-like symptoms. Diabetes can sometimes feel like a viral illness, with fatigue, weakness and loss of appetite. Sugar is your body's main fuel, and when it doesn't reach your cells you may feel tired and weak.
- Weight gain or loss. Because your body is trying to compensate for lost fluids and sugar, you may eat more than usual and gain weight. But the opposite also can occur. You may eat more than normal, but still lose weight because your muscle tissues don't get enough glucose to generate growth and energy. This is especially true if you have type 1 diabetes, in which very little sugar gets into your cells. In fact, most people with type 1 diabetes are at or below their normal weight.
- Blurred vision. High levels of blood sugar pull fluid out of the tissues in your body — including the lenses of your eyes. This affects your ability to focus. Once your diabetes is treated and your blood sugar levels drop, your vision should improve. Over a period of years, however, diabetes can also cause new blood vessels to form in your retina — the back part of your eye — as well as damage old vessels. For most people this causes only mild vision problems. But for others, the effects may be much more serious. In some cases, diabetes can lead to blindness.
- Slow-healing sores or frequent infections. Diabetes affects your body's ability to heal and fight infection. Bladder and vaginal infections can be a particular problem for women.
- Nerve damage (neuropathy). Excess sugar in your blood can damage the small blood vessels to your nerves, leading to a number of symptoms. The most common are tingling and loss of sensation in your hands and especially your feet. You may also experience burning pain in your legs, feet, arms and hands. In addition, more than half the men age 50 and older with diabetes may experience some degree of sexual dysfunction from damage to the nerves that help produce an erection.
- Red, swollen, tender gums. Diabetes increases the risk of infection in your gums and in the bones that hold your teeth in place. As a result, your gums may pull away from your teeth, your teeth may become loose, or you may develop sores or pockets of pus in your gums. This is especially true if you have a gum infection before the onset of diabetes.
During digestion, your body breaks down carbohydrates from foods such as bread, rice, pasta, vegetables, fruits, and milk products into various sugar molecules. One of these sugar molecules is glucose, the main energy source for your body. Glucose is absorbed directly into your bloodstream after you eat, but it can't enter your cells without the help of insulin.
Your pancreas — a gland located just behind your stomach — produces insulin continuously. But when the amount of blood sugar increases after eating, insulin production also increases. The extra insulin "unlocks" your cells so that more sugar can enter, providing your body with energy and maintaining a normal level of sugar in your blood.
Your liver also plays a key role in maintaining a normal blood sugar level. If you have more glucose than your cells need for energy, your body can remove the excess from your bloodstream and store it in your liver as glycogen. Then, when you run low on glucose — if you haven't eaten for a while, say — your body can tap into the stored glucose and release it into your bloodstream.
- Don't smoke. People with diabetes who smoke are three times more likely to die of
cardiovascular disease or stroke than are nonsmokers. Smoking also increases your risk of nerve
damage and kidney disease. Talk to your doctor about ways to quit smoking.
- Avoid alcohol. Alcohol prevents the release of glucose from your liver and can increase the risk of your blood sugar falling too low. If you drink alcoholic beverages, do so only in moderation, and eat food before you have a drink.
- Take a daily aspirin. Taking one aspirin every day — either a baby aspirin or an adult dose — may reduce your risk of heart attack by up to 60 percent. But keep in mind that regular aspirin use can cause stomach irritation, bleeding or ulcers and can make you bruise more easily. Children shouldn't take aspirin because of the risk of Reye's syndrome — a potentially life-threatening condition. Be sure to check with your doctor before starting to use aspirin on a daily basis.
- Monitor your blood pressure. If you have diabetes, you're twice as likely as people who don't have the disease to develop high blood pressure. The risk for black Americans and Hispanics is even higher. The combination of diabetes and high blood pressure is serious because both conditions can damage your blood vessels, increasing your risk of heart attack, stroke or a number of other life-threatening conditions. But following a healthy diet and getting regular exercise can help reduce your blood pressure. When these aren't enough, your doctor may recommend medications such as angiotensin-converting enzyme (ACE) inhibitors.
- Learn to manage stress. Constantly dealing with stress can make it more difficult to take care of yourself and manage your diabetes. You may find yourself eating all the wrong foods or forgetting to exercise or take your medications. Furthermore, prolonged stress can cause your blood sugar levels to rise. Try to find ways to reduce your stress level. For instance, you may need to limit certain relationships or reduce your workload. In addition, a healthy diet, regular exercise and adequate rest can help relieve stress. You might also consider specific stress reduction techniques, such as yoga, meditation, tai chi or deep breathing exercises. Above all, stay positive. Diabetes is a serious illness, but it can be controlled. If you're willing to do your part, you can continue to enjoy an active and healthy life.
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June 9, 2003 —
