Major Types of Diabetes

Type 1 diabetes Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes. Type 2 diabetes Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes. Gestational diabetes Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually, type 2. Pre-diabetes Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes. Heart Disease People with diabetes have extra reason to be mindful of heart and blood vessel disease. Diabetes carries an increased risk for heart attack, stroke, and complications related to poor circulation. Kidney Disease (Nephropathy)/Kidney Transplantation Diabetes can damage the kidneys, which not only can cause them to fail, but can also make them lose their ability to filter out waste products. This is called nephropathy.

Why diabetes can cause kidney disease (nephropathy)

When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.Diabetes can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak. Useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria. When kidney disease is diagnosed early, (during microalbuminuria), several treatments may keep kidney disease from

getting worse. Having larger amounts is called macroalbuminuria. When kidney disease is caught later (during macroalbuminuria), end-stage renal disease, or ESRD, usually follows.In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, ESRD, is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis). Eye Complications Diabetes can cause eye problems and may lead to blindness. People with diabetes do have a higher risk of blindness than people without diabetes. Early detection and treatment of eye problems can save sight. Diabetes, Oral Health and Hygiene There are more bacteria in your mouth right now than there are people on Earth. If those germs settle into your gums, you've got gum disease. "Not me?" you say. Diabetic Neuropathy and Nerve Damage One of the most common complications of diabetes is diabetic neuropathy. Neuropathy means damage to the nerves that run throughout the body, connecting the spinal cord to muscles, skin, blood vessels, and other organs. There are two common types of nerve damage. The first is sensorimotor neuropathy, also known as peripheral neuropathy. This can cause tingling, pain, numbness, or weakness in your feet and hands. The second is called autonomic neuropathy. This type can lead to: digestive problems such as feeling full, nausea, vomiting, diarrhea, or constipation problems with how well the bladder works, problems having sex, dizziness or faintness, loss of the typical warning signs of a heart attack, loss of the warning signs of low blood glucose, increased or decreased sweating, changes in how your eyes react to light and dark Foot Complications People with diabetes can develop many different foot problems. Foot problems most often happen when there is nerve damage in the feet or when blood flow is poor. Learn how to protect your feet by following some basic guidelines. Foot problems most often happen when there is nerve damage, also called neuropathy, which results in loss of feeling in your feet. Poor blood flow or changes in the shape of your feet or toes may also cause problems.

Neuropathy
Although it can hurt, diabetic nerve damage can also lessen your ability to feel pain, heat, and cold. Loss of feeling often means you may not feel a foot injury. You could have a tack or stone in your shoe and walk on it all day without

knowing. You could get a blister and not feel it. You might not notice a foot injury until the skin breaks down and becomes infected. Nerve damage can also lead to changes in the shape of your feet and toes. Ask your health care provider about special therapeutic shoes, rather than forcing deformed feet and toes into regular shoes.

Skin Changes
Diabetes can cause changes in the skin of your foot. At times your foot may become very dry. The skin may peel and crack. The problem is that the nerves that control the oil and moisture in your foot no longer work. After bathing, dry your feet and seal in the remaining moisture with a thin coat of plain petroleum jelly, an unscented hand cream, or other such products. Do not put oils or creams between your toes. The extra moisture can lead to infection. Also, don't soak your feet - that can dry your skin.

Calluses
Calluses occur more often and build up faster on the feet of people with diabetes. This is because there are high-pressure areas under the foot. Too much callus may mean that you will need therapeutic shoes and inserts. Calluses, if not trimmed, get very thick, break down, and turn into ulcers (open sores). Never try to cut calluses or corns yourself - this can lead to ulcers and infection. Let your health care provider cut your calluses. Also, do not try to remove calluses and corns with chemical agents. These products can burn your skin. Using a pumice stone every day will help keep calluses under control. It is best to use the pumice stone on wet skin. Put on lotion right after you use the pumice stone.

Foot Ulcers
Ulcers occur most often on the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by a health care provider right away. Neglecting ulcers can result in infections, which in turn can lead to loss of a limb. What your health care provider will do varies with your ulcer. Your health care provider may take x-rays of your foot to make sure the bone is not infected. The health care provider may clean out any dead and infected tissue. You may need to go into the hospital for this. Also, the health care provider may culture the wound to find out what type of infection you have, and which antibiotic will work best. Keeping off your feet is very important. Walking on an ulcer can make it get larger and force the infection deeper into your foot. Your health care provider

may put a special shoe, brace, or cast on your foot to protect it. If your ulcer is not healing and your circulation is poor, your health care provider may need to refer you to a vascular surgeon. Good diabetes control is important. High blood glucose levels make it hard to fight infecton. After the foot ulcer heals, treat your foot carefully. Scar tissue under the healed wound will break down easily. You may need to wear special shoes after the ulcer is healed to protect this area and to prevent the ulcer from returning.

Poor Circulation
Poor circulation (blood flow) can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. You can control some of the things that cause poor blood flow. Don't smoke - smoking makes arteries harden faster. Also, follow your health care provider's advice for keeping your blood pressure and cholesterol under control. If your feet are cold, you may be tempted to warm them. Unfortunately, if your feet cannot feel heat, it is easy for you to burn them with hot water, hot water bottles, or heating pads. The best way to help cold feet is to wear warm socks. Some people feel pain in their calves when walking fast, up a hill, or on a hard surface. This condition is called intermittent claudication. Stopping to rest for a few moments should end the pain. If you have these symptoms, you must stop smoking. Work with your health care provider to get started on a walking program. Some people can be helped with medication to improve circulation. Exercise is good for poor circulation. It stimulates blood flow in the legs and feet. Walk in sturdy, good-fitting, comfortable shoes. Don't walk when you have open sores.

Amputation
People with diabetes are far more likely to have a foot or leg amputated than other people. The problem? Many people with diabetes have artery disease, which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation. Most amputations are preventable with regular care and proper footware. For these reasons, take good care of your feet and see your health care provider right away about foot problems. Ask about prescription shoes that are covered by Medicare and other insurance. Always follow your health care provider's advice when caring for ulcers or other foot problems.

One of the biggest threats to your feet is smoking. Smoking affects small blood vessels. It can cause decreased blood flow to the feet and make wounds heal slowly. A lot of people with diabetes who need amputations are smokers. Skin Complications As many as one-third of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, such problems are sometimes the first sign that a person has diabetes. Luckily, most skin conditions can be prevented or easily treated if caught early.

Bacterial Infections
Several kinds of bacterial infections occur in people with diabetes. One common one are styes. These are infections of the glands of the eyelid. Another kind of infection are boils, or infections of the hair follicles. Carbuncles are deep infections of the skin and the tissue underneath. Infections can also occur around the nails. Inflamed tissues are usually hot, swollen, red, and painful. Several different organisms can cause infections. The most common ones are the Staphylococcus bacteria, also called staph. Once, bacterial infections were life threatening, especially for people with diabetes. Today, death is rare, thanks to antibiotics and better methods of blood sugar control. But even today, people with diabetes have more bacterial infections than other people do. Doctors believe people with diabetes can reduce their chances of these infections in several ways.

Fungal Infections
The culprit in fungal infections of people with diabetes is often Candida albicans. This yeast-like fungus can create itchy rashes of moist, red areas surrounded by tiny blisters and scales. These infections often occur in warm, moist folds of the skin. Problem areas are under the breasts, around the nails, between fingers and toes, in the corners of the mouth, under the foreskin (in uncircumcised men), and in the armpits and groin. Common fungal infections include jock itch, athlete's foot, ringworm (a ring-shaped itchy patch), and vaginal infection that causes itching.

Itching
Localized itching is often caused by diabetes. It can be caused by a yeast infection, dry skin, or poor circulation. When poor circulation is the cause of itching, the itchiest areas may be the lower parts of the legs. You may be able to treat itching yourself. Limit how often you bathe, particularly when the humidity is low. Use mild soap with moisturizer and apply skin cream after bathing.

Diabetic Dermopathy

Diabetes can cause changes in the small blood vessels. These changes can cause skin problems called diabetic dermopathy. Dermopathy often looks like light brown, scaly patches. These patches may be oval or circular. Some people mistake them for age spots. This disorder most often occurs on the front of both legs. But the legs may not be affected to the same degree. The patches do not hurt, open up, or itch.

Necrobiosis Lipoidica Diabeticorum

Another disease that may be caused by changes in the blood vessels is necrobiosis lipoidica diabeticorum (NLD). NLD is similar to diabetic dermopathy. The difference is that the spots are fewer, but larger and deeper. NLD often starts as a dull red raised area. After a while, it looks like a shiny scar with a violet border. The blood vessels under the skin may become easier to see. Sometimes NLD is itchy and painful. Sometimes the spots crack open. NLD is a rare condition. Adult women are the most likely to get it. As long as the sores do not break open, you do not need to have it treated. But if you get open sores, see a doctor for treatment.

Atherosclerosis
Thickening of the arteries - atherosclerosis - can affect the skin on the legs. People with diabetes tend to get atherosclerosis at younger ages than other people do. As atherosclerosis narrows the blood vessels, the skin changes. It becomes hairless, thin, cool, and shiny. The toes become cold. Toenails thicken and discolor. And exercise causes pain in the calf muscles because the muscles are not getting enough oxygen. Because blood carries the infection-fighting white cells, affected legs heal slowly when the skin in injured. Even minor scrapes can result in open sores that heal slowly. People with neuropathy are more likely to suffer foot injuries. These occur because the person does not feel pain, heat, cold, or pressure as well. The person can have an injured foot and not know about it. The wound goes uncared for, and so infections develop easily. Atherosclerosis can make things worse. The reduced blood flow can cause the infection to become severe.

Allergic Reactions
Allergic skin reactions can occur in response to medicines, such as insulin or diabetes pills. You should see your doctor if you think you are having a reaction to a medicine. Be on the lookout for rashes, depressions, or bumps at the sites where you inject insulin.

Diabetic Blisters (Bullosis Diabeticorum)

Rarely, people with diabetes erupt in blisters. Diabetic blisters can occur

on the backs of fingers, hands, toes, feet, and sometimes, on legs or forearms. These sores look like burn blisters. They sometimes are large. But they are painless and have no redness around them. They heal by themselves, usually without scars, in about three weeks. They often occur in people who have diabetic neuropathy. The only treatment is to bring blood sugar levels under control.

Eruptive Xanthomatosis
Eruptive xanthomatosis is another condition caused by diabetes that's out of control. It consists of firm, yellow, pea-like enlargements in the skin. Each bump has a red halo and may itch. This condition occurs most often on the backs of hands, feet, arms, legs, and buttocks. The disorder usually occurs in young men with type 1 diabetes. The person often has high levels of cholesterol and fat in the blood. Like diabetic blisters, these bumps disappear when diabetes control is restored.

Digital Sclerosis
Sometimes, people with diabetes develop tight, thick, waxy skin on the backs of their hands. Sometimes skin on the toes and forehead also becomes thick. The finger joints become stiff and can no longer move the way they should. Rarely, knees, ankles, or elbows also get stiff. This condition happens to about one third of people who have type 1 diabetes. The only treatment is to bring blood sugar levels under control.

Disseminated Granuloma Annulare

In disseminated granuloma annulare, the person has sharply defined ring-shaped or arc-shaped raised areas on the skin. These rashes occur most often on parts of the body far from the trunk (for example, the fingers or ears). But sometimes the raised areas occur on the trunk. They can be red, red-brown, or skin-colored.

Acanthosis Nigricans
Acanthosis nigricans is a condition in which tan or brown raised areas appear on the sides of the neck, armpits, and groin. Sometimes they also occur on the hands, elbows, and knees. Acanthosis nigricans usually strikes people who are very overweight. The best treatment is to lose weight. Some creams can help the spots look better. Gastroparesis and Diabetes Gastroparesis is a disorder that affects people with both type 1 and type 2 diabetes. Gastroparesis is a disorder affecting people with both type 1 and type 2

diabetes, where the stomach takes too long to empty its contents. It happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.Just as with other types of neuropathy, diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. Depression Feeling down once in a while is normal. But some people feel a sadness that just won't go away. Life seems hopeless. Feeling this way most of the day for two weeks or more is a sign of serious depression.

Diet Control
The Naked truth about the diabetic diet.In the tale, The Emperors New Clothes by Hans Christian Anderson. The con men posing tailors convince the vain emperor that the suit they fabricated for him is exquisitely rendered in the finest silks and brocades. But when he flaunts his attire in procession, the child shouts the obvious, he has nothing on. The moral? Just because everyone thinks something is true doesnt make it true. In our society, the idea of a Diabetic Diet that requires a severely limited range of specialized foods is, much like the emperors suit---- it just doesnt exist. Full Fiber these nutrients are especially important for people with diabetes, since the disease increases ones risk for some many conditions. For example getting enough potassium, magnesium, and calcium every day has been shown to decrease blood pressure, a major risk factor for cardiovascular disease that often accompanies diabetes. Whole foods are always the healthiest choices since they are minimally processed and contain important nutrients. People tend to be more satisfied and have fewer cravings when eating whole foods over processed ones. Fiber is the foundations. It includes plant foods such as grains, dry beans, vegetables, fruits and nuts. Fiber has been credited with a myriad of health boosters from ushering bad LDL cholesterol out of the body to improving long term glucose control. The American Dietetic Association

recommends a diet high in fiber-rich plants for the treatment of obesity, cardiovascular disease, and diabetes. To help increase the amount of fiber you eat. You can make it half whole wheat and half white to start. Remember that all carbohydrates will raise blood sugars levels if eaten in too large of quantities. Cut the fast-food French fry habit with homemade oven veggie fried. The reeducation in fat can be phenomenal. Try rutabaga, sweet potatoes, russet potatoes, or other starchy vegetables. Pat dry and place on a large baking sheet. Coat lightly with extra virgin olive oil from spray bottle. Bake in a preheated 375 degree over for 40 minutes turning occasionally. Are you sinking in soda? Soft drinks are a major source of empty calories in our diets. The equivalent of liquid candy. Drinking just one 12 ounce soda most days can add approximately 10 pounds to our weight each year. But instead of replacing soda with diet soda think about other beverages. Thats because theres some evidence that artificial sweeteners may actually make us fatter. Try unsweetened brewed regular or herbal iced tea, sparkling water with a wedge of lemon, fat free milk, or ice water. Finding fats. Choose monounsaturated oils such as olive oil, peanut oil, and canola oil, or polyunsaturated oils such as safflower or sunflower, as the healthiest choices. Try avoiding Trans fats, which occur in hydrogenated vegetable shorting, this can be found in crackers, frozen dinners, chips, snacks, bottled salad dressings, preseason rice and grain mixes, and so on. GOSLOWWHOA FOODS
Post this chart on your refrigerator or take it along when you shop for food. GO FoodsEat almost anytime. Nutrient-dense foods that are the highest in quality and the least processed. Low in fat, sugar, sodium, and calories. In the plant groups, they are highest in fiber. SLOW FoodsEat sometimes, at most several times a week. These foods are more processed and may be high in fat, added sugar, sodium, and calories. WHOA FoodsEat only once in a while or for special treats, about three times a month. These are low-nutrient foods that may be highly processed and may contain unnecessary additives. Highest in fat, sugar, and sodium. In the plant food groups, they are lowest in fiber.
GO
SLOW WHOA Fresh, plain frozen, or low-sodium canned vegetables with no added fat and sauces; homemade oven-baked "french fries" All vegetables cooked with moderate amounts of healthy unsaturated fats (such as olive and canola oils) and low-fat tomato sauces French fried potatoes, hash browns, or other fried potatoes; other deep-fried vegetables; frozen vegetables in cheese or other high-fat sauces

Fruits
GO
SLOW All fresh, frozen, dried, and canned (in juice) fruits Fruits canned in light syrup

WHOA

Fruits canned in heavy syrup

Breads and Cereals

GO
Whole grain types of the following: breads, pitas, crackers, tortillas, pasta, brown rice, waffles; steel-cut oats and other hot breakfast cereals; cooked bulgur, barley, and quinoa; homemade low-fat whole grain muffins; homemade whole grain French toast and pancakes Refined-flour products or other refined grains: bread, white rice, pasta, French toast, biscuits, and pancakes High-fat, refined-flour products: commercially prepared croissants, muffins, doughnuts, sweet rolls, and crackers made with trans fats; sweetened breakfast cereals

SLOW WHOA

Milk and Diary Produce

GO

Fat-free or 1% milk; fat-free or low-fat plain yogurt; part skim, reduced-fat, and fat-free Cheese. 1% or fat free cottage cheese. 2% milk; cream cheese, goat, and feta cheese; small amounts of regular full-fat cheese such as American, Cheddar, Swiss, Monterey Jack, Colby, Parmesan (no more than 2 to 3 ounces per week) Whole milk; whole-milk yogurt; processed cheese spread

SLOW

WHOA

Beans, soy, fish, poultry, meats, eggs, and nuts.

GO All dried beans or canned beans, split peas, lentils, hummus; tofu; tuna canned in water; baked, broiled, steamed, or grilled fish and shellfish; chicken and turkey without skin; fat-trimmed beef and pork; extra lean ground beef; eggs (limit four egg yolks per week); Canadian bacon; all-natural peanut butter; 1 ounce nuts (three or four times per week) Frozen veggie burgers; lean ground beef, broiled hamburgers; ham; chicken and turkey with skin; low-fat hot dogs; tuna canned in oil Fried fish and shellfish; fried chicken, chicken nuggets; untrimmed beef and pork; regular ground beef; fried hamburgers; ribs; bacon; hot dogs, delicatessen meats, pepperoni, sausage

SLOW WHOA

|
GO

Sweets and snacks

Popcorn made with healthy fats, whole grain tortilla chips, baked chips, whole grain crackers and crispbreads, homemade muffins or quick breads made with healthy fats and whole grain flour; homemade desserts with quality ingredients; dark chocolate; ice milk bars and low-fat ice cream; boxed gingersnaps, animal crackers, graham crackers (Though some of these "GO" choices are lower in fat and calories, all sweets and snacks need to be limited in order not to exceed one's daily calorie requirements.) Frozen fruit juice bars; low-fat frozen yogurt or sorbet; packaged fig bars, pretzels, low-fat microwave popcorn Commercial cookies and cakes; pies; cheesecake; ice cream; candy; chips; microwave popcorn

SLOW WHOA

FAT

GO

Olive, canola, and other unsaturated vegetable oils; unsaturated oil-based salad dressing, mayonnaise, and low-fat mayonnaise; low-fat sour cream; 1 ounce nuts (three or four times per week); pesto; Va avocado,. Better Butter (page 337)

Tartar sauce; sour cream; olives; trans-fat free spread; butter Slow Margarine, solid vegetable shortening, lard; salt pork; gravy; regular creamy salad dressing; cheese sauce; cream sauce; cream cheese dips

WHOA

Beverages
GO SLOW Water, fat-free milk, 1% milk, club soda or seltzer water, mineral water, unsweetened iced tea with lemon, herbal tea

2% milk, wine, beer, hard liquor, sports drinks

WHOA

Whole milk; regular and diet soda; sweetened iced teas and lemonade; fruit drinks and fruit juice, diet iced teas, and diet lemonade

Source: Adapted from the National Heart, Lung, and Blood Institute (NHLBI). Published by the US Department of Health and Human Services; Public Health Service; National Institutes of Health; and the National Heart, Lung, and Blood Institute.