What is Diabetes?
Diabetes is a condition that causes high blood glucose (sugar) levels. It is a chronic condition that can be managed, but so far, there is no cure.
When you eat, some of your food is broken down into glucose (a kind of sugar). Glucose travels in your blood to all your body cells, where it supplies energy. Insulin, made by your pancreas, helps glucose move from your blood into your cells. When insulin is not available, glucose stays in your bloodstream and cannot be used for energy. When you have Type 1 diabetes your body has stopped making insulin. You must assist your body to keep your insulin and glucose in balance.
If Type 1 diabetes is left untreated, blood glucose levels will remain high and cause death. High blood glucose levels over a long period of time will cause damage to blood vessels. This can cause heart, eye, and kidney or nerve problems. People with diabetes can lead long and healthy lives through proper treatment, education and self-care.
What causes Type 1 diabetes?
Type 1 diabetes is considered an auto-immune disease. Autoimmune means the body attacks its own cells. In people with Type 1 diabetes (formerly called “juvenile-onset” diabetes or “insulin-dependent” diabetes), the body loses the ability to make insulin. This occurs when the immune system attacks the insulin-producing cells of the pancreas. These cells eventually stop producing insulin. Most cases occur for unknown reasons.
Type 1 usually occurs in children or in young adults under age 30 and comes on quickly. Everyone who develops Type 1 diabetes is thought to have a genetic risk for it. But, not everyone who is “at risk” develops the disease. Scientists are unsure why this is, but they do think that the autoimmune response that leads to the beta-cell destruction must be triggered by an environmental cause, such as a viral infection for the disease process to start.
A number of genetic factors are likely linked with Type 1 diabetes, but many of these factors are as yet unknown. There are also suspected environmental links, such as viral infections, chemicals and stressful situations, but as yet there is no specific cause identified.
Relatives of people with Type 1 diabetes have a slightly increased chance of developing the disease. For example, if your parent has Type 1 diabetes, you have a 2-5 percent chance of developing Type 1 diabetes. If your child, brother or sister has Type 1, then you have about a 5 percent chance. If your twin has diabetes, your risk is higher.
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Lifestyle Factors Affect Your Risk for Diabetes
Although the development of Type 2 diabetes may be affected by your genes, behavioural and lifestyle factors are also important, and are things we can change. Recent studies in the United States suggest that 90 percent of Type 2 diabetes in women can be attributed to: excess weight, lack of exercise, a less-than-healthy diet, and smoking. Information from several clinical trials strongly supports the idea that Type 2 diabetes is preventable.
Making healthy changes in your diet can have a big impact on reducing the risk of type 2 diabetes. This includes a diet rich in whole grains and whole grain products, and choosing healthy fats.
Choose a diet rich in complex carbohydrates such as whole grains and whole-grain products over highly processed carbohydrates.
White bread, white rice, mashed potatoes, donuts and many breakfast cereals have what’s called a high glycemic index. That means they cause sustained spikes in blood sugar and insulin levels.
Carbohydrates that aren’t as easily digested cause lower, slower increases in blood sugar and insulin. As a result, they stress the body’s insulin-making machinery less, and may help prevent Type 2 diabetes. Such foods have a low glycemic index.
Examples include whole wheat, brown rice, other whole grains, most beans and nuts, and whole grain breakfast cereals.
Choose healthy fats instead of saturated or trans fats.
The types of fats in your diet can also affect the development of diabetes.
Good fats, such as the polyunsaturated fats found in tuna, salmon, liquid vegetable oils, and many nuts, are considered healthy fats. Trans fats do just the opposite. These bad fats are found in much margarine, packaged baked products, fried foods in most fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label. If you already have diabetes, eating fish can help protect you against a heart attack or dying from heart disease.
If you smoke, you are at increased risk for diabetes. Add Type 2 diabetes to the long list of health problems linked with smoking.
If you have not been diagnosed with Type 2 diabetes, the good news is that there are things you can do to reduce your risk.
Diabetes and Pregnancy
If you have diabetes, either Type 1 or Type 2, you can expect a healthy pregnancy and a healthy baby if your diabetes is carefully managed. Careful management means hard work: extra attention to your food intake, more blood glucose testing and recording, and more frequent visits to your doctors.
Poorly controlled diabetes increases the risk of birth defects, stillbirth, and macrosomia (a baby bigger than nine pounds). Your health and diabetes management before and during your pregnancy affects the healthy development of your baby.
Many diabetes experts refer to a “12 month pregnancy” for women with diabetes. For about three months before you become pregnant, it is important that blood glucose levels be as close to normal as possible and that blood haemoglobin A1c be less than 7 percent. This ensures the healthiest possible environment for your baby’s conception.
If your body glucose levels are too high, your developing body is exposed to these high levels, and the baby’s risk of birth defects increases. Your risk of miscarriage increases as well. The longer your body glucose levels remain high, the higher the risks to you and your baby.
If your diabetes has been carefully managed before becoming pregnant, and is carefully managed during the first six to eight weeks in your pregnancy (when the baby’s major organs are forming), the risk of birth defects is similar to the risk among women without diabetes.
What diabetic emergencies can occur in pregnancy?
Diabetic Ketoacidosis (DKA): DKA is very dangerous for your baby. If you are unable to eat your usual meal plan due to nausea and vomiting, you need to follow sick-day guidelines and test your blood glucose and urine ketones more frequently (every 1-2 hours). If ketones are present you need to call your diabetes doctor immediately.
Hypoglycemia (low blood glucose): This may occur more often and be harder to detect. You need to recheck your blood glucose levels 15-20 minutes later to be sure you have adequately treated the low blood glucose. We recommend that you have a Glucagon emergency kit available and a family member trained in its use.
Managing Type 1 Diabetes
Your insulin needs will drop dramatically after delivery. After you deliver, it is important to continue to work with your health care team to readjust your insulin dose and meal plans.
The best time to control your diabetes is before you become pregnant. Work with your health care team to ensure the best outcome.
Have these supplies on hand:
- Blood glucose testing equipment
- Urine ketone testing supplies
- Glucagon kit for testing severe hypoglycemia
- Clear glucose-containing fluids (eg. soda) and soda crackers for sick-day management.
When to call your health care provider:
You should call your health care provider between appointments for a review of your blood glucose if ketones are present in urine, or if you are unable to follow your usual meal.
What you SHOULD do to keep DIABETES under control
- Loose weight in case of obesity.
- Avoid or reduce consumption of alcoholic beverages.
- Regularly brush your teeth, tongue and gums with toothpaste.
- In case of elderly patients or visually impaired, it is suggested that someone else check your feet.
- Wash your feet daily with water and soap. To dry gently rub with a soft towel, particularly between toes.
- Wear shoes and socks without folds, wrinkles or holes.
- Have your eyes examined by an Ophthalmologist every six months.
- Check water temperature with your elbow before washing your feet in the shower or bathtub.
- Check and lubricate the skin of legs and feet regularly.
- Check your creatinine clearance and albumin in 24 hours urine every six months.
- Check blood glycosylated haemoglobin levels every three months.
- Take your medications as prescribed by your physician.
- Shoes should be wide and from non-synthetic material. The sole should be thick, flexible and non-slippery. The inside should not have seams and should have arch support.
- For exercising it is recommended to wear leather shoes with tick sole, laces and cushioning prescribed by the specialist.
What you should NOT do to keep DIABETES under control
- Interrupt the medication prescribed by your physician.
- Use sharp objects to remove corns or for cutting your toenails
- Eating between programmed meals.
- Gain weight
- Take antidiabetic pills after meals
- Quit exercising
- Use garters or tight clothes
- Use narrow, tight or high-heel shoes
- Introduce objects inside your shoes
- Use corn removers
- Cut your toenails the wrong way.
- Drink alcoholic beverages
- Skip your appointments with your physician
- Place hot water bags on your feet
- Walk barefoot
Understanding Your Lab Tests
Central Medical Laboratories Limited (CML) offer a number of Panels of tests for Diabetes Management.
Diabetes Control 1
2 HR PP (Blood Glucose exactly two hours after a meal), LIPIDS, CREATININE, CBC
Diabetes Control 2
HBA1c, LIPIDS, CREATININE, MICROALBUMIN
Many of the tests you have done at the CML can help you to understand the status of your diabetes. They can also help you see changes over time and whether the strategies you are using in your diabetes management are working or not.
All testing at Central Medical Laboratories Limited is done under a strict quality control system. This means that the tests you have done at the laboratory are reliable and accurate.
The start of this section deals with the tests you may have done to find out if you have diabetes. If you already know you have diabetes, go to the second section: “What tests will tell me how my diabetes management is going?”.
What tests can be done to find out if I have diabetes?
There are a number of tests that may be done to find out if you have diabetes.
Fasting blood glucose
A fasting blood glucose level is a measure of how much glucose is in your blood when you have not eaten anything for the past eight to ten hours.
The test is normally taken first thing in the morning. Your doctor or nurse will ask you to have nothing to eat after you go to bed at night. When you wake up in the morning you visit the laboratory for the test before you have had anything to eat or drink (except water).
A fasting blood glucose level of 7.0 mmol/L (126 mg/dl)or greater tells you that you have diabetes. If you have no symptoms of diabetes (thirst, tiredness, repeated infections and needing to pass urine often) the test should be repeated on another day.
A fasting blood glucose level can tell you other things as well.
If your fasting blood glucose level is between 6.1mmol/L (110 mg/dl) and 6.9mmol/L (124 mg/dl) you may have a condition called “impaired fasting glycaemia” (IFG) or pre-diabetes. This means that the level of glucose in your blood after fasting overnight is higher than it is in people without pre-diabetes or IFG, but not as high as it is in people who have diabetes.
Most doctors will ask you to have a test called an “Oral Glucose Tolerance Test” (OGTT) if your fasting blood glucose shows that you have IFG. The oral glucose tolerance test may show that you actually have diabetes or “impaired glucose tolerance” (IGT) instead of IFG.
If your tests show that you have either IFG or IGT you need to take action to manage these conditions. Having either of these conditions means you are more likely to go on to develop diabetes. You are also at higher risk of developing cardiovascular disease, that is, disease of your heart and blood vessels.
If you have IFG or IGT you should:
Organise to be checked once a year for diabetes (and at any time that you have the symptoms of diabetes). Ask your doctor to put you on an annual recall for this test. Or remember to have it done at a time of the year you will remember, eg: in the New Year or in the month of your birthday.
- Make sure you eat in a healthy way
- Keep your weight in a healthy range
- Have your cholesterol checked every year
- Have your blood pressure checked often
- Have 20 – 30 minutes of moderate exercise on most days of the week
Oral Glucose Tolerance Test (OGTT)
An oral glucose tolerance test is a test where you go to the laboratory before eating anything in the morning. A blood glucose level is taken. Then you will be asked to drink a glass of fluid containing 75 grams of glucose (this is a lot!). You stay in the laboratory and another blood glucose level is taken at one hour and two or more hours after the drink. These blood glucose levels tell you how well your body uses and stores the glucose you have taken in the drink.
You will normally be asked to do an OGTT if your doctor is unsure whether you have diabetes or not. This is normally if your fasting blood glucose is less than 7.0 mmol/L (126 mg/dl) but more than 6.1mmol/L (110 mg/dl).
You will also sometimes be asked to do an OGTT when you are pregnant. CML recommendation is that doctors ask all pregnant women in Jamaica to have a “glucose challenge” test when they are 28 weeks pregnant.
Glucose Challenge Test
Sometimes doctors order a Glucose Challenge Test as it is less stressful than an OGTT. The test is similar to the OGTT except that only two samples of blood are required ie. fasting sample and one 2 hours after the 75 gram glucose drink. If the results of this test show your body is not using glucose in the normal way you may be asked to do a full OGTT.
An OGTT is how diabetes of pregnancy (gestational diabetes) is usually diagnosed.
Preparing for an OGTT
An OGTT may not be accurate if you have either eaten a very low carbohydrate diet or been having very strenuous exercise in the three days before taking the test. If you are doing either of these things talk to your doctor before having an OGTT.
The most accurate results of an OGTT will be achieved if it is done after you have had a diet with normal amounts of carbohydrate and moderate exercise only over the previous three days.
What do the results of an OGTT mean?
If you are not pregnant and your blood glucose two hours after an OGTT is 11.1mmol/L (200 mg/dl) or more you have diabetes.
If you are having a glucose tolerance test to see whether you have diabetes of pregnancy (gestational diabetes), and your blood glucose two hours after the glucose drink is 9.0 mmol/L (162 mg/dl) or more than this, you have diabetes of pregnancy (gestational diabetes).
Random blood glucose level
If you have the symptoms of diabetes you may be asked to go to the laboratory for a random blood glucose test. This is a blood glucose level taken at any time of the day after you have eaten at any time (i.e. not in a fasting state). If this level is 11.1mmol/L (200 mg/dl) or more, you have diabetes.
Islet Cell Antibody tests – Quest Diagnostic, Flordia, USA
Many people with Type 1 diabetes have antibodies in their blood that show the autoimmune process that results in Type 1 diabetes. If you have a direct relative (parent, sibling or child) with Type 1 diabetes you can have this test done. If you have these antibodies it’s extremely likely that you will develop Type 1 diabetes.
Glucose O’Sullivan Test
This is a test in which the pregnant woman is given 50 grams of glucose and the blood glucose is measured one hour after. In health the result should not exceed 7.8 mmol/L (140 mg/dl). In pregnancy, when the insulin made is insufficent diabetes may result. This is called GDM (Gestational Diabetes Mellitus). A diet low in sugar and carbohydrates may be able to bring the blood glucose to a normal level. This is what is meant by diet-controlled gestational diabetes and actually works fairly well with this condition.
Because diet does work well, very few women need insulin injections with GDM. As many as 1 out of 10-20 pregnancies will have GDM. It used to be an under-diagnosed condition until routine screening of all pregnancies with the O’Sullivan test ( a 1-hour blood glucose determination after a sugar drink) was implemented. Ones with abnormal results are best confirmed by an OGTT using a 100gms glucose drink.
What tests should be done to assess the status of my diabetes management?
Managing your diabetes means managing a number of factors in your life. You can get a good idea of how effective this management is by the results of some of the laboratory tests you have done.
Fasting Blood (or plasma) glucose level
This measures how much glucose you have in your blood at the time the test is taken. A person without diabetes would nearly always have a blood glucose level in the range 3.9 – 6.1 mmol/L (70 – 110 mg/dl) in the fasting state.
What are healthy levels for a blood glucose series?
Everybody will have different target levels depending on lots of individual factors. You and your doctor need to work out what are realistic and safe target levels for you. A general guide to target levels for a blood glucose series is:
- Fasting ranges 3.9 – 6.1 mmol/L or 70- 110 mg/dl
- 2 HR PP (after a meal) < 7.8 mmol/L or < 140 mg/dl
HBA1c level (also called glycosalated haemaglobin level)
This measures your average blood glucose over the past 2 – 3 months. It measures how much glucose is attached to your red blood cells. Red blood cells have a life span of about 120 days and so the test gives a good indication of your average blood glucose levels over that period of time.
Most diabetes specialists and GPs have a lot of confidence in this test and will use it to help show your progress with your blood glucose management.
HBA1c levels are measured as a percentage. The HBA1c level is not directly equivalent to blood glucose levels. For example, an HBA1c level of 13% means that your average blood glucose for the past 3 months has been around 18 – 19 mmol/L (324 – 342 mg/dl).
What are healthy HBA1c levels?
Once again target HBA1c levels will vary from person to person. Work out a safe target HBA1c for you with your doctor. A general range for HBA1c levels is:
- Less than or equal to 7% is an indication of good control
- Between 7% – 8% is a fair HBA1c level and needs work to improve
- Between 8% – 10% indicates your blood glucose levels are much too high
- Above 10% indicates your blood glucose levels are extremely high
What laboratory tests are done to measure my blood fats (Cholesterol or Lipid Levels)?
The level of cholesterol or fats in your blood is measured by a test called a blood lipid profile. This measures the level of a number of different fats in your blood. The fats that are measured are:
- Total cholesterol
- HDL Cholesterol high density lipoproteins (Good Cholesterol)
- LDL Cholesterol low density lipoproteins (Bad Cholesterol)
Healthy levels of these fats are:
- Total cholesterol less than or equal to 5.0 mmol/L (193 mg/dl).
- HDL Cholesterol greater than 1.5 mmol/L (57.9 mg/dl).
- LDL Cholesterol less than 2.5 mmol/L (96.5 mg/dl).
- Triglycerides less than 1.5 mmol /L (132.8 mg/dl).
What other lab tests am I likely to have done?
A test you will have done regularly (it should be done at least once a year) is your ‘microalbuminuria’ level. This is a laboratory test that is done on a sample of urine. It involves checking for microscopic amounts of protein in your urine.
Small amounts of protein leaking out into your urine is an early sign that your kidneys are being damaged by your diabetes (diabetic nephropathy). The amount of protein leaking into your urine can tell if you have kidney damage and also if it is getting worse or not.
Your microalbuminuria levels should be plotted on a graph over time. Hopefully, these levels will stay low, but if they are rising then this shows there may be a problem with your kidneys. It is best if your microalbuminuria levels are less than 30 mg/min.
If your test comes back with raised microscopic protein levels your doctor may ask for you to repeat the test. This is because, sometimes, your microalbuminuria levels can be raised if you have an infection or even if you have been performing vigorous exercise. If it is elevated for these reasons the elevated result will be just temporary and not sigificant. Repeating the test helps to eliminate a ‘false positive’ for either of these reasons.
You may also have your thyroid hormone levels tested (especially if you have Type1 diabetes). Checking your thyroid function involves having a sample of blood taken at the laboratory. Some diabetes clinics will check your thyroid function on a fairly regular basis. Your doctor will discuss the results with you.