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All food that you eat turns to sugar in your body.

Carbohydrate-containing foods alter your sugar

levelsmore than any other type of food. Carbohydrates are found in starchy or sugary foods, such as
bread, rice, pasta, cereal, potatoes, peas, corn, fruit, fruit juice, milk, yogurt, cookies, candy, soda, and
other sweets.

Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the
digestive tract, thereby lowering the after-meal glucose levels.

Biguanides (Metformin) tell the liver to decrease its production of glucose, which lowers glucose levels in the

Sulfonylureas drug

Oral sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pancreas to make more insulin.


Thiazolidinediones (such as rosiglitazone) help insulin work better at the cell site. In essence, they increase the cell's
sensitivity (responsiveness) to insulin.

Food and insulin release

Insulin is a hormone secreted by the pancreas in response to increased glucose levels in the blood.
Foot Care
People with diabetes are more likely than those without diabetes to have foot problems. Diabetes damages the
nerves. This can make you less able to feel pressure on the foot. You many not notice a foot injury until you get a
severe infection.
Diabetes can also damage blood vessels. Small sores or breaks in the skin may become deeper skin sores (ulcers).
The affected limb may need to be amputated if these skin ulcers do not heal or become larger, deeper or infected.
To prevent problems with your feet:

Stop smoking if you smoke.

Improve control of your blood sugar.
Get a foot exam by your doctor at least twice a year and learn if you have nerve damage.
Check and care for your feet every day. This is very important when you already have nerve or blood vessel
damage or foot problems.
Make sure you wear the right kind of shoes. Ask your doctor what is right for you.

Possible Complications
After many years, diabetes can lead to serious problems:

You could have eye problems, including trouble seeing (especially at night), and light sensitivity. You could
become blind.
Your feet and skin can develop sores and infections. After a long time, your foot or leg may need to be
amputated. Infection can also cause pain and itching in other parts of the body.
Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart attack,
stroke, and other problems. It can become harder for blood to flow to your legs and feet.
Nerves in your body can get damaged, causing pain, tingling, and numbness.
Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or
have trouble going to the bathroom. Nerve damage can make it harder for men to have an erection.

High blood sugar and other problems can lead to kidney damage. Your kidneys may not work as well as
they used to. They may even stop working so that you need dialysis or akidney transplant.

When to Contact a Medical Professional

Call 911 right away if you have:

Chest pain or pressure

Fainting or unconsciousness
Shortness of breath

These symptoms can quickly get worse and become emergency conditions (such as convulsionsor hypoglycemic
Also call your doctor if you have:

Numbness, tingling, or pain in your feet or legs

Problems with your eyesight
Sores or infections on your feet
Symptoms of high blood sugar (being very thirsty, having blurry vision, having dry skin, feeling weak or tired,
needing to urinate a lot)
Symptoms of low blood sugar (feeling weak or tired, trembling, sweating, feeling irritable, having trouble
thinking clearly, fast heartbeat, double or blurry vision, feeling uneasy)

What is diabetes insipidus?

Diabetes insipidus (DI) is a rare disease that causes frequent urination. The large volume of urine is
diluted, mostly water. To make up for lost water, a person with DI may feel the need to drink large
amounts and is likely to urinate frequently, even at night, which can disrupt sleep and, on occasion,
cause bedwetting. Because of the excretion of abnormally large volumes of dilute urine, people with
DI may quickly become dehydrated if they do not drink enough water. Children with DI may be
irritable or listless and may have fever, vomiting, or diarrhea. Milder forms of DI can be managed by
drinking enough water, usually between 2 and 2.5 liters a day. DI severe enough to endanger a
person's health is rare.

What is the difference between diabetes insipidus and diabetes

DI should not be confused with diabetes mellitus (DM), which results from insulin deficiency or
resistance leading to high blood glucose, also called blood sugar. DI and DM are unrelated, although
they can have similar signs and symptoms, like excessive thirst and excessive urination.
DM is far more common than DI and receives more news coverage. DM has two main forms, type 1
diabetes and type 2 diabetes. DI is a different form of illness altogether.

How is fluid in the body normally regulated?

The body has a complex system for balancing the volume and composition of body fluids. The
kidneys remove extra body fluids from the bloodstream. These fluids are stored in the bladder as

urine. If the fluid regulation system is working properly, the kidneys make less urine to conserve fluid
when water intake is decreased or water is lost, for example, through sweating or diarrhea. The
kidneys also make less urine at night when the body's metabolic processes are slower.

The hypothalamus makes antidiuretic hormone (ADH), which directs the kidneys to make less urine.

To keep the volume and composition of body fluids balanced, the rate of fluid intake is governed by
thirst, and the rate of excretion is governed by the production of antidiuretic hormone (ADH), also
called vasopressin. This hormone is made in the hypothalamus, a small gland located in the brain.
ADH is stored in the nearby pituitary gland and released into the bloodstream when necessary.
When ADH reaches the kidneys, it directs them to concentrate the urine by reabsorbing some of the
filtered water to the bloodstream and therefore make less urine. DI occurs when this precise system
for regulating the kidneys' handling of fluids is disrupted.

What are the types of diabetes insipidus?

Central DI
The most common form of serious DI, central DI, results from damage to the pituitary gland, which
disrupts the normal storage and release of ADH. Damage to the pituitary gland can be caused by
different diseases as well as by head injuries, neurosurgery, or genetic disorders. To treat the ADH
deficiency that results from any kind of damage to the hypothalamus or pituitary, a synthetic
hormone called desmopressin can be taken by an injection, a nasal spray, or a pill. While taking
desmopressin, a person should drink fluids only when thirsty and not at other times. The drug
prevents water excretion, and water can build up now that the kidneys are making less urine and are
less responsive to changes in body fluids.
Nephrogenic DI
Nephrogenic DI results when the kidneys are unable to respond to ADH. The kidneys' ability to
respond to ADH can be impaired by drugslike lithium, for exampleand by chronic disorders
including polycystic kidney disease, sickle cell disease, kidney failure, partial blockage of the ureters,
and inherited genetic disorders. Sometimes the cause of nephrogenic DI is never discovered.
Desmopressin will not work for this form of DI. Instead, a person with nephrogenic DI may be given
hydrochlorothiazide (HCTZ) or indomethacin. HCTZ is sometimes combined with another drug called

amiloride. The combination of HCTZ and amiloride is sold under the brand name Moduretic. Again,
with this combination of drugs, one should drink fluids only when thirsty and not at other times.
Dipsogenic DI
Dipsogenic DI is caused by a defect in or damage to the thirst mechanism, which is located in the
hypothalamus. This defect results in an abnormal increase in thirst and fluid intake that suppresses
ADH secretion and increases urine output. Desmopressin or other drugs should not be used to treat
dipsogenic DI because they may decrease urine output but not thirst and fluid intake. This fluid
overload can lead to water intoxication, a condition that lowers the concentration of sodium in the
blood and can seriously damage the brain. Scientists have not yet found an effective treatment for
dipsogenic DI.
Gestational DI
Gestational DI occurs only during pregnancy and results when an enzyme made by the placenta
destroys ADH in the mother. The placenta is the system of blood vessels and other tissue that
develops with the fetus. The placenta allows exchange of nutrients and waste products between
mother and fetus.
Most cases of gestational DI can be treated with desmopressin. In rare cases, however, an
abnormality in the thirst mechanism causes gestational DI, and desmopressin should not be used.

How is diabetes insipidus diagnosed?

Because DM is more common and because DM and DI have similar symptoms, a health care
provider may suspect that a patient with DI has DM. But testing should make the diagnosis clear.
A doctor must determine which type of DI is involved before proper treatment can begin. Diagnosis
is based on a series of tests, including urinalysis and a fluid deprivation test.
Urinalysis is the physical and chemical examination of urine. The urine of a person with DI will be
less concentrated. Therefore, the salt and waste concentrations are low and the amount of water
excreted is high. A physician evaluates the concentration of urine by measuring how many particles
are in a kilogram of water or by comparing the weight of the urine with an equal volume of distilled
A fluid deprivation test helps determine whether DI is caused by one of the following:

excessive intake of fluid

a defect in ADH production

a defect in the kidneys' response to ADH

This test measures changes in body weight, urine output, and urine composition when fluids are
withheld. Sometimes measuring blood levels of ADH during this test is also necessary.
In some patients, a magnetic resonance imaging (MRI) of the brain may be necessary as well.

Points to Remember

Diabetes insipidus (DI) is a rare disease that causes frequent urination and excessive thirst.

DI is not related to diabetes mellitus (DM).

Central DI is caused by damage to the pituitary gland and is treated with a synthetic hormone
called desmopressin, which prevents water excretion.

Nephrogenic DI is caused by drugs or kidney disease and is treated with hydrochlorothiazide

(HCTZ), indomethacin, or a combination of HCTZ and amiloride.

Scientists have not yet discovered an effective treatment for dipsogenic DI, which is caused by
a defect in the thirst mechanism.

Most forms of gestational DI can be treated with desmopressin.

A doctor must determine which type of DI is involved before proper treatment can begin.

Blood samples analyzed in a health care providers office, known as point-of-care (POC)
tests, are not standardized for diagnosing diabetes. The following table provides the
percentages that indicate diagnoses of normal, diabetes, and prediabetes according to A1C


A1C Level


below 5.7 percent


6.5 percent or above


5.7 to 6.4 percent

Points to Remember

The A1C test is a blood test that provides information about a persons average levels of blood
glucose, also called blood sugar, over the past 3 months.

The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood
cells that carries oxygen. Thus, the A1C test reflects the average of a persons blood glucose
levels over the past 3 months.

In 2009, an international expert committee recommended the A1C test be used as one of the
tests available to help diagnose type 2 diabetes and prediabetes.

Because the A1C test does not require fasting and blood can be drawn for the test at any time
of day, experts are hoping its convenience will allow more people to get testedthus,
decreasing the number of people with undiagnosed diabetes.

In the past, the A1C test was not recommended for diagnosis of type 2 diabetes and
prediabetes because the many different types of A1C tests could give varied results. The

accuracy has been improved by the National Glycohemoglobin Standardization Program

(NGSP), which developed standards for the A1C tests. Blood samples analyzed in a health care
providers office, known as point-of-care (POC) tests, are not standardized for use in diagnosing

The A1C test may be used at the first visit to the health care provider during pregnancy to see if
women with risk factors had undiagnosed diabetes before becoming pregnant. After that, the
oral glucose tolerance test (OGTT) is used to test for diabetes that develops during
pregnancyknown as gestational diabetes.

The standard blood glucose tests used for diagnosing type 2 diabetes and prediabetesthe
fasting plasma glucose (FPG) test and the OGTTare still recommended. The random plasma
glucose test may be used for diagnosing diabetes when symptoms of diabetes are present.

The A1C test can be unreliable for diagnosing or monitoring diabetes in people with certain
conditions that are known to interfere with the results.

The American Diabetes Association recommends that people with diabetes who are meeting
treatment goals and have stable blood glucose levels have the A1C test twice a year.

Estimated average glucose (eAG) is calculated from the A1C to help people with diabetes relate
their A1C to daily glucose monitoring levels.

People will have different A1C targets depending on their diabetes history and their general

health. People should discuss their A1C target with their health care provider.
Insulin Basics

There are different types of insulin depending on how quickly they work, when they peak, and
how long they last.

Insulin is available in different strengths; the most common is U-100.

All insulin available in the United States is manufactured in a laboratory, but animal insulin can
still be imported for personal use.

Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to
help the body use or store the blood glucose it gets from food.
In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been
destroyed and they need insulin shots to use glucose from meals.
People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people
with type 2 diabetes need diabetes pills or insulin shots to help their bodies use glucose for energy.
Insulin cannot be taken as a pill because it would be broken down during digestion just like
the protein in food. It must be injected into the fat under your skin for it to get into your blood. In some
rare cases insulin can lead to an allergic reaction at the injection site. Talk to your doctor if you believe
you may be experiencing a reaction.

Types of Insulin

Rapid-acting insulin, begins to work about 15 minutes after injection, peaks in about 1 hour,
and continues to work for 2 to 4 hours. Types: Insulin glulisine (Apidra), insulin lispro (Humalog),
and insulin aspart (NovoLog)

Regular or Short-acting insulin usually reaches the bloodstream within 30 minutes after
injection, peaks anywhere from 2 to 3 hours after injection, and is effective for approximately 3
to 6 hours. Types: Humulin R, Novolin R

Intermediate-acting insulin generally reaches the bloodstream about 2 to 4 hours after

injection, peaks 4 to 12 hours later, and is effective for about 12 to 18 hours. Types: NPH
(Humulin N, Novolin N)

Long-acting insulin reaches the bloodstream several hours after injection and tends to lower
glucose levels fairly evenly over a 24-hour period. Types: Insulin detemir (Levemir) and insulin
glargine (Lantus)

Premixed insulin can be helpful for people who have trouble drawing up insulin out of two bottles and
reading the correct directions and dosages. It is also useful for those who have poor eyesight or
dexterity and is convenient for people whose diabetes has been stabilized on this combination.
Characteristics of Insulin
Insulin has 3 characteristics:

Onset is the length of time before insulin reaches the bloodstream and begins lowering blood

Peaktime is the time during which insulin is at maximum strength in terms of lowering blood

Duration is how long insulin continues to lower blood glucose.

Insulin Strength
All insulins come dissolved or suspended in liquids. The standard and most commonly used strength in
the United States today is U-100, which means it has 100 units of insulin per milliliter of fluid, though U500 insulin is available for patients who are extremely insulin resistant.
U-40, which has 40 units of insulin per milliliter of fluid, has generally been phased out around the
world, but it is possible that it could still be found in some places (and U-40 insulin is still used in
veterinary care).
If you're traveling outside of the U.S., be certain to match your insulin strength with the correct
size syringe.

Fine-Tuning Your Blood Glucose

Many factors affect your blood glucose levels, including the following:

What you eat

How much and when you exercise
Where you inject your insulin
When you take your insulin injections

Self Monitoring
Checking your blood glucose and looking over results can help you
understand how exercise, an exciting event, or different foods affect
your blood glucose level. You can use it to predict and avoid low or
high blood glucose levels. You can also use this information to make
decisions about your insulin dose, food, and activity.

Site Rotation

The place on your body where you inject insulin affects your blood
glucose level. Insulin enters the blood at different speeds when
injected at different sites. Insulin shots work fastest when given in the
abdomen. Insulin arrives in the blood a little more slowly from the
upper arms and even more slowly from the thighs and buttocks.
Injecting insulin in the same general area (for example, your
abdomen) will give you the best results from your insulin. This is
because the insulin will reach the blood with about the same speed
with each insulin shot.
Don't inject the insulin in exactly the same place each time, but move
around the same area. Each mealtime injection of insulin should be
given in the same general area for best results. For example, giving
your before-breakfast insulin injection in the abdomen and your
before-supper insulin injection in the leg each day give more similar
blood glucose results. If you inject insulin near the same place each
time, hard lumps or extra fatty deposits may develop. Both of these
problems are unsightly and make the insulin action less reliable. Ask
your health care provider if you aren't sure where to inject your


Insulin shots are most effective when you take them so that insulin
goes to work when glucose from your food starts to enter your blood.
For example, regular insulin works best if you take it 30 minutes
before you eat.

Too much insulin or not enough?

High morning blood glucose levels before breakfast can be a puzzle. If

you haven't eaten, why did your blood glucose level go up? There are
two common reasons for high before-breakfast blood glucose levels.
One relates to hormones that are released in the early part of sleep
(called the Dawn Phenomenon). The other is from taking too little
insulin in the evening. To see which one is the cause, set your alarm to
self-monitor around 2 or 3 a.m. for several nights and discuss the
results with your health care provider.

Type 1

People diagnosed with type 1 diabetes usually start with two injections
of insulin per day of two different types of insulin and generally
progress to three or four injections per day of insulin of different
types. The types of insulin used depend on their blood glucose levels.
Studies have shown that three or four injections of insulin a day give
the best blood glucose control and can prevent or delay the eye,
kidney, and nerve damage caused by diabetes.

Type 2

Most people with type 2 diabetes may need one injection per day
without any diabetes pills. Some may need a single injection of insulin
in the evening (at supper or bedtime) along with diabetes pills.
Sometimes diabetes pills stop working, and people with type 2
diabetes will start with two injections per day of two different types of
insulin. They may progress to three or four injections of insulin per

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