Diabetes Facts

What is diabetes?

Diabetes is a disease in which the body either fails to produce any insulin (type 1, also called insulin-dependent or juvenile-onset), or the insulin that it does produce is unable to adequately trigger the conversion of food into energy (type 2, also called non-insulin-dependent or adult-onset).

Who has diabetes?

Federal statistics estimate that 18.2 million children and adults in the United States ? 6.3 percent of the population ? have diabetes. While an estimated 13 million of these have been diagnosed with diabetes, 5.2 million are estimated to have type 2 diabetes and not know it. Most people with diabetes have type 2; an estimated 800,000 have type 1. About 1 million people age 20 or older will be diagnosed with diabetes this year. Diabetes is more prevalent among Native Americans, African Americans, Hispanic Americans and Asian Americans/Pacific Islanders. An estimated 20 million people in the U.S have pre-diabetes, a condition that occurs when one has higher than normal blood glucose levels, but not high enough to be diagnosed as having type 2 diabetes. (Research shows that if action is taken to control glucose levels, those with pre-diabetes can prevent or delay the onset of diabetes.)

What are the symptoms of diabetes?

• Excessive thirst
• Frequent urination
• Weight loss
• Blurred vision
• Increased hunger
• Frequent skin, bladder or gum infections
• Irritability
• Tingling or numbness in hands or feet
• Slow to heal wounds
• Extreme unexplained fatigue
• Sometimes there are no symptoms (type 2 diabetes)Who is at greatest risk for developing diabetes?

People who:

• are 45 or over
• are overweight
• are habitually physically inactive
• have previously been identified as having IFG (impaired fasting glucose) or IGT (impaired glucose tolerance)
• have a family history of diabetes
• have members of certain ethnic groups (including Asian American, African-American, Hispanic American, and Native American)
• have had gestational diabetes or have given birth to a child weighing more than 9 pounds
• have elevated blood pressure
• have an HDL cholesterol level (the ?good? cholesterol) of 35 mg/dl or lower and/or a triglyceride level of 250 mg/dl or higher
• have polycystic ovary syndrome
• have a history of vascular disease

What are the long-term complications of diabetes?

• People with diabetes are two to four more times more likely to develop heart disease or have a stroke than those who don't have diabetes
• Diabetes is the leading cause of new blindness among adults between 20 and 74 years old.
• Diabetes is the leading cause of treated end-stage kidney disease in the U.S.
• More than 60 percent of the limb amputations in the U.S. occur among people with diabetes
• About 60-70 percent of the people with diabetes have mild to severe nerve damage

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History of Diabetes

1552 B.C.	Earliest known record of diabetes mentioned on 3rd Dynasty Egyptian papyrus by physician Hesy-Ra; mentions polyuria (frequent urination) as a symptom.
1st Century A.D.	Diabetes described by Arateus as 'the melting down of flesh and limbs into urine.'
c. 164 A.D.	Greek physician Galen of Pergamum mistakenly diagnoses diabetes as an ailment of the kidneys.
Up to 11th Century	Diabetes commonly diagnosed by 'water tasters,' who drank the urine of those suspected of having diabetes; the urine of people with diabetes was thought to be sweet-tasting. The Latin word for honey (referring to its sweetness), 'mellitus', is added to the term diabetes as a result.
16th Century	Paracelsus identifies diabetes as a serious general disorder.
Early 19th Century	First chemical tests developed to indicate and measure the presence of sugar in the urine.
late 1850s	French physician, Priorry, advises diabetes patients to eat extra large quantities of sugar as a treatment.
1870s	French physician, Bouchardat, notices the disappearance of glycosuria in his diabetes patients during the rationing of food in Paris while under siege by Germany during the Franco-Prussian War; formulates idea of individualized diets for his diabetes patients.
19th Century	French researcher, Claude Bernard, studies the workings of the pancreas and the glycogen metabolism of the liver. Czech researcher, I.V. Pavlov, discovers the links between the nervous system and gastric secretion, making an important contribution to science's knowledge of the physiology of the digestive system.
Late 19th Century	Italian diabetes specialist, Catoni, isolates his patients under lock and key in order to get them to follow their diets.
1869	Paul Langerhans, a German medical student, announces in a dissertation that the pancreas contains contains two systems of cells. One set secretes the normal pancreatic juice, the function of the other was unknown. Several years later, these cells are identified as the 'islets of Langerhans.'
1889	Oskar Minkowski and Joseph von Mering at the University of Strasbourg, France, first remove the pancreas from a dog to determine the effect of an absent pancreas on digestion.
1900-1915	'Fad' diabetes diets include: the 'oat-cure' (in which the majority of diet was made up of oatmeal), the milk diet, the rice cure, 'potato therapy' and even the use of opium!
1908	German scientist, Georg Zuelzer develops the first injectible pancreatic extract to suppress glycosuria; however, there are extreme side effects to the treatment.
1910-1920	Frederick Madison Allen and Elliot P. Joslin emerge as the two leading diabetes specialists in the United States. Joslin believes diabetes to be 'the best of the chronic diseases' because it was 'clean, seldom unsightly, not contagious, often painless and susceptible to treatment.'
c. 1913	Allen, after three years of diabetes study, publishes Studies Concerning Glycosuria and Diabetes, a book which is significant for the revolution in diabetes therapy that developed from it.
1919	Frederick Allen publishes Total Dietary Regulation in the Treatment of Diabetes, citing exhaustive case records of 76 of the 100 diabetes patients he observed, becomes the director of diabetes research at the Rockefeller Institute.
1919-20	Allen establishes the first treatment clinic in the USA, the Physiatric Institute in New Jersey, to treat patients with diabetes, high blood pressure and Bright's disease; wealthy and desperate patients flock to it.
October 31, 1920	Dr. Banting conceives of the idea of insulin after reading Moses Barron's 'The Relation of the Islets of Langerhans to Diabetes with Special Reference to Cases of Pancreatic Lithiasis' in the November issue of Surgery, Gynecology and Obstetrics. For the next year, with the assistance of Best, Collip and Macleod, Dr. Banting continues his research using a variety of different extracts on de-pancreatized dogs.
Summer 1921	Insulin is 'discovered'. A de-pancreatized dog is successfully treated with insulin.
December 30, 1921	Dr. Banting presents a paper entitled 'The Beneficial Influences of Certain Pancreatic Extracts on Pancreatic Diabetes', summarizing his work to this point at a session of the American Physiological Society at Yale University. Among the attendees are Allen and Joslin. Little praise or congratulation is received.
1940s	Link is made between diabetes and long-term complications (kidney and eye disease).
1944	Standard insulin syringe is developed, helping to make diabetes management more uniform.
1955	Oral drugs are introduced to help lower blood glucose levels.
1959	Two major types of diabetes are recognized: type 1 (insulin-dependent) diabetes and type 2 (non-insulin-dependent) diabetes.
1960s	The purity of insulin is improved. Home testing for sugar levels in urine increases level of control for people with diabetes.
1970	Blood glucose meters and insulin pumps are developed. Laser therapy is used to help slow or prevent blindness in some people with diabetes.
1983	First biosynthetic human insulin is introduced.
1986	Insulin pen delivery system is introduced.
1993	Diabetes Control and Complications Trial (DCCT) report is published. The DCCT results clearly demonstrate that intensive therapy (more frequent doses and self-adjustment according to individual activity and eating patterns) delays the onset and progression of long-term complications in individuals with type 1 diabetes.
1998	The United Kingdom Prospective Diabetes Study (UKPDS) is published. UKPDS results clearly identify the importance of good glucose control and good blood pressure control in the delay and/or prevention of complications in type 2 diabetes.

AADE Survey: Taking Insulin Is a Hardship on Many—and They’re Reluctant to Talk About It With Caregivers

Results from a Harris survey commissioned by the American Association of Diabetes Educators (AADE) show that people with diabetes who must take insulin often struggle with dread and negative impacts on their lives because of it. But more than half of them—52 percent—are reluctant to share their concerns with their healthcare providers.

The “Injection Impact Report” survey, which was conducted online between June 12 and July 7, surveyed 502 people with diabetes who inject insulin using either a syringe or a pen. The survey also queried healthcare professionals who treat people with diabetes who inject insulin, including 101 primary care physicians (PCPs), 100 endocrinologists, and 100 diabetes educators.

Among the findings:

• 33 percent of respondents have experienced some level of dread related to insulin injections (eight percent strongly agreed/and 25 percent somewhat agreed)
• 14 percent of those surveyed feel that insulin injections have a negative impact on their life (three percent experience a major negative impact and 11 percent experience a moderate negative impact)
• More than 29 percent of the people surveyed feel that injecting insulin is the hardest aspect of their diabetes care (eight percent strongly agreed and 21 percent somewhat agreed).
• 52 percent do not proactively discuss their concerns regarding the physical and emotional aspects of injecting with their healthcare provider.

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Diabetic Diet Plan

The optimal way to plan a diabetic diet meal is to first assess the nutritional needs of a person with diabetes and the amounts of fat, protein, carbohydrate, and then calculating the corresponding total calories needed per day. >This information is converted into recommendations for amounts and types of foods to be included in the daily diet. Every person having diabetes must consult a Registered Dietitian to prepare for his diabetic diet plan. However, the total number of meals and snacks and their timing throughout the day can differ for each person, depending on his or her nutritional needs, lifestyle, and the action and timing of medications. But then the rest of it is pretty much up to you. You get your meal plan 'budget', and then you decide how to spend it at each meal. Just as a non-diabetic can't eat cookies and cakes all day long and expect to be healthy, if you have diabetes you have to eat a balanced diet to remain healthy. But within limits, and with proper education, if you have diabetes you can eat whatever anybody else does.

In general, a nutrition plan for a person with diabetes includes

• 10 to 20 percent of calories from protein

• no more than 30 percent of calories from fats (with no more than 10 percent from saturated fats)

• and the remaining 50 to 60 percent from carbohydrates.

Given below are the ideal nutrition portions for your diet, according to size categories.

Diabetic Diet Plan (1200-1600 Calories)This diabetic diet plan is perfect for if you are a small woman who exercises, a small or medium woman who wants to lose weight or even a medium woman who does not exercise much. Choose this many servings from these food groups to have 1,200 to 1,600 calories a day:

· 6 starches

· 2 milk and yogurt

· 3 vegetables

· 2 meat or meat substitute

· 2 fruit

· Up to 3 fats

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Diabetic Diet

If you have diabetes, your body cannot make or properly use insulin. This leads to high blood glucose, or sugar, levels in your blood. Healthy eating helps to reduce your blood sugar. It is a critical part of managing your diabetes, because controlling your blood sugar can prevent the complications of diabetes.

Wise food choices are a foundation of diabetes treatment. Diabetes experts suggest meal plans that are flexible and take your lifestyle and other health needs into account. A registered dietitian can help you design a meal plan.

Healthy diabetic eating includes

• Limiting sweets
• Eating often
• Being careful about when and how many carbohydrates you eat
• Eating lots of whole-grain foods, fruits and vegetables
• Eating less fat
• Limiting your use of alcohol

Start Here

• Diabetes - Meal Planning(Patient Education Institute) - Requires Flash Player

  Also available in Spanish

• Recipe and Meal Planner Guide: Eating Healthy and Staying Fit to Control and Manage Diabetes(National Institute of Diabetes and Digestive and Kidney Diseases)

  Also available in Spanish

• What I Need to Know about Eating and Diabetes(National Institute of Diabetes and Digestive and Kidney Diseases)

  Also available in Spanish

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Diabetic Wound Care

What is a Diabetic Foot Ulcer?A diabetic foot ulcer is an open sore or wound that most commonly occurs on the bottom of the foot in approximately 15 percent of patients with diabetes. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.

Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation. Research, however, has shown that the development of a foot ulcer is preventable.

Who Can Get a Diabetic Foot Ulcer?
Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics and older men are more likely to develop ulcers. People who use insulin are at a higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.

How do Diabetic Foot Ulcers Form?
Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of feeling in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain and one may not even be aware of the problem. Your podiatric physician can test feet for neuropathy with a simple and painless tool called a monofilament.

Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also retard healing.

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What is Type 1 Diabetes?

There is more than one form of type 1 diabetes and each can develop for different reasons. Type 1 diabetes can result from hereditary deficiencies in the beta-cells of the pancreas (maturity onset diabetes of the young, or MODY), damage to the pancreas from trauma or drugs, another illness like hemochromatosis (iron overload) or cystic fibrosis that damages the pancreas, or will result when the pancreas is surgically removed.

The most commonly diagnosed form of type 1 diabetes is juvenile diabetes, or, insulin-dependent diabetes. People with juvenile type 1 diabetes have an inherited genetic predisposition towards developing diabetes (the genes are different for type 1 and type 2 but both have a genetic aspect involved). Many people have these genes but will never develop the disease. For those that do become diabetic, something triggers the body to attack and destroy the insulin producing beta cells in the pancreas.

Triggers for type 1 diabetes are thought in include certain viruses (including rotaviruses), chemical, or some other environmental factor. Visit our general diabetes information page for causes of diabetes, genetic transmission rates of diabetes for type 1 and type 2 diabetes, and other diseases and disorders that are associated with diabetes.

Other diseases that affect persons with diabetes at a higher rate than in the general population include Addison's Disease, Hashimoto’s Thyroiditis. celiac disease (sprue, or gluten intolerance), and polycystic ovarian syndrome. Anyone diagnosed with type 1 diabetes should also be tested for these.
Juvenile type 1 diabetes is an autoimmune disease. An autoimmune disease is when the body attacks and destroys good cells and tissues mistaking them as foreign intruders. With type 1 diabetes the insulin-producing beta cells in the pancreas are slowly destroyed and eventually they fail to produce insulin. When this happens a person will need to take insulin to live.
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Pre-Diabetes

Before people develop type 2 diabetes, they almost always have "pre-diabetes" -- blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. There are 57 million people in the United States who have pre-diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes.

Research has also shown that if you take action to manage your blood glucose when you have pre-diabetes, you can delay or prevent type 2 diabetes from ever developing. Together with the National Institute of Diabetes and Digestive and Kidney Diseases, the American Diabetes Association published a Position Statement on "The Prevention or Delay of Type 2 Diabetes" to help guide health care professionals in treating their patients with pre-diabetes.

There is a lot you can do yourself to know your risks for pre-diabetes and to take action to prevent diabetes if you have, or are at risk for, pre-diabetes. The American Diabetes Association has a wealth of resources for people with diabetes. People with pre-diabetes can expect to benefit from much of the same advice for good nutrition and physical activity. The links on this page are cornerstones of successful management of pre-diabetes.

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Women and Diabetes

Today, almost 21 million children and adults in the US have diabetes -- including 9.7 million women -- and almost one third of them do not know it. Diabetes can be especially hard on women. The burden of diabetes on women is unique, because the disease can affect both mothers and their unborn children. Diabetes can cause difficulties during pregnancy such as a miscarriage or a baby born with birth defects. Women with diabetes are also more likely to have a heart attack, and at a younger age, than women without diabetes.

Diabetes is the fifth-deadliest disease in the United States, and it has no cure. For women who do not currently have diabetes, pregnancy brings the risk of gestational diabetes. Gestational diabetes develops in 2% to 5% of all pregnancies but disappears when a pregnancy is over. Women who have had gestational diabetes or have given birth to a baby weighting more than 9 pounds are at an increased risk for developing type 2 diabetes later in life.

The prevalence of diabetes is at least 2-4 times higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than among white women. The risk for diabetes also increases with age. Because of the increasing lifespan of women and the rapid growth of minority populations, the number of women in the United States at high risk for diabetes and its complications is increasing.

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All About Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

There are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately, 5.7 million people (or nearly one quarter) are unaware that they have the disease.

In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes. The American Diabetes Association recommends the FPG because it is easier, faster, and less expensive to perform.

With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.

In the OGTT test, a person's blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.
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