Diabetes is a disorder of the body's metabolism, the process of converting the food we eat into energy. Insulin is the major factor in this process, which begins when food is broken down during digestion to create glucose, the main source of fuel for the body. This glucose passes into the bloodstream, where insulin, a hormone secreted by the pancreas (a large gland behind the stomach), allows it to get into the cells.

In people with diabetes, one of two parts of this system fails to work properly:

Types of Diabetes

There are two major types of diabetes. Type I, or insulin-dependent, diabetes is sometimes referred to as juvenile diabetes because it most often begins in childhood (although it may also occur in adults). Because the body does not manufacture insulin, people with Type I diabetes must take insulin shots to live. Less than 10 percent of people who have diabetes have Type I.

In Type II diabetes, also referred to as adult-onset-diabetes, the body may make insulin, but either it makes too little, or it can't use what it makes--the insulin is there, but it can't escort the glucose through the entrances to the cells. Type II diabetes occurs most commonly in people over age forty.

The Importance of Good Diabetes Control

This insulin failure causes glucose to build up in the blood, so the body is deprived of its main source of energy. Moreover, the high level of glucose in the blood can cause damage to blood vessels, eyes, kidneys and nerves.

There is no cure for diabetes, so the key to good health for people who have this disorder is to control it: to keep the blood sugar level as near to normal as possible. Good control can go a long way toward Prevention of Complications of Diabetes related to the heart and circulatory system, eyes, kidneys and nerves.

Good control of blood sugar levels are/is possible by planning what you eat, staying physically active, taking your medication as directed and checking your blood sugar level often.

How To Achieve Better Diabetes Control

A number of advances in recent years have made improved blood sugar control easier to achieve.

Many people with Type I diabetes have seen improved control with intensive insulin therapy, using multiple daily injections or an insulin pump. The Food and Drug Administration (FDA) has approved Humalog, a new, very fast-acting insulin, which should help control the rise in blood sugar that occurs immediately after eating. And research is continuing on the development of an implantable insulin pump that would make injections a thing of the past.

New pills for the treatment of Type II diabetes are now available. Glucophage (metformin) works by sensitizing the body to insulin. Unlike other diabetes pills, which tend to promote weight gain, Glucophage use often results in weight reduction. Some people with Type II diabetes who have been taking insulin are able to stop it when Glucophage is added to their treatment program. Precose (acarbose), another new pill, works by blocking the absorption of starch, resulting in less of a rise in blood sugar immediately after eating.

Improvements continue to be made in home blood glucose monitoring devices, with newer instruments being smaller, faster, and requiring less blood than older models.

One of the best indicators of how well your diabetes is controlled is the GLYCOSYLATED HEMOGLOBIN TEST, which shows your average blood sugar level over the past three months. By using these test results to improve your diabetes control, you can reduce your risk of complications of diabetes.

The Importance of Diabetes Education

Despite all the advances in diabetes treatment, education remains the cornerstone of diabetes management. People with diabetes, unlike those with many other medical problems, can't just take pills or insulin in the morning, then forget about their health the rest of the day. Differences in diet, exercise levels, stress and other factors may all affect blood sugar levels. So the more people with diabetes learn how these factors affect them, the better control they will be able to achieve.

People also need to know what they can do to help prevent or decrease the risk of complications of diabetes. For example, it is estimated that proper foot care can eliminate 75 percent of all amputations performed on people with diabetes!

Although diabetes education classes are useful for providing general information, we at the Diabetes and Hormone Center of the Pacific believe education should be tailored to the specific needs of each patient. Our Center provides a comprehensive evaluation of each patient's medical condition, current activities and dietary intake, performed by a team that includes a physician, a diabetes educator and a dietitian. An individualized treatment plan is then developed to address each person's physical, emotional, dietary and educational needs.

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Diabetes and Hormone Center of the Pacific
Ala Moana Pacific Center
1585 Kapiolani Boulevard, Suite 1500
Honolulu, Hawaii 96814
Tel: (808) 531-6886 Fax: (808) 523-5115

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  1996 All Rights Reserved. David Fitz-Patrick, M.D.