The Joslin Guide to Diabetes

A Program for Managing Your Treatment

Richard S. Beaser, Amy P. Campbell

• Editorial: Touchstone
• Año: 2008
• ISBN:
  9780743271806
• Categoría: Medicine
• Categoría: Diseases & Allergies

An indispensable, up-to-date resource for managing your diabetes from the global leader in diabetes research, care, and education. Finding out that you have diabetes immediately raises questions about the condition, its treatment, and its impact on your future. Why did I get diabetes? What will I have to do to treat it? How will my future health be affected by having diabetes? What will my life be like? Getting accurate answers to these and many other questions will determine how well you are able to live with diabetes.This completely updated edition of The Joslin Guide to Diabetes will help provide the answers you need. It's an easy-to-understand resource that explains not only the types of diabetes treatment but also every aspect of diabetes self-management, including: • Meal planning and carbohydrate counting
• Monitoring blood glucose
• Administering insulin and taking oral medications
• Treating high and low blood glucose
• Using physical activity to help control diabetes, maintain good health, and reduce the chances of future problems
• Successfully fitting diabetes into your lifestyleBased upon research and the clinical experience of the world-renowned Joslin Diabetes Center and written by physician and diabetes expert Richard S. Beaser, M.D., and nutritionist and diabetes educator Amy Campbell, R.D., M.S., C.D.E., this book will help those with diabetes integrate the medical treatments and lifestyle changes necessary to learn how to live healthfully with this condition.

CHAPTER 1
Join the Team!

When you have diabetes, you become a member of a very important team. Teams need players and coaches, and, in many ways, having diabetes is similar. It’s hard to manage diabetes alone. You need a coach or coaches to help you learn the skills necessary to do the very best you can and to help guide your skill development. Others, such as family members, significant others, and friends, cheer your successes and provide support when things are not going well. But coaches and others can’t do it for you. You have to learn about diabetes and be the one who controls your health and your diabetes care.

The first step in joining the team is to acquire the skills you need. Any time you want to learn about a medical problem or condition, it helps to approach it in two steps. First, learn how the body functions normally. Then learn what happens when something goes wrong. This is the best way to learn about diabetes too. The Joslin Guide to Diabetes will help you learn how your bodyworks—what happens to it when you have diabetes—and how to keep your body working as normally as possible.

If you have been diagnosed with diabetes, you may wonder: “Why do I need to know about diabetes? After all, isn’t my doctor the one responsible for my treatment?” The answer to this isn’t as simple as it seems. The care provided by your doctor and your healthcare team is a very important part of managing diabetes. But to properly control your diabetes, you are the one who must be primarily responsible.

You will also need to know your treatment goals and how to achieve them. For many individuals this may mean acquiring some new skills so you can put into action the information you have learned. This action plan is called your diabetes treatment program. However, you also need coaches. That’s where your healthcare team becomes important. It can help you take the information, goals, and skills you gain from reading and practicing and put them into an individual “game plan.”

And once you understand the importance of a treatment program and your role in carrying it out, you’re on the way to being a successful team player. The other players are only there to assist you to do the best you can. They are important because they have a lot to share with you.

Diabetes—an Old Disease, but Many New Remedies

Medical descriptions of diabetes date back to at least 1500 B.C., more than 3,500 years ago. Writings from ancient cultures in China and the Middle East describe the classic signs of diabetes, such as passing large quantities of urine through the body. The ancient Greeks gave us the name diabetes, which means “to flow through.” Later the Latin word mellitus (meaning “sweet urine”) was added to form the present medical name diabetes mellitus. Physicians actually diagnosed diabetes in ancient times by tasting the urine, but modern physicians have developed newer methods to accomplish this!

Until recent times, people with diabetes could use only diet, exercise, or weight control for treatment. But in 1921, a major breakthrough occurred that changed the outlook and saved the lives of millions of individuals with diabetes—insulin was discovered. Later in this book you will learn a lot about how insulin is used today. Research in diabetes has continued to make major strides. In the late 1970s it became possible for someone to check his or her blood glucose without the help of a doctor or nurse—one of the most important advances in the care of diabetes since the discovery of insulin. Once self-monitoring of blood glucose became available, research studies of people with type 1 and type 2 diabetes were undertaken, and these studies proved that controlling one’s blood glucose makes a difference. By maintaining near-normal blood glucose levels, you can prevent or slow the progression of the long-term complications of diabetes. These include problems with the eyes, nerves, kidneys, feet, skin, heart, and blood vessels. The list of advances in diabetes management goes on and on, and all of them help you to gain increased control of your diabetes and thus reduce the risk of developing complications.

Discovering Your Diabetes

If you think back to the time just before you learned you had diabetes, you may have noticed some physical symptoms and some changes in your health. For example, you may have felt very tired and sluggish because your body was unable to properly use food for energy. For some of you, the symptoms were severe enough to cause you to see your doctor to find out what the cause was. For others of you, the symptoms were mild and you had little reason to suspect anything was wrong. But what is important is that at some point you discovered you have diabetes and now you want to learn more about it.

No doubt, you felt some type of stress even before the diagnosis of diabetes. And once you realized that you had diabetes, the stresses associated with its symptoms probably didn’t go away. Questions occurred to you, such as How did this happen? What causes diabetes? Can it be cured? How will it affect my daily life? Can I keep my job? What will it cost? What lies ahead? Will I still be healthy enough to do the things in life that I enjoy? Such questions are steps in the right direction. They mean you are concerned about your health. To help you with your feelings about diabetes, it’s often a good idea to find someone in whom you can confide—perhaps your physician, a healthcare professional, a family member, or a good friend.

It is extremely important that you gain a complete understanding of diabetes and methods of treatment. Diabetes is a uniquely personal condition. At first you may ask yourself, “Can I really handle this?” But your skills and confidence will grow as the weeks pass and as you learn about and have more experiences living with diabetes. Understanding diabetes will happen over time—you don’t have to learn it all at once. However, by becoming more actively involved in your diabetes management, you will feel more confident about your own ability to solve problems, less angry and fearful about diabetes, and more motivated to keep up the effort. The Joslin Guide to Diabetes will help you develop that confidence.

This book is designed to be used as a reference tool for people with diabetes who are under the care of a physician and other healthcare professionals. It was written and reviewed by a team of experts in the field of diabetes care and education here at Joslin Diabetes Center in Boston, Massachusetts. Founded in 1898 by Elliott P. Joslin, M.D., a pioneer in diabetes research and care, Joslin Diabetes Center is affiliated with Harvard Medical School and has treated over a quarter of a million people with diabetes. Healthcare providers and educators at Joslin are dedicated to making sure that people with diabetes have the very latest information and know how to use this information to improve their diabetes care. We want you to live healthfully and well with diabetes, and we think this book will help.

PART ONE

Understanding Diabetes

CHAPTER 2
Deciphering Diabetes: What Type of Diabetes Do You Have?

Do you know someone besides yourself who has diabetes? These days the answer is likely to be yes. That’s because diabetes has become one of the most common health problems in the United States and in the world. About 18 million Americans—8.4 percent of the population—have diabetes. That seems like a large number, but it is often hard for us to visualize what these large numbers mean. To do this, think of the last time you were in a sports stadium, concert hall, or theater. Estimate about how many groups of 100 were with you, and then realize that out of every 100 people, approximately 10 have diabetes. If 200 people attended a concert with you yesterday evening, that would mean that besides you, there were 19 persons with diabetes. Even more of a concern is that about a third of those, or 6 people in that group of 20 who have diabetes, are not even aware that they have it. They have not been diagnosed yet, but they have the condition.

The risk of developing diabetes increases with age—nearly 19 percent of adults 65 or older are reported to have diabetes. But of great concern is the fact that today more—and younger—adults, and even children and adolescents, are developing diabetes. It’s reported that the number of people in their thirties with diabetes increased by 76 percent during the 1990s. And among children with newly diagnosed diabetes, the number with type 2 diabetes has increased from less than 4 percent before 1990 to as high as 45 percent among certain racial and ethnic groups who are at increased risk of developing diabetes. So if you or someone close to you has diabetes, you are not alone—there are a lot of people with diabetes!

It is very important to discover diabetes as early as possible. If left untreated or uncontrolled, it can lead to serious health problems—heart disease, stroke, blindness, amputations, kidney failure, and even death. If you have diabetes, a lifestyle that includes healthy food choices and healthy eating habits along with physical activity can help you keep it under control and reduce your risk of developing serious complications. For many individuals, this means that medications such as diabetes pills will need to be combined with lifestyle changes. For other individuals it may mean combining insulin with diabetes pills and lifestyle changes, or insulin alone and lifestyle changes. The good news is that advances in treatment options, medications (new diabetes pills and different types of insulin), and medical devices are making it easier than ever before for you to live a healthy life with diabetes.

To understand diabetes, you first need to know how the human body works without diabetes. Understanding how the body normally uses blood glucose (blood sugar), the body’s main source of energy, and the role that insulin plays, makes it easier to understand how a breakdown in this process leads to diabetes. Diabetes—high blood glucose levels—develops when your body either can’t make any or enough insulin or can’t properly use the insulin that it does make.

How the Body Normally Metabolizes Food

Your body needs food to survive. Food is both fuel and building material. Metabolism is the process by which the cells of the body change food so that it can be used for energy or to build or maintain cells. To do this, the body breaks food down into basic nutrients. Three basic nutrients—carbohydrate, protein, and fat—will be discussed first because they all require insulin for the body to use them normally.

Carbohydrate is the main source of fuel for the body. Carbohydrate includes starches and sugars and is found in bread, pasta, fruits, vegetables, milk, and sweets. It is broken down into a sugar called glucose. During digestion, glucose passes through the wall of the intestine into the bloodstream to the liver and eventually into the general circulation, where it can enter individual cells or tissues throughout the body to be used for fuel to provide energy. Insulin is the key that lets glucose into cells to be used for energy.

Protein is found in meats, poultry, fish, eggs and dairy products such as milk and cheese, and some vegetable foods, such as peas, beans, legumes, and soy foods. Protein breaks down into amino acids, which are used to build and repair body tissues; some protein can also be stored for use as a secondary source of energy. Protein also requires insulin in order to be used properly.

Fats are found in foods such as oils, salad dressings, meats, some dairy products, and nuts. They break down into triglycerides, which are a combination of three fatty acids, and travel to the liver and eventually to fat cells to be used or stored for energy. Fat is burned differently than glucose and can produce a by-product called ketones. Fats also require insulin to be used properly. They can also contribute to insulin resistance, which is a condition that makes it harder for the cells to use insulin correctly.

After eating, all three of these nutrients are digested, or broken down, in the stomach and intestines, and glucose from carbohydrate enters the bloodstream. If one has diabetes, because there is insufficient insulin, possibly combined with insulin resistance, the body is not able to use this glucose the way it should. Since protein and fat also require insulin, if one has diabetes, they are not used properly either.

The Role of Insulin

You can see that insulin is essential in order to use the foods we eat correctly, but insulin is important for other body processes as well. Insulin is a hormone. Hormones are chemical messengers made in one part of the body to transfer “information” through the bloodstream to cells in another part of the body. Your body makes many types of hormones, and insulin is a specific kind. It is made in the organ called the pancreas.

The pancreas is a small gland located below and just behind the stomach. It is shaped like a cone lying on its side, with the end tapering off into a “tail.” Within this tail are tiny cells known as islets of Langerhans. A normal pancreas has about 10,000 islets of Langerhans. These islets are clusters of various types of cells. The most important are the beta cells—the tiny “factories” that make insulin. The beta cells also serve as “warehouses,” storing insulin until it’s needed.

The pancreas has other important functions as well. Cells called alpha cells produce glucagon. Glucagon, also a hormone, has the opposite action of insulin—it raises blood glucose levels. It does this by causing glucose stored in the liver or muscles (called glycogen) to be released into the bloodstream. The balance between insulin and glucagon keeps blood glucose levels in the normal fasting range (first thing in the morning and before eating), which is approximately 70-100 milligrams (mg) of glucose per deciliter (dl) of blood.

When the beta cells sense that the level of glucose in the blood is rising, they respond by releasing just the right amount of insulin into the bloodstream. Insulin binds to receptors on the body’s cells and signals substances in the cells to produce a chemical passageway that allows glucose to enter the cells. After one eats, the beta cells are triggered to make more insulin. When functioning normally, the beta cells release just enough insulin to maintain the level of glucose in the blood within the normal range after eating, which is less than 140 mg/dl. However, even when you are not eating, such as at night when you are asleep, the beta cells release a constant, low level of insulin.

Generally when you eat, you don’t need to use all the glucose from your food immediately. The body, with the help of insulin, removes excess glucose from your bloodstream and stores it as glycogen in your liver and muscles. Glycogen is used when your body needs extra glucose—for instance, when blood glucose levels are low or during exercise. In addition, glycogen will release glucose overnight to take care of your energy needs when you’re not eating. Insulin helps convert some of the extra glucose into fat, which is stored in the body’s fat cells.

Insulin is also needed for amino acids from protein to repair and build new body tissues and for the storage of triglycerides from food fats in the fat cells.

You can see how important insulin is for the normal use and storage of food fuels and why there would be serious problems if insulin is missing or does not work properly.

The beta cells of the pancreas release another hormone, called amylin. Amylin is secreted with insulin, and its main function is to slow stomach emptying. It also suppresses the release of glucagon, and both of these actions help keep blood glucose levels normal after eating. Amylin is a hormone you will hear more about later.

Other cells in the pancreas produce substances called enzymes. Enzymes help in digestion by splitting foods into simpler substances that can be absorbed through the intestinal walls into the bloodstream.

What Causes Diabetes?

Diabetes is caused by a breakdown in the normal processes described above. This breakdown can occur because the body produces little or no insulin, or because cells are resistant to the action of insulin (“insulin resistance”), or because both of these problems develop. Instead of glucose entering cells throughout the body, excess glucose builds up in the bloodstream.

The most common forms of diabetes are type 1 and type 2 diabetes. Type 1 diabetes results when no insulin or very little insulin is produced, whereas type 2 diabetes is a problem of both insulin resistance and insulin deficiency. There are similarities between type 1 and type 2 diabetes, and some people have characteristics of both.

Symptoms of Diabetes

Below are the symptoms of diabetes:

FREQUENT URINATION AND EXCESSIVE THIRST. This is caused by hyperglycemia, or high blood glucose levels. Blood circulates through the kidneys, which remove waste materials from the blood and expel them into the urine. The kidneys also act like a “dam” to keep and recycle important nutrients such as glucose, sending them back into the blood. But in diabetes, blood glucose rises to excessively high levels and the kidneys can’t send all the glucose back into circulation. The kidneys try to “wash out” excessive amounts of glucose from the blood, and glucose spills over the “dam” into the urine. But it takes water to get rid of the glucose, and this results in large amounts of urine. As you lose fluids, you get very thirsty, your body’s signal to take in more fluids.

LACK OF ENERGY. If your body can...