Do I Have Diabetes?

More than 29 million people in the U.S. have diabetes, and about 8 million of them don’t know they have it. So now is as good a time as any to find out if you (or a loved one) might have Type 1 or Type 2 diabetes.

First, a couple of definitions:

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• Type 1 (T1) diabetes: The body’s immune system attacks the insulin-making beta cells in the pancreas, and, as a result, the body stops making insulin. Those with Type 1 diabetes must take insulin to survive. Type 1 affects both children and adults, and accounts for between 5% and 10% of those who have diabetes.

• Type 2 (T2) diabetes: The body doesn’t use insulin efficiently (a condition called insulin resistance) and/or doesn’t make enough insulin to keep blood sugar (glucose) levels in a safe range. Type 2 diabetes can be managed with lifestyle changes, but many people need to take medication, including insulin. Type 2 accounts for 90% to 95% of diabetes cases.

Risk factors
Type 1 diabetes risk factors include:

• Family history: Having a parent or sibling with Type 1.
• Age: Anyone at any age can get Type 1, but there’s a strong prevalence in children ages 4–7 and ages 10–14.
• Race/ethnicity: Caucasians are at higher risk than African-Americans and Hispanics.
• Viral infection: Viruses including Epstein-Barr, mumps, and Coxsackie may increase the risk for Type 1.
• Geography: People living in northern climates have a higher risk for getting Type 1.
• Autoimmune conditions: Other autoimmune conditions, such as thyroid disease, celiac disease, and pernicious anemia, are associated with an increased risk.

Type 2 diabetes risk factors include:

• Family history: Having a parent or sibling with Type 2.
• Age: Being age 45 or older.
• Weight: Having overweight or obesity.
• Race/ethnicity: African-Americans, Hispanics, Asian Americans, Native Americans, and Pacific Islanders have a higher risk than Caucasians.
• Gestational diabetes: Having diabetes during pregnancy or giving birth to a baby weighing 9 pounds or more.
• Not being physically active.
• High blood pressure.
• High triglycerides (blood fats) or low HDL (“good”) cholesterol.
• Higher-than-normal blood sugar levels (prediabetes).

Symptoms
Symptoms for both Type 1 diabetes and Type 2 diabetes can vary. In the case of Type 2, you may not have any symptoms.

Type 1 symptoms include:

• Being very thirsty and/or hungry
• Having to urinate frequently
• Extreme fatigue
• Bedwetting in children
• Weight loss
• Blurry vision
• Cuts or sores that don’t heal quickly
• Numbness or tingling in the feet
• Frequent yeast infections in women

Type 2 symptoms include:

• Being very thirsty and/or hungry
• Frequent urination
• Fatigue
• Blurry vision
• Cuts or sores that don’t heal quickly
• Frequent yeast infections in women
• Or, no symptoms!

Getting checked
If you have any of the risk factors and/or symptoms listed above, it’s time to pay a visit to your doctor. For the most part, the tests used to diagnose diabetes are the same for Type 1 and Type 2. There may be additional tests used to check for Type 1 diabetes, however.

There are different types of blood tests used to diagnose diabetes. If the first test indicates a diagnosis of diabetes, it should be repeated on a different day to confirm the diagnosis. Also, these tests should be done at a doctor’s office and not by a fingerstick at a health fair or pharmacy or by using a home blood glucose meter. Here’s how diabetes is diagnosed:

HbA1c (or A1C) test: This blood test measures your average blood sugar over the past 2–3 months. You don’t need to fast (avoid eating or drinking) before getting this test done. An A1C of 6.5% or higher indicates diabetes.

Fasting plasma glucose (FPG): This blood test checks your fasting (first thing in the morning without having eating anything for the previous 12 hours) blood sugar. A fasting plasma glucose level of 126 mg/dl or higher indicates diabetes.

Oral glucose tolerance test (OGTT): For this test, your blood sugar is checked before you drink a very sweet beverage, and again two hours later. A blood sugar of 200 mg/dl or higher two hours later indicates diabetes

Random plasma glucose: This test can be done at any time of the day (without fasting) if you have symptoms of diabetes, such as extreme thirst or frequent urination. A result of 200 mg/dl indicates possible diabetes.

If your doctor suspects Type 1 diabetes or perhaps isn’t sure what type you may have, he or she may order:

An antibody test: This blood test measures antibodies that indicate autoimmune activity.

A C-peptide test: This fasting blood test measures C-peptide, which is a by-product of insulin production. Low levels usually indicate Type 1 diabetes.

Urine ketones: The presence of ketones (by-products of burning fat instead of glucose for energy) in the urine usually indicates Type 1, not Type 2, diabetes.

Treatment
If your doctor tells you that you have Type 1 diabetes, the treatment is pretty straightforward: You’ll need to take insulin. You have options for how you can take insulin:

• With a syringe
• With an insulin pen
• With an insulin pump
• With an inhaler (only for a certain type of fast-acting insulin; you will still need to inject a long-acting insulin)

There is no insulin pill that you can take at this time. Certain factors will help to determine what the best way for you to take insulin, such as your lifestyle, your vision and dexterity, and your health-plan coverage. Ask to meet with a diabetes educator to learn how to properly take your insulin.

If you have Type 2 diabetes, your treatment will likely depend on how high your blood sugar and/or A1C level is at diagnosis. You may initially be able to manage your diabetes with weight loss, a healthy eating plan, and regular exercise. However, most treatment plans recommend starting off on a diabetes pill, such as metformin. If your blood sugar and/or A1C is above a certain level, you may even need to start taking insulin. It’s important to ask about your options for how your diabetes should best be treated.

Regardless of what type of diabetes you have, learning how to check your blood sugar with a meter is pretty much essential. Your blood sugar checks help you — and your health-care team — understand how your food, activity, stress, illness, and medication are working to help you keep your blood sugars in a safe range.

Questions to ask
Your doctor just told you that you have diabetes. Now what? Most likely, you’re feeling shocked, scared, sad, or overwhelmed. Or all of these things. However, you need to ask questions. You might bring someone with you to your appointment; you might even need to make a follow-up appointment and be prepared with a list of questions. Here are examples of questions to ask (you likely will have many more!)

• What type of diabetes do I have?
• How will it be treated? Do I have to take medication?
• Should I be checking my blood sugar, and, if so, when and how often?
• What should my blood sugar level be?
• How can I prevent complications, such as eye, heart, and kidney disease?
• How can I learn more about my diabetes and how to manage it?
• What should I be eating?
• Can I still work/exercise/travel? (The answer is “yes” to all of them, by the way!)

Diabetes is a serious, but manageable, condition. There’s a lot that you will need to do to take care of yourself. You’ll need support from your health-care team, family, friends — and maybe a support group or an online community. Just remember: You can live a long, healthy life with diabetes.

When your child has a physical challenge such as diabetes, one of the hardest things can be walking the line between keeping him safe and letting him grow, says Amy Mercer. Bookmark DiabetesSelfManagement.com and tune in tomorrow to read more.

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