Symptoms
The symptoms of diabetes may begin gradually and can be hard to identify at first. They may include fatigue, a sick feeling, frequent urination, especially at night, and excessive thirst. When there is extra glucose in blood, one way the body gets rid of it is through frequent urination. This loss of fluids causes extreme thirst. Other symptoms may include sudden weight loss, blurred vision, and slow healing of skin, gum and urinary tract infections. Women may notice genital itching.

A doctor also may suspect a patient has diabetes if the person has health problems related to diabetes. For instance, heart disease, changes in vision, numbness in the feet and legs or sores that are slow to heal, may prompt a doctor to check for diabetes. These symptoms do not mean a person has diabetes, but anyone who has these problems should see a doctor.

What Causes Noninsulin-Dependent Diabetes?
There is no simple answer to what causes noninsulin-dependent diabetes. While eating sugar, for example, doesn't cause diabetes, eating large amounts of sugar and other rich, fatty foods, can cause weight gain. Most people who develop diabetes are overweight. Scientists do not fully understand why obesity increases someone's chances of developing diabetes, but they believe obesity is a major factor leading to noninsulin-dependent diabetes. One of the reason is an association between obesity and insulin resistance, a major cause of diabetes.

Scientists are still searching for the causes of insulin resistance, but they have identified two possibilities. The first could be a defect in insulin receptors on cells. Like an appliance that needs to be plugged into an electrical outlet, insulin has to bind to a special receptor to perform its function. Several things can go wrong with receptors. There may not be enough receptors for insulin to bind to, or a defect in the receptors may prevent insulin from binding.

A second possible cause involves the process that occurs after insulin plugs into the receptor. Insulin may bind to the receptor, but the cells don't read the signal to metabolize the glucose. Scientists are studying cells to see why this might happen.

Who Develops Noninsulin-Dependent Diabetes?
Age, sex, weight, physical activity, diet, lifestyle, and family health history all affect someone's chances of developing diabetes. The chances that someone will develop diabetes increase if the person's parents or siblings have the disease. Diabetes is more common in blacks, Hispanics, American Indians and Hawaiians than whites. They believe this is the result of both heredity and environmental factors, such as diet and lifestyle. The highest rate of diabetes in the world is in an Arizona community of American Indians called the Pimas. While the chances of developing diabetes increase with age, gender isn't a risk factor.

While you can't change family history, age, or race, it is possible to control weight and physical fitness. Being at risk is not the same as having the disease. There are certain measures that can be taken to reduce your risk of developing diabetes.

Diagnosing Diabetes
A doctor can diagnose diabetes by checking for symptoms such as excessive thirst and frequent urination and by testing for glucose in blood or urine. When blood glucose rises above a certain point, the kidneys pass the extra glucose in the urine. However, a urine test alone is not sufficient to diagnose diabetes.

A second method for testing glucose is a blood test usually done in the morning before breakfast (fasting glucose test) or after a meal (postprandial glucose test).

The oral glucose tolerance can sometimes detect diabetes when a simple blood test does not. In this test, blood glucose is measured before and after a person has consumed a special liquid high in sugar. Normally, the glucose in a person's blood rises quickly after the drink and then falls gradually again as insulin signals the body to metabolize the glucose. In someone with diabetes, blood glucose rises and remains high after consumption of the liquid.

A doctor can decide, based on these tests and a physical exam, whether someone has diabetes. If a blood test is borderline abnormal, the doctor may want to monitor the person's blood glucose regularly. If a person is overweight, he or she probably will be advised to lose weight. The doctor also may monitor the patient's heart, since diabetes increases the risk of heart disease.

Treating Diabetes
The goals of diabetes treatment are to keep blood glucose within normal range and to prevent long-term complications. Why control blood glucose? In the first place, diabetes can cause short-term effects: some are unpleasant and some are dangerous. These include thirst, frequent urination, weakness, lack of ability to concentrate, loss of coordination, and blurred vision. Loss of consciousness is possible with very high or low blood sugar levels, but is more of a danger in insulin-dependent than in noninsulin-dependent diabetes.

In the second place, the long-term complications of diabetes are usually the result of many years of high blood glucose.Most doctors feel that if people with diabetes keep their blood glucose levels under control, they will reduce the risk of complications.

In 1986, a National Institutes of Health panel of experts recommended that the best treatment for noninsulin-dependent diabetes is a diet that helps the person maintain normal weight. In people who are overweight, losing weight is the one treatment that is clearly effective in controlling diabetes.

In some people, exercise can help keep weight and diabetes under control. However, when diet and exercise alone can't control diabetes, two other kinds of treatment are available: oral diabetes medications and insulin. The treatment a doctor suggests depends on the person's age, lifestyle, and the severity of the diabetes. Also see Alternatives below.

Diabetes Diet
The proper diet is critical to diabetes treatment, because it can really make a difference in controlling the disease.

A diabetes diet should do three things: achieve ideal weight, maintain normal blood glucose levels, and limit foods that contribute to hear disease.

The most important function of the diet is to help you achieve and maintain desirable weight. Many people with diabetes can control their blood glucose by losing weight and keeping it off.

The guidelines for diabetes diet planning include the following:

Many experts, including the American Diabetes Association, recommend that 50 to 60 percent of daily calories come from complex carbohydrates, 15 to 20 percent from protein, and no more than 30 percent from fat.

Spacing meals throughout the day, instead of eating heavy meals once or twice a day, can help a person avoid extremely high or low blood glucose levels.

With few exceptions, the best way to lose weight is gradually, one or two pounds a week. Strict diets must never be undertaken without the supervision of a doctor.

People with diabetes have twice the risk of developing heart disease as those without diabetes, and high blood cholesterol levels raise the risk of heart disease. Losing weight and reducing intake of saturated fats and cholesterol, in favor of monounsaturated fats, can help lower blood cholesterol.

For example, meats and dairy products are major sources of saturated fats, which should be avoided; most vegetable oils are high in unsaturated fats, which are fine in limited amounts; and olive oil is a good source of monounsaturated fat, the healthiest type of fat. Liver and other organ meats are particularly high in cholesterol.

Studies show that foods with fiber, such as fruits, vegetables, peas, beans, and whole-grain breads and cereals may help lower blood glucose. However, it seems that a person must eat much more fiber than the average American now consumes to get this benefit.

Exercise
Exercise has many benefits, and for someone with diabetes regular exercise combined with a good diet can help control diabetes. Exercise not only burns calories, which can help with weight reduction, but it also can improve the body's response to insulin. As a result, following a regular exercise program can make oral diabetes medications and insulin more effective and can help control blood glucose levels.

Exercise also reduces some risk factors for heart disease. For example, exercise can lower fat and cholesterol levels. It also can lower blood pressure and increase production of HDL ("good" cholesterol) that protects against heart disease.

Walking is a great exercise, especially for an inactive person, and it's easy to do. You can start by walking for 15 or 20 minutes, three or four times a week, and gradually increase the speed and/or distance of the walks. The purpose of a good exercise program is to find an enjoyable activity and do it regularly. Doing strenuous exercise irregularly isn't as effective. People taking oral drugs or insulin need to remember that strenuous exercise can cause dangerously low blood glucose and they should carry a food or drink high in sugar for medical emergencies.

Signs of hypoglycemia include hunger, nervousness, shakiness, weakness, sweating, headache, and blurred vision. As a precaution, a person with diabetes should wear an identification bracelet or necklace to alert others that the wearer has diabetes and may need special medical help in an emergency.

Oral Medications
Oral diabetes medicines, or oral hypoglycemics, can lower blood glucose. They are an option if diet and exercise don't work. Oral diabetes medications are not insulin and are not a substitute for diet and exercise. They work by increasing insulin production. These medications are most effective in people who developed diabetes after age 40, have had diabetes less than 5 years, are normal weight, and have never received insulin or have taken only 40 units or less of insulin a day.

Pregnant and nursing women shouldn't take oral medications because their effect on the fetus and newborn is unknown, and because insulin provides better control of diabetes during pregnancy.

Six FDA-approved oral diabetes medications are now on the market. Their generic names are tolbutamide, chlorpropamide, tolazamide, acetohexamide, glyburide, and glipizide. These are generic names. Some of these medications are made by more than one pharmaceutical company and have more than one brand name. All six are different types of one class of medication, called sulfonylureas.

The purpose of oral medications is to lower blood glucose. Therefore, the person taking them may have hypoglycemia if he is not careful about eating regular meals. Some medications taken for other health problems also can lower blood sugar and may react with the diabetes medicine. That’s why it’s important to let your doctor know that you are taking an oral hypoglycemic to prevent a harmful interaction. Lowering blood sugar too much can cause hypoglycemia with symptoms such as headache, weakness, shakiness, and if the condition is severe enough, collapse.

Like all medications, oral diabetes medications can cause side effects. They are nausea, skin rashes, headache, either water retention or increased urination and sensitivity to direct sunlight. These effects should gradually subside, but a person should see a doctor if they persist. For reasons that aren't always clear, sometimes oral diabetes medications don't do what they are supposed to. Investigations are under way to learn why this happens.

The most important side effect of these medications is an increased risk of cardiovascular mortality, in other words a risk of dying or a heart attack. The Food and Drug Administration (FDA), the agency of the Federal Government that approves medications for use in this country, requires that oral diabetes medicines carry a warning concerning the increased risk of heart attack. According to the FDA, there is a 250% increase in risk of dying from a heart attack.

Most doctors tend to downplay this warning, but you should at least be aware of it and decide whether it’s worth taking an oral hypoglycemic medication.

Insulin
Like oral diabetes medications, insulin is an alternative for some people with noninsulin-dependent diabetes who can't control their blood glucose levels with diet and exercise. In special situations, such as surgery and pregnancy, insulin is the only means of controlling blood glucose.

A person also may have to take insulin if his blood glucose fluctuates a great deal and is difficult to control. Various types of insulin are available that differ in purity, concentration, and how quickly they work. They also are made differently. In the past, all commercially available insulin came from the pancreas glands of cows and pigs. Today, human insulin is available in two forms: one uses genetic engineering and the other involves chemically changing pork insulin into human insulin.

Checking Blood Glucose Levels
When a person's body is operating normally, it automatically checks the level of glucose in blood. If the level is too high or too low, the body will adjust the sugar level to return it to normal. This system operates in much the same way that cruise control adjusts the speed of a car. With diabetes, the body doesn't do the job of controlling blood glucose automatically. To make up for this, someone with diabetes has to check blood sugar regularly and adjust treatment accordingly.

A doctor can measure blood glucose during an office visit. However, sugar levels change from hour to hour and someone who visits the doctor only every few weeks won't know what his blood glucose is doing on a daily basis. Do-it-yourself tests enable people with diabetes to check their blood sugar daily.

The easiest test someone can do at home is a urine test. When the level of glucose in blood rises above normal, the kidneys eliminate the excess glucose in urine. Glucose in urine, therefore, reflects an excess of glucose in blood.

Urine testing is easy, but not completely accurate. It's more accurate to measure blood glucose directly. Kits are available that allow people with diabetes to test their blood glucose at home. The test involves pricking a finger to draw a drop of blood. The drop of blood is placed on a strip of specially coated plastic or into a small machine that "reads" how much sugar is in the blood. Self blood glucose monitoring can show how the body responds to meals, exercise, stress, and diabetes treatment.

Another test that measures the effectiveness of treatment is a "glycosylated hemoglobin" test. It measures the glucose that has become attached to hemoglobin, the substance in red blood cells that gives blood its red color. Over time, hemoglobin absorbs glucose, according to its concentration in blood. Once glucose is absorbed by hemoglobin it remains there until the blood cells die and new ones replace them, which happens every 3 months. With the "glycosylated hemoglobin" test, a doctor can tell whether blood glucose has been very high over the last few months.

Related Links
Mediconsult.com : Diabetes, Diabetic Health and Medical Information -- This link has a lot of information for Diabetes specific information.

10/26: National Diabetes Physicians Group Describes 'Early Warning Sign' forComplications in type 2 diabetes.

American Diabetes Association -- Learn about Diabetes here and everything related to this disease.

STARBRIGHT Foundation --A link for Children with Diabetes. This site has some of the best resources I have ever seen on this disease and how it affects kids physically and emotionally. And it also teaches parents and kids coping skills. How to read labels, balance food, and how to read blood sugar levels.

CureShirts --Cure shirts were designed and created by the mom of a young boy who has juvenile diabetes. Check out this creative way to raise money for research. This mom is very dedicated to finding a cure.

November 18th is The Great American Smoke Out Day

Healthy Kids