Diabetes Program

Diabetes mellitus is a disease that prevents your body from properly using the energy from the food you eat. Diabetes occurs when either:

• the pancreas (an organ behind your stomach) produces little insulin or no insulin at all. (Insulin is a naturally occurring hormone produce by the pancreas that helps the body use sugar for energy.)
  
  Or
  
  
• the pancreas makes some insulin, but the insulin does not work as it should. This condition is called insulin resistance. Without enough working insulin, sugar cannot get into the body's cells for use as energy. This causes sugar to rise. Too much sugar in the blood is called "hyperglycemia" (high blood sugar) or diabetes.

Diabetes can be caused by a combination of genetic and lifestyle factors. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 diabetes is overweight. Many patients with type 2 diabetes have a history of diabetes in their family.

Type 1 diabetes occurs when the body's immune system attacks the pancreas. The cells of the pancreas are destroyed and can no longer make insulin. Type 1 diabetes usually, but not always, happens at a younger age.

• Increased thirst
• Increased hunger (especially after eating)
• Dry mouth
• Frequent urination
• Unexplained weight loss (even though you are eating and feel hungry)
• Feeling weak or tired
• Blurred vision
• Numbness or tingling of the hands or feet
• Slow healing sores or cuts
• Dry and itchy skin (usually in the vaginal or groin area)
• Frequent yeast infections

Your health care provider can perform blood and urine tests to see if you have diabetes.

Blood sugar ranges may be different for each person and can change throughout the day. Your health care provider will tell you what range is good for you. For most people, morning blood sugars should be between 70 and 130 mg/dL. Two hours after meals, blood sugar should be less than 180 mg/dL. If your blood sugar is less than 70 mg/dL at any time, or more than 180 mg/dL for three days in a row, contact your health care provider.

If you have been taking an oral medication and your blood glucose levels remain consistently high, your doctor may change your treatment plan to include insulin. This change is often made to help people with type 2 diabetes gain better control of their blood sugar. Many people with type 2 diabetes will eventually need to take insulin.

• Eye disease (retinopathy)
  All patients with diabetes should see an ophthalmologist yearly for a dilated eye examination — beginning at diagnosis in people with type 2 diabetes, and after 5 years in people with type 1 diabetes after puberty. Patients with known eye disease, symptoms of blurred vision in one eye, or blind spots may need to see their ophthalmologist more frequently. Your HCA team can help you book appointments at the Longwood Medical Eye Clinic, located on the 5th floor of the Shapiro Building or the Joslin Diabetes Center eye clinic.
  
  
• Kidney disease (nephropathy)
  Urine testing should be performed yearly. Regular blood pressure checks are important, since control of hypertension (high blood pressure) is essential in slowing kidney disease. Generally, blood pressure should be maintained less than 140/90 in adults with diabetes.
  
  
• Nerve disease (neuropathy)
  Numbness or tingling in your feet should be reported to your doctor at your regular visits. You should check your feet daily for redness, calluses, cracks, or skin breakdown. If you notice these symptoms before your scheduled visit, notify your doctor immediately. Some people need to see a podiatrist on a regular basis. Your PCP and your Medical Assistant will perform foot checks for you during your annual exam.

Your doctor, nurse practitioner, or endocrinologist will want to see you every 3-6 months depending on how severe your diabetes is and your other medical issues.

In addition to your primary care provider, you may also see a clinical nurse, a clinical pharmacist, a licensed practical nurse, a nurse practitioner and a medical assistant; HCA also has several Certified Diabetes Educators (CDEs).

Testing your blood sugar at home with a glucometer is the best way to see the immediate effects of food choices and exercise on your blood sugar.

Bring your blood glucose meter to all of your HCA appointments. Also bring your medication bottles and any tracking sheets that you have (blood glucose, diet, exercise, etc).

Your medical assistants will look at your records and determine if you are due for any tests. Your PCP will approve this and the lab work will be drawn in one of HCA's phlebotomy rooms. These are the most important tests for monitoring your diabetes health:

The roles of carbohydrate in the body includes providing energy for working muscles, providing fuel for the central nervous system, enabling fat metabolism, and preventing protein from being used as energy. Carbohydrate is the preferred source of energy or fuel for muscle contraction and biologic work.

After carbohydrate is eaten, it is broken down into smaller units of sugar (including glucose, fructose and galactose) in the stomach and small intestine.

All living cells contain glucose. For glucose to enter the cells it needs help from a hormone called insulin. Insulin acts as gatekeeper and is released once carbohydrate is ingested. It signals the cells to absorb the glucose. The glucose is then used for energy, stored in the liver and the muscles as glycogen, or stored as fat.

Carbohydrates are a source of energy found in our food, and include simple sugar, starch, and fiber. Although your body needs carbohydrates for energy, too many carbohydrates in your diet can cause your blood sugar to be high. It is important to limit portion sizes of foods containing carbohydrates.

Carbohydrate counting helps you to keep track of how many carbohydrates you are eating at each meal. Finding the right amount of carbohydrate depends on many things including how active you are and what, if any, medicines you take. Most people with diabetes can have about 45-60 grams of carbohydrates per meal. Your HCA team can help you find the right amount for you.

Yes, some types of carbohydrates are healthier than others. For example, whole grain foods such as whole wheat bread, rye, barley, whole wheat pasta, brown rice, sweet potatoes, and quinoa are better choices than highly refined white bread, white pasta, white rice, and white potatoes.

Talk to your doctor before starting any exercise program. Tell your doctor what kind of exercise you want to do so adjustments can be made to your medicine schedule or meal plan, if necessary. It is important to start a new exercise program with small goals. For most people, it is good to work up to a routine that includes aerobic exercise at least five times a week for 30 minutes each session.

It is important that you understand how your medications work to control your diabetes. If you have any questions, please contact your PCP, NP, or clinical pharmacist.

Medications play an important role in keeping your blood sugars in a normal range, and your blood sugars may become too high if you don't take your medications every day as prescribed. If you are having trouble remembering to take your medicines, talk to your HCA team to see if your medication routine can be simplified.